bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Immediate Postlateral Skull Base Surgery CT Scans on Clinical Management
Authors: Jiang Zi Y. , Allen Kyle P. , Isaacson Brandon
Published: August 2013

Objectives:

Determine the frequency of abnormalities on immediate (<24 hours) postoperative CT scans for lateral skull base surgical patients and the impact of abnormalities found on postoperative management.

Methods:

Study Design: case series with chart review. Setting: inpatient tertiary care hospital. Adult patients undergoing lateral skull base surgery were identified using a CPT code search from September 2011 to December 2012. Patient demographics, type of skull base lesion, surgical approach, length of operation, time between end of the surgery and computed tomography (CT) scan, CT scan findings, and patient post‐surgical neurologic status were collected.

Results:

Sixty‐two patients were identified (mean age 48, 50% male). 32 patients had schwannomas, 11 cerebrospinal fluid leaks, 5 encephaloceles, 5 meningioma, 5 superior semicircular canal dehiscences, and 4 other disease processes. The approaches were middle fossa (28), translabyrinthine (20), suboccipital (3), retrosigmoid (3), and combined/other (8). Mean total anesthesia time was 6.5 hours (range 2.3 to 14 hours). Mean time between surgery and CT scan was 11 hours (range 3.5‐17). Mild pneumocephalus was almost always found, along with mild extra‐axial blood. Three patients had significant mass effect found on CT scan, but this was present preoperatively. One patient had a mild subdural without neurological decline. No patient suffered any drastic neurological decline, although one patient reported 4th and 5th finger numbness that resolved spontaneously.

Conclusions:

Clinically significant abnormalities on immediate postoperative CT scans were rare, as were cases of neurological decline. Further prospective studies would determine a reasonable algorithm for routine use of postoperative imaging.
In Vivo Gene Transfer into Neonatal Mice Cochlea Using Adeno‐ Associated Viral Vectors
Authors: Meyer Anais , Danos Olivier , Akil Omar , Petit Christine , Safieddine Saaid
Published: August 2013

Objectives:

Although sensory hearing loss is the most common sensory disorder, with more than 75% of genetic origin, there are no curative treatments available. A promising approach to restore inherited hearing loss consists of introducing a functional copy of the deficient gene using gene therapy. The present study develops a non‐invasive surgical approach using adeno‐associated viruses (AAV) vector to introduce reporter genes into neonatal mice cochleae, without affecting the normal development of hearing.

Methods:

AAV2, AAV2/8, AAV2/1, and AAV8, carrying green fluorescent protein (GFP) reporter gene, were tested using 150 neonatal mice. Two microliters of vectors, with titer of 1013 vg/ml, were injected into the scala tympani through the round window. Two weeks after viral injection, evoked auditory brain‐stem responses (ABR) were recorded; cellular expression and distribution of GFP were analyzed by immunohistochemistry and confocal imaging.

Results:

AAV2/8 vector transduced cochlear inner hair cells with high efficiency (80%) and to a lesser degree supporting cells (40%). Serotype 8 transduced mostly neurons (30%). The efficiency of serotypes 2/1, 1, and 2 varied from 5% to 80% of the inner hair cells and from 35% to 80% of supporting cells. The recording of the evoked ABR responses of the injected mice at P16 showed that cochlear function is not affected.

Conclusions:

We have developed a surgical procedure that might be useful for AAV gene transfer into the cochlea to treat genetic deafness. As a next step, a therapeutic gene will be transferred into a mouse model for human deafness to correct hearing loss.
Intraoperative Monitoring of Hearing Improvement during Ossiculoplasty by LDV‐ABR‐ECochG Technique
Authors: Morawski Krzysztof F. , Niemczyk Kazimierz , Hryciuk Aleksandra , Sokolowski Jacek , Bartoszewicz Robert
Published: August 2013

Objectives:

Assess utility of combined electrophysiological and laser‐Doppler Vibrometry (LDV) technique for intraoperative monitoring (IM) of hearing threshold (HT) improvement during ossiculoplasty.

Methods:

Study Design: A prospective, feasibility study. Setting: Academic, tertiary referral center. Ten patients underwent two‐stage canal wall‐up tympanoplasty due to chronic otitis media with cholestaetoma. During the second look surgery performed 6 to 9 months later, ossiculoplasty was monitored intraoperatively by LDV to assess prosthesis movability and by electrocochleography from the round window (RW‐ECochG), and by auditory brainstem responses (ABR) to evaluate HT improvement. The ear was stimulated acoustically by tone‐bursts: 0.5kHz, 1.0kHz, 2.0kHz, and 4.0kHz. Intraoperative HT, defined as the last intensity for which RW‐ECochG and ABR wave V was present, were tested for various configurations of prosthesis placement. Simultaneously for the same stimulation, LDV measured prosthesis moveability. In all subjects, pre‐ and postoperative pure tone audiometry was performed to evaluate postoperative air‐bone gap closure (ABG‐C).

Results:

Postoperative ABG‐C ranged between 10 and 45 dB. HT improvement evaluated intraoperatively correlated with postoperative ABG‐C. Various prosthesis configurations and placements resulted in measurable changes mostly in the RW‐ECochG thresholds. LDV appeared sensitive mostly to prosthesis position changes manifesting by movability improvement at 0.5 and 1.0kHz.

