Hasil untuk "Otorhinolaryngology"

Kiran Abraham‐Aggarwal, Xiaoxuan Chen, Daniel J. Spertus et al.

Abstract Objective To evaluate the perceptions of American Rhinologic Society (ARS) members on the compensation models of academic rhinologists and their impact on clinical practice, teaching, and academic responsibilities. Study Design Survey study. Setting Academic rhinologists across the United States who are members of the ARS. Methods A twenty‐six‐question survey was distributed to 295 ARS members. The survey collected demographic information such as years of experience, geographic location, practice setting, and consultation volume. It also explored various compensation models and their impact on compensation, patient volume, case types, and the ability to support teaching and academic responsibilities. Results Out of 295 surveyed ARS members, 107 responded (36%), and 80 academic rhinologists were included in the final sample. Respondents varied in experience and geographic distribution. Most respondents were salaried (69%), while 63% were under relative value units (RVU)‐based models, and 25% were under collections‐based models. Additionally, 66% reported poor or no support for research and educational activities. Compensation models were found to influence patient volume (28%), procedure choices (14%), and academic duties, with 55% of respondents indicating reduced engagement with students. Conclusion Although a plurality of respondents (39%) believed that salaried models are most conducive to balancing academic and clinical responsibilities, survey findings highlight a dissonance. Respondents under collections‐based models were more likely to feel adequately supported (64.71%) compared to those under salaried or RVU‐based models. This suggests that although many perceive salaried models as ideal for balance, collections‐based models may better address financial and structural needs, emphasizing the importance of developing flexible, tailored compensation structures that align with individual and institutional goals while fostering academic productivity.

Patricia Couroux, Nicole Grosse, Anne Marie Salapatek et al.

Abstract Background House Dust Mite (HDM) is the most common indoor allergen triggering allergic symptoms. First‐line pharmacotherapy treatment is recommended in international guidelines, while the avoidance of allergens represents a still unmet guideline principle. AM‐301 is a new non‐pharmacological nasal spray that creates a protective gel‐like barrier on the nasal mucosa, preventing the contact with the allergens. Methods This randomized, open‐label, 3‐period crossover study assessed the efficacy and safety of AM‐301. The objective was to determine whether AM‐301 reduces allergic rhinitis (AR) symptoms in patients exposed to HDM allergens. Adults with confirmed Perennial Allergic Rhinitis (PAR; n = 37) were exposed to HDM allergen in a controlled Allergen Exposure Chamber before and during a treatment course of AM‐301 (in six different sequences) within 3 weeks (A: One spray AM‐301 per nostril/B: Two sprays AM‐301 per nostril/C: no treatment). For the primary efficacy analysis, data from the total nasal symptom score (TNSS) were pooled from treatment A + B (D) and analyzed with Analysis of Covariance Model. As secondary endpoints, single time points, visits and symptoms were analyzed. Results The primary endpoint (overall change in TNSS from baseline over all three visits) showed significant results (p = 0.0085). A comparable alleviation of all four symptoms (itchy nose, nasal congestion, runny nose, sneezing) by the protective layer started to emerge after 40 min and lasted up to 180 min (end of challenge). AM‐301 resulted to be safe and well‐tolerated. Conclusion AM‐301 significantly reduced HDM‐related allergic symptoms in a standardized allergen challenge. Protection was observed to last up to 180 min.

Marília Cardoso Prudêncio, Ana Alice Alves Barbosa, Wanderson Laerte de Oliveira Carvalho et al.

