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Bilateral subtotal thyroidectomy versus total thyroidectomy for Graves' disease
The extent of thyroid resection in Graves' disease remains controversial. The aim of this study was to evaluate long-term results of bilateral subtotal thyroidectomy (BST) compared with total thyroidectomy (TT) in patients with Graves' disease and mild active ophthalmopathy. Overall it was shown that TT for Graves' disease prevented recurrent hyperthyroidism but did not prevent the progression of ophthalmopathy compared with BST. 

Head/Neck Cancer Treatments Less Effective in HIV Patients
Definitive radiation therapy with or without chemotherapy was less tolerated and less effective in HIV-positive patients with head and neck squamous cell carcinoma than in HIV-negative patients in a single-institution retrospective study of 71 HIV-positive patients.

Association Between Obstructive Sleep Apnea and Sudden Sensorineural Hearing Loss
This article examined the putative association between obstructive sleep apnea (OSA) and sudden sensorineural hearing loss (SSNHL) using a nationwide population-based data set. Obstructive sleep apnea has been associated with generalized inflammation and nervous-endocrine, cardiovascular, and other systemic biophysiologic phenomena. This article found that in male patients with SSNHL had a higher proportion of prior OSA than non-SSNHL-diagnosed controls; no such association was found among female patients. Further study will be needed to confirm our findings, explore the underlying pathomechanisms, and investigate the difference between sexes.

Effects of Thrombolytic Agents on Tympanostomy Tubes Occluded by Blood Clots
The authors of this article investigated the efficacy of various topical applications in opening a clotted tympanostomy tube (TT) using an in vitro model. They found that Thrombolytic agents and H2O2 were not effective in resolving TTs that were clotted with blood in an in vitro environment simulating the ear canal. Increasing concentrations of acetic acid are increasingly effective in this capacity.

Factors Associated With Mortality in 2-Year Survivors of Head and Neck Cancer
This authors of this article sought to determine the conditional survival rates of 2-year survivors of head and neck cancer and to identify risk factors of increased mortality thought a prospective, observational study. The authors found that in addition to older age and advanced stage, pain, poor overall quality of life, and tobacco use 2 years after diagnosis characterize patients who might need longer and more intense follow-up care to improve their observed and disease-specific survival. This information is useful in developing management plans for patients transitioning from a focus on cancer surveillance into survivorship.

Using 5-Aminolevulinic Acid and Pulsed Dye Laser for Photodynamic Treatment of Oral Leukoplakia
The authors of this article sought to determine the safety and efficacy of photodynamic therapy in the treatment of oral leukoplakia with 5-aminolevulinic acid and pulsed dye laser. The application of 5-aminolevulinic acid was applied to lesions followed by activation with high-power 585-nm pulsed dye laser in a nonrandomized, single-arm, single-site phase 1/2 pilot study. Overall it was found that photodynamic therapy with 5-aminolevulinic acid and pulsed dye laser could be used to achieve regression of oral leukoplakia. The treatment is safe and well tolerated. An application time of 1.5 hours and laser radiant exposure of 8 J/cm2 with 1.5-ms pulse time were found to be the optimal settings in this study. The high-power laser used in this study allows completion of laser therapy within 1 to 3 minutes. Further studies are necessary to determine the optimal laser radiant exposure and drug application to maximize the response rate.

The effect of histamine on ciliary beat frequency in the acute phase of allergic rhinitis
There have been few studies about the effect of histamine on ciliary beat frequency (CBF) in the acute phase of allergic rhinitis. The present study was designed to investigate CBF in the acute phase of allergic rhinitis and the effect of histamine on CBF. It found that Ciliary beat frequency increased in the acute phase of a mouse model of allergic rhinitis. Physiologic concentrations of histamine had no effect on CBF, and thus, it appears that other mechanisms control CBF in the acute phase of allergic rhinitis.

