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1.
Otol Neurotol ; 41(1): 60-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746816

RESUMO

OBJECTIVES: Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study. DESIGN: Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative, and long-term results of pure-tone average, speech discrimination in quiet at 65 dB (German language Freiburg Monosyllabic Test) and noise (German language Oldenburger Sentence Test), rate of revision surgeries as well as explantations and the novel parameter patient years (py). RESULTS: Mean of follow-up was 3.0 ±â€Š1.7 years resulting in a total of 135.6 py. Bone conduction was stable in all patients pre- to postoperatively as well as preoperatively to the long-term. Round window patients had the broadest air-bone gap (31.4 ±â€Š19.4 dB HL) benefitting the most from the AMEI (functional gain = 39.0 ±â€Š12.8 dB HL). Regarding speech discrimination, incus patients performed the best both in quiet (77.7 ±â€Š22.8%) and noise (3.4 ±â€Š2.9 dB SNR). In terms of revision surgery and explantations, round window patients exhibited the highest rates (20%). CONCLUSIONS: Regarding all coupling sites, satisfying long-term stability results and comparable complication rates were reported with best performance of coupling to the incus. Implementation of patient years might be a novel parameter for the comparison of revisions and explantations.

2.
Laryngoscope ; 2019 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-31837151

RESUMO

OBJECTIVES/HYPOTHESIS: Indication for postoperative radiotherapy in patients with locally circumscribed tumors (pT1-pT2) and a single ipsilateral lymph node metastasis (pN1) is debatable. The aim of this study was to evaluate the oncological long-term outcome of patients with pT1-pT2 pN1 squamous cell carcinoma (SCC) of the oral cavity, the oropharynx, and the hypopharynx without extracapsular spread (ECS) after a margin-negative surgical resection, who either received or did not receive postoperative (chemo)radiotherapy. STUDY DESIGN: Retrospective case series. METHODS: The oncological outcome of patients with pT1-pT2 pN1 SCC without ECS was evaluated retrospectively. All patients underwent primary tumor resection that included transoral laser microsurgery and neck dissection at an academic tertiary referral center. RESULTS: Of 65 identified patients treated between 1986 and 2015 (18 oral cavity, 30 oropharynx, 17 hypopharynx), 21 (32%) received postoperative radiotherapy, and 44 (68%) were treated by surgery alone. The group of patients receiving postoperative treatment showed a significantly superior 5-year disease-specific (94.4% vs. 73.2%, P = .029) and recurrence-free survival (85.2% vs. 43.2%, P = .002), as well as a higher local control rate (90.2% vs. 64.9%, P = .042). The overall survival was 71.4% vs. 62.6% (P = .53). The mean follow-up was 80.7 months. CONCLUSIONS: Patients with locally circumscribed carcinomas and a single ipsilateral ECS-negative lymph node metastasis seem to benefit from postoperative radiotherapy. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

3.
Audiol Neurootol ; 24(5): 245-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31639802

RESUMO

BACKGROUND: Cochlear implantation is an important method of hearing rehabilitation. Earlier studies have shown the influence of implantation on the vestibular system. However, until now, the effect of hearing rehabilitation with cochlear implants (CI) on postural control and body stability has not been sufficiently studied. OBJECTIVE: To analyse the effect of hearing rehabilitation with activated CI and different sound inputs (music, speech text, and white noise) on postural control and risk of falls after implantation. METHODS: This was a prospective clinical trial that included 33 adult patients with at least 6 months' use of a CI (mean time after implantation = 23 months). All patients underwent a standard or geriatric (for patients >60 years) balancing deficit test protocol with a mobile posturography system (VertiGuard®) in different situations (CI deactivated/activated and different sound inputs). As the main outcome measure, the risk of falls (%) after each protocol was calculated by evaluating body sway both forward to backward and side to side (°/s). RESULTS: With the CI deactivated, the mean risk of falls was 45.5%. After activation of the CI, there was a small decrease in the mean risk of falls, but it was statistically significant. With an additional sound input (music or speech text) this decrease was more pronounced: 42.0 and 42.4%, respectively. This effect seems to be more pronounced in older patients. Regarding the individual patients, 72% had an improvement in the risk of falls with an activated CI, and 28% had a slight deterioration. An activated CI accompanied by sound input (music) further improved the individual risk of falls. CONCLUSIONS: Compared with prior research, this study found that the risk of falls after implantation decreased over a longer time period. Furthermore, the use of a CI and different sound inputs had a positive effect on postural control. These findings support the need for optimal hearing rehabilitation, especially in elderly patients. Although this effect is relatively small, it is important to consider for further studies that rehabilitation with CI may reduce the risk of falls. While the auditory system supposedly contributes to postural control only to a small degree and the mechanism is still poorly understood, further studies with bigger samples are warranted to clarify these effects.