Conclusions:

RW‐ECochG was found to be better than ABR for IM of HT improvement, showing the best correlations with postoperative ABG‐C. RW‐ECochG and LDV showed their usefulness to control prosthesis position changes by confirming better acoustic energy transfer through the reconstructed ossicular chain.
A Lack of Association between Human Herpes Viridiae (HHV) and Vestibular Schwannoma: Analysis of 121 Cases
Authors: Bhimrao Sanjiv K. , Maguire John , Garnis Cathie , Westerberg Brian D.
Published: August 2013

Objectives:

Vestibular schwannoma (VS) is a benign tumor thatarises from the Schwann cells of the vestibular nerve. Human herpes virus (HHV) 1 and 2 have been found within the parenchyma of virtually all the organs of the body and the dorsal root ganglia of the spinal cord in humans. HHV has been shown to replicate within Schwann cells, and infection by HHV has been shown to mimic VS on magnetic resonance imaging. Others hypothesized that the likely cause of VS is HHV infection and that prior exposure to HHV‐3 is a potential risk factor in VS development. Our objective wasto assess for the presence of HHV viral DNA using immunohistochemical techniques in surgically excised vestibular schwannoma samples.

Methods:

Tissue microarrays (TMAs) representing sporadic and NF2‐associated vestibular schwannomas from 121 patients, as well as both positive and negative controls, were studied. TMA sections were immunostained‐using antibodies directed against HHV‐1, HHV‐2, HHV‐3, HHV‐5, and HHV‐8.

Results:

There was no immunohistochemically detectable HHV (HHV‐1, HHV‐2, HHV‐3, HHV‐5, HHV‐8) in any of the 121 cases of sporadic or NF2 cases analyzed.

Conclusions:

These data offer no support for an association between HHV and the development of sporadic or NF2 associated VS in humans.
Light‐based Contact Hearing Device: Characterization of Available Feedback Gain Margin at Two Device Microphone Locations
Authors: Perkins Rodney C. , Levy Suzanne , Puria Sunil
Published: August 2013

Objectives:

Assistive devices compensate for hearing impairment by amplifying sounds with gain, which is limited by acoustic feedback. The light‐based Contact Hearing Device (CHD) provides amplification to 10 kHz by mechanically vibrating the umbo with a wireless Tympanic Contact Actuator (TCA). Driving the eardrum mechanically generates a pressure wave, which travels laterally down the ear canal and produces feedback. Placing the microphone closer to the canal entrance may preserve more natural acoustic cues than the BTE location, although it may reduce available FGM. Our objective was to characterize the feedback gain margin (FGM) at two microphone locations using the CHD to determine if both locations are compatible with treating a broad range of hearing‐impaired subjects.

Methods:

Thirteen subjects with bilateral mild‐to‐severe hearing impairment were fitted with CHDs (26 ears). The TCA was driven with light‐pulses, and the feedback pressure was measured at two microphone locations: at the fossa triangularis (FT) and above the pinna at the BTE microphone location. The FGM from 1‐10 kHz was computed (FGM below 1 kHz is not measureable).

Results:

The mean FGM varied from 32‐48 dB and 38‐60 dB for the FT and BTE microphone locations respectively. FGM was lowest in the 3‐5 kHz range and highest at about 7 kHz. The STD of FGM varied from 5.3‐13 dB due individual anatomies.

Conclusions:

A microphone at the BTE has 6‐12 dB additional FGM over a microphone at a FT location and allows a broader inclusion range to fit impaired patients with amplification to 10 kHz.
Merlin Expression in Spiral Ganglion Neurons Is Decreased in Deafened Mice
Authors: Tokita Joshua , Fernando Augusta , Harpole Bethany , Shah Hetel , Hansen Marlan R.
Published: August 2013

Objectives:

1) Evaluate the expression and phosphorylation status of merlin, the protein product of the Nf2 tumor suppressor gene, in auditory neural structures before and after deafening. 2) Determine the extent to which merlin influences neurite growth in spiral ganglion neurons (SGNs). 3) Determine whether merlin expression in SGNs or spiral ganglion Schwann cells (SGSCs) inhibits neurite growth.

Methods:

Immunostaining of cochlear sections before and after deafening and organotypic explants with anti‐merlin antibodies were used to assess merlin expression in SGNs and SGSCs. A (Tx)‐inducible Cre‐mediated recombination system was used to knock out merlin in neonatal SGNs. Cultures were maintained with (+) or without (‐) Tx for 24h to induce Cre expression. To evaluate loss of merlin expression in SGNs versus SGSCs, we plated (+)Tx and (‐)Tx neurons onto a bed of (+)Tx and (‐)Tx SGSCs. Neurite length and branching were determined for each condition.

Results:

Merlin expression in SGNs raises the possibility that merlin regulates SGN neurite growth. Merlin expression in SGNs decreased in cochlear sections taken from P30 versus P60 control rats and in P30 and P60 deafened versus P30 and P60 control rats respectively. Reduced merlin expression in cultured neurons but not SCs significantly increases both the number and length of SGN neurites in SGNs.

Conclusions:

The pattern of merlin expression and phosphorylation following deafening in SGNs and SGSCs taken together with results indicating that neuronal expression of merlin inhibits neurite growth raises the possibility that merlin plays a role in auditory neural maintenance, regeneration, or both.
Metallurgical Considerations in Shape‐Memory Nitinol Middle Ear Prosthetics
Authors: Knox Glenn W.
Published: August 2013

Objectives:

At the conclusion of this presentation, the participants should be able to 1) describe how the metallurgical phenomenon of creep may be involved in the failure of nitinol middle ear devices, and 2) describe how other metallurgical phenomena such as microfractures can also be involved.

