bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathological Features Frequently Found in Recurrent Papillary Thyroid Cancer
Authors: McHugh Tobial , Forest Veronique‐Isabelle , Payne Richard J. , Hier Michael P. , Mlynarek Alex M. , Tamilia Michael
Published: September 2014

Objectives:

Despite the rising prevalence of malignant papillary thyroid carcinoma, locoregional recurrence remains low. Clinico‐pathological features associated with recurrence are not well defined. The objective of this study is to describe and evaluate the various pathological features found in patients with recurrent papillary thyroid carcinoma.

Methods:

A retrospective review was conducted identifying patients who were found to have recurrent papillary thyroid carcinoma between July 2006 and May 2013 at the McGill University Thyroid Cancer Centre.

Results:

There was a total of 552 patients with malignant papillary thyroid carcinoma. Over the study period, recurrent disease occurred in 2.0% of patients (n = 11), of whom 10 were pT3N1b and 1 was a pT4aN1. When these patients were compared with the 541 patients who did not have recurrence of their disease, there were significant differences for sex (P =. 0271), size of primary tumor (P =. 0355), positive margins (=0 0002), lymphovascular invasion (P <. 0001), extrathyroidal extension (P =. 0001), lymph node metastasis (P <. 0001), and extra‐nodal extension (P <. 0001). There was no significant difference for age, presence of multifocal disease, and perineural invasion. On regression analysis, positive margins, lymphovascular invasion, regional lymph node metastasis, and extra‐nodal extension were found to be independent predictors of recurrence (P =. 0011, P =. 0248, P =. 0146, and P =. 0007, respectively).

Conclusions:

In patients with papillary thyroid cancer, sex, tumor size, and extra‐thyroidal extension are features frequently found in patients with recurrence. However, positive surgical margins, lymphovascular invasion, lymph node metastasis, and extra‐nodal extension were found to be independent predictors of recurrence in this study.
Prophylactic PEG Tube and Swallowing following Chemoradiation in Head and Neck Cancer Patients
Authors: Pohar Surjeet , Demarcantonio Michael , Whiting Phillip B. , Crandley Edwin F. , Wadsworth J. Trad , Karakla Daniel W.
Published: September 2014

Objectives:

(1) Compare swallowing status in patients receiving a prophylactic gastrostomy (PPEG) tube versus relying on oral intake during chemoradiation (CRT) for head and neck cancer. (2) Discuss prognostic factors associated with gastrostomy tube dependence 1 year after completion of CRT.

Methods:

The Eastern Virginia Medical School Cancer registry identified patients with a new head and neck cancer diagnosis from January 1, 2001, to July 1, 2008. We excluded patients treated with primary surgical therapy, at an outside facility, and with radiation therapy only. Our final cohort of patients who lived at least 1 year with follow‐up was 105. Primary outcomes were oral intake status at 1 year and need for esophageal dilation.

Results:

Eighty‐one patients received a PPEG, and 24 did not. There was no difference in swallowing function at 6 months (P =. 27) or the rate of esophageal dilation (P =. 22). Stricture rates were 13% in the initial oral group versus 25% in the PPEG group. Univariate analysis predictors for PEG tube dependence at 1 year were Zubrod score >1 (P <. 001), PPEG (P =. 03), and higher T stage (P =. 008). On multivariate analysis, PPEG (P =. 05), Zubrod score >1 (P =. 000001), and higher T stage (P =. 02) were independent predictors for PEG tube dependence at 1 year.

Conclusions:

PPEG tube, Zubrod score >1, and higher T stage were independent predictors for PEG tube dependence after chemoradiation. An approach of initial oral intake with placement of therapeutic PEG due to inability to maintain adequate nutrition by mouth should be considered.
Sources and Quality of Online Surgical Videos: Using YouTube to Learn Thyroid Surgery
Authors: Sebelik Merry E. , Wilson Caleb
Published: September 2014

Objectives:

(1) Estimate the volume of thyroid surgery‐related video content readily available to the surgical trainee. (2) Stratify the sources of thyroid surgery‐related video content by source (patient, institution, surgeon, or other) and estimate the quality of the surgeon source by related scholarly output.

Methods:

A search of YouTube, a widely used source of open‐access video content, was undertaken using thyroid surgery as the search term. The first 50 hits were analyzed for source. When the video was surgeon‐sourced, the surgeon's name was used in a PubMed author query for thyroid surgery and publications noted.

Results:

Approximately 2750 videos were returned using thyroid surgery as the search term. The first 50 hits were stratified by source, assuming the typical surgical trainee would not delve further into the list. The sources were primarily surgeons, followed by patient testimonials and institutions. The surgeons were stratified by related publications listed in PubMed. The majority of surgeons were not published in thyroid surgery‐related topics.

Conclusions:

Internet video content is an increasingly utilized source of surgical education. Since video content can be posted without peer review or confirmation of veracity, this study measures the variety of sources of thyroid surgery information. Individuals without thyroid surgery publication history posted the majority of surgeon‐sourced video content, although this history serves only as a surrogate for an academic career. Trainees and educators alike should critically analyze the quality of video content.
Swallowing Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma
Authors: Sutton Collin B. , Fink Daniel S. , Kunduk Melda , McWhorter Andrew J.
Published: September 2014

Objectives:

Review the swallowing outcomes of patients undergoing salvage transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma.

Methods:

A retrospective chart review was conducted at an academic practice in a regional referral center. Forty‐one patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013. Twenty‐seven patients had glottic recurrences while 14 had recurrences in the supraglottis. Swallowing outcomes were evaluated by the necessity for a gastrostomy tube and the M.D. Anderson Dysphagia Index (MDADI) questionnaire.

