Wegener's granulomatosis: a challenging disease for otorhinolaryngologists

Diagnosis of Wegener's granulomatosis (WG) can be delayed because of its aspecific presenting symptoms. Detection of serum circulating antineutrophil cytoplasm antibodies (c-ANCAs), in combination with histology, permits one to identify WG at an early stage and to implement stage-adapted therapy. c-ANCA levels may also help to evaluate the response to medical therapy. Recently, the quality of life of WG patients has been improved by administering cotrimoxazole in order to prevent infections and recurrent diseases during the remission period.WG is of special significance to the otorhinolaryngologist because it is often initially limited to the upper respiratory tract before becoming systemic. The aim of this paper was to describe a series of WG patients and underline the difficulties involved in diagnosing and treating this challenging disease.This was a prospective study in 23 consecutive patients with head and neck manifestations of WG (17 systemic, 6 limited). Diagnosis was performed by means of both c-ANCAs detection using indirect immunofluorescence and histology in biopsy specimens. Treatment consisted of daily cyclophosphamide (CYC; 2 mg/kg/day) and glucocorticoids (prednisone; 1 mg/kg/day). If an improvement or toxic events occurred, CYC was discontinued and methotrexate was started. If, during remission of the disease, low serum c-ANCAs levels were detected, CYC was suspended and cotrimoxazole (1 g/day) was introduced.Serum c-ANCAs detection was positive for all patients. Biopsy was diagnostic from the beginning in 19/23 cases. The six patients with limited WG did not show a progression to systemic disease. Only 3 patients with a diagnosis of delayed systemic WG died, whereas 19/23 patients were alive with good control of relapses.     

Management and Follow-up of Localized Wegener's Granulomatosis: A Review of Five Cases

Objective —To evaluate the complications, efficacy of surgical treatment and outcome in patients with the localized form of Wegener's granulomatosis (WG).

Materials and Methods —We reviewed a series of 5 patients (3 males, 2 females; age range 22–67 years; mean age 44.6 years) with WG in the upper and lower respiratory tracts.

Results —Aural, nasal and ocular complications were common in our patients. All patients responded to standard immunosuppressive treatment, and all surgical treatments had a favorable outcome in the remission stage. Although there was no life-threatening disease activity during the course of treatment, minor relapses occurred in three patients.

Conclusions —Patients with localized WG may have a better outcome than those with systemic WG, but complications due to the disease or medication must be actively managed. Reconstructive surgery for patients with WG is safe and effective during the remission stage.     

Difficulty of diagnosing Wegener's granulomatosis in the head and neck region

Objective

The objective of this study was to review the various clinical features associated with Wegener's granulomatosis (WG) in the head and neck region and to discuss the difficulty of diagnosing patients with early stage WG.

Methods

Between January 1998 and August 2007, WG was diagnosed and treated in 16 patients at the Department of Otolaryngology, Hyogo College of Medicine. Clinical and operating records of these patients were analyzed retrospectively. Diagnosis was based on the Japanese criteria proposed by the Japanese Ministry of Health and Welfare in 1998.

Results

Ten patients (62.5%) had a definite diagnosis of WG, and the other six patients (37.5%) had a probable diagnosis of WG. The period from the onset to diagnosis was between 1 month and 30 years. The generalized form of WG was observed in three patients (18.8%), and the limited form of WG was observed in the other 13 patients (81.2%). Nasal, aural, and ophthalmic symptoms were initially presented in 10, 3, and 3 patients, respectively. Cytoplasmic pattern antineutrophil cytoplasmic antibodies (cANCAs) and perinuclear pattern ANCA (pANCA) were positively detected in 68.8% (11/16) and 27.2% (3/11) of the patients, respectively. Five of 14 patients (35.7%) had pathologic features of WG in biopsy samples from the head and neck region. Three patients in whom a diagnosis of WG was difficult are presented, and immediate lessons of our experience were discussed.

Conclusions

This study emphasized the difficulty of diagnosing WG, particularly at an early stage and when limited to the head and neck region. The biggest challenge faced in diagnosing WG is that it requires a high index of suspicion. When WG was suspected, we should obtain an accurate medical history from patients and repeat serologic and histopathologic examinations.     

Effects of early intratympanic steroid injection in patients with acoustic trauma caused by gunshot noise

Conclusion: This study evaluated the efficacy of concurrent administration of ITSI and systemic steroids in delayed treatment of NIHL after gunshot noise exposure. The results showed additional hearing benefits with administration of ITSI. Further evaluation is warranted to confirm this efficacy.

