bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivering the Diagnosis of Sex Chromosome Aneuploidy: Experiences and Preferences of Parents and Individuals
Authors: Jaramillo Carolina , Nyquist Christina , Riggan Kirsten A. , Egginton Jason , Phelan Sean , Allyse Megan
Published: December 2018

Increased prenatal diagnoses of sex chromosome aneuploidies (SCAs) amid limited knowledge of their prognoses heighten the need to understand how families contend with the implications of an SCA. To explore the experiences of parents and individuals who received a genetic diagnosis of an SCA (excluding Turner syndrome), we conducted semistructured qualitative telephone interviews with 43 participants affected by these conditions. Parents (n = 35) and individuals (n = 8) expressed almost unanimous interest in more optimistic portrayals of their condition from their providers, even when the prognosis is uncertain. While some participants reported success in receiving accurate information from their provider and identifying supportive resources, numerous families received outdated or misleading information about their condition and lacked direction in accessing follow-up care and support. Parents desire greater coordination of their child’s medical care and access to care that approaches an SCA holistically. Opportunities remain to improve the diagnosis and care of individuals with SCAs.
Impact of the Sequence of Norepinephrine and Vasopressin Discontinuation in Patients Recovering From Septic Shock
Authors: Bredhold Benjamin E. , Winters Shauna D. , Callison John C. , Heidel Robert E. , Allen Lauren M. , Hamilton Leslie A.
Published: December 2018

Background: Septic shock is a serious medical condition affecting millions of people each year and guidelines direct vasopressor use in these patients. However, there is little information as to which vasopressor should be discontinued first. Objective: The objective of this study was to assess the impact of the sequence of norepinephrine and vasopressin discontinuation on intensive care unit (ICU) length of stay. Methods: This was a single-center retrospective cohort study conducted at The University of Tennessee Medical Center in Knoxville, Tennessee. Patients included in this study were adults 18 years of age and older with a diagnosis of septic shock who received norepinephrine in combination with vasopressin. Patients were excluded if norepinephrine or vasopressin were not the last 2 vasoactive agents used or if the patient expired or care was withdrawn. Measurements and Main Results: A total of 86 patients were included in this study, with 34 patients in the norepinephrine discontinued first group (NDF) and 52 in the vasopressin discontinued first group (VDF). For the primary outcome of ICU length of stay, no statistically significant difference was found between the NDF and the VDF groups (9.38 days vs 11.07 days, P = .313). The secondary outcome of the dose of norepinephrine at which vasopressin was initiated was also found to not be significant between the NDF and VDF groups (22 µg/min vs 31.1 µg/min, P = .11). The rates of hypotension within 24 hours of discontinuation of the first agent were also not significant between the NDF and VDF groups (17% vs 31%, P = .38). Conclusions: Based on the results of this study, there was significant no difference in ICU length of stay based on the sequence of discontinuation between norepinephrine and vasopressin in patients recovering from septic shock.
Evaluation of a Long-Acting Opioid Restriction Policy: Does Restriction Reduce the Need for Naloxone Reversal?
Authors: Fancher Jenna L. , Seabury Robert W. , Darko William , Probst Luke A. , Miller Christopher D.
Published: December 2018

Purpose: After a sentinel event related to long-acting (LA) opioid administration at our institution and subsequent root cause analysis, an inpatient LA opioid restriction policy was implemented to improve patient safety. The objectives of this study were to evaluate the effect of an inpatient LA opioid restriction policy on inpatient therapy utilization and to compare rates of naloxone reversal events among patients administered LA opioids before and after policy implementation. Methods: To evaluate the first objective, an electronic medical record report was created to capture all inpatient LA opioid orders prescribed to adults at our institution between March 1, 2014, and July 30, 2017. Utilization was compared before and after policy implementation and use controlled for by patient days. To evaluate the second objective, naloxone administrations were identified via a query of the medical record between March 1, 2014, and July 30, 2017. Naloxone reversal events were independently evaluated by 2 trained reviewers, and a third when discrepancies existed. Rates of naloxone reversal events related to LA opioid administration were compared between the pre- and post-policy phase. Results: The results of our first objective demonstrate that policy implementation was associated with a statistically significant reduction in LA opioid utilization that was sustained throughout the study duration. For our second objective, among the 144 patients deemed to have an opioid-related naloxone reversal event, a LA opioid was administered to 12 patients (18.9%) in the pre-policy phase and 17 patients (15.9%) in the post-policy phase. This difference was not statistically significant (odds ratio [OR] = 1.629, confidence interval [CI] = 0.711-3.732, P = .248). Conclusion: A LA opioid restriction policy significantly reduced LA opioid utilization at our institution. Despite this, we did not find a significant reduction in inpatient naloxone reversals related to LA opioids. Further study is warranted to identify an optimal method to reduce LA opioid-related toxicity.
Dialectics of Post-1979 Iranian Foreign Policy in West Asia
Authors: Houshisadat Seyed Mohammad
Published: December 2018

