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Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 4)
3D Printing in Medicine     Open Access   (Followers: 5)
4 open     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 6)
AAS Open Research     Open Access   (Followers: 2)
ABCS Health Sciences     Open Access   (Followers: 8)
Abia State University Medical Students' Association Journal     Full-text available via subscription   (Followers: 3)
AboutOpen     Open Access  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 48)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Científica Estudiantil     Open Access  
Acta Facultatis Medicae Naissensis     Open Access   (Followers: 1)
Acta Herediana     Open Access  
Acta Informatica Medica     Open Access   (Followers: 2)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access   (Followers: 1)
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access   (Followers: 1)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 3)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 7)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 9)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access   (Followers: 1)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 10)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 9)
Advanced Therapeutics     Hybrid Journal   (Followers: 1)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 8)
Advances in Cell and Gene Therapy     Hybrid Journal   (Followers: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 2)
Advances in Life Course Research     Hybrid Journal   (Followers: 12)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 32)
Advances in Medical Ethics     Open Access   (Followers: 1)
Advances in Medical Research     Open Access   (Followers: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access   (Followers: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 4)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Traditional Medicine     Hybrid Journal   (Followers: 4)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 14)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 13)
African Health Sciences     Open Access   (Followers: 5)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 4)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 3)
African Journal of Thoracic and Critical Care Medicine     Open Access  
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 3)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal   (Followers: 1)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 5)
Al-Azhar Assiut Medical Journal     Open Access   (Followers: 2)
Al-Qadisiah Medical Journal     Open Access   (Followers: 1)
Alerta : Revista Científica del Instituto Nacional de Salud     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 2)
Althea Medical Journal     Open Access   (Followers: 2)
American Journal of Biomedical Engineering     Open Access   (Followers: 15)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 8)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 12)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 6)
American Journal of Managed Care     Full-text available via subscription   (Followers: 13)
American Journal of Medical Case Reports     Open Access   (Followers: 2)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 5)
American Journal of Medicine     Hybrid Journal   (Followers: 50)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 3)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 11)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 6)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 2)
Anatomy     Open Access   (Followers: 3)
Anatomy Research International     Open Access   (Followers: 4)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales des Sciences de la Santé     Open Access  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 3)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 19)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 4)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 15)
Annals of Family Medicine     Open Access   (Followers: 17)
Annals of Health Research     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Medicine and Surgery Case Reports     Open Access   (Followers: 1)
Annals of Medicine and Surgery Protocols     Open Access   (Followers: 1)
Annals of Microbiology     Hybrid Journal   (Followers: 13)
Annals of Musculoskeletal Medicine     Open Access   (Followers: 2)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access  
Annals of Saudi Medicine     Open Access  
Annals of the College of Medicine, Mosul     Open Access   (Followers: 1)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annals of the RussianAacademy of Medical Sciences     Open Access   (Followers: 1)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 5)
Annual Review of Medicine     Full-text available via subscription   (Followers: 18)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Reports     Open Access   (Followers: 1)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 2)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 4)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 14)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arabian Journal of Scientific Research / المجلة العربية للبحث العلمي     Open Access   (Followers: 1)
Archive of Biomedical Science and Engineering     Open Access   (Followers: 1)
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Asthma, Allergy and Immunology     Open Access  
Archives of Clinical Hypertension     Open Access   (Followers: 2)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Medicine and Surgery     Open Access   (Followers: 1)
Archives of Organ Transplantation     Open Access   (Followers: 2)
Archives of Preventive Medicine     Open Access   (Followers: 3)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 2)
Archives of Renal Diseases and Management     Open Access   (Followers: 2)
Archives of Trauma Research     Open Access   (Followers: 4)
Archivos de Medicina (Manizales)     Open Access   (Followers: 1)
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access   (Followers: 1)
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Hybrid Journal   (Followers: 19)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 19)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access   (Followers: 5)
Asia Pacific Family Medicine Journal     Open Access   (Followers: 4)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 13)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access   (Followers: 1)
Asian Bioethics Review     Full-text available via subscription   (Followers: 4)

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Auris Nasus Larynx
Journal Prestige (SJR): 0.712
Citation Impact (citeScore): 1
Number of Followers: 0  
  Full-text available via subscription Subscription journal
ISSN (Print) 0385-8146 - ISSN (Online) 1879-1476
Published by Elsevier Homepage  [3203 journals]
  • Endoscopic endonasal transmaxillary ligation of a feeding artery and
           coblation plasma technology enables en bloc resection of advanced juvenile
           nasopharyngeal angiofibroma without preoperative embolization
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Hiroyuki Morishita, Masayoshi Kobayashi, Kazuhiko TakeuchiAbstractJuvenile nasopharyngeal angiofibroma (JNA) is a hypervascular tumor and uncontrolled hemorrhage makes its removal very difficult. Although preoperative intravascular embolization of a feeding artery is recommended, serious complications such as iatrogenic thrombosis in the brain and insufficient decrease in blood flow to the tumor are concerns. Recently, coblation plasma technology has been reported to be useful for tumor removal with minimum hemorrhage under a clear surgical field. Here we report successful removal of advanced JNA without preoperative embolization, using intraoperative ligation of the maxillary artery and coblation plasma technology. The left nasal cavity of a 23-years-old man was closed by a JNA tumor at Radkowski stage IIC, which was 65 mm in size and extended from the nasal cavity to the infratemporal fossa. MRA imaging showed the maxillary artery running along the posterior wall of the maxillary sinus. Therefore, the maxillary artery was first clipped using an endoscopic modified medial maxillectomy (EMMM) approach and endoscopic endonasal en bloc resection of the tumor was then completed using coblation technology with no need for blood transfusion. This case illustrates that preoperative embolization is dispensable in JNA surgery even at Stage IIC if the maxillary artery can be ligated during surgery and a coblation device can be utilized.
  • Oncological outcomes of early glottic carcinoma treated with transoral
           robotic surgery
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Fatma Tulin Kayhan, Arzu Karaman Koc, Ibrahim ErdimAbstractObjectiveAlthough glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.MethodsWe retrospectively investigated patients with early glottic carcinoma (Tis, T1, T2) who underwent TORS cordectomy in a tertiary hospital between January 2010 and June 2018.ResultsForty-eight patients were enrolled in the study. Mean follow-up time was 65.6 ± 16.6 months. Only one patient died and overall survival rate was found 97.9%. Local recurrence occurred in five patients and disease free survival rate was found 89.6%. Anterior commissure involvement was occurred in 6 (12.5%) patients and local recurrence was seen two of them (33.3%). Synechia complication was occurred in 8 (16.7%) patients and local recurrence was seen three of them (36.7%). Although local recurrence rate was high in both anterior commissure involvement and synechia, only synechia reached to statistical significance for local recurrence (p: 0.027). The recurrences of four patients were treated with radiation therapy (RT) and the remaining one patient underwent total laryngectomy. Laryngeal preservation rate was found 97.9%.ConclusionOur investigation of the oncological outcomes of TORS on early-stage glottic carcinoma revealed that TORS has similar results when compared with transoral laser microsurgery and RT in terms of recurrence, laryngeal preservation and survival rates. Synechia is also a cautionary complication for recurrence and must be followed closely. We expect that TORS usage will be wider if robotic technology works on innovative developments oriented to glottic area.
  • Advanced head and neck surgical techniques: A survey of US otolaryngology
           resident perspectives
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Karolina A. Plonowska, Patrick K. Ha, William R. RyanAbstractObjectivesTo assess the perspectives of OHNS residents with regards to their training in the following advanced head and neck surgery techniques: transoral robotic surgery (TORS), transoral laser microsurgery (TLM), sialendoscopy, and surgeon-performed ultrasound (SP-US) for possible curricula development.MethodsCross-sectional survey. A 20-item questionnaire was electronically distributed to OHNS residency programs assessing volume of cases, training barriers, satisfaction, additional training preferences, and pertinence to future practice.ResultsOne hundred thirty-one residents completed the questionnaire. Trainee satisfaction with advanced techniques did not vary significantly with level of training (PGY) or intent to pursue fellowship. Residents who participated in more TLM, sialendoscopy, and SP-US cases were significantly more likely to be satisfied with their training (all p 
  • The impact of the number of harvested central lymph nodes on the lymph
           node ratio
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Eun-Jae Chung, Sung-Jin Cho, Min-Woo Park, Young-Soo RhoAbstractObjectiveThe purpose of this study was to analyze the impact of lymph node harvest on the lymph node ratio (LNR).MethodsWe retrospectively reviewed 106 patients diagnosed preoperatively with PTMC (papillary thyroid microcarcinoma), no evidence of central or lateral neck nodal metastasis, and who underwent a total thyroidectomy and bilateral central lymph node neck dissection (CND).ResultsThe median number of retrieved lymph nodes in the central compartments was 7 ± 6.59 (range: 1–42). The mean number of metastatic lymph nodes in the central compartments on pathology was 1.1 ± 1.79 (range: 0–7). The high node volume group (>7) had a significantly higher rate of central lymph node (CLN) metastasis than the low node volume group (≤7) in the final pathologic report (p 
  • Mucosal melanoma of the cranio-facial region: Surgical challenges and
           therapeutic options
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Julia Thierauf, Anna-Maria Glück, Peter Plinkert, Johannes A. Veit, Thomas K. Hoffmann, Andreas Körber, Christoph BergmannAbstractObjectiveAlthough current therapeutic options for cutaneous melanoma (CM) are constantly improving survival, mucosal melanoma (MM) remains a rare tumor disease with a poor clinical outcome. While radical surgery is the gold standard, clear margin resections in the head and neck area are particularly critical due to high density of vulnerable structures. Adjuvant therapeutic options increases local control and data on the effect of systemic agents is sparse. The aim of this study was to elucidate surgical challenges in the craniofacial area and to evaluate the effect of local and systemic therapy in Head and Neck Mucosal Melanoma (HNMM).MethodsIn total, 21 patients with nasal mucosal malignant melanoma were included in this study over the course of 20 years in two German tertiary referral centers. Patient characteristics and conducted therapy as well as clinical outcomes were analyzed retrospectively.ResultsBy performing survival analysis for multimodal therapies, we observed a superiority effect of interferon therapy compared to surgery with radiation and surgery alone in the first therapeutic approach. However, patients treated with surgery alone in a recurrent setting showed the best outcome.ConclusionBoth, Interferon and radiation as adjuvant therapies, demonstrated survival benefits in initial treatment compared to surgery alone. Analysis after recurrence, however, revealed salvage surgery as a reliable and powerful tool to prolong post-recurrence survival without exposing palliative patients to the risk of severe adverse events from systemic therapies.
  • Substernal goiter: Treatment and challenges. Twenty-two years of
           experience in diagnosis and management of substernal goiters
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Maria Doulaptsi, Alexandros Karatzanis, Emmanuel Prokopakis, Stylianos Velegrakis, Alexia Loutsidi, Athina Trachalaki, George VelegrakisAbstractObjectiveDescending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity.Methods and materialsA retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed.ResultsAmong 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%.ConclusionDescending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.
  • Efficacy and safety assessment of expiratory positive airway pressure
           (EPAP) mask for OSAHS therapy
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Yaxuan Liu, Yangyang Ying, Jaffar S. Pandu, Yan Wang, Shuang Dou, Yanzhong Li, Dedong MaAbstractObjectiveWe have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy.Methods40 healthy volunteers were enrolled to measure the end-tidal carbon dioxide pressure (PETCO2) while being treated by EPAP mask. 40 symptomatic moderate or severe OSAHS patients (AHI ≥ 15/h) recruited were equally divided into two groups randomly and treated with CPAP or mask for a week respectively. After a week of washing out, the patients were applied with exchanged therapeutic methods for another week. The PSG was performed at the end of each week of treatment with device-on.ResultsThere were no significant differences of PETCO2 under different exhaled positive pressure level between CPAP, EPAP therapies and non-therapy for the healthy volunteers (P > 0.05). After being treated, among the OSAHS patients in the two groups, the ESS scores and AHI decreased, and minimum SaO2 and mean SaO2 increased significantly (all P > 0.05). There was no significant differences of the efficacy between EPAP and CPAP therapy.ConclusionsEPAP mask therapy was safe and reliable with significant efficacy for selected OSAHS patients. However, the compliance needs further improvement.
  • Optical coherence tomography for observation of the olfactory epithelium
           in mice
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Toshio Ueda, Tatsunori Sakamoto, Masayoshi Kobayashi, Fumihiko Kuwata, Masaaki Ishikawa, Koichi Omori, Takayuki NakagawaAbstractObjectiveOptical coherence tomography (OCT) is an imaging tool that exploits the coherence of infrared light and is clinically utilized in the field of ophthalmology and dermatology. This study aimed to examine the feasibility of using OCT for diagnosing degeneration and regeneration of the olfactory epithelium in mice.MethodsThe olfactory and respiratory epithelia in excised nasal septa of adult mice were observed using OCT. Subsequently, histological assessments were performed with hematoxylin and eosin (H–E) staining. The thicknesses of the olfactory or respiratory epithelia were measured in both OCT images and H–E-stained paraffin sections. The ability of OCT to distinguish olfactory epithelia from respiratory epithelia in normal mice was compared with that of H–E staining. The feasibility of using OCT assessments for detecting changes in the thickness of olfactory epithelia was tested in a mouse model of the degeneration and regeneration of olfactory epithelia.ResultsOCT allowed visualization of the gross morphology of the olfactory and respiratory epithelium in normal mice, although it was limited in terms of visualizing cellular components. OCT-based measurements of epithelial thickness helped to distinguish olfactory epithelia from respiratory epithelia. Similar to H–E staining, OCT also clarified changes in the olfactory epithelium thickness after methimazole application.ConclusionsThese findings indicate the utility of OCT for assessment of olfactory epithelial thickness and its potential for clinical evaluation of human olfactory epithelia.
