Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Haicang Zeng, Xiaoxin Chen, Yaodong Xu, Yiqing Zheng, Hao Xiong Abstract Purpose To assess the effectiveness of Buteyko breathing technique in patients with obstructive Eustachian tube dysfunction (ETD). Materials and methods Fifty-one patients (77 ears) aged between 21 and 62 years were randomized to Buteyko breathing in conjunction with medical management (nasal steroid) group or medical management alone group. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up. Results Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05). Conclusions Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery. The Buteyko method is based on the concept that "hidden" or undiagnosed hyperventilation is the underlying cause of numerous medical conditions, including asthma. It is known that hyperventilation can lead to low carbon dioxide levels in the blood (or hypocapnea), which can subsequently lead to disturbances of the acid-basebalance in the blood and lower tissue oxygen levels. Advocates of this method believe that the effects of chronic hyperventilation would have even wider effects than is commonly accepted.[5] These effects include widespread spasms of the muscle in the airways (bronchospasm),[8] disturbance of cell energy production via the Krebs cycle, as well as disturbance of numerous vital homeostatic chemical reactions in the body. The Buteyko method is a purported method of "retraining" the body's breathing pattern to correct for the presumed chronic hyperventilation and hypocapnia, and thereby treat or cure the body of these medical problems.[5] The Buteyko method is not widely supported in the medical community, in part due to the fact that research has not supported this theory that hyperventilation and hypocapnia causes disease,[5] with one review noting that there is no convincing evidence to indicate that trying to change asthmatic's carbon dioxide level is either "desirable or achievable."[8] Studies that have looked for evidence to corroborate this theory, such as looking at the carbon dioxide levels in practitioners of Buteyko, have not found this evidence, leading some to propose alternate theoretical pathways for this method to improve symptoms.[5] Although variations exist among teachers of the technique in different countries, the main objective is "normalization" of breathing and the three core principles of Buteyko remain the same: nasal breathing, reduced breathing and relaxation. Nasal breathing The Buteyko method emphasizes the importance of nasal breathing, which protects the airways by humidifying, warming, and cleaning the air entering the lungs. A majority of asthmatics have problems sleeping at night, and this is thought by Buteyko practitioners to be linked with poor posture or unconscious mouth-breathing. By keeping the nose clear and encouraging nasal breathing during the day, night-time symptoms can also improve. Strictly nasal breathing during physical exercise is another key element of the Buteyko method.[1] Reduced breathing exercises The core Buteyko exercises involve breath control: consciously reducing either breathing rate or breathing volume.[9] Many teachers refer to Buteyko as 'breathing retraining' and compare the method to learning to ride a bicycle. Once time has been spent practicing, the techniques become instinctive and the exercises are gradually phased out as the condition improves. Buteyko uses a measurement called the Control Pause (CP), the amount of time between breaths that an individual can comfortably hold breath.[5] According to Buteyko teachers, people with asthma who regularly practice Buteyko breathing will notice an increase in CP and decrease in pulse rate that corresponds to decreased asthma symptoms. Relaxation Dealing with asthma attacks is an important factor of Buteyko practice. The first feeling of an asthma attack is unsettling and can result in a short period of rapid breathing. By controlling this initial over-breathing phase, asthmatics can prevent a "vicious circle of over-breathing" from developing and spiraling into an asthma attack. This theory asserts that asthma attacks may be averted simply by breathing less. Medical evidence Advocates of the Buteyko method claim that it can treat a wide range of other diseases and symptoms (numbering up to 150), including diabetes, reproductive disorders and psychological disorders, which they believe is aggravated by hyperventilation and hypocapnia, and therefore are treated by use of the Buteyko method. However, research into the effectiveness of Buteyko have focused almost exclusively on asthma with a small amount of research on sleep apnea.[5] Members of the medical community have been skeptical of the efficacy of Buteyko due to the often "exaggerated and unsubstantiated claims" earlier made by Buteyko practitioners.[6] There are few high quality studies such as randomized controlled trials looking at the efficacy of treating asthma with "breathing retraining" methods in general, which include the Buteyko method, yoga training and other relaxation techniques.[10] Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample sizes,[11] possible patient selection bias as well as heterogeneity in design that makes coming to a firm conclusion difficult.[12] These studies are also hampered by the difficulty in proper blinding and placebo control which could introduce more bias into these studies.[11] In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; the Buteyko method was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.[1] A Cochrane review had earlier found "no reliable conclusions" could be determined based on the limited available evidence.[10] A 2014 British clinical guideline said that for adults the Buteyko method could improve some asthma symptoms and quality of life, but that it had little impact on lung function.[2]

