ORL

ORL

Clinical and Radiographic Characteristics of Sinonasal Posttransplant Lymphoproliferative Disorder and Invasive Fungal Sinusitis

10-10-2019 –

Background: Sinonasal posttransplant lymphoproliferative disorder (PTLD) is a serious but uncommon complication of solid organ and hematopoietic stem cell transplantation that can overlap in many features with invasive fungal sinusitis (IFS). Objective: To identify clinical, laboratory, and radiographic features that may help to differentiate sinonasal IFS and PTLD in the posttransplant population. Methods: We performed a retrospective chart review of patients with posttransplant sinonasal PTLD and IFS to evaluate for clinical, laboratory, and imaging characteristics. Results: A total of 4 patients with sinonasal PTLD and 10 posttransplant IFS patients were evaluated. A total of 2 of 4 PTLD patients presented with a symptom duration of greater than 3 months compared to none in the IFS group (p = 0.07). Mean absolute neutrophil count (ANC) was 2,976 per mm3 (range 2,488–3,462) in the PTLD group compared to 773 per mm3 (range 0.0–2,744) in the IFS group (p = 0.01). Both PTLD lesions with available diffusion-weighted imaging demonstrated diffusion restriction on magnetic resonance im­aging (MRI) compared to zero of the IFS lesions (p = 0.10). No PTLD lesions demonstrated mucosal infarcts compared to three of seven IFS lesions (p = 0.23). Conclusion: IFS was associated with a significantly lower ANC at the time of diagnosis compared to PTLD. Additionally, three other measures trend towards association with their respective pathology. PTLD typically has a more chronic time course than IFS, diffusion restriction on MRI is predominantly associated with PTLD patients, and mucosal infarct on MRI is more suggestive of IFS. Additionally, all cases of sinonasal PTLD arose following solid organ transplantation. These factors may assist clinicians during diagnosis.
ORL

High-Grade Neuroendocrine Carcinoma of the Head and Neck: Human Papillomavirus Status and PD-L1 Expression

24-09-2019 – K Bahr,S Zimmer,E Springer,C Fottner,S Becker,BP Ernst,C Matthias,J Künzel

Journal Article

Background: Human papillomavirus (HPV)-related head and neck squamous cell carcinoma represents an important subgroup of head and neck cancer, but HPV occurs also in the less common neuroendocrine carcinomas (NEC). The PD-1/PD-L1 pathway appears to be activated in pulmonary NEC and correlates with a higher mutation burden, but the potential of NEC to respond to checkpoint inhibitors is unknown to a large extent. Objectives: To determine the HPV status of NEC of the head and neck region and to investigate the expression of PD-1 and its ligands PD-L1 and PD-L2. Methods: Surgical tumor samples from 2006 to 2017 were analyzed. HPV status was determined by p16 immunohistochemistry (IHC) and multiplex PCR. IHC using the Cologne Score was performed for PD-1, PD-L1, and PD-L2. Results: Seven NEC tumor samples were analyzed, three of them showed HPV type 18. Expression of PD-1 and PD-L1 differed widely and showed no correlation to HPV status. IHC showed an overexpression of PD-L2 in most of the patients. Conclusions and Significance: A multicentric analysis of NEC is needed to further evaluate the role of HPV as well as immunocheckpoints with regard to inflammatory immune response in genesis and clinical course of this rare tumor entity. Biomarkers for selection of novel treatment regimens, including immunotherapeutic approaches, are warranted.
ORL

Comparative Analysis of Radial Forearm Free Flap and Anterolateral Thigh Flap in Tongue Reconstruction after Radical Resection of Tongue Cancer

18-09-2019 – YC Cai,C Li,DF Zeng,YQ Zhou,RH Sun,CY Shui,J Pei,W Liu,X Wang,ZH Jiang,ZQ Tang,J Jiang,W Wang

Journal Article, Review

Background: Surgery is still the preferred treatment for tongue cancer. Reconstruction should be performed immediately after extensive resection of the tumor. The purpose of this study was to investigate the clinical effect, advantages, and disadvantages of radial forearm free (RFF) flap and anterolateral thigh (ALT) flap in tongue reconstruction after radical resection of tongue cancer. Methods: Thirty-nine cases of tongue reconstruction with RFF flap or ALT flap from 2014 to 2018 were analyzed. The survival of the flap, the functional status after repair, and the influence on the donor area were examined, in addition to the advantages and disadvantages of the flap and the critical points of the technique. Results: Twenty-one cases with RFF flaps and 18 cases with ALT flaps showed complete flap survival. Among them, 1 case involved a venous vessel crisis after an ALT operation, and the flap survived after reoperation after thrombus removal and anastomosis. The recovery of tongue function was as follows: 41.0% patients exhibited normal speech, 43.6% patients exhibited near-normal speech, 12.8% patients exhibited vague speech, and 2.6% patients could not speak. There was no significant difference between the 2 groups (p = 0.134). The recovery of tongue flexibility was as follows: 41.0% of the patients had normal postoperative tongue flexibility, 43.6% of the patients had slightly limited tongue flexibility, 12.8% of the patients had severely limited tongue flexibility, and 2.6% of the patients were completely limited. The difference between the 2 groups was statistically significant (p = 0.045). The postoperative diet of patients was as follows: 51.3% of patients had a regular diet, 33.3% of patients had soft foods, 12.8% of patients received a fluid diet, and 2.6% of patients could not eat after the operation. There was no significant difference between the 2 groups (p = 0.209). The satisfaction of donor area was as follows: 46.2% of the patients were satisfied with the donor area, 51.3% of the patients were basically satisfied with the donor area satisfaction, and 2.6% of the patients were not satisfied with the donor area satisfaction. There was no significant difference between the 2 groups (p = 0.809). Conclusion: The RFF flap is the most widely used technique in tongue reconstruction, especially in patients with tongue defects less than half of tongue tissue. However, for a large number of tissue defects caused by radical resection of advanced tongue cancer, the ALT flaps can provide a sufficient tissue volume, conceal scars after the operation, cause fewer complications in the donor area, and facilitate tongue function and aesthetic quality.
ORL

