Τρίτη 25 Μαΐου 2021

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):131-141. doi: 10.14639/0392-100X-N0977.

ABSTRACT

OBJECTIVE: This study evaluated the effect of voice intervention in patients who received chemoradiation to the neck for non-laryngeal head and neck malignancies.

METHODS: Twenty individuals with non-laryngeal malignancies of the head and neck who received chemoradiation were divided by block randomisation into an intervention group that received voice rehabilitation and a contr ol group without rehabilitation. All patients underwent acoustic analysis, perceptual and subjective analysis of voice before the commencement of chemoradiotherapy and at 1, 3 and 6 months after chemoradiotherapy.

RESULTS: In both groups, all parameters were significantly altered at one month follow-up except for fundamental frequency (females in control group and males in intervention group). In the intervention group, all parameters returned to pretreatment levels (no statistical differences) at 6 months. In the control group, all except for a few subjective parameters (grade, breathiness and asthenia) remained significantly altered at 6 months compared to the levels before radiotherapy.

CONCLUSIONS: In non-laryngeal head and neck malignancies, voice rehabilitation offered at 1 month after treatment ameliorates chemoradiation-induced dysphonia within 6 months.

PMID:34028457 | DOI:10.14639/0392-100X-N0977

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Tracheo-bronchial recurrent respiratory papillomatosis: role of powered instruments in overcoming surgical challenges

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):146-150. doi: 10.14639/0392-100X-N0822.

ABSTRACT

OBJECTIVE: Respiratory papillomatosis involving the trachea is a challenging problem. In this paper, we present our experience in the management of 13 cases of tracheal papillomatosis and the difficulties encountered in the procedure. The surgical technique and results are discussed.

METHODS: A modified transoral trans-stomal approach was employed for the removal of papillomas b y using microdebrider. All patients were operated on under general anaesthesia with intermittent removal of intubation tube and apnoea. All patients required repeated surgeries. Tracheostomy removal was considered after adequate surgery and recurrence-free interval. The follow-up period was 12-24 months.

RESULTS: The total number of surgeries per patient ranged from 3-35 (mean 10). Decannulation could be successfully achieved in 9 patients. There were no procedure-related complications.

CONCLUSIONS: Transoral trans-stomal microdebrider assisted excision of tracheal papilloma showed excellent results without procedure-related complications. It can be used as a routine procedure for tracheal papillomas. The prognosis of tracheal involvement is fair and most patients can be decannulated.

PMID:34028459 | DOI:10.14639/0392-100X-N0822

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The SWI/SNF complex in eosinophilic and non eosinophilic chronic rhinosinusitis

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):159-167. doi: 10.14639/0392-100X-N0760.

ABSTRACT

INTRODUCTION: Chronic rhinosinusitis (CRS) can be classified as eosinophilic (eCRS) or non-eosinophilic (neCRS) based on infiltration type. The SWI/SNF complex may be involved in the pathophysiology of CRS.

AIM: To assess the expression of the SWI/SNF complex in both CRS groups; to correlate blood eosinophil count (BEC), and histopathology eosinophil count (HPEC) with the SWI/SN F expression level in eCRS and neCRS.

MATERIALS AND METHODS: The study population consisted of 96 patients (68 eCRS, 28 neCRS). Immunohistochemical staining was performed on sinonasal mucosa for assessment of SWI/SNF protein expression. Type of tissue infiltration was assessed in samples obtained from examined groups (HPEC). The diagnostic value of eCRS was 10 cells/HPF (high power field). Complete blood count was analysed in order to calculate BEC.

RESULTS: BEC and HPEC correlated negatively with all the SWI/SNF subunits. HPEC and BEC correlated positively with clinical findings (L-M and SNOT-22), while SWI/SNF correlated negatively with clinical findings (L-M and SNOT-22).

CONCLUSIONS: The SWI/SNF was observed in both eCRS and neCRS, with lower expression in former. The meaning of its negative correlation with BEC, HPEC and clinical findings in eCRS group remains to be understood.

