bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Treatment and Rehabilitation of Prelingually and Perilingually Deafened Children and Adults with the Nucleus Multichannel Cochlear Implant
Authors: García Juan Manuel , de Otero Clemencia Barón , García Jorge , Peñaranda Augusto , Niño Claudia , Campos Silvia
Published: May 2019

We began our program in September 1992, using the Nucleus 22 Channel Cochlear Implant. To date, we have operated on four patients, one child with congenital hearing loss, two prelinguistically deaf adults and one perilingually deaf adult.

Our results have shown a significant increase in auditory and speech reception and perception skills in the child. The perilingually deaf adult is able to understand speech in open set speech discrimination testing and, although we do not expect open set speech discrimination in the prelinguistically deaf adults, to date their results have been satisfactory.

The two prelingually deaf adults are in an audiological rehabilitation program. Their response in prosodic aspects of speech and lipreading ability with sound have improved significantly.

The only surgical complication was an infection of the flap in the child, but it was treated satisfactorily with I.V. penicillin.
Ionomeric Cement – A Bone Glue for Device Fixation
Authors: Rüdel Christiana , Zöllner Werner
Published: May 2019

Ionocap®, an ionomeric cement, is a new bone replacement material. Its generic name is polymaleinate ionomer, and it is an inert standardized biomaterial which is offered in a two component system.

Since 1988 the ionomeric cement has been evaluated clinically in different situations. Its unique properties of biocompatibility, biostability and permanent adherence to bone make this new material very useful in head and neck surgery.
Improvement of Olfaction following Pansinus Surgery
Authors: Eichel Berkley S.
Published: May 2019

This study involves ten consecutive anosmic patients who underwent pansinus surgery and have been followed and tested a minimum of one year. They all had advanced obstructive bilateral nasal polyposis and pansinusitis. Persistent severe loss of smell was one of the chief complaints in all ten patients. The surgery performed included bilateral nasal polypectomies, bilateral sphenoidethmoidectomies and bilateral nasal antral windows. Post-operatively, all were treated with a topical corticosteroid nasal spray. Seven of these patients were asthmatic and three were also aspirin-sensitive, some being cortisone-dependent. The University of Pennsylvania Smell Identification Test (UPSIT) was administered pre-operatively and then at six-month intervals in the post-operative period. Significant initial improvement in smell acuity occurred in seven of the ten patients. One of the seven, however, developed recurrence of the nasal polyposis and again lost his smell capabilities somewhere between the twelfth and eighteenth post-operative months. Another of the patients who did not improve smell sensitivity post-operatively occasionally is aware of fleeting periods of return.
Review of Published Results for Endoscopic Sinus Surgery
Authors: Terris Mark H. , Davidson Terence M.
Published: May 2019

Chronic sinusitis is one of the more common chronic diseases in the United States. Over the past decade endoscopic sinus surgery (ESS) has become more common than ethmoidectomy and inferior meatal nasoantral windows. A review of the recent ESS literature, including 10 large series with a total of 1,713 patients, shows a 91% improvement rate. Subjectively, 63% of patients reported a very good result, 28% a good result, and 9% an unsatisfactory result. Twelve percent of patients required revision surgery. Major complications occurred in 1.6% of patients. Objective evaluation of the effectiveness of ESS, through the use of sinus CT, endoscopy, rhinometry, and olfactory testing, has shown mixed results.
Literature Review: The Common Cold
Authors: Hilding David A.
Published: May 2019

Most colds are caused by rhinovirus infection, perhaps facilitated by chilling or stress. Virus infection begins in the nasopharynx and causes spotty destruction of the nasal ciliated epithelium. Transmission occurs chiefly via droplets of various sizes transported through the air, but some types of virus persist in moist secretions on handled objects and may retain their infectiousness. Living in crowded, poorly-ventilated quarters facilitates transmission. Not many virus particles survive in saliva and it is difficult to infect via the lips or mouth. Kissing does not efficiently spread cold infection. Prophylactic treatment with interferon does not protect against cold infection. Aspirin and acetaminophen reduced serum antibody response and increased nasal symptoms in a controlled Australian study. The combination of intranasal interferon and ipratropium with oral naproxen gave promising results in experimental rhinovirus inoculation. Basically, there has been little or no progress towards effective cold treatment in the past century.
Lyme Disease: A Review for the Otolaryngologist
Authors: Goldfarb David , Sataloff Robert T.
Published: May 2019

