bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperacusis and Other Inner Ear Disorders Are Improving after Light Irradiation with Photobiostimulation Laser
Authors: Prosper Joaquin , Hack Eugenio
Published: September 2014

Objectives:

There are several theories about pathophysiologic mechanisms involved in hyperacusis as an inner ear disease. Several authors discuss and focus hyperacusis around neurophysiological processes currently against the cochlear poor condition. This research describes effects of treatment by laser light irradiation on hyperacusis and recognizes that hyperacusis is a poor cochlear disorder instead of other auditory or neurophysiologic processes.

Methods:

A prospective study of a group of 58 patients who were suffering hyperacusis from several inner ear disorders (Ménière's, tinnitus, and other disorders) was made with laser irradiation therapy based upon a photobiostimulation energy protocol. Patients were treated twice a week for 6 weeks by irradiation of a dose of low‐level laser light. A laser device with double wavelength and independent light beams were used to irradiate through the ear canal with light power irradiance of 90 to 300 mw/cm2.

Results:

Hyperacusis significantly improved in all patients. Ninety‐nine percent of observations had a large improvement of auditory capacity and 78.9% of them reached normal discomfort levels (no hyperacusis). Dynamic range of each ear was measured before and after treatment.

Conclusions:

Irradiation of the cochlea with a specific dose of light laser energy produces an obvious improvement in hyperacusis and other auditory disorders. This can be evaluated by comparing the audiometric dynamic range before and after the treatment period. The results confirm that hyperacusis as a disorder is more susceptible to a poor cochlear condition than other known neurophysiological processes.
Immunohistochemical Study of the Possible Role of Osteoprotegrin OPG in Inhibition of Otic Capsule Remodeling
Authors: Shewel Yasser G.
Published: September 2014

Objectives:

Recognize the differential expression of osteoprotegrin (OPG) in the otic capsule of adult male mice compared with other selected skeletal bones, both in nearby locations such as the temporal bone, and in distant bones, such as the tibia.

Methods:

The experimental study was conducted in 2011 on 20 normal adult male albino mice with average weight 50 to 60 g.  Animal housing at the physiology department (Alexandria Faculty of Medicine) followed the rules of research ethics for experimental animals approved by Faculty of Medicine, University of Alexandria, Egypt. The following bone specimens were harvested from normal adult male albino mice by microdissection: (1) temporal bone, (2) otic capsule bone surrounding the cochlea, and (3) tibia and stained immunohistochemically for anti‐OPG monoclonal antibody. Positive staining was graded and analyzed using image software that measured the staining intensity as units of pixels/microscopic field examined at 400 magnification. Quantitative data were described using mean, standard deviation, median, minimum and maximum. Comparison between different sites were analyzed using F‐test (analysis of variance) and post hoc test (least significant difference) for pairwise comparison.

Results:

OPG was detected as a brown DAB chromogen staining of tissue components expressing a positive OPG monoclonal antibody immune reactivity. Statistical analysis of the results revealed that high OPG level concentrations were found in otic capsule followed by temporal bone and finally the tibia.

Conclusions:

The findings highlight the role of a OPG in inhibition of otic capsule remodeling.
The Impact of Perioperative Oral Steroid Use on Low‐Frequency Hearing Preservation after Cochlear Implantation
Authors: Sweeney Alex D. , Zuniga M. Geraldine , Wanna George B. , Haynes David S. , Rivas Alejandro
Published: September 2014

Objectives:

(1) Investigate factors that impact low frequency hearing preservation following cochlear implantation. (2) Evaluate the efficacy of a perioperative oral steroid taper in this setting.

Methods:

Retrospective series from a single surgeon at a tertiary academic referral center. Patients were candidates for a hearing preservation protocol based on their preoperative pure tone thresholds. The tympanic space was bathed in steroids prior to opening the round window membrane in all cases, and all patients were implanted using electrodes designed for atraumatic insertion. One group of patients received a 2‐week oral prednisone taper beginning 3 days prior to surgery. The primary outcome measure was the preservation of low frequency pure tone hearing on a 1‐month postoperative audiogram.

Results:

Twenty‐two hearing preservation candidates were implanted during an 18‐month period (mean age 50 years; range 3‐80) ending in December 2013. Thirteen patients (59.1%, mean age 45.6 years) received the oral prednisone taper while 9 (40.9%, mean age 56.3 years) did not. There was no significant age difference between the groups (P =. 18). Within the oral prednisone group, 84.6% of patients had at least a partial hearing preservation (23.1% complete preservation) compared with 33.3% (0% complete preservation) in those not taking prednisone (P <. 01).

Conclusions:

Oral steroids may play a role in low‐frequency hearing preservation following cochlear implantation. Though the optimal protocol has yet to be identified, a 2‐week oral prednisone taper given 3 days before surgery appears to positively impact the rate of and degree of preservation.
The Importance of the Individual Adjustments in Sound Therapy
Authors: Suzuki Flavia A. B. , Suzuki Fabio A. , Yonamine Fernando K. , Onishi Ektor T. , Penido Norma O.
Published: September 2014

Objectives:

The difficulty in choosing appropriate therapy for chronic tinnitus lies in its various forms of impact on the quality of life of patients and requires personalization. The aim of the study was to evaluate the efficacy of the use of sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous drug treatment.

Methods:

This was a prospective study of 10 patients, 5 male and 5 female, ages ranging from 41 to 78 years with chronic tinnitus who were resistant to previous drug treatments. Bilateral sound generators Reach62 or Mind 9 models were used for at least 6 daily hours for 18 months. Audiometrics testing, pitch, loudness, minimum masking level (MML), Tinnitus Handicap Inventory (THI), Visual Analogue Scales (VAS), and Hospital Anxiety and Depression Scale (HADS) questionnaires were given. Sound generators were used before 1 month and, sequentially every 3 months up to 18 months. The sound generators were individually adjusted, according to criteria of personal complaints in each visit.

