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Journal of Otolaryngology - Head and Neck Surgery
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  This is an Open Access Journal Open Access journal
     ISSN (Print) 1916-0216
     Published by Biomed Central Ltd. Homepage  [268 journals]   [SJR: 0.564]   [H-I: 11]
  • Metallic hairpin inhalation: a healthcare problem facing young Muslim

    • Authors: Nabil Rizk, Noor Gwely, Vincent Biron, Usama Hamza
      First page: 21
      Abstract: ObjectivesTo perform an epidemiological assessment of metallic hairpin inhalation in young Muslim females and highlight the need for a health education program in this population. Methods: We performed a retrospective analysis of females with a history of metallic hairpin inhalation presenting to the Otolaryngology and Cardiothoracic Surgery Departments at Mansoura University Hospitals from January 2000 to October 2006. Results: A total of 83 patients were identified with metallic hairpin inhalation, of which 2 were excluded as they were coughed and expelled by the patient. Ages ranged from 7 to 19 years. A history of inhaled foreign body (FB) was found in all cases but the majority of patients were asymptomatic, with only 6 patients (7%) presenting with cough. Chest x-rays confirmed the presence of metallic hairpin inhalation in all cases. The metallic hairpins were present in the trachea in 7 patients (9%), in the left bronchial tree in 43 patients (53%) and in the right bronchial tree in 31 patients (38%). Rigid bronchoscopy was performed in all patients with a retrieval rate of 80%. Repeat bronchoscopy was performed in 16 patients (20%), which was successful in 11 patients (14%). The remaining 5 patients required thoracotomy for removal of the metallic hairpin (6%). Conclusion: The significant number of inhaled metallic hairpins in young Muslim females highlights the need for a health education program in this population. Rigid bronchoscopy remains the primary tool for retrieval of these inhaled foreign bodies. However, when repeat broncoscopy is necessitated, a thoracotomy may be required.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:21
      PubDate: 2014-08-02T12:00:00Z
      DOI: 10.1186/s40463-014-0021-y
      Issue No: Vol. ${item.volume} (2014)
  • Differential expression of transforming growth factor-beta in benign vs.
           papillary thyroid cancer nodules; a potential diagnostic tool'

    • Authors: Matthew Brace, Jun Wang, Mark Petten, Martin Bullock, Fawaz Makki, Jonathan Trites, S Taylor, Robert Hart
      First page: 22
      Abstract: Background: Thyroid nodules are common, but only 5% of nodules are found to be malignant. In North America, the incidence of thyroid cancer is increasing. Fine needle aspirate (FNA) biopsy is the diagnostic test of choice. Unfortunately, up to 20% of FNAs are non-diagnostic. A specific molecular marker for thyroid cancer is desirable. Evidence suggests that cell signaling through transforming growth factor beta (TGF- β) is important in the development of thyroid cancer. We sought to compare the expression of TGF- β in malignant and benign thyroid nodules. Methods: From 2008-present, thyroid nodule tissue from thyroidectomy specimens was prospectively collected and stored at −80°C. RNA extraction and reverse transcription was performed on 47 samples (24 papillary thyroid cancer and 23 benign nodules). Quantitative PCR using SYBR green was performed to detect TGF-β-1 and −2. Resulting CT values were normalized against β-actin. Gene expression was calculated using the 2-ΔC T method. Results: A significantly greater expression of TGF- β1 (p 
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:22
      PubDate: 2014-07-18T12:00:00Z
      DOI: 10.1186/s40463-014-0022-x
      Issue No: Vol. ${item.volume} (2014)
  • Mixed reality temporal bone surgical dissector: mechanical design

    • Authors: Jordan Hochman, Nariman Sepehri, Vivek Rampersad, Jay Kraut, Milad Khazraee, Justyn Pisa, Bertram Unger
      First page: 23
      Abstract: ObjectiveThe Development of a Novel Mixed Reality (MR) Simulation.An evolving training environment emphasizes the importance of simulation. Current haptic temporal bone simulators have difficulty representing realistic contact forces and while 3D printed models convincingly represent vibrational properties of bone, they cannot reproduce soft tissue. This paper introduces a mixed reality model, where the effective elements of both simulations are combined; haptic rendering of soft tissue directly interacts with a printed bone model.This paper addresses one aspect in a series of challenges, specifically the mechanical merger of a haptic device with an otic drill. This further necessitates gravity cancelation of the work assembly gripper mechanism. In this system, the haptic end-effector is replaced by a high-speed drill and the virtual contact forces need to be repositioned to the drill tip from the mid wand.Previous publications detail generation of both the requisite printed and haptic simulations.MethodCustom software was developed to reposition the haptic interaction point to the drill tip. A custom fitting, to hold the otic drill, was developed and its weight was offset using the haptic device. The robustness of the system to disturbances and its stable performance during drilling were tested. The experiments were performed on a mixed reality model consisting of two drillable rapid-prototyped layers separated by a free-space. Within the free-space, a linear virtual force model is applied to simulate drill contact with soft tissue. Results: Testing illustrated the effectiveness of gravity cancellation. Additionally, the system exhibited excellent performance given random inputs and during the drill’s passage between real and virtual components of the model. No issues with registration at model boundaries were encountered. Conclusion: These tests provide a proof of concept for the initial stages in the development of a novel mixed-reality temporal bone simulator.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:23
      PubDate: 2014-08-08T12:00:00Z
      DOI: 10.1186/s40463-014-0023-9
      Issue No: Vol. ${item.volume} (2014)
  • Tonsillotomy versus tonsillectomy on young children: 2 year post
           surgery follow-up

