Publications by authors named "Mark C Aarts"

18 Publications

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Author's response to letter to the editor: "Fungal otitis externa and wet ear with mucopurulent should be a influencing factors on tympanic membrane closure".

Eur Arch Otorhinolaryngol 2020 07 24;277(7):2147. Epub 2020 Mar 24.

Department of ENT, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.

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http://dx.doi.org/10.1007/s00405-020-05917-9DOI Listing
July 2020

Healthcare utilisation, follow-up of guidelines and practice variation on rhinosinusitis in adults: A healthcare reimbursement claims study in The Netherlands.

Clin Otolaryngol 2020 03 20;45(2):159-166. Epub 2020 Jan 20.

Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.

Objectives: To provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation.

Design: Anonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016.

Setting: Secondary and tertiary care in the Netherlands.

Participants: Patients ≥18 years with diagnostic code "sinusitis."

Main Outcome Measures: Healthcare utilisation (prevalence, co-morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation.

Results: We identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554-that is 0.2% of total hospital-related care costs (€21 831.3 × 10 ). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X-ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery.

Conclusion: Prevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.
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http://dx.doi.org/10.1111/coa.13453DOI Listing
March 2020

Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis.

Eur Arch Otorhinolaryngol 2019 Nov 3;276(11):3081-3087. Epub 2019 Sep 3.

Department of ENT, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.

Objectives: The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties.

Design: Retrospective cohort.

Setting: Medium-sized medical centrum.

Participants: 195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands.

Main Outcome Measures: Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air-bone gap improvement after surgery.

Results: The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10 dB if the perforation was closed compared to 3.38 dB after an unsuccessful procedure.

Conclusion: The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.
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http://dx.doi.org/10.1007/s00405-019-05611-5DOI Listing
November 2019

Publications on Clinical Research in Otolaryngology-A Systematic Analysis of Leading Journals in 2010.

Front Surg 2019 9;6:18. Epub 2019 Apr 9.

Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam, VU University, Amsterdam, Netherlands.

We wanted to asses and characterize the volume of Otolaryngology publications on clinical research, published in major journals. To assess volume and study type of clinical research in Otolaryngology we performed a literature search in high impact factor journals. We included 10 high impact factor Otolaryngology journals and 20 high impact factor medical journals outside this field (2011). We extracted original publications and systematic reviews from 2010. Publications were classified according to their research question, that is therapy, diagnosis, prognosis or etiology. From Otolaryngology journals (impact factor 1.8 to 2.8) we identified 694 (46%) publications on original observations and 27 (2%) systematic reviews. From selected medical journals (impact factor 6.0 to 101.8) 122 (2%) publications related to Otolaryngology, 102 (83%) were on original observations and 2 (0.04%) systematic reviews. The most common category was therapy (40%). Half of publications in Otolaryngology concerns clinical research, which is higher than other specialties. In medical journals outside the field of Otolaryngology, a small proportion (2%) of publications is related to Otolaryngology. Striking is that systematic reviews, which are considered high level evidence, make up for only 2% of publications. We must ensure an increase of clinical research for optimizing medical practice.
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http://dx.doi.org/10.3389/fsurg.2019.00018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467099PMC
April 2019

A Systematic Review of Non-Echo Planar Diffusion-Weighted Magnetic Resonance Imaging for Detection of Primary and Postoperative Cholesteatoma.

Otolaryngol Head Neck Surg 2016 Feb 2;154(2):233-40. Epub 2015 Nov 2.

Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.

Objective: To investigate the diagnostic value of non-echo planar diffusion-weighted magnetic resonance imaging (DW-MRI) for primary and recurrent/residual (postoperative) cholesteatoma in adults (≥18 years) after canal wall up surgery.

Data Sources: We conducted a systematic search in PubMed, Embase, and Cochrane up to October 22, 2014.

Review Methods: All studies investigating non-echo planar DW-MRI for primary and postoperative cholesteatoma were selected and critically appraised for relevance and validity.

Results: In total, 779 unique articles were identified, of which 23 articles were included for critical appraisal. Seven articles met our criteria for relevance and validity for postoperative cholesteatoma. Four studies were additionally included for subgroup analysis of primary cases only. Ranges of sensitivity, specificity, positive predictive value, and negative predictive value yielded 43%-92%, 58%-100%, 50%-100% and 64%-100%, respectively. Results for primary subgroup analysis were 83%-100%, 50%-100%, 85%-100%, and 50%-100%, respectively. Results for subgroup analysis for only postoperative cases yielded 80%-82%, 90%-100%, 96%-100%, 64%-85%, respectively. Despite a higher prevalence of cholesteatoma in the primary cases, there was no clinical difference in added value of DW-MRI between primary and postoperative cases.

