bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging Prevalence of Sigmoid Sinus Dehiscence among Patients with and without Pulsatile Tinnitus
Authors: Nicholas Brian D. , Schoeff Stephen S. , Mukherjee Sugoto , Kesser Bradley W.
Published: August 2013

Objectives:

1) Appreciate the incidence of sigmoid sinus diverticulum/dehiscence (SSDD) among patients with pulsatile tinnitus (PT) and its prevalence in patients undergoing high resolution temporal bone computed tomography (HRCT) for other reasons. 2) Understand comorbidities associated with SSDD.

Methods:

Retrospective chart review of patients undergoing temporal bone imaging between January 2003 and November 2012 at a tertiary care university medical center. Two groups were evaluated for evidence of SSDD. The first (“PT”) group included all patients whose radiology report mentioned a clinical history of PT (n = 38 symptomatic ears in 30 patients). The second group (“non‐PT”) included all patients undergoing temporal bone HRCT between November 2011 and November 2012 (n = 323 ears in 171 patients). Primary outcome measure was the radiographic presence of SSDD. Variables including age, gender, body mass index (BMI), and systemic hypertension were analyzed by two‐tailed Fisher's exact tests.

Results:

Within the PT group, SSDD was identified in 24% of ears (9/38) and 23% of patients (7/30); all SSDD patients were female (P =. 029). There were no differences in mean age, BMI, or presence of hypertension between those with and those without SSDD. In the non‐PT group, SSDD was identified in 2 (both female) of 171 patients (1.2%; 0.6% of ears). The difference in SSDD prevalence between the two groups was significant (P =. 0001).

Conclusions:

The prevalence of SSDD in patients with PT was 24%. The prevalence of SSDD among all patients undergoing HRCT in one year was 1.2%. In our study, SSDD affected females exclusively.
The Implications of Physical Injury on Otovestibular and Cognitive Symptomatology following Blast Exposure
Authors: Perez Colleen , Johnson Christopher M. , Hoffer Michael
Published: August 2013

Objectives:

Identify a potential difference in the spectrum of otovestibular and cognitive symptoms in blast‐exposed patients either with or without significant extremity injuries.

Methods:

A retrospective chart review of 100 consecutive blast‐exposed patients seen in the otolaryngology department vestibular clinic at a military tertiary care medical center in 2011 was performed. New patient encounters were identified in the electronic medical record, and all patients referred for otovestibular evaluation after a blast injury or exposure were included. A convenience sample of 100 consecutive patients meeting the criteria was studied. Data including presence of extremity injuries, diagnosis of mild traumatic brain injury, symptoms of imbalance, vertigo, headache, tympanic membrane perforation, hearing loss, tinnitus, insomnia, and memory loss were collected and analyzed.

Results:

Of 100 patients included, 38 suffered severe extremity injuries. Those patients with severe extremity injuries were more likely to suffer from tympanic membrane perforations (58% vs. 23%, P = 0.0004) and hearing loss (53% vs. 23%, P = 0.002), less likely to suffer from imbalance (32% vs. 79%, P = 0.000002) and vertigo (2% vs. 47%, P = 0.000003), and less likely to have been diagnosed with a mild traumatic brain injury (26% vs. 66%, P = 0.0001).

Conclusions:

Blast‐exposed individuals who sustained severe extremity injuries reported significantly fewer cognitive and vestibular symptoms. In the aftermath of a blast, those who can walk away may have still sustained a significant injury. Specifically, they may suffer more long‐term cognitive and vestibular symptoms than those with severe physical injuries.
Longitudinal Comparison of Quality‐of‐Life Outcomes in Vestibular Schwannoma Patients
Authors: Robinett Zachary N. , Walz Patrick C. , Miles‐Markley Beth A. , Spear Samuel A. , Welling D. Bradley
Published: August 2013

Objectives:

1) Compare long‐term quality of life (QOL) outcomes in vestibular schwannoma (VS) patients managed conservatively, with microsurgery, or with stereotactic radiation; 2) Evaluate factors contributing to their QOL.

Methods:

The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was administered to 645 patients treated for VS at a tertiary care center over 24 years. Patients in each treatment group were sub‐divided by years since diagnosis (0‐5, 6‐10, and >10). Composite QOL (cQOL) scores and sub‐scores in hearing, balance, facial symptoms, pain, anxiety, and energy were compared by ANOVA at each time interval. Regression analysis correlated QOL with tumor size, speech recognition threshold, and reported symptoms.

Results:

Survey return rate was 49%. Mean follow‐up was 7.6 years. The only significant difference in cQOL was at 1‐5 years, where stereotactic radiation was best and conservative treatment was worst (P =. 009). No significant differences in cQOL were detected at 6‐10 or >10 years. Significant differences between sub‐scores were found in hearing, balance, and facial symptoms. Overall tumor size was inversely proportional to QOL (R =. 54; P <. 001); this correlation decreased with time (1‐5 R =. 61, P <. 001 / 6‐10 R =. 40, P <. 001 / >10 R =. 16, P =. 02).

Conclusions:

1) We found no significant difference in long‐term QOL outcomes between treatment groups; however, patients treated by stereotactic radiation may experience better overall QOL up to 5 years post‐treatment. 2) Tumor size at presentation is a good prognostic tool in VS patients but may be limited in predicting long‐term QOL outcomes.
Magnetic Resonance Imaging as a Useful Tool in the Evaluation of Clinical Treatment of Otospongiosis
Authors: de Oliveira Vicente Andy , Chandrasekhar Sujana S. , Yamashita Helio K. , Cruz Oswaldo‐Laercio M. , Barros Flavia A. , Penido Norma O.
Published: August 2013

Objectives:

Evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment.

