OTO-RHINO-LARYGOLOGY

Nutritional counselling and ONS are associated with relatively low CRT-related toxicity and with mild deterioration of nutritional parameters.

2012-02-09T23:02:00.001-08:00

Nutritional counselling and oral nutritional supplements in head and neck cancer patients undergoing chemoradiotherapy; Valentini V, Marazzi F, Bossola M, Miccichè F, Nardone L, Balducci M, Dinapoli N, Bonomo P, Autorino R, Silipigni S, Giuliani F, Tamanti C, Mele MC, Martorana GE; Journal of Human Nutrition & Dietetics (Jan 2012)

Background: The role of nutritional counselling (NC) with or without oral nutritional supplements (ONS) in patients receiving chemoradiotherapy (CRT) for head and neck cancer (HNC) still remains to be clearly defined, particularly with regard to CRT-related toxicity. Methods: Patients undergoing CRT for HNC received NC by the dietitian within the first 4 days of radiotherapy and weekly for the course of radiotherapy (approximately 6 weeks). A weekly supply of oral nutrition supplements [1560 kJ (373 kcal) per 100 g] for up to 3 months was provided to all patients. Results: Twenty-one patients completed CRT. Mucositis G3 developed in seven (33.3%) patients, whereas mucositis G4 was absent. Dysphagia was present before the start of treatment in four patients. In the remaining 17 patients, dysphagia G3 developed during/at the end of treatment in five cases. The percentage of patients interrupting anti-neoplastic treatment for was 28% for ≥6 days, 28% for 3-5 days and 44% for 0-2 days. Mucositis G3 frequency was lower in patients with a baseline body mass index (BMI, kg m(-2) ) ≥25 (two out of 12; 16.6%) than in patients with BMI<25 (five out of nine; 55.5%) (P = 0.161) and in patients with a baseline mid arm circumference>30 cm than in those with a mid arm circumference in the range 28.1-30 cm and<28 cm, and higher in patients with a greater weight loss and a greater reduction of serum albumin and mid arm circumference.

Precisely distinguishing among normal mucosa, dysplasia and invasive carcinoma is necessary

2012-02-09T23:01:00.001-08:00

Advances in endoscopic diagnosis of dysplasia and carcinoma of the larynx; Arens C, Vorwerk U, Just T, Betz CS, Kraft M; Hals-Nasen-Ohrenheilkunde (HNO) 60 (1), 44-52 (Jan 2012)

To improve the preoperative and intraoperative diagnosis of laryngeal cancer and its precursors, various endoscopic imaging techniques have been developed in recent years. These techniques differ markedly in their specific applications and goals. Precisely distinguishing among normal mucosa, dysplasia and invasive carcinoma with these procedures is necessary. Furthermore, the exact identification of tumor margins should be possible. The long-term goal is the development of optical biopsy. Since so far there have only been small studies regarding the evaluation of the presented methods, it is necessary to establish multi-center trials with large sample sizes to accurately estimate the value of these endoscopic imaging techniques.

Number of cycles of cisplatin delivered is an independent prognostic factor in patients with stage II-III NPC undergoing CRT with weekly cisplatin.

2012-02-09T23:00:00.000-08:00

Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma; Loong HH, Ma BB, Leung SF, Mo F, Hui EP, Kam MK, Chan SL, Yu BK, Chan AT; Radiotherapy & Oncology (Jan 2012)

BACKGROUND AND PURPOSE: Concurrent chemoradiotherapy (CRT) confers survival benefit over radiotherapy (RT) alone in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). This study explored the prognostic significance of the total dose of cisplatin delivered during CRT. MATERIALS AND METHODS: A retrospective analysis was performed in patients with stage II to IVB NPC (AJCC 6th edition) who participated in 3 prospective studies. All patients received cisplatin at a fixed dose of 40mg/m(2)/week during a 6-7-weeks course of CRT. Chi-square test was used in the univariate analysis. Relationship between prognostic factors, the total dose of cisplatin administered and time-to-event endpoints were analyzed with the Cox Hazards model. RESULTS: Two hundred and forty-one patients were identified with the following stage distribution: Stage II=13.7%, III=45.2%, IV=41.1%. The median total number of cycles of cisplatin administered per patient was 5 cycles (range 1-8 cycles). At a median follow-up of 56.5months (range 4.2-200.2months), 93 patients (38.6%) had relapsed and 85 patients (35.2%) died. For all patients, the total number of cycles of cisplatin delivered was significantly associated with survival in the univariate but not the multivariate analysis. In a sub-group analysis of 142 patients with stage II and III NPC, patients who received more than 5 cycles of cisplatin had significantly better overall survival than those who did not (hazard ratio 0.44; 95% confidence interval, 0.23-0.85; p=0.02).

Simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy

2012-02-09T22:59:00.000-08:00

Simultaneous integrated boost using intensity-modulated radiotherapy compared with conventional radiotherapy in patients treated with concurrent Carboplatin and 5-Fluorouracil for locally advanced oropharyngeal carcinoma; Clavel S, Nguyen DH, Fortin B, Després P, Khaouam N, Donath D, Soulières D, Guertin L, Nguyen-Tan PF; International Journal of Radiation Oncology, Biology and Physics (IJROBP Online) 82 (2), 582-9 (Feb 2012)

PURPOSE To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. METHODS AND MATERIALSBetween January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. RESULTSMedian follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p<0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months.

The focus of SCCHN therapy has more recently shifted to the molecular level, particularly the epidermal growth factor receptor (EGFR/ErbB) pathway

2012-02-09T22:57:00.001-08:00

New approaches to EGFR inhibition for locally advanced or metastatic squamous cell carcinoma of the head and neck (SCCHN); Agulnik M; Medical Oncology (Northwood, London, England) (Jan 2012)

Despite recent advances in radiotherapy and chemotherapy, survival rates for squamous cell carcinoma of the head and neck (SCCHN) have remained poor. The focus of SCCHN therapy has more recently shifted to the molecular level, particularly the epidermal growth factor receptor (EGFR/ErbB) pathway. Several agents that target the EGFR pathway, including monoclonal antibodies and tyrosine kinase inhibitors, are under investigation for SCCHN. Searches of PubMed and results of key oncology congresses were performed to identify relevant articles and abstracts. The EGFR-targeted monoclonal antibody cetuximab is approved for the treatment of locally advanced SCCHN in combination with radiotherapy, for first-line treatment of recurrent or metastatic SCCHN in combination with platinum-based chemotherapy and 5-fluorouracil, and for recurrent or metastatic SCCHN following progression with platinum-based chemotherapy. Other investigational EGFR-targeted monoclonal antibodies (e.g., panitumumab, nimotuzumab, zalutumumab) are in clinical development for SCCHN. Inhibition of the tyrosine kinase domain of EGFR has also been explored as a therapeutic approach in SCCHN using small-molecule reversible inhibitors, such as gefitinib and erlotinib. However, a key challenge in SCCHN is the development of resistance, and strategies are being pursued to delay or overcome resistance to EGFR-targeted agents. These strategies include development of agents that inhibit multiple ErbB receptors simultaneously (e.g., lapatinib) or that bind multiple ErbB family receptors irreversibly (e.g., afatinib, PF-00299804) and investigation of combinations of agents that target multiple pathways implicated in the pathogenesis of SCCHN. Ongoing large clinical trials are evaluating these emerging agents and combinations for the treatment of SCCHN

Results of endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy in the treatment of patients with symptomatic subglottic tracheal stenosis

2012-02-09T22:56:00.000-08:00

Subglottic tracheal stenosis; Karaiskaki N, Mann WJ; Hals-Nasen-Ohrenheilkunde (HNO) (Jan 2012)

OBJECTIVES: To assess the results of endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy in the treatment of patients with symptomatic subglottic tracheal stenosis.

MATERIALS AND METHODS: Eleven patients (all female) with subglottic tracheal stenosis were divided into two groups: six patients with idiopathic subglottic tracheal stenosis and five with subglottic tracheal stenosis of known etiology (four with Wegener's disease and one with polychondritis of the trachea). Three patients showed signs of reflux. The primary outcome measure was improvement of the clinical symptoms and the secondary the postoperative reduction of airway resistance.

RESULTS: All patients were treated with CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy. Postoperative examinations during a period of 7 to 72 months demonstrated a reduction of symptoms and of airway resistance in all patients.

CONCLUSIONS: One or more endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy are effective in the treatment of subglottic tracheal stenoses. Long-term oral steroid and immunosuppressive therapy as well as the use of proton pump inhibitors positively influences the postoperative outcome.

Post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients

2012-02-09T22:54:00.001-08:00

Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients; Dwivedi RC, St Rose S, Chisholm EJ, Bisase B, Amen F, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ, Kazi R; Oral Oncology (Jan 2012)

The aim of this study was to explore post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients. Sixty-three consecutive OC and OP cancer patients in follow-up participated in this study. Descriptive analyses have been presented as percentages, while Mann-Whitney U-test and Kruskall-Wallis test have been used for the quantitative variables. Statistical Package for Social Science-15 statistical software (SPSS Inc., Chicago, IL) was used for the statistical analyses. Over a third (36.1%) of patients reported their speech as either average or bad. Speech intelligibility and articulation were the main speech concerns for 58.8% and 52.9% OC and 31.6% and 34.2% OP cancer patients, respectively. While feeling of incompetent and being less outgoing were the speech-related psychosocial concerns for 64.7% and 23.5% OC and 15.8% and 18.4% OP cancer patients, respectively. Worse speech outcomes were noted for oral tongue and base of tongue cancers vs. tonsillar cancers, mean (SD) values were 56.7 (31.3) and 52.0 (38.4) vs. 10.9 (14.8) (P<0.001) and late vs. early T stage cancers 65.0 (29.9) vs. 29.3 (32.7) (P<0.005). The English version of the SHI is a reliable, valid and useful tool for the evaluation of speech in HNC patients. Over one-third of OC and OP cancer patients reported speech problems in their day-do-day life. Advanced T-stage tumors affecting the oral tongue or base of tongue are particularly associated with poor speech outcomes.

Rrole of CTCAE version 4.0 (v4.0) and version 3.0 (v3.0) in assessing chemoradiation-induced oral mucositis (OM) for locally advanced nasopharyngeal carcinoma (LA-NPC)

2012-02-09T22:51:00.000-08:00

Comparison of the NCI-CTCAE version 4.0 and version 3.0 in assessing chemoradiation-induced oral mucositis for locally advanced nasopharyngeal carcinoma; Liu YJ, Zhu GP, Guan XY; Oral Oncology (Jan 2012)

To compare the role of CTCAE version 4.0 (v4.0) and version 3.0 (v3.0) in assessing chemoradiation-induced oral mucositis (OM) for locally advanced nasopharyngeal carcinoma (LA-NPC). Patients with LA-NPC were recruited into the study. All eligible participants received docetaxel and cisplatin-based induction chemotherapy followed by intensity modulated radiation therapy concurrent with cisplatin. OM was assessed before and weekly during radiotherapy (RT), using CTCAE v3.0 (clinical exam) and v4.0 separately. OM-related quality of life (QOL) was also evaluated in these patients with the EORTC Quality of Life Questionnaire - Head and Neck module (QLQ-H&N35). From June 2010 to February 2011, 23 eligible patients were enrolled. A highly significant correlation (rho=0.838, p=0.000) and a non-significant difference (p=0.167) in OM grades were found between the two CTCAE versions. However, the trend lines showed that the mean grade determined by CTCAE v3.0 reached a plateau while the mean grade determined by v4.0 continued to increase after the fourth week during RT. Changing trends of several QOL subscale mean scores were similar to that of OM mean grade evaluated by CTCAE v4.0. Both grades of the two CTCAE versions were significantly and positively correlated with scores of several QOL subscales. Nonetheless, the correlation coefficients related to CTCAE v4.0 were higher than those related to v3.0 (rho: 0.727-0.865 versus 0.727-0.778). CTCAE v4.0 could serve as a good surrogate for v3.0 (clinical exam) in assessing chemoradiation-induced oral mucositis. Moreover, CTCAE v4.0 has a few subtle advantages over v3.0 under some circumstances such as delegating QOL. However, there is still no "gold standard" assessment scale for oral mucositis. Therefore, the appropriate tool should be carefully chosen according to the purpose of assessment.

Cricotracheal reconstruction with free radial forearm flap and titanium mesh Head & Neck, 02/07/2012 Balasubramanian D et al. – This reconstructive technique enabled us to maintain the integrity of the subglottic airway. The technique was unique in that the authors used the skin–lined part of the radial forearm flap to line the airway and the fascia to cover the titanium mesh outside, thereby preventing plate exposure.

2012-02-07T07:36:00.001-08:00

Posterior pharyngeal flap for velopharyngeal insufficiency patients

2012-02-07T07:35:00.001-08:00

The Laryngoscope, 02/07/2012

Emara TA et al. – The minimal complication and ease of flap design with precise flap inset make this modified superior flap technique easily applicable with a high success rate for patients with velopharyngeal insufficiency (VPI) after cleft palate repair.

The sternocleidomastoid (SCM) muscle flap was an effective method in preventing Frey’s syndrome. Moreover, Galvanic skin responses (GSR) test was highly sensitive and specific for diagnosis.

2012-02-07T07:34:00.001-08:00

The Efficiacy of Sternocleidomastoid Muscle Flap on Freys Syndrome via a Novel Test: Galvanic Skin Response
Indian Journal of Otolaryngology and Head & Neck Surgery, 02/02/2012

Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single–stage procedure.

2012-02-07T07:33:00.001-08:00

Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes
The Journal of Laryngology & Otology, 02/01/2012

Cephalometric analysis for microvascular head and neck reconstruction Head & Neck, 02/03/2012 Chang EI et al. – When premorbid craniofacial anatomy cannot be discerned in the setting of extensive trauma or tumor involvement, normative dimensions may be a helpful guide for flap design and should be in the armamentarium of surgeons engaged in complex head and heck reconstruction.

2012-02-07T07:32:00.000-08:00

Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy

2012-02-07T07:30:00.001-08:00

The Laryngoscope, 02/06/2012

Higgins KM et al. – The pharyngocutaneous fistula (PCF) rate of 8% is significantly better than in similar salvage cases without flap coverage. Moreover, the PCF rate is comparable to the results shown for the pectoralis major muscle flap. The most obvious benefit of the temporoparietal fascia free flap for pharyngeal coverage in salvage laryngectomy is a reduced PCF rate with diminished donor–site morbidity, including cosmetic outcome, shoulder girdle function, and chest deformity.

