bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Hearing Outcomes in Patients with Enlarged Endolymphatic Duct and/or Sac on MRI
Authors: York Christopher A. , Booth Tim N. , Johnson Romaine F. , Isaacson Brandon , Roland Peter S.
Published: September 2014

Objectives:

(1) Analyze the longitudinal hearing outcomes in children with evidence of dilated endolymphatic duct (ED) or endolymphatic sac (ES) on high resolution magnetic resonance imaging (HRMRI). (2) Correlate severity of hearing loss with ED/ES size and fluid‐attenuated inversion recovery (FLAIR) signal.

Methods:

This retrospective chart review examined medical records from 2000 to 2013 at a tertiary pediatric referral center to identify patients with evidence of enlarged ED and/or ES by HRMRI. Longitudinal audiometric data (pure tone averages [PTA]) was analyzed using chi‐squared and simple linear regression analysis. Significance was set at P =. 05.

Results:

Seventy‐four patients were identified with an enlarged ED or ES in at least one ear (normal ears used as controls). Audiometric data were available for 106 ears. In our patient population, increasing ED (linear regression, P <. 01, R2 = 0.35) and ES size (linear regression, P <. 01, R2 = 0.28) predicted severity of hearing loss. Increased FLAIR signal, more common in patients with abnormal ED and ES, predicted poorer hearing outcomes (linear regression, P <. 01, R2 = 0.16). Combining ED, ES, and FLAIR signal had a more pronounced effect (linear regression, P <. 01, R2 = 0.47). However, there was no evidence of progression in our data set over a mean of 32 months.

Conclusions:

Contrary to our current understanding, our data does not support a progressive nature for the hearing loss associated with enlargement of the ED and/or ES. It also introduces increased FLAIR signal as an additional predictor of poorer hearing outcomes.
Long‐term Results of Adult Cholesteatoma Surgery Using Canal‐Wall‐Down Approach with Primary Obliteration: 5‐Year Observational Study
Authors: Trinidade Aaron , Yung Matthew
Published: September 2014

Objectives:

Present the results of a 5‐year longitudinal study in an adult population undergoing cholesteatoma surgery using a canal‐wall‐down (CWD) approach with obliteration.

Methods:

Prospective longitudinal study from 1999 to 2013 in a district general hospital. Subjects studied: Adults (≥16 years) with cholesteatoma (256 ears). Interventions: Surgery for cholesteatoma. (1) Residual, recurrence, and recidivist cholesteatoma rates at 5 years postsurgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgeries required. Independent variables: Age and sex.

Results:

The follow‐up rate at 5 years was 81.5% (n = 195). Using Kaplan‐Meier analysis, the residual cholesteatoma rates at 5 years postsurgery was 2.1% at a rate of 6.5 per 1000 years of adult follow‐up (95% confidence interval [CI]: 2.4‐17.3), representing 4 cases of residual cholesteatoma and no recurrences. The otorrhea rate was 5.6% at 12 months and the rate of definitive waterproofing was 89.8% at 12 months. There was a reoperation rate of only 6.7% at 5 years which included second stage ossiculoplasty. Regarding hearing, 62.2% preserved their hearing (change between −10 to = 10 dB), 36.5% had hearing gain (>10 dB), and 16.9% had hearing reduction at 12 months postoperation. Forty‐eight percent (48%) achieved a postoperative air‐bone gap of ≤20 dB.

Conclusions:

Use of a CWD approach with obliteration of the mastoid cavity to surgically treat cholesteatoma results in a low recurrence rate and high rate of a trouble‐free ear in the long term.
Minimally Invasive Repair of Posterior‐Superior Retraction Pockets in Children with Lysis of Middle Ear Adhesions
Authors: Neff Laura , Poe Dennis S. , Chao Wei‐Chieh
Published: September 2014

Objectives:

(1) Treat adhesive tympanic membrane (TM) retractions in children by lysis of middle ear adhesions during insertion of tympanostomy tubes (TT). (2) Analyze the ability to improve conductive hearing loss and to prevent progression of retraction pockets, incus erosion, and avoid future tympanoplasty.

Methods:

A retrospective review from 2005 to 2013 was performed in 22 ears of 18 patients who were candidates for cartilage tympanoplasty to correct a progressive posterior‐superior retraction pocket, with or without incus erosion. Lysis of middle ear adhesions using angled picks was performed through the myringotomy before insertion of a TT. The hypothesis was that the released redundant TM, wrapped around the barrel of the TT to maintain it under tension, could allow regeneration of a healthy tympanic membrane in children.

Results:

TM retractions were elevated and adhesions lysed in 22 ears. Mean age was 11.3 years (range, 4‐22 years). Follow‐up ranged from 3 to 72 months (mean, 23.2 months). Preoperatively, there were 15 Sade grade III and 7 grade IV atelectatic TMs. Postoperatively, there were 14 without retraction, 6 grade I, 1 grade III, and 1 grade IV TMs. Grade I and nonretracted TMs healed without dimers. Mean AB gap improved from 19.94 to 3.88 dB. Two ears required a revision procedure and a third ear developed a cholesteatoma.

