bluuebunny/crossref_metadata_2025 huggingface dataset:
S111 – Monitoring Frequency: A Determinant in Free Tissue Transfer
Authors: Hornig Joshua D
Published: August 2008

Objectives

1) To compare the success rates of free tissue transfer (FTT) between a cohort of patients who underwent frequent scheduled checks to a cohort who received checks on an as‐needed basis. 2) To compare the overall flap survival, ICU stay, in‐hospital stay, complications, and cost.

Methods

Patients meeting the criteria for free tissue transfer were divided into 2 cohorts: minimal FTT monitoring and frequent scheduled FTT monitoring. In August 2005, frequent scheduled flap monitoring was instituted. The study was set up to identify if this method impacted overall patient outcomes. The 2 groups were compared over several dimensions: overall flap outcome, total vs. partial flap loss, length of stay in hospital, revision procedures, and complications.

Results

A total of 212 patients were identified. 107 of the patients were in the frequent, scheduled group and 105 were in the minimal group. The overall FTT success rates were significantly higher in the frequently scheduled group versus the minimal group (100% vs 89%). The rates of partial flap loss and total flap loss were higher in the minimal group (11% vs 4%). The overall length of stay in the hospital, length of stay in the ICU, and complication rates were nonsignificant between the 2 groups. However, the number of revision procedures were significantly lower in the frequently scheduled FTT group.

Conclusions

The implementation of frequent scheduled flap monitoring significantly improves free tissue transfer survival in head and neck patients and decreases the number of revision procedures that need to be performed.
S116 – Microbiology of PTA in the Age of Antibiotic Resistance
Authors: Burkhead Steven K , Curry Martin P , Miller Lee A.
Published: August 2008

Objectives

Numerous publications have demonstrated Group A Streptococcus pyogenes is the most common pathogen isolated from peritonsillar abscesses (PTAs). We have noted multiple patients presenting with PTAs despite being recently treated with penicillin for tonsillitis. The objective of this study was to assess the bacterial content of PTAs in our practice to determine proper antibiotic therapy.

Methods

A retrospective chart review was conducted at 2 tertiary care hospitals. Charts of patients diagnosed with PTA from 2001 through 2005 were reviewed for microbiology studies. If cultures were drawn, the microbiology content and any available sensitivities were assessed.

Results

205 patients were given the diagnosis of PTA, with an average age of 26. Of these, 64 patients (31.2%) had culture results available for study. Most cultures demonstrated mixed organisms. At least 35.9% demonstrated anaerobic organisms, most commonly Fusobacterium species (20.3%). The 3 most common aerobic organisms isolated were Group A Streptococcus pyogenes (18.8%), Group C Streptococcus (15.6%), and Streptococcus viridans (14.1%). Interestingly, 1 culture (1.6%), grew Escherichia coli as a single pathogen and 2 cultures (3.1%) grew Group D Streptococcus resistant to clindamycin.

Conclusions

Most prior studies of PTAs have found Streptococcus pyogenes to be the most common isolate. Our review of 64 cultures found the most frequent pathogen to be anaerobic species, particularly those from genus Fusobacte‐rium. Interestingly, at least 8 cultures (12.5%) isolated pathogens not sensitive to the antibiotic most commonly used in our practice after incision and drainage. These results support the use of broader spectrum antibiotics in the treatment of periton‐sillar abscess.
S126 – Missed Diagnoses in Otolaryngology
Authors: Gorman Mary E. , Gould Herbert , Giel Dana W. , Thompson Jerome W
Published: August 2008

Objectives

1) Increase awareness of common missed diagnoses in the practice of otolaryngology. 2) Identify opportunities for improvement in the quality of patient care.

Methods

Working with the State Volunteer Mutual Insurance Company of Tennessee State, we evaluated malpractice claims in otolaryngology that were closed with indemnity payment between 1981 and 2005. We identified all such claims resulting from alleged missed or delayed diagnoses by otolaryngologists. Claims were divided into two main categories based on whether the missed diagnosis was primarily otolaryngologic or non‐otolaryngologic.

Results

A total of 9 missed diagnosis claims were identified, representing 9% of claims overall. 6 of the 9 were otolaryngologic missed diagnoses, with the remaining 3 non‐otolaryngologic diagnoses. The total indemnity payment for missed diagnosis claims was $4,072,100, representing 32% of all indemnity payments for the study period.

Conclusions

Missed diagnoses represent a danger to patients and a disproportionately high percent of total indemnity payments (32%). Increased awareness of missed diagnoses is necessary to improve patient care and maintain a level of excellence within the field of otolaryngology‐head and neck surgery.
S163 – Laser Endoscopic Microsurgery for Supraglottic Cancer
Authors: Pinto Jose A , Godoy Luciana , Marquis Valéria , Brunoro Michelle , Bellotto Silvana , Gasques Cris
Published: August 2008

Objectives

Report our experience in the endoscopic treatment of supraglottic cancer with CO2 laser. Show the outcome reached with laser microsurgery in the treatment of supraglottic cancer.

Methods

From 1990 to 2007, 19 patients with supraglottic cancer underwent CO2 laser microsurgery.

Results

There were 7 (36.8%) T1, 5 (26.4%) T2, and 7 (36.8%) T3. T1 and T2 supraglottic tumors underwent endoscopic surgery with CO2 laser. T2 stage patients also were submitted to unilateral neck dissection. 2 patients (10.5%) with early supraglottic cancers had recurrence (one local and cervical and another cervical metastasis submitted to external surgery). Supraglottectomy with CO2 laser was performed to analize the preepiglottic space and to allow tumor stage. All T3 supraglottic tumors had pre‐epiglottic invasion and underwent external supraglottic laryngectomy with neck dissection.

