European Archives of Oto Rhino Laryngology 2020-10-01

Reply to letter to the editor “The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls”

L Dostalova,D Kalfert,A Jechova,V Koucky,S Novak,M Kuchar,M Zabrodsky,D Novakova Kodetova,M Ludvíkova,I Kholova,J Plzak

Publicatie 01-10-2020


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Moderate hypofractionation for early laryngeal cancer improves\n local control

MS Luo

Publicatie 01-10-2020


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Moderate hypofractionation for early laryngeal cancer improves local control with increased risk of mucositis: clarification

R Benson,P Giridhar,S Mallick

Publicatie 01-10-2020


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Correction to: ATF5 involved in radioresistance in nasopharyngeal carcinoma by promoting epithelial-to-mesenchymal phenotype transition

Y Shuai,E Fan,Q Zhong,G Feng,Q Chen,X Gou,G Zhang

Publicatie 01-10-2020


The article ATF5 involved in radioresistance in nasopharyngeal carcinoma by promoting epithelial-to-mesenchymal phenotype transition, written by Yu Shuai, Erxi Fan, Qiuyue Zhong, Guangyong Feng, Qiying Chen, Xiaoxia Gou, Guihai Zhang, was originally published.

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The role of fine‑needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls

D Tretiakow,B Mikaszewski,A Skorek

Publicatie 01-10-2020


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Reply to “Could a mannequin simplify rhinopharyngeal swab collection in COVID 19 patients?”

M Tagliabue,G Pietrobon,S Ugolini,F Chu,M Ansarin

Publicatie 01-10-2020


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Personal protective equipment for ENT activity during COVID-19 pandemic

P Farneti,F Sorace,I Tasca

Publicatie 01-10-2020


Abstract Background In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. Methods A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patients chair. Results Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. Conclusion A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.

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Could a mannequin simplify rhinopharyngeal swab collection in COVID 19 patients?

BN Francesca,P Barbara,F Emanuele,SDC Francesco,C Giovanni,M Fabio,C Giovanni

Publicatie 01-10-2020


Abstract Rhinopharyngeal swab collection is used to test patients for COVID-19; unfortunately, the false negative rate is around 30% in symptomatic patients, and maybe even higher in asymptomatic ones. A correct swab collection is consequently critical. Swabs are usually performed by dedicated personnel, but at the present moment, the methods for its training are not standardized. In a Letter to the Editor recently published in the European Archives of Otorhinolaringology, Tagliabue et al. describe the training method used in their Institution: the personnel dedicated to swab collection increases its confidence with the procedure by observing endoscopic anatomy, while an otolaryngologist performs rigid endoscopy. Although we found this paper interesting, we think that the author’s proposal has timing and financial drawbacks that should be considered in daily activity, especially in an emergency period like the pandemic we are experiencing. In this Letter to the Editor, we discuss some pre-analytic and analytic issues that should be considered while performing rhinopharyngeal swabs, and we propose the use of a mannequin to train personnel, thus reducing the risk of infection for health workers, and patient’s discomfort.

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The nasal tent: an adjuvant for performing endoscopic endonasal surgery in the Covid era and beyond

SH Maharaj

Publicatie 01-10-2020


Abstract Purpose To propose a cost-effective reproducible barrier method to safely perform endoscopic endonasal surgery during the Covid-19 pandemic. Methods This manuscript highlights the use of a clear, cost-effective disposable plastic sheet that is draped as a tent over the operating area to contain aerolization of particles. This is then connected to a suction to remove airborne particles and thus reduce transmission of the virus. Conclusion The use of a nasal tent is a simple and affordable method to limit particle spread during high-risk aerolisation procedures during the Covid era and beyond.

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Acetic acid disinfection as a potential adjunctive therapy for non-severe COVID-19

L Pianta,A Vinciguerra,G Bertazzoni,R Morello,F Mangiatordi,VJ Lund,M Trimarchi

Publicatie 01-10-2020


Abstract Purpose SARS-CoV-2 is a new pandemic influenza caused by a coronavirus which main route of transmission is through exhaled droplets that primarily infect the nose and the nasopharynx. The aim of this paper is to evaluate the effect of acetic acid, the active component of vinegar, as a potential disinfectant agent for upper airways. Methods Twenty-nine patients were enrolled and divided into two groups: group 1 (14 patients) was composed of patients treated with off-label hydroxychloroquine and lopinavir/ritonavir, whereas group 2 (15 patients) was composed of patients treated with hydroxychloroquine only, combined with the inhalation of acetic acid disinfectant at a 0.34% concentration. A questionnaire-based evaluation of symptoms was performed after 15 days in both groups. Results It appears that the number of patients treated with acetic acid (group 2) that experienced improvement in individual symptoms was double that of the other group of patients (group 1), although numbers are too small for robust statistical analysis. Conclusions Considering its potential benefits and high availability, acetic acid disinfection appears to be a promising adjunctive therapy in cases of non-severe COVID-19 and deserves further investigation.

