Abstract The autonomic nervous system maintains homeostasis, with the vestibulosympathetic reflex playing a key role in regulating blood pressure during postural changes. Benign paroxysmal positional vertigo (BPPV), a common vestibular disorder, has been linked to autonomic dysfunction, but the impact of vestibular-autonomic interactions on BPPV recurrence remains unclear. This prospective study investigated whether changes in diastolic blood pressure (DBP) responses during head-up tilt tests before and after treatment are associated with BPPV recurrence in 370 patients with idiopathic BPPV. DBP responses were recorded at 1 and 2 min after tilting, and patients were categorized into three groups based on DBP changes. At 6 months, the high-response group in the 1-minute DBP category had a 1.98-fold higher recurrence rate than the low-response group (p = 0.029). At 12 months, this group showed a 9.8-fold higher multiple recurrence rate (p = 0.033), while the high-response group in the 2-minute category had a 14.3-fold higher rate (p = 0.012). These results suggest that elevated DBP responses during vestibulosympathetic reflex activation are significantly associated with BPPV recurrence. Monitoring DBP through head-up tilt tests could provide valuable insights into recurrence risk, highlighting the role of vestibular-autonomic interactions in BPPV.
Agnes Stephanie Harahap, Mutiah Mutmainnah, Maria Francisca Ham
et al.
Background The diagnosis of thyroid neoplasms necessitates the identification of distinct histological features. Various education/hospital centers located in cities across Indonesia likely result in discordances among pathologists when diagnosing thyroid neoplasms. Methods This study examined the concordance among Indonesian pathologists in assessing nuclear features and capsular and vascular invasion of thyroid tumors. Fifteen pathologists from different centers independently assessed the same 14 digital slides of thyroid tumor specimens. All the specimens were thyroid neoplasms with known BRAFV600E and RAS mutational status, from a single center. We evaluated the pre- and post-training agreement using the Fleiss kappa. The significance of the training was evaluated using a paired T-test. Results Baseline agreement on nuclear features was slight to fair based on a 3-point scoring system (k = 0.14 to 0.28) and poor to fair based on an eight-point system (k = –0.02 to 0.24). Agreements on vascular (κ = 0.35) and capsular invasion (κ = 0.27) were fair, whereas the estimated molecular type showed substantial agreement (κ = 0.74). Following the training, agreement using the eight-point system significantly improved (p = 0.001). Conclusions The level of concordance among Indonesian pathologists in diagnosing thyroid neoplasm was relatively poor. Consensus in pathology assessment requires ongoing collaboration and education to refine diagnostic criteria.
Jonna Kuuskoski, Jaakko Vanhatalo, Jussi Hirvonen
et al.
Abstract Background Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal‐abnormal ratings, objective measurements have been developed. We compared the inter‐rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods Two blinded raters analyzed the subjective normal‐abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter‐rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results In the pharyngeal findings, the subjective analysis inter‐rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter‐rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions The subjective analysis had moderate to strong inter‐rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter‐observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence 4.
Introduction: Adenoid cystic carcinoma (ACC) is an uncommon malignant tumour arising from salivary glands. It is more common in minor salivary glands, palate being the commonest site. Local recurrence, distant metastasis and perineural invasion are the common clinico-pathological features of this tumour. ACC of nasal septum and pterygo-palatine fossa is extremely rare entity with a very few reported cases in the available literature.
Case Report: We report a case of ACC of nasal septum and pterygo-palatine fossa with its surgical management through endoscopic approach and follow up in the background of available literature. The article is aimed to highlight the clinical features, diagnosis, endoscopic approach for surgical management and long term post operative follow up of this rare entity.
Discussion: Adenoid cystic carcinoma (ACC) itself is rare in nasal cavity; where lateral nasal wall is the commonest site of occurrence. ACC arising in the pterygo-palatine fossa is further rare entity; only 3 or 4 cases have been reported till date. ACC arising in these two sites simultaneously is a unique occurrence.
Eren Yılmaz, Mustafa Caner Kesimli, İbrahim Yağcı
et al.
