Kinnari Teemu J. Aarnisalo Antti A. Rihkanen Heikki Lundin Johan Jero Jussi

AbstractOBJECTIVE:Owing to anecdotal evidence, in bilateral tympanostomy, there is a risk of tube occlusion in the ear that stays superior during the recovery after anesthesia. This observational analysis was designed to evaluate the side difference of tympanostomy tube occlusions owing to head position during the operation and postoperative recovery. It was part of a prospective clinical trial with bilateral tympanostomy tube insertion that was conducted to evaluate the effect of albumin coating tympanostomy tube sequelae.METHODS:In the bilateral tympanostomy, the right ear was always operated on first. After left ear tube insertion and during the recovery phase after anesthesia, the patient was turned to lie on the right side. The number of tube sequelae were studied during a 9-month follow-up period.RESULTS:At the first 1-month follow-up visit, 7 right ear tubes and 18 left ear tubes had occluded (p = .043). The same tendency was seen throughout the follow-up. Also, according to a survival analysis, in which survival functions according to laterality were compared using the log-rank test, stratified by tube coating, the left tube occluded at a significantly higher rate.CONCLUSIONS:The position of the patient's head when awake after anesthesia may have an influence on tube occlusion. In this study, the tube located superiorly was occluded more often. This tendency remained during the follow-up. We concluded that there is a possible association between the position of the head during early recovery and occlusion of the tympanostomy tube.

Panda Naresh K. Jain Rishabh Bakshi Jaimanti Munjal Sanjay

AbstractINTRODUCTION:There is general concern regarding the possible hazardous health effects of exposure to radiofrequency electromagnetic radiation emitted from mobile phones. This study aimed to assess the effects of chronic exposure to electromagnetic waves emitted from Global System for Mobile Communication (GSM) mobile phones on auditory functions.MATERIAL AND METHODS:A retrospective, cross-sectional, randomized, case control study was carried out in a tertiary care hospital. One hundred twelve subjects who were long-term mobile phone users (more than 1 year) and 50 controls who had never used a mobile phone underwent a battery of audiologic investigations including pure-tone audiometry (both speech and high frequency), tympanometry, distortion product otoacoustic emissions, auditory brain responses, and middle latency responses. Changes in the various parameters were studied in the mobile phone– and non–mobile phone–using ears of subjects and corresponding ears of the controls to ascertain the effects of electromagnetic exposure.RESULTS:There was no significant difference between users and controls for any of the audiologic parameters. However, trends for audiologic abnormalities were seen within the users. High-frequency loss and absent distortion product otoacoustic emissions were observed with an increase in the duration of mobile phone use, excessive use of mobile phones, and age more than 30 years. Additionally, users with some complaints during mobile phone use demonstrated absent distortion product otoacoustic emissions and abnormalities in auditory brainstem response.CONCLUSION:Long-term and intensive mobile phone use may cause inner ear damage. A large sample size would be required to reach definitive conclusions.

Choi Ji Yun Cho Sung Il Do Nam Yong Kang Cha Young Lim Sung Chul

AbstractBACKGROUND:Because advanced-stage squamous cell carcinoma of the larynx undergoes a generally poor hospital course, the prognostic significance of squamous cell carcinoma in the larynx was evaluated to identify those features associated with aggressive biologic behaviour according to the immunologic and histopathologic characteristics. Molecular prognostic and predictive factors have been extensively studied in different cancers over the past decades, and some of these factors were found to be useful in diagnosis, follow-up, or even treatment of some malignant tumours.AIMS:To concretize the pathogenesis of malignant tumours in the larynx and to examine the possible prognostic factors related to malignancy.METHODS:To assess the significance of galectin-3 and Pim-1 protein in laryngeal tumours and their correlation with prognostic factors, samples from 77 patients with squamous cell carcinoma of the larynx were studied immunohistochemically. We examined the correlations of galectin-3 and Pim-1 protein expression according to tumour stage, nodal status, clinical stage, and histologic differentiation to investigate the clinical significance.RESULTS:Squamous cell carcinoma showed increased galectin-3 and Pim-1 expression in the more advanced clinical stage, tumour stage, and nodal status.CONCLUSIONS:The pathogenetic role of galectin-3 and Pim-1 expression in laryngeal squamous cell carcinoma indicates that galectin-3 and Pim-1 might be used as a possible prognostic factor.

