bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharyngolaryngeal Reflux Simulating Vocal Fold Paralysis Hoarseness following Total Thyroidectomy
Authors: Ramalho Sara C. , Castro Eugénia , Ribeiro Leandro , Lima Nuno B. , Condé Artur
Published: August 2013

Objectives:

Systemic multifocal fibrosclerosis is a syndrome characterized by the presence of fibrosis in various locations, most often retroperitoneal, mediastinal, and thyroid (Riedel thyroiditis). The fibrosis in the thyroid tissue can extend to the laryngeal cartilages and muscles, leading to respiratory distress. A thyroidectomy is, in these cases, an intervention to consider. Recognize potential “rare” causes of hoarseness following thyroid surgery.

Method:

Hoarseness case study. A 69 year old man presented to the ear, nose, and throat (ENT) consultation with a history of hoarseness and aspiration following total thyroidectomy for Riedel's thyroiditis. Physical examination revealed exuberant pharyngolaryngeal reflux with consequent edema and redundancy of arytenoid mucosa with simetric mobility of the vocal folds.

Results:

Worsening dysphonia after total thyroidectomy, particularly in the context of Riedel thyroiditis, leads to suspicion of iatrogenic vocal fold paresis. The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage, reveals an unsuspected cause of hoarseness. The authors postulate that post‐operatory changes in esophagic sphincter pressure may have triggered reflux.

Conclusions:

Rare causes of hoarseness following thyroid surgery should be considered in order to promptly establish a correct treatment plan.
Tacrolimus Prevents the Development of Laryngotracheal Stenosis in the Novel Rat Model
Authors: Araki Koji , Mizokami Daisuke , Tanaka Nobuaki , Tomifuji Masayuki , Yamashita Taku , Shiotani Akihiro
Published: August 2013

Objectives:

Acquired laryngotracheal stenosis (LTS) is a challenging problem for otolaryngologists. Modulating the wound healing of airway mucosa is the key component for treating LTS. Drug‐eluting stents (DESs) with immunosuppressants as Tacrolimus have been dominant for the treatment of coronary artery diseases in the interventional cardiology owing to their efficacy in significantly reducing restenosis. Several studies suggested Tacrolimus might potentially have inhibitory effects on airway stenosis as seen in coronary DESs. The objective of the present study is to determine whether immunosuppressants modulate the wound healing of airway mucosa and prevent obstructive airway disease in an acute injury animal model.

Methods:

The authors recently reported the novel reliable LTS model in rats, whose laryngotracheal mucosa was scraped with a nylon brush through the tracheostoma. Tacrolimus (0.2 or 1.0 mg/kg i.m.) was systemically administered for 5 days. The pathological changes at the airway mucosa and the tracheal lumen were assessed at 7 days after the scraping. The percentage of stenosis was calculated by image analysis software.

Results:

Both hyperplasia of airway epithelium and thickened submucosal layer with extensive fibrosis, angiogenesis, and collagen deposition provoked lumen stenosis. There was significant preventive effect on airway stenosis in the lower dose of Tacrolimus (0.2mg/kg) compared to brushing only group (P < 0.05). The high dose of Tacrolimus group (1.0mg/kg) also showed a trend to potential protection of airway stenosis.

Conclusions:

This study suggests that the systemic immunosuppressive agent, Tacrolimus, has a preventive effect on LTS from mucosal injury of the airway.
Treatment of Recurrent Vocal Fold Hemorrhage in Ehlers‐Danlos Syndrome
Authors: Du Eugenie , Geller Melin T.
Published: August 2013

Objectives:

Ehlers‐Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders. Generalized tissue and vascular fragility underlie many physical findings and resultant complications from the syndrome. We present a patient with vascular subtype of EDS with recurrent vocal fold hemorrhage who underwent successful treatment by microflap excision and CO2 laser ablation of true vocal fold microaneurysm. This is the first case report of a successful therapeutic laryngeal intervention for an EDS patient.

Methods:

Case report of one patient at a single institution.

Results:

A patient with hemorrhagic polyp after intubation underwent standard microscopic direct laryngoscopy and excision of a hemorrhagic polyp on her right true vocal fold. Hemorrhage recurred, and the patient underwent repeat microflap excision with identification of and CO2 laser ablation of a vocal fold microaneurysm. The patient experienced resolution of hemorrhage with resolution of dysphonia.