Results:

The mean value of patients with a preoperative MDADI was 78.25. The mean value of patients with a postoperative MDADI was 73.6. The mean change in patients who completed a pre‐ and postoperative MDADI was a decrease by 4.9 points. Seventeen patients required a gastrostomy tube either placed during radiation treatment or perioperatively to their TLM procedure. Thirteen gastrostomy tubes were removed, 2 gastrostomy tubes were still in place, and 2 patients died with their gastrostomy tubes in place. All living patients resumed a regular, nonmodified diet.

Conclusions:

TLM is a successful surgical option for recurrent laryngeal cancer with acceptable swallowing outcomes.
The Use of Electrochemotherapy as Neoadjuvant Treatment for Head and Neck Cancer
Authors: Domanico Rossana , Trapasso Serena , Franco Teresa , Allegra Eugenia
Published: September 2014

Objectives:

Electrochemotherapy (ECT) is a cancer treatment based on the transport of chemotherapic drugs such as cisplatin and bleomycin into cell cytosol through depolarization of cell membrane. A locally applied electric field modifies the membrane permeability allowing intracellular accumulation of the chemotherapeutic agent.

Methods:

Prospective study: 12 patients with head and neck cancer treated with ECT with bleomycin at the ENT Department of Catanzaro teaching hospital from January to December 2013 were recruited. The primary endpoint of the study was ECT efficacy in the neoadjuvant treatment of head and neck cancer. For each patient clinical‐anamnestic data were collected in a database and the local tumor control, survival, and effects on quality of life (Health Survey Questionnaire, SF‐36 [v1], and Quality of Life Questionnaire, EORTC QLQ‐C30, and EORTC QLQH&N35) and pain control (Analgesia Post‐Surgery, APS scale) were evaluated. The treatments were performed by Cliniporator IGEA according to the European Standard Operating Procedures of Electrochemotherapy (ESOPE, 2006). Response to ECT treatment was evaluated after 30 days. All patients received postoperative chemoradiotherapy.

Results:

Local control and impact on quality of life were evaluated. Six of 12 lesions exhibited a partial response, 4 of 12 exhibited a complete response, and in 2 cases disease progression was observed.

Conclusions:

ECT represents a safe and effective therapeutic approach that is associated with clear benefits in terms of quality of life (minimal discomfort, mild post‐treatment pain, and short duration of hospital stay).
Barriers to Adoption of Office‐Based Laryngeal Surgery
Authors: Verma Sunil P. , Merati Albert L.
Published: September 2014

Objectives:

Office‐based laryngeal surgery (OBLS) has been shown to be safe and efficacious for many common laryngeal disorders. Despite this, OBLS is not widely adopted by otolaryngologists. This study investigated what barriers exist to OBLS through a survey of practicing otolaryngologists.

Methods:

A questionnaire was sent to the membership of the Academy of Otolaryngology—Head and Neck Surgery in winter 2013.

Results:

A total of 173 otolaryngologists completed the survey. The availability of lasers for OBLS was cited as a major obstacle by 119 out of 173 (75%) of respondents. Reimbursement of disposables and lack of CPT codes for OBLS were the second and third major obstacles noted, respectively (85/173 [53%] and 68/173 [43%]). Reliability of results in the office was less commonly cited as a major obstacle by 24 out of 173 (15%) of respondents.

Conclusions:

Organizational and financial considerations continue to be barriers for adoption of OBLS.
Laryngeal Manipulation for Dysphagia from Muscle Tension Dysphonia
Authors: Depietro Joseph D. , Stein Daniel J. , Rippberger Matthew J. , Noordzij J. P.
Published: September 2014

Objectives:

(1) Appreciate the use of laryngeal manipulation as treatment for perceived dysphagia resulting from excessive paralaryngeal muscle tension. (2) Describe the patients likely to have symptomatic improvement.

Methods:

A retrospective review identified patients from 2007‐2011 with laryngeal manipulation for muscle tension‐caused dysphagia in an academic otolaryngology practice. Subjects with dysphagia not attributable to anatomic cause who attended therapy twice or more had symptoms, demographic information, treatment, and response to therapy abstracted.

Results:

Thirty‐five subjects were included, consisting of 28 women and 7 men. Race was recorded as black (11), Hispanic (8), white (9), and other (7). Improvement in dysphagia was seen in 25 (71.4%, 95% confidence interval 53.7% to 86.4%). No significant differences were seen in improvement based on sex (P =. 381) or race (P =. 439) in chi‐square testing. The combination of age and number of sessions were predictive of improvement (P =. 041) but were not individually significant (age P =. 096, sessions P =. 084) using logistic regression.

Conclusions:

We found improvement with laryngeal manipulation among individuals with muscle‐tension‐caused dysphagia. No significant differences in efficacy were seen among racial and sex subgroups. A model with age and number of sessions was significant. A prospective trial of this therapy appears warranted.
Lysophosphatidic Acid Receptor 4 Signaling Potentially Modulates Malignant Behavior in Laryngeal Carcinoma Cells
Authors: Matayoshi Sen , Suzuki Mikio
Published: September 2014

Objectives:

The extacellular lipid mediators known as lysophosphatidic acids (LPAs) have been implicated in tumorigenesis of head and neck squamous cell carcinoma (HNSCC). LPAs activate G protein–coupled receptors not only in the endothelial differentiation gene (Edg) family (LPA1, LPA2, LPA3) but also in the phylogenetically distant non‐Edg family (LPA4, LPA5, LPA6). The distinct roles of these receptor isoforms in HNSCC tumorigenesis have not been clarified. In the present study, we investigated the effect of ectopic expression of LPA4 in SQ‐20B, a HNSCC cell line, expressing a trivial level of endogenous LPA4.

