Acta oto-laryngologica
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Acta oto-laryngologica · Jan 2010
Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent (GBCA) administration with MRI for Meniere's disease.
Bilateral intratympanic administration of a gadolinium-based contrast agent (GBCA) in MRI was successfully performed and proved to be beneficial in the semi-quantitative evaluation of endolymphatic hydrops. Such image-based diagnosis will lead to re-revaluation and reclassification of the diagnostic criteria for Meniere's disease (MD). ⋯ Three-dimensional, fluid-attenuated inversion recovery (3D-FLAIR) MRI showed that the gadodiamide successfully penetrated the round window membrane, entering the perilymphatic space and delineating the gadodiamide-enhanced perilymphatic and gadodiamide-negative endolymphatic spaces of the inner ear. All the patients with MD showed a reduced gadodiamide-enhanced area representing the perilymphatic space, and the quantitative ratio was 0.15 to 0.85. Furthermore, endolymphatic hydrops was also demonstrated in the patient with atypical MD who had fluctuating low frequency sensorineural hearing loss without vertigo.
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Acta oto-laryngologica · Dec 2009
Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study.
Compared with larynx cancers salvage rates are poorer for hypopharyngeal cancers and the role of primary surgery seems to be significantly higher and more decisive in overall survival (OS). Hypopharyngeal cancers therefore warrant a closer follow-up after an organ preservation protocol, to detect recurrence at the earliest stage and plan for an effective salvage surgery. ⋯ Of a total of 167 cases, 123 (74%) had salvage surgery for failed chemoradiotherapy/radical radiotherapy and 44 (26%) had primary surgical treatment. Conservation surgery was undertaken in 4 cases, near total laryngectomy or pharyngectomy (NTL/NTLP) was done in 14 and total laryngectomy (TLPE) with gastric pull up was done in 5. Total laryngectomy (TL) or TL with partial or subtotal pharyngectomy was done in 144 cases. Concomitant neck dissection (ND) was done in 46 cases, 14 posterolateral selective, 15 radical neck dissections (RNDs), 2 extended RNDs, 12 bilateral NDs and 3 modified neck dissections (MNDs). Five patients received platinum-based neoadjuvant chemotherapy and nine had postoperative chemotherapy. In 116 patients the pharyngeal remnant was closed primarily, 21 patients had pectoralis major myocutaneous flap patch reconstruction, 18 had tubed pectoralis major myocutaneous (PMMC) flap reconstruction, 4 had folded (bipaddled) PMMC flap reconstruction, 7 had PMMC and 3 patients had deltopectoral (DP) flap for skin cover. Pathological margin positivity was seen in seven cases and perinodal disease was seen in nine. There was a statistically significant survival difference between salvage and primary surgical cases among cancers of the larynx and hypopharynx. Hypopharyngeal salvage rate was significantly lower in the present study. Sixty-two (37%) patients had postoperative leaks. Five leaks persisted to form pharyngocutaneous fistulae. All of these patients had either wound infection with or without flap necrosis or previous radiation. Two were repaired and in two cases speech prosthesis insertion was possible due its anatomical position. One patient refused further surgical closure after a partially failed repair. Fifty-six (34%) patients recurred locoregionally, 4 (2.3%) patients developed a second primary and 5 (2.9%) had distant metastasis. Thirty patients were voice rehabilitated with an electronic larynx. Seventeen patients had voice prosthesis insertion (6 primary and 10 secondary), 3 patients developed good oesophageal speech and voice preservation was possible in 18 patients. Seventy-nine patients were alive at the time of completing the study.
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Acta oto-laryngologica · Aug 2009
Correlation between enhanced MRI and surgical findings in herpes zoster oticus.
This study demonstrates good correlation between enhanced MRI and surgical findings. ⋯ Commonly enhanced segments on MRI were the labyrinthine, intracanalicular, and geniculate ganglion, found in 84%, 69%, and 69% of all patients, respectively. The most common pathologic segment was the labyrinthine segment (92%), followed by the geniculate ganglion (84%).
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Acta oto-laryngologica · Aug 2009
Expression of aquaporins, vasopressin type 2 receptor, and Na+₋K+₋Cl⁻ cotransporters in the rat endolymphatic sac.
Since many water channels and pumps, such as aquaporin (AQP) 1-4, AQP6-9, vasopressin type 2 receptor (V(2)-R), Na(+)-K(+)-Cl(-) cotransporter (NKCC) 1, and NKCC2 were expressed in the rat endolymphatic sac, it should play an important role in the physiological function of acid-based metabolism and water balance in endolymphatic fluid homeostasis. ⋯ mRNAs and proteins of AQP1-4, AQP6-9, V(2)-R, NKCC1, and NKCC2 were expressed, but AQP5 was not expressed in the rat endolymphatic sac.
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Acta oto-laryngologica · Aug 2009
Comparative StudyComparison between tongue base and soft palate obstruction in obstructive sleep apnea.
In obstructive sleep apnea syndrome (OSAS), respiratory disturbances are more serious in tongue base-associated obstructions (TBOs) than in soft palate-associated obstructions (SPOs), and the proportion of TBO was predicted by average duration of apnea and hypopnea, and inversely by percentage time of snoring. ⋯ Average duration of apnea and hypopnea, percentage of apnea among apnea-hypopneas, average O(2) desaturation, and percentage of event-related arousals were significantly higher in TBOs compared with SPOs (all p<0.05). The percentage of TBO among total obstructions (TBO%) was independently associated with average duration of apnea and hypopnea (=0.38, p<0.05) and percentage time of snoring (=-0.44, p<0.01) (adjusted R(2)=30%, p<0.01).