5.
Head Neck ; 41(10): 3499-3515, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31355988

RESUMO

BACKGROUND: MicroRNAs (miRNA) recently evolved as potential cancer biomarkers. Therefore, the aim of the present study was to evaluate the prognostic impact of eight miRNAs connected to oral squamous cell carcinoma (OSCC). METHOD: Expression levels of hsa-mir-21-5p, hsa-mir-29b-3p, hsa-mir-31-5p, hsa-mir-99a-5p, hsa-mir-99b-3p, hsa-mir-100-5p, hsa-mir-143-3p and hsa-mir-155-5p were analyzed in tumor tissue (n = 36) and healthy oral mucosal tissue (n = 17) and correlated with clinical variables. Results of the study cohort were validated in an OSCC cohort of The Cancer Genome Atlas. RESULTS: Increased hsa-mir-99b-3p expression level showed a tendency toward advanced tumor stages, and high levels of hsa-mir-100-5p expression were associated with extracapsular extension. While a high expression level of hsa-mir-99b-3p was associated with better survival, a high expression level of hsa-mir-100-5p was correlated with a poorer survival in the study cohort. CONCLUSION: Our results indicate that hsa-mir-99b-3p and hsa-mir-100-5p may serve as novel prognostic biomarkers in OSCC.

6.
Head Neck ; 41(9): 3144-3158, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31179614

RESUMO

BACKGROUND: Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept. METHODS: A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%). RESULTS: Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.

7.
Laryngorhinootologie ; 98(S 01): S290-S333, 2019 Mar.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31096302

RESUMO

The wide distribution and availability of the internet during the last decades revolutionized the human information and communication behavior. Via internet, information can be easily retrieved and participative applications allow new types of interaction. The healthcare system is directly affected because information and communication represent a relevant part of it. The present contribution is intended to describe this development and its impact on otorhinolaryngology. The use of the internet for the research of health-related information is continuously increasing since several years and has meanwhile achieved significant importance. In the clinical context, other information sources still have a higher relevance. Laypeople mostly use the search engine of Google when performing health-related research. Even if the reliability of the presented information is difficult to assess, alternative offers that are specialized on valid healthcare information could not prevail. Anecdotic or incorrect information are regularly observed. Numerous trials investigated the quality of healthcare information on web pages. The methodical spectrum reaches from formula-depending readability testing via structured assessment tools up to certificates. The result shows that healthcare information on internet sites is often difficult to understand for the general population. Nearly all social media contain healthcare information and their relevance is increasing. Nonetheless, there is only few scientific knowledge on the characteristics and the effect of healthcare information in social media. The availability of online healthcare information requires new understanding of health literacy. The concept of digital literacy (eHealth literacy) contains among others the readability, media competence, IT knowledge, and basic scientific knowledge. The implementation of those skills depends on individual and social factors such as education, socio-economic status, and age. Investigations revealed a low healthcare literacy in a high percentage of the patients.The distribution of the internet also modifies the relationship between physician and patient. Well-informed patients request being involved in medical decisions. Physicians have a particular responsibility regarding the consultation of medical laypeople by weighting and verifying information. By actively participating, physicians should contribute to digitization in medicine for the benefit of their patients. Medical associations are particularly invited to contribute to this process.


Assuntos
Otolaringologia , Alfabetização em Saúde , Humanos , Internet , Reprodutibilidade dos Testes , Telemedicina
8.
Head Neck ; 41(9): 2892-2903, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31017352

RESUMO

BACKGROUND: Tissue-resident mesenchymal stem cells (MSCs) possess the ability to migrate to areas of inflammation and promote the regeneration of damaged tissue. However, it remains unclear how radiation influences this capacity of MSC in the head and neck region. METHODS: Two types of MSCs of the head and neck region (mucosa [mMSC] and parotid gland [pMSC]) were isolated, cultured and exposed to single radiation dosages of 2 Gy/day up to 10 days. Effects on morphology, colony forming ability, apoptosis, chemokine receptor expression, cytokine secretion, and cell migration were analyzed. RESULTS: Although MSC preserved MSC-specific regenerative abilities and immunomodulatory properties following irradiation in our in vitro model, we found a deleterious impact on colony forming ability, especially in pMSC. CONCLUSIONS: MSC exhibited robustness and activation upon radiation for the support of tissue regeneration, but lost their potential to replicate, thus possibly leading to depletion of the local MSC-pool after irradiation.

