Clinical Otolaryngology 2020-09-13

The role of upper GI flexible endoscopy in management of large pharyngeal pouches

\nSamyukta Ravisankar, \nSomayyeh Shahsavari, \nJaiganesh Manickavasagam, \nSamit Majumdar, \nPradeep Patil\n

Publicatie 13-09-2020


Pharyngeal pouch operations are commonly performed in ENT. However, some pouches can be large, with poor access making surgical management more complex.

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Efficacy of argon‐helium cryoablation andits effects on immune function of patients with neck malignant tumors

\nZheng Zheng, \nYingchun Zhao, \nYonghui An, \nNa Li, \nChangwen Bo, \nWenhua Ma, \nYing Guo, \nChangpeng Zou, \nBo Tian, \nSujing Zhang\n

Publicatie 13-09-2020


AbstractObjectivesOur study aimedto investigate the clinical efficacy of argon‐helium cryoablation and its effects on the immune function of patients with neck malignant tumors.DesignRetrospective study.SettingSingle‐institution academic tertiary care center.MethodsTotally 180 patients harboring head and neck malignant tumors were divided intothe the argon‐helium cryoablation group(n=150) and the radiotherapy group(n=50). The efficacy of the two groups was compared and the immune function was observed.ResultsThe short‐term clinical effect of the argon‐helium cryoablation group was significantly higher than that of the radiotherapy group(P<0.05). After treatment, the CD3+, CD4+, CD8+ and CD4+/CD8+ of the argon‐helium cryoablation group were significantly better than those of the radiotherapy group(P < 0.001). The results of TNF‐ α, IL‐1 β and CRP in the argon‐helium cryoablation group was significantly better than that in the radiotherapy group(P < 0.001).ConclusionArgon‐helium cryoablation could effectively improve the immune function, 5‐year survival rate and local remission rate.

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A low fidelity Peritonsillar Abscess Drainage Simulator – Our experience of feedback from 117 trainees

\nDorota Alicja Chudek, \nI Wilson, \nE Hogg, \nH Emerson, \nE Heward, \nD Yang, \nD Selwyn, \nAS Lau\n

Publicatie 13-09-2020


AbstractPeritonsillar abscesses are usually managed by junior and non‐specialist medical staff, therefore there is an increasing need to provide them with practical training.Simulation is known to be a valuable tool in medical education; low‐fidelity simulation models can introduce learners to new technical skills while remaining low‐cost and logistically easy to deliver.We have developed a low‐cost peritonsillar abscess drainage simulator tested by 117 junior doctors.Learners rated this model highly for developing skills specific to peritonsillar abscess drainage, such as headlight usage and depth perception; it also increased their confidence overall.

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Identification of putative laryngeal and pharyngeal lichen planus lesions: An endoscopic preliminary evaluation in 16 patients

"\nAntonio M. Bulfamante, \nUmberto DAgostino Fiorenza, \nPaolo Castellarin, \nCarlotta Pipolo, \nGiancarlo Cacioppo, \nGiovanni Felisati, \nAlberto M. Saibene\n"

Publicatie 09-09-2020


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Lithuanian version of nasolacrimal duct obstruction symptom scoring questionnaire. Cross‐cultural adaptation and validation. Short‐ and long‐term results

\nTomas Jakštas, \nTomas Balsevičius, \nSaulius Vaitkus, \nEvaldas Padervinskis\n

Publicatie 07-09-2020


AbstractObjectivesThe objective of this study was to perform translation, cross‐cultural adaptation and validation of the Lithuanian version of specific nasolacrimal duct obstruction symptom scoring (NLDO‐SS) questionnaire and to evaluate short‐ and long‐term results of endoscopic endonasal dacryocystorhinostomy (EN‐DCRS) procedure.Design, Setting, ParticipantsPermission for questionnaire translation, cross‐cultural adaptation and validation was obtained from the authors of the original questionnaire. Translation, validation and cross‐cultural adaptation were carried out according to generally accepted methodology. Validation study of the Lithuanian version of NLDO‐SS (L‐NLDO‐SS) was performed, and short‐ and long‐term results of EN‐DCRS procedure were evaluated according to symptoms. In total, 44 patients were evaluated 2 weeks before the surgical intervention, a day before the surgery and 41 patients 2 months after the surgery, and again 10 months later.Main outcome measuresWe analysed the internal consistency and test‐retest reliability of the L‐NLDO‐SS questionnaire. Cronbachs alpha was used to represent and evaluate internal consistency for ordinal responses. Validity was assessed by comparing scores between a control group of volunteers without NLDO and the NLDO group using Mann‐Whitney test. To test the limiting score on which the sensitivity and specificity curves cross in identifying patients with NLDO, receiver operating characteristic (ROC) curve analysis was used. The pre‐ and post‐operative scores were compared using the paired t‐test.ResultsThe results showed an acceptable internal consistency of L‐NLDO‐SS questionnaire, with Cronbachs alpha—.73 in the initial test group and .71 in the retest group. Pearsons correlation coefficient was .94 (P < .001), revealing good correlation between the initial scores and the retest scores. Our sample of healthy individuals had a mean L‐NLDO‐SS score of 11.42 (±12.69) points, and patients being scheduled for EN‐DCRS had a mean L‐NLDO‐SS score of 27.45 (±9.81) points. Post‐operatively mean L‐NLDO‐SS scores improved from 27.45 (±9.81) points to 4.45 (±6.29) points in the short term and to 5.83 (±4.17) in the long term, demonstrating the statistically significant responsiveness of the instrument over both timescales.ConclusionsLithuanian version of NLDO‐SS questionnaire is a valid instrument for assessing patients with NLDO in the Lithuanian population. It demonstrated good internal consistency, reproducibility, validity and responsiveness.

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Adults with inflammatory bowel disease are at a greater risk of developing chronic rhinosinusitis: a nationwide population‐based study

\nYu‐Shuna Lin, \nCheng Li Lin, \nChia‐Hung Kao\n

Publicatie 04-09-2020


AbstractBackgroundBoth inflammatory bowel disease (IBD) and chronic rhinosinusitis (CRS) are characterized by dysregulated immune responses. Though previous studies have demonstrated the coexistence of IBD and CRS, investigations of their association using large sets of epidemiologic data are lacking.MethodsWe examined IBD and the subsequent risk of CRS in a nationwide setting. For January 1, 2000 to December 31, 2010, we identified in the National Health Insurance Dataset of Taiwan a total of 8,313 patients over the age of 20 years with IBD. We randomly extracted 33,252 cases without IBD to create a comparison group matching patients by age, sex, and index year. Cumulative incidences were obtained using the Kaplan–Meier method, and we calculated risk estimates for the development of CRS using the Cox proportional hazards model.ResultsIn 295,007 person‐years, we identified 521 (1.25%) cases of IBD. The IBD cohort had a 1.26‐fold (95% confidence interval CI, 1.17–1.35) greater risk of developing CRS than the comparison group; for ulcerative colitis it was 1.73 fold (95% CI, 1.48‐2.05) and for Crohns disease was 1.20‐fold (95% CI = 1.11‐1.29). Subsequent analysis stratified by age revealed that the risk was highest among the population with IBD aged 50 to 64 years (adjusted hazard ratio = 1.37; 95% CI, 1.18‐1.59). A follow‐up‐specific analysis demonstrated that the risk appeared to be highest with a follow‐up duration of less than 2 years.ConclusionThe present analysis indicates that personal history of IBD, especially the phenotype ulcerative colitis, is associated with increased risk of subsequent CRS.

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Video laryngoscope‐guided (GlideScope ®) injection of botulinum toxin in laryngectomy patients with limited neck extension

\nYadsan Devabalan, \nAkshat Malik, \nMargaret Coffey, \nPeter Clarke\n

Publicatie 02-09-2020


AbstractBotox injections are utilised to improve pharyngoesophageal segment tonicity to improve speech and swallowing outcomesVideo‐laryngoscope guided injection of Botox into the neopharynx is a easy and safe techniqueIt is particularly useful for post‐radiotherapy patients with limited neck extension where rigid direct pharyngoscopy is impossible

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Using post‐operative trend in C‐reactive protein to predict fistula in neopharyngeal repairs following laryngectomy and pharyngectomy surgery in fifty‐five patients

\nEdwin Halliday, \nAjith George\n

Publicatie 02-09-2020


AbstractPharyngocutaneous fistula is a major post‐operative complication after laryngectomy and pharyngectomy surgery with potentially devastating consequences.The aim of the current study was to determine if post‐operative trend in C‐reactive protein (CRP) after laryngectomy and pharyngectomy surgery can predict pharyngocutaneous fistula.A screening test to identify those patients who healed and would not go on to develop a pharyngocutaneous fistula was defined as a 35% reduction from maximum CRP to the CRP recorded at post‐operative day five.This test was found to predict a favourable post‐operative outcome with no fistula with a sensitivity 84%, specificity 88%, positive predictive value 97% and negative predictive value 50%.The high positive predictive value for this test may allow early oral intake in these patients, resulting in faster recovery times and reduced hospital stays.

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Impact of bile acids on the severity of Laryngo‐Pharyngeal reflux

\nE. De Corso, \nS. Baroni, \nG. Salonna, \nM. Marchese, \nM. Graziadio, \nG. Di Cintio, \nG. Paludetti, \nG. Costamagna, \nJ. Galli\n

Publicatie 02-09-2020


AbstractObjectivesthe primary endpoint of this study was to evaluate the impact of bile acids on severity of laryngo‐pharyngeal reflux (LPR) and the possible correlation with esophagitis and upper airway malignancies. The second endpoint was to evaluate if salivary bile acids and molecules other than pepsin might serve as diagnostic biomarkers of LPR.Designobservational prospective comparative study.SettingOtorhinolaryngology unit of a tertiary hospital.Participants62 consecutive adult outpatients suspected of LPR.Main outcome measuresbile acids, bilirubin, and pepsinogen I‐II were measured in saliva. Patients underwent pH‐metry and based on the results of bile acids were subdivided as acid, mixed, and alkaline LPR.Resultssignificantly higher Reflux Findings Score (RFS) and Reflux Symptoms Index (RSI) were seen in patients with alkaline and mixed LPR compared to acid LPR. Salivary bile acids >1 umol/L seems to be a reliable indicator of the severity of LPR. Compared to those without, patients with esophagitis or a history of upper airway malignancy have high concentrations of bile acids in saliva. Among the molecules studied, bile acids were the most suitable for diagnosis of LPR, with a sensitivity of 86% and a positive predictive value of 80.7%.Conclusionsour data suggest that high concentrations of bile acids are associated with higher values of RSI and RFS in LPR as well as a higher risk of esophagitis and history of upper airway malignancies. We finally observed that bile acids provided the best biometric parameters for diagnosis of LPR among the molecules tested.

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Analysis of reflux as the etiology of laryngeal dysplasia progression through a matched case‐control study

\nWei Gu, \nYan‐Yan Niu, \nWen‐Ze Wang, \nZhi‐Yong Liang, \nXiao‐Feng Jin, \nHong Huo, \nJian Wang\n

Publicatie 01-09-2020


AbstractObjectivesLaryngeal dysplasia (LD) is a precancerous lesion of the larynx. In this study, the laryngeal tissue of patients with laryngeal dysplasia was taken as the research object, and the etiology of reflux was analyzed.MethodPatients with laryngeal dysplasia after surgery were selected as our subjects. The levels of pepsin, enterokinase, and bilirubin in laryngeal tissue samples of the two groups were detected by immunohistochemical method.ResultsThe OR values (95% CI) of pepsin, enterokinase and bilirubin were 0.67 (0.19‐2.36), 0.80 (0.22‐2.98) and 1.33 (0.30‐5.96), respectively, in the univariate analysis. Besides, in the multivariate analysis, the OR values (95% CI) of pepsin, enterokinase, and bilirubin were 0.57 (0.14‐2.30), 0.73 (0.18‐2.92) and 1.40 (0.30‐6.53), respectively.ConclusionLarger sample size should be applied to prospective studies on whether reflux is a risk factor for laryngeal cancer.

