bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision Rates after Endoscopic Sinus Surgery: A Recurrence Analysis
Authors: Mendelsohn Daniel , Jeremic Goran , Wright Erin D. , Rotenberg Brian W.
Published: October 2014

Objectives:

Chronic rhinosinusitis with nasal polyposis is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. We used a contemporary database to investigate recurrence and revision surgery rates following endoscopic sinus surgery.

Methods:

We performed a cohort study using a survival analysis technique. Records were reviewed of 549 patients with nasal polyposis who underwent endoscopic sinus surgery over a 10-year period. The main outcome measure was disease-free and surgery-free survival following endoscopic sinus surgery, investigated with Kaplan-Meier analyses.

Results:

Patients with Samter's triad were significantly more likely to have a recurrence and undergo a second surgery following recurrence (risk-odds ratio, 2.7; 95% confidence interval, 1.5 to 3.2; p < 0.01) than were patients without asthma or with only asthma from the triad. The presence of initial frontal sinus disease also increased the likelihood of revision surgery (risk-odds ratio, 1.6; 95% confidence interval, 1.2 to 1.8; p < 0.05).

Conclusions:

This is the first study to use survival analysis to document revision surgery rates following endoscopic sinus surgery. Revision surgery occurs at a high rate, especially in patients with asthma, Samter's triad, or frontal sinus disease. Patients should routinely be informed during clinical consultations about the likelihood of recurrence. Early intervention for frontal sinus disease may be considered.
Audioprofile-Directed Successful Mutation Analysis in a DFNA2/KCNQ4 (p.Leu274His) Family
Authors: de Heer Anne-Martine R. , Schraders Margit , Jaap Oostrik , Hoefsloot Lies , Huygen Patrick L. M. , Cremers W. R. J.
Published: October 2014

Objectives:

We undertook to show that in a family with nonsyndromic autosomal dominant sensorineural hearing loss, genetic analysis can be successful when there is a match with a specific DFNA audioprofile. We also provide an update of relevant DFNA2/ KCNQ4 audioprofiles and report the results of automatic audioprofile analysis using the Internet program AudioGene.

Methods:

Audiometric data and blood samples were obtained from the family W08-0384. Based on the audiograms of the affected participants, mutation analysis of KCNQ4 was started. Original audiometric threshold data were collected for all identified KCNQ4-related DFNA2 families. The Internet computer program AudioGene, recently developed for automatic audioprofile analysis, was accessed.

Results:

The family's audioprofile and the program AudioGene predicted the DFNA2/ KCNQ4 locus. Mutation analysis of KCNQ4 revealed a c.821T>A (p.Leu274His) mutation of the KCNQ4 gene. This mutation has been previously identified in a Dutch family. Genetic analysis revealed a common haplotype in these two families over a region including the KCNQ4 gene.

Conclusions:

Familiarity with the audioprofiles of DFNA traits may lead to successful mutation analysis of the gene involved, even in a small family in which genetic linkage analysis is not an option. Alternatively, the specially developed program AudioGene can be accessed on the Internet to perform automatic audioprofile analysis of a family's (audiological) phenotype.
Comparative Case Series of Exostoses and Osteomas of the Internal Auditory Canal
Authors: Baik Fred M. , Nguyen Linda , Doherty Joni K. , Harris Jeffrey P. , Mafee Mahmood F. , Nguyen Quyen T.
Published: October 2014

Exostoses and osteomas are benign bony lesions of the auditory canal. Although common in the external auditory canal, they are rare and difficult to distinguish in the internal auditory canal (IAC). In this literature review and case presentation, we define radiologic and histologic criteria to differentiate exostoses from osteomas of the IAC. Two patients with exostoses and 1 patient with an osteoma of the IAC are described here. Patient 1 presented with disabling vertigo and was found to have bilateral exostoses with nerve impingement on the right. After removal of the right-sided exostoses via retrosigmoid craniotomy, the patient had complete resolution of her symptoms over 1 year. Patient 2 presented with bilateral pulsatile tinnitus and vertigo and was found to have bilateral IAC exostoses. Patient 3 presented with hearing loss and tinnitus, and a unilateral IAC osteoma was ultimately discovered. Because of the mild nature of their symptoms, patients 2 and 3 were managed without surgery. We show that IAC osteomas can be differentiated from exostoses by radiographic evidence of bone marrow in high-resolution computed tomography scans, or by the presence of fibrovascular channels on histologic analysis. Management of these rare entities is customized on the basis of patient symptoms.
Effects of Liquid Type, Delivery Method, and Bolus Volume on Penetration-Aspiration Scores in Healthy Older Adults during Flexible Endoscopic Evaluation of Swallowing
Authors: Butler Susan G. , Stuart Andrew , Case L. Douglas , Rees Catherine , Vitolins Mara , Kritchevsky Stephen B.
Published: October 2014

Objectives:

The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES.

