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1.
Cameron C. Wick Nauman F. Manzoor Caileigh McKenna Maroun T. Semaan Cliff A. Megerian 《American journal of otolaryngology》2017,38(3):285-290
Objectives
To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.Study design
Retrospective case series and patient survey.Setting
Tertiary university hospital.Patients
Meniere's disease (MD) patients that failed medical therapy and subsequently underwent an endolymphatic sac shunt procedure. All patients had definitive or probable MD and at least 18-months of follow-up.Interventions
Three variations on endolymphatic sac decompression with shunt placement were performed: Group A received no local steroids, Group B received intratympanic dexamethasone prior to incision, and Group C received dexamethasone via both intratympanic injection and direct endolymphatic sac instillation.Main outcome measure(s)
Vertigo control, hearing results, and survey responses.Results
Between 2002 and 2013, 124 patients with MD underwent endolymphatic sac decompression with shunt placement. 53 patients met inclusion criteria. Groups A, B, and C had 6 patients, 20 patients, and 27 patients, respectively. Mean follow-up was 56 months. Vertigo control improved in 66%, 83%, and 93% of Groups A, B, and C. Functional level improved for Group B (? 2.0) and Group C (? 2.2) but was unchanged in Group A. Pure-tone average and speech discrimination scores changed by + 22 dB and ? 30%, + 6 dB and ? 13%, and + 6 dB and ? 5% in Groups A, B, and C. The long-term hearing results were significantly better with steroids (Groups B and C) according to the AAO-HNS 1995 criteria but did not meet significance on non-parametric testing.Conclusions
Endolymphatic sac shunt procedures may benefit from steroid instillation at the time of shunt placement. 相似文献2.
Marianne Abouyared Mikhaylo Szczupak Eric Barbarite Zoukaa B. Sargi David E. Rosow 《American journal of otolaryngology》2017,38(1):7-12
Purpose
The purpose was to assess the success of open tracheal resection and re-anastomosis for non-malignant tracheal stenosis in adults. Successful operations were defined as T-tube or tracheostomy-free status by 6 months post-operatively.Materials and methods
Retrospective chart review was performed and data were recorded in a de-identified manner. The primary outcome was T-tube or tracheostomy-free status by 6 months following tracheal resection. Clinical and demographic characteristics were evaluated as potential prognostic variables.Results
Thirty-two patients met inclusion criteria, with a median age of 46. Seven patients underwent tracheal resection with primary closure, without stenting. Successful tracheal resection was defined as tracheostomy or T-tube free by 6 months post-operation, and this was possible in 21 patients (66%). Eighty-two percent of patients with cricoid cartilage-sparing tracheal resection had a successful outcome, versus 30% of patients who underwent cricoid cartilage resection (HR 5.02, 95% CI 1.46–17.3; p = 0.011). Patients with a history of tracheostomy-dependence were four times more likely to remain tube-dependent at 6 months (HR 4.15, 95% CI 1.56–10.86; p = 0.004).Conclusions
Tracheal stenosis remains a very difficult problem to treat. In our series, we confirm that patients with cricoid involvement or with a history of tracheostomy were more likely to be tube dependent at 6-months post-operation. 相似文献3.
Purpose
To explore the effectiveness of fibrin coating in reducing web formation after endoscopic management of the anterior commissure of the larynx.Materials and methods
Using a spray device that is generally used for laparoscopic operations, we covered the wound with fibrin glue (Bolheal®) to avoid web formation. This technique was employed in cases wherein the anterior commissure was mainly managed by laser operation; the glue was sprayed after vaporization. Fibrinogen was first sprayed and the wound was properly soaked with a swab, which was followed by application of thrombin. We used this method in 17 cases and evaluated voice function by acoustic analysis – pitch perturbation quotient (PPQ) and amplitude perturbation quotient (APQ) – and maximum phonation time (MPT) before and after the operation.Results
No severe web formation was observed at three months after the operation. PPQ values improved from 3.048 ± 2.801% to 0.653 ± 0.463% (p < 0.05, paired t-test). APQ values improved from 7.996 ± 5.003% to 3.042 ± 1.872% (p < 0.05, paired t-test). Voice quality did not worsen in any of the cases. MPT values improved from 17.2 ± 10.8 s to 26.7 ± 14.2 s (p < 0.05, paired t-test) Voice function improved 3 months after the operation in all cases.Conclusion
The fibrin coating method is an easy and effective approach to avoid web formation without creating cervical wounds in cases that require handling of the anterior commissure under laryngomicrosurgery. 相似文献4.
