Clinical Otolaryngology

Clinical Otolaryngology

Effect of piezoelectric osteotomy on postoperative edema and ecchymosis after rhinoplasty: a systemic review and meta‐analysis

22-08-2019 – Do Hyun Kim, Haram Kang, Ho Jun Jin, Se Hwan Hwang

Abstract
Objectives
This study evaluated the efficacy of piezoelectric osteotomy in reducing edema and ecchymosis during rhinoplasty via a systematic review with meta‐analysis.
Data Sources
PubMed, Embase, SCOPUS, the Web of Science, the Cochrane library, and Google Scholar.
Review Methods
Two authors independently searched the referenced databases from inception to January 2019. They included studies that compared piezoelectric osteotomy (treatment groups) with conventional osteotomy (control group). The outcomes of interest were operative time, mucosal injury, edema, ecchymosis, and postoperative pain. Baseline study characteristics, quality of study, numbers of patients in the treatment and control groups, and outcomes were extracted. Sufficient data were retrieved for a meta‐analysis of six trials with a total of 327 patients.
Results
Intraoperative mucosal injury was significantly lower in the treatment group versus the control group, but operative time was longer in the treatment group. Eyelid edema and ecchymosis in the first seven days postoperatively were statistically decreased in the treatment group versus the control group. In addition, pain in the first three days postoperatively was statistically decreased in the treatment group versus the control group. However, in a subgroup analysis according to osteotomy visibility in the control group (blind osteotomy versus osteotomy under direct vision), there was no significant difference in edema and ecchymosis between treatment and osteotomy under direct vision.
Conclusion
Piezoelectric osteotomy during rhinoplasty can reduce eyelid edema and eyelid ecchymosis compared to conventional osteotomy. However, piezoelectric osteotomy had no significant advantages in terms of postoperative edema and ecchymosis compared to osteotomy under direct vision.
This article is protected by copyright. All rights reserved.

Vocal Fold Nodules – A Disorder of Phonation Organs or Auditory Feedback?

22-08-2019 – S.‐H. Lee, J.‐F. Yu, T.‐J. Fang, G.‐S. Lee

Abstract
Objective
Increasing evidence supports that auditory feedback of ones own voice closely relates to real‐time adjustments of vocal control. Previous studies highlighted that the low‐frequency modulations of below 3 Hz (LFM) embedded in vocal fundamental frequency (F0) showed a reflex‐like response to altered auditory inputs. However, the auditory feedback control of different vocal disorders remains unclear.
Design
A cross‐sectional, case‐controlled study.
Setting
A tertiary medical centre.
Participants
Sustained vocalizations of vowel /a/ from adult healthy controls and patients with vocal fold nodules, vocal fold polyps, and vocal fold cysts, respectively. The vocalizations were made at comfortable pitch and at the intensity of 70~80 d
BC under the following four auditory conditions: natural hearing, 90‐d
BC speech noise, 10‐d
BC enhanced feedback of self‐produced voice, and both the noise and voice feedback.
Main outcome measurespower spectral analysis of F0 contour of sustained vowel.
Results
Patients with vocal fold nodules presented with different audio‐vocal feedback behavior and audio‐vocal response to speech noise from the other two vocal pathologies of vocal fold polyp and vocal fold cyst as well as the healthy controls (p < 0.001, one‐way ANOVA).
Conclusion
The vocal fold nodules may be not only a vocal fold disease but also a disease caused by abnormal audio‐vocal feedback. Moreover, the distinct audio‐vocal feedback of vocal fold nodules could be revealed by power spectral analysis of vocal fundamental frequencies. Although further investigations are necessary, adjustments of audio‐vocal feedback behavior may provide a new insight and benefit to the treatment of vocal fold nodules in the future.
This article is protected by copyright. All rights reserved.

Long term swallowing outcomes following transoral surgery and adjuvant radiotherapy versus adjuvant chemoradiotherapy for oropharyngeal carcinoma; Our experience in 37 patients

22-08-2019 – “A Ivy, S Stephen, D Goff, J Patterson, L Warner, V Paleri, R Goranova, J Kovarik, G Shaikh, C Kelly, J OHara”

Abstract
Approximately 75% of patients are recommended adjuvant oncological treatment after transoral surgery (TOS) for oropharyngeal squamous cell carcinoma.
Radiotherapy and chemoradiotherapy can result in significant long‐term swallowing difficulties, which can negatively impact upon quality of life.
This prospective study utilised a comprehensive and complementary set of measures, including a patient reported, clinician‐rated and an objective measure, to assess the change in swallowing function at long‐term follow‐up in patients undergoing TOS and adjuvant therapy.
Our results suggest a trend towards greater long‐term swallowing impairment with adjuvant chemoradiotherpy compared to adjuvant radiotherapy alone.
This article is protected by copyright. All rights reserved.

Retrospective analysis of sub mucosal radiofrequency procedure for the treatment of nasal bleeding in forty‐four patients with hereditary hemorrhagic telangiectasia

21-08-2019 – Baptiste Hochet, Sophie Achard, Helene Maillard, Geoffrey Mortuaire

Journal Article

Abstract
No treatment of epistaxis has proved its superiority in hereditary hemorrhagic telangiectasia.
Submucosal radiofrequency (SRF) can reduce Epistaxis Severity Score up to 24 months after surgery.
SRF is well tolerated under local anesthesia.
A unilateral SRF can reduce epistaxis on both nasal sides.
Repeated SRF procedures require controlling energy delivery to prevent nasal perforation.
This article is protected by copyright. All rights reserved.

The correlation analysis of intralabyrinthine haemorrhage magnetic resonance imaging with hearing loss and prognosis: A retrospective analysis of 207 cases

20-08-2019 – Jinye Li, Mingming Wang, Lixin Sun, Hui Zhao, Gesheng Song, Jing Tian, Na Hu, Min Li, Weiqiang Dou, Jianxun Qu, Haibo Wang, Ruozhen Gong

Letter

Squamous cell carcinoma of the nasal cavity: A descriptive analysis of cases from the Head and Neck 5000 study

16-08-2019 – O T Dale, M Pring, A Davies, S Leary, K Ingarfield, S Toms, T Waterboer, M Pawlita, A R Ness, S J Thomas

