for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3123 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, 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: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
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   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, 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: 10, 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: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, 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: 4, 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: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 138, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, 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: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, 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: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 45, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, 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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
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: 36, 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: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
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: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 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: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 370, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 337, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, 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: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, 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: 5, 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: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
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   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, 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: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, 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: 26, 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: 45, 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: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, 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: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Otolaryngology
  [SJR: 0.59]   [H-I: 45]   [24 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-0709
   Published by Elsevier Homepage  [3123 journals]
  • Identifying eustachian tube dysfunction prior to hyperbaric oxygen
           therapy: Who is at risk for intolerance'
    • Authors: Jason E. Cohn; Michael Pfeiffer; Niki Patel; Robert T. Sataloff; Brian J. McKinnon
      Pages: 14 - 19
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Jason E. Cohn, Michael Pfeiffer, Niki Patel, Robert T. Sataloff, Brian J. McKinnon
      Purpose Determine whether specific risk factors, symptoms and clinical examination findings are associated with hyperbaric oxygen therapy (HBOT) intolerance and subsequent tympanotomy tube placement. Materials and methods A retrospective case series with chart review was conducted from 2007 to 2016 of patients undergoing HBOT clearance at a tertiary care university hospital in an urban city. Eighty-one (n=81) patient charts were reviewed for risk factors, symptoms and clinical examination findings related to HBOT eustachian tube dysfunction and middle ear barotrauma. Relative risk was calculated for each variable to determine risk for HBOT intolerance and need for tympanotomy tube placement. Risk factor, symptom, physical examination and HBOT complication-susceptibility scores were calculated for each patient. Results Mean risk factor, clinical and HBOT complication-susceptibility scores were significantly higher in patients who did not tolerate HBOT compared to patients who tolerated HBOT. Patients reporting a history of otitis media, tinnitus, and prior ear surgery were at a higher risk for HBOT intolerance. Patients reporting a history of pressure intolerance and prior ear surgery were more likely to undergo tympanotomy tube placement. Patients noted to have otologic findings prior to HBOT were at a higher risk for both HBOT intolerance and tympanotomy tube placement. Conclusions A thorough otolaryngological evaluation can potentially predict and identify patients at risk for HBOT intolerance and tympanotomy tube placement.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.10.005
       
  • Payer database and geospatial analysis to evaluate practice patterns in
           treating allergy in North Carolina
    • Authors: Matthew G. Crowson; Kristine Schulz; Alex Ulvila; David L. Witsell
      Pages: 20 - 24
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Matthew G. Crowson, Kristine Schulz, Alex Ulvila, David L. Witsell
      Objective The objective of this study was to characterize the delivery of allergy care in North Carolina using a large payer charge database and visualization techniques. Study design Geospatial database analysis. Setting North Carolina State claims database. Subjects & methods Medical data from the 2013 FAIR Health National Private Insurance Claims (FH NPIC) database for North Carolina was mined for CPT codes and charges for allergy testing, and for the preparation and provision of allergen immunotherapy. Provider and patient variables were analyzed. Analyses were performed to compare differences in allergy care delivery. A visualization strategy complemented the analytic approach. Results 162,037 CPT charge entries were analyzed. Allergy-immunology specialists were the most common provider specialty to perform allergy immunotherapy treatments (68.9%, p<0.05). Among other specialties, there were no significant differences between specialists performing immunotherapy when comparing otolaryngology, family practice, and internal medicine (16.3%; 4.6%; 2.6%; p>0.05). Providers with an M.D. degree were the most common provider type. The three most commonly treated diagnoses were allergic rhinitis variants. Females were more likely to receive allergy treatments versus males (55.9% vs. 51.5%; p<0.001), and were more likely to receive allergy testing (65.3% vs. 34.7%: p<0.005). Internal medicine providers charged higher than any other specialist type (p<0.05) for allergy immunotherapy. Conclusions Using a large payer database coupled with visualization techniques was an efficient approach to characterizing the state-wide provision patterns of allergy diagnostic and therapy services in North Carolina. This first tier approach to efficiently exploring questions and describing populations is valuable.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.10.004
       
  • Pediatric airway study: Endoscopic grading system for quantifying
           tonsillar size in comparison to standard adenotonsillar grading systems
    • Authors: Neha A. Patel; Kristen Carlin; Joseph M. Bernstein
      Pages: 56 - 64
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Neha A. Patel, Kristen Carlin, Joseph M. Bernstein
      Significance Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children. Objective To propose and validate an easy-to-use flexible fiberoptic endoscopic grading system that provides physicians with a more accurate sense of the three-dimensional relationship of the tonsillar fossa to the upper-airway. Methods 50 consecutive pediatric patients were prospectively recruited between February 2015 and February 2016 at a pediatric otolaryngology outpatient clinic. The patients had no major craniofacial abnormalities and were aged 1 to 16years. Each patient had data regarding BMI, Friedman palate position, OSA-18 survey results collected. For each child, digital video clips of fiberoptic nasopharyngeal, oropharyngeal and laryngeal exams were presented to 2 examiners. Examiners were asked to independently use the proposed Endoscopic tonsillar grading system, the Brodsky tonsillar grading scale, the Modified Brodsky tonsillar grading scale with a tongue depressor, and the Parikh adenoid grading system to rate adenotonsillar hypertrophy. Cohen's Kappa and weighted Kappa scores were used to assess interrater reliability for each of the four grading scales. The Spearman correlation was used to test the associations between each scale and OSA-18 scores, as well as Body Mass Index (BMI). Results 50 pediatric patients were included in this study (mean age 6.1years, range of 1year to 16years). The average BMI was 20. The average OSA-18 score was 61.7. The average Friedman palate position score was 1.34. Twelve percent of the patients had a Friedman palate position score≥3, which made traditional Brodsky grading of their tonsils impossible without a tongue depressor. All four scales showed strong agreement between the two raters. The weighted Kappa was 0.83 for the Modified Brodsky scale, 0.89 for the Brodsky scale, 0.94 for the Parikh scale to 0.98 for the Endoscopic scale (almost perfect agreement). The Endoscopic scale showed the most consistent agreement between the raters during the study. There was a moderate association between the Parikh adenoid grading system with OSA-18 scores (Spearman's ρ=0.58, p <0.001) compared to a low association of the tonsillar grading systems with OSA- 18 scores. None of the scales correlated with patient BMI. Conclusions The proposed Endoscopic tonsillar grading system is as reliable of a method of grading tonsillar size as conventional grading systems. It offers the advantage of allowing for critical evaluation of the tonsils without any anatomic distortion which may occur with the use of a tongue blade. This new validated endoscopic grading system provides a tool for communicating the degree of airway obstruction at the level of the oropharynx regardless of Friedman palate position and may be used in future outcomes projects.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.10.013
       