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Pathognomonic ultrasonic images of congenital pyriform sinus fistula in Children

\nChe‐Yi Lin, \nTzu‐Yu Hsiao, \nWei‐Chung Hsu\n

Publicatie 31-08-2020


AbstractHead and neck ultrasound can be used as a non‐invasive image modality for the diagnosis of congenital pyriform sinus fistula (CPSF) in children.The pathognomonic ultrasonic images of CPSFs include a hypoechoic fistulous tract by the perithyroid or trans‐thyroid route, a hyperechoic gas‐line within an inflammatory mass or cystic lesion during the Valsalva maneuver or swallowing action, and thyroiditis with increasing vascular flow in the ipsilateral thyroid lobe.The diagnosis of CPSF depends on the clinician’s awareness of the condition and should be confirmed by endoscopic findings. No imaging modalities can confirm CPSF diagnosis with 100% accuracy.With real‐time guidance, head and neck ultrasonography can enable minimally invasive tissue sampling for the diagnosis of CPSF, and can be used to monitor the outcome of subsequent treatment.We consider head and neck ultrasonography to be superior to other imaging modalities as a first‐line imaging tool for the pediatric population.

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Otorhinolaryngology litigation in England: 727 clinical negligence cases against the NHS

\nAnnakan Victor Navaratnam, \nAhmad Hariri, \nCherrie Ho, \nJohn Machin, \nTim Briggs, \nAndrew Marshall\n

Publicatie 31-08-2020


AbstractIntroductionLitigation against the National Health Service (NHS) in England is rising, costing £2.4 billion in 2018/19. The aim of this study was to determine the incidence and characteristics of otorhinolaryngology clinical negligence claims in England.MethodsA retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to otorhinolaryngology between April 2013 and April 2018. Analysis was performed using information for cause, patient injury and claim cost. Where claim information was adequately detailed, the authors categorised claims by subspecialty, diagnosis and surgery.ResultsA total number of 727 claims were identified with an estimated potential cost of £108 million. Out of these, 463 were closed claims. Including open claim reserves, the mean cost of a claim was £148,923. Head and neck surgery was the subspecialty with the highest number of claims (n=313, 43%) and highest cost (£51.5 million) followed by otology (n=171, £24.5 million) and rhinology (n=171, £13.6million). Over half of claims were associated with an operation (n=429, 59%) where mastoid surgery (n=46) and endoscopic sinus surgery (n=46) were equally associated with the greatest number of claims. The most frequent causes for litigation included failure or delay to diagnose (n=178, 25%) failure or delay to treat (n=136, 19%), intra‐operative complications (n=130, 18%) and failure of the consent process (n=107, 15%).DiscussionClinical negligence claims in otorhinolaryngology are related to several different components of patient management and are not limited to post‐operative complications. This study highlights the importance of robust pathways in outpatient diagnostics and the consenting process, especially in the high‐risk speciality of head and neck surgery, in order to deliver better patient care and reduce the impact of litigation.

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HPV genotype is prognosticator for recurrence of respiratory papillomatosis in children

\nRodrigo L. Nogueira, \nDaniel S. Küpper, \nCaroline M. do Bonfim, \nDavi C. Aragon, \nThiago A. Damico, \nCarolina S. Miura, \nIvna M Passos, \nMaurício L. Nogueira, \nPaula Rahal, \nFabiana C.P. Valera\n

Publicatie 31-08-2020


ABSTRACTObjectivesThis study aimed to compare the prognosis according to age, genotype or HPV variant in patients with recurrent respiratory papillomatosis (RRP).DesignNon‐concurrent cohort.Participants41 patients with RRP.SettingTertiary referral hospital.Main outcome measuresDisease severity was defined by the number of surgeries performed, and Derkay score at surgeries, obtained from medical records. HPV was detected and genotyped, and HPV‐6 variants were also assessed.Results15 (36.58%) individuals belonged tothe juvenile RRP group (JoRRP, less than 18 years), while 26 patients (63.41%) were allocated at the adult group (AoRRP, equal or more than 18 years). JoRRPpatients needed, in average, a higher number of surgeries to control the disease than AoRRP patients (mean difference: 3.36). Also, JoRRPpatients showeda higher Derkay score at each surgery (mean difference: 3.76). There was no significant difference in the number of surgeries when we compared patients infected with HPV‐6 or HPV‐11, neither in accordance to HPV‐6 variants.Patients with HPV‐11 presented a higher mean Derkay score at surgery than those with HPV‐6 (mean difference: 4.39); when co‐variated by age, we observed that this difference occurred only among JoRRP patients (mean difference: 6.15).ConclusionsAge‐onsetof RRPhasanimportant impact on number of surgeries to control disease. Patients with JoRRP and HPV‐11 tend to present worse Derkay score at each surgery. HPV genotype among adults and HPV‐6 variants had no impact on the outcome of the disease.

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Three‐dimensional printing to compare endoscopic endonasal surgical approaches: a technical note

\nValentin Favier, \nYaser Najaf, \nArnaud Damecourt, \nGérard Subsol, \nGuillaume Captier, \nJulien Boetto, \nLouis Crampette\n

Publicatie 31-08-2020


AbstractChoosing the best approach for selected pathologies is always source of debates and controversies, whatever the surgical speciality. In endoscopic endonasal surgery (EES), most of surgical series have compared their outcomes with conventional procedures to assess their safety and efficacy.However, there are few objective ways to compare the technical advantages of one approach versus another.Nowadays, it is possible to generate surgical models of skull base anatomy in several identical samples thanks to the three‐dimensional (3D) printers1. In this study, authors present an objective method to comparethe operative field provided by different EES techniques, taking the example of transsphenoidal surgery.

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Olfactory changes after endoscopic sinus surgery for chronic rhinosinusitis: a meta‐analysis

\nRui Zhao, \nKai Chen, \nYuedi Tang\n

Publicatie 31-08-2020


AbstractBackgroundEndoscopic sinus surgery (ESS) is an important treatment modality for chronic rhinosinusitis (CRS). However, its effect on olfaction remains controversial.Objective of reviewTo assess the olfactory impact of ESS in patients with CRSType of reviewA meta‐analysisSearch strategyA systematic literature search in the PubMed, EMBASE, and Cochrane Library databases was conducted to identify studies that assessed change in olfaction after ESS in patients with CRS.Search terms were related to paranasal sinus diseases, smell, and endoscopy.Evaluation MethodThe extracted data included authors, publication year, study type, age, sex, diagnostic criteria, surgical mode, sample size, follow‐up time, olfaction measurement tool, and outcome. We analysed the olfactory changes as continuous variables.ResultsThirty‐five studies including 3164 patients with CRS were eligible for the meta‐analysis. Among patients havingCRSwith nasal polyps, olfactory dysfunction improved, as assessed bythe Sniffin’ Sticks total score (P =0.000), Sniffin’Sticks discrimination score (P=0.023), Sniffin’Sticks identification score (P=0.005), University of Pennsylvania Smell Identification Test (P=0.046), and Visual Analogue Scale (P=0.000). However,the threshold score of the Sniffin’ Sticks test did not improve significantly (P=0.361). Olfactory dysfunctiondid not improve in patients having CRS without nasal polypsaccording tothe University of Pennsylvania Smell Identification Test(P=0.404). In non‐classified CRS patients, improvement in olfactory dysfunction was observed according tothe University of Pennsylvania Smell Identification Test (P=0.000), Visual Analogue Scale (P=0.001), and Questionnaire of Olfactory Disorders‐Negative Statements (P=0.001). However, there were no significant improvements according tothe Brief Smell Identification Test (P=0.325), Sniffin’ Sticks threshold score (P=0.160), and Sniffin’ Sticks identification score (P=0.079).ConclusionESS may be beneficial for improvement in olfactory conditions in patients with CRS.Further thorough and comprehensive studies need to be conducted.

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Management of new onset loss of sense of smell during the COVID‐19 pandemic ‐ BRS Consensus Guidelines

\nClaire Hopkins, \nMikkel Alanin, \nCarl Philpott, \nPhil Harries, \nKatherine Whitcroft, \nAli Qureishi, \nShahram Anari, \nYujay Ramakrishnan, \nAnshul Sama, \nElgan Davies\n

Publicatie 27-08-2020


AbstractObjectivesThe primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smellduring the COVID‐19 pandemicDesignAfter undertaking a literature review, we used the RAND/UCLA methodology with a multi‐step process to reach consensus about treatment options, onward referral andimaging.Setting and participantsAn expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists.Main outcome measuresThe panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID‐19 pandemic.Using a 9‐point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean.ResultsConsensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A Drops. Alpha lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made.ConclusionThis study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID‐19 related loss of sense of smell. The guideline may evolve as our experience of COVID‐19 develops.

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Manuka honey versus saline sinus irrigation in the treatment of cystic fibrosis‐associated chronic rhinosinusitis: A randomized pilot trial

\nVictoria S. Lee, \nIan M. Humphreys, \nPatricia L. Purcell, \nGreg E. Davis\n

Publicatie 27-08-2020


AbstractObjectivesManuka honey attacks biofilms, which contribute to bacterial persistence in cystic fibrosis sinusitis. The primary objective was to determine feasibility of investigating manuka honey as an irrigation treatment for cystic fibrosis sinusitis and secondarily to assess the treatment’s preliminary effectiveness.DesignProspective, single‐blinded (clinician only), randomized, parallel two‐armpilot trial.SettingTertiary rhinology clinic.ParticipantsSubjects had recalcitrantcystic fibrosis sinusitis and previous sinus surgery. They received manuka honey or saline sinus irrigations twice daily for 30 days.Main Outcome MeasuresMain outcomes were recruitment/retention rates andtolerability. Preliminary effectivenesswas assessed based onquality of life Sino‐Nasal Outcome Test‐22and Lund‐Kennedy endoscopic change scores and post‐treatment culture negativity.ResultsOver 10 months, 13 subjects were enrolled, and 77% (10/13) were included in the analysis. Manuka honey irrigations were well‐tolerated.The quality of lifechange score was clinically significant for manuka honey (‐9 ‐14,‐6) but not saline (‐5 ‐9,‐1), although the differencewas not statistically significant (p=0.29). Lund‐Kennedy endoscopic change score was significantly better for manuka honey (‐3 ‐5,‐3) versussaline (0 0,0) (p=0.006). There was no difference in post‐treatment culture negativity between manuka honey (1/5, 20%) and saline (0/5, 0%) (p=1.00).ConclusionsManuka honey irrigations were well tolerated, and retention rates were high.Preliminary data showed thatmanuka honey achieved a clinically important difference in quality of life score anda significantly better endoscopic outcome. Microbiological controlwas difficult to achieve. A future definitive trial would require multi‐institutional recruitment.

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New findings in a retrospective study on the efficacy of precision sound therapy of 156 tinnitus: “Drift” of tinnitus sites

\nPiao Xu, \nQiongping Lin, \nDafei Li, \nJingya Yang, \nHaiyan Zhao, \nShanshan Zhang, \nGuangyong Tian\n

Publicatie 25-08-2020


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Expiratory airflow obstruction due to tracheostomy tube: A spirometric study in 50 patients

\nJose Antonio Sanchez‐Guerrero, \nJoanne Guerlain, \nMaria Àngels Cebrià i Iranzo, \nBertrand Baujat, \nJean Lacau St Guily, \nSophie Périé\n

Publicatie 20-08-2020


AbstractObjectivesTracheostomy is commonly used in intensive care units and in head and neck departments. Airway obstruction due to occluded cuffless tracheostomy tubes themselves remains unknown, although capping trials are commonly used before decannulation. The aim of this study was to evaluate the extent to which airway obstruction can be caused by occluded cuffless tubes in patients who underwent head and neck surgery.DesignProspective Research Outcome.SettingsUniversity teaching hospital.ParticipantsFifty patients requiring transient tracheostomy after head and neck surgery.Main outcome measuresA flow‐volume loop (FVL) through the mouth using a portable spirometer, with the occluded fenestrated cuffless tube, was measured before and immediately after decannulation, by obstructing the orifice of tracheostomy tube. The measurement of FVL recorded the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), forced expiratory flow at 50% of FVC, peak inspiratory flow (PIF) and forced inspiratory flow at 50% of FVC.ResultsA statistically significant difference between all spirometric parameters was found. Mean PEF and PIF, respectively, increased from 2.8 to 4.5 L/s (P < .0001) and 2.3 to 2.7 L/s (P < .01) before and after decannulation, with a strong positive correlation (r = 0.7; P < .05). A mean expiratory (34%) and inspiratory (9%) airflow reduction was observed due to cannula.ConclusionsOccluded cuffless tracheostomy tubes cause a dramatic airflow obstruction, mainly in the expiratory phase of FVL. This should be taken into account during capping trials.