The article focuses on Iran’s foreign relations with the West Asia and North Africa (WANA) region since the Islamic Revolution. It looks at interplay of domestic and transnational variables. The domestic factors include the beliefs system of the policymakers, interest of political survival, political economy, the geopolitics of Persia and also geographical realm. The transnational variables consist of the global order, symmetrical and asymmetrical interdependence as well as the regional systemic status. These major components are vital in Persia’s relationships with the regional and trans-regional players in the WANA region. Unlike the Iranian negative or conflictual dialectics, the Iranian positive or cooperative dialectics is the main consequence of the agent–structure’s interactions in this region.
Indian Perceptions of the Chinese Belt and Road Initiative
Authors: Sachdeva Gulshan
Published: December 2018

This article has captured evolving Indian narratives concerning One Belt One Road (OBOR) or the Belt and Road Initiative (BRI). In the context of changing scope of the BRI, perceptions are also evolving. The article has covered wider perceptions, which go much beyond limited official narrative. Broader India–China ties have affected BRI discussions. The sovereignty-related issues concerning the China–Pakistan Economic Corridor (CPEC) and broader geopolitical implications within the Indian Ocean Region have overshadowed other aspects of the BRI. India’s participation in the Asian Infrastructure Investment Bank (AIIB), Shanghai Cooperation Organisation (SCO) and BRICS had relatively little impact on New Delhi’s perception of the BRI. In fact, the Bangladesh–China–India–Myanmar Economic Cooperation (BCIM) corridor, which was graduated to Track I in 2013, has rather become victim of the BRI geopolitics. Although a large number of independent analysts have argued for a selective participation in the BRI, this has hardly been reflected in government policy. As the BRI progresses, the Indian focus is more on perusing its own connectivity plans (individually or with other partners) and also on showing how some of the BRI projects are creating difficulties for recipient countries. From the earlier geopolitical and developmental aspects of the initiative, the focus is now shifting more towards a political economy analysis of participating countries. Increasing difficulties faced by BRI projects in terms of debt trap, corruption, political controversies, negative environmental implications and overall sustainability of projects are also being analysed in India.
The New Silk Roads: European Perceptions and Perspectives
Authors: Vergeron Karine Lisbonne de
Published: December 2018

The focus of this article is on European perceptions and attitudes towards the New Silk Roads or Belt and Road Initiative (BRI). The New Silk Roads is neither a formal policy nor a clearly defined geographical or geopolitical strategy, rather it is an evolving narrative. These perceptions have been partly shaped by the importance of the EU–China bilateral relation as well as European plans towards Asian connectivity. Europe’s developing strategic approach towards Eurasia has also affected these views as well as national prerogatives. Since 2017, a more coordinated European approach has evolved. The EU greatly welcomes Chinese initiatives of increasing investments in cross-border infrastructure with the view that it should adhere to market rules, international financial and environmental norms. Through BRI, China has focused more on Central and Eastern Europe (CEE) and the Mediterranean region. Some of the projects have led to concerns over the possibility of diluting European political unity or investments rules. There is, however, much room for greater political coordination among European countries, notably by being more proactive in promoting, for example, the infrastructure projects which the EU has already financed in CEE and by generally seeking to promote the EU–Asia connectivity plans.
Self-Compassion, Social Constraints, and Psychosocial Outcomes in a Pet Bereavement Sample
Authors: Bussolari Cori , Habarth Janice M. , Phillips Sharleen , Katz Rachel , Packman Wendy
Published: December 2018

This study investigated self-compassion in the context of grief following the death of a companion animal in a recently bereaved sample ( N = 431). We addressed social contexts and individual differences focusing on how psychosocial outcomes vary as a function of social constraints, as well as individual differences in self-compassion and use of continuing bonds (CB). We observed that self-compassion related to the frequency of engagement in CB. Self-compassion also moderated relationships between grief severity and depression as well as social constraints and depression. We recommend future research on self-compassion training and psychosocial outcomes, especially for those experiencing social constraints or disenfranchised grief.
Turkish Emotional Word Norms for Arousal, Valence, and Discrete Emotion Categories
Authors: Kapucu Aycan , Kılıç Aslı , Özkılıç Yıldız , Sarıbaz Bengisu
Published: December 2018