Lyme disease is an important consideration in the differential diagnosis of patients seen by the otolaryngologist. Facial paralysis is the most common sign. The otolaryngologist may also see patients with temporal mandibular joint pain, cervical lymphadenopathy, facial pain, headache, tinnitis, vertigo, decreased hearing, otalgia and sore throat. The incidence is increasing and known to be endemic to certain areas of the United States and abroad. This paper reviews the various ways Lyme disease appears to the otolaryngologist. Three cases along with a discussion including epidemiology, vector, animal host relationship, clinical manifestations and pathophysiology are included. The literature is reviewed and the treatment discussed.
When is Isolated Vertigo a Harbinger of Stroke?
Authors: Rao T. Hemanth , Libman Richard B.
Published: May 2019

Isolated vertigo is usually a distressing though benign clinical entity. Recently, however, it has been recognized that in a subset of patients isolated vertigo may be a harbinger of vertebrobasilar stroke. Recognition of this “at risk” subgroup may be difficult. Brainstem auditory evoked potentials (BAEPs) are usually normal in patients with vertigo from labyrinthine disease.

We describe a patient with isolated vertigo, in whom BAEPs were abnormal, and who subsequently developed an anterior inferior cerebellar artery territory infarct.

BAEP testing might lead to early recognition of those patients at risk for catastrophic stroke, and prompt appropriate investigation and treatment to prevent this outcome.
Dysphagia in Patients with Three Different Etiologies of Salivary Gland Dysfunction
Authors: Rhodus Nelson L. , Moller Karlind , Colby Steven , Bereuter Janna
Published: May 2019

Dysphagia is a common complaint from patients with salivary gland dysfunction (SGD). The purpose of this study was to assess and compare dysphagia in three patient groups with SGD: primary Sjögren's syndrome (SS-1); secondary Sjögren's syndrome with systemic lupus erythematosus (SS-2-SLE) and a group of patients who had post-irradiation therapy (PIT) (for head and neck cancer xerostomia) and a matched control group. Subjects diagnosed with SS-1 (n=7); SS-2-SLE (n=7) and PIT (n=7) were selected for the study. An age-sex-matched group of control subjects (n=7) was selected for comparison. Dysphagia assessments, including videofluoroscopy, were performed. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significiant difference in the DS as compared to the WBS for all SGD groups and for both DS and WBS in each SGD group as compared to controls.

Videofluoroscopy also yielded significantly prolonged pharyngeal transit times (PTT) in all SGD groups as compared to controls. Subjective results indicated a greater degree of dysphagia symptoms in all of the SGD groups (p<0.001). Conclusions from this study indicate clinically significant dysphagia in patients with SS-1, SS-2-SLE and PIT as compared to a control population.
Retropharyngeal Abscess: Clinical Review
Authors: Pontell Jonathan , Har-El Gady , Lucente Frank E.
Published: May 2019

Retropharyngeal abscess, once a relatively common entity in children, is uncommon today. From 1981 to 1991, we treated 20 cases. Abscesses secondary to upper respiratory infection in children were seen only in three (15%) cases. Trauma and foreign bodies were the most common etiologic factors in the adult subgroup. Streptococcus viridans and Klebsiella pneumoniae were the most common pathogens. The use of contrast-enhanced computed tomography has had a significant impact on the diagnostic work-up. The choice of initial antibiotic therapy is discussed. There were no deaths in this series.
Powered Instrumentation in Functional Endoscopic Sinus Surgery II: A Comparative Study
Authors: Krouse John H. , Christmas Dewey A.
Published: May 2019

The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.
Asthma: An Important Disease to Otolaryngologists — Part III: Anti-Inflammatory Therapy
Authors: Gordon Bruce R.
Published: May 2019

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants, and is commonly encountered in otolaryngologic practice. This three-part review is designed to assist otolaryngologists in recognizing and managing asthmatic patients. Part one summarized current knowledge of the pathophysiology and increasing prevalence of asthma, and its assessment and diagnosis. Part two discussed asthma management by environmental controls, anti-inflammatory therapies, and patient education, and compared pharmacologic treatments which are not primarily anti-inflammatory. These include mucolytic, anticholinergic, antihistamine, theophylline and beta agonist drugs. In this final part, anti-inflammatory treatments for asthma control are critically reviewed, including a balanced discussion of cromolyn, nedocromil, glucocorticoids, allergy immunotherapy, and the appropriate indications, possible toxicities and reasonable precautions for their use.
Postoperative Bleeding in Tonsillectomy Patients
Authors: Szeremeta Wasyl , Novelly Norman J. , Benninger Michael
Published: May 2019

A three-year retrospective study was performed on 494 patients to compare the effects of two techniques of tonsillectomy, with respect to rates of postoperative bleeding. One surgeon performed primarily mechanical dissections, while the other primarily performed electrocautery dissections. Intraoperative blood loss was assessed and correlated to the age and gender of the patient and to the size of the tonsil.

