Microsecretory Adenocarcinoma of the Ear Canal: Novel Cutaneous Analog of a Salivary Gland Neoplasm

ABSTRACT

Microsecretory adenocarcinoma (MSA) of the salivary gland is a new entity recently added to the World Health Organization Classification of Head and Neck Tumors. This tumor is characterized by a recurrent MEF2C-SS18 translocation. We present a nodular tumor confined to the dermis of the ear canal of a 44-year-old patient, which demonstrated classic histopathologic features and molecular alteration of MSA. Specifically, the tumor was composed of numerous tubules and microcysts filled with abundant basophilic mucinous secretion and associated with a fibromyxoid stroma. The tumor cells were diffusely positive for CK7 and SOX10 and variably positive for S100 and p63. Breakapart fluorescence in situ hybridization for SS18 confirmed rearrangement of this gene. Together, these findings support a primary cutaneous MSA, presumably arising from ceruminous glands of the ear canal. Based on current knowledge of its salivary gland counterpart, cutaneous MSA is expected to be locally invasive but unlikely to recur or metastasize on complete excision.

Real-World Compliance With Follow-up in 2,554 Cochlear Implant Recipients: An Analysis of the HERMES Database

BACKGROUND

Traditional paradigms of care recommend close audiology follow-up and regular speech perception outcomes assessment indefinitely for cochlear implant (CI) recipients after device activation. However, there is scant published data on actual compliance with this paradigm in clinical practice.

METHODS

A multi-center cochlear implant database was queried to identify follow-up rates after cochlear implantation. Follow-up rates where speech perception outcomes assessment occurred at 1-, 3-, 6-, 12-, 18-, and 24-months post-activation were determined by tabulating observed follow-up divided by expected follow-up (O/E ratio) expressed as a percentage. To determine all-cause audiology follow-up rates (with or without testing speech perception outcomes assessment), the database patients from two participating centers (one private practice and one academic center) were similarly analyzed using electronic health record (EHR) data to calculate O/E rates where audiology follow-up occurred for any reason.

RESULTS

O/E follow-up rates where speech perception outcomes assessment occurred was 42, 40, 31, 29, 5, and 22% for 1-, 3-, 6-, 12-, 18-, and 24-months post-activation, respectively (n = 2,554). All-cause audiology follow-up rates (with or without speech perception outcomes assessment) using EHR-confirmed data from two individual centers were 97, 94, 81, 66, 41, and 35% at 1-, 3-, 6-, 12-, 18-, and 24-months post-activation visits, respectively (n = 118).

CONCLUSIONS

Compliance with audiology follow-up and speech perception outcomes assessment is generally low and decreases significantly as time post-activation increases. Future paradigms of care for CI should be designed recognizing the significant attrition that occurs with CI follow-up.

Benefits of a Hearing Registry: Cochlear Implant Candidacy in Quiet Versus Noise in 1,611 Patients

Purpose This retrospective study used a cochlear implant registry to determine how performing speech recognition candidacy testing in quiet versus noise influenced patient selection, speech recognition, and self-report outcomes. Method Database queries identified 1,611 cochlear implant recipients who were divided into three implant candidacy qualifying groups based on preoperative speech perception scores (≤ 40% correct) on the AzBio sentence test: quiet qualifying group, +10 dB SNR qualifying group, and +5 dB SNR qualifying group. These groups were evaluated for demographic and preoperative hearing characteristics. Repeated-measures analysis of variance was used to compare pre- and postoperative performance on the AzBio in quiet and noise with qualifying group as a between-subjects factor. For a subset of recipients, pre- to postoperative changes on the Speech, Spatial and Qualities of Hearing Scale were also evaluated. Results Of the 1,611 patients identified as cochlear implant candidates, 63% of recipients qualified in quiet, 10% qualified in a +10 dB SNR, and 27% qualified in a +5 dB SNR. Postoperative speech perception scores in quiet and noise significantly improved for all qualifying groups. Across qualifying groups, the greatest speech perception improvements were observed when tested in the same qualifying listening condition. For a subset of patients, the total Speech, Spatial and Qualities of Hearing Scale ratings improved significantly as well. Conclusion Patients who qualified for cochlear implantation in quiet or background noise test conditions showed significant improvement in speech perception and quality of life scores, especially when the qualifying noise condition was used to track performance.

Clinical evaluation of a bioresorbable implant for medialization of the middle turbinate in sinus surgery

BACKGROUND

During endoscopic sinus surgery (ESS), postoperative lateralization of the middle turbinate can lead to scarring and obstruction of key drainage pathways, including the osteomeatal complex. The technique of suturing the middle turbinate to the nasal septum to enhance exposure can be difficult and time consuming. This study presents the first clinical results using the Middle Turbinate Implant (MTI), a device composed of absorbable copolymer polylactide-co-glycolide and intended to medialize the middle turbinate during surgical procedures such as ESS.

