Faculty Bibliography

Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options.

Patients often believe they have a sinus headache when in fact the headache frequently has another cause. The diagnosis of sinus headache can be confusing because of signs and symptoms in common with migraine. Although not as common a diagnosis as migraine, sinus headache and the associated treatments can be found extensively in references on the Internet.

Design: The relationship of the recurrent laryngeal nerve to the superior parathyroid gland during consecutive thyroidectomies was prospectively evaluated. When one structure was noted, careful dissection was performed to locate the other structure, to preserve their natural anatomical relationship. Patients: In total, 103 consecutive thyroid lobectomies were performed on 73 patients. The distance from the superior parathyroid gland to the recurrent laryngeal nerve was recorded. Results: In 88 cases (88.9 per cent), the superior parathyroid gland was identified within 5 mm of the recurrent laryngeal nerve. In 62 cases (62.6 per cent), the gland was within 1 mm of the recurrent laryngeal nerve. The height of the thyroid lobe was positively associated with the distance between the two structures (p = 0.001), as was the incidence of cancer (p = 0.033). The incidence of recurrent laryngeal nerve paresis was less than 4 per cent. Conclusion: In most cases, the recurrent laryngeal nerve was found in close proximity to the superior parathyroid gland. In a thyroid gland with a large height, or in a cancerous lobe, this relationship is less reliable.

Anoctamin 1 (TMEM16A, Ano1) is a recently identified Ca(2+)-activated chloride channel and a member of a large protein family comprising 10 paralogues. Before Ano1 was identified as a chloride channel protein, it was known as the cancer marker DOG1. DOG1/Ano1 is expressed in gastrointestinal stromal tumours (GIST) and particularly in head and neck squamous cell carcinoma, at very high levels never detected in other tissues. It is now emerging that Ano1 is part of the 11q13 locus, amplified in several types of tumour, where it is thought to augment cell proliferation, cell migration and metastasis. Notably, Ano1 is upregulated through histone deacetylase (HDAC), corresponding to the known role of HDAC in HNSCC. As Ano1 does not enhance proliferation in every cell type, its function is perhaps modulated by cell-specific factors, or by the abundance of other anoctamins. Thus Ano6, by regulating Ca(2+)-induced membrane phospholipid scrambling and annexin V binding, supports cellular apoptosis rather than proliferation. Current findings implicate other cellular functions of anoctamins, apart from their role as Ca(2+)-activated Cl(-) channels.

Animals often listen selectively for particular sounds, a strategy that could alter neural encoding mechanisms to maximize the ability to detect the target. Here, we recorded auditory cortex neuron responses in well trained, freely moving gerbils as they performed a tone detection task. Each trial was initiated by the animal, providing a predictable time window during which to listen. No sound was presented on nogo trials, permitting us to assess spontaneous activity on trials in which a signal could have been expected, but was not delivered. Immediately after animals initiated a trial, auditory cortex neurons displayed a 26% reduction in spontaneous activity. Moreover, when stimulus-driven discharge rate was referenced to this reduced baseline, a larger fraction of auditory cortex neurons displayed a detection threshold within 10 dB of the behavioral threshold. These findings suggest that auditory cortex spontaneous discharge rate can be modulated transiently during task performance, thereby increasing the signal-to-noise ratio and enhancing signal detection.

OBJECTIVE/HYPOTHESIS: Currently, no clinical standards exist with regard to antireflux medications in the perioperative period for patients undergoing surgery for benign vocal fold lesions. The present study sought to determine the clinical yield of these medications on operative outcomes in patients who underwent surgical treatment for benign vocal fold lesions. STUDY DESIGN: Retrospective, outcomes study. METHODS: Medical records were reviewed from a single surgeon database between January 2011 and June 2012 to quantify outcomes in patients taking antireflux medications compared with subjects not taking medications at the time of surgery. Voice Handicap Index (VHI)-10 and Reflux Symptom Index (RSI) scores were the primary dependent variables. The t test analyses were conducted to compare VHI-10 and RSI scores. Additional multivariate regression analyses were conducted to evaluate medication effects on VHI and RSI, adjusting for potential confounds. RESULTS: A total of 51 patients met inclusion criteria. Of these patients, 12 (23.5%) were using antireflux medication(s) at the time of surgery and 39 (76.5%) were not. The mean shifts in VHI-10 and RSI after surgery for the antireflux therapy (ART) group were -14.75 and -7.5, respectively. For the non-antireflux therapy (non-ART) group, mean DeltaVHI-10 and DeltaRSI values were -9.87 and -5.05, respectively. Both t test and regression analyses confirmed no statistical difference between the ART and non-ART groups for both DeltaVHI-10 and DeltaRSI. Additional regression analysis revealed a positive correlation between preoperative RSI score and DeltaRSI score. CONCLUSION: Antireflux medications did not significantly alter postoperative outcomes in this preliminary cohort of patients.

A non-parametric bootstrapping statistical method is introduced and investigated for estimating confidence intervals resulting from information transfer (IT) analysis of confusion matrices. Confidence intervals can be used to statistically compare ITs from two or more confusion matrices obtained in an experiment. Information transfer is a nonlinear analysis and does not satisfy many of the assumptions of a parametric method. The bootstrapping method accurately estimated IT confidence intervals as long as the confusion matrices contained a sufficiently large number of presentations per stimulus category, which is also a condition for reduced bias in IT analysis.