bluuebunny/crossref_metadata_2025 huggingface dataset:
Results Using 3M/Vienna Extracochlear Implant in Five Patients
Authors: Rose D. E. , Facer G. W. , King A. M. , Fabry D. A.
Published: January 2017

Five patients have been implanted using the 3M/Vienna extracochlear implant. A standard battery of tests have been conducted both preoperatively and postoperatively. Pure tone audiograms, hearing aid evaluation, as well as promontory threshold and dynamic range stimulation were conducted to evaluate implant candidacy and to determine whether a particular patient met the criteria for inclusion in this study. Speech reading tests were also conducted before implantation. Postimplantation testing consisted of thresholds and tolerance levels for pure tones and speechreading with and without acoustic stimulation. Scores on the environmental sounds, speech discrimination, and word discrimination tests were conducted. Minimal Auditory Capability I, II, V, VI, VII, and XII scores were determined over several time intervals. The results across patients varied tremendously. All five patients are presently wearing their units. The presentation will cover the advantages and disadvantages that we have encountered with this particular unit.
Extracochlear Eight- and 16-Channel Cochlear Implants with Percutaneous and Transcutaneous Transmission: Experiences with 129 Patients
Authors: Banfai P. , Karczag A. , Kubik S. , Lüers P. , Sürth W. , Banfai S.
Published: January 2017

The Cologne-Düren research group has developed a multichannel extracochlear method of implantation and has carried out 129 operations as of June 1985. To simulate the basic physiologic principles of the inner ear, we also used the place and periodicity principle. Experience so far has shown that the electrical stimulus pattern is perceived as an auditory sensation by the bony wall of the middle ear, and that even a certain selectivity can be achieved. All 129 patients have attained acoustic contact with the environment. They can largely differentiate environmental noises and distinguish human voices from each other. Their lipreading is substantially improved with the support of the speech processor. Moreover, pronunciation becomes very much more distinct in the congenitally deaf. Apart from these average results, signs of development of open speech were observed in 11% of the patients.
Progress in Development and Application of the University of California at San Francisco/Storz Multichannel Cochlear Implant
Authors: Merzenich M. M. , Kessler D. K. , Rebscher S. J. , Schindler R. A.
Published: January 2017

A four-channel bipolar cochlear implant developed at the University of California at San Francisco through a long series of animal experiments, engineering development studies, and speech processor design-optimization studies with experimental prosthetic devices in patients, is now being applied in a clinical investigation, as a joint project of the UCSF group and the manufacturer, Storz Medical Instruments.
Evaluation of a Two-Formant Speech-Processing Strategy for a Multichannel Cochlear Prosthesis
Authors: Dowell R. C. , Seligman P. M. , Blamey P. J. , Clark G. M.
Published: January 2017

Initial results with the two-formant speech-processing strategy (F0F1F2) confirm the advantage of a multichannel cochlear prosthesis capable of stimulating at different sites within the cochlea. The successful presentation of two spectra] components by varying the place of stimulation leads to the possibility of presenting further spectral information in this manner. Because virtually all multichannel implant patients demonstrate good “place” (electrode site) discrimination, these more refined coding strategies should lead to benefits for the majority of implantees. Already, with the F0F1F2 strategy, we have a system that appears to provide some effective auditory-alone communication ability for the average patient.
Strategies for Optimizing the Single-Channel Cochlear Implant: Preliminary Data
Authors: Cudahy E. , Beck D. , Danhauer J. , Danley M. , Mobley P. , Pratarelli M.
Published: January 2017

Perception of consonants for the House 3M single-channel cochlear implant using a two-channel signal processing model was investigated. The input signal was split into a low frequency band and a high frequency band with the cutoff frequencies of the bands adjusted in nine conditions. The conditions ranged from overlapping bands that yielded a flat spectrum to bands that removed a considerable portion of the midrange frequencies. The stimuli for this study were 60-item vowel-consonant-vowel lists with male and female talkers that were presented through direct electrical connection to the implant wearer. The stimuli were recorded on tape in quiet and noise backgrounds to measure interactions among speaker gender, background, and filtering scheme. The four patients in this study were experienced implant wearers. The results were analyzed both in terms of percent correct consonant and in terms of percent correct consonant category. Three of the filter conditions show better performance than the patient's own processor. Interestingly, the best conditions have large portions of the midfrequency regions attenuated.
Cochlear Implants in Children
Authors: Luxford W. M. , Berliner K. I. , Eisenberg L. S. , House W. F.
Published: January 2017

The House 3M cochlear implant system is currently undergoing clinical trials in profoundly deaf children aged 2 through 18 years. Although the use of the implant in children continues to be controversial, the evidence to date indicates that this prosthesis can provide significant benefit for a selected population of profoundly deaf children. As of August 1985, a total of 189 children have received the cochlear implant. The majority of these children were deafened by bacterial meningitis. The children as a group show significant improvement of hearing performance and speech production abilities over time. Children implanted at a younger age (under 5 years) show an even more significant improvement in speech skills. Significantly improved speech production occurs in both the oral/aural children (most cases postlingually deaf) and the total communication children (most cases prelingually deaf). Psychological tests have shown improved performance on intelligence measures, perceptual motor tests, and academic achievement ratings. Surgical and postoperative complications have been minimal, with few measurable adverse effects.
Vowel and Consonant Confusions among Cochlear Implant Patients: Do Different Implants Make a Difference?
Authors: Tyler R. S. , Tye-Murray N. , Preece J. P. , Gantz B. J. , McCabe B. F.
Published: January 2017

