Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

xlomafota13 shared this article with you from Inoreader Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jun 14. doi: 10.1007/s00405-021-06937-9. Online ahead of print. ABSTRACT PURPOSE: The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. METHODS: Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6 months af ter septoplasty. RESULTS: Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively). CONCLUSION: Septoplasty and inferior turbinate hypertrophy r eduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life. PMID:34125283 | DOI:10.1007/s00405-021-06937-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

xlomafota13 shared this article with you from Inoreader Episodic versus Chronic Dizziness: An Analysis of Predictive Factors Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jun 13:34894211025416. doi: 10.1177/00034894211025416. Online ahead of print. ABSTRACT OBJECTIVES: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. METHODS: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic d izziness group (<15 dizzy days per month). RESULTS: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière's disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance i n the chronicity of dizziness (pseudo-R2 = 0.15; P < .001). CONCLUSIONS: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients. PMID:34121469 | DOI:10.1177/00034894211025416 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study

xlomafota13 shared this article with you from Inoreader Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jun 13:34894211005982. doi: 10.1177/00034894211005982. Online ahead of print. ABSTRACT BACKGROUND: Reliable use of surgical navigation depends upon the registration process. The gold standard is paired-point registration with bone-anchored fiducials, but contour-map registration is more practical. Surgeons may employ variable contour maps and less experienced team members often perform this critical step. The impact of these practices on target registration error (TRE) is not well-studied. METHODS: A dry lab set-up consisting of a navigation system (Fusion ENT, Medtronic, Jacksonville, FL) and a sinus phantom with 2 mm radiopaque spheres in the sphenoid and ethmoid regions was developed. A CT (0.625 mm slice thickness) was obtained. Registration was performed with a contour-based protocol. Accuracy was determined using the software's distance measurement tool. Registration was performed with narrow-field (NF; forehead points medial to the mid-pupillary line) and wide field (WF; entire forehead) contour maps. An experienced rhinologist and a resident surgeon performed each registration in triplicate and TRE at the sphenoid and ethmoid markers was measured in triplicate. RESULTS: WF mapping had a lower TRE than NF (1.09 mm [95% Confidence Interval (CI) 0.96-1.22] vs 1.68 mm [95% CI 1.50-1.86]). The experienced surgeon had a lower TRE compared to the resident (1.21 mm [95% CI 1.08-1.34] vs 1.54 mm [95% CI 1.35-1.7 4]). CONCLUSIONS: In this navigation model, wide field mapping offers better accuracy than narrow-field mapping, and an experienced surgeon seemed to achieve better accuracy than a resident surgeon. These observations have potential implications for the use of this technology in the operating room. PMID:34121472 | DOI:10.1177/00034894211005982 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bone Cement Internal Auditory Canal Reconstruction to Reduce CSF Leak After Vestibular Schwannoma Retrosigmoid Approach

xlomafota13 shared this article with you from Inoreader Bone Cement Internal Auditory Canal Reconstruction to Reduce CSF Leak After Vestibular Schwannoma Retrosigmoid Approach Via leak of cerebrospinal fluid Otol Neurotol. 2021 Jun 11. doi: 10.1097/MAO.0000000000003215. Online ahead of print. ABSTRACT OBJECTIVE: To describe rates of cerebrospinal fluid (CSF) rhinorrhea after reconstruction of the IAC with calcium phosphate bone cement during retrosigmoid resections of vestibular schwannomas. METHODS: A retrospective chart review of 177 patients who underwent retrosigmoid craniotomy and opening of the internal auditory canal for resection of a vestibular schwannoma between January 2016 and September 2019 at a tertiary referral center. Patients with other cerebellopontine angle tumor histology, neurofibromatosis type II, or those undergoing revision surgeries were excluded. RESULTS: Out of 177 patients, six patients (3.4%) developed postoperative rhinorrhea. Four patients (2.3%) were taken back to the OR for mastoidectomy and repair of CSF leak. Three of these patients were noted to have a CSF leak from the peri-labyrinthine air cells, and one was found to have a leak from the craniotomy site communicating with the mastoid air cells. Two patients were conservatively managed with diuretics and had resolution of their CSF leak. Six patients (3.4%) were readmitted for postoperative infection. Two patients were diagnosed with meningitis (1.1%), one aseptic and one H. Influenza, and three patients developed surgical site infections (1.6%). One patient was empirically treated with antibiotics and ultimately had a negative CSF culture. CONCLUSIONS: Our results demonstrate that the use of calcium phosphate bone cement for IAC closure in retrosigmoid resection of vestibular schwannomas is a safe and effective technique with low rates of postoperative CSF rhinorrhea. PMID:34121078 | DOI:10.1097/MAO.0000000000003215 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Matched Cohort Analysis of the Effect of the Facial Recess Approach on Cerebrospinal Fluid Leak After Translabyrinthine Surgery for Schwannoma

