Does the Kyphotic Change Decrease the Risk of Fall?

Objectives

Falls are a major problem in the elderly. Age-related degeneration of the human balance system increases the risk of falls. Kyphosis is a common condition of curvature of the upper spine in the elderly and its development occurs through degenerative change. However, relatively little is known about the effect of kyphotic changes on balance in the elderly. The aim of this study is to investigate the influence of kyphosis on the balance strategy through use of the motor control test (MCT) in computerized dynamic posturography.

Methods

Fifty healthy subjects who were not affected by other medical disorders that could affect gait or balance were enrolled in the study. By simulation of kyphotic condition through change of the angles of the line connecting the shoulder to the hip and the ankle axis by approximately 30°, the latency and amplitude of the MCT were measured in upright and kyphotic condition.

Results

In the kyphotic condition, latency was shortened in backward movement. In forward movement, latency was shortened only in large stimulation. The amplitude in forward movement was decreased in kyphotic condition. However, the change of amplitude was not significant in large intensity backward movement in the same condition.

Conclusion

Kyphotic condition decreases the latency of MCT, especially in backward movement. These findings imply that kyphotic condition may serve as a protective factor against falls.     

Bell’s palsy workup:Does audiometry add value?

Objective:To investigate if routine audiometry in Bell’s palsy patients has prognostic value.Methods:Retrospective case review was conducted on all Bell’s palsy patients(n紏191)seen at the tertiary otolaryngology specialist outpatient clinic from 2015 to 2017.Correlation of ipsilesional audiometric thresholds with patients’time-to-recovery and initial clinical severity(measured by House-Brackmann(HB)scoring)were used for the prognostic outcome measure.Audiometry results were analyzed using three contiguous frequency pure-tone average(1kHz,2kHz,4kHz).Statistical analysis was done via Stata(v13.1),significance tests were 2-sided at 5%significance level.Results:There was no significant difference between audiometric thresholds between the ipsilesional ear and the contralateral ear(p=0.87).Time-to-recovery was significantly longer for patients with severe initial presentation as compared to mild and moderate severity(p<0.01).There was no correlation found between the audiometry results and HB score at presentation(p=0.39).There was no correlation found between ipsilesional audiometric thresholds and time-to-recovery(p=0.58).Conclusion:Our study suggests that routine audiometry has limited prognostic value in Bell’s palsy patients.     

Does xanthine oxidase contribute to the hydroxyl radical generation in ischemia and reperfusion of the cochlea?

We investigated the effect of a hydroxyl radical scavenger, 1,3-dimethyl-2-thiourea (dimethylthiourea), and two xanthine oxidase inhibitors, oxypurinol and allopurinol, on the threshold shift of the compound action potential (CAP) after transient ischemia of the cochlea. Transient ischemia of 30 min duration was induced in albino guinea pigs via a skull base approach. The animals were treated with perilymphatic perfusion of dimethylthiourea, oxypurinol or allopurinol from 10 min before the onset of ischemia to 4 h after the termination of ischemia. Dimethylthiourea ameliorated the CAP threshold shifts at 4 h after the onset of reperfusion in a dose-dependent manner. However, oxypurinol and allopurinol did not affect the post-ischemic cochlear dysfunction. These results imply that the hydroxyl radical plays an important role in generation of cochlear dysfunction induced by ischemia-reperfusion and that xanthine oxidase may not be the primary source of this radical.     

Use of positron emission tomography scanning in metastatic head and neck cutaneous squamous cell cancer: Does it add to patient management?

Purpose

To evaluate the impact of whole-body positron emission tomography in comparison to staging by conventional methods alone in management of patients with head and neck cutaneous squamous cell cancer (cSCC) with confirmed regional nodal metastasis.

Materials and methods

This is a retrospective case cohort study carried out at a tertiary referral cancer centre. The participants were thirty-one adults with head and neck cSCC and regional nodal metastasis. The original treatment plan based on conventional cross-sectional imaging and clinical examination was compared to the final treatment plan after additional PET staging to evaluate the impact of 18F-FDG PET–CT on patient management.

