Positive predictive values of ultrasound-guided fine-needle aspiration with parathyroid hormone assay and Tc-99m sestamibi scintigraphy in sporadic primary hyperparathyroidism

ObjectivesUltrasonography (US) and Tc-99m sestamibi scintigraphy (SS) are usually performed as preoperative imaging modalities for patients with sporadic primary hyperparathyroidism (SPHP). Fine-needle aspiration (FNA) under US guidance for parathyroid hormone (PH) assay can enhance the diagnostic accuracy of US. The main aim of the present study was to compare positive predictive values between US-FNA and SS. The secondary aim was to draw up a decision-tree for FNA and SS.MethodsThe single-center retrospective study included patients with previously non-operated SPHP. They underwent US-guided FNA, PET-CT SS, and 18 F-choline scintigraphy if the first two methods were inconclusive. PH washout level was considered pathological when greater than the serum PH level. Postoperative histology data were correlated to imaging data.ResultsIn total, 117 patients were included, with a mean age of 64 years (range, 26–89 years). A single adenoma was identified on pathology in 101 patients (89%). FNA findings were pathologic for 64 patients (55%), with a mean PH level of 2,604 ng/L [range, 585–9,074 ng/L], higher than the serum level of 179 ng/L [range, 60–1,000 ng/L]. US-guided FNA showed sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of respectively 72%, 92%, 99% and 28%, compared to 89%, 42%, 93% and 32% for SS. The rate of error in locating the parathyroid gland was 8% for US-guided FNA versus 12% for SS. Comparison of the two methods showed better sensitivity for SS (P = 0.0052) and better specificity for FNA (P = 0.0143), with no significant difference in PPV or NPV. 18 F-choline scintigraphy detected the hyperfunctioning parathyroid in 11 out of the 15 patients.ConclusionPPV did not significantly differ between FNA and SS. US-guided FNA performed by an experienced operator could be a simple first-line method for more than 50% of patients with non-operated SPHP, with 99% PPV. In case of negative or doubtful FNA findings, SS can be performed in second line.     

MRI criteria for the diagnosis of pleomorphic adenoma: a validation study

ObjectivesTo validate an MRI algorithm characteristic of pleomorphic adenoma (PA).Study designCross-sectional analysis.SettingAcademic tertiary-care medical center.MethodsA radiologic algorithm for the MRI diagnosis of PA was developed on the basis of five “high probability” criteria that all must be fulfilled for the MRI to qualify as a positive test result: bright T2-signal, sharp margins, heterogeneous nodular enhancement, lobulated contours, T2-dark rim. We then identified MRI images from our institutional database to test the diagnostic accuracy of the proposed algorithm.ResultsA total of 103 parotidectomy cases with adequate MRI studies were identified (pleomorphic adenoma n = 41, mucoepidermoid carcinoma n = 11, Warthin's tumor n = 8, adenoid cystic carcinoma n = 6, oncocytoma n = 6, acinic cell carcinoma n = 5, salivary duct carcinoma n = 5, and other n = 21). Eighteen of 21 cases that met all five “high probability” MRI criteria were consistent with PA on final histopathology; 3 were consistent with carcinoma. MRI had a specificity of 95.1% [95% confidence interval: 85.6–98.7%] and sensitivity of 43.9% [95% C.I.: 28.8–60.1%] for PA. The positive predictive value was 85.7% [95% C.I.: 70.4–100%] and the negative predictive value was 71.9% [95% C. I.: 62.0–81.9%]. The overall diagnostic accuracy was 74.8% [95% C.I.: 66.2–83.3%].ConclusionA “high probability” MRI is about 95% specific for pleomorphic adenoma. A subset of patients with MRI imaging that is highly suggestive of PA may reliably avoid further workup. The value of MRI in this setting is especially useful if preoperative fine needle aspiration is not readily available. A significant proportion of PAs, however, have indeterminate imaging features that overlap considerably with other benign and malignant lesions.     

