Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension

Conclusions: Patients with BPPV comorbid with hypertension (h-BPPV) tend to receive a delayed diagnosis of BPPV. Comorbidity with hypertension did not influence the efficacy of the repositioning maneuver; however, comorbidity with hypertension was associated with an increased recurrence rate of BPPV.

Objectives: To determine the clinical characteristics and outcomes of h-BPPV, as well as the clinical differences between h-BPPV and idiopathic BPPV (i-BPPV).

Methods: The authors reviewed the medical records of 41 consecutive patients with h-BPPV (the h-BPPV group) from March to December 2014 and 47 patients with i-BPPV (the i-BPPV group) during the same period.

Results: There were no significant differences in age, sex ratio, or the affected side between the h-BPPV and i-BPPV groups. The proportion of patients reporting an initial episode of positional vertigo was significantly lower in the h-BPPV group (51.22% vs 74.47%; p?=?.024). Patients in the h-BPPV group reported a longer median episode duration than did those in the i-BPPV group (60 days vs 15 days; p?=?.017). The results of treatment using repositioning maneuvers were similar between the two groups. At follow-up, 13 patients in the h-BPPV group were diagnosed with recurrent BPPV compared with six in the i-BPPV group (p?=?.031).     

Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis

Background: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. This study aimed to evaluate the effects of the Semont maneuver (SM) for BPPV treatment, compared with other methods.

Methods: Studies were selected in relevant databases under pre-defined criteria up to June 2015. The Cochrane evaluation system was used to assess the quality of the studies. Effect size was indicated as a risk-ratio (RR) with corresponding 95% confidential interval (CI). Statistical analysis was conducted under a randomized- or fixed-effects model. Sub-group analysis was performed.

Results: Ten studies were included in the meta-analysis. All of the studies presented a low attrition bias, but a high selection and reporting bias. SM had a much higher recovery rate (SM vs no treatment: RR?=?2.60, 95% CI?=?1.97–3.44, p?p?p?Conclusion: SM is as effective as EM and BDE for BPPV treatment.     

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome

Conclusion: HPV?+?HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can’t improve the Survival of the HPV-negative HNSCC patients.

Objective: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Methods: A search in PubMed and Chinese CNKI (2000–2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).

Results: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV?+?patients compared to HPV???patients (HR?=?0.48; 95% CI?=?0.37–0.62, p?p?p?p?p?= 0.05).     

外伤后良性阵发性位置性眩晕的临床特点和治疗

目的 探讨外伤后良性阵发性位置性眩晕(posttraumatic benign paroxysmal positional vertigo,t-BPPV)的临床特点和治疗.方法 回顾性分析2006年7月～2010年6月所诊治的17例t-BPPV患者的临床特点和治疗结果,并与同时间段治疗的43例特发性良性阵作性位置性眩晕...     

Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis

ObjectiveThis meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV).MethodsA extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver.ResultsFive randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54–4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99–1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56–8.07, p = 0.27).ConclusionGufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate.     

Matched analysis of the prognosis of amelanotic and pigmented melanoma in head and neck

Abstract

Background: The prognosis of mucosal melanoma is poor, and the difference in clinical prognosis between patients with and without pigment needs further study.

Aim: To analyze data with head and neck mucosal melanoma, and compare the prognosis of patients with and without pigment.

Material and methods: The patients of amelanotic melanoma were matched with pigmented type according to age, sex, stage, location of disease, treatment history, tobacco and alcohol history. The Kaplan–Meier and Cox proportional risk regression model was used for analyzation.

Results: 46 patients of amelanotic melanoma and 46 of pigmented type were included in this study. The overall survival rate and progression-free survival rate of patients with pigmented melanoma were higher than in patients with amelanotic melanoma (HR = 0.533, p?=?.035, 95% CI = 0.296–0.957; HR = 0.530, p?=?.034, 95% CI = 0.294–0.953, respectively), and the risk of distant metastases in patients with amelanotic melanoma was significantly higher than that in patients with pigmented melanoma (HR = 0.474, p?=?.046, 95% CI = 0.228–0.987).

Conclusions and significance: The prognosis and disease-free survival of amelanotic melanoma is worse than for the pigmented type group. More identifying the differences in clinical characteristics will help to further individualized treatment decisions.     