Postoperative bleeding was seen in 2.8% of patients who underwent electrocautery tonsillectomy and in 7.6% of patients who underwent mechanical tonsillectomies. Patients undergoing electrocautery dissection lost an average of 37 ml of blood intraoperatively, whereas those undergoing mechanical dissection lost 105 ml.

Mechanical tonsillectomies exhibited higher intraoperative blood loss than electrocautery tonsillectomies. A higher rate of postoperative bleeding was seen in mechanical tonsillectomies, but this difference was lost when peritonsillar abscesses were removed from the study.
Management of Malignant Schwannomas of the Paranasal Sinuses and Anterior Skull Base
Authors: DiNardo Laurence J. , Rumsey Robert L.
Published: May 2019

The evolution of skull base surgery has facilitated the extirpation of previously unresectable tumors. As experience with skull base surgery increases, the feasibility of resection and long-term outcomes is becoming apparent for the more common lesions. Neoplasms such as malignant schwannomas are rare and, therefore, defy single-institution analysis. The treatment and four-year follow-up of a malignant paranasal sinus and anterior skull base schwannoma is described. Analysis of the literature confirms the low incidence of this tumor and supports the efficacy of skull base surgery in its treatment.
Utricular Macular Ablation for Benign Paroxysmal Positional Vertigo
Authors: Anthony Philip F.
Published: May 2019

Seventeen percent of all vertiginous patients have benign paroxysmal positional vertigo. Treatment can include occlusion of the posterior semicircular canal for control of these positional vertigo symptoms. More recently, use of an argon laser technique to occlude the posterior membranous semicircular canal has been proposed. However, this laser technique was not tolerated by a diabetic patient.3 This report describes a new technique using the argon laser to ablate the utricular macula in the affected ear in patients with benign paroxysmal positional vertigo. This procedure is done as outpatient surgery under local anesthesia. The procedure successfully resolved benign paroxysmal positional vertigo in 14 patients. Symptoms in these patients improved from 20-100% (median 87%; mean 80%) as measured by the Dizziness Handicap Inventory.
Pediatric Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Ruboyianes John M. , Cruz Raul M.
Published: May 2019

Forty-four children who underwent adenotonsillectomy for obstructive sleep apnea (OSA) were studied. The diagnosis was confirmed polysomnographically. Patients with other medical problems or complications of OSA were excluded. The overall complication rate was 32%. Significant airway complications occurred in 16%. Factors associated with development of statistically significant airway complications were acute airway compromise, age <3 years, thin body habitus, and both oxygen (O2) desaturation and carbon dioxide (CO2) retention seen polysomnographically. Although many OSA patients can safely have outpatient adenotonsillectomy, perioperative monitoring of patients with these risk factors is needed.
Cicatricial Pemphigoid of the Larynx: A Case Report of Surgical Treatment
Authors: El-Sayed Yousry , Al-Muhaimeed Hamad
Published: May 2019

Although laryngeal stenosis caused by cicatricial pemphigoid (CP) is a well documented entity, reports about its surgical treatment are scant. This may be due to the reluctance of the surgeons to excise the scarring, knowing the recurrent nature of the disease.

In this paper we report a case of severe laryngeal stenosis caused by CP which necessitated a tracheostomy. When the disease had stabilized, laryngeal airway was restored following open surgical excision and stenting.

The historic, clinical, histologic, immunopathologic and therapeutic features of CP are presented with special reference to the laryngeal lesions.
Argon Laser and Gherini-Causse Endo-Otoprobe™ in Otologic Surgery
Authors: Vincent Robert , Gratacap B. , Causse Jean-Bernard , Gherini Stuart
Published: May 2019

The authors describe the various surgical indications and techniques of the argon laser and Gherini-Causse Endo-Otoprobe™ in otologic surgery, from otosclerosis to chronic otitis. The advantages are numerous, permitting the surgeon to vaporize or coagulate tissue with optimal effect, avoiding excessive mobilization of the ossicular chain and diminishing the risk of damage to the facial nerve and inner ear structures.
Ancient Schwannoma of the Submandibular Gland: A Case Report
Authors: Bondy Peter C. , Block Robert M. , Green Jimmy
Published: May 2019

Schwannomas (neurilemmomas) are neurogenic tumors that arise from the Schwann cells of the neural sheath. They are most often benign and solitary. Extracranial schwannomas are rare, and can be mistaken for metastatic disease or other non-neurogenie tumors. Ancient schwannoma is a rare variant of schwannoma with a course typical of a slow-growing benign tumor. Histologically, it can be confused with a malignant mesenchymal tumor. An unusual case of an ancient schwannoma of the submandibular gland is reported. The clinical, histological and surgical aspects of this tumor are discussed, and the literature regarding this rare entity is reviewed.
Replacement of a Single-Channel with a Multichannel Cochlear Implant as an Upgrade
Authors: Gyo Kiyofumi , Yumoto Eiji , Yanagihara Naoaki , Takahashi Nobuo
Published: May 2019

