Sahel Medical Journal

Growth patterns of preterm infants: A prospective study in an indigenous African population Rosena Olubanke Oluwafemi, Moses Temidayo Abiodun Sahel Medical Journal 2018 21(4):181-188 Background: Optimal growth of preterm infants reflects their overall health status; however, indigenous growth charts are rarely available to monitor them adequately in infancy. Objectives: The aim of this study was to describe growth patterns of preterm infants and to generate percentile charts as well as relevant predictive equations for expected weight-for-age in their various birth weight categories. Materials and Methods: This was a prospective, analytic study. Anthropometric measurements of eligible consecutive preterm babies were monitored biweekly/monthly in infancy. Temporal changes in body weights and occipitofrontal circumferences (OFCs) were presented graphically. The Pearson's correlation coefficient was done to derive predictive equations. LMS chartmaker light version 2.54 (Medical Research Council, UK) generated percentile charts. P < 0.05 was considered statistically significant. Results: A total of 154 preterm infants were recruited during the study period, with a male-to-female ratio of 1:1.5. Their mean gestational age (GA) was 31.3 ± 2.4 weeks, and mean birth weight was 1510.8 ± 347.5 g. Average daily weight gains were 9.4, 17.4, and 20.0 for extremely low birth weight (ELBW), very LBW (VLBW), and LBW, respectively, in the 1st month (F = 1.733, P = 0.183). The peak weight gain period occurred at the 4th month for ELBW (28.3 g/day), 5th month for VLBW (38.3 g/day), and 7th month for LBW (38.3 g/day). There was a strong positive correlation of their body weight with their postnatal age (y = 505.6x + 1511.5; R2 = 0.92) as well as OFC with age (y = 1.33x + 29.94; R2 = 0.94). Growth charts for weights and OFCs were generated showing 5th, 50th, and 95th percentiles. Conclusion: The preterm infants gained weight with increasing postnatal age following an initial weight loss in the early neonatal period. Their relative growth velocities were similar in all birth weight categories.

The use of hydroxycarbamide in children with sickle cell anemia Hafsat Rufai Ahmad, Jamilu Abdullahi Faruk, Adekunle Matthew Sobowale, Amos Solomon, Adebiyi Niyi Mustapha, Olufemi Gboye Ogunrinde Sahel Medical Journal 2018 21(4):189-193 Background: Although hydroxycarbamide (hydroxyurea [HU]) has been in use for decades in both adults and child populations with sickle cell disease (SCD), its reported use has remained low in Africa and Nigeria where the largest number of SCD patients reside. Availability, cost, and concerns about safety and efficacy are some of the challenges to its use. Objectives: This study highlights the experience of using HU for children with sickle cell anemia in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A descriptive, retrospective observational study of children is presented. Demographic, clinical, and laboratory features of children on HU, the indications for therapy and adverse clinical events encountered were analyzed. Results: A total of 165 children were treated with HU over a 4-year period, their ages ranging between 0.9 and 17 years. A total of 85 (47.5%) had HU for >12 months, while 61 (34.1%) were on treatment <11 months, while 19 (10.2%) were lost to follow-up. There was a significant increase in the weight, height, fetal hemoglobin, mean corpuscular volume, and a significant reduction in white cell counts; with no differences in the packed cell volume, hemoglobin concentration, creatinine, alanine transaminase, and bilirubin levels. Adverse events and/or comorbidities were reported in 48 (56.5%) patients, while one patient discontinued treatment because of skin rash. Conclusion: This study highlights the increased utilization of HU among children in an African region, the observed clinical events, and laboratory parameters. The benefits are demonstrable, and the drug-related organ toxicities appear minimal.

Oral manifestations of dengue fever Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran Sahel Medical Journal 2018 21(4):194-198 Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever.

Target organ damage among subjects with high-normal blood pressure in a Nigerian tertiary health institution H Saidu, KM Karaye, BN Okeahialam Sahel Medical Journal 2018 21(4):199-203 Background: There is paucity of data on the relationship between high – normal blood pressure (BP) and target organ damage (TOD) in sub-Saharan Africa including Nigeria. This study therefore, aimed to assess target organ damage (TOD) among subjects with high – normal BP in comparison with hypertensives and subjects with optimal BP. Materials and Methods: The study was cross-sectional and comparative conducted at Aminu Kano Teaching Hospital, Kano on eligible subjects aged 18 years and above. Three groups comprising of randomly selected subjects (high -normal (group 1), hypertension (group 2) and optimal BP (group 3)), with each group having 100 in number were studied. Funduscopy and relevant investigations including transthoracic echocardiography were carried out. High – normal BP was defined as systolic BP of 130 -139mmHg and/or diastolic BP of 80-89mmHg. Results: The mean age of subjects in group 1 was 27.32 ± 8.20 years and 60% were female, 34.04±6.25 years for group 2 and 53% were female, and 52.81 ± 13.3 years for group 3 and 56% were female (P = < 0.001). The most prevalent TOD was left ventricular hypertrophy, present in 62% of hypertensives, 14% of those with high-normal BP and 2% of those with optimal BP(P = <0.001). Micro albuminuria and slight increase in creatinine were found in 12.9% and 6% of subjects with high-normal BP; 25.7% and 25% of hypertensives and 4.1% and 3% of subjects with optimal BP. The study found a significant progressive increase in both cardiovascular disease risk factors and target organ damage (TOD) as BP increased across the blood pressure categories from optimal BP to high – normal BP and to hypertension (P = <0.05). Conclusion: Subjects with high-normal BP had significantly higher prevalence of both TOD and cardiovascular disease risk factors than those with optimal BP but lower than hypertensives, suggesting that efforts to control BP should start early to reduce the complications of high BP.

Snakebites in a Nigerian children Population: A 5-year review Ikenna Kingsley Ndu, Benedict Onyeka Edelu, Uchenna Ekwochi Sahel Medical Journal 2018 21(4):204-207 Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes. Objectives: This study was carried out to review the demographics, risk factors, interventions, and outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database. Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5-year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi-square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952). Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health-seeking behavior and emergency interventions for snakebite victims.

