bluuebunny/crossref_metadata_2025 huggingface dataset:
The Expression of Activin Receptor‐like Kinase 1 in HNSCC
Authors: Chien Chih‐Yen
Published: February 2015

Objective

We investigated the expression and clinical significance of activin receptor‐like kinase 1 (ACVRL1) in patients with head and neck squamous cell carcinoma (HNSCC).

Method

Patients diagnosed with HNSCC (n = 169) underwent surgical resection followed by radiotherapy and/or chemotherapy for aggressive tumors between November 2000 and March 2004. ACVRL1 expression was assessed using quantitative reverse‐transcription polymerase chain reaction and immunohistochemistry approaches by tissue microarray.

Results

High levels of ACVRL1 expression were significantly correlated with advanced T classification, positive N classification, advanced TNM stage, lymphovascular invasion, and extracapsular spread of lymph node. A poor 5‐year overall survival rate was associated with high ACVRL1 expression (P =. 0001), advanced T classification (P =. 0075), positive N classification (P =. 0024), advanced TNM stage (P =. 0077), and extracapsular spread of lymph node (P =. 0002), but a multivariate analysis using Cox’s regression model revealed that the only independent prognostic factors for survival were ACVRL1 expression (P =. 002) and ECS (P =. 007).

Conclusion

ACVRL1 is not only an important prognostic factor but also contributes to the development of new therapeutic strategies in HNSCC patients.
Ultrasound for Localization in Primary Hyperparathyroidism
Authors: Smith Russell B. , Zitsch Robert P. , Evasovich Maria , Pagedar Nitin A. , Girod Douglas A. , Jorgensen Jeffrey B.
Published: February 2015

Objective

Minimally invasive surgery for primary hyperparathyroidism has gained significant popularity. Preoperative localization is required, with ultrasonography and sestamibi imaging being most commonly utilized. When both are obtained, frequently the same site is localized. It is unclear that 2 localization techniques are required in patients with hyperparathyroidism.

Method

Prospectively collected data from the Midwest Head and Neck Cancer Consortium’s parathyroid protocol was retrospectively reviewed. The study included patients that had preoperative localization and subsequently underwent surgery. The localization studies were correlated to surgical findings.

Results

Of the 96 patients, preoperative US, sestamibi, or both studies were obtained in 77, 88, and 71, respectively. Preoperative US and sestamibi localized an abnormality in 69% and 80%, respectively. In patients with localizing US, surgical findings were exactly as predicted in 75% and localized to the correct side in 84%. The accuracy of localization was similar for sestamibi imaging. In 8 patients with inaccurate US localization, the sestamibi detected an abnormal gland in only 50%. In patients with a nonlocalizing US, sestamibi was able to detect disease in 75%, with 2 being in the mediastinum.

Conclusion

Given the lower cost of ultrasonography, it is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi imaging should be obtained. Frequently potential sites of disease will be identified, still allowing for a minimally invasive surgical approach.
Vanderbilt’s Experience with 201 Carotid Body Tumors
Authors: Netterville James L. , Kuwada Clinton A. , Schmalbach Cecelia E. , Zender Chad A. , Van Deusen Mark B. , Athavale Sanjay , Sinard Robert J.
Published: February 2015

Objective

To discuss the evolving treatment considerations of carotid body tumors (CBT) based on a large cohort.

Method

A retrospective review of 149 patients with 201 CBT treated at Vanderbilt University’s Dept. of Otolaryngology over a 25‐year period (1986‐2011). Patients were analyzed for preoperative deficits, familial involvement, progression under observation, operative details, and postoperative sequelae.

Results

Bilateral CBTs were identified in 44%, associated vagal paragangliomas in 26%, and jugular tumors in 22% of patients. Familial inheritance was noted in 35%. A total of 163 tumors were resected from 139 patients. Preoperative embolization was utilized in 33% of tumors. Internal carotid resection‐reconstruction was performed in 13%. No postoperative strokes occurred. Postoperative cranial nerve dysfunction was rare. Of patients who underwent staged resection of bilateral CBTs, 73% experienced baroreflex failure. Although transient mild first bite syndrome was common, only 30% of patients had ongoing significant symptoms. No recurrence has been noted from the CBTs resected at Vanderbilt.

Conclusion

Management of CBTs requires consideration of familial inheritance and potential for multiple paraganglioma. We believe the primary treatment of CBT should remain surgical resection, which can be performed with curative intent with minimal morbidity. Slow growth patterns in paragangliomas makes temporary or long‐term observation a treatment option in selected patients.
Acoustic Effects of Asymmetric Laryngeal Activation
Authors: Mendelsohn Abie , Chhetri Dinesh K. , Neubauer Juergen , Berry David A. , Berke Gerald S.
Published: February 2015

Objective

Symmetric activation of laryngeal intrinsic musculature is considered essential for optimal voice production. However, phonatory consequences of asymmetric laryngeal activation are poorly understood. The objective of this study was to investigate the phonatory characteristics of an asymmetrically activated larynx.

Methods

Bilateral recurrent laryngeal nerves (RLNs) were stimulated in a graded fashion (from threshold to maximal activation) in a canine phonation model. 121 combinations of left‐right RLN activation states (spanning symmetric and asymmetric activation states) were analyzed for phonatory instabilities (number of bifurcations) in the 1.5s acoustic signal after neuromuscular activation.

