Hossein Soleimani, Devin L. McCaslin, Mansoureh Adel Ghahraman
et al.
Background and Aim: Due to the annoying nature and prevalence of dizziness, vertigo, and imbalance, the need for rapid diagnosis, and challenges in the differential diagnosis of various vestibular disorders, this study aimed to translate the Dizziness Symptom Profile (DSP), which is a self-report tool that helps clinicians differentiate the most common vestibular system disorders, into the Persian language and evaluate its validity, reliability, sensitivity, and specificity.
Methods: The profile was translated into Persian as DSP-P. Face, known-groups, and concurrent validities, internal consistency, test-retest reliability, sensitivity, and specificity were determined. 253 patients with dizziness and 59 healthy individuals completed the DSP-P before visiting the otolaryngologist, and the agreement between the proposed diagnoses of DSP-P and the final diagnosis of the otolaryngologist (our gold standard) was examined.
Results: The qualitative face validity of DSP-P was confirmed. There was a significant difference between the mean scores of the study groups (p<0.001). The diagnosis of DSP-P was completely in agreement with the gold standard in 53.3% of cases. Internal consistency was excellent (α≥0.81) for all categories except the persistent postural-perceptual dizziness, superior canal dehiscence and unspecified unsteadiness categories (0.62≤α≤0.69). Generally, the test-retest reliability of the DSP-P scores and diagnoses was very good. The sensitivity of DSP-P was 94.4% for diagnosing benign paroxysmal positional vertigo, 93.5% for Meniere’s disease, 100% for vestibular neuritis, 86.3% for vestibular migraine, and 84.2% for persistent postural-perceptual dizziness.
Conclusion: The DSP-P was demonstrated to be a valid and reliable history-based diagnostic tool with high sensitivity and specificity.
Otitis media (OM) is a common cause of hearing loss in children that requires corrective surgery. Various studies have investigated the pathomechanisms and treatment of OM. Autophagy, an essential cellular recycling and elimination mechanism implicated in various diseases, is known to play an important role in the pathogenesis of OM. Here, we conducted a literature review on autophagy in OM, highlighting the relationship between expression patterns of autophagy-related factors and pathophysiological and clinical aspects of OM. We summarized the existing research results on the expression of autophagy-related factors in acute OM (AOM), OM with effusion (OME), chronic OM (COM) with cholesteatoma, and COM without cholesteatoma (CholeOM) in animals and humans. Autophagy-related factors are expressed in the middle ear mucosa or fluid of AOM, effusion of OME, granulation tissue of COM, and cholesteatoma of CholeOM. Among ATGs and other autophagy-related factors, the most extensively studied in relation to the pathogenesis of OM are mTOR, LC3II/I, PI3K, Beclin-1, FLIP, Akt, and Rubicon. Expression of autophagy-related factors is associated with AOM, OME, COM, and CholeOM. Inadequate expression of these factors or a decrease/increase in autophagy responses can result in OM, underscoring the critical role of ATGs and related factors in the pathogenesis of OM.
Abstract Objective Vestibular dysfunction is a known risk of cochlear implantation (CI). However, the utility of the physical exam to screen CI candidates for vestibular dysfunction is not well‐studied. The objective of this study is to evaluate the preoperative role of the clinical head impulse test (cHIT) in subjects undergoing CI surgery evaluation. Study Design Setting, and Subjects We conducted a retrospective review of 64 adult CI candidacy cases between 2017 and 2020 at a tertiary health care center. Methods All patients underwent audiometric testing and evaluation by the senior author. Patients with an abnormal catch‐up saccade contralateral to their worse hearing ear during cHIT were referred for formal vestibular testing. Outcomes included clinical and formal vestibular results, operated ear with regard to audiometric and vestibular results, and postoperative vertigo. Results Among all CI candidates, 44% (n = 28) reported preoperative disequilibrium symptoms. Overall, 62% (n = 40) of the cHITs were normal, 33% (n = 21) were abnormal, and 5% (n = 3) were inconclusive. There was one patient who presented with a false positive cHIT. Among the patients who endorsed disequilibrium, 43% had a positive preoperative cHIT. Fourteen percent of the subjects (n = 9) without disequilibrium had an abnormal cHIT. In this cohort, bilateral vestibular impairment (71%) was more common than unilateral vestibular impairment (29%). In 3% of the cases (n = 2), surgical management was revisited or altered due to cHIT findings. Conclusion There is a high prevalence of vestibular hypofunction in the CI candidate population. Self‐reported assessments of vestibular function are often not congruent with cHIT results. Clinicians should consider incorporating cHITs as part of the preoperative physical exam to potentially avoid bilateral vestibular dysfunction in a minority of patients.
