Otosclerosis surgery under local anesthesia with sedation: Assessment of quality of life and stress

OBJECTIVES

The main study endpoint was tolerance of stapedotomy under local anesthesia with sedation and under general anesthesia using stress and quality of life assessment questionnaires. Secondary endpoints comprised operative time and functional results.

MATERIAL AND METHOD

In a consecutive series of stapedotomy patients operated on over a 12-month period, quality of life and perioperative stress were analysed by 3 questionnaires: the Glasgow Benefit Inventory, Cohen's perceived stress scale and the Post-traumatic stress disorder checklist scale. Questionnaire responses and audiometric data were compared between groups treated under local anesthesia with sedation and under general anesthesia.

RESULTS

Twenty-two patients were included in the local anesthesia with sedation group and 6 in the general anesthesia group. There was no difference between the groups for quality of life, onset of post-traumatic stress, or perceived pre- and postoperative stress. There was also no difference in operative time. The audiometric data confirmed the reliability of stapedotomy. Stapedotomy under local anesthesia with sedation improved air conduction with≤10dB air-bone gap (ABG), comparable to results under general anesthesia. The rate of ABG≤10dB was 71.4%; no labyrinthisation was observed.

CONCLUSION

Under local anesthesia with sedation, stapedotomy was well tolerated without increasing the stress associated with otosclerosis surgery. By correcting hearing loss, the procedure improves quality of life.

Automatic Detection and Analysis of Swallowing Sounds in Healthy Subjects and in Patients with Pharyngolaryngeal Cancer

Assessment of swallowing function is often invasive or involves irradiation. Analysis of swallowing sounds is a noninvasive method for assessment of swallowing but is not used in daily medical practice. Dysphagia could be the first symptom that occurs in head and neck cancer. This study evaluated a method for the automatic detection and analysis of swallowing sounds in healthy subjects and in patients with pharyngolaryngeal cancer. A smartphone application, developed for automatic detection and analysis of swallowing sounds was developed and tested in 12 healthy volunteers and in 26 patients with pharyngolaryngeal cancer. Swallowing sounds were recorded with a laryngophone during a standardized meal (100 mL mashed potatoes, 100 mL water, and 100 mL yogurt). Swallowing number and duration were noted; the results were compared to a standard swallowing sound analysis using the software AUDACITY^®. There were no statistically significant differences in swallowing number or duration between the two analysis methods for the three types of foods in healthy volunteers and only for water in patients. In healthy volunteers, the results of our automatic analysis were comparable with those obtained with the standard analysis. However, a better discrimination of swallowing sounds is necessary for the algorithm to obtain reliable results with thicker food in patients with head and neck cancer.

Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall

Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi² test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.

Clinical outcomes of transoral robotic surgery for supraglottic squamous cell carcinoma: experience of a french evaluation cooperative subgroup of gettec

BACKGROUND

Transoral, minimally invasive, organ preservation surgeries are increasingly used to treat laryngopharyngeal carcinomas to avoid the toxicity associated with combined chemoradiotherapy regimens. This study investigated the efficiency, safety, and functional outcomes of using transoral robotic surgery (TORS) to perform supraglottic laryngectomy (SGL).

METHODS

This was a multicenter study using a case series with planned data collection from 2009 to 2012 for patients with supraglottic squamous cell carcinomas (SCC) who underwent SGL using TORS.

RESULTS

Eighty-four (84) of 262 patients underwent TORS for supraglottic SCC. Within 24 hours of surgery, 24% of the patients started on an oral diet. The median use of a feeding tube was 8 days for 76% of other patients. Definitive percutaneous gastrostomy feeding was necessary for 9.5% of the patients. 24% of the patients did require a tracheostomy, and the median use was 8 days. One percent (1%) of the patients had a definitive tracheostomy. Aspiration pneumonia was observed in 23% of the patients during the postoperative course, and was responsible for the death of one patient. Postoperative bleeding occurred in 18% of the patients. Based on the pathology results, 51% of the patients received adjuvant radiation therapy.

CONCLUSION

TORS for SGL in intermediate stage SCC is a safe procedure with good functional outcomes and fast recovery times. However, adverse events can occur. Consequently, this technique requires good patient selection criteria to reduce the risk of postoperative complications.