9.
Eur Arch Psychiatry Clin Neurosci ; 269(8): 973-984, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30421149

RESUMO

Alzheimer's disease (AD) pathology precedes the onset of clinical symptoms by several decades. Thus, biomarkers are required to identify prodromal disease stages to allow for the early and effective treatment. The methoxy-X04-derivative BSC4090 is a fluorescent ligand which was designed to target neurofibrillary tangles in AD. BSC4090 staining was previously detected in post-mortem brains and olfactory mucosa derived from AD patients. We tested BSC4090 as a potential diagnostic marker of prodromal and early AD using olfactory mucosa biopsies from 12 individuals with AD, 13 with mild cognitive impairment (MCI), and 10 cognitively normal (CN) controls. Receiver-operating curve analysis revealed areas under the curve of 0.78 for AD versus CN and of 0.86 for MCI due to AD versus MCI of other causes. BSC4090 labeling correlated significantly with cerebrospinal fluid levels of tau protein phosphorylated at T181. Using NMR spectroscopy, we find that BSC4090 binds to fibrillar and pre-fibrillar but not to monomeric tau. Thus, BSC4090 may be an interesting candidate to detect AD at the early disease stages.

10.
Biomed Res Int ; 2018: 7929104, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29693014

RESUMO

In epithelial tumors, a shift towards a mesenchymal phenotype has been associated with increased invasiveness and metastasis. It is assumed that this phenomenon plays a major role in disease progression and ultimately prognosis. This study investigated epithelial-mesenchymal transition (EMT) in human papillomavirus- (HPV-) negative pharyngeal squamous cell carcinoma. Tissue was obtained from one hypopharyngeal primary tumor and a regional lymph node metastasis during surgery with curative intention. A cell culture was established from the primary tumor and mesenchymal growth conditions were emulated. Gene expression profiling was performed (Human 8 × 60 K design array, Agilent Technologies) and EMT was assessed by a gene set (MSigDB: M5930, Hallmark_epithelial_mesenchymal_transition), applying gene set expression analysis (GSEA). Immunohistochemical staining and flow cytometry of CD44 and E-cadherin were compared in primary tumor, metastasis, and cell cultures. Primary tumor and metastasis were highly positive for CD44. A loss of E-cadherin occurred in the metastasis. Flow cytometry showed the appearance of a population without E-cadherin in spheroid colonies. In GSEA, the EMT phenotype was enriched in the primary tumor compared to metastasis and cell cultures (FDR < 25%, p < 5%). EMT showed variable expression during metastasis. It may thereby be a dynamic state in HPV-negative pharyngeal squamous cell carcinoma that is active only during the process of metastasis itself. Thereby, the primary tumor as well as the metastasis may exhibit fewer EMT properties.


Assuntos
Carcinoma de Células Escamosas/patologia , Transição Epitelial-Mesenquimal/fisiologia , Neoplasias de Cabeça e Pescoço/patologia , Metástase Neoplásica/patologia , Neoplasias Faríngeas/patologia , Biomarcadores Tumorais/metabolismo , Caderinas/metabolismo , Carcinoma de Células Escamosas/metabolismo , Linhagem Celular Tumoral , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Receptores de Hialuronatos/metabolismo , Masculino , Pessoa de Meia-Idade , Papillomaviridae/patogenicidade , Neoplasias Faríngeas/metabolismo , Prognóstico , Carcinoma de Células Escamosas de Cabeça e Pescoço
11.
Otol Neurotol ; 39(1): e5-e11, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29116963

