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Paker M, Pichkhadze E, Miron D, Shlizerman L, Mazzawi S, Goldman T, Shupak A. [ACUTE OTITIS MEDIA BACTERIOLOGY IN CHILDREN YOUNGER THAN THREE MONTHS IN THE LAST 16 YEARS]. Harefuah 2023; 162:598-604. [PMID: 37965857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Only scant information is available regarding the bacteriology of acute otitis media (AOM) in neonates. OBJECTIVES To investigate the bacteriology of AOM post the introduction of Pneumococcal Conjugate Vaccine (PCV13) in children younger than 3 months and its relation to the mode of delivery. METHODS Retrospective bacteriological analysis of middle ear fluids taken from children younger than 60 months suffering from AOM. The effect of PCV13 and mode of delivery, caesarian section vs vaginal delivery, on AOM bacteriology was evaluated and compared between children younger than 3 months (group 1) and children aged 3-60 months (group 2). RESULTS The prevalence of Streptococcus pneumoniae (S.pneumoniae) and Enterobacteriaceae (E.bact) was higher in group 1 compared to group 2, 47.1% vs 35.8% and 12.3% vs 4.3%, respectively (p<0.001), while that of Haemophilus influenza (H. influenzae) and Group A streptococcus (GAS) was higher in group 2 compared to group 1, 40.3% vs 30.1% and 17.5% vs 8.3% respectively (p<0.001). The mode of delivery did not affect AOM bacteriology. The introduction of PCV13 yielded in an increase in the prevalence of GAS (7% to 15%, P<0.001) in group 1. CONCLUSIONS S. pneumoniae and E. bact are more common AOM pathogens in neonates. Also, the prevalence of GAS was increased in this age group following the introduction of PCV13. DISCUSSION Our results are applicable towards the formulation AOM treatment guidelines in neonates. This study contributed additional information on a topic that has not been adequately researched so far - neonatal AOM.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology, Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Elena Pichkhadze
- Department of Otolaryngology, Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Dan Miron
- The Pediatric Infectious Disease Service, Ha'Emek Medical Center, Afula, Israel
| | - Lev Shlizerman
- Department of Otolaryngology, Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Salim Mazzawi
- Department of Otolaryngology, Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Tal Goldman
- Tissue Diagnosis and Cancer Research Institute, Ha'Emek Medical Center, Afula, Israel
| | - Avi Shupak
- Unit of Otoneurology, Lin and Carmel Medical Centers, Haifa, Israel, Department of Communication Science and Disorders, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Gutkovich YE, Shlizerman L, Paker M, Mazzawi S, Siag K, Shupak A. Barotrauma-Induced Perilymph Fistula: Video Head Impulse Test and High-Resolution Temporal Bones Computed Tomography Role in Evaluation and FollowUp. J Int Adv Otol 2023; 19:350-354. [PMID: 37528600 PMCID: PMC10544128 DOI: 10.5152/iao.2023.22771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/20/2022] [Indexed: 08/03/2023] Open
Abstract
We report a case of a woman presenting with unilateral right profound hearing loss accompanied by vertigo secondary to barotrauma-induced perilymph fistula during recreational skydiving. Video head impulse test demonstrated a reduced gain in both the right horizontal and right anterior semicircular canals accompanied by frequently gathered overt corrective saccades. High-resolution computed tomography revealed an enlarged vestibular aqueduct on the affected side, a predisposing factor for the development of perilymph fistula. An exploratory tympanotomy was performed during which a perilymph leak was visualized at the round window niche. Temporal fascia patches enforced by absorbable gelatin sponges were applied to both round and oval windows. During post-surgery follow-up, the patient remained free of vestibular symptoms. An audiogram displayed mild improvement in the right ear speech reception threshold, although her hearing remained non-serviceable. The video head impulse test showed a favorable dynamic with a stepwise return to normal gain values in all semicircular canals and the disappearance of overt corrective saccades. This is the first case in which video head impulse test was employed as a valuable diagnostic tool for the evaluation and post-surgery follow-up of vestibular function in a barotrauma-induced perilymph fistula. The demonstration of an enlarged vestibular aqueduct on high-resolution computed tomography and the risk of perilymph fistula recurrence are discussed.