Results:

LPA (18:1) stimulated proliferation of SQ‐20B cells, but did not affect proliferation of HEp‐2, a SCC cell line expressing higher levels of LPA4, comparable to those of with LPA1. LPA‐stimulated proliferation of SQ‐20B cells was attenuated by Ki16425 and Rac1 inhibitor, but not by Y‐27632. Infection with doxycycline‐regulatable adenovirus vector expressing green fluorescent protein‐tagged LPA4 (AdvLPA4G) abolished LPA‐stimulated proliferation in SQ‐20B cells with the accumulation of G2/M‐phasic cells. Ectopic LPA4 induction further down‐regulated proliferation of Ki16425‐treated SQ‐20B cells, of which down‐regulation was partially recovered by LPA. Ectopic LPA4 induction also down‐regulated proliferation of Rac1 inhibitor‐treated SQ‐20B cells; however, LPA no longer recovered it. Finally, LPA‐induced cell motility was suppressed by ectopic LPA4 expression as well as by Ki16425, Rac1 inhibitor or Y‐27632.

Conclusions:

Our data suggest that LPA4 signaling potentially modulates malignant behaviors of SQ‐20B cells. LPA signaling, which is mediated by both Edg and non‐Edg receptors, may be a determinant of malignant behavior of HNSCC and could therefore be a promising therapeutic target.
Patient Factors Associated with the Development of Intubation Granulomas
Authors: Tibbetts Kathleen M. , Nicolli Elizabeth A. , Mirza Natasha , Tan Melin
Published: September 2014

Objectives:

While there is a well‐documented association between intubation and laryngeal granuloma development, not every intubation results in granulomas. We identify patient factors associated with the development of laryngeal granulomas after endotracheal intubation and analyze the efficacy of different treatment interventions on granuloma resolution.

Methods:

A retrospective review of the medical records of patients treated for laryngeal granulomas after endotracheal intubation at 2 tertiary care centers between 2005 and 2013 was performed. Medical comorbidities, peri‐intubation medications, and treatment modalities and outcomes were recorded. Fisher exact test was used to compare patients with laryngeal granulomas to matched control patients who did not develop granulomas after intubation. Efficacy of treatment modalities was also analyzed.

Results:

Twenty‐three patients with laryngeal granulomas after intubation were identified and compared with controls. There was a statistically significant association between the development of laryngeal granulomas and hypertension/cardiovascular disease, obesity, renal disease, and gastroesophageal reflux (P <. 05). Diabetes mellitus (P =. 137), tobacco use (P =. 253), alcohol consumption (P =. 304), peri‐intubation steroid administration (P =. 339), and antibiotic administration (P =. 187) were not statistically significant. Of the granuloma patients, 13 achieved remission after treatment. Remission was achieved with surgical excision in 69.2%, with or without intraoperative steroid injection (38.4% and 30.8%, respectively). Proton pump inhibitor therapy alone was successful in 23.1%, and 7.7% resolved with inhaled steroids alone.

Conclusions:

Patient comorbidities likely play a role in the development of laryngeal granulomas after endotracheal intubation, while peri‐intubation medications and tobacco/alcohol use do not appear to significantly impact development. Surgical excision was most effective in achieving remission.
Assessment of Ocular and Cervical Vestibular‐Evoked Myogenic Potentials in Cisptin‐Induced Otolith Toxicity in Guinea Pigs
Authors: Lo Wu C. , Cheng Po‐Wen
Published: September 2014

Objectives:

(1) Determine if cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials oVEMPs are good electrophysiological examinations to represent the degree of cisplatin‐induced otolith toxicity. (2) Examine if D‐methionine (D‐met) pre‐injection protects the otolith organs against cisplatin‐induced changes of enzyme activities and oxidative status.

Methods:

Guinea pigs were intraperitoneally injected with sterile 0.9% saline alone, cisplatin (5 mg/kg) alone, D‐met (300 mg/kg) alone, or D‐met (300 mg/kg) 30 minutes before cisplatin (5 mg/kg) in combination, once daily for 7 consecutive days. Each animal was given the oVEMP and cVEMP tests before and after treatment. Changes in otolithic biochemistry, including membranous Na+, K+‐ATPase, and Ca2+‐ATPase, lipid peroxidation (LPO), and nitric oxide (NO), were also evaluated.

Results:

In the cisplatin‐treated guinea pigs, the mean amplitudes of cVEMP and oVEMP tests were significantly (P’s <. 05) decreased in comparison with the other 3 groups. In guinea pigs receiving both D‐met and cisplatin, their amplitudes of cVEMP and oVEMP tests were significantly larger (P <. 05) than those of the cisplatin group, but smaller (P <. 05) than those of the saline or D‐met group. In comparison with the other 3 groups, cisplatin alone group had the lowest (P <. 05) mean Na+, K+‐ATPase, and Ca2+‐ATPase, and the highest (P <. 05) LPO and NO levels.

Conclusions:

The cVEMP and oVEMP tests were feasible for the evaluation of cisplatin‐related otolith dysfunction. The D‐met–mediated improvement in otolith function correlated with a significant attenuation of increased oxidative stress and reduced ATPase activities.
Can Routine Office‐Based Audiometry Predict Cochlear Implant Evaluation Results?
Authors: Gartrell Brian C. , Ploch Jennifer L. , Gubbels Samuel P.
Published: September 2014

Objectives:

Determining cochlear implant candidacy status requires a specific sentence‐level testing paradigm in best‐aided conditions. Correlation of the findings on routine audiometry with those of formal cochlear implant (CI) evaluation has not been performed. Our objective was to determine if findings on routine office‐based audiometry could predict the results of a formal CI candidacy evaluation.

