Curr Opin Otolaryngol Head Neck Surg
. 2020 Aug;28(4):228-234. doi: 10.1097/MOO.0000000000000632.
Considerations for the Otolaryngologist in the Era of COVID-19: A Review of the Literature
Lauren E Miller 1, David A Shaye, Linda N Lee
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PMID: 32628416 DOI: 10.1097/MOO.0000000000000632
Abstract
Purpose of review: The SARS-CoV-2 coronavirus pandemic, referred to as COVID-19, has spread throughout the globe since its first case in China in December 2019, leaving a significant number of people infected and clinically ill. The purpose of this review is to provide the current known clinical characteristics of and management for COVID-19 as it relates to otolaryngology.

Recent findings: COVID-19 is a highly transmissible respiratory disease with common presenting symptoms of fever, cough, and fatigue. In the absence of available vaccines or antiviral therapies, symptomatic and respiratory support is the current standard of therapy. Measures to prevent further transmission have been enacted globally including social distancing and cancellation of public events. Given elevated viral load in the upper aerodigestive tract, extra precautions in patients with otolaryngology needs have been recommended for protection of both healthcare workers and patients.

Summary: Otolaryngologists face unique risk from COVID-19. Maintaining appropriate preventive health measures and remaining updated on institutional clinical guidelines is paramount for both caretaker safety and patient care.

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52
J Stomatol Oral Maxillofac Surg
. 2020 Jul 3;S2468-7855(20)30163-4. doi: 10.1016/j.jormas.2020.06.016. Online ahead of print.
Integra® Dermal Regeneration Template for Full Thickness Carcinologic Scalp Defects: Our 6 Years' Experience Retrospective Cohort and Literature Review
Golda Romano 1, Jebrane Bouaoud 2, Antoine Moya-Plana 3, Nadia Benmoussa 3, Jean-François Honart 4, Nicolas Leymarie 5
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PMID: 32629168 DOI: 10.1016/j.jormas.2020.06.016
Abstract
Background: The aim of the study is the use of Integra® dermal regeneration template (DRT) in scalp reconstruction after tumor resection by comparing results of literature and Gustave Roussy Institut' series of 20 patients. Materiel and methods: A systematic review, with a PubMed search was performed using the following keywords "artificial dermis OR DRT" AND "scalp". Eligible articles were selected to study patients and defects characteristics, operative modalities, and the follow up results. This case series presents the experience of immediate DRT reconstruction after scalp full thickness carcinologic surgery, in the plastic surgery service of Gustave Roussy cancer center.

Results: Twenty patients with primary scalp tumors underwent two steps DRT reconstruction for full thickness scalp defect. The mean surface defect was 72 cm2. The mean operative combined time was 94 min, with a total healing delay of 68 days. All patients successfully recovered. Five patients had minor complications (3 delayed healing and 2 DRT infections) with no need of additional surgery. Fourteen articles, totalizing n=210 patients, were included and reviewed. Reported ages ranged from 58 to 82 years old. Almost all patients were operated for oncologic resections. The mean surface defect was 73 cm2. The mean follow-up was 15 months. The skin graft taking rates ranged from 95% up to 100%.

Conclusion: In large scalp full thickness defects after cancer resection, DRT appears to be a suitable reconstruction option for patients with comorbidities, and aggressive tumors. This technique allows immediate coverage of the calvarium with short operative time and prevents from healing delay. The oncologic follow-up is no disturbed and cancer recurrences are easily diagnosed.

Keywords: Integra; artificial dermis; dermal regeneration template; reconstruction; scalp.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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53
Prog Orthod
. 2020 Jul 6;21(1):19. doi: 10.1186/s40510-020-00319-3.
Unilateral Sagittal Split Osteotomy: Effect on Mandibular Symmetry in the Treatment of Class III With Laterognathia
Naji Abou Chebel 1 2, Maria Saadeh 1 3 4, Ramzi Haddad 5
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PMID: 32627109 DOI: 10.1186/s40510-020-00319-3
Abstract
The bilateral sagittal split osteotomy is considered the standard surgery to correct facial asymmetries. More recently, unilateral sagittal split osteotomy (USSO) was used to treat such malocclusions.

Aim: To assess facial symmetry following USSO in the treatment of class III laterognathia.

Methods: Frontal facial photographs of four groups of patients were assessed: (1) pre-surgical group (n = 30) with skeletal asymmetry, (2) postsurgical group assessing patients of the first group 2 years after USSO, (3) control group (n = 30) of patients judged to have harmonious facial norms, and (4) mirrored group (n = 30) in which the control photographs were altered by duplicating the right half side of the face to replace the left half, thus creating perfectly symmetrical faces. All 120 photographs were distributed to 40 expert orthodontists to evaluate and score facial symmetry using the visual analog scale. Skin sensitivity and temporomandibular joint (TMJ) disorders were also assessed clinically pre and postsurgically.

Results: Statistically significant differences were observed between the pre-surgical group and each of the postsurgical and control groups (p < 0.001). The control and postsurgical groups received similar scores of symmetry (p = 0.774). The mirrored group received statistically significantly higher symmetry scores than either of the control or the postsurgical groups (p < 0.001). A reduction in TMJ disorders was noted after USSO and all patients reported normal skin sensation 2 years post-surgery.

Conclusion: When indicated, USSO is a dependable and practical surgical approach to correct facial asymmetries associated with class III malocclusion.

Keywords: Facial asymmetry; Unilateral sagittal split osteotomy.

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54
Review Front Neurol
. 2020 Jun 18;11:659. doi: 10.3389/fneur.2020.00659. eCollection 2020.
Potential of SARS-CoV-2 to Cause CNS Infection: Biologic Fundamental and Clinical Experience
Jianhan Huang 1, Meijun Zheng 2, Xin Tang 1, Yaxing Chen 1, Aiping Tong 3, Liangxue Zhou 1
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PMID: 32625165 PMCID: PMC7314941 DOI: 10.3389/fneur.2020.00659
Free PMC article
Abstract
SARS-CoV-2 is a novel coronavirus leading to serious respiratory disease and is spreading around the world at a raging speed. Recently there is emerging speculations that the central nervous system (CNS) may be involved during SARS-CoV-2 infection, contributing to the respiratory failure. However, the existence of viral replication in CNS has not been confirmed due to the lack of evidence from autopsy specimens. Considering the tropism of SARS-CoV-2, ACE2, is prevailing in CNS, and the neuro-invasive property of human coronavirus was widely reported, there is a need to identified the possible complications during COVID-19 for CNS. In this review, we conduct a detailed summary for the potential of SARS-CoV-2 to infect central nervous system from latest biological fundamental of SARS-CoV-2 to the clinical experience of other human coronaviruses. To confirm the neuro-invasive property of SARS-CoV-2 and the subsequent influence on patients will require further exploration by both virologist and neurologist.