Xuan Su Caiyun He Tao Tang Weichao Chen Zhaoqu Li Yong Chen Ankui Yang 《American journal of otolaryngology》2017,38(1):52-56
Objective
The value of additional use of cetuximab with the classical cisplatin, docetaxel and 5-fluorouracil regimen in larynx preservation remains unknown. This study was designed to resolve this issue and appraise its toxicity.Materials and methods
Thirteen untreated patients with stage III–IV larynx or hypopharynx squamous cell carcinoma were recruited and received two cycles of C + TPF regimen (cetuximab plus docetaxel, cisplatinand and 5-fluorouracil), followed by one more cycle of C + TPF and intensity-modulated radiotherapy (70 Gy). Primary endpoint was larynx preservation (LP) rate at 3 months. Secondary endpoints were larynx function preservation (LFP) and overall survival (OS) at 12, 36 and 60 months.Results
With a two-cycle induction treatment of C + TPF protocol, four (31%) and nine (69%) patients achieved complete and partial response, respectively. The top three toxicities were dermatitis (9 cases), nausea/vomiting (6 cases), and anemia (4 cases). After the full-course treatment, 12 out of 13 patients (92.3%) obtained LP at 3 months. This strategy demonstrated relatively high LFP rates of 92.3%, 69.2% and 54.5% and satisfactory OS rates of 100%, 84.6% and 54.5% at 12, 36 and 60 months, respectively.Conclusions
These preliminary results suggest induction treatment with C + TPF regimens, followed by intensity-modulated radiotherapy is well-tolerated, which warrants further evaluation. 相似文献5.
Jessica Meshman Pin-Chieh Wang Robert Chin Maie St. John Elliot Abemayor Sunita Bhuta Allen M. Chen 《American journal of otolaryngology》2017,38(1):31-37
Purpose
To evaluate the prognostic significance of p16 expression among patients with squamous cell carcinoma of the larynx (LSCC) and hypopharynx (HSCC).Methods
The medical records of all patients with locally advanced, non-metastatic LSCC/HSCC were reviewed. p16INK4A (p16) protein expression was evaluated on pathological specimens by immunohistochemistry (IHC), and the Kaplan–Meier method was used to estimate overall survival (OS) and locoregional control (LRC). In select cases, p16 expression was correlated to high-risk and low-risk HPV genotypes using in situ hybridization (ISH).Results
Thirty-one patients (23 LSCC; 8 HSCC) were identified. Seventeen (54.8%) patients were p16 negative; 14 (45.2%) were p16-positive. The primary treatment modality was radiation therapy for 22 (71.0%) patients and surgery for 9 (29.0%). Nineteen (61.3%) patients were evaluated for high-risk HPV and low-risk HPV genotypes by IHC, of whom 2 (10.5%) patients were positive for high-risk HPV and 1 (5.3%) was positive for low-risk HPV. For high-risk HPV, the positive predictive value (PPV), sensitivity, and specificity of p16 was 20.0%, 100%, and 52.9%. There was no significant difference in the 2-year actuarial rates of OS (91% vs. 64%, p = 0.34) or LRC (51% vs. 46%, p = 0.69) between the p16-positive and p-16 negative patients.Conclusion
In this small cohort of 31 LSCC and HSCC patients, p16 was not a significant predictive of either LRC or OS. Furthermore, p16 was poorly correlated with HPV genotyping as identified by ISH. 相似文献6.
Objective
We evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus.Study design
A prospective, randomized, controlled clinical study.Setting
A university-affiliated teaching hospital.Subjects and methods
We prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting > 25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only.Results
We analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p < 0.05).The mean closure times were 15.7 ± 5.1, 24.8 ± 4.9, and 35.7 ± 9.2 days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p < 0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group.Conclusions
FGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings. 相似文献7.