RESUMO

OBJECTIVE: In cochlea implantation, assessment of the electrically evoked stapedius reflex threshold (eSRT) provides information for postoperative adjustment of the speech processor. This is used to prevent undesired overstimulation. To this day, the reflex is visually identified by the surgeon. However, this method may be prone to error due to ventilation-associated situs excursions, blinking, or other distractions. Therefore, the aim of this study was to establish an objective and automatized method to determine the eSRT. METHODS: Video material documenting the intraoperative measurements was analyzed offline applying a tracking software to quantify stapes head movements. Moreover, a computer program (TrackerAnalyzer) was developed to detect reflex associated movements automatically. RESULTS: Reflex responses seen visually by the surgeon compared with visual registration on the video material postoperatively and to results of the automatized method with TrackerAnalyzer showed a high inter-rater agreement (Cohen's kappa coefficient = 0.47-0.59). 82% of events in which the TrackerAnalyzer registered reflexes that were not seen by the surgeon had values close but lower to the intraoperatively determined eSRT (mean -1.02 current units). CONCLUSION: We demonstrated the feasibility of an objective and automatized method to determine electrically evoked stapedius reflex thresholds in cochlea implantation.


Assuntos
Testes de Impedância Acústica/métodos , Implante Coclear/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Estapédio/fisiologia , Estimulação Elétrica/métodos , Feminino , Humanos , Reflexo/fisiologia
12.
Otol Neurotol ; 38(10): e545-e550, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29135875

RESUMO

OBJECTIVE: The aim of this work was to evaluate the effect of tumor necrosis factor (TNF) and its neutralization with etanercept on the capability of cochlear pericytes to alter capillary diameter in the stria vascularis. METHODS: Twelve Dunkin-Hartley guinea pigs were randomly assigned to one of three groups. Each group was treated either with placebo and then placebo, TNF and then placebo, or TNF and then etanercept. Cochlear pericytes were visualized using diaminofluorescein-2-diacetate and intravasal blood flow by fluorescein-dextrane. Vessel diameter at sites of pericyte somas and downstream controls were quantified by specialized software. Values were obtained before treatment, after first treatment with tumor necrosis factor or placebo and after second treatment with etanercept or placebo. RESULTS: Overall, 199 pericytes in 12 animals were visualized. After initial treatment with TNF, a significant decrease in vessel diameter at sites of pericyte somas (3.6 ±4.3%, n = 141) compared with placebo and downstream controls was observed. After initial treatment with TNF, the application of etanercept caused a significant increase (3.3 ±5.5%, n = 59) in vessel diameter at the sites of pericyte somata compared with placebo and downstream controls. CONCLUSION: We have been able to show that cochlear pericytes are capable of reducing capillary diameter after exposition to TNF. Moreover, the reduction in capillary diameter observed after the application of TNF is revertible after neutralization of tumor necrosis factor by the application of etanercept. It seems that contraction of cochlear pericytes contributes to the regulation of cochlear blood flow.


Assuntos
Cóclea/irrigação sanguínea , Pericitos/efeitos dos fármacos , Fator de Necrose Tumoral alfa/farmacologia , Vasoconstrição/efeitos dos fármacos , Animais , Capilares/efeitos dos fármacos , Etanercepte/farmacologia , Cobaias
13.
Life Sci ; 187: 17-21, 2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-28818391

RESUMO

AIMS: Betahistine is a histamine analogue that is used for the treatment of Menière's disease. Animal studies showed that it increases local blood flow in the stria vascularis. In terms of its mode of action, recent studies have prompted discussion of whether betahistine actively affects cochlear microcirculation by dilations of pericytes or of precapillary arterioles or by mere downstream effects. Hence, we investigated the effects of betahistine on cochlear capillary pericytes and precapillary arterioles. MAIN METHODS: The stria vascularis was visualized in 12 guinea pigs by in vivo fluorescence microscopy. In these, 152 pericytes were stained and local diameter at sites of pericyte somas and downstream controls as well as intravascular blood flow were measured before and after betahistine application. Moreover, in two guinea pigs the precapillary arterioles were visualized by 2-photon-microscopy before and after betahistine application. KEY FINDINGS: There was no significant change in capillary diameter at sites of pericyte somas after betahistine application compared to controls, baseline or downstream controls, even though cochlear blood flow increased significantly. The two-photon measurements indicated an active dilation of precapillary arterioles. SIGNIFICANCE: Since we found no evidence that betahistine affects cochlear microcirculation by cochlear pericytes, its main mode of action is evidently active dilation of pre-capillary arterioles. These findings are in line with similar effects reported in the central nervous system and indicate an active effect on cochlear microcirculation.