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio among Patients with Vestibular Neuritis

09-09-2019 – S Shushan,S Shemesh,OJ Ungar,O Cavel,O Handzel,SO Tamir,Y Oron

Journal Article

Objective: To compare the level of the inflammatory markers (IM) neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) among healthy subjects and those presenting with vestibular neuritis (VN). Methods: A cross-sectional retrospective study was conducted in a tertiary hospital setting. The medical records of patients (20–60 years old) who were hospitalized between the years 2005 and 2014 with the diagnosis of VN were retrieved. Inclusion criteria were: (1) acute vertigo lasting for at least 24 h, (2) absence of auditory complaints, (3) presence of horizontal unidirectional nystagmus during physical examination, (4) absence of neurological symptoms or signs. The levels of the IM were compared with levels reported among two large cohorts of healthy subjects, within the same age range. Results: A statistically significant difference was found between the levels of NLR in VN subjects compared with controls, with higher levels of NLR in VN subjects (p #x3c; 0.001), while no significant difference was found between both groups concerning the levels of PLR. Conclusion: Higher levels of IM were found among VN patients, with significantly higher levels of NLR, but not PLR. This may suggest a possible inflammatory etiology of VN.
ORL

Endoscopic Tympanoplasty without Mastoidectomy for Active Mucosal Chronic Otitis Media with Mastoid and Tympanic Antrum Lesions: A Prospective Clinical Study

04-09-2019 – D He,Z Shou,Y Hsieh,C Wang,J Wang,Z Han,FL Chi

Journal Article

Objective: This study aims to assess the effectiveness of endoscopic tympanoplasty without mastoidectomy in the management of active mucosal chronic otitis media (COM) patients with mastoid and tympanic antrum lesions. Methods: It is a prospective controlled study where 42 patients with active mucosal COM with mastoid and tympanic antrum lesions or normal aeration were recruited from the outpatient clinic of the otology department, Eye Ear Nose and Throat Hospital of Fudan University. All patients underwent endoscopic tympanoplasty without mastoidectomy by using the underlay technique with tragal cartilage graft with one side-perichondrium. The follow-up period was at least 3 months and results were evaluated in terms of graft uptake, ear dryness and hearing improvement. Results: Statistics showed no significant difference in graft uptake between the mastoid and tympanic antrum lesions group (90.5%) and the normal aeration group (95.2%). There was no significant difference in ear dryness between the mastoid and tympanic antrum lesions group (95.2%) and the normal aeration group (100%). Hearing improvement was comparable in the 2 groups. Conclusion: Regardless of the occurrence of soft density shadows in temporal bone showed by high-resolution computerized tomography in the mastoid and tympanic antrum, mastoidectomy is an unnecessary procedure for dealing with active mucosal COM without cholesteatoma. Therefore, this study shows that endoscopic tympanoplasty without mastoidectomy may be applied to active mucosal COM without cholesteatoma.
ORL

Expression of NIS, VEGF-A and Thyroid Autoantibody in Papillary Thyroid Carcinoma with or without Hashimoto’s Disease

03-09-2019 – Y Ma,J He,N Shen,R Guo

Journal Article

Background: Since the incidence of papillary thyroid carcinoma (PTC) combined with Hashimoto’s thyroiditis (HT) has increased year by year, but the mechanism is still unknown, the goal of this study was to investigate the expression of Na+/I– symporter (NIS), vascular endothelial growth factor (VEGF)-A and thyroid autoantibodies in HT combined with PTC, and to explore the relationship between HT and PTC. Methods: Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of VEGF-A and NIS in 38 cases of PTC and HT combined with PTC and in 20 cases of normal tissues; preoperative serum TPOAb and Tg
Ab levels in each group were detected by ELISA. Results: The expression of VEGF-A in PTC and HT combined with PTC was significantly higher than that in normal tissues (p #x3c; 0.05), and the expression of VEGF-A in HT combined with PTC was higher than that in PTC (p #x3c; 0.05). The expression of NIS m
RNA in PTC and HT combined with PTC was significantly decreased compared to that in normal tissues (p #x3c; 0.05), and NIS m
RNA in HT combined with PTC tissue was lower than that in PTC tissue (p #x3c; 0.05). The preoperative levels of TPOAb and Tg
Ab in the HT combined with PTC group were higher than those in the normal group and the PTC group (p #x3c; 0.05). Conclusion: The presence of HT may inhibit iodine uptake and cause a decrease in NIS. Increased levels of TPOAb and Tg
Ab in HT patients lead to a high expression of TSH and stimulate VEGF secretion. This may explain why HT could accelerate the occurrence and development of PTC.
ORL

