bluuebunny/crossref_metadata_2025 huggingface dataset:
Cartilage versus Fascia in Pediatric Type 1 Tympanoplasty: Anatomic and Audiometric Results
Authors: Gupta Sachin , Kutz Joe W. , Roland Peter S. , Isaacson Brandon
Published: September 2014

Objectives:

To assess the anatomic and audiometric results of type I cartilage tympanoplasty and to compare them with the results of type I fascia tympanoplasty in children.

Methods:

A retrospective chart review was performed of pediatric patients who underwent primary type I tympanoplasty with cartilage or fascia at a tertiary academic center between July 2007 and July 2013. Patients were excluded who underwent concurrent mastoidectomy or ossicular chain reconstruction. Graft acceptance rates were compared between the 2 groups. In addition, preoperative and postoperative audiometric results were compared.

Results:

One hundred twenty patients were identified for inclusion into the study. The mean follow‐up time was 1 year. There was no significant difference between the cartilage and fascia tympanoplasty groups in terms of graft acceptance rate. Audiometrically, there were also no significant differences between the 2 groups in terms of mean pure tone average and speech discrimination score. A significantly higher percentage of patients who underwent cartilage tympanoplasty had a type B tympanogram (P <. 05).

Conclusions:

In children, cartilage and fascia tympanoplasty have similar results in terms of graft acceptance and hearing outcomes. This study corroborates the findings of other studies, that cartilage tympanoplasty is a safe and effective technique in children.
Clinical Features and Natural Course of Anteriorly Located Congenital Cholesteatoma
Authors: Chung Won‐Ho , Ryu Nam‐gyu , Chang Young Soo , Jang Kyu‐Sun , Hong Sung Hwa , Cho Yang‐Sun
Published: September 2014

Objectives:

Anteriorly located congenital cholesteatoma is a silent disease in the pediatric population. In most cases, they are diagnosed incidentally by endoscopic examination of tympanic membrane. The aims of this study were to evaluate the clinical features and natural courses of congenital cholesteatoma, especially anteriorly located group.

Methods:

From 2000 to 2012, 117 patients were diagnosed with congenital cholesteatoma. Retrospective chart review was done. Among them, 65 cases were anteriorly located congenital cholesteatoma. A total of 53 patients were exclusively located in the anterosuperior quadrant. Other cases were extended to posteriorly (n = 4) or inferiorly (n = 8). Age distribution, types (closed or open), volumes (measured by tetrahedron beam computed tomography), ossicular involvement, and possible origin of cholesteatoma were assessed.

Results:

Mean age was 3.07 years (1‐6). Patients older than 6 years were not encountered. Closed type was 61.5% (n = 40) and open type was 38.5% (n = 25). Volume of cholesteatoma was 59.38 ± 6.53 mm3 (closed type: 33.02, open type: 98.44). The incidence of open type and volume increased as age increased. Hearing loss was found in 5 cases. Ossicular involvement was found in 4 cases. During surgery, in many cases, the attachment of cholesteatoma to anterior side of cochleariform process was found by endoscopic examination.

Conclusions:

Anteriorly located congenital cholesteatoma seems to originate from the anterior side of the cochleariform process. Its size grows with age and tends to rupture into open type. In addition, it might be washed out through E‐tube as patients get older.
Cochlear Implantation Outcome in Patients with Common Cavity Deformity
Authors: Igarashi Kazunori , Hoshi Yujiro , Ashio Akinori , Karino Shotaro , Akamatsu Yusuke , Ogata Erika , Amasoba Tatsuya
Published: September 2014

Objectives:

(1) Analyze our own cases and those in published reports involving cochlear implantation (CI). (2) Determine the factors affecting outcome in patients with common cavity (CC) deformity.

Methods:

We reviewed the English and Japanese literature published from January 1995 to December 2013 using the keywords “CC,” “CI,” and “cochlear malformation.” We included cochlear implanted CC patients whose records on occurrence of cerebral spinal fluid (CSF) gusher, facial nerve stimulation (FNS), number of inserted and actively used electrodes, or hearing levels before or after CI were available.

Results:

A total of 72 cochlear implanted CC patients were identified from 11 reports, including 5 patients from our institution. Individual hearing results as monosyllable and word scores were reported in 9 and 15 patients, respectively. Monosyllable hearing levels were greater in patients inserted with ≥20 electrodes and in those younger at time of CI. CSF gusher occurred in 18 (32%) of 57 patients, and FNS occurred in 12 (44%) of 27 patients.

Conclusions:

Individual data are important in assessing the outcome after CI in patients with CC because the outcomes vary significantly. Although there have been several reports, only a few have reported efficient data to discuss the propriety of each operation. Younger age at CI and greater number of inserted electrodes were associated with better outcome following CI in patients with CC. However, additional data are needed to confirm our findings.
Comparison of 3 Different Steroid Regimes for Idiopathic Sudden Sensorineural Hearing Loss: Trinidadian Experience
Authors: Trinidade Aaron , Trinidade Austin I.
Published: September 2014

Objectives:

Compare the efficacy of 3 steroid regimes in the management of idiopathic sudden sensorineural hearing loss (ISSNHL) in an adult population in Trinidad, West Indies, where management of this phenomenon has not previously been described.