Conclusions:

Lysis of middle ear adhesions through a myringotomy at the time of TT insertion allows for healing of the tympanic membrane, improved hearing, and can be effective in preventing progression of atelectasis and incus erosion in children.
Myringotomy and Ventilation Tube Insertion: Endoscopic versus Microscopic Technique
Authors: Martellucci Salvatore , Pagliuca Giulio , De Vincentiis Marco , Gallipoli Camilla , De Virgilio Armando , Scaini Ettore , Gallo Andrea
Published: September 2014

Objectives:

(1) Assess the feasibility of endoscopic‐assisted myringotomy and ventilation tube insertion in patients affected by chronic otitis media with effusion (COME). (2) Describe advantages and disadvantages of the endoscopic technique. (3) Compare the outcomes of the endoscopic‐assisted approach with those obtained with the traditional microscopic technique.

Methods:

The study was conducted from May 2010 to September 2013 at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome. A total of 24 patients (average age 46 ± 4.5 years; 9 males, 15 females) affected by unilateral or bilateral COME (27 ears, 12 right, 15 left) were enrolled in this prospective controlled trial. The diagnoses were confirmed by otoendoscopic examination, tympanometric and pure‐tone audiometric measurements. Patients were randomly divided in 2 groups. Group A patients underwent myringotomy and ventilation tube insertion under endoscopic viewing, whereas in Group B the same procedure was performed using a surgical microscope. All cases were evaluated 1 week after surgery and then monthly until tube extrusion. Complications and tube extrusion times were recorded during follow‐up. Audiometric measurements were carried out 2 months after tube extrusion.

Results:

The outcomes of surgery, assessed with endoscopy and audiometric measurements, were similar in the 2 groups. There were no significant differences in mean operative times, tube extrusion times, or complication rates (P >. 05).

Conclusions:

The endoscopic technique seems to be a viable alternative to the traditional microscopic approach for myringotomy and ventilation tube positioning in patients affected by COME in the era of endoscopic ear surgery.
Reconstruction of Parotidectomy Defects
Authors: Peck Jessica J. , Petrisor Daniel , Cannady Steven B. , Wax Mark K.
Published: September 2014

Objectives:

Describe common cosmetic deformities and options for reconstruction following parotidectomy.

Methods:

The authors reconstructed parotid defects in 50 patients and will present an algorithm for reconstruction based on volume, location, and coexisting defects.

Results:

The parotid gland is the largest salivary gland in the head and neck, occupying a significant tissue volume. While not every parotidectomy requires reconstruction, excision of large parotid lesions, especially those involving the preauricular area, produce sizeable concavity and skeletonization of the mandible. The resulting cosmetic deformity can significantly affect patients’ self‐image and negatively impact their quality of life. Free fat, alloderm, superficial musculoaponeurotic system, rotational sternocleidomastoid flap, and free tissue transfer are possible reconstructive options. Choosing an appropriate donor site requires consideration of the volume, location, and coexisting defects. Free fat grafts are best suited for small lateral parotid defects. In larger volume defects the amount of fat reabsorption is variable, making long‐term results less reliable. Similarly, the muscle atrophy of rotational sternocleidomastoid flaps limits their use to filling medium‐ sized defects, and the arch of rotation allows for only middle and inferior filling of the gland. Finally, large volume reconstruction of total parotidectomy defects, with or without skin, is best accomplished with free tissue transfer.

Conclusions:

Reconstructing parotid defects slightly increases operative time and blood loss, but patient satisfaction with the cosmetic outcome is high. Regardless of method used, same‐stage reconstruction of parotidectomy defects is advocated and of benefit to the patient. An algorithm for choosing one of several reconstructive options is presented.
The Nervus Intermedius in Children with Cochlear Nerve Deficiency Submitted to Auditory Brainstem Implantation
Authors: Colletti Giacomo , Mandala Marco , Colletti Liliana , Colletti Vittorio
Published: September 2014

Objectives:

Anatomical distortions of the neural structures surrounding the foramen of Luschka (FL) characterize children with cochlear nerve deficiency (CND). Our goal was to investigate the anatomical features of the nervus intermedius (NI) and cranial nerve 7 (CN) VII in children with CND and verify if the NI can provide an additional landmark during auditory brainstem implantation (ABI) surgery, preventing intraoperative injuries of the nearby vessels and nerves.

Methods:

Sixty‐four CND children ranging in age from 8 months to 16 years (2.92 ± 1.54) were video‐recorded during retrosigmoid surgery for fitting the ABI and retrospectively examined with particular reference to the number and variety of NI bundles, the associated malformations of CN VII, the relationship with CN VII, and the possibility that NI might represent a landmark for ABI insertion.

Results:

Absence of CNs VI, VII, and VIII was observed respectively in 3, 8, and all children. Eighteen children showed several abnormalities of CN VII in the cerebellopontine angle. The identification of CN VII and of the bundles comprising NI was possible anatomically in 46 children. In 12 the identification was obtained with the assistance of intraoperative monitoring. The number of bundles comprising the NI varied from 1 to 6. The NI and CN IX were useful landmarks for identifying the FL of the lateral recess.

