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Publisher: Springer-Verlag (Total: 2350 journals)

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Showing 1201 - 1400 of 2350 Journals sorted alphabetically
J. of Clinical Geropsychology     Hybrid Journal   (Followers: 1)
J. of Clinical Immunology     Hybrid Journal   (Followers: 14, SJR: 1.611, CiteScore: 3)
J. of Clinical Monitoring and Computing     Hybrid Journal   (Followers: 1, SJR: 0.712, CiteScore: 2)
J. of Clinical Psychology in Medical Settings     Hybrid Journal   (Followers: 14, SJR: 0.596, CiteScore: 2)
J. of Cluster Science     Hybrid Journal   (SJR: 0.332, CiteScore: 1)
J. of Coal Science and Engineering (China)     Hybrid Journal  
J. of Coastal Conservation     Hybrid Journal   (Followers: 5, SJR: 0.393, CiteScore: 1)
J. of Coatings Technology and Research     Hybrid Journal   (Followers: 5, SJR: 0.415, CiteScore: 2)
J. of Combinatorial Optimization     Hybrid Journal   (Followers: 6, SJR: 0.579, CiteScore: 1)
J. of Communications Technology and Electronics     Hybrid Journal   (Followers: 2, SJR: 0.273, CiteScore: 1)
J. of Community Genetics     Hybrid Journal   (SJR: 0.687, CiteScore: 1)
J. of Community Health     Hybrid Journal   (Followers: 8, SJR: 0.784, CiteScore: 2)
J. of Comparative Physiology A: Neuroethology, Sensory, Neural, and Behavioral Physiology     Hybrid Journal   (Followers: 10, SJR: 1.246, CiteScore: 2)
J. of Comparative Physiology B : Biochemical, Systemic, and Environmental Physiology     Hybrid Journal   (Followers: 5, SJR: 0.952, CiteScore: 2)
J. of Compassionate Health Care     Open Access   (Followers: 3)
J. of Computational Analysis and Applications     Hybrid Journal   (SJR: 0.396, CiteScore: 1)
J. of Computational Electronics     Hybrid Journal   (Followers: 4, SJR: 0.274, CiteScore: 1)
J. of Computational Neuroscience     Hybrid Journal   (Followers: 25, SJR: 0.888, CiteScore: 2)
J. of Computer and Systems Sciences Intl.     Hybrid Journal   (SJR: 0.316, CiteScore: 1)
J. of Computer Science and Technology     Open Access   (Followers: 5, SJR: 0.295, CiteScore: 1)
J. of Computer Virology and Hacking Techniques     Hybrid Journal   (Followers: 6, SJR: 0.271, CiteScore: 1)
J. of Computer-Aided Molecular Design     Hybrid Journal   (Followers: 3, SJR: 0.941, CiteScore: 3)
J. of Computers in Education     Hybrid Journal   (Followers: 12)
J. of Computing in Higher Education     Hybrid Journal   (Followers: 12, SJR: 1.019, CiteScore: 2)
J. of Consumer Policy     Hybrid Journal   (Followers: 7, SJR: 0.56, CiteScore: 2)
J. of Contemporary Mathematical Analysis     Hybrid Journal   (SJR: 0.353, CiteScore: 0)
J. of Contemporary Physics (Armenian Academy of Sciences)     Hybrid Journal   (Followers: 10, SJR: 0.229, CiteScore: 0)
J. of Contemporary Psychotherapy     Hybrid Journal   (Followers: 6, SJR: 0.473, CiteScore: 1)
J. of Control Theory and Applications     Hybrid Journal   (Followers: 2)
J. of Control, Automation and Electrical Systems     Hybrid Journal   (Followers: 9, SJR: 0.274, CiteScore: 1)
J. of Crop Science and Biotechnology     Hybrid Journal   (Followers: 3, SJR: 0.316, CiteScore: 1)
J. of Cross-Cultural Gerontology     Hybrid Journal   (Followers: 6, SJR: 0.506, CiteScore: 1)
J. of Cryptographic Engineering     Partially Free   (Followers: 4, SJR: 0.423, CiteScore: 2)
J. of Cryptology     Hybrid Journal   (Followers: 3, SJR: 0.347, CiteScore: 2)
J. of Cultural Economics     Hybrid Journal   (Followers: 2, SJR: 0.607, CiteScore: 2)
J. of Database Marketing & Customer Strategy Management     Hybrid Journal   (Followers: 10)
J. of Derivatives & Hedge Funds     Hybrid Journal   (Followers: 7)
J. of Developmental and Physical Disabilities     Hybrid Journal   (Followers: 7, SJR: 0.605, CiteScore: 1)
J. of Digital Imaging     Hybrid Journal   (Followers: 6, SJR: 0.54, CiteScore: 2)
J. of Direct Data and Digital Marketing Practice     Hybrid Journal   (Followers: 8, SJR: 0.157, CiteScore: 0)
J. of Dynamical and Control Systems     Hybrid Journal   (Followers: 1, SJR: 0.316, CiteScore: 1)
J. of Dynamics and Differential Equations     Hybrid Journal   (SJR: 1.208, CiteScore: 1)
J. of Earth Science     Hybrid Journal   (Followers: 9, SJR: 0.604, CiteScore: 1)
J. of Earth System Science     Open Access   (Followers: 49, SJR: 0.366, CiteScore: 1)
J. of East Asian Linguistics     Hybrid Journal   (Followers: 6, SJR: 0.319, CiteScore: 0)
J. of Echocardiography     Hybrid Journal   (Followers: 5, SJR: 0.337, CiteScore: 1)
J. of Ecology and Environment     Open Access   (Followers: 1, SJR: 0.171, CiteScore: 0)
J. of Economic Growth     Hybrid Journal   (Followers: 21, SJR: 5.529, CiteScore: 5)
J. of Economic Interaction and Coordination     Hybrid Journal   (SJR: 0.559, CiteScore: 1)
J. of Economics     Hybrid Journal   (Followers: 12, SJR: 0.434, CiteScore: 1)
J. of Economics and Finance     Hybrid Journal   (Followers: 6, SJR: 0.227, CiteScore: 0)
J. of Educational Change     Hybrid Journal   (Followers: 6, SJR: 0.932, CiteScore: 1)
J. of Elasticity     Hybrid Journal   (Followers: 6, SJR: 0.899, CiteScore: 2)
J. of Electroceramics     Hybrid Journal   (SJR: 0.427, CiteScore: 1)
J. of Electronic Materials     Hybrid Journal   (Followers: 4, SJR: 0.474, CiteScore: 2)
J. of Electronic Testing     Hybrid Journal   (Followers: 2, SJR: 0.191, CiteScore: 1)
J. of Electronics (China)     Hybrid Journal   (Followers: 4)
J. of Elementary Science Education     Hybrid Journal   (Followers: 8, SJR: 1.243, CiteScore: 3)
J. of Elliptic and Parabolic Equations     Hybrid Journal  
J. of Engineering Mathematics     Hybrid Journal   (SJR: 0.418, CiteScore: 1)
J. of Engineering Physics and Thermophysics     Hybrid Journal   (Followers: 1, SJR: 0.316, CiteScore: 0)
J. of Engineering Research     Open Access   (Followers: 1, SJR: 0.138, CiteScore: 0)
J. of Engineering Thermophysics     Hybrid Journal   (Followers: 4, SJR: 0.435, CiteScore: 1)
J. of Environmental Studies and Sciences     Partially Free   (Followers: 2, SJR: 0.404, CiteScore: 1)
J. of Ethology     Hybrid Journal   (Followers: 2, SJR: 0.591, CiteScore: 1)
J. of Evolution Equations     Hybrid Journal   (SJR: 1.588, CiteScore: 1)
J. of Evolutionary Biochemistry and Physiology     Hybrid Journal   (Followers: 1)
