Differential Impact of Advanced Age on Clinical Outcomes After Vestibular Schwannoma Resection in the Very Elderly: Cohort Study

xlomafota13 shared this article with you from Inoreader Differential Impact of Advanced Age on Clinical Outcomes After Vestibular Schwannoma Resection in the Very Elderly: Cohort Study Via leak of cerebrospinal fluid Oper Neurosurg (Hagerstown). 2021 May 26:opab170. doi: 10.1093/ons/opab170. Online ahead of print. ABSTRACT BACKGROUND: Vestibular schwannomas (VS) have a peak incidence in the sixth and seventh decades of life. Stereotactic radiosurgery is often the preferred treatment for VS among patients of advanced age. The fraction of elderly patients potentially requiring consideration for surgical treatment is anticipated to expand, mandating an update to management paradigms in this population. OBJECTIVE: To describe our experience with surgical management of VS in patients aged 75 yr and older. METHODS: Cohort study of all patients aged ≥75 yr with sporadic VS requiring surgical treatment at our institution between 1999 and 2020. Data included preoperative baseline characteristics and outcome data including extent of resection, facial nerve and hearing status, functional outcome, length of stay, and complications. RESULTS: A tota l of 24 patients were included, spanning an age range of 75 to 90 yr. Average tumor size was 2.76 ± 1.04 cm, and average baseline Modified 5-item Frailty Index (mFI-5) score was 1.08 ± 0.93. Extent of resection was gross total in 5 (20.8%), near total in 3 (12.5%), and sub-total resection in the remaining 16 (66.7%). One patient died in the postoperative period because of an acute sub-dural hematoma. Favorable facial nerve function (HB1-2) was preserved in 12 patients (75%) between 75 and 79 yr and 2 patients (28.6%) aged ≥ 80 yr. No cerebrospinal fluid leak or surgical site infection was observed; 3 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement. Nine patients required out-of-home disposition; all patients eventually returned to independent living. CONCLUSION: Microsurgical resection of VS can be safely undertaken in patients greater than 75 y/o but may carry an increased risk of poor facial function. PMID:34038941 | DOI:10.1093/ons/opab170 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Isolated Cricoid Fracture and Thyroid Hematoma in Blunt Injury of the Neck

xlomafota13 shared this article with you from Inoreader Isolated Cricoid Fracture and Thyroid Hematoma in Blunt Injury of the Neck Via Otolaryngology Indian Abstract Introduction Blunt trauma to the neck may result in life threatening injuries due to airway compromise. Thyroid Injury in a previously normal gland is rare, so is Isolated Cricoid Fracture. The expanding thyroid hematoma and an unstable larynx compound the effects of compression and lead to sudden deterioration of the patient. Case Report We report the case of young male, who sustained a blunt injury in front of the neck. He developed a swelling in the front of his neck and suddenly deteriorated, needing intubation and airway management. Computed Tomographic imaging of the neck showed thyroid hematoma and fracture of the cricoid ring requiring an emergency hemi thyroidectomy and fixation of the cricoid fracture. Discussion This case brings forth the occurrence of two rare entities, Thyroid hematoma and Isolated Cricoid fracture in the same patient needing expert airway management and exploration. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nasal Septal Abscess Resulting From Poorly Fitting Dentures

xlomafota13 shared this article with you from Inoreader Nasal Septal Abscess Resulting From Poorly Fitting Dentures Via JAMA Otolaryngology–Head & Neck Surgery Online First This case report describes a woman in her 50s who presented wi th nasal septal abscess resulting from poorly fitting dentures that resulted in translocation of oral flora into the nasal septum. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tracheostomy and Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

xlomafota13 shared this article with you from Inoreader Tracheostomy and Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals Via JAMA Otolaryngology–Head & Neck Surgery Online First This systematic review and meta-analysis examines the associat ion of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Topographic Evaluation of Superior Thyroid Artery-A Terrain to be Well Versed for Surgeon’s Knife

xlomafota13 shared this article with you from Inoreader Topographic Evaluation of Superior Thyroid Artery-A Terrain to be Well Versed for Surgeon's Knife Via Otolaryngology Indian Abstract Observing the origin, varied branching configurations of superior thyroid artery (STA) and evaluating morphometric details with its surrounding relations was aimed at in this cadaveric neck dissection study to avoid surgical mishaps and its repercussions. This observational study was conducted on 40 fresh frozen embalmed and colored latex infused cadavers in the Department of Otorhinolaryngology and Head and Neck Surgery in collaboration with Department of Anatomy of our institute, which involved systematic evaluative dissection of both sides of neck especially focusing on superior thyroid artery, its branching variations and morphometric details with its surrounding relations. Details were measured using digital caliper. The collected data was statistically analyzed by applying chi-square test and significance was set at 5% level (p < 0.05). The analysis revealed the location of the origin of the superior thyroid artery of cadavers from carotid b ifurcation and above it in 40% and from above the level of superior border of thyroid cartilage in 40% of cases. The distribution patterns of the superior thyroid artery were classified into three types depending on the branching pattern typical and variant glandular branching patterns were observed in 85% and 15% of the specimens respectively. A sound knowledge of the regional anatomy and its possible variations helps the surgeon in isolating and preserving the vital structures and avoid iatrogenic complications. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tinnitus Frequency is Higher in Patients with Chronic Heart Failure with Reduced Ejection Fraction and is Closely Related to NT-proBNP Level