Results:

There was an important reduction in tinnitus in 9 patients using an protocol with a personalized approach, independent of its psychoacoustic characteristics, when THI and VAS were applied. Patients with more than one specific kind of tinnitus concomitantly showed more reduction in pure tone tinnitus. Only 1 patient was indicative of depression in HADS and did not respond to sound therapy.

Conclusions:

We observed an importance in the individual adjustments in therapy, regardless the equipment used. There was an improvement in tinnitus disturbance and quality of life of these patients.
Intraoperative Nerve Monitoring Crisis: Sounding the Alarm
Authors: Kartush Jack M.
Published: September 2014

Objectives:

Otolaryngology was one of the first specialties to use intraoperative nerve monitoring (IOM) to reduce the risk of facial and recurrent laryngeal nerve paralysis. Unfortunately, many external changes have occurred in the field that impact standards of care and correct coding. The objective is to identify these new external standards so AAO members can describe and apply new regulations to reduce adverse medicolegal and coding abuse risks.

Methods:

Rigorous, newly published standards in neurophysiologic monitoring created by neurologic and electrodiagnostic associations are reviewed and compared with the more lax procedures commonly used by otolaryngologists with informal, on‐the‐job IOM training. Similarly, new third party payor changes in billing and coding are reviewed and compared to common IOM coding practices.

Results:

A comparison of routine IOM methods performed by otolaryngologists reveals marked differences in procedure and documentation compared to published standards in neurophysiological monitoring. In addition, many otolaryngologists have failed to change their IOM coding strategies to comply with new third party payor guidelines.

Conclusions:

(1) The absence of specialty‐specific American Academy of Otolaryngology Practice Guidelines on IOM places otolaryngologists at risk for noncompliance with external standards published in the neurophysiology field. Failure to observe national standards of IOM also compromises the quality of the monitoring provided to our patients. (2) Because “ignorance of the law is no excuse,” failure to identify and comply with new IOM coding regulations places the otolaryngologist at risk for charges of “fraud and abuse” billing. Implementing both clinical and coding changes will benefit patient and physician alike.
Intratympanic Steroid Treatment for Acute Low‐Frequency Sensorineural Hearing Loss without Vertigo: Prospective Controlled Study
Authors: An Yong‐Hwi , Yu Kwang‐Kyu , Yoon Sang Won , Shim Hyun Joon
Published: September 2014

Objectives:

Compare the effectiveness of treatment for acute low frequency sensorineural hearing loss (LFHL) with tinnitus and without vertigo between intratympanic dexamethasone injections (ITDI) and oral diuretics.

Methods:

A total of 35 tinnitus patients with LFHL that had developed within previous 2 weeks were enrolled and randomly assigned into 2 groups: (1) treated with ITDI 4 times on each of 4 consecutive days (19 patients) and (2) treated with diuretics orally for 2 weeks (16 patients). The group assignments and the process of treatments were double‐blinded. After 8 weeks, we analyzed treatment outcomes of LFHL using subjective symptom score and audiometric change.

Results:

The cure rate of ITDI group (42.1%) was significantly higher than that of diuretics group (25.0%). For subjective symptom score, there were no statistically significant differences of improvement rate in both groups (ITDI 63.2%, diuretics 56.3%). In pure tone audiometry, the improvement rate of ITDI group (73.7%) was significantly higher than that of diuretics group (62.5%). There was a significant correlation between the cure rate and duration of symptoms.

Conclusions:

ITDI is a more effective treatment modality than oral diuretics for LFHL within 2 weeks of development. Duration of symptom affects the cure rate of acute LFHL with tinnitus and without vertigo.
In Vitro Model of Cochlear Implant Trauma: Oto‐Protection by a Combination of NAC, Dex, and Mannitol
Authors: Eshraghi Adrien A. , Mittal Jeenu , Telischi Fred F. , Rodrigues Helio , Van De Water Thomas R. , Bas Esperanza , Gupta Chhavi
Published: September 2014

Objectives:

(1) Describe the otoprotective mechanisms involved in common otoprotective drugs (ie, NAC, dexamethasone, and mannitol). (2) Describe the otoprotective effect of combining these drugs to prevent hair cell (HC) losses.

Methods:

Cochlear explants were dissected from P‐3 rats and placed in serum‐free media. Explants were divided into 3 groups: (1) untreated controls; (2) electrode insertion trauma (EIT); (3) Tri‐therapy (L‐NAC + DXM + mannitol). Cochlea of groups 2 and 3 were implanted and HC counts, oxidative stress and cleaved caspase‐3 markers were studied in all explants post EIT.

Results:

There was a significant increase of HC loss in the EIT explants as opposed to control or the tri‐therapy cochlea. The implantation resulted in an increased production of the total reactive oxygen species (ROS) in both HCs and the supporting cells (SCs) of only EIT group. There is also cleaved caspase‐3 activation in EIT cochlea as compared to the control or tri‐therapy cochlea.

Conclusions:

The tri‐therapy combining NAC, dexamethasone, and mannitol has an otoprotective effect on survival of hair cells and support cells post–cochlear implantation. This in vitro oto‐protection needs to be tested in vivo, in an animal model of cochlear implantation trauma.
Is the Extent of the Preoperative Air‐Bone Gap an Indictor of Potential Success in Stapedectomy?
Authors: Lavy Jeremy , Huins Charlie , Hall Andrew , Whitcroft Katherine , Khalil Sherif
Published: September 2014

Objectives:

(1) Could preoperative air‐bone gap (ABG) magnitude act as a predictor of postoperative outcome in patients undergoing stapedectomy for otosclerosis? (2) If this were to occur, is it frequency specific?

