Regional disease in head and neck cutaneous squamous cell carcinoma: the role of primary tumor characteristics and number of nodal metastases

xlomafota13 shared this article with you from Inoreader Regional disease in head and neck cutaneous squamous cell carcinoma: the role of primary tumor characteristics and number of nodal metastases 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 Jun 25. doi: 10.1007/s00405-021-06944-w. Online ahead of print. ABSTRACT PURPOSE: To identify potential risk factors impacting on overall survival (OS) of patients affected by lymph node metastasis from cutaneous squamous cell carcinoma (cSCC) of the head and neck (HN), with special emphasis on primary tumor characteristics and pattern of nodal recurrence (intraparotid and/or cervical). METHODS: A bi-institutional retrospective study on consecutive patients affected by cervical and/or intraparotid NM from HN cSCC and surgically treated with curative intent from May 2010 to January 2020 was conducted. OS was considered the outcome of interest. RESULTS: The study included 89 patients (M:F = 3.4:1; median age, 78 years; range, 22-99). Among the primary tumor characteristics, the most relevant prognostic factors were diameter ≥ 4 cm (hazard ratio [HR] = 2.56, p = 0.010) and depth of infiltratio n ≥ 6 mm (HR = 3.54, p = 0.027). Cervical NM was associated with worse OS (HR = 2.09, p = 0.016) compared to purely intraparotid NM (5-year OS: 60.9% vs. 28.1%, p = 0.014). At multivariable analysis, age, immunosuppression, pT3-T4 categories and a high burden of nodal disease (> 2 NM) confirmed to be independent risk factors, whereas adjuvant radiotherapy was independently associated with better outcome. CONCLUSION: This study confirms the association of several independent prognosticators related to the patient, primary tumor, and nodal burden status. Patients with cervical NM should be considered at risk for harboring a higher number of metastatic lymph nodes. PMID:34170382 | DOI:10.1007/s00405-021-06944-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Epley’s Manoeuvre: A Single Line Treatment for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo

xlomafota13 shared this article with you from Inoreader Epley's Manoeuvre: A Single Line Treatment for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo Via Otolaryngology Indian Abstract Benign Paroxysmal Positional Vertigo (BPPV) is the commonest cause of peripheral vertigo. Displaced free floating otoconia in the semicircular canals are responsible for brief attacks of vertigo and nystagmus. Epley's manoeuvre relocates these particles into the utricle. Here we studied the efficacy of Epley's manoeuvre in posterior semicircular canal BPPV without labyrinthine sedatives. 120 patients presented with positional vertigo were included in the study based on positive Dix- hallpike test from August 2018 to July 2019. These patients were treated with only the Epley's manoeuvre and followed up for 6 months. Patients who were previously on labyrinthine sedatives were advised to stop them and treated with only the Epley's manoeuvre. In our study of 120 patients, mean age was 43.5 yrs. Females (52.5%) were commonly affected. Left side posterior semicircular involvement was more than the right side. Epley's manoeuvre had 90% efficacy at 1s t week and 100% efficacy at 4th week. Duration of vertigo had significant association (p < 0.01) with the number of sessions required. There was significant improvement in the duration of vertigo attack (p < 0.0001) and frequency of attack (p < 0.0001) before and after the manoeuvre. Epley's manoeuvre lead to significant (p < 0.001) improvement in the quality of life of affected patients measured by DHI scoring. In our 6 months follow up, 10 recurrences occurred having significant (p < 0.01) association with the duration of vertigo attack. Only Epley's manoeuvre without any labyrinthine sedatives is an effective treatment for posterior semicircular canal BPPV patients. It also improves the quality of life of affected patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prolonged ulcerative laryngitis

