Ετικέτες

Τετάρτη 23 Μαρτίου 2022

Second primary malignancies induced by radioactive iodine treatment of differentiated thyroid carcinoma - a critical review and evaluation of the existing evidence radioactive iodine 5h Tracking Uptake and Metabolism of Xenometallomycins Using a Multi-Isotope Tagging Strategy radioactive iodine 5h A Study to Assess the Effect of Size & Site of Tympanic Membrane Perforation on Hearing Loss Otolaryngology Indian 8h Response to “Radioiodine Is Molecular Radiotherapy Governed by Predictable Deterministic Radiobiology Expressed in Gray, Not Millicuries” by Kao liebertpub1 12h Sex Differences in Differentiated Thyroid Cancer liebertpub1 12h Unique Molecular Signatures Are Associated with Aggressive Histology in Pediatric Differentiated Thyroid Cancer liebertpub1 12h Severe Resistance to Thyroid Hormone Beta in a Patient with Athyreosis liebertpub1 12h Follicular and Hurthle Cell Carcinoma: Comparison of Clinicopathological Features and Clinical Outcomes liebertpub1 12h For more inform


Second primary malignancies induced by radioactive iodine treatment of differentiated thyroid carcinoma - a critical review and evaluation of the existing evidence
radioactive iodine
5h
Tracking Uptake and Metabolism of Xenometallomycins Using a Multi-Isotope Tagging Strategy
radioactive iodine
5h
A Study to Assess the Effect of Size & Site of Tympanic Membrane Perforation on Hearing Loss
Otolaryngology Indian
8h
Response to "Radioiodine Is Molecular Radiotherapy Governed by Predictable Deterministic Radiobiology Expressed in Gray, Not Millicuries" by Kao
liebertpub1
12h
Sex Differences in Differentiated Thyroid Cancer
liebertpub1
12h
Unique Molecular Signatures Are Associated with Aggressive Histology in Pediatric Differentiated Thyroid Cancer
liebertpub1
12h
Severe Resistance to Thyroid Hormone Beta in a Patient with Athyreosis
liebertpub1
12h
Follicular and Hurthle Cell Carcinoma: Comparison of Clinicopathological Features and Clinical Outcomes
liebertpub1
12h
For more information and a current list of upcoming thyroid-related meetings, visit www.thyroid.org/professionals/meetings
liebertpub1
12h
Thyroidectomies in Italy: A Population-Based National Analysis from 2001 to 2018
liebertpub1
12h
Functional Characterization of the Novel and Specific Thyroid Hormone Transporter SLC17A4
liebertpub1
12h
Enhancing Radioiodine Incorporation in BRAF-Mutant, Radioiodine-Refractory Thyroid Cancers with Vemurafenib and the Anti-ErbB3 Monoclonal Antibody CDX-3379: Results of a Pilot Clinical Trial
liebertpub1
12h
Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population
Voice
14h
Where do we come from? Where are we? Where are we going? : President's speech at the 92nd Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery on the occasion of its centennial. German version
hno
15h
Eustachian tube dysfunction after cleft palate surgery : Use of the latest diagnostics
hno
15h
Survey of Pediatric Otolaryngology Frenotomy Practice Patterns
The Laryngoscope
16h
Breast reconstruction during the COVID-19 pandemic: Single institution experience from the pandemic's epicenter in the United States
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
17h
"Pandemic puppies" - The UK animal bite pandemic
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
17h