Keywords: COVID-19; SARS-CoV-2; central nervous system; human coronavirus; viral infection.

Copyright © 2020 Huang, Zheng, Tang, Chen, Tong and Zhou.

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55
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Jun 7;55(6):576-579. doi: 10.3760/cma.j.cn115330-20200305-00162.
[Application of Tracheotomy in the Treatment of Severe Cases of COVID-19]
[Article in Chinese]
Z F Deng 1, T Zhu 1, Y J Ding 1, C L Zhou 2, Y Kang 3, J N Qu 1, Q Q Hua 1, Y Xu 4
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PMID: 32610401 DOI: 10.3760/cma.j.cn115330-20200305-00162
Abstract in English , Chinese
Objective: To discuss the the effects, indications and protective measures of tracheotomy for severe cases of coronavirus disease 2019 (COVID-19) patients. Methods: A retrospectively analysis was conducted to explore the clinical data of COVID-19 patients who received tracheotomy in February to March 2020, and descriptive statistics were used to analyze the indication of tracheotomy, particularity of intraoperative treatment and protective measures. Results: A total of 4 cases were included in this article. All patients were successfully operated. One case had postoperative incision continuous bleeding, there were not other complications and nosocomial infection among the medical staff. The patient's condition was relieved in different degrees after the operation, who remained hospitalized. Conclusion: Tracheotomy for severe cases of COVID-19 can achieve certain curative effect, but the occurrence of tracheotomy related complications and nosocomial infection should be effectively controlled, and the risk benefit ratio of tracheotomy should be carefully weighed before surgery.

Keywords: COVID-19; Critical type; Protective measures; Surgical indications; Tracheostomy.

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56
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):979-984. doi: 10.1177/0194599820919363. Epub 2020 May 12.
Budesonide vs Saline Nasal Irrigation in Allergic Rhinitis: A Randomized Placebo-Controlled Trial
Nikitha Periasamy 1, Kailesh Pujary 1, Ajay M Bhandarkar 1, Naveen D Bhandarkar 2, Balakrishnan Ramaswamy 1
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PMID: 32393099 DOI: 10.1177/0194599820919363
Abstract
Objectives: Budesonide nasal irrigation is currently widely used in the treatment of chronic sinusitis typically following endoscopic sinus surgery to improve inflammatory control. Its application in treatment of allergic rhinitis has not been previously studied. This study assesses the subjective and clinical response to budesonide buffered hypertonic saline nasal irrigation and hypertonic saline nasal irrigation in patients with allergic rhinitis.

Study design: This is a prospective, single-center, double-blind, randomized placebo-controlled trial.

Setting: Tertiary care hospital.

Subjects and methods: Fifty-two patients diagnosed with allergic rhinitis were randomized into 2 groups to receive either buffered hypertonic saline nasal irrigation with a placebo respule or buffered hypertonic saline nasal irrigation with a budesonide respule. Patients were assessed at baseline and 4 weeks subjectively using the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire and visual analog scale (VAS). Clinical assessment was done using the modified Lund-Kennedy score.

Results: The average SNOT-22, VAS, and modified Lund-Kennedy scores improved in both groups (P < .001). The budesonide irrigation group was found to have significantly better improvement than the saline nasal irrigation group with the SNOT-22 scores (P = .012) and VAS scores (P = .007). However, the difference in the clinical response between the 2 groups was not significant (P = .268).

Conclusion: This study adds evidence to the use of saline nasal irrigation in allergic rhinitis but also demonstrates efficacy of the addition of budesonide to irrigations. Budesonide nasal irrigation thus appears to be a viable treatment option for allergic rhinitis.

Keywords: allergic rhinitis; budesonide; corticosteroid; hypertonic saline; nasal lavage.

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57
PLoS One
. 2020 Jul 6;15(7):e0235069. doi: 10.1371/journal.pone.0235069. eCollection 2020.
Nomogram for Pneumonia Prediction Among Children and Young People With Cerebral Palsy: A Population-Based Cohort Study
Tsu Jen Kuo 1 2 3, Chiao-Lin Hsu 4 5 6, Pei-Hsun Liao 7 8, Shih-Ju Huang 9, Yao-Min Hung 10 11 12 13, Chun-Hao Yin 14
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PMID: 32628682 DOI: 10.1371/journal.pone.0235069
Free article
Abstract
Background: Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP.

Methods: This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia.

Results: Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance.

Conclusions: The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.

Conflict of interest statement
The authors have declared that no competing interests exist.

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58
PLoS One
. 2020 Apr 17;15(4):e0227582. doi: 10.1371/journal.pone.0227582. eCollection 2020.
Constitutive Hydrogen Inhalation Prevents Vascular Remodeling via Reduction of Oxidative Stress
Takeshi Kiyoi 1 2, Shuang Liu 1, Erika Takemasa 1, Hirotomo Nakaoka 3, Naohito Hato 4, Masaki Mogi 1
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PMID: 32302306 PMCID: PMC7164592 DOI: 10.1371/journal.pone.0227582
Free PMC article
Abstract
Molecular hydrogen is thought to have an inhibitory effect on oxidative stress, thereby attenuating the onset and progression of various diseases including cardiovascular disease; however, few reports have assessed the preventive effect of constitutive inhalation of hydrogen gas on of vascular remodeling. Here, we investigated the effect of constitutive inhalation of hydrogen gas on vascular neointima formation using a cuff-induced vascular injury mouse model. After constitutive inhalation of compressed hydrogen gas (O2 21%, N2 77.7%, hydrogen 1.3%) or compressed air only (O2 21%, N2 79%) by C57BL/6 mice for 2 weeks from 8 weeks of age in a closed chamber, inflammatory cuff injury was induced by polyethylene cuff placement around the femoral artery under anesthesia, and hydrogen gas administration was continued until sampling of the femoral artery. Neointima formation, accompanied by an increase in cell proliferation, was significantly attenuated in the hydrogen group compared with the control group. NADPH oxidase NOX1 downregulation in response to cuff injury was shown in the hydrogen group, but the expression levels of NADPH oxidase subunits, p40phox and p47phox, did not differ significantly between the hydrogen and control groups. Although the increase in superoxide anion production did not significantly differ between the hydrogen and control groups, DNA damage was decreased as a result of reduction of reactive oxygen species such as hydroxyl radical (⋅OH) and peroxynitrite (ONOO-) in the hydrogen group. These results demonstrate that constitutive inhalation of hydrogen gas attenuates vascular remodeling partly via reduction of oxidative stress, suggesting that constitutive inhalation of hydrogen gas at a safe concentration in the living environment could be an effective strategy for prevention of vascular diseases such as atherosclerosis.