Pattern of hearing loss in a tertiary hospital in the North Western Nigeria Iliyasu Yunusa Shuaibu, Dotiro Chitumu, Ibrahim Babatunde Mohammed, Nurudeen Adebola Shofoluwe, Mohammed Aminu Usman, Aminu Bakari, Lateef Kunle Lawal Sahel Medical Journal 2018 21(4):208-212 Background: Hearing impairment is a major public health problem in developing countries. According to the World Health Organization, approximately 15% of the world's adult population has some degree of hearing loss. About one-third of those who are affected have disabling hearing loss and two-third of them live in developing countries. Aim: This study aims to determine the causes and pattern of hearing loss in Zaria, North Western Nigeria. Materials and Methods: This was a retrospective study conducted at ear, nose, and throat unit of Ahmadu Bello University Teaching Hospital Zaria, Kaduna Nigeria. The hospital is a tertiary health-care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary and private health facilities in Nigeria. The records of all patients who were managed for hearing loss in our unit over a period of 5 years between January 2011 and December 2015 were reviewed. Information obtained from the case files included demographic characteristics, main presenting symptoms, and causes of hearing loss. Findings of pure tone audiograms, tympanograms, and otoacoustic emission were also recorded. The data obtained were analyzed using statistical package for Social Science Version 21. Results: Of the 277 patients who presented with hearing loss, only 144 met the inclusion criteria. There were 86 (59.7%) males and 58 (40.3%) females with sex ratio (M:F) of 1.4:1. The mean age was 29.9 years with standard deviation of ±2.18. The most common cause of hearing loss was presbyacusis 24 (16.7%) followed by ototoxicity 14 (9.7%), most of the patients 91 (63.2%) had bilateral hearing loss while 53 (36.8%) had unilateral hearing loss. Majority 112 (77.8%) had sensorineural hearing loss, followed by 24 (16.7%) conductive and mixed 8 (5.5%). Majority of the patients 94 (64.3%) had mild to moderately severe with the remaining 50 (34.7%) having severe to profound hearing losses, respectively. Tympanometric findings showed that 118 (90.8%) and 11 (8.5%) had Types A and B tympanograms, respectively. Conclusion: Majority of the patients were adult with bilateral mild to moderately severe sensorineural hearing loss. Age-related hearing loss was the most common cause of hearing loss followed by ototoxicity.

Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit Bello Yusuf Jamoh, Sani Atta Abubakar, Sani Muhammad Isa Sahel Medical Journal 2018 21(4):213-217 Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self-referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4-year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age range of 15–92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male-to-female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%), respiratory (12.4%), cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory, hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0–12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria.

Turnaround time for electrolytes, urea, and creatinine in a clinical laboratory Ekiye Ayinbuomwan, Tomi Mathew Adaja Sahel Medical Journal 2018 21(4):218-221 Background: Timeliness is expressed as the turnaround time and is often used by the clinician as a benchmark for laboratory performance. Clinicians depend on fast turnaround time to achieve early diagnosis and treatment of their patients and early patient discharge from emergency departments or hospital in-patient services. Determination of the turnaround time would enable a critical self- appraisal of our laboratory services and improve our turnaround time. Objective: This study assessed the turnaround time for electrolytes, urea and creatinine tests from the emergency departments of the hospital. Materials and Methods: An observational study was conducted between September and October 2016 amongst patients from the Intensive Care Unit, Accident and Emergency Department and Children Emergency Room, whose blood specimens were received at the Chemical Pathology Department for emergency electrolytes, urea and creatinine tests. A total of 122 specimens were randomly selected and the average time taken to complete each phase was measured and the overall turnaround time calculated. Data was analysed using statistics software SPSS (version 13.5). Results: Audited cases consisted of 20 (16.4%) specimens from the Intensive Care Unit, 40 (32.8%) from the Children Emergency Room and 62 (50.8%) from the Accident and Emergency Department. The average turnaround time for the Accident and Emergency Department, Intensive Care Unit, and Children Emergency room were 6.5hours, 4.2hours and 5.2hours respectively. Conclusion: This study revealed that the turnaround time for electrolytes, urea and creatinine for patients in the emergency units is quite long and requires some improvement which could be done with the use of Laboratory Information System to track specimens from the various emergency units of the hospital.

Multi-organ dysfunction syndrome as the first presentation of acute brucellosis, a case report and literature review Ibrahim Masoodi Sahel Medical Journal 2018 21(4):222-226 Multiple organ dysfunction syndrome (MODS) is a continuous process with incremental degrees of physiologic derangements in individual organs. The alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. MODS, as defined, is a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems that are induced by a variety of acute insults, including sepsis. The cornerstone in the management remains correction of the triggering agent. The clinical scenario of a young male who presented with progressive shortness of breath, renal failure, and epistaxis (MODS) at presentation is discussed in this report. The diagnosis of this patient was clinically quite challenging. On evaluation, he proved to have multi-organ failure due to Brucella melitensis. The patient improved with conventional B. melitensis treatment. The Brucella infection is a male predominant disease and frequently presents with typical symptoms of fever, fatigue, etc., and the diagnosis often is straightforward, but the reports of atypical presentation have been described in the literature. The heaviest disease burden of B. melitensis lies in countries of the Mediterranean basin and Arabian Peninsula. However, the disease is not uncommon in India, Mexico, and Central America. Hence, clinicians need to be aware of this clinical entity all over the globe. The report of the case and brief review of literature are presented in this report.

Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria Idris Abdullahi Nasir, Maryam Muhammad Zakari, Adamu Idris, Abdurrahman Elfulaty Ahmad Sahel Medical Journal 2018 21(4):227-228

Oral manifestations of dengue fever

Oral manifestations of dengue fever
Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran

Sahel Medical Journal 2018 21(4):194-198

Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever. 

MicroRNA‐184 and its lncRNA sponge uca1 are induced in wounded keratinocytes in a store‐operated calcium entry‐dependent manner

Abstract

There remains a significant need for therapeutic interventions for wound healing as the clinical and socioeconomic challenges presented by the ageing population and associated rise in non‐healing wounds persist, exerting enormous pressure on health services. MicroRNAs (miRNAs) are short ≈22 nucleotide non‐coding RNA molecules that fine‐tune gene expression by degradation of mRNA targets. Several miRNAs promote keratinocyte migration, including miR‐21, miR‐31 and miR‐132 (reviewed in ³), hence miRNA‐dependent migration is emerging as a framework for wound healing.

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Substantially reduced life expectancy in patients with hidradenitis suppurativa: A Finnish nationwide registry study

Abstract

Hidradenitis suppurativa (HS) is associated with severe comorbidities,^1,2 but has not previously been subject to a systematic evaluation of mortality risk. We conducted a retrospective registry‐based case‐control study to describe life expectancy and cause‐specific death risks in patients with HS.