  • Endolymphatic hydrops severity in magnetic resonance imaging evidences
           disparate vestibular test results
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Nicolas Pérez-Fernández, Pablo Dominguez, Raquel Manrique-Huarte, Diego Calavia, Lorea Arbizu, Reyes Garcia-Eulate, Laura Alvarez-Gomez, Carlos Guajardo, Jose Luis ZubietaAbstractObjectivesIt has been suggested that in Ménière’s disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops’ cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal.Methods22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4 h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed.ResultsPatients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (χ2; p = 0.028).ConclusionSignificant canal paresis in the caloric test is associated with more severe endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a more severe vestibular deficit.Level of evidence: 2a
  • Vibrant Soundbridge implantation via a retrofacial approach in a patient
           with congenital aural atresia
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Ryoukichi Ikeda, Hiroshi Hidaka, Takaki Murata, Hiromitsu Miyazaki, Yukio Katori, Toshimitsu KobayashiAbstractObjectiveA method of Vibrant Soundbridge (VSB) placement to the round window (RW) via the retrofacial approach with preoperative evaluation of the relationship between the facial nerve (FN) and RW by 3D-CT reconstruction was proposed for the treatment of congenital aural atresia (CAA) patient.MethodsA fenestration to the mesotympanum was made mastoid portion of the FN. During the approach, part of the stapedial muscle was encountered and removed. The RW niche was identified, and the floating mass transducer was placed from an inferior approach into the RW niche.ResultsThere were no intra-operative or post-operative surgical complications.ConclusionThe VSB placement to the RW via the retrofacial approach with partial removal of the stapedial muscle can be feasible alternative in CAA cases associated with an anteriorly and laterally positioned aberrant FN. Preoperative assessment using 3D CT may facilitate in assessing the feasibility of the approach and implantation of VSB.
  • Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the
           treatment of eosinophilic otitis media
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Yukiko Iino, Eri Takahashi, Saeko Ida, Saori KikuchiAbstractObjectiveEosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion containing eosinophils, and it is mostly associated with bronchial asthma. Recently, anti-IL-5 therapy using mepolizumab has been reported to be effective for patients with severe and refractory eosinophilic bronchial asthma. EOM shows accumulation of eiosinophils in the middle ear effusion and most EOM patients have high numbers of peripheral blood eosinophils. Therefore, we carried out a retrospective study to determine whether anti-IL-5 therapy is also effective in the treatment of EOM.Patients and methodsNine patients with EOM associated with bronchial asthma received the anti-IL-5 agent mepoliumab as an add-on therapy for at least 6 months (mepolizumab group). They were evaluated by EOM severity scores, symptom scores, bone conduction hearing levels, and surrogate markers before and after receiving the anti-IL-5 therapy. Thirteen EOM patients associated with bronchial asthma who did not receive the anti-IL-5 therapy were also included as controls (control group).ResultsThe severity scores of most patients in the mepolizumab group were dramatically reduced at 3 months after the initiation of this therapy and, as therapy continued, they further decreased to levels significantly lower than the baseline. However, two patients with a granulation type of EOM showed minimal improvement from the therapy. The severity scores of control patients showed no significant changes during the study period. Significant deterioration of the bone conduction hearing levels was not observed in either group. The number of peripheral blood eosinophils was significantly reduced, and eosinophils were scarcely observed in the middle ear effusion and middle ear mucosa after the mepolizumab therapy.ConclusionsAnti-IL-5 therapy using mepolizumab was effective at inhibiting eosinophilic recruitment to the middle ear in patients with EOM. However, this therapy showed minimal effect on patients with the granulation type of EOM. Therefore, this therapy may be a viable treatment option for refractory EOM without severe mucosal change.
  • How does cochlear implantation affect five vestibular end-organ functions
           and dizziness'
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Muhammed Dagkiran, Ulku Tuncer, Ozgur Surmelioglu, Ozgur Tarkan, Suleyman Ozdemir, Fikret Cetik, Mete KirogluAbstractObjectiveTo evaluate all five vestibular end-organ functions (lateral, anterior, posterior semicircular canal, utricule, and saccule) and to investigate the relationship between Dizziness Handicap Inventory (DHI) and vestibular functions prior to CI (cochlear implantation) and at postoperative day 3 and month 3.MethodsA total of 42 patients (age 16–70 years) with normal vestibular functions preoperatively and undergoing unilateral CI were included in this prospective descriptive study. Video head impulse test (vHIT) for three semicircular canal (SSC) functions, ocular vestibular-evoked myogenic potential (oVEMP) for utricule function, cervical vestibular-evoked myogenic potential (cVEMP) for saccule function and DHI for subjective vertigo symptoms were performed prior to CI and at postoperative day 3 and month 3.ResultsThere was a significant impairment of vestibular function in 12 patients (28.5%) on the implantation side and significant DHI increase was observed in 13 of 42 (30.9%) patients at postoperative day 3 after CI (p 
  • The efficacy of hesperidin for treatment of acute otitis media
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Erdem Atalay Cetinkaya, Osman Ciftci, Saadet Alan, M. Namık Oztanır, Nese BasakAbstractObjectivesIn this experimental study, the effect of hesperidin on the treatment of acute otitis media (AOM) was investigated in an AOM-induced rat model.MethodsIn total, 35 rats were randomly divided into the following five groups (n = 7): group 1 (control), group 2 (AOM with no treatment), group 3 (AOM + antibiotic), group 4 (AOM + hesperidin), and group 5 (AOM + hesperidin + antibiotic). On day 14, group 3,4 and 5 rats were given antibiotic and hesperidin via gavages, respectively. Histopathological and immunological analyses were performed and the results analyzed.ResultsSerum levels of TNF-α, IL-4, IL-6 and IL-1β were significantly decreased in the hesperidin- and antibiotic-treated groups compared to the AOM group. The AOM + antibiotic and AOM + hesperidin groups demonstrated reduced histological damage compared to the AOM group. Between the AOM + antibiotic and AOM + hesperidin groups, significant differences in tympanic membrane thickness(ThicTM), inflammation(Inf), and sclerosis(Sc) values were observed. However, no difference in epithelial damage(DamEpith), was seen between the two groups. There was a significant difference in the AOM + antibiotic and AOM + antibiotic + hesperidin groups compared to AOM group (P 
  • Comparison of clinical outcomes between butterfly inlay cartilage
           tympanoplasty and conventional underlay cartilage tympanoplasty
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Min Bum Kim, Jin-A. Park, Michelle J. Suh, Chan Il SongAbstractObjectiveTo assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes.Materials and methodsThe study included 35 patients (36 ears) who underwent butterfly inlay cartilage tympanoplasty (inlay group, 23 ears of 22 patients) or conventional underlay cartilage tympanoplasty (underlay group, 13 ears). The anatomical success rate and hearing outcomes were analysed.ResultsRe-perforation occurred in 2 cases (8.7%) in the inlay group and 3 (23.1%) in the underlay group. One patient in the inlay group developed a serious infection, and one in the underlay group developed massive granulation of the tympanic membrane. In the inlay group, the air-bone gap (ABG) decreased from 19.9 (±12.6) dB HL preoperatively to 13.8 (±11.3) dB HL postoperatively (p = 0.047), in the underlay group, it decreased from 23.5 (±15.8) dB HL to 18.3 (±20.6) dB HL. Regarding improvement in ABG, the difference between the group was not statistically significant (p = 0.968).ConclusionButterfly inlay cartilage tympanoplasty is comparable with conventional underlay cartilage tympanoplasty in both anatomic and audiological success rates. Owing to its simplicity, shorter operation time, and rapid patient recovery, butterfly inlay cartilage tympanoplasty could be considered a favourable surgical option.
  • Effects of cold atmospheric plasma (CAP) on bacteria and mucosa of the
           upper aerodigestive tract
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Sven Becker, Julia L. Zimmermann, Philipp Baumeister, Theresa F. Brunner, Tetsuji Shimizu, Yang-Fang Li, Gregor E. Morfill, Ulrich Harréus, Christian WelzAbstractObjectiveEar, nose and throat infections are among the most common reasons for absence from work. They are usually caused by various bacteria like Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes. Cold atmospheric plasma (CAP) can effectively eliminate even multi-resistant bacteria and has no cytotoxic or mutagenic effects on the mucosa when applied for less than 60 s. Aim of the study was to evaluate the effects of CAP on common ENT bacteria and on the mucosa of the upper aerodigestive tract.MethodsThe bactericidal effects of CAP against the bacteria most commonly causing ENT infections were investigated using the colony-forming units assay (CFU) on a Müller-Hinton agar plate after applying CAP for 30, 60, 90 and 120 s. To evaluate the interaction of CAP with mucosal cells, 3D mini organ cultures were treated for up to 180 s, after which cell viability and necrosis induction were evaluated.ResultsTreatment with CAP for 60 s or longer induced at least a 3-log10 reduction in the bacterial load (> 99.9%). Treatment times shorter than 60 s had only slight cytotoxic effects on cell viability and necrosis whereas treatment times above 60 s showed a fast increase of cytotoxic side effects.ConclusionCAP exhibited strong bactericidal effects on the most common ENT pathogens. Treatment times of up to 60 s showed only minimal adverse reactions in healthy mucosa. CAP could be a promising new therapeutic modality for ENT infections.
  • Cartilage conduction as the third pathway for sound transmission
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Hiroshi Hosoi, Tadashi Nishimura, Ryota Shimokura, Tadashi KitaharaAbstractIt has been long considered that air and bone are the two major mediators that conduct sounds to the inner ear. In 2004, Hosoi found that vibration of aural cartilage, generated by placing gently a transducer on it, could create audible sound with the same level of clarity as air- and bone-conduction sound. He thus proposed the term “cartilage conduction” for this concept. This research identified a third mediator for sound conduction to the inner ear. Hosoi also proposed the development of novel communication devices, such as hearing aids, telephones, etc. using his findings.For cartilage conduction, three sound pathways can be assumed. The transducer vibration may cause airborne sound which passes into the external auditory canal through the canal entrance (direct air pathway). Alternatively, the vibration at the cartilage may generate audible sound in the external auditory canal (cartilage-air pathway), or propagate directly to the inner ear through the skull bone (cartilage-bone pathway). A series of studies has illustrated that the cartilage-air pathway is dominant for hearing sensations in listeners with normal ears. The cartilage-bone pathway works for patients with bony aural atresia. A fourth pathway, the fibrotic-tissue pathway, is considered to act in the case of fibrotic aural atresia.In this review, we summarize this series of studies and discuss the nature of cartilage conduction.
  • Extranasopharyngeal angiofibroma mimicking choanal polyp in patients with
           chronic paranasal sinusitis
    • Abstract: Publication date: April 2019Source: Auris Nasus Larynx, Volume 46, Issue 2Author(s): Hae Dong Kim, Ick Soo ChoiAbstractExtranasopharyngeal angiofibroma (ENA) is an angiofibroma that occurs in the extranasopharynx. It shows pathologic findings, such as juvenile angiofibroma (JNA), which accounts for 0.5% of head and neck mass. However, compared with JNA, the prevalence, affected site, and clinical characteristics are completely different, which leads some physicians to classify ENA as a disease different from JNA. ENA of the nasal turbinate origin are rarely reported in the literature. In addition, choanal polyp originating from the posterior part of the nasal turbinate is uncommonly reported. Recently, we encountered two cases of ENA, which were not diagnosed by intraoperative frozen section examination, but were histopathologically diagnosed post-operatively. Although we were unable to diagnose and perform embolization pre-operatively, ENA has been successfully treated by endoscopic surgery, without profuse bleeding.
  • Extra-axial chordoma of the gingiva
    • Abstract: Publication date: Available online 21 March 2019Source: Auris Nasus LarynxAuthor(s): Tsutomu Ueda, Kazunori Kubota, Noriyuki Shiroma, Shogo Maeda, Hiromi Furuie, Takayuki Taruya, Takao Hamamoto, Sachio TakenoAbstractBackgroundExtra-axial chordomas are exceedingly rare malignant tumours. Herein, we present the first case of an extra-axial chordoma in the gingivae.Methods and resultsA 21-year-old man presented with a suspected chordoma in the upper right gingiva. Diagnosis was difficult; however, owing to strong expression of the chordoma marker brachyury, extra-axial chordoma was ultimately diagnosed. The tumour was completely resected without performing a facial incision. To ensure its safety and effectiveness, the surgical procedure was simulated several times before its performance using a three-dimensional (3D) model. Twenty-four months after surgery, the patient remains disease-free.ConclusionA diagnosis of extra-axial chordoma can be confirmed by immunohistochemical staining for brachyury.
