Wednesday, October 6, 2021

Virtual reality versus optokinetic stimulation in visual vertigo rehabilitation

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Eur Arch Otorhinolaryngol. 2021 Oct 5. doi: 10.1007/s00405-021-07091-y. Online ahead of print.

ABSTRACT

BACKGROUND: Visual vertigo (VV) is a condition at which there is worsening or triggering of vestibular symptoms in certain visual environments with large size (full field) repetitive or moving visual patterns as shopping malls.

PURPOSE: This work was designed to study effect of virtual reality and optokinetic stimulation on rehabilitation of VV.

METHOD: A total of 60 subjects divided into 2 groups that were simply randomized by the concealed envelope method: Group I consisted of 30 VV patients underwent vestibular rehabilitation using virtual reality. Group II consisted of 30 VV patients underwent vestibular rehabilitation using optokinetic stimulation.

RESULTS: Significant improvement in performance in the two groups after rehabilitation with no statistically significant difference when comparing both groups.

CONCLUSIONS: A combined intense rehabilitation program including OPK stimulation or VR rehabilitation combined with home-based exercises appeared to be equally effective for management of patients with VV and improving their quality of life.

PMID:34611745 | DOI:10.1007/s00405-021-07091-y

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Putting the Pieces Together: the Hair Cell Transduction Complex

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Abstract

Identification of the components of the mechanosensory transduction complex in hair cells has been a major research interest for many auditory and vestibular scientists and has attracted attention from outside the field. The past two decades have witnessed a number of significant advances with emergence of compelling evidence implicating at least a dozen distinct molecular components of the transduction machinery. Yet, how the pieces of this ensemble fit together and function in harmony to enable the senses of hearing and balance has not been clarified. The goal of this review is to summarize a 2021 symposium presented at the annual mid-winter meeting of the Association for Research in Otolaryngology. The symposium brought together the latest insights from within and beyond the field to examine individual components of the transduction complex and how these elements interact at molecular, structural, and biophysical levels to gate mechanosensitive channels and in itiate sensory transduction in the inner ear. The review includes a brief historical background to set the stage for topics to follow that focus on structure, properties, and interactions of proteins such as CDH23, PCDH15, LHFPL5, TMIE, TMC1/2, and CIB2/3. We aim to present the diversity of ideas in this field and highlight emerging theories and concepts. This review will not only provide readers with a deeper appreciation of the components of the transduction apparatus and how they function together, but also bring to light areas of broad agreement, areas of scientific controversy, and opportunities for future scientific discovery.

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Comparison of Laryngeal Palpatory Scale (LPS), With Surface Electromyographic Measures in Patients with Muscle Tension Dysphonia

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The aim of this study was to examine the laryngeal palpatory scale (LPS) to ascertain possible correlation with neck surface electromyography (sEMG).
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Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism

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Objective

Near-infrared imaging for intraoperative parathyroid gland (PG) detection has recently commanded significant attention. The PTeye (Medtronic, Minneapolis, MN) is a probe-based system for near-infrared autofluorescent evaluation of PGs. This study was designed to evaluate the capabilities of the PTeye in the setting of surgery for primary hyperparathyroidism.

Study Design

Prospective, Cohort study.

Methods

This single-institution, prospective cohort study included all patients undergoing parathyroidectomy for primary hyperparathyroidism with presumed single gland disease from June 2020 to December 2020. Absolute intensity and intensity ratios, with the thyroid as the control tissue, were obtained for the adenoma, ipsilateral normal PG, and adjacent tissue. The ability of the PTeye to function when not in direct contact with tissue was measured.

Results

Twenty-two patients were included. The median intensity ratio for the in situ adenomas was 4.38 (interquartile range [IQR]: 2.03–5.87), ipsilateral normal PGs 6.17 (IQR: 3.83–7.67), strap muscle 0.47 (IQR: 0.30–0.60), and fat 0.20 (IQR: 0.17–0.47). All normal PGs and 21/22 adenomas demonstrated autofluorescence above the detection threshold. The PTeye functioned at a maximum distance of separation of 10 mm through saline medium and 6 mm through clear solid medium.