Journal Article

Abstract
Objectives
This paper aims to provide contemporary epidemiological data on squamous cell carcinoma (SCC) of the nasal cavity, which represents a rare type of head and neck cancer.
Design, Setting & Participants
A descriptive analysis of people with nasal cavity SCC treated with curative intent from the Head and Neck 5000 study; a multicentre clinical cohort study of people from the UK with head and neck cancer. People with tumours of the nasopharynx, paranasal sinuses and other sub‐sites of the head and neck were excluded.
Main outcome measures
Demographic data and treatment details are presented for all participants. The main outcomes were overall survival and survival according to categories of characteristics (e.g. smoker vs non‐smoker); these were explored using Kaplan‐Meier plots.
Results
Thirty people with nasal cavity SCC were included in the study, of which most were male (67%) and current or ex‐smokers (70%). The majority (70%) presented with early stage (T1/2, N0) tumours. Cervical lymph node metastases at presentation were rare, occurring in only one person. Nine people died during the follow up period (30%). Worse survival outcomes were seen in people with moderate or severe co‐morbidities.
Conclusions
This paper provides epidemiological data on nasal cavity SCC in the UK. Patterns of disease and survival outcomes are described, identifying high‐risk groups. Further studies should explore whether primary treatment modality alters survival.
This article is protected by copyright. All rights reserved.

Clinical utility and effectiveness of a training programme in the application of a new classification of narrow‐band imaging for vocal cord leukoplakia: A multicentre study

13-08-2019 – Xiao‐Guang Ni, Gui‐Qi Wang, Feng‐Ying Hu, Xin‐Mao Xu, Ling Xu, Xiao‐Qin Liu, Xue‐Song Chen, Lin Liu, Xue‐Lian Ren, Yong Yang, Li Guo, Ya‐Jun Gu, Jin Hou, Jun‐Wei Zhang, Yan Yang, Biao Xing, Jia Ren, Hong‐Qiang Guo

Journal Article

Abstract
Objective
To analyse the application of a new narrow‐band imaging (NBI) classification in the diagnosis of vocal cord leukoplakia by laryngologists with different levels of laryngoscopic experience and to explore the impact of NBI training programmes on laryngologists’ identification of benign and malignant leukoplakia.
Design
Prospective multicentre study.
Setting
Tertiary hospitals.
Participants
Sixteen laryngologists were divided into less‐experienced and experienced groups and received NBI training course. Thirty cases of vocal cord leukoplakia were investigated.
Main outcome measures
Diagnostic accuracy and interobserver agreement under white light imaging (WLI), before and after NBI training, were analysed among doctors with varying levels of experience.
Results
The accuracy in the less‐experienced group was significantly lower than that of experience group (0.59 vs 0.69) under WLI. There was no significant difference in the diagnostic accuracy between the less‐experienced group and the experienced group before NBI training (0.75 vs 0.74) and after NBI training (0.79 vs 0.83). NBI training could improve the interobserver agreement from fair or moderate to good agreement.
Conclusion
The new NBI diagnostic classification is helpful for identifying benign and malignant vocal cord leukoplakia. In addition, the NBI training programme can improve the diagnostic accuracy and interobserver agreement of less‐experienced doctors to the level of experienced laryngologists.

Long‐term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory‐8

13-08-2019 – Olcay Cem Bulut, Ralph Hohenberger, Dare Oladokun, Katharina Odenwald, Peter K. Plinkert, Philippe A. Federspil

Journal Article

Abstract
Objectives
This study aimed to evaluate sensory dysfunction resulting from great auricular nerve (GAN) sacrifice versus preservation in parotid surgery for benign lesions and its imact on long‐term health‐related quality of life (QOL).
Design
Retrospective.
Setting/main outcome measures
Participants were divided into two groups (GAN and non‐GAN), and both short‐term (two postoperative weeks) and long‐term (at least 5 years) QOL were assessed. The second item of the Parotidectomy Outcome Inventory‐8 (POI‐8) was used to analyse postoperative sensory loss. All items of the POI‐8 questionnaire were used to determine health‐related QOL.
We used t test for dependent samples and Mann‐Whitney U‐test to compare patient groups
Participants
A total of 137 patients (65 male and 72 female) enrolled in this study. Average age at the time of surgery was 53 years (±12.8).
Results
The GAN preservation group had significantly better sensation than the GAN sacrifice in short term (2.8 vs 2.1; P = 0.017). Both groups experienced improved sensation in the long term, and there was a trend towards better QOL in the GAN‐preservation group. However, the difference in sensation was not statistically significant (1.7 vs 1.3; P = 0.145). Health‐related QOL also increased in the long term (compared to short term) for both groups (7.6 ± 6.2 to 12 ± 7.6; P < 0.0001) postoperatively. GAN preservation did not significantly improve sensation in long term, nor did it increase health‐related QOL postoperatively.
Conclusion
Although GAN preservation was easily feasible, it only improved sensation in short term. We report a negative result: GAN preservation did not significantly improve sensation in long‐term, nor did it increase health‐related QOL postoperatively when compared to GAN sacrifice.

Increased maternal serum placental growth hormone variant in pregnancies complicated by otosclerosis

13-08-2019 – Shutan Liao, Shan Lu, Guangliang Li, Ruiying Chen

Journal Article

Abstract
Objective
To investigate the potential role of maternal serum concentrations of placental growth hormone variant (GH‐V), insulin‐like growth factor (IGF) 1 and 2, and IGF‐binding proteins (IGFBP) 1 and 3 in pregnancies complicated by otosclerosis.
Method
Otosclerosis cases (n = 22) and age, ethnicity‐matched controls (n = 22) were selected in a nested case‐control study. Maternal serum hormone concentrations at 26 and 34 weeks of gestation were determined by enzyme‐linked immunosorbent assay (ELISA).
Results
Concentrations of all measured hormones except IGFBP‐1 were increased as gestation progressed. Maternal serum GH‐V concentrations at 26 and 34 weeks of gestation were significantly increased in the otosclerosis group, when compared to the control group (2.53 ± 0.17 ng/ml vs. 1.78 ± 0.19 ng/ml, P = 0.036; 4.34 ± 0.31 ng/ml vs. 3.12 ± 0.18 ng/ml, P < 0.001, respectively). Maternal serum IGF‐1 concentrations at 34 weeks in otosclerotic patients were significantly higher than in the controls (589.1 ± 21.4 ng/ml vs. 499.7 ± 17.8 ng/ml, P < 0.001). The increase of IGF‐1 was not observed at 26 weeks of gestation. Serum IGF‐2, IGFBP‐1 and IGFBP‐3 at either 26 or 34 weeks were unaltered between the two groups.
Conclusion
Maternal serum concentrations of GH‐V and IGF‐1 were altered in pregnancy complicated by otosclerosis, suggesting that the GH‐IGF axis may contribute to the development of this condition during pregnancy.

