Multiple skull base defects: features of pathogenesis, diagnosis and treatment

xlomafota13 shared this article with you from Inoreader Multiple skull base defects: features of pathogenesis, diagnosis and treatment Via leak of cerebrospinal fluid Zh Vopr Neirokhir Im N N Burdenko. 2021;85(4):58-63. doi: 10.17116/neiro20218504158. ABSTRACT OBJECTIVE: To determine the risk factors of multiple skull base defects, as well as features of diagnosis and treatment of this pathology. MATERIAL AND METHODS: A retrospective analysis included 39 patients who underwent surgery for nasal CSF leakage at the Burdenko Neurosurgical Center in 2000-2019. The study recruited patients with multiple simultant skull base defects. RESULTS: Traumatic defects were observed in 23 (59%) patients, spontaneous defects - in 16 (41%) cases. All patients underwent endoscopic endonasal closure of skull base defects with autografts. CONCLUSION: Multiple defects are more common in severe traumatic brain injury. The main risk factors of multiple spontaneous defects are female sex and overweight. Adequate diagnosis implies high-resolution CT (slice width 0.5-1 mm), as well as intraoperative control of all suspicious and «weak» areas. Endoscopic endonasal technique is effective and safe for multiple skull base defects (efficiency 97%). PMID:34463451 | DOI:10.17116/neiro20218504158 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Prospective Study of the Effect of Tinnitus Sound Matching Degree on the Efficacy of Customized Sound Therapy in Patients with Chronic Tinnitus

xlomafota13 shared this article with you from Inoreader A Prospective Study of the Effect of Tinnitus Sound Matching Degree on the Efficacy of Customized Sound Therapy in Patients with Chronic Tinnitus Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Objectives: The aim of this study was to explore and compare the customized sound therapy effect between tinnitus sound matching and nonmatching patients in tinnitus customized sound therapy and therapy-related influencing factors. Methods: This prospective study investigated a total of 100 patients with unilateral chronic tinnitus who received customized sound therapy. The participants were dichotomously divided into matching (group A) and nonmatching (group B) groups after 4 stages of tinnitus matching via the tinnitus assistant ap p (provided by Sound Ocean Company, SuZhou, China). Each group consists of 50 participants. Before and 6 months after the treatment, Hospital Anxiety and Depression Scale (HADS), tinnitus handicap inventory (THI), and tinnitus loudness Visual Analog Scale (VAS) were used to evaluate the customized sound therapy effect and explore other related influencing factors. Results: (1) The HADS-A, HADS-D, THI, and VAS scores of 2 groups were both significantly decreased after treatment. (2) The HADS-A and THI scores improved markedly in group A than that in group B, which could be related to the hearing loss of the tinnitus side ear before treatment; the lighter the degree of hearing loss, the better the improvement. No statistically significant differences were detected in HADS-D and VAS scores between the 2 groups, and also, these were not related to the degree of hearing loss. The differences in age, gender, and tinnitus duration did not show any statistically significant ef fect on the improvement of the 2 groups. Conclusions: Both tinnitus sound matching and nonmatching of the customized sound therapy brought a significant effect to tinnitus participants. Our study also suggests that THI and HADS-A scores of those with tinnitus matching participants improved markedly as compared to those of nonmatching participants, and the customized sound therapy effect is negatively correlated with the severity of hearing loss. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use

xlomafota13 shared this article with you from Inoreader Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use Via The Laryngoscope Objectives/Hypothesis Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post-tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non-steroidal anti-inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. Study Design Retrospective chart review. Methods We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. Results A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69–1.49; P = .95). Conclusions This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher-powered study is needed. Level of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Flexible endoscopic approach to verrucous carcinoma of the larynx

xlomafota13 shared this article with you from Inoreader Flexible endoscopic approach to verrucous carcinoma of the larynx Via Clinical Otolaryngology Abstract Close cooperation between clinician and pathologist is vital for correct diagnosis of verrucous carcinoma of the larynx. Obtaining of large biopsy specimen is critical for conclusive histologic response for the diagnosis of verrucous carcinoma of the larynx. Conventional biopsy is often inadequate. Diathermy snare excision through the flexible endoscope allows performing of an adequate biopsy, under local anesthesia, in the outpatient setting. Transoral microsurgery is not possible in some patients, due to anatomic particularities and comorbidities. Flexible endoscopic laser surgery can be a valid treatment alternative for patients with verrucous carcinoma of the larynx, that allows avoidance of general anesthesia, laryngofissure and tracheotomy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