Methods:

Retrospective case series from January 2010 to December 2012 in a tertiary London teaching hospital. Intervention: Laser stapedectomy using Smart Nitinol stapes prosthesis. Main outcome measure: Audiometric. Retrospective analysis comparing preoperative and postoperative air‐bone gap in 302 patients undergoing stapedectomy. Patients were stratified into subgroups according to their preoperative ABG and this was compared to their postoperative result of air‐bone closure. In addition, for each commonly tested frequency (0.5, 1, 2, 3, 4 kHz) the preoperative and postoperative air‐bone gap were analyzed in order to ascertain whether the preoperative ABG could act as a predictor. Having not passed normality testing, Wilcoxon matched paired signed rank test and Spearman rank coefficient were used for analysis.

Results:

Throughout the statistical analysis, preoperative ABG correlated most strongly with net difference in postoperative ABG (P <. 0001). For each commonly tested frequency assessed this demonstrated a “very strong” positive correlation. As such, the greater the preoperative ABG, the greater the closure obtained through stapedectomy in this series.

Conclusions:

In performing stapedectomy for otosclerosis, our series suggested the preoperative ABG may have a role in preoperative patient counseling and consent but is unable to predict success in stapedectomy surgery.
Long‐term Cross‐Hatching Eustachian Tuboplasty Outcomes
Authors: Yanez Carlos , Velazquez Sandra , Mora Nallely
Published: September 2014

Objectives:

Review the long‐term outcomes of cross‐hatching Eustachian tuboplasty (ChEt) in patients with chronic obstructive Eustachian tube dysfunction (COETD), as well assess the clinical factors associated with surgical success.

Methods:

Case series with chart review in a tertiary health care institution. This is a retrospective review by the senior author of all cases of patients who had non‐revision ChEt for COETD. Follow‐up period was 5 years. The curvature of the posterior cushion was modified using an argon laser to alter the spring of the cartilage alleviating the obstructed valve's aperture. Several clinical factors were reviewed in relation to the successful opening of the Eustachian tube valve.

Results:

One hundred twenty patients, 72 males/48 females, average age 42.4 + 2 years old, met inclusion criteria to the study. COETD patients/obstructive causes were: Posterior cushion hypertrophy, 68 (56.6%). Tensor Veli and Levator Veli Palatini muscles hypertrophy, 15 (12.5%). Mucosal hypertrophic disease, 37 (30.8%). Total treated tubes was 198, bilateral 143 (72.2%), 55 unilateral (27.7). ET valve was seen more open postoperatively on simple endoscopy (SE) and slow motion video analysis (SMVEA). There were no complications. Mean pure tone average improved by 20 dB postoperatively; P =. 015. Mean immitance changes in tympanometric measurements improved postoperatively at least 0.10 mmhos in 91% of the patients (P =. 010). Resolution of symptoms was considered a successful outcome. Failure correlated with the severity of disease.

Conclusions:

High rates of improvement (96%) were found. Therefore, ChEt is a promising technique for the treatment of COETD.
Long‐term Results of Pediatric Cholesteatoma Surgery Using Canal‐Wall‐Down Approach with Primary Obliteration: 5‐Year Observational Study
Authors: Trinidade Aaron , Yung Matthew
Published: September 2014

Objectives:

Present the results of a 5‐year longitudinal study in a pediatric population undergoing cholesteatoma surgery using a canal wall down approach with obliteration.

Methods:

Prospective longitudinal study in a district general hospital from 1999 to 2013.46 children (<16 years) with cholesteatoma were included. Outcome measurements were: (1) residual, recurrence, and recidivist cholesteatoma rates at 5 years postsurgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgeries required.

Results:

Using Kaplan‐Meier analysis, the residual cholesteatoma rate at 5‐years post‐surgery was 6.7% at a rate of 20.9 per 1000 years of child follow‐up (95% confidence interval: 7.8‐55.6), representing 4 cases of residual cholesteatoma and no recurrences. No children experienced otorrhea at 5 years and the rate of definitive waterproofing was 94.8%. There was a reoperation rate of 18.3% (n = 11) at 5 years, which included planned ossiculoplasty. Regarding hearing, of the data available (n = 17), 12 children (70.6%) preserved maintained their hearing (change between –10 to =10 dB), 1 child (5.9%) had hearing gain (>10 dB), and 3 children (17.6%) had hearing reduction at 12 months postoperation. Six out of 17 children (35.3%) had a postoperative hearing level of ≤30 dB.

Conclusions:

The use of a canal wall down approach with obliteration of the mastoid cavity to surgically treat cholesteatoma is safe in pediatric populations and results in a low recurrence rate and high rate of a trouble‐free ear in the long term.
Longitudinal Change of Varicella‐Zoster Virus‐Specific Cell‐Mediated Immunity in Hunt Syndrome and Bell's Palsy
Authors: Ichihara Takahiro , Haginomori Shin‐Ichi , Mori Atsuko , Kanazawa Atsuko , Nishikado Akira , Kawata Ryo
Published: September 2014

Objectives:

(1) Compare longitudinal changes of Varicella‐zoster virus (VZV)‐specific cell‐mediated immunity (CMI) in Hunt syndrome with Bell's palsy using IFN‐γ enzyme‐linked immunospot (ELISPOT). (2) Examine the role of VZV‐specific CMI for VZV reactivation in the facial nerve in Hunt syndrome.

