Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

xlomafota13 shared this article with you from Inoreader Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment Via The Laryngoscope Objectives Assesses whether preoperative functional testing can distinguish vestibular schwannomas from facial nerve schwannomas medial to the labyrinthine segment. Study Design Retrospective cohort. Methods Retrospectively review surgically managed intracranial facial and vestibular schwannomas between January 2015 and December 2019 at two tertiary care centers. Patients with neurofibromatosis 2 and surgery for recurrence were excluded. Preoperative functional testing to include House-Brackmann scores, electroneuronography (ENoG), cervical vestibular evoked myogenic potentials (cVEMP), caloric testing, acoustic brainstem responses (ABRs), acoustic reflexes, and audiograms was compared between the two groups of schwannomas. Results Twelve facial and 128 vestibular schwannomas met inclusion criteria. In only one case was a facial schwannoma diagnosed preoperatively from imaging. No statistically significant difference was found in preoperative House-Brackmann scores, ENoG, cVEMP, caloric testing, ABRs, or acoustic reflexes. Pure tone average was worse in the vestibular schwannoma group (63 dB [95% CI: 58–68 dB] vs. 46 dB [95% CI: 34–58 dB], P = .01), and the difference was more apparent in the lower frequencies. Word recognition score was better in the facial schwannoma group (66% [95% CI: 45–86%] vs. 41% [95% CI: 34–47%], P = .02). Conclusion Specialized preoperative functional evaluation of the nerves of the internal auditory canal cannot reliably predict the presence of an intracranial facial schwannoma. Hearing is better in facial schwannomas, particularly in the lower frequencies. This should raise the index of suspicion for an intracranial facial schwannoma, especially in candidates for hearing preservation vestibular schwannoma surgery. Level of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up

xlomafota13 shared this article with you from Inoreader A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up Via The Laryngoscope Objectives Utilize a multi-institutional outcomes database to determine expected performance for adult cochlear implant (CI) users. Estimate the percentage of patients who are high performers and achieve performance plateau. Study Design Retrospective database study. Methods Outcomes from 9,448 implantations were mined to identify 804 adult, unilateral recipients who had one preoperative and at least one postoperative consonant-nucleus-consonant (CNC) word score. Results were examined to determine percent-correct CNC word recognition preoperatively and at 1, 3, 6, 12, and 24 months after activation. Outcomes from 318 similar patients who also had at least three postoperative CNC word scores were examined. Linear mixed-effects regression was used to examine CNC word performance over time. The time when each patient achieved maximum performance was recorded as a surrogate for time of performance plateau. Patients were assigned as candidates for less intense follow-up if they were high performers and achieved performance plateau. Results Among 804 patients with at least one postoperative score, CNC score improved at all time intervals. Average performance after the 3-month time interval was 47.2% to 51.5%, indicating a CNC ≥ 50% cutoff for high performers. Among 318 patients with at least three postoperative scores, performance improved from 1 to 3 (P = .001), 3 to 6 (P = .001), and 6 to 12 (P = .01) months. Scores from the 12- and 24-month intervals did not significantly differ (P = .09). By 12 months after activation, 59.7% of patients were considered candidates for less intense follow-up. Conclusion Findings suggest that CNC ≥ 50% is a reasonable cutoff to separate high performers from low performers. Within 12 months after activation, 59.7% of patients were good candidates for less intense follow-up. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of a Postoperative Data‐Extraction Questionnaire After Adenotonsillectomy in Children

xlomafota13 shared this article with you from Inoreader Outcomes of a Postoperative Data‐Extraction Questionnaire After Adenotonsillectomy in Children Via The Laryngoscope Objectives/Hypothesis To evaluate outcomes of a postoperative telephone questionnaire for children who underwent adenotonsillectomy (T&A). To determine whether episodes of postoperative hemorrhage were not captured until the call, and whether this impacted knowledge of physician rates of hemorrhage. Study Design Retrospective database analysis. Methods Retrospective analysis of outcomes of an 11-question data extraction tool utilized at a tertiary care children's hospital for follow-up in T&A patients <18 years of age over a 2-year period. Sub-analysis of positive responses to the question asking about incidence of postoperative hemorrhage. Results During the study period, 1,068/3,142 (34.0%) parents responded to the phone call. Median age was 6.0 years (interquartile range [IQR] 4.0–8.2), and 566 (53.0%) were male. Ninety (8.4%) noted that the child was still snoring, but only 9 (0.84%) reported signs of obstructed breathing. A total of 402 (37.6%) reported a voice change after surgery. Most children (n = 885, 82.9%) did not receive opioid analgesics, and 252 (23.6%) received acetaminophen/ibuprofen 7 days postoperatively. Return visits to the emergency department were reported in 149 patients; primarily for hemorrhage in 46 (30.8%). In 7 (15.2%) patients, the hemorrhage event was not recorded until the call. The majority-of respondents (n = 1,031, 96.5%) were satisfied with the outcome of the procedure. Conclusions The postoperative T&A tool provided a means of gathering information on success and satisfaction with surgical outcomes. Children were able to be managed primarily with acetaminophen and ibuprofen. Most complications were captured in the electronic record, although some episodes of hemorrhage were not noted until the call, emphasizing the importance of follow-up. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transoral Laser Microsurgical Excision of a Laryngeal Schwannoma Located in the Paraglottic Space

