The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis

alexandrossfakianakis shared this article with you from Inoreader The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis via Clinical Otolaryngology Abstract Background Olfactory dysfunction (OD) is a common but underreported problem that can significantly impact a patient's quality of life. OD is prevalent in over 5% of the adult population and can be broadly categorised into conductive and sensorineural causes. Magnetic Resonance Imaging (MRI) can form part of the diagnostic work up, although its exact role is often debated. Objectives The aim of this study was to evaluate the value of MRI in managing patients with OD. Design/ Method A retrospective analysis of the records of patients presenting to a national smell and taste clinic over a five-year period was performed. Variables included demographics, endoscopic findings, final diagnosis, psychophysical smell test and imaging results. Results A total of 409 patients, with an age range of 10-93 years, underwent clinical assessment and smell testing, of which 172 patients (42%) had MRI scans. Imaging in younger age-groups was associated with a higher rate of positive findings, however identifiable causes for OD were recorded across the range. MRI provided both diagnostic and prognostic information in those with idiopathic, traumatic, and congenital causes of OD. For example, MRI provided information on the extent or absence of gliosis in those with a head trauma history allowing further treatment and prognosis. Conclusion We recommend the adjunct use of MRI in patients with a clear history and examination findings of head injury, congenital cases and in apparent idiopathic cases. MRI should be requested to compliment clinical findings with a view to aiding decision-making on treatment and prognosis independent of patient's age. View on Web

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

alexandrossfakianakis shared this article with you from Inoreader Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes via The Laryngoscope Our retrospective cohort study identified that Black patients comprised the greatest proportion of patients with iatrogenic laryngotracheal stenosis. Of all etiologies, the iatrogenic form of stenosis had the highest incidence of temporary tracheostomy and tracheostomy dependence. Objective Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency. Methods Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit. Results 129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only. Conclusion This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study. Level of Evidence III Laryngoscope, 2022 View on Web

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The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users

alexandrossfakianakis shared this article with you from Inoreader The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users via The Laryngoscope CI users face significant difficulty with music perception, which negatively impacts sound quality and music appreciation. Our study demonstrates commercially available vocal boost software can be used to improve the perception of musical sound quality appraisals among CI users, which may contribute positively to quality of life. Given these findings, front-end vocal manipulations and settings should be considered as an adjunct to current methods of hearing accessibility and accommodations for CI music listening experiences. Objective To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals. Methods An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with −9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise ("anchor"), and an unaltered version ("hidden reference"). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt. Results Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62–21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64–38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76–40.7, p = 0.028). Conclusions CI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users. Level of Evidence II (Individual cohort study) Laryngoscope, 2022 View on Web

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Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification

alexandrossfakianakis shared this article with you from Inoreader Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification via The Laryngoscope Objective To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. Methods Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated. Results One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6–25), recurrent (QoL-RSS = 26–38), and chronic (QoL-RSS > 38) LPR. Conclusion Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR. Level of Evidence III Laryngoscope, 2022 View on Web

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Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study

alexandrossfakianakis shared this article with you from Inoreader Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study via The Laryngoscope This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics measurements. We found that lower nasal mucosal temperature and higher heat flux anteriorly correlate with a perception of improved unilateral nasal patency in healthy individuals. Objectives Recent evidence suggests that detection of nasal mucosal temperature, rather than direct airflow detection, is the primary determinant of subjective nasal patency. This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics (CFD) measurements. Methods Healthy adult participants completed Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A temperature probe measured nasal mucosal temperature at the vestibule, inferior turbinate, middle turbinate, and nasopharynx bilaterally. Participants underwent a CT scan, used to create a 3D nasal anatomy model to perform CFD analysis of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area where heat flux >50 W/m2 (SAHF50). Results Eleven participants with a median age of 27 (IQR 24; 48) were recruited. Probe-measured temperature values correlated strongly with CFD-derived values (r = 0.87, p < 0.05). Correlations were seen anteriorly in the vestibule and inferior turbinate regions between nasal mucosal temperature and unilateral VAS (r = 0.42–0.46; p < 0.05), between SAHF50 and unilateral VAS (r = −0.31 to −0.36; p < 0.05) and between nasal mucosal temperature and SAHF50 (r = −0.37 to −0.41; p < 0.05). Subjects with high patency (VAS ≤10) had increased heat flux anteriorly compared with lower patency subjects (VAS >10; p < 0.05). Conclusion Lower nasal mucosal temperature and higher heat flux within the anterior nasal cavity correlates with a perception of improved unilateral nasal patency in healthy individuals. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Effect of different cleansing methods on the artificially aged bond strength of resin to contaminated zirconia: A systematic review

