bluuebunny/crossref_metadata_2025 huggingface dataset:
Computed Tomography in 15 Patients with Congenital Aural Atresia Treated with Floating Mass Transducer on the Round Window
Authors: Carner Marco , Colletti Liliana , Barillari Marco , Cerini Roberto , Mucelli Roberto Pozzi , Colletti Vittorio
Published: September 2011

Objective

Illustrate preoperative (to assess radiological landmarks useful for diagnosis and surgery) and postoperative (to visualize complications and evaluate the correct positioning of the FMT) imaging features in patients with congenital aural atresia (CAA) treated with the floating mass transducer (FMT) of the Vibrant Soundbridge on round window (RW).

Method

Fifteen patients, aged from 2 months to 54 years, treated with FMT on the RW for bilateral (11 patients) and monolateral (4 patients) CAA, underwent high resolution computed tomography (HRCT) scans and/or cone‐beam CT scans (CBCT) preoperatively and postoperatively at 12‐to‐60‐month follow‐up times. The first 4 patients had plain‐film X‐rays.

Results

The tympanic cavity was reduced in size in 20 out of 26 ears (76.9%). Ossicular chain abnormalities were present in all ears. These consisted most frequently of a fusion of the malleus to the incus, as observed in 15 ears (61.5%). The RW area was normal in all patients, while the oval window (OW) was stenotic in 7 ears (26.9%). The facial nerve had an abnormal course and/or caliber in 15 ears (61.5%). The mastoid was reduced in size in 9 ears (34.6%). Correct positioning of the FMT on the RW was observed in all patients at the last follow‐up.

Conclusion

Plain‐film x‐rays are not adequate. HRCT and CBCT scans permit a complete understanding of the CAA anatomy and a precise determination of the location of the FMT on RW. CBCT has a lower administered radiation dose: a very important feature as the FMT is fitted on RW in infancy.
Correlation of Measured vs Averaged 3kHz Pure Tone Averages
Authors: Gurgel Richard K. , Oghalai John S. , Chang Kay W. , Blevins Nikolas H. , Jackler Robert K. , Popelka Robert K.
Published: September 2011

Objective

AAO‐HNS reporting guidelines for hearing results recommend a pure tone average (PTA) using thresholds at 0.5, 1, 2, and 3 kHz. 3 kHz measurements, however, are not always included in routine audiometry. We determined the magnitude of PTA errors using 3 kHz thresholds interpolated from 2 and 4 kHz measurements.

Method

Retrospective analysis of audiogram data from an academic, tertiary referral center from April to August 2010. All patients (N = 1,204) in our clinic having audiograms for any reason were eligible for inclusion. Audiograms missing threshold data at any of the frequencies evaluated were excluded.

Results

The difference between calculated and measured 3 kHz was within 5 dB, 10dB, and 20dB in 89.5%, 68.9%, and 98.6% of audiograms respectively. When the 3kHz level varied more than 10 dB from actual, the error underestimated the degree of hearing loss by a 3:1 margin (7.9% vs 2.6%). The steeper the slope of the hearing loss, the greater the divergence of the interpolated value from actual. When factored into the PTA, however, measured verses interpolated thresholds at 3 kHz showed a difference within 5 dB in 98.6%, R = 0.996, with a mean difference of 0.6 dB (SD = 1.7dB).

Conclusion

While interpolation of 3 kHz introduces a degree of error in measurement of this specific frequency, the effect on PTA is minor. These data suggest that 3 kHz thresholds can be reliably interpolated using available 2 and 4 kHz thresholds when utilized in PTAs.
CT or MRI before Cochlear Implantation
Authors: Hajioff Daniel , Joy Rajive , Robinson Philip J. , MacKeith Samuel A.
Published: September 2011

Objective

Previous studies of CT and MRI before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.

Method

Clinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.

Results

A total of 27.9% (95% CI: 21.0 ‐ 35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9 ‐ 18.9). All of these were detected by MRI. They were missed by CT in 6.3% (3.1 ‐ 11.3). A total of 6.3% also had noncritical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children, but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone is estimated to miss no critical abnormalities (95% CI: 0 ‐ 2.3%).

Conclusion

MRI can detect all abnormalities critical to patient management. Most candidates for cochlear implantation can therefore be assessed by MRI initially. CT is most likely to be helpful in those with a history of severe middle ear disease, meningitis, or dysmorphic syndromes, who should undergo both CT and MRI.
Customized Web‐Based Sound/Music Therapy for Tinnitus
Authors: Djalilian Hamid R. , Ziai Kasra , McGuire John
Published: September 2011

Objective

Learn whether customized sound therapy can be delivered via the Web. Understand the efficacy of customized Internet‐based therapy in reducing tinnitus loudness.

Method

Thirty‐two subjects were enrolled. The patients matched their tinnitus frequency using a Web‐based protocol. A customized harmonic sound therapy file was downloaded by the patient onto an MP3 player. The subjects listened to the sound file for 1 hour using open‐ear headphones at a level equal to tinnitus loudness (mixing‐point).

Results

The age ranged between 32 and 67 years. Prior to harmonic sound therapy, tinnitus loudness mean was 6 (range, 0‐10) which decreased to 3.3 (range, 0‐6) after 1 hour of sound therapy. Some reduction in loudness was seen in 88%, while 72% experienced a reduction of 25% or more. Tinnitus annoyance decreased from an average of 6.1 (range, 1‐10) to 3.1 (range, 0‐8). Median duration of residual inhibition was 60 minutes, with an average of 86 minutes (range, 0‐720). The harmonic masking protocol and some characteristics associated with a significant reduction of the tinnitus will be discussed.