创伤后良性阵发性位置性眩晕的临床特点及近期疗效研究

目的 探究原发性(i-BPPV)与创伤性(t-BPPV)良性阵发性位置性眩晕的临床特点及近期疗效是否存在显著性差异。 方法 回顾性分析2014年7月至2016年9月在海军总医院全军耳鼻咽喉头颈外科中心确诊的307例i-BPPV及25例t-BPPV患者的临床资料,分析两组病例在性别、年龄、并发症(恶心、呕吐、耳鸣、听力减退)、患侧、受累半规管及近期疗效(3 d及1周)等方面是否存在显著性差异。 结果 i-BPPV组与t-BPPV组患者在性别、年龄、并发症、患侧等方面不存在显著差异(P>0.05);t-BPPV具有相对较差的短期疗效(P<0.001);t-BPPV患者更易出现前半规管受累(P=0.024)。 结论 相比i-BPPV,t-BPPV的预后较差,前半规管BPPV的正确治疗对t-BPPV预后更重要。     

Efficacy of the Li maneuver in treating posterior canal benign paroxysmal positional vertigo

Conclusion: The Li maneuver is a safe, effective, and simple repositioning method for the treatment of BPPV. It is simple to master and exerts an exact effect. As a rapid repositioning method, the Li maneuver can result in reduced treatment times and increased treatment efficacy, and is, therefore, especially suitable for patients with limited cervical spine movement.

Objective: To compare the short-term efficacies of the Li and Epley maneuvers in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV).

Methods: A total of 120 patients with PC-BPPV were randomly treated by either the Li or Epley maneuvers at our department between May 5, 2014 and July 30, 2015. Follow-up examinations were performed 3 days and 1 week after the first repositioning.

Results: Of the 120 patients initially enrolled, 113 (72 females; 41 males; average age?=?52 years; Li and Epley maneuver groups, 56 and 57 cases, respectively) satisfied the inclusion and exclusion criteria of this study. There were no statistically significant differences between the two groups of patients in terms of the success rates of treatment at either the 3-day or 1-week follow-ups (p?=?.756 and .520, respectively).     

Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer

Abstract

Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy.

Material and methods: 170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery.

Results: Median survival time was 30 months (range: 3–59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6–32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5–49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p?=?.237), however patients with a partial response had a significant decrease in survival (32.2%) (p?<?.001).

Conclusions: In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.     

EGFR cut-off point for prognostic impact in laryngeal squamous cell carcinoma

Abstract

Background: Various molecular biomarkers, including epidermal growth factor receptor (EGFR), have gained importance as predictors of head and neck cancer disease progression.

Aims: This study aimed to investigate the ability of EGFR expression as a prognostic marker for laryngeal squamous cell carcinoma (LSCC).

Materials and methods: A total of 31 patients with LSCC with immunohistochemistry (IHC) staining for EGFR were examined. Digital image processing was applied to analyze EGFR staining intensity and percent distribution, which were calculated as the H-score. We used a receiver operating characteristic (ROC) curve to identify the best cut-off point of EGFR expression, with H-score separated into high- and low-grade for cancer recurrence prediction.

Results: The cut-off point of EGFR expression for high- and low-grades was an H-score of 170 with a sensitivity of 75% and a specificity of 66.7%. Using this cut-off, 14 (45.16%) and 17 (54.84%) patients were categorized as having high- and low-grades EGFR, respectively. The analysis showed a significant reverse correlation between the EGFR grade and LSCC recurrence (RR, 0.4; 95% CI, 0.17–0.98; p?=?.02).

Conclusions: Our study demonstrated that EGFR grading using H-score with the generated cut-off point by the ROC curve might be further applied as a potential marker for LSCC prognostic prediction.     

Recurrent pleomorphic adenoma: is treatment considerably delayed thus affecting surgical morbidity?

Objective: To examine the incidence of late presentation of patients with recurrent pleomorphic adenoma (RPA) of the parotid gland.

Methods: This is a retrospective analysis of patients treated in our center. We examined patients demographics, disease characteristics, treatment, and outcome and as well as the time period length from the first discovery of a recurrent mass until seeking treatment at our clinic and its effect on morbidity.

Results: A total of 30 patients were included. 26% underwent initial enucleation in other institutions. In eight patients (26%), the recurrence of the mass was second or higher. The patients average time period length until seeking treatment was 2.48 years, with 33% of patients showing a time period length of over three years. Multifocal tumor, tumor diameter larger than 2?cm and facial nerve involvement were found in 15 (50%),16 (53.3%) and seven (25%) patients respectively. Patient's delay of presentation by ≥3 years was associated with a tumor size of ≥2?cm (Relative Risk [RR]?=?2, p?=?.02). Patient's delay of presentation by ≥2 years was also associated with a trend towards a higher rate of post-operative facial nerve palsy (RR?=?3.37, p?=?.07, CI?=?0.88–12.85).

Conclusion: Most patients with RPA were presented late, thus affecting disease extent and surgical morbidity.     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.     

Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis

Conclusions: Tympanoplasty using cartilage grafts has a better graft take rate than that using temporalis fascia grafts. There are no significant differences between cartilage grafts and temporalis fascia grafts for hearing outcomes. Contrary to the sliced cartilage sub-group, full-thickness cartilage grafts generate better hearing outcomes than temporalis fascia grafts.