Marcela Sanhueza-Garrido, Carlos Rojas-Zepeda, Virginia García-Flores
ABSTRACT Purpose: to explore whether the diadochokinetic index of syllable production variability (DDKcvp%) is useful for the detection of articulatory inaccuracies in different stages of Parkinson's disease (PD). Methods: a diadochokinetic speech task of the consonant-vowel type [pa-pa-pa] was applied to 18 people with PD (classified in stages of progression from 1 to 5 according to the Hoehn & Yahr scale) to determine their diadochokinetic performance. Records of the study group were compared to a reference value obtained from a control group made up of 40 subjects. Results: 77.78% of the study group showed articulatory inaccuracies. The DDKcvp% index allowed to detect articulatory difficulties from stage 1 of PD, and its variation showed that articulatory deficits were permanent from stage 2 onwards. A significant and direct correlation was obtained between the increase in the DDKcvp% index and the increase in the stage of evolution of the participants. Conclusion: DDKcvp% index evaluated by means of a simple and fast consonant-vowel diadochokinetic task [pa-pa-pa], could be useful to determine articulatory inaccuracies in different stages of PD, although it is suggested that investigation of this index in larger sample sizes be conducted.
Nasopharyngeal carcinoma is one of the common malignant tumors that the pathogenesis has not yet been completely defined. SETD1A (histone lysine methyltransferase SET domain-containing 1A) is related to the occurrence of various cancers. However, the role of SETD1A in nasopharyngeal carcinoma remains unclear. The SETD1A overexpression vector, si-NC, si-SETD1A#1, and si-SETD1A#2 were transfected into nasopharyngeal carcinoma cells to overexpress or knockdown SETD1A expression. The assay of biofunction was used to explore the role of SETD1A in nasopharyngeal carcinoma cells. The assay of glucose uptake, lactate release, ATP level, western blot, cell proliferation, and cellular apoptosis analysis were performed to investigate the potential mechanism of SETD1A regulation in nasopharyngeal carcinoma. This study was the first to show that SETD1A was upregulated in nasopharyngeal carcinoma cells and the overexpression of SETD1A significantly promoted the cell proliferation and glycolysis and suppressed the cellular apoptosis. Moreover, SETD1A enhances aerobic glycolysis and cell biological function of nasopharyngeal carcinoma cells via PI3K/AKT signaling pathway. SETD1A induced PI3K/AKT activation and subsequently prevented cellular apoptosis. In conclusion, this study identified overexpressed SETD1A as a positive regulator of proliferation that induced nasopharyngeal carcinoma cells’ aerobic glycolysis via PI3K/AKT signaling activation in vitro. This study laid a strong foundation for unveiling the precise anticancer mechanism of SETD1A. The SETD1A may become a novel biomarker for further inhibitor design to obstruct the PI3K/AKT-dependent nasopharyngeal carcinoma progression.
Kyohei Itamura MD, Franklin L. Rimell MD, Elisa A. Illing MD
et al.
This study evaluates the patient experience during virtual otolaryngology clinic visits implemented during the coronavirus disease 2019 (COVID-19) pandemic. Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020, for both telehealth and in-person visits. A descriptive analysis of the question responses was performed. There were 195 virtual and 4013 in-person visits with surveys completed in this time period. Ratings related to provider-patient communication were poor for virtual visits. Telehealth has become the new norm for most health care providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent.