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http://bit.ly/2EYpcDV

“Invasive Proliferative Gelatinous Mass” of Hidradenitis Suppurativa contains distinct inflammatory components

Abstract

As defined by the European Dermatology Forum, Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease of the hair follicle in the axillae, inguinal and anogenital regions (Fig 1a, top). For severe cases, surgical management of lesions by "deroofing" is helpful. As first described by William Danby, sinus tracts contain an "invasive proliferative gelatinous mass (IPGM)" attached to the sinus tract epithelium[1]. However, the components of IPGM have not been investigated. We used existing, de‐identified, un‐matched samples of IPGM, serum and skin biopsies from normal subjects, HS patients, and acne patients to compare the composition of immune cells and cytokines all in an effort to understand the magnitude and potential biological impact of IPGM within HS lesions.

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Misuse of veterinary wormers in self‐medication of rosacea and scabies

Abstract

Dermatology patients are increasingly well informed about chronic skin conditions such as rosacea. Online forums are a popular way for patients to discuss treatments ranging from prescription drugs to alternative medicines. The introduction of topical ivermectin 1% has recently gained traction in these forums. We report a patient with papulopustular rosacea who had an excellent response to topical ivermectin 1% cream.

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http://bit.ly/2EZ93hO

Goblet cell scarcity and conjunctival inflammation during treatment with dupilumab in patients with atopic dermatitis

Abstract

Higher rates of conjunctivitis have been reported in atopic dermatitis (AD) patients treated with dupilumab, an anti‐interleukin (IL)‐4Rα antibody inhibiting IL‐4 and IL‐13, compared to patients treated with placebo.¹ However, the exact pathomechanism has not been clarified. Given the necessity of optimal treatment and risk management, the aim of this study was to describe the histopathological characteristics of conjunctivitis during dupilumab treatment in AD patients.

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The Novel Mevalonate Kinase Mutations Cause Disseminated Superficial Actinic Porokeratosis

Abstract

Disseminated superficial actinic porokeratosis (DSAP) is a rare autosomal dominant disease. In our previous research, we found that a linkage region of DSAP in a large family is located at 12q23.2‐q24.1. Subsequently, mevalonate kinase (MVK) gene was proved as a pathogenic gene of DSAP. Here, we report a new missense mutation c.566 C> T (p.A189V) in MVK in a Chinese DSAP pedigree. Mechanically, we demonstrate that both pathogenic p.A189V mutant and a sporadic mutation p.H312R(c.935A>G) which we reported previously have rapid degradation, decreased kinase activity and reduced production of cell cholesterol. Meanwhile, we found p.H312R mutation make MVK inability to form dimers. Furthermore, we demonstrate that the mutants are impaired in mitochondrial function and lead to increased apoptosis. Our results provide an important basis for elucidating the mechanism by which MVK missense mutations contribute to DSAP.

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Factors influencing current low‐value follow‐up care after basal cell carcinoma and suggested strategies for de‐adoption: a qualitative study

Summary

Background

Providing follow‐up to low‐risk basal cell carcinoma (BCC) patients can be considered as low‐value care. However, dermatologists still provide substantial follow‐up care to this patient group, for reasons not well understood.

Objectives

The aim of this study was to identify factors influencing current BCC follow‐up practices among dermatologists and suggested strategies to de‐adopt this low‐value care. In addition, views of patients regarding follow‐up care were explored.

Methods

A qualitative study was conducted consisting of 18 semi‐structured interviews with dermatologists and three focus groups with a total of 17 low‐risk BCC‐patients who had received dermatological care. The interviews focused on current follow‐up practices, influencing factors, and suggested strategies to de‐adopt the follow‐up care. The focus groups comprised preferred follow‐up schedules and providers as well as content of follow‐up. All (group)interviews were transcribed verbatim, and analysed by two researchers using Atlas.ti software.

Results

Factors influencing current follow‐up care practices among dermatologists included complying with patients' preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow‐up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de‐adopt the low‐value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realising appropriate financial reimbursement and informing dermatologists about the low‐value of care.

Conclusions

A mixture of factors appear to contribute to current follow‐up practices after low‐risk BCC. In order to de‐adopt this low‐value care, strategies should be aimed at dermatologists, GPs as well as patients.

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“A Novel Non-invasive Patient-specific Navigation Method for Orbital Reconstructive Surgery: A Phantom Study using Patient Data.”

Background: The correction of orbital deformities is an ongoing challenge in maxillofacial surgery. Computer-assisted navigation can improve surgical outcomes. However, conventional registration methods for navigation are not appropriate for orbital reconstructive surgery. This study proposes an accurate, noninvasive, patient-specific navigation method and demonstrates its feasibility. Methods: A noninvasive, patient-specific registration frame based on the external auditory canals and upper front teeth was designed using in-house developed software. A three-dimensional (3D) craniofacial model was segmented from patient computed tomography (CT) data for the registration frame. A customized craniofacial phantom was also made using this 3D model, with 20 embedded target points on the orbital model and 21 landmark points on the reference standard model. The proposed method was compared with two conventional registration methods: the dental splint-based method and the invasive marker frame-based method. Twenty trials were conducted for evaluation. Target registration error (TRE) and surface registration error (SRE) were computed to measure accuracy. Results: The proposed method showed a TRE of 1.05±0.52 mm, with greater accuracy than conventional methods (dental splint: 2.10±0.63 mm, invasive marker frame: 1.22±0.46 mm). The proposed method yielded the best results for SRE, with 0.38 mm of deviation (dental splint: 0.82 mm, invasive marker frame: 0.60 mm). Conclusions: The proposed noninvasive, patient-specific registration method demonstrated superior results for both TRE and SRE, compared to other conventional registration methods for computer-assisted navigation in orbital reconstructive surgery. Financial disclosure Statement: This work has been supported by the KIST Institutional program (2V05810, 2E27990). This study was also supported by a grant (16-724) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. Acknowledgement: This work was supported by the KIST Institutional program (2V05430). This study was also supported by a grant (16-724) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea Co-Corresponding authors: Jong Woo Choi, MD, PhD, MMM, Professor, Department of Plastic and Reconstructive Surgery, Biomedical Engineering Research Center, University of Ulsan College of Medicine, Seoul Asan Medical Center, Address: 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Tel.: +82-2-3010-3604, E-mail: pschoi@amc.seoul.kr Youngjun Kim, PhD, Principal Researcher, Center for Bionics, Korea Institute of Science and Technology, Address: 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul 02792, Republic of Korea. Tel.: +82-2-958-5606, E-mail: junekim@kist.re.kr ©2018American Society of Plastic Surgeons

