bluuebunny/crossref_metadata_2025 huggingface dataset:
Disablement Index for Eustachian Tube Dysfunction
Authors: Yanez Carlos , Pirron Jose Antonio
Published: February 2015

Objective

1) To describe the development of the Disablement Index for Eustachian tube dysfunction (DIETD‐12), a preliminary and a final 12‐item survey (DIETD‐12) designed for the evaluation of the self‐perceived impact on disease‐specific Eustachian tube diseases. 2) To establish and validate the DIETD‐12 to evaluate patients with Eustachian tube diseases.

Method

A 12‐item tool was developed and administered, and the results were analyzed in a prospective, controlled, review board–approved study. Forty‐eight ETD patients and 50 patients with no ET pathology participated. The survey measuring ET‐related health in physical, functional, and emotional domains was analyzed. Responses were compared to verify results and validation.

Results

Fifty healthy patients (control group) and 48 patients with ETD completed the DIETD‐12 preoperatively and postoperatively. Patients improved an average of 41.2% postoperatively and analyses revealed a significant difference between preoperative and postoperative scores across all domains (P <. 001). Data showed a statistical change in DIETD‐12 scores postoperatively. Cronsbach alpha and Spearman correlation exhibited excellent test‐retest reliability and were obtained for the survey score (R = 0.87) with little random error on test‐retest on construct and validity of the measuring tool. The median survey score was 2.9 (96% confidence interval, 2.8‐3.1) of a maximum 8.0, with higher values indicating poorer quality of life.

Conclusion

The DIETD‐12 has been rigorously validated. It is a valid measuring tool for patients with ETD, exhibiting good construct and content validity and proven to be strong when test‐retest stability was analyzed.The brevity and ease of administration make DIETD‐12 ideal for use in outcomes studies, clinical trials, and routine clinical care.
Does Combat Hearing Preservation Equipment Affect Balance?
Authors: Ambrosio Art A. , Hoffer Michael E. , Pfannenstiel Travis J. , Donaldson Chadwick J.
Published: February 2015

Objective

1) To investigate whether the occlusion effect produced by Department of Defense (DoD) Combat Arms Ear Plugs (CAEP) affects balance. 2) To investigate whether the noise‐canceling Nacre QuietPro system affects balance.

Method

Prospective study conducted from June to August 2010. Twenty subjects with normal hearing and balance function were tested with blackened goggles in 3 conditions—no hearing protection, CAEP, and with the Nacre QuietPro.

Results

An AMTI Forceplate was used to measure the 20 individuals’ average angular acceleration during a period of 20 seconds. The order of the conditions given was randomized for each individual. The mean angular acceleration for no hearing protection, CAEP, and the Nacre QuietPro conditions were 0.65, 0.69, and 0.70, respectively (1‐way ANOVA, P =. 706), showing a nonsignificant trend between the unprotected and protected conditions.

Conclusion

The components of an intact balance system include a variety of neural inputs, to include visual, auditory, and proprioceptive cues. Both the CAEP and Nacre QuietPro are combat hearing preservation devices currently deployed by the DoD in Afghanistan. Our pilot data show no decrement in balance with their utilization.
Effects of Japanese Herbal Medicine on MRSA Otitis
Authors: Kanoh Naoyuki
Published: February 2015

Objective

Establish new treatment for patients with MRSA infected ears without using anti‐MRSA antibiotics, in order to not produce new resistant bacteria to the anti‐MRSA antibio‐tics. Japanese herbal medicines have never produced any new resistant bacteria, and some agents have anti‐MRSA function.

Method

Three concurrent therapies using 2 local treatments, ear irrigation with normal saline and nasal povidone iodine gel treatment, and Japanese herbal medicine administration were applied 3 times a week to 14 patients with MRSA‐infected ears. In this study, we first selected Hocchuekikitou as Japanese herbal medicine.

Results

In 11 patients, MRSA successfully disappeared after several weeks and the infection was also controlled. However, 3 patients were cured after changing Japanese herbal medicine from Hocchuekikitou to Jyuzentaihotou. The mucous membrane of the tympanic cavity which can be observed through tympanic perforation was normal. Therefore, tympanoplasty was easily performed under the normal noninfectious condition after the present combined treatments and postoperative course were fairly good.

Conclusion

The present new combined therapy, concurrent 2 local treatments and Japanese herbal administration, is useful for the MRSA infected ears.
Etiology of 26 Cases with Progressive Bilateral Sensorineural Hearing Loss
Authors: Kishimoto Ippei , Yamazaki Hiroshi , Naito Yasushi , Shinohara Shogo , Fujiwara Keizo , Kikuchi Masahiro , Kurihara Risa
Published: February 2015

Objective

To reveal the causes of rapidly progressive bilateral sensorineural hearing loss (SNHL), too fast to be age‐related degeneration, and too slow to be sudden sensorineural hearing loss.

Method

We retrospectively evaluated 26 patients with bilateral progressive HL who visited our hospital from 2007 to 2011. We excluded the patients with bilateral Ménière’ss disease and acute low‐tone SNHL from our study.

Results

We diagnosed 5 cases with immune‐mediated inner ear disease (IMIED) such as vasculitis, 5 with functional HL, 4 with intracranial diseases including nonbacterial meningitis, lymphoma, and siderosis, and 1 with drug‐induced HL. We could not identify causes in the remaining 11 cases. HL was one of the first symptoms in 10 of 11 cases with IMIED and intracranial diseases. Treatments including steroid administration achieved significant hearing recovery in 4 cases, including 3 with IMIED and 1 with lymphoma.