Results

Asymmetric laryngeal activation produced frequent phonatory instabilities. Highest levels of instabilities were seen during phonation at extreme asymmetric conditions and asymmetries during near‐maximum RLN stimulation. Linear regression models demonstrated significant association (P <. 01) between percent of RLN stimulation and acoustic/aerodynamic measures. Phonation onset time (ms) (Left RLN: Coef = 1.44, CI = 1.01‐1.86; Right RLN: Coef = 2.71, CI = 2.29‐3.13) and subglottic pressure (kPa) (Left RLN: Coef = 0.01, CI = 0.011‐0.014; Right RLN: Coef = 0.01, CI = 0.009‐0.013) increased with increasing RLN stimulation. Subglottic airflow (l/min) (Left RLN: Coef = −0.29, CI = −0.36‐0.20; Right RLN: Coef = −0.29, CI = −0.37‐0.21) and fundamental frequency (Hz) (Left RLN: Coef = −0.59, CI = −0.76‐0.42; Right RLN: Coef = −0.24, CI = −0.41‐0.07) decreased with increasing RLN stimulation.

Conclusion

Higher levels of asymmetric laryngeal activation are associated with increasing phonatory instabilities. These results can be applied to further characterize asymmetric laryngeal states that lead to vocal irregulaties.
Association of Laryngopharyngeal Symptoms
Authors: Chirakkal Pramod
Published: February 2015

Objective

To determine the incidence of laryngopharyngeal symptoms and signs in gastroesophageal reflux disease and to assess the response of these symptoms and signs to antireflux therapy.

Method

Thirty patients were selected for this 2‐year prosepective randomized case control study based on the inclusion and exclusion criteria. A complete history, videolaryngoscopy, UGI endoscopy with biopsy, and 24‐hour pH monitoring were performed. Ten healthy volunteers without any laryngopharyngeal symptoms or symptoms of GERD were used as controls.

Results

In this 2‐year prospective study the incidence of laryngopharyngeal symptoms and signs with GERD and their response to antireflux therapy was established. Eighty‐seven percent of patients with laryngopharyngeal complaints had gastroesophageal reflux studied. Statistical analysis: Pearson chi‐square test was used for statistical analyses of the comparative studies. A P value of <.05 was considered significant.

Conclusion

In short gastroesophageal reflux disease is a common disease that impairs quality of life. Laryngopharyngeal symptoms are reliable predictors of GERD. With increased number of GERD symptoms one should be aware of the most common symptoms so as to institute early therapy.
Dysphagia Characteristics in Zenker’s Diverticulum
Authors: Bergeron Jennifer L. , Long Jennifer L. , Chhetri Dinesh K.
Published: February 2015

Objective

To evaluate the presenting signs and symptoms of dysphagia in patients with Zenker’s diverticulum (ZD).

Method

All patients surgically treated for ZD over a 6‐year period were identified. Charts were reviewed for dysphagia history and findings on fiberoptic endoscopic evaluation of swallowing (FEES). Dysphagia symptoms and swallowing abnormalities were compared across groups based upon diverticulum size (small <1 cm, medium 1‐3 cm, and large >3 cm).

Results

Forty‐one patients were identified. ZD size was available in 39 cases (6 small, 18 medium, 15 large). Regurgitation symptoms were less frequent in patients with small (17%) compared to medium (70%) or large diverticula (73%) (P <. 01). Similarly, esophagopharyngeal reflux (EPR) on FEES was less frequent in patients with small (17%) compared to medium (88%) and large diverticula (92%) (P <. 01). EPR was present in all patients presenting for revision surgery (N = 9). In all cases, EPR resolved after successful treatment. Eighteen percent of all patients had evidence of pharyngeal weakness on FEES which did not change significantly on initial postoperative exam.

Conclusion

Dysphagia with EPR is predictive of a ZD larger than 1 cm, and may be useful in preoperative planning. EPR is also helpful in identifying patients with recurrent or residual symptomatic ZD following surgical treatment. Pharyngeal weakness is present in a subset of ZD patients.
Injection Laryngoplasty: Impact on Swallowing and Aspiration
Authors: Willis Elena , Tan Melin , Palma Gina , Herschman Miriam
Published: February 2015

Objective

Vocal fold paralysis (VCP) and glottic insufficiency result in difficulties with dysphonia, dysphagia, and cough strength. This pilot study compares quality of life (QOL) and aspiration in patients with VCP before and after injection laryngoplasty (IL).

Methods

A prospective case series at an academic tertiary care hospital on 7 pilot patients (age 64‐85 years, mean 71 years) with VCP and symptoms of aspiration. All patients underwent modified barium swallow (MBS) or fiberoptic endoscopic evaluation of swallow (FEES). MBS and FEES studies were evaluated using Penetration‐Aspiration scale (PENASP). Additionally, patients completed 2 QOL questionnaires, the EAT‐10 and the Voice Handicap Index (VHI). All patients underwent IL with micronized dermis. Four underwent unilateral injection, 3 underwent bilateral injection. Repeat evaluation at 3 months with MBS or FEES was again scored with PENASP scale. Patients again completed the questionnaires.

Results

All 7 reported improvement in QOL on VHI (P =. 03). There was no difference in pre and post procedure EAT‐10 scores. Two of 7 patients showed decreased aspiration on thin liquid PENASP scores and 5 of 7 patients showed no change (P =. 19). There was no difference in pre and post PENASP scores with semi‐solids.