The removal of a functioning cochlear implant in order to upgrade to a more advanced device is a critical issue to many otologists, since we currently have no means to predict the results preoperatively. This paper reports on two patients who successfully upgraded from a single-channel to a multichannel implant. The new implants outperformed the original devices in both the live-voice test and the videotaped test. The patients stated that the hearing quality afforded by the multichannel implant was much better than that provided by the original implant.
Laser-Assisted Otoendoscopy
Authors: Silverstein Herbert , Rosenberg Seth I. , Arruda Johnny
Published: May 2019

In order to determine if laser tympanostomy is a useful adjunct to middle ear endoscopy, a retrospective case review of 95 patients over 18 years of age and requiring middle ear endoscopy was conducted in a tertiary referral center. The review revealed that clear, rapid visualization of the middle ear structures was accomplished with minimal complications. The tympanic membrane usually healed after the procedure. We conclude that laser tympanostomy safely provides a middle ear opening which streamlines the procedure by providing a bloodless field, and by greatly reducing the need for frequent cleaning of the endoscopic lens.
Early Postoperative Otorrhea after Tympanostomy Tube Placement: A Comparison of Topical Ophthalmic and Otic Drops
Authors: Charnock David R.
Published: May 2019

In a retrospective review of the incidence of early postoperative otorrhea, we compared cortisporin otic suspension with sulfacetamide/prednisolone ophthalmic drops and found them to be approximately equally effective.

The beneficial effect of topical otic and ophthalmic antibiotic drops after tympanoplasty tube placement has already been well documented. It is therefore suggested that the potentially more comfortable and theoretically less ototoxic ophthalmic drop be used to decrease the incidence of early postoperative otorrhea.
Laser-Assisted Uvulopalatoplasty: Long-Term Results with a Treatment for Snoring
Authors: Coleman Jack A.
Published: May 2019

We present a retrospective analysis of the initial results of our institution's evaluation of a new procedure designed to help relieve snoring, as well as having the potential to assist in the treatment of obstructive sleep apnea. The ambulatory, in-office CO2 laser procedure is performed with a local anesthetic. It is a serial procedure that achieves the same end-result as conventional uvulopalatopharyngoplasty, but without many of the associated problems. The indications for the procedure are reviewed, and detailed technical aspects of its performance, including use of new instrumentation, are discussed.

Detailed analysis of the first 20 patients to undergo the procedure in the United States is presented. This is the first series of patients presented in the American literature who have undergone this procedure and who have had long-term follow-up of more than five years. A 90% success rate was achieved. The complication rate, patient tolerance, relative costs, indications and contraindications are discussed.
Aplasia of the Epiglottis: A Rare Congenital Anomaly
Authors: Bonilla Jose A. , Pizzuto Michael P. , Brodsky Linda S.
Published: May 2019

Aplasia of the epiglottis is a rare laryngeal anomaly. We present a case of absence of the epiglottis in a child whose clinical course has been followed for nine years. She required a tracheostomy at two years of age for obstructive sleep apnea which resulted in heart failure; she was eventually decannulated at age seven. This case report highlights the clinical challenges faced in the identification and treatment of the sequelae of this defect. Both endoscopic and computed tomography (CT) documentation are provided. Embryological development and a review of the literature are also discussed.
Diagnosis and Management of Middle Ear Osteomas: A Case Report and Literature Review
Authors: Greinwald John H. , Simko Eric J.
Published: May 2019

Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, 16 cases have been reported in the literature, the vast majority of which appear as middle ear masses in young males with a progressive conductive hearing loss. In most patients, the diagnosis is confirmed by computed tomography (CT) or at the time of surgical exploration. Although these lesions have been described as slow-growing, no long-term follow-up has been reported. We present the seventeenth case of a middle ear osteoma in a 33-year-old man who remains asymptomatic and wthout evidence of tumor growth after nine years of follow-up. We suggest that asymptomatic middle ear osteomas can be appropriately managed without removal in a select group of patients.
Fungal Sinusitis: Progression of Disease in Immunosuppression — A Case Report
Authors: Gungor Anil , Adusumilli Vijay , Corey Jacquelynne P.
Published: May 2019