J. of Evolutionary Economics     Hybrid Journal   (Followers: 7, SJR: 0.518, CiteScore: 1)
J. of Experimental and Theoretical Physics     Hybrid Journal   (Followers: 3, SJR: 0.437, CiteScore: 1)
J. of Experimental Criminology     Hybrid Journal   (Followers: 48, SJR: 2.639, CiteScore: 4)
J. of Failure Analysis and Prevention     Hybrid Journal   (Followers: 5, SJR: 0.315, CiteScore: 1)
J. of Family and Economic Issues     Hybrid Journal   (Followers: 3, SJR: 0.587, CiteScore: 1)
J. of Family Violence     Hybrid Journal   (Followers: 41, SJR: 0.679, CiteScore: 1)
J. of Financial Services Marketing     Hybrid Journal   (Followers: 4, SJR: 0.289, CiteScore: 1)
J. of Financial Services Research     Hybrid Journal   (Followers: 25, SJR: 1.31, CiteScore: 1)
J. of Fixed Point Theory and Applications     Hybrid Journal   (SJR: 0.416, CiteScore: 1)
J. of Fluorescence     Hybrid Journal   (Followers: 3, SJR: 0.391, CiteScore: 2)
J. of Food Measurement and Characterization     Hybrid Journal   (SJR: 0.369, CiteScore: 1)
J. of Food Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.689, CiteScore: 2)
J. of Forest Research     Hybrid Journal   (Followers: 2, SJR: 0.371, CiteScore: 1)
J. of Forestry Research     Hybrid Journal   (Followers: 3, SJR: 0.401, CiteScore: 1)
J. of Fourier Analysis and Applications     Hybrid Journal   (Followers: 1, SJR: 1.024, CiteScore: 1)
J. of Friction and Wear     Hybrid Journal   (Followers: 7, SJR: 0.432, CiteScore: 1)
J. of Fusion Energy     Hybrid Journal   (Followers: 3, SJR: 0.411, CiteScore: 1)
J. of Gambling Studies     Hybrid Journal   (Followers: 7, SJR: 0.969, CiteScore: 2)
J. of Gastroenterology     Hybrid Journal   (Followers: 11, SJR: 2.322, CiteScore: 5)
J. of Gastrointestinal Cancer     Hybrid Journal   (Followers: 3, SJR: 0.414, CiteScore: 1)
J. of Gastrointestinal Surgery     Hybrid Journal   (Followers: 11, SJR: 1.556, CiteScore: 3)
J. of General Internal Medicine     Hybrid Journal   (Followers: 16, SJR: 1.612, CiteScore: 2)
J. of General Plant Pathology     Hybrid Journal   (SJR: 0.529, CiteScore: 1)
J. of Genetic Counseling     Hybrid Journal   (Followers: 6, SJR: 0.761, CiteScore: 2)
J. of Genetics     Open Access   (Followers: 5, SJR: 0.357, CiteScore: 1)
J. of Geodesy     Hybrid Journal   (Followers: 8, SJR: 2.399, CiteScore: 4)
J. of Geographical Sciences     Hybrid Journal   (Followers: 1, SJR: 0.759, CiteScore: 2)
J. of Geographical Systems     Hybrid Journal   (Followers: 4, SJR: 0.589, CiteScore: 2)
J. of Geometric Analysis     Hybrid Journal   (Followers: 2, SJR: 1.497, CiteScore: 1)
J. of Geometry     Hybrid Journal   (Followers: 1, SJR: 0.265, CiteScore: 0)
J. of Global Optimization     Hybrid Journal   (Followers: 4, SJR: 1.311, CiteScore: 2)
J. of Global Policy and Governance     Hybrid Journal   (Followers: 10)
J. of Grid Computing     Hybrid Journal   (Followers: 1, SJR: 0.698, CiteScore: 4)
J. of Happiness Studies     Hybrid Journal   (Followers: 26, SJR: 0.827, CiteScore: 2)
J. of Hematopathology     Hybrid Journal   (Followers: 3, SJR: 0.26, CiteScore: 0)
J. of Heuristics     Hybrid Journal   (Followers: 4, SJR: 1.008, CiteScore: 2)
J. of High Energy Physics     Hybrid Journal   (Followers: 17, SJR: 1.227, CiteScore: 4)
J. of Homotopy and Related Structures     Hybrid Journal   (SJR: 0.539, CiteScore: 0)
J. of Housing and the Built Environment     Hybrid Journal   (Followers: 7, SJR: 0.794, CiteScore: 2)
J. of Huazhong University of Science and Technology [Medical Sciences]     Hybrid Journal   (SJR: 0.406, CiteScore: 1)
J. of Ichthyology     Hybrid Journal   (Followers: 2, SJR: 0.284, CiteScore: 0)
J. of Immigrant and Minority Health     Hybrid Journal   (Followers: 12, SJR: 0.735, CiteScore: 1)
J. of Inclusion Phenomena and Macrocyclic Chemistry     Hybrid Journal   (Followers: 1)
J. of Indian Council of Philosophical Research     Hybrid Journal  
J. of Indian Philosophy     Hybrid Journal   (Followers: 9, SJR: 0.267, CiteScore: 0)
J. of Industrial Microbiology and Biotechnology     Hybrid Journal   (Followers: 16, SJR: 1.107, CiteScore: 3)
J. of Industry, Competition and Trade     Hybrid Journal   (Followers: 8, SJR: 0.333, CiteScore: 1)
J. of Infection and Chemotherapy     Hybrid Journal   (Followers: 2, SJR: 0.848, CiteScore: 2)
J. of Information Technology     Hybrid Journal   (Followers: 56, SJR: 1.752, CiteScore: 4)
J. of Information Technology Teaching Cases     Hybrid Journal   (Followers: 11, SJR: 0.135, CiteScore: 0)
J. of Infrared, Millimeter and Terahertz Waves     Hybrid Journal   (Followers: 2, SJR: 0.803, CiteScore: 2)
J. of Inherited Metabolic Disease     Hybrid Journal   (Followers: 2, SJR: 1.668, CiteScore: 3)
J. of Inorganic and Organometallic Polymers and Materials     Partially Free   (Followers: 10, SJR: 0.402, CiteScore: 2)
J. of Insect Behavior     Hybrid Journal   (Followers: 7, SJR: 0.521, CiteScore: 1)
J. of Insect Conservation     Hybrid Journal   (Followers: 10, SJR: 0.842, CiteScore: 2)
J. of Intelligent and Robotic Systems     Hybrid Journal   (Followers: 3, SJR: 0.537, CiteScore: 2)
J. of Intelligent Information Systems     Hybrid Journal   (Followers: 1, SJR: 0.481, CiteScore: 2)
J. of Intelligent Manufacturing     Hybrid Journal   (Followers: 3, SJR: 1.179, CiteScore: 3)
J. of Interventional Cardiac Electrophysiology     Hybrid Journal   (SJR: 1.017, CiteScore: 2)
J. of Intl. Business Studies     Hybrid Journal   (Followers: 37, SJR: 5.198, CiteScore: 7)
J. of Intl. Entrepreneurship     Hybrid Journal   (Followers: 12, SJR: 0.57, CiteScore: 2)
J. of Intl. Migration and Integration / Revue de l integration et de la migration internationale     Hybrid Journal   (Followers: 14, SJR: 0.499, CiteScore: 1)
J. of Intl. Relations and Development     Hybrid Journal   (Followers: 20, SJR: 0.758, CiteScore: 1)
J. of Labor Research     Hybrid Journal   (Followers: 19, SJR: 0.209, CiteScore: 1)
J. of Logic, Language and Information     Hybrid Journal   (Followers: 6, SJR: 0.361, CiteScore: 1)
J. of Low Temperature Physics     Hybrid Journal   (Followers: 3, SJR: 0.471, CiteScore: 1)
J. of Machinery Manufacture and Reliability     Hybrid Journal   (Followers: 2, SJR: 0.238, CiteScore: 0)