Assuntos
Arteríolas/efeitos dos fármacos , beta-Histina/farmacologia , Orelha Interna/efeitos dos fármacos , Pericitos/efeitos dos fármacos , Animais , Arteríolas/fisiologia , Orelha Interna/irrigação sanguínea , Cobaias , Agonistas dos Receptores Histamínicos/farmacologia , Microscopia de Fluorescência , Microscopia de Fluorescência por Excitação Multifotônica , Pericitos/fisiologia , Vasodilatadores/farmacologia
14.
Otol Neurotol ; 38(8): 1213-1216, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28742634

RESUMO

HYPOTHESIS: The potential of Fingolimod (FTY-720), a sphingosine-1-phosphate analogue, to revoke the changes in cochlear blood flow induced by tumor necrosis factor (TNF) was investigated. BACKGROUND: Impairment of cochlear blood flow has often been considered as the common final pathway of various inner ear pathologies. TNF, an ubiquitous cytokine, plays a major role in these pathologies, reducing cochlear blood flow via sphingosine-1-phosphate-signaling. METHODS: Fifteen Dunkin-Hartley guinea pigs were randomly assigned to one of three groups (placebo/placebo, TNF/placebo, TNF/FTY-720). Cochlear microcirculation was quantified over 60 minutes by in vivo fluorescence microscopy before and after topical application of placebo or TNF (5 ng/ml) and after subsequent application of placebo or FTY-720 (200 µg/ml). RESULTS: Treatment with TNF led to a significant decrease of cochlear blood flow.Following this, application of placebo caused no significant changes while application of FTY-720 caused a significant rise in cochlear blood flow. CONCLUSIONS: FTY-720 is capable of reversing changes in cochlear blood flow induced by application of TNF. This makes FTY-720 a valid candidate for potential treatment of numerous inner ear pathologies.


Assuntos
Cóclea/irrigação sanguínea , Cóclea/efeitos dos fármacos , Cloridrato de Fingolimode/farmacologia , Microcirculação/efeitos dos fármacos , Animais , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Citocinas/metabolismo , Cobaias , Imunossupressores/farmacologia , Lisofosfolipídeos/metabolismo , Microscopia de Fluorescência , Transdução de Sinais , Esfingosina/análogos & derivados , Esfingosina/metabolismo , Fator de Necrose Tumoral alfa/farmacologia
15.
Head Neck ; 39(8): 1631-1638, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28474378

RESUMO

BACKGROUND: The oncologic and functional outcome of transoral laser microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept. METHODS: Two hundred eleven patients with squamous cell carcinoma (SCC) of the hypopharynx (pT1-4a, pN0-2, M0) were treated by TLM +/- neck dissection (88%) +/- (chemo)radiotherapy ([C]RT; 51%). The majority of cases were advanced stages III and IVa (85%). RESULTS: The 5-year Kaplan-Meier estimates for local control after TLM were pT category-related 88.1%, 74.8%, 77.3%, and 61.8% for pT1-4a tumors. The 5-year estimates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for early stages I and II were 68.2%, 96.7%, and 74.6%, respectively; for stage III they were 65.9%, 83.8%, and 56.4%, respectively; and the rates for stage IVa were 44.5%, 60.7%, and 50.3%, respectively. Overall, 95.7% of the patients maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment (+/- neck dissection, +/- [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Terapia a Laser/métodos , Microcirurgia , Esvaziamento Cervical , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia Adjuvante , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hipofaríngeas/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Eur Arch Otorhinolaryngol ; 274(8): 3001-3009, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28528370