Conclusion

This study confirms the PTeye's ability to recognize PGs with a high degree of precision. The device was found to function properly even with the probe not in direct contact with the tissue. Although adenomatous PGs appear to demonstrate altered autofluorescent properties from normal PGs, additional research is required to determine if these differences are clinically useful.

Level of Evidence

3 Laryngoscope, 2021

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The Long-term Effect of Inferior Turbinate Surgery Techniques on Nasal Obstruction and Quality of Life

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Ann Otol Rhinol Laryngol. 2021 Oct 6:34894211049573. doi: 10.1177/00034894211049573. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to compare the long-term effects of radiofrequency ablation (RFA), microdebrider-assisted inferior turbinoplasty (MAIT), and diode laser techniques on the severity of nasal obstruction and quality of life (QOL) in a 3-year follow-up.

METHODS: The patients filled a Visual Analog Scale (VAS) regarding the severity of nas al obstruction and the Glasgow Health Status Inventory (GHSI) questionnaire preoperatively and during the control visits at 3 months and 3 years. Acoustic rhinometry was also performed. A total of 78 patients attended both control visits.

RESULTS: All 3 techniques improved the VAS score for the severity of nasal obstruction and the GHSI total score significantly compared to the preoperative values at both 3 months and 3 years. Compared to the preoperative values, all 3 techniques increased the V2 to 5 cm values significantly at 3 months. After 3 years, compared to the preoperative values, the MAIT (P = .005) and diode laser (P < .001) still had a statistically significant volume increase in V2 to 5 cm, whereas the RFA (P = .06) did not achieve a statistically significant effect.

CONCLUSION: The RFA, MAIT, and diode laser all improved both the patients' subjective sensation of the severity of nasal obstruction and QOL significantly. The response wa s sustained during the 3-year follow-up period with all 3 techniques. A weakening in the objective treatment response to RFA was found in the longer follow-up, but that did not cause a weakening of the patients' subjective treatment response.

PMID:34612723 | DOI:10.1177/00034894211049573

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Impact of Preoperative Steroids Administration on Endoscopic Sinus Surgery: Systematic Review of Literature, and a Survey in Saudi Arabia

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Abstract

There is limited knowledge in the literature and lack of clear protocols among practitioners regarding preoperative steroids administration for patients undergoing endoscopic sinus surgery (ESS). This study aimed to identify the practice patterns of rhinologists in Saudi Arabia as well as systematically review all health-related evidence regarding the use of preoperative steroids for ESS. A previously used questionnaire was modified and distributed in Saudi Arabia among rhinologists who finished their residency training. It entailed questions about their qualifications and preoperative steroids use, preferred regimen, and possible benefits. Also, a systematic literature review using four major databases was conducted to build a scoping view of the current evidence. A total of 94 subjects responded to the mailed survey. Of them, 72(76.6%) used preoperative steroids; 40 subjects believed that there is a strong supporting evidence while 32 reported that there is no solid evidence. The commonest indication was chronic rhinosinusitis with nasal polyp followed by allergic fungal rhinosinusitis. More than half of subjects (54.2%) preferred medium-dose prednisone (30–40 mg/day). A considerable number believed that steroids decreased surgical bleeding (n = 57, 79.2%), improved surgical field visualization (77.8%), decreased surgical time (77.8%), and decreased mucosal inflammation (61.1%). Thirteen studies including 1028 patients were eligible for the systematic review. Only three studies reported a statistically significant effect of steroids in reducing intraoperative hemorrhage, while only two studies revealed that steroids significantly improved surgical field quality. In two studies, steroids showed a significant effect in reducing eosinophil infiltration. There is a major number of rhinology experts using preoperative steroids for patients undergoing ESS but there is a wide variation among their practice patterns. The current potent ial advantages of steroids need to be supported by further large randomized clinical trials to establish clear guidelines.

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Loupe Assisted Thyroidectomy: A Tool for Reducing Complications

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Abstract

The objective of this study is to assess if the use of magnification can reduce the incidence of hypocalcemia and vocal cord palsy in thyroid surgery. Data of patients who underwent total thyroidectomy (N = 50) for thyroid malignancy were analyzed retrospectively for 1 year. The patients were divided into two groups based on surgery with and without loupes. Hypocalcemia and Vocal cord palsy was assessed pre as well as post-operatively and the observations were noted. Descriptive statistics were performed to assess the proportion of the respective groups. Inferential statistics to find out the difference between the groups was done using the chi-square test. Significance level was kept at 5%. The incidence of hypocalcemia was 36.9% in the group done without loupes compared to 7.6% with loupes. The event of vocal cord injury though transient was 33% when done without loupes (p < 0.05). Magnification is crucial for the visualization of the n eurovascular anatomy which is depicted in our study. Although the study includes less number of cases, it is evident that the use of loupe magnification can reduce the morbidity associated with thyroid surgery to a great extent. We recommend the use of loupe magnification during surgery whenever possible.

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Efficacy of Sucralfate in Alleviating Post Tonsillectomy Symptoms and Morbidity: A Comparative Randomized Interventional Study

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Abstract

Pain following tonsillectomy still remains the main concern of topic and it occurs along with sever ear pain and trismus until and unless the exposed and inflamed mucosa gets covered with the regenerated mucosa. To study the efficacy of sucralfate in alleviating postoperative pain and morbidity following tonsillectomy. Subjects included in our study were patients which were fulfilling criteria for tonsillectomy and were admitted under the Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur from 1st July 2019 to 31st March 2020. 64 patients were evaluated and were randomly allocated into study and control group based on the administration of topical sucralfate. 64 patients who were admitted for tonsillectomy under the Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur from 1st July 2019 to 31st March 2020 were included in study. Patients were evaluated and were randomly allocated into study and control group based o n the administration of topical sucralfate. The incidence of throat pain and otalgia showed significant difference among both the group following postoperative day 2 onwards. On postoperative day 2, significant difference in trismus was also found. Effective alleviation of pain not only improves early dietary intake of the patients but also allays fear of apprehensive parents.

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Gluten-Free Diet Reduces Pain in Women with Myofascial Pain in Masticatory Muscles: A Preliminary Randomized Controlled Trial

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J Oral Facial Pain Headache. 2021 Summer;35(3):199-207. doi: 10.11607/ofph.2823.

ABSTRACT

AIMS: To evaluate the efficacy of a gluten-free diet (GFD) as a treatment modality for pain management in women with chronic myofascial pain in masticatory muscles.

METHODS: In this randomized controlled trial, 39 female subjects were evaluated according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided into three groups: a healthy group (n = 14; mean ± SD age = 34.57 ± 9.14 years); a control group (n = 12; age = 31.50 ± 7.38 years); and an experimental group (n = 13; age 30.00 ± 7.64 years). The outcome variables were: pain intensity, mechanical pain threshold (MPT), and pressure pain threshold (PPT). MPT was performed on the masseter muscle, and PPT was performed on both the masseter and anterior temporalis muscles. A nutritionist prescribed a 4-week individualized GFD for the experimental group. The healthy group was analyzed only initially, whereas the control and experimental groups were analyzed again after 4 weeks. Data were subjected to statistical analysis with a significance level of 5% (one-way analysis of variance followed by Bonferroni post hoc, paired t, Wilcoxon signed rank, Kruskal-Wallis/Dunn, and Pearson chi-square tests).

RESULTS: Participants who underwent a GFD showed reduction in pain intensity (P = .006) and an increase in PPT of the masseter (P = .017) and anterior temporalis (P = .033 ) muscles. The intervention did not influence the MPT of the masseter muscle (P = .26). In contrast, the control group showed no improvement in any parameter evaluated.

CONCLUSION: GFD seemed to reduce pain sensitivity in women with TMD and may be beneficial as an adjunctive therapy for chronic myofascial pain in masticatory muscles; however, further studies in the fields of orofacial pain and nutrition are required.

PMID:34609378 | DOI:10.11607/ofph.2823

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Long-Term Efficacy of Ultrasound-Guided Laser Ablation for Papillary Thyroid Microcarcinoma: Results of a 10-Year Retrospective Study

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Thyroid, Ahead of Print.
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First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits

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Surg Radiol Anat. 2021 Oct 6. doi: 10.1007/s00276-021-02845-z. Online ahead of print.

ABSTRACT

BACKGROUND: Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functional anatomy of a first dorsal metacarpal artery (FDMA) perforator flap.