xlomafota13 shared this article with you from Inoreader Prolonged ulcerative laryngitis Via hno HNO. 2021 Jun 25. doi: 10.1007/s00106-021-01079-0. Online ahead of print. ABSTRACT BACKGROUND: Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician. OBJECTIVES: Presentation of the current database to provide an overview of the etiology, progress and treatment for every day clinical practice. METHODS: Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature. RESULTS: The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided. CONCLUSIONS: The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed. PMID:34170335 | DOI:10.1007/s00106-021-01079-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Definition and illustration of the different types of nasal cycle using long-term rhinometry

xlomafota13 shared this article with you from Inoreader Definition and illustration of the different types of nasal cycle using long-term rhinometry Via hno HNO. 2021 Jun 25. doi: 10.1007/s00106-021-01078-1. Online ahead of print. ABSTRACT BACKGROUND: A reciprocal swelling of the nasal mucosa is often referred to as the classical nasal cycle; however, reports in the literature suggest a more complex picture. Most of the research on the nasal cycle is based on individual measurements. The long-term rhinometry (LRM) now makes it possible to continuously examine the cyclic swelling of the nasal mucosa over 24 h. The aim of this stu dy was therefore to evaluate the nasal cycle with LRM over 24 h. MATERIAL AND METHODS: An LRM was performed in 55 rhinologically healthy subjects over 24 h using the portable measuring system Rhino-Move© (Happersberger Otopront; Hohenstein, Germany). RESULTS: In addition to the expected strictly reciprocal swelling of the nasal mucosa in the sense of the classical nasal cycle, the following cycle types were detected: in-concert type with simultaneous rise and drop of the air flow on both sides of the nose, the one-sided type with significant congestion and decongestion of the mucous membrane only on one side and no detectable changes on the other side of the nose and the non-cycle type without any change in airflow on both sides. Most subjects showed a complex picture with multiple cycle types within the 24 h measurement (mixed nasal cycle). The types often differed during the day and night. CONCLUSION: This study confirms the assumption that the nasal cycle measu red over 24 h is much more complex than often described in the literature. Most subjects showed several of the 5 cycle types described here. The LRM has proven to be an easy to- use and reliable measurement method. The relationship between cycle type and physical activity as well as other factors remains to be investigated. PMID:34170336 | DOI:10.1007/s00106-021-01078-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Critical aspects of the transmandibular approach to the oral cavity and oropharynx

xlomafota13 shared this article with you from Inoreader Critical aspects of the transmandibular approach to the oral cavity and oropharynx Via hno HNO. 2021 Jun 25. doi: 10.1007/s00106-021-01073-6. Online ahead of print. ABSTRACT BACKGROUND: In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise. OBJECTIVE: The results and complications of the median mandibulotomy will be presented based on data co llected from our own patient collective. MATERIALS AND METHODS: A total of 21 patients who had undergone a median mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over a period from 01 January 2010 to 31 December 2020. The patient files were retrospectively evaluated. RESULTS: A stair-step median mandibulotomy was performed in all 21 patients. Reconstruction was performed using a 2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8 months. In all, 7 patients (33%) had a recurrence at the time of surgery; 5 patients (24%) had already undergone pre-radiation. Furthermore, 18 patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0 of 21 cases. A salivary fistula (4.7%) was observed in 1 patient. Trismus was found in 4 (19%) cases during follow-up. Osteoradionecrosis was found in 2 (9.5%) of 21 cases. Cosmetic defi cits were not observed. CONCLUSION: Our results show that the stair-step median mandibulotomy in combination with a 2.8 mm thick reconstruction plate and bicortical locking screws leads to a stable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur. PMID:34170338 | DOI:10.1007/s00106-021-01073-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Continuing education and training-where does it begin and where does it end?

