Indocyanine green fluorescence for parathyroid gland identification and function prediction: Systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Indocyanine green fluorescence for parathyroid gland identification and function prediction: Systematic review and meta‐analysis Via Head & Neck Abstract Background To evaluate the diagnostic accuracies of indocyanine green (ICG) fluorescence for identifying parathyroid glands during surgery and predicting the postoperative function. Methods From six databases, 21 studies were finally included in the study. True-positive, true-negative, false-positive, and false-negative data were extracted for the analysis. The quality of each study was analyzed using the QUADAS-2 tool. Results The sensitivity of ICG-based parathyroid gland identification was 0.9380 (95% CI [0.9003, 0.9621]). The diagnostic odds ratio for ICG-based prediction of parathyroid gland function was 54.5652 [13.2059, 225.4570]. The area under the summary receiver operating characteristic curve was 0.909. Fluorescence intensity-based prediction presented higher diagnostic accuracy than that of score-based prediction. The incidence of postoperative hypoparathyroidism was higher in the group with a zero ICG score compared to the high scored group. Conclusions Identification of parathyroid gland and prediction of postoperative function using ICG are valuable to patients undergoing thyroidectomy or parathyroidectomy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Posterior canal wall reconstruction in squamosal type of chronic otitis media: One-year follow-up study

xlomafota13 shared this article with you from Inoreader Posterior canal wall reconstruction in squamosal type of chronic otitis media: One-year follow-up study Via Indian Journal of Otology Abhinav Srivastava, Chander Mohan Indian Journal of Otology 2021 27(3):163-167 Introduction: The removal of Cholesteatoma remains a matter of debate with varying opinion, but the primary objectives remain complete eradication of the disease and creation of a safe ear. Restoration of hearing is secondary objective. Reconstruction of posterior canal wall can be attempted after complete removal of cholesteatoma with different materials. Aim and Objectives: The aim of the study was to study the outcome of posterior canal wall reconstruction in patients undergoing modified radical mastoidectomy. Materials and Methods: This prospective interventional cross-sectional study has been done on forty patients in the department of otorhinolaryngology and head-neck surgery, in a tertiary care hospital in Western Uttar Pradesh with an enrolment period of 1 year and a minimum of 1-year follow-up. Results: In the present study, the success rate of canal reconstruction was 85%. The most common site of middle ear cleft which was found to be mostly affected by cholesteatoma was ad itus in 94.12%, followed by posterior attic, middle ear, and sinus tympani accounting for 91.18%, 82.35%, and 79.41%, respectively. Incus was found to be the most common ear ossicle affected. A statistically significant result was found in the pre- and post-operative average hearing loss and air-bone gap. Conclusion: Canal reconstruction in patients undergoing canal wall down mastoidectomy is a good option in patients presenting with limited disease of squamosal type of chronic otitis media. A candidacy criterion has been proposed for deciding patients in whom canal reconstruction can be tried. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of duration of residual inhibition on tinnitus masking in patients with and without hearing impairment

xlomafota13 shared this article with you from Inoreader Impact of duration of residual inhibition on tinnitus masking in patients with and without hearing impairment Via Indian Journal of Otology Indranil Chatterjee, Geeta Gore Indian Journal of Otology 2021 27(3):131-139 Introduction: Residual inhibition (RI) is described as a temporary reduction in the loudness of tinnitus as a result of stimulation from a noise. Aim: This study is aimed to determine the efficacy of durational aspects of tinnitus masking on self-reported tinnitus handicapped measures in patients with and without hearing impairment. Sample Size: Sixty participants were included and divided into two groups – Group A (mean age 44.7, standard deviation [SD] 12.02) included tinnitus participants with normal hearing and Group B (mean age 43.81, SD 12.79) included participants with hearing impairment. Methodology: Audiological evaluation was done after a detailed case history visual analog scale (VAS) and tinnitus handicapped inventory (THI) were used pre- and post-therapy to assess the severity of tinnitus. Tinnitus masking was done at the level MML + 20 dB at matched frequency of the tinnitus. Each group had three subgroups of ten participants for masking duration– 15, 20, and 30 min of RI. The therapy was terminated when the tinnitus disappeared or after 1 month (5 days a week). Statistical analysis was performed using Paired t-test, Independent t-test, and ANOVA. Results: There was a significant difference in the effect of tinnitus masking for pre- and post-data among different masking durations measured in VAS and THI irrespective of hearing status. 30-min masking duration can be used as a standardized norm for tinnitus masking. Conclusion: Thus, the study provides a structured temporal course for providing tinnitus masking. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Presbycusis