Abstract The impact of age-related hearing loss extends beyond the auditory pathway and impacts brain areas related to cognitive impairment and even dementia. The presence of tinnitus, a sensation of sound that frequently co-occurs with hearing loss, is additionally linked to cognitive decline. Interestingly, structural neuroimaging studies have reported that hearing loss may precede or modulate the onset of cognitive impairment. In this study, we aimed to disentangle the effects of age, hearing loss, and tinnitus on gray matter structure. In total, 39 participants with hearing loss and tinnitus, 21 with hearing loss but without tinnitus, and 39 controls were included in this voxel- and surface-based morphometry MRI study. Whole brain volume and surface thickness measures were compared between the groups. Age-related gray matter volume decline was observed in all groups. Several brain areas showed smaller gray matter volume and cortical surface thickness in hearing loss without tinnitus, relative to controls. This reduction was observed both within and outside of the auditory pathway. Interestingly, these reductions were not observed in participants with tinnitus, who had similar hearing loss and were of similar age. Since we have tools to improve hearing loss, hearing screening may aid in the battle against cognitive decline.
Chen Zhao,1,2 Alonço Viana,2– 4 Yifei Ma,5 Robson Capasso2 1Department of Otorhinolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China; 2Division of Sleep Surgery, Department of Otolaryngology- Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USA; 3Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil; 4Department of Otorhinolaryngology, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil; 5Department of Otolaryngology- Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USACorrespondence: Chen ZhaoDepartment of Otorhinolaryngology, The First Affiliated Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang, Liaoning 110001, People’s Republic of ChinaTel +86 13998856576Fax +86 02483282997Email zhaochen@cmu.edu.cnPurpose: Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE).Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed.Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals.Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.Keywords: drug-induced sedation endoscopy, sleep endoscopy, obstructive sleep apnea, tongue position, upper airway collapse, complete concentric collapse
Introduction: South Africa has a high prevalence of co-existing tuberculosis and HIV. As ototoxicity linked to the treatments for these conditions occurs with concomitant exposure to other ear toxins such as hazardous noise exposure, it is important to investigate the combination impact of these toxins. Limited published evidence exists on the co-occurrence of these conditions within this population. Objectives: The objective of this study was to compare the hearing function of gold miners with (treatment group) and without (non-treatment group) the history of tuberculosis treatment, in order to determine which group had increased risk of noise induced hearing loss. Furthermore, possible influence of age and HIV in these two groups was examined. Methods: A retrospective record review of 102 miners’ audiological records, divided into two groups, was conducted, with data analyzed both qualitatively and quantitatively. Results: Findings suggest that gold miners with a history of tuberculosis treatment have worse hearing thresholds in the high frequencies when compared to those without this history; with evidence of a noise induced hearing loss notch at 6000 Hz in both groups. Pearson's correlations showed values between 0 and 0.3 (0 and −0.3) which are indicative of a weak positive (negative) correlation between HIV and hearing loss, as well as between hearing loss and age in this population. Conclusions: Current findings highlight the importance of strategic hearing conservation programs, including ototoxicity monitoring, and the possible use of oto-protective/chemo-protective agents in this population. Resumo: Introdução: A África do Sul apresenta uma alta prevalência de coinfecção de tuberculose e HIV. Como a ototoxicidade associada aos tratamentos para essas condições é observada na exposição concomitante a outros agentes ototóxicos, como a exposição a ruídos perigosos, é importante investigar o impacto da combinação desses agentes. São poucas as evidências publicadas sobre a co-ocorrência dessas condições nessa população. Objetivo: Comparar a função auditiva de garimpeiros com (grupo tratamento) e sem (grupo sem tratamento) história de tratamento de tuberculose, a fim de determinar que grupo apresentava maior risco de perda auditiva induzida por ruído. Além disso, avaliou-se a possível influência da idade e do HIV nesses dois grupos. Método: Os registros audiológicos de 102 garimpeiros, divididos em dois grupos, foram revisados de forma retrospectiva; os dados foram qualitativa e quantitativamente analisados. Resultados: Os achados indicam os garimpeiros com histórico de tratamento de tuberculose apresentam piores limiares auditivos nas altas frequências quando comparados àqueles sem esse histórico; em ambos os grupos, observou-se perda auditiva induzida por ruído com entalhe audiométrico a 6.000 Hz. As correlações de Pearson mostraram valores entre 0 e 0,3 (0 e -0,3), que são indicativos de uma fraca correlação positiva (negativa) entre o HIV e a perda auditiva, bem como entre a perda auditiva e a idade nessa população. Conclusões: Os resultados atuais destacam a importância de programas estratégicos de conservação auditiva, inclusive monitoramento de ototoxicidade, e o possível uso de agentes oto-/quimioprotetores nessa população.