The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction

2012-02-07T07:29:00.001-08:00

Journal of Plastic, Reconstructive & Aesthetic Surgery, 02/06/2012

Roche NA et al. – In the vessel–depleted neck, the internal mammary vessels (IMVs) are a reliable and easy accessible recipient area for microsurgical reconstruction of the head and neck. Surgical management and technique refinements for dissection of the vessels are discussed. In combination with free flaps with a long pedicle, especially perforator flaps, vein grafts are unnecessary and microsurgery can safely be performed outside the zone of injury.

Secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous fla

2012-02-07T07:28:00.000-08:00

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Shen Y et al. – The authors recommend that the horizontal class d defect in Brown’s revised classification of maxilla and midface be divided into two sub–types according to whether it involves the contralateral canine or not. Special considerations in virtual surgical planning are helpful to perform accurate secondary maxillary reconstruction with a vascularised fibular osteomyocutaneous flap.

Methods

Eleven patients with different maxillary defects according to Brown’s revised classification underwent virtual surgical planning for secondary accurate reconstruction.
For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition.

Results

Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra–operatively.
Virtual surgical planning was replicated intra–operatively in all patients.
The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b–d1 defects, respectively.
The overall success rate for 11 flaps was 100%.
Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients.
Maximum incisal opening ranged from 3.0 to 4.0 cm.
All patients tolerated a regular diet postoperatively.
Postoperative midfacial appearance was good in all patients.

IL-21 Derived from Human Follicular Helper T Cells Acts as a Survival Factor for Secondary Lymphoid Organ, but Not for Bone Marrow, Plasma Cells Journal of Immunology, 02/06/2012 Rodriguez–Bayona B et al. – Tonsillar T follicular helper (Tfh) cells or exogenous IL–21 reduce tonsillar plasma cells (PC) apoptosis and increases PC recovery but does not modify their nonproliferating status. These results suggest that IL–21 derived from Tfh cells acts as a survival factor for secondary lymphoid organs (SLO) PC in vivo.

2012-02-07T07:26:00.001-08:00

Potential for promoting recurrent laryngeal nerve regeneration by remote delivery of viral gene therapy The Laryngoscope, 02/06/2012 Rubin AD et al. – AAV2–TO–6876vp16 demonstrated a neurotrophic effect when injected into the crushed recurrent laryngeal nerve (RLN). The RLN offers a conduit for viral gene therapy to the brainstem that could be useful for the treatment of RLN injury or bulbar motor neuron disease.

2012-02-07T07:25:00.001-08:00

Common genetic variants in the 8q24 region and risk of papillary thyroid cancer The Laryngoscope, 02/03/2012 Neta G et al. – The findings do not support a strong association between SNPs in the 8q24 chromosomal region and risk of sporadic papillary thyroid cancer (PTC), but several Single nucleotide polymorphisms (SNPs) with small effects might exist.

2012-02-07T07:24:00.001-08:00

DNA repair gene excision repair cross complementing-group 1 (ERCC1) in head and neck squamous cell carcinoma Histopathology, 02/02/2012 Lima LMC et al. – The findings may reflect a high rate of DNA repair due to frequent tissue injury during the lifetime of these individuals, and also more advanced disease presentation in this population with worse prognosis.

2012-02-07T07:23:00.001-08:00

The detection of promoter hypermethylation of the seven genes in salivary rinse as an independent prognostic indicator of overall survival in patients with head and neck squamous cell carcinoma (HNSCC) was not validated. Detection of promoter hypermethylation of TIMP3 in pretreatment salivary rinse is independently associated with local recurrence–free survival in patients with HNSCC and may be a valuable salivary rinse biomarker for HNSCC recurrence.

2012-02-07T07:22:00.001-08:00

Detection of TIMP3 Promoter Hypermethylation in Salivary Rinse as an Independent Predictor of Local Recurrence-Free Survival in Head and Neck Cancer
Clinical Cancer Research, 01/30/2012

Comparison of montelukast and mometasone furoate in the prevention of recurrent nasal polyps Therapeutic Advances in Respiratory Disease, 02/03/2012 Clinical Article Vuralkan E et al. – Both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

2012-02-07T07:21:00.001-08:00

The correlation between nasal CC16 and nasal nitric oxide (nNO) levels in patients with allergic rhinitis, along with an inverse relationship between their levels and the occurrences of MC (mast cells) in allergic inflammation, may indicate that both biomarkers have anti–inflammatory effects by suppression of cell recruitment.

2012-02-07T07:20:00.001-08:00

Corticosteroids are the mainstay of treatment and are the most effective drugs for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.

2012-02-07T07:16:00.001-08:00

Biomarkers in head and neck cancer

2012-02-02T23:29:00.001-08:00

Langer CJ; Cancer (Jan 2012)

Personalized medicine based on predictive markers linked to drug response, it is hoped, will lead to improvements in outcomes and avoidance of unnecessary treatment in squamous cell carcinoma of the head and neck (SCCHN). Recent research has shown that expression of ERCC1 may predict resistance to treatment with platinum agents. Future testing for this marker may help select the optimal type of chemotherapy. Infection with human papillomavirus (HPV) is associated with less aggressive disease and better prognosis in locally advanced SCCHN treated with chemoradiation or radiation alone; HPV-positive patients may ultimately benefit from less intensive, less toxic therapy. K-RAS mutations, occurring in about 40% of colorectal cancers and associated with lack of benefit from epidermal growth factor receptor (EGFR) antibodies in this disease, are found in<5% of SCCHN patients, making routine testing for K-RAS mutations unwarranted at this time. Virtually all head and neck tumors overexpress EGFR, which limits the usefulness of EGFR expression as a marker for treatment selection. Although the incidence of EGFR tyrosine kinase domain mutations is very rare, a better understanding of the role of EGFR mutations, expression, amplification, and downstream effects in SCCHN may help define the role of EGFR in this setting. These observations caution against extrapolating results obtained with biomarkers in other types of cancer to SCCHN. Validation of each biomarker in the context of SCCHN clinical trials will be required before a specific marker can be incorporated into daily practice. Cancer 2012;. © 2012 American Cancer Society.

Oral human papillomavirus (HPV) is found in about 7% of people in the US aged 14 to 69 years, and the infection occurs in men about 3 times as commonly as in women

2012-02-02T23:27:00.001-08:00

HPV Virus 3 Times More Common in Men Than Women

By Nancy A. Melville

PHOENIX, Ariz -- January 27, 2012 -- Oral human papillomavirus (HPV) is found in about 7% of people in the US aged 14 to 69 years, and the infection occurs in men about 3 times as commonly as in women, according to research presented here January 26 at the 2012 Multidisciplinary Head and Neck Cancer Symposium (MHNCS).

Researchers evaluating data from 5,579 men and women who participated in the Centers for Disease Control and Prevention’s (CDC) National Health and Nutrition Examination Survey between 2009 and 2010 found the rates of oral HPV infection to be 10.1% among men and 3.6% among women (P <.001).

About 1% of the population had HPV type 16 infection, which is linked to a significantly greater risk of head and neck cancer.

In the new study, the cancer type was found to be 5 times more common in men than in women (1.6 vs 0.31%; P <.001).

Factors including gender, age, number of sexual partners, and intensity of current cigarette smoking were independently associated with oral HPV infection.

There was a bimodal distribution with age, with peak prevalence among individuals aged 30 to 35 years (7.3%) and those aged 60 to 64 years (11.4%).

“We showed 2 separate age spikes in terms of prevalence,” said lead author Maura Gillison, MD, Cancer Research, Ohio State University, Columbus, Ohio. “One was among people in their 30s and a second peak, which is actually higher, was among people in their 60s.”

The results also showed an association between infection rates and sexual activity: Rates of infection were significantly lower than those with sexual activity (0.7% vs 7.4%; P <.0001) and infection rates increased with number of sexual partners (P <.001), as well as with number of cigarettes smoked per day (P <.001).

Dr. Gillison noted that there was no variance in infection rates relating to sexual behaviours according to gender.

“We looked at sexual behaviours by gender, but a multivariate analysis showed they did not explain the differences,” said Dr. Gillison. “In fact, all of the covariates in the study explained only 16% of the prevalence in differences between men and women, so this obviously is not entirely explained by gender -- there is some biology here.”

“This study of oral HPV infection is the critical first step toward developing potential oropharyngeal cancer prevention strategies,” Dr. Gillison concluded.

“This is clearly important because HPV-positive oropharyngeal cancer is poised to overtake cervical cancer as the leading type of HPV-caused cancers in the US and we currently do not have another means by which to prevent or detect these cancers early.”

The 2012 Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiation Oncology, and the Society of Nuclear Medicine.

[Presentation title: Prevalence of Oral HPV Infection in the United States, 2009-2010. Abstract LBPL1]

Sentinel Node-Positive Melanoma of the Head and Neck ; Compared with SLNB alone, CLND does not seem to be associated with improved survival

2012-02-02T23:26:00.000-08:00

Completion Node Dissection in Patients with Sentinel Node-Positive Melanoma of the Head and Neck; Smith VA, Cunningham JE, Lentsch EJ; Otolaryngology - Head and Neck Surgery (Jan 2012)

Objective. Determine if completion lymph node dissection (CLND) is associated with improved survival in sentinel lymph node (SLN)-positive cutaneous melanoma of the head and neck (CMHN) patients.Study Design. Retrospective analysis of large population database.Setting. Surveillance, Epidemiology and End Results (SEER) database/multiple settings.Subjects and Methods. Using the SEER database, the authors identified patients with SLN-positive CMHN. Clinicopathologic data and 5-year disease-specific survival (DSS) were examined for patients who underwent sentinel lymph node biopsy (SLNB) alone vs SLNB + CLND.Results. Among 350 SLN-positive patients, 210 (60%) had SLNB + CLND, and 140 (40%) had SLNB only. Patients in the SLNB-only group were significantly older (median age 62 vs 53 years, P<.0001). The cohort as a whole did not significantly benefit from CLND; however, CLND was associated with improved DSS for a subgroup of patients age<60 years with nonulcerated tumors ≤2 mm thick (P = .03). Relative to SLNB alone, CLND did not improve survival for patients age ≥60 years or those with thicker (>2 mm) or ulcerated tumors.Conclusions. Compared with SLNB alone, CLND does not seem to be associated with improved survival for most patients with SLN-positive CMHN. CLND likely improves survival for patients age<60 years with thin (≤2 mm) nonulcerated tumors and when there is a low risk of identifying positive non-SLNs.

Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors.

2012-02-02T23:24:00.000-08:00

Matted nodes: Poor prognostic marker in oropharyngeal squamous cell carcinoma independent of HPV and EGFR status; Spector ME, Gallagher KK, Light E, Ibrahim M, Chanowski EJ, Moyer JS, Prince ME, Wolf GT, Bradford CR, Cordell K, McHugh JB, Carey T, Worden FP, Eisbruch A, Chepeha DB, The University of Michigan Head Neck Specialized Program of Research Excellence (SPORE) Program; Head & Neck (Jan 2012)

BACKGROUND:

Despite better prognosis, there is a group of oropharyngeal squamous cell carcinoma (SCC) human papillomavirus (HPV)+ patients who experience treatment failure and succumb to distant metastasis.

METHODS:

Seventy-eight previously untreated patients nested in a concurrent chemoradiation protocol were reviewed to correlate patterns of local-regional tumor extent to distant metastasis. Biomarker assessment was: HPV in situ hybridization and epidermal growth factor receptor (EGFR) immunointensity. RESULTS: The 3-year disease-specific survival (DSS) for patients presenting with and without matted nodes was 69% and 94%, respectively (p = .003). Matted nodes were a poor prognostic factor independent of T classification, HPV, EGFR, and smoking status. For patients who were HPV+, 7 of 11 died of distant metastasis and 6 of 7 with distant metastasis had matted nodes.

CONCLUSION:

Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors. Matted nodes may identify patients at risk for the development of distant metastasis who could benefit from systemic therapy, whereas patients without matted nodes may be candidates for de-escalation of therapy

Concurrent Chemoradiotherapy versus Induction Chemotherapy

2012-02-02T23:22:00.000-08:00

Comparison of Concurrent Chemoradiotherapy versus Induction Chemotherapy Followed by Radiation in Patients with Nasopharyngeal Carcinoma;

Komatsu M, Tsukuda M, Matsuda H, Horiuchi C, Taguch T, Takahashi M, Nishimura G, Mori M, Niho T, Ishitoya J, Sakuma Y, Hirama M, Shiono O; Anticancer Research 32 (2), 681-6 (Feb 2012)

Purpose:

The study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) with platinum-based chemotherapy as a primary treatment for nasopharyngeal carcinoma (NPC) and to further compare the results of CCRT with these of neoadjuvant chemotherapy (NAC) followed by radiotherapy (RT).

PATIENTS AND METHODS

Before 1998, 21 patients with NPC received NAC followed by RT (NAC-RT). Between 1999 and 2008, a total of 25 NPC patients received CCRT. The CCRT group received a regimen including docetaxel (50 mg/m(2), day1), cisplatin (CDDP, 60 mg/m(2), day4) and continuous 5-fluorouracil (5-FU) infusion (600 mg/m(2), day 1-5), the TPF regimen, or a regimen including CDDP (60 mg/m(2), day4), continuous 5-FU infusion (600 mg/m(2), day 1-5), methotrexate (MTX, 30 mg/m(2), day 1) and leucovorin (LV, 20 mg/m(2), day 1-5), PFML regimen. The CCRT group received 2 cycles of chemotherapy during definitive RT. The NAC group of patients received a PFML regimen.

RESULTS

The overall response rate after CCRT was 96%. The 3-year and 5-year disease-specific survival rates were 75.6% and 60.1%, respectively. In patients receiving NAC-RT, the 3-year and 5-year disease-specific survival rates were 84.1% and 67.3%, respectively. There was no difference observed in terms of survival rates between the group receiving CCRT and that receiving NAC-RT.

CONCLUSION

CCRT with the TPF or PFML regimen was tolerable, and the NPC patients receiving this treatment showed excellent survival rates. In comparison to the group receiving NAC-RT, CCRT had no advantage in terms of the survival rate. In the future, the control of distant metastasis might play an important role in improving the survival rate of patients with advanced NPC receiving CCRT.

2012-02-02T23:20:00.000-08:00

Pemphigus vegetans of the nose; Sigmund GA, Oppenheimer R; Ear, Nose, & Throat Journal 91 (1), E14-5 (Jan 2012)

Pemphigus vegetans is an unusual form of pemphigus vulgaris. Pemphigus of the head and neck region is usually found in areas with mucosa, such as the mouth and pharynx. We present a fascinating case of pemphigus vegetans arising from the nasal dorsum that completely deformed the external nose of a 43-year-old woman. The patient was treated successfully with high-dose prednisone.

