Hasil untuk "Otorhinolaryngology"

Luciana Lozza de Moraes Marchiori, Glória de Moraes Marchiori, Licia Sayuri Tanaka Okamura et al.

Introduction An association between the sensation of vertigo, and body composition has not been investigated in post-coronavirus disease 2019 (COVID-19) patients.

Usama Waqar, Aahan Arif, Ayesha N. Hameed et al.

Abstract Objectives Racial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors. Methods This retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian. Results A total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity. Conclusions Black patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.

Ahmed Elsobki, Hemmat Baz, Reham AE Ibrahim et al.

Introduction The classification and management of laryngomalacia are challenging topics that are continuously updated and modified by pediatric airway surgeons. However, a numerical stratification of the patients to decide on the conservative management or intervention has not yet been established.

Hanqing Lin, Hanqing Lin, Yuanteng Xu et al.

In the conventional view, CD4+ regulatory T cell (Treg) represents a subset of lymphocytes that involve the perception and negative regulation of the immune response. CD4+Treg plays an important role in the maintenance of immune homeostasis and immune tolerance. However, recent studies have revealed that CD4+Treg do not suppress the immune response in some diseases, but promote inflammatory injury or inhibit tissue remodeling, suggesting the functional heterogeneity of CD4+Treg. Their involvement in tumor pathogenesis is more complex than previously understood. This article reviews the relevant research on the heterogeneity of CD4+Treg, subtype classification, and their relationship with tumor therapy.

Zhiqiu Zhu, Chaoran Zhao, Ming Wang

Abstract Type 2 dominant inflammation in nasal mucosa is the key underlying pathophysiological mechanism of allergic rhinitis (AR) and most presentations of chronic rhinosinusitis with nasal polyps (CRSwNP). Interleukin‐4 (IL‐4) and IL‐13 share common receptor subunits and signaling molecules, which lead to various pathological changes in different cells, playing key roles in the pathogenesis of nasal type 2 inflammation. Numerous clinical trials have shown that biologics targeting key molecules of the IL‐4/IL‐13 pathway, especially IL‐4 receptor alpha, can treat CRSwNP and AR with high efficacy, and are generally well tolerated. Several biologics have been approved for the treatment of difficult‐to‐control CRSwNP, while others also show promising results. Here, we review the IL‐4/IL‐13 pathway, its role in nasal type 2 inflammation, and current targeted therapies related to the IL‐4/IL‐13 pathway, with a focus on AR and CRSwNP.

Carolyn Lai, Demir Bajin, Joseph M. Chen et al.

Jacob Poynter, Peter Dziegielewski

Background: Proliferating Pilar tumors are uncommon dermal lesions that are most commonly found on the scalp. Due to the rarity of the lesion and certain similarities, proliferating pilar tumors are often mistaken for other malignant skin lesions. Certain characteristics can aid in early diagnosis and help guide clinical decision making. We report a case of a large, fungating proliferating pilar tumor that was thought to represent malignancy prior to final surgical pathology results. Case presentation: A 70-year-old female with extensive sun exposure and prior cutaneous malignancies presented with a large fungating, malodorous right parietal scalp mass (Fig. 1) as well as another midline subcutaneous scalp mass. Physical exam and contrast-enhanced CT demonstrated a 9.5cm mass in the right parietal region arising in the skin and demonstrating full-thickness invasion of the scalp without obvious bony invasion, but possible adherence to the periosteum. Punch Biopsy was obtained which was concerning for squamous cell carcinoma. Recommendations were made for wide local excision with likely need for post-operative radiation. Final pathology results were consistent with a proliferating pilar tumor accompanied by a simple pilar cyst. Conclusions: We report a case of a rare, locally aggressive, proliferating pilar tumor. A high-index of suspicion is required as these lesions are rare and easily mistaken for cutaneous malignancy. Judicious work-up as well as careful attention to certain characteristics can allow for early diagnosis, assisting in patient counseling and management.

