Ear, Nose & Throat Journal

Research Article

Correlation Between HMGB1 and TLR4 Expression in Sinonasal Mucosa in Patients With Chronic Rhinosinusitis

Mohammad Hossein Taziki, Ramin Azarhoush, Mohammad Mahdi Taziki, Mahdieh Naghavi-Alhosseini, Naeme Javid, Homa Davoodi Ear, Nose & Throat Journal Jun 26, 2019 | OnlineFirst OnlineFirst Last updated June 26, 2019 Research Article Free Access Correlation Between HMGB1 and TLR4 Expression in Sinonasal Mucosa in Patients With Chronic Rhinosinusitis Mohammad Hossein Taziki, MD, Ramin Azarhoush, MD, Mohammad Mahdi Taziki, MD, Mahdieh Naghavi-Alhosseini, MSc, Naeme Javid, MSc, Homa Davoodi, PhD https://doi.org/10.1177/0145561319858915 | First Published June 26, 2019 Abstract Hide Preview Objectives: Chronic rhinosinusitis (CRS) is one of the most common inflammations in the upper airway. Despite the wide prevalence of CRS, the pathogenesis of this disease is poorly understood. Several components of the innate immune system may play a significant role in CRS, including Toll-like receptor 4 (TLR4), TLR9, and high-mobility group box 1 protein (HMGB1). This study was conducted to determine the expression of TLR4, TLR9, HMGB1, and pNFκ-B p65 in paraffin-embedded blocks of patients with CRS with nasal polyps compared with those of the control group. Methods: Twenty-six formalin-fixed, paraffin-embedded samples from patients with confirmed CRS and 26 patients undergoing septoplasty due to anatomic variations and no other inflammatory nasal diseases as the control group were assessed. Expression patterns of HMGB1, TLR9, TLR4, and pNFκ-B p65 genes were examined using real-time quantitative reverse transcription polymerase chain reaction (Real-Time qRT-PCR). Statistical analyses were performed with SPSS and analyzed using unpaired 2-tailed t tests or 1-way analysis of variance. Results: Real-time PCR showed that the expression level of HMGB1 messenger RNA was significantly increased in the tissues of patients with CRS compared with controls (P < .05). The other 3 genes were also upregulated in the patients, but were not significant compared with control. Analysis of the Pearson correlation coefficient (r) revealed a significant positive correlation between HMGB1 and TLR4 (r = 0.79, P < .05) in patients and negative correlation between TLR4 and NfκB in the control group (r = 0.94; P < .05). Conclusions: Both HMGB1 and TLR4 are increased in the paranasal sinus mucosa of patients with CRS. These results suggest a possible contribution of HMGB1 and its internal receptor (TLR4) in the pathophysiology of CRS. Full Text PDF Download | Permissions   Other Free Access Adult Hand, Foot, and Mouth Disease Che-Jui Lee, MD, Hsin-Chien Chen, MD, PhD https://doi.org/10.1177/0145561319856569 | First Published June 17, 2019 Abstract Full Text PDF Download | Permissions   Research Article Free Access Management of Incus Defects in Children: Comparison of Incus Transposition Versus Glass Ionomer Cement Ismail Guler, MD, Rauf Oguzhan Kum, MD https://doi.org/10.1177/0145561319856325 | First Published June 17, 2019 Abstract Hide Preview The aim of this study was to investigate the functional results of glass ionomer cement (GIC) and incus transposition (IT) used for treatment of incus long process defects in pediatric patients. The medical records of 40 patients, aged 10 to 16 years, who underwent ossicular reconstruction due to incus long process defect between January 2010 and July 2017 were reviewed for age and gender, types of ossiculoplasty technique, types of graft used for tympanic membrane repair, preoperative–postoperative audiological examinations, and length of follow-up. The mean preoperative air-bone gap (ABG) was 29.40 (8.47) dB, the mean postoperative ABG was 15.25 (8.55) dB in the entire group, and the difference was statistically significant (P < .001). The functional outcome (ABG ≤ 20 dB) was 80% (32 patients) in the entire group. The mean hearing gain was 18.83 (9.43) dB and postoperative mean ABG was 20 dB or better in 17 (94.4%) patients in the GIC group. The mean hearing gain was 10.31 (9.44) dB, and