bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing Preservation in Adolescent Cochlear Implantation
Authors: Felton Mark , Melling Christine , Green Kevin , Bruce Iain
Published: August 2013

Objectives:

Soft surgical techniques are increasingly being used in an attempt to preserve residual low frequency hearing in adults undergoing cochlear implantation. We describe our experience of cochlear implantation with hearing preservation in adolescents.

Methods:

Attempts at cochlear implantation with hearing preservation in adolescents were identified from the Manchester Auditory Implant Centre, UK. A retrospective case note review was performed, with emphasis on: functional hearing deficit pre‐operatively, surgical technique, age at implantation, type of electrode implanted, and functional hearing ability at sequential follow up. Functional outcomes were evaluated with the aim of evaluating both the potential benefit of preserving residual low‐frequency hearing and the maintenance of preserved hearing over time.

Results:

Sixteen adolescents (10 girls, 6 boys) received 18 cochlear implants over a 5 year period. The average age at implantation was 13 years, 5 months (range 10.5 to 17 years, 11 months). Average follow up was 2.5 years (range 1 year to 4 years, 3 months). Varying degrees of hearing preservation were achieved across the group, with hearing preservation being successful in all cochlear implantations. Detailed analysis of the audiological outcomes will be presented. Functional hearing significantly improved in all patients over time, including 3 patients whose low frequency hearing diminished with time.

Conclusions:

Residual hearing can be preserved in adolescents using a soft surgical technique. Adolescents may require several re‐insertions of their cochlear implants over a lifetime and therefore increasing emphasis is being placed on atraumatic electrode insertion, in order to limit intra‐cochlear scarring.
Hearing Restoration with Intravenous Transplantation of Mesenchymal Stem Cells Derived from Human Umbilical Cord Blood
Authors: Choi Mi‐Young , Bae Seong‐Cheon , Yeo Sang‐Won
Published: August 2013

Objectives:

Confirm the effect of transplantation of human umbilical cord blood mesenchymal stem cells (UCB‐MSCs) on hearing restoration in a sensorineural hearing loss (SNHL) animal model.

Methods:

UCB was collected from pregnant women after obtaining consent, and mesenchymal stem cells (MSCs) were extracted. We established an SNHL model and transplanted UCB‐MSCs through the brachial vein of the guinea pigs. The animals were divided into 4 groups: animals with normal hearing, animals with SNHL, animals with SNHL and injected with saline, and animals with SNHL and transplanted with UCB‐MSCs. Hearing tests were conducted at 1, 3, and 5 weeks, and the results were compared by grading auditory brainstem response (ABR) recordings and distortion product otoacoustic emissions (DPOAEs) for each treatment. Lastly, cochlear pathological features were examined, and surface preparations and morphological changes in each animal model were compared using hematoxylin and eosin staining and light microscopy studies.

Results:

In SNHL group, decreased DPOAEs and increased ABR threshold were noted. Furthermore, in the SNHL group, ABR hearing thresholds were unconverted and were similar to those observed in deafness. The transplanted UCB‐MSC group showed a significant improvement in hearing threshold (40 dB) compared to that in all the SNHL group (80–90 dB). Examination of the SNHL animals’ cochlear morphological features demonstrated a noticeable lack of spiral ganglion cells and also showed degenerated outer hair cells. However, the transplanted UCB‐MSCs showed an increase in spiral ganglion and hair cells.

Conclusions:

Intravenous transplantation of UCB‐MSCs can enhance hearing thresholds, outer‐hair cells and increase the number of spiral ganglion neurons (SGNs).
Imaging Evaluation of Endolymphatic Hydrops in Cases with Otosclerosis
Authors: Mukaida Tohru , Sone Michihiko , Yoshida Tadao , Otake Hironao , Kato Ken , Teranishi Masaaki , Nakashima Tsutomu
Published: August 2013

Objectives:

Human temporal studies have shown that endolymphatic hydrops (EH) is accompanied by otosclerosis, which is a risk factor for complications after stapes surgery. Recently, visualization of EH has become possible using magnetic resonance imaging (MRI) with contrast agents. The presence of EH in cases with otosclerosis was investigated by MRI to prevent complications following stapes surgery.

Methods:

Sixteen ears from nine cases diagnosed as having otosclerosis were evaluated by 3‐Tesla MRI examinations taken 4 h after intravenous gadolinium injection. More than half of the ears showed mixed hearing loss and were suspected to have cochlear otosclerosis. Imaging data were compared with clinical findings in all ears and postoperative symptoms in ears undergoing surgery.

Results:

Varying degrees of EH were observed in 14 of the 16 ears. Episodes of acute sensorineural hearing loss or vertigo occurred in 4 ears with severe EH in the cochlea and 3 ears with severe EH in the vestibules. Overall, 12 of 14 ears with EH did not undergo stapes surgery. Ears without EH showed no postoperative complications, but one ear with mild EH in the vestibule showed severe vertigo following the surgery.

Conclusions:

The presence of EH in cases with otosclerosis was clearly visualized, and the degree of EH was correlated with the clinical findings in most patients. Such preoperative MRI evaluation could provide useful information to prevent complications following stapes surgery.
Is Pitch and Loudness Associated with Tinnitus Annoyance?
Authors: Rosito Leticia S. , Bonfitto Miguel , Deutsch Konrado M. , Bombardell Karine , Butzke Bruna , Silva Alice L. , Dalligna Celso
Published: August 2013

Objective:

Verify if there is an association between tinnitus pitch and loudness and degree of annoyance.