xlomafota13 shared this article with you from Inoreader Transoral Laser Microsurgical Excision of a Laryngeal Schwannoma Located in the Paraglottic Space Via The Laryngoscope Objectives/Hypothesis To report the first case of transoral excision of a paraglottic laryngeal schwannoma. Methods Case report. Results Laryngeal schwannomas are rare tumors, with approximately 75 cases reported to date worldwide. Most cases involve superficial supraglottic tumors excised transorally, and some have been found in deeper compartments and treated using transcervical approaches. This report describes the first excision of a schwannoma of the paraglottic space via endoscopic laser laryngotomy. The procedure allowed return to normal function, without recurrence within 8 months, after which the patient was lost to follow-up. Conclusions Transoral excision of benign paraglottic tumors is safe and feasible. Level of Evidence N/A. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients

xlomafota13 shared this article with you from Inoreader Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients Via The Laryngoscope Objectives/Hypothesis Previous studies have demonstrated that electrocochleography (ECochG) measurements made at the round window prior to cochlear implant (CI) electrode insertion can account for 47% of the variability in 6-month speech perception scores. Recent advances have made it possible to use the apical CI electrode to record intracochlear responses to acoustic stimuli. Study objectives were to determine 1) the relationship between intracochlear ECochG response amplitudes and 6-month speech perception scores and 2) to determine the relationship between behavioral auditory thresholds and ECochG threshold estimates. The hypothesis was that intracochlear ECochG response amplitudes made immediately after electrode insertion would be larger than historical controls (at the extracochlear site) and explain more variability in speech perception scores. Study Design Prospective case series. Methods Twenty-two adult CI recipients with varying degrees of low-frequency hearing had intracochlear ECochG measurements made immediately after CI electrode insertion using 110 dB SPL tone bursts. Tone bursts were centered at five octave-spaced frequencies between 125 and 2,000 Hz. Results There was no association between intracochlear ECochG response amplitudes and speech perception scores. But, the data suggest a mild to moderate relationship between preoperative behavioral audiometric testing and intraoperative ECochG threshold estimates. Conclusion Performing intracochlear ECochG is highly feasible and results in larger response amplitudes, but performing ECochG before, rather than after, CI insertion may provide a more accurate assessment of a patient's speech perception potential. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Dynamic Tracheoesophageal Prosthesis Length

xlomafota13 shared this article with you from Inoreader The Dynamic Tracheoesophageal Prosthesis Length Via Journal of Voice In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Un-sedated Office-Based Application of Blue Laser in Vocal Fold Lesions

xlomafota13 shared this article with you from Inoreader Un-sedated Office-Based Application of Blue Laser in Vocal Fold Lesions Via Journal of Voice Office-based laser procedures in laryngology have gained a lot of popularity in the last decade with the use of the KTP, PDL and Thulium lasers. Preliminary investigations currently report on the use of the 445 nm wavelength Blue laser for the treatment of various laryngeal pathologies, given its dual photoangiolytic and cutting properties. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined Endonasal Endoscopic and Sub-brow Orbitotomy Access to Manage a Lateral Extending Frontal Sinus Inverting Papilloma with Endo-orbital Invasion: A Case Report

xlomafota13 shared this article with you from Inoreader Combined Endonasal Endoscopic and Sub-brow Orbitotomy Access to Manage a Lateral Extending Frontal Sinus Inverting Papilloma with Endo-orbital Invasion: A Case Report Via Otolaryngology Indian Abstract Sinonasal inverting papilloma is a rare benign, locally aggressive tumour, arising from sinus and/or nasal fossa mucosa, with high recurrence rate, and risk of malignant transformation. This is a case of orbital invasive, lateral extending inverting papilloma approached via combined external and endoscopic surgery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Deafness after COVID-19?