The use of freeze‐dried retronasal stimuli to assess olfactory function

13-08-2019 – Pooja Pal, Daniel Shepherd, Nazimah Hamid, Michael J. Hautus

Journal Article

Abstract
Objectives
To evaluate a test of olfactory perception that uses freeze‐dried stimuli developed to rapidly release aromas capable of migrating to the olfactory mucosa retronasally.
Design
Validation study.
Setting
Psychology and Chemistry Departments.
Participants
First, 15 participants provided data for psychometric functions. Second, 70 participants made perceptual judgments of retronasal stimuli. Inclusion criterion included informed consent and a satisfactory Nasal Obstruction Symptom Evaluation result.
Main outcome measures
First, psychometric functions were generated for two types of freeze‐dried stimuli (coffee and orange) using the Single‐Interval Adjustment Matrix method. Second, participants provided ratings of pleasantness, intensity, and familiarity and performed a standardised identification test using seven retronasally presented aromas alongside the previously validated Sniffin’ Sticks orthonasal olfactory test.
Results
Psychometric functions indicated a dose‐response relationship between aroma concentration and probability of detection. Test‐retest reliability of the retronasal stimuli was acceptable (r70 = 0.72, P < 0.001), and identification scores were not dependent on testing method (ie, retronasal vs Sniffin’ Sticks). Stimuli delivered using the Sniffin’ Sticks test were rated more pleasant than their retronasal counterparts.
Conclusions
Freeze‐dried retronasal stimuli offer an easy‐to‐use and rapid means to test olfaction function and are arguably well suited for clinical practice, but require further development and trialing prior to the adoption in the clinical context.

Validation of the olfactory disorders questionnaire for English‐speaking patients with olfactory disorders

13-08-2019 – Lorna Langstaff, Nisha Pradhan, Allan Clark, Duncan Boak, Mahmoud Salam, Thomas Hummel, Carl M. Philpott

Journal Article

Abstract
Objectives
To adapt the existing German language olfactory disorders questionnaire for use with English‐speaking patients. To validate the adapted version for routine clinical use.
Design
The translated version of the original German questionnaire was revised with a patient and a clinician to reflect British language and culture. Patients attending an olfactory dysfunction clinic were recruited to perform the adapted questionnaire on two occasions at least 1 month apart. Additional online participants completed the questionnaire via the charity Fifth Sense.
Main outcome measures
Retest reliability of the English olfactory disorders questionnaire (e
ODQ) in affected patients including potential for redundancy in any of the included questions. Correlation of e
ODQ scores with Sniffin’ Sticks scores.
Results
Eighty‐seven patients reporting olfactory dysfunction were recruited and had a mean age of 48 with 35% of them being male; 50 datasets were available for analysis. A total of 957 members of the charity entered responses into the online questionnaire; 699 responses could be scored with participants mean age of 55 years and with 69% reporting as female. The e
ODQ score and Sniffin’ Sticks threshold, discrimination and identification score at timepoint 1 were correlated to assess for concurrent validity, (r = −0.15, P = 0.17) and showed no significant correlation. Female participants had a significantly higher mean total e
ODQ score than men, 55.75 compared to 52.28 (P = 0.001). The average score was 54.7 (SD 13.5) with a range from 26 to 87. The internal consistency of the questionnaire was good with a Cronbachs alpha of 0.90 (confidence intervals 0.89, 0.91).
Conclusions
The results of this study support the use of the e
ODQ in a native English‐speaking population and highlight the different distinctions between “objective” testing of olfaction with the Sniffin’ Sticks test, and the patient reported impact of olfactory dysfunction on daily life. These two types of assessment can be easily administered in an outpatient setting and used in the assessment and management of olfactory dysfunction.

Responsiveness of acoustic rhinometry to septorhinoplasty by comparison with rhinomanometry and subjective instruments

13-08-2019 – Edward Ansari, Florence Rogister, Philippe Lefebvre, Sophie Tombu, Anne‐Lise Poirrier

Journal Article

Abstract
Objectives
Nose patency measures and instruments assessing subjective health are increasingly being used in rhinology. However, there is very little evidence of comparing existing methods responsiveness to change. We evaluated the responsiveness of acoustic rhinometry to nasal valve surgery by comparison with rhinomanometry and patient‐reported outcome instruments.
Design
Prospective case‐control study.
Setting
Tertiary referral University Hospital.
Participants
Sixty consecutive patients with internal nasal valve dysfunction and 20 healthy volunteers as control group were enrolled. Prospectively collected data included acoustic rhinometry, rhinomanometry, NOSE scale, SNOT‐23 questionnaire, visual analogue scale and demographics.
Main outcome measures
Primary endpoint was the responsiveness of acoustic rhinometry to functional septorhinoplasty surgery at 3 months. Secondary endpoints were ability of acoustic rhinometry to reflect “known group” differences and correlation to subjective symptoms.
Results
Acoustic rhinometry was highly responsive to septorhinoplasty (P < 0.0001) while anterior rhinomanometry was not (P = 0.08). Based on the quartiles of the postoperative change in NOSE score, patients were classified as, respectively, non‐responders, mild, moderate and good responders to surgery. Logistic regression model showed that acoustic rhinometry was able to discriminate non‐responders to responders to surgery (P = 0.019), while anterior rhinomanometry failed (P = 0.611). Sensitivity and specificity of acoustic rhinometry were significantly higher (ROC area = 0.76) than rhinomanometry (ROC area = 0.48). Acoustic rhinometry was also superior than rhinomanometry to discriminate patients from control subjects and agreed better with patients‐based subjective questionnaires.
Conclusions
Our study confirms and quantifies the responsiveness of acoustic rhinometry to nasal valve surgery, with a higher sensitivity and specificity than rhinomanometry.

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

13-08-2019 – Jerome R. Lechien, Vinciane Muls, Giovanni Dapri, François Mouawad, Pierre Eisendrath, Antonio Schindler, Andrea Nacci, Maria R. Barillari, Camille Finck, Sven Saussez, Lee M. Akst, Robert T. Sataloff

Journal Article

Abstract
Objective
To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients—those who do not respond to anti‐reflux medical treatment.
Methods
A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti‐reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non‐responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow‐up and quality of outcome assessment were evaluated.
Results
Of the 139 articles screened, 45 met the inclusion criteria. The definition of non‐responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non‐responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non‐acid or mixed) or addressed personalised treatment with the addition of alginate or magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy.
Conclusion
To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non‐responder LPR patients.
Level of evidence2a.