Methods:

Retrospective literature review of nitinol middle ear device failure; retrospective literature review of known metallurgical properties of nitinol such as creep and microfractures; and prospective survey of otologic surgeons. Study period: January 2001 to present (literature review), and 2011 to present (survey). Condition studied: Delayed conductive hearing loss after stapes surgery. Subjects studied: Patients with otosclerosis described in previous studies who underwent surgery with nitinol shape‐memory devices. Surgeons who implanted such devices. Interventions: Analysis of known metallurgical properties of nitinol applied to results obtained with such devices.

Results:

A comprehensive literature review revealed many instances of delayed conductive hearing loss after middle ear surgery with nitinol shape‐memory devices. A survey of otologic surgeons by the author revealed 50% of surgeons reporting “loose‐wire” syndrome as a delayed complication of such surgeries, signifcant to P < 0.05 confidence level (94 surgeons).

Conclusions:

1) “Loose‐wire” syndrome is a frequent complication encountered by surgeons performing middle‐ear surgery with nitinol shape‐memory devices. 2) Metallurgical properties of nitinol such as creep (deformation over time as a result of stress) and microfractures may theoretically be responsible. 3) Additional metallurgical laboratory analysis of nitinol is indicated in order to explain and prevent such complications.
Modern Pharmacotherapies Revivify Patulous Eustachian Tube as Di Bartolomeo's Syndrome of Misophonic Autophony
Authors: Di Bartolomeo Joseph R. , Gallo Andrea , Di Bartolomeo Maxine G. , Di Bartolomeo Raymond O.
Published: August 2013

Objectives:

1) Analyze the contemporary etiologic factors for the increasing incidence of rare patulous Eustachian Tube (PET) disorders within this century. 2) Enable physicians to recognize this elusive syndrome in the clinical otologic history and physical examination. 3) Identify the specific etiologies causing the PET in Di Bartolomeo's Syndrome of pathognomic autophony and the complex factors that enable the disturbing autogenic tubular sounds.

Methods:

Double blind, random clinical trial, employing the preferred topical nasal medication. A collateral PET study (2002‐2006) to formulate a drug‐free remedy which supports healing and tissue strength, within the generally regarded as safe (GRAS) Food and Drug Administration standards. The National Institutes of Health, and collateral PET support group social media forum, informed new PET inquirers of The Ear Foundation's former research website.160 subjects completed the study. In the online forum, 3,500 PET patients (4,000 ears) were treated. The results of the investigational new drug clinical trials and separate drug‐free study are presented.

Results:

Recent scientific and cultural advances in this century are identified which facilitate the evolution and increase in patients with disabling PET symptoms. Each has an individual multi‐factorial and enigmatic etiology and mechanism of action.

Conclusions:

None provided by author.
A New Method for Identifying Cochlear Ossification in Cochlear Implant Candidates with Deafness following Meningitis
Authors: Ichikawa Kazunori , Kashio Akinori , Ochi Atushi , Karino Shotaro , Sakamoto Takashi , Kakigi Akinobu , Yamasoba Tatsuya
Published: August 2013

Objectives:

To develop a new method to determine the presence of intracochlear ossification and/or fibrosis in candidates for cochlear implantation (CI) with deafness following meningitis.

Methods:

This study involved 13 patients (15 ears: normal structures, soft tissue alone, partial bony occlusion, and complete bony occlusion in 4, 3, 2, and 6 ears, respectively) with profound deafness due to meningitis who underwent CI. We measured the radiodensity in Hounsfield Units (HU) using 0.5‐mm‐thick, axial, high‐resolution computed tomography (CT) image slices at 3 different points in the basal turn, including the fenestration site and inferior and ascending segment sites, which were located along the electrode‐insertion path. Pixel‐level analysis on the DICOM viewer yielded actual CT values of intracochlear soft tissues by eliminating the partial volume effect. The values were compared with the intraoperative findings.

Results:

Values for ossification (n = 12) ranged from +547 HU to +1137 HU (n = 12); for fibrosis (n = 11), from +154 HU to +574 HU (n = 11); and for presence of fluid (n = 22), from −49 HU to +255 HU. From these values, we developed 2 presets of window width (WW) and window level (WL): 1) WW: 1800, WL: 1100 (200 HU to 2000 HU) and 2) WW: 1500, WL: 1250 (500 HU to 2000 HU). The results using these 2 presets corresponded well with the intraoperative findings.

Conclusions:

Our new method is easy and feasible to preoperatively determine the presence of cochlear ossification and/or fibrosis that develop following meningitis.
Nocturnal Middle Ear Pressure and the Effects of Continuous Positive Airway Pressure
Authors: Thom Joshua J. , Carlson Matthew L. , Driscoll Colin L.W. , St. Louis Erik K. , Ramar Kannan , Olson Eric J. , Neff Brian A.
Published: August 2013

Objectives:

1) Quantify normal middle ear pressure during sleep; 2) Quantify middle ear pressure during sleep in the presence of continuous positive airway pressure (CPAP).

Methods:

A prospective cohort study was conducted on adults without middle ear disease undergoing polysomnography at a tertiary referral sleep medicine center during 2012. Tympanometry was performed on sleeping patients, and middle ear pressure was recorded at 1‐hour intervals during diagnostic polysomnography and at all CPAP levels during CPAP titration. Mean middle ear pressures were calculated. Pearson correlation coefficients (r) were used for analysis.

