Head and Neck Diseases by Alexandros G.Sfakianakis: 05/22/16

Κυριακή 22 Μαΐου 2016

Idelalisib for the treatment of indolent non-Hodgkin lymphoma

a review of its clinical potential:

Jacqueline C Barrientos

CLL Research and Treatment Program, Division of Hematology/Oncology, Department of Medicine, Hofstra Northwell School of Medicine, Hofstra University, Lake Success, NY, USA

Abstract: Idelalisib is a first-in-class, oral, selective phosphatidylinositol 3-kinase δ inhibitor that offers a chemotherapy-free option for patients with relapsed or refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). Clinical trials in iNHL have evaluated idelalisib as monotherapy and as combination therapy with rituximab, bendamustine, and rituximab + bendamustine. When administered to heavily pretreated patients with R/R iNHL, idelalisib monotherapy or combination therapy showed durable antitumor activity accompanied by sustained or improved quality-of-life outcomes. Idelalisib has an acceptable safety profile; however, serious or fatal diarrhea/colitis, hepatoxicity, pneumonitis, and intestinal perforation have occurred in treated patients. Selective inhibition of phosphatidylinositol 3-kinase δ with idelalisib is a valuable addition to available treatment options for patients with iNHL, many of whom do not respond to or cannot tolerate chemoimmunotherapy. Two Phase III, randomized, placebo-controlled trials of idelalisib as combination therapy with rituximab or bendamustine + rituximab and a Phase I trial of idelalisib in combination with the Bruton's tyrosine kinase inhibitor ONO/GS-4059 in R/R B-cell malignancies are currently ongoing. A Phase III monotherapy trial in previously treated follicular lymphoma or small lymphocytic lymphoma is planned. The development of other kinase inhibitors for the treatment of iNHL raises the potential for new treatment combinations. Additional research is needed to determine optimal therapy (monotherapy vs combination regimens), treatment sequencing, and long-term management.

Keywords: B-cell receptor, follicular lymphoma, elderly, targeted therapy, kinase inhibitor, phosphatidylinositol 3-kinase

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Enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy

Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis:

Zhihong Zhang,^1,2 Yu Zhu,¹ Yun Ling,³ Lijuan Zhang,¹ Hongwei Wan¹

¹Department of Nursing, Shanghai Proton and Heavy Ion Center, ²Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, ³Department of Human Resource, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China

Abstract: Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy were frequently used in the head and neck cancer patients when malnutrition was present. Nevertheless, the evidence was inclusive in terms of the choice and the time of tube placement. The aim of this network meta-analysis was to evaluate the comparative effects of prophylactic percutaneous endoscopic gastrostomy (pPEG), reactive percutaneous endoscopic gastrostomy (rPEG), and NGT in the head and neck cancer patients receiving radiotherapy or chemoradiotherapy. Databases of PubMed, Web of Science, and Elsevier were searched from inception to October 2015. Thirteen studies enrolling 1,631 participants were included in this network meta-analysis. The results indicated that both pPEG and NGT were superior to rPEG in the management of weight loss. pPEG was associated with the least rate of treatment interruption and nutrition-related hospital admission among pPEG, rPEG, and NGT. Meanwhile, there was no difference in tube-related complications. Our study suggested that pPEG might be a better choice in malnutrition management in the head and neck cancer patients undergoing radiotherapy or chemoradiotherapy. However, its effects need to be further investigated in more randomized controlled trials.

Keywords: malnutrition, tube feeding, weight loss, treatment interruption, readmission, complication

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Low-grade nasopharyngeal papillary adenocarcinoma

a case report and review of the literature:

Xiaoli Wang,^1,2 Hongjiang Yan,¹ Yijun Luo,^1,2 Tingyong Fan¹

¹Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, ²School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China

Abstract: Low-grade nasopharyngeal papillary adenocarcinoma is an extremely rare tumor, with only a limited number of cases reported in the literature. Some published studies have paid more attention to the clinicopathological features of nasopharyngeal adenocarcinoma, while little effort has been made to study the optimal therapeutic strategies. We report about a woman diagnosed with low-grade nasopharyngeal papillary adenocarcinoma. She received the treatment approach that combined transnasal endoscopic surgery to remove the lesion with postoperative radiotherapy for nasal cavity. There was no evidence of recurrence after 4 months of surgery, and further follow-up is being continued. Through this example, we wanted to explore the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas.

Keywords: nasopharyngeal adenocarcinoma, immunohistochemistry, treatment policy, survival and prognosis

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)

A changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology:

The change in the diagnosis of noninvasive encapsulated follicular variant papillary thyroid carcinoma to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (ie, not carcinoma) will have significant impact on the risk of malignancy for categories according to The Bethesda System for Reporting Thyroid Cytopathology, and especially for the indeterminate categories.

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Follicular dendritic cell tumour/sarcoma

a commonly misdiagnosed tumour in the thorax Intrathoracic follicular dendritic cell sarcoma:

Abstract

Aims

Follicular dendritic cell sarcoma (FDCS) is a rare tumour reported to occur occasionally in association with the hyaline-vascular type of Castleman's disease (HVCD). Most cases arise in lymph nodes though extranodal presentation is described.