Does access to saltwater swimming pools reduce ear pathology and hearing loss in school children of remote arid zone aboriginal communities? A prospective 3‐year cohort study

13-08-2019 – Linnett Sanchez, Andrew Simon Carney, Adrian Esterman, Karen Sparrow, David Turner

Journal Article

Abstract
Objective
To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children.
Design
A prospective 3‐year cohort study of children in 10 remote Aboriginal communities in South Australia with (n = 4) or without (n = 6) swimming pools.
Setting
Outback Australia.
Participants
Eight hundred and thirteen school‐age children residing in remote South Australia.
Main outcome measures
Prevalence of open and closed middle ear disease and prevalence of hearing loss.
Results
About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non‐pool communities (P = 0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non‐pool communities in the frequency of either inactive (19.4% pool vs 22.6% non‐pool; P = 0.232) or active (19.8% pool vs 17.8% non‐pool; P = 0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non‐pool communities in the frequency of type B tympanometry (P = 0.465).
Conclusions
Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.

E‐cigarettes and head and neck cancers: A systematic review of the current literature

13-08-2019 – Susanne Flach, Pavithran Maniam, Jaiganesh Manickavasagam

Journal Article

Abstract
Background
Cigarette smoking is a well‐established risk factor for head and neck (HN) cancers. Use of electronic cigarettes (e‐cigarettes) is gaining popularity, being advertised as benign alternatives to tobacco. A wide variety of potentially harmful chemical components with variable quantity have been identified in e‐liquids and aerosols of e‐cigarettes. However, use of e‐cigarettes remains controversial due to conflicting evidence.
Objectives
We aimed to assess the association between e‐cigarettes and HN cancers. We conducted a systematic review to evaluate the literature for evidence on carcinogenic effects of e‐cigarettes in the pathogenesis of HN cancers.
Type of review
Qualitative systematic review.
Search strategy
A PubMed/MEDLINE, Cochrane, CINAHL Plus, Trip Medical Database and Web of Science search was done for studies on e‐cigarettes and HN cancer.
Evaluation method
Abstract review of all articles, full article revision of included studies, data extraction and quality assessment were performed by two independent assessors.
Results
The literature search resulted in the identification of 359 articles. Eighteen articles were selected for inclusion into the systematic review. The majority were laboratory‐based studies, followed by several cohort and case studies, representing low‐level evidence. A few reports suggested DNA damage following exposure to e‐cigarettes potentially due to increased oxidative stress. Flavoured e‐liquids appear to be more harmful. There is variable evidence from clinical studies.
Conclusions
Our review outlines potential dangers associated with the use of e‐cigarettes and their role in HN cancers. More longitudinal and controlled studies are needed to assess the possible link between e‐cigarettes and HN cancers.

Role of diffusion‐weighted imaging in the discrimination of purulent intrasinusal content: A retrospective study

13-08-2019 – Thomas Radulesco, Ugo Scemama, Julien Mancini, Guy Moulin, Patrick Dessi, Justin Michel, Arthur Varoquaux

Journal Article

Abstract
Objectives
The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non‐aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS).
Design
A retrospective study.
Setting
Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non‐enhanced sinus filling.
Participants
We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis, non‐purulent sinusitis, naso‐sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded.
Main outcome measures
We analysed T1, T2, b1000 and MRI sequences and ADC map.
Results
On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases (P < 0.001) as were low ADC values (P < 0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041 × 10−3 mm2/sec, P < 0.01). On multivariate analysis, MRI with ADC < 0.725 × 10−3 mm2/sec and b1000_SI > brain was significantly associated with the case group. MRI with b1000_SI < brain and ADC > 1.450 × 10−3 mm2/sec was significantly associated with the control group.
Conclusions
Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.

Functional relevance of computational fluid dynamics in the field of nasal obstruction: A literature review

13-08-2019 – Thomas Radulesco, Lionel Meister, Gilles Bouchet, Jérôme Giordano, Patrick Dessi, Pierre Perrier, Justin Michel

Journal Article

Abstract
Background
Nasal airway obstruction (nasal obstruction) is a common symptom affecting the quality of life of patients. It can be estimated by patient perception or physical measurements. Computational fluid dynamics (CFD) can be used to analyse nasal ventilation modalities. There is a lack of comparative studies investigating the correlations between CFD variables and patient perception or physical measurements.
Objective of the review
Our goal was to define correlations between CFD variables and patient perception and physical measurements. We also aimed to identify the most reliable CFD variable (heat flux, WSS, total pressure, temperature…) characterising nasal breathing perception.
Type of review
Systematic literature review using PRISMA guidelines.
Search strategy
The selected studies were obtained from the US National Library of Medicine (PubMed) online database, MEDLINE (Ovid), Google Scholar and the Cochrane Library using a combination of Me
SH terms (nose, paranasal sinus, fluid dynamics, rhinology) and non‐Me
SH terms (CFD, nasal airway, nasal airflow, numerical, nasal symptoms). Studies that did not incorporate objective or subjective clinical assessment were excluded.
Evaluation method
We compared all results obtained by authors regarding CFD variables and assessment of nasal airway obstruction (clinical or physical).
Results
To compare nasal obstruction with CFD variables, most authors use CFD‐calculated nasal resistances, airflow, heat flux, wall shear stress, total pressure, velocities and streamlines. We found that heat flux appears to be the CFD variable most closely correlated with patient perception. Total pressure, wall shear stress and velocities are also useful and show good correlations. Correlations between CFD‐calculated nasal resistances and patient perception are stronger after correction of the nasal cycle.
Conclusions
The growing number of CFD studies on the nose has led to a better understanding of nasal obstruction. The clinical interpretation of previously unknown data, such as WSS and heat flux, is opening up new horizons in the understanding of this symptom. Heat fluxes are among the best CFD values correlated with patient perception. More studies need to be performed including temperature and humidity exchanges.

“How clean are your injections?”