PMID:34028461 | DOI:10.14639/0392-100X-N0760

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Cochlear implant in prelingually hearing-impaired adults: prognostic factors and results

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):173-179. doi: 10.14639/0392-100X-N1146.

ABSTRACT

OBJECTIVES: The aim of present study is to evaluate the impact of prognostic factors on the outcome in a group of prelingually hearing-impaired patients submitted to cochlear implantation (CI) at an adult age.

METHODS: This is a retrospective study on a cohort of prelingually severe-to-profound hearing-impaired patients cochlear implanted in adulthood and followed by a single au diology centre. We correlated post-CI results in term of speech perception with patients' speech perception with hearing aids before implantation, history of progression of hearing loss (HL), and levels of education and cognition. The study group was composed of 49 patients.

RESULTS: Post-CI open-set recognition score in silence and noise was significantly correlated with pre-CI open-set recognition score in silence and with background noise. Patients with a history of progression of HL gained significantly better results. Furthermore, we found higher improvements in patients with a higher level of education.

CONCLUSIONS: Prelingually deafened patients implanted in adulthood achieved satisfactory results. Significantly better results were achieved by patients with better pre-operative speech perception scores, progressive HL and higher level of education.

PMID:34028463 | DOI:10.14639/0392-100X-N1146

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Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):151-158. doi: 10.14639/0392-100X-N0907.

ABSTRACT

OBJECTIVE: The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis.

METHOD: Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclome thasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry.

RESULTS: After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1.

CONCLUSION: Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

PMID:34028460 | DOI:10.14639/0392-100X-N0907

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Evolution of migraine vertigo in overlapping syndrome with Ménière's disease: prognostic role of instrumental examination

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):180-184. doi: 10.14639/0392-100X-N0752.

ABSTRACT

INTRODUCTION: Migraine vertigo (MV) and Ménière's disease (MD) share several signs and symptoms such as tinnitus, fullness, photophobia, phonophobia, headache and vertigo spells lasting hours.

OBJECTIVE: The aim of the present study was to prospectively observe patients with MV with a sporadic audiological symptom evaluated with clinical examination, Vestibular Evoked Myogenic P otentials (VEMPs), ECochG and v-HIT.

RESULTS: The finding of VEMP asymmetry, according to our cut-off of 33% of difference between sides, resulted in 20 cases, of which 6 had asymmetry of both c-VEMPs and o-VEMPS, all with development of fluctuating hearing during follow-up. ECochG was positive for endolymphatic hydrops in 12 patients.

CONCLUSIONS: The evolution of MV may have a variable course in which some patients may develop symptoms typical of MD. The two diseases may be contextually present at the same time configuring an overlapping syndrome, and asymmetric VEMPs might predict development of fluctuating hearing.

PMID:34028464 | DOI:10.14639/0392-100X-N0752

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Endoscopic balloon dilatation of the olfactory cleft - a feasibility study of a novel technique in cadavers

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Acta Otorhinolaryngol Ital. 2021 Apr;41(2):168-172. doi: 10.14639/0392-100X-N1132.

ABSTRACT

OBJECTIVE: Smell dysfunctions are common with almost 20% percent of the population affected. There are no interventional solutions for these patients. The aim of this study is to investigate the feasibility and security of the balloon dilatation technique.

METHODS: This paper describes interventional steps and determines the feasibility and safety of endoscopic olfactory cleft d ilatation via balloon device. We included 10 nasal cavities in the study and dilated olfactory cleft areas via balloon device.

RESULTS: We could smoothly perform the procedure and did not observe any fractures on the skull base or olfactory cleft of the cadavers after dilatation.

CONCLUSIONS: A combination of this intervention with medical treatments can be promising for smell dysfunctions.

