Head and Neck Diseases by Alexandros G.Sfakianakis: 12/01/16

Πέμπτη 1 Δεκεμβρίου 2016

Is Follow-up for Small Asymptomatic Abdominal Aortic Aneurysm Justified?

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): Z. Ahmed, S. Kelly, S. Tierney, B. Egan

http://ift.tt/2gbSBug

Editorial Board

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6

http://ift.tt/2gpMxBi

Arterial Stiffness and Arteriovenous Fistula Outcomes

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): D.G. McGrogan, G. McKevitt, S. Stringer, P. Cockwell, M. Jesky, C. Ferro, A.P. Maxwell, N.G. Inston

http://ift.tt/2gbN6Mt

Intervention for Superficial Venous Insufficency in Patients with Venous Ulcers: Early Experience from an Ambulatory Venous Clinic

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): E. O'Connell, R. Mihu, H. Mohan, G. Fulton, B.J. Manning

http://ift.tt/2gpP1jk

One Hundred Consecutive Ruptured Abdominal Aortic Aneurysms in an “Open Surgery for Ruptures” Centre in the “EVAR for Ruptures Era” – Lessons Learned

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): N. Donlon, M. Bourke, S. Creedon, S. Flynn, T. Fitzgerald, G. O'Brien, G. McGreal

http://ift.tt/2gCMIqJ

Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): R. Kumar, N. Dattani, O. Asaad, M.J. Bown, R.D. Sayers, A. Saratzis
ObjectivesThe management of concomitant intra-abdominal malignancy (IAM) and abdominal aortic aneurysm (AAA) remains a challenge, even though malignancy is common in an elderly population. By means of systematic review and meta-analysis, the aim was to investigate outcomes in patients undergoing open (OAR) or endovascular AAA repair (EVAR) that have a concomitant malignancy.MethodsA systematic literature review was performed (Medline and EMBASE databases) to identify all series reporting outcomes of AAA repair (OAR or EVAR) in patients with concomitant IAM. Meta-analysis was applied to assess mortality and major morbidity at 30 days and long term.ResultsThe literature review identified 36 series (543 patients) and the majority (18 series) reported on patients with colorectal malignancy and AAA. Mean weighted mortality for OAR at 30 days was 11% (95% CI: 6.6% to 17.9%); none of the EVAR patients died peri-operatively. The weighted 30-day major complication rate for EVAR was 20.4% (10.0–37.4%) and for OAR it was 15.4% (7.0–30.8%). Most patients had their AAA and malignancy treated non-simultaneously (56.6%, 95% CI, 42.1–70.1%). In the EVAR cohort, three patients (4.6%) died at last follow-up (range 24–64 months). In the OAR cohort 23 (10.6%) had died at last follow up (range from 4 to 73 months).ConclusionIn this meta-analysis, OAR was associated with significant peri-operative mortality in patients with an IAM. EVAR should be the first-line modality of AAA repair. The majority of patients were not treated simultaneously for the two pathologies, but further investigation is necessary to define the optimal timing for each procedure and malignancy.

http://ift.tt/2fVwISg

Medtronic Endurant Stent Graft System; a Single UK Centre's 7 Year Experience

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): G.L. McKevitt, K.A. Love, J.A. Reid, C. O'Doherty

http://ift.tt/2gCM2BA

EJVES vol. 52, issue 6 (December 2016) - Spanish Translated Abstracts

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6

http://ift.tt/2fVCkvQ

Multiple Choice Questions

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6

http://ift.tt/2gCSoAV

Initial Experience with Mechanochemical Endovenous Ablation in the Treatment of Primary Varicose Veins

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): M. Wynne, M.M. Popp-Mittal, F.M. Shaikh, S.R. Walsh

http://ift.tt/2fVE3S1

Hybrid Procedures as Feasible Option in Critically Ischaemic Limbs with Multi-level Vascular Disease

