1618 articles - 08.09.10
1: Clin Otolaryngol. 2010 Aug;35(4):313-20.
Yaneza MM, Broomfield SJ, Morar P.
West of Scotland Deanery, Glasgow, UK. maymcyaneza@doctors.org.uk
BACKGROUND: Nasal crusting is frequently encountered by the otorhinolaryngologist and often requires no specific treatment. It is, however, important to carry out a full history and examination, followed by appropriate investigations, in order to detect the small number of cases in which crusting is caused by systemic or malignant disease. METHODS: This review was based on a literature search last performed on 30th July 2009. The MEDLINE, EMBASE and Cochrane databases were searched using the subject headings (nasal crusting OR crusts) and in combination with diagnosis, therapy and surgery. Similar searches were performed for relevant diseases, e.g. Wegener's granulomatosis, sarcoidosis. Results were limited to English language articles including clinical trials, meta-analyses, systematic reviews and review articles. Relevant references from selected articles were reviewed. RESULTS: Knowledge of the causes of nasal crusting will help to target the history, examination and investigation of patients with this condition. Screening tests for systemic conditions can be useful but most have limited sensitivity and must be interpreted cautiously. Nasal septal biopsy is indicated when there is a suspicion of malignancy, or to support a suspected diagnosis of vasculitis. The treatment offered depends upon the cause of crusting and the severity of symptoms. CONCLUSION: A careful and thorough history and examination, and targeted investigation, of the patient with nasal crusting will ensure correct diagnosis and treatment of patients with this common condition.
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PMID: 20738341 [PubMed - in process]2: Clin Otolaryngol. 2010 Aug;35(4):277-83.
Doddi NM, Eccles R.
Common Cold Centre, Cardiff University, Cardiff, UK. dnmouli@yahoo.co.uk
BACKGROUND: Anthropometric measurements of the nose provide objective data about the size and shape of the nose. Data of average nasal anthropometric values for various ethnic groups is promoted to be of great importance in planning aesthetic nasal surgery, but there may be fundamental problems with this approach. OBJECTIVE OF REVIEW: To collate existing knowledge on nasal anthropometry and, determine its value to the nasal surgeon, in planning aesthetic nasal surgery and in research. SEARCH STRATEGY: A structured search of PubMed was performed from 1 January 1973 to 31 December 2009 focussing on nasal anthropometry. The MeSH keywords used were nasal/nose, anthropometry/history/methods/measurements, aesthetic, surgery, nose, otorhinolaryngologic surgical procedures. RESULTS: There is published literature on the average values of the nasal dimensions for various ethnic groups, to aid surgeons in planning improvements of the face. However the large overlap of anthropometric data between racial groups and the lack of any scientific basis for the concept of race means that the published data for racial groups is of little use in planning nasal surgery. Nasal anthropometry, however, helps to answer important clinical questions in research. It has established the role of primary rhinoplasty in patients with cleft lip nasal deformity. It serves as an objective tool to investigate whether reconstructive nasal septoplasty in the paediatric population has any deleterious effect on nasal growth. Anthropometry also helps in the characterisation of dysmorphic syndromes. CONCLUSIONS: The published anthropometric data for racial groups is of little use in planning nasal surgery. Anthropometric measurements of the nose may help to answer important clinical questions in research on the effects of surgery on nasal and facial development.
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PMID: 20738336 [PubMed - in process]3: J Laryngol Otol. 2010 Aug 24;:1-10 [Epub ahead of print]
Hopkins C, Noon E, Bray D, Roberts D.
ENT Department, Guy's and St Thomas' Hospital, London, UK.
Introduction:Balloon sinuplasty is a new technology which has only recently been introduced in the UK. We review the current literature, and we present our first year's results for the technique together with a description of indications, outcomes and problems.Methods:Retrospective case note review of 27 consecutive patients undergoing sinuplasty alone in the first year in which this procedure was performed. The main outcome measures used were subjective improvement and Sino-Nasal Outcome Test (SNOT-22) score.Results:Dilatation was successful in 98 per cent of sinuses in which it was attempted; however, subjective improvement was noted in only 62 per cent of patients thus treated.Conclusion:We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.
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PMID: 20731885 [PubMed - as supplied by publisher]4: ORL J Otorhinolaryngol Relat Spec. 2010;72(3):138-43; discussion 144. Epub 2010 Aug 13.
Hurst SA.