Somnath Saha, Nirmalya Kumar Majumder, D P Thombre
Introduction
Much of the perennial cold are of vasomotor origin still a less appreciated phenomenon even among the medical personnel, much of which is dubbed in a cursorily in the clinical analogue of a west paper wrap as ‘allergic rhinitis’. This study was attempted to find out the role of thermoregulatory system with causation of vasomotor rhinitis and assessing role of hypothalamus in causation of vasomotor rhinitis.
Materials and Methods
In this study conducted during the period of July 1987 to August 1988, 20 normal adult individuals were taken as control and thermoregulatory study was done on them. The results were compared with cases of vasomotor rhinitis/non-allergic rhinopathy cases. In experimental study thermoregulatory study was done on albino rats before and after stereotaxis of anterior and posterior hypothalamic nuclei and the result were compared before stereotaxis and post stereotaxis.
Results
Among human study in clinical subjects, patient suffering from vasomotor rhinitis showed a definite shift towards thermoregulatory imbalance both for generalized body caloric fluctuation and particularly on the nasal mucosa. Post-vidian neurectomy results for thermoregulation test was highly significant. In animal study post-hypothalamic stereotaxis temperature measurement showed minimal depression. Dorsal anterior hypothalamic lesion ablation showed significant derangement in the thermoregulatory tolerance profile of the rats’ belly temperature. Posterior hypothalamic lesion showed that there may be some amount of derangements in the thermoregulatory tolerance, which however is not statistically conclusive. Thermoregulatory control is done at hypothalamus, particularly at anterior hypothalamic nuclei level and posterior hypothalamic nuclei in the brain. Thermoregulatory study proves a close correlation between non allergic rhinitis with imbalance in central thermal regulation by hypothalamus.
Conclusion
Thermoregulatory study in control and clinical subjects proves a close correlation between vasomotor rhinitis and sympathetic, parasympathetic system.
Vivek V. Kanumuri MD, Bishoy Ameen, Osama Tarabichi MD
et al.
Perioperative teaching and feedback of technical performance are essential during surgical training but are limited by competing demands on faculty time, resident work-hour restrictions, and desire for efficient operating room utilization. The increasing use of high-definition video microscopy and endoscopy in otolaryngology offers opportunities for trainees and faculty to evaluate performance outside the operating room but still requires faculty time. Our hypothesis is that automated motion tracking via video analysis offers a way forward to provide more consistent and objective feedback for surgical trainees. In this study, otolaryngology trainees at various levels were recorded performing a cortical mastoidectomy on cadaveric temporal bones using standard surgical instrumentation and high-definition video cameras coupled to an operating microscope. Videos were postprocessed to automatically track the tip of otologic dissection instruments. Data were analyzed for key metrics potentially applicable to the global rating scale used in the Accreditation Council for Graduate Medical Education’s Objective Structured Assessments of Technical Skills.
Ekaterina Pylaeva, Sharareh Bordbari, Ilona Spyra
et al.