Conclusions

Endoscopic treatment for laryngeal cancer is an efficient therapy for early supraglottic cancers and is the best method to evaluate the preepiglottic invasion. This therapy makes local function possible without prejudice to oncological results.
S165 – Locally Advanced Head and Neck Cancer Treatment Patterns
Authors: Farwell Wildon R , Lawler Elizabeth , Chittamooru Subha , Botteman Marc F
Published: August 2008

Objectives

We assessed the extent of chemoradiation therapy (CRT) or high‐dose platinum‐based chemotherapy plus radiation (P‐CRT) initiation for patients with stage III/IV, locally advanced head and neck cancer (LAHNC) treated in the VA New England Healthcare System (VA‐NEHS), and identified the factors associated with such initiation.

Methods

Newly diagnosed LAHNC patients treated in the VA‐NEHS (from 1996 to 2006) were identified from electronic records. Patients’ tumor staging (TNM), demographics, performance score, comorbidities, alcohol and tobacco use or dependence, and diagnosis year were abstracted via chart review. The primary outcome was the initial treatment strategy, grouped as CRT ± surgery (including P‐CRT), chemotherapy (CT) ± surgery, radiation therapy (RT) ± surgery, surgery alone, or no treatment. Multiple logistic regressions compared odds of failure to initiate CRT or P‐CRT across the aforementioned patient characteristics.

Results

Of 496 patients identified, 34.5%, 34.7%, 6.7%, and 5.4% initiated CRT, RT, CT, and surgery alone, respectively, whereas 18.8% were untreated. Most patients initiating CRT (59.7%) or CT (51.5%) received platinum‐based chemotherapy. Predictors of failure to initiate CRT included diagnosis year 2002 (OR=3.57, 95% CI: 2.32, 5.55), age >65 years old (OR=2.47, 95% CI: 1.55, 3.92), performance score <90 (OR=2.27, 95% CI: 1.43, 3.59), and past/present alcohol use (OR=1.95, 95% CI: 1.08, 3.52). Similar factors predicted failure to initiate P‐CRT.

Conclusions

Although CRT/P‐CRT initiation increased over time, older patients, patients with poorer performance status, and those using alcohol were less likely to initiate CRT. Research is needed to describe treatment outcomes in LAHNC patients not initiating CRT/P‐CRT.
S177 – Treatment Efficacy of Locally Advanced Skin Cancers
Authors: Ardeshirpour Farhad , Apisarnthanarax Smith J , Park Richard Chan Woo , David Hayes , Rosenman Julian , Shores Carol G.
Published: August 2008

Objectives

To evaluate the treatment outcomes of our patients with locally advanced head and neck non‐melatomatous skin cancers (HNNMSC). In this study we determined the 1‐and 2‐year disease‐free survival and the 5‐year overall survival of our patients treated with surgery, radiation, and chemotherapy, as a single modality or in combination.

Methods

Between 1994 and 2006, 197 patients with locally advanced HNNMSC were identified from our institution's Head and Neck Clinical Cancer Database. These patients had their medical records reviewed and of those, 66 met inclusion criteria. We included patients with pathological documentation of locally advanced HNNMSC.

Results

The majority of these patients were Caucasian and males with an average age of 69 years. 52 patients (79%) had squamous cell carcinoma and 14 (21%) had basal cell carcinoma. 23 patients (35%) received surgery alone, of which 20 (87%) showed no evidence of disease (NED). 5 patients (7%) received radiation alone, all of which showed NED except 1 who is alive with disease. 29 patients (44%) received surgery and radiation, of which 15 (51%) showed NED and the others recurred. 4 patients (6%) had chemotherapy plus radiation, of which 2 recurred. 5 patients (7%) had surgery plus chemotherapy and radiation, of which 2 showed NED, with the others recurred.

Conclusions

We cannot show statistical differences between different treatment modalities; however, there were more patients with NED in the surgery group compared to surgery and radiation. It is difficult to make conclusions about the chemoradiation because of the small number of patients.
S179 – Voice Self‐evaluation after Treatment for T1 Glottic Cancer
Authors: Nunez Faustino , Caminero Maria Jesus , Llorente‐Pendas Jose‐Luis , Suarez‐Nieto Carlos
Published: August 2008

Objectives

1) To present the objective and subjective analysis of voice quality following treatment of an early epidermoid glottic carcinoma. 2) Results from the objective evaluation of the voice, along with the self‐evaluation of voice quality quantified using the Voice Handicap Index of a group of patients treated with endoscopic laser surgery, are compared with patients treated with radiotherapy.

Methods

We performed an objective voice evaluation, as well as a physical, emotional, and functional well‐being assessment of 19 patients treated with laser surgery and 18 patients treated with radiotherapy. The data obtained was gathered in the statistical database SPSS 12.0. The statistical analysis used was the “Student t test” in order to compare averages and the Chi‐squared test for comparing proportions. The statistical differences were considered significant when p was lower than 0.05.

Results

Voice quality is affected both by surgery and radiotherapy. Voice parameters only show differences in the maximum phonation time between both treatments (p < 0,005). Patients Self‐Perception Analysis (Voice Handicap Index) Upon completing the comparison between the two groups, the statistical difference is significant, in favor of the radiotherapy patients in functional and emotional ratings, as well as the global scores (p < 0,005). No significant differences were found in the physical scales.

