bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing Improvement after CO2 Laser Myringoplasty
Authors: Ryan Marisa A. , Kaylie David
Published: February 2015

Objective

1) Report hearing improvement after CO2 laser myringoplasty using handheld fiber. 2) Describe method for CO2 laser myringoplasty.

Method

Retrospective study of hearing over a 4‐year period of patients with atelectacic TM and hearing loss. CO2 laser myringoplasty performed using handheld fiber to contract TM at 2W 100‐msec pulse. Attempts to reinflate the retraction pocket were performed using Valsalva, hydrodissection, or manual dissection. Tympanostomy tubes were placed in all patients.

Results

Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative ABG was 15 dB. The average postoperative ABG was significantly improved at 7 dB (P <. 001). Hearing improvement remained significantly improved in 17 patients with greater than 2 years follow‐up with final ABG of 7 dB (P =. 007). The presence of effusion on hearing was assessed. Patients with effusion had worse preoperative ABG (19 dB) compared to dry ears (12 dB) (P =. 02), however, postoperative ABG and long‐term ABG was not significantly different in the 2 groups (P =. 3). Patients with myringostapediopexy that could not be elevated did not experience significant hearing improvement.

Conclusion

Laser myringoplasty for treatment of TM retraction using a CO2 laser with handheld flexible fiber significantly improves hearing immediately and in long term follow‐up. This system allows precise control of energy delivery to the TM. It also allows for laser delivery outside of direct line of sight. Patients with hearing loss and no effusion had significant immediate hearing improvement. Patients with effusions experience the greatest hearing improvement. Patients with TM adherence to ossicles that cannot be elevated with Valsalva are at greater risk for suboptimal hearing results.
INFα and Ototoxicity
Authors: Sharifian Shahriar M.R. , Bakhshaee Mehdi , Sima Hamid , Kamandi Shima , Afshari Reza , Tale Mohammad R.
Published: February 2015

Objective

INFα is a common standard drug for the treatment of hepatitis B and C. Although a variety of related complications have been discussed, possible ototoxic effects of this mediation are not well described.

Method

In a descriptive cross‐sectional before and after study, 24 patients who received INFα for treatment of hepatitis B and C were included. Subjective and objective ototoxicity evaluations via questionnaire, high‐frequency audiometry, and measuring transiently evoked otoacoustic emissions (TEOAEs) were performed before, 1 week, and a month after starting the medication.

Results

Eighteen patients (75%) were male with mean age of 40 ± 14.4 years. In the frequencies of 4000 and 8000 Hz before (9.38 ± 1.0 and 10.7 ± 1.2, respectively) and after (17.9 ± 2.6 and 17.6 ± 2.6, respectively) 1 month (but not 1 week) of treatment, a significant difference (P =. 001) was detected. A progressive decrease in amplitude of the OAE during TEOAE measurement in 1, 2, and 4 frequencies among 41.66%, 18.75%, and 43.75% were observed, respectively. Interestingly, all of the hearing impaired patients were males. Hearing impairment was statistically more common among older patients (51.6 ± 16 vs 33.1 ± 14; P =. 002).

Conclusion

INFα may cause some ototoxic effects. Baseline audiogram, close observation, and TEOAE monitoring during therapy are recommended.
Minimally Invasive Osseointegrated Hearing Implant Surgery
Authors: Hawley Karen A. , Haberkamp Thomas J.
Published: February 2015

Objective

1) To report on the results and complications arising from using a minimal tissue removal procedure for the placement of an osseointegrated hearing implant. 2) To understand the advantages and disadvantages for this technique compared to the more standard techniques.

Method

Retrospective study in tertiary academic center of all patients undergoing minimally invasive single‐stage osseointegrated implant surgery (BAHA®) from 2008‐2010. Technique: A small incision (1.5 cm) with little to no soft tissue (fat only) removal with good skin to periosteum fixation after placement of a 4 mm screw and 8.5 mm abutment.

Results

Thirty‐three patients were assessed (aged 16‐86, range of follow‐up 18‐45 months). No patients experienced hair loss, significant numbness, cosmetic defects, intraoperative complications, or audiologic complications. Seven patients required some combination of bactroban, steroid ointment, and/or oral antibiotic for mild erythema around the abutment in the first 2 months postop. Two patients required conservative management for delayed skin reactions (3.5 months and 2.5 years). Five of these 6 patients had 1 more episode requiring similar treatment. All reactions resolved in approximately 2‐4 weeks. Two additional patients required minor surgical soft tissue revision.

Conclusion

We have demonstrated comparable outcomes to other surgical techniques with less cosmetic and other associated complaints. This study indicates that a less invasive approach for the surgical implantation of the osseointegrated auditory implant may have merit.
Monaural Hearing before/after Sequential Cochlear Implants
Authors: Pelosi Stanley , Wanna George B. , Sisler‐Dinwiddie Allyson , Rivas Alejandro , Labadie Robert F. , Bennett Marc L. , Haynes David S.
Published: February 2015

Objective

The relationship between pre‐ and postimplantation monaural auditory performance in patients undergoing bilateral sequential cochlear implantation (SCI) has not been clearly defined. A greater understanding of this relationship could potentially affect preoperative counseling to patients regarding choice of initial side to implant.

Method

Retrospective review was performed of monaural auditory performance pre‐ and postimplantation in 90 SCI recipients between 1997 and 2011 at Vanderbilt University. A “better‐hearing ear” had lower pure tone average or speech awareness threshold by at least 10 dB, or open/closed‐set speech perception score at least 10% higher.