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Affiliation(s)
- Yoni E. Gutkovich
- Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
| | - Lev Shlizerman
- Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
| | - Miki Paker
- Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
| | - Salim Mazzawi
- Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
| | - Kfir Siag
- Department of Otolaryngology—Head and Neck Surgery, Haemek Medical Center, Afula, Israel
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
| | - Avi Shupak
- Technion—Israel Institute of Technology, Rappaport Faculty of Medicine,Haifa, Israel
- Department of Otoneurology, Lin Medical Center, Haifa, Israel
- University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa, Israel
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Paker M, Pichkhadze E, Miron D, Shlizerman L, Mazzawi S, Shupak A. Two decades of otitis media in northern Israel: Changing trends in the offending bacteria and antibiotic susceptibility. Int J Pediatr Otorhinolaryngol 2022; 152:110940. [PMID: 34810003 DOI: 10.1016/j.ijporl.2021.110940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/05/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Bacteriology and antibiotic resistance trends changed considerably following introduction of the pneumococcal conjugate vaccines (PCV) 7 and 13, with differences between geographic regions. The objective of this study was to evaluate changes in acute otitis media (AOM) bacteriology and antibiotic susceptibility from the pre-vaccination period (2002-2008) to after the introduction of PCV13 (2010-2019) in northern Israel. METHODS Data were collected from 3277 middle ear fluid (MEF) cultures and 4822 common AOM-generating pathogens of children aged <5 years with otitis media, taken during 2002-2019. Age of the child, bacteriology, and antibiotic resistance were compared between 2002 and 2008, the pre-vaccination period when no vaccination was available and 2010-2019 when PCV13 was introduced. RESULTS The mean age of the children in the pre-vaccination and the vaccination periods was 18.7 ± 13.7 and 15.7 ± 12.5 months, respectively (p < 0.001); the mean age of those with group A streptococcus (GAS) positive cultures was older, p < 0.001.The prevalence of Streptococcus pneumoniae (S. pneumoniae) decreased between those periods, from 47% to 25.8%, p < 0.001, Haemophilus influenzae (H. influenza) increased from 38.4% to 47.1%, p < 0.001, GAS increased from 12.9% to 23.8%, p < 0.001, and Moraxella catarrhalis (M. cat) increased but not statistically significant from 1.7% to 3.1%. The yearly number of positive MEF cultures decreased from 395.1 to 205.6, p < 0.001. The antibiotic sensitivity rate of almost all antibiotics increased between the two study periods. CONCLUSION The most common MEF bacteria in northern Israel today is H. influenzae. Comparing the pre-vaccination to the vaccination period, the incidence of S. pneumonia-positive cultures decreased while GAS and H. influenza cultures increased. The age of children with positive cultures increased, and the antibiotic sensitivity rate increased. Key This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Emek Medical Center, Afula, Israel.
| | - Elena Pichkhadze
- Department of Otolaryngology Head and Neck Surgery, Emek Medical Center, Afula, Israel.
| | - Dan Miron
- The Pediatric Infectious Disease Service. Emek Medical Center, Afula, Israel.
| | - Lev Shlizerman
- Department of Otolaryngology Head and Neck Surgery, Emek Medical Center, Afula, Israel.
| | - Salim Mazzawi
- Department of Otolaryngology Head and Neck Surgery, Emek Medical Center, Afula, Israel.
| | - Avi Shupak
- Unit of Otoneurology, Lin and Carmel Medical Centers, Haifa, Israel; Department of Communication Science and Disorders, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Cohen JT, Fridman E, Trushin V, Benyamini L, Duek I, Shinnawi S, Keshet Y, Cohen A, Paker M. The role of voice rest after micro-laryngeal surgery for benign vocal fold lesions. Eur Arch Otorhinolaryngol 2021; 279:835-842. [PMID: 34773168 DOI: 10.1007/s00405-021-07114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare post-operative vocal outcomes of a voice rest regimen versus no voice restrictions following micro-laryngeal surgery for benign glottic lesions. METHODS This was a combined prospective and retrospective cohort study on 167 patients who underwent micro-laryngeal surgery for benign focal fold lesion removal. Participants were divided into two regimens: standard voice rest (n = 92) or no voice restriction (n = 75). The primary outcome was post-operative vocal improvement, evaluated using voice handicap index questionnaire (VHI-10), GRBAS scale, and computerised acoustic analysis (shimmer, jitter, and the harmonic-to-noise ratio). The secondary outcome was emergence of vocal fold mucosal abnormalities in the immediate post-operative period. Parameters were collected at baseline and at the last clinical visit. RESULTS There was no statistically significant difference between the voice rest and no-voice rest groups regarding baseline parameters of age, gender, laryngeal pathology, and voice use. Improvement in GRBAS scale values and VHI-10 scores between pre- and post-operative periods between groups did not demonstrate any statistically significant differences (P = 0.5303 and P = 0.1457, respectively). Similarly, the results of computerized voice analysis also showed no differences between groups in terms of shimmer (P = 0.9590), jitter (P = 0.5692), and harmonic-to-noise ratio (P = 0.1871). No correlation was found between the post-operative vocal fold's mucosal abnormalities and the type of voice rest regimen. CONCLUSION Voice quality and wound healing were similar regardless of the type of voice rest regimen applied. No voice rest at all was as good as voice rest after micro-laryngeal surgery.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel.