The impact of parity in primary breast augmentation: A clinical and cost-effective case control study
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
17h
Monomeric C-reactive protein level is associated with osteoarthritis
Experimental and therapeutic medicine
17h
MicroRNA-302 inhibits cell migration and invasion in cervical cancer by targeting DCUN1D1
Experimental and therapeutic medicine
17h
miR-150-5p inhibits osteogenic differentiation of fibroblasts in ankylosing spondylitis by targeting VDR
Experimental and therapeutic medicine
17h
Expression of TMED3 is independently associated with colorectal cancer prognosis
Experimental and therapeutic medicine
17h
Gelsolin impairs barrier function in pancreatic ductal epithelial cells by actin filament depolymerization in hypertriglyceridemia-induced pancreatitis <em>in vitro</em>
Experimental and therapeutic medicine
17h
Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma
Experimental and therapeutic medicine
17h
Effects and early diagnostic value of lncRNA H19 on sepsis-induced acute lung injury
Experimental and therapeutic medicine
17h
Adrenocortical carcinoma: Pediatric aspects (Review)
Experimental and therapeutic medicine
17h
Circular RNA hsa_circ_0011946 promotes the malignant process of salivary adenoid cystic carcinoma by downregulating miR-1205 expression
Experimental and therapeutic medicine
17h
MicroRNA-200a-3p and GATA6 are abnormally expressed in patients with non-small cell lung cancer and exhibit high clinical diagnostic efficacy
Experimental and therapeutic medicine
17h
Long non-coding RNA TUG1 promotes osteosarcoma cell proliferation and invasion through inhibition of microRNA-212-3p expression
Experimental and therapeutic medicine
17h
Nephroprotective effect of magnesium isoglycyrrhizinate against arsenic trioxide-induced acute kidney damage in mice
Experimental and therapeutic medicine
17h
Anagliptin promotes apoptosis in mouse colon carcinoma cells via MCT-4/lactate-mediated intracellular acidosis
Experimental and therapeutic medicine
17h
pH regulates the lumen diameter of tissue-engineered capillaries
Experimental and therapeutic medicine
17h
Diabetes mellitus: Plasticizers and nanomaterials acting as endocrine-disrupting chemicals (Review)
Experimental and therapeutic medicine
17h
An integrative therapeutic approach to elephantiasis nostras verrucosa: A case report
Experimental and therapeutic medicine
17h
S100A9 blockade improves the functional recovery after spinal cord injury via mediating neutrophil infiltration
Experimental and therapeutic medicine
17h
A propósito de un caso: procedimiento EXIT (<em>Extrauterine Intrapartum Treatment</em>) en gestación con teratoma cervical
Acta Otorrinolaringológica Española
17h
Language lateralization and outcome in perinatal stroke patients with different vascular types
Brain and Language
17h
Neuroradiological Basis of COVID‐19 Olfactory Dysfunction: A Systematic Review and Meta‐Analysis
The Laryngoscope
18h
Endoscopic Image Luminance Enhancement Based on the Inverse Square Law for Illuminance and Retinex
The International Journal of Medical Robotics and Computer Assisted Surgery
18h
Effectiveness of gabapentin in reducing opioid requirements after radiation in head and neck cancer in a single institution
Head & Neck
20h
Radiologic–pathologic correlation of major versus minor extranodal extension in oral cavity cancer
Head & Neck