Results

A difference in preimplantation hearing status was identified in 35 patients. The first‐implanted ear was better‐hearing in 11 and worse‐hearing in 24. 28/35 patients had available data on post‐implantation monaural auditory performance. At last follow‐up (mean 24 months, range 1‐69), the first‐implanted ear exhibited better closed/open‐set speech perception scores in 19/28 (68%) patients. There were no differences when comparing patients grouped according to preimplantation hearing status (Fisher’s exact test, P <. 05). Median time between implant activations was 31 months when the first‐implanted ear exhibited better performance, and 17 when the second‐implanted ear performed better (difference NS, rank sum test).

Conclusion

A relationship between pre‐ and postimplantation monaural auditory performance in SCI recipients was not identified. The first implanted ear is more likely to exhibit better monaural auditory performance, even if this ear had worse pre‐implantation hearing. This finding highlights the plasticity of central auditory pathways in cochlear implant recipients.
Novel Completely‐in‐the‐Canal Magnet‐Drive Micro Hearing Aid
Authors: Mahboubi Hossein , Paulick Peyton , Kiumehr Saman , Merlo Mark , Bachman Mark , Djalilian Hamid R.
Published: February 2015

Objective

To describe a novel magnet‐drive micro hearing aid (MMHA), a 3.5‐mm wide device, that fits entirely into the bony canal and drives the tympanic membrane (TM) using a magnet in a noncontact fashion. To test the effectiveness and optimal positioning of the magnet on the TM.

Method

Cadaveric temporal bones were prepared for laser Doppler vibrometry (LDV) of the stapes. MMHA was placed at 1 and 2 mm away from the TM, and the magnets were glued to umbo and lateral process of the malleus. Frequency sweeps between 300 Hz to 12 kHz were performed.

Results

The MMHA showed frequency response from 300 Hz to 12 kHz at loudness levels from 60 to 120 dBA at 10 dBA steps. Placement of magnet on the umbo resulted in higher amplitudes and lower power requirements than placement on the lateral process. The same results were observed when the device was placed at 1‐mm distance from the TM.

Conclusion

MMHA is a small completely‐in‐the‐canal hearing aid that drives the TM in a noncontact fashion through a magnet. This novel device has a frequency output wider than air conduction devices. The device’s ability to directly drive the TM enables it to potentially sound more naturally and similar to implantable devices.
Pack or No Pack after Ear Surgery: A Randomized Controlled Trial
Authors: Javed Faisal , Whitwell Russell , Macleod Ian , Hajioff Daniel , Robinson Philip , Rea David , Nunez Desmond
Published: February 2015

Objective

1) To see if there is a difference in patient and clinician reported outcomes between patients randomized to postoperative ear packing, compared to those who did not have the ear packed after middle ear surgery. 2) To see if there is a also a difference in hearing outcome between both groups.

Method

Randomized controlled trial of adult patients to have either Bismuth Iodoform Paraffin Paste pack or no ear pack postoperatively after primary canal wall up middle ear surgery. Setting: tertiary teaching hospital, UK (2011). Outcome measures: clinicians/patients recorded visual analogue scale scores at 3 weeks and 3 months postoperatively. Audiometry was recorded at 3 months.

Results

Thirty‐two patients of similar sex and age were randomized to the 2 treatment arms. There was no statistically significant inter‐group difference in 3‐week composite clinician and patients mean visual analogue scores (146 mm versus 184 mm [P =. 3]). The graft take rates and the appearance of the ear canals at 3 months were similar in both groups (P = 1.0 for both outcomes). There was also no significant inter‐group difference in the change in mean air conduction thresholds in response to surgery (11.3 dB and 3.5 dB) in the ear pack and no pack groups, respectively (P =. 08).

Conclusion

No differences in total patient symptoms and clinician findings or hearing were demonstrated between patients with a postoperative pack compared to those without a postoperative pack following middle ear surgery. This pilot study provides justification for a larger clinical trial to investigate the need for postoperative ear canal packing.
Prevention of Biofilm Formation by Polyquaternary Polymer
Authors: Ojano‐Dirain Carolyn , Antonelli Patrick J. , Silva Rodrigo C. , Bashir Usman
Published: February 2015

Objective

Biofilm formation has been linked to otologic implant infection and extrusion. The purpose of this study was to determine if a microbicidal polyquaternary polymer (PP) could prevent biofilm development by common otopathogens, Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA).

Method

Polyurethane tubes (20 per treatment) with and without a PP were briefly exposed to plasma or saline, then to SA or PA. Tubes were incubated in growth media. After 4 days, antibiotics were added to kill planktonic bacteria. Biofilm formation was assessed by bacterial counts and scanning electron microscopy.

Results

SA biofilm was reduced by 8 logs on tubes with the PP compared to the control tubes (P <. 0001). PA biofilm formation was also less on tubes with the PP (P <. 0001), but the reduction was only 1 log. Plasma promoted SA and PA biofilm on the control tubes (P <. 0001) but not on the tubes with the PP (P =. 07 and. 40 for SA and PA, respectively).