Methods:

This prospective study was conducted in our tertiary referral hospital between 2010 and 2013. Nineteen Hunt syndrome and 59 Bell's palsy patients were enrolled. Mononuclear cells isolated from whole blood were incubated with VZV antigen in culture plates for 40 hours. Anti IFN‐γ antibody was added and the ELISPOT system counted immunostained spots indicating VZV‐specific CMI. The relationship between the spots and days from the onset of palsy were compared between Hunt syndrome and Bell's palsy patients.

Results:

Immediately after the onset, the number of spots in the Hunt syndrome group was much lower than in the Bell's palsy group, indicating low VZV‐specific CMI. However, it increased rapidly and showed a strong positive relationship between the number of spots and days from the onset of palsy (r = 0.64) in Hunt syndrome. Several months after the onset, the number of spots in Hunt syndrome decreased gradually. In contrast, the Bell's palsy group showed no such relationship (r = –0.22).

Conclusions:

These results suggest that low CMI to VZV may play an important role in VZV reactivation in the facial nerve, thus leading to facial palsy in Hunt syndrome. VZV vaccination is considered to be a candidate to promote VZV‐specific CMI for the prevention of Hunt syndrome.
Magnetic Resonance Imaging versus Computed Tomography in Temporal Bone Carcinoma: Radiological and Pathological Correlation
Authors: Spear Samuel A. , Mehta Rahul , Jackson Neal , Ying Yu‐Lan Mary , Nuss Daniel W. , Arriaga Moises A.
Published: September 2014

Objectives:

Correlate the findings of preoperative magnetic resonance imaging (MRI) and computed tomography (CT) in temporal bone carcinoma with histopathological findings following lateral temporal bone resection.

Methods:

In this retrospective review, 11 cases of temporal bone carcinoma over the past 3 years were reviewed at our institution. Preoperative CT and MRI scans were systematically reviewed for tumor involvement in 10 anatomic areas involving and surrounding the temporal bone. These were compared with results found on final histopathology.

Results:

Among the 11 cases, 30 anatomic areas of tumor involvement identified on CT imaging were also found on MRI and confirmed on final histopathology. Two areas suggestive on tumor involvement on CT and MRI (parotid gland and regional lymph nodes) and 2 areas on MRI alone (mastoid antrum and middle ear) were negative on final histopathology. MRI did not change the preoperative clinical staging in any of the 11 cases, however, examination of the MRI in 1 case suggested temporal lobe involvement that was not seen on CT images and subsequently changed the management of the patient.

Conclusions:

The addition of MRI in the preoperative evaluation of these patients confirmed the extent of tumor involvement seen on CT and did not identify additional tumor or facial nerve involvement in most cases except for one advanced case. In this case, the addition of the MRI findings changed the treatment plan. While CT remains the imaging gold‐standard for preoperative evaluation and staging, MRI should be obtained in evaluating advanced temporal bone tumors.
Trauma‐Induced Parkinson's Syndrome
Authors: Ho Brian , Yu Jack C. , Davis Franklin , Morgan John
Published: September 2014

Objectives:

Investigate if facial fractures predispose patients to developing Parkinson's disease. Facial trauma ranges from lacerations to complex facial fractures. These fractures can result from sports, motor vehicle collisions, or assaults. The long‐term neurologic effects of facial fractures have not been studied. Significant force is required to break midface buttresses or the mandible. Such force is transmitted toward the cranial vault contents. The location of the basal ganglia along the skull base predispose this area to higher strain. Chronic traumatic encephalopathy (CTE) shows similar neurologic damage related to repeated head injuries, as seen in the NFL and boxing.

Methods:

A total of 146 Parkinson's patients were recruited from the neurology clinic. They were given a voluntary survey. This survey consisted of demographic questions: sex, age, age of diagnosis, involvement in sports, and history of facial fractures. The incidences of facial fracture ICD9 820.0 were analyzed with Wolfram Alpha and then chi‐square.

Results:

Twenty‐two of 146 (15%) had a positive history of facial fractures. Of the 22, 9 (6%) experienced multiple fractures. Twenty‐six of 146 (17.8%) patients were involved in contact sports, with 7 out of 26 patients having fractures and participating in sports. Utilizing Wolfram Alpha, the incidence of ICD9 820.0 was calculated to be 1 out of 4100 (0.024%) in the US population. A chi‐square test comparing our results showed a P value of. 023

Conclusions:

Based on these statistically significant results, patients who experience facial fractures show an increased predilection for developing Parkinson's disease.
Marginal Tympanic Membrane Perforations: A Critical View
Authors: da Costa Sady S. , Rosito Leticia S. , Canali Inesangela , Jung Yuri P. , Pauletti Marcos G. T. , Freitas Luiza A. , Jung Larissa P.
Published: September 2014

Objectives:

(1) Assess the marginal perforation prevalence in patients with chronic otitis media (COM). (2) Analyze evidence suggesting prior moderate or severe tympanic retractions (TM) of the pars tensa in marginal perforation cases. (3) Correlate the abnormal findings with those in the contralateral ear (CLE).

Methods:

Prevalence study. The bilateral videotoscopies of 1510 patients diagnosed with COM in a tertiary hospital were analyzed. Previous TM retraction was evaluated according to: (1) medialization of the manubrium of malleus, (2) remnant tympanum adhered to the ossicular chain, (3) remnant tympanum adhered to the promontory, and (4) ossicular chain erosion. The videotoscopies of the CLE were also described.

