bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of G9a in Tumorigenesis in Head and Neck Cancer
Authors: Tan Ching‐Ting , Ko Jenq‐Yuh , Tsai Hung‐Huey
Published: February 2015

Objective

Head and neck squamous cell carcinoma (HNSCC) represents a major worldwide health problem with patients, exhibiting a 5‐year average survival rate lower than 50%. G9a is a histone methyltransferase (HMTase) for histone H3 lysine 9 dimethylation (H3K9me2), and it was reported that G9a‐mediated H3K9me2 aberrantly repressed tumor suppressor genes in many cancers. However, the mechanistic understanding of the role of G9a in HNSCC progression remains largely unknown.

Method

IHC of patients’ tissues were performed. RT‐PCR, western blot, cell viability assay, and anchorage‐independent growth analysis of HNSCC cells were performed. Age‐matched NOD‐SCID mice were used to establish the mouse model for tumorigenesis. Microarray analysis was scanned with the AffymetriGeneChip scanner to evaluate the signal pathway regulated by G9a.

Results

The results revealed that mRNA expression level of G9a was higher in tumors compared with normal parts. G9a was over‐expressed in cancerous specimens compared with mucosa. Inhibited G9a expression by shRNA or treated G9a enzymatic activity inhibitor BIX‐01294 in HNSCC cells, the results showed that both can significantly inhibit HNSCC cell growth and anchorage‐independent growth. The in vivo animal model also revealed that G9a knockdown would decrease tumor growth. We discovered that DUSP4 was upregulated in G9a‐downregulated HNSCC cells and the expression level of phospho‐ERK was inhibited. DUSP4 expression could also be inhibited after treatment with BIX‐01294 in HNSCC cells.

Conclusion

Our findings suggested that G9a possessed strong oncogenic properties and correlated with sustained malignant phenotype. Inhibition of G9a expression could suppress HNSCC cells growth and in vivo tumorigenecity.
Thyroid Nodules in a Veterans Affairs Population
Authors: Leblanc Blake J. , Ryan Sherry , Martin Elizabeth , Milligan Edward , Nathan Cherie‐Ann O.
Published: February 2015

Objective

1) Determine if follicular thyroid lesions in a Veteran Affairs (VA) population are at increased risk of harboring malignancy compared to the general population. 2) Analyze imaging modalities leading to diagnosis.

Method

Retrospective analysis of 107 patients undergoing partial or total thyroidectomy from 2005 to 2010 at a single Veteran Affairs hospital. Outcome measures included age, sex, method of nodule detection, fine needle aspiration (FNA) cytopathology, final histopathology, associated 2deoxy‐2[18F]fluoro‐D‐glucose positron emission tomography (FDG‐PET) uptake, and incidence of cancer compared with previously published data.

Results

Age range was 27 to 84 years (mean, 60 years). Fine needle aspiration (FNA) cytopathology results were benign in 31% (n = 33), follicular lesion in 41% (n = 46); suspicious for malignancy or malignant in 11.2% (n = 12). The overall malignancy rate was 36.4% (n = 39). Of the indeterminant FNA lesions, 41% (n = 19) had malignancy confirmed histopathologically. This is higher compared to recently published rates of malignancy in follicular lesions (15%‐30%). In 9 of the 10 patients who underwent 2deoxy‐2[18F]fluoro‐D‐glucose positron emission tomography (FDG‐PET), focal thyroid uptake was identified and was significantly (P <. 01) associated with malignancy. This percentage is also much higher prevalence than the approximately 33% reported.

Conclusion

Follicular thyroid nodules of undetermined significance on FNA may harbor malignancy more frequently in the VA population compared to the general population. Focal FDG‐PET uptake is significantly associated with malignancy.
Videoflouroscopic Evaluation of Swallowing in Glossectomy
Authors: Meera P. C.s , Menon Jayakumar , Iyer Subramania
Published: February 2015

Objective

The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resection, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort.

Method

A prospective evaluation of 16 glossectomy patients (15 men and 1 woman), aged 40 to 60 years, who underwent glossectomy with reconstruction were volunteers in this study. Tumor stages were T1 in 1 patient, T2 in 8 patients, T3 in 5 patients, T4 in 2 patients, and node.

Results

Patients who underwent a total glossectomy with laryngeal preservation had an increase in oral transit time and stasis of food in the oral cavity, the pharynx. Patients who underwent a partial glossectomy (lateral border of tongue involvement only) had difficulties with formation and antero‐posterior propulsion of the bolus in the oral cavity. The stasis in the oral cavity/valleculae and oral transit delay was comparatively less and was evident only with materials of thicker consistencies. All patients benefited from rehabilitative and compensatory swallowing maneuvers.

Conclusion

Video‐fluoroscopic analysis of swallowing could characterize swallowing dysfunction in patients who underwent a glossectomy with flap reconstruction. Videoflouroscopic analysis of swallowing is not only a mere diagnostic tool but also a prognostic tool. Appropriate swallowing intervention benefited the patients in regaining swallowing function.
Cyclooxygenase Inhibition of LTC Stenosis in the Mouse Model
Authors: Lee Jennifer Y. , Singhal Sunil , Leahy Kevin , Cohen Noam A. , Philiponis Genevieve , Ghosh Ankona , Mirza Natasha
Published: February 2015

Objective

The study explores possible therapies to decrease or prevent subglottic stenosis. We aim to study the effects of cyclooxygenase (COX) inhibition on laryngotracheal granulation and stenosis in a previously described murine model.