postoperative mean ABG was 20 dB or better in 14 (63.6%) patients in the IT group. The mean hearing gain was significantly higher in the GIC group than in the IT group (P = .026), and the postoperative mean ABG was significantly higher in the IT group than in the GIC group (P = .045). The functional success rates were significantly higher in GIC group than in IT group (P = .020). There were no statistically significant differences between groups in terms of postoperative speech reception threshold and word recognition scores (P = .628, P = .260, respectively). The graft success rates were 94.4% (17 patients) in the GIC group and 90.9% (20 patients) in the IT groups. There was no statistically significant difference between groups in operated side (P = 1.000). Reconstruction of small incus long process defects using GIC is a valuable technique and can be safely used in pediatric patients. The hearing outcomes are significantly better in GIC rebridging technique when compared with a sculpted IT technique. Full Text PDF Download | Permissions   Research Article Free Access Cautionary Findings for the Presence of Facial Canal Dehiscence During Cholesteatoma Surgery Muammer Melih Sahin, MD, Melih Cayonu, MD, Ayse Secil Kayalı Dinc, MD, Suleyman Boynuegri, MD, Fulya Eker Barut, MD, Adil Eryilmaz, MD https://doi.org/10.1177/0145561319856886 | First Published June 17, 2019 Abstract Hide Preview Our aim was to investigate the relationship between facial canal dehiscence (FCD) and surgical findings and procedures in patients with cholesteatoma. A total of 186 patients (118 males, 39.2 ± 15 years) who underwent surgery for advanced cholesteatoma between 2013 and 2018 were included in the study. The relationship between FCD and surgical findings was investigated via the surgical registries. The prevalence of FCD was 36.6% (68/186). The prevalence of FCD was 44%, and 13.2% for the patients who underwent canal wall down mastoidectomy (62/141) and canal wall up mastoidectomy (6/45), respectively (P < .001). Facial canal dehiscence was detected in 73.9% of the 23 patients who had a lateral semicircular canal (LSCC) defect (P < .001), in 61.9% of 21 patients who had a tegmen tympani defect, and in 58.1% of the 31 patients who had erosion on the posterior wall of the external auditory canal (EAC; P < .05). The prevalence of FCD was 3.1% in patients with isolated incus erosion, 59.1% in patients with erosion of malleus and incus, 60.7% in patients with erosion of stapes suprastructure and incus, and 43.2% in patients with whole ossicular chain deformation (P < .001). The defects on LSCC, EAC, tegmen tympani, and malleus and incus might be cautionary findings for the presence of FCD during cholesteatoma surgery. Full Text PDF Download | Permissions   Research Article Free Access Categorization of Tinnitus Severity for the Mandarin Tinnitus Questionnaire Zhaoli Meng, PhD, Fei Zhao, PhD, Zhenxi Chen, BA, Yun Zheng, PhD https://doi.org/10.1177/0145561319853256 | First Published June 14, 2019 Abstract Hide Preview Background: The Tinnitus Questionnaire is commonly used to evaluate the psychological impact of tinnitus and has been translated into Mandarin. The original English version of the Tinnitus Questionnaire was translated into Mandarin (Mandarin Tinnitus Questionnaire [MTQ]). The MTQ included not the same items compared with original version. Thus, MTQ should have its own severity categorization. Aims/Objectives: The objective of this research was to develop a method to categorize tinnitus patients by clinical severity using scores from the MTQ. Material and Methods: A total of 192 participants with primary complaint of tinnitus were enrolled. Cross-tabulation was used to compare 2 categorization approaches of tinnitus severity. With the first approach, categories were assigned based purely on quartiles of MTQ scores. In the second approach, severity was determined based on ordinal logistic regression. The 2 approaches were verified by comparing the consistency with clinical judgment. Results: Categorization based on quartiles showed low