Institute for Biomedical Ethics, Geneva University Medical School, Geneva, Switzerland. samia.hurst@unige.ch
PURPOSE OF THE STUDY: Asking whether imaging is indicated before middle ear surgery requires us to examine the question of indication more generally. PROCEDURES: Clinical indication integrates different levels, which are distinguished in this paper. As deciding whether or not an intervention is indicated requires different approaches on each of these levels, these approaches are also explored. RESULTS: Even when sufficient data are available to determine whether an intervention brings some benefit, knowing whether or not this intervention is indicated still requires us to answer 3 additional questions: (1) Is the intervention sufficiently beneficial to be clinically relevant? (2) Is the intervention 'reasonable' in terms of its opportunity costs? (3) How are we to decide which interventions 'make the cut', and which do not? Although we may all have an informed opinion on this topic, the question of the thresholds we ought to apply to very marginal benefits is one where the best answer can only be the one we have all agreed on. This requires a guideline integrating elements of procedural fairness, developed in conditions of protection from the risks of conflicts of interests. CONCLUSION: Although some of these questions integrate considerations of costs, not all do. However, all integrate value judgements, making clinical indication in part a question of ethical appraisal. Copyright 2010 S. Karger AG, Basel.
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PMID: 20714198 [PubMed - in process]5: Arch Otolaryngol Head Neck Surg. 2010 Aug;136(8):784-9.
Altman KW, Yu GP, Schaefer SD.
Department of Otolaryngology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA. Kenneth.altman@mountsinai.org
OBJECTIVE: To determine if comorbid dysphagia in all hospitalized patients has the potential to prolong hospital stay and increase morbidity. Dysphagia is increasingly prevalent with age and comorbid medical conditions. Our research group has previously shown that dysphagia is a bad prognostic indicator in patients with stroke. DESIGN: Analysis of national database. MAIN OUTCOME MEASURES: The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medical conditions. Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated. RESULTS: There were over 77 million estimated hospital admissions in the period evaluated, of which 271,983 were associated with dysphagia. Dysphagia was most commonly associated with fluid or electrolyte disorder, esophageal disease, stroke, aspiration pneumonia, urinary tract infection, and congestive heart failure. The median number of hospitalization days for all patients with dysphagia was 4.04 compared with 2.40 days for those patients without dysphagia. Mortality increased substantially in patients with dysphagia associated with rehabilitation, intervertebral disk disorders, and heart diseases. CONCLUSIONS: Dysphagia has a significant impact on hospital length of stay and is a bad prognostic indicator. Early recognition of dysphagia and intervention in the hospitalized patient is advised to reduce morbidity and length of hospital stay.
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PMID: 20713754 [PubMed - in process]6: Arch Otolaryngol Head Neck Surg. 2010 Aug;136(8):773-6.
Tracy JC, Spiro JD.
Department of Otolaryngology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA. jtracy@tuftsmedicalcenter.org
OBJECTIVES: To review the clinical characteristics of patients who had a short hospital stay (<24 hours) following neck dissection, and to assess the incidence and type of complications in this patient group. DESIGN: Case series. SETTING: University-based academic medical center. PATIENTS: All patients who underwent neck dissection at our institution from July 2004 through June 2008 and were discharged within 24 hours postoperatively (short stay) were included. MAIN OUTCOME MEASURES: Patient demographics, cancer site and type, and details of the procedures performed were quantified. In addition, medical records were reviewed for complications requiring readmission within 30 days postoperatively. RESULTS: Review of a prospectively maintained surgical database identified 122 consecutive neck dissections performed at our institution from July 1, 2004, to June 30, 2008. Of these 122 procedures, 71 involved a subsequent postoperative stay of less than 24 hours. These 71 procedures were performed in 69 patients; they had a mean age of 59 years and a sex distribution that was 33% female and 67% male. Neck dissection alone was performed in 22 of the 71 short-stay cases (31%). The most commonly performed concurrent procedures included limited oral cavity or oropharyngeal resections (21 patients) and parotidectomy (13 patients). Modified radical neck dissection was performed in 22 of the 71 cases (31%); the remaining procedures were selective neck dissections. Cranial nerve XI, the internal jugular vein, and the sternocleidomastoid muscle were all preserved in 57 cases (80%). Of the 71 short-stay cases, only 2 (3%) required readmission for a surgical complication within 30 days of their procedure. CONCLUSIONS: In carefully selected patients, discharge within 24 hours following neck dissection seems to be safe and appropriate. Given the potential for substantial cost savings, short stay should be studied further in this patient population.