Methods:

Prospective, randomized, controlled, double‐ blind study involving 31 patients with clinical, audiometric, and tomographic diagnosis of otosclerosis. If computed tomography (CT) demonstrated active lesions, these patients underwent (MRI) in order to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into three groups and received treatment with placebo, alendronate sodium, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. The MRIs were evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Outcomes were assessed by comparing the MRI, clinical, and audiometric evaluations in the pre‐ and post‐treatment periods.

Results:

Otospongiosis was most predominantly identified in the region anterior to the oval window (RAOW), and this site was reliable for comparing pre‐ and post‐treatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations.

Conclusions:

MRI shows higher sensitivity for detecting reduction in inflammatory activity of otospongiosis compared to clinical and audiometric findings. The objective MRI evaluation was the most accurate method of monitoring clinical treatment response in otospongiosis.
Medication Associated with Hearing Loss: 25 Years of Medical Malpractice Cases in the United States
Authors: Martell David W. , Ruhl Douglas S. , Cable Benjamin B.
Published: August 2013

Objectives:

Many medications used today continue to have the potential for ototoxicity. To potentiate management of this risk, this study examines malpractice litigation trends of lawsuits involving hearing loss associated with medication use.

Methods:

Court records of legal trials from 1987 to 2012 were obtained from two major computerized databases: WESTLAW and LexisNexis. Data were compiled on the demographics of the defendant and plaintiff, use of otolaryngologists as expert witnesses, medication used, legal allegations, verdicts, and judgments.

Results:

Forty‐six unique cases met inclusion criteria and were selected for review. Antibiotics (72%), specifically aminoglycosides (47%), were the most common medications cited as causing hearing loss. Eleven (22%) cases were resolved through a settlement before a verdict was reached. Verdicts in favor of the plaintiffs (37%) were awarded an average of $1,134,242. Pediatric patients were more likely to win their lawsuits (P = 0.03) compared to adults. However, no statistical difference existed between average awards. Of the cases found in favor of the plaintiff, the most common reasons cited were inappropriate medication, dose or duration (39%), failure to properly monitor (36%), failure to choose a less toxic medication (18%), and an error in diagnosis or failure to diagnose or treat (18% each).

Conclusions:

Physicians must be aware of the potential effects of the medications they prescribe. An understanding of potential drug interactions, proper monitoring, and appropriate use of less toxic medications is important to improve patient care. Analyzing litigation trends may be used to prevent future lawsuits and improve physician awareness.
Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension in Tympanoplasty Surgery
Authors: House Laura K. , House James R.
Published: August 2013

Objectives:

1) Determine the safety of using a commercially available suspension of polymycin B, neomycin, and hydrocortisone in tympanoplasty surgery.2) Apply evidence based medicine in tympanoplasty surgery when considering potential ototoxicity.

Methods:

Study Design: Retrospective chart review. Setting: Tertiary otology practice, single surgeon. Data were gathered on 277 consecutive type 1, underlay tympanoplasties for which both pre‐ and postoperative audiometric data were available over a 10 year period. In each surgery, gelatin sponge saturated in a commercially available suspension of polymycin B, neomycin, and hydrocortisone was placed in the middle ear to support the graft. Patients ranged from age 3y/o to 79y/o. Preoperative and postoperative bone conduction audiometric thresholds were measured at 500, 1000, 2000, 3000, and 4000Hz.

Results:

The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000Hz. The changes by frequencies were as follows: 500Hz (‐1.624dB), 1000Hz (‐1.399dB), 2000Hz (‐0.975), 3000Hz (‐0.596dB), and 4000Hz (+0.56dB). The five frequency average change was (‐0.545dB).

Conclusions:

The commonly used otic solution containing polymycin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.
Recurrent Vertigo after Intratympanic Gentamicin for Ménière's Disease: Long‐term Follow‐up of Two Regimens
Authors: Casani Augusto P. , Cerchiai Niccolò , Dallan Iacopo , Navari Elena , Franceschini Stefano S.
Published: August 2013

Objectives:

1) Analyze the recurrence rate of vertigo and the need for repeated injections of two different regimens of intratympanic gentamicin (ITG) (low dose and multiple daily dose). 2) Evaluate the efficacy of retreatment after long‐term recurrence of vertigo attacks.

Methods:

We retrospectively analyzed 2 series of patients suffering from unilateral Ménière's disease treated with low dose ITG (42) and multiple daily dose ITG (35) in a tertiary referral center. The mean period of follow‐up was 4.8 years, and the outcome measurements were a) control of vertigo attacks, b) need of repeated treatment for recurrent vertigo evaluated using the Kaplan‐Meyer method, and c) incidence of side effects (post‐treatment dizziness, hearing loss).

Results:

At 2‐year follow‐up, complete control of vertigo was obtained with only 1 round of treatment in 30 (71%) low dose patients and 28 (80%) multiple daily dose patients. Side effects of ITG were significantly higher in the multiple daily dose group. At long‐term follow‐up (> 4 years), the complete control vertigo rate decreased significantly, especially in the low dose group. 13 (31%) patients in the low dose group and 9 (25%) in the multiple daily dose group needed multiple rounds of treatment.

