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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 302, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 195, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
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: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
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: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
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: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
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: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
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: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 303, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 389, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 152, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 141, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Otolaryngology
  [SJR: 0.59]   [H-I: 45]   [22 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-0709
   Published by Elsevier Homepage  [3031 journals]
  • A comparative study of the surgical outcomes between video-assisted and
           open lateral neck dissection for papillary thyroid carcinoma with lateral
           neck lymph node metastases
    • Authors: Deguang Zhang; Lei Xie; Gaofei He; Liang Fang; Yuwen Miao; Zhezhe Wang; Li Gao
      Pages: 115 - 120
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Deguang Zhang, Lei Xie, Gaofei He, Liang Fang, Yuwen Miao, Zhezhe Wang, Li Gao
      Purpose Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM. Materials and methods Between May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness. Results The mean follow-up period was 18.6months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p=0.0001) and mean age was lower (p=0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p=0.0003 and p<0.0001, respectively). Conclusions The safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.07.005
       
  • Audiological features in congenital bony atresia of external auditory
           canal with temporal-mandibular joint retroposition
    • Authors: Ran Ren; Shouqin Zhao; Danni Wang; Lin Yang; Zhonglin Liu; Ying Li; Chenyi Wei
      Pages: 121 - 126
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Ran Ren, Shouqin Zhao, Danni Wang, Lin Yang, Zhonglin Liu, Ying Li, Chenyi Wei
      Objectives To facilitate the diagnosis, treatment and surgical options for congenital bony atresia of external auditory canal (EAC) with temporal-mandibular joint (TMJ) retroposition by analyzing its audiological features and the morphology of temporal bone on CT scan. Materials and methods Two cohorts of patients with congenital EAC bony atresia with (n=23) or without (n=21) TMJ retroposition were recruited from September 2012 to July 2014 at Beijing Tongren Hospital, Capital Medical University. The patients with TMJ retroposition were set as the group A and those without as group B. Based on the degree of TMJ retroposition, group A was further divided into two sub-groups A1 (n=13) and A2 (n=10). The temporal bone CT scan, pure tone average (PTA) and air-bone gap (ABG) were obtained for the main outcome measurements. SPSS 17.0 was used for the statistics analysis with t and t test. Results For group A, the average air conduction (AC) was 55.22±12.53dBHL, the average bone conduction (BC) was 7.07±3.34dBHL, and the average ABG was 50.69±8.60dBHL. For the sub-groups A1 and A2, the average AC was respectively 45.77±8.43dBHL and 59.50±7.43dBHL, BC 7.07±3.34dBHL and 6.89±4.37dBHL, and ABG 47.31±7.92dBHL and 53.00±7.91dBHL. For group B, the average AC was 70.24±5.63dBHL, BC 6.78±4.37dBHL, and ABG 60.19±6.09dBHL. Conclusions The degree of TMJ retroposition is negatively related to the severity of hearing loss among patients with congenital EAC bony atresia, and those with TMJ have suffered less severe hearing loss than those without. Although TMJ retroposition might be a disadvantage for patients undergoing EAC plasty and tympanoplasty, it must be considered for its influence on hearing loss severity and auditory canal abnormality when planning the surgical treatment. Different from normal surgical protocol for congenital EAC bony atresia, we commend other hearing reconstruction methods such as BAHA and VSB, even without intervention.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.09.008
       
  • The financial impact of clinic no-show rates in an academic pediatric
           otolaryngology practice
    • Authors: Zhen Huang; Mariam Ashraf; Heather Gordish-Dressman; Pamela Mudd
      Pages: 127 - 129
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Zhen Huang, Mariam Ashraf, Heather Gordish-Dressman, Pamela Mudd
      Purpose To investigate determinants of no-show rates in an academic pediatric otolaryngology practice including appointment time, age, sex, new patient status, payer mix, and median household income by zip code. Materials and methods Retrospective chart review of clinic no-show rates and patient demographics in a free standing children's hospital and affiliated outpatient clinics across eight providers in a one-year period. Results Analysis shows that the overall no-show rate across all providers was 15% with the highest rate of 19% in the zip code with the lowest median income. Highest no-shows are in June, but overall, seasons did not play a significant role in no-show rates. Male gender, morning appointments, and having public insurance appear to significantly predict no-shows. Lost revenue on no-shows range from $191K to $384K per year. The average percentage of the amount billed paid by insurance range from the lowest by out-of-state Medicaid at 16% to the highest by managed care at 54%. Conclusions No-show rates account for a significant portion of lost revenue in the outpatient setting for an academic practice, and can be predicted by lower median income, male gender, morning appointments, and public insurance. Such patients may need different appointment reminders. Future clinic templates should be optimized for no-shows to increase productivity and access to care.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.004
       
  • True abscess formation is rare in bacterial orbital cellulitis;
           consequences for treatment
    • Authors: Eline G. Van der Veer; Nicolien A. van der Poel; Maartje M.L. de Win; Roel J. Kloos; Peerooz Saeed; Maarten P. Mourits
      Pages: 130 - 134
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Eline G. Van der Veer, Nicolien A. van der Poel, Maartje M.L. de Win, Roel J. Kloos, Peerooz Saeed, Maarten P. Mourits
      Background Pre- or retroseptal bacterial orbital cellulitis (pOC/rOC) is not an uncommon orbital disease. Treatment consists of antibiotics with or without surgical drainage. Several questions regarding course, complications and outcome of treatment are unanswered and the indication for surgery is not well defined. The aim of this study is to: 1. describe the outcome of orbital cellulitis (OC) in a large cohort, 2. assess the significance of Chandler's classification, 3. assess the incidence of abscess formation in OC, and 4. redefine criteria for surgery. Methods Retrospective case series of patients with OC seen between 1-1-2007 and 1-1-2014 in a tertiary referral center. Results Sixty-eight patients presented with (presumed) bacterial pOC. Two out of these 68 developed rOC. All 68 patients had a full recovery. Forty-eight patients presented with rOC. Four out of 48 (8%) had intracranial extension of the infection at the time of admission. No admitted patient developed distant seeding. Only four (8%) patients with rOC had a true orbital abscess. In the other 92% we found a diffuse orbital inflammation or a subperiosteal empyema. Forty-four (92%) patients with rOC had a full recovery. Conclusions 1. The prognosis of both pOC and rOC nowadays is generally favorable. 2. Chandler's classification is of little use. 3. True abscess formation in OC is rare. 4. The indication for surgical intervention must be based on the clinical presentation and the assessment of true orbital abscess formation.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.006
       
  • The effect of topical 5-flurouracil application post endoscopic inferior
           turbinoplasty
    • Authors: Amjad F. Nuseir; Mohammad Alsalem; Mouhamad Alzahr; Muthanna Ababneh; Ahmad I. Alomari; Firas Alzoubi
      Pages: 135 - 138
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Amjad F. Nuseir, Mohammad Alsalem, Mouhamad Alzahr, Muthanna Ababneh, Ahmad I. Alomari, Firas Alzoubi
      Rationale and objectives Adhesions are the most common complication after nasal surgery and revision. 5-Fluorouracil (5-FU) reduces various adhesions and epithelial growth related complications. The aim of this study was to evaluate the effects of 5-flurouracil application in the nasal cavity after a multi-procedure nasal surgery in term of complications frequency. Materials and methodology Institutional ethical approval was granted and a double-blinded prospective clinical trial was conducted to study the effect of 5-fu on post-operative complications. At the end of a combined endoscopic inferior turbinoplasty with one or more other nasal surgeries, 5-flurouracil-soaked cottonoid with 1mL of 5-flurouracil (5mg/mL) was applied in one side of nasal cavity and saline-soaked cottonoid was applied contralaterally and left for 5min. Patients were assessed over 2months postoperatively by a blinded observer in terms of adhesions, crustation, discharge, pain, discharge, loss of smell and other complications and nasal symptoms. Results On the 1st follow up week postoperatively, adhesions were observed in (24 patients) 35%, bilateral in (6 patients) 9% and unilateral in (18 patients) 26%. Unilateral Adhesions were statistically significantly higher in control sides than those in 5-FU sides (22% vs 4% respectively) (p=0.025). Crustation, continued to statistically significantly diminish over time (p=0.035). On the 8th follow up week, adhesions reduction was still statistical significant at the 5-FU treated side (p=0.01). Conclusion 5-FU is safe and effective in preventing adhesions formation when applied during combined endoscopic inferior turbinoplasty procedure with other nasal procedure surgery.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.007
       