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The marginal mandibular nerve of the face, vascular and nerve relations: anatomy and clinical relevance

Background: The marginal mandibular nerve (MMN) is the branch of the facial nerve that is injured most frequently during corrective and cosmetic surgery. Recent or emerging techniques such as the injection of filler materials, botulinum toxin, allotransplantation of composite tissues of the face, placement of chin implants, and submental cryolipolysis require in-depth knowledge of the anatomy of the MMN. The studies to date are not in agreement regarding the number of branches of the MMN and its relationship with the vasculature and other nerves. Methods: This study involved dissection of 62 half-heads from cadavers. Results: In 22.58% of the cases, the marginal mandibular nerve of the facial nerve was a single branched entity and lateral to the pedicle, with respect to the facial artery and the facial vein. In 16 cases (29%), the MMN had two branches. In 12.9% of the cases, the MMN gave rise to three branches. In 17 cases (35.48%), the MMN gave rise to between four and more than ten branches, thereby forming a plexus at its end. Analysis of this collection of cases revealed that the MMN was more consistently lateral to the facial vein than to the facial artery. The MMN exhibited connections with other branches of the facial nerve and branches of the trigeminal nerve. Conclusion: The facial vein had a more consistent relationship with the MMN than the facial artery. This study provides the anatomical bases of substitution, proprioception, and clinical variations in injuries of the MMN and in their prognosis. Financial disclosure: The authors have no conflicts of interest or specific sources of funding to declare. Acknowledgements: The author thanks those who donated their bodies for anatomical research and the Laboratoire d'anatomie, Paris. Acknowledgments: The authors thank those who donated their bodies for anatomical research and the Laboratoire d'anatomie, Paris. Author Participation : GT conceived of and chose the topic to be investigated and the methodology, performed the dissections, and wrote the manuscript. He discussed these various aspects with the coauthors. MKTF, TR, SV, and VP participated in dissection sessions and in the bibliographic research. CV participated in writing-up the study and preparation of the manuscript. Corresponding author: Gaoussou Touré, Service de chirurgie maxillofaciale–chirurgie plastique, Centre hospitalier intercommunal, 40 allée de la source, Villeneuve Saint-Georges 94195, France. Email:gaoussou.toure@chiv.fr; gtoure1@gmail.com ©2018American Society of Plastic Surgeons

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Multi-modal Characterization of the Mature Septal Deformity and Airspace Associated with Unilateral Cleft Lip and Palate

Background: The nasal deformity that accompanies cleft conditions is often acknowledged as the most difficult obstacle to restoring facial balance in affected children. Despite considerable progress in the treatment of cleft lip and palate, the outcomes of cleft septorhinoplasty have proven variable and difficult to predict, possibly due to incomplete understanding of the underlying anatomic deformities. We sought to characterize the unilateral cleft septal and dorsal deformities through a detailed morphologic model based on photogrammetric, qualitative, and quantitative computerized tomography (CT) image analysis. Methods: Twenty- five consecutive patients with a unilateral cleft nasal deformity without prior septorhinoplasty were included. Results: Dorsal angulation, as measured by the nasal dorsal angle (NDA), consistently deviated away from the cleft side at a mean angle of 8.9 degrees. In a majority of patients, the septal deformity was complex and consistent in the anterior and middle regions of the airspace, but variable in the posterior region. Finally, discreet sites of potential nasal obstruction were noted in the anterior, middle, and posterior regions along the acoustic axis. Considerable variation was seen in the anterior and posterior regions with potential obstructions variably on both the cleft and non-cleft sides. Conclusions: Our results underscore the importance of subject-specific analysis in cleft septorhinoplasty in order to address multiple potential sites of nasal obstruction. Financial disclosure statement: No authors have any disclosures. Corresponding author: Jeffrey R. Marcus, MD, Director, Duke Cleft & Craniofacial Center, Children's Chief of Surgery, Duke Children's Hospital, Duke Cleft & Craniofacial Center Chief, Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital & Children's Health Center, DUMC 3974 — Room 110 Baker House, 200 Trent Drive at Erwin Road, Durham, NC 27710 , jeffrey.marcus@duke.edu 919-668-3110 ©2018American Society of Plastic Surgeons

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Can a cohesive silicone bandage outperform an adhesive silicone gel sheet in the treatment of scars? A randomised comparative trial.

BACKGROUND: The use of topical silicone to treat scars is widespread and various randomised clinical studies have demonstrated its efficacy to treat scars. A new form of silicone application is a cohesive elastic bandage. The aim of this study was to compare the effects of this bandage versus an adhesive silicone gel sheet on scar elasticity after burn injury. METHODS: A total of 60 patients were enrolled in a randomised, prospective, single-blind, single-centre, comparative, parallel-group study. The participants were randomly assigned to 2 treatment arms: one for treatment with a cohesive silicone bandage, and the other for treatment with a silicone gel sheet. The colour was objectively measured using a Minolta Chromameter® and the Cutometer® was used to assess vertical elasticity. For subjective assessment of the scars we used the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: Our results reveal that there were no significant differences between the two interventions for most subjective assessments and colour measurements. However, the group who received treatment with the cohesive silicone bandage did seem to perform statistically significantly better than the silicone gel sheet group for vertical elasticity and the global score of the POSAS observer. This was probably due to the unique microstructure of the bandage which ensured a standardised pressure together with uninterrupted contact with the skin. CONCLUSION: An elastic cohesive silicone bandage seems to outperform silicone gel sheets for vertical elasticity when treating hypertrophic burn scars. The authors recommend including timing of application and duration of application in future studies. Financial Disclosure Statement: The funding sponsor of this study was Gottlieb Binder Gmbh & Co. KG, Bahnhofstr. 19, 71088 Holzgerlingen, Germany. The authors have no financial interests to declare The study was approved by the local Ethical Committee of ZNA Antwerp 009 OG.031 under the E.C. approval number 4046. The trial is registered as EUDRACT n° 003834-26 Corresponding author: Peter Moortgat, Oscare, Van Roiestraat 18, 2170 Antwerp, Belgium. Email: peter.moortgat@oscare.be ©2018American Society of Plastic Surgeons

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JAMA Otolaryngology,Head & Neck Surgery,The Most Talked About Articles of 2018 : Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood, Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia, Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss, Factors Associated With Phantom Odor Perception, Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea, Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments, Association Between Portable Music Player Use and Hearing Loss Among Children of School Age, Association of Gastroesophageal Reflux With Malignancy of the Upper Aerodigestive Tract in Elderly Patients, Association of Tinnitus and Other Cochlear Disorders With a History of Migraines, Incidence of Thyroid Cancer Among Ch

Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood

Sean G. Byars, PhD1,2; Stephen C. Stearns, PhD3; Jacobus J. Boomsma, PhD2

Author Affiliations Article Information

JAMA Otolaryngol Head Neck Surg. 2018;144(7):594-603. doi:10.1001/jamaoto.2018.0614

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Questions  Are there long-term health risks after having adenoids or tonsils removed in childhood?

