bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Intracranial Complications of Otitis Media: Clinical Perspective from a Regional Otolaryngology Program
Authors: Lin James , Nuss Daniel W. , Walvekar Rohan R.
Published: September 2011

Objective

Analyze the problems, methods, and outcomes encountered in treating intracranial complications of otitis media in an underserved region by an otolaryngology program distributed over 3 cities up to 130 miles apart with limited neurosurgical availability. Suggest systems‐based improvements in optimizing care and cost‐effectiveness of complicated otologic patients.

Method

A retrospective review of intracranial complications of otitis media managed by the LSUHSC Otolaryngology program in public and private hospitals with variable neurosurgical availability from July 2008 to January 2011. Limitations of access to sub specialty evaluations, medical therapy, and surgical therapy are discussed. Outcomes for 8 patients with intracranial otologic complications are described.

Results

In our retrospective review, 2 patients with petrous apicitis (25%), 3 patients with meningitis (37.5%), 2 patients with brain abscess (25%), and 1 patient with sigmoid sinus thrombophlebitis (12.5%) were encountered. A total of 75% of patients (6/8) received intravenous antibiotics as initial treatment, while 2 patients (25%) underwent urgent otologic surgery. All patients initiated on conservative protocol improved clinically. Of these, 3 patients underwent outpatient combined otologic‐neurosurgical surgery and 1 patient required an urgent neurosurgical intervention, while 2 patients could be managed without surgical intervention. Three of 8 patients (37.5%) were lost to long‐term follow‐up. There were no known patient deaths.

Conclusion

In a regional otolaryngology program, concerns in managing emergent otologic conditions include limited access to subspecialty surgeons, diagnostic studies, and patient transportation. Antibiotic therapy is often effective as a single treatment modality or in stabilizing patients until definitive elective surgery, which may reduce the need for costly urgent patient transportation.
Role of Postoperative Aspirin in Free Tissue Transfer
Authors: Lighthall Jessyka G. , Bell Rachel A. , Wax Mark K. , Ghanem Tamer Abdel‐Halim
Published: September 2011

Objective

Examine if flap outcomes and complication rates in free tissue transfer surgery performed by a single microvascular surgeon vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation.

Method

A retrospective chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, re‐exploration, and salvage. Chi square analysis was performed to identify differences based on type of postoperative antithrombotic therapy.

Results

A total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received only aspirin, and 54 received a combination of agents. The overall complication rate was 38% with significantly more complications in the aspirin group compared with no prophylaxis (P =. 002). There was no significant difference in bleeding complications (P =. 192) or flap failure (P =. 839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group (P =. 039) with a trend toward a higher salvage rate in these cases (P =. 058) when compared with the no prophylaxis group.

Conclusion

Postoperative thromboprophylaxis with aspirin after microvascular free tissue transfer is associated with a higher complication rate without an increase in bleeding or improvement in free flap survival in our series. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.
Management of Inverted Papilloma of the Temporal Bone
Authors: Rowan Nicholas , Kalyoussef Evelyne , Liu James K. , Jyung Robert W.
Published: September 2011

Objective

1) Understand the clinical presentation, etiology, and histopathology of inverted papilloma of the temporal bone. 2) Discuss current treatment and management of inverted papilloma of the temporal bone as well as considerations for future management.

Method

Inverted papilloma (IP), a benign neoplasm typically arising within the sinonasal tract, has rarely been reported occurring outside the sinonasal tract. Only 18 cases of temporal bone IP have been reported. We review our 2 cases of temporal bone IP and discuss their management.

Results

Our cases demonstrate both primary and secondary temporal bone involvement. The first case was a primary lesion with atypical otoscopic appearance of a granular mass extending from the middle ear through a tympanic membrane perforation. This was managed with a tympanoplasty, canal wall up mastoidectomy, and facial recess approach. The second case presented as a subepithelial mass extending from the posterior wall of the ear canal after 3 resections of a sinonasal IP. Because of advanced bone destruction, extensive resection similar to a retrolabyrinthine approach was required, followed by tympanomastoid obliteration. Recurrence was monitored with baseline and follow‐up PET‐CT scans.

Conclusion

Temporal bone IP is a rare neoplasm with no definitive treatment algorithm. We recommend aggressive surgical resection with close postoperative follow‐up. PET‐CT may be useful for identifying multicentric disease at presentation or for early identification of recurrent disease. HPV detection may identify IPs at risk for multicentric or recurrent disease.
Middle Ear Cholesteatoma and Its Complications
Authors: Cosgarea Marcel , Maniu Alma , Necula Violeta
Published: September 2011

Objective

Cholesteatoma is still one of the most challenging ear diseases, its evolution leading sometimes to serious complications (facial palsy, vestibular disorders, meningitis, intracranial abscesses, sigmoid sinus thrombosis, etc). Surgical treatment is always required to heal the disease.

Method

We reviewed the surgical reports of 534 patients treated in the ENT Clinic from Cluj between 2003 to 2010. Patients’ ages ranged from 3 to 81 years, with a mean age of 30 years. The surgical procedure was to follow the cholesteatoma extension from the tympanic cavity to the mastoid cavity.

Results

Most of the cases were operated in closed technique. We have used for ossicular reconstruction incus body without osteitis, the head of the malleus, and cortical of temporal bone. For tympanic membrane and canal wall reconstruction we have used perichondrium cartilage with or without perichondrium. Patients with complications underwent open technique. Recurrence of suppuration was noticed in 28% of cases, requiring a second intervention. Hearing improvement was obtained in 58% of patients, satisfactory results were obtained in 19% of patients, and 23% of patients showed no improvement of hearing.