Methods:

Retrospective review from 2005 to 2013 of 71 adults presenting with unilateral ISSNHL and treated within 72 hours of onset at a private general otolaryngology practice in Trinidad. Patients fell into 3 treatment groups: Group 1, oral prednisolone as the primary modality (n = 25); Group 2, oral prednisolone followed by salvage intratympanic methylprednisolone (n = 28); Group 3, intratympanic methylprednisolone as the primary modality (n = 18). Oral prednisolone was given as 60mg/d for 2 weeks and intratympanic methylprednisolone was given as 1 mL of a 40 mg/mL solution once weekly for 3 weeks.

Results:

Audiometric measurements were taken pre‐ and poststeroid therapy. Group 1: 50% (n = 13) of patients experienced an improvement in hearing (average 8 dB). Group 2: 22% (n = 6) of patients experienced an improvement in hearing (average 10 dB). Group 3: 88% (n = 16) of patients experienced an improvement in hearing (average 15 dB).

Conclusions:

The use of intratympanic methylprednisolone as a primary modality in ISSNHL is likely to be more beneficial than oral prednisolone or as salvage therapy following prednisolone. Early intervention is associated with more favorable outcomes.
Comparison of Tinnitus Characteristics and the Impact on Patients with Presbycusis and Noise‐Induced Hearing Loss
Authors: Rosito Leticia S. , Dalligna Celso , Dalligna Daniela P. , Deutsch Konrado M. , Beduschi Giuliana , Jorge Karolina B. , Pappen Carlos H.
Published: September 2014

Objectives:

Compare acufenometry findings of patients with chronic unilateral disturbing tinnitus due to noise‐induced hearing loss (NIHL) or presbycusis, and determine if there is an association with the degree of annoyance.

Methods:

In this cross‐sectional study, 38 patients with presbycusis and 17 with NIHL were evaluated between September 2003 and January 2014. The tinnitus pitch and loudness were evaluated using acufenometry. Tinnitus handicap inventory (THI) and the visual analog scale (VAS) were used to assess the impact of tinnitus on the patient's life. Statistical analysis was performed using SPSS and Student t test.

Results:

The mean age of the patients with presbycusis and NIHL was 67.74 ± 8.73 years and 62.29 ± 9.57 years, respectively (P =. 04). The tinnitus pitch (3092 ± 2203 Hz vs 4220.59 ± 2907.26 Hz; P =. 12) as well as the loudness (42.71 ± 19.80 vs 47.40 ± 20.80; P =. 44) were similar in both groups. In addition, no statistically significant difference was observed in the THI and VAS of either group (P =. 76 and P =. 46, respectively).

Conclusions:

Despite the differences observed in the cause of tinnitus and the mean ages of the patients, no significant difference was observed in the behavior of tinnitus in the groups with presbycusis and NIHL. Furthermore, tinnitus had a similar impact on the lives of patients from both groups.
Conchal Approach Tympanoplasty
Authors: Man S. Christopher , Nunez Desmond A.
Published: September 2014

Objectives:

(1) Review standard tympanoplasty approaches. (2) Describe a novel approach that minimizes soft tissue dissection and provides good access.

Methods:

The charts of consecutive adult patients who underwent a conchal approach tympanoplasty between January 2010 and December 2012 at an urban teaching hospital under the care of a single surgeon were reviewed. The patient's age in decades at the time of surgery, sex, and proportion of intact tympanic membranes noted at follow‐up were recorded. Postoperative analgesic use and patient recorded satisfaction with the cosmetic appearance of the ear using a Likert type scale from 1 least to 5 most satisfied was collected for consecutive patients undergoing the procedure in 2013. The mean patient satisfaction score was calculated.

Results:

In the 3‐year period from 2010‐2012, the charts of 75 adults were reviewed. There were 45 females and 30 males with ages ranging from third to eighth decades. Complete tympanic membrane closure was achieved in 74 (98.7%). Twenty‐one adults treated in 2013 recorded a mean satisfaction score with the appearance of the postoperative ear scar of 4.8 out of 5. Postoperative analgesic consumption consisted of acetaminophen or diclofenac sodium on the day of surgery. No patients used analgesics beyond postoperative day 2.

Conclusions:

The conchal approach tympanoplasty is associated with a high graft take rate, low morbidity and high patient satisfaction with scar cosmesis.
Preoperative Peroneal Perforator Mapping with Dynamic Time‐Resolved Magnetic Resonance Angiography
Authors: Lawson Bradley R. , Ram Roopa , Pandey Tarun , Jambhekar Kedar , Moreno Mauricio A.
Published: September 2014

Objectives:

Dynamic time‐resolved magnetic resonance angiography (DTR MRA) is a novel imaging algorithm that allows for better visualization of small‐caliber vessels when compared with standard MRA. We sought to estimate the technique sensitivity when compared with intraoperative findings.

Methods:

Retrospective review of 25 patients undergoing reconstruction with free fibula flap at an academic tertiary setting from 2009 to 2013. Preoperative DTR MRA was performed in all cases. Two radiologists performed blind reviews of the images and their findings were compared with surgical descriptions of the perforator anatomy.

Results:

Surgical exploration identified 32 perforators while DTR MRA identified 45 vessels. The technique confirmed the presence of perforators in 22 out of 23 patients with at least one perforator, and their absence in 1 out of 2 patients who had a negative exploration. There was a significant correlation in the number of perforators identified clinically and radiologically in each case (P =. 005). Twenty‐seven perforators were localized to their correct anatomic location by the technique, yielding a sensitivity of 84.4% and a specificity of 16.7%. Ten out of the 18 vessels incorrectly identified by this technique were located within 30 mm of a confirmed perforator.

