Benign Tumors of the Anterior Cranial Base.
Authors: Snyderman CH, Lavigne P Abstract Benign tumors of the anterior cranial base may originate from intracranial, cranial, or extracranial sites. Intracranial tumors such as meningiomas may secondarily involve the cranial base and extend into the sinuses or nasal cavity. Bony tumors arising from the cranium include benign fibro-osseous lesions such as osteoma, fibrous dysplasia, and ossifying fibroma. The most common extracranial tumors that may extend to the skull base include angiofibroma and inverted papilloma. Symptoms are nonspecific and diagnosis is often delayed. In most cases, a diagnosis can be establi...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Endoscopic Endonasal Approaches for Anterior Skull Base Meningiomas.
Authors: Todeschini AB, Beer-Furlan A, Otto B, Prevedello DM, Carrau RL Abstract Anterior skull base meningiomas are a diverse group of tumors that involve different locations. The role of the expanded endoscopic transnasal approach in the management of anterior cranial fossa meningiomas has significantly changed over the past 2 decades. Patient selection is paramount to benefit from the advantages of endoscopic transnasal surgery such as direct access to ventral skull base lesions avoiding brain and brainstem retraction, early de-vascularization, removal of bone infiltrated by tumor, near-field magnification, bett...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Squamous Cell Carcinoma and Its Variants.
Authors: Mani N, Shah JP Abstract Squamous cell carcinoma (SCC) is one of the most common malignant neoplasms involving the anterior skull base, resulting from local invasion from an adjacent anatomical region. The primary sites of origin are most frequently the nasal cavity and paranasal sinuses, and less often the skin and orbit. Treatment strategies for these tumors have evolved, although management remains challenging due to the proximity to critical structures and their location at the intracranial-extracranial interface. The rarity of these tumors, and limited numbers at any one institution, has meant that mo...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Other Rare Sinonasal Malignant Tumours Involving the Anterior Skull Base.
Authors: Naga R, Pai PS Abstract Sinonasal tumours are rare, and among these there exist a small number of histologic subtypes that are infrequently encountered and rarely mentioned in the literature. These have been presented as either case reports or small case series, and their very low incidence makes prospective studies practically impossible. This review analyses the available literature, including our own experience and endeavours to outline management strategies, which involve a high index of suspicion and counselling of patients. In most instances, these tumours require aggressive multimodal treatment to i...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Posttreatment Imaging Surveillance.
Authors: Farina D, Zorza I, Golemi S, Lombardi D, Borghesi A, Maroldi R, Ravanelli M Abstract Posttreatment imaging surveillance in patients treated for anterior skull base tumors is a multifaceted issue which - as a first step - requires tailoring of the selection of imaging technique and acquisition protocol to the clinical scenario. As a general rule, acute symptoms suggesting the onset of a complication of treatment require prompt diagnosis through an easily accessible technique, such as CT; on the other hand, monitoring recurrences in asymptomatic patients is best achieved with MRI, exploiting the inherently h...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Treatment Options for Recurrent Anterior Skull Base Tumors.
Authors: Orlandi E, Iacovelli NA, Ingargiola R, Resteghini C, Bossi P, Licitra L, Ferrari M, Nicolai P Abstract Malignancies of the anterior skull base are rare and recur in 40-80% of treated cases, varying with substantial variance according to histology, stage at primary diagnosis, and other factors. Most recurrences manifest within 2-5 years after primary treatment, but some histologies can relapse even decades after the first presentation. Management of recurrent anterior skull base tumors is challenging and a wide variety of treatment options are available. Similar to the primary setting, surgery is the mainst...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Future Perspectives in the Management of Tumors of the Anterior Skull Base.
Authors: Nicolai P, Bradley PJ, Bossi P, Ferrari M Abstract In the coming years, further developments can be expected in the field of diagnosis and management of tumors involving the anterior skull base, and especially malignant tumors of the sinonasal tract, which account for the majority of lesions affecting this anatomic area. Advances in genomics and radiomics will undoubtedly lead to better profiling of tumor biology, with consequent refinement of treatment according to the principles of precision medicine. Similarly, the continuous evolution of morphologic and metabolic imaging will improve the accuracy of pr...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

A Comprehensive Update on Intestinal- and Non-Intestinal-Type Adenocarcinomas.
