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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]
  • Women in Otolaryngology

    • Authors: Jonas Johnson
      First page: 14
      Abstract: n/a
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:14
      PubDate: 2014-06-12T00:00:00Z
      DOI: 10.1186/1916-0216-43-14
      Issue No: Vol. ${item.volume} (2014)
  • Age related changes to the dynamics of contralateral DPOAE suppression in
           human subjects

    • Authors: Ujimoto Konomi, Sohit Kanotra, Adrian James, Robert Harrison
      First page: 15
      Abstract: Background: The two ears are linked with a neural pathway such that stimulation of one ear has a modulating effect on the contralateral cochlea. This is mediated by cochlear afferent neurons connecting with olivo-cochlear efferents. The monitoring of this pathway is easily achieved by measuring contralateral suppression of otoacoustic emissions, and there is some clinical value in the ability to assess the integrity of this pathway. An important step in an evaluation of clinical utility is to assess any age-related changes. Accordingly, in the present study we measure the dynamics of contralateral DPOAE suppression in a population of normal hearing subjects of different ages. Methods: Using a real-time DPOAE recording method we assessed contralateral DPOAE suppression in 95 ears from 51 subjects (age range 2–52 years). DPOAE (2f1-f2; f2 = 4.4 kHz; f2/f1 = 1.22) input–output functions were measured. In response to contralateral broadband noise, dynamic aspects of DPOAE suppression were measured, specifically suppression onset latency and time constants. Results: An age-related reduction in DPOAE amplitudes was observed. Both the detectability and the degree of contralateral DPOAE suppression were decreased in older age groups. We find an age-related increase in the latency of onset of DPOAE suppression to contralateral stimulation, but no significant change in suppression time-constants. Conclusion: Olivo-cochlear function as revealed by contralateral suppression of DPOAEs shows some important age-related changes. In addition to reduced emissions (outer haircell suppression) we find an increased latency that may reflect deterioration in auditory brainstem function. Regarding clinical utility, it is possible that the changes observed may reflect an aspect of age-related hearing loss that has not been previously considered.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:15
      PubDate: 2014-06-16T00:00:00Z
      DOI: 10.1186/1916-0216-43-15
      Issue No: Vol. ${item.volume} (2014)
  • Identification alone versus intraoperative neuromonitoring of the
           recurrent laryngeal nerve during thyroid surgery: experience of 2034
           consecutive patients

    • Authors: Pietro Calò, Giuseppe Pisano, Fabio Medas, Maria Pittau, Luca Gordini, Roberto Demontis, Angelo Nicolosi
      First page: 16
      Abstract: Background: The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone. Methods: Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041. Results: In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative. Conclusions: Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:16
      PubDate: 2014-06-18T00:00:00Z
      DOI: 10.1186/1916-0216-43-16
      Issue No: Vol. ${item.volume} (2014)
  • Primary squamous cell of the thyroid¿an abbreviated clinical

    • Authors: Justin Lui, Moosa Khalil, Shamir Chandarana
      First page: 17
      Abstract: Background: Lacking any squamous epithelium, thyroid gland with primary squamous cell carcinoma (PSCC) proves to be an etiopathophysiological quandary. Two major theories do exist, though few cases have been documented to support either. We present a case that supports the “metaplasia” theory, which serves to enhance our understanding of a disease that carries with it a very poor prognosis.Case presentationWe present a case of an extremely advanced, primary squamous cell carcinoma of the thyroid with distant metastases in a thirty-six year-old male. Dying of airway compromise seventeen days following his admission, this is the shortest median survival of all documented cases. Conclusion: In addition to being the most abbreviated time period between presentation and death of all documented thyroid primary squamous cell carcinomas, we share the fifth case of thyroid PSCC in the setting of lymphocytic thyroiditis. This case should build awareness of the aggressivity of the disease and the lack of established diagnostic criteria.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:17
      PubDate: 2014-06-18T00:00:00Z
      DOI: 10.1186/1916-0216-43-17
      Issue No: Vol. ${item.volume} (2014)
  • Carcinoma of the larynx, metastatic to illeum, presents as ruptured
           appendicitis: case report and literature review