Vowel and consonant confusions were obtained from two patients, one using the Melbourne implant (M3) and one the Utah device (U1). The confusion matrices were analyzed using information transfer analysis and multidimensional scaling. The results from the two patients were generally consistent with the different processing strategies of their implants. For the vowels, M3 appeared to be processing second formant (F2) and duration, whereas U1 appeared to be attending primarily to first formant (F1) and duration. For the consonants, the responses of M3 reflected sensitivity to frication, voicing, and envelope, whereas the results from U1 suggested sensitivity to voicing, nasal, frication, and possibly “place” information.
Evaluation of four Cochlear Implant Designs
Authors: Gantz B. J. , McCabe B. F. , Tyler R. S. , Preece J. P.
Published: January 2017

Multichannel cochlear implant systems that provide spectral information in addition to temporal and intensity cues are consistently allowing profoundly deafened postlingual adults to recognize some words without visual cues. All four of the devices enhance speech-reading ability and provide useful information about nonspeech sounds. The multichannel implant patients are generally functioning at a higher level in this limited random series.
Single-Channel and Multichannel Performance for Reimplanted Cochlear Prosthesis Patient
Authors: Lindeman R. C. , Mangham C. A. , Kuprenas S. V.
Published: January 2017

We compared House single-channel and Nucleus multichannel cochlear prosthesis performance in the same individual. The Minimal Auditory Capabilities (MAC) battery was used to assess performance. In most instances, the reimplanted Nucleus device was equivalent to or outperformed the original House prosthesis, and compared favorably with reported data from a group of multichannel users. Results from this case tend to support the feasibility of explanting a House device and reimplanting a Nucleus prosthesis without a measurable decrement in performance.
Microbiology of Chronic Suppurative Otitis Media in Children
Authors: Kenna Margaret A.
Published: January 2017

The aerobic microorganisms present in 57 MEs of 40 children with C Supp OM without cholesteatoma were evaluated. Specimens were taken directly from the ME through a patent perforation or tympanostomy tube and cultured using standard techniques. Twenty-six organisms were identified, with Pseudomonas aeruginosa being the most prevalent (65% of ears) and the only organism in 30% of ears. The initial treatment of all patients was intravenous administration of an antimicrobial selected on the basis of culture and susceptibility reports. This treatment was successful in all but four children, who subsequently required tympanomastoid surgery. These results indicate that the microbiology of C Supp OM is similar to that in patients with cholesteatoma. However, based on the results of culture and susceptibility studies, medical therapy provides a viable alternative to major mastoid surgery in the management of C Supp OM without cholesteatoma.
Animal Models of Osteomyelitis
Authors: Norden Carl W.
Published: January 2017

Clinical studies of osteomyelitis are difficult because of the multiple variables found in this disease. Reproducible animal models in rabbits, rats, and dogs have been introduced and have been useful. Each animal model has certain advantages and limitations, and the ideal model is not yet available. However, the models have provided us with a clearer understanding of the disease and its treatment. Clinical research into osteomyelitis is difficult because of the multiple variables involved in the disease process and because of the difficulty of standardizing treatment protocols. To perform controlled experiments in the field of osteomyelitis, it is clear that reliable animal models are needed. Most studies have been performed with S aureus (the major pathogen isolated from patients with osteomyelitis), but other organisms have also been tested more recently.
Multichannel Cochlear Implants in Partially Ossified Cochleas
Authors: Balkany Thomas , Gantz Bruce , Nadol Joseph B.
Published: January 2017

Deposition of bone within the fluid spaces of the cochlea is encountered commonly in cochlear implant candidates and previously has been considered a relative contraindication to the use of multichannel intracochlear electrodes. This contraindication has been based on possible mechanical difficulty with electrode insertion as well as uncertainty about the potential benefit of the multichannel device in the patient. Fifteen profoundly deaf patients with partial ossification of the basal turn of the cochlea received implants with long intracochlear electrodes (11, Nucleus; 1, University of California at San Francisco/Storz; and 3, Symbion/Inneraid). In 11 cases, ossification had been predicted preoperatively by computed tomographic scan. Electrodes were completely inserted in 14 patients, and partial insertion was accomplished in one patient. All patients currently are using their devices and nine of 12 postlingually deaf patients have achieved some degree of open-set speech discrimination. This series demonstrates that in experienced hands, insertion of long multichannel electrodes into partially ossified cochleas is possible and that results are similar to those achieved in patients who have nonossified cochleas.
Incidence of Bell's Palsy
Authors: Yanagihara Naoaki
Published: January 2017

The annual incidence of Bell's palsy in three consecutive years — 1984, 1985, and 1986 — was investigated in Ehime Prefecture in Japan, which has a population of 1,530,000. The number of new patients with Bell's palsy was solicited from 1,377 medical institutions and their referral hospitals. The clinical records of the 15 main hospitals were examined personally by the author to confirm the exact numbers. Special care was taken to ensure minimal error in the present epidemiologic investigation. The annual incidence of Bell's palsy per 100,000 population was found to be 30, and no annual variation was noted. The ratio of male to female patients was 48:52 in all cases. There was no geographic difference in incidence.
Association of Diabetes Mellitus and Hypertension with Bell's Palsy and Ramsay Hunt Syndrome
Authors: Yanagihara Naoaki , Hyodo Masamitsu
Published: January 2017

