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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 332, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (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   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, 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: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 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: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, 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: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
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: 35, 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: 5)
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: 9)
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: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, 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: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 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: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, 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: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 309, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, 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)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, 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: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, 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: 11)
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: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Otolaryngology
  [SJR: 0.59]   [H-I: 45]   [23 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-0709
   Published by Elsevier Homepage  [3043 journals]
  • Management of recurrent tonsillitis in children
    • Authors: Diaa El Din El Hennawi; Ahmed Geneid; Salah Zaher; Mohamed Rifaat Ahmed
      Pages: 371 - 374
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Diaa El Din El Hennawi, Ahmed Geneid, Salah Zaher, Mohamed Rifaat Ahmed
      Objective To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. Methods The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. Results Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. Conclusion AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.001
       
  • From transmandibular to transoral robotic approach for parapharyngeal
           space tumors
    • Authors: Francesco Chu; Marta Tagliabue; Gioacchino Giugliano; Luca Calabrese; Lorenzo Preda; Mohssen Ansarin
      Pages: 375 - 379
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Francesco Chu, Marta Tagliabue, Gioacchino Giugliano, Luca Calabrese, Lorenzo Preda, Mohssen Ansarin
      Purpose Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics. Materials and methods Critical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes. Results Between January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes. Conclusions PPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.004
       
  • Treatment of locally advanced parotid malignancies with parotidectomy and
           temporal bone resection
    • Authors: James R. Martin; Peter Filip; Eric J. Thorpe; John P. Leonetti
      Pages: 380 - 382
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): James R. Martin, Peter Filip, Eric J. Thorpe, John P. Leonetti
      Purpose In this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies. Methods Patients undergoing lateral temporal bone resection and parotidectomy from 2007–2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively. Results Fifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series. Conclusion Local and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.005
       
  • Xylitol nasal irrigation in the treatment of chronic rhinosinusitis
    • Authors: Lin Lin; Xinyue Tang; Jinjin Wei; Fei Dai; Guangbin Sun
      Pages: 383 - 389
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Lin Lin, Xinyue Tang, Jinjin Wei, Fei Dai, Guangbin Sun
      Objective To evaluate the efficacy of xylitol nasal irrigation (XNI) treatment on chronic rhinosinusitis (CRS) and to investigate the effect of XNI on nasal nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA in maxillary sinus. Materials and methods Patients with CRS were enrolled and symptoms were assessed by Visual Analog Scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22). Nasal NO and iNOS mRNA in the right maxillary sinus were also examined. Then, they were treated with XNI (XNI group) or saline nasal irrigation (SNI, SNI group) for 30days, after which their symptoms were reassessed using VAS and SNOT-22, and nasal NO and iNOS mRNA in the right maxillary sinus were also reexamined. Results Twenty-five out of 30 patients completed this study. The scores of VAS and SNOT-22 were all reduced significantly after XNI treatment, but not after SNI. The concentrations of nasal NO and iNOS mRNA in the right maxillary sinus were increased significantly in XNI group. However, significant changes were not found after SNI treatment. Furthermore, there were statistical differences in the assessments of VAS and SNOT-22 and the contents of nasal NO and iNOS mRNA in the right maxillary sinus between two groups. Conclusions XNI results in greater improvement of symptoms of CRS and greater enhancement of nasal NO and iNOS mRNA in maxillary sinus as compared to SNI.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.006
       
  • Hydroxyapatite bone cement for suboccipital retrosigmoid cranioplasty: A
           single institution case series
    • Authors: Alexander L. Luryi; Ketan R. Bulsara; Elias M. Michaelides
      Pages: 390 - 393
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Alexander L. Luryi, Ketan R. Bulsara, Elias M. Michaelides
      Objective To report rates of cerebrospinal fluid leak, wound infection, and other complications after repair of retrosigmoid craniotomy with hydroxyapatite bone cement. Methods Retrospective case review at tertiary referral center of patients who underwent retrosigmoid craniotomy from 2013 to 2016 with hydroxyapatite cement cranioplasty. Outcome measures Presence of absence of cerebrospinal fluid leak, wound infection, and other complications. Results Twenty cases of retrosigmoid craniotomy repaired with hydroxyapatite cement were identified. Median length of follow up was 9.8months. No cases of cerebrospinal fluid leak were identified. One patient developed a wound infection which was thought to be related to a chronic inflammatory response to the implanted dural substitute. No other major complications were noted. Conclusions A method and case series of suboccipital retrosigmoid cranioplasty using hydroxyapatite cement and a are reported. Hydroxyapatite cement cranioplasty is a safe and effective technique for repair of retrosigmoid craniotomy defects.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.007
       
  • Parotid adenoid cystic carcinoma: Retrospective single institute analysis
    • Authors: Giuditta Mannelli; Lorenzo Cecconi; Martina Fasolati; Roberto Santoro; Alessandro Franchi; Oreste Gallo
      Pages: 394 - 400
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Giuditta Mannelli, Lorenzo Cecconi, Martina Fasolati, Roberto Santoro, Alessandro Franchi, Oreste Gallo
      Purpose Adenoid cystic carcinoma (ACC) is a uncommon salivary malignant tumor. Our aim was to review our experience with parotid ACC, to identify clinical-pathological parameters predictive for outcome. Materials and methods We retrospectively reviewed 228 patients affected by parotid gland carcinomas surgically treated at our Institution. Forty-four ACC were included in this study. Multivariate analysis risk models were built to predict recurrence free probability (RFP), distant recurrence free probability (DRFP), overall survival (OS) and disease free survival (DFS). Results Twenty-one patients (47.7%) died from ACC and 2.3% for other causes. The 41% presented local-regional recurrence, with a regional-RFP rate of 93%, and the 34% reported distant metastases (DM). The five and ten-year OS rates were 74% and 50%, respectively. Conclusions Recurrences were mainly influenced by the presence of perineural invasion and nerve paralysis, whilst female gender and age<50 were predictors for good prognosis.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.008
       
  • Dizziness, malpractice, and the otolaryngologist
    • Authors: Anthony M. Tolisano; Sungjin A. Song; Douglas S. Ruhl; Philip D. Littlefield
      Pages: 401 - 404
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Anthony M. Tolisano, Sungjin A. Song, Douglas S. Ruhl, Philip D. Littlefield
      Purpose To assess malpractice claims related to the management of dizziness in otolaryngology in order to improve care and minimize the risk of litigation. Materials and methods This is a retrospective review of the LexisNexis “Jury Verdicts and Settlements” database. All lawsuits and out of court adjudications related to the management of dizziness by otolaryngologists were collected. Data including patient demographics, plaintiff allegation, procedure performed, and indemnities were analyzed. Results Of 21 cases meeting inclusion criteria, 17 were decided by a trial jury and four were resolved out of court. Jury verdicts favored the plaintiff 53% of the time and a payout was made in 57% of cases overall. Average payments were higher for jury verdicts in favor of the plaintiff ($1.8 million) as compared to out of court settlements ($545,000). Two-thirds of cases involved surgery, most commonly stapes surgery. Legal allegations, including physical injury, negligence, and lack of informed consent failed to predict the legal outcome. Conclusions Appropriate examination, testing, and referrals within a timely manner are crucial in the management of dizzy patients to avoid misdiagnoses. It is imperative that patients undergoing ear surgery are appropriately counseled that dizziness is a potential complication. The analysis of malpractice literature is complementary to clinical studies, with the potential to educate practitioners, improve patient care, and mitigate risk.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.009
       