Conclusion

This study suggests that IL improves QOL for patients with VCP and that IL may improve aspiration with thin liquids. A prospective case series with a larger sample size is needed to further evaluate the effects of IL on aspiration and quality of life.
Murine Model of a Drug‐Eluding Stent on Subglottic Stenosis
Authors: Lee Jennifer Y. , Cohen Noam A. , Singhal Sunil , Leahy Kevin , Ghosh Ankona , Philiponis Genevieve , Mirza Natasha
Published: February 2015

Objective

The study investigates the effect of a localized, steroid‐eluding stent on laryngotracheal complex (LTC) granulation in the murine model. We hypothesize that steroid treated LTCs will have reduced granulation compared to non‐treated LTCs using 2 techniques.

Method

The established murine model of LTC stenosis was used to compare effects of local mometasone furoate on airway granulation tissue. Using H&E staining, the thickness of lamina propria between control and treatment LTCs were compared. Using real‐time PCR, the relative level of IL1 and TGF beta were compared.

Results

Using microscopy and H&E staining, the LTCs were found to have decreased amounts of granulation after treatment with mometasone furoate compared to untreated LTCs. Using RT‐PCR, the inflammatory marker IL‐1 was significantly decreased in LTCs treated with the mometasone furoate stent compared to untreated mice.

Conclusion

Localized drug eluding stent appears to decrease granulation and inflammatory markers within laryngotracheal complexes. Further investigation into the therapeutic benefit of local drug‐eluding stents in the airway is warranted.
New Approaches for Locally Advanced Nasopharyngeal Carcinoma
Authors: Pecorari Giancarlo , Raimondo Luca , Garzaro Massimiliano , Airoldi Mario , Riva Giuseppe , Cerutti Marta , Giordano Carlo
Published: February 2015

Objective

To evaluate 2 different schemes of neoadjuvant chemotherapy (NACT) followed by 2 different concomitant chemoradiotherapy (CHRT) schedules in loco‐regionally advanced nasopharyngeal carcinoma (A‐NPC) observed in a nonendemic population.

Method

Seventy homogeneous patients affected by A‐NPC were enrolled in this retrospective study. Forty patients (group A) underwent 3 cycles of NACT with cisplatin+epirubicin followed by cisplatin+70 Gy RT; and 30 patients (group B) received 3 cycles of NACT with carboplatin+taxol followed by weekly carboplatin+taxol for 7 weeks+concomitant 70Gy RT.

Results

After NACT, results in group A and B were: CRs 30% vs 33%, PRs 60% vs 60%, NC 10% vs 6.6%; after CHRT: CRs 75% vs 87%, PRs 25% vs 13%. After median follow‐up of 54 months (A) and 49 months (B), 3‐5 years progression‐free survival were 75% vs 80% and 65% vs 75%, respectively, and overall survival was 84% vs 85% and 77% vs 80%, respectively; 5 years locoregional control was 70% vs 90%, and 5 years distant metastases–free survival was 75% vs 85%. NACT toxicity was as follows: G3‐4 neutropenia 40% vs 83%, G3 thrombocytopenia 12% vs 13%, G3 anemia 0% vs 10% and G3 mucositis 2.5% vs 6.6%; CHRT toxicity was as follows: G3‐G4 neutropenia 20% vs 63%; G3 anemia 2.5% vs 17%, G3‐G4 mucositis 32.5% vs 69%; skin toxicity 25% vs 23% and G3 neurotoxicity 5% vs 10%.

Conclusion

NACT followed by CHRT represents a feasible, highly effective treatment for patients with A‐NPC, with excellent locoregional disease control and overall survival and with low incidence of distant metastases. Double drug CHRT in group B is characterized by higher incidence of acute toxicities without significant impact on major clinical outcomes.
Nonsurgical versus Surgical Management of Vocal Cord Nodules
Authors: Salari Behzad , Toutounchi Javad S. , Ghiasi Samad , Mobaraki Hajar Y. , Toutounchi Neghisa , Nezami Nariman
Published: February 2015

Objective

Vocal cord nodules are of the most common benign laryngeal pathologies that may cause dysphonia and hoarseness. This study aimed to assess the effectiveness of surgical versus nonsurgical interventions for vocal cord nodules.

Method

In a cohort study, 60 patients with vocal cord nodules were enrolled in 2 groups. The study was carried out from 2010‐2011 at Imam Reza Hospital of Tabriz. One group underwent surgical microscopic excision, and the other one was managed with medical and speech therapies. The results were evaluated 3 months later.

Results

The mean age of patients was 37.35 ± 9.22 years with male to female ratio of 36/24. In each group, 27% of patients were smokers. Sixty percent of patients in the surgical group had job‐related use of voice, compared to 72% in the nonsurgical group. In the surgical group, 63% of patients had bilateral nodules versus 76% in the nonsurgical group. In evaluating improvement of voice quality there was no statistically significant difference between the 2 groups regarding patient satisfaction and the surgeon’s evaluations (P =. 16 and P =. 07, respectively).

Conclusion

There was no definite difference between surgical and nonsurgical interventions of vocal cord nodules.
The Use of the Pulse Dye Laser: Treatment of Sulcus Vocalis
Authors: Choi Hong‐Shik , Chisang Hwang
Published: February 2015

Objective

Based on the similarity between the histopathology of sulcus vocalis and scar tissue, and numerous reports on pulse dye laser (PDL) regarding laryngeal lesions, especially the scar tissue, the authors evaluated the efficacy of treating sulcus vocalis with PDL and named this surgical procedure “PDL glottoplasty.”

Methods

This study was conducted on 25 patients diagnosed with sulcus vocalis on video‐stroboscopy at Gangnam Severance Hospital from August 2006 to February 2012. The delivery energy was fixed at 0.74J per pulse, and all procedures were performed under general anesthesia, exposing the larynx with suspension laryngoscope and observing the lesion with microscope. Aerodynamic, stroboscopic, and acoustic voice analyses were performed pre‐ and postoperatively, and electroglottographic analysis was conducted for voice analysis on sentence domain.