Conclusion

Incorporation of a microbicidal PP into polyurethane dramatically inhibits SA biofilm formation. Further research is warranted to evaluate the efficacy and safety of this technology in otologic implants.
Regulated Chitosan‐Based Inner‐Ear Drug Delivery
Authors: Lajud Shayanne A. , Han Zhao , Bur Andres , Sanyal Samudra , Bezpalko Orysia , O’Malley Bert W. , Li Daqing
Published: February 2015

Objective

1) To evaluate a novel system for regulating the chitosan‐glycero‐phosphate (CGP)‐based hydrogel drug delivery to the inner ear. 2) To understand the distribution of gentamicin in the inner ear following CGP drug delivery with and without regulation.

Method

Chitosanase, specifically targeting CGP, was identified and purified for its use as a CGP regulation system. In vitro and in vivo studies were conducted to evaluate the effect of the chitosanase on the inner ear drug delivery and distribution. Gentamicin‐Texas Red (GTTR) was used for tracking the drug distribution.

Results

Purified chitosanase was confirmed with Western blot. The in vitro study showed that the chitosanase‐based regulation system effectively controlled the gentamicin releasing. The in vivo data concur with in vitro findings and demonstrated that the gentamicin concentration in the inner ear can be successfully regulated by applying the chitosanase. Moreover, the gentamicin inner ear distribution can also be regulated by changing its inner ear concentration.

Conclusion

Our study suggests that the chitosanase‐based regulation system can be effectively used for controlled inner ear drug delivery. This system has a potential to stop inner ear drug application when side effects or drug‐related toxicities start to occur and should be used for safe drug application in the inner ear.
Repair of Big Drum‐Head Defect by Underlay Fascia and STSG
Authors: Ahmed Hamza E.
Published: February 2015

Objective

1) Describe the technique of grafting total and near‐total tympanic membrane perforations using underlay temporalis‐ fascia graft augmented by split‐thickness skin graft from the ear lobule. 2) Evaluate the procedure in terms of graft take, hearing outcomes, and complications.

Method

This clinical study was conducted on 91 patients (93 perforations) having total (6) or near‐total (87) tympanic‐membrane perforation from January 2005 till December 2010 in a teaching university hospital. Myringoplasty utilizing temporalis‐fascia graft underlay supported externally by split‐thickness lobular‐skin graft. Graft take, early and late PTA changes, and complications were evaluated.

Results

Graft take was achieved in 86 out of 93 operations (92%), with 7 cases of graft failure (8%). PTA improvement was 16.3 dB at 3‐month postoperative versus 15.5 dB at 1 year. Other complications noticed were prolonged graft swelling with discharge (3 cases), 2 of them ended by graft breakdown and the third improved. Bleeding from the jugular bulb during abrasion of middle‐ear floor mucosa occurred twice, and in one of them bleeding stopped with surgicel. In the other extraluminal packing of the sigmoid sinus was necessary. The procedure was completed. No blunting or donor site complications were noticed.

Conclusion

Large TM perforations can be managed successfully by underlay temporalis‐fascia graft supported externally by STSG from the ear lobule laid in part over the deep meatal skin and in the other part over the graft. One can expect >90% graft take, >15 dB PTA improvement, and a limited number of complications.
Risk for Complications from CPA Surgery due to BMI
Authors: Mantravadi Avinash V. , Leonetti John P. , Marzo Sam J. , Burgette Ryan C.
Published: February 2015

Objective

To determine the relationship between body mass index (BMI) and risk for complications from transtemporal surgery for non‐malignant disease processes of the cerebellopontine angle (CPA). To determine the threshold BMI above which risk is increased.

Method

Retrospective review of 106 patients undergoing transtemporal CPA surgery for non‐malignant disease processes from 2010 to 2011 (tertiary‐care academic center). Preoperative BMI, approach, hospital stay, and complications including cerebrospinal fluid (CSF) leak, wound complications, and brachial plexopathy. Data were analyzed to determine whether BMI affects postoperative CSF leak, wound infection, or brachial plexopathy.

Results

A total of 106 patients were included, with a mean BMI of 28.17. Statistical analysis demonstrated an increased incidence of CSF leak in patients with a preoperative minimum BMI of 31.4 (rpb = 0.216, df = 101, P <. 05). There was no clear relationship between BMI and the development of postoperative wound complications. An increased risk for postoperative brachial plexopathy was found in patients with a BMI > 29.97.

Conclusion

Risk of CSF leak and brachial plexopathy after transtemporal CPA surgery for non‐malignant processes are increased in patients with an elevated BMI. Consideration should be given to preoperative dietary/lifestyle modifications and exercise programs and/or perioperative lumbar drain placement and intraoperative upper extremity evoked potential monitoring to decrease these risks.
The Inferior Vestibular Nerve and Posterior Canal BPPV
Authors: Shupak Avi
Published: February 2015

Objective

The aim of the study was to learn whether normal ipsilateral cervical vestibular myogenic potential (cVEMP) responses, for which functional integrity of the inferior vestibular nerve is required, are present in all patients having the clinical picture of posterior canal benign paroxysmal positional vertigo (PCBPPV).

Method

Twenty‐four patients with PCBPPV participated in a prospective open study, conducted between November 1, 2009, and November 30, 2011. All had cVEMP after the completion of canal repositioning procedure. Follow‐up 1, 3, 6, and 12 months after the initial treatment included the Dizziness Handicap Inventory (DHI) questionnaire and otoneurological bed‐side examination.

