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  • ISSN: 2379-948X
    Volume 2, Issue 10
    Research Article
    Alberto Eibenstein, Matteo De Luca, Alessandra Barbara Fioretti, Theodoros Varakliotis*, Sara Cisternino, Luisa Crosta and Maria Lauriello
    Abstract:
    Aim: The aim of this study was to deeply investigate the relationship between tinnitus, hyperacusis, sleep disorders and perceived stress levels in a study group of patients with tinnitus exposed to a traumatic event (earth quake) and a control group of patients with tinnitus not exposed to a traumatic event.
    Methods: We studied 83 patients with tinnitus. The study group was composed by 47 patients exposed to earthquake. The control group was composed by 36 patients not exposed to the earthquake. Each patient was studied with clinical history, ENT examination and audiological tests. The following questionnaires were carried out: Tinnitus Sample Case History (TSCH), Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI), Khalfa's questionnaire and Brief Symptom Inventory (BSI 53).
    Results: The psychological screening used in the study need to have confirmation of further more specific investigations to evaluate the possible correlation between PTSD and tinnitus. It is possible that the exposure to a traumatic event, such as the earthquake, may have had an influence in the genesis of tinnitus. Analysis of the study group has revealed higher scores in the PSQI test and in the BSI test components of anxiety, somatization and depression.
    Conclusion: The connection between psychopathology, tinnitus and treatment is complex and, perhaps not sufficiently investigated with adequate methodologies. Psychiatric comorbidity in subjects affected by tinnitus is frequent, even if this study showed that the relationship between psychopathology and tinnitus is not linear.
    Pradeep Pradhan*, Swagatika Samal and Santanu Mandal
    Abstract:
    Objective: To study the anatomical and hearing outcomes in endoscopic assisted atticotomy with cartilage tympanoplasty in patients with limited mastoid disease (involving attic, antrum).
    Material and methods: Study was conducted in a tertiary care referral hospital between July 2012 and April 2015. Total 28 patients with limited mastoid diseases were included in the study. All underwent endoscopic assisted atticotomy and cartilage tympanoplasty. Patients were evaluated at 3 months, 6 months and 12 months after surgery to assess the graft uptake and hearing outcome. In postoperative period, ≥10 dB closure of air bone gap was considered significant improvement in hearing.
    Result: Of 28 patients, cholesteatoma involving attic was found in 13(45%) patients, posterorsuperior mesotympanum in 7(25%) patients and 8(30%) patients presented with attic retraction. Out of 28 patients, 8(28.57%) were undergone type I tympanoplasty, 16(57.14%) were undergone type IIIB tympanoplasty and 4(14.28%) were undergone type IIIC tympanoplasty. The mean AB closure were 11.13 dB, 9.56 dB, and 8.0 dB in type I, type IIIB and type IIIC cartilage tympanoplasty respectively after 12 months. 75% of patients with type 1 tympanoplasty, 6(37.50%) patients with type IIIB tympanoplasty showed significant improvement in hearing (≥10.00 dB). 2 patients had residual perforation after 3 months of surgery and none of them had postoperative retraction.
    Conclusion: Atticotomy supplemented with otoendoscopy is an effective surgical technique for the management of limited mastoid disease and autologous conchal cartilage is an ideal autograft considered for the reconstruction of the attic and for cartilage tympanoplasty associated with satisfactory outcomes.
    Alexander Karatzanis*, Maria Doulaptsi, Emmanuel Prokopakis, Eleftherios Koudounarakis, Stylianos Velegrakis and George Velegrakis
    Abstract:
    Transoral Laser CO2 Microsurgery is an established mode of treatment for early glottic carcinomas. However, there are doubts in the literature with regard to histologic margin assessment following laser resection, as well as the prognostic significance of margin's status. We assess the prognostic significance of histopathologic margins status following surgical treatment of early laryngeal cancer with TLM.
    A retrospective study was conducted at an academic tertiary center. The files of all cases that underwent primary laser microsurgical treatment for T1 glottic cancer within a two-year period were included in the study. Focus was given on oncologic outcomes with regard to tumor margin status on permanent histology.
    Among 36 patients treated with curative intent by transoral laser resection for T1a, and T1b lesions, clear histologic borders were achieved in 24 cases. Undetermined or suspicious margins were reported in 12 cases. These cases were either followed up closely or re-operated upon depending on the surgeon's level of clinical suspicion. Oncologic outcomes were found to be comparable among groups, as rates of local control and organ preservation were 100% for cases with free margins, and similarly for those with initially undetermined or suspicious margins.
    Therefore, it is suggested that in cases where the surgeon is confident with the outcome of CO2 laser microsurgery, a "watch and wait" philosophy may be considered as an acceptable option even in cases where surgical margins are labeled undetermined or suspicious on pathology.
    Case Report
    Anish Abrol*, Matthew M Smith and Alvin B Ko
    Abstract:
    A 55-year-old Hispanic woman presented with a slow growing right-sided neck mass that was intermittently painful over the last year. There were no complaints of difficulty swallowing or breathing. Physical examination identified a four centimeter mobile, painless right submandibular neck mass. Computed tomography (CT) revealed a 3.1 cm lesion superficial to the platysma and fine needle aspiration was non-diagnostic. Excision of the mass confirmed a grey, well circumscribed mass with gritty consistency. Pathological examination revealed an epithelial neoplasm arranged in a nest of basaloid cells forming shadow cells among a multinucleate giant cell reaction. This neck mass was believed to be a pilomatrixoma, a rare, benign neoplasm arising from hair cortex cells. These masses most commonly arise in children, but can occur at any age in both males and females. Typically, pilomatrixomas are located on the eyebrows, scalp, trunk, and upper extremities. Symptoms typically include pain, tenderness, and inflammation from a solitary mass ranging from 0.5 to 3 centimeters. CT scan, ultrasound, and Magnetic Resonance Imaging (MRI) can all be used in the diagnosis, but fine needle aspiration is usually the test of choice. Pathology typically demonstrates ghost cells, basaloid cells, and calcium deposition. Treatment is complete surgical excision, and recurrence is as a low as 1% following excision.
    Hiroshi Miyahara*, Toshiaki Yamanaka, Katsunari Yane, Tomoyuki Kamijo, Aya Kamakura, Hiroaki Fushimi and Reiko Shimoyama
    Abstract:
    Salivary duct carcinoma (SDC) is one of the rarest and most aggressive forms of salivary gland malignancy, and is more likely to affect older male patients. A diagnosis of SDC for any patient has historically been associated with a poor prognosis, with a high incidence of both loco-regional and distant metastases. We report two cases of SDC of the parotid gland. They were treated by parotidectomy and ipsilateral neck dissection followed by postoperative irradiation. However both patients died of multiple lung metastases relatively early, showing that SDC is a highly aggressive form of parotid malignant tumor. Here, inthe light of the literature, we discuss the value of focusing on over-expression/amplification of HER-2 and androgen receptors as well as the clinical usefulness of trastuzumab and anti-androgen therapy.
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