  • Corrigendum to “Reliability and validity of the Japanese version of the
           Glasgow Edinburgh Throat Scale (GETS-J): use for a symptom scale of globus
           sensation” [Auris Nasus Larynx 45 (2018) 1041–1046]
    • Abstract: Publication date: Available online 14 March 2019Source: Auris Nasus LarynxAuthor(s): Nao Takahashi, Kaori Mori, Hironori Baba, Takanobu Sasaki, Masaaki Ohno, Fumio Ikarashi, Naotaka Aizawa, Kunihiro Sato, Akio Tsuchiya, Hideyuki Hanazawa, Masahiko Tomita, Yamato kubota, Yuka Morita, Kuniyuki Takahashi, Arata Horii
  • Lysis of the long process of the incus secondary to vibrant SounBridge®
           middle ear implants, treated with hydroxyapatite bone cement
    • Abstract: Publication date: Available online 13 March 2019Source: Auris Nasus LarynxAuthor(s): Vincent Pitiot, Ruben Hermann, Aurélie Coudert, Eric TruyAbstractWe report two patients presenting with delayed complicationsafter Vibrant SounBridge® middle ear implant surgery: in both cases, a revision surgery was performed and lysis of the long process of the incus was highlighted. A re-assembly of the clip around the remaining long process of the incus was performed, associated with hydroxyapatite bone cement application, on the clip and the incudo-stapedial joint. Both patients had a satisfying result, with a mean follow up of 12 months.
  • Radiation-induced angiosarcoma of the parotid gland after postoperative
           radiotherapy for hypopharyngeal carcinoma
    • Abstract: Publication date: Available online 6 March 2019Source: Auris Nasus LarynxAuthor(s): Akihito Arai, Satomi Ozawa, Shota Kinoshita, Kanako Yoshimura, Junichi Mitsuda, Sumiyo Saburi, Daichi Mori, Mari Takenaka, Takahiro Tsujikawa, Eiichi Konishi, Shigeru HiranoAbstractSecondary carcinogenesis within the irradiation range is one of the most severe problems in cancer survivors. A 60-year-old woman developed hypopharyngeal carcinoma, and she received radical surgery and postoperative radiotherapy. Eight years later, brown pigmentation and induration were observed in the left subaural region. Fine-needle aspiration biopsy revealed malignancy and the parotid tumor was diagnosed as recurrence of hypopharyngeal carcinoma. Neoadjuvant chemotherapy followed by radical parotidectomy was performed. The pathological diagnosis was angiosarcoma, which was most likely induced by past irradiation. About two months after surgery, lung metastases were detected. Docetaxel did not affect to lung metastases, but paclitaxel therapy was partially effective. The lung tumors increased in size, and brain metastases developed, resulting in death. Both neoadjuvant chemotherapy and radical surgery played important roles in the local disease control. Administration of newer agents as adjuvant chemotherapeutic agent should also be considered for improving the prognosis.
  • Electrical properties of cells from human olfactory epithelium
    • Abstract: Publication date: Available online 5 March 2019Source: Auris Nasus LarynxAuthor(s): Kengo Tamari, Hiroko Takeuchi, Masayoshi Kobayashi, Kazuhiko Takeuchi, Takashi Kurahashi, Tetsuro YamamotoAbstractObjectiveThe electrical properties of olfactory cells (OCs) are typically examined using animals such as newts, mice, and frogs, with few studies on human OCs. This study investigated the electrical properties of human cells from olfactory epithelium (hCOEs) obtained from subjects of olfactory epithelium showing no clinical symptoms during endoscopic sinus surgery.MethodshCOEs were isolated by collagenase treatment for whole-cell patch clamp recording. The identity of the cells was confirmed by immunohistochemistry with an antibody against olfactory maker protein. Under the voltage clamp with the whole-cell recording configuration, the voltage-gated currents of isolated hCOEs were recorded when the membrane potential was depolarized from a holding potential of −100 mV in a stepwise manner between −90 mV and + 40 mV.ResultsOnly one of 14 hCOE samples expressed a transient inward current at the depolarizing voltage step that was activated by depolarization beyond −40 mV and reached a peak at −30 mV. Delayed and sustained outward currents (444 ± 106 pA at + 40 mV pulse; n = 20) were suppressed by tetraethyl ammonium (n = 3), which is consistent with the properties of newt OCs.ConclusionsMost hCOEs did not exhibit the transient inward current observed in animal models. These findings provide insight into the physiological basis of the unique aspects of human olfactory signal transduction.
  • Attachment-oriented endoscopic surgical management for inverted papillomas
           in the nasal cavity and paranasal sinuses
    • Abstract: Publication date: Available online 2 March 2019Source: Auris Nasus LarynxAuthor(s): Seiichiro Makihara, Shin Kariya, Tomoyuki Naito, Kensuke Uraguchi, Junya Matsumoto, Yohei Noda, Mitsuhiro Okano, Kazunori NishizakiAbstractObjectiveThe treatment of all forms of sinonasal inverted papilloma (IP) is a complete, wide, local resection. The main surgical purpose is to remove all diseased mucosa and mucoperiosteum, together with a cuff of normal-looking mucosa at the attachment site, followed by drilling and/or coagulation. Our aim is to present our experiences in endoscopic surgical management of IP by using attachment-oriented excision.MethodsWe present 20 cases of sinonasal IP. The data collected includes the histopathological diagnosis, staging, extension of the tumor, tumor attachment site, approach to surgery, serum squamous cell carcinoma antigen (SCCA) level, and recurrences.ResultsAll patients underwent endoscopic surgery. A Caldwell-Luc operation was required in addition to the endoscopic surgery in one case. There was one case of recurrence (5%). After the additional operation, there was no recurrence. The tumor attachment sites vary, and the case of recurrence had a wide attachment site at the primary surgery. No major intra- or post-operative complications were observed.ConclusionThe present study shows that attachment-oriented excision for IP is useful for complete resection of IP. Surgeons should choose the surgical approach according to the location of the tumor attachment site rather than the Krouse staging system.
  • Modified spiral tracheoplasty after extensive window resection of trachea
           for advanced thyroid cancer
    • Abstract: Publication date: Available online 28 February 2019Source: Auris Nasus LarynxAuthor(s): Naoki Otsuki, Naruhiko Morita, Tatsuya Furukawa, Hirotaka Shinomiya, Masanori Teshima, Yasutaka Kojima, Ken-ichi NibuAbstractPapillary thyroid carcinoma (PTC) occasionally invades tracheal cartilages. We adapted a reconstructive procedure “modified spiral tracheoplasty” to extensive tracheal defect after resection of locally advanced thyroid cancer. Extensive window resection of tracheal wall was performed in a 72-year-old woman and a 48-year-old man with PTC invading intraluminal trachea. Remaining stumps of trachea were separated from the esophageal wall and were rotated by 90 degrees in opposite directions. Posterior and lateral walls were anastomosed and tracheocutaneous fistula was created to prevent postoperative airway obstruction. Postoperative course was uneventful in both cases. Tracheocutaneous fistula was successfully closed 3 to 4 months after the initial surgery. Modified spiral tracheoplasty is a safe and useful method to recreate a framework of trachea after extensive window resection for advanced thyroid cancer.
  • Microglial activation in the cochlear nucleus after early hearing loss in
    • Abstract: Publication date: Available online 28 February 2019Source: Auris Nasus LarynxAuthor(s): Masao Noda, Miyako Hatano, Tsuyoshi Hattori, Mika Takarada-Iemata, Tomohiro Shinozaki, Hisashi Sugimoto, Makoto Ito, Tomokazu Yoshizaki, Osamu HoriAbstractObjectiveMicroglia are highly specialized tissue macrophages in the central nervous system. Their activation in the auditory system has been reported in adult hearing loss models, but their status in the developing auditory system is less understood. Therefore, we investigated microglial status in the cochlear nucleus (CN) during normal developing periods and after exposing rats to amikacin, a potent ototoxin, around the time of hearing onset.MethodsTo develop the deafness model, rats were administered with a daily intraperitoneal injection of amikacin (500 mg/kg) from postnatal day 7 (P7) to P15. To evaluate the expression of ionized calcium binding adaptor molecule 1 (Iba1), we performed immunohistochemical analysis using rat brains from P10–60. To compare the expression of microglia-related gene, reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis were performed.ResultsImmunohistochemical analysis revealed that, under normal conditions, microglia had relatively large cell bodies with several extended processes that surrounded other cells at P10, while the sizes and number of these cells gradually decreased afterward. In contrast, when amikacin was administered from P7 to P15, microglia maintained large cell bodies with relatively shorter processes at both P15 and P21. Furthermore, RT-qPCR analysis revealed upregulation of genes including phagocytotic and anti-inflammatory markers after amikacin administration.ConclusionThese results suggest that microglia are activated in the CN, and they may contribute to tissue remodeling after early hearing loss in the developing auditory system.
  • Normalization of breathing with adenotonsillectomy in Japanese pediatric
    • Abstract: Publication date: Available online 22 February 2019Source: Auris Nasus LarynxAuthor(s): Sachie Arima, Shigefumi Koike, Maki Fujinaga, Takenao Mihara, Shintaro Sato, Motohiko Suzuki, Shingo Murakami, Meiho NakayamaAbstractObjectiveSince reports on surgical results for pediatric obstructive sleep apnea (OSA) in Japan are insufficient for debate, this study aimed to evaluate the feature of Japanese OSA children and surgical result and document whether is obesity and affecting factor similar to non-Asian countries.MethodsThis is a retrospective study. A total of 242 children with OSA at the Department of Otolaryngology and the Good Sleep Center, Nagoya City University Hospital and the Toyohashi Mates Sleep Disorders Center were included in the study. All children underwent pre- and postsurgical polysomnography. OSA was defined as an apnea hypopnea index (AHI) 5 or greater. Pre- and postsurgical respiratory parameters were compared using paired T test.ResultsNormalization of breathing after surgery for OSA children was 40% with AHI 
  • Oral administration of an herbal medicine to prevent progressive hearing
           loss in a mouse model of diabetes
    • Abstract: Publication date: Available online 22 February 2019Source: Auris Nasus LarynxAuthor(s): Takeshi Hori, Kazuma Sugahara, Junko Tsuda, Yoshinobu Hirose, Makoto Hashimoto, Yousuke Takemoto, Shunsuke Tarumoto, Hiroshi YamashitaAbstractObjectiveTsumura Suzuki Obese Diabetes (TSOD) mice exhibit early age-associated hearing loss. Histopathological analysis of these mice shows narrowing of capillaries in the stria vascularis and chronic reduction of blood flow in the cochlea. In this study, we investigated the effect of oral administration of a herbal medicine or calorie restriction on hearing in TSOD mice.MethodsTSOD mice were divided into 4 groups: CR (calorie restriction), BF and DS (treated with the herbal medicines, Bofutsushosan and Daisaikoto, respectively), and the control group. Body weight, blood glucose levels, and auditory brainstem responses (ABRs) were measured. The cochleae were excised and evaluated histopathologically.ResultsBlood glucose levels were suppressed in the CR, BF, and DS groups. In addition, the elevation of ABR thresholds was inhibited in the CR, BF, and DS groups. Cochlear blood vessels remained wide in the three treatment groups compared with the control group. These results suggested that the administration of these herbal medicines improved glucose tolerance and yielded results similar to those on calorie restriction.ConclusionOral administration of 2 herbal medicines can prevent hearing function disorder in a model mouse of diabetes. The results may clarify the possibility of clinical application.
  • The efficacy of cotton ball packing after endoscopic sinus surgery: A
           prospective, randomized, controlled trial
    • Abstract: Publication date: Available online 17 February 2019Source: Auris Nasus LarynxAuthor(s): Seon-Lin Kim, Sung-Dong Kim, Han-Seul Na, Jae-Wook Kim, Keun-Ik Yi, Sue-Jean Mun, Kyu-Sup ChoAbstractObjectiveThe blocking of airflow into sinonasal cavity may decrease postoperative crusting and the development of adhesions. The purpose of this study was to investigate the efficacy of cotton ball packing in patients following endoscopic sinus surgery (ESS).MethodsThirty nine patients with chronic rhinosinusitis requiring the same extent of ESS were included. As a part of postoperative care, the patients were instructed to perform a nasal saline irrigation and apply a nasal spray in each nostril, and then informed to put a cotton ball in a one side of nostril, and the other side was kept to be empty as a control. Patients’ subjective symptoms, patients’ pain while receiving sinonasal cavity debridement, time required to perform debridement, and postoperative wound healing were evaluated.ResultsAlthough cotton ball packing resulted in less discomfort for postnasal drip, rhinorrhea, headache, and facial pain than no packing, there were no statistically significant differences between the groups. The cotton ball packing was associated with significantly less pain on while performing postoperative debridement, therefore less time was needed to perform debridement. The cotton ball packing appears to improve wound healing within the sinus cavities up to 1 month postoperatively.ConclusionThe use of the cotton ball packing after ESS results in significantly less formation of crusts and adhesions, leading to decreasing pain and time during postoperative debridement and promoting faster wound healing.