Dong-Hyun Kim, Jung-Hun Kown, Hyung-Bon Koo et al.

Background and Objectives The purpose of this study was to classify radiological findings of patients diagnosed with maxillary sinus fungus ball and to analyze the differences in surgical approach methods and postoperative results. Methods As a retrospective study, we reviewed the medical records of 221 patients (unilateral in 216: bilateral in 5). Results On computed tomography (CT), 49% of the lesions had an irregular surface or a protruding part. There was a significant difference in surgical approach according to pneumatization of the maxillary sinus when middle meatal antrostomy (MMA) was performed alone or combined with MMA and inferior meatal antrostomy (IMA) (p=0.042). Extension of a maxillary sinus lesion caused by fungus ball was not associated with stenosis of the MMA (p=0.328). Conclusion Diagnosis of maxillary sinus fungus on CT was associated with irregular lesion surface or a protruding calcification. In patients with fungus ball of the maxillary sinus, the more severe is the maxillary sinus pneumatization, the larger is the extent of IMA needed.

Zuraini Mohammad Nasir, Sethu Thakachy Subha

Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.

Suárez C, López F, Mendenhall WM et al.

Carlos Su&aacute;rez,1,2 Fernando L&oacute;pez,1&ndash; 3 William M Mendenhall,4 Simon Andreasen5&ndash; 7&dagger;, Lauge Hjorth Mikkelsen,7 Johannes A Langendijk,8 Stefano Bondi,9 Juan P Rodrigo,1&ndash; 3 Leif B&auml;ck,10 Antti A M&auml;kitie,10&ndash; 12 Ver&oacute;nica Fern&aacute;ndez-Alvarez,13 Andr&eacute;s Coca-Pelaz,1&ndash; 3 Robert Smee,14 Alessandra Rinaldo,15 Alfio Ferlito16 1Instituto de Investigaci&oacute;n Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; 2Instituto Universitario de Oncolog&iacute;a del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain; 3Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; 4Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA; 5Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark; 6Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, K&oslash;ge, Denmark; 7Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 8Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 9Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy; 10Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; 11Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; 12Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; 13Vascular Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain; 14Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia; 15University of Udine School of Medicine, Udine, Italy; 16International Head and Neck Scientific Group, Padua, Italy&dagger;Simon Andreasen passed away on February 28, 2020Correspondence: Carlos Su&aacute;rezInstituto de Investigaci&oacute;n Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Avenida de Roma s/n, Oviedo 33011, SpainEmail csuareznieto@gmail.comFernando L&oacute;pezDepartment of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, Oviedo 33011, SpainEmail flopez_1981@yahoo.esAbstract: The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5&ndash; 10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.Keywords: schwannoma, head and neck, cranial nerves, non-vestibular, skull base

Alejandro Zuazua-Gonzalez MD, Teresa Collazo-Lorduy MD, Guadalupe Coello-Casariego MD et al.

Objective The main purpose of this work is to describe the sociodemographic and clinical characteristics of intensive care unit (ICU) patients in a second-level hospital in Madrid, Spain, focusing in those who underwent surgical tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The surgical technique and associated complications are also detailed. Study Design Observational and historical cohort. Setting Single center. Methods Eighty-three intubated COVID-19 patients were analyzed. Thirty bedside surgical tracheostomies had been performed following our safety protocol. Results Data from 83 patients admitted to the ICU in Infanta Leonor University Hospital were collected; 74.7% were male. The average age was 59.7 years. The main comorbidities found were hypertension in 51.8%, diabetes mellitus in 25.3%, asthma in 7.2%, and chronic obstructive pulmonary disease in 3.6%. A surgical tracheostomy was carried out in 36.1% of patients who needed a prolonged intubation. The most frequent complication of the surgical procedure, bleeding, occurred in 30%, but the majority were mild and ceased with compression only. The most relevant complication was local infection, which occurred in 26.7% of patients. There were statistically significant differences in the time from the beginning of mechanical ventilation until weaning between tracheostomized and nontracheostomized patients. The mortality rate of patients who underwent tracheostomy was 56.7%. Despite severe acute respiratory syndrome coronavirus 2 being highly contagious and tracheostomy being considered a high-risk procedure, our rate of infected ear, nose, and throat specialists was only 11.8%. Conclusion In our experience, bedside surgical tracheostomy is a safe procedure in COVID-19 patients when safety protocols are followed.