Effectiveness of gabapentin in reducing opioid requirements after radiation in head and neck cancer in a single institution
20h
by
David R. Gilley, Andrew D. Clark, Maggie E. Wieser, Craig A. Bollig, Laura M. Dooley, Gregory B. Biedermann
via
Head & Neck
Abstract
Background
Gabapentin has been shown to reduce opioid use in head and neck cancer patients. Here, we examine the efficacy of prophylactic gabapentin at reducing opioid use in these patients at our institution.

Methods
A retrospective study of patients receiving radiation was performed, using patients from our previous study as controls. Risk factors for opioid use at 3 and 6 months were determined using univariate and multivariate analyses.

Results
In total, 53/185 patients were treated with gabapentin, 39.6% of which took opioids at 3 months vs. 58.3% in the non-gabapentin cohort (p = 0.021). Gabapentin was independently associated with less opioid use on multivariate analysis at 3 months (OR 0.47, 95% CI 0.24–0.9). Gastrostomy tube dependence and pretreatment opioid use were associated with chronic opioid use despite gabapentin.

Conclusions
Gabapentin is effective at expediting opioid tapering in head and neck cancer patients who are not gastrostomy tube dependent or taking opioids pretreatment.

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Radiologic–pathologic correlation of major versus minor extranodal extension in oral cavity cancer
20h
by
Michael A. Blasco, Christopher W. Noel, Tra Truong, Shao Hui Huang, David P. Goldstein, Jonathan C. Irish, Ralph Gilbert, Ali Hosni, Andrew Hope, Brian O'Sullivan, John Waldron, Bayardo Perez‐Ordonez, Ilan Weinreb, Stephen M. Smith, Eric Bartlett, Eugene Yu, John R. Almeida
via
Head & Neck
Abstract
Background
To evaluate the diagnostic performance of radiologic extranodal extension (rENE) in predicting major (>2 mm) and minor (≤2 mm) pathologic ENE (pENE).

Methods
All oral cavity squamous cell carcinoma patients who underwent neck dissection with pathological nodal disease (pN+) between 2010 and 2015 were reviewed. Preoperative computed tomography and/or magnetic resonance imaging were reviewed by two head and neck neuroradiologists.

Results
Three hundred and thirty-four patients were included. The sensitivity and specificity of rENE were 37% [95% CI 29–44] and 98% [95% CI 96–100], respectively. Sensitivity for pENE improved in the subset of patients with major ENE (48% [95% CI 38–57]). The presence of rENE was associated with inferior 3-year overall survival: 26% [95% CI 17–41] versus 60% [95% CI 54–67].

Conclusions
This large cohort study demonstrates high specificity, but low sensitivity for preoperative imaging in the detection of pENE in OCSCC. Patients with rENE demonstrated poor OS. pENE in the absence of rENE is still an adverse risk factor.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,

Neue Therapieansätze für Speicheldrüsenmalignome

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Laryngorhinootologie
DOI: 10.1055/a-1792-2246

In den vergangenen Jahren haben sich durch die Verbesserung und Verbreitung molekularpathologischer Testverfahren und die Möglichkeit von zielgerichteten Therapien neue Optionen in der Behandlung von Speicheldrüsenmalignomen ergeben. Durch die neuen zielgerichteten Therapieoptionen werden Patienten deutlich weniger toxische Alternativen zur konventionellen zytostatischen Chemotherapie geboten. Zum einen gibt es neue entitätsspezifische Therapien, wie z.B. die Therapie mit NTRK-Inhibitoren bei sekretorischen Karzinomen und die Therapie mit Axitinib bei adenoidzystischen Karzinomen. Darüber hinaus rücken aber auch entitätsübergreifende Therapeutika, wie z.B. die antiandrogene The rapie, die HER2-Inhibition oder auch die PI3K-Inhibition, in den Vordergrund. Bei metastasierten/rezidivierten Speicheldrüsenkarzinomen, welche nicht mit einer zielgerichteten Therapie behandelt werden können, werden weiterhin hauptsächlich platinbasierte Chemotherapien eingesetzt.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Endoscopic dacryocystorhinostomy for refractory nasolacrimal duct obstruction with a small lacrimal sac (≤ 5 mm in diameter)

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Eur Arch Otorhinolaryngol. 2022 Mar 23. doi: 10.1007/s00405-022-07347-1. Online ahead of print.

ABSTRACT

BACKGROUND: Although endoscopic dacryocystorhinostomy (DCR) is a standard procedure for nasolacrimal duct obstruction (NLDO), the failure rate remains approximately 10%. A small lacrimal sac is considered the main reason for surgical failure. We explored the efficacy of endoscopic DCR for the treatment of NLDO with a small lacrimal sac.

METHODS: The clinical data of 72 patients (88 eyes) diagnosed with NLDO and undergoing endoscopic DCR from 2012 to 2020, with at least 24 months of follow-up were retrospectively collected. Intraoperatively, the Rosenmüller valves were fully exposed, mucosal flaps were preserved to cover the naked bone, and a silicone tube was implanted if necessary. Postoperative intervention was performed if necessary. The main outcome measures were symptomatic improvement and objective ostium patency.

RESULTS: Eighty-eight eyes of 72 patients were divided into two groups: the refractory group (34 patients, 47 eyes), with a small lacrimal sac (≤ 5 mm in diameter), and the simple group (38 patients, 41 eyes). Patients with small lacrimal sacs were more prone to bilateral eye disease than those in the simple group (P = 0.014) and required a longer postoperative follow-up (P < 0.001). Refractory NLDO and simple NLDO had a success rate of 91.5% and 95.1%, respectively, with no significant difference.