Methods:

We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows.

Results:

The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively.

Conclusions:

These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.
Determination of Predictive Factors of Tracheobronchial Prosthesis Removal: Stent Brands are Crucial
Authors: Buiret Guillaume , Colin Carole , Landry Guillaume , Poupart Marc , Pignat Jean-Christian
Published: October 2014

Objectives:

We sought to describe in a retrospective study our experience in the endoscopic management of tracheobronchial stenoses over 20 years and to determine prognostic factors of stent removal.

Methods:

We analyzed the medical records of 166 patients (111 male and 55 female) who underwent the placement of a prosthesis for all causes of tracheobronchial stenosis between 1990 and 2009.

Results:

Overall, 34% of the patients had their stents removed. The incidence of complications for the first stent was 0.08 per patient-month. One hundred five patients (63%) had no complications. In univariate analysis, stent removal was significantly linked with the stent brand. In multivariate analysis, taking into account the causes of stenosis, the stent brand appeared to be the only factor that significantly influenced stent removal. Finally, stenosis with more than 1 stent replacement was most prone to repeat endoscopies.

Conclusions:

Even though endoscopic stent placement is a relatively safe and effective treatment for tracheobronchial stenoses, particularly in cases with malignancy, complications led to stent removal in about one third of cases. The type of stent chosen is crucial.
Effects of Fenestra Size and Piston Diameter on the Outcome of Stapes Surgery for Clinical Otosclerosis
Authors: Gristwood Ronald Edward , Venables William Norman
Published: October 2014

Objectives:

We determined the effect of piston diameter (0.8 or 0.6 mm) and fenestra size (total, three-quarter, or half removal or calibrated stapedotomy) on hearing gains after stapes surgery for clinical otosclerosis.

Methods:

We analyzed the mean air conduction hearing gains at various frequencies in a sample of 911 strictly consecutive patients who underwent 1,168 stapes procedures with piston reconstruction carried out by the same surgeon between 1963 and 1979. Assiduous follow-up of patients was attempted for at least 10 years, and in some cases for 20 years. Results over time at the various audiometric frequencies were stored for computer analysis.

Results:

There is no apparent advantage of one piston diameter (0.8 or 0.6 mm) over another for hearing gains at 0.25, 0.5, 1, 2, 3, and 4 kHz. The slim piston appeared to have a significant advantage for 6 and 8 kHz at 5 to 10 years after operation, but interpretation here requires caution, because the slim piston was usually chosen for cases with a small fenestra. Of the various sizes of footplate fenestras, total removal of the stapes footplate had significantly worse air conduction results, most clearly demonstrated at higher frequencies. Below 2 kHz, there is only weak evidence that the means differ significantly at all for the different sizes of fenestra. Small fenestras (stapedotomies) appear to offer advantages for hearing gains, particularly at the higher frequencies of 3 to 8 kHz, and for at least 10 years.

Conclusions:

The diameter (0.6 or 0.8 mm) of the pistons selected for reconstruction after stapes surgery appears to have little effect on the outcome, except perhaps at 6 and 8 kHz, where the slim piston appeared to have a significant advantage. The size of the footplate fenestra is of paramount importance to the outcome. A small footplate fenestra has statistically significant advantages for hearing gain over all other sizes of fenestra (ie, total, three-quarter, or half removal of the footplate), at least for the first 10 years after surgery, at frequencies of 2 kHz and above. Total stapedectomy has given the worst results for hearing gain at frequencies above 2 kHz, and the rate of deterioration of gain over time seems to be more rapid than after small-fenestra techniques. Small fenestras are recommended as the preferred technique in all cases of surgically treatable otosclerosis.
Fitting of an 8.5-Millimeter Abutment for Bone Conduction Devices: Indications and Postintervention Course
Authors: Dun Catharina A. J. , Hol Myrthe K. S. , Mylanus Emmanuel A. M. , Cremers W. R. J.
Published: October 2014

Objectives:

We present indications and clinical outcomes of fitting an 8.5-mm abutment for bone conduction devices.

Methods:

In 39 cases with a follow-up time of more than 12 months after fitting of an 8.5-mm abutment, the preintervention and postintervention courses were retrospectively evaluated. The outcome measures were indications for fitting and complications during the preintervention and postintervention courses (local skin reaction, skin level, revision surgery, and implant loss).