Methods:

The charts of all adult patients who were evaluated for CI candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure‐tone hearing thresholds and recorded monosyllabic word recognition test [MWRT] results) were then correlated with best‐aided sentence‐level word discrimination test (SWDT) results using either the Hearing in Noise Test (HINT) or AzBio sentences.

Results:

The degree of hearing loss at 250 to 4000 Hz significantly correlated with SWDT results. Additionally, 87% of patients who scored <30% in MWRT qualified for implantation using HINT sentences. Similarly, in patients whose MWRT scores were <35%, 81%, and 93% met CI candidacy criteria when using AZBio sentence testing in quiet and noise, respectively.

Conclusions:

Routine office‐based audiometry can be used to identify patients who would highly likely meet CI candidacy upon formal testing. For example, a pure tone threshold of ≥55 dB at 250 Hz and a MWRT score of ≤35% when evaluating using AzBio sentences collectively identifies a patient who is likely to meet candidacy criteria. Using these predictive patterns during routine audiometry may assist hearing health professionals in deciding when to refer patients for a formal CI evaluation.
Cholesteatoma in Children: An Overview
Authors: da Costa Sady S. , Rosito Leticia S. , Canali Inesangela , Jung Yuri P. , Jung Larissa P. , Freitas Luiza A. , Ronchi Andre D.
Published: September 2014

Objectives:

Describe in children: (1) cholesteatoma growth patterns; (2) conductive hearing loss severity; (3) contralateral ear (CLE) findings.

Methods:

Cross‐sectional study. Videotoscopies of 129 pediatric patients at a tertiary care hospital were analyzed for cholesteatoma growth patterns, air‐bone gap, and CLE otoscopic findings. Data were compared with the chi‐squared test and analyzed using SPSS.

Results:

The mean patient age was 12.4 ± 4.36 years. The cholesteatoma growth patterns were anterior epitympanic cholesteatomas (5.4%), posterior epitympanic (21.7%), posterior mesotympanic (43.4%), 2 routes pattern (17.1%), and undetermined (12.4%). The pure tone average air‐bone gap (PTA‐ABG) was ≤20 dB in 8.7% of patients, between 20 to 40 dB in 43.4% of patients, and ≥40 dB in 47.9%. The CLE was normal in 34.9% of patients and had moderate or severe tympanic membrane (TM) retractions in 46.5%, TM perforation in 7.8%, and cholesteatoma in 10.9% of patients. The CLE disease prevalence was similar between the groups, except in anterior epitympanic group, which had normal CLE (P =. 004).

Conclusions:

Posterior mesotympanic cholesteatomas were the most prevalent in the study population. Most patients had a PTA‐ABG greater than 20 dB, and the most prevalent CLE abnormalities were moderate or severe TM retraction and cholesteatoma. The CLE of patients diagnosed with anterior epitympanic cholesteatoma were normal, suggesting a probable congenital origin.
Cochlear Implant in Children with Otitis Media
Authors: Al Ahmari Mohammed S. , Aljabr Ibrahim K. , Hagr Abdulrahman A.
Published: September 2014

Objectives:

Otitis media comes with the need for cochlear implantation. These conditions contributing complications generated our interest in describing surgical difficulties and complications of cochlear implantation in children with otitis media, as well as estimating the period of time needed to implant those children.

Methods:

Retrospective study of the data collected from records of patients receiving cochlear implantation. A total of 200 cochlear implant surgeries were performed in King Abdul‐Aziz University Hospital from January 2012 to December 2012. Thirty‐two patients had otitis media disease. For all patients’ complications, operative time, and duration from presentation to implantation were documented. Exclusion criteria were age 18 years or more, revision surgeries, patients that had auditory brain stem implant at the same time, and patients with incomplete data.

Results:

The complications were wound infection in one case and one case that developed hematoma. Both were treated conservatively and the last one was incomplete insertion. However, all belonged to the nonotitis media group. The operative time was longer in the otitis media group with a difference of 35 minutes (P value =. 001). Delay in implantation showed no significant difference between the 2 groups.

Conclusions:

Pediatric patients with otitis media can be implanted safely and effectively.
Comparison of Outcomes of Myringoplasty with Cartilage Palisades and Temporalis Fascia in Large Perforations
Authors: Arun K. C. , Shakya Dipesh
Published: September 2014

Objectives:

Compare graft uptake rate and postoperative hearing results of myringoplasty using cartilage palisades and temporalis fascia in large perforations.

Methods:

Prospective, longitudinal, randomized controlled trial from December 2010 to December 2012. at the Ganesh Man Singh Memorial Academy of ENT‐Head and Neck Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. Patients were above 13 years of age with chronic otitis media‐mucosal (tubotympanic) with >50% perforation of tympanic membrane. Sixty‐one cases included for myringoplasty were randomly divided into 2 groups, cartilage palisades and temporalis fascia, by lottery. There were 30 cases in cartilage palisades group and 31 cases in temporalis fascia group. Patients underwent myringoplasty using either cartilage palisades or temporalis fascia. Graft uptake rate and postoperative hearing were evaluated after 12 weeks. Fisher exact test and t test were used as statistical tools.

Results:

Graft uptake rate in the cartilage palisades group was 86.66% and 90.32% in the temporalis fascia group, with no significant difference (P =. 707) between the 2 groups. The mean pre‐ and postoperative air bone gaps in the cartilage palisades group were 29.26 dB ± 10.66 and 20.41 dB ± 10.54, respectively. Similarly, in the temporalis fascia group, these were 29.52 ± 11.12 dB and 17.93 ± 8.83 dB, respectively. There was no statistical significance in hearing improvements between the 2 groups (P =. 384).