  • Adenoid cystic carcinoma with high-grade transformation forming spindle
           cell component of the submandibular gland
    • Abstract: Publication date: Available online 16 February 2019Source: Auris Nasus LarynxAuthor(s): Masaru Miyazaki, Mikiko Aoki, Kaori Koga, Makoto Hamasaki, Yoshikazu Sugiyama, Kensuke Midorikawa, Daisuke Hamatake, Michio Masaki, Yasushi Takamatsu, Akinori Iwasaki, Toshifumi Sakata, Toshitaka Nagao, Kazuki NabeshimaAbstractAdenoid cystic carcinoma (AdCC) with high-grade transformation (AdCC-HGT) is rare, and AdCC-HGT with spindle cell component is particularly rare. The patient was a 65-year-old man with a 5 cm sized swelling of the right submandibular gland. Submandibular sialoadenectomy was performed. Histopathological findings mainly showed conventional AdCC, and minorly showed two other components: (1) the pleomorphic component, a proliferation of atypical pleomorphic epithelial cells forming solid or small clusters and accompanied by necrosis; (2) the spindle cell component, containing atypical spindle cells invading the stroma. Postoperative chemoradiotherapy was performed. Multiple right lung nodular lesions were found on the contrast-enhanced chest CT one month after the surgery. Thoracoscopic pulmonary resection was performed. The lung tumors exhibited a proliferation of atypical spindle cells, accompanied by necrosis. We considered that the spindle cell component of the AdCC-HGT of the submandibular gland developed lung metastases. The patient died seven months after submandibular sialoadenectomy due to respiratory failure. Although rare, our case highlights the importance of recognising spindle cell components in conventional AdCC; even if the area is small, these high-grade transformation areas can metastasise and become prognostic factors.
  • Methotrexate-associated lymphoproliferative disorder with multiple
           pulmonary nodules and bilateral cervical lymphadenopathy
    • Abstract: Publication date: Available online 8 February 2019Source: Auris Nasus LarynxAuthor(s): Seiichiro Makihara, Shin Kariya, Mai Noujima-Harada, Nobuya Ohara, Tomoyuki Naito, Junya Matsumoto, Yohei Noda, Mitsuhiro Okano, Tadashi Yoshino, Kazunori NishizakiAbstractAs has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible.
  • Endocytosis of CF in marginal cells of stria vascularis regulated by ROCK
           and MLCK signaling cascade, but not G-proteins
    • Abstract: Publication date: Available online 8 February 2019Source: Auris Nasus LarynxAuthor(s): Akinobu Kakigi, Teruhiko Okada, Taizo Takeda, Natsumi Uehara, Ken-ichi NibuAbstractObjective The endocytosis of cationized feritin (CF) via a clathrin-mediated pathway is regulated by a signaling network. Marginal cells showed the active endocytosis of CF via a clathrin-mediated pathway. The internalization of receptors through this clathrin-mediated pathway is an important regulatory event in signal transduction. Numerous kinases are involved in endocytosis, and each endocytic route is subjected to high-order regulation by cellular signaling mechanisms. In this study, we investigated whether ROCK and MLCK signaling cascades and G-proteins regulate the endocytosis of CF in marginal cells of the stria vascularis.Methods CF was infused into the cochlear duct with pertussis toxin (PTX),Clostridium botulinum C3 toxin (BTX), guanosine(g-thio)-triphosphate (GTP-γS), ML-7, Y-27632. Endocytic activity was measured at 30 min after the start of infusion under an electron microscope.Results In marginal cells, CF was internalized via a clathrin-mediated pathway that depends on F-actin and microtubules (MT). Its processes were controlled by myosin light chain kinase (MLCK) and Rho-associated kinase (ROCK), but not affected by G-protein-coupled receptor (GPCR) or the RhoA signaling cascade.Conclusion Our previous study showed that the main endocytotic pathway of microperoxidase (MPO) did not depend on the Rho/ROCK molecular switch or actin/myosin motor system, but was mainly regulated by the RhoA signaling cascade. The present study results indicate that these signaling cascades regulating CF internalization completely differ from the cascades for MPO internalization.
  • Successful treatment of eosinophilic otitis media associated with severe
           bronchial asthma with an anti-IL-5 monoclonal antibody, mepolizumab
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Isao Suzaki, Yurika Kimura, Akihiko Tanaka, Kojiro Hirano, Atsushi Ishibashi, Tomomi Mizuyoshi, Izumi Ando, Tatsuya Kitajima, So Watanabe, Yasuyuki Hinohira, Hitome KobayashiAbstractEosinophilic otitis media (EOM), which is characterized by the accumulation of eosinophils in middle ear effusion and the middle ear mucosa, is a refractory type of otitis media that is often associated with asthma. Although an early diagnosis and appropriate treatment are necessary to prevent the progression of hearing loss in patients with EOM, there are currently no well-established treatments for this condition. We treated a 60-year-old male patient with asthma and EOM. The patient’s asthma was poorly controlled, despite the use of high-dose inhaled corticosteroids, long-acting beta-agonist treatment, and the regular use of systemic corticosteroids. Mepolizumab, an anti-IL-5 monoclonal antibody, was started to treat the patient’s refractory asthma. At 4 months after the initiation of mepolizumab treatment, the patient’s asthma, hearing, and middle ear effusion improved. The present case suggests that mepolizumab therapy can control EOM and asthma.
  • Surgical margins in head and neck cancer: Intra- and postoperative
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): K. Thomas Robbins, Asterios Triantafyllou, Carlos Suárez, Fernando López, Jennifer L. Hunt, Primož Strojan, Michelle D. Williams, Boudewijn J.M. Braakhuis, Remco de Bree, Michael L. Hinni, Luiz P. Kowalski, Alessandra Rinaldo, Juan P. Rodrigo, Vincent Vander Poorten, Iain J. Nixon, Robert P. Takes, Carl E. Silver, Alfio FerlitoAbstractObjectiveTo provide a perspective on the significance of recent reports for optimizing cancer free surgical margins that have challenged standard practices.MethodsWe conducted a review of the recent literature (2012–2018) using the keywords surgical margin analysis, frozen and paraffin section techniques, head and neck cancer, spectroscopy and molecular markers.ResultsOf significance are the reports indicating superiority of tumor specimen directed sampling of margins compared to patient directed (tumor bed) sampling for frozen section control of oral cancers. With reference to optimal distance between tumor and the surgical margin, recent reports recommended cutoffs less than 5 mm. Employment of new technologies such as light spectroscopy and molecular analysis of tissues, provide opportunities for a “real time” assessment of surgical margins.ConclusionsThe commonly practiced method of patient directed margin sampling involving previous studies raises concern over conclusions made regarding the efficacy of frozen section margin control. The recent studies that challenge the optimal distance for clear surgical margins are retrospective and address patient cohorts with inherently confounding factors. The use of novel ancillary techniques require further refinements, clinical trial validation, and justification based on the additional resources.
  • Age-related hearing loss and cognitive decline — The potential
           mechanisms linking the two
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Yasue Uchida, Saiko Sugiura, Yukiko Nishita, Naoki Saji, Michihiko Sone, Hiromi UedaAbstractThe amount of attention to age-related hearing loss (ARHL) has been growing, not only from the perspective of being one of the most common health conditions affecting older adults, but also from the perspective of its relation to cognition. Results from a number of epidemiological and laboratory studies have demonstrated a significant link between ARHL and cognitive decline. The Lancet International Commission on Dementia, Prevention, Intervention, and Care has estimated that mid-life hearing loss, if eliminated, might decrease the risk of dementia by nine percent, since hearing loss is a modifiable age-associated condition linked to dementia. Despite numerous research efforts, elucidation of the underlying causal relationships between auditory and cognitive decline has not yet reached a consensus.In this review article, we focused on the hypotheses of etiological mechanisms between ARHL and cognitive decline: (1) cognitive load hypothesis; (2) common cause hypothesis; (3) cascade hypothesis; and (4) overdiagnosis or harbinger hypothesis. Factual evidence obtained in previous studies was assessed to understand the link between ARHL and cognitive decline or dementia. Additionally, an overview of the conceivable effects of hearing intervention, e.g., hearing aids and cochlear implants, on cognition were presented, and the role of hearing aid use was considered for the relevant hypotheses.We should continue to strive for social enlightenment towards the importance of ‘hearing well’, and cultivate a necessity for hearing screening among patients at risk of cognitive decline.
  • A pilot study to investigate the therapeutic effect of Valsalva maneuver
           on otitis media with effusion in adults
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Jung Ju Han, Jung Mee Park, Dong Kee Kim, So Young Park, Shi Nae ParkAbstractObjectiveThis pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response.MethodsThirty nine ears of 32 adult patients who were diagnosed as otitis media with effusion and managed by one-week Valsalva maneuver (>20/day) without any other medication were included in this study. Its therapeutic efficacy was evaluated and the prognostic factors which predict the response of Valsalva maneuver were analyzed by comparing various clinical and audiological factors between success and failure groups.ResultsMean duration of otitis media in the study subjects was 30.9 days (SD 31.6 days). A success rate of 1-week Valsalva maneuver as a single therapeutic modality was up to 64.1% (25/39 ears) and hearing was significantly recovered in success group. No recurrence or side effects were observed. Successful Valsalva maneuver checked and confirmed as bulging of the tympanic membrane by otoendoscopic examination was an excellent indicator of therapeutic response in a week (p 
  • The treatment outcomes of rituximab for intractable otitis media with
           ANCA-associated vasculitis
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Masahiro Okada, Koichiro Suemori, Daiki Takagi, Masato Teraoka, Hiroyuki Yamada, Jun Ishizaki, Takuya Matsumoto, Hitoshi Hasegawa, Naohito HatoAbstractObjectiveTo investigate treatment outcomes, hearing outcomes, and adverse effects of rituximab (RTX) for intractable otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV).MethodsTwenty-three patients who met the criteria proposed by the OMAAV study group were included. RTX was used for patients who had difficulty achieving induction of remission using glucocorticoids (GC) and intravenous cyclophosphamide (IVCY).ResultsSix patients were treated with RTX (RTX group), while 17 patients did not require RTX for induction of remission (non-RTX group). All six patients in the RTX group achieved remission. Age, sex, and months from onset to diagnosis did not differ significantly between the groups. The air-conduction hearing thresholds at diagnosis and remission were 71.7 ± 6.3 dB and 50.1 ± 5.1 dB in the RTX group, and 56.8 ± 4.8 dB and 35.8 ± 4.8 dB in the non-RTX group, respectively. Hearing level at remission was significantly better in the non-RTX group (p 
  • Differentiating among conductive hearing loss conditions with wideband
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): So Young Kim, Jae Joon Han, Seung Ha Oh, Jun Ho Lee, Myung-whan Suh, Me Hee Kim, Moo Kyun ParkAbstractObjectiveThis study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information.MethodsWe recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups.ResultsThe normal subjects showed an average peak pressure of −19.51 daPa and an average resonance frequency of 965.94 Hz. Tympanic membrane perforation only patients showed a very low peak pressure (−124.93 daPa) and resonance frequency (73.12 Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08 daPa) without changes in the resonance frequency (1024.8 Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71 Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707 Hz, the area under the ROC curve was 0.719 (P 
  • The effect of cochlear implants on vestibular-evoked myogenic potential
           responses and postural stability
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Toru Miwa, Ryosei Minoda, Hidetake Matsuyoshi, Hiroki TakedaAbstractObjectiveCurrent spread by electrical stimulation via inserted cochlear implant (CI) electrodes and the consequential increase in sound input can affect the equilibrium of patients. The aim of the present study was to clarify the effect of CIs on the equilibrium of patients through cervical vestibular-evoked myogenic potential (cVEMP) testing and static stabilometry performed with the CIs turned on (CI-on) and off (CI-off).MethodsThis prospective study included nine adult patients who underwent unilateral cochlear implantation surgery at our institution. cVEMP testing and stabilometry were performed before surgery and repeated after surgery in the CI-on and CI-off modes.ResultsBefore surgery, cVEMP responses were diminished in five of the nine patients (55.6%), while the results of stabilometry were poor in six patients (66.7%). After surgery, both cVEMP responses and stabilometry findings in the CI-off mode exhibited significant deterioration relative to the preoperative results (cVEMP: 7/9, 77.8%; stabilometry: 7/9, 77.8%). However, in the CI-on mode, there were significant improvements in both test results relative to the findings in the CI-off mode for all patients.ConclusionCIs compensated for the surgical trauma-induced deterioration in static postural stability when turned on, resulting in a considerable improvement. Our findings suggest that postoperative cVEMP testing in the CI-on and CI-off modes will enable more accurate assessment of the saccule–inferior vestibular nerve system function after cochlear implant surgery.
  • Effects of residual speech and auditory deprivation on speech perception
           of adult cochlear implant recipients
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Ufuk Derinsu, Mustafa Yüksel, Cennet Reyyan Geçici, Ayça Çiprut, Esra AkdenizAbstractObjectivePossible predictive factors of cochlear implant (CI) outcomes have been extensively reported in literature for different user groups such as prelingual pediatric or postlingual adult users. However, there remains unexplained outcome variability among adult CI users; therefore, research concerning these patients continues and many different variables have been reported. This study aimed at evaluating the relationship between preoperative speech reception capacity, residual hearing, duration of deafness, age of implantation, and postoperative monosyllabic word recognition scores (WRSs) in postlingual CI users.MethodsEffect of onset age of hearing loss, duration of hearing loss, cochlear implantation age, pre CI speech reception thresholds (SRT) and pre CI WRS on the post-CI WRS of 76 adults were analyzed.ResultsThere are statistically significant relationships between hearing loss duration, pre-CI WRS, residual hearing and the post CI WRS. We observed that patients with shorter auditory deprivation with measurable speech perceptions and residual hearing might perform better with CI.ConclusionEar selection in cases of unilateral CI should be considered on an individual basis with respect to the speech perception abilities.