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Metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma

\nRatko Prstačić, \nBoris Bumber, \nMarcel Marjanović Kavanagh, \nMartin Jurlina, \nIrena Ivković, \nDrago Prgomet\n

Publicatie 20-08-2020


AbstractObjectiveTo investigate possible metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma (PTC) with lateral neck metastasis and to determine the reliability of preoperative ultrasound‐guided fine‐needle aspiration biopsy (FNAB) as a method of detecting positive lymph nodes in sublevel IIa in comparison with the finding of definitive pathohistological analysis.DesignProspective study with patients with proven lateral neck metastases from PTC at the time of initial diagnosis. All patients had total thyroidectomy, central neck dissection (level VI) and selective neck dissection (levels II‐V). Potential predictive factors for the occurrence of metastasis in sublevel IIb were analysed. Sensitivity and specificity tests were used to determine the reliability of preoperative ultrasound‐guided FNAB. Patients were monitored for recurrence for at least ten years.SettingSingle‐centre study.ParticipantsStudy included 53 patients with proven lateral neck metastases from PTC at the time of initial diagnosis.ResultsPredictive factors for the occurrence of metastasis in sublevel IIb that have reached statistical significance are positive sublevel IIa, number of positive lymph nodes and positive levels IIa + III + IV + V. None of the patients who fulfilled predefined criterion for minimum 10‐year follow‐up had local recurrence in operated lateral levels.ConclusionHighest clinical significance has positivity of sublevel IIa. Therefore, it is necessary to prove or exclude metastasis in sublevel IIa, preoperatively or intraoperatively, to decide whether to include sublevel IIb in dissection. Preoperative ultrasound‐guided FNAB is a reliable method for the detection of positive lymph nodes in sublevel IIa in comparison with the definitive histopathological analysis.

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Side asymmetry in nasal resistance correlate with nasal obstruction severity in patients with septal deformities: Computational fluid dynamics study

\nNataša Janović, \nAleksandar Ćoćić, \nMirjana Stamenić, \nAleksa Janović, \nMarija Djurić\n

Publicatie 20-08-2020


AbstractObjectivesThe objective of this study was to investigate the relationship between side asymmetry in nasal resistance (NR) and severity of the nasal airway obstruction (NAO) in patients with different types of nasal septal deformity (NSD).DesignComputational fluid dynamics (CFD) study.SettingThe study was conducted in a tertiary medical centre.ParticipantsThe study included 232 patients, who were referred to the CT examination of the paranasal sinuses. Exclusion criteria were sinonasal and respiratory diseases that may interfere with the nasal obstruction. The presence and the type of NSD were recorded according to the Mladinas classification.Main outcome measuresThe presence and severity of NAO in each patient were assessed by NOSE questionnaire. Eight computational models of the nasal cavity were created from CT scans. Models represented seven Mladinas NSD types and a straight septum of a symptomless patient. CFD calculated airflow partitioning and NR for each nasal passage. Side differences in NR were calculated by the equation ∆NR = NRleft − NRright. The relationship between NOSE scores, airflow partitioning and side differences in NR was explored using Spearmans correlation analysis.ResultsMladinas types of NSD showed differences in airflow partitioning and the degree of side asymmetry in NR. A significant positive correlation was detected between side differences in NR and NOSE scores (R = .762, P = .028). A significant negative correlation was found between the per cent of unilateral airflow and NR (R = −.524, P = .037).ConclusionsOur results demonstrated that side asymmetry in NR could explain differences in NAO severity related to the NSD type.

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A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable?

\nStijn Weert, \nJohannes A. Rijken, \nFrancesca Plantone, \nElisabeth Bloemena, \nMarije R. Vergeer, \nBirgit I. Lissenberg‐ Witte, \nC. René Leemans\n

Publicatie 20-08-2020


AbstractBackgroundTransoral robotic surgery (TORS) is increasingly used in head and neck surgery and in carcinoma of unknown primary (CUP) origin specifically. Due to the rising incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC), there is a rationale for finding ways to de‐escalate treatment strategies. This review aims to test the hypothesis that TORS is a meaningful adjunct in the diagnostic (and therapeutic) pathway in CUP in head and neck.MethodsA structured search of the literature was performed with the search terms ‘TORS’ and ‘Carcinoma of Unknown Primary’.ResultsTwo hundred and seventy four cases of CUP in which TORS was used were identified for further analysis. Workup for CUP was comparable in all series with regard to physical examination, fine and/or gross needle examination of cervical nodes, fibre optic endoscopy, imaging and robot assisted mucosectomy of the base of tongue (BOT). Identification rate of the primary tumour was 72% on average (range 17%‐ 90%), and 55%‐ 96% were HPV positive. Clear margins were achieved in 60% (range 0%‐85%) of resected occult tumours. Complication rate of TORS BOT mucosectomy was low with mainly grade I‐III sequelae according to Clavien–Dindo.ConclusionsTransoral robotic surgery seems to be a useful and safe adjunct in the diagnostic and therapeutic pathway in case of CUP in an era of increasing incidence of HPV‐positive OPSCC.

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Weight change before and after adenotonsillectomy in children: An analysis based upon pre‐surgery body mass category

\nMarshall T. Beauchamp, \nBetsy Regier, \nAnne Nzuki, \nRebecca Swinburne Romine, \nBrooke Sweeney, \nMei Liu, \nAnn Davis\n

Publicatie 20-08-2020


AbstractObjectivesTo determine the standardised body mass index (BMIz) trajectory before and after adenotonsillectomy/tonsillectomy between children in different weight classifications in a larger sample than has been studied previously, and to identify which patient factors would explain the difference in these outcomes.DesignWe used a retrospective chart review and leveraged data of weight status pre‐ and post‐adenotonsillectomy/tonsillectomy from a cohort of paediatric patients seen between May 2004 and April 2017.SettingData were collected from an electronic medical record at a single Midwest paediatric health system.ParticipantsThe study population included a convenience sample of 1,751 paediatric patients who underwent adenotonsillectomy or tonsillectomy and had at least two height and weight measurements recorded on the same date both before and after surgery.Main Outcome MeasuresChange in BMIz trajectories before and after surgery.ResultsOf 1751 paediatric patients (ages 3‐11) underwent adenotonsillectomy/tonsillectomy procedures. Age at time of surgery and gender were not significant predictors. Children in different weight classifications demonstrated differences in BMIz trajectory after surgery. Children with overweight/obesity experience a decrease in BMIz, whereas children with underweight or normal weight experience an increase in BMIz.ConclusionsImprovement in weight status is seen after surgery: increased BMI for those underweight and decreased BMI for those with overweight/obesity. We advocate for behavioural strategies as a first‐line treatment in children with underweight or overweight/obesity, and results suggest that coordinating these efforts alongside adenotonsillectomy/tonsillectomy when indicated for medical reasons may be warranted. However, further research is needed to confirm these findings due to the observational nature of this study.

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The Melbourne Mastoidectomy Scale: Validation of an end‐product dissection scale for cortical mastoidectomy

"\nBenjamin James Talks, \nJesslyn Lamtara, \nSudanthi Wijewickrema, \nJean‐Marc Gerard, \nAlistair Macleold Mitchell‐Innes, \nStephen OLeary\n"

Publicatie 20-08-2020


AbstractIntroductionCortical mastoidectomy is a common otolaryngology procedure and represents a compulsory part of otolaryngology training. As such, a specific validated assessment score is needed for the progression of competency‐based training in this procedure. Although multiple temporal bone dissection scales have been developed, they have all been validated for advanced temporal bone dissection including posterior tympanotomy, rather than the task of cortical mastoidectomy.MethodsThe Melbourne Mastoidectomy Scale, a 20‐item end‐product dissection scale to assess cortical mastoidectomy, was developed. The scale was validated using dissections by 30 participants (10 novice, 10 intermediate and 10 expert) on a virtual reality temporal bone simulator. All dissections were assessed independently by three blinded graders. Additionally, all procedures were graded with an abbreviated Welling Scale by one grader.ResultsThere was high inter‐rater reliability between the three graders (r = .9210, P < .0001). There was a significant difference in scores between the three groups (P < .0001). Additionally, there was a large effect size between all three groups: the differences between the novice group and both the intermediate group (P = .0119, η2 = 0.2482) and expert group (P < .001, η2 = 0.6356) were significant. The difference between the intermediate group and expert group again had a large effect size (η2 = 0.3217), but was not significant. The Melbourne Mastoidectomy Scale correlated well with an abbreviated Welling Scale (r = .8485, P < .0001).ConclusionThe Melbourne Mastoidectomy Scale offers a validated score for use in the assessment of cortical mastoidectomy.

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Functional sparing surgery policy for giant vestibular schwannomas

\nMaxime Bretonnier, \nFlorian Bernard, \nJulien Tinois, \nLucas Troude, \nHélène Cebula, \nBenoit Godey, \nXavier Morandi\n

Publicatie 20-08-2020


AbstractObjectiveThe objective of this study was to compare the tumour control and facial nerve outcome according to the therapeutic strategy, that is extent of resection and post‐operative radiotherapy.DesignRetrospective study of patients with a giant vestibular schwannoma surgically treated from 4 academic skull base centres.SettingExtent of resection, neurological complications, facial nerve function, MRI follow‐up and occurrence of complementary treatment were reviewed.ParticipantsSixty patients were included from 2000 to 2018.Main outcome measuresPrimary end points were comparison the tumour control rate and the post‐operative House‐Brackmann grade at last follow‐up according to the extent of tumour removal (ie total or subtotal removal). Secondary end points were assessment risk factors of poor facial nerve function and comparison complication rate according to extent of tumour removal.ResultsSixty patients had initial surgery at diagnosis. A total resection was realised in 21 cases and a subtotal resection in 39 cases. Thirteen patients needed further treatment. One patient had a recurrence and needed a second surgery 108 months after the initial total resection surgery. Twelve patients underwent post‐operative radiotherapy, for an evolutive residual tumour. Tumour control was more successful in the total resection group (log‐rank test, P = .015). There was no tumour recurrence after post‐operative radiotherapy. The facial nerve outcome was significantly better in the subtotal resection group (Mean House‐Brackmann grade at last follow‐up: 2.2 ± 1.9) than in the total resection group (House‐Brackmann grade: 3.5 ± 2.2) (P = .033). Vestibular schwannoma with a cystic component had better facial nerve outcome (P = .0082). Other than facial paralysis, neurological complications were observed in six patients (10% of patients): lower cranial nerves dysfunction in five cases and hemiparesis in one case.ConclusionsSubtotal resection of giant vestibular schwannomas leads to favourable tumour control and facial nerve function and therefore seems to be a valuable strategy.

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Vascular endothelial growth factor (VEGF) and Endocrine gland‐VEGF (EG‐VEGF) are down regulated in head and neck cancer

\nSi Mohamed Bouzoubaa, \nMohammed Benlahfid, \nMustapha Sidqui, \nTouria Aboussaouira, \nChouaib Rifki, \nSophie Brouillet, \nWael Traboulsi, \nNadia Alfaidy, \nMohamed Benharouga\n

Publicatie 20-08-2020


AbstractObjectiveTo characterise the role of VEGF, EG‐VEGF and its receptors in the development and progression of HNC.DesignHuman serum and tissues samples were collected from healthy, epulis and HNC patients and used for ELISA assays and immunohistochemistry studies, respectively.SettingIbn Rochd Hospital of Casablanca (Morocco), INSERM and University of Grenoble Alpes (France).ParticipantsWe used serum from 64 patients with head and neck cancers and from 71 controls without general pathology. Tissues samples were collected from seven patients with OSCC and from seven patients with Epulis.Main outcome measuresWe compared circulating VEGF and EG‐VEGF in normal and HNC patients and determined the expression, localisation and quantification of VEGF, EG‐VEGF and its receptors; PROKR1 and PROKR2 as well as Ki67, CD31 and CD34 in OSCC and Epulis patients.ResultsBoth EG‐VEGF and VEGF circulating levels were significantly decreased in the HNC (P < .01). OSCC patients expressed less EG‐VEGF and VEGF proteins, higher PROKR1 and PROKR2 with no change in CD31 and CD34 levels. A significant increase in Ki67 was observed in OSCC.ConclusionsWe demonstrated that circulating VEGF and EG‐VEGF are downregulated in HNC patients and in OSCC tissue. EG‐VEGF receptors were increased in OSCC, along with a stabilisation of two key markers of angiogenesis. These findings strongly suggest that downregulation of angiogenesis in HNC might explain its moderate metastatic feature.