Methods:

Transversal study involving 129 consecutives patients with unilateral disturbing tinnitus between September 2003 and December 2011. The tinnitus pitch and loudness was measured by acufenometry. The impact of tinnitus in patient's quality of life was evaluated using both tinnitus handicap inventory (THI) and visual analog scale (VAS) at the same time when acufenometry was performed. Statistical analysis was made using the Pearson correlation test.

Results:

The mean age was 57.7 ± 12.6 years old and 62.8% were female. The correlation coefficient between loudness and VAS was R = 0.2, P = 0.03 and between loudness and THI was R=0.16 (P = 0.07). When we analyzed the pitch and VAS, R was ‐0.02 (P = 0.7) and between pitch and THI the R was 0.08 (P = 0.3).

Conclusions:

There are no significant associations between either the tinnitus pitch and loudness and the symptom's impact in the patient's quality of life.
Legal Culpability in Otology and Neurotology Litigation
Authors: Blake Danielle M. , Svider Peter F. , Carniol Eric T. , Mauro Andrew , Eloy Jean A. , Jyung Robert W.
Published: August 2013

Objectives:

1) Analyze otologic and neurotologic procedural malpractice litigation in the United States of America. 2) Discuss ways to prevent future malpractice litigation.

Methods:

The study is a retrospective review of court records pertaining to otologic and neurotologic procedures using the Westlaw legal database conducted in October, 2012. The term “medical malpractice” was searched in combination with terms related to otology and neurotology obtained from the American Academy of Otolaryngology‐Head and Neck Surgery website.

Results:

Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury, (53.2%), and resulted in the highest proportion of cases that lead to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000 respectively).

Conclusions:

Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.
Long‐term Effects of a Single Intratympanic Gentamycin Injection on Ménière's Disease
Authors: Chung Won‐Ho , Byun Hayoung , Lee Nak‐Joon , Ryu Nam‐Gyu
Published: August 2013

Objectives:

Intratympanic gentamycin (ITGM) injection is a useful treatment option in medically intractable Ménière's disease (MD). Single ITGM injection has been used to control vertigo with lower risk of sensorineural hearing loss (SNHL) than multiple injections. The aim of this study was to evaluate the long‐term effects of single‐shot ITGM with regard to the vertigo control rate and incidence of SNHL.

Methods:

We retrospectively reviewed a cohort of MD patients in Samsung Medical Center to screen those who were intractable to medical management and underwent a single ITGM procedure. All enrolled patients were followed up for more than 2 years. Treatment efficacy was evaluated by using the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) Committee on Hearing and Equilibrium guidelines. Hearing was assessed by pure tone audiometry (PTA) results at 3 months after procedure and at the final visits.

Results:

Thirty‐five patients were enrolled for the analysis, among whom five patients (14.2%) were in stage 4, twenty‐eight (80%) were stage 3, and two (5.8%) were stage 2. In the long‐term results, vertigo attacks were controlled completely (class A) in 25 patients (71.4%), substantially (class B) in 7 cases (20%), and limitedly (class C) in 3 cases (8.6%). SNHL was observed in 3 patients (8.5%) at 3 months and 9 cases (25.8%) at long‐term follow‐up.

Conclusions:

Single‐shot ITGM therapy showed satisfactory vertigo control rate (91%) in long‐term follow up. SNHL was observed in 17% at short term visits, and had reached 25% in long term evaluation, probably due to disease progression.
Long‐term Outcomes of Tinnitus after Steroid Therapy in Sudden Sensorineural Hearing Loss Accompanied by Tinnitus
Authors: Kim Young‐Ho , Park Kyung‐Tae , Seok Joon‐Geol , Yi Yeo‐Jin , Kang Sung‐Il
Published: August 2013

Objectives:

Investigate long‐term outcomes of tinnitus after steroid therapy in sudden sensorineural hearing loss (SSNHL) accompanied by tinnitus.

Methods:

Thirty‐four patients diagnosed with SSNHL with tinnitus were retrospectively included for this study. All patients underwent systemic steroid therapy and/or intratympanic steroid injection. Clinical and audiological findings, and assessment of tinnitus were performed before and after treatment of SSNHL. Assessment of hearing recovery after treatment was done with Kim's and Siegel's criteria.

Results:

The study group consisted of 17 male and 17 female patients. The ages of all patients ranged from 19 to 81 years (mean age 49.8 years) and the mean follow‐up period was 16.5 months. Eight patients (23.5%) had dizziness and medical treatment for tinnitus was done in all patients. Final hearing after treatment evaluated by the two criteria was that complete recovery was approximately 30% and no recovery approximately 40%. Patients showing the poor recovery of final hearing in both Kim's and Siegel's criteria revealed significantly poor global subjective tinnitus score (P <0.016 and P < 0.033, respectively). There was a high correlation between the grades of initial hearing in SSNHL and Kim's criteria (P < 0.029). However, there was no significant correlation between the grade of initial hearing in SSNHL and global subjective tinnitus score.

Conclusions:

Successful treatment of SSNHL may assure the favorable long‐term control of tinnitus.
Medio‐Lateral Myringoplasty versus Medial Myringoplasty: A Comparative Study
Authors: Gulia Joginder S. , Yadav Samar P. S. , Khaowas Ajoy K.
Published: August 2013

Objectives:

One of the most important factors in the success of myringoplasty is the size of the perforation. The repair of subtotal and large central perforation is less likely to be successful compared with the repair of small perforations. Moreover anterior tympanic membrane is less vascular and the re‐peroration rates are higher in this part. Medio‐lateral myringoplasty offers an advantage in both of these situations and can be a viable alternative to conventional underlay myringoplasty.