Results

Normal cVEMPs were recorded in 20 (83%) and were pathological in 4 (17%) subjects. The average DHI score in patients with normal cVEMP was 13.9 + 16.6 vs 0.7 + 1.1 among those with pathological cVEMP (N = 4 in the pathological VEMP group too small to allow statistical analysis). 14 (58%) patients had recurrent PCBPPV (rPCBPPV). Twelve (86%) of the subjects with rPCBPPV had normal and 2 (14%) had pathological cVEMP. The proportions of subjects having abnormal cVEMP did not differ significantly between the recurrence and non‐recurrence groups (Fisher exact test).

Conclusion

Most patients suffering from PCBPPV had normal cVEMP. Reduced symptomatology as quantified by the DHI score was found when the cVEMP was pathological. This finding suggests that functional integrity of the inferior vestibular nerve is required for the complete clinical picture of PCBPPV to take place.
Type II and Type III Tympanoplasties: A 10‐Year Revision
Authors: Silva Clara N. , Mesquita Pedro , Silvestre Natercia , Ribeiro Joao C. , Amorim Ana M. , Paiva António
Published: February 2015

Objective

Portmann’s type II (T2) and III (T3) tympanoplasties are often performed for the treatment of chronic ear pathology. This study aims to assess the epidemiological and functional differences between type II and III tympanoplasties, trying to find functional predictors of success.

Method

Observational retrospective study of 171 patients undergoing a T2 or T3 surgery in a tertiary hospital between 2000 and 2009. Age, gender, side, surgical technique, type of prosthesis, disease activity, malleus presence, type and use of cartilage, preoperative and postoperative air‐bone gap (ABG), and pure tone average (PTA) were recorded.

Results

A total of 171 cases (119 T2 and 52 T3) were pooled with a mean age of 38.6 ± 16.0 years. T2 had a preoperative ABG of 28.1 ± 8.5 dB and PTA of 47.1 ± 15.2 dB, while T3 showed a 32.8 ± 8.0 dB ABG and a 51.4 ± 20 dB PTA (P <. 05), suggesting that preoperative ABG and PTA are predictors of the type of surgery to perform. The average improvement was 9.69 ± 13.8 dB and 7.0 ± 11.8 dB for tympanoplasty type II and III, respectively (P <. 05). Functional success was significantly different between T2 (82%) and T3 (63%, P <. 05). We found no predictors of functional success relatively to epidemiological factors or otological characteristics in the multivariate analysis.

Conclusion

Our data suggest that the preoperative ABG and PTA are predictors of the type of what tympanoplasty to perform as well as predictors of functional success in both T2 and T3. Functional success is greater in T2 rather than T3.
Vibrant Soundbridge in Children
Authors: Wolf‐Magele Astrid , Schnabl Johannes V. , Koci Viktor , Riechelmann Herbert , Sprinzl Georg M.
Published: February 2015

Objective

The VSB is an AMEI which is approved for children. It is also used for patients with aural atresia or chronic otitis media (COM), with limited hearing rehabilitation solutions. The aim for this study is to investigate the hearing rehabilitation in children using VSB suffering from atresia or COM.

Method

Standard audiological tests were performed pre‐ and postoperatively. CT images were acquired to assess feasibility of the FMT placement in the middle ear and to determine the Jahresdorfer score in patients with atresia. Functional gain and speech improvement are analyzed.

Results

Thirteen children (median age 9.1) with congenital aural atresia or COM were implanted with the VSB. The average Jahresdorfer scale was 5.9. There were no pre‐ or postoperative medical complications observed, and hearing levels were preserved. The surgical technique is safe, due to the unchanged pre‐ versus postsurgery BC levels. CT images provide crucial information about the accessibility for the attachment of the FMT. Patients with atresia showed a functional gain of 40 dB and an improvement of 60% in speech. Patients with COM showed a functional gain of 38 dB and an improvement of 50% in speech.

Conclusion

In these cases, the audiological outcome shows an effective gain in hearing and an improvement in speech. The VSB therefore offers an excellent audiological rehabilitation intact skin solution for children suffering with congential aural atresia or COM.
A National Survey of Pediatric Sleep‐Disordered Breathing
Authors: Gudnadottir Gunnhildur , Hellgren Johan
Published: February 2015

Objective

This study estimated the national childhood prevalence of sleep‐disordered breathing in a random population sample from The Swedish Population Register including all residents and compared it to data from The National Board of Health and Welfare where all tonsillectomies are registered.

Method

The validated OSA 18 questionnaire was mailed twice to the caretakers of 1320 randomly selected children aged 0‐11 stratified by gender, age group, and area of residence. The OSA 18 includes questions regarding sleep disordered breathing, physical and emotional symptoms, daytime function, and caretakers’ concerns during the last month.

Results

The questionnaire was answered by 754 subjects (57%); 3.5% of the children had an OSA 18 score >60 indicating OSAS, and in this group 63% were not assessed by the healthcare. The highest prevalence was found in the 3‐5 year olds, and it was higher in boys than girls. Area of residence and age adjusted BMI did not affect the results. Loud snoring “always” or “often” was reported among 4.8% of the children and was significantly associated with male gender and night sweats. In Sweden, 7000 tonsillectomies are performed each year in this age group, representing 0.4% of the population.

Conclusion

This general population study shows that sleep disordered breathing is common in children and that many symptomatic children are undiagnosed. Comparison with the national tonsillectomy registry indicates that less than 15% of the children at risk of having OSAS are treated with tonsillectomy in Sweden.
Accuracy of Office Laryngoscopy in Children with Dysphagia
Authors: Sowder Justin C. , Richter Gresham T. , Bower Charles M. , Hartzell Larry
Published: February 2015

Objective

Airway endoscopy is often performed in older and developmentally normal children to rule out laryngeal sources of orpharyngeal dysphagia. This study examines whether office‐based flexible laryngoscopy (FL) can accurately identify laryngeal factors involved in dysphagia.