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Claviculotracheopexy for complex airway reconstructions

K Sandu,P Vinckenbosch-Jaballah,L Duchoud

Publicatie 01-10-2020


Abstract Purpose Revision surgery for correcting benign laryngotracheal stenosis is challenging and it gets complicated in patients with comorbidities. To improve results in such cases, we describe a new technique of stabilizing the trachea by splinting it to the clavicle on both sides. Methods Retrospective case series. Results Three patients received claviculotracheopexy to maintain their tracheal static. The surgery offers an immediate and optimal support to an unstable trachea. Conclusion Claviculotracheopexy can be used as a complementary procedure in complex airway reconstructions.

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Laryngopharyngeal reflux and autonomic nerve dysfunction: what about stress?

Publicatie 01-10-2020


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The primary tumor resection in patients with distant metastatic laryngeal carcinoma

Z Lin,H Lin,X Chen,Y Xu,X Wu,X Ke,C Lin

Publicatie 01-10-2020


Abstract Background The role of primary tumor resection in patients with distant metastatic laryngeal carcinoma (DMLC) has not been clarified completely. Thus, we used propensity score matching (PSM) and survival analysis to address this issue. Methods The PSM was utilized to avoid selection bias and disproportionate distributions of the confounding factors. Kaplan–Meier estimates and Cox proportional hazard analysis were utilized to evaluate overall survival (OS) and cancer-specific survival (CSS). Results From the Surveillance, Epidemiology, and End Results Program database, a cohort of 480 patients with DMLC were included. After PSM, the OS and CSS for patients who underwent resection were significantly longer than those without resection (median OS: 19 months vs. 8 months, P < 0.001; median CSS: 19 months vs. 9 months, P = 0.002). Tumor resection significantly prolonged survival of DMLC patients with appropriate demographic and clinical characteristics. In the multivariate analysis, age at diagnosis, race, pathologic subtype, and marital status were found significantly affecting both OS and CSS of patients who underwent surgical resection. Predictive nomograms were developed to help distinguish patients with early mortality potential after surgical resection. Conclusions This study is the first one using PSM to assess the role played by surgical resection in DMLC and evaluate the prognostic factor of resected patients. Premised on well controlled postoperative complications, resection could significantly prolong OS and CSS of certain patients.

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Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT

J Fehrm,A Borgström,P Nerfeldt,D Friberg

Publicatie 01-10-2020


Abstract Purpose In our previous randomized controlled trial (RCT), comparing adenotonsillectomy (ATE) with adenopharyngoplasty (APP) in children with severe obstructive sleep apnea (OSA), there were no differences in respiratory sleep parameters or quality of life. The purpose of the present report was to evaluate postoperative morbidity from this RCT. Methods The study was a blinded RCT in 83 children (ATE = 47; APP = 36), 2–4 years of age, with an obstructive apnea–hypopnea index of ≥ 10. Pain was assessed from the first until the tenth day after surgery with a logbook that reported pain by child (FPS-R, Faces Pain Scale-Revised) and caregiver (visual analogue scale), analgesic use, return to normal diet, and weight change. Bleeding, infection, satisfaction with treatment, speech, and swallowing were assessed with a questionnaire and medical records 6 months after surgery. Results Sixty-four children (77%) returned the logbook and 65 (78%) answered the questionnaire. The median (interquartile range) day the children graded themselves as pain free (FPS-R = 0) was 7 (6–10) after ATE, compared with 9 (7 to > 10) after APP (p = 0.018). There were no other significant differences between the groups regarding any other pain-related outcomes, bleeding, infection, satisfaction, swallowing, or speech, but three children (11%) reported impaired speech after APP compared to none after ATE (p = 0.067). Conclusion The results regarding postoperative morbidity were in favor of ATE and the results from our previous report showed no advantages of APP. Therefore, APP should not be recommended in young, otherwise healthy children with OSA.