Conclusions

There is a reduced impact in patient's perception of voice quality after radiotherapy, despite no significant differences in vocal quality between radiotherapy and laser cordectomy.
S197 – Detection of HPV and Adenovirus in Laryngeal Lesions
Authors: Gallo Andrea , Degener Anna Marta , Pagliuca Giulio , Pierangeli Alessandra , Bizzoni Federica , Greco Antonio , De Vincentiis Marco
Published: August 2008

Objectives

To investigate the role of Human Papillomavirus (HPV) and Adenovirus (AdV) infections in the oncogenesis of squamous cell carcinomas of the larynx and of laryngeal dysplasia.

Methods

Between April 2002 and November 2003, biopsy samples were taken from 40 patients with squamous cell carcinomas of the larynx, 1 with verrucous carcinoma, 5 with laryngeal papillomas, 4 with dysplastic lesions, and 18 control cases. The control biopsies were taken in microlaryngoscopy from patients with vocal disorders caused by nodules and polyps, or by inflammatory or traumatic conditions of the larynx. All the frozen tissue samples, which were previously taken from fresh tissue and then stored at −70°C, were analyzed using the Polymerase Chain Reaction (PCR) with 2 groups of primers for HPV and with a pair of primers for AdV. In the positive cases, the viral type was established by using the automated DNA sequence analysis.

Results

All the cases of squamous cell carcinomas, laryngeal verrucous carcinomas, dysplasia, and all the control cases were negative for both viruses. 4 of the 5 cases of laryngeal papillomas (80%) were only positive for HPV (2 HPV6 and 2 HPV11), confirming the role of these viral types in the origin of papillomas.

Conclusions

The absence of viral genomes in laryngeal carcinomas as in the other cases studied suggests the existence of other factors playing a more important role than viral infection in the carcinogenesis of these lesions.
S199 – Subglottic Stenosis: Clinical Outcomes in 131 Patients
Authors: Kasperbauer Jan L , Hinkley Lucinda , Alon Eran E. , Moore Eric J , Bungum Aaron , Edell Eric
Published: August 2008

Objectives

Evaluate outcomes of patients treated for dyspnea secondary to subglottic stenosis.

Methods

Retrospective medical record review of patients from February 2000‐January 2008 that underwent intervention for subglottic airway stenosis.

Results

131 patients ages 16 to 88 years (mean 46.68 years) (17 male and 114 female) were treated for subglottic airway obstruction. The stenosis was idiopathic in 73 (56%), traumatic in 4 (3%), Wegner's Granulomatosis in 13 (10%), and other in 41 (31%). In the idiopathic group, 73 (100%) were female. 88 (67%) of the patients had pretreatment maximum voluntary ventilation (MVV) recorded with a mean value of 52.16 (47.33 % Predicted). 16 patients with idiopathic stenosis were managed by nd‐YAG laser therapy and rigid bronchoscopic dilation. 131 patients were treated with CO2 laser division of scar or dilation with Kenalog injection and Mitomycin C application. A select group underwent laryngotracheal res‐construction or resection. Retreatment in the idiopathic group varied widely. The average number of treatments per patient were 2.8 with symptom control from 1 month to 4 years.

Conclusions

Sublglottic stenosis is a challenging clinical entity. Pulmonary function testing using the MVV can be helpful in predicting those patients that will benefit from treatment. Idiopathic subglottic stenosis is primarily a female disorder. Endoscopic management of idiopathic subglottic stenosis with CO2 laser, Kenalog, and Mitomycin C treatment improves length of symptom control compared to nd‐YAG laser therapy with rigid dilation alone.
S229 – One‐Stage Tympanoplasty with or without Mastoid Obliteration
Authors: Hayashi Ken , Shinkawa Atsushi
Published: August 2008

Objectives

To confirm the efficacy of one‐stage tympanoplasty with mastoid obliteration and a tymapanoplasty by transcanal approach using ceramic prosthesis.

Methods

Our surgical procedure was performed on 163 patients with cholesteatoma and 545 patients with chronic otitis media in Shinkawa Clinic. The operative method was classified into 2 groups. We use one‐stage tympanoplasty with mastoid obliteration, a canal wall down procedure for chronic otitis media with cholesteatoma and chronic otomastoiditis. On the other hand, we use a tympanoplasty by an endaural approach for chronic otitis media without chronic otomastoiditis. The ossicular chain was reconstructed using the ceramic ossicular prosthesis (P‐type and T‐type). We performed modified Type III tympanoplasty using the P‐type ceramic when the superstructure of the stapes could be utilized, while we performed modified Type IV tympanoplasty using the T‐type ceramic when the superstructure of the stapes could not be used.

Results

In chronic otitis media with cholesteatoma or chronic otomastoiditis, the success rate of modified Type III tympanoplasty using ceramic P type was 77.8%; on the contrary, that of modified Type IV tympanoplasty using ceramic T type was 70.6%. In chronic otitis media without chronic otomastoiditis, the success rate of modified Type III tympanoplasty using ceramic P‐Type was 69.8%, while that of modified Type IV tympanoplasty using ceramic T was 69.1%.