CONCLUSION: Endoscopic DCR for refractory NLDO with a small lacrimal sac could achieve a beneficial result by exposing the Rosenmüller valves, preserving mucosal flaps, implanting necessary intubation, and intervening postoperatively. Thus, a small lacrimal sac should not be regarded as a contraindication to surgery.

PMID:35320400 | DOI:10.1007/s00405-022-07347-1

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Pelvic Pain after italian coffee consumption : Ischemic colitis (IC) is an inflammatory condition of the large intestine, or colon. It develops when there isn't enough blood flow to the colon.

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. It can be a sharp and stabbing pain in a specific spot, or a dull pain that is spread out. If the pain is severe, it might get in the way of your daily activities.Pelvic pain can be steady, or it can come and go. It can be a sharp and stabbing pain felt in a specific spot, or a dull pain that is spread out.
Ischemic colitis occurs when blood flow to part of the large intestine (colon) is temporarily reduced, usually due to constriction of the blood vessels supplying the colon or lower flow of blood through the vessels due to low pressures.
For patients who present with symptoms of ischemia, a CT scan of the abdomen with oral and IV contrast and laboratory testing can be performed. Manifestations of ischemic colitis on CT include colonic wall thickening, edema, thumbprinting, bowel dilatation, and effusion of intestinal circumference.

  


#
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,

Τρίτη 22 Μαρτίου 2022

ROBOTIC REPAIR OF ATRIAL SEPTAL DEFECT WITH PARTIAL PULMONARY VENOUS RETURN ANOMALY: OUR 5‐YEAR EXPERIENCE

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ABSTRACT

Introduction

Partial pulmonary venous return anomalies (PPVRA) were not considered as a good candidate for robotic surgery in early time of robotic cardiac surgery. In this study, we present our experience in patients undergoing robotic atrial septal defect (ASD) and PPVRA surgery.

Methods

Between November 2014-January 2020, data of 21 patients underwent robotic ASD with PPVRA was collected. Inclusion criterion was presence of right-sided PPVRA with ASD. All operations were performed robotically.

Results

The mean age of patients was 26.7±10.3 years. 17 patients (81 %) had superior-caval ASD with supracardiac PPVRA and double-patch technique was used. Four patients had inferior-caval ASD with intracardiac PPVRA and single-patch technique was preferred. Cross-clamp time and cardiopulmonary bypass time were 92.8±29.6 and 127.8±38.1, respectively. There was no mortality. One patient had atrioventricular-block and required pacemaker.

Conclusion

Robotic repair of ASD with PPVRA is feasible and effective method as an alternative to conventional surgery.

This article is protected by copyright. All rights reserved.

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The effectiveness of topical 1% lidocaine with systemic oral analgesics for ear pain with acute otitis media

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Publication date: May 2022

Source: International Journal of Pediatric Otorhinolaryngology, Volume 156

Author(s): Ateş Kara, Ayşe Büyükcam, Murat Sütçü, Enes Sali, Şefika Elmas Bozdemir, Manolya Kara, Eda Çullas İlarslan, Cemil Kaya, Sabahat Karakaşlılar, Gülsüm Sönmez, Soner Sertan Kara, Tuğba Bedir, Eda Albayrak, Tuğçe Tural Kara, Solmaz Çelebi, Fatma Nur Öz, Adem Karbuz, Ayper Somer, Derya Alabaz, Hasan Tezer

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Comparison of Video Head Impulse Test Findings in Individuals Aged between 20–39 and 40–60 Years

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Özge Gedik, Nilüfer Bal, Sümeyye Özdemir, Berna Özge Mutlu, Elifnur Taşdemir, Burcu Kaya, Eda Kurt, Nur Sema Kaya, Zeynep Durukan

