Showing papers in "Current Opinion in Otolaryngology & Head and Neck Surgery in 2012"
TL;DR: Odontogenic sinusitis is frequently recalcitrant to medical therapy and usually requires treatment of the dental disease, however, sinus computed tomography (CT) or Cone Beam Volumetric CT (CBVCT) are far more successful in identifying dental disease causing Sinusitis.
Abstract: Purpose of reviewFor well over 100 years, it has been appreciated that maxillary dental infections can cause sinusitis. This insight has been largely overlooked with the advent of functional endoscopic sinus surgery (ESS) and its emphasis on the osteomeatal complex. We review several recent case ser
138 citations
TL;DR: The microvascular transfer of free osteocutaneous flaps remains the standard of care, with the fibula flap the clear favorite, and improvement on this standard of practice continues to be elusive.
Abstract: Purpose of reviewThis article reviews literature pertaining to advances in the reconstruction of segmental mandibular defects in the context of an established standard of care, microvascular transfer of free osteocutaneous flaps.Recent findingsMost literature reiterates established reconstructive te
122 citations
TL;DR: This review provides information for surgeons on how to predict surgical outcomes of the repair of nasal septal perforation and which surgical techniques to choose in order to obtain better results.
Abstract: Purpose of reviewAlthough numerous surgical techniques have been introduced thus far in order to achieve the surgical closure of nasal septal perforation, the repair of nasal septal perforation is still challenging for surgeons and operative techniques are not standardized. Furthermore, predictive f
107 citations
TL;DR: An overview of all publicly available reports about cochlear implant as a treatment for tinnitus in single-sided deafness (SSD) reveals an overview of the results, and appropriate patient selection is essential as it is expected that it is a requirement that tinnitis arises from co chlear deafferentation.
Abstract: Purpose of review Tinnitus is a symptom that is highly associated with hearing loss. Its incidence is expected to increase due to the detrimental effects of occupational and leisure noise. Even though no standard treatment is currently available, the effect of cochlear implants on tinnitus in single-sided deafness (SSD) is under scientific attention. This review reveals an overview of all publicly available reports about cochlear implant as a treatment for tinnitus in SSD. Recent findings Cochlear implantation in SSD suppresses tinnitus in most of the cases. Some studies even demonstrate complete tinnitus suppression after implantation. No tinnitus worsening is reported in any of the cases. Furthermore, tinnitus does not restore during the electrical stimulation presented by the cochlear implant. The tinnitus level seems to stabilize after 3-6 months after the first fitting. Summary Although the underlying mechanism responsible for the observed tinnitus suppression is not yet clear, cochlear implantation should be considered as a treatment option for tinnitus arising from SSD. However, appropriate patient selection is essential as it is expected that it is a requirement that tinnitus arises from cochlear deafferentation.
105 citations
TL;DR: Branchial anomalies are common congenital pediatric head and neck lesions but are comprised by several diverse anomalies and treatment must be tailored depending on which branchial arch is involved and whether a cyst mass or sinus/fistula tract is present.
Abstract: Purpose of reviewBranchial anomalies comprise approximately 20% of pediatric congenital head and neck lesions. This study reviews current literature detailing the diagnosis and management of first, second, third and fourth branchial cysts, sinuses and fistulae.Recent findingsBranchial anomalies rema
95 citations
TL;DR: Technological advancements in HSV and associated research findings are driving increased interest in the clinical adoption of HSV to complement videostroboscopic assessment, pointing to the future potential of complementing stroboscopy with alternative imaging modalities in hybrid systems.
Abstract: Purpose of reviewTo summarize recent technological advancements and insight into the role of stroboscopy in laryngeal imaging.Recent findingsAlthough stroboscopic technology has not undergone major technological improvements, recent clarifications have been made to the application of stroboscopic pr
92 citations
TL;DR: NBI continues to receive confirmations of its validity as an ancillary diagnostic tool for endoscopic evaluation of oncologic patients, particularly intriguing is the capacity of NBI to properly distinguish postactinic changes from persistent/recurrent disease.