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PMID: 20713752 [PubMed - in process]7: Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):702-12.
Kane SV, Bagwan IN.
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400017, India.
OBJECTIVE: To analyze the importance of unique cytoarchitectural patterns and the immunohistochemical profile in the diagnosis of myoepithelial carcinomas. DESIGN: Retrospective case analysis. SETTING: Tertiary cancer center. PATIENTS: A total of 51 patients with myoepithelial-rich carcinomas diagnosed over a 14-year period were studied for demographic data and tumor histologic characteristics and biologic behavior. MAIN OUTCOME MEASURES: We analyzed various histopathologic parameters and an immunohistochemical profile consisting of pan-cytokeratin (Pan-CK), epithelial membrane antigen (EMA), CD10, smooth-muscle actin (SMA), S-100 protein, p63, calponin, and carcinoembryonic antigen (CEA). RESULTS: The parotid gland (n = 15) and the palate (n = 15) were common sites involved. The cell types encountered were epithelioid, stellate, plasmacytoid, spindle, clear, and mixed with myxoid, hyaline, or myxohyaline stroma. Immunohistochemical analysis revealed vimentin (100%), CK (74%), EMA (27%), CD10 (62%), SMA (35%), S-100 protein (82%), p63 (28%), and calponin (98%) positivity and CEA (100%) negativity. Cervical node dissection was performed in 17 cases: 7 showed nodal metastasis, 2 with pure spindle-cell morphologic characteristics and 3 with spindle cells mixed with other cells. Distant metastasis was noted in 3 of these 7 cases: 2 of these 3 cases showed spindle-cell morphologic characteristics. CONCLUSIONS: Myoepithelial carcinomas showed varied cell types and patterns leading to a wide range of differential diagnoses. Immunohistochemical analysis helped determine the diagnosis. Spindle morphologic characteristics were observed with nodal and distant metastasis.
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PMID: 20644067 [PubMed - indexed for MEDLINE]8: Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):677-81.
Lee CH, Kim JW, Lee HJ, Seo BS, Yun PY, Kim DY, Yoon IY, Rhee CS, Park JW, Mo JH.
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
OBJECTIVE: To determine the predictors affecting treatment outcome after application of the mandibular advancement device (MAD). DESIGN: Retrospective analysis. SETTING: Tertiary care university hospital. PATIENTS: A total of 76 patients (68 men and 8 women) who were treated with the MAD for obstructive sleep apnea (OSA) were included from September 2005 through August 2008. All the subjects underwent cephalometry, nocturnal polysomnography, and sleep videofluoroscopy (SVF) before and at least 3 months after receipt of a custom-made MAD. Sleep videofluoroscopy was performed before and after sleep induction and was analyzed during 3 states of awakeness, normoxygenation sleep, and desaturation sleep. Subjects were divided into success and nonsuccess groups depending on treatment outcome. MAIN OUTCOME MEASURES: Multiple variables from cephalometry and SVF including the length of the soft palate, retropalatal space, retrolingual space, and mouth opening angle were evaluated during sleep events with or without the MAD between success and nonsuccess group. RESULTS: The soft palate was significantly longer in the nonsuccess group than in the success group. The retropalatal and retrolingual airway spaces and mouth opening angle were not different between 2 groups. Application of the MAD increased the retrolingual space and decreased the length of the soft palate and the mouth opening angle significantly in both success and nonsuccess groups. However, retropalatal space was widened only in the success group, which showed that retropalatal space may be important in determining treatment response of the MAD. CONCLUSION: The length of the soft palate showed a difference between success and nonsuccess groups, and widening of retropalatal space might be an important factor for successful outcome with MAD application.
Publication Types: Comparative Study
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PMID: 20644062 [PubMed - indexed for MEDLINE]9: Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):673-6.