Conclusion

We revealed that the bilateral progressive HL was often the first symptom of systemic or intracranial diseases. Screening for systemic and intracranial diseases is, thus, important for adequate treatment at early stage of disease.
Current Indications and Outcomes of the Adult Tonsillectomy
Authors: Hsu Nicole M. , Kacker Ashutosh
Published: February 2015

Objective

While there have been numerous studies on tonsillectomies for the pediatric population, there are few studies focused on tonsillectomies performed on adult patients. We sought to determine the current indications for adult tonsillectomy and to examine factors associated with postoperative complications.

Method

Medical records of 184 patients aged >18 years who underwent tonsillectomy in an academic general otolaryngology practice from 2006 to 2011 were retrospectively reviewed. There were 185 tonsillectomies performed (149 total tonsillectomies [TT] and 36 partial intracapsular tonsillectomies [PIT]); 1 patient underwent primary and revision tonsillectomy.

Results

Indications for TT were 58.4% infection (71.3% recurrent, 9.2% tonsilliths/halitosis, and 19.5% recurrent and tonsilliths/halitosis), 34.2% upper airway obstruction, 3.4% obstruction/infection, and 4.0% other medical. Indications for PIT were 77.8% infection (28.6% recurrent, 50.0% tonsilliths/halitosis, and 21.4% recurrent and tonsilliths/halitosis), 19.4% upper airway obstruction, and 2.8% obstruction/infection. Complication rates were 16.5% for infection, 6.9% for upper airway obstruction, 16.7% for obstruction and infection, and 0% for other medical reasons. Complications occurred in 14.8% of TT (72.7% hemorrhage, 27.3% dehydration) and in 5.6% PIT (hemorrhage). No significant difference in complication rate was noted for technique (P =. 17) or indication (P =. 21).

Conclusion

While recurrent infection remains the most common indication for adult tonsillectomy, there is a growing rate of tonsillectomies performed for upper airway obstruction. Complication rates varied according to indication for surgery and surgical technique (total versus partial intracapsular); however, neither was found to significantly increase risk of postoperative complications.
Multiple Otosclerotic Foci: Impact on Cochlear Function
Authors: Richard Celine , Doherty Joni K. , Treadway Jamie P. , Fayad Jose N. , Linthicum Frederick H.
Published: February 2015

Objective

Quantify and illustrate the location of otosclerosic foci using morphologic images and 3D reconstruction. Evaluate the impact of multiple otosclerotic foci on hearing loss.

Method

We investigated our histopathological collection to identify all the temporal bones with: 1) oval window otosclerosis (n = 200), 2) oval window and multiple otosclerotic foci (n = 35), 3) oval window plus cochlear otosclerosis (n = 133), and 4) oval window foci with cochlear and multiple other otosclerotic foci (n = 31). Foci were tabulated for each specimen. Cochlear function (hearing) and morphology (otosclerotic foci quantity and location) were compared.

Results

Of 574 temporal bones with evidence of otosclerosis, 67 had multiple foci. Ectopic foci were found in the internal auditory canal, the peri‐carotid area, semicircular canals and anterior to the cochlea. There was no influence of the number of foci (not involving the cochlea) on hearing loss and cochlear morphology.

Conclusion

This is the first systematic evaluation of the number and location of ectopic multiple otosclerotic foci. As previously reported, there is a relationship between cochlear otosclerosis and sensorineural hearing loss, however the addition of other foci does not affect hearing.
New Route for Stem Cell Transplantation into the Cochlea
Authors: Bae Seong‐Cheon , Park Kyoung‐Ho , Park Shi‐Nae , Yeo Sang‐Won
Published: February 2015

Objective

Cell transplantation provides a potential method to replace the irreversible loss of auditory hair cells and neurons. In this study, we will prove the intravenous route of stem cell transplantation to the inner ear and the efficacy of the umbilical cord blood‐derived mesenchymal stem cell transplantation in hearing restoration of deaf animal model.

Method

About 100,000 umbilical cord blood‐derived mesenchymal stem cells which were tagged as PKH26 were infused to deaf guinea pigs intravenously. After 1 week and 3 weeks, auditory brainstem response test was checked and we obtained a guinea pig cochlea. A cryosection of each cochlea every 120 μm was obtained and we calculated stem cells for 3 sections of each animal.

Results

No hearing gain was shown after stem cell transplantation, but PKH26 tagging mesenchymal stem cell was found in Modiolus, Rosenthal’s canals and organ of Corti. Cells were not found in scala tympani, scala media, and scala vestibuli. Average number of cells in the inner ear was about 88 cells (59‐123 cells/section). Most cells were found in spiral ganglion and migrated into the organ of Corti.

Conclusion

In this study, we demonstrated that cord blood‐derived mesenchymal stem cells could be delivered into the inner ear with intravenous infusion. Based on these results, intravenous injection of stem cells may be used in the treatment of sensorineural hearing loss, regeneration of the auditory hair cells, and neurons.
New Surgical Approach for Lateralized Tympanic Membranes
Authors: Narui Yuya
Published: February 2015

Objective

Lateralization of the tympanic membrane (TM) is a condition in which the visible surface of the TM is located lateral to the bony annular ring and loses contact with the ossicular chain of the middle ear. This condition typically occurs as a complication of otological surgery. Surgical correction of the lateralized TM and restoration of hearing may pose some problems because the grafts tend to relateralize after the revision. Though we have performed that surgical correction in our hospital, we have not had good success. Therefore we have changed our way of technique.