  • Otolaryngology sleep medicine curriculum objectives as determined by sleep
           experts
    • Authors: Nathan Cass; Alan Kominsky; Cristina Cabrera-Muffly
      Pages: 139 - 142
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Nathan Cass, Alan Kominsky, Cristina Cabrera-Muffly
      Purpose (1) Ascertain the most important concepts and topics for otolaryngology resident education in sleep medicine and surgery, as determined by faculty who teach sleep medicine to otolaryngology residents. (2) Create learning objectives within the area of otolaryngologic sleep medicine in order to design a sleep medicine curriculum for otolaryngology residents. Materials and methods Two web-based surveys were sent to 163 academic otolaryngologists who teach sleep medicine. The first survey determined the topics, and their relative importance, considered most vital to learn during otolaryngology training. Using the Delphi method, the second clarified questions regarding topics determined by the first survey. Sleep medicine learning objectives for residents were ascertained from responses. Results The response rate of first and second surveys were 24.5% and 19%, respectively. Topics ranked most important for resident education included upper airway anatomy, polysomnogram interpretation, and understanding the range of medical and surgical therapies used to treat sleep disorders. Respondents listed surgical therapy as the most critical topic that most residents do not understand well. The second survey clarified the specific anatomic features, surgical techniques, and polysomnography data points deemed most critical for resident learning. Conclusions Academic otolaryngology sleep experts hold opinions regarding relative value of different topics for teaching sleep medicine, which is useful in creating a curriculum for otolaryngology residents. Otolaryngology learning objectives related to sleep medicine identified during this study are being used to create an online curriculum to supplement resident education.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.009
       
  • Improved smell function with increased nasal mucus sonic hedgehog in
           hyposmic patients after treatment with oral theophylline
    • Authors: Robert I. Henkin; Suzanna Hosein; William A. Stateman; Alexandra B. Knöppel; Mona Abdelmeguid
      Pages: 143 - 147
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Robert I. Henkin, Suzanna Hosein, William A. Stateman, Alexandra B. Knöppel, Mona Abdelmeguid
      Purpose We previously demonstrated the presence of sonic hedgehog (Shh) in nasal mucus in normal subjects and in patients with smell loss (hyposmia). Nasal mucus Shh levels were found significantly diminished in untreated hyposmic patients of multiple etiologies. Since treatment with oral theophylline has been previously associated with improvement in smell function we wished to study if such treatment increased nasal mucus Shh as well as improved smell function in patients with hyposmia. Methods Forty-four patients with hyposmia of several etiologies were evaluated for changes in hyposmia by subjective measurements of smell, taste and flavor perception and by olfactometry. Measurements of nasal mucus Shh were made in relationship to each set of sensory measurements. Patients were treated with oral theophylline at doses of 200–800mg for periods of 2–10months with sensory function, nasal mucus Shh and serum theophylline levels evaluated at these time intervals. Nasal mucus Shh measurements were made with a sensitive spectrophotometric ELISA assay and theophylline with a fluorometric assay. Results There was consistent, significant improvement in subjective responses in smell, taste and flavor perception and in olfactometry associated with increased nasal mucus Shh and serum theophylline after theophylline treatment. Conclusions Improvement in smell function and in nasal mucus Shh was positively correlated in a dose-response relationship after treatment with oral theophylline. Results are consistent with a successful role for theophylline in improvement of smell function in hyposmic patients of multiple etiologies associated with increased nasal mucus Shh which can act as a biochemical marker for smell function.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.010
       
  • Multivariate analysis as an advantageous approach for prediction of the
           adverse outcome in head and neck microvascular reconstructive surgery
    • Authors: Pawel Golusinski; Jakub Pazdrowski; Mateusz Szewczyk; Piotr Pieńkowski; Ewa Majchrzak; Augusto Schneider; Michal M. Masternak; Wojciech Golusinski
      Pages: 148 - 152
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Pawel Golusinski, Jakub Pazdrowski, Mateusz Szewczyk, Piotr Pieńkowski, Ewa Majchrzak, Augusto Schneider, Michal M. Masternak, Wojciech Golusinski
      Background The use of a free flap has become a mainstay of reconstruction following the ablative surgery in head and neck. The success rates are about 90%, however, several factors have been described to have an adverse effect on free flap survival. Methods We have performed a retrospective analysis of the treatment outcome of 93 microvascular flaps and evaluated the factors influencing the risk of flap loss including patients' age, body mass index, smoking, general medical history and previous oncological treatment. Results Out of 93 flaps the total necrosis have been observed in 15 flaps with gradual improvement in the consecutive years. In individual analysis the patients age, BMI, and comorbidities did not reveal any significant relation. The history of any previous oncological treatment represented a significant adverse factor of success rate (p =0.035), and was even more significant when patients experienced all treatment modalities prior to the reconstructive procedure (p =0.009). Multivariate logistic regression model indicated that only surgery (p =0.0008), chemotherapy (p =0.02), cardiovascular diseases (p =0.05) and patient's age (p =0.02) represented significant factors impairing the success rate. Conclusion Incorporating multivariate analysis represents important statistical approach for better prediction of free flaps survival in head and neck reconstructive surgery. Incorporation of additional collective information could provide more precise approach in the risk of the flap loss assessment.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.012
       
  • Squamous cell carcinoma presenting with trigeminal anesthesia: An uncommon
           presentation of head & neck cancer with unknown primary
    • Authors: Ameer T. Shah; Walid I. Dagher; Miriam A. O'Leary; Richard O. Wein
      Pages: 153 - 156
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Ameer T. Shah, Walid I. Dagher, Miriam A. O'Leary, Richard O. Wein
      Background The differential diagnosis of facial anesthesia is vast. This may be secondary to trauma, neoplasm, both intracranial and extracranial, infection, and neurologic disease. When evaluating a patient with isolated facial anesthesia, the head and neck surgeon often thinks of adenoid cystic carcinoma, which has a propensity for perineural invasion and spread. When one thinks of head and neck squamous cell carcinoma with or without unknown primary, the typical presentation involves dysphagia, odynophagia, weight loss, hoarseness, or more commonly, a neck mass. Squamous cell carcinoma presenting as facial anesthesia and perineural spread, with no primary site is quite rare. Methods Case presentations and review of the literature. Conclusions Trigeminal anesthesia is an uncommon presentation of head and neck squamous cell carcinoma with unknown primary. We present two interesting cases of invasive squamous cell carcinoma of the trigeminal nerve, with no primary site identified. We will also review the literature of head and neck malignancies with perineural spread and the management techniques for the two different cases presented.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.013
       
  • Clinicopathologic and prognostic factors in adenoid cystic carcinoma of
           head and neck minor salivary glands: A clinical analysis of 130 cases
    • Authors: Shizhi He; Pingdong Li; Qi Zhong; Lizhen Hou; Zhenkun Yu; Zhigang Huang; Xuejun Chen; Jugao Fang; Xiaohong Chen
      Pages: 157 - 162
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Shizhi He, Pingdong Li, Qi Zhong, Lizhen Hou, Zhenkun Yu, Zhigang Huang, Xuejun Chen, Jugao Fang, Xiaohong Chen
      Purpose This study was to investigate clinicopathologic characteristics and prognostic factors in adenoid cystic carcinoma of head and neck minor salivary glands. Materials and methods We conducted a retrospective review of 130 patients with adenoid cystic carcinoma of head and neck minor salivary glands that were evaluated between 2000 and 2013 in Beijng Tongren Hospital. Results Five-year overall survival and disease-free survival rates were 80.8% and 55.6%. Local recurrence rate was 40%, regional recurrence 3.8%, and distant metastasis was 28.5%. On univariate analysis, solid histological subtype, perineural invasion, positive surgical margins and advanced stages were found to be poor prognostic indicators. On multivariate analysis, solid histological subtype and positive surgical margins were significant prognostic factors of worse overall survival. Conclusions Solid histological subtype and positive surgical margins were the most important predictors of poor outcome in adenoid cystic carcinoma of minor salivary glands. Surgery with postoperative radiation were recommended treatment and offered durable local control.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.11.014
       
  • Extended high frequency audiometry in users of personal listening devices
    • Authors: Poornima Kumar; Prabhakar Upadhyay; Ashok Kumar; Sunil Kumar; Gautam Bir Singh
      Pages: 163 - 167
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Poornima Kumar, Prabhakar Upadhyay, Ashok Kumar, Sunil Kumar, Gautam Bir Singh
      Purpose Noise exposure leads to high frequency hearing loss. Use of Personal Listening Devices may lead to decline in high frequency hearing sensitivity because of prolonged exposure to these devices at high volume. This study explores the changes in hearing thresholds by Extended High Frequency audiometry in users of personal listening devices. Material and method A descriptive, hospital based observational study was performed with total 100 subjects in age group of 15–30years. Subjects were divided in two groups consisting of 30 subjects (Group A) with no history of Personal Listening Devices use and (Group B) having 70 subjects with history of use of Personal Listening Devices. Conventional pure tone audiometry with extended high frequency audiometry was performed in all the subjects. Result Significant differences in hearing thresholds of Personal Listening Device users were seen at high frequencies (3kHz, 4kHz and 6kHz) and extended high frequencies (9kHz, 10kHz, 11kHz, 13kHz, 14kHz, 15kHz and 16kHz) with p value <0.05. Elevated hearing thresholds were observed in personal listening devices users which were directly proportional to volume and duration of usage. Conclusion In present study no significant changes were noted in hearing thresholds in PLD users before 5years of PLD use. However, hearing thresholds were significantly increased at 3kHz, 10kHz, 13kHz in PLD users having >5years usage at high volume. Thus, it can be reasonably concluded that extended high frequencies can be used for early detection of NIHL in PLD users.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.12.002
       