Abstract: Purpose of review Narrow band imaging (NBI) is a novel endoscopic technique using filtered wavelengths in order to enhance the microvascular abnormalities associated with the preneoplastic and neoplastic changes of the mucosal lining of the upper aerodigestive tract. The present review is focused on the use of NBI in the management of patients with laryngeal cancer. Recent findings The larynx and hypopharynx represent an ideal site for NBI application because their thin, nonkeratinized, stratified squamous epithelium permits optimal visualization of the subtle neoangiogenic changes associated with precancerous and neoplastic diseases, including benign processes like recurrent respiratory papillomatosis. These abnormal vascular patterns have been recently described in great detail and demonstrated to be useful diagnostic tools in different settings of laryngeal cancer management: from preoperative diagnosis and staging to intraoperative evaluation of microsurgical margins and posttreatment follow-up. Particularly intriguing is the capacity of NBI to properly distinguish postactinic changes from persistent/recurrent disease. Summary From different institutions in several countries, NBI continues to receive confirmations of its validity as an ancillary diagnostic tool for endoscopic evaluation of oncologic patients. This also holds true for laryngeal and hypopharyngeal neoplastic diseases.
87 citations
TL;DR: In this article, the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus are reviewed, and the advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flaps, fasciocUTaneous free flaps as well as free flapping flaps are discussed.
Abstract: Purpose of reviewThe present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as
68 citations
TL;DR: Current evidence supports a positive impact of ESS on improving olfactory outcomes in patients with preoperative nasal polyposis and anosmia, however, despite improvements in smell, most of these patients remain with severe hyposmia and it is challenging to predict improvement following ESS.
Abstract: Purpose of reviewOlfactory dysfunction is a common complaint in patients with chronic rhinosinusitis (CRS). The purpose of this article is to review the current evidence on the impact of endoscopic sinus surgery (ESS) on CRS-related olfactory dysfunction.Recent findingsThe recent literature suggests
65 citations
TL;DR: Subtotal and near-total resection of vestibular schwannomas is a reasonable surgical paradigm for VestibularSchwannoma which cannot be completely removed without injuring the facial nerve.
Abstract: Purpose of reviewThe review evaluates current literature on subtotal and near-total resection of vestibular schwannomas.Recent findingsRecent findings suggest that subtotal and near-total resection of vestibular schwannomas can be performed to improve facial nerve outcomes. This is particularly true
64 citations
TL;DR: It is now clear that ABIs can produce excellent speech recognition in some patients with NF2, allowing even conversational telephone use, and these new results show that excellent hearing is possible for NF2 patients with the ABI.
Abstract: Purpose of reviewNeurofibromatosis type 2 (NF2) produces benign Schwann cell tumors on many cranial nerves, in particular on the vestibular portions of the VIIIn bilaterally. Removal of these vestibular schwannomas usually severs the auditory portion of the VIIIn, thus deafening the patients. The au
TL;DR: It is currently not advisable to change management for either HPV-positive or HPV-negative OPC as there is a lack of high-quality evidence to support this and high- quality randomized controlled trials are required to assess the efficacy of the different treatment modalities currently available.
Abstract: Purpose of review There is currently strong evidence supporting human papilloma virus (HPV) causation in a distinct disease entity of oropharyngeal cancer (OPC), with an increasing incidence worldwide.This review aims to critically analyse whether a change in our management approaches to HPV-positive OPC is now required for this increasingly significant public health concern. Recent findings HPV-positive OPC appears to have increased worldwide. HPV status has a strong prognostic effect, and, in combination with smoking status, primary, and nodal stage, is useful in the risk stratification of OPC. HPV-positive OPC responds better to chemoradiotherapy, surgery, and postoperative chemoradiotherapy than HPV-negative tumours, with improved survival outcomes. There remain concerns regarding the efficacy of HPV detection assays in clinical practice. HPV-negative head and neck cancer still accounts for the largest subset of patients that we treat and carries poor survival outcomes. Summary It is currently not advisable to change management for either HPV-positive or HPV-negative OPC as there is a lack of high-quality evidence to support this. High-quality randomized controlled trials are required to assess the efficacy of the different treatment modalities currently available for both HPV-positive and HPV-negative OPC.