Rehabilitation following total laryngectomy: Oncologic,functional, socio-occupational and psychological aspects

GoalTo review rehabilitation following total laryngectomy by an analysis of epidemiological, oncologic and functional data.Materials and methodsThis retrospective observational study focused on patients having undergone total laryngectomy or pharyngolaryngectomy between January 1, 2005 and December 31, 2016. Oncologic data notably comprised survival and relapse and predictive factors. The impact of the procedure on quality of life and the voice was analyzed by self-administered questionnaires (EORTC QLQ-C30 and H&N35, VHI 30). A satisfaction questionnaire was also sent to patients.ResultsOne hundred and thirty three patients were included. Overall specific 5-year survival was 65%. The relapse rate was 32%. Factors influencing survival were WHO performance status ≥ 2 (P < 0.05), tumor location (P = 0.07), metastatic lymphadenopathy (P = 0.017) and positive resection margins (P = 0.01). Quality of life was moderately degraded (global EORTC QLQ-C30 status: 61.4 ± 23.9). Type of rehabilitation (P = 0.03), tube feeding (P = 0.03) and relapse (P < 0.01) influenced quality of life. There were no differences in voice quality according to rehabilitation method, and no predictive factors for failure of voice rehabilitation. More than 90% of patients were satisfied with their hospital stay; 43%, however, were not satisfied with community caregiver training for laryngectomy patients.ConclusionRehabilitation of laryngectomized patients is a current therapeutic challenge. A therapeutic education tool was designed to better meet patient expectations.     

Helicobacter pylori is associated with poor prognosis of laryngeal precancerous lesion

ObjectivesPrevious evidence suggested Helicobacter pylori (H. pylori) promoted tumorigenesis by inducing inflammation in gastric premalignant disease. Whether this organism affected the development of head and neck precancerous lesion remains unknown. We performed this study to assess the prognostic impact of H. pylori infection on patients with laryngeal precancerous lesion.MethodsIn this prospective study, 41 enrolled patients with laryngeal precancerous lesion were arranged into H. pylori-positive group (n = 16) and H. pylori-negative group (n = 25). Two poor outcomes were recurrence and malignant transformation. Prognostic impact of H. pylori infection was analyzed using the Univariate Cox proportional hazard model and Cochran–Mantel–Haenszel test. We also analyzed the prognostic value of systemic inflammation-based markers.ResultsDuring a median follow-up of 32.9 months, recurrence developed in 8 patients in the H. pylori positive group and 5 patients in the H. pylori negative group (50.0% vs. 20.0%, P = 0.026, Log-rank test). Malignant transformation developed in 4 patients in the H. pylori positive group and no patients in the H. pylori negative group (25.0% vs. 0.0%, P = 0.005, Log-rank test). H. pylori positive group had a significant higher malignant transformation rate after stratifying on the observed covariates. There was no significant difference of recurrence rate in two groups stratified with laryngopharyngeal reflux, size of lesion, and pathological type (Cochran–Mantel–Haenszel test). The basal levels of lymphocyte counts and neutrophils to lymphocytes ratio were significantly different in patients with H. pylori infection. Moreover, the receiver operating characteristic curve analysis revealed a predictive value of lymphocyte counts and neutrophils to lymphocytes ratio for poor outcomes (areas under the curve, 0.658 and 0.651, respectively).ConclusionThe data demonstrate a malignant transformation-relevant role of H. pylori in laryngeal precancerous lesion. H. pylori infection combined with laryngopharyngeal reflux, size of lesion, and pathological type might relate to recurrence of laryngeal precancerous lesion. And changes of lymphocyte counts and neutrophils to lymphocytes ratio associated with H. pylori infection might deserve as predictive indicators for poor prognosis of laryngeal precancerous lesion.     