  • Impact of treatment modality on quality of life of head and neck cancer
           patients: Findings from an academic medical institution
    • Authors: Kara M. Christopher; Nosayaba Osazuwa-Peters; Rebecca Dougherty; Sarah A. Indergaard; Christina Popp; Ronald Walker; Mark A. Varvares
      Pages: 168 - 173
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Kara M. Christopher, Nosayaba Osazuwa-Peters, Rebecca Dougherty, Sarah A. Indergaard, Christina Popp, Ronald Walker, Mark A. Varvares
      Purpose The objective of this pilot study was to determine how different treatment modalities (surgery, radiation, and chemotherapy) impact quality of life (QOL) in a population of head and neck cancer (HNC) survivors. Methods Fifty-nine newly diagnosed, biopsy-confirmed HNC patients were recruited between 2007-2012. They completed the EORTC Quality of Life Questionnaire and Head & Neck Module at 5 intervals pre- and post-treatment. Participants were grouped into four categories based on modality: surgery only, surgery/radiation, chemoradiation, or surgery/chemoradiation. Repeated measures ANOVA examined effect of treatment modality on QOL over time. Results Xerostomia symptoms were significantly associated with chemoradiation (F(2.47, 59.27)=3.57, p=0.03), lowest at pretreatment and highest 6 months post-treatment. Time was significantly associated with head and neck pain, F(2.95,67.89)=3.39, p=0.02. Conclusions HNC survivors exhibit different QOL related symptoms depending on combined treatment modalities, and time post-treatment. It is important to understand QOL differences based upon treatment modalities when developing treatment plans for HNC patients.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.12.003
       
  • Use of interactive iBooks for patient education in otology
    • Authors: Omid Moshtaghi; Yarah M. Haidar; Ronald Sahyouni; Ramin Rajaii; Afsheen Moshtaghi; Amin Mahmoodi; Yaser Ghavami; Harrison W. Lin; Hamid R. Djalilian
      Pages: 174 - 178
      Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2
      Author(s): Omid Moshtaghi, Yarah M. Haidar, Ronald Sahyouni, Ramin Rajaii, Afsheen Moshtaghi, Amin Mahmoodi, Yaser Ghavami, Harrison W. Lin, Hamid R. Djalilian
      Introduction Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter. Objective To evaluate the efficacy of an iPad-based interactive educational module (iBook) in various otologic pathologies. Methods Patients presenting with symptoms of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. In total, 44 patients received the iBook and 22 patients served as controls. Prior to viewing the iBook, patients completed a pre-survey to assess baseline knowledge. After viewing the iBook, patients completed a post-survey to assess changes in perception and knowledge of their disease. Results were compared to that of the control group who did not receive iBook supplementation prior to being seen by the physician. Results Paired t-test analysis showed significant improvements (p<0.01) in both self-reported perception and concrete understanding in various concepts when compared to pre-iBook results. This was further compared to the control group, which showed a significant gain in factual knowledge (p=0.02). Conclusion Patients who viewed the iBook, personalized to their diagnosis, displayed significantly improved understanding of their condition. Increased use of interactive educational modalities, such as the iBook, can be of benefit to an otologic practice in improving patient education and satisfaction.

      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2016.12.004
       
  • The effect of handedness and laterality in a microlaryngeal surgery
           simulator
    • Authors: Matthew R. Naunheim; Amanda Le; Matthew M. Dedmon; Ramon A. Franco; Jennifer Anderson; Phillip C. Song
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Matthew R. Naunheim, Amanda Le, Matthew M. Dedmon, Ramon A. Franco, Jennifer Anderson, Phillip C. Song
      Purpose There are no controlled prospective studies evaluating the effect of dominant handedness in left- and right-sided surgery in otolaryngology. Endoscopic microlaryngeal phonosurgery is an ideal procedure to assess technical aspects of handedness and laterality, due to anatomic symmetry. In this study, we analyzed (1) choice of surgical approach and (2) outcomes based on handedness and laterality in a microlaryngeal simulator. Methods Using a validated high-fidelity phonosurgery model, a prospective cohort of 19 expert laryngologists undertook endoscopic resection of a simulated vocal fold lesion. These resections were video-recorded and scored by 2 blinded expert laryngologists using a validated global rating scale, procedure-specific rating scale, and a hand preference analysis. Results There were 18 right-handed participants and 1 left-handed. 12 left and 7 right excisions were evaluated. Cronbach's alpha for inter-rater reliability was good (0.871, global scale; and 0.814, procedure-specific scale). Surgeons used their dominant hand 78.9% of the time for both incision and dissection. In cases where the non-dominant hand would have been preferred, surgeons used the non-dominant hand only 36.4% of the time for incision and dissection. Use of the non-dominant hand did not influence global or procedural rating (p =0.132 and p =0.459, respectively). Conclusions In this simulation of microlaryngeal surgery, there were measurable differences in surgical approaches based on hand dominance, with surgeons preferring to cut and perform resection with the dominant hand despite limitations in the instrumentation and exposure. Regardless of hand preference, overall outcomes based on global rating and technique specific rating scales were not significantly different.

      PubDate: 2017-04-20T21:45:08Z
      DOI: 10.1016/j.amjoto.2017.04.009
       
  • Correlation of frontal sinus recess anatomy with ethnicity, gender, and
           pathology
    • Authors: Laura K. House; Scott P. Stringer; Samantha Seals
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Laura K. House, Scott P. Stringer, Samantha Seals
      Purpose Research on frontal sinus cells has been conflicting regarding relationship between frontal sinus cells and frontal sinus disease. There are no published studies regarding gender differences in frontal sinus disease. No comparisons between African Americans and Caucasians and frontal sinus disease have been published. This study attempts to define the above relationships as well as the relationship between number and types of cells and disease. Methods A retrospective chart review was performed on sinus CT scans done from 2003 to 2011 at an academic medical center. Exclusion criteria included previous frontal sinus surgery, sinus malignancy, obvious trauma, congenital anomalies, and poor quality of scan. Number and type of frontal cells were recorded for 602 scans. Statistical analysis performed demographic comparisons and compared number and types of cells to evidence of disease. Results Males were more likely than females to have frontal sinus disease. Patients with Type 3 and Type 4 cells were more likely to have disease. No significant ethnic related differences in disease were found using a multivariate logistic regression model. Total number of cells did not significantly affect likelihood of disease. Conclusions This is one of the largest collections of data on frontal sinus cells as predictors of frontal sinus disease. These results suggest that gender and certain types of cells affect likelihood of disease. This study is the first to demonstrate a lack of difference in disease in African Americans and Caucasians. These results are significant regarding gender, race, number and type of cells as predictors of disease.

      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.04.003
       
  • Assessing cumulative acute toxicity of chemoradiotherapy in head and neck
           cancer with or without induction chemotherapy
    • Authors: Bhartesh A. Shah; Muhammad M. Qureshi; Jennifer M. Logue; Timothy P. Cooley; Ken S. Zaner; Scharukh Jalisi; Minh Tam Truong
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Bhartesh A. Shah, Muhammad M. Qureshi, Jennifer M. Logue, Timothy P. Cooley, Ken S. Zaner, Scharukh Jalisi, Minh Tam Truong
      Background To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT). Methods 77 patients underwent definitive CCRT (30 I/CCRT and 47 CCRT). Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. Using the TAME adverse event reporting system, short-term toxicity (T) scores were generated for IC (TIC), CCRT (TCCRT), total treatment duration (TRx), post-treatment period (TPT) and an overall score (Toverall) from treatment start to post treatment period. Results Acute toxicity other than dysphagia, odynophagia, or dermatitis was reported in 90.0% and 66.0% of I/CCRT and CCRT patients, respectively (P =0.02). Compared to CCRT group, I/CCRT patients reported greater mean TRx (TRx: 2.11 vs. 2.87, P =0.01) and Toverall (Toverall: 2.60 vs. 3.70, P =0.003). Conclusion I/CCRT patients reported more cumulative acute toxicity during treatment compared to CCRT patients using the TAME reporting system.