Conclusions

Our results show that there are no significant differences of success rate between these 2 procedures. We confirmed that the use of ceramic implant was satisfactory for both one‐stage tympanoplasty with mastoid obliteration and a tympanoplasty by an endaural approach.
S236 – Novel Biomarker Use in the Evaluation of Facial Nerve Palsy
Authors: Flanagan Carrie , Gerry Shaw , Odland Rick
Published: August 2008

Objectives

1) To determine whether a novel biomarker (hyperphosphorlyated neurofilament‐heavy subunit) is able to be quantitated in patients with idiopathic facial nerve paralysis. 2) To determine whether correlation exists between biomarker quantitation and clinical parameters in patients with idiopathic facial nerve paralysis.

Methods

This is a prospective pilot study that assesses the utility of the serum biomarker hyperphosphorylated neurofilament‐heavy subunit protein(NF‐H) in evaluating patients with idiopathic facial nerve paralysis. From May 2006 to August 2007, 12 patients that presented to the Emergency, Neurology, and Otolaryngology departments at a county hospital with acute onset unilateral facial paralysis were enrolled into the study. Serum samples at the time of presentation were obtained, and the following additional data was recorded and analyzed: age, sex, severity of paralysis at presentation, duration between time of onset of paralysis and presentation, side of paresis, associated comorbidities, time to recovery, and ancillary testing results. Data analysis was performed using Student's T‐test and analysis of variance; linear regression models and correlation coefficients were calculated using Microsoft Excel computer software.

Results

There was no significant relationship between patient age (r2=0.20), sex (p=0.19), and side of paralysis (p=0.49) and biomarker level. The biomarker level increased with increasing facial paresis severity (p=0.002, r2=0.17), and had a more pronounced correlation when patients presented within the first 24 to 48 hours of paralysis (p=0.006, r2=0.59). There was no correlation between biomarker and prognosis or ancillary testing results.

Conclusions

Hyperphosphorylated neurofilament‐heavy subunit levels correlated with initial severity of facial paralysis, but were time‐dependent.
S252 – The Efficacy of Tympanostomy Tubes In Down Syndrome Patients
Authors: Cordes Brett M , Madduri Nurupama , Friedman Ellen M
Published: August 2008

Objectives

The purpose of this report is to relate a single institution's experience with middle ear disease and the incidence and efficacy of tympanostomy tube (PET) insertion in children with Down syndrome.

Methods

Retrospective chart review of 130 consecutive pediatric Down syndrome patients seen at a single tertiary care children's hospital between the years 2001–2007. Middle ear function, and speech and language development, is reported and those patients who underwent tympanostomy tube insertion for middle ear disease are analyzed.

Results

The mean age of the patient population was 4.5 years, ranging from 8 months to 10 years. 41/130 patients (31.5%) were treated with tympanostomy tube insertion for middle ear disease. Of this group, 11/41 patients (26.8%) and 2/11 patients (18.1%) required second and third tube insertions, respectively, for persistent pathology and failed tube function. The mean age at first tube insertion was 3.3 years, while the mean age at second and third tube insertion was 6.9 and 6.0 years. Outcome measures included a documented conductive hearing loss on audiological assessment and/or persistent middle ear effusion on physical exam. Speech and language skills were also assessed.

Conclusions

Children with Down syndrome have an increased incidence and persistence of middle ear disease. Additionally, affected children may require multiple surgical interventions for persistent disease and failed tube function. The multiple medical problems often associated with Down syndrome result in an increased anesthetic risk for these patients. Therefore, we propose the utility of a durable tympanostomy tube for more efficient treatment and the avoidance of multiple interventions.
S254 – Bone Conduction Noise Exposure via Ventilators in the NICU
Authors: Black Angela P , Sidman James D
Published: August 2008

Objectives

To demonstrate that neonatal ventilators produce high noise levels through bone conduction (BC) via endotracheal tubes, as well as air conduction (AC) from ambient noise.

Methods

A sound level meter was used to measure the noise levels 4 feet from the ventilator and in direct contact at the end of a balloon attached to the ETT to simulate the noise presented to the infant. 3 commonly used neonatal ventilators (Sensormedics 3100A, VIP Bird and Bunnell Jet) were examined.

Results

Noise levels were significantly higher (6 – 14 dB) at the end of the ETT than 4 ft from the ventilator for all ventilators studied.

Conclusions

Previous studies have shown high ambient noise levels in NICUs, but have failed to address the actual noise presented to the infant. ETT transmission of noise as a direct bone stimulus through the skull has been overlooked. This study has shown that high noise intensities are being presented not only as AC, but as BC to the infants though the ETT. This study demonstrates, therefore, that ear protection alone will not save these at‐risk infants from hearing damage. More must be done to decrease noise exposure and develop quieter machines.
S255 – Treatment of Complicated and Uncomplicated Preauricular Pits
Authors: Vivero Richard J. , Roy Soham
Published: August 2008

Objectives

1) To review our experience with complicated and uncomplicated preauricular pits requiring surgical excision. 2) To review relevant embryology, anatomy, and surgical technique.

Methods

A retrospective chart review from 2002 to 2007 was conducted at a tertiary care university hospital to identify patients less than 18 years old undergoing surgical excision of a preauricular pit. Charts were reviewed for patient age, presentation, complications, treatment algorithm, and outcome.

Results

13 patients underwent surgical excision of a preauricular pit. The indication for excision was either recurrent infection or recurrent drainage in all cases. 3 of 13 patients had a pre‐surgical complication of the infection, including localized cellulitis of the preauricular skin or infection of the helical cartilage. These patients were treated with a prolonged course of antibiotics prior to surgical excision. All 13 patients were treated with wide surgical excision; in the 3 patients with pre‐excision complications, careful attention was paid to meticulous surgical excision of all involved tissue. There were no postoperative complications. No recurrences were noted at up to 3‐year follow‐up. Parents were satisfied with the cosmetic outcome in all cases.