Topical Corticosteroids Decrease IL-25 Expression by Immunohistochemistry

09-08-2019 – HS Moustafa,M Qotb,MA Hussein,A Eid,EE Ayad,T Fawzy

Journal Article

Background: Interleukin-25 (IL-25) is an important contributing factor in the pathogenesis of allergic rhinitis. It leads to increasing peripheral and infiltrating eosinophilia as well as serum Ig
E, Ig
G, and Th2 cytokines (IL-4, IL-5, IL-13), which are responsible for the allergic symptoms. Intranasal steroids (INS) are effective in treating allergic rhinitis, but their effect on IL-25 release has not been studied. We aimed to study the link between IL-25 and the pathophysiology of allergic rhinitis as well as the effect of INS on its release. Methodology: This was a cohort, prospective, nonrandomized study that included 60 patients, 35 allergic rhinitis patients and 25 controls. We studied the effect of INS on IL-25 release. Results: Of allergic rhinitis patients 68.6% had strong cytoplasmic stain of IL-25 in the epithelial layer, while 25.7% had intermediate stain. INS caused significantly reduced IL-25 stain as only 14.3% of patients had intermediate stain and 85.7% had weak stain. Moreover, a correlation was found between nasal smear eosinophilia and the degree of IL-25 staining in the epithelial layer. Conclusion: Intranasal corticosteroids appear to be effective in the downregulation of IL-25, which may explain some of the utility of intranasal corticosteroid treatment in improving allergic rhinitis symptoms.
ORL

The Relationship between Age-Related Hearing Loss and Cognitive Disorder

07-08-2019 – SH Dong,JM Park,OE Kwon,SH Kim,SG Yeo

Journal Article

Background: Although the rates of occurrence of age-related diseases, including presbycusis and cognitive disorders, have increased with an increase in the geriatric population, the relationship between these two conditions remains unclear. Objective: To investigate the association between presbycusis and cognitive disorder. Subjects and Methods: A retrospective review of patient medical records was conducted at a single tertiary university hospital. This study enrolled 399 patients aged ≥65 years who were prescribed hearing aids for the chief complaint of hearing loss. For main outcomes and measures we used audiograms, the Korean Mini-Mental State Examination, and the Global Deterioration Scale (GDS). Results: Of the 399 patients who were prescribed hearing aids for presbycusis, 45 (11.3%) had dementia and 354 (88.7%) did not have dementia. When the cognitive disorder group was divided into mild (1–4) and severe (5–7) subgroups based on the GDS scores, the threshold of hearing loss was significantly higher in the severe group than in the mild group (p #x3c; 0.05). The prevalence of dementia was significantly higher in patients with hearing loss for ≥10 years than in patients with hearing loss for #x3c;10 years (p #x3c; 0.05). Conclusion: Presbycusis and cognitive disorder are correlated. More severe and prolonged hearing loss is associated with a higher prevalence of cognitive disorder.
ORL

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière’s Disease

07-08-2019 – E Kharkheli,S Japaridze,Z Kevanishvili,I Oz,LN Ozluoglu

Journal Article

Objective: To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière’s disease (MD). Methods: Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups. Results: Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD. Conclusion: VEMPs can be used for objective validation of the stage of MD.
ORL 2019;81:193–201

Investigation of the Safety of Injection Laryngoplasty under Antithrombotic Therapy

26-07-2019 – T Sato,T Nito,R Ueha,T Goto,T Yamasoba

Journal Article

Background: Glottic insufficiency negatively affects phonation and swallowing function. Injection laryngoplasty is a convenient and minimally invasive treatment for glottic insufficiency. This study assessed whether injection laryngoplasty is safe under continued administration of antithrombotic drugs, and aimed to establish measurable laboratory values under which such a procedure can be safely performed. Method: This retrospective medical record review covered the period from November 2012 to June 2018. We examined 17 patients who underwent injection laryngoplasty (47 injections) under continued administration of antithrombotic drugs at the University of Tokyo Hospital. We analyzed clinical and demographic profiles, complications, and blood test values. Statistical analyses were performed regarding the risks of complications due to injection side, route of administration, and number of antithrombotic drugs. Results: No patients exhibited airway narrowing or dyspnea; however, bleeding after injection laryngoplasty was observed in 3 patients. All patients exhibited values within the optimal treatment range. There were no significant differences regarding the risks of complications due to injection side, route of administration, or number of antithrombotic drugs. Conclusions: When the platelet count, prothrombin time-international normalized ratio, and activated partial thromboplastin time were within the optimal range prior to treatment, injection laryngoplasty could safely be performed, regardless of the administration of antithrombotic drugs.
ORL 2019;81:215–223