Conclusion

Customized sound therapy can be delivered via the internet. Harmonic sound therapy is effective in reducing the loudness and annoyance of tinnitus in a diverse group of subjects. Advantages and limitations of this method of tinnitus therapy will be discussed.
Detecting Reflux in Adults with Eustachian Tube Dysfunction
Authors: Brunworth Joseph D. , Djalilian Hamid R. , Garg Rohit
Published: September 2011

Objective

1) Ascertain whether adult patients with Eustachian tube dysfunction (ETD) have a higher incidence of reflux into the nasopharynx compared with controls. 2) Utilize recent advances in pH probe technology to detect acidity at the Eustachian tube orifice for direct comparison.

Method

A prospective study was performed on 38 adult patients in an outpatient setting between November 2009 and February 2011. Seventeen patients with Eustachian tube dysfunction and 21 control subjects had a Dx‐pH probe (Restech, San Diego, California 2006) placed near the torus tubarius in the posterior nasopharynx for 24 hours.

Results

The average pH value obtained from the nasopharynx of adults with no history of ETD was 7.03 (range, 6.10‐7.92; SD, 0.69). In comparison, the average pH for patients with ETD was 6.90 (range, 5.33‐8.06; SD, 0.77). This P value for this difference was. 48. The average number of reflux events for subjects was 0.55 events over a 24‐hour period for controls and 2.1 for patients with ETD. Decreases in pH were considered reflux events if the pH dropped below 5.5 while in the upright position or below 5.0 in the supine position.

Conclusion

By utilizing a novel pH probe that allows detection of acidity in a non‐liquid environment, a comparison of nasopharyngeal pH between control patients and those with ETD was performed. A trend toward higher numbers of reflux events was found in patients with ETD when compared to control subjects.
Digital Image Stabilization in the Treatment of Oscillopsia
Authors: Pothier David D. , Hughes Cian , Sulway Shaleen , Dillon Wanda , Rutka John A.
Published: September 2011

Objective

1) Develop real‐time image stabilization using immersive augmented reality eyewear to counteract bobbing oscillopsia in patients with bilateral vestibular loss (BVL). 2) Measure change in dynamic visual acuity (DVA) in patients with BVL using the device.

Method

Immersive virtual reality glasses used in combination with a compact digital video camera were used. A software algorithm was developed that used a center‐weighted Lucas‐Kanade optical flow method to stabilize video in real time. Six patients were tested for changes in DVA using the eyewear.

Results

The ability to read a Snellen chart during a 2Hz oscillating head rotation DVA test showed a drop in visual acuity during head movement from a mean of 7.9 (SD = 0.8) lines at rest to 3.1 (SD = 2.0) lines during a 2Hz head rotation. This improved to 5.7 (SD = 1.2) lines with image stabilization with the same 2Hz rotation (P <. 001). All reported a considerable subjective improvement in vision in addition to the Snellen chart test.

Conclusion

This is the first successful attempt to improve dynamic visual acuity in patients with bilateral vestibular loss. Recent hardware upgrades are promising in improving these results even further.
ECoG during Cochlear Implantation for Hearing Preservation
Authors: Mandalà Marco , Colletti Liliana , Colletti Vittorio
Published: September 2011

Objective

Determine if intraoperative electrocochleography (ECoG) during cochlear implant (CI) surgery provides online feedback to the surgeon to modify surgery and reduce trauma for increasing preservation of residual hearing.

Method

Seventeen adult patients undergoing CI who had measurable auditory thresholds preoperatively in the low‐ to mid‐frequencies were enrolled. Eight subjects had intraoperative compound action potentials (CAPs) measured to assess cochlear function during surgery. In those patients, surgery was modified according to ECoG feedback. Nine subjects performed CI without ECoG feedback.

Results

The average preoperative PTA thresholds (0.25‐2 KHz) were 76 ± 9 and 84 ± 12 dBHL in the unmonitored and monitored cohorts, respectively (P >. 05). CAPs recording showed latency shift (0.5‐1.5msec) and normalized amplitude deterioration (10%‐50%) during surgery. All these changes reverted to normal after electrode insertion in all but one subject. The average postoperative PTA threshold shifts (0.25‐2 KHz) were 4 ± 2 and 23 ± 11 dBHL in the monitored and unmonitored cohorts, respectively (P =. 0022). Complete hearing preservation (loss of ≤10 dB) at 6 months was achieved in 88% (7/8) of subjects who had ECoG feedback and in 33% (3/9) of unmonitored patients.

Conclusion

Monitoring cochlear function with ECoG provides real‐time feedback to the surgeon during CI surgery providing objective data to modify his or her surgical technique in ways that can improve the rate of hearing preservation.
Electroconvulsive Therapy and Cochlear Implantation
Authors: Rivas Alejandro , Hedley‐Williams Andrea , Raj Vidya , Clark Nathaniel , McRackan Theodore R. , Labadie Robert F.
Published: September 2011

Objective

Electroconvulsive therapy (ECT), used for recalcitrant psychiatric illnesses, is contraindicated in patients with cochlear implants (CI) because of potential risk of damage to the CI and/or the patient. With increasing numbers of CI recipients, ECT in this population warrants further study. Herein, we present a cadaveric study of such.

Method

Ten functional CIs were unilaterally implanted in fresh cadaveric heads. Each head then received 12 ECT treatments replicating a standard clinical treatment protocol. CI impedance testing was performed prior to and immediately after CI insertion, and then after the 1st, 3rd, 5th, 7th, 9th, and 12th ECT treatments.