    • Authors: Jordan Glicksman, David Bottoni, Jessica Shepherd, Neil Parry, Jason Franklin
      First page: 18
      Abstract: ObjectivesMetastasis of laryngeal squamous cell carcinoma (SCC) to the intra-abdominal gastrointestinal tract is exceedingly rare. The objectives of this case report are to describe a case involving a perforated metastasis of a laryngeal SCC to the ileum and to review the literature pertaining to other similar cases. Methods: A review of patient’s chart and a review of the English literature involving malignant SCC of the larynx with metastasis to the small bowel. Results: We describe the case of a 58-year-old man who had failed induction chemotherapy and underwent a laryngopharyngectomy with bilateral neck dissection and pectoralis major flap for a T4N2c laryngeal SCC. Subsequently, the patient was treated with postoperative radiation and cituximab.The patient went on to present with symptoms consistent with a ruptured appendix, supported by ultrasound imaging. The patient was taken to the operating room where a right hemicolectomy was performed. Pathological gross examination confirmed a 4 cm transmural perforation in the terminal ileum. Microscopy demonstrated deposits of metastatic squamous cell carcinoma in the surrounding smooth muscle. Metastatic carcinoma was also found in a separate nodule from the abdominal wall. The patient had an uncomplicated post-operative period, and survived several months thereafter. Conclusions: Metastasis of laryngeal SCC to the small bowel with perforation is exceedingly rare, but possible. These patients may be successfully managed with resection.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:18
      PubDate: 2014-06-25T00:00:00Z
      DOI: 10.1186/1916-0216-43-18
      Issue No: Vol. ${item.volume} (2014)
  • Management of oropharyngeal cancer: a cross-sectional review of
           institutional practice at a large Canadian referral centre

    • Authors: Lindsay Wilson, Danny Enepekides, Kevin Higgins
      First page: 19
      Abstract: Background: Over the years, the treatment of oropharyngeal cancer has changed; in the past, first-line treatment consisted of surgery followed by adjuvant radiotherapy, today however, primary treatment typically involves concomitant chemoradiation, and reserves surgery for salvage. While chemoradiation is the modality of choice for primary management of oropharyngeal cancer, disease characteristics, institutional bias, and patient preferences influence treatment choice. This has lead to variation in the treatment of OPC, and has generated some uncertainly regarding the ideal therapeutic approach. The objective of this study was to describe the treatment of OPC a large Canadian referral center, highlighting trends in treatment choice and outcome. Methods: This is a cross-sectional retrospective review of clinical practice at Sunnybrook Health Science Centre (Toronto, ON). This investigation documents type of first-line treatment, rates of treatment failure, rates of surgical salvage, and 5-year disease-free survival. This study also asses the therapeutic impact of free-flap reconstruction on the use of a postoperative tracheostomy and/or percutaneous endoscopic gastrostomy tube. Results: The majority of oropharyngeal cancer patients presented with regionally metastatic disease (stage III-IV) and underwent concomitant chemoradiation as first-line treatment. Just over half of patients who failed chemoradiation were eligible for salvage surgery. Forty-six percent of salvage patients recurred at approximately 6 months, and died approximately 12 months following the first sign of disease recurrence. Five-year survival for salvage patients stage II, III, IVA, and IVB was 100%, 54.5%, 53.8%, and 50%, respectively. The incidence of percutaneous endoscopic gastrostomy tubes and tracheostomies was comparable between patients who underwent free-flap reconstruction and patients who did not. Conclusion: The modality of choice for first-line treatment of oropharyngeal cancer is concomitant chemoradiation. The moderate failure rate following chemoradiation and the modest survival rate following salvage surgery could indicate that selected patients may benefit from undergoing surgery as first-line treatment. While this study did not show that functional outcomes were better for free-flap patients, it is highly likely that those who received a free-flap did better then they would have had they not undergone reconstructive surgery. More research regarding the therapeutic effects of free-flaps in OPC survivors is needed.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:19
      PubDate: 2014-06-24T00:00:00Z
      DOI: 10.1186/1916-0216-43-19
      Issue No: Vol. ${item.volume} (2014)
  • In vitro efficacy of N-acetylcysteine on bacteria associated with chronic
           suppurative otitis media