Method

We now use a custom‐made ceramic columella which is 2 times longer than the one we had previously used. It now directly reaches the lateralized TM from the stapes, instead of changing the position of the lateralized TM.

Results

The merit of this approach is that relateralizing never occurs because we do not change the position of the TM. Some patients have improved hearing over 30 dB. The demerit of this approach is that the columellae sometimes fall or break through the eardrum because it is difficult to adjust the length because of long distance. So we have tried to work out the solution by accurately measuring the distance in units of 0.1 mm between the lateralized TM and stapes by using a 3D cone‐beam CT. We also measure the distance throughout the operation.

Conclusion

Though there is a short observation period, we have had good success with this approach. We will report our new surgical approach details with some case reports.
Otoacustic Emission Test Abnormalities among Teenagers
Authors: Sampaio Andre L.L. , Silva Valéria G. , Oliveira Carlos A.C.P. , Tauil Pedro L. , Jansen Glaucia M. B.
Published: February 2015

Objective

To investigate the prevalence of injury of outer hair cells by means of transient evoked otoacoustic emission and distortion product evoked otoacoustic emission tests among teenagers of a private high school in Brazil.

Method

Survey study. We performed transient evoced otoacoustic emission and distortion product evoced otoacoustic emission tests in 134 young individuals from January to December 2011. We analyzed the results according to the “pass/fail” criterion for the parameters amplitude of the signal and signal/noise ratio.

Results

A total of 80.6% of 134 participants had abnormal transient otoacoustic emissions and most were men (92.9%; P <. 05). In all, 97.8% showed abnormal distortion product otoacoustic emissions and no difference regarding the gender (P =. 2). A total of 79.9% showed abnormalities in both transient and distortion product in at least 1 ear, most were men (P <. 05). In sum, 94.0% reported the use of headphones, and 82.8% reported attending some type of place with amplified music.

Conclusion

The high prevalence of abnormal tests could early indicate a cochlear dysfunction, and the high number of participants who reported being exposed to loud music leads to suspicion that this habit might be causing these cochlear changes.
Pediatric Cholesteatoma: Congenital versus Acquired
Authors: Shim Byoung Soo , Shim Myung Joo , Lim Hyun Woo , Yoon Tae Hyun
Published: February 2015

Objective

1) To compare the characteristics of congenital and acquired pediatric cholesteatoma. 2) To investigate the risk factors influencing recidivism after initial surgery to propose a guided therapeutic approach.

Method

Retrospective analysis was made on pediatric cholesteatoma cases under the age of 18 years. A total of 163 patients (92 of congenital and 71 of acquired cholesteatoma) were operated by the same surgeon from 1993 to 2011. We analyzed the symptoms, physical findings, computed tomography, operative findings, hearing, and recurrence.

Results

The ages at diagnosis and operation in congenital cholesteatoma were significantly younger than acquired. The chief complaint of congenital was mainly the incidental mass (74%), whereas the otorrhea (66%) in acquired. Mass shadow behind the intact tympanic membrane was observed in 95% of congenital cholesteatoma. The main tympanic membrane abnormalities of acquired cholesteatoma were attic retraction and pars tensa perforation (56% and 56%). Invasion of epitympanum and ossicular erosion were more frequently found in the acquired cholesteatoma (P <. 05). There was no difference in recurrence rate between congenital and acquired cholesteatoma. Statistically significant factors at high risk of recurrence were pars tensa perforation, diploic pneumatization, incus erosion. On the other hand, lowering risk factors were sclerotic mastoid on CT and no mastoidectomy.

Conclusion

The congenital and acquired cholesteatoma showed very different clinical features. Careful eradication and continued follow‐up is recommended in the children with high risk of recurrence.
Effect of Work Hour Restriction on Residents’ Case Volume
Authors: Darrat Ilaaf , Thorne Marc C.
Published: February 2015

Objective

1) To determine the effect of the Accreditation Council for Graduate Medical Education (ACGME) 80‐hour work restriction on the total number of cases of graduating residents. 2) To determine the effect of the ACGME 80‐hour work restriction on the total number of key indicator cases of the graduating residents.

Method

The ACGME national data reports of case logs for graduating residents from 2004‐2011 were analyzed. Linear regression was used to evaluate for changes in total case numbers over time. Separate models were generated for total case volume, ACGME categories for resident participation (surgeon, assistant, supervisor), and ACGME key indicator categories.

Results

A statistically significant increase in total case volume was observed over the study period, with graduating residents on average performing 25.8 more cases per study year (95% CI = 6.5 to 44.9, P =. 018). This increase is primarily accounted for by an increase in the number of cases categorized as surgeon, with 19.8 more cases per study year (95% CI = 5.8 to 33.7, P =. 015). An increase of 4.1 cases per study year in the key indicator category of Head and Neck was observed (95% CI = 1.6 to 6.5, P =. 008).

