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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]
  • Reviewer acknowledgement 2013

    • Authors: Hadi Seikaly, Erin Wright
      First page: 3
      Abstract: Contributing reviewersThe Editors of Journal of Otolaryngology - Head & Neck Surgery would like to thank all our reviewers who have contributed to the journal in Volume 42 (2013).
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:3
      PubDate: 2014-02-25T17:41:54Z
      DOI: 10.1186/1916-0216-43-3
      Issue No: Vol. ${item.volume} (2014)
  • Management of locally advanced laryngeal cancer

    • Authors: Alexander Karatzanis, Georgios Psychogios, Frank Waldfahrer, Markus Kapsreiter, Johannes Zenk, George Velegrakis, Heinrich Iro
      First page: 4
      Abstract: Background: Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods: Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results: A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion: This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:4
      PubDate: 2014-01-28T00:00:00Z
      DOI: 10.1186/1916-0216-43-4
      Issue No: Vol. ${item.volume} (2014)
  • Validation of 1-hour post-thyroidectomy parathyroid hormone level in
           predicting hypocalcemia

    • Authors: Trung Le, Paul Kerr, Donna Sutherland, Pascal Lambert
      First page: 5
      Abstract: Background: Prior work by our group suggested that a single one hour post-thyroidectomy parathyroid hormone (1 hr PTH) level could accurately stratify patients into high and low risk groups for the development of hypocalcemia. This study looks to validate the safety and efficacy of a protocol based on a 1 hr PTH threshold of 12 pg/ml.Study design: Retrospective analysis of consecutive cohort treated with standardized protocol. Methods: One hundred and twenty five consecutive patients underwent total or completion thyroidectomy and their PTH level was drawn 1-hour post operatively. Based on our previous work, patients were stratified into either a low risk group (PTH < 12 pg/ml) or a high risk group (PTH >= 12 pg/ml). Patients in the high risk group were immediately started on prophylactic calcium carbonate (5-10 g/d) and calcitriol (0.5-1.0 mcg/d). The outcomes were then reviewed focusing mainly on how many low risk patients developed hypocalcemia (false negative rate), and how many high risk patients failed prophylactic therapy. Results: Thirty one patients (25%) were stratified as high risk, and 94 (75%) as low risk. Five (16%) of the high risk patients became hypocalcemic despite prophylactic therapy. Two of the low risk group became hypocalcemic, (negative predictive value = 98%). None of the hypocalcemic patients had anything more than mild symptoms. Conclusions: A single 1-hour post-thyroidectomy PTH level is a very useful way to stratify thyroidectomy patients into high and low risk groups for development of hypocalcemia. Early implementation of oral prophylactic calcium and vitamin D in the high risk patients is a very effective way to prevent serious hypocalcemia. Complex protocols requiring multiple calcium and PTH measurements are not required to guide post-thyroidectomy management.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:5
      PubDate: 2014-01-29T00:00:00Z
      DOI: 10.1186/1916-0216-43-5
      Issue No: Vol. ${item.volume} (2014)
  • CO2 laser versus cold steel margin analysis following endoscopic excision
           of glottic cancer

    • Authors: Fawaz Makki, Matthew Rigby, Martin Bullock, Timothy Brown, Robert Hart, Jonathan Trites, Michael Hinni, S Taylor
      First page: 6
      Abstract: ObjectiveTo compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery. Methods: Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. Results: 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). Conclusion: Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:6
      PubDate: 2014-02-06T00:00:00Z
      DOI: 10.1186/1916-0216-43-6
      Issue No: Vol. ${item.volume} (2014)
  • High definition video teaching module for learning neck dissection