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): M. Elkassaby, Y. Mihes, R. Joyce, M. Tubassam

http://ift.tt/2gCTZa4

“A Difficult Task” – Management of TASC D Aorto-iliac Disease

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): E. Boyle, M. Amir, S. McHugh, M.P. Colgan, S. O'Neill, P. Madhavan, Z. Martin, A. O'Callaghan

http://ift.tt/2fVwnyY

Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): M. Bourke, T. Fitzgerald, N. Donlon, S. Flynn, S. Creedon, P. Sparrow, A. Brady, P. McEneaney, G. O'Brien, G. McGreal

http://ift.tt/2gCTTze

Antibiotic Prophylaxis in Vascular Surgery: an Audit of Compliance with Local Guidelines

Publication date: December 2016
Source:European Journal of Vascular and Endovascular Surgery, Volume 52, Issue 6
Author(s): C. Cunningham, A. Gomati, D.W. Harkin

http://ift.tt/2fVATxr

Drinking motives and alcohol outcome expectancies as mediators of the association between negative urgency and alcohol consumption

Publication date: March 2017
Source:Addictive Behaviors, Volume 66
Author(s): Amber M. Anthenien, Jordanna Lembo, Clayton Neighbors
ObjectiveTo determine whether the effects of negative urgency, a unique facet of impulsivity marked by engaging in potentially unhealthy and rash behaviors in order to cope with anxiety or negative moods, on drinking behavior can be explained by positive and negative alcohol outcome expectancies and specific drinking motives (i.e., coping and enhancement).MethodsCollege students (N=194) completed web-based surveys in exchange for course credit. Students completed measures of negative urgency, comprehensive effects of alcohol, drinking motives, and alcohol use behaviors.ResultsResults of path analysis indicated significant indirect effects of negative urgency and alcohol use through both alcohol outcome expectancies and enhancement motives. The effects of enhancement motives on drinking were mediated by positive alcohol outcome expectancies. The effects of coping motives on drinking were not attributable to negative expectancies.ConclusionsIndividuals high on negative urgency may consume alcohol in order to ameliorate their emotional distress due to strong desires to increase positive and decrease negative experiences associated with drinking. Emotion-focused impulsivity's influence on drinking outcomes can be ascribed to enhancement motives for drinking as well as positive and negative alcohol outcome expectancies. Prevention efforts should target drinking motives and alcohol outcome expectancies among those higher in negative urgency.

http://ift.tt/2gbHMIQ

Syk inhibition blocks airway constriction and protects from Th2-induced airway inflammation and remodeling in mice

Abstract

Background

Spleen tyrosine kinase (Syk) is an intracellular non-receptor tyrosine kinase, which has been implicated as central immune modulator promoting allergic airway inflammation. Syk inhibition has been proposed as a new therapeutic approach in asthma. However, the direct effects of Syk inhibition on airway constriction independent of allergen sensitization remain elusive.

Methods

Spectral confocal microscopy of human and murine lung tissue was performed to localize Syk expression. The effects of prophylactic or therapeutic Syk inhibition on allergic airway inflammation, hyperresponsiveness and airway remodeling were analyzed in allergen-sensitized and airway-challenged mice. The effects of Syk inhibitors BAY 61-3606 or BI 1002494 on airway function were investigated in isolated lungs of wild-type, PKCα-deficient, mast cell-deficient or eNOS-deficient mice.

Results

Syk expression was found in human and murine airway smooth muscle cells. Syk inhibition reduced allergic airway inflammation, airway hyperresponsiveness and pulmonary collagen deposition. In naïve mice, Syk inhibition diminished airway responsiveness independently of mast cells, or PKCα or eNOS expression and rapidly reversed established bronchoconstriction independently of NO. Simultaneous inhibition of Syk and PKC revealed additive dilatory effects, whereas combined inhibition of Syk and rho kinase or Syk and p38 MAPK did not cause additive bronchodilation.