RESUMO Objetivo Analisar a autopercepção de crianças e adolescentes com deficiência auditiva e de suas famílias quanto ao uso diário dos dispositivos auditivos, comparando o uso referido com os dados de data logging, bem como conhecer os seus benefícios autorrelatados. Métodos Estudo transversal, observacional, descritivo-analítico. Aplicados questionários a 38 famílias e seus filhos com deficiência auditiva, bem como coletado o data logging com o número de horas/dia de uso dos aparelhos auditivos. Realizada a análise descritiva e comparativa, por meio do coeficiente de Kappa, entre o data logging e o uso referido pelos usuários e famílias, além da análise qualitativa sobre a percepção de ambos com relação aos dispositivos. Resultados As crianças, adolescentes e suas famílias superestimaram, respectivamente, em média, 5,3 e 2,5 horas por dia o tempo de uso, em comparação à medida de data logging. Os usuários referiram benefícios com o uso dos equipamentos, embora o uso e o manuseio dos microfones remotos tenham sido o maior desafio identificado, tanto para eles como para as suas famílias. Conclusão Houve discordância entre o número de horas relatadas pelos usuários e famílias entre si, bem como entre eles e a medição do data logging. As famílias referiram a necessidade de mais orientações quanto aos microfones remotos, o que aponta para a importância da intervenção personalizada voltada ao empoderamento desses familiares, crianças e adolescentes, com o envolvimento da equipe escolar e rede de apoio, identificadas pelas famílias como essenciais para o uso efetivo dos dispositivos auditivos.

Ying‐Ying Huang, Xun Cao, Zhuo‐Chen Cai et al.

Abstract Background To explore the short‐ and long‐term outcomes in patients with nasopharyngeal carcinoma (NPC) with magnetic resonance imaging (MRI)‐detected residual disease at 3 months post‐treatment who received intervention either promptly (0 month) or following observation (after an additional 3 months). Methods A total of 272 patients with residual disease at 3 months post‐treatment (observation [observation for additional 3 months]: 122, intervention [prompt intervention]: 150) were analyzed. Univariate and multivariate analyses were performed to examine the survival. Adverse events were analyzed in all patients. Results Patients in the observation group had a lower 3‐year overall survival (77.1% vs. 85.2%), progression‐free survival (10.2% vs. 18.1%), and locoregional relapse‐free survival (10.2% vs. 20.6%) (all p < .05), but not distant metastasis‐free survival (83.8% vs. 78.4%, p = .189), whereas patients in the intervention group achieved higher complete remission (CR) rates (43.3% vs. 21.2%, p = .003). Patients who achieved CR after prompt intervention had a better survival rate than those who achieved observation‐CR or non‐CR (p < .001). Multivariate analyses revealed that a wait‐and‐see policy was an independent prognostic factor for impaired survival (p < .001). No significant differences of acute or late toxicities were observed between the two groups. Conclusions Patients with NPC with MRI‐detected residual disease 3 months post‐radiotherapy should be encouraged to undergo prompt intervention rather than adopting a passive wait‐and‐see policy.

Fan Yuan, Tianhao Huang, Yongxiang Wei et al.

Background: Postviral olfactory dysfunction (PVOD) is a clinical challenge due to limited therapeutic options and poor prognosis. Both steroids and olfactory training have been proved to be effective for olfactory dysfunction with varied etiologies. We sought to perform a systematic review to summarize the evidence of steroids or olfactory training for patients with PVOD.Methods: A systematic literature review using PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies assessing olfactory change in patients with PVOD receiving steroid or olfactory training.Results: Of the initial 273 abstracts reviewed, 20 articles with data from 2,415 patients with PVOD were included. Treatments including topical steroids, systemic steroids, classical olfactory training (COT), modified olfactory training (MOT), and olfactory training with steroid were analyzed. Both psychophysical olfactory testing and subjective symptom scores were utilized to assess the olfactory function. The routine use of nasal steroid spray alone during the management of PVOD seems to have no positive effect on olfactory dysfunction. Direct injection of steroid or nasal steroid spray into the olfactory cleft significantly improved the olfactory function in patients with PVOD. Olfactory improvement is greater than that of the natural course of the disease with short-term COT. Patients with PVOD would benefit more from long-term COT (&gt;12 weeks). Treatment duration, various odorants, olfactory training devices, changing the types of odors periodically, different molecular odorants, and different concentrations of odorants tended to increase the efficiency of MOT. Clinically significant improvement after olfactory training was defined as an increase of threshold, discrimination, and identification (TDI) score ≥6. From week 24 to week 36, both COT and MOT groups reached the maximum therapeutic effect regarding the number of participants achieving clinically significant improvement. A combination of local or oral steroids with olfactory training is more efficient than COT only.Conclusion: Olfactory function in patients with PVOD was effectively improved through direct steroid administration in the olfactory cleft, COT, or modification of COT. The addition of topical steroids to COT therapy showed a tendency for greater olfactory improvement in patients with PVOD.