Conflict of interest statement
The authors have declared that no competing interests exist.

36 references6 figures
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59
Comparative Study J Laryngol Otol
. 2020 May;134(5):398-403. doi: 10.1017/S0022215120000821. Epub 2020 Apr 20.
A Comparison Between Endoscopic and Microscopic Approaches for Stapes Surgery: A Systematic Review
H F Pauna 1, R C Pereira 2, R C Monsanto 3, M S A Amaral 1, M A Hyppolito 1
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PMID: 32308176 DOI: 10.1017/S0022215120000821
Abstract
Objectives: To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery.

Methods: Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results.

Results: Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques.

Conclusion: Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.

Keywords: Endoscopes; Otosclerosis; Stapes Mobilization; Stapes Surgery.

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60
Clin Exp Otorhinolaryngol
. 2020 Jul 7. doi: 10.21053/ceo.2019.01900. Online ahead of print.
Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study
Eui-Suk Sung 1, Hyun-Keun Kwon 1, Sung-Chan Shin 2, Young-Il Cheon 2, Jung-Woo Lee 2, Da-Hee Park 1, Seong-Wook Choi 1, Hwa-Bin Kim 2, Hye-Jin Park 2, Jin-Choon Lee 1, Jung-Hoon Ro 3, Byung-Joo Lee 2
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PMID: 32623851 DOI: 10.21053/ceo.2019.01900
Free article
Abstract
Objectives: Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy.

Methods: We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity.

Results: The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG.

Conclusion: The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.

Keywords: Electromyography; Facial Nerve; Intraoperative Neurophysiological Monitoring; Parotidectomy; Surface Pressure Sensor.

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61
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):926-932. doi: 10.1177/0194599820911707. Epub 2020 Mar 17.
Influence of Age at Cochlear Implantation and Frequency-to-Place Mismatch on Early Speech Recognition in Adults
Michael W Canfarotta 1, Brendan P O'Connell 1, Emily Buss 1, Harold C Pillsbury 1, Kevin D Brown 1, Margaret T Dillon 1
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PMID: 32178574 DOI: 10.1177/0194599820911707
Abstract
Objective: Default frequency filters of cochlear implant (CI) devices assign frequency information irrespective of intracochlear position, resulting in varying degrees of frequency-to-place mismatch. Substantial mismatch negatively influences speech recognition in postlingually deafened CI recipients, and acclimatization may be particularly challenging for older adults due to effects of aging on the auditory pathway. The present report investigated the influence of mismatch and age at implantation on speech recognition within the initial 6 months of CI use.

Study design: Retrospective review.

Setting: Tertiary referral center.

Subjects and methods: Forty-eight postlingually deafened adult CI recipients of lateral wall electrode arrays underwent postoperative computed tomography to determine angular insertion depth of each electrode contact. Frequency-to-place mismatch was determined by comparing spiral ganglion place frequencies to default frequency filters. Consonant-nucleus-consonant (CNC) scores in the CI-alone condition at 1, 3, and 6 months postactivation were compared to the degree of mismatch at 1500 Hz and age at implantation.

Results: Younger adult CI recipients experienced more rapid growth in speech recognition during the initial 6 months postactivation. Greater degrees of frequency-to-place mismatch were associated with poorer performance, yet older listeners were not particularly susceptible to this effect.

Conclusions: While older adults are not necessarily more sensitive to detrimental effects of frequency-to-place mismatch, other factors appear to limit early benefit with a CI in this population. These results suggest that minimizing mismatch could optimize outcomes in adult CI recipients across the life span, which may be particularly beneficial in the elderly considering auditory processing deficits associated with advanced age.

Keywords: age; cochlear implant; frequency-to-place mismatch; speech recognition.

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62
Curr Opin Otolaryngol Head Neck Surg
. 2020 Aug;28(4):195-200. doi: 10.1097/MOO.0000000000000643.
The Science of Art: Leonardo Da Vinci and Facial Plastic Surgery
David A Shaye 1
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PMID: 32628412 DOI: 10.1097/MOO.0000000000000643
Abstract
Purpose of review: Leonardo Da Vinci possessed one of humanity's greatest minds, known for exploring the boundaries of art and science. The discipline of facial plastic surgery also relies on art and science for its advancement. This review focuses on key elements of Leonardo Da Vinci's work, and how they relate to concepts within facial plastic surgery.

Recent findings: Leonardo Da Vinci was a self-taught creative genius. Common themes that permeated his art were those of proportion, perspective, light and shadow, anatomy, and science. These principles are reflected in key aspects of facial plastic surgery, such as facial analysis, human gaze, facial subunits, surgery of the craniofacial skeleton, and evidence-based medicine.

Summary: Leonardo Da Vinci's approach to scientific inquiry and artistic beauty strikes a balance from which facial plastic surgeons have much to learn. In depth study of how Leonardo Da Vinci viewed the world furthers the analytical and creative sides of a facial plastic surgeon as well as informs their personal development.

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63
Autophagy
. 2020 Jul 5;1-17. doi: 10.1080/15548627.2020.1781368. Online ahead of print.
MIR106A-5p Upregulation Suppresses Autophagy and Accelerates Malignant Phenotype in Nasopharyngeal Carcinoma
Qingwen Zhu 1 2, Qicheng Zhang 1 2, Miao Gu 1 2, Kaiwen Zhang 1 2, Tian Xia 1 2, Siyu Zhang 1 2, Wenhui Chen 1 2, Haimeng Yin 1 2, Hui Yao 1 2, Yue Fan 1 2, Si Pan 1 2, Haijing Xie 1 2, Huiting Liu 1 2, Tianyi Cheng 1 2, Panpan Zhang 1 2, Ting Zhang 1 2, Bo You 1 2, Yiwen You 1 2
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PMID: 32627648 DOI: 10.1080/15548627.2020.1781368
Abstract
Dysregulated microRNAs (miRNAs) are involved in carcinoma progression, metastasis, and poor prognosis. We demonstrated that in nasopharyngeal carcinoma (NPC), transactivated MIR106A-5p promotes a malignant phenotype by functioning as a macroautophagy/autophagy suppressor by targeting BTG3 (BTG anti-proliferation factor 3) and activating autophagy-regulating MAPK signaling. MIR106A-5p expression was markedly increased in NPC cases based on quantitative real-time PCR, miRNA microarray, and TCGA database analysis findings. Moreover, MIR106A-5p was correlated with advanced stage, recurrence, and poor clinical outcomes in NPC patients. In addition to three-dimensional cell culture assays, zebrafish and BALB/c mouse tumor models revealed that overexpressed MIR106A-5p targeted BTG3 and accelerated the NPC malignant phenotype by inhibiting autophagy. BTG3 promoted autophagy, and its expression was correlated with poor prognosis in NPC. Attenuation of autophagy, mediated by the MIR106A-5p-BTG3 axis, occurred because of MAPK pathway activation. MIR106A-5p overexpression in NPC was due to increased transactivation by EGR1 and SOX9. Our findings may lead to novel insights into the pathogenesis of NPC.