Objective: This investigation evaluated the effects of early administration of an intratympanic steroid injection (ITSI) in combination with systemic steroids treatment in patients with acoustic trauma caused by gunshot noise.

Methods: Nineteen patients eligible under the criteria established concerning delayed treatment for noise-induced hearing loss (NIHL) were enrolled in this study. Patients were divided into two groups: those who received prednisolone (PD) only (n?=?8), and those who received PD with ITSI (n?=?11). ITSI treatment was initiated simultaneously alongside systemic PD administration. These patients received ITSI every other day for a total of four treatments. Pure-tone air conduction threshold audiometry, to record the pure-tone average (PTA) at 2, 4, and 8?kHz, was conducted upon each patient’s initial visit, and 1 month after starting treatment, to evaluate the degree of hearing gain (hearing gain (dB)?=?(initial PTA) – (final PTA)).

Results: The initial PTA in PD-only and PD with ITSI groups were 52.75?±?15.50?dB and 50.27?±?12.01?dB, respectively. There were no significant differences in the baseline characteristics of the two groups, which include age and the number of days that treatment was delayed. In the multivariable linear regression analysis, both the initial PTA and the treatment method showed a significant association (R^2?=^?0.41). The unstandardized regression coefficient of the initial PTA was 0.47 (p?=?0.02). Patients with additional ITSI showed significant improvement in the degree of hearing gain compared with the PD-only group (unstandardized regression coefficient =11.48, p?=?0.03)     

Detection of perilymphatic fistula in labyrinthine windows by virtual endoscopy and variation of reconstruction thresholds on CT scan

Abstract

Background: Perilymphatic fistula (PLF) is a breach in a labyrinthine window. The opening might decrease the radiological density of the window.

Aims/objectives: To evaluate the radiological density of the labyrinthine windows by virtual endoscopy on CT scan.

Materials and methods: This prospective study included 47 adult patients with PLF and 98 control patients. Diagnosis of PLF was based on a composite radio clinical score and/or intra operative visualization of the fistula and/or resolution of the symptoms after surgery. On routine CT-scan, labyrinthine windows were examined by virtual endoscopy. The reconstruction threshold was gradually increased until a virtual opening appeared (opening threshold [OT]) and compared to the contralateral window (OT difference).

Results: The OT difference was higher in patients than in controls (60.2?±?10.36 (SEM), n?=?47 versus 28.0?±?2.29 Hounsfield units (HUs), n?=?98, p?<?.01 unpaired t-test). A ROC analysis showed that at an OT difference of 31.5 UH had a sensitivity of 75% and a specificity of 75% for the PLF diagnosis.

Conclusions: CT-scan virtual endoscopy and threshold variation provided high specificity and sensitivity in the PLF diagnosis.

Significance: This post processing of radiological data appears to enhance the diagnostic value of CT scan.     

Frequency-specific efficacy of intratympanic steroid on idiopathic sudden sensorineural hearing loss

Abstract

Background: Hearing recovery would be different in each sound frequency in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Aims/objectives: To analyze frequency-specific efficacy of intratympanic steroid on ISSNHL.

Materials and methods: Of a total of 381 patients with ISSNHL (hearing threshold ≥40?dB; ≤30?days until treatment), 174 patients (174 ears) received systemic steroid plus hyperbaric oxygen therapy (HBO group), and 207 patients (208 ears) received systemic plus intratympanic steroid (IT group). Hearing thresholds at 125–8000?Hz were measured at every octave before and after treatment.

Results: % of patients with hearing gains ≥10?dB in the IT group was significantly higher for 500?Hz and the average of 5 mid-frequencies, tended to be higher for 1000?Hz, but was significantly lower for 8000?Hz, compared to the HBO group. Multiple regression analysis showed that hearing recovery was negatively correlated with patients’ age for 125/2000/4000/8000?Hz and with days from onset to treatment for all frequencies, and also revealed better hearing recovery at 500/1000?Hz in the IT group than in the HBO group.

Conclusions: Intratympanic steroid is more effective than hyperbaric oxygen to yield better hearing outcomes at mid-frequencies and would be advantageous to restore sound/speech perception.

Significance: Superiority of intratympanic steroid over hyperbaric oxygen for treating ISSNHL was verified.     

Intratympanic steroids as a salvage therapy for severe to profound idiopathic sudden sensorineural hearing loss

Abstract

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a decline in hearing affecting three or more frequencies by 30?dB

Objective: The aim of this study was to evaluate the results of intratympanic steroids as a salvage treatment for severe ISSNHL.