    • Authors: Elisabeth Ericsson, Jonas Graf, Inger Lundeborg-Hammarstrom, Elisabeth Hultcrantz
      First page: 26
      Abstract: ObjectivesTo study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months.MethodChildren, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and children’s behavior with the Child Behavior Checklist. Results: After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery. Conclusion: Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:26
      PubDate: 2014-07-27T12:00:00Z
      DOI: 10.1186/s40463-014-0026-6
      Issue No: Vol. ${item.volume} (2014)
  • Resource development in otolaryngology-head and neck surgery: an analysis
           on patient education resource development

    • Authors: Jeremy Goldfarb, Vishaal Gupta, Heather Sampson, Albino Chiodo
      First page: 27
      Abstract: Background: There is a need for educational tools in the consenting process of otolaryngology-head and neck procedures. A development strategy for the creation of educational tools in otolaryngology-head and neck surgery, particularly pamphlets on the peri-operative period in an adenotonsillectomy, is described. Methods: A participatory design approach, which engages key stakeholders in the development of an educational tool, is used. Pamphlets were created through a review of traditional and grey literature and then reviewed by a community expert in the field. The pamphlets were then reviewed by an interdisciplinary team including educational experts, and finally by less vulnerable members of the target population. Questionnaires evaluating the pamphlets’ content, layout, style, and general qualitative features were included. Results: The pamphlets yielded high ratings across all domains regardless of patient population. General feedback was provided by a non-vulnerable patient population and final pamphlets were drafted. Conclusions: By using a participatory design model, the pamphlets are written at an appropriate educational level to incorporate a broad audience. Furthermore, this methodology can be used in future resource development of educational tools.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:27
      PubDate: 2014-07-16T12:00:00Z
      DOI: 10.1186/s40463-014-0027-5
      Issue No: Vol. ${item.volume} (2014)
  • Practice patterns in the management of patients with differentiated
           thyroid cancer in Ontario Canada 2000-2008

    • Authors: Stephen Hall, Jonathan Irish, Patti Groome, David Urbach
      First page: 29
      Abstract: Background: The extent of treatment for differentiated thyroid cancer remains controversial. The objective of this study was to describe the variations in practice prior to diagnosis and for the first year after diagnosis, including the investigations, the extent of surgery and the use of RAI 131, for all patients with thyroid cancer (TC) treated Jan 1 2000 to Dec 2008 across Ontario Canada.MethodPopulation-based study of all patients who had a therapeutic surgical procedure for TC based on the data holdings of the Institute of Clinical Investigative Sciences (ICES) linking the Ontario Cancer Registry to the Ontario Health Insurance Plan and to the Canadian Institutes of Health Information. The analysis includes comparisons between health care utilization/geographic regions and between treating specialties. The study population was 12957 patients. Results: There was a 112% increase in case detection over 9'years. Overall the initial (index) surgery was less-than-total thyroidectomy (LTT) in 37.6% and 63.4% of the patients who had total thyroidectomy (TT) as an index surgery went on to adjuvant RAI, however there was wide variation in all aspects of patient care across the province, between Local Health Networks and between surgical specialties. Conclusion: In Ontario, there was wide variation for most aspects of the management of TC and, as the incidence of TC is increasing at least 7% per year in females, these data provide a foundation for future discussions, the provision of health care services and research.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:29
      PubDate: 2014-07-24T12:00:00Z
      DOI: 10.1186/s40463-014-0029-3
      Issue No: Vol. ${item.volume} (2014)
  • Cochlea sparing effects of intensity modulated radiation therapy in head
           and neck cancers patients: a long-term follow-up study

