Different Vestibular Rehabilitation Modalities in Unilateral Vestibular Hypofunction: A Prospective Study.

OBJECTIVE: To assess the effectiveness of three vestibular rehabilitation protocols in patients with chronic unilateral vestibular hypofunction. STUDY DESIGN: Prospective randomized trial. SETTING: Audiology-neurootology laboratory in a general public hospital. PATIENTS: Eighty-one patients were randomly allocated into three groups: adaptation exercises (AEs), habituation exercises (HEs), and combined exercises (AE-HEs). INTERVENTIONS: Each patient completed an 8-week vestibular rehabilitation program with exercise, depending on their allocation group. MAIN OUTCOME MEASURES: Evaluations performed at baseline, 4 weeks, and 8 weeks with (a) Functional Gait Assessment (FGA), (b) Mini-BESTest, (c) Vestibular Rehabilitation Benefit Questionnaire, and (d) Dizziness Handicap Inventory. RESULTS: FGA and Mini-BESTest scores showed significant improvement between the baseline and 8-week scores in all groups (p < 0.001), except for the FGA score in the HE group. The AE-HE group showed better scores for all measurements at 4 weeks and had significantly better FGA and Mini-BESTest scores than the AE group and better FGA scores than the HE group. The Vestibular Rehabilitation Benefit Questionnaire and Dizziness Handicap Inventory scores in the AE-HE group were significantly better (p ≤ 0.001) than those in the HE group at 8 weeks. CONCLUSIONS: The AE-HE group showed faster improvement and significantly better outcomes for static balance, dynamic postural stability, and self-perceived disability than the single-exercise protocols in chronic unilateral vestibular hypofunction.

Accuracy of the sleep clinical record for the diagnosis of pediatric moderate-to-severe obstructive sleep apnea syndrome.

PURPOSE: The sleep clinical record (SCR) has been used to diagnose obstructive sleep apnea syndrome (OSAS) in children when access to polysomnography (PSG) is limited. Our aim was to determine the best SCR score that could facilitate diagnosis of moderate-to-severe OSAS in children with snoring. METHODS: Healthy children with history of snoring, who were referred for PSG, were prospectively recruited. The SCR score was calculated. Receiver operating characteristic curves (ROCs) were plotted to determine the area under curve (AUC), and the optimum SCR cutoff value was determined using the Youden index (J). RESULTS: Two hundred and seventy-three children were recruited (mean age 6.3 ± 2.5 years; median obstructive apnea-hypopnea index 1.5 episodes/h; range 0-61.1). The mean SCR score was 6.9 ± 3.6. Forty-six children had moderate-to-severe OSAS. Subjects with moderate-to-severe OSAS had a significantly higher mean SCR score (10.2 ± 2.9) than those with mild OSAS (6.2 ± 3.3; P < 0.001). Based on the plotted ROC, the AUC was 0.811 (95% confidence interval: 0.747-0.876; P < 0.001). Calculation of J, based on its ROC coordinates, indicated that the optimum cutoff SCR score to predict moderate-to-severe OSAS was 8.25, corresponding to a sensitivity of 83% and a specificity of 70%. CONCLUSION: Among children with history of snoring, an SCR score above 8.25 can identify those with moderate-to-severe OSAS.

The Effect of Supervision in Vestibular Rehabilitation in Patients with Acute or Chronic Unilateral Vestibular Dysfunction: A Systematic Review.