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The effectiveness of voice therapy on voice‐related handicap: A network meta‐analysis

\nBen Barsties v. Latoszek, \nChristopher R. Watts, \nKatrin Neumann\n

Publicatie 20-08-2020


AbstractBackgroundTreatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence‐based practice.Objective of reviewTo quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30‐items (VHI‐30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta‐analysis (NMA) with a random effects model.Type of reviewMeta‐analysis.Search strategyWe searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI‐30 as an outcome measure in adult participants with non‐organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered.Evaluation methodThe primary outcome variable was VHI‐30 with a score from 0 to 120. The pre‐post treatment change in VHI‐30 scores was an average score of 13 points related to various VHI‐30 test‐retest results.ResultsWe retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch‐and‐Flow Phonation (SFP) (mean pre‐post difference −28.37, 95% confidence interval CI, −43.05 to‐13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements.ConclusionsOf the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI‐30 scores from pre‐ to post‐treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high‐quality intervention studies are needed to support evidence‐based practice in vocology.

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Turn analysis and patient‐centredness in paediatric otolaryngology surgical consultations

\nDavid Forner, \nGilanders Ungar, \nJill Chorney, \nJeremy Meier, \nPaul Hong\n

Publicatie 20-08-2020


AbstractObjectivesPhysician and patient/parent communication is of utmost importance in consultations to improve the shared decision‐making (SDM) processes. This study investigated SDM‐related outcomes through turn analysis and an assessment of patient‐centred dialogue.DesignMulti‐centre prospective cohort study analysing audio‐ and video‐recorded patient/parent‐physician interactions.SettingTwo tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah.ParticipantsPaediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy.Main outcome measuresMedical dialogue measures (turn analysis, patient‐centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM‐Q‐9).ResultsTurn density was significantly higher for physicians than patients/parents (P < .001), as were total statements (P < .001), and total time talking (P < .001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P = .003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient‐centredness score was 0.2 (range 0‐0.56). Significant negative correlations between patient‐centredness score and physician turn density (r = −.390, P = .002), physician mean turn time (r = −.406, P = .001), total physician statements (r = −.426, P = .001) and total physician speaking time (r = −.313, P = .016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient‐centredness scores.ConclusionsSurgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient‐centredness nor turn analysis correlated with perceptions of SDM from the parents perspective.

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Treacher Collins syndrome: A novel TCOF1 mutation and monopodial stapes

\nPiranit Nik Kantaputra, \nKanich Tripuwabhrut, \nWorrachet Intachai, \nBruce M. Carlson, \nNatalina Quarto, \nChumpol Ngamphiw, \nSissades Tongsima, \nNuntigar Sonsuwan\n

Publicatie 20-08-2020


AbstractTreacher Collins syndrome (TCS: OMIM 154500) is an autosomal dominant craniofacial disorder belonging to the heterogeneous group of mandibulofacial dysostoses.ObjectiveTo investigate four Treacher Collins syndrome patients of the Sgaw Karen family living in Thailand.MethodClinical examination, hearing tests, lateral cephalometric analyses, Computed tomography, whole exome sequencing and Sanger direct sequencing were performed.ResultsAll of the patients affected with Treacher Collins syndrome carried a novel TCOF1 mutation (c.4138_4142del; p.Lys1380GlufsTer12), but clinically they did not have the typical facial gestalt of Treacher Collins syndrome, which includes downward‐slanting palpebral fissures, colobomas of the lower eyelids, absence of eyelashes medial to the colobomas, malformed pinnae, hypoplastic zygomatic bones and mandibular hypoplasia. Lateral cephalometric analyses identified short anterior and posterior cranial bases, and hypoplastic maxilla and mandible. Computed tomography showed fusion of malleus and incus, sclerotic mastoid, hypoplastic middle ear space with a soft tissue remnant, dehiscence of facial nerve and monopodial stapes.ConclusionTreacher Collins syndrome in Sgaw Karen patients has not been previously documented. This is the first report of monopodial stapes in a TCS patient who had a TCOF1 mutation. The absence of a common facial phenotype and/or the presence of monopodial stapes may be the effects of this novel TCOF1 mutation.

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Characterising the potential for recall bias in anchor‐based MCID calculation of patient‐reported outcome measures for chronic rhinosinusitis

\nAdam C. McCann, \nKatie M. Phillips, \nMichal Trope, \nDavid S. Caradonna, \nStacey T. Gray, \nAhmad R. Sedaghat\n

Publicatie 20-08-2020


AbstractObjectiveAnchor‐based methods to calculate the minimal clinically important difference (MCID) of a patient‐reported outcome measure (PROM) may suffer from recall bias. This has never been investigated for otolaryngic PROMs. We sought to identify evidence of recall bias in calculation of MCIDs of PROMs for patients with chronic rhinosinusitis (CRS).DesignRetrospective analysis of data from two previous studies calculating the MCID of the 22‐item Sinonasal Outcome Test (SNOT‐22) and 5‐dimensonal EuroQol questionnaire (EQ‐5D) in CRS patients.SettingTertiary rhinology clinic.ParticipantsAdults with CRS.Main outcome measuresSNOT‐22 score, and EQ‐5D visual analog scale scores (EQ‐5D VAS) and health utility values (EQ‐5D HUV) before and after medical treatment for CRS. After treatment, participants were asked to rate the change in sinonasal symptoms and general health (the anchor question) as “Much worse,” “A little worse,” “About the same,” “A little better” or “Much better.” Participants’ responses to the anchor question were checked for association with post‐treatment and pre‐treatment scores using ordinal regression.ResultsOn univariate association, post‐treatment SNOT‐22 and EQ‐5D scores were associated with respective participants’ anchor question responses (P < .001 in all cases). Only pre‐treatment SNOT‐22 score was associated with anchor question responses (P = .017) on univariate association, in contrast to pre‐treatment EQ‐5D scores. Pre‐treatment EQ‐5D scores only associated with anchor question responses when controlling for post‐treatment scores.ConclusionThe anchor‐based MCIDs of the SNOT‐22, which reflects disease‐specific QOL, and the EQ‐5D, which reflects general health‐related QOL, appear to be largely free of recall bias.

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Nasal Packs for Epistaxis: Predictors of Success

\nINTEGRATE (The UK ENT Trainee Research Network), \nY. Abbas, \nM. Abdelkader, \nM. Adams, \nA. Addison, \nR. Advani, \nT. Ahmed, \nV. Alexander, \nV. Alexander, \nB. Alli, \nS. Alvi, \nN. Amiraraghi, \nA. Ashman, \nR. Balakumar, \nJ. Bewick, \nD. Bhasker, \nS. Bola, \nP. Bowles, \nN. Campbell, \nN. Can Guru Naidu, \nN. Caton, \nJ. Chapman, \nG. Chawdhary, \nM. Cherko, \nM. Coates, \nK. Conroy, \nP. Coyle, \nO. Cozar, \nM. Cresswell, \nL. Dalton, \nJ. Danino, \nC. Daultrey, \nK. Davies, \nK. Davies, \nD. Dick, \nP. A. Dimitriadis, \nN. Doddi, \nM. Dowling, \nR. Easto, \nR. Edmiston, \nD. Ellul, \nS. Erskine, \nA. Evans, \nA. Farboud, \nC. Forde, \nJ. Fussey, \nA. Gaunt, \nJ. Gilchrist, \nR. Gohil, \nE. Gosnell, \nD. Grech Marguerat, \nR. Green, \nR. Grounds, \nA. Hall, \nJ. Hardman, \nA. Harris, \nL. Harrison, \nR. Hone, \nE. Hoskison, \nJ. Howard, \nD. Ioannidis, \nI. Iqbal, \nN. Janjua, \nK. Jolly, \nS. Kamal, \nT. Kanzara, \nN. Keates, \nA. Kelly, \nH. Khan, \nT. Korampalli, \nM. Kuet, \nP. Kul‐loo, \nR. Lakhani, \nA. Lambert, \nH. Lancer, \nC. Leonard, \nG. Lloyd, \nE. Lowe, \nJ. Mair, \nE. Maughan, \nC. Gao, \nT. Mayberry, \nL. McCadden, \nF. McClenaghan, \nG. McKenzie, \nR. Mcleod, \nS. Meghji, \nM. Mian, \nA. Millington, \nO. Mirza, \nS. Mistry, \nE. Molena, \nJ. Morris, \nT. Myuran, \nA. Navaratnam, \nE. Noon, \nO. Okonkwo, \nB. Oremule, \nL. Pabla, \nE. Papesch, \nV. Puranik, \nR. Roplekar, \nE. Ross, \nJ. Rudd, \nE. Schechter, \nA. Senior, \nN. Sethi, \nS. Sharma, \nR. Sharma, \nF. Shelton, \nZ. Sherazi, \nA. Tahir, \nT. Tikka, \nO. Tkachuk Hlinicanova, \nK. To, \nA. Tse, \nE. Toll, \nK. Ubayasiri, \nS. Unadkat, \nN. Upile, \nA. Vijendren, \nH. Walijee, \nM. Wilkie, \nR. Williams, \nM. Williams, \nG. Wilson, \nW. Wong, \nG. Wong, \nC. Xie, \nA. Yao, \nH. Zhang\n

Publicatie 20-08-2020


AbstractObjectivesTo investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).DesignProspective cohort study.SettingA nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period.ParticipantsPatients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs.Main outcome measuresThe primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.ResultsA cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2).ConclusionsThe majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis.

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Ten years of experience with the Ponto bone‐anchored hearing system—A systematic literature review

\nHelén Lagerkvist, \nKarin Carvalho, \nMarcus Holmberg, \nUlrika Petersson, \nCor Cremers, \nMalou Hultcrantz\n

Publicatie 20-08-2020


AbstractBackgroundBone‐anchored hearing systems (BAHSs) are widely used for hearing rehabilitation and are indicated in cases of conductive and mixed hearing loss and in single‐sided deafness. The Ponto system, that is one available option, has been on the market since 2009.Objective of reviewThe aim of this study is to systematically review the literature reporting on the Ponto system, with regard to audiological and surgical outcomes and patients quality‐of‐life scores.Type of reviewA systematic literature search was performed in the PubMed database 2009‐July 2019.Search strategySearch term: ((osseointegrated hearing aid) OR (bone conduction implant) OR (bone anchored hearing) OR BAHA OR BAHS OR BAHI). Pre‐defined inclusion and exclusion criteria were applied.Evaluation methodEnglish‐language articles reporting original clinical data (audiological, surgical or quality‐of‐life outcomes) on the Ponto system were included.Articles reporting on Ponto and another BAHS system where the results on Ponto constituted less than 50% of the patient population or including only results on testband or softband devices were excluded.ResultsAudiological outcomes were discussed in 20 publications. Improvement against the unaided thresholds was demonstrated. The functional improvement was on average 33.9 dB. The effective gain or remaining air‐bone gap was on average 6.7 dB. All evaluated data showed aided speech reception thresholds significantly below normal speech level. Twenty‐seven publications reported surgical and follow‐up data for the Ponto system. Implant survival was 97.7%, adverse skin reactions (Holgers ≥ 2) were 5% across visits and 15% across patients. No complications were life‐threatening, causing permanent disability/damage or requiring a hospitalisation. Five studies reported quality of life using the Glasgow benefit inventory, 98% reported an improvement when analysing the score on an individual level.ConclusionsThe outcomes of this systematic review confirm that percutaneous systems provide consistent audiological benefits and improved quality of life for patients. Further, the review demonstrates that the percutaneous systems are safe, with relatively low complication rates. Skin‐related complications are the most common complication type and are experienced by approximately one patient out of seven, or in less than one of 20 follow‐up visits.

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Sleep apnoea is associated with hearing impairment: The Paris prospective study 3

\nQuentin Lisan, \nThomas Sloten, \nRachel E. Climie, \nPierre Boutouyrie, \nCatherine Guibout, \nFrederique Thomas, \nNicolas Danchin, \nXavier Jouven, \nJean‐Philippe Empana\n

Publicatie 20-08-2020


AbstractObjectivesHearing impairment (HI) is a leading impairment worldwide, and identifying modifiable risk factors of HI may have major public health implications. The aim of this study was to investigate the association between obstructive sleep apnoea (OSA) and HI.DesignObservational longitudinal study (the Paris Prospective Study 3).SettingPopulation‐based.ParticipantsVolunteers aged 50‐75 years and consulting at a preventive medical centre were included between 2008 and 2012. 6797 participants were included in the present analysis.Main outcome measuresAudiometry testing was performed in both ears in all participants, and HI was defined by a pure‐tone average (PTA) >25 decibels (dB) hearing level in the better ear.ResultsObstructive sleep apnoea (estimated by the Berlin questionnaire) was present in 18.6% (n = 1267) and HI in 13.9% (n = 947) of the participants. Mean age was 59.5 years (SD 6.2) and 63.5% were male (n = 4317). In multiple logistic regression modelling, OSA was significantly associated with a 1.21‐increased odds of HI (95% confidence interval 1.01‐1.44). Several sensitivity analyses supported this finding.ConclusionObstructive sleep apnoea is associated with a 21% increased odds of HI. These results support active screening of HI in subjects with OSA, and future studies should evaluate whether the treatment of OSA can delay the onset of HI.