Methods and Results

Clinical, radiological and histological characteristics, including diagnosis on pre-resection material, were assessed in seven intrathoracic cases from five males and two females with a median age of 38 years. Clinical symptoms were related to mass location, six cases presenting within central and/or posterior mediastinal compartments and one within the lungs. PET/CTs demonstrated marked fluoro-deoxy-glucose (FDG) avidity and the prominent vessels traversing the lesions. Four of six cases (67%) were initially misdiagnosed. HVCD was present in three cases. Two cases with high mitotic rates recurred after resection. All were positive for at least one of the follicular dendritic cell markers (CD21, CD35 and CD23). Six of seven cases (86%) show Cyclin D1 expression ranging from 5% to 90%.

Conclusions

FDCS is often misdiagnosed on biopsy and pathologists need to be aware of the tumour to request the relevant immunohistochemistry, especially in masses presenting in the central/posterior mediastinum with high vascularity and SUV levels. Background HVCD appears more common than previously thought.

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Small B-cell lymphoid neoplasms involving the bone marrow and peripheral blood Report on the Bone Marrow

Issues in diagnosis of small B-cell lymphoid neoplasms involving the bone marrow and peripheral blood Report on the Bone Marrow workshop of the XVIIth meeting of the European Association for Haematopathology and the Society for Hematopathology:

Abstract

Small B-cell lymphoid neoplasms are the most common lymphoproliferative disorders involving peripheral blood (PB) and bone marrow (BM). The Bone Marrow Workshop (BMW) organized by the European Bone Marrow Working Group (EBMWG) of the European Association for Haematopathology (EAHP) during the 17^th EAHP Meeting in Istanbul October 2014 was dedicated to discussion of cases illustrating how the recent advances in immunophenotyping, molecular techniques and cytogenetics provide better understanding and classification of these entities. Submitted cases were grouped into following categories:

cases illustrating diagnostic difficulties in chronic lymphocytic leukaemia (CLL).

cases of BM manifestations of small B-cell lymphoid neoplasms other than CLL.

transformation of small B-cell lymphoid neoplasms in the BM.

multiclonality and composite lymphomas in the BM.

This report summarizes presented cases and conclusions of the BMW and provides practical recommendations for classification of the BM manifestations of small B-cell lymphoid neoplasms based on the current state of knowledge.

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Eosinophils and mast cells of the gastrointestinal tract

Histologic analysis of eosinophils and mast cells of the gastrointestinal tract in healthy Canadian children

via Human Pathology

Publication date: August 2016
Source:Human Pathology, Volume 54
Author(s): Elizaveta Chernetsova, Katrina Sullivan, Joseph de Nanassy, Janice Barkey, David Mack, Ahmed Nasr, Dina El Demellawy
Many gastrointestinal (GI) disorders, including GI eosinophilia and inflammatory bowel disease, can be characterized by increased mucosal eosinophils (EOs) or mast cells (MCs). Normal mucosal cellular counts along the GI tract in healthy children have not been established for a Canadian pediatric population. To establish a benchmark reference, we quantified EO and MC from 356 mucosal biopsies of the GI tract obtained during upper and lower endoscopic biopsies of 38 pediatric patients in eastern Ontario. Mean total counts of EO varied for the 11 tissues we examined, from a low of 7.6±6.5/high-power field (HPF) (×40 [×400, 0.55mm²]) in the body of the stomach to a high of 50.3±17.4/HPF in the cecum. The lower GI tract (ileum, cecum, colon, sigmoid, and rectum) generally had higher total EO counts than the upper GI tract (antrum and body of stomach, duodenum, and duodenal cap) (combined average of 32.1±20.6 versus 19.3±15.8, respectively). Similarly, the number of mucosal MC was different in the various regions of the GI tract ranging from 0.04±0.2/HPF in the duodenal cap to 0.9±2.6/HPF in the ileum. Total counts for EO and MC in the lamina propria were not significantly different between sexes when adjusted for multiple testing. EO polarity was absent in many cases, irrespective of the GI region. These numeration and localization of EO and MC will provide normative data for upper and lower endoscopic GI biopsies in the pediatric population of Eastern Ontario.

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Use of the ETView Tracheoscopic Ventilation Tube in airway management of a patient with unanticipated difficult bag-mask ventilation

Use of the ETView Tracheoscopic Ventilation Tube in airway management of a patient with unanticipated difficult bag-mask ventilation:

Abstract

The management of unanticipated difficult airway is a clinical challenge to anesthesiologists. The ETView Tracheoscopic Ventilation Tube (ETView), which is capable of real-time video imaging of the airway without needing additional equipment, may provide a promising settlement for the cases. Here, we reported a successful management of unanticipated difficult bag-mask ventilation airway with the ETView. More importantly, we successfully maintained oxygenation by modifying its injection and suction port.

