Advances in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Follow-Up in Head and Neck Cancer: A Management Dilemma Wed, 14 Jan 2015 07:58:37 +0000 Follow-up program in squamous cell carcinoma of head and neck district is crucial to detect locoregional recurrence and second primary tumors and to manage treatment toxicities. The choice of the appropriate frequency of visits and imaging modality can be troublesome. Details of timing surveillance and type of diagnostic procedure are still not well defined. This review highlights the problem from a clinician’s point of view. Francesca De Felice, Daniela Musio, and Vincenzo Tombolini Copyright © 2015 Francesca De Felice et al. All rights reserved. Predicting Neck Abscess with Contrast-Enhanced Computed Tomography Tue, 18 Nov 2014 00:00:00 +0000 Neck abscesses are difficult to diagnose and treat. Currently, contrast-enhanced computed tomography (CECT) is the imaging modality of choice. The study aims to determine the predictive value of CECT findings in diagnosing neck abscess, causes of neck abscess and the most common neck space involved in the local population. 84 consecutive patients clinically suspected to have neck abscess who underwent CECT and surgical confirmation of pus were included. Demographic and clinical data were recorded. 75 patients were diagnosed as having neck abscess on CECT; out of those 71 patients were found to have pus. Overall CECT findings were found to have a high sensitivity (98.6%) and positive predictive value (PPV) (94.7%) but lower specificity (67.2%) in diagnosing neck abscess. The CECT diagnostic criterion with the highest PPV is the presence of rim irregularity (96%). The most common deep neck space involved is the submandibular compartment, which correlates with the finding that odontogenic cause was the most common identifiable cause of abscess in the study population. Thus, in a patient clinically suspected of having neck abscess, CECT findings of a hypodense mass with rim irregularity are helpful in confirming the diagnosis and guiding clinical management. Melisa Lim Seer Yee, Noraini Abdul Rahim, Ning Ajleaa Ngah, Yang Faridah Abdul Aziz, and Sethu Subha Copyright © 2014 Melisa Lim Seer Yee et al. All rights reserved. The Modified Transcanal Approach for Cochlear Implantation: Technique and Results Thu, 13 Nov 2014 00:00:00 +0000 The aim of this work is to present a modified transcanal technique for cochlear implantation. It was a prospective study on 125 cochlear implant patients presenting to two tertiary referral hospitals between January 2010 and January 2013 and followed up for 6–30 months. Their age range was 2–56 (mean 3.4 years) and the male: female ratio was of 2.1 : 1. A modified transcanal technique was adopted through a small postauricular incision. A tympanomeatal flap is elevated, the middle ear is exposed, and the round window membrane is exposed by drilling the overhanging niche. The electrode is channeled in an open trough along the posterosuperior meatal wall, which is reconstructed by autologous cartilage. The round window was used for insertion in 110 patients and a cochleostomy in 15. The main outcome measures were technical steps, operative time, and ease and completeness of electrode insertion. The actual surgical time (excluding device testing) ranged between 25 and 40 minutes (mean 30.1 min). There were 115 complete insertions and 10 partials. There were 6 chorda tympani injuries, 2 electrode exposures with 1 requiring revision, and 2 cases with a tympanic membrane perforation which were grafted uneventfully. One case had severe infection with extrusion of the device 1 year after successful implantation. Badr Eldin Mostafa, Walid Farag Ezzat, and Abdel Monem El Mogui Copyright © 2014 Badr Eldin Mostafa et al. All rights reserved. Early versus Delayed Oral Feeding in Patients following Total Laryngectomy Sun, 28 Sep 2014 10:00:53 +0000 Objectives. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. Method. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. Results. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD −2.72 days [95% CI −5.34 to −0.09]. Conclusion. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence. Ashley Hay, Lisa Pitkin, and Kurinchi Gurusamy Copyright © 2014 Ashley Hay et al. All rights reserved. The Potential Use of Melatonin for Preventing Cisplatin Ototoxicity: An Insight for a Clinical Approach Mon, 18 Aug 2014 07:46:12 +0000 Cisplatin, one of the most effective and potent anticancer drugs, is used in the treatment of a wide variety of both pediatric and adult malignancies. However, the chemotherapeutic use of cisplatin is limited by its serious side effects, such as nephrotoxicity and ototoxicity. Ototoxicity produced by cisplatin is usually persistent, depending on the age of the patient, the cumulative number of doses, the number of chemotherapy cycles, the history of noise exposure, and deteriorating renal function. The mechanism of the ototoxicity caused by cisplatin is based on the generation of reactive oxygen species, which interfere with the antioxidant protection of the organ of Corti. Thus, protecting the cochlea with antioxidants ameliorates ototoxicity from cisplatin. In this context, melatonin appears as a therapeutic option for preventing the ototoxic effects of cisplatin, since the research in the last decade has proven its ability to be both a direct free radical scavenger and indirect antioxidant. In this sense, some of the evidence suggesting that melatonin is efficient for combating cisplatin-induced ototoxicity is summarized and discussed in this paper. Juliana Gusmão de Araujo, André Luiz Lopes Sampaio, Alessandra Ramos Venosa, and Carlos Augusto Costa Pires de Oliveira Copyright © 2014 Juliana Gusmão de Araujo et al. All rights reserved. Evaluation of Autogenous Engineered Septal Cartilage Grafts in Rabbits: A Minimally Invasive Preclinical Model Wed, 23 Jul 2014 11:01:49 +0000 Objectives. (1) Evaluate safety of autogenous engineered septal neocartilage grafts and (2) compare properties of implanted grafts versus controls. Study Design. Prospective, basic science. Setting. Research laboratory. Methods. Constructs were fabricated from septal cartilage and then cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of constructs were evaluated. Results. No serious complications were observed. Implanted constructs contained more DNA () and less sGAG perDNA () when compared with in vitro controls. Confined compressive aggregate moduli were also higher in implanted constructs () and increased with longer in vivo incubation time (). Implanted constructs displayed resorption rates of 20–45 percent. Calcium deposition in implanted constructs was observe. Conclusion. Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and less sGAG when compared with in vitro controls. Confined compressive aggregate moduli were higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage. Anton Kushnaryov, Tomonoro Yamaguchi, Kristen K. Briggs, Van W. Wong, Marsha Reuther, Monica Neuman, Victor Lin, Robert L. Sah, Koichi Masuda, and Deborah Watson Copyright © 2014 Anton Kushnaryov et al. All rights reserved. Benign Paroxysmal Positional Vertigo: An Integrated Perspective Thu, 17 Jul 2014 06:29:58 +0000 Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition. Kourosh Parham Copyright © 2014 Kourosh Parham. All rights reserved. Retrospective Analysis of Pediatric Tracheostomy Thu, 26 Jun 2014 00:00:00 +0000 Purpose. This paper reviews analyses for tracheostomy within our patient population over the last 6 years. Methods. We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at the tertiary Dicle University Medical hospital, Turkey, from January 2006 to December 2012. Patient age, sex, emergency, planned tracheostomy, indications, complications, and decannulation time were all assessed. Results. Fifty-six (34 male, 22 female) adult Pediatric patients undergoing tracheostomy between 2006 and 2013 were investigated. The most common indication for tracheostomy was upper airway obstruction (66.7%), followed by prolonged intubation (33.3%). Mean decannulation times after tracheostomy ranged between 1 and 131 days, the difference being statistically significant (). There was no significant difference in terms of mean age (; ). There was also no statistical difference between emergency and planned tracheotomies (). Conclusion. In our patient population, there was a significant decline in the number of tracheotomies performed for prolonged intubation and an increasing number of patient tracheostomy for upper airway obstruction. According to the literature, permanent decannulation rates were slightly higher with an increase in genetic diseases such as neuromuscular disease. Mehmet Akdag, Zeynep Baysal, Ayfer Gozu Pirinccioglu, Aylin Gul, Fazıl Emre Ozkurt, and Ismail Topcu Copyright © 2014 Mehmet Akdag et al. All rights reserved.