Conclusions

Syk inhibition directly attenuates airway smooth muscle cell contraction independent of its protective immunomodulatory effects on allergic airway inflammation, hyperresponsiveness and airway remodeling. Syk mediates bronchoconstriction in a NO-independent manner, presumably via rho kinase and p38 MAPK, and Syk inhibition might present a promising therapeutic approach in chronic asthma as well as acute asthma attacks.

http://ift.tt/2gPmmRy

Syk inhibition blocks airway constriction and protects from Th2-induced airway inflammation and remodeling in mice

Abstract

Background

Methods

Results

Conclusions

http://ift.tt/2gPmmRy

Highlights from the Current Issue: December 2016

http://ift.tt/2fJ3ub3

Highlights from the Current Issue: December 2016

http://ift.tt/2fJ3ub3

Drainage Patterns to Nontraditional Nodal Regions and Level IIB in Cutaneous Head and Neck Malignancy

Objectives

(1) Determine the frequency of nontraditional sentinel lymph node (SLN) locations in cutaneous head and neck malignancy and (2) determine the frequency of level IIB SLNs in cutaneous head and neck malignancy.

Design

Case series with chart review.

Setting

Tertiary academic hospital.

Subjects and Methods

In total, 145 consecutive sentinel lymph node biopsy (SLNB) specimens for cutaneous head and neck malignancies were reviewed from 2007 to 2015. Nodal regions were categorized into levels I to V, parotid, external jugular (EJ), perifacial, suboccipital, and postauricular regions. Primary locations were divided into scalp, forehead, cheek, ear, neck, nose, periocular, and lip. Frequencies of sentinel lymph node (SLN) locations for each primary location were determined.

Results

Parotid, EJ, perifacial, suboccipital, postauricular, and level IIB lymph SLNs were identified as nontraditional lymph node regions at risk in head and neck cutaneous malignancy. EJ SLNs were present in over 15% of all cases and over 25% of periocular and cheek lesions. Perifacial SLNs were frequently present in nose and lip lesions. Suboccipital and postauricular nodes were only present in scalp lesions. Level II was the most common location for a SLN. In total, 15.9% of all cases involved level IIB. Scalp and ear primary lesions were most likely to drain to level IIB.

Conclusions

Nontraditional SLN locations, such as EJ, perifacial, suboccipital, postauricular, and parotid, as well as level IIB, are important sites of drainage for head and neck cutaneous malignancy. Prediction of at-risk lymph node regions is important to help guide SLNBs, elective and completion neck lymphadenectomy and radiation, and long-term observation.

http://ift.tt/2gYFwJ6

Uvulopalatopharyngoplasty: Does Multilevel Surgery Increase Risk?

Objectives

(1) Determine the rate of postoperative complications, reoperation, readmission, and death after uvulopalatopharyngoplasty (UPPP) for sleep apnea through multi-institutional clinical data. (2) Compare outcomes of UPPP between multilevel and single-level procedures for the treatment of sleep apnea.

Study Design

Retrospective database analysis.

Methods

The American College of Surgeons National Surgical Quality Improvement Program—a nationally validated, prospective, multi-institutional database from 2005 to 2013—was analyzed for patients who underwent UPPP, per corresponding Current Procedural Terminology codes. Patients were categorized into 3 groups: UPPP alone, UPPP + nasal cavity (NC), and UPPP + base of tongue (BOT). Perioperative outcome measures of interest include surgical/medical complications, reoperation, readmission, and death. Comparisons were made among surgical groups through univariate cross-sectional analysis.

Results

A total of 1079 patients underwent UPPP; 413 patients had UPPP + NC; and 200 patients had UPPP + BOT procedures. One death was reported for the entire cohort of patients. Among all 3 groups (UPPP, UPPP + NC, and UPPP + BOT), no differences were noted in the rates of medical complications (P = .445), surgical complications (P = .396), reoperation (P = .332), and readmission (P = .447). However, the length of hospital stay in days was greatest for the UPPP + BOT group (UPPP, 0.81 ± 0.69; UPPP + NC, 0.87 ± 0.90; UPPP + BOT, 1.50 ± 2.70; P < .001).