Materials and methods: A regimen of three IT steroid injections was offered to patients who failed a 7-days intravenous steroid treatment. Eighty-four patients underwent IT salvage treatment (IT group). Their outcomes were compared with those of 255 patients with severe ISSNHL who received the same intravenous steroid regimen without salvage IT steroid therapy (Control group).

Results: 56% of the patients in the IT group had a hearing improvement of >15?dB after one month. The average hearing improvements were 26.5?±?28?dB and 27.9?±?24?dB in the IT group and the Control group, respectively (p?=?.67). However, patients with a type E audiogram pattern (total deafness), displayed a substantial hearing gain.

Conclusion: Intratympanic steroids failed to show a global auditory benefit as a salvage treatment in patients with severe ISSNHL.

Significance: Our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed.     

Evaluation of smell and taste in patients with Wegener’s granulomatosis

Although a reduced olfactory/gustatory function affects patients in all parts of life, this problem has not received much attention in Wegener’s granulomatosis (WG). The aim of this study was to assess the smell/taste function of WG patients. Demographic data of 16 WG patients (9 males, 7 females) were obtained. They all subjectively assessed their taste/smell function on visual analogue scale. Olfactory/gustatory functions of the patients were tested with ‘Sniffin’ Sticks and ‘Taste’ strips, respectively. The results were then compared with those from sex and age-matched control group (n = 16) and normative data. WG patients subjectively assessed their olfactory (p = 0.03) and gustatory (p = 0.02) function to be lower than control group. All the olfactory scores (odour identification, odour discrimination and threshold) in both genders were significantly below the scores in the control group. WG patients were hyposmic. For taste (total taste score, as well as scores for the qualities sweet, sour, salty and bitter), WG patients did not significantly differ from controls and were normogeusic. However, the gustatory scores showed the tendency of reduction as compared to the control group. In conclusion, WG patients truly suffer from olfactory/taste dysfunction, but this is worse with olfaction. It is, therefore, imperative that physicians should make their patients to be aware of these sensory dysfunctions and educate them on methods to cope with it for better quality of life.     

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.     

D-methionine (D-met) significantly reduces kanamycin-induced ototoxicity in pigmented guinea pigs

Objective: Test D-methionine (D-met) as an otoprotectant from kanamycin-induced ototoxicity and determine the lowest maximally protective D-met dose. Design: Auditory brainstem responses (ABR) were measured at 4, 8, 14, and 20?kHz at baseline and two, four, and six weeks after kanamycin and D-met administration initiation. ABR threshold shifts assessed auditory function. Following six-week ABR testing, animals were decapitated and cochleae collected for outer hair cell (OHC) quantification. Study sample: Eight groups of 10 male pigmented guinea pigs were administered a subcutaneous kanamycin (250?mg/kg/dose) injection once per day and an intraperitoneal D-met injection (0 (saline), 120, 180, 240, 300, 360, 420, or 480?mg/kg/day) twice per day for 23 days. Results: Significant ABR threshold shift reductions and increased OHC counts (p ≤0.01) were measured at multiple D-met-dosed groups starting at two-week ABR assessments. A 300?mg/kg/day optimal otoprotective D-met dose provided 34–41?dB ABR threshold shift reductions and OHC protection. Lesser, but significant, D-met otoprotection was measured at lower and higher D-met doses. Conclusions: D-met significantly reduced ABR threshold shifts and increased OHC percentages compared to kanamycin-treated controls. Results may be clinically significant particularly for multidrug-resistant tuberculosis patients who frequently suffer from kanamycin-induced hearing loss in developing countries.     

Foudroyanter Verlauf einer therapierefrakt?ren Wegener Granulomatose bei negativen c-ANCA

BACKGROUND: Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology. CASE-REPORT: A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease. CONCLUSIONS: 1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence. 2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis. 3. Wegener's granulomatosis can take a progressive, therapy resistent course.     

Outcomes research analysis of continuous intratympanic glucocorticoid delivery in patients with acute severe to profound hearing loss: Basis for planning randomized controlled trials