  • Binaural sensitivity to temporal fine structure and lateralization ability
           in children with suspected (central) auditory processing disorder
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Yones Lotfi, Tayebeh Ahmadi, Abdollah Moossavi, Enayatollah BakhshiAbstractObjectivePrevious studies have shown that a subgroup of children with suspected (central) auditory processing disorder (SusCAPD) have insufficient ability to use binaural cues to benefit from spatial processing. Thus, they experience considerable listening difficulties in challenging auditory environments, such as classrooms. Some researchers have also indicated the probable role of binaural temporal fine structure (TFS) in the perceptual segregation of target signal from noise and hence in speech perception in noise. Therefore, in the present study, in order to further investigate the underlying reason for listening problems against background noise in this group of children, their performance was measured using binaural TFS sensitivity test (TFS-LF) as well as behavioral auditory lateralization in noise test, both of which are based on binaural temporal cues processing.MethodsParticipants in this analytical study included 91 children with normal hearing and no listening problems and 41 children (9–12 years old) with SusCAPD who found it challenging to understand speech in noise. Initially, the ability to use binaural TFS was measured at three frequencies (250, 500 and 750 Hz) in both the groups, and the results of preliminary evaluations were compared between normal children and those with SusCAPD who participated in the study. Thereafter, the binaural performance of the 16 children with SusCAPD who had higher thresholds than the normal group at all three frequencies tested in TFS-LF test was examined using the lateralization test in 7 spatial locations.ResultsTotal 16 of the 41 children with SusCAPD who participated in this study (39%) showed poor performance on the TFS-LF test at all three frequencies, compared to both normal children and other children in the APD group (p 
  • Objective measures of physical activity in patients with chronic
           unilateral vestibular hypofunction, and its relationship to handicap,
           anxiety and postural stability
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Hiroyuki Morimoto, Yuji Asai, Eric G. Johnson, Yoshinori Koide, Junichi Niki, Shigeki Sakai, Meiho Nakayama, Kayoko Kabaya, Ayako Fukui, Yoko Mizutani, Takehiko Mizutani, Yoshino Ueki, Jun Mizutani, Takatoshi Ueki, Ikuo WadaAbstractObjectiveDizziness is one of the most common symptoms in the general population. Patients with dizziness experience balance problems and anxiety, which can lead to decreased physical activity levels and participation in their daily activities. Moreover, recovery of vestibular function from vestibular injury requires physical activity. Although there are reports that decreased physical activity is associated with handicap, anxiety, postural instability and reduced recovery of vestibular function in patients with chronic dizziness, these data were collected by self-report questionnaires. Therefore, the objective data of physical activity and the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness are not clear. The purpose of this research was to objectively measure the physical activity of patients with chronic dizziness in daily living as well as handicap, anxiety and postural stability compared to healthy adults. Additionally, we aimed to investigate the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness.MethodsTwenty-eight patients with chronic dizziness of more than 3 months caused by unilateral vestibular hypofunction (patient group) and twenty-eight age-matched community dwelling healthy adults (healthy group) participated in this study. The amount of physical activity including time of sedentary behavior, light physical activity, moderate to vigorous physical activity and total physical activity using tri-axial accelerometer, self-perceived handicap and anxiety using questionnaires, and postural stability were measured using computerized dynamic posturography.ResultsThe results showed worse handicap, anxiety and postural stability in the patient group compared to the healthy group. Objective measures of physical activity revealed that the patient group had significantly longer time of sedentary behavior, shorter time of light physical activity, and shorter time of total physical activity compared to the healthy group; however, time of moderate to vigorous physical activity was not significantly different between groups. Moreover, there were correlations between physical activity and postural stability in the patient group, while there were no correlations between physical activity, handicap or anxiety in the patient group.ConclusionThese results suggest that objectively measured physical activity of the patients with chronic unilateral vestibular hypofunction is lower compared to the healthy adults, and less active patients showed decreased postural stability. However, the details of physical activity and causal effect between physical activity and postural stability were not clear and further investigation is needed.
  • A novel fluoroscopic method for multidimensional evaluation of swallowing
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Nobuyuki Arai, Kozo Hanayama, Takaharu Yamazaki, Tetsuya Tomita, Akio Tsubahara, Kazuomi SugamotoAbstractObjectiveDynamic videofluoroscopic swallow study (VFSS) is used to investigate swallowing movements. However, it requires prolonged radiation exposure and mainly provides qualitative information. Herein, we present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the size, position, and temporal profile of the bolus to obtain a more comprehensive and realistic analysis of swallowing movements.MethodsFifteen healthy adults drank two liquids: 20 mL of pure water followed by 20 mL of contrast medium mixture in a fluoroscopic study. Data were recorded in serial-shot images (7.5 frames/second, 1024 × 1024-pixel resolution, DICOM format). The images from the water and contrast swallows were inverted, synchronized, and subtracted to visualize the bolus in each frame. The pathway of the bolus was divided into 15 parts traversing the oropharynx, hypopharynx, and upper esophagus, and the total gray value was measured in each section. The results were presented as contour graphs.ResultsThe contour graphs allowed for information on the size, anatomical location, and temporal location of the bolus during swallowing to be displayed simultaneously. Two distinct swallowing patterns were observed in the subjects. The bolus showed two peaks—one in the hypopharynx and one in the upper esophagus—in all subjects. However, in nine of the 15 subjects, the two peaks were in different frames, whereas in six of the subjects, the two peaks were in the same frame.ConclusionWe developed a new method for quantitatively evaluating swallowing. The technique allows for multidimensional assessment of the size, position, and temporal profile of the movement of the bolus across the pharynx. This method evaluates the swallowing movements using sharp, high-resolution images obtained by serial-shot, pulsed fluoroscopy with low radiation exposure. Additional studies are required to further clarify the variability of swallowing patterns and their clinical relevance in the evaluation of swallowing movements in healthy subjects and in patients with swallowing disorders.
  • Radiographic and histologic characterization of tongue base tissues
           obtained by transoral robotic surgery in patients with obstructive sleep
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Jeong-Whun Kim, Seung Hoon Lee, Hong Joong Kim, Chae-Seo Rhee, Seung-No HongAbstractObjectiveOur aim was to radiographically and histologically characterize the tongue base tissues removed after robotic surgery and to analyze their relationship with polysomnographic measurements in obstructive sleep apnea.MethodsMedical records, radiographs and histologic specimen of the patients who underwent transoral robotic tongue base reduction surgery were retrospectively reviewed. Findings in computed tomography (CT) images, histopathological features of the removed tongue base tissues, and respiratory parameters in polysomnography were compared and analyzed.ResultsSurgical specimens and CT images were available from 13 patients (aged 29–61 years). Histologic examination showed that the removed tissues comprised four layers—epithelial, lymphoid follicular, glandular, and muscle tissue. The median (interquartile range) thickness of the epithelial, lymphoid, and glandular layers was 0.29 (0.24–0.44) mm, 3.37 (1.67–4.75) mm, and 3.75 (3.45–4.10) mm, respectively. The lymphoid layer thickness on CT was correlated with that in the histologic section (r = 0.967, p 
  • Sleep hygiene-related conditions in patients with mild to moderate
           obstructive sleep apnea
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Su Young Jung, Hyung-sik Kim, Jin-Young Min, Kyoung Jin Hwang, Sung Wan KimAbstractObjectiveSleep hygiene-related conditions are factors that affect the symptoms experienced by patients with obstructive sleep apnea (OSA). However, very few studies have investigated the association between sleep hygiene and sleep symptoms, especially in patients with mild or moderate OSA. This study evaluated the relationship between factors related to sleep hygiene and clinical symptoms in patients with mild to moderate OSA.MethodsOne hundred and seventy-four patients who visited the Sleep Breathing Disorder Center at a tertiary academic center to evaluate suspected OSA were included. All patients underwent standard polysomnography (PSG) and the Epworth sleepiness scale (ESS) and questionnaires related to daytime and nighttime symptoms and sleep hygiene. Medical records were reviewed for demographic, clinical, and PSG parameters. Correlation analysis between sleep hygiene-related conditions and clinical symptoms in patients with mild to moderate OSA was performed.ResultsThe correlation analysis between the nine categories of sleep hygiene and the three categories of clinical symptoms showed that, in the case of inadequate temperature and humidity conditions, the three categories of clinical symptoms were more severe (daytime symptoms r = 0.382, nighttime symptoms r = 0.568, ESS score r = 0.321). Drinking alcohol before sleep (daytime symptoms r = 0.457, nighttime symptoms r = 0.649, ESS score r = 0.301) and emotional excitement or arousal (daytime symptoms r = 0.378, nighttime symptoms r = 0.545, ESS score r = 0.341) were correlated with greater severity of each of the clinical symptoms (p 
  • MicroRNA-4497 functions as a tumor suppressor in laryngeal squamous cell
           carcinoma via negatively modulation the GBX2
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Xudong Chen, Litao Zhang, Shixiong TangAbstractObjectiveMicroRNAs (miRNAs) are aberrantly expressed in various tumors and play a critical role in the progression and development of tumors. However, there is little information about the role of miR-4497 in laryngeal squamous cell carcinoma (LSCC). The aim of this study is to investigate the role of miR-4497 in LSCC.MethodsMiR-4497 expression in tumor tissues and adjacent normal tissues was measured by RT-PCR. The effects of miR-4497 on cell viability and apoptosis were evaluated by the MTT assay, Flow cytometry and caspase-3 activity assay. Western blot analysis was used to measure the expression of various proteins. Bioinformatic analysis and luciferase reporter assay were applied to investigate the relationship between miR-4497 and GBX2.ResultsWe found that miR-4497 expression was downregulated in LSCC tumor tissues and cell lines compared to the normal counterparts. Overexpression of miR-4497 inhibits the proliferation and induces apoptosis of LSCC cells accompanied by the down-regulation of anti-apoptotic Bcl-2 proteins. Mechanisms investigation revealed that GBX2 is a direct target of miR-4497. miR-4497 expression was inversely correlated with GBX2 expression in LSCC tissues. Moreover, overexpression of miR-4497 leads to the activation of ERK, JNK but not p38. Inhibition of ERK by specific inhibitor SCH772984 could interfere the apoptosis induced by overexpression of miR-4497.ConclusionTherefore, our results indicate that miR-4497 may play a suppressive role in LSCC by targeting GBX2, which offer new insights into the tumorigenesis of LSCC.
  • Management of retrosternal goiter: Retrospective study of 72 patients at
           two secondary care centers
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Wai Keat Wong, Subhaschandra Shetty, Randall P. Morton, Nicholas P. McIvor, Tony ZhengAbstractObjectiveData pertaining to the outcomes of retrosternal goiter surgeries performed at secondary care centers, where thoracic surgery expertise is not readily available, is infrequently reported. Careful patient selection is crucial to avoid an unexpected need for a sternotomy during surgery. We sought to evaluate the surgical management of patients with retrosternal goiters treated at two secondary care centers.MethodsRetrospective review of clinical records and computed tomographic (CT) scans of 557 patients who underwent thyroid surgery at the Departments of Otolaryngology, Head and Neck Surgery of Manukau Surgery Center and Whangarei Base Hospital. Inclusion criterion was extension of goiter below the plane of the thoracic inlet on CT scan. Clinicopathologic features and surgical outcomes were recorded.ResultsThe prevalence of retrosternal goiter was 72 of 557 patients (12.9%). All patients in this series underwent thyroidectomy transcervically. Dyspnea was present in 48 patients (66.7%). On preoperative CT scans, the goiter was noted to extend beyond the aortic arch in seven patients (9.7%), tracheal bifurcation in five patients (6.9%) and posterior mediastinum in 15 patients (20.8%). Malignancy was diagnosed in eight patients (11.1%) histologically. Postoperatively, vocal cord paralysis was temporary in 5 patients (6.9%) and permanent in 1 patient (1.4%). Hypocalcaemia was transient in 10 patients (13.9%). No permanent hypocalcemia, tracheomalacia, postoperative hematoma or patient death was reported. During the study period, 4 patients were encountered in the outpatients setting whereby the evaluation of their CT imaging demonstrated features deemed to be at high risk of requiring a sternotomy: primary mediastinal goiter (n = 2) and inferior extent of goiter to the level of right atrium (n = 2). These patients were pre-emptively referred to a tertiary center where thoracic surgery service was available and their data was reported separately.ConclusionWith careful patient selection, the majority of retrosternal goiter can be resected transcervically with minimal morbidities. Preoperative CT scan yielded useful surgical information; in the presence of primary mediastinal goiter or inferior extent of goiter to the level of the right atrium, surgery should be planned in a tertiary center where thoracic surgeon is available.
