Τετάρτη 6 Νοεμβρίου 2019


  1. Risk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact?

    Nurullah Seyhun, Senem Kurt Dizdar, Alican Çoktur, Merve Ekici Bektaş, ... Suat Turgut
    In Press, Journal Pre-proof, Available online 6 November 2019
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  2. Research articleAbstract only

    Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinate

    Christopher J. Ito, Nelson May, Stilianos Kountakis
    In Press, Journal Pre-proof, Available online 1 November 2019
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    Abstract
    Objective
    The purpose of this study was to evaluate the outcomes of patients with cribriform cerebrospinal fluid leaks undergoing endoscopic repair with an easy and reproducible middle turbinate-sparing technique.
    Material and methods
    Date was obtained by retrospective chart review and includes a description of the technique with technical pearls and contraindications to the approach.
    Results
    We report 17 patients who underwent repair of cribriform cerebrospinal fluid leaks with a middle turbinate-sparing technique with 100% success rate at a mean follow up of 38 months. One patient complained of hyposmia. There were no other complications.
    Conclusions
    The endoscopic middle turbinate-sparing approach to repair cribriform cerebrospinal fluid leaks using a free mucosal graft is easy, effective, and reproducible.
  3. Research articleAbstract only

    Orbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional study

    Asma Ben Mabrouk, Selmen Wannes, Mehdi Hasnaoui, Amina Werdani, ... Bahri Mahjoub
    In Press, Journal Pre-proof, Available online 31 October 2019
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    Abstract
    Objective
    The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis.
    Design and methods
    This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5).
    Results
    In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment.
    Conclusion
    Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention.
  4. Case reportAbstract only

    Alternative techniques in cochlear implant surgery: Subtotal petrosectomy

    Santiago Hernández, Juan C. Ospina, Elisa Gutiérrez-Gómez, María Teresa Rodríguez-Ruiz, Juan G. Trujillo
    In Press, Journal Pre-proof, Available online 31 October 2019
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    Abstract
    Objectives
    To report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered.
    Materials and method
    A retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019.
    Results
    A total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery.
    The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention.
    Conclusion
    Subtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications.
  5. Research articleAbstract only

    Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons

    Liyang Tang, Andrew T. Day, Rebecca Lee, Eli Gordin, ... Jeremy D. Richmon
    In Press, Journal Pre-proof, Available online 30 October 2019
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    Abstract
    Objectives
    To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications.
    Methods
    The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications.
    Results
    Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced “very few” complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have “very few” complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course.
    Conclusions
    Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported “very few” complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.
  6. Research articleAbstract only

    Clinical significance of head shake movement in three planes in individuals with dizziness

    Büşra Altın, Songül Aksoy
    In Press, Journal Pre-proof, Available online 30 October 2019
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    Abstract
    Purpose
    This study aims to evaluate the efficacy of head shake movement on three head movement planes (yaw, pitch and, roll) in patients with dizziness despite normal vestibular test results.
    Materials and methods
    Twenty individuals aged between 20 and 51 years with complaints of dizziness were included in the study, and their results were compared with the results from twenty age- and gender-matched controls. Participants were assessed using the Sensory Organization Test, Head Shake-Sensory Organization Test which is based on the modification of the Sensory Organization Test on the yaw, pitch, and roll planes, videonystagmography, caloric test, and Dizziness Handicap Inventory.
    Results
    Significant differences were found in the yaw (p = 0.007), pitch (p < 0.001), and roll (p = 0.002) planes between the study and control groups of the Head Shake-Sensory Organization Test-5 scores. There were no statistically significant differences between the two groups of the Head Shake-Sensory Organization Test-2 scores in the yaw (p = 0.448), pitch (p = 0.213), and roll (p = 0.531) planes. When the sensitivity and specificity of Head Shake-Sensory Organization Test-5 conditions were examined, the highest specificity was observed in the pitch plane (100%), followed by the yaw (95%) and roll plane (95%).
    Conclusion
    Dynamic head movements are an important parameter for the evaluation of balance performance. The head shake modification could be used effectively in three-movement planes in individuals with dizziness.
  7. Research articleAbstract only