Pemphigus vegetans is a localized form of pemphigus vulgaris in which there is a localized vegetating papillomatous response. The eroded areas do not heal like usual but form papillomatous growth and vegetation.
Accounts for 1-2% of pemphigus cases and is a relatively benign variant of Pemphigus Vulgaris. Two forms are recognized:
Neumann type: more common and characterized by early lesions similar to Pemphigus Vulgaris with large bullae and erosive areas. Healing is through formation of granulation tissue.
Hallopeau type: less aggressive and has pustules not bullae. These pustules heal by verrucios hyperkeratotic vegetations.

Biofilms in Chronic Rhinosinusitis

2012-02-02T23:16:00.000-08:00

Prevalence of Biofilms and Their Response to Medical Treatment in Chronic Rhinosinusitis without Polyps; Tatar EC, Tatar I, Ocal B, Korkmaz H, Saylam G, Ozdek A, Celik HH; Otolaryngology - Head and Neck Surgery (Jan 2012)

Objective. The aim of this study was to investigate the prevalence of biofilms and the effects of medical treatment modalities in chronic rhinosinusitis (CRS) patients without nasal polyps.

Study Design. Randomized controlled trial.

Settings. Tertiary referral hospital.

Subjects and Methods. The authors randomly divided 32 adult patients with CRS without nasal polyps into 2 groups. In the first group (n = 16), oral clarithromycin was administered 500 mg/bid for 2 weeks and then 250 mg/d for the following 6 weeks. In the second group (n = 16), an 8-week course of 200-mcg/d topical mometasone furoate was added to the clarithromycin regimen, identical to the first group. The pre- and posttreatment nasal tissue samples were evaluated by scanning electron microscopy for biofilm prevalence and graded from 0 to 3 according to density and extension.Results. Biofilms were detected in 24 of 32 patients (75%) before the treatment (grades 1-3). Biofilms were detected in 14 of 32 patients (43.8%) after the treatment (grades 1-2). When each group was evaluated independently, there was a significant improvement after the treatment in both groups I and II. When the biofilm grades of group I were compared to those of group II, there was no significant difference both in the pre- and posttreatment evaluation.

Conclusion. The prevalence of biofilms in CRS without polyps was 75% in our study. Regression of biofilms to 43% was observed under medical treatment. Adding nasal steroids to macrolides gave no further benefit.

Παράδειγμα Υπο-Αλλεργιογονικής Δίαιτας

2012-02-02T08:55:00.000-08:00

ΚΡΕΑΣ : Αρνάκι,Γαλοπούλα,Κοτόπουλο.
ΔΗΜΗΤΡΙΑΚΑ : Ρύζι και τα προϊόντα του.
ΛΑΧΑΝΙΚΑ : Μαρούλι,Παντζάρια,Σπανάκι,Σέλινο.
ΛΙΠΗ : Ελαιόλαδο.
ΦΡΟΥΤΑ : Αχλάδια,Ανανάς.

ΠΡΕΠΕΙ ΝΑ ΑΠΟΦΕΥΓΟΝΤΑΙ :
Γάλα
Τσάι
Καφές
Ποτά τύπου cola
Αναψυκτικά
Λεμονάδες
Ελαιομαργαρίνες

Λάστιχο LATEX

2012-02-02T08:42:00.001-08:00

Ακάρεα Οικιακής Σκόνης

2012-02-02T08:41:00.000-08:00

Αλλεργικά Τεστ

2012-02-02T08:33:00.001-08:00

Φάρμακα

2012-02-02T08:31:00.001-08:00

Αλλεργιογόνα Τροφών

2012-02-02T08:30:00.000-08:00

Αλλεργιογόνα Ζώων

2012-02-02T08:27:00.001-08:00

Σφήκες και Μέλισσες

2012-02-02T08:25:00.000-08:00

Αλλεργιογόνα Φυτά

2012-02-02T08:07:00.000-08:00

Μύκητες

2012-02-02T08:05:00.000-08:00

Γύρεις

2012-02-02T08:02:00.001-08:00

A higher frequency of CD161+ T cells is present in the peripheral blood of allergic rhinitis (AR) patients.

2012-01-31T07:29:00.001-08:00

Higher Frequencies of CD161+ Circulating T Lymphocytes in Allergic Rhinitis Patients Compared to Healthy Donors
International Archives of Allergy and Immunology, 01/26/2012

Detection of promoter hypermethylation of TIMP3 in pretreatment salivary rinse is independently associated with local recurrence–free survival in patients with HNSCC and may be a valuable salivary rinse biomarker for HNSCC recurrence.

2012-01-31T07:28:00.001-08:00

Detection of TIMP3 Promoter Hypermethylation in Salivary Rinse as an Independent Predictor of Local Recurrence-Free Survival in Head and Neck Cancer
Clinical Cancer Research, 01/30/2012

Sun W et al. – The detection of promoter hypermethylation of the seven genes in salivary rinse as an independent prognostic indicator of overall survival in patients with head and neck squamous cell carcinoma (HNSCC) was not validated.

Secondary accurate maxillary reconstruction

2012-01-31T07:27:00.000-08:00

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Methods

Eleven patients with different maxillary defects according to Brown’s revised classification underwent virtual surgical planning for secondary accurate reconstruction.
For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition.

Results

Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra–operatively.
Virtual surgical planning was replicated intra–operatively in all patients.
The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b–d1 defects, respectively.
The overall success rate for 11 flaps was 100%.
Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients.
Maximum incisal opening ranged from 3.0 to 4.0 cm.
All patients tolerated a regular diet postoperatively.
Postoperative midfacial appearance was good in all patients.

Unilateral cleft-lip nasal deformities

2012-01-31T07:26:00.000-08:00

Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/27/2012

Masuoka H et al. – Performing open rhinoplasty using conchal cartilage during childhood effectively improves unilateral cleft–lip nasal deformities.

Methods

Open rhinoplasty is performed.
The conchal cartilage is harvested and used as a strut to strengthen and extend the septum.
The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position.
The operative results of 38 patients were evaluated photogrammetrically.
The nasal height, nostril height and the columella angle on a basilar view of the nose were measured.

Results

In most patients, the nose was refined and became less distorted.
Poorly projecting nasal tips and drooping alar rims were corrected.
The reformed configuration was relatively well maintained for many years.
Photogrammetric analysis demonstrated increases in both the nasal height to nasal width ratio and the nostril height to nostril width ratio, and improvement of the columella angle.

Submucosal uvulopalatopharyngoplasty is an effective tool in treating patient’s subjective symptoms of OSAS

2012-01-31T07:24:00.001-08:00

Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome
European Archives of Oto-Rhino-Laryngology, 01/26/2012

Tanyeri H et al. – Submucosal uvulopalatopharyngoplasty is an effective tool in treating patient’s subjective symptoms of OSAS. Objective findings suggest that smUPPP is inadequate in treating OSAS. It cannot abolish OSAS, though it can decrease the intensity of the condition in nearly half of the patients. Weight gain decreases the success of the procedure over the years.

Canalith Repositioning Procedures

2012-01-31T07:23:00.001-08:00

Canal Conversion and Reentry: A Risk of Dix-Hallpike During Canalith Repositioning Procedures
Otology and Neurotology, 01/25/2012

Foster CA et al. – If the first CRP clears the posterior canal, there is an elevated risk of reentry or canal conversion if another Dix–Hallpike is performed immediately. These complications can be treated by additional maneuvers; if unfamiliar with these techniques, the risk can be reduced by waiting at least 15 minutes between repetitions of CRP.

Corticosteroids are the mainstay of treatment and are the most effective drugs for treating chronic rhinosinusitis with nasal polyps

2012-01-31T07:22:00.001-08:00

Role of Medical Therapy in the Management of Nasal Polyps
Current Allergy and Asthma Reports, 01/30/2012

Alobid I et al. – Corticosteroids are the mainstay of treatment and are the most effective drugs for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.

GERD may be one of the contributing factors in the etiopathogenisis of OME

2012-01-31T07:21:00.001-08:00

Role of GERD in Children with Otitis Media with Effusion
The Indian Journal of Pediatrics, 01/26/2012

Nair S et al. – Otitis media with effusion (OME) appears to be multifactorial disease.GERD may be one of the contributing factors in the etiopathogenisis of OME.

Methods

This is a prospective study conducted in a tertiary care hospital. Middle ear effusion samples were collected from 32 children undergoing surgery for OME.
The samples were measured for pepsinogen level as well as total protein content.
Samples were subjected to electrophoresis study by SDS PAGE (Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis).

Results

A total of 21 patients out of 32 were found to have higher pepsinogen level in their middle ear effusion samples than the cut off value of 90 mg/ml.
The lack of symptoms associated with GERD among the children in this study corroborates with other similar studies in the world literature.
It was also statistically shown that the association between GERD score and pepsinogen level was insignificant (P?=?0.512).

Llevocetirizine is effective on persistent allergic rhinitis (PER) symptoms, including a transient improvement in loss of smell, and that this improvement concurs more with reduction of nasal inflammation than of nasal patency.

2012-01-31T07:20:00.001-08:00

The Loss of Smell in Persistent Allergic Rhinitis Is Improved by Levocetirizine due to Reduction of Nasal Inflammation but Not Nasal Congestion (the CIRANO Study)
International Archives of Allergy and Immunology, 01/27/2012

Vestibular migraine (VM) and Menière's disease (MD)

2012-01-26T23:45:00.000-08:00

Vestibular evoked myogenic potentials to sound and vibration: characteristics in vestibular migraine that enable separation from Meniere's disease; Taylor RL, Zagami AS, Gibson WP, Black DA, Watson SR, Halmagyi GM, Welgampola MS; Cephalalgia (Jan 2012)

Objectives:

It can be difficult to distinguish vestibular migraine (VM) from Menière's disease (MD) in its early stages. Using vestibular-evoked myogenic potentials (VEMPs), we sought to identify test parameters that would help discriminate between these two vestibular disorders.

Methods:

We first recorded ocular and cervical VEMPs (oVEMP/cVEMP) to air-conducted clicks and bone-conducted vibration in 30 control participants, 30 participants with clinically definite VM and 30 participants with clinically probable VM. Results were compared with a group of 60 MD patients from a previous study. oVEMPs and cVEMPs were then recorded at octave frequencies of 250 Hz to 2000 Hz in 20 controls and 20 participants each with clinically definite VM and MD. Inter-aural amplitude asymmetry ratios and amplitude frequency ratios were compared between groups.Results: For click, tendon-hammer-tap and minishaker-tap VEMPs, there were no significant differences in reflex amplitudes or symmetry between controls, definite VM and probable VM. Compared with MD patients, participants with VM had significantly fewer reflex abnormalities for click-cVEMP, click-oVEMPs and minitap-cVEMPs. The ratio of cVEMP amplitude generated by tone bursts at a frequency of 0.5 kHz to that generated by 1 kHz was significantly lower for MD affected ears than for VM or controls ears. cVEMP asymmetry ratios for 0.5 kHz tone bursts were significantly higher for MD than VM.Conclusions: The 0.5/1 kHz frequency ratio, 0.5 kHz asymmetry ratio and caloric test combined, separated MD from VM with a sensitivity of 90.0% and specificity of 70.0%.

Tuberculum sellae meningioma

2012-01-26T23:43:00.001-08:00

Endoscopic endonasal approach for a tuberculum sellae meningioma; Fernandez-Miranda JC, Pinheiro-Nieto C, Gardner PA, Snyderman CH; Journal of Neurosurgery 32 (1), E8 (Jan 2012)

The authors present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a tuberculum sellae meningioma. The patient is a 47-year-old female with headaches and an incidental finding of a small tuberculum sellae meningioma with no vascular encasement, no optic canal invasion, but mild inferior to superior compression of the cisternal segment of the left optic nerve. Neuroophthalmology assessment revealed no visual defects. Treatment options included clinical observation with imaging follow-up studies, radiosurgery, and resection. The patient elected to undergo surgical removal and an endonasal endoscopic approach was the preferred surgical option. Preoperative radiological studies showed the presence of an osseous ring between the left middle and anterior clinoids, the so-called carotico-clinoidal ring. The surgical implications of this finding and its management are illustrated. The surgical anatomy of the suprasellar region is reviewed, including concepts such as the chiasmatic sulcus and limbus sphenoidale, medial and lateral optico-carotid recesses, and the paraclinoidal and supraclinoidal segments of the internal carotid artery. Emphasis is made in the importance of exposing the distal dural ring of the internal carotid artery and the precanalicular segment of the optic nerve for adequate intradural dissection. The endonasal route allows for early coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without any manipulation of the optic nerve. The lateral limit of dural removal is formed by the distal dural ring, which is gently coagulated after the tumor is resected. A 45° scope is used to inspect for any residual tumor, in particular at the entrance of the optic nerve into the optic canal and at the most anterior margin of the exposure (limbus sphenoidale). The steps for reconstruction are detailed and include intradural placement of dural substitute and extradural placement of the nasoseptal flap. The nuances for proper harvesting, positioning, and reinforcement of the flap are described. No lumbar drain was used. The patient had an uneventful recovery with no CSF leak or any other complications. Imaging follow-up at 6 months showed complete removal of the tumor. The patient had no sinonasal or neurological symptoms, and olfaction was fully preserved. The video can be found here: http://youtu.be/kkuV-yyEHMg .

New therapies currently under investigation include mTOR inhibitors, anti-angiogenic agents, and IGF1R inhibitors

2012-01-26T23:42:00.001-08:00

Current Treatment Options for Metastatic Head and Neck Cancer; Price KA, Cohen EE; Current Treatment Options in Oncology (Jan 2012)

OPINION STATEMENT: Head and neck squamous cell carcinoma is now the 8th most common cancer affecting men in the United States largely due to a rising epidemic of oropharynx cancer (tonsil and tongue base) associated with the human papillomavirus (HPV). The median overall survival for recurrent or metastatic head and neck cancer (R/M HNSCC) remains less than 1 year despite modern chemotherapy and targeted agents. Palliative chemotherapy and the epidermal growth factor receptor inhibitor, cetuximab, constitute the backbone of treatment for patients with R/M HNSCC. Platinum doublets studied in phase III trials include cisplatin/5-FU, cisplatin/paclitaxel, and cisplatin/pemetrexed. Platinum chemotherapy in combination with 5-fluorouracil and cetuximab has resulted in the longest median overall survival. Combination platinum regimens increase response rates and toxicity but not survival and should be reserved for patients who are symptomatic from their disease for whom the benefit of a partial response may be worth the cost of increased treatment-related side effects. For many patients who are asymptomatic with a low disease burden, single agent regimens are appropriate to balance treatment with side effects. Drugs commonly used as single agents in the treatment of R/M HNSCC include docetaxel, paclitaxel, cetuximab, capecitabine, pemetrexed, and methotrexate. Best supportive care alone is often appropriate for poor performance status patients. Palliative radiation therapy is beneficial for treating symptomatic metastatic sites. Aggressive symptom management is imperative for all patients and often should include referral to experts in palliative care and pain management. New therapies currently under investigation include mTOR inhibitors, anti-angiogenic agents, and IGF1R inhibitors. Given the poor prognosis for most patients with R/M HNSCC, enrollment in clinical trials investigating novel approaches to therapy should be encouraged.