Conclusions

Preauricular pits are an important entity due to their potential for significant infectious morbidity. Appropriate diagnosis and management with wide local excision, especially in the context of a complicated presentation, can result in excellent cosmesis with minimal risk of recurrence. Relevant embryology, anatomy, and surgical technique will be reviewed.
S274 – Smoker's Nose
Authors: Kjaergaard Thomas , Småstuen Cvancarova Milada , Steinsvåg Sverre
Published: August 2008

Objectives

Do smokers have more upper airway symptoms than non‐smokers? Despite extensive knowledge about the health‐damaging effects of smoking, little is known about whether and to what extent smoking causes complaints from the upper airway. The main objectives of our study: 1) evaluate the role of cigarette smoking in relation to upper airway symptoms, and 2) study the dose response relationship between daily cigarette consumption and upper airway symptoms.

Methods

2294 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring or nose‐related complaints were included in this cross‐sectional study. Subjects completed a detailed questionnaire including Visual Analogue Scales (VAS), grading 13 upper airway symptoms. In addition, smoking habits were registered. Associations between VAS recordings and smoking status were evaluated by multivariate analysis based on regression analysis and Anova, adjusting for age, sex, body mass index, asthma, and allergy. Differences of 10% or more were considered clinically relevant. The study was conducted in the period 2005–2007.

Results

Smokers had between 12 and 27% higher VAS scores in 8 out of 13 symptoms compared with non‐smokers (p<0,001). Further, VAS scores were related to the daily cigarette consumption in a dose‐dependent manner within the majority of the symptom categories.

Conclusions

Our study indicates that cigarette smoking is an important etiologic factor for upper airway symptoms. The results give support to campaigns against smoking even in an upper airway perspective. Cessation of smoking should be considered, accepted, and used as a therapeutic measure when dealing with smokers presenting with upper airway complaints.
S298 – Difference of P/Ex and Severity of OSA According to Age
Authors: Kim Sanghoon , Kim Sung Wan , Jo Joong Saeng
Published: August 2008

Objectives

It has been proved by many researchers that there are different dominant narrowing site of upper airway according to age and many sleep parameters change with age. We evaluate the difference of physical examination and severity of obstructive sleep apnea according to age.

Methods

255 male patients were subjected to this study. All of them were diagnosed OSAS by polysomnography and examined preoperative work‐up including BMI, cephalometry parameter(PAS, PNS‐P, MPH), nasopharyngoscopy with Muller maneuver before surgical treatment. We measured sleep parameters (lowest oxygen saturation, Apnea‐hypopnea index) by polysomnography and studied the difference of physical exam and sleep parameter among the 4 groups (‐29,30–39, 40‐,50‐) according to age.

Results

Among the estimated parameters of 4 groups which were divided according to age, there were significant difference in BMI, neck circumference, chest circumference, abdominal circumference in physical exam and PNS‐P, MPH in radiologic finding. (p<0.05) AHI that reflects OSA severity was significantly different among 4 groups. Patient distribution of over 15 AHI score were 36% in the under 29 group, 72% in 30–39 group, 59% in 40–49 group and 55% in the over 50‐years‐old group.

Conclusions

According to the ages, we found that physical exam, and radiologic finding were different significantly among age groups. AHI were significantly different among 4 groups and OSA severity was increased significantly after 30 years old, but there was no difference significantly in the over‐30 groups.
Does Early Speech Discrimination Predict Language Ability?
Authors: Ting Jonathan Y , Houston Derek M , Miyamoto Richard T
Published: August 2008

Problem

There is a paucity of instruments available to assess speech discrimination in normal‐hearing (NH) and hearing‐impaired (HI) infants. We assess the utility of a hybrid visual habituation paradigm (HVHP) in assessing speech discrimination and predicting later language ability.

Methods

NH infants were tested with the HVHP on an easier vowel contrast or a more difficult fricative contrast. Parents completed Macarthur Communicative Development Inventories (CDI) when infants were 14,18,24, and 30 months old to assess correlations between discrimination abilities and later language ability. Similarly, HVHP and CDI measures were obtained from HI infants at following hearing aid (HA) or cochlear implant (CI) use.

Results

29% of NH infants significantly discriminated the vowel contrast. 6% of NH infants significantly discriminated the fricative contrast. Effect size of fricative discrimination at 9 months correlated with early gestures (n=10), r=.73 p=.02, and later gestures (n=10, r=.81 p =. 01), at 14 months of age. HI infants tested on the vowel contrast at 3 months of HA use demonstrated significant correlations of effect size of discrimination with phrases understood at 6 months of HA use (n=4, r=.96, p=0.04) and vocabulary production at 9 months of HA use (n=5, r=.90, p=0.04).

Conclusion

The HVHP can be used with various contrasts to assess the speech discrimination abilities of NH and HI infants. While data collection is ongoing, it appears that performance on the HVHP may correlate with later language outcomes in both NH and HI infants.

Significance

This study assesses the utility of the HVHP in assessing speech discrimination, and is a step towards developing clinical tools to assess the progress of HI infants following early intervention.

Support

Supported by a 2007 AAO‐HNSF Resident Research Award and NIH grant R01DC6235 to Indiana University.
Guinea Pig Ototoxicity With Hydrocodone and Acetaminophen
Authors: Hughes Timothy J , Matz Gregory J , Marzo Sam J
Published: August 2008

Problem

Human case reports have been published demonstrating a rapidly progressive sensorineural hearing loss associated with overuse or abuse of acetaminophen/hydrocodone. We hypothesized that hearing loss would result in the guinea pig model if given high, chronic doses of this drug.