13-08-2019 – Hannah Lancer, Mark Simmons

Letter

Effects of a wireless frequency modulation system on learning ability and emotional and behaviour problem improvement in 11 children with cochlear implant

13-08-2019 – Young Sang Cho, Ji Hyeon Ahn, Hye Yoon Seol, Sung Hwa Hong, Il Joon Moon

Letter

Evolving management strategies in head and neck paragangliomas: A single‐centre experience with 147 patients over a 60‐year period

13-08-2019 – J.A. Rijken, B. de Vos, L.P. van Hest, K.M.A. Dreijerink, M. den Heijer, W. Wisselink, G.J. Blom, E.F. Hensen, C.R. Leemans

Letter

Does cartilage thickness affect hearing results in real life? Long‐term results of cartilage and fascia graft in type 1 tympanoplasty

13-08-2019 – Mahmut Tayyar Kalcioglu, Ozan Tuysuz, Muhammed Zeki Yalcin, Erkan Karatas

Letter

The use of ARTISS™ in performing parotidectomies as day case surgery: A single‐centre review of 31 cases

13-08-2019 – Yanish Poolovadoo, Rohini Aggarwal, Sean Loughran

Letter

Post‐laryngectomy adjuvant radiotherapy in patients with pharyngocutaneous fistulae: Treatment regimens, outcomes and complications in 67 patients

13-08-2019 – Thomas Parzefall, Axel Wolf, Stefan Grasl, Gabriela Altorjai, Shelly Czeiger, Matthaeus Ch. Grasl, Boban M. Erovic

Letter

“CT and clinical prognostic factors in Bells palsy: A study of 56 cases”

13-08-2019 – Rémi Hervochon, Vincent Madelain, Ian Seiller, Ghizlene Lahlou, Yann Nguyen, Frédéric Tankéré

Letter

Large parapharyngeal tumours: Operative technique and case series of 17 patients

13-08-2019 – Andrew Williamson, Liam Sutton, Jagdeep Virk, Peter Clarke

Letter

Transoral laser microsurgery using high‐flow nasal cannula oxygenation: Our experience of 21 cases

13-08-2019 – Susanne Flach, Azza Elhoweris, Samit Majumdar, Simon Crawley, Jaiganesh Manickavasagam

Letter

Usefulness of ENT clinical examinations in hospitalised patients chronically addicted to alcohol and tobacco to detect head and neck squamous cell carcinomas. A retrospective study of 159 patients

13-08-2019 – Maxime Baert, Caroline Pascual, Aurélie Biet‐Hornstein, Ritoungarte Nadjingar, Céline Haremza, Cyril Page

Letter

Abstract
Objective
To determine whether an ENT clinical screening examination done on all patients chronically addicted to alcohol or tobacco would allow the early diagnosis of cancer of the upper aerodigestive tract.
Study Design
Case series with chart review.
Setting
Non‐university general hospital.
Subjects and methods
A total of 159 patients presenting chronic addiction to alcohol or tobacco hospitalized in an addiction center or a comprehensive medical clinic were included in this study covering the period 2011‐2016. All patients systematically benefitted from an ENT clinical examination to detect mucous membrane lesions. The lesions were categorized as: cancerous, pre‐cancerous, or benign. The patients were divided into two groups for comparison: 1) patients with symptoms (dysphagia, dysphonia, dyspnea upon inhalation, cervico‐facial pain, secondary otalgia, pharyngeal discomfort unrelated to deglutition, presence of a cervical swelling, or weight loss), and 2) asymptomatic patients.
Results
The ENT exam was normal in 121 patients (76.1%). Fifty‐two patients (32.7%) had at least one symptom. The ENT exam allowed us to detect a benign lesion in 11 patients, a pre‐cancerous lesion in 11 patients, and a cancer in 16 (13.22%) patients. All patients with cancer had at least one symptom.
Conclusion
An ENT clinical screening examination done on patients chronically addicted to alcohol or tobacco can allow early diagnosis of cancer, particularly in patients with at least one symptom.

The genetics of cholesteatoma study. Loss‐of‐function variants in an affected family

13-08-2019 – Peter Prinsley, Barbara A. Jennings, Mahmood Bhutta, Daniel Swan, Gavin Willis, Carl Philpott

Letter

The intra‐operative use of biological products: A multi‐centre regional patient perspective of a potential consenting conundrum

13-08-2019 – Karan Jolly, Adnan Darr, Anastasia Aslanidou, Duncan Bowyer, Shahzada Ahmed

Letter

A population‐based time trend study in the incidence of malignant otitis externa

13-08-2019 – Yen‐Fu Cheng, Tzong‐Han Yang, Chuan‐Song Wu, Yi‐Wei Kao, Ben‐Chang Shia, Herng‐Ching Lin

Letter

Polydioxanone sheet as a rigid framework in skull‐base repair: Our experience in thirteen patients

13-08-2019 – Mohd Afiq Mohd Slim, Hussain Jasem, Louise Melia, Gerald McGarry

Letter

Preoperative electrophysiological analysis predicts preservation of hearing and facial nerve function following vestibular schwannoma surgery with continuous intraoperative neural monitoring: Clinical outcomes of 22 cases

13-08-2019 – Makoto Hosoya, Naoki Oishi, Takanori Nishiyama, Masaru Noguchi, Kento Kasuya, Noriomi Suzuki, Hidemi Miyazaki, Kaoru Ogawa

Letter

Issue Information

13-08-2019 –

Giving epistaxis two fingers

13-08-2019 – Ayeshah Abdul‐Hamid, Ali Qureishi, Pablo Martinez‐Devesa, Robert Almeyda

Journal Article

CO2 laser “Ablation Suction” technique for treatment of laryngeal recurrent respiratory papillomatosis

13-08-2019 – Philippe F. Bowles, Alison Liu, Meredydd L. Harries

Journal Article

Validate the classification of fungal rhinosinusitis: A retrospective analysis of 162 patients at a single institution

12-08-2019 – Man‐Wei Hua, Chih‐Ying Wu, Rong‐San Jiang, Ching‐Yun Chang, Kai‐Li Liang

Journal Article

Abstract
In 1997, de
Shazo et al.1, 2 conducted a literature review and proposed a novel classification of fungal rhinosinusitis. The authors divided fungal rhinosinusitis into invasive and noninvasive forms. The classification included acute and chronic invasive fungal rhinosinusitis (AIFRS and CIFRS), chronic granulomatous fungal rhinosinusitis, fungus ball, and allergic fungal rhinosinusitis (AFRS). Nowadays, the classification proposed by de
Shazo et al. is widely accepted and is frequently cited in related studies. Classification of fungal rhinosinusitis is important to accurately predict the prognosis and choose an appropriate therapy.
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Three‐dimensional computed tomography analysis of frontoethmoidal cells: a critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

09-08-2019 – Tomasz Gotlib, Paulina Kołodziejczyk, Magdalena Kuźmińska, Konstancja Bobecka‐Wesołowska, Kazimierz Niemczyk