Importance
Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.Objective
To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series.Design
The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015.Setting
The study took place at MetroHealth Medical Center in Cleveland, Ohio.Participants
Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10–67 years).Intervention for clinical trials or exposure for observational studies
Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap.Main outcomes and measures
The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery.Results
Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (< 1 cm) had a 93.3% success rate, medium (1–2 cm) 88.9%, and all seven large perforations (> 2 cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure.Conclusions and relevance
Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum. 相似文献8.
N. Guberina U. Dietrich D. Arweiler-Harbeck M. Forsting A. Ringelstein 《American journal of otolaryngology》2017,38(6):649-653
Purpose
To examine radiation-doses imparted during multislice (MSCT) and cone-beam computed-tomography (CBCT) for perioperative examination of cochlear-implant insertion.Methods
Radiation-doses were assessed during standardized petrous-bone CT-protocols at different MSCT ((I) single-source CT-scanner Somatom-Definition-AS +, (II) 2nd generation of dual-source CT-scanner Somatom-Definition-Flash, (III) 3rd generation of dual-source CT-scanner Somatom-Force and at the CBCT Ziehm-Vision-RFD3D ((IV) (a) RFD-3D (Standard-modifier), (b) RFD-3D (Low-dose-modifier)). Image quality was examined by two radiologists appraising electrode-array placement, quality-control of cochlear-implant surgery and complications based on real patients' examinations (n = 78).Results
In MSCT-setting following radiation-doses were assessed (CTDIw; DLP): (I) 21.5 mGy; 216 mGy cm; (II) 19.7 mGy; 195 mGy cm; (III) 12.7 mGy; 127 mGy cm; in the CBCT setting radiation doses were distributed as follows: (IV) (a) 1.9 mGy; 19.4 mGy cm; (b) 1.2 mGy; 12.9 mGy cm. Overall, image quality was evaluated as good for both, MSCT- and CBCT-examinations, with a good interrater reliability (r = 0.81).Conclusion
CBCT bears considerable dose-saving potential for the perioperative examination of cochlear-implant insertion while maintaining adequate image quality. 相似文献9.
Sarah M. Kidwai Arjun K. Parasher Yan W. Ho Marita S. Teng Eric M. Genden 《American journal of otolaryngology》2017,38(1):26-30
Introduction
The mainstay of treatment for primary hyperparathyroidism is surgery. Hypocalcemia after parathyroidectomy is common and poses a significant challenge, leading to increased patient morbidity and health care costs. While several groups have found predictor factors for hypocalcemia, none have created a risk stratification model. Here, we recognize important factors and optimal cut-off values that can allow risk stratification of patients.Methods
A single-institution retrospective chart review of 339 patients that underwent parathyroidectomy from 2009 to 2012 was conducted. Pre-operative, intra-operative, and post-operative data were collected. A non-routine outcome was defined as post-operative admission, outpatient hypocalcemia-related complication, or inpatient hypocalcemia-related complication. The preoperative or intraoperative factors of patients that experienced a non-routine outcome were compared to those that did not. Optimal cut-off values were determined for preoperative and intraoperative factors and a risk stratification method was created.Results
A total of 39 patients experienced a non-routine outcome including 24 postoperative admissions, 2 inpatient hypocalcemia-related complications, and 17 outpatient hypocalcemia-related complications. Patients with a non-routine outcome displayed a trend toward preoperative hypercalcemia (calcium >11.0 mg/dL) than not (p = 0.0543). The median preoperative parathyroid hormone (PTH) level was significantly higher among patients with a non-routine outcome (p = 0.0037). Furthermore, the median percent decrease in PTH at 20 min intraoperatively among patients with a non-routine outcome was significantly higher compared to those that did not (p = 0.0421). The optimal cut-off value for preoperative PTH was 129 pg/mL and for median percent decrease in intraoperative PTH at 20 min was 90.7% for predicting a non-routine outcome. A risk stratification model was created based on these data.Conclusion
Our analysis reveals that patients with larger intraoperative decrease in PTH levels (greater than 90.7% drop at 20 min), higher preoperative hypercalcemia (greater than 11 mg/dL), and higher preoperative PTH levels (greater than 129 pg/mL) are more likely to experience a non-routine outcome during outpatient parathyroidectomy. Patients can be risk stratified based on this criteria. 相似文献10.