Indian Journal of Otology 2021 27(4):225-229

Objective: The aim of this study was to investigate the normal gain values specific to each semicircular canals by using the goggle-less model of video head impulse test (vHIT) between ages of 20–39 and 40–60, gender and age-related gain values changes. Materials and Methods: The present study was performed in 99 participants aged 20–39 years and 100 participants aged 40–60 years. Each semicircular canal gain values were interpreted by comparing for both the age group of 20–39 and 40–60 years and gender. Results: The mean right lateral, right posterior, left lateral, and left posterior canal gain of 20–39 age group was significantly higher than the 40–60 age group. Regardless of age, while the mean left lateral canal gain in females was significantly higher than males, the mean right anterior and right posterior canal gain was significantly higher in males. The mean right lateral and the left lateral canal gains were significantly higher in females in the 20–39 year s' age group; however, the mean right anterior, right posterior, and left posterior canals gains were significantly higher in males than in females. The mean right lateral canal gain in males was significantly higher in the 40–60 age group than that of females. Conclusions: The vHIT as a standard test for vestibular assessment provides clinical benefits, in addition the comparing for different age groups for goggle-less vHIT model will provide more beneficial results in the evaluation of patients. In the literature, there are not many studies on the goggle-less vHIT device, so we believe our study will be a pioneer in this field.
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Otogenic Cerebral Venous Sinus Thrombosis: A Case Report and Literature Review

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Mostafa Meshref, Ahmed Taher Masoud, Amira Yasmine Benmelouka

Indian Journal of Otology 2021 27(4):238-240

Cerebral venous sinus occlusion is an exceptional presentation in the emergency department. Otitis and mastoiditis are rarely associated with cerebral venous sinus occlusion. It is considered as a redoubtable complication with potentially severe outcomes. Symptoms that may indicate this thrombosis are variable and include progressive headache, intracranial hypertension, seizures, focal neurological deficits, and ophthalmologic symptoms. In this article, we report a case of a young female patient presenting with otitis and mastoiditis complicated with intracranial thrombosis. She was successfully treated with antibiotics, anticoagulants, and analgesics. Furthermore, we provide a brief review on cerebral venous sinus thrombosis with a focus on its risk factors and its management. Finally, we emphasize the need for better awareness about this potential intracranial complication.
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The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls

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Background. Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective. This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims t o emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results. Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion. Fungal ball may present with variety of symptoms but m ost commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.
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Evolution of midface microvascular reconstruction: three decades of experience from a single institution

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Eur Arch Otorhinolaryngol. 2022 Mar 22. doi: 10.1007/s00405-022-07321-x. Online ahead of print.

ABSTRACT

PURPOSE: Midface reconstruction poses a complex set of challenges for reconstructive surgeons. The optimal midface reconstruction must possess a durable underlying bone construct capable of integrating dental implants. Facial contour is restored by the overlying microvascular soft tissue reconstruction with reestablishment of the oral cavity. A plethora of microvascular flaps used in clinical practice have been described including those harvested from the iliac crest, scapula, fibula, forearm and back (latissimus dorsi). The objective was to share our experiences with each of these treatment options that have continued to evolve over time for the benefit of patients.

METHODS: Our institution has over three decades of experience in reconstructing complex midface defects and this article summarizes midface reconstruction from an evolutionary perspective (for type II, III and IV defect; Browns classification, Supplementary Table I). We broadly divide this into (i) flaps supplied by the subscapular system (ii) autologous reconstruction with titanium mesh and (iii) fibula microvascular flaps using 3D planning.

RESULTS: The advantages and disadvantages for each approach are discussed (Supplementary Table II).

CONCLUSION: In the future, it is expected that 3D planning coupled with rapid prototyping, intraoperative navigation and CT imaging will become standard procedural practice.

PMID:35316380 | DOI:10.1007/s00405-022-07321-x

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Δευτέρα 21 Μαρτίου 2022

Common exacerbation-prone phenotypes across asthma and chronic obstructive pulmonary disease (COPD)

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Via Rhinitis

journal.pone.0264397.t005&size=inline

by Kentaro Hyodo, Hironori Masuko, Hisayuki Oshima, Rie Shigemasa, Haruna Kitazawa, Jun Kanazawa, Hiroaki Iijima, Hiroichi Ishikawa, Takahide Kodama, Akihiro Nomura, Katsunori Kagohashi, Hiroaki Satoh, Takefumi Saito, Tohru Sakamoto, Nobuyuki Hizawa

Background and objectives

Chronic inflammatory airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are complex syndromes with diverse clinical symptoms due to multiple pathophysiological conditions. In this study, using common and shared risk factors for the exacerbation of asthma and COPD, we sought to clarify the exacerbation-prone phenotypes beyond disease labels, and to specifically investigate the role of the IL4RA gene polymorphism, which is related to type 2 inflammation, in these exacerbation-prone phenotypes.