Methods:

A prospective controlled study was undertaken from January 2008 to December 2010. Disease/ condition studied: Inactive (mucosal) chronic otitis media with large central, subtotal and anterior perforations. Subjects Forty cases of either sex in the age group of 18‐40 years. Setting: Pt. B.D.S Post graduate Institute Medical Sciences Rohtak, a tertiary care center. Patients were randomly divided into two groups of twenty each. Group A underwent medial myringoplasty and group B underwent medio‐lateral myringoplasty. The graft uptake rate and the preoperative and postoperative hearing thresholds in each group were analyzed. Independent variables: Size and location of the perforation, preoperative air bone gap and technique of myringoplasty used.

Results:

The overall graft uptake in group A was 80% as compared to graft uptake of 95% in group B. Further, the average postoperative gain in group A was 14 dB as compared to 17.5 dB of group B.

Conclusions:

Medio‐lateral myringoplasty is better than medial myringoplasty in subtotal and large central perforations.
Molecular Mechanism of Tinnitus from the Standpoint of Autophagy
Authors: Hayashi Ken , Goto Fumiyuki , Tsuchihashi Nana A. , Fujioka Masato , Kanzaki Sho , Ogawa Kaoru
Published: August 2013

Objectives:

Recent studies described that the expression of BDNF was decreasing in patients with depression and severe tinnitus. However, the relationship between the incidence of tinnitus and the role of BDNF still remain unclear in auditory cells. The aim of this study is to consider the molecular mechanism of tinnitus from the standpoint of the autophagy‐based regulation of cell death and BDNF signaling pathway in auditory cells.

Methods:

We used auditory cell line HEI‐OC1 in this study. Tunicamycin was used as endoplasmic reticulum (ER) stress. The viability of HEI‐OC1 was determined by cell viability assays. Immunofluorescent confocal laser microscopy was used. Western blot was performed.

Results:

It was confirmed that autophagy was consistently induced in HEI‐OC1 after treatment of tunicamycin. The cell viability after treatment of tunicamycin was decreased in dose‐ and time‐dependent matter. The expression of BDNF which has the potential to become a biomarker of tinnitus and calcium‐dependent activator protein for secretion 2 (CAPS2), which promotes BDNF section, were decreased in tunicamycin treated HEI‐OC1 cells. The expression of Bcl‐2 which controls apoptosis and Beclin1 that regulates autophagy were decreased in tunicamycin treated HEI‐OC1 cells.

Conclusions:

We consider that Bcl‐2 and Beclin 1 serve as adapter proteins between BDNF signaling pathway and autophagy in auditory cells under ER stress. Our results led to the suggestion that the autophagy‐mediated regulation of cell death and BDNF signaling pathway play a major part of the incidence of tinnitus.
Motion of the Human Tympanic Membrane and Stapes Velocity after Placement of TORP with Cartilage Cover
Authors: Ulku Cagatay H. , Cheng Jeffrey T. , Merchant Saumil N. , Rosowski John J.
Published: August 2013

Objectives:

Investigate how prosthesis of different lengths affect tympanic membrane (TM) and footplate motion in a temporal bone model of tympanoplasty with Laser‐Doppler vibrometry (LDV) and opto‐electronic holography (OEH) measurements.

Methods:

Four human temporal bones without history of otologic disease were prepared using universal precautions. Preparation included removal of the bony external auditory canal to expose the majority of the TM surface, and canal wall‐up mastoidectomy with wide posterior tympanotomy. Retroreflective balls were placed on the posterior crus of the stapes. Control measurements were made in bones with intact ossicular chain, then the incus and the stapes suprastructure were removed with a KTP laser. The ossicular chain was reconstructed using a total ossicular replacement prosthesis (TORP). LDV measurements of the footplate motions, together with OEH measurements of TM surface and umbo motions, were made before and after placement of different length TORPs. The effect of different sizes of a cartilage disk interposed between the TM and the prosthesis was also investigated.

Results:

A ‘Best Fit’ TORP with a small cartilage disk gave the highest stapes velocities. Either TORP with a small disk produced larger OEH determined displacements of the whole TM surface, particularly at low frequency. In general, a smaller cartilage disk resulted in higher mobility of the TM and stapes.

Conclusions:

Preliminary results indicate reconstruction length and the size of the cartilaginous disk differentially affect the mobility of the TM and the stapes. However, there is significant variation in the acoustic response of similarly reconstructed ears, even in this relatively well‐controlled preparation.
A Novel Animal Model for Chronic Tympanic Membrane Perforation
Authors: Archundia Enrique G. , Zárate García Rafael A. , Vargas Cynthia , Sanchez Eduardo
Published: August 2013

Objectives:

In order to assess and treat chronic tympanic membrane perforations it is necessary to have a reliable and reproducible animal model. After a literature review, different surgical techniques and rates of patency of tympanic membrane perforation were encountered. We report an inexpensive, readily available, and easy to create animal model.

Methods:

We performed an anatomic study of the guinea pig ear using endoscopic, computed tomography, and tympanometric measures. Bilateral microinstrumental endoscopic perforations were performed in 17 guinea pigs (34 ears). Three subjects served as controls using perforation without flaps in the anterior quadrants of the tympanic membrane. In 14 subjects, local microflaps combined with infolding technique and local application of glutaraldehyde in anterior quadrants were performed. Endoscopic follow up at 7, 14, 30 and 60 days was performed, and after that histological analysis was conducted.