OBJECTIVE: The investigation of supervised vestibular rehabilitation treatment role for individuals with dizziness and imbalance due to peripheral, unilateral vestibular disorders. DATABASES REVIEWED: Cochrane, PubMed, and Physiotherapy Evidence Database (PEDro) were utilized to identify relevant studies. METHODS: The key search terms used were "Vestibular Rehabilitation and Unilateral Vestibular Hypofunction," "Vestibular Rehabilitation and Unilateral Vestibular Loss," and "Vestibular Rehabilitation and Supervision." A manual search was performed by exploring the references of included articles to identify studies not captured through the computer-based searches. The quality of the studies was assessed according to the PEDro scale. Inclusion criteria were: 1) studies with patients, aged from 18 to 80 years, with acute or chronic dizziness and disequilibrium due to unilateral vestibular dysfunction, 2) randomized control trials (RCTs), 3) studies comparing supervised vestibular rehabilitation program with an unsupervised vestibular rehabilitation program or home-based training or standard care or placebo, and 4) articles written in the English language. Studies reporting cases of vertigo and imbalance due to possible recurrent pathologies, acute benign paroxysmal positional vertigo, or central neurological/orthopedic deficits, were excluded. RESULTS: A total of 448 articles were retrieved from the systematic database search strategy. Five of them were included in the systematic review after full-text analysis, plus one more after manual searching of their references. All studies involved supervised vestibular rehabilitation treatment programs compared with unsupervised home training, the performance of daily activities and, standard care. Based on PEDro's scoring system, one study rated as high-quality RCT, three studies were considered of fair quality and one scored as low-quality RCT. CONCLUSIONS: Although most RCTs report better outcomes with a supervised vestibular rehabilitation treatment program regarding the emotional status, dizziness, and balance improvement, this systematic review failed to provide a strong evidence that supervision is superior to unsupervised protocols in patients with UNH. The self-reported subjective measures used by the included RCTs represent a serious limitation of their results.

Piezoelectric or Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of Clinical Outcomes.

INTRODUCTION: Osteotomy of nasal bones in rhinoplasty is associated with postsurgical morbidities. Recent evidence has suggested that a surgical method applying piezoelectric ultrasound waves for nasal osteotomies in rhinoplasty reduces soft tissue damage and causes less postsurgical morbidities compared to conventional methods. The purpose of this study is to compare clinical outcomes of piezoelectric and conventional lateral nasal osteotomies in rhinoplasty. METHODS: We searched PubMed, CENTRAL, and Web of Science up to 17 August 2019 for studies comparing postoperative outcomes of piezoelectric and conventional lateral osteotomies in rhinoplasty. We included studies comparing results of patients subjected to piezoelectric or conventional lateral nasal osteotomies in rhinoplasty. For outcomes, we considered postoperative pain, eyelid edema, periorbital ecchymosis, and intraoperative mucosal injury. RESULTS: For eyelid edema, a statistically significant difference in favor of piezoelectric osteotomy was documented within the first 3 postoperative days (standardized mean difference [SMD] = -0.65; 95% CI = -1.18, -0.12, p = 0.02; I2 = 69%) and on postoperative day 7 (SMD = -0.69; 95% CI = -1.47, -0.09; p = 0.08; I2 = 85%). This was also the case for periorbital ecchymosis within the first 3 postoperative days (SMD = -0.85; 95% CI = -1.42, -0.28; p = 0.004; I2 = 72%) and on postoperative day 7 (SMD = -0.52; 95% CI = -0.79, -0.24; p = 0.0003; I2 = 71%). Intraoperative mucosal injury (OR = 0.06; 95% CI = 0.01, 0.53; p = 0.01; Ι2 = 0%) and postoperative pain (SMD = -0.99; 95% CI = -1.78, -0.11; p = 0.01; I2 = 49%) were also statistically lower during piezoelectric osteotomies. CONCLUSIONS: This study shows that lateral piezoelectric osteotomy in rhinoplasty decreases postoperative pain, edema, ecchymosis, and intraoperative mucosa injuries compared to the conventional osteotomy technique with a chisel. Piezoelectric osteotomies are especially associated with less postoperative edema and ecchymosis in osteotomies not executed under direct vision.

Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review.

BACKGROUND: Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting. METHODS: We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016. RESULTS: Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear. CONCLUSION: IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely.

Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases.

We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Age related changes in ocular motor testing in healthy subjects.