Psychosocial quality of life in hereditary haemorrhagic telangiectasia patients

OBJECTIVES: The aim of this study was to evaluate psychosocial quality of life (PQoL) in patients with Hereditary Haemorrhagic Telangiectasia (HHT). STUDY DESIGN AND SETTING: A retrospective study was performed on PQoL in HHT patients presenting with epistaxis. One hundred fifteen patients were interviewed using a questionnaire designed by two sociologists and a head and neck surgeon. Changes over time were assessed according to information on psychosocial well-being, social life, family support, occupation, and medical and demographic data regarding age, gender and patient appearance. RESULTS: Analysis of Psychosocial Quality of Life (PQoL) revealed no statistical difference in relation to gender, marital status, household income or place of residence (rural or urban); however, a significant difference was observed with age. Elderly patients had a poorer PQoL than younger patients. Workers had a better PQoL than unemployed patients. Epistaxis and professional duties were correlated: workers with less than one episode of epistaxis per month were more active. Frequent episodes of epistaxis and abundant bleeding decreased PQoL. These patients felt different and often experienced a desire to withdraw compared to others. CONCLUSION: Epistaxis in hereditary haemorrhagic telangiectasia patients was associated with the impairment of many PQoL criteria, together with relationship modifications.

[Microdebrider-assisted partial turbinoplasty: technique and results in perennial non-allergic rhinitis]

AIM OF THE STUDY

To assess objective and subjective outcomes in patients with perennial non-allergic rhinitis who had undergone endoscopic microdebrider-assisted inferior turbinoplasty.

PATIENTS AND METHODS

Twenty patients (13 men and 7 women; age range, 15-64 years; mean age, 42.6 years) were included in a prospective study. Each patient had a perennial non-allergic rhinitis with substantial mucosal hypertrophy of the inferior turbinates, resistant to a 4- to 6-week course of nasal saline irrigations and nasal steroid spray. Then, they underwent endoscopic microdebrider-assisted inferior turbinoplasty with follow-up 6 months after surgery. This technique describes an elevator incorporated into a small microdebrider blade (2.0 mm). It provides a method for achieving the goals of volumetric reduction with mucosal preservation, with 0O endoscopic guidance, and minimal risk of complications. Objective outcomes were evaluated by peak nasal inspiratory flow (PNIF), an easy and highly reproducible measurement. Subjective symptoms were measured by a standard 10-cm visual analog scale, and analyzed before, at 1, 3 and 6 months after surgery.

RESULTS

Preoperative PNIF measurement was 65 L/min, 98 L/min at 1 month, 123 L/min at 3 months and 126 l/min at 6 months. Statistical analysis (Wilcoxon signed rank test) showed significant improvement between preoperative and 1, 3 and 6 months. Subjective nasal obstruction improvement was statistically significant between preoperative and 1, 3 and 6 months.

CONCLUSIONS

Our results suggest that microdebrider-assisted inferior turbinoplasty is effective for decreasing objective and subjective nasal in patients with perennial allergic rhinitis who have substantial nasal congestion.

Otosclerosis in children and adolescents: a clinical and CT-scan survey with review of the literature

OBJECTIVE

To assess the role of the CT-scan in the preoperative evaluation of juvenile otosclerosis and to study additional outcome data.

DESIGN AND SETTING

We performed a retrospective case series study from an academic referral hospital using data from 1992 to 2005.

PATIENTS AND METHODS

We selected patients younger than 18-year-old who had undergone primary stapedectomy for otosclerosis among the 10 stapedectomies performed over the study period and analyzed the patients' systematic pre- and post-operative audiograms and CT-scan findings.

RESULTS

For this survey, complete data was available for 7 children, totaling 10 primary stapedectomies for otosclerosis. Their ages at diagnosis ranged from 10 to 17 years. In 4 children, CT-scan demonstrated bilateral findings typical of otosclerosis: poorly calcified foci near the fissula ante fenestram, associated with a hypodense edging surrounding the labyrinthine capsule in 2 children. The youngest patient had no CT-scan abnormalities. Stapedectomy was performed in one case and laser stapedotomy in 9 cases. Seven children were immediately improved following surgery and no postoperative facial palsy or prolonged vertigo was reported. The mean (S.D.) postoperative ABG was 6.5dB (+/-3.7). The mean closure was 19dB (+/-11.2). The mean change in high-tone bone conduction level was 1.8dB (+/-7.5). Six children had a postoperative ABG less than 10dB while in one, the ABG was inferior to 20dB.