TL;DR: Although single-sided deafness is not a currently approved indication for cochlear implantation, limited investigational studies to date have demonstrated patient improvement in both sound localization and speech perception.
Abstract: Purpose of review To examine the current literature regarding application of cochlear implantation in patients with single-sided deafness for improvement in sound localization. Recent findings As familiarity of the technical and biological capabilities of cochlear implantation improves and criteria for use broaden, investigators have begun examining usage of cochlear implantation in patients with single-sided deafness as a viable solution in attempts to improve sound localization and speech perception. Although studies of such application are limited, from the available published literature, modest benefits have been described in both sound localization and speech perception. Patients consistently report improvement in quality of life after cochlear implantation for single-sided deafness. Summary Although single-sided deafness is not a currently approved indication for cochlear implantation, limited investigational studies to date have demonstrated patient improvement in both sound localization and speech perception.
TL;DR: High-speed kymography visualizes vibratory features which are not simply observable via traditional methods and shows large potential in better understanding the functional origin of hoarseness and unsteady phonatory states.
Abstract: Purpose of review Kymographic imaging is a modern method for displaying and evaluating vibratory behaviour of the vocal folds which is crucial for voice production. This review summarizes the state of the art of this method, and focuses on the progress in this area within the last 5 years. Recent findings Videokymography, using a special videocamera, offers high-speed (video) kymographic images in real time, which is advantageous in daily clinical practice. Two other methods use software to create kymograms retrospectively: digital kymography processes high-speed videolaryngoscopic recordings and offers numerous research possibilities, whereas strobovideokymography processes videostroboscopic recordings, and its use is limited to regular vibration patterns. Current studies reveal that high-speed kymographic images allow more reliable visual evaluation of vibrations than by watching video recordings. Image analysis procedures have been advanced to quantify the vibration properties of the vocal folds. New information has been obtained on asymmetry, mucosal waves, irregularities, phonation onset, and nonlinear dynamic phenomena in voice disorders, as well as in singing. Summary High-speed kymography visualizes vibratory features which are not simply observable via traditional methods. It shows large potential in better understanding the functional origin of hoarseness and unsteady phonatory states. Further research in this area is envisioned.
TL;DR: Environmental factors have been noted to induce sinonasal mucosal mucosal irritation and often contribute to the multifactorial cause of chronic Rhinitis and allergic rhinitis.
Abstract: Purpose of reviewTo review the current knowledge of the pathophysiology, epidemiology, and management of environmental pollutants and allergic rhinitis.Recent findingsBoth active cigarette smoking and passive exposure to cigarette smoke are associated with chronic rhinitis and sinusitis. Matrix meta
TL;DR: Although vestibular implant users should not expect normal Vestibular function – any more than cochlear implantusers should expect normal hearing – data suggest that significant functional improvements are possible.
Abstract: Purpose of review To summarize the recent progress in the development of vestibular implants. The review is timely because of the recent advances in the field and because MED-EL has recently announced that they are developing a vestibular implant for clinical applications. Recent findings The handicap experienced by patients suffering from bilateral vestibulopathy has a strong negative impact on physical and social functioning that appears to justify a surgical intervention. Two different surgical approaches to insert electrodes to stimulate ampullary neurons have been shown to be viable. The three-dimensional vestibulo-ocular reflex in rhesus monkeys produced with a three-dimensional vestibular implant showed gains that were relatively normal during acute stimulation. Rotation cues provided by an implant interact with otolith cues in a qualitatively normal manner. The brain appears to adapt plastically to the cues provided via artificial electrical stimulation. Summary Research to date includes just a few human studies, but available data from both humans and animals support the technological and physiological feasibility of vestibular implants. Although vestibular implant users should not expect normal vestibular function - any more than cochlear implant users should expect normal hearing - data suggest that significant functional improvements are possible.