Journal Article

Abstract
Objectives
Two major classifications of frontoethmoidal cells, Lee and Kuhn’s and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study is to verify the IFAC and characterise cells, which are inconsistent with this classification.
Design
A radioanatomic analysis. Setting: Tertiary university hospital. Participants: 103 Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. Main Outcomes Measure: Results of assessment of multiplanar reconstruction of thin slice CT.
Results
Two types of cells that cannot be classified using the IFAC were found: 1. Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, 2. Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively.
Conclusions
Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.
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A local guideline reduces inappropriate requests for CT imaging of the paranasal sinuses

06-08-2019 – David John Laurie Pennell, Emma McClelland, Charlie Sayer, Mahmood Faisal Bhutta, Simon James Watts

Journal Article

Abstract
Place and Duration
Initial Audit of CT PS performed at Royal Sussex County Hospital over a three month period from 1st December 2016 to 1st March 2017. Following focused clinician education and the introduction of a CT paranasal sinus protocol a second audit cycle was performed from 1st June 2017 to 1st August 2017.
Methods
All patients who had CT paranasal sinuses requested by the ENT department within the audit cycle periods were included. Retrospective electronic case nose review was used to assess the symptoms, preoperative management and reason for CT. The European Position Paper on Sinusitis (EPOS Document 2007) was used to guide best practice and a departmental protocol was used to judge whether the investigation was appropriate.
Results
Conclusion: These findings show that with the use of departmental education and introduction of a protocol to guide requests of CT paranasal Sinuses significantly reduces the rate of inappropriate CT paranasal sinuses thus reducing the number of inappropriate scans (and subsequently unnecessary radiation exposure and economic expenditure).
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A simple and effective method for closure of enlarged tracheoesophageal puncture in seven patients

06-08-2019 – Emine Deniz Gozen, Firat Tevetoglu, Caglar Eker, H. Murat Yener, Emin Karaman

Journal Article

A mixed methods comparative evaluation of a low cost otoscope (Arclight) with a traditional device in twenty‐one clinicians

06-08-2019 – Shi Ying Hey, Joanna C. Buckley, Somayyeh Shahsavari, Obaid Kousha, Kerry A. Haddow, Andrew Blaikie, Frank David Lathangie Walker

Letter

Optimal wound closure techniques for thyroid and parathyroid surgery: A systematic review of cosmetic outcomes

01-08-2019 – Kristina Lee, Nicholas Ward, Babatunde Oremule, Navin Mani

Journal Article

Abstract
Objectives
Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri‐strips and glue.
Design
We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri‐strips, using appropriate MESH terms and Boolean operators.
Main outcome measures
Primary outcome was wound cosmesis. Secondary measures were also extracted.
Results
Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri‐strips and two studies for suture vs glue. In general, short‐term cosmesis was better with subcuticular sutures compared to glue or clips, long‐term cosmetic outcomes were not influenced by closure method.
Conclusions
We found closure with subcuticular suture or steri‐strips produced superior short‐term cosmetic outcomes. Although long‐term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.

The investigation of hyaluronic acid and hyaluronidase‐1 levels as tumour marker in larynx cancer

01-08-2019 – Hakkı Caner İnan, Murat Yener, Nur Buyru, Asuman Çelebi, Mehmet Yilmaz, Nil Çomunoğlu

Journal Article

Abstract
Objective
The purpose of this study was to investigate the hyaluronic acid (HA) and hyaluronidase‐1 (HYAL‐1) levels in laryngeal cancer patients.
Study design
Prospective, controlled clinical trial.
Setting
University Medical Center.
Participants
Fifty laryngeal squamous cell carcinoma patients and 50 volunteers who gave saliva samples investigated prospectively between 2016 and 2017.
Methods
Hyaluronidase‐1 expression was measured by RT‐PCR in normal and tumour tissue samples; hyaluronic acid values of saliva and tumour tissues were measured by ELISA method.
Results
HYAL‐1 expression increased 2.5‐fold in tumour tissues compared to normal tissues, and the difference was statistically significant (P < 0.001).
Mean saliva HA levels were 103.93 ± 69.04 ng/m
L and 177.29 ± 98.44 ng/m
L in the patients and controls’ saliva specimens, respectively. The difference was not statistically significant (P = 0.657). HA levels were higher in tumour tissue samples than saliva samples, but there was not statistically significant difference between saliva and tumour tissue HA levels.
Conclusion
HYAL‐1 expression in laryngeal squamous cell carcinomas is elevated compared to normal tissues of same patients. Targeting this gene and HA catabolism products may use treatment of larynx cancer in the future.

Fine needle aspiration cytology and radiological imaging in parotid gland tumours: our experience in 103 patients

01-08-2019 – Clare Perkins, Edward Toll, Philip Reece

Journal Article

Abstract
Parotid gland tumours are usually investigated with fine needle aspiration cytology, although the reported sensitivity for detecting malignancy is variable
Pre‐operative imaging is used to aid staging, delineate anatomy for surgery and to look for malignant characteristics
Suspicion of malignancy on fine needle aspiration cytology and radiological imaging can help with planning the extent of surgical excision
Our results show a high sensitivity and specificity for fine needle aspiration cytology, and high sensitivity for pre‐operative imaging
The sensitivity and specificity of fine needle aspiration cytology is improved when combined with results of pre‐operative radiological imaging
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“Comparison of soft tissue preservation techniques for BAHA insertion in 41 patients: ‘Bus‐stop (open approach) vs MIPS (minimally invasive approach)”

30-07-2019 – Alex Bennett, Rupali Sawant

Journal Article

Abstract
Several studies have reported improved outcomes with soft tissue preservation, minimally invasive or ‘punch techniques when compared to soft tissue reduction
The only two studies comparing a minimally invasive or ‘punch techniques with soft tissue reduction demonstrate no evidence of reduced implant loss
This is the first study to directly compare the 12 month outcomes of two non soft tissue reduction techniques performed by a single surgeon
MIPS demonstrated a statistically significant increase in implant loss compared to the ‘Bus‐stop approach while failing to achieve better healing, hearing or patient satisfaction
Implant loss appeared the result of failure of osseointegration due to a combination of unseen soft tissue interposition, which occurs between removal of the cannular and placing the implant, and overheating of the bone during drilling as a result of the lack of continuous saline irrigation
This article is protected by copyright. All rights reserved.