Conclusions:

NI provides an additional landmark during ABI microsurgery. Knowledge of NI anatomy and its topographical relationship with the neurovascular structures around the FL may prevent iatrogenic injuries and ABI electrical stimulation of the surrounding cranial nerves.
Quality of Life Assessment in Patients with Neurofibromatosis Type II
Authors: Cosetti Maura , Golfinos John , Roland J. Thomas
Published: September 2014

Objectives:

(1) Develop a multidimensional metric for assessing quality of life (QoL) in patients with NF2. (2) Compare NF2 results with reference values for the general population and patients with head and neck or brain cancer.

Methods:

Structured interviews with NF2 providers and patients identified relevant domains. Items in these domains were extracted from validated EORTC modules, combined with items unique to NF2 and pre‐tested on NF2 providers and patients (N = 118). The questionnaire included 61 items assessing overall QoL and 10 additional domains including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain and vocal communication. Responses were compared to reference values for the general population and head and neck cancer and brain cancer patients.

Results:

QoL in NF2 patients was lower than that of the general population (P <. 01) and similar to that of patients with cancer. NF2 patients whose treatment included radiation therapy had worse overall QoL than patients who did not undergo radiation. Patients with more facial weakness, hearing loss and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty and pain. When compared to patients with head and neck and brain cancer, NF2 patients demonstrated significantly higher levels of psychosocial stressors, including disease‐related anxiety, personal and financial stress, and lack of social support (P <. 01).

Conclusions:

Psychosocial stress and pain significantly impact QoL in NF2 indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.
Therapeutic Effect of Middle Ear Tendon Resection on Middle Ear Myoclonic Tinnitus
Authors: Park Shi‐Nae , Kim Dong Kee , Park So Young , Lee Sung‐Hun , Park Kyoung‐Ho , Yeo Sang‐Won
Published: September 2014

Objectives:

Tinnitus secondary to middle ear myoclonus (MEM) is very rare but troublesome symptom. Recently, we published a paper about the clinical characteristics and the general therapeutic effects of this rare type of tinnitus in a large case series. Here in this study, we evaluated the therapeutic effects of middle ear tendon resection surgery on intractable tinnitus caused by MEM.

Methods:

This study included 20 patients with intractable tinnitus diagnosed with MEM and treated eventually with surgical resection of middle ear tendons through January 2007 to December 2013. Clinical characteristics and therapeutic response to surgical therapy were thoroughly evaluated.

Results:

Patients had a mean age of 32.3 years (range, 16‐60 years) and the male to female ratio was 10 to 10. The most frequent nature of their tinnitus was crackling sound. Impedance audiogram and otoendoscopic examination of the tympanic membrane were helpful in diagnosing MEM. Postoperatively, tinnitus decreased or even immediately disappeared in all cases of the study. Scores of tinnitus visual analog scale (VAS) and Tinnitus Handicap Inventory were significantly decreased. One of the patients showed delayed facial nerve palsy with complete recovery in 2 weeks. One patient showed the recurrence of symptom of MEM tinnitus within 1 year and was completely recovered by re‐operation.

Conclusions:

Sectioning of the middle ear tendons for middle ear myoclonic tinnitus seems to be safe and effective which can be considered as a promising treatment modality for intractable MEM tinnitus.
Tight Subperiosteal Pocket during Cochlear Implant Surgery: Results in a Large Cohort of Patients
Authors: Sweeney Alex D. , Carlson Matthew L. , Valenzuela Carla V. , Bennett Marc L. , Wanna George B. , Rivas Alejandro , Haynes David S.
Published: September 2014

Objectives:

(1) Investigate the results of cochlear implant receiver‐stimulator (RS) placement using the tight postauricular subperiosteal pocket technique. (2) Compare the efficiency of solely using a tight subperiosteal pocket compared to the conventional bone‐recess technique.

Methods:

Retrospective series from a tertiary academic referral center. All primary and revision cochlear implant patients in whom the RS was placed into a tight subperiosteal pocket without additional fixation were included. Primary outcome measures included RS migration, prevalence of flap complications requiring revision surgery, and time difference comparing the conventional bony well and trough technique to use of a tight subperiosteal pocket.

Results:

Two hundred consecutive cochlear implants (average age 46.9 years) were analyzed. At a mean follow‐up of 12.8 months, only 1 patient experienced device migration; however, none have required revision to date for complications related to RS placement. One patient experienced a hematoma that was managed with observation, and no other soft‐tissue flap complications occurred. The subperiosteal pocket technique resulted in a 20% reduction in total operative time compared to conventional RS placement methods (P <. 01).

Conclusions:

The tight subperiosteal pocket is a safe, durable, and time saving technique for RS placement during cochlear implantation. Notably, the prevalence of device migration was exceedingly low, and none have required revision surgery for device drift or flap complications to date.
Ubiquitous Aspirin: A Systematic Review of Its Impact on Sensorineural Hearing Loss
Authors: Kyle Meghann E. , Wang James C. , Shin Jennifer J.
Published: September 2014

Objectives:

The primary goal of this systematic review was to test the null hypotheses: (1) aspirin has no impact on the prevalence of sensorineural hearing loss; and (2) any such impact is not dose‐dependent.

Methods:

Computerized searches of MEDLINE, PubMed, Cochrane, and EMBASE databases through January 2014 were performed with manual searches and inquiries to topic experts. A systematic review was performed according to an a priori standardized protocol. Data extraction was performed by 2 independent parties (an audiologist and an otolaryngologist) and focused on relevant audiological measurements, study designs, and potential confounders.