  • Open vs. endoscopic cricopharyngeal myotomy; Is there a difference'
    • Authors: Colin Huntley; Maurits Boon; Joseph Spiegel
      Pages: 405 - 407
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Colin Huntley, Maurits Boon, Joseph Spiegel
      Introduction The upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM). Methods A retrospective review of all patients undergoing endoscopic and open CPM was undertaken. We recorded demographic, clinical, operative, hospital, and postoperative data for both groups from January 2010–March 2015. The endoscopic and open CPM groups were directly compared. Results Our cohort consisted of 38 open and 41 endoscopic CPM patients. There were 22 males and 16 females in the open group and 9 males and 32 females in the endoscopic group. The primary diagnosis for both groups was cricopharyngeal hyperfunction. We found a significant improvement in surgical time and symptomatic outcomes in the endoscopic group (p=0.008 and p=0.010). There was no difference in UES preop pressure, hospital stay, complication rate, time to oral intake, or length of follow-up between cohorts. Conclusion Endoscopic CPM is a safe and effective alternative to the open approach. Patients undergoing endoscopic CPM have shorter operative times and improved outcomes when compared to the open approach.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.010
       
  • The vagal nerve stimulation outcome, and laryngeal effect:
           Otolaryngologists roles and perspective
    • Authors: Ahmad I. Al Omari; Firas Q. Alzoubi; Mohammad M. Alsalem; Samah K. Aburahma; Diala T. Mardini; Paul F. Castellanos
      Pages: 408 - 413
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Ahmad I. Al Omari, Firas Q. Alzoubi, Mohammad M. Alsalem, Samah K. Aburahma, Diala T. Mardini, Paul F. Castellanos
      Introduction Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12years. VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively. Objectives This study is to review the outcomes of vagal nerve stimulator (VNS) implantation in terms of the surgical procedures, complications, seizure frequency, and the clinical effect on larynx and vocal folds motion. Methods Series of thirty consecutive patients who had VNS implantation between 2007 and 2014 were recruited. Seizure-frequency outcome, surgical complications and device adverse effects of VNS were retrospectively reviewed. Additional evaluation included use of the Voice Handicap Index and Maximum Phonation Time (MPT) were conducted before and after the implantation. Videolaryngoscopy was used to evaluate the vocal fold mobility before and after the VNS implantation. Results Seizure frequency reduction over a minimum of 2years of follow up demonstrated: 100% in seizure frequency reduction in 1 patient, drastic reduction in seizure frequency (70–90%) in 9 patients, a good reduction in terms of seizure frequency (50%) in 8 patients, a 30% reduction in 5 patients, no response in 6 patients, and 1 patient had increased frequency. The most commonly reported adverse effects after VNS activation were coughing and voice changes with pitch breaks, as well as mild intermittent shortness of breath in 33% of patients. For those patients secondary supraglottic muscle tension and hyper function with reduced left vocal fold mobility were noticed on videolaryngoscopy, though none had aspiration problems. Surgical complications included a wound dehiscence in one patient (3%) which was surgically managed, minor intra-operative bleeding 3%; a superficial wound infection in one patient (3%) which was treated conservatively, none of the complications necessitated VNS removal. Conclusions VNS appears to be an effective non-pharmacologic adjuvant therapy in patients with medically refractory seizures. With the favorable adverse-effect profile previously described, VNS is generally well tolerated and of a great benefit to such patients. Laryngeal side effects, of which hoarseness being of the greatest repetition, are the most common after the VNS implantation. VNS can affect the voice and reduced vocal cord motion on the implantation side with secondary supraglottic muscle tension. Otolaryngologists are not only capable of performing VNS implantation, but can also manage surgical complications, assess laryngeal side effects and treat them as needed.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.011
       
  • Eustachian tube diameter: Is it associated with chronic otitis media
           development'
    • Authors: Ceki Paltura; Tuba Selçuk Can; Behice Kaniye Yilmaz; Mehmet Emre Dinç; Ömer Necati Develioğlu; Mehmet Külekçi
      Pages: 414 - 416
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Ceki Paltura, Tuba Selçuk Can, Behice Kaniye Yilmaz, Mehmet Emre Dinç, Ömer Necati Develioğlu, Mehmet Külekçi
      Objective To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis. Study design Retrospective. Subjects and methods Patients with unilateral COM disease are included in the study. The connection between fibrocartilaginous and osseous segments of the Eustachian Tube (ET) on axial Computed Tomography (CT) images was defined and the diameter of this segment is measured. The measurements were carried out bilaterally and statistically compared. Results 154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947mm (Std. deviation±0.5247) for healthy ears and 1788mm (Std. deviation±0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p <0.01). Conclusion The dysfunction or anatomical anomalies of ET are correlated with COM. Measuring of the bony diameter of ET during routine Temporal CT examination is recommended for our colleagues.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.012
       
  • Post-operative MRSA infections in head and neck surgery
    • Authors: Sharon Lin; Sami Melki; Michelle V. Lisgaris; Emily N. Ahadizadeh; Chad A. Zender
      Pages: 417 - 421
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Sharon Lin, Sami Melki, Michelle V. Lisgaris, Emily N. Ahadizadeh, Chad A. Zender
      Purpose Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution. Materials and methods This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed. Results We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06–6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133–52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750–7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031). Conclusions Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.013
       
  • Morphological characteristics of external auditory canal in congenital
           aural stenosis patients
    • Authors: Dongming Yin; Chenlong Li; Keguang Chen; Juan Hong; Jieying Li; Lin Yang; Tianyu Zhang; Peidong Dai
      Pages: 422 - 427
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Dongming Yin, Chenlong Li, Keguang Chen, Juan Hong, Jieying Li, Lin Yang, Tianyu Zhang, Peidong Dai
      Objective To investigate characteristics of congenital aural stenosis (CAS) patients' external auditory canal (EAC) (position, length, orientation, etc.) and compare them with normal EAC. Methods CT images of normal people and CAS patient were utilized. We obtained coordinates of EAC landmarks. Then the Matlab program could calculate some anatomic parameters about EAC, including distances from central point of tympanic annulus (CA), central point of osseous EAC opening (CO), central point of cartilaginous EAC inside opening (CCi), central point of cartilaginous EAC outside opening (CCo) to the Frankfurt horizontal plane (Pfrkt), the median sagittal plane (Psag), the coronal plane (Pcor); orientations of EAC bendings; straight and arc lengths of EAC. Results Distances from CA, CO, CCi and CCo to Pfrkt were all shorter in CAS group than control group (p <0.05). The straight and arc lengths of cartilaginous EAC in CAS group were shorter than control group (p <0.05). Straight and arc lengths of EAC in CAS group were shorter than those in control group (p <0.05). The proportion of one bending in cartilaginous EAC in control group was significantly lower than CAS group (p <0.05). Orientations of EAC bendings in CAS group differed from those in control group (p <0.05). Conclusion In addition to smaller diameters, compared with normal EAC, the position of CAS patients' osseous EAC was higher compared with the normal. The majority of CAS patients have a bending and downward slanting cartilaginous EAC. Orientations of EAC bending in CAS patients were different from normal. Besides, the length of CAS patients' cartilaginous EAC was shorter. However, there were no significant differences between CAS patients and normal people in length of osseous EAC. These differences in anatomic parameters could provide the basis for optimizing the meatoplasty.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.015
       