Intensity-modulated radiotherapy (IMRT)

2012-01-26T23:41:00.000-08:00

Improved outcomes in buccal squamous cell carcinoma; Lin CS, Jen YM, Kao WY, Ho CL, Dai MS, Shih CL, Cheng JC, Chang PY, Huang WY, Su YF; Head & Neck (Jan 2012)

BACKGROUND: The treatment results of buccal squamous cell carcinoma before and after 2002 were compared. METHODS: Two hundred forty-five patients with buccal cancer who underwent curative treatment were retrospectively reviewed. RESULTS: The 5-year overall survival rate was 30.0% before 2002 and 53.5% after 2002 (p = .004). On multivariate analysis, T classification, surgical margins, and treatment modality significantly affected overall survival, and N classification and histologic grade had trends to affect it. Invasion depth had a trend to influence locoregional control. For patients with early-stage disease without adverse factors, the locoregional control was similar between surgery alone group and surgery + radiotherapy group. CONCLUSION: The survival of patients with buccal cancer was improved after 2002, which represented the start of intensity-modulated radiotherapy (IMRT) in our institute. Ipsilateral neck alone irradiation was recommended for T1-2N0-1 and small T3N0 disease, and bilateral neck irradiation could be reserved for advanced disease.

Radio frequency is a rapidly evolving technique and in the future will have an increasing role to play in the endoscopic resection of intranasal and sinus tumors.

2012-01-26T23:39:00.001-08:00

Early experience of radio frequency coblation in the management of intranasal and sinus tumors; Syed MI, Mennie J, Williams AT; The Laryngoscope (Jan 2012)

The purpose of this study was to evaluate the safety and efficacy of the use of radiofrequency coblation for endoscopic resection of intranasal and sinus tumors. A review was conducted of 15 adult patients with intranasal and or sinus tumors endoscopically treated with radio frequency coblation between November 2008 and November 2010 at St. John's Hospital at Livingston, a tertiary referral center that covers otolaryngology services for the southeast of Scotland. Fifteen patients with intranasal and sinus tumors were treated with transnasal endoscopic resection using radiofrequency coblation. The tumors included inverted papilloma (seven), paraganglioma (one), glomangiopericytoma (one), capillary hemangioma (one), hemangiopericytoma (one), juvenile angiofibroma (one), juvenile ossifying fibroma (one), oncocytic adenoma (one), and transitional cell carcinoma (one). We found that radiofrequency coblation is a useful and safe tool associated with minimal blood loss (<200 mL to 600 mL) in the resection of these tumors, and the average operating time was 1.67 hours.

Combination therapy corticosteroids plus an oral antioxidant L-N-acetylcysteine (LNAC) was associated with improved hearing over corticosteroids alone

2012-01-26T23:38:00.000-08:00

L-N-Acetylcysteine treatment is associated with improved hearing outcome in sudden idiopathic sensorineural hearing loss; Angeli SI, Abi-Hachem RN, Vivero RJ, Telischi FT, Machado JJ; Acta Oto-Laryngologica (Jan 2012)

Abstract Conclusion: Combination therapy corticosteroids plus an oral antioxidant L-N-acetylcysteine (LNAC) was associated with improved hearing over corticosteroids alone, particularly at the 6-month follow-up and at high frequencies (i.e. 4000 Hz). This is the first report of a beneficial effect of LNAC in sudden idiopathic sensorineural hearing loss (SISNHL). Objective: To determine the association between antioxidant treatment and functional outcomes in SISNHL. Methods: This was a case-control study of adult patients with SISNHL, treated with oral prednisone plus intratympanic dexamethasone either alone or in combination with LNAC. The outcome measure was change in pure-tone thresholds at 500-4000 Hz. Hearing recovery was also recorded as the percentage of subjects with final pure-tone threshold average (PTA) within 50% of the difference between the initial value of the affected ear and the value of the unaffected ear. Comparisons were made between combination (corticosteroids plus LNAC) and single (no LNAC use) therapy groups. Results: At 6 months, the mean PTA improvements were 26.1 dB and 15.1 dB for the combination and single therapy groups, respectively (p = 0.046). Higher gains at 4000 Hz were noted with LNAC use. The percentage of patients with at least 50% recovery was 63% and 35% for the combination and single therapy groups, respectively (p = 0.0319).

Eeriparatide as an adjunctive modality for bisphosphonate-related osteonecrosis of the jaws (BRONJ)

2012-01-26T23:36:00.001-08:00

Short-term teriparatide therapy as an adjunctive modality for bisphosphonate-related osteonecrosis of the jaws; Kwon YD, Lee DW, Choi BJ, Lee JW, Kim DY; Osteoporosis International (Jan 2012)

To review the effect of teriparatide as an adjunctive modality for bisphosphonate-related osteonecrosis of the jaws (BRONJ), we describe a series of cases of teriparatide therapy for the treatment of BRONJ and serial changes of serum osteoclacin (s-OC) and serum C-terminal telopeptide cross-link of type I collagen (s-CTX). INTRODUCTION: Management of BRONJ is quite challenging and the currently recommended modalities for BRONJ are still suboptimal. For the improvement of bony remodeling, some clinicians advocated bisphosphonate holiday although validity of this drug holiday has been debated so far. Recently, the use of teriparatide was introduced in several cases, but the number of the publication is limited and mostly anecdotal so far. METHOD: Bisphosphonate was suspended and teriparatide was given to six patients diagnosed with BRONJ by single bone specialist. Medical record review and interviews were carried out. S-CTX and s-OC were measured at the baseline, 2 months and 3 months later teriparatide therapy. The outcome of the treatment and the change of biochemical markers were compared. RESULT: In all six patients, s-OC values were significantly elevated within 2 months after teriparatide treatment and the BRONJ lesions were healed. S-CTX values were also elevated in four patients, whereas those of the rest two patients stayed within minimal change. The change was marginally significant at 3 months. CONCLUSION: In terms of the multifactorial etiology of BRONJ, bone formation suppression was noticed in the patients. Based upon this finding, the short-term use of teriparatide might be beneficial to the resolution of BRONJ lesions by improving suppressed bone remodeling.

Application of a sternocleidomastoid (SCM) flap is an efficient method by which to prevent Frey’s syndrome, and the galvanic skin responses (GSR) test is beneficial both in diagnosiing and determining the severity of the disease as well as evaluating the efficacy of surgical techniques used to prevent Frey’s syndrome.

2012-01-24T08:25:00.001-08:00

Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy
Indian Journal of Otolaryngology and Head & Neck Surgery, 01/20/2012

Surface Electromyography (SEMG) assessment of analgesia in treatment of posttonsillectomy pain

2012-01-24T08:23:00.000-08:00

In surface electromyography (SEMG), the electrical activity of individual muscles or muscle groups is detected, amplified, and analyzed by a computer. The most basic information obtainable from an EMG signal is whether the tested muscle was used during a period of exertion. The test has legitimate use for analyzing certain types of performance in the workplace.

EMG assessment of analgesia in treatment of posttonsillectomy pain: random allocation, preliminary report
The Clinical Journal of Pain, 01/18/2012

Vaiman M et al. – sEMG might be used for quantitative evaluation of analgesic drugs by assessment of muscular reactions to pain and to analgesia. This method might add quantitative justification to the information obtained by VAS pain testing and clinical data.

Subannular Tube vs Repetitive Transtympanic Tube Technique

2012-01-24T08:20:00.001-08:00

Archives of Otolaryngology, 01/20/2012 Clinical Article

Saliba I et al. – Insertion of an SAT is a safe and effective method for long–term middle ear ventilation in recurrent or refractory otitis media (OM), adhesive OM, and retracted tympanic membrane. Associated with fewer complications, subannular T–tube (SAT) offer an alternative to repeated use of the short–term transtympanic Duravent tube (TTT) without damaging the tympanic membrane.

Interventions that achieve substantial reductions in house dust mite (HDM) load may offer some benefit in reducing rhinitis symptoms.

2012-01-24T08:19:00.001-08:00

House dust mite avoidance measures for perennial allergic rhinitis
Allergy, 01/16/2012

Nurmatov U et al. – Trials have tended to be small and of poor methodological quality, making it difficult to offer any definitive recommendations. Interventions that achieve substantial reductions in house dust mite (HDM) load may offer some benefit in reducing rhinitis symptoms. Isolated use of HDM impermeable bedding is unlikely to prove effective.

Physiologic saline irrigation is beneficial in the treatment of symptoms of chronic rhinosinusitis (CRS).

2012-01-24T08:18:00.001-08:00

Nasal irrigation with or without drugs: the evidence
Current Opinion in Otolaryngology and Head & Neck Surgery, 01/17/2012 Clinical Article

Adappa ND et al. – Physiologic saline irrigation is beneficial in the treatment of symptoms of chronic rhinosinusitis (CRS). Low–level evidence supports the effectiveness of topical antibiotics in the treatment of CRS. The use of topical antifungals is not supported by the majority of studies. Intranasal steroids are beneficial in the treatment of CRS with nasal polyposis. There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without nasal polyposis.

Significantly less intraoperative or postoperative complications and morbidity in coblation tonsillectomy in comparison with traditional method. Coblation was associated with less pain and quick return to normal diet and daily activity. These findings addressed coblation tonsillectomy as an advanced method.

2012-01-24T08:17:00.001-08:00

Coblation versus traditional tonsillectomy: A double blind randomized controlled trial
Journal of Research in Medical Sciences, 01/19/2012

Περί Εὐσχημοσύνης

2012-01-20T01:52:00.001-08:00

Μετάγειν δή τήν σοφίην ἐς τήν ἰατρικήν καί τήν ἰατρικήν ἐς τήν σοφίην∙ ἰατρός γάρ φιλόσοφος ἰσόθεος.

Πρέπει να ανάγει κανείς την Φιλοσοφία στην Ιατρική και την Ιατρική στην Φιλοσοφία∙ διότι ο Ιατρός που είναι και Φιλόσοφος ανέρχεται σε θεϊκό επίπεδο.

Ἱπποκράτης, Περί Εὐσχημοσύνης.

Outcomes of patients managed with different routes of enteral feeding during chemoradiotherapy for oropharynx cancer

2012-01-19T23:35:00.001-08:00

Enteral feeding outcomes after chemoradiotherapy for oropharynx cancer: A role for a prophylactic gastrostomy?; Williams GF, Teo MT, Sen M, Dyker KE, Coyle C, Prestwich RJ; Oral Oncology (Dec 2011)

The hospital and dietetic records of consecutive patients with oropharynx squamous cell carcinoma treated between January 2007 and June 2009 with concurrent chemoradiotherapy were reviewed retrospectively. One hundred and four patients were analysed. Seventy-one received a prophylactic gastrostomy, 21 were managed with a strategy of NG tube as required and 12 received a therapeutic gastrostomy. Patients with a prophylactic gastrostomy commenced enteral feeding a median of 24days after commencing radiotherapy, compared with a median of 41days (p<0.001) for the NG as required group. Comparing prophylactic gastrostomy, NG as required and therapeutic gastrostomy, median number of unplanned inpatient days were 6, 14 and 7, respectively (p<0.01 for prophylactic gastrostomy vs. NG as required). Mean percentage weight loss at the end of treatment (6.1% vs. 7.1% vs. 5.2%, respectively) and at 6months post-radiotherapy (11.7%, 14.3% and 8.9%) were similar in all groups (p=0.23). There was no significant difference in type of diet post-radiotherapy between prophylactic gastrostomy and NG as required groups (p=0.22). Median duration of enteral feeding was 181, 64 and 644days, respectively (p<0.01 for prophylactic gastrostomy vs. NG as required). Use of a prophylactic gastrostomy (p<0.01) and higher T stage (p<0.01) were associated with increased duration of enteral feeding on a multivariate analysis. These data reinforce concerns regarding the detrimental impact of prophylactic gastrostomy placement upon long-term enteral feed dependence.

Re-irradiation is an attractive alternative treatment for selected inoperable patients and its effectiveness can be potentiated by systemic treatments such as chemotherapy or targeted therapy. The development of new radiotherapy techniques such as IMRT and SBRT has improved healthy tissues tolerance and future studies should help define the specific IMRT and SBRT indications.

2012-01-19T23:34:00.000-08:00

Evidence based and new developments in re-irradiation for recurrent or second primary head and neck cancers; Mouttet-Audouard R, Gras L, Comet B, Lartigau E; Current Opinion in Otolaryngology & Head and Neck Surgery (Jan 2012)

PURPOSE OF REVIEW: The standard treatment for recurrent or second primary head and neck cancers is surgery which can only be performed in 25% of the patients. For inoperable patients, three options can be discussed: supportive care only, chemotherapy or radiotherapy with or without chemotherapy. The goal of this article is to review the indications and new developments in re-irradiation for recurrent or second primary head and neck cancers.

RECENT FINDINGS: The le Groupe d'Etude des Tumeurs de la Tête et du Cou (GETTEC)-le Groupe d'Oncologie et de Radiothérapie Tête et Cou (GORTEC) (99-01) trial showed that radio-chemotherapy improved disease-free survival for a highly selected population. All conventional and conformational radiotherapy series showed improved local control and disease-free survival rates, but at the expense of acute and late toxicities demanding a drastic patients selection. New radiotherapy techniques such as intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) have improved oncological results with reduced toxicities, offering treatments which are spread over six to seven weeks for IMRT and two weeks for SBRT.

Facial animation represents a difficult challenge for the reconstructive surgeon

2012-01-19T23:32:00.000-08:00

Facial nerve coaptation technique with masseteric nerve, babysitter procedures, and neuromuscular transplantation represent today the gold standard for facial reanimation after facial nerve sacrifice.

Surgeon's experience and patient selection have to be considered as other important factors for surgical approach selection.

Facial reanimation after nerve sacrifice in the treatment of head and neck cancer; Bianchi B, Ferri A, Sesenna E; Current Opinion in Otolaryngology & Head and Neck Surgery (Jan 2012)

This article reviews literature on the facial reanimation technique, from direct facial nerve repair and grafting to neuromuscular-free transplantation. The discussion will focus on the indications of the different approaches based on timing of the facial palsy and on patient's features.

Facial animation represents a difficult challenge for the reconstructive surgeon. A large number of surgical techniques and modifications have been published, and the appropriate approach must be selected based on the kind of facial palsy, its timing, and the patient's age, prognosis, and general condition. A complete grasp of all the approaches that allows for a target surgery represents today an essential assumption for the facial reanimation.