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Heparin bridging anticoagulation on perioperative bleeding and thromboembolic risks

in patients undergoing abdominal malignancy surgery:

Abstract

Recent publications provided controversial results indicating that perioperative heparin bridging anticoagulation (HBA) increased the bleeding risk without decreasing the thromboembolic risk in patients undergoing minor surgery. To investigate if this is also the case in high-risk patients undergoing major abdominal malignancy surgery, we retrospectively collected data of 3268 patients over a 10-year period. After the interruption of preoperative antithrombotic agents, HBA was initiated with a prophylactic-dose of unfractionated heparin in 133 patients (HBA group), and 62 patients did not receive HBA (non-HBA group). The incidence of exogenous blood transfusion (EBT) and thromboembolic events (TEEs) within 30 days after surgery were compared between the HBA and non-HBA groups. The results showed that the incidence of EBT and TEEs was similar between the two groups (23.3 vs 19.4 %; P = 0.535) and (4.1 vs 3.2 %; P = 0.821), respectively. The amount of intraoperative bleeding and the length of postoperative hospital stay were also similar [median (quantile 1−3); 192 (71–498) vs 228 ml (100–685); P = 0.422] and [12 (9–19) vs 14.5 days (10–21); P = 0.052], respectively. These findings may suggest it is unlikely that prophylactic-dose HBA affects bleeding and thromboembolic risks in patients undergoing major abdominal malignancy surgery.

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Predictors of Difficult Intubation with the Bonfils Rigid Fiberscope

Predictors of Difficult Intubation with the Bonfils Rigid Fiberscope:

BACKGROUND: Endotracheal intubation is commonly performed via direct laryngoscopy (DL). However, in certain patients, DL may be difficult or impossible. The Bonfils Rigid Fiberscope® (BRF) is an alternative intubation device, the design of which raises the question of whether factors that predict difficult DL also predict difficult BRF. We undertook this study to determine which demographic, morphologic, and morphometric factors predict difficult intubation with the BRF.

METHODS: Four hundred adult patients scheduled for elective surgery were recruited. Patients were excluded if awake intubation, rapid sequence induction, or induction without neuromuscular blocking agents was planned. Data were recorded, including age, sex, weight, height, American Society of Anesthesiologist classification, history of snoring and sleep apnea, Mallampati class, upper lip bite test score, interincisor, thyromental and sternothyroid distances, manubriomental distances in flexion and extension, neck circumference, maximal neck flexion and extension, neck skinfold thickness at the cricoid cartilage, and Cormack and Lehane grade obtained via DL after paralysis was confirmed. Quality of glottic visualization (good or poor), as well as the number of intubation attempts and time to successful intubation with the BRF, was noted. Univariate analyses were performed to evaluate the association between patient characteristics and time required for intubation. Variables that exhibited a significant correlation were included in a multivariate analysis using a standard least squares model. A P 1 attempt; 4 patients could not be intubated by using the BRF alone. These 4 patients were intubated by using a combination of DL and BRF (2 patients), DL and a Frova bougie (1 patient), and DL and an endotracheal tube shaped with a semirigid stylet (1 patient). Mean time for successful intubation was 26 ± 13 seconds. Multivariate analysis showed that decreased mouth opening (P = 0.008), increased body mass index (P = 0.011), and higher Cormack and Lehane grade (P = 0.038) predicted longer intubation times, whereas shorter thyromental distance predicted slightly shorter intubation times (P

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Osteoprotective Effects of Estrogen in the Maxillary Bone Depend on ER{alpha}

Osteoprotective Effects of Estrogen in the Maxillary Bone Depend on ER{alpha}:

Estrogen deficiency results in disruption of maxillary alveolar bone microarchitecture. Most of the actions of estrogen in long bones occur via estrogen receptor α (ERα). However, the function of ERα in the maxillary bone has not been defined. We aimed to investigate the role and underlying mechanisms of ERα in the physiological and mechanically induced alveolar bone remodeling in female and male mice. Wild-type (WT) and ERα^–/– (ERKOα) mice were subjected to mechanically stimulated bone remodeling by inducing orthodontic tooth movement (OTM). The maxillary bone was analyzed using histomorphometric analysis, micro–computed tomography, quantitative polymerase chain reaction, and energy-dispersive spectroscopy. Bone marrow cells (BMCs) from WT and ERKOα mice were tested for their capacity to differentiate into osteoblasts and osteoclasts. Both male and female ERKOα mice exhibited marked reduction of alveolar bone mass and increased OTM. This response was associated with an increased number of osteoclasts and reduced number of apoptotic cells and osteoblasts in the periodontium and alveolar bone. Consistently, ERKOα mice exhibited lower levels of calcium in bone and increased expression of IL-33 (interleukin-33), TNF-α (tumor necrosis factor α), and IL-1β (interleukin-1β) and decreased expression of dentin matrix acidic phosphoprotein and alkaline phosphatase in periodontal tissues. Moreover, the differentiation of osteoclasts and osteoblasts in vitro was significantly higher in BMCs obtained from ERKOα. ERα is required to maintain the microarchitecture of maxillary alveolar bone. This process is linked to bone cell differentiation and apoptosis, as well as local production of inflammatory molecules such as IL-33, TNF-α, and IL-1β.