Abbreviations: ACTB: actin beta; ATG: autophagy-related; ATG5: autophagy related 5; BLI: bioluminescence; BTG3: BTG anti-proliferation factor 3; CASP3: caspase 3; ChIP: chromatin immunoprecipitation; CQ: chloroquine; Ct: threshold cycle; DAPI: 4',6-diamidino-2-phenylindole; DiL: 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate; EBSS: Earle's balanced salt solution; EGR1: early growth response 1; GAPDH: glyceraldehyde-3-phosphate dehydrogenase; GEO: Gene Expression Omnibus; GFP: green fluorescent protein; IF: immunofluorescence; IHC: immunohistochemistry; ISH: in situ hybridization; MAP1LC3B: microtubule associated protein 1 light chain 3 beta; MIR106A-5p: microRNA 106a-5p; miRNAs: microRNAs; MKI67: marker of proliferation ki-67; mRNA: messenger RNA; MTOR: mechanistic target of rapamycin kinase; NPC: nasopharyngeal carcinoma; qRT-PCR: quantitative real-time PCR; siRNA: small interfering RNA; SOX9: SRY-box transcription factor 9; SQSTM1: sequestosome 1; TCGA: The Cancer Genome Atlas; WB: western blot.

Keywords: MIR106A-5p; Autophagy; BTG3; malignant phenotype; nasopharyngeal carcinoma.

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64
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):950-953. doi: 10.1177/0194599820912034. Epub 2020 Mar 24.
Pilot Study to Assess the Use of Ultrasound in Evaluating the Abnormal Pediatric Airway
Jason R Bell 1, Aliza P Cohen 1, Justin T Graff 2, Robert J Fleck 3, Sally O'Hara 3, Alessandro de Alarcon 1, Catherine K Hart 1
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PMID: 32204669 DOI: 10.1177/0194599820912034
Abstract
In this study, we sought to explore the feasibility of using ultrasonography to evaluate airway anomalies in awake children with previous airway reconstruction. For the month of December 2018, we reviewed the medical records of patients aged <18 years old with prior airway reconstruction who had an outpatient appointment and a microlaryngoscopy and bronchoscopy within 24 hours of each other. Four patients met inclusion criteria and were enrolled. Sonographic airway images and measurements were obtained during the outpatient appointment and compared with those obtained during endoscopy. Ultrasound identified extraluminal stents and glottic, subglottic, and tracheal pathology. Subglottic measurements obtained sonographically were within 0.1 to 0.5 mm of the outer diameter of the appropriate endotracheal tubes. Ultrasound did not visualize tracheotomy tubes or posterolateral pathology. Our findings lay the foundation for expanding the role of ultrasound in pediatric airway assessment, keeping in mind its apparent inability to visualize posterolateral airway pathology.

Keywords: airway reconstruction; pediatric airway; ultrasound.

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65
J Laryngol Otol
. 2020 May;134(5):419-423. doi: 10.1017/S0022215120000997. Epub 2020 May 19.
Framingham Risk Score Is Associated With Hearing Outcomes in Patients With Idiopathic Sudden Sensorineural Hearing Loss
Y-S Chang 1, S Park 1, M K Lee 1, Y C Rah 1, J Choi 1
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PMID: 32425141 DOI: 10.1017/S0022215120000997
Abstract
Objective: To assess the Framingham risk score as a prognostic tool for idiopathic sudden sensorineural hearing loss patients.

Methods: Medical records were reviewed for unilateral idiopathic sudden sensorineural hearing loss patients between January 2010 and October 2017. The 10-year risk of developing cardiovascular disease was calculated. Patients were subdivided into groups: group 1 - Framingham risk score of less than 10 per cent (n = 28); group 2 - score of 10 to less than 20 per cent (n = 6); and group 3 - score of 20 per cent or higher (n = 5).

Results: Initial pure tone average and Framingham risk score were not significantly associated (p = 0.32). Thirteen patients in group 1 recovered completely (46.4 per cent), but none in groups 2 and 3 showed complete recovery. Initial pure tone average and Framingham risk score were significantly associated in multivariable linear regression analysis (R2 = 0.36). The regression coefficient was 0.33 (p = 0.003) for initial pure tone average and -0.67 (p = 0.005) for Framingham risk score.

Conclusion: Framingham risk score may be useful in predicting outcomes for idiopathic sudden sensorineural hearing loss patients, as those with a higher score showed poorer hearing recovery.

Keywords: Hearing Loss, Sudden; Risk Assessment; Steroids; Treatment Outcome.

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66
Laryngoscope
. 2020 Jul 6. doi: 10.1002/lary.28884. Online ahead of print.
Disruption of Sinonasal Epithelial Nrf2 Enhances Susceptibility to Rhinosinusitis in a Mouse Model
Murugappan Ramanathan Jr 1, Anuj Tharakan 1, Venkataramana K Sidhaye 2 3, Andrew P Lane 1, Shyam Biswal 3, Nyall R London Jr 1
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PMID: 32628788 DOI: 10.1002/lary.28884
Abstract
Objectives/hypothesis: Oxidative stress has been postulated to play an important role in chronic rhinosinusitis. Nrf2 is a transcription factor that is involved in the regulation of multiple antioxidant genes, and its function has been previously shown to be important in sinonasal inflammation. Although the sinonasal implications of whole body Nrf2-/- has been reported, the function of sinonasal epithelial expression of Nrf2 has not been studied. The primary aim of this study was to generate a mouse model that is genetically deficient in epithelial-specific Nrf2 and to understand its role in regulating sinonasal inflammation.

Study design: Basic science.