Conclusions:

Both regimen of ITG offered an excellent rate of vertigo control at 2‐year follow‐up. At long‐term follow‐up, the probability of recurrent vertigo attacks progressively increases, especially in the low dose group. The patients who experienced late recurrences of vertigo had less chance of achieving good results with additional rounds of ITG.
Retrospective Study Comparing Audiologic Performance and Surgeon Learning Curve between Cochlear Implant Devices
Authors: Mandour Mahmoud , Samy Ravi N. , Houston Lisa
Published: August 2013

Objectives:

1) Describe the challenges of using a new cochlear implant (CI) manufacturer in a well‐established CI program. 2) Recognize that a learning curve exists for all surgeons and audiologists using new CIs.

Methods:

A retrospective study was performed in a tertiary care center involving 25 consecutive CIs placed in post‐lingually deafened adults from January 2009 to September 2012. Audiological evaluations were compared at 3‐4 month and 12‐month follow‐up visits. Patients were divided into two groups: patients implanted using a new manufacturer to the institution (Med‐El, M group, n = 13) and patients implanted using an established manufacturer (Cochlear, C group, n = 12). Multiple linear regression analyses models used soundfield detection, Consonant Nucleus Consonant (CNC), and Hearing In Noise Test HINT) while adjusting for confounding factors (significance if P < 0.001).

Results:

A strong statistical correlation (r2 > 0.5) was observed among age at implantation, duration of deafness, pre‐implant speech perception score, and device type and the outcome measures at 3‐4 months and 1‐year follow‐up. However, none of them reached statistical significance (P value > 0.001). The device type (Cochlear against Med‐El) approached significance with SFD at 3‐4 months and at 1‐year follow‐up (P value = 0.003, 0.002 respectively).

Conclusions:

While the Cochlear system recipients initially seemed to perform better than the Med‐El recipients, this difference disappeared as experience with the newer implant system progressed. Other variables are more important than device type. However, sources of variability such as surgical and audiological inexperience with a new CI system highlight challenges facing a CI center attempting to modify an existing CI program.
Study of the Cochlear Function in Patients with Myotonic Dystrophy Type 1
Authors: Felekis Dimitrios , Balatsouras Dimitrios G. , Panas Marios , Korres Stavros , Xenelis John E.
Published: August 2013

Objectives:

Myotonic Dystrophy type 1 is a progressive autosomal dominant multisystem disorder, the second most common form of muscular dystrophy. The disease is associated with various vestibular, oculomotor, and auditory disorders. The aim of the present study was to undertake a detailed vestibular and audiological evaluation, and specifically to analyze the cochlear function using transiently evoked otoacoustic emissions.

Methods:

24 patients with genetically diagnosed myotonic dystrophy type 1 were studied during the past 4 years in Eginition hospital of Athens. Twenty‐one normal subjects were used as controls. Testing included pure‐tone audiometry, tympanometry, auditory brainstem responses (Abr), transiently evoked otoacoustic emissions, and nystagmography.

Results:

Tympanograms were normal in most patients. 15 (62.5%) patients had a varying degree of sensorineural hearing loss, with no conductive element. In 9 of them (37.5%), ABR abnormalities were found, such as absence of wave I or increased latencies of waves III and V, compatible with sensorineural hearing loss (5 patients), as well as increased I‐III and I‐V interpeak latencies, compatible with retrocochlear involvment of the auditory pathways (4 patients). Subclinical cochlear damage was found in all patients, as evidenced by absent otoacoustic emissions or lower otoacoustic emission amplitude. Vestibular hypersthesia was found in 9 patients (37.5%), accompanied by spontaneous nystagmus in 4 of them (15.6%).

Conclusions:

Audiovestibular abnormalities are quite common in patients with myotonic dystrophy type 1. We have found that subclinical cochlear damage is a common finding of the disease, as concluded from the absence or decrease of otoacoustic emissions in these patients.
Surgeon Behavior in a New Virtual Reality Temporal Bone Simulator Compared to Cadaveric Dissection
Authors: Szudek Jacek , Avery Alex , Ioannau Ioanna , Zhou Yun , Kennedy Gregor , O'Leary Stephen
Published: August 2013

Objectives:

The gold standard for teaching otologic surgery is cadaveric temporal bone (TB) dissection. However, learning may be enhanced by virtual reality (VR) simulation, which improves access and allows reproducibility. The main criticism of VR has been its lack of fidelity. The objectives of this study were to 1) assess the fidelity of a novel VR TB simulator, and 2) compare surgeon behavior to that in cadaveric TB dissection.

Methods:

A new 3D high‐fidelity force‐feedback VR simulator was developed for otologic procedures. Using prospective paired comparisons conducted in June 2012, 6 surgeons each performed a mastoidectomy, facial recess dissection, and a cochleostomy on a human cadaveric TB and in the VR simulator. Drill movements were then compared between cadaveric and VR trials.

Results:

Stroke number (P = 0.69), speed (P = 0.08), and rate (P = 0.74) did not differ significantly between VR and cadaveric environments for all 3 stages. Compared to cadaveric dissection, subjects in the VR simulator spent less time completing each stage (236s vs. 698s; P = 0.01); spent a greater percentage of time drilling (69.5% vs. 30.4%; P = 0.002); and used a larger percentage of long strokes (39.8% vs. 6.9%; P < 0.001).