Conclusion

Despite implementation of the 80‐hour duty restriction, case logs of graduating residents demonstrated an increase in case volume over calendar time. Further research will be necessary to determine if this finding reflects improved efficiencies in training programs or redistribution of resident activities away from other educational opportunities.
Procedure and Outcome in Simple Underlay Myringoplasty
Authors: Hashimoto Shigehisa , Takahashi Sugata
Published: February 2015

Objective

To assess tympanic membrane (TM) closure rates achieved by 3 operative procedures in simple underlay myringoplasty with fibrin glue (SUM) for TM perforation.

Method

A SUM was performed under local anesthesia under a microscope in patients with perforated TM defects of 50% or less. In those with defects exceeding 50%, we chose a method allowing SUM to be conducted under general anesthesia. A SUM using an endoscope was performed in cases with curved EAC.

Results

A total of 158 ears were treated by SUM. There were 60 ears on which a SUM was performed using an operating microscope under local anesthesia, and complete closure was achieved in 54 (90%). Eighty‐four ears were treated by a SUM under general anesthesia, and closure was achieved in 74 (88%). Endoscopy (1.9 mm in diameter) was performed in 14 ears, of which 13 (93%) attained TM closure. There were no significant differences in closure rates among the surgical procedures selected, and neither enlargement of perforation nor decreased hearing acuity occurred, as compared to the preoperative condition, even in patients suffering reperforation.

Conclusion

This operative procedure is simple and minimally invasive, and provides a satisfactory perforation closure rate. The present data indicate that selection of operative procedures appropriate to various disease states may permit greater extension of surgical indications.
Surgical Site Infections in Ear Surgery: Hair Removal Effect
Authors: Kattipattanapong Woraya , Isaradisaikul Suwicha
Published: February 2015

Objective

1) Compare the rate of surgical site infections in ear surgery between the groups with and without hair removal. 2) Study factors associated with surgical site infections.

Method

A randomized clinical study was conducted in 136 patients who were planned for external or middle ear disease via postauricular approach at Chiang Mai University Hospital from May 2010 to May 2011. Demographic data, surgical site infection within 30 days after operations, and associated factors were recorded.

Results

Fifty‐eight cases were men and 78 cases were women. Demographic data between the 2 groups—age, gender, the side of operated ear, types of anesthesia, emergency or elective setting, BMI, history of alcohol drinking or smoking, underlying diseases, operative time, and the length of stay in the hospital—showed no significant difference. A postoperative surgical site infection was developed in 5 patients: 3 in the group with hair removal (5%) and 2 in the group without hair removal (3%) (P =. 674, Fisher’s exact test). All infected cases had mastoidectomy surgery.

Conclusion

Surgical site infection rate between the groups with and without hair removal showed no difference. Hair removal in ear surgery via postauricular incision showed no effect on the surgical site infection.
Use of Embolization with Liquid Agent in Glomus Surgery
Authors: Rangel Gustavo , Araujo Marcio , Guimarães Luanda , Mury Isabelle , Tavares Diogo , Felix Felipe
Published: February 2015

Objective

Evaluate the effects of embolization using liquid embolic agent (Onyx) in surgery for jugulotympanic tumors with regard to length of stay in hospital, duration of procedure, signs of facial palsy, intraoperative hemorrhage, and postoperative complications.

Method

Six patients were admitted for evaluation therapeutic options. Two patients were treated with radiotherapy and 4 proceeded to surgery. The selection criteria for the therapeutic choice were staging of the lesion, intraoperative risks of the procedure and patient expectations. The embolization with liquid material was performed 2 days prior to surgery by the radiology department in the operative cases. The evaluation was done retrospectively using medical data.

Results

Four patients underwent surgery and 2 patients maintained follow‐up after radiotherapy. In comparison with the literature, a reduction of days in the hospital without requiring intensive care a reduction in (average time of 3 days) and a reduction in duration of surgery time (average length of 150 minutes) was noted. There was no need for hemotransfusion, neither facial palsy nor infection of wound was reported after the surgery in patients that underwent preoperative embolization.

Conclusion

We have a shorter duration of surgery and reduced bleeding and reduced length of hospitalization days with a secure embolization, and as a consequence, less postoperative complications.
Vibrant Soundbridge vs BAHA: Outcomes Comparison
Authors: Rivas Jose A. , Rivas Adriana , Rincon Luz A. , Tamayo Cesar A. , Forero Victor H. , Rivas Alejandro
Published: February 2015

Objective

1) Evaluate results of the implant Vibrant Soundbridge vs BAHA in conductive or mixed deafness. 2) Compare audiological and satisfaction outcomes.

Method

Retrospective study of 50 patients with mixed or conductive deafness. Twenty‐five patients using VSB, 25 using BAHA.

Results

With VSB 46% were men, and the age at implantation was 39 years (SD, 15 years). A total 96% of cases FMT were placed on the round window. Mean postoperative pure tone average without VSB was 69 (±17) dB HL and with VSB in free‐field condition 33 (±17) dB HL. Mean hearing gain was 34 (±17) dB HL. When comparing with the BAHA users’ group, the hearing gain was 38 (±14), and there were no statistical differences, P =. 37.

