Cholesteatoma Causing a Horizontal Semicircular Canal Fistula

xlomafota13 shared this article with you from Inoreader Cholesteatoma Causing a Horizontal Semicircular Canal Fistula Via ear nose throat Ear Nose Throat J. 2021 Aug 25:1455613211040580. doi: 10.1177/01455613211040580. Online ahead of print. ABSTRACT Horizontal canal fistulas are not uncommon in patients with cholesteatoma. Patients with canal wall down cavities and exposed horizontal canal fistulas develop significant dizziness with wind or suction exposure. Obliteration of mastoid cavities in patients with exposed fistulas can be challenging. We describe a patient with horizontal canal fistula and chronic di zziness from wind exposure who underwent successful mastoid cavity obliteration with preservation of hearing. Patients with horizontal canal fistulas in a canal wall down cavity can be managed with mastoid obliteration for relief of dizziness. PMID:34428983 | DOI:10.1177/01455613211040580 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear Implant Research and Development in the Twenty-first Century: A Critical Update

xlomafota13 shared this article with you from Inoreader Cochlear Implant Research and Development in the Twenty-first Century: A Critical Update Via Journal of the Association for Research in Otolaryngology Abstract Cochlear implants (CIs) are the world's most successful sensory prosthesis and have been the subject of intense research and development in recent decades. We critically review the progress in CI research, and its success in improving patient outcomes, from the turn of the century to the present day. The review focuses on the processing, stimulation, and audiological methods that have been used to try to improve speech perception by human CI listeners, and on fundamental new insights in the response of the auditory system to electrical stimulation. The introduction of directional microphones and of new noise reduction and pre-processing algorithms has produced robust and sometimes substantial improvements. Novel speech-processing algorithms, the use of current-focusing methods, and individualised (patient-by-patient) deactivation of subsets of electrodes have produced more modest improvements. We argue that incremental advances have and will continue to be made , that collectively these may substantially improve patient outcomes, but that the modest size of each individual advance will require greater attention to experimental design and power. We also briefly discuss the potential and limitations of promising technologies that are currently being developed in animal models, and suggest strategies for researchers to collectively maximise the potential of CIs to improve hearing in a wide range of listening situations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

High DNMT1 Is Associated With Worse Local Control in Early‐Stage Laryngeal Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader High DNMT1 Is Associated With Worse Local Control in Early‐Stage Laryngeal Squamous Cell Carcinoma Via The Laryngoscope Objectives/Hypothesis Early-stage laryngeal squamous cell carcinoma (LSCC) has yielded local control rates of 75% after radiotherapy. DNA methylation, in which DNA methyltransferases play an important role, has influence on tumorigenesis. In this study, we investigated the association between the expression of DNA methyltransferase 1 (DNMT1) and local control in early-stage LSCC treated with radiotherapy. Study Design Retrospective cohort study. Methods We analyzed a well-defined homogeneous series of 125 LSCC patients treated with radiotherapy with curative intent. The association of immunohistochemical expression of DNMT1 with local control was evaluated using Cox proportional hazard regression models. Results With a median follow-up of 58 months, 29 local recurrences (23%) were observed. On univariate analysis, worse local control was associated with high DNMT1 expression (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.10–6.01). Also, higher T-stage (HR 2.48, 95% CI 1.06–5.80) and positive N-status (HR 2.62, 95% CI 1.06–6.47) were associated with worse local control. Multivariate Cox regression demonstrated that high DNMT1 (HR 2.81; 95% CI 1.20–6.58) was independently associated with worse local control. Conclusions We found an association between high DNMT1 expression and worse local control in a homogeneous well-defined cohort of early-stage LSCC patients treated with definitive radiotherapy. The association between DNA methylation status as determined by DNMT1 expression and local control suggests that DNMT1 acts as a potential prognostic tumor marker in treatment decision-making in early-stage laryngeal carcinoma. Level of evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic

xlomafota13 shared this article with you from Inoreader Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic Via The Laryngoscope Objective To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status. Study Design Retrospective cohort study. Methods This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018. Results Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71–0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976–0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64–0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979–0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98–1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25–3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75–3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99–1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not as sociated with attendance or no-shows. Conclusion Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes. Quality of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis

xlomafota13 shared this article with you from Inoreader Long‐Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis Via The Laryngoscope Objectives/Hypothesis Cricotracheal resection (CTR) is an effective treatment for refractory idiopathic subglottic stenosis (iSGS) but is associated with persistent dysphonia. Outcomes were measured longitudinally to characterize how patients' voices and self-perceived voice handicaps changed after CTR. Study Design Retrospective case-series. Methods We conducted a retrospective cohort study of patients with refractory iSGS treated by CTR from 2006 to 2017. Voice Handicap Index (VHI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and acoustic analysis were prospectively collected preoperatively and postoperatively at 1, 3, 6, 12, and 24-month intervals. A linear mixed model was used to evaluate temporal change. Results Thirty-three patients (97% female) were included. VHI scores increased significantly from baseline preoperative score (27.2 ± 22.7) to a mean value of 44.3 ± 25.6 (P < .001) 1-month postoperatively but decreased below preoperative scores after 2 years (18.8 ± 11.9, P = .795). Mean fundamental frequency (F0) values in speech decreased significantly from 192.0 ± 24.9 Hz preoperatively to 167.1 ± 19.8 Hz at a 2-year follow-up (P = .002), with a nadir value at 1-month postoperatively (148.4 ± 20.5, P < .001). CAPE-V scores increased significantly from preoperative to 1-month postoperative (3.0 ± 2.3 vs. 21.9 ± 17.3, P < .001) but returned toward baseline values at 24 months after CTR (6.9 ± 4.8, P = .027). CAPE-V measurements postoperatively were correlated with VHI and F0 (Pearson coefficient = 0.54 (VHI), −0.46 (F0), P&n bsp;< .001). Conclusions Following CTR, mean F0 values were significantly and consistently lower but did increase over time, correlating with patients' improving VHI and CAPE-V scores. VHI values indicate that patient's perception of their voice is not significantly impacted in long term. These results provide a framework to counsel patients about long term voice expectations. Level of Evidence Level 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery.