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Porphyromonas gingivalis (P. gingivalis)

Porphyromonas gingivalis attenuates the insulin-induced phosphorylation and translocation of forkhead box protein O1 in human hepatocytes

via Oral Biology

Publication date: September 2016
Source:Archives of Oral Biology, Volume 69
Author(s): Haruna Takamura, Kaya Yoshida, Hirohiko Okamura, Natsumi Fujiwara, Kazumi Ozaki
ObjectivePorphyromonas gingivalis (P. gingivalis) is a pathogen involved in periodontal disease. Recently, periodontal disease has been demonstrated to increase the risk of developing diabetes mellitus, although the molecular mechanism is not fully understood. Forkhead box protein O1 (FoxO1) is a transcriptional factor that regulates gluconeogenesis in the liver. Gluconeogenesis is a key process in the induction of diabetes mellitus; however, little is known regarding the relationship between periodontal disease and gluconeogenesis. In this study, to investigate whether periodontal disease influences hepatic gluconeogenesis, we examined the effects of P. gingivalis on the phosphorylation and translocation of FoxO1 in insulin-induced human hepatocytes.DesignThe human hepatocyte HepG2 was treated with insulin and Akt and FoxO1 phosphorylation was detected by western blot analysis. The localization of phosphorylated FoxO1 was detected by immunocytochemistry and western blot analysis. HepG2 cells were treated with SNAP26b-tagged P. gingivalis (SNAP-P.g.) before insulin stimulation, and then the changes in Akt and FoxO1 were determined by western blot analysis and immunocytochemistry.ResultsInsulin (100nM) induced FoxO1 phosphorylation 60min after treatment in HepG2 cells. Phosphorylated FoxO1 translocated to the cytoplasm. SNAP-P.g. internalized into HepG2 cells and decreased Akt and FoxO1 phosphorylation induced by insulin. The effect of insulin on FoxO1 translocation was also attenuated by SNAP-P.g.ConclusionsOur study shows that P. gingivalis decreases the phosphorylation and translocation of FoxO induced by insulin in HepG2 cells. Our results suggest that periodontal disease may increase hepatic gluconeogenesis by reducing the effects of insulin on FoxO1.

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The Emotional Brain as a Predictor and Amplifier of Chronic Pain

The Emotional Brain as a Predictor and Amplifier of Chronic Pain:

Human neuroimaging studies and complementary animal experiments now identify the gross elements of the brain involved in the chronification of pain. We briefly review these advances in relation to somatic and orofacial persistent pain conditions. First, we emphasize the importance of reverse translational research for understanding chronic pain—that is, the power of deriving hypotheses directly from human brain imaging of clinical conditions that can be invasively and mechanistically studied in animal models. We then review recent findings demonstrating the importance of the emotional brain (i.e., the corticolimbic system) in the modulation of acute pain and in the prediction and amplification of chronic pain, contrasting this evidence with recent findings regarding the role of central sensitization in pain chronification, especially for orofacial pain. We next elaborate on the corticolimbic circuitry and underlying mechanisms that determine the transition to chronic pain. Given this knowledge, we advance a new mechanistic definition of chronic pain and discuss the clinical implications of this new definition as well as novel therapeutic potentials suggested by these advances.

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Initial biofilm formation

Effects of different titanium zirconium implant surfaces on initial supragingival plaque formation:

Abstract

Objectives

The aim of the current study was the evaluation of biofilm development on different implant surfaces.

Material and Methods

Initial biofilm formation was investigated on five different implant surfaces, machined titanium (MTi), modified machined acid-etched titanium (modMATi), machined titanium zirconium (MTiZr), modified machined and acid-etched titanium zirconium (modMATiZr) and sandblasted large grid and acid-etched titanium zirconium surface (SLATiZr) for 24 and 48 h. Biocompatibility was tested after tooth brushing of the samples via cell viability testing with human gingival fibroblasts.

Results

After 24 h of biofilm collection, mean plaque surface was detected in the following descending order:

After 24 h: MTiZr > MTi > SLATiZr > modMATiZr > modMATi. Both M surfaces showed significant higher biofilm formation than the other groups.

After 48 h: MTiZr > MTi > SLATiZr > modMATiZr > modMATi.

After tooth brushing: SLATiZr > modMATi > modMATiZr > MTi > MTiZr. All native samples depicted significant higher cell viability than their corresponding surfaces after biofilm removal procedure.

Conclusions

The TiZr groups especially the modMATiZr group showed slower and less biofilm formation. In combination with the good biocompatibility, both modMA surfaces seem to be interesting candidates for surfaces in transgingival implant design.