Conclusions:

The graft uptake rate and hearing results of myringoplasty with cartilage palisades are comparable to those of temporalis fascia in large perforations.
Congenital Hearing Loss and Internal Auditory Canal Anomalies: Imaging Findings and Implications for Management
Authors: Somerville Jessica M. , MacDonald Charles B.
Published: September 2014

Objectives:

Approximately 20% of patients with congenital sensorineural hearing loss are found to have a radiologically proven inner ear anomaly. Of the inner ear abnormalities, duplication of the internal auditory canal is rare. We sought to describe clinical characteristics and treatment results of patients found to have duplicated internal auditory canal on imaging.

Methods:

This case series identified patients from over a 2 year period obtained in a random manner from teaching files and daily case material. Imaging findings, clinical characteristics, audiology testing and treatment were reviewed.

Results:

A total of 7 patients were identified with a total of 12 ears (2 patients had unilateral presentation). Three patients in this series had a history of branchio‐oto‐renal syndrome. All patients had high‐resolution computerized tomography (CT) performed. Two patients had magnetic resonance imaging (MRI) performed. All patients had audiogram evaluation. Six patients had sensorineural hearing loss, and one patient had conductive hearing loss. As hearing loss became more severe as documented by decibels of hearing loss on audiogram, increasing number of middle and inner ear anomalies were found on imaging.

Conclusions:

This series is one of the largest series to evaluate duplicated internal auditory canal in conjunction with cochlear anomalies. MRI is a useful adjunct to evaluate presence of the cochlear nerve and should be considered in patients undergoing cochlear implantation with findings of duplicated internal auditory canal on CT scan. More severe hearing loss may be indicative of potential for more anomalies found on imaging.
Differences in Acufenometry and Tinnitus Annoyance among Patients with Presbycusis and Ménière's Disease
Authors: Dalligna Celso , Dalligna Daniela P. , Freitas Luiza A. , Jorge Karolina B. , Beduschi Giuliana , Pappen Carlos H.
Published: September 2014

Objectives:

Analyze the difference in acufenometry between patients with presbycusis and Ménière's disease and correlate the findings with the annoyance caused by tinnitus.

Methods:

This cross‐sectional study included 59 patients with unilateral tinnitus treated at a tertiary hospital. Out of these patients, 38 had presbycusis and 21 had Ménière's disease. Acufenometry was performed to determine the pitch and loudness of tinnitus in the 2 groups. The tinnitus handicap inventory (THI) and visual analogue scale (VAS) was used to evaluate the annoyance caused due to tinnitus. Statistical analysis was performed using SPSS and the Student t test.

Results:

The mean age of the patients with Ménière's disease and presbycusis was 56.05 ± 8.73 years and 67.74 ± 8.73 years, respectively (P <. 0001). Similar tinnitus pitch was observed in patients with Ménière's disease and those with presbycusis (2119 ± 2000 Hz vs 3092 ± 2203 Hz; P =. 09); however, the loudness varied between the groups (61.19 ± 17.2 dB vs 42.17 ± 19.8 dB; P =. 001). The THI and VAS score were similar between the two groups (P =. 33 vs P =. 66).

Conclusions:

Although tinnitus was louder in patients with Ménière's disease than in those with presbycusis, the tinnitus pitch and its impact on patient quality of life was similar in both groups.
Differentiation of Human Mesenchymal Stem Cells to Otic Progenitor‐like Cells
Authors: Perez Raffo Gabriela M. , Cardozo Alejandra J. , Boccio Carlos M.
Published: September 2014

Objectives:

Differentiate mesenchymal stem cells to otic progenitor‐like cells.

Methods:

We isolated and cultured the stromal vascular fraction (SVF) of 3 samples of human adipose tissue. We differentiated human adipose stem cells (hASCs) to otic lineage, using a differentiation medium containing DMEM HG, F12, N2, B27 and different growth factors like FGF3, FGF10, EGF, and IGF‐1. The differentiated cells were fixed and RNA extracted at day 10 and 38 to analyze the expression of otic progenitor, neuronal or inner ear hair cell markers.

Results:

After 10 days of differentiation we detected otic placode markers expression: Pax2 (90.9 ± 0.16%), Pax8 (44.2 ± 0.03%), and BMP7 (86.4 ± 0.24%). Brn3.c (24.2 ± 0.05%), MyoVIIa (10.8 ± 0.05%), and BIII tubulin (28.8 ± 0.37%) were also detected, consistent with the presence of progenitors of sensorineural and inner ear hair cells. At day 38, an increase of inner ear hair cell markers (33.2 ± 0.04% MyoVIIa, 33.9 ± 0.3% Brn3.c and 14.3% Math1), a decreased of otic progenitor markers (46.2% Pax2 and 15.9% Pax8) and absence of neural markers were seen. The same pattern was seen at mRNA level.

Conclusions:

Even though these results are preliminary and a protocol improvement is necessary, this work demonstrates the ability of hASCs to differentiate into otic lineage, opening a door to a future therapeutic option for sensorineural hearing loss.
A Dual Role of Sox2 on Atoh1 Regulation
Authors: Cheng Yenfu , Petrillo Marco , Edge Albert S.
Published: September 2014

Objectives:

Loss of mammalian auditory hair cells is usually permanent, and there is currently no method to recover hearing after hair cell damage. Atoh1, a basic helix‐loop‐helix transcription factor, plays a critical role in formation of hair cells. Experiments overexpressing Atoh1 in the inner ear via gene transfer have shown new hair cell formation and improved hearing in tested animals. However, we do not currently know how cells regulate Atoh1. We found that Sox2, a pluripotency marker for stem cells and also present in inner ear stem cells, is involved in the regulation of Atoh1. In this study, we try to understand the role of Sox2 in the regulation of Atoh1 for hair cell formation.

