Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept

xlomafota13 shared this article with you from Inoreader Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept Via hno HNO. 2021 May 4. doi: 10.1007/s00106-021-01059-4. Online ahead of print. ABSTRACT Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases. PMID:33944963 | DOI:10.1007 /s00106-021-01059-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Allogenes und autologes Material führt bei Mastoidhöhlenobliteration zu vergleichbaren Rezidivraten

xlomafota13 shared this article with you from Inoreader Allogenes und autologes Material führt bei Mastoidhöhlenobliteration zu vergleichbaren Rezidivraten Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1432-3123 Einleitung Bei symptomatischen Mastoidhöhlen nach Ohroperationen besteht die Therapie der Wahl in der chirurgischen Verkleinerung. Hierbei stehen verschiedene Methoden und Materialien zur Obliteration zur Verfügung. Allogenes Material ist leicht verfügbar, kann jedoch zu Wundinfektionen aufgrund von Abstoßungsreaktionen, Granulationen und Entzündungsreaktionen führen, weshalb autologes Material aufgrund seiner guten Biokompatibilität häufig bevorzugt wird. Ziel dieser Studie war es, die Langzeitergebnisse von Patienten nach Mastoidhöhlenobliteration mit allogenem und autologem Material im Hinblick auf das Auftreten von Rezidivcholesteatomen, die Anzahl der Revisionsoperationen und den Einfluss der Operation auf die Lebensqualität zu vergleichen.Methoden Patienten, die sich einer Mastoidhöhlenobliteration mit dem allogenen Material Hydroxylapatit-Matrix (HMM) unterzogen, wurden retrospektiv in die Studie eingeschlossen. In einem prospektiven Studienteil wurden Patienten eingeschlossen, welche sich einer Mastoidhöhlenobliteration mit autologem Rekonstruktionsmaterial (AutoM) unterzogen. Bei allen Patienten wurde neben einer ausführlichen Aktenanalyse eine Reintonaudiometrie durchgeführt und bei der postoperativen Untersuchung das Zürcher Mittelohrinventar (Zurich Chronic Middle Ear Inventory (ZCMEI-21)) zur Erhebung der gesundheitsbezogenen, krankheitsspezifischen Lebensqualität ausgefüllt.Ergebnisse Insgesamt wurden 22 Patienten mit einem durchschnittlichen Alter von 56,9 Jahren (SD 18,7 Jahre) und HMM (mittleres Nachuntersuchungsintervall: 88,3 Monate; SD 21,9 Monate) sowie 25 Patienten mit einem Durchschnittsalter von 52,4 Jahren (SD 13,7 Jahre) und AutoM (mittleres Nachuntersuchungsintervall: 13,5 Monate; SD 9,5 Monate) in die Studie eingeschlossen. Die audiologische Revisionsfreiheit lag nach einem Jahr für HMM bei 100% und für AutoM bei 85%. Die Rezidivfreihe it lag nach einem Jahr für HMM bei 95% und für AutoM bei 100%. Die Gruppen unterschieden sich weder hinsichtlich des postoperativen Hörergebnisses noch der postoperativen Lebensqualität.Diskussion Die Obliteration von Mastoidhöhlen ist eine chirurgische Herausforderung. Es zeigte sich kein relevanter Unterschied zwischen den verwendeten Materialien im Hinblick auf die Rezidivrate, das Hören und die Lebensqualität über den für beide Gruppen beobachteten Zeitraum von 13,5 Monaten. Die oft fehlende subjektive Symptomatik zusammen mit der hohen Rate an Rezidivcholesteatomen und Revisionsindikationen unterstreicht die Notwendigkeit einer regelmäßigen klinischen Nachsorge inklusive der Ohrmikroskopie bei chronischen Mittelohrerkrankungen und lässt regelmäßige Nachuntersuchungen dringend empfehlen. [...] Georg Thieme Verlag KG R� �digerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition

xlomafota13 shared this article with you from Inoreader Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition Via leak of cerebrospinal fluid Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06850-1. Online ahead of print. ABSTRACT BACKGROUND: Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery. OBJECTIVE: To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery. METHODS: A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution. RESULTS: One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (1 1.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571). CONCLUSION: Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%. PMID:33942123 | DOI:10.1007/s00405-021-06850-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The adjunctive use of carbimazole during radioactive iodine treatment reduces the cure rate of Graves' disease