xlomafota13 shared this article with you from Inoreader Continuing education and training-where does it begin and where does it end? Via hno HNO. 2021 Jul;69(7):531-533. doi: 10.1007/s00106-021-01067-4. Epub 2021 Jun 25. NO ABSTRACT PMID:34170373 | DOI:10.1007/s00106-021-01067-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic factors for overall survival in oropharyngeal carcinoma depending on HPV status

xlomafota13 shared this article with you from Inoreader Prognostic factors for overall survival in oropharyngeal carcinoma depending on HPV status Via hno HNO. 2021 Jun 25. doi: 10.1007/s00106-021-01076-3. Online ahead of print. ABSTRACT BACKGROUND: Due to their differing carcinogenesis, prognosis and clinical manifestation, human papillomavirus (HPV)-associated and HPV-negative oropharyngeal squamous cell carcinoma (OSCC) have been classified separately as two entities since the 8th edition of the AJCC/UICC TNM staging system (UICC 8). MATERIALS AND METHODS: A total of 524 patients with OSCC treated between 2000 and 201 6 at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital Muenster, Germany, were examined for the detection of HPV type 16-specific DNA (HPV16-DNA), nicotine and alcohol consumption and the influence of therapy on overall survival (OS). RESULTS: There was a significant increase in the annual prevalence of HPV16-DNA-positive OSCC from 40% (n = 12/30) in 2000 to 46% (n = 18/39) in 2016 (p = 0.025, β = 0.539). Of the HPV16-DNA-positive OSCC, 89% (n = 212) were downgraded on the basis of UICC 8 compared to UICC 7. In the overall collective, frequent alcohol and nicotine (≥ 10 pack years) consumption showed a significant negative influence on OS (p = 0.004 and p = 0.009, respectively). Frequent alcohol consumption was also prognostically relevant in the HPV16-DNA-negative group (p = 0.049). In the HPV16-DNA-positive group, the prognosis for OS according to UICC 8 showed no statistically significant difference between stages I and II (p = 0,481 ), or between III and IV (p = 0.439). CONCLUSIONS: The current UICC 8 improves the prognostic stratification of OSCC due to the separation of HPV-positive and HPV-negative tumors in comparison to UICC 7. However, the prognostic significance of UICC 8 for HPV-associated OSCC is still insufficient. In the future, alcohol and nicotine consumption could influence the UICC classification in order to further improve prognostic significance. PMID:34170339 | DOI:10.1007/s00106-021-01076-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'Ear rage': misophonia : Review and current state of knowledge

xlomafota13 shared this article with you from Inoreader "Ear rage": misophonia : Review and current state of knowledge Via hno HNO. 2021 Jun 25. doi: 10.1007/s00106-021-01072-7. Online ahead of print. ABSTRACT Misophonia is a devastating disorder. It is known as an affective sound-processing disorder characterized by the experience of strong negative emotions (e.g., anger, distress) in response to human sounds such as eating/swallowing/breathing. Other sounds produced by humans but not directly by human bodies can also be misophonic triggers (e.g. pen clicking) or environmental sounds (animal sounds /sounds of machines). The type of aversive triggers is individual. The reaction to trigger sounds can depend on many factors, such as assessment of the sound, personal experience, social context or psychological profile. However, there is currently no consensus in defining misophonia. Misophonia is also not yet classified by any official diagnostic system, although it seems to be a separate disorder. There are also associations with other disorders such as activity disorders, tinnitus, hyperacusis, and autism spectrum disorders. In 2013, the first definition criteria were published for the diagnosis of misophonia. Specifically, fMRI showed abnormal activation of the anterior insular cortex (AIC) and other brain areas responsible for the processing and regulation of emotions. To date, no randomized controlled trials evaluating treatments have been published. The use of cognitive and behavioral interventions have been reported as well as external sound systems and sound masking system s as known in the tinnitus retraining therapy. Sufferers try to minimize the trigger sounds by wearing ear plugs or music headphones. Otolaryngologists may also encounter patients with symptoms of misophonia, e.g., when hearing screening is requested or advice should be given on different therapeutic options. This report provides an overview of the current state of knowledge in misophonia and its diagnosis and treatment. PMID:34170337 | DOI:10.1007/s00106-021-01072-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Renal Pelvis Opacification on Postmyelography Computed Tomography as an Indicator for Cerebrospinal Fluid Loss in Spontaneous Intracranial Hypotension

