Otolaryngology

Research articleAbstract only

Clinicopathological features of papillary thyroid microcarcinoma with a diameter less than or equal to 5 mm

Lei Yan, Jayjay Blanco, Vijaya Reddy, Samer Al-Khudari, ... Paolo Gattuso

In Press, Accepted Manuscript, Available online 8 May 2019

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Abstract

Abstract

Purpose

This retrospective study was conducted to assess the epidemiological, clinical and histologic characteristics of incidentally identified and presurgically diagnosed papillary thyroid microcarcinomas less than or equal to 5 mm in size (small PTMC).

Materials and methods

Cases from October 2003 to February 2018 were retrieved from pathology databases, and their clinicopathological features were reviewed.

Results

There were a total of 182 cases of small PTMCs, 141 women and 41 men. The mean age at diagnosis was 53.5. Most of the small PTMCs were not detected on clinical examination and workup and were diagnosed incidentally during pathologic examination. 21.4% of small PTMCs showed multifocality, with 21 cases of unilateral multifocal lesions and 18 cases with bilateral multifocal tumors. Small PTMCs were most often follicular variant (51.9%) followed by classic type (47.5%). The average size of follicular variants appeared to be larger than that of the classic type PTMCs (2.84 ± 1.43 mm vs 2.26 ± 1.51 mm, P = 0.01). A total of 66 cases (36.3%) had regional lymph node sampling or selective neck dissection and 15 of these cases identified lymph node metastasis (22.7%). 46.7% of patients with node positive microcarcinomas were male compared with 16% male in group with negative lymph nodes (P = 0.03).

Conclusions

Small PTMCs (≤5 mm) are often multifocal and bilateral and histology is commonly both the classical and follicular variant of PTC. While often diagnosed incidentally small PTMC can lead to regional lymph node involvement in a significant portion of cases and evaluation of the regional lymph nodes should be considered in the clinical management of these patients.

select article An unusual case of sudden sensorineural hearing loss after cycling class

Case reportAbstract only

An unusual case of sudden sensorineural hearing loss after cycling class

Vivian F. Kaul, Sarah Kidwai, Adam Lupicki, Maura Cosetti

In Press, Accepted Manuscript, Available online 25 April 2019

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Abstract

Abstract

In this case report, our patient developed sudden sensorineural hearing loss (SSNHL) after loud noise exposure during a popular cardiovascular group exercise cycling class. To increase awareness among all healthcare professionals of the effects of these modern-day group fitness classes on hearing loss, we describe this case and review the current literature on SSNHL and its management. A 35-year old man developed SSNHL in the setting of loud noise exposure during a high intensity aerobic exercise class. After a short course of oral steroids with no improvement, intratympanic steroids were administered weekly for three weeks. The patient showed minimal improvement; thus, hyperbaric oxygen therapy was conducted. Serial audiograms continued to show severe to profound mixed hearing loss in the right ear. In conclusion, individuals who participate in loud, high-intensity aerobic group-exercise classes should be careful of the potential for noise-induced hearing loss. Aerobic exercise may make these individuals more susceptible to noise-induced hearing loss. Early intervention is critical for any chance of recovery.

select article Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer

Research articleAbstract only

Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer

Michael H. Berger, Yarah M. Haidar, Benjamin Bitner, Monica Trent, Tjoson Tjoa

In Press, Corrected Proof, Available online 25 April 2019

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Abstract

Abstract

Objective

To identify practice patterns regarding human papillomavirus (HPV) vaccination efforts and vaccination rates in context of head and neck cancer prevention, identify barriers to vaccination, and identify gaps in knowledge regarding the link between HPV and head and neck cancer in the pediatrician population.

Study design/Methods

A 27-question cross-sectional survey was distributed to members of the four California chapters of the American Academy of Pediatrics.