The relationship between repeat tympanostomy tube insertion and adenoidectomy
The purpose of this article was to examine the relationship between adenoidectomy and repeat tympanostomy tube placement in the treatment of otitis media, and the relationship between potential risk factors for otitis media and repeat tympanostomy tube placement. This was a Retrospective, cross-sectional analysis of consecutive patients undergoing tympanostomy tube placement at an academic/teaching hospital with 400+ beds.  904 children were included in the study. Of the 780 children who initially underwent tympanostomy tube placement alone, 178 required additional tube placement; a repeat rate of 20%. Of the 90 children who initially underwent tympanostomy tube placement with adenoidectomy, only 6 required repeat tube placement, a statistically significant decrease in the incidence of repeat tympanostomy tube placement concluding that adenoidectomy performed at the first tympanostomy tube for the treatment of otitis media may decrease the risk of repeat tube placement, especially for children >4–10 years of age.

Single-shot, low-dose intratympanic gentamicin in Ménière disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome
This is a prospective cohort study with the aim to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Ménière disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. Twenty-five intractable Ménière disease patients were included as the study group where Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. This study showed that Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Ménière patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control.

Prevalence of Epstein–Barr virus in tonsils and adenoids of United Arab Emirates nationals
Given that Epstein–Barr virus (EBV) often inhabits human tonsils and adenoids, it remains to be distinctively determined its prevalence and in which cell and microenvironment the virus is present. The authors wanted to determine the prevalence of EBV in the tonsils and adenoids of the United Arab Emirates (UAE) nationals and to provide a basis for understanding the origin and biology of EBV-infected cells. EBV was found in 43% of tonsillectomy specimens and 15% of adenoidectomy specimens. All EBV-infected cells were found to be B lymphocytes. About 90% of the infected B cells are found in the interfollicular regions of tonsils and adenoids and the remaining 10% are found within the follicles. There is no significant association between EBV infection, age and gender.

Propranolol vs Corticosteroids for Infantile Hemangiomas
The authors of this article sought to determine whether propranolol therapy is safe and effective and superior to oral corticosteroids for treating infantile hemangiomas (IHs). They found that Propranolol therapy was more clinically effective and more cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, with minimal adverse effects, compared with oral corticosteroids. Therefore, propranolol should be considered a first-line agent given its safety and efficacy in the treatment of IHs.

Removal of Tonsils, Appendix Linked to Early MI
People who had their tonsils, appendix, or both removed before the age of 20 had a higher risk of acute myocardial infarction before age 40, according to a Swedish population study. When compared with controls and adjusted for parental occupation and parental history of acute myocardial infarction, these patients had a hazard ratio for MI of 1.33 (95% CI 1.05 to 1.70) with appendectomy and 1.44 (95% CI 1.04 to 2.01) with tonsillectomy, Imre Janszky, MD, from the Karolinska Institute in Stockholm, and colleagues found.

Intratympanic Corticosteroid Therapy for Idiopathic Sudden Sensorineural Hearing Loss Proves Non-Inferior to Oral Therapy.
Idiopathic sudden sensorineural hearing loss has been treated with oral corticosteroids for more than 30 years. Recently, many patients' symptoms have been managed with intratympanic steroid therapy. No satisfactory comparative effectiveness study to support this practice exists. The authors sought to compare the effectiveness of oral vs intratympanic steroid to treat sudden sensorineural hearing loss. Prospective, randomized, noninferiority trial involving 250 patients with unilateral sensorineural hearing loss.  One hundred twenty-one patients received either 60 mg/d of oral prednisone for 14 days with a 5-day taper and 129 patients received 4 doses over 14 days of 40 mg/mL of methylprednisolone injected into the middle ear. Overall patients with idiopathic sudden sensorineural hearing loss, hearing level 2 months after treatment showed that intratympanic treatment was not inferior to oral prednisone treatment.

Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus
Studies suggest that hypercholesterolemia promotes the development of inner ear disorders such as tinnitus. However, the underlying pathomechanisms are still not clearly defined. A retrospective study was performed to assess whether a reduction of serum cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors may result in a relief of subacute tinnitus. After administration of simvastatin over 4 months, this retrospective study has shown no significant efficacy in treatment of subacute tinnitus. For a more conclusive answer, further prospective, double-blind, and placebo-controlled studies with a larger number of patients are needed.

Obstructive Sleep Apnea Syndrome and Postoperative Complications
This article sought to determine whether high risk scores on preoperative STOP-BANG (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) questionnaires during preoperative evaluation correlated with a higher rate of complications of obstructive sleep apnea syndrome (OSAS). A total of 135 patients were included in the study, of whom 56 (41.5%) had high risk scores for OSAS. The mean (SD) age of patients was 57.9 (14.4) years; 60 (44.4%) were men. Patients at high risk of OSAS had a higher rate of postoperative complications compared with patients at low risk (19.6% vs 1.3%; P < .001). Age, American Society of Anesthesiologists class of 3 or higher, and obesity were associated with an increased risk of postoperative complications. On multivariate analysis, high risk of OSAS and American Society of Anesthesiologists class 3 or higher were associated with higher odds of complications.

Sex Practices Driving Surge in HPV-Linked Oral Cancer
Changing sexual practices, including increased oral sex, multiple sex partners, and an early start of sexual activity, are behind an epidemic of oropharyngeal squamous cell carcinoma (OSCC) linked to sexually transmitted human papillomavirus (HPV), according to an article in the November issue of Emerging Infectious Diseases.

Propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma
This article conducted a Multicentric, retrospective study of clinical files of 14 children; pre- and post-treatment endoscopies for the preliminary assessment of the efficacy of propranolol on subglottic hemangioma in children on a nation-wide scale. The results confirms that propranolol high effectiveness against airways’ localization of infantile hemangiomas. Propranolol also allows alleviation or cut-off of previous medical treatments. However, recurrences are possible after early treatment interruption.

A case of head and neck cancer metastasizing to the axillary lymph nodes
IntroductionSquamous cell carcinoma (SCC) accounts for 95% of all head and neck cancers.1 Distant metastasis occurs in approximately 8% of these cases.1 Based on our review of the English-language literature, metastases of head and neck cancers to the axilla are rare, as we found only five such reports involving 10 patients.1-5 However, Hoye et al6 reported autopsy evidence of axillary metastasis in 2 to 9% of patients with head and neck cancer, and Kowalski7 suggested that this figure may actually be higher because axillary nodes are not routinely dissected at autopsy unless they are clinically palpable.In this article, we describe a new case of head and neck cancer metastatic to the axilla, and we discuss how this case was unique.

Dexamethasone Administration Doesn't Reduce Postoperative Bleeding Risk in Children Undergoing Tonsillectomy
This article assessed whether administration of dexamethasone during tonsillectomy is associated with a dose-dependent increased rate of postoperative tonsillectomy hemorrhage. A retrospective review of 2788 children and adolescents who underwent tonsillectomy with or without adenoidectomy for sleep-disordered breathing or infectious tonsillitis and received perioperative dexamethasone between January 1, 2002, and March 3, 2009. In this observational review of children undergoing tonsillectomy or adenotonsillectomy, perioperative dexamethasone administration is not associated with a dose-dependent elevation of postoperative hemorrhage rates after adjusting for age, sex, primary diagnosis, and surgical technique.

Retropharyngeal and parapharyngeal abscess in children—Epidemiology, clinical features and treatment
This article sought to describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs). And was found that Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.