xlomafota13 shared this article with you from Inoreader Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery. Via The Laryngoscope Objectives/Hypothesis The recurrent laryngeal nerve (RLN) is at risk during pediatric cervical, thoracic, and cardiac surgery. We aim to determine the feasibility and effectiveness of RLN monitoring techniques in all pediatric patients. Study Design Retrospective case series. Methods Retrospective review of patients/procedures with RLN(s) at risk and RLN monitoring at Boston Children's Hospital July 2019–October 2020. Primary outcomes: pre/postoperative vocal fold mobility by awake flexible fiberoptic laryngoscopy (FFL). Results One hundred one patients (median [interquartile range, IQR] age 14.6 months [4.6–49.7 months], weight 10 kg [5.2–16.2 kg]) underwent 122 procedures with RLN(s) at risk. RLN monitoring attempted 111 cases, successful 96 (84%). Surgical indications: esophageal atresia/tracheoesophageal fistula, and tracheobronchomalacia. Sixty-two (56%) procedures in reoperative field. Median follow-up 112 days (IQR 41–230). Pre/postoperative FFL performed 84 procedures (69%), 19 new postoperative RLN injuries (16%), median age 12 months, reoperative fields 11 (18%). Prass probes: 34 cases (28 successful, 82%), 6 injuries (18%), age 12.2 (5.8–23.6) months. Dragonfly electrodes: 45 cases (37 successful, 82%), 8 injuries (18%), age 7.5 (3.8–19) months. Nerve integrity monitoring (NIM) integrated electrode endotracheal tube: 33 cases (33 successful, 100%), 5 injuries (15%), age 90 (58.8–136.7) months. Automatic periodic stimulation (APS): 16 cases, 13 successful (81%), four inju ries (25%), age 7.2 (5.3–20.6) months. NIM RLN monitoring is significantly more successful than Prass, Dragonfly (95%CI −0.3 to 0.02, P = .02; and 95%CI 0.05–0.31, P = .008). Rates of injury are not different between types of RLN monitoring (P = .94), with APS use (P = .47), or with monitoring success (95%CI −0.36 to 0.09, P = .28). Conclusions RLN monitoring is feasible in pediatric patients of all ages. Although NIM type RLN monitoring success is superior, all forms offer similar rates of nerve protection. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis

xlomafota13 shared this article with you from Inoreader Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis Via radiol anat Surg Radiol Anat. 2021 Aug 25. doi: 10.1007/s00276-021-02821-7. Online ahead of print. ABSTRACT PURPOSE: An antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important. METHODS: This study measured the diameters and surface areas of the proximal and distal posterior tibi al vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured. RESULTS: The mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm2, respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm2), distal posterior tibial vein (3.29 mm and 0.091 cm2), and peroneal vein (3.43 mm and 0.081 cm2). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis. CONCLUSIONS: The distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein. PMID:34432130 | DOI:10.1007/s00276-021-02821-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predisposing conditions for bacterial meningitis in children: what radiologists need to know

xlomafota13 shared this article with you from Inoreader Predisposing conditions for bacterial meningitis in children: what radiologists need to know Via leak of cerebrospinal fluid Jpn J Radiol. 2021 Aug 25. doi: 10.1007/s11604-021-01191-9. Online ahead of print. ABSTRACT A variety of underlying diseases can predispose infants and children to bacterial meningitis (BM). For the diagnosis, treatment, and prevention of its recurrence, radiologists should be familiar with its predisposing conditions so that they can suggest the appropriate imaging approach. Predisposing conditions of BM can be broadly classified into two categories: infection spread from the adjacent tissue to the cerebrospinal fluid (CSF) space and immunodeficiency. Diseases in the former category are further divided according to regardless of whether there is a structural defect between the CSF space and the adjacent tissue. When a structural defect is suspected in a patient with BM, computed tomography (CT) of the head and magnetic resonance (MR) imaging are first-line imaging examinations. Radionuclide cisternography should be implemented as a second-li ne step to identify the CSF leak site. In patients with suspected parameningeal infection without any structural defect, such as sinusitis or otitis media/mastoiditis, CT or MR images can identify not only the disease itself but also the associated intracranial complications. The purpose of this article is to discuss the diagnostic approach and imaging findings associated with the variety of conditions predisposing patients to recurrent BM, focusing on the role of radiology in their management. PMID:34432172 | DOI:10.1007/s11604-021-01191-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.