Conclusion

Autologous materials remain a useful alternative for middle ear reconstruction, improving the hearing in most of the cases. The treatment in cholesteatoma is always surgical, requiring a careful removal of the infection. The surgical technique should be individualized from case to case.
Middle Ear Irrigations Decrease the Density of Mucosal Biofilms in an Animal Model of Acute Otitis Media
Authors: Walker Thomas J. , Abi Hachem Ralph , Angeli Simon I. , Liu Zue‐Zhong
Published: September 2011

Objective

Bacteria in biofilms are extremely resistant to antibiotics. Recurrent acute otitis media appears to be a disease related to biofilm formation. The goal of this study is to determine if middle ear irrigations with saline or baby shampoo could eradicate mucosal biofilms in a chinchilla model of acute otitis media.

Method

After a baseline ABR, middle ears of 10 chinchillas were inoculated with Haemophilus influenzae. On day 5, the ears were irrigated with saline or 1% baby shampoo using a syringe or hydrodebrider. A final ABR was obtained before the animals were euthanized and middle ear mucosa were harvested for SEM analysis.

Results

Biofilm formation on middle ear mucosa in chinchillas was in nonuniform distribution. SEM analysis by a blinded microscopist showed a statistically significant decrease in biofilm densities of middle ear mucosa after normal saline or 1% baby shampoo irrigations when compared with nonirrigated ears using Wilcoxon/Kruskal‐Wallis Tests (P <. 01). No statistically significant difference in biofilm densities between normal saline and 1% baby shampoo irrigations was seen. The hearing thresholds on auditory brainstem responses (ABR) at frequencies 16 kHz, 4 kHz, 1 kHz, and 500 Hz were unchanged two days after normal saline or 1% baby shampoo irrigations.

Conclusion

Middle ear irrigations with 1% baby shampoo or normal saline lead to a statistically significant decrease in biofilm densities. One percent baby shampoo or normal saline are non‐ototoxic and can be safely used for middle ear irrigations. Future work in our laboratory will study the effect of a hydrodebrider prototype.
One Stage BAHA Surgery in Children: Two Centers Experience
Authors: Rivas Alejandro , Forero Victor H. , Rivas Adriana , Haynes David S. , Rivas Jose A. , Hall Joseph E. , Labadie Robert F.
Published: September 2011

Objective

Determine the incidence of postoperative complications associated with bone anchored hearing aid—BAHA—implantation in one surgical time frame for children and adolescents.

Method

Retrospective study at 2 tertiary referral centers. A total of 84 patients less than 18 years old (104 BAHA procedures) with conductive, mixed, and single sided deafness between 2003 and 2010.

Results

Postoperative complications occurred in 21 (20.2%) implants placed. Complications related to skin in 11 (10.5%) cases, implant extrusion occurred in 7 (6.7%) cases, and loss of abutment occurred in 3 (2.8%) cases. 40 dB average functional hearing gain was observed in the whole group of patients.

Conclusion

We found overall incidence (20.2%) of postoperative complications for this group involving 2 different centers and implantations in one surgical time frame, which is not higher than that reported in the 2 stage procedure. These results support the feasibility and safety of single‐stage surgery for BAHA implantation in this group of patients.
Ossicle Erosion and Conductive Hearing Loss in Cholesteatoma
Authors: Martins Olga , Selesnick Samuel H. , Victor Jonathan
Published: September 2011

Objective

Investigate and analyze the relationship between individual ossicular erosion and ABG among patients with cholesteatoma. Data from patients undergoing initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative PTA data, intraoperative assessment of individual ossicular destruction, and clinical characterization of cholesteatoma.

Method

For each patient, the cholesteatoma was categorized as primary acquired, secondary acquired, congenital, or unable to discern. Ossicular destruction was graded, and ABG was calculated. For each ossicle, the relationship between degree of cholesteatoma involvement and ossicular erosion and the ABG were analyzed using univariate and multivariate linear regression.

Results

A total of 158 primary cholesteatoma surgeries were performed by the senior author between 1992 and 2009 that met our inclusion criteria. The status of each ossicle was significantly associated with the ABG in a graded and independent manner; this association was most significant for the incus. Cholesteatoma abutting an intact ossicle did not significantly affect the ABG. Clinical categorization of cholesteatoma was not significantly associated with the ABG.

Conclusion

Via the use of a new and detailed grading scale, this study reveals that the erosion of each ossicle contributes in a graded and independent manner to the increase in ABG, with the status of the incus having the most statistically significant association with ABG.
Ossiculoplasty Efficacy Monitored by ECoG‐Laser‐Doppler Technique
Authors: Niemczyk Kazimierz , Bartoszewicz Robert , Sokolowski Jacek , Morawski Krzysztof F.
Published: September 2011

Objective

1) Understand changes in the acoustic conductivity of the ossicular chain reconstruction during ossiculoplasty. 2) Assess the need to change shape and positioning of the prosthesis during surgery.

Method

Six patients underwent a “second look” procedure 12 months after closed tympanoplasty. A prosthesis was positioned between the stapes plate and graft. Laser Doppler Vibrometer (LDV) was used to assess prosthesis moveability. Simultaneously round window electrocochleography (RW‐ECoG) was recorded to evaluate hearing threshold. LDV and RW‐ECoG were recorded following acoustic stimulation.