Results

Twelve rounds of ECT (800 mA per treatment) were performed on each of the implanted heads by a staff psychiatrist. Measured responses were typical to those encountered clinically. Impedance measurements after each ECT treatment did not show any increases. No open circuits developed because of ECT. After the first ECT treatment there was a trend toward decreased impedance measurements, which were sustained throughout the rest of the testing. Regarding ipsilateral vs contralateral application of ECT therapy, no statistically significant differences (all P >. 5) in impedance measurements were noted.

Conclusion

ECT does not cause any electrically measureable damage to CIs via either ipsilateral or contralateral therapy. Coupled with case reports on the safety of ECT in patients with CIs and similar technology (ie, deep brainstimulators), this study suggests that ECT can be safely used in patients with CIs.
Etiologic Diagnosis of Nonsyndromic Genetic Hearing Loss in Adult vs Pediatric Populations
Authors: King Peter , Angeli Simon I. , Ouyang Xiaomei , Liu Xue‐Zhong
Published: September 2011

Objective

1) Determine the diagnostic yield of a shared genetic screening algorithm in adult and pediatric populations with sensorineural hearing loss (SNHL). 2) Recommend effective testing strategies to evaluate for genetic causes of deafness in patients presenting with idiopathic sensorineural hearing loss.

Method

A total of 221 adult and 163 pediatric patients with non‐syndromic sensorineural hearing impairment were recruited from otology clinics between 2001 and 2011. Peripheral blood samples were screened for mutations in GJB2 and GJB6 and mitochondrial DNA mutations 1555A>G, 7444G>A, and 3243A>G. Audiometric data and family history were also collected.

Results

GJB2/GJB6 related deafness was diagnosed in 23 out of 163 pediatric patients (14%) compared with only 3 out of 221 adults (1%). All 3 adults had a family history of hearing loss, and 2 patients noted deafness onset at birth. Nineteen GJB2 mutations were identified with 35delG, the most common mutation. The 35delG homozygous state was the most common pathogenic genotype (54%). Mitochondrial DNA (mtDNA) mutations were found in 6 adult probands (3%). No mtDNA mutations were found in pediatric patients.

Conclusion

Testing for common GJB2/GJB6 mutations in pediatric patients has considerable value in establishing an etiologic diagnosis for SNHL. Similar testing in adults is of very low yield except perhaps in cases of early onset HL or strong family history. Mitochondrial DNA testing should be considered in adults with idiopathic SNHL.
Inner Ear Anomalies and Risk for Stapedectomy
Authors: Brickman Daniel S. , Warren Frank Manley
Published: September 2011

Objective

1) Quantify the anatomic relationships within the vestibule of temporal bones with known inner ear malformations that are relevant to stapes surgery complication rates. 2) Evaluate for pathologic evidence of stapes complications in temporal bones with structural inner ear malformations that have undergone stapes surgery.

Method

Sensorineural hearing loss after primary stapes surgery is rare. Histologic examinations in these cases have identified hydrops formation, scala media atrophy, adhesion formation, and perilymph fistula. The study is a pathologic review of the National Temporal Bone Database for cases of inner ear malformations with and without otosclerosis.

Results

The database contains 7,490 subjects with greater than 12,000 temporal bone specimens from 16 institutions. Database queries yielded 122 examples of structural inner ear malformations not related to chronic ear disease or malignancy. Of these, 10 had pathologic evidence of otosclerosis, and 6 of these had stapes surgery performed. Though retrospective and with malformations diagnosed postmortem, the clinical record of this group noted no operative complications. Only 1 of these 6 patients had documented worsening of hearing from the first to last clinical visit. Four of 6 patients had documented hearing improvement.

Conclusion

The decision to perform stapes surgery in patients with known inner ear malformations has been dictated by surgical dogma in the past. This review may lend histopathological evidence to loosen those criteria, though more rigorous clinical testing is needed.
Double‐Doyle Intranasal Airway Splint Technique
Authors: Paik Young S. , Rice Gabriel , Liess Benjamin D. , Renner Gregory J.
Published: September 2011

Objective

Present a novel technique utilized by the senior author for support of unstable, comminuted nasal bone fractures and its adaptation to rhinoplasty and septal surgery to provide greater stabilization of the nasal septum and bones. Illustrate safe and adequate results with this technique.

Method

Retrospective chart review of the senior author’s past surgical procedures since 2001 utilizing this Double‐Doyle intranasal airway splint technique. Patient demographics, diagnoses, surgical procedure, stenting duration, and complications were identified. This technique involves 2 modified Doyle II intranasal airway splints (Medtronic) to provide greater intranasal support.

Results

Eighty‐seven cases involving the Double‐Doyle intranasal airway splint technique performed for closed nasal reduction, selected cases of open rhinoplasty, and septal procedures revealed overall that this intranasal splint modification was safe, tolerated well by patients, and presented minimal morbidity. All but one patient experienced a successful cosmetic and functional outcome as described by the senior author. Six overall possible complications were noted; 3c cases of minor nasal mucosa damage and 3c cases of possible infection that resolved after removal of the splint and treatment with antibiotics.

Conclusion

We present a safe technique that provides prolonged nasal dorsal support in severely comminuted nasal bone fractures without the need for external suspension devices or additional incisions. Additionally, this technique may be applied to rhinoplasty and septal procedures involving significant septal correction to allow greater stabilization of the septum postoperatively.
Isolation of Transtympanic Characteristics Utilitizing a High‐Definition Video Otoscope at Individual Visible Light Frequencies
Authors: Roehm Corrie , Valdez Tulio A.
Published: September 2011

Objective

Otoscopic diagnosis has relied on virtually unchanged century‐old otoscopic technology utilizing white light reflection from the tympanic membrane to the examiner. The utility of a specific visible light video‐otoscopic alternative was investigated using multiple wavelengths including 405, 450, 532, and 635 nanometers to isolate unique transtympanic characteristics.