Results

Of the completed responses, 89.4% identified as "always" recommending the HPV vaccine to patients, but only 19.5% of pediatricians estimated that >75% of their eligible patients had completed the HPV vaccination series. 71.5% of respondents felt that further education about HPV's link to head and neck cancer them more comfortable discussing vaccination. Physicians who were in practice longer were less likely to respond that additional education about HPV and its link to head and neck cancer would make them more comfortable discussing vaccination with patients (p = 0.043). Physicians who were in practice longer were more likely to correctly respond that HPV type 16 is the most common strain linked to head and neck cancer (p = 0.021).

Conclusion

There is need to improve both the knowledge base and comfort level of pediatricians in counseling their patients during vaccine recommendations. Otolaryngologists have a critical role in providing education to physicians, trainees, and the general public in the effort to combat the epidemic of HPV-associated head and neck cancer.

select article The molecular differences between human papillomavirus-positive and -negative oropharyngeal squamous cell carcinoma: A bioinformatics study

Research articleAbstract only

The molecular differences between human papillomavirus-positive and -negative oropharyngeal squamous cell carcinoma: A bioinformatics study

Jiaming Wang, Xiaoxi Xi, Wei Shang, Aneesha Acharya, ... Xianda Hu

In Press, Corrected Proof, Available online 23 April 2019

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Abstract

Abstract

Objective

To investigate the genetic and epigenetic differences between human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) and HPV-negative OPSCC.

Methods

Microarray data of HPV-positive and -negative OPSCC were retrieved from NCBI GEO datasets. Differentially expressed genes (DEGs) and differentially expressed miRNAs (DE-miRNAs) were identified by performing differential expression analysis. A functional enrichment analysis was performed to explore the biological processes and signaling pathways that DEGs and DE-miRNAs were involved in, respectively. A protein-protein interaction (PPI) network of DEGs was constructed to identify hub genes. miRNA-target network and miRNA-miRNA functional synergistic network were each constructed in order to identify risk-marker miRNAs. An miRNA-target-pathway network was constructed in order to explore the function of identified risk-marker miRNAs.

Results

Microarray data from 3 datasets (GSE39366, GSE40774, and GSE55550) was included and analyzed. The PPI network identified 3 hub genes (VCAM1, UBD, and RPA2). MiR-107 and miR-142-3p were found to play the most significant role in both the DE-miRNA-target network as well as in the miRNA-miRNA functional synergistic network. MiR-107 was involved in HPV-induced tumorigenesis by targeting many genes (CAV1, CDK6, MYB, and SERPINB5) and regulating the p53 signaling pathway, the PI3K-Akt signaling pathway, and the autophagy pathway. In addition, miR-142-3p was implicated in HPV-induced tumorigenesis by targeting the PPFIA1 gene and regulating transcriptional dysregulation and other cancerous pathways.

Conclusion

Three genes (VCAM1, UBD, and RPA2), two miRNAs (miR-107 and miR-142-3p), and four pathways (p53, PI3K-Akt, autophagy, and transcription dysregulation in cancer) were identified to play critical roles in distinguishing HPV-positive OPSCC from HPV-negative OPSCC.

select article Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

Research articleAbstract only

Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

Anita Sulibhavi, Matthew L. Rohlfing, Scharukh M. Jalisi, David B. McAneny, ... J. Pieter Noordzij

In Press, Corrected Proof, Available online 22 April 2019

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Abstract

Abstract

Purpose

As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates.

Materials and methods

The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors.

Results

Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p < 0.001).

Conclusions

The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.

select article Failed larynx preservation and survival in patients with advanced larynx cancer

Research articleAbstract only

Failed larynx preservation and survival in patients with advanced larynx cancer

Cheryl C. Nocon, Jessica Yesensky, Gaurav S. Ajmani, Mihir K. Bhayani

In Press, Corrected Proof, Available online 22 April 2019

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Abstract

Abstract

Purpose

To evaluate the survival benefit of total laryngectomy (TL) after induction chemotherapy in locally advanced laryngeal cancer patients.