Gauthier Pierre Arteau-Gauthier Isabelle Pilon Line Comeau Lise Allaire André Guertin Louis Audet Nathalie Rochette Linda

AbstractOBJECTIVE:Positive margins for squamous cell carcinoma of the oral tongue on final pathology are a poor prognostic factor associated with a higher likelihood of local recurrence. Obtaining margin status in a relatively short time by using complete frozen sections, such as Mohs margins for skin cancer, would lower the recurrence rate. The goal of this study was to compare, on pig tongue, the efficacy of different techniques used to obtain complete frozen sections on histologic glass slides of optimal quality.STUDY DESIGN:We compared the quality of frozen section glass slides on fresh pig tongues. The partial glossectomy was executed with either a sharp instrument (scalpel and scissors), electrocautery in the cutting mode, or electrocautery at the coagulation mode. For each of the three methods, we also compared the frozen section, obtained on the line of resection and for a thickness of 1 to 1.3 mm, using either the cryostat or isopentane for the freezing phase. The percentage and quality of epithelium and muscle present on histologic glass slides were assessed by a pathologist independently.RESULTS:Complete frozen margins of high quality were obtained in a relatively short time for all techniques (28–38 minutes). Sharp dissection showed better results: a shorter processing time for the specimens and better quality for the histologic glass slides. Using cryostat or isopentane for the freezing phase did not show any significant difference.CONCLUSION AND SIGNIFICANCE:Complete frozen margins (Mohs margins) of high quality are feasible. Histologic glass slides of very good quality are obtained when using a sharp dissection technique. For the freezing period, both isopentane and cryostat offer very good results. This approach is appropriate on animals and needs further study in clinical situations. The human experience will be presented in the next article which is: Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the oral tongue (Clinical experience Part 2 [CSO2008]).

Gauthier Pierre Audet Nathalie Guertin Louis Arteau-Gauthier Isabelle Comeau Lise Pilon Line Allaire André Camiré Marcel Beaudoin Danielle Dubé Robert Lussier Christian Nguyen Félix Phuc Rochette Linda

AbstractOBJECTIVE:To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique.STUDY DESIGN:Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature.RESULTS:For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20–75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70–120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12–34 months).CONCLUSION:The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.

Jaswal Abhishek Haldar Atish Biswas Gautam Sikder Biswajit Nandi Tapan

Cherkaoui Amine Oudidi Abdellatif El Alami Mohammed

AbstractINTRODUCTION:The aim of this study was to highlight the diagnostic problems posed by laryngeal tuberculosis and to incite practitioners to seek it more frequently, especially with the current resurgence in tuberculosis.PATIENTS AND METHODS:Eleven cases of laryngeal tuberculosis were diagnosed over a period of 4 years and included in a retrospective study.RESULTS:We identified seven men and four women (average age 43 years). Dysphonia was the primary symptom. Direct laryngoscopy revealed more often a budding ulcerative aspect and allowed us to perform laryngeal biopsy; the pathologic study confirmed the diagnosis in all patients. Medical treatment for tuberculosis for a short period of 6 months was introduced. In all cases, the long-term evolution was favourable, with an average of 15 months.DISCUSSION AND CONCLUSION:The topography of tuberculosis is diverse, with many sites of localization. The otorhinolaryngologist must be able to discuss the diagnosis of laryngeal tuberculosis, especially when suggested by the clinical context.

Duflo Suzy Mahieu-Renard Laurence Gras Régis Grob Jean-Jacques Zanaret Michel

AbstractOBJECTIVE:The aim of this study was to evaluate the lymphoscintigraphy appearance time (LAT) of the sentinel lymph node (SLN) in head and neck cutaneous melanoma and to determine whether a correlation exists between LAT and SLN status (negativity or positivity).DESIGN/SETTING:In vivo study.MATERIALS AND METHODS:A retrospective cohort of 33 patients with Breslow index ≥ 1.5 mm, Clark index ≥ 4 mm, and ulceration > 1 mm underwent a lymphoscintigraphy and SLN biopsy for a cutaneous head and neck melanoma.MAIN OUTCOME MEASURES:LAT was noted and correlated to SLN status, Breslow and Clark indices, ulceration, and recurrence.RESULTS:Sixty SLNs were identified; 58 were removed, and 17 were positive. In 31% (n = 18), the LAT was < 10 minutes; in 59% (n = 34), the LAT was > 10 minutes and < 30 minutes; and in 10% (n = 6), the LAT was > 30 minutes. SLN was significantly positive (p = .02) when the LAT was less than 10 minutes and the negative predictive value was 100% for LAT > 30 minutes. A recurrence was significantly observed (p = .02) for LAT < 10 minutes.CONCLUSION:LAT > 30 minutes is associated with negative SLN in head and neck melanoma; however, a prospective study on a more important cohort is needed for a better evaluation of this new variable.