Results:

The 37 criterion‐meeting studies included a combined total of 185,155 participants. Audiometric data consistently suggested aspirin had a deleterious, dose‐dependent effect. The strongest data analysis arose from a randomized placebo‐controlled trial, which demonstrated worse pure tone thresholds, speech discrimination scores, and hearing in background noise in the group receiving aspirin in 325 mg doses. Data from self‐report of hearing symptoms suggests the potential for effect modification by sex. Paradoxically, level 1 evidence also demonstrates that aspirin has a protective effect on hearing when co‐administered with gentamicin.

Conclusions:

With the large‐scale population use of aspirin for cardiovascular prophylaxis and other benefits, the potential risks to hearing health should be considered, particularly given that the effects may be reversible or improved with altered dosing. With the increasing prevalence of hearing loss in all age groups and segments of the population, attention to widespread exposures of risk may help preserve hearing‐related health.
Value of Endoscopy in Surgical Procedures to Stapedial Region
Authors: Alicandri‐Ciufelli Matteo , Marchioni Daniele , Villari Domenico , Presutti Livio
Published: September 2014

Objectives:

Evaluate the role of endoscopic approaches during exclusive or combined (microscopic and endoscopic) procedures to stapedial region, particularly in difficult cases or in anatomic abnormalities.

Methods:

From 2009 to 2014, 56 endoscopic exclusive or combined (microscopic and endoscopic) approaches to the stapedial region were performed at the otolaryngology department, University Hospital of Modena. Operations performed were stapedoplasties or explorative tympanotomies for conductive hearing loss. Video, patient charts, and operative reports from surgeries were reviewed in February 2014. Cases in which stapedial abnormalities were identified were included and analyzed in the present study.

Results:

In 8 cases a malformed stapes was identified. Of those, 6 were eventually treated, while in 2 cases, after a diagnosis was made, a conservative attitude was chosen. Under endoscopic view, precise procedures under direct view were made possible, even in very delicate and hidden regions.

Conclusions:

Whether chosen as a pure explorative tool, or as the main operatory visualization modality, endoscopy can guarantee very good visualization of the stapedial region, and may help in diagnosing and fixing altered stapedial conditions.
Comparison of Hybrid Laryngotracheal Reconstruction to Traditional Single and Double‐Stage Laryngotracheal Reconstruction
Authors: Raol Nikhila P. , Rogers Derek J. , Setlur Jennifer , Hartnick Christopher J.
Published: September 2014

Objectives:

(1) Describe outcomes from and modifications to the hybrid, also known as the one‐and‐a‐half stage, laryngotracheal reconstruction (LTR) technique. (2) Compare this technique to traditional single and double‐stage LTR (ssLTR/dsLTR).

Methods:

Retrospective review of patients under 18 years of age who underwent LTR by a single surgeon at a tertiary care otolaryngology specialty hospital from July 1, 2009, to December 31, 2013, was performed. Charts were assessed for age, sex, etiology of stenosis, type of reconstruction, comorbidities, length of stay, complications, and tracheostomy status.

Results:

Forty‐four patients were identified, with 13 one‐and‐a‐half stage LTRs, 27 ssLTRs, and 4 dsLTRs. Of the one‐and‐a‐half stage LTRs, an operation‐specific decannulation rate of 77% was noted, comparable with those for ssLTR and dsLTR. The one‐and‐a‐half stage LTR technique offered a significantly shorter period of narcotic use when compared with ssLTR (16 vs 23 days, P <. 01). Average length of stay for ssLTRs and hybrid LTRs was identical at 16 days; difference in length of stay between hybrid and dsLTRs was not statistically significant (16 vs 12.5 days, P =. 16).

Conclusions:

The hybrid LTR technique is well‐tolerated and useful in patients of all ages. Narcotics are able to be weaned more quickly because of the presence of a secure airway at all times via the existing tracheostomy. Use of a long stent prevents formation of granulation tissue that may be seen with a suprastomal stent. This technique should be considered in patients with high‐grade stenosis with a pre‐existing tracheostomy.
Ear Disease following Cleft Lip and Palate Surgery without Tympanostomy Tube Placement
Authors: Markey Jeff D. , Maine Rebecca G. , Daniels Kimberly , Corlew D. Scott , Gregory George , Palacio Herminia
Published: September 2014

Objectives:

(1) Describe the current benefits and risks associated with perioperative prophylactic myringotomy during cleft lip/palate surgery. (2) Recognize potential predictive factors associated with middle ear disease following cleft lip/palate surgery. (3) Incorporate ethnic differences into treatment algorithms regarding tympanostomy tubes.

Methods:

A total of 241 children (129 Ecuadorian, 112 Chinese) underwent cleft lip/palate repair (2000‐2009). Veau classification, age, history of ear infections, and cleft side were recorded. Average age was 2.4 years and 11.1 years for Ecuadorian and Chinese children, respectively. No patients underwent tympanostomy tube placement. Following surgical correction, serial otoacoustic emissions (OAE) testing, and tympanometry were performed, and a parental questionnaire was administered regarding behavioral hearing deficits and history of ear infections before and after surgery. Data were recorded and compared individually for the 2 populations and as a group to identify disease prevalence and correlative factors.