Results

The vocal folds generally showed alleviated vocal fold stiffness and mucosal wave, resulting in improved vocal fold vibration and dysphonia. And most PDL glottoplasty patients showed definite improvement in post‐treatment voice analysis indices. The differences between pre‐ and postoperative voice parameter were statistically significant.

Conclusion

PDL glottoplasty seems to be beneficial to the treatment of sulcus vocalis. Considering that the results of other various elaborate techniques have been disappointing and even induced secondary scar formation, resulting vocal fold stiffness, our study of PDL glottoplasty using the characteristic photoangiolysis of the sublesional microcirculation of the PDL offers favorable alternative to the treatment of sulcus vocalis.
Endoscopic Excision of Forehead Lipomas
Authors: Groom Kelly L. , Roofe Scott B.
Published: February 2015

Objective

Describe a method of endoscopic forehead lipomas that results in minimal visible scarring and good cosmetic results.

Method

We present a retrospective case series of 4 patients who presented with forehead lipomas from July 2009 to December 2011. Patients underwent endoscopic excision of the lipomas using pretrichial incisions and standard endoscopic brow instrumentation. Outcomes measured were cosmetic results, presence of a depressed scar, and postoperative complications.

Results

All patients had good cosmetic results with no depressed scars and no postoperative complications.

Conclusion

Endoscopic excision is an effective, minimally invasive, and cosmetically satisfying approach to forehead lipomas in the population who desires to avoid a visible scar.
Ultrasound Study of the Normal Upper Esophageal Sphincter
Authors: Moriniere Sylvain , Hammoudi Karim , Boiron Michele , Patat Frederic
Published: February 2015

Objective

The purpose of this study was to develop a methodology and standard settings for ultrasound study of the upper esophageal sphincter (UES) during swallowing.

Method

This was a prospective study of 25 healthy volunteers. Neck ultrasonography was performed as each volunteer swallowed 10 mL of water. The parameters studied were: diameter, anterior and lateral displacement of UES duration of UES, opening and UES displacement. Student’s t tests were applied for the statistical analysis.

Results

The mean diameter of the closed UES was 0.78 ± 0.13 cm, while the mean duration of opening was 415 ± 57.66 ms, and the mean duration of displacement was 937 ± 120.98 ms. Maximum anterior and lateral displacement of the UES was 0.42 ± 0.12 cm and 0.35 ± 0.18 cm, respectively. There was a significant difference between men and women for lateral displacement of the UES (P =. 04).

Conclusion

This study established standards for ultrasound study of the UES during swallowing, using a non‐invasive readily accessible method that may be useful for assessing swallowing disorders involving the UES (Zenker’s diverticulum, fibrosis, stricture).
A Study of Cholesteatoma and Mastoid Pneumatization
Authors: Iqbal Isma Z. , Watson Carl
Published: February 2015

Objective

1) To evaluate the relationship between cholesteatoma and the degree of mastoid pneumatization. 2) To assess the relationship between the location of cholesteatoma and mastoid pneumatization.

Method

A prospective analysis on all patients undergoing mastoid exploration for cholesteatoma during 1993‐2011 was performed. The degree of mastoid pneumatization and the site of cholesteatoma were recorded. All patients were operated on and graded by the same surgeon. Revision surgery and atticotomy, where pneumatization could not be assessed, were excluded.

Results

A total of 393 (222: male, 171: female) patients underwent surgery for cholesteatoma; 203 were left sided, and 190 were right sided. The mean age of the patients was 37 years (range 6‐79). Pneumatization of the mastoid was: sclerotic 23% (90), diploic 16.7% (66), and cellular 60.3% (237, P <. 001), respectively. Attico‐antral cholesteatoma was present in 88.9% sclerotic, 95.4% diploic, and 91.1% cellular mastoids. Middle ear (ie, sinus tympani, anterior tympanum, posterior tympanum, and Eustachian tube) cholesteatoma was present in 54.4% of sclerotic, 56% of diploic, and 51.9% of cellular mastoids.

Conclusion

In this study, cholesteatoma was most frequently found in relatively well‐pneumatized mastoids; this casts doubt on the theory that relatively poor mastoid pneumatization and the subsequent development of cholesteatoma may have a common etiology.
Anterior Cartilage Island Tympanoplasty: Functional Outcome
Authors: Saleh Essam A.
Published: February 2015

Objective

Describe a technique of anterior cartilage island tympanoplasty and report outcome and hearing results using this technique in type I tympanoplasty.

Method

Retrospective chart review at a tertiary referral center. One hundred thirty‐one patients who underwent type I tympanoplasty were evaluated. A semilunar conchal cartilage island was placed under the anterior annulus, and an underlay temporalis fascia graft was placed over the cartilage. Hearing results were assessed by comparing the preoperative and postoperative air‐bone gaps.

Results

The fascia was either placed medial to the handle of the malleus (group I) or lateral to the handle after separating it from the drum (group II). Graft take was successful in 95.4% of cases with no statistical difference between both groups (95.8% in group I and 94.4% in group II). Air‐bone gap improved significantly in both groups compared to the preoperative one (P <. 001). The postop air‐bone gap was 5.2 dB and 7.1 dB for groups I and II, respectively. Ninety percent of cases had an air‐bone gap of 10 dB or less.