  • The clinical value of serum squamous cell carcinoma antigens 1 and 2 in
           head and neck squamous cell carcinoma
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Ryuji Yasumatsu, Takafumi Nakano, Kazuki Hashimoto, Ryunosuke Kogo, Takahiro Wakasaki, Takashi NakagawaAbstractObjectiveThe usefulness of pretreatment measurement of SCC antigen in patients with head and neck SCC is still controversial. Our aim of this study was to evaluate the clinical usefulness of serum SCC antigen, SCCA1 and SCCA2 in the management of patients with head and neck SCC.MethodsSerum samples for the analysis of SCCA1, SCCA2 and SCC antigen were taken from head and neck SCC patients before treatment. Serum SCC antigen was assayed with a solid phase immunoradiometric assay. The SCCA1 and SCCA2 protein level was determined by a sandwich ELISA.ResultsFifty-two of 96 cases (54%) showed evaluated serum SCC antigen levels above the upper limit. The serum SCCA2 level was significantly higher in the head and neck SCC patients than in control group, whereas there were no significant differences in the serum SCCA1 level between head and neck SCC patients and control group. 72% of head and neck SCC patients demonstrated SCCA2 levels higher than 0.15, whereas 68% of the control subjects had SCCA2 levels less than 0.15.ConclusionThe serum SCCA2 levels were increased during the progression of cancer and might be a useful tool for the management of head and neck SCC.
  • Japanese translation, cross-cultural adaption and multicentre validation
           of the Zurich chronic middle ear inventory (ZCMEI-21-Jap)
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): David Bächinger, Daiki Takagi, Hiroyuki Yamada, Masato Teraoka, Masahiro Okada, Jun Hyodo, Christof Röösli, Alexander M. Huber, Naohito HatoAbstractObjectiveIn the assessment of chronic otitis media (COM) and its treatment, patient-reported outcomes are becoming increasingly important. The aim of the present study was to translate and validate the Zurich chronic middle ear inventory (ZCMEI-21) in Japanese in order to provide the first Japanese-language instrument for measuring health-related quality of life (HRQoL) in COM.MethodsThe ZCMEI-21 was translated into Japanese according to published guidelines. In order to assess validity, the ZCMEI-21-Jap total score was compared to a question directly addressing HRQoL as well as the five-level version of the EQ-5D questionnaire, a generic measure of HRQoL.ResultsDemographic data and validity were assessed in a total of 91 COM patients. The ZCMEI-21-Jap total and subscale scores were well comparable to those of the original validation study. Cronbach’s α of the ZCMEI-21-Jap was 0.85, indicating an excellent internal consistency. The ZCMEI-21-Jap total score showed a strong correlation (r = 0.68, p 
  • Nasal septal abscess caused by anaerobic bacteria of oral flora
    • Abstract: Publication date: February 2019Source: Auris Nasus Larynx, Volume 46, Issue 1Author(s): Yukiyoshi Hyo, Hisaki Fukushima, Tamotsu Harada, Hirotaka HaraAbstractAlthough nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected. Symptoms were relieved by needle and incisional drainage. Our patient represents a very rare case of NSA in terms of the cause of onset and the detected bacteria. Early drainage can result in good outcomes.
  • Detecting the recruitment phenomenon in adults using 80-Hz auditory
           steady-state response
    • Abstract: Publication date: Available online 29 January 2019Source: Auris Nasus LarynxAuthor(s): Toshinori Kubota, Tsukasa Ito, Yasuhiro Abe, Hiroyuki Chiba, Yutaka Suzuki, Seiji Kakehata, Masaru AoyagiAbstractObjectivesThe ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.Subjects and methodsWe examined 2 groups of subjects: 10 subjects with unilateral hearing impairment in whom the recruitment phenomenon was detected by the alternate binaural loudness balance test and 12 normal subjects. We compared the relationships between the ASSR response and the stimulus sound pressure level in the 2 groups using the 80-Hz ASSR.ResultsThe amplitude of ASSR was significantly higher in the impaired ear in hearing-impaired subjects compared to a normal ear in normal subjects. The latency of ASSR was significantly shorter in the impaired ear in hearing-impaired subjects than in the normal ear in the normal subjects.ConclusionThis study showed that the recruitment phenomenon caused the higher amplitude and the shorter latency observed in hearing-impaired subjects in the 80-Hz auditory steady-state response (ASSR) in comparison with normal subjects.
  • Frequency characteristics and speech recognition in cartilage conduction
    • Abstract: Publication date: Available online 19 January 2019Source: Auris Nasus LarynxAuthor(s): Tadashi Nishimura, Ryosuke Miyamae, Hiroshi Hosoi, Osamu Saito, Ryota Shimokura, Toshiaki Yamanaka, Tadashi KitaharaAbstractObjectiveCartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.MethodsEight volunteers with normal hearing participated. The performance-intensity function and maximum speech recognition scores for CC with an earplug (i.e., occluded) and air conduction (AC) were measured under high- and low-pass filter (HPF and LPF) conditions, respectively.ResultsAn HPF improved the maximum speech recognition scores for CC in occluded ears. The scores for CC (occluded) under the conditions of the first- and second-order HPF did not differ from that for AC under the no-filter condition. Conversely, an LPF reduced the scores for AC. The scores and confusion matrices under the second-order LPF condition were similar to those for CC (occluded).ConclusionThe conditions under the second-order LPF resembled those of CC in occluded ears. An HPF can compensate excessive low-tone emphasis and improve speech recognition.
  • Tonsillectomy plus steroid pulse therapy is the most effective treatment
           in adult patients with C-Grade I IgA nephropathy, and the weight of the
           extracted palatine tonsils and Yamamoto scale have no significant
           correlation with the effects of this treatment
    • Abstract: Publication date: Available online 18 January 2019Source: Auris Nasus LarynxAuthor(s): Norio Kondo, Takahito Moriyama, Mayako Tachikawa, Erika Tomita, Ai Hattori, Yukie Yamamura, Manabu NonakaAbstractObjectiveWe studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.MethodsWe analyzed 118 IgAN patients who underwent TSP. We collected patients’ data retrospectively, including age, sex, blood pressure, onset of IgAN, pathological findings of a renal biopsy, serum concentration of creatinine, estimated glomerular filtration rate, serum concentration of protein, urinary protein, hematuria, past history of tonsillitis, the Yamamoto scale, the weight and pathological findings of the extracted palatine tonsils, and the presence or absence of anti-platelet drugs and renin-angiotensin system inhibitors (RAS-I) usage. This study included participants who were over 18 years of age, had undergone tonsillectomy within three months of steroid pulse therapy administered thrice, in whom renal biopsy was performed within a year before treatment, and with follow-up period of over 3 years. Clinical remission (CR) of urinary abnormalities was defined as remission of both proteinuria and hematuria: three consecutive negative results over a 6-month period, with a urinary sediment red blood cell count of
  • Outcome prediction for Bonebridge candidates based on audiological
           indication criteria
    • Abstract: Publication date: Available online 8 January 2019Source: Auris Nasus LarynxAuthor(s): Wilhelm Wimmer, Moritz von Werdt, Georgios Mantokoudis, Lukas Anschuetz, Martin Kompis, Marco CaversaccioAbstractObjectiveTo re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.MethodsWe assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65 dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects.ResultsWe found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found.ConclusionBone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38 dB HL to achieve an aided sound field threshold of at least 30 dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.
  • Contrast-enhanced magnetic resonance imaging of facial nerve swelling in
           patients with severe Ramsay Hunt syndrome
    • Abstract: Publication date: Available online 7 January 2019Source: Auris Nasus LarynxAuthor(s): Toshiya Minakata, Akira Inagaki, Shinji Sekiya, Shingo MurakamiAbstractObjectiveIn Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery.MethodsWe retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system.ResultsA significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5–42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery.ConclusionIn particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.
  • Successful management of recurrent adenoid cystic carcinoma in the deep
           infratemporal fossa by maxillo-orbito-zygomatic approach
    • Abstract: Publication date: Available online 6 January 2019Source: Auris Nasus LarynxAuthor(s): Takahiro Hongo, Junichi Fukushima, Yoshinori Uchida, Fumihide Rikimaru, Satoshi Toh, Yuichiro Higaki, Muneyuki MasudaAbstractObjectiveIn the case of deep invasion of an infratemporal fossa (ITF) tumor, surgeons find it difficult to gain sufficient visualization and working space by conventional surgical approaches. To overcome these limitations, we have developed a novel surgical technique, maxillo-orbito-zygomatic (MOZ) approach, by combining partial lateral maxillectomy with the conventional orbito-zygomatic approach.MethodsA 63-year-old male presented with the fifth recurrent adenoid-cystic carcinoma in the right deep ITF. Using a Weber–Ferguson-type incision and partial dismasking, we elevated the skin and scalp flap, while preserving the facial nerve and orbicularis oculi muscle intact in the flap. Then, we performed MOZ osteotomy using three cut lines, the zygomatic arch, the frontozygomatic suture, and from the inferior orbital fissure to the anterolateral wall of the maxilla. Following this, we temporarily elevated the bone flap by partially opening the lateral maxillary sinus. We obtained an excellent surgical view of the ITF, middle skull base, and pterygopalatine fossa with this technique, which facilitated the safe removal of the tumor.ResultsThe postoperative course remained almost uneventful, and we obtained favorable cosmetic results.ConclusionsOur novel MOZ approach could be a robust approach to remove deep ITF tumors.
  • Single versus double suspension sutures for selected cases of obstructive
           sleep apnea
    • Abstract: Publication date: Available online 6 January 2019Source: Auris Nasus LarynxAuthor(s): Mohammad Waheed El-Anwar, Sherif Askar, Amr Hassan El-Sinbawy, Ahmed Mohamed Hassan SalemAbstractObjectiveTo compare the results of expansion pharyngoplasty using bilateral single palatal suspension sutures (SSS) versus double suspension sutures (DSS) for the treatment of selected cases of obstructive sleep apnea (OSA) with retropalatal collapse.MethodsPatients were randomly categorized into two groups: the first group for whom bilateral SSS were performed and a second group for whom bilateral DSS were done. Snoring on the basis of the visual analog scale (VAS), Epworth Sleepiness Scale (ESS), apnea hypopnea index (AHI), lowest O2 saturation were assessed preoperatively and 6 months postoperatively in all patients.ResultsDSS provided significantly more retroplatal space (p = 0.0137) and less snoring score (p = 0.0005). While no significance difference between SSS and DSS as regard inter pillar distance (p = 0.0985), AHI (p = 0.1677), ESS (p = 0.4094), and lowest O2 saturation (p = 0.0839).ConclusionBoth SSS and DSS are simple, rapid, bloodless and effective procedures for treating OSA (in patients with retropalatal collapse) with no temporary or persistent postoperative complications. Adding the second suture in DSS could significantly enlarge more retropalatal space and reduce more snoring scale than SSS.
  • Expression of C-type lectin receptor mRNA in otitis media with effusion
           and chronic otitis media with and without cholesteatoma
    • Abstract: Publication date: Available online 1 January 2019Source: Auris Nasus LarynxAuthor(s): Jeon Gang Doo, Young Il Kim, Haeng Seon Shim, Dong Joon Kim, Jeong Won Park, Sung Hwa Dong, Sang Hoon Kim, Seung Geun YeoAbstractBackground & objectivesC-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.MethodsCLR mRNA levels in patients with OME, COM, and Chole OM were assessed by real-time polymerase chain reaction. The level of expression of each mRNA was compared in patients with and without bacteria, and in patients with conductive hearing loss (CHL) and sensorineural hearing loss (SNHL).ResultsThe patterns of expression of CLRs differed in patients with OME, COM, and Chole OM. Galectin-1 mRNA level was significantly higher in the COM than in the Chole OM group (p 
  • Rhinolith: Examining the clinical, radiological and surgical features of
           23 cases
    • Abstract: Publication date: Available online 28 December 2018Source: Auris Nasus LarynxAuthor(s): Ceyhun AksakalAbstractObjectiveRhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases.MethodsThe medical records and radiological findings of 23 cases, who were operated for rhinolith between January 2010 and June 2018 in Tokat State Hospital, were analyzed retrospectively. The age, gender, the side where rhinolith exists, nidus presence, type of surgery and sinonasal pathologies that accompany rhinolith, and accompanying secondary sinonasal surgeries were examined.ResultsA total of 17 (73.2%) of the 23 cases were female, and 6 (26.8%) were male. The mean age was 24.9 years. The symptoms that were seen in the patients were nasal obstruction (100%), rhinorrhea (82.6%), nasal malodor (78.2%), oral malodor (26%), headache (26%), epistaxis (17.3%), face pain (4,3%), respectively. Nidus could be detected in 6 patients. The most frequent localization of rhinolith was between the inferior concha and the nasal septum (n = 21). The most common concomitant sinonasal pathology in rhinolith was septum deviation (43.4%); and the second most common pathology was mucosal thickening (30.4%) in the maxillary sinus. The surgery type that accompanied rhinolith at the highest frequency was septoplasty (n = 5). Other surgeries were septorhinoplasty (n = 1), antrochoanal polyp excision (n = 1), adenoidectomy (n = 1).ConclusionThe most common symptoms of rhinolith, which is a rare nasal pathology, are nasal obstruction and rhinorrhea. Radiological imaging together with a rigid endoscopy is important especially to evaluate the placement of rhinolith. In addition to this, radiological imaging, evaluation of the sinuses that are not sufficiently evaluated with rigid endoscope are important for planning the type of the operation and secondary surgical procedures which may accompany.