Conclusions:

DTR MRA is a highly sensitive technique for determining the presence and location of cutaneous perforators in patients undergoing reconstruction with free fibula flap. The majority of the false‐positive findings corresponded to vessels located within 30 mm of a confirmed perforator; we hypothesize that they could represent distal branching patterns presenting radiologically as separate entities. These results compare favorably to perforator mapping with standard MRA techniques.
The Effect of Controlled‐Release Hyaluronic Acid on Drug Delivery to the Cochlear Spiral Ganglion
Authors: Inagaki Yozo , Kanzaki Sho , Fujioka Masato , Ogawa Kaoru
Published: September 2014

Objectives:

The spatiotemporal distribution of drugs in the inner ear has not fully been characterized because of the area's small size and complicated compartments. In the present study, we investigate the pharmacokinetics of a small molecule conjugated with different amounts of carrier in the cochlea by using transgenic technology and the IVIS Imaging System.

Methods:

Luciferin, a 280 MW substrate of luciferase, was conjugated with different MW of hyaluronic acid and was subcutaneously administered to the transgenic mouse, GFAP‐luc, which expresses luciferase specifically in the cochlear spiral ganglion cells. Bioluminescence produced by a chemical reaction of luciferin‐luciferase was monitored using the Xenogen‐IVIS 100.

Results:

The peak photon count decreased dose‐dependently on the MW of hyaluronic acid, whereas the duration was prolonged.

Conclusions:

Our imaging system successfully detected differences in the pharmacokinetics of luciferin in the inner ear. The sustained‐release effect of hyaluronic acid was observed and differed by its MW. The result suggests the clinical significance of hyaluronic acid for controlling drug delivery to the cochlea.
Quantitative Analysis of Functional Rhinoplasty Procedures: A Cadaveric Study to Evaluate a Novel Assessment Technique
Authors: Haffey Timothy M. , Vakharia Kalpesh T.
Published: September 2014

Objectives:

A wide array of surgical techniques has been developed to address internal nasal valve collapse. In particular, butterfly grafts and spreader grafts are used ubiquitously without any objective comparison being made on the efficacy of these approaches. The objective of this study was to quantitatively assess the effect that these techniques have on lateral nasal wall compliance.

Methods:

A total of 11 fresh nonfixed cadavers (22 valves) were utilized for this study. Baseline measurements of lateral wall compliance were performed using a tension gauge and a novel procedure (herein described), and each nasal valve was measured independently. The valves were augmented with butterfly graft, endonasal spreader graft, and open spreader graft. Lateral nasal wall compliance was measured after each technique, and statistical analysis was performed.

Results:

There was an increase in force required to displace the lateral nasal wall compared with baseline after butterfly and endonasal spreader techniques (P <. 05). The greatest effect was after butterfly‐type graft placement (P <. 05). An endonasal spreader graft technique resulted in a stiffer lateral nasal wall when compared to the open technique (P <. 05). Open spreader graft had no effect relative to baseline measurements.

Conclusions:

This cadaveric study describes the application of a novel assessment tool used to quantitatively compare different grafting techniques used in functional rhinoplasty. Butterfly grafts are the most effective in strengthening the lateral nasal wall. Endonasal spreader grafts are also effective to a lesser degree. Open spreader techniques had no effect on the compliance of the lateral nasal wall.
The Effects of Cochlear Implant Signal Processing on Discrimination of Musical Instrument Harmonic Changes
Authors: O'Niel Mallory B. , Friedland David R. , Runge Christina
Published: September 2014

Objectives:

Compare MED‐EL fine structure processing (FSP) and high‐definition continuous interleaved sampling (HDCIS) in discrimination of musical instrument harmonic changes.

Methods:

Twelve MED‐EL users were programmed with novel FSP and HDCIS maps. With each map they underwent discrimination testing of paired sound stimuli. The stimuli were native and harmonically‐manipulated sound clips of a single note played by an instrument. The instruments tested were the trumpet, alto saxophone, and tuba. The harmonic manipulations consisted of removal of either the first or second harmonic. Discrimination was quantified by calculating d′; higher d′ values indicated better performance.

Results:

There were no significant differences in discrimination performance between FSP and HDCIS across conditions. However, for both strategies, significant differences in discrimination were observed between discrimination of the first and the second harmonic manipulation conditions for the trumpet and the tuba. For trumpet, significantly better performance was observed with removal of the second harmonic (d′ = 1.57) compared with removal of the first harmonic (d′ = 0.58; P <. 05). For tuba, the opposite was observed (first d′ = 1.12, second d′ = 0; P <. 05). Discrimination of the saxophone stimuli was significantly more difficult compared to the other instruments, which was likely related to the saxophone harmonics’ close frequency/channel proximity.

Conclusions:

Results from this novel‐map study did not show a difference in harmonic cue discrimination between FSP and HDCIS. Evidence was found regarding important harmonic information for individual instruments tested. Perception of harmonic cues could be affected by channel discrimination. These results can be used to improve cochlear implant signal processing strategy.
Efficiency of Exploration of Molecular Genetic Etiology for Cochlear Implantees and Its Implication
Authors: Park Joo Hyun , Kim Nayoung K. D. , Kim Ah‐Reum , Koo Ja‐Won , Oh Seung Ha , Park Woong‐Yang , Choi Byung Yoon
Published: September 2014

Objectives:

Evaluate the efficiency of exploration of molecular genetic etiology for cochlear implantees (CI).