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Bidirectional analysis of the association between Ménière’s disease and depression: Two longitudinal follow‐up studies using a national sample cohort

\nSo Young Kim, \nChang Ho Lee, \nChanyang Min, \nIl‐Seok Park, \nHyo Geun Choi\n

Publicatie 20-08-2020


AbstractObjectiveThis study aimed to delineate the causal relationship between Ménières disease and depression.DesignTwo longitudinal follow‐up studies.Main Outcome MeasuresThe 2002‐2013 Korean National Health Insurance Service‐Health Screening Cohort was used. In study I, Ménières disease patients were 1:4 matched with the control I group for age group, sex, income group and region of residence, and the occurrence of depression was observed. In study II, the depression patients were 1:4 matched with the control II group for the same variables, and the occurrence of Ménières disease was observed. The stratified Cox proportional hazard model was used. Subgroup analyses were performed according to age and sex.ResultsIn study I, 6.9% (420/6044) of the Ménières disease patients and 3.7% (885/24 176) of the control I participants experienced depression. The adjusted hazard ratio (HR) of Ménières disease for depression was 1.94 (95% confidence intervals CI = 1.73‐2.18, P < .001). In study II, 1.6% (490/31 649) of the depression patients and 1.0% (1240/126 596) of the control II participants were diagnosed with Ménières disease. The adjusted HR of depression for Ménières disease was 1.58 (95% CI = 1.43‐1.76, P < .001). All age and sex subgroups demonstrated higher HRs of Ménières disease for depression (study I) and depression for Ménières disease (study II).ConclusionMénières disease patients showed an increased likelihood of depression. Conversely, depression patients showed an elevated likelihood of Ménières disease.

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"Prognostic factors for the outcome of Bells palsy: A cohort register‐based study"

\nElisabeth Urban, \nGerd Fabian Volk, \nKatharina Geißler, \nJovanna Thielker, \nAndreas Dittberner, \nCarsten Klingner, \nOtto W. Witte, \nOrlando Guntinas‐Lichius\n

Publicatie 20-08-2020


AbstractObjectivesThere is a lack of data on patients and diagnostic factors for prognostication of complete recovery in patients with Bells palsy.Design and settingCohort register‐based study of 368 patients with Bells palsy and uniform diagnostics and standardised treatment in a university hospital from 2007 to 2017 (49% female, median age: 51 years).Main outcome measuresClinical data, facial grading, electrodiagnostics, motor function tests, non‐motor function tests and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.ResultsMedian onset of treatment was 1.5 days. 46% of patients had a House‐Brackmann scale at baseline of ≥ III. The median recovery time was 2.6 months (95% confidence interval CI = 2.1‐3.0). 54.9% achieved a complete recovery. If prednisolone therapy started later than 96 hours after onset, the recovery rate decreased significantly. Beyond less severe palsy, no abnormal electroneurography side difference, no pathological spontaneous activity in electromyography and normal stapedius reflex testing were the most powerful tool for prognostication of recovery after Bells palsy.ConclusionBeyond severity of the palsy, facial electrodiagnostics and stapedius reflex testing are the most powerful tool for prognostication of recovery time after Bells palsy. Prednisolone therapy should have started at best within a time window of 96 hours after onset to reach the highest probability of complete recovery.

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Identifying non‐otologic risk factors for tinnitus: A systematic review

\nAnn N. Deklerck, \nJens M. Debacker, \nHannah Keppler, \nIngeborg J. M. Dhooge\n

Publicatie 20-08-2020


AbstractBackgroundThe origin of tinnitus has been attributed to a peripheral auditory lesion, inducing bottom‐up changes and resulting in the perception of a “phantom sound.” However, non‐auditory factors can co‐exist as well, and can even lie at the origin of tinnitus development. An increasing body of literature focuses on psychological, (neuro)muscular, cardiovascular and many other influences and their respective associations with tinnitus prevalence.Objective of reviewThe purpose of this study was to provide a comprehensive description of these non‐otologic risk factors, and to summarise the evidence in literature about their link with tinnitus.Type of reviewA narrative systematic review was conducted, following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses statement.Search strategyThe MEDLINE, Embase and Web of Science databases were systematically searched for eligible articles, supplemented with manual search methods and grey literature search. Epidemiological studies reporting on the relationship between various non‐otologic risk factors and tinnitus were included.Evaluation methodQuality assessment was performed using the Hoy & Brooks tool.ResultsFifty‐five studies were included. Studies were of variable quality, with poor tinnitus definitions and evaluations or questionable sampling of the study population as main contributing factors for high risk of bias. Multiple associated factors have been identified, including cardiovascular, psychological, neurological, musculoskeletal and dietary factors.ConclusionsThe current literature review identified multiple risk factors that could be of significant importance for tinnitus development, maintenance or aggravation. While causality remains uncertain, this systematic elaboration of possible tinnitus comorbidities/risk factors can help provide direction for future research, and can direct clinicians to identify patients at risk and treat relevant symptoms accordingly.

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Trans‐oral robotic surgery for mandibulotomy sparing in posteriorly positioned oral tongue cancers

\nSmriti Panda, \nAlok Thakar, \nSuresh C. Sharma, \nKapil Sikka, \nAtul Sharma, \nSuman Bhasker, \nVirender K. Mohan, \nMehar C. Sharma\n

Publicatie 20-08-2020


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An effective decision‐making aid for patients with tinnitus: A retrospective review of 205 patients

\nDeclan C. Murphy, \nJohn S. Phillips\n

Publicatie 20-08-2020


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Learning curve using the Sunnybrook Facial Grading System in assessing facial palsy: An observational study in 100 patients

\nMartinus M. van Veen, \nTessa E. Bruins, \nMadina Artan, \nPaul M.N. Werker, \nPieter U. Dijkstra\n

Publicatie 20-08-2020


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Prevalence and treatment of co‐morbid anxiety and depression among 352 dizzy patients: A retrospective study

\nChristopher Y.K. Williams, \nRichard Knight, \nNeil Donnelly, \nManohar Bance\n

Publicatie 20-08-2020


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Caution in the use of TissuePatchDS‐P™ in drainless benign superficial parotidectomy, a pilot study: Our experience in three patients

\nJonathan Bird, \nAdal Hussain Mirza, \nEmma King\n

Publicatie 20-08-2020


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18F‐FDG PET/CT for response evaluation of regional lymph nodes in 97 head and neck squamous cell carcinoma patients: Differences in the predictive value of residual disease after radiotherapy and chemoradiotherapy

\nSaskia H. Hanemaaijer, \nMaran Fazzi, \nRoel J. H. M. Steenbakkers, \nBart Dorgelo, \nBert Vegt, \nMax J. H. Witjes, \nBernard F. A. M. Laan, \nSjoukje F. Oosting, \nGilles N. Stormezand, \nBoudewijn E. C. Plaat\n

Publicatie 20-08-2020


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Percutaneous ethanol sclerotherapy for auricular arteriovenous malformation: Our experience with 11 patients

\nFangYun Yang, \nBiao Yang, \nZiYu Qu, \nYuPing Tan, \nFaCheng Lu, \nZhengYin Liao\n

Publicatie 20-08-2020


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Issue Information

Publicatie 20-08-2020


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Indocyanine green dye guided surgical planning in metastatic cutaneous squamous cell carcinoma of the head, face and neck

\nDeclan C. Murphy, \nDaniel Bernard Saleh\n

Publicatie 20-08-2020


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Safe nasendoscopy assisted procedure in the post‐COVID‐19 pandemic era

\nAjith George, \nMark Prince, \nChris Coulson\n

Publicatie 20-08-2020


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Long‐term outcomes of juvenile‐onset recurrent respiratory papillomatosis

\nYang Xiao, \nXianxiang Zhang, \nLijing Ma, \nJun Wang\n

Publicatie 19-08-2020


AbstractObjectiveTo investigate the adult outcomes of children with juvenile‐onset recurrent respiratory papillomatosis via long‐term follow‐up.Study DesignRetrospective studySettingBeijing Tongren HospitalParticipantsThe study includes 121 patients with recurrent respiratory papillomatosis.Main outcome and measureWe followed‐up respiratory papillomatosis patients aged least 14 years and analysed their clinical features based on recurrence‐free time.ResultsIn total, 112 (92.6%) patients underwent three or more operations. The age at initial operation was 4.3 ± 2.9 years; 47.9% (58/121) experienced recurrence and underwent surgical treatment after age 14. At follow‐up, 5% (6/121) had died, 41.3% (50/121) had been recurrence‐free for 5 years or more (cured group), and 53.7% (65/121) had recurrence in the past 5 years (recurrent group). The age at the last operation was 9.2 ± 4.6 years in the cured group. The overall operation frequency was higher in the recurrence group than in the cured group (17.8 ± 11.9 vs 8.7 ± 6.5). Additionally, the human papillomavirus (HPV) infection and tracheal dissemination rates were higher in the recurrence group than in the cured group (90.8% 59/65 vs 54.0% 27/50 and 26.2% 17/65 vs 10% 5/50, respectively).ConclusionThe mortality rate for juvenile‐onset recurrent respiratory papillomatosis is 5%. Approximately 50% of children experience recurrence and require repeated operations in adulthood. No significant difference in sex, age at initial operation, or adjuvant therapy between the cured and recurrent groups was observed; however, significant between‐group differences were found in overall operation frequency, aggressive disease, tracheal dissemination of papilloma, and HPV infection.

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Floseal: A novel application technique for the treatment of challenging epistaxis

\nQuentin Bonduelle, \nTimothy C Biggs, \nFabian Sipaul\n

Publicatie 17-08-2020


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In scalp incision technique for cochlear implantation

\nHisashi Sugimoto, \nMiyako Hatano, \nTomokazu Yoshizaki\n

Publicatie 12-08-2020


AbstractThe skin incision is a vital step in cochlear implantation surgery and must ensure a good visual field with sufficient working space for the surgeon. Patients can be concerned with esthetics, so that is also an important consideration.We devised a method wherein the caudal end of the extended postauricular incisional line runs posteriorly and ends in the scalp (in‐scalp incision technique, Fig. 1B).The skin incision scar is entirely within the scalp so the postoperative wound is completely hidden by hair (Fig. 4), alleviating concerns about postoperative esthetics.This technique gives the surgeon a good visual field and sufficient working space. The temporal bone is widely exposed, so the operation can be performed without the stress and potential complications of a mastoidectomy. Furthermore, it allows for easy creation of the pocket for the receiver‐stimulator (RS) fixation.A potential disadvantage is the larger incision, theoretically increasing the risk of postoperative infection. The operation is also a slightly longer duration than surgery done with an extended postauricular incision.

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Outcomes of a Multidisciplinary Ear Nose and Throat Allied Health Primary Contact Outpatient Assessment Service

\nChristopher L Payten, \nJennifer Eakin, \nTamsin Smith, \nVicky Stewart, \nCatherine J Madill, \nKelly A Weir\n

Publicatie 11-08-2020


ABSTRACTBackgroundTraditionally patients are seen by an Ear Nose Throat (ENT) surgeon prior to Allied Health referral for treatment of swallowing, voice, hearing, and dizziness. Wait‐times for ENT consultations often exceed those clinically recommended. We evaluated the service impact of five Allied Health Primary Contact clinics (AHPC‐ENT) on wait‐times and access to treatment.SettingAmetropolitan Australian University Hospital outpatient ENT Department.ParticipantsWe created five AHPC‐ENT pathways (dysphonia, dysphagia, vestibular, adult and paediatric audiology)for low acuity patients referred to ENT with symptoms of dysphonia, dysphagia, dizziness and hearing loss.Main Outcome MeasuresUsing multiple regression analysis, we compared waiting times in the 24‐months pre and 12‐months post implementation of the AHPC‐ENT service. In addition, we measured the number of patients requiring specialist ENT intervention after assessment in the AHPC‐ENT, adverse events, and evaluation of service delivery costs.ResultsSeven‐hundred and thirty‐eight patients were seen in the AHPC‐ENT over the first 12‐months of implementation, (dysphagia 66; dysphonia 153; vestibular 151; retro‐cochlear 60; Paediatric glue ear 308). All pathways significantly reduced the waiting times for patients by an average of 277 days, compared with usual care. The majority of patients were able to be discharged without ongoing ENT intervention (72% Dysphagia; 81% Dysphonia; 74% Vestibular; 53% retro cochlear; 32% Paediatric glue ear). No adverse events were recorded.ConclusionsThe AHPC‐ENT improved waiting times for assessment and access to treatment. Future research on cost‐effectiveness and diagnostic agreement between AHPs and ENT clinicians would provide further confidence in the model.