    Therapeutic effects of metformin for noise induced hearing loss

    Özge Gedik, Remzi Doğan, Mehmet Ali Babademez, Ersin Karataş, ... Orhan Özturan
    In Press, Journal Pre-proof, Available online 30 October 2019
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    Abstract
    Objective
    This study aimed to investigate the healing effect of metformin on noise induced hearing loss (NIHL) by measuring audiological, biochemical and histological parameters.
    Materials and methods
    32 rats were divided into four groups (Group 1: Noise, Group 2: Noise + Metformin, Grup 3: Metformin, Grup 4: Control). Broadband noise was applied to Group 1 and Group 2 after basal measurements. Measuring audiological (distortion product otoacoustic emission (DPOAE) and Auditory Brainstem Response (ABR)), biochemical (total antioxidant status (TAS), total oxidant status (TOS), oxidative status index (OSI), DNA damage, IL-1 beta, IL-6, TNF alfa, HSF-1 and COX-2) and histological parameters.
    Results
    Group 2 had significant decreases in ABR thresholds on day 7 and day 14 compared to day 1. DPOAE values of Group 2 on the 7th and 14th days were significantly higher than the post-noise levels. DNA damage, TOS and OSI values of Group 1 were significantly higher than the other groups. The Cox-2 value of Group 1 was higher than all other groups. The HSF-1 value of Group 2 was significantly higher than that of Group 1. In terms of IL-1 Beta, IL-6 and TNF-alpha values, there was no significant difference between groups 2, 3 and 4 and these values were significantly lower than group 1. In histopathological results of our study, no significant difference was found between the groups being exposed to noise and the control group.
    Conclusion
    This study showed that early period of Metformin treatment has therapeutic effect on NIHL.
  8. Research articleAbstract only

    Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting

    Danny Jandali, Sarah Shearer, Richard Byrne, Peter Papagiannopoulos, ... Pete S. Batra
    In Press, Journal Pre-proof, Available online 29 October 2019
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    Abstract
    Introduction
    Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction.
    Methods
    Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.
    Results
    83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.
    Conclusion
    Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.
  9. Research articleAbstract only

    The effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus

    Belgin Tutar, Sevgi Atar, Güler Berkiten, Onur Üstün, ... Yavuz Uyar
    In Press, Journal Pre-proof, Available online 29 October 2019
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    Abstract
    Objectives
    Chronic Subjective Tinnitus is a very highly prevalent disorder worldwide. There is no definitive treatment. The aim of this study is to investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) applied to the auricula for treating tinnitus using the Depression Anxiety Stress Scales (DASS) and Tinnitus Handicap Inventory (THI).
    Methods
    The 60 patients were randomly divided into 3 groups of 20 patients. The first group (A) had one ear stimulated with TENS, and the second group (B) had both ears stimulated. Group C (placebo group) received no electrical or sound stimulation. All group patients received total of 10 sessions with a maximum of 4 days between the sessions.
    Results
    The THI and DASS scores decreased significantly after the treatment (p < 0.05). A significant difference was also observed between the groups after treatment (p < 0.05). While there was no difference between group A and B, it was shown that group C's post-treatment score was significantly higher than those of both groups (p < 0.05.)
    Conclusion
    It is important to note that TENS has a therapeutic effect on subjective chronic tinnitus as well as a placebo effect.
  10. Review articleAbstract only

    An update on autoimmune inner ear disease: A systematic review of pharmacotherapy

    David Strum, Sunny Kim, Timothy Shim, Ashkan Monfared
    In Press, Journal Pre-proof, Available online 28 October 2019
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  11. Research articleAbstract only

    Zenker's diverticulotomy with bipolar tissue sealer: Retrospective review of safety and short-term outcomes

    K.K. Bommakanti, W.J. Moss, R.A. Weisman, P.A. Weissbrod
    In Press, Journal Pre-proof, Available online 25 October 2019
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    Abstract
    Objectives
    The objective of this study is to analyze and report the institution's experience using the Enseal bipolar tissue sealing device to perform endoscopic Zenker's diverticulotomy. Safety and early functional outcomes are presented as primary endpoints of the study.
    Materials & methods
    This is a retrospective study of consecutive patients with Zenker's diverticulum (ZD) treated via a transoral approach using a rigid endoscope and a bipolar tissue sealer between 2011 and 2019. Demographic data, ZD size, complications and preoperative versus postoperative symptoms were assessed. The Eating Assessment Tool-10 (EAT-10) questionnaire was used to evaluate functional outcomes, and statistical comparisons were made using the student's t-test.
    Results
    Nineteen ZD patients were identified who underwent rigid endoscopic diverticulotomy using a bipolar tissue sealer. The mean age was 71 years and 74% were male. The mean diverticulum size was 3.1 cm. There were no intraoperative or postoperative complications identified. Average pre-operative EAT-10 score was 21 and post-operative EAT-10 score was 12 at one to two weeks after surgery (p = .05).
    Conclusions
    Evidence from this preliminary study of endoscopic Zenker's diverticulotomy using the Enseal device indicates that it is both safe and effective. Several features of the device, including its narrow profile, articulation and rotation capability, rapid repeatable activation, and low risk of collateral thermal injury, make it an appealing option for endoscopic Zenker's diverticulotomy.
  12. Research articleAbstract only

    Comparison of arytenoid vertical height discrepancy in normal versus patients with vocal cord palsy