Conclusion

These national data demonstrate no significant increase in risk when UPPP is performed as a single- or multilevel procedure. When indicated, UPPP with multilevel procedures may be safely performed for treatment of sleep apnea. These data set a benchmark for perioperative risk in UPPP surgery and will prove useful for counseling patients.

http://ift.tt/2gM3FzB

Gabapentin for Perioperative Analgesia in Otorhinolaryngology-Head and Neck Surgery: Systematic Review

Objective

Recent research has investigated the role of gabapentin in perioperative pain relief in otorhinolaryngology–head and neck surgery. This review aims to identify whether sufficient evidence exists for the routine use of gabapentin in the perioperative setting.

Data Sources

MEDLINE, Cochrane CENTRAL, EMBASE, and Google Scholar.

Review Methods

A comprehensive systematic search was performed with keywords for articles up to November 2015. The systematic review included all randomized, placebo-, and active-controlled trials investigating the role of perioperative gabapentin for pain in otorhinolaryngology–head and neck surgery. The studies were assessed for risk of bias and selected and reviewed by the main author. Selected trials were required to have data in the form of pain intensity scores, analgesic consumption, adverse effects, or return to normal function.

Results

A total of 14 randomized controlled trials were included, of which 4 had an active control. The placebo-controlled trials included 4 for tonsillectomy, 3 for rhinology, and 3 for thyroidectomy. These studies were not suitable for meta-analysis. Trial quality involving gabapentin in tonsillectomy surgery is variable. The higher-quality studies reported significantly reduced analgesic consumption in the gabapentin groups, with the effect on pain scores less clear. There was a significant benefit, within the first 24 hours, in pain and analgesic consumption as compared with placebo favoring the gabapentin groups following rhinologic and thyroid surgery.

Conclusion

Overall, gabapentin appears to have a significant beneficial effect on perioperative pain relief and analgesic consumption in otorhinolaryngology–head and neck surgery procedures within the first 24 hours.

http://ift.tt/2gYwImm

Bimodal Stimulation in Prelingually Deaf Children: Lessons from a Cross-sectional Survey

Objective

(1) To survey the use of bimodal stimulation by prelingually deaf children receiving unilateral cochlear implantation and (2) to investigate demographic and audiologic factors explaining the use of bimodal stimulation.

Study Design

Cross-sectional survey.

Setting

Tertiary care institution.

Subjects and Methods

The study included 44 unilaterally implanted prelingually deaf children from a single institution, with a minimum follow-up of 1 year. During routine follow-up visits, an examiner interviewed parents on their children's use of bimodal stimulation. At the same time, residual hearing and hearing aid gain in the contralateral ear were assessed.

Results

Approximately half of patients (52%) used bimodal stimulation. On average, bimodal users showed better mean unaided and aided thresholds than nonbimodal users (P < .001). A mean 250- to 500-Hz unaided threshold ≤90 dB HL in the contralateral, nonimplanted ear was associated with a higher probability of bimodal use (P = .008). Parental satisfaction with the contralateral hearing aid was inversely correlated with mean 125- to 500-Hz and 1000- to 4000-Hz unaided thresholds (P < .001) and mean 250- to 500-Hz and 1000- to 4000-Hz aided thresholds (P < .001).

Conclusions

A mean 250- to 500-Hz unaided threshold ≤90 dB HL is associated with a higher probability of bimodal use by prelingually deaf children. Better residual hearing is associated with a higher degree of parental satisfaction with the contralateral hearing aid. This information could be useful to counsel parents of prelingually deaf children, when deciding between bimodal stimulation and simultaneous bilateral cochlear implantation.

http://ift.tt/2gMaeSz

Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis

Objective

Uvulopalatopharyngoplasty (UPPP) remains one of the most common surgical treatments for patients with obstructive sleep apnea. However, the results after UPPP are unpredictable. The purpose of this meta-analysis is to identify predictors of success after UPPP.

Data Sources

A literature search was performed utilizing PubMed, EMBASE, SCOPUS, and the Cochrane Library.

Review Methods

The keywords and medical subject heading terms used were uvulopalatopharyngoplasty and UPPP. Studies were included if UPPP was used as a single surgical procedure for the treatment of obstructive sleep apnea and results were presented separately as responder (surgical success) and nonresponder (surgical failure). Exclusion criteria included pediatric patients and other surgical procedures (eg, nasal and hypopharyngeal) performed at the same time as the UPPP. Age, body mass index, preoperative apnea-hypopnea index, Friedman stage, and several cephalometric variables were compared between responders and nonresponders.