The use of Transnasal Humidified Rapid‐insufflation Ventilatory Exchange (THRIVE) in one hundred and five upper airway endoscopies. A case series

29-07-2019 – Eleanor Waters, Maximiliane Kellner, Pamela Milligan, Richard M. Adamson, Iain J. Nixon, Alistair F McNarry

Journal Article

Abstract
The successful use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) has up to now only been reported in small groups by dedicated teams.
We report its effective use in 105 cases having upper airway endoscopy cared for by a variety of surgeons and anaesthetists.
THRIVE still has a failure rate of between 3 and 6% and clinicians need to have a Plan B to effectively oxygenate the patient.
Causes of failure are multifactorial but obesity is one statistically significant factor identified by our work.
Ninety‐five percent of our patient cohort could successfully be oxygenated for 20 minutes

Endoscopic Type I Tympanoplasty is as Effective as Microscopic Type I Tympanoplasty but Less Invasive – a Meta‐Analysis

29-07-2019 – István Pap, István Tóth, Noémi Gede, Péter Hegyi, Zsolt Szakács, Alexandros Koukkoullis, Péter Révész, Kinga Harmat, Adrienne Németh, László Lujber, Imre Gerlinger, Tímea Bocskai, Gábor Varga, István Szanyi

Journal Article

Abstract
Background
Endoscopic type I tympanoplasty was originally introduced in the 1990s and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty.
Objective of Review
The aim of this study is the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty.
Type of Review
We conducted a meta‐analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines.
Search Strategy
A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics‐Web of Science, Clinical
Trials. gov, World Health Organization Library, and Scopus by inserting, “myringoplasty OR (tympanoplasty AND perforation)” into the search query. We applied only a “human” filter. We excluded non‐English studies. Additional records were identified by checking the references of relevant studies.
Evaluation Method
Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias, and estimated the quality of evidence for each outcome.
Results
Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82‐1.77; I2=0.0%), the postoperative hearing results (WMD=‐1.13; 95% CI: ‐2.72‐0.45; I2=78.1%) and the operation time (WMD=‐21.11; 95% CI: ‐42.60‐0.38; I2=99.3%), were all comparable among the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR=7.96; 95% CI: 4.30‐14.76; I2=0.0%, p=1.000) and features an increase in desirable cosmetic results (OR=19.29; 95% CI: 11.37‐32.73; I2=0.0%, p=0.839), when compared with the microscopic approach.
Conclusions
Based on our meta‐analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.
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Analysis of revision and reimplantation of cochlear implantations in 45 cases

26-07-2019 – Yi Jiang, Jianan Li, Yongyi Yuan, Lihua Wu, Bo Gao, Qingshan Jiao, Guojian Wang, Dongyi Han, Shiming Yang, Pu Dai

Journal Article

Abstract1、The most common reasons for revision and reimplantation of cochlear implantations were device‐related failure, infection , device migration and misplaced electrodes.2、The “sandwich method” using a superior temporal fascia flap, auricle cartilage, and a deep temporal muscle flap can repair the defect in the posterior wall of the ear canal and cover the electrode.3、Fixation of the internal receiver–stimulator can reduce the risk for device migration.4、Intraoperative imaging guidance can ensure the correct placement of electrodes in cases with severe inner ear malformation.5. The revision and reimplantation will be safe procedures with thoughtful preparation and individualized appropriate repair scheme according to the different complications after the primary cochlear implantation.
This article is protected by copyright. All rights reserved.

Effect of endoscope‐assistence in tympanomastoidectomy for lowering the rate of residual cholesteatoma results from 91 pediatric patients

23-07-2019 – Dan Yaniv, Sharon Tzelnick, David Ulanovski, Ohad Hilly, Eyal Raveh

Journal Article

Abstract
Canal wall up (CWU) mastoidectomy is commonly performed in cases of chronic otitis media with cholesteatoma. The use of endoscopes during this surgery is increasing in order to improve visualization of difficult access sites.
We aim to determine the efficacy of adding endoscopy to traditional microscopic mastoidectomy in reducing the rate of residual cholesteatoma in children.
We conducted a retrospective cohort review in a tertiary university‐affiliated pediatric medical center, including patients undergoing primary surgery for cholesteatoma in 2009‐2016 by a microscopy‐only or endoscopy‐assisted approach.
The cohort included 91 patients who underwent CWU surgery for primary cholesteatoma. Intraoperative endoscopic evaluation was performed in 49 cases (53.8%).
Intraoperative endoscopic technique significantly lowered the rate of residual cholesteatoma to 18.36% compared to 38.09% in the microscopy‐only group (P=0.036).
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Preoperative plasma fibrinogen as a predictive factor for post‐tonsillectomy hemorrhage

20-07-2019 – Stefan Grasl, Stefan Janik, Erich Vyskocil, Lorenz Kadletz, Matthaeus C. Grasl, Boban M. Erovic

Journal Article

Abstract
Objectives To assess whether preoperative plasma fibrinogen is able to predict severe post‐tonsillectomy hemorrhage. Study Design Retrospective chart review. Methods We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. Results 414 (90.8%) had no severe post‐tonsillectomy hemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (p = 0.023) in patients with a severe bleeding. Univariate Cox‐regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (p = 0.003; HR 2.66; 95% CI 1.38‐5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased plasma fibrinogen levels were a significantly worse prognostic factor for post‐tonsillectomy hemorrhage (p = 0.014; HR16.1; 95% CI 1.75‐142.85). High preoperative PFL was associated with significantly higher risk for post‐tonsillectomy hemorrhage within the first 31 days after surgery (65% vs. 90%; p = 0.002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. Conclusions Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTHThis article is protected by copyright. All rights reserved.

Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: a systematic review of the evidence

12-07-2019 – Thuy T Frakking, Anne B Chang, Michael David, Jane Orbell‐Smith, Kelly A Weir,

Journal Article

Abstract
Background
Cervical auscultation (i.e. listening to swallowing sounds) is the most commonly used technique in adjuvant to the clinical feeding examination by speech‐language pathologists worldwide to assess for oropharyngeal aspiration risk in children. Despite its relative popularity in clinical practice, little is known on the clinical utility of cervical auscultation within a paediatric population.
Objective
To determine the diagnostic test accuracy of the clinical feeding examination with cervical auscultation in the detection of aspiration in children.
Type of review
Narrative review. Prospero Registration: CRD42017081467 Search strategy: Medline/Pub Med, Embase, CINAHL, Aust
Health, Cochrane and UQ (Scopus) were searched up until October 2017. Specifically, the search terms used were: (((oropharyngeal OR respiratory) aspiration) AND (child* OR pediatr* OR paediatr*) and (cervical auscultation OR swallow sounds OR swallowing sounds OR accelerometry OR swallowing acoustics)). The search strategy also included scanning reference lists and citations of retrieved studies.
Evaluation method
Extracted studies were reviewed by two independent reviewers. Methodological quality of studies was assessed using the QUADAS‐2 tool.
Results
Only one study met inclusion criteria for this review, which had a bias for flow and timing. Use of cervical auscultation in conjunction with the clinical feeding examination to predict aspiration had a positive predictor value (PPV) of only 0.49 (0.31‐0.66), indicating potential over‐prediction of aspiration when cervical auscultation is used. In contrast a high NPV of 0.92 (0.78‐0.98) was reported indicating that cervical auscultation is useful at ruling out aspiration in children.
Conclusion
This review highlights the paucity of research studies assessing the accuracy of cervical auscultation as an adjuvant to the clinical feeding examination in aspiration detection within the pediatric population.
This article is protected by copyright. All rights reserved.