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Polyethylene glycol (PEG) hydrogel with or without the addition of an arginylglycylaspartic acid (RGD)

Bone augmentation at peri-implant dehiscence defects comparing a synthetic polyethylene glycol hydrogel matrix vs. standard guided bone regeneration techniques:

Abstract

Objectives

The aim of the study was to test whether or not the use of a polyethylene glycol (PEG) hydrogel with or without the addition of an arginylglycylaspartic acid (RGD) sequence applied as a matrix in combination with hydroxyapatite/tricalciumphosphate (HA/TCP) results in similar peri-implant bone regeneration as traditional guided bone regeneration procedures.

Material and methods

In 12 beagle dogs, implant placement and peri-implant bone regeneration were performed 2 months after tooth extraction in the maxilla. Two standardized box-shaped defects were bilaterally created, and dental implants were placed in the center of the defects with a dehiscence of 4 mm. Four treatment modalities were randomly applied: i)HA/TCP mixed with a synthetic PEG hydrogel, ii)HA/TCP mixed with a synthetic PEG hydrogel supplemented with an RGD sequence, iii)HA/TCP covered with a native collagen membrane (CM), iv)and no bone augmentation (empty). After a healing period of 8 or 16 weeks, micro-CT and histological analyses were performed.

Results

Histomorphometric analysis revealed a greater relative augmented area for groups with bone augmentation (43.3%–53.9% at 8 weeks, 31.2%–42.8% at 16 weeks) compared to empty controls (22.9% at 8 weeks, 1.1% at 16 weeks). The median amount of newly formed bone was greatest in group CM at both time-points. Regarding the first bone-to-implant contact, CM was statistically significantly superior to all other groups at 8 weeks.

Conclusions

Bone can partially be regenerated at peri-implant buccal dehiscence defects using traditional guided bone regeneration techniques. The use of a PEG hydrogel applied as a matrix mixed with a synthetic bone substitute material might lack a sufficient stability over time for this kind of defect.

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Gait and balance disorders are common in Parkinson‘s disease (PD)

Reactive but not predictive locomotor adaptability is impaired in young parkinson's disease patients

via Gait & Posture

Source:Gait & Posture
Author(s): María Moreno Catalá, Dirk Woitalla, Adamantios Arampatzis
BackgroundGait and balance disorders are common in Parkinson's disease (PD) and major contributors to increased falling risk. Predictive and reactive adjustments can improve recovery performance after gait perturbations. However, these mechanisms have not been investigated in young-onset PD.ObjectiveWe aimed to investigate the effect of gait perturbations on dynamic stability control as well as predictive and reactive adaptability to repeated gait perturbations in young PD patients.MethodsFifteen healthy controls and twenty-five young patients (48±5yrs.) walked on a walkway. By means of a covered exchangeable element, the floor surface condition was altered to induce gait perturbations. The experimental protocol included a baseline on a hard surface, an unexpected trial on a soft surface and an adaptation phase with 5 soft trials to quantify the reactive adaptation. After the first and sixth soft trials, the surface was changed to hard, to examine after-effects and, thus, predictive motor control. Dynamic stability was assessed using the 'extrapolated center of mass' concept.ResultsPatients' unperturbed walking was less stable than controls' and this persisted in the perturbed trials. Both groups demonstrated after-effects directly after the first perturbation, showing similar predictive responses. However, PD patients did not improve their reactive behavior after repeated perturbations while controls showed clear locomotor adaptation.ConclusionsOur data suggest that more unstable gait patterns and a less effective reactive adaptation to perturbed walking may be a disease-related characteristic in young PD patients. These deficits were related to reduced ability to increase the base of support.

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Maturation of Subjective Visual Vertical

in Children.: Objective: The attraction of the subjective visual vertical (SVV) to the side of initial rod presentation has already been described in adults. The aim of this study was to evaluate this phenomenon in children and to analyze the effect of sex and maturation in this population.

Study Design: Retrospective cross-sectional study.

Setting: Tertiary referral center.

Patients: Six hundred and one individuals aged between 4 and 19 years.

Intervention: All subjects underwent a complete balance workup. SVV was measured by presenting a laser line 12 times in total darkness with a 45 degrees deviation from the vertical alternatively on the left and the right. The patient was seated and asked to replace the bar vertically with a remote control.

Results: On average, SVV was tilted to the side of the rod presentation at each iteration. The cumulative tilt to the side of presentation after 12 measures was higher in the 4 to 7 years age group and decreased progressively with age (25 +/- 2.2 degrees in 4-7 years, n = 109 versus 5 +/- 1.4 in 15-19 years, n = 204, p

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Connection Between the Temporomandibular Joint and Middle Ear Space

Transient Hearing Loss and Objective Tinnitus Induced by Mouth Opening: A Rare Connection Between the Temporomandibular Joint and Middle Ear Space.: Objectives: To describe objective tinnitus complicated with transient low-tone hearing loss coinciding with mouth opening, which was related to the connection between the mandibular fossa and middle ear space.

Patients: A 41-year-old man presented with tinnitus, ear fullness, and hearing loss in the left ear on mouth opening.

Main Outcome Measures: Clinical case records, audiological data, and radiological analyses including computed tomography (CT) and magnetic resonance imaging.