Results

A total of 1257 studies were screened, with 15 studies included in this meta-analysis. Our results demonstrate that Friedman stage I is a strong predictor for success after UPPP, while Friedman stage III and low hyoid position are negative predictors. Age, body mass index, preoperative apnea-hypopnea index, and other cephalometric measurements were not significant.

Conclusion

Friedman stage and hyoid position are important predictors for UPPP.

http://ift.tt/2gYLysU

"Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy"

http://ift.tt/2gM5HQ7

Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media: Literature Review and Cost Analysis

Objective

Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management.

Data Sources

PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science.

Review Method

A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic.

Results

From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit.

Conclusions

Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.

http://ift.tt/2gYFvF2

Dual pH with Multichannel Intraluminal Impedance Testing in the Evaluation of Subjective Laryngopharyngeal Reflux Symptoms

Objectives

Minimal data exist to define the use of contemporary dual pH with multichannel intraluminal impedance (MII) probes integrating both pharyngeal acid and impedance sensors to evaluate laryngopharyngeal reflux (LPR) symptoms in a laryngology clinic population. This study was performed to review a series of patients tested with dual pH-MII for suspected LPR symptoms and to analyze pH-MII data findings for this patient cohort.

Study Design

Case series with planned data collection.

Setting

Tertiary laryngology clinic.

Subjects and Methods

Patients with symptoms suggestive of possible LPR (dysphonia, chronic cough, globus sensation, subglottic stenosis,) were evaluated with a dual pH-MII system, as well as previously validated reflux finding score (RFS) and reflux symptom index (RSI) instruments.

Results

A total of 109 patients were evaluated with dual pH-MII studies between 2010 and 2015, with 51 (47%) studies interpreted as "positive" for evidence of significant LPR, 43 (39%) as "negative," and 15 (14%) as "equivocal." Dual pH-MII data analysis showed that positive studies had an average of 2.84 pharyngeal acid exposures below pH 4 (vs 0.28 for negative) and 46 episodes of proximal reflux exposure (either acid or nonacid) by impedance detection (vs 30.6 for negative). RSI scores were significantly different between positive and negative studies, while RFS scores were not.

Conclusions

Dual pH-MII analysis is a useful supplementary tool to provide objective evidence of pharyngeal reflux exposure in patients with suspected LPR. RSI scores appear to correlate with objective evidence of acid exposure in the pharynx, while RFS scores do not.

http://ift.tt/2gM831i

Patient-Reported Outcome Measures Related to Laryngopharyngeal Reflux: A Systematic Review of Instrument Development and Validation

Objectives

Patient-reported outcome (PRO) measures are often used to diagnose laryngopharyngeal reflux (LPR) and monitor treatment outcomes in clinical and research settings. The present systematic review was designed to identify currently available LPR-related PRO measures and to evaluate each measure's instrument development, validation, and applicability.

Data Sources

MEDLINE via PubMed interface, CINAHL, and Health and Psychosocial Instrument databases were searched with relevant vocabulary and key terms related to PRO measures and LPR.

Review Methods

Three investigators independently performed abstract review and full text review, applying a previously developed checklist to critically assess measurement properties of each study meeting inclusion criteria.

Results

Of 4947 studies reviewed, 7 LPR-related PRO measures (publication years, 1991-2010) met criteria for extraction and analysis. Two focused on globus and throat symptoms. Remaining measures were designed to assess LPR symptoms and monitor treatment outcomes in patients. None met all checklist criteria. Only 2 of 7 used patient input to devise item content, and 2 of 7 assessed responsiveness to change. Thematic deficiencies in current LPR-related measures are inadequately demonstrated: content validity, construct validity, plan for interpretation, and literacy level assessment.