Method

Laryngotracheal complexes (LTC) were transplanted into a previously established recipient mouse model. Treatment group (n = 4) received COX inhibitor chow for 3 weeks. Control group (n = 4) did not. After 3 weeks, LTCs were harvested and examined microscopically for comparison. Relative levels of IL‐1, COX2, and TGF beta were compared using RT‐PCR.

Results

Comparison of hematoxylin and eosin staining of granulation tissue showed no difference in lamina propria thickness between LTCs that received COX inhibitor or LTCs that did not. Also, no difference in lamina propria thickness was noted between different types of injury such as acid or wire brush. Furthermore, no further differences were noted in the RT‐PCR results in the samples.

Conclusion

Inhibition of cyclooxygenase (COX) does not lead to significant differences in granulation formation or in cytokine levels in the murine model of subglottic stenosis.
Disease‐Specific Self‐efficacy in Spasmodic Dysphonia
Authors: Hu Amanda , Isetti Derek , Hillel Al , Waugh Pat , Meyer Tanya K.
Published: February 2015

Objective

Self‐efficacy (SE) is an optimistic self‐belief that one can cope with adversity. For chronic conditions, a standardized measure of SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease‐specific SE‐SD scale.

Method

Disease‐specific SE‐SD items were developed through expert opinion. These items, general SE scale, Voice Handicap Index (VHI), Consensus Auditory Perceptual Evaluation of Voice (CAPE‐V), and Hospital Anxiety and Depression Scale (HADS) were administered to SD patients who presented to University of Washington for botulinum toxin injections over a 6‐month period.

Results

Eighty SD patients completed the study with a mean age 58.7 years. The general self‐efficacy score (Cronbach’s α =. 871) was 34.7 ± 3.7 out of 40 and was negatively correlated with VHI (r = −0.22, P =. 08), CAPEV (r = −0.14, P =. 36), and HADS‐A (r = −0.50, P <. 001) and HADS‐D (r = −0.53, P <. 001). Factor analysis was performed and selected 7 items from the general self‐efficacy scale and 6 disease‐specific SE‐SD items to generate a 13‐item disease specific SE‐SD scale (Cronbach’s α =. 913). Disease‐specific SE‐SD score was 43.9 ± 5.6 out of 52 and is negatively correlated with VHI (r = −0.35, P =. 001), CAPE‐V (r = −0.29, P =. 026), HADS‐A (r = −0.49, P <. 001), and HADS‐D (r = −0.58, P <. 001).

Conclusion

SD patients who are established with botulinum toxin injections have a high degree of general SE and disease‐specific SE. Patients with higher SE demonstrate higher subjective and objective vocal quality and lower levels of anxiety and depression. A 13‐item disease specific SE‐SD scale has been developed.
Meta‐analysis of Vocal Fold Steroid Injection
Authors: Wang Chi‐Te , Lai Mei Shu , Cheng Po Wen , Liao Li‐Jen
Published: February 2015

Objective

In recent decades, emerging literature had pointed out the usefulness of vocal fold steroid injection (VFSI) as an alternative treatment option for benign vocal lesions, especially when conservative management and/or surgery are not applicable. This study intends to review the existing literature and to quantify the clinical effectiveness using meta‐analysis.

Method

Electronic databases were systematically searched using relevant keywords. Extracted data included author, year of publication, diagnosis, steroid regimen and recurrence. Reported treatment outcomes were clustered into 5 categories, ie, subjective, perceptual, acoustic, aerodynamic and stroboscopic. Meta‐analysis was conducted among studies with available numerical data before and after VFSI.

Results

Six articles were identified with a total of 321 patients. All the studies reported significant improvement after VFSI in all categories of outcome measurements. VFSI were used to treat vocal nodules, polyp/cyst, Reinke’s edema, and scar. Meta‐analysis demonstrated a 1.94 second improvement of maximal phonation time (P <. 001, 95% confidence interval [CI]: 0.96 to 2.92) and a 27.61 points decrease of voice handicap (P <. 001, 95% CI: 16.49~38.73 16.49). Adverse effects include local hematoma, whitish plaque deposition, and mild vocal fold atrophy, which resolve spontaneously within 1 month. Recurrence rate after VFSI ranged from 4% to 31%.

Conclusion

This study demonstrated that VFSI is well tolerated under local anesthesia in the office setting. Pooled estimate from meta‐analysis showed significant objective and subjective improvements after VFSI. Further controlled studies are mandatory to delineate the role of VFSI in the treatment of benign vocal fold lesions.
A Review of Platinum‐Induced Ototoxicity Criteria
Authors: Peleva Emilia , Waissbluth Sofia , Daniel Sam
Published: February 2015

Objective

1) Evaluate the commonly used ototoxicity criteria. 2) Develop a method for establishing comparisons among studies using different criteria. 3) Use this comparison method to evaluate the effect of treatment and assessment factors (ie, chemotherapy agent, cumulative dose, head and neck radiotherapy, and follow‐up period) on the reported incidence of ototoxicity.

Method

A review was performed on studies regarding platinum compounds and hearing loss published between January 1, 2000, and July 15, 2011. A total of 47 pediatric and 42 adult studies were evaluated. Data analyzed included patient demographics, treatment modalities (surgery, radiotherapy and chemotherapy), and auditory outcomes.

Results

Ten methods for defining ototoxicity were identified, and each was critically reviewed. Grades within each criteria were then classified as either “mild/moderate” or “severe” ototoxicity, based on their definitions and on the agreement between these criteria in the literature. The total incidence of ototoxicity was 25% and 43% for adult and pediatric studies, respectively. The platinum agent used, cumulative dose, concomitant radiotherapy, and follow‐up period all seem to affect the incidence of hearing loss reported. It was observed that various studies lack essential details regarding treatment and ototoxicity assessment.