Pawel Burduk, Piotr Sawicki, Lukasz Szylberg et al.

Introduction: Metalloproteinases and their tissue inhibitors play an important role in the metastases formation. A multistage process of carcinogenesis requires the involvement of numerous enzymes and compounds that facilitate the expansion of tumor cells. The formation of metastases depends on both metalloproteinases and tissue inhibitors activation leading to the activation of neoangiogenesis. The changes of the expression in stromal and tumor proteins could be prognostic factors in patients with oropharyngeal squamous cell carcinoma.   Materials and Methods: This study was conducted on a total of 34 patients with squamous cell carcinoma of the oropharynx divided into 2 groups, including 20 patients with neck metastasis and 14 patients without lymph node metastasis. Immunohistochemistry was performed with a standard protocol.   Results: The results of the present analysis indicated a higher expression of metalloproteinases 2 in the stroma than in tumor with increasing tumor grade. The dynamics of changes in the expression of metalloproteinases showed the increase in metalloproteinases 2 and the decrease in metalloproteinases 9 depending on the tumor size. Dynamics of changes in the expression of tissue inhibitor 1 in the tumor stroma significantly increased with the tumor stage. In the assessment of nodal staging from N0 to N3, the expression of tissue inhibitor 1 and 2 were higher in the tumor tissues. The increase of metalloproteinases 2, tissue inhibitor 1 in the tumor, and metalloproteinases 9 in the stroma were characterized by a reduction in the odds ratio of patient’s survival.   Conclusion: The complex evaluation of the expression of metalloproteinases and tissue inhibitors may be used for the prognosis of the patient’s survival.

Joana Pires, Tiago Coelho, Mafalda Ferreira et al.

Objetivos: Identificar fatores de prognóstico da reabilitação vestibular (RV) em doentes com hipofunção vestibular unilateral crónica (HVUC). Desenho do Estudo: Estudo retrospetivo dos processos dos doentes com HVUC que realizaram RV. Material e Métodos: Registo de dados epidemiológicos, clínicos, resultados da posturografia e dizziness handicap inventory (DHI) antes e após a RV. Pesquisa de uma possível relação entre os diferentes dados e os resultados dos testes. Resultados: Registamos 71 doentes, a maioria com 2 a 3 comorbilidades. Verificámos um aumento significativo das pontuações da aferência vestibular e das taxas de estabilidade da posturografia e uma redução significativa do DHI após RV. Doentes obesos apresentaram uma diminuição aferência somatossensorial e aumento da dependência visual. Doentes medicados com ototóxicos registaram um aumento da taxa de estabilidade da posturografia, significativamente inferior aos restantes doentes. Conclusões: Doentes com obesidade ou medicados com ototóxicos apresentam piores resultados após RV. Apesar das múltiplas comorbilidades, a RV foi maioritariamente eficaz.

Ana Carla Filgueira de Souza e Souza, Luciana Lyra Casais-e-Silva, Eduardo Pondé de Sena

ABSTRACT Purpose: to check the use of phonological processes in preterm infants. Methods: phonological evaluation was performed through the ABFW Child Language Test in 40 children, aged two to four years, i.e., 20 preterm and 20 full-term children, matched according to age, gender and socioeconomic level. Preterm children were evaluated at the State Center for Prevention and Rehabilitation of People with Disabilities - CEPRED; full-term children were selected and evaluated in a municipal nursery in the city of Salvador, BA, Brazil. The pertinent statistical tests were applied adopting the level of significance lower than 0.05%. Results: in the phonology test, the number of productive phonological processes not expected for the chronological age was statistically significant in the preterm group, especially syllable reduction, consonantal harmony, velar backing and liquid reduction. The high prevalence of cluster reduction and final consonant deletion, though still compatible with chronological age, shows the need to follow up the language acquisition of these children, after the age of four. Conclusion: the results evidenced the difficulty found by preterm infants in the development of phonological skills, emphasizing the importance of early diagnosis and speech-language monitoring in language acquisition.