    • Authors: Adrian Mendez, Hadi Seikaly, Kal Ansari, Russell Murphy, David Cote
      First page: 7
      Abstract: IntroductionVideo teaching modules are proven effective tools for enhancing student competencies and technical skills in the operating room. Integration into post-graduate surgical curricula, however, continues to pose a challenge in modern surgical education. To date, video teaching modules for neck dissection have yet to be described in the literature.Purpose: To develop and validate an HD video-based teaching module (HDVM) to help instruct post-graduate otolaryngology trainees in performing neck dissection. Methods: This prospective study included 6 intermediate to senior otolaryngology residents. All consented subjects first performed a control selective neck dissection. Subjects were then exposed to the video teaching module. Following a washout period, a repeat procedure was performed. Recordings of the both sets of neck dissections were de-identified and reviewed by an independent evaluator and scored using the Observational Clinical Human Reliability Assessment (OCHRA) system. Results: In total 91 surgical errors were made prior to the HDVM and 41 after exposure, representing a 55% decrease in error occurrence. The two groups were found to be significantly different. Similarly, 66 and 24 staff takeover events occurred pre and post HDVM exposure, respectively, representing a statistically significant 64% decrease. Conclusion: HDVM is a useful adjunct to classical surgical training. Residents performed significantly less errors following exposure to the HD-video module. Similarly, significantly less staff takeover events occurred following exposure to the HDVM.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:7
      PubDate: 2014-03-25T00:00:00Z
      DOI: 10.1186/1916-0216-43-7
      Issue No: Vol. ${item.volume} (2014)
  • The effect of topically applied tissue expanders on radial forearm skin
           pliability: a prospective self-controlled study

    • Authors: Jeffson Chung, James Bonaparte, Michael Odell, Martin Corsten
      First page: 8
      Abstract: Background: The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. Methods: Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. Results: There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [-0.04, 0.12], p = 0.30). Conclusions: This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:8
      PubDate: 2014-04-16T00:00:00Z
      DOI: 10.1186/1916-0216-43-8
      Issue No: Vol. ${item.volume} (2014)
  • Fiber-optic endoscopic evaluation of swallowing to assess swallowing
           outcomes as a function of head position in a normal population

    • Authors: Lucas Badenduck, T Matthews, Alanna McDonough, Joseph Dort, Kristin Wiens, Rachelle Kettner, Susan Crawford, Bonnie Kaplan
      First page: 9
      Abstract: Background: Head position practice has been shown to influence pill-swallowing ability, but the impact of head position on measures of swallowing outcomes has not yet been studied with fiber-optic endoscopic evaluation of swallowing (FEES). The primary purpose of this study was to determine whether head position impacts penetration-aspiration scale scores and/or post-swallow pharyngeal residue as assessed by FEES. Documenting the incidence of pharyngeal residue and laryngeal penetration and aspiration in a normal population was a secondary goal. Methods: Adults without swallowing difficulties (N = 84) were taught a pill swallowing technique based on learning five head positions and were asked to practice with small, hard candies (e.g., TicTacs) for two weeks. Then they demonstrated swallowing in each of the head positions for two conditions, liquid and puree, while undergoing FEES. Results: Out of 840 examined swallows, one event of aspiration and 5 events of penetration occurred. During practice >50% participants found positions they preferred over the center position for swallowing but head position was not associated with penetration-aspiration scores assessed by FEES. Significant associations and non-significant trends were found between pharyngeal residue and three variables: age, most preferred head position, and least preferred head position. Conclusion: Head position during swallowing (head up) and age greater than 40 years may result in increased pharyngeal residue but not laryngeal penetration or aspiration.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:9
      PubDate: 2014-04-22T00:00:00Z
      DOI: 10.1186/1916-0216-43-9
      Issue No: Vol. ${item.volume} (2014)
  • Role of season, temperature and humidity on the incidence of epistaxis in
           Alberta, Canada