consistency with clinical assessment (κ = 0.33), while categorization based on ordinal logistic regression showed good consistency with clinical assessment (κ = 0.86). Regression-based MTQ score cutoffs were <21 for no problem with tinnitus, 21 to 36 for mild tinnitus, 37 to 47 for moderate tinnitus, and >47 for severe tinnitus. Conclusions and Significance: Tinnitus severity can be categorized accurately using ordinal logistic regression analysis of MTQ scores. Full Text PDF Download | Permissions   Research Article Free Access The Difference in the Clinical Features Between Carcinoma ex Pleomorphic Adenoma and Pleomorphic Adenoma Jungirl Seok, MD, Se Jin Hyun, MD, Woo-Jin Jeong, MD, PhD, Soon-Hyun Ahn, MD, PhD, Hyojin Kim, MD, PhD, Young Ho Jung, MD, PhD https://doi.org/10.1177/0145561319855376 | First Published June 13, 2019 Abstract Hide Preview Carcinoma ex pleomorphic adenoma (CXPA) arises from the primary or recurrent benign pleomorphic adenoma. The purpose of this study was to evaluate the clinical features that could be referenced in the differentiation. The medical records of 221 patients with pleomorphic adenoma and 15 patients with CXPA were retrospectively reviewed. Clinical characteristics, computed tomography and magnetic resonance imaging findings, and surgical pathology were analyzed. Patients with CXPA were older (55.1 vs 42.3; P < .01). Carcinoma ex pleomorphic adenoma was observed at higher rates in the minor salivary glands (24.9% vs 2.7%) and higher incidence of regional lymph node enlargement (P = .04). While all CXPA showed a low-to-intermediate mean apparent diffusion coefficient value (ADC), most of pleomorphic adenoma had an intermediate-to-high (P = .01). From this study, the following features should be considered as the clinical features of CXPA: (1) old age; (2) minor salivary gland tumor; (3) regional lymph node enlargement (>5 mm); and (4) low ADC findings. Full Text PDF Download Supplemental Material | Permissions   Other Free Access Frontocutaneous Fistula Secondary to Pott's Puffy Tumor Hyun Jin Min, MD, PhD, Kyung Soo Kim, MD, PhD https://doi.org/10.1177/0145561319856858 | First Published June 13, 2019 Abstract Full Text PDF Download | Permissions   Research Article Free Access Baseline Low Prognostic Nutritional Index Predicts Poor Survival in Locally Advanced Nasopharyngeal Carcinomas Treated With Radical Concurrent Chemoradiotherapy Erkan Topkan, MD, Nur Yucel Ekici, MD, Yurday Ozdemir, MD, Ali Ayberk Besen, MD, Huseyin Mertsoylu, MD, Ahmet Sezer, MD, Ugur Selek, MD https://doi.org/10.1177/0145561319856327 | First Published June 10, 2019 Abstract Hide Preview Background: To retrospectively assess the impact of prognostic nutritional index (PNI) on survival outcomes of patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT). Methods: This study incorporated 154 patients with LA-NPC who received exclusive cisplatinum-based CCRT. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of pretreatment PNI cutoffs influencing survival results. The primary end point was the interaction between the overall survival (OS) and PNI values, while cancer-specific survival (CSS) locoregional progression-free survival (LR-PFS), distant metastasis–free survival (DMFS), and PFS were the secondary end points. Results: A rounded PNI cutoff value of 51 was identified in ROC curve analyses to exhibit significant link with CSS, OS, DMFS, and PFS outcomes, but not LR-PFS. Patients grouping per PNI value (≥51 [N = 95] vs <51 [N = 49]) revealed that PNI < 51 group had significantly shorter median CSS (P < .001), OS (P < .001), DMFS (P < .001), and PFS (P < .001) times than the PNI ≥ 51 group, and the multivariate results confirmed the PNI < 51 as an independent predictor of poor outcomes for each end point (P < .05 for each). The unfavorable impact of the low PNI was also continued at 10-year time point with survival rates of 77.9% versus 42.4%, 73.6% versus 33.9%, 57.9% versus 27.1%, and 52.6% versus 23.7% for CSS, OS, DMFS, and PFS, respectively. Additionally, we found that PNI < 51 was significantly associated