Conclusion

Laryngopharyngeal reflux is often diagnosed according to symptoms. Currently available LPR-related PRO measures used to symptomatically identify suspected LPR patients have disparate developmental rigor and important methodological deficiencies. Care should be exercised to understand the measurement characteristics and contextual relevance before applying these PRO measures for clinical, research, or quality initiatives.

http://ift.tt/2gYBxw9

Structured Preoperative Phone Counseling by Junior Medical Staff for Improving the Consent Process for Tonsillectomy

Objective

To assess the effectiveness of preoperative phone counseling by junior medical staff for improving the standard of informed consent for tonsillectomy.

Study Design

Prospective randomized controlled trial.

Setting

District general hospital.

Subjects and Methods

A total of 43 patients undergoing tonsillectomy were randomly allocated to 2 groups. Group A (n = 25) underwent the conventional consent process by the consultant ear, nose, and throat surgeon at the time of assessment (which generally takes place 6 to 12 months prior to surgery due to wait-list times). Group B (n = 18) underwent this same consent process but received a structured preoperative phone call 2 to 3 weeks prior to the day of surgery. A preoperative questionnaire assessing the knowledge of tonsillectomy, perioperative course, and risks was completed on the day of surgery.

Results

Group B had a better recall of the risks of tonsillectomy, recalling 7.1 of the 10 most significant risks, as compared with 4.6 for group A (P = .017). Group B had a better awareness of tooth damage (78% vs 30% of patients, P ≤ .001), voice change (61 vs 19%, P = .005), and burns to lips and mouth (44% vs 8%, P = .005). Finally, 35% more patients from group B rated their understanding of tonsillectomy as good or very good (P = .017).

Conclusion

Preoperative phone counseling by junior medical staff closer to the time of surgery reinforces and clarifies the information previously provided by senior consultants at the time of initial consent for tonsillectomy.

http://ift.tt/2gM8OYb

Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis

Objective

To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis–related olfactory impairment.

Data Sources

CINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015.

Review Methods

Studies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery.

Results

Thirty-one studies were used in the meta-analysis. Weighted mean differences of olfactory measures demonstrated significant improvement in mixed CRS patients (those with and without polyps) through visual analog scales (–0.83, P = .001), altered taste/smell item on Sinonasal Outcome Test (–1.32, P < .00001), 40-item Smell Identification Test (3.49, P = .0010), and Sniffin' Sticks identification (0.34, P = .03). Chronic rhinosinusitis mixed patients demonstrated nonsignificant improvements via Sniffin' Sticks threshold (1.60, P = .16) and Brief Smell Identification Test (0.20, P = .32). When separated, polyp patients and dysosmic patients experienced the highest levels of olfactory improvement. Polyp patients improved by 7.87 (P = .006) on the 40-item Smell Identification test, 11.54 (P < .0001) with the Sniffin' Sticks total score, and 2.57 (P < .00001) through Sniffin' Sticks identification. Dysosmic patients improved by 5.75 via the 40-item Smell Identification Test (P = .0001).

Conclusion

Endoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree.

http://ift.tt/2gYxUWK

Auricular Split-Thickness Skin Graft for Ear Canal Coverage

Split-thickness skin graft (STSG) continues to be the preferred means of external auditory canal (EAC) reconstruction. We thus sought to describe our experience using skin from the posterior aspect of the auricle (SPAA) as a donor site in EAC reconstruction. Grafts were, on average, 5 x 10 mm in size and obtained with a No. 10 blade after tumescence injection. The cases of 39 patients who underwent 41 procedures were retrospectively reviewed. Of the 38 patients with both 3- and 6-month follow-ups, no postoperative stenosis or bony exposure occurred. STSG from the SPAA can be a good option in EAC reconstruction. Total EAC/tympanic membrane coverage can be obtained with STSG from the SPAA.

http://ift.tt/2gM61hY

Does the Preoperative Administration of Steroids Reduce Intraoperative Bleeding during Endoscopic Surgery of Nasal Polyps?

Objectives

Corticosteroids are frequently used in a range of otorhinolaryngologic conditions due to their anti-inflammatory and antiedematous properties. In this meta-analysis, we aimed to assess the role of preoperative steroids for attenuating intraoperative bleeding during endoscopic sinus surgery among patients with nasal polyps.