Results:

All control subjects healed within 2 weeks. Of the 14 guinea pigs, patent perforations were achieved in almost all subjects. Our results are comparable with the studies reported by Amoils and Kaftan.

Conclusions:

Our procedure is a feasible method and may be useful in further investigations to assess and treat tympanic membrane perforations.
Outcome Measures for Middle Ear Cholesteatoma Treated with Mastoidectomy: A Systematic Review
Authors: Mor Niv , Finkel Dina , Hanson Matthew B. , Rosenfeld Richard M.
Published: August 2013

Objectives:

The inconsistent measures used to report outcomes after mastoidectomy for cholesteatoma make it impossible for clinicians to compare results and apply them appropriately to patient care. We sought to identify commonly used outcome measures and assess their variability.

Methods:

We searched three independent databases for articles that reported outcomes of middle ear cholesteatoma treated with mastoidectomy. Using PRISMA protocol, articles were assessed for eligibility and data was extracted independently by two different investigators. Observational and randomized control trials from the past 30 years were included. Articles with less than 50 subjects and non‐surgical studies were excluded.

Results:

43 of 380 articles met criteria. The most commonly reported measurements were time to follow‐up, extent of disease, recurrent/residual disease, need for additional surgery, otorrhea, pre and post‐operative audio, tympanic membrane integrity and complications. The most varied outcome was time to follow‐up (14% up to 1 yr, 26% 1 yr ‐5 yrs, 33% 5 yrs ‐10 yrs, 26% greater than 10 yrs). 88% of studies reported on recurrent/residual disease; and only 12% presented results as a Kaplan‐Meier disease free curve. 58% of articles referred to the pre‐operative audio in their hearing outcomes. 79% of studies staged the extent of disease and 72% made mention of complications.

Conclusions:

Reported outcome measures were inconsistent amongst studies. The most varied outcome was time to follow‐up which made comparisons between studies unreliable. We plan on identifying the strength and limitations of each reported measure to establish best practices and optimize future reporting.
Performing Transcanal Tympanoplasty with Human Amniotic Membrane Allograft
Authors: Hsu Griffith S.
Published: August 2013

Objectives:

Determine if dehydrated human amniotic membrane (dHAM) can be successfully used in tympanoplasty.

Methods:

A prospective observational study was conducted on 14 patients in one year with a tympanic membrane perforation of >6 months’ duration who underwent type I tympanoplasty with a dHAM allograft. The subjects did not have active infection, mastoiditis, or previous attempted repair. All patients underwent pre‐operative audiologic testing and transcanal repair with an overlay technique. Operative time was recorded in each patient, as well as pre‐operative and post‐operative photographs. Patients were examined at 1‐, 3‐ and 6‐weeks post‐operatively, at which point audiograms were repeated. Success was measured using photomicrographs. Study outcomes included operative time, post‐operative pain assessment, graft success and audiologic improvement. Patients were also surveyed post‐operatively on their satisfaction of undergoing transcanal tympanoplasty with dHAM.

Results:

The mean operative time was 13.3 ± 0.10 minutes. Only one patient (7%) in the group reported having post‐operative pain one week after surgery. About 70% of patients had complete or partial success. The pre‐operative mean air‐bone gap was 23.0dB and the post‐operative mean air‐bone gap was 16.7dB. All patients (100%) were satisfied in undergoing transcanal tympanoplasty with dHAM.

Conclusions:

Transcanal tympanoplasty with dHAM is a time efficient alternative to traditional tympanoplasty with a high rate of surgical success and high patient satisfaction.
Physiological Significance of p62‐mediated Autophagy in Auditory Cells
Authors: Hayashi Ken , Goto Fumiyuki , Tsuchihashi Nana A. , Fujioka Masato , Kanzaki Sho , Ogawa Kaoru
Published: August 2013

Objectives:

Elucidate how Keap1, Nrf2 and p62 provide molecular foundation for a possible crosstalk between autophagy and necrosis pathways in auditory cells.

Methods:

We used auditory cell line HEI‐OC1 in this study. The viability of HEI‐OC1 was determined by cell viability assays. The samples after treatment of HEI‐OC1 were analyzed by a flow cytometer. Immunofluorescent confocal laser microscopy was used. Western blot was performed. Morphological observation was performed by transmission electron microscope (TEM). Transient GFP‐LC3 and p62 siRNA were transfected into HEI‐OC1 with electroporation.

Results:

HEI‐OC1 treated with H2O2 exhibited dose‐ and time‐dependent cell death. After treatment of H2O2, not apoptotic cell but necrotic cell was detected by a flow cytometer. H2O2 treatment resulted in time‐dependent accumulation of LC3‐II and the expression of GFP‐LC3 in HEI‐OC1 cells. Autophagosomes were confirmed under TEM in H2O2 treated‐HEI‐OC1. Immunostaining analysis demonstrated that the majority proportion of Nrf2 translocated into the nucleus in p62 KD HEI‐OC1 cells, while the majority proportion of Nrf2 disappeared from nucleus after treatment of H2O2 in p62 KD HEI‐OC1. The suppression of autophagy by p62 knockdown accelerated cell death in H2O2‐treated HEI‐OC1.

