- Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018 Feb 01; :194599818758994
- Objectives Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateraliz...
Objectives Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design Retrospective review. Setting Two academic medical centers. Subjects and Methods Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2and Fisher exact tests (significance at P = .05), as appropriate. Results Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures ( P = .519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients ( P = .246). Conclusion These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
- The anatomic applicability of transcanal endoscopic ear surgery in children. [Journal Article]
- IJInt J Pediatr Otorhinolaryngol 2018; 105:118-122
- CONCLUSIONS: TEES is applicable for most pediatric patients using an endoscope with a diameter of 3 mm or smaller. With an appropriate endoscope and instruments, TEES is a safe and effective alternative to treat pediatric middle ear disease.
- Vertebro-vertebral fistula presenting as a pulsatile tinnitus. [Journal Article]
- BCBMJ Case Rep 2018 Feb 05; 2018
- Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile...
Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.
- Where Does Telemedicine Fit into Otolaryngology? An Assessment of Telemedicine Eligibility among Otolaryngology Diagnoses. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018 Feb 01; :194599818757724
- Telemedicine applications are expanding to improve access to specialty care in rural areas. Telemedicine is not routinely used to evaluate new patients in otolaryngology, and it remains unclear which...
Telemedicine applications are expanding to improve access to specialty care in rural areas. Telemedicine is not routinely used to evaluate new patients in otolaryngology, and it remains unclear which patients could benefit from this technology. This study estimates the rate of telemedicine eligibility among specific otolaryngology diagnoses. We conducted a retrospective cohort study of all ear, nose, and throat consults between August 1, 2013, and July 31, 2015. We paired diagnoses ( International Classification of Disease, Ninth Revision) with office-based procedures ( Current Procedural Terminology) and applied prespecified telemedicine eligibility criteria to encounters retroactively. If a specialized procedure was necessary to reach a diagnosis, the diagnosis was considered ineligible for telemedicine. We found that 62% of otolaryngology encounters would likely be eligible for telemedicine. Patients with inner and middle ear problems were more likely eligible for telemedicine, while patients with problems affecting the larynx and external ear were least likely eligible. Nearly 90% of veterans drove >1 hour round-trip for services. Understanding which otolaryngology problem types are more frequently eligible for telemedicine may assist those who are planning to implement a telemedicine program.
- Clinical features of LONP1-related infantile cataract. [Journal Article]
- JAJ AAPOS 2018 Feb 03
- Biallelic mutations in the nuclear gene LONP1 (LON peptidase 1, mitochondrial) cause CODAS syndrome (cerebral, ocular, dental, auricular, and skeletal anomalies), a systemic disease that can include ...
Biallelic mutations in the nuclear gene LONP1 (LON peptidase 1, mitochondrial) cause CODAS syndrome (cerebral, ocular, dental, auricular, and skeletal anomalies), a systemic disease that can include infantile cataract. However, we have found that biallelic mutations in the gene can also underlie infantile cataract in the setting of minimal or no apparent extraocular findings. This report highlights our clinical experience with children referred for the management of infantile cataract who were found to harbor biallelic LONP1 gene mutations. Ptosis, external ear abnormalities, and joint abnormalities were accompanying findings and thus should raise suspicion for mutations in the gene when one or more are present in children with infantile cataract.
- Role of cone-beam computed tomography with a large field of view in Goldenhar syndrome. [Journal Article]
- AJAm J Orthod Dentofacial Orthop 2018; 153(2):269-277
- CONCLUSIONS: Cone-beam computed tomography with a large field of view was able to accurately identify craniofacial and vertebral skeletal anomalies, and to quantify asymmetries between the nonaffected and affected sides for an efficient maxillofacial treatment planning.
- Assessment of Response to Treatment in Patients with Otomycosis. [Journal Article]
- IJIran J Otorhinolaryngol 2018; 30(96):41-47
- CONCLUSIONS: Based on the results of this research in Babol, the recurrence of otomycosis was 7.3% and was related to swelling and erythema in ear canal.
- Paired Ear Creases of the Helix (PECH): A Possible Physical Sign. [Journal Article]
- CCureus 2017 Nov 27; 9(11):e1884
- Diagonal ear lobe creases, often known as Frank's sign, are a folding in the skin of the ear lobe. Many studies have found an association between diagonal ear lobe creases and coronary artery disease...
Diagonal ear lobe creases, often known as Frank's sign, are a folding in the skin of the ear lobe. Many studies have found an association between diagonal ear lobe creases and coronary artery disease. To our knowledge, this is the first report of paired ear creases of the helix. They may have similar relevance to cardiovascular disease as the diagonal ear lobe creases. We report the case of a 68-year-old South Asian man with coronary artery disease and a diagonal ear lobe crease. On closer inspection of the auricle, he also had ear creases on the helix on the same side. We postulate that diagonal ear lobe creases and paired ear creases of the helix are formed due to pressure during sleep on a hard surface. The pathophysiological association of these creases to coronary artery disease and metabolic syndrome are not well understood. We report a new possible sign: paired ear creases of the helix which may have similar clinical significance as the diagonal ear lobe crease with respect to cardiovascular disease.
- Otologic Manifestations and Progression in Patients with Wegener's granulomatosis: A Survey in 55 Patients. [Journal Article]
- IJIran J Otorhinolaryngol 2017; 29(95):327-331
- CONCLUSIONS: Precise clinical examination is crucial for the early diagnosis of GPA. Otological manifestations are common, especially loss of hearing and otitis serous, and can be the first sign of this disease. Early diagnosis can lead to better treatment of Wegener's granulomatosis.
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- Emerging Role of Proteases in the Pathogenesis of Chronic Rhinosinusitis with Nasal Polyps. [Review]
- FCFront Cell Infect Microbiol 2017; 7:538
- Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous upper airway disease with multiple etiologies. Clinically, CRSwNP can be classified into either eosinophilic or non-eosinophilic s...
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous upper airway disease with multiple etiologies. Clinically, CRSwNP can be classified into either eosinophilic or non-eosinophilic subtypes. The eosinophilic phenotype of CRSwNP is widely thought to be highly associated with recurrence of nasal polyps or surgical failure. Epithelial cells have a crucial role in the development of Th2-biased airway diseases. Recent studies have shown that a wide range of external stimuli such as allergens and microorganisms can elicit the release of epithelial-derived Th2-driving cytokines and chemokines. Protease activity is a feature common to these multiple environmental insults and there is growing evidence for the concept that an imbalance of proteases and protease inhibitors in the epithelial barrier leads to both the initiation and maintenance of chronic eosinophilic airway inflammation. In this review, we analyze recent work on the role of proteases in the development of the sinonasal mucosal type 2 immune response with an emphasis on the molecular pathways promoting adaptive Th2 cell immunity.