      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.04.004
       
  • Improving resident familiarity with the translabyrinthine approach to the
           internal auditory canal
    • Authors: Matthew M. Dedmon; Brendan P. O'Connell; Austin S. Adams; George P. Wanna; David S. Haynes
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Matthew M. Dedmon, Brendan P. O'Connell, Austin S. Adams, George P. Wanna, David S. Haynes
      Objective To increase otolaryngology resident experience with drilling and dissection of the internal auditory canal (IAC) via a translabyrinthine approach. Study design Pilot study involving temporal bone education and drilling with completion of pre- and post-drilling surveys. Methods Participants observed an educational presentation on IAC anatomy and drilling, followed by manipulation of IAC nerves using a prosected cadaveric temporal bone. Participants then drilled the IAC and identified nerves using temporal bones with previously drilled mastoidectomies and labyrinthectomies. Pre- and post-drilling 5-point Likert-based surveys were completed. Results 7 participants were included in this study ranging in experience from PGY1 through PGY 5. The median number of times the IAC had been drilled previously was 0. Participants reported statistically significantly improved familiarity with the translabyrinthine approach after the session with median scores increasing from 2 to 3 (p=0.02), and a near-significant increase in familiarity with IAC anatomy with median scores increasing from 3 to 4 (p=0.06). Prior to the session, 71% of participants either disagreed or strongly disagreed that they had an idea of what the procedure would be like in a real operating room, whereas after the session 0% reported disagreement. 100% of participants were very satisfied with the overall experience. Conclusions An educational session and temporal bone drilling experience using prosected bones significantly increased the reported familiarity with the translabyrinthine approach. Experiences such as this may enhance resident exposure to advanced lateral skull base approaches in a safe environment, and increase comprehension of the complex anatomic relationships of the IAC.

      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.04.005
       
  • Significance of intraoperative findings in revision tympanomastoidectomy
    • Authors: Andro Iva; Kelava Jakov Ajduk Mihael Ries Robert Vladimir
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Andro Košec, Iva Kelava, Jakov Ajduk, Mihael Ries, Robert Trotić, Vladimir Bedeković
      Purpose The study was designed to assess correlations between intraoperative findings in revision tympanomastoidectomy as predictors of cholesteatoma recurrence. Materials and methods A retrospective single-institution cohort of 101 patients who underwent surgical treatment for recurrent chronic otitis media in a tertiary referral otology centre. Results Out of 101 patients, 65 had canal wall up and 36 canal wall down revision surgery. There were 35 cholesteatoma recurrences. Sites most commonly associated with recurrent disease were residual facial ridge cells in 46 (45.5%), ossicular chain sites in 46 (45.5%) patients, posterior external auditory canal wall erosions in 38 (37.6%) patients and mastoid apex recurrence in 35 (34.7%) patients. Ossicular and posterior external auditory canal wall erosion and incomplete removal of mastoid apex cells correlate well with cholesteatoma recurrence accompanied by canal wall up surgery (p =0.009). Residual mastoid apex cells, posterior external auditory canal wall erosion and presence of residual facial ridge cells were identified as the strongest positive predictors of cholesteatoma recurrence, identifying high risk patients associated with canal wall down procedures (p =0.0036). Conclusions Correlations between intraoperative findings and cholesteatoma recurrence could improve preoperative and intraoperative planning and reduce the rates of postoperative failures1 due to mismanagement of high risk areas.

      PubDate: 2017-04-13T20:55:57Z
       
  • Abrasion and blunt tissue trauma study of a novel flexible robotic system
           in the porcine model
    • Authors: Michael Z. Lerner; Michael Tricoli; Marshall Strome
      Abstract: Publication date: Available online 11 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Michael Z. Lerner, Michael Tricoli, Marshall Strome
      Objectives The objective of this study was to determine if a flexible robotic system caused increased tissue reaction when accessing the oropharynx and hypopharynx compared to intubation controls in only 2 scenarios: high speed tissue impact and multiple unit insertions and retractions. The data obtained were submitted as part of the entirety of information submitted for FDA approval. Methods This study consisted of 5 groups of Yorkshire pigs (2 animals per group). On Day 0, all animals were intubated. For group 1 (control), a second endotracheal tube was advanced to just above the vocal cords. In abrasion groups 2 and 3, the flexible robotic system was advanced against the oropharyngeal and hypopharyngeal tissues, respectively. In blunt trauma groups 4 and 5, the flexible robotic system was advanced at maximum speed (22mm/s) to collide with oropharyngeal and hypopharyngeal tissues, respectively. Pre- and post-procedure endoscopic assessments of tissue reaction were performed daily for 4 days. An independent reviewer graded tissue reaction using a 0–3 point scale. Results Tissue reaction scores at each observation time point for all test groups were less than or equal to control scores except for one instance of moderate scoring (2 out of 3) on Day 2 for an animal in the blunt trauma group where reaction was likely intubation-related rather than device impact related. Otherwise, all flexible robotic system-treated animal scores were less than 1 by Day 4. Conclusions In this limited study, the flexrobotic system afforded surgical access to the oropharynx and hypopharynx without an increased level of abrasion or tissue trauma when compared to intubation alone.

      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.04.002
       
  • Detection of endolymphatic hydrops using traditional MR imaging sequences
    • Authors: John H. Keller; Barry E. Hirsch; Ryan S. Marovich; Barton F. Branstetter
      Abstract: Publication date: Available online 6 April 2017
      Source:American Journal of Otolaryngology
      Author(s): John H. Keller, Barry E. Hirsch, Ryan S. Marovich, Barton F. Branstetter
      Purpose The purpose of this study was to determine whether Meniere's disease (MD) produces endolymphatic cavity size changes that are detectable using unenhanced high-resolution T2-weighted MRI. Materials & methods This retrospective case-control study included patients with documented MD who had a high-resolution T2-weighted or steady-state free procession MRI of the temporal bones within one month of diagnosis, between 2002 and 2015. Patients were compared to age- and sex- matched controls. Cross sectional area, length, and width of the vestibule and utricle were measured in both ears along with the width of the basal turn of the cochlea and its endolymphatic space. Absolute measurements and ratios of endolymph to perilymph were compared between affected, contralateral, and control ears using analysis of variance and post-hoc pairwise comparisons. Results Eighty-five case-control pairs were enrolled. Mean utricle areas for affected, contralateral, and control ears were 0.038cm2, 0.037cm2, and 0.033cm2. Mean area ratios for affected, contralateral, and control ears were 0.32, 0.32, and 0.29. There was a statistically significant difference between groups for these two variables; post-hoc comparisons revealed no difference between affected and contralateral ears in Meniere's patients, while ears in control patients were different from the ears of patients with MD. All other measurements failed to show significant differences. Conclusions Enlargement of the endolymphatic cavity can be detected using non-contrast T2-weighted MRI. MRI, using existing protocols, can be a useful diagnostic tool for the evaluation of MD, and intratympanic or delayed intravenous contrast may be unnecessary for this diagnosis.

      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.01.038
       
  • Reduced post-tonsillectomy bleeding rates through a refined technique
    • Authors: Kent Burton; Stephanie Hanke; Anil Gungor
      Abstract: Publication date: Available online 6 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Kent Burton, Stephanie Hanke, Anil Gungor


      PubDate: 2017-04-13T20:55:57Z
      DOI: 10.1016/j.amjoto.2017.01.037
       
  • Perioperative cardiac complications in patients undergoing head and neck
           free flap reconstruction
    • Authors: Peter J. Ciolek; Kate Clancy; Michael A. Fritz; Eric D. Lamarre
      Abstract: Publication date: Available online 6 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Peter J. Ciolek, Kate Clancy, Michael A. Fritz, Eric D. Lamarre
      Background Limited data exists on cardiac complications following head and neck free flaps. Design A retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015. Results 368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay. Conclusions There is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.017
       
  • Quantitative imaging analysis of transcanal endoscopic Infracochlear
           approach to the internal auditory canal
    • Authors: Judith Kempfle; Benjamin Fiorillo; Vivek V. Kanumuri; Samuel Barber; Albert Edge; Marybeth Cunnane; Aaron K. Remenschneider; Daniel J. Lee; Elliott D. Kozin
      Abstract: Publication date: Available online 4 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Judith Kempfle, Benjamin Fiorillo, Vivek V. Kanumuri, Samuel Barber, Albert Edge, Marybeth Cunnane, Aaron K. Remenschneider, Daniel J. Lee, Elliott D. Kozin
      Purpose A transcanal endoscopic infracochlear surgical approach to the internal auditory canal in a human temporal bone model has been described. The proportion of patients with favorable anatomy for this novel surgical technique is unknown. Herein, we perform a quantitative analysis of the infracochlear corridor to the IAC based on computed tomography. Materials and methods Computed tomography scans of adult temporal bones were measured to determine the accessibility of the IAC when using a transcanal, cochlear-sparing surgical corridor. Results This approach to the IAC was feasible in 92% (35 of 38) specimens based on a minimum distance of 3mm between the basilar turn of the cochlear and the great vessels (jugular bulb and carotid artery). Conclusions Infracochlear access to the IAC is feasible in the majority of adult temporal bones and has implications for future hearing preservation drug delivery approaches to the IAC.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.014
       