PMID:34028462 | DOI:10.14639/0392-100X-N1132

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Oral Squamous Cell Carcinoma Bone Invasion: Possible Roles of E-Cadherin in Osteoclastogenesis and Bone Infiltration

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Introduction: Squamous cell carcinoma is the most common cancer of the oral cavity. When the tumor invades the bone tissue, the prognostic and survival rates decrease a lot, and the treatment becomes more aggressive, with several damages to the patient and health system. Many of the molecular mechanisms of bone invasion process are not understood yet, but it is already known that one of central processes of tumor evolution – adjacent tissues invasion and metastasis – is a la rge spectrum of phenotypic changes in epithelial cells to mesenchymal, in a process named as epithelial-mesenchymal transition (EMT). Loss of E-cadherin, an important epithelial cell adhesion protein, is a hallmark of this phenomenon. The objective of this retrospective study is to evaluate the expression of E-cadherin protein, comparing its distribution with clinical characteristics of the patients and possibly relation to EMT. Methods: Sixty-two cases with respective clinical data were analyzed by comparing immunohistochemical, H and E staining, and clinical data, observing the tumor-bone interface (TBI) and the surrounding tumor that had no direct contact with the bone surface (ST). Results: Forty cases were positive for E-cadherin (64%) with a heterogeneous pattern. Statistical analysis showed a significant difference between the presence of E-cadherin expression and tobacco smokers. Also, the equal or weaker protein expression in the ST than TBI is r elated to a worse overall survival. No statistically significant difference in other prognostic factors was observed. Conclusion: Our results suggest that the tumor cells that interact with the bone tissue could gain molecular changes, like partial EMT and osteoclastogenesis induction, which facilitate their migration and increase the bone resorption, resulting in a worse patient's prognosis.
ORL
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Clinical symptoms of chronic rhinosinusitis with nasal polyps (eosinophilic and non-eosinophilic) are related to sinus computed tomography but not to endoscopic findings

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Publication date: Available online 25 May 2021

Source: Acta Otorrinolaringológica Española

Author(s): Mohd Shaiful Nizam Mamat Nasir, Mohd Ezane Aziz, Sharifah Emilia Tuan Sharif, Rohaida Ibrahim, Baharudin Abdullah

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Spontaneous Expulsion of Foreign Body Bronchus: Understanding the Mechanism

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Abstract

Foreign Body (FB) aspiration pose a challenge to the otolaryngologist of its early diagnosis along with safe removal. Almost all airway foreign bodies require bronchoscopy and removal. Very rarely, spontaneous expulsion of bronchial FB may happen. We are reporting one such case of spontaneous expulsion of a metallic FB from right main bronchus in a fourteen-year-old boy. The mainstay of treatment for FB bronchus is bronchoscopic removal. Spontaneous expulsion occurs very rarely & may be associated with life threatening complications. Impaction of FB in sub glottis may lead to sudden choking & death. In this report we also have tried to provide insight into the physics and physiological mechanism facilitating spontaneous expulsion of a bronchial foreign body.

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Media Commercials Conveying Awareness Regarding Prevention of Head and Neck Cancer by Focusing on Stigmatized Perspective of Disease: Right or Wrong?

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Abstract

Cancer in the head and neck region is among the most common cancer around the world, the incidence of which keep increasing in past years. Treatment of disease is usually done by the surgical excision which often leads to some degree of facial disfigurements which cause mutilation in patients. Mutilation imparts the feeling of stigma in patients, and patients usually tend to hide facial disfigurements using additional clothing. As a prevention strategy, awareness regarding the disease conveys to the mass population via media commercials. Media commercials which highlight the adverse outcomes of cancer are found to target the stigmatized perspective of disease. On the brighter side, more stigmatized is the patient image in the commercials, more motivation it will create in masses to avoid risk factors like tobacco, smoking and alcohol. But on the darker side, stigmatized commercials create a social environment in which people tend to maintain social distance to cancer patients, and patients have to bear social disapproval by society for their whole life. It reduces the self-esteem and quality of life of patients which affects their overall survival. In the present article, we review the status of stigma in head and neck cancer patients, tools that are available for a ssessment of stigma, and effects of the stigmatized media commercials on the patient's self-esteem. The present article represents the accurate picture of the problem and highlights the policies which could be employed to balance the paradox of stigmatized media commercials and a healthy social environment for cancer patients.

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