with higher rates of weight loss >5% over past 6 months (49.2% versus 11.6%; P = .002) compared to PNI < 51 group. Conclusion: Low pre-CCRT PNI levels were independently associated with significantly reduced CSS, OS, DMFS, and PFS outcomes in patients with LA-NPC treated with definitive CCRT. Full Text PDF Download | Permissions   Other Free Access Rare Earth Metal Magnets: An Unusual Airway Foreign Body Roberto N. Solis, MD, Felicity Lenes-Voit, MD, Ron B. Mitchell, MD, Gopi Shah, MD, MPH https://doi.org/10.1177/0145561319856005 | First Published June 10, 2019 Abstract Full Text PDF Download | Permissions   Other Free Access Nasal Polyps and Chronic Obstructive Pulmonary Disease—An Oft Overlooked Association Evelyn Tai Li Min, MD, Baharudin Abdullah, MBBS https://doi.org/10.1177/0145561319856576 | First Published June 10, 2019 Abstract Full Text PDF Download | Permissions   Other Free Access Accidental Intubation of the Soft Palate Wen-Sen Lai, MD, PhD, Yuan-Yung Lin, MD, Yueng-Hsiang Chu, MD, PhD, Jih-Chin Lee, MD, PhD https://doi.org/10.1177/0145561319840138 | First Published June 6, 2019 Abstract Full Text PDF Download | Permissions   Research Article Free Access Head and Neck Cancer Complications in the Geriatric Population Based on Hospital Case Volume Samuel J. Rubin, MD, MPH, Kevin Y. Wu, BS, Diana N. Kirke, MBBS, MPhil, Waleed H. Ezzat, MD, Minh Tam Truong, MD, Andrew R. Salama, MD, DDS, Scharukh Jalisi, MD, MA https://doi.org/10.1177/0145561319856006 | First Published June 6, 2019 Abstract Preview Full Text PDF Download | Permissions   Research Article Free Access Traumatic Orbital Subperiosteal Hematoma With Acute Visual Compromise: Role of the Head and Neck Surgeon Tom Shokri, MD, Vijay A. Patel, MD, Neerav Goyal, MD, MPH https://doi.org/10.1177/0145561319854743 | First Published June 6, 2019 Abstract Hide Preview The primary goal was to report our institutional experience of a rare, vision-threatening complication following craniomaxillofacial trauma. A retrospective review was performed between January 2016 and January 2018 to identify 3 patients with traumatic orbital subperiosteal hematoma (OSPH). Visual acuity, intraocular pressures (IOPs), and the need for surgical intervention were abstracted. The age range was 36 to 88 years. Indications for surgical intervention include relative afferent pupillary defect, gaze restriction, visual impairment, and elevated IOP. Preoperatively, IOP range was 15.0 to 25.0. Two patients required OSPH evacuation via a medial brow approach. Follow-up after ocular injury ranged from 25 to 41 days, with IOP range of 13.0 to 16.0. Traumatic OSPH is an uncommon clinical finding; prompt assessment with consideration of surgical intervention may mitigate deleterious long-term morbidity, chiefly sudden blindness. Further research efforts may elucidate the optimal method in the management of this complex clinical entity. Full Text PDF Download | Permissions   Editorial Free Access The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, DO, Eric Masao Sugihara, DO, Wakisa Mulwafu, MB, BCh, FCORL(SA), David Nathan Madgy, DO https://doi.org/10.1177/0145561319855366 | First Published June 6, 2019 Abstract Hide Preview There is a significant lack of surgeons in the developing world. Malawi Africa is one of the poorest and medically underserved countries in the World, with surgical care particularly lacking. Providing surgical services has numerous barriers, such as availability of well-trained surgeons, infrastructure, continuity of care, and access to care. There is currently one otolaryngologist in Malawi who provides complete access to this subspecialty. The development of the otolaryngology department was successful through institutional, local, national, and international collaboration, with a long-term goal of sustainability. An established department can train the next generation of surgeons for the preservation and growth of the surgical workforce. Once the department approaches independence, the role of outside collaboration transforms primarily from financial to a bi-directional