Fungal sinusitis is a disease which can be grouped into invasive and noninvasive forms. The invasive entities include the acute/fulminant and chronic/indolent forms. The noninvasive entities include the fungus ball and allergic forms. The noninvasive forms, however, can develop into invasive disease under certain immunosuppressive states. The patient in this case report had the fungus ball form of fungal sinusitis which evolved into chronic, and then the acute/fulminant form approximately two weeks after undergoing cadaver-donor kidney transplantation. Due to the patient's immunosuppressed state, the fungus spread beyond the sinus region and eventually lead to fulminant disseminated disease. The severity of the fungal disease corresponded directly to the severity of the patient's immunosuppression.
Animal Bites to the Head and Neck
Authors: Kountakis Stilianos E. , Chamblee Socorro A. , Maillard Alberto A.J. , Stiernberg Charles M.
Published: May 2019

There is controversy regarding the timing of repair and the use of prophylactic antibiotics in patients with animal bites to the head and neck. In this paper we review our experience with such wounds, and address surgical management and the use of prophylactic antibiotic therapy. A retrospective review of the medical records of 29 patients with animal bites to the head and neck was conducted. All patients were seen and treated at a large teaching hospital in Houston, Texas over an 18-month period. Seventy-six percent of our patients were 12 years old or younger. Most came to the emergency room soon after sustaining their injuries, and their wounds were repaired primarily with favorable results. There were no cases of wound infection. Ninety percent were treated with prophylactic antibiotics. The wounds of the 10% of patients who did receive antibiotics were similar to those of the other patients and healed well without infection. Wounds resulting from animal bites to the head and neck can be repaired primarily when treated shortly after injury. Further prospective, randomized studies are recommended to evaluate the effectiveness and necessity of prophylactic antibiotic therapy in this patient population.
Lingual Osseous Choristoma: A Study of Eight Cases and Review of the Literature
Authors: Supiyaphun Pakpoom , Sampatanakul Pichet , Kerekhanjanarong Virachai , Chawakitchareon Prasit , Sastarasadhit Veerapong
Published: May 2019

A choristoma is a tumor-like mass of normal tissue in an “abnormal” location. Lingual osseous choristoma, previously known as osteoma of the tongue, is a rare entity: we found documentation of eight cases at our center during the 10-year period between 1987 and 1996. These cases were analyzed along with 50 others reported in the English language literature between 1913 and 1996. Lingual osseous choristoma frequently occurs during the third and fourth decades of life, and predominantly affects women (81 %). Most of the osseous choristomas in our review were located in the posterior third of the tongue, primarily at or close to the foramen cecum or circumvallate papillae (87.9%). While 39.7% of the patients were asymptomatic, the remaining patients complicated of symptoms including a lump in the throat (25.8%), dysphagia (6.9%), gagging (5.1%), nausea (3.4%) and irritation (3.4%). Treatment of lingual osseous choristoma consists of simple excision. The tumor's origin has been discussed elsewhere.
Autoinflation: Historical Highlights and Clinical Implications
Authors: Stangerup Sven-Eric
Published: May 2019

In 1563, Eustachius first described the tube that came to be named for him. In 1704, Valsalva described the maneuver that bears his name, and in 1836 Deleau became one of the first to advocate infusion of pure air through the eustachian tube using a catheter. Politzer devised his own method for actively inflating the middle ear without using a catheter in 1863. Most modern studies examining the use of autoinflation in the treatment of secretory otitis media have shown a beneficial effect, with effusion being cleared in 52 to 62% of ears up to nine months after the treatment. In two studies, no effect of autoinflation could be demonstrated, and in one publication the autoinflation group had deteriorated compared to the control group. In light of the fact that secretory otitis media is a benign and transient condition, that treatment with antibiotics or insertion of ventilation tubes is not without problems, and that the chance of improving the condition by autoinflation is approximately 50%, it is concluded that autoinflation should be considered first-line treatment, before antibiotic or surgical treatment is planned.
Assessment of the Indoor Environment in Respiratory Allergy
Authors: Sarpong Sampson B. , Corey Jacquelynne P.
Published: May 2019

Many types of allergens may be present in the indoor environment and may lead to sensitization and respiratory allergy. Common indoor allergens include dust mites, animal dander, cockroach exposure and molds. Exposure to indoor pollutants, such as tobacco smoke, wood-burning stoves or fireplaces and chemical sprays, can precipitate and exacerbate symptoms. An allergic reaction in the airways caused by natural exposure to allergens has been shown to lead to an increase in inflammatory reaction, increased airway hyperresponsiveness and increased eosinophils in bronchoalveolar lavage. Other research has demonstrated that asthma symptoms correlate with levels of domestic dust mite and cockroach exposure.

In the case of dust mites, ending exposure results in symptomatic relief.
Management of Neurofibromatosis Type 2
Authors: Bance Manohar , Ramsden Richard T.
Published: May 2019

Neurofibromatosis type 2 (NF2), an as-yet incurable disease that predisposes patients to multiple intracranial and spinal tumors, requires a team approach to treatment, because of its multisystem nature. Included on the team should be neuro-otologists, neurosurgeons, ophthalmologists, geneticists, audiologists, speech therapists and other rehabilitative personnel, including counselors, psychologists and, occasionally, psychiatrists.