Davidson TM, Smith WM.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery and Continuing Medical Education, University of California, San Diego, School of Medicine, 9500 Gilman Dr, La Jolla, CA 92037-0612, USA. tdavidson@ucsd.edu
OBJECTIVE: To apply the Bradford Hill criteria, which are widely used to establish causality between an environmental agent and disease, to evaluate the relationship between over-the-counter intranasal zinc gluconate therapy and anosmia. DESIGN: Patient and literature review applying the Bradford Hill criteria on causation. SETTING: University of California, San Diego, Nasal Dysfunction Clinic. PATIENTS: The study included 25 patients who presented to the University of California, San Diego, Nasal Dysfunction Clinic complaining of acute-onset anosmia after intranasal application of homeopathic zinc gluconate gel. MAIN OUTCOME MEASURES: Each of the 9 Bradford Hill criteria--strength of association, consistency, specificity, temporality, biological gradient (dose-response), biological plausibility, biological coherence, experimental evidence, and analogy--was applied to intranasal zinc gluconate therapy and olfactory dysfunction using published, peer-reviewed medical literature and reported clinical experiences. RESULTS: Clinical, biological, and experimental data support the Bradford Hill criteria to demonstrate that intranasal zinc gluconate therapy causes hyposmia and anosmia. CONCLUSIONS: The Bradford Hill criteria represent an important tool for scientifically determining cause between environmental exposure and disease. Increased Food and Drug Administration oversight of homeopathic medications is needed to monitor the safety of these popular remedies.
Publication Types: Review
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PMID: 20644061 [PubMed - indexed for MEDLINE]10: Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):666-70.
Brigger MT, Ashland JE, Hartnick CJ.
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA. matt.brigger@alumni.vanderbilt.edu
OBJECTIVE: To identify children who may benefit from calcium hydroxylapatite (CaHA) injection pharyngoplasty for symptomatic velopharyngeal insufficiency (VPI). DESIGN: Retrospective review of children with VPI who underwent injection pharyngoplasty with CaHA. SETTING: Multidisciplinary pediatric aerodigestive center. PATIENTS: Children with symptomatic VPI as defined by abnormal speech associated with subjective and objective measures of hypernasality. INTERVENTION: Posterior pharyngeal wall augmentation with injectable CaHA. MAIN OUTCOME MEASURE: Nasalence scores recorded as number of standard deviations (SDs) from normalized scores, and perceptual scoring recorded as standardized weighted score and caretaker satisfaction from direct report. RESULTS: Twelve children who had undergone injection pharyngoplasty with CaHA were identified. Of the 12 children, 8 demonstrated success at 3 months as defined by nasalence (<1 SD above normal nasalance scores), perceptual scoring (decrease in weighted score), and overall caretaker satisfaction. Four children were followed up for more than 24 months and continued to demonstrate stable success. The 4 children who failed the procedure all failed before the 3-month evaluation and demonstrated increased baseline severity of VPI as defined by increased preoperative nasalence scores (5.25 SD vs 2.4 SD above normalized scores), perceptual scores (weighted score, 4.25 vs 3.85), and characteristic nasendoscopy findings of a broad-based velopharyngeal gap or unilateral adynamism. Three of the 4 treatment failures occurred early in the senior author's (C.J.H.) experience with the technique. CONCLUSIONS: Injection pharyngoplasty with CaHA is a useful adjunct in the treatment of children with mild VPI. Efficacy and safety have been demonstrated more than 24 months after injection. Patient selection and operative technique are critical to the success of the procedure. Success is seen most often in children with mild VPI and small well-defined velopharyngeal gaps consistent with touch closure.
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PMID: 20644060 [PubMed - indexed for MEDLINE]11: Arch Otolaryngol Head Neck Surg. 2010 Jul 19; [Epub ahead of print]
Lin HC, Lin PW, Friedman M, Chang HW, Su YY, Chen YJ, Pulver TM.
Su, and Chen) and Ophthalmology (Dr P.-W. Lin) and Sleep Center (Dr H.-C. Lin), Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Otolaryngology and Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois (Dr Friedman); Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago (Drs Friedman and Pulver); and Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung (Dr Chang).
OBJECTIVE: To study the long-term outcomes of radiofrequency (RF) turbinate surgery for the treatment of allergic rhinitis refractory to medical therapy. DESIGN: A retrospective review of a prospective data set. SETTING: Tertiary referral center. PATIENTS: A total of 146 patients with allergic rhinitis refractory to medical therapy undergoing RF turbinoplasty were included. MAIN OUTCOME MEASURES: A standard 0 to 10 visual analog scale (VAS) was used to assess the allergic symptoms including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes prior to RF turbinoplasty and at 6 months and 5 years postoperatively. The long-term clinical benefits and complications were reviewed. Statistical analysis was determined by repeated measures of analysis of variance. RESULTS: No adverse reactions such as bleeding, infection, adhesions, or olfactory change were encountered. Of the 146 patients, 119 were followed up at least 5 years postoperatively. Five years after treatment, 101 patients had complete data available for analysis. They reported improvement of nasal obstruction, with the mean (SD) VAS score decreasing from 6.65 (1.92) to 4.45 (2.54). The mean (SD) VAS score changed from 5.90 (2.79) to 3.79 (2.97) for rhinorrhea; from 5.15 (2.77) to 3.50 (2.77) for sneezing; from 3.67 (3.03) to 2.41 (2.30) for itchy nose; and from 2.94 (3.02) to 2.02 (2.42) for itchy eyes (all P < .001, paired t test with Bonferroni correction). CONCLUSION: This long-term study has demonstrated that the RF turbinoplasty for allergic rhinitis appears to be an effective and safe tool for treating allergic rhinitis refractory to medical therapy.Published online July 19, 2010 (doi:10.1001/archoto.2010.135).