Authors: Vander Poorten V, Jorissen M Abstract This review of sinonasal adenocarcinoma, both intestinal and non-intestinal type, aims at providing a comprehensive overview of etiological factors, diagnostic workup, histological subtypes, advances in molecular characterization and the genetic basis, current optimal treatment strategies, resulting oncological outcome, and prognostic factors modifying the final treatment results. The current treatment of choice remains surgical resection with a curative intent, using the least invasive approach that allows for removal of the entire tumor with negative margins, supplem...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Olfactory Neuroblastoma.
Authors: Veyrat M, Vérillaud B, Fiaux-Camous D, Froelich S, Bresson D, Nicolai P, Herman P Abstract Olfactory neuroblastoma is a rare tumor. Nasal endoscopy typically identifies a soft mass arising from the olfactory cleft. Computer tomography and magnetic resonance imaging are mandatory for staging (in association with 18F-fluorodeoxyglucose positron emission tomography) in high-grade and/or high-stage tumors. Biopsy must be representative to confirm a diagnosis and for grading purposes. Two complementary classifications are described: one (Kadish) based on clinical-radiological analysis, and the other (Hya...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Pathology and Differential Diagnosis of Anterior Skull Base Tumours.
Authors: Williams MD, El-Naggar AK Abstract The anterior skull base is a complex anatomic site which may be involved by a large number of biologically heterogenous neoplasms. They arise from the epithelium, both surface mucosa and glands, as well as soft tissues, bone, and cartilage. Many benign and malignant tumours in the anterior skull base are similar to their counterparts in other anatomic sites. Interestingly, unique tumours including teratocarcinosarcoma, olfactory neuroblastoma, and angiofibroma can also be found. Recognition of overlapping morphologic features of entities encountered in this anatomic site ...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Role of Morphologic and Functional Imaging in Pretreatment Assessment.
Authors: Maroldi R, Borghesi A, Ravanelli M, Golemi S, Farina D Abstract Anterior skull base (ASB) tumors can be classified into three groups according to their site of origin: (1) sinonasal neoplasms involving or extending through the anterior cranial base; (2) neoplasms which arise from the bony framework of the base itself; (3) neoplasms originating from adjacent intracranial structures. With few exceptions, most of these tumors have a non-specific appearance on CT and MRI, which limits the role of imaging in terms of characterization. However, treatment planning (transnasal endoscopic surgery in particular) mos...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Transnasal Endoscopic Surgery: Surgical Techniques and Complications.
Authors: Battaglia P, Lambertoni A, Castelnuovo P Abstract Nowadays, surgeons have a wide armamentarium of surgical approaches available to safely treat sinonasal malignancies, which includes open approaches, with the traditional craniofacial resection (CFR), and endoscopic transnasal techniques. The correct choice depends on the features of the pathology. It is well known that endoscopic approaches have a lower morbidity compared with traditional open techniques, due to a shorter hospitalization, absence of facial incisions, and avoidance of brain retraction. Moreover, endoscopic surgery presents clear technical a...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Macroscopic and Endoscopic Anatomy of the Anterior Skull Base and Adjacent Structures.
Authors: Ferrari M, Mattavelli D, Schreiber A, Nicolai P Abstract The anterior skull base can be divided into three segments: a midline and two symmetrically placed segments located laterally. The midline segment is the roof of the nasal cavity and serves as a watershed between the sinonasal tract and the intracranial space, whereas the lateral segments separate the intracranial compartment from the orbital content. Several peculiar anatomical areas make up the midline segment (posterior frontal plate, cribriform plate, ethmoidal roof, planum sphenoidale, and tuberculum sellae), while the lateral segments are more ...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Neuroendocrine Carcinoma and Sinonasal Undifferentiated Carcinoma.