The challenge is to arrive at a treatment strategy that preserves useful hearing and quality of life without increasing the risk of complications to the facial nerve or compromising neurologic status. Choosing the best treatment approach involves considering a complex set of competing factors that affect various aspects of the patient's outcome.
Cranial Polyneuropathies in Multiple Sclerosis: Case Report and Literature Review
Authors: Thomas Richard W. , Liening Douglas A. , Auber Andrew E. , Johnson Robert E.
Published: May 2019

Although cranial neuropathies are common disorders in multiple sclerosis patients, multiple cranial nerve involvement is an unusual occurrence. Correlation of clinical symptoms with magnetic resonance imaging evidence of demyelinating central nervous system lesions can confirm the diagnosis. The authors report on the case of a 43-year-old woman who initially was thought to have suffered a brainstem infarct but, in fact, had developed multiple cranial nerve functional deficits. Treatment of multiple sclerosis remains primarily supportive in nature, with corticosteroids used for acute exacerbations and chronic progression.
Inner Ear Barotrauma from Scuba Diving
Authors: Sheridan Mark F. , Hetherington Hugh H. , Hull Jeffrey J.
Published: May 2019

Inner ear barotrauma among scuba divers is believed to be caused by any of three conditions: a hemorrhage in the inner ear, a tear of the labyrinthine membrane, or a perilymphatic fistula. These injuries may occur concurrently or separately. Hemorrhage and membrane rupture are managed conservatively, while fistula requires surgical repair.

In this report, we describe three cases of inner ear barotrauma in scuba divers. We also discuss the proposed etiologies of this injury and the controversy over whether or not divers who have suffered an inner ear trauma can safely resume scuba diving. Although the older literature clearly suggests otherwise, we believe that scuba divers who completely recover from inner (or middle) ear barotrauma may return to diving as long as they exercise caution and care.
Acoustic Neuroma Surgery in Geriatric Patients
Authors: Pulec Jack L.
Published: May 2019

Patients older than 65 years who develop acoustic neuromas have the same signs and symptoms as younger patients. Age limits beyond which surgery for acoustic neuroma is currently not recommended are unreasonable. Untreated vertigo in older patients frequently results in falls that can cause fracture of the femur and significant morbidity and mortality. Surgical removal of acoustic neuromas in patients older than 65 produces results that are as good as those seen in younger patients. The patient's general medical condition, life expectancy, and factors other than chronological age should be considered when surgery is being contemplated. Acoustic neuroma surgery for the older patient can provide gratifying results and should not be withheld strictly on the basis of age.
Equilibrium and Balance in the Elderly
Authors: Hobeika Claude P.
Published: May 2019

Complaints of dizziness and disequilibrium increase with age. Sixty-five percent of individuals older than 60 years of age experience dizziness or loss of balance, often on a daily basis.

Some degree of imbalance is present in all individuals older than 60. This is the result of a generalized functional degradation. Initially, the imbalance is situational and manifests when the righting reflexes cannot meet the demands of a challenging environment, such as a slippery surface. As the functional degradation progresses, the imbalance occurs during everyday activities, independent ambulation becomes difficult, and the likelihood of falls increases. When instability is constant, the individual resorts to the use of a cane, a walker, or a wheelchair.
A Sleep Medicine Curriculum for Otolaryngology-Head and Neck Surgery
Authors: Davidson Terence M. , Loredo Jose S.
Published: May 2019

As otolaryngologists play increasingly important roles in the evaluation and treatment of sleep disordered breathing, it is important that all practitioners systematically study the field of sleep. The curriculum outlined in this article has been developed for resident training at the University of California, San Diego, School of Medicine. It is divided into goals and objectives, curriculum, differential diagnosis of sleep disordered breathing, international classification of sleep disordered breathing, a glossary of sleep terms, and a list of resources.
Snoring Surgery: Which One is Best for You?
Authors: Littlefield Philip D. , Mair Eric A.
Published: May 2019

Excessive snoring is a common problem that is frequently treated surgically. In the early 1980s, uvulopalatopharyngoplasty was introduced to the United States as the first surgical treatment for excessive snoring. It remains in common use, but its limitations created an incentive to develop a procedure that is as effective, but safer and more economical. Several other surgical procedures for snoring were developed, including laser-assisted uvulopalatoplasty, palatal stiffening operations, and radiofrequency ablation. Each of these procedures has its own advantages and limitations; which procedure is the best treatment for excessive snoring is controversial. We present our experience with each of these procedures, along with a thorough review of the literature, to help the otolaryngologist determine which is the best snoring surgery for the individual patient.
Outcomes after Laser Stapedotomy with and without Preservation of the Stapedius Tendon
Authors: Silverstein Herbert , Hester T. Oma , Deems Daniel , Rosenberg Seth , Crosby Noël , Kwiatkowski Terrence
Published: May 2019