Results:

No association existed between Veau classification and deficits in tympanometry, OAE, or subjective hearing. Reported ear infections after surgery were fewer than before but were not significant (26% to 21%). Abnormal OAE testing was associated with abnormal tympanometry and subjective hearing deficits (P <. 0001 and P =. 004). Ecuadorian children had higher number of ear infections pre‐ and postoperatively (P =. 043 and P <. 001) and higher number of abnormal tympanograms (P =. 003). No significant difference existed regarding OAE testing.

Conclusions:

Severity of the cleft lip/palate is not a predictive factor of middle ear disease and hearing impairment when no tympanostomy tube is placed. Ideal pressure equalization tube protocols should incorporate ethnic differences.
The Efficacy of Mometasone Furoate Nasal Spray in the Treatment of Adenoidal Hypertrophy in Children
Authors: Hassanzadeh Nadia , Majidi Mohammad R. , Salehi Maryam , Hajipour Reyhaneh
Published: September 2014

Objectives:

Realize whether the adenoid size and severity of chronic nasal obstruction symptoms may decrease with intranasal mometasone furoate application in children affected with adenoidal hypertrophy.

Methods:

Forty children with severe adenoidal hypertrophy (aged between 4‐12 years) were recruited between August 2012 and April 2013 in a prospective randomized clinical trial. Primary nasal endoscopy showed more than 75% choanal obstruction in all patients. Subjects were randomly divided into 2 groups. The study group (n = 20) underwent mometasone nasal spray treatment (100 micrograms per nostril every 12 hours) for 4 weeks, and the control group (n = 20) received saline solution nasal spray as placebo in the same manner. Adenoid size and subjective symptoms were evaluated and compared between the 2 groups.

Results:

At the start of the experiment, there was no significant difference in the mean scores for any of the subjective symptoms (nasal obstruction, snoring, mouth breathing) between the 2 treatment groups. At the end of 4 weeks, statistically significant improvement was observed in total subjective symptom scores with mometasone treatment compared with placebo (P <. 05). A significantly greater number of patients in the study group showed a reduction in adenoid size compared with the control group (70% versus 20%, P =. 001).

Conclusions:

Treatment with mometasone furoate nasal spray causes a substantial improvement in nasal obstruction symptoms and reduction in size of adenoid in children with adenoidal hypertrophy and may obviate the need for surgery in these patients.
Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration
Authors: Padia Reema , Wilkes Jacob , Korgenski Kent , Srivastava Rajendra , Meier Jeremy D.
Published: September 2014

Objectives:

American Academy of Otolaryngology—Head and Neck Surgery 2011 guidelines for pediatric tonsillectomies recommend routine administration of perioperative dexamethasone and against routine antibiotic administration. The purpose of this study is to review adherence to these 2 guidelines.

Methods:

An observational cohort was reviewed of all children ages 1 to 18 years undergoing same‐day‐surgery adenotonsillectomy (T&A) at a multi‐hospital network from 2007 to 2012. A standardized electronic data system was used to determine whether dexamethasone and/or antibiotics were given in the hospital. The rate of dexamethasone and antibiotic administration was compared in the years 2007 to 2011 (preguidelines) with the year 2012 (postguidelines).

Results:

The study cohort included 16,310 children undergoing T&A at 19 hospitals by 61 surgeons. A total of 91.3% of the patients from 2007 to 2011 (N = 13,557) received dexamethasone compared with 93.2% of the children in 2012 (N = 2,753). A total of 18.2% of the children from 2007 to 2011 received antibiotics compared with 14.7% in 2012 (P <. 05). Dexame‐thasone was given in the majority of cases before and after the guidelines were published. Seventeen of the 61 surgeons administered antibiotics in more than 50% of the cases in 2007 to 2011. Postguidelines in 2012, only 2 of these 17 surgeons adhered to the guidelines by not giving antibiotics in the majority of cases.

Conclusions:

The majority of hospitals and surgeons administered perioperative dexamethasone before and after the guidelines were published. While the rate of antibiotic administration statistically decreased in 2012 compared to 2007‐2011, only 2 surgeons appeared to have changed their practice. With the purpose of the guideline to limit the risks and side effects of perioperative antibiotics, interventions are needed to improve guideline adherence.
Outcome of Overlay versus Underlay in Pediatric Tympanoplasty
Authors: Duval Melanie , Park Albert H.
Published: September 2014

Objectives:

Determine whether overlay tympanoplasty has equivalent outcome to underlay tympanoplasty in children.

Methods:

A retrospective cohort study was performed. Data from primary tympanoplasties performed between 2005 and 2013 in children ages 2 to 13 years old by a single surgeon at a single pediatric tertiary care institution were reviewed. Outcome reviewed included anatomical success, hearing results and cholesteatoma.

Results:

A total of 104 cases were included; 21 overlay and 83 underlay tympanoplasties. Children having undergone an overlay tympanoplasty were more likely to have an anterior perforation (P =. 003); other characteristics were similar between the 2 groups including size of the perforation. The rate of anatomical success was 82% for underlay and 95% for overlay tympanoplasties (odds ratio = 4.41, P =. 006). Children having undergone an overlay tympanoplasty had significantly worse hearing results (P =. 02) and had an increased rate of post‐tympanoplasty cholesteatoma (P =. 03). After multivariate analysis controlling for the effect of perforation location and size the odds of anatomical success after overlay tympanoplasty was 2.45 times greater (P =. 44) compared to underlay tympanoplasty. Age and craniofacial anomalies were not found to influence the success rate of overlay compared to underlay tympanoplasty.