The association of congenital tracheobronchial stenosis and cardiovascular anomalies

ObjectivesCongenital tracheobronchial stenosis (CTBS) is a rare disorder characterized by the presence of focal or diffuse complete tracheal or bronchial cartilage rings resulting in a fixed lumen narrowing. The aim of this study was to expose the association of various cardiovascular (CV) anomalies with various types of CTBS.MethodsA retrospective review of 58 patients who had bronchoscopically proven CTBS between 1997 and 2011 was conducted. Totally, 48 cases who had received echocardiography, computed tomography and other examinations including cardiac catheterization were enrolled. There were 33 boys and 15 girls, and the median age of diagnosis was 4 months (0–44 months). The image findings of associated CV anomalies were reviewed and analyzed, along with the clinical manifestations and patients’ outcome.ResultsThere were 14 generalized hypoplasia (29.2%), 10 funnel type (20.8%), 15 segmental type (31.3%), and 9 isolated bronchial stenosis cases (18.7%). Among 48 cases of CTBS, 32 patients (66.7%) had various CV anomalies including atrial septal defect (n = 9), pulmonary artery sling (n = 7), ventricular septal defect (n = 7), patent ductus arteriosus (n = 6), tetralogy of Fallot (n = 3), peripheral pulmonary stenosis (n = 3), etc. No significant difference existed in the incidence and types of comorbid CV anomalies among 4 types of CTBS, except that funnel type had significantly higher comorbidity of pulmonary artery sling (50%, p < 0.01).ConclusionPatients with CTBS had high incidence of various associated CV anomalies. Isolated bronchial stenosis had similar high comorbidity of CV anomalies as did the 3 classical categories of congenital tracheal stenosis. The higher comorbidity of pulmonary artery sling in patients with funnel CTBS might be related to its gradual caudal narrowing of the trachea.     

Cervical lymphadenopathies in children: A prospective clinical cohort study

AimCervical lymphadenopathy (LAP) is a common sign and may raise fears about serious illnesses. The aim of our study was to evaluate the patients with cervical LAPs in a general pediatrics clinic setting, and to evaluate follow-up results for potential causes and risk factors for malignancies.Material and methodsTwo hundred-eighteen patients aged between 79.4 ± 46.7 months with LAP were enrolled in this prospective cohort study. The patients were examined in terms of demographics, clinical, radiologic and serologic aspects like Epstein–Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19. A lymph node biopsy was performed in selected patients. The patients were followed-up for 8 weeks and risk factors for malignancy were evaluated.ResultsSeventy patients (41.3%) had specific etiology and 6 (2.7%) had malignant causes. The causes were as follows: 27% (n = 59) infections; 2.7% (n = 6) malignancies; 11.4% (n = 25) other causes. EBV was responsible for 27% of infectious causes. The other common infectious etiologies were CMV 4.3%, parvovirus B-19 2.9%, and group-A beta-hemolytic streptococcus (GAS) 10.8%. Four of the six malignancies were lymphomas. Predictive factors for malignancy were having LAP larger than 30 mm, rubbery lymph node, high serum CRP and LDH values, no hilum in ultrasonography, and enlargement of lymph node in follow-up. High uric acid levels and leucopenia were also common in the malignancy group.ConclusionEtiology of cervical LAPs was diagnosed in 41.3% patients. Infectious causes were the most common cause with 27%. Malignancy was diagnosed in 2.7% and lymphoma was the most common malignancy.     

Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic

AimsTo assess the benefit of telemedicine consultation during the Covid-19 pandemic.Material and methodsA prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations. Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors. The significance threshold was set at P < 0.005. The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown. The secondary endpoint comprised predictive factors for overall satisfaction.ResultsOne hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire. Overall satisfaction was 87%. There were no clinically relevant predictive factors significantly associated with satisfaction. Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR = 3.40, P-value = 0.049; and OR = 3.79, P-value = 0.049). Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR = 0.30, P-value = 0.027).ConclusionTelemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients. It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals.     

Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio

Introduction and objectives

Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

IntroductionPsychogenic dysphonia is a functional disorder with variable clinical manifestations.ObjectiveTo assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series.MethodsThe study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings.Results28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n = 17), teacher (n = 4), salesclerk (n = 4), nurse (n = 1), retired (n = 1), and psychologist (n = 1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms.ConclusionsIn this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.     