TL;DR: The majority of surgeons who perform auricular reconstruction continue to employ the well-established techniques developed by Brent and Nagata, and synthetic frameworks have been employed instead of autogenous rib cartilage.
Abstract: Purpose of review To review the current practice in the field of auricular reconstruction and to highlight the recent advances reported in the medical literature. Recent findings The majority of surgeons who perform auricular reconstruction continue to employ the well-established techniques developed by Brent and Nagata. Surgery takes between two and four stages, with the initial stage being construction of a framework of autogenous rib cartilage which is implanted into a subcutaneous pocket. Several modifications of these techniques have been reported. More recently, synthetic frameworks have been employed instead of autogenous rib cartilage. For this procedure, the implant is generally covered with a temporoparietal flap and a skin graft at the first stage of surgery. Tissue engineering is a rapidly developing field, and there have been several articles related to the field of auricular reconstruction. These show great potential to offer a solution to the challenge associated with construction of a viable autogenous cartilage framework, whilst avoiding donor-site morbidity. Summary This article gives an overview of the current practice in the field of auricular reconstruction and summarizes the recent surgical developments and relevant tissue engineering research.
TL;DR: There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender and it is essential to include the perspective of the individual when evaluating therapy outcome.
Abstract: Purpose of review This review covers recent research findings that demonstrate the effectiveness of speech pathology intervention in enabling male-to-female transsexual individuals to portray their gender identity through speech. Research reports that extend our understanding of communication characteristics that contribute to perceptions of sex in male-to-female transsexuals are identified. Current issues related to the measurement of therapy effectiveness are also presented. Recent findings Earlier studies confirmed that an increase in voice pitch is achievable for many transsexuals. However, it is now accepted that pitch is not the sole contributor to perceptions of gender. Recently, modification of vocal resonance has been shown to increase perceptions of a speaker as female. There is evidence that encouraging precise articulation results in increased perceptions of the speaker as female. Evidence for the contribution of voice quality and loudness to perceptions of gender is inconclusive. Speech rate does not appear to contribute significantly to gender perceptions. Recent findings Ecologically valid measures of the individual's vocal functioning and its impact on everyday life in clinical assessment of male-to-female transsexuals are needed to provide meaningful measures of therapy outcome. Summary There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender. It is essential to include the perspective of the individual when evaluating therapy outcome.
TL;DR: The purpose of this article is to describe the current understanding of central neural mechanisms in tinnitus and to summarize recent developments in clinical approaches to tinnitis patients.
Abstract: Purpose Of Review
Tinnitus is the sensation of hearing a sound when no external auditory stimulus is present. Most individuals experience tinnitus for brief, unobtrusive periods. However, chronic sensation of tinnitus affects approximately 17% of the general US population, 44 million people. Tinnitus, usually a benign symptom, can be constant, loud and annoying to the point that it causes significant emotional distress, poor sleep, less efficient activities of daily living, anxiety, depression and suicidal ideation/attempts. Tinnitus remains a major challenge to physicians because its pathophysiology is poorly understood and there are few management options to offer patients. The purpose of this article is to describe the current understanding of central neural mechanisms in tinnitus and to summarize recent developments in clinical approaches to tinnitus patients.
TL;DR: This article summarizes the advantages and disadvantages of several graft and implant options for dorsal augmentation, a critically important factor for minimizing morbidity while still achieving an optimal aesthetic result.
Abstract: Purpose of reviewThere is ongoing debate regarding the optimal material for augmentation rhinoplasty. Each graft and implant has its own advantages and disadvantages. This review addresses the use of several grafts and implants in augmentation rhinoplasty, with a particular focus on dorsal augmentat
TL;DR: The hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected and antifungal treatment should not be used.
