European Archives of Oto Rhino Laryngology 2020-12-21

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

Publication date 21-12-2020


Purpose The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). Methods A pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. Results Consultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. Conclusion This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

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A new nomogram to predict the need for tracheostomy in burned patients

Publication date 21-12-2020


Purpose To evaluate the impact of tracheostomy on complications, dysphagia and outcome in second and third degree burned patients. Methods Inpatient mortality, dysphagia, severity of burn injury (ABSI, TBSA) and complications in tracheotomized burn patients were compared to (I) non-tracheotomized burn patients and (II) matched tracheotomized non-burn patients. Results 134 (30.9%) out of 433 patients who underwent tracheostomy, had a significantly higher percentage of inhalation injury (26.1% vs. 7.0%; p < 0.001), higher ABSI (8.9 ± 2.1 vs. 6.0 ± 2.7; p < 0.001) and TBSA score (41.4 ± 19.7% vs. 18.6 ± 18.8%; p < 0.001) compared to 299 non-tracheotomized burn patients. However, complications occurred equally in tracheotomized burn patients and matched controls and tracheostomy was neither linked to dysphagia nor to inpatient mortality at multivariate analysis. In particular, dysphagia occurred in 6.2% of cases and was significantly linked to length of ICU stay (OR 6.2; p = 0.021), preexisting neurocognitive impairments (OR 5.2; p = 0.001) and patients’ age (OR 3.4; p = 0.046). A nomogram was calculated based on age, TBSA and inhalation injury predicting the need for a tracheostomy in severely burned patients. Conclusion Using the new nomogram we were able to predict with significantly higher accuracy the need for tracheostomy in severely burned patients. Moreover, tracheostomy is safe and is not associated with higher incidenc of complications, dysphagia or worse outcome.

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European white paper: oropharyngeal dysphagia in head and neck cancer

LWJ Baijens,M Walshe,LM Aaltonen,C Arens,R Cordier,P Cras,L Crevier-Buchman,C Curtis,W Golusinski,R Govender,JG Eriksen,K Hansen,K Heathcote,MM Hess,S Hosal,JP Klussmann,CR Leemans,D MacCarthy,B Manduchi,JP Marie,R Nouraei,C Parkes,C Pflug,W Pilz,J Regan,N Rommel,A Schindler,AMWJ Schols,R Speyer,G Succo,I Wessel,ACH Willemsen,T Yilmaz,P Clavé

Publication date 19-12-2020


Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

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Practical applicability of the STAMCO and ChOLE classification in cholesteatoma care

Geen auteurs bekend

Publication date 18-12-2020


Background To compare cholesteatoma care internationally and to evaluate outcomes, ear surgeons must use the same terminology. However, a clear universal definition on how to describe the extension, destruction and accompanying morbidity caused by the cholesteatoma is lacking. The practical applicability by means of interrater agreement is assessed for the STAMCO and the ChOLE classification. Methods A total of 134 adult patients derived from the nationwide multicentre study in the Netherlands, entitled Dutch Cholesteatoma Data (DCD) were included. Retrospective analysis of 134 surgical reports according to the STAMCO and ChOLE classification for localisation/extension of the cholesteatoma, complication status and ossicular chain status. Both the percentage agreement and the interrater agreement were determined for each item of the classifications and interrater agreement was compared between the classifications as a whole. Results Differences in interrater agreement were found for both the localisation/extension of the cholesteatoma and ossicular chain status. STAMCO classification derived from the surgical report scored better on the localisation/extension of the cholesteatoma, whereas the ChOLE classification derived from the surgical report scored better on the status of the ossicular chain. In both classifications, complication status had a low agreement level but was also poorly registered in the surgical reports. Conclusion Both STAMCO and ChOLE will be beneficial in uniform registration of cholesteatoma pathology in practice. Modifications proposed for both classifications may make them even more practical applicable in the future. A common denominator obtained from these two classifications may be incorporated in a standardised surgical report to facilitate evaluation which make outcomes transferable towards both classifications.

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Monitoring of the auditory pathway maturation after early intervention during the first year of life in infants with sensorineural hearing loss