J. of Mammalian Evolution     Hybrid Journal   (Followers: 6, SJR: 1.19, CiteScore: 2)
J. of Mammary Gland Biology and Neoplasia     Hybrid Journal   (Followers: 2, SJR: 1.278, CiteScore: 3)
J. of Management and Governance     Hybrid Journal   (Followers: 9, SJR: 0.441, CiteScore: 1)
J. of Management Control     Hybrid Journal   (Followers: 6, SJR: 0.262, CiteScore: 1)
J. of Marine Science and Application     Hybrid Journal   (Followers: 2, SJR: 0.288, CiteScore: 1)
J. of Marine Science and Technology     Hybrid Journal   (Followers: 3, SJR: 0.784, CiteScore: 2)
J. of Maritime Archaeology     Hybrid Journal   (Followers: 17, SJR: 0.29, CiteScore: 1)
J. of Market-Focused Management     Hybrid Journal   (Followers: 2)
J. of Marketing Analytics     Hybrid Journal   (Followers: 5, SJR: 0.206, CiteScore: 1)
J. of Material Cycles and Waste Management     Hybrid Journal   (Followers: 2, SJR: 0.491, CiteScore: 2)
J. of Materials Engineering and Performance     Hybrid Journal   (Followers: 23, SJR: 0.611, CiteScore: 2)
J. of Materials Science     Hybrid Journal   (Followers: 22, SJR: 0.807, CiteScore: 3)
J. of Materials Science : Materials in Electronics     Hybrid Journal   (Followers: 4, SJR: 0.503, CiteScore: 2)
J. of Materials Science : Materials in Medicine     Hybrid Journal   (Followers: 4, SJR: 0.647, CiteScore: 3)
J. of Mathematical Biology     Hybrid Journal   (Followers: 9, SJR: 0.977, CiteScore: 2)
J. of Mathematical Chemistry     Hybrid Journal   (Followers: 3, SJR: 0.332, CiteScore: 1)
J. of Mathematical Fluid Mechanics     Hybrid Journal   (Followers: 8, SJR: 1.613, CiteScore: 1)
J. of Mathematical Imaging and Vision     Hybrid Journal   (Followers: 5, SJR: 0.724, CiteScore: 2)
J. of Mathematical Modelling and Algorithms     Hybrid Journal   (Followers: 1)
J. of Mathematical Sciences     Hybrid Journal   (SJR: 0.304, CiteScore: 0)
J. of Mathematics Teacher Education     Hybrid Journal   (Followers: 16, SJR: 1.006, CiteScore: 1)
J. of Maxillofacial and Oral Surgery     Hybrid Journal   (Followers: 3)
J. of Mechanical Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.553, CiteScore: 1)
J. of Medical and Biological Engineering     Hybrid Journal   (Followers: 4, SJR: 0.356, CiteScore: 1)
J. of Medical Humanities     Hybrid Journal   (Followers: 22, SJR: 0.249, CiteScore: 1)
J. of Medical Systems     Hybrid Journal   (SJR: 0.619, CiteScore: 3)
J. of Medical Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.74, CiteScore: 2)
J. of Medical Ultrasonics     Hybrid Journal   (Followers: 2, SJR: 0.221, CiteScore: 1)
J. of Medicine and the Person     Hybrid Journal  
J. of Membrane Biology     Hybrid Journal   (Followers: 1, SJR: 0.567, CiteScore: 2)
J. of Micro-Bio Robotics     Hybrid Journal   (SJR: 0.783, CiteScore: 3)
J. of Microbiology     Hybrid Journal   (Followers: 8, SJR: 0.911, CiteScore: 2)
J. of Mining Science     Hybrid Journal   (Followers: 4, SJR: 0.316, CiteScore: 1)
J. of Molecular Evolution     Hybrid Journal   (Followers: 6, SJR: 0.911, CiteScore: 2)
J. of Molecular Histology     Hybrid Journal   (Followers: 4, SJR: 0.981, CiteScore: 2)
J. of Molecular Medicine     Hybrid Journal   (Followers: 11, SJR: 2.177, CiteScore: 5)
J. of Molecular Modeling     Hybrid Journal   (Followers: 4, SJR: 0.36, CiteScore: 1)
J. of Molecular Neuroscience     Partially Free   (Followers: 11, SJR: 0.974, CiteScore: 2)
J. of Mountain Science     Hybrid Journal   (Followers: 2, SJR: 0.442, CiteScore: 1)
J. of Muscle Research and Cell Motility     Hybrid Journal   (Followers: 1, SJR: 0.936, CiteScore: 2)
J. of Nanoparticle Research     Hybrid Journal   (Followers: 3, SJR: 0.528, CiteScore: 2)
J. of Natural Medicines     Hybrid Journal   (SJR: 0.643, CiteScore: 2)
J. of Near-Death Studies     Hybrid Journal   (Followers: 1)
J. of Nephrology     Hybrid Journal   (Followers: 4, SJR: 1.003, CiteScore: 2)
J. of Network and Systems Management     Hybrid Journal   (SJR: 0.264, CiteScore: 2)
J. of Neural Transmission     Hybrid Journal   (Followers: 2, SJR: 1.232, CiteScore: 3)
J. of Neuro-Oncology     Hybrid Journal   (Followers: 2, SJR: 1.168, CiteScore: 3)
J. of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1, SJR: 1.379, CiteScore: 3)
J. of Neurology     Hybrid Journal   (Followers: 16, SJR: 1.626, CiteScore: 3)
J. of NeuroVirology     Hybrid Journal   (Followers: 1, SJR: 1.475, CiteScore: 3)
J. of Nondestructive Evaluation     Hybrid Journal   (Followers: 9, SJR: 0.773, CiteScore: 2)
J. of Nonlinear Science     Hybrid Journal   (SJR: 1.568, CiteScore: 2)
J. of Nonverbal Behavior     Hybrid Journal   (Followers: 5, SJR: 0.92, CiteScore: 2)
J. of Nuclear Cardiology     Hybrid Journal   (SJR: 0.796, CiteScore: 2)
J. of Nutrition, Health and Aging     Hybrid Journal   (Followers: 24, SJR: 1.249, CiteScore: 3)
J. of Obstetrics and Gynecology of India     Hybrid Journal   (Followers: 4, SJR: 0.236, CiteScore: 0)
J. of Occupational Rehabilitation     Hybrid Journal   (Followers: 16, SJR: 0.88, CiteScore: 2)
J. of Ocean Engineering and Marine Energy     Hybrid Journal   (Followers: 4, SJR: 0.913, CiteScore: 2)
J. of Ocean University of China (English Edition)     Hybrid Journal   (Followers: 1, SJR: 0.265, CiteScore: 1)
J. of Oceanography     Hybrid Journal   (Followers: 11, SJR: 0.989, CiteScore: 2)
J. of Ocular Biology, Diseases, and Informatics     Hybrid Journal  
J. of Optical and Fiber Communications Reports     Hybrid Journal   (Followers: 4)
J. of Optics     Hybrid Journal   (Followers: 8)
J. of Optimization Theory and Applications     Hybrid Journal   (Followers: 5, SJR: 0.813, CiteScore: 1)
J. of Ornithology     Hybrid Journal   (Followers: 23)
J. of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal   (SJR: 0.579, CiteScore: 1)

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Journal Cover
European Archives of Oto-Rhino-Laryngology
Journal Prestige (SJR): 0.8
Citation Impact (citeScore): 2
Number of Followers: 4  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1434-4726 - ISSN (Online) 0937-4477
Published by Springer-Verlag Homepage  [2350 journals]
  • The lymphocyte-to-monocyte ratio as a prognostic indicator in head and
           neck cancer: a systematic review and meta-analysis
    • Authors: Tristan Tham; Caitlin Olson; Julian Khaymovich; Saori Wendy Herman; Peter David Costantino