Authors: Abdelmeguid AS, Bell D, Hanna EY Abstract Sinonasal malignancies are uncommon, representing 1% of all neoplasms. A wide spectrum of malignant neoplasms arise from the sinonasal and skull base regions; the majority of these tumors are poorly or undifferentiated tumors manifesting overlapping features that result in diagnostic challenges. Sinonasal neuroendocrine carcinoma (SNEC) and sinonasal undifferentiated carcinoma (SNUC) are types of sinonasal neuroendocrine tumor, together with olfactory neuroblastoma. They share overlapping clinical, radiological, and histopathological features, albeit with variabili...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Sinonasal Malignant Melanoma.
Authors: Lund VJ Abstract Sinonasal malignant mucosal melanoma (SNMM) is a rare, aggressive, and capricious tumour accounting for 4% of sinonasal malignancies. Recent studies suggest an increasing frequency. There are few large published series, but all authors report poor outcomes irrespective of treatment of approximately 25% 5-year survival. As a consequence, the American Joint Committee on Cancer (AJCC) have restaged all SNMMs as T3 or greater, irrespective of extent. Surgery remains the principle treatment modality. Survival and recurrence data analysis from a single-centre prospective cohort of 125 cases (all...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Adenoid Cystic Carcinoma.
Authors: Castelnuovo P, Turri-Zanoni M Abstract Sinonasal adenoid cystic carcinoma is a rare malignancy characterized by an insidious growth pattern and a tendency for perineural spread along major and minor nerves, resulting in invasion of the skull base and intracranial extension. Therefore, many patients present with advanced disease and involvement of critical structures, making treatment difficult and potentially associated with high morbidity. Surgery represents the mainstay of treatment of the primary tumor. Complete resection of the tumor with negative margins, whenever feasible, is associated with better s...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Update of Radiation Techniques Using Photons for Anterior Skull Base Tumors.
Authors: Foster CC, Kim JK, Melotek JM, Lee NY Abstract Anterior skull base tumors represent a challenge for radiation therapy (RT) planning given the close proximity of the target lesion to numerous critical structures in this complex anatomic location. Despite this challenge, surgery followed by postoperative RT is a common treatment paradigm for malignant sinonasal tumors that has been associated with improved outcomes compared to single-modality treatment. Therefore, technological advancements allowing for increasingly conformal target coverage and sparing of organs at risk are important to accomplish the goal ...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Particle Therapy: Protons and Heavy Ions.
Authors: Jensen AD Abstract Particle therapy is a comparatively new radiotherapy treatment form allowing the application of extremely conformal treatment plans. In head and neck malignancies, especially in the paranasal sinus and anterior skull base, this technology is very valuable in order to maintain normal tissue tolerance of critical structures while still applying high doses to the tumour. The following paper will further explore the rationale of particle therapy and available clinical experience of the most commonly treated malignancies arising in these anatomical sites. The potential of particle therapy for...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Evolving Role of Systemic Therapy in the Primary Treatment of Sinonasal Cancer.
Authors: Licitra L, Resteghini C, Bossi P Abstract The inclusion of systemic therapy in the multimodal approach of locally advanced sinonasal cancers, at least in some selected histologies, may improve locoregional control and reduce the frequency of distant metastasis, allowing longer survival. Response to induction chemotherapy is a strong prognostic factor for a patient's outcome and it may improve disease control by surgery and radiation. Concurrent chemoradiation aims at increasing locoregional control in squamous cell cancer of the head and neck; this is particularly important in sinonasal cancers, with a ris...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Anterior Skull Base Surgery in the 21st Century: The Role of Open Approaches.
Authors: Abu-Ghanem S, Shilo S, Yehuda M, Abergel A, Safadi A, Fliss DM Abstract Treating malignant tumors of the anterior skull base (ASB) is a challenging task, given their late presentation, diverse histology, and involvement of an intricate anatomical space requiring complex surgery. Advances in imaging, gradual refinement of surgical and reconstruction techniques, and improvement of perioperative care during recent decades have resulted in improved clinical outcomes for patients. In addition, assessing functional outcomes and quality-of-life issues have become a fundamental part in the holistic care of patient...