    Eugene H. Wong, Murray Smith, Richard Tjahjono, Danielle B. Stone, ... Faruque Riffat
    In Press, Journal Pre-proof, Available online 24 October 2019
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    Abstract
    Objective
    Cadaveric experiments and more recently clinical data have demonstrated that patients with vertical height discrepancy between their arytenoids experience poorer voice outcomes in patients with unilateral vocal cord palsy (UVP) after medialisation laryngoplasty. However, the presence or severity of height discrepancy in normal patients without UVP has not yet been clearly defined.
    Study design
    Case-control study.
    Setting
    Tertiary Australian hospitals.
    Subjects and methods
    A retrospective review was performed on patients who underwent high computed tomography imaging of the neck. Scans were assessed for discrepancy in arytenoid vertical height discrepancy and compared to a cohort with known UVP.
    Results
    44 normal patients (50% female, mean age 57.6 ± 14.8 years) were compared to 23 patients with UVP (43.4% female, mean age 52.3 ± 14.9 years.) Normal patients were found to have a smaller height discrepancy compared to UVP patients (student's t-test,2.00 mm ± 0.00 vs 2.39 mm ± 0.72, p < .001.)
    Conclusion
    This study suggests that discrepancy is pathologic, and it is plausible that this results in acoustic consequences.
  13. Research articleAbstract only

    Expression of maspin tumor suppressor and mTOR in laryngeal carcinoma

    Gino Marioni, Giancarlo Ottaviano, Andrea Lovato, Leonardo Franz, ... Stella Blandamura
    In Press, Journal Pre-proof, Available online 23 October 2019
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    Abstract
    Purpose
    The main aim of this study was to conduct a preliminary investigation into the possible relationship between mTOR and the nuclear tumor suppressor maspin in laryngeal carcinoma (LSCC).
    Materials and methods
    mTOR expression and maspin pattern were ascertained, also with the aid of image analysis in 79 consecutive LSCCs.
    Results
    Considering the whole series, univariate statistical analysis identified significant differences in the distributions by lymph node status (N0 vs N+) between two subgroups of patients with and without loco-regional carcinoma recurrences (p = 0.017). The log-rank test also showed a shorter disease-free survival (DFS) in pN+ patients (p = 0.0008). mTOR expression was significantly higher in patients whose disease recurred (p = 0.009). The DFS rate was also significantly shorter in cases of LSCC with an mTOR expression ≥11.55% (p = 0.049). Multivariate analysis showed that N status (p = 0.002) and mTOR expression (p = 0.037) retained their prognostic significance in relation to cancer recurrence.
    In a subgroup of LSCCs with a non-nuclear maspin pattern, mTOR expression was significantly higher in patients whose disease recurred. Multivariate analysis disclosed that N stage (p = 0.012) retained its independent prognostic significance for disease recurrence in this setting. mTOR expression showed a trend towards independent significance in terms of carcinoma recurrence (p = 0.083).
    Conclusions
    mTOR inhibitors seem promising for use in cancer therapies. Further investigations are needed on the prospects of incorporating modern mTOR inhibitors in multimodality or multitarget strategies against advanced LSCCs, also considering the role and expression of tumor suppressor genes.
  14. Research articleAbstract only

    Minimally invasive surgery for the treatment of hyperacusis: New technique and long term results

    Herbert Silverstein, Brian Kellermeyer, Ulyseius Martinez
    In Press, Journal Pre-proof, Available online 20 October 2019
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    Abstract
    Objective
    A minimally invasive surgery developed by the senior author has previously been reported to significantly improve sound tolerance after surgery. This report compares the new versus original surgical technique used and long-term results of all patients who have undergone minimally invasive surgery for hyperacusis.
    Study design
    A prospective, IRB approved clinical research trial at a single institution with surgery performed by the author (HS).
    Setting
    All patients were evaluated and treated at a tertiary level otologic referral center.
    Subjects and methods
    47 subjects were enrolled from 2014 through 2019, 40 met inclusion criteria including adequate follow-up in the analysis. All subjects underwent oval and round window reinforcement. 20 subjects underwent surgery before 2017 with the original technique of round window reinforcement. 20 subjects underwent new technique with additional oval window and stapes reinforcement.
    Results
    80% of subjects who underwent the new surgical technique had improvement in hyperacusis symptoms after surgery compared to 60% of subjects who underwent the original technique. Long term follow-up showed sustained results with both techniques with a mean follow-up of 2 years after surgery.
    Conclusions
    The most recent, newer technique employed appears to have an 80% success rate in improving sound tolerance with small changes to hearing. The improvement in hyperacusis symptoms after surgery is significant and now found to be sustainable with a mean follow-up of 2 years after initial surgery. Psychological measures of anxiety and depression also were found to be significantly improved after surgery in the newer technique group.
  15. Research articleAbstract only

    Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps

    Lin Lin, Fei Dai, Guoqiang Ren, Jinjin Wei, ... Xinyue Tang
    In Press, Journal Pre-proof, Available online 18 October 2019
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    Abstract
    Objectives
    Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP.
    Materials and methods
    CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups.
    Results
    One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances.
    Conclusion
    These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
  16. Research articleAbstract only

    The clinical significance of methylation of MAGE-A1 and-A3 promoters and expression of DNA methyltransferase in patients with laryngeal squamous cell carcinoma

    Shenghui Liu, Yan Zhao, Yuru Xu, Meixiang Sang, ... Baoen Shan
    In Press, Journal Pre-proof, Available online 18 October 2019
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    Abstract
    Purpose
    Abnormal DNA methylation plays an important role in clinical diagnosis and prognosis of various tumors. DNA methylation is catalyzed by DNA methyltransferase (DNMT). However, the methylation status of MAGE-A1 and MAGE-A3 promoter regions in LSCC is unclear. To investigate the methylation levels of MAGE-A1, -A3 in LSCC and corresponding normal tissues. The expression of DNMTs (DNMT1, DNMT3a and DNMT3b) in LSCC and the relationship between the methylation status of MAGE-A1, -A3 were analyzed.
    Materials and methods
    We examined methylation status of MAGE-A1, -A3 in LSCC by using MSP. Meanwhile, the expression level of DNMTs in LSCC was detected by immunohistochemistry. And further analysis the correlation between DNMTs expression level and methylation status of MAGE-A1 and MAGE-A3.
    Results
    The unmethylation rate of MAGE-A1, -A3 were 39.62% and 46.23%. The expression of DNMTs was 33.02% to 37.74%. The level of demethylation of MAGE-A1 and MAGE-A3 were negative related to DNMTs protein. MAGE-A1 and MAGE-A3 unmethylation status and DNMT3a expression were independent prognostic factors for LSCC.
    Conclusions
    The DNMTs may participate in the methylation process of MAGE-A1 and MAGE-A3, which may play an important role in the occurrence and development of LSCC.
  17. Research articleAbstract only

    Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database

    Vanessa C. Stubbs, Karthik Rajasekaran, Steven B. Cannady, Jason G. Newman, ... Jason A. Brant
    In Press, Journal Pre-proof, Available online 18 October 2019
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    Abstract
    Background
    Given the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates.
    Methods
    Our analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES.
    Results
    15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58–0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64–0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63–0.91] and HR 0.84 95% CI [0.74–0.96], respectively). We found no significant survival association based on income level.
    Conclusion
    In this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.
  18. Research articleAbstract only

    Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance

    Hülya Eyigör, İlknur Haberal Can, Armağan İncesulu, Yeşim Şenol
    In Press, Journal Pre-proof, Available online 18 October 2019
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    Abstract
    Objective
    The aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers.
    Study design and setting
    A prospective survey study.
    Subjects and methods
    The study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses.
    Results
    Out of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29–75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57).
    Conclusion
    Healthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.
  19. Research articleAbstract only

    Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis

    Shin Kariya, Mitsuhiro Okano, Takaya Higaki, Seiichiro Makihara, ... Kazunori Nishizaki
    In Press, Journal Pre-proof, Available online 17 October 2019
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    Abstract
    Purpose
    Chronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine.
    Materials and methods
    Thirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment, a computed tomography (CT) scan of the paranasal sinuses, lung function test, peripheral blood test, and sino-nasal outcome test (SNOT-20) were applied.
    Results
    Both the lung function and Lund-MacKay CT scores were improved by the long-duration therapy with macrolide antibiotics. The change in obstructive pulmonary function and the improvement of the CT score in each subject were significantly correlated. SNOT scores also improved after the treatment.
    Conclusions
    The macrolide antibiotics treatment has beneficial effects on lung function in non-asthmatic chronic cough patients with normal chest X-ray findings. The improvement of chronic rhinosinusitis may have some role in the lung condition. Upper respiratory tract examination and treatment may be useful for the management of chronic cough.
  20. Research articleAbstract only

    Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function

    Eugene H. Wong, Carolyn A. Orgain, E. Ritter Sansoni, Raquel Alvarado, ... Richard J. Harvey
    In Press, Journal Pre-proof, Available online 17 October 2019
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    Abstract
    Objective
    The impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.
    Study design
    Retrospective case series.
    Setting
    Tertiary Australian Hospitals.
    Subjects and methods
    A retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0–4) was determined by the number of inferior or middle turbinate subtotal resections.
    Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.)
    Results
    294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93–3.38], OR = 0.60[0.33–1.12], B = 0.56[−1.58–2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04–4.13], P = 0.04, OR = 3.97[1.08–14.49], P = 0.04, respectively).
    Conclusion
    In patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.
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