  • Survival in patients with parotid gland carcinoma – Results of a
           multi-center study
    • Authors: Keigo Honda; Shinzo Tanaka; Shogo Shinohara; Ryo Asato; Hisanobu Tamaki; Toshiki Maetani; Ichiro Tateya; Morimasa Kitamura; Shinji Takebayashi; Kazuyuki Ichimaru; Yoshiharu Kitani; Yohei Kumabe; Tsuyoshi Kojima; Koji Ushiro; Masanobu Mizuta; Koichiro Yamada; Koichi Omori
      Pages: 65 - 70
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Keigo Honda, Shinzo Tanaka, Shogo Shinohara, Ryo Asato, Hisanobu Tamaki, Toshiki Maetani, Ichiro Tateya, Morimasa Kitamura, Shinji Takebayashi, Kazuyuki Ichimaru, Yoshiharu Kitani, Yohei Kumabe, Tsuyoshi Kojima, Koji Ushiro, Masanobu Mizuta, Koichiro Yamada, Koichi Omori
      Background Parotid gland carcinoma is a rare malignancy, comprising only 1–4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach. Methods The study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors. Results The median patient age was 63years old (range 9–93years), and the median observation period was 39months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N+, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N+ and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients. Conclusion Nodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.10.012
       
  • Effect of transcranial direct current stimulation on short-term and
           long-term treatment of chronic tinnitus
    • Authors: Hamidreza Abtahi; Ahmadreza Okhovvat; Somaiie Heidari; Azar Gharagazarloo; Motahare Mirdamadi; Mohammad Hossein Nilforoush; Hossein Ghazavi
      Abstract: Publication date: Available online 6 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Hamidreza Abtahi, Ahmadreza Okhovvat, Somaiie Heidari, Azar Gharagazarloo, Motahare Mirdamadi, Mohammad Hossein Nilforoush, Hossein Ghazavi
      Objective This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control. Methodology This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20. Results Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01). Conclusion In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2018.01.001
       
  • Primary mucinous eccrine carcinoma of the buccal space: A case report and
           review of the literature
    • Authors: Kirkland N. Lozada; Muhammed S. Qazi; Azita S. Khorsandi; Raymond L. Chai
      Abstract: Publication date: Available online 5 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Kirkland N. Lozada, Muhammed S. Qazi, Azita S. Khorsandi, Raymond L. Chai
      Importance Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses. Observation An 84-year-old male presented with a blue mass on the left cheek. This mass started as a small bump and grew significantly over one year. His primary care physician monitored its growth and ultimately referred to an otolaryngologist. Imaging findings revealed a multi-lobular solid and cystic left buccal lesion. FNA was suggestive of low grade mucoepidermoid carcinoma. Intervention Patient underwent surgical excision with primary closure of the defect. Frozen section was consistent with low grade salivary malignancy. Final pathology revealed primary mucinous eccrine carcinoma of the skin. Conclusions and relevance Mucinous eccrine carcinoma is a rare entity commonly seen in the head and neck region. Mucinous deposits to the skin from primaries elsewhere in the body are much more common than primary lesions of the skin. Histology is a key component of the diagnosis but full oncologic workup is required. Treatment typically includes wide local excision with possible adjuvant chemotherapy or radiation for high risk features.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.020
       
  • Risk factors of sensorineural hearing loss in patients with unilateral
           safe chronic suppurative otitis media
    • Authors: Abd Elrheem Ahmed Singer; Osama G. Abdel-Naby Awad; Rafeek Mohamed Abd El-Kader; Ahmed Rabeh Mohamed
      Abstract: Publication date: Available online 5 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Abd Elrheem Ahmed Singer, Osama G. Abdel-Naby Awad, Rafeek Mohamed Abd El-Kader, Ahmed Rabeh Mohamed
      Purpose Chronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings. Material and methods This is a prospective study conducted from June 2016 to June 2017 in a tertiary referral hospital. 200 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The diseased ears were taken as study ears and normal ears as control ears in all patients. Detailed otologic history, clinical and audiometric findings were recorded and analyzed. Results were statistically compared in all patients for both study and control ears using different parameters. Results Twenty patients had an average bone conduction threshold of all frequencies above 25dB, which implies SNHL (10%). The incidence of SNHL was statistically significant at higher speech frequencies. The incidence increased with the presence of Diabetes Mellitus, smoking, duration of disease, presence of active discharge and the increase in size of perforation. However, it is not age dependent and there was no difference between males and females. Conclusion Safe mucosal CSOM can cause SNHL with multiple predisposing factors.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2018.01.002
       
  • Image analysis of the interarytenoid area to detect laryngopharyngeal
           reflux disease
    • Authors: Jerome R. Lechien; Bernard Harmegnies; Sven Saussez
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Jerome R. Lechien, Bernard Harmegnies, Sven Saussez


      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2018.01.004
       
  • Commentary on letter to the editor on manuscript “Image analysis of
           interarytenoid area to detect cases of Laryngopharyngeal Reflux: An
           objective method”
    • Authors: Anindya Nayak
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Otolaryngology
      Author(s): Anindya Nayak


      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2018.01.003
       
  • Surgical management of pulsatile tinnitus secondary to jugular bulb or
           sigmoid sinus diverticulum with review of literature
    • Authors: W.X. Yeo; S.H. Xu; T.Y. Tan; Y.M. Low; H.W. Yuen
      Abstract: Publication date: Available online 29 December 2017
      Source:American Journal of Otolaryngology
      Author(s): W.X. Yeo, S.H. Xu, T.Y. Tan, Y.M. Low, H.W. Yuen
      Introduction Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature. Objectives To report two cases of pulsatile tinnitus with jugular bulb and/or sigmoid sinus diverticulum, and their management strategies and outcomes. In this series, we describe the first reported successful case of pulsatile tinnitus due to jugular bulb diverticulum that was surgically-treated. Subjects and methods Two patients diagnosed with either jugular bulb and/or sigmoid sinus diverticulum, who had presented to the Otolaryngology clinic with pulsatile tinnitus between 2016 and 2017, were studied. Demographic and clinical data were obtained, including their management details and clinical outcomes. Results Two cases (one with jugular bulb diverticulum and one with both sigmoid sinus and jugular bulb diverticula) underwent surgical intervention, and both had immediate resolution of pulsatile tinnitus post-operatively. This was sustained at subsequent follow-up visits at the outpatient clinic, and there were no major complications encountered for both cases intra- and post-operatively. Conclusion Transmastoid reconstruction/resurfacing of jugular bulb and sigmoid sinus diverticulum with/without obliteration of the diverticulum is a safe and effective approach in the management of bothersome pulsatile tinnitus arising from these causes.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.019
       
  • Post-tonsillectomy hemorrhage: Underlying factors and prevention
    • Authors: Zheng-cai Lou; Zi-han Lou
      Abstract: Publication date: Available online 28 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Zheng-cai Lou, Zi-han Lou