Conclusion

A variety of criteria are now available to define and grade platinum‐induced ototoxicity. The use of multiple criteria and the lack of relevant information in published studies impedes a precise comparison regarding ototoxicity. Further research is required in order to establish a gold standard for hearing loss detection and grading.
Cochlear Implant Outcomes of Cases with Temporal Bone Malformations
Authors: Yamazaki Hiroshi , Koyasu Sho , Moroto Saburo , Yamamoto Rinko , Yamazaki Tomoko , Fujiwara Keizo , Naito Yasushi
Published: February 2015

Objective

1) To reveal the relationship between cochlear implant (CI) outcomes and the types of temporal bone malformation.2) To establish a high‐resolution CT (HRCT)–based classification of temporal bone malformations for predicting CI outcomes.

Method

We retrospectively evaluated 23 deaf children with cochleovestibular and/or internal auditory canal (IAC) malformations who underwent cochlear implantation from 2004 to 2010 at our hospital. Their temporal bone malformations were assessed by HRCT and their CI outcomes were evaluated by speech discrimination scores and category of auditory performance scores.

Results

We classified cochleovestibular and IAC malformations into 3 groups by 1) presence of a bony modiolus in the cochlea and 2) patency of cochlear nerve canal (CNC) and IAC. Eleven cases with a bony modiolus and patent CNC/IAC (Group 1) showed excellent CI outcomes and could communicate without visual language, while all of 6 cases with atresia of CNC or narrow IAC (Group 3) needed lipreading or sign language for understanding common phrases, even if their cochleae were well developed. The remaining 6 cases with a cystic cochlea and patent CNC/IAC (Group 2) showed varying CI outcomes depending on maturity of the cochlea.

Conclusion

Our classification based on presence of a bony modiolus in the cochlea and patency of CNC/IAC covered the all types of temporal bone malformations including cochleovestibular and CNC/IAC abnormalities and was useful to predict CI outcomes of children with temporal bone malformations.
Differentiation into Hair Cells from AM‐Derived Stem Cells
Authors: Park Kyoung‐Ho , Bae Seong‐Cheon , Park Shi‐Nae , Yeo Sang‐Won
Published: February 2015

Objective

Placenta, umbilical cord, and blood are alternative sources of stem cells. We designed an experiment to isolate and culture stem cells from human amniotic membrane. And we made a plan to induce auditory hair cells and neurons from the stem cells of amniotic membrane.

Method

Human amniotic membrane was obtained.) We dissociated amniotic membrane with trypsin and transferred it to culture medium which contained 10ï¼… fetal bovine serum and 1ï¼… penicillin‐streptomycin. We sub cultured it until the third generation was used for further experimental procedures. For differentiation into neural progenitor cells, we cultured amniotic membrane stem cells in EGF (epidermal growth factor) and β‐FGF (fibrous growth factor) and for differentiation into hair cells and neurons, we cultured in neurobasal medium.

Results

We can isolate and culture stem cells from human amniotic membrane. By flow cytometric analysis of stem cells from human amniotic membrane, they showed positive responses at mesenchymal stem cell marker (CD 73, CD90, CD105) and negative responses at hematopoietic stem cell marker (CD34, CD14, CD19, HLA). The results of culture at different culture medium showed a differentiation to neural progenitor cells, hair cells, and neuron, and we confirmed by immunofluorescence staining and RT‐PCR.

Conclusion

We demonstrated that amniotic membrane–derived stem cells could be differentiated into neuronal progenitor cells, and this could lead to the differentiation into hair cells and neurons.
Effects of c‐Jun N‐Terminal Kinase(JNK) on Neurite Growth
Authors: Ju Youn H. , Cho Chang H.
Published: February 2015

Objective

JNK (c‐Jun N‐terminal Kinase) is a member of MAPK (mitogen‐activated protein kinase) family which phosphorylates various transcription factors in nucleus and also cytoplasmic targets. We examined the contribution of JNK signaling to SGN neurite growth by transfection with nutant dominant negative JNK (dnJNK) plasmids in vitro.

Method

Dissociated spiral ganglion cultures were prepared from P4‐5 rat pups, plated on polyornithine‐ and laminin‐coated 8‐well culture chambers, and maintained in high glucose Dulbecco’s Modified Eagles’s Medium with N2 supplement in a humidified incubator with 6.5% CO2. After 1 hour, BDNF and NT‐3 were added to support SGN survival during transfection. Two hours later, the cultures were transfected with expression plasmids, dnJNK1 or dn JNK2 or combination of dn JNK1 and 2, using calcium‐phophate precipitation as previously described. As a negative control, we used pc DNA3 and as a positive control, we used MKK7‐JNK1 plasmid which is a potent neurite growth enhancer. GFP (green fluorescene protein) was stimultaneously added to all culture chambers to be an indicator of transfected neuron.

Results

Transfection of the constitutively active MKK‐JNK‐1 isoform apparently promotes SGN neurite growth, and co‐transfection significantly reduced SGN neurite growth, whereas transfection of either dnJNK1 or JNK2 singly failed to reduce neurite growth. Thus, JNK1 and JNK2 may serve redundant functions in stimulating SGN neurite growth. SP600125, a small molecule kinase inhibitor, strongly inhibits SGN neurite growth.
Epithelial Proliferation in Cholesteatoma
Authors: Sharma Suresh C. , Sikka Kapil , Thakar Alok , Dattagupta S.
Published: February 2015

Objective

Comparison of the proliferative potential of pediatric cholesteatoma with that of adult cholesteatoma, using Ki‐67 as a proliferation marker.