The aim of the present study was the investigation of age influenced changes in ocular motility testing in healthy subjects. Two hundred and fifty subjects between 18 and 70 years old were enrolled in a prospective study. Study population was divided in 5 groups of 50 subjects each (group A: 18-30 years old, group B: 31-40 years old, group C: 41-50 years old, group D: 51-60 years old and group E: 61-70 years old). Ocular motility was recorded by video-oculography and age related normative data were obtained with respect to: a) gain and slow phase velocity of smooth pursuit tracking, b) latency, velocity and accuracy of saccade eye movements and c) gain and slow phase velocity of optokinetic eye movements. The influence of age on all parameters was examined by one-way ANOVA. A statistically significant difference was found in all parameters analyzed for smooth pursuit test, saccade eye movements and optokinetic eye movements in between groups. In conclusion, aging influences the majority of the parameters in ocular motility testing, carried out by means of video-oculography. Elderly healthy subjects showed a deterioration of performance in all parameters of the eye tracking tested. Age must be taken into account during interpretation of the eye tracking tests, especially in patients with central nervous system lesions.

Anaplastic carcinoma in submandibular region: A diagnostic dilemma.

INTRODUCTION: Thyroid carcinoma arising in an extrathyroid area is a rare entity. PRESENTATION OF CASE: We report a case of anaplastic carcinoma in the submandibular region occurring in a 70-year-old woman. DISCUSSION: The location of the mass along with no evidence of primary tumor at the orthotopic thyroid gland posed a diagnostic dilemma: was this an ectopic thyroid carcinoma or rather a case of occult differentiated thyroid carcinoma metastasis that transformed to anaplastic carcinoma? Based on the histopathological findings we concluded that the tumor arised in ectopic thyroid tissue. Although the mass was completely resected, the patient died 10 months after diagnosis due to pulmonary metastases. CONCLUSION: Conclusively, the possibility of ectopic thyroid tissue, with or without disease, should be considered in cases of a mass in the submandibular region.

Idiopathic acquired dacryocystocele treated with endonasal endoscopic dacryocystorhinostomy.

A 64-year-old woman presented with a medial canthal mass in her left eye, which was accompanied only by mild epiphora. There was no history of dacryocystitis, bloody tears, midfacial trauma or surgery. Physical examination showed a non-inflammatory, subcutaneous, immobile mass below the level of the medial canthal tendon. Lacrimal irrigation demonstrated blockage at the nasolacrimal duct. A CT revealed a non-enhancing, low density, cystic lesion in the inferomedial aspect of the left orbit without bony erosion, which was compatible with an idiopathic acquired dacryocystocele. The patient underwent endonasal endoscopic dacryocystorhinostomy (DCR) and silicone intubation. Epiphora resolved immediately after surgery. Two years after surgery, the patient has had no recurrence of either the epiphora or the orbital. Idiopathic acquired dacryocystocele associated only with epiphora without accompanying dacryocystitis although rare should be considered in the differential diagnosis of acquired non-inflammatory medial canthal masses. Endonasal endoscopic DCR represents a safe and effective treatment.

Tonsilloplasty in children with obstructive symptoms.

OBJECTIVE: Obstructive symptoms, caused by tonsillar hypertrophy, have been attracting increasing interest, and tonsillectomy is often performed as a result of this indication. This study was undertaken to investigate the effect of the different surgical techniques, tonsilloplasty and tonsillectomy, on clinical symptoms in children with obstructive symptoms owing to tonsillar hypertrophy. METHODS: Thirty children, 3 to 12 years old, were included; 15 of them underwent tonsilloplasty and 15 tonsillectomy. Tonsilloplasty was performed with a knife or scissors, and the trauma was closed with two or three sutures. The tonsillar capsule and about 15 to 20% of tonsillar tissue remain as a barrier to prevent exposure of the pharyngeal muscles. All children were operated on under the same anesthesia and followed the same postoperative scheme for analgesia. RESULTS: All of the children were cured of their breathing obstruction. In the tonsilloplasty group, the tonsillar remnants healed completely within 1 week. The postoperative pain recorded was significantly less than in the tonsillectomy group. No major side effects occurred. The mean time used for the surgery was the same, and no postoperative bleeding was seen in both groups. The intraoperative bleeding observed was small in both groups, although significantly smaller for the tonsilloplasty group. CONCLUSIONS: Tonsilloplasty is a less traumatic and much less painful surgical method, and children recover more quickly. The results with respect to breathing obstruction are almost the same for both methods at the 1-year follow-up. It seems to be the most suitable method for children with tonsillar hypertrophy and obstructive symptoms.