It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate

2012-01-19T23:29:00.000-08:00

Coprevalence of Anxiety and Depression With Spasmodic Dysphonia: A Case-Control Study; White LJ, Hapner ER, Klein AM, Delgaudio JM, Hanfelt JJ, Jinnah HA, Johns MM; Journal of Voice (Dec 2011)

INTRODUCTION:

There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD.

MATERIALS AND METHODS:

A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. RESULTS: One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR]=0.985, 95% confidence interval [CI]=0.59-1.63; and OR=1.314; 95% CI=0.75-2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups.

CONCLUSION:

Patients with SD were no more likely to have depression or anxiety than those with other voice disorders.

HNSCC patients receiving concurrent cisplatin and radiation, ERCC1 expression was not a significant predictor of survival or response

2012-01-19T23:28:00.000-08:00

ERCC1 Expression and Outcomes in Head and Neck Cancer Treated with Concurrent Cisplatin and Radiation; Hayes M, Lan C, Yan J, Xie Y, Gray T, Amirkhan RH, Dowell JE; Anticancer Research 31 (12), 4135-9 (Dec 2011)

BACKGROUND

Overexpression of excision repair cross complementing group 1 (ERCC1), a DNA repair enzyme, is associated with resistance to cisplatin.

MATERIALS AND METHODS

Tissues from 73 patients with squamous cell carcinoma of the head and neck (HNSCC) who received concurrent cisplatin and radiation was analyzed immunohistochemically to determine if ERCC1 expression predicted for survival and response. Expression was scored as follows: 0=0% tumor nuclei positive, 1+=<50%, 2+=50-75% and 3+=>75%.

RESULTS

ERCC1 expression was 0 in 0%, 1+ (14%), 2+ (42%) and 3+ (44%). In uni- and multivariate analyses, 3+ ERCC1 expression was not a significant predictor of survival or response. Median survival for the ERCC1 3+ patients was 2.9 years versus 2.1 years for the ERCC1<3+ group (p=0.44).

Bortezomib in combination with radiation therapy and cisplatin chemotherapy is safe in the treatment of HNC with a bortezomib maximum tolerated dose of 1.0 mg/m(2) in patients previously treated for HNC and 1.3 mg/m(2) in radiation-naive patients.

2012-01-19T23:26:00.000-08:00

Phase I Trial Using the Proteasome Inhibitor Bortezomib and Concurrent Chemoradiotherapy for Head-and-Neck Malignancies; Kubicek GJ, Axelrod RS, Machtay M, Ahn PH, Anne PR, Fogh S, Cognetti D, Myers TJ, Curran WJ, Dicker AP; International Journal of Radiation Oncology, Biology and Physics (IJROBP Online) (Jan 2012)

PURPOSE:

Advanced head-and-neck cancer (HNC) remains a difficult disease to cure. Proteasome inhibitors such as bortezomib have the potential to improve survival over chemoradiotherapy alone. This Phase I dose-escalation study examined the potential of bortezomib in combination with cisplatin chemotherapy and concurrent radiation in the treatment of locally advanced and recurrent HNC.

METHODS AND MATERIALS:

Eligible patients received cisplatin once weekly at 30 mg/m(2) per week and bortezomib along with concurrent radiation. Bortezomib was given on Days 1, 4, 8, and 11 every 3 weeks, with an initial starting dose of 0.7 mg/m(2) and escalation levels of 1.0 and 1.3 mg/m(2). Dose escalation was performed only after assessment to rule out any dose-limiting toxicity.

RESULTS:

We enrolled 27 patients with HNC, including 17 patients with recurrent disease who had received prior irradiation. Patients received bortezomib dose levels of 0.7 mg/m(2) (7 patients), 1.0 mg/m(2) (10 patients), and 1.3 mg/m(2) (10 patients). No Grade 5 toxicities, 3 Grade 4 toxicities (all hematologic and considered dose-limiting toxicities), and 39 Grade 3 toxicities (in 20 patients) were observed. With a median follow-up of 7.4 months, the overall median survival was 24.7 months (48.4 months for advanced HNC patients and 15.4 months for recurrent HNC patients).

The HPV status may augment the predictive utility of an initial negative PET/CT result.

2012-01-19T23:24:00.000-08:00

The benefit of early PET/CT surveillance in HPV-associated head and neck squamous cell carcinoma; Zhang I, Branstetter BF, Beswick DM, Maxwell JH, Gooding WE, Ferris RL; Archives of Otolaryngology - Head and Neck Surgery 137 (11), 1106-11 (Nov 2011)

OBJECTIVE

To evaluate the ability of posttreatment positron emission tomography and computed tomography (PET/CT) to predict ultimate disease status in patients with head and neck squamous cell carcinoma and known human papillomavirus (HPV) status.

DESIGN : Retrospective.

SETTING : Single tertiary academic referral center.

PATIENTS

Clinical and radiographic data, including HPV status, were available for 62 patients with head and neck squamous cell carcinoma who underwent treatment from 2005 to 2010.

MAIN OUTCOME MEASURES

The first posttreatment PET/CT scan, performed between 4 and 16 weeks (median, 9 weeks) after treatment, was categorized as negative, probably negative, or positive for residual disease. The PET/CT and clinical follow-up results, including disease status, were obtained every 3 months thereafter.

RESULTS

Among the 62 patients, 35 results (56%) were negative, 15 (24%) were probably negative, and 12 (19%) were positive. Eight of the 27 HPV-negative patients were PET/CT positive compared with 4 of the 35 HPV-positive patients (Cochran-Armitage trend test, P = .11). The median follow-up for disease-free patients was 21 months from the completion of the treatment. Disease-free survival was associated with PET/CT outcome (log-rank P < .001) and HPV status (log-rank P = .01). Using recurrence at 2 years as a reference standard, the early PET/CT scans had a specificity of 69% (95% confidence interval [CI], 46%-91%) and a negative predictive value of 79% (95% CI, 57%-99%). All PET/CT-negative HPV-positive patients (n = 6) were free of disease at 2 years, although this proportion was not statistically different from the PET/CT-negative HPV-positive patients in this small cohort.

CONCLUSIONS

A negative posttreatment PET/CT result may have the potential to identify patients who are at very low risk of recurrence. The HPV status may augment the predictive utility of an initial negative PET/CT result.

Surgery is the main treatment modality for adenoid cystic carcinoma (ACC) originated from the head and neck. However, the extensive local infiltrative and perineural spread related to this malignancy often cause difficulty to achieve high tumor control.

2012-01-19T23:21:00.000-08:00

Treatment outcomes and prognostic features in adenoid cystic carcinoma originated from the head and neck; Shen C, Xu T, Huang C, Hu C, He S; Oral Oncology (Dec 2011)

The aim of this study is to evaluate the efficacy of postoperative radiotherapy (RT) in ACC, and to identify prognostic variables associated with treatment outcomes.

A retrospective review of 101 patients diagnosed with ACC in the head and neck region was performed. T stage distribution was T1, 25; T2, 35; T3, 18; and T4, 23 patients.

All patients were grouped into two arms: surgery alone or combined with postoperative radiotherapy. The 5-year local-regional control (LRC), overall survival (OS) and disease-free survival (DFS) rates for all the patients were 70.5%, 91.7% and 63.2%, respectively. On univariant analysis, postoperative radiotherapy did improve the 5-year LRC and DFS compared to surgery alone (81.0% vs. 53.4%, p=0.0003 and 71.3% vs. 50.0%, p=0.0052, respectively). And patients with T1-T2 lesions achieved better treatment outcomes, whereas stage T3-T4 was associated with high local failure and poor disease-free survival. Furthermore, multivariate analysis revealed that the addition of radiotherapy and early lesions were both favorite predictors for local control and survival rates. The prognosis for ACC of the head and neck was excellent. Surgery combined with postoperative radiotherapy significantly reduced the local failure, and further improved disease-free survival. Nevertheless, the relatively high distant metastasis was an obstacle of curing the ACC patients.

Treatment selection for larynx preservation should not merely be decided by guidelines but considering each patient's individual condition. Head and neck surgeons are encouraged to take reasonable risks in performing salvage larynx preservation surgery when it is the only option to save a functioning larynx.

2012-01-19T23:19:00.000-08:00

Functional Organ Preservation for Laryngeal Cancer: Past, Present and Future; Nakayama M, Laccourreye O, Holsinger FC, Okamoto M, Hayakawa K; Japanese Journal of Clinical Oncology (Jan 2012)

OBJECTIVE:

Management of laryngeal cancer has focused on improving survival while preserving function. Over the past 20 years, the trends have shifted from surgery to chemoradiotherapy and presently we are facing various challenges. It is imperative to re-examine what has happened and what can be done.

METHODS:

Review of the literature along with our experience in the management of functional organ preservation for laryngeal cancer.

RESULTS:

There was an increasing use of chemoradiotherapy with a decreasing use of surgery. Inappropriate patient selection along with inability to properly apply salvage surgeries have been presumed to be responsible for survival deterioration in laryngeal cancer. Reports concerning late adverse events after chemoradiotherapy are also increasing. Reconfirmation of the multidisciplinary team approach is imperative. Transoral laser microsurgery can be used for early laryngeal cancer and, in some experienced institutes, for advanced-stage cancers. Supracricoid laryngectomy demonstrated satisfactory oncologic and functional outcomes, based on our experience.

Susac syndrome is a mysterious vasculopathy affecting brain, retina and inner ear in young women

2012-01-19T23:18:00.000-08:00

Susac syndrome; Papo T, Klein I, Sacré K, Doan S, Bodaghi B, Aubart-Cohen F; Revue de Medecine Interne (Dec 2011)

Susac syndrome is a mysterious vasculopathy affecting brain, retina and inner ear in young women. Main features of the disease are increasingly recognized:

subacute encephalopathy often mimicking psychosis

and frequently heralded with unusual ophthalmic migraine;

frequent subclinical meningitis;

brain MRI with multiple and bilateral white and gray matter nuclei lesions,

with prominent involvement of corpus callosum;

bilateral involvement of central retina artery branches,

not only with occlusions but also with peculiar leakage of fluorescein through arteriolar walls on late stages of angiography;

non-specific bilateral cochleovestibular symptoms with audiogram showing perception hypoacousia that predominates on low frequencies.

A key message for the clinician should be to perform brain MRI, audiogram and retinal angiography whatever the mode of entry, in order not to miss one (or two) features of this syndrome triad.

Neurofibromatosis type 2 (NF2) gene inactivation by promoter hypermethylation is a rare or very uncommon mechanism of NF2 gene inactivation in sporadic VS. Other mechanisms destabilizing the NF2 gene product, yet to be identified, might play a role in the genesis of VS apart from the loss or mutation of the NF2 gene.

2012-01-17T23:28:00.000-08:00

Lack of Neurofibromatosis Type 2 Gene Promoter Methylation in Sporadic Vestibular Schwannomas
Journal for Oto-Rhino-Laryngology, 01/17/2012

Bone work is generally taught well in all temporal bone workshops but no emphasis is laid on soft tissue work hence the failure and recurrence. Thus the authors emphasize the need to teach the budding otologists the importance of and proper technique of meatoplasty.

2012-01-17T23:26:00.000-08:00

Cartilage is usually removed from around the ear canal opening whilst preserving the overlying skin. The skin is then stitched to the underling tissues to open up the canal. Another variant is to split the skin of the ear canal and move one of a number of local skin flaps into the split and so widening it and the canal.

Gustatory rhinitis is a conspicuous type of food–associated rhinorrhea, which can occasionally be associated with significant quality–of–life impairment.

2012-01-17T23:23:00.000-08:00

Gustatory rhinitis
Current Opinion in Otolaryngology and Head & Neck Surgery, 01/16/2012

Georgalas C et al. – Gustatory rhinitis is a conspicuous type of food–associated rhinorrhea, which can occasionally be associated with significant quality–of–life impairment. It results from an abnormal gustatory reflex associated with a hyperactive, nonadrenergic, noncholinergic, or peptidergic neural system. The use of nasal ipratropium bromide may be effective, if avoidance is not possible or successful. The authors have had excellent results with the use of intranasal capsaicin or endoscopic vidian neurectomy (including removal of 4–5mm of the nerve between pterygopalatine fossa and the sphenoid floor) in patients with nonallergic rhinitis, and these could potentially be used as a last resort in patients with intractable gustatory rhinitis.

Surgery and adjuvant radiotherapy offer the best chance for cure for patients with resectable adenoid cystic carcinomas of the head and neck. Some patients with advanced, incompletely resectable disease can be cured with radiotherapy alone. elective nodal irradiation (ENI) should be considered for primary sites located in lymphatic–rich regions.

2012-01-17T23:21:00.001-08:00

Adenoid cystic carcinoma of the head and neck
American Journal of Otolaryngology, 01/09/2012

Transnasal endoscopic examination is suggested to be the most appropriate method to assess the amount of residual adenoid tissue after conventional curettage adenoidectomy. The residual adenoid tissue with the help of a microdebrider in case of a large residual adenoid tissue located in the choana are necessary for complete adenoidectomy.

2012-01-17T23:20:00.001-08:00

Is Transnasal Endoscopic Examination Necessary Before and After Adenoidectomy?
Indian Journal of Otolaryngology and Head & Neck Surgery, 01/12/2012

Arytenoid adduction (AA) combined with ansa cervicalis–recurrent laryngeal nerve anastomosis (ACN-RLN) in the treatment of unilateral vocal fold paralysis.

2012-01-16T23:44:00.000-08:00

Vocal Outcome After Arytenoid Adduction and Ansa Cervicalis Transfer

Megahed M. Hassan, MD; Eiji Yumoto, MD; Yoshihiko Kumai, MD; Tetsuji Sanuki, MD; Narihiro Kodama, BA

Arch Otolaryngol Head Neck Surg. 2012;138(1):60-65. doi:10.1001/archoto.2011.228

Objective To evaluate the long-term efficacy of arytenoid adduction (AA) combined with ansa cervicalis–recurrent laryngeal nerve anastomosis (ACN-RLN) in the treatment of unilateral vocal fold paralysis.

Design Retrospective review of clinical records.

Setting Institutional practice.

Patients Nine patients with severe paralytic dysphonia with large glottal gap were included. Voice outcome was followed up over 24 months postoperatively. One patient did not attend the 24-month evaluation.

Interventions All patients underwent AA + ACN-RLN. The ansa cervicalis nerve to the sternohyoid muscle was used as the donor nerve.

Main Outcome Measures Maximum phonation time (MPT), pitch range, harmonics-to-noise ratio (HNR), and perceptual voice quality were evaluated preoperatively and postoperatively at 1 to 3 months, 6 to 8 months, 12 to 14 months, and 24 months.