Conclusion

VSB is an efficient alternative for patients with conductive‐mixed hearing losses, comparable to bone anchored hearing device. The use of the FMT on the round window has demonstrated to be effective in well‐selected cases.
Bupivacaine Infiltration Effect on Post‐Tonsillectomy Pain
Authors: Bakhshaee Mehdi , Bameshki Ali Reza , Khadivi Ehsan , Razavi Majid , Razban Marzieh
Published: February 2015

Objective

Tonsillectomy is one of the most frequent operations performed worldwide. Pain and hemorrhage are the most complications. Reduction in post‐operative pain prevents the dehydration from reduced oral intake. Peritonsillar infiltration of epinephrine with bupivacaine might have some role for this purpose.

Method

72 children who were candidates for adenotonsillectomy randomly were divided into three groups including: patients who injected by normal saline preoperation (placebo group); those injected by bupivacaine and epinephrine preoperation (group 2); and postoperation (group 3). Postoperative pain, hemorrhage and the time of oral intake were measured.

Results

Only VAS pain score in 30 minutes post‐operation was significantly different between placebo and the group 2 (p=0.02). Swallowing pain in 6 hours after tonsillectomy was decreased in drug injection groups compared with placebo group (p< 0.05). The first time of oral intake was not different among groups, statistically. Immediate post‐tonsillectomy hemorrhage was significantly higher in placebo group compare to the other groups while delay hemorrhage did not show any difference.

Conclusion

Peritonsillar injection of epinephrine with bupivacaine before or after tonsillectomy will reduce immediate post‐operative hemorrhage and lead to reduction in the swallowing pain. Early feeding could be a factor for prevention of unwanted outcomes such as fever and secondary dehydration.
Cochlear Implantation in X‐linked Mixed Deafness
Authors: Prickett Kara K. , Todd Norman W.
Published: February 2015

Objective

1) Describe important points of consideration when planning cochlear implant surgery for patients at risk for cerebrospinal fluid (CSF) gusher on cochleostomy. 2) Report successful cochlear implantation in patients with X‐linked mixed deafness.

Method

Fraternal twins with X‐linked mixed deafness were enrolled in an observational study at a tertiary academic medical center from 2010 to 2011. Subjects underwent cochlear implantation and were followed during recovery and auditory rehabilitation. Main outcome measures included successful placement of electrode arrays into the cochlea, adequate control of leaking CSF, incidence of postoperative complications, and development of listening and speaking communication skills in children with implants.

Results

Electrode arrays were successfully placed despite challenging middle and inner ear abnormalities. Leaking CSF was controlled without the use of lumbar drains. No perioperative or postoperative complications occurred. Both patients progressed rapidly in the development of hearing, listening, and speaking skills after successful cochlear implantation. A new surgical instrument was designed and used to aid in electrode insertion into gushing CSF.

Conclusion

Cochlear implantation in patients with X‐linked mixed deafness requires careful planning and execution, but may result in excellent communicative outcomes.
Congenital Familial Subglottic Stenosis
Authors: Manickavasagam Jaiganesh , Thevasagayam Ravi , Bateman Neil D.
Published: February 2015

Objective

Congenital stenosis may be caused by either a small cricoid cartilage or a thick submucosa secondary to a failure of canalization of the subglottic lumen. Acquired subglottic stenosis is caused by trauma. Congenital subglottic stenosis is a well‐known cause of stridor in infancy. It usually occurs sporadically and familial occurrence is rare.

Method

Case series. Pediatric tertiary referral center.Three children who presented with subglottic stenosis born to consanguineous parents were identified. For the literature research, reports published from 1950 to January 2012 were retrieved. We also screened bibliographies of the collected articles to identify pertinent reports.

Results

Three Asian children were born with congenital subglottic stenosis for closely related consanguineous parents. Their presentation, family tree, genetic tests, associated features, and treatment will be discussed. All patients underwent laryngotracheal reconstruction.

Conclusion

Congenital familial subglottic stenosis in unrelated parents has been reported previously but not in consanguineous parents. Family genetic work up is recommended. Further genetic research is needed to assess the mode of possible heritage in these cases.
Development of a Murine Model for CMV‐Induced Hearing Loss
Authors: Patel Rusha J. , Wang Yong , Park Albert H.
Published: February 2015

Objective

1) Illustrate phenotypical evidence of sensorineural hearing loss by showing elevation of auditory evoked brainstem response (ABR) thresholds and diminished distortion product otoacoustic emission (DPOAE) in newborn mice inoculated with murine cytomegalovirus (mCMV). 2) Demonstrate evidence of mCMV‐mediated pathology based on microscopic examination of infected cochleas.

Method

BALB/c mice were injected at postnatal day 3 with 100 pfu of mCMV; controls received saline. Hearing thresholds were assessed using DPOAE and ABR at 4 weeks of age and onward. Histologic changes in temporal bones were compared between infected and control mice.

Results

More than 50% of infected mice had significantly higher DPOAE and ABR thresholds at 4 weeks of age as compared to age‐matched controls (P <. 008). Five mice (45%) had profound hearing loss (≥80 dB) at 4 weeks of age; 7 mice (50%) progressed to profound hearing loss at 6 weeks. 40% of mice had asymmetric hearing loss. Temporal bone histology showed diffuse loss of outer hair cells in profoundly deaf mice as compared to controls.

Conclusion

Intracerebral injection of mCMV to newborn mice can cause hearing loss with high to low frequency ABR progression, and diminished DPOAE. This hearing loss is asymmetric and progressive, similar to human infection. Histologic examination shows loss of outer hair cells in mCMV infected mice, suggesting that CMV infection may target the outer hair cells. Further studies using this model should shed light on the mechanism underlying CMV‐mediated hearing loss and provide foundation for better managing and treatment of the condition.
Evaluation of the Function of Auditive Tube
Authors: Testa José Ricardo G. , Dos Santos Ana Carolina S.
Published: February 2015

Objective

Evaluate the possibility of glucose test in assessing the function of the Eustachian tube.