Methods:

A 293T cell line that stably expresses Atoh1 was developed for Atoh1 expression assays. Atoh1 level was measured by real time qPCR and western blot. Mass spectrometry was used to identify Atoh1 protein partners. Plasmids transfection was used for gain‐of‐function studies, while small interfering RNA was used for loss‐of‐function studies.

Results:

We found that Sox2 upregulates Atoh1 at the transcriptional level but also enhances Atoh1 degradation post‐translationally. We found that Sox2 is involved in the major post‐translational regulation, the ubiquitin‐proteasomal pathway, which is the control mechanism through which Sox2 regulates specification of hair cells.

Conclusions:

Sox2 has dual role on Atoh1 regulation: upregulation of Atoh1 transcription by binding to Atoh1 3′enhancer, and post‐translational Atoh1 degradation through activating ubiquitin‐proteasome pathway.
Effect of Intratympanic Steroid Administration on Sensorineural Hearing Loss Associated with Acute Otitis Media
Authors: Heywood Rebecca , Ifeacho Sonna , Narula Antony A.P.
Published: September 2014

Objectives:

Sensorineural hearing loss associated with acute otitis media (acute infective sensorineural hearing loss [AISNHL]) is a well‐recognized but rare phenomenon with no accepted treatment pathway. Our objectives were to (1) evaluate the effects of intratympanic steroid (ITS) administration on AISNHL and (2) analyze factors which may be associated with a favorable outcome following ITS.

Methods:

A retrospective case note review of 7 consecutive patients (5 men, 2 women) seen between November 2006 and October 2013 and diagnosed with AISNHL was performed. Patients were prescribed 7 days of oral antibiotics and prednisolone and offered ITS thereafter if there was no improvement. Up to 3 intratympanic injections of methylprednisolone (40 mg/mL) were administered.

Results:

Patients were considered to have a significant improvement in their hearing if average change in threshold was equal to or greater than 10 dB following ITS. This was the case in 57% (4/7) of patients. The mean improvement in threshold was 24 dB (range 10‐52 dB) in these responders. Three‐fourths of responders had a mild high frequency hearing loss. Responders had a smaller sensorineural loss at presentation (responders mean 39 dB pre‐ITS,15 dB post‐ITS; nonresponders mean 65 dB pre‐ITS, 83 dB post‐ITS), presented earlier (4 days, range 3‐6 days versus 12 days, range 2‐21 days) and received their first ITS earlier (24 days, range 13‐37 days versus 35 days, range 24‐42 days) than nonresponders.

Conclusions:

ITS may provide a valuable contribution to the treatment of SNHL in acute otitis media. A larger study looking at timing of intratympanic administration after antibiotics and/or oral steroid treatment would be beneficial.
Epitympanic Area and Volume in Human Temporal Bones with and without Chronic Otitis Media
Authors: Shirai Kyoko , Schachern Patricia A. , Schachern Monika G. , Paparella Michael M. , Suzuki Mamoru , Cureoglu Sebahattin
Published: September 2014

Objectives:

(1) Investigate the difference in epitympanic bony volume and size of tympanic isthmus (TI) between human temporal bones (HTBs) with and without chronic otitis media (COM). (2) Investigate the relationship between TI size and epitympanic bony volume in HTBs with and without COM.

Methods:

Eleven HTBs from children with COM (COM group) and 11 HTBs without COM (control group) were examined. Three‐dimensional models were generated from HTB histopathologic slides with reconstruction software (Amira), and epitympanic bony volumes were measured. Within the boundaries of TI, only the aerated space, excluding exudates and soft tissues, were measured as aerated TI, and all space surrounded by the boundaries including exudates and soft tissues were measured as the bony TI. We chose the minimum aerated/bony TI area from all slides and compared them between the 2 groups. We also investigated the correlation between bony epitympanic volume and minimum aerated/ bony TI area in each group.

Results:

There were no significant differences in epitympanic bony volume or bony TI area between the groups. Aerated TI area in the COM group was significantly smaller than in control group (P <. 01). There was no relationship between aerated TI area and bony epitympanic volume in the 2 groups. In the COM group, there was a negative correlation between bony TI area and epitympanic volume (P <. 001).

Conclusions:

Our study suggests that congenital or developmental stenosis of the TI is not associated with epitympanic pathology, but blockage of TI with soft tissue pathology is.
Fat Myringoplasty: Better Patient Selection for Better Results
Authors: Garem Hani F. El
Published: September 2014

Objectives:

(1) Evaluate the outcome of fat myringoplasty in relation to the perforation size. (2) Compare the outcome in relation to 2 fat sources (ear lobule and abdominal wall).

Methods:

This study was conducted between May 2012 and April 2013 in the ENT department, University of Alexandria, Egypt. It was carried out on 30 patients with tympanic membrane perforations <30% of its surface (20 patients with perforations equal or less than 2 mm and 10 patients with perforations exceeding 2 mm in diameter), and with a maximum air bone gap of 20 dB. There were 2 randomized groups. Group A: 15 patients who had myringoplasty with ear lobule fat. Group B: 15 patients operated on using abdominal wall fat. Patients were followed for 6 months postoperatively.