xlomafota13 shared this article with you from Inoreader Presbycusis Via Indian Journal of Otology Mahendra Kumar Taneja Indian Journal of Otology 2021 27(3):121-123 Presbycusis is aging deafness, progressive decrease in hearing, high frequency usually associated with tinnitus. This is due to the release of free radicals in cellular metabolism leading to cell death of cochlear hair cells, stria vascularis, and sensorineural degeneration. It also leads to vasoconstriction of end arteries resulting in hypoxia, ischemia, and necrosis of cells. Apart from hair cells, rest all can be regenerated by suitable environment, diet positivity, lifestyle changes, and proper diet along with Yoga and Pranayama. It is a long-run exercise. Since visual integration is a part of hearing, focused concentration, dynamic neurobics, and mid-brain activation also help in rehabilitation. The most important Pranayama is modified Nadi Shodhan (Kumbhak). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of hearing loss in temporal bone fractures

xlomafota13 shared this article with you from Inoreader Assessment of hearing loss in temporal bone fractures Via Indian Journal of Otology M Abhishek, Revathishree Kaleeswaran, K Srinivasan Indian Journal of Otology 2021 27(3):158-162 Introduction: Thirty percent to seventy percent of skull fractures in adult head trauma patients is due to temporal bone fractures and is caused due to road traffic accidents (RTAs). Temporal bone fractures are more commonly associated with hearing loss. Objective: The objective of this study is to assess the type and the amount of hearing loss in temporal bone fractures. Methodology: A 3-month retrospective study was conducted at the department of ear, nose, and throat in a tertiary care center. Fifty patients, diagnosed as cases of temporal bone fractures with hearing loss were included in the study. The patients with temporal bone fractures were categorized into two groups-otic-capsule sparing (OCS) and otic-capsule violating (OCV) fractures, and hearing loss was evaluated with Pure tone audiogram (PTA). Results: OCS fractures were more common (64%) than OCV. Conductive type of hearing loss was commonly associated with OCS, whereas sensorineural hearing loss was more common in OCV fractures. The average degree of hearing loss ranged from 20 to 68 db. The correlation was statistically significant for temporal bone fractures (OCS and OCV) with respect to hearing loss (P < 0.00001). Other complications such as external auditory canal filled with blood, perforation of tympanic membrane, and hemotympanum were also observed in our study. Conclusion: Temporal bone fractures are most commonly due to RTAs and are frequently associated with severe brain injury. Classifying temporal bone fractures as OCS and OCV fractures correlates well with the severity of hearing loss, and conductive hearing loss was the most common type hearing loss. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Difficult Airway Management in a Patient With Hereditary Hemorrhagic Telangiectasia

xlomafota13 shared this article with you from Inoreader Difficult Airway Management in a Patient With Hereditary Hemorrhagic Telangiectasia Via JAMA Otolaryngology–Head & Neck Surgery Online First To the Editor In reference to the recent publication by Safi et al regarding rapid sequence induction and intubation in a patient with hereditary hemorrhagic telangiectasia (HHT), I would like to congratulate the authors on a successful outcome. Also, I would like to suggest that, rather than mask ventilation after induction of anesthesia, consideration be given to awake fiber-optic oral/nasal intubation, as directed by the preoperative assessment, to establish the airway in patients with HHT undergoing elective procedures. Rapid sequence induction and emergency tracheostomy, in that order, could then be further on in the difficult airway algorithm, if needed, as in this case. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Large superficial angiomyxoma of the tongue causing dysphagia

xlomafota13 shared this article with you from Inoreader Large superficial angiomyxoma of the tongue causing dysphagia Via ear nose throat Ear Nose Throat J. 2021 Dec 16:1455613211068004. doi: 10.1177/01455613211068004. Online ahead of print. NO ABSTRACT PMID:34913381 | DOI:10.1177/01455613211068004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility

xlomafota13 shared this article with you from Inoreader The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility Via ear nose throat Ear Nose Throat J. 2021 Dec 15:1455613211064045. doi: 10.1177/01455613211064045. Online ahead of print. ABSTRACT OBJECTIVE: The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility. METHODS: A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assesse d by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release. RESULTS: Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43). CONCLUSION: The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility. PMID:34911396 | DOI:10.1177/01455613211064045 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A New Dynamic Response to Therapy Assessment in Postoperative Patients With Low-Risk Differentiated Thyroid Cancer Treated Without Radioactive Iodine