  • Magnetic resonance imaging predicts chronic dizziness after benign
           paroxysmal positional vertigo
    • Authors: Wang Woon Cha; Kudamo Song; In Kyu Yu; Myoung Su Choi; Dong Sik Chang; Chin-Saeng Cho; Ho Yun Lee
      Pages: 428 - 432
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Wang Woon Cha, Kudamo Song, In Kyu Yu, Myoung Su Choi, Dong Sik Chang, Chin-Saeng Cho, Ho Yun Lee
      Objectives We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). Methods A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. Results The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p >0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67–34.48; p =0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11–21.28; p =0.036) were positively associated with dizziness lasting longer than 3months. Conclusion Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.001
       
  • Perioperative cardiac complications in patients undergoing head and neck
           free flap reconstruction
    • Authors: Peter J. Ciolek; Kate Clancy; Michael A. Fritz; Eric D. Lamarre
      Pages: 433 - 437
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Peter J. Ciolek, Kate Clancy, Michael A. Fritz, Eric D. Lamarre
      Background Limited data exists on cardiac complications following head and neck free flaps. Design A retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015. Results 368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay. Conclusions There is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.017
       
  • Reduced post-tonsillectomy bleeding rates through a refined technique
    • Authors: Kent Burton; Stephanie Hanke; Anil Gungor
      Pages: 438 - 441
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Kent Burton, Stephanie Hanke, Anil Gungor


      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.01.037
       
  • Detection of endolymphatic hydrops using traditional MR imaging sequences
    • Authors: John H. Keller; Barry E. Hirsch; Ryan S. Marovich; Barton F. Branstetter
      Pages: 442 - 446
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): John H. Keller, Barry E. Hirsch, Ryan S. Marovich, Barton F. Branstetter
      Purpose The purpose of this study was to determine whether Meniere's disease (MD) produces endolymphatic cavity size changes that are detectable using unenhanced high-resolution T2-weighted MRI. Materials & methods This retrospective case-control study included patients with documented MD who had a high-resolution T2-weighted or steady-state free procession MRI of the temporal bones within one month of diagnosis, between 2002 and 2015. Patients were compared to age- and sex- matched controls. Cross sectional area, length, and width of the vestibule and utricle were measured in both ears along with the width of the basal turn of the cochlea and its endolymphatic space. Absolute measurements and ratios of endolymph to perilymph were compared between affected, contralateral, and control ears using analysis of variance and post-hoc pairwise comparisons. Results Eighty-five case-control pairs were enrolled. Mean utricle areas for affected, contralateral, and control ears were 0.038cm2, 0.037cm2, and 0.033cm2. Mean area ratios for affected, contralateral, and control ears were 0.32, 0.32, and 0.29. There was a statistically significant difference between groups for these two variables; post-hoc comparisons revealed no difference between affected and contralateral ears in Meniere's patients, while ears in control patients were different from the ears of patients with MD. All other measurements failed to show significant differences. Conclusions Enlargement of the endolymphatic cavity can be detected using non-contrast T2-weighted MRI. MRI, using existing protocols, can be a useful diagnostic tool for the evaluation of MD, and intratympanic or delayed intravenous contrast may be unnecessary for this diagnosis.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.01.038
       
  • Abrasion and blunt tissue trauma study of a novel flexible robotic system
           in the porcine model
    • Authors: Michael Z. Lerner; Michael Tricoli; Marshall Strome
      Pages: 447 - 451
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Michael Z. Lerner, Michael Tricoli, Marshall Strome
      Objectives The objective of this study was to determine if a flexible robotic system caused increased tissue reaction when accessing the oropharynx and hypopharynx compared to intubation controls in only 2 scenarios: high speed tissue impact and multiple unit insertions and retractions. The data obtained were submitted as part of the entirety of information submitted for FDA approval. Methods This study consisted of 5 groups of Yorkshire pigs (2 animals per group). On Day 0, all animals were intubated. For group 1 (control), a second endotracheal tube was advanced to just above the vocal cords. In abrasion groups 2 and 3, the flexible robotic system was advanced against the oropharyngeal and hypopharyngeal tissues, respectively. In blunt trauma groups 4 and 5, the flexible robotic system was advanced at maximum speed (22mm/s) to collide with oropharyngeal and hypopharyngeal tissues, respectively. Pre- and post-procedure endoscopic assessments of tissue reaction were performed daily for 4 days. An independent reviewer graded tissue reaction using a 0–3 point scale. Results Tissue reaction scores at each observation time point for all test groups were less than or equal to control scores except for one instance of moderate scoring (2 out of 3) on Day 2 for an animal in the blunt trauma group where reaction was likely intubation-related rather than device impact related. Otherwise, all flexible robotic system-treated animal scores were less than 1 by Day 4. Conclusions In this limited study, the flexrobotic system afforded surgical access to the oropharynx and hypopharynx without an increased level of abrasion or tissue trauma when compared to intubation alone.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.002
       
  • Correlation of frontal sinus recess anatomy with ethnicity, gender, and
           pathology
    • Authors: Laura K. House; Scott P. Stringer; Samantha Seals
      Pages: 452 - 455
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Laura K. House, Scott P. Stringer, Samantha Seals
      Purpose Research on frontal sinus cells has been conflicting regarding relationship between frontal sinus cells and frontal sinus disease. There are no published studies regarding gender differences in frontal sinus disease. No comparisons between African Americans and Caucasians and frontal sinus disease have been published. This study attempts to define the above relationships as well as the relationship between number and types of cells and disease. Methods A retrospective chart review was performed on sinus CT scans done from 2003 to 2011 at an academic medical center. Exclusion criteria included previous frontal sinus surgery, sinus malignancy, obvious trauma, congenital anomalies, and poor quality of scan. Number and type of frontal cells were recorded for 602 scans. Statistical analysis performed demographic comparisons and compared number and types of cells to evidence of disease. Results Males were more likely than females to have frontal sinus disease. Patients with Type 3 and Type 4 cells were more likely to have disease. No significant ethnic related differences in disease were found using a multivariate logistic regression model. Total number of cells did not significantly affect likelihood of disease. Conclusions This is one of the largest collections of data on frontal sinus cells as predictors of frontal sinus disease. These results suggest that gender and certain types of cells affect likelihood of disease. This study is the first to demonstrate a lack of difference in disease in African Americans and Caucasians. These results are significant regarding gender, race, number and type of cells as predictors of disease.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.003
       
  • Assessing cumulative acute toxicity of chemoradiotherapy in head and neck
           cancer with or without induction chemotherapy
    • Authors: Bhartesh A. Shah; Muhammad M. Qureshi; Jennifer M. Logue; Timothy P. Cooley; Ken S. Zaner; Scharukh Jalisi; Minh Tam Truong
      Pages: 456 - 461
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Bhartesh A. Shah, Muhammad M. Qureshi, Jennifer M. Logue, Timothy P. Cooley, Ken S. Zaner, Scharukh Jalisi, Minh Tam Truong
      Background To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT). Methods 77 patients underwent definitive CCRT (30 I/CCRT and 47 CCRT). Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. Using the TAME adverse event reporting system, short-term toxicity (T) scores were generated for IC (TIC), CCRT (TCCRT), total treatment duration (TRx), post-treatment period (TPT) and an overall score (Toverall) from treatment start to post treatment period. Results Acute toxicity other than dysphagia, odynophagia, or dermatitis was reported in 90.0% and 66.0% of I/CCRT and CCRT patients, respectively (P =0.02). Compared to CCRT group, I/CCRT patients reported greater mean TRx (TRx: 2.11 vs. 2.87, P =0.01) and Toverall (Toverall: 2.60 vs. 3.70, P =0.003). Conclusion I/CCRT patients reported more cumulative acute toxicity during treatment compared to CCRT patients using the TAME reporting system.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.004
       