METHODS

The trial included 22 implantations (21 successful implantations) on 14 subjects (6 unilateral and 8 bilateral implantations). The primary outcome measure was the position of the middle turbinate at 1, 2, and 4 weeks postoperatively. The extent of tissue reaction at the site of implantation was also evaluated.

RESULTS

At 1, 2, and 4 weeks postoperatively, 100% of the middle turbinates were held medially or in the neutral position with no significant synechiae present. At 1, 2, and 4 weeks postoperatively, there was either no (95%, 90%, and 95%) or mild (5%, 10%, and 5%) tissue reaction at the site of implantation. No complications were noted during implantation.

CONCLUSION

The use of the bioresorbable MTI appears to be a safe and effective method of medializing the middle turbinate during ESS.

Acquired tracheoesophageal fistula following disc-battery ingestion: can we watch and wait?

Acquired tracheoesophageal fistulas (TEF) are rare but dangerous complications of disc-battery ingestion. Management approaches include endoscopic or open surgical repair. Unfortunately, these procedures can be complicated by high rates of recurrent laryngeal nerve injury, tracheal stenosis, recurrent fistula and significant patient mortality. Thus, several authors have advocated the use of esophageal rest as conservative management of acquired TEF to permit closure by secondary intention. This study describes a patient with spontaneous closure of an acquired TEF following disc-battery ingestion. The late recurrence of the TEF following conservative management, and endoscopic and radiographic evidence of closure, illustrates the importance of long term evaluation before assuming fistula resolution. Practitioners must carefully weigh the risks and benefits before deciding surgical versus conservative management of TEF. An extended follow-up of at least 6 months should be instituted with a high index of suspicion if conservative management is utilized. Transtracheal repair using an imbricated suture technique is a good surgical option when conservative management fails.

Antioxidant Pretreatment Does Not Ameliorate Alcohol-Induced Purkinje Cell Loss in the Developing Rat Cerebellum

BACKGROUND

Recent research has suggested that oxidative stress is a potential mechanism for alcohol-induced injury and that supplementation with antioxidants can ameliorate alcohol-induced damage. In this study, two known antioxidants, melatonin and U83836E, were assessed for their effectiveness in blocking the expected alcohol-induced cerebellar Purkinje cell loss in neonatal rat pups.

METHODS

Sprague-Dawley rat pups were artificially reared from postnatal days (PDs) 4-9 and were exposed to either alcohol or antioxidants (melatonin or U83836E) individually or in combination. A normal control group (raised by rat dams) was included in this study. On PD 9, the brain from each pup was removed and weighed, and the cerebellar vermis was processed for stereological cell counting.

RESULTS

Alcohol exposure during the brain growth spurt produced microencephaly, in addition to significant decreases in the number and density of Purkinje cells in lobule I and the volume of lobule I. The antioxidants did not reduce any of the adverse effects observed from alcohol exposure, and they did not decrease the Purkinje cell number when administered alone. Furthermore, antioxidants did not change the only blood alcohol concentration measured on PD 6.

CONCLUSIONS

The results confirmed alcohol-induced microencephaly and cerebellar Purkinje cell loss from neonatal alcohol exposure, and they showed that neither antioxidant could attenuate these adverse effects on the developing brain. The inability of antioxidants to reduce Purkinje cell loss from neonatal alcohol exposure suggests the existence of alternative mechanisms for developmental alcohol-induced Purkinje cell loss.

Neonatal alcohol exposure increases malondialdehyde (MDA) and glutathione (GSH) levels in the developing cerebellum

It has been suggested that developmental alcohol-induced brain damage is mediated through increases in oxidative stress. In this study, the concentrations of malondialdehyde (MDA) and reduced glutathione (GSH) were measured to indicate alcohol-mediated oxidative stress. In addition, the ability of two known antioxidants, melatonin (MEL) and lazaroid U-83836E (U), to attenuate alcohol-induced oxidative stress was investigated. Sprague-Dawley rat pups were randomly assigned to six artificially-reared groups, ALC (alcohol), MEL, MEL/ALC, U, U/ALC, and GC (gastrostomy control), and one normal suckle control (to control for artificial-rearing effects on the dependent variables). The daily dosages for ALC, MEL, and U were 6 g/kg, 20 mg/kg, and 20 mg/kg, respectively. Alcohol was administered in 2 consecutive feedings, and antioxidant (MEL or U) was administered for a total of 4 consecutive feedings (2 feedings prior to and 2 feedings concurrently with alcohol). The animals received treatment from postnatal days (PD) 4 through 9. Cerebellar, hippocampal, and cortical samples were collected on PD 9 and analyzed for MDA and GSH content. The results indicated that MDA concentrations in the cerebellum were significantly elevated in animals receiving alcohol; however, MDA levels in the hippocampus and cortex were not affected by alcohol treatment. Additionally, GSH levels in the cerebellum were significantly elevated in groups receiving alcohol, regardless of antioxidant treatment. Neither antioxidant was able to protect against alcohol-induced alterations of MDA or GSH. These findings suggest that alcohol might increase GSH levels indirectly as a compensatory mechanism designed to protect the brain from oxidative-stress-mediated insult.