Sheahan Patrick Ahn Chadwick N. Harvey Richard J. Wise Sarah K. Mulligan Ryan M. Lathers Deanne M.R. Schlosser Rodney J.

AbstractINTRODUCTION:Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an eosinophilic T-helper 2 inflammatory response. Local production of IgE within nasal polyps (NPs) has been demonstrated, suggesting a role for local IgE in the pathogenesis of NP in atopic CRS patients. We hypothesized that local IgE specific to inhalant allergens may also play a role in the genesis of NP in nonatopic CRS patients.METHODS:Sinus and inferior turbinate tissue was obtained from nonatopic CRSwNP patients (n = 7), chronic rhinosinusitis without nasal polyps (CRSsNP) patients (n = 15), and healthy controls (n = 9) at the time of surgery. ImmunoCAP analysis (Phadia AB, Portage, MI) for 14 common inhalant antigens was performed on tissue homogenates to determine the antigen-specific response.RESULTS:Total IgE levels did not differ in sinus or turbinate tissue between CRSwNP, CRSsNP, or control patients. CRSwNP sinus tissue had higher levels of specific IgE for cockroach and plantain (p = .03) than other groups and elevated Alternaria IgE levels when compared with CRSsNP sinus tissue (p < .05). No significant differences were found for any of the other antigen-specific IgE levels. Fifty-seven percent of CRSwNP polyps demonstrated a polyclonal IgE response, whereas the other 43% had no demonstrable antigen-specific IgE. In contrast, only 17% of CRSsNP patients demonstrated a polyclonal response within sinus tissue, whereas 67% had no detectable antigen-specific IgE. There was no significant difference in levels of IgE in inferior turbinate tissue between the groups (p > .05).CONCLUSIONS:Localized mucosal IgE specific to common inhalant allergens appears to play a role in a subset of CRSwNP patients without evidence of systemic atopy.

Oncel Semih Pinar Ercan Sener Gamze Calli Caglar Karagoz Umit

AbstractOBJECTIVE:We investigated the presence of biofilms in patients with chronic rhinosinusitis.DESIGN:Prospective study.METHODS:Thirty patients with chronic rhinosinusitis scheduled for endoscopic sinus surgery were enrolled in this study. Nasal swab cultures were taken at the time of surgery. Samples were cultured using conventional methods for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus.MAIN OUTCOME MEASURES:Culture-positive samples were evaluated for slime-forming ability. Qualitative detection of biofilm formation by all slime-producing strains was studied by culturing the strains on Congo red agar plates.RESULTS:Twenty-three of 30 patients' samples were culture positive (76.6%). Thirteen S. aureus and 10 P. aeruginosa cultures were identified on 23 specimens. Bacterial biofilms were present on 15 of 23 (65.2%) culture-positive specimens. Nine of 13 (69.2%) S. aureus cultures and 6 of 10 (60%) P. aeruginosa cultures produced bacterial biofilms.CONCLUSION:This conventional method is capable of demonstrating biofilm-forming ability in bacteria recovered from patients with chronic rhinosinusitis. The biofilm-forming ability was higher in S. aureus compared with P. aeruginosa.

Sun Xi-Cai Wang De-Hui Yu Hua-Peng Wang Feng Wang Wei Jiang Jack J.

AbstractOBJECTIVE:Surgical outcomes and prognostic factors were analyzed to determine what factors increase the probability of juvenile nasopharyngeal angiofibroma (JNA) recurrence.METHODS:Ninety-seven males with JNA were diagnosed and underwent surgery at Fudan University Affiliated Eye, Ear, Nose and Throat Hospital from 1997 to 2006. Clinical data were extracted from medical records and were used in the statistical analysis.RESULTS:The total recurrence rate of JNA was 39.2% after the initial surgery. A patient whose tumour staging was higher was more likely to have a recurrence than a patient whose tumour staging was lower (p = .0031). The recurrence rates in two groups (age ≥ 18 years group and < 18 years group) were 26.8% and 48.2%, respectively (p = .03). The recurrence rates with tumour size < 4 cm and ≥ 4 cm were 21.7% and 54.9%, respectively (p = .0008).CONCLUSION:The significant predictors of recurrence in our study were age at diagnosis, tumour size, and Radkowski classification.