The present study combined dimensional and categorical approaches to emotion to develop normative ratings for a large set of Turkish words on two major dimensions of emotion: arousal and valence, as well as on five basic emotion categories of happiness, sadness, anger, fear, and disgust. A set of 2031 Turkish words obtained by translating Affective Norms for English Words to Turkish and pooling from the Turkish Word Norms were rated by a large sample of 1527 participants. This is the first comprehensive and standardized word set in Turkish offering discrete emotional ratings in addition to dimensional ratings along with concreteness judgments. Consistent with Affective Norms for English Words and word databases in several other languages, arousal increased as valence became more positive or more negative. As expected, negative emotions (anger, sadness, fear, and disgust) were positively correlated with each other, whereas the positive emotion, happiness, was negatively correlated with the negative emotion categories. Data further showed that the valence dimension was strongly correlated with happiness, and the arousal dimension was mostly correlated with fear. These findings show highly similar and consistent patterns with word sets provided in other languages in terms of the relationships between arousal and valence dimensions, relationships between dimensions and specific emotion categories, relationships among specific emotions, and further support the stability of the relationship between basic discrete emotions at the word level across different cultures.
The Technical Efficiency of Community Health Service Centers in Wuhan, China: Estimation and Policy Implications
Authors: Liu Xinliang , Wang Quan , Sara Barsanti , Yang Wei , Dong Siping , Li Hao
Published: December 2018

This study seeks to measure the technical efficiency of Community Health Service Centers (CHSCs) in Wuhan City, China, to propose some policy recommendations to improve the efficiency of CHSCs. A total of 46 CHSCs in Wuhan City were included in the study as research subjects. Data of 11 selected input and output indicators were collected from Hubei Provincial Health and Family Planning Commission. R3.2.1 statistical software was used to estimate the efficiency scores of CHSCs using Bootstrap-Data Envelopment Analysis (DEA), and, on average, the bias-corrected technical efficiency score is found to be 0.7845. All the bias-corrected scores of CHSCs are lower than classical scores. At both local and regional level, large gaps exist in relative technical efficiency scores among the CHSCs, and 12 out of 46 CHSCs (26.09%) have efficiency scores at or below average levels. The results indicate big potential for the CHSCs in Wuhan to improve their technical efficiency, such as the optimization of health resources allocation, capacity building, information system strengthening, third party performance evaluation, and mechanisms design, and so on.
“Good” and “Bad” Control in Public Administration: The Impact of Performance Evaluation Systems on Employees’ Trust in the Employer
Authors: Wiemann Meike , Meidert Nadine , Weibel Antoinette
Published: December 2018

In the course of the New Public Management reform movement, public administrations have increasingly implemented output-oriented control schemes, including systems to evaluate employees’ performance. However, contradictory evidence exists about how such output control that fundamentally differs from traditional bureaucratic control affects performance-relevant employee attitudes and behaviors. In this article, we present evidence that performance evaluations have positive or negative consequences depending on the specific design of the system. Analyzing survey data from 184 employees and 60 supervisors from the German municipal administration by structural equation modeling, we find performance evaluations employed as Management by Objectives (MbO) have a positive impact on trust in the employer and that those designed as Systematic Performance Appraisal (SPA) affect trust negatively. Both relationships are mediated by perceived cooperative climate. These findings advocate employing performance evaluations that are participative, adaptive, learning-oriented, and transparent and thus enable fair cooperation between organizational members.
The social and economic impact of international female migration on left-behind parents in East Java, Indonesia
Authors: Aminuddin M. Faishal , Pallikadavath Saseendran , Kamanda Amie , Sukesi Keppi , Rosalinda Henny , Hatton Kieron
Published: December 2018

The objective of this article is to examine the impact of international female labor migration on left-behind parents by taking into consideration the daughters' marital status. Data were taken from in-depth interviews with 37 left-behind parents of migrant women in East Java Province. The study showed that left-behind parents had limited access to the remittances sent by married daughters, except when they carried out childcare responsibilities. Parents of unmarried daughters had some access to remittances, but this varied according to the economic conditions of the family. Left-behind parents were concerned about the safety of their daughters overseas, the marriage prospects of unmarried daughters, the stability of their daughters' marriages and the welfare of left-behind grandchildren. Because the migration of married and unmarried daughters has diverse impacts on left-behind parents, this should be considered in programs that aim to mitigate potential negative impacts of women's migration.
Evaluation of Patient Satisfaction with Different Hearing Aids: A Study of 107 Patients
Authors: Ulusoy Seçkin , Muluk Nuray Bayar , San Turhan , Cingi Cemal
Published: December 2018