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PMID: 20644029 [PubMed - as supplied by publisher]12: Clin Otolaryngol. 2010 Jun;35(3):204-9.
Maguire J, Steele JG, Gibson GJ, Wilson JA, Steen N, McCracken GI.
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
OBJECTIVES: To compare a mandibular advancement splint to a control bite raising appliance in the treatment of snoring with or without mild obstructive sleep apnoea syndrome. DESIGN: A prospective two-treatment randomised cross-over clinical trial. Setting: Single centre secondary care Dental Hospital. PARTICIPANTS: Fifty-two subjects (36 men, 16 women) diagnosed with non-apnoeic snoring or mild obstructive sleep apnoea syndrome (apnoea/hypopnoea index < or =15 events/h), were recruited from Departments of Respiratory Medicine and ENT surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust. MAIN OUTCOME MEASURES: The Snoring Symptoms Inventory questionnaire (SSI) and the Epworth Sleepiness Score (ESS) were used to evaluate changes in symptoms. Patient reported outcomes (compliance, adverse events, splint preference) were recorded by questionnaire. Subjects attended for five study visits and used a mandibular advancement splint and a bite raising appliance at home each for 4 weeks, with a 3-week washout period between devices. RESULTS AND CONCLUSIONS: Thirty-eight subjects completed the study. Both the mandibular advancement splint and bite raising appliance significantly reduced the SSI compared to the baseline scores: mandibular advancement splint 5.5, P = 0.013; bite raising appliance 3.1, P = 0.005. No statistically significant difference between the two treatment periods was detected (P > 0.05). The reduction in the Epworth Sleepiness Score was: mandibular advancement splint 1.0, P = 0.02; bite raising appliance 0.3, P = 0.4. The change in the Epworth Sleepiness Score was not statistically significantly different between the mandibular advancement splint and bite raising appliance treatment periods (P > 0.05). CONCLUSIONS: In this cohort of patients diagnosed with snoring +/- mild OSA: 1 both the mandibular advancement splint and bite raising appliance designs of splint appeared to reduce the symptoms of snoring; 2 no difference in the magnitude of this effect was detected in favour of one design of splint.
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PMID: 20636739 [PubMed - in process]13: Clin Otolaryngol. 2010 Jun;35(3):177-89.
Paleri V, Patterson J.
The Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle Upon Tyne, UK. vinidh.paleri@ncl.ac.uk
OBJECTIVES: To perform a systematic review of studies, which investigate the role of gastrostomy tube feeding in head and neck squamous cell cancer. DESIGN: A systematic review of the English literature, identifying areas of clinical equipoise and recommendations for future studies. MAIN OUTCOME MEASURES: Varying practices in G-tube use in HNSCC, the benefits and disadvantages of G-tubes, the effect of G-tube placement on multidimensional outcomes in patients with head and neck cancer, including quality of life and health economics and to draw themes that may lend themselves to future research. RESULTS: The search identified 216 articles of which 59 were considered relevant. During treatment, a significant number of patients need enteral nutritional supplementation through nasogastric or G-tubes. Gastrostomy tubes have a good safety profile. Most clinicians agree that the use should be restricted to advanced tumours. Studies on prophylactic insertion of G-tubes do not show a consistent advantage to the nutritional status compared with NG tubes. At 1 year, G-tube retention rates vary between 10% and 30%. The presence of a feeding tube has a negative impact on quality of life. Placing G-tubes may have an adverse effect on swallowing after chemoradiation. CONCLUSIONS: There is a lack of consensus among clinicians about indications for placing G-tubes. There is sufficient equipoise in this area for further investigation of the effect of varying feeding practices on functional outcomes, quality of life and health economics.