Results:

Soft tissue overgrowth was the most frequent reason (31 of 39 cases) for fitting the 8.5-mm abutment. Severe skin reactions decreased by 7.9% after fitting, and the number of fixtures that remained free of any skin reaction increased by 32.2%. In 7 cases, soft tissue overgrowth required revision surgery before placement of the 8.5-mm abutment; further surgical intervention was needed only once. In 1 case, the 8.5-mm abutment was removed because of recurring soft tissue problems. No spontaneous abutment or implant loss occurred.

Conclusions:

This retrospective evaluation showed that fitting an 8.5-mm abutment is an easy step in managing soft tissue problems and preventing revision surgery. Also, it is of value in patients with a thick scalp that interferes with bone conduction device coupling. In these cases, we advise placing the 8.5-mm abutment during primary surgery.
Complications of Cochlear Implantation in Adults
Authors: Stamatiou Georgios A. , Kyrodimos Efthimios , Sismanis Aristides
Published: October 2014

Objectives:

We describe our experience of intraoperative and postoperative complications of cochlear implantation in an adult population.

Methods:

Between April 1986 and June 2010, the senior author (A.S.) performed 449 cochlear implantations in two different institutions. Of these, 212 implantations were in adults. The operative techniques were similar in all cases.

Results:

Complications were observed in 12 of the 212 adult cases (5.7%), of which 10 were major (4.7%) and 2 minor (1%). In 7 cases, reimplantation was necessitated by device failure (6 cases; 2.8%) or device extrusion (1 case; 0.5%). In 2 elderly patients (1%), a minor dural injury with a cerebrospinal fluid leak was controlled during the operation with temporalis fascia grafting. In 1 patient (0.5%), a subdural hematoma was observed after bipolar cauterization of a prominent diploic vein. In 2 subjects (1%), a wound infection was noted soon after implantation and was treated successfully on an outpatient basis.

Conclusions:

Cochlear implantation is generally a safe procedure. The most common complication was device failure. Although complications in this adult population were rather uncommon, some of them were serious, and an immediate intervention was necessary for a successful outcome.
Audiology Telepractice in a Clinical Environment: A Communication Perspective
Authors: Crowell Ellen S. , Givens Gregg D. , Jones Gloria L. , Brechtelsbauer P. Bradley , Yao Jianchu
Published: October 2014

Access to adequate hearing health care is an obstacle that many individuals face worldwide. The prospect of providing audiology services via the Internet is an attractive and viable alternative to traditional face-to-face interaction between patients and audiologists, thus affording improved access to hearing health care for traditionally underserved populations. This article details our experience of using a web-based system with wireless audiometers and videoconferencing software to administer remote audiological assessments in an active medical practice. It discusses the technological infrastructure used and the pragmatic issues that arise when the Internet, Bluetooth wireless audiometers, and videoconferencing devices are converged into a clinical setting. Patients at a local office of otolaryngologists were recruited to participate in a study in which remote assessment results were compared to those collected from a traditional face-to-face assessment. Preliminary data demonstrated that the assessment results from the two sources were comparable. We conclude that remote hearing assessment over the Internet can be achieved through a distributed system synthesized with Internet, wireless communication, and videoconferencing technologies, supported by appropriate staff.
Outcomes of Conventional Amplification for Pediatric Unilateral Hearing Loss
Authors: Briggs Lauren , Davidson Lisa , Lieu Judith E. C.
Published: October 2014

Objectives:

Although children with unilateral hearing loss (UHL) are at risk for educational difficulties and behavioral problems, the research on treatment outcomes is limited. Previous studies suggested that children with UHL would benefit from frequency-modulated assistive devices only. The objective of this study was to examine whether children with UHL would benefit from using a conventional hearing aid in the poorer-hearing ear.

Methods:

Eight children, 7 to 12 years of age, with mild to moderately severe UHL and their parents and teachers participated in this study. The participants were fitted with digital hearing aids by use of pediatric prescriptive targets. The primary outcome measures were speech perception tests in quiet and noise and subjective assessments from participants, parents, and teachers, administered before hearing aid fitting and after 3 months of hearing aid use.

Results:

The group average speech perception scores showed no significant aided benefit or detriment in any of the conditions tested. However, subjective assessments showed large significant aided benefits at home and school according to the children and their parents, and in quality of life as reported by the children with UHL.

Conclusions:

Overall, the results suggest that a hearing aid trial should be considered for children with mild to moderately severe UHL, with individual monitoring for benefit.
Epiglottic Repositioning Procedure for Supraglottic Stenosis/Collapse
Authors: Varghese Ajoy M. , Cheng Alan T.
Published: October 2014

Objectives:

Supraglottic stenosis/collapse is an uncommon condition. It can be difficult to detect and may be a cause of failed decannulation following tracheostomy. We present a novel technique to correct supraglottic stenosis/collapse.