Objective: Tympanic membrane perforation can cause middle ear relapsing infection and lead to hearing damage. Various techniques have been applied in order to reconstruct the tympanic membrane. Recently, cartilage grafts and temporalis fascia grafts have been widely used for tympanic membrane closure. A systemic review and meta-analysis was carried out based on published retrospective trials that investigated the efficacy of cartilage grafts and temporalis fascia grafts in type 1 tympanoplasty. Both graft take rates and mean AIR-BONE-GAP gains were analyzed.

Methods: Cochrane Library, PubMed, and Embase were systematically searched. After a scientific investigation, we extracted the relevant data following our selection criteria. Odds ratio (OR) of graft take rates and mean difference (MD) of AIR-BONE-GAP gains were calculated within 95% confidence intervals.

Results: Eight eligible articles with 915 patients were reviewed. The pooled OR for graft take rate was 3.11 (95% CI =1.94–5.00; p =?0.43) and the difference between the two groups was significant, which means that the cartilage grafts group got a better graft take rate than the temporalis fascia grafts group. The pooled MD for mean AIR-BONE-GAP gain was 1.92 (95% CI?= ?0.12–3.95; p?p?=?0.14) and the difference was significant, which means that the full thickness cartilage grafts sub-group got a better hearing outcome than the temporalis fascia grafts group. On the contrary, the pooled MD of sliced cartilage grafts sub-group was 0.12 (95% CI?=??0.44–0.69; p?=?0.61) and there was no significant difference between the sliced cartilage grafts and temporalis fascia group.     

Double-blind randomized controlled trial on efficacy of cupulolith repositioning maneuver for treatment of apogeotropic horizontal canal benign paroxysmal positional vertigo

Abstract

Backgrounds: Although various therapeutic maneuvers have been proposed, it is still unclear which maneuver is better to treat apogeotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV).

Objectives: This study aimed to assess the therapeutic efficacy of the cupulolith repositioning maneuver (CuRM) in apogeotropic HC-BPPV in comparison with the therapeutic head-shaking maneuver and modified Lempert maneuver.

Materials and Method: This is double-blind randomized prospective study. Forty-nine consecutive patients diagnosed with apogeotropic HC-BPPV were allocated randomly to CuRM (n?=?18), therapeutic head-shaking (n?=?16), or modified Lempert maneuver (n?=?15). The presence of nystagmus and vertigo on positional testing were evaluated at 30?min, on 1?day, and 1?week after treatment.

Results: There were no significant differences in any clinical characteristics between the three groups at randomization. After a single trial of therapeutic maneuvers on the initial visit day, the CuRM (38.9%) and therapeutic head shaking maneuver (12.5%) did not show differences compared to modified Lempert maneuver (33.3%). The therapeutic effects on the 2nd day and at 1?week after treatment also did not differ between the three groups.

Conclusions: Although the CuRM is theoretically considered to be a better therapeutic method, the therapeutic efficacy of CuRM was not statistically different compared to the other two maneuvers.     

Repositioning intervals in the modified Epley’s maneuver and their effect on benign paroxysmal positional vertigo treatment outcome

Introduction: This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.

Objective: The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).

Study design: Longitudinal prospective study.

Setting: Outpatient practice in a tertiary care facility.

Subjects and methods: Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120?s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.

Results: The mean age of the patients was 49.25 years (range =19–76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.     

A comparison between systemic and intratympanic steroid therapies as initial therapy for idiopathic sudden sensorineural hearing loss: a meta-analysis

Conclusions: Intratympanic steroid (ITS) treatment groups exhibited better outcomes in PTA improvement and recovery rate than systemic steroid therapy (SST) groups. Whether initial hearing loss severity would influence the PTA improvement and recovery rate still requires further research.

Objective: This article was aimed at evaluating whether intratympanic steroid (ITS) treatment would provide benefits over systemic steroid therapy (SST) as initial therapy in patients with idiopathic sudden sensorineural hearing loss (ISSHL). A meta-analysis was carried out based on published RCTs that included the hearing outcomes of ITS treatment and SST in ISSHL as initial therapy. Both PTA differences and recovery rate were analyzed.

Methods: The literature search was based on the online database including Pubmed, Embase, and Cochrane trails, which completed in July 2016. This study extracted the relevant data following the selection criteria. Mean difference (MD) of PTA differences and Odds ratio (OR) of recovery rate were calculated within 95% confidence intervals.