Prevalence and ethnic variation of pre-auricular sinuses in children

ObjectivesPre-auricular sinus (PAS) describes a congenital ear malformation presenting as a pit or sinus that may become infected, often requiring antibiotics and/or surgical excision. Although the presentation of PAS in otolaryngology clinics is not uncommon, there is limited epidemiological data regarding this malformation in children. Some evidence also suggests a potential ethnic variation in prevalence rates and potential heritability patterns within families, however these have yet to be proven. This study is the first to use pediatric population level data to investigate prevalence rate, ethnic variation, and to explore the unproven hypotheses of a genetic basis of PAS.MethodsIn this prospective cross-sectional study, we enrolled 1106 subjects (mean age = 6.8, male-to-female ratio = 1.15:1) between June and September 2014. Subjects were recruited from B.C. Children's Hospital in Vancouver, Canada. Inclusion criteria was children <18 years of age; exclusion criteria was those seeking care for PAS. Subjects were visually inspected for the presence of PAS by clinical observers followed by verbal questionnaire (demographics, self-identified ethnicity, family history of PAS, chronic medical conditions). Data analysis utilized Pearson Chi-Square Test to determine the potential ethnic variation, and odds ratios of family history were used to determine a potential genetic basis.Results26 (7 bilateral, 19 unilateral) of 1106 subjects were positive for PAS (2.4%). Using Pearson Chi-Square Test, a significant ethnic variation was found to exist (χ² (6,N = 1106) = 22.80, p < 0.0001), with Asians having the highest prevalence (6.6%), followed by African Americans (4.5%), Middle Easterners (3.4%), First Nations (2.0%), and Caucasians (1.2%). None were found in South Asians (n = 124) or Latin Americans (n = 18). Subjects with positive family history of PAS had greater likelihood of having PAS (OR = 16.7, 95% CI = 7.3–38.5, p < 0.0001). There was also stronger association between family history and bilateral PAS (OR = 26.5, 95% CI = 5.8–121.7, p < 0.0001) compared to unilateral PAS (OR = 12.2, 95% CI = 4.6–32.5, p < 0.0001).ConclusionsThis was the largest pediatric population level study to date, and showed the prevalence of PAS was 2.4% in this pediatric population, whose ethnic diversity was representative of B.C.’s community. A significant ethnic variation existed and associations between family history and PAS suggested a potential genetic basis, particularly with bilateral PAS.     

Non-tuberculous mycobacterial head and neck infections in children: Analysis of results and complications for various treatment modalities

ObjectivesAnalyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications.MethodsRetrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive.Results104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n = 48, 46%), cervical (n = 40, 38%), parotid (n = 18, 17%) and submental (n = 4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p < 0.01) versus incisional interventions (44%, p < 0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p < 0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula.ConclusionsExcision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.     

Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study

IntroductionDifferent theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus.ObjectivesWe aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls.MethodsRetrospective case-control study. Two-hundred and eighty-seven patients aged 18–59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients.ResultsThe ratio of female patients was higher in patient group than control group (58.5%, n = 168 vs. 49.4%, n = 127; respectively; p = 0.033). The mean age of patient group was significantly higher than those of control group (44.89 ± 10.96 years and 38.37 ± 10.65 years, respectively; p = 0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n = 27, and 3.1%, n = 8 respectively; p = 0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95 ± 1.02 and 1.67 ± 0.57, p = 0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio = 1.99, 95% confidence interval 1.31–3.02).ConclusionHigh mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.     

Prevention and management of hearing loss in syndromic craniosynostosis: A case series