Conclusions. The data presented herein form the basis for conducting randomized placebo-controlled clinical trials evaluating the safety and efficacy of salvage treatment in patients with idiopathic sudden severe sensorineural hearing loss (but not anacusis) refractory to initial systemic therapy. Comparison of different application protocols and drug delivery systems will allow assessment of the value of continuous versus intermittent intratympanic glucocorticoid drug delivery. Objectives. To describe and critically evaluate the results of continuous intratympanic glucocorticoid delivery in patients with acute unilateral severe and profound sensorineural hearing loss refractory to initial systemic therapy and to compare the outcome with a historical control group. Material and methods. In a retrospective chart review, treatment results were analyzed in 23 patients with acute severe and profound hearing loss and failure of systemic standard therapy who received a continuous intratympanic delivery of glucocorticoids as a salvage treatment. Audiological results were compared within the local therapy group and with the results of an historical control group who did not receive salvage treatment. The study and control groups were matched with respect to hearing loss after initial systemic treatment failure. Results. The average pure-tone threshold after intratympanic salvage treatment showed a statistically significant improvement of 15?dB (95% CI?7–24 dB; p<0.001). After exclusion of patients with complete anacusis, i.e. a non-measurable hearing threshold, the local therapy group showed a significantly better improvement (mean 19?dB; 95%?CI?6–32 dB) than the historical control group (mean 5?dB;?95%?CI ??2–11 dB; p<0.05).     

Necessity of admission to improve the hearing-recovery rate in idiopathic sudden sensorineural hearing loss

Objectives: The purpose of this study was to determine the prognostic potential of admission of a patient for idiopathic sudden sensorineural hearing loss (ISSNHL).

Study design: Retrospective clinical study.

Methods: We conducted a retrospective study of 301 patients with ISSNHL. The patients were divided into a study (57 patients at out-patients department (OPD) based treatment, using systemic steroids and intra-tympanic (IT) steroid injection) and a control groups (301 patients at admission, using systemic steroids and IT steroid injection). We compared the success rate (15?dB cut off), Siegel’s criteria and hearing gain decibels between two groups.

Results: The overall recovery rate of the OPD based treatment group (29.8%) was poor than that of the admission group (52.9%) (p?=?.002). The odd ratio of OPD based treatment factor was 2.035 when the OPD based treatment and poor prognostic factors were analyzed at logistic regression test (Duration of delayed treatment, 1.073; average hearing loss level, 0.972) (p?=?.041).

Conclusion: Admission must be strongly recommended when the patients with ISSNHL asked about the necessity of admission. We hypothesized that resting, getting out of their social stress, and relief of anxiety might be helpful to their hearing recoveries.     

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study

Objectives: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air–bone gap.

Methods: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.

Results: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p?>?0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p?p?Conclusions: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.     

Utilization of incus with bone cement for total ossicular reconstruction

Abstract

Background: Total ossicular chain reconstructions are performed to connect mobile stapes footplate and tympanic membrane. Data on the use of incus for total ossicular reconstruction is quite limited in the literature.

Objective: The main objective of this study is to describe a novel surgical method that utilizes incus with bone cement to stabilize the ossicular chain for total ossicular reconstruction.

Materials and methods: 16 patients who underwent total ossicular reconstruction using our method were included in this study. We evaluated hearing by comparing preoperative and postoperative air-bone gap (ABG), air conduction (AC) and bone conduction (BC). The percentage of patients achieving ABG ≤20?dB was determined.

Results: The mean preoperative ABG was 35.3?±?8.2 and postoperative ABG decreased significantly to 23.7?±?7.6 (p?<?.001). The mean preoperative AC (57.5?±?10) decreased significantly postoperatively to (46.5?±?13.3)(p?=?.014). There was not any difference between pre- and post-operative BC. We achieved successful hearing results (ABG ≤ 20dB) in 44% of patients.

Conclusion: The use of incus with bone cement stabilization for total ossicular reconstruction seems a feasible option. Good hearing outcomes, and low cost, complication, and extrusion rate may be the main reasons to prefer this method.     

Extended use of systemic steroid is beneficial in preserving hearing in guinea pigs after cochlear implant

Conclusion: Seven-day administration of systemic steroids was more effective in preserving hearing for 12 weeks after cochlear implantation (CI) than a 3-day delivery.

Objectives: To determine the effectiveness of extended delivery of systemic steroids to preserve hearing in guinea pigs after CI.

Methods: Dexamethasone (4?mg/ml) was delivered parenterally via a mini-osmotic pump for either 3 or 7 days. A dummy CI electrode was inserted via cochleostomy approach in 8-week-old guinea pigs. Auditory thresholds were assessed from tone burst auditory brainstem responses (2, 8, 16, 24, and 32?kHz) at 1?day prior to CI, and 1, 4, and 12 weeks after implantation. Histologic evaluation of the cochleae was carried out.