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Preface.
Authors: Nicolai P, Bradley PJ PMID: 32731243 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - August 1, 2020 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Post-Traumatic Dizziness: Clinical and Medicolegal Aspects.
Authors: Westerberg BD, Lea J, Cameron AF Abstract Subjective complaints of dizziness after mild-to-moderate traumatic brain injury are common. Alterations in the mode of injury have changed the presentation symptoms. Evolutions in neuroimaging challenge conventional concepts regarding lack of evidence of injury following mild head trauma and provide hope for elucidating the site of lesion in patients with post-traumatic balance symptoms. Yet the vestibular clinician must maintain a healthy level of suspicion regarding potential exaggeration of symptoms and disability in patients with a financial incentive. Unique ...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Imaging of Temporal Bone.
Authors: Pyykkö I, Zou J, Gürkov R, Naganawa S, Nakashima T Abstract Multidetector computed tomography has been the benchmark for visualizing bony changes of the ear, but has recently been challenged by cone-beam computed tomography. In both methods, all inner ear bony structures can be visualized satisfactorily with 2D or 3D imaging. Both methods produce ionizing radiation and induce adverse health effects, especially among children. In 3T magnetic resonance imaging, the soft tissue can be imaged accurately. Use of gadolinium chelate (GdC) as a contrast agent allows the partition of fluid spaces to be vi...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Meniere's Disease.
This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the clinical diagnosis, and the medical and surgical treatments. The characteristic attacks of vertigo are unlikely to be due to membrane ruptures, so a hypothesis that the vertigo is caused by a volume of endolymph shifting suddenly from the cochlea into the pars superior is suggested. The definite diagnosis according to the American Academy of Otolaryngology HNS 1995 criteria [13] failed to exclude vestibular migraine sufficiently and a revision in 2015 [14] has pa...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Perilymphatic Fistulas and Superior Semi-Circular Canal Dehiscence Syndrome.
Authors: Weinreich HM, Carey JP Abstract Perilymphatic fistulas (PLF) and superior semi-circular canal dehiscence syndrome (SCDS) are 2 conditions that can present with sound and/or pressure-induced vertigo. PLF should be suspected in cases of trauma or surgery, while a spontaneous PLF is a diagnosis of exclusion. Research is ongoing to identify an ideal biomarker for perilymph. The diagnosis of SCDS continues to evolve with further research into vestibular-evoked myogenic potentials, electrocochleography, and higher resolution CT imaging. Treatment advances include the transmastoid approach, smaller middle fossa c...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Migraine Associated Vertigo.
Authors: Hain T, Cherchi M Abstract This chapter is a brief overview of migraine associated vertigo (MAV), focusing on the points most relevant to the practicing clinician. We review the definition of MAV, theories regarding its underlying pathophysiology, clinical presentation, epidemiology, findings on physical examination and oto vestibular testing, differential diagnosis, management and prognosis. PMID: 30947176 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advances in Vestibular Rehabilitation.
Authors: Sulway S, Whitney SL Abstract Vestibular rehabilitation is an exercise-based program that has been in existence for over 70 years. A growing body of evidence supports the use of vestibular rehabilitation in patients with vestibular disorders, and evolving research has led to more efficacious interventions. Through central compensation, vestibular rehabilitation is able to improve symptoms of imbalance, falls, fear of falling, oscillopsia, dizziness, vertigo, motion sensitivity and secondary symptoms such as nausea and anxiety. Early intervention is advised for falls prevention and symptom management; howev...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Video Head Impulse Testing.