Results:

Ten adults with type A tympanograms and normal otoscopic examinations were included (4 females; 6 males; mean age 58 years). The mean awake middle ear pressure was 3.2 decapascals (daPa). The mean middle ear pressure during sleep without CPAP rose steadily from 14.3 daPa at 1 hour to 41.4 daPa at 4 hours, r = 0.53 (P < 0.001). The mean middle ear pressure did not change with sleep stages (P = 0.99). At a CPAP of 5 cm of water, the mean middle ear pressure was 53.7 daPa. The mean middle ear pressure rose with increasing CPAP levels and was 104 daPa at 10 cm of water, r = 0.86 (P < 0.001).

Conclusions:

In normal ears, middle ear pressure rises with time asleep. CPAP causes a greater than physiologic elevation in middle ear pressure that rises with increasing CPAP levels. These findings may help guide future studies examining the safety of CPAP following ear surgery and potential therapeutic roles for CPAP in patients with middle ear disease.
Modified Z‐Plasty of the Ala to Relieve Nasal Vestibular Stenosis
Authors: Hariri Ahmad , Choudhury Natasha , Saleh Hesham
Published: August 2013

Objectives:

Nasal vestibular stenosis results in significant functional impairment and cosmetic deformity. Various techniques can be used, including excision of the deformed segment and replacement with healthy tissue using local flaps, composite or cartilage grafts, with or without stents. W‐plasty, Z‐plasty, and double‐cross plasty techniques have also been described. We aimed to evaluate the following outcome measures: 1) Describe our modified Z‐plasty technique to widen the ala base. 2) Report patient satisfaction with respect to functional and cosmetic improvement.

Methods:

A retrospective study over a 4‐year period was conducted on patients who underwent modified Z‐plasty of the ala. This is performed under general anaesthetic, with infiltration of 2% lignocaine, and 1:80,000 adrenaline to the lateral alar margin and adjacent soft tissue, overlying the piriform aperture margin. A Z‐plasty incision is made around the lateral ala and anterior nasal process of maxilla. The two triangular flaps are transposed to lateralize the ala and widen the vestibule.

Results:

Six patients have undergone modified Z‐plasty of the ala, including 5 females and 1 male, with a mean age of 40 +/‐13.5years. All patients presented with narrowing of the vestibule from scarring of the ala, secondary to burn, blast, and traumatic injuries. All patients confirmed significant improvement in their nasal breathing. There were no post‐operative complications.

Conclusions:

Nasal vestibular stenosis is a challenging deformity, with a variety of potential surgical approaches. We describe our modified Z‐plasty of the ala, which we have used in 6 patients, all of whom have reported both functional and cosmetic improvement.
Outcomes following Semicircular Canal Plugging
Authors: Goddard John C. , Wilkinson Eric P. , Friedman Rick A.
Published: August 2013

Objectives:

1) Examine audiometric outcomes following semicircular canal plugging for either superior semicircular canal dehiscence syndrome or refractory positional vertigo. 2) Review symptom control rates and complication rates for canal plugging procedures.

Methods:

Retrospective chart review at a private neurotologic tertiary referral center. Patients undergoing semicircular canal plugging for superior semicircular canal dehiscence syndrome or refractory positional vertigo from January 1, 2007, to December 31, 2012, were included. Pre‐ and postoperative audiometry, operative findings, and clinical symptoms were assessed through chart review. Acoustic reflex testing, vestibular testing, and canal dehiscence size were examined in superior canal dehiscence patients.

Results:

A total of 28 patients underwent a canal plugging procedure during the study period: 24 superior canal dehiscence syndrome patients and 4 posterior canal occlusion patients. Postoperative air conduction pure‐tone averages were 22.5 and 13.0 dB for these two groups, respectively, compared to their preoperative values of 21.1 and 11.0 dB. The average pre‐ and postoperative word‐recognition scores for the entire cohort were 96.2% and 94.0%. Vestibular evoked myogenic potential data showed reduced thresholds in 7 canal dehiscence patients. The average size of the canal dehiscence, based on preoperative radiological measurements, was 3.4 mm. Surgical complications were limited to one temporary facial weakness (Grade 2). Complete symptom improvement was noted in 35.7% of all patients, while 16.7% of canal dehiscence patients reported no change in symptoms.

Conclusions:

Semicircular canal plugging procedures are associated with excellent hearing outcomes and may reduce preoperative symptoms in patients with canal dehiscence and refractory positional vertigo.
Randomized Controlled Trial to Assess the ACE Program for Rehabilitation in Patients with Hearing Loss
Authors: Cardemil Felipe , Esquivel Patricia , Barría Tamara , Aguayo Lorena , Fuente Adrian , Espejo Maritza R.
Published: August 2013

Objectives:

Implement a standardized counselling program in elderly patients with hearing loss users of hearing aids and evaluate its utility in terms of adherence to hearing aids.

Methods:

A randomized clinical trial was carried out during the period from October 2011 to August 2012, with a follow‐up of 6 months, approved by the hospital ethics committee. Patients 65 years and older with hearing loss diagnosed by pure tone audiometry who were patients from the National Public Health Service were included. The intervention used was a rehabilitation program called Active Communication Education (ACE), designed in Australia in 2007, which aims to improve rehabilitation of hearing aids users. To assess adherence, the International Outcome Inventory for Hearing Aids scale was used.

Results:

One hundred and eighty patients were evaluated, corresponding to 90 control and 90 rehabilitated patients. The overall adherence of hearing aids use was 78%. There was no difference in sex, age, and audiometric variable groups. The average daily hours of use in the control group were 6.9 hours, compared with 9.6 hours in the intervention group (P < 0.0001). There was a significant association between the intervention and the use of the hearing aid, with a greater proportion of patients who used more than 8 hours per week in the intervention group (66.6% vs 33.3%, P < 0.001).