Methods:

Ninety‐four patients of 273 CIs who consented to molecular genetic testing (MGT) were included. Patients with either a characteristic radiologic or audiologic marker were subject to Sanger sequencing of corresponding candidate genes. The GJB2 gene was sequenced in patients with no phenotypic marker. Targeted resequencing of known 200 deafness genes (TRS‐200) was applied to GJB2‐negative cases with no phenotypic marker. The recurrence risk of hearing loss (HL) between undiagnosed probands after TRS‐200 and diagnosed probands with autosomal recessive genotype was evaluated.

Results:

Thirty of 42 probands (71.4%) who underwent the direct Sanger sequencing of candidate genes were diagnosed. The most rewarding phenotypic markers were enlarged vestibular aqueduct (with/without incomplete partition [IP] type II) and IP type III, followed by long QT syndrome, lateral semicircular canal dysplasia as a part of the constellation of anomalies suggesting a CHARGE syndrome, and ski‐slope type high frequency HL. Focusing upon these 5 markers, the detection rate went up to 83.3% (30/36). Ten of 52 probands carried mutant allele of GJB2. The detection rate by TRS‐200 was 26.0% (12/46). The recurrent risk of HL was calculated to 0.03 (95% confidence interval [CI] 0‐0.13) in undiagnosed group and 0.18 (95% CI 0.09‐0.34) in diagnosed probands.

Conclusions:

Molecular genetic diagnosis was made in 55.3% (52/94) of CIs through our hierarchical MGT. The sequencing of high‐yield candidate genes associated with phenotypic markers will be useful for evaluating deaf patients cost‐effectively before applying next generation sequencing. A Mendelian genetic etiology does not seem to contribute to undiagnosed probands after TRS‐200.
Electrode Migration after Cochlear Implantation in Association with External Auditory Canal Closure
Authors: Wood Joshua W. , Watkins Jeremy P. , MacDonald Charles B.
Published: September 2014

Objectives:

(1) Review the occurrence of electrode migration following cochlear implantation. (2) Compare the rate of migration in those patients who underwent concurrent radical mastoidectomy.

Methods:

A retrospective case series of all patients who underwent cochlear implantation at our institution, with a single surgeon, between 2001 and 2013. The specific outcome studied was implant migration. A total of 224 patients underwent cochlear implantation with a total of 294 implants performed. Four patients (1.3%) underwent radical mastoidectomy with Rambo type obliteration of the external auditory canal.

Results:

This approach was used in 2 young children with congenital malformations to provide adequate exposure for cochleostomy, and both of these patients experienced electrode migration. In 2 older patients this approach was used due to chronic infections, and neither of these patients has electrode migration. Of the 224 patients in the series who underwent cochlear implantation, these 2 children are the only patients who have experienced implant migration.

Conclusions:

Electrode migration is a rare complication following cochlear implantation. In our experience, there seems to be a higher incidence of electrode migration in patients who have undergone cochlear implantation in association with radical mastoidectomy with external auditory canal obliteration. Alternative techniques to avoid the need for the canal‐wall‐down mastoidectomy with Rambo closure have been used with success and are described in detail.
Evaluation of Hearing Results of Anterior Atticoantrostomy in Childhood Cholesteatoma
Authors: Uyar Yavuz , Kumral Tolgar L. , Salturk Ziya , Atar Yavuz , Berkiten Güler , Yildirim Guven , Kilic Mehmet V.
Published: September 2014

Objectives:

We aimed to evaluate hearing results and complications of anterior atticoantrostomy in pediatric patients who had cholesteatoma.

Methods:

This is a clinical retrospective study. Fifty children who underwent anterior atticoantrostomy for cholesteatoma were included. Patients’ preoperative and postoperative pure tone audiometry results were compared. In addition, postoperative complications including formation of retraction pockets, perforation, recurrence of cholesteatoma, and absorption of cartilage were analyzed.

Results:

The mean age of the patients was 12.7 years, with 27 female and 23 male patients. Patients’ preoperative and postoperative air‐bone gaps were narrowed significantly. Number of retraction pockets, recurrence of cholesteatoma, and perforations seen were 3, 7, and 4, respectively.

Conclusion:

Anterior atticoantrostomy is a safe method with low complication rate and can be applied in pediatric cholesteatoma cases with good hearing results.
Evolution of the Degree of Peripheral Facial Palsy in Diabetic and Nondiabetic Patients
Authors: Ribeiro Thais K. , Testa José Ricardo G.
Published: September 2014

Objectives:

Peripheral facial palsy (PFP) is a disorder of common neural causes that are still unknown. Other possible causes include vascular disorders, inflammatory and immunological factors, and possibly viral infections. According to the literature there is an association between the incidence of PFP and diabetes mellitus (DM), a disease which is known to cause neuropathies. The objective of this study is to evaluate the outcome of patients with concomitant DM and PFP, as well as to compare the evolution of these patients compared to patients without DM and PFP through clinical, laboratory, and electrophysiological tests.

Methods:

An observational case‐control study. Outpatient follow‐up between 2011‐2012 of 50 patients according to the presence or absence of PFP and DM that were divided into 4 groups and matched. All patients underwent the following tests: tearing (Schirmer's test), tonal and speech audiometry, tympanometry with reflex of the stapedius muscle, Test Hilger, and glucose analysis.

Results:

The rate of complete recovery considered grade I or II of the House‐Brackman classification at the end of 6 months of follow‐up showed that 58.4% of diabetic patients presented a good evolution in contrast to 80% of nondiabetics.