Method

Nine‐year retrospective chart review of children >2 years old who underwent microscopic laryngoscopy and rigid bronchoscopy (MLB) at a tertiary pediatric hospital. FL documentation was reviewed, and the findings were compared to MLB results. Children who did not undergo FL prior to MLB were excluded.

Results

From the 763 records reviewed, 59 children over the age of 2 years underwent FL in clinic followed by MLB under anesthesia (M = 36, F = 23, mean age = 5.05 years, median age = 3 years). Diagnoses in clinic prior to MLB included oropharyngeal dysphagia (41%), chronic respiratory symptoms (ie, asthma, stridor, chronic cough; 37%), obstructive sleep apnea (25%), hoarseness (14%), and hemoptysis (2%). No patient was found to have a laryngeal cleft on either FL or MLB. However, laryngomalacia, airway erythema/edema, and subglottic stenosis were the most common laryngeal findings on FL (27%, 25%, 22%) and MLB (25%, 27%, 25%), respectively.

Conclusion

Flexible laryngoscopy may be sufficient to rule out laryngeal cleft in older children with oropharyngeal dysphagia. Similarly, laryngomalacia, laryngeal edema, and subglottic stenosis are accurately diagnosed by FL when compared to MLB in children.
Changing Breathing Pattern in Laryngomalacia after Surgery
Authors: Trozzi Marilena , Dotta Andrea , Savignoni Ferdinando , Bottero Sergio
Published: February 2015

Objective

Most of the studies on the surgical treatment of severe laryngomalacia have aimed to describe the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. The aim of this study is to analyze the changes in breathing patterns following aryepiglottoplasty for severe laryngomalacia.

Method

A series of retrospective cases at a tertiary referral children’s hospital. Between 2005 and 2010, 40 infants with severe laryngomalacia were studied before (T1) and after surgery (T2). Breathing patterns were studied using an ultrasonic flow‐meter measuring: tidal volume, respiratory rate, time to peak and mean expiratory flow/expiratory time ratio.

Results

The surgical procedure was well tolerated in all the infants and no perioperative and long‐term complications were present. In T1, the breathing pattern is characterized by low tidal volume and high flow/expiratory time ratio (tPTEF/Te) and mean expiratory/mean inspiratory flow ratio (MEF/MIF), suggesting a severe reduction in upper airways patency for all patients. After surgery (T2), all above mentioned variables significantly improved, reaching normal values for the age.

Conclusion

Pulmonary function test in this study showed the diagnostic value of testing respiratory functionality in severe laryngomalacia and comparing them to clinical and endoscopic data. Moreover, we also propose the use of this available test to verify the therapeutic effects and to monitor future respiratory development in these infants.
Cochlear Nerve Deficiency: Prevalence and Audiologic Features
Authors: Clemmens Clarice S. , Germiller John A. , Cohn Samuel
Published: February 2015

Objective

Cochlear nerve deficiency (CND) is increasingly being recognized as a cause of sensorineural hearing loss. Our objectives were to 1) determine the prevalence of CND in children with unilateral SNHL, and 2) explore the relationship between imaging and audiologic features.

Method

In 115 consecutive children with unilateral SNHL who underwent high resolution MRI, diameter and image intensity of the CN were measured and normalized to the ipsilateral facial nerve (FN). Patients were divided into 2 groups, normal or CND, based on our published criteria (ie, a CN density < FN density, or CN area).

Results

CND was present in 38 of 115 (33%) of patients with unilateral SNHL. In the CND group, a strong correlation was found between PTA and relative CN density (r2 0.55, P <. 0001) and area (r2 0.50, P <. 0001). Cochlear nerve aplasia was always accompanied by severe to profound SNHL. No progression was observed in any patient, except 1 with an ipsilateral EVA. All contralateral ears remained normal. In the normal group (ie, unilateral SNHL without CND), normal variations in nerve size did not correlate with hearing severity.

Conclusion

CND, once thought rare, is actually a relatively common cause of pediatric unilateral SNHL. Diagnosis is easily made on MRI. A consistent hearing phenotype is observed, whereby hearing levels correlate with nerve size, and remain remarkably stable over years of follow‐up.
Dexmedetomidine and Outcomes after Airway Reconstruction
Authors: McCormick Michael E. , Pena Maria T. , Zalzal George H. , Preciado Diego A.
Published: February 2015

Objective

To examine the outcomes of children receiving dexmedetomidine (Dex) as a primary sedation agent after single‐stage airway reconstruction.

Method

Retrospective analysis of a prospective case cohort protocol using Dex as a primary sedation agent vs ketamine/midazolam/morphine in single‐stage airway reconstruction at a tertiary care children’s hospital between November 2005 and January 2012. Primary outcomes included length of intubation/PICU admission. Secondary outcomes included the need for polypharmacy and complication rates.

Results

Forty‐eight patients were included; 28 received Dex sedation. Median age was 18.0 months (2‐131). Age and weight were similar between the groups, as was length of intubation (9 days Dex vs 8 days no‐Dex, P =. 46). There were no statistical differences between lengths of PICU stay after extubation (4 days Dex vs 3.5 days no‐Dex, P =. 83), lengths of stay after extubation (7 days Dex vs 7.5 days no‐Dex, P =. 122), percentage of polypharmacy days (81.6% Dex vs 64.6% no‐Dex, P =. 20), reintubation rates (20% Dex vs 14% no‐Dex, P =. 60), withdrawal rates (46% Dex vs 45% no‐Dex, P =. 92), or rates of airway infection (36% Dex vs 25% no‐Dex, P =. 43).