Methods: An epithelial-specific Nrf2 knockout mouse was generated by crossing Krt5-cre(K5) with Nrf2flox/flox . A papain-induced model of rhinosinusitis was performed in the resulting K5 Nrf2-/- mouse. Immunohistochemistry was performed to quantify goblet cell hyperplasia. Mucosal cellular infiltrates were quantified using flow cytometry, and tissue cytokines were measured using an enzyme-linked immunosorbent assay. Lastly, the cellular source of type 2 cytokines was determined using intracellular cytokine staining.

Results: Papain-sensitized mice lacking epithelial-specific Nrf2 demonstrate increased goblet cell hyperplasia, significant tissue eosinophilia, and statistically significant increase in mucosal IL-13 when compared to Nrf2 wild-type mice. Lastly, mucosal T cells were identified as the cellular source of IL-13.

Conclusions: We demonstrate enhanced severity of eosinophilic sinonasal inflammation from disruption of the epithelial-specific Nrf2 pathway. The responsiveness of Nrf2-directed antioxidant pathways may act as a major determinant of susceptibility to eosinophilic inflammation and may have potential as a therapeutic target for chronic rhinosinusitis.

Level of evidence: NA Laryngoscope, 2020.

Keywords: Nrf2; chronic rhinosinusitis; epithelial; mouse model; sinonasal.

© 2020 The American Laryngological, Rhinological and Otological Society, Inc.

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67
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):905-913. doi: 10.1177/0194599820921404. Epub 2020 May 12.
Subglottic Stenosis: Development of a Clinically Relevant Endoscopic Animal Model
Leila J Mady 1, Matthew Criado 2, James Park 3, Khalil Baddour 1, Ali Mubin Aral 4, Abhijit Roy 5, Lora Heather Rigatti 6, Prashant N Kumta 7, David H Chi 8
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PMID: 32393104 DOI: 10.1177/0194599820921404
Abstract
Objective: Develop a clinically relevant and reproducible endoscopic animal model for subglottic stenosis amenable to testing of minimally invasive therapeutic modalities.

Study design: Cohort study.

Setting: Division of Laboratory Animals Research, University of Pittsburgh.

Subjects and methods: Subglottic stenosis was induced endoscopically via microsuspension laryngoscopy in 26 New Zealand white rabbits. A trimmed polypropylene brush connected to a novel electronic stenosis induction apparatus was used to create circumferential trauma to the subglottis. By using open source image analysis software, the cross-sectional areas of the stenotic and native airways were compared to calculate the percentage of stenosis and the Myer-Cotton classification grade.

Results: Of the 26 rabbits, 24 (92%) exhibited stenosis after the first attempt. The mean percentage of airway stenosis was 57% (range, 34%-85%; SD, 15%). Five rabbits (19.2%) died on the day of stenosis induction from procedural complications. Of the 21 rabbits, 2 demonstrated no stenosis 7 days after initial injury and so underwent reinduction of airway injury, upon which they developed stenosis. Overall, 14 of the 21 rabbits (67%) exhibited moderate to severe stenosis (grade 2 or 3).

Conclusion: The stenosis induction apparatus reliably induced stenosis with a low mortality rate as compared with that of other methods in the literature. The device could be improved to generate a predetermined potentially reproducible grade of stenosis as desired by the operator. This method sets the stage for a clinically relevant and reproducible subglottic stenosis disease model that is amenable to testing of minimally invasive treatment modalities.

Keywords: animal model; endoscopic; minimally invasive; pediatric; rabbit; subglottic stenosis.

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68
Eur J Ophthalmol
. 2020 Jul 6;1120672120941433. doi: 10.1177/1120672120941433. Online ahead of print.
Orbital Anatomical Parameters Affecting Outcome of Deep Lateral Orbital Wall Decompression
Mohammad Taher Rajabi 1, Mohammadreza Tabary 1, SeyedMahbod Baharnoori 1, Mirataollah Salabati 1, Raziyeh Mahmoudzadeh 1, Farideh Hosseinzadeh 2, S Saeed Mohammadi 1, Robert A Goldberg 3
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PMID: 32627588 DOI: 10.1177/1120672120941433
Abstract
Purpose: To determine orbital anatomical parameters that affect surgical outcome of deep lateral orbital wall decompression.

Methods: Twenty orbits of 20 patients with moderate proptosis (maximum 25 mm) due to thyroid eye disease who were stable for at least 6 months were included in this prospective cohort study. Four parameters including lateral orbital wall distance (LOWD), removable surface area (RSA), removable surface length (RSL), and sphenoid door jamb thickness (SDJ) were evaluated by computed tomography (CT) scan prior to surgery in these patients. Deep lateral orbital wall decompression without fat removal was done in all patients. Relationship between all these factors and proptosis reduction, 6 months after surgery was assessed.

Results: Mean proptosis before decompression surgery (mean ± SD) was 23.22 ± 1.19 mm and reduction in Hertel exophthalmometry (mean ± SD) was -3.27 ± 1.03 mm (p = 0.006). Pearson correlation showed that LOWD, RSL, and SDJ had statistically significant correlation with proptosis reduction (p = 0.017, 0.002, and 0.001, respectively.). Linear multivariate regression analysis showed SDJ as the only independent factor in predicting surgical outcome.

Conclusion: several orbital anatomical factors have significant role in predicting surgical outcome following deep lateral wall orbital decompression. Among these parameters, SDJ is an independent factor, whereas LOWD and RSL are dependent factors. Preoperative assessment of the bony sphenoid anatomy may be helpful in predicting the amount of potential decompression.

Keywords: Deep lateral decompression; lateral orbital wall distance; removable surface area; removable surface length; sphenoid door jamb thickness.

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69
J Laryngol Otol
. 2020 May;134(5):453-457. doi: 10.1017/S0022215120000328. Epub 2020 Apr 20.
The Effect of Bleeding on Children's Haemodynamic Indices: An Analysis of Previous Post-Tonsillectomy Bleeding Cases
O Ronen 1 2, E Sela 1 2, L Degabli 2
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PMID: 32308159 DOI: 10.1017/S0022215120000328
Abstract
Objective: Post-surgical bleeding after tonsillectomy occurs in 2-7 per cent of cases. This study examined whether heart rate and haematocrit changes are associated with the amount of bleeding.

Method: In this retrospective analytical study, data were collected from the medical charts of patients admitted with post-surgical bleeding.

Results: Over the course of 10 years, there were 218 cases of post-operative bleeding in children aged under 18 years. There was a significant increase in heart rate after the bleeding had started, and a significant decrease in both haemoglobin and haematocrit levels (p < 0.05). There was no significant correlation between the differences in haemoglobin and haematocrit and changes in heart rate.