Development of the Alberta Facial Clinical Evaluation (A‐FaCE) scale: A patient‐centered outcomes instrument for facial nerve paralysis

08-07-2019 – Amr F. Hamour, Adrian I. Mendez, Vincent L. Biron, Robert Seemann, Kal Ansari, Richard Liu, Hadi Seikaly, David W.J. Côté

Journal Article

Abstract
Objectives
Facial nerve paralysis has functional, psychological, and social consequences for patients. Traditionally, outcome measurements for facial nerve injuries have been clinician derived. Recent literature has shown that patient perspective is valuable and necessary in outcomes research. This study aimed to identify patient domains of concern and subsequently, develop a point‐of‐care questionnaire for clinical use.
Design
This mixed‐methods prospective study was completed in three phases.
In Phase I, 15 facial nerve injury patients were interviewed individually. Interviews were digitally recorded, transcribed, and coded with NVIVO software. Analysis led to a conceptual framework detailing the most important quality of life outcomes. During Phase II, a focus group was held with 5 new patients in order to prioritize the outcome themes to a top six list. A second focus group was held with Otolaryngology – Head and Neck staff surgeons to create a 25‐item questionnaire based on these six themes. In Phase III, the questionnaire was administered to 10 new patients to test for comprehension.
Setting
University of Alberta Hospital, Edmonton, Alberta, Canada.
Participants
A total of 30 patients with facial nerve injury were included in the various phases in the study. In addition, 5 staff Otolaryngology – Head and Neck surgeons participated as focus group contributors.
Main outcome measures
Domains of concern and quality of life outcomes as reported by facial nerve injury patients.
Results
Patients identified a total of 16 themes encompassing both functional and psychological deficits related to their facial nerve injury. From these findings, a 25‐item Likert‐type scale, the A‐Fa
CE scale, was developed for clinical use.
Conclusions
Patients with facial nerve paralysis experience functional and psychological deficits. This study led to the creation of the first patient‐reported instrument for this population that addresses functional impairment, social function, psychological well‐being, and self‐perception of appearance.
This article is protected by copyright. All rights reserved.

A simple drainage technique to manage pharyngocutaneous fistula following laryngectomy

29-05-2019 – Samuel T. Roberts, Megan Hobson, Robert Eisenberg

Journal Article

Long term evaluation of sound localization in single sided deaf adults fitted with a BAHA device

28-05-2019 – Nicolas‐Xavier Bonne, Jean‐Noël Hanson, Fanny Gauvrit, Michaël Risoud, Christophe Vincent

Journal Article

Abstract
Objective
To perform a long term evaluation of the localization capabilities in the horizontal plane of single‐sided deaf patients fitted with a BAHA device.
Design
Single center retrospective study.
Participants
Twenty one adults with single sided deafness (SSD) with normal hearing in the contralateral ear (pure tone average <20 d
B, SDS >90%) rehabilitated with a Cochlear BAHA device from 2003 to 2012 on the deaf side over a median follow‐up of 8 years.
Outcome measures
The task used in this paper is a sound localization identification task with a setup of 7 loudspeakers on a semi‐circular array at 30‐degree intervals performed at 3 periods: before BAHA, initially and at last follow‐up. Our main criterion of judgment was the RMS localization error. In addition, the Bern Benefit in Single‐Sided Deafness Questionnaire (BBSS) was administered.
Results
The mean RMS localization error was initially estimated at 64° without any rehabilitation (for a chance level RMS estimated at 81°). Initially with the BAHA device, the RMS localization error dropped to 51°. At the last follow‐up evaluation, a significant decrease at 23° was noted. Concerning the Bern Questionnaire, 19% of the patients (n=4) did not report any change (score of 0), 33% (n=7) are satisfied (score of +1 or +2) and 48% (n=10) are very satisfied with the BAHA device (score better than +3).
Conclusion
Improvement of sound localization in the horizontal plane for some SSD patients is likely related to altered processing of monaural spectral cues. The time needed to learn to use the azimuth‐dependent spectral cues takes time. Long‐term follow‐up should be considered for studies investigating sound localization performance.
This article is protected by copyright. All rights reserved.

Novel technique for nasal septal button insertion: The sutured rosette

16-05-2019 – Jason E. Cohn, Resha S. Soni, Katherine Chemakin, Alyssa R. Terk

Journal Article

A new method for lumen restoration in a patient with aphagia: Oro‐oesophageal through‐the‐scope magnetic compression anastomosis

24-04-2019 – Erkan Parlak, Ahmet Tarık Eminler, Aydın Seref Koksal, Bilal Toka, Mustafa Ihsan Uslan, Cenk Sokmensuer, Mehmet Guven

Journal Article

Drainless parotidectomy and the same day discharge with routine use of topical haemostatic agent and Balaclava bandage

24-04-2019 – Shi Ying Hey, Susanne Flach, Somayyeh Shahsavari, Jaiganesh Manickavasagam

Journal Article

Evolution of impedance values in two different electrode array designs following activation of cochlear implants 1xa0day after surgery: A study of 58 patients

08-04-2019 – Hao‐Chun Hu, Joshua Kuang‐Chao Chen, Lieber Po‐Hung Li, William Kuan‐Hua Chen, Mei‐Jui Huang, Chia‐Hsin Yeh, Li‐Ching Chen, Tao‐Hsin Tung

Letter

Proposal of a new clinical method for removal of button batteries and other ferrous material from the external auditory canal and nasal cavity using a fine magnet probe

06-03-2019 – Waqas Bin Majid Din, Gerard Kelly, Cindy Liu

Journal Article

Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic

28-02-2019 – Joshua D. Whittaker, Wai Sum Cho, Sameer Mallick

Journal Article

Modified Z‐plasty of the internal nasal valve—To treat mechanical nasal obstruction: How we do it

22-02-2019 – Kiran Varadharajan, Natasha Choudhury, Hesham A. Saleh

Journal Article