F Matin,S Haumann,W Roßberg,D Mitovska,T Lenarz,A Lesinski-Schiedat

Publication date 18-12-2020


Purpose The objective of this study was to investigate the auditory pathway maturation monitored by auditory brainstem responses (ABR) in infants with hearing loss during the first year of life. ABR were used to estimate hearing thresholds and the effect of early intervention strategies using hearing aids (HA). Methods Click-evoked ABRs were measured in 102 infants aged from 0 to 12 months to determine their individual auditory threshold. Early therapy intervention was recommended before 12 months of age and analyzed. To evaluate the effect of hearing amplification on auditory maturation, different subgroups of infants with moderate hearing loss were analyzed and the auditory pathway maturation was determined based on IPL I–V shortening. Results Overall, 110 ears (54.0% of 204 ears) with mild to profound HL showed threshold changes of 10 dB up to 60 dB in the follow-up ABR testing. HA were prescribed at the age of 3.8 ± 3.9 months. Cochlear implantation (CI) was performed in cases of repeated profound HL at the age of 9.9 months ± 4.5 months. A significant shortening of IPL I–V in all subgroups of infants (with and without risk factors) who received HA was shown and assumed auditory pathway maturation. Conclusion An early intervention using optimally fitted HA influenced auditory pathway maturation and may lead to improvements of hearing thresholds during the first year of life in infants. This study underscores the importance of not only providing HAs to infants, but also controlling for hearing threshold changes ensuring that HAs provide the optimal level of intervention or CI is indicated.

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Multimodal control of neck muscles for vestibular mediated head oscillation damping during walking: a pilot study

M Hölzl,W Neuhuber,O Ueberschär,A Schleichardt,N Stamm,C Arens,A Biesdorf,U Goessler,R Hülse

Publication date 15-12-2020


Purpose It is still in question whether head oscillation damping during walking forms a part of the vestibular function. The anatomical pathway from the vestibular system to the neck muscles via the medial vestibulospinal tract (MVST) is well known but there is a lack of knowledge of the exact influence and modulation of each other in daily life activities. Methods (I) We fixed a head–neck unit of a human cadaver specimen in a steal frame to determine the required pitch-torque for a horizontal head position. The mean value of the acquired pitch-torque was 0.54 Nm. (II) On a motorized treadmill we acquired kinematic data of the head, the sternum and both feet by wireless 3D IMUs for seven asymptomatic volunteers. Subsequently three randomized task conditions were performed. Condition 1 was walking without any irritation. Condition 2 imitated a sacculus irritation using a standardized cVEMP signal. The third condition used an electric neck muscle-irritation (TENS). The data were analyzed by the simulation environment software Open Sim 4.0. Results 8 neck muscle pairs were identified. By performing three different conditions we observed some highly significant deviations of the neck muscle peak torques. Analysing Euler angles, we found during walking a LARP and RALP head pendulum, which also was strongly perturbated. Conclusion Particularly the pitch-down head oscillation damping is the most challenging one for neck muscles, especially under biomechanical concerns. Mainly via MVST motor activity of neck muscles  might be modulated by vestibular motor signals. Two simultaneous proprioceptor effects might optimize head oscillation damping. One might be a proprioceptive feedback loop to the vestibular nucleus. Another might trigger the cervicocollic reflex (CCR).

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Facial palsy in children: long-term outcome assessed face-to-face and follow-up revealing high recurrence rate

M Kanerva,H Liikanen,A Pitkäranta

Publication date 15-12-2020


Purpose To evaluate the long-term (minimum of 2 years from the palsy onset) outcome of pediatric facial palsy by patient questionnaire and face-to-face assessment by the Sunnybrook facial grading system, House–Brackmann grading system, and Facial Nerve Grading System 2.0. To compare the outcome results of self-assessment with the face-to-face assessment. To assess the applicability of the grading scales. To assess the palsy recurrence rate (minimum of a 10-year follow-up).
Methods 46 consecutive pediatric facial palsy patients: 38 (83%) answered the questionnaire and 25 (54%) attended a follow-up visit. Chart review of 43 (93%) after a minimum of 10 years for the facial palsy recurrence rate assessment. Results Of the 25 patients assessed face-to-face, 68% had totally recovered but 35% of them additionally stated subjective sequelae in a self-assessment questionnaire. Good recovery was experienced by 80% of the patients. In a 10-year follow-up, 14% had experienced palsy recurrence, only one with a known cause. Sunnybrook was easy and logical to use, whereas House–Brackmann and the Facial Nerve Grading System 2.0 were incoherent. Conclusions Facial palsy in children does not heal as well as traditionally claimed if meticulously assessed face-to-face. Patients widely suffer from subjective sequelae affecting their quality of life. Palsy recurrence was high, much higher than previously reported even considering the whole lifetime. Of these three grading systems, Sunnybrook was the most applicable.

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Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

S Riemann,I Speck,K Gerstacker,C Becker,A Knopf

Publication date 15-12-2020


Purpose The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. Methods We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. Results We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. Conclusion The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.

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Author’s reply: Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy

C Cipolla,E Fiorentino

Publication date 01-12-2020


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Correction to: Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study

I Dallan,C Cambi,E Emanuelli,D Cazzador,FR Canevari,D Borsetto,JR Tysome,NP Donnelly,M Rigante,C Georgalas,I Alobid,G Molteni,D Marchioni,AK Shahzada,M Scarano,V Seccia,E Pasquini

Publication date 01-12-2020


In the original publication of the article, the following affiliation “Medical school, University of Nicosia, Nicosia, Cyprus” of the author “Christos Georgalas” was missed and included in this correction.