Results: Hearing thresholds on the affected side, which were evaluated with mouth opening, showed elevations of approximately 20 dB in the frequencies below 1000 Hz. Again, peak pressure on the tympanogram deviated negatively to -220 mmH2O under mouth opening without changing peak amplitude. CT showed a connection between the mandibular fossa and middle ear space, as revealed by a gas collection around the joint capsule evaluated in two phases (with and without mouth closing). Ear symptoms resolved after myringotomy.

Conclusions: Although an influence of temporomandibular disorder (TMD) on tinnitus perception has been debated, whether this association is causal or fortuitous has remained contentious. The present case showed a unique feature of tinnitus attributed to a connection between the mandibular fossa and middle ear space.

Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Vestibular Schwannomas

Influence of Marital Status on Vestibular Schwannoma in the United States.: Objective: To evaluate the influence of marital status on sporadic vestibular schwannoma (VS) in the United States.

Study Design: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

Setting: National, population-based tumor registry.

Subjects and Methods: The SEER database was queried to identify all patients with sporadic VS between 2004 and 2012. Univariable and multivariable analyses were used to identify differences in tumor size at presentation, management strategy, and mortality on the basis of patient marital status.

Results: Eight thousand and eight hundred thirty eight patients met inclusion criteria. When comparing patient groups on the basis of marital status, significant differences emerged. Univariable and multivariable analyses revealed that married subjects were older, had smaller tumors at presentation, and had better overall survival compared with non-married patients. After adjusting for baseline differences between groups, non-married subjects were more likely to undergo observation (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.35, p = 0.009), and were less likely to undergo surgery (OR 0.85, 95% CI 0.76-0.94, p = 0.002) than married subjects, while there was no difference between groups with regard to radiation treatment (OR 0.99, 95% CI 0.88-1.11, p = 0.828). Individual differences between non-married subgroups (i.e., single, separated/divorced, and widowed) are also reported.

Conclusion: Marital status influences disease presentation, treatment, and outcome in patients with sporadic VS in the United States. The authors speculate that greater social support of married subjects may drive many of these differences between groups. Future research is needed to further elucidate the underlying causes for these findings as well as the influence of other important demographic variables such as socioeconomic status and general health status.

Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Cochlear Implant Impedance Fluctuation in Meniere's Disease

A Case Study.: Objective: To contribute to the understanding of hearing fluctuation in Meniere's disease (MD) by disseminating a case study of a cochlear implanted ear with ongoing fluctuation of electrode impedances with episodic tinnitus and no associated vestibular symptoms.

Study Design: Retrospective case review.

Setting: Tertiary referral audiology clinic.

Patient: Man, born in 1936, with a total hearing loss in the right ear because of Mumps at age 8 years and a fluctuating progressive hearing loss in the left ear because of Meniere's disease since age 63 years.

Intervention: Sequential bilateral cochlear implantation right ear in August 2002 and left ear in March 2006.

Main Outcome Measure: Impedance measurements of implanted intracochlear electrodes via common ground stimulation using proprietor programming software.

Results: Electrode impedances in the MD showed significant ongoing variation since implantation, whereas the contralateral non-MD ear remained stable over a period of 9 years.

Conclusion: Electrode impedances in the ear with MD showed a variation pattern similar to that found in the hearing fluctuation characteristic of the disease. These findings raise the possibility that the same physiological mechanisms of hearing fluctuation may be responsible for intracochlear electrode impedance changes. We hypothesize that impedance fluctuation is because of changes in the permeability of the blood-labyrinth barrier because of cyclic immune activity in the inner ear which alters the electrical resistance between scala tympani and blood.

Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Cochlear-Facial Dehiscence

Prevalence of Cochlear-Facial Dehiscence in a Study of 1,020 Temporal Bone Specimens.: Objective: To determine the prevalence of cochlear-facial dehiscence (CFD) and to examine the influence of otic capsule area, age, sex, and race on CFD.

Study Design: Descriptive study of archived temporal bone specimens.

Materials and Methods: Targeted sections from 1,020 temporal bone specimens were scanned and examined for CFD. Cochlear-facial partition width (CFPW) and otic capsule area (OCA), a marker of bone thickness, were measured using image analysis software. Demographic data were analyzed using multiple linear regression analysis.

Results: The mean CFPW was 0.23 mm (range, 0-0.92 mm; SD, 0.15 mm). Six patients were completely dehiscent (0.59%). Fallopian canal width, age, sex, race, and OCA were found to be significant predictors of CFPW. Age was found to be negatively correlated with CFPW ([beta] = -0.001) (p

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Automated audiometry with continuous noise-monitoring

Clinical validation of automated audiometry with continuous noise-monitoring in a clinically heterogeneous population outside a sound-treated environment: 10.1080/14992027.2016.1178858<br/>Christopher G. Brennan-Jones