Conclusions:

In the current series, overlay pediatric tympanoplasty was associated with a higher rate of anatomical success, but worse hearing outcome and increased risk of cholesteatoma. Further, larger studies are needed to define which children benefit from the increased anatomical success rate of overlay tympanoplasty.
Pediatric Head and Neck Malignancies: Incidence and Trends 1973 to 2010
Authors: Hughes Charlotte , Schwartz Isaac E. , Brigger Matthew T.
Published: September 2014

Objectives:

Determine the current epidemiology of head and neck cancer in the US pediatric population.

Methods:

The SEER (Surveillance, Epidemiology, and End Results) database was accessed to gather epidemiologic data regarding pediatric head and neck cancer between 1973 and 2010. Specific trends related to demographic background, histologic diagnosis, tumor location and incidence, as well as general trends of all pediatric cancers were extracted.

Results:

The total burden and incidence rates of pediatric cancer as well as head and neck cancer specifically continue to rise. Cancer was diagnosed in children under15 years of age at a rate of 12.5 (95% confidence interval [CI] 11.9‐13.1) per 100,000 from 1973 to 1975 and 17.3 (95% CI 16.7‐17.9) per 100,000 in 2007 to 2009, representing an increase of 38%. Head and neck cancers in the same age group increased from 1.1 (95% CI 1.0‐1.3) per 100,000 in 1973 to 1975 to 2.0 (95% CI 1.8‐2.2) per 100,000 in 2007 to 2009, a total increase of 81%. Despite this increased incidence, the proportion of head and neck cancers to all cancers in the pediatric population has remained stable.

Conclusions:

Similar to pediatric cancer in general, the public health burden of pediatric head and neck cancer continues to rise. Although the proportion of head and neck malignancy to pediatric cancer in general is stable, the increasing incidence raises concern for potential underlying associations that may be amenable to intervention.
Prevalence and Risk Factors of Otitis Media with Effusion Among School Children in Saudi Arabia
Authors: Abou‐Halawa Ashraf S. , Alhumaid Humaid I.
Published: September 2014

Objectives:

Determine prevalence of otitis media with effusion (OME) in school children and analyze relevant risk factors.

Methods:

Through a cross‐sectional study, 1488 children in the age range, 6 to 12 years were randomly selected from 25 primary schools. A questionnaire was used to determine risk factors for OME. Otoscopy and tympanometry were used to diagnose and confirm OME. Pure tone average for children with confirmed OME was measured. Teachers of the children were asked to complete a questionnaire evaluating child's level of school performance. Those with or without OME were compared.

Results:

Prevalence of OME was 7.5% (112/1488). In univariate analysis, it was strongly associated with recurrent acute otitis media (AOM; P <. 0001) a large family size (P <. 0001), young age (P <. 0001), low maternal education (P <. 0001), and hearing loss symptom (P <. 0001). OME was significantly higher in schools located in rural districts (P <. 001). It is less strongly associated with history of preschool acute otitis media (P =. 002), nasal discharge (P =. 003), and snoring (P =. 03). Of these factors, 5 were found to be significant in the multivariate logistic regression model: age (odds ratio [OR] = 0.191, 95% confidence interval [CI]: 0. 124‐0.295), family size (OR = 4.192, 95% CI: 2.033‐8.643), school district (OR = 3.037, 95% CI: 1.933‐4.772), maternal education (OR = 0.399, 95% CI: 0.256‐0.621), and recurrent AOM (OR = 4.914, 95% CI: 2.677‐9.02).

Conclusions:

Prevalence of OME in Qassim region reaches 7.5% in school children. Young age, large family size, low maternal education, preschool AOM, hearing loss symptom, recurrent AOM, nasal discharge, and snoring are significant factors associated with the disease.
Standardizing OSA‐18 Instrument for Use as Metric in Pediatric Otolaryngology
Authors: Leslie Jessica , Bannos Cassandra , Kirby Alexann , Roberson David W.
Published: September 2014

Objectives:

(1) Determine whether the change in obstructive sleep apnea (OSA)‐18 pre‐ and posttonsillectomy could serve as a measure of surgical success. (2) Determine the practicality of administering pre‐ and posttonsillectomy OSA to a valid patient sample. Obstructive Sleep Apnea 18 (OSA‐18), a validated instrument, assesses quality of life (QOL) relative to severity of sleep‐related problems. Higher OSA‐18 scores are associated with poorer QOL.

Methods:

Prospective, case series methodology at a tertiary pediatric hospital. Patients undergoing tonsillectomy ± adenoidectomy for sleep‐disordered breathing (SBD). Two distribution‐collection methods were trialed attempting to systemize the process. In phase one (14 months) we collected pre‐intervention scores during the ambulatory clinic visit. In phase 2 (8 months) a single provider distributed pre‐intervention instruments to parents on the day of surgery. Both methods sent post‐tonsillectomy instruments using a web‐based tool.