alexandrossfakianakis shared this article with you from Inoreader Effect of different cleansing methods on the artificially aged bond strength of resin to contaminated zirconia: A systematic review via Journal of Prosthodontics ABSTRACT Purpose The aim of this review was to evaluate studies investigating the effect of cleansing methods on the artificially aged bond strength of resin to contaminated zirconia restorations and determine which cleansing method of contaminated zirconia for resin bonding improvement is more efficient. Methods An electronic search of published studies in English language was carried out until July 2021 on Scopus, Web of Science, and Medline databases. Data from in vitro studies involving the evaluation of the artificially aged bond strength of resin to contaminated zirconia following different cleansing methods were included. In vitro studies in which samples were not subjected to at least 5000 thermocycles, were excluded. Results Of 162 articles retrieved initially, 19 were eligible to be included in the systematic review, of which 5 articles were excluded. Therefore, the final sample was 14 in vitro studies. All of the included studies for air abrasion suggested this method as an effective cleansing method but 6 of 8 included studies reported cleaning paste (Ivoclean) as an effective cleansing method. All of the included studies for NaOCl and a cleaning gel (AD Gel) reported their efficacy. Finally, the results of included studies showed the ineffectiveness of phosphoric acid, water, isopropanol, enzymatic detergents, hydrogen peroxide, and acetone. Conclusions Air abrasion has been reported as an effective cleansing method to improve the bond strength of resin to contaminated zirconia. For improvement of cleaning paste effectiveness in resin bonding, another efficient cleansing method should be followed after this method. However, the superior cleaning potential of air-abrasion rather than cleaning paste has been reported. Sodium hypochlorite and cleaning gel seem to be as effective as air abrasion, but extensive water-rinsing is necessary after the application of these cleaning agents. This article is protected by copyright. All rights reserved View on Web

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The role of intraoral scanners in the shade matching process: a systematic review

alexandrossfakianakis shared this article with you from Inoreader The role of intraoral scanners in the shade matching process: a systematic review via Journal of Prosthodontics ABSTRACT Purpose The variation in findings with regards to accuracy and precision of intraoral scanners for shade selection are no doubt confusing for clinicians who may find it difficult to make evidence-based decisions. The aim of this systematic review is to provide a comprehensive and in-depth assessment of available studies to determine the viability of using intraoral scanners for the purpose of shade matching. The PICO guided research question is as follows: when shade matching, are intraoral scanners as valid as visual or other digital shade measuring devices in determining tooth colors. Methods Electronic databases including PubMed/MEDLINE, SCOPUS, EBSCO, Cochrane, and ProQuest were systematically searched for articles published between January 1, 2011 and December 30, 2021 using the main search terms: "intraoral scanners", "scanners", "TRIOS", "CEREC", "Planmeca", "Medit", "digital dentistry" in concurrence with one of the following keywords: "EasyShade" OR "shade selection" OR "shade matching" OR "shade" OR "tooth color" OR "tooth shade" OR "digital shade matching". Bibliographies of included articles and the following journals were searched for relevant articles: Journal of Prosthetic Dentistry, Journal of Prosthodontics, Journal of Esthetic and Restorative Dentistry, Journal of Advanced Prosthodontics and Journal of Dentistry. A total of 15 articles were included in the review. Results Intraoral scanners are highly repeatable for shade matching, and outperformed visual shade matching. Accuracy varied significantly between studies, with the majority recommending the use of visual shade matching to confirm/verify the intraoral scanner results. Setting intraoral scanners to the Vita 3D Master shade guide improved both accuracy and precision. Shade matching with intraoral scanners may be influenced by external factors such as ambient light sources and incorrect use or manipulation. Conclusion Intraoral scanners set to the Vita 3D Master shade guide may be used for shade matching, but shade should be verified with visual shade matching. Further studies are required to address limitations of current studies. This article is protected by copyright. All rights reserved View on Web

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Non‐carious cervical lesions (NCCLs): morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

alexandrossfakianakis shared this article with you from Inoreader Non‐carious cervical lesions (NCCLs): morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration via Journal of Prosthodontics Abstract Purpose : To synthesize the literature regarding non-carious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. Material and Methods : A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. Results : NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineral ization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multi-step and single-step adhesives have been used. Dentin etching should be increas ed to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. Conclusions : Non-carious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multi-step or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators. This article is protected by copyright. All rights reserved View on Web

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Constitutive programmed death ligand 1 expression protects gastric G‐cells from Helicobacter pylori–induced inflammation

alexandrossfakianakis shared this article with you from Inoreader Constitutive programmed death ligand 1 expression protects gastric G‐cells from Helicobacter pylori–induced inflammation via Helicobacter Abstract Introduction Gastric intestinal metaplasia (GIM) is a premalignant lesion, highly associated with Helicobacter pylori infection. Previous studies have shown that H. pylori is able to induce the expression of programmed death ligand 1 (PD-L1), an inhibitory immune modulator, in gastric cells. Our aim was to investigate whether tissues from GIM patients may exploit PD-L1 expression upon H. pylori infection to evade immunosurveillance. Methods Immunohistochemistry was performed for PD-L1 and enteroendocrine markers somatostatin and gastrin on samples derived from a cohort of patients with known GIM, both before and after H. pylori eradication. To determine the identity of any observed PD-L1-positive cells, we performed multiplex immunofluorescent staining and analysis of single-cell sequencing data. Results GIM tissue was rarely positive for PD-L1. In normal glands from GIM patients, PD-L1 was mainly expressed by gastrin-positive G-cells. While the D-cell and G-cell compartments were both diminished 2-fold (p = .015 and p = .01, respectively) during H. pylori infection in the normal antral tissue of GIM patients, they were restored 1 year after eradication. The total number of PD-L1-positive cells was not affected by H. pylori, but the percentage of PD-L1-positive G-cells was 30% higher in infected subjects (p = .011), suggesting that these cells are preferentially rescued from destruction. Conclusions Antral G-cells frequently express PD-L1 during homeostasis. G-cells seem to be protected from H. pylori-induced immune destruction by PD-L1 expression. GIM itself does not express PD-L1 and is unlikely to escape immunosurveillance via expression of PD-L1. View on Web

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