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Risk factors for residual mouth breathing in children who had completely resolved obstructive sleep apnea after adenotonsillectomy

J Bae,DK Kim

Publicatie 01-10-2020


Abstract Purpose Adenotonsillectomy is the first-line treatment for pediatric obstructive sleep apnea (OSA). However, although completely resolved OSA after adenotonsillectomy, some children still showed persistence of mouth breathing. Therefore, we attempted to identify risk factors for residual mouth breathing in children with OSA after successful adenotonsillectomy. Materials and methods This study retrospectively enrolled children who underwent adenotonsillectomy as a treatment of OSA. Additionally, children who showed apnea–hypopnea index ≥ 1 on 1-year postoperative polysomnography or adenoid regrowth on one-year postoperative lateral cephalogram were excluded. The presence of allergic rhinitis, septal deviation, dentofacial abnormalities, the size of tonsil and adenoid was also evaluated in all enrolled children. Dentofacial abnormalities were defied as a high palatal arch, macroglossia, retrognathia, micrognathia, and overcrowding of teeth which assessed by dentists. Results A total of 62 children were enrolled (no residual mouth-breathing group, n = 18 and residual mouth-breathing group, n = 44) in this study. There were no significant differences in demographic factors, physical examination, and sleep parameters, except age and preoperative adenoid size. On the multiple logistic regression analysis, we found that older age, large adenoid size, and presence of dentofacial abnormalities significantly correlated with residual mouth breathing (adjusted coefficient estimates = 0.3890, 2.3611, and 2.8615, respectively) after successful adenotonsillectomy. Conclusions Older age, large adenoid size, and presence of dentofacial abnormalities in children with OSA may be the risk factors for residual mouth breathing after successfully resolved OSA.

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Added value of susceptibility-weighted imaging to diffusion-weighted imaging in the characterization of parotid gland tumors

JS Jiang,LN Zhu,W Chen,L Chen,GY Su,XQ Xu,FY Wu

Publicatie 01-10-2020


Abstract Purpose To assess the added value of susceptibility-weighted imaging (SWI) to diffusion-weighted imaging (DWI) in the characterization of parotid gland tumors. Methods Seventy-eight patients with pathologically confirmed parotid gland tumors, who underwent DWI and SWI for pre-surgery evaluation, were enrolled. Apparent diffusion coefficient (ADC) and degree of intratumoral susceptibility signal intensity (ITSS) were measured and compared between benign and malignant groups, and among pleomorphic adenoma (PA), Warthin tumor (WT) and malignant tumor (MT). Independent sample t test, one-way analysis of variance and receiver operating characteristic curve analysis were used for statistical analyses. Results Benign parotid gland tumor showed a significantly higher mean ADC value than malignant tumors (0.836 ± 0.350 vs 0.592 ± 0.163, p = 0.001). Setting an average ADC value of 0.679 as the cut-off value, optimal differentiating performance could be obtained (AUC, 0.700; sensitivity, 62.69%; specificity, 81.82%) for differentiating malignant from benign tumors. PA showed significantly higher mean ADC and less ITSS than WT (ADC, p < 0.001; ITSS, p = 0.033) and MT (ADC, p < 0.001; ITSS, p = 0.024), while the difference between WT and MT was not significant (ADC, p = 0.826; ITSS, p = 0.539). After integration with ITSS, the diagnostic performance of ADC was improved for differentiating PA from WT (AUC 0.921 vs 0.873) and from MT (AUC 0.906 vs 0.882). Conclusion SWI could provide added information to DWI and serve as a supplementary imaging marker for the characterization of parotid gland tumors.

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Olfactory and gustatory abnormalities in COVID-19 cases

F Altin,C Cingi,T Uzun,C Bal

Publicatie 01-10-2020


Abstract Purpose At the time of writing, there is a pandemic affecting virtually every country on Earth. There is considerable discussion amongst clinicians as well as lay people about anosmia and ageusia in COVID-19 sufferers. We aimed to report the results from comprehensive olfactory and gustatory testing in a series of hospital in-patients. Methods The prospective study evaluated 81 individuals with a COVID-19 infection, as confirmed by 2019 n-cov Real-Time PCR laboratory testing. The control group consisted of forty individuals with COVID-19 negative. Olfactory and gustatory testings were carried out by an examiner utilizing stringent safety standards and wearing full personal protective equipment. The results obtained in the case group were then compared with those obtained for the controls. Results In the case group, 41(50.6%) of patients were male and 40 (49.4%) were female, mean age of 54.16 ± 16.98 years (18–95). In the control group, 21 (52.5%) of subjects were male and 19 (47.5%) were female, and mean age was 55 ± 15.39 years (18–90). Fifty (61.7%) COVID-19-positive patients had complaints related to olfaction. The distribution of olfactory symptoms in the case group differed at the level of statistical significance from the control group (p < 0.001). Turning to gustatory abnormalities, within the case group, 22 individuals (27.2%) had taste malfunction. A statistically significant difference was found in the distribution of gustatory abnormalities between cases and controls (p < 0.001). Conclusions Olfactory and gustatory dysfunctions are strongly associated with SARS-CoV-2 infection. Hyposmia with or without hypogeusia is potentially a reliable indicator of latent COVID-19.