  • The vagal nerve stimulation outcome, and laryngeal effect:
           Otolaryngologists roles and perspective
    • Authors: Ahmad I. Al Omari; Firas Q. Alzoubi; Mohammad M. Alsalem; Samah K. Aburahma; Diala T. Mardini; Paul F. Castellanos
      Abstract: Publication date: Available online 4 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Ahmad I. Al Omari, Firas Q. Alzoubi, Mohammad M. Alsalem, Samah K. Aburahma, Diala T. Mardini, Paul F. Castellanos
      Introduction Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12years. VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively. Objectives This study is to review the outcomes of vagal nerve stimulator (VNS) implantation in terms of the surgical procedures, complications, seizure frequency, and the clinical effect on larynx and vocal folds motion. Methods Series of thirty consecutive patients who had VNS implantation between 2007 and 2014 were recruited. Seizure-frequency outcome, surgical complications and device adverse effects of VNS were retrospectively reviewed. Additional evaluation included use of the Voice Handicap Index and Maximum Phonation Time (MPT) were conducted before and after the implantation. Videolaryngoscopy was used to evaluate the vocal fold mobility before and after the VNS implantation. Results Seizure frequency reduction over a minimum of 2years of follow up demonstrated: 100% in seizure frequency reduction in 1 patient, drastic reduction in seizure frequency (70–90%) in 9 patients, a good reduction in terms of seizure frequency (50%) in 8 patients, a 30% reduction in 5 patients, no response in 6 patients, and 1 patient had increased frequency. The most commonly reported adverse effects after VNS activation were coughing and voice changes with pitch breaks, as well as mild intermittent shortness of breath in 33% of patients. For those patients secondary supraglottic muscle tension and hyper function with reduced left vocal fold mobility were noticed on videolaryngoscopy, though none had aspiration problems. Surgical complications included a wound dehiscence in one patient (3%) which was surgically managed, minor intra-operative bleeding 3%; a superficial wound infection in one patient (3%) which was treated conservatively, none of the complications necessitated VNS removal. Conclusions VNS appears to be an effective non-pharmacologic adjuvant therapy in patients with medically refractory seizures. With the favorable adverse-effect profile previously described, VNS is generally well tolerated and of a great benefit to such patients. Laryngeal side effects, of which hoarseness being of the greatest repetition, are the most common after the VNS implantation. VNS can affect the voice and reduced vocal cord motion on the implantation side with secondary supraglottic muscle tension. Otolaryngologists are not only capable of performing VNS implantation, but can also manage surgical complications, assess laryngeal side effects and treat them as needed.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.011
       
  • Xylitol nasal irrigation in the treatment of chronic rhinosinusitis
    • Authors: Lin Lin; Xinyue Tang; Jinjin Wei; Fei Dai; Guangbin Sun
      Abstract: Publication date: Available online 4 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Lin Lin, Xinyue Tang, Jinjin Wei, Fei Dai, Guangbin Sun
      Objective To evaluate the efficacy of xylitol nasal irrigation (XNI) treatment on chronic rhinosinusitis (CRS) and to investigate the effect of XNI on nasal nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA in maxillary sinus. Materials and methods Patients with CRS were enrolled and symptoms were assessed by Visual Analog Scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22). Nasal NO and iNOS mRNA in the right maxillary sinus were also examined. Then, they were treated with XNI (XNI group) or saline nasal irrigation (SNI, SNI group) for 30days, after which their symptoms were reassessed using VAS and SNOT-22, and nasal NO and iNOS mRNA in the right maxillary sinus were also reexamined. Results Twenty-five out of 30 patients completed this study. The scores of VAS and SNOT-22 were all reduced significantly after XNI treatment, but not after SNI. The concentrations of nasal NO and iNOS mRNA in the right maxillary sinus were increased significantly in XNI group. However, significant changes were not found after SNI treatment. Furthermore, there were statistical differences in the assessments of VAS and SNOT-22 and the contents of nasal NO and iNOS mRNA in the right maxillary sinus between two groups. Conclusions XNI results in greater improvement of symptoms of CRS and greater enhancement of nasal NO and iNOS mRNA in maxillary sinus as compared to SNI.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.006
       
  • Magnetic resonance imaging predicts chronic dizziness after benign
           paroxysmal positional vertigo
    • Authors: Wang Woon Cha; Kudamo Song; In Kyu Yu; Myoung Su Choi; Dong Sik Chang; Chin-Saeng Cho; Ho Yun Lee
      Abstract: Publication date: Available online 4 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Wang Woon Cha, Kudamo Song, In Kyu Yu, Myoung Su Choi, Dong Sik Chang, Chin-Saeng Cho, Ho Yun Lee
      Objectives We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). Methods A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. Results The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p >0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67–34.48; p =0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11–21.28; p =0.036) were positively associated with dizziness lasting longer than 3months. Conclusion Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.04.001
       
  • Clinical and audiological characteristics of 1000Hz audiometric notch
           patients
    • Authors: Hyun-Min Lee; Seok-Hyun Kim; Jae-Hwan Jung; Se-Joon Oh; Soo-Keun Kong; Il-Woo Lee
      Abstract: Publication date: Available online 1 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Hyun-Min Lee, Seok-Hyun Kim, Jae-Hwan Jung, Se-Joon Oh, Soo-Keun Kong, Il-Woo Lee
      Purpose Among the hearing loss patients, we can confirm that the hearing loss of the specific frequency decreases, such as the 2000Hz notch in otosclerosis and the 4000Hz notch (c5-dip) in noise-induced hearing loss. The 1000Hz notch (c3-dip), however, is rarely studied. We fortuitously encountered a group of patients with a 1kHz hearing loss and report it with a review of the literature. Methods Otological history, audiogram, diagnosis, occupation, and history of noise exposure were reviewed from charts and telephone interview, and compared between c3-dip and c5-dip patients (n =98). Results Thirty-one patients (mean age: 46.2years) demonstrated 1kHz hearing loss; these included 11 males. The pure-tone threshold was 37.97dB at 1kHz and the average threshold was 22.38dB at other frequencies. In the c3-dip group, tinnitus was the most common complaint, while sudden sensorineural hearing loss and idiopathic tinnitus (n =8 each) were the most common diagnoses. Female patients and unilateral cases were more common in the c3-dip than in the c5-dip group, and ear fullness was more common in the c3-dip group than in the c5-dip group. The duration of occupation-related noise exposure was longer in the c5 group, and head or ear trauma was more frequent in the c3-dip group. Conclusion We have defined a new clinical entity of 1kHz hearing loss in patients, defined as the c3-dip, which was clinically and audiologically distinct from the c5-dip. Further study is needed to clarify this new entity of hearing loss.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.016
       
  • Morphological characteristics of external auditory canal in congenital
           aural stenosis patients
    • Authors: Dongming Yin; Chenlong Li; Keguang Chen; Juan Hong; Jieying Li; Lin Yang; Tianyu Zhang; Peidong Dai
      Abstract: Publication date: Available online 1 April 2017
      Source:American Journal of Otolaryngology
      Author(s): Dongming Yin, Chenlong Li, Keguang Chen, Juan Hong, Jieying Li, Lin Yang, Tianyu Zhang, Peidong Dai
      Objective To investigate characteristics of congenital aural stenosis (CAS) patients' external auditory canal (EAC) (position, length, orientation, etc.) and compare them with normal EAC. Methods CT images of normal people and CAS patient were utilized. We obtained coordinates of EAC landmarks. Then the Matlab program could calculate some anatomic parameters about EAC, including distances from central point of tympanic annulus (CA), central point of osseous EAC opening (CO), central point of cartilaginous EAC inside opening (CCi), central point of cartilaginous EAC outside opening (CCo) to the Frankfurt horizontal plane (Pfrkt), the median sagittal plane (Psag), the coronal plane (Pcor); orientations of EAC bendings; straight and arc lengths of EAC. Results Distances from CA, CO, CCi and CCo to Pfrkt were all shorter in CAS group than control group (p <0.05). The straight and arc lengths of cartilaginous EAC in CAS group were shorter than control group (p <0.05). Straight and arc lengths of EAC in CAS group were shorter than those in control group (p <0.05). The proportion of one bending in cartilaginous EAC in control group was significantly lower than CAS group (p <0.05). Orientations of EAC bendings in CAS group differed from those in control group (p <0.05). Conclusion In addition to smaller diameters, compared with normal EAC, the position of CAS patients' osseous EAC was higher compared with the normal. The majority of CAS patients have a bending and downward slanting cartilaginous EAC. Orientations of EAC bending in CAS patients were different from normal. Besides, the length of CAS patients' cartilaginous EAC was shorter. However, there were no significant differences between CAS patients and normal people in length of osseous EAC. These differences in anatomic parameters could provide the basis for optimizing the meatoplasty.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.015
       
