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Journal Cover   Journal of Otolaryngology - Head and Neck Surgery
  [SJR: 0.571]   [H-I: 31]   [7 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1916-0216
   Published by Biomed Central Ltd. Homepage  [270 journals]
  • Selectively false-positive radionuclide scan in a patient with sarcoidosis
           and papillary thyroid cancer: a case report and review of the literature

    • Authors: Nicole Lebo, Francois Raymond, Michael Odell
      First page: 18
      Abstract: Background: Radioiodine and Tc-99 m pertechnetate scans are routinely relied upon to detect metastasis in papillary thyroid cancer; false-positive scans are relatively rare. To our knowledge, no published reports exist of sarcoidosis causing such selectively false-positive scans. Methods: We present a case of a 41-year-old woman with known metastatic papillary thyroid cancer (T1bN1aMx) in whom sarcoidosis-affected cervical and mediastinal lymph nodes demonstrated uptake of thyroid-targeting radionuclides. Only the minority of these nodes demonstrated radionuclide uptake, raising the suspicion of adjacent or coexisting sarcoid and metastatic involvement. Selective uptake of thyroid-targeted radionuclides by isolated sarcoidosis is, to our knowledge, a previously undocumented occurrence. Results: Biopsies of uptake-negative mediastinal nodes revealed sarcoidosis. Pathology from a subsequent neck dissection excising uptake-positive cervical nodes also showed sarcoidosis, with no coinciding malignancy. Conclusions: We document a case of sarcoidosis causing a selectively false-positive thyroid scintigraphy scan. It is useful for clinicians to be aware of potential false-positives and deceptive patterns on radionuclide scans when managing patients with both well-differentiated thyroid cancer and a co-existing disease affecting the nodal basins draining the thyroid gland.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:18
      PubDate: 2015-05-15T12:00:00Z
      DOI: 10.1186/s40463-015-0069-3
      Issue No: Vol. ${item.volume} (2015)
  • Optimal site for facial nerve transection and neurorrhaphy: a randomized
           prospective animal study

    • Authors: Adrian Mendez, Hadi Seikaly, Vincent Biron, Lin-fu Zhu, David Côté
      First page: 19
      Abstract: Background: Since the first facial allograft transplantation was performed, several institutions have performed the procedure with the main objectives being restoration of the aesthetic appearance and expressive function of the face. The optimal location to transect the facial nerve during flap harvest in transplantation to preserve facial movement function is currently unknown. There are currently two primary methods to perform facial nerve neurorrhaphy between the donor and recipient-one protocol involves transection and repair of the facial nerve at the main trunk while the another protocol advocates for the neurorrhaphy to be performed distally at the main branches. The purpose of this study is to establish the optimal location for transection and repair of the facial nerve to optimize functional recovery of facial movement. Methods: A prospective randomized controlled trial using a rat model was performed. Two groups of 12 rats underwent facial nerve transection and subsequent repair either at the main trunk of the nerve (group 1) or 2 cm distally, at the main bifurcation (group 2). Primary outcome of nerve functional recovery was measured using a previously validated laser curtain model, which measured amplitude of whisking at 2, 4, and 6 post-operatively. The deflection of the laser curtain sent a digital signal that was interpreted by central computer software. Results: At week 2 post-nerve surgery, the average amplitude observed for group 1 and 2 was 4.4 and 10.8 degrees, respectively. At week 4, group 1 showed improvement with an average amplitude of 9.7 degrees, while group 2 displayed an average of 10.2 degrees. The week 6 results showed the greatest improvement from baseline for group 1. Group 1 and 2 had average amplitudes of 17.2 and 6.9 degrees, respectively. There was no statistically significant difference between the two groups at 2, 4, and 6 weeks after facial nerve surgery (p > 0.05). Conclusions: We found no statistical difference between these two locations of nerve repair using identical methods. Therefore, the authors recommend a single versus multiple nerve repair technique. This finding has potential implications for future facial allograft transplantations and at minimum necessitates further study with long-term follow-up data.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:19
      PubDate: 2015-05-24T12:00:00Z
      DOI: 10.1186/s40463-015-0072-8
      Issue No: Vol. ${item.volume} (2015)
  • Predictors of round window accessibility for adult cochlear implantation
           based on pre-operative CT scan: a prospective observational study