xlomafota13 shared this article with you from Inoreader A New Dynamic Response to Therapy Assessment in Postoperative Patients With Low-Risk Differentiated Thyroid Cancer Treated Without Radioactive Iodine Via radioactive iodine Front Oncol. 2021 Nov 29;11:764258. doi: 10.3389/fonc.2021.764258. eCollection 2021. ABSTRACT BACKGROUND: Total thyroidectomy (TT) or lobectomy without radioactive iodine (RAI) is becoming a common management for patients with low-risk differentiated thyroid cancer (DTC). However, the assessment of response to therapy for these patients remains controversial. The aim of this study was to propose and validate a new dynamic evaluation strategy to assess the response to therapy in pat ients with low-risk DTC treated with TT or lobectomy but without RAI. METHODS: We performed a retrospective analysis of 543 adult patients with low-risk DTC who underwent TT or lobectomy without RAI therapy. Follow-up consisted of trends of serum thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb) levels and neck ultrasonography (US) were conducted every 6-24 months. Response to therapy assessments were defined as excellent response, biochemical incomplete response, structural incomplete response, and indeterminate response according to the follow-up findings. RESULTS: At a median follow-up of 51 months (range 33-66 months), 517 (95%) had excellent response, while the other 26 had either biochemical incomplete response (an increasing trend of suppressed serum Tg levels, n=9; an increasing trend of TgAb levels, n=3) or indeterminate response (a stable or decreasing trend of suppressed serum Tg levels, but a stable positive trend of TgAb levels, n=14). No patients had s tructural incomplete response or no deaths related to thyroid cancer. The risk of incomplete response was significantly higher in lobectomy than in TT (p<0.001). CONCLUSION: Our study proposed and validated a new dynamic response to therapy assessment depending on trends of suppressed serum Tg, TgAb levels, and neck US findings which could be an appropriate tool for postoperative follow-up in low-risk DTC patients without RAI therapy. Our findings provided further evidence to support no routine recommendation of RAI after surgery in low-risk DTC. PMID:34912712 | PMC:PMC8667687 | DOI:10.3389/fonc.2021.764258 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Apatinib vs Placebo in Patients With Locally Advanced or Metastatic, Radioactive Iodine-Refractory Differentiated Thyroid Cancer: The REALITY Randomized Clinical Trial

xlomafota13 shared this article with you from Inoreader Apatinib vs Placebo in Patients With Locally Advanced or Metastatic, Radioactive Iodine-Refractory Differentiated Thyroid Cancer: The REALITY Randomized Clinical Trial Via radioactive iodine JAMA Oncol. 2021 Dec 16. doi: 10.1001/jamaoncol.2021.6268. Online ahead of print. ABSTRACT IMPORTANCE: Patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) have a poor prognosis and limited treatment options. OBJECTIVE: To assess the efficacy and safety of apatinib, a highly selective vascular endothelial growth factor (VEGFR-2) inhibitor, in patients with progressive locally advanced or metastatic RAIR-DTC. DESIGN, SETTING, AND PARTICIPAN TS: This randomized, double-blind, placebo-controlled, phase 3 trial (Efficacy of Apatinib in Radioactive Iodine-refractory Differentiated Thyroid Cancer [REALITY]) was conducted in 92 patients with progressive locally advanced or metastatic RAIR-DTC between February 17, 2017, and March 2, 2020, at 21 sites within China, and the data cutoff date for this analysis was March 25, 2020. INTERVENTIONS: Patients were randomly assigned (1:1) to apatinib, 500 mg/d, or placebo. Patients who developed progression while receiving placebo were allowed to cross over to apatinib. MAIN OUTCOMES AND MEASURES: The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall survival, objective response rate (ORR), disease control rate (DCR), duration of response, time to objective response, and safety. Intention-to-treat analyses were performed to evaluate efficacy. RESULTS: Of the 92 patients included in the trial, 56 were wome n (60.9%); mean (SD) age at baseline was 55.7 (10.6) years. Patients were randomized to the apatinib (n = 46) or placebo (n = 46) group. The median follow-up duration was 18.1 (IQR, 12.7-22.2) months. The median PFS was 22.2 (95% CI, 10.91-not reached) months for apatinib vs 4.5 (95% CI, 1.94-9.17) months for placebo (hazard ratio, 0.26; 95% CI, 0.14-0.47; P < .001). The confirmed ORR was 54.3% (95% CI, 39.0%-69.1%) and the DCR was 95.7% (95% CI, 85.2%-99.5%) in the apatinib group vs an ORR of 2.2% (95% CI, 0.1%-11.5%) and DCR of 58.7% (95% CI, 43.2%-73.0%) in the placebo group. The median overall survival was not reached for apatinib (95% CI, 26.25-not reached) and was 29.9 months (95% CI, 18.96-not reached) for placebo (hazard ratio, 0.42; 95% CI, 0.18-0.97; P = .04). The most common grade 3 or higher-level treatment-related adverse events in the apatinib group were hypertension (16 [34.8%]), hand-foot syndrome (8 [17.4%]), proteinuria (7 [15.2%]), and diarrhea (7 [15.2%])-none of which occurred in the placebo group. CONCLUSIONS AND RELEVANCE: The REALITY trial met its primary end point of PFS at the prespecified interim analysis. Apatinib showed significant clinical benefits in both prolonged PFS and overall survival with a manageable safety profile in patients with progressive locally advanced or metastatic RAIR-DTC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03048877. PMID:34913959 | DOI:10.1001/jamaoncol.2021.6268 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

xlomafota13 shared this article with you from Inoreader 90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1740395 Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up. Setting The study included national inpatient hospitalization and outpatient visits. Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). Interventions This study investigated transphenoidal or subfrontal approach for tumor resection. Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001). Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.