Conclusions:

Our results demonstrated that the intracellular clearance is decreased under oxidative stress due to the impairment of crosstalk of p62, Nrf2 and Keap1. This leads to the progression of auditory cell death. Taken together, a crosstalk between Keap1/Nrf2 pathway and the p62‐mediated autophagy play an important role in cell survival of auditory cells under oxidative stress.
Prevalence of Tinnitus and the Risk Factors in Korea
Authors: Cho Yang‐Sun , Park Kyoung Ho
Published: August 2013

Objectives:

Evaluate the prevalence of tinnitus & its risk factors in Korea.

Methods:

We obtained data from the 2008 to the 2010 Korea National Health and Nutrition Examination Surveys (KNHANES), which were cross‐sectional surveys of the civilian, non‐institutionalized population of South Korea (n =19,321). A field survey team that included an otolaryngologist, nurses, and interviewers moved with a mobile examination unit and performed interviews and physical examinations.

Results:

In this nationwide cross sectional study, the prevalence of subjective tinnitus was 19.6%. Women were more prevalent than men and the prevalence rate increased according to age. (P < 0.001) Among the subjective tinnitus group, about 28.7% participants experience annoying tinnitus that induces uncomfortable daily life. This annoying tinnitus increases with age, but no sexual difference. (P < 0.001) Otolaryngologic problems, such as hearing loss, tympanic membrane perforation and presence of rhinitis, past/current history of smoking, and stress were associated with subjective tinnitus in participants over 19 years old (P < 0.05). As for annoying tinnitus, hearing difficulty, depressive mood and stress were associated (P < 0.05).

Conclusions:

Overall prevalence of subjective tinnitus is 19.6% and annoying tinnitus is 6.4% in general populations. Considering the high prevalence of tinnitus and its close association with stress and depressive mood as well as known hearing loss, the results call for additional studies to better prevent and manage psychological problem and otolaryngologic diseases.
The Prognostic Factors of Intratympanic Steroid Treatment for Acute Tinnitus
Authors: Shim Hyun‐Joon , An Yong‐Hwi , Kang Hyun Woo , Yoon Sang Won
Published: August 2013

Objectives:

We report the better therapeutic efficacy of intratympanic dexamethasone injection (ITD) in patients with acute subjective tinnitus (AST) compared to alprazolam medication only. The present study aimed to determine the prognostic factors of ITD injection for AST.

Methods:

A total of 139 subjects who underwent treatment of ITD injection for AST from 2009 to 2012 were enrolled. The relationships between treatment outcomes and various clinical features or audiometric findings were analyzed retrospectively. Three months post‐treatment tinnitus questionnaires were completed in 90 patients. Audiologic response was defined as hearing threshold recovery greater than 15 dB in any frequency of the pure‐tone audiogram.

Results:

Tinnitus completely disappeared in 43 patients (cure rate = 30.9%). The mean duration of symptoms and initial tinnitus loudness score were significantly lower in the cure group than in other groups (P <.05). In the cure group, the number of patients with asymmetric hearing were larger than the number with symmetric hearing (P <.05). The mean improvement index of tinnitus was significantly higher in the unilateral tinnitus group than in the bilateral tinnitus group (P <.05). The audiologic response following ITD is more frequent in the patients with asymmetric hearing than in those with symmetric hearing (P <.05).

Conclusions:

Duration of symptoms and initial tinnitus loudness score might affect the cure rate of AST by ITD injection. Audiometric asymmetry and unilaterality of tinnitus are preferable factors of ITD treatment for AST.
Regenerative Stem Cell Therapy with Umbilical Cord Mesenchymal Stromal Cells in Deaf Animal Model
Authors: Park Kyoung Ho
Published: August 2013

Objectives:

This study was performed to confirm the effect of transplantation of human umbilical cord blood mesenchymal stem cells (UCB‐MSCs) on hearing restoration in deaf animal model.

Methods:

UCB was collected from pregnant women after obtaining consent, and mesenchymal stem cells (MSCs) were extracted. We established deaf animal model and transplanted UCB‐MSCs through the brachial vein of the guinea pigs. The animals were divided into 4 groups: animals with normal hearing, animals with sensorineural hearing loss (SNHL), animals with SNHL and injected with saline, and animals with SNHL and transplanted with UCB‐MSCs. Hearing tests were conducted at 1, 3, and 5 weeks, and the results were compared by grading auditory brainstem response (ABR) recordings and distortion product otoacoustic emissions (DPOAEs) for each treatment. Lastly, cochlear pathological features were examined.

Results:

In SNHL group, decreased DPOAEs and increased ABR threshold were noted. And ABR hearing thresholds were unconverted and were similar to those observed in deafness. The transplanted UCB‐MSC group showed a significant improvement in hearing threshold (40 dB). Examination of the SNHL animals’ cochlear morphological features demonstrated a noticeable lack of spiral ganglion cells and also showed degenerated outer hair cells. However, the transplanted UCB‐MSCs showed an increase in spiral ganglion and hair cells.

Conclusions:

Intravenous transplantation of UCB‐MSCs can enhance hearing thresholds, and regenerate inner ear hair cells and spiral ganglion neurons (SGNs).
Report on a Novel Mutation, p.Leu213X, in Connexin‐26 Protein
Authors: O'Neill Assunção , Gonçalves Ana C. , Matos Tiago D. , Santos Ricardo , Escada Pedro A. , Fialho Graça , Caria Helena
Published: August 2013

Objectives:

Nonsyndromic sensorineural hearing loss (HL) is predominantly inherited in an autosomal recessive pattern. The DFNB1 locus, at chromosome 13q11‐q12, includes the GJB2 and GJB6 genes, which encode connexin‐26 (Cx26) and connexin‐30 (Cx30), respectively. The objective of this study was to assess the genetic etiology of HL in a Portuguese family, presenting two siblings with nonsyndromic sensorineural moderate and severe HL, respectively.

