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Αλέξανδρος Γ. Σφακιανάκης

Monday, September 27, 2021

The mismatch negativity responses of individuals with tinnitus with normal extended high-frequency hearing-is it possible to use mismatch negativity in the evaluation of tinnitus?

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Eur Arch Otorhinolaryngol. 2021 Sep 26. doi: 10.1007/s00405-021-07097-6. Online ahead of print.

ABSTRACT

OBJECTIVE: This study uses the multi-feature paradigm to compare the MMN responses of individuals with normal hearing thresholds, including the high frequencies with and without tinnitus.

METHODS: Sixteen subjects with chronic subjective idiopathic tinnitus and twenty matched healthy controls were included in the study. Participants with hearing thresholds (0.125-16 kHz) less than 20 dB HL and MoCA test scores above 21 were included in the study. MMN responses and topographical maps of the responses resulting from the multi-feature MMN paradigm were recorded from 22 surface scalp electrodes. Amplitude and latency parameters of the MMN responses of five different deviants, consisting of frequency, intensity, duration, location, and silent gap, were compared between the two groups.

RESULTS: The amplitudes of MMN responses were lower in the tinnitus group than in the control group at Fz electrode for all deviant types. At the same time, there was no difference between the groups for MMN latencies and, no correlation was found between THI and MMN.

CONCLUSION: According to our results, the MMN might indicate a possible impairment in pre-attentive and automatic central auditory processing for chronic tinnitus patients. Since MMN responses in the tinnitus group differ from those of healthy individuals, it might be used as a reference for evaluating the central auditory pathways of tinnitus patients.

PMID:34564749 | DOI:10.1007/s00405- 021-07097-6

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Beyond VOTE: The New Frontier of Drug-Induced Sleep Endoscopy

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Alternatives to positive airway pressure therapy, including surgery, represent an important area of research. Specifically, predictors of response to surgical therapy remain underdeveloped. Drug-induced sleep endoscopy (DISE) holds promise as a diagnostic tool to identify patient-specific causes of airway collapse. Herein, we present a novel, standardized approach which combines anatomic and physiologic measurements during DISE. Our DISE platform measures airflow, airway compliance, airway co llapsibility, and structural drivers of collapse. Taken together, these inputs provide a comprehensive framework to further inform the surgeon in providing personalized care of the patient with obstructive sleep apnea.
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Factors that influence the postoperative upper eyelid position following surgery for involutional blepharoptosis

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J Plast Reconstr Aesthet Surg. 2021 Sep 5:S1748-6815(21)00386-7. doi: 10.1016/j.bjps.2021.08.007. Online ahead of print.

ABSTRACT

External levator advancement is commonly performed for involutional blepharoptosis repair; however, it is difficult to predict the postoperative upper eyelid position (UEP) accurately in blepharoptosis surgery. The purpose of this study was to determine the factors that influence postoperative UEP following surgery for involutional blepharoptosis. We retrospectively studied 40 Japanese women (80 eyelids) who underwent bilateral external levator advancement surgery. We used digital analysis software to measure the UEP and the eyebrow position from straight-gaze view photographs. Statistical analysis was performed to determine the correlation between postoperative UEP and related factors, including age, levator function, amount of levator advancement, anatomical fixed position, and preoperative and intraoperat ive UEP. We also compared UEP changes in mild, moderate, and severe ptosis groups. Levator function affected both preoperative and postoperative UEP. The amount of levator advancement and the anatomical fixation position on the aponeurosis did not affect the postoperative UEP. However, both preoperative (r = 0.49) and intraoperative (r = 0.55) UEPs affected the postoperative UEP. In cases of severe ptosis, there was significant re-drooping after surgery, while in cases with mild ptosis, the intraoperative eyelid position was maintained or slightly elevated. In involutional blepharoptosis, the degree of preoperative and intraoperative UEP contributed to the postoperative eyelid position. These data suggested that the levator muscle function is a major contributing factor in the pathogenesis of involutional blepharoptosis.

PMID:34565702 | DOI:10.1016/j.bjps.2021.08.007

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Does post-mastectomy radiation therapy worsen outcomes in immediate autologous breast flap reconstruction? A systematic review and meta-analysis

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J Plast Reconstr Aesthet Surg. 2021 Aug 28:S1748-6815(21)00383-1. doi: 10.1016/j.bjps.2021.08.005. Online ahead of print.

ABSTRACT

BACKGROUND: There is great uncertainty regarding the practice of immediate autologous breast reconstruction (IBR) when post-mastectomy radiotherapy (PMRT) is indicated. Plastic surgery units differ in their treatment protocols, with some recommending delayed breast reconstruction (DBR) following PMRT. IBR offers significant cosmetic and psychosocial benefits; however, the morbidity of flap exposure to radiation remains unclear.

OBJECTIVE: The aim of this review was to comprehensively analyze the existing literature comparing autologous flaps exposed to PMRT and flaps with no radiation exposure.