Conclusion: No correlation was found between the differences in haemoglobin and haematocrit levels and the changes in heart rate from before the surgery to after the bleeding had started. The monitoring of paediatric patients' heart rate after tonsillectomy surgery solely for the purpose of predicting acute blood loss is therefore discouraged.

Keywords: Children; Hemorrhage; Postoperative Adenoidectomy; Pulse; Tachycardia; Tonsillectomy.

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70
Multicenter Study Otolaryngol Head Neck Surg
. 2020 Jun;162(6):860-866. doi: 10.1177/0194599820913495. Epub 2020 Mar 24.
Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits
Kevin Hur 1 2, Joseph Gibbons 3, Brian Karl Finch 4
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PMID: 32204646 DOI: 10.1177/0194599820913495
Abstract
Objective: To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists.

Study design: Retrospective cross-sectional analysis.

Setting: United States.

Subject and methods: Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics.

Results: There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county's disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space.

Conclusions: There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.

Keywords: CPT; Medicare; geographic disparities; geographic weighted regression; health disparities; health services; healthcare utilization; new patient visits; spatial science.

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71
Curr Opin Otolaryngol Head Neck Surg
. 2020 Aug;28(4):201-205. doi: 10.1097/MOO.0000000000000640.
Gender Affirming and Aesthetic Cranioplasty: What's New?
Jeffrey H Spiegel 1
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PMID: 32628413 DOI: 10.1097/MOO.0000000000000640
Abstract
Purpose of review: Esthetic cranioplasty is an important part of facial feminization surgery. Additionally, it is an often underappreciated procedure for facial beautification. This chapter reviews current trends in esthetic cranioplasty for transgender women and others. Valuable techniques and innovations that do not advance the field are reviewed.

Recent findings: Although promoted in recent literature, among the key concepts discussed in this review are the limitations of cutting guides, the rare indications for preoperative imaging, and when burring the glabellar area is appropriate rather than doing a full osteoplastic flap setback.

Summary: Forehead feminization cranioplasty is a highly dependent upon the surgeon's artistic ability. Modeling and guides are potentially helpful for the novice surgeon but better is to learn appropriate anatomy for a more refined result.

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72
Case Reports J Oral Maxillofac Surg
. 2020 Jun 10;S0278-2391(20)30583-8. doi: 10.1016/j.joms.2020.06.009. Online ahead of print.
Microvascular Reconstruction of Total Maxillary Avascular Necrosis as a Complication of Routine Orthognathic Surgery
Kyle S Ettinger 1, John Nathan 2, Lidia M Guerrero 3, Thomas J Salinas 4, Kevin Arce 5
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PMID: 32628933 DOI: 10.1016/j.joms.2020.06.009
Abstract
Severe complications and morbidity after orthognathic surgery are infrequently encountered and have been even more infrequently reported considering the extent to which this procedure is performed by surgeons within the specialty of maxillofacial surgery. Avascular necrosis of the maxilla after Le Fort I osteotomy is perhaps the most dreaded outcome of orthognathic surgery. However, it accounts for an extremely small subset of overall surgical complications. The reported risk factors associated with avascular maxillary necrosis include segmental osteotomies, vertical posterior impactions, large transverse expansions, anterior advancements exceeding 9 to 10 mm, an improper surgical technique, excessive soft tissue degloving of the maxilla, intraoperative hemorrhage, perforation or laceration of the palatal soft tissue pedicle, previous maxillary or palatal surgery, and other medical comorbidities. Although anecdotal cases of total maxillary necrosis after orthognathic surgery have been alluded to within the specialty as a whole, to the best of our knowledge, no previous studies have reported total maxillary necrosis occurring after routine orthognathic surgery. We have presented a truly unique case of total maxillary avascular necrosis that occurred after standard 1-piece Le Fort I osteotomy in a patient without medical or surgical risk factors for the complication either known preoperatively or identified postoperatively. The resultant maxillary defect from total avascular necrosis was comprehensively treated with surgical debridement of the nonviable maxilla, osteocutaneous fibular free flap reconstruction, staged endosseous implant reconstruction of the neomaxilla, and comprehensive prosthodontic rehabilitation.

Copyright © 2020. Published by Elsevier Inc.

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73
Curr Opin Otolaryngol Head Neck Surg
. 2020 Aug;28(4):212-217. doi: 10.1097/MOO.0000000000000631.
Optimizing Septal Perforation Repair Techniques
Raj D Dedhia 1, Seth J Davis, Scott J Stephan
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PMID: 32628414 DOI: 10.1097/MOO.0000000000000631
Abstract
Purpose of review: Multiple successful techniques and approaches for nasal septal perforation repair have been described, yet consistency in perforation and outcome metrics is required to identify the optimal approach to repair. The present article will review the recent literature.

Recent findings: Computational fluid dynamic studies continue to expand our understanding of the airflow dynamics in nasal septal perforation and after repair. Combining rhinoplasty and nasal septal perforation repair in appropriately selected patients can be safely done with excellent results. There has been a rise in utilization of a temporoparietal fascia with polydiaxonone plate construct for septal perforation repair with excellent outcomes.

Summary: The present review provides the reconstructive surgeon with an update on nasal septal perforation repair and describes a recently popularized technique of temporoparietal fascia-polydiaxonone plate for perforation reconstruction.

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74
Eur J Cancer
. 2020 Jul 3;136:35-42. doi: 10.1016/j.ejca.2020.05.013. Online ahead of print.
Prognostic Nomogram in Patients With Metastatic Adenoid Cystic Carcinoma of the Salivary Glands
Stefano Cavalieri 1, Luigi Mariani 2, Vincent Vander Poorten 3, Laure Van Breda 3, Maria C Cau 4, Salvatore Lo Vullo 2, Salvatore Alfieri 5, Carlo Resteghini 5, Cristiana Bergamini 5, Ester Orlandi 6, Giuseppina Calareso 7, Paul Clement 8, Esther Hauben 9, Francesca Platini 5, Paolo Bossi 5, Lisa Licitra 10, Laura D Locati 5
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PMID: 32629365 DOI: 10.1016/j.ejca.2020.05.013
Abstract
Background: Distant metastases in adenoid cystic carcinoma (ACC) are common. There is no consensus on the management of metastatic disease because no therapeutic approach has demonstrated improvement in overall survival (OS) and because of prolonged life expectancy. The aim of this study is to build and validate a prognostic nomogram for metastatic ACC patients.

