Search

Key Clinical Message: Bilateral vocal fold paresis (BVFP) is a rare complication in COVID‐19 and should be considered as differential diagnosis in COVID‐19‐patients presenting with dyspnea and stridor. High‐dose intravenous corticosteroids can be useful treating COVID‐19‐related laryngeal edema and vocal fold paresis. This case shows the complexity of laryngeal complications in COVID‐19 requiring surgeries and functional therapies. Although COVID‐19 is known to affect peripheral as well as cranial nerves, there is a paucity of reports on vocal fold paresis in COVID‐19, bilateral vocal fold paresis (BVFP) in particular. We describe a case of BVFP and glottal bridge synechia following COVID‐19‐pneumonia discussing pathomechanisms and treatment options. [ABSTRACT FROM AUTHOR]

Objectives: The VIBRANT SOUNDBRIDGE is a widely used active middle ear implant to treat hearing loss. The floating mass transducer is surgically coupled to the ossicles, the round or oval window. A reliable method to monitor the coupling efficiency intraoperatively is highly desired. Research groups have developed several methods, but limitations remain. This study aims to evaluate the clinical feasibility of a new research setup for auditory brainstem response measurement to evaluate the coupling efficiency. Method: In 14 subjects, the new tool was used to record VSB‐evoked ABR thresholds during surgery. The intra‐op ABR thresholds were compared to pre‐op bone conduction (BC) thresholds and post‐op vibrogram thresholds to evaluate the feasibility of the method as a tool to monitor coupling efficiency. Results: The mean pre‐op BC threshold average at 1, 2, and 4 kHz (PTA3) was 47 dB HL, the mean intra‐op ABR threshold was 54 dB nHL, and the mean post‐op vibrogram PTA3 was 60 dB HLeq. ABR was measurable in all subjects using the new tool. Correlation between pre‐op BC thresholds and intra‐op ABR thresholds was statistically significant; however, one outlier was present. Conclusion: Intra‐op hearing threshold detection through ABR and direct stimulation of the VSB implant was reliable using this new tool. Despite some individual variability, first results correlate well with pre‐op BC and post‐op vibrogram thresholds. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to demonstrate the long‐term outcomes of patients implanted with the active middle ear implant (AMEI) Vibrant Soundbridge (VSB) through coupling the floating mass transducer (FMT) to the round window (RW). Methods: This retrospective study evaluated the short‐ and long‐term clinical performance (audiological outcomes) and safety (revisions/explantations) of the VSB coupled to the RW between 2013 and 2019 at the St. Pölten University Hospital, Austria. For the outcome analysis, the sample was divided into a short‐term examination group followed up for less than 12 months (<12 months) and a long‐term examination group followed up for more than 12 months (>12 months). Cumulative survival outcomes were separately analyzed for subjects with and without cholesteatoma. Results: 46 patients with an average long‐term follow‐up period of 31.43 months (13–75 months) were investigated. Complications requiring revision surgery were reported in total in seven patients with cholesteatoma (15.2%) and none in subjects without cholesteatoma (0%). Residual hearing was not affected by VSB surgery. Word understanding on the Freiburger monosyllabic speech test improved significantly at 65 dB (P <.0001) and 80 dB (P <.0001), and these outcomes were stable for long‐term follow up. Conclusion: The VSB coupled to the RW is a safe implantation method for patients with conductive or mixed hearing loss. Hearing improvement was stable for the long‐term follow‐up up to 74 months. The revision rates are directly related to the underlying pathology of cholesteatoma (with radical cavity); thus, this special cohort requires additional counseling on potential complications. Level of Evidence: 4 (Case‐series) Laryngoscope, 131:E1434–E1442, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Hyperplastic lesions of the laryngeal mucosa can eventually develop into squamous cell carcinoma. The relationship between dendritic cell infiltration of head and neck cancers and prognosis is well known. Surprisingly, data regarding dendritic cell infiltration in precancerous lesions are not available today. It was the purpose of our study to extend these observations and to investigate in more detail the density and distribution of dendritic cells in precancerous lesions. Study Design: Retrospective survey by immunohistochemistry. Methods: For this study we investigated paraffin-embedded tissue sections of 41 specimens. Histological diagnosis disclosed precancerous lesions of the larynx in 34 cases and in 7 cases, squamous cell carcinoma. Immunohistochemical study was performed using antibodies against the cell surface markers S-100, HLA-DR, CD20, CD45 RO, CD45 RA, and Lag. Typical dendritic cell distributions of the immunostained specimens were photographed and measured on a quantitative basis. The medical histories of the patients were then analyzed retrospectively. Results: HLA-DR+ cells could be detected in 14 of 16 cases in mild dysplastic lesions. The infiltration of the dysplastic lesions was sparse compared to cases with higher-graded dysplastic lesions. The distribution patterns of the dendritic cells in specimens with severe dysplastic lesions, but squamous cell carcinoma were extremely similar and markedly different from those in grades I and II specimens. Memory T lymphocytes (CD45 RO+) were detected more often in the group with severe dysplastic lesions (8 of 9 cases) than in the group with squamous cell carcinoma (3 of 8 cases). The inverse became evident for CD20 and CD45 RA immunolabeling. Conclusions: Few dendritic cells were found in the precancerous lesions. This may suggest that these early lesions (grades I and II) are not efficiently monitored by the immune system. Therefore they may develop into carcinomas unimpaired by cytotoxic T cells. As the degree of malignancy rises (grade III), more dendritic cells infiltrate the tumor. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: Although anatomic data regarding the gross anatomy of the paranasal sinuses are available, severe complications of endonasal sinus surgery (ESS) are frequently reported. To understand and to avoid these complications, density of bony walls of the paranasal sinuses were studied in this report. Special attention was given to the analysis of the bone density in regions where minor and major complications occur in ESS. Methods: Thirty cadaver heads were embedded in epoxy resin. The plastic blocks were sectioned with a diamond-coated wire saw into 1.0-mm thick, parallel slices in axial, coronal, and sagittal planes for 10 specimens each. The slices were x-rayed and scanned with a computerized image analyzing system. For each specimen the bone density in 12 regions of interest was measured. Results: Besides the macroscopic examination of the plastinated specimens, a bone density analysis based on x-ray films is presented. Lowest bone density was found at the lateral wall of the sphenoid sinus (3.31 ± 0.99 mm aluminum [Al]); highest density was measured at the roof of the sphenoid sinus (12.91 ± 1.75 mm Al). Overall bone density in female specimens was 0.41 mm Al (mean) lower than in male specimens. Conclusions: This study is the first to use plastinated whole-organ serial sections and bone density images for the analysis of potential complications in ESS. The illustration of regions with minor and major bone density of the paranasal sinuses and the ethmoid floor as presented in this study may help the novice sinus surgeon to minimize the risks of ESS and to avoid severe complications. [ABSTRACT FROM AUTHOR]