Conclusion

Dexmedetomidine sedation does not decrease the lengths of intubation or PICU admission, the need for polypharmacy, or the rates of reintubation, withdrawal, and infection after single‐stage airway reconstruction in children. Although surgical success can be expected in greater than 90% of these patients, the optimal postoperative sedation management remains challenging.
Distal Airway Lesions in Mandibular Distraction Patients
Authors: Mulder Corlyne , Rastatter Jeffrey , Patel Pravin , Vicari Frank
Published: February 2015

Objective

1) Determine prevalence and type of synchronous airway lesions (SALs) in patients undergoing mandibular distraction osteogenesis (MDO) at Children’s Memorial Hospital. 2) To determine whether these SALs affect surgical success of MDO in relieving airway obstruction.

Method

Restrospective review of patients with micrognathia undergoing MDO and direct laryngoscopy and bronchoscopy (DLB) over a period of 11 years (2001‐2011) at a tertiary care pediatric hospital. Charts were reviewed for demographics, prevalence/type of SALs, success rate for airway improvement for MDO, and coexisting medical and craniofacial conditions.

Results

Eighteen patients were found who had undergone both MDO and DLB. The incidence of at least 1 SAL was 77.8%. Types of SALs encountered include laryngeal edema (61.1%), tracheobronchitis (50%), laryngomalacia (38.9%), tracheomalacia (16.7%), bronchomalacia (16.7%), subglottic stenosis (11.1%), pulsatile airway compression (11.1%), posterior laryngeal cleft (0%), and subglottic cysts (0%). 94.4% of MDO patients received tracheostomy, and 88.9% had airway improvement following MDO. Craniofacial anomalies include micrognathia (100%), cleft palate (61.1%), midface hypoplasia (33.3%), craniosynostosis (5.6%), choanal stenosis/atresia (5.6%), pyriform aperture stenosis (5.6%), and macroglossia (0%). Baseline medical characteristics/syndromes include Pierre Robin sequence (61.1%), Nager syndrome (11.1%), Stickler syndrome (11.1%), asthma (11.1%), Goldenhar syndrome (11.1%), arthrogryposis (5.6%), Mobius syndrome (5.6%), and Cornelia de Lange syndrome (5.6%).

Conclusion

There is a high rate of SALs in patients undergoing MDO. The most common SALs are laryngeal edema, tracheobronchitis, and laryngomalacia. MDO is highly successful in relieving upper airway obstruction in micrognathic patients despite the high incidence of SALs. DLB should be considered in all patients who require MDO.
DNA Damage in Children with Snoring
Authors: Yoruk Ozgur , Alp Hakan , Yüksel Sancak , Bakan Ebubekir
Published: February 2015

Objective

Learning the levels of oxidative DNA damage in children with obstructive adenotonsillar hypertrophy. We determined the 8‐hydroxy 2‐deoxyguanosine levels in leukocyte DNA and in urine samples as a specific marker of oxidative damage to DNA, and the plasma and urine malondialdehyde levels as an index of lipid peroxidation in children.

Method

Prospective, randomized controlled study conducted between 2010 and 2011. The study consisted of 30 patients and 25 healthy controls. Patients had snoring and pauses of breathing during sleep. We obtained blood and urine samples from each child to measure 8‐hydroxy 2‐deoxyguanosine and malondialdehyde levels in their initial visit.

Results

A significant difference was observed in leukocyte and urine 8‐hydroxy 2‐deoxyguanosine levels in patients with obstructive adenotonsillar hypertrophy compared to controls (P <. 001 for both). Similarly, a significant difference was observed in plasma and urine malondialdehyde levels in patients with obstructive adenotonsillar hypertrophy compared to controls (P <. 001 for both). In addition, significant correlations were observed between the levels of 8‐hydroxy 2‐deoxyguanosine in leukocyte DNA and plasma malondialdehyde (r = 0.648, P <. 001), and between the levels of urine 8‐hydroxy 2‐deoxyguanosine excretion and urine malondialdehyde (r = 0.588, P <. 001).

Conclusion

8‐hydroxy 2‐deoxyguanosine in leukocyte DNA and urine levels in children can be useful as an indicator for obstructive adenotonsillar hypertrophy screening.
How to Avoid Malpractice in Forensic ENT Medicine
Authors: Attia Mohamed E.
Published: February 2015

Objective

With so many cases of medical malpractice referred from police, courts, medico‐legal doctors, and lawyers that need medico‐legal consultation reports from ASCC about their criminal or civil cases, a scientific curriculum or guide in this field is necessary.

Method

A forensic ENT specialist who examines 9830 cases over 11 years in the General Department of Criminal Evidence, Arabian Scientific Consultancy Center, in Kuwait and records notes using most recent procedures and apparatuses with total quality means for accurate ENT exam. Cases clinically focus on medico‐legal points, trauma or pathology, the way it was inflicted, and a clinical picture.

Results

Forensic ENT medicine studies clinical aspects and medical rules related to ENT. Practice from the medicolegal points of view and preparing to be ready for law application in service of justice and science for the sake of human rights. Differentiation between real or fabricated, recent or old, traumatic, pathological, or malingering reporting about cause, tools, date, cure time and fate, disability and its percentage—clear much new facts in this new specialty practice.