Results:

Of the 1510 patients evaluated, 34 (2.25%) had marginal TM perforation. Only 5.9% of ears showed no evidence of previous retraction, and 88.3% showed 2 or more abnormal findings. The CLE was diagnosed with perforation‐retraction (2.9%), moderate or severe retraction (52.9%), and cholesteatoma (14.7%); 23.5% were normal.

Conclusions:

The study population had a low marginal perforation prevalence. The vast majority of ears with marginal perforation had evidence suggesting previous TM retraction. In addition, retraction or cholesteatoma occurred in 70.5% of CLE.
Molecular Network of Tinnitus Focusing on BDNF Signal and Autophagy in Auditory Cells
Authors: Hayashi Ken , Goto Fumiyuki , Tsuchihashi Nana A. , Fujioka Masato , Kanzaki Sho , Ogawa Kaoru
Published: September 2014

Objectives:

Recent studies show that the expression of brain‐derived neurotrophic factor (BDNF) is decreasing in patients with depression and severe tinnitus. However, the relationship between the incidence of tinnitus and the role of BDNF remains unclear in auditory cells. The aim of this study is to consider the molecular network of tinnitus focusing on BDNF signal and autophagy in auditory cells.

Methods:

We used auditory cell line (HEI‐OC1) in this study. Tunicamycin was used as endoplasmic reticulum (ER) stress. The viability of HEI‐OC1 was determined by cell viability assays. Morphological observation was performed under transmission electron microscope (TEM). Western blot analysis was performed.

Results:

The cell viability after treatment of tunicamycin was decreased in dose‐ and time‐dependent matter. Autophagosomes and autolysososmes were confirmed into the cytoplasm of HEI‐OC1 under TEM. The expression of LC3‐II was increased in HEI‐OC1 after treatment of tunicamycin. These results mean that autophagy was consistently induced in tunicamycin‐treated cells. The expression of CHOP was decreased after peaking at 12 hours after the treatment of tunicamycin. The expression of BDNF, which has the potential to become a biomarker of tinnitus, and calcium‐dependent activator protein for secretion 2 (CAPS2) that promotes BDNF section, were decreased in tunicamycin‐treated cells. The expression of Bcl‐2 that control apoptosis and Beclin1 that regulate autophagy were decreased in tunicamycin‐treated cells.

Conclusions:

Our results lead to the suggestion that the autophagy‐mediated regulation of cell death and molecular network focusing on BDNF signal play a major part of the incidence of tinnitus.
Ossicular Chain Trauma during Middle Ear Endoscopy
Authors: Abou‐Bieh Alaa A.
Published: September 2014

Objectives:

(1) Evaluate the risk of ossicular chain trauma and injuries due to different middle ear endoscopic techniques and maneuvers. (2) Describe types, incidence, and causes of these injuries. (3) Suggest methods to avoid them.

Methods:

Thirty temporal bones were approached using 0°, 30°, and 70° otoendoscopes with 2.7 mm and 4 mm diameters. Three areas were systematically approached in each bone: retrotympanum, protympanum and epitympanum. They were also manipulated using 3 sets of otologic surgical instruments: regular straight, regular curved and especially designed for endoscopic ear surgery.

Results:

The most common injury was the fracture of the posterior stapedial curs (27%). Other types were incudostapedial joint dislocation (23%), fracture of foot plate (23%), stapes dislocation (17%), fracture both stapedial crura (13%), fracture of the incus long process (6%), and incudomalleolar joint dislocation (3%). Single injuries were 44% and combined or multiple injuries were 56%. Highest incidence of injuries was with the 70° otoendoscope (89%) and with both the straight and curved regular instruments (67%). The diameter of otoendoscopes did not affect the number of injuries. Positioning of the scopes and familiarity with the technique reduced the incidence of trauma.

Conclusions:

Middle ear endoscopy can lead to a significant risk of ossicular chain injuries with their sequelae on hearing. Minimizing this risk necessitates adequate familiarity with the anatomy, techniques and otoendoscopes and usage of especially designed surgical instruments. In addition, combining both microscopic and otoendoscopic approaches or surgically assisted otoendoscopic approaches can reduce this risk considerably.
Otologic Surgery Preoperative Imaging: Mandatory or Recommended? Useful or Defensive?
Authors: Peixoto Maria , Oliveira José , Caiado Ricardo , Melo Ana , Bastos José
Published: September 2014

Objectives:

Look for and implement guidelines for preoperative imaging requests to facilitate clinical practice and avoid medico‐legal problems.

Methods:

A review of contemporary English medical literature via Medline using the terms imaging, preoperative imaging, computed tomography (CT) scan/CT, magnetic resonance imaging (MRI)/magnetic resonance plus otosclerosis, chronic otitis media, cholesteatoma, simple chronic otitis, tympanoplasty/myringoplasty, and middle ear was performed. Abstracts were reviewed independently by two authors and relevant articles were then evaluated. Indications for preoperative imaging study for each pathology considered, benefits, main findings and the cost‐beneficial relationship were investigated.

Results:

Few articles address this issue. Otosclerosis: 152 articles, with some of the studies referring to the assessment of activity and extension of the disease, but only 3 were related to the demand for imaging. Myringoplasty/tympanoplasty: a total of 87 items were found but only 4 address the issue of preoperative imaging evaluation. Chronic otitis media/cholesteatoma: 467 articles, with 32 approaching this subject. For each abstract evaluated, conditions were considered: the indications and relevant findings versus the diagnosis controversial aspects and the real need of the request (findings that can be easily diagnosed intraoperatively).