Conclusions:

In our findings we concluded that diabetic patients had a slower recovery time and poor degree of facial paralysis when compared to nondiabetics.
The Exclusive Endoscopic Traspromontorial Approach and Its Pilot Clinical Experiences
Authors: Alicandri‐Ciufelli Matteo , Marchioni Daniele , Presutti Livio
Published: September 2014

Objectives:

Describe a minimally invasive transcanal endoscopic approach, starting from the external auditory canal and reaching the internal auditory canal, used to treat inner ear pathology.

Methods:

Three patients, affected respectively by cochlear schwannoma, acoustic neuroma, and temporal bone cholesteatoma, were treated by an exclusive endoscopic approach without external incisions. Surgical steps and useful landmarks were reviewed and described.

Results:

The operation provided a direct transcochlear intradural approach from lateral to medial and from external to internal auditory canal, without any external incision. The pathology was totally removed in all patients. Results regarding facial nerve were very satisfying. Hospital stay was markedly reduced compared to traditional approaches.

Conclusions:

The transcanal exclusive endoscopic approach proved successful for pathology removal involving the fundus, internal auditory canal, and cochlea. Potential future application of this kind of approach in lateral skull base surgery will depend on the development of technology and surgical and anatomical refinements.
Expression of Angiogenic Molecules in Cochlear Vasculature
Authors: Lee Sungsu , Cho Hyong‐Ho
Published: September 2014

Objectives:

(1) Three‐dimensionally (3D) visualize the cochlear vessels and blood‐labyrinth barrier. (2) Analyze the expression of angiogenic molecules in cochlear vessels.

Methods:

Postnatal day 5 and 8‐week old mice were used. After obtaining the cochlea, bony shell was removed. Whole mount immunostaining was done with endothelial cell marker PECAM‐1 and VE‐cadherin. NG2 and demins were used for pericyte marker. aSMA was used as vascular smooth muscle cell and S100 was used as fibrocyte marker. 3D reconstruction was done to visualize the blood‐labyrinth barrier components. VEGFR2, VEGFR3, Sox17, angiopoietin‐2, Dll4 were used for angiogenic markers. Claudin‐5 was used to visualize the tight junction.

Results:

We could visualize the cochlear vasculature in overall, from precapillar arteriole, stria vascularis, and postcapillary venule. The relationship between components of blood‐labyrinth barrier also could be visualized from basal turn to apical turn of the cochlea. Cochlear vessels well expressed VEGFR3, VEGFR2, Sox17 in the endothelial cell showing that cochlea is in active state, not static. Claudin‐5 was robustly expressed suggesting its important role in blood‐labyrinth barrier. aSMA was well expressed demonstrating its need for vessel contraction.

Conclusions:

A vessel is not merely a conduit for blood flow. It is newly made and is also regressed. It permits or limits many molecules on crossing over to the tissue. The cochlear vessel is an active vessel. We suggest that visualizing the cochlear vessel and checking the expression of angiogenic molecules could help understand the pathophysiology in hearing loss models.
Reconstruction of Oromandibular Defects after Prior Irradiation Using a Temporalis Muscle and Temporoparietal Fascia Flap
Authors: Zenga Joseph , Diaz Jason A. , Nussenbaum Brian A. , Rich Jason T. , Sclaroff Allen
Published: September 2014

Objectives:

Reconstruction of oromandibular defects in the setting of previous treatment, or significant patient comorbidities, presents a significant challenge. Although free tissue transfer has shown success, it is not without considerable risk, especially in patients with poor baseline functional status. In these patients, regional pedicled flaps may provide a more suitable alternative. The combined temporalis muscle and temporoparietal fascia flap is a versatile option for oromandibular reconstruction in a previously treated field, or in patients with severe comorbidities and poor functional status. Our objective was to report our experience using a combined temporalis muscle and temporoparietal fascia flap for reconstruction of oromandibular defects in high‐risk situations.

Methods:

Three patients were identified, medical records were reviewed, and their clinical courses were described. Functional outcomes were reviewed. We include a discussion of the relevant surgical anatomy and operative technique. All patients had previously undergone extensive treatment. They needed additional ablative surgery for different reasons: new malignancy, intractable trismus, and osteoradionecrosis. A combined temporalis muscle and temporoparietal fascia flap was used to reconstruct the oromandibular defects in each patient.

Results:

All flaps survived. Functional status improved in all patients. There were no significant operative or postoperative complications.

Conclusions:

The combined temporalis muscle and temporoparietal fascia flap provides a reliable option for reconstruction of complex oromandibular defects in high‐risk situations. In previously treated fields, the transfer of a vascularized flap into the wound hastens healing and improves the quality of native oral cavity tissue.
Hearing Efficacy of Intratympanic Methylprednisolone Perfusion for Severe and Profound Sudden Sensorineural Hearing Loss
Authors: She Wandong , Dai Yanhong , Hou Jie , Lu Ling
Published: September 2014

Objectives:

Investigate the efficacy of intratympanic methylprednisolone perfusion (IMP) for severe and profound sudden sensorineural hearing loss (SSNHL).

Methods:

Hearing recovery was analyzed retrospectively in SSNHL patients, who received IMP after not fully responding to conventional treatments and were hospitalized in our department between January 2008 and December 2012.