      Pages: 1663 - 1670
      Abstract: Purpose The aim of this systematic review and meta-analysis was to investigate the relationship between the pre-treatment lymphocyte-to-monocyte ratio (LMR) and prognosis in HNC. Methods PubMed (via the Web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-free survival (DFS). Results Our analysis included the results of 4260 patients in seven cohorts. The pooled data demonstrated that an elevated LMR was associated with significantly improved OS (HR 0.5; 95% CI 0.44–0.57), and DFS (HR 0.70; 95% CI 0.62–0.80). Of note, there was no detectable heterogeneity in either OS (I2 = 0%) or DFS (I2 = 0%). Conclusions An elevated LMR may be an indicator of favorable prognosis in HNC. However, our results should be interpreted with some degree of caution due to the retrospective nature of cohort studies. Further research with high-quality prospective studies is needed to confirm the effect of LMR in HNC prognosis.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4972-x
      Issue No: Vol. 275, No. 7 (2018)
  • Provox 2 ® and Provox Vega ® device life-time: a case-crossover study
           with multivariate analysis of possible influential factors and duration
    • Authors: Miguel Mayo-Yáñez; Irma Cabo-Varela; Loredana Dovalo-Carballo; Christian Calvo-Henríquez; Alejandro Martínez-Morán; Jesús Herranz González-Botas
      Pages: 1827 - 1830
      Abstract: Introduction Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Current literature is limited and contradictory about the possible causes of device failure. The aim of the study is to compare the device life-time between the Provox 2 and Provox Vega and to examine possible related factors that influence their duration. Methods Retrospective case-crossover study in 34 laryngectomized patients who had undergone tracheoesophageal voice rehabilitation using indwelling Provox 2 and Provox Vega voice prostheses between 2010 and 2016 in a tertiary care centre. Results A total of 440 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 221, 64.2%) in both models. Radiotherapy increases the risk of prosthesis replacement (IRR = 1.88, p = 0.007) as well as bilateral neck dissection (IRR = 1.56, p = 0.017) in Provox 2. Age and unilateral neck dissection do not seem to influence the duration of the prosthesis. Mean life-time of Provox 2 was 106.64 days and 124.19 days for Provox Vega (p = 0.261). Complementary treatment with radiotherapy demonstrated a lower device survival (p < 0.001). Discussion Results confirmed the non-significant differences on device life between Provox Vega and Provox 2, as well as the relevant role of radiotherapy treatment in the increase of replacements and diminution of the device duration.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5008-2
      Issue No: Vol. 275, No. 7 (2018)
  • Patient-reported outcome: results of the multicenter German post-market
    • Authors: Katrin Hasselbacher; B. Hofauer; J. T. Maurer; C. Heiser; A. Steffen; J. U. Sommer
      Pages: 1913 - 1919
      Abstract: Purpose Upper airway stimulation (UAS) is an alternative second-line treatment option for patients with obstructive sleep apnea (OSA). In our substudy of a previous multicentre study of patients implanted with UAS, we focused on patient-related outcomes like Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), snoring and personal satisfaction 6 and 12 months after the implantation. Methods 60 patients, who were initially non-adherent to CPAP and implanted with UAS, were included in a prospective multicentre study. Data were collected preoperative, 6 and 12 months after implantation regarding FOSQ, ESS, snoring, and their experience with the UAS device. Results Besides relevant Apnoea–Hypopnea Index (AHI) reduction, we saw significant improvements in ESS (p < 0.001), FOSQ (p < 0.001) and snoring under UAS therapy. A strong correlation between AHI results postoperative and the personal satisfaction of the patients after implantation was found as well as between usage results and AHI compared to the preoperative results. Conclusion The more the patients benefit from UAS according to their self-reported outcome, the higher is the therapy use.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5017-1
      Issue No: Vol. 275, No. 7 (2018)
  • De-mucosalized pharyngeal flap: a modified technique for selected cases of
           velopharyngeal insufficiency
    • Authors: Sherif M. Askar
      Pages: 1939 - 1943
      Abstract: Background and purpose Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate. Unfortunately, bad healing of the donor site defect might be a considerable cause of morbidity of the surgery. With some modifications of flap elevation we could achieve better surgical outcomes. The aim of this study was to present the new modification of the conventional maneuver and its surgical/functional outcomes. Subjects and methods The study design is a case series. 17 patients underwent the de-mucosalized superiorly based pharyngeal flap for the treatment of velopharyngeal insufficiency. A wide laterally based (mucosa-only) flap was elevated off the submucosa of the posterior pharyngeal wall and then a superiorly based posterior pharyngeal flap (bared of its covering mucosa) was elevated and sutured to the palate. The mucosal flap was draped over the bed and sutured. Results No significant complications as airway problems, infection and bleeding were reported. Also, the postoperative pain was tolerable and there were no reports of neck rigidity with early ambulation; VAS showed significant improvement. No patients showed flap dehiscence or palatal fistula. Speech assessment showed improvement. Conclusion The modified de-mucosalized, superiorly based pharyngeal flap technique ensured self-mucosal draping of the bed, thus it would enhance primary healing and decrease postoperative pain with the resultant early ambulation. We believe that the new modified technique could correct VPI, in addition to the improvement of patients’ comfort and decrease the morbidity of the procedure.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5018-0
      Issue No: Vol. 275, No. 7 (2018)