xlomafota13 shared this article with you from Inoreader Matched Cohort Analysis of the Effect of the Facial Recess Approach on Cerebrospinal Fluid Leak After Translabyrinthine Surgery for Schwannoma Via leak of cerebrospinal fluid Otol Neurotol. 2021 Jun 11. doi: 10.1097/MAO.0000000000003223. Online ahead of print. ABSTRACT OBJECTIVE: The facial recess approach during translabyrinthine surgery has been used to expose the eustachian tube (ET) for packing. We sought to determine the effect of this technique on the development of postoperative nasopharyngeal cerebrospinal fluid (CSF) leaks. PATIENTS: Cohorts of patients with cerebellopontine angle schwannomas who underwent a facial recess approach or no facial recess approach were matched based on tumor size. INTERVENTIONS: Translabyrinthine surgery for tumor resection. MAIN OUTCOME MEASURES: Postoperative CSF leaks were recorded and nasopharyngeal CSF leaks were utilized as the primary outcome measure. RESULTS: Using an exact matching protocol based on tumor size, 102 patients were included in each group (204 total, 111 female, 93 male). Overall, 9 patients (4.4%) demonstrated a postoperative naso pharyngeal CSF leak. Postoperative CSF rhinorrhea was noted in 3.9% of the group who underwent a facial recess approach for packing of the ET and 4.9% of the group who did not undergo a facial recess approach. This rate was not significantly different between groups (p = 0.99, Odds ratio: 0.79, 95% CI: 0.15-3.8). Secondary variables including age, tumor size, a diagnosis of NF2, and the packing material used were not significant predictors of nasopharyngeal CSF leaks. CONCLUSIONS: CSF rhinorrhea is infrequent after translabyrinthine surgery. The incidence of this complication is not affected by whether or not a facial recess approach is performed during surgery to pack the ET. Based on these data, use of this technique should be based on surgeon comfort and preference. PMID:34121082 | DOI:10.1097/MAO.0000000000003223 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebrospinal Fluid Leaks from the Lateral Ventricle: A Case Series

xlomafota13 shared this article with you from Inoreader Cerebrospinal Fluid Leaks from the Lateral Ventricle: A Case Series Via leak of cerebrospinal fluid Otol Neurotol. 2021 Jun 11. doi: 10.1097/MAO.0000000000003211. Online ahead of print. ABSTRACT OBJECTIVES: Describe the diagnosis and management of lateral skull base (LSB) cerebrospinal fluid (CSF) leaks originating from the lateral ventricle. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral academic center. PATIENTS: Patients with CSF leaks with direct communication to the lateral ventricle on preoperative imaging. INTERVENTION: Surgical repair via the middle cranial fossa (MCF) approach. MAIN OUTCOME MEASURES: CSF leak patient characteristics (age, sex, body mass index [BMI]) and postoperative course (complications and CSF leak resolution) were collected. RESULTS: Three patients had CSF leaks from the lateral ventricle and all patients demonstrated encephalomalacia of the temporal lobe on preoperative imaging. Encephalomalacia resulted from trauma in one case (age 5) and neurodegenerat ion in two cases (age 77 and 84). BMI ranged from 16.3 to 26.6 mg/kg2 and follow-up ranged from 4 to 21 months. Two patients presented with preoperative meningitis and all patients had resolution of CSF leaks after MCF repair. With the exception of the higher rate of meningitis, patient presentations did not differ from other spontaneous CSF leaks through middle fossa defects. There were no minor or major postoperative complications. CONCLUSIONS: CSF leaks from the lateral ventricle represent a rare subset of LSB CSF leaks and can occur in non-obese patients secondary to temporal lobe encephalomalacia. The MCF approach allows for repair of the dura and skull base in this cohort of patients with high-flow CSF leaks and loss of brain parenchyma. PMID:34121080 | DOI:10.1097/MAO.0000000000003211 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pituitary Tumor Surgery: Comparison of Endoscopic and Microscopic Techniques at a Single Center