Results:

Among the 20 patients with a perforation size ≤2 mm, 18 patients (90%) succeeded and 2 (10%) failed. Among the 10 patients with a perforation exceeding 2 mm, 5 patients (50%) succeeded and 5 (50%) failed. There was a significant statistical difference between perforation size and success rate. In group A, 12 patients (80%) had successful operations and 3 patients (20%) failed. In group B, 11 patients (73.3%) were successful and 4 patients (26.7%) failed. There were no significant differences between the 2 groups with regard to the success rate and hence its relation to the fat source (P >. 05).

Conclusions:

Fat myringoplasty can be performed safely in cases with small perforations, especially up to 2 mm in diameter and small air bone gap. Ear lobule constitutes a convenient source of fat.
Hearing Screening in the Elderly: Preliminary Results
Authors: Vasconcelos Leticia B. , Vasconcelos Natália , Espindola Marcelo , Gomes Erika F. , Diogenes Levi
Published: September 2014

Objectives:

Presbycusis is hearing impairment resulting from aging. Hearing‐impaired elderly are more likely to experience emotional distress, social engagement restrictions, and depression. Hearing loss also affects posture and balance and predisposes patients to falls. In comparison to universal screening of newborns, efforts for early diagnosis and prevention of hearing loss in the elderly are still insufficient. A prevalence study of disabling hearing loss in a developing country detected 30% of affected elderly. The aim of the study was to perform a screening of disabling hearing loss (DHL) in the elderly in a city of a population of 500,000 and to detect hearing loss in the elderly without diagnosis and offer them audiologic rehabilitation.

Methods:

A cross‐sectional population screening of 70,000 elderly individuals of which approximately 21,000 are probably hearing impaired and about 12,000 are in need of some kind of rehabilitation. The work consists of promoting a city campaign to submit all citizens over 60 years to an ear, nose, and throat (ENT) consultation, including audiometric tests and survey applications.

Results:

In the first year, 4080 examinations were performed. Of these, 960 had indication for hearing aids. Statistical analysis was performed using descriptive and exploratory techniques of data.

Conclusions:

The preliminary results indicated a high prevalence of hearing impaired aged adults in whom medical intervention (rehabilitation) can potentially prevent further complications and co morbid conditions. In future perhaps we will have evidence to recommend universal screening in everyone above 65 years.
Histologic Analysis of Chronos in an Optogenetic‐Based Auditory Brainstem Implant Model
Authors: Lehmann Ashton E. , Kozin Elliott D. , Hight Ariel E. , Darrow Keith , Boyden Ed , Brown Chris , Lee Daniel J.
Published: September 2014

Objectives:

Optogenetics affords the potential for improved spatial resolution compared with electric stimulation in future auditory neuroprostheses. No histologic studies have yet examined the virally‐mediated gene transfer of Chronos, a new opsin, to the murine cochlear nucleus (CN). Herein, we aim to (1) identify CN regions and neurons receptive to gene transfer of Chronos and (2) describe the morphology of putative cell types that express Chronos.

Methods:

CBA/CaJ mice underwent CN‐targeted injection of Chronos. The Chronos construct consisted of an adeno‐associated viral vector (AA2/8), CAG promoter, and a fluorescent marker. Following a 4‐week incubation period, mice were sacrificed and intravascularly fixed with paraformaldehyde, and brains were extracted, sucrose cryoprotected, and cryostatically sectioned. Sections of 35‐µm thickness were co‐labeled with neuron‐specific markers microtubule associated protein‐2 and anti‐tubulin, beta III isoform and DAPI‐fluoromounted. Sections of 60‐µm thickness were DAPI‐fluoromounted, and confocal microscopy revealed cellular morphologies.

Results:

Opsin‐linked fluorescence demonstrates Chronos expression throughout the dorsal CN with contiguous extension routinely into the ventral CN and variably into the auditory nerve and inferior cerebellar peduncle. Chronos localizes to neuronal‐specific and nonneuronal populations. Confocal microscopy suggests involvement of a wide array of CN cell types, including morphologies consistent with pyramidal cells and giant cells.

Conclusions:

Our histologic analyses confirm widespread infection of multiple neuronal populations throughout the CN. This work sets the stage for correlation with ongoing neurophysiology experiments. Future work with CN‐specific promoters to target neuronal subpopulations may further improve clinical potential for an optogenetics‐based auditory neuroprosthesis.
Influence of Tinnitus on Auditory Spectral, Temporal Resolution, and Speech Perception Ability in Tinnitus Patients
Authors: Yu Kwang‐Kyu , An Yong‐Hwi , Won Jong Ho , Shim Hyun Joon , Yoon Sang Won
Published: September 2014

Objectives:

(1) Evaluate the influence of tinnitus upon the auditory spectral and temporal resolution. (2) Evaluate the effect of tinnitus on speech perception ability in noise.

Methods:

To exclude the effect of decreased hearing threshold, unilateral idiopathic tinnitus patients with symmetric hearing threshold were enrolled. The subjects were 13 patients with symmetric hearing loss >20 dB HL and binaural difference <10 dB at 0.25, 0.5, 1, 2, 3, 4, and 8 kHz, or who have normal hearing threshold and binaural difference <10 dB at 0.25, 0.5, 1, 2, 3, 4, and 8 kHz, and threshold discrepancies <15 dB at 9, 11.2, 12.5, 14, 16, 18, and 20 kHz. A total of 13 volunteers with normal hearing were enrolled as a control group. Four different psychoacoustic measurements were performed: (1) spectral‐ripple discrimination, (2) temporal modulation detection, (3) Schroeder‐phase discrimination, and (4) word recognition in noise.