  • Expression of cancer stem cell markers CD44, ALDH1 and p75NTR in actinic
           cheilitis and lip cancer
    • Abstract: Purpose The aim of this work was to evaluate the expression of the cancer stem cell (CSC) markers CD44, ALDH1 and p75NTR in the ultraviolet-induced lesions actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC), and to correlate it with p53 expression. Methods Immunohistochemistry was performed in 4 cases of normal lip (NL), 43 of AC and 20 of LSCC. Results All cases were positive for CD44, showing a membranous staining without differences between the groups. ALDH1 showed cytoplasmic staining and it was invariable amongst the grades of epithelial dysplasia and between AC and LSCC. p75NTR presented membranous/cytoplasmic staining in the basal and parabasal layer of NL and AC, while LSCC presented cytoplasmic staining in the peripheral layers of the tumor islands. p75NTR showed different expression amongst the dysplasia grades (p < 0.001) but no differences between AC and LSCC. p53 expression was similar amongst the dysplasia grades and between AC and LSCC. CD44, ALDH1 and p75NTR were unrelated amongst themselves and to p53 expression. Conclusions CSC markers are expressed in potentially malignant and malignant lesions of the lip. Their expressions were invariable between AC and LSCC and unrelated to p53. p75NTR expression increased with the worsening of epithelial dysplasia grade.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5002-8
  • P1 cortical auditory evoked potential in children with unilateral or
           bilateral cochlear implants; implication for the timing of second cochlear
    • Abstract: Objective To examine maturation of the central auditory pathway, using P1 cortical auditory evoked potential (CAEP), in children who had received unilateral or bilateral cochlear implantation (CI). Study design Prospective study. Setting Tertiary referral hospital. Methods Twenty children who had received CI due to congenital, or prelingual, deafness participated in the study. Participants had received the 1st implant at a mean age of 3.4 ± 0.7 years; 16 had also received a 2nd CI for the contralateral ear, at a mean age of 11.1 ± 2.1 years. P1 CAEP was recorded while using the 1st implant and, for those who received contralateral CI, within 2 weeks of switching on the 2nd implant. Relations between P1 latency and duration with the 1st implant, and between age at 1st CI and P1 latency, were investigated. Relations between P1 latency with the 1st and 2nd implants, and between the interstage interval and difference between P1 latencies with the 1st and 2nd implants, were also examined. Results P1 CAEP with the 1st implant was present in 16 of the 20 children. Mean P1 latency was shorter in the early CI group compared with the late CI group, but this difference was not statistically significant (p = 0.154). There was a significant negative correlation between the duration with the 1st implant and P1 latency (r = − 0.783, p < 0.001). Among the 16 children with sequential bilateral CI, P1 CAEP with the 2nd implant was present in 10. There was a significant negative correlation between the duration with the 1st implant before receiving the 2nd implant and P1 latency with the 2nd implant (r = − 0.710, p = 0.021); there was also a significant positive correlation between P1 latency with the 1st and 2nd implants (r = 0.722, p = 0.018). There was not a significant correlation between interstage interval and the difference between the two P1 latencies (r = − 0.430, p = 0.248). Conclusion Longer cochlear implant use is associated with shorter P1 latency. Unilateral hearing with the 1st implant may positively affect P1 latency with the 2nd CI ear. These findings imply that increased auditory experience may influence central auditory pathway maturation and that the degree of central auditory pathway maturation before the 2nd CI, rather than the timing when the surgery is received, may influence 2nd CI outcome in children with sequential bilateral cochlear implants.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5021-5
  • Proposal of a form for the collection of videolaryngostroboscopy basic
    • Abstract: Videolaryngostroboscopy is a useful investigation required for a correct diagnosis of laryngeal diseases and voice disorders. We present a form for the collection of basic laryngostroboscopic findings, which provides for the evaluation of the classical six parameters codified by Hirano (symmetry and periodicity of glottic vibration, glottic closure, profile of vocal fold edge, amplitude of vocal fold vibration, mucosal wave) and six other parameters which we have included in the form for an essential and complete laryngostroboscopic evaluation (supraglottic framework behaviour, seat of phonatory vibration, vocal fold morphology and motility, level of the vocal fold, stops of vocal fold mucosa vibration). This form was created in 2002 during the elaboration of the protocol for the assessment of dysphonia of the Italian Society of Phoniatrics and Logopedics, which follows the guidelines of the European Laryngological Society published in 2001. We used this form for 15 years in our daily laryngological practice with great satisfaction. We propose a more detailed version of this form, which provides for drawings which show the various videolaryngostroboscopic findings, helping the laryngologist in the collection of videolaryngostroboscopic examination basic findings.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4991-7
  • Robotic lateral oropharyngectomy following diagnostic tonsillectomy is
           oncologically safe in patients with high risk human papillomavirus related
           squamous cell cancer
    • Abstract: Purpose Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. Methods 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). Results Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2–50.4). Conclusions This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4968-6
  • Comparison of narrow band imaging and the Storz Professional Image
           Enhancement System for detection of laryngeal and hypopharyngeal