xlomafota13 shared this article with you from Inoreader Deafness after COVID-19? Via hno HNO. 2021 May 21. doi: 10.1007/s00106-021-01041-0. Online ahead of print. ABSTRACT This article presents a case of sudden bilateral deafness in the context of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and resultant coronavirus disease 2019 (COVID-19). After treatment in the intensive care unit for acute respiratory distress syndrome and acute kidney failure, hearing ability had drastically changed. While hearing had been subjectively normal befo re the infection, deafness was now measured on the left and profound hearing loss on the right ear. The patient was treated with cochlea implants on the left and a hearing aid in the right ear. The hearing loss is most likely a complication of COVID-19. PMID:34019138 | DOI:10.1007/s00106-021-01041-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation

xlomafota13 shared this article with you from Inoreader Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation Via hno HNO. 2021 May 21. doi: 10.1007/s00106-021-00997-3. Online ahead of print. ABSTRACT Vestibular schwannomas (VS) are benign tumors that originate from the nerve sheath of one of the two vestibular nerves. VS can have a severe impact on everyday life of the patient and may lead to symptoms such as vertigo, hearing loss (e.g., as sudden deafness), deafness, and tinnitus. Treatment concepts include observational waiting with regular imaging control ("wait and scan"), radiotherapy , or surgical resection. Depending on the size of the tumor and status of functional hearing, the surgical approach may be retrosigmoidal, transtemporal, retrolabyrinthine, or translabyrinthine. The translabyrinthine approach always results in complete deafness due to opening of the bony labyrinth. If the nerve structure of the cochlear nerve is preserved, hearing rehabilitation with a cochlear implant (CI) may be successful. In this article the surgical technique for microsurgical resection of VS using a translabyrinthine approach with simultaneous cochlear implantation under intraoperative monitoring of the cochlear nerve by electrical stimulation is presented. PMID:34019139 | DOI:10.1007/s00106-021-00997-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Salvage laryngectomy after primary radio- and radiochemotherapy : A retrospective study

xlomafota13 shared this article with you from Inoreader Salvage laryngectomy after primary radio- and radiochemotherapy : A retrospective study Via hno HNO. 2021 May 21. doi: 10.1007/s00106-021-01030-3. Online ahead of print. ABSTRACT BACKGROUND: Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important therapeutic option in these cases. OBJECTIVE: The study assessed rates of recurrence and residual tumor as well as survival and complication rates after salvage laryngectomy at the authors' academic cancer center . MATERIALS AND METHODS: A retrospective examination of all patients receiving laryngectomy between 2001 and 2019 due to tumor residuals or recurrence after primary radio- and radiochemotherapy was conducted. RESULTS: A total of 33 salvage procedures were performed. Defect reconstruction was performed by free flap surgery in 30.3% (n = 10) and regional flap surgery in 15.2% (n = 5) . One patient received regional flap surgery and free flap surgery simultaneously. Overall survival after 1, 2, and 5 years was 68.7, 47.9, and 24.2%, and disease-free survival was 81.6, 47.8, and 24.2%, respectively, with 48.5% (n = 16) postoperative tumor recurrences overall. Disease-free survival was significantly shorter for tumor extension into or onto the hypopharynx (p = 0.041). Postoperatively, 72.7% of patients developed a pharyngocutaneous fistula, of which 24.2% required surgical treatment. The hospital stay was 28.0 ± 16.1 days. CONCLUSION: Salvage laryngectomy is associated with a high rate of treatable complications and high morbidity. Nevertheless, considering the advanced tumor stages treated, it allows for respectable oncological results. PMID:34019140 | DOI:10.1007/s00106-021-01030-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization?

xlomafota13 shared this article with you from Inoreader How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization? Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 21. doi: 10.1007/s00405-021-06862-x. Online ahead of print. ABSTRACT PURPOSE: For perennial inhalant allergens such as house dust mite (HDM), the German guideline on allergen-specific immunotherapy explicitly recommends provocation testing. This procedure is time-consuming, expensive, and potentially dangerous for the patient. Recently it has been discussed whether provocation tests are really necessary for diagnosing allergy to Dermatophagoides species. Thus, our study aimed to analyze the concordance between nasal provocation tests with Dermatophagoides species and anamnestic data. METHODS: We retrospectively analyzed the concordance between patients' histories including self-reported symptom scores and the results of provocation testing in 471 individuals with proven sensitization to Dermatophagoides species. RESULTS: 248 patients had a positive nasal provocation test (NPT) result to D ermatophagoides species and 223 individuals a negative NPT result. Patients allergic to HSM suffered significantly more often from atopic dermatitis (14% vs. 7%, p = 0.046) and more from asthma (20% vs. 19%, p = 0.851). Moreover, individuals with clinically silent sensitization complained less about nasal secretion (37% vs. 45%, p = 0.244) but significantly more about nasal dryness (46% vs. 34%, p = 0.046) whereas rates of nasal airway obstruction, ocular complaints and sleep quality were comparable in both groups. Allergic patients reported more often perennial (34% vs. 30%, p = 0.374) and location-dependent (39% vs. 31%, p = 0.090) symptoms. However, the discrepant prevalence of atopic dermatitis was the only statistically significant difference between both groups. CONCLUSION: Despite slight differences between both patient groups, clinical data are not sufficient to distinguish between silent sensitization and clinically relevant allergic rhinitis to HDM. Therefore, nasal provocation testing remains the gold standard for assessing clinical relevance in patients sensitized to Dermatophagoides species. PMID:34019148 | DOI:10.1007/s00405-021-06862-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.