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PMID: 20636736 [PubMed - in process]14: Arch Otolaryngol Head Neck Surg. 2010 Jun;136(6):566-75.
Carlson ML, Beatty CW, Neff BA, Link MJ, Driscoll CL.
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
OBJECTIVE: To describe presenting symptoms, evaluation findings, and surgical management of cranial base hyperostosis in patients with Camurati-Engelmann disease (CED). DESIGN: Retrospective study and literature review. SETTING: The Mayo Clinic, Rochester, Minnesota. PATIENTS: A total of 306 patients diagnosed as having CED, including 12 primarily evaluated at our institution between 1968 and 2008, and 294 identified in the international literature. MAIN OUTCOME MEASURES: Presenting symptoms, methods of diagnosis, treatment strategies, and patient outcomes. RESULTS: One hundred seventy-three of 306 patients (56.5%) had radiographically proven skull base hyperostosis, whereas less than one-fourth were symptomatic. The most common manifestations of cranial base involvement were hearing loss (19.0%), headache (10.4%), exophthalmos (8.2%), and frontal bossing (7.2%); less common were vision changes, vertigo, facial weakness, symptomatic brainstem compression, facial numbness, and hyposmia. Although corticosteroids and bisphosphates may treat torso and extremity involvement, they demonstrate no benefit for symptomatic skull base disease. In select symptomatic patients, aggressive decompression surgery may provide the only means of treatment. Decompression surgery is more challenging with thick sclerotic bone, loss or obscuration of bony landmarks, and decreased supratentorial space. Patients must be counseled on the increased risks associated with surgery and the potential for redeposition of bone and recurrence of symptoms. CONCLUSIONS: Physicians should include CED in the differential diagnosis for patients with radiographic evidence of skull base thickening and synchronous cranial neuropathies or symptoms of elevated intracranial pressure. In mild forms of the disease, the clinical course of patients should be followed with serial examination, audiometric testing, and radiography. In select patients with progressive cranial base symptoms, aggressive wide decompression of involved neurovascular structures may provide benefit.
Publication Types: Review
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PMID: 20566907 [PubMed - indexed for MEDLINE]15: Arch Otolaryngol Head Neck Surg. 2010 Jun;136(6):561-5.
Maturo S, Hartnick CJ.
EPI, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114-3914, USA.
OBJECTIVE: To describe the initial pediatric experience with intralesional bevacizumab (Avastin) treatment for children with severe, recurrent respiratory papilloma (RRP). DESIGN: Retrospective medical chart review. SETTING: Tertiary care multidisciplinary aerodigestive center. PATIENTS: Three children, aged 3 to 6 years, with severe RRP requiring more than 4 operative interventions in 1 year whose parents (or legal guardians) consented to adjuvant treatment with intralesional bevacizumab. INTERVENTION: All 3 children were treated as follows: surgical debridement with a microdebrider, pulsed potassium titanyl phosphate laser treatments, and adjuvant intralesional injections with bevacizumab (1.25 mg total). MAIN OUTCOME MEASURES: Time interval between operative interventions, Derkay severity scale for RRP, and pediatric voice-related quality of life (PVRQOL) scores. RESULTS: All 3 children demonstrated increased time between operative interventions. Two children had a substantial decrease in their Derkay score and improved PVRQOL scores. One child, although time between operative interventions improved, did not have any change in Derkay score and required further adjuvant therapy. CONCLUSIONS: Injectable bevacizumab appears to show some efficacy in prolonging the time between treatments and therefore reducing the number of treatments per year in children with severe RRP. However, before any meaningful conclusions can be drawn, further studies must be conducted in the form of head-to-head trials looking specifically at the issues of time between treatment intervals, efficacy of one adjunct over another, vocal outcomes, and whether several adjunctive treatments confer advantage over 1 treatment. In-depth and careful informed consent is mandatory for these studies so that parents are aware of the risks and benefits (known and unknown) before such individualized decisions are made.
Publication Types: Case Reports
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PMID: 20566906 [PubMed - indexed for MEDLINE]16: Arch Otolaryngol Head Neck Surg. 2010 Jun;136(6):557-60.
Baranano CF, Sweitzer RS, Mahalak ML, Alexander NS, Woolley AL.
Pediatric ENT Associates, 1940 Elmer Bissell Rd, Birmingham, AL 35243, USA.