We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients—60 males and 47 females, aged 8 to 84 years (mean: 53.8)—with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.
Fiddler's Neck: A Review
Authors: Myint Calvin W. , Rutt Amy L. , Sataloff Robert T.
Published: December 2018

Fiddler's neck is a common dermatologic condition associated with instrument use in violin and viola players. It typically manifests as a submandibular and/or supraclavicular lesion. It is a benign condition, but it may be mistaken for lymph-edema or a salivary gland malignancy. Otolaryngologists who treat patients with fiddler's neck should be aware of appropriate management protocols and the need to avoid surgical excision. We obtained informed consent from 3 violinists to present their cases as specific examples of fiddler's neck. In addition, we present a literature review based on our PubMed search for articles about this instrument-induced dermatitis. The literature suggests that submandibular fiddler's neck is caused by mechanical pressure and shear stress on the skin and that it can present as erythema, scarring, edema, and lichenification. Supraclavicular fiddler's neck, on the other hand, is caused by allergic contact dermatitis, and it can present as an eczematous, scaly, and/or vesicular lesion. In most cases, a good history (especially of string instrument use), physical examination, and a patch test are sufficient to diagnose this condition. Management of fiddler's neck includes a topical steroid, proper instrument handling, neck padding, changing the instrument's materials, and/or reducing the amount of playing time. Surgical excision is usually not advisable.
Estimation of Partitioning of Airflow in Septal Surgery: A Prospective Study with Reference to the NOSE Scale
Authors: Sen Indranil , Dutta Mainak , Haldar Dibakar , Sinha Ramanuj
Published: December 2018

Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.
Efficacy of Intralipid Infusion in Reducing Amphotericin-B–associated Nephrotoxicity in Head and Neck Invasive Fungal Infection: A Randomized, Controlled Trial
Authors: Hasibi Mehrdad , Jafari Sirous , Manshadi Seyyed Ali Dehghan , Asadollahi Marjan , Salehi Mohammadreza , Zarch Varasteh Vakili , Kouhi Ali
Published: December 2018

Amphotericin B deoxycholate (ABD) is the best therapeutic agent available for the treatment of most systemic fungal infections. However, some untoward adverse effects such as nephrotoxicity may limit its appropriate therapeutic use. We conducted a randomized, controlled trial ofthe infusion of fat emulsion (Intralipid) shortly after the infusion of ABD to evaluate its effects on reducing ABD-associated nephrotoxicity. Our patient population was made up of 31 patients who were randomized into two groups: an intervention group (n = 16) and a control group (15 patients). There were no statistically significant differences between the two groups in demographic or clinical variables. All patients received 1mg/kg/day of ABD in dextrose 5%. In addition, the patients in the intervention arm received Intralipid 10%, which was started as soon as possible within 1 hour after the infusion of ABD. ABD-associated nephrotoxicity was defined as a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl. We also measured daily serum creatinine changes during the first 2 weeks of treatment, and we compared some other relevant indices of renal function, as well as ABD-related hypokalemia. We found no statistically significant differences between the two treatments in terms of ABD-associated nephrotoxicity or any of the other indices. We conclude that the administration of Intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity or hypokalemia.
Quality-of-Life Outcomes in Graves Disease Patients after Total Thyroidectomy
Authors: Kus Lukas H. , Hopman Wilma M. , Witterick Ian J. , FreemanFreemanFreeman Jeremy L.
Published: December 2018