Cameron C. Wick Rod P. Rezaee Tammy Wang Andrea M. Garcia-Jarchow Chad A. Zender Michael Gibson Min Yao Pierre Lavertu 《American journal of otolaryngology》2017,38(1):72-76
Hypothesis
Patients with advanced laryngeal cancer sometimes desire organ preservation protocols even if it portends a worse outcome.Background
To assess outcomes of patients with T4 laryngeal cancer treated with chemoradiation therapy.Methods
Case series with chart review at a tertiary university hospital. Twenty-four patients with T4 laryngeal cancer all declined total laryngectomy with adjuvant radiation as the primary treatment modality and alternatively received concurrent chemoradiation therapy. The primary outcome was overall survival. Secondary outcomes were rates of tracheotomy dependence, gastric tube dependence, and need for salvage laryngectomy.Results
All patients had T4 laryngeal disease, 71% had cartilage invasion and 59% had regional metastasis to the neck. Kaplan–Meier analysis determined 2-year and 5-year overall survival to be 64% and 59% respectively. The locoregional recurrence rate was 25%. The distant metastasis rate was 21%. The rate of salvage laryngectomy was 17%, which occurred at a mean of 56.5 months after the original diagnosis. The rate of tracheotomy dependence was 33% while gastric tube dependence was 25%.Conclusion
Advanced T4 laryngeal cancer, particularly with cartilage invasion, remains a surgical disease best treated with total laryngectomy and adjuvant radiation. This data may help guide patients and practitioners considering concurrent chemoradiation therapy for definitive treatment of advanced laryngeal cancer. 相似文献11.
Sharon Lin Sami Melki Michelle V. Lisgaris Emily N. Ahadizadeh Chad A. Zender 《American journal of otolaryngology》2017,38(4):417-421
Purpose
Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution.Materials and methods
This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed.Results
We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06–6.69, z statistic 2.086, p = 0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133–52.3217, p < 0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750–7.7968, p = 0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8 ± 4.72 days, p = 0.031).Conclusions
Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay. 相似文献12.
Objective
This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).Study design
A case series with chart review.Setting
A tertiary university hospital.Materials and methods
The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test.Results
One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P > 0.05). However, the average closure time differed significantly between the two groups (P < 0.05): 29.4 ± 3.7 days for perforations without bleeding and 20.6 ± 9.2 days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P < 0.01) within 2 weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2 weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P > 0.05) between the groups without and with bleeding within 4 weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P = 0.0).Conclusion
This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs. 相似文献13.
Joel Franco Michael S. Harris Dominic Vernon Taha Z. Shipchandler 《American journal of otolaryngology》2017,38(3):351-353
Importance
Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19 year old female, creating a unique defect requiring repair.Objective
Demonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant.Design
Case report.Results
The patient presented with a 7 month history of an idiopathic progressive deformity of the right cheek. Computed tomography of the paranasal sinuses revealed extensive bone loss of the right midface and orbit. The patient underwent facial reconstruction using a customized Medpor (Stryker Corp, Kalamazoo, MI) implant. At 6 month follow-up the patient and physician were both pleased with the patient's overall appearance. The patient did have some residual lower lid retraction present as well as some lateral pull at the lateral canthus outward from the orbit itself.Conclusions
Preoperative planning for midface reconstruction requires a deep understanding of the aesthetic, functional, and supportive roles this structure holds. Computer assistance allows the creation of custom made implants, providing the reconstructive surgeon with innovative options for reconstruction with minimal morbidity to the patient. As the technology around the design and creation of the custom implants continues to improve, the role of computer assistance in reconstruction will become more prominent. 相似文献14.
15.
Deguang Zhang Lei Xie Gaofei He Liang Fang Yuwen Miao Zhezhe Wang Li Gao 《American journal of otolaryngology》2017,38(2):115-120
Purpose
Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM.Materials and methods
Between May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness.Results
The mean follow-up period was 18.6 months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p = 0.0001) and mean age was lower (p = 0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p = 0.0003 and p < 0.0001, respectively).Conclusions
The safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM. 相似文献16.
