Functional Brain Regions Linked to Tinnitus Pathology and Compensation During Task Performance: A Systematic Review.

OBJECTIVE: To systematically search the literature and organize relevant advancements in the connection between tinnitus and the activity of different functional brain regions using functional magnetic resonance imaging (fMRI). DATA SOURCES: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Web of Science, ProQuest Dissertations & Theses Global, Cochrane Database of Systematic Reviews, and PROSPERO from inception to April 2022. REVIEW METHODS: Studies with adult human subjects who suffer from tinnitus and underwent fMRI to relate specific regions of interest to tinnitus pathology or compensation were included. In addition, fMRI had to be performed with a paradigm of stimuli that would stimulate auditory brain activity. Exclusion criteria included non-English studies, animal studies, and studies that utilized a resting state magnetic resonance imaging or other imaging modalities. RESULTS: The auditory cortex may work to dampen the effects of central gain. Results from different studies show variable changes in the Heschl's gyrus (HG), with some showing increased activity and others showing inhibition and volume loss. After controlling for hyperacusis and other confounders, tinnitus does not seem to influence the inferior colliculus (IC) activation. However, there is decreased connectivity between the auditory cortex and IC. The cochlear nucleus (CN) generally shows increased activation in tinnitus patients. fMRI evidence indicates significant inhibition of thalamic gating. Activating the thalamus may be of important therapeutic potential. CONCLUSION: Patients with tinnitus have significantly altered neuronal firing patterns, especially within the auditory network, when compared to individuals without tinnitus. Tinnitus and hyperacusis commonly coexist, making differentiation of the effects of these 2 phenomena frequently difficult.

Systematic review of validated parent-reported questionnaires assessing swallowing dysfunction in otherwise healthy infants and toddlers.

OBJECTIVES: There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs. DATA SOURCE: A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods. REVIEW METHOD: Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties. RESULTS: Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed. CONCLUSION: Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.

Central Processing in Tinnitus: fMRI Study Outlining Patterns of Activation Using an Auditory Discrimination Task in Normal Versus Tinnitus Patients.

OBJECTIVE: Elucidate brain activity differences between patients with tinnitus and controls. STUDY DESIGN: Cross-sectional cohort study. SETTING: Outpatient Otolaryngology clinic. PATIENTS: Three cohorts; 8 controls, 12 with subjective idiopathic tinnitus (tinnitus without hearing loss), and 12 with both tinnitus and hearing loss. INTERVENTION: An auditory oddball identification task was performed in fMRI scanner. MAIN OUTCOME MEASURES: Task performance and Tinnitus Handicap Inventory (THI) scores were recorded. Brain activation maps were generated comparing deviant and standard tones as well as at rest. One-way and two-way T-contrasts were generated in addition to multiple regression modeling which identified significant brain regions predicting tinnitus, disease severity, duration, and task performance. RESULTS: Task performance worsened in tinnitus patients with increased auditory workload, in terms of additional hearing loss. THI score and grade correlated with false alarms. The limbic system, heschel's gyrus, angular gyrus and cerebellum have a significant effect on both brain behavior in patients with tinnitus, and predictability of tinnitus and its behavioral implications. CONCLUSION: Increased auditory workload resulted in poorer task performance. Moreover, it is possible to predict auditory task performance in patients with tinnitus by looking at the activity of specific regions of interest. Heschl's gyrus, angular gyrus, cerebellar, and limbic system activity are important contributors to neurological activity associated with tinnitus. Finally, predictive modeling may influence further research surrounding tinnitus treatment.

Long-Term Results of a Pedicled and Innervated Sternocleidomastoid Muscle Flap to Immediately Reconstruct Superficial Parotidectomy Defects.