Methods

Sixty female, pigmented guinea pigs were randomly assigned to a control, acetaminophen, hydrocodone, or acetaminophen/hydrocodone group. All guinea pigs were tested with baseline ABRs on day 0, and post drug/placebo administration on days 30, 60, 90, and 120. At the end of the study 5 animals from each group were sacrificed and their cochleae were harvested for histological investigation.

Results

No significant change in threshold (dB) was seen between the 4 groups. Histological studies of the cochleae revealed no hair cell damage in any of the groups.

Conclusion

Hydrocodone and acetaminophen/hydrocodone do not have an obvious deleterious effect on guinea pig cochlear function or structure.

Significance

This study may indicate that human hearing loss seen with abuse of acetaminophen/hydrocodone is multi‐factorial and not just related to the drug abuse alone.
Enlarged Vestibular Aqueduct in Pediatric SNHL
Authors: Dewan Karuna , Lieu Judith C.
Published: August 2008

Problem

Current diagnostic criteria for enlarged vestibular aqueduct (EVA), >1.5mm at the midpoint, was determined in the pre‐CT era by Valvassori. Recent research, based on 73 CTs from children with no sensorineural hearing loss (SNHL), suggests new criteria for the diagnosis of EVA—midpoint of >0.9mm or operculum >1.9mm. We evaluated the proposed new radiographic, Cincinnati criteria for the diagnosis of EVA.

Methods

In a retrospective cohort study, we reviewed temporal bone CT scans of 130 pediatric cochlear implant recipients to measure the vestibular aqueduct midpoint and opercular width and 5 other temporal bone dimensions.

Results

The Cincinnati criteria identified 44% of patients with EVA versus 16% with the Valvassori criterion (P < 0.01). Of those with EVA, 45% were unilateral and 55% were bilateral using Cincinnati criteria; 64% were unilateral and 36% bilateral using Valvassori criterion (P<0.01). Right and left side measurements of vestibular aqueduct operculum (r=0.67, P<0.01) and midpoint (r=0.58, P<0.01) correlated substantially. The Cincinnati criteria diagnosed 70 ears with EVA classified as normal using the Valvassori criterion (P<0.01). Of these 70 ears, 59 had no other medical explanation for their hearing loss.

Conclusion

The Cincinnati criteria identified a large percentage of pediatric cochlear implant patients with EVA who otherwise had no known etiology for their deafness. Significant correlations between right and left side measurements suggest that EVA may not be morphologically asymmetric as previously thought.

Significance

The Cincinnati criteria potentially alters the current estimation of the most common etiologies of bilateral severe‐to‐profound sensorineural hearing loss in the pediatric population.

Support

KD is a Doris Duke Clinical Research Fellow, supported by the Doris Duke Foundation.
Hydrogel and Polyester Ventilation Tubes in an Animal Model
Authors: Tansavatdi Kristina , David Hoyt , Park Albert H , Prestwich Glenn D. , Hunter Lisa , Shu Xiaozheng , Britt David , Chase Shane
Published: August 2008

Problem

Determine the resorption rate and biocompatibility characteristics of novel cross‐linked hydrogel ventilations tubes and varied formulations of polyester ventilation tubes.

Methods

Three cross‐linked hydrogel ventilation tubes (chondroitin sulfate, Carbylan‐S and Carbylan‐Sx) and 5 different polyester ventilation tubes (PLA, PLGA, and silver impregnated versions of PLA and PLGA tubes) were placed into the tympanic membranes of chinchillas. Integrity of the tubes was assessed by weekly otoscopic examination. Collar or Armstrong ventilation tubes were used as controls on the opposite ear in each animal. Biocompatibility was assessed by comparing auditory brainstem response and by examining tympanic membrane changes following tube resorption.

Results

The PLA tubes remained in the tympanic membrane the longest (36.4 ± 5.2 days), while silver‐impregnated PLA tubes lasted for a shorter period of time than non‐impregnated tubes. The hydrogel tubes had very short resorption times (7–9.4 days) and were found on exam to significantly swell and expand the tympanic membrane perforation. Initial tissue histopathology confirmed these changes to the tympanic membrane. In contrast, the tympanic membrane and resorbable tube interface demonstrated equivalent findings for auditory thresholds and tissue histopathology at the implant site compared to nonresorbable controls for all polyester ventilation tubes with the exception of PLGA. Silver seemed to confer some stability for the PLGA tubes as tissue histopathology revealed significantly increased neutrophils and fibrosis in the PLGA tubes but not the silver‐impregnated PLGA tubes.

Conclusion

Resorbable polyester pressure equalization tubes demonstrate predictable resorption behavior and similar biocompatibility characteristics when compared with nonresorbable tubes. Silver impregnation may confer some stability to PLGA tubes. Hydrogel tubes have very short resorption times and lack tissue biocompatibility due to increased injury and inflammation of the tympanic membrane.

Significance

The data suggests that resorbable polyester tubes are equivalent to other FDA‐approved tympanostomy devices with regard to biocompatibility in the chinchilla model examined.