Methods

The study population comprised patients with asthma (n = 117), asthma-COPD overlap (ACO; n = 37) or COPD (n = 48) and a history of exacerbation within the previous year. Cluster analyses were performed using factors associated with both asthma and COPD exacerbation. The association of the IL4RA gene polymorphism rs8832 with each exacerbation-prone phenotype was evaluated by multinomial logistic analyses usi ng non-asthma non-COPD healthy adults as controls (n = 1,529). In addition, the genetic influence of rs8832 was also examined in asthma patients with allergic rhinitis and no history of exacerbation (n = 130).

Results

Two-step cluster analyses identified five clusters that did not necessarily correspond to the diagnostic disease labels. Cluster 1 was characterized by high eosinophil counts, cluster 2 was characterized by smokers with impaired lung function, cluster 3 was characterized by the presence of gastroesophageal reflux, cluster 4 was characterized by non-allergic females, and cluster 5 was characterized by allergic rhinitis and elevated total immunoglobulin E levels. A significant association with rs8832 was observed for cluster 5 (odds ratio, 3.88 (1.34–11.26), p = 0.013) and also for the type 2 exacerbation-prone phenotypes (clusters 1 and 5: odds ratio, 2.73 (1.45–5.15), p = 1.9 × 10−3).

Discussion

Our results indicated that t he clinical heterogeneity of disease exacerbation may reflect the presence of common exacerbation-prone endotypes across asthma and COPD, and may support the use of the treatable traits approach for the prevention of exacerbations in patients with chronic inflammatory airway diseases.

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Laboratory and imaging findings of necrotizing otitis externa are associated with pathogen type and disease outcome: A retrospective analysis

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Ear Nose Throat J. 2022 Mar 19:1455613221080973. doi: 10.1177/01455613221080973. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine associations of laboratory and imaging data with diagnostic parameters of necrotizing otitis externa (NOE) and its severity, and to compare between bacterial and fungal infections.

METHODS: Records of patients diagnosed with NOE during 2010-2018 at the Department of Otolaryngology, Head and Neck Surgery were reviewed retrospectively for demographics; disease characteristics; and laboratory, scintigraphy, and imaging results.

RESULTS: Of 48 patients with NOE, the mean age is 73±11.6 years; 32 (67%) were males; 83% had diabetes mellitus. Common pathogens were pseudomonas (49%) and fungi (33%). Sensitivities of the technetium-scan (SPECT ratio ≥1.5), temporal bone computed tomography (CT), and gallium-scan (SPECT ratio ≥1.3) were: 78.7%, 48.8%, and 31.4%, respectively. Gallium-scan results correlated positively with CT bone involvement (p=0.002) and hospital length of stay (p=0.0014). C-reactive protein (CRP) level correlated with hospital length of stay (p=0.028) and positive technetium-scan results (p=0.012). Fungal infection had a higher technetium SPECT ratio (2.16 vs. 1.77, p=0.04), gallium SPECT ratio (1.4 vs. 1.2, p=0.02), longer duration of systemic treatment (87.4 vs. 37.9 days, p=0.014), and longer hospital length of stay (31.6 vs. 15.2 days, p=0.004) compared to non-fungal infection. Eight (17%) patients had responded poorly to treatment. Fungal pathogens, facial nerve paresis, extra-auricular, and bilateral disease were more prevalent among the non-responders.

CONCLUSION: The technetium scan has higher sensitivity than temporal bone CT for diagnosing NOE. The gallium scan and CRP correlated well with hospital length of stay. A high rate of fungal infection was found, with significantly higher technetium and gallium SPECT ratios and worse outcome compared to bacterial infection. Fungal NOE remains therapeutically challenging.

PMID:35311376 | DOI:10.1177/01455613221080973

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