Conclusions:

There is a growing number of otolaryngologists who routinely request preoperative imaging before middle ear surgery based on ambiguous criteria. The proposal for the creation of guidelines will help clinicians in their diagnostic decisions and to avoid medico‐legal problems.
PENTOCLO for Treatment of Osteoradionecrosis of the Temporal Bone
Authors: Glicksman Jordan T. , Khalili Sammy , Fung Kevin , Parnes Lorne S. , Agrawal Sumit K.
Published: September 2014

Objectives:

Osteoradionecrosis is a rare but devastating complication of radiation therapy that often requires surgical intervention. The objective of this report is to describe a case of osteoradionecrosis (ORN) of the temporal bone that was managed medically with PENTOCLO (pentoxifylline‐tocopherol‐clodronate). The use of PENTOCLO in the treatment of ORN of other sites in the head and neck will also be described.

Methods:

We report the case of a patient treated at our institution and present a review of literature. A 52‐year‐old woman presented with ORN of the temporal bone 20 years following radiation therapy for an ipsilateral parotid tumor. The patient had chronic infections and otorrhea.

Results:

She failed conservative treatment including antibiotic‐steroid ear drops and aural lavage. As an alternative to hyperbaric oxygen and/or temporal bone resection, treatment with PENTOCLO was pursued and her condition improved dramatically. A literature review of ORN of the temporal bone and the use of PENTOCOLO in the management of ORN of other sites of the head and neck are described.

Conclusions:

PENTOCLO was effectively used in the management of our patient and may represent a valuable management option for other patients with ORN of the temporal bone. Further research is required to determine the effectiveness of PENTOCLO.
Perilymphatic Gentamicin Trafficking through Basolateral Channels May Underlie Enhanced Ototoxicity by Noise‐Induced Threshold Shifts
Authors: Luk Lauren J. , Li Hongzhe , Steyger Peter
Published: September 2014

Objectives:

(1) Demonstrate gentamicin uptake from perilymph into hair cells via basolateral channels such as the postsynaptic acetylcholine receptor (nAChR) and the TRPA1 in neonatal mice in vivo and in vitro. (2) Recognize alternative gentamicin trafficking pathways to the well established endolymphatic mechanoelectrotransducer channel underlying aminoglycoside ototoxicity.

Methods:

Neonatal mice were intraperitoneally injected with fluorescently‐conjugated Gentamicin‐Texas Red (GTTR), prior to fixation 30 minutes later. Cochlear explants were treated with GTTR 1 µg/mL, with or without 100 µM acetylcholine or cinnamaldehyde then fixed, and analyzed. Fluorescence intensities were measured by calculating the mean gray value of each cell with Image J. Student t test was used to determine any significant differences in fluorescence values between treatment groups.

Results:

Application of acetylcholine increased GTTR uptake by wildtype outer hair cells (OHC) in vivo and in vitro. These results were also replicated in Myo7a8J/8J mice, which lack functional mechanoelectrotransducer channels. Application of cinnamaldehyde (TRPA1 agonist) also increased GTTR uptake in OHCs in wildtype, myo7a8J/8J mice and guinea pigs.

Conclusions:

Endolymphatic gentamicin trafficking via the mechanoelectrotransducer (MET) channel is a well established mechanism of ototoxicity. Noise‐induced threshold shifts (NITS) have been shown to damage the mechanically gated tip link, thus closing MET channel. However, aminoglycoside hair cell uptake is enhanced by NITS. This suggests one or more aminoglycoside entry route(s) into hair cells in addition to, and independent of, the MET channel. The results of this study support perilymphatic trafficking of gentamicin via basolateral channels including the nAChR Ca2+ channel, and TRPA1.
Pitch Adaptation Patterns in Bimodal Cochlear Implant Users: Over Time and Long‐term
Authors: Liao Selena , Eggleston Jessica , Becker Jillian , Lakin Carrie , Warren Frank M. , McMenomey Sean O. , Reiss Lina A. J.
Published: September 2014

Objectives:

(1) Characterize pitch adaptation patterns in bimodal long‐electrode cochlear implant (CI) users over time, and correlate these with electrode discrimination and speech perception outcomes. (2) Compare to pitch plasticity observed in hybrid CI users.

Methods:

Observational cohort over a 12‐month period after CI activation or of long‐term CI experience. Severe to profound hearing impairment in 19 newly activated bimodal CI users and 20 long‐term CI users was studied in an audiology clinic. Outcome measures: Electric‐to‐acoustic pitch matches, audiometric thresholds, electrode discrimination performance, and speech perception scores, measured over time.

Results:

Recently activated (12 months) subjects had these pitch adaptation patterns: pitch‐adapting, pitch‐dropping, and pitch‐unchanging. Long‐term subjects had a parallel set of adaptation patterns: matched‐pitch, low‐pitch, and nonmatched‐pitch. Unlike hybrid CI users who are mostly pitch‐adapting/matched‐pitch, the majority of bimodal CI users demonstrated pitch‐dropping/low‐pitch or pitch‐unchanging/nonmatched‐pitch. Subjects with pitch‐adapting/matched‐pitch patterns trended towards better low‐frequency thresholds. Changes in electrode discrimination were not associated with pitch differences between electrodes. Reductions in speech perception scores over time were associated with dropping‐pitch patterns.