Method

Prospective study included 20 subjects with chronic otitis media not cholesteatoma, presenting dry tympanic perforation for at least 30 days. These patients were subjected to instillation of ear drops of glucose solution in the ear with dry tympanic perforation. Later these patients were subjected to a audiologic evaluation with impedance and Eustachian tube function test.

Results

In glucose test there was a statistical difference between the 2 responses of test, since it can be stated that there is a greater percentage of subjects with positive responses (80%). There was no statistical difference between the 2 responses in Eustachian tube function test. The test with the greater percentage of semipermeable was glucose test, with 80%, versus 45% of Eustachian tube function test. Consequently the Eustachian tube function test had a greater percentage of not permeable, with 50% versus 20% of glucose test. The glucose test has an excellent sensitivity (100%) and specificity is very low (33.3%).

Conclusion

The glucose test gives informations about the function of the auditive tube.
General Otolaryngology Knowledge in Primary Care Residents
Authors: Error Marc E. , Wilson Kevin F. , Gale Derrick C. , Ward Preston D. , Meier Jeremy D.
Published: February 2015

Objective

1) Determine the amount of exposure to otolaryngology in medical training of nonotolaryngology residents (NOR). 2) Evaluate the general otolaryngology‐related knowledge in these residents.

Method

A 10‐question multiple‐choice quiz was given to residents in family practice, pediatrics, emergency medicine, and internal medicine during scheduled educational conferences. Residents were also asked if they ever participated in an otolaryngology rotation during medical school or residency. Medical students and otolaryngology residents completed the quiz to act as controls.

Results

A total of 49 NOR and 44 medical students answered the questionnaire. Only 24% of the NOR had an otolaryngology rotation during medical school. The same amount (24%) had a rotation during residency. The average percentage correct on the quiz was 49%, 57%, and 91% for medical students, NOR, and otolaryngology residents respectively (P <. 05). Questions with surprising results included one with an endoscopic image of the middle turbinate, and examinees were asked to identify the structure (NOR = 18% correct). A laryngectomy stoma was also shown, and participants were asked what would happen if the stoma was occluded for 10 minutes (NOR = 20% correct).

Conclusion

In this sample of nonotolaryngology residents, a minority experienced a clinical rotation in otolaryngology during medical school or residency. This nonvalidated questionnaire also suggested significant deficiencies in basic otolaryngology knowledge in these residents. Identifying mechanisms to improve exposure to otolaryngology in the medical training curriculum is needed.
Impact of Tonsillectomy Clinical Practice Guidelines
Authors: Setabutr Dhave , Adil Eelam , Chaikhoutdinov Irina , Carr Michele M.
Published: February 2015

Objective

To evaluate the effect of the recently published pediatric tonsillectomy and polysomnography clinical guidelines on current practice patterns.

Method

An anonymous 15‐question survey was sent to members of the American Academy of Otolaryngology–Head and Neck Surgery regarding their awareness of the Clinical Practice Guideline: Tonsillectomy in Children and Clinical Practice Guideline: Polysomnography for Sleep‐Disordered Breathing Prior to Tonsillectomy in Children and whether or not they have changed their practice as a result.

Results

A total of 93% of respondents read the guidelines. Most respondents had completed a pediatric otolaryngology fellowship (84%). A small majority of physicians (54%) continue to prescribe antibiotics within 24 hours after surgery. One‐third of respondents stopped prescribing antibiotics because of the new guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%) in concordance with the guideline’s recommendations. A total of 45% of physicians prescribe NSAIDs for pain control despite its safety profile, and 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intraoperative steroids (90%).

Conclusion

The guidelines are intended to provide evidence‐ based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. A majority of the surveyed otolaryngologists reviewed these guidelines. There is some evidence practice has changed secondary to the guidelines.
Model for Hearing Loss Identification in Belarus
Authors: Merkulova Elena P. , Levaya‐Smaliak Anastasia M. , Danilenko Nina G.
Published: February 2015

Objective

1) To analyze 35delG mutation rates in the large group of children with sensorineural hearing loss (SNHL); 2) To optimize the diagnosis of SNHL in children.

Method

A total of 392 children with SNHL from moderate‐to‐profound hearing loss were examined. A screening for 35delG, pure tone audiometry, and family interviews were performed. A comparative analysis of hearing loss degree and risk factors in 3 groups of children, including 35delG heterozygous, 35delG homozygous, and without this mutation was performed.

Results

Among children with SNHL, 45% are homozygous and 15% are heterozygous for 35delG GJB2. The frequency rate of perinatal pathology in the group of 35delG absence patients is significantly higher (P value =. 03) than in groups of 35delG homozygous and 35delG heterozygous. Our study shows a positive family history is present in 45% of cases with 35delG homozygous children, while for the group without this mutation the deafness of relatives is only 15%. On comparison of 35delG homozygous with 35delG absent patients, the prevalence of severe‐to‐profound hearing loss was significantly (P value =. 046) higher in the group of 35 delG associated SNHL patients.