  • Significance of intraoperative findings in revision tympanomastoidectomy
    • Authors: Andro Košec; Iva Kelava; Jakov Ajduk; Mihael Ries; Robert Trotić; Vladimir Bedeković
      Pages: 462 - 465
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Andro Košec, Iva Kelava, Jakov Ajduk, Mihael Ries, Robert Trotić, Vladimir Bedeković
      Purpose The study was designed to assess correlations between intraoperative findings in revision tympanomastoidectomy as predictors of cholesteatoma recurrence. Materials and methods A retrospective single-institution cohort of 101 patients who underwent surgical treatment for recurrent chronic otitis media in a tertiary referral otology centre. Results Out of 101 patients, 65 had canal wall up and 36 canal wall down revision surgery. There were 35 cholesteatoma recurrences. Sites most commonly associated with recurrent disease were residual facial ridge cells in 46 (45.5%), ossicular chain sites in 46 (45.5%) patients, posterior external auditory canal wall erosions in 38 (37.6%) patients and mastoid apex recurrence in 35 (34.7%) patients. Ossicular and posterior external auditory canal wall erosion and incomplete removal of mastoid apex cells correlate well with cholesteatoma recurrence accompanied by canal wall up surgery (p =0.009). Residual mastoid apex cells, posterior external auditory canal wall erosion and presence of residual facial ridge cells were identified as the strongest positive predictors of cholesteatoma recurrence, identifying high risk patients associated with canal wall down procedures (p =0.0036). Conclusions Correlations between intraoperative findings and cholesteatoma recurrence could improve preoperative and intraoperative planning and reduce the rates of postoperative failures1 due to mismanagement of high risk areas.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.006
       
  • Skull base osteomyelitis secondary to malignant otitis externa mimicking
           advanced nasopharyngeal cancer: MR imaging features at initial
           presentation
    • Authors: J.P.N. Goh; A. Karandikar; S.C. Loke; T.Y. Tan
      Pages: 466 - 471
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): J.P.N. Goh, A. Karandikar, S.C. Loke, T.Y. Tan
      Purpose Skull base osteomyelitis (SBOM) is an inflammatory process which often arises from malignant otitis externa (MOE); the diffuse skull base and adjacent soft tissue involvement may be mistaken at initial imaging for advanced nasopharyngeal carcinoma (NPC), especially if there is no prior knowledge of MOE, direct spread from the sphenoid sinus or in atypical presentations of MOE. This study aims to evaluate imaging features on MR that may differentiate SBOM from NPC. Materials and Methods The MR examinations of 26 patients diagnosed with SBOM between January 1996 and January 2013 were retrospectively reviewed. Comparison was also made with the MR images of 22 consecutive patients with newly diagnosed advanced T3 and T4 NPC between July 2011 and August 2012. Imaging features in both conditions were compared, including the presence of a nasopharyngeal bulge, nasopharyngeal mucosal irregularity, lateral extension, architectural distortion (or lack thereof), increased T2 signal and enhancement patterns. Results The most prevalent findings in SBOM were lateral extension, increased T2 signal in adjacent soft tissues, lack of architectural distortion and enhancement greater than or equal to mucosa. The combination of these 4 findings was found to best differentiate SBOM from advanced NPC, and found to be statistically significant (p <0.001). Conclusion We suggest that the combination of lateral extension, increased T2 signal, lack of architectural distortion and enhancement greater than or equal to mucosa is helpful in differentiating SBOM from advanced NPC.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.007
       
  • The effect of handedness and laterality in a microlaryngeal surgery
           simulator
    • Authors: Matthew R. Naunheim; Amanda Le; Matthew M. Dedmon; Ramon A. Franco; Jennifer Anderson; Phillip C. Song
      Pages: 472 - 474
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Matthew R. Naunheim, Amanda Le, Matthew M. Dedmon, Ramon A. Franco, Jennifer Anderson, Phillip C. Song
      Purpose There are no controlled prospective studies evaluating the effect of dominant handedness in left- and right-sided surgery in otolaryngology. Endoscopic microlaryngeal phonosurgery is an ideal procedure to assess technical aspects of handedness and laterality, due to anatomic symmetry. In this study, we analyzed (1) choice of surgical approach and (2) outcomes based on handedness and laterality in a microlaryngeal simulator. Methods Using a validated high-fidelity phonosurgery model, a prospective cohort of 19 expert laryngologists undertook endoscopic resection of a simulated vocal fold lesion. These resections were video-recorded and scored by 2 blinded expert laryngologists using a validated global rating scale, procedure-specific rating scale, and a hand preference analysis. Results There were 18 right-handed participants and 1 left-handed. 12 left and 7 right excisions were evaluated. Cronbach's alpha for inter-rater reliability was good (0.871, global scale; and 0.814, procedure-specific scale). Surgeons used their dominant hand 78.9% of the time for both incision and dissection. In cases where the non-dominant hand would have been preferred, surgeons used the non-dominant hand only 36.4% of the time for incision and dissection. Use of the non-dominant hand did not influence global or procedural rating (p =0.132 and p =0.459, respectively). Conclusions In this simulation of microlaryngeal surgery, there were measurable differences in surgical approaches based on hand dominance, with surgeons preferring to cut and perform resection with the dominant hand despite limitations in the instrumentation and exposure. Regardless of hand preference, overall outcomes based on global rating and technique specific rating scales were not significantly different.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.009
       
  • Angiosarcoma of the tongue: A case series and literature review
    • Authors: Pratik B. Patel; Edward C. Kuan; Kevin A. Peng; Frederick Yoo; Scott D. Nelson; Elliot Abemayor
      Pages: 475 - 478
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Pratik B. Patel, Edward C. Kuan, Kevin A. Peng, Frederick Yoo, Scott D. Nelson, Elliot Abemayor
      Purpose Angiosarcoma of the tongue is an exceedingly rare malignancy of the head and neck. Such lesions can be primary in nature or occur in a previously irradiated field. We examine a series of cases with relation to clinical presentation, diagnosis, management, and outcomes. Materials and methods Retrospective chart review of all patients with angiosarcoma of the tongue at a tertiary academic institution yielded a single case between 2005 and 2016. The MEDLINE database was additionally searched for all case series or reports of angiosarcoma arising in the tongue, and pertinent clinical data were extracted. Results The clinical presentation, disease course, and management of a patient with angiosarcoma of the tongue are presented. Institutional and literature search yielded a total of eight patients with angiosarcoma of the tongue. The most common primary sites were dorsal and lateral oral tongue. Treatment consisted of surgical resection in 63% of cases with adjuvant therapy administered in 75% of cases. Follow-up times varied per patient, but 63% had persistent or recurrent disease and 67% died of or with disease within two years of index presentation. Conclusion Angiosarcoma of the tongue is a rare and highly aggressive tumor, accounting for fewer than 1% of all head and neck malignancies. The mainstay of treatment is surgical resection with negative margins followed by adjuvant chemoradiation for high-risk features. Due to rarity of the disease, consensus on optimal treatment approach is lacking, and multi-center prospective studies would be helpful to set clinical guidelines.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.013
       