Historically, research into surgical treatment of Graves disease has assessed subtotal rather than total thyroidectomy. Most clinicians now recommend total thyroidectomy, but little information is available regarding quality-of-life (QOL) outcomes for this procedure. Our aim was to assess QOL after total thyroidectomy. This is a retrospective, pilot study of patients with Graves disease who underwent total thyroidectomy from 1991 to 2007 at a high-volume tertiary referral center in Toronto, Canada. Questionnaires addressing disease-specific symptoms and global QOL concerns were sent to 54 patients. Analyses included parametric and nonparametric tests to assess the differences between perception of symptoms and global QOL before and after surgery. Forty patients responded (response rate: 74%) at a median of 4.8 years postoperatively. On a 10-point scale, overall wellness improved from 4.1 pre-operatively to 8.7 postoperatively (p < 0.001). Patients recalled missing less work or school after surgery (7.8 vs. 1.1 days/year; p = 0.001). Overall satisfaction with the procedure was high. On average, symptoms improved within 32 days of surgery, and all symptoms showed substantial improvement. This is the first North American study to assess QOL outcomes of patients with Graves disease after total thyroidectomy. Patients experienced marked and rapid improvement in QOL postoperatively. These findings suggest that total thyroidectomy is a safe and effective treatment.
Is Computed Tomography Perfusion a useful Method for Distinguishing between Benign and Malignant Neck Masses?
Authors: Düzgün Fatih , Tarhan Serdar , Ovalı Gülgün Yılmaz , Eskiizmir Görkem , Pabuşçu Yüksel
Published: December 2018

Evaluation of neck masses is frequent in ear, nose, and throat clinics. Successful outcomes associated with neck mass are directly related to rapid diagnosis and accurate treatment for each patient. Late diagnosis of a malignant mass increases the magnitude of morbidity and the rate of mortality of the disease. Although magnetic resonance imaging and computed tomography (CT) examinations are important tools for evaluating head and neck pathologies, they do not allow functional evaluation. For this reason, CT perfusion (CTP) as a method of functional evaluation for distinguishing benign from malignant masses is gaining attention. The utility of CTP for distinguishing between benign and malignant mass lesions was investigated in 35 patients with masses in the neck (11 benign, 24 malignant). CTP was shown to be a useful method for identifying head and neck tumors and blood volume values to enable the differential diagnosis of benign and malignant head and neck tumors.
Is There An Association between Migraine and Allergic Rhinitis?
Authors: Güvenc Işıl Adadan , Acar Mustafa , Muluk Nuray Bayar , Kucukcan Nagehan Erdogmus , Cingi Cemal
Published: December 2018

We conducted a prospective study to evaluate nasal signs and symptoms and to perform allergen-specific immunoglobulin E (IgE) testing to investigate the relationship between migraine and allergic rhinitis. Our study group consisted of 40 patients diagnosed with migraine—22 men and 18 women, aged 21 to 38 years (mean: 25.7). We compared their findings with a control group of 40 healthy adults—15 men and 25 women, aged 19 to 36 years (mean: 25.1). Allergen-specific IgE measurements were obtained with six groups of allergens: fungi, grass pollens, tree pollens, wild herbs, house dust mite 1, and house dust mite 2. We found no significant difference between the migraine patients and the controls in the incidence of nasal signs and symptoms (i.e., discharge, congestion, itching, and sneezing) or inferior turbinate signs (i.e., color and edema). According to the IgE assays, 14 migraine patients (35.0%) were sensitized to one or more allergens, compared with 11 of the controls (27.5%); the difference was not statistically significant. Sensitization was highest for the grass pollens panel in both groups. Even though we did not find an association between migraine and allergic rhinitis, the recent literature supports a correlation between migraine and atopy. The two conditions share common neural pathways and common mediators, and they can be linked statistically in patients and their families. A pathophysiologic association between the two conditions seems more likely than an etiologic association. In this regard, future efforts could be focused on the determination of atopy in migraine patients and the therapeutic implications of this diagnosis.
A Comparison of Tonsillar Surface Swabbing, Fine-Needle Aspiration Core Sampling, and Dissected Tonsillar Core Biopsy Culture in Children with Recurrent Tonsillitis
Authors: Sarkar Saurav , Sil Abheek , Sarkar Soma , Sikder Biswajit
Published: December 2018