Conclusion: We found a high predictive value of non-echo planar DW-MRI for the detection of primary and postoperative cholesteatoma. Given the moderate quality of evidence, we strongly recommend both the use of non-echo planar DW-MRI scans for the follow-up after cholesteatoma surgery, and when the correct diagnosis is questioned in primary preoperative cases.
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http://dx.doi.org/10.1177/0194599815613073DOI Listing
February 2016

Nasal endoscopy is recommended for diagnosing adults with chronic rhinosinusitis.

Otolaryngol Head Neck Surg 2014 Mar 9;150(3):359-64. Epub 2013 Dec 9.

Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.

Objective: To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis.

Data Sources: PubMed, EMBASE, and the Cochrane Library.

Review Methods: A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data.

Results: Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%.

Conclusion And Recommendation: Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.
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http://dx.doi.org/10.1177/0194599813514510DOI Listing
March 2014

No evidence for distinguishing bacterial from viral acute rhinosinusitis using symptom duration and purulent rhinorrhea: a systematic review of the evidence base.

Otolaryngol Head Neck Surg 2014 Apr 10;150(4):533-7. Epub 2014 Feb 10.

Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.

Objective: To evaluate the diagnostic value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis.

Data Sources: PubMed, EMBASE, and the Cochrane Library.

Review Methods: We performed a comprehensive systematic search on March 28, 2013. We included studies on the diagnostic value of duration of symptoms and purulent rhinorrhea in patients suspected of having acute bacterial rhinosinusitis. We assessed study design of included articles for directness of evidence and risk of bias. We extracted prevalence and positive and negative predictive values.

Results: Of 4173 unique publications, we included 1 study with high directness of evidence and moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval [CI], 0.24-0.35); we could not extract posterior probabilities. Odds ratios (95% CI) from univariate analysis were 1.03 (0.78-1.36) for duration of symptoms and 2.69 (1.39-5.18) for colored discharge on the floor of the nasal cavity.

Conclusion And Recommendation: We included 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. Recommendations to distinguish between a viral and a bacterial source based on purulent rhinorrhea are not supported by evidence, and the decision to prescribe antibiotic treatment should not depend on its presence. Based on judgment driven by theory and subsidiary evidence of a greater likelihood of bacterial rhinosinusitis after 10 days, antibiotic therapy may seem a reasonable empirical option.
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http://dx.doi.org/10.1177/0194599814522595DOI Listing
April 2014

No evidence for distinguishing bacterial from viral acute rhinosinusitis using fever and facial/dental pain: a systematic review of the evidence base.

Otolaryngol Head Neck Surg 2014 Jan 15;150(1):28-33. Epub 2013 Nov 15.

Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.

Objective: To assess the diagnostic value of fever and facial and dental pain in adults suspected of acute bacterial rhinosinusitis.

Data Sources: PubMed, EMBASE, and the Cochrane Library.

Review Methods: A comprehensive systematic search was performed on March 18, 2013. We included articles reporting studies on the diagnostic value of fever or facial and dental pain in patients suspected of acute bacterial rhinosinusitis. For included articles, the reported study design was assessed for directness of evidence and risk of bias. Prevalences, positive predictive values, and negative predictive values were extracted.

Results: Of 3171 unique records, we included 1 study with a high directness of evidence and a moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval: 0.24 to 0.35). We could not extract posterior probabilities with accompanying positive and negative predictive values. The study reported an odds ratio from univariate analysis for fever of 1.02 (0.52 to 2.00) and 1.65 (0.83 to 3.28) for facial and dental pain. In subsequent multivariate analysis, the odds ratio of facial and dental pain was 1.86 (1.06 to 3.29).

Conclusion And Recommendation: There is 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of fever and facial and dental pain in adults suspected of an acute bacterial rhinosinusitis. Therefore, these symptoms should not be used in clinical practice to distinguish between a bacterial and viral source of acute rhinosinusitis or for decision making about prescribing antibiotic treatment.
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http://dx.doi.org/10.1177/0194599813510891DOI Listing
January 2014

Remarkable differences between three evidence-based guidelines on management of obstructive sleep apnea-hypopnea syndrome.

Laryngoscope 2013 Jan 18;123(1):283-91. Epub 2012 Sep 18.

Department of Otorhinolaryngology, University Medical Centre, Utrecht, The Netherlands.