Abstract

Objective: Examine the accuracy of automated audiometry in a clinically heterogeneous population of adults using the KUDUwave automated audiometer. Design: Prospective accuracy study. Manual audiometry was performed in a sound-treated room and automated audiometry was not conducted in a sound-treated environment. Study sample: 42 consecutively recruited participants from a tertiary otolaryngology department in Western Australia. Results: Absolute mean differences ranged between 5.12–9.68 dB (air-conduction) and 8.26–15 dB (bone-conduction). A total of 86.5% of manual and automated 4FAs were within 10 dB (i.e. ±5 dB); 94.8% were within 15 dB. However, there were significant (p < 0.05) differences between automated and manual audiometry at 250, 500, 1000, and 2000 Hz (air-conduction) and 500 and 1000 Hz (bone-conduction). The effect of age (≥55 years) on accuracy (p = 0.014) was not significant on linear regression (p > 0.05; R² = 0.11). The presence of a hearing loss (better ear ≥26 dB) did not significantly affect accuracy (p = 0.604; air-conduction), (p = 0.218; bone-conduction). Conclusions: This study provides clinical validation of automated audiometry using the KUDUwave in a clinically heterogeneous population, without the use of a sound-treated environment. Whilst threshold variations were statistically significant, future research is needed to ascertain the clinical significance of such variation.

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Online hearing screening

Measuring motivation using the transtheoretical (stages of change) model: A follow-up study of people who failed an online hearing screening: 10.1080/14992027.2016.1182650<br/>Elisabeth Ingo

Abstract

Objective: Acceptance and readiness to seek professional help have shown to be important factors for favourable audiological rehabilitation outcomes. Theories from health psychology such as the transtheoretical (stages-of-change) model could help understand behavioural change in people with hearing impairment. In recent studies, the University of Rhode Island change assessment (URICA) has been found to have good predictive validity.Design: In a previous study, 224 Swedish adults who had failed an online hearing screening completed URICA and two other measures of stages of change. This follow-up aimed to: (1) determine prevalence of help-seeking at a hearing clinic and hearing aid uptake, and (2) explore the predictive validity of the stages of change measures by a follow-up on the 224 participants who had failed a hearing screening 18 months previously. Study sample: A total of 122 people (54%) completed the follow-up online questionnaire, including the three measures and questions regarding experience with hearing help-seeking and hearing aid uptake. Results: Since failing the online hearing screening, 61% of participants had sought help. A good predictive validity for a one-item measure of stages of change was reported.Conclusions: The Staging algorithm was the stages of change measure with the best ability to predict help-seeking 18 months later.

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Cochlear perfusion

with a viscous fluid

via Hearing Research

Publication date: Available online 21 May 2016
Source:Hearing Research
Author(s): Yi Wang, Elizabeth S. Olson
The flow of viscous fluid in the cochlea induces shear forces, which could provide benefit in clinical practice, for example to guide cochlear implant insertion or produce static pressure to the cochlear partition or wall. From a research standpoint, studying the effects of a viscous fluid in the cochlea provides data for better understanding cochlear fluid mechanics. However, cochlear perfusion with a viscous fluid may damage the cochlea. In this work we studied the physiological and anatomical effects of perfusing the cochlea with a viscous fluid. Gerbil cochleae were perfused at a rate of 2.4 μL/min with artificial perilymph (AP) and sodium hyaluronate (Healon, HA) in four different concentrations (0.0625%, 0.125%, 0.25%, 0.5%). The different HA concentrations were applied either sequentially in the same cochlea or individually in different cochleae. The perfusion fluid entered from the round window and was withdrawnfrom basal scala vestibuli, in order to perfuse the entire perilymphatic space. Compound action potentials (CAP) were measured after each perfusion. After perfusion with increasing concentrations of HA in the order of increasing viscosity, the CAP thresholds generally increased. The threshold elevation after AP and 0.0625% HA perfusion was small or almost zero, and the 0.125% HA was a borderline case, while the higher concentrations significantly elevated CAP thresholds. Histology of the cochleae perfused with the 0.0625% HA showed an intact Reissner's membrane, while in cochleae perfused with 0.125% and 0.25% HA Reissner's membrane (RM) was torn. Thus, the CAP threshold elevation was likely due to the broken of RM, which likely caused by the shear stress produced by the flow of the viscous fluid. Our results and analysis indicate that the cochlea can sustain, without a significant CAP threshold shift, up to a 1.5 Pa shear stress. Beside these finding, in the 0.125% and 0.25% HA perfusion cases, a temporary CAP threshold shift was observed, perhaps due to the presence and then clearance of viscous fluid within the cochlea, or to a temporary position shift of the Organ of Corti. After 0.5% HA perfusion, a short latency positive peak (P0) appeared in the CAP wavefrom. This P0 might be due to a change in the cochlea's traveling-wave pattern, or distortion in the cochlear microphonic.