    • Authors: Leigh Sowerby, Joshua DeSerres, Luke Rudmik, Erin Wright
      First page: 10
      Abstract: Background: Classical dogma holds that epistaxis is more common in winter months but there is significant variability reported in the literature. No study has yet examined the effect of season, humidity and temperature on epistaxis in a location with as severe weather extremes as seen in Alberta, Canada. The objective of the study is to evaluate for an effect of these meteorological factors on the incidence of epistaxis in Alberta.MethodA retrospective review of consecutive adult patients presenting to the Emergency room (ER) in Edmonton and Calgary, Alberta over a three-year period was performed. Daily temperature and humidity data was recorded from the respective airports. Statistical analysis with Pearson's correlation coefficient was performed. Results: 4315 patients presented during the study period. Mean daily temperatures ranged from a low of -40[degree sign]C to a high of +23[degree sign]C. A significant negative correlation was found for mean monthly temperature with epistaxis (Pearson's r = -0.835, p = 0.001). A significant correlation was also present for daily temperature and epistaxis presentation (Pearson's r = -0.55, p = 0.018, range 1.8 to 2.2 events/day). No correlation was identified with humidity and no significant seasonal variation was present. Conclusions: A negative correlation was found to exist for both daily and mean monthly temperature with rates of epistaxis. A seasonal variation was seen in Edmonton but not in Calgary. No correlation was found for humidity when compared to both presentation rates and admissions.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:10
      PubDate: 2014-04-22T00:00:00Z
      DOI: 10.1186/1916-0216-43-10
      Issue No: Vol. ${item.volume} (2014)
  • Measurement tools for the diagnosis of nasal septal deviation: a
           systematic review

    • Authors: Tehnia Aziz, Vincent Biron, Kal Ansari, Carlos Flores-Mir
      First page: 11
      Abstract: ObjectiveTo perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD). Methods: Electronic database searches were performed using MEDLINE (from 1966 to second week of August 2013), EMBASE (from 1966 to second week of August 2013), Web of Science (from 1945 to second week of August 2013) and all Evidence Based Medicine Reviews Files (EBMR); Cochrane Database of Systematic Review (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of s of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), NHS Economic Evaluation Database (NHSEED) till the second quarter of 2013. The search terms used in database searches were 'nasal septum', 'deviation', 'diagnosis', 'nose deformities' and 'nose malformation'. The studies were reviewed using the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases. An additional 15 abstracts were excluded due to lack of relevance. A total of 8 studies were systematically reviewed. Conclusions: Diagnostic modalities such as acoustic rhinometry, rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity, but these tests in isolation are of limited utility. Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:11
      PubDate: 2014-04-24T00:00:00Z
      DOI: 10.1186/1916-0216-43-11
      Issue No: Vol. ${item.volume} (2014)
  • Development of an ototoxicity model in the adult CBA/CaJ mouse and
           determination of a golden window of corticosteroid intervention for

    • Authors: Vinay Fernandes, Vincent Lin
      First page: 12
      Abstract: ObjectiveTo investigate the effect of timing of dexamethasone administration on auditory hair cell survival following an ototoxic insult with kanamycin and furosemide.Study design: Controlled experimental study.Setting: Translational Science Experimental Laboratory. Methods: 5-6 week old CBA/CaJ mice, divided into 6 groups, were injected with kanamycin (1 mg/g SC) followed by furosemide (0.5 mg/g IP). Dexamethasone (0.1 mg/g IP) was injected at either 1 hour prior to insult, +1 hr, +6 hr, +12 hr, or +72 hr post insult. Temporal bones harvested on day 7 underwent Organ of Corti dissection. Immunohistochemical staining was performed using antibodies to myosin 7a, phalloidin, and TO-PRO. Results: Hair cell counts demonstrate a uniform ototoxicity model with total loss of outer hair cells (OHCs) and near-total loss of inner hair cells (IHCs). The group pre-treated with dexamethasone showed a statistically significant improvement in counts compared to controls (p = 0.004). Counts from the other experimental groups given dexamethasone after the insult were highly variable but demonstrated some apical and middle turn inner hair cell survival. Conclusion: Treatment of systemic dexamethasone prior to ototoxic insult attenuates hair cell loss in a reliable, novel, ototoxicity model using kanamycin and furosemide in CBA/CaJ mice. Dosing with dexamethasone following ototoxic insult shows promising yet variable response in hair cell survival.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:12
      PubDate: 2014-04-24T00:00:00Z
      DOI: 10.1186/1916-0216-43-12
      Issue No: Vol. ${item.volume} (2014)
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