Method

High‐definition tympanic membrane images of normal adult subjects were obtained under 405, 450, 532, and 635 nanometer (nm) wavelength illumination using a high‐definition color CCD camera video otoscope.

Results

Under 405 nm wavelength light, improved definition of the ossicles and promontory was seen compared with white light and the other 3 individual wavelengths. Large absorption by hemoglobin along the annulus and malleus was seen using 532 nm wavelength. Cerumen and keratin debris were found to have highly reflective properties on both 405 nm and 450 nm wavelength.

Conclusion

Specific visible light reflectance high‐definition CCD otoscopy at 405 and 450 nm wavelengths offers additional definition of transtympanic features over traditional white light otoscopy, specifically highlighting bony landmarks including the ossicular chain and promontory.
Jellyfish Model for Aminoglycoside Toxicity
Authors: McAfee Jacob Seth , Strasnick Barry
Published: September 2011

Objective

Pharmacologic ototoxicity is well described in the medical literature, yet efficient models are lacking. Aurelia aurita aphyrae, transparent jellyfish with identifiable, easily stained hair cells, are effective models because hair cell changes are readily observed and ototoxicity is manifested behaviorally. We treated ephyrae with various gentamycin dilutions, evaluated motility, and quantified structural changes.

Method

Cultured Aurelia aurita polyps underwent strobilation, yielding ephyrae. Baseline pulsing (P), swimming (S), and orientation (O) values were recorded. Ephyrae were transferred to test tubes containing artificial sea water (ASW) or gentamycin (GM). P, S, and O were scored at 30 minutes, 1 hour, 12 hours, and 24 hours. Ephyrae were fixed in formalin, and hair cells were stained and imaged with confocal microscopy, then analyzed with Metamorph image processing program.

Results

P was impaired in a dose dependent fashion, with controls maintaining baseline P, S, and O values through 48 hours. Impairment of S and O occurred with 3.5 mM GM at 12 and 24 hours. Changes occurred rapidly (within 30 minutes) and were stable at 24 hours. For 6 experiments using 10 ephyrae (n = 60), at 24 hours P was reduced on average from 75 in ASW to 29, 12, and 2 for GM concentrations of 1, 2, and 3.5 mM, respectively (P <. 001 in all cases compared with control). Hair cell loss per rhopalia at 48 hours (3.5 mM GM) compared with control was significant (36 vs 43, P <. 002), correlating with motility.

Conclusion

The ephyrae model readily demonstrates functional and histological impairments when treated with GM, showing promise as a tool for ototoxicity screening and identification of chemoprotective agents.
Low‐Cost Auditory Biofeedback for Bilateral Vestibular Loss
Authors: Pothier David D. , Hubbard Bradley , Hughes Cian , Sulway Shaleen , Dillon Wanda , Rutka John A.
Published: September 2011

Objective

1) Develop an auditory biofeedback device based on the Apple iPod Touch. 2) Investigate the efficacy of auditory biofeedback for patients with bilateral vestibular loss (BVL) using posturography.

Method

The “Vestio” vestibular prosthesis provides auditory biofeedback via a small head‐mounted device that can be housed in a cap. It uses inputs from the iPod’s onboard accelerometer and gyroscope to determine head movement. This generates auditory biofeedback using a combination of pure tone sounds and wide‐band pulses.

Results

Following a short training period, 5 patients with BVL were tested using the modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Path length and COP were determined for each participant with Vestio turned off then repeated with the Vestio device turned on. These were compared using path length and sway. Both were found to be statistically significantly improved (P =. 001). Repeat testing without the device showed a return to pre‐test conditions. Patients in our pilot study went from falling on a hard surface with their eyes open to being stable on a compliant surface with their eyes closed.

Conclusion

Auditory biofeedback can be successfully applied using this specialized software on a widely available, low‐cost device. Further work is being undertaken to exploit real‐time gait measurement to incorporate a walking version of the algorithm.
Mastoidectomy Cavity Obliteration with Bioactive Glass
Authors: Silvola Juha Tapio
Published: September 2011

Objective

1) Show that mastoid cavities with continuous infections and cleaning problems can be obliterated with bioactive glass (BG). Bioactive glass S53P4 inhibits bacterial growth, turns slowly into bone, and activates new bone formation. 2) Present results of a pilot study for 16 operations on adults.

Method

A prospective follow‐up of mastoid obliterations started in 2007. The mean follow‐up time is 1.16 years. Fourteen ears had a large open radical cavity with recurrent infections. Two ears had discharge and pain after simple mastoidectomy. A re‐mastoidectomy included support of the cavity skin and obliteration with BG.

Results

All ears become dry. One reoperation was needed, as the fascia support to the EC skin was too weak and part of the BG leaked into the EC. The ear stayed dry, and the missing BG was replaced in a reoperation. A slightly short musculoperiosteal flap supported the EC skin in one ear. A minor amount of BG leaked into the EC. The ear stayed dry. The aim was an ample ear canal (EC). One ear was overfilled and waits for meatoplasty. Simple mastoid cavities were isolated from the middle ear and became asymptomatic.