Results:

There were no significant differences in spectral‐ripple threshold, temporal modulation detection threshold, and Schroeder‐phase discrimination between affected sides and non‐affected sides of unilateral tinnitus patients. For the word in noise test, affected sides showed worse signal‐to‐noise ratio compared to non‐affected side.

Conclusions:

We could not find any evidence that the tinnitus‐affected ears show worse spectral and temporal processing compared with nontinnitus ears in unilateral tinnitus patients. The spectral ripple discrimination data suggests that the tinnitus‐affected ear does not have more damage in its cochlea (especially the outer hair cell) causing the auditory filters to broaden compared with the nonaffected ear with the same hearing threshold.
In Vivo Cochlea Hair Cell Rescue after Noise‐Induced Hearing Loss Using Low‐Level Laser Therapy
Authors: Kim Se‐Hyung
Published: September 2014

Objectives:

There is no study regarding the effects of low level laser therapy (LLLT) on cochlear after noise‐induced hearing loss (NIHL). The aims of this study were to (1) elucidate the ability of LLLT applied to noise‐induced damaged cochlea to recover NIHL and (2) demonstrate histopathological changes of remaining outer hair cells (OHCs).

Methods:

A total of 6 rats (C group) for control and 9 rats (N group) as the noise‐exposure group were included. Nine rats were exposed to noise once and the left ears (NL side) were treated with low‐level laser daily. Right ears (N side) were the control sides. Hearing thresholds were observed through auditory brainstem response recordings. Thresholds were monitored before noise exposure and also after the twelfth irradiation. Cochlear pathology and number of OHCs were observed by scanning electron microscopy.

Results:

The initial average hearing threshold levels were 26 ± 4, 24 ± 5, 24 ± 5, 24 ± 3, 24 ± 5 dB SPL in 4, 8, 12, 16, 32 kHz, respectively. After noise exposure, N group thresholds were 63 ± 15, 64 ± 16, 71 ± 11, 73 ± 15, 67 ± 14 dB SPL. After 12 irradiations, NL side thresholds recovered significantly (27 ± 4, 26 ± 4, 28 ± 8, 30 ± 9, 27 ± 6 dB SPL, P <. 05). N side thresholds were 46 ± 16, 51 ± 13, 63 ± 16, 50 ± 12, 48 ± 14 dB SPL. OHC number was significantly larger in the NL side than the N side. In the C group, OHCs counts were 176 ± 16, 146 ± 5, 154 ± 6 cells for apical, middle, basal turns, respectively. N side counts were 122 ± 2, 113 ± 2, and 116 ± 19. NL side counts displayed promising results (167 ± 27, 140 ± 29, 129 ± 26).

Conclusions:

This study demonstrates that LLLT promotes recovery of hearing and OHCs survival from apoptotic changes by NIHL.
Is There an Association between Tinnitus Pitch and Hearing Loss?
Authors: Dalligna Celso , Rosito Leticia S. , Dalligna Daniela P. , Deutsch Konrado M. , Pappen Carlos H. , Sangoi Ana P. A. , Borges Felipe M.
Published: September 2014

Objectives:

Correlate tinnitus pitch to the audiometric frequencies of hearing loss.

Methods:

This cross‐sectional study evaluated 378 ears of consecutive patients diagnosed with hearing loss and chronic tinnitus of any etiology. Audiometry and acufenometry were performed at the first clinical evaluation; a tinnitus pitch within the frequencies of greatest hearing loss indicated a positive association. The acufenometric frequency was similarly assessed relative to the greatest hearing loss on audiometry. Data were compared using the Spearman correlation test and analyzed using SPSS.

Results:

In total, 61.6% of patients were female, and the mean patient age was 57.9 years. In 58% of cases, the tinnitus frequency was within the region of greatest hearing loss, but only 20% corresponded exactly to the highest hearing loss frequency. There was a weak correlation (r = 0.1, P =. 02) between the tinnitus pitch in acufenometry and the greatest hearing loss frequency in audiometry.

Conclusions:

The tinnitus pitch and the region of audiometric loss were correlated in most patients. In several cases, the tinnitus pitch corresponded to the exact frequency of greatest hearing impairment, and the 2 variables had a weak association.
Scar Cosmesis: Assessment, Perception, and Impact on Body Image and Quality of Life—A Systematic Review
Authors: Sethukumar Priya , Awad Zaid , Catling Finneas J. R. , Tolley Neil S.
Published: September 2014

Objectives:

(1) Review current validated scar assessment tools and (2) describe the impact of scar cosmesis perception on body image and quality of life.

Methods:

Three independent reviewers performed comprehensive searches and identified 680 English language studies published between 1950 and 2014 (data sources: Medline, EMBASE, Cochrane Library, and Web of Science). Literature including case series, cross sectional studies, meta‐analyses, and reviews was then screened and selected according to strict inclusion/exclusion criteria.

Results:

Scar assessment: Review included Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, Manchester Scar Scale, Wound Evaluation Scale, and Western Scar Index. Validated qualitative assessment tools were clinically more useful than their quantitative counterparts. Patient perception input increased validity. Subjective satisfaction rating had little correlation with objective assessment of scarring. Perceptions: The size of defect did not correlate with impact, however location and visibility did. Psychosocial distress correlated with subjective severity. The large impact on physical and psychosocial quality of life (ascertained by generic and symptom‐specific validated assessment tools, as well as qualitative studies with interpretive phenomenologic analysis) is not to be overlooked.

Conclusions:

Careful selection of scar assessment tools is vital to gauge severity and plan further treatment. No consensus exists on the single most appropriate tool. A validated assessment tool is important in the assessment of scarring. There is a tendency to underestimate and thereby worsen the impact of scarring on patients’ quality of life. Further studies are required, particularly in the context of thyroid surgery.