Conclusions:

The intervention implemented has shown excellent preliminary results in terms of time of use of the hearing aid. It would be useful to include this intervention in the hearing loss national public policy.
Round Window Vibroplasty in Infants and Children with Atretic Ear
Authors: Colletti Vittorio , Mandala Marco , Colletti Liliana
Published: August 2013

Objectives:

Evaluate long‐term safety and outcome of round window vibroplasty (RWVPL) by the placement of the floating mass transducer (FMT) on the round window membrane in infants and children with congenital aural atresia (CAA).

Methods:

External auditory canal and middle ear malformation, accompanied by more or less severe conductive or mixed hearing impairment characterize children and infants with CAA. Several atresiaplasty procedures have been proposed without evidence of long‐term air‐bone gap closure despite initial satisfactory outcome. Prospective study at atertiary referral center. Seven infants and 10 children with CAAwere judged not to be candidates for air and bone conductive hearing aids and their parents declined bone‐anchored hearing aids. Intervention: RW implantation with the Med‐El VSB. Main outcome measures: Pure tone audiogram and free‐field speech testing, free‐field Auditory Brainstem Response (ABR).

Results:

Significant improvements were observed in pure‐tone threshold and speech perception immediately after surgery and at follow‐up intervals (12 to 60 months) in older children (P <0.01). In infants and younger children free‐field ABRs showed a significant shift of the mean air conduction threshold from 110 dB sound pressure level (SPL) preoperatively to 40 dB SPL (P < 0.05) and 30 dB SPL (P < 0.01), respectively postoperatively and at the last follow‐up. No complications or instances of device extrusion were observed in this series of patients.

Conclusions:

RWVPL offers a safe, viable and improved treatment option for infants and children with CAA.
Single‐Stage Surgery for Placement of Pediatric Bone‐Anchored Hearing Aids
Authors: Agan Ashley D. , Isaacson Brandon , Roland Peter S. , Lee Kenneth H. , Kutz J. Walter
Published: August 2013

Objectives:

1) Determine the incidence of skin overgrowth and failure of osseointegration in pediatric patients undergoing single‐staged placement of a bone anchored hearing aid. 2) Compare these results to patients undergoing staged surgery.

Methods:

Pediatric patients who underwent placement of a bone anchored hearing aid in an academic pediatric medical center from July 1, 2006, to December 2012 were identified in a retrospective manner using CPT code 69714. Cause of hearing loss, surgical technique, staging of surgery, and postoperative findings including skin overgrowth and failure of osseointegration were recorded.

Results:

Sixty‐six patients underwent placement of a bone anchored hearing aid, with 11 patients undergoing bilateral surgery. Sixty‐four sides were performed in 1 stage and 13 sides in 2 stages. The overall osseointegration failure rate was 4.5%, all in patients who underwent single‐staged surgery. Two of these patients had Treacher‐Collins syndrome, and the other patient had craniofacial abnormalities. Five patients (7.5%) required revision surgery for skin overgrowth, with 4 having single‐stage surgery and the other having staged surgery.

Conclusions:

Single‐staged surgery placement of a bone anchored hearing aid is an acceptable alternative to staged surgery with low rates of osseointegration failure or skin overgrowth.
Social Isolation and Hearing Loss in the Elderly
Authors: Mick Paul T. , Lin Frank R.
Published: August 2013

Objectives:

By the end of the presentation the participant should better understand 1) the association between social isolation and hearing loss in the elderly; and 2) the consequences of social isolation and age‐related hearing loss on the health and functioning of older adults.

Methods:

Data from the National Health and Nutrition Examination Survey (NHANES) from 1999‐2006 were used to calculate odds ratios (OR) for the cross‐sectional association between social isolation and hearing level using multivariate logistic regression models. Social isolation was defined as a binary variable based on the presence or absence of emotional support, financial support, close friends, spouse, or partner. Hearing level was defined by pure tone average in the better hearing ear. Results were stratified by age categories (60‐69 and 70+).

Results:

1613 NHANES participants completed hearing testing and the social support questionnaire. Nine hundred and forty‐eight were aged 60‐69, and 664 were older than 70. The association between social isolation and 25 dB increments of hearing loss was significant in the 60‐69 year old age group (OR = 2.4, 95% CI = (1.36, 4.23) P = 0.003) but not in the 70+ age group (OR = 1.06, 95% CI = (0.62, 1.82), P = 0.82). The association in the 60‐69 year old age group was significantly stronger in women (OR = 4.0, 95% CI = (2.21, 7.36), P < 0.001) than men (OR = 0.98, 95% CI = (0.53,1.84), P = 0.96).

Conclusions:

There was a strong association between social isolation and hearing loss in 60‐69 year old women. The finding may contribute to our understanding of the consequences of hearing loss on the aging process.
Oncologic Safety of the Submental Flap for Reconstruction in Oral Cavity Malignancies
Authors: Howard Brittany E. , Nagel Thomas H. , Donald Carrlene B. , Hinni Michael L. , Hayden Richard E.
Published: August 2013

Objectives:

1) Recognize the submental flap as an excellent option for oral cavity reconstruction. 2) Evaluate the oncologic safety of the submental flap given transposition of potentially involved nodal basins to the reconstruction site.

Methods:

Retrospective chart review of submental flap reconstructions for oral cavity defects secondary to cancer resections performed at a tertiary referral center between 2001 and 2012. Analysis included tumor location, staging, reconstructive details, postoperative course, and outcomes.