This study included 625 patients with Bell's palsy and 124 patients with Ramsay Hunt syndrome. Seven percent of the cases of Bell's palsy and 1.6% of the cases of Ramsay Hunt syndrome were associated with diabetes mellitus, while 14.1% of the cases of Bell's palsy and 10.4% of the cases of Ramsay Hunt syndrome were associated with hypertension. In the patients over 40 years of age, rates of association with diabetes and hypertension were 11.2% and 23.0% in Bell's palsy and 1.3% and 10.4% in Ramsay Hunt syndrome, respectively. The rates of diabetes and hypertension in association with Bell's palsy were significantly high compared with those of the general population.
Facial Nerve Biopsy for Etiologic Clarification of Bell's Palsy
Authors: Matsumoto Yasushi , Patterson Michael J. , Pulec Jack L. , Yanagihara Naoaki
Published: January 2017

Electron microscopic findings of biopsy specimens of the infratemporal facial nerve from four selected patients with Bell's palsy are described, and the results of clinical examinations and surgical findings are presented. In all specimens, wallerian degeneration of various degrees was demonstrated. In one specimen, extravascular erythrocytes, and in another, lymphatic infiltrations were noted. On the basis of the present investigation and reported temporal bone histopathologic evidence, the causes of Bell's palsy are concluded to be multiple and to be vascular, inflammatory, or degenerative.
Historical Perspectives and Concepts in Otitis Media Research at the University of Minnesota
Authors: Paparella Michael M. , Giebink G. Scott
Published: January 2017

The University of Minnesota Otitis Media Research Center, formed in 1978, comprises a multidisciplinary research team in the clinical fields of otolaryngology, pediatrics, audiology, and infectious disease as well as the basic science fields of histopathology, epidemiology, microbiology, immunology, biostatistics, pharmacology, physiology, and biochemistry. The team has focused on studies designed to elucidate the pathophysiology of the otitis media continuum, and considerable progress has been made in describing this continuum by using the basic science approaches available in the Center. The collaboration of basic and clinical scientists has created a synergy of goals, ideas, and methods leading to new hypotheses and progress, ultimately resulting in improved patient care methods.
Morphometric Studies of the Continuum of Otitis Media
Authors: Yoon Tae H. , Schachern Patricia A. , Paparella Michael M. , Lindgren Bruce R.
Published: January 2017

Morphometric changes in the epithelium and subepithelium of the middle ear mucosa from children younger than 10 years of age were measured at the promontory in 85 temporal bones with otitis media and in 29 normal temporal bones by use of quantitative and semiquantitative methods. Comparisons of morphologic analysis in different otitis media types showed that acute inflammatory changes were usually seen in purulent otitis media with effusion and serous otitis media with effusion, and chronic inflammatory changes were more severe in mucoid otitis media with effusion and chronic otitis media. There were overlaps, however, in histopathologic findings between different types of otitis media that suggest a continuum of otitis media types, with one type of otitis media changing into another type.
Effect of Prostaglandin, Leukotriene, and Arachidonic Acid on Experimental Otitis Media with Effusion in Chinchillas
Authors: Park Young Min , Miller Stanley , Jung Timothy T. K. , Schlund Daniel , Wong ON , Weeks Douglas , Juhn Steven K.
Published: January 2017

Although previous studies have shown that prostaglandins (PGs), leukotrienes (LTs), and other arachidonic acid (AA) metabolites play an important role in the pathogenesis of otitis media with effusion (OME), the exact role of each AA metabolite in OME is still unknown. The purpose of this study was to examine the effect of several individual AA metabolites alone or in combination and AA itself on experimental otitis media in chinchillas. Normal chinchillas were inoculated daily with normal saline, PGE2, LTC4, LTC4 + PGE2, and AA through the superior bullae over 7 days. Animals were followed by otoscopy and tympanometry, samples of middle ear effusion were collected for biochemical assay, and temporal bones were processed for histopathology. The highest number of ears that developed OME was in the group inoculated with PGE2 + LTC4. The degree of inflammatory change was more pronounced in groups injected with LTC4 than any other group. The findings of this study suggest that eicosanoids PGE2, LTC4, and AA alone or in combination inoculated into the middle ear can induce OME.
Role of Middle Ear Endotoxin in Inner Ear Inflammatory Response and Hydrops: Long-Term Study
Authors: Lim David J. , Kawauchi Hideyuki , DeMaria Thomas F.
Published: January 2017