Findings  In this population-based cohort study of almost 1.2 million children, removal of adenoids or tonsils in childhood was associated with significantly increased relative risk of later respiratory, allergic, and infectious diseases. Increases in long-term absolute disease risks were considerably larger than changes in risk for the disorders these surgeries aim to treat.

Meaning  The long-term risks of these surgeries deserve careful consideration.

Abstract

Importance  Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system.

Objective  To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood.

Design, Setting, and Participants  A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.

Exposures  Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life.

Main Outcomes and Measures  The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born.

Results  A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.

Conclusions and Relevance  In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.

Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia

A Systematic Review and Meta-analysis

David G. Loughrey, BA(Hons)1,2; Michelle E. Kelly, DPsychBAT1,3; George A. Kelley, DA4; et al Sabina Brennan, PhD1; Brian A. Lawlor, MD, FRCPI, FRCPsych1,2,5

Author Affiliations Article Information

1NEIL (Neuro Enhancement for Independent Lives) Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland

2School of Medicine, Trinity College Dublin, Dublin, Ireland

3Department of Psychology, National University of Ireland Maynooth, Kildare, Ireland

4Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown

5Mercer's Institute for Successful Ageing, St James Hospital, Dublin, Ireland

JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126. doi:10.1001/jamaoto.2017.2513

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Key Points

Question  Is age-related hearing loss associated with an increased risk for cognitive decline, cognitive impairment, and dementia?

Findings  In this systematic review and meta-analysis of 36 epidemiologic studies and 20 264 unique participants, age-related hearing loss was significantly associated with decline in all main cognitive domains and with increased risk for cognitive impairment and incident dementia. Increased risks for Alzheimer disease and vascular dementia were nonsignificant.

Meaning  Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia.

Abstract

Importance  Epidemiologic research on the possible link between age-related hearing loss (ARHL) and cognitive decline and dementia has produced inconsistent results. Clarifying this association is of interest because ARHL may be a risk factor for outcomes of clinical dementia.

Objectives  To examine and estimate the association between ARHL and cognitive function, cognitive impairment, and dementia through a systematic review and meta-analysis.

Data Sources and Study Selection  A search of PubMed, the Cochrane Library, EMBASE, and SCOPUS from inception to April 15, 2016, with cross-referencing of retrieved studies and personal files for potentially eligible studies was performed. Keywords included hearing, cognition, dementia, and Alzheimer disease. Cohort and cross-sectional studies published in peer-reviewed literature and using objective outcome measures were included. Case-control studies were excluded.

Data Extraction and Synthesis  One reviewer extracted and another verified data. Both reviewers independently assessed study quality. Estimates were pooled using random-effects meta-analysis. Subgroup and meta-regression analyses of study-level characteristics were performed.

Main Outcomes and Measures  Hearing loss measured by pure-tone audiometry only and objective assessment measures of cognitive function, cognitive impairment, and dementia. Cognitive function outcomes were converted to correlation coefficients (r value); cognitive impairment and dementia outcomes, to odds ratios (ORs).

Results  Forty studies from 12 countries met our inclusion criteria. Of these, 36 unique studies with an estimated 20 264 unique participants were included in the meta-analyses. Based on the pooled maximally adjusted effect sizes using random-effects models, a small but significant association was found for ARHL within all domains of cognitive function. Among cross-sectional studies, a significant association was found for cognitive impairment (OR, 2.00; 95% CI, 1.39-2.89) and dementia (OR, 2.42; 95% CI, 1.24-4.72). Among prospective cohort studies, a significant association was found for cognitive impairment (OR, 1.22; 95% CI, 1.09-1.36) and dementia (OR, 1.28; 95% CI, 1.02-1.59) but not for Alzheimer disease (OR, 1.69; 95% CI, 0.72-4.00). In further analyses, study, demographic, audiometric, and analyses factors were associated with cognitive function. Vascular dysfunction and impaired verbal communication may contribute to the association between hearing loss and cognitive decline.

Conclusions and Relevance  Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia. Additional research and randomized clinical trials are warranted to examine implications of treatment for cognition and to explore possible causal mechanisms underlying this relationship.

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

Elham Mahmoudi, PhD1,2; Philip Zazove, MD1,2; Michelle Meade, PhD2,3; et al Michael M. McKee, MD, MPH1,2

Author Affiliations Article Information

1Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor

2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor

3Department of Physical Medicine & Rehabilitation, School of Medicine, University of Michigan, Ann Arbor

JAMA Otolaryngol Head Neck Surg. 2018;144(6):498-505. doi:10.1001/jamaoto.2018.0273

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Question  Is the use of hearing aids associated with the probability of hospitalizations and emergency department visits as well as health care use and spending among older people with self-reported hearing loss?

Findings  In this cohort study of nationally representative data from 1336 US Medicare beneficiaries who reported hearing loss, self-reported use of hearing aids was associated with reducing any visits to the emergency department and hospitalizations, both by means of 2 percentage points. Use of hearing aids increased the number of office visits, if any, by 1.40 days and reduced the number of nights in the hospital, if any, by 0.46 nights; hearing aids also increased total health care spending by $1125 and out-of-pocket costs by $325 but decreased Medicare spending by $71.

Meaning  This information might be useful for the Centers for Medicare & Medicaid in deciding on insurance coverage of hearing aids for older adults with hearing loss.

Abstract

Importance  Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.

Objective  To determine whether HA use is associated with health care costs and utilization in older adults.

Design, Setting, and Participants  This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.

Exposures  Encounter with the US health care system.