Results:

Fifty patients were identified having undergone submental flap reconstruction of defects following resection for oral cavity malignancies. No patient had identifiable Level I nodal involvement. Patients’ ages ranged from 35 to 88 (mean 70) years old. Subsites involved were mobile tongue (n=11), buccal mucosa (n=12), retromolar trigone (n=9), hard palate (n=5), lip (n=3), superior alveolar ridge (n=3), and inferior alveolar ridge (3). AJCC staging of patients included stage II (n=16, 32%), stage III (n=10, 20%), and stage IVa disease (n = 28, 48%). All patients underwent a level 1A and 1B dissection with removal of the nodal basin and submandibular gland. The prevalence of occult lymph node metastasis involving level 1 was 10.6%. On follow‐up there were no local recurrences associated with submental flap transposition to the oral cavity. Tongue recurrence occurred in 1 patient with multifocal disease discrete from the submental flap reconstruction. There was 100% flap survival.

Conclusions:

The submental flap provides a rapid and reliable option for oral cavity defect reconstruction. With appropriate management of the level 1 nodal compartment oncologic outcomes are not compromised.
A Systematic Review of Electrocochleography (ECochG) in Ménière's Disease Diagnosis
Authors: Qi Li , Nunez Desmond A.
Published: August 2013

Objectives:

Electrocochleography (ECochG) is an objective test that can be used in the diagnosis of Ménière's Disease (MD). This study 1) reviews the sensitivity and specificity of non‐invasive ECochG in articles reporting on MD diagnosis over the past 10 years; 2) determines the non‐invasive ECochG test parameters that increase the test's sensitivity in MD diagnosis.

Methods:

An extensive search of Medline, the Cochrane library, EBASE, Web of Science, and Google Scholar was performed. Only English language articles published from 2002 to 2012 that diagnosed Ménière's disease based on the 1995 American Academy of Otolaryngology—Head and Neck Surgery criteria were included. The Oxford Centre for Evidence‐Based Medicine (March 2009) levels of evidence were adopted.

Results:

The most widely used diagnostic criteria show the click induced SP/AP amplitude ratio provides approximately 53‐70% sensitivity and 80‐90% specificity (evidence level 2). Combining click and tone burst induced ECochG derived measurement parameters SP/AP area ratio, latencies shift, amplitude ratio, and interaural SP/AP ratio provide approximately 84‐92% sensitivity with a specificity of approximately 85‐90% (evidence level 2).

Conclusions:

ECochG diagnostic specificity for MD is 80‐90%; however, the 53‐70% sensitivity of ECochG can be increased to 84‐92% by combining multiple measurements derived from click and tone burst ECochG.
Targeted Amelioration of Cisplatin‐Induced Ototoxicity
Authors: Mohan Shaulnie , Gratton Michael A. , Smyth Brendan , Phillips Grady , Namin Arya
Published: August 2013

Objectives:

Determine if local intratympanic (IT) administration of N‐acetylcysteine (LNAC) improves cochlear glutathione levels versus systemic LNAC intraperitoneal (IP) administration, as indicated by decreased oxidized (GSSG)/reduced (GSH) glutathione ratios. Cisplatin is a platinum based ototoxic chemotherapeutic agent that induces injury secondary to the accumulation of reactive oxygen species. This pilot study assesses if different LNAC formulations or modes of administration decrease cochlear oxidative stress (GSSG/GSH ratio).

Methods:

Cisplatin was administered subcutaneously for 3 days (5.5 mg/kg SC/day x 3). Single LNAC formulations were administered to guinea pigs either via IT (solution), IT (nanocapsular gel), or IP (250mg/kg) 2 hours prior to Day 1 cisplatin dosing. On Day 3, cochlear tissue was microdissected, flash frozen, stored ‐70ºC, and assayed within 21 days. The levels of GSSG and GSH in homogenized cochlear tissue supernatants were determined in white half area 96‐well plates (Corning) by assay kits (Promega) via luminometry (Dynex) and referenced per total protein (BCA assay, Pierce).

Results:

The greatest reduction in cisplatin induced GSSG/GSH occurred for LNAC 250 mg/kg IP pretreated animals, compared to the IT formulations and cisplatin only control groups.

Conclusions:

The greatest decrease of cochlear oxidative stress was seen when L‐NAC was delivered IP prior to cisplatin treatment. Further studies are needed to determine the effects on hearing thresholds and the utility of this proposed cisplatin protective treatment.
Transmastoid Approach to Spontaneous Temporal Bone CSF Leaks: Hearing Improvement and Success of Repair
Authors: Kim Leslie , Wisely Clayton E. , Dodson Edward E.
Published: August 2013

Objectives:

1) Recognize that transmastoid repair of spontaneous CSF leaks is safe and effective. 2) Recognize that improvement in conductive hearing loss is an achievable goal with this approach.

Methods:

This is a retrospective case review at a tertiary academic medical center of 17 consecutive patients (18 ears) who presented with spontaneous temporal bone CSF leaks over an 8‐year period. Clinical data, imaging, audiometry, operative reports, and postoperative course were reviewed. The primary outcome was success of the repair. The secondary outcome was hearing preservation.

Results:

Median age was 57.5 years. Mean body mass index was 39.27mg/kg2. All presented with chronic otorrhea after tympanostomy tube placement and conductive/mixed hearing loss. The mean preoperative air‐bone gap was 19dB. A transmastoid approach alone was used in 17 cases; 1 underwent middle fossa craniotomy approach. Defects were located over the tegmen mastoideum and tegmen tympani. Most repairs used autologous mastoid bone, temporalis fascia, and tissue sealant. Primary surgical repair was successful in 17 cases; 1 patient with persistent postoperative otorrhea subsequently underwent middle fossa craniotomy, but no frank leakage was found. No complications were encountered. The average improvement in postoperative air‐bone gap was 12dB. Closure of the air‐bone gap to <10dB occurred in over 80% of the cases.