Results

The average value of LDV‐speed at 500 Hz is 0.29 m/s (SD 0,19), at 1000 Hz is 0.16 m/s (SD 0.084), at 2000 Hz is 0.043 m/s (SD 0.026), at 4000 Hzis 0.047 m/s (SD 0.0093) and at 8000 Hz is 0.018 m/s (SD 0.0093). The prosthesis revealed a significantly higher mobility at 500 to 1000 Hz than at 2000 Hz. Ossicular movability measured on the prosthesis compared to intraoperatively measured hearing thresholds. Both techniques showed its utility in assessment of efficacy of acoustic energy transfer after ossiculoplasty, though in patients with affected bone curve, discrepancies between hearing thresholds and LDV results were observed.

Conclusion

Intraoperative assessment of amplitudes and thresholds of ossicular chain movability informs the surgeon about efficiency of the acoustic energy transfer through the reconstructed ossicular chain. LDV technique with RW‐ECoG led to achievement of the optimal position and tension of reconstructed ossicles.
Stability of Midface Fracture Repair Using Absorbable Plates
Authors: Pereira Lucio M. , Zuliani Giancarlo , Abu‐Hamdan Maher D. , Carron Michael
Published: September 2011

Objective

Determine if the KLS Martin Sonic Weld system provides plate‐screw construct stability in human skulls even when placed at acute angles at the midface buttresses. The strength of the construct will be compared with absorbable miniplates with screws placed at 90‐degree angles.

Method

Ten skulls will be prepared by creating midface osteotomies bilaterally. All screws will be placed at 90 degrees on the control side. The contralateral side will be plated with the absorbable system at more acute angles. The data will be compared as matched pairs within each specimen and statistically analyzed.

Results

Fractures fixated with the ultrasonic absorbable plating system placed with screws at all tested angles will fail at similar to our control plates placed at 90 degrees. This will allow the surgeon to successfully reduce fractures in the midface fragments in difficult to reach areas and possibly cut down on operative time and improve the chance of achieving a long lasting adequate reduction.

Conclusion

There is no difference in the strength of the plate‐screw construct using the ultrasonic plate‐pin system between pins placed at the conventional 90° or at more acute angles. This is likely a function of the design of the plating system.
Otologic Disease in Polyostotic Fibrous Dysplasia and McCune‐Albright Syndrome
Authors: DeKlotz Timothy , King Kelly , Collins Michael T. , Zalewski Christopher K. , Kim Hung Jeff J. , Brewer Carmen C.
Published: September 2011

Objective

1) Characterize the spectrum of otologic disease in patients with polyostotic fibrous dysplasia (PFD) and McCune‐Albright Syndrome (MAS). 2) Correlate audiometric analysis with temporal bone computed tomography (CT) findings in this cohort.

Method

A retrospective review was performed in a cohort of PFD/MAS (n = 123) followed in a longitudinal natural history protocol. Patients with craniofacial involvement and those who underwent comprehensive otologic evaluation, audiologic analysis, and cranial CT imaging evaluation were included.

Results

Complete evaluations were available for 107 patients. Fibrous dysplasia (FD) of the temporal bones was identified in the majority (71%). Clinically significant hearing loss (.5/1/2/4 kHz PTA >20 dB HL) was identified in 30 ears (20%). A conductive loss (70%) was more frequent than a sensorineural loss (30%) and overall was primarily mild (70%). External auditory canal stenosis, epi‐tympanic involvement, and internal auditory canal involvement based on CT were found to be rare potential contributors to overall hearing loss (n = 10 ears). While canal cholesteatoma can be a major complication, it was only identified in one patient.

Conclusion

FD of the temporal bones in patients with PFD/MAS was common. Clinical manifestations depend on the location and degree of skeletal involvement. Otologic problems and hearing loss were present in a minority and were generally mild. Serious complications were rare. Conservative management may often be the best plan of care.
Prevalence of Profound Hearing Loss and Cophosis in 1015 Patients from the Chronic Otitis Media Outpatient Clinic in Brazil
Authors: Migliavacca Raphaella , Manica Denise , Rosito Leticia S. , Da Costa Sady S. , Dornelles Cristina
Published: September 2011

Objective

An issue that has recently gained attention is, in addition to conductive hearing loss, sensorineural hearing loss (SNHL) due to chronic otitis media (COM). The objective of this study is to evaluate the prevalence of profound hearing loss and cophosis in chronic otitis media patients with or without cholesteatoma.

Method

Transversal study. We studied 1015 patients from the Chronic Otitis Media Outpatient Clinic of the Hospital de Clínicas in Porto Alegre, evaluated between August 2000 and January 2011. The inclusion criterion was presence of COM, with or without cholesteatoma. The main outcome was the presence of profound hearing loss and cophosis.

Results

A total of 1015 patients were evaluated. Ages varied between 2 and 87 years, with an average age of 28.36 ± 18.85 years; 50% of them were females, and 371 had cholesteatoma. Of all samples, 16 had profound hearing loss or cophosis (1.57%). Considering only our deaf samples, ages varied between 10 and 74 years, with an average age of 44.23 ± 19.20 years; 11 patients (68.8%) were females, and 7 had cholesteatoma. The prevalence of profound hearing loss or cophosis in patients with and without cholesteatoma was 1.3 and 2.2%, respectively. Cholesteatoma determined an estimated risk of 1.69 for very significant hearing loss.