Data Sources

PubMed, SCOPUS, EMBASE, the Web of Science, and Cochrane database.

Methods

Literature was screened from January 1980 to January 2016. Five articles comparing patients who were preoperatively administered steroids (steroid groups) with patients who received a placebo or no treatment (control group) were included for analysis, which encompassed intraoperative bleeding, endoscopic surgical field visibility, operative time, and side effects during endoscopic sinus surgery.

Results

Intraoperative bleeding and operative time during endoscopic sinus surgery in the steroid group were significantly reduced as compared with the control group. Additionally, the preoperative administration of steroids had a significant effect on improving endoscopic surgical field visibility during sinus surgery. There were no significant adverse effects reported in the enrolled studies. In subgroup analyses of these results, steroids showed similar effects on intraoperative bleeding regardless of administration type (topical or systemic).

Conclusion

This study demonstrated that the preoperative administration of steroids in patients with nasal polyps could effectively reduce intraoperative bleeding. However, the duration of treatment and dosing standard require further investigation, and more trials need to be included.

http://ift.tt/2gYCzrO

Discharge Destination after Head and Neck Surgery: Predictors of Discharge to Postacute Care

Objective

In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery.

Study Design

Retrospective review of national database.

Setting

American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013.

Subjects and Methods

We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care.

Results

The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea.

Conclusion

Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.

http://ift.tt/2gMaDVb

Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends

Four-dimensional computed tomography (4D-CT) is a new modality for preoperative localization of parathyroid adenomas. We performed a survey study to describe the role and trends in the utilization of 4D-CT. Of 361 radiologists, 200 (55%) reported that 4D-CT was used in their practices. Nineteen (10%) used 4D-CT as the first-line imaging study; 155 (76%) reported that 4D-CT played a secondary role; and 26 (13%) reported that it is performed routinely in combination with ultrasound and scintigraphy. Early adopters of 4D-CT (use for >3 years) were 3 times more likely to use 4D-CT in a first-line role (18%) when compared with radiologists who used 4D-CT for ≤3 years (6%; P < .05). In conclusion, more than half of radiologists perform 4D-CT, and a majority reported that 4D-CT plays a secondary role. However, this role may change, as utilization is increasing and radiologists may follow early adopters, who are more likely to use it as a first-line study.

http://ift.tt/2gYCynK

Laryngology in Art: The Portrait of Dr Wilhelm Mayer-Hermann

Otto Dix's portrait of the laryngologist Dr Wilhelm Mayer-Hermann represents a shining example of Neue Sachlichkeit, or New Objectivity, offering a return to unsentimental reality and a focus on the objective world, as opposed to the more abstract and idealistic tendencies of expressionism. However, precious little is known about the subject of the portrait. This article examines the portrait and attempts to shed light on the life and career of the Dr Wilhelm Mayer-Hermann.

http://ift.tt/2gM5XhY

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology

Objective

Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations.

Study Design

Case series with chart review.

Setting

Tertiary care hospital.

Subjects and Methods

We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available.

Results

Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01).

Conclusions

Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates.

http://ift.tt/2gYH59Z

Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas

Objective

Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome.

Study Design

Case series with chart review.

Setting

Academic referral center.

Subjects and Methods

A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed.

Results

Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P = .01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P = .04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00).

Conclusion

Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

http://ift.tt/2gM4ys0

Drainage Patterns to Nontraditional Nodal Regions and Level IIB in Cutaneous Head and Neck Malignancy

Objectives

Design

Case series with chart review.

Setting

Tertiary academic hospital.

Subjects and Methods

Results

Conclusions

http://ift.tt/2gYFwJ6

Health Literacy Assessment in an Otolaryngology Clinic Population

Objective

To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy.

Study Design

Cross-sectional study.

Setting

Tertiary care otolaryngology clinic.

Subjects and Methods

The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen.

Results

Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy.

Conclusion

Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes.

http://ift.tt/2gYDKYm

Uvulopalatopharyngoplasty: Does Multilevel Surgery Increase Risk?

Objectives

Study Design

Retrospective database analysis.