Objectives/hypothesis: The aim of this study was to compare available guidelines for the diagnosis and treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) regarding their content, conclusions on the available evidence, and recommendations.

Study Design: Literature review/systematic review.

Methods: We retrieved guidelines from Embase, PubMed, Web of Science, and Web sites of several health care improvement centers and with a Google Scholar search. We appraised the quality of selected guidelines according to the Appraisal of Guidelines for Research and Evaluation instrument. For similar clinical questions we compared the conclusions, the attached levels of evidence, and the references used. If differences were found, we checked search strategies, appraisal criteria, and publication date as possible sources for these differences.

Results: We selected the guidelines on diagnosis and treatment of OSAHS of the Scottish Scottish Intercollegiate Guidelines Network, the Dutch Institute for Healthcare Improvement, and the Institute for Clinical Systems Improvement in the United States for this comparison. For similar clinical questions these three guidelines showed conflicting conclusions (11%-18%), differences in attached levels of evidence (32%-62%), and remarkable discrepancies in cited studies. A plausible reason for these differences is the citation preference for articles from members of the guidelines workgroup and from their own country. Despite different publication dates, more recent guidelines fail to cite earlier published guidelines.

Conclusions: Despite the generally accepted approach regarding the development of evidence-based guidelines, remarkable differences exist between guidelines from different countries on the same clinical subject.
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http://dx.doi.org/10.1002/lary.23521DOI Listing
January 2013

Insufficient evidence for the effect of corticosteroid treatment on recovery of vestibular neuritis.

Otolaryngol Head Neck Surg 2012 Nov 21;147(5):826-31. Epub 2012 Aug 21.

Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands.

The authors studied the effect of corticosteroid treatment on clinical recovery and recovery of vestibular function in patients with vestibular neuritis. The comprehensive search (March 29, 2012) yielded 496 original papers, of which 5 (including 199 patients) during full-text screening satisfied our eligibility criteria. Methods assessment showed that 1 study (30 patients) provided direct evidence and carried low risk of bias. Two studies properly reported on their random and concealed allocation of treatment. In 1 study, patients were not randomly allocated to treatment. Blinding of outcomes was lacking in 2 studies, whereas outcome data were clearly incomplete for 2 studies. Given the wide variety in outcome measures and scales and follow-up duration, the meaning of the size of reported effects is not clear. Therefore, the reported effects cannot simply be compared between studies, and this precludes pooling of study results. Still, there are large differences between studies in the size of the reported absolute effects after the placebo treatment. Moreover, the difference in effects between treatments is rather small and does not always favor corticosteroids. The moderate to high risk of bias of studies precludes firm conclusions, whereas the reported short-term effects on symptom recovery and improvement of peripheral vestibular function are too small to be clinically important. No long-term effect on symptom recovery has been shown. Recommendations or decisions for corticosteroid treatment in patients with vestibular neuritis cannot be based on current best evidence and therefore should be discussed with the patient.
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http://dx.doi.org/10.1177/0194599812457557DOI Listing
November 2012

No evidence for the diagnostic value of Borrelia serology in patients with sudden hearing loss.

Otolaryngol Head Neck Surg 2012 Apr 6;146(4):539-43. Epub 2012 Mar 6.

Department of Otolaryngology, University Medical Centre, Utrecht, The Netherlands.

In this evidence-based case report, we address the following clinical question: What is the predictive value of serological testing for Borrelia for diagnosing neuroborreliosis in patients with sudden sensorineural hearing loss? We searched for relevant articles in PubMed, Embase, and Web of Science. We retrieved 49 unique publications and screened the title and abstract of these articles for relevance. We included 2 of 12 studies initially considered relevant to answer our question. These 2 studies reported a seroprevalence of antibodies against Borrelia of 16% in patients with sudden sensorineural hearing loss (SHL) as compared with 13.5% in the general population, but in neither patients with definite neuroborreliosis were they found. To date, there is no evidence regarding the added value of routine diagnostic serologic testing for Borrelia in diagnosing neuroborreliosis in patients with sudden SHL. Neuroborreliosis seems to be a rare cause of sudden SHL, and routine screening of patients for borrelia antibodies in serum should therefore not be recommended.
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http://dx.doi.org/10.1177/0194599811432535DOI Listing
April 2012

Awareness of, opinions about, and adherence to evidence-based guidelines in otorhinolaryngology.

Arch Otolaryngol Head Neck Surg 2012 Feb;138(2):148-52

Department of Otolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands.