Conclusion

BG works as obliteration material in problematic open radical cavities safely and with success. BG seems to tolerate chronic infection in the mastoid and prevent postoperative infections.
Ménière Disease: Intratympanic Gentamicin or Dexamethasone
Authors: Casani Augusto P. , Cerchiai Niccolò , Seccia Veronica , Dallan Iacopo , Sellari Stefano
Published: September 2011

Objective

Determine the efficacy (control of acute vertigo attacks) and effects on hearing (evaluated by pure tone average, PTA, and speech discrimination score) of low dose intratympanic gentamicin (IG) compared with intratympanic dexamethasone (ID) in patients with unilateral intractable “definite” Ménière Disease (MD).

Method

This was an open, prospective study. Sixty patients affected with unilateral MD were enrolled between January 1, 2007, and June 30, 2008. A total of 32 patients were treated with IG (maximum 2 injections); 28 patients were treated with ID (4 mg/ml, 3 injections at intervals of one every three days).

Results

At 2‐year follow‐up, in the gentamicin group, complete control of vertigo (class A) was achieved in 26 patients (81%), and substantial control of vertigo (class B) was achieved in 4 (12.5%). In the ID group, complete control of vertigo was obtained in 12 patients (43%), and substantial control was achieved in 5 (18%). Nine patients (32%) reported limited control despite 1 to 2 series of retreatment with ID. In the gentamicin group, 4 patients showed a reduction of PTA of 10 or more decibels. In the ID group, PTA results improved in 10 patients, were unchanged in 7 (belonging to class A‐B), and were worse in 11.

Conclusion

The results of this study suggest that IG achieved better outcome than ID in the control of vertigo attacks, with a very low incidence of hearing deterioration. ID was associated with good hearing preservation (only in class A‐B subjects), but the control of vertigo spells showed a high failure rate.
Microbiology Reporting of Ear Swab Results in Otitis Externa
Authors: Geyer Marcel , Howell‐Jones Rebecca , Cunningham Richard , McNulty Cliodna A. M.
Published: September 2011

Objective

To review current microbiology laboratory reporting of ear swab specimens in primary care and reach an evidence‐based reporting policy consensus.

Method

Prospective primary care study commenced June 2006. Analyzed 50 consecutive ear swab reports of otitis externa from 12 laboratories in the southwest UK to determine reporting practice. The HPA GP Laboratory Use Group achieved consensus of expert microbiology opinion for reporting using a modified version of the Delphi technique.

Results

487 reports were reviewed (54% female; 46% male). Pseudomonas species (36%), Staphylococcus species (21%), Streptococcus species (15%), and fungi (11%) predominated. Five reporting policies agreed. Policy 1: Common pathogens (above) — “Reported by name with antibiotic susceptibilities.” Policy 2: Pseudomonas species— “Always reported; antibiotic susceptibilities in severe disease.” Policy 3: Aspergillus, Candida, coliform etc— “Only reported if moderate numbers of colonies and predominant organism present; if appropriate report antibiotic susceptibilities.” Policy 4: Coagulase‐negative staphylococci, diphtheroids— and enterococci, “generic terms used; susceptibilities not reported.” Policy 5: “When antibiotic susceptibilities reported, these should include susceptibility to a topical antibiotic.”

Conclusion

This paper provides microbiology laboratories with consensus reporting guidelines for ear swabs of otitis externa.
Effect of Glucocorticoids on Facial Nerve Injury
Authors: Seth Rahul , Alam Daniel , Ghosh Debabrata , Rajasekaran Karthik , Meltzer Noah , Revenaugh Peter , Kaltenbach James A.
Published: September 2011

Objective

Examine the effect of both local and systemic dexamethasone administration on facial nerve return of function after complete axotomy and immediate microsurgical repair in a rat model. After nerve injury, an exaggerated neuro‐inflammatory process may hinder regeneration. Therefore, our hypothesis is that glucocorticoid administration will improve nerve recovery.

Method

A total of 74 Wistar rats underwent facial nerve axotomy with immediate neurorrhaphy. Blinded and randomized, rats were assigned a postoperative group: control (no therapy), systemic dexamethasone 0.5, 1, 5, or 10 mg/kg for 3 doses, or topical dexamethasone 2 or 4 mg/mL. Standardized facial assessments and nerve conduction studies (NCS) were performed.

Results

At 8 weeks, rats receiving systemic dexamethasone at 1 and 5 mg/kg attained greater eye blink closure (P =. 014 and P =. 018, respectively) and vibrissae motion (P =. 018 and P =. 023, respectively) compared with controls. Systemic dexamethasone at 0.5 and 10 mg/kg had similar facial motion to controls. Intraoperative topical application of dexamethasone 2 or 4 mg/mL to the neurorrhaphy site was not superior to controls. Gross facial motion assessments were corroborated with vibrissae motion frequency video analysis. NCS’s indicated an increased return of compound muscle action potential amplitude levels to baseline among rats that received systemic dexamethasone 5 mg/kg (P =. 048).

Conclusion

In a rat facial nerve axotomy model, postneurorrhaphy systemic dexamethasone therapy improved functional and neurophysiological outcomes at doses of 1 and 5 mg/kg. Locally delivered steroid was not beneficial compared with control groups. Therefore, systemic glucocorticoid administration may provide a substantial recovery benefit after facial nerve injury.
Middle Ear Myoclonus: A Treatable Cause of Objective Tinnitus
Authors: Kolb Caroline M. , Fukuda Denby , Healy David Y.
Published: September 2011

Objective

1) Describe the presentation of an underdiagnosed cause of objective tinnitus. 2) Review the current literature and present an algorithm on diagnosis and management of middle ear myoclonus. 3) Use video to demonstrate surgical ablation of the stapedial and tensor tympani tendons to alleviate middle ear myoclonus.