Problem: The superfamily of cell surface tyrosine kinase receptors plays an important role in fundamental cellular processes including cell cycle progression, migration, metabolism, proliferation, differentiation, and survival. Many human tumors express high levels of growth factor receptors, raising the possibility that receptor blockade may be useful as a cancer treatment strategy.Methods: In order to identify those patients who may benefit from targeted therapy with inhibitors of EGFR and HER2 signaling pathways, we determined the expression status of EGFR and HER2 in tissue specimens from patients with the oral cavity and pharynx tumors by semiquantitative immunohistochemistry. Two pharmacodiagnostic kits EGFR (pharmDx™ and Hercep-Test™), were used in accordance with manufacturers’ instructions to identify head and neck squamous cell carcinoma (HNSCC) patients who overexpress EGFR or HER2.Results: EGFR was overexpressed in 42.6% of 129 specimens, whereas the HER2 overexpression was observed in 3.1% of samples only. EGFR positivity of assessed tumors and stage of disease achieved a marginal correlation (p=0.046), whereas no other clinicopathological parameters such as T, N, M, or histological grading correlated with EGFR expression status.Conclusion: Given the necessity for new therapeutic modalities in HNSCC, targeted treatment of patients that overexpress EGFR with its specific inhibitors appears to be reasonable. HER2 seems to be an inappropriate target for the treatment of head and neck cancer.Significance: The ambition of the oncologist in the near future will be to achieve success with a lot of new agents targeting diverse tumor-associated molecules. With regard to this objective, the pharmacodiagnostic evaluation of the EGFR expression may significantly improve the assessment of HNSCC patients eligible for treatment with EGFR-specific inhibitorsSupport: This work was supported by grants from Austrian science found (P14933 and P16301) and Tyrol science fund for medical research (50a). [Copyright &y& Elsevier]