xlomafota13 shared this article with you from Inoreader Tinnitus Frequency is Higher in Patients with Chronic Heart Failure with Reduced Ejection Fraction and is Closely Related to NT-proBNP Level Via Otolaryngology Indian Abstract There is not enough information about tinnitus and related parameters in patients with heart failure with reduced ejection fraction (HFrEF). In our study, we aimed to investigate the frequency of tinnitus in HFrEF patients and the clinical parameters associated with this condition. This study included 100 patients with HFrEF and whose medical treatment was arranged according to their disease stage, and 100 control patients without HFrEF with similar age, gender and cardiovascular risk factors. Routine history, physical examinations, echocardiography and laboratory examinations were performed. In addition, a detailed ear examination and tinnitus evaluation were performed in all patients. First of all, the frequency of tinnitus in patients with and without HFrEF was determined. Afterwards, all individuals included in the study were divided into two groups as individuals with and without tinnitus. It was determined that the frequency of tinnitus was higher in patien ts with HFrEF compared to individuals without HFrEF. (25% and 13%, p = 0.023). It was determined that hypertension and hyperlipidemia were more common in the patient group with tinnitus, the patients were older, and the frequency of use of beta blocker, diuretic or spironolactone treatment was higher (p < 0.05 for each). Serum uric acid and NT-proBNP levels were found to be higher in patients with tinnitus (p < 0.05 for each). Logistic regression analysis was performed with the parameters which were found to be significantly different in patients with tinnitus, and in this analysis, age and NT-proBNP levels were found to be independently associated with the presence of tinnitus (p < 0.001 and p = 0.005). According to this analysis, it was determined that every one year increase of age and every 20 pg/mL increase of NTproBNP increased the frequency of tinnitus by 12% and 6.1%, respectively. The frequency o f tinnitus increases in patients with HFrEF. Although the increased frequency of tinnitus in these patients is associated with diuretic therapy, increasing age and high NT-proBNP levels are independently associated with the presence of tinnitus in these patients. NT-proBNP may be a follow-up parameter for tinnitus in patients with HFrEF. However, our study needs to be supported by other studies and studies involving more patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chest Wall Reconstruction in Male Poland Syndrome Patients with Endoscopic-Assisted Latissimus Dorsi Muscle Flap Transfer

xlomafota13 shared this article with you from Inoreader Chest Wall Reconstruction in Male Poland Syndrome Patients with Endoscopic-Assisted Latissimus Dorsi Muscle Flap Transfer Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 May 4:S1748-6815(21)00221-7. doi: 10.1016/j.bjps.2021.03.117. Online ahead of print. ABSTRACT BACKGROUND: Pectoralis major absence generates chest wall deformity and always requires surgical intervention. This study aimed to introduce a technique to reconstruct the chest wall for male Poland Syndrome patients with endoscopic latissimus dorsi muscle (ELDM) flap via a single transverse axillary incision and evaluate its safety and effectiveness. METHODS: A prospective study was designed to recruit male Poland Syndrome candidates for ELDM chest reconstruction. By performing a short and hidden transaxillary incision, we created anterior chest wall pocket and transferred the latissimus dorsi muscle (LDM) flap to recontour the chest wall. Data for patient demographics, LDM flap dimension, operative time, and complications were collected. Upper extremity functional disabilities were evaluated by the d isabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Satisfaction with the outcome was measured by satisfaction with outcome subscale of the BREAST-Q questionnaire. RESULTS: This study recruited 11 eligible patients to receive ELDM chest wall reconstruction. ELDM flap harvesting averagely consumed 79.9 minutes. Without significant complications, all patients recovered uneventfully. Chest wall anomalies of different severity were corrected safely and effectively. The score of DASH was 3.7±3.3 preoperatively and 4.0±3.7 postoperatively with no statistically significant difference. The score of satisfaction with the outcome was 84.8±14.3. CONCLUSIONS: For chest wall anomalies of different severity in male Poland Syndrome patients, the ELDM technique provides a safe and efficient way to reconstruct the chest wall with a better aesthetic outcome, high satisfaction rate, and satisfactory upper limb function. PMID:34039526 | DOI:10.1016/j.bjps.2021.03.117 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Metabolomic Expression of Laryngeal and Hindlimb Muscles in Adult versus Senescent Rats