METHODS: A comprehensive search in MEDLINE, EMBASE and CENTRAL databases was conducted in November 2020. Primary studies comparing IBR with and without adjuvant PMRT were assessed for the following primar y outcomes: clinical complications, observer-reported outcomes and patient-reported satisfaction rates. Meta-analysis was performed to obtain pooled risk ratios of individual complications.

RESULTS: Twenty-one articles involving 3817 patients were included. Meta-analysis of pooled data gave risk ratios for fat necrosis (RR = 1.91, p < 0.00001), secondary surgery (RR = 1.62, p = 0.03) and volume loss (RR = 8.16, p < 0.00001) favoring unirradiated flaps, but no significant difference was observed in all other reported complications. The no-PMRT group scored significantly higher in observer-reported measures. However, self-reported aesthetic and general satisfaction rates were similar between groups.

CONCLUSION: IBR should be offered after mastectomy to patients requiring PMRT. The higher risks of fat necrosis and contracture appear to be less clinically relevant as corroborated by positive scores from patients developing these complications. Preoperative and intraope rative measures should be taken to further optimize reconstruction and mitigate post-radiation sequel. Careful management of patients' expectations is also imperative.

LEVEL OF EVIDENCE: Level III.

PMID:34565703 | DOI:10.1016/j.bjps.2021.08.005

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Nasal irrigation with corticosteroids in Brazil: the clinical response of 1% compounded budesonide drops and betamethasone cream

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Braz J Otorhinolaryngol. 2021 Aug 4:S1808-8694(21)00131-2. doi: 10.1016/j.bjorl.2021.06.008. Online ahead of print.

ABSTRACT

INTRODUCTION: High-volume corticosteroid nasal irrigation is a treatment option in patients with chronic rhinosinusitis. In Brazil, alternatives are used to optimize its cost and popularize its use, such as 1% compounded budesonide drops or betamethasone cream, and it is necessary to study these treatment modalities.

OBJECTIVE: To evaluate the clinical response of nasal irrigation with 1% compounded budesonide drops or betamethasone cream compared to nasal sprays utilized in patients with chronic rhinosinusitis.

METHODS: This was a retrospective observational study with 257 patients. One hundred and eight patients using corticosteroid nasal irrigation (292 treatment cycles) and 149 using corticosteroid nasal spray (300 treatment cycles) were included. Evaluation of subjective improvement, adverse even ts, exacerbations, and objective assessments with SNOT-22 and Lund-Kennedy endoscopic score were performed, in addition to sub-analyses related to nasal polyps and previous surgery.

RESULTS: Corticosteroid nasal irrigation and corticosteroid nasal spray improved the Lund-Kennedy endoscopic score, with more adverse events in the corticosteroid nasal irrigation group. Previous surgery increased corticosteroid nasal irrigation improvement, with greater subjective improvement and fewer exacerbations. 1% compounded budesonide drops were better than betamethasone cream in the Lund-Kennedy endoscopic score, with fewer adverse events. A 1,000 µg dose of 1% compounded budesonide drops was more effective than 500 µg.

CONCLUSION: Corticosteroid nasal irrigation was effective in improving the Lund-Kennedy endoscopic score in chronic rhinosinusitis, especially in patients with nasal polyps and previous surgery, in addition to promoting a higher rate of subjective improvement and fe wer exacerbations than corticosteroid nasal spray, but with more adverse events. 1% compounded budesonide drops improved the Lund-Kennedy endoscopic score with fewer adverse events than betamethasone cream, particularly at higher doses (1000 µg).

PMID:34563470 | DOI:10.1016/j.bjorl.2021.06.008

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cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack

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Ear Nose Throat J. 2021 Sep 25:1455613211043672. doi: 10.1177/01455613211043672. Online ahead of print.

ABSTRACT

We report a case of cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack treated with microvascular decompression (MVD) of the superior vestibular nerve. This report discusses the merits of surgical intervention through a review of related literature. A 58-year-old woman was referred to our clinic with a chief complaint of intermittent, strong, right-sided tinnitus lasting for a few seconds immediately prior to drop attack. Magnetic resonance imaging (MRI) showed bilateral neurovascular contact between the anterior inferior cerebellar artery (AICA) and the vestibulocochlear nerve. Based on MRI findings, history of present illness, and response to anticonvulsants, CVCS was suspected, and surgical decompression on the right side was subsequently performed. The patient became asymptomatic immediately after the surgery, and the vestibular-evoked myogenic potentials were normalized. No recurrence was reported during a 1-year follow-up period.

PMID:34565213 | DOI:10.1177/01455613211043672

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Drop Attack Treated by Microvascular Decompression of the Superior Vestibular Nerve

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Ear Nose Throat J. 2021 Sep 25:1455613211043672. doi: 10.1177/01455613211043672. Online ahead of print.