      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.018
       
  • Inhalant allergen sensitization is an independent risk factor for the
           development of angioedema
    • Authors: Jacob E. Kuperstock; Nicholas Pritchard; Michal Horný; Christopher C. Xiao; Christopher D. Brook; Michael P. Platt
      Abstract: Publication date: Available online 27 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Jacob E. Kuperstock, Nicholas Pritchard, Michal Horný, Christopher C. Xiao, Christopher D. Brook, Michael P. Platt
      Background/objective The etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema. Methods A retrospective review of patients who had in vitro inhalant allergy testing from 2006 to 2010 was performed. Patients with a diagnosis of angioedema who underwent inhalant allergy testing were identified. Analyses for co-morbidities, class of sensitization, seasonal timing of angioedema, and concurrent use of known hypertensive medications that can cause angioedema were performed. Results There were 1000 patients who underwent inhalant allergy testing and qualified for the study. 37/1000 had at least one episode of angioedema and of these patients, 34 had positive inhalant sensitization testing results. Multivariate regression models showed overall sensitization status, seasonal allergen and epidermal/mite sensitization as independent risk factors (p <0.001, p =0.005, p =0.025 respectively) when controlling for ACE inhibitor use and other covariates. Tree, and epidermal/mite sensitizations were independent risk factors for angioedema in mono-sensitized subject analysis (p =0.028, p =0.029, respectively). Conclusion Both seasonal and perennial allergen sensitizations are independent risk factors for the development of angioedema. In patients with angioedema and an unknown trigger, inhalant allergen sensitization should be considered as a potential contributing factor to the development of angioedema.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.013
       
  • Is tracheotomy on the decline in otolaryngology' A single
           institutional analysis
    • Authors: Andrew J. Bowen; Amy S. Nowacki; Michael S. Benninger; Eric D. Lamarre; Paul C. Bryson
      Abstract: Publication date: Available online 20 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Andrew J. Bowen, Amy S. Nowacki, Michael S. Benninger, Eric D. Lamarre, Paul C. Bryson
      Objective A recent study reported decreasing trends in tracheotomy procedures by its otolaryngology service. We set out to determine whether the previously reported decrease in otolaryngology performed tracheotomies by one institution is a local or generalizable phenomenon. Design Retrospective cohort study from 2010 to 2015. Setting Tertiary care hospital and affiliated regional hospitals. Subject and methods All patients who received tracheotomy during the period of analysis were included. Performing specialty, surgical technique, and procedure location were recorded. Procedures were stratified by year and specialty to generate incidence rate ratios for otolaryngologists and non-otolaryngologists. Incidence rate ratios were estimated with negative binomial regression across services. Results The otolaryngology service demonstrated a yearly decrease of 3.4% in the total number of tracheotomies (95% CI −7.9% to +1.4, P=0.17). While the thoracic service remained constant (+0.3%, 95% CI −2.6% to +3.3%, p=0.83), general surgery demonstrated the greatest increase in procedures (+4.4%, 95% CI −6.0% to +15.8%, P=0.42). Thoracic and general surgery both dramatically increased the number of percutaneous tracheotomies performed, with general surgery also performing a greater number of bedside procedures. Conclusions and relevance We observed a similar decline in the number of tracheotomies otolaryngology over six years. Our trend is likely due to changes in consultations patterns, increasing use of the percutaneous method, and an increase in adjunctive gastrostomy tube placements. Investigations on the impact of a greater number of non-otolaryngology performed tracheotomies on follow up care is warranted.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.017
       
  • Primary surgical management with radial forearm free flap reconstruction
           in T4 oropharyngeal cancer: Complications and functional outcomes
    • Authors: John R. Sims; Eric J. Moore
      Abstract: Publication date: Available online 18 December 2017
      Source:American Journal of Otolaryngology
      Author(s): John R. Sims, Eric J. Moore
      Purpose Functional outcomes and complication rates after open surgery for advanced-stage oropharyngeal cancers are rarely reported. These measures are critical for choice of treatment modality and patient counseling. We describe the long term functional outcomes and associated complications of primary surgical management of T4 oropharyngeal cancers reconstructed with radial forearm free flaps. Materials and methods A retrospective review was performed of 40 patients with T4 oropharyngeal cancers treated between 2005 and 2015 at a tertiary care center. Results Forty patients with T4 oropharyngeal cancers underwent open surgical resection and radial forearm free flap reconstruction at the time of surgery. Mandibulotomy was required in 33 (82.5%) cases. Thirty-five (87.5%) patients received adjuvant radiation or combined chemotherapy and radiation. Tracheostomy was performed in all patients, but every patient was eventually decannulated. Twenty (57.1%) patients required gastrostomy tube placement at some point during treatment; however, 91.4% were on a completely oral diet with a mean FOSS score of 1.6 by 1year after completion of treatment. The addition of adjuvant treatment was the only factor significantly associated with poorer FOSS scores. The overall rates of short and long-term complications were 60.0% and 57.1% respectively. The most common short and long-term complications were infection (30.0%) and velopharyngeal insufficiency (25.7%) respectively. Conclusions Traditional open surgical approaches to large tumors of the oropharynx carry higher complication rates than more recent advanced transoral approaches. However, they can still be utilized with excellent long-term functional results in certain cases of advance oropharyngeal cancers not amenable to transoral approaches. With careful reconstruction of oropharyngeal defects, over 90% of patients can achieve a completely oral diet.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.012
       
  • Combined use of a nanocarbon suspension and 99mTc-MIBI for the
           intra-operative localization of the parathyroid glands
    • Authors: Jun Chen; Qinyi Zhou; Jialin Feng; Jiadong Wang
      Abstract: Publication date: Available online 13 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Jun Chen, Qinyi Zhou, Jialin Feng, Jiadong Wang
      Objective To investigate the combined use of a nanocarbon (NC) suspension and low-dose 99mTc-MIBI for parathyroid localization during surgery in patients with secondary hyperparathyroidism (sHPT). Methods Between March 2010 and September 2015, 40 patients with sHPT were enrolled in this study and were randomized to receive either low-dose 99mTc-MIBI+NC (group I) or low-dose 99mTc-MIBI (group II). Pre- and post-operative serum levels of intact PTH (iPTH), calcium and phosphorus between groups were compared and the intra-operative radioactive counts of the parathyroid glands were measured. Results The post-operative iPTH level was significantly lower in patients of group I (24.2±31ng/L) than in those of group II (106±155ng/L) (P =0.03) while there were no significant differences in intra-operative parathyroid gland radioactive counts between the groups. The duration of the surgical procedure was shorter for patients of group I than patients of group II. There were no serious intra-operative or post-operative complications. Conclusion The combined use of an NC suspension and 99mTc-MIBI for patients with sHPT is strongly recommended for the localization of parathyroid glands during surgery and is likely to improve clinical outcomes for patients.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.12.008
       
  • Symptomatic unilateral vocal fold paralysis following cardiothoracic
           surgery
    • Authors: Cassandra Puccinelli; Mara C. Modzeski; Diana Orbelo; Dale C. Ekbom
      Abstract: Publication date: Available online 6 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Cassandra Puccinelli, Mara C. Modzeski, Diana Orbelo, Dale C. Ekbom
      Purpose Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility. Materials and methods Retrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery. Results Pulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days ( x ¯ =114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days ( x ¯ =29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days ( x ¯ =367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility. Conclusions Many cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.11.011
       