Methods:

We performed a retrospective analysis of the records of patients in whom attempts at decannulation had failed at our center between 2003 and 2007. A subgroup with supraglottic stenosis/collapse with posterior displacement of the base of the epiglottis was identified. Our epiglottic repositioning procedure was performed in these patients. Through an external incision, the epiglottis was divided above the anterior commissure and attached to the superior border of the thyroid cartilage.

Results:

Eight decannulation failures out of 36 attempted decannulations were identified. Three of these 8 cases involved supraglottic stenosis/collapse due to posterior displacement of the base of the epiglottis. Correction of the supraglottic stenosis/collapse led to successful decannulation in all cases.

Conclusions:

Diagnosis-directed laryngoscopy is required to identify this condition. We describe precisely a technique of repositioning the epiglottis to correct supraglottic stenosis/collapse.
Comparison of Purified Plant Polysaccharide (HemoStase) versus Gelatin-Thrombin Matrix (FloSeal) in Controlling Bleeding during Sinus Surgery: A Randomized Controlled Trial
Authors: Beyea Jason A. , Rotenberg Brian W.
Published: October 2014

Objectives:

Purified plant polysaccharide (HemoStase) is a plant-derived hemostatic agent that has not previously been used in sinus surgery. This study was conducted to evaluate the effectiveness of this novel agent in the control of nasal bleeding during endoscopic sinus surgery. The volume of bleeding during endoscopic sinus surgery was hypothesized to not be statistically significantly different between a control group (gelatin-thrombin matrix; FloSeal) and an experimental group (purified plant polysaccharide; HemoStase).

Methods:

Eighteen patients with a history of chronic rhinosinusitis in whom maximal medical therapy failed who underwent endoscopic sinus surgery were randomized into one of two groups (control FloSeal group or experimental HemoStase group). In the control group, sites in the nose that were actively bleeding during the operation were controlled with FloSeal. In the experimental group, sites in the nose that were actively bleeding during the operation were controlled with HemoStase. The main outcome measure was total operative blood loss. Blood loss was the sum of blood removed by suction during the surgery (recorded in milliliters) and blood on surgical sponges (weighed and converted to milliliters). Statistical analysis was performed with the t-test and the Mann-Whitney U test.

Results:

The amounts of blood loss (mean ± SEM) were not significantly different between the FloSeal (262 ± 15 mL) and HemoStase (265 ± 33 mL) groups (p = 0.93).

Conclusions:

The results of this study demonstrate the use of a novel product for the control of intraoperative bleeding during endoscopic sinus surgery.
Balloon Dilation of the Frontal Recess: A Randomized Clinical Trial
Authors: Plaza Guillermo , Eisenberg Gustavo , Montojo José , Onrubia Tomás , Urbasos María , O'Connor Carlos
Published: October 2014

Objectives:

We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus.

Methods:

We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months.

Results:

Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed.

Conclusions:

Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.
Effect of Surgical Technique on Electrode Impedance after Cochlear Implantation
Authors: Jia Huan , Venail Frédéric , Piron Jean-Pierre , Batrel Charlène , Pelliccia Pierfrancesco , Artières Françoise , Uziel Alain , Mondain Michel
Published: October 2014

Objectives:

We compare the evolution of electrode impedance values (IVs) following either conventional cochlear implantation or implantation by the soft surgery (SS) technique.

Methods:

We performed a retrospective chart review of 20 consecutive adult patients who underwent implantation with the Nucleus CA 24 device between 2004 and 2007. Five patients with preoperative residual hearing at the frequencies 256, 512, and 1,024 Hz underwent implantation by an SS cochlear implantation technique (SS group), and the 15 other patients underwent a conventional implantation technique (conventional cochleostomy [CC] group). The active electrodes were classified as distal (17 to 22), middle (10 to 16), or proximal (3 to 9) according to their position in relation to the tip of the electrode array. Their IVs were collected at 1, 3, 12, 24, and 36 months after implantation. Changes in auditory thresholds at 3 and 24 months were reported for patients in the SS group.

Results:

The postoperative IVs of both the CC and SS groups decreased significantly between 1 and 3 months after implantation (p < 0.05) and then remained stable. The IVs after 12 months were significantly lower (p < 0.05) in the SS group than in the CC group.

Conclusions:

Patients who underwent the SS technique displayed lower long-term electrode IVs than did their counterparts in the CC group. If electrode IVs are indeed an indirect representation of cochlear fibrosis, the use of the SS technique in lieu of the CC technique could reduce fibrotic development.
Randomized Study Comparing Fascia and Cartilage Grafts in Myringoplasty
Authors: Yung Matthew , Vivekanandan Senthilnathan , Smith Philip
Published: October 2014

Objectives:

The study compares the medium-term outcomes of myringoplasty procedures using fascia and cartilage grafts.