Methods: The study end-point was OS, measured from the date of first metastatic presentation to death/last follow-up. A retrospective analysis including metastatic ACC patients was performed to build the prognostic nomogram at the INT (Milan, Italy). The model was validated on an independent cohort of patients with similar characteristics treated at Leuven (Belgium). Outcome data and covariates were modelled by resorting to a random forest method. This machine-learning approach was used to guide and benchmark the subsequent use of more conventional modelling methods. Cox model performance was assessed in terms of discrimination (Harrell's c-index).

Results: Two hundred ninety-eight patients with metastatic ACC (testing set 259 INT, validation set 39 Leuven) were studied. Akaike Information Criterion-based backward selection yielded a 5-factor model showing a bias-corrected c-index of 0.730. Five independent prognostic factors were found: gender, disease-free interval and presence of lung, liver or bone metastases. Nomogram discrimination in the validation series was c = 0.701.

Conclusion: This retrospective analysis allowed the building of an externally validated prognostic nomogram. This tool might help clinicians to discriminate patients requiring prompt management from who can benefit from a 'watchful waiting'. In addition, the nomogram might be useful to stratify patients in clinical trials.

Keywords: Adenoid cystic carcinoma; Nomogram; Prognosis; Salivary gland cancer.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Conflict of interest statement
Conflict of interest statement L.D.L. declares grant and other financial relationship with Biogen, Eisai, Ipsen, Lilly, Merck Serono, MSD and BMS. P.B. is on advisory board of Merck, Sanofi, Merck Sharp & Dohme, Sun Pharma, Angelini, AstraZeneca, Bristol-Myers Squibb, Helsinn and received conference honoraria from Bristol-Myers Squibb, Kyowa Hakko Kirin, Angelini, Sanofi, Roche, GSK. L.L. has received funding (for her Institution) for clinical studies and research from AstraZeneca, Boehringer Ingelheim, Eisai, Merck Serono, MSD, Novartis and Roche; has received compensation for service as a consultant/advisor and/or for lectures from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Debiopharm, Eisai, Merck Serono, MSD, Novartis, Roche and Sobi and she has received travel coverage for medical meetings from Bayer, Bristol-Myers Squibb, Debiopharm, Merck Serono, MSD and Sobi. The remaining authors declare no conflict of interest.

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75
Clin Exp Otorhinolaryngol
. 2020 Jul 7. doi: 10.21053/ceo.2019.01921. Online ahead of print.
Cluster Analysis of Inhalant Allergens in South Korea: A Computational Model of Allergic Sensitization
Dong-Kyu Kim 1, Young-Sun Park 2, Kyung-Joon Cha 2, Daeil Jang 2, Seungho Ryu 3, Kyung Rae Kim 4, Sang-Heon Kim 5, Ho Joo Yoon 5, Seok Hyun Cho 4
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PMID: 32623852 DOI: 10.21053/ceo.2019.01921
Free article
Abstract
Objectives: Sensitization to specific inhalant allergens is a major risk factor for the development of atopic diseases, which impose a major socioeconomic burden and significantly diminish quality of life. However, patterns of inhalant allergic sensitization have yet to be precisely described. Therefore, to enhance the understanding of aeroallergens, we performed a cluster analysis of inhalant allergic sensitization using a computational model.

Methods: Skin prick data were collected from 7,504 individuals. A positive skin prick response was defined as an allergen-to-histamine wheal ratio ≥1. To identify the clustering of inhalant allergic sensitization, we performed computational analysis using the four-parameter unified-Richards model.

Results: Hierarchical cluster analysis grouped inhalant allergens into three clusters based on the Davies-Bouldin index (0.528): cluster 1 (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cluster 2 (mugwort, cockroach, oak, birch, cat, and dog), and cluster 3 (Alternaria tenus, ragweed, Candida albicans, Kentucky grass, and meadow grass). Computational modeling revealed that each allergen cluster had a different trajectory over the lifespan. Cluster 1 showed a high level (>50%) of sensitization at an early age (before 19 years), followed by a sharp decrease in sensitization. Cluster 2 showed a moderate level (10%-20%) of sensitization before 29 years of age, followed by a steady decrease in sensitization. However, cluster 3 revealed a low level (<10%) of sensitization at all ages.

Conclusion: Computational modeling suggests that allergic sensitization consists of three clusters with distinct patterns at different ages. The Results of this study will be helpful to allergists in managing patients with atopic diseases.

Keywords: Allergen; Cluster Analysis; Computational Biology; Skin Test.

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76
J Laryngol Otol
. 2020 May;134(5):409-414. doi: 10.1017/S0022215120000973. Epub 2020 May 19.
An Intact Bony Tympanic Facial Canal Does Not Protect From Secondary Facial Paresis in Adult Acute Otitis Media
C Meerwein 1, S Pazahr 2, T M Stadler 1, N Nierobisch 2, A Dalbert 1, A Huber 1, C Röösli 1
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PMID: 32425144 DOI: 10.1017/S0022215120000973
Abstract
Objective: To investigate the prevalence of bony dehiscence in the tympanic facial canal in patients with acute otitis media with facial paresis compared to those without facial paresis.

Method: A retrospective case-control study was conducted on acute otitis media patients with facial paresis undergoing high-resolution temporal bone computed tomography.

Results: Forty-eight patients were included (24 per group). Definitive determination of the presence of a bony dehiscence was possible in 44 out of 48 patients (91.7 per cent). Prevalence of bony dehiscence in acute otitis media patients with facial paresis was not different from that in acute otitis media patients without facial paresis (p = 0.21). Presence of a bony dehiscence was associated with a positive predictive value of 66.7 per cent in regard to development of facial paresis. However, an intact bony tympanic facial canal did not prevent facial paresis in 44.8 per cent of cases (95 per cent confidence interval = 34.6-55.6).

Conclusion: Prevalence of bony dehiscence in acute otitis media patients with facial paresis did not differ from that in acute otitis media patients without facial paresis. An intact tympanic bony facial canal does not protect from facial paresis development.

Keywords: Computed Tomography; Facial Paralysis; Otitis Media; Retrospective Studies; Temporal Bone; X-Ray.

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77
Ann Otol Rhinol Laryngol
. 2020 Jul 4;3489420937036. doi: 10.1177/0003489420937036. Online ahead of print.
Cryptococcal Anterior Glottic Web From Disseminated Infection Presenting as Confusion: A Case Report
Erica Haught 1, Christopher Roberts 2, Jason McChesney 2
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PMID: 32627566 DOI: 10.1177/0003489420937036
Abstract
Objectives: To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient's disease burden.