Results

Addition of 18F-FDG PET–CT did not change the management in 24/31 (77%) of patients. In four cases the 18F-FDG PET–CT failed to pick up biopsy proven metastatic disease. Two patients who had reduced extent of surgery have shown no features of regional failure after one year of follow-up.

Conclusion

Overall the management in majority of head and neck cSCC patients with regional metastasis does not change by addition of 18F-FDG PET–CT over conventional imaging.     

Does the hypopharyngeal cavernous body protect the development of Zenker's diverticulum?

Objective

The aim of this study was to examine the morphology of the cavernous body at the pharyngoesophageal segment.

Methods

In 47 cadavers the submucosal vascular plexus of the pharyngoesophageal segment and the cricopharyngeal muscle were examined.

Results

A vascular plexus which was macroscopically non visible or slightly identified was observed in the majority of the specimens (28 or 59.6%). Fourteen of the cadavers (29.8%) exhibited macroscopically lightly observable blood vessels which were covering a discontinuous area of the hypopharyngeal wall. In the other five specimens (10.6%) the vascular plexus was covering a large part of the dorsal wall of the pharyngoesophageal segment as a compact mass. The grade of dilation of the vascular plexus corresponded to the degree of protrusion of the cricopharyngeal muscle.

Conclusions

In the case of a persistent constricted cricopharyngeal muscle, the dilation of the hypopharyngeal cavernous body may protect from developing a Zenker's diverticulum by reinforcing the Killian's dehiscence.     

Does Helicobacter pylori colonize the nasopharynx of children and contribute to their middle ear disease?

OBJECTIVE: There is growing interest in studying the presence of HP in the upper aerodigestive tract. It was shown in several pilot studies that it colonizes the area, while other authors found no evidence of its presence there and a third group of authors believed that it had only a transient presence there. In this study we investigated a possible role for HP in middle ear disease in children. MATERIAL AND METHODS: Consecutive patients undergoing myringotomy and adenoidectomy for chronic otitis media with effusion or recurrent otitis media were enrolled. Middle ear fluids were cultured on three types of agar plate (Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens. Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux in their children. RESULTS: Eighteen patients were enrolled in the study (mean age 4.4 years; age range 3-8 years) with an equal gender distribution. All 28 middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28 samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of the 13 adenoid specimens obtained were positive on rapid urease testing, but none on PCR. Seven of the 18 patients had at least 1 symptom suggestive of gastroesophageal reflux during the 6 months preceding the study but this did not have an impact on any of the results. CONCLUSION: There was no evidence from this study that Helicobacter pylori (HP) colonizes the nasopharynx of children with middle ear disease, whether dyspeptic or not. There is also no apparent role for this bacterium in middle ear pathology.     

Does rhinitis lead to asthma?

Rhinitis and asthma are commonly linked even if the precise pathological mechanisms explaining the relationship are not fully understood. Although there is increasing evidence that rhinitis may influence the development of asthma, there remain many gaps in our understanding of the processes involved. The complexity of this relationship is mainly due to the multiple interactions between genetic background, environmental factors and the specific host reaction. Epidemiological surveys have highlighted significant clinical associations and identified some factors that favour the progression from rhinitis to asthma. Basic research has demonstrated numerous similarities in inflammatory and immunological mechanisms.     

Sonography of the larynx--an alternative to laryngoscopy?