  • Prevalence and clinical implications of low-risk human papillomavirus
           among patients with recurrent respiratory papillomatosis in Rio de
           Janeiro, Brazil
    • Abstract: Publication date: Available online 21 December 2018Source: Auris Nasus LarynxAuthor(s): Marcelo Cardoso Figueiredo, Mariana Chantre Justino, Lucas Delmonico, Rafaele Tavares Silvestre, Thiago Luz de Castro, Aline dos Santos Moreira, Jacyara Maria Brito Macedo, Maria da Glória da Costa Carvalho, Luciano Scherrer, Daniel José Matos de Medeiros Lima, Gilda Alves, Maria Helena OrnellasAbstractObjectiveThe aim of this study was to investigate the presence of human papillomavirus (HPV) in biopsy specimens from juvenile and adult patients with histopathological diagnosis of recurrent respiratory papillomatosis (RRP) treated in two public hospitals in Rio de Janeiro, Brazil.MethodsWe performed the detection and genotyping of HPV by PCR technique for the types 6, 11, 16, and 18 in biopsy specimens from 41 RRP patients.ResultsThe juvenile onset RRP (JoRRP) corresponded to 61% and the adult onset RRP (AoRRP) corresponded to 39% of the study group. Prevalence of males was observed in both the adult (81.3%) and the juvenile (56%) groups. Lesions in the larynx were more frequent in the glottis (46%). Genotyping analysis only revealed patients with HPV-6 (34.1%), HPV-11(17.1%), and co-infection HPV-6 and -11 (48.8%). RRP severity was significantly associated with the JoRRP (p 
  • Post-transplantation laryngeal actinomycosis
    • Abstract: Publication date: Available online 20 December 2018Source: Auris Nasus LarynxAuthor(s): Hirofumi Sei, Jumpei Nouta, Shota Miyaji, Naohito HatoAbstractA case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4 month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2 weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia. Excision of the mass proved it to be a soft granulation including sulfur granules. Oral administration of amoxicillin 750 mg per day was initiated as a postoperative medication. On day 17, histological study confirmed that the tumor-like mass was Actinomyces granuloma, and therefore amoxicillin administration continued. The medication was effective to subside the disease and the arytenoid lesion healed on day 31. Amoxicillin was further administered until day 70 to prevent recurrence. At 6 month after the biopsy, she was free from the disease.
  • Developmental delays assessed using the Enjoji Scale in children with
           cochlear implants who have intellectual disability with or without autism
           spectrum disorder
    • Abstract: Publication date: Available online 19 December 2018Source: Auris Nasus LarynxAuthor(s): Masaomi Motegi, Akira Inagaki, Toshiya Minakata, Shinji Sekiya, Mariko Takahashi, Yoshimasa Sekiya, Shingo MurakamiAbstractObjectiveIntellectual disability (ID) and autism spectrum disorder (ASD) are common among children who are candidates for cochlear implants. However, the implications of these comorbidities for cochlear implant placement have been not fully established. This study sought to identify these implications by comparing developmental delays among children with these conditions.MethodsParticipants were children who were followed up at least every 6 months for 24 months after cochlear implant surgery. Developmental delays were assessed using the Enjoji Scale of Infant Analytical Development (Enjoji Scale) and compared in three groups with hearing loss: those with ID (ID group, n = 4); those with ASD and ID (ASD + ID group, n = 4); and those with typical development (control group, n = 5). Developmental delay was evaluated longitudinally before and after cochlear implant placement for 18 months.ResultsAmong the six subscales that make up the Enjoji Scale, language development and intelligence development were significantly delayed in all three groups and were exacerbated over time except for language development in the control group. Emotional development and social behavior were significantly delayed only in the ASD + ID group. Comparison of intergroup differences revealed delays in language development in the ID and ASD + ID groups compared with the control group.ConclusionThe Enjoji Scale successfully demonstrated developmental delays characteristic to the underlying comorbidities of ID with or without ASD in children with cochlear implants. The Enjoji Scale can be a useful diagnostic tool for screening children with cochlear implants for ID with or without ASD.
  • ☆Comparison of transcutaneous laryngeal ultrasound with video
           laryngoscope for assessing the vocal cord mobility in patients undergoing
           thyroid surgery
    • Abstract: Publication date: Available online 19 December 2018Source: Auris Nasus LarynxAuthor(s): Manish Kumar Shah, Babita Ghai, Nidhi Bhatia, Roshan Kumar Verma, Naresh Kumar PandaAbstractObjectiveWe evaluated the accuracy and feasibility of transcutaneous laryngeal ultrasonography as an alternative to videolaryngoscopy for assessing vocal cord mobility to rule out recurrent laryngeal nerve injury following thyroidectomy.MethodsForty-five adult patients scheduled to undergo elective thyroidectomy under general anesthesia were included. Preoperatively, indirect laryngoscopy and transcutaneous laryngeal ultrasonography was done for assessing vocal cord mobility. Intraoperatively, following induction, patients were intubated using videolaryngoscope. On completion of the surgical procedure, one anesthetist performed videolaryngoscopy so as to record vocal cord mobility while the patients were being extubated in deep plane of anesthesia. Simultaneously another anesthesiologist performed transcutaneous laryngeal ultrasonography.Vocal cord mobility, changes in hemodynamics and total time duration for the two procedures was recorded. Indirect laryngoscopic assessment and flexible fiberoptic laryngoscopy was done on postoperative day 1 and 7 respectively.ResultsPostoperative videolaryngoscopy picked up bilaterally mobile vocal cords in 88.8% cases. Transcutaneous laryngeal ultrasonography could correctly identify 39(86.6%) of these patients, with 1(2.5%) patient being misdiagnosed as having bilaterally immobile vocal cords. Further, videolaryngoscopy identified 5 patients of vocal cord palsy, of which transcutaneous laryngeal ultrasonography correctly identified 3 (60%) patients. Hence, in comparison to videolaryngoscopy, the sensitivity, specificity, positive predictive value, and negative predictive value of transcutaneous laryngeal ultrasonography for assessment of vocal cords was 75%, 95.1%, 60%, and 97.5% respectively.ConclusionIn patients undergoing thyroidectomy, transcutaneous laryngeal ultrasonography can serve as a non-invasive, bedside screening tool for assessing vocal cord palsy postoperatively.
  • Objective and subjective sinonasal and pulmonary outcomes in aspirin
           desensitization therapy: A prospective cohort study
    • Abstract: Publication date: Available online 19 December 2018Source: Auris Nasus LarynxAuthor(s): Timothy Cooper, Samuel R. Greig, Han Zhang, Robert Seemann, Erin D. Wright, Harissios Vliagoftis, David W.J. CôtéAbstractObjectiveAspirin exacerbated respiratory disease (AERD) patients are challenging to manage with sinonasal and pulmonary symptoms refractory to maximal medical and surgical therapies. Our objective was to comprehensively examine objective and validated, disease-specific subjective sinonasal and pulmonary outcomes of aspirin (ASA) desensitization therapy in this patient population.MethodsProspective cohort study at an academic tertiary center. AERD patients with a history of chronic rhinosinusitis with nasal polyposis (CRSwNP), prior diagnosis of asthma, and a history of ASA sensitivity were eligible for inclusion. Patients underwent ASA desensitization using an established institutional protocol and continued on a 650 mg twice daily maintenance dose. Baseline Sinonasal Outcome Test (SNOT-22) and Asthma Control Questionnaire (ACQ) responses, acoustic rhinometry, peak flow readings, and endoscopic scoring of nasal polyps were recorded prior to desensitization and after 6 months of maintenance therapy.ResultsTwelve patients were recruited for participation and underwent desensitization. Eight patients continued maintenance therapy and follow up at 6 months. Prior to desensitization, patients reported bothersome sinonasal symptoms with a median SNOT-22 score of 30.0 ± 34.5 (interquartile range (IQR)). There was significant improvement after 6 months of maintenance therapy to a median SNOT-22 score of 18.5 ± 17.3 (p = 0.025, Wilcoxon signed rank test). Acoustic rhinometry, endoscopic scores, ACQ and forced expiratory volume values remained stable at 6 months.ConclusionsAERD patients may benefit from ASA desensitization with subjective sinonasal symptom improvement at 6 months and stable asthma and objective sinonasal measures. Further discussion is needed in the otolaryngology community regarding ASA desensitization in AERD management.
  • Two cases of Tullio phenomenon in which oval and round window
           reinforcement surgery was effective
    • Abstract: Publication date: Available online 17 December 2018Source: Auris Nasus LarynxAuthor(s): Mitsuya Suzuki, Takuya Okamoto, Munetaka Ushio, Yasushi OtaAbstractAimTo report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 2000 or 4000 Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear. Leftward horizontal nystagmus was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 500 or 1000 Hz in the right ear. Surgical findings indicated that the prosthesis was inserted deep into the oval window, which was closed with thin connective tissue.OutcomesAfter oval and round window reinforcement surgery was performed in the right ear, and loud, pure-tone sounds elicited neither nystagmus nor dizziness in either patient.
  • An internal carotid artery pseudoaneurysm with neck hematoma: A rare cause
           of a life-threatening neck mass mimicking an abscess
    • Abstract: Publication date: Available online 14 December 2018Source: Auris Nasus LarynxAuthor(s): Ana Penezić, Luka Ljubešić, Tomislav Gregurić, Krešo Zurak, Davor Vagić, Dijana ZadravecAbstractA neck mass has a broad and complex differential diagnosis, generally divided into neoplastic, congenital and inflammatory categories. An internal carotid artery hemorrhage with pseudoaneurysm formation is a very rare entity that may resemble other common conditions in the differential diagnosis. Large, expanding or symptomatic pseudoaneurysm is critical to efficiently diagnose and manage, due to risk of life-threatening hemorrhage. We present a case of an adult male patient with clinical and laboratory signs of severe neck cellulitis and a large gradually increasing neck mass, primarily suggestive of an abscess. Neck CT and MRI imaging revealed the presence of a disruption of the internal carotid artery resulting in a large hematoma and formation of pseudoaneurysm. A multidisciplinary team of interventional radiologists and ENT surgeons successfully treated the patient by endovascular placement of stents and subsequent surgical drainage. Awareness of such a rare, life-threatening condition and efficient multidisciplinary teamwork are essential for patient management.
  • The differences in the expression of fractalkine and its receptor in
           conditions of tonsillar hypertrophy and chronic tonsillitis
    • Abstract: Publication date: Available online 13 December 2018Source: Auris Nasus LarynxAuthor(s): Elif Koclu Hetemoglu, Seda Turkoglu Babakurban, Yunus Kasım Terzi, Feride Iffet Sahin, Selim Sermed ErbekAbstractObjectiveFractalkine, member of chemokine family, is involved in many inflammatory processes in the human body. The aim of this study is to compare expression levels of fractalkine ligand and its receptor in chronic tonsillitis and hypertrophic tonsil samples.MethodsThe study was conducted at Baskent University Departments of Otorhinolaryngology and Medical Genetics. It is designed as a prospective, non-randomized, controlled clinical study. Total 97 samples, obtained from adenotonsillectomy due to chronic tonsillitis or tonsillar hypertrophy, were participated in the study. Fractalkine and its receptor expression levels were determined and comparison was made between the tissue groups. c.839C > T (T280 M) polymorphism of fractalkine receptor was analyzed, then relationship between polymorphism and the expression level of fractalkine receptor was investigated.ResultsFractalkine receptor expression was significantly higher in the hypertrophic tonsil group than chronic tonsillitis group (p 
  • CD4+ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s
           in a murine model of allergic rhinitis
    • Abstract: Publication date: Available online 13 December 2018Source: Auris Nasus LarynxAuthor(s): Lin Lin, Zheng Chen, Fei Dai, Jin-Jin Wei, Xin-Yue Tang, Guang-Bin SunAbstractObjectiveCD4+ T cells play an important role not only in the induction of allergy but also in allergic inflammation. Group 2 innate lymphoid cells (ILC2s) also mediate type 2 immune responses in allergic rhinitis (AR). However, the relationships between CD4+ T cells and ILC2s in allergic condition are currently not well defined. The study aimed to evaluate the potential influences of CD4+ T cells on ILC2s in the murine model of AR.MethodsA murine model of AR was established using ovalbumin (OVA), and OVA-induced ILC2s were sorted and purified from the mouse nasal-associated lymphoid tissue (NALT), and cultured in vitro. Then, the expression of major histocompatibility complex class II (MHCII) on ILC2s was examined. CD4+ T cells were separated from AR mice peripheral blood mononuclear cells (PBMCs). After that, productions of IL-5 and IL-13 on ILC2s cultures were assessed when CD4+ T cells or plus anti-MHCII antibody or anti-CD4 antibody were administered into the cultures. Finally, we adoptively transferred ILC2s alone or ILC2s plus anti-MHCII antibody to the murine model of AR to investigate their roles in the nasal allergic inflammation.ResultsWe showed that ILC2s could be induced by OVA in the mouse NALT. The number and percentage of ILC2s in AR mice were increased. MHCII was expressed on ILC2s, and its protein and mRNA were all enhanced in allergic condition. IL-5 and IL-13 proteins and mRNAs were elevated after CD4+ T cells administration, and were reduced after these cells plus anti-MHCII antibody or anti-CD4 antibody application. Numbers of sneezing and nasal rubbing as well as counts of eosinophils in nasal lavage fluid (NLF) were all enhanced after the adoptive transfer of ILC2s when compared to AR mice. IL-5 and IL-13 in the NLF of allergic mice were also increased in comparison with AR group. However, above parameters were all decreased after the transfer of ILC2s plus anti-MHCII antibody versus AR mice or ILC2s-treated ones.ConclusionThese findings show that CD4+ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s in AR mice models.