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel
| | - Vladimir Trushin
- Department of Otolaryngology Head and Neck Surgery, Barzilai Medical Centre, Ashkelon, Israel
| | - Limor Benyamini
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Irit Duek
- Department of Otolaryngology Head and Neck Surgery, Sourasky Medical Centre, Tel Aviv, Israel
| | - Shadi Shinnawi
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Rambam Medical Centre, The Technion, Israel Institute of Technology, 6 Ha'Aliya Street, POB 9602, 31096, Haifa, Israel
| | - Yosi Keshet
- Department of Computer Science, Bar-Ilan University, Ramat-Gan, Israel
| | - Alma Cohen
- Berglas School of Economics, Tel Aviv University, Tel Aviv, Israel
| | - Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
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Paker M, Goldman T, Masalha M, Shlizerman L, Mazzawi S, Ashkenazi D, Ghanayim R. A Comparison of Two Widely Used Risk Stratification Systems for Thyroid Nodule Sonographic Evaluation. Isr Med Assoc J 2021; 23:714-719. [PMID: 34811987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA2015) and the American College of Radiology Thyroid Imaging and Reporting Data System (ACR TI-RADS) are two widely used thyroid sonographic systems. OBJECTIVES To compare the two systems for accuracy of cancer risk prediction. METHODS Preoperative ultrasound images from 265 patients who underwent thyroidectomy at our hospital from January 2012 to March 2019 were retrospectively categorized by the ACR TI-RADS and ATA2015 systems. Diagnostic performances were compared. RESULTS Of 238 nodules assessed, 115 were malignant. Malignancy risks for the five ACR TI-RADS categories were 0%, 7.5%, 11.4%, 59.6%, and 90.0%. Malignancy risks for the five ATA2015 categories were 0%, 6.8%, 17.0%, 55.5%, and 92.1%. The proportion of total nodules biopsied was higher with the ATA2015 system than the ACR TI-RADS system: 88.7% vs. 66.3%. Proportions of malignant nodules and benign nodules biopsied were higher with ATA2015 than with ACR TI-RADS: 93.3% vs. 87.8% and 84.4% vs. 46.3%, respectively. Specificity and sensitivity rates were 53.6% and 84.3%, respectively, for ACR TI-RADS, and 15.5% and 93.3%, respectively, for ATA2015. The two systems showed similarly accurate diagnostic performance (AUC > 0.88). False negative rates for ACR TI-RADS and ATA2015 were 15.6% and 6.6%, respectively. Rates of missed aggressive cancer were similar for the two systems: 3.4% and 3.7%, respectively. CONCLUSIONS ACR TI-RADS was superior to ATA2015 in specificity and avoiding unnecessary biopsies. ATA2015 yielded better sensitivity and a lower false negative rate. Identification of aggressive cancers was identical in the two systems.