ObjectiveTo assess the audiological profile in a cohort of children affected by syndromic craniosynostosis.MethodsEleven children with Apert syndrome (n = 4), Saethre-Chotzen syndrome (n = 3), Muenke syndrome (n = 2), Crouzon syndrome (n = 1) and Pfeiffer syndrome type 1 (n = 1) were submitted to a complete audiologic evaluation including otoscopy, pure-tone audiometry, tympanometry and acoustic reflex testing, ABR, otoacustic emissions, temporal bone High Resolution CT (HRCT) scan. The main outcome measures were prevalence, type and severity of hearing loss, prevalence of chronic otitis media, correlation with the time of first surgical correction.ResultsSeven of 11 patients (64%) presented hearing loss (HL), conductive in 3/7 patients (43%) and mixed in 4/7 (57%). No patients showed a purely sensorineural HL. All hearing impaired patients displayed middle ear disorders: the patients with conductive HL had otitis media with effusion (OME) and 3/4 patients with mixed HL showed tympanic alterations or cholesteatoma. A bilateral vestibular aqueduct enlargement was detected by HRCT scan in one normal hearing patient. The ABRs resulted normal in all cases.ConclusionOur study confirms the high prevalence of otologic diseases in such patients. In contrast with previous studies, middle ear disorders were responsible for the hearing impairment also in patients with mixed HL due to secondary inner ear damage. These findings restate the necessity of a close audiologic follow-up. We did not detect the specific ABR abnormalities previously reported, possibly because of an early correction of the cranial vault malformations.     

Sleep-disordered breathing in children with Down syndrome: Usefulness of home polysomnography

ObjectiveTo investigate the technical feasibility of unattended home polysomnography (HPSG) in children with Down syndrome.MethodsData from children with Down syndrome under 10 years of age referred to a diagnostic sleep study was analyzed. A full sleep-lab based polysomnography (PSG) or a HPSG with a portable device was performed. Uninterpretable HPSGs were defined as: recordings with (i) loss of ≥2 of the following channels: nasal flow, or thoracoabdominal sensors, or (ii) HPSG with less than 4 h of artifact-free recording time or (iii) less than 4 h SpO₂ (peripheral capillary oxygen saturation) signal.ResultsA total of 44 children (68% males) were included in the study, with a mean age of 3.6 (0.1–10) years. PSG was performed in 8 cases and HPSG in 36 cases. Six HPSG recordings were classified as uninterpretable and had to be repeated. Age, gender and BMI were no significant predictors of uninterpretability of the HPSG. Obstructive sleep apnea (OSA) was present in 61% (n = 27) of all subjects, and classified as mild, moderate, and severe in 43% (n = 19), 11% (n = 5), and 7% (n = 3) of cases, respectively. Interpretable and technically acceptable HPSGs were obtained in 30 subjects (83%). Age, gender and BMI were no significant predictors for interpretability of the HPSG.DiscussionThis study demonstrates that a portable polysomnographic home device may be helpful for diagnosing OSA in children with Down syndrome. Considering the potential consequences of untreated OSA, this screening test may be helpful for early diagnosis of OSA in children with Down syndrome.     

Effect of local anesthesia on facial nerve blood flow and muscle action potential

Background & objectiveThe effect of direct application of local lidocaine with epinephrine on the facial nerve (FN) has not been reported. The aim of this study is to assess the effects of 2% lidocaine with 1:100,000 epinephrine at clinically relevant concentrations in a rat FN model with respect to facial nerve blood flow (FNBF) and subsequent electrophysiological changes.Materials and methodsTo assess the influence of drugs on FNBF and electrically evoked muscle action potential (EMAP), small pieces of gelfoam were soaked in PBS 100 μl (n = 5, control group), 50 μl (n = 5, treatment group A) and 100 μl (n = 5, group B) of 2% lidocaine with 1:100,000 epinephrine, and 50 μl (n = 5, group C) and 100 μl (n = 5, group D) of 2% lidocaine. After 5 min of stable recordings, we applied a 2% lidocaine with or without 1:100,000 epinephrine impregnated gelfoam over the main trunk of the facial nerve of rats for 30 min. After removing the applied gelfoam, FNBF and threshold of EMAP were measured separately in each group.ResultsCompared to the control group, the treatment groups showed a significant reduction in FNBF in a dose-dependent manner. The maximal reductions in FNBF were observed in all treatment groups for a period after 10 min of the application. Synergistic reduction in FNBF was greater in groups A and B than in the lidocaine applied groups (C and D). The maximal increase in the EMAP threshold was observed immediately after the respective drug application in all groups. The greatest increase in the EMAP threshold was observed in group B. The increased EMAP threshold returned to the baseline value within 120 min in groups A and C.ConclusionFrom these results, it can be considered that the topical application of lidocaine with epinephrine caused reduction in FNBF and elevation of EMAP threshold. These acute reductions in FNBF and elevations in the EMAP threshold were restored in a time-dependent manner.     