xlomafota13 shared this article with you from Inoreader Pituitary Tumor Surgery: Comparison of Endoscopic and Microscopic Techniques at a Single Center Via leak of cerebrospinal fluid Mayo Clin Proc. 2021 Jun 10:S0025-6196(21)00254-8. doi: 10.1016/j.mayocp.2021.03.028. Online ahead of print. ABSTRACT OBJECTIVE: To understand the transition from microscopic surgery (MS) to endoscopic surgery (ES) on the pituitary across the United States, we assessed a single institution practicing both procedures to discern advantages and disadvantages for each. PATIENTS AND METHODS: Retrospective institutional chart review of 534 patients in a large practice over a 6-year period (January 1, 2014, to December 31, 2019) comparing a single MS neurosurgeon with a single ES neurosurgeon operating on the same days. RESULTS: In this series, 14% (n=75) of patients had a prior operation, there were no carotid artery injuries, the overall risk for a postoperative infection was 0.4% (n=2), and risk for a postoperative cerebrospinal fluid leak requiring treatment was 2.0% (n=11). Mean ± SD hospital stay was 1.3±0.04 days; readmission fo r any reason within 30 days occurred in 3.4% (n=18) of patients. The mean volumetric resection for MS was 86.9%±1.7% and for ES was 91.7%±1.3% (P=.03). There was a higher rate of notable events (P=.015) with MS, but MS had 16% lower cost and operative times were 48 minutes shorter than for ES (83±7 vs 131±6 minutes). The ES required substantially fewer postoperative secondary treatments such as radiation therapy (P=.003). CONCLUSION: Pituitary surgery is a very safe and effective procedure regardless of technique. The MS has shorter operative times and overall lower cost. The ES results in increased volumetric resection and fewer secondary treatments. Both techniques can be valuable to a large practice, and understanding these niches is important when selecting optimal approaches to pituitary surgery for a given patient. PMID:34120752 | DOI:10.1016/j.mayocp.2021.03.028 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Sweet Voice: Acute Febrile Neutrophilic Dermatosis of the Larynx

xlomafota13 shared this article with you from Inoreader A Sweet Voice: Acute Febrile Neutrophilic Dermatosis of the Larynx Via ear nose throat Ear Nose Throat J. 2021 Jun 12:1455613211022098. doi: 10.1177/01455613211022098. Online ahead of print. ABSTRACT SIGNIFICANCE STATEMENT: Acute febrile neutrophilic dermatosis (Sweet syndrome) is a rare idiopathic condition characterized by fever and whole-body rash of tender erythematous plaques of unknown etiology. Otorhinolaryngologic manifestations of the disease can be severe, yet they are sparsely reported in the literature. We present the first documented case of laryn geal involvement of Sweet syndrome. PMID:34121481 | DOI:10.1177/01455613211022098 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incidence of Olfactory Dysfunction and Associated Factors: A Nationwide Cohort Study From South Korea