Conclusion

Anterior cartilage island tympanoplasty is an effective technique that yielded good anatomic and functional results.
Bax siRNA Protects against TNFα‐Induced Hair Cell Loss
Authors: Dinh Christine T. , Bas Esperanza , Gupta Chhavi , Dinh John N. , Vu Ly , Van De Water Thomas R.
Published: February 2015

Objective

1) Understand the role of Bain tumor necrosis factor alpha (TNFα)‐induced auditory hair cell (HC) death in rat organ of Corti (OC) explants in vitro 2. Determine the effectiveness of short interfering RNA that targets Bax mRNA (Bax siRNA) against TNFα‐induced HC loss.

Method

OC explants dissected from 3‐day‐old rats were cultured in control media, TNFα, TNFα+BasiRNA, or Bax siRNA for 0, 48, and 96 hours in vitro. Real‐time PCR, ELISA, HC viability studies, immunofluorescence, and confocal microscopy were performed. ANOVA with post hoc testing was used with P value set <.05.

Results

Explants exposed to TNFα‐only demonstrated significant declines in the number of viable HCs while displaying increased Bax mRNA and protein expression, when compared to control explants. In contrast, the levels of viable HCs, Bax mRNA, and protein expression in explants treated with TNFα+Bax siRNA or Bax siRNA alone approached levels similar to OC explants cultured in control media. Immunolocalization studies demonstrated increased expression of Bax protein in the auditory HCs of the basal turn in TNFα‐only treated explants, while OC explants cultured in control media, TNFα+Bax siRNA, or Bax siRNA alone did not display noticeable Bax expression.

Conclusion

TNFα initiates the programmed cell death of auditory HCs in vitro through up regulation of pro‐apoptotic Bax gene and protein expression. Bax siRNA blocks TNFα‐induced apoptosis of HCs as demonstrated by decreased Bax mRNA and protein expression, which results in increased numbers of viable HCs in the treated OC explants.
Facelift Approach for Parotidectomy
Authors: Grover Nancy , D’Souza Alwyn
Published: February 2015

Objective

1) To critically evaluate the literature on the use of facelift approach (MFI) for parotidectomy, where available, in direct comparison to the traditional cervicofacial approach (CFI). 2) To provide objective evidence for its use.

Method

Retrospective review of literature up to 2011,The terms parotidectomy, parotid, face lift, and aesthetic were used to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were cross‐checked to include relevant studies. Only English language literature with human subjects was searched.

Results

We identified 19 relevant studies. A total of 416 patients undergoing parotidectomy via MFI have been described. Most were performed for benign lesions, and superficial/partial parotidectomy were the most commonly performed procedures. Exposure of facial nerve was adequate. Complication rates are not increased with MFI. Outcomes in terms of postoperative scarring are good as reported by patients. Major limitations were: anterior exposure, though a recent study has reported 49 cases of anterosuperior tumors successfully resected with MFI; use in obese patients; ptotic and voluminous parotid masses; and restraint by fresh trainees.

Conclusion

Objective evidence certainly justifies using the facelift approach for well‐selected cases, which has been increasingly reported in literature in the last decade with expanding indications. In our opinion the limitations described are surmountable. PROMs have shown high satisfaction rates with this approach.
Bilateral Bone‐Anchored Hearing Aids: A Systematic Review
Authors: Janssen Renee M. , Hong Paul , Chadha Neil K.
Published: February 2015

Objective

To systematically review the outcomes of bilateral versus unilateral bone‐anchored hearing aids (BAHA) for individuals with bilateral permanent conductive hearing loss (CHL) with the goal of 1) deriving clinically oriented insights into the advantages and disadvantages of bilateral fitting; and 2) identifying gaps in knowledge to stimulate future research.

Method

Medline, EMBASE, and Cochrane databases were searched for studies of all languages published between 1977 and July 2011. Studies were included if subjects of any age had permanent bilateral CHL and bilateral implanted BAHAs. Outcome measures of interest included audiologic evaluation, quality of life indicators, and reports of adverse events.

Results

A total of 628 abstracts were generated from the literature searches; 11 studies met the criteria for data extraction and analysis. All 11 studies were observational. In most studies, comparisons between unilateral and bilateral BAHA were intra‐subject. Bilateral BAHA provided additional audiologic benefit compared to unilateral BAHA (improved thresholds for tones [2 studies], speech in quiet [5 studies] and in noise [3 studies], and improved localization [3 studies]), and patients perceived additional subjective benefit from bilateral BAHA [3 studies]. Disadvantages of bilateral BAHA included listening in noise in some conditions [3 studies], additional cost, and presumed increase in adverse event risk.

Conclusion

Bilateral BAHA provided additional objective and subjective benefit compared to unilateral BAHA; however, there was a limited number of studies available with good quality evidence. Aspects of bilateral BAHA that would benefit from further investigation are described, and recommendations for bilateral BAHA candidacy criteria are provided.
Bimodal Hearing on Music and Speech with FSP and HDCIS
Authors: Atwood Keenan , Runge Christina , Friedland David R.
Published: February 2015

Objective

1) Evaluate the effects of bimodal listening on performance for music and speech tasks when the implanted ear uses either fine structure processing (FSP) or high‐definition continuous interleaved sampling (HDCIS) strategies. 2) Understand whether the everyday listening condition of subjects affected their performance on these tasks.

Method

A double‐blinded prospective study was performed on 10 adult subjects experienced with a cochlear implant (CI) and contralateral hearing aid (HA). Subjects were tested using FSP and HDCIS in bimodal and CI alone conditions. Musical instrument identification (timbre) and vowel recognition were tested. Outcomes were scored as percent correct.