  • Assessment and spontaneous healing outcomes of traumatic eardrum
           perforation with bleeding
    • Authors: Zhong-hai Jin; Zi-Han Lou; Zheng-Cai Lou
      Pages: 479 - 483
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Zhong-hai Jin, Zi-Han Lou, Zheng-Cai Lou
      Objective This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs). Study design A case series with chart review. Setting A tertiary university hospital. Materials and methods The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test. Results One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0). Conclusion This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.014
       
  • Sir Charles Bell: Unheralded laryngologist
    • Authors: Elliot Abemayor
      Pages: 492 - 495
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Elliot Abemayor
      Introduction Sir Charles Bell is renowned and revered as an outstanding surgeon, anatomist, clinician and teacher and his many contributions to various medical fields have been amply described. What are less well-known are his contributions to the field of laryngology. Methods Selected clinical and physiological publications by Bell were examined that addressed issues related specifically to the airway or pharynx. These included both case reports and case series. Results Bell was keenly interested in the physiology of voice production, disorders of the airways and deglutition. Despite a busy clinical and teaching practice, he took careful notice of individual cases that highlighted important generalizations regarding care for upper aerodigestive tract disorders that are relevant today. He was also the first to recognize the anatomy and physiology of pharyngoesophageal diverticula that Zenker later made more famous. Conclusions In addition to his many contributions to neurology, facial nerve anatomy and physiology, Sir Charles Bell was also a keen Laryngologist before the era of subspecialization. Rediscovery and study of his work should make us more appreciative of past clinician-investigators who cast a wide net to advance knowledge rather than burrow into a narrow tunnel of vision.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.011
       
  • Spontaneous resolution of hypercalcemia
    • Authors: Emily N. Ahadizadeh; Nauman F. Manzoor; Jay Wasman; Pierre Lavertu
      Pages: 496 - 497
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Emily N. Ahadizadeh, Nauman F. Manzoor, Jay Wasman, Pierre Lavertu
      Background Primary hyperparathyroidism (PHPT) is a frequently encountered endocrine disorder due to benign neoplastic lesions or gland hyperplasia. It is often discovered incidentally when routine lab work reveals hypercalcemia. Methods This case presents a 55-year-old male with a neck mass and electrolyte irregularities consistent with PHPT. However, his laboratory values suddenly normalized prior to surgery. Results Post-operative pathologic analysis of the specimen demonstrated massive infarction of the affected gland, and explained the spontaneous resolution of the patient's electrolyte derangements. Conclusions The objective of this case study is to demonstrate the importance of further investigation in patients with fluctuating lab values and emphasize the potential dangers of gland infarction.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.03.003
       
  • Teaching and practice patterns of lateral osteotomies for rhinoplasty
    • Authors: Jenny X. Chen; Elliott D. Kozin; Matthew M. Dedmon; Linda N. Lee
      Pages: 498 - 500
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Jenny X. Chen, Elliott D. Kozin, Matthew M. Dedmon, Linda N. Lee
      Purpose Lateral osteotomies are important during rhinoplasty and represent a challenging technique that otolaryngology and plastic surgery trainees must learn. The approaches for osteotomies are difficult to teach as they are accomplished through tactile feedback. Trends in teaching and practice patterns of lateral osteotomies are poorly described in the literature, and this study aims to fill this knowledge gap. Materials and methods Members of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed to characterize surgeon preferences for intranasal versus percutaneous lateral osteotomies and understand how techniques are taught. Results Among surgeons who completed the survey (n=172), 87% reported that they “always” or “mostly” use intranasal lateral osteotomies whereas only 8% “always” or “mostly” use percutaneous approaches. There is no significant trend towards changing osteotomy techniques when teaching trainees. Only 15% of respondents allow trainees to perform lateral osteotomies in more than half of operations. Conclusions Most facial plastic surgeons prefer to use intranasal lateral osteotomies. However, many do not allow trainees to perform this critical step during rhinoplasty. This study has implications for both patient care and surgical education.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.008
       
  • Primary mucosal melanoma of the palatine tonsil: Report of a case and
           review of the literature
    • Authors: Marcela Osorio; Sami P. Moubayed; Juan Hernandez-Prera; John C. Scott; Mark L. Urken
      Pages: 501 - 504
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Marcela Osorio, Sami P. Moubayed, Juan Hernandez-Prera, John C. Scott, Mark L. Urken
      Background Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment. Methods A 62-year-old female presented with a deeply pigmented and exophytic lesion in the left tonsillar fossa. The patient underwent a partial pharyngectomy through a midline labio-mandibulotomy approach along with a left level I–V neck dissection. Reconstruction with a left radial forearm free flap and a pharyngeal constrictor advancement pharyngoplasty was performed. Results The patient remains free of disease at eight months after adjuvant proton therapy and eleven months after surgery. To our knowledge, less than thirty cases have been either reported or referenced in the literature since the early 1900′s. This report is the first in English literature to compile all reported cases of primary tonsillar melanoma. Conclusion Currently, evidence suggests that mucosal melanoma in the palatine tonsil should be treated in the same fashion as other head and neck mucosal melanomas, mindful of the high rates at which locoregional and distant metastases occur.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.010
       
  • Pleomorphic liposarcoma of the head and neck: Presentation of two cases
           and literature review
    • Authors: Jay Agarwal; Sameep Kadakia; Abbas Agaimy; Anna Ogadzanov; Azita Khorsandi; Raymond L. Chai
      Pages: 505 - 507
      Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4
      Author(s): Jay Agarwal, Sameep Kadakia, Abbas Agaimy, Anna Ogadzanov, Azita Khorsandi, Raymond L. Chai
      Background Pleomorphic liposarcoma (PL) is an exceedingly rare tumor of the head and neck. This aggressive liposarcoma variant portends a poorer prognosis compared to more typical sarcomatous tumors. Methods Multi-institutional study including two cases of PL, the first case occurring in the post-auricular region and the second in the cheek with later recurrence within the parotid bed. Results Both patients were treated surgically with wide local excision. One patient required reoperation to obtain negative margins. The other patient underwent a total parotidectomy with neck dissection for recurrent intraparotid nodal disease. Both patients underwent adjuvant radiotherapy. No patient had evidence of recurrent disease with minimum one year follow-up. Conclusion Although the literature is sparse on this disease, wide surgical extirpation with negative margins and adjuvant radiation is recommended. Increased reports of this pathology can be helpful in providing practitioners with experienced-based information that can aid in early detection and treatment. We present the first case series of PL of the head and neck in the literature.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.04.012
       
  • Retropharyngeal abscess as a result of hyaluronic acid injection
           pharyngoplasty: A first of its kind
    • Authors: Joseph Capo; Samuel N. Helman; Lianne M. de Serres
      Abstract: Publication date: Available online 1 August 2017
      Source:American Journal of Otolaryngology
      Author(s): Joseph Capo, Samuel N. Helman, Lianne M. de Serres