partnership encompassing education, training, and leadership. Full Text PDF Download | Permissions   Other Free Access Extranodal NK/T-Cell Lymphoma, Nasal Type—Case Report of 2 Cases Marina Neves Cavada, MD, Aline Silveira Martha, MD, Luise Sgarabotto Pezzin, MD, Juliana Mazzaferro Krebs, MD, Luciane Mazzini Steffen, MD, Gerson Schultz Maahs, MD, PhD https://doi.org/10.1177/0145561319856016 | First Published June 6, 2019 Abstract Full Text PDF Download | Permissions   Research Article Free Access Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally Sok Yan Tay, MD, Rekha Krishnasarma, MD, Deepak Mehta, MD, Amy Mehollin-Ray, MD, Binoy Chandy, MD https://doi.org/10.1177/0145561319855641 | First Published June 3, 2019 Abstract Hide Preview Introduction: Advances in fetal imaging have allowed us to identify abnormalities previously not appreciated. With this study, we hope to identify factors predicting a difficult airway at birth and review the perinatal outcomes of these patients. Methods: Sixteen patients with antenatally diagnosed micrognathia were reviewed from a tertiary care hospital database from 2011 to 2016. Jaw index (JI), amniotic fluid index (AFI), glossoptosis, gastric size, and oropharynx obliteration were assessed. The airway support required at birth, specialist team involvement, and outcomes were evaluated. Results: Nine (56.3%) of 16 patients had JI <5th percentile, 3 (33.3%) of 9 had difficult intubation, 2 (22.2%) of 9 needed an emergency tracheostomy, and 1 (11.1%) of 9 died. Seven patients had polyhydramnios, 2 (28.6%) of 7 had difficult intubation, 2 (28.6%) of 7 required tracheostomy, and 1 (14.3%) of 7 died. Twelve patients had either JI <5th percentile or abnormal AFI, 5 (41.7%) of 12 had difficult intubation, 2 (16.7%) of 12 required tracheostomy, and 1 (8.33%) of 12 died. For the group without otolaryngology consultation, 8 (50%) of 16, 1 (12.5%) of 8 had difficult intubation and 1 (12.5%) of 8 died because airway was not secured after 45 minutes of resuscitation. Conclusion: Jaw index <5th percentile or abnormal AFI predicts a difficult airway. A multidisciplinary approach with otolaryngology involvement for airway intervention may be required at birth. Full Text PDF Download | Permissions   Research Article Free Access Expression Profile of Survivin and p16 in Laryngeal Squamous Cell Carcinoma: Contribution of Tunisian Patients Mariem Ben Elhadj, PhD, Olfa E. L. Amine, MD, Nehla Mokni Baizig, PhD, Wided Ben Ayoub, MD, Aida Goucha, MD, Michèle-Veronique El May, PhD, Asma Fourati, PhD https://doi.org/10.1177/0145561319855644 | First Published June 3, 2019 Abstract Hide Preview The objective of this study was to evaluate the expression of survivin and p16 in laryngeal squamous cell carcinoma (LSCC) in order to analyze their pathogenesis and prognostic significance in Tunisian patients. A total of 70 patients with LSCC collected at the Salah Azaiez Cancer Institute of Tunis were retrospectively evaluated. Expression of survivin and p16 was examined using immunohistochemistry, and the correlations with clinicopathological parameters, overall survival (OS), and disease-free survival (DFS) were statistically evaluated. The positive expression of survivin and p16 were found in 58.6% and 51.43% of LSCC cases, respectively. The p16 expression was not associated with either clinical parameters or patient survival, whereas there was a strong correlation of survivin expression and lymph node metastases (P = .002), alcohol consumption (P = .024), and therapeutic protocol (with or without chemotherapy; P = .001). Kaplan-Meier survival curves showed that patients with LSCC having positive survivin expression have shorter OS (P = .026) and shorter DFS (P = .01) than those with negative expression. Positive survivin expression was also correlated with high recurrence rate (P = .014). Therefore, survivin is a poor prognostic marker for LSCC but the therapeutic protocol remains, in multivariate study, the most decisive for the OS and DFS of our patients with P < .01. Our data indicated that, in Tunisian laryngeal