Methods:

Patients with chronic otitis media with perforations larger than 50% of the size of the tympanic membrane were included in a randomized, controlled, prospective clinical trial. The perforations were repaired with either temporalis fascia (20 ears) or cartilage (18 ears) grafts selected randomly. A search of the literature was performed to look for other randomized studies comparing fascia and cartilage.

Results:

The graft take rates of fascia and cartilage grafts at 24 months were 84.2% and 80%, respectively. The postoperative air-bone gaps and hearing gains at 24 months were 16.97 dB and 13.63 dB, respectively, in the fascia group and 20.63 dB and 12.60 dB, respectively, in the cartilage group. There was no significant difference in the graft take rates or postoperative hearing between the two groups. The literature search identified one other randomized study comparing fascia and cartilage grafts in the repair of large perforations. The pooled data from the two studies did not show a difference in the graft take rates or hearing gains between cartilage and fascia.

Conclusions:

There was no statistical difference in the outcomes of fascia and cartilage grafts in the repair of large perforations.
Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology
Authors: Bhattacharyya Neil
Published: October 2014

Objectives:

I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States.

Methods:

I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years.

Results:

An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034).

Conclusions:

The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.
Nasal Packing with Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient with Glanzmann Thrombasthenia
Authors: Humphreys Ian , Saraiya Sonal , Belenky Walter , Dworkin James
Published: October 2014

Objectives:

Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery, laser coagulation, septoplasty, and embolization) have been described with various degrees of success.

Methods:

We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances.

Results:

Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment.

Conclusions:

To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.
Protective Effect of Systemic Administration of Erythropoietin on Auditory Brain Stem Response and Compound Action Potential Thresholds in an Animal Model of Cochlear Implantation
Authors: Quesnel Stéphanie , Nguyen Yann , Campo Pierre , Hermine Olivier , Ribeil Jean-Antoine , Elmaleh Monique , Grayeli Alexis Bozorg , Ferrary Evelyne , Sterkers Olivier , Couloigner Vincent
Published: October 2014

Objectives:

An animal model of cochlear implantation has been developed, and the hearing threshold was evaluated after different surgical procedures. The effect of perioperative systemic administration of erythropoietin on the hearing loss induced by cochlear implantation was tested.

Methods:

Twenty-nine guinea pigs with normal hearing underwent implantation of a 254-μm-diameter array through a cochleostomy. The effects on hearing of cochleostomy and transient and long-term array implantation (21 days) were assessed by testing of the auditory brain stem responses and compound action potentials. Eleven implanted animals received intraperitoneal administration of erythropoietin. Selected computed tomographic scans and cochlear histologic studies were performed 1 month after implantation to confirm proper placement of the array. The erythropoietin concentration at the time of surgery was assessed in samples of perilymph, cerebrospinal fluid, and blood.

Results:

The cochleostomy and transient array insertion had no effect on hearing thresholds. Long-term array implantation induced a stable decrease of hearing threshold (30 dB), a decrease that was reduced by 12 dB in erythropoietin-treated animals. The erythropoietin-treated animals had better hearing preservation at higher frequencies. Fibrosis surrounding the array was seen in both groups.

Conclusions:

The hearing loss observed was probably due to the presence of the array in the cochlea. The intraperitoneal injection of erythropoietin improved the hearing threshold shift induced by implantation.
Pathologic Effects of External-Beam Irradiation on Human Vocal Folds
Authors: Berg Eric E. , Kolachala Vasantha , Branski Ryan C. , Muller Susan , Johns Michael M.
Published: October 2014

Objectives:

We sought to better characterize pathologic changes that occur in the human vocal fold after radiotherapy for head and neck cancer.

Methods:

In a blinded, controlled study of archived tissue, we evaluated postirradiation salvage laryngectomy vocal fold tissue without evidence of malignant disease. Clinical and demographic patient data were collected. In a blinded fashion, irradiated tissue was compared to nonirradiated, benign control tissue. Histomorphometric analysis was used to assess muscle and collagen organization, superficial lamina propria (SLP) and vocal ligament thickness, vocalis muscle fiber area, collagen content, and hyaluronic acid content. Immunohistochemical analysis was used to assess the content of type I collagen, type IV collagen, vimentin, fibronectin, α–smooth muscle actin, matrix metalloproteinase 9, and laminin.