Dorji Penjor

Abstract Natural myringostapediopexy is a result of tympanic membrane retraction with automastoidectomy that causes the tympanic membrane to plaster onto the stapes directly. It causes minimal conductive hearing impairment.

Mélissa Putman, Samantha Hassid, Sébastien Van der Vorst et al.

T. Kim, H. Cha, Jong-Geun Lee et al.

Tae-Hun Kim, Heung Eog Cha, Jong-Geun Lee, Gi Jung Im, Jae-Jun Song, Shin Hye Kim, Il Joon Moon, Young Ho Kim, Jae Yong Byun, and Sung-Won Chae Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon; and Department of Otorhinolaryngology-Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan; and Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea

V. Favier, P. Gallet, G. Subsol et al.

Copyright © 2019 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinical and Experimental Otorhinolaryngology Vol. 12, No. 2: 231-232, May 2019 https://doi.org/10.21053/ceo.2018.01627

A. Werner, C. Holsinger, S. Guiquerro et al.

From a reading of various sources (scientific articles, books, dictionaries and websites), this article documents eponyms in the field of laryngology (other than those related to anatomy or therapeutics), memorializing certain notable events in this subspecialty of otorhinolaryngology and in the life of our illustrious forebears.

D. Han, C. Rhee

Copyright © 2019 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinical and Experimental Otorhinolaryngology Vol. 12, No. 3: 239-240, August 2019 https://doi.org/10.21053/ceo.2019.00689

Jorge Rodrigues, Eduardo Breda, Eurico Monteiro

Abstract Introduction Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy. Objective This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors. Methods All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively. Results A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%. Conclusion The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p < 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p < 0.05) and vascular invasion (30.5% versus 22.5% respectively; p < 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p < 0.05).

Nadine Saraiva, Joana Rodrigues, Nuno Bonito et al.

A infeção por Papiloma Vírus Humano (HPV) é um dos fatores de risco para o desenvolvimento de tumores da cabeça e pescoço. Pretende-se avaliar a prevalência do HPV nestes tumores em doentes sem hábitos alcoólicos e tabágicos associados. A presença de DNA do HPV foi testada por PCR (Polymerase Chain Reaction) em todos os doentes com tumor da cabeça e pescoço identificados entre 2010 e 2013. Foram identificados 44 doentes, com média de idades de 61.4 anos, com predomínio do sexo masculino. 6 destes doentes foram DNA-HPV positivo, sendo que 50,0% apresentavam um estadio IV A. 66,7% dos doentes foram submetidos a cirurgia e os restantes a quimio-radioderapia concomitante. A sobrevivência global da população DNA-HPV positiva aos 12 e 60 meses foi de 100% e 50%, respetivamente e da população DNA-HPV negativa de 86.8% e 15.8% respectivamente. Na nossa população, 13,6% dos doentes apresentaram positividade para DNA – HPV, o que é comparável com estudos publicados.

Fábio Muradás Girardi

Abstract Introduction Patients with thyroid cancer in different age groups present with different prognosis. Objective The objective of this study is to analyze the clinicopathological pattern of thyroid carcinoma presentation according to age groups. Methods This is a retrospective study. From 2000 to 2010, 623 patients underwent thyroidectomy for cancer in our institution, with 596 enrolled. Patients were divided into groups of 10 years and then in four age subgroups (≤ 24, 25–44, 45–64, and ≥65 years) for statistical analysis. We compared age, gender, and histopathological characteristics between groups. Results Individuals belonging to the earlier age group presented with a highest prevalence of neuro-vascular invasion, capsular invasion and lymph node metastasis. Together with individuals of advanced age, that group also had larger tumor diameter and higher prevalence of extra-glandular disease. Even when analyzed only cases with well-differentiated carcinoma, younger individuals remain with a highest prevalence of lymph node metastasis, neuro-vascular invasion and larger tumor diameter. Conclusion We observed a distinct pattern of clinicopathological manifestation of thyroid cancer according to age. Individuals belonging to age extremes resemble in several pathological features, and young people usually present with more aggressive disease characteristics.