Erica Antero da Silva, Loretta Fabianne Nigri, Maria Cecília Martinelli Iorio

RESUMO Objetivo Investigar os efeitos dos processos cognitivos e do Índice de Inteligibilidade de Fala no reconhecimento de fala no ruído em idosos, com e sem alteração cognitiva, usuários de próteses auditivas. Métodos 34 idosos, de 64 a 87 anos, com perda auditiva neurossensorial simétrica de grau moderado, usuários de próteses auditivas, foram distribuídos em grupos de idosos sem (GA; n=21) e com (GB; n=13) evidências de alteração cognitiva. A fim de garantir que o ajuste das próteses auditivas estivesse adequado, realizou-se o mapeamento visível de fala amplificada e foram obtidos os indices de ínteligibilidade de fala. Os idosos foram submetidos a uma triagem cognitiva (10-CS) e ao teste Lista de Sentenças em Português. A avaliação constou da pesquisa do limiar de reconhecimento de sentenças no ruído. Esta pesquisa foi realizada em campo livre, na condição sem e com próteses auditivas. Para análise estatística, foram utilizados os testes de Qui-Quadrado e Mann-Whitney. O nível de significância adotado foi de 0,05. Resultados Não houve diferença significativa entre os índices de inteligibilidade de fala obtidos em ambos os grupos, tanto na condição com próteses auditivas, como na condição sem as próteses. Verificou-se que os idosos com e sem alteração cognitiva apresentaram o mesmo acesso aos sons da fala (SII), nas duas condições. Observou-se que os idosos sem alteração cognitiva apresentaram menor relação sinal/ruído média, para o reconhecimento de 50% das sentenças na presença de ruído tanto na condição sem próteses auditivas como na condição com próteses, do que aqueles com alteração cognitiva. Conclusão Idosos com melhor cognição apresentaram melhor reconhecimento de fala em condições de escuta difícil.

Flurin Pfiffner, Lukas Prochazka, Ivo Dobrev et al.

(1) Background: The measurement of intracochlear sound pressure (ICSP) is relevant to obtain better understanding of the biomechanics of hearing. The goal of this work was a proof of concept of a partially implantable intracochlear acoustic receiver (ICAR) fulfilling all requirements for acute ICSP measurements in a large animal. The ICAR was designed not only to be used in chronic animal experiments but also as a microphone for totally implantable cochlear implants (TICI). (2) Methods: The ICAR concept was based on a commercial MEMS condenser microphone customized with a protective diaphragm that provided a seal and optimized geometry for accessing the cochlea. The ICAR was validated under laboratory conditions and using in-vivo experiments in sheep. (3) Results: For the first time acute ICSP measurements were successfully performed in a live specimen that is representative of the anatomy and physiology of the human. Data obtained are in agreement with published data from cadavers. The surgeons reported high levels of ease of use and satisfaction with the system design. (4) Conclusions: Our results confirm that the developed ICAR can be used to measure ICSP in acute experiments. The next generation of the ICAR will be used in chronic sheep experiments and in TICI.

Ann E. Todd, Griet Mertens, Paul Van de Heyning et al.