CONCLUSION

Preoperative CT-scan is useful for the preoperative diagnosis of otosclerosis in children. The images seen must be distinguished from other footplate pathologies or deformities of the ossicular chain which are often associated with poorer surgical results. This survey provides additional evidence that stapes surgery is an effective procedure for treating juvenile otosclerosis.

[CT imaging and fourth branchial pouch fistula in adults]

We report two cases of fourth branchial pouch in adult. This rare and little-known pathology is indeed responsible for suppurative thyroiditis and left lower cervical abscess recurring in spite of antibiotic treatment and incision-drainage. CT scan using, iv contrast, air as a agent contrast with Valsalva test, shows air in the thyroid and perithyroid soft tissue infection, proving communication between the pyriform fossa and the thyroid. Bubble of air behind the left thyroid alar in the sinus track is the best argument for diagnosis. Hypopharyngoscopy shows the mucous opening of the bottom at the pyriform sinus.

Detection of polyglutamine expansion in a new acidic protein: a candidate for childhood onset schizophrenia?

Polyglutamine expansion (PGE) encoded by a CAG repeat underlies eight inherited neurodegenerative diseases, among which is Huntington's disease. CAG expansion has also been reported in schizophrenia, suggesting a role for PGE. To investigate the potential role of PGE as a candidate for schizophrenia, we searched for PGE in nuclear families comprising a patient affected by childhood onset schizophrenia (COS, a rare and severe form of the disease) as a variation of the candidate gene approach for identifying susceptibility genes. We tested lymphoblastoid cell lines from COS patients (n = 32) by Western blot analysis with 1C2, a monoclonal antibody that specifically recognizes long polyglutamines. Eight of 11 unrelated black American COS patients showed a 60-kDa (approximately) band indicative of PGE. A strong 60-kDa band (suggestive of a large PGE) was detected in two of the eight positive patients. A weaker 60-kDa band (suggestive of a smaller and non pathogenic PGE) was detected in some unaffected parents or sibs of these two COS patients, and in six other black American COS patients. The strong and weak PGE signals were found to correspond to two different proteins. Unrelated black Americans unaffected by COS (n = 38) were negative for the strong 60-kDa PGE signal. Healthy white Americans (n = 53) were negative for both the strong and weak 60-kDa PGE signals. Two-dimensional gel analysis suggested that the strong PGE signal corresponds to an acidic (pI 4 approximately) protein and resulted in a more precise estimation (52-57 kDa) of its relative mass. This protein appeared to be not represented in Genbank, as suggested by the exclusion of several candidate CAG repeats. Our data suggest that this acidic protein might be a candidate for COS.

Bilateral conductive deafness related to erosive lichen planus

A case of bilateral progressive stenosis of both external auditory canals with resultant conductive hearing loss is presented. The stenosis revealed multifocal erosive and synechiant lichen planus. To our knowledge, this is the first reported case of lichen planus involvement of the external ear.

CAG/CTG and CGG/GCC repeats in human brain reference cDNAs: outcome in searching for new dynamic mutations

CAG and CGG expansion is associated with 10 inherited neurological diseases and is thought to be involved in other human genetic diseases. To identify new candidate genes, we have undertaken a large-scale screening project for CAG/CTG ([CAG]n) and CGG/GCC ([CGG]n) repeats in human brain reference cDNAs. Here, we present the final classification for 597 cDNAs selected by CAG and CGG hybridization from two libraries (100,128 clones) and the updated characterization of [CAG]n- and [CGG]n-positive cDNAs (repeat polymorphism and cDNA localization). We have selected 124 CAG and 83 CGG hybridization-positive clones representing new genes, from which 49 CAG and 7 CGG repeats could be identified. New [CAG]n and [CGG]n with more than seven to nine units were rare (1/2000), and perfect [CAG]n 9 were more likely polymorphic. Overall, highly polymorphic to monomorphic new [CAG]n > 9 and [CGG]n > 7 were characterized. The comparison of our data with other [CAG]n and [CGG]n resources suggests that the screening of reference cDNAs leads to unique sources of new [CAG]n and [CGG]n and will enhance the study of enlarged triplet repeats in human genetic diseases.