The permeability of the round window membrane for Salmonella typhimurium-derived endotoxin was examined with use of a total of 33 chinchillas. One milligram of each endotoxin was instilled into the tympanic cavities via the superior bullae. The endotoxin activities in middle ear effusions (MEEs), perilymph, and sera were determined by limulus amebocyte lysate assay. Endotoxin was detected in perilymph on the inoculated side by 12 hours after endotoxin instillation and persisted for up to 3 weeks. Endotoxin level peaked at 24 to 48 hours postinstillation, and it steadily declined afterward. This result suggests that the maximum penetration occurred during the active inflammatory stage. Histologic evidence demonstrated remarkable pathologic changes in the inner ear, including bleeding and inflammatory cell recruitment, mostly in the perilymphatic spaces (eg, scalae tympani, scalae vestibuli, spiral ligament), strial swelling, and sensory cell degeneration. This result suggests that endotoxin present in the middle ear can permeate the round window membrane, causing inner ear tissue damage in this animal model.
Round Window Membrane Permeability during Experimental Purulent Otitis Media: Altered Cortisporin Ototoxicity
Authors: Ikeda Katsuhisa , Morizono Tetsuo
Published: January 2017

Round window membrane (RWM) permeability is the most critical factor influencing cochlear function following otitis media. Because otic drops are frequently used during purulent otitis media (POM), we investigated RWM permeability and ototoxicity of Cortisporin otic suspension after inducing experimental POM. Unilateral POM was induced in eight chinchillas by inoculating type 7F Streptococcus pneumoniae into the right ears. Left ears were inoculated with phosphate-buffered saline (control). When POM resolved, the animals were divided into two groups. The round window niches of group 1 were covered with Cortisporin otic suspension. Compound action potentials were measured before and after drug application. The RWM permeability was measured in group 2 by use of tetraethylammonium (TEA) ions as tracers, and the arrival time of TEA and the slope of the potassium-selective microelectrode response were measured. Animals with otitis media exhibited less susceptibility to ototoxicity of Cortisporin otic suspension and reduced RWM permeability to the medium-sized molecule TEA.
Ten Years of Experience with the Swedish Bone-Anchored Hearing System
Authors: Lidén Gunnar , Jacobsson Magnus , Håkansson BO , Tjellström Anders , Carlsson Peder , Ringdahl Anders , Erlandson Björn-Erik
Published: January 2017

In 1977, a new phase began in hearing rehabilitation of patients with chronic middle and external ear diseases and atresias. Thus far, these patients have had to rely on conventional bone conduction and air conduction devices that for various reasons give poor rehabilitation. The principle of the new treatment, made possible by the Swedish bone-anchored hearing system, is simple: sound vibrations are directly transmitted to the skull bone via a skin-penetrating titanium implant and then are further transmitted to the cochlea, bypassing the middle ear. The present paper summarizes our results in 147 patients over 10 years, including a total of 6,334 follow-up months. No significant rate of skin infections was observed. In over 93% of the observations, no sign of adverse skin reaction was seen. When herein-suggested indications for treatment with the bone-anchored sound processor HC-200 are followed, the success rate is over 90%. The improved quality of life reported by the patients is a combination of improved quality of sound, improved comfort, and relief from middle ear and ear canal disease occasioned by conventional hearing aids.
Head and Neck Cancer: An Analysis of the Incidence, Patterns of Treatment, and Survival at the University of Iowa
Authors: Hussey David H. , Latourette Howard B. , Panje William R.
Published: January 2017

A retrospective study was performed with use of tumor registry data to evaluate tumor population characteristics, the patterns of care, and patient survival in 4,506 patients with head and neck cancers seen at The University of Iowa Hospitals and Clinics between 1960 and 1985. The total number of patients with head and neck cancers seen per year and the distribution by anatomic site remained relatively stable over the 26-year period. However, there was a general trend toward more advanced stages in later years. The selection of a treatment modality for this patient population correlated well with the site and stage of the disease and with the treatment philosophy of the managing physicians. Patient survival rates correlated well with the site and stage of the disease. There was a gradual improvement in 5-year survival rates over the 26-year period, from approximately 39% in 1960 to approximately 47% in 1984. This was principally due to an improvement in the 5-year survival rate for patients with “regional stage” disease, from approximately 22% in 1960 to approximately 41% in 1985.
Diagnosis and Management of Anaerobic Infections of the Head and Neck
Authors: Brook Itzhak
Published: January 2017

Anaerobic bacteria are important pathogens in head and neck infections such as chronic otitis media, chronic sinusitis, chronic mastoiditis, head and neck abscesses, cervical adenitis, parotitis, and postoperative infection. Bacteroides sp ( Bacteroides melaninogenicus group, Bacteroides oralis, and Bacteroides fragilis group), Peptostreptococcus sp, and Fusobacterium sp predominate. The observed recent increase in the number of β-lactamase—producing strains of Bacteroides sp isolated in head and neck infections has been associated with increased failure rates of the penicillins in the management of these infections. The pathogenicity of these organisms is expressed through their ability not only to survive penicillin therapy but also to shield penicillin-susceptible pathogens from the drug. Because of these direct and indirect virulent characteristics of anaerobic bacteria, appropriate antimicrobial therapy must be directed against all pathogens in mixed infections.
Antimicrobial Prophylaxis for Recurrent Acute Otitis Media
Authors: Paradise Jack L.
Published: January 2017