Pattern of parotid gland tumors on Crete, Greece: a retrospective study of 131 cases.

BACKGROUND: Salivary gland tumors constitute a highly heterogeneous group. There are few large epidemiological studies of benign and malignant salivary gland tumors in Greece. The aim of the present study was to define the pattern of parotid gland neoplasms on the island of Crete. MATERIAL/METHODS: The medical records of 131 patients who underwent parotidectomy in the Otorhinolaryngology department of the University hospital of Heraklion over the last ten years were retrospectively reviewed. Gender and age of the patients, size, location, and histology of the tumors, as well as postoperative complications were analyzed and tabulated. RESULTS: There were 101 (77.1%) benign parotid gland tumors and 30 (22.9%) of malignant ones. The most common benign tumor was pleomorphic adenoma (44.2%), while the most common malignant tumor was mucoepidermoid carcinoma (5.3%). The female-to-male ratio was 1.18/1.00. Median age was 48.2 years (range: 16-75 years) in patients with benign tumors and 65.4 years (range: 27-90 years) in patients with malignancy. After superficial parotidectomy, the most common postoperative complication was Frey syndrome (8.1%), while after total parotidectomy the most frequent complication was transient facial nerve palsy (45.5%). CONCLUSIONS: On Crete, parotid gland tumors show epidemiological characteristics similar to studies worldwide. Benign parotid tumors are largely more frequent than malignant tumors. The most common benign parotid gland tumor was pleomorphic adenoma, while the most frequent malignant tumor was mucoepidermoid carcinoma. Future research needs to be done to better define the epidemiology of these tumors among the Greek population.

Laryngeal leiomyosarcoma: a case report and review of the literature.

Laryngeal leiomyosarcoma (LLM) is a rare malignancy originating from the smooth muscles of blood vessels or from aberrant undifferentiated mesenchymal tissue. Histological diagnosis may be particularly difficult and correct diagnosis is based on immunohistochemical investigations and electron microscopy. A case report of a LLM in a 74-year-old man is presented. Direct laryngoscopy revealed a large glottic lesion causing airway compromise and an emergency tracheotomy was performed. Subsequent total laryngectomy confirmed the diagnosis of leiomyosarcoma. Lung metastases developed 8 months following treatment, despite the absence of local or regional recurrence, and the patient died 3 months later. A review of the English and French literature revealed 30 previous cases of LLM. Clinical presentation, histological diagnosis, and management of this rare malignancy are analyzed aiming to improve our knowledge regarding the best treatment modality.

Oral mucosal melanoma: a malignant trap.

Oral mucosal melanomas are highly malignant tumors. The 'chameleonic' presentation of a mainly asymptomatic condition, the rarity of these lesions, the poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health provider. We present the case of a 75-year-old man who was referred to the Ear, Nose and Throat department. His symptoms were voice alteration and saliva drooling, progressively worsening during the last few weeks. The absence of pain was the reason for the delay of seeking medical care. The diagnosis was an oversized oral melanoma. This is an example of how the time of diagnosis and the evolution of a disease could be seriously influenced by patient's behavior. Melanomas arising from oral mucosa have poor prognosis unless they are discovered and treated early. The vigilance of the physicians is necessary to have success in this difficult task.