Results:

Twenty irradiated vocal folds were evaluated and compared to control specimens. Collagen and muscle disorganization was noted in the irradiated specimens. The SLP and vocal ligament thicknesses and the mean muscle fiber diameters did not differ significantly. The SLP fibronectin and the vocalis muscle and SLP collagen content were significantly increased in the irradiated vocal folds, and the SLP collagen content increased significantly with time between irradiation and resection. The laminin content of irradiated vocalis muscles was significantly decreased.

Conclusions:

Radiotherapy results in significant vocal fold tissue changes. Having more precisely defined these changes, we plan continued investigation seeking targeted preventive and therapeutic interventions for improved vocal quality following radiotherapy.
Neuronal Mechanisms Underlying the Laryngeal Adductor Reflex
Authors: Sun Qi-Jian , Chum Jia Min , Bautista Tara G. , Pilowsky Paul M. , Berkowitz Robert G.
Published: October 2014

Objectives:

Electromyographic studies of the laryngeal adductor reflex, glottal closure occurring in response to laryngeal stimulation, have demonstrated an early ipsilateral response (R1) and a late bilateral response (R2). To better define the physiologic properties of these responses, we recorded responses from expiratory laryngeal motoneurons (ELMs) in rats during stimulation of the superior laryngeal nerve (SLN).

Methods:

Single unit extracellular recordings were obtained from 5 ELMs, identified by their antidromic responses to recurrent laryngeal nerve stimulation and postinspiratory firing pattern, in 4 Sprague-Dawley rats.

Results:

Unilateral stimulation of the SLN (at 20 Hz) stopped both phrenic nerve inspiratory activity and ELM postinspiratory activity. However, the ELMs displayed robust tonic firing, consisting of non-respiratory burst activity and single action potentials. The single action potentials were identified as short-latency ones (5 to 10 ms) activated by ipsilateral SLN stimulation, with an occurrence rate of 90%, and long-latency ones (20 to 50 ms) activated by bilateral SLN stimulation, with occurrence rates of 47% on the ipsilateral side and 58% on the contralateral side.

Conclusions:

The R1 response appears to be the result of the short-latency action potentials, orthodromically activated by ipsilateral stimulation of the SLN. The R2 response is likely to be a result of the long-latency action potentials that can be recorded from ELMs on both sides.
In Vitro Evaluation of the iValve: A Novel Hands-Free Speech Valve
Authors: van der Houwen Eduard B. , van Kalkeren Tjouwke A. , Burgerhof Johannes G. M. , van der Laan Bernard F. A. M. , Verkerke Gijsbertus J.
Published: October 2014

Objectives:

We performed in vitro evaluation of a novel, disposable, automatic hands-free tracheostoma speech valve for laryngectomy patients based upon the principle of inhalation. The commercially available automatic speech valves close upon strong exhalation and open again when the pressure drops. This method makes long sentences or pauses difficult. The novel iValve is designed to allow almost natural speech, with mid-sentence pausing and whispering.

Methods:

The inhalation closing flows and exhalation opening pressures of 6 iValve prototype versions at different settings were compared with physiological values. The airflow resistance at inhalation was compared to physiological values and to commercial valve values.

Results:

The iValve prototypes showed flow and pressure ranges in concordance with the physiological values in the literature. The airflow resistance in the breathing mode was within the physiological airflow resistance range, yet above the values from the two commercial valves. The resistance in the speaking mode was above the physiological airflow resistance range.

Conclusions:

In vitro tests show that the iValve versions can be selected and adjusted to operate within the physiological range. The airflow resistance in the breathing mode is good. In speaking mode, inhalation should, and can, be decreased. The iValve should offer the patient a more intuitively useable alternative with more dynamic speech. Its low cost allows disposability and wider use.
Validation of a Pediatric Vocal Fold Nodule Rating Scale Based on Digital Video Images
Authors: Nuss Roger C. , Ward Jessica , Recko Thomas , Huang Lin , Woodnorth Geralyn Harvey
Published: October 2014

Objectives:

We sought to create a validated scale of vocal fold nodules in children, based on digital video clips obtained during diagnostic fiberoptic laryngoscopy.

Methods:

We developed a 4-point grading scale of vocal fold nodules in children, based upon short digital video clips. A tutorial for use of the scale, including schematic drawings of nodules, static images, and 10-second video clips, was presented to 36 clinicians with various levels of experience. The clinicians then reviewed 40 short digital video samples from pediatric patients evaluated in a voice clinic and rated the nodule size. Statistical analysis of the ratings provided inter-rater reliability scores.

Results:

Thirty-six clinicians with various levels of experience rated a total of 40 short video clips. The ratings of experienced raters (14 pediatric otolaryngology attending physicians and pediatric otolaryngology fellows) were compared with those of inexperienced raters (22 nurses, medical students, otolaryngology residents, physician assistants, and pediatric speech-language pathologists). The overall intraclass correlation coefficient for the ratings of nodule size was quite good (0.62; 95% confidence interval, 0.52 to 0.74). The p value for experienced raters versus inexperienced raters was 0.1345, indicating no statistically significant difference in the ratings by these two groups. The intraclass correlation coefficient for intra-rater reliability was very high (0.89).

Conclusions:

The use of a dynamic scale of pediatric vocal fold nodule size most realistically represents the clinical assessment of nodules during an office visit. The results of this study show a high level of agreement between experienced and inexperienced raters. This scale can be used with a high level of reliability by clinicians with various levels of experience. A validated grading scale will help to assess long-term outcomes of pediatric patients with vocal fold nodules.
Novel Use of a Suction-Irrigation Device to Remove Impacted Blood Clot from the Airway
Authors: Westbrook Benjamin J. , Wilhelm Michael , Shvidler Joseph
Published: October 2014

Objectives:

We sought to describe the novel use of a suction-irrigation device to remove a large blood clot that was causing critical obstruction of the trachea and main stem bronchi in our patient.

Methods:

A large-bore suction-irrigation device designed for use in gynecologic cases was adapted for use in removal of an obstructing blood clot in the face of patient decompensation after several unsuccessful attempts at removal with standard otolaryngological instruments.

Results:

The tracheal obstruction and the significant bronchial obstructions were successfully removed with the suction-irrigation device. The patient's ventilatory status quickly stabilized. He was extubated the following day and discharged home.

Conclusions:

The suction-irrigation device proved highly successful in removing a large blood clot from the airway. A similarly designed device made specifically for the airway could prove useful in similar cases in the future.
Yeast Colonization of Voice Prostheses: Pilot Study Investigating Effect of a Bovine Milk Product Containing Anti—Candida Albicans Immunoglobulin A Antibodies on Yeast Colonization and Valve Leakage
Authors: Holmes Ann R. , Chong Kenneth , Rodrigues Ely , Cannon Richard D. , Carpenter Elizabeth , Ruske Dean R. , Dawes Patrick J. D.
Published: October 2014

Objectives:

Our goals were to determine whether a bovine milk product containing anti– Candida albicans immunoglobulin A antibodies (“immune milk”) could reduce the adherence of C albicans to voice prosthesis silicone in vitro, and whether administration of the milk could reduce C albicans colonization and voice prosthesis damage in vivo.

Methods:

An in vitro assay of C albicans attachment to silicone was developed with radiolabeled C albicans. A pilot crossover in vivo trial, over 3 periods of 3 months, was also undertaken for 4 patients with voice prostheses, comparing daily administrations of immune milk and a control milk product. The prosthesis valves were replaced at each change-over and were assessed for wet weight of removable biofilm, yeast numbers in removable biofilm, valve leakage, and valve damage.

Results:

Immune milk inhibited C albicans adherence to silicone in vitro. However, in a small clinical pilot study, this effect was not replicated.

Conclusions:

There is scope to further investigate the topical use of immune milk for management of voice prosthesis biofilms.
Audiometric Characteristics in Patients with Noise-Induced Hearing Loss after Sodium Enoxaparin Treatment
Authors: Mora Renzo , Mora Enzo , Salzano Francesco Antonio , Guastini Luca
Published: October 2014

Objectives:

The aim of this study was to evaluate the effect of sodium enoxaparin treatment on patients with noise-induced hearing loss.

Methods:

Sixty patients with noise-induced hearing loss were included and randomly divided into two numerically equal groups. Group A underwent therapy with sodium enoxaparin for 10 days, followed by an additional 10 days of treatment after 10 days of no treatment. Group B received placebo as a control. Before treatment, at the end of treatment, and 2 months after the end of treatment, all patients underwent evaluation by laboratory tests, pure tone audiometry, transient evoked otoacoustic emissions (TEOAEs) testing, distortion product otoacoustic emissions (DPOAEs) testing, and auditory brain stem response testing.

Results:

In contrast to group B, at the end of the treatment in group A pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 0.5, 1, 2, 4, and 8 kHz. Depending on the air and bone conduction thresholds, TEOAEs and DPOAEs, which had previously been absent, were evoked at the frequencies examined. These improvements were confirmed at last follow-up. We found no significant differences in auditory brain stem responses or laboratory results.

Conclusions:

These preliminary data encourage further studies to collect additional evidence on the effect of sodium enoxaparin in preventing the development of noise-induced hearing loss.
Pseudo—Sudden Deafness
Authors: Song James E. , Sapthavee Andrew , Cager Gabrielle R. , Saadia-Redleaf Miriam I.
Published: October 2014

Objectives:

We describe the symptom complex and management of a clinical entity we refer to as “pseudo–sudden deafness,” which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination.

Methods:

We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component.

Results:

Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients.

Conclusions:

Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.
Parotidectomy: A 17-Year Institutional Experience at a Rural Academic Medical Center
Authors: Maddox Patrick Tate , Paydarfar Joseph Ali , Davies Louise
Published: October 2014

Objectives:

We describe the parotidectomy experience at a single rural institution over 17 years.

Methods:

We retrieved the records of all patients who underwent parotidectomy for any nontrauma indication (current procedural terminology codes 42410, 42415, 42420, 42425, and 42426) from January 1990 to June 2007 at Dartmouth-Hitchcock Medical Center, a rural medical center that provides both primary and tertiary care to a local population of 14,000, with a catchment area of 600,000 people. Information was collected on initial patient presentation, use of fine-needle aspiration, extent of surgery, final pathologic diagnosis, and complications.

Results:

We performed 341 parotidectomy procedures in 334 patients. The largest number of malignancies came from metastatic tumors; squamous cell carcinoma was the most common (37% of malignancies). The most common presenting complaint overall was a painless mass. The most common complication was facial weakness in 17% (57 of 341); 36 of the 57 cases of facial weakness (63%) were associated with surgery for malignancy. The most common benign tumor was pleomorphic adenoma (114 of 186; 61%). Mucoepidermoid carcinoma was the most common primary parotid malignancy (12%).

Conclusions:

In this 17-year rural case series of all parotidectomy procedures done for nontrauma indications, the largest number of malignancies came from metastatic tumors. Although facial nerve paralysis is not a common complication, it occurs most often when surgery is performed for either primary or metastatic malignancy. Surgeons will benefit from this information as they counsel patients who are considering parotidectomy.
Endoscopic Treatment of Benign and Malignant Strictures of the Cervical Esophagus and Hypopharynx
Authors: Gallo Andrea , Pagliuca Giulio , de Vincentiis Marco , Martellucci Salvatore , Iallonardi Elsa , Fanello Gianfranco , Cereatti Fabrizio , Fiocca Fausto
Published: October 2014

Objectives:

We evaluated the efficacy of endoscopic techniques employed in the management of cervical esophageal and hypopharyngeal strictures.

Methods:

A series of 45 patients with cervical esophageal (35) and/or hypopharyngeal strictures (10) were included. Twenty-five patients (55.6%) with neoplastic strictures were treated for palliation alone. The stenosis was related to radiotherapy in 11 patients (24.4%) and to postsurgical complications in 9 (20%). A group of 23 patients was treated with dilation alone (group 1). A second group included 22 patients treated with insertion of a self-expandable stent after failure of dilation treatment (group 2). The swallowing test data, clinical notes, and surgical reports were reviewed.

Results:

All of the patients showed some degree of relief of dysphagia. In group 1, 19 of the 23 patients required multiple dilation treatments to maintain normal deglutition. In group 2, 7 of the 22 patients recovered regular oral feeding after stent placement, 10 patients reported pain and foreign body sensation, 2 patients reported pain so severe that stent removal was required, and 3 patients experienced stent migration. All but 3 of the 25 patients with inoperable tumors died during follow-up, but no patients with benign stenosis died.

Conclusions:

The two groups showed comparable functional results. Dilation often requires multiple procedures, but is usually well tolerated. Placement of self-expandable stents is effective, but is generally less well tolerated.
Effects of Early Commercial Air Travel on Graft Healing Rates after Tympanoplasty
Authors: Konishi Masaya , Sivalingam Shailendra , Shin Seung-Ho , Vitullo Francesca , Falcioni Maurizio
Published: October 2014

Objectives:

We sought to determine whether commercial air travel soon after tympanoplasty significantly affects graft healing rates.

Methods:

We performed a retrospective analysis of 169 patients who underwent tympanoplasty from 1993 to 2009, comparing two groups of patients: 69 patients who flew 1 day after surgery and 100 who did not. The confounding factors analyzed were side of surgery, size of perforation, surgical approach, graft material, and grafting technique. The primary outcome measure analyzed was successful closure of the perforation at the first follow-up visit, at 4 weeks, evidenced by direct otoendoscopic examination.

Results:

There was no significant difference in the confounding variables between the two groups. There was no significant difference in the primary outcome measure of graft healing rates between the two groups (p = 0.494). Additionally, the overall graft healing rates compared favorably with previously published data from other authors.

Conclusions:

Early commercial air travel after tympanoplasty does not significantly affect graft healing rates and should be considered a relatively safe option.