Conclusion

COM can affect round and oval windows and others sites of the inner ear. The prevalence of profound hearing loss and cophosis strongly associated with COM was only 1.4% in our sample. Patients with cholesteatoma have 1.7 times more chance of profound deafness/cophosis due to COM than patients without cholesteatoma.
Repair of Temporal Bone Defects with Bone Cement: Our Experience
Authors: Pérez‐Fernández C. Aranzazu , Contreras J. Diego , Rodríguez‐Francos M. Isabel , García‐Sevilla Tomás , Calatayud Vincente , Cervan Fernando
Published: September 2011

Objective

The defects of temporal bone are classified according to their causative factor. Definitive repair of the defect is paramount to prevent potentially devastating complications. There are different approaches, and multiple materials have been used to repair the defects. We describe our experience using bone cement.

Method

Medical records of consecutive patients with spontaneous defect of the temporal bone were reviewed. A retrospective review was performed over a 5‐year period. Clinical presentation, diagnosis process, intraoperative findings, operative technique, and postoperative follow‐up. The surgical technique was reviewed as well as the wound healing and structural integrity results.

Results

Five of the 7 patients were women (4 spontaneous cerebrospinal fluid otorrhea, 1 colesterine granuloma, and 2 after mastoidectomy). Ages ranged from 42 to 63 years. Four patients presented with meningitis. The location and the extent of the defect were detected by computed tomography in all cases. The most common defect sites were located over the tegmen mastoideum and tegmen tympany. All the tegmen defects were repaired using a middle fossa approach with bone cement. All patients had complete resolution of the problem without adverse effects.

Conclusion

Surgical management using a middle fossa craniotomy is outlined. The bone cement is hard within minutes of application. This procedure offers a simple and reliable method for repairing the tegmen defects with a high cure rate.
Results of Revision Tympanoplasty for Chronic Non‐cholesteatomatous Otitis Media
Authors: Lesinskas Eugenijus , Stankeviciute Vilma
Published: September 2011

Objective

Evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and retympanoplasty using the same technique, and to analyze the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome.

Method

Patients who underwent tympanoplasty (n = 617) or re‐tympanoplasty (n = 94) for chronic otitis media without cholesteatoma. The different data were analyzed. The temporal fascia, perichondrium, and cartilage‐perichondrium composite grafts were used. Ossiculoplasty was performed as needed. The interrelation between preoperative parameters, postoperative morphological outcomes, and functional outcomes was analyzed.

Results

Successful closure rates of the TM perforation were 93.6% and 90.2% in the primary and revision tympanoplasty groups. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re‐tympanoplasty group (63.4%, compared with 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4%, compared with 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1% and for re‐tympanoplasty in 69.5% (P <. 01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty.

Conclusion

Patients who underwent tympanoplasty (n = 617) or re‐tympanoplasty (n = 94) for chronic otitis media without cholesteatoma. Different data were analyzed. The temporal fascia, perichondrium, and cartilage‐perichondrium composite grafts were used. Ossiculoplasty was performed as needed. The interrelation between preoperative parameters, postoperative morphological outcomes, and functional outcomes was analyzed.
Retrograde Guided Balloon Dilatation Eustachian Tuboplasty
Authors: Testa Jose Ricardo Gurgel , Tamiso Arnaldo B. , Paris Oswaldo , Testa Tatian , Balsalobre Filho Leonardo L. , de Oliveira Penido Norma
Published: September 2011

Objective

Evaluate a new option for treatment of patients with Eustachian tube stenosis.

Method

Prospective surgical study. Three patients with unilateral intractable Eustachian tube stenosis (after surgical procedures) underwent retrograde illumination with Relieva Luma Sentry from middle ear to nasopharyngeal area and with endoscopic nasal approach to balloon dilatation to that area under general anesthesia. The procedures were done between 2010 and 2011.

Results

By following the light that was dissected through the stenosis tissue until we could have the Relieva Luma Sentry, we then inserted it retrograde inside a sphenoid balloon catheter and inserted the balloon inside a tubal lumen. After that, the balloon was inflated for 2 minutes with 10 atm to tubal dilatation. The approach to the middle ear was done transtympanically. Balloon catheters had success in dilatation in all cartilaginous Eustachian tubes. Balloon dilatation was not difficult to perform. Patients reported a very good improvement of hearing levels and a good dilatation comparing the tomography before and two months after the procedure.

Conclusion

Retrograde guided balloon dilatation of the nasopharyngeal Eustachian tube ostia showed good results. Larger studies are now needed to show the real role of this surgery.
The Differences in Management of Isolated Orbital Floor Fractures
Authors: Alinasab Babak , Stjärne Pär
Published: September 2011

Objective

To evaluate 1) differences in opinion between the subspecialties and surgeons from Sweden and the United States in the management of branchio‐oculo‐facial syndrome (BOF); 2) if the surgeons handle these cases based on their own individual criteria; 3) the correlation between the management of the patients with BOF and late sequels upon eye examination.

Method

Eleven patients with BOF were selected from the records in the Department of ENT and Head & Neck Surgery, Karolinska University Hospital. They were presented to surgeons from different countries and subspecialties who gave their opinion regarding the need for surgery and risk for late enophthalmus.