Peter T. Johannesen, Patricia Pérez-González, Sridhar Kalluri et al.

The aim of this study was to assess the relative importance of cochlear mechanical dysfunction, temporal processing deficits, and age on the ability of hearing-impaired listeners to understand speech in noisy backgrounds. Sixty-eight listeners took part in the study. They were provided with linear, frequency-specific amplification to compensate for their audiometric losses, and intelligibility was assessed for speech-shaped noise (SSN) and a time-reversed two-talker masker (R2TM). Behavioral estimates of cochlear gain loss and residual compression were available from a previous study and were used as indicators of cochlear mechanical dysfunction. Temporal processing abilities were assessed using frequency modulation detection thresholds. Age, audiometric thresholds, and the difference between audiometric threshold and cochlear gain loss were also included in the analyses. Stepwise multiple linear regression models were used to assess the relative importance of the various factors for intelligibility. Results showed that (a) cochlear gain loss was unrelated to intelligibility, (b) residual cochlear compression was related to intelligibility in SSN but not in a R2TM, (c) temporal processing was strongly related to intelligibility in a R2TM and much less so in SSN, and (d) age per se impaired intelligibility. In summary, all factors affected intelligibility, but their relative importance varied across maskers.

Giannicola Iannella, Alessandra Manno, Emanuela Pasqualitto et al.

Cerebrospinal fluid (CSF) leakage of the temporal bone region is defined as abnormal communications between the subarachnoidal space and the air-containing spaces of the temporal bone. CSF leak remains one of the most frequent complications after VS surgery. Radiotherapy is considered a predisposing factor for development of temporal bone CSF leak because it may impair dural repair mechanisms, thus causing inadequate dural sealing. The authors describe the case of a 47-year-old man with a massive effusion of CSF which extended from the posterior and lateral skull base to the first cervical vertebrae; this complication appeared after a partial enucleation of a vestibular schwannoma (VS) with subsequent radiation treatment and second operation with total VS resection.

Rusha Patel M.D., Richard R. Orlandi M.D.

Background Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls. Method A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection. Conclusion Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum.

M. Hoenigl, E. Aspeck, T. Valentin et al.

R. Ciuman

In recent years, huge advances have taken place in understanding of inner ear pathophysiology causing sensorineural hearing loss, tinnitus, and vertigo. Advances in understanding comprise biochemical and physiological research of stimulus perception and conduction, inner ear homeostasis, and hereditary diseases with underlying genetics. This review describes and tabulates the various causes of inner ear disease and defines inner ear and non-inner ear causes of hearing loss, tinnitus, and vertigo. The aim of this review was to comprehensively breakdown this field of otorhinolaryngology for specialists and non-specialists and to discuss current therapeutic options in distinct diseases and promising research for future therapies, especially pharmaceutic, genetic, or stem cell therapy.

A. D. Azevedo, Anna Bárbara de Castro Soares, Henrique Queiroz Correa Garchet et al.

Summary Introduction: Chronic otitis media (COM) is an inflammatory condition associated with otorrhea as well as large and persistent perforations of the tympanic membrane in some cases. COM can also lead to cholesteatoma. Surgical treatment with canal wall-down and canal wall-up tympanomastoidectomy is considered for both types of illness. The choice of technique is controversial and is dependent on several factors, including the extent of disease. Objective: We aimed to evaluate surgical outcomes in COM patients with and without cholesteatoma treated with canal wall-down and canal wall-up tympanomastoidectomy. Disease eradication and post-operative auditory thresholds were assessed. Method: Patient records from the otorhinolaryngology department of a tertiary hospital were assessed retrospectively. Results: Patients who underwent canal wall-up tympanomastoidectomy had a higher rate of revision surgery, especially those with cholesteatoma. However, there were no statistically significant differences in post-operative hearing thresholds between the two techniques. Conclusion: The canal wall-down technique is superior to the canal wall-up technique, especially for patients with cholesteatoma.