One year into the COVID‐19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

xlomafota13 shared this article with you from Inoreader One year into the COVID‐19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review Via Clinical Otolaryngology Abstract Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will globally emerge from the shadow of COVID-19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: (1) those which made an assessment as to the aerosolisation of droplets during sinus surgery, further subdivided into work which considered macroscopically visible droplets and that which considered smaller particles; (2) and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. Whilst results both highlight a range of innovative adjunctive strategies and support suction as an important variable to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery given studies have demonstrated that close adherence to PPE use is effective at preventing COVID-19 infection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing intraoperative time with laryngeal mask airway and stretcher in pediatric adenotonsillectomy

xlomafota13 shared this article with you from Inoreader Reducing intraoperative time with laryngeal mask airway and stretcher in pediatric adenotonsillectomy Via American Journal of Otolaryngology Publication date: Available online 3 September 2021 Source: American Journal of Otolaryngology Author(s): Arturo Eguia, Zi Yang Jiang, Lauren Brollier, Maria Matuszczak, Sancak Yuksel, Soham Roy, Zhen Huang View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Head and neck free-flap salvage

xlomafota13 shared this article with you from Inoreader Head and neck free-flap salvage Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To highlight three clinical arenas in which head and neck free-flap compromise is encountered and acted upon: nonoperative, operative and postoperative realms. Recent findings Time to identification and intervention is paramount to successful free-flap salvage. Surgical microvascular revision remains chief amongst strategies to revert vascular compromise of a free-flap. Adjuncts, such as thrombolytics and systemic anticoagulation have an important role in the complex work of microvascular free tissue care. Venous congestion of free flaps holds favorable for salvage when compared with arterial insufficiency. Summary Vascular compromise of head and neck free flaps is a rare and feared event for microvascular surgeons, with successful transfers rates approaching above 95%. Success in salvage is dependent on prompt identification of tissue compromise and timely, directed interventions to re-establish tissue perfusion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hearing restoration and the stria vascularis: evidence for the role of the immune system in hearing restoration

xlomafota13 shared this article with you from Inoreader Hearing restoration and the stria vascularis: evidence for the role of the immune system in hearing restoration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This article reviews the current literature regarding the pathogenesis of immune-mediated sensorineural hearing loss, utilizes previously published single-nucleus transcriptional profiles to characterize cytokine and cytokine receptor expression in the adult stria vascularis cell types to support immune system interaction with the stria vascularis and reviews the current literature on immunomodulatory agents currently being used for hearing-restoration treatment. Recent findings The literature review highlights recent studies that elucidate many cytokines and immune markers, which have been linked to various immune-mediated disease processes that have been observed with sensorineural hearing loss within the stria vascularis and highlights recent publications studying therapeutic targets for these pathways. Summary This review highlights the current literature regarding the pathogenesis of immune-mediated hearing loss. The role of cochlear structures in human temporal bones from patients with immune-mediated sensorineural hearing loss are highlighted, and we review cytokine signalling pathways relevant to immune-mediated sensorineural hearing loss and localize genes encoding both cytokine and cytokine receptors involved in these pathways. Finally, we review immunomodulatory therapeutics in light of these findings and point to opportunities for the application of novel therapeutics by targeting these signalling pathways. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sarcopenia and microvascular free flap reconstruction