  • The extent of surgery for benign parotid pathology and its influence on
           complications: A prospective cohort analysis
    • Authors: Wai Keat Wong; Subhaschandra Shetty
      Abstract: Publication date: Available online 29 November 2017
      Source:American Journal of Otolaryngology
      Author(s): Wai Keat Wong, Subhaschandra Shetty
      Background The surgical management of benign parotid tumors is aimed at complete extirpation of the mass with preservation of facial nerve function. There is a relative paucity of literature pertaining to complications after benign parotid surgery and related risk factors. We aim to critically review the outcomes following treatment of benign parotid pathology when surgery entailed either complete superficial parotidectomy (CSP), partial superficial parotidectomy (PSP) or extracapsular dissection (ECD). Material and methods This is a review of prospectively collected data of all parotidectomies performed between June 2006 to June 2016 for histologically-proven benign pathology of the parotid. Median follow-up time was 31.6weeks. Results A total of 101 parotidectomies were carried out on 97 patients (40 CSP, 56 PSP and 5 ECD). Pleomorphic adenoma (48.4%) and Warthin's tumors (32.7%) were the most common pathologies. Temporary facial weakness occurred after 7 operations (6.9%). Facial weakness was permanent in 4 cases (3.9%). The rates of sialocele and salivary fistula were 4.9% and 0.9%, respectively. Only one patient (0.9%) developed Frey Syndrome postoperatively. No significant associations between extent of parotid surgery and postoperative facial nerve dysfunction (p=0.674) or wound complications (p=0.433) were observed. Univariate analyses for potential contributing factors such as advanced age, smoking status, tumor location or histology did not demonstrate any increased risk with developing postoperative complications. Conclusion Partial superficial parotidectomy was associated with low rates of morbidity to the facial nerve and surgical wound. The results were comparable to complete superficial parotidectomy. We recommend offering patient partial superficial parotidectomy where appropriate and this is in line with the current trend of minimising surgical dissection, thereby potentially decreasing the risk of short-term and long-term complications.

      PubDate: 2018-01-10T11:11:48Z
      DOI: 10.1016/j.amjoto.2017.11.015
       
  • Prognostic significance of standardized uptake value on F18-FDG PET/CT in
           patients with extranodal nasal type NK/T cell lymphoma: A multicenter,
           retrospective analysis
    • Authors: Kyoungjune Pak; Bum Soo Kim; Keunyoung Kim; In Joo Kim; Sungmin Jun; Young Jin Jeong; Hye Kyung Shim; Sung-Dong Kim; Kyu-Sup Cho
      Pages: 1 - 5
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Kyoungjune Pak, Bum Soo Kim, Keunyoung Kim, In Joo Kim, Sungmin Jun, Young Jin Jeong, Hye Kyung Shim, Sung-Dong Kim, Kyu-Sup Cho
      Objectives The purpose of this study was to evaluate the value of parameters assessed with F18-flurodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting relapse free survival and overall survival in patients with extranodal nasal type NK/T cell lymphoma. Methods Thirty-six patients with extranodal nasal type NK/T cell lymphoma, and who underwent PET/CT prior to curative treatment, were enrolled at five institutions. Volumes of interest covering the entire tumor volume were delineated on PET/CT images, and the maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured using thresholds of 40% of SUVmax. Furthermore, we compared the difference in F18-FDG avidity according to Epstein-Barr virus (EBV) infection status. Results The SUVmax (p =0.041) and SUVmean (p =0.049) in patients who died were higher than the respective values of those who survived. A higher TLG (>45.8) was associated with relapse free survival (HR 7.856, p =0.034). Ann Arbor stage (III–IV, HR 14.12, p =0.004), and a higher SUVmax (>12.6, p =0.024) and SUVmean (>6.4, p =0.024) were associated with poor survival. However, neither the MTV nor the TLG (volumetric parameters) were significant predictors of death. The PET parameters SUVmax (p =0.181), SUVmean (p =0.237), MTV (p =0.636), and TLG (p =0.469) did not differ significantly between patients with and without EBV infections. Conclusions High TLG was the only significant predictive factor on relapse free survival. The SUVmax and SUVmean measured by F18-FDG PET/CT could be significant prognostic factors in patients with extranodal nasal type NK/T cell lymphoma.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.10.009
       
  • Landmarks for the preservation of the middle temporal artery during
           mastoid surgery: Cadaveric dissection study
    • Authors: Pedram Daraei; Douglas E. Mattox
      Pages: 6 - 9
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Pedram Daraei, Douglas E. Mattox
      Importance The middle temporal artery flap is a vascularized periosteal flap that is highly useful for otologic reconstruction including the middle cranial fossa, mastoidectomy defect, and external auditory canal. The course of the artery is close to the external auditory canal and is easily injured during preliminary exposure and elevation of flaps. Objectives To describe the course of the middle temporal artery in relation to the external auditory canal and the superficial temporal artery in order to enhance preservation and use in otologic reconstruction. Design Dissection of preserved, injected cadaveric temporal bones. Setting Anatomical laboratory. Participants Seven cadaveric temporal bones. Intervention Temporal bones were dissected in a planar manner to identify the middle temporal artery along the squamous temporal bone to its origin. The superior border of the external auditory canal was divided, horizontally, into thirds to create three measurement points. Distances between the middle temporal artery and the bony portion of the external auditory canal were then determined. Main outcomes and measures Horizontal diameter of the external auditory canal, distance from the superior-most border of the external auditory canal to the middle temporal artery, various patterns of the middle temporal artery. Results The middle temporal artery branched from the superficial temporal artery in all specimens. Mean horizontal diameter of the external auditory canal was 9.97mm. Mean distances between the bony portion of the external auditory canal and middle temporal artery for the first, second, and third points along the horizontal diameter of the external auditory canal were 1.57, 2.96, and 4.02mm, respectively. In at least one specimen, the artery dipped into the external auditory canal. Conclusions and relevance The middle temporal artery runs closest to the external auditory canal at the anterosuperior border. To preserve the middle temporal artery for use in reconstruction after otologic surgery, the surgeon should avoid dissection superior to the external auditory canal until the artery is positively identified.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.10.008
       
  • Outcome of spray cryotherapy plus functional endoscopic sinus surgery on
           management of healing in nasal polyposis
    • Authors: Ahmad Rezaeian
      Pages: 10 - 13
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Ahmad Rezaeian
      Background Nasal Polyposis is a benign tumor in nasal or paranasal mucosa, which confronts difficulties in management of healing after treatments with surgery. The aim of this study was to evaluate the effects of Spray Cryotherapy (SCT) on management of healing in patients with nasal polyposis who undergone functional endoscopic sinus surgery. Methods In this prospective, clinical trial study, we investigated on 40 patients with nasal polyposis that had indication for functional endoscopic sinus surgery. Patients were divided randomly into two parallel group; cryotherapy (with SCT) and placebo (without SCT). Evaluation of healing after surgery was evaluated with Lund-Mackay and The Sino-nasal outcome test (SNOT-22)-22 scores. Result Postoperatively, Lund-Mackay and SNOT-22 scores were significantly decreased in both groups, however these scores were significantly lower in cryotherapy group in comparison with placebo group. Also there were no reported serious side effects in both groups. Conclusion In this paper, we concluded that usage of SCT is an effective and safe method on management of healing and develops recovery rates in patients with nasal polyposis undergoing functional endoscopic sinus surgery.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.10.007
       
