Objectives/Hypothesis
PENTOCLO treatment, associating pentoxifylline, tocopherol, and clodronate, resolves radiation‐induced fibrosis. The main aim of the present study was to prospectively assess ...efficacy in mandibular osteoradionecrosis (ORN).
Study Design
Prospective cohort study.
Methods
Twenty‐seven patients with mandibular ORN were included in the Pentoclauvergne Study between January 2014 and February 2016. After an initial 28‐day phase of antibiotic, antifungal, and corticosteroid therapy, they received the PENTOCLO association daily until cure or a maximum of 24 months. The main assessment criterion was exposed bone area (EBA); secondary criteria comprised the Subjective, objective, management, and analytic (SOMA) score.
Results
Under PENTOCLO, EBA decreased by 28% at 2 months, 55% at 6 months, and 92% at 24 months; the SOMA score decreased by 23%, 38%, and 50%, respectively. A complete treatment course cured 76.5% of patients at a mean 9.6 months.
Conclusions
PENTOCLO is a simple, well‐tolerated, and effective treatment for mandibular ORN.
Level of Evidence
4 Laryngoscope, 130:E559–E566, 2020
The main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a ...paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (
n
= 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (
n
= 24) underwent concomitant endoscopic surgery. A 65.8% (
n
= 125) of the patients were diagnosed with laryngomalacia, 21.1% (
n
= 40) with isolated posterior excess of mucosa, 9.5% (
n
= 18) with another diagnosis and 3.7% (
n
= 7) with a normal examination. The presence of comorbidity was associated (
p
< 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery.
Conclusion
: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia.
What is Known:
•
Previous research has established that laryngomalacia is the main aetiology of stridor.
•
Comorbidities are linked with a poor tolerance of stridor.
What is new:
•
About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery).
•
Laryngomalacia and isolated posterior excess of mucosa account for 85–90% of the patients seen in consultation for stridor.
Objectives
To determine whether deterioration of dental condition at the outset of management of head and neck cancer (HNC) is a nutritional risk and whether social deprivation is a cause of the poor ...dental condition observed in HNC patients.
Material and methods
A nutritional assessment form (NAF) and the Nutrition Risk Index (NRI) were used to standardize the nutritional status of 108 patients at the outset of management of HNC (2017-2019). The NAF includes assessment of weight loss over the past 3 months, the amount and difficulty of food intake, and the presence of digestive disorders. Dental condition was assessed by the decayed, filled, and missing teeth acopre (DFM) index and the masticatory coefficient (MC). Dental status and social deprivation were correlated with the EPICES score.
Results
A correlation was found between the extent of weight loss and dental condition. The MC was higher in absence of weight loss (46% vs. 27%,
p
= 0.03) and the DMF lower when weight loss was less than 5% (22.3 vs. 26.9 if > 5% loss of weight,
p
= 0.005). No correlation was found between dental status and nutritional status. Social deprivation was associated with a lower MC (26% vs. 50%,
p
< 0.001).
Conclusion
Dental condition is a risk factor for weight loss at the outset of management of HNC but is not a determinant of nutritional status.
Clinical relevance
Dental condition is no longer considered simply as a source of potential complications after radiotherapy but also as an important factor for nutritional status.
Investigation of long-term satisfaction and correlation with audiometric measurements after osseointegrated bone-conduction device (OBCD) surgery for patients with single-sided deafness (SSD).
...Thirty-six patients implanted with an OBCD for SSD.
Retrospective review in a university medical center.
Rehabilitative. The patients were implanted after a test with an OBCD worn on a headband during 15 days in a daily use. The patients were implanted if the test gave us satisfaction.
A series of audiometric tests, including speech perception in noise, prosthetic gain, and sound localization measurements, with and without OBCD on headband before surgery and on the transcutaneous implant remote from the surgery. Assessment of benefit and satisfaction using the modified Entific Medical System Questionnaire (EMSQ), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Glasgow Benefit Index (GBI).
The mean follow-up is 2.2 years. Approximately 64% of the patients use their OBCD more than 8 hours per day and 82% more than 4 hours per day. Mean satisfaction score is 7.3/10. The APHAB and GBI show a significant benefit (APHAB ease of communication before and after implantation, +21; GBI total score, +17). These results show an improvement in speech perception in noise with the OBCD, but no differences between the preoperative and postoperative tests. There is no improvement in sound localization. A high level of satisfaction is correlated with good results on the pre operative speech perception in noise.
The OBCD is an effective way of rehabilitation for SSD. The BAHA improves the speech perception in noise but provided no significant improvement in sound localization as revealed in the postoperative test. With 3 questionnaires we noticed an improvement in the quality of life with the OBCD.
The role of secreted factors from the tumor cells in driving cancer cachexia and especially muscle loss is unknown. We wanted to study both the action of secreted factors from head and neck cancer ...(HNC) cell lines and circulating factors in HNC patients on skeletal muscle protein catabolism.
Conditioned media (CM) made from head and neck cancer cell lines and mix of sera from head and neck cancer (HNC) patients were incubated for 48 h with human myotubes. The atrophy and the catabolic pathway were monitored in myotubes. The patients were classified regarding their skeletal muscle loss observed at the outset of management.