Method

Prospective study on 67 patients with aural cholesteatoma from 2003 to 2005. Thirty‐eight adult and 29 pediatric cases were evaluated using clinical parameters, including bone erosion, complications, and extent of disease. Histological evaluation of cholesteatoma and measurement of the proliferation index using Ki‐67 labeling was performed. Normal skin specimen from a control group was also examined.

Results

Final assessment could be performed in 28 adult and 25 pediatric cholesteatoma cases and 12 controls. The mean Ki‐67 labeling index of cholesteatoma cases was 29.2 out of 200 (14.6%). The mean index for controls was 19 out of 200 (9.5%), significantly lower than cholesteatoma group (P =. 033). The mean Ki‐67 labeling index was 33.5 per 200 in pediatric cases and 26.5 per 200 in adult cases. Though proliferation index was higher in pediatric cases, difference was insignificant (P =. 13). Pediatric cholesteatoma was also similar to adult cholesteatoma in terms of complications, bone erosion, and disease spread.

Conclusion

Cholesteatoma is a disorder of epithelial proliferation. Although postulated to be more aggressive in children than adults, this study found no pathological differences between pediatric and adult cases.
Health‐Related Quality of Life in Romanian Cochlear Implanted Patients
Authors: Necula Violeta , Cosgarea Marcel , Stanciu Antonius
Published: February 2015

Objective

Cochlear implants are a well‐established treatment method in severe to profound hearing loss. It is important to assess the benefits in term of health‐related quality of life (HR QoL) not only on auditory‐verbal performances.

Method

We compared the HRQoL between a hearing aid group (50 patients) and a cochlear implant group (84 patients), split into 2 subgroups, according to the age of implantation. We used the Nijmegen HRQoL questionnaire. All implanted patients had MedEl devices and more than 6 months experience with the speech processor.

Results

Although there were differences between children with hearing aids and children with implants in all areas of HRQoL, in the physical area these differences were greater than for psychological and social domains. HRQoL was positively correlated with auditory performance and speech intelligibility and negatively correlated with implantation age. Good auditory performance and speech intelligibility had a positive influence on HRQoL. The correlation coefficient, R = 0.78, indicates a very good linear and directly proportional correlation between the 3 variables, implantation age, SIR, and CAP and HRQoL. A total of 59.5% of quality of life’s variation is explained by the variation of these 3 parameters.

Conclusion

Cochlear implant improves the auditory performance and speech production more than hearing aids. Children implanted at a younger age develop better than older patients, but even the older patients demonstrate good performances if they are properly selected. Associated diseases had a negative effect on outcomes, but cochlear implants improve their quality of life.
Dizziness Improved by Vertical Heterophoria Treatment
Authors: Rosner Arthur J. , Rosner Mark S. , Feinberg Debra L.
Published: February 2015

Objective

Vertical heterophoria (VH) is a binocular vision disorder with symptoms of headache, dizziness, anxiety, neck pain, and reading difficulties, treatable with prismatic lenses. The study’s objective was to quantify dizziness and associated symptom reduction after prismatic lens treatment in patients with a chief complaint of dizziness concomitantly diagnosed with VH.

Method

Retrospective analysis of 46 patients presenting to an optometric binocular vision subspecialist between August 2009 and May 2011. Pre‐ and posttreatment data included Dizziness Handicap Inventory (DHI), Headache Disability Index (HDI), Zung Self‐rating Anxiety Scale (Zung), and Vertical Heterophoria Symptom Questionnaire (VHSQ). A visual analog scale measured overall symptom reduction.

Results

Treatment effects were analyzed using paired t tests. Following prismatic lens treatment, there was a 51.4% decrease in DHI score (P <. 0001), 45.9% reduction in HDI score (P <. 0001), 22.4% reduction Zung score (P <. 0001), 50.2% reduction in VHSQ score (VHSQ, a VH symptom burden instrument developed by the authors; P <. 0001), and a 71.4% reduction in overall symptoms as measured by the 10‐cm visual analog scale (P <. 0001).

Conclusion

Treatment of dizziness with prismatic lenses resulted in a marked score reduction of the validated metrics for dizziness, headache, and anxiety, which correlated with a marked reduction of overall VH symptom level. Prospective studies are needed to further validate this intervention and determine prevalence of VH in dizziness patients.
Middle Ear Morbidity after Head and Neck Chemoradiation
Authors: Bhandare Niranjan , Antonelli Patrick J. , Mendenhall William M. , Morris Christopher G.
Published: February 2015

Objective

Radiation therapy (RT) for head and neck cancers (HNC) has been associated with middle ear mobidity (MEM). The goal of this study is to evaluate the post‐RT incidence of middle ear morbidity in HNCa patients receiving RT ± chemotherapy (chemo) and associated patient and treatment related factors.

Method

Pre‐ and post‐RT records of HNC patients were retrospectively assessed to estimate the incidence of chronic otitis media with effusion (OME), chronic suppurative otitis media (CSOM), tympanosclerosis, persistent tympanic membrane perforation (TMP), mastoiditis, dysgeusia, and corresponding radiation doses to the middle ear.

Results

A total of 375 patients (750 ears) were evaluated. The rate of MEM included OME (31.5), CSOM (8.0), TMP with (7.0) and without (8.5) tympanostomy, tympanosclerosis (20.5), mastoiditis (5.5), middle ear fibrosis (6.0), dysgeusia (7.5). With a range of 0.25 to 6.5 years, the median times for detection of MEM varied from 0.95 to 2.3 years. Univariate and multivariate analyses indicated that dose to middle ear was significant for all MEM, but age (>60 years), gender, and race were not. Significance of dose fractionation (daily/twice daily) for OME was marginal (P =. 0498). Adjuvant chemotherapy was significant for incidence of OME, TMP (P <. 05).

