Tinnitus:Pathophysiology, diagnosis and treatment

Tinnitus is a common and heterogeneous condition, characterised by experiencing sound in the absence of an external source. Various treatment options are available in the Netherlands for patients with tinnitus, but these have limited support from methodologically sound studies. Diagnosis and treatment of tinnitus demands a standardized and multidisciplinary approach. Ideally, there should be a stepwise approach to diagnosis and treatment of tinnitus, with a gradual increase in intensity of treatment. This increase should depend upon the patient's requirements and degree of distress. Current scientific evidence suggests that intensive treatment of tinnitus based on cognitive behavioural therapy (CBT) is indicated for patients with severe tinnitus.</p

Evaluation of the SAMEO-ATO surgical classification in a Dutch cohort

Purpose: Differences in the definition and classification of cholesteatoma hinders comparing of surgical outcomes of cholesteatoma. Uniform registration is necessary to allow investigators to share and compare their findings. For many years surgical cholesteatoma procedures were divided into two main groups: canal wall up mastoidectomy (CWU) and canal wall down mastoidectomy (CWD). Recently, mastoid obliteration can be added to both procedures. Because of great variation within these main groups, the International Otology Outcome Group (IOOG) proposed the new SAMEO-ATO classification system to categorize tympanomastoid operations. The aim of our study was to correlate the mastoid bone extirpation (M-stage) with the contemporary (CWU, CWD with or without obliteration) system. Methods: Demographic characteristics and type of performed surgery were registered for 135 cholesteatoma patients from sixteen hospitals, both secondary and tertiary care institutions, across the Netherlands. In addition, the surgical reports were collected, retrospectively classified according to the contemporary system and the new system and compared. Correlations of the outcomes were calculated. Results: In total, there were 112 CWU and 14 CWD (both with or without obliteration) suitable for correlation analysis. Z test for correlation between the M-stage and CWU procedure was significant for M1a and M1b procedure and significant for M2c with the CWD procedure. Conclusion: The newly proposed SAMEO-ATO classification seems to be more detailed in the registration of surgical procedures than surgeons currently are used to. All M-stages of the SAMEO-ATO system are correlating well to the standard CWU and CWD except one ‘in between’ M-stage

Anosmia after endovascular and open surgical treatment of intracranial aneurysms Clinical article

Object. Patients treated for aneurysmal subarachnoid hemorrhage (SAH) often report a loss of smell. To discriminate between the effects of aneurysmal rupture and treatment, the authors assessed the occurrence of anosmia after clipping and coiling of unruptured aneurysms as well as after the coiling of ruptured aneurysms. Methods. The authors interviewed patients in whom an unruptured aneurysm was treated by clipping (32 cases) or endovascular coiling (26 cases) as well as patients with SAH who underwent coil therapy (32 cases). A geographically defined subset of 20 patients per group was invited to undergo olfactory testing. Results. Nine clip-treated patients (28% [95% CI 14-47%]) in the unruptured group reported having anosmia, and no coil-treated patient in the unruptured group (95% [CI 0-13%]) reported having anosmia: in the SAH group, 7 patients (22% [95% CI 9-40%]) reported having anosmia. Anosmia had improved over time in 3 of the clip-treated patients and in all but I of the patients with SAH. Examination revealed olfactory disturbance in 13 (65% [95% CI 41-85%]) of the clip-treated and 8 (42% [95% CI 20-67%]) of the coil-treated patients with unruptured aneurysms, and also in 7 (35% [95% CI 15-59%]) coil-treated patients with SAH. In 20 patients who underwent clip therapy for unruptured aneurysms, 19 (95% [95% CI 75-100%]) had olfactory dysfunction on the side ipsilateral to surgery (anosmia reported by 8 of them). Conclusions. Both clip treatment and SAH contribute to the occurrence of anosmia, with different chances of improvement. Olfactory dysfunction occurs in almost all patients on the side of surgery and can occur subclinically after coil deployment. (DOI: 10.3171/2008.8.JNS08761

Tinnitus: Pathofysiologie, diagnostiek en behandeling

Tinnitus is a common and heterogeneous condition, characterised by experiencing sound in the absence of an external source. Various treatment options are available in the Netherlands for patients with tinnitus, but these have limited support from methodologically sound studies. Diagnosis and treatment of tinnitus demands a standardized and multidisciplinary approach. Ideally, there should be a stepwise approach to diagnosis and treatment of tinnitus, with a gradual increase in intensity of treatment. This increase should depend upon the patient's requirements and degree of distress. Current scientific evidence suggests that intensive treatment of tinnitus based on cognitive behavioural therapy (CBT) is indicated for patients with severe tinnitus

THE AMORE PROTOCOL FOR ADVANCED-STAGE AND RECURRENT NONORBITAL RHABDOMYOSARCOMA IN THE HEAD-AND-NECK REGION OF CHILDREN: A RADIATION ONCOLOGY VIEW

Purpose: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with after-loading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. Methods and Materials: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. Results: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, I died of distant metastases only, and I patient died of a second primary tumor. Overall 5-year survival rates were 70% for the primary treatment group and 82% for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. Conclusions: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable. (C) 2009 Elsevier In