Commentary on Surgical management of patients with Eagle syndrome Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Zhengcai- Lou

What is the evidence for cannabis use in otolaryngology?: A narrative review Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): William L. Valentino, Brian J. McKinnon Abstract Objectives Review of the English literature for all studies involving cannabis and Otolaryngology. Methods PubMed was searched using a combination of the terms cannabis, marijuana, otolaryngology, hearing, tinnitus, vestibular, rhinology, sinusitis, laryngology, voice, airway, head and neck, head and neck cancer, facial trauma, spasm, pediatric otolaryngology, sleep medicine, obstructive sleep apnea, and other variations. Literature included in the review provided substantive research on cannabis in Otolaryngology. Results Seventy-nine unique publications were found in the literature. The majority were published in the last decade and pertain to the subspecialty of Head and Neck; specifically, its association with incident cancers. A small number of studies exist that suggest cannabis may be a useful therapy for Otolaryngological patients suffering from blepharospasm, the effects of radiation, and the psychological sequelae of receiving a cancer diagnosis. Conclusion Further research is required to determine the potential therapeutic roles and adverse effects of cannabis on conditions related to Otolaryngology. This study serves the Otolaryngological researcher with the most current, comprehensive literature review for the exploration into possible projects to undertake.

Treatment for lymphedema following head and neck cancer therapy: A systematic review Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Albina Tyker, Joel Franco, Sean T. Massa, Shaun C. Desai, Scott G. Walen Abstract Objective To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research. Data sources Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases. Review methods A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria. Results Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis. Conclusion Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.

Efficacy and safety of sublingual dust mite drops in children with mono- or polysensitized allergic rhinitis Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Yao-zu Zhang, Juan Luo, Zi-han Wang, Jie Wang Abstract Objective To explore the efficacy and safety of sublingual house dust mite (HDM) drops in children with mono- or polysensitized allergic rhinitis. Methods We conducted a retrospective cohort study of 65 children with monosensitized AR and 118 children with polysensitized AR who were scheduled for sublingual administration of HDM drops from January 2015 to June 2016. Interleukin (IL)-2, IL-4, and IL-17α, transforming growth factor-β1 (TGF-β1), specific immunoglobulin E (IgE), and specific IgG4 were detected by ELISA. The efficacies were assessed using symptoms score and medication score. All the outcomes were measured 1 month before the study and 1 month after the end of the 2-year treatment. Results The total nasal symptoms score (TNSS) decreased significantly from 11.27 (9.81 ± 12.73) at baseline to 3.48(1.98 ± 4.98) at the end of sublingual treatment for the monosensitized AP group (t = 30.00, P < 0.01), and from 11.54(10.04 ± 13.04) to 3.56 (2.00 ± 5.16) for the polysensitized AR group (t = 40.05, P < 0.01), respectively. IL-2 and TGF-β1 increased significantly after treatment in contrast with before treatment in both the monosensitized group and the polysensitized group (both P < 0.01). In contrast, IL-4 and IL-17α decreased significantly after treatment compared with the baseline in both groups (both P < 0.01). Sublingual HDM drops were generally safe and well tolerant in both groups. Conclusions This study confirmed the efficacy and safety of sublingual AIT in both monosensitized and polysensitized AR patients (Chinese children).