Conclusion

Incidence of post‐RT MEM is proportional to the radiation dose received by middle ear. Adjuvant chemotherapy is associated with MEM, but further investigation into this risk factor is needed.
Neural Response Telemetry in Pediatric Cochlear Implantation
Authors: Heubi Christine H. , Ida Jonathan B. , Meinzen‐Derr Jareen , Scott Michael P. , Greinwald John H.
Published: February 2015

Objective

1) Evaluate the neural response telemetry (NRT) of patients with inner ear anomalies, and determine correlations between NRT and postoperative speech recognition thresholds (SRT). 2) Determine if higher incidence of negative intraoperative NRT exists in pediatric patients with inner ear anomalies, namely enlarged vestibular aqueduct syndrome (EVAS).

Method

Retrospective chart review of pediatric patients who underwent cochlear implantation at a tertiary care pediatric referral center from 2001 to present. Patients with inner ear anomalies were age matched to controls without anomalies. Associations between abnormal NRT and perilymphatic gusher and correlations between NRT and audiometry were assessed.

Results

Twenty‐seven subjects with radiographic evidence of EVAS were evaluated; 35 ears implanted. Median age of implantation was 77.5 months. NRT was normal in 69%, abnormal 11%, marginal 6%, missing 4%. Intraoperative data revealed a perilymphatic gusher in 8 patients (23%); of which 50% had abnormal NRT compared to 8% among patients without gusher (P =. 03). Postoperative audiometric data were available for 8 out of 35 ears. No significant correlations between intraoperative and postoperative NRT with postoperative SRT at 1 kHz, 2 kHz, 4 kHz (P >. 2). There appeared to be a correlation between intraoperative NRT and postoperative SRT at 500 kHz (ρ = 0.68, P =. 14); this was not statistically significant.

Conclusion

The presence of perilymphatic gusher at the time of cochlear implantation in patients with enlarged vestibular aqueduct syndrome (EVAS) seems to be related to abnormal NRT. There is no significant correlation between intraoperative and postoperative NRT and speech recognition thresholds (SRT) at 1 kHZ, 2 kHz, and 4 kHz in patients with EVAS.
Persistent Activation of Nrf2 through p62 in Auditory Cells
Authors: Hayashi Ken , Goto Fumiyuki , Kanzaki Sho , Ogawa Kaoru
Published: February 2015

Objective

Oxidative stress affects auditory cellular functions. The Nrf2/Keap1 signaling pathway is the main pathway responsible for cell defense against oxidative stress. The purposes of this study were to elucidate how Keap1 and Nrf2 provide molecular foundation for a possible crosstalk between autophagy and necrosis pathways in auditory cells.

Method

We used auditory cell line (HEI‐OC1) in this study. The viability of HEI‐OC1 was determined by cell viability assays. The samples after treatment of HEI‐OC1 were analyzed by a flow cytometer. Immunofluorescent confocal laser microscopy was used. Western blot was performed. HEI‐OC1 was transfected with Nrf2, Keap1 and p62 siRNA.

Results

H2O2 treatment resulted in time‐dependent accumulation of LC3‐II and the expression of GFP‐LC3 in HEI‐OC1 cells. Autophagic vacuoles were confirmed under transmission electron microscope in H2O2‐treated HEI‐OC1. Necrosis and autophagy were coincidentally identified in H2O2‐treated HEI‐OC1 cells. There were significant differences of cell viability between H2O2 only and H2O2 and Rapamycin‐treated cells. The knockdown of p62 by siRNA, which loses its ability to interact with Keap1, had no effect on Nrf2 stability, demonstrating that p62‐mediated Nrf2 up regulation is Keap1 dependent. These findings demonstrate that p62 could be a molecular hub of the Nrf2/Keap1 pathway in auditory cells.

Conclusion

We demonstrated a promotion of autophagy through the mTOR signaling pathway to enhance cell survival in auditory cells under oxidative stress. A crosstalk between Nrf2/Keap1 pathway in the autophagy related‐p62 are also presented. The selective autophagy substrate p62 activates the oxidative stress responsive factor Nrf2 through inactivation of keap1.
Robotic Tremor Suppression: A Tool for Stapes Surgery?
Authors: Knisely Anna J. , Hirsch Barry E. , Becker Brian C. , Riviere Cameron R.
Published: February 2015

Objective

1) Create a custom micropick for Micron, a fully handheld robotic micromanipulator. 2) Demonstrate phenomenon of physiologic tremor and evaluate bracing technique in simulated otologic surgery. 3) Evaluate feasibility and efficacy of Micron, to decrease surgeon tremor, positioning error, and force applied in tasks simulating otologic surgery.

Method

Two positioning conditions tested: hovering mid‐air and lightly contacting surface. 3D axes error, tremor, and force measurements. Experimental conditions: 1) unaided, 2) unaided with bracing, 3) Micron alone, 4) Micron with bracing. Tremor and position error were analyzed with a high‐pass filter. Significance (P <. 05)(*) via 2‐tailed t test.

Results

Positioning Error: Root mean square (RMS) and maximum error (ME) are reported. Reduction in ME was seen in the surface task, with bracing alone and Micron alone. However, the hover task showed significant benefits with only Micron + bracing. Force Error: RMS and maximum force error showed no difference between conditions. Tremor Error: Positioning error contains tremor and overall drift from the goal position. Statistically significant reduction in tremor both in RMS and ME is seen with Micron, bracing, and the combination. Micron + bracing produced the largest reduction in tremor.