Background: Guidelines may assist physicians and patients in decisions about effective and safe care. Little is known about the awareness of, opinions about, and adherence to evidence-based guidelines in otolaryngology.

Methods: We performed a survey among 440 otorhinolaryngologists of the Dutch Society of Otolaryngology-Head and Neck Surgery. The questionnaire consisted of questions about the characteristics of the respondents, their knowledge and opinions of available evidence-based guidelines, and their adherence to them. Furthermore, 2 clinical scenarios were included to test their knowledge regarding the guideline for diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome.

Results: The daily practice of most otorhinolaryngologists (70%) was influenced by evidence based guidelines: 62% stated that evidence-based guidelines supported their clinical practice; 32% stated that guidelines directed their clinical practice. The mean confidence in the evidence of recommendations stated in the guidelines was 77%. The mean percentage of nonadherence to guideline recommendations was 45%. The guideline adherence was higher in younger otorhinolaryngologists. Sex, type of hospital, and PhD grade did not affect the preferences of the responders. In general, surveyed otorhinolaryngologists treated patients in accordance with the guidelines. However, when disease characteristics were less distinct, on the one hand, the guidelines included a wider range of treatment options, and on the other hand, variation in chosen treatment by otorhinolaryngologists increased.

Conclusions: Dutch otorhinolaryngologists are well aware of the available evidence-based guidelines, and many use these to support their clinical practice. The treatment by Dutch otorhinolaryngologists is in accordance with the Dutch guidelines. When guidelines, however, do not provide strict recommendations and allow flexibility in treatment, larger variations in chosen treatment occur. This may reflect that otorhinolaryngologists still may encounter difficulties when applying the current guidelines to an individual patient.
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http://dx.doi.org/10.1001/archoto.2011.1166DOI Listing
February 2012

No evidence for diagnostic value of Mallampati score in patients suspected of having obstructive sleep apnea syndrome.

Otolaryngol Head Neck Surg 2011 Aug 13;145(2):199-203. Epub 2011 May 13.

Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands.

Objective: To analyze whether the Mallampati score is reliable as a simple diagnostic test for predicting obstructive sleep apnea syndrome (OSAS).

Data Sources: A literature search was performed using PubMed, Embase, Scopus, Cochrane, and CINAHL databases.

Review Methods: Studies were ranked by their relevance and validity in a critical appraisal table. Positive and negative predictive values were obtained or recalculated from the selected articles.

Results: Eight relevant articles met the inclusion criteria. Three studies reported predictive values for a Mallampati score of 3 to 4. The prevalence (or prior probability) of OSAS in these 3 studies was 58% (95% confidence interval [CI], 50-67), 76% (95% CI, 72-79), and 82% (95% CI, 80-84), respectively. With a Mallampati score of 1 to 2, the risk of OSAS decreases to 45% (95% CI, 33-58), 74% (95% CI, 70-78), and 81% (95% CI, 77-86), respectively. With a Mallampati score of 3 to 4, the risk of OSAS is 69% (95% CI, 59-80), 82% (95% CI, 74-89), and 82% (95% CI, 79-85), respectively. The differences between the prior and the posterior probabilities are rather small and do not reach statistical significance.

Conclusion: There is no evidence to maintain that the Mallampati score is of added value for ruling in or ruling out a diagnosis of OSAS in patients suspected for OSAS.
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http://dx.doi.org/10.1177/0194599811409302DOI Listing
August 2011

The value of a mandibular repositioning appliance for the treatment of nonapneic snoring.

Otolaryngol Head Neck Surg 2011 Feb 11;144(2):170-3. Epub 2011 Jan 11.

Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands.

In this evidence-based case report, the authors addressed the following clinical question: What is the effect of a mandibular repositioning appliance (MRA) in patients with nonapneic snoring on the snoring loudness, partners' sleep disturbance, and quality of life? The authors retrieved relevant publications from Embase, PubMed, Cinahl, CENTRAL, and Web of Science. They used title and abstract field searches with relevant synonyms for the domain, patients with nonapneic snoring, and for the determinant, MRA. The search yielded 499 records. After selection based on relevance and validity, 2 articles remained for answering the authors' clinical question. The authors pooled the data for the level of snoring. MRA as compared to placebo resulted in a reduction of snoring loudness in 38% of patients with nonapneic snoring and in an improvement of sleep disturbance in 54% of the partners. No effect on quality of life and daytime sleepiness of partners was found. Furthermore, evidence for sustained long-term effects and complete recovery is lacking.
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http://dx.doi.org/10.1177/0194599810392149DOI Listing
February 2011

Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae?