xlomafota13 shared this article with you from Inoreader Incidence of Olfactory Dysfunction and Associated Factors: A Nationwide Cohort Study From South Korea Via ear nose throat Ear Nose Throat J. 2021 Jun 12:1455613211012906. doi: 10.1177/01455613211012906. Online ahead of print. ABSTRACT OBJECTIVES: Olfactory dysfunction, a reduced or complete loss of the ability to smell, is gaining attention because of its substantial impact on an individual's quality of life and the possibility that it is an important sign of underlying disease. However, olfactory dysfunction is underdiagnosed in the general population due to diagnostic difficulty and unpredict able prognosis. This study aimed to evaluate the prevalence of clinically diagnosed olfactory dysfunction in South Korea by using well-organized, nationwide, population-based cohort data, and the associations between olfactory dysfunction and risk of neurodegenerative disorders. METHODS: We investigated the Korean National Health Insurance Service-National Sample Cohort for patients diagnosed with olfactory dysfunction according to the International Classification of Diseases. Annual and overall incidence and prevalence of olfactory dysfunction during 2003 to 2013 and patient characteristics were analyzed. Based on those identified patients who were later diagnosed with neurodegenerative disorder, hazard ratios (HRs) of sociodemographic factors and comorbidities associated with neurodegenerative disorder were evaluated using a Cox proportional hazard regression model. RESULTS: In total, 6296 patients were clinically diagnosed with olfactory dysfunction during the study p eriod (524.67 patients/year). The prevalence increased annually and was higher in female patients. The incidence of neurodegenerative disorders among patients with olfactory dysfunction was 4.2% within the study period. Multivariate cox regression analysis of the patients (n = 249) revealed that diabetes mellitus (HR = 1.976) and depression (HR = 2.758) were significant risk factors. CONCLUSIONS: Olfactory dysfunction is underdiagnosed in South Korea, but it is clinically important considering the possibility of presymptom of neurodegenerative disorders. In clinical practice, we should consider its association with neurodegenerative disorders and possibly other systemic conditions. PMID:34121478 | DOI:10.1177/01455613211012906 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Expressions of CXCL12, CXCL10 and CCL18 in Warthin tumors characterized pathologically by having a lymphoid stroma with germinal centers

xlomafota13 shared this article with you from Inoreader Expressions of CXCL12, CXCL10 and CCL18 in Warthin tumors characterized pathologically by having a lymphoid stroma with germinal centers Via Cellular and Molecular Biology Histol Histopathol. 2021 Jun 14:18352. doi: 10.14670/HH-18-352. Online ahead of print. ABSTRACT The Warthin tumor is a benign neoplasm of the salivary glands, histologically, the tumor has an oncocytic epithelial component forming uniform rows of cells surrounded by cystic spaces associated with a lymphoid stroma often showing the presence of germinal centers. The lymphoid stroma is a representative microscopic finding. If this lymphocytic accumulation is active, some sort of transmitter should exist between the Warthin tumor cells and lymphocytes. C-X-C motif chemokine ligand 12 (CXCL12), CXCL10 and C-C motif chemokine ligand 18 (CCL18) are a chemoattractant for lymphocytes in vivo. There is no report on the relationship between these chemokines and Warthin tumors. In this study, we investigated these chemokines expressions in 20 Warthin tumors using immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). Fo r comparison, we also enrolled samples of pleomorphic adenoma, which is another benign salivary gland tumor type without prominent lymphocytic infiltration. All Warthin tumors were immunopositive for CXCL12 and CXCL10, and these reactivities were diffuse. Meanwhile, the majority of pleomorphic adenomas were immunonegative for CXCL12 (95%), CXCL10 (80%) and CCL18 (85%). Warthin tumor and pleomorphic adenoma cases were significantly different in these immunostaining expressions (CXCL12, p<0.001; CXCL10, p<0.001; CCL18, p=0.024). We examined CXCL12, CXCL10 and CCL18 mRNA expressions of 3 representative Warthin tumor samples, each having these chemokines immunopositive areas detected by RT-PCR. Finding CXCL12 and CXCL10 expressions indicate that these chemokines may play a part in the formation of a lymphoid stroma within Warthin tumors. In regards to this phenomenon, the participation of CCL18 might be restrictive compared to CXCL12 and CXCL10. PMID:34124768 | DOI:10.14670/HH-18-352 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.