Materials and methods

This is a retrospective study utilizing the National Cancer Database, which captures >80% of newly diagnosed head and neck squamous cell carcinoma cases in the United States. We included patients diagnosed with advanced stage laryngeal squamous cell carcinoma between 2004 and 2013 (n = 5649) who received either TL (n = 4113; 72.8%) or induction chemotherapy followed by either radiation therapy (n = 1431) or TL (n = 105). Kaplan-Meier curves and Cox proportional hazards regression were used to evaluate overall survival. A Cox regression model was computed to examine how the prognostic impact of treatment differed by clinical stage.

Results

In multivariable analysis, when compared to patients receiving TL alone, those receiving induction chemotherapy followed by TL experienced no significant difference in survival (HR 0.85, 95% CI 0.63–1.13), while those receiving induction chemotherapy followed by radiation experienced poorer survival (HR 1.15, 95% CI 1.06–1.26). Induction chemotherapy followed by TL was associated with improved survival compared to induction chemotherapy and radiation (P = .042). Among patients with T4a tumors, TL (P < .001) and induction chemotherapy followed by TL (P = .002) were both associated with improved survival compared to induction chemotherapy and radiation. There were no survival differences between TL and induction chemotherapy followed by TL (HR 0.76, 95% CI 0.52–1.10).

Conclusions

Larynx preservation may be attempted without compromising survival in patients with locally advanced larynx cancer who fail induction chemotherapy and undergo TL.

select article Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway

Research articleAbstract only

Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway

Clare Richardson, Anish Abrol, Chelsea S. Hamill, Nicole Maronian, ... Brian D'Anza

In Press, Corrected Proof, Available online 16 April 2019

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Abstract

Abstract

Introduction

Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway.

Materials and methods

A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma.

Results

73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer.

Conclusions

Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.

select article Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Research articleAbstract only

Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Ramez Philips, Phillip Nulty, Nolan Seim, Yubo Tan, ... Garth Essig

In Press, Corrected Proof, Available online 16 April 2019

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Abstract

Abstract

Objective

To assess the utility of rapid parathyroid hormone (PTH) values in predicting transient post-operative hypocalcemia in patients with unplanned parathyroidectomy during total or completion thyroidectomy.

Methods

All patients who underwent total or completion thyroidectomy between January 2010 and January 2015 were reviewed. Incidences of post-operative hypocalcemia were compared in patients with and without unplanned parathyroidectomy. Unplanned parathyroidectomy was defined as intra-operative incidental or intentional parathyroidectomy. Logistic regression assessed for predictors of hypocalcemia and optimum amount of calcium supplementation.

Results

Thirty-eight (13.6%) patients had evidence of incidental parathyroidectomy and 39/280 (13.9%) patients had parathyroid autotransplantation intra-operatively. Central neck dissection and malignancy were identified as risk factors for unplanned parathyroidectomy (p = 0.001, p = 0.060). Patients with unplanned parathyroidectomy were more likely to have hypocalcemia (p = 0.002) and hypoparathyroidism (p < 0.0005). PTH value was the only significant predictor of hypocalcemia in these patients. In patients with a post-operative PTH of ≤15, initial calcium supplementation ≥ 1000 mg decreased the risk of hypocalcemia (p < 0.05).

Conclusion

Post-operative PTH value predicts hypocalcemia in patients undergoing total and completion thyroidectomy with unplanned parathyroidectomy. In patients with a post-operative PTH < 15, initial calcium supplementation with ≥1000 mg of elemental calcium is recommended.

select article Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Research articleAbstract only

Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Krzysztof Piersiala, Lee M. Akst, Alexander T. Hillel, Simon R. Best

In Press, Corrected Proof, Available online 12 April 2019

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Abstract

Abstract

Objectives

After the publication of large clinical trials, in January 2014 The U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers. A significant proportion of patients with laryngeal cancer (LC) meet the introduced criteria, and we hypothesized that clinical practice would change as a result of these evidence-based guidelines.

Methods

Retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the introduction of screening guidelines (January 2010 to December 2017) was performed to identify those who had recommended screening CT chest.