Objective: Sinonasal diseases are one of the main causes of foul breath. Disruption of mucus drainage leading to bacterial putrefaction is the leading factor of volatile organic compounds (VOCs) production. Concha bullosa (CB) is also one of the factors affecting mucus drainage. Its effect on foul breath was investigated in this study.Materials and methods: Sixty patients were included in the study. The participants were selected from those complaining of halitosis, who have CB formation on at least one side, and pathologic VOCs, hydrogen sulfide, methylmercaptan, and dimethylsulfide levels in their OralChroma measurements. The patients were divided into two groups. Surgery was applied to 32 patients, and no treatment was given to 28 patients. The VOCs levels were evaluated using OralChroma.Results: Sixty patients with a mean age of 36.5 years were included in the study. Before and after the operation of concha bullosa and also when the surgical group and control groups were compared, the decrease in methylmercaptan values was shown to be statistically significant (p<0.05).Conclusion: Concha bullosa should be considered in the etiology of halitosis in cases with no determined cause and high methylmercaptan values.
Amar Miglani, Matthew Germroth, Kristina A. LaPointe
et al.
Abstract Objective To determine if simultaneous administration of acoustic vibration and oscillating expiratory pressure affects the severity of facial pain among patients with complaint of “sinus headache”. Methods This is a prospective single‐arm observational study performed at a tertiary care medical center. Subjects with complaint of sinus headache without evidence of chronic rhinosinusitis on exam or computed tomography participated in a clinical study applying simultaneous acoustic vibrations and positive expiratory pressure to the nasal cavity twice daily over 4 weeks. Efficacy was assessed using three validated pain metrics—pain visual analog scale (VAS), brief pain inventory‐short form (BPI‐SF), and McGill pain questionnaire‐short form (MPQ‐SF). Device safety and patient satisfaction were also assessed using questionnaires. Results Twenty‐nine patients (mean age 49 years, 55% female) completed the study without any major adverse events. At the 4 week follow‐up, facial pain VAS improved from mean ± SD of 59.6 ± 15.7 to 34.6 ± 21.7 (p < .001), BPI mean pain (mean ± standard deviation) improved from 4.4 ± 2.0 to 2.9 ± 1.9 (p = .007), and MPQ‐SF total improved from 12.2 ± 6.5 to 6.5 ± 5.2 (p < .001) with approximately 70% of patients achieving a minimal clinically important difference (MCID) across all metrics. Additionally, pain VAS was assessed 5 min after a single use at baseline with significant improvement (p < .001). Eighty‐six percent of subjects would both use device again and recommend it to others. Conclusions Simultaneous administration of acoustic vibration and oscillating expiratory pressure appears to be a safe treatment for sinus headaches in patients without objective evidence of chronic sinusitis. Results from this initial study are promising with regard to efficacy in treatment of sinus headaches but will require further study. Level of evidence 2c.
Miguel Saro- Buendía, Pedro Suárez Urquiza, Judit Amigo González
et al.
The lingual abscess is rare due to several protective mechanisms against infection in this location. Concretely, the abscess in the base of the tongue (posterior lingual abscess) is even more exceptional. Its prompt detection is crucial to avoid potentially fatal airway complications. To familiarize physicians with this condition, we report 2 cases of posterior lingual abscess. Both were referred to our emergency department due to minor oropharyngeal complaints. Finally, both were diagnosed and required surgical drainage. The clinical evolution was successful: both were discharged in less than 72 hours and follow-up one week later confirmed clinical recovery.
Medical emergencies. Critical care. Intensive care. First aid
Ravin Suvanich, Uraiwan Chatchawan, Chanchai Jariengprasert
et al.
Introduction: “Dizziness” is a common complaint in clinical practice that can occur with anyone. However, since the symptom is caused by a wide range of disorders, a general clinician usually faces some difficulty to detect the cause. Objective: This study aimed to formulate and validate a simple instrument that can be used to screen and predict the most likely cause of dizziness in Thai outpatients. Methods: This study was divided into two phases. Phase I included 41 patients diagnosed with common causes of dizziness to determine the algorithm and construct the “structural algorithm questionnaire version 1”. In addition, to test and retest its content validity and reliability until the instrument had an acceptable level of both. Phase II of the study pertained to evaluating its accuracy in clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their medical appointment. Results: The degree of agreement between the algorithm results and clinical diagnoses was within an acceptable level (κ = 0.69). Therefore, this algorithm was used to construct the structural algorithm questionnaire version 1. The content validity of the structural algorithm questionnaire version 1 evaluated by seven experts. The content validity index values of the questionnaire ranged from 0.71 to 1.0. The Cohen’s kappa coefficient (κ) of intra-rater reliability of the structural algorithm questionnaire version 1 was 0.71. In clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their appointment. The overall agreement between their questionnaire responses and final diagnoses by specialists showed a moderate degree of clinical accuracy (κ = 0.55). Conclusions: The structural algorithm questionnaire version 1 had a well-developed design and acceptable quality pertaining to both validity and reliability. It might be used to differentiate the cause of dizziness between vestibular and non-vestibular disorders, especially of outpatients with dizziness symptoms.
Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users.
Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users.
Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels.
Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency (p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone (p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels.
Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.
Raffaella Nenna, Greta Di Mattia, Laura Petrarca
et al.
Introduction:Laryngeal web is a rare cause of pediatric stridor and respiratory distress. The clinical presentation is variable and symptoms usually correlate with the severity of the airway obstruction. Case Reports:We describe the cases of three children unexpectedly diagnosed with laryngeal web after a severe episode of bronchiolitis and after thirteen and eleven years, respectively, of persistent symptoms despite asthma medications.Conclusion:Even if it is a rare cause of stridor and respiratory distress, congenital subglottic web could be a life threatening condition and clinicians should always consider it in the differential diagnosis of persistent noisy breathing, even in adolescents and young adults.
Florian Scheible, Raphael Lamprecht, Marion Semmler
et al.
The voice producing process is a complex interplay between glottal pressure, vocal folds, their elasticity and tension. The material properties of vocal folds are still insufficiently studied, because the determination of material properties in soft tissues is often difficult and connected to extensive experimental setups. To shed light on this less researched area, in this work, a dynamic pipette aspiration technique is utilized to measure the elasticity in a frequency range of 100–1000 Hz. The complex elasticity could be assessed with the phase shift between exciting pressure and tissue movement. The dynamic pipette aspiration setup has been miniaturized with regard to a future in-vivo application. The techniques were applied on 3 different porcine larynges 4 h and 1 d postmortem, in order to investigate the deterioration of the tissue over time and analyze correlation in elasticity values between vocal fold pairs. It was found that vocal fold pairs do have different absolute elasticity values but similar trends. This leads to the assumption that those trends are more important for phonation than having same absolute values.
El diagnóstico de trastorno específico del lenguaje (TEL) suele abordarse desde los saberes del profesional fonoaudiólogo con escaso aporte de otras disciplinas. Se ha demostrado que el desarrollo infantil es un proceso complejo influido por diferentes factores que se retroalimentan y participan en la evolución de habilidades, aptitudes y destrezas durante la niñez. Debido a la imbricación de distintas dimensiones, resulta de interés visualizar las interrelaciones que puedan darse entre la adquisición patológica del lenguaje y otras esferas del desarrollo. En este estudio se observaron los perfiles psicomotores de 22 niños/as diagnosticados con TEL mixto entre 5 y 7 años y 11 meses, que asistían a un establecimiento educacional gratuito de la Región Metropolitana de Chile. A continuación, se correlacionaron estos perfiles con algunas variables lingüísticas: vocabulario, gramática receptiva, gramática expresiva y fonología. Los resultados muestran que los niños/as con diagnóstico de TEL mixto presentan un perfil psicomotor normal o dispráxico, sin diferencias entre los tres rangos etarios estudiados. Todos los factores psicomotores correlacionan con al menos una variable lingüística, a excepción de lateralidad. El vocabulario fue la variable lingüística que correlacionó con más factores psicomotores. Los factores psicomotores que aparecieron más descendidos fueron noción de cuerpo, estructuración espaciotemporal y praxia fina.
Introduction Although computed tomography scanning is the most common method for the diagnosis of sinusitis today, X-ray imaging is still used in outpatient clinics. Because X-ray imaging is beneficial for patients with severe sinusitis but not for those with mild sinusitis, an alternative method to visualize sinusitis without X-ray imaging is desirable.
Objective To study the possibility of using thermography to visualize sinusitis.
Methods In the present study, heat distribution on the faces of individuals with and without sinusitis was studied using thermography. Overall, 10 control subjects and 20 patients with sinusitis were included. Original thermography data were cropped, resized, and converted to relative thermography data based on the average temperature for visualization and statistical analysis.
Results The shape of the maxillary and/or frontal sinuses was determined based on regions indicating increased temperature in patients with sinusitis. The region with increasing temperature was statistically visualized, and the significant side (t test, p < 0.05) coincided with the maxillary shadow on X-ray imaging.