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Affiliation(s)
- Miki Paker
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
| | - Tal Goldman
- Institute of Tissue Diagnostics and Cancer Research, Emek Medical Center, Afula, Israel
| | - Muhamed Masalha
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
| | - Lev Shlizerman
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
| | - Salim Mazzawi
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
| | - Dror Ashkenazi
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
| | - Rami Ghanayim
- Department of Ear, Nose, and Throat, Emek Medical Center, Afula, Israel
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Cohen JT, Goldman T, Paker M, Fridman E. Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy. Otolaryngol Head Neck Surg 2021; 166:901-906. [PMID: 34399642 DOI: 10.1177/01945998211037658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. STUDY DESIGN Retrospective study. SETTING A voice and swallowing clinic at a tertiary referral hospital. METHODS We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. RESULTS For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. CONCLUSION Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
| | - Tal Goldman
- Tissue Diagnosis and Cancer Research Institute, Ha'Emek Medical Center, Afula, Israel
| | - Miki Paker
- Department of Otolaryngology Head and Neck Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; The Technion, Haifa, Israel
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Siag K, Mazzawi S, Paker M, Biener R, Ghanayim R, Lumelsky D. Acute longus colli tendinitis and otolaryngology. Braz J Otorhinolaryngol 2020; 88:351-357. [PMID: 33342696 PMCID: PMC9422725 DOI: 10.1016/j.bjorl.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Acute longus colli tendinitis is caused by calcium hydroxyapatite deposition in the tendon of the longus colli muscle with subsequent inflammation. The calcifications are commonly located at the superior oblique portion at the level of the C1-C2 vertebrae. The typical clinical presentation consists of acute neck pain, odynophagia, and painful limitation of neck range of motion. OBJECTIVES We will describe this disease with three that cases presented to our institution and compare the findings on imaging studies. METHODS We retrospectively reviewed the clinical data, radiological features, and laboratory reports of three patients diagnosed with acute longus colli tendinitis. Computed tomography and plain radiographs were reviewed and compared by a single radiologist. A contemporary review of the literature was conducted using PubMed (Medline), Embase, and Cochrane library databases. RESULTS Computed tomography showed greater sensitivity for the detection of the pathognomonic calcification than plain radiographs and facilitated the exclusion of other more severe conditions by following a systematic interpretation composed of five key elements. Plain radiographs showed non-specific signs of prevertebral soft tissue swelling and a decreased cervical lordotic curve. However, no calcification was identified on plain radiographs. The literature review revealed 153 articles containing 372 cases. Surgical or invasive procedures were mentioned in 13.7% of publications and were performed in 28 patients. CONCLUSIONS Acute longus colli tendinitis can mimic the clinical presentation of more severe conditions that the otolaryngologist may be required to evaluate, such as infectious, traumatic, and neoplastic diseases. Knowledge of this entity, with its pathognomonic imaging findings, can prevent misdirected medical therapy and unnecessary invasive procedures.
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Affiliation(s)
- Kfir Siag
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel.
| | - Salim Mazzawi
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Miki Paker
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Roy Biener
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Rami Ghanayim
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
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Paker M, Duek I, Awwad F, Benyamini L, Meshyeev T, Gil Z, Cohen JT. Long-term swallowing performance following transoral robotic surgery for obstructive sleep apnea. Laryngoscope 2018; 129:422-428. [PMID: 30443909 DOI: 10.1002/lary.27364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the long-term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). STUDY DESIGN Retrospective and prospective cohort study. METHODS Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long-term swallowing functions were assessed using subjective self-evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty-five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. CONCLUSIONS BOT reduction via TORS has a negative effect on long-term swallowing function. A self-assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow-up. Proper patient selection and detailed information about surgery and possible late-swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:422-428, 2019.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Irit Duek
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Faten Awwad
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Limor Benyamini
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tsipi Meshyeev
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacob T Cohen
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
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Paker M, Cohen JT, Moed N, Shleizerman L, Masalha M, Ashkenazi D, Mazzawi S. Facial vein thrombophlebitis: A case report and literature review. Int J Pediatr Otorhinolaryngol 2018; 113:298-301. [PMID: 30174005 DOI: 10.1016/j.ijporl.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
Septic thrombophlebitis of the facial vein (STFN) commonly presents with facial erythema, tenderness, and swelling above the involved vessel. Due to its rarity, diagnosis and treatment remain a challenge. Lemierre syndrome (LS), which consists of a triad of internal jugular vein thrombophlebitis, septicemia, and distant septic emboli, is a more common entity of which physicians are more familiar. Whether tonsillitis-related STFN is actually LS in a different anatomical area and shares the same characteristics is still left to be answered. We present a case of STFN with a review of all cases reported in the literature.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Haifa, Israel; Rappaport Institute of Medicine and Research, The Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nedal Moed
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Lev Shleizerman
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Muhamed Masalha
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Dror Ashkenazi
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Salim Mazzawi
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
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Duek I, Paker M, Gil Z, Cohen JT. Warthin tumor of the larynx: A case report and review of the literature. Ear Nose Throat J 2018; 97:E8-E11. [PMID: 30036439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Warthin tumor (papillary cystadenoma lymphomatosum) is a benign salivary gland tumor that occurs almost exclusively in the parotid gland. As far as we know, only 15 cases of laryngeal Warthin tumor have been previously reported worldwide. We describe the case of a 75-year-old woman with a supraglottic tumor that mimicked a mucoepidermoid carcinoma. The tumor was completely excised via a transcervical approach. Pathology identified it as a Warthin tumor. At follow-up, the patient maintained good oral intake. Computed tomography 3 months postoperatively confirmed complete tumor resection and detected no evidence of residual disease or recurrence. We also discuss our review of the literature on benign laryngeal salivary gland tumors, which included an analysis of 112 cases. The most common tumors were oncocytic cystadenomas (n = 65), pleomorphic adenomas (n = 28), and Warthin tumors (n = 15); we also found 2 cases each of basal cell adenomas and myoepitheliomas. The most common single tumor site was the glottis (n = 25), followed by the supraglottis (n = 24), and the subglottis (n = 22); 5 cases occurred in multiple sites, and the specific site was not reported in 36 cases. Benign laryngeal neoplasms of salivary gland origin should be carefully evaluated. Distinguishing these tumors from malignant lesions and establishing the correct diagnosis are crucial for treatment planning. Large lesions with extralaryngeal extension can be resected completely via an open external approach.