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Letter to editor: A systematic review of the incidence of thyroid carcinoma in patients undergoing thyroidectomy for thyrotoxicosis

\nOvie Edafe, \nSabapathy P. Balasubramanian\n

Publicatie 09-08-2020


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Treating twenty‐five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series

\nShayan Shahidi, \nAbdul Nassimizadeh, \nChris Coulson\n

Publicatie 08-08-2020


AbstractChronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these casesbeing challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case‐series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.

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The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta‐Analysis

\nBen Barsties v. Latoszek, \nGeun‐Hyo Kim, \nJonathan Delgado Hernández, \nKiyohito Hosokawa, \nMarina Englert, \nKatrin Neumann, \nSvetlana Hetjens\n

Publicatie 08-08-2020


AbstractBackgroundThe evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features.Objective of reviewThe goal of the present meta‐analysis is to quantify, from existing cross‐validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity.Type of reviewMeta‐analysisSearch strategyWe searched in MEDLINE, Google Scholar, Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020.Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customized Praat script, and two groups of subjects (vocally‐healthy and voice‐disordered). Furthermore, the diagnostic accuracy of ABI was measured.Evaluation methodThe primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness.A meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses of diagnostic test accuracy studies guidelines. Data were extracted and the risk of bias was assessed using the QUADAS‐2 tool. The pooled sensitivity and specificity of ABI was determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity.ResultsA total of 34 unique citations were screened, and 10 full‐text articles were reviewed, including 6 studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally‐healthy and 3136 voice‐disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83‐0.85) and the pooled specificity was 0.92 (95% CI, 0.89‐0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84‐0.87.; specificity: 0.90, 95% CI 0.88‐0.92).ConclusionsThe results confirm the ABI as robust and valid objective measure for evaluating breathiness.

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Targeted skull base biopsies in the management of central skull base osteomyelitis

\nRegi Thomas\n

Publicatie 07-08-2020


AbstractCentral skull base osteomyelitis has an infective pathology located in the deep‐seated regions of the skull base, close to critical neurovascular structures.The disease has significant morbidity and mortality risks associated with it especially if early specific management is not initiated.The diagnostic and therapeutic challenges are in identifying the causative organisms and administering specific antimicrobial therapy on a long‐term basis.The routine nasopharyngeal mucosal biopsies tend to be non‐representative as the foci of infection is deep‐seated and the infected bone sample is necessary to diagnose osteomyelitis.The targeted skull base biopsy technique described in this article outlines the principles of wide exposure and early identification of intraoperative landmarks in order to safely take biopsy and cultures from deep‐seated regions, located close to the internal carotid artery.

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Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography

\nNikul Amin, \nAbigail Walker, \nIsam Alobid, \nShahram Anari, \nFlorian Bast, \nRajiv K. Bhalla, \nRussell Cathcart, \nPhilip G. Harries, \nIain Hathorn, \nCarl M. Philpott, \nYujay Ramakrishnan, \nBenjamin Stew, \nPavol Surda, \nFiona Ting, \nClaire Hopkins\n

Publicatie 06-08-2020


AbstractObjectivesConebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment.CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery.We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons.DesignThe RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria.SettingA virtual panel of 13 international experts in ESS.ParticipantsThe expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision‐making processes.Main outcome measuresTo define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT.ResultsPatients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus.For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered.ConclusionsThis study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT.

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Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients

\nHilal Burcu Ozkan, \nBetul CicekCinar, \nEsra Yucel, \nGonca Sennaroglu, \nLevent Sennaroglu\n

Publicatie 04-08-2020


AbstractBackground and ObjectiveInner Ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs.MethodsThe study included 274 CI users with and without IEMs as two groups (n = 137, each). Both groups’ chronological age at implantation and duration of CI usage were matched (± 8 months). All subjects were evaluated preoperatively and postoperatively by the Ling’s sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed‐set Pattern Perception Test (PPT), and open‐set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development.ResultsProgress in the IEMs group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed‐set test while having difficulty with the open‐set test.ConclusionCochlear implantation outcomes are favourable in IEMs patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow‐up and rehabilitation programs. Each CI user should be evaluated according to his or her individual needs.

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Concurrent chemoradiotherapy with low‐dose weekly platinum agent for head and neck carcinoma

\nMasahiro Kitano, \nTsuyoshi Kojima, \nYusuke Okanoue, \nShintaro Fujimura, \nSeiji Oyagi, \nKazuhiko Shoji, \nRyusuke Hori\n

Publicatie 01-08-2020


Abstract1. Combined radiation therapy and every‐3‐weeks high‐dose cisplatin has been often reported for head and neck cancer. However, this regimen can cause both severe acute complications and late complications.2. The objective of this study is to evaluate the efficacy of combined weekly chemoradiation therapy using low‐dose platinum agent combined with radiation therapy. The 3‐ and 5‐year overall survival rates are comparable to those associated with combination high‐dose cisplatin and radiation therapy.3. The simplicity of patient management with weekly chemotherapy combined with radiation therapy is considered to be a key advantage. Even if a side effect occurs during patient observation, it will be possible to skip and reduce the number of administrations until recovery.4. Since high‐dose cisplatin may worsen kidney function and decrease the completion rate among patients with small physiques and a small number of nephrons, it is reasonable to reduce the total dose by skipping the administration and/or switch to carboplatin.5. The continuation of low‐dose platinum‐based chemotherapy during radiation therapy is considered to be essential for improving the efficacy of treatment.

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Is loss of sense of smell a diagnostic marker in COVID‐19: A Systematic Review and Meta‐analysis

\nJohn Rocke, \nClaire Hopkins, \nCarl Philpott, \nNirmal Kumar\n

Publicatie 01-08-2020


AbstractAims1. To systematically review the currently available evidence investigating the association between olfactory dysfunction (OD) and the novel coronavirus (COVID‐19).2. To analyse the prevalence of OD in patients who have tested positive on Polymerase Chain Reaction (PCR) for COVID‐19.2. To perform a meta‐analysis of patients presenting with olfactory dysfunction, during the pandemic, and to investigate the Positive Predictive Value for a COOVID‐19 positive result in this population.3. To assess if olfactory dysfunction could be used as a diagnostic marker for COVID‐19 positivity and aid public health approaches in tackling the current outbreak.MethodsWe systematically searched MedLine (PubMed), Embase, Health Management Information Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID‐19 Study Register, NIHR Dissemination centre, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify the current published evidence which associates coronaviridae or similar RNA viruses with anosmia.The initial search identified 157 articles. 145 papers were excluded following application of our exclusion criteria. The 12 remaining articles, that presented evidence on the association between COVID‐19 and olfactory dysfunction, were critically analysed.ResultsOD has been shown to be the strongest predictor of COVID‐19 positivity when compared to other symptoms in logistic regression analysis. In patients who had tested positive for COVID‐19 there was a prevalence of 62% of OD. In populations of patients who are currently reporting OD there is a positive predictive value of 61% for a positive COVID‐19 result.ConclusionOur review has shown that there is already significant evidence which demonstrates an association between OD and the novel coronavirus – COVID‐19. It is unclear if this finding is unique to this coronavirus as individual viral phenotypes rarely present in such concentrated large numbers. We have demonstrated that OD is comparatively more predictive for COVID‐19 positivity compared to other associated symptoms. We recommend that people who develop OD during the pandemic should be self‐isolate and this guidance should be adopted internationally to prevent transmission.

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Emergency airway training: “Who are you going to FONA?”

\nSanjana Bhalla, \nIssa Beegun, \nChris Hogan, \nZaid Awad, \nNeil Tolley\n

Publicatie 01-08-2020


AbstractObjectivesTo demonstrate face and content validity of a home‐made simulation model as a training tool for front of neck access (FONA) procedures.DesignThis was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model.SettingThe study was completed during regular simulation training days and international conferences.ParticipantsA total of 52 participants completed the questionnaire and, were included in the study; 25 were experts and 27 were trainees.Main outcome measuresAll participants completed a validated 15‐item questionnaire using a 5‐point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task specific content (TSC) and curriculum applicability (CTR).ResultsThere were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (p= 0.76, 0.13, 0.4 and 0.67 respectively). The model achieved a median FV of 4 (IQR 4‐5) with the agreement of experienced and trainee groups (68.9% and 92% respectively). The median GC validity score was 5 (IQR 4‐5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4‐5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4‐5) with the agreement of 54.4% and 100% in respected groups.ConclusionOur home made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees.

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Efficacy of toluidine blue in the diagnosis and screening of oral cancer and precancer: A systematic review and meta‐analysis

\nDo Hyun Kim, \nEun A Song, \nSung Won Kim, \nSe Hwan Hwang\n

Publicatie 01-08-2020


AbstractAimsThe accuracy of toluidine blue (TB) and chemiluminescence for diagnosing oral cancer and precancer was evaluated.MethodsTwo authors (working independently) comprehensively reviewed six databases (PubMed, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar) from their dates of inception until March 2020. Oral mucosal disorder, as detected by TB, was compared with that detected by chemiluminescence. True‐positive, true‐negative, false‐positive, and false‐negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). The extent of interrater agreement was also assessed.ResultsTwenty‐nine prospective and retrospective studies were included. The diagnostic odds ratio (DOR) of TB was 7.017 (95% confidence interval CI, 4.544; 10.836). The area under the summary receiver operating characteristic curve was 0.766. The correlation between the sensitivity and the false‐positive rate was 0.196, indicating the absence of heterogeneity. TB exhibited moderate interrater reliability (0.6777; 95% CI, 0.43; 0.7455). Compared with chemiluminescence, as used in nine studies, TB had a lower sensitivity (0.659 vs. 0.841), but a higher specificity (0.809 vs. 0.345), negative predictive value (0.766 vs. 0.690), and DOR (10.565 vs. 5.203). Compared with clinical examination, as used in four studies, TB method had a higher sensitivity (0.891 vs. 0.891), specificity (0.739 vs. 0.634), negative predictive value (0.920 vs. 0.714), and DOR (28.491 vs. 8.526). Subgroup analysis showed that screening for severe dysplasia or more severe disease was significantly more sensitive, but less specific, than screening for all dysplasias.ConclusionsAlthough the diagnostic accuracy of TB in the diagnostic work‐up of oral cancer and precancer was higher than that of clinical examination, it was not high enough for TB to reliably be used alone. Instead, it should be combined with chemiluminescence or other diagnostic tools.

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Preradiation tooth extraction and jaw osteoradionecrosis: Nationwide population‐based retrospective study in Taiwan

\nPei‐Hsun Liao, \nChi‐Hsiang Chu, \nPei‐Ling Tang, \nPei‐Chen Wu, \nTsu‐Jen Kuo\n

Publicatie 01-08-2020


AbstractObjectiveRadiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national health care database, we reviewed the contraindications and analysed other risk factors for ORNJ.DesignA retrospective cohort study.SettingBy using Taiwan’s National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1–21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included.The patients were divided into two groups according to the time of tooth extraction before the index day: 1–7 days and 8–21 days.ParticipantsTaiwanese patients with head and neck cancer.Main Outcomes MeasureUnivariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ.ResultsThe overall incidence of ORNJ in the included patients was 1.03% (mean follow‐up duration, 4.07 ± 3.01 years; range, 1.00–13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio HR = 0.734; p = 0.312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488), and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all p < 0.001).ConclusionIn a mean follow‐up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7–21 days before RT.