Antimicrobial prophylaxis for recurrent otitis media was first reported in 1960 in an uncontrolled study using a long-acting sulfonamide in Native American children younger than 11 years of age. In subsequent controlled studies using various antimicrobial drugs (primarily aminopenicillins or sulfonamides) subjects receiving prophylaxis continued to have episodes of acute otitis media, but at rates substantially lower than those of controls. More recently, prophylaxis has appeared effective in reducing the number of acute recurrences, but not the cumulative proportion of time with middle ear effusion that was present independent of such recurrences. Although questions remain about choice of drug, optimal dosage schedules, risk of untoward drug reactions, duration of use, and the risk of encouraging the emergence of resistant strains of pathogenic bacteria, antimicrobial prophylaxis currently appears to be the most logical first approach in the management of the child with recurrent otitis media.
Sinusitis in Infants and Children
Authors: Wald Ellen R.
Published: January 2017

The major clinical problem in considering a diagnosis of sinusitis is differentiating uncomplicated upper respiratory tract infection from a secondary bacterial infection of the paranasal sinuses that may benefit from antimicrobial therapy. A diagnosis of sinusitis is suggested by presentation with protracted upper respiratory tract symptoms or a cold that is more severe than usual with fever and purulent nasal discharge. Confirmatory tests of sinus disease are transillumination (useful in adolescents if interpretation is confined to the extremes — normal or absent); radiographic findings of opacification, mucous membrane thickening, or an air-fluid level; and sinus aspiration (indicated for severe pain, clinical failures, or complicated disease). When clinical signs and symptoms are accompanied by abnormal radiographic findings, bacteria in high colony count are recovered from the maxillary sinus aspirate in 70% of patients. The common bacterial species recovered from children with acute maxillary sinusitis are Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis, and Hemophilus influenzae.
Medical and Surgical Management of Sinusitis in Adults
Authors: Richtsmeier William J.
Published: January 2017

Sinusitis may be caused by bacteria, viruses, or trauma and may appear in immunosuppressive settings. Acute sinusitis is most commonly diagnosed on the basis of pain and discharge; endoscopic or fiberoptic examination may be helpful in less obvious cases. Radiography can identify maxillary, frontal, and sphenoid sinusitis; transillumination can be used if radiography is undesirable. Culture and Gram stains may help determine the appropriate antibiotic therapy. Surgery may be necessary if the frontal or sphenoid sinus is involved, or if ethmoiditis is progressing to orbital cellulitis. In chronic sinusitis, endoscopic examination and computed tomographic scanning are useful for diagnosis. Chronic sinusitis may be associated with airway disease, aspirin allergy, and such diseases as cystic fibrosis. Antibiotic therapy that acts against anaerobes and β-lactamase—producing organisms should be chosen. Surgical treatment includes intranasal and external ethmoidectomy, antrostomy, and, on occasion, obliteration of the involved cavity.
Etiology and Management of Pharyngitis and Pharyngotonsillitis in Children: A Current Review
Authors: Paradise Jack L.
Published: January 2017

Although viruses are the most common causes of childhood throat infections, interest in the etiology of these infections has primarily focused on whether an individual episode is caused by group A β-hemolytic streptococcus (GABHS), particularly since the recent outbreaks of rheumatic fever in certain areas of the country. Penicillin remains the cornerstone of treatment in GABHS pharyngitis. Early treatment effects prompt clinical improvement and reduces the risk of transmission. Whether early treatment suppresses immunologic response and results in a higher recurrence rate than does delayed treatment is still unknown, but recent evidence suggests that it does not. The causes of persistent GABHS carriage, its clinical importance, and optimal methods of treatment are all still in question. When penicillin treatment does not eradicate carriage, other drugs may be efficacious. In children severely affected with recurrent throat infection, tonsillectomy is generally effective and is sometimes a desirable option.
The Three Bellies of the Canine Cricothyroid Muscle
Authors: Zaretsky Lauren S. , Sanders Ira
Published: January 2017

The cricothyroid muscle is capable of multiple functions, including vocal cord elongation and adduction. In addition, the cricothyroid can lengthen the glottis as well as provide posture to the cricothyroid joint. The purpose of the present study is to demonstrate that the many functional capabilities of the cricothyroid are a reflection of the existence of separate bellies within the muscle. Microdissection revealed three distinct muscle bellies within the cricothyroid: rectus, oblique, and horizontal. These differ in fiber orientation (rectus 79°, oblique 48°, horizontal 7°) and are separated by fascial planes. Histochemistry showed that these three bellies are composed of different percentages of slow twitch fibers (rectus 31.3%, oblique 43.3%, horizontal 39.6%). Finally, electromyography demonstrated differences in the electrical activity patterns of the three bellies. It is concluded that the cricothyroid muscle is composed of three distinct muscle bellies that probably play separate roles in the complex function of this muscle.
Detection of Genomic Sequences of Respiratory Syncytial Virus in Otitis Media with Effusion in Children
Authors: Okamoto Yoshitaka , Kudo Kazuo , Shirotori Koji , Nakazawa Misao , Ito Eiko , Togawa Kiyoshi , Patel Janak A. , Ogra Pearay L.
Published: January 2017

The reverse transcriptase—polymerase chain reaction and the nested polymerase chain reaction were used for detection of respiratory syncytial virus (RSV) sequences in middle ear effusions collected from children with otitis media. Sequences of RSV were detected in 21 of 34 samples tested. These samples were collected during and/or after natural outbreaks of RSV infection in the community. In those patients from whose nasopharynges RSV was isolated, the viral sequences were highly detectable (75%) in the effusions. These observations suggest RSV as an important factor in the pathogenesis of otitis media with effusion.
Erythromycin Inhibition of Lipopolysaccharide-Stimulated Tumor Necrosis Factor Alpha Production by Human Monocytes in Vitro
Authors: Iino Yukiko , Toriyama Minoru , Natori Yasuhiro , Kudo Koichiro , Yuo Akira
Published: January 2017