Results

In only 48% of the cases the surgeons were in agreement of the management of the patients regarding whether or not to operate. In evaluating the risk for late enophthalmus the surgeons were in agreement in 51% of the eleven cases. The surgeons from the United States found need of surgery 13% more than the surgeons from Sweden.

Conclusion

The management of BOF appears to be based on both individual and local traditions. There are considerable differences in the management of BOF, due to lack of reliable consensus. Guidelines based on randomized prospective study in BOF are required.
Role of Pathogens in Ossicular Prosthesis Problems
Authors: Wingkun Niel‐Jeremy G. , Ojano‐Dirain Carolyn P. , Fulton Edward , Antonelli Patrick J.
Published: September 2011

Objective

Microbial biofilms are commonly found on ossicular chain reconstruction prostheses (ORPs). They have been implicated as a cause of suboptimal hearing outcomes. The purpose of this study was to determine which middle ear pathogens might be involved with ORP biofilms and ORP problems, such as scarring or extrusion.

Method

ORPs were explanted at the time of revision surgery and analyzed for microbial colonization using quantitative polymerase chain reaction (qPCR) with pathogen‐specific primers for Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Candida albicans, Candida parapsilosis, and Aspergillus niger. Results were correlated with the otologic status.

Results

The majority of ORPs (19 of 21) tested positive for at least one pathogen. On average, each ORP tested positive for the presence of 2 pathogens. Twelve tested positive for S aureus, 10 for H influenzae, 9 for P aeruginosa, and 1 for S pneumoniae. No samples revealed C albicans, C parapsilosis, or A niger. Hearing, cholesteatoma, presence of effusion, extent of middle ear scarring, and extrusion did not appear to correlate with the presence of specific pathogens.

Conclusion

ORPs commonly harbor polymicrobic bacterial colonies or biofilms. Fungal pathogens are not commonly found on ORPs. While the presence of these biofilm‐forming organisms is evident, it is unclear whether these pathogens play a role in unfavorable outcomes with middle ear reconstruction.
Spontaneous Cerebrospinal Fluid Leak through the Posterior Aspect of the Petrous Bone
Authors: Nadaraja Garani S. , Monfared Ashkan , Jackler Robert K.
Published: September 2011

Objective

Spontaneous cerebrospinal fluid (CSF) leak through the posterior fossa aspect of the petrous bone (PF) is very rare. A case series allows analysis of possible etiologies and how they may differ from the more common middle fossa (MF) route of leakage.

Method

A series of 3 patients with PF spontaneous temporal bone CSF leaks is described. High‐resolution imaging (CT & MRI) and intraoperative observation characterize the anatomical characteristics of the pathway.

Results

This series of patients did share the demographics typically found in the MF leak population. Two patterns of PF CSF leak were identified: large unilateral with cerebellar encephalocele and bilateral small defects just lateral to the endolymphatic sac. Two out of our 3 patients presented with simultaneous MF and PF leaks suggesting the possibility of a shared etiology, at least in some cases, with a role for increased intracranial pressure.

Conclusion

In spontaneous CSF leaks it is important to evaluate the posterior petrous bone along with the tegmen. The concomitant appearance of MF with PF leaks points out the risk that repair via MF craniotomy could fail to identify a leakage site in the vicinity of the endolymphatic sac.
Stress Hormone Sensitivity and Endolymphatic Hydrops
Authors: Kitahara Tadashi , Maekawa Chie , Inohara Hidenori , Okazaki Suzuyo , Horii Arata , Kamakura Takefumi
Published: September 2011

Objective

Ménière’s disease is peculiar to humans, and attacks of this affliction can occur under conditions of stress. The present study aimed to assess the link between inner ear hydrops in Ménière’s disease and vasopressin, an anti‐diuretic stress hormone with a potential role in inner ear fluid homeostasis.

Method

We obtained blood samples from Ménière disease patients to examine plasma vasopressin (pAVP) and obtained inner ear tissue during endolymphatic sac surgery to examine vasopressin type‐2 receptor (V2R) in the endolymphatic sac. We examined pAVP and the relative V2R mRNA expression in the endolymphatic sac using real‐time PCR.

Results

A significant negative correlation was revealed between pAVP and inner ear V2R (P =. 014). We also examined relative cyclic AMP (cAMP) activity in the endolymphatic sac using tissue culture and cAMP assay. Both pAVP (1.6 times vs controls; P =. 048) and inner ear V2R mRNA expression (41.5 times vs controls; P =. 022) were significantly higher in Ménière patients. cAMP activity was basally upregulated (2.1 times vs controls) and cAMP sensitivity to vasopressin application was largely elevated (4.9 times vs controls) in Ménière patients.

Conclusion

We concluded that in the pathogenesis of inner ear hydrops resulting in Ménière attacks, pAVP elevation probably as a result of stress may present a matter of consequence, but susceptibility of the V2R‐overexpressed and cAMP‐hypersensitized inner ear to pAVP elevation might be essential as a basis of this disease.
Symptom‐Based Intratympanic Dexamethasone for MénièreDisease
Authors: McRackan Theodore R. , Pearce Elizabeth C. , Bennett Marc L. , Labadie Robert F.
Published: September 2011

Objective

Understand the effectiveness of intratympanic (IT) dexamethasone for Ménière disease when given on an as‐needed basis for worsening symptoms.

Method

Retrospective cohort of 115 patients with AAO‐HNS criteria for definite Ménière disease who had failed lifestyle modifications and medical therapy. All patients received initial IT dexamethasone treatment. If unsuccessful in controlling symptoms, patients then chose further IT dexamethasone injections or ablative therapy (IT gentamicin or endolymphatic sac surgery).

Results

Of the 115 patients in this study, 92 (80.0%) reported satisfactory control of their Ménière disease symptoms with IT dexamethasone while 18 (20.0%) chose to receive ablative therapy. In those patients controlled with IT dexamethasone 58 (63.0%) were controlled with 3 or less injections, 28 (30.4%) were controlled with 4 to 10 injections, and 6 (6.5%) were controlled with more than 10 injections. Of those patients who chose ablative therapy, 8 (34.8%) chose IT gentamicin and 15 (65.2%) chose endolymphatic sac surgery. Age, sex, and duration of symptoms were not statistically associated with failed IT dexamethasone therapy (all P >. 05).

Conclusion

While multiple injections may be required, IT dexamethasone appears to be an effective alternative to ablative therapy in controlling symptoms in the majority of patients and can be used on an as‐needed basis when a patient’s symptoms significantly worsen.
Systematic Screening for KCTD12 Mutations Tinnitus
Authors: Kleinjung Tobias , Langguth Berthold , Sand Philipp
Published: September 2011

Objective

With regard to inhibition, GABAB receptors have been implicated in frequency‐dependent depression of transmitter release affecting synaptic plasticity. We speculated that genetic variation in potassium channel T1 domain‐containing 12 protein (KCTD12), a recently identified constituent of GABAB receptors, may predispose to over‐excitability as experienced by tinnitus subjects.

Method

A total of 81 white outpatients with a diagnosis of chronic tinnitus were systematically screened for mutations in the KCTD12 N‐terminal, cytoplasmic tetramerisation domain by direct sequencing.

Results

No novel variants were identified. We confirmed the presence of one synonymous substitution, rs34544607 (T178T), and one noncoding variant in the gene’s 3′UTR, rs41287030. When genotypes were grouped assuming dominance of the minor alleles, no significant genotype or compound genotype effects were observed on tinnitus severity by scores on the Tinnitus Questionnaire.

Conclusion

This is the first study to have addressed KCTD12 mutations in chronic tinnitus. Further investigations are invited in larger samples and in controls to assess a possible modulatory role of the above exonic variants on tinnitus susceptibility, or on related phenotypes.
The Effect of Depressor Septi Nasi Cutting on the Nasal Tip
Authors: Toutounchi Javad Seyed , Salari Behzad , Nezami Nariman , Toutounchi Neghisa , Banaem Samira Moghaddam
Published: September 2011

Objective

The nasal tip is an important aesthetic feature of the face and its surgery is the most interesting and challenging part of a rhinoplasty. The aim of this study was to evaluate the effect of cutting the depressor septi nasi muscle on the nasal tip rotation and projection.

Method

This clinical trial was carried out from 2008 to 2010 in Imam Reza hospital of Tabriz. Forty primary rhinoplasty patients who required nasal tip modifications underwent rhinoplasty including cutting of depressor septi nasi. The nasal tip rotation and projection and patient satisfaction were evaluated before and 6 months after the operation.

Results

The mean age of patients was 24.10 ± 5.37 years with male to female ratio of 13/27. Following rhinoplasty including depressor septi nasi muscle cutting, nasal tip rotation and projection, and patient satisfaction were improved in 58%, 70%, and 85% of patients, respectively (P <. 001 for all).

Conclusion

Rhinoplasty by cutting and repositioning of depressor septi nasi muscle has effectively improved the nasal tip rotation and projection and patient satisfaction.
The Effect of DizzyFIX in the Treatment of Benign Paroxysmal Positional Vertigo
Authors: Son Won‐Sang , Su Lee Jang , In Kim Young , Park Byung‐Cheol , Kim Wee‐Hwang
Published: September 2011

Objective

The treatment of benign paroxysmal positional vertigo (BPPV) is a repositioning maneuver in order to remove otolithic debris. We use a new device (the DizzyFIX) to assist in the performance of the modified Epley maneuver (MEM). The purpose of this study is to find out the effect of the dizzyFIXR in the treatment of BPPV.

Method

Sixty cases of posterior semicircular canal BPPV were studied. All patients were treated by MEM. They were divided into 2 groups. The first group (group A, 30 patients) was only MEM group. The second group (group B, 30 patients) was instructed to use the dizzyFIXR in MEM.

Results

In group A and B, dizziness handicap inventory(DHI) scores were found in pre‐ and post‐MEM. (The DHI scores pre‐ and post‐MEM in group A were 40.12 ± 6.58 and 19.42 ± 3.29, p in group A were 6.5 ± 0.5 and 3.4 ± 0.4, and in group B were 6.7 ± 0.4 and 2.2 ± 0.3, P <. 05) was noted.

Conclusion

From the analysis of this study, the use of this new device to assist in the performance of MEM for the treatment of posterior BPPV may be effective to relieve anxiety related to unsteadiness in BPPV patients and to increase satisfaction of MEM in BPPV patients.
Three‐Dimensional Reconstruction of Auricles by HRCT
Authors: Chen Chin‐Kuo , Huang Kuo‐Wei , Tsai Men‐Shen , Chang Kai‐Ping
Published: September 2011

Objective

The purpose of this study was to compare the dimensional measurements and surface topography of geometry reconstructed from high‐resolution computerized tomography (HRCT) of temporal bone with the same natural ears.

Method

HRCT of temporal bone was performed using simultaneous acquirement of 64 sections with a slice thickness of 0.5 mm. Corresponding image data were uploaded into software Amira 4.1 for segmentation and three‐dimensional reconstruction. A comparison of the surface topography of the CT reconstructed ear and the natural ear was made.

Results

This prospective study included 10 subjects, including 5 males and 5 females with normal hearing and no previous otologic disorders. A significant correlation of coefficients of various measurements on reconstructed auricles and natural auricles was made. The shape and volume of reconstructed ears by Amira was identical to the natural ear.

Conclusion

The shape and volume of reconstructed auricles by Amira was identical to the natural ears. CT may be appropriate to fabricate a prosthesis through non‐invasive techniques. The use of this technique in clinical practice may be in production of a prothesis.
Tissue Modeling in a Patient‐Specific Skull Base Surgical Simulator
Authors: Roberts Erik , Salisbury Kenneth , Chan Sonny , Blevins Nikolas H.
Published: September 2011

Objective

Patient‐specific surgical simulation is a new frontier that promises great benefits for surgical planning and rehearsal. However, it requires an efficient means of generating virtual anatomic models. Our objective is to develop a workflow to convert clinical imaging data into computational representations that support real‐time simulation and haptic interaction.

Method

Standard computed tomography was obtained from 3 otologic patients. Key anatomy was segmented, cleaned by morphological operations, and converted into 3D polygonal meshes. These were reduced to the desired complexity and converted to solid tetrahedral meshes. Results were imported into the Simulation Open Framework Architecture (SOFA) for interactive simulation.

Results

Using the workflow developed, we were able to create accurate patient‐specific virtual models of surgically relevant otologic anatomy. The resulting structures can be deformed and manipulated interactively through a haptic interface. Although still labor‐intensive, the workflow promises considerable time‐saving over purely manual segmentation and model creation. The resulting models are amenable to derivation and application of physical properties of specific tissues to improve behavioral realism.

Conclusion

Our prototype is an effective means of converting preoperative imaging into patient‐specific 3D models suitable for interactive physical simulation. We continue to make model creation more automated. The potential for adding tissue‐specific physical properties will augment realism and increase the utility of the simulation for surgical rehearsal.
TNF‐Alpha Expression on Acquired Cholesteatoma Behavior
Authors: Martin Cristina N. , Santos Ana Carolina S. , Castanheira Luis V. , Camera Marcela G. , Testa Jose R. , Testa Norma
Published: September 2011

Objective

This article aims to show the qualitative TNF‐alpha expression on acquired cholesteatoma behavior and the recurrence prognostic factor.

Method

We retrospectively selected 2 groups of patients with acquired cholesteatoma who underwent open tympanomastoidectomy to remove the disease: the first group had recurrence after at least 2 years, and the second group had the disease under control over 4 years.

Results

Immunohistochemistry was done using a TNF‐alpha receptor marker in both groups and was evaluated by 3 observers who followed the patterns according to the relationship between the reagent expression and the epithelium. The 0 level means no reagent expression, the + level means that a third were dyed, the ++ level means more than two thirds were dyed, and the +++ level means the fullest extent of the epithelium was dyed. The mean expression of TNF‐alpha was slightly higher in the group with recurrence than in the control group, respectively 1.7 + 1.4 +, but there was not detected a statistically significant difference between the groups (P =. 456).

Conclusion

Although several articles show TNF‐alpha action bone destruction in cholesteatoma cases in vitro, the qualitative expression of TNF‐alpha was not a good predictor in cholesteatoma recurrence.
Transient Low‐Tone AB Gaps after Canal Plugging Surgery
Authors: Uetsuka Satoru , Inohara Hidenori , Kamkura Takefumi , Sakata Yoshiharu , Horii Arata , Kitahara Tadashi
Published: September 2011

Objective

The present study aimed to determine the time course and frequency patterns of transient low‐tone air‐bone gaps (ABGs) after canal plugging for intractable BPPV.

Method

We investigated 8 patients with intractable BPPV who underwent canal plugging. Four cases had posterior semicircular canal type BPPV (pBPPV), and the other 4 had horizontal semicircular canal type BPPV (hBPPV). Pure‐tone audiometries (PTAs) were performed before surgery and 7 days, 1 month, and 6 months after surgery.

Results

The ratio of the number of patients with ABGs (+) was 100.0% (8/8) on the 7th day and 1st month postoperatively, and it was 0.0% (0/8) in the 6th month postoperatively. There were no significant differences in the time course or frequency patterns of ABGs between pBPPV and hBPPV.

Conclusion

Our findings suggest that, during such a convalescence period, the plugged area might not be completely repaired yet and could still induce dizziness and low‐tone ABGs, since enlarged vestibular aqueduct syndrome and superior semicircular canal deficiency syndrome exhibit low‐tone ABGs because of a third mobile window into the inner ear.
Tympanostomy Tube Sequelae Related to Pathogens
Authors: Fulton Edward , Ojano‐Dirain Carolyn P. , Antonelli Patrick J. , Wingkun Niel‐Jeremy G.
Published: September 2011

Objective

Posttympanostomy tube (TT) sequelae have been associated with a wide range of middle ear pathogens. Though microbes commonly bind to TTs, it is unclear what leads to clinical pathology. The goal of our study was to investigate the role of middle ear pathogens in post‐TT sequelae.

Method

TTs were explanted for a range of indications and analyzed for biofilm formation using electron microscopy (EM) and quantitative polymerase chain reaction (qPCR) with specific primers for otopathogens. Results were correlated with the otologic status.

Results

None of the 18 TTs demonstrated Aspergillus niger, Candida parapsilosis, or Candida albicans. Streptococcus pneumonia was found in one TT with recurrent otorrhea. Pseudomonas aeruginosa was found in 44.4% of TTs, 2 out of 2 TTs with active otorrhea, and 87.5% with recent or current otorrhea. Staphylococcus aureus was found in 78% of TTs and 6 out of 6 TTs with granulation tissue. Haemophilus influenza was found in 72% of TTs, irrespective of clinical status. EM revealed that TTs commonly have complex topographical features, which may serve as reservoirs for microbial growth and biofilm formation.

Conclusion

Post‐TT sequelae, such as otorrhea and granulation tissue, are more common with P aeruginosa and S aureus colonization and/or biofilm development. H influenza is also prevalent, but less clearly related to clinical pathology. These findings may have implications related to the pathogenesis and treatment of post‐TT sequelae.
Unilateral Sensorineural Deafness: BAHA vs TransEar Device
Authors: Rivas Adriana , Bernal Elizabeth , Usaquen Francy , Forero Victor H. , Rivas Alejandro , Rivas Jose A.
Published: September 2011

Objective

Compare the audiological and quality of life assessment in 2 groups of patients: users of BAHA and users of TransEar devices.

Method

Retrospective study of 20 patients with unilateral sensorineural hearing loss. Group number 1, 10 patients using TransEar. Group number 2, 10 patients using BAHA. Prefitting Pure Tone Average (PTA) 0.25 to 4kHz compared with postfitting PTA 0.25‐ 3kHz between groups. Survey results of the Hearing Device Satisfaction Scale tool.

Results

Functional hearing gain was observed in both groups. The BAHA system showed higher hearing benefit than the TransEar system. When mean thresholds of each system were compared, mean functional response was 41dBSPL with the TransEar and 25dBSPL with the BAHA. The satisfaction level of sound category was slightly better for the BAHA device. TransEar is preferred over BAHA in fitting, cosmesis, and management issues. BAHA showed better scores for quality of life aspects.

Conclusion

In this group of patients, higher hearing benefit of osseointegrated implant regarding the effectiveness over the intracanal system was observed. When satisfaction level is analyzed related to fitting, management, and quality of life, an intracanal device is preferred.
Vagal Palsy Following Cerebellopontine Angle Surgery
Authors: Best Simon R. , Starmer Heather M. , Hillel Alexander T. , Francis Howard W. , Akst Lee M. , Chien Wade W. , Agrawal Yuri
Published: September 2011

Objective

1) Understand that the vagus nerve is at risk during excision of lesions of the cerebellopontine angle (CPA), with a potential impact on voice and swallowing function. 2) Describe the incidence and risk factors for vagal palsy in patients undergoing excision of CPA tumors.

Method

Retrospective chart review of 181 consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Unilateral vagal palsy was identified by laryngoscopy or cine‐esophagram, and clinical variables were collected from medical records.

Results

Unilateral vagal palsy was identified in 19 out of 181 (10%) patients. Vocal fold motion impairment (VFMI) in combination with pharyngeal palsy was more common than VFMI or pharyngeal palsy alone. Those with vagal palsy had a larger mean tumor size (30 mm) than those without vagal palsy (20 mm, pp with vagal palsy (67%).

Conclusion

Voice and swallowing function can be affected by surgical excision of pathology of the CPA. Tumor size is an independent risk factor for postoperative vagal palsy, with consequences for prolonged hospital stay, aspiration, and voice, and swallowing impairment.
Vertebrobasilar Artery Aneurysms: An Uncommon Cause of Vertigo
Authors: Hart Catherine , Pensak Myles L.
Published: September 2011

Objective

Review our experience with vertebrobasilar artery aneurysms and discuss factors which may enable clinicians to distinguish between these potentially life‐threatening posterior circulation aneurysms and other conditions with similar presentations.

Method

Case series with chart review. The charts of patients who underwent surgical management of posterior circulation aneurysms at a tertiary care center between December 1995 and February 2008 were reviewed.

Results

A total of 57 patients (40 females, 17 males) with an average age of 52.8 years (range, 27‐79 years) were included. A total of 44 patients were white, 5 were African American, and 8 were unspecified. Aneurysms of the posterior communicating artery and posterior inferior cerebellar artery were most common, occurring in 28 (49%) and 26 (46%) of patients, respectively. The most common initial symptoms were headache in 31 patients (54%) and acute mental status changes in 18 patients (32%). Eight patients (14%) presented acutely with dizziness or vertigo. 26 patients (46%) underwent suboccipital craniotomy with aneurysm clipping. Fifteen (26%) underwent frontotemporal craniotomy, and 5 (9%) underwent a combined neurosurgical‐neurotologic approach. There were 8 deaths.

Conclusion

Vertebrobasilar aneurysms are uncommon and typically present emergently after rupture. A small number of patients with such aneurysms may present with neurotologic symptoms, such as vertigo and disequilibrium. Given the potentially grave consequences of a ruptured aneurysm, it is essential that otolaryngologists remain cognizant of the presentation of posterior circulation aneurysms.