Main Outcomes and Measures  (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.

Results  Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, −$81 to −$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, −2% to −2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, −3% to −1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, −0.47 to −0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).

Conclusions and Relevance  This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

Factors Associated With Phantom Odor Perception Among US Adults

Findings From the National Health and Nutrition Examination Survey

Kathleen E. Bainbridge, PhD, MPH1; Danita Byrd-Clark, BBA2; Donald Leopold, MD3

Author Affiliations Article Information

1National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland

2Social & Scientific Systems, Inc, Silver Spring, Maryland

3University of Vermont Medical Center, Burlington

JAMA Otolaryngol Head Neck Surg. 2018;144(9):807-814. doi:10.1001/jamaoto.2018.1446

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Key Points

Question  How does the prevalence of phantom odor perception vary by age, sex, socioeconomic position, health status, health behaviors, smell function, and oral and sinonasal symptoms among US adults?

Findings  In this cross-sectional study of 7417 adults, the prevalence of phantom odor perception was 6.5% (n = 534) and was greater among women, younger age groups, and those of lower socioeconomic position. Phantom odor perception was more common among those with poorer health, a history of head injury, or dry mouth symptoms.

Meaning  Epidemiologic characterization may provide clues to cause and alert clinicians to the importance of this disorder.

Abstract

Importance  Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data.

Objective  To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition.

Design, Setting, and Participants  In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey.

Exposures  Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status.

Main Outcomes and Measures  Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists.

Results  Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51).

Conclusions and Relevance  An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.

Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea

Follow-up Study of a Randomized Clinical Trial

Sebastian M. Jara, MD1; Martin L. Hopp, MD, PhD2; Edward M. Weaver, MD, MPH1,3

Author Affiliations Article Information

1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle

2Department of Otolaryngology–Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California

3Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington

JAMA Otolaryngol Head Neck Surg. 2018;144(7):587-593. doi:10.1001/jamaoto.2018.0485

Key Points

Question  What is the association of long-term continuous positive airway pressure with sexual quality of life in patients with sleep apnea?

Findings  In a cohort study of 182 patients with sleep apnea, a significant improvement in sexual quality of life measures was observed among patients who used continuous positive airway pressure vs those who did not at long-term follow-up.

Meaning  In patients with sleep apnea, successful continuous positive airway pressure use may be associated with better improvements in sexual quality of life.

Abstract

Importance  Obstructive sleep apnea reduces sexual quality of life (QOL) as a result of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. Treatment for obstructive sleep apnea may improve sexual QOL.

Objective  To test the association of long-term continuous positive airway pressure (CPAP) treatment with sexual QOL for patients with obstructive sleep apnea.

Design, Setting, and Participants  Prospective cohort study at a single, tertiary medical center of patients with newly diagnosed obstructive sleep apnea who were prescribed CPAP treatment from September 1, 2007, through June 30, 2010 (follow-up completed June 30, 2011). The statistical analysis was performed from February 1 through December 31, 2017.

Exposures  Use of CPAP treatment objectively measured by the number of hours per night. Users of CPAP were defined as patients who used CPAP treatment for more than 4 hours per night, and nonusers were defined as patients who used CPAP treatment for fewer than 0.5 hours per night.

Main Outcomes and Measures  Data were collected from eligible patients before CPAP treatment was prescribed and 12 months later by using the validated Symptoms of Nocturnal Obstruction and Related Events–25 (SNORE-25) QOL instrument. The 2 sex-specific items used to create the sexual QOL domain were taken from the SNORE-25. The sexual QOL domain was scored in a range from 0 to 5 (higher score is worse). The difference in sexual QOL between CPAP users and nonusers was analyzed using a paired, 2-tailed t test and multivariable linear regression adjusted for potential confounders.

Results  Of the 182 participants in the cohort, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) with severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). At the 12-month follow-up, 72 CPAP users (mean [SD] use, 6.4 [1.2] hours per night) had greater improvement than 110 nonusers (0 [0] hours per night) in sexual QOL scores (0.7 [1.2] vs 0.1 [1.1]; difference, 0.54; 95% CI, 0.18-0.90; effect size, 0.47). A moderate treatment association was observed after adjustment for age, sex, race/ethnicity, marital status, income level, educational level, body mass index, apnea-hypopnea index, and the Functional Comorbidity Index (adjusted difference, 0.49; 95% CI, 0.09-0.89; effect size, 0.43). Subgroup analysis revealed a large treatment association for women (adjusted difference, 1.34; 95% CI, 0.50-2.18; effect size, 0.87) but not for men (adjusted difference, 0.16; 95% CI, −0.26 to 0.58; effect size, 0.19).

Conclusions and Relevance  Successful CPAP use may be associated with improved sexual QOL. Subgroup analysis revealed a large improvement in women but no improvement in men. Further study is warranted to test other measures of sexual QOL and other treatments.

Trial Registration  ClinicalTrials.gov Identifier: NCT00503802

Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments

Eric T. Carniol, MD, MBA1; Amishav Bresler, MD2; Kevin Shaigany, MD3; et al Peter Svider, MD4; Soly Baredes, MD2,5; Jean Anderson Eloy, MD2,5,6,7; Yu-Lan Mary Ying, MD2

Author Affiliations Article Information

1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada

2Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark

3Department of Otolaryngology–Head and Neck Surgery, University of Maryland, Baltimore

4Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan

5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark

6Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark

7Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark

JAMA Otolaryngol Head Neck Surg. 2018;144(2):136-139. doi:10.1001/jamaoto.2017.2550

Key Points

Question  What are the leading causes of traumatic tympanic membrane perforation in the United States?

Findings  In this cross-sectional analysis of 949 emergency department visits, foreign body instrumentation (including cotton-tipped applicators) was the most frequent cause of traumatic tympanic membrane perforations.

Meaning  The leading cause of traumatic tympanic membrane perforations may be preventable, and patient education may prevent this frequent cause of injury.

Abstract

Importance  Tympanic membrane perforations (TMPs) are frequent events leading to evaluation in the primary care and otolaryngology offices or the emergency department (ED). Despite specific warning labels on packaging of cotton-tipped applicators regarding the risk of injury to the ear canal with personal use, these products are commonly used to remove ear cerumen.

Objective  To analyze the mechanism of injury for traumatic TMPs among patients presenting to the ED.