RESUMO

The aim of this study was the evaluation of three localizations for the implantation of a semi-implantable transcutaneous bone conduction device after previous mastoid surgery. This is a retrospective review of electronic datasets of cranial computed tomography studies. The study setting is one tertiary referral center and included 52 consecutive adult patients (60 temporal bones) with a history of mastoid surgery. The intervention was virtual placement of the device with a planning software within the remaining mastoid as well as dorsal of the sigmoid sinus and caudal of the transverse sinus (retrosigmoidal localization) and dorsocranial of the parietomastoid suture and cranial of the transverse sinus (parietal localization). The main outcome measure included dimensions of the bone for the reception of implant and screws, relative localization of dura mater or sinus sigmoideus, distance to the cochlea, thickness of the epicranium and classification of implantation as possible or impossible. Implantation within the remaining mastoid was deemed possible in 35 mastoid bones (58.3%). The best-suited alternative localization was retrosigmoidal in 22 (42.3%) and parietal in 29 patients (55.8%). The mean distance from the implantation site to the cochlea was lowest with on average 41.2 ± 3.1 mm from within the remaining mastoid. The differences in distance from the cochlea to the alternative localizations were each statistically significant (p < 0.01, ANOVA/Bonferroni t test). The retrosigmoidal and parietal localizations are suitable alternative implantation sites. The application of spacers may prevent contact to the sinuses or dura. Preoperative CT-based planning is recommended in cases of previous mastoid surgery. LEVEL OF EVIDENCE: 4 (case series).


Assuntos
Auxiliares de Audição , Perda Auditiva Condutiva , Mastoidectomia/efeitos adversos , Ajuste de Prótese/métodos , Implantação de Prótese/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Projeto Auxiliado por Computador , Feminino , Alemanha , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/cirurgia , Humanos , Masculino , Mastoidectomia/métodos , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem
17.
Otol Neurotol ; 38(5): 648-654, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28369007

RESUMO

OBJECTIVE: Disturbance of cochlear microcirculation is considered to be the final common pathway of various inner ear diseases. Hyperfibrinogenemia causing increased plasma viscosity is a known risk factor for sudden sensorineural hearing loss and may lead to a critical reduction of cochlear blood flow. The aim of this study was to evaluate the effect of a substantial reduction of plasma fibrinogen levels by drug-induced defibrinogenation for the treatment of acute hearing loss in vivo. METHODS: Acute hearing loss was induced by hyperfibrinogenemia (i.v. injection of 330 mg/kg BW fibrinogen), using a guinea pig animal model. Parameters of cochlear microcirculation and hearing thresholds were quantified by intravital microscopy and evoked response audiometry. After obtaining baseline values, the course of hearing loss and disturbances of microcirculation were investigated under influence of intravenous defibrinogenation therapy (ancrod), corticosteroid, or placebo treatment, using 5 animals/group. RESULTS: Acute hyperfibrinogenemia caused hearing loss from 10 ±â€Š7 to 26 ±â€Š10 dB SPL at baseline. Drug-induced reduction of fibrinogen levels showed a significant increase of cochlear microcirculation (1.6-fold) and recovered hearing threshold (11 ±â€Š6 dB SPL). Placebo or corticosteroid treatment had no effect on hearing loss (35 ±â€Š7 dB SPL and 32 ±â€Š18 dB SPL, respectively). CONCLUSION: Acute hyperfibrinogenemia resulted in hearing loss. Drug-induced reduction of elevated fibrinogen levels caused an increase in cochlear blood flow and a decrease in hearing thresholds. Placebo or corticosteroid treatment had no effect. Reduction of plasma fibrinogen levels could serve as a clinical treatment option for acute hearing loss.


Assuntos
Cóclea/irrigação sanguínea , Fibrinogênio/efeitos adversos , Fibrinolíticos/farmacologia , Perda Auditiva Neurossensorial/etiologia , Ancrod/farmacologia , Animais , Audiometria de Resposta Evocada , Limiar Auditivo/efeitos dos fármacos , Limiar Auditivo/fisiologia , Cóclea/fisiopatologia , Modelos Animais de Doenças , Cobaias , Perda Auditiva Neurossensorial/fisiopatologia , Masculino , Microcirculação/efeitos dos fármacos
18.
Head Neck ; 39(6): 1166-1176, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28252821

RESUMO

BACKGROUND: Surgical treatment options for local recurrences of laryngeal cancer can be either organ-preserving surgery or total laryngectomy. The purpose of this study was to present our evaluation of the treatment with transoral laser microsurgery (TLM) in comparison to laryngectomy. METHODS: We conducted a retrospective review of 199 consecutive patients with recurrent laryngeal cancer at 1 tertiary referral center. RESULTS: The 5-year overall survival, disease-specific survival, and local control rates were 64.8%, 79.6%, and 57.5%, respectively, for 93 patients with early tumors treated by TLM, 28.9%, 41.7%, and 43.7%, respectively, for 52 patients with advanced tumors treated by TLM as well as 39.4%, 44.6%, and 68.8%, respectively, for 54 patients with advanced tumors treated by total laryngectomy. Five-year larynx-preservation rate was 77.7% for early as well as 68.4% for advanced tumors treated by TLM. CONCLUSION: TLM is an option in early and in selected cases of advanced locally recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1166-1176, 2017.