    • Abstract: Objective The aim of this study was to compare narrow band imaging (NBI) endoscopy and Storz Professional Image Enhancement System (SPIES) in observing epithelial and/or subepithelial microvascular irregularities and pathologies. Methods A total of 73 patients with laryngeal or hypopharyngeal lesions were investigated using high-definition NBI endoscopy preoperatively in local anesthesia and using SPIES system intraoperatively in general anesthesia from August 2016 to October 2017. Superficial vascular structures were classified preoperatively (NBI) and intraoperatively (SPIES) according to descriptive guidelines of vascular changes by Arens. All lesions were endoscopically evaluated and divided according to the histological examination into four groups (A—benign lesions, B—recurrent respiratory papillomatosis, C—low-grade dysplasia, D—high-grade dysplasia, carcinoma in situ or invasive squamous cell carcinoma), and results were compared with NBI and SPIES optical biopsy. Results Benign lesions (polyps, cysts, chronic inflammation, hyperkeratosis) were histologically confirmed in 26/73 (35.6%) cases and identified by NBI in 20/26 lesions (76.9%) and in 20/26 cases (76.9%) by SPIES, respectively. Recurrent respiratory papillomatosis was confirmed in 16/73 (21.9%) and detected in 15/16 cases (93.8%) by NBI and in 16/16 cases (100.0%) by SPIES. Low-grade dysplasia (mild and moderate dysplasia) was histologically detected in 7/73 patients (9.6%) and accurately identified by NBI in 6/7 (85.7%) and by SPIES in 6/7 (85.7%) cases, respectively. Histopathological features of severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma were detected in 24/73 (32.9%) patients. According to the NBI endoscopy the suspected vascular neoangiogenesis was recognized in 19/24 cases (79.2%) and in 18/24 cases (75.0%) using SPIES endoscopy. Sensitivity and specificity of NBI endoscopy and SPIES system in correct prediction of histological diagnosis of already detected lesions were 83.0 and 98.0% and 86.0 and 96.0%, respectively. Results of NBI/SPIES endoscopy and histopathological features of laryngeal and hypopharyngeal lesions were compared and the level of agreement was 81.43%, kappa index κ = 0.7428 (95% CI 0.682–0.832) (p < 0.001) by NBI endoscopy and 81.16%, kappa index κ = 0.7379 (95% CI 0.638–0.880) (p < 0.001) by SPIES endoscopy, respectively. The agreement was confirmed as substantial and strong. Level of agreement of both endoscopic methods was 92.54%, kappa index κ = 0.8965 (95% CI 0.877–0.954) (p < 0.001), agreement was confirmed as almost perfect. Between NBI and SPIES endoscopic imaging methods is no significant differentiation. Conclusion Both methods, NBI endoscopy and SPIES system, are comparable in detection and analysis of superficial neoangiogenesis, typical for benign lesion and for precancerous or cancerous changes in larynx and hypopharynx.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4987-3
  • Percutaneous bone-anchored hearing implant surgery: linear incision
           technique with tissue preservation versus linear incision technique with
           tissue reduction
    • Abstract: Objectives To identify differences in skin thickening and soft tissue reactions between the linear incision technique with tissue reduction (LITT-R) and the linear incision technique with tissue preservation (LITT-P). Study design Retrospective cohort study. Methods All adult patients who underwent the LITT-R or LITT-P between August 2005 and December 2016 at a large general teaching hospital with a minimum follow-up of 6 months were included. Results A total of 83 implants were included using the LITT-R with a median follow-up of 74.0 months. In the LITT-P cohort 58 implants were included with a median follow-up of 16.5 months. Skin thickening was seen in seven implants (8.4%) in LITT-R cohort and 11 implants (19.0%) in the LITT-P cohort in the first 2 years of follow-up (p = 0.024). Skin thickening in need of treatment was registered in 5 (6.0%), respectively, 6 (10.3%) implants (p = 0.100). Moreover, treatment was successful in all cases. A soft tissue reaction (Holgers ≥ 1) was noticed in 28 (33.7%) implants in the LITT-R group compared to 16 implants (27.6%) in the LITT-P group (p = 0.679). An adverse soft tissue reaction (Holgers ≥ 2) was registered in 16 (19.2%), respectively, 2 (3.4%) implants. This difference was significant (p = 0.040). Conclusion LITT-P has a significantly higher rate of skin thickening and LITT-R has a significantly higher proportion of adverse soft tissue reactions. Nevertheless, combined with the advantages of LITT-P described in other studies, this can be advocated as the preferred technique.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5005-5
  • Laser debulking or tracheotomy in airway management prior to total
           laryngectomy for T4a laryngeal cancer
    • Abstract: Purpose Retrospective studies have shown that tracheotomy prior to total laryngectomy (TL) is associated with decreased survival. We sought to investigate whether this is due to higher local invasiveness associated with obstructive disease or whether it is the result of tracheotomy itself. Methods We reviewed patients with a T4a (AJCC 7th edition) laryngeal squamous-cell carcinoma treated with a primary TL followed by adjuvant radiotherapy between 2001 and 2013. We compared patients who had obstructive lesions with those who had non-obstructive lesions in terms of preoperative data, pathological features, and treatment outcomes. Second, we compared tracheotomized patients with patients who underwent endoscopic laser debulking (ELD). Results One hundred patients were reviewed. Thirty-seven of them required an airway intervention prior to a TL (tracheotomy n = 24/ELD n = 13). Patients with obstructive tumors had more frequently subglottic extension (p = 0.0066) and a shorter disease-free survival (DFS) (p = 0.046), due to a higher incidence of additional distant metastases. Tracheotomy was associated with a shorter DFS (p = 0.035) and more frequent perineural invasion (p = 0.0272) as compared to ELD, but not with a higher incidence of stomal recurrence. Conclusions A tracheotomy prior to a total laryngectomy is associated with decreased survival. We recommend laser debulking as the preferred treatment whenever management of an obstructive airway is required prior to a total laryngectomy.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4994-4