Conclusion

Our study reveals mutation 35delG is the main genetic cause of SNHL in Belarus as it is detected in 60% of the patients with SNHL. All newborns despite presence or absence of risk factors should be given a molecular analysis for 35delG in cases of positive family history, severe‐ profound congenital hearing loss, and absence of perinatal risk factors.
Quality of Life in Childhood Hearing Loss: Systematic Review
Authors: Rachakonda Tara , Lieu Judith E. C. , Thorne Marc C.
Published: February 2015

Objective

Though the functional performance of children with hearing loss (HL) has been assessed through audiometric and educational testing, quality of life (QOL) has not been as thoroughly addressed. This systematic review was undertaken to test the hypothesis that QOL in children with HL is worse than children with normal hearing.

Method

MEDLINE, EBSCO, and EMBASE databases (end date 11/9/11) were searched for peer‐reviewed articles that examined QOL of children 0 to 18 years with HL using validated QOL surveys. Abstracts were reviewed by 2 reviewers. Articles were excluded if children had fluctuating/temporary HL (such as otitis media) and/or cognitive impairment.

Results

Of 963 articles initially located, 32 articles will be included for further evaluation using modified STROBE criteria: 2 case‐control studies, 11 observational cohort studies, and 19 cross‐sectional studies. Meta‐analysis will be performed to combine data from the studies, and sensitivity analysis will be performed to evaluate the effect of methodologic quality on the overall results. Tests of heterogeneity will be performed and the literature collected will be examined for evidence of publication bias.

Conclusion

We expect that though children with HL may experience worse QOL than their normal hearing peers, hearing assistive devices, such as conventional hearing aids, bone‐anchored hearing aids, and cochlear implants, may provide QOL benefits to these children, above and beyond functional benefits.
The Effect of Tonsillectomy on the Immune System
Authors: Bitar Mohamed A. , Dowli Alexander , Mourad Marc
Published: February 2015

Objective

Parents of children undergoing tonsillectomy often ask about its effect on their child’s immunity. To answer this question, we conducted a thorough review of the literature, including an unpublished study we previously conducted.

Method

A Medline search was conducted. All articles up to January 2012 addressing the effect of tonsillectomy on the immune system were included. No exclusion criteria were used. We previously studied 19 patients undergoing total or partial tonsillectomy. Preoperative and postoperative serum and saliva immunoglobulin levels were taken.

Results

We reviewed 27 articles, published between 1971 and 2010, including 1665 patients (aged 1.5 to 45 years). The studies looked at different parameters, for example, serum immunoglobulins, salivary immunoglobulins, and delayed hypersensitivity test. The lack of standardization of diagnostic tools, follow‐up duration, indication for tonsillectomy, and patients’ ages precluded a meta‐analysis. Six studies (722 patients) found that tonsillectomy negatively affects the immune system, while 21 studies (943 patients) showed no effect. In our study, there was statistically nonsignificant decrease in secretory IgA level after both total (178.02 to 95.01 µg/mL) and partial (197.24 to 111.34 µg/mL) tonsillectomy.

Conclusion

Though the reviewed studies had variability in many aspects, one is more likely to believe that tonsillectomy has no significant effect on the immune system. Articles supporting this conclusion were more recent and had a more comprehensive assessment of the immune system.
The Role of Direct Laryngoscopy in Hospitalized Croup
Authors: Hede Sannya V. , Ongkasuwan Julina
Published: February 2015

Objective

Provide insight into: 1) The frequency of viral vs bacterial hospitalized croup at Texas Children’s Hospital. 2) The epidemiology of hospitalized croup. 3) The efficacy of applying operative direct laryngoscopy and bronchoscopy (DL and B) in the detection of other significant respiratory pathology.

Method

A retrospective chart analysis of 345 patients with the coded diagnosis of croup at TCH between 2003 and 2011 was carried out. Patients with tracheostomy, epiglottitis, and non‐respiratory complications were excluded from the study. Patient information from children with a DL and B was compared to those without the procedure and tabulated into diagnostic and therapeutic criteria. DL and B findings were categorized as normal, grade 1 (< 50% subglottic obstruction), grade 2 (50‐70%), grade 3 (70‐90%), or grade 4 (> 90%).

Results

Of the 345 patients, 125 were girls (36.2%) and 224 were boys (64.9%; mean age, 3.25 years). Of these, 25 patients (7.25%) underwent operative endoscopy. Of these 25, 7 were girls and 18 were boys. Twenty‐three of 25 were of viral origin and 2 of 25 were of bacterial origin. Ten patients were febrile and 11 patients had abnormal oxygen saturation values. Of the 25 cases analyzed, DL and B findings changed management once.

Conclusion

Mild airway abnormalities are common in children with hospitalized croup and cannot be ruled out based on history. The data suggests that in absence of risk factors, the incidence of a significantly abnormal finding is quite low. A predictive model based on this evidence will be discussed.
Traits of Mitochondrial Deafness in a National Repository
Authors: Yelverton Josh. C. , Amos Kathleen , Nance Walter E. , Pandya Arti , Dodson Kelley M.
Published: February 2015

Objective

1) Characterize the mitochondrial sequence variants present in a national hereditary deafness DNA repository. 2) Define clinical presentation and audiometric characteristics of the various subgroups.

Method

Retrospective record review of 86 patients with mitochondrial sequence variants compiled in a national hereditary deafness DNA repository from 1997‐2008.

