Research articleAbstract only
Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway
Clare Richardson, Anish Abrol, Chelsea S. Hamill, Nicole Maronian, ... Brian D'Anza
In Press, Accepted Manuscript, Available online 16 April 2019
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Abstract
Abstract
Introduction
Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway.
Materials and methods
A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma.
Results
73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer.
Conclusions
Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.
select article Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy
Research articleAbstract only
Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy
Ramez Philips, Phillip Nulty, Nolan Seim, Yubo Tan, ... Garth Essig
In Press, Accepted Manuscript, Available online 16 April 2019
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Abstract
Abstract
Objective
To assess the utility of rapid parathyroid hormone (PTH) values in predicting transient post-operative hypocalcemia in patients with unplanned parathyroidectomy during total or completion thyroidectomy.
Methods
All patients who underwent total or completion thyroidectomy between January 2010 and January 2015 were reviewed. Incidences of post-operative hypocalcemia were compared in patients with and without unplanned parathyroidectomy. Unplanned parathyroidectomy was defined as intra-operative incidental or intentional parathyroidectomy. Logistic regression assessed for predictors of hypocalcemia and optimum amount of calcium supplementation.
Results
Thirty-eight (13.6%) patients had evidence of incidental parathyroidectomy and 39/280 (13.9%) patients had parathyroid autotransplantation intra-operatively. Central neck dissection and malignancy were identified as risk factors for unplanned parathyroidectomy (p = 0.001, p = 0.060). Patients with unplanned parathyroidectomy were more likely to have hypocalcemia (p = 0.002) and hypoparathyroidism (p < 0.0005). PTH value was the only significant predictor of hypocalcemia in these patients. In patients with a post-operative PTH of ≤15, initial calcium supplementation ≥ 1000 mg decreased the risk of hypocalcemia (p < 0.05).
Conclusion
Post-operative PTH value predicts hypocalcemia in patients undergoing total and completion thyroidectomy with unplanned parathyroidectomy. In patients with a post-operative PTH < 15, initial calcium supplementation with ≥1000 mg of elemental calcium is recommended.
select article Clinical practice patterns in laryngeal cancer and introduction of CT lung screening
Research articleAbstract only
Clinical practice patterns in laryngeal cancer and introduction of CT lung screening
Krzysztof Piersiala, Lee M. Akst, Alexander T. Hillel, Simon R. Best
In Press, Accepted Manuscript, Available online 12 April 2019
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Abstract
Abstract
Objectives
After the publication of large clinical trials, in January 2014 The U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers. A significant proportion of patients with laryngeal cancer (LC) meet the introduced criteria, and we hypothesized that clinical practice would change as a result of these evidence-based guidelines.
Methods
Retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the introduction of screening guidelines (January 2010 to December 2017) was performed to identify those who had recommended screening CT chest.
Results
A total of 151 patients met the inclusion criteria of the study and were followed for a total of 746 patient-years. 184/332 (55%) patient-years in the pre-guidelines period and 246/414 (59%) in the post-guidelines period included at least one recommended chest imaging (CT or PET-CT; p = 0.27). 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included any radiological chest imaging (X-ray, CT or PET-CT; p = 0.72). Screening scans were ordered by OHNS (45%), Medical Oncology (31%), Radiation Oncology (8%), and primary care (14%) with 70% of patients missing at least one year of indicated screening.
Conclusions
The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to effective evidence-based screening and coordination of care is warranted.
select article Wideband timpanometry results of bone cement ossiculoplasty
Research articleAbstract only
Wideband timpanometry results of bone cement ossiculoplasty
O. Yigit, S. Tokgoz-Yilmaz, E. Tahir, M.D. Bajin, ... L. Sennaroglu
In Press, Accepted Manuscript, Available online 12 April 2019
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Abstract
Abstract
Objective
We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study.
Study design
A prospective study.
Setting
Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed.
Results
A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups.
Conclusion
Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.
select article Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management
Research articleAbstract only
Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management
Mark A. Prendes, Brett Gudgel, Enoch B. Kassa, Amelia M. Todd, ... H.B. Harold Lee
In Press, Corrected Proof, Available online 9 April 2019
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Abstract
Abstract
Purpose
To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants.
Methods
A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants.
Results
Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years.
Conclusions
To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported.
Précis
A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.
select article Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension
Case reportAbstract only
Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension
Adele Chin Wei Ng, Heng Wai Yuen, Xin Yong Huang
In Press, Accepted Manuscript, Available online 8 April 2019
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select article The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review
Case reportAbstract only
The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review
Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew
In Press, Corrected Proof, Available online 5 April 2019
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Abstract
Abstract
We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.
select article Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients
Research articleAbstract only
Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients
Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, ... Andreas M. Lazaris
In Press, Corrected Proof, Available online 3 April 2019
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Abstract
Abstract
Purpose
Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry.
Materials and methods
Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins.
Results
NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC.
Conclusions
VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.
select article Spontaneous cervical chyle fistula: A case report
Case reportAbstract only
Spontaneous cervical chyle fistula: A case report
Swathi Appachi, Joseph B. Meleca, Paul C. Bryson
In Press, Corrected Proof, Available online 2 April 2019
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Abstract
Abstract
Background
Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.