  • Endoscopic versus microscopic approach in attic cholesteatoma surgery
    • Authors: Giuseppe Magliulo; Giannicola Iannella
      Pages: 25 - 30
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Giuseppe Magliulo, Giannicola Iannella
      Purpose Compare the outcomes of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in a group of patients affected by attic cholesteatoma. Materials and methods Eighty patients suffered from attic cholesteatoma. Forty patients surgical treated with endoscopic ear surgery and forty patients surgical treated with microscopic ear surgery. Results No statistical differences were found in the parameters analysed (frequency of facial nerve dehiscence, age, disease duration, site of dehiscence) between the endoscopic and microscopic groups indicating a homogeneous selection thus providing a good comparison of the outcomes between the two groups. None of the patients in our survey developed postoperative iatrogenic facial palsy. Graft success rate was 100% in both groups. The overall operation time of endoscopic ear surgery presented a mean value of 87.8min, while in the group of patients treated via microscopic ear surgery a lower mean value of 69.9min was reported. The average healing time was 36.3days for the endoscopic subgroup and 47.8days for the microscopic subgroup. Conclusion The surgical outcomes of endoscopic ear surgery are comparable to those of the conventional approach in terms postoperative air-conduction, graft success rate and taste sensation. The analysis of postoperative pain and healing times showed better results for EES. The mean operative times of endoscopic ear surgery gradually shortened as the surgeons gained expertise in performing one-hand surgery.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.10.003
       
  • Reduction of bone mineral density in native Chinese female idiopathic
           benign paroxysmal positional vertigo patients
    • Authors: Yunqin Wu; Chengyao Gu; Weiwei Han; Xiaoxiong Lu; Caijing Chen; Zhenyi Fan
      Pages: 31 - 33
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Yunqin Wu, Chengyao Gu, Weiwei Han, Xiaoxiong Lu, Caijing Chen, Zhenyi Fan
      Objective This study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD). Methods BMD was measured in 78 native Chinese female de novo idiopathic BPPV patients and 126 healthy controls using dual-energy X-ray absorptiometry. We compared the mean T-scores and abnormal BMD prevalence between the two groups. Results The mean T-scores were significantly lower in idiopathic BPPV patients than in healthy controls. The prevalence of osteopenia and osteoporosis were significantly higher in idiopathic BPPV patients than in healthy controls (65.4% vs 48.4%, p =0.013). Conclusion BMD reduction may be associated with idiopathic BPPV occurrence.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.09.004
       
  • Extra-ocular movement restriction and diplopia following orbital fracture
           repair
    • Authors: H.A. Shah; Taha Shipchandler; Dominic Vernon; Maraya Baumanis; David Chan; William R. Nunery; Hui Bae Harold Lee
      Pages: 34 - 36
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): H.A. Shah, Taha Shipchandler, Dominic Vernon, Maraya Baumanis, David Chan, William R. Nunery, Hui Bae Harold Lee
      Purpose To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. Methods A chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. Results Ten patients were identified with a mean time to primary orbital fracture repair at 9days (range 1–48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. Conclusions Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.08.008
       
  • 3D-printed tracheoesophageal puncture and prosthesis placement simulator
    • Authors: Samuel R. Barber; Elliott D. Kozin; Matthew R. Naunheim; Rosh Sethi; Aaron K. Remenschneider; Daniel G. Deschler
      Pages: 37 - 40
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Samuel R. Barber, Elliott D. Kozin, Matthew R. Naunheim, Rosh Sethi, Aaron K. Remenschneider, Daniel G. Deschler
      Objectives A tracheoesophageal prosthesis (TEP) allows for speech after total laryngectomy. However, TEP placement is technically challenging, requiring a coordinated series of steps. Surgical simulators improve technical skills and reduce operative time. We hypothesize that a reusable 3-dimensional (3D)-printed TEP simulator will facilitate comprehension and rehearsal prior to actual procedures. Methods The simulator was designed using Fusion360 (Autodesk, San Rafael, CA). Components were 3D-printed in-house using an Ultimaker 2+ (Ultimaker, Netherlands). Squid simulated the common tracheoesophageal wall. A Blom-Singer TEP (InHealth Technologies, Carpinteria, CA) replicated placement. Subjects watched an instructional video and completed pre- and post-simulation surveys. Results The simulator comprised 3D-printed parts: the esophageal lumen and superficial stoma. Squid was placed between components. Ten trainees participated. Significant differences existed between junior and senior residents with surveys regarding anatomy knowledge(p <0.05), technical details(p <0.01), and equipment setup(p <0.01). Subjects agreed that simulation felt accurate, and rehearsal raised confidence in future procedures. Conclusions A 3D-printed TEP simulator is feasible for surgical training. Simulation involving multiple steps may accelerate technical skills and improve education.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.08.001
       
  • Malignant external otitis: The shifting treatment paradigm
    • Authors: Daniel A. Carlton; Enrique E. Perez; Eric E. Smouha
      Pages: 41 - 45
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): Daniel A. Carlton, Enrique E. Perez, Eric E. Smouha
      Importance Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat. Objective Determine if there has been a shift in the microbiology and outcomes of MEO. Design A retrospective case series at a tertiary care institution. Setting Inpatient and outpatient tertiary care hospital. Participants 12 cases of recent MEO were reviewed. Main Outcomes and measures The primary outcome was progression of disease. Secondary outcomes were drug resistance and complications of MEO. Results Only 4 patients were cured of MEO. Four patients expired during the study period and at least one of these deaths was a direct result of the MEO. 7 patients developed Cranial nerve palsies, and 3 patients developed abscesses. Conclusions Select cases of MEO now require multi-drug and long-term parenteral antibiotic therapy with extended hospital stays.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.05.010
       
  • The role of explorative tympanotomy in patients with sudden sensorineural
           hearing loss with and without perilymphatic fistula
    • Authors: N.K. Prenzler; B. Schwab; D.M. Kaplan; S. El-Saied
      Pages: 46 - 49
      Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1
      Author(s): N.K. Prenzler, B. Schwab, D.M. Kaplan, S. El-Saied
      Purpose The purpose of this study was to describe the role of explorative tympanotomy in patients with Profound Sudden Sensorineural Hearing Loss (SSNHL) without clinical evidence of perilymphatic or labyrinthine fistula and to compare intraoperative findings with the postoperative hearing outcome. Study design Retrospective study of all patients diagnosed with SSNHL who underwent explorative tympanotomy between 2002 and 2005. Settings Tertiary care university-affiliated hospital. Subjects and methods Eighty-two patients were diagnosed with unilateral profound SSNHL and underwent tympanotomy with sealing of the round and oval windows. Values of pure tone audiograms and percentage hearing loss of patients with and without intraoperative diagnosed perilymphatic fistula (PLF) were compared and analyzed. Results PLF was diagnosed in 28% cases intraoperatively. In most cases, hearing improved significantly after surgery. Interestingly, patients with PLF had a 2.4 times greater decrease of percentage hearing loss compared to patients without PLF. Conclusions Explorative tympanotomy seems to be useful in patients with profound SSNHL. Patients with PLF benefit more from the surgical procedure and have better outcome than patients without PLF.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.10.006
       
  • Guidelines for Contributing Authors
    • Abstract: Publication date: January–February 2018
      Source:American Journal of Otolaryngology, Volume 39, Issue 1