Methods:

The individuals from one Portuguese family were evaluated by pure tone audiometry and blood samples were collected for DNA extraction. Polymerase chain reaction (PCR) amplification of GJB2 coding region followed standard methodologies. PCR products were automatically sequenced in both directions. A random control sample of 480 Portuguese individuals was also screened for the GJB2 coding region.

Results:

A novel mutation, c.638T>A (p.Leu213X), was identified in the GJB2 gene. This nonsense mutation was found in both siblings, and was inherited from their hearing father. Molecular analysis showed that the two siblings were also heterozygous for c.333‐334delAA, a previously described GJB2 deletion, inherited from their hearing mother. The novel mutation wasn't found in the control sample. The mutation p.Leu213X is located to the C‐terminus domain of the connexin‐26 and changes the codon 213, that codes for a highly conserved and slowly evolving residue of this protein, to a STOP codon, leading to the deletion of the last 14 amino acids of the protein.

Conclusions:

The HL of the two Portuguese siblings is most probably due to the presence of the c.333‐334delAA deletion and the p.Leu213X novel mutation, in compound heterozygosity.
The Role of Otoendoscopy in Detecting Residual and Recurrent Cholesteatoma after Microdissection
Authors: Yau Yuk Y. A. , Mahboubi Hossein , Djalilian Hamid R.
Published: August 2013

Objectives:

Determine the efficacy of otoendoscopy in detecting residual and recurrent cholesteatoma after traditional microdissection.

Methods:

Retrospective review of 273 consecutive cases on 215 patients who underwent cholesteatoma surgery with or without otoendoscopy from May 2006 to January 2013 at a tertiary referral center. Main outcome measures: The incidence of residual cholesteatoma after microsurgery that was found by angled otoendoscopes, and of recurrent cholesteatoma on second look procedures.

Results:

Otoendoscopy was used in 48% of the cases. Of the 114 canal wall down mastoidectomies, otoendoscopy was used in 11.7%. There were 47 (17.2%) second look procedures. Of the 124 cases of cholesteatoma surgeries using otoenedoscopy, residual cholesteatoma was found in 66 cases (53.2%). Residual cholesteatoma was most frequently found in the epitympanum (30.7%), followed by the sinus tympani and oval window (each at 9.6%). The overall recurrent cholesteatoma rate found on second look surgery was 5.1% (14 of 273). Cholesteatoma was found in 10 of 27 cases (37%) when otoendoscopy was used in the primary surgery, and in 11 of 20 cases (55%) when otoendoscopy was not used in primary surgery. Residual cholesteatoma was missed by microsurgery but found by otoendoscopy in 8 of 21 cases (38.1%). There was no significant difference in the locations of the residual and recurrent cholesteatoma, found by otoendoscopy or microsurgery (P = 1).

Conclusions:

Otoendoscopy can decrease the rate of residual and recurrent cholesteatoma and should be included in the armamentarium of all otologists.
Salvage Intratympanic Steroid Therapy for Refractory Idiopathic Sudden Sensorineural Hearing Loss
Authors: Ifeacho Sonna , Heywood Rebecca , Narula Antony A. P.
Published: August 2013

Objectives:

Describe the role of salvage intratympanic steroids (ITS) in refractory cases of idiopathic sudden sensorineural hearing loss and review the results.

Methods:

Case note review of 24 consecutive adult patients having salvage therapy in an out‐patient setting. At 7‐10 day post‐initial treatment if there was failure of improvement in hearing thresholds, between 1 and 5 injections of intratympanic methylprednisolone (40mg/ml) were administered via a round window cannula (Silverstein MicroWick) or ventilation tube. Post‐ITS hearing thresholds were calculated, with significant improvement in hearing recorded as an average change in threshold equal to or greater than 10dB.

Results:

The first intratympanic injection was given at a mean of 29 days after the onset of symptoms (range 14‐74 days). Fifty‐two percent (11/21) of patients were considered to have an improvement in their hearing. The mean change in threshold was 24dB. In this group the mean number of days following onset of symptoms at which they presented was 19 days (range 1‐60 days) and the mean number of days after onset of symptoms at which they received their first ITS treatment was 27 days (range 12‐74 days).

Conclusions:

Approximately half of the patients treated with salvage ITS responded with an improvement in average threshold of 10dB or more, suggesting that patients with SSNHL are a heterogenous group with steroid responsive and non‐steroid responsive pathologies. Salvage ITS can be offered to patients who do not respond to oral steroids with a possible 50% chance of improvement in thresholds.
Scala Tympani Cochleostomy Survey: A Follow‐up Study
Authors: Iseli Claire E. , Adunka Oliver F. , Buchman Craig A.
Published: August 2013

Objectives:

Reassess cochleostomy techniques among North American cochlear implant surgeons after a 6‐year period of widespread education and research on the topic.

Methods:

A multiple‐choice survey of cochlear implant techniques was distributed to surgeons attending the William House Cochlear Implant Study Group in 2006 and 2012. This survey contained questions regarding routine surgical access and cochleostomy techniques. Responses were anonymous and more than 50% were repeat respondents. Statistical analysis sought changes in technique in the last 6 years.

Results:

Comparisons between 2006 and 2012 responses revealed no significant changes in the proportion of surgeons identifying the facial nerve or chorda tympani. By contrast, respondents in 2012 were more likely to drill off the round window‐niche overhang (P < 0.001), use a round window insertion (P < 0.001), or make a smaller cochleostomy (P = 0.003). In two images of a trans‐facial recess approach, there was a significant increase in the proportion choosing an inferior or anterior cochleostomy site over a superior location (Image1‐76% in 2006 to 92% in 2012 (P = 0.003), Image 3 78% to 90%, respectively (P = 0.044).

Conclusions:

This repeat survey documents a change in practice among cochlear implant surgeons. Specifically, scala tympani access techniques now appear to be more consistent with known anatomical relationships in the round window region. These findings may have resulted from the concerted education and research efforts over the last six years.
Varicella‐Zoster Virus‐Specific Cell‐Mediated Immunity in Facial Palsy: Comparison between Hunt Syndrome and Bell's Palsy
Authors: Ichihara Takahiro , Haginomori Shin‐Ichi , Mori Atsuko , Kanazawa Atsuko , Kawata Ryo
Published: August 2013

Objectives:

1) Compare Varicella‐zoster virus (VZV)‐specific cell‐mediated immunity (CMI) in Hunt syndrome to Bell's palsy using IFN enzyme‐linked immunospot (ELISPOT). 2) Examine the role of VZV‐specific CMI for VZV reactivation in the facial nerve in Hunt syndrome.

Methods:

This prospective study was conducted in our tertiary referral hospital between 2010 and 2012. Six Hunt syndrome and 28 Bell's palsy patients were enrolled. Mononuclear cells were isolated from whole blood and incubated with VZV antigen in culture plates for 40 h. Anti IFN antibody was added and the ELISPOT system counted immunostained spots indicating VZV‐specific CMI. Numbers of spots and the relationship between the spots and days from the onset of palsy were compared between Hunt syndrome and Bell's palsy patients.

Results:

No difference in the number of spots was observed between Hunt syndrome and Bell's palsy. However, Hunt syndrome showed a strong positive relationship between numbers of spots and days from the onset of palsy (r = 0.87). In the early days, spot numbers in Hunt syndrome were much lower, indicating low VZV‐specific CMI. In contrast, Bell's palsy showed no such relationship (r = ‐0.24).

Conclusions:

This study indicates that low CMI to VZV may play a role in VZV reactivation in the facial nerve. VZV vaccination may promote VZV‐specific CMI, leading to prevention of Hunt syndrome.
Vestibular Apparatus Dysfunction after External Beam Radiation Therapy for Head and Neck Cancers
Authors: Bhandare Niranjan , Mendenhall William , Morris Christopher G. , Antonelli Patrick J.
Published: August 2013

Objectives:

Radiation therapy (RT) for head and neck cancers (HNC) may be associated with vestibular dysfunction (VD). The goal of this study is to examine the post‐RT incidence of VD in HNC patients receiving RT +/‐ chemotherapy (chemo) and its association with patient and treatment related factors.

Methods:

Pre and post‐RT records of 376 HNC patients were retrospectively assessed for the presence of possible VD. Dose received by vestibular apparatus was estimated using the CT‐based treatment plan for the patient. Uni‐ and multivariate analyses evaluated the association between various variables and incidence of VD.

Results:

Subjective vertigo or dizziness was reported in 53(14.5%) patients over a median time of 16 months (range 0 to 36 months). Abnormal elecronystagmography was observed in 41 of 49 (83.6%) tested patients: 24 (48.9%) bithermal caloric stimulation, 8 (16.3%) sinusoidal tracking, and 5 (10.2%) with both. Doses received by vestibular apparatus varied between 45 to 80 Gy. Vestibular RT dose was significantly associated with VD (P < 0.05), but age (>60), gender, fractionation were not. Use of chemo was marginally associated with VD (P = 0.056).

Conclusions:

Radiation dose to the vestibular apparatus appears to be the primary determinant of VD in HNC patients treated with RT. Further prospective investigation is needed to better understand the effects of RT and chemo‐RT on vestibular apparatus.
Vitamin C Deficiency–Induced Hearing Loss and Ossicular Defect in Transgenic Mice
Authors: Hu Jinwei , Guthrie O'neil , Mohan Subburaman , Jung Timothy T. K.
Published: August 2013

Objectives:

Certain forms of hearing loss (HL) are life‐long disabilities that critically affect the development of language and cognition. Recent studies show that vitamin C (ascorbic acid; AA) can protect from hearing loss; while vitamin C deficiency (VCD) accelerates long bone loss. Humans are particularly sensitive to VCD due to genetically evolved disability to synthesize AA and require dietary supplementation. However, the effect of VCD on the ossicles and the underlying mechanisms have not been understood. In this study we used a transgenic VCD mouse model (sfx mice) to determine whether VCD can affect the maturation of the ossicles.

Methods:

Auditory function in sfx (GULO‐/‐) and control (GULO+/‐) mice was measured with auditory brainstem responses (ABR) and distortion product otoacoustic emission (DPOAE). The middle ears were dissected and the morphological characteristics of the ossicles in sfx and control mice were evaluated with a stereoscopic microscopy.