Method

This retrospective study analyzes the presentation and management of 6 patients diagnosed with middle ear myoclonus from 2009 to 2011. A review of the literature revealed 15 additional cases of middle ear myoclonus. An algorithm for the diagnosis and management of these patients is presented.

Results

We report on the diagnostic findings of 6 patients identified at a tertiary care military medical center with middle ear myoclonus. Four of the 6 patients had a significant history of loud, explosive noise exposure during military deployments. Patients were diagnosed based on history, examination findings, and standard audiometry testing using a nonstimulated, spontaneous acoustic reflex decay tracing. Fifteen additional reported cases of either stapedial or tensor tympani myoclonus were identified in the English language literature. Observation, medications, botulinum toxin, and surgical sectioning of the stapedius and/or tensor tympani are recognized treatments of this disorder.

Conclusion

Middle ear myoclonus is an underdiagnosed cause of objective tinnitus likely due to lack of familiarity with diagnostic findings. For symptomatic myoclonus, middle ear exploration with transection of the stapedius tendon, tensor tympani tendon, or both demonstrated the best outcomes, with 100% of patients achieving complete relief of tinnitus.
Neurofeedback‐Based, Vestibular Rehabilitation in Ménière Disease
Authors: Ernst Hamid R. , Basta Dietmar
Published: September 2011

Objective

Report on the effects of a neurofeedback‐based vestibular training (VT) with a recently developed vibrotactile prosthesis (VertiGuard RT) in patients with stage IV Ménière disease (due to AAO‐HNS) and resulting otolith disorders (ie, macular degeneration).

Method

A total of 17 patients with long‐standing, bilateral Ménière disease were diagnosed with accompanying otolith (macular) disorders. The patients were free of vertiginous (Ménière) attacks but complained of an increased sway in roll/pitch (DHI 56.3 mean). Otolith diagnostics (VEMP, eccentric rotation) revealed combined sacculo‐utricular (12) and bilateral utricular (5) degeneration.

Results

All patients were tested with the standard balance deficit test, and the 6 worst test conditions were used for the neurofeedback‐based training. Body sway could be reduced by 36% in roll and by 35% in pitch, and DHI scores were reduced by 25 points on average.

Conclusion

Neurofeedback‐based vestibular rehab with a recently developed, vestibular prosthesis (VertiGuard RT) gives long‐term, postural stability to patients with otolith degeneration as late sequaelae of Ménière disease.
Outpatient Labyrinthectomy
Authors: McKennan Kevin X.
Published: September 2011

Objective

With newly available anti‐nausea/vertigo medications, selected patients can undergo transmastoid labyrinthectomy as an outpatient procedure.

Method

Ten patients pretreated with a cocktail of Emend/Transderm Scop Patch/Decadron underwent a transmastoid labyrinthectomy. These patients were all treated as outpatients. These 10 patients will be compared with 10 similar patients hospitalized after surgery.

Results

Substantial financial savings occurred to those patients treated as outpatients. No patients treated as outpatients required admission to the hospital.

Conclusion

Selected patients with Ménière can undergo a transmastoid labyrinthectomy as an outpatient operation when pretreated with a combination of Emend/Transderm Scop Patch/Decadron.
Predictors for Outcomes in Pediatric Stapedectomy
Authors: Zang Richard , Neilan Ryan E , Isaacson Brandon , Roland Peter S. , Lee Kenneth H. , Kutz J. Walter
Published: September 2011

Objective

Identify predictive factors for successful stapedectomy in children under 17 years old.

Method

A retrospective chart review was performed from January 1, 1999 until January 1, 2011, to identify patients under 17 years old who underwent a stapedectomy. Age, gender, pre‐ and postoperative audiograms, intraoperative findings including cause of stapes fixation, type of prosthesis used, and complications were recorded.

Results

Eighteen children were identified who had undergone a stapedectomy. The cause of fixation included otosclerosis (n = 7), congenital footplate fixation (n = 9), and unknown cause (n = 2). The overall mean preoperative air‐bone gap (ABG) was 35.7 dB (±10.4), compared with a postoperative mean ABG of 15.1 (±15.6) (P < 000.1). The mean postoperative ABG of 14.5 (±5.3) in the congenital footplate fixation group was lower than the mean postoperative ABG of 24.25 dB (±5.8) in children with otosclerosis, although this did not reach statistical significance (P = 0.236). One patient developed profound sensorineural hearing loss three weeks after surgery.

Conclusion

Pediatric stapedectomy has comparable results with stapedectomy in adults regardless of the cause of stapes fixation.
Quantifying Tinnitus: Measurement of Cortical Thickening
Authors: Natt Ravinder Singh , Aldhafeer F. , Sluming V. , Mackenzie Ian J.
Published: September 2011

Objective

Tinnitus is an auditory phenomenon categorized by perception of sound without external stimuli. The purpose of this study is to investigate radiological brain structural changes in tinnitus patients, in particular cortical thickness changes, and correlate these with severity of tinnitus as measured by the Newman Tinnitus Handicap Inventory score.

Method

Liverpool Research Ethics Committee provided approval. Patients were recruited from audiology clinics. Cortical thicknesses of tinnitus patients were measured using a 1.5T MRI‐scanner. In total 8 patients with bilateral tinnitus and 7 healthy control subjects without tinnitus were recruited for comparison. Data were analyzed using Brain Voyager QX.