Results

With a CI alone, subjects scored higher using FSP than HDCIS on timbre (51.5% to 46.5%). The effect was opposite on vowel recognition (41.2% to 46.3%). However, when bimodal, FSP had a lower performance on timbre (52.6% to 55.1%) but higher on vowel recognition (72.7% to 70.8%). The bimodal condition provided larger benefit in timbre for HDCIS than FSP (8.6% to 1.1%). Further, the improvement in the bimodal condition was significantly higher for vowel tests than for timbre regardless of strategy. Subjects with FSP as their regular strategy outperformed subjects with HDCIS in every condition for both tests.

Conclusion

The FSP processor may provide more information to users than HDCS, producing the better performance from FSP without an HA and the greater benefit for HDCIS with an HA. Using FSP regularly may improve central processing plasticity for users improving their performance with any processor.
Case‐Specific Simulation in Temporal Bone Surgery
Authors: Arora Asit , Swords Chloe , Khemani Sameer , Darzi Ara , Singh Arvind , Tolley Neil S.
Published: February 2015

Objective

1) To investigate the feasibility of performing case specific surgical rehearsal (CSSR) using a virtual reality (VR) temporal bone simulator. 2) To identify potential clinical applications in temporal bone surgery.

Method

Preclinical study conducted in a London teaching hospital. Twenty‐four cadaver temporal bones were CT scanned and uploaded onto the Voxelman simulator. Sixteen participants (trainer and trainee group) performed 3 dissection tasks on VR and cadaver models. CSSR was assessed for feasibility and clinical applications using a 5‐point Likert scale.

Results

The upload process required a semi‐automated system. The average time for each upload was 15 minutes. Suboptimal reconstruction occurred (n = 4) when the mastoid process and ossicular chain were not captured. CSSR rated highly among both groups (Likert score >4) for surgical anatomy (75%), facilitating surgical planning (75%), and training (94%). Both groups reported suboptimal realism compared to cadaver models due to poor depth perception. The most relevant clinical procedures for CSSR were ossicular chain surgery, pediatric cochlear implantation, and congenital anomalies. CSSR involving the facial nerve and cholesteatoma surgery were not feasible due to suboptimal soft tissue VR representation.

Conclusion

The process of uploading CT data onto a temporal bone simulator to perform CSSR is feasible using a semi‐automated system. It represents a promising application for selected clinical procedures. Further clinical evaluation is warranted to assess the potential benefit.
Cerebellar Infarctions Mimicking Acute Peripheral Vertigo
Authors: Casani Augusto P. , Dallan Iacopo , Cerchiai Niccolò , Lenzi Riccardo , Franceschini Stefano Sellari
Published: February 2015

Objective

1) To determine the true incidence of cases of missed cerebellar stroke mimicking acute peripheral vertigo (APV), the so‐called pseudo‐APV without additional symptoms. 2) To identify the clinical indicators useful for differentiating APV from cerebellar infarction presenting isolated vertigo.

Method

We conducted a retrospective chart review of cases of missed cerebellar infarction over the past 3 years. All patients had first undergone a neurological evaluation and CT scan of the brain in the emergency unit, before performing a complete bedside examination in the Dizziness Unit of our tertiary referral center.

Results

We identified 11 patients with cerebellar infarction mimicking APV (2.8% of all the cases presenting to the dizziness unit complaining of acute vertigo). Spontaneous horizontal nystagmus (of central type in 2 cases) was recorded in all patients. Head Impulse Test (HIT) was negative in 10 cases. MRI showed 9 cases of infarction in the posterior‐inferior cerebellar artery territory; in 2 patients an involvement of the anterior‐inferior cerebellar artery territory was recorded. The duration of vertigo lasted more than 72 hours in 8 patients. In 4 patients acute vertigo was followed by delayed neurological signs 2‐3 days after the onset.

Conclusion

Pseudo‐APV is not an uncommon diagnosis in otoneurological practice. HIT, a careful evaluation of spontaneous nystagmus, persistence of vertigo, and imbalance more than 72 hours from the onset are useful clinical indicators for recognizing a cerebellar ischemic origin in cases of acute vertigo, especially in patients with vascular risk factors.
Clinical Features of Unilateral Cochlear Nerve Deficiency
Authors: Clemmens Clarice S. , Germiller John A. , Cohn Samuel
Published: February 2015

Objective

Cochlear nerve deficiency (CND) is increasingly recognized as a cause of sensorineural hearing loss. Our objectives were to 1) describe the clinical and genetic features of children with unilateral CND, 2) understand the relationships to other features on imaging, and 3) determine if either the IAC or bony cochlear nerve canal (BCNC) could predict CND.

Method

Clinical and genetic data were reviewed in 66 children with unilateral CND, defined either by our MRI criteria or by atresia of the BCNC. Temporal bone imaging was reviewed for any additional anomalies. BCNC and IAC diameters were compared with CN size by regression analysis.

Results

In most patients, the cochlear division was the only branch involved (72%). Associated labyrinthine anomalies were uncommon (21%). Most children (71%) were non‐ syndromic. Of the 9 with syndromes, 2 each had 22q11.2 deletion, Down syndrome, and VACTERL, and 1 had a mild form of CHARGE syndrome. BCNC width correlated significantly with CN size (r2 0.50, P <. 0001). Though only 61% sensitive for CND, it was 100% specific. Size of the IAC was highly variable and showed no relationship to CN size.