Conclusions:

Bimodal CI users with more residual hearing seem similar to hybrid CI users in adapting pitch perception to reduce mismatch with the frequencies allocated to the electrodes and acoustic hearing. In contrast, those with less residual hearing exhibit no adaptation or a drop in the pitches of the basal electrodes. Our data suggest that electrode discrimination does not depend on perceived pitch differences between electrodes. Speech perception may depend more on pitch perception and the ability to distinguish pitch between electrodes.
Pneumococcal Colonization and Otitis Media: Streptococcus salivarius as a Probiotic Inhibitor
Authors: John Mary , Dunne Eileen , Licciardi Paul , Satzke Catherine , Wijburg Odilia , Robins‐Browne Roy
Published: September 2014

Objectives:

Nasopharyngeal colonization is the initial step in pathogenesis of pneumococcal diseases, including otitis media. Previous studies suggested that Streptococcus salivarius, a commercial probiotic, could be a potential pharyngeal probiotic. We investigated the effects of S salivarius on pneumococcal colonization and otitis media by in vitro and in vivo models of infection and colonization pattern of S salivarius by pilot study.

Methods:

Descriptive study conducted at Melbourne University and Murdoch Childrens Research Institute, Melbourne from 2011 to 2013. High, medium, or low numbers of S salivarius were added before, with, or after pneumococcal administration to human epithelial (CCL‐23) cells in vitro. The percent colonization of pneumococci was determined after 3 hours of incubation. In experiments using infant mice, repeated pernasal administration of S salivarius (~107 CFU/dose) was used as an intervention in pneumococcal colonization model and otitis media. Colonization of upper respiratory tract of healthy adults after one week of probiotic consumption was determined.

Results:

There was time‐dependent and dose‐dependent inhibition of pneumococcal adherence to CCL‐23 cells by S salivarius. However, S salivarius colonized the nasopharynx of mice poorly, and did not alter pneumococcal colonization levels or the development of otitis media in vivo. Oral administration of S salivarius in humans increased the colonization levels in the throat.

Conclusions:

Our data indicated that S salivarius can inhibit pneumococcal colonization in vitro, but not in infant mice. Colonization levels in throat increased after oral administration. Further well‐designed human trials are warranted to evaluate S salivarius as a potential probiotic to reduce otitis media.
Prevalence of Hearing Loss among Preterm Very‐Low‐Birth‐Weight Babies
Authors: Rahman Roslenda A. , Abdullah Asma , Hashim Wan F. , Awang Mahamad A. , Ishak Shareena
Published: September 2014

Objectives:

Determine the prevalence of hearing impairment and auditory neuropathy among preterm very‐low‐birth‐weight (VLBW) babies at 1 year corrected age.

Methods:

Twenty babies were recruited. The subjects underwent transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) at 34 to 36 weeks while they were still in the neonatal intensive care unit. The subjects were followed up with brainstem evoked response (BSER) at 3 months and 1 year of corrected age. A patient was considered to have hearing impairment if either 1 or both ears failed the test. The risk factors for hearing impairment are noted.

Results:

Thirty‐five percent (14 out of 40 ears) failed TEOAE and 12.5% (5 out of 40 ears) failed AABR screen. Two babies defaulted BSER appointment. BSER at 3 months corrected age showed 5.5% (1 out of 18) with bilateral profound sensorineural hearing loss, 16.7% (3 out of 18) bilateral mild conductive hearing loss, and 77.8% (14 out of 18) with normal hearing. At 1 year of corrected age 5.5% (1 out of 18) had profound sensorineural hearing loss, 5.5% (1 out of 18) mild conductive hearing loss, and 89% (16 out of 18) had normal hearing. There was no prevalence of auditory neuropathy or progressive hearing loss in this study.

Conclusions:

Those VLBW babies achieved maturity of hearing at 3 months corrected age, therefore no repeat BSER is required at 1 year.
Prevalence of Ménière's and the Importance of Socioeconomic Factors
Authors: Baugh Reginald F. , Qu Weikai , Simo Hermann , Nazzal Munier , Preis Michal
Published: September 2014

Objectives:

(1) Describe the prevalence of Ménière's disease and migraine in the United States. (2) Recognize patient and environmental factors in Ménière's disease.

Methods:

Discharge data from the Nationwide Inpatient Sample, the largest US all‐payer inpatient care database, was analyzed for migraine or Ménière's disease between 2008‐2010 in patients >10 years old. Patient characteristics, including prevalence, age, sex, race, household income, and geographic location were studied to determine any correlation with disease prevalence. T test, chi‐square, and linear regression testing were used to compare the differences between groups for continuous and categorical data.

Results:

Ménière's prevalence was 73 per 100,000, females 84 per 100,000 compared with 56 per 100,000 among males (odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.48‐1.54, P <. 01). Among Ménière's patients, migraine prevalence was 142 per 100,000 compared to 25 per 100,000 (relative risk [RR] = 5.7, 95% CI 4.7‐6.9, P <. 01) in those patients without Ménière's. Ménière's prevalence was highest in Caucasians, 91 per 100,000, and was significantly higher than other ethnic groups (P <. 05). Ménière's prevalence increased with age, with the highest prevalence found in 81‐90 year age group. Midwest prevalence (94 per 100,000) was significantly higher than other regions (P <. 001). Ménière's disease is more common in less populated locations and the prevalence decreased as population increased. Ménière's disease increased with household income. The highest prevalence was found amongst the 76th to 100th quartile with rates of 86 per 100,000 for Ménière's disease.

Conclusions:

Environmental factors, race and ethnicity, sex, and age appear to be important factors in the prevalence of Ménière's disease.
Prussak's Space: Anatomy Revisited
Authors: Abou‐Bieh Alaa A. , Haberkamp Thomas J.
Published: September 2014

Objectives:

(1) Describe the anatomy of Prussak's space (PS) using the recently available data due to the incorporation of endoscopes in its studying. (2) Evaluate previously described theories about its development, physiology, aeration, and pathophysiology of its diseases.

Methods:

Fifty‐five temporal bones were dissected, and anatomic details were studied using an operating microscope and otoendoscopes.