  • Malleostapedotomy with the self-fixing and articulated titanium piston
    • Abstract: Objective To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler. Study design Retrospective case review. Setting Tertiary referral center. Patients and interventions This study concerns a retrospective analysis of the results of malleostapedotomy with the use of a self-fixing articulated titanium piston in 16 ears of 16 consecutively treated patients between 2005 and 2009. The medical files were used for the acquisition of data on medical and surgical history and to obtain pre- and postoperative audiometry. Diagnosis and outcomes of mainly revision surgeries are presented and compared to the literature. Main outcome measures Effect of (revision) malleostapedotomy by evaluating postoperative audiometry and air–bone gap closure. Results The postoperative air–bone gap closure was ≤ 10 dB in 9/16 (56%) ears and within ≤ 20 dB in 13/16 (81%) ears. The mean postoperative air–bone gap was 14.3 dB HL (0.5–2.0 kHz) and 17.3 dB HL (0.5–4.0 kHz). Postoperatively, there was no increase in bone conduction thresholds larger than 3 dB (0.5–2.0 kHz) and postoperative dizziness was absent or very limited and transient. Conclusions The malleostapedotomy procedure has become surgically less demanding over time by the technical improvements present in the nowadays available pistons. The design of the self-fixing and articulated titanium piston used in the present group of patients allows a safe and straight-forward malleostapedotomy procedure. Present hearing outcomes match with results presented in the literature.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4999-z
  • Cancer stage and pack-years, but not p16 or HPV, are relevant for survival
           in hypopharyngeal and laryngeal squamous cell carcinomas
    • Abstract: Purpose Recently, p16 has been included in the TNM guideline for oropharyngeal carcinomas. The role of HPV and p16 in hypopharyngeal and laryngeal carcinomas has not yet been established sufficiently. Methods Hundred and thirty-four patients with hypopharyngeal and laryngeal carcinomas were included in this retrospective analysis. Only patients with known HPV status were eligible for the investigation. Survival probabilities were estimated for different risk factors. Results Eighty-five patients presented with laryngeal carcinoma and 49 patients with hypopharyngeal carcinoma. 8% were HPV positive (10.6% laryngeal, 4.1% hypopharyngeal carcinoma). Median follow-up time was 58 months. We observed a significantly better overall survival for patients with an early tumor stage compared to advanced carcinoma. One of the hypopharyngeal HPV positive carcinomas was also p16 positive and one was p16 negative. Of the nine HPV positive laryngeal carcinomas, four were p16 positive and five p16 negative. Neither patients who were HPV positive nor patients positive for p16 showed a significantly better outcome than HPV or p16 negative patients. In contrast, nicotine pack-years showed a highly significant correlation with survival in our patient collective. Conclusions The data suggest that tumor stage and nicotine exposure seem to have the highest impact on survival in hypopharyngeal and laryngeal squamous cell carcinoma patients. There is no evidence for a better survival for p16 positive or HPV positive patients with hypopharyngeal or laryngeal squamous cell carcinoma. HPV seems to play a minor role in these entities of head and neck carcinoma.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4997-1
  • Impact of residual frontal recess cells on frontal sinusitis after
           endoscopic sinus surgery
    • Abstract: Purpose Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus. Methods We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3 months after surgery. Results The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification. Conclusions Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5003-7
  • Anatomical variations of the ethmoidal roof: differences between men and
    • Abstract: Aim During the paranasal sinuses surgery different complications may occur, both vascular and bony. The objective of the present study was to evaluate the ethmoidal roof configuration through the Keros and Yenigun classifications, analyzing results stratified by gender and side. Materials and methods We retrospectively analyzed 120 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in a coronal view and the anterior–posterior length in a cross section. Results The Keros Type II was the most frequent and no statistically significant difference was found when comparing by gender. Yenigun type I was more prevalent, and a statistically significant difference was found between men and women in types I and II (p = 0.010 and p = 0.049, respectively). Statistical difference was observed in anterior–posterior means in the comparison between both classifications. In both, right and left side for men (p = 0.003 and p = 0.05) and women (p = 0.029 and p = 0.039). Conclusion We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4992-6
  • Identification of dizzy patients who will develop an acute cerebrovascular
           syndrome: a descriptive study among emergency department patients