xlomafota13 shared this article with you from Inoreader Sarcopenia and microvascular free flap reconstruction Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This article reviews the recent literature regarding the impact of sarcopenia on microvascular free flap reconstruction outcomes. Recent findings Malnutrition, and consequent muscle loss, is a prevalent issue among head and neck cancer patients. However, diagnosis remains challenging due to a paucity of reliable objective measures. Traditional markers, such as albumin, have been used in the past to assess nutritional status, but cancer-related inflammation limits their predictive value. Recently, developments in the diagnosis of sarcopenia through the novel use of computed tomography (CT) cross-sectional muscle mass indices to evaluate body composition have proven effective and accessible. Summary Literature shows compelling evidence that sarcopenia is associated with higher rates of surgical complications that delay recovery and increase mortality. The use of CT imaging to quantify muscle loss offers an objective way to evaluate nutritional status, which is predictive of postoperative rates of complications. Research on ways to optimize muscle mass prior to surgery is limited, however, immunonutrition is emerging as a promising intervention that can attenuate sarcopenia-related inflammation to improve outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Understanding the differentiation and epigenetics of cochlear sensory progenitors in pursuit of regeneration

xlomafota13 shared this article with you from Inoreader Understanding the differentiation and epigenetics of cochlear sensory progenitors in pursuit of regeneration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Sensory hair cells (HCs) of the inner ear are responsible for our ability to hear and balance. Loss of these cells results in hearing loss. Stem cell replacement and in situ regeneration have the potential to replace lost HCs. Newly discovered contributions of transcription factor regulatory networks and epigenetic mechanisms in regulating HC differentiation and regeneration are placed into context of the literature. Recent findings A wealth of new data has helped to define cochlear sensory progenitors in their developmental trajectories. This includes transcription factor networks, epigenetic manipulations, and cochlear HC subtype specification. Summary Understanding how sensory progenitors differ and how HC subtypes arise will substantially inform efforts in hearing restoration. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Insights into the molecular mechanisms regulating mammalian hair cell regeneration

xlomafota13 shared this article with you from Inoreader Insights into the molecular mechanisms regulating mammalian hair cell regeneration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To give an overview of recent advances in mammalian auditory hair cell regeneration. Recent findings Supporting cells act as progenitors to regenerate hair cells in the prehearing mammalian cochlea but not in the mature cochlea. To overcome this developmental obstacle, manipulation of multiple genes and intracellular pathways has been investigated, which has obtained promising data. This review focuses on recent advances in auditory hair cell regeneration, including synergic gene regulation associated with Atoh1 and Notch signaling, epigenetics, and functional recovery of regenerated hair cells. Co-manipulation of genes critical for hair cell development and cell cycle re-entry, including Atoh1, Isl1, Pou4f3, Gata3, Gfi1, P27kip1, RB, Myc, and Notch-signaling genes, has generated hair cell-like cells in the adult cochlea both in vitro and in vivo. The epigenetic mechanism has been studied in hair cell development and regeneration. Regeneration of hair cell function has a very limited progress, which lacks in-vitro and in-vivo electrophysiology data. Summary Regeneration of adult auditory hair cells remains a major challenge. Manipulation of multiple genes and pathways together with epigenetic regulation might potentially regenerate functional hair cells in the adult mammalian cochlea. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Advances in hearing preservation in cochlear implant surgery

xlomafota13 shared this article with you from Inoreader Advances in hearing preservation in cochlear implant surgery Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Advancements in cochlear implant surgical approaches and electrode designs have enabled preservation of residual acoustic hearing. Preservation of low-frequency hearing allows cochlear implant users to benefit from electroacoustic stimulation, which improves performance in complex listening situations, such as music appreciation and speech understanding in noise. Despite the relative high rates of success of hearing preservation, postoperative acoustic hearing outcomes remain unpredictable. Recent findings Thin, flexible, lateral wall arrays are preferred for hearing preservation. Both shortened and thin, lateral wall arrays have shown success with hearing preservation and the optimal implant choice is an issue of ongoing investigation. Electrocochleography can monitor cochlear function during and after insertion of the electrode array. The pathophysiology of hearing loss acutely after cochlear implant may differ from that involved in delayed hearing loss following cochlear implant. Emerging innovations may reduce cochlear trauma and improve hearing preservation. Summary Hearing preservation is possible using soft surgical techniques and electrode arrays designed to minimize cochlear trauma; however, a subset of patients suffer from partial to total loss of acoustic hearing months to years following surgery despite evidence of residual apical hair cell function. Early investigations in robotic-assisted insertion and dexamethasone-eluting implants show promise. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.