Methods

Results

Conclusion

http://ift.tt/2gM3FzB

Perceptual Assessment of Velopharyngeal Dysfunction by Otolaryngology Residents

Objective

To assess the ability of otolaryngology residents to rate the hypernasal resonance of patients with velopharyngeal dysfunction. We hypothesize that experience (postgraduate year [PGY] level) and training will result in improved ratings of speech samples.

Study Design

Prospective cohort study.

Setting

Otolaryngology training programs at 2 academic medical centers.

Subjects and Methods

Thirty otolaryngology residents (PGY 1-5) were enrolled in the study. All residents rated 30 speech samples at 2 separate times. Half the residents completed a training module between the rating exercises, with the other half serving as a control group. Percentage agreement with the expert rating of each speech sample and intrarater reliability were calculated for each resident. Analysis of covariance was used to model accuracy at session 2.

Results

The median percentage agreement at session 1 was 53.3% for all residents. At the second session, the median scores were 53.3% for the control group and 60% for the training group, but this difference was not statistically significant. Intrarater reliability was moderate for both groups. Residents were more accurate in their ratings of normal and severely hypernasal speech. There was no correlation between rating accuracy and PGY level. Score at session 1 positively correlated with score at session 2.

Conclusion

Perceptual training of otolaryngology residents has the potential to improve their ratings of hypernasal speech. Length of time in residency may not be best predictor of perceptual skill. Training modalities incorporating practice with hypernasal speech samples could improve rater skills and should be studied more extensively.

http://ift.tt/2gMa51m

Gabapentin for Perioperative Analgesia in Otorhinolaryngology-Head and Neck Surgery: Systematic Review

Objective

Data Sources

MEDLINE, Cochrane CENTRAL, EMBASE, and Google Scholar.

Review Methods

Results

Conclusion

http://ift.tt/2gYwImm

Bimodal Stimulation in Prelingually Deaf Children: Lessons from a Cross-sectional Survey

Objective

Study Design

Cross-sectional survey.

Setting

Tertiary care institution.

Subjects and Methods

Results

Conclusions

http://ift.tt/2gMaeSz

Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis

Objective

Data Sources

A literature search was performed utilizing PubMed, EMBASE, SCOPUS, and the Cochrane Library.

Review Methods

Results

Conclusion

Friedman stage and hyoid position are important predictors for UPPP.

http://ift.tt/2gYLysU

"Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy"

http://ift.tt/2gM5HQ7

Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media: Literature Review and Cost Analysis

Objective

Data Sources

PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science.

Review Method

Results

Conclusions

http://ift.tt/2gYFvF2

Dual pH with Multichannel Intraluminal Impedance Testing in the Evaluation of Subjective Laryngopharyngeal Reflux Symptoms

Objectives

Study Design

Case series with planned data collection.

Setting

Tertiary laryngology clinic.

Subjects and Methods

Results

Conclusions

http://ift.tt/2gM831i

Patient-Reported Outcome Measures Related to Laryngopharyngeal Reflux: A Systematic Review of Instrument Development and Validation

Objectives

Data Sources

MEDLINE via PubMed interface, CINAHL, and Health and Psychosocial Instrument databases were searched with relevant vocabulary and key terms related to PRO measures and LPR.

Review Methods

Results

Conclusion

http://ift.tt/2gYBxw9

Structured Preoperative Phone Counseling by Junior Medical Staff for Improving the Consent Process for Tonsillectomy

Objective

To assess the effectiveness of preoperative phone counseling by junior medical staff for improving the standard of informed consent for tonsillectomy.

Study Design

Prospective randomized controlled trial.

Setting

District general hospital.

Subjects and Methods

Results

Conclusion

http://ift.tt/2gM8OYb

Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis

Objective

To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis–related olfactory impairment.

Data Sources

CINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015.

Review Methods

Studies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery.

Results

Conclusion

http://ift.tt/2gYxUWK

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 1 Δεκεμβρίου 2016

Abstract

Background

Methods

Results

Conclusions

Abstract

Background

Methods

Results

Conclusions

Αρχειοθήκη ιστολογίου