Methods: An extensive review of the patient's clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications.

Results: Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient.

Conclusion: Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.

Keywords: Cryptococcus; glottic stenosis; glottic web; hoarseness.

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78
Biochem Biophys Res Commun
. 2020 Jan 1;521(1):72-76. doi: 10.1016/j.bbrc.2019.10.075. Epub 2019 Oct 16.
3-Benzyl-5-((2-nitrophenoxy) methyl)-dihydrofuran-2(3H)-one Suppresses FcεRI-mediated Mast Cell Degranulation via the Inhibition of mTORC2-Akt Signaling
Valeriya Rakhmanova 1, Sukyoung Park 1, Sungwook Lee 2, Young Hyo Kim 3, Jinwook Shin 4
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PMID: 31629474 DOI: 10.1016/j.bbrc.2019.10.075
Abstract
Mast cells express high-affinity IgE receptor (FcεRI) on their surface, cross-linking of which leads to the immediate release of proinflammatory mediators such as histamine but also late-phase cytokine secretion, which are central to the pathogenesis of allergic diseases. Despite the growing evidences that mammalian target of rapamycin (mTOR) plays important roles in the immune system, it is still unclear how mTOR signaling regulates mast cell function. In this study, we investigated the effects of 3-benzyl-5-((2-nitrophenoxy) methyl)-dihydrofuran-2(3H)-one (3BDO) as an mTOR agonist on FcεRI-mediated allergic responses of mast cells. Our data showed that administration of 3BDO decreased β-hexosaminidase, interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α) release in murine bone marrow-derived mast cells (BMMCs) after FcεRI cross-linking, which was associated with an increase in mTOR complex 1 (mTORC1) signaling but a decrease in activation of Erk1/2, Jnk, and mTORC2-Akt. In addition, we found that a specific Akt agonist, SC79, is able to fully restore the decrease of β-hexosaminidase release in 3BDO-treated BMMCs but has no effect on IL-6 release in these cells, suggesting that 3BDO negatively regulates FcεRI-mediated degranulation and cytokine release through differential mechanisms in mast cells. The present data demonstrate that proper activation of mTORC1 is crucial for mast cell effector function, suggesting the applicability of the mTORC1 activator as a useful therapeutic agent in mast cell-related diseases.

Keywords: 3BDO; Activation; Akt; Mast cells; mTOR.

Copyright © 2019 Elsevier Inc. All rights reserved.

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79
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):922-925. doi: 10.1177/0194599820907866. Epub 2020 Mar 17.
Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery
Samuel R Barber 1, Saurabh Jain 2, Michael A Mooney 3, Kaith K Almefty 3, Michael T Lawton 3, Young-Jun Son 2, Shawn M Stevens 3 4
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PMID: 32180502 DOI: 10.1177/0194599820907866
Abstract
Mastery of lateral skull base (LSB) surgery requires thorough knowledge of complex, 3-dimensional (3D) microanatomy and techniques. While supervised operation under binocular microscopy remains the training gold standard, concerns over operative time and patient safety often limit novice surgeons' stereoscopic exposure. Furthermore, most alternative educational resources cannot meet this need. Here we present proof of concept for a tool that combines 3D-operative video with an interactive, stereotactic teaching environment. Stereoscopic video was recorded with a microscope during translabyrinthine approaches for vestibular schwannoma. Digital imaging and communications in medicine (DICOM) temporal bone computed tomography images were segmented using 3D-Slicer. Files were rendered using a game engine software built for desktop virtual reality. The resulting simulation was an interactive immersion combining a 3D operative perspective from the lead surgeon's chair with virtual reality temporal bone models capable of hands-on manipulation, label toggling, and transparency modification. This novel tool may alter LSB training paradigms.

Keywords: education; lateral skull base; stereoscopic; surgical simulation; temporal bone; video; virtual reality.

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80
Editorial Hear Res
. 2020 Jun 18;108010. doi: 10.1016/j.heares.2020.108010. Online ahead of print.
Introduction to the Hearing Research Special Issue on Inner Ear Gene Therapy
Jeffrey R Holt 1, Yehoash Raphael 2
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PMID: 32624335 DOI: 10.1016/j.heares.2020.108010
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81
Front Oncol
. 2020 Jun 18;10:801. doi: 10.3389/fonc.2020.00801. eCollection 2020.
The Potential of Tumor Debulking to Support Molecular Targeted Therapies
Felix Oppel 1, Martin Görner 2, Holger Sudhoff 1
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PMID: 32626653 PMCID: PMC7314947 DOI: 10.3389/fonc.2020.00801
Free PMC article
Abstract
Tumors may consist of billions of cells, which in malignant cases disseminate and form distant metastases. The large number of tumor cells formed by the high number of cell divisions during tumor progression creates a heterogeneous set of genetically diverse tumor cell clones. For cancer therapy this poses unique challenges, as distinct clones have to be targeted in different tissue locations. Recent research has led to the development of specific inhibitors of defined targets in cellular signaling cascades which promise more effective and more tumor-specific therapy approaches. Many of these molecular targeted therapy (MTT) compounds have already been translated into clinics or are currently being tested in clinical studies. However, the outgrowth of tumor cell clones resistant to such inhibitors is a drawback that affects specific inhibitors in a similar way as classical cytotoxic chemotherapeutics, because additionally acquired genetic alterations can enable tumor cells to circumvent the particular regulators of cellular signaling being targeted. Thus, it might be desirable to reduce genetic heterogeneity prior to molecular targeting, which could reduce the statistical chance of tumor relapse initiated by resistant clones. One way to achieve this is employing unspecific methods to remove as much tumor material as possible before MTT, e.g., by tumor debulking (TD). Currently, this is successfully applied in the clinical treatment of ovarian cancer. We believe that TD followed by treatment with a combination of molecular targeted drugs, optimally guided by biomarkers, might advance survival of patients suffering from various cancer types.

Keywords: cancer genetics; cancer therapy; clonal heterogeneity; molecular targeting; precision oncology; therapy resistance.

Copyright © 2020 Oppel, Görner and Sudhoff.

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82
Ear Nose Throat J
. 2020 Jul 5;145561320936489. doi: 10.1177/0145561320936489. Online ahead of print.
Endotracheal Tube Bridle Associated With Full-Thickness Facial Necrosis and Parotid Gland Mucormycosis
Steven G Hoshal 1, Maryroz Timbang 1, Brianna N Harris 2, Morgan A Darrow 3, Arnaud F Bewley 1
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PMID: 32627585 DOI: 10.1177/0145561320936489
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