Conclusion

Our initial results demonstrate Micron significantly reduced maximum positioning error (tremor) in simulated otologic surgery. Additionally, we confirmed bracing significantly dampens tremor. Interestingly, the use of Micron and bracing yielded the largest reduction in tremor, suggesting an additive effect. No difference in force applied was found.
Stapes Surgery: National Survey of British Otologists
Authors: Manickavasagam Jaiganesh , Lancer Hannah , Zaman Azrina , Lancer Jack
Published: February 2015

Objective

No standardized treatment protocols are available with regard to stapes surgery in the UK. We have therefore investigated individual stapes surgery practice.

Method

Postal questionnaire to all stapes‐performing otologists in UK. Questionnaire designed to address the following issues with stapes surgery: preferred technique, hearing aid trial, unilateral and bilateral surgery, prosthesis type, daycase preference, use of laser, covering of fenestration, gusher management, revision surgery, postopeartive flying time, facial nerve overhanging issues,and training juniors.

Results

Of the questionnaires we received (182/197), 77 surgeons perform 6‐15 operations/year, most (107) under GA. 123 advise stapes surgery in unilateral disease. 119 always advise patients about trying a hearing aid. 130 perform second side stapes surgery and most wait for at least 6 months for second side surgery. Stapedotomy is preferred (123), stapedectomy (11). Cause prosthesis is the most common. 57 always, and 47 never use a vein‐graft. 67 use laser. 64 prefer daycase surgery. 37 would abandon surgery for a 50% or more overhanging facial nerve. 34 have encountered a “gusher.” 112 would recommend revision surgery. Most would advise patients “flying” after 6 weeks.

Conclusion

In UK, the majority prefer GA, an overnight stay, a hearing aid trial, carrying out surgery in unilateral disease, 2nd side surgery, stapedotomy, inserting the prosthesis after removal of the stapes, advise revision surgery in conductive loss, and are willing to train trainees with an otological interest.
Epidemiology of Otorhinolaryngology Emergency Attendances
Authors: Andrade Jose S.C. , Albuquerque André M. S. , Penido Norma O. , Matos Rafaella C. , Godofredo Valéria R.
Published: February 2015

Objective

To evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital in Sao Paulo over a 12‐month period.

Method

Epidemiological, cross‐sectional study, with data collection carried out from medical records of the emergency department of otorhinolaryngology of a high complexity hospital in Sao Paulo, for a period of 12 months. Data collected were: age, sex, clinical diagnosis, and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngoesthomatology, and head and neck surgery. Level of urgency/emergency, etiology, and monthly distribution of visits were evaluated.

Results

A total of 18,279 medical records were obtained, and 2639 were excluded. Of the 15,640 cases included, the average age was 36.3 years; 54.49% were women and 45.50% were men. A total of 9818 (62.77%) corresponded to cases considered as emergency/urgency. Among the urgency/emergency cases, 6422 (65.41%) were diagnosis in otology, 1767 (17.99%) in rhinology, 1453 (14.79%) in pharyngolaryngoesthomatology, and 176 (1.79%) in head and neck surgery. Inflammatory and infectious diseases comprised 65.04% among the urgency/emergency cases.

Conclusion

Among the attendances in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty. Inflammatory and infectious diseases comprised most cases.
Attic Reconstruction in Pediatric Canal Wall‐up Mastoidectomy
Authors: Kanotra Sohit P. , James Adrian L.
Published: February 2015

Objective

1) To evaluate 3 methods: conchal cartilage, tragal cartilage, and bone pate, for primary attic reconstruction (scutumplasty) in pediatric canal wall‐up mastoidectomies in terms of recurrence rates and formation of retraction pockets.

Method

All patients undergoing attic reconstruction following a canal wall up mastoidectomy were evaluated from a single surgeon prospective pediatric otological database maintained over a 10‐year period. The reconstruction of the scutum defects was done using bone pate, conchal and tragal cartilage. The outcome measures were postoperative retraction pocket formation and recurrence of cholesteatoma.

Results

A total of 120 patients underwent primary attic reconstruction following canal wall‐up mastoidectomy over a 10‐year period. The overall recurrence rate was 9.83% (n = 12). Fifty‐one patients underwent attic reconstruction with tragal cartilage, while 33 were reconstructed using conchal cartilage and 36 with bone pate. The recurrence rate with various reconstruction methods was 5.8% (n = 2), 15.1% (n = 5), and 13.8% (n = 5) for tragal, conchal, and bone pate, respectively. Cholesteatoma recurrence rates with the use of tragal cartilage for reconstruction of the scutum were significantly lower as compared to that of conchal cartilage (P =. 034, chi square = 3.308) and bone pate (P =. 046, chi square = 2.834).

Conclusion

The use of the tragal cartilage for scutum reconstruction is associated with the least recurrence rate for pediatric cholesteatoma. The easy accessibility, stability, and good long‐term results with the use of the tragal cartilage makes it an ideal material for outer attic wall reconstruction in pediatric canal wall up mastoidectomies.
Carotid Canal Injury and High‐Resolution Computed Tomography in Pediatric T‐Bone Fractures
Authors: Gale Derrick C. , Meier Jeremy D.
Published: February 2015

Objective

1) Review the incidence of carotid canal involvement in pediatric temporal bone fractures. 2) Determine the benefit of temporal bone high‐resolution computed tomography (HRCT) in identifying carotid canal fractures (CCF). 3) Evaluate if the mechanism of injury (MOI) predicts the likelihood of CCF.