Ceki Paltura Tuba Selçuk Can Behice Kaniye Yilmaz Mehmet Emre Dinç Ömer Necati Develioğlu Mehmet Külekçi 《American journal of otolaryngology》2017,38(4):414-416
Objective
To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis.Study design
Retrospective.Subjects and methods
Patients with unilateral COM disease are included in the study. The connection between fibrocartilaginous and osseous segments of the Eustachian Tube (ET) on axial Computed Tomography (CT) images was defined and the diameter of this segment is measured. The measurements were carried out bilaterally and statistically compared.Results
154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947 mm (Std. deviation ± 0.5247) for healthy ears and 1788 mm (Std. deviation ± 0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p < 0.01).Conclusion
The dysfunction or anatomical anomalies of ET are correlated with COM. Measuring of the bony diameter of ET during routine Temporal CT examination is recommended for our colleagues. 相似文献17.
Edward T. Chang Camilo Fernandez-Salvador Jeremy Giambo Blaine Nesbitt Stanley Yung-Chuan Liu Robson Capasso Clete A. Kushida Macario Camacho 《American journal of otolaryngology》2017,38(3):272-278
Objective
Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA.Methods
Three authors independently and systematically searched four databases (including PubMed/MEDLINE) through June 26, 2016. We followed guidelines set within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Results
Sixteen studies with 242 patients met criteria. The overall means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) decreased from 33.6 ± 21.1/h to 15.8 ± 16.0/h (53% reduction). Seven studies (81 patients) reported lowest oxygen saturation (LSAT), which improved from 79.8 ± 17.5% to 83.9 ± 8.6%. Four studies (93 patients) reported Epworth sleepiness scale (ESS), which decreased from 10.8 ± 4.8 to 8.2 ± 4.5, p < 0.0001. Four studies (31 patients) reported Oxygen Desaturation Index (ODI) which decreased from 29.6 ± 32.1 to 12.9 ± 8.7, a 56.4% reduction.Conclusion
Current international literature demonstrates that tongue retaining devices reduce apnea-hypopnea index by 53%, increase lowest oxygen saturation by 4.1 oxygen saturation points, decrease oxygen desaturation index by 56% and decrease Epworth sleepiness scale scores by 2.8 points. Tongue retaining devices provide a statistically effective alternative treatment option for obstructive sleep apnea. 相似文献18.
William S. Tierney Scott L. Gabbard Claudio F. Milstein Michael S. Benninger Paul C. Bryson 《American journal of otolaryngology》2017,38(5):603-607
Objective
Laryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR.Design
Single center prospective cohort study.Setting
Tertiary medical centerParticipants
27 adult patients with diagnosed laryngopharyngeal reflux.Intervention
An SPD consisting of a two-component wedge-shaped base pillow and a lateral positioning body pillow (Medcline, Amenity Health Inc.) was given to patients with a diagnosis of LPR. Subjects slept using the device for at least 6 h per night for 28 consecutive nights.Main outcomes
Primary outcomes were Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and the Reflux Symptoms Index (RSI) survey instrument. Each was collected at baseline, after 14, and after 28 days of SPD use.Results
27 patients (19 female and 8 male; age 57.1 ± 12.8, BMI 29.0 ± 8.1) were recruited. At baseline mean N-GSSIQ was 50.1 ± 22.4 and mean RSI of 29.6 ± 7.7. Repeated measure analysis showed that subjects' total N-GSSIQ scores decreased by an average of 19.1 (p = 0.0004) points by two weeks and 26.5 points by 4 weeks (p < 0.0001). RSI decreased an average of 5.3 points by 2 weeks (p = 0.0425) and an average of 14.0 points by 4 weeks (p < 0.0001).Conclusions
In patients with LPR, SPD treatment significantly improves self-reported symptoms of nocturnal reflux as well as symptoms specific to LPR. These results support the therapeutic efficacy of a SPD for patients with LPR. 相似文献19.
Wang Woon Cha Kudamo Song In Kyu Yu Myoung Su Choi Dong Sik Chang Chin-Saeng Cho Ho Yun Lee 《American journal of otolaryngology》2017,38(4):428-432
Objectives
We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV).Methods
A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed.Results
The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p > 0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67–34.48; p = 0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11–21.28; p = 0.036) were positively associated with dizziness lasting longer than 3 months.Conclusion
Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure. 相似文献20.