One way to provide pitch information to cochlear implant users is through amplitude-modulation rate. It is currently unknown whether amplitude-modulation rate can provide cochlear implant users with pitch information adequate for perceiving melodic information. In the present study, the notes of a song were encoded via amplitude-modulation rate of pulse trains on single electrodes at the apex or middle of long electrode arrays. The melody of the song was either physically correct or modified by compression or expansion. Nine cochlear implant users rated the extent to which the song was out of tune in the different conditions. Cochlear implant users on average did not show sensitivity to melody compression or expansion regardless of place of stimulation. These results were found despite the fact that three of the cochlear implant users showed the expected sensitivity to melody compression and expansion with the same task using acoustic pure tones in a contralateral acoustic ear. Normal-hearing listeners showed an inconsistent and weak effect of melody compression and expansion when the notes of the song were encoded with acoustic pulse rate. The results suggest that amplitude-modulation rate provides insufficient access to melodic information for cochlear-implant and normal-hearing listeners.

A. Grammatica, A. Bolzoni Villaret, M. Ravanelli et al.

Il tumore fibroso solitario (SFT) è una neoplasia rara, benigna, di origine mesenchimale che generalmente origina nella pleura ma che raramente può coinvolgere altre sedi al di fuori degli spazi sierosi (mediastino, polmone, fegato, tiroide); il coinvolgimento laringeo è molto raro con solo pochi casi riportati in letteratura. Riportiamo un caso di SFT in una paziente di 41 anni con coinvolgimento della laringe sopraglottica. La sintomatologia è comparsa con disfonia e modesta odinofagia da 2 anni; L’esame fibrolaringoscopico ha evidenziato una massa sottomucosa con coinvolgimento della sovraglottide di sinistra e della parete mediale del seno piriforme. L’RMN rappresenta l’esame principale per escludere altre diagnosi (schwannoma, paragangliome ed emangioma) e per una corretta stadiazione mentre l’immunoistochimica e l’analisi citomorfologica (bcl-2 e CD34 positiva nel 90% dei casi) è la base per una diagnosi definitiva. La chirurgia (endoscopica o cielo aperto) è la prima scelta di trattamento e l’obbiettivo è un bilancio tra la radicalità oncologica e la funzione d’organo; nel caso riportato l’approccio è stato a cielo aperto per il volume della massa tumorale. La prognosi è buona e solo in alcuni casi (specialmente nei SFT pleurici) il comportamento biologico del tumore può essere di tipo maligno.

Di Zhang, Xiaming Wang, Xueru Yuan et al.

Background: China has witnessed remarkable progress in scientific performance in recent years. However, the quantity and quality of nursing publications from three major regions (Mainland China, Taiwan, and Hong Kong) have not been reported. This study aimed to investigate the characteristics of scientific research productivity from Mainland China, Taiwan, and Hong Kong in the field of nursing. Methods: Articles published in the 110 nursing journals originating from Mainland China, Taiwan, and Hong Kong between 2005 and 2014 were retrieved from the Web of Science. The total number of articles published, the impact factor, and the citation count were analyzed. Results: There were 2,439 publications between 2005 and 2014 from China, including 438 from Mainland China, 1,506 from Taiwan, and 495 from Hong Kong. There was a significant increase in publications for these three regions (p < 0.05), especially for Mainland China, with a 59.50-fold increase experienced. From 2011, the number of publications from Mainland China exceeded that from Hong Kong. Taiwan had the highest total journal impact factor (2,142.81), followed by Hong Kong (720.39) and Mainland China (583.94). The mean journal impact factor from Hong Kong (1.46) was higher than that from Taiwan (1.42) and Mainland China (1.33). Taiwan had the highest total citation count (8,392), followed by Hong Kong (3,785) and Mainland China (1,493). The mean citation count from Hong Kong (7.65) was higher than that from Taiwan (5.57) and Mainland China (3.41). The Journal of Clinical Nursing was the most popular journal in the three regions. Discussion: Chinese contributions to the field of nursing have significantly increased in the past ten years, particularly from Mainland China. Taiwan is the most productive region in China. Hong Kong had the highest-quality research output, according to mean journal impact factor and mean citation count.