  • Sinonasal inverted papilloma associated with small cell neuroendocrine
           carcinoma: A case report and literature review of rare malignancies
           associated with inverted papilloma
    • Abstract: Publication date: Available online 10 December 2018Source: Auris Nasus LarynxAuthor(s): Yoshihisa Nakamura, Motohiko Suzuki, Shinya Ozaki, Makoto Yokota, Meiho Nakayama, Hideo Hattori, Hiroshi Inagaki, Shingo MurakamiAbstractWe report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP.We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p = 0.04 and p = 0.03, respectively; T-test).
  • Nasal function and CPAP compliance
    • Abstract: Publication date: Available online 8 December 2018Source: Auris Nasus LarynxAuthor(s): Akiko Inoue, Shintaro Chiba, Kentaro Matsuura, Hiroshi Osafune, Robson Capasso, Kota WadaAbstractObjectiveContinuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specific criteria or recommendations for the evaluation and management of these patients exist. The aim of this retrospective study is to evaluate the effects of nasal anatomic features and disease on adherence to CPAP therapy for patients with OSA and determine the indications for pre-CPAP nasal treatment by using data obtained at clinical examination.MethodsIn total, 711 adult patients with initial diagnosis of OSA and an apnea–hypopnea index of ≥20 who were amenable to CPAP were included. We analyzed nasal parameters, past history of nasal disease, subjective symptoms, and disease severity in addition to whether CPAP therapy had been initiated, rate of CPAP therapy use (initial and 1 year), treatment continuation rate at 2 months and 1 year, and nasal treatments for all patients.ResultsCPAP therapy was initiated in 543 of 711 patients. Nasal resistance was significantly higher in patients who discontinued therapy soon after CPAP initiation. Nasal disease and nasal parameters were not found to be predictors of treatment adherence at 1 year.Allergic rhinitis, moderate to severe nasal congestion at bedtime, slight or extensive sinus opacification, and a high nasal septum deviation score were found to be independent predictors of nasal treatment, while strong awareness of nasal congestion, a past history of sinusitis, and a total nasal resistance (supine position) of ≥0.35 Pa/cm3/s were independent predictors of surgical treatment.ConclusionLong-term CPAP therapy adherence in patients with OSA can be predicted from initial CPAP adherence. Nasal disease and nasal parameters are important factors for early CPAP therapy discontinuation and should be adequately treated before therapy initiation to ensure long-term adherence. Indications for pre-CPAP nasal treatment and nasal surgery for patients with OSA can be predicted from the data obtained at the first examination, and these patients should be treated differently from those without OSA.
  • Endoscopic sinus surgery with and without computer assisted navigation: A
           retrospective study
    • Abstract: Publication date: Available online 6 December 2018Source: Auris Nasus LarynxAuthor(s): Bruno Galletti, Francesco Gazia, Francesco Freni, Federico Sireci, Francesco GallettiAbstractObjectiveIn the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.MethodsWe retrospectively reviewed the records of 96 patients with chronic rhinosinusitis (CRS). 48 patients undergoing endoscopic sinus surgery with surgical navigation (A group) and other 48 without navigation (B group). Data about percentage of complications, olfactory function (Visual Analogue Scale), Sino-nasal Outcomes Test (SNOT-22), Rhinosinusitis Quality of Life (RhinoQoL), recurrence (CT Lund–Mackay score), total nasal resistance (rhinomanometry) and duration of the intervention were collected and analyzed.ResultsA group evidenced a decrease of recurrence rate (p = 0.009), a reduction of total nasal resistance (p = 0.007), of frontal recess stenosis (p = 0.04) and of nasal symptomatology (p = 0.008). QoL had a better improvement in group A. Rate of other complications and olfactory function did not show statistically significant differences between the two groups. The average calibration time was approximately 11 min in the A group. Total time of surgical procedure does not evidenced statistically significant difference between the two groups (p > 0.05) but if it is considered only the time of the surgical intervention, the difference of duration is significant reduced statistically (p 
  • Risk factors and distribution features of level IB lymph nodes metastasis
           in nasopharyngeal carcinoma
    • Abstract: Publication date: Available online 6 December 2018Source: Auris Nasus LarynxAuthor(s): Lei Zeng, Qin Zhang, Fan Ao, Chun-Ling Jiang, Yun Xiao, Hong-Hui Xie, Yi-Qiang Tang, Xiao-Chang Gong, Jin-Gao LiAbstractObjectiveThe objective of this study is to investigate the risk factors and distribution features for level IB metastasis in nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications and clinical target volume (CTV) of prophylactic level IB irradiation.MethodsWe retrospectively analyzed 798 patients with newly-diagnosed, non-metastatic and histologically confirmed NPC underwent intensity-modulated radiation therapy (IMRT). Two sides of neck in each patient have been analyzed separately. The correlations of level IB metastasis and the clinical risk factors were analyzed with Chi-square test and logistic regression model. The risk score model (RSM) of level IB metastasis was calculated by totaling up the scores of each independent variable. We divided level IB into three areas, including anterolateral space of submandibular glands, medial space of the submandibular glands and submandibular glands.ResultsMaximal axial diameter (MAD) of level IIA nodes>20 mm or extra capsular spread (ES) of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression were independently significantly risk factors for level IB lymph nodes (LNs) metastasis at diagnosis. Two groups based on RSM were obtained: low risk (total score = 0–2.5); high risk (4–8.5). The incidence of IB LNs metastasis at diagnosis of the two groups were 0.9% and 6.3%, respectively (P 20 mm or ES of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression in NPC patients. Omission of level IB irradiation may be feasible for patients with low-risk IB LNs metastasis at diagnosis. The submandibular gland should not be included in level IB.
  • Nasal nitric oxide in the inferior turbinate surface decreases with
           intranasal steroids in allergic rhinitis: A prospective study
    • Abstract: Publication date: Available online 4 December 2018Source: Auris Nasus LarynxAuthor(s): Daisuke Takahara, Takashi Kono, Sachio Takeno, Takashi Ishino, Takao Hamamoto, Kazunori Kubota, Tsutomu UedaAbstractObjectiveIt remains controversial whether nasal nitric oxide (NO) serves as a reliable parameter to evaluate treatment efficacy in patients with allergic rhinitis (AR). The measurement of local nasal NO levels has been shown to be a sensitive marker for the diagnosis of symptomatic AR patients. Here we assessed the applicability of nasal NO to evaluations of the efficacy of intranasal steroids (INS) in a prospective design.MethodsWe enrolled 25 patients with perennial AR and 10 age-matched healthy participants. The AR patients received fluticasone furoate (FF) once daily for 2 months. Fractional exhaled NO and nasal NO measurements were carried out using an electrochemical analyzer at pretreatment and at 2 weeks and 2 months after treatment. Nasal NO levels were directly measured at two different areas of the nasal cavity: the surface of the inferior turbinate (IT area) and the front of the middle meatus (MM area). Subjective nasal symptoms were also recorded at each visit.ResultsThe mean total nasal symptom score in the AR patients decreased significantly after FF treatment (p 
  • Inhibition of autophagy by chloroquine makes chemotherapy in
           nasopharyngeal carcinoma more efficient
    • Abstract: Publication date: Available online 2 December 2018Source: Auris Nasus LarynxAuthor(s): Tomomi Aga, Kazuhira Endo, Akira Tsuji, Mitsuharu Aga, Makiko Moriyama-Kita, Takayoshi Ueno, Yosuke Nakanishi, Miyako Hatano, Satoru Kondo, Hisashi Sugimoto, Naohiro Wakisaka, Tomokazu YoshizakiAbstractObjectivesA combination of platinum-based chemotherapy and radiotherapy is the standard treatment for nasopharyngeal carcinoma (NPC). However, the efficacy of chemotherapy has reached a plateau. Many autophagy studies suggest that autophagy can either promote or suppress to cancer progression. Thus, a role of autophagy in the acquisition of chemoradioresistance has recently been a notable event. Therefore, we examined the relationship between autophagy and chemotherapy in NPC.MethodsThe expression of Beclin 1 and microtubule-associated protein light chain 3 (LC3), a marker of autophagy, was determined by immunohistochemistry in the biopsy samples of patients with NPC before and after the first course of chemotherapy. Additionally, to investigate in the effect of autophagy suppression in chemotherapy, NPC cell line C666-1 cells were treated with cisplatin and/or chloroquine, an inhibitor of autophagy.ResultsThe expression of Beclin 1 increased after chemotherapy in all patients. In NPC cell line C666-1, compared to cisplatin alone, combination therapy (cisplatin and chloroquine) reduced cell viability, and promoted cell apoptosis.ConclusionsThese results suggest that autophagy, represented by Beclin 1, is upregulated after chemotherapy in both in vitro and in vivo NPC studies. Inhibition of autophagy could therefore be new strategy for NPC treatment.
  • Magnetic resonance-based volumetric measurement of the endolymphatic space
           in patients with Meniere’s disease and other endolymphatic
           hydrops-related diseases
    • Abstract: Publication date: Available online 30 November 2018Source: Auris Nasus LarynxAuthor(s): Hiroshi Inui, Tsuyoshi Sakamoto, Taeko Ito, Tadashi KitaharaAbstractObjectiveTo employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere’s disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.MethodsForty-one patients with ALHL, 82 with SD, 48 with cMD, 72 with uMD, and 47 CS participated in the study. With the exception of all uMD patients, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph signal, and positive endolymph signal were acquired using a 3-T MRI scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images and the ELS images.ResultsThe cochlear ELS/total fluid space (TFS) volume ratio was 10.2 ± 6.7% (mean ± standard deviation) in the CS group, 12.1 ± 5.7% in ALHL patients, 15.2 ± 8.7% in SD patients, 18.1 ± 8.2% in cMD patients, and 21.9 ± 16.4% in uMD patients. The vestibular ELS/TFS volume ratio was 17.7 ± 10.2% in the CS group, 18.9 ± 8.3% in ALHL patients, 19.9 ± 11.3% in SD patients, 22.5 ± 13.7% in cMD patients, and 35.7 ± 24.1% in uMD patients. The cochlear ELS/TFS volume ratio in patients with uMD was similar to that in the cMD group and significantly higher than that in the CS, ALHL, and SD groups (CS = ALHL 
  • Role of phosphorylcholine in Streptococcus pneumoniae and nontypeable
           Haemophilus influenzae adherence to epithelial cells
    • Abstract: Publication date: Available online 29 November 2018Source: Auris Nasus LarynxAuthor(s): Hiroyuki Iuchi, Junichiro Ohori, Takayuki Kyutoku, Kotoko Ito, Yuichi KuronoAbstractObjectivePhosphorylcholine (PC) is a structural component of Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi), and is known to be associated with adherence through the platelet activating factor receptor (PAF-R). Furthermore, high PC expression is considered to be involved in Spn and NTHi virulence. In this study, we examined the influence of PC expression on the adherence of Spn and NTHi to epithelial cells in order to clarify the potential effectiveness of a vaccine targeting PC.MethodsTwenty-seven strains of Spn and twenty-two strains of NTHi were used, cultured overnight, and PC expression was evaluated by fluorescence activated cell sorting; the strains were divided into two groups: PC low expression (PC-low) and PC high expression (PC-high) groups. Bacterial adherence was then examined using Detroit 562 cells and BALB/c mice. Bacterial invasion was then examined in Detroit 562 cells.ResultsThe adherence of Spn and NTHi and invasion of NTHi in the PC-high group was significantly reduced by pretreatment with a monoclonal anti-PC antibody (TEPC-15), PAF-R antagonist (ABT-491), and PC-keyhole limpet hemocyanin (PC-KLH). However, such findings were not observed in the PC-low group.ConclusionThe present study suggests that PC is involved in the mucosal adhesion of Spn and NTHi, and the mucosal invasion of NTHi with PC-high strains, but not PC-low strains. These results suggest that a PC-targeting mucosal vaccine only affects PC-high Spn and NTHi strains and does not disturb commensal bacterial flora in the upper respiratory tract, which comprises nonpathogenic PC-low bacteria.
  • Corrigendum to “Environmental factors associated with allergic rhinitis
           symptoms in Japanese university students: A cross-sectional study”
           [Auris Nasus Larynx 45 (2018) 1006–1013]
    • Abstract: Publication date: Available online 29 November 2018Source: Auris Nasus LarynxAuthor(s): Hironobu Nishijima, Sayaka Suzuki, Kenji Kondo, Tatsuya Yamasoba, Shintaro Yanagimoto
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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