Results

The 8 bilateral tinnitus patients had a mean Newman‐score of 60. Right hemisphere: significant cortical thinning found in middle temporal gyrus (P =. 0081), inferior temporal gyrus (P =. 052), precentral gyrus (P =. 032), postcentral gyrus (P =. 031), and temporal lobe (P = 0.023) in tinnitus patients compared with controls using the t test. Left hemisphere: significant cortical thinning was found in prefrontal gyrus (P =. 058), middle frontal gyrus (P =. 058), and posterior cingulate cortex (P =. 045). Individual cortical thickness results analysis did not reveal correlation between tinnitus severity and cortical thinning.

Conclusion

Preliminary evidence is presented, establishing a quantitative measure for tinnitus‐related structural changes in cortical thickness. Reduced cortical thickness may contribute to negative emotions experienced by tinnitus sufferers. Findings are consistent with posttraumatic stress disorder studies. Similar treatment strategies may be employed for tinnitus patients. A larger population size is being assessed.
Facial Artery Mucosa Muscular Flap: Possible after Oral Chemoradiotherapy
Authors: Valette Gerald , Rogez Florence , Potard Gael , Delahaye Laurent , Marianowski Remi , Abgral Ronan , Gauvin Yves
Published: September 2011

Objective

The Facial Artery Mucosa Muscular (FAMM) Flap, described by Pribaz in 1992, can be used in oral surgery on different indications. The primary reconstruction after the resection for an oral cancer is the most evaluated indication.

Method

Thirty‐five cases from the University Hospital of Brest Head and Neck Surgery Center between April 2007 and November 2010 were analyzed in a retrospective study. The indication, the status of treatment (post chemoradiotherapy or not), complications (hematoma, infection, necrosis), the weaning delay of the pedicula, and time to an oral feeding were all analyzed.

Results

Twelve cases for primary reconstruction, 7 cases for buccosinusis defect and 16 cases in osteoradionecrosis. One case of hematoma, no infection and no necrosis were observed. One case did not give a good result. There is no difference in terms of viability between postchemoradiotherapy surgery. The weaning delay and the time delay to an oral feeding is twice longer after radiotherapy.

Conclusion

This flap can be used after radiotherapy with a precaution of care. The FAMM flap represents a good solution event after chemoradiotherapy for the loss of medium size substance, it represents a good solution between directed healing and more consistent skin flaps.
Symptom Timeline Preceding Cochlear Implant Failure
Authors: Roby Brianne Barnett , Ferrello Melissa , Rimell Frank L. , Levine Samuel C. , Huang Tina C.
Published: September 2011

Objective

1) Review cochlear explants and determine the incidence of device and medical failures. 2) Develop a pattern of symptoms indicating probable implant failure.

Method

This is a retrospective chart review at a tertiary referral center. Subjects were selected if they underwent cochlear explantation. A total of 847 implants were performed from 1988 to 2008, with 128 devices explanted. Data were reviewed to determine initial symptom and symptom timeline preceding implant failure.

Results

Of total implants, 72% were Advanced Bionic devices, 28% were Nucleus. Overall failure rate was 128 out of 847 (15%). Patients with Advanced Bionic devices underwent 102 explants (16.7% failure rate), with 35% medical failures and 65% device failures. Patients with Nucleus devices underwent 26 explants (11% failure rate), with 58% medical failures and 42% device failures. Medical failures included infected devices and wound dehiscence, the pattern averaging 4.5 months to explantation. Hard device failures included sudden malfunction and slow decline in function, with pattern of failure over 4.2 months. Soft failures included tinnitus and discomfort, with failure over 8 months.

Conclusion

There were common patterns when evaluating both medical and device failures. By recognizing patterns of symptoms that may indicate probable implant failure, otolaryngologists can better counsel patients on what to expect with their implants when they present with certain symptoms.
The Incidence and Clinical Course of Facial Nerve Paresis following Contemporary Cochlear Implant Surgery
Authors: Thom Joshua , Neff Brian A. , Beatty Charles W. , Driscoll Colin L. W. , Carlson Matthew
Published: September 2011

Objective

In contemporary otologic surgery, iatrogenic facial nerve paresis is an uncommon but distressing complication. This study will describe our institutional experience with facial nerve injury following cochlear implantation. We report the incidence, clinical presentation, course, and possible mechanisms of facial nerve paresis following implantation surgery and review the relevant literature.

Method

A retrospective chart review at a tertiary otologic referral center (teaching hospital) including all patients who underwent cochlear implant surgery between 2000 and 2010. Patients experiencing postoperative facial nerve weakness were identified, and data were gathered with respect to intraoperative findings, onset, severity, management strategy, and level of recovery.

Results

In the past decade, 815 implant surgeries were performed at our institution. All patients underwent a limited mastoidectomy with posterior tympanotomy (facial recess) approach, and intraoperative electromyographic facial nerve monitoring was routinely employed. No patients experienced immediate paresis while 5 implantees (0.6%) developed delayed onset weakness. All 5 patients were treated with steroid therapy, and all but one recovered to a House‐Brackmann grade 1 (of 6) facial nerve function within 6 months of surgery.

Conclusion

The incidence of temporary facial nerve paresis following cochlear implantation at a tertiary teaching hospital was 0.49% while the incidence of permanent incomplete paralysis was 0.12%. Thermal injury and/or reactivation of latent virus with progressive neuroedema and subsequent delayed weakness are the most likely mechanisms of injury.
Three‐Week Loading for Baha BI‐300 Implant System
Authors: Wazen Jack J. , Wycherly Benjamin , Darley David S. , Babu Seilesh , Daugherty Julie
Published: September 2011

Objective

Loading of titanium craniofacial implants is dependent upon osseointegration, the bonding of titanium oxide and bone. The purpose of this study seeks to determine the safety of early loading of the Baha BI‐300 implant system (Cochlear Limited, Englewood, Colorado), which has been modified with novel surface texture and geometric design.