The mechanism of clinical effectiveness of low-dose and long-term erythromycin (EM) treatment for diffuse panbronchiolitis, sinobronchial syndrome, and associated otitis media with effusion was investigated by studying the effects of EM on tumor necrosis factor alpha (TNF-α) production by cultured human monocytes stimulated with lipopolysaccharide. At concentrations of 0.1 μg/mL or more, EM inhibited TNF-α release from human monocytes stimulated by lipopolysaccharide in a dose-dependent manner. Of the other macrolides tested, roxithromycin, an EM derivative, also showed significant inhibition of TNF-α production, whereas josamycin failed to inhibit TNF-α release from monocytes. Nonmacrolidic drugs such as minocycline hydrochloride, ofloxacin, or penicillin G had no significant effect on TNF-α production. These results suggest that the clinical improvement of chronic respiratory diseases by EM may depend on the suppression of production of inflammatory cytokines such as TNF-α.
Interleukin-1 of Cholesteatomatous Keratinocytes
Authors: Kakiuchi Hiromu , Katoh Yutaka , Kinoshita Kazuya , Tabata Toshihide
Published: January 2017

Interleukin-1 (IL-1) has been thought to be one of the essential cytokines mainly produced by macrophages. It has recently been reported that epidermal keratinocytes produce IL-1, and attention is being paid to local immune reactions mediated with this cytokine. Interleukin-1 not only activates lymphocytes, but also acts as an osteoclast-activating factor. In this study, we used immunohistochemistry and immunoblotting on cholesteatomatous epithelium with anti-IL-1α antibody and anti-IL-1β antibody. Next, the relationship of cholesteatomatous debris to the production of IL-1 by keratinocytes was evaluated. Highly concentrated IL-1α was found in the cholesteatomatous epithelium, especially in the basal cell layer. The intensity of IL-1β staining was weaker than that of IL-1α staining. In the immunoblotting study, the 31 kd band, an intracellular immature precursor molecule, was identified. The production of IL-1α from keratinocytes was augmented to a greater degree by cholesteatomatous debris than by lipopolysaccharide or keratin. The keratinocytes did not produce IL-1β. These findings suggest that IL-1α is derived from cholesteatomatous keratinocytes. Interleukin-1, mainly IL-1α, from the stimulated cholesteatomatous keratinocytes may be an important factor in the markedly increased bone resorption observed in cholesteatoma.
Vestibular Disorders following Immune Response of the Endolymphatic Sac in the Guinea Pig
Authors: Nonaka Manabu , Tomiyama Shun-Ichi , Ikezono Tetsuo , Gotoh Yuichi , Yagi Toshiaki
Published: January 2017

The effect of a direct antigen challenge to the endolymphatic sac on vestibular function was investigated in guinea pigs. Following keyhole limpet hemocyanin (KLH) challenge to the sac in systemically presensitized guinea pigs, caloric responses were examined in 18 animals on days 1, 7, 14, 21, and 28. Caloric responses were significantly suppressed in 13 animals by day 7; of these, 5 animals had recovered by day 14 and 8 animals had not yet recovered by day 28. The behavior of spontaneous nystagmus was examined every hour in 10 animals at intervals of 3 to 56 hours after sac challenge. Irritative spontaneous nystagmus preceding paralytic nystagmus appeared in 5 animals, for which the mean onset was 14.6 ± 3.1 hours and the mean duration was 4.4 ± 6.5 hours. Paralytic spontaneous nystagmus appeared in all animals, for which the mean onset time was 23.3 ± 12.3 hours. Neither direct KLH primary challenge of the sac nor phosphate-buffered saline injection to the sac caused significant changes in the vestibular function. These results suggest that an immune response of the sac induces a vestibular disorder and may produce an attack of vertigo similar to that of Meniere's disease.
Localization of Type IV Collagen and Laminin in the Guinea Pig Inner Ear
Authors: Takahashi Mitsuaki , Hokunan Kazuhiko
Published: January 2017

The distribution of type IV collagen (C-IV) and laminin, which are important components of the basement membrane (BM), was studied immunohistochemically in the inner ear of healthy Hartley guinea pigs. Antibodies against C-IV and laminin were used in this study. The distribution of C-IV in the inner ear was almost the same as that of laminin, but the extent of staining for laminin was less than that for C-IV in some sites. The sites of the inner ear in which these components were most densely localized were the areas surrounding the spiral ganglion cells and nerve fibers, the capillary vessels in the stria vascularis and the spiral prominence, and an area directly beneath the epithelium of the endolymphatic sac. Type IV collagen and laminin were also localized around the other vascular BM and the epithelial BM in the inner ear, but the tectorial membrane, the cupula of the crista ampulla, and the sensory epithelium did not take up stain. These results suggest that the vascular BM of the stria vascularis and spiral prominence, as well as the epithelial BM of the endolymphatic sac, may play an important role in fluid transport, and that the perineural BM of the inner ear might play an important role in the functional maintenance of the optimal environment of the inner ear nervous system.
Alterations of Charge Barrier in the Inner Ear following Immune Reactions
Authors: Tomoda Koichi , Yamawaki Toshio , Yamashita Toshio , Suzuka Yuko , Kumazawa Tadami
Published: January 2017