Method

A retrospective case series was reviewed from 2008 to 2011 in a tertiary children’s hospital. A database including all patients admitted for trauma was searched to identify children with temporal bone fractures and an otolaryngology consultation. Patient age, MOI, and standard head CT and HRCT reports were collected.

Results

A total of 140 temporal bone fractures in 129 pediatric patients were identified. The average age was 9.0 ± 0.4 years. The most common MOI included falls (24%), sports (17%), bicycle (16%), off‐road vehicle (12%), motor vehicle (9%), and pedestrian (8%). CCF was identified in 16.2% of the temporal bone fractures. Although nearly half of the CCF were not clearly seen on the CT head, only 9% of all the HRCT ordered identified a previously undetected CCF. A CCF was seen in 60% of pedestrian accidents, while only 3% of falls had an associated CCF (P <. 05).

Conclusion

A minority of temporal bone fractures have associated CCF. Although there are other indications for HRCT with temporal bone fractures, routine HRCT infrequently identifies undetected CCF. MOI may help predict temporal bone fractures at higher risk for CCF and suggest when HRCT would help identify CCF and reduce unnecessary HRCT.
Eustachian Tube Function following Total Laryngectomy
Authors: Meric Aysenur , Dogan Remzi , Kahya Volkan , Yilmaz Fahrettin , Ozturan Orhan
Published: February 2015

Objective

The function of the Eustachian tube has been investigated in various conditions. However, its status has not been evaluated in total laryngectomized patients. This study was designed to investigate short‐ and long‐term changes of the Eustachian tube that occur following total laryngectomy.

Method

We enrolled 53 total laryngectomy patients. These patients were divided into 2 groups (within 2 years and more than 2 years after surgery). Fifty‐one healthy volunteers were studied as a control. The functions of the Eustachian tube were evaluated using the P1(resting), P2 (Toynbee maneuver), and P3 (Valsalva maneuver) tympanometric measurement.

Results

All groups were evaluated using intergroup comparisons in terms of right‐side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1‐P2, Pmax‐Pmin values (respectively, P =. 329, P =. 474, P =. 487). All groups were evaluated using intergroup comparisons in terms of left‐side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1‐P2, Pmax‐Pmin values (respectively, P =. 562, P =. 400, P =. 151).

Conclusion

We determined that the functions of Eustachian tubes were not different between the patients who underwent total laryngectomy and the healthy volunteers. The lack of active airflow in the upper respiratory tract following total laryngectomy has no effect on the function of the Eustachian tube in the short and long term.
ENT Aspects of Sudden Infant Death Syndrome
Authors: Marom Tal , Cinamon Udi , Castellanos Paul , Cohen Marta
Published: February 2015

Objective

To address sudden infant death syndrome from the otolaryngologist’s perspective, describe relevant pathologies, discuss controversies, and suggest preventive measures in high‐risk populations.

Method

A MEDLINE search and hand search were conducted to identify reports published between 1969 and 2011 in the English language on the pathophysiology of SIDS related to the head and neck organs. Search terms included SIDS (MeSH term), SIDS and pathophysiology (text words), and SIDS and autopsy (text words).

Results

A growing number of reports suggested head and neck organ involvement in SIDS autopsies. Laryngeal, oropharyngeal, maxillofacial, otologic, cervical vascular abnormalities, and infectious etiologies were recognized and discussed.

Conclusion

Otolaryngologists should be aware of relevant pathologies, as some are treatable, if identified early enough in infancy. A proactive risk‐management approach is warranted in infants presenting with certain abnormalities reviewed here.
National Trends in Feeding Interventions for Cleft Palate
Authors: Scott Andrew R. , Lander Lina , Shah Rahul K.
Published: February 2015

Objective

1) To determine national trends in the rates of failure to thrive (FTT) and subsequent gastrostomy tube placement in infants with cleft palate. 2) To identify risk factors for developing FTT and/or gastrostomy tube placement in the setting of underlying dysphagia related to cleft palate.

Method

Retrospective series. The Kids’ Inpatient Database 2006 was analyzed for children under 1 year of age with any form of cleft palate with and without the diagnosis of FTT. The cohort of children with cleft palate and FTT were analyzed for procedure codes indicating gastrostomy placement during admission.

Results

In total, 12,067 children under 1 year of age with cleft palate were identified. Of these, 2,085 (17%) also had the diagnosis of FTT. Children with cleft palate and FTT had a g‐tube placement rate of 18%, with the overall rate of g‐tube placement for any infant with cleft palate being 3%. Odds of FTT among infants with cleft palate were significantly elevated for those with reflux, musculoskeletal anomalies, atrial or ventricular septal defect, circulatory system anomalies, and respiratory problems. Similar concurrent diagnoses increased the odds ratios for g‐tube placement in infants with cleft palate and FTT.

Conclusion

Failure to thrive among infants with cleft palate approaches 20%. Children with gastrointestinal, cardiac, and respiratory comorbidies are particularly at risk and gastrostomy tube placement for feeding supplementation may be required. Infants without these comorbidities may benefit from longer trials of conservative feeding interventions prior to surgical intervention.
Pan American Guideline on Tonsillitis and Adenoid Hypertrophy
Authors: De La Torre Gonzalez Carlos , Mayorga Butron Jose L. , Macías Fernández Luis A. , Sih Tania M. , Chaverri‐Polini Julian , Melendez‐Medina Amarilis M. , Mocellin Marcos
Published: February 2015

Objective

This evidence‐based clinical practice guideline (CPG) aims to improve clinical decision making of general practitioners and specialists in the treatment of acute tonsillitis and adenoid hypertrophy and supports clinicians in clinical decision making for medical treatment, targeting the pathophysiological process and evidence‐based efficacy, safety, and tolerability.