Conclusion

Most cases of unilateral CND appear sporadic and non‐syndromic, with no other anomalies of the temporal bone. Nevertheless, it can occur as part of certain syndromes. CT is only useful in diagnosis if it shows a stenotic cochlear aperture, which strongly predicts CND. However, CT alone will miss the diagnosis in 39% of cases.
Cochlear Implants vs Hearing Aids in Auditory Neuropathy
Authors: Pelosi Stanley , Wanna George B. , Watkins Linsey , Hayes Cathrine , Bennett Marc L. , Haynes David S. , Rivas Alejandro
Published: February 2015

Objective

Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. Cochlear implantation (CI) is thought to improve neural synchrony in response to auditory stimuli and improve speech perception relative to conventional hearing amplification (HA).

Method

Retrospective review was performed of 40 patients with ANSD treated at Vanderbilt University in 1999‐2011. Twenty‐two patients underwent CI, 11 received HA only, and 7 were observed. Pretreatment performance was assessed through parent questionnaire (IT‐MAIS) and speech/language evaluation. Posttreatment outcomes were assessed using IT‐MAIS and closed/open‐set speech perception scores.

Results

Average follow‐up for all patients was 36 months (range 0‐90). Two of 7 observed patients exhibited neuromaturation over time. Median available pretreatment IT‐MAIS scores were 13 and 34 for CI and HA groups, respectively (difference NS, rank sum test, P =. 06). All CI patients had a prior HA trial with failure of auditory skills development. Posttreatment, 15/20 CI patients and 5/11 HA patients with available data achieved closed/open‐set speech perception scores ≥60%. No differences between groups were found in post‐treatment IT‐MAIS scores (rank sum test, P =. 69) or the percentage of patients achieving the above levels of closed/open‐set speech perception (Fisher’s exact test, P =. 13).

Conclusion

In our ANSD population, patients undergoing CI achieved at least comparable and possibly improved overall speech perception outcomes relative to HAs despite a greater initial level of auditory impairment as assessed by parent questionnaire. These findings further validate use of CIs in ANSD patients with failure of auditory skills development.
Comparison of Packing Material in Middle Ear Mucosal Trauma
Authors: Hachem Ralph Abi , Perez Enrique , Bueno Isabel , Van De Water Thomas R. , Angeli Simon I.
Published: February 2015

Objective

To compare absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma.

Method

Controlled animal experiment. Thirty‐six guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS. Contralateral ears were used as nonpacked paired controls. Auditory brainstem response (ABR) thresholds were measured preoperatively and repeated at 1, 2, and 6 weeks postoperatively. Histological analysis was done by a pathologist blinded to the type of packing using hematoxylin and eosin staining to measure inflammatory reaction and trichome staining to measure fibrosis in each group.

Results

ABR recordings demonstrates that threshold level changes from baseline were minor in the PUF and the control groups. Threshold levels were higher in the AGS group compared with both control groups and the PUF group for the 1 KHz and 0.5 KHz frequencies. Macoscopic analysis showed no tympanic membrane perforation and packing material was absorbed in all groups at 6 weeks postoperatiely. The histological analysis showed normal mucosal healing in the PUF and control groups. There was more packing retention, inflammation, and osteoneogenesis in the AGS group than the PUF or either control group.

Conclusion

Following surgical trauma, the middle ear mucosa healed well without packing or with PUF packing material, and hearing was not affected. In contrast AGS packing material showed hearing loss at low frequencies and osteogenesis.
Complications after Cochlear Implantation in Older Adults
Authors: Clarrett Danisa M. , Li Lingsheng , Lin Frank R.
Published: February 2015

Objective

1) Analyze the postoperative complications associated with cochlear implantation (CI) surgery in older adults. 2) Understand how the safety profile of CI in older adults compares with that in children and younger adults.

Methods

We conducted a retrospective chart review of all individuals aged 60 years or older who underwent a first CI from 1999‐2011 at Johns Hopkins to abstract data on postoperative follow‐up and complications. Statistical analyses comparing observed complication frequencies were performed using goodness‐of‐fit Fisher exact tests.

Results

From 1999‐2011, 445 individuals 60 years or older received a first cochlear implant at Johns Hopkins. The mean age at implantation was 72.7 years (range 60‐94.9 years) and the median duration of follow‐up was 4.8 years (range 0.1‐12.5 years). There were a total of 42 minor complications in 41 patients (9.2%) and 36 major complications in 21 patients (4.7%). There were no cases of meningitis or postoperative facial paralysis. Seventeen patients (3.8%) required surgical device removal. Complication rates did not differ between individuals 60‐75 years and those 75 years or older except for balance problems which were slightly more prevalent in the older cohort (9.5% vs 4.9%, P =. 05).

Conclusion

Our results demonstrate that CI in older adults has a safety profile comparable to CI in younger adults and children. We suggest that concerns for increased postoperative complications in patients of advanced age should not be considered when determining CI candidacy.
Facial Functioning following Split XI‐VII Anastomosis
Authors: Sappington Joshua M. , Leonetti John P. , Marzo Sam J.
Published: February 2015

Objective

1) Assess facial function in patients who underwent a split XII‐VII nerve anastomosis for facial reanimation. 2) Review our series of 4 patients. 3) Present a facial recovery grading system for patients who undergo a combination of static and mimetic procedures for facial reanimation.

Method

Patients were included with facial paralysis who were treated with XII‐VII anastomosis at our institution between March of 2008 and December of 2011. Each patient’s facial function was evaluated using a new facial recovery grading scale that takes into account any method of static or mimetic facial reanimation techniques.

Results

All 4 patients had complete facial paralysis prior to performing a split XII‐VII anastomosis. All of the patients demonstrated gains in facial functioning without compromising their oral competence. This proposed facial recovery grading scale provides a means by which clinicians can follow gains in facial function in patients who lack an anatomically intact facial nerve.