Tewfik Marc A. Bossé Yohan Al-Shemari Hasan Desrosiers Martin

AbstractModern methods for the study of genetics offer promising new means of exploring complex diseases such as chronic rhinosinusitis (CRS). Powerful new high-throughput tools extend the capabilities of existing technologies. However, for the inexperienced reader, a lack of familiarity with the techniques used may limit comprehension of the articles and hamper the appreciation of the potential of this area of research. To improve understanding, we present an introduction to research methods in common user language, describing the techniques and applications of each while outlining differences between techniques of study of gene expression and genetic association studies. Online tools for experiment design and data analysis are presented. Practical examples from our work in the genetics of CRS are used to help understand applications for these tools. It is expected that this article will allow physicians to acquire an improved understanding of the uses and limitations of these types of studies as these techniques become increasingly commonplace in our specialty.

Nader Marc-Elie Abou-Jaoude Peter Cabaluna Myrna Desrosiers Martin

AbstractOBJECTIVES:Studies of the genetics of chronic rhinosinusitis offer potential insights into the pathophysiology of this poorly understood condition. However, genetic studies are both expensive and time consuming-hence the importance of establishing beforehand the proper population and target genes. We wished to identify patient factors associated with a proposed definition of severe chronic rhinosinusitis to minimize heterogeneity and maximize the impact of genetic contributions. We therefore wanted to determine if the response to a standardized therapy following endoscopic sinus surgery could be used as a viable phenotypic criterion for subsequent genetic studies.DESIGN:Retrospective chart review.SETTING:Tertiary sinus centre.METHODS:Seventy-one cases of chronic rhinosinusitis refractory to medical and surgical treatment were studied. They formed two groups according to their response to a standardized treatment protocol. We collected information concerning patients' characteristics and bacteriology on endoscopic culture.RESULTS:60.5% patients were managed successfully with budesonide irrigations. Atopy was present in 33.8%, asthma in 69.0%, and aspirin sensitivity in 33.3%. The rate of asthma was higher in nonresponders. Bacterial colonization rates showed the presence of Staphylococcus aureus (36.4%), gram-negative rods (29.1%), and Pseudomonas aeruginosa (32.7%).CONCLUSIONS:Patients with refractory chronic rhinosinusitis represent a severely diseased, more homogeneous population in which the genetic contribution(s) to disease may be maximal. Strong associations with asthma, aspirin intolerance, and atopy suggest links between these disorders. Irrigation with budesonide solution appears to be effective in management. Studies of the genetics of chronic rhinosinusitis will include genes known to be involved with both asthma and innate immunity.

Stucken Emily Weissman Joshua Spiegel Jeffrey H.

AbstractOBJECTIVE:(1) To assess the knowledge of a group of experts in head and neck cancer regarding risk factors for oral cancer; (2) to describe the quality of the available literature on the topic of oral cancer risk factors; and (3) to compare expert opinion about oral cancer risk factors with the literature.METHODS:Survey of head and neck cancer experts and extensive literature review and classification of levels of evidence for published data.RESULTS:Extensive data demonstrating the level of published literature support for or against many compounds and behaviours are presented. In several cases, there was good correlation between expert opinions and literature support, whereas for others, there was a clear discordance.CONCLUSION:Experts in oral cancer are in agreement that tobacco smoking and betel use are significant risk factors for the development of oral cavity carcinoma. There is a lack of agreement about the risks of alcohol, poor-fitting dentures, maté tea, and a diet low in fruits and vegetables. Sufficient data have been published demonstrating the risk associated with each factor; however, it appears that the most current data and research are not as available to medical professionals as they should be. The perceived risks of tobacco chewing and use of khat were not substantiated by a solid foundation of data. A higher degree of concordance among experts was found for riskier health habits such as tobacco, alcohol, and betel chewing, whereas the votes were more dispersed for the risk factors that received lower ratings.