Conclusions:

Drill stroke characteristics among surgeons in the VR simulator were similar to those in the cadaveric dissection. This suggests that real‐life drilling behavior was replicated in VR and that it may be a useful adjunct to traditional TB dissection.
Traumatic Hearing Loss in the Context of Blast‐Related Tympanic Membrane Perforation
Authors: Pusz Max D. , Robitschek Jon M.
Published: August 2013

Objectives:

Identify associated clinical factors and characterize the various forms of hearing loss in the context of blast related traumatic tympanic membrane perforation sustained in the combat setting.

Methods:

A prospective study of 41 patients who sustained a perforation secondary to blast injury between 2010‐12 while serving in combat. Clinical exams and audiograms were obtained for all patients by a single institution ear, nose, and throat (ENT) service with comparative data generated from review of pre‐ and post‐trauma hearing screens. Follow‐up clinical and audiogram data were obtained on all available subjects.

Results:

Fifty‐nine tympanic membrane (TM) perforations were documented with audiograms. A conductive hearing loss of 14.8dB, 22.4dB, 20.3dB, and 18.9dB and sensorineural hearing loss of 18.0dB, 13.5dB, 19.9dB, and 22.0dB at 500, 1000, 3000, and 4000 Hz respectively was observed. Forty‐nine percent of all hearing loss was SNHL. Clinical factors did not correlate to hearing loss (P > 0.05). Follow‐up data were available in 33 patients at an average of 11.8 months. Eighty‐eight percent of patients still had tinnitus, and 11% had continued vertigo. Forty‐nine percent of perforations healed spontaneously, and 42% had surgical correction. On average, patients demonstrated a 51% improvement in SNHL at time of follow‐up.

Conclusions:

In the subacute setting, patients with traumatic TM perforations secondary to combat blast injury demonstrate conductive and sensorineural hearing loss, with 49% of all loss being sensorineural. An average sensorineural hearing loss improvement of 51% was seen at follow‐up. Clinical factors did not correlate with hearing loss. 49% of perforations healed spontaneously, and 42% were surgically corrected.
Acetaminophen plus Ibuprofen for Treatment of Post‐tonsillectomy Pain in Children
Authors: Mattos Jose L. , Robison Jacob G. , Yellon Robert F.
Published: August 2013

Objectives:

Determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post‐tonsillectomy pain compared to acetaminophen plus opioids in children.

Methods:

A retrospective medical record review was performed of children (n = 575) who underwent adenotonsillectomy at a tertiary care children's hospital between September 2012 and January 2013. All patients received acetaminophen. 342 (59%) received ibuprofen, and 233 (41%) received opioids (oxycodone or hydrocodone) without ibuprofen. In the ibuprofen group, 109 (32%) received opioids. None received codeine. Descriptive analysis, two‐tailed t‐tests, and multivariate regression controlling for age and diagnosis analyzed differences of outcomes: 1) postoperative hemorrhage, 2) nurse phone calls from families, and 3) emergency department (ED) visits for pain, dehydration, or bleeding.

Results:

For the entire group, 7% had postoperative hemorrhage. 43% of these required operative intervention. There were 73 ED visits and 216 nurse calls. No significant difference was found in bleeding, ED visits, or nurse calls (P = 0.2, 0.8, and 0.3, respectively) between groups. No difference was found in operative intervention for hemorrhage (P = 0.9). No further difference was found when adjusting for age and/or diagnosis. After excluding the children who received ibuprofen plus opioids, there was still no significant difference in outcomes.

Conclusions:

There appears to be no difference in incidence of hemorrhage, operative intervention for bleeding, ED visits, or nurse calls between children receiving acetaminophen plus ibuprofen and those who received acetaminophen plus narcotics with/without ibuprofen. These data suggest that safety and pain control profiles are similar when using ibuprofen instead of opioids in post‐adenotonsillectomy patients.
A Comparison of Postoperative Tramadol versus Acetaminophen with Codeine in Children Undergoing Tonsillectomy
Authors: Friedrichsdorf Stefan J. , Nugent Andrea P. , Foster Laurie P. , Lu Yi , Sidman James D.
Published: August 2013

Objectives:

1) Evaluate the effectiveness of tramadol compared to codeine/acetaminophen for post‐tonsillectomy pain management. 2) Describe the safety and side effects of tramadol compared to codeine/acetaminophen during the post‐tonsillectomy recovery period.

Methods:

Prospective, double‐blinded, randomized controlled clinical trial of children ages 4‐15 who underwent routine tonsillectomy (with or without adenoidectomy) surgery at Children's Hospitals and Clinics of Minnesota in 2011 and 2012. Children were randomized to receive scheduled—followed by PRN—dosing of either tramadol or codeine/acetaminophen. Primary outcomes were assessed during a 10‐day postoperative follow‐up period with parent diaries and chart review. Diaries captured the following domains: physical recovery; pain (multiple pain scales); sleep; side effects; need for medical attention; and global satisfaction with treatment.

Results:

The final sample of 74 children was mostly white (92%), female (65%), and 6 years of age (range 4‐14). Most parents completed diaries for ≥ 4 days (92%). There were no significant differences between groups in terms of medication efficacy or overall experience with side effects. Groups did not differ in terms of days with a mean pain score >4 (P = 0.85) (tramadol = 1 day; codeine = 1.5 days).