Magnetic resonance imaging screening in acoustic neuroma
Magnetic resonance imaging (MRI) is the definitive investigation for detection of an acoustic neuroma. It is however an expensive resource, and pick-up rate of a tumor can be as low as 1% of all patients scanned. This study aims to examine referral patterns for MRI screening for patients presenting with asymmetrical sensorineural hearing loss (ASHL). A second aim was to suggest appropriate screening criteria. Overall two acoustic neuromas were picked up out of 132 scans performed. Of the scans performed for ASHL, a third did not fit with any of the published criteria. Of the 30 positive scans for a tumor, the patients/audiograms revealed that 10% did not fit the published criteria despite the patients having no other audiovestibular symptoms. There appears to be no universally accepted guidelines on screening in ASHL with clinical acumen being used by most ENT consultants in this region. Applying protocols may reduce the amount of scans performed, but up to 10% of tumors may be missed by this approach.

Prevalence and Characteristics of Tinnitus among US Adults
Tinnitus is common; however, few risk factors for tinnitus are known. This article examined cross-sectional relations between several potential risk factors and self-reported tinnitus in 14,178 participants in the 1999-2004 National Health and Nutrition Examination Surveys, a nationally representative database. Approximately 50 million US adults reported having any tinnitus, and 16 million US adults reported having frequent tinnitus in the past year. The prevalence of frequent tinnitus increased with increasing age, peaking at 14.3% between 60 and 69 years of age. Non-Hispanic whites had higher odds of frequent tinnitus compared with other racial/ethnic groups. Hypertension and former smoking were associated with an increase in odds of frequent tinnitus. Loud leisure-time, firearm, and occupational noise exposure also were associated with increased odds of frequent tinnitus. Among participants who had an audiogram, frequent tinnitus was associated with low-mid frequency and high frequency hearing impairment. Among participants who were tested for mental health conditions, frequent tinnitus was associated with generalized anxiety disorder.

Acute otitis media: To follow-up or treat?
Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin.

The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.

Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use
IntroductionPhosphodiesterase-5 inhibitors have become an increasingly popular class of medications for the treatment of erectile dysfunction. These medications dilate the penile blood vessels and cause prolonged erections. While these agents are effective in treating impotence, a number of side effects have been reported as a result of their use and misuse. Among these complications are epistaxis, esophageal variceal hemorrhage, intracranial hemorrhage, and hemorrhoidal bleeding.1-5 We report a case of a vocal fold hemorrhage associated with the casual use of vardenafil in a 31-year-old man

Use of Botulinum Toxin Type A for Chronic Cough
An article in the Archives of Otolaryngology reviewed the experience and outcomes of a novel use of botulinum toxin type A (BtxA) in the treatment of chronic cough. In the study all patients had significant relief of cough after BtxA injection, with complete resolution after a median of 7 injections (range, 4-16), using a mean dose of 4.0 U (range, 1.0-10.0 U) per treatment session for a mean duration of 25.7 months. According to this article, this is the first reported series in the literature of the use of BtxA in the treatment of chronic cough in adults. Further research and long-term follow-up are warranted, but BtxA is effective in directly decreasing laryngeal hypertonicity and possibly reducing neurogenic inflammation and neuropeptide-mediated cough. Botulinum toxin type A can be considered for the treatment of chronic cough refractory to other medical therapies.

High-resolution ultrasound in the evaluation and prognosis of Bell's palsy
Bell's palsy is a commonly encountered paralysis of the facial nerve occurring worldwide. Prognosis for Bell's palsy is good, but the proportion of patients with poor outcomes may reach 30%. Ultrasound (US) may provide a novel approach for evaluating and prognosticating Bell's palsy, in comparison with known electrophysiological techniques. A study out of the European Journal of Neurology measured the diameter of the distal facial (VII) nerve using US in patients with Bell's palsy treated with prednisolone, in comparison with healthy controls. Overall it was found that the diameter of the distal VII nerve is a good predictor of favorable (positive predictive value: 100%) and bad outcomes (negative predictive value: 77%) in Bell's palsy at 3 months after clinical presentation. US was also found to be superior to VII nerve conduction and blink reflex studies in outcome prediction. For More News Visit our ENT ARCHVIES