Conclusion

The first textbook of its kind in the world, this is a guide for doctors on how to avoid malpractice.
Genetic Assay for Newborn Auditory Screening
Authors: Colby Candice C. , Todd N. Wendell , Lin Xi
Published: February 2015

Objective

1) Perform genetic screening on newborns that fail physiologic hearing screening and determine confirmed positives with hearing loss and false‐positives. 2) Compare physiological screening results to genetic screening results and identify deafness genes. 3) Provide additional data to assist with the development and implementation of a universal protocol.

Method

Prospective, large‐scale, multi‐institution project examining genetic causes of hearing loss in newborn children at a tertiary‐care academic center and private hospital that has the largest number of births in the country. The primary outcome measure is deafness genes. Data collection began January 2012 and is ongoing.

Results

Our hypothesis is that a majority of newborns confirmed to have hearing impairment based on physiological tests would have identifiable genetic mutations in the currently known 84 deafness genes. This genetic assay technology for identifying genetic abnormalities was tested in patients with known bilateral sensorineural hearing impairment and identified a genetic cause of hearing loss in 26 of 32 (81.3%) patients with usable specimens that were tested. The 2 most commonly identified genetic mutations identified were the SLC26A4 gene, known to encode the pendrin protein, followed by the GJB2 gene, responsible for gap‐junction protein Connexin 26.

Conclusion

This DNA‐based genetic hearing screening approach has allowed us to identify genes that are responsible for deafness and may be able to identify children at risk for developing delayed‐onset hearing loss that current screening methods miss. It may have widespread applications in clinical practices beyond hearing screening.
Ibuprofen and Prednisolone after Tonsillectomy in Children
Authors: Rezende Carlos E. , Monteiro Joao T. , Fiorin Luciano , Lima Diego O. , Bertoncello Flavio , Veiga Fernando A. , Rapoport Priscila B.
Published: February 2015

Objective

Evaluate the use of ibuprofen and prednisolone during postoperative of tonsillectomy of pediatric patients.

Method

A total of 105 children submitted to tonsillectomy were distributed into 3 groups. The group A used ibuprofen. The group B used prednisolone. The group C didn’t use anti‐inflammatories. The caregivers, during the 5 days after surgery, evaluated descriptively about children pain, alimentation, complications, and the need of symptomatic medication.

Results

The groups were homogeneous regarding gender and age. There was no difference among the groups in regards to bleeding and the necessity of use of symptomatic medication. There was a faster alimentary progression and pain control among patients who used ibuprofren and prednisolone, and there was no difference between these 2 groups. There was no difference in regard to nausea and vomiting; however, the fever was significantly less present in the group that used ibuprofen.

Conclusion

The use of ibuprofen and prednisolone presented safe and effective in controlling postoperative pain, also improving the alimentary acceptance and decreasing the need of rescue medication such as metamizole or dimenidrinate, without raising the complication index.
Is Airway Endoscopy Mandatory in Children Under Three with Obstructive Sleep Apnea?
Authors: Michelson Andrew P. , Hawley Karen A. , Anne Samantha
Published: February 2015

Objective

Cure rates for obstructive sleep apnea (OSA) in children <3 range from 0‐35%. Previous studies suggest that these low rates are due to high incidence of synchronous airway lesions (SALs), necessitating intraoperative airway evaluation. This study examines effectiveness of adenotonsillectomy in children <3 and evaluates necessity of laryngoscopy and/or bronchoscopy.

Method

Retrospective chart review of children <3 years undergoing tonsillectomy and/or adenoidectomy for OSA from 2005‐2011. Only patients who underwent both pre‐ and postoperative polysomnogram (PSG) were included in analysis. Children with prior airway surgery were excluded. Clinical history, PSG data, intraoperative findings, and SALs were recorded.

Results

A total of 243 charts were reviewed; 48 patients met inclusion criteria. Twenty‐one of 48 were cured (AHI <1 or AHI <5 and minimum SpO2 >92%) of OSA. Patients failing adenotonsillectomy had significantly higher preoperative AHI and lower minimum SpO2 versus cured patients (P <. 001). No significant difference was noted in age, BMI, or incidence of genetic abnormalities between outcome groups. Eight cured and 11 failed patients underwent office laryngoscopy or intraoperative laryngoscopy and/or bronchoscopy. No statistical difference in frequency of airway evaluation or incidences of SALs was found between outcome groups. Flexible laryngoscopy alone could have diagnosed 79% of SALs identified. No surgery was required for lower airway SALs.

Conclusion

Adenotonsillectomy for OSA in children <3 cured 44% of patients. Failure was associated with higher preoperative AHI and lower minimum SpO2, but not incidence of SALs. No lower airway SALs required surgery and none contributed to failure, suggesting that office laryngoscopy is sufficient when intraoperative evaluation is not otherwise needed.
Management of the Chronically Inflamed Pediatric Airway
Authors: Smith Nicholas , Boesch Paul , Germann Janet , Rutter Michael J. , de Alarcon Alessandro
Published: February 2015

Objective

To examine our initial experience with the use of azithromycin in children with airway stenosis and chronically inflamed airways.

Method

This retrospective study examined 20 children with airway stenosis and chronically inflamed airways. Patients tested negative for eosinophilic esophagitis and gastroesophageal reflux and took azithromycin (10 mg/kg) 3 times per week for at least a 1‐month period. Outcomes were status of airway inflammation after azithromycin and decision to intervene on airway stenosis.