Conclusions:

There were no differences between groups in terms of postoperative medication efficacy or safety in this small trial. Due to codeine's declining acceptability for use in children and risks associated with its efficacy and safety, tramadol should be considered as a first line prescription for children undergoing this common procedure. Further evaluations of oral pain medications for post‐tonsillectomy care should be conducted.
Does the Mode of Delivery Affect Wideband Reflectance Measurements in Newborns?
Authors: Masaoudi Laila Al , Pitaro Jacob , Daniel Sam J.
Published: August 2013

Objectives:

Determine whether wideband reflectance (WBR) measurements in babies who were born by vaginal delivery are different from those of babies born by C‐section. Our working hypothesis is that babies delivered by Caesarian section have higher reflectance scores on WBR, as they have more fluid and debris in the outer and middle ear. This can have an impact on universal hearing screening passing rates.

Methods:

Following standard newborn hearing screening, WBR was measured in 225 healthy babies. Sixty‐six babies were delivered by Caesarean section compared to 159 babies delivered vaginally. A total of 123 ears were included in the C‐section group and were compared to a total of 288 ears in the second group. The results were obtained for 60 frequencies.

Results:

The mean screening age for babies in the C‐section delivery group was 27.5 hours compared to 24.3 hours for babies in the vaginal delivery group. For both groups reflectance was high between 0.24 to 0.79 kHz and 2.50 to 4.80 kHz, with the highest at 4.5 kHz. Low reflectance was observed between 0.84 kHz and 2.50 kHz, with a second decrease in reflectance between 4.8 kHz and 8 kHz for both groups. In general, reflectance of the C‐section group was slightly lower than the reflectance for babies in the vaginal delivery group.

Conclusions:

Further studies are needed to conclude whether the type of delivery may have an effect on hearing screening results and possibly on the optimal timing for screening babies delivered via C‐section.
Parotid Duct Injury in Temporalis Tendon Transfer
Authors: Peterson Nathaniel , Shipchandler Taha Z.
Published: August 2013

Objectives:

1) Know the course of the parotid duct relative to the path of dissection for temporalis tendon transfer. 2) Apply anatomic concepts and technique modifications to protect the parotid duct during temporalis tendon transfer.

Methods:

A retrospective chart review of 40 consecutive adult patients undergoing temporalis tendon transfer for unilateral facial reanimation was performed. Cases represent operations done with the technique described in the literature as well as those performed with the additional step of parotid duct cannulation. In the latter, the path of dissection and course of the parotid duct were documented with introperative X‐ray. Instances of parotid duct injury using both techniques were recorded. Treatment course for patients with parotid duct injury was also reviewed.

Results:

Two instances of parotid duct injury were identified (incidence = 5%). Both were in cases without parotid duct cannulation. However, only 3 cases have been performed since the addition of parotid duct cannulation to our surgical technique. Intraoperative plain films showed that the path of dissection and the course of the parotid duct run obliquely and passed within 5 mm of each other. Both patients with parotid duct injury had resolution of symptoms with medical management, including botulinum toxin injection into the affected parotid gland and placement of pressure dressings.

Conclusions:

Parotid duct injury is an uncommon complication of temporalis tendon transfer that can be adequately managed with medical treatment. Cannulation of the parotid duct allows for intraoperative localization and possibly prevention of injury to this important structure.
Lack of Significant Seasonality in Detecting Respiratory Viruses on Hypertrophic Adenotonsillar Tissues Suggests Persisting Infections
Authors: Valera Fabiana , Tamashiro Edwin , Proença‐Modena Jose L. , Buzatto Guilherma P. , Paula Flavia E. , Arruda Eurico , Anselmo Lima Wilma T.
Published: August 2013

Objectives:

Determine the seasonality of respiratory viruses in adenoids and palatine tonsils in children with chronic adenotonsillitis. These seasonal oscillations were used to estimate the presence of persistent or acute asymptomatic viral infections.

Methods:

This was a cross‐sectional study which included 172 children with adenotonsillar hypertrophy and clinical evidence of obstructive sleep apnea syndrome or recurrent adenotonsillitis from 2010 through 2012. The respiratory viruses were detected by TaqMan real‐time polymerase chain reaction (qPCR) in nasopharyngeal secretions, adenoids, and palatine tonsils biopsies from all analyzed patients.

Results:

Frequency of several respiratory viruses was extremely high in the adenotonsillar tissues among all analyzed patients. In fact, genomes of at least one respiratory virus were detected in over 87% of them. Although some viruses have not shown any discernible seasonal variations, human enterovirus detection peaks in summer/autumn months and summer nadirs of human respiratory syncytial virus in both years of the study, they were discrete, and not significant. No obvious seasonality was observed among the analyzed viruses.

Conclusions:

This frequent rate of viral detection associated with the lack of significant seasonality of detection of respiratory viruses in patients with chronic adenotonsillar diseases during the 2‐year study period supports the notion that such high frequency of virus genome detection is related to virus persistence in lymphoepithelial tissues of the upper respiratory tract, which can function as natural reservoirs of respiratory viruses for the community.
Older Siblings Are at Increased Risk for Head and Neck Foreign Bodies
Authors: Bartindale Matthew R. , Rosenthal Laura S. , Fridirici Zachary
Published: August 2013

Objectives:

1) Describe the role siblings play in foreign bodies of the head and neck. 2) Recognize the locations where children are most at risk for foreign bodies.