Design, Setting, and Participants  Cross-sectional analysis of cases from 100 emergency departments in the United States. The National Electronic Injury Surveillance System was searched on April 3, 2015, for ear-related injuries with analysis information regarding patient age, patient sex, time and date of injury, specific injury diagnoses, and specific injury mechanisms that occurred across 5 years, from January 1, 2010, through December 31, 2014.

Main Outcomes and Measures  Diagnoses of traumatic TMP documented in the ED visit record as well as patient demographics, diagnoses, and other aspects of the injury, including mechanism of injury.

Results  There were 949 case entries in the database for traumatic TMP, which extrapolates to 4852 ED visits nationally. Of 949 patients evaluated, 568 (59.8%) were men and 381 (40.2%) were women resulting in a male to female ratio of 1.49:1. Most injuries occurred in patients 18 years or younger (602 of 949 [63.4%]) with children younger than 6 years most at risk (331 of 949 [34.9%]). Ear canal instrumentation including foreign bodies was noted in 581 of 949 cases (61.2%), with cotton-tipped applicators noted in 261 (44.9%) of these cases. While foreign body instrumentation represented the leading cause of traumatic TMP in patients aged 0 to 5 years (284 of 331 cases [85.8%]), 6 to 12 years (108 of 158 [68.4%]), 19 to 36 years (85 of 223 [38.1%]), 37 to 54 years (48 of 91 [52.7%]), and 55 years or older (22 of 33 [66.7%]), water trauma was the leading cause of TMP in patients aged 13 to 18 years (43 of 113 cases [38.1%]).

Conclusions and Relevance  Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.

Association Between Portable Music Player Use and Hearing Loss Among Children of School Age in the Netherlands

Carlijn M. P. le Clercq, MD1,2; André Goedegebure, PhD1; Vincent W. V. Jaddoe, MD, PhD2,3,4; et al Hein Raat, MD, PhD, MBA2,5; Robert J. Baatenburg de Jong, PhD, MD1; Marc P. van der Schroeff, PhD, MD1,2

Author Affiliations Article Information

1Department of Otolaryngology and Head–Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands

2The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands

3Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands

4Department of Paediatrics, Erasmus University Medical Center–Sophia Children's Hospital, Rotterdam, the Netherlands

5Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands

JAMA Otolaryngol Head Neck Surg. 2018;144(8):668-675. doi:10.1001/jamaoto.2018.0646

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Key Points

Question  What is the prevalence of noise-induced hearing loss among children aged 9 to 11 years in the Netherlands?

Findings  In this cross-sectional, population-based study among 3316 children with normal middle-ear function, audiometry data showed the prevalence of audiometric notches and high-frequency hearing loss was 14.2%. Portable music players, used by 40.0% of the cohort, were associated with high-frequency hearing loss.

Meaning  Signs of noise-induced hearing loss may already be present in children aged 9 to 11 years old and may be associated with portable music player use prior to exposure to known noise hazards, such as club and concert attendance.

Abstract

Importance  Portable music player use may have harmful effects on hearing. The magnitude and effect of frequent music exposure, especially at younger ages, on hearing are unclear.

Objectives  To examine the prevalence of noise-induced hearing loss in a 9- to 11-year-old population and associations with portable music player use and sociodemographic factors.

Design, Setting, and Participants  A cross-sectional study within an ongoing, prospective, birth cohort study within Rotterdam, the Netherlands was conducted. Between ages 9 and 11 years, 5355 children underwent their first audiometric evaluation. Children were excluded if they had missing or failed tympanometry results. The study was conducted from April 16, 2012, to October 25, 2015.

Exposures  Portable music player (PMP) use and sociodemographic factors assessed via parental questionnaires.

Main Outcomes and Measures  Hearing acuity measured by pure-tone audiometry at 0.5 to 8 kHz. Possible noise-induced hearing loss was contingent on a high-frequency notch and/or high-frequency hearing loss in the audiogram, or reported hearing-related symptoms.

Results  The final sample included 3116 participants who were a mean (interquartile range) age of 9.7 (9.6-9.9) years and equally distributed between boys (1550 [49.7%]) and girls (1566 [50.3%]). Of these, 1244 (39.9%) reported no PMP use, 577 (18.5%) reported use 1 or 2 days per week, 254 (8.2%) reported use 3 or more days per week, and for 1041 (33.4%), PMP use was not reported. Audiometric notches and high-frequency hearing loss were present in 443 (14.2%) of all children; 140 (4.5%) fulfilled the criteria of a notch, 238 (7.6%) of high-frequency hearing loss, and 65 (2.1%) of both. Of the cohort, 52 (1.7%) showed bilateral impairment. Hearing-related symptoms were reported for 232 (11.3%) of the respondents, and 831 (40.0%) of the respondents used portable music players. Portable music player use was associated with high-frequency hearing loss (odds ratio [OR], 2.88; 95% CI, 1.36-6.980 for 1 or 2 days per week and OR, 2.74; 95% CI, 1.22-6.96 for ≥3 days per week), but listening time and duration were not. There was no association of music exposure with high-frequency notches.

Conclusions and Relevance  In this study, 14.2% of school-aged children showed audiometric notches or high-frequency hearing loss. This hearing impairment is already present prior to exposure to known noise hazards, such as club and concert attendance, and may have lifelong consequences. Repeated measurements are needed to confirm the association of portable music player use with hearing impairment in children.

Association of Gastroesophageal Reflux With Malignancy of the Upper Aerodigestive Tract in Elderly Patients

Charles A. Riley, MD1; Eric L. Wu, MS1; Mei-Chin Hsieh, PhD2; et al Michael J. Marino, MD1; Xiao-Cheng Wu, MD, MPH2; Edward D. McCoul, MD, MPH1,3,4

Author Affiliations Article Information

1Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana

2Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans

3Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana

4Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana

JAMA Otolaryngol Head Neck Surg. 2018;144(2):140-148. doi:10.1001/jamaoto.2017.2561

Key Points

Question  Is gastroesophageal reflux disease (GERD) associated with malignancy of the upper aerodigestive tract (UADT)?

Findings  A case-control study of individuals in the United States aged 66 years and older was performed with data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. GERD was associated with a greater odds of developing malignancy of the larynx, hypopharynx, oropharynx, nasopharynx, and paranasal sinuses.

Meaning  GERD is associated with the presence of malignancy of the UADT in the elderly population of the United States.