PROBLEM: The aim of this study was to determine whether the pictorial results obtained from B-mode ultrasonography duplicate those of laryngeal endoscopy and whether there are any additional advantages when using ultrasonography. PATIENTS AND METHODS: A total of 22 patients with various diseases of the larynx were examined ultrasonically with the ultrasound plusing a Sonoline Elegra as well as with a '7.5 L40' and a 'VF 13/5' linear array. In order to compare both methods directly, reference data were prepared and contrasted. RESULTS: All of the laryngeal lesions recognised in the endoscopic investigation were also demonstrable by the use of ultrasound, although minor changes were difficult to detect. In one case, ultrasonography suggested the presence of an infiltration of the thyroid cartilage, otherwise no additional information was available using this method. CONCLUSIONS: Using ultrasonography, the image quality of the larynx is worse than that of the soft tissue of the neck, which is determined by the air-mucous membrane boundary as well as the (ossified) cartilaginous skeleton. Thus, ultrasonography is useful in cases of larger laryngeal lesions, while there is no advantage in the detection of small processes.     

Does septoplasty enhance the quality of life in patients?

Evaluation of the severity of disease and the effectiveness of operative treatment is commonly done by registering pre- and postoperative symptoms. During the preceding decade, greater awareness has focused not only on the symptoms but also on patients’ quality of life (QoL). The aim of the study was to determine the effect of septoplasty, as measured by generic and disease-specific QoL questionnaires. The generic 15D and disease-specific SNOT-22 questionnaires were given to patients before the operation and 6?months after the operation. Data analysis consisted originally of 188 septoplasty patients. One-hundred and twenty-six patients (67%) answered the SNOT-22 questions, and in the 15D, the response rate was 76%. In the post-operative SNOT-22, the need to blow the nose, sneezing, runny nose, nasal obstruction, loss of smell or taste, post-nasal discharge, facial pain/pressure, difficulty in falling asleep and waking up at night improved significantly. However in the 15D the mean QoL, i.e., general well-being, became significantly poorer. The QoL became increasingly poor especially in the older age groups and among the patients in which the improvement achieved in nasal symptoms postoperatively was minor. The more nasal symptoms the patients had pre- or postoperatively, the poorer the QoL was in general. Based on our results, critical evaluation of the symptoms and findings in the patients is essential in deciding whether surgery or other treatment should be given to individual patients having nasal blockage symptoms. Especially in patients with mild symptoms or among older patients, adequate medical treatment has to be tried before even considering surgery. The results also encourage the use of a systematic questionnaire to estimate the severity of symptoms in daily clinical practice.     

Does septoplasty improve the quality of life in children?

Objectives

The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS).

Methods

Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery.

Results

Thirty-five patients with a mean age of 13.4 ± 2.8 (8–16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction.

Conclusion

Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.     

Does the presence of a tracheoesophageal fistula predict the outcome of laryngeal cleft repair?

OBJECTIVE: To determine if the presence of a tracheo-esophageal fistula (TEF) alters outcome following laryngeal cleft repair. DESIGN: A retrospective review of patients diagnosed and treated for laryngeal clefts, with a minimum follow-up period of 1 year. SETTING: An academic tertiary care children's hospital. PATIENTS: Twenty-five pediatric patients diagnosed and surgically treated for laryngeal cleft. MAIN OUTCOME MEASURES: Each chart was reviewed to determine if patients with a laryngeal cleft had been diagnosed with TEF and had undergone a surgical TEF repair procedure. The success of the surgery was evaluated based on the resolution of symptoms and the endoscopic evaluation of the repair site. RESULTS: Twenty-five patients were reviewed for study purposes. Fourteen had a history of TEF repair and 11, no history of TEF. All 25 patients underwent surgical repair of the laryngeal cleft. Twelve of the 14 patients with a history of TEF repair experienced a breakdown of the laryngeal cleft repair. Only 1 of the 11 patients with no history of TEF experienced such a breakdown. In 8 of 9 patients with a laryngotracheoesophageal type I cleft, surgical repair was not successful. CONCLUSIONS: In our series, patients with laryngeal clefts who also had a history of TEF had a much higher incidence of breakdown of cleft repair compared with patients with no history of TEF. This finding is not conclusive and requires further investigation. The failure of cleft repair correlated with the severity of the cleft. The importance of these associations may lead to enhanced surgical planning and realistic preoperative family expectations.