    • Authors: Edward Park, Hosam Amoodi, Jafri Kuthubutheen, Joseph Chen, Julian Nedzelski, Vincent Lin
      First page: 20
      Abstract: Background: Cochlear implantation has become a mainstream treatment option for patients with severe to profound sensorineural hearing loss. During cochlear implant, there are key surgical steps which are influenced by anatomical variations between each patient. The aim of this study is to determine if there are potential predictors of difficulties that may be encountered during the cortical mastoidectomy, facial recess approach and round window access in cochlear implant surgery based upon pre-operative temporal bone CT scan. Methods: Fifty seven patients undergoing unilateral cochlear implantation were analyzed. Difficulty with 1) cortical mastoidectomy, 2) facial recess approach, and 3) round window access were scored intra-operatively by the surgeon in a blinded fashion (1 = “easy”, 2 = “moderate”, 3 = “difficult”). Pre-operative temporal bone CT scans were analyzed for 1) degree of mastoid aeration; 2) location of the sigmoid sinus; 3) height of the tegmen; 4) the presence of air cells in the facial recess, and 5) degree of round window bony overhang. Results: Poor mastoid aeration and lower tegmen position, but not the location of sigmoid sinus, are associated with greater difficulty with the cortical mastoidectomy. Presence of an air cell around the facial nerve was predictive of easier facial recess access. However, the degree of round window bony overhang was not predictive of difficulty associated with round window access. Conclusion: Certain parameters on the pre-operative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:20
      PubDate: 2015-05-28T12:00:00Z
      DOI: 10.1186/s40463-015-0073-7
      Issue No: Vol. ${item.volume} (2015)
  • Frontal recess anatomy in Japanese subjects and its effect on the
           development of frontal sinusitis: computed tomography analysis

    • Authors: Kazunori Kubota, Sachio Takeno, Katsuhiro Hirakawa
      First page: 21
      Abstract: Background: Comprehensive understanding of frontal recess anatomy is essential for the successful treatment of patients with frontal sinus disease. This study was designed to determine the prevalence of specific frontal recess cells in Japanese subjects and the association of these cells with the development of frontal sinusitis. Methods: Frontal recess anatomy was analyzed using high-resolution spiral computed tomography images of paranasal sinuses from December 2008 through September 2011. The distribution of various frontal recess cells in patients with and without frontal sinusitis was compared by logistic regression analysis. Results: A total of 150 patients met the criteria, and 300 sides were analyzed. Agger nasi cells were present in 88.0 % of sides; frontal cell types 1 (FC1), 2 (FC2), 3 (FC3), and 4 (FC4) were present in 37.0 %, 6.3 %, 4.3 %, and 1.3 %, respectively; supraorbital ethmoid cells in 6.0 %, suprabullar cells in 37.0 %, frontal bullar cells (FBC) in 7.0 %, and interfrontal sinus septal cells in 8.6 %. Multiple logistic regression analysis showed that the presence of FBCs was significantly associated with the development of frontal sinusitis (p = 0.043). Conclusions: The frequencies of frontal recess cells in Japanese adult patients were similar to those reported for other East Asian adult populations, including Chinese, Korean, and Taiwanese. Anatomically, FBCs may show a greater association with the development of frontal sinusitis than other frontal recess cells.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:21
      PubDate: 2015-05-29T00:00:00Z
      DOI: 10.1186/s40463-015-0074-6
      Issue No: Vol. ${item.volume} (2015)
  • The use of nasal packing post rhinoplasty: does it increase periorbital
           ecchymosis' A prospective study

    • Authors: Ahmed Al Arfaj
      First page: 22
      Abstract: Background: Periorbital edema and ecchymosis following rhinoplasty is disturbing for both the patients and their surgeons. The study aim was to determine whether nasal packing after lateral osteotomies in rhinoplasty surgery increases the risk of periorbital ecchymosis post-operatively. Methods: This was a prospective self-controlled single-blinded study. Seventy four patients who underwent rhinoplasty with bilateral lateral osteotomies by a single surgeon were enrolled in the study. Nasal cavity packing for one side was done while the other side was left unpacked. Periorbital ecchymosis was evaluated by the operating surgeon and a separate surgeon who is unaware of the packing side separately on the first, fourth and seventh day post-operatively. A 4-grade scale was utilized to assess the ecchymosis with grade 4 being the most severe. Results: Nasal packing was found to significantly increase the severity and duration of periorbital ecchymosis post rhinoplasty. While no difference was observed between the packed and unpacked sides on the first post-operative day, significant difference was noted on the 4th day (mean score 2.36 and 1.15 for the packed and unpacked sides, respectively) and on the 7th day after surgery in favor of the unpacked side (score 1.24 and 0.61 for the packed and unpacked sides, respectively). Conclusion: We advise against the routine use of nasal packing in rhinoplasty unless necessary as it contributes to worsen the periorbital ecchymosis from lateral osteotomies and thereby increases the patients’ “down time” after surgery.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:22
      PubDate: 2015-06-16T12:00:00Z
      DOI: 10.1186/s40463-015-0075-5
      Issue No: Vol. ${item.volume} (2015)
  • Completion thyroidectomy: predicting bilateral disease