OBJECTIVE: To investigate the impact of myringotomy tubes (MTs) on outcomes for pediatric cochlear implant (CI) recipients. DESIGN: Retrospective case-control chart review. SETTING: Tertiary care pediatric hospital. PATIENTS: Sixty-two patients received an MT before CI (mean [SD] age at initial CI, 3.20 [2.45] years). Seventy-eight ears received CIs and MTs. INTERVENTION: The MTs were removed and allowed to extrude before CI (59% [n = 46]) or kept in place until CI (41% [n = 32]). MAIN OUTCOME MEASURES: Otorrhea, persistent tympanic membrane (TM) perforation, and need for additional procedures were recorded. Statistical analysis was performed with the Fisher exact test. RESULTS: Forty ears (51%) required more than 1 set of MTs. Ten ears (22%) in which the MTs were removed before CI required a separate MT after CI compared with 6 ears (19%) in which the MTs remained in place until CI (P = .78). The MTs that were present during CI were either removed with myringoplasty (31% [n = 10]) or retained after surgery (69% [n = 22]). All TMs in which the tubes were removed before or during CI healed. There were 3 persistent TM perforations that required surgical treatment. There were no cases of meningitis and no removals of CIs because of infection. CONCLUSIONS: Myringotomy tubes do not appear to adversely affect the final outcomes of pediatric CI recipients and can be managed similarly to MTs in other otitis media-prone children. They may be left in place in children who continue to experience recurrent acute otitis media or removed in children who no longer need them.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20566905&dopt=ExternalLink
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PMID: 20566905 [PubMed - indexed for MEDLINE]17: J Laryngol Otol. 2010 Jun 18;:1-4 [Epub ahead of print]
Nassif RG, Soliman R, Edwards DH, Kara N, Hussain SS.
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK.
Objectives:(1) To identify newly diagnosed cases of methicillin-resistant Staphylococcus aureus ear infection in our local population; (2) to determine the risk factors involved in these patients' clinical courses, and (3) to type the bacterial strains isolated and thus identify whether they were hospital- or community-acquired.Design and setting:Retrospective review of case notes, together with laboratory-based molecular studies in the departments of otolaryngology and medical microbiology in a university teaching hospital in Scotland, UK.Subjects:Over a two-year period, 35 patients were identified with ear swabs positive for methicillin-resistant Staphylococcus aureus infection. These cases came from both hospital and community settings.Main outcome measures:(1) Identification of primary methicillin-resistant Staphylococcus aureus otorrhoea in patients with no previously documented colonisation; and (2) molecular typing of the strains isolated, using spa technology, to identify whether they were hospital- or community-acquired.Results:Of the 35 positive patients, 27 were previously known carriers of methicillin-resistant Staphylococcus aureus. The eight patients with newly diagnosed methicillin-resistant Staphylococcus aureus otorrhoea presented initially in the community. All of these patients had had contact with hospital staff (as in-patients or out-patients) in the weeks preceding development of their ear infection. Using the spa technique for molecular typing, we identified hospital-acquired ('epidemic') methicillin-resistant Staphylococcus aureus type 15 in all eight patients' isolates. All were sensitive to topical gentamicin.Conclusions:In our cohort, hospital-acquired methicillin-resistant Staphylococcus aureus type 15 was the commonest cause of methicillin-resistant Staphylococcus aureus otorrhoea, despite the fact that these patients all first presented in the community. We believe that contact with hospital staff or health care workers is a risk factor for acquiring methicillin-resistant Staphylococcus aureus otorrhoea in the community.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20561383&dopt=ExternalLink
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PMID: 20561383 [PubMed - as supplied by publisher]18: J Laryngol Otol. 2010 Aug;124(8):823-7. Epub 2010 Jun 2.
Charaklias N, Raja H, Humphreys ML, Magan N, Kendall CA.
ENT Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
INTRODUCTION: Recent advances in electronic nose technology, and successful clinical applications, are facilitating the development of new methods for rapid, bedside diagnosis of disease. There is a real clinical need for such new diagnostic tools in otolaryngology. MATERIALS AND METHODS: We present a critical review of recent advances in electronic nose technology and current applications in otolaryngology. RESULTS: The literature reports evidence of accurate diagnosis of common otolaryngological conditions such as sinusitis (acute and chronic), chronic suppurative otitis media, otitis externa and nasal vestibulitis. A significant recent development is the successful identification of biofilm-producing versus non-biofilm-producing pseudomonas and staphylococcus species. CONCLUSION: Electronic nose technology holds significant potential for enabling rapid, non-invasive, bedside diagnosis of otolaryngological disease.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20519037&dopt=ExternalLink
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PMID: 20519037 [PubMed - in process]19: Clin Otolaryngol. 2010 Apr;35(2):87-96.