xlomafota13 shared this article with you from Inoreader The adjunctive use of carbimazole during radioactive iodine treatment reduces the cure rate of Graves' disease Via radioactive iodine S Afr Med J. 2021 Feb 1;111(2):176-179. doi: 10.7196/SAMJ.2021.v111i2.14522. ABSTRACT BACKGROUND: Radioactive iodine (RAI) is widely used in the treatment of hyperthyroidism. Adjunctive antithyroid drugs (ATDs) are commonly prescribed to treat the hyperthyroid state before the RAI has taken effect. However, there is no consensus on the use of or timing of adjunctive ATD treatment with RAI. OBJECTIVES: To determine the influence of the ATD carbimazole on the cure rate of RAI t reatment for Graves' disease. METHODS: A retrospective chart review was conducted in the Department of Nuclear Medicine of the Steve Biko Academic Hospital in Pretoria. The cure rate of patients treated with RAI for Graves' disease was analysed. The effect of adjunctive carbimazole treatment with regard to its use and timing with RAI dosing was analysed. The cure rate was determined in patients treated with carbimazole either before RAI or before and after RAI administration. Cure rate was defined by the biochemical thyroid function status (thyroxine (T4), thyroid-stimulating hormone (TSH)) as euthyroid or hypothyroid from 3 months and sustained at 12 months. The need for a second dose of RAI was recorded. RESULTS: RAI treatment was administered to 171 patients with Graves' disease. The cure rate was higher in patients receiving a higher dose of RAI. The overall cure rate increased progressively from 3 months and was 91% at 12 months. The cure rate in 97 patients not rec eiving carbimazole was 98%. The cure rate of the 27 patients on carbimazole treatment given before RAI administration was 81%, and 73% in the 37 patients in whom it was resumed after RAI administration. The overall cure rate was lower in patients who received carbimazole (p<0.001), but especially in patients in whom carbimazole was continued after RAI administration (p<0.001). CONCLUSIONS: Adjunctive carbimazole treatment decreased the RAI cure rate of Graves' disease significantly. PMID:33944730 | DOI:10.7196/SAMJ.2021.v111i2.14522 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas

xlomafota13 shared this article with you from Inoreader Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06819-0. Online ahead of print. ABSTRACT PURPOSE: The objective of this study is to assess the prognostic capacity of the nodal yield in elective neck dissections performed in patients with head and neck squamous cell carcinomas (HNSCC) without clinical or radiological evidence of regional involvement (cN0) at the time of diagnosis. METHODS: Retrospective study including 647 patients with HNSCC treated with an elective neck dissection. RESULTS: Patients with < 15 dissected nodes (n = 172, 26.6%) had a 5-year disease-specific survival of 64.9% (95% CI: 57.3-72.5%), while for patients with ≥ 15 dissected nodes (n = 475, 73.4%), it was of 81.9% (95% CI: 78.4-85.4%) (P = 0.0001). The nodal yield category had prognostic capacity on the disease-specific survival in patients with tumors located in the oral cavity (P = 0.001), the oropharynx (P = 0.023) and the hyp opharynx (P = 0.034), while for patients with tumors located in the larynx, no significant differences appeared (P = 0.779). Differences in regional recurrence-free survival were also observed based on the nodal yield category in patients with extra-laryngeal tumors (5-year regional recurrence-free survival of 81.0% in patients with < 15 dissected nodes vs 89.0% in patients with ≥ 15 dissected nodes; P = 0.046). CONCLUSION: The nodal yield in elective neck dissections in patients without evidence of lymph node disease (cN0) had prognostic capacity depending on the location of the primary tumor. For tumors located in the larynx, the number of dissected nodes did not significantly influence the prognosis. For tumors located in the oral cavity, oropharynx or hypopharynx, patients with < 15 dissected nodes had a disease-specific mortality 2.9 times higher than patients with ≥ 15 dissected nodes. PMID:33938992 | DOI:10.1007/s00405-021-06819-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lasers in endoscopic middle ear surgery: where do we stand today?

xlomafota13 shared this article with you from Inoreader Lasers in endoscopic middle ear surgery: where do we stand today? Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06807-4. Online ahead of print. ABSTRACT OBJECTIVE: To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery. METHODS: Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded. RESULTS: Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with mini mal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications. CONCLUSION: Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue. PMID:33938993 | DOI:10.1007/s00405-021-06807-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing

xlomafota13 shared this article with you from Inoreader Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727148 Tuberculum sellae meningiomas pose significant challenges because they are surrounded by crucial neurovascular structures, such as the optic and oculomotor nerves, pituitary stalk, internal carotid artery and its branches, and the anterior cerebral arteries. Even if small, such meningiomas frequently extend to the optic canal that is considered a poor prognostic factor for vision. In this video clip, we illustrate the case of a 60-year-old female who had an approximately 3-cm tuberculum sellae meningioma with optic canal involvement. She underwent surgical resection of the tumor through a pterional approach. After extradural optic canal unroofing, detaching, devascula rizing, and debulking the tumor, careful dissection of the meningioma from the surrounding tissues was performed. Next, the tumor extensions into both of the optic canals were removed. Finally, coagulation and resection of the tumor origin on the dura of the tuberculum sellae following Simpson's grade-I resection were performed. Histopathology revealed that the tumor was a World Health Organization (WHO) grade-I meningioma. The patient had an uneventful postoperative course and her visual acuity was preserved, with no visual field defect on postoperative visual examination. In this video, the basic surgical techniques in performing extradural optic canal unroofing, preserving the arachnoid plane, and stay in collect layer, which is the essential technique for dissecting meningiomas and for preserving neurovascular structures, are demonstrated.The link to the video can be found at: https://youtu.be/vD54Iji0C4Q. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.