Our goal was to investigate the postoperative differences in hearing between patients who had had their stapedius tendon sacrificed and those whose stapedius tendon was preserved during laser stapes surgery for otosclerosis. To that end, we performed a retrospective review by mailing extensive questionnaires to patients who had been operated on between 1994 and 1997. We also performed routine and special audiometric testing to augment the subjective data. Seventy-nine of 124 questionnaires (64%) were returned. Of the respondents, 75 patients had undergone additional pre- and/or postoperative audiometric testing, including tests to evaluate “hearing in noise “ and to determine the “uncomfortable loudness level” (dynamic range).

We found no statistically significant differences between the two groups with respect to their subjective responses and their audiologic test results. The responses to the questionnaire indicated that in most cases, hearing was improved by stapes surgery. We conclude that the stapedius tendon should be preserved whenever possible during stapes surgery, provided that it does not jeopardize the exposure or outcome.
A Counter-Forensic Audit Trail: Disassembling the Case of The Hateful Eight
Authors: Fuller Matthew , Mazurov Nikita
Published: May 2019

Forensics is proposed as a means to understand, trace, and recompile data and computational activities. It has a securitocratic dimension and one that is being developed as a means of opening processes, events and systems into a more public state. This article proposes an analysis of forces at play in the circulation of a ‘screener’ of Quentin Tarantino’s The Hateful Eight and associated files, to suggest that forensic approaches used to control flows of data may be repurposed for dissemination. The article maps a brief history of digital forensics and sets out some of its political entailments, indicating further lines of enquiry regarding the inter-relation of technosocial powers constituted in the interactions between forensics and counter-measures. The article proposes that the posthumanities are partially constituted by a renewed relationship between questions of culture, subjectivity, knowledge and the technical. Some propositions for the technical as grounds for cultural politics are made.
A Clean Slate!
Authors: Segura Harold
Published: May 2019

The teaching of the jubilee constitutes a fundamental pillar for the comprehension of the biblical theology about justice and peace. Juan Stam, distinguished theologian identified with Latin American evangelical theology, has written about this subject through the years as a Christian thinker. In this article, and as a tribute to him, it is a synthesis of his thoughts. The jubilee appeals to the experience of human and solidary faith, as well as the Christian mission practice, as a search for a just world where God’s Shalom be a personal and social reality.
Dying in Service to a Dangerous Idea: Organising the Foundations of an African Jubilee Movement
Authors: Giljam Miles
Published: May 2019

Jubilee is a revolutionary idea that many generations have struggled to act on. Africa is seeking to overcome centuries of colonialism and its extractive structures. Yet this is the African century where African population growth and youthful energy will profoundly impact the globe – for good or ill. Having courage to enact Jubilee principles through grassroots movements could see the creation of a uniquely African economy good for people and the environment that could bless the nations. We can do this by implementing a combination of different movement principles: 1) prayer and discipleship; 2) developing new organisational wineskins; 3) building peace and deep relationships; 4) communicating a unifying and hopeful narrative; 5) forging new identities; 6) formulating concrete plans and communicating clear demands; and 7) persisting in our action even through difficulties. If African movements can tap into the deep divine well of courage and strength to die in service to God’s jubilee calling then perhaps we will see a continent changed forever. Dying each day to self, we cannot rest until we hand over this vision to the next generation.
Jubilee as Restoration of Eco-Relationality: A Decolonial Theological Critique of ‘Land Expropriation without Compensation’ in South Africa
Authors: Kaunda Chammah J , Kaunda Mutale M
Published: May 2019

This article engages with the question of land in South Africa based on the jubilee notion, from a decolonial theological perspective. It shifts the focus from debating the merits of ‘expropriation of land without compensation’ towards assessing the relations of power that determine and legitimate what constitutes the human relationship to the land. It argues that disruption in eco-relationality wrought by colonial-apartheid is a foundational factor of the land struggles in post-apartheid South Africa. In order to promote land justice, there is a need to liberate the land from apartheid through reclaiming African and Christian notions of land as belonging to God.
How reliable is renal ultrasound to measure renal length and volume in patients with chronic kidney disease compared with magnetic resonance imaging?
Authors: Braconnier Philippe , Piskunowicz Maciej , Vakilzadeh Nima , Müller Marie-Eve , Zürcher Emilie , Burnier Michel , Pruijm Menno
Published: May 2019

Background

Renal length, volume, and parenchymal thickness are important clinical parameters, yet data concerning the accuracy and reproducibility of ultrasound (US)-based renal length and volume assessment in patients with chronic kidney disease (CKD) are scarce.