The influence of cognitive tasks on sensory organization test performance

IntroductionMany static postural tasks requiring vestibular contributions are completed while dual- tasking.ObjectiveWe investigated the influence of dual-tasks on sensory integration for postural control and cognitive performance during the sensory organization test and examined the relationship between cognitive function and dual-task cost during the sensory organization test.MethodsTwenty adults completed single and dual-task versions of the six conditions of the sensory organization test were completed during two visits separated by one week. A subset of 13 participants completed three National Institute of Health (NIH)-toolbox cognitive tests including the Flanker inhibitory control and attention test, dimensional change card sort test and pattern comparison processing speed test. Wilcoxon signed rank tests were used to compare postural sway during single and dual-task sensory organization test. Friedman’s test, with pairwise comparison post-hoc tests, was used to compare single task serial subtraction performance to the 6 dual-task sensory organization test conditions. Spearman’s correlation coefficients were used to assess the relationship between cognitive performance on NIH-toolbox test and postural and cognitive dual-task cost during the sensory organization test.ResultsPerforming a cognitive dual-task during the sensory organization test resulted in a significant increase in postural sway during condition 1 (Z = ?3.26, p = 0.001, ES = 0.73), condition 3 (Z = ?2.53, p = 0.012, ES = 0.56), and condition 6 (Z = ?2.02, p = 0.044, ES = 0.45). Subtraction performance significantly decreased in during condition 6 (Z = ?2.479, p = 0.011, ES = 0.55) compared to single-task. The dimensional change card sort test demonstrated moderate correlations with dual-task cost of serial subtraction performance in condition 5 (dimensional change card sort test: r = ?0.62, p = 0.02) and condition 6 (dimensional change card sort test: r = ?0.56, p = 0.04). Pattern comparison processing speed test scores were significantly correlated with dual-task cost of postural control during condition 2.ConclusionPerforming a cognitive task during the sensory organization test resulted in significantly increased postural sway during three conditions, particularly during visual environment manipulation oppose to vestibular and somatosensory manipulation. Cognitive performance decreased during the most complex sensory organization test condition. Additionally, we found participants with poorer executive function had greater dual-task cost during more complex sensory integration demands.     

Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement

ObjectivesTo analyze oncologic and functional outcomes after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in glottic carcinoma with anterior commissure (AC) involvement, to determine predictive factors, and to compare results with those reported for other therapeutic strategies.Material and methodsA retrospective analysis included all patients who underwent SCL-CHEP for glottic squamous cell carcinoma with anterior commissure involvement in our institution, between 2000 and 2014. Swallowing function was evaluated on the DOSS (Dysphagia Outcomes and Severity Scale).ResultsFifty-three patients were included. Three-year overall, cause-specific and recurrence-free survival rates were 86, 95 and 80%, respectively. There were 5 cases of local recurrence (9%), all treated by total laryngectomy. Smoking was the only predictive factor of recurrence-free survival (P = 0.02). Mean DOSS score was 5.5 ± 0.9. DOSS scores ≥ 6 (normal oral feeding) were recovered by 59% of patients. T-stage ≥ 2 was the only predictive factor for DOSS score (P = 0.04).ConclusionIn glottic carcinoma with anterior commissure involvement, SCL with CHEP provided a local control rate of more than 90%, which is higher than reported with endoscopic surgery or external radiotherapy. However, contrary to LSC, salvage of local recurrence can often be obtained by conservative treatments after endoscopic surgery. Therefore, total-laryngectomy-free survival rates after SCL-CHEP and endoscopic surgery are finally comparable.     

Capacidad pronóstica de la densidad ganglionar en los carcinomas escamosos de cabeza y cuello

Introduction and objectivesLymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC.MethodsWe carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN + ). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable.ResultsThree categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n = 654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n = 394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n = 263, 20.1%) it was 27.3% (P=.0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival.ConclusionThe LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes.