bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Traditional and New Classification System of Temporal Bone Fractures for Clinical Relevance
Authors: Kang Homin , Lee Joonseok , Lee So Yoon , Yeo Seung Geun
Published: September 2011

Objective

The traditional classification of temporal bone fracture is subdivided into transverse, longitudinal, and mixed fracture. But questions have arisen about its limited correlation with clinical symptoms. Recent studies have been introduced, including petrous bone invasion and otic capsule violation. And a newer system is introduced about invasion of four areas of temporal bone.

Method

Clinical records and computed tomography scans were reviewed retrospectively on patients diagnosed with temporal bone fractures for the last seven years. We evaluated correlations of clinical presentation with each category of temporal bone fracture.

Results

A total of 129 temporal bone fracture patients were reviewed. In the traditional classification scheme, transverse fracture presented at a significantly higher rate of sensorineural hearing loss (SNHL). The invasion of petrous bone system showed a significantly higher rate of SNHL, dizziness, and perforation of the tympanic membrane. The otic capsule‐based system demonstrated a statistically significant rate and severity of SNHL among patients with otic capsule violation (P <. 05).

Conclusion

Although the traditional classification scheme, otic capsule involvement, and four areas of temporal bone systems did not demonstrate clear clinical correlations, petrous bone involvement showed significant correlations. So a petrous involvement based scheme better reflects clinical aspects.
Deafness after Skull Encephalic Trauma and Cochlear Implant
Authors: Graziadio Marilena , Negri Maurizio , Cola Claudio
Published: September 2011

Objective

Total deafness may be among the consequences of a skull encephalic trauma with bilateral fracture of the temporal bone. The recovery of hearing function can occur with the application of a cochlear implant. The functional results will depend on the presence of neurological or neuropsychological alterations both morphological at cochlear level.

Method

We present four cases of postverbal total deafness subsequent to single and/or bilateral fracture of the temporal bone who underwent cochlear implantation from 2000 to 2009. Two patients had monolateral anacusia with onset in childhood contralateral to the fracture, and 2 patients had injuries with bilateral fracture of the petrosal bone.

Results

In all cases correct positioning of the electrode array was possible without complications after surgery, and at the activation all electrodes were working. Because of the greater encephalic damage and the reduced capacity of cortical integration, in 2 patients the spectral type of stimulation strategies was chosen with low rates of stimulation. One year after the activation of the perceptual‐verbal ability all patients reached the recognition level in open set, and 3 patients were able to have telephone conversations with familiar voices. The patients with greater neurological complications also obtained significant benefits on the cognitive side.

Conclusion

In these cases different variables affect the recovery of hearing function with the cochlear implant. CNS damage may be associated with fibrosis or ossification of the cochlea and limits to the proper insertion of the electrodes array. The neuropsychological and neurological complications, in our opinion, are not factors of exclusion.
Defining the Level of Abnormal ECOG in a Neurotology Practice
Authors: Klumpp Micah L. , Gusman Makarena , Arriaga Moises A.
Published: September 2011

Objective

1) Identify the different levels of sensitivity and specificity of electrocochleography (ECOG) in our laboratory setting as normal or abnormal SP/AP ratio; and 2) select the level of specificity as the desired parameter of the abnormal SP/AP ratio of ECOG.

Method

This retrospective study reviews 61 patients undergoing ECOG in our vestibular laboratory who were diagnosed with unilateral endolymphatic hydrops (Ménière syndrome or cochlear hydrops) on the basis of clinical findings, audiogram, and vestibular studies. Sensitivity and specificity levels of ECOG in our laboratory are reported across various SP/AP ratios.

Results

Sensitivity and specificity levels of ECOG obtained in our vestibular laboratory are demonstrated for SP/AP ratios ranging from greater than 30% to greater than 50%. These data are the following: 1) greater than 30% (sensitivity, 0.72; specificity, 0.57); 2) greater than 35% (sensitivity, 0.66; specificity, 0.84); 3) greater than 40% (sensitivity, 0.52; specificity, 0.92); 4) greater than 45% (sensitivity, 0.43; specificity, 0.98); and 5) greater than 50% (sensitivity, 0.28; specificity, 0.98).

Conclusion

Inherent inter‐site testing variability requires that each laboratory should set its own level of “abnormal” for ECOG. This study demonstrates sensitivity and specificity for ECOG at different ratios. For our use as a confirmatory test, we selected 80% specificity and set 35% as our abnormal SP/AP ratio.
Determining a Suitable Material to Simulate the Tympanic Membrane Based on Quantitative Linear Elasticity
Authors: Lai Elizabeth , Chang C. W. David
Published: September 2011

Objective

Find a material to simulate the quantitative, as well as qualitative, qualities of the tension and compliance of a tympanic membrane based on published values of the elastic modulus for a tympanic membrane.

Method

Prospective study that took place from August to December 2009. Using the Instron Testing Instrument, an elastic modulus was calculated for various materials. Based on these values, 3 materials were chosen. Seven physicians performed a myringotomy and completed a survey to rank subjective qualities of the materials.

Results

Nitrile gloves, Kimwipes, and laboratory stretch film all had an elastic modulus that fell within the previously published range of the tympanic membrane elastic modulus and were chosen to undergo further evaluation. Kimwipes scored the highest in terms of compliance, tension, and texture compared with an actual TM during blunt palpation. Nitrile gloves scored the highest in terms of compliance, tension, and texture while making the myringotomy incision. Nitrile gloves scored best when comparing how the incision split open, responded to suction, and felt during introduction of the PE tube. Overall Nitrile gloves scored the highest.

Conclusion

As competency‐based teaching and evaluation becomes a bigger part of resident‐training, the utility of training models will also likely become more widespread. Nitrile gloves represent a material that is inexpensive, is widely available, and displays a quantitative and qualitative linear elasticity similar to that of a true tympanic membrane.
Effect of Glutathione S‐transferase Polymorphisms to Music‐Induced Hearing Loss
Authors: Chang Yu‐Tuan , Chao Chun‐Chih , Lin Cheng‐Yu , Wu Jiumm‐Liang
Published: September 2011

Objective

Both genetic and environmental factors contribute to noise‐induced hearing loss (NIHL). The objective of this study is to investigate the hypothesis that Glutathione S‐transferase (GST) genetic polymorphisms is related to susceptibility to developing NIHL caused by music exposure.

Method

This cross‐sectional study recruited high school students who habitually listen to music with portable players. PTA, distortion product otoacoustic emission (DPOAE), and questionnaire were obtained. Cumulative noise exposure (CNE) was calculated by listening time and volume of using portable players. Effects of GST1, GSTM1, and GSTP1‐105 on NIHL were analyzed.

Results

A total of 312 subjects were analyzed. Mean of PTA at high frequency (average of 3000, 4000, and 6000 Hz) was 8.07 dB HL (SD = 5.98). DPOAE amplitude level at high frequency was 20.28 dB SPL (SD = 5.10). Mean of CNE was 84.57 dB‐year (SD = 11.42). With the regression analysis model, there was a good dose‐response relationship between CNE and DPOAE amplitude levels at high frequency (P <. 05). Furthermore, those subjects, with GSTT1‐null, GSTM1‐null, and GSTP1‐105 Ile/Ile genotypes, had higher susceptibility for developing hearing threshold elevation at high frequency (P <. 05).

Conclusion

This study identified that GST genetic polymorphisms might modify the susceptibility of hearing threshold elevation at high frequency caused by music exposure. Moreover, investigations of other genotypic variants involved in oxidative stress response for elucidating the gene‐environment interaction for NIHL are warranted.
Effects of Early Surgical Exploration on Hearing Outcomes in Suspected Traumatic Perilymph Fistulas
Authors: Byun Hayoung , Choi Jeesun , Park Ga Young , Ho‐Chung Won
Published: September 2011

Objective

Analyze the outcomes of early surgical exploration in suspected traumatic perilymph fistulas (PLF).

Method

Study Design: Retrospective case review. Setting: Tertiary otology referral center. Patients and Intervention: Nine patients (10 cases) that developed sudden sensorineural hearing loss and dizziness following head trauma underwent exploratory tympanotomy and PLF repair with the clinical impression of traumatic PLF. Outcome Measure: Postoperative hearing changes and control of dizziness.

Results

All patients had sudden or progressive hearing loss and dizziness following head trauma; a car accident, slap injury, and barotraumas. Surgical exploration was performed 2 to 47 days after the trauma. Possible evidence of PLF was found in 9 cases and included: fibrous web around the oval window (OW) (n = 3), perilymph collection around the round window (RW) (n = 5), and bulging of the RW membrane (n = 1). After surgical repair, the mean hearing gain was 28dB (10~55dB); the hearing improved to serviceable levels in 6 out of 10 cases (60%). All patients had resolution of the vestibular symptoms after the surgery.

Conclusion

Sudden or progressive sensorineural hearing loss accompanied by dizziness following head trauma should prompt the consideration of a traumatic PLF. Early surgical exploration is recommended to control dizziness and improve hearing outcomes.
Electronystagmography in the Diagnosis of Central Vertigo
Authors: Mora Renzo , Salami Angelo , Salzano Francesco‐Antonio , Guastini Luca , Dellepiane Massimo
Published: September 2011

Objective

Determine the efficacy and applicability of electronystagmography (ENG) testing in the differential diagnosis between peripheral and central vertigo, through the visual‐vestibular interaction test, in patients with vertigo.

Method

Patients were submitted to ENG recording. Patients sat on a rotatory chair, which was placed in the middle of a rotary rotatory cylindrical chamber. The rotatory chamber was driven by a direct current engine, which turned it clockwise and counterclockwise, and its internal area was covered with 32 black vertical contrast.

Results

All patients underwent rotatory vestibular stimulation by Stop test (VOR), optokinetic stimulation (OKN), and contemporary rotatory vestibular and optokinetic stimulation (VVOR). Our experiences highlight as normal that subjects and/or patients affected by peripheral vertigo present a VVOR nystagmus homodirectional to optokinetic nystagmus; patients affected by central vertigo present a VVOR nystagmus homodirectional to vestibular‐ocular‐reflex (VOR). In healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR.

Conclusion

The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification, and highlights a CNS disease. Our data highlight the role of ENG in the diagnosis between peripheral and central vertigo.
Emerging Role of Nonmuscle Myosin II and Implications for NMMII Associated Deafness
Authors: Kozin Elliott , Kachar Bechara , Salles Felipe , Adelstein Robert , Ma Xuefei , Zhang Yingfan , Andrade Leonardo R.
Published: September 2011

Objective

Data are scarce regarding the role of nonmuscle myosin II (NMMII) isoforms in the postnatal inner ear. Here we seek to: 1) understand the localization and function of each isoform in the postnatal environment, and 2) investigate the cause of hearing loss observed in mutations of NMMII.

Method

Organ of Corti tissue was dissected from neonatal eGFP‐NMMII‐A or ‐B mice, and immunohistochemistry was performed using NMMII‐isoform specific antibodies. OC cultures of rat were exposed to NMMII inhibitors at multiple time points. NMMII‐C KO mice were stained with NMMII‐isoform specific antibodies. ABRs on NMMII‐A mutants were performed at various frequencies.

Results

In WT mice, NMMII isoforms localize to the apical junction between hair and supporting cells. In eGFP‐NMMII‐A‐ or ‐B mice, NMMII isoform antibodies show a similar pattern of distribution, but are potentially expressed at different amounts. At the adhesion belt, the isoforms take on a “sarcomeric‐like” pattern. NMMII inhibition results in variability of hair cell shape. In NMMII‐C KO mice, NMMII‐A demonstrates a new distribution and NMMII‐B is upregulated. ABRs reveal an absence of hearing loss in NMMII‐A D1424N and R702C mutant mice compared to controls.

Conclusion

NMMII has a previously unrecognized “sarcomeric‐like” pattern of organization, compatible with a contractile structure. Absence of hearing loss in NMMII‐A mutants indicates that hearing loss may require a secondary insult, and isoforms have potential for compensation and overlap in function, which may also mitigate hearing loss.
Endolymphatic Sac Assessed by 3D Cone Beam CT in Ménière Disease
Authors: Miuchi Shinya , Hyodo Jun , Yanagihara Naoaki , Sakagami Masafumi
Published: September 2011

Objective

The poster introduces new 3D Cone‐beam CT (CBCT) images of endolymphatic sac (ELS). The volume rendering provides realistic image of ELS in relation to the semicircular canal, enabling one to assess location, size, and shape preoperatively. The results are compared with operative findings to confirm clinical values of the new imaging technology.

Method

The 3D Cone‐beam CT images of the 12 patients with Ménière diseases who underwent an endolymphatic mastoid shunt operation between 2008 and 2011 were obtained at our hospital. We assessed location, size, and shape of the ELS. The results of preoperative assessments were compared with the operational findings.

Results

First we present clear and sharp 3D pictures of ELS and the semicircular canal using volume rendering incomparable to conventional CT. In 11 patients, the ELS was located exactly along the Donaldson line. In one patient, it was located inferiorly to the line. Size of the ELS was moderate in 6 patients, small in 5, and exceedingly small in 1. Cross section of the sac was circular in 3 patients, oval and flat in 8, and unverified in 1 because the size was too small. The above findings agree with the operational findings closely.

Conclusion

In 3D Cone‐beam CT, we could get more informative and better quality images than in conventional CT. Thanks to the preoperative realistic 3D images of ELS and the semicircular canal, we could perform the sac operation more safely and easily. Imaging information thus obtained may help deepen the understanding of Ménière’s disease.
Endoscopic 3D Anatomy of the Middle Ear
Authors: Nogueira Joao‐Flavio , Cruz Daniel N.
Published: September 2011

Objective

Demonstrate the stereoscopic tridimensional (3D) endoscopic anatomy of the middle ear, showing important anatomical landmarks and a new endoscopic view of the structures of the middle ear.

Method

We conducted an endoscopic dissection of 5 human temporal bones. The dissections were performed using traditional ear surgery instruments and sinonasal endoscopes. Two different endoscopic pictures of the same anatomical image were taken and merged using a computer program to generate stereoscopic anaglyphic images.

Results

We were able to generate excellent quality stereoscopic 3D endoscopic images of the anatomy of the middle ear.

Conclusion

Endoscopic middle ear surgery is becoming more popular. However there are still several limitations, such as the lack of specialized instruments and anatomical studies. We got excellent 3D pictures of the endoscopic anatomy of the middle ear, which can be used to help guide surgeons during procedures.
Enlarged Vestibular Aqueducts from Autosomal Recessive Parents
Authors: Mun Sue Jean
Published: September 2011

Objective

Enlargement of the vestibular aqueduct is a commonly detected inner ear abnormality and is inherited as an autosomal recessive trait caused by bi‐allelic SLC26A4 mutations. Vertical transmission of EVA has rarely been reported in the literature. We report a case where EVA is inherited as a vertical transmission.

Method

A bi‐directional sequencing of SLC26A4 was performed to have a molecular genetic diagnosis of the 3 affected members of this family whose radiologic phenotype was documented by temporal bone CT.

Results

The father and the mother as well as the proband were shown to have either EVA only or incomplete partition type II. The bi‐directional sequencing of SLC26A4 demonstrated homozygous mutations of p.H723R and c.IVS7‐2A>G from the father and the mother, respectively. The proband turned out to be a compound heterozygote of p.H723R and c.IVS7‐2A>G.

Conclusion

Given a wide variety of etiology for congenital deafness, it is interesting to find an assortative mating between EVA patients. We observed a vertical transmission of EVA and documented that SLC26A4 mutations segregating in the family with vertical transmission of EVA, which is usually inherited as a recessive manner.
Epitympanum Dimensions Do Not Correlate with Extent of Mastoid Pneumatization
Authors: Villari Craig R. , Todd N. Wendell
Published: September 2011

Objective

The epitympanum is an anatomic region of great surgical importance, yet its dimensions have gone largely unstudied since Bezold in the 1800s. We investigated the radiologic dimensions of the epitympanum, compared these dimensions with those determined at anatomic dissection by Bezold, and compared them to mastoid pneumatization.

Method

Of 41 clinically normal human crania, the 5 with the smallest mastoid pneumatization areas and the 5 with the largest areas were imaged by high‐resolution computed tomography, both direct axial and direct coronal. The two authors measured the heights, breadths, and lengths independently.

Results

Wide ranges were found for epitympanum heights (5.0‐10.0 mm), breadths (6.0‐7.0 mm). and (lengths 9.5‐12.5 mm), and for mastoid sizes. The range of heights was wider than Bezold reports, but the range of breadths was tighter. Bilateral symmetry was found for mastoid pneumatization.

Conclusion

Epitympanic heights and breadths were generally consistent with the report by Bezold over 100 years ago. Epitympanic dimensions were unrelated to mastoid size.
Evaluation of Hearing and Cochlear Function in Patients with Ankylosing Spondylitis
Authors: Kahveci Orhan Kemal , Duran Abidin , Altuntas Ali , Demirdal Secil , Kavuncu Vural , Okur Erdogan
Published: September 2011

Objective

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of cochlear system in patients with AS.

Method

We prospectively evaluated 37 AS patients and 20 healthy controls. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech tests, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Basdai scores, and hematolgic findings (CRP, Sedimentation) were also collected.

Results

Pure tone audiometry findings and of the patients and controls were significantly different in all frequencies (P >. 05). No significant difference was found between DPOE responses of the patients and controls (P > 0.05).

Conclusion

This study demonstrated that there is an association between AS and hearing loss. But the cochlea is not the main source of hearing loss.
Facial Nerve Grading 2.0 and Sunnybrook Facial Grading System
Authors: Soon Sue Rene , Heah Harold , Yuen Heng‐Wai
Published: September 2011

Objective

We aim to measure the intra‐system reliability and the inter‐system agreement between the Facial Nerve Grading 2.0 and Sunnybrook Facial Grading system (SFGS).

Method

Video clips of 12 patients with facial nerve dysfunction performing a protocol of facial expressions were recorded. Thirteen physicians were asked to evaluate the videos independently using the 2 scales.

Results

The ICC score for FNG 2.0 and SFGS was 0.820 (95% CI=0.677‐0.931) and 0.831 (95% CI=0.696‐0.936), respectively. The FNG 2.0 and SFGS inter‐system agreement ICC score was 0.959 (95% CI=0.944‐0.970).

Conclusion

Studies have established high intra‐system reliability for the SFGS, and our results corroborate these. FNG 2.0 similarly shows high intra‐system reliability. As the inter‐system agreement was found to be near perfect in our study, the new FNG 2.0 should be considered as an alternative grading scale for facial nerve palsy.
Facial Nerve Paralysis in Head Injury Cases
Authors: Agrawal Rahul , Morwani K. P. , Agrawal S. R.
Published: September 2011

Objective

Timing of surgical intervention in posthead injury facial nerve paralysis cases has been a constant topic of discussion. This study’s objectives are: 1) know the site of facial nerve trauma, and 2) determine the best timing of surgical intervention in post head injury facial nerve paralysis.

Method

Prospective study of 18 patients who underwent facial nerve surgery in past 3 years for facial nerve paralysis due to head injury at Agrawal Hospital & Research Institute was done. Site of injury, timing of surgery, and facial nerve outcome were noted. This is an analysis of an ongoing study.

Results

The most common site of injury was found to be at the first genu (83.33%) followed by the horizontal segment (11.11%). Earlier surgical intervention showed better results in the form of time duration taken for recovery and also facial nerve status (House‐Brackmann grading).

Conclusion

In our series, earlier surgical intervention gives better results, and the most common site of injury is found to be at the first genu followed by the horizontal segment.
Factors Affecting Myringoplasty Success
Authors: Carr Simon , Raine Chris
Published: September 2011

Objective

A retrospective study in a teaching hospital on all patients who underwent myringoplasty between January 2005 and January 2010 in order to determine the independent factors which significantly affect success in myringoplasty in a pediatric and adult age groups.

Method

Main outcome measures were recurrence of tympanic membrane perforation and closure of the air‐bone gap to within 10dbHL. Chi‐squared analysis determined the significance of: surgeon grade, condition of the ipsilateral and contralateral middle ear, perforation site and size, and cortical mastoidectomy for both the pediatric and adult groups.

Results

A total of 395 procedures were included. A total of 39 of these were on patients aged ≤ 16 years. Mean overall age: 35.8 years (range, 10‐72 years). Mean length of follow‐up: 7.5 months (range, 2‐48 years). Overall graft take rate was 81%. Graft take in those aged 16 months was 85%. Significant factors in the adult age group were the site of perforation, with anterior perforations associated with the poorest outcome, and simultaneous cortical mastoidectomy (P <. 05). These were not significant in the pediatric age group. Perforation size, the condition of the ipsilateral and contralateral middle ear and grade of surgeon were insignificant in both age groups.

Conclusion

It is important for the operating surgeon to have an appreciation of the factors which affect graft take in myringoplasty when deciding to operate and when consenting the patient preoperatively, as these may affect the chance of success.
Florical and Early Otosclerosis
Authors: Cheng Jeffrey , Chandrasekhar Sujana S. , Del Signore Anthony
Published: September 2011

Objective

Report our results with Florical in stabilizing hearing loss in patients with early otosclerosis.

Method

A retrospective chart review was undertaken of patients with early otosclerosis treated with Florical. Using a paired t test, comparisons were made in amount of change between speech recognition threshold (SRT) and pure tone average (PTA) air‐bone gap (ABG). A P‐value of <. 05 was considered statistically significant.

Results

Eight patients with 10 affected ears were studied. Average age was 44.1 ± 14.2 years old. No statistically significant decline was detected at 3, 6, and 12 months in SRT (P‐value = 1.0,. 68,. 68, respectively) and PTA ABG (P‐value =. 46,. 61, and. 39, respectively). Baseline average ABG was 10.5 ± 8.7 dB. Eight of the 10 ears experienced improvement of PTA ABG (mean = 6.6 ± 5.7 dB). One patient (1 ear) had complete closure of the PTA ABG. Mean follow‐up was 5.7 months. No patients discontinued use of Florical because of adverse side effects. Only 2 patients (25%) reported dyspepsia.

Conclusion

Our early experience demonstrates that Florical may prevent hearing deterioration and even reversal of early conductive hearing loss. It may be better tolerated than other sodium fluoride preparations, as calcium carbonate may help to alleviate the gastrointestinal side effects associated with sodium fluoride administration.
Foil Technique for Optimized Cosmetic Results in CI Surgery
Authors: Pein M. Katharina , Hoffmann Kerstin
Published: September 2011

Objective

Cosmetic results in bilateral cochlear implantations strongly depend on the symmetric position of the coils, not only the scars. The primary purpose of this work is to present a simple method to find the correct position for the second coil and to ensure symmetry in single and 2‐step implantation procedures.

Method

In a proof‐of‐principle study, 5 CI patients were supplied with a second CI. Important reference points were marked using a silicone foil. The foil then was transferred to the opposite side, and according to reference points, the exact symmetric position of the speech‐processor coil could be located.

Results

Coil positions were measured postoperatively, and photographs were taken to evaluate success. In all patients, the second coil could be placed symmetrically to the opposite side. The location error is less then 5 mm, measured with the pre‐ or intraoperatively drawn transparency. The cosmetic outcome was associated with a high degree of patient satisfaction in all patients. Furthermore, silicone transparencies have excellent hygienic properties and are easily to sterilize.

Conclusion

The introduced silicone foil technique is easy and quickly implemented. Other intraoperative methods in coil positioning, such as those based on photography, are less accurate and depend highly on the surgeon’s capabilities. Especially in bilateral CI‐surgery, silicone transparencies should become a standard technique for higher patient satisfaction and outstanding cosmetic results.
Rehabilitation of Microglossia with Mandibular Distraction
Authors: Berg Erik , Laskarides Constantinos , Vecchiotti Mark A. , Scott Andrew R.
Published: September 2011

Objective

Describe an approach to surgical rehabilitation of feeding, speech, and upper airway obstruction in an infant with microglossia and micrognathia.

Method

Case report and literature review.

Results

We describe a 17‐month‐old child with micrognathia, microglossia, and submucus cleft palate who was initially fed via g‐tube and did not require early airway interventions. As the child was attaining normal developmental milestones, the decision was made to perform bilateral mandibular distraction osteogenesis as a means of improving feeding, speech, and clinical symptoms of obstructive sleep apnea. In this report, relevant literature is also reviewed as it pertains to the rehabilitation and reconstruction of this rare craniofacial anomaly.

Conclusion

Mandibular distraction osteogenesis improved glossoptosis and created a more favorable position of the tongue within the oral cavity. This in turn allowed for an overall improvement in oral motor function culminating in removal of the feeding tube.
Glomus Jugulare Tumors: A Series of 24 Cases
Authors: Escada Pedro Alberto , de Almeida Gonçalo Neto , Vitala José Pratas , Branco Gabriel
Published: September 2011

Objective

Describe the surgical technique and experience of a neurotology surgical team working in Lisbon, Portugal, in the surgical treatment of glomus jugulare tumors.

Method

The retrospective study included 24 patients operated between 1988 and 2007. Data were obtained from the medical records and after a recent evaluation of the patients. The outcome measures were: clinical manifestations, preoperative embolization and surgical technique, tumor removal, morbidity, mortality, and evolution of residual lesions.

Results

Symptoms included hearing loss (33%); pulsatile tinnitus (21%); and cranial nerves X (29%), VII (25%), and XII (21%) paralysis. Preoperative embolization was performed in 92% of the cases, and the surgical technique was the infratemporal fossa aproach type A in all the cases. Total removal of the tumor was obtained in 11 (45%) cases. Only 21% of the patients had a grade III‐IV House‐Brackmann or worse after 12 months. Two patients died from pneumonia. Five (21%) of the patients required a second surgery, but only one patient required radiotherapy after incomplete removal of the tumor.

Conclusion

Glomus jugulare tumors and their treatment have significant morbidity and mortality. Neurotology surgical teams should be created to develop surgical expertise and competence in the treatment of the disease in order to offer the best options to these patients.
Hearing Loss as Factor That Influences the Quality of Life in Tinnitus Patients
Authors: Rosito Letícia Petersen Schmidt , Vanni Bruna , Deutsch Konrado , de Brito Belline Vanessa
Published: September 2011

Objective

Tinnitus is a sensation of noise. In most cases it is accompanied by hearing loss, but it can be an independent symptom occurring in patients with normal hearing. We want to compare the impact of tinnitus on quality of life in patients with or without associated hearing loss.

Method

We selected patients with chronic and disturbing tinnitus. They underwent audiometry and answered the Tinnitus Handicap Inventory (THI) in order to evaluate and quantify the impact of tinnitus. The criterion defined as the threshold of hearing loss records was less than 25 dB at all frequencies in either ear.

Results

From January 2005 to January 2011, 308 patients were included. The patients were divided into 2 groups: 1) with hearing loss (n = 272), and 2) with normal hearing (n = 34). Among patients with normal hearing, the average score on the THI was 33.8, whereas among patients with hearing loss, the average was 42.33, P =. 04 (t test).

Conclusion

Patients with hearing loss have a mean THI significantly higher than patients with normal hearing. Thus, we found that although the tinnitus alone would lead to worse quality of life of patients, hearing loss is one factor that contributes additionally and independently.
Hearing Recovery by Local IGF1 Therapy in Sudden Deafness
Authors: Nakagawa Takayuki , Sakamoto Tatsunori , Tabata Yasuhiko , Hiraumi Harukazu , Ito Juichi , Yamamoto Norio
Published: September 2011

Objective

Evaluate hearing recovery following local application of insulin‐like growth factor 1 (IGF1) in patients with sudden sensorineural hearing loss (SSHL) that was refractory to systemic steroids.

Method

Subjects were 25 patients with SSHL showing no hearing recovery following systemic steroid treatment. We applied gelatin hydrogels, impregnated with IGF1, into the round window niche, and examined alterations in pure tone audiometry and evoked otoacoustic emission over time.

Results

In total, 25 patients received the test treatment at a median of 23 days after the onset of SSHL. Before the test treatment, the mean hearing level at the 5 frequencies tested was 81.2 dB. At 24 weeks after the test treatment, 11.9 dB recovery in the mean hearing level was found. Statistically significant recovery was identified at 0.5 kHz (16.6 dB). Hearing recovery of more than 10 dB in pure tone audiometry appeared within 4 weeks after the test treatment and saturated. Four patients showed the recovery in evoked otoacoustic emission together with hearing recovery in pure tone audiometry.

Conclusion

Local IGF1 application via gelatin hydrogels may be efficacious for hearing recovery in patients with SSHL that is resistant to systemic steroids, and induces recovery of outer hair cell function similarly to previous findings in animal experiments.
Hippocampus Function Related with Space Map in Humans
Authors: Sunami Kishiko , Yamamoto Hidefumi , Morino Michiharu , Tsuyuguchi Naochiro , Yamane Hideo
Published: September 2011

Objective

Perception of spatial orientation and self‐motion can benefit from integration of multiple sensory cues, including vestibular signals. Place cells were found in hippocampus areas, and correlates of head orientation collectively map spatial locations. To elucidate hippocampus function related with spatial orientation in humans, we examined subjects who had undergone hippocampectom.

Method

Data were obtained from 16 patients with hippocampus sclerosis and temporal lobe epilepsy. Eleven patients were also investigated after amygdalohippocampectomy. To determine the path integration, they were investigated by modified step test. We also investigated sound lateralization test (the interaural time difference and interaural level difference).

Results

A modified step test may provide a sense of direction and path integration. In this test, initially the subjects walk for 1m on a straight road and turn 90° to the right or left, and then walk straight for 1m with their eyes opened. Subsequently they return with their eyes closed. The results of the modified step test got worth after amygdalohippocampectomy. Sound is an important factor of a sense of direction. The insufficiency of the sound lateralization test was detected in patients, and this was also detected after amygdalohippocampectomy.

Conclusion

The hippocampus should play a role in path integration and sound lateralization in humans.
Histopathological Differences between Polyvinyl Alcohol and Ethylene Vinyl Alcohol Copolymer in Preoperative Glomus Jugulare Embolization
Authors: Herman Bjorn S. , Angeli Simon I. , Gomez Carmen , Aziz‐Sultan Mohammed Ali , Telischi Fred F. , Elhammady Mohamed Samy
Published: September 2011

Objective

1) Histopathologically characterize glomus jugulare paragangliomas preoperatively embolized with ethylene vinyl alcohol copolymer (EVAC). 2) Describe histopathological differences between glomus jugulare paragangliomas preoperatively embolized with polyvinyl alcohol (PVA) and EVAC.

Method

Case series of glomus jugulare paragangliomas preoperatively embolized with EVAC. The tumors were subsequently resected at a tertiary care center between 2003 and 2010. Patient demographic and clinical data were collected, and histopathological analysis of the preoperatively embolized tumors was performed.

Results

Glomus jugulare paragangliomas embolized with EVAC demonstrated 100% or near 100% occlusion of arterial vessels by histopathological analysis, whereas in previous studies PVA demonstrated a significantly lower percentage of embolization. Even when resection was performed several months after embolization, there was no revascularization of EVAC embolized vessels, whereas PVA embolized vessels have demonstrated partial revascularization. In one patient whose tumor was not completely resected after embolization with EVAC, there was no evidence of subsequent growth of the remnant disease.

Conclusion

Histopathological analysis of preoperatively embolized glomus jugulare paragangliomas indicates that EVAC provides a more thorough and longer lasting embolic profile than PVA.
Impairments in Estimation of Target Velocity in SCA 6
Authors: Takeichi Norihito , Tsubuku Takashi , Fujiwara Keishi , Fukuda Satoshi
Published: September 2011

Objective

Perception during visual motion is a fundamental function for the equilibrium system. Neural substrates for these systems are still incompletely known. We examined the role of cerebellum for those systems in Spinocerebellar ataxia type 6 patients.

Method

Seven SCA6 patients and 7 age‐matched normal controls participated in this study. Two tasks were tested. Task 1 examined subjects’ ability to estimate the timing of a target movement indicated by a finger movement. Task 2 examined the ability to match the remembered velocity of visual pattern movement.

Results

In Task 1, when the target was always visible, the difference between the 2 groups was not significant at 2°/s and 5°/s of target movement. At 8°/s, there was significant difference between them. During the 50% target blanking condition, the patients showed lower successful ratios at 5°/s and 8°/s, respectively. In Task 2, when both subject groups fixated a stationary spot, there was no significant difference between the two groups at 2°/s and 5°/s. However, at 8°/s, the difference was significant. When a fixation spot was not presented, the difference was significant at all three velocities.

Conclusion

Most SCA6 patients exhibited a larger variability in their timing estimation, and their estimations significantly lagged compared with controls. The present findings shed light on the mechanisms of estimation of target velocity and timing of movement initiation and support the conclusion that the cerebellum is involved in these functions.
Rhinophyma: Current Management
Authors: Singh Narinder , Roberts David N.
Published: September 2011

Objective

1) Describe and assess the results of our technique for the surgical management of rhinophyma. 2) Review contemporary concepts in rhinophyma management.

Method

We describe a relatively simple combined‐modality technique that addresses each of the 4 steps of rhinophyma surgery. The method allows accurate delineation of tissues whilst maintaining reduced operative times, excellent hemostasis, and an uncomplicated postoperative course, together with satisfactory cosmetic results. We present video of the technique.

Results

The technique was used for 7 patients. There were no major complications. All patients were satisfied with the outcome and no patients requested revision. Assessment by an independent facial plastic surgeon indicated a mean cosmetic improvement in visual‐analogue score (1‐10) of 8.5 ± 0.7.

Conclusion

The ideal technique for the surgical management of rhinophyma is yet to be found. We describe a method that is relatively simple, low cost, easy to learn, has a short operative time, requires minimal postoperative care and provides a satisfactory cosmetic outcome with minimal complications.
Interobserver Reliability of the “Clockface” Method of Describing the Site and Size of Tympanic Membrane Perforations
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat , Counter Paul R.
Published: September 2011

Objective

Analyze the interobserver reliability of a “clockface” method for describing the site and size of tympanic membrane perforations.

Method

Six junior doctors (ENT experience 0‐3 months) and 6 ENT surgeons (ENT experience 4‐26 years) were asked to estimate the position, percentage size, and “clockface” position of perforations in 30 images of tympanic membrane perforations. Four juniors repeated the exercise 2 weeks later to investigate test‐retest reliability.

Results

Results were analyzed using intraclass correlation coefficients (95% confidence interval in brackets). With junior raters, perforation size percentage estimate gave 0.85 (0.77‐0.92), clockhand method site of perforation (CM1) gave 0.91 (0.87‐0.94), and clockhand method size of perforation (CM2) gave 0.82 (0.73‐0.90). With ENT surgeons, perforation size percentage estimate gave 0.85 (0.77‐0.92), CM1 gave 0.96 (0.94‐0.99), and CM2 gave 0.88 (0.78‐0.94). With all raters, perforation size percentage estimate gave 0.86 (0.78‐0.92), CM1 gave 0.93 (0.90‐0.95), and CM2 gave 0.84 (0.76‐0.91). In test‐retest reliability, using Pearson correlation coefficients, perforation size percentage estimate gave 0.94 (P <. 001), CM1 gave 0.91(P <. 001), and CM2 gave 0.92(P <. 001).

Conclusion

The clockface method allows quick, detailed, and reliable recording of site and size of perforation at the time of clinical assessment. This may also become a valuable research and audit tool.
Largest CT‐Identifiable Hypotympanic Cell and Mastoid Size
Authors: Todd N. Wendell , Hoddeson Elizabeth K. , MacLean Jonathan
Published: September 2011

Objective

The hypotympanum is important, especially when the surgeon confronts cholesteatomas and tumors, and when a hypotympanic cell simulates the round window niche. Hypotympanic cell size is generally considered wide‐ranging and stochastic. We hypothesized that size of hypotympanic cells is not related to size of mastoid.

Method

Of 41 clinically normal human crania, the 5 with the smallest mastoid pneumatization areas and the 5 with the largest areas were imaged by high‐resolution computed tomography, both direct axial and direct coronal. The diameter of each ear’s largest identifiable hypotympanic cell, on either axial or coronal imaging, was measured.

Results

Wide ranges were found for the largest identifiable hypotympanic cell: 0‐11mm. Bilateral symmetry was found for both the largest hypotympanic cells (Spearman r = 0.68, P =. 03), and for mastoid pneumatization (Spearman r = 0.66, P <. 05). The diameter of the largest hypotympanic cell positively correlated with the extent of mastoid pneumatization: for left ears, Spearman r =. 73, P <. 03.

Conclusion

The greatest diameter of largest CT‐identifiable hypotympanic cells ranged from 0 to 11 mm. Even in this small series of specimens, hypotympanic cell size positively correlated with mastoid size.
Laser‐Assisted Stapedotomy
Authors: Sergi Bruno , Parrilla Claudio , Paludetti Gaetano , Galli Jacopo
Published: September 2011

Objective

Assess and compare the functional results obtained by means of multiple‐shot Erbium: yttrium‐aluminum‐garnet (Er:YAG) laser to those obtained using “one‐shot” CO2 laser stapedotomy in patients affected by otosclerosis. Study Design: A retrospective case review was performed. Setting: The study was conducted at the Catholic University of Rome.

Method

We compared the results obtained in 2 series. From January 2004 to January 2006, a Er:YAG laser stapedotomy was performed on 101 patients. From January 2008 to December 2009, 110 subjects underwent “one‐shot” CO2 laser stapedotomies for otosclerosis. Pure‐tonal audiometric test was performed preoperatively and after surgery during the follow‐up.

Results

In both groups the closure of air‐bone gap began in the early postoperative period and continued to improve through the late postoperative period. Bone‐conduction hearing thresholds were stable even in the early postoperative follow‐up and remained stable trough the course of the study.

Conclusion

Our findings confirm that laser stapedotomy is a safe and effective surgery. Respect to Er:YAG laser, the improvement of the CO2 laser and the development of the “one‐shot” technique justify a larger use of this equipment that allows one to achieve the stapedotomy with less manipulations and a reduced acoustic trauma.
Limiting Hazardous Noise Exposure from Noisy Toys
Authors: Jabbour Noel , Weinreich Heather , Levine Samuel C. , Yueh Bevan
Published: September 2011

Objective

1) Assess the decibel (dB) level of toys from the Sight & Hearing Association 2010 Noisy Toys List. 2) Evaluate the change in dB level of these toys after covering the speakers with tape or glue.

Method

Sight & Hearing Association 2010 Noisy Toys List (n = 18) toys were tested at a distance of 0 cm and 25 cm from the sound source in a soundproof booth using a digital sound‐level meter. Toys with speakers (n = 16) were tested before and after covering the speakers with packing tape or non‐toxic glue.

Results

Mean dB level for nontaped toys at 0 cm and 25 cm was 107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB Mean dB level for non‐taped toys at 0 cm and 25 cm was 107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB (P <.001). With glue, there was a statistically significant decrease in loudness at 0cm and 25 cm (P <. 001). The average duration of sound produced was 9.2 seconds.

Conclusion

Adding tape or glue to cover the speakers of noisy toys can significantly limit the dB level of these toys. These are simple measures that parents can perform to limit hazardous noise exposure from noisy toys.
Long‐term Outcomes and Reliability of Jahn Ventilating Tube
Authors: Sajan Javad A. , Hilton Christopher W. , Levine Samuel C.
Published: September 2011

Objective

The Jahn ventilating tube (JVT) is an osseointegrated middle ear ventilating tube that is used internationally in the treatment of Eustachian tube dysfunction (ETD). Little long‐term data exists quantifying the functions and complications of this device. This study aims to assess the long‐term outcomes with use of the JVT.

Method

Retrospective chart review of 22 patients (24 ears) with ETD managed with JVT (1994‐2008) with at least 3 years of follow‐up, or documented JVT failure at any time point. Main outcome measures were duration of patency, time to extrusion, middle ear aeration, audiogram, Sade score, and complication rate.

Results

Twelve out of 24 JVTs were patent at last follow‐up. Mean duration of retention of a patent tube was 6 years. Aeration of the middle ear with a patent JVT was excellent, with mean Sade score at last visit of 1.08. Mean improvement in air bone gap between the preoperative and last visit was 3 dB. Twelve out of 24 JVTs extruded during the study period. The mean time to extrusion was 21 months. There was no difference in age at insertion between the 2 groups (P =. 113). Two complications were identified, which were persistent tympanic membrane perforations.

Conclusion

JVTs are a safe alternative to traditional pressure equalization tubes. When successful, they can establish a well‐aerated middle ear for extended periods of time. However, early extrusion undermines reliability.
Management of Hearing in Pediatric Neurofibromatosis 2
Authors: Shepard Taylor H. , Kaylie David , Tucci Debara L.
Published: September 2011

Objective

Pediatric patients with neurofibromatosis type 2 (NF2) present a unique and difficult challenge to the neurotologist. The participants should be able to discuss the various approaches to pediatric patients with NF2 in regard to hearing preservation techniques and individualized management strategies.

Method

Case study format. Five unique clinical scenarios demonstrate various surgical approaches and management techniques for hearing preservation.

Results

Patients with NF2 are still developing physically, mentally, and socially. They generally have a poorer prognosis and diminished life expectancy compared to adult patients. Considerations of utmost importance include management of the tumor with the goal of minimizing outcomes such as significant bilateral hearing loss, facial paralysis, and injury to other cranial nerves. This review provides insight into clinical challenges associated with NF2 and illuminates the therapeutic options for hearing preservation and optimized quality of life in these patients. Each case clearly demonstrates important management principles that provide a framework for care of the pediatric NF2 patient.

Conclusion

Each patient with NF2 is unique. Methods to preserve hearing must be individually tailored in order to preserve optimal hearing and avoid disruption of the development of the pediatric patient.