      PubDate: 2017-08-09T00:06:38Z
      DOI: 10.1016/j.amjoto.2017.07.008
       
  • Top Reviewers
    • Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4


      PubDate: 2017-07-30T23:56:28Z
       
  • Surgical management of temporal bone osteoradionecrosis: Single surgeon
           experience of 47 cases
    • Authors: Sameep Kadakia; Arvind Badhey; Jared Inman; Moustafa Mourad; Yadranko Ducic
      Abstract: Publication date: Available online 23 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Sameep Kadakia, Arvind Badhey, Jared Inman, Moustafa Mourad, Yadranko Ducic
      Purpose To report the outcomes of 47 patients with temporal bone osteoradionecrosis treated primarily with surgical resection in order to analyze whether flap type and hyperbaric oxygen use affect wound breakdown. Materials and methods Between January 1998 and January 2016, 47 patients were treated for temporal bone osteoradionecrosis with surgery. Some patients were also treated with hyperbaric oxygen. Resection of grossly necrotic temporal bone was followed by immediate reconstruction with local, regional, or free flaps. Minimum follow-up was 6months. If patients had breakdown of their initial reconstructions, secondary reconstruction was performed with either a regional or free flap. During the post-operative period, wound breakdown, flap complications, and patient survival were noted. Results 30 patients developed ORN from primary radiotherapy while 17 had post-operative radiation. It was found that wound breakdown was significantly associated with type of flap reconstruction (p=0.02) with local flap reconstruction portending a poorer prognosis. Hyperbaric oxygen was not associated with decreased wound breakdown (p=0.5). Conclusions Surgical treatment can be an effective treatment for temporal bone osteoradionecrosis, without hyperbaric oxygen providing any additional benefit. Reconstruction with regional or free flaps may be a more reliable method to resurface defects compared to local flaps.

      PubDate: 2017-07-23T23:54:13Z
      DOI: 10.1016/j.amjoto.2017.07.005
       
  • Randomized double blind trial of amitriptyline versus placebo in treatment
           of chronic laryngopharyngeal neuropathy
    • Authors: Minyoung Jang; Samuel J. Rubin; Daniel J. Stein; Jacob Pieter Noordzij
      Abstract: Publication date: Available online 12 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Minyoung Jang, Samuel J. Rubin, Daniel J. Stein, Jacob Pieter Noordzij
      Objective A neuropathic etiology has been suggested for patients with chronic laryngopharyngitis symptoms without visible structural pathology. Prior studies have shown that treatment with neuro-modulating medications is beneficial, but it is unknown if this was due to placebo effect. Our objective was to compare the efficacy of amitriptyline versus placebo in treating chronic laryngopharyngeal neuropathy. Study design Prospective, randomized placebo-controlled trial. Methods Patients were randomized to receive placebo or amitriptyline for 8weeks. Primary outcome was change in modified Reflux Symptom Index (mRSI) score. Secondary outcomes were change in Voice Handicap Index-10 (VHI) scores, rates of adverse effects, and overall symptom severity. Results Eighteen patients completed the study. The average difference in mRSI and VHI scores after treatment were not significantly different between study arms. However, more subjects taking amitriptyline felt their symptoms had subjectively improved (6 out of 9, 67%), while the remainder noted no change. In the placebo group, only 4 out of 9 subjects (44%) felt their symptoms were better and 2 felt worse. Subjects took an average of 25mg of amitriptyline or placebo daily by the end of the 8-week treatment period. No serious adverse effects were noted. Conclusion Although there was a trend toward greater subjective improvement in overall symptoms with amitriptyline, interpretation is limited due to the small sample size. Larger randomized controlled trials to determine the efficacy of neuro-modulating agents in the treatment of chronic laryngopharyngeal neuropathy, as well as better metrics to characterize this disorder, are warranted.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.006
       
  • Eosinophilic hyperplastic lymphogranuloma: Clinical diagnosis and
           treatment experience of 41 cases
    • Authors: Yang Jiang; Qingquan Hua; Jie Ren; Feng Zeng; Jianfei Sheng; Hua Liao; Zhijian Zhang; Hongxia Guan
      Abstract: Publication date: Available online 12 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Yang Jiang, Qingquan Hua, Jie Ren, Feng Zeng, Jianfei Sheng, Hua Liao, Zhijian Zhang, Hongxia Guan
      Purpose The purpose of this study was to investigate the clinical features of eosinophilic hyperplastic lymphogranuloma (EHLG) in the head and neck. Materials and methods Collecting the patients who diagnose with EHLG by pathological examination. The EHLG patients with the masses involved regions, such as involved inguinal region, chest wall, abdominal wall, anterior superior iliac spine or clavicle, instead of head and neck were excluding. All of the participants will sign the informed consent form. The history data includes: clinical history, blood routine test, pathological examination, and recurrence will be collected. Results A total of 41 patients of EHLG were included. These patients predominantly presented as an enlarging and painless single or multiple masses with a history of repeated swelling. There were the complaint of itchy skin and pigmentation. The routine blood test showed that the percentage value of eosinophil increased in almost patients including 26 cases had raised absolute eosinophil count. The serum level of lgE was increased in 29 cases remarkably. With the methods of treatments, 36 patients received surgical excision, 3 patients accepted hormonotherapy, and another 2 patients for radiotherapy. The recurrence of EHLG was in 9 patients. Conclusions EHLG is a rare disease. The clinical manifestation (itchy skin and pigmentation) and increased eosinophil play critical values to the diagnosis of EHLG. Confirmed diagnosis always depends on pathological examination. Surgery is a preferred treatment, while low dose of radiotherapy is necessary for preventing relapse after operation and hormonotherapy.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.007
       
  • Total lower lip and chin reconstruction with radial forearm free flap: A
           novel approach
    • Authors: Eliza H. Dewey; Ansley M. Roche; Cathy L. Lazarus; Mark L. Urken
      Abstract: Publication date: Available online 8 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Eliza H. Dewey, Ansley M. Roche, Cathy L. Lazarus, Mark L. Urken
      Background The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip. Methods Literature review performed. Results Presentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap. Conclusions This procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.004
       
  • Metastatic squamous cell carcinoma to the superior cervical ganglion
           mimicking a retropharyngeal lymph node
    • Authors: Sami P. Moubayed; Rosalie Machado; Marcela Osorio; Azita Khorsandi; Juan Hernandez-Prera; Mark L. Urken
      Abstract: Publication date: Available online 5 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Sami P. Moubayed, Rosalie Machado, Marcela Osorio, Azita Khorsandi, Juan Hernandez-Prera, Mark L. Urken
      Background Metastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG. Methods We report a case of a 69year-old never smoking male, who presented with right retropharyngeal PETCT-avid disease following chemoradiation for squamous cell carcinoma of the tonsil. He was brought to the operating room for resection, intraoperative radiation and reconstruction. Results Intraoperatively, visualization and frozen section confirmed squamous cell carcinoma located in the superior cervical ganglion. The ganglion was resected, intraoperative radiation was given and the patient was reconstructed with a radial forearm free flap. Postoperatively, the patient displayed features of a Horner's syndrome. Conclusions The superior cervical ganglion may be mistaken for a retropharyngeal lymph node. Although extremely rare, these entities may be differentiated on the basis of radiological studies.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.001
       
  • The contemporary utility of intraoperative frozen sections in thyroid
           surgery
    • Authors: Samuel J. Trosman; Rohith Bhargavan; Brandon L. Prendes; Brian B. Burkey; Joseph Scharpf
      Abstract: Publication date: Available online 5 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Samuel J. Trosman, Rohith Bhargavan, Brandon L. Prendes, Brian B. Burkey, Joseph Scharpf
      Purpose To determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making. Study design Retrospective chart review. Methods A retrospective review was performed on all patients who underwent thyroidectomy or thyroid lobectomy with intraoperative frozen sections at a tertiary care academic center from 2009 to 2015. Results There were 74 total patients who underwent partial or total thyroidectomy with intraoperative frozen section analysis of a thyroid nodule whom had previously undergone a thyroid fine needle aspiration of the nodule. The sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section with respect to its prediction for malignancy was 81%, 95%, 98%, and 66%, respectively, with a diagnostic accuracy of 85%. For 37 patients with an indeterminate cytologic diagnosis on fine needle aspiration (Bethesda categories III–V), the sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section was 81%, 91%, 95%, and 67%, respectively, with a diagnostic accuracy of 84%. False positives and false negatives resulted in 1 completion thyroidectomy for benign pathology and 3 reoperations for malignancy not discovered on frozen section. Conclusion While intraoperative frozen sections on thyroid specimens may be helpful if positive, the false negative rate remains high. There appears to be limited value in routine frozen sections to guide clinical management and decision-making in the era of the Bethesda system.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.003
       