Conclusion

The split XII‐VII nerve graft is a dynamic procedure that can assist in reanimating patients with facial nerve paralysis in whom the proximal facial nerve is not available. Patients in this group experienced minimal morbidity, maintained their oral competence, and demonstrated significant improvement in eye closure and midface animation.
Complications and Clinical Analysis of Cochlear Implatations
Authors: Qiu Jianhua
Published: February 2015

Objective

To investigate complications of cochlear implantation for prevention and therapy.

Method

Retrospective study at a tertiary referral center. The patients (n = 673) who received cochlear implants in our department between 2000 and 2011 were followed up (range, 6 months to 10 years). All complications were systematically reviewed, and their causes were analyzed for prevention and therapy.

Results

There were a total of 33 complications (4.9%). The minor were 26 cases (3.9%), including postoperative subcutaneous hematoma in 14 cases, acute otitis media in 2 cases, postoperative wound infection in 2 cases, delayed facial paralysis in 1 case, clonic facial spasm in 1 case, and severe dizziness in 6 cases. The major were 7 cases (1.1%), including cerebrospinal fluid leakage in 2 cases, implant‐related infection and extrusion in 2 cases, tympanic membrane perforation induced electrode exposed in 1 case, implantation failure due to cochlear ossification in 1 case, and magnet displacement in 1 case.

Conclusion

Cochlear implantation is a safe and reliable operation, but it is still a serious problem to lower the incidence of complications.
Dizziness and Sleep Disorders
Authors: Duarte Juliana A. , Ganança Fernando F. , Chen Vitor G. , Bongiovanni Giuliano , Azevedo Lia R. , Gregorio Luis C.
Published: February 2015

Objective

Assess the prevalence of the risk of sleep disorders in patients with dizziness and vestibular symptoms in patients with sleep disorders.

Method

Perfoming a cross‐sectional study that included adult patients treated at the first consultation at the clinic of the Discipline of Otology and Neurotology (group 1) and Sleep Apnea ambulatory in the Department of Sleep Medicine (group 2) from UNIFESP and applying questionnaires about vestibular complaints and validated questionnaires on the risk of sleep disturbances.

Results

Group 1 consisted of 24 patients, being 83.3% female, with mean age of 47.08 years. In assessing the risk for sleep disorders, 54.2% were at high risk according to the Berlin scale, 66.7% were at risk by the Pittsburgh scale, and 41.7% were at risk by the Epworth Sleepiness Scale. The second group was represented by 18 patients, being 77.8% male, with a mean age of 49.67 years. As for the vestibular symptoms, 44.4% reported dizziness, being vertigo in 22.2% of the cases and 22.2% with worsening at head movement.

Conclusion

There is a high prevalence of the risk of sleep disorders in patients with dizziness and vestibular symptoms in patients with sleep disorders.
Electrical Stimulation Reduces Apoptotic Signaling in SGNs
Authors: Kopelovich Jonathan C. , Cagaanan Alain P. , Miller Charles A. , Abbas Paul J. , Green Steven H.
Published: February 2015

Objective

To establish the intracellular consequences of electrical stimulation (ES) to spiral ganglion neurons (SGNs) after deafferentation. SGNs die as a result of loss of hair cells, their sole afferent input. Some histologic animal studies of chronic ES after deafening show that ES alone may improve SGN survival. Here we use a rat model to determine the effect of both low and high pulse rate ES on activation of the pro‐apoptotic transcription factor Jun in deafferented SGNs in vivo.

Methods

A single electrode was implanted through the round window of kanamycin‐deafened rats at either postnatal day 32 (P32) or P60 for 4 hours of ES (monopolar, biphasic pulses, amplitude twice eABR threshold) at either 100 or 5000 Hz. Jun phosphorylation, a proapoptotic signaling event known to occur in apoptotic SGNs after deafening, was assayed by immunofluorescence to quantitatively assess the effect of ES on proapoptotic signaling.

Results

Jun phosphorylation was reliably suppressed by 100 Hz ES in deafened cochleae of P32 rats (P =. 045) but this effect was less robust when 5000 Hz ES was used. This effect was most significant in the cochlear turn just apical to the stimulating electrode and was not significant in P60 rats.

Conclusion

Suppression of phospho‐Jun occurs in deafferented SGNs after only 4 hours of ES, consistent with the hypothesis that ES provides trophic support to SGNs after deafferentation. Stimulation frequency may be consequential: 100 Hz ES was significantly more effective than 5000 Hz ES in suppressing phospho‐Jun.
Facial Nerve Findings in 210 Consecutive Atresia Repairs
Authors: Goldsztein Hernan , Roberson Joseph B.
Published: February 2015

Objective

Describe intraoperative facial nerve findings in 210 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high‐risk facial nerve anatomy.

Method

Retrospective review of 210 consecutive atresia cases treated between 2007 and 2011 at a subspecialty private practice. Descriptive analysis of intraoperative findings.

Results

Two hundred and ten consecutive patients (ages 2‐47) underwent atresia repair between 2007‐2011. Preoperative Jahrsdoerfer Scale was 9 (26%), 8 (47%), 7 (21%), 6 (3%), and 5 or less (4%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial‐stapes contact was found in 11% of cases. A single patient had a transient postoperative mild paresis (House‐Brackmann 2) as a consequence of surgery.

Conclusion

Atresia repair remains one of the most challenging procedures in otology. Despite modern preoperative imaging, the facial nerve remains at risk given the variable development of the first and second branchial arches. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.