sledbee9

PURPOSE According to certain cancer treatment protocols, the response to induction chemotherapy of lymph node metastases based on radiographic measurements guides further management. The aim of this study is to verify the observation that cystic metastatic lymph nodes tend not to shrink as rapidly as solid metastatic lymph nodes in response to induction chemotherapy in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma. METHODS The lymphadenopathy in a cohort of patients from a clinical trial with human papillomavirus-related oropharyngeal squamous cell carcinoma with both baseline and postinduction chemotherapy (carboplatin/paclitaxel/cetuximab) contrast-enhanced neck computed tomography was retrospectively reviewed. The appearance of the metastatic lymph nodes on computed tomography was characterized as cystic or solid. A cystic lymph node was defined as having a hypoattenuating component greater than 20% of the total volume. The rates of short-axis and volume changes of cystic and solid lymph nodes were compared using 1-tailed t test. RESULTS A total of 46 patients were included in this study, comprising 39 solid and 45 cystic lymph nodes. The rate of short-axis decrease was significantly greater for solid (1.33% per day) than cystic (1.08% per day) lymph nodes (P = 0.036). Likewise, the rate of volume decrease was significantly greater for solid (2.13% per day) than cystic (1.87% per day) lymph nodes (P = 0.014). CONCLUSIONS This study suggests that in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma solid lymph node metastases generally decrease in size at a greater rate than cystic lymph nodes after induction chemotherapy.The aim of this study was to identify quantitative tools to classify the severity of trigonocephaly to guide surgical management and predict outcome. METHODS We reviewed high-resolution computed tomography images of 59 patients with metopic synostosis. We assessed the craniofacial sutural pattern as well as interfrontal and metopic angles, and we related the frontal angulation degree with the sutural pattern, the surgical management, and clinical outcome. RESULTS We identified 3 groups according to the severity of trigonocephaly. No difference was found between the sutural pattern of nasion complex and severity, whereas the closure of zygomatic maxillary sutures increased with the severity degree (P less then 0.05). The operative management was related to the severity degree (P less then 0.001) and to the reduced age (P = 0.009). CONCLUSIONS Interfrontal and metopic angles are complementary measurements to evaluate with high accuracy the degree of frontal angulation. In preoperative assessment, they may guide surgery decision in particular when the choice is not straightforward.OBJECTIVE We compared 40- to 70-keV virtual monoenergetic to conventional computed tomography (CT) perfusion reconstructions with respect to quality of perfusion maps. METHODS Conventional CT perfusion (CTP) images were acquired at 80 kVp in 25 patients, and 40- to 70-keV images were acquired with a dual-layer CT at 120 kVp in 25 patients. First, time-attenuation-curve contrast-to-noise ratio was assessed. Second, the perfusion maps of both groups were qualitatively analyzed by observers. Last, the monoenergetic reconstruction with the highest quality was compared with the clinical standard 80-kVp CTP acquisitions. RESULTS Contrast-to-noise ratio was significantly better for 40 to 60 keV as compared with 70 keV and conventional images (P less then 0.001). Visually, the difference between the blood volume maps among reconstructions was minimal. The 50-keV perfusion maps had the highest quality compared with the other monoenergetic and conventional maps (P less then 0.002). CONCLUSIONS The quality of 50-keV CTP images is superior to the quality of conventional 80- and 120-kVp images.INTRODUCTION Three-dimensional (3D) tools have played a significant role in advancing anatomical knowledge, in simulation and clinical practice in Otology. Technology is evolving at a rapid rate with new applications being reported at an overwhelming pace. It is important to continuously review new applications, assess emerging trends, and identify challenges to innovation so clinical translation progresses in an efficient and evidenced-based manner. METHODS A review of 20 years of literature in 3D technology specific to Otology was undertaken using Medline, Embase, PubMed, and Google Scholar search engines. Trends in the literature were analyzed as applications are evaluated and adopted into clinical practice. A literature review was conducted to identify barriers to translation. RESULTS There was increasing volume of literature reporting innovations in 3D technology in Otology with a more recent increase in reviews and meta-analysis. The most marked trend was in literature regarding clinical applications of such technology and in 3D printing. Where this may indicate that translation of these technologies is adequate, this is not reflected in routine clinical practice or even in education and training platforms. CONCLUSION Barriers to translation of 3D tools specific to Otology include ongoing challenges in attaining high-resolution data, rendering parameters and with the advent of 3D printing a multitude of new variables in software, printers, and materials adding complexity to selecting most appropriate options. These need methodical evaluation to selectively customize solutions to clinical challenges so effective translation, scale, and adoption can occur without causing confusion about choices.OBJECTIVE To compare functional hearing preservation (HP) with a slim perimodiolar array (SPA) and a slim lateral wall array (SLW) in cochlear implantation (CI). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS All adult, post-lingual CI recipients with serviceable preoperative hearing serially implanted with SPA or SLW electrodes from July 2015 through July 2018. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Hearing preservation (HP). Patients with a low frequency pure-tone average (LFPTA) (125, 250, 500 Hz) threshold less than 80 dB were considered HP candidates based on preoperative audiograms. Postoperative audiograms were obtained before activation. Successful HP was defined as retention of LFPTA less than 80 dB. The change in LFPTA (ΔLFPTA) was also calculated. RESULTS One hundred twenty one patients were implanted with either the SPA or SLW electrodes, 82 (42,40) of whom were HP candidates with postoperative audiograms. Average (standard deviation, SD) preoperative LFPTA was 54.86 [19.38] and 54.38 [13.58] dB for SLW and SPA respectively, with a mean ΔLFPTA of 24.6 [15.94] and 24.92 [16.66] dB. Successful HP was achieved in 21 (50%) and 22 (55%). Preoperative LFTPA, ΔLFPTA, and postoperative LFPTA were not significantly different (p = 0.89, 0.75, 0.93) between electrodes. CONCLUSIONS The SPA is as effective at immediate functional HP after CI as a SLW.INTRODUCTION This study aimed to investigate the association between candidate genetic variants and audiometric measures of noise-induced hearing loss (NIHL) in young musicians. METHODS The study analyzed a database by Phillips et al. (Feasibility of a bilateral 4000-6000 Hz notch as a phenotype for genetic association analysis. Int J Audiol 2015;54645-52.) which included behavioral hearing thresholds, distortion-product otoacoustic emissions (DPOAE), tympanometric, and genetic data of 166 participants meeting the inclusion criteria. Nineteen single nucleotide polymorphisms (SNPs) in 13 cochlear genes previously associated with NIHL in factory workers were included in the present investigation. The average hearing threshold at 3000 and 4000 Hz (AHT) and average DPOAE signal to noise ratio (DPOAE SNR) in both ears were calculated. RESULTS The regression analyses showed that two SNPs- one in KCNE1 (rs2070358) and the other in CAT (rs12273124) revealed a statistically significant relationship with DPOAE SNR in both ears. Two SNPs in MYH14 and one in GJB4 revealed a significant association with DPOAE SNR in the left ear. Two SNPs in HSP70, one in CDH23 and one in KCNJ10 showed significant association with DPOAE SNR in the right ear. None of the included SNPs showed association with AHT in both ears. CONCLUSIONS A genetic variant in KCNE1 was associated with the strength of the cochlear amplifier as assessed by DPOAE SNR. Musicians carrying causal genetic variants to NIHL might exhibit changes in their auditory functions early in the lifespan even when most subjects had their hearing thresholds within normal limits. These participants are likely to show the clinical manifestation of NIHL in the future if no preventive measures are applied.OBJECTIVE We describe our experience using the extracorporeal video microscope, the “exoscope” for repair of a temporal bone encephalocele. METHOD The patient is a 69-year-old male with a right temporal lobe encephalocele herniating through a tegmen defect. He underwent definitive tegmen defect repair and bipolar cauterization of the encephalocele. The authors elected for a combined transmastoid and transtemporal approach in order to isolate the tegmen defect and provide watertight repair. The Synaptive robotic BrightMatter (Toronto, ON) drive video exoscope monitor system was used for the entirety of the case including both the transmastoid approach and transtemporal craniotomy. RESULTS No intraoperative complications were encountered during either the transmastoid (mastoidectomy) or transtemporal craniotomy. The authors were able to complete the entire case without abandonment of the exoscope in favor of the traditional binocular microscope. Advantages of this technology in clinical practice includes high-resolution three-dimensional visualization, increased degrees of freedom for exoscope adjustment, and reduced surgeon fatigue in a fixed, unnatural posture. Limitations include decreased depth perception and increased operative time. CONCLUSION The exoscope system is a safe and effective alternative or adjunct to the existing binocular operating microscope for lateral skull based procedures. The exoscope provides the surgeon with a comfortable, high-resolution visualization without compromising surgical exposure and patient safety.SDC video link http//links.lww.com/MAO/A837. Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal (SCC). Patients with SCD Syndrome (SCDS) may experience symptoms such as aural fullness, pulsatile tinnitus, hyperacusis, autophony, or pressure or noise-induced vertigo . The defect can be repaired in various ways, but there is potential for loss of perilymphatic fluid during transmastoid approaches that could result in postoperative sensorineural hearing loss . We hypothesize that if the procedure were performed “underwater” in balanced salt solution (BSS), loss of perilymphatic fluid would be minimized. CASE REPORT A 55-year-old male presented with right-sided autophony, pulsatile tinnitus, and hyperacusis. Audiometric testing demonstrated a low-frequency airbone gap and a supranormal bone-conduction threshold at 4 kHz. Akt inhibitor Ocular VEMP responses were increased amplitude. Temporal bone imaging revealed a SCC dehiscence.The patient was taken to the operating room for an underwater, endoscopic repair of the SCC using a transmastoid approach.