Method

Pan‐American Association of Otorhinolaryngology and Head and Neck Surgery in partnership with Ibero American Agency for Development and Assessment of Health Technologies developed a clinical practice guideline on medical management of acute tonsillitis and adenoid hypertrophy in children. This document provides punctual evidence‐based recommendations for primary care physicians and otolaryngologists on the medical management of these conditions and complies with evidence‐based medicine fundamentals and with well‐validated guidelines methodology as recommended by the National Institute for Clinical Excellence, the National Institutes of Health, and the Scottish Intercollegiate Guidelines Network.

Results

This document provides from A Grade to D Grade of clinical recommendations for treatment of these conditions. The Guideline Development Group made recommendations based on well‐designed randomized controlled trials and systematic reviews. Some clinical questions could not be answered by high‐quality research and for these questions a Panel Delphi was conducted to provide clinical guidance. Overall there is a need for well‐designed RCTs and economic assessments to answer most of the gaps of knowledge for the treatment of acute tonsillitis and adenoid hypertrophy.

Conclusion

This clinical practice guideline provides guidance for the medical treatment of children with acute tonsillitis and adenoid hypertrophy.
Pediatric Epiglottitis: Predictors of Conservative Treatment
Authors: Neidich Marci J. , Black Angela P. , Hart Catherine K. , Lander Lina , Shah Rahul K. , Johnson Kaalan E.
Published: February 2015

Objective

1) To evaluate predictors of conservative management in pediatric patients with epiglottitis. 2) To use national trends, variances, and outcomes to better understand current management trends of this rare though highly morbid disease.

Method

The Kids’ Inpatient Databases (2006 and 2009) were searched using ICD‐9 CM codes for acute epiglottitis with (464.30) and without (464.31) obstruction. Demographics and hospital characteristics of pediatric patients who required airway intervention (defined as intubation or tracheotomy) were compared with those who were managed conservatively without airway intervention.

Results

A total of 820 patients were included in the analysis, and 115 (14%) required intervention and 86% were managed conservatively. Mortality was less than 10 patients. There were no significant differences between groups with respect to age, gender, or race. Characteristics predictive of conservative management include urgent admission type (vs emergent, P =. 015), urban nonteaching hospital (vs urban teaching, P =. 002), nonchildren’s hospital (vs children’s unit or children’s hospital, P <. 0001) and small/medium‐sized hospital (vs large, P =. 03). Length of hospital stay was shorter (mean 3.65 days vs 10.87 days, P =. 01) and cost was lower in patients who were managed conservatively (mean $18,487 vs $83,037, P <. 0001).

Conclusion

The majority of pediatric epiglottitis patients are currently managed without intubation or tracheotomy with low mortality. Conservatively managed admissions are more likely for nonemergent presentations at nonpediatric, nonteaching, small/medium‐sized hospitals, and are lower in cost. Additional studies are needed to further characterize patients which would be appropriate for conservative management.
Gesture‐Controlled Interactive 3‐Dimensional Anatomy
Authors: Hochman Jordan B. , Unger Bert , Kraut Jay , Klonish Sabine H.
Published: February 2015

Objective

The creation of a novel 3‐dimensional (3D) teaching tool was generated with the employment of the Microsoft Kinect. Within this construct, 3D temporal bone anatomy is manipulated with the use of hand gestures, in the absence of mouse or keyboard.

Method

CT temporal bone data are imported into an image processing program and segmented. This information is then exported in a polygonal mesh format to a proprietary 3D graphics engine with an integrated Microsoft Kinect. Motion in the virtual environment is undertaken by tracking hand position relative to the user’s left shoulder.

Results

The construct successfully tracked scene depth and user joint locations. This permitted gesture‐based control over the entire 3D environment. Stereoscopy was deemed appropriate with significant object projection while still maintaining the operator’s ability to resolve the image as singular. Specific anatomic structures can be selected from within the larger virtual environment. These graphic representations can be extracted and rotated at the discretion of the user. Voice command employing the Kinect’s intrinsic speech library works, yet is easily confused by environmental noise.

Conclusion

There is a need for the development of virtual anatomy models to complement traditional education. Initial development is time intensive, and the constructed images are a stylized abstraction. Nonetheless, our novel gesture‐ controlled interactive 3D model of the temporal bone represents a promising teaching tool.
Resident and Attending Tube Placement: Is There a Difference?
Authors: Goyal Neerav , Carr Michele M.
Published: February 2015

Objective

To determine if there is a difference in patient outcomes between resident and attending placed ventilation tubes.

Method

Charts of pediatric patients who underwent tube placement between 2003 and 2010 at a tertiary referral center were reviewed. Patients served as self‐controls, with the resident and attending each having done one ear. Level of training, ear operated, patient age, operative findings, and findings at first follow‐up were recorded.

Results

Of 1488 pediatric patients, 809 met inclusion and exclusion criteria. A total of 59% were boys and residents preferentially operated on the left ear (86%). A total of 160 patients did not follow up in the first 10 weeks. There were no significant differences between attending and resident operated ears with respect to operative findings (P =. 09), or findings at first follow‐up (P =. 35). There was no significance for each operative finding: tube extrusion (P =. 32), blocked tube (P =. 15), otorrhea (P =. 82), and patent tube (P =. 09). Comparing the PGY2 residents to the attending also failed to reveal significant differences (P =. 30), with a power of greater than 80%.

Conclusion

Differences between tube outcomes between resident and attending placed ventilation tubes were not found to be statistically significant. This suggests that placement of ventilation tubes by resident surgeons can be performed in a safe manner without affecting patient safety or patient outcomes.