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Trends in tonsillectomy surgery in children in Scotland 2000‐2018

\nHaytham Kubba, \nLaura S Downie\n

Publicatie 31-07-2020


AbstractBackgroundTonsillectomy is one of the most common surgical procedures in children but indications and surgical practice change over time.ObjectivesWe aimedto identify trends in tonsillectomy procedures in children, in particular the number of procedures performed, the age of child undergoing tonsillectomy and the type of hospital in which the surgery was performed.DesignReview of Scottish Morbidity Records data (SMR01) which are routinelycollected after every day case procedure or overnight stay in all Scottish NHS hospitals.SettingAll NHS hospitals in all 14 Scottish health boards.ParticipantsAll children (0‐16 years) undergoing tonsillectomy, 2000‐2018.Main outcome measuresNumber of tonsillectomy procedures; rate of tonsillectomy per 1000 children in the population; number of children aged 0‐2 years and 3‐4 years undergoing tonsillectomy; health board in which the surgery occurred; diagnostic coding for these episodes; length of stay and readmission within 30 days of surgery.ResultsDuring 2000‐2018, there were 50,208 tonsillectomies performed in children in Scotland (mean 2642/ year). The number of tonsillectomies per year remained constant (R=0.322, p=0.178) but tonsillectomies performed in children 0‐2 years rose from 0.41 to 1.56 per 1000 (R=0.912, p<0.001), and 3‐4 years from 3.06 to 6.93 per 1000 (R=0.864, p<0.001). The proportion of all children’s tonsillectomies performed up to age 4 rose from 20.6% to 35.9%, and up to age 2 from 2.4% to 8.1%.Allspecialist children’s hospitals showed a significant increase in surgery in very young children.ConclusionsTonsillectomy rates remained static between 2000 and 2018, despite a falling population. More tonsillectomies are now performed for obstructive sleep apnoea, at a young age and in regional children’s hospitals. This has important implications for the workload of these specialist hospitals.

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Quality of life changes following three‐dimensional printing of prosthesis for large nasal septal perforations – our experience of 13 patients

\nGaurav S Medikeri, \nGrace C Khong, \nSarah Fleming, \nTaran Malhotra, \nSamuel C Leong\n

Publicatie 31-07-2020


AbstractLarge nasal septal perforations have higher extrusion rates with pre‐fabricated septal obturators.A prospective cohort study was conducted including patients with septal perforation who underwent custom‐made septal buttons and quality‐of‐life outcomes were measured.The mean total SNOT‐22 score improved after insertion of the prosthesis with highest change in perforation specific symptoms (crusting, bleeding, whistling).Accurate sizing and successful closure with 3‐D printing technology for obturation of large septal perforations have resulted in improvement in quality of life scores and perforation specific symptoms.Long‐term retention rates of the prosthesis and temporal changes in quality of life indices will require further evaluation.

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Polysomnography in Children with Obstructive Sleep Apnea and Neurocognitive Disorders

\nArvind Chandrakantan, \nDeep Patel, \nMica Glaun, \nDeepak Mehta, \nMary F Musso, \nAmee Patel, \nAdam C Adler\n

Publicatie 31-07-2020


AbstractObjectiveThe neurocognitive associationsinpediatric obstructive sleep apnea (OSA) are well known; however, whether polysomnographic features can predict these associations is unknown. Therefore, the primary objective of this study was to compare common polysomnographic parameters in children with OSA in the presence and absence of neurocognitive dysfunction.MethodsPolysomnography datafor children ages3‐6 yearswith mild‐moderate OSA who as defined by AHI between 5‐10 were analyzed from a single sleep center at a tertiary pediatric hospitalfrom January 2016‐December 2018. The following parameters were identified: arousals per hour, percentage of time asleep, apnea‐hypopnea index (AHI), oxygen desaturation nadir during sleeps, baseline oxygen saturation during sleep, time spent with SpO2 less than 90%, maximum transcutaneous CO2, percent of the total sleep time spent with TcCO2 greater than 50 mmHg, age, body mass index (BMI), gender, and type of disability in the neurocognitive dysfunction group.Neurocognitive diagnoses were recorded. Those with syndromic comorbidities were excluded.The study cohort was then compared to a cohort of 200 subjects with OSA and no neurocognitive disorders matched for age, gender, and BMI. A paired column analysis by chi‐squared analysis was then undertaken between the two groups.ResultsA total of 200 children were identified(126 males and 74 females) in the neurocognitive dysfunction group (OSA with neurocognitive dysfunction) and compared with200 children in the control group (OSA without neurocognitive dysfunction) (113 males and 87 females). There were no statistical differences between groups.ConclusionCommonly used polysomnographic indices are not predictive of neurocognitive dysfunction in pediatric OSA

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Surgiflo® may have a potential impact on the healing process in cricotracheal resection anastomosis

\nAhmed Musaad Abd El‐Fattah, \nHishamAtef Ebada, \nAli Tawfik\n

Publicatie 31-07-2020


AbstractObjectivesTo evaluate the role of thrombin based hemostatic agent Surgiflo® (Ethicon, Somerville, USA) in improving the outcome of cricotracheal resection anastomosis.DesignRandomized controlled clinical trial.SettingOtorhinolaryngology Department, Mansoura University Hospitals, Egypt.ParticipantsThis study included 55 patients with grade III and IV subglottic and/or cervical tracheal stenosis, who underwent cricotracheal resection anastomosis. Patients were randomly assigned into two groups: Surgiflo group (n=20) and control group (n=35). In Surgiflo patients, Surgiflo® was applied at the end of surgery over the whole operative field including the line of airway anastomosis with the purpose of adequate hemostasis and enhancing healing of the anastomosis.Main outcome measuresThe success rate and the incidence of complications in both groups were compared.ResultsAt the end of treatment, decannulation rate was 95% (19/20) in the Surgiflo groups and 82.8% (29/35) in the control group. The overall incidence of complications was significantly lower in the Surgiflo group (p=0.021). Need for further surgical airway interventions in the form of repeated dilatation, granulation tissue removal or performing a tracheotomy was reported in 22.9% (8/35) of control group patients, in comparison to 5% (1/20) in Surgiflo group.ConclusionDirect Surgiflo® application in the operative field enhances the anastomotic healing, decreases the incidence of anastomotic complications and subsequently improves the outcome. It can be recommended as an adjuvant to surgery in patients undergoing cricotracheal resection anastomosis.

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Rhinology in the COVID‐19 era; our experience from a rhinology tertiary referral hospital and implications for future practice

\nJC Magill, \nS Unadkat, \nE Bullock, \nMS Ferguson, \nC Rennie, \nWE Grant, \nHA Saleh\n

Publicatie 31-07-2020


AbstractThe United Kingdom has been hit hard by the COVID‐19 pandemic with the highest death toll in Europe exceeding 40,000. London has been the epicentre of the UK outbreak, with more than 1600 positive recorded cases in our institution alone. Consequently, hospital specialities have had to adapt rapidly to the challenges COVID‐19 has posed.

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Post‐Treatment Head and Neck Cancer Care: National Audit and Analysis of Current Practice in the United Kingdom

\nMatthew Ellis, \nGeorge Garas, \nJohn Hardman, \nMaha Khan, \nHisham Mehanna, \nMatthew E Smith, \nTheofano Tikka, \nKishan Ubayasiri, \nRichard Williams, \nINTEGRATE (UK ENT Trainee Research Network), \nK. Davies, \nD. Dick, \nM. Adams, \nH. Jones, \nT. Myuran, \nS. Goh, \nM. Dowling, \nJ. Sinnott, \nA. Hardy, \nE. Halliday, \nJ. Virk, \nF. Ahmed, \nJ. Walton, \nB. van Beugen, \nN. Hope, \nM. Edmond, \nK. Lau, \nT. Ahmed, \nD. Nair, \nK. Varadharajan, \nD. Lin, \nL. Ferguson, \nS. Mahalingam, \nY. Kamhieh, \nM. Afiq Slim, \nT. Tornari, \nA. Abdel‐Rahim, \nK. Hutson, \nA. Millington, \nT. Moorhouse, \nE. Farrar, \nS. Doumas, \nG. Wilson, \nU. Kamel, \nP. Coyle, \nD. McAnerney, \nO. Mirza, \nD. Leopard, \nT. Saunders, \nL. McMurran, \nL. Johnstone, \nT. Oremule, \nJ. Bates, \nA. Iacovidou, \nN. Upile, \nC. Swords, \nR. Chessman, \nR. Mcleod, \nK. Ubayasiri, \nT. Milner, \nR. Cheong, \nA. Gaunt, \nK. To, \nA. Tse, \nD. Yap, \nE. Noon, \nM. Cresswell, \nS. Mallick, \nW. Crookes, \nC. Corner, \nN. Walker, \nR. Ricks, \nS. Healy, \nW. Kendall, \nG. Fragkiadakis, \nK. Conroy, \nA. Pervez, \nN. Caton, \nR. Balakumar, \nC. Smith, \nA. Waters, \nR. Advani, \nM. Shaker, \nE. Schecter, \n ZW.Liu, \nK. Karamali, \nS. Alvi, \nB. Cosway, \nD. Thorley, \nM. Williams, \nJ. Hardman, \nP. Bijoor, \nB. Anwar, \nN. Hamilton, \nG. Moghul, \nS. Ansari, \nN. Mahon, \nS. Hey, \nH. Lancer, \nR. Ghedia, \nS. Dewhurst, \nM. Cherko, \nA. Carter, \nD. Pennell, \nM. Khan\n

Publicatie 30-07-2020


AbstractObjectivesWe aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post‐treatment surveillance against national guidelines, and determine the outcomes of these practices in detecting recurrence.DesignNational cross‐sectional study of current HNC surveillance practice.SettingUK HNC outpatient departments.ParticipantsHNC patients reviewed for post‐treatment surveillance.Main outcome measuresCompliance with UK multidisciplinary guidelines, and rates of cancer recurrence detection by time, clinic type and symptoms.ResultsData were analysed from 5,123 consultations across 89 UK centres.30% of consultations were in dedicated multidisciplinary clinics, with input from Allied Health Professionals (AHPs) available on the day in 23% of all consultations.Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n=102) and PET‐CT in 14.2% (n=49).Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2%, and 5.3% of cases, respectively.Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow‐ups (p=0.0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians.Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV=10.4%) and mouth/throat pain (PPV=9.2%).ConclusionsDedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET‐CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient‐initiated symptom driven follow‐up.

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Locoregional control, progression‐free survival and morbidity rates in N3 head and neck cancer patients with low primary tumor burden, a 301‐patient study

\nF. Carsuzaa, \nX. Dufour, \nP. Gorphe, \nC. Righini, \nA. Cosmidis, \nM. Rogé, \nE. De Mones, \nS. Servagi Vernat, \nD. Tonnerre, \nS. Morinière, \nA. Dugas, \nO. Malard, \nF. Pasquier, \nS. Vergez, \nU. Schick, \nM. Gérard, \nJ. Salleron, \nJ. Thariat\n

Publicatie 29-07-2020


AbstractObjectivesIn patients with N3 head and neck squamous cell carcinoma (HNSCC), N3‐disease is associated with high regional relapse and metastatic risks. Patients with resectable N3‐disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3‐disease.MethodsThis retrospective multicentric study included T0‐2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non‐surgical groups were analyzed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes.Resultsof 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy, and 91 (30%) chemoradiation. The 24‐ and 60‐month incidence of locoregional relapse was 23.2% 18.3%; 28.4% and 27.4% 21.8%; 33.3%; it was lower in patients undergoing uND (p = 0.006). In patients with non‐surgical treatments, success rates were 57.8% 49.4%; 66.3% after chemoradiation and 38.1% 29.6%; 46.7% after neoadjuvant chemotherapy (p = 0.001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (p < 0.001).ConclusionuND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non‐responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted.

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Drainless head and neck surgery: a retrospective review of 156 procedures (thyroidectomy, parotidectomy and neck dissections in a tertiary setting)

\nEJ Crossley, \nTC Biggs, \nM Jog, \nK Marinakis, \nF Sipaul, \nP Brown, \nT Singh\n

Publicatie 29-07-2020


AbstractPercutaneous drains are frequently used in head and neck surgery cases. However, although effective at preventing postoperative haematoma formation their use can also be associated with significant complications, including infection, fistulae, pain, psychosocial implications, and most notably prolongation of hospital stay. As such, some authors have advocated approaches to minimise or avoid the use of percutaneous drains altogether, mainly through the use of surgical adjuncts such as fibrin glue to ‘stick down’ flaps preventing fluid/blood accumulating; pressure dressings to minimise the risk of haematoma formation; or consideration of early drain removal to facilitate expedited hospital discharge. Some authors are beginning to advocate drainless techniques without the use of advanced dressings or glues, typically thyroid surgery in selected cases. Indeed, meta‐analyses of thyroid and parathyroid surgery have demonstrated no significant difference in complication rates between the routine use of drains and patients managed without. However to our knowledge there are currently no studies examining complete drainless Head and Neck surgery. To this end, this case series examines 156 consecutive head and neck surgical procedures undertaken within a tertiary centre without the traditional use of percutaneous drains or any associated adjuncts.