In recurrent tonsillitis, the pathogenic bacteria are harbored in the tonsil core, and therefore cultures of superficial swab samples are not particularly accurate in identifying specific types of core bacteria. On the other hand, the results of fine-needle aspiration (FNA) cultures of core samples have been closely correlated with the findings of core cultures in excised tonsils, and both methods are far superior to surface swabbing. We conducted a prospective study to compare the accuracy of culture findings from tonsillar tissue obtained by surface swabbing, FNA sampling of the tonsil core in situ, and core sampling of the excised tonsil in children with recurrent tonsillitis. Our patient population was made up of 54 children—22 boys and 32 girls, aged 4 to 14 years (mean: 10.7)—who were undergoing elective tonsillectomy during a 1-year period. On the day of surgery, a surface swab, core FNA sample, and dissected core sample were obtained from each patient and sent for culture. Culture showed that the three methods were in agreement in 34 cases (63.0%). In 9 cases (16.7%) the surface swab culture grew different pathogens from those of the two core cultures, and in 3 other cases (5.6%) the surface swab culture was negative while the two core cultures were positive for the same pathogens. In all, the results of core FNA culture and dissected core culture were in agreement in 46 cases (85.2%); in only 4 cases (7.4%) did the core FNA culture fail to accurately identify the causative pathogens. Overall, the sensitivity and specificity of core FNA sampling were 100 and 50% respectively, compared with 82.9 and 30.8% for the superficial tonsillar swab. We conclude that routine culture of surface swab specimens in patients with chronic or recurrent tonsillitis is neither reliable nor valid. We recommend that core FNA sampling be considered the diagnostic method of choice since it can be done on an outpatient basis, it would reliably allow for culture-directed antibiotic therapy, and it could obviate the need for elective tonsillectomy in many cases. However, its feasibility as an office procedure in children remains to be determined.
Idiopathic Pretracheal Deep Neck Space Infection with Mediastinal Extension: A Series of 3 Cases and Review of the Literature
Authors: Roberts Samuel , Chan Lyndon , Eisenberg Robert
Published: December 2018

Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.
Prospective, Randomized, Controlled Trial Using Best-Selling Smoking-Cessation Book
Authors: Foshee James P. , Oh Anita , Luginbuhl Adam , Curry Joseph , Keane William , Cognetti David
Published: December 2018

Our prospective, randomized, controlled trial aimed to evaluate the efficacy of the self-help book, The Easy Way to Stop Smoking, by Allen Carr, in promoting smoking cessation in patients with head and neck cancer. We assessed active smokers for their willingness to read a smoking cessation book. Participants were randomized to either receive the book from our department or recommended to purchase the book. All patients received smoking cessation counseling at recruitment. Phone surveys were conducted at short- and long-term intervals to determine if the patients had purchased and/or read the book and whether they were still smoking. One hundred twelve patients were recruited, 52 of whom completed follow-up surveys. Those who received the book for free were more likely to read the book (p = 0.05). Reading the book did not correlate with successful smoking cessation (p = 0.81). Some 26% of the 27 patients who received the book quit smoking compared with 32% of the 25 patients who were recommended the book (p = 0.76). Patients who indicated motivation to quit smoking were more likely to succeed. In our study, smoking cessation did not appear to be influenced by reading The Easy Way to Stop Smoking. Despite 80.8% of the cohort indicating at least a readiness to quit smoking at recruitment, only 28.8% of patients managed to achieve successful smoking cessation at long-term follow-up. Patient motivation remains an important factor in achieving long-term smoking abstinence. Quitting smoking remains a daunting challenge for patients, with multiple interventions likely needed to achieve cessation.
The Sophono Bone-Conduction System: Surgical, Audiologic, and Quality-of-Life Outcomes
Authors: Mclean Timothy , Pai Irumee , Philipatos Andrew , Gordon Michael
Published: December 2018

We prospectively evaluated the surgical, audiologic, and quality-of-life outcomes in 5 patients—2 men and 3 women, aged 22 to 64 years (mean: 41.8)—who were implanted with the Sophono Alpha 2 MPO Processor. The indications for implantation of this bone-conduction device included recurrent ear canal infections with hearing aids (n = 3), single-sided deafness (n = 1), and patient preference in view of difficulty using a conventional hearing aid (n = 1). In addition to the patient with single-sided deafness, 3 patients had a bilateral mixed hearing loss and 1 had a bilateral conductive hearing loss. Outcomes measures included surgical complications, functional gain (FG), speech discrimination in quiet and noise, and patient satisfaction as determined by the Glasgow Benefit Inventory (GBI) and the Entific Medical Systems bone-anchored hearing aid questionnaire (BAQ). The only postsurgical complication noted was a minor skin reaction and pain in 1 patient that resolved with conservative management. In the 3 patients with the mixed hearing loss, the mean FG was 13.3, 20.0, 11.7, and 11.7 dB at 0.5, 1, 2, and 4 kHz, respectively; in the patient with the bilateral conductive hearing loss, the FG was 10, 25, 10, and 15 dB at the same frequencies. Speech discrimination scores with the Sophono device were comparable to those seen with conventional hearing aids. After implantation, all 5 patients experienced a positive quality-of-life outcome according to the GBI, although 1 of them had only a marginal improvement. On follow-up, all patients reported that they remained satisfied with their implant and that they used their device all day long. We conclude that the Sophono bone-conduction system is a safe and effective option that should be considered for patients with a mixed or conductive hearing loss who are unable to use a conventional hearing aid, as well as for those with single-sided deafness.
Cornelia de Lange Syndrome: What Every Otolaryngologist should Know
Authors: Eliason Michael J. , Melzer Jonathan M. , Gallagher Thomas Q.
Published: December 2018