Results All parameters improved significantly after surgery and continued to improve over the 24-month period. The MPT continued to improve over time (P = .01,P = .006, and P = .001 when comparing the 1- to 3-month evaluation with the 6- to 8-month, 12- to 14-month, and 24-month evaluations, respectively). Also, pitch range and HNR showed significant, steady improvement over the 24-month duration of the study. Perceptual voice quality markedly improved at 24 months compared with the 1- to 3-month, 6- to 8-month, and 12- to 14-month follow-ups (P = .004, P = .005, and P = .02, respectively, for grade overall, and P = .004,P = .008, and P = .02, respectively, for breathiness grade).

Conclusions Treatment with AA + ACN-RLN provides near-normal vocal function in the 24-month follow-up. Therefore, this method could be a successful surgical treatment for severe paralytic dysphonia.

Male patients with SSNHL had a higher proportion of prior OSA than non-SSNHL-diagnosed controls; no such association was found among female patients

2012-01-16T23:42:00.001-08:00

Association Between Obstructive Sleep Apnea and Sudden Sensorineural Hearing Loss

A Population-Based Case-Control Study

Jau-Jiuan Sheu, MD, MPH; Chuan-Song Wu, MD, MPH; Herng-Ching Lin, PhD

Arch Otolaryngol Head Neck Surg. 2012;138(1):55-59. doi:10.1001/archoto.2011.227

Objective To examine the putative association between obstructive sleep apnea (OSA) and sudden sensorineural hearing loss (SSNHL) using a nationwide population-based data set. Obstructive sleep apnea has been associated with generalized inflammation and nervous-endocrine, cardiovascular, and other systemic biophysiologic phenomena. However, to our knowledge, no investigations have been conducted using large data sets to examine the association between OSA and auditory disorders.

Design Case-control study.

Participants We identified 3192 patients diagnosed with SSNHL from the Taiwan Longitudinal Health Insurance Database as the study group and randomly extracted the data of 15 960 subjects matched by sex, age and year of first SSNHL diagnosis as controls.

Main Outcome Measures Cases of OSA were identified by having been diagnosed as OSA prior to the index date of SSNHL diagnosis. Conditional logistic regression matched on age group and sex was used to assess the possible association between SSNHL and OSA among the sampled patients.

Results Of 19 152 patients, 1.2% had OSA diagnoses prior to the index date; OSA was diagnosed in 1.7% of the SSNHL group and 1.2% of the controls. After adjusting for sociodemographic characteristics and co-morbid medical disorders, we found that male patients with SSNHL were more likely to have prior OSA than controls (odds ratio, 1.48; 95% CI, 1.02-2.16) (P = .04). No such association was found among female patients.

Conclusions Male patients with SSNHL had a higher proportion of prior OSA than non-SSNHL-diagnosed controls; no such association was found among female patients. Further study will be needed to confirm our findings, explore the underlying pathomechanisms, and investigate the difference between sexes.

Nasoseptal Cholesterol Granuloma

2012-01-16T23:41:00.001-08:00

Arjuna B. Kuperan, MD; Megan M. Gaffey, MD; Paul D. Langer, MD; Neena M. Mirani, MD; James K. Liu, MD; Jean Anderson Eloy, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):83-86. doi:10.1001/archoto.2011.218

Cholesterol granulomas are rare inflammatory deposits that can be located corporally, but are classically found in the petrous apex and other pneumatized areas of the temporal bone. Originally thought to be a response to hypoventilation due to mucosal swelling and occlusion of air cells, the pathogenesis of cholesterol granulomas recently has come under speculation. This is partly due to new theories of the importance of a rich blood supply in the lesion's development. Cholesterol granulomas have been reported in uncommon areas of the head and neck, such as surrounding the endolymphatic sac and pterygoid process of the sphenoid sinus.¹ This entity has been described within the paranasal sinuses, including the maxillary, ethmoid, sphenoid, and frontal sinus locations. To our knowledge, we report the first case of a nasoseptal cholesterol granuloma.

Cholesterol granulomas are rare, benign cysts that can occur at the tip of the petrous apex, a part of the skull that is next to the middle ear. The cysts are expanding masses that contain fluids, lipids, and cholesterol crystals surrounded by a fibrous lining.
Granulomas can occur throughout the body as a reaction to foreign material. They usually have no symptoms or serious effects. However, cholesterol granulomas of the petrous apex are dangerous because of their proximity to the ear and several important nerves. Permanent hearing loss, nerve damage, and bone destruction can occur if the mass is left untreated and continues to expand.
Cholesterol granulomas can form when the air cells in the petrous apex are obstructed. The obstruction creates a vacuum that causes blood to be drawn into the air cells. As red blood cells break down, cholesterol in the hemoglobin is released. The immune system reacts to the cholesterol as a foreign body, producing an inflammatory response. Associated small blood vessels rupture as a result of the inflammation. Recurrent hemorrhaging makes the mass expand.
The surgical approach depends on the location of the cyst and the status of the patient's hearing. At UPMC, the preferred surgical approach for cholesterol granulomas is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.

Continuing progress in the surgical management of congenital skull base defects demonstrates that endoscopic repair is a successful alternative to traditional craniotomy approaches, with less morbidity.

2012-01-16T23:39:00.000-08:00

Congenital Intranasal Skull Base Defects

Bradford A. Woodworth, MD; Rodney J. Schlosser, MD; Russell A. Faust, PhD, MD; William E. Bolger, MD

Arch Otolaryngol Head Neck Surg. 2004;130:1283-1288.

Background Congenital skull base defects have traditionallybeen treated via an intracranial approach. Recent advances inendoscopic management have made minimally invasive extracranialapproaches feasible, with less morbidity.

Objective To determine the success of endoscopic treatmentof congenital cerebrospinal fluid leaks and encephaloceles.

Main Outcome Measures Retrospective review of congenitalcerebrospinal fluid leaks and encephaloceles treated from January1, 1992, to December 31, 2003. Data collected include demographiccharacteristics, presenting signs/symptoms, site of the skullbase defect, surgical approach, repair technique, and clinicalfollow-up.

Results Eight patients were treated via the endoscopicapproach for congenital cerebrospinal fluid leaks and encephaloceles.The average age at presentation was 6 years (range, birth to18 years). Three patients presented with meningitis (averageage, 6 years), 4 had cerebrospinal fluid rhinorrhea, and 3 developeda nasal obstruction. Five defects originated at the foramencecum, and 3 others involved the ethmoid roof/cribriform plateonly. Our endoscopic approaches were successful on the firstattempt, with a mean follow-up of 19 months. One patient experiencednasal stenosis postoperatively.

Conclusions Continuing progress in the surgical managementof congenital skull base defects demonstrates that endoscopicrepair is a successful alternative to traditional craniotomyapproaches, with less morbidity. This technique requires meticulouspreparation and precise grafting of the defect to avoid collateraldamage to surrounding structures. While reduction in the riskof meningitis, intracranial complications, and facial growthabnormalities and alleviation of nasal obstruction necessitatethe timely repair of these skull base defects, special considerationsare discussed regarding the optimal timing of surgical intervention,operative working space, and exposure in a smaller nasal cavity.

Sialendoscopy is useful for the improvement of symptoms due to radioiodine-induced sialadenitis in patients who are refractory to conservative medical therapy. Therapeutic sialendoscopy appears to provide effective and sustained symptom improvement in most patients in our experience.

2012-01-16T23:37:00.001-08:00

Therapeutic Sialendoscopy for the Management of Radioiodine Sialadenitis

Brandon L. Prendes, MD; Lisa A. Orloff, MD; David W. Eisele, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):15-19. doi:10.1001/archoto.2011.215

Objective To describe our experience with therapeutic sialendoscopy for radioiodine (iodine 131 [¹³¹I]) sialadenitis.

Design Retrospective medical chart review.

Setting Academic tertiary referral center.

Patients The study included 11 patients who underwent therapeutic sialendoscopy for the treatment of ¹³¹I sialadenitis after failing medical management.

Interventions Therapeutic sialendoscopy with dilation and irrigation of the ductal system was performed in all patients.

Main Outcome Measures Patient-reported frequency and severity of symptoms.

Results Our series included 9 women and 2 men (mean age, 51 years; age range, 35-65 years). A total of 23 parotid glands and 5 submandibular glands were treated. Sialendoscopy was possible in all patients, except one in whom the Stensen duct could not be cannulated. Typical endoscopic findings included pale ductal mucosa, thick mucous plugs, ductal debris, and stenosis of the duct. Most patients (91%) reported improvement of symptoms after a single procedure. Complete resolution of symptoms, with sustained benefit, was reported by 6 patients (54%) at a mean follow-up of 18 months. Partial improvement of symptoms, with some persistent intermittent episodes of pain or swelling, was reported by 4 patients (36%). One patient reported no subjective symptomatic improvement after 2 procedures and subsequently underwent a parotidectomy.

Most infantile hemangiomas do not require treatment. Surgical excision of auricular infantile hemangiomas at any phase is effective in preventing fibrofatty scarring, reducing cartilage deformities, and treating complicated cases or patients who have failed medical management. Surgical excision with Z-plasty reconstruction is a viable option that should be considered to limit postoperative deformities.

2012-01-16T23:36:00.001-08:00

Auricular Infantile Hemangiomas

Opeyemi O. Daramola, MD; Robert H. Chun, MD; Joseph E. Kerschner, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):72-75. doi:10.1001/archoto.2011.207

Objective To report our experience with surgical management of auricular infantile hemangiomas and reconstruction of the affected ear.

Design Retrospective case series.

Setting Dedicated Birthmarks and Vascular Anomalies Center in a tertiary pediatric hospital.

Patients Ten patients with surgically treated, histopathologically confirmed auricular infantile hemangiomas.

Main Outcome Measures Outcomes of surgical management.

Results The case series included 5 male and 5 female patients (age range, 4 months to 4 years). Indications for surgery were pain, bleeding, infection, and cosmetic deformity. Four patients had failed prior medical treatment, including pulsed dye laser, topical corticosteroids, and intralesional corticosteroids. Nine patients underwent single-stage resection. Otoplasty reconstruction was performed in 2 patients with hemangioma-induced deformities, while primary Z-plasty closure was performed in 2 patients with extensive lesions. No recurrence or complication has been reported to date.

Jugular bulb abnormalities can erode into the vestibular aqueduct, facial nerve, and the posterior semicircular canal.

2012-01-16T23:34:00.000-08:00

Jugular Bulb Abnormalities

David R. Friedmann, MD; Jan Eubig, MD; Leon S. Winata, BA; Bidyut K. Pramanik, MD; Saumil N. Merchant, MD; Anil K. Lalwani, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):66-71. doi:10.1001/archoto.2011.231

Objective To further define the spectrum of clinical presentation and explore the histologic sequelae of jugular bulb abnormalities (JBAs).

Design Retrospective review.

Setting Academic medical center.

Patients Thirty patients with radiologic evidence of inner ear dehiscence by JBA.

Main Outcome Measure Thirty patients with radiologic inner ear dehiscence by JBA and 1579 temporal bone specimens were evaluated for consequences from JBA.

Results We found that JBA-associated inner ear dehiscence could be identified on computed tomography of the temporal bone but not on magnetic resonance imaging scan. Jugular bulb abnormalities eroded the vestibular aqueduct most often (in 25 patients), followed by the facial nerve (5 patients) and the posterior semicircular canal (4 patients). Half of the patients (15) were asymptomatic. Results from vestibular evoked myogenic potential (VEMP) tests were positive in 8 of 12 patients with inner ear dehiscence. Histologically, only 2 of 41 temporal bones with dehiscence of the vestibular aqueduct demonstrated endolymphatic hydrops.

Conclusions Jugular bulb abnormalities can erode into the vestibular aqueduct, facial nerve, and the posterior semicircular canal. While symptoms may include pulsatile tinnitus, vertigo, or conductive hearing loss, in contrast to earlier reports, half of the patients were asymptomatic. Dehiscence of vestibular aqueduct rarely leads to clinical or histologic hydrops. The VEMP testing was useful in confirming the presence of inner ear dehiscence due to JBAs. Because the natural history of JBAs is unknown, these patients should be followed closely to evaluate for progression of the JBA or development of symptoms.

Heterotopic ossification of the vocal cords was found to be an early complication of acute spinal cord injury and multiple trauma. This rare complication should be considered in the differential diagnosis of patients showing signs of upper airway obstruction.

2012-01-16T23:33:00.000-08:00

Heterotopic ossification (HO) is a metabolic disorder, characterized by new lamellar bone formation in sites outside the normal skeletal structure. It may occur in the periarticular regions, particularly after trauma to the brain or spinal cord and less frequently in nontraumatic central nervous system (CNS) disorders. HO has also been associated with other processes such as joint replacement surgery,burns, and rarely in peripheral nerve disorders. The incidence of HO after trauma to the CNS varies from 16% to 53% .

Prolonged intubation, a life-saving procedure in major trauma insults, may, in itself, cause trauma to the larynx, including scarring of the posterior commissure and the cricoarytenoid joints. We present an unusual case of HO involving both vocal cords after acute spinal cord injury (SCI) and multiple trauma.

Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia

2012-01-16T23:28:00.000-08:00

Surgical division or reconstruction of shortened aryepiglottic folds in children with severe stridor or respiratory obstruction due to laryngomalacia.

Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome

Dylan K. Chan, MD, PhD; Mai Thy Truong, MD; Peter J. Koltai, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):50-54. doi:10.1001/archoto.2011.233

Objective To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia.

Design Retrospective case series with medical chart review.

Setting Tertiary pediatric medical center.

Patients Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded.

Intervention Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS.

Main Outcome Measure Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically.

Results Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP.

Laryngomalacia is usually a self-limited condition, but it can be associated with gastroesophageal reflux, neuromotor disease, and obstructive apnea.Infants with severe laryngomalacia may require supraglottic surgery to prevent the consequences of neonatal upper airway obstruction.

Holinger described several patterns of inspiratory supraglottic collapse, one or more of which are found in each infant with laryngomalacia: inward aryepiglottic fold collapse (type 1), tubular epiglottic shape (type 2), anterior-medial collapse of the arytenoids (type 3), posterior epiglottic displacement (type 4), short aryepiglottic folds (type 5), and an acutely angled epiglottis at the petiole (type 6).

The mainstay of surgical treatment has been resection of the aryepiglottic fold.Resection of a portion of the aryepiglottic fold has been shown to be effective,but simple incision of the aryepiglottic fold improved almost 90% of children with severe laryngomalacia in one series.The need to lengthen the aryepiglottic fold is highlighted by Manning and colleagues,who found lower aryepiglottic fold length-glottic length ratios in children requiring surgery for laryngomalacia when compared with controls.