  • Treatment of locally advanced parotid malignancies with parotidectomy and
           temporal bone resection
    • Authors: James R. Martin; Peter Filip; Eric J. Thorpe; John P. Leonetti
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): James R. Martin, Peter Filip, Eric J. Thorpe, John P. Leonetti
      Purpose In this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies. Methods Patients undergoing lateral temporal bone resection and parotidectomy from 2007–2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively. Results Fifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series. Conclusion Local and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.005
       
  • Open vs. endoscopic cricopharyngeal myotomy; Is there a difference?
    • Authors: Colin Huntley; Maurits Boon; Joseph Spiegel
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Colin Huntley, Maurits Boon, Joseph Spiegel
      Introduction The upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM). Methods A retrospective review of all patients undergoing endoscopic and open CPM was undertaken. We recorded demographic, clinical, operative, hospital, and postoperative data for both groups from January 2010–March 2015. The endoscopic and open CPM groups were directly compared. Results Our cohort consisted of 38 open and 41 endoscopic CPM patients. There were 22 males and 16 females in the open group and 9 males and 32 females in the endoscopic group. The primary diagnosis for both groups was cricopharyngeal hyperfunction. We found a significant improvement in surgical time and symptomatic outcomes in the endoscopic group (p=0.008 and p=0.010). There was no difference in UES preop pressure, hospital stay, complication rate, time to oral intake, or length of follow-up between cohorts. Conclusion Endoscopic CPM is a safe and effective alternative to the open approach. Patients undergoing endoscopic CPM have shorter operative times and improved outcomes when compared to the open approach.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.010
       
  • From transmandibular to transoral robotic approach for parapharyngeal
           space tumors
    • Authors: Francesco Chu; Marta Tagliabue; Gioacchino Giugliano; Luca Calabrese; Lorenzo Preda; Mohssen Ansarin
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Francesco Chu, Marta Tagliabue, Gioacchino Giugliano, Luca Calabrese, Lorenzo Preda, Mohssen Ansarin
      Purpose Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics. Materials and methods Critical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes. Results Between January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes. Conclusions PPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.004
       
  • Eustachian tube diameter: Is it associated with chronic otitis media
           development?
    • Authors: Ceki Paltura; Tuba Selçuk Can; Behice Kaniye Yilmaz; Mehmet Emre Dinç; Ömer Necati Develioğlu; Mehmet Külekçi
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Ceki Paltura, Tuba Selçuk Can, Behice Kaniye Yilmaz, Mehmet Emre Dinç, Ömer Necati Develioğlu, Mehmet Külekçi
      Objective To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis. Study design Retrospective. Subjects and methods Patients with unilateral COM disease are included in the study. The connection between fibrocartilaginous and osseous segments of the Eustachian Tube (ET) on axial Computed Tomography (CT) images was defined and the diameter of this segment is measured. The measurements were carried out bilaterally and statistically compared. Results 154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947mm (Std. deviation±0.5247) for healthy ears and 1788mm (Std. deviation±0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p <0.01). Conclusion The dysfunction or anatomical anomalies of ET are correlated with COM. Measuring of the bony diameter of ET during routine Temporal CT examination is recommended for our colleagues.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.012
       
  • Post-operative MRSA infections in head and neck surgery
    • Authors: Sharon Lin; Sami Melki; Michelle V. Lisgaris; Emily N. Ahadizadeh; Chad A. Zender
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Sharon Lin, Sami Melki, Michelle V. Lisgaris, Emily N. Ahadizadeh, Chad A. Zender
      Purpose Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution. Materials and methods This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed. Results We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06–6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133–52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750–7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031). Conclusions Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.013
       
  • Dizziness, malpractice, and the otolaryngologist
    • Authors: Anthony M. Tolisano; Sungjin A. Song; Douglas S. Ruhl; Philip D. Littlefield
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Anthony M. Tolisano, Sungjin A. Song, Douglas S. Ruhl, Philip D. Littlefield
      Purpose To assess malpractice claims related to the management of dizziness in otolaryngology in order to improve care and minimize the risk of litigation. Materials and methods This is a retrospective review of the LexisNexis “Jury Verdicts and Settlements” database. All lawsuits and out of court adjudications related to the management of dizziness by otolaryngologists were collected. Data including patient demographics, plaintiff allegation, procedure performed, and indemnities were analyzed. Results Of 21 cases meeting inclusion criteria, 17 were decided by a trial jury and four were resolved out of court. Jury verdicts favored the plaintiff 53% of the time and a payout was made in 57% of cases overall. Average payments were higher for jury verdicts in favor of the plaintiff ($1.8 million) as compared to out of court settlements ($545,000). Two-thirds of cases involved surgery, most commonly stapes surgery. Legal allegations, including physical injury, negligence, and lack of informed consent failed to predict the legal outcome. Conclusions Appropriate examination, testing, and referrals within a timely manner are crucial in the management of dizzy patients to avoid misdiagnoses. It is imperative that patients undergoing ear surgery are appropriately counseled that dizziness is a potential complication. The analysis of malpractice literature is complementary to clinical studies, with the potential to educate practitioners, improve patient care, and mitigate risk.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.009
       
  • Parotid adenoid cystic carcinoma: Retrospective single institute analysis
    • Authors: Giuditta Mannelli; Lorenzo Cecconi; Martina Fasolati; Roberto Santoro; Alessandro Franchi; Oreste Gallo
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Giuditta Mannelli, Lorenzo Cecconi, Martina Fasolati, Roberto Santoro, Alessandro Franchi, Oreste Gallo
      Purpose Adenoid cystic carcinoma (ACC) is a uncommon salivary malignant tumor. Our aim was to review our experience with parotid ACC, to identify clinical-pathological parameters predictive for outcome. Materials and methods We retrospectively reviewed 228 patients affected by parotid gland carcinomas surgically treated at our Institution. Forty-four ACC were included in this study. Multivariate analysis risk models were built to predict recurrence free probability (RFP), distant recurrence free probability (DRFP), overall survival (OS) and disease free survival (DFS). Results Twenty-one patients (47.7%) died from ACC and 2.3% for other causes. The 41% presented local-regional recurrence, with a regional-RFP rate of 93%, and the 34% reported distant metastases (DM). The five and ten-year OS rates were 74% and 50%, respectively. Conclusions Recurrences were mainly influenced by the presence of perineural invasion and nerve paralysis, whilst female gender and age<50 were predictors for good prognosis.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.008
       
  • Hydroxyapatite bone cement for suboccipital retrosigmoid cranioplasty: A
           single institution case series
    • Authors: Alexander L. Luryi; Ketan R. Bulsara; Elias M. Michaelides
      Abstract: Publication date: Available online 31 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Alexander L. Luryi, Ketan R. Bulsara, Elias M. Michaelides
      Objective To report rates of cerebrospinal fluid leak, wound infection, and other complications after repair of retrosigmoid craniotomy with hydroxyapatite bone cement. Methods Retrospective case review at tertiary referral center of patients who underwent retrosigmoid craniotomy from 2013 to 2016 with hydroxyapatite cement cranioplasty. Outcome measures Presence of absence of cerebrospinal fluid leak, wound infection, and other complications. Results Twenty cases of retrosigmoid craniotomy repaired with hydroxyapatite cement were identified. Median length of follow up was 9.8months. No cases of cerebrospinal fluid leak were identified. One patient developed a wound infection which was thought to be related to a chronic inflammatory response to the implanted dural substitute. No other major complications were noted. Conclusions A method and case series of suboccipital retrosigmoid cranioplasty using hydroxyapatite cement and a are reported. Hydroxyapatite cement cranioplasty is a safe and effective technique for repair of retrosigmoid craniotomy defects.