squamous cell carcinoma, survivin expression is associated with unfavorable outcomes and represents a predictor marker of recurrence and chemoresistance. However, p16 expression has no prognosis value. Full Text PDF Download | Permissions   Research Article Free Access The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study Theodore A. Schuman, MD, Josephine H. Nguyen, MD, Joshua C. Yelverton, MD, Jorge A. Almenara, PhD, Celeste N. Powers, MD, PhD https://doi.org/10.1177/0145561319840853 | First Published June 2, 2019 Abstract Hide Preview Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention. Full Text PDF Download | Permissions   Research Article Free Access Histological Study of The Healing of Traumatic Tympanic Membrane Perforation After Vivosorb and Epifilm Application Mahmut Sinan Yilmaz, MD, Elvan Sahin, MD, Recep Kaymaz, MD, Berrin Zuhal Altunkaynak, MD, Ayse Oznur Akidil, MD, Sevinc Yanar, MD, Deniz Demir, MD, Mehmet Guven, MD https://doi.org/10.1177/0145561319854320 | First Published June 2, 2019 Abstract Hide Preview Background: Untreated traumatic tympanic membrane perforations (TMPs) may lead to permanent perforations and hearing loss. There are many materials that have been previously used for repairing the TMPs. Aims and Objectives: The purpose of this study is to evaluate the clinical and histological effects of Vivosorb (Vv) and Epifilm on healing of TMPs in a rat model. Material and Methods: The posterior-inferior quadrant of the tympanic membranes (TMs) in right ears of 14 rats was perforated using a 20-g needle and then the animals were randomly divided into 2 equal groups (n = 7). The perforated right TMs were treated with either Vv (Vv group) or Epifilm (Ep group). The left TMs of 7 rats were perforated in same way and allowed to close spontaneously without any topical material applications (spontaneous closure group as sham control, SC). The left tympanic membranes of the other 7 rats were not perforated and used as normal controls (NC group). On postoperative 15th day, tympanic bullas were extracted from killed rats and examined morphometrically and histopathologically. Results: Perforation closure rate was 85.7% (6/7) in both Vv and SC groups. Perforations of Ep group closed in 7/7 (100%) ears. The thicknesses of the perforated membranes were increased in SC and especially Vv groups. Also, connective tissue fibrosis, blood clots, and epithelial degenerations were detected in SC and Vv groups. The mean fibroblastic reaction scores of Vv, Ep, and SC groups were 2.14(+), 0.57(+), and 1.71(+) respectively, on comparison with NC group. The mean neovascularization score was 1.42(+) in Vv group, 0.14(+) in Ep group, and 0.57(+) in SC group. Conclusion and Significance: Vivosorb and especially Epifilm can improve the healing process in traumatic TMPs and additionally, Epifilm might be more preferred for the treatment of TMPs because of causing lesser fibrosis. Full Text PDF Download | Permissions   Research Article Free Access Incidence of Developing Contralateral Ménière's Disease in Patients Undergoing Transmastoid Labyrinthectomy for Unilateral Ménière's Disease Bo Pang, DO, Anya Costeloe, DO, Neal M. Jackson, MD, Seilesh Babu, MD https://doi.org/10.1177/0145561319854744 | First Published June 2, 2019 Abstract Hide Preview Objectives: To analyze the incidence of developing contralateral Ménière's disease (MD) in patients who undergo labyrinthectomy for vestibular dysfunction in unilateral MD. Study Design: Retrospective chart review. Participants and Methods: Adult patients with a diagnosis of MD who underwent surgical labyrinthectomy with minimum follow-up of 12 months were included. Patients who experienced chemical labyrinthectomy, surgical labyrinthectomy for a diagnosis other than MD, contralateral ear surgery, or bilateral MD before the labyrinthectomy were excluded. The key outcome measure is whether symptoms of MD developed in the contralateral ear post-labyrinthectomy. Statistical analysis was performed using χ2 (Fisher exact) test for discrete variables and the Student t test for continuous