    • Authors: Badr Ibrahim, Véronique-Isabelle Forest, Michael Hier, Alex Mlynarek, Derin Caglar, Richard Payne
      First page: 23
      Abstract: IntroductionIt is not uncommon for patients with indeterminate thyroid nodules to undergo diagnostic hemithyroidectomy. When the final pathology determines that the nodule is in fact malignant, patients require counseling as to the whether a completion thyroidectomy is necessary.Objectives1. Determine the incidence of well differentiated thyroid cancer (WDTC) in the contralateral thyroid lobe in patients undergoing completion thyroidectomy.2. Identify features of the malignant tumor in the initial resection that increase the likelihood of malignancy in the contralateral lobe. Methods: Retrospective chart review of 97 patients who underwent hemithyroidectomy and completion thyroidectomy in a university’s teaching hospital network between 2006 and 2012. Pathology reports from both surgeries as well as patient and thyroid nodule characteristics were reviewed. Results: Of the 97 patients, 47 (48 %) had a malignancy in the contralateral lobe. In the contralateral lobe, 42/47 (89 %) of malignancies were papillary microcarcinomas (PMC) and 15/42 (36 %) of the PMC were multifocal. Multifocal malignancies in the initial specimen had a 60 % rate of contralateral malignancy and were found to be a predictor of bilateral disease (p = 0.04) with OR = 2.74 (95 % CI: 1.11–6.79; p = 0.003) in WDTC and OR = 3.59 (95 % CI:1.35 9.48; p = 0.01) in papillary cancer specifically. There was no statistical significant correlation established for the following variables: presence of positive cervical nodes, extrathyroidal extension, positive resection margins, size and angio-lymphatic invasion. Moreover, there was no statistical correlation between any of the variants of papillary thyroid cancer and bilateral disease, even though most aggressive subtypes were found to be bilateral. Conclusion: In this study, the rate of malignancy in the contralateral lobe was 48 %. Multifocality and presence of an aggressive subtype of papillary thyroid cancer in the initial specimen were found to be more important variables to consider in decision-making regarding completion thyroidectomy than size of the initial tumor alone.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:23
      PubDate: 2015-06-16T12:00:00Z
      DOI: 10.1186/s40463-015-0076-4
      Issue No: Vol. ${item.volume} (2015)
  • Immunoglobulin G4-related diseases in the head and neck: a systematic

    • Authors: Graeme Mulholland, Caroline Jeffery, Paras Satija, David Côté
      First page: 24
      Abstract: Background: Immunoglobulin G4 related disease (IgG4-RD) is a poorly understood chronic inflammatory disorder affecting the middle-aged and elderly that can present to the otolaryngologist. We aim to summarize the current literature regarding the manifestations and management of IgG4-RD in the head and neck. Methods: Pubmed and EMBASE were searched using the term relevant search algorithm utilizing keywords such as: IgG4 related disease, head and neck, orbit, salivary glands, sialadenitis, Kuttner, angiocentric eosinophilic fibrosis, submandibular, lacrimal, thyroid, dacryoadenitis, nasal, sinus, and Mikulicz’s. Reference lists were searched for identification of relevant studies.Case reports, original research and review articles published in English from 1964 to 2014 whose major topic was IgG4-RD affecting the head and neck were included. Data regarding patient demographics, presentation, histopathology, management and treatment outcomes of IgG4-RD were extracted. Level of evidence was also assessed and data were pooled where possible. Three independent reviewers screened eligible studies; extracted relevant data and discrepancies were resolved by consensus, where applicable. Descriptive and comparative statistics were performed. Results: Fourty-three articles met our inclusion criteria. IgG4-RD most often presents as a mass lesion in the head and neck region. Common diagnostic features include: 1) elevated serum IgG4 level, 2) marked infiltration of exocrine glands by IgG4-positive plasma cells with fibrosis, and 3) marked improvement with corticosteroid therapy and additional immunosuppressive therapy in corticosteroid refractory cases. Early diagnosis and involvement of rheumatology is important in management. Conclusions: IgG4-RD is a challenging non-surgical disease that has multiple manifestations in the head and neck. It must be distinguished from various mimics including malignancy, systemic diseases, and infectious. Otolaryngology-Head and Neck surgeons should be aware of this condition and its management.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:24
      PubDate: 2015-06-20T00:00:00Z
      DOI: 10.1186/s40463-015-0071-9
      Issue No: Vol. ${item.volume} (2015)
  • Methods considerations for nystagmography