Methods:

This is a prospective case‐control study in a tertiary care facility conducted from 2011‐2013. Any child (0‐17yo) with a foreign body removed from the head or neck was included. Data collected included location of the foreign body (eg, esophagus), location of acquisition (eg, home), and the number and ages of siblings. Controls were matched by age, gender, and location of removal (clinic, operating room, or emergency department).

Results:

There were 27 patients enrolled (16 male, 11 female). The average age was 5.2yo (median 4.6yo, range 9mo‐13yo). The average age of patients with foreign bodies in the ear was 6.0yo (n = 17), esophagus 4.3yo (n = 6), and nose 3.2yo (n = 4). Children with a younger sibling are more likely to have a foreign body than children with no younger siblings (odds ratio [OR] = 3.025, P = 0.0738). This is particularly true when children are at home (n=17, OR 11.20, P = 0.0153). There is no statistically increased risk for patients with older siblings compared to no older siblings (OR = 0.6250, P = 0.4023) or having a sibling compared to no siblings (OR = 0.6786, P = 0.5346).

Conclusions:

Older siblings are more likely to acquire foreign bodies in the home than younger siblings. Increased awareness of this may help prevent some foreign bodies of the head and neck.
Outcomes of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency
Authors: Bohm Lauren A. , Padgitt Noëlle , Tibesar Robert J. , Lander Timothy , Sidman James D.
Published: August 2013

Objectives:

Compare surgical outcomes between pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty in the management of pediatric velopharyngeal insufficiency.

Methods:

Retrospective review of 96 patients with velopharyngeal insufficiency, who underwent surgical intervention at a tertiary pediatric care center between 2008 and 2012. Patients with velocardiofacial syndrome were excluded from the study. Surgical interventions were categorized as pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty. Main outcome measures included perceptual speech analyses, complications, and surgical revision rates.

Results:

Of the 96 reviewed patients, 38 (39.6%) underwent pharyngeal flap, 20 (20.8%) sphincter pharyngoplasty, and 38 (39.6%) concomitant Furlow palatoplasty and sphincter pharyngoplasty. The mean improvement in postoperative perceptual speech analysis scores was significantly higher in both the combined procedure and pharyngeal flap when compared to sphincter pharyngoplasty alone (P =. 013, P =. 031). No statistically significant difference in speech improvement was observed between the combined procedure and pharyngeal flap. There were no differences in complications among the three surgical interventions. However, the combined procedure required significantly less surgical revisions than the pharyngeal flap (P =. 019).

Conclusions:

Concomitant Furlow palatoplasty and sphincter pharyngoplasty is an effective procedure for the management of pediatric velopharyngeal insufficiency and may result in superior speech outcomes and lower revision rates than sphincter pharyngoplasty and pharyngeal flap, respectively.
Pediatric Vocal Fold Immobility: An 11‐Year Review
Authors: Jabbour Jad R. , Martin Timothy J. , Beste David J. , Robey Thomas C.
Published: August 2013

Objectives:

1) Describe the etiologies, manifestations, clinical course, and prognosis of vocal fold immobility (VFI) in a pediatric population. 2) Recognize the morbidities associated with neonatal VFI.

Methods:

Retrospective review of patients at a private pediatric otolaryngology practice in a metropolitan area. All patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI were included. Records were reviewed for data regarding demographics, etiologies, symptomatology, follow‐up, and resolution.

Results:

A total of 418 patients were identified. Left VFI was present in 66.0%, right VFI in 7.9%, and bilateral VFI in 26.1%. Median age at presentation was 90 days. Major etiological categories included cardiac surgery in 68.2%, neurologic disease in 8.1%, idiopathic causes in 11.7%, and paralysis associated with prematurity/prolonged neonatal intubation in 9.1%. On presentation, 61.7% experienced dysphonia, 54.1% respiratory symptoms, and 49.3% dysphagia. Tracheostomies were performed in 25.8% and gastrostomies in 40.7%. Outpatient follow‐up occurred in 90.7% of patients, with median follow‐up of 16 months. Resolution evidenced by laryngoscopy was found in 35.6%, with median time to resolution of 5 months. In patients without laryngoscopic resolution, median follow‐up was 20 months, and 24.1% reported symptomatic resolution.

Conclusions:

Vocal fold injury early in life, often secondary to cardiac surgery, may lead to lasting VFI and considerable morbidity. In this large database, the majority of patients did not experience resolution. This warrants further investigation into predictors of VFI and possible interventions to reduce morbidity.
Supraglottoplasty in Premature Infants: A Comparison Study
Authors: Durvasula Venkata S. , Lawson Bradley , Bower Charles M. , Richter Gresham T.
Published: August 2013

Objectives:

Prematurity is thought to be to be an independent risk factor for supraglottoplasty (SGP) failure. This study aimed to compare the outcomes of SGP in premature (<36 weeks) versus term infants.

Methods:

Retrospective analysis was performed on 325 patients undergoing SGP between 2004 and 2012. Patients >12 months age, syndromic, or with neurological or cardiac comorbidities were excluded. Resolution of airway symptoms after SGP was considered a success while revision SGP and tracheostomy were considered failures. The rates of secondary airway lesions (SAL), dysphagia, and gastrostomy tube (GT) placement were also compared.