      PubDate: 2017-12-27T09:40:09Z
       
  • Safety and efficacy of intratympanic ciprofloxacin otic suspension
           post-tubes in a real-world pediatric population
    • Authors: Joseph E. Dohar; Debra Don; Jeffrey Koempel; Chung H. Lu; Dean Hakanson; Kenny H. Chan
      Abstract: Publication date: Available online 21 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Joseph E. Dohar, Debra Don, Jeffrey Koempel, Chung H. Lu, Dean Hakanson, Kenny H. Chan
      Purpose Otorrhea frequently follows tympanostomy tube (TT) placement. We evaluated otorrhea following single 6mg OTO-201 (OTIPRIO®, ciprofloxacin otic suspension 6%) intraoperative injection into each middle ear in a variety of effusion types and concurrent procedures in children undergoing TT placement. Secondary objective: Efficacy based on Medicaid status and safety. Basic procedures In this prospective, 8-week, multicenter, open-label study, 501 patients were enrolled: mean age 2.9years, male (56.9%), wet/wet ears (66.9%), wet/dry (16.8%), dry/dry (16.3%), and Medicaid-insured (32.9%). Main findings In per-protocol population (n=410), otorrhea rate through Day 15 were 8.8% (CI:5.7%–12.8%), 6.6% (CI:2.2%–14.7%), 3.3% (CI:0.4%–11.3%) in wet/wet, wet/dry, and dry/dry ears, respectively. For Medicaid patients through Day 15, Week 4 and Week 8, otorrhea rates were 8.1% (CI:4.1%–14.1%), 17.0% (CI:11.1%–24.5%), and 17.8% (CI:11.7%–25.3%) compared with those commercially-insured: 7.3% (CI:4.5%–11.0%), 14.5% (CI:10.6%–19.3%), and 21.8% (CI:17.1%–27.2%), respectively. Safety was similar to previous Phase 3 trials. Principal conclusions OTO-201 demonstrated otorrhea rates consistent with Phase 3 trials in a broader, real-world, ENT practice-based pediatric population. Outcomes were similar in Medicaid- and commercially-insured patients. OTO-201 was well-tolerated.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.016
       
  • Reconstruction of a skull base defect after endoscopic endonasal resection
           of a pituitary adenoma: Sphenoid mucosal flaps
    • Authors: Erden Goljo; Eliezer Kinberg; Katelyn Stepan; Jill K. Gregory; Alfred M. Iloreta; Satish Govindaraj; Hongyan Zou
      Abstract: Publication date: Available online 20 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Erden Goljo, Eliezer Kinberg, Katelyn Stepan, Jill K. Gregory, Alfred M. Iloreta, Satish Govindaraj, Hongyan Zou
      This report describes a bilateral sphenoid sinus mucosal flap for the repair of a sellar floor defect and CSF leak following endoscopic endonasal skull base surgery. The key advantage of this technique is enabling the sphenoid mucosal flaps to remain vascularized, which reduces postoperative complications including CSF leakage, recurrent sinusitis, meningitis, encephalitis and pneumocephalus. The use of this technique is a viable and possibly favorable alternative to free grafts in the reconstruction of small to medium sized sellar defects with low flow or absent CSF leaks base surgery.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.015
       
  • Pediatric Cochlear implant soft failure
    • Authors: David Ulanovski; Joseph Attias; Meirav Sokolov; Tali Greenstein; Eyal Raveh
      Abstract: Publication date: Available online 19 December 2017
      Source:American Journal of Otolaryngology
      Author(s): David Ulanovski, Joseph Attias, Meirav Sokolov, Tali Greenstein, Eyal Raveh
      Purpose Hard cochlear implant failures are diagnosed by objective tests whereas soft failures are suspected on the basis of clinical signs and symptoms. This study reviews our experience with children in tertiary pediatric medical center who underwent revision cochlear implantation, with emphasis on soft failures. Materials and methods Children (age<18years) who underwent revision cochlear implantation from 2000 to 2012 were identified by database search. Pre- and post-explantation data were collected. Results Twenty-six revision surgeries were performed, accounting for 7.4% of all cochlear implant surgeries at our center during the study period. The pre-explantation diagnosis was hard failure in 7 cases (27%), soft failure in 12 (46%), and medical failure in 7 (27%). On post-explantation analysis, 7/12 devices from the soft-failure group with a normal integrity test had abnormal findings, yielding a 63% false-negative rate (12/19) for the integrity test. All children regained their initial performance. Compared to hard failures, soft failures were associated with a shorter median time from first implantation to symptom onset (8 vs 25months) but a significantly longer time from symptom onset to revision surgery (17.5 vs 3months; P =0.004). Conclusions Soft cochlear implant failure in young patients poses a diagnostic challenge. A high index of suspicion is important because a delayed diagnosis may have severe consequences for language development. A normal integrity test does not unequivocally exclude device failure and is unrelated to functional outcome after revision surgery. Better education of parents and rehabilitation teams is needed in addition to more accurate diagnostic tests.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.014
       
  • Voice and swallowing outcomes following hypoglossal nerve stimulation for
           obstructive sleep apnea
    • Authors: Andrew J. Bowen; Amy S. Nowacki; Alan H. Kominsky; Douglas K. Trask; Michael S. Benninger; Paul C. Bryson
      Abstract: Publication date: Available online 15 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Andrew J. Bowen, Amy S. Nowacki, Alan H. Kominsky, Douglas K. Trask, Michael S. Benninger, Paul C. Bryson
      Objective Hypoglossal nerve stimulation is an effective treatment for a subset of patients with Obstructive Sleep Apnea (OSA). Although multiple clinical trials demonstrate its efficacy, no previous literature explores the potential impact the stimulator has on swallowing and voice. Our primary objective is to evaluate patient reported post-operative changes in voice or swallowing following hypoglossal nerve stimulator placement. Study design Prospective cohort study. Setting Tertiary care hospital. Subject and methods Patients scheduled to receive a hypoglossal stimulator were enrolled. Participants completed baseline Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10) questionnaires preoperatively and again at 1week, 3months, and 6months post-operatively following placement of a hypoglossal nerve stimulator. Results 9 males and 5 females completed the study. The mean pre-operative VHI-10 and EAT-10 score was 3 and 0.8 respectively. Using linear mixed models, a clinically and statistically significant increase in the mean EAT-10 score was observed post-operatively at 1week (p =0.007), which was not observed at the time points the stimulator was active. A clinically and statistically significant decrease in VHI-10 score was observed following 2months of active stimulator use (p =0.02), which was not observed at any other time point. Conclusion The implantation and use of the hypoglossal nerve stimulator over 5months did not demonstrate any sustained, patient reported changes in voice handicap and swallowing function. While larger studies are warranted, our findings can be used to provide further informed consent for hypoglossal nerve stimulator implantation.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.011
       