We investigated electron microscopically the changes of anionic sites of a charge barrier in the capillary basement membrane of the stria vascularis and endolymphatic sac following inner ear immune reactions. Hartley guinea pigs were immunized with bovine type II collagen, keyhole limpet hemocyanin, or horseradish peroxidase, with boosted and challenged antigens through the stylomastoid foramen. Animals were killed painlessly from several days up to 56 days after the antigen challenge. Polyethylenimine was used as a cationic tracer in order to observe the localization of anionic sites of the charge. In the animals immunized with bovine type II collagen or horseradish peroxidase, a significant decrease of anionic charge in the stria and the sac was found in the early stage of immunization. However, the keyhole limpet hemocyanin immunization group did not show any remarkable changes in the charge because of its lesser transfer into the inner ear due to of its high molecular weight and negative surface charge. A decrease of the charge under immunologic conditions may induce a hyperpermeability of vessels and a malabsorption of endolymph, and thus may cause endolymphatic hydrops.
Mechanism of Immune Complex—Mediated Inner Ear Diseases
Authors: Harada Tamotsu , Sano Mitsuhito , Ogino Satoshi , Sakagami Masafumi , Matsunaga Toru
Published: January 2017

Tissues of the stria vascularis of normal rabbits were collected as cochlear antigen and injected into the foot pad of guinea pigs. The mechanism of development of endolymphatic hydrops was studied by the tracer method. Damage to the capillary endothelium and an increase in vascular permeability were found in the stria vascularis. Therefore, we studied patients with a raised level of immunoglobulin (Ig) G—class circulating immune complexes (CICs). Hearing loss was found in 3 of 22 patients with significantly elevated IgG CIC levels (13.6%). The relationship between inner ear disease and the presence of CIC was considered to be very significant. The possible mechanism of CIC-mediated inner ear diseases is discussed.
Antimicrobial Treatment of Acute Otitis Media
Authors: Canafax Daniel M. , Giebink G. Scott
Published: January 2017

Episodes of acute otitis media frequently occur in childhood and are attended by significant morbidity, such as hearing loss and possible speech delay. Bacteria play an important etiologic role in the pathogenesis of otitis media; therefore, antimicrobial agents are the cornerstone in the treatment of this disease. Many antimicrobial choices are available for treating children with acute otitis media. To choose an antimicrobial for each patient, consideration must be given to the patient's age, history of otitis media episodes, and responses to previously used antimicrobial drugs, and the regional antimicrobial susceptibility of the otitis media pathogens.
Role of Ige-Mediated Hypersensitivity in Otitis Media with Effusion: Pathophysiologic Considerations
Authors: Bernstein Joel M. , Doyle William J.
Published: January 2017

A pathophysiologic model of otitis media with effusion secondary to IgE-mediated hypersensitivity is described. Specific mediators of inflammation are released by mucosal mast cells in the nasal mucosa following the interaction of antigen and specific IgE antibody. These mediators increase vascular permeability, mucosal blood flow, and, most important, mucus production. Furthermore, accessory cell types are recruited by colony-stimulating factors that in turn provide an autocrine-positive feedback for the influx of further inflammatory cells. The eustachian tube is then effectively obstructed by both intrinsic venous engorgement and extrinsic mucus plugs, isolating the middle ear space from the ambient environment The net result is the increased exchange of nitrogen into the middle ear mucosa from the middle ear cavity. This causes the development of a significant middle ear underpressure that disrupts tight junctions and allows for transudation of fluids into the middle ear space. The prolonged obstruction of the eustachian tube with mucus results in middle ear inflammation, mucosal metaplasia, and increased glandular activities, all of which are hallmarks of chronic otitis media with effusion.
Preventing Otitis Media
Authors: Giebink G. Scott
Published: January 2017

Recurrent acute otitis media (AOM) is an extremely prevalent disease in young children. Epidemiologic associations suggest that primary prevention or reduction of AOM frequency may be achieved with breast-feeding during infancy, elimination of household tobacco smoking, and use of small rather than large day-care arrangements for infants and toddlers. Secondary antimicrobial prophylaxis with amoxicillin or sulfisoxazole reduces the frequency of recurrent AOM by about 50%, but it does not appear to reduce the duration of otitis media with effusion (OME). Tympanostomy tube insertion is not as effective as amoxicillin in reducing AOM frequency in children without OME. Adenoidectomy appears to be warranted for children who develop recurrent AOM after extrusion of tubes. Vaccines against the common bacteria and viruses causing AOM hold the greatest promise of preventing AOM and blocking the sequence of pathologic events leading to chronic OME and middle ear sequelae. The greatest progress has been made recently with pneumococcal protein conjugate vaccines, and clinical testing is in progress.
Pathology of Otitis Media
Authors: Wright Charles G. , Meyerhoff William L.
Published: January 2017