Pseudomonas aeruginosa is an opportunistic multidrug-resistant pathogen, able to grow in biofilms. It causes life-threatening complications in diseases characterized by the up-regulation of type I interferon (IFN) signaling, such as cancer or viral infections. Since type I IFNs regulate multiple functions of neutrophils, which constitute the first line of anti-bacterial host defense, in this work we aimed to study how interferon-activated neutrophils influence the course of P. aeruginosa infection of the lung. In lungs of infected IFN-sufficient WT mice, significantly elevated bacteria load was observed, accompanied by the prominent lung tissue damage. At the same time IFN-deficient animals seem to be partly resistant to the infection. Lung neutrophils from such IFN-deficient animals release significantly lower amounts of neutrophil extracellular traps (NETs) and reactive oxygen species (ROS), as compared to WT neutrophils. Of note, such IFN-deficient neutrophils show significantly decreased capacity to stimulate biofilm formation by P. aeruginosa. Reduced biofilm production impairs in turn the survival of bacteria in a lung tissue. In line with that, treatment of neutrophils with recombinant IFN-β enhances their NETosis and stimulates biofilm formation by Pseudomonas after co-incubation with such neutrophils. Possibly, bacteria utilizes neutrophil-derived NETs as a scaffold for released biofilms. In agreement with this, in vivo treatment with ROS-scavengers, NETs disruption or usage of the bacterial strains unable to bind DNA, suppress neutrophil-mediated biofilm formation in the lungs. Together, our findings indicate that the excessive activation of neutrophils by type I IFNs leads to their boosted NETosis that in turn triggers biofilm formation by P. aeruginosa and supports its persistence in the infected lung. Targeting these mechanisms could offer a new therapeutic approach to prevent persistent bacterial infections in patients with diseases associated with the up-regulation of type I IFNs.
Paolo Castelnuovo, Giacomo Fiacchini, Francesca Romana Fiorini
et al.
Abstract
Orbital lesions are traditionally managed through external approaches when laterally located, and through a transnasal approach or other external approaches when medially located. However, when the lesion is superomedially located, it may determine a technical challenge.
In this study, we present the case of a patient with a superomedial intraconal venous malformation of the left eye. We addressed the mass through a combined approach, using the transnasal route as the main approach, and the superior eyelid approach to push down the lesion to facilitate the excision. We have called this approach “push–pull technique.”
We achieved a complete resection of the lesion and did not observe any intraoperative or postoperative complications. The last follow-up at 6 months postoperatively showed no recurrence, and the patient was satisfied and completely recovered.
According to our experience, the “push–pull” technique seems to be a safe procedure and might be considered a valid alternative to address selected superomedial intraconal lesions.
Saikat Samaddar, Diptanshu Mukherjee, Anita Nandi (Mitra)
et al.
Introduction:
Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.
Materials and Method:
A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically.
Result:
There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre.
Discussion:
The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks.
Conclusion:
Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population.
Adriana Handra-Luca, Zakaria Y. Abd Elmageed, Christina Magkou
et al.
Nasal glomangiopericytoma is rare. The immunophenotype is heterogeneous, more frequently smooth-muscle-actin and CD34-positive. We report expression patterns for several vascular-related proteins such as CD99, CD146, Bcl2, and WT1 as well as for treatment-related proteins such as mTOR and EGFR in a nasal glomangiopericytoma. The patient (woman, 86 years) presented with a left nasal tumefaction. The resected specimen (1.5-cm) showed a glomangiopericytoma. Tumor cells expressed smooth-muscle-actin, CD31, CD34, and progesterone receptor. They also expressed the vascular-cell-related proteins Bcl2, CD99, CD146, and WT1, as well as mTOR and EGFR. Nasal glomangiopericytomas show immunohistochemical heterogeneity for vascular-related markers, suggesting a possible extensive pericytic differentiation. The expression of potential targets for drug treatments such as mTOR and EGFR may impact on the clinical follow-up of these tumors occurring at advanced ages, which may require complex surgery.
A variety of noises have been employed for decades in an effort to facilitate habituation, mask, or suppress tinnitus. Many of these sounds have reportedly provided benefit, but success has not been universal. More recently, musical stimuli have been added as a sound therapy component. The potential advantages of using such stimuli, in particular fractal tones, in combination with amplification are discussed in this paper.