Results:

A total of 178 infants (138 term, 40 premature) were identified for the analysis. SGP was successful in 91% (126/138) term and 90% (36/40) premature infants with no significant difference (P = 0.8) in success rates. Twelve term infants and 3 preterm infants required revision SGP. One premature infant required tracheostomy. Incidence of SAL was significantly higher in premature (72.5%) compared to term infants (34.97%) (P = 0.0002). Intubation rates were significantly higher in premature infants. This did not affect the higher SAL in premature infants compared to term infants. Dysphagia rates were also higher in premature (13/40, 32.5%) versus term infants (10/138, 7.25%, P < 0.001) and lasted longer on follow‐up. The rate of GT insertion was greater in premature (27.5%) compared to term infants (7.25%) (P = 0.003).

Conclusions:

Supraglottoplasty outcomes in term and premature infants were similar. However, premature infants experience significantly more SAL and dysphagia.
Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?
Authors: Lombardi Davide , Mattavelli Davide , Semeraro Francesco , Nicolai Piero
Published: August 2013

Objectives:

To evaluate the efficacy of endoscopic dacryocystorhinostomy (endoDCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE).

Methods:

Design: Single center cohort study. Setting: Academic tertiary center. Patients: Twenty‐one consecutive patients who underwent endoDCR for ADLSE between August 2005 and December 2012 were included. Main outcome measures: The success of the procedure was defined as complete complaint relief and DCR patency. Time from referral to surgery, post‐operative complications, and revision surgery data were also reported.

Results:

The present cohort of patients included 3 males (14.3%) and 18 females (85.7%) (median age: 66 years). Median time between referral and surgery was 0 days (mean: 0.86 days). Median follow‐up was 12 months. All patients showed immediate relief from symptoms, with no recurrences of ADSLE. Complete success was achieved in 20 of 21 (95.2%) cases; the only failure was recorded in a patient who had previously undergone radio‐iodine treatment. In this case also revision endoDCR was not successful. The only perioperative complication was an epistaxis requiring revision surgery under general anesthesia. The definitive success rate was 95.2% after primary and revision surgery.

Conclusions:

EndoDCR enables rapid solution of ADSLE with a very high success rate. Immediate surgery minimizes the risk of skin fistulization and/or orbital complications; DCR shrinkage and lacrimal obstruction are unlikely since the procedure is performed on an enlarged sac. In comparison with external DCR, the absence of skin incision in an inflamed and infected field is the main advantage.
Disparities in Chronic Rhinosinusitis Outcomes and Income
Authors: Park Renee E. , Smith Timothy L.
Published: August 2013

Objectives:

Chronic rhinosinusitis (CRS) is prevalent with high burden of disease. Both general health and disease‐specific quality of life (QOL) measures have been found to significantly improve after endoscopic sinus surgery (ESS). It is also well known that social disparities in health are significant predictors for health outcomes. This study aimed to test the association between income and QOL outcomes in CRS.

Methods:

Patients were selected from a multicenter prospective cohort of adult CRS patients undergoing ESS (N=302). Outcomes included SF‐36 general health QOL and disease‐specific QOL as measured by the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Linear regression was applied to test the association of income with QOL outcomes, controlling for significant covariates.

Results:

Multivariable regression demonstrated better QOL in the high‐income group in all SF‐36 domains (p=0.000‐0.037) except mental health. There was no significant change in RSDI or CSS between income groups. Further, non‐white patients in the low‐income group demonstrated worse SF‐36 QOL after ESS in comparison to their white counterparts.

Conclusions:

Within the general health domains, low‐income minorities fared worse than their white counterparts in all SF‐36 domains. Low‐income minorities reported worse QOL after ESS in the SF‐36 domains of physical function, physical role, and emotional role. These domains focus on limitations of work effectiveness or activities, which may disproportionately impact this population. Income is not significantly associated with disease‐specific QOL. Low‐income is associated with worse general health QOL in most domains. CRS‐specific QOL surveys may fail to measure some important health outcomes.
Do the Material and Time of Nasal Packing Influence the Prognosis of Septomeatal Plasty?
Authors: Huang Tzu‐Chin , Hsu Ying‐Chieh
Published: August 2013

Objectives:

The purpose of this retrospective, randomized study was to analyze the influence of the material and time of nasal packing on the prognosis of Septomeatal plasty (SMP).

Methods:

We collected 120 patients who received SMP and randomly adopted Merocel (non‐resolvable) or Nasapore (biodegradable) as nasal packing during January to July 2012. Forty‐five cases (group N) adopted Nasapore, which was left in the nasal cavity and resolved spontaneously without manipulation. Those who used Merocel were further divided into 3 subgroups by the time of packing removal. The Merocel was randomly removed after the surgery on day one (M1:20 cases), day two (M2:39 cases) or day three (M3:16 cases). We compare these 4 groups in two aspects: 1) Medical resource consumptions, including the duration of medication, times of follow‐up, and period of treatment; 2) Postoperative complications, including bleeding, adhesion formation, subsequent septal hematoma, and septal perforation.