  • A novel method to measure the external auditory canal: Normative data and
           practical implications
    • Authors: Jason Barnes; Roy T. Sabo; Daniel H. Coelho
      Abstract: Publication date: Available online 14 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Jason Barnes, Roy T. Sabo, Daniel H. Coelho
      Purpose To accurately measure external auditory canal (EAC) dimensions by high resolution computed tomography (CT), and compare results with a traditional method of EAC measurement. Methods Using an advanced multidimensional open source digital imaging and communications in medicine (DICOM) analysis program (OsiriX, Pixmeo, Geneva, Switzerland) 91 adult EACs were analyzed on a previously obtained temporal bone CT scan. Tympanometric data were also recorded for each ear. The methods were compared using a linear mixed effect model. Results EAC volume was compared between tympanometrically calculated volumes and CT measured volumes. It was found that CT measured volumes are, on average, smaller (1.12cm3, SE=0.04) than tympanometry volumes (1.27cm3, SE=0.04cm3). There was a significant difference in CT measured volume between genders (p =0.0125), with males having larger measured volumes (1.23cm3, SD=0.28cm3) than females (1.06cm3, SD=0.20cm3). There was a significant difference in average circumference between ear laterality (p =0.0071), with the right ear having a slightly larger average circumference (2.49cm, SD=0.23cm) than the left ear (2.44cm, SD=0.50cm).There was also a significant difference in minimum circumference between age groups (p =0.0448), with patients younger than 60years having larger minimum circumferences (1.89cm, SD=0.21cm) than older patients (1.78cm, SD=0.25cm). Conclusions This study demonstrates that CT analysis can provide more information about EAC dimensions than traditional techniques. Moreover, slight but statistically significant differences are associated with age, gender and laterality. Accurate estimation of EAC dimensions is important for the development of hearing aids and personal protective equipment and can also be helpful for surgical planning, specifically otoendoscopy. Future research will focus on simplifying computation, developing cross-cultural cohort comparisons, and application to otoendoscopic procedures.

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.006
       
  • MRI screening of the internal auditory canal: Is gadolinium necessary to
           detect intralabyrinthine schwannomas'
    • Authors: Johnathan C. Valesano; Carrie M. Carr; Laurence J. Eckel; Matthew L. Carlson; John I. Lane
      Abstract: Publication date: Available online 13 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Johnathan C. Valesano, Carrie M. Carr, Laurence J. Eckel, Matthew L. Carlson, John I. Lane
      Objective Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors. Methods 31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the “gold standard.” A consensus review of cases with discordant results was conducted. Results The sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4mm (±2.9mm) and most (18/31) were intracochlear in location. Conclusion Non-contrast high-resolution T2WI alone can detect ILSs with 84–100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL. Level of evidence 4

      PubDate: 2017-12-27T09:40:09Z
      DOI: 10.1016/j.amjoto.2017.12.009
       
  • Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge
           about its management
    • Authors: Giuditta Mannelli; Roberto Santoro; Francesco Segala; Elisabetta Surrenti; Oreste Gallo
      Abstract: Publication date: Available online 11 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Giuditta Mannelli, Roberto Santoro, Francesco Segala, Elisabetta Surrenti, Oreste Gallo
      Purpose Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. Materials and methods Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. Results 40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). Conclusions Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.

      PubDate: 2017-12-13T05:44:40Z
      DOI: 10.1016/j.amjoto.2017.12.010
       
  • A novel technique for superior-based pharyngeal flaps: 10-year results
           with formal speech outcomes assessment
    • Authors: Ryan Winters; John Carter; J. Lindhe Guarisco
      Abstract: Publication date: Available online 11 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Ryan Winters, John Carter, J. Lindhe Guarisco
      Purpose Describe a novel technique for superior-based pharyngeal flaps allowing restoration of bulk to the soft palate and intraoperative fine-tuning of lateral port size, while avoiding midline palate-splitting. Validated speech assessment tools are employed for quantitative analysis. Methods Retrospective review of all patients who underwent superior-based pharyngeal flap in a 10-year period by a single surgeon. Pittsburgh Weighted Values for Speech Symptoms Associated with VPI and the Goldman-Fristoe Test of Articulation were used for formal speech assessment. Results 78 patients met inclusion criteria with clinical data up to 10years postoperatively. 31 patients had congenital velopharyngeal insufficiency (VPI), and the remainder acquired VPI after cleft palate repair or adenoidectomy. 37 patients had a recognized syndrome. All patients noted subjective improvement in nasality, and evaluation with the validated speech assessment tools demonstrated statistically significant improvement in speech. Only one flap takedown was required in a patient with severe midface hypoplasia who developed sleep apnea several years postoperatively. Conclusions This technique is successful in congenital and acquired VPI, and in patients with complex craniofacial syndromes. Customization of lateral ports based on preoperative nasopharyngoscopy, and avoidance of a midline palate splitting incision, make this an attractive option for superior-based flap surgery.

      PubDate: 2017-12-13T05:44:40Z
      DOI: 10.1016/j.amjoto.2017.12.007
       
  • Is an endoscopic or a microscopic approach optimal for management of attic
           cholesteatoma'
    • Authors: Zhengcai-Lou; Zihan-Lou; Zhenqi-Gong
      Abstract: Publication date: Available online 8 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Zhengcai-LouZihan-LouZhenqi-Gong


      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.12.004
       
  • In response to Letter to the Editor entitled ‘Is an endoscopic or a
           microscopic approach optimal for management of attic cholesteatoma'’
           
    • Authors: Giuseppe Magliulo; Giannicola Iannella
      Abstract: Publication date: Available online 8 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Giuseppe Magliulo, Giannicola Iannella


      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.12.005
       
  • Comparison of transcanal endoscopic tympanoplasty with sterile acellular
           dermal allograft to conventional endaural microscopic tympanoplasty with
           tragal perichondrium
    • Authors: Jia Min; Se-Hyung Kim
      Abstract: Publication date: Available online 7 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Jia Min, Se-Hyung Kim
      Objectives This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium. Methods This was a retrospective comparative study of 53 patients (25 males and 28 females) with tympanic membrane perforation who underwent type I tympanoplasty in the department of otorhinolaryngology at a tertiary medical center from March 2011 to April 2017. The subjects were classified into two groups; transcanal endoscopic tympanoplasty with ADA (TET, n=26), conventional endaural microscopic tympanoplasty with autologous tragal perichondrium (EMT, n=27). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3months postoperatively, operation time, sequential postoperative pain scale, and postoperative graft failure rate were evaluated. Results The perforation size of the tympanic membrane in TET and EMT group was 22.3±10.9% and 23.5±9.7%, respectively (P =0.143). Mean operation time of EMT (92.3±16.5min) was longer than that of the TET (65.3±20.5min) with a statistical significance (P =0.004). Graft success rate in the TET and EMT group were 92.3% and 96.3%, respectively; the values were not significantly different (P =0.610). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Pain in the immediate postoperative and day 1 after surgery were significantly less in the TET group. Conclusion With human cadaveric ADA, minimal invasive endoscopic tympanoplasty can be achieved with similar postoperative results and less pain.