Support

American Society of Pediatric Otolaryngology Research Grant provided the majority of the funding for this research. Also, the USU Center for Integrated Biosystems provided additional funding. Drs. Park and Prestwich are co‐founders of Sentrx Surgical, Inc.
Chronic Rhinosinusitis Defined at Protein Levels
Authors: Deroee Armin Farajzadeh , Christian Scharf , Naraghi Mohsen , Bahador Athary , Hosemann Werner G.
Published: August 2008

Problem

Chronic rhinosinusitis (CRS) is a leading health care problem worldwide. Although many studies have been performed on different aspects of this disease, there are still no unanimous agreement on the pathophysiology, definition and classification of the disease. Two major groups of CRS are CRS with nasal polyposis (CRSwNP) and CRS without NP (CRSsNP). These 2 groups seem to have different features in pathophysiology, treatment and response to therapy. Recently, a lot of attention has been directed to gene expression and protein biomarkers in CRS. Different proteins were found in CRSwNP and CRSsNP mucosa. Studying CRS at protein level in large scale enables us to get vast information about their structure and function. In this study we investigated the protein profile of CRSwNP and CRSsNP mucosa.

Methods

Samples were taken from nasal mucosa of CRSwNP and CRSsNP patients. Proteins from these samples were extracted and separated by immobilized pH gradient (IPG)‐based two‐dimensional difference gel electrophoresis (2‐D DIGE). Resulting 2D‐gel images were statistically analyzed using Delta2D software and differently expressed protein spots were identified by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF/TOF‐MS).

Results

A reference map of approximately 1250 proteins could be established.74 proteins were significantly different (2‐fold, p<0.05) between CRSwNP and CRSsNP mucosa. Up to now several of these significantly changed proteins could be identified by MALDI‐TOF/TOF‐MS.

Conclusion

Up to now several of these significantly changed proteins could be identified by MALDI‐TOF/TOF‐MS and their biological function will be discussed concerning the pathogenesis of human nasal polyps.

Significance

Knowing the proteome of mucosa in CRSwNP and CRSsNP and biological functions of proteins can lead us to new ways of treatment and open new horizons in CRS research field.

Support

The first author received a fellowship grant for performing the research from European Academy of Allergology and Clinical Immunology.
The MD, MBA: Key to Cochlear Implant Program Survival?
Authors: McKinnon Brian J , Brace Kenneth W.
Published: August 2008

Problem

Despite the well established clinical efficacy of cochlear implantation in children and adults, many cochlear implant programs face daunting financial challenges. This presentation reports how the application of business principles achieved a successful financial resurrection of a cochlear implant closed due to excessive financial losses.

Methods

Using currently accepted business practices of financial analysis, supply chain and cost management, and market assessment, the economic data leading up to the program's financial failure were methodically assessed. Financial assessment of a cochlear implant program performed by an implant surgeon formally trained in business methodology.

Results

Identified during the financial exam were poor cost controls, little standardization of financial reporting, little understanding of actual and potential sources of revenue and cost, and a failure of the all parties to establish a suitable business model that would allow for the formal and accurate assessment of the program. Improved financial performance based on appropriate supply chain management, revenue enhancement, and accurate program financial reporting allowed for the cochlear implant program to reduce costs, increase revenue, and ultimately become financially viable.

Conclusion

Not understanding the business management of the cochlear implant program had a profoundly detrimental effect on the program's survival, despite the clinical success. Physicians must develop a business acumen that matches their clinical acumen, and use those tools to ensure that clinical success is not threatened by economic failure.

Significance

Understanding of the financial aspects of a cochlear implant program is as important as understanding the clinical aspects of cochlear implantation, and emphasis should be placed on developing those skills in the process of developing and managing cochlear implant programs.
R410 – Immunosuppressive Properties of Tonsil‐Derived MSCs
Authors: Janjanin Sasa , Djouad Farida , Prgomet Drago , Shanti Rabie M , Kiran Gollapudi , Joshi Arjun S , Tuan Rocky S
Published: August 2008

Problem

We have previously shown that stroma of human palatine tonsils contains mesenchymal stem cells (MSCs) that can be isolated and expanded in culture. These tonsil‐derived MSCs (T‐MSCs) show multipotent differentiation properties, i.e. can differentiate along multiple mesenchymal lineages, including osteoblasts, chondrocytes, adipocytes, and myocytes. Recent findings also show that MSCs display immunoregulatory properties. Although the exact immunosuppressive mechanisms are unknown, the capacity of MSCs to suppress T‐cell proliferation stimulated by allogeneic lymphocytes, dendritic cells, and phytohemaglutinin (PHA) is well documented. This study explores immunosuppressive characteristics of T‐MSCs and compares them with characteristics of bone marrow‐derived MSCs (BM‐MSCs), a well‐characterized cell population.

Methods

The mixed lymphocyte reaction (MLR) using human peripheral blood mononuclear cells (PBMC) from healthy donors and xenogeneic murine splenocytes was used to test the immunosuppressive properties of T‐MSCs and BMMSCs. Indoleamine 2,3‐dioxygenase (IDO) enzyme activity was measured spectrophotometrically based on tryptophan‐to‐kynurenine conversion in the supernatant. Interferon (IFN)‐g in culture supernatants was quantified using a commercially available ELISA kit.

Results

Addition of BM‐MSCs and T‐MSCs both inhibited the PHA‐induced proliferative response of PBMC and xenogeneic splenocytes. The difference in immunosuppressive activity correlates with the level of cell surface interferon (IFN)‐g receptor as well as the differential ability of IFN‐g to stimulate of IDO activity by T‐MSCs compared to BM‐MSCs.