Results

A total of 151 patients met the inclusion criteria of the study and were followed for a total of 746 patient-years. 184/332 (55%) patient-years in the pre-guidelines period and 246/414 (59%) in the post-guidelines period included at least one recommended chest imaging (CT or PET-CT; p = 0.27). 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included any radiological chest imaging (X-ray, CT or PET-CT; p = 0.72). Screening scans were ordered by OHNS (45%), Medical Oncology (31%), Radiation Oncology (8%), and primary care (14%) with 70% of patients missing at least one year of indicated screening.

Conclusions

The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to effective evidence-based screening and coordination of care is warranted.

select article Wideband Tympanmetry Results of Bone Cement Ossiculoplasty

Research articleAbstract only

Wideband Tympanmetry Results of Bone Cement Ossiculoplasty

O. Yigit, S. Tokgoz-Yilmaz, E. Tahir, M.D. Bajin, ... L. Sennaroglu

In Press, Corrected Proof, Available online 12 April 2019

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Abstract

Abstract

Objective

We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study.

Study design

A prospective study.

Setting

Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed.

Results

A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups.

Conclusion

Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.

select article Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Research articleAbstract only

Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Mark A. Prendes, Brett Gudgel, Enoch B. Kassa, Amelia M. Todd, ... H.B. Harold Lee

In Press, Corrected Proof, Available online 9 April 2019

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Abstract

Abstract

Purpose

To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants.

Methods

A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants.

Results

Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years.

Conclusions

To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported.

Précis

A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.

select article Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Case reportAbstract only

Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Adele Chin Wei Ng, Heng Wai Yuen, Xin Yong Huang

In Press, Corrected Proof, Available online 8 April 2019

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Abstract

Abstract

Thyroglossal duct cysts (TDC) are the most common congenital neck masses. Although they are anatomically closely related to the larynx, intra-laryngeal extension is very rare. We present a case, review the literature and discuss the challenges of intra-laryngeal TDC. A 55-year-old man presented with a neck mass associated with dysphagia. Computer Tomography neck scan showed a midline cyst extending to the pre-epiglottic space with partial obliteration of the right pyriform sinus and narrowing of the larynx. The cyst was excised en-bloc via Sistrunk procedure. Intra-laryngeal TDC are surgically challenging due to risk of perforation into the aerodigestive tract.

select article The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Case reportAbstract only

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew

In Press, Corrected Proof, Available online 5 April 2019

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Abstract

Abstract

We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

select article Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Research articleAbstract only

Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, ... Andreas M. Lazaris

In Press, Corrected Proof, Available online 3 April 2019

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Abstract

Abstract

Purpose

Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry.

Materials and methods

Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins.

Results

NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC.

Conclusions

VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.

select article Spontaneous cervical chyle fistula: A case report

Case reportAbstract only

Spontaneous cervical chyle fistula: A case report

Swathi Appachi, Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Background

Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.

Methods

Case report.

Results

A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.

Conclusion

A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.

select article Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Research articleAbstract only

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, ... Andrea Gallo

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Purpose

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy.

Materials and methods

The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days.

Results

The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008).

Conclusions

Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

select article Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Research articleAbstract only

Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Background

There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital.

Method

We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS).

Results

From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months).

Conclusion

The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.

select article Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Research articleAbstract only

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera-Schmitz, Jose Angel González-García, ... Xabier Altuna-Mariezcurrena

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Introduction

There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary.

Material and methods

Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α.

Results

35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26).

Conclusion

The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

select article Sex-specific enlarged vestibular aqueduct morphology and audiometry

Research articleAbstract only

Sex-specific enlarged vestibular aqueduct morphology and audiometry

Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, ... Todd D. Otteson

In Press, Corrected Proof, Available online 29 March 2019

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Abstract

Abstract

Objective

Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.

Materials and methods

A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.

Results

Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).

Conclusions

Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

select article Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Research articleAbstract only

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Nael M. Shoman

In Press, Corrected Proof, Available online 29 March 2019

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Abstract

Abstract

Objective

Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.

Study design

Retrospective case series.

Setting

Tertiary care facility.

Patients

Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.

Intervention

In-office modified myringoplasty technique under local anesthesia without sedation.

Main outcome measures

Complete perforation closure rate and audiometric outcomes.

Results

250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).

Conclusion

The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.