    • Authors: Brian Blakley, Laura Chan
      First page: 25
      Abstract: Objectives1. To assess the reproducibility of eye movement velocity measurement using two methods: traditional electro-oculography (EOG) and infrared video-oculography (VOG) and,2. Determine whether the normal values for unilateral weakness and bilateral reduction of caloric responses vary according to method employed. Background: Vestibular testing frequently involves measurement of eye movements. EOG has been the standard method for decades, but VOG and other methods have recently become popular. The assumption has been that all methods measure eye movements equally and accurately but this assumption has not been validated. In this paper we examine this assumption. Methods: Eye movements were recorded simultaneously with commercially available EOG and VOG methods to evaluate differences in results for nineteen normal subjects undergoing caloric tests with warm and cold water. Examination of the records permitted identification and simultaneous measurement of 840 nystagmus beats. Results: EOG and VOG measurements were correlated but the correlation was not strong (Spearman rho = 0.529, p 
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:25
      PubDate: 2015-06-24T00:00:00Z
      DOI: 10.1186/s40463-015-0078-2
      Issue No: Vol. ${item.volume} (2015)
  • Does a mineral wristband affect balance' A randomized, controlled,
           double-blind study

    • Authors: Eva Hansson, Anders Beckman, Liselott Persson
      First page: 26
      Abstract: Background: Having good balance is a facilitating factor in the performance of everyday activities. Good balance is also essential in various sport activities in order to both get results and prevent injury. A common measure of balance is postural sway, which can be measured both antero-posteriorly and medio-laterally. There are several companies marketing wristbands whose intended function is to improve balance, strength and flexibility. Randomized controlled trials have shown that wristbands with holograms have no effect on balance but studies on wristbands with minerals seem to be lacking.ObjectiveThe aim of this study was to investigate if the mineral wristband had any effect on postural sway in a group of healthy individuals.Study designRandomized, controlled, double-blind study.Material/MethodsThe study group consisted of 40 healthy persons. Postural sway was measured antero-posteriorly and medio-laterally on a force plate, to compare: the mineral wristband, a placebo wristband, and without any wristband. The measurements were performed for 30 s, in four situations: with open eyes and closed eyes, standing on a firm surface and on foam. Analyses were made with multilevel technique. Results: The use of wristband with or without minerals did not alter postural sway. Closed eyes and standing on foam both prolonged the dependent measurement, irrespective if it was medio-lateral or antero-posterior. Wearing any wristband (mineral or placebo) gave a small (0,22-0,36 mm/s) but not statistically significant reduction of postural sway compared to not wearing wristband. Conclusion: This study showed no effect on postural sway by using the mineral wristband, compared with a placebo wristband or no wristband. Wearing any wristband at all (mineral or placebo) gave a small but not statistically significant reduction in postural sway, probably caused by sensory input.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:26
      PubDate: 2015-06-26T00:00:00Z
      DOI: 10.1186/s40463-015-0079-1
      Issue No: Vol. ${item.volume} (2015)
  • Bilateral vocal fold immobility: a 13 year review of etiologies,
           management and the utility of the empey index

    • Authors: Maria Brake, Jennifer Anderson
      First page: 27
      Abstract: Background: Bilateral vocal fold immobility (BVFI) is a rare diagnosis causing dyspnea, dysphonia and dysphagia. Management depends on respiratory performance, airway patency, vocal ability, and quality-of-life priorities. The authors review the presentation, management and outcome in patients diagnosed with BVFI. The utility and efficacy of the Empey index (EI) and the Expiratory Disproportion Index (EDI) are evaluated as an objective monitoring tools for BVFI patients. Methods: A 13-year retrospective review was performed of BVFI patients at a tertiary referral centre at St. Michael’s Hospital at the University of Toronto. Results: Forty-eight patients were included; 46 presented with airway obstructive symptoms. Tracheotomy was required for airway management in 40 % of patients throughout the course of their treatment, which was reduced to 19 % at the end of treatment. Twenty-one patients underwent endoscopic arytenoidectomy/cordotomy. Non-operative management included home continuous positive airway pressure devices. Pulmonary function testing was carried out in 29 patients. Only a portion of the BVFI patients met the defined obstruction criteria (45 % EI and 52 % EDI). Seven patients had complete pre- and post-operative PFTs for comparison and all seven had ratios that significantly improved post-operatively which appeared to correlate clinically. Conclusion: The EI and EDI have limited use in evaluating patients with who have variable upper airway obstruction, but may be helpful in monitoring changes in patients’ airway status.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2015, null:27
      PubDate: 2015-06-26T00:00:00Z
      DOI: 10.1186/s40463-015-0080-8
      Issue No: Vol. ${item.volume} (2015)
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