Results:

Eighty‐seven patients with SSNHL were divided into 4 types according to primary hearing curve: total deafness (77.01%), mild to moderate hearing loss in all frequencies (18.39%), hearing loss in low‐tone frequencies (2.30%), and hearing loss in high‐tone frequencies (2.30%). The effective rate was 66.7% and average pure tone average (PTA) improvements were 18.53 ± 13.54 dB in the patients of interval from onset to IMP within 15 days, 21.2% and 5.92 ± 15.18 dB in the patients of interval between 16 and 30 days, 4.8% and 3.69 ± 7.00 dB in the patients of interval more than 30 days, respectively. The effective rate had significant differences among the 3 different interval groups (χ2 = 25.91, P =. 000), and the PTA improvements in the patients of interval within 15 days were the best in the 3 groups (F = 11.182， P =. 000). A total of 30 cases were responsive to IMP, one of them was hearing loss in low tone frequencies and the other 29 cases were in all frequencies. The average hearing improvements in the lower 3 frequencies (0.25 kHz‐1 kHz)were better than those in the higher 3 frequencies (2 kHz‐8 kHz; F = 9.494, P =. 000).

Conclusions:

Receiving IMP earlier may help to improve hearing recovery for the patients with SSNHL not fully responding to conventional treatments. The hearing improvements in the lower frequencies may be better than those in the higher frequencies after IMP.
Hyperbaric Oxygen Therapy for Sudden Hearing Loss after Failure of Intratympanic and Oral Corticosteroid Therapy
Authors: Celis‐Aguilar Erika , Burgos‐Paez Alan , Mayoral‐Flores Homero O. , Bernal‐Espinoza Yancy M. , López‐Ramos Enrique G.
Published: September 2014

Objectives:

Determine the efficacy of hyperbaric oxygen therapy (HBOT) in idiopathic sudden sensorineural hearing loss (ISSHL) after unsuccessful treatment with oral and intratympanic corticosteroids. The current treatment for ISSHL remains controversial. Systemic and intratympanic steroids are usually prescribed; unfortunately, only 61% of patients achieve full recovery. Recently, hyperbaric oxygen therapy has emerged as a new possible treatment.

Methods:

Case series at a secondary care center. Patients were included from March 2013 to July 2013. Inclusion criteria: age >18 years, failure to systemic and intratympanic corticosteroids. Ten sessions of HBOT were conducted, 60 minutes each, at 2 atmospheres. All patients underwent audiometry before and after treatment. Pure tone average (PTA) was defined as the average of the frequencies of 500, 1000, 2000, and 4000 Hz.

Results:

We included 4 female patients, mean age 51 years. The mean time from onset of illness to HBOT was 108.75 days. Initial mean PTA was 55.31 dB, final PTA was 54.6875 dB (P =. 958). Mean hearing gain was 0.625 dB. One patient had complete hearing recovery, 2 patients slight improvement (recovery of 3.75 dB), and 1 patient worsened. Two patients reported subjective improvement of dizziness. Although hearing gain was observed at low frequencies in 2 patients (25 dB and 20 dB), no statistical significance was achieved (P =. 817). No complications were reported.

Conclusions:

The use of HBOT in patients who fail steroid therapy did not demonstrate a beneficial hearing effect in ISSHL patients. However, symptoms such as dizziness improved subjectively. More studies are needed to corroborate our results.
Images on the Way to the Cochlear Nucleus Complex for Auditory Brainstem Implantation in Children
Authors: Colletti Giacomo , Mandala Marco , Colletti Liliana , Colletti Vittorio
Published: September 2014

Objectives:

Identify and differentiate among the cranial nerves (CN) and vessels close to the foramen of Luschka (FL) and improve the understanding of the normal and abnormal microanatomy in children with cochlear nerve deficiency (CND) fitted with auditory brainstem implants (ABI).

Methods:

From 2000 to 2013, 64 children ranging in age from 8 months to 16 years (2.92 ± 1.54) with CND and several degrees of cochlear abnormalities were video‐recorded during retrosigmoid surgery for ABI fitting. Four independent experts retrospectively examined all the videos. CNs VI, VII, IX, X, XI and the vascular structures around the FL were identified either by surgical inspection and/or intraoperative neurophysiological monitoring.

Results:

Cranial nerves VI, VII, VIII were absent respectively in 3, 8 and 64 children; CN VII had an aberrant course in the CPA in 18 children; bifurcated in 4 and trifurcated in 3; CNs IX, X and XI were observed in all children; a double CN XI was observed in 2 children; and the nerve root bundles of the cranial and spinal segment of CN XI were identified in 48 and 52 children, respectively. Landmarks useful in identifying the FL included the nervus intermedius, CNs VII and IX, and the choroid plexus of the lateral recess.

Conclusions:

The collection of surgical images allowed a successful display of the detailed normal and abnormal anatomy of the CNs and vessels around the area of the FL. These data have the potential to facilitate an uneventful approach to the FL and a correct insertion of the ABI array.
The Impact of Diving on Hearing of Industrial and Recreational Divers
Authors: Gurpinar Berk
Published: September 2014

Objectives:

This study aims to determine the negative effects of diving on hearing and to compare the hearing levels of the industrial divers to the recreational ones.

Methods:

The study was conducted among industrial divers (ID) and recreational divers (RD) between June 2012 and November 2013. A total of 30 industrial divers and 30 recreational divers were recruited. The participants received a self‐structured questionnaire, detailed otolaryngologic, otologic, and radiologic examinations. The continuous variables were compared using the Student t test or analysis of variance.

Results:

The mean age of the ID group was 28.3 ± 4.4 and RD was 32.7 ± 5.2. Hearing levels above 25 dB were considered as normal. No significant hearing loss was obtained in the ID group while the RD group had mild to moderate hearing loss (P <. 001). Divers older than 30 years of age had higher hearing losses.