Results:

In phase 1, 348 pre‐intervention instruments were collected. Fifty‐eight (16%) met inclusion criteria, and of these, 22 (38%) completed the postintervention instrument. In phase 2, 11 pretonsillectomy scores were collected, and 6 (55%) of these completed the posttonsillectomy instrument. In both groups, the average change in OSA‐18 was 33 points (1: 65 pre, 31 post; 2: 61 pre, 29 post, respectively).

Conclusions:

The OSA‐18 instrument demonstrates tonsillectomy +/‐ adenoidectomy is very successful at improving pediatric OSA‐related QOL. These data could document the value of the procedure. However, collecting pre‐ and post‐intervention scores from busy parents is operationally burdensome and only modestly successful. Use of change in OSA‐18 as an outcome metric will require a yet‐to‐be‐determined strategy to reliably collect pre‐and post‐surgery scores.
The Utility of Various Common Surgical Instruments for Pediatric Adenotonsillectomy: Analysis of Time, Hemorrhage, and Cost
Authors: Thottam Prasad J. , Christenson Jennifer R. , Cohen David S. , Metz Christopher M. , Haupert Michael S. , Saraiya Sonal
Published: September 2014

Objectives:

Evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage and associated health care cost for pediatric adenotonsillectomy.

Methods:

Retrospective chart analysis from a tertiary care pediatric hospital of patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and chi‐square analysis was used to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.

Results:

A total of 1280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the 3 instrumentation groups. When examining the various instruments’ effects on procedure time in minutes, univariate ANOVA did demonstrate a significant difference overall between the 3 groups (F = 8.79; P <. 001). Post hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either both PlasmaBlade (P =. 03) or radiofrequency ablation (P <. 001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ2 = 2.36; P =. 31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated as $30.04 for monopolar cautery, $246.95 for PlasmaBlade and $244.32 for radiofrequency ablation.

Conclusions:

The ideal surgical instrumentation would be efficient, have a low complication rate, and be relatively inexpensive. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
Weight Gain after Tonsillectomy and Adenotonsillectomy: A Case Control Study
Authors: Lewis Travis L. , Johnson Romaine F. , Choi Jonathan , Mitchell Ron B.
Published: September 2014

Objectives:

(1) Compare height and weight changes of children who underwent tonsillectomy and adenotonsillectomy (T&A) with a control group. (2) Analyze differences in growth based on starting weight class.

Methods:

A total of 154 children who underwent T&A between December 2010 and March 2011 were included. They were compared with 182 children with similar demographics who were seen in primary care clinics (control). Height and weight were compared at 6‐month intervals over a 24‐month period. Patients were divided into normal weight, overweight, and obese based on Centers for Disease Control and Prevention criteria. A multilevel regression model was used for analysis. Significance was set at P =. 05.

Results:

There were no differences in average starting weight, age, or sex between surgical and nonsurgical groups. Average starting weight was 47.6 kg (confidence interval [CI] 42.0‐53.2) and 48.1 kg (CI 41.8‐54.3) for the obese surgical and obese control groups respectively. There was no difference in weight gain at 6 months. However at 12, 18, and 24 months, the obese surgical group had a significant weight increase over and above the obese control group (P <. 001). An average of 14.3 kg weight gain at 24 months was seen in obese children who underwent T&A compared to 10.1 kg for controls (a difference of 4.2 kg (±2.9)). There were no differences in weight changes between the normal and overweight groups or in height for any of the groups.

Conclusions:

T&A leads to significant increase in weight in obese but not in normal or overweight children. Efforts should be made to provide weight reduction counseling prior to T&A in obese children.
Allergic Fungal Sinusitis Infratemporal Fossa Involvement: Saudi Experience
Authors: Al Dousary Surayie H.
Published: September 2014

Objectives:

Allergic fungal rhinosinusitis (AFRS) is well known to expand and to extend to the surrounding structures like the orbit and the brain; however, it has not been reported to extend to the infratemporal fossa (ITF). Because of the difficulty of accessing the ITF, we report our experience over 5 years.

Methods:

One hundred one patients with AFRS were operated upon by the author between 2008 and 2013.

Results:

All of these patients had preoperative computed tomography scans (CTs), and all but 2 had postoperative CT of the paranasal sinus. Twelve had expansion or extension of the disease into the ITF: 8 males and 4 females, their ages ranged from 10 to 34 years with mean of 20.4 years. Four of them were children below 15 years of age. Three patients had bilateral disease and 9 had unilateral sinus involvement. Seven cases had expansion of the posterior wall of the maxillary sinus into the ITF, which was unilateral and mil; however, extension from the sphenoid sinus was more extensive in most of the cases; bilateral in 2 and unilateral in the others.