Results:

The Kruskal‐Willis Test was adopted to analyze the medical resource consumption items: duration of medication (weeks): N (2±0.6), M1 (2±0.3), M2 (2±0.7), M3 (2±0.6), P= 0.899; times of follow‐up: N (3.5±0.9), M1 (3.7±1.1), M2 (3.5±1), M3 (3.2±1), P= 0.585; period of treatment (weeks): N (4.3±1.4), M1 (4.8±1.7), M2 (4.8±1.4), M3 (4.2±1.6), P= 0.225. There were no significant differences among these 4 groups. We used Chi‐square test to analyze the incidence of postoperative complications, and there were no significant differences among these 4 groups either (p>0.05).

Conclusions:

The material and time of nasal packing seem to make no differences on the prognosis of SMP. Since prolonged nasal packing may cause more discomfort, we should consider shortening the packing time to provide higher patient satisfaction.
Doxycycline for Recurrent Chronic Rhinosinusitis with Nasal Polyps
Authors: Bezerra Thiago , Soter Ana C. , Abdo Tatiana , Pilan Renata , Pezato Rogerio , Pinna Fabio , Voegels Richard L.
Published: August 2013

Objectives:

Evaluate factors related to improvement after doxycycline treatment for patients with recurrent chronic rhinosinusitis with nasal polyps.

Methods:

We conducted an open label study from 2012 to 2013 on 32 patients with difficult‐to‐treat chronic rhinosinusitis with nasal polyps uncontrolled after endoscopic sinus surgery and long‐term low‐dose clarithromycin treatment. Patients received doxycycline 100mg per day for 12 weeks after a three‐month wash‐out period. The main outcome measure was a meaningful improvement in SNOT‐20 (>0.80). Other outcome measures were the SNOT‐20, NOSE, and Lund‐Kennedy scores. The following parameters were analyzed: asthma, rhinitis, DREA, and blood testing before treatment for C3, C4, IgG, IgA, IgE, IgM, ANCA, and blood eosinophil count.

Results:

53.1% (17/32) of patients showed a clinically significant improvement in SNOT‐20 (>0.8) score after treatment. The patients also showed a statistically significant improvement in SNOT‐20 (p<0.001), Lund‐Kennedy (p<0.001), and NOSE (p<0.004) scores. Presence of asthma (p<0.001), AERD (p<0.008), increased level of blood eosinophil count, and increased serum IgE (p<0.018) were factors associated with a worse prognosis after treatment.

Conclusions:

Our group of patients showed a positive result after treatment with doxycycline, especially in patients without asthma, DREA, andincreased serum levels of IgE and eosinophil counts.
The Effect on Health Status in Patients with Aspirin‐Exacerbated Respiratory Disease
Authors: Kumar Rohit
Published: August 2013

Objectives:

Assess the impact of aspirin desensitization therapy on the quality of life in patients suffering from chronic rhinosinusitis with nasal polyposis and aspirin‐exacerbated respiratory disease.

Methods:

We used the Glasgow Benefit Inventory (GBI) to establish the change in health status in all patients who underwent aspirin desensitization therapy in our unit between January 2009 and December 2012. The GBI was chosen because it is a well‐validated post‐intervention questionnaire that allows a direct comparison between other otorhinolaryngology interventions.

Results:

Twenty‐one patients were referred for ADT, from which 10 patients were suitable, of which 5 were male and 5 were female. The mean age was 44 years old, and the median follow‐up interval was 16 months. An average of 3.6 +/‐1.4 surgical procedures had been undertaken. Sustained symptom relief was achieved in 6 patients. 2 patients completed the treatment but gained no perceived benefit, and 2 were unable to tolerate the treatment. Average GBI scores for those who benefitted were 38.2 +/‐ 13.9 (general), 0 (social), and 30.5 +/‐ 9.9 (physical health). For those who failed to improve, the score was 0 for all categories.

Conclusions:

GBI outcomes for aspirin desensitization therapy are comparable to middle ear surgery for hearing and BAHAs, which show a significant improvement in quality of life. Although some patients gained no benefit, no patients reported any negative outcomes.
Repair of Parotidectomy Defects Using Layered Meshed Allogenic Grafts
Authors: Lerrick Andrew J.
Published: August 2013

Objectives:

Cervicofacial deformities following parotidectomy are commonly repaired using autologous tissue and allogenic grafts. Using two layers of allogenic material, oriented perpendicularly after meshing, and accented by eccentric spindle‐shaped gaps, affords a more favorable outcome with respect to appearance and healing.

Methods:

Following parotidectomy, the defect is measured and the allogenic tissue cut to size, using sterile paper as a template, if desired. A duplicate graft is prepared using either the first graft or the template. Each graft is oriented with ink, then meshed 1.5:1. The critical step is to orient the second graft on the mesher platform by 90 degrees. This maneuver creates spindle‐shaped holes oriented perpendicularly once each graft is placed. The meshed grafts are thinner and more pliable than the original material, facilitating in‐setting. The deep and superficial grafts are placed, taking into account the orientation of the spindles. Both grafts are trimmed in situ. The spindle sizes are altered by varying the tension, achieved by peripheral trimming. The superficial graft is tacked down beyond the deeper graft to provide a smoother transition zone. A suction drain is placed superficial to the grafts.

Results:

The integrity of each graft protects the facial nerve, affords precise contouring, and avoids donor site morbidity. Graft porosity facilitates drainage, expediting healing. Fibrinous in‐growth exceeds that of non‐porous tissue. The overlapping spindles inhibit neural in‐growth, reducing the likelihood of gustatory sweating.

Conclusions:

Allogenic grafts with eccentrically‐overlapping spindles provide an optimal setting for healing following parotidectomy.