METHODS : Twenty-nine fixed cadaveric hands were dissected to determine the origin, course, and branches of the FDMA. Clinically, five cases of soft tissue defects of the hand underwent reconstructive surgery using an FDMA perforator-based propeller flap.

RESULTS: The FDMA was found in 27 specimens (93%). The ulnar branch of the FDMA always supplied the cutaneous perforator (mean ± SD, 4.3 ± 1.6), and the most distal cutaneous perforating branch was found along the metacarpal long axis within 25 mm of the tip of the metacarpal head with high frequency (28/29, 97%). In the two hands that had aplasia of the FDMA, well-developed perforators arose directly from the radial artery and advanced to the metacarpal head. Seven hands (24%) had perforators arising from the palmar arterial system, penetrating through or passing close by the second metacarpal bone. In clinical application, all the flaps survived completely without major complications.

CONCLUSIONS: The FDMA perforator-based propeller flap is minimally invasive and technically simple. It is expected to be a new option for hand reconstruction.

PMID:34613448 | DOI:10.1007/s00276-021-02845-z

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Tuesday, October 5, 2021

Case Reports in Otolaryngology

Frontal Sinus "Hump": An Anatomical Risk Factor for Anterior Skull Base Injury in the Endoscopic Modified Lothrop Approach (Outside-In Frontal Drill-Out), Teppei Takeda, Kazuhiro Omura, Haw Torng, Teru Ebihara, Satoshi Aoki, Kosuke Tochigi, Hiromi Kojima, and Nobuyoshi Otori
Volume 2021 (2021), Article ID 3402496, 5 pages
Unilateral Cysticercosis of the Parotid Gland: Case Report, Diagnosis, and Clinical Management, Zachary Elwell, Shethal Bearelly, Khalid Aboul-Nasr, and Jonathan Lara
Volume 2021 (2021), Article ID 9999441, 4 pages
Traumatic Cochlear Implant Electrode Extrusion: Considerations, Management, and Outcome, Ching Yee Chan, Feifan Wang, Haryani Omar, and Henry Kun Kiaang Tan
Volume 2021 (2021), Article ID 2918859, 4 pages
The Rare Cases of Parotid Gland Arteriovenous Malformations, Manish Gupta, Vijay Shrawan Nijhawan, Cynthia Kaur, Sukhpreet Kaur, and Akanksha Gupta
Volume 2021 (2021), Article ID 6072155, 5 pages
Osteochondroma Arising from the Thyroid Cartilage: A Case Report and Literature Review, Jessa E. Miller, Shaghauyegh S. Azar, and Dinesh K. Chhetri
Volume 2021 (2021), Article ID 8286012, 4 pages
A Rare Case of Posttraumatic Bilateral BPPV Presentation, Sinisa Maslovara, Andro Kosec, Ivana Pajic Matic, and Anamarija Sestak
Volume 2021 (2021), Article ID 8636676, 5 pages
Nasopharyngeal Coil Dislocation of an Embolized Internal Carotid Artery Pseudoaneurysm, Nazli Ay, Ingo Todt, and Holger Sudhoff
Volume 2021 (2021), Article ID 4270441, 4 pages
Presence of Two Separate Hairy Polyps with Meningothelial Elements in a 15-Month-Old Child, Ahmad Saeed A. Alghamdi, Nasser Almutairi, and Ghassan Alokby
Volume 2021 (2021), Article ID 1844244, 5 pages
Case of Amelanotic Malignant Melanoma of the Lingual Base That Was Diagnosed Based on a Biopsy of Late Metastasis to a Lumbar Vertebra after Being Misdiagnosed as HPV-Positive Oropharyngeal Anterior Wall Squamous Cell Carcinoma, Takumi Okuda, Shinsuke Ide, Kei Kajihara, and Tetsuya Tono
Volume 2021 (2021), Article ID 7139280, 6 pages
Survival of Toddler with Aortoesophageal Fistula after Button Battery Ingestion, Hannah Gibbs, Rishabh Sethia, Patrick I. McConnell, Jennifer H. Aldrink, Toshiharu Shinoka, Kent Williams, and Kris R. Jatana
Volume 2021 (2021), Article ID 5557054, 7 pages

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