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Device-related epistaxis risk: continuous-flow left ventricular assist device-supported patients

A Koycu,O Vural,M Bahcecitapar,S Jafarov,G Beyazpinar,DS Beyazpinar

Publicatie 01-10-2020


Abstract Background The aim of this study was to analyze the effect of device-dependent factors on epistaxis episodes comparing patients supported with a continuous-flow left ventricular assist device (CF-LVAD) to patients under the same antithrombotic therapy. Methods Patients who underwent CF-LVAD between 2012 and 2018 were reviewed retrospectively from the institutionally adopted electronic database. Patients who underwent mitral valve replacement (MVR) surgery receiving the same anticoagulant and antiaggregant therapy were included as a control group. Demographics, epistaxis episodes, and nonepistaxis bleeding between the two groups were compared. Results A total of 179 patients met the inclusion criteria (61 patients CF-LVAD group, 118 patients MVR group). The median (range) follow-up periods for the study (CF-LVAD) and control (MVR) groups were 370 (2819) and 545.70 (2356) days, respectively. There was a significant difference for frequency of bleeding episodes per month between CF-LVAD and MVR groups (p = 0.003 < 0.05). The most common site of bleeding was the anterior septum in both groups (90.9% for the CF-MVR group and 100% for the MVR group). While 14 patients (23%) had nonepistaxis bleeding in the CF-LVAD group, only two patients (1.7%) had nonepistaxis bleeding in the MVR group. There were significant differences in nonepistaxis bleeding rates between the CF-LVAD and MVR groups (χ2=19.79, p < 0.001). Conclusion Both epistaxis and nonepistaxis bleeding rates were higher in the CF-LVAD group than in the MVR group. This suggests that the use of CF-LVAD support could directly increase the risk of hemorrhagic complications. Level of evidence 2A (Etiology/Harm)

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External auditory canal carcinoma: clinical characteristics and long-term treatment outcomes

P Correia-Rodrigues,S Ramalho,P Montalvão,M Magalhães

Publicatie 01-10-2020


Abstract Purpose Evidence-based treatment recommendations for external auditory canal (EAC) carcinoma are lacking in available literature. This study aims to evaluate the clinical characteristics and long-term outcomes of EAC carcinoma in a tertiary referral centre in a period of 15 years and identify independent prognostic factors. Methods Retrospective observational study enrolling all patients with primary EAC carcinoma who underwent primary surgical treatment at the Portuguese Institute of Oncology (Lisbon) between 2004 and 2018. Epidemiological, clinical, histopathological and surgical data were retrieved from clinical records and analysed. Results Twenty-seven patients were identified, with a median age of 77 years (range 29–92 years) and a slight female predominance (59.3%). Squamous cell carcinoma (55.6%) was the most common histological type, followed by basal cell carcinoma (40.7%) and ceruminous adenocarcinoma (3.7%). Pittsburgh tumour staging was distributed as early stage in 51.9% (I: 40.7%; II: 11.1%) and advanced stage in 48.1% (III: 29.6%; IV: 18.5%). Median follow-up period was 21 months (interquartile-range: 47). Four patients (14.8%) showed recurrence; recurrence rate was significantly higher in individuals aged < 60 years (p = 0.025) and with lymphovascular invasion (p = 0.049). Median overall survival was 88 months and estimated 2-year and 5-year overall survival rates were both 66%. Survival rates were higher in early stage patients (p = 0.021) and in those without facial palsy (p = 0.032). Conclusion Based on the available evidence in this review, individuals aged < 60, facial nerve impairment, advanced stage lesions, presence of lymphovascular invasion and squamous cell carcinoma histology are all associated with poor outcome and may be considered when discussing optimal treatment strategies in patients with EAC carcinoma.

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The evaluation of prognostic factors in endoscopic cartilage tympanoplasty

E Dursun,S Terzi,E Demir,A Özgür,Ö Çelebi Erdivanlı,Z Özergin Coşkun,M Çeliker

Publicatie 01-10-2020


Abstract Purpose The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty. Methods This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated. Results The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05). Conclusion Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.

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