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Sound coding in the auditory nerve

of gerbils

via Hearing Research

Publication date: Available online 21 May 2016
Source:Hearing Research
Author(s): Antoine Huet, Charlène Batrel, Yong Tang, Gilles Desmadryl, Jing Wang, Jean-Luc Puel, Jérôme Bourien
Gerbils possess a very specialized cochlea in which the low-frequency inner hair cells (IHCs) are contacted by auditory nerve fibers (ANFs) having a high spontaneous rate (SR), whereas high frequency IHCs are innervated by ANFs with a greater SR-based diversity. This specificity makes this animal a unique model to investigate, in the same cochlea, the functional role of different pools of ANFs. The distribution of the characteristic frequencies of fibers shows a clear bimodal shape (with a first mode around 1.5 kHz and a second around 12 kHz) and a notch in the histogram near 3.5 kHz. Whereas the mean thresholds did not significantly differ in the two frequency regions, the shape of the rate-intensity functions does vary significantly with the fiber characteristic frequency. Above 3.5 kHz, the sound-driven rate is greater and the slope of the rate-intensity function is steeper. Interestingly, high-SR fibers show a very good synchronized onset response in quiet (small first-spike latency jitter) but a weak response under noisy conditions. The low-SR fibers exhibit the opposite behavior, with poor onset synchronization in quiet but a robust response in noise. Finally, the greater vulnerability of low-SR fibers to various injuries including noise- and age-related hearing loss is discussed with regard to patients with poor speech intelligibility in noisy environments. Together, these results emphasize the need to perform relevant clinical tests to probe the distribution of ANFs in humans, and develop appropriate techniques of rehabilitation.

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What does EEG tell us about arithmetic strategies? A review

Publication date: Available online 21 May 2016
Source:International Journal of Psychophysiology
Author(s): Thomas Hinault, Patrick Lemaire

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Modeling of speech localization in a multi-talker mixture

using periodicity and energy-based auditory features:

A recent study showed that human listeners are able to localize a short speech target simultaneously masked by four speech tokens in reverberation [Kopčo, Best, and Carlile (2010). J. Acoust. Soc. Am. 127, 1450–1457]. Here, an auditory model for solving this task is introduced. The model has three processing stages: (1) extraction of the instantaneous interaural time difference
(ITD) information, (2) selection of target-related ITD information ("glimpses") using a template-matching procedure based on periodicity, spectral energy, or both, and (3) target location estimation. The model performance was compared to the human data, and to the performance of a modified model using an ideal binary mask (IBM) at stage (2). The IBM-based model performed similarly to the subjects, indicating that the binaural
model is able to accurately estimate source locations. Template matching using spectral energy and using a combination of spectral energy and periodicity achieved good results, while using periodicity alone led to poor results. Particularly, the glimpses extracted from the initial portion of the signal were critical for good performance. Simulation data show that the auditory features investigated here are sufficient to explain human performance in this challenging listening condition and thus may be used in models of auditory scene analysis.

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Gait and balance disorders are common in Parkinson‘s disease (PD)

Reactive but not predictive locomotor adaptability is impaired in young parkinson's disease patients

via Gait & Posture

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Maturation of Subjective Visual Vertical

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Connection Between the Temporomandibular Joint and Middle Ear Space

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Vestibular Schwannomas

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Cochlear Implant Impedance Fluctuation in Meniere's Disease

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Cochlear-Facial Dehiscence

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Automated audiometry with continuous noise-monitoring

Abstract

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Online hearing screening

Measuring motivation using the transtheoretical (stages of change) model: A follow-up study of people who failed an online hearing screening: 10.1080/14992027.2016.1182650<br/>Elisabeth Ingo

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Cochlear perfusion

with a viscous fluid

via Hearing Research

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Sound coding in the auditory nerve

of gerbils

via Hearing Research

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What does EEG tell us about arithmetic strategies? A review

Histological outcomes of sinus augmentation for dental implants with calcium phosphate or deproteinized bovine bone: a systematic review and meta-analysis

Publication date: Available online 21 May 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Wu, B. Li, X. Lin
This study compared the histological outcomes of deproteinized bovine bone (DBB) and technically derived calcium phosphate for sinus floor augmentation. MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until April 2015 with the following key words: dental implants, augmentation/augmented, calcium phosphate/ceramic/tricalcium phosphate, bovine bone/Bio-Oss, deproteinized/anorganic. Randomized controlled trials (RCTs) and two-arm prospective/retrospective studies that used DBB or biphasic calcium phosphate/tricalcium phosphate (BCP/TCP) for sinus augmentation with quantitative results were included. Outcomes were the percentage of new bone formed and percentage of surface contact between the graft material and new bone (bone-to-graft contact). Four RCTs and one prospective study were included, with a total of 110 patients and 145 implants. All studies reported the percentage of new vital bone; however, large heterogeneity was present (Q=15.23, P=0.004, I²=73.8%). BCP/TCP was associated with a higher percentage of new bone, but the pooled results did not reach significance (pooled standardized mean difference (SMD)=0.145, 95% confidence interval (CI) −0.488 to 0.778, P=0.654). Only two studies reported bone-to-graft contact, and BCP/TCP was associated with significantly lower bone-to-graft contact (pooled SMD=−0.807, 95% CI −1.276 to −0.337, P=0.001). This meta-analysis does not allow us to conclude superiority of one particular material with respect to histological outcomes.

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Κυριακή 22 Μαΐου 2016

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