Methods
Case report.
Results
A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.
Conclusion
A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.
select article Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?
Research articleAbstract only
Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?
Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, ... Andrea Gallo
In Press, Corrected Proof, Available online 2 April 2019
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Abstract
Abstract
Purpose
Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy.
Materials and methods
The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days.
Results
The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008).
Conclusions
Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.
select article Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center
Research articleAbstract only
Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center
Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow
In Press, Corrected Proof, Available online 2 April 2019
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Abstract
Abstract
Background
There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital.
Method
We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS).
Results
From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months).
Conclusion
The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.
select article Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish
Research articleAbstract only
Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish
Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera-Schmitz, Jose Angel González-García, ... Xabier Altuna-Mariezcurrena
In Press, Corrected Proof, Available online 2 April 2019
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Abstract
Abstract
Introduction
There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary.
Material and methods
Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α.
Results
35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26).
Conclusion
The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.
select article Sex-specific enlarged vestibular aqueduct morphology and audiometry
Research articleAbstract only
Sex-specific enlarged vestibular aqueduct morphology and audiometry
Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, ... Todd D. Otteson
In Press, Accepted Manuscript, Available online 29 March 2019
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Abstract
Abstract
Objective
Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.
Materials and methods
A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.
Results
Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).
Conclusions
Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.
select article Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting
Research articleAbstract only
Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting
Nael M. Shoman
In Press, Accepted Manuscript, Available online 29 March 2019
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Abstract
Abstract
Objective
Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.
Study design
Retrospective case series.
Setting
Tertiary care facility.
Patients
Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.
Intervention
In-office modified myringoplasty technique under local anesthesia without sedation.
Main outcome measures
Complete perforation closure rate and audiometric outcomes.
Results
250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).
Conclusion
The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.
select article Cricoarytenoid joint abscess associated with rheumatoid arthritis
Case reportAbstract only
Cricoarytenoid joint abscess associated with rheumatoid arthritis
Megan J. Foggia, Henry T. Hoffman
In Press, Corrected Proof, Available online 28 March 2019
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Abstract
Abstract
Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.
select article Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty
Case reportAbstract only
Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty
Joseph B. Meleca, Paul C. Bryson
In Press, Corrected Proof, Available online 27 March 2019
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Abstract
Abstract
Background
Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.
Methods
Case report.
Results
A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability.
The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.
Conclusions
Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.
select article Conservative thyroidectomy for papillary thyroid microcarcinoma
Research articleAbstract only
Conservative thyroidectomy for papillary thyroid microcarcinoma
Hyun Joo Nahm, Sung Jun Choi, Young Chang Lim
In Press, Corrected Proof, Available online 21 March 2019
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Abstract
Abstract
Objective
According to American Thyroid Association (ATA) guideline, thyroid lobectomy is recommended for the management of papillary thyroid microcarcinomas (PTMC) with a diameter lesser than 1 cm. However, this procedure is associated with a risk of potential complications such as vocal cord palsy. Thus, we considered the applicability of conservative thyroidectomy, involving partial removal of the thyroid cancer lesion, not the entire ipsilateral thyroid lobe.
Methods
A retrospective analysis of all PTMC patients who underwent conservative thyroidectomy at Konkuk University Hospital between August 2008 and February 2014 was performed. Oncologic results of these patients along with the incidence of postoperative complications were evaluated. Seventy-nine patients who underwent conservative thyroidectomy for the treatment of PTMC were enrolled in the present study.
Results
Four of the 79 patients (5.0%) showed recurrence, 2 local (2.5%) and 2 regional (2.5%), respectively. All of these patients consequently underwent surgery alone and were salvaged. Temporary postoperative complications such as vocal cord palsy and hypocalcemia developed in 1 and 1 case, respectively, but completely recovered over time.
Conclusions
Conservative thyroidectomy is an oncologically and functionally safe procedure for surgical treatment of PTMC and can be considered as an alternative to thyroid lobectomy for the surgical management of PTMC.
select article Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes
Research articleAbstract only
Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes
Feng Wang, Yang Yang, Qihan Wu, Haihong Chen
In Press, Corrected Proof, Available online 21 March 2019
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Abstract
Abstract
Objective
This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis.
Setting
Hospital of Zhejiang University.
Study design
Retrospective analysis of collected data.
Subjects and methods
One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively.
Results
Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively.
Conclusions
Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.
select article Vestibulotoxicity in a patient without renal failure after inhaled tobramycin
Case reportAbstract only
Vestibulotoxicity in a patient without renal failure after inhaled tobramycin
Adam C. Kaufman, Steven J. Eliades
In Press, Corrected Proof, Available online 19 March 2019
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Abstract
Abstract
Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.
select article Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study
Research articleAbstract only
Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study
Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz
In Press, Corrected Proof, Available online 18 March 2019
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Abstract
Abstract
Objective
To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI).
Study design
Pilot, prospective efficacy trial.
Setting
Tertiary care hospital.
Patients
Men and women, over the age of 18 with chronic subjective tinnitus for >6 months.
Intervention
Daily application of commercially available transdermal lidocaine patch.
Outcome measure
Change in the TFI.
Results
The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment.
Conclusions
In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.
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