      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.11.014
       
  • Reliability of temporal bone high-resolution CT in patients with facial
           paralysis in temporal bone fracture
    • Authors: Yaofeng Chen; Kai Zhang; Yanfeng Xu; Yanxu Che; Linna Guan; Yefeng Li
      Abstract: Publication date: Available online 5 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Yaofeng Chen, Kai Zhang, Yanfeng Xu, Yanxu Che, Linna Guan, Yefeng Li
      Objective This study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis. Methods HRCT with cross-sectional scanning and multi-planar reformation (MPR) was performed on 26 cases with traumatic facial paralysis, and the preoperative imaging manifestations were compared with surgical findings. Results Preoperative HRCT revealed fallopian canal damage at the posterior genu in 1 case, geniculate ganglion in 22 cases, labyrinthine segment in 4 cases, tympanic segment in 13 cases and mastoid segment in 0 case, while surgical findings confirmed fallopian canal damage at the posterior genu in 7 cases, geniculate ganglion in 23 cases, labyrinthine segment in 4 cases, tympanic segment in 17 cases and mastoid segment in 7 cases. The accuracy of temporal bone HRCT in revealing damage at those segments of fallopian canal was 14.3%, 95.7%, 100%, 76.5, and 0%, respectively. Conclusion Temporal bone HRCT can generally estimate the extent of damage and provide important information for traumatic facial paralysis before surgery. However, it is unreliable in revealing the damage of fallopian canal at the posterior genu and mastoid segment.

      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.12.003
       
  • Intestinal permeability and Ménière's disease
    • Authors: F. Di Berardino; E. Ciusani; C. Caccia; V. Leoni; U. De Grazia; E. Filipponi; D. Zanetti; L. Elli
      Abstract: Publication date: Available online 5 December 2017
      Source:American Journal of Otolaryngology
      Author(s): F. Di Berardino, E. Ciusani, C. Caccia, V. Leoni, U. De Grazia, E. Filipponi, D. Zanetti, L. Elli
      Purpose Ménière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage. Materials and methods Twenty-six with definite unilateral MD were studied: 14 patients were symptomatic for at least 3months with moderate to severe vertigo spells and a functional level ≥4; 12 patients had been asymptomatic (no vertigo spells) for at least 3months and had a functional level=1 at the time of testing. Twenty healthy volunteers were recruited as “control group”. Results Lactulose and mannitol absorption was significantly increased in the symptomatic M patients compared to the asymptomatic group (p<0.02 and p<0.004, respectively) and to the controls. FC were also higher than normal only in the symptomatic group. (p<0.01). Conclusions An altered intestinal permeability, according to the two assays, was found only in symptomatic MD patients. The rationale for a possible relationship between MD and intestinal permeability is forwarded. The double-sugar test and FC quantification might be implemented in the MD diagnostic workup.

      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.12.002
       
  • Commentary to letter to the editor to manuscript “Effects of surgical
           treatment of hypertrophic turbinates on the nasal obstruction and the
           quality of life”
    • Authors: Katharina Stölzel
      Abstract: Publication date: Available online 2 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Katharina Stölzel


      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.11.010
       
  • Mycology of chronic suppurative otitis media-cholesteatoma disease: An
           evaluative study
    • Authors: Gautam Bir Singh; Medozhanuo Solo; Ravinder Kaur; Rubeena Arora; Sunil Kumar
      Abstract: Publication date: Available online 2 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Gautam Bir Singh, Medozhanuo Solo, Ravinder Kaur, Rubeena Arora, Sunil Kumar
      Aims & objectives To detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance. Study design Prospective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital. Materials & methods Forty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed. Results Out of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established. Conclusions There is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.

      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.12.001
       
  • Retrograde parotidectomy and facial nerve outcomes: A case series of 44
           patients (Letter to Editor)
    • Authors: Tam-Lin Chow
      Abstract: Publication date: Available online 1 December 2017
      Source:American Journal of Otolaryngology
      Author(s): Tam-Lin Chow


      PubDate: 2017-12-10T04:29:23Z
      DOI: 10.1016/j.amjoto.2017.11.013
       
  • Image analysis of interarytenoid area to detect cases of Laryngopharyngeal
           Reflux: An objective method
    • Authors: Anindya Nayak; Sunil Kumar; Rubeena Arora; Gautam Bir Singh
      Abstract: Publication date: Available online 28 November 2017
      Source:American Journal of Otolaryngology
      Author(s): Anindya Nayak, Sunil Kumar, Rubeena Arora, Gautam Bir Singh
      Purpose To diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy. Materials and methods Endoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS. Results RGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values. Conclusion Image analysis is an easy, economical and objective method to diagnose LPR.

      PubDate: 2017-11-29T03:08:38Z
      DOI: 10.1016/j.amjoto.2017.11.012
       
  • Adenoidectomy and chronic nasal obstruction developing after failure of
           nasal steroid therapy
    • Authors: Zhengcai Lou
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Otolaryngology
      Author(s): Zhengcai Lou


      PubDate: 2017-11-10T16:24:54Z
      DOI: 10.1016/j.amjoto.2017.11.002
       
  • It is vital to identify the underlying cause of chronic laryngopharyngeal
           neuropathy
    • Authors: Zhengcai Lou
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Otolaryngology
      Author(s): Zhengcai Lou


      PubDate: 2017-11-10T16:24:54Z
      DOI: 10.1016/j.amjoto.2017.11.001
       
  • Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program
           with comparison to medications
    • Authors: Jin Yang; Salem Dehom; Stephanie Sanders; Thomas Murry; Priya Krishna; Brianna K. Crawley
      Abstract: Publication date: Available online 31 October 2017
      Source:American Journal of Otolaryngology
      Author(s): Jin Yang, Salem Dehom, Stephanie Sanders, Thomas Murry, Priya Krishna, Brianna K. Crawley
      Objective To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone. Study design Retrospective study. Setting Tertiary care academic center. Subjects and methods A database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifications). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough severity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification. Results Of 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change. Conclusion The anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone.

      PubDate: 2017-11-04T15:51:04Z
      DOI: 10.1016/j.amjoto.2017.10.014
       
  • Effects of intratympanic dexamethasone on noise-induced hearing loss: An
           experimental study
    • Authors: Sait Serdar Gumrukcu; İlhan Topaloglu; Ziya Salturk; Belgin Tutar; Yavuz Atar; Güler Berkiten; Ayşe Enise Göker
      Abstract: Publication date: Available online 27 October 2017
      Source:American Journal of Otolaryngology
      Author(s): Sait Serdar Gumrukcu, İlhan Topaloglu, Ziya Salturk, Belgin Tutar, Yavuz Atar, Güler Berkiten, Ayşe Enise Göker
      Aim Aim of the study was to evaluate the effect of intratympanic steroid treatment on hearing based on oto-acoustic emission. Methods A total of 16 healthy female Wistar albino rats weighing were used in this study. They were divided in to 2 groups and each group was exposed to noise at 110dB for 25min to induce acoustic trauma. Intratympanic dexamethasone was administered to the middle ears of animals in the experimental group on the same day as exposure to noise. The control group was given 0.09% saline solution. Distortion product otoacoustic emission measurements were performed on days 7 and 10. Results There were no differences between the emission results of two groups before treatment at 4004, 4761, 5652, 6726, and 7996Hz. There were significant group differences on measurement days 7 and 10 at all frequencies. Conclusion Our study revealed a significant difference in DPOAE measurements on days 7 and 10 between the experimental and control groups. We detected a positive effect of dexamethasone on noise-induced hearing loss.

      PubDate: 2017-10-27T14:30:58Z
      DOI: 10.1016/j.amjoto.2017.10.011
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.227.48.147
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-