Results:

The sfx mice developed spontaneous fracture and delayed growth at 6 weeks of age. The sfx mice showed significantly increased hearing thresholds in ABR (P < 0.05) and decreased DPOAE (P < 0.05). The bony structures of the external ear canal, middle ear walls and otic capsule of sfx mice were smaller and more friable as compared to control mice. All the ossicles in sfx mice were thinner than that of control mice.

Conclusions:

These findings suggest that VCD can induce ossicular defect and hearing loss in sfx mice. Further studies will illustrate the underlying mechanisms of ossicular defect related to osteoblast differentiation.
Amoxicillin, Ibuprofen, or Prednisolone Does Not Modify Post‐tonsillectomy Pain in Children: A Randomized Controlled Trial
Authors: Tamashiro Edwin , Azevedo Carolina B. , Carenzi Lucas R. , Valera Fabiana , Anselmo Lima Wilma T.
Published: August 2013

Objectives:

Evaluate the effect of amoxicillin, ibuprofen, or prednisolone on post‐tonsillectomy pain in children.

Methods:

225 children between 6‐10 years‐old undergoing cold knife adenotonsillectomy/tonsillectomy were included in the study. Pain was monitored in the first seven days after surgery by the parent's (“Parents’ Post‐Operative Pain” ‐PPPM) and child's assignment (“Revised‐Facial Pain Scale” ‐R‐FPS). Pain was also indirectly analyzed by the number of analgesic administration and return to solid food intake. 45 children were randomized into 5 distinct groups, with the respective number of patients analyzed after losses and exclusions: 1) control n = 42; 2) amoxicillin 50mg/kg/day, n = 31; 3) oral prednisolone 0.5mg/kd/day, n = 30; 4) ibuprofen 5mg/kg/dose tid, n = 32; 5) amoxicillin plus prednisolone, n = 37. All groups received oral analgesics (dypirone and acetaminophen) to use as required. PPPM was analyzed by a linear regression model with mixed effects with Tukey post‐test for multiple comparisons (SAS 9.0). R‐FPS and analgesic intake were analyzed by Kruskal‐Wallis. Return to solid intake was analyzed by Wilcoxon test, considering significant when P < 0.05.

Results:

Multiple comparisons demonstrated that the evolution of pain, matched day‐per‐day among the different groups, was not statistically different either by PPPM or R‐FPS (P > 0.05). The number of analgesic intake was also similar in all groups (P = 0.10) as well as the return to solid food intake (P = 0.41). Also, all groups presented a similar standard of clinical improvement in intervals of two days (P < 0.01).

Conclusions:

Our data demonstrate that the addition of amoxicillin, ibuprofen, or prednisolone to simple analgesic prescription does not modify post‐tonsillectomy pain in children.
An Anatomic Study of the Suspensory Ligaments of the Anterior Commissure
Authors: Tonn Christopher R. , Spiegel Jeffrey H.
Published: August 2013

Objectives:

Delineate the location and anterior/posterior and superior/inferior orientation of the suspensory ligaments of the anterior commissure attachment of the vocal folds in order to characterize how much of the laryngeal cartilage may be safely removed for aesthetic or oncologic purposes without compromising vocal function.

Methods:

Study design: anatomic dissection of cadaver larynges. Preserved cadaver larynges were dissected with careful attention to ligamentous attachments to the laryngeal framework of the vocal folds. AP and superior/inferior relationships are described. Removal of various amounts of cartilage around the anterior commissure was correlated with vocal fold length and tension.

Results:

Our results help to characterize the extent to which laryngeal framework may be removed around the anterior commissure while maintaining vocal fold support.

Conclusions:

These data may help surgeons to better understand the degree of laryngeal cartilage that may be safely removed in situations of oncologic resection, aesthetic intervention (eg, aesthetic chondrolaryngoplasty), or post‐traumatic reconstruction.
Head and Neck Cancer Mortality, Socioeconomic Status, and Distribution of Otolaryngologists
Authors: Schleiffarth Jack R. , Charlton Mary , Pagedar Nitin A.
Published: August 2013

Objectives:

Assess the relationship between distribution of otolaryngologists and head and neck cancer mortality rates, taking into account measures of socioeconomic status.

Methods:

We used the number of deaths from head and neck cancer in each U.S. county during 2002‐2009 reported by National Center for Health Statistics. Due to low numbers in many counties, we aggregated counties into the 949 Health Service Areas (HSAs), which reflect hospital referral patterns. We used the Area Resource File to obtain numbers of otolaryngologists, general practice physicians, and dentists, as well as urban/rural designation, poverty rate, educational attainment, median household income, and racial minority proportion for each HSA. The impact of these covariates was evaluated on mortality rates adjusted for age and sex distribution.

Results:

The crude mortality rate was 4.1/100,000. There were no otolaryngologists in 274 HSAs (median 2, range 0‐351). There were no significant relationships between number of otolaryngologists, general practitioners, or dentists, as continuous variables, and mortality rate. However, HSAs with no otolaryngologists had a higher mortality rate (by 0.32/100,000) than those with one or more otolaryngologist (p=.005). Mortality rates were significantly higher in HSAs with lower median income and greater poverty rate, non‐white population, and proportion of adults without high school education, and also in entirely rural HSAs (P <. 0001). On multivariate analysis, adverse socioeconomic factors and rural status were independently associated with higher mortality (p <. 0001), but presence of an otolaryngologist was not (P =. 23).

Conclusions:

Socioeconomic factors are stronger independent predictors of head and neck cancer mortality than otolaryngologist distribution.