Abstract

Importance  Chronic inflammatory states have been linked to the development of malignancy. Gastroesophageal reflux disease (GERD) is a known risk factor for esophageal adenocarcinoma as the end result of chronic inflammatory changes.

Objective  To investigate the association of GERD with the risk of malignancy in the upper aerodigestive tract (UADT).

Design, Setting, and Participants  We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a case-control study of individuals in the United States who had been added from January 2003 through December 2011 and were 66 years or older. The study included patients diagnosed with malignancy of the larynx, hypopharynx, oropharynx, tonsil, nasopharynx, and paranasal sinuses. GERD was examined as an exposure. Controls were matched from a 5% random sample of Medicare beneficiaries without cancer. Multivariable unconditional logistic regression was performed.

Main Outcomes and Measures  Incidence of invasive malignancies of the UADT.

Results  A total of 13 805 patients (median [range] age, 74 [66-99] years; 3418 women [24.76%] and 10 387 men [75.24%]) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio [aOR], 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).

Conclusions and Relevance  GERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility.

Association of Tinnitus and Other Cochlear Disorders With a History of Migraines

Juen-Haur Hwang, MD, PhD1,2; Shiang-Jiun Tsai3; Tien-Chen Liu, PhD4; et al Yi-Chun Chen, MD2,5; Jen-Tsung Lai, MD6

Author Affiliations Article Information

1Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

2School of Medicine, Tzu Chi University, Hualien, Taiwan

3Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

4Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan

5Department of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

6Department of Otolaryngology, Kuang-Tien General Hospital, Shalu, Taichung, Taiwan

JAMA Otolaryngol Head Neck Surg. 2018;144(8):712-717. doi:10.1001/jamaoto.2018.0939

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Key Points

Question  Does a history of migraines increase the risk of tinnitus and other cochlear disorders?

Findings  In this cohort study of claims data among patients in Taiwan, 1056 patients with a history of migraines and 4224 controls were identified. The cumulative incidence of cochlear disorders, especially tinnitus, was found to be significantly higher among patients with history of migraines than those without a history of migraines.

Meaning  A history of migraines may increase the risk of tinnitus and other cochlear disorders.

Abstract

Importance  A headache is a symptom of a migraine, but not all patients with migraine have headaches. It is still unclear whether a migraine might increase the risk of cochlear disorders, even though a migraine does not occur concurrently with cochlear disorders.

Objective  To investigate the risk of cochlear disorders for patients with a history of migraines.

Design, Setting, and Participants  This study used claims data from the Taiwan Longitudinal Health Insurance Database 2005 to identify 1056 patients with migraines diagnosed between January 1, 1996, and December 31, 2012. A total of 4224 controls were also identified from the same database based on propensity score matching. Statistical analysis was performed from January 23, 1996, to December 28, 2012.

Main Outcomes and Measures  The incidence rate of cochlear disorders (tinnitus, sensorineural hearing impairment, and/or sudden deafness) was compared between the cohorts by use of the Kaplan-Meier method. The Cox proportional hazards regression model was also used to examine the association of cochlear disorders with migraines.

Results  Of the 1056 patients with migraines, 672 were women and 384 were men, and the mean (SD) age was 36.7 (15.3) years. Compared with the nonmigraine cohort, the crude hazard ratio for cochlear disorders in the migraine cohort was 2.83 (95% CI, 2.01-3.99), and the adjusted hazard ratio was 2.71 (95% CI, 1.86-3.93). The incidence rates of cochlear disorders were 81.4 (95% CI, 81.1-81.8) per 1 million person-years for the migraine cohort and 29.4 (95% CI, 29.2-29.7) per 1 million person-years for the nonmigraine cohort. The cumulative incidence of cochlear disorders in the migraine cohort (12.2%) was significantly higher than that in the matched nonmigraine cohort (5.5%). Subgroup analysis showed that, compared with the nonmigraine cohort, the adjusted hazard ratios in the migraine cohort were 3.30 (95% CI, 2.17-5.00) for tinnitus, 1.03 (95% CI, 0.17-6.41) for sensorineural hearing impairment, and 1.22 (95% CI, 0.53-2.83) for sudden deafness.

Conclusions and Relevance  In this population-based study, the risk of cochlear disorders, especially for tinnitus, was found to be significantly higher among patients with a history of migraines. This finding may support the presence and/or concept of "cochlear migraine."

Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident

Akira Ohtsuru, MD1,2; Sanae Midorikawa, MD1,2; Tetsuya Ohira, MD2,3; et al Satoru Suzuki, MD2; Hideto Takahashi, PhD2; Michio Murakami, PhD2,4; Hiroki Shimura, MD2,5; Takashi Matsuzuka, MD2,6; Seiji Yasumura, MD2,7; Shin-ichi Suzuki, MD8; Susumu Yokoya, MD9; Yuko Hashimoto, MD10; Akira Sakai, MD2,11; Hitoshi Ohto, MD2; Shunichi Yamashita, MD2,12; Koichi Tanigawa, MD2; Kenji Kamiya, MD2,13

Author Affiliations Article Information

1Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan

2Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan

3Department of Epidemiology, Fukushima Medical University, Fukushima, Japan

4Department of Health Risk Communication, Fukushima Medical University, Fukushima, Japan

5Department of Laboratory Medicine, Fukushima Medical University, Fukushima, Japan

6Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan

7Department of Public Health, Fukushima Medical University, Fukushima, Japan

8Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima, Japan

9Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan

10Department of Pathology, Fukushima Medical University, Fukushima, Japan

11Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan

12Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

13Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

JAMA Otolaryngol Head Neck Surg. Published online November 29, 2018. doi:10.1001/jamaoto.2018.3121

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Comment

Key Points

Question  What is the pattern by age group of cancer detection via ultrasonographic screening of the thyroid among children and young adults within 5 years of the 2011 Fukushima Daiichi nuclear power station accident?

Findings  In this cohort study of 324 301 children and young adults, thyroid cancer was diagnosed in 187 individuals within 5 years when health effects of radiation were hardly conceivable. The distribution pattern of the incidence rate by age group in second-round examinations increased with older age.

Meaning  Large-scale mass screening resulted in the diagnosis of many thyroid cancers even in young age; to avoid overdiagnosis, an improvement in screening strategy based on the understanding of the natural history of thyroid cancer will be urgently needed.

Abstract

Importance  Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed.

Objectives  To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations.

Design, Setting, and Participants  In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry.

Main Outcomes and Measures  Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round.

Results  Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years.

Conclusions and Relevance  Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.