xlomafota13 shared this article with you from Inoreader Metabolomic Expression of Laryngeal and Hindlimb Muscles in Adult versus Senescent Rats Via otol rhinol Ann Otol Rhinol Laryngol. 2021 May 27:34894211014692. doi: 10.1177/00034894211014692. Online ahead of print. ABSTRACT OBJECTIVES: (1) Determine the feasibility of obtaining a global, unbiased metabolomic profile on laryngeal muscle in a rat model; (2) evaluate the impact of biological aging on the laryngeal metabolome; and (3) characterize biochemical expression differences between aged and non-aged laryngeal and hindlimb muscle. METHODS: Thyroarytenoid laryngeal muscl e and plantaris hindlimb muscle were harvested from 5 young adult (9 months old) and 5 older adult (32 months old) F344BN rats. Tissue was processed and analyzed using LC-MS methods. Detected metabolites were compared to widely used metabolite databases and KEGG pathway enrichment was performed on significant metabolites. RESULTS: The greatest differences in metabolite expression were between laryngeal and limb muscle with 126 different metabolites found between laryngeal and limb within the young group and 149 different metabolites within the old group. Significant hits between muscle groups highlighted amino acid differences between these tissues. There were more robust differences with age in limb muscle compared to laryngeal muscle. CONCLUSIONS: Amino acid metabolism is a key difference between muscles of the limbs and larynx. Due to the number of differentially expressed metabolites between the 2 muscle groups, caution should be exercised when applying skeletal limb muscle physiology and biology concepts to the vocal muscles in both aged and non-aged musculoskeletal systems. Mechanisms underlying less robust effects of age on laryngeal muscle compared to limb muscle require elucidation. PMID:34041924 | DOI:10.1177/00034894211014692 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adult Onset Bilateral Cochlear Nerve Atrophy and Cochlear Implantation: A Case Report and Review of the Literature

xlomafota13 shared this article with you from Inoreader Adult Onset Bilateral Cochlear Nerve Atrophy and Cochlear Implantation: A Case Report and Review of the Literature Via otol rhinol Ann Otol Rhinol Laryngol. 2021 May 27:34894211019518. doi: 10.1177/00034894211019518. Online ahead of print. ABSTRACT OBJECTIVE: To describe a case of idiopathic bilateral cochlear nerve atrophy acquired in adulthood. PATIENT: A 75-year-old male with acquired bilateral cochlear nerve atrophy. INTERVENTION(S): Unilateral cochlear implantation. MAIN OUTCOME AND RESULTS: Description of a patient with acquired bilateral cochlear nerve atrophy diagnosed at the a ge of 75. The patient had normal hearing and no communication deficits until the age of 66. At this point, the patient demonstrated a slight asymmetric hearing loss, which progressed to severe sensorineural hearing loss. Due to the resulting communication deficit, cochlear device implantation candidacy was pursued. Pre-operative magnetic resonance imaging (MRI) showed severe atrophy versus absence of the cochlear nerves bilaterally. After careful counseling regarding the expected communication outcomes given the MRI findings, the patient underwent left-sided cochlear implantation. The patient gained sound awareness, but no additional communication benefit compared to pre-operative baseline abilities. CONCLUSION: Cochlear nerve deficiency is a known finding in certain cases of congenital and acquired hearing loss, but no cases of idiopathic adult-onset bilateral nerve atrophy have been reported. Without MR imaging, the clinically significant finding would not have been identifi ed. Thus, MRI is advantageous when compared with other imaging modalities in patients with progressive sensorineural hearing loss and enables improved patient counseling regarding expected auditory and communication outcomes. PMID:34041922 | DOI:10.1177/00034894211019518 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients

xlomafota13 shared this article with you from Inoreader Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients Via otol rhinol Ann Otol Rhinol Laryngol. 2021 May 27:34894211018914. doi: 10.1177/00034894211018914. Online ahead of print. ABSTRACT OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and comple ted DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depress ion (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048). CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group. PMID:34041923 | DOI:10.1177/00034894211018914 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Metastatic Prostate Cancer Involving the Sphenoid Sinus and Mandible

xlomafota13 shared this article with you from Inoreader Metastatic Prostate Cancer Involving the Sphenoid Sinus and Mandible Via ear nose throat Ear Nose Throat J. 2021 May 26:1455613211006009. doi: 10.1177/01455613211006009. Online ahead of print. ABSTRACT Prostate cancer is the third most leading cause of cancer in men in the United States. Although expected metastatic spread to bone, liver, and lymph nodes are often monitored, there are other rare presentations that can occur. This case report demonstrates a rare presentation of prostate cancer spreading to the paranasal sinuses and orbit. Not only did this case h ave an atypical presentation mimicking infection, the diagnosis was also only achieved through pathological evaluation after an endoscopic examination and biopsy. This case demonstrates the importance of a low threshold for endoscopic examinations in uncertain sinonasal presentations, and consistent biopsies when performing endoscopic examinations. PMID:34039052 | DOI:10.1177/01455613211006009 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.