Bond M, Elston J, Mealing S, Anderson R, Weiner G, Taylor R, Stein K.
Peninsula Medical School, University of Exeter, Exeter, EX2 4SG, UK. mary.bond@pms.ac.uk
OBJECTIVE: In the UK approximately 3% of over 50 years olds and 8% of over 70 year olds have severe (794-94 dBHL) to deafness. As deafness increased, hearing aids become increasingly ineffective. Cochelear implants can provide an alternative treatment. OBJECTIVE OF REVIEW: To bring together the research evidence through the robustness of a systematic review of the effectiveness of unilateral cochlear implants for adults. We also sought to systematically review the published literature on cost-effectiveness. TYPES OF REVIEW: Systematic review. SEARCH STRATEGY: This examined 16 electronic databases, plus bibliographies and references for published and unpublished studies from inception to june 2009. EVALUATION METHOD: Abstracts were independently assessed against inclusion criteria by two researchers were compared and disagreements resolved. Included papers were then retrieved and further independently assessed in a similar way. Remaining studies had their data independently extracted by one of five reviewers and checked by another reviewer. RESULTS: From 1,580 titles and abstracts nine studies were included. These were of variable quality; some study's results should be viewed with caution. The studies were too hetrogeneous to pool the data. However, overall the results firmly supported the use of unilateral cochler implants for severe to profoundly deaf adults. Additionally, four UK based economic evaluations found unilateral cochlear implants to be cost-effectivene in adults at UK implants centres. CONCLUSION: The methodologically weak but universally positive body of effectiveness evidence supports the use of unilateral cochlear implants in adults. Previous economic evaluations indicate that such implants are likely to be cost-effective.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20500577&dopt=ExternalLink
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PMID: 20500577 [PubMed - in process]20: Arch Otolaryngol Head Neck Surg. 2010 May;136(5):463-7.
Ozgursoy OB, Salassa JR.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, USA. OzanOzgursoy@yahoo.com
OBJECTIVES: To investigate functional and manofluorographic findings of patients with pharyngoesophageal diverticulum before and after transoral endoscopic pharyngoesophageal diverticulostomy (TEPD) and to comment on outcomes relative to predictors of successful treatment and pathogenesis of pharyngoesophageal diverticulum. DESIGN: Retrospective medical record review. SETTING: Academic center. PATIENTS: Thirty patients underwent TEPD between July 1, 1997, and June 30, 2007, and met the study inclusion criteria. According to the depth of their pharyngoesophageal diverticulum, patients were categorized as having small (<20 mm) or large (>or=20 mm) diverticula. INTERVENTION: Manofluorography before and 6 months after TEPD. MAIN OUTCOME MEASURES: Functional and manofluorographic findings before and 6 months after surgery. RESULTS: Functional Outcome Swallowing Scale stage was significantly decreased in patients after surgery. Videofluoroscopy demonstrated normal swallowing coordination and a significant decrease in pouch depth after surgery (from 29.62 to 4.78 mm). Manometry confirmed normal swallowing coordination and showed significant mean postoperative pressure reductions in the following: cricopharyngeal (CP) resting pressure (from 16.23 to 9.26 mm Hg), CP midbolus pressure (from 32.86 to 19.26 mm Hg), intrabolus pressure gradient across the CP region (from 22.48 to 10.16 mm Hg), and CP peak clearing pressure (from 41.98 to 26.99 mm Hg). The mean preoperative intrabolus pressure gradient across the CP region and the mean postoperative CP nadir were significantly greater in patients having large diverticula. CONCLUSIONS: Statistically significant decreases in functional and objective measures occurred after TEPD. High CP midbolus pressure and high intrabolus pressure gradient across the CP region are reliable objective indicators of patients who might benefit from TEPD and are appropriate variables for follow-up after surgery. There was no manofluorographic evidence of abnormal swallowing coordination in this small series. Our study supports the hypothesis that anatomical hypopharyngeal wall weakness has a major role in the pathogenesis of pharyngoesophageal diverticulum.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20479376&dopt=ExternalLink
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PMID: 20479376 [PubMed - indexed for MEDLINE]