    • Authors: Jane Lea, Anne Conlin, Inna Sekirov, Veronica Restelli, Komathi Ayakar, LeeAnn Turnbull, Patrick Doyle, Michael Noble, Robert Rennie, William Schreiber, Brian Westerberg
      First page: 20
      Abstract: Background: The safety and efficacy of Ciprodex® has been demonstrated for treatment of chronic suppurative otitis media (CSOM). However, symptoms fail to resolve in 9-15% of patients. The objective of this study is to evaluate the efficacy of N-acetylcysteine (NAC) on S. aureus, and planktonic and sessile (biofilm forming) P. aeruginosa in vitro using clinical isolates from patients with CSOM. Methods: 1) Stability was assessed using liquid chromatography-mass spectrometry for each component in a prepared mixture of Ciprodex® and NAC over 15 days. Sterility was assessed by measuring bacterial growth on a blood agar plate. Efficacy was assessed using a disc diffusion method by inoculating plates with S. aureus ATCC 29513 and P. aeruginosa ATCC 27853, and measuring the clearance zone.2) Fifteen P. aeruginosa strains were isolated from patients with CSOM and tested in vitro using the bioFILM PA™ antimicrobial susceptibility assay. Treatment solutions included Ciprodex® & ciprofloxacin +/- NAC, and NAC alone (0.25%, 0.5% & 1.25%). Results: 1) NAC combined with Ciprodex® demonstrated stability, sterility, and efficacy over a two-week period2) P. aeruginosa strains in the sessile (33%-40%) and planktonic (13%) state demonstrated resistance to Ciprodex® and ciprofloxacin. When NAC ≥0.5% was used in isolation or as an adjunct to either of these medications, no resistance was found in the sessile or planktonic state among all 15 strains. Conclusion: 1) Ciprodex® combined with NAC has a shelf life of at least two weeks given the documented preservation of stability, sterility, and clinical efficacy of the mixed compounds.2) P. aeruginosa strains demonstrated resistance to both Ciprodex® and ciprofloxacin. NAC ≥0.5% overcomes issues with resistance and shows promise in the treatment of CSOM.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:20
      PubDate: 2014-07-07T00:00:00Z
      DOI: 10.1186/1916-0216-43-20
      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)
  • Prevalence of voice & swallowing complaints in Pre-operative
           thyroidectomy patients: a prospective cohort study

    • Authors: Theresa Holler, Jennifer Anderson
      First page: 28
      Abstract: Background: Compressive symptoms are common in patients with thyroid disease and are an accepted indication for thyroidectomy. The objective of this study was to evaluate the prevalence and severity of voice and swallowing complaints in pre-operative thyroidectomy patients and to compare these with thyroid volume, thyroid pathology and laryngopharyngeal reflux. Methods: A consecutive case series design was performed. All patients undergoing a thyroidectomy (subtotal or total) at a tertiary care centre during a 2'year period were invited to participate. Fifty nine (10 male, 49 female) aged 19'73 were enrolled (59.3% total thyroidectomy, 40.7% subtotal thyroidectomy). Voice and swallowing complaints were subjectively evaluated using the Voice Handicap Index (VHI) and the Modified Swallowing Impairment Score (MSIS), respectively. All patients completed the Reflux Symptom Index (RSI) and underwent videostroboscopy. Vocal function was objectively evaluated using perceptual ratings (GRBAS) and acoustic voice analysis (jitter, shimmer, maximum phonation time, maximum fundamental frequency range). The relationship between voice and swallowing symptoms was compared with thyroid volume and surgical pathology.Results and discussionThe average VHI score was 8.39, representing normal voice scores. Of the objective voice measures, only jitter and a subset of GRBAS measures were slightly elevated. Swallowing complaints were reported at least 'some of the time' by 25 patients (41.7%), and 'often or always' by 16 patients (26.7%). Of the patients with voice and swallowing complaints, 68.4% and 56%, respectively, had elevated RSI scores consistent with laryngopharyngeal reflux. No correlation was found with thyroid volume or thyroid pathology. Conclusions: Swallowing complaints appear to be common in pre-operative thyroidectomy patients. A large percentage, however, have associated laryngopharyngeal reflux which may in part account for these symptoms. Patients presenting with compressive thyroid symptoms should be evaluated for laryngopharyngeal reflux, and treated where appropriate.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:28
      PubDate: 2014-07-15T00:00:00Z
      DOI: 10.1186/PREACCEPT-8455644671045748
      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)
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