xlomafota13 shared this article with you from Inoreader Renal Pelvis Opacification on Postmyelography Computed Tomography as an Indicator for Cerebrospinal Fluid Loss in Spontaneous Intracranial Hypotension Via leak of cerebrospinal fluid Clin Neuroradiol. 2021 Jun 25. doi: 10.1007/s00062-021-01042-0. Online ahead of print. ABSTRACT PURPOSE: To assess early renal pelvis opacification on postmyelography computed tomography (CT) as a marker for cerebrospinal fluid (CSF) loss in patients with spontaneous intracranial hypotension (SIH). METHODS: The SIH patients referred to our hospital between January 2012 and May 2018 were retrospectively reviewed and divided into 2 groups based on the presence of spinal longitudinal extrathecal CSF collection (SLEC): (1) SLEC(+) with, and (2) SLEC(-) without proof of SLEC on multimodal imaging. Non-SIH patients (n = 20) undergoing CT myelography served as controls. The renal pelvis density on postmyelography CT was measured in all patients. Mean difference in renal pelvis density between the groups was calculated. RESULTS: In total, 111 SIH patients (mean age 48 ± 13 years; 60% female) were included, 71 (64%) SLEC(+) and 40 (36%) S LEC(-). The adjusted renal pelvis density in the SLEC(+), SLEC(-), and the non-SIH group was 108 Hounsfield unit (HU), 83 HU, and 32 HU, respectively, resulting in a significant difference between SLEC(+) vs. control group 1 (75 HU, p < 0.001), SLEC(-) vs. control group 1 (50 HU, p < 0.001), and a tendency for higher density in SLEC(+) than SLEC(-) (25 HU, p = 0.16). CONCLUSION: Increased renal pelvis opacification on postmyelography CT was observed in SIH patients, even in the absence of a CSF leak or a CSF venous fistula, when compared to non-SIH patients. Although the provenance of early renal opacification in SLEC (-) SIH patients remains unclear, our results suggest that it may be a surrogate for increased spinal CSF resorption via spinal arachnoid granulations and along spinal nerve sheaths occult to direct imaging. PMID:34170368 | DOI:10.1007/s00062-021-01042-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Images: Unilateral rhinorrhea in a patient starting autotitrating positive airway pressure therapy for obstructive sleep apnea

xlomafota13 shared this article with you from Inoreader Images: Unilateral rhinorrhea in a patient starting autotitrating positive airway pressure therapy for obstructive sleep apnea Via leak of cerebrospinal fluid J Clin Sleep Med. 2021 Jun 22. doi: 10.5664/jcsm.9470. Online ahead of print. ABSTRACT We rerpot a case of a 65-year-old obese female who developed a unilateral nasal cerebrospinal fluid (CSF) leak after starting autotitrating positive airway pressure therapy for obstructive sleep apnea. The CSF leak was confirmed by beta-2 transferrin testing of the nasal fluid, as well as by identification of the leak through the anterior cribriform plate after administration of intrathecal fluorescein. The CSF leak was successfully repaired endoscopically, and autotitrating positive airway pressure was reinitiated one month postoperatively. PMID:34170244 | DOI:10.5664/jcsm.9470 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Proceedings of the Canadian Thyroid Cancer Active Surveillance Study Group 2019 national investigator meeting

xlomafota13 shared this article with you from Inoreader Proceedings of the Canadian Thyroid Cancer Active Surveillance Study Group 2019 national investigator meeting Via Journal of Otolaryngology - Head & Neck Surgery Active surveillance (AS) in the management of small, low risk papillary thyroid cancer (PTC) as an alternative option to thyroidectomy, is an area of active research. A national Canadian study is proposed to e... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.