Conclusions:

Although IDs dive more frequently than RDs, their age, physical capacity, and diving depth plays a major saving role on their hearing levels. It is a well‐known fact that RD are older and dive deeper. To best of our knowledge and from our results, older age and deeper depths are believed to worsen the hearing levels.
Role of Vastus Lateralis Myofascial Free Flap in Reconstruction of Head and Neck Defects
Authors: Robb Philip , Boyette Jennings R.
Published: September 2014

Objectives:

There is a paucity of data regarding the role of the vastus lateralis free flap (VLFF) in head and neck reconstruction. Our objectives were to (1) describe the flap outcomes in this setting and (2) identify ideal clinical scenarios for its use.

Methods:

Retrospective review of 7 patients undergoing reconstruction with a VLFF at an academic tertiary institution between 2009 and 2013. Demographics, indications, complications, and outcomes were retrieved.

Results:

There were 4 males and 3 females with a mean age of 54.7 years. Indications included skull base reconstruction (n = 3/43%), scalp/calvarial defect (n = 2/28%), maxillary (n = 1), and exposed pharyngeal cervical spine hardware (n = 1). The myofascial component length ranged from 7 to 20 cm, and width ranged from 6 to 11 cm, with a mean area of 102 cm2 (range, 35‐240). The mean pedicle length was 11.3 cm. Handheld (n = 3) or implantable (n = 4) Doppler was used for monitoring, and there were no flap losses. The flap was skin grafted in 3 cases with no reported graft loss. The mean intensive care unit stay was 1.1 days (0‐3) and length of stay was 7.8 days (5‐13). Complications included wound infection (n = 1) and myocardial infarction (n = 1) in a patient with significant comorbidities. The donor site was closed primarily in all cases, with no significant donor site morbidity reported.

Conclusions:

The VLFF is an underutilized option in head and neck reconstruction. This flap provides a large amount of soft tissue that can be harvested in supine position and with minimal donor site morbidity. Given its long pedicle and variable myofascial component that can be tailored to a wide range of defects, the VLFF appears ideal for skull base reconstruction.
Indications, Results, and New Frontiers of Auditory Brainstem Implants in Children
Authors: Monsanto Rafael C. , Bittencourt Aline G. , Neto Natal J. B. , Beilke Silvia C. A. S. B. , Salomone Raquel , Lorenzetti Fabio T. M.
Published: September 2014

Objectives:

Review the literature regarding auditory brainstem implant (ABI) indications, surgical techniques, activation methods, and postsurgery follow‐up in children.

Methods:

A search was performed in LILACS, MEDLINE, SciELO, and PubMed databases from January to March 2013, and the key words used in the search were brainstem AND implant OR implantation AND children OR child. Studies that referred to results of the ABI fitting process in children were selected.

Results:

Seventy‐two studies that met the criteria were read in full; 17 studies referred to the ABI fitting process in children and were selected for appraisal. The studies showed the cases of 49 children (younger than 18 years old) fitted with ABIs. Evaluation after surgery showed that 47 (95.9%) of the patients improved in their ability to recognize environmental sounds and speech perception. Patients with tumors or those with cochlear or cochlear nerve malformations had good outcomes as well. Two of the children achieved no sound perception upon ABI activation.

Conclusions:

The US Food and Drug Administration (FDA) only approves the auditory brainstem implant for children older than 12 years old, but good outcomes in children younger than that age were achieved, improving environmental sound awareness and oral language development. The FDA only recently approved clinical trials for patients younger than 12 years old. We propose that the FDA auditory brainstem implant indications should be extended to patients with nontumoral diseases of the cochlea and cochlear nerve and younger than 12 years old.
Intraoperative Round Window Electrocochleography and Speech Perception Outcomes in Pediatric Cochlear Implant Recipients
Authors: Formeister Eric J. , McClellan Joseph H. , Merwin William H. , Iseli Claire E. , Buchman Craig A. , Fitzpatrick Douglas , Adunka Oliver F.
Published: September 2014

Objectives:

(1) Understand how intraoperative electrocochleograpy (ECoG) is used for assessing residual cochlear function in pediatric implant recipients. (2) Appreciate the utility of electrocochleograpy in predicting speech perception outcomes.

Methods:

A prospective cohort study of pediatric cochlear implant patients at a tertiary hospital was conducted starting in July 2011 and is ongoing. ECoG recordings were obtained from 77 children (89 ears) during cochlear implantation and provided a total response metric that can quantify the underlying hair cell and neural health. Follow‐up speech perception tests were conducted at ≥7 months postoperatively with the phonetically balanced kindergarten (PB‐k) word lists (n = 24). PB‐k scores were compared to ECoG total response and other clinical and audiologic variables using multiple linear regression analysis in order to construct a parsimonious model for predicting speech outcomes.

Results:

Postoperative PB‐k scores were significantly correlated with ECoG total response (r2 = 0.32, P =. 006) and preoperative pure tone averages (PTA; r2 = 0.41, P =. 001). ECoG total response was weakly and inversely correlated with PTA (r2 = 0.14, P =. 001, n = 89). Hierarchical multiple linear regression identified a model for speech perception performance that included preoperative PTA, duration of cochlear implant use, and ECoG total response that predicted about half of the variance in PB‐k performance (adjusted r2 = 0.49, P =. 002).

Conclusions:

Intraoperative ECoG recordings are significantly correlated with speech perception outcomes in pediatric cochlear implant recipients and alone can account for a similar proportion of variance in speech perception when compared to other bioaudiometric factors. ECoG provides useful prognostic information about attainment of open set speech perception in children.
Intratympanic Dexamethasone in the Treatment of Ménière's Disease
Authors: Gupta Sachin , Isaacson Brandon , Kutz Joe W. , Roland Peter S.
Published: September 2014

Objectives:

Describe vertigo control outcomes when intratympanic steroid injections are used for medically refractory Ménière's disease.