Importance: Conventional reconstruction techniques for superficial parotidectomy have been criticized for their ability to provide long-term volumetric correction and to prevent Frey's syndrome. Objective: To demonstrate the long-term effectiveness of a pedicled and innervated sternocleidomastoid muscle flap (PISCMMF) to reconstruct superficial parotidectomy defects. Design, Setting, and Participants: This is a retrospective cohort study of patients treated by a single surgeon in a tertiary care center from July 2012 to March 2018. Seventeen of a possible 34 eligible adults having undergone reconstruction with a PISCMMF for benign parotid disease with at least 1 year of follow-up were included through convenience sampling. Patients with revision parotid surgery, malignant parotid tumors, neck dissections, or prior spinal accessory nerve dysfunction were excluded. Intervention: A PISCMMF was used to immediately reconstruct superficial parotidectomy defects. Main Outcomes and Measures: Participants underwent three-dimensional facial imaging, starch-iodine testing for Frey's syndrome, and completed a validated satisfaction questionnaire. The surface area of the positive starch-iodine tests was calculated. An average model was generated from participant images, allowing the calculation of surface millimeter differences comparing the operative with nonoperative sides. Results: Seventeen patients [7 male (41.2%), mean age 50.82 ± 12.37 years] underwent a PISCMMF to reconstruct excision (mean specimen weight = 21.45 ± 12.22 g) of benign lesions [9 pleomorphic adenomas (52.9%), 5 Warthin's tumors (29.4%), 2 cysts (11.8%), 1 chronic parotitis (5.9%)], with a mean follow-up time of 35.41 ± 12.30 months. Rates of objective and subjective Frey's syndrome were 29.4% and 11.8%, respectively. The average surface area affected was 2.32 cm2 [standard deviation (SD) = 1.95 cm2] compared with the average surface area of 16.35 cm2 (SD = 9.20 cm2) of the excised specimens. Facial symmetry analysis revealed an average millimeter difference of -1.57 ± 2.55 mm that was not significant at a threshold of 2 mm [t(16) = 0.69, p = 0.50]. No participants had postoperative shoulder or neck dysfunction. Overall satisfaction was 95.4%. Age (ß = -0.51, p = 0.02) and case number (ß = 0.44, p = 0.04) were significant predictors of smaller millimeter difference (R2 = 0.48, F(2,14) = 6.41, p = 0.01). The specimen mass (ß = -0.05, p = 0.35) did not predict millimeter difference (R2 = 0.11, F(1,8) = 0.10, p = 0.35). Conclusions and Relevance: A PISCMMF immediately reconstructing parotidectomy defects successfully restores facial symmetry, prevents clinically significant Frey's syndrome, and results in high patient satisfaction in the long term without significant morbidity.

Biomarkers for Inner Ear Disorders: Scoping Review on the Role of Biomarkers in Hearing and Balance Disorders.

The diagnostics of inner ear diseases are primarily functional, but there is a growing interest in inner ear biomarkers. The present scoping review aimed to elucidate gaps in the literature regarding the definition, classification system, and an overview of the potential uses of inner ear biomarkers. Relevant biomarkers were categorized, and their possible benefits were evaluated. The databases OVID Medline, EMBASE, EBSCO COINAHL, CA PLUS, WOS BIOSIS, WOS Core Collection, Proquest Dissertations, Theses Global, PROSPERO, Cochrane Library, and BASE were searched using the keywords "biomarker" and "inner ear". Of the initially identified 1502 studies, 34 met the inclusion criteria. The identified biomarkers were classified into diagnostic, prognostic, therapeutic, and pathognomonic; many were detected only in the inner ear or temporal bone. The inner-ear-specific biomarkers detected in peripheral blood included otolin-1, prestin, and matrilin-1. Various serum antibodies correlated with inner ear diseases (e.g., anti-type II collagen, antinuclear antibodies, antibodies against cytomegalovirus). Further studies are advised to elucidate the clinical significance and diagnostic or prognostic usage of peripheral biomarkers for inner ear disorders, filling in the literature gaps with biomarkers pertinent to the otology clinical practice and integrating functional and molecular biomarkers. These may be the building blocks toward a well-structured guideline for diagnosing and managing some audio-vestibular disorders.

Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence.

BACKGROUND: The application of radioactive iodine in differentiated thyroid carcinomas has become more selective in an attempt to decrease morbidity. While ablative success has been documented, it is less clear how changes in radioactive iodine treatment strategies will influence long-term recurrence rates for patients with larger tumors and adverse pathological features, including extrathyroidal extension and nodal metastases. METHODS: Patients diagnosed between 1995 and 2008 with differentiated thyroid carcinoma treated with thyroidectomy followed by radioactive iodine treatment were eligible. All patients were followed for a minimum of five years using a standardized follow-up protocol requiring both biochemical and imaging assessments for recurrent disease (n = 219). Patients were stratified by initial radioactive iodine activity, and disease-free survival was calculated using the Kaplan-Meier method, with significant differences defined by the log-rank test. RESULTS: In this cohort, 46% of patients had clinical metastases and 74% had primary tumors >1.5 cm. Patients who had recurrences were more likely to present with extrathyroidal extension (p = 0.002) and lymph node metastases at diagnosis (p < 0.001). Patients presenting with both extrathyroidal extension and lymph node metastases had a significantly worse time to progression if treated with <1850 MBq radioactive iodine compared to those patients treated with >1850 MBq (25 months vs. 121 months; p = 0.004). The use of lower-activity radioactive iodine ablative therapy was associated with more early recurrences (p = 0.003). Being aged younger or older than 45 years did not impact the time to recurrence nor did the use of level 6 dissection. On multivariate analysis, lymph node metastases at diagnosis and multiple applications of radioactive iodine were linked to increased risk of recurrence. Patients with neither, or only one, adverse pathologic feature had excellent outcomes, regardless of initial ablative activity, with <10% of patients recurring over a 10-year time span. CONCLUSIONS: Recurrent disease in differentiated thyroid carcinoma is more common in patients treated with low-activity radioactive iodine in patients with lymph node metastases and extrathyroidal extension. These recurrences typically occur within four years of initial treatment. Patients lacking both of these risk factors treated with low radioactive iodine activity (<1850 MBq) have excellent outcomes, even after 10 years.