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Affiliation(s)
- Irit Duek
- Corresponding author: Rambam Medical Center, Technion, Israel Institute of Technology, 6 Ha'Aliya St., PO Box 9602, Haifa 31096, Israel
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Paker M, Fisher S, Mazzawi S, Colodner R, Ashkenazi D. Intraoperative Parathyroid Aspiration and Parathyroid Hormone Assay During Parathyroidectomy for Primary Hyperparathyroidism. Isr Med Assoc J 2017; 19:731-735. [PMID: 29235733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Direct aspiration from suspected pathological tissue and rapid parathyroid hormone analysis may offer a reliable, cost effective alternative to currently used "gold standard" tests. OBJECTIVES To validate the accuracy of intraoperative measurements of parathyroid hormone levels in parathyroid adenomas. METHODS A prospective study included 22 patients diagnosed with primary hyperparathyroidism who underwent parathyroidectomy due to an adenoma or hyperplasia. Aspirations of tissues extracted from three adjacent areas (the pathological parathyroid, thyroid, and muscle tissues) were sent for rapid parathyroid hormone analysis. The assay values of these tissue aspirates were compared to the results of the pathology report based on frozen section analysis and the final pathology report. RESULTS All assay results were significantly higher for parathyroid tissue 16,800 to 1,097,986 pmol/L (median 26,600), than for either thyroid 1.7 to 415 pmol/L (median 6.5), P < 0.001, or muscle tissue 1.1 to 1230 pmol/L, (median 11.3), P < 0.001. All tissues showing high parathyroid assay values were also verified by pathology examinations: 7 had adenomas and 15 had a differential diagnosis of adenoma or hyperplasia. The frozen section identified all but one (false negative). Rapid intraoperative parathyroid levels > 1500 predicted parathyroid tissue with a 99% level of confidence, while levels between 1000 and 1500 predicted it with 95% confidence. The intraoperative parathyroid hormone assay showed > 70% decrease in 15/21 cases. CONCLUSIONS Rapid intraoperative parathyroid hormone analysis is a reliable and precise technique, equally accurate for frozen section analysis in predicting with high certainty intraoperative parathyroid tissue.
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Affiliation(s)
- Miki Paker
- Department of Ear, Nose and Throat, Emek Medical Center, Afula, Israel
| | - Shani Fisher
- Department of Dermatology and Venereology, Emek Medical Center, Afula, Israel
| | - Salim Mazzawi
- Department of Ear, Nose and Throat, Emek Medical Center, Afula, Israel
| | | | - Dror Ashkenazi
- Department of Ear, Nose and Throat, Emek Medical Center, Afula, Israel
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Sitrava-Gunenc S, Paker M. P-1169 - A descriptive study: the use of psychotherapy in the clinical practice of the mental health professionals in Turkey. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Berger G, Kogan T, Paker M, Berger-Achituv S, Ebner Y. Pediatric chronic rhinosinusitis histopathology: differences and similarities with the adult form. Otolaryngol Head Neck Surg 2011; 144:85-90. [PMID: 21493393 DOI: 10.1177/0194599810390443] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the histopathology and immunohistochemistry of pediatric and adult chronic rhinosinusitis (CRS). STUDY DESIGN Cross-sectional study. SETTING University-affiliated hospital. PATIENTS AND METHODS Inflamed sinus-mucosal samples of 16 children (mean age, 11.6 ± 2.9 years) with refractory CRS who underwent endoscopic sinus surgery were studied. Twenty-nine diagnosis-matched adults served as controls. Study analysis covered sinus computed tomography (CT) scores, general pathologic features, eosinophil and T-lymphocyte population, and thickness and integrity of the epithelium. RESULTS Children had a lower CT score than adults did (P = .005). The inflammatory response of the children, which differed greatly from that of adults, was dominated by cellular infiltration of the lamina propria with chronic inflammatory cells and fibrosis (8/16 had extensive fibrosis); eosinophils were scanty. Adult CRS was characterized by polypoid mucosa and eosinophilia (type A) or glandular hyperplasia (type B). Extensive fibrosis was shown in adult type-B patients (7/13). Assessment of eosinophils in the lamina propria showed marginal statistical significance between children and adults (P = .065). This difference was accentuated when pediatric and adult type A were compared (14.6 ± 25.3 vs 121.5 ± 174.2 cell/mm(2); P = .043). Complete epithelial shedding was less significant in children (9.4% ± 8.2% vs 25.4% ± 15.1%; P < .001). The number of lamina propria and epithelial T lymphocytes was similar. CONCLUSIONS The marked differences in the inflammatory response of children and adults with CRS may attest to different pathophysiologic pathways. The significantly reduced epithelial shedding in children is probably associated with diminished tissue eosinophilia. Extensive fibrosis was found in half of adult type-B patients; similar findings were found in children.