Supraglottoplasty has been performed with “cold” microsurgical instruments and the CO₂ laser.Supraglottic stenosis and interarytenoid adhesion have been described as complications, scarring that has a much poorer prognosis than laryngomalacia itself. Kelly and Gray used unilateral supraglottoplasty as a means of reducing the potential for such complications, although staged surgery on the second side was required in 3 of their 18 patients.Conservative, precise tissue division or removal seems prudent.

Suicide rates have significantly increased in patients with OC/OP cancer since 1980 to 1984. Although cardiovascular disease–and pneumonia-related deaths have significantly decreased over time, they remain higher than the general US population. Increased knowledge of risk factors associated with non–cancer-related mortality in OC/OP cancer may lead to early intervention and enhanced overall survival.

2012-01-16T23:21:00.001-08:00

Non–Cancer-Related Deaths From Suicide, Cardiovascular Disease, and Pneumonia in Patients With Oral Cavity and Oropharyngeal Squamous Carcinoma

Guo-Pei Yu, MD, MPH; Vikas Mehta, MD; Daniel Branovan, MD; Qiang Huang, MD, PhD; Stimson P. Schantz, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):25-32. doi:10.1001/archoto.2011.236

Objective To study non–cancer-related mortality rates over time and examine the possible causes for several major deaths in patients with oral cavity and oropharyngeal (OC/OP) cancer.

Design Retrospective cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) cancer registry data of the National Cancer Institute.

Main Outcome Measure Cause-specific mortality rates during the first year after diagnosis of OC/OP cancer were calculated for 4 cohorts (1980-1984, 1990-1994, 2000-2003, and 2004-2007). The percentage changes over time were calculated. Standardized mortality ratios (SMRs) for suicide, cardiovascular disease, and pneumonia were calculated and compared with patient demographic and clinical characteristics.

Results We analyzed data for 32 487 patients in 4 cohorts. From 1980-1984 to 2004-2007, mortality from suicide increased by 406.2% (P = .01), cardiovascular disease–related and pneumonia–related mortality decreased by 45.9% (P < .001) and 42.9% (P = .009), respectively, and rates of other non–cancer-related deaths did not change. Compared with the general population, patients diagnosed as having OC/OP cancer were at a significantly higher risk of mortality from suicide (SMR, 7.8; 95% CI, 4.6-12.4; P < .001), cardiovascular disease (SMR, 2.4; 95% CI, 2.1-2.7; P < .001), and pneumonia (SMR, 8.9; 95% CI, 6.8-11.5; P < .001) during the first year after cancer diagnosis. Risk factors for increased mortality included age of 55 to 64 years, marital status (including never married, divorced, or separated), advanced tumor stage (including regional and distant disease), treatment with radiotherapy alone, and pharyngeal tumor location.

The radial forearm free flap donor site carries significant morbidity. Donor site UBTF closure was associated with improved wrist extension and represents an alternative method of closure for small donor site defects.

2012-01-16T23:20:00.001-08:00

Radial Forearm Free Flap Donor Site Morbidity

Ulnar-Based Transposition Flap vs Split-Thickness Skin Graft

Yves Jaquet, MD; Danny J. Enepekides, MD, FRCS; Cory Torgerson, MD, PhD, FRCSC; Kevin M. Higgins, MD, MSc, FRCSC

Arch Otolaryngol Head Neck Surg. 2012;138(1):38-43. doi:10.1001/archoto.2011.216

Objectives To evaluate morbidity associated with the radial forearm free flap donor site and to compare functional and aesthetic outcomes of ulnar-based transposition flap (UBTF) vs split-thickness skin graft (STSG) closure of the donor site.

Design Case-control study.

Setting Tertiary care institution.

Patients The inclusion criteria were flap size not exceeding 30 cm², patient availability for a single follow-up visit, and performance of surgery at least 6 months previously. Forty-four patients were included in the study and were reviewed. Twenty-two patients had UBTF closure, and 22 had STSG closure.

Main Outcome Measures Variables analyzed included wrist mobility, Michigan Hand Outcomes Questionnaire scores, pinch and grip strength (using a dynamometer), and hand sensitivity (using monofilament testing over the radial nerve distribution). In analyses of operated arms vs nonoperated arms, variables obtained only for the operated arms included Vancouver Scar Scale scores and visual analog scale scores for Aesthetics and Overall Arm Function.

Results The mean (SD) wrist extension was significantly better in the UBTF group (56.0° [10.4°] for nonoperated arms and 62.0° [9.7°] for operated arms) than in the STSG group (59.0° [7.1°] for nonoperated arms and 58.4° [12.1°] for operated arms) (P = .02). The improvement in wrist range of motion for the UBTF group approached statistical significance (P = .07). All other variables (Michigan Hand Outcomes Questionnaire scores, pinch and grip strength, hand sensitivity, and visual analog scale scores) were significantly better for nonoperated arms vs operated arms, but no significant differences were observed between the UBTF and STSG groups.

Molecular mutations in tumors with and without LNM.

2012-01-16T23:19:00.001-08:00

The Role of Molecular Markers and Tumor Histological Type in Central Lymph Node Metastasis of Papillary Thyroid Carcinoma

Lorien Paulson, MD; Maisie Shindo, MD; Kathryn Schuff, MD; Christopher Corless, MD, PhD

Arch Otolaryngol Head Neck Surg. 2012;138(1):44-49. doi:10.1001/archoto.2011.226

Objective To look for genetic mutations that might predict central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) using strict criteria for N0 and N1 disease.

Design We identified patients with PTC from our institution's pathology archives. Strict criteria were used for assessing the presence or the absence of central neck LNM. Disease was classified as N0 only if a comprehensive ipsilateral and pretracheal central neck dissection was performed and if pathological analysis revealed no evidence of LNM. Primary tumor samples were analyzed for a panel of known or suspected PTC-associated molecular markers, including BRAF, RET -PTC, KRAS, NRAS, HRAS, PIK3CA, and their variants.

Setting Academic medical center.

Patients Three hundred eighty-nine patients with PTC.

Main Outcome Measure Molecular mutations in tumors with and without LNM.

Results Of 389 identified cases, 209 fit the inclusion criteria, with 158 classified as node positive (N1) and 51 as node negative (N0). The follicular variant histological type was present in 7 of 158 N1 tumors (4.4%) and 24 of 51 N0 tumors (47.1%) and thus was strongly associated with lack of central neck metastasis in this study (odds ratio, 0.05; 95% CI, 0.02-0.14). Predictive factors for central LNM included extracapsular extension, angiolymphatic invasion, and higher T stage (T3 and T4). The BRAF mutation was more prevalent in the classic PTC histological type than the follicular variant. None of the molecular marker mutations that were analyzed in this study, including the BRAF mutation, predicted LNM in classic PTC.

Conclusions Positive risk factors for central LNM include male sex, extracapsular extension, angiolymphatic invasion, and advanced T stage. The follicular variant histological type has a significantly lower incidence of central neck metastasis. In contrast to recent studies, the BRAF mutation was not significantly associated with central neck LNM from PTC when using a strict definition of a central neck dissection.

Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level.

2012-01-16T23:18:00.001-08:00

Efficacy and Safety of Central Compartment Neck Dissection for Recurrent Thyroid Carcinoma

Manish D. Shah, MD, MPhil, FRCSC; Luke D. Harris, MD; Ramez G. Nassif, MBBCh, FRCS; Dae Kim, MBChB, PhD, FRCS; Spiro Eski, MD;Jeremy L. Freeman, MD, FRCSC

Arch Otolaryngol Head Neck Surg. 2012;138(1):33-37. doi:10.1001/archoto.2011.223

Objective To explore the safety and efficacy of central compartment neck dissection (CCND) in the treatment of well-differentiated thyroid carcinoma (WDTC) recurrences in the central compartment of the neck.

Design Retrospective medical chart review.

Setting Tertiary-care academic hospital.

Patients Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months.

Results Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND—2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not.

Conclusion Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.

The presence of infection, treatment of infected TGDCs, and relationship between infection, treatment of infection, and recurrence.

2012-01-16T23:17:00.001-08:00

Impact of Incision and Drainage of Infected Thyroglossal Duct Cyst on Recurrence After Sistrunk Procedure

Lawrence Mariano Simon, MD; Anthony E. Magit, MD

Arch Otolaryngol Head Neck Surg. 2012;138(1):20-24. doi:10.1001/archoto.2011.225

Objective To determine whether incision and drainage of infected thyroglossal duct cysts (TGDCs) is associated with increased risk of recurrence after Sistrunk procedure when compared with antibiotic treatment alone.

Design Retrospective case review.

Setting Tertiary referral practice.

Patients Patients treated for thyroglossal duct remnants in a tertiary care pediatric center from January 1, 2002, through December 31, 2008. Study subjects were identified using the diagnosis code for TGDC or the procedure code for excision of thyroglossal duct cyst or sinus.

Results We identified 120 patients from 2002 through 2008 who met the search criteria. The mean age at the time of presentation was 5.1 years; at the time of surgery, 5.4 years. More than half the patients (58.2%) were male, and the most common presentation was an asymptomatic midline neck mass. Forty-nine of our patients (40.8%) had a history of infection and 6 of these (12%) required incision and drainage. The overall recurrence rate was 10.8%. Ten of the patients with preoperative infection (20%) had a recurrence compared with 3 of the 71 patients (4%) without preoperative infection (P = .002). Of all patients with recurrences, only 1 had undergone incision and drainage.

Conclusions This case series suggests that preoperative infection is associated with an increased recurrence rate. Incision and drainage of an infected TGDC may not increase the risk of postoperative recurrence. The results of this case series may assist in preoperative counseling and management of infected TGDC prior to definitive surgery.

Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation

2012-01-16T08:58:00.001-08:00

Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD.

STUDY DESIGN:

Case series.

SETTING:

University hospital.

SUBJECTS AND METHODS:

Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/.

RESULTS:

Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery.

CONCLUSIONS:

Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD.

Head and neck cancer patients are prone to nutritional problems, partly due to the location and size of the disease, due to significant comorbidity and also often therapeutic intervention.From this assessment derives the indication of a safe pre-therapeutic application of a percutaneous endoscopic gastrostomy (PEG).

2012-01-12T23:12:00.001-08:00

Prediction model for early percutaneous endoscopic gastrostomy (PEG) in head and neck cancer treatment; Wermker K, Jung S, Hüppmeier L, Joos U, Kleinheinz J; Oral Oncology (Dec 2011)

Head and neck cancer patients are prone to nutritional problems, partly due to the location and size of the disease, due to significant comorbidity and also often therapeutic intervention.

Excessive weight loss after surgery reduces further the patients' physical resistibility and increases the complication rate for adjuvant radiation and or chemotherapy.

Possible effective interventions are dietary counseling, nutritional supplements or drug interventions. Aim of our research was to reveal reliable clinical predictive parameters, which calculate risks as the reduced nutritional state against the possible complications of PEG insertion and finally define an algorithm for pre-therapeutic PEG insertion to optimize the general treatment conditions by sufficient nutrition. We explored the data of 152 patients in a time period from 2005 to 2010 considering age, gender, body mass index, staging, size and localization of the tumor or need for a neck dissection.

The decisive predictive parameters are: body mass index, size and localization of tumor, lymph node affection, resection of the root of the tongue or the oropharynx region and performance of a neck dissection.

In this retrospective study we established a prediction model that allows a substantiated evaluation of post-therapeutic dysphagia considering relevant clinical features as well as the specific surgical therapy. From this assessment derives the indication of a safe pre-therapeutic application of a percutaneous endoscopic gastrostomy (PEG).

In patients with oral squamous cell carcinomas (OSSC) it is desirable to avoid unnecessary bone resection without neglecting the overall surgical treatment goal of tumor-free margins. Whereas computed tomography (CT) is most commonly used to detect mandibular invasion

2012-01-12T23:10:00.001-08:00

CT-scan is a valuable tool to detect mandibular involvement in oral cancer patients; Handschel J, Naujoks C, Depprich RA, Kübler NR, Kröpil P, Kuhlemann J, Jansen TM, Boeck I, Sproll KC; Oral Oncology (Dec 2011)

In patients with oral squamous cell carcinomas (OSSC) it is desirable to avoid unnecessary bone resection without neglecting the overall surgical treatment goal of tumor-free margins. Whereas computed tomography (CT) is most commonly used to detect mandibular invasion, there are conflicting reports regarding the accuracy of CT. Therefore, the aim of this study was to reinvestigate the accuracy of CT in predicting mandibular involvement by OSSC. One hundred and seven patients with OSSC who received a mandibulectomy were included. Before treatment all patients underwent a contrast-enhanced multi-detector CT. Axial 3 or 1.25mm thick images were reconstructed for evaluation in overlapping technique and displayed in a bone (1400/400HU) and a soft tissue window (350/50HU). CT scans were examined by three investigators and compared with the histological findings. The radiological examination showed a high interrater reliability (Cronbachs alpha 0.982). Comparing the radiological findings with the histological results the CT showed 8 false-positive results and 8 false-negative patients. The quality criteria for detecting bone involvement of OSSC by CT were calculated as follows: sensitivity 82.6%; specificity 86.9%; positive predictive value 82.6%; negative predictive value 86.9%. However, in all false-positive patients a sagittal bone defect of 15.1mm could be found presumably caused by pressure of the tumor, but no histologically detectable bone infiltration. Modern CT (1-2mm sections) is a valuable tool for surgical treatment planning. If bone invasion is detected, a mandibulectomy seems always reasonable. In radiologically negative cases histological assessment is necessary to detect mandibular involvement.

Docetaxel and cisplatin arterial infusion for recurrent head and neck cancer

2012-01-12T23:09:00.001-08:00

Nakamura T, Fuwa N, Takayama K, Inokuchi H, Tomoda T, Takada A, Makita C, Shiomi M, Yokouchi JI, Watanabe K; Head & Neck (Dec 2011)

BACKGROUND:

We planned a phase I study of weekly arterial infusion of docetaxel and cisplatin via a superficial temporal artery for recurrent head and neck cancer to determine the optimal dose.

METHODS:

The dose of cisplatin was fixed and the dose of docetaxel was escalated from 8 mg/m(2) , with an increase of 2 mg/m(2) per step, to identify the maximum tolerated dose (MTD). In total, 4 courses of weekly chemotherapy were administered.

RESULTS:

Twelve patients were recruited to this trial. The MTD of docetaxel was 14 mg/m(2) . At this dose level, dose-limiting toxicity was observed in 2 of 3 patients. One patient experienced grade 3 leukopenia, while the other experienced grade 3 leukopenia. Myelosuppression was the dose-limiting toxicity for this regimen.

CONCLUSION:

The recommended dose for weekly arterial infusion of docetaxel was identified as 12 mg/m(2) combined with weekly cisplatin at 40 mg/m(2) , with 4 courses of each.