Abstract: Purpose of review Fungi have been suggested to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). This review describes the recent knowledge concerning the role of fungi in the pathogenesis of CRS and allergic fungal rhinosinusitis (AFRS) and the clinical implications for treatment. Recent findings Recent studies show that, although there are several potential deficits in the innate and potentially also in the acquired immunity of CRS patients that might reduce or change their ability to react to fungi, there are not many arguments to suggest a causative role for fungi in CRS with or without nasal polyps. However, due to the intrinsic or induced change in immunity of CRS patients, fungi might have a disease-modifying role. The fact that AFRS is more prevalent in warm and humid areas may point to fungi as a factor in this disease. Summary Almost a decade after the launching of the hypothesis by Ponikau, the absence of convincing immunological data or evidence for clinical improvement of CRS upon therapy with antifungal agents now means that the hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected and antifungal treatment should not be used.
TL;DR: There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without nasal polyposis, and the use of topical antifungals is not supported by the majority of studies.
Abstract: Purpose of reviewTo review the recent literature of nasal irrigations with or without drugs, including delivery systems, nasal saline, antibiotics, antifungals, steroids, surfactants, and interleukin (IL)-5 modulators, for the treatment of chronic rhinosinusitis (CRS).Recent findingsAs antibiotic re
TL;DR: New procedures for tracheal reconstruction hold much promise for treating difficulttracheal disorders and improving the quality of life for affected patients.
Abstract: PURPOSE OF REVIEW Many patients require tracheal reconstruction either for tracheal stenosis/malacia or following tumor extirpation. However, such patients can be debilitated following failed conventional treatments. Recent advances in tissue engineering and vascularized composite grafts are accelerating the field of tracheal reconstruction. This article reviews new clinical concepts for tracheal reconstruction. RECENT FINDINGS Novel treatments include composite autografts, allografts, chimeric autografts and allografts, tissue-engineered grafts, prosthetic scaffolds, and the use of free-tissue vascularized carriers. SUMMARY New procedures for tracheal reconstruction hold much promise for treating difficult tracheal disorders and improving the quality of life for affected patients. Many of the techniques reviewed herein are single case series and require further investigation and validation.
TL;DR: Improved diagnostics and a growing understanding of prognosis can help guide therapy decisions along with the goals and desires of the patient and his or her family.
Abstract: Purpose of reviewHistorically, information gained from the treatment of unilateral true vocal cord paralysis (UVCP) in adults was the same used to treat children. Today, there is a growing body of literature aimed specifically at the treatment of this condition in children. It is an area of growing
TL;DR: Recent evidence suggests that GERD does not play a causative role in CRS, however, there is evidence of an oesophageal–nasal reflex, particularly in regard to mucus secretion and symptoms of postnasal drip.
Abstract: Purpose of reviewChronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) are two common conditions which have been reported to occur together more frequently than expected. It has, therefore, been proposed that GERD may have an aetiologic role in CRS. This study reviews the results o
TL;DR: Current knowledge and recent discoveries in nasal innate immunity as they pertain to the cause and management of allergic rhinitis and novel treatments such as toll-like receptor agonists used as targets or adjuvants for immunotherapy are being tested and may hold promising roles in future allergic rhinian treatment.
Abstract: Purpose of review The immunologic causes of allergic rhinitis underscore the important roles of both adaptive and innate immune systems. In recent years, appreciation of the role of nasal innate immunity has grown and evidence suggests that the pathogenesis of allergic rhinitis is partially mediated by the innate immune system. This review focuses on our current knowledge and recent discoveries in nasal innate immunity as they pertain to the cause and management of allergic rhinitis. Recent findings Previously thought to be nonspecific, innate immunity also possesses specific mechanisms as demonstrated by toll-like receptors. The interplay between the external environment and nasal mucosa contributes to innate-immune-mediated development of allergic rhinitis. Certain innate immune cells such as plasmacytoid dendritic cells and natural killer T cells may be important in the induction of Th2 cytokine production characterized in allergic airway disease. Summary The increasing knowledge of nasal innate immunity gained from recent research not only expands our understanding of the causes of allergic rhinitis, it also leads to new therapeutic approaches. Although current management of allergic rhinitis includes one or a combination of pharmacotherapy, immunotherapy, and/or surgery, novel treatments such as toll-like receptor agonists used as targets or adjuvants for immunotherapy are being tested and may hold promising roles in future allergic rhinitis treatment.