Conclusions:

ITF extension from the sphenoid sinus is more extensive than from the maxillary sinus. In a pediatric population, because of the incomplete fusion of the suture line, the disease expanded and eroded into the ITF. In adults, the opticocarotid recess is the weakest area and the disease can expand through it into the ITF. Posterior wall of maxillary sinus expansion into the ITF is mild in all cases, and all the ITF extensions were cured endoscopically.
Analysis of Potential Determinants of a Reduced Intercarotid Distance in Patients Undergoing Endoscopic Transsphenoidal Surgery
Authors: Mascarella Marco A. , Forghani Reza , Sirhan Denis , Maio Salvatore Di , Mohr Gerard , Zeitouni Anthony G. , Tewfik Marc A.
Published: September 2014

Objectives:

(1) Evaluate the anatomic variability of the distance between the internal carotid arteries (ICA) at the paraclival, intracavernous, and paraclinoid segments in normal variants and in patients with sellar or parasellar lesions. (2) Identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and identify subgroups at higher risk for ICA injury during endoscopic skull base surgery.

Methods:

A retrospective case‐control study was performed at an academic tertiary care center. The smallest distance between the ICAs at the paraclival, intracavernous. and paraclinoid segments on coronal T2‐weighted magnetic resonance imaging was measured in patients with sellar or parasellar tumors and in nontumor controls. Factors such as demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential predictors of the ICD.

Results:

In total, 154 cases and 34 controls were analyzed. Patients with growth hormone (GH) secreting adenomas had a markedly reduced ICD at the paraclival segment as compared to controls (1.59 cm and 1.77 cm, respectively; P =. 02; 95% confidence interval [CI] [0.03‐0.32]). The paraclinoid ICD was reduced in patients with a planum sphenoidale meningioma (1.09 cm and 1.33 cm, respectively; P =. 04; 95% CI [0.01‐0.45]). The transverse dimension of pituitary adenomas was linearly correlated to the ICD (P <. 001). No narrowing of the ICD was associated with sphenoid configuration or cephalometric measurements.

Conclusions:

Patients with a GH secreting adenoma or planum sphenoidale meningioma had a reduced ICD. Identifying these populations can help surgeons recognize constraints imposed by a reduced ICD to endoscopic access of the skull base and avoid inadvertent ICA injury.
Effect of Strong Fragrance on Olfactory Detection Thresholds of Health Workers at UCH Ibadan, Nigeria
Authors: Fasunla Ayotunde J. , Douglas David D. , Adeosun Aderemi A. , Steinbach Silke , Nwaorgu Onyekwere G.
Published: September 2014

Objectives:

Assess the effect of perfume on olfactory detection thresholds of health workers at the University College Hospital, Ibadan.

Methods:

This was a quasi‐experimental study on olfactory detection thresholds of one hundred healthy health workers in a tertiary health institution from September 2013‐November 2013. A structured questionnaire was administered to participants to obtain information on sociodemographics, occupation, ability to perceive smell, use of perfume, effects of perfume on appetite and self‐confidence, history of allergy, and previous nasal surgery. Participants subjectively rated their olfactory performance and thereafter had olfactory detection threshold testing done with varied concentrations of n‐butanol in a forced triple response and staircase fashion. Olfactory detection thresholds at baseline and after exposure to Lynx perfume were determined and compared.

Results:

Thirty‐seven males and 63 females were evaluated. Their ages ranged from 19‐59 years with a mean age 31 years ± 8. Subjectively, 94% participants had excellent olfactory function. In the pre‐exposure forced triple response, 88% participants were able to detect the odor at ≤0.25 mmol/L concentrations while in the post‐exposure forced triple response, only 66% participants were able to detect the odor at ≤0.25 mmol/L concentrations. There was also a statistically significant difference in the olfactory detection threshold score between the pre‐exposure and post‐exposure period in the participants (P <. 05).

Conclusions:

Use of fragrance affects the olfactory detection threshold. Therefore, wearers should be aware of this and its implications on test of olfaction.
Interrelation between Symptoms and Nasal Endoscopic Findings in the Diagnosis of Chronic Rhinosinusitis
Authors: Kim Kyung‐Su , Park Do Yang , Lee Eun Jung , Kim J. I. Hoon
Published: September 2014

Objectives:

The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) criteria are the most commonly used criteria in the diagnosis of chronic rhinosinusitis (CRS) in Korea. Symptom‐based EP3OS criteria are used in epidemiological studies, but its reliability and the best composition of criteria have not been thoroughly examined. Therefore, we aimed to verify its reliability and search the best combination of criteria to diagnose CRS in a large scale.

Methods:

The 2009 and 2010 data (15,445 people) on Korean National Health & Nutrition Examination Survey symptom questionnaire and nasal endoscopic findings were analyzed. EP3OS criteria composed of major and minor symptoms were used to define symptom‐based CRS. Either mucopurulent rhinorrhea from middle meatus or nasal polyp was the definition of endoscopy‐based CRS. The correlation between these definitions of CRS and the relative importance of symptoms, and the best combination of symptoms were analyzed.

Results:

The symptom‐based definition of CRS showed statistically significant correlation with the endoscopy‐based definition of CRS (Pearson r =0.120, P <. 001). As to the correlation between symptoms and positive endoscopic finding, hyposmia or anosmia was the most correlated symptom (Pearson r = 0.134, P <. 001). The most reliable symptom‐based definition of CRS was +one of major symptoms + hyposmia or anosmia.

Conclusions:

Because the symptom‐based definition didn't show strong correlation with the endoscopy‐based definition, the combination of both definitions is essential in the diagnosis of CRS. If symptom‐based definition is used, one of major symptoms + hyposmia or anosmia is the most reliable criterion in the diagnosis of CRS.