Results: No differences were observed in hearing thresholds among groups before CI. Significant hearing preservation was achieved at 8, 16, 24, and 32?kHz only in the 7-day infusion group compared with the control group at 1 week after CI. The same trend was maintained at 4 weeks (16, 24?kHz) and 12 weeks (16, 24, and 32?kHz). Histologic review of the 7-day infusion group revealed less fibrosis and ossification in the scala tympani and the preservation of more spiral ganglion cells, compared with the control group.     

Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision

Objective: The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty.

Study design: Prospective clinical study.

Methods: Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success.

Results: Mean follow-up time was 14.76?±?4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4?kHz were 13.87?±?7.30?dB HL, 9.09?±?7.59?dB HL, 9.74?±?6.40?dB HL and 7.46?±?6.37?dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p?p?>?.05).

Conclusions: Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.     

Decision making for position-dependent obstructive sleep apnea syndrome on the basis of patient information and physical examinations of the upper airway,acquired on an outpatient basis

Conclusions: Patients with body mass index (BMI)?2 and obstructive sleep apnea syndrome (OSAS) are highly suspicious for position-dependent OSAS. Diagnosis of position-dependent/position-independent OSAS can be difficult in patients satisfying both ‘BMI?>25?kg/m²’ and ‘any of tongue enlargement (TE), palatine tonsil hypertrophy (PTH) and obstruction by Muller’s maneuver (OMM)’. Polysomnography is warranted in such patients.

Objectives: The objective was to retrospectively elucidate criteria for differentiating position-dependent OSAS on the basis of patient information and physical examinations of the upper airway obtainable in clinics.

Methods: The 643 patients were categorized as positional patients (PPs) or non-positional patients (NPPs). The patient background factors examined were sex, age, BMI, and hypertension. TE, PTH, pharyngeal tonsil hypertrophy, and OMM were evaluated. Cross-validation was performed using even-numbered registrations as the training set group (Group A) and odd-numbered registrations as the test case group (Group B).

Results: In Group A, patients with BMI?<25?kg/m² were clearly more frequent among PP than among NPP. In Group A with BMI?≥25?kg/m², significant differences were found for TE, PTH and OMM. Significant differences were found between 0 and 1/2/3 for number of factors. Results generated from Group A were validated in Group B.     

Intratympanic steroids for combined treatment of idiopathic sudden hearing loss: when is it too late?

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) requires early treatment.

Objective: To describe our experience on intratympanic steroid treatment (ITS) of ISSNHL analyzing the delay to start therapy as prognostic factor.

Material and methods: We perform a retrospective study on ISSNHL treated with systemic steroids without full recovery on PTA (pure tone average) according to Siegel criteria. They were divided into two different groups: one group that additionally received ITS as combined therapy (treatment group), and another without it (control group). We analyzed the hearing recovery at 6 months and 2 years, and the influence of the delay to start ITS in the recovery.

Results: After ITS was added, further complete recovery was achieved in 10 patients of the treatment group. After 6 months, PTA improvement in the treatment group was 10.84?dB, compared to 1.13?dB in the control group (p<.0001). Nevertheless, patients starting such combination of oral steroids and ITS within 8 days of diagnosis had an additional gain of 15?dB in the first 6 months, that increased to 19.17?dB after 24 months (p<.022).

Conclusions: When ITS was added within the first 8 days, a significantly better and more stable response was obtained.     

Cachexia at diagnosis is associated with poor survival in head and neck cancer patients

Conclusions: One third of the patients had cachexia with an association of significantly shorter survival. These results suggest that combining HGS and MAMA seems to be a practical method to screen cachexia in patients with head and neck cancer and may also be used when assessing their prognosis.

Objectives: The aim of this study was to analyze the hypothesis that cachexia defined as both low mid-arm muscle area (MAMA) and handgrip strength (HGS) is associated with decreased survival in patients with head and neck squamous cell carcinoma (HNSCC).

Methods: Sixty-five consecutive patients with primary HNSCC were enrolled prior to cancer therapy. Cachexia was defined as low handgrip strength (HGS) and low mid-arm muscle area (MAMA). Nutritional status was assessed by patient-generated subjective global assessment (PG-SGA) and sarcopenia by low MAMA. Biochemical parameters reflecting nutritional status and S-25-OHD were measured.

Results: Cachexia was seen in 31% and sarcopenia in 46% of patients. Altogether, 34% of patients were malnourished. Disease-free survival was 13 months (3–62) in cachectic patients, compared with 66 months (31–78) in non-cachectic patients (p?=?0.009). S-25-OHD was 28?nmol/l in cachectic patients, compared with 46?nmol/l in non-cachectic patients (p?=?0.009) and prealbumin 187?mg/l and 269?mg/l, respectively (p?相似文献