Methods:

A retrospective chart review was performed of patients diagnosed with unilateral Ménière's disease at a tertiary academic center. Patients were included who underwent intratympanic (IT) dexamethasone therapy after failing initial medical treatment between July of 2007 and July of 2013. Vertigo control was defined as when patients were satisfied and did not progress to further nonablative or ablative treatment.

Results:

Forty‐one patients with Ménière's disease underwent IT dexamethasone injections after failing medical therapy. Twenty‐six patients (63%) underwent more than 1 injection, with a median of 2 injections in the study population. Fifteen patients (37%) had vertigo control, at a mean follow‐up time of 9 months after the last injection. Vertigo control required 1 injection in 6 patients (40%), 2 in 2 patients (13%), 3 in 5 patients (33%), 4 in 1 patient (7%), and 5 in 1 patient (7%). Nineteen patients (46%) underwent further treatment that included endolymphatic sac surgery (9), IT gentamicin (5), betahistine therapy (4), and labyrinthectomy (1). No complications of infection or tympanic membrane perforation from the injections were observed.

Conclusions:

IT dexamethasone injection therapy can control vertigo symptoms in patients with Ménière's disease. However, this retrospective study reports a lower control rate than that reported in previous studies. Further studies are necessary to clarify specific patient factors that would predispose towards vertigo control with IT dexamethasone.
Linear Acceleration Response Variation in Inbred Strains of Mice: The Requisite for Gene Discovery
Authors: Lavinsky Joel
Published: September 2014

Objectives:

(1) Evaluate gravity receptor function using vestibular evoked potentials (VsEPs) recordings in different strains of mice. (2) Indicate functional variation in VsEPs response parameters across strains for the Genome‐Wide Association Study (GWAS) mapping of the vestibular system.

Methods:

Mice (6 weeks old) were anesthetized with ketamine 100 mg/kg and xylazine 10 mg/kg and were positioned supine with the head mount coupled and the cranium securely fastened to a mechanical shaker. Stimuli consisted of linear acceleration (17 pulses/s) applied to the cranium in the naso‐occipital axis. The first (P1) and second (P2) positive and negative response peaks were measured as phenotypes. Mice were selected based on a combined set of classic inbred (CI) and recombinant inbred (RI) strains from the Hybrid Mouse Diversity Panel (HMDP). A total of 13 CI (C57BL/6J, FVB/NJ, Balb/cJ, C3H/HeJ, Balb/cByJ, AKR/J, 129x1/SvJ, A/J, DBA/2J, SJL/J, CBA/J, SEA/GnJ, and NOD/ShiLtJ) and 10 RI (BXA14/PgnJ, BXD84/RwwJ, BXH19/TyJ, BXH22/KccJ, BXH9/TyJ, BXH10/TyJ, BXA14/PgnJ, BXA4/PgnJ, BXA16/PgnJ, and CXB9/HiAJ) were evaluated with an average of 2.7 mice/strain.

Results:

A wide range of phenotypic responses was observed. The mean threshold (–8.73 ± 5.1 dB re: 1 g/ms) and P2‐N2 amplitude at +6 dB re: 1 g/ms (0.682 ± 0.51 mV) both demonstrated statistical significant variation (analysis of variance) in VsEP thresholds (P =. 008) and P2‐N2 amplitude (P =. 001).

Conclusions:

These data demonstrate significant variation in VsEP response parameters across strains, strongly suggesting the hypothesis that there exists functional variation of vestibular function among strains of mice and the genetic determinants of such variation can be mapped using GWAS.
Long‐term Use of Cochlear Implants in Older Adults: Results from a Large Consecutive Case Series
Authors: Choi Janet S. , Contrera Kevin J. , Betz Joshua F. , Blake Caitlin R. , Niparko John K. , Lin Frank R.
Published: September 2014

Objectives:

Investigate rates of long‐term use of cochlear implants (CI) in a large, consecutive case series of older adults (≥ 60 years) and characteristics associated with continuing CI use.

Methods:

From 1999‐2011, 447 individuals ≥60 years received their first CI at Johns Hopkins, and we successfully contacted 397 individuals (89%) to ascertain data on the individual's daily CI use averaged over the past 4 weeks. Regular CI use was defined as ≥8 hours/d. We investigated the time from implantation to the date when an individual reported discontinuing regular CI use with Kaplan‐Meier and Cox proportional hazard analyses.

Results:

The overall rate of regular CI use at 13.5 years of follow‐up was 82.6% (95% confidence interval: 72.5‐89.3%). Individuals who received a CI at 60‐74 years had significantly higher rates of regular CI use at 13.5 years of follow‐up (91.1%, [95% confidence interval: 83.2‐95.4%], n = 251) than individuals who received a CI at ≥75 years (55.7%, [95% confidence interval: 24.9‐78.1%], n = 146). The rate of discontinuing regular CI use (<8 hours per day) increased on average by 7.8% (95% confidence interval: 3.0‐12.8%) per year of age at implantation.

Conclusions:

Rates of long‐term CI use in older adults at >10 years of follow‐up exceed 80%. The rate of discontinuing regular CI use was strongly associated with older age at implantation. These results suggest that the earlier implantation of older adults, once critically low levels of speech recognition are present, is associated with greater usage of the device.