      PubDate: 2017-04-06T20:19:07Z
      DOI: 10.1016/j.amjoto.2017.03.007
       
  • Spontaneous resolution of hypercalcemia
    • Authors: Emily N. Ahadizadeh; Nauman F. Manzoor; Jay Wasman; Pierre Lavertu
      Abstract: Publication date: Available online 29 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Emily N. Ahadizadeh, Nauman F. Manzoor, Jay Wasman, Pierre Lavertu
      Background Primary hyperparathyroidism (PHPT) is a frequently encountered endocrine disorder due to benign neoplastic lesions or gland hyperplasia. It is often discovered incidentally when routine lab work reveals hypercalcemia. Methods This case presents a 55-year-old male with a neck mass and electrolyte irregularities consistent with PHPT. However, his laboratory values suddenly normalized prior to surgery. Results Post-operative pathologic analysis of the specimen demonstrated massive infarction of the affected gland, and explained the spontaneous resolution of the patient's electrolyte derangements. Conclusions The objective of this case study is to demonstrate the importance of further investigation in patients with fluctuating lab values and emphasize the potential dangers of gland infarction.

      PubDate: 2017-03-30T19:58:37Z
      DOI: 10.1016/j.amjoto.2017.03.003
       
  • Corrigendum to “malignant transformation of keratocystic odontogenic
           tumor: Two case reports” [American journal of otolaryngology 34 (2013)
           357–361]
    • Authors: Bernard Tan; Sok Yan Tay; Lee Shermin; Kwa Chong Teck; Poon Choy Yoke; Christopher Goh; Abhilash Balakrishnan
      Abstract: Publication date: Available online 21 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Bernard Tan, Sok Yan Tay, Lee Shermin, Kwa Chong Teck, Poon Choy Yoke, Christopher Goh, Abhilash Balakrishnan


      PubDate: 2017-03-23T19:02:29Z
      DOI: 10.1016/j.amjoto.2017.03.002
       
  • Guidelines for Contributing Authors
    • Abstract: Publication date: March–April 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 2


      PubDate: 2017-03-23T19:02:29Z
       
  • The role of surgery in anaplastic thyroid cancer: A systematic review
    • Authors: Shirley Hu; Samuel N. Helman; Elyse Hanly; Ilya Likhterov
      Abstract: Publication date: Available online 3 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Shirley Hu, Samuel N. Helman, Elyse Hanly, Ilya Likhterov
      Objective To elucidate the role of surgery in the management of anaplastic thyroid cancer. Methods Ovid MEDLINE, Cochrane Library, and Google Scholar databases were searched for publications from December 2000 to July 2016. Selection criterion was a focus on the management of anaplastic thyroid cancer in adults. Studies addressing only nonsurgical management and review articles were excluded. Data extraction was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Kaplan-Meier analysis was performed on a subset of patients. Results 40 publications were included in the study. Approaches to unresectability and interpretations of resection varied widely. For patients undergoing primary surgery, the median survival was 6.6months. The median survival for non-surgical patients was 2.1months. In the subgroup analysis, the median survival time for patients undergoing surgery was significantly longer in Stage IVB (p=0.022) but not IVC disease. Negative margins did not afford a statistically significant survival benefit. Conclusion Surgery is a mainstay of treatment for Stage IVA and IVB disease. For Stage IVC cancer, distant metastasis was not a strict criterion against surgical candidacy among surgeons. The extent of resection and the definition of resectability remain controversial. Negative margins did not significantly increase survival.

      PubDate: 2017-03-06T16:26:10Z
      DOI: 10.1016/j.amjoto.2017.02.005
       
  • Management of recurrent tonsillitis in children
    • Authors: Diaa El Din El Hennawi; Ahmed Geneid; Salah Zaher; Mohamed Rifaat
      Abstract: Publication date: Available online 3 March 2017
      Source:American Journal of Otolaryngology
      Author(s): Diaa El Din El Hennawi, Ahmed Geneid, Salah Zaher, Mohamed Rifaat
      Objective To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. Methods The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. Results Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. Conclusion AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

      PubDate: 2017-03-06T16:26:10Z
      DOI: 10.1016/j.amjoto.2017.03.001
       
  • Healthcare Usage after Uvulopalatopharyngoplasty – Impact of
           Analgesic Regimen
    • Authors: William S. Tierney; Gabriel Gabarain; Alan H. Kominsky
      Abstract: Publication date: Available online 23 January 2017
      Source:American Journal of Otolaryngology
      Author(s): William S. Tierney, Gabriel Gabarain, Alan H. Kominsky
      Outcome Objectives 1) Analyze differences in healthcare usage between subjects receiving different perioperative analgesic medications after uvulopalatopharyngoplasty (UPPP) surgery. 2) Comment on the impact of perioperative analgesic medication on length of hospital stay and complications after UPPP. Methods A retrospective cohort study of 120 UPPPs conducted by a single surgeon in the past 5 years was conducted. Subjects were grouped based on perioperative pain medication regimen into three groups; narcotics alone (n=83), narcotics with gabapentin (n=27), or narcotics with ketorolac trimethamine (n=10). The primary outcome variable was total number of clinic/emergency room and/or telephone encounters related to post-UPPP pain. Secondary outcomes included length of post-operative hospital stay, number of telephone and/or clinical encounters in which the patient complained specifically of pain or requested a refill for analgesics, and post-operative complications. Results No significant difference was found between the three analgesic regimens in post-operative hospital stay length (p=0.28, median stay 23.5hrs), number of clinic or telephone encounters related to pain(p=0.26, mean value 0.71 encounters), or post-operative complication rate (p=0.82, 5.9% complication rate). Conclusion This study shows no significant difference in post-operative healthcare usage between patients with peri-operative analgesic regimens including narcotics alone, gabapentin with narcotics, or ketorolac with narcotics. Post-operative complication rate and length of stay did not differ between groups. These data suggest that these three medication regimens have similar impact on post-operative course for UPPP patients. Therefore, the most affordable or simplest options have equivalent effects on post-operative healthcare usage.

      PubDate: 2017-01-25T15:53:48Z
      DOI: 10.1016/j.amjoto.2017.01.024
       
  • Extended use of perioperative antibiotics in head and neck microvascular
           reconstruction
    • Authors: Stefanie Saunders; Stephen Reese; Jimmy Lam; Jacqueline Wulu; Waleed Ezzat
      Abstract: Publication date: Available online 19 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Stefanie Saunders, Stephen Reese, Jimmy Lam, Jacqueline Wulu, Waleed Ezzat
      Purpose Many head and neck surgical procedures are considered clean-contaminated wounds and antibiotic prophylaxis is recommended. Despite prophylaxis, the incidence of surgical site infections remains significant – especially in the setting of free tissue transfer. The antibiotic course is often of a longer duration after free tissue transfer than the recommended 24 hours post-operatively. Currently, there is no consensus on appropriate antibiotic regimen or duration at this time. This study investigates the outcomes of a 7-day perioperative antibiotic regimen after microvascular reconstruction of the head and neck at our institution. Materials and Methods A retrospective review was performed of 72 patients undergoing microvascular free tissue at our institution between 09/2011 and 03/2014. The antibiotic regimen, post-operative surgical (including surgical site infections) and medical complications were noted. Our rates of complications and adverse events were compared to all surgical patients, as well as all inpatients hospital-wide with use of the University HealthSystem Consortium database. Results Seventy-two subjects met inclusion criteria for this study. The majority of subjects received cefazolin/metronidazole (69.4%). Subjects with beta-lactam allergy received clindamycin (12.5%). The remainder received an alternative regimen (18.1%). All received at least 7 days of antibiotics. The rate of hospital acquired C. difficile diarrhea was 0.57% hospital-wide, 1.13% in Otolaryngology patients, and 1.4% in this study. There were no instances of a multi-drug resistant infection or any adverse reactions to the administration of antibiotics. When compared with other antibiotic regimens, clindamycin was associated with a significantly increased rate of either medical or surgical infections (OR 14.38, p=0.02) and longer hospital stay (average=18 days, p < 0.05). Conclusion The use of a 7-day prophylactic antibiotic regimen is not associated with an increased risk of antibiotic-associated infections, multi-drug resistant infections, or antibiotic-associated complications. The use of clindamycin is associated with increased risk of medical and surgical infections post-operatively and should be avoided in the prophylactic perioperative phase after free tissue transfer of the head and neck.