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation.Both asthma and AR could independently increase the FeNO levels in schoolchildren. Other diseases besides asthma should be considered when applying FeNO as a screening tool for asthma in children.

2012-01-12T23:07:00.001-08:00

Fractional exhaled nitric oxide in relation to asthma, allergic rhinitis, and atopic dermatitis in children; Xu F, Zou Z, Yan S, Li F, Kan H, Norback D, Wieslander G, Xu J, Zhao Z; Journal of Asthma 48 (10), 1001-6 (Dec 2011)

OBJECTIVE

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation. Our aim was to analyze the interrelationship and differentiate the predicting effects of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) on the FeNO levels in children.

METHODS

A case-control study with age- and gender matched 1:1 was designed based on a larger cross-sectional survey on asthma, AR, and AD. A self-administered questionnaire was used to collect information on children's health information. Children with positive reports on physician-diagnosed asthma and/or AR and/or AD were recruited as cases, and children with no report of any of the diseases were designated as controls. The FeNO measurement was performed online, using the NIOX MINO® instrument (Aerocrine AB, Solna, Sweden) at 50 ml/min.

RESULTS

A total of 130 subjects (65 cases and 65 controls, average age = 10 years) were recruited in this study. The average FeNO level was significantly higher in the cases (29.8 ± 1.9 ppb) than that in the controls (13.3 ± 1.7 ppb) (p<.001). Using multiple linear regression analysis controlling for confounding factors, including parental asthma/allergic diseases and home exposure, asthma (β = 0.330, p<.001) and AR (β = 0.157, p = .006) showed significant predicting effects for high FeNO levels, whereas AD was not related to the FeNO levels.

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation.Both asthma and AR could independently increase the FeNO levels in schoolchildren. Other diseases besides asthma should be considered when applying FeNO as a screening tool for asthma in children.

Human papillomavirus (HPV) has been reported in up to 50% of head and neck squamous cell carcinomas (HNSCCs). Presence of HPV in HNSCC has been associated with more favorable prognosis

2012-01-12T23:03:00.001-08:00

HPV genotypes and their prognostic significance in head and neck squamous cell carcinomas; Rautava J, Kuuskoski J, Syrjänen K, Grenman R, Syrjänen S; Journal of Clinical Virology (Dec 2011)

BACKGROUND: Human papillomavirus (HPV) has been reported in up to 50% of head and neck squamous cell carcinomas (HNSCCs). Presence of HPV in HNSCC has been associated with more favorable prognosis.

OBJECTIVES: This study was designed to disclose HPV genotype distribution in head and neck squamous cell carcinomas (HNSCC) and their role in disease outcome. In addition, role of herpesviruses 1 and 2 (HSV-1 and -2) and cytomegalovirus (CMV) as co-factors was elucidated.

STUDY DESIGN: HPV-genotyping of 106 HNSCC was done with Multimetrix(®)-kit. Luminex-based-method was used to detect HSV-1 and -2 and CMV. RESULTS: In males, 50% of HNSCC were HPV DNA positive and 25% of these were multiple HPV-types infections and in women, 72% and 31%, respectively. Low-risk (LR) HPV-types were found in 20.5% and co-infection with HSV-1 in 6.6%. Patients with HPV-positive and -negative HNSCC had similar survival. Patients not treated with chemoradiotherapy and co-infected with HSV-1 and HPV had a worse outcome. Similarly patients with LR-HPVs treated with radiotherapy had a poor prognosis.

DISCUSSION: Radiotherapy for HNSCC in patients with either the presence of LR-HPV-types or a co-infection with HPV and HSV-1 may result in poor outcome.

OTO-RHINO-LARYGOLOGY

Nutritional counselling and ONS are associated with relatively low CRT-related toxicity and with mild deterioration of nutritional parameters.

Precisely distinguishing among normal mucosa, dysplasia and invasive carcinoma is necessary

Advances in endoscopic diagnosis of dysplasia and carcinoma of the larynx; Arens C, Vorwerk U, Just T, Betz CS, Kraft M; Hals-Nasen-Ohrenheilkunde (HNO) 60 (1), 44-52 (Jan 2012)

Number of cycles of cisplatin delivered is an independent prognostic factor in patients with stage II-III NPC undergoing CRT with weekly cisplatin.

Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma; Loong HH, Ma BB, Leung SF, Mo F, Hui EP, Kam MK, Chan SL, Yu BK, Chan AT; Radiotherapy & Oncology (Jan 2012)

Simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy

The focus of SCCHN therapy has more recently shifted to the molecular level, particularly the epidermal growth factor receptor (EGFR/ErbB) pathway

New approaches to EGFR inhibition for locally advanced or metastatic squamous cell carcinoma of the head and neck (SCCHN); Agulnik M; Medical Oncology (Northwood, London, England) (Jan 2012)

Results of endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy in the treatment of patients with symptomatic subglottic tracheal stenosis

Subglottic tracheal stenosis; Karaiskaki N, Mann WJ; Hals-Nasen-Ohrenheilkunde (HNO) (Jan 2012)

Post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients

Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients; Dwivedi RC, St Rose S, Chisholm EJ, Bisase B, Amen F, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ, Kazi R; Oral Oncology (Jan 2012)

Rrole of CTCAE version 4.0 (v4.0) and version 3.0 (v3.0) in assessing chemoradiation-induced oral mucositis (OM) for locally advanced nasopharyngeal carcinoma (LA-NPC)

Comparison of the NCI-CTCAE version 4.0 and version 3.0 in assessing chemoradiation-induced oral mucositis for locally advanced nasopharyngeal carcinoma; Liu YJ, Zhu GP, Guan XY; Oral Oncology (Jan 2012)

Posterior pharyngeal flap for velopharyngeal insufficiency patients

The Laryngoscope, 02/07/2012

The sternocleidomastoid (SCM) muscle flap was an effective method in preventing Frey’s syndrome. Moreover, Galvanic skin responses (GSR) test was highly sensitive and specific for diagnosis.

The Efficiacy of Sternocleidomastoid Muscle Flap on Freys Syndrome via a Novel Test: Galvanic Skin Response Indian Journal of Otolaryngology and Head & Neck Surgery, 02/02/2012

Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single–stage procedure.

Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes The Journal of Laryngology & Otology, 02/01/2012

Temporoparietal fascia free flap for pharyngeal coverage after salvage total laryngectomy

The Laryngoscope, 02/06/2012

The role of the internal mammary vessels as recipient vessels in secondary and tertiary head and neck reconstruction

Journal of Plastic, Reconstructive & Aesthetic Surgery, 02/06/2012

Secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous fla

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Biomarkers in head and neck cancer

Langer CJ; Cancer (Jan 2012)

Oral human papillomavirus (HPV) is found in about 7% of people in the US aged 14 to 69 years, and the infection occurs in men about 3 times as commonly as in women

Sentinel Node-Positive Melanoma of the Head and Neck ; Compared with SLNB alone, CLND does not seem to be associated with improved survival

Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors.

Concurrent Chemoradiotherapy versus Induction Chemotherapy

Pemphigus vegetans of the nose; Sigmund GA, Oppenheimer R; Ear, Nose, & Throat Journal 91 (1), E14-5 (Jan 2012)

Biofilms in Chronic Rhinosinusitis

Prevalence of Biofilms and Their Response to Medical Treatment in Chronic Rhinosinusitis without Polyps; Tatar EC, Tatar I, Ocal B, Korkmaz H, Saylam G, Ozdek A, Celik HH; Otolaryngology - Head and Neck Surgery (Jan 2012)

Παράδειγμα Υπο-Αλλεργιογονικής Δίαιτας

Λάστιχο LATEX

Ακάρεα Οικιακής Σκόνης

Αλλεργικά Τεστ

Φάρμακα

Αλλεργιογόνα Τροφών

Αλλεργιογόνα Ζώων

Σφήκες και Μέλισσες

Αλλεργιογόνα Φυτά

Μύκητες

Γύρεις

A higher frequency of CD161+ T cells is present in the peripheral blood of allergic rhinitis (AR) patients.

Higher Frequencies of CD161+ Circulating T Lymphocytes in Allergic Rhinitis Patients Compared to Healthy Donors International Archives of Allergy and Immunology, 01/26/2012

Detection of promoter hypermethylation of TIMP3 in pretreatment salivary rinse is independently associated with local recurrence–free survival in patients with HNSCC and may be a valuable salivary rinse biomarker for HNSCC recurrence.

Detection of TIMP3 Promoter Hypermethylation in Salivary Rinse as an Independent Predictor of Local Recurrence-Free Survival in Head and Neck Cancer Clinical Cancer Research, 01/30/2012

Secondary accurate maxillary reconstruction

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Unilateral cleft-lip nasal deformities

Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/27/2012

Submucosal uvulopalatopharyngoplasty is an effective tool in treating patient’s subjective symptoms of OSAS

Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome European Archives of Oto-Rhino-Laryngology, 01/26/2012

Canalith Repositioning Procedures

Canal Conversion and Reentry: A Risk of Dix-Hallpike During Canalith Repositioning Procedures Otology and Neurotology, 01/25/2012

Corticosteroids are the mainstay of treatment and are the most effective drugs for treating chronic rhinosinusitis with nasal polyps

Role of Medical Therapy in the Management of Nasal Polyps Current Allergy and Asthma Reports, 01/30/2012

GERD may be one of the contributing factors in the etiopathogenisis of OME

Role of GERD in Children with Otitis Media with Effusion The Indian Journal of Pediatrics, 01/26/2012

Llevocetirizine is effective on persistent allergic rhinitis (PER) symptoms, including a transient improvement in loss of smell, and that this improvement concurs more with reduction of nasal inflammation than of nasal patency.

The Loss of Smell in Persistent Allergic Rhinitis Is Improved by Levocetirizine due to Reduction of Nasal Inflammation but Not Nasal Congestion (the CIRANO Study) International Archives of Allergy and Immunology, 01/27/2012

Vestibular migraine (VM) and Menière's disease (MD)

Vestibular evoked myogenic potentials to sound and vibration: characteristics in vestibular migraine that enable separation from Meniere's disease; Taylor RL, Zagami AS, Gibson WP, Black DA, Watson SR, Halmagyi GM, Welgampola MS; Cephalalgia (Jan 2012)

Tuberculum sellae meningioma

Endoscopic endonasal approach for a tuberculum sellae meningioma; Fernandez-Miranda JC, Pinheiro-Nieto C, Gardner PA, Snyderman CH; Journal of Neurosurgery 32 (1), E8 (Jan 2012)

New therapies currently under investigation include mTOR inhibitors, anti-angiogenic agents, and IGF1R inhibitors

Current Treatment Options for Metastatic Head and Neck Cancer; Price KA, Cohen EE; Current Treatment Options in Oncology (Jan 2012)

Intensity-modulated radiotherapy (IMRT)

Improved outcomes in buccal squamous cell carcinoma; Lin CS, Jen YM, Kao WY, Ho CL, Dai MS, Shih CL, Cheng JC, Chang PY, Huang WY, Su YF; Head & Neck (Jan 2012)

Radio frequency is a rapidly evolving technique and in the future will have an increasing role to play in the endoscopic resection of intranasal and sinus tumors.

Early experience of radio frequency coblation in the management of intranasal and sinus tumors; Syed MI, Mennie J, Williams AT; The Laryngoscope (Jan 2012)

Combination therapy corticosteroids plus an oral antioxidant L-N-acetylcysteine (LNAC) was associated with improved hearing over corticosteroids alone

L-N-Acetylcysteine treatment is associated with improved hearing outcome in sudden idiopathic sensorineural hearing loss; Angeli SI, Abi-Hachem RN, Vivero RJ, Telischi FT, Machado JJ; Acta Oto-Laryngologica (Jan 2012)

Eeriparatide as an adjunctive modality for bisphosphonate-related osteonecrosis of the jaws (BRONJ)

Short-term teriparatide therapy as an adjunctive modality for bisphosphonate-related osteonecrosis of the jaws; Kwon YD, Lee DW, Choi BJ, Lee JW, Kim DY; Osteoporosis International (Jan 2012)

Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy Indian Journal of Otolaryngology and Head & Neck Surgery, 01/20/2012

The Efficiacy of Sternocleidomastoid Muscle Flap on Freys Syndrome via a Novel Test: Galvanic Skin Response
Indian Journal of Otolaryngology and Head & Neck Surgery, 02/02/2012

Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes
The Journal of Laryngology & Otology, 02/01/2012

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Higher Frequencies of CD161+ Circulating T Lymphocytes in Allergic Rhinitis Patients Compared to Healthy Donors
International Archives of Allergy and Immunology, 01/26/2012

Detection of TIMP3 Promoter Hypermethylation in Salivary Rinse as an Independent Predictor of Local Recurrence-Free Survival in Head and Neck Cancer
Clinical Cancer Research, 01/30/2012

Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/30/2012

Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities
Journal of Plastic, Reconstructive & Aesthetic Surgery, 01/27/2012

Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome
European Archives of Oto-Rhino-Laryngology, 01/26/2012

Canal Conversion and Reentry: A Risk of Dix-Hallpike During Canalith Repositioning Procedures
Otology and Neurotology, 01/25/2012

Role of Medical Therapy in the Management of Nasal Polyps
Current Allergy and Asthma Reports, 01/30/2012

Role of GERD in Children with Otitis Media with Effusion
The Indian Journal of Pediatrics, 01/26/2012

The Loss of Smell in Persistent Allergic Rhinitis Is Improved by Levocetirizine due to Reduction of Nasal Inflammation but Not Nasal Congestion (the CIRANO Study)
International Archives of Allergy and Immunology, 01/27/2012

Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy
Indian Journal of Otolaryngology and Head & Neck Surgery, 01/20/2012

EMG assessment of analgesia in treatment of posttonsillectomy pain: random allocation, preliminary report
The Clinical Journal of Pain, 01/18/2012

House dust mite avoidance measures for perennial allergic rhinitis
Allergy, 01/16/2012

Nasal irrigation with or without drugs: the evidence
Current Opinion in Otolaryngology and Head & Neck Surgery, 01/17/2012 Clinical Article

Coblation versus traditional tonsillectomy: A double blind randomized controlled trial
Journal of Research in Medical Sciences, 01/19/2012

Lack of Neurofibromatosis Type 2 Gene Promoter Methylation in Sporadic Vestibular Schwannomas
Journal for Oto-Rhino-Laryngology, 01/17/2012

Gustatory rhinitis
Current Opinion in Otolaryngology and Head & Neck Surgery, 01/16/2012

Adenoid cystic carcinoma of the head and neck
American Journal of Otolaryngology, 01/09/2012

Is Transnasal Endoscopic Examination Necessary Before and After Adenoidectomy?
Indian Journal of Otolaryngology and Head & Neck Surgery, 01/12/2012