  • Histopathological investigation of intranodular echogenic foci detected by
           thyroid ultrasonography
    • Authors: Suat Bilici; Ozgur Yigit; Firat Onur; Bahtiyar Hamit; Mehmet Ali Nazli; Feray Gunver; Yesim Karagoz
      Abstract: Publication date: Available online 5 July 2017
      Source:American Journal of Otolaryngology
      Author(s): Suat Bilici, Ozgur Yigit, Firat Onur, Bahtiyar Hamit, Mehmet Ali Nazli, Feray Gunver, Yesim Karagoz
      Objective To determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy. Methods We prospectively evaluated 81 dominant nodules from 81 patients. Thyroid glands were assessed preoperatively with thyroid ultrasonography, and the presence of sonographic calcification was specified as intranodular macro (coarse) and micro calcification. Micro and macro calcification in surgery specimens were specified postoperatively as present or absent in the histopathological evaluation. The correlation between sonographic and histopathologic calcifications and the relationship between malignancy and calcification patterns were determined. Results Calcification was detected histopathologically in 66.7% of the sonographically calcified nodules and in 12.8% of the sonographically noncalcified nodules. The sensitivity and specificity of sonography for detecting histopathologic calcification were 84.8 and 70.8%, respectively, while positive and negative predictive values were 66.7 and 87.2%, respectively. The sonographical and histopathological outcomes for detection of macro and micro calcification showed 85 and 50% compatibility, respectively. The difference in malignancy rates between sonographic macro and micro calcified nodules was not significant (p=0.976). Histopathologic detection of calcification showed no significant difference between malignant and benign nodules (p=0.129). Conclusion Histopathology confirmed a high rate of sonographic macrocalcifications. The micro and macro patterns of sonographic calcification showed no particular association with thyroid malignancy. The preoperative risk of malignancy should be determined in conjunction with other known sonographic risk factors and diagnostic tests.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.07.002
       
  • Guidelines for Contributing Authors
    • Abstract: Publication date: July–August 2017
      Source:American Journal of Otolaryngology, Volume 38, Issue 4


      PubDate: 2017-07-12T23:45:41Z
       
  • Letter to the editor
    • Authors: Satvinder Singh Bakshi
      Abstract: Publication date: Available online 30 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Satvinder Singh Bakshi


      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.06.013
       
  • Letter to Editors: Detection of endolymphatic hydrops using traditional MR
           imaging sequences
    • Authors: Shinji Naganawa; Michihiko Sone
      Abstract: Publication date: Available online 30 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Shinji Naganawa, Michihiko Sone


      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.06.014
       
  • Lateral cervical approach for supracricoid partial laryngectomy
    • Authors: Giuseppe Spriano; Giuseppe Mercante; Giovanni Cristalli; Raul Pellini; Fabio Ferreli
      Abstract: Publication date: Available online 27 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Giuseppe Spriano, Giuseppe Mercante, Giovanni Cristalli, Raul Pellini, Fabio Ferreli
      Introduction The supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor. Objective To verify the feasibility of a minimally invasive procedure for supracricoid partial laryngectomy by adopting the lateral cervical approach. Methods/results A 61-year old man affected by a cT3N0 glottic cancer already treated 10years prior with radiotherapy for oropharyngeal cancer underwent supracricoid laryngectomy using the lateral approach. The key point of the procedure was a subfascial dissection with the harvesting of anterior cervical flap including skin, fat, platysma, fascia superficialis, anterior jugular veins, homo- and sterno-hyoid muscles. Conclusion Supracricoid laryngectomy by a lateral approach is feasible and safe; it allows to perform a simultaneous neck dissection and the removal of the entire laryngeal specimen preserving ample healthy tissue compared to the classic anterior approach.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.06.011
       
  • Treatment of laryngopharyngeal reflux using a sleep positioning device: A
           prospective cohort study
    • Authors: William S. Tierney; Scott L. Gabbard; Claudio F. Milstein; Michael S. Benninger; Paul C. Bryson
      Abstract: Publication date: Available online 27 June 2017
      Source:American Journal of Otolaryngology
      Author(s): William S. Tierney, Scott L. Gabbard, Claudio F. Milstein, Michael S. Benninger, Paul C. Bryson
      Objective Laryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR. Design Single center prospective cohort study. Setting Tertiary medical center Participants 27 adult patients with diagnosed laryngopharyngeal reflux. Intervention An SPD consisting of a two-component wedge-shaped base pillow and a lateral positioning body pillow (Medcline, Amenity Health Inc.) was given to patients with a diagnosis of LPR. Subjects slept using the device for at least 6h per night for 28 consecutive nights. Main outcomes Primary outcomes were Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and the Reflux Symptoms Index (RSI) survey instrument. Each was collected at baseline, after 14, and after 28days of SPD use. Results 27 patients (19 female and 8 male; age 57.1±12.8, BMI 29.0±8.1) were recruited. At baseline mean N-GSSIQ was 50.1±22.4 and mean RSI of 29.6±7.7. Repeated measure analysis showed that subjects' total N-GSSIQ scores decreased by an average of 19.1 (p=0.0004) points by two weeks and 26.5 points by 4weeks (p<0.0001). RSI decreased an average of 5.3 points by 2weeks (p=0.0425) and an average of 14.0 points by 4weeks (p<0.0001). Conclusions In patients with LPR, SPD treatment significantly improves self-reported symptoms of nocturnal reflux as well as symptoms specific to LPR. These results support the therapeutic efficacy of a SPD for patients with LPR.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.06.012
       
  • Hearing loss in enlarged vestibular aqueduct and incomplete partition type
           II
    • Authors: Emily Ahadizadeh; Mustafa Ascha; Nauman Manzoor; Amit Gupta; Maroun Semaan; Cliff Megerian; Todd Otteson
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Emily Ahadizadeh, Mustafa Ascha, Nauman Manzoor, Amit Gupta, Maroun Semaan, Cliff Megerian, Todd Otteson
      Purpose The purpose of this work is to identify the role of incomplete partition type II on hearing loss among patients with enlarged vestibular aqueduct (EVA). Background EVA is a common congenital inner ear malformation among children with hearing loss, where vestibular aqueduct morphology in this population has been shown to correlate to hearing loss. However, the impact of incomplete partition between cochlear turns on hearing loss has not been, despite meaningful implications for EVA pathophysiology. Methods A retrospective review of radiology reports for patients who had computed tomography (CT) scans with diagnoses of hearing loss at a tertiary medical center between January 2000 and June 2016 were screened for EVA. CT scans of the internal auditory canal (IAC) for those patients with EVA were examined for evidence of incomplete partition type II (IP-II), measurements of midpoint width and operculum width a second time, and patients meeting Cincinnati criteria for EVA selected for analysis. Statistical analysis including chi-square, Wilcoxon rank-sum, and t-tests were used to identify differences in outcomes and clinical predictors, as appropriate for the distribution of the data. Linear mixed models of hearing test results for all available tests were constructed, both univariable and adjusting for vestibular aqueduct morphometric features, with ear-specific intercepts and slopes over time. Results There were no statistically significant differences in any hearing test results or vestibular aqueduct midpoint and operculum widths. Linear mixed models, both univariable and those adjusting for midpoint and operculum widths, did not indicate a statistically significant effect of incomplete partition type II on hearing test results. Conclusions Hearing loss due to enlarged vestibular aqueduct does not appear to be affected by the presence of incomplete partition type II. Our results suggest that the pathophysiological processes underlying hearing loss in enlarged vestibular aqueduct may not be a result of cochlear malformation, and instead are more likely to involve vestibular aqueduct or cellular and molecular-level mechanisms of hearing loss.