Conclusion

T‐MSCs share similar immunosuppressive characteristics as BM‐MSCs in MLR. The immunosuppressive activity is significant and dose‐dependent, although at a lower level than that of BM‐MSCs.

Significance

Owing to their ease of isolation, rapid proliferation in the culture and self‐renewal capacity, MSCs to date are considered an attractive candidate cell type for the development of novel cell‐based therapies. They could be relevant in a wide range of clinical applications, including tissue and organ repair, drug or gene delivery to diseased tissues, improvement of allogenic hematopoietic cell transplantation, and the management of graft‐versus‐host disease.

Support

Supported by NIAMS Intramural Research Program (NIH ZO1 AR 41131). Sasa Janjanin is a recipient of the Fulbright Scholarship of the U.S. Department of State.
R440 – Generation of Neuron‐Like Cells in Spiral Ganglion Cultures
Authors: Gawthrop Charles Stroud , Challagulla Kavitha , Vu Annette , Bianchi Lynne , Barald Kate F , Germiller John A
Published: August 2008

Problem

Development of the auditory nerve is dependent on neurotrophic factors. Neurotrophins BDNF and NT‐3 are critical in the later stages of development. More recently, a substance secreted by the early inner ear, otocyst‐derived factor (ODF), was shown to stimulate development of primitive auditory neurons at the earliest stages. We hypothesized that this powerful neurotrophic substance might be capable of regenerating auditory neurons in the mature animal.

Methods

Cultured neurons and whole explants from neonatal mouse spiral ganglia were incubated with either BDNF or supernatant from an ODF‐secreting cell line.

Results

Exposure to ODF resulted in large numbers of cells which stained with neuronal markers, and had neuronal morphology. Though they appeared somewhat different from the native spiral ganglion neurons seen in BDNF‐treated cultures, they were present in vastly greater numbers, and appeared to arise from within the proliferating, migrating glial cell populations growing along with the neurons. These cells were not seen in cultures containing either control serum or BDNF. Addition of beta‐bungarotoxin, a neurotoxin, to spiral ganglia just after harvest destroyed the native neurons, which did not regenerate upon addition of BDNF. However, many of the new neuron‐like cells were observed after rescue with ODF, suggesting they represented a newly regenerated population of cells.

Conclusion

These data suggest that the components of ODF have the potential to regenerate neuronal cells, possibly from precursors or stem cells existing within the supporting cell populations of the auditory nerve.

Significance

The ability to regenerate auditory neurons would have exciting implications on the design and function of cochlear implants. Work continues in our lab to better define the properties of these new cells, and to isolate ODF's active component growth factors.

Support

Commonwealth of Pennsylvania's Tobacco Formula Fund.
R456 – Managing Nasal Polyps with Minimally Invasive Surgery
Authors: Pepe Graciela , Obregon Ricardo , Pepe Guillermo Jorge
Published: August 2008

Problem

To assess disease‐specific short and long term quality‐of‐life outcomes after minimally invasive surgery (MIS) with Bipolar Radiofrequency Interstitial thermotherapy (RFITT) and CO2 laser, in patients with nasal polyps.

Methods

Selected nasal polyp patients, with or without previous surgery who failed at medical management, were included in a prospective observational outcome study. CT, bacteriological and histological studies were performed. We used a validated outcome instrument, the nasal obstruction symptom evaluation (NOSE AOHNS) completed by the patients both before and after (1 – 12 months) the procedure. Statistical analysis ANOVA of repeated measures. We managed the obstruction using RFITT, laser and endoscopes, in office‐based procedures under local anesthesia.

Results

Significant improvement was seen in NOSE score a month after the procedure, unchanged at month 12 (basal NOSE 93.75 ± 9.5 vs NOSE 1 month 7.3 ± 8.39 and NOSE 12 months 14.38 ± 11, p 0.0001). No differences were detected between single or multiple polyposis, or septoplasty. No pain, complication or need for packaging. Increase of secretions was referred the first week, some crusting the first month. Very high (78,04%) and moderate (21,95%) patient satisfaction. Patients with previous surgery (46%) keenly consider MIS for future treatments.

Conclusion

Nasal polyps would be treated with MIS using CO2 laser and RFITT with significant improvement in disease specific quality of life that remains stable for the first year, and very high patient satisfaction with an almost pain free, low risk, fast office‐based procedure.

Significance

It's a promising technique for those who are focusing in clinical outcomes, quality of life, and patient satisfaction.

Support

No grants. Supported by the School of Medicine Northeastern University Argentina.
National Ignition Facility target design and fabrication
Authors: Cook R.C. , Kozioziemski B.J. , Nikroo A. , Wilkens H.L. , Bhandarkar S. , Forsman A.C. , Haan S.W. , Hoppe M.L. , Huang H. , Mapoles E. , Moody J.D. , Sater J.D. , Seugling R.M. , Stephens R.B. , Takagi M. , Xu H.W.
Published: August 2008

The current capsule target design for the first ignition experiments at the NIF Facility beginning in 2009 will be a copper-doped beryllium capsule, roughly 2 mm in diameter with 160-µm walls. The capsule will have a 75-µm layer of solid deuterium-tritium on the inside surface, and the capsule will be powered by X-rays generated from a gold/uranium cocktail hohlraum. The design specifications are extremely rigorous, particularly with respect to interfaces, which must be very smooth to inhibit Rayleigh-Taylor instability growth. This paper outlines the current design, and focuses on the challenges and advances in capsule fabrication and characterization; hohlraum fabrication, and deuterium-tritium layering and characterization.