Results:

PS is a 3‐dimensional sagittal space located laterally and superficially to the tympanum and formed by mucosal and bony walls. Four types of PS could be distinct based on the pathways of their aeration and communication with the various spaces and areas of the tympanum, as demonstrated by the development of the mucosal folds, pouches and pathways. The first and most common type (71%) was aerated solely retrogradely via the posterior pouch of von Troeltsch. Second type (2%) was only aerated via the anterior pouch of von Troeltsch. Third type (2%) was only aerated through a special superior mucosal pathway. Spaces classified under the fourth PS type (25%) were aerated through combined or multiple pathways of the above types.

Conclusions:

PS, unlike what has been usually thought, has different types. Although the differences between these types might look trivial, they mostly contribute in the development and progress of the space pathological conditions. This might play a role in the explanation of the PS isolated infections and also the mechanism of retraction pockets and cholesteatoma formation and the modes of their extension.
Rates of Long‐term Cochlear Implant Use in Children
Authors: Contrera Kevin J. , Choi Janet S. , Blake Caitlin R. , Betz Joshua F. , Niparko John K. , Lin Frank R.
Published: September 2014

Objectives:

Determine the rate of long‐term cochlear implant (CI) use in children.

Methods:

Consecutive case series in a tertiary referral center. Approximately 474 patients younger than 18 years who received their first cochlear implantation from 1999 to 2011. Main outcome measures: Regular CI use, defined as using the CI for 8 hours or greater per day.

Results:

We successfully contacted and obtained follow‐up data on 402 patients (85%) via email, telephone, and postal survey. The rate of regular CI use was 93.2% (95% CI, 90.0‐95.4) at 5 years’ postimplantation and 87.7% (95% CI, 82.9‐91.3) at 10 years’ postimplantation. The mean number of hours of use per day was 12.0 hours (SD, 4.1 hours). Cox proportional hazard regression analysis demonstrated a linear association between the age at implantation and the risk of discontinuing regular CI use. Rates of CI discontinuation increased by 18.2% per year of age at implantation (95% confidence interval, 7.2%‐30.4%). Reported reasons for CI use less than 8 hours per day include poor hearing benefit (53.2%), social pressure (21.3%), and recurrent displacement of the transmitter coil (17.0%).

Conclusions:

High rates of regular CI use are sustained after childhood implantation, and younger age at implantation is associated with a higher rate of continued device usage.
The Association of Reflux and Lingual Tonsil Hypertrophy: A Systematic Review
Authors: Valle Elizabeth S. , Yalamanchali Sreeya , Friedman Michael
Published: September 2014

Objectives:

Evaluate the association between lingual tonsil hypertrophy (LTH), gastroesophageal reflux disease (GERD), and laryngopharyngeal reflux (LPR).

Methods:

A systematic literature search was performed using MEDLINE and the Cochrane Library databases through July 2013 to identify original research articles examining the effects of GERD or LPR on LTH in both adults and children. Only original research articles in English were retrieved using the keywords “reflux and lingual tonsil,” “reflux and base of tongue hypertrophy,” “laryngopharyngeal reflux and lingual tonsil,” “LPR and lingual tonsil,” and extraesophageal reflux and lingual tonsil.”

Results:

Out of 33 studies that matched the search criteria, 5 studies in adults and 3 studies in children met the inclusion criteria. In adults, one study noted a significantly increased prevalence of LTH in patients with signs and/or symptoms of LPR (62.4%) versus patients without signs and/or symptoms of LPR (29.3%). Four studies noted an increase in the severity of LTH in the presence of signs or symptoms of LPR. In the pediatric population, all 3 studies noted a positive association between the presence of LPR and GERD and the presence of LTH (30%‐70%).

Conclusions:

The results of this systematic review suggest an association between LTH and reflux in both adults and children. This study is limited by heterogeneity in methodology and definitions of LTH and reflux between included studies. Further investigation is needed to characterize the clinical entity of LTH as well as the nature of the relationship between LTH and reflux disease.
Screening for NIHL among Military Personnel in Eastern Province of Saudi Arabia
Authors: Al‐Saif Saud S.
Published: September 2014

Objectives:

Study the effect of noise exposure on the hearing sensitivity of the screened study subjects, analyze the questionnaire for noise exposure, and compare between hearing impairment in different noise exposure categories.

Methods:

A total of 1879 subjects were evaluated and a noise exposure survey was completed by the study group. Screening air conduction pure tone audiogram was done for each participant. Patients who did not pass the screening were referred to the ear, nose, and throat and audiology unit for further evaluation: complete history, otological examination, pure tone audiometry, tympanometry and distortion product otoacoustic emissions (DPOAEs).

Results:

The study group's average duration of duty was 10.26 ± 8.06 years. Of the study group, 33.9% were cigarette smokers. A total of 188 subjects out of 1879 (10%) did not pass the screening air conduction pure tone audiogram and they were referred to the audiology clinic. The mean emission amplitude across the DPOAEs measured frequencies in noise‐induced hearing loss (NIHL) patients at high frequencies were significantly lower than that of the low frequencies. Also it was noticed that as the hearing loss increases at high frequencies region with the NIHL the DPOAEs amplitude decreases.

Conclusions:

Ten percent of the high‐risk noise exposed subjects had high frequency hearing loss which can be minimized by using hearing protective devices during exposure to intense noise level. Reduction in the emission amplitude of DPOAEs at high frequencies region was significant in comparison with that of the low frequencies. These differences can be attributed to the hearing loss and the patho‐physiologic mechanism at the level of outer hair cells encountered in those patients.