      PubDate: 2017-07-12T23:45:41Z
      DOI: 10.1016/j.amjoto.2017.06.010
       
  • Parathyroidectomy for tertiary hyperparathyroidism: A systematic review
    • Authors: Jessica A. Tang; Jacob Friedman; Michelle S. Hwang; Anna M. Salapatas; Lauren B. Bonzelaar; Michael Friedman
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Jessica A. Tang, Jacob Friedman, Michelle S. Hwang, Anna M. Salapatas, Lauren B. Bonzelaar, Michael Friedman
      Objective Analyze the efficacy and indications for parathyroidectomy as an intervention for tertiary hyperparathyroidism. Data sources PubMed, MEDLINE, and Cochrane Library databases. Review methods A systematic literature search was performed using the. Original research articles in English were retrieved using the search terms (“tertiary hyperparathyroidism” OR “3HPT”) AND “parathyroidectomy”. Articles were analyzed in regards to their surgical indications, operative endpoints, comparison between different surgical interventions, characterization of disease recurrence rates, and evaluation of alternative medical management. Results Thirty studies met the criteria for inclusion. Among the studies that report indications for parathyroidectomy, persistent hypercalcemia as well as clinical manifestations of hypercalcemia despite medical therapy predicted which patients would eventually need surgical intervention. The majority of studies comparing the extent of parathyroidectomy recommended a more focused approach to parathyroidectomy when warranted. All studies found that parathyroidectomy was an effective treatment for 3HPT. Three studies discussed alternative conservative approaches. Conclusion Interestingly, hyperparathyroidism alone is not an indication for surgery without other findings; rather, symptomatic hypercalcemia appears to be the main indication. Most studies recommend limited or subtotal parathyroidectomy for 3HPT. The operative endpoint of surgery is not necessarily a return of PTH to normal, but a >50% drop in PTH level even if PTH remains above normal. Additionally, “success” or “cure” is defined as normal calcium levels regardless of whether or not PTH is elevated. It appears the goal of surgery for 3HPT is not a normal PTH value, but a normal calcium level at least six months postoperatively.

      PubDate: 2017-06-23T23:30:43Z
      DOI: 10.1016/j.amjoto.2017.06.009
       
  • Utilization of sinus stents as a novel approach for benign cystic lesions
           of the sella
    • Authors: Akina Tamaki; Berje Shammassian; Abhishek Ray; Warren R. Selman; Kenneth Rodriguez
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Otolaryngology
      Author(s): Akina Tamaki, Berje Shammassian, Abhishek Ray, Warren R. Selman, Kenneth Rodriguez
      Steroid-releasing sinus stents have emerged as a safe and effective tool in endoscopic sinus surgery. In this case report, we present two patients with recurrent cystic sellar masses. Transsphenoidal approach was used to access the sella. Following resection and drainage of the cystic pathology, a Propel (Menlo Park, CA) stent was placed through the corridor of the resection site to stent the cavity open. This is the first report where a steroid-releasing sinus stent was used in the treatment of a sellar lesion. It supports that this technology is safe and effective for use in skull base surgery.

      PubDate: 2017-06-23T23:30:43Z
      DOI: 10.1016/j.amjoto.2017.06.008
       
  • Decreased clinic visits for acute respiratory infections following an
           adult tonsillectomy: A population-based study
    • Authors: Shiu-Dong Chung; Shih-Han Hung; Herng-Ching Lin; Kuan-Chen Chen
      Abstract: Publication date: Available online 5 May 2017
      Source:American Journal of Otolaryngology
      Author(s): Shiu-Dong Chung, Shih-Han Hung, Herng-Ching Lin, Kuan-Chen Chen
      Purpose This study attempted to investigate the effects of a tonsillectomy on utilization of medical resources for acute respiratory infections by comparing numbers and costs of clinic visits within 1year before and after a tonsillectomy. Materials and methods Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. The study includes 481 patients aged 18–80years who underwent a tonsillectomy and 481 comparison patients. A multivariate regression model employing difference-in-difference was carried out to assess the independent association between a tonsillectomy and the number and costs of clinic visits. Results We found that for patients who underwent a tonsillectomy, the mean number of clinic visits for acute respiratory care 1year before and after the index date significantly decreased from 7.3 to 4.2 (p <0.001). However, for the comparison group, there was no significant difference in the number (p =0.540) or costs (p =0.221) of clinic visits for acute respiratory care 1year before and after the index date. A multivariate regression model revealed that a tonsillectomy was associated with a reduction of 3.38 in the mean number of clinic visits for acute respiratory care (p <0.001). In other words, a tonsillectomy reduced by 46.3% (3.38/7.3) the number of clinic visits for acute respiratory care after adjusting for sociodemographic characteristics and medical comorbidities compared to comparison patients. Conclusions This study demonstrated that a tonsillectomy was of substantial benefit to adult patients in that it provides decreased healthcare utilization for acute respiratory infections.

      PubDate: 2017-05-09T22:54:28Z
      DOI: 10.1016/j.amjoto.2017.05.004
       
  • A sustained increase of plasma fibrinogen in sudden sensorineural hearing
           loss predicts worse outcome independently
    • Authors: Yoon Ah. Park; Tae Hoon Kong; Young Joon Seo
      Abstract: Publication date: Available online 5 May 2017
      Source:American Journal of Otolaryngology
      Author(s): Yoon Ah. Park, Tae Hoon Kong, Young Joon Seo
      Objectives A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed. Vascular disturbance is one cause of ISSNHL and has been reported to be associated with fibrinogen. We aimed to determine whether hyperfibrinogenemia is associated with poor outcome and whether a serial change in fibrinogen level is associated with outcome. Methods Twenty-two patients with ISSNHL were enrolled. We compared the levels of fibrinogen in ISSNHL groups classified as improved and non-improved according to improvement of hearing. Blood samples were also collected from patients who visited the emergency room with coronary heart disease (CHD) as the control group. Results Initial fibrinogen level was significantly different between the non-improved and improved ISSNHL group (350.63±87.20 vs. 310.71±81.06. The improved ISSNHL group showed a “surge phenomenon”, in which fibrinogen started to decrease at day 5 and increased at day 26. In the non-improved group, fibrinogen remained elevated throughout the course of therapy. Conclusion It is important to measure not only the initial fibrinogen level but also to monitor its change throughout the course of therapy in order to predict the outcome of ISSNHL.

      PubDate: 2017-05-09T22:54:28Z
      DOI: 10.1016/j.amjoto.2017.05.002
       
 
 
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