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Affiliation(s)
- Gilead Berger
- Ear, Nose, and Throat Histopathological Research Laboratory, Meir Medical Center, Kfar Saba, Tel Aviv, Israel.
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Abstract
BACKGROUND Although much research has focused on mechanisms of traumatization and factors related to post-trauma psychological functioning in survivors of trauma, there have been few studies of survivors of torture despite the widespread practice of torture in the world. The aim of this study was to examine the role of 'psychological preparedness' for trauma in post-traumatic stress responses in survivors of torture. METHOD Thirty-four torture survivors who had no history of political activity, commitment to a political cause or group, or expectations of arrest and torture were compared with 55 tortured political activists, using structured interviews and measures of anxiety, depression, and post-traumatic stress disorder. RESULTS Compared with tortured political activists, tortured non-activists were subject to relatively less severe torture but showed higher levels of psychopathology. Less psychological preparedness related to greater perceived distress during torture and more severe psychological problems, explaining 4% of the variance in general psychopathology and 9% of the variance in post-traumatic stress disorder symptoms. CONCLUSIONS The study findings lend support to the role of prior immunization to traumatic stress and to unpredictability and uncontrollability of stressors in the effects of traumatization. Further research aimed at identifying the behavioural and cognitive components of psychological preparedness that play a role in traumatization may provide useful insights into effective treatment strategies for survivors of torture.
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Başoğlu M, Ozmen E, Sahin D, Paker M, Taşdemir O, Ceyhanli A, Incesu C, Sarimurat N. Appraisal of self, social environment, and state authority as a possible mediator of posttraumatic stress disorder in tortured political activists. J Abnorm Psychol 1996; 105:232-6. [PMID: 8723004 DOI: 10.1037/0021-843x.105.2.232] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study examined appraisal of self and others, as measured by semantic differential ratings of Police, State, Society, Family, Friend, Myself as a Man/Woman, and Myself as a Political Person, in 55 tortured political activists in Turkey, 55 nontortured political activists, and 55 nontortured, politically noninvolved controls. There were no remarkable differences between tortured and nontortured political activists; both groups differed from controls in having a more negative appraisal of the police and the state and stronger perceptions of danger, mistrust, and injustice in relation to state authority. Lack of beliefs concerning a "benevolent state" may have protected the survivors from the traumatic effects of state-perpetrated torture. Further research into the possible protective role of belief systems in posttraumatic stress disorder is needed.
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Affiliation(s)
- M Başoğlu
- Institute of Psychiatry, University of London, England
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Abstract
OBJECTIVE To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture. DESIGN The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors. SETTING Istanbul, Turkey. MAIN OUTCOME MEASURES Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory. RESULTS Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms. CONCLUSIONS These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.
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Affiliation(s)
- M Başoğlu
- Institute of Psychiatry, University of London, England
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Başoğlu M, Paker M, Paker O, Ozmen E, Marks I, Incesu C, Sahin D, Sarimurat N. Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey. Am J Psychiatry 1994; 151:76-81. [PMID: 8267139 DOI: 10.1176/ajp.151.1.76] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners. METHOD The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features. RESULTS The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology. CONCLUSIONS The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.
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Affiliation(s)
- M Başoğlu
- Institute of Psychiatry, London, England
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