Otolaryngol Head Neck Surg 2011 Jan;144(1):5-9

Department of Otorhinolaryngology, University Medical Centre Utrecht, The Netherlands.

In this evidence based case report we addressed the clinical question: which factors predict the occurrence of a pharyngocutaneous fistula after total laryngectomy in patients that already were treated with radiotherapy for a squamous cell carcinoma of the larynx? We searched for relevant synonyms for the domain, being patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx and having a recurrence for which a salvage total laryngectomy is necessary, with the outcome being the development of a post-operative pharyngocutaneous fistula. We searched for relevant publications in Embase, Pubmed and Web of Science using search terms in title and abstract fields. The search yielded 1764 records, of which three were relevant and valid for our clinical question. Our results show that the absolute risk of a pharyngocutaneous fistula after total laryngectomy in patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx mainly depends on characteristics and site of the primary tumor. In patients who have a primary glottic laryngeal T1 or T2 tumor the absolute risk of developing a fistula is 11% (95% CI 6; 15%), whereas the risk of developing a fistula in patients with a T3 or T4 extra laryngeal tumor is 35% (95% CI 25; 46%). Other patient and surgical characteristics can however not be ruled out as important prognostic factors since many of them have to date not been studied, e.g. diabetes mellitus, alcohol consumption, smoking, suture materials and surgical technique used.
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http://dx.doi.org/10.1177/0194599810390914DOI Listing
January 2011

The diagnostic value of diffusion-weighted magnetic resonance imaging in detecting a residual cholesteatoma.

Otolaryngol Head Neck Surg 2010 Jul;143(1):12-6

Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands.

In this evidence-based case report, we address the following clinical question: What is the predictive value of diffusion-weighted magnetic resonance imaging (DW MRI) for detecting a residual cholesteatoma in patients with chronic otitis media with cholesteatoma who have previously undergone a canal-wall-up procedure? We searched for relevant synonyms for the determinant, MRI, and for the outcome, cholesteatoma, and retrieved relevant publications in Embase, PubMed, Cinahl, and Web of Science by using search terms in the title and abstract fields. The search yielded 683 records, of which 11 were relevant and valid for our clinical question. We pooled the data of the MRI findings of the included studies by adding the two-by-two tables of the individual studies. For the eight echo planar imaging (EPI) DW MRI studies, this resulted in a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 68 percent, 87 percent, 81 percent, and 78 percent, respectively. For the three non-echo planar (non-EPI) DW MRI studies, the sensitivity, specificity, positive predictive value, and negative predictive value were 97 percent, 97 percent, 97 percent, and 97 percent, respectively. DW MRI, especially the non-EPI DW MRI, appears to be a rather accurate method, as opposed to a standard second-look operation, for the follow-up of patients who have undergone a canal-wall-up procedure for a chronic otitis media with cholesteatoma and who have no clinical signs of recurrent cholesteatoma.
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http://dx.doi.org/10.1016/j.otohns.2010.03.023DOI Listing
July 2010

Effects of isoflurane on auditory evoked potentials in the cochlea and brainstem of guinea pigs.

Hear Res 2010 Feb 28;260(1-2):20-9. Epub 2009 Oct 28.

Department of Otorhinolaryngology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.

Electrophysiological recordings of the auditory system are commonly performed in deeply anesthetized animals. This study evaluated the effects of various concentrations of the volatile anesthetic isoflurane (1-3%) on the compound action potential (CAP), cochlear microphonic (CM) and auditory brainstem response (ABR). Recordings were initiated in the awake, lightly restrained animal. Anesthesia was induced with a single dose of Hypnorm (fentanyl and fluanisone). After tracheostomy increasing isoflurane concentrations were applied in N(2)O/O(2) via controlled ventilation. Data were compared to recordings in the awake animal using repeated measures ANOVA and Dunnett's post hoc test. On average, isoflurane dose-dependently suppressed the amplitude and increased the latency of the CAP. CM amplitude was suppressed. These effects were most profound at high frequencies and were typically significant at isoflurane concentrations of 2.5% and 3%. Amplitude and latency of the second negative peak of the CAP (N(2)) were affected to a greater extent compared to the first peak (N(1)). On average, isoflurane dose-dependently reduced the amplitude and increased the latency of the ABR. These effects were typically significant at an isoflurane concentration of 2%. Effects on peak IV and V were more pronounced compared to the early peaks I and III.
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http://dx.doi.org/10.1016/j.heares.2009.10.015DOI Listing
February 2010
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