Otitis media is characterized by inflammation of the middle ear. The pathologic changes seen in this condition tend to occur on a continuum, progressing from acute and subacute stages to the chronic phase, in which irreversible tissue damage is observed. The earliest morphological changes involve the lamina propria of the middle ear mucosa and include increased capillary permeability, edema, and leukocytic infiltration. During the late acute to subacute stages, the mucosa also tends to show a marked increase in numbers of ciliated and secretory epithelial cells. As the inflammatory process enters the chronic phase, there is a continuing shift in the population of infiltrating leukocytes toward increasing numbers of mononuclear cells that secrete substances that facilitate tissue destruction and fibrosis. There is also development and proliferation of granulation tissue, which is intimately involved in the process of bone erosion. As granulation tissue matures, it becomes denser and less vascular—a process that leads to permanent fibrosis and formation of adhesions that may significantly compromise middle ear function. Other pathologic entities occasionally associated with chronic otitis media include cholesteatoma, cholesterol cysts and granuloma, and tympanosclerosis, all of which may contribute to irreversible alterations of middle ear structure.
Risk Factors for Otitis Media Sequelae and Chronicity
Authors: Daly Kathleen
Published: January 2017

Otitis media (OM) is a very common childhood illness, with identified risk factors for chronicity and recurrence. Although a few treatment studies have described clinical factors that predict increased morbidity, there is little information on risk factors for middle ear sequelae of OM. These conditions have an estimated annual incidence of 0.5% to 4% among children with chronic OM with effusion. Prospective studies to identify risk factors for sequelae, although usually preferred by researchers, are expensive to conduct and impractical for rare conditions such as cholesteatoma. Knowledge of risk factors for chronicity and sequelae can be used clinically to target high-risk children for earlier, more aggressive therapy or more frequent surveillance and testing to prevent sequelae and increase early detection of these conditions. A clinician's advice about modifiable risk factors may motivate parents to decrease their child's exposure to factors that increase the risk of OM, OM chronicity, and sequelae. Research is needed to identify risk factors for OM sequelae by means of well-designed controlled studies.
Determining Otitis Media Severity from Middle Ear Fluid Analysis
Authors: Juhn Steven K. , Garvis William J. , Le Chap T. , Lees Chris J. , Kim C. S.
Published: January 2017

Otitis media has a complex multifactorial pathogenesis, and the middle ear inflammatory response is typified by the accumulation of cellular and chemical mediators in middle ear effusion. However, specific biochemical and immunochemical factors that may be responsible for the severity or chronicity of otitis media have not been identified. Identification of factors involved in chronicity appears to be an essential step in the treatment and ultimate prevention of chronic otitis media. We analyzed 70 effusion samples from patients 1 to 10 years of age who had chronic otitis media with effusion for two cytokines (interleukrn-1β and tumor necrosis factor α) and total collagenase. The highest concentrations of all three inflammatory mediators were found in purulent otitis media, and concentrations were higher in younger than in older patients. Mediator concentrations were similar in samples obtained from patients having their first myringotomy for otitis media with effusion and in those who had had multiple previous myringotomies. The multiresponse star, which incorporates several biochemical parameters in one graphic illustration, may best characterize the complex nature of middle ear inflammation.
Identification of Hearing Loss in Children with Otitis Media
Authors: Hunter Lisa L. , Margolis Robert H. , Giebink G. Scott
Published: January 2017

Hearing loss is the most common complication of otitis media. Hearing loss secondary to otitis media has increasingly been associated with significant developmental and educational problems. However, not enough is known about the peripheral auditory effects of otitis media. The young age of most children affected by otitis media makes detailed audiologic assessment challenging. This paper presents a brief synopsis of audiologic strategies that may be employed to assess the hearing status of infants and children with otitis media with effusion. Data pertaining to the risk of hearing loss recurrence after tympanostomy tube insertion are presented from a prospective longitudinal study of hearing in children with chronic otitis media with effusion.
Programming Features of the Clarion® Multi-Strategy™ Cochlear Implant
Authors: Zimmerman-Phillips Susan , Murad Carol
Published: January 2017

Because patient performance with multichannel cochlear implants varies widely, cochlear implant systems must address the diverse needs of patients during the postoperative fitting of the external equipment. This paper describes the processing strategies available with the CLARION® Multi-Strategy™ Cochlear Implant and the different programming features available for optimization of these speech processing strategies. In addition, preliminary data are presented about the frequency of use of various fitting parameters with adult Simultaneous Analog Stimulation (SAS) and Continuous Interleaved Sampler (CIS) patients and pediatric CIS users. The data reveal that many of the programming features available to the clinician are useful with both the adult and pediatric populations and across strategies. The flexibility of both processing strategies and the programming options clearly contribute to the optimization of patient device fittings. Optimized device fittings, in turn, maximize patient performance.
Surgical Technique for the Clarion® Cochlear Implant
Authors: Balkany Thomas J. , Cohen Noel L. , Gantz Bruce J.
Published: January 2017

This paper describes a technique for implantation of the CLARION® Multi-Strategy™ Cochlear Implant based upon the authors' surgical experience with the device. Although much of the procedure is similar to many commonly performed otologic operations, including implantation of other cochlear prostheses, several device-specific modifications are highlighted. Those modifications include a substantial bony seat, facial recess, and cochleostomy, and the use of an electrode insertion tool.