Cornelia de Lange Syndrome (CdLS) can be expressed in multiple organ systems requiring a variety of specialists, including pediatric otolaryngology. We present the case of a 20-month-old boy with CdLS actively managed by an aerodigestive team consisting of pediatric otolaryngology, pediatric pulmonology, pediatric gastroenterology, with support staff from audiology, speech, and nutrition. His presentation included mixed hearing loss, dysphagia, microaspiration, gastroesophageal reflux, and failure to thrive. We submit this challenging case of CdLS with a review of the literature to focus specific attention on the otolaryngic manifestations of the syndrome and to discuss the benefits of a multidisciplinary approach to these unique patients.
A Clinicopathologic and Epidemiologic Study of Chronic White Lesions in the Oral Mucosa
Authors: Ghosh Sampurna , Pal Sudipta , Ghatak Soumya , Saha Somnath , Biswas Surajit , Srivastava Prabha
Published: December 2018

Invasive oral squamous cell carcinoma is often preceded by the presence of clinically identifiable premalignant changes of the oral mucosa, including white lesions. We conducted a cross-sectional, observational study to assess the clinicopathologic and epidemiologic aspects of chronic oral mucosal white lesions to determine the necessity of early biopsy in these cases. Our study population was made up of 77 patients—50 males and 27 females, aged 15 to 70 years (mean: 42.9)—who presented with white lesions persisting for at least 4 weeks. All but 3 patients underwent a biopsy; the 3 exceptions were diagnosed with smear-proven candidiasis. Patients with moderate or severe dysplasia underwent an excision biopsy. The buccal mucosa was the single most common site of white lesions, occurring in 15 patients (19.5%), although 21 patients (27.3%) exhibited a diffuse involvement of the oral mucosa. Of the 77 patients, 59 (76.6%) had concerning findings: premalignant lesions in 45 patients (58.4%) and malignant lesions in 14 (18.2%). Also, dysplasia was seen in 8 patients (10.4%), all of whom had premalignant lesions. Tobacco chewing (p = 0.008) and betel quid chewing (p = 0.029) were significantly associated with the development of premalignant and malignant lesions; a longer duration of tobacco chewing (≥10 yr) was significantly associated with a higher risk of malignant but not premalignant lesions (p = 0.031). Finally, illiteracy was a significant risk factor for premalignant and malignant lesions (p = 0.03). Our findings support the necessity of biopsy in every case. Early detection of oral carcinoma by biopsy of all oral white lesions would not only prevent patients from undergoing disfiguring surgery and chemoradiation, but it also would increase the 5-year survival rate.
Assessment of Discrimination Ability in Ipsilateral and Contralateral Ears with a Unilateral Bone-Anchored Hearing System
Authors: Celikgun Bahtiyar , Kalcioglu M. Tayyar
Published: December 2018

This study aimed to determine the speech discriminatory ability of the contralateral ear of users of a unilateral bone-anchored hearing system (BAHS). The Oticon Medical Ponto Pro/Ponto Pro Power device brand was used for all patients. Five BAHS users (3 men, 2 women) participated in the study. Pure-tone air-conduction thresholds at 250 to 6,000 Hz, masked and unmasked bone-conduction thresholds at 250 to 4,000 Hz, and participants’ speech discrimination scores in both ears were determined. Speech discrimination tests were carried out in a silent environment with monosyllabic and trisyllabic word lists. After this, the ipsilateral ear (the BAHS side) was masked with wide-band noise using an insert earphone, and the word tests were repeated. A mild decrease was observed in monosyllabic words in ipsilateral masking; however, this was not found to be statistically significant. Conversely, a decrease was not observed in the repetition of trisyllabic words in any participants, even under high-level ipsilateral masking. These results suggested that unilateral BAHS application could prevent or reduce the neural deprivation of the contralateral ear.
Platelet-Rich Plasma Myringoplasty: A New Office Procedure for the Repair of Small Tympanic Membrane Perforations
Authors: El-Anwar Mohammad Waheed , Elnashar Ismail , Foad Yaser Ahmad
Published: December 2018