Olfaction and quality of life in patients with nasal septal deviation treated with septoplasty Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Konstantinos Valsamidis, Athanasia Printza, Konstantinos Titelis, Jannis Constantinidis, Stefanos Triaridis Abstract Objective Patients with septal deviation-induced nasal obstruction may experience olfactory impairment. This study aimed to evaluate septoplasty-related changes in olfactory function and their effect on patients' quality of life (QoL). Methods Prospective study of sixty patients with nasal obstruction and septal deviation and 25 healthy controls. Objective measurements were performed for the evaluation of nasal patency and “Sniffin' sticks” tests were used for quantitative assessment of lateralized and bilateral olfactory performance. All participants self-assessed their smell using a visual analog scale and completed validated questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation: NOSE), for nasal symptoms QoL (SinoNasal Outcome Test-22: SNOT-22), for olfaction-associated QoL (Questionnaire of Olfactory Deficits: QOD) preoperatively and six months after septoplasty and reported personal benefit after surgery (Glasgow Benefit Inventory: GBI), six months postoperatively. Results Smell was significantly compromised due to septal deviation especially in the more obstructed nasal cavity side. Smell improved significantly after septoplasty (subjective report and olfactory measurements), along with increased nasal patency. Increased nasal cavity volume was significantly correlated with olfactory thresholds but not with suprathreshold measurements. Subjective hyposmia and lateralized olfaction were significantly reduced postoperatively. Postoperatively, normosmic patients reported higher personal benefit from surgery than patients with olfactory disorders. The patients' QoL improved significantly, but it remained lower than the controls' group. Olfaction-associated QoL was not significantly different between patients and controls before and after septoplasty. Conclusion Septoplasty leads to improvement in smell perception, and patients with improved smell report greater personal benefit from septoplasty than patients with remaining olfactory deficits.

Intraoperative cytological examination of bone medullary. A useful technique to predict the extension of bone invasion in segmental mandibulectomy Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Paolo Cariati, Almudena Cabello Serrano, Jose Fernandez Solis, Silvano Ferrari, Pablo Torné Poyatos, Ildefonso Martinez Lara Abstract Aim The main of the present report is to evaluate the utility of intraoperative cytological analysis of medullary bone to predict the extension of bone infiltration in segmental mandibulectomy. Materials and method Between the years 2016 and 2018, a total of 17 previously untreated patients with squamous cell carcinoma of the oral cavity underwent a segmental mandibular resection and intraoperative cytological analysis of the bone medullary at Virgen de las Nieves University Hospital (HUVN). The results of the intraoperative cytological analysis were compared with the result of the postoperative histopathological examination and sensitivity, specificity, positive predictive value, and negative predictive value of the test were calculated. Results Cytological analysis was positive in three patients and the bone resection was consequently extended. All the extensions of these bone margins were clean following the postoperative histological examination. However, two other patients previously classified as clean with intraoperative cytological analysis of bone medullary presented infiltration of bone margins postoperatively. The protocol demonstrated a high negative predictive value (85,7%). The positive predictive value, sensitivity, and specificity were 33,3%, 33,3%, and 85,7% respectively. Conclusion Intraoperative cytological analysis of bone medullary could represent an easy, fast, reliable and inexpensive method to reduce the rate of r1 surgeries attributable to the infiltration of the bone margin. This may have a positive impact on overall survival without increasing the duration and the iatrogenicity of surgery.

Endoscopic approach in second stage ossicular chain reconstruction Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Giannicola Iannella, Marco De Vincentiis, Antonio Greco, Claudio Vicini, Andrea De Vito, Giuseppe Meccariello, Giovanni Cammaroto, Stefano Pelucchi, Giuseppe Magliulo Abstract Purpose Today limited studies regarding surgical and hearing outcomes in patients undergoing the totally endoscopic ossicular chain reconstruction has been published. The aim of this study is to show the different materials and endoscopic technique used in our experience to perform a second stage endoscopic ossiculoplasty. Materials and methods Patients underwent to second stage endoscopic ossiculoplasty has been enrolled in the study. According to the ossicular defect the endoscopic surgical procedures of ossicular chain reconstruction used in our clinical practice were: ossicular chain reconstruction using PORP (13 cases); ossicular chain reconstruction using TORP (11 cases); incus interposition ossiculoplasty (6 cases); cartilage ossiculoplasty (10 cases). Intraoperative and postoperative complications were analyzed. Final hearing recovery at 6 months follow-up was used to evaluate audiological outcomes. Results None of the patients developed intraoperative complications. Postoperative TM complications emerged in 5% of cases: one patient (2.5%) presented TM perforation and prosthesis extrusion (TORP) after 3 months follow up. A significative difference between preoperative and postoperative values of AC-PTA, ABG and WRS (p < 0.05 in each case) emerged. Conclusions Different materials and methods can be used for performing an endoscopic ossicular chain reconstruction in order to obtain optimal clinical-audiological outcomes. Endoscopic surgery can be considered a valid alternative technique to traditional microscopic surgery for ossiculoplasty surgery.

Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Kathryn M. Van Abel, Melanie H. Quick, Darlene E. Graner, Christine M. Lohse, Daniel L. Price, Katharine A.R. Price, Dan J. Ma, Eric J. Moore Abstract Objectives To review swallowing, airway and speech outcomes following transoral robotic surgery (TORS) ± adjuvant therapy for human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV[+]OPSCC). Methods Patients underwent TORS ± standard adjuvant therapy from 5/1/2007–5/31/2015. Clinical data were recorded and descriptive analysis was performed. Results 267 patients met criteria. All patients underwent surgery at Mayo, however, only 41/81 and 71/119 patients received RT and CRT at a Mayo Clinic site. A PEG was placed in 77 patients (3 prior to any treatment, 74 reactively during adjuvant therapy), with 3 PEG dependent and 3 partially PEG reliant at last follow-up. Tracheostomy was performed in 30 (11%) patients; 28 were decannulated. Swallow evaluations were completed for 20/81 undergoing RT and 50/119 undergoing CRT at a median of 3.8 and 7.6 months post-treatment, respectively. An unrestricted oral diet was reported by 5% following RT and 12% following CRT on the Functional Oral Intake Scale. HN-PSS normalcy of diet scores indicated a diet beyond soft chewable foods for 27% following RT and 46% following CRT. No restriction of place, food, or companion was reported for the HN-PSS for public eating in 13% after RT and 33% after CRT. Aspiration of thin liquid was present in 17% and 28% following RT and CRT, respectively. HN-PSS understandability of speech was “always understandable” in 60% and 63%, following RT and CRT, respectively. Hoarseness was reported in 56% and 45% following RT and CRT respectively. Conclusion Long-term PEG and tracheostomy dependence in this cohort is low. However, these outcomes under-represent the decrement in patient speech and swallowing following TORS ± standard adjuvant therapy for HPV(+)OPSCC.

The effectiveness of cognitive rehabilitation program on auditory perception and verbal intelligibility of deaf children Publication date: September–October 2019 Source: American Journal of Otolaryngology, Volume 40, Issue 5 Author(s): Mohammad Ashori, Seyyedeh Somayyeh Jalil-Abkenar Abstract Linguistic information and cognitive rehabilitation has more related with auditory perception and verbal intelligibility. The aim of the present study was to assessment of the effectiveness of cognitive rehabilitation program on the auditory perception and verbal intelligibility of deaf children. This study was a quasi-experimental study with pre-test, post-test and control group design. Participants were 24 deaf children from Ava rehabilitation center of mother child in Isfahan city, Iran. Participants were selected by convenient sampling method. They were randomly divided into experimental and control groups, each group consisted of 12 children. The experimental group participated in the cognitive rehabilitation training program in 10 sessions for 45 min, while control group did not participate this program. The instruments of present research were Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). The data were analyzed using multivariate analysis of covariance (MANCOVA) in 24th version of SPSS. The results of MANCOVA showed that cognitive rehabilitation program had significant effect on the auditory perception and verbal intelligibility in the experimental group at post intervention stage (P < 0/0001). There was a positive and significant increase in auditory perception and verbal intelligibility of experimental group. Our findings showed that Cognitive rehabilitation program training led to promote of auditory perception and verbal intelligibility of deaf children.