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Correction to: Total thyroidectomy with therapeutic level II–IV neck dissection for papillary thyroid carcinoma: level VI recurrence patterns

NN Carmel-Neiderman,I Duek,D Amsterdam,A Wengier,B Kuzmenko,B Ringel,A Warshavsky,U Shapira,G Horowitz,E Izkhakov,DM Fliss

Publication date 01-12-2020


The original article can be found online.

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Author’s Reply to Letters to the Editor: “A comparison of endoscopic transtympanic myringoplasty and endoscopic type I tympanoplasty for repairing medium- to large-sized tympanic membrane perforation: a randomized clinical trial”

V Atchariyasathian,R Suwannajak,Y Plodpai,P Pitathawatchai

Publication date 01-12-2020


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Two-drape closed pocket technique: minimizing aerosolization in mastoid exploration\xa0during COVID-19 pandemic

A Das,S Mitra,S Kumar,A Sengupta

Publication date 01-12-2020


Background Mastoidectomy is associated with extensive bone-drilling which makes it a major aerosol generating procedure. Considering the ongoing COVID-19 global pandemic, it is essential to devise methods to minimize aerosolization and hence ensure safety of the healthcare workers during the operative procedure. Methods Two disposable surgical drapes are used to create a closed pocket prior to commencement of mastoid bone-drilling. This limits aerosolization of bone-dust in the external operating theatre environment. Conclusion Two-drape closed pocket technique is an easy, cost-effective and safe method to limit aerosolization of tissue particles during mastoidectomy.

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Pharyngo-esophageal complications of Ryle tube insertion in neonates: management and fate

AM Refaat,MN Kotby

Publication date 01-12-2020


Introduction The following provides clinical reporting of seven neonates with iatrogenic pharyngeal trauma due to forceful untrained use of nasogastric feeding tube. A range of symptoms were observed beginning with excessive frothy secretions culminating in more severe pneumothorax in some. These cases are presented in the context of an exhaustive literature review producing only 50 similar cases worldwide. Special attention is paid toward accurate diagnosis, prognosis, and guidance on most effective modes of treatment. Patients and Methods Using Medtronic flexible nasopharyngolaryngeal endoscope, examination of the presented neonates was done in the neonatal care unit. Some neonates underwent videofluroscopic study. Conclusion Ryle tube insertion in neonates could result in range of complications that could be easily avoided and managed.

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Endoscopic transtympanic myringoplasty should be cautious for repairing large perforation

Z Lou

Publication date 01-12-2020


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Laryngopharyngeal reflux after thyroidectomy

JR Lechien,M Verhasselt,D Dequanter,A Rodriguez,S Saussez

Publication date 01-12-2020


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Author’s response to the letter of the editor regarding the “Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors”

G Psychogios,C Bohr,J Constantinidis,M Canis,V Vander Poorten,J Plzak,A Knopf,C Betz,O Guntinas-Lichius,J Zenk

Publication date 01-12-2020


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Change in Warthin’s tumor incidence: a 20-year joinpoint trend analysis

O Tunç,B Gönüldaş,Y Arslanhan,M Kanlıkama

Publication date 01-12-2020


Purpose The incidence of Warthin’s tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population. Methods We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend. Results In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = − 3.6–12.9, P = 0.300). Conclusion The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.

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Changes in the use of Otorhinolaryngology Emergency Department during the COVID-19 pandemic: report from Lombardy, Italy

F Elli,M Turri-Zanoni,AD Arosio,A Karligkiotis,P Battaglia,P Castelnuovo

Publication date 01-12-2020


Purpose This paper aims to report the impact of COVID-19 outbreak on Emergency Ear nose and Throat (ENT) activity, in Lombardy (Italy), during COVID-19 pandemic. Methods The number of accesses to Emergency Department requiring ENT consultations between February 21st and May 7th, 2020, was retrospectively collected, along with the conditions treated. Data were stratified in 1-week time spans, to evaluate the evolving trends during the on-going epidemic and a comparison with the two previous years was performed. Results A significant reduction in the number of consultations performed during the pandemic was observed, as high as − 91% compared to the same period of 2018. Conclusion Multiple reasons can explain such a reduction of Emergency ENT consultations, not least the fear of potentially being infected by SARS-CoV-2 by while accessing the hospital. The analysis performed might be useful as a starting point for a future reorganization of first aid consultations once the epidemic will be resolved.

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Regarding the “Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors”

D Tretiakow,A Skorek

Publication date 01-12-2020


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