Conclusion Thermography demonstrates visually the correlation between the surface temperature of the face and inflammation patterns in the paranasal sinus. Therefore, our comparative study using thermography to visually differentiate individuals with and without sinusitis was effective, indicating that thermography is a possible alternative to X-ray imaging to detect sinusitis.
RESUMO Objetivo Determinar efetividade da terapia de sensibilidade oral em idosos institucionalizados com demência grave. Métodos Uma série de oito casos residentes em instituição de longa permanência. Foram incluídos idosos com diagnóstico de demência grave e disfagia grave, com consentimento da família. Foram excluídos idosos em atendimento fonoaudiológico e com alimentação somente por via alternativa. A divisão entre grupo experimental e grupo controle foi por sorteio. A avaliação pré e pós terapia, realizada por uma fonoaudióloga cega para a intervenção, utilizou protocolo Northwestern Patient Dysphagia Check Sheet (NDPCS), a escala Clinical Dementia Rating (CDR) e a Functional Oral Intake Scale (FOIS). Durante a oferta a velocidade da deglutição e o número de deglutições (pastoso e líquido) foram avaliados. Os participantes do grupo experimental foram submetidos a cinco sessões consecutivas de estimulação tátil-térmica por 30 minutos. Resultados Oito participantes, com idade entre 68 e 98 anos, fizeram parte da amostra seis mulheres e dois homens. No grupo experimental não observou-se modificação na velocidade da deglutição bem como no número de deglutições nas consistências pastosa e líquida. Não foram encontradas diferenças significativas para os itens 23 a 28 do instrumento NDPCS nas duas consistências, bem como não houve modificação na escala FOIS. Também não houve diferenças estatisticamente significativas entre o grupo experimental e o grupo controle para essas duas consistências. Conclusão A estimulação tátil-térmica não modificou o padrão de deglutição em idosos institucionalizados com demência grave.
Anthony C. Nichols, Pencilla Lang, Eitan Prisman
et al.
Abstract Background Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches. Methods This is a multicenter phase II study randomizing one hundred and forty patients with T1–2 N0–2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50–60 Gy based on risk factors). Patients will be stratified based on smoking status (< 10 vs. ≥ 10 pack-years). The primary endpoint is OS of each arm compared to historical control; we hypothesize that a 2-year OS of 85% or greater will be achieved. Secondary endpoints include progression free survival, QOL and toxicity. Discussion This study will provide an assessment of two de-escalation approaches to the treatment of HPV+ OPC on oncologic outcomes, QOL and toxicity. Results will inform the design of future definitive phase III trials. Trial Registration Clinicaltrials.gov identifier: NCT03210103. Date of registration: July 6, 2017, Current version: 1.3 on March 15, 2019.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Takayuki Kageyama, Takashi Yano, Sonoko Kuwano
et al.
The association of wind turbine noise (WTN) with sleep and physical/mental health has not been fully investigated. To investigate the relationship of WTN with the prevalence of self-reported symptoms of sleep and health problems, a socioacoustic survey of 1079 adult residents was conducted throughout Japan (2010-2012): 747 in 34 areas surrounding wind turbine plants and 332 in 16 control areas. During face-to-face interviews, the respondents were not informed of the purpose of the survey. Questions on symptoms such as sleeplessness and physical/mental complaints were asked without specifying reasons. Insomnia was defined as having one or any combination of the following that occurs three or more times a week and bothers a respondent: Difficulty initiating sleep, difficulty maintaining sleep, premature morning awakening, and feeling of light overnight sleep. Poor health was defined as having high scores for health complaints, as determined using the Total Health Index, exceeding the criteria proposed by the authors of the index. The noise descriptor for WTN was LAeq,n outdoor, estimated from the results of actual measurement at some locations in each site. Multiple logistic analysis was applied to the LAeq,n and insomnia or poor health. The odds ratio (OR) of insomnia was significantly higher when the noise exposure level exceeded 40 dB, whereas the self-reported sensitivity to noise and visual annoyance with wind turbines were also independently associated with insomnia. OR of poor health was not significant for noise exposure, but significant for noise sensitivity and visual annoyance. The above two moderators appear to indicate the features of respondents who are sensitive to stimuli or changes in their homeostasis.