      PubDate: 2017-01-25T15:53:48Z
      DOI: 10.1016/j.amjoto.2017.01.009
       
  • Cortactin and phosphorylated cortactin tyr466 expression in temporal bone
           carcinoma
    • Authors: Gino Marioni; Elisabetta Zanoletti; Antonio Mazzoni; Andrea Gianatti; Elisa Valentini; Laura Girasoli; Martina Guariento; Luciano Giacomelli; Alessandro Martini; Stella Blandamura
      Abstract: Publication date: Available online 19 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Gino Marioni, Elisabetta Zanoletti, Antonio Mazzoni, Andrea Gianatti, Elisa Valentini, Laura Girasoli, Martina Guariento, Luciano Giacomelli, Alessandro Martini, Stella Blandamura
      Purpose Cortactin is a multidomain protein engaged in several cellular mechanisms involving actin assembly and cytoskeletal arrangement. Cortactin overexpression in several malignancies has been associated with increased cell migration, invasion, and metastatic potential. Cortactin needs to be activated by tyrosine or serine/threonine phosphorylation. The role of cortactin and phosphorylated cortactin (residue tyr466) was investigated in temporal bone squamous cell carcinoma (TBSCC). Materials and methods Immunohistochemical expression of cortactin and phosphorylated cortactin (residue tyr466) was assessed in 27 consecutively-operated TBSCCs. Results Several clinicopathological variables correlated with recurrence (pT stage, dura mater involvement), and disease-free survival (DFS) (cT stage, pT stage, pN status, dura mater involvement). Twenty-three of 24 immunohistochemically evaluable TBSCCs were cortactin-positive. Median cortactin expression was 75.0%. Cortactin reaction in the cytoplasm was more intense in carcinoma cells than in normal adjacent tissue. Recurrence and DFS rates did not correlate with cortactin and phosphorylated cortactin (residue tyr466) expression in TBSCC specimens. Conclusions Cortactin upregulation in TBSCC supports the conviction that inhibiting cortactin functions could have selective effects on this malignancy. Multi-institutional studies should further investigate the role of cortactin and phosphorylated cortactin in TBSCC, and their potential clinical application in integrated treatment modalities.

      PubDate: 2017-01-25T15:53:48Z
      DOI: 10.1016/j.amjoto.2017.01.012
       
  • Two-stage CO2-laser-assisted bilateral cordectomy for cT1b glottic
           carcinoma
    • Authors: Andy Bertolin; Marco Lionello; Gianni Salis; Giuseppe Rizzotto; Marco Lucioni
      Abstract: Publication date: Available online 18 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Andy Bertolin, Marco Lionello, Gianni Salis, Giuseppe Rizzotto, Marco Lucioni
      Purpose The aim of the present paper was to investigate the oncological safety of two-stage bilateral cordectomy for the treatment of cT1b glottic SCC, and to compare its oncological outcome and synechia development rate with those of single-stage procedures. Materials and Methods A retrospective cohort study was performed at the Otolaryngology Unit of Vittorio Veneto Laryngeal Cancer Center (Italy). The prognostic significance of clinical, pathological and surgical factors was also investigated, in terms of recurrence rate and disease-free survival, in a univariate statistical setting. Results Our results indicate that patients treated with primary two-stage bilateral cordectomy achieved local control in 96% of cases, with 95% disease-specific and 88% overall survival rates, and a 95% organ preservation rate, with anterior synechiae developing in 1 case. Involvement of the deep surgical margins correlated with a worse prognosis. Patients developed anterior synechiae less frequently after two-stage bilateral cordectomy, and experienced no higher recurrence rate or shorter disease-free survival than patients treated with a single-stage procedure. Conclusions Two-stage bilateral cordectomy is a safe and effective procedure. In selected patients it could be considered the primary approach for the treatment of early glottic cT1b carcinomas.

      PubDate: 2017-01-25T15:53:48Z
      DOI: 10.1016/j.amjoto.2017.01.004
       
  • Intranasal azelastine and mometasone exhibit a synergistic effect on a
           murine model of allergic rhinitis
    • Authors: Do Hyun Kim; Boo-Young Kim; Ji-Hyeon Shin; Sung Won Kim; Soo Whan Kim
      Abstract: Publication date: Available online 18 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Do Hyun Kim, Boo-Young Kim, Ji-Hyeon Shin, Sung Won Kim, Soo Whan Kim
      Purpose The purpose of this study was to compare the anti-allergic effects of the combination of azelastine and mometasone with those of either agent alone in a Dermatophagoides farinae (Derf)-induced murine model of allergic rhinitis (AR). Materials and Methods Forty BALB/c mice were divided into five groups: azelastine (A), mometasone (M), a combination of azelastine and mometasone (MA), Derf, and control. Derf served as the allergen. Allergic symptom scores, eosinophil counts, and serum Derf-specific IgE levels were measured. The mucosal levels of mRNAs encoding interferon (IFN)-γ, T-bet, interleukin (IL)-4, GATA-3, Foxp3, IL-17, and ROR-γt were determined by real-time polymerase chain reaction. The T-bet, GATA-3, Foxp3, and ROR-γt results were confirmed by Western blotting. Results Nose-rubbing motions; the levels of mRNAs encoding IL-4, GATA-3, and ROR-γt; and tissue eosinophil count were reduced in the MA compared with those in the Derf group (all P values <0.05). The levels of mRNAs encoding GATA3 and IL-4 mRNA [synthesized by T helper (Th)2 cells] were reduced and that of mRNA encoding Foxp3 was increased in the MA compared with those in the Derf and A groups. Western blotting confirmed these findings. Conclusion We found that the combination of intranasal azelastine and mometasone synergistically suppressed Th17 responses and (reciprocally) elevated Treg responses. Therefore, this combination not only ameliorated allergic inflammation by suppressing Th2 responses, but also usefully modified the Treg/Th17 balance.

      PubDate: 2017-01-18T15:23:58Z
      DOI: 10.1016/j.amjoto.2017.01.008
       
  • Treatment Outcomes in Veterans with HPV-Positive Head and Neck Cancer
    • Authors: Aaron J. Feinstein; Sophie G. Shay; Elena Chang; Michael S. Lewis; Marilene B. Wang
      Abstract: Publication date: Available online 18 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Aaron J. Feinstein, Sophie G. Shay, Elena Chang, Michael S. Lewis, Marilene B. Wang
      Objectives Head and neck squamous cell carcinoma (HNSCC) caused by the human papilloma virus (HPV) has an improved prognosis relative to HPV-negative tumors. Patients with HPV-positive disease may benefit from different treatment modalities in order to optimize survival and quality of life. We sought to investigate HPV-positive HNSCC within the military veteran population, and analyze the role of treatment modality in outcomes of patients with HPV-positive and HPV-negative tumors. Methods Patients diagnosed with HNSCC between January 1, 2010 and December 31, 2014 at one regional veterans health center were retrospectively examined. Pathologic specimens underwent testing for HPV subtype and p16 expression. Demographic and clinical factors, including treatment modality, were analyzed for their impact on the primary outcome of overall survival. Results There were 209 patients with primary tumor sites including larynx (25.4%), oral tongue (19.6%), oral cavity (13.4%), oropharynx (17.2%), tonsil (17.2%), unknown primary (2.9%), nasopharynx (1.9%), and multiple sites (2.4%). Patients had HPV-positive (n =82, 39.2%), HPV-negative (n =89, 42.6%) or unknown HPV status (n =38, 18.2%). Primary treatment modalities were chemoradiation (n =124, 59.3%), surgery (n =39, 18.7%), radiation therapy (n =37, 17.7%), or no treatment (n =9, 4.3%). Survival analysis with Cox proportional hazards model demonstrated significant associations with T classification (T4 3.61, P =0.005), N classification (N3 3.52, P =0.0159), M classification (M1 2.8, P = 0.0209), and HPV status (HPV-positive 0.43, P = 0.0185), but no relation with primary treatment modality (primary surgery vs. primary chemoradiation 1.01, P = 0.9718). Conclusion HPV-positive HNSCC in the veteran population has a significantly improved prognosis relative to similarly staged patients with HPV-negative disease. This study demonstrates that the primary treatment modality – chemoradiation, radiation therapy, or surgery – does not impact overall survival among veterans with HPV-positive HNSCC.

      PubDate: 2017-01-18T15:23:58Z
      DOI: 10.1016/j.amjoto.2017.01.005
       
  • Endonasal septal perforation repair using posterior and inferiorly based
           mucosal rotation flaps
    • Authors: Steven Dayton; Nipun Chhabra; Steven Houser
      Abstract: Publication date: Available online 16 January 2017
      Source:American Journal of Otolaryngology
      Author(s): Steven Dayton, Nipun Chhabra, Steven Houser
      Importance Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations. Objective To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series. Design The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015. Setting The study took place at MetroHealth Medical Center in Cleveland, Ohio. Participants Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10–67years). Intervention for clinical trials or exposure for observational studies Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap. Main outcomes and measures The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery. Results Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (<1cm) had a 93.3% success rate, medium (1–2cm) 88.9%, and all seven large perforations (>2cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure. Conclusions and relevance Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum.

      PubDate: 2017-01-18T15:23:58Z
      DOI: 10.1016/j.amjoto.2017.01.001
       
 
 
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