Tumor CM (TCM) was able to produce atrophy on myotubes as compared with control CM (CCM). However, a mix of sera from HNC patients was not able to produce atrophy in myotubes. Despite this discrepancy on atrophy, we observed a similar regulation of the catabolic pathways by the tumor-conditioned media and mix of sera from cancer patients. The catabolic response after incubation with the mix of sera seemed to depend on the muscle loss seen in patients.
This study found evidence that the atrophy observed in HNC patients cannot be solely explained by a deficit in food intake.
The presence of endolymphatic hydrops as a marker of Menière’s disease (MD) suggests abnormal pressure in the intralabyrinthine compartments of patients and excessive stiffness of sound-sensitive ...structures. Otoacoustic emissions (OAEs) have been reported to respond to changes in the ear’s stiffness, including those produced by intracranial pressure steps, by a characteristic phase shift around 1 kHz, thereby suggesting a noninvasive means of monitoring MD. Here, body tilt was used for modulating intracranial pressure in forty-one patients with definite MD who were tentatively measured at two stages, with and without active symptoms. Their distortion-product OAEs (DPOAEs) were dynamically monitored around 1 kHz every few seconds in response to body tilt. In a control sample of thirty normal ears, the maximum phase rotation of DPOAEs produced by body tilt was between −18° and +37°. In MD ears with the complete set of symptoms, the posture-induced phase shifts in 32 out of 35 tests fell outside the normative interval, and in 10 tests, although DPOAEs were well above noise floor, their phase was always so abnormally erratic that body tilt produced hardly any additional effect. When MD ears were asymptomatic, nine out of 32 posture tests were abnormal. The excessive DPOAE phase shift is consistent with either a too stiff cochlear partition or a displacement of the operating point of outer hair cells by endolymphatic hydrops.
► Body tilt increases intracranial pressure and the phase of otoacoustic emissions. ► Normally the posture-induced phase shift does not exceed about 37°. ► In Menière patients near an attack, the posture-induced phase shift was excessive. ► Away from an attack, the phase instability could persist.
It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We ...report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021−October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.
The aim of this study was to investigate the hypothesis that, independent of other known prognostic factors, pessimistic head and neck (H&N) cancer patients have a greater risk of being dead 1 year ...after diagnosis than do optimistic patients.
A prospective observational study design was used with a cohort of H&N cancer patients diagnosed during the period from March 1, 1997, to August 31, 1998, at the Centre Hospitalier Universitaire, Clermont-Ferrand, France. Dispositional optimism (DO) was evaluated at baseline using a French version of the Life Orientation Test translated and validated for this study. One-year survival status was collected on all subjects. The analysis of the hypothesized association between DO and 1-year survival was performed using multiple logistic regression analysis, controlling for other sociodemographic and clinical variables.
The sample size was 101 patients, representing all but one of those patients fitting the inclusion criteria who were diagnosed during the recruitment period. Of these, 51 were alive at 1 year after diagnosis, 45 were dead, and five were lost to follow-up. The multivariate analysis was performed on the data from the 96 subjects in whom 1-year survival status was known. Controlling for known predictors of H&N cancer survival, pessimistic subjects (odds ratio OR, 1.12; 95% confidence interval CI, 1.01 to 1.24) and those living alone (OR, 4.14; 95% CI, 1.21 to 14.17) were more likely than optimistic subjects and those living with others to be dead at 1 year.
The results of this study of a cohort of French H&N cancer patients indicate that dispositional optimism predicts 1-year survival independent of other sociodemographic and clinical variables.
It is known that by influencing stapes stiffness thus the ear’s impedance, changes in intracranial and intralabyrinthine pressure induce a characteristic phase shift in otoacoustic emissions (OAE) ...around 1
kHz in human ears. Thus, if the regulation of pressure in intralabyrinthine compartments were abnormal in Menière patients, OAEs might help detect it. Body tilt, which acts on intracranial pressure, and administration of an osmotically active substance provide two simple ways of manipulating intralabyrinthine pressure. Here, 14 patients with typical signs of an attack of unilateral endolymphatic hydrops were submitted to postural changes and a glycerol test. Their OAEs initially collected in upright position served as references, then OAEs were measured in supine position, and back to the upright posture one and 3
h after glycerol intake. Twenty control subjects were also tested for body tilt. The main effect of body tilt and glycerol was a phase rotation of OAEs peaking around 1
kHz. Its frequency dependence matched the one due to a pressure-related change in stapes or basilar membrane stiffness predicted by the ear model of
Zwislocki (1962). The average glycerol-induced phase shifts were similar in size in Menière vs. asymptomatic ear and audiometric thresholds were stable after glycerol intake in line with the model predicting little change in the magnitude of the transfer function. These data support a simple conductive pressure-related mechanism explaining the action of glycerol on inner ear responses. The fact that the mean postural shift was three times larger in Menière than asymptomatic and control ears suggests an additional effect in allegedly hydropic ears.
Abstract Background: Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely. Objective: Lingual abscesses call for prompt and aggressive management because they ...are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated. Case Report: A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan. Discussion: Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection. Conclusion: We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy.