variables. A P value < .05 was considered significant. Results: Of the140 patients who underwent labyrinthectomy for intractable vertigo due to unilateral MD, 84 had at least 1 year follow-up appointments. Twelve percent (10/84) of these patients developed contralateral MD, which was diagnosed by a neuro-otologist based on symptoms consistent with MD, including low-frequency sensorineural hearing loss. Average age in years is 63.12 (10.83; mean [SD]) at time of surgery. Average follow-up was 35.57 (15.89) months (range: 12-69 months). Conclusion: The incidence of contralateral MD development in patients who underwent labyrinthectomy for unilateral MD is 12%. The current literature states that MD has a 30% bilateral involvement rate. Our incidence is significantly lower when compared to the current literature. Full Text PDF Download | Permissions   Research Article Free Access Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, MD, Paige Thayer, BS, Yan Yan, MD, Qingsong Liu, MD, Li Wang, MD, Jack Jiang, MD, PhD https://doi.org/10.1177/0145561319854745 | First Published June 2, 2019 Abstract Hide Preview Introduction: In our previous study, we demonstrated that there might be correlations between laryngopharyngeal reflux disorder and the hue value of laryngoscopic images. And we found that different regions of larynx have different hue values. It was hypothesized that the degree of inflammation varies between different laryngeal regions, due to an acid reflux pattern. Objective: The objective of this study was to compare the changing trends of hue values of different laryngeal regions in patients with laryngopharyngeal reflux (LPR) disease. Methods: Ninety-seven patients, including 20 pH-positive, 19 pH-negative were tested for LPR through multichannel intraluminal impedance 24-hour pH monitoring, and 58 controls with reflux symptom index less than 13. Laryngoscopic images of all patients were obtained. The hue values of 7 areas of interest, including both sides of the true vocal folds, the false vocal folds, the arytenoids, and the interarytenoid space, were quantified using a hue calculation. The analysis of variance analysis was applied to find if there was significant difference between different groups within each region. Results: (1) In the regions of both sides of the true vocal folds and interarytenoid, there was no significant difference between positive group and negative group; (2) in the regions of both sides of false vocal folds, there was no significant difference between negative group and control group; (3) in the regions of both sides of arytenoids, there was neither significant difference between positive group and negative group nor between negative group and control group; (4) in other comparisons, there were significant differences. Conclusion: Hue values of separate laryngeal regions are different. In negative group, the hue values of interarytenoid region are similar with positive group, and the sensitivity to the acid are different from different regions. The sensitivity in the true vocal folds may be present. Full Text PDF Download | Permissions   Other Free Access Guns n' Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, MBBS, Andrew Y. Lee, MD, Waleed M. Abuzeid, MD, Nadeem A. Akbar, MD https://doi.org/10.1177/0145561319850813 | First Published June 2, 2019 Abstract Full Text PDF Download | Permissions   Case Report Free Access Isolated Congenital Round Window Atresia: Report of 2 Cases Wai Keat Wong, MBChB, Lesley Salkeld, FRACS, David Flint, FRACS https://doi.org/10.1177/0145561319840541 | First Published June 2, 2019 Abstract Hide Preview Round window atresia (RWA) is an uncommon condition and can result in a conductive hearing loss. Two cases of nonsyndromal bilateral RWA in 2 members of the same family are reported. Both cases presented with a conductive hearing loss of 20 to 30 dB. High-resolution computed tomography scanning was used to diagnose the condition. The patients were rehabilitated with hearing aids. Review of the literature has shown disappointing results in hearing improvement