Method

This prospective multi‐institutional study follows implant stability as determined by clinical evaluation and resonance frequency analysis (RFA) at implantation, 1, 3, 6, 12, and 24 weeks postopative, in 20 patients who underwent single‐stage implantation and exteriorization of the BI‐300. The processor was loaded at 3 weeks postoperative.

Results

Implant stability and the incidence of implant loss was compared with patients loaded at 6 weeks and the traditional 12 weeks postoperative. Our preliminary results confirm implant stability at 3 weeks postoperative. No increase in implant loss or postoperative complications were encountered as a result of the early loading.

Conclusion

Three‐week loading of the BI‐300 implant did not result in any failure of osseointegration. Earlier activation of the external processor with earlier hearing rehabilitation resulted in improved patient satisfaction.
Tumor Necrosis Factor Alpha Ototoxicity Is Associated with Upregulation of Smac/Diablo Gene Expression in Rat Organ of Corti Explants
Authors: Dinh Christine Thuyvan , Dinh John , Vu Ly , Yan Denise , Liu Xue‐Zhong , Van De Water Thomas
Published: September 2011

Objective

1) Review the role of tumor necrosis factor alpha (TNFa) in programmed cell death of auditory hair cells (AHCs) in organ of Corti (OC) explants in vitro. 2) Understand effects of TNFa on Smac/Diablo gene expression in TNFa‐induced apoptosis of OC explants in vitro.

Method

OC explants were dissected from 3‐day‐old rat pups and cultured in (1) no treatment – control and (2) TNFa (2ug/mL) for 96 hours in vitro for hair cell count studies and 24 and 48 hours in vitro for gene expression studies for GAPDH and Smac/Diablo genes.

Results

There are statistically significant decreases in the numbers of viable inner and outer hair cells in TNFa‐treated OC explants, when compared with the control group. Gene expression of pro‐apoptotic Smac/Diablo is significantly increased at 48 hours in vitro (but not at 24 hours), when compared with controls. On‐going studies are evaluating the expression of Smac/Diablo gene at 72 and 96 hours in vitro.

Conclusion

The role of Smac/Diablo gene expression has not previously been studied in TNFa‐challenged OC explants. These results suggest late up regulation of Smac/Diablo expression in TNFa ototoxicity, which may be important for the propagation of the apoptosis pathway in OC explants in vitro. (NIDCD RO1‐05575)
Fibula Flap Donor Site Wound Healing with Compression Stockings
Authors: Seaman Bradley J. , Budacki Ross , Reilly Michael J.
Published: September 2011

Objective

Investigate the efficacy of graduated compression stockings (GCSs) at improving donor site skin graft take after fibula free flap (FFF).

Method

Retrospective review of 12 patients (13 donor sites) that underwent FFF for mandibular reconstruction over a 1‐year period. One‐third of the patients were instructed to use graduated compression stockings after removal of the initial wound‐vac dressing. Wound healing was followed closely for all patients. Operative and comorbid factors were reviewed.

Results

Two patients reported regular GCS use and 2 were non‐compliant. Both patients with regular use had excellent wound healing and 90% to 100% skin graft take. Of the remaining 11 donor sites, 3 had no wound complications, 4 had minor wound complications, 3 had major wound complications, and 1 was lost to follow‐up. Skin graft area varied with an average of 25 cm2 for GCS patients and 60 cm2 for non‐GCS. Cardiovascular disease, alcohol use, and smoking were more common among the non‐GCS group with strong tendency toward patients with major wound complications. Other operative and comorbid factors were similar between groups.

Conclusion

Graduated compression stocking use demonstrates some promise for use in fibula free flap donor site healing. Patients wearing GCSs had excellent wound healing and no morbidities related to their use. Further studies are warranted to determine if improvement in fibular donor site wound healing occurs with GCS use.
Type of Electrode Insertion and Hearing Preservation Outcomes
Authors: Rivas Alejandro , Forero Victor H. , Rivas Adriana , Haynes David S. , Rivas Jose A. , Wanna George
Published: September 2011

Objective

Assess the levels of hearing preservation during cochlear implant surgery by comparing different electrode insertion techniques (standard cochleostomy, soft surgery, round window).

Method

Retrospective chart review looking at levels of hearing preservation after cochlear implantation in children and adults, using different electrode insertion techniques (N = 144 ears from 32 patients). Pre‐ and postoperative pure tone thresholds at 250, 500, and 1000 Hz frequencies were measured. Statistical analysis was performed using nonparametric method (Kruskal Wallis test).

Results

One hundred and four (72%) procedures were performed using standard cochleostomy, 25 (17 %) procedures were performed using soft surgery, and 15 (11 %) procedures were performed using round window insertion. Postoperative hearing thresholds were used as the main outcome measure. In all groups, residual hearing was preserved in different degrees (total: 30 %, moderate: 27 %, marginal: 37 %, none: 6 %). Statistically significant differences were encountered between the 3 groups. Soft surgery technique and round window insertion had better hearing preservation results compared to standard cochleostomy (P <. 008 and P <. 009, respectively). No difference between round window and soft surgery techniques was encountered (P =. 07).

Conclusion

Although cochlear implants are a revolutionary technology, they carry the risk of destroying residual hearing. Our study demonstrates that the use of soft surgery or round window techniques warrants better residual hearing when compared to standard cochleostomy.