Results

The mean age was 3.6 years (range 0.9‐8.0) with 13 females and 7 males. Diagnoses included subglottic stenosis (85%), tracheal stenosis (5%), bronchial stenosis (5%), and bilateral vocal cord paralysis (5%). Mean duration of azithromycin therapy was 116.6 days (range 42‐192). Airway inflammation improved in 14 patients (70%) allowing successful airway intervention in 12 patients. Two did not undergo surgery due to reasons other than airway inflammation. Six patients had persistent inflammation, 5 of whom are currently being observed.

Conclusion

Children with airway stenosis and chronic inflammation pose significant challenges for the airway surgeon. Our initial experience suggests that azithromycin can reduce airway inflammation, allowing one to proceed with surgical intervention. Further studies evaluating azithromycin are warranted.
Pharyngeal Dysphagia in Children with Down Syndrome
Authors: O’Neill Ashley C. , Richter Gresham T.
Published: February 2015

Objective

Swallowing problems in children with Down Syndrome (DS) are poorly understood. In particular, longitudinal examination of pharyngeal dysphagia (PD) in this population has not been performed. This study explores PD in a large group of children with DS to assess the incidence, risk factors, and role of intervention on PD.

Method

Twenty‐year retrospective chart review; children with DS were identified by ICD‐9 codes. Multidisciplinary charts were longitudinally reviewed for medical and surgical interventions of PD. Patients were excluded if records were incomplete or could not be assessed.

Results

Two hundred twelve (m = 117, f = 95) children with DS were identified for review. One hundred seventeen (55.2%) patients (m = 67, f = 50) demonstrated PD by video fluoroscopic swallow study (VFSS) with an age range of 0.24 to 24.67 years. The mean age at first diagnosis was 1.69 years. Seventy‐eight patients with PD underwent 1 or more surgeries for upper airway obstruction (UAO). A laryngeal cleft was identified in 3 patients. At the time of the study, PD was unresolved in 97 patients (average age = 6.57 years) and resolved in 20 (average age = 6.72 years). Surgical procedures for UAO had no significant impact on PD.

Conclusion

This study suggests that PD is common (greater than 50%) and should be routinely explored in children with DS. Laryngeal clefts and surgical intervention for UAO do not appear to play a significant role in PD for DS patients.
SurgiSIS Myringoplasty: A 10‐Year Study in Children
Authors: D’Eredita Riccardo
Published: February 2015

Objective

SurgiSIS is a bioactive material derived from porcine small intestinal mucosa (SIS). This material promotes early vessel growth, provides scaffolding for the remodeling tissues, and is inexpensive and ready‐to‐use. We evaluated efficacy, safety, and surgery time of SIS myringoplasty, and compared with patients’ temporalis fascia (PTF) repair in children.

Method

Prospective, 2‐group (SIS and PTF) randomized, blinded study in a tertiary‐care pediatric institution; 404 children with tympanic membrane (TM) repair were randomly assigned to receive SIS or PTF myringoplasty. Primary outcomes were the healing of the TM and surgical time. Ten years’ follow‐up was obtained in all enrolled children.

Results

Four hundred thirty‐two TM (217 in the SIS and 215 in the ATF groups) perforations were treated. There were 212 stable TM closures in the SIS (97.2%) and 204 (94.8%) in the PTF arm. TM closure was higher in the SIS arm. Results were not statistically significant (OR = 0.4, 95% CI 0.12‐1.41). SIS myringoplasty yielded reduced surgical time. No reaction to SIS was encountered.

Conclusion

SIS myringoplasty is a safe and effective method for TM closure in children with reduced surgical time, as compared to PTF.
The Use of Next‐Generation Sequencing for Hearing Loss
Authors: Black Angela P. , Greinwald John H. , Arumugam Sivakumaran , Kissell Diane , Husami Ammar , Tinkle Brad , Zhang Kejian
Published: February 2015

Objective

Recently, next‐generation sequencing (NGS) technology has emerged as a possible revolutionary force changing the paradigm of molecular diagnosis by offering high‐throughput sequencing. In the present study, we have evaluated the performance of NGS to identify the sequence variants in a panel of 24 genes associated with hereditary hearing loss.

Method

The coding and flanking intronic regions covering 177 kb target sequence were enriched using microdroplet PCR from 8 samples and sequenced in a single lane on Illumina HiSeq 2000 instrument. The quality filtered sequence reads were mapped to the human reference sequence. The sequence variants were evaluated using novel pathogenecity filter.

Results

Of the 1148 variants detected in all 8 samples, 810 (71%) were classified as true variants using our filtering criteria. To validate our strategy, we Sanger sequenced regions of 4/24 genes, accounting for about 25% of all target sequences. Of the 373 variants detected in these 4 genes, we classified 265 variants as potentially true using our filtering criteria. We were able to detect 259 variants found on sequencing, including deletions/insertions up to 22 bp. Our NGS‐based mutation screening strategy showed 99.99% concordance between NGS and Sanger sequencing, resulting in the analytical sensitivity and specificity of 100% and 99.99%, respectively.

Conclusion

This study demonstrated that our NGS‐based mutation screening strategy is highly sensitive in detecting sequence variants in the selected hearing loss genes. Therefore, this approach would be a good alternative to current technologies for identifying the multiple genetic causes of hearing loss.