Authors: Welgampola MS, Taylor RL, Halmagyi GM Abstract The bedside head impulse, first described nearly 20 years ago, is the single most useful clinical test of the human vestibulo-ocular reflex (VOR). The video head impulse test (vHIT), its laboratory counterpart, now enables the objective assessment of the VOR. We examine how the vHIT can be utilized in three common clinical scenarios: the acute vestibular syndrome, recurrent spontaneous vertigo, and chronic imbalance. Combined with vestibular evoked myogenic potentials (VEMPs), vHIT enables assessment of all five vestibular end-organs by a clinician within the ...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Vestibular Neuritis: Recent Advances in Etiology, Diagnostic Evaluation, and Treatment.
Authors: Le TN, Westerberg BD, Lea J Abstract Purpose of Chapter: This chapter highlights the recent advances in etiology, diagnostic evaluation, and management of vestibular neuritis (VN). Recent Findings: The viral hypothesis has been strengthened with new evidence as the main etiology of VN. Recent evidence indicates that bedside oculomotor findings play a critical role in differentiating VN from stroke. The implementation of cervical and ocular vestibular evoked myogenic potential, and video head impulse test in vestibular function testing has made it possible to diagnose selective damage of the vestibular nerv...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Otolith Function Testing.
Authors: Taylor RL, Welgampola MS Abstract Two technically simple tests, vestibular evoked myogenic potential (VEMP) and subjective visual vertical/horizontal (SVV/H) test, have the potential to transform otolith function testing from the research laboratory to the outpatient clinic. Cervical- and ocular-VEMPs are short latency surface potentials produced through the activation of saccular and utricular afferents by sound and vibration. They are tests of dynamic otolith function. The SVV/H test in peripheral lesions probes static asymmetries in utricular function and represents a perceptual error in perceived gravi...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Vestibular Testing-Rotary Chair and Dynamic Visual Acuity Tests.
Authors: Gimmon Y, Schubert MC Abstract The human vestibular system is exquisitely sensitive to detect linear and rotational head acceleration signals, processed in the brainstem and subsequently relayed to the extraocular motor neurons to generate a compensatory eye rotation. This vestibulo-ocular reflex (VOR) ensures clear and stable vision during head rotation, enabling humans to keep gaze on their desired target. In this chapter, we describe the rotary chair - one physiologic measure of the VOR, and the dynamic visual acuity (DVA) test - one behavioral measure of the VOR. Advances in the use of each measure are...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Aminoglycoside Vestibulotoxicity.
Authors: Rutka J Abstract Many pharmaceuticals have ototoxicity (both cochlear and/or vestibular) as part of their adverse medication profile. The aminoglycoside class of antimicrobials has been especially well studied in this regard. Many questions remain unanswered as to how to best monitor and prevent this complication. A bilateral vestibular loss profoundly affects an individual's quality of life, physical activities, and overall independence. Paradoxically, the effects of gentamicin ototoxicity have provided further insight into the workings of the vestibular system, especially the vestibulo-ocular reflex. The...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Benign Paroxysmal Positional Vertigo.
Authors: Instrum RS, Parnes LS Abstract Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin. Calcium homeostasis has also been shown to contribute to the pathogenesis of the disorder by creating an environment in which otoconia a...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Assessment of the Vestibular System: History and Physical Examination.
Authors: Welgampola MS, Bradshaw AP, Halmagyi GM Abstract So common is vertigo that diverse healthcare professionals, from audiologists to orthopedic surgeons, will eventually encounter it in their patients, if not in themselves. So treatable are vestibular disorders that it is an immense advantage to know how to assess the vestibular system. This review summarizes the history and physical examination that will help diagnose common vestibular disorders presenting with vertigo. PMID: 30947199 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Videonystagmography and Posturography.
Authors: Falls C Abstract Videonystagmography (VNG) and posturography are two vestibular assessment techniques that are still in use today. VNG: VNG allows clinicians to observe and record eye movements in real-time. Compared with electronystagmography (ENG), VNG tracings are more detailed and can capture subtle clinical findings. The utility of the monothermal caloric screen has been proposed in various studies. When appropriate cut-offs are used, the monothermal screen can be completed with a low false-negative rate. Air is often used as a medium for caloric testing, though not without some controversy. When air ...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Psychiatric Considerations in the Management of Dizzy Patients.