Lan Ming-Chin Hsu Yen-Bin Chang Shyue-Yih Huang Jui-Lin Tai Shyh-Kuan Chien Chih-Hung Chu Pen-Yuan

AbstractOBJECTIVES:To evaluate the usefulness and safety of flexible laryngovideostroboscopic (FLVS) surgery in patients with vocal fold polyp and to discuss its advantages and limitations in comparison with traditional direct microlaryngoscopic technique under general anesthesia.DESIGN:Retrospective analysis.PATIENTS AND METHODS:Twenty patients with vocal fold polyp treated by FLVS surgery under topical anesthesia were reviewed. The results were evaluated by videostroboscopy and grade of the severity of dysphonia, roughness, and breathiness (GRB) scales. Phonatory results, including maximum phonation time, jitter, shimmer, and noise to harmonic ratio, were also reviewed for objective evaluations.RESULTS:All patients completed the surgery smoothly, and seven of them had a higher risk for general anesthesia because of their medical diseases. The procedure was typically accomplished within 20 minutes, and no complications were noted. Videostroboscopy showed improved degree of glottic closure (p < .001), regularity (p = .046), phase symmetry (p = .008), and mucosal wave (p = .008) after FLVS. A significant improvement was noted between preoperative and postoperative results with regard to GRB scale (p < .001, p = .001, and p = .013, respectively). Maximum phonation time also increased significantly after surgery (p = .002). Trivial mucosal residual was noted in one patient. No recurrence was found after a 6-month follow-up period.CONCLUSIONS:FLVS surgery is a highly applicable procedure with low invasiveness and minimal morbidity. It offers a simple and cost-effective alternative to the traditional direct microlaryngoscopic procedure, especially for those who are not candidates for general anesthesia or suspension of the larynx.

Bonaparte James P. Corsten Martin Rourke Ryan

AbstractOBJECTIVE:To test the hypothesis that using an alcohol–based, mint-flavoured oral mouthwash prior to applying oral lidocaine spray will result in an improvement in the unpleasant taste of the lidocaine.DESIGN:A double-blind, randomized, controlled trial using a crossover design.SETTING:A tertiary care hospital.METHODS:Fifteen able-bodied volunteers rinsed for 30 seconds with either a mint-flavoured, alcohol-based mouthwash (treatment) or plain water (placebo) prior to the administration of topical lidocaine spray. All subjects received both the treatment and the placebo; however, the order of exposure was randomized.OUTCOME MEASURES:Subjects completed two 100 mm visual analogue scales (VASs). The first assessed the overall satisfaction with the taste of the lidocaine. This consisted of a 100 mm VAS with 0 defined as the “most unpleasant taste” and 100 mm defined as the “most pleasant taste,” whereas 50 mm was defined as neutral or no taste. The second VAS assessed subjective analgesia after lidocaine administration.RESULTS:There was a statistically significant improvement in the taste of oral lidocaine after administering the treatment intervention (p = .003). There was a reduction in subjective analgesia, which did not reach statistical significance (p = .03). Use of the oral mouthwash reduced the perception of the negative flavour of the lidocaine from 20.77 (13.2) mm to 50.2 (12.84) mm as assessed by the VAS.CONCLUSIONS:A brief rinse with a mint-flavoured, alcohol-based mouthwash prior to administration of topical lidocaine resulted in a significant improvement in the perceived flavour of topical lidocaine with a minimal reduction in subjective analgesia.

Brace Matthew Taylor S. Mark Trites Jonathan R. Bethune Drew Attia Elhamy Hart Robert D.

AbstractOBJECTIVE:To compare endoscopic stapling versus external transcervical approaches in the treatment of Zenker diverticulum.DESIGN:A 10-year retrospective institutional review was performed to identify all patients treated for Zenker diverticulum.SETTING:Academic tertiary care centre.METHODS:Patients treated surgically for Zenker diverticulum were identified through an electronic records search. Patient charts were reviewed, and patients were interviewed at follow-up.MAIN OUTCOME MEASURES:Patient age, sex, duration of symptoms, procedural time, time to oral liquids, length of posttreatment hospital stay, and post procedure patient satisfaction were recorded and compared.RESULTS:Ten patients treated endoscopically were compared with eight patients treated via an external approach. There were no significant differences in patient age, sex, and duration of symptoms. The external technique took significantly longer (110.88 ± 59.61 minutes) than the staple technique (19.50 ± 6.47 minutes) (p < .0001). There was no significant difference in time to full oral liquids (p = .11). The postsurgical hospital stay (4.71 ± 1.98 days) was significantly longer for the external technique compared with the staple technique (2.30 ± 2.83) (p = .03). Patient symptom relief was reported as completely resolved or improved in all cases, regardless of treatment type.CONCLUSIONS:Endoscopic stapling of Zenker diverticulum achieves operative success and patient satisfaction comparable to those of traditional external transcervical techniques, with significantly decreased operative times and hospital stays, allowing for more efficient use of resources.