We conducted a prospective study to assess the effectiveness of a platelet-rich plasma hourglass graft in the repair of small tympanic membrane perforations as an office-based procedure. Our study population was made up of 25 patients—10 men and 15 women, aged 19 to 45 years (mean: 30.4 ± 7.2)—who each underwent repair of one eardrum. After administration of topical anesthesia, a single piece of platelet-rich plasma approximately double the size of the perforation was obtained from each patient's intravenous blood sample. After the margin of the perforation was freshened, the platelet-rich plasma was placed in an hourglass configuration, with equal portions lying medial and lateral to the perforation. Successful perforation repair was achieved in 21 of the 25 ears (84%). No patient developed an infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. We conclude that office-based platelet-rich plasma myringoplasty is a safe and effective minimally invasive procedure that is suitable for repairing small tympanic membrane perforations.
Multinodular Goiter: A Study of Malignancy Risk in Nondominant Nodules
Authors: Yong Jenica Su-ern , Loh Kwok Seng , Petersson Bengt Fredrik , Thong Mark
Published: December 2018

The long-standing belief that multinodular goiters are associated with a lower risk of developing into carcinoma has been challenged by the results of some recent studies. In addition, we have noticed in our practice that a sizable proportion of cancers have been arising from nondominant nodules. We performed a retrospective study of 223 cases to determine (1) the incidence of carcinoma in multinodular goiters that required surgical management in our local, predominantly Asian population and (2) the incidence of carcinoma arising from nondominant nodules. We reviewed the records of all patients with a multinodular goiter who had undergone a thyroidectomy over a period of more than 10 years in our Department of Otolaryngology–Head and Neck Surgery. We examined the histopathology reports for (1) the presence of carcinoma, (2) whether the carcinoma was isolated/unifocal or multifocal, (3) the histologic type of cancer, and (4) whether the isolated/unifocal cancers arose from the dominant or nondominant nodule. Our study population was made up of 47 males and 176 females, aged 15 to 90 years (mean: 53). We found that the incidence of malignancy in surgically treated multinodular goiters was 14.3% (32 of 223 patients). Of the 32 malignancies, 18 (56.3%) were isolated/unifocal and 14 (43.8%) were multifocal. In the isolated/unifocal group, 9 malignancies (50.0%) arose from nondominant nodules and 8 (44.4%) from dominant nodules; in the remaining case, the nodule of origin could not be determined. Our findings corroborate those in the recent literature in that the risk of malignancy associated with multinodular goiters is comparable to that of single thyroid nodules. We recommend that physicians be equally vigilant when monitoring dominant and nondominant nodules.
Olfactory Dysfunction in β-Thalassemia Major Patients Treated with Iron-Chelating Agents
Authors: Derin Serhan , Erdogan Selvet , Sahan Murat , Azik Mehmet Fatih , Derin Hatice , Topal Yasar , Topal Hatice
Published: December 2018

Ocular and ophthalmologic adverse effects may occur in patients with β-thalassemia major (BTM) treated regularly with blood transfusions and iron-chelating agents. We hypothesized that olfactory dysfunction may be present in this patient population. We aimed to investigate olfactory dysfunction in patients with BTM and to determine etiologic factors. A total of 43 patients with BTM were included in the study. Forty-three subjects without nasal complaints, history of facial trauma, or nasal surgery were included as the controls. All participants had nasal endoscopy. The use of iron-chelating agents by patients with BTM and their duration of use were recorded, as well as hemoglobin and ferritin levels. The Sniffin Sticks test (SST) was used to assess olfactory function, comparing results between the BTM and control groups. The correlations of SST scores with the other study parameters were analyzed. Eight (18.6%) of 43 patients in the BTM group and none of the subjects in the control group had hyposmia (p < 0.001). Older age, low hemoglobin level, and longer use of deferoxamine were found to be correlated with olfactory dysfunction. Olfactory dysfunction can occur in patients with BTM treated with iron-chelating agents. The results suggest that screening for olfactory function should be part of the routine follow-up of patients with BTM.
A Controlled Comparison of Auditory Steady-State Responses and Pure-Tone Audiometry in Patients with Hearing Loss
Authors: Wadhera Raman , Hernot Sharad , Gulati Sat Paul , Kalra Vijay
Published: December 2018

We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears—80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.
Management of Benign Middle Ear Tumors: A Series of 7 Cases
Authors: Qian Z. Jason , Coffey Amy M. , O'Toole Kathleen M. , Lalwani Anil K.
Published: December 2018

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.