    • Authors: Eleonoor Theunissen, Charlotte Zuur, Marta Yurda, Sieberen van der Baan, Anne Kornman, Jan de Boer, Alfons Balm, Coen Rasch, Wouter Dreschler
      First page: 30
      Abstract: Background: Radiation to the inner ear may lead to (irreversible) sensorineural hearing loss. The purpose of this study was to demonstrate the long-term effect of radiotherapy on hearing in patients treated with Intensity Modulated Radiation Therapy (IMRT), sparing the inner ear from high radiation dose as much as possible. Methods: Between 2003 and 2006, 101 patients with head and neck cancer were treated with IMRT. Audiometry was performed before, short-term, and long-term after treatment. Data were compared to normal hearing levels according to the International Organisation for Standardization (ISO). Statistical analysis was done using repeated measurements. None of the patients received chemotherapy. Results: In 36 patients a audiogram at long-term follow-up (median 7.6'years) was available. The mean dose to the cochlea was 17.8'Gy (1.0-66.6'Gy). A hearing deterioration of 1.8'dB at Pure Tone Average (PTA) 0.5-1-2'kHz (p'='0.11), 2.3'dB at PTA 1-2-4'kHz (p'='0.02) and 4.4'dB at PTA 8-10-12.5'kHz (p'='0.01) was found. According to the ISO, the expected age-related hearing loss was 2.7, 4.8, and 8.8'dB at PTA 0.5-1-2'kHz, 1-2-4'kHz and 8-10-12.5'kHz, respectively. Conclusions: After IMRT with radiation dose constrain to the cochlea, potential long-term adverse effects of IMRT remained subclinical. The progressive hearing loss over time was mild and could be attributed to the natural effects of ageing. Therefore, we recommend that a dose constraint to the cochlea should be incorporated in the head and neck radiotherapy protocols.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:30
      PubDate: 2014-08-06T12:00:00Z
      DOI: 10.1186/s40463-014-0030-x
      Issue No: Vol. ${item.volume} (2014)
  • Current management of papillary thyroid microcarcinoma in Canada

    • Authors: Mazin Merdad, Antoine Eskander, John De Almeida, Jeremy Freeman, Lorne Rotstein, Shereen Ezzat, Anna Sawka, David Goldstein
      First page: 32
      Abstract: IntroductionThe detection of papillary thyroid microcarcinoma (PTMC) is on the rise and its optimal management remains controversial. Our aim was to determine the current self-reported management of PTMC amongst Canadian otolaryngologist-head and neck surgeons (OHNS) and endocrinologists and to identify factors influencing their management decisions. Methods: A nine item web-based questionnaire was distributed to Canadian OHNS and endocrinologists. The three main domains were demographics, current management of PTMC scenarios, and factors influencing the decisions. Results: One hundred and thirteen OHNS and endocrinologists completed the survey. Respondents were closely divided between recommending hemithyroidectomy (47%) or total thyroidectomy (43%) for a newly diagnosed PTMC in a low risk patient. Observation was the preferred method for managing PTMC detected incidentally after hemithyroidectomy (76%). Respondents chose more aggressive treatment for males patients compared to female patients. A positive history of thyroid cancer or previous radiation exposure was the most important factor influencing the management of PTMC. Conclusion: The current practices of Canadian OHNS and endocrinologist largely coincide with available guidelines. The slight variation in practice might be explained by the opposing evidence supporting different management options. Given the dramatic increase in the incidence of PTMC we suggest future guidelines address the management of PTMC independently.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:32
      PubDate: 2014-08-14T00:00:00Z
      DOI: 10.1186/s40463-014-0032-8
      Issue No: Vol. ${item.volume} (2014)
  • Physician payment methods: a focus on quality and cost control

    • Authors: Luke Rudmik, Dominika Wranik, Caroline Rudisill-Michaelsen
      First page: 34
      Abstract: With rising health care costs, governments must develop innovative methods to deliver efficient and equitable health care services. With physician remuneration being the third largest health care expense, the design of remuneration methods is a priority in health care policy. Otolaryngology-Head and Neck surgeons should have an understanding of the behavioural incentives associated with different physician payment methods. This article will outline the different physician payment methods with a focus on discussing the impact on quality of care and health care costs.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:34
      PubDate: 2014-08-03T00:00:00Z
      DOI: 10.1186/s40463-014-0034-6
      Issue No: Vol. ${item.volume} (2014)
  • Factors associated with severe deep neck space infections: targeting
           multiple fronts

    • Authors: Brittany Barber, Peter Dziegielewski, Vincent Biron, Andrew Ma, Hadi Seikaly
      First page: 35
      Abstract: ObjectivesTo determine factors predictive of a severe deep neck space infection (DNSI), defined as those requiring surgery and/or postoperative intensive care unit (ICU) admission. To specifically examine dental practices and socioeconomic factors that may contribute to the development of a DNSI.Study designRetrospective review. Methods: This study was conducted at 2 tertiary care academic referral centers from January 2007 to September 2011. The study was composed of 2 arms: a prospective questionnaire and data collection to identify modifiable risk factors such as dental practices and socioeconomic considerations for a DNSI, and a retrospective review of deep neck space infections to identify commonly associated risk factors predictive of a severe DNSI, requiring surgery and/or postoperative ICU admission. Results: 233 patients were reviewed retrospectively and 25 patients prospectively. Patients with a low level of education (p = 0.03), those living greater than 1 hour from a tertiary care center (p = 0.002), those that have tonsils (p = 0.03), and those with Streptococcus infections (p = 0.03) have an increase risk of developing a severe DNSI. Patients that were smokers (p = 0.02) or had diabetes (p = 0.02), and those that presented with airway compromise (p = 0.03) were more likely to have a prolonged hospital stay. Conclusions: Factors predictive of severe DNSIs are Streptococcus infections, the presence of tonsils, education level, and geographic location.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:35
      PubDate: 2014-08-16T12:00:00Z
      DOI: 10.1186/s40463-014-0035-5
      Issue No: Vol. ${item.volume} (2014)
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