Authors: Staab JP Abstract Research over the last 4 decades has revealed a great deal of information about psychiatric and functional causes, consequences, and comorbidity of vestibular syndromes. Primary care clinicians, neurologists, and otologists who are willing to set aside the 20th century notion of "psychogenic dizziness" and incorporate 21st century concepts about 5 behavioral entities into their practices will be rewarded for their efforts with a marked improvement in diagnostic acumen and therapeutic effectiveness. Panic attacks may cause or contribute to acute or episodic vestibular symptoms. G...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Systemic Disease Considerations in the Management of the Dizzy Patient.
Authors: Rea PA, Ronan N Abstract Patients with symptoms of dizziness may present to a wide range of medical services. Awareness of the full breadth of possible diagnoses is thus helpful in managing dizzy patients. This chapter provides a comprehensive review of systemic diseases that may contribute to the complex symptom of dizziness and provide a review of recent advances in each field. PMID: 30947210 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Special Considerations for the Pediatric Patient.
Authors: Cushing SL, Papsin BC Abstract Children frequently present with complaints of vertigo and/or disequilibrium. The etiology of such diagnoses include inner ear pathology, migraine and its variants, lesions of the central nervous system as well as mental health disorders, among others. The ability to reliably evaluate vestibular end-organ function is central to accurate diagnosis, however, examining children can be challenging. The current chapter will focus on the approach to assessing vestibular end-organ function in children, as well as the causes of vestibular impairment that are unique to this population...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

An Overview of Central Vertigo Disorders.
Authors: Ranalli P Abstract Head motion recorded by the vestibular labyrinths is conveyed to specific brainstem and cerebellar structures that relay velocity information to eye muscles to stabilize vision, and to the axial and limb muscles necessary to stabilize balance. Neural networks enhance and extend the primary vestibular signal, and create adaptation to movement when appropriate. Pathological lesions to one or more of these structures may cause central vertigo and imbalance, and may be localized by specific forms of nystagmus and other abnormal neurological signs. Vertigo treatment may be directed to the und...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Aging Vestibular System: Dizziness and Imbalance in the Elderly.
Authors: Jahn K Abstract Aging in vestibular structures with loss of hair cells in the inner ear starts early in life, but vestibular function usually remains relatively unimpaired up to advanced ages. However, dizziness and imbalance are common in the elderly and have substantial impact on the quality of life. Dizziness interferes with the everyday activities of 30% of persons over age 70. As causes can be multiple, including vestibular and non-vestibular components, it is crucial to detect the factors leading to dizziness and imbalance to maintain mobility and avoid secondary complications like falls and anxiety....
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Quality of Life Outcomes following Treatment of Hypopharyngeal Cancer.
Authors: Mahalingam S, Spielmann P Abstract Quality of life (QoL) is an important consideration in the management of individuals with head and neck cancer. The poor prognosis and significant impact of treatment modalities on function of the salivary glands, larynx and pharynx combine to make hypopharyngeal carcinoma a particularly challenging condition to treat. The impact of diagnosis and treatment on health related QoL is substantial. There is increased understanding that organ preservation does not necessarily correlate with function preservation as was previously expected. The impact on QoL, of chemoradiotherap...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Future Perspectives in Hypopharyngeal Cancer Care.
Authors: Eckel HE, Bradley PJ Abstract Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently remains unlikely that these approaches will gain a more major universal impact on hypopharyngeal cancer care. In advanced stage hypopharyngeal cancer, the use of the traditional radical surgery, such as laryngo-pharyngectomy, is no longer accepted by many patients. In recent years, most would rather opt for less mutilating treatment, preferring a non-surgical option. Patients, fami...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Salvage Treatment Options after Failed Primary Treatment of Hypopharyngeal Cancer.