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Clinical outcome of exclusive endoscopic tympanoplasty with porcine small intestine submucosa in 72 patients

\nChin‐Kuo Chen, \nLi‐Chun Hsieh\n

Publicatie 28-07-2020


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Our experience of the increased rates of post tonsillectomy haemorrhage in 1538 children with pre‐operative infective symptoms or signs

\nJames Johnston, \nAaron Vergeer, \nNatasha Donaldson, \nSubhaschandra Shetty, \nMurali Mahadevan\n

Publicatie 27-07-2020


AbstractTonsillectomy is one of the most commonly performed operations in the paediatric population worldwide. Despite the improvement in technology and perioperative care, the incidence of post‐tonsillectomy haemorrhage (PTH) has remained stable at around 5%. Risk factors that are associated with an increased incidence of PTH include older age at the time of surgery, and a background of attention deficit hyperactivity disorder (ADHD). There is conflicting evidence as to whether the primary surgical indication is associated with PTH, with some groups reporting a higher incidence in recurrent tonsillitis and other groups reporting a higher incidence in children with sleep‐disordered breathing symptoms.

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How many patients will be eligible for cochlear implantation (CI) on audiological grounds, once the new 2019 NICE guidance takes effect? Evaluation of audiological data for the population of East Kent to estimate cochlear implantation eligibility based on NICE 2019 guidance (TA566) and NICE 2009 guidance (TA166)

\nRobert Grounds, \nEleojo Miachi, \nTina Beckham, \nCodruta Neumann, \nJoseph Wasson\n

Publicatie 22-07-2020


The 2019 revised NICE guidance (TA566) on cochlear implantation (CI) lowered the audiological threshold at which patients become eligible for CI. NICE estimates this will result in a 70% increase in CI by 2024/25. We performed a retrospective audit of all audiograms performed at East Kent Hospitals University Foundation Trust (serving a population of 695,000 people) over the last 6 years. We identified how many patients were eligible for CI using both the 2009 guidelines and the revised 2019 guidelines. When using the 2019 guidelines, 262% more patients were eligible on audiological grounds for CI (P=0.0009). Increased demand for CI surgeons will require either higher throughput from existing centres, or the creation of new centres entirely, whilst training more surgeons may require a corresponding increase in CI fellowships.

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Letter to the Editor in reference to: Interspecialty referral of oesophagogastric and pharyngolaryngeal cancers delays diagnosis and reduces patient survival: A matched case‐control study

\nJohn E. Fenton\n

Publicatie 22-07-2020


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Acknowledging personal biases in otolaryngology manuscript selection

\nWilliam James Moss\n

Publicatie 22-07-2020


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Pan‐Scotland tonsillectomy outcomes: a national cross‐sectional study

\nThomas D Milner, \nOmar Hilmi, \nJohn Marshall, \nKenneth MacKenzie\n

Publicatie 19-07-2020


AbstractObjectivesThe aim of this study was to assess the current post‐tonsillectomy haemorrhage and return to theatre rates in ScotlandDesignNational cross‐sectional studyParticipants and settingTonsillectomy outcomes data were collated for all NHS patients undergoing tonsillectomy in Scotland between 1998‐2002 and 2013‐2017Main outcome measuresUsing Information Services Division (ISD) Scotland retrospective data, 30‐day readmission and 30‐day return to theatre rates allowed an assessment of post‐tonsillectomy haemorrhage rates. Data were validated through comparison with an audit conducted in NHS Greater Glasgow & Clyde between 2015‐2016.ResultsTonsillectomy was performed in 27,819 patients between 1998‐2002, and 23,184 patients between 2013‐2017. 30‐day readmission rates increased considerably between the 1998‐2002 and 2013‐2017 cohorts, from 4.7% to 12.1% in paediatric patients, and 9.8% to 19.9% in adult patients. Similarly, 30‐day ‘return to theatre rates’ increased between the two cohorts, from 1.2% to 1.7% in paediatric patients, and 3.6% to 4.9% in adult patients. Re‐admission and return to theatre rates were similar across Health Boards for both adult and paediatric tonsillectomies in each cohort.ConclusionsCurrent 30‐day readmission and return to theatre rates are significantly higher than the majority of reported series to date. The rising rate of tonsillectomy haemorrhage between cohorts is likely to be multifactorial, possibly reflecting an underestimation of previous rates, and the changing profile of the tonsillectomy patient. A detailed audit of current practice is needed to investigate these tonsillectomy outcomes, which are similar across all Health Boards in Scotland. Of most significance are the implications for accurate patient consent and non‐elective ENT service provision.

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Endopharyngeal Ultrasound: description of a novel technique to overcome a common diagnostic dilemma in a patient with a deep neck space mass

\nTaha Mur, \nOsamu Sakai, \nLauren Tracy, \nKei Suzuki, \nDaniel Faden\n

Publicatie 14-07-2020


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Management of cN0 low‐grade mucoepidermoid carcinomas of salivary glands: Prospective multicentre study of 152 cases of the French Network of Rare Head and Neck Tumors (REFCOR)

\nLaurie Saloner Dahan, \nRoch Giorgi, \nRenaud Garrel, \nLudovic Le Taillandier de Gabory, \nValérie Costes‐Martineau, \nPhilippe Herman, \nGilles Poissonnet, \nOlivier Mauvais, \nOlivier Malard, \nSébastien Vergez, \nEmmanuelle Uro‐Coste, \nBéatrix Barry, \nChristine Bach, \nDominique Chevalier, \nFrancois Mouawad, \nJean‐Claude Merol, \nVianney Bastit, \nJuliette Thariat, \nLaurent Gilain, \nXavier Dufour, \nChristian‐Adrien Righini, \nPatrick Dessi, \nJustin Michel, \nThomas Radulesco, \nCaroline Even, \nBertrand Baujat, \nNicolas Fakhry\n

Publicatie 14-07-2020


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Prospective anatomical study to determine the site of insertion of recurrent laryngeal nerve into the larynx

\nJames X. Wu, \nMartin Hanson, \nShivangi Lohia, \nHao Li, \nLaura Wang, \nAshok R. Shaha, \nIan Ganly\n

Publicatie 08-07-2020


AbstractObjectivesDetermine whether the insertion site of the recurrent laryngeal nerve (RLN) occurs at a predictable distance from the midline trachea, to help guide safe dissection during thyroid surgery.DesignProspective clinical trial. At the inferior edge of the cricoid cartilage, we measured the distance from mildline trachea to the RLN insertion site.SettingSingle institution.Participants50 consecutive patients undergoing thyroid surgery.Main outcome measuresDistance from midline trachea to laryngeal insertion of RLN.ResultsThe study population included 36 women and 14 men, with 72 total nerves measured. The average distance‐to‐midline + standard deviation (range) of the RLN was 20.7 + 2.3 (17‐26) mm in women compared to 26.3 + 2.1 (22‐32) mm in men.ConclusionThe insertion point of the RLN into the larynx at the level of inferior border of the cricoid cartilage can be reliably predicted, to facilitate early identification of the RLN during thyroid surgery.

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Regenerative Efficacy of Fibroblast Growth Factor for the Treatment of Aged Vocal Fold: From Animal Model to Clinical Application

\nMyung Jin Ban, \nSeung Chul Lee, \nJae Hong Park, \nKi Nam Park, \nHee Kyung Kim, \nSeung Won Lee\n

Publicatie 18-06-2020


AbstractObjectivesWe assessed fibroblast growth factor (FGF) regenerative efficacy in an aged vocal fold rat model and confirmed it in a prospective clinical trial.Design, Setting, and ParticipantsFor animal experiments, 48 Sprague‐Dawley rats were divided into two groups: 24 six‐month‐olds (young group) and 24 twenty‐four‐month‐olds (old group). FGF was injected once a week thrice into the left vocal fold of the old group, dividing them into two sub‐groups (injected left and uninjected right). Additionally, we conducted a prospective clinical trial for 38 patients with aged atrophic vocal fold.Main Outcome MeasuresA month post‐injection, excised larynx from the three groups was subjected to comparative histopathological (ratio of relative lamina propria to total vocal fold) and mRNA expression analysis (of procollagen I, hyaluronic acid synthase (HAS)‐2, and matrix metalloproteinase (MMP)‐2) by real‐time PCR. We performed perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index survey prior to and 1, 6, and 12 months after FGF injection.ResultsIn rats, the relative lamina propria ratio increased after FGF injection. Procollagen I mRNA level decreased, whereas that of HAS‐2 and MMP‐2 increased significantly in the injected compared to the uninjected old group. Enrolled patients showed improved subjective and objective voice parameters after FGF injection and these were maintained for a year. Potential side effects were not observed.ConclusionsAnimal experiments and prospective clinical trial suggest that FGF injection to vocal fold can significantly improve voice quality until one year, without complications, and is effective for aged atrophic vocal fold treatment.

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Comparative Cohort Study of Volumetric Modulated Arc Therapy for Squamous cell cancer of unknown primary in the Head and Neck – involved neck only versus mucosal irradiation

\nWY Poon, \nM Thomson, \nP McLoone, \nC Wilson, \nR Crosbie, \nS Schipani, \nD Grose, \nA James, \nC Lamb, \nM Rizwanullah, \nF Campbell, \nF Easton, \nC Paterson\n

Publicatie 05-06-2020


AbstractObjectivesTarget volumes for irradiation remain ill‐defined for squamous cell cancer of unknown primary in the head and neck (SCCUP). The aim of this study was to compare involved neck only (INO) radiotherapy (RT) with irradiating involved neck plus potential mucosal primary sites and contralateral neck (MUC) in patients diagnosed and treated with modern diagnostics and techniques.DesignThis is a retrospective cohort study. Patients with a diagnosis of SCCUP with unilateral neck disease were included.Results30 patients were identified. All underwent FDG PET‐CT. 47% of patients had HPV positive SCC. 20 patients received RT to INO, 10 patients to MUC, all with volumetric modulated arc therapy (VMAT).A significantly lower dose for each organ at risk was delivered in INO treated patients, with mean dose to contralateral parotid gland 57% less. The proportion of patients with late grade 2 or worse xerostomia was higher in MUC patients. The incidence of grade 2‐3 mucositis (89% vs. 45%) and grade 3 or worse dysphagia (50% Vs 10%) was higher in MUC patients.Median follow up was 31 months. No mucosal primaries emerged. Progression free survival at 2 years was 74.7% for INO patients, 70% in the MUC group. Overall survival at 2 years was 79.7% in the INO group and 70% in the MUC patients.ConclusionINO radiotherapy for patients with SCCUP of the head and neck is a safe treatment strategy resulting in clinically significant lower RT doses to OARS. Acute and late toxicities are reduced without detriment to patient survival.

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Quantitative comparison of endoscopically‐assisted endonasal, sublabial, and transorbital transmaxillary approaches to the anterolateral skull base

\nBon‐Jour Lin, \nDa‐Tong Ju, \nTzu‐Hsien Hsu, \nYi‐An Chen, \nTzu‐Tsao Chung, \nWei‐Hsiu Liu, \nDueng‐Yuan Hueng, \nYuan‐Hao Chen, \nChung‐Ching Hsia, \nHsin‐I Ma, \nMing‐Ying Liu, \nChi‐Tun Tang\n

Publicatie 29-04-2020


AbstractObjectivesThe aim of this anatomical study is to make quantitative comparison among three endoscopic approaches, encompassing contralateral endonasal transseptal transmaxillary transpterygoid approach (contralateral EEA), endoscopic sublabial transmaxillary transalisphenoid (Caldwell‐Luc) approach, and endoscopic transorbital transmaxillary approach through inferior orbital fissure (ETOA), to the anterolateral skull base for assisting preoperative planning.Design & ParticipantsAnatomical dissections were performed in four adult cadaveric heads bilaterally using three endoscopic transmaxillary approaches described above.SettingSkull Base Laboratory at the National Defense Medical Center.Main outcome measuresThe area of exposure, angles of attack, and depth of surgical corridor of each approach were measured and obtained for statistical comparison.ResultsThe ETOA had significantly larger exposure over middle cranial fossa (731.40 ± 80.08 mm2) than contralateral EEA (266.60 ± 46.74 mm2) and Caldwell‐Luc approach (468.40 ± 59.67 mm2). In comparison with contralateral EEA and Caldwell‐Luc approach, the ETOA offered significantly greater angles of attack and shorter depth of surgical corridor (P < 0.05 for all comparisons).ConclusionsThe ETOA is the superior choice for target lesion occupying multiple compartments with its epicenter located in the middle cranial fossa or superior portion of infratemporal fossa.

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