Assuntos
Laringectomia/métodos , Terapia a Laser/métodos , Microcirurgia/métodos , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia/mortalidade , Terapia a Laser/mortalidade , Masculino , Microcirurgia/mortalidade , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Terapia de Salvação/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Estatísticas não Paramétricas , Análise de Sobrevida
19.
Eur Arch Otorhinolaryngol ; 274(4): 1997-2004, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28028607

RESUMO

For the treatment of T1b glottic carcinoma, different treatment options, such as transoral laser microsurgery, open surgical techniques, and primary radiotherapy, are under discussion. In this context, the aim of the present study was to describe oncologic results and complication rates of transoral laser microsurgery in treatment of T1b glottic carcinoma. This is a retrospective unicenter chart review of patients treated at an academic tertiary referral center between 1986 and 2006. Fifty-one previously untreated T1b cases were exclusively treated by transoral laser microsurgery and included into this study, 47 were male, and 4 were female. The main outcome measures included local control rate and complications, overall, disease specific, and recurrence-free survival. The median follow-up period was 98 months. The 5-year local control rate was 90.2%; larynx preservation rate was 92.2%. No intra- or postoperative complications, such as wound infections, postoperative bleeding, hematoma, edema, and fistula development, were observed. A single patient required revision surgery due to synechia. Five-year survival rates were: overall 84.7%, disease specific 97.7%, and recurrence free 72.4%. Our data support the conclusion that transoral laser microsurgery is a considerable treatment option in T1b glottic carcinoma. The oncologic outcome was at least comparable to other treatment options, while the perioperative morbidity and complication rate were lower.


Assuntos
Carcinoma de Células Escamosas , Glote , Neoplasias Laríngeas , Terapia a Laser , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Alemanha , Glote/patologia , Glote/cirurgia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Boca/cirurgia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Estudos Retrospectivos
20.
J Environ Pathol Toxicol Oncol ; 35(4): 343-354, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27992314

RESUMO

The popularity of electronic cigarettes (ECs) is rapidly growing and ECs are claimed to be an uncritically regarded alternative to conventional cigarettes. The mucosal tissue of the upper aerodigestive tract (UADT) is the first contact organ for xenobiotics such as liquids of ECs. The aim of this study is to investigate the bimolecular effects of e-liquids on human pharyngeal tissue cultures to evaluate whether e-liquids and their components present a risk factor for head and neck squamous cell carcinoma. Fresh tissue samples of healthy oropharyngeal mucosa were assembled into mucosal tissue cultures. Two fruit-flavored liquids (FLs), one tobacco-flavored liquid (TL) (all containing nicotine), and the corresponding base mixtures (free of nicotine and flavor) were used in three different dilutions. Cytotoxicity was assessed using the water-soluble tetrazolium-8 assay. DNA fragmentation was quantified using alkaline microgel electrophoresis. All liquids caused a significant reduction in cell viability. FLs especially showed a higher toxicity than TL. DNA fragmentation significantly increased by incubation with FL, whereas treatment with TL did not show serious DNA damage. E-liquids are cytotoxic to oropharyngeal tissue, and some liquids can induce relevant DNA damage. Thus, mutagenicity for mucosa of the UADT and e-liquids as risk factors for head and neck cancer cannot entirely be ruled out. Only the implementation of standards and regulations for liquid production and distribution can ensure a valid scientific investigation and assessment of carcinogenic potential of long-term EC use.


Assuntos
Carcinoma de Células Escamosas/induzido quimicamente , Citotoxinas/toxicidade , Sistemas Eletrônicos de Liberação de Nicotina/efeitos adversos , Neoplasias de Cabeça e Pescoço/induzido quimicamente , Mutagênicos/toxicidade , Orofaringe/efeitos dos fármacos , Adulto , Carcinoma de Células Escamosas/epidemiologia , Sobrevivência Celular/efeitos dos fármacos , Dano ao DNA/efeitos dos fármacos , Feminino , Alemanha/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Masculino , Membrana Mucosa/efeitos dos fármacos , Fatores de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço , Adulto Jovem
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