Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Thursday, February 4, 2021

An Enlarging Parotid Mass in a 9-Year-Old Boy

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A 9-year-old boy presents with a left-sided neck mass that has been enlarging, mild intermittent pain, episodes of upper respiratory infection, and previous adenotonsillectomy and bilateral ear tubes placement. What is your diagnosis?
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Povidone Iodine to Reduce Viral Load in Patients With COVID-19

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This randomized clinical trial investigates the efficacy of na sopharyngeal povidone iodine solutions in reducing the viral load of patients with COVID-19.
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Diffuse Type 2 Dominant Rhinosinusitis and Corticosteroid Irrigation After Surgical Neosinus Cavity Formation

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This cohort study examines long-term treatment outcomes in pat ients with eosinophilic rhinosinusitis who have received corticosteroid irrigations after surgical creation of a neosinus cavity.
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New Age Mentoring and Disruptive Innovation

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This study examines how mentoring has evolved over time, what new challenges have recently emerged, and how to implement effective structural solutions in the field of otolaryngology–head and neck surgery.
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Risk and Clinical Factors of Late Lower Cranial Neuropathy in Oropharyngeal Squamous Cell Carcinoma

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This cohort study assesses the cumulative incidence of and cli nical factors associated with late lower cranial neuropathy among patients with long-term survival of oropharyngeal squamous cell carcinoma.
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Prognostic Significance of Systemic Inflammatory Response in Cases of Temporal Bone Squamous Cell Carcinoma

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Objective/Hypothesis

Squamous cell carcinoma (SCC) of the temporal bone is an extremely rare condition. This rarity has led to a delay in the establishment of a standard treatment protocol and adequate staging system. Identification of prognostic markers of this disease from a variety of fields is desirable in the establishment of treatment guidelines for temporal bone SCC. The aim of this study is to assess the prognostic role of inflammation‐based prognostic scores in cases of temporal bone SCC.

Study Design

Case reries with chart review.

Methods

A total of 71 cases of primary malignancy eligible for curative treatment at a single tertiary medical institute were retrospectively analyzed. Univariate and multivariate regression analyzes were used to investigate the association between the inflammation‐based scores and 5‐year overall survival.

Results

Univariate Cox regression analyzes showed that a high neutrophil‐to‐lymphocyte ratio, high platelet‐to‐lymphocyte ratio, low lymphocyte‐to‐monocyte ratio, a Glasgow prognostic score of 2, and the systemic inflammation score of 2 were significantly associated with a poor prognosis, as well as a classification of T4 stage, presence of cervical lymph node metastasis, high white blood cell counts, and high C‐reactive protein levels. The multivariate analysis showed that a clinical stage of T4 and a systemic inflammation score of 2 were independent prognostic markers.

Conclusions

Inflammation‐based prognostic markers are associated with the survival of patients with temporal bone SCC, as well as other head and neck SCCs.

Level of Evidence

4 Laryngoscope, 2021

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Residual Hair Cell Responses in Electric-Acoustic Stimulation Cochlear Implant Users with Complete Loss of Acoustic Hearing After Implantation

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Abstract

Changes in cochlear implant (CI) design and surgical techniques have enabled the preservation of residual acoustic hearing in the implanted ear. While most Nucleus Hybrid L24 CI users retain significant acoustic hearing years after surgery, 6–17 % experience a complete loss of acoustic hearing (Roland et al. Laryngoscope. 126(1):175-81. (2016), Laryngoscope. 128(8):1939-1945 (2018); Scheperle et al. Hear Res. 350:45-57 (2017)). Electrocochleography (ECoG) enables non-invasive monitoring of peripheral auditory function and may provide insight into the pathophysiology of hearing loss. The ECoG response is evoked using an acoustic stimulus and includes contributions from the hair cells (cochlear microphonic—CM) as well as the auditory nerve (auditory nerve neurophonic—ANN). Seven Hybrid L24 CI users with complete loss of residual hearing months after surgery underwent ECoG measures before and after loss of hearing. While significant reductions in CMs were evident after hearing loss, all participants had measurable CMs despite having no measurable acoustic hearing. None retained measurable ANNs. Given histological data suggesting stable hair cell and neural counts after hearing loss (e.g., Quesnel et al. Hear Res. 333:225-234. (2016)), the loss of ECoG and audiometric hearing may reflect reduced synaptic input. This is consistent with the theory that residual CM responses coupled with little to no ANN responses reflect a "disconnect" between hair cells and auditory nerve fibers (Fontenot et al. Ear Hear. 40(3):577-591. 2019). This "disconnection" may prevent proper encoding of auditory stimulation at higher auditory pathways, leading to a lack of audiometric responses, even in the presence of viable cochlear hair cells.

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