Conclusions:

The transmastoid approach for repair of temporal bone CSF leak is safe and highly successful. Furthermore, the majority of patients in this series had excellent hearing results with closure of their air‐bone gap to <10dB, which has not been previously described.
Trigeminal Nerve Deficit in Large/Compressive Acoustic Neuromas (ANs) and Its Correlation with MRI Findings
Authors: Karkas Alexandre , Gay Emmanuel , Lamblin Elea , Meyer Mikael , Schmerber Sebastien
Published: August 2013

Objectives:

Evaluate the risk of pre‐ and postoperative trigeminal nerve (V) impairment in large ANs. Determine predictive risk factors on pre‐ and postoperative MRIs.

Methods:

Retrospective study (1994‐2009) including patients with stage 4 or 5 AN (classification of Zini‐Magnan). All underwent surgical resection (chiefly translabyrinthine approach). Pre‐ and postoperative trigeminal symptoms were sought. Pre‐ and 3‐month‐postoperative MRIs were obtained.

Results:

Fifty‐four patients (30 females, mean 51 years) were operated. Preoperatively, 3 patients (5.5%) had trigeminal neuralgia, 29 (54%) had trigeminal hypoesthesia (V1 < V2 = V3), and 16 (30%) had no corneal reflex (V1 branch). Postoperatively, 2 patients (4%) had trigeminal neuralgia, 1 (2%) had trigeminal anesthesia, 25 (46%) had trigeminal hypoesthesia (V1 = V2 = V3), 26 (48%) had no corneal reflex, and most also had House‐Brackmann ≥ grade IV facial paralysis. Keratitis occurred in 42% of patients with absent corneal reflex postoperatively. After analyzing preoperative MRI, there was only one predictive factor of preoperative trigeminal impairment: impaction of the tumor on cerebellar peduncles (P < 0.05). Postoperative trigeminal deficit was correlated with one finding on postoperative MRI: nonvisibility of V on MRI (P < 0.05). Postoperative trigeminal deficit was correlated with one finding on preoperative MRI: impaction of the tumor on cerebellar peduncles (P < 0.05).

Conclusions:

Trigeminal impairment in large/compressive ANs has to be sought particularly to avoid corneal complications. If the frequency of trigeminal hypoesthesia slightly diminishes after tumor removal, there is worsening of preoperative function of V1 and increased frequency of absent corneal reflex, also worsened by facial paralysis. We were able to correlate trigeminal involvement with pre‐ and postoperative MRI findings.
Using LDV and ECR Measurements in the Differential Diagnosis of Partial and Complete Ossicular Discontinuity
Authors: Ulku Cagatay H. , Roosli Christof , Merchant Gabrielle R. , Halpin Christopher F. , Rosowski John J. , Merchant Saumil N. , Nakajima Hideko H.
Published: August 2013

Objectives:

Evaluate the reability of laser doppler vibrometry (LDV) of the tympanic membrane (TM) and ear canal reflectance (ECR) measurements in the differential diagnosis of partial and complete ossicular discontinuity (OD).

Methods:

Patients, with surgically confirmed partial or complete OD and an intact TM, were recruited from the Otology clinic. Pre‐operative possible diagnosis were made by otoscopic examination, audiometry, LDV and ECR. Audiometry, LDV and ECR data in each of the two OD subgroups were evaluated in order to determine their use in differential diagnosis.

Results:

44 patients with surgically confirmed OD with intact TM (27 complete, 17 partial) were included in this study. Audiometry was performed in all cases. There were statistically significant differences in air‐bone gap (ABG) between the two subgroups below 1 kHz. LDV was performed in 29 (16 complete, 13 partial). An increase in LDV magnitude and a decrease in phase angle below 1 kHz were greater in the complete OD subgroup, but not significantly. ECR was performed in 11 (5 complete, 6 partial). ECR near 1 kHz was lower than the normal in both OD subgroups and the difference between the two subgroups was significant.

Conclusions:

A difference between the means of ECR measurements suggests a possible clinical utility. On the other hand, subgroup difference in LDV magnitude and phase angle were not significant. A combination of LDV, ECR and audiometry may help differentiate the two conditions. More patient data will enable better evaluation of the diagnostic significance of the observed differences.
Vestibular Compensation following Retrosigmoid Vestibular Schwannoma Surgery
Authors: Betka Jan , Chovanec Martin , Zverina Eduard , Profant Oliver , Cakrt Ondrej
Published: August 2013

Objectives:

Balance problems following vestibular schwannoma (VS) surgery are most apparent in the acute stage and usually improve over time. Persisting vestibular symptoms are related to significant morbidity and decreased quality of life.

Methods:

Eighty‐nine patients undergoing unilateral VS resection via a retrosigmoid approach during 2008‐2010 were prospectively analyzed. Definitive assessment of vestibular compensation was performed 24 months postoperatively. Persistent vertigo or spontaneous nystagmus and deviation of subjective visual vertical were classified as non‐compensated vestibular pathology. We performed multivariate statistic analysis (Anova) of patient (age, gender), tumor (size – Koos and international classification), preoperative vestibular pathology (ipsilateral/contralateral peripheral, central), and intraoperative (conventional or minimally‐invasive approach, tumor adherence, consistency, bleeding, cystic, origo, cerebellar injury) factors. To assess impact of vestibular symptoms on quality of life, we employed Dizziness Handicap Inventory (DHI) and SF36 questionnaires.