Results: Six eligible articles were reviewed. The pooled MDs of PTA differences was 3.42 (95% CI?=?0.17–6.67, p?=?.04) and the pooled ORs of recovery rate was 2.05 (95% CI?=?1.38–3.03, p?=?.0003), which indicated that ITS treatment yielded better PTA improvement than SST. Sub-group analyses based on the initial hearing loss were also conducted; however, the difference was insignificant according to our analysis results (p?=?.82 for PTA improvement and p?=?.26 for recovery rate).     

Residual dizziness after successful treatment of idiopathic benign paroxysmal positional vertigo originates from persistent utricular dysfunction

Objective: We used ocular vestibular evoked myogenic potentials to investigate the relationship between residual dizziness and utricular function following the canalith repositioning procedure for benign paroxysmal positional vertigo.

Methods: Ocular vestibular evoked myogenic potentials were measured in 44 patients (40 included in analyses, four excluded) with successful results from the canalith repositioning procedure. The patients were examined before treatment and again one week after treatment. We analyzed how various general factors and ocular vestibular evoked myogenic potentials related to residual dizziness.

Results: Residual dizziness was not related to gender, affected side, age, duration of symptoms, recurrence, or the results of the initial ocular vestibular evoked myogenic potential test (p?>?.05). However, residual dizziness was significantly associated with the results of the second ocular vestibular evoked myogenic potential test (p?=?.007).

Conclusions: Residual dizziness after a successful canalith repositioning procedure may be caused by persistent utricular dysfunction.     

Topical versus oral antibiotics,with or without corticosteroids,in the treatment of tympanostomy tube otorrhea

ObjectiveAntibiotic treatment is the standard of care for tympanostomy tube otorrhea. This meta-analysis aims to evaluate the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children.Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ProQuest.Review MethodsThe above databases were searched using a search strategy for randomized controlled trials for optimal treatment of tube otorrhea in the pediatric population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Primary outcome was cure (i.e. clearance of otorrhea) at 2–3 weeks. Secondary outcomes were microbiological eradication and complications such as dermatitis and diarrhea. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) and number needed to benefit (NNTB) in a random-effects model.ResultsWe identified 1491 articles and selected 4 randomized controlled trials which met our inclusion criteria. Topical treatment had better cure (NNTB = 4.7, pooled RR = 1.35, p < 0.001) and microbiological eradication (NNTB = 3.5, pooled RR = 1.47, p < 0.001 among 3 of the studies) than oral antibiotics. Oral antibiotics had higher risk of diarrhea (pooled RR = 21.5, 95% CI 8.00–58.0, p < 0.001, Number needed to harm (NNTH) = 5.4) and dermatitis (pooled RR = 3.14, 95% CI 1.20–8.20, p = 0.019, NNTH = 32). The use of topical steroids in addition to topical antibiotics was associated with a higher cure rate (pooled RR = 1.59, p < 0.001 vs pooled RR = 1.57, p = 0.293).ConclusionTopical antibiotics should be the recommended treatment for management of tympanostomy tube otorrhea in view of its significantly improved clinical and microbiological efficacy with lower risk of systemic toxicity as compared to oral antibiotics. Further research is necessary to confirm the benefits of topical corticosteroids as an adjunct to topical antibiotics.     

Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes

Conclusions: Objective benign paroxysmal positional vertigo (O-BPPV) and subjective BPPV (S-BPPV) have similar demographic and clinical features. Canalith repositioning manoeuvres (CRMs) can be an effective treatment for patients with S-BPPV, and a diagnosis of positional nystagmus is not essential for considering CRMs. This study supports the use of CRMs as the primary treatment for S-BPPV.

Objective: To examine differences in demographic and clinical features, as well as treatment outcomes, between O-BPPV and S-BPPV.

Methods: The medical records of 134 patients with BPPV were reviewed for demographic characteristics, past medical history, associated symptoms, response to CRMs, interval between symptom onset and the first medical visit, and recurrence rate. The O-BPPV group (n?=?101) comprised patients who experienced vertigo and accompanying autonomic symptoms, and showed typical nystagmus. The S-BPPV group (n?=?33) comprised patients who, when subjected to a provoking manoeuvre, showed all of the classic BPPV symptoms but did not show nystagmus. All patients had at least 3 years of follow-up.

Results: The demographics (age and sex ratio), past medical history, and associated symptoms were not significantly different between the two groups. Posterior semi-circular canal BPPV appeared more than twice as often as horizontal semi-circular canal BPPV in patients with S-BPPV. However, both canals were affected to a similar proportion in patients with O-BPPV, and the difference was marginally significant (p?=?0.073). Overall improvement was better in O-BPPV than in S-BPPV; however, there was no significant difference. The total numbers of manoeuvres for recovery and the interval between symptom onset and the first medical visit also did not show any significant inter-group differences. During a 3-year follow-up, the recurrence rate was 13.8% for O-BPPV and 21.2% for S-BPPV.