with cochlear fenestration in an attempt to address this condition. Patients presenting with unexplained conductive hearing loss should be offered computed tomography scanning. The cases we report add to the literature to benefit future patients in preoperative counseling and better inform management. Full Text PDF Download | Permissions   Research Article Free Access A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, MD, Pei-Yin Wei, MD, Chia-Huei Chu, MD, MPH, Wen-Huei Liao, MD, PhD, An-Suey Shiao, MD, Mao-Che Wang, MD, PhD https://doi.org/10.1177/0145561319840884 | First Published June 2, 2019 Abstract Hide Preview Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis media (COM) remains an important but unresolved issue. In the literature, routine canaloplasty has been suggested to help elucidate this problem. In this study, we intended to investigate the relationship between the diameter or shape of OEAC and COM. We retrospectively reviewed the high-resolution computed tomography (HRCT) images of the temporal bones of 62 patients with unilateral COM who underwent tympanoplasty from January 1, 2011, to December 31, 2013. For comparison, the HRCT images of another 62 patients with normal ears were collected to be the control group. The shape of OEAC was categorized into 5 groups according to Mahboubi's classification, and the dimension of each patient's OEAC was measured at 2 defined sections (annular section and isthmus/midcanal section). The most prevalent shape of OEAC for the lesion sides of the ears was cylindrical, followed by conical, and hourglass in both the COM and the control groups. As to the dimension of OEAC, there were no significant differences between lesion ears and normal ears among patients in the COM group as well as between lesion ears in the COM group and normal ears in the control group. We concluded that the bony dimension of the external ear canal was not related to COM. This suggested that chronic inflammation or infection of middle ear may not cause bony thickening of OEAC, despite the kind of OEAC shape involved. Full Text PDF Download | Permissions   Research Article Free Access Impact of Sinus Surgery on Hospital Utilization for Complications of Sinusitis Vivek Pandrangi, BA, Evan R. Reiter, MD https://doi.org/10.1177/0145561319853786 | First Published June 2, 2019 Abstract Hide Preview Background: Sinusitis complications are potentially lethal conditions that generally require extensive treatment and thus place a significant burden on the health-care system. The purpose of this study was to assess the impact of surgery on hospital utilization associated with treatment of sinusitis complications. Methods: Retrospective cohort study using a national hospital database. The 2012 to 2013 National Inpatient Sample was queried for adult patients with sinusitis and complications. Patients were grouped based upon the presence or absence of sinus procedures. Patient demographics and health status, hospital characteristics, length of stay (LOS), and charges were determined. Results: Of 1645 patients with sinusitis and associated complications, 232 (14%) underwent sinus procedures. These patients had higher LOS (8.0 ± 7.3 days vs 4.3 ± 5.2 days; P < .001) and charges (US$96 107 ± 108 089 vs US$30 661 ± 47 138; P < .001) than nonprocedure patients. Increased time to procedure in one operation patients (n = 209) of more than 2 days increased total LOS (11.4 ± 9.3 days vs 6.2 ± 5.5 days; P < .001) and charges (US$120 306 ± 112 748 vs US$76 923 ± 81 185; P = .005). Patients with multiple sinus procedures (n = 23) versus one had increased LOS and charges, despite no time difference from admission to first procedure (P = .35). On regression analysis, sinus procedure patients had excess LOS of 0.827 days and charges of US$36 949. Conclusion: Although often necessary, sinus procedures lead to increased LOS and charges. As prolonged time to sinus procedure and revision operations also increase charges, shorter trials of medical therapy and earlier surgical intervention may improve outcomes and reduce costs.