TL;DR: Imaging the layered microstructure of vocal folds to precisely delineate boundaries between normal pliability and scar provides valuable information during diagnosis and treatment of benign and malignant disorders.
Abstract: Purpose of review Using optical coherence tomography (OCT) to image the larynx during diagnosis and treatment of a vast array of laryngeal disorders continues to develop along with innovative surgical techniques. Precise delineation of vocal fold-layered microstructure allows for better understanding of the impact of benign and malignant lesions on laryngeal function, and optical coherence is uniquely suited to provide detail of the interface between these lesions and adjacent normal tissue. This review provides the reader with a timely update on current clinical and research applications of OCT. Recent findings Recent advances in OCT include adaptation of these modalities to obtain images of moving vocal folds and provide real-time information during procedures. Additionally, an augmented form of OCT called polarization-sensitive optical coherence tomography (PS-OCT) shows promise in further characterizing benign and malignant lesions and in delineating areas of normal pliability from scar. PS-OCT can quantify areas of increased collagen (scar) and three-dimensional PS-OCT imaging can visualize the extent and location of lesions within vocal folds. Summary Imaging the layered microstructure of vocal folds to precisely delineate boundaries between normal pliability and scar provides valuable information during diagnosis and treatment of benign and malignant disorders. Current OCT imaging techniques are guiding phonomicrosurgical interventions and improving patient care.
TL;DR: Endoscopic techniques have an increasing role in the management of pediatric subglottic and tracheal stenosis; however, open airway reconstructive procedures are still required in cases of mature scar, high-grade stenosis, and long-segment stenosis.
Abstract: Purpose of reviewThe treatment for pediatric tracheal stenosis has evolved over the past 50 years. Open airway reconstruction has traditionally been the treatment of choice for this condition. Numerous recent publications now support the use of endoscopic techniques to both augment and sometimes rep
TL;DR: The introduction of three-dimensional planning, guided implant surgery and manufacturing tools has facilitated the treatment of head and neck cancer patients and challenges long-held dogma of treatment.
Abstract: Purpose of review This article reviews the recent literature relating to dental rehabilitation of the oral cancer patient. The impact of loss of teeth on the well being of the oral cancer patient, the process of dental rehabilitation and the latest outcome studies are discussed. Recent findings For patients treated for oral cancer major concerns may include their ability to masticate, speak and swallow and if these issues are not addressed this may lead to psychological difficulties. The loss of teeth is a determinant of patient health-related quality of life, with a reduced self-perceived oral health status in association with greater numbers of missing teeth. There is, therefore, a patient need and demand for dental rehabilitation which aims to restore orofacial form and function and general well being. Dental rehabilitation begins at time of diagnosis and a multidisciplinary approach is critical for best treatment outcomes. Implant-based dental rehabilitation is an effective treatment modality but should be used judiciously. The beneficial effects of dental rehabilitation may be veiled by the side effects of cancer and concurrent comorbidities. Summary The introduction of three-dimensional planning, guided implant surgery and manufacturing tools has facilitated the treatment of head and neck cancer patients and challenges long-held dogma of treatment.
TL;DR: This review tries to present relevant recent publications dealing with this still controversial subject, emphasizing the advantages and disadvantages of neuromonitoring in thyroidectomy.
Abstract: Purpose of reviewLaryngeal nerve injuries are among the most important complications of thyroidectomy. Recently, the use of neuromonitoring has been increasingly employed in order to predict and document nerve function at the end of thyroidectomy.Recent findingsThere is much controversy in recent st