    • Abstract: Purpose To calculate the incidence of subsequent acute cerebrovascular syndrome in emergency department patients with vertigo or dizziness symptoms and to determine predictors of subsequent acute cerebrovascular syndrome in these patients. Methods Descriptive and retrospective hospital based-population study among emergency department patients with vertigo or dizziness symptoms in 1 year. One year follow-up since the medical visit was performed. Chi-square and Fisher tests were used for qualitative variables; Mann–Whitney U test for quantitative variables. A multivariate model was created. Results 1243 dizzy patients who visited emergency department during 2015 were identified, finally 928 were included. 12 acute cerebrovascular syndromes were identified; 8 strokes and 4 transient ischemic attacks. Percentages over the sample size: 1.29% for acute cerebrovascular syndromes, 0.43% for transient ischemic attack and 0.86% for stroke. Odds ratio values to develop an event over the general population were 7.24 for acute cerebrovascular syndrome, 95% CI (3.98–13.12); 14.9 for transient ischemic attack, 95% CI (4.8–40.9) and 5.86 for stroke, 95% CI (2.72–12.0). Atrial fibrillation and diabetes mellitus were identified as significant risk factors to develop an acute cerebrovascular syndrome. Conclusion Emergency department patients with symptoms of vertigo or dizziness had sevenfold higher risk of acute cerebrovascular syndromes than the general population. Atrial fibrillation and diabetes mellitus are risk factors associated with high risk of acute cerebrovascular syndromes in these patients.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4988-2
  • Is the modified cupulolith repositioning maneuver effective for treatment
           of persistent geotropic direction-changing positional nystagmus'
    • Abstract: Objective Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a “light cupula” in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN. Study design Retrospective cohort study. Methods Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups. Results On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan–Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups. Conclusion Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5006-4
  • Optical coherence tomography and confocal laser scanning microscopy as
           non-invasive tools in the diagnosis of sinonasal inverted papilloma: a
           pilot study
    • Abstract: Optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM) are light-based imaging techniques that allow for a visualization of microscopic tissue properties in vivo. Our study was to examine whether they allow for differentiation of inverted papilloma (IP) from nasal polyps (NP). Five cases of IP and NP, respectively, were investigated intraoperatively with OCT and CLSM. Biopsies were taken of the investigated area and were analyzed ex vivo with OCT and CLSM and then underwent HE-staining for standard light microscopy. On OCT images, IP showed the characteristic inverted character of the epithelium, that was thicker with a high degree of variability of thickness compared to the thin and homogenous epithelium of NP. In addition, the characteristic stromal edema of NP could be visualized. On CLSM images, the typical epithelial invaginations of IP appeared as crypts, while in NP the highly organized cylindric epithelium could be visualized. In vivo, OCT acquired images of sufficient quality to visualize these characteristics, while CLSM did not. Our study demonstrates that OCT and CLSM can distinguish IP from NP. Further technical development is required to apply the techniques clinically to guide intranasal biopsies or even to make them dispensable.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-4995-3
  • Reliability and validity of the Eating Assessment Tool-10 (Greek
           adaptation) in neurogenic and head and neck cancer-related oropharyngeal
    • Abstract: Purpose Dysphagia is a symptom associated with significant morbidity and mortality, with profound impact on physical ability and quality of life. Many questionnaires have been used to assess patient-reported dysphagia, but issues related to developmental and measurement properties affect their wide applicability. The purpose of this study was to assess the validity and reliability of the Eating Assessment Tool-10 (EAT-10, Greek adaptation) in neurogenic and head and neck cancer-related dysphagia. Methods The study consisted of: item generation in the Greek language, internal consistency and reliability analysis, normative data generation, and validity analysis. Data were collected prospectively from 421 participants: 144 asymptomatic subjects, 146 patients with dysphagia, and 131 patients with dysphagia-related diagnoses. Validity was assessed by comparing scores of healthy and dysphagic participants, by comparing pre- and post-treatment scores, and by correlating the Greek-EAT-10 with fibreoptic endoscopic evaluation of swallowing (FEES). Results The mean participants’ age was 52.85 years (ranging from 18 to 85 years). All questionnaires were completed in less than 3 min. The overall internal consistency (assessed with Cronbach’s alpha) was 0.963. The test–retest reliability was excellent with Spearman’s rho ranging from 0.937 to 1. Dysphagic patients had a significantly higher score compared to healthy participants (p < 0.001). The mean EAT-10 improved significantly after treatment (Wilcoxon signed rank, p < 0.001). The Greek-EAT-10 and FEES scores were significantly correlated (Spearman’s rho = 0.69). Conclusions The EAT-10 is a valid, reliable, symptom-specific tool for the assessment of dysphagia, easily self-administered, and practical for clinical use.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5001-9
  • ENT audit and research in the era of trainee collaboratives
    • Abstract: Large surgical audits and research projects are complex and costly to deliver, but increasingly surgical trainees are delivering these projects within formal collaboratives and research networks. Surgical trainee collaboratives are now recognised as a valuable part of the research infrastructure, with many perceived benefits for both the trainees and the wider surgical speciality. In this article, we describe the activity of ENT trainee research collaboratives within the UK, and summarise how INTEGRATE, the UK National ENT Trainee Research Network, successfully delivered a national audit of epistaxis management. The prospective audit collected high-quality data from 1826 individuals, representing 94% of all cases that met the inclusion criteria at the 113 participating sites over the 30-day audit period. It is hoped that the audit has provided a template for subsequent high-quality and cost-effective national studies, and we discuss the future possibilities for ENT trainee research collaboratives.
      PubDate: 2018-07-01
      DOI: 10.1007/s00405-018-5009-1
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