IgG4-related disease in the head and neck

Purpose of review To summarize current evidence regarding the pathophysiology, diagnostic criteria, and management of IgG4 disease in the head and neck. Recent findings The anti-CD20 antibody, rituximab is being used increasingly as a primary treatment modality in cases with a definitive diagnosis. Despite the favorable prognosis, it is now recognized that the incidence of cancer development within 3 years of diagnosis is higher than that of the general population. Summary IgG4-related disease is a sclerosing, chronic inflammatory disease, that is benign, and usually occurs in middle-aged to elderly individuals. Definitive diagnosis of IgG4-related disease requires radiological confirmation of enlargement of the affected organ, elevated serum IgG4 levels, and characteristic histopathological findings. Treatment is primarily with systemic corticosteroids or the monoclonal anti-CD20 antibody rituximab, surgical excision, or a combination of treatment modalities. Prognosis is good with complete remission in up to 90% of patients. Correspondence to James Johnston, Department of Surgery, University of Auckland, PO Box 99743, Newmarket, Auckland 1149, New Zealand. Tel: +64 21 1716814; e-mail: jj.johnston@auckland.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Tympanostomy tube otorrhea in children: prevention and treatment

Purpose of review One in two children treated with tympanostomy tubes, experience episodes of otorrhea whilst their tubes are in place. In this review, we present the results of the most recent publications on prevention and treatment of tympanostomy tube otorrhea (TTO). Recent findings Recent systematic reviews on water precautions for children with tympanostomy tubes support the American Academy of Otolaryngology – Head and Neck Surgery guideline recommendation against such preventive measures as there is no evidence that it protects against TTO. Studies on tympanostomy tube design and material suggest that silicone tubes have a lower TTO risk and that biofilms appear to be mainly located in the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Another study shows that the biofilm-component DNAB-II protein is present in otorrhea of half of children with TTO. Targeting this protein could lead to a collapse of the biofilm structure and as such a potential new treatment for chronic TTO. New systematic reviews show that antibiotic eardrops are the most effective first-line treatment of acute TTO and suggest that an antibiotic–corticosteroid combination is more effective than antibiotic only. Although in many countries, quinolone eardrops are the preferred choice because of being non-ototoxic, one study found a higher risk of persistent perforation after tube extrusion in children treated with quinolone eardrops as compared with children treated with aminoglycoside eardrops. Summary Recent evidence confirms that water precautions for children with tympanostomy tubes are not effective in preventing TTO. Antibiotic–corticosteroid eardrops are the most effective treatment of acute TTO. Correspondence to Thijs M.A. van Dongen, MD, PhD, Julius Center for Health Sciences and Primary Care, STR 6.131, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Tel: +3161199973; e-mail: tmavandongen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms

Purpose of review The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia. Recent findings Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3–C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter. Summary Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases. Correspondence to Mosaad Abdel-Aziz, Department of Otolaryngology, Faculty of Medicine, Cairo University, 2 El-Salam St., King Faisal, Above El-Baraka Bank, Giza, Cairo, Egypt. Tel: +20 1005140161; fax: +20 225329113; e-mail: mosabeez@yahoo.com;www.ent-egypt.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2JRSqmn). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Swallowing function in advanced age

Purpose of review To present current literature regarding swallowing function in advanced age, including healthy ageing, dysphagia and trends in multidisciplinary team service delivery. Recent findings Normative studies support swallowing efficiency but greater variability in healthy advanced age, through to 100 years old. Deviations from normative data and symptoms of dysphagia leading to aspiration or nutritional risk, imply swallowing disorder, rather than simply the ageing process. Quantitative and qualitative studies are emerging that promote management of swallow dysfunction for an ageing society, including innovative assessment, home treatment, swallowing exercise and optimized mealtimes. Summary Current literature on swallowing function in advanced age provides multidisciplinary perspectives and initiatives, with clear commitment to improving quality of life for older adults. The diversity of the older population and serious consequences of swallowing difficulties calls for routine screening tools for swallowing impairment and malnutrition risk. Representation of 'oldest old' in future normative studies is essential to guide swallowing management in adults over 85 years old. Correspondence to Marie Jardine, Speech Science, School of Psychology, Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 923 8177; e-mail: m.jardine@auckland.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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High-resolution manometry: what about the pharynx?

Purpose of review High-resolution pharyngeal manometry (HRPM) is a well tolerated, catheter-based, method for recording the pressures and bolus flow generated by the pharyngeal muscles during swallowing. Despite a body of published evidence and a critical mass of investigators in the field, there is a lack of consensus surrounding what biomechanical phenomena to measure. The purpose of this review is to provide some insights into the information on swallowing physiology that can be gathered using HRPM. Recent findings HRPM literature has focused on measuring biomechanical phenomena that may be relevant to measure in relation to dysphagia research. This review focuses on the measurement of pharyngeal luminal occlusive forces, intrabolus distension pressure, bolus presence and bolus flow timing as key features of pharyngeal swallowing that require measurement and allow for derivation of the Swallow Risk Index, a global measure of swallow function indicative of swallowing functional reserve. Summary HRPM allows objective derivation of measures of swallow function that may have value for diagnosis and research in relation to swallowing disorders. HRPM has demonstrated clinical applicability in specific patient populations and offers unique advantages that compliment current assessment methods. Correspondence to Taher Omari, Human Physiology & Centre for Neuroscience, College of Medicine and Public Health, Flinders University, South Australia, Australia. Tel: +61 8 8204 7482; mob: +61 409 427 876; e-mail: taher.omari@flinders.edu.au Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018

Purpose of review To review the recent literature on presentation, diagnosis and treatment of laryngopharyngeal reflux. Recent findings Patients with laryngopharyngeal reflux have a higher risk for gastroesophageal reflux and respiratory-related diseases. Many symptoms and findings are underestimated, contributing to the inconclusive results of many therapeutic trials. Additionally, little significance is given to nonacid and mixed refluxates, although a significant prevalence. The association between symptoms, signs, impedance-pH studies and pepsin detection could be the most accurate way for a clear diagnosis. 'Reflux profiling' is also important for the administration of a personalized treatment based on diet, proton pump inhibitors, alginate, magaldrate and other second-line drugs. There are only a handful of studies focusing on the addition of alginate or magaldrate to the treatment of laryngopharyngeal reflux, although their contribution has extensively been demonstrated. Summary Diagnosis remains controversial despite improvement in impedance and availability of pepsin detection in daily practice. With recent studies exhibiting a significant prevalence of nonacid or mixed refluxes, the addition of alginate or magaldrate to proton pump inhibitors should be considered. Future studies are needed to assess these new therapeutic schemes in moderate and severe laryngopharyngeal reflux. Correspondence to Dr Jerome R. Lechien, MD, PhD, MS, Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de mars, 6, B7000 Mons, Belgium. Tel: +32 65 37 35 84; e-mail: Jerome.Lechien@umons.ac.be Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea

Purpose of review Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO. Recent findings Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction. Summary TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue–lip adhesion, and hyoid suspension may play a role in management. Correspondence to Stacey L. Ishman, MD, MPH, Professor, Divisions of Pediatric Otolaryngology – Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC# 2018, Cincinnati, OH 45229-2018, USA. Tel: +1 513 636 4356; fax: +1 513 636 8813; e-mail: Stacey.Ishman@cchmc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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