Results

Of the 86 patients with mitochondrial sequence variants, 21 (24.4%) had the m. 7445A>G mutation, 18 (20.9%) had the m.1555 A>G, 18 (20.9%) had the m.961 T>G mutation, and 29 (33.7%) had a different mutation at the m961 position, most of which (62%) were the m. 961delT+C(n) variant. The majority of patients had bilateral severe to profound hearing loss. Fifty‐three (62%) patients were female and a family history of hearing loss was documented in 60 (69.7%) patients. Deafness was diagnosed before 3 years old in 26 patients.

Conclusion

Mitochondrial deafness can be caused by a variety of genetic mutations with a wide spectrum of clinical presentations. Because of the increased aminoglycoside susceptibility in some forms, it is important to make an accurate diagnosis prior to exposure.
Unusual Tumors of the Jaws in Children
Authors: Perry Katherine , Chang Alice J. , Ambro Bryan T. , Strome Scott E. , Pereira Kevin D.
Published: February 2015

Objective

Present 3 cases of unusual pediatric jaw tumors, including the first reported case in the literature of an immature teratoma of the maxillary sinus.

Method

Retrospective chart review of 3 patients who presented to a tertiary care center with rare jaw tumors over 15 years. Cases include a desmoplastic fibroma of the maxilla, an immature teratoma of the maxillary sinus, and infantile fibromatosis of the mandible. Their clinical presentation, imaging, pathology, treatment, and outcomes are reviewed.

Results

Three unusual pediatric jaw tumors were identified. An 18‐month‐old boy with a desmoplastic fibroma of the left anterior maxilla underwent surgical excision and is disease‐free after 12 months. A 10‐year‐old boy presented with an immature teratoma of the right maxillary sinus and underwent wide surgical resection with primary reconstruction and postoperative chemotherapy. His tumor recurred requiring a maxillectomy after which he remained disease free. A 10‐month‐old boy presented with infantile fibromatosis of the right mandible and underwent surgical resection. His tumor recurred after 4 months requiring a hemi‐mandibulectomy with reconstruction. He has been disease free for 5 years.

Conclusion

Jaw tumors in children are relatively uncommon and have a broad differential diagnosis. We present 3 rare cases, including the first reported case in the literature of an immature teratoma of the maxillary sinus. This case series may help guide care for these complepatients given the paucity of literature.
YouTube as a Source of Pediatric Tonsillectomy Information
Authors: Strychowsky Julie , Nayan Smriti , Maclean Jonathan
Published: February 2015

Objective

Tonsillectomy is a common surgery performed on pediatric patients. Patients and their caregivers may search the Internet for information related to this procedure, and YouTube is a popular Web site that they may consult. We investigated YouTube as an information source on pediatric tonsillectomy.

Method

YouTube was searched on February 17, 2012, for videos containing relevant information about tonsillectomies in pediatric patients using the keywords pediatric tonsillectomy, tonsillectomy and tonsil surgery. Non‐English videos were excluded. Two physician reviewers watched each video and assessed for content (useful, misleading, personal experience). The StatsDirect software will analyze measures.

Results

The search for each keyword identified over 2555 videos (pediatric tonsillectomy = 91, tonsillectomy = about 1800, tonsil surgery = 664). The first 200 videos were screened for each keyword on the assumption that most users would not go beyond the first 10 pages. Therefore, 491 videos were screened for inclusion and exclusion criteria, and duplicates were removed. At the time of abstract submission, final data analysis was not yet available. Outcomes included content assessment and characteristics, and video total viewership, number of days since upload, total duration, viewer rating, and source of upload. Reviewer degree of agreement and relevant statistical analysis will be reported.

Conclusion

YouTube has a substantial number of videos on pediatric tonsillectomy with a variety of content ranging from useful to misleading. Health care professionals must recognize the potential influence that these user‐generated video Web sites may have on the attitudes of patients and their caregivers.
A Case of Atrophic Rhinitis Caused by Klebsiella ozaenae
Authors: Rodgers Brian C. , Baker Kim
Published: February 2015

Objective

To educate clinicians on the presentation and management of this uncommon pathogen as it pertains to atrophic rhinitis and to review the role of autoimmune tendencies in the development of ozena in this patient with nasal infection by Klebsiella ozaenae.

Method

This case report describes a 17‐year‐old Somalian female with ozena (atrophic rhinitis). She presented to our tertiary care center in Kansas City, Missouri, in November 2011 with classic symptoms of atrophic rhinitis and was diagnosed based on a positive surgical culture of K ozanae. She was noted to have bilateral middle turbinate destruction preoperatively and has been treated thus far with serial surgical debridements, topical nasal rinses and an oral fluoroquinolone. We are measuring cure of her disease with multiple parameters including improved nasal obstruction (symptomatic), endoscopic documentation of resolution of rhinitis, and pathologic/microbiologic confirmation of cure.

Results

Our patient experienced temporary relief of her symptoms after endoscopic debridement. Recurrence of her symptoms was delayed by topical nasal rinses and steroids. A prolonged course of therapy with an oral fluoroquinolone augmented by serial nasal debridements was necessary to obtain resolution of her disease.

Conclusion

Management of atrophic rhinitis in the setting of K ozaenae infection is a multidisciplinary approach between surgical specialists and infectious disease specialists. Autoimmune factors may play a role in development and severity of this disease.