ABSTRACT

We report a case of cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack treated with microvascular decompression (MVD) of the superior vestibular nerve. This report discusses the merits of surgical intervention through a review of related literature. A 58-year-old woman was referred to our clinic with a chief complaint of intermittent, strong, right-sided tinnitus lasting for a few seconds immediately prior to drop attack. Magnetic resonance imaging (MRI) showed bilateral neurovascular contact between the anterior inferior cerebellar artery (AICA) and the vestibulocochlear nerve. Based on MRI findings, history of present illness, and response to anticonvulsants, CVCS was suspected, and surgical decompression on the right side was subsequently performed. The patient became asymptomatic immediately after the surgery, and the vestibular-evoked myogenic potentials were normalized. No recurrence was reported during a 1-year follow-up period.

PMID:34565213 | DOI:10.1177/01455613211043672

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Pediatric Otolaryngology During COVID-19: Parental Concern About Elective Surgery

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Ann Otol Rhinol Laryngol. 2021 Sep 25:34894211047653. doi: 10.1177/00034894211047653. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the concerns of parents whose children may need elective surgery during the COVID-19 pandemic.

METHODS: In December 2020, parents of pediatric otolaryngology patients were recruited for a survey about concerns related to elective surgery during the COVID-19 pandemic. A Likert scale quantified concern. The 1 was anchored "Not at al l important" and 5 was "Most important." Demographics included gender, age, race, education level, number of children in household, and whether their child had surgery since March 2020.

RESULTS: About 253 participants were included. Medians ranged from 1 for concerns about emotional and family support to 4 for concerns about their child being exposed to COVID-19 in the Emergency Room. Black parents were more concerned about the risks of COVID than White parents; they were more concerned about their child contracting COVID-19 during surgery compared to White parents, median was 4 versus 3 (P = .027). Black parents had a median score of 3 for concern about medical expenses compared to a median of 2 (P = .001). Parents of children who had surgery since March 2020 had less concern about their child being exposed to COVID-19 during hospitalization (P = .045) and less concern about critique from others (P = .024).

CONCLUSION: Parents were most conce rned about the risk of seeking Emergency Room care. Black parents were generally more concerned about having their child undergo elective surgery. Whether this is translated into fewer Black children undergoing important but elective surgery requires more study.

PMID:34565199 | DOI:10.1177/00034894211047653

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Comparative Treatment Outcome in T3N0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-Dose Intra-Arterial Cisplatin Infusion

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Ann Otol Rhinol Laryngol. 2021 Sep 25:34894211047789. doi: 10.1177/00034894211047789. Online ahead of print.

ABSTRACT

OBJECTIVES: Selective radiotherapy and concomitant intra-arterial cisplatin infusion (m-RADPLAT) with a lower cisplatin dosage have been performed for organ and function preservation in patients with locally advanced squamous cell carcinoma of the larynx (SCC-L), and results showing a lower rate of adverse events have been reported. This study evaluated the t reatment outcomes of patients with T3N0 glottic SCC-L with or without vocal fold fixation (VFF) who were treated with m-RADPLAT.

METHODS: We retrospectively reviewed the data of 33 patients with T3N0 SCC-L who received m-RADPLAT.

RESULTS: The vocal fold in patients with VFF 3 months after completing m-RADPLAT resumed normal movement in 15 patients (83%) and persisted fixation in 3 (17%). The 3-year local control, laryngeal cancer-specific survival, and overall survival rates of patients with or without VFF were 88.9% and 86.7%, 94.1% and 93.3%, and 88.9% and 86.7%, respectively. Additionally, the 3-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates of patients with or without VFF were 94.4% and 86.7%, 88.9% and 73.3%, and 83.3% and 73.3%, respectively. Grade 3 or higher toxicities were observed in all patients: leukopenia in 4 patients (12%), neutropenia in 5 (15%), anemia in 2 (6%), thrombocytopenia in 3 (9 %), and mucositis in 2 (6%).

CONCLUSIONS: This study demonstrated that m-RADPLAT yielded VFF improvement and a favorable survival while maintaining laryngeal function not only in patients with T3N0 glottic SCC-L without VFF but also in patients with VFF.

PMID:34565187 | DOI:10.1177/00034894211047789

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SARS-CoV-2 vaccination may help patients with persistent COVID-19 smell dysfunction

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Ear Nose Throat J. 2021 Sep 26:1455613211044770. doi: 10.1177/01455613211044770. Online ahead of print.

NO ABSTRACT

PMID:34569299 | DOI:10.1177/01455613211044770

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Using platelet-rich fibrin scaffolds with diced cartilage graft in the treatment of empty nose syndrome

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Ear Nose Throat J. 2021 Sep 25:1455613211045567. doi: 10.1177/01455613211045567. Online ahead of print.

ABSTRACT

Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabi litate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.

PMID:34569297 | DOI:10.1177/01455613211045567

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