Results:

Twelve of 89 patients undergoing VS surgery suffered from disordered vestibular compensation. Among the factors analyzed, the advanced age seems to be a crucial negative prospective factor of vestibular compensation (P =0.006) (55 ± 10 years in noncompensated vs. 44 ± 13 years in compensated patients). Disbalance was more prevalent in the group of uncompensated patients (P = 4 x 10‐7). Surprisingly, poor compensation did not correlate with worse DHI and SF36 scoring.

Conclusions:

Identification of factors that may contribute to a poor vestibular compensation is crucial for both VS management planning and proper postoperative vestibular rehabilitation. Employment of biofeedback and vestibular prehabituation represent promising methods to improve and speed up postoperative vestibular compensation.
Caregiver Quality of Life Is Related to Severity of Otitis Media in Children
Authors: Blank Sarah I. , Grindler David J. , Lieu Judith E.C.
Published: August 2013

Objectives:

Otitis media (OM) in children is the most frequent reason for physician visits in developed countries and burdens caregivers and society, as well as the child. Our objective was to describe the impact of OM severity on caregiver quality of life (QoL).

Methods:

Multi‐institutional prospective cross‐sectional study. Setting: Otolaryngology, family practice, and pediatrics clinics. Children 6‐24 months old with and without a primary diagnosis of recurrent OM and their caregivers. Physicians provided patient history, and parents/caregivers completed a Family Information form, the PedsQL Family QoL survey, the PROMIS survey, and the 6‐item child with OM QoL survey (OM‐6).

Results:

A total of 2414 patients were enrolled. The average age was 16 months, and 58% were male. The mean OM‐6 score was 3.26, slightly more severe than the reported 2.8 for the average child with OM. The mean PedsQL Family score was 68.63, worse than the reported mean of 81.00 of parents with children with chronic disease in a convalescent hospital. Higher OM‐6 scores correlated significantly with worse PedsQL Family scores, Pearson r ‐0.502, P < 0.01. Similarly, more severe OM‐6 scores strongly correlated with increased parental anxiety, depression, fatigue, and decreased satisfaction, all P < 0.01.

Conclusions:

Parents of children ages 6‐24 months with OM had mean PedsQL scores similar to parents of chronically ill children requiring full time home care. Worse PedsQL Family scores were highly correlated with elevated OM‐6 scores, suggesting that severity of OM significantly affects parental QoL.
Children with Deep Space Neck Infections: Our Experience with 178 Children and Proposed Management Strategy
Authors: Elden Lisa M. , Cheng Jeffrey
Published: August 2013

Objectives:

Identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNI). Propose a clinical decision‐making algorithm, which may avoid radiation exposure from computed tomography (CT) imaging, based on clinical features found to be associated with surgical intervention for DSNI and those at highest risk for complicated clinical courses.

Methods:

Consecutive case series with chart review at a tertiary‐care, academic children's hospital. One hundred and seventy‐eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012.

Results:

Median age was 34.5 months (2.9 years, range 2 to 142 months); two‐thirds were male. Increased surgical drainage was found in children age ≤ 15 months (P = 0.002) and for abscesses greater than 2.2 cm (P = 0.0001). Risk factors associated with increased likelihood of medical therapy failure included ≤ 51 months, ICU admission, and CT findings consistent with abscess size greater than 2.2 cm. Methicillin‐resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤ 15 months of age (P = 0.001). All children had resolution of infection.

Conclusions:

Deep space neck infections in children can often be successfully managed with medical therapy alone, but life‐threatening complications may occur. We recommend that young patients be managed cautiously. A proposed decision making algorithm is presented, but caution and careful clinical judgment need to be exercised as further prospective study is warranted.
Cochlear Reimplant Rates in Children: Twenty‐Year Experience in a Quaternary Pediatric Cochlear Implant Center
Authors: Trozzi Marilena , Sharp James , Toma Shamim , Powell Harry , Broxholme Catherine , Jephson Christopher G. , Cochrane Lesley‐Ann
Published: August 2013

Objectives:

Determine the incidence and risk factors for cochlear re‐implantation in children.

Methods:

Retrospective case review in a quaternary pediatric cochlear implant (CI) center. Subjects studied: Pediatric CI patients requiring cochlear re‐implantation. Interventions: Cochlear explantation/re‐implantation. Outcome measures: Etiology and timing of device re‐implantation, risk factors for revision surgery. Independent variables: patient age, side, surgeon, etiology of deafness, co‐morbidities, CI manufacturer, incidence of re‐implantation, timing of re‐implantation.

Results:

Seven hundred and fifty‐two pediatric cochlear implants were performed in 619 children between 1993 and 2013. 37 patients underwent 39 explanation/re‐implantation procedures (5.2%). The most common reason for explantation/re‐implantation was device failure in 21 (2.8%). Risk factors for device failure were preceding head trauma and known manufacturing defect/recalled device. Medical/surgical issues accounted for 18 (2.4%) re‐implantations and changed over the study period. The mean time to re‐implantation surgery was 4 years. Etiology of deafness did not correlate with the need for revision surgery.

Conclusions:

The incidence of re‐implantation in our pediatric cochlear implant population is comparable to other published studies. However the etiology of deafness, in particular meningitis, does not appear to increase the risk of failure as described in previous series. The most common reason for re‐implantation remains device failure.