Authors: Simo R, Rovira A, Townley W Abstract Recurrent hypopharyngeal cancer (rHPC) is a high-risk fatal disease associated with poor prognosis and high risk of complications in patients who are suitable to undergo salvage treatment. The treatment of such patients should be managed by a dedicated multidisciplinary team, most frequently a tertiary centre. and with the agreement of the patient. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. When persistent or recurrent disease is suspected, cross-sectional computed tomography imaging (CT) and p...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Primary Treatment of T1-T2 Hypopharyngeal Cancer: Changing Paradigms.
Authors: Meulemans J, Delaere P, Vander Poorten V Abstract There has been a general shift in the treatment of hypopharyngeal cancer from open surgical techniques (either radical or partial "organ" preserving) toward non-surgi cal "organ preserving" strategies (radiotherapy [RT] or chemoradiotherapy [CRT]) and minimally invasive transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Oncologic outcomes reported are comparable whatever modality is chosen, but better functional outcomes are observed in the RT/CRT and TLM/TORS-treated patients. Because of the high rate of second prim...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Natural History of Treated and Untreated Hypopharyngeal Cancer.
Authors: Eckel HE, Bradley PJ Abstract Patients with hypopharyngeal cancers frequently present at advanced stage and in poor general health status. Their natural history is characterised by diffuse local primary disease, mucosal and submucosal spread, early cervical nodal metastasis, and a relatively high rate of distant spread. By the time of initial diagnosis, some 60% of all hypopharyngeal cancer patients will be with stage IV disease, some 5% will present with distant metastases, and almost 40% will have a significant reduction in performance status. Less than 20% are diagnosed with a localised early stage dise...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Surgical Treatment of Advanced Staged Hypopharyngeal Cancer.
Authors: Wei WI, Chan JYW Abstract It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while s...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Systemic Therapy, Palliation and Supportive Care of Patients with Hypopharyngeal Cancer.
Authors: Bradley PJ, Füreder T, Eckel HE Abstract Hypopharyngeal cancer patients have a very poor prognosis and limited therapeutic options. Seventy to eighty per cent of all hypopharyngeal cancer patients will require palliative and/or end-of-life care for incurable end-stage disease during the course of their illness. The overall proportion of hypopharyngeal cancer patients not qualifying for initial curative treatment, or requiring palliation and supportive care over time is higher than for any other subsite of the head and neck. Surgery and radiotherapy usually have a very limited role in this setting, whi...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Epidemiology of Hypopharyngeal Cancer.
Authors: Bradley PJ Abstract Hypopharyngeal cancer is uncommon in the developed world; it is mostly diagnosed in men who smoke tobacco and consume excessive alcohol and uncommon in women. However, recent trends in the developed world show that there has been an annual increase in the percentage of women with hypopharyngeal cancer. In France, there has been a significant annual percentage change in the incidence of this form of cancer - a decrease in men and a greater increase in women since the 1980s. In the developing world, India, Taiwan and other countries, the incidence of hypopharyngeal cancer has increased in...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Symptoms and Signs, Staging and Co-Morbidity of Hypopharyngeal Cancer.
Authors: Bradley PJ Abstract Early throat symptoms are common and a diagnosis of hypopharyngeal cancer rare; therefore, confirming or excluding a serious diagnosis is missed or overlooked by both the patient and the practitioner - however, symptoms such as throat clearing and food sticking, which persist in adult patients who have the social habit of tobacco usage and/or drink excessive alcohol should be examined by a specialist to exclude the presence of hypopharyngeal cancer. Late symptoms/signs include neck swelling (uni- or bilateral), dysphagia, odynophagia, otalgia, dysphonia, dyspnoea and stridor. Associated...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Treatment Options for Hypopharyngeal Cancer.
Authors: Eckel HE, Bradley PJ Abstract Patients with hypopharyngeal cancer are difficult to treat because they typically present with advanced disease, poor general health status and severe nutritional problems. Currently, treatment options for previously untreated and newly diagnosed hypopharyngeal cancer patients include surgery of the primary tumour and lymph nodes metastasis, radiotherapy, systemic medical treatment, including traditional chemotherapy and immunotherapy. Currently, a multimodal treatment approach is preferred using surgery, radiotherapy and systemic therapy with curative intent and best supporti...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research