Purpose

To establish whether renal length, volume, and parenchymal thickness can be reliably measured with renal US in patients with CKD.

Material and Methods

All participants underwent renal US, immediately followed by 3-T magnetic resonance imaging (MRI). Renal length, width, transverse diameter, and parenchyma thickness were measured with both methods; renal volume was calculated using the ellipsoid formula. A total of 45 patients with CKD (eGFR [mean ± SD] 57.4 ± 4.4 mL/min/1.73 m2) and 46 participants without CKD (eGFR 97.0 ± 2.4 mL/min/1.73 m2) were included.

Results

US-measured renal length correlated strongly with MRI-measured renal length in no-CKD patients (Spearman’s r = 0.83 and 0.85 for the right and left kidney, respectively; P < 0.005) and CKD patients (r = 0.89 and 0.92 for the right and left kidney, respectively; P < 0.005). There was a significant but weaker correlation between MRI- and US-measured right and left renal volume (r = 0.72, P < 0.005) in no-CKD (r = 0.74 and r = 0.72, respectively; for both: P < 0.005) and CKD patients (r = 0.83 and 0.85, P < 0.005). Weak to moderate correlations were found for parenchyma thickness for the right (CKD group: r = 0.29, no-CKD: r = 0.23; for both: P < 0.05) and left kidney (CKD: r = 0.52, no-CKD group: r = 0.37, P < 0.05). Both intra-observer (Pearson’s correlations of 0.82 for the right and 0.89 for the left kidney) and inter-observer (Lin’s correlation coefficient of 0.90 for the right and 0.82 for the left kidney) reproducibility of US-assessed renal length was high.

Conclusions

US-based assessment of renal length in CKD patients is comparable to MRI measures. Both intra- and inter-observer reproducibility of US-assessed renal length in CKD patients are high. Measurements of US renal volume and parenchymal thickness should, however, be interpreted with caution.
Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study
Authors: Basha Mohammad Abd Alkhalik , Saber Sameh , El-Hamid M Abdalla Ahmed A , Aly Sameh Abdelaziz , GObran T , Waly Amira , Arafa Ahmed Salah
Published: May 2019

Background

Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome.

Purpose

To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS).

Material and Methods

A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months–6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher’s exact test, or Student’s t-test when appropriate.

Results

On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value.

Conclusion

The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.
Thirty Years in the Making: Attitudes to Abortion among Czechs and Slovaks at the End of the State Socialist Era in Czechoslovakia
Authors: Hubatková Barbora
Published: May 2019

The text aims to analyze attitudes to abortion at the end of state socialism in Czechoslovakia, trying to see whether thirty plus years of legally obtainable abortion resulted in markedly favorable stance and whether there was any difference in attitudes between persons socialized under different legal regulation of abortion. Results show that the attitudes in the general population were dependent upon the circumstances of pregnancy in a way that indicated some link to the broader historical context of abortion under state socialism, especially where attitudes to “abortion as a mean of birth control” were concerned. Czechoslovaks born in the latter part of the 1940s, in the 1950s, and the first half of the 1960s were found to be more tolerant to abortion than their older and younger counterparts but did not differ among themselves.
Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents
Authors: Perkins Crystal A. , Busch Michael T. , Christino Melissa , Herzog Mackenzie M. , Willimon S. Clifton
Published: May 2019

Background:

Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons.

Purpose:

To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture.

Results:

A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo ( P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo ( P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7).

Conclusion:

ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.
Community Treatment Orders and Other Forms of Mandatory Outpatient Treatment
Authors: O’Reilly Richard L. , Hastings Thomas , Chaimowitz Gary A. , Neilson Grainne E. , Brooks Simon A. , Freeland Alison
Published: May 2019

This position paper has been substantially revised by the Canadian Psychiatric Association’s Professional Standards and Practice Committee and approved for republication by the CPA’s Board of Directors on July 26, 2018. The original position paper1 was first approved by the Board of Directors on January 25, 2003. It was subsequently reviewed and approved for republication with minor revisions on June 2, 2009.
Cultivating eHealth evaluation leadership
Authors: Lau Francis
Published: May 2019

This article discusses eHealth evaluation leadership in terms of the need, key characteristics, and means to cultivate this leadership. It is well known that health leaders with technical informatics skills and prior eHealth adoption experience are more likely to commit to a long-term eHealth vision, are highly motivated, and can navigate through complex adoption issues. However, much less attention is paid to leadership when it comes to electronic health evaluation. The aim here is to engage the eHealth and broader health leadership communities in a dialogue about eHealth evaluation leadership in terms of its importance, the issues involved, and ways to build capacity in Canada and abroad.