Conclusions:

This case report, the first documented therapeutic intervention for a vocal fold abnormality in EDS, highlights not only the care that should be taken when intubating patients with EDS but also the importance of considering additional measures needed to prevent recurrence of hemorrhage in patients with this connective tissue disorder.
Value of the Portuguese VHI and SVHI Instruments to Discriminate Voice Pathologies in Voice Professionals
Authors: Capucho Maria‐Clara P. , Escada Pedro A. , Aguiar Pedro , Ruah Carlos‐Moises B.
Published: August 2013

Objectives:

1) Determine the sociodemographic characteristics of a group of elite vocal performers (singers and actors). 2) Investigate the discriminating power of the Portuguese validated versions of the instruments VHI and SVHI in addressing different voice pathologies.

Methods:

The study had the participation of 324 individuals (217 singers and 107 actors). All the participants were evaluated by telescopic or transnasal laryngoscopy and completed: 1) a questionnaire addressing sociodemographic characteristics and vocal use; and 2) the Portuguese version of the VHI. All the singers completed also the Portuguese version of the SVHI. Descriptive statistics used mean, median, standard deviation, minimum, maximum values for quantitative variables, and absolute (n) and relative (%) values for qualitative variables. Receiver operating characteristic (ROC) curves were used to investigate the discriminating power of the VHI and SVHI instruments to address different voice pathologies.

Results:

Of the 324 subjects, 51.2% were female and 48.8% were male with a mean age of 40.8 years (range: 15‐82 years). 52.3% were single, followed by married (32.1%) and divorced/widowed (15.6%). Approximately 34% of subjects smoked on average and worked with the voice for nearly 21 years. Receiver‐operating characteristic curve analysis showed a weak discriminating power between diagnoses and VHI or SVHI scores, except for vocal cord nodules that are associated with a higher (worse) VHI score.

Conclusions:

The Portuguese versions of the VHI and SVHI instruments are useful to measure the voice handicap among Portuguese actors and singers but have a limited value to discriminate between vocal pathologies.
Vocal Fold Cover Layer with a Tissue‐Engineered Structure Containing Epithelium and Fibroblast of Oral Mucosa
Authors: Chitose Shunichi , Fukahori Mioko , Sueyoshi Shintaro , Kurita Takashi , Sato Kiminori , Nakashima Tadashi
Published: August 2013

Objectives:

A potential treatment option for severe vocal fold scarring is to replace the vocal fold cover layer with a tissue‐engineered structure containing autologous cells. The aim of this study is to develop a three‐dimensional cell‐populated matrix resembling the vocal fold layers of epithelium and lamina propria from autologous oral mucosa.

Methods:

A 3‐by‐3‐mm specimen of canine buccal mucosa was harvested and divided into epithelium and submucosa. Epithelial cells from the epithelium and fibroblasts from the submucosa were isolated and separately cultured. After the culturing for 2 weeks, the epithelial cells were seeded on mesh type oriented collagen gels containing the fibroblasts throughout a 2‐week‐culture period. The morphological characteristics of the cultured tissue were observed with immunohistochemical staining and transmission electron microscopy. Normal canine vocal fold and buccal mucosa were used as positive controls.

Results:

We successfully fabricated a vocal fold cover layer with a tissue‐engineered structure closely resembling the normal vocal fold layers of epithelium and lamina propria. The epithelium had three to five cell layers and did not resemble the original oral mucosa. The epithelial cells were immunostained with anti‐keratin 3 antibodies, anti‐b1 integrin antibodies, and anti‐p63 antibodies. The fibroblasts in the collagen gels were immunostained with anti‐vimentin antibodies. Electron microscopy revealed developed microvilli on the apical surface of the epithelial cells.

Conclusions:

The tissue‐engineered vocal fold cover layer from autologous oral mucosa has the possibility to reconstruct the vocal fold surface and to restore voice in patients with severe vocal fold scarring.
Vocal Fold Vibration of Patients with Reinke's Edema Observed Using High‐Speed Digital Imaging
Authors: Watanabe Takeshi , Kaneko Kennichi , Sakaguchi Koichi , Takahashi Haruo
Published: August 2013

Objectives:

1) Assess vocal fold vibration of patients with Reinke's edema using high‐speed digital imaging (HSDI) and videostoroboscopy. 2) Confirm that HSDI is useful for examining vocal folds with severe Reinke's edema.

Methods:

Study design is observational and cross‐sectional. The subjects were 7 patients with Reinke's edema (6 severe, 1 moderate; 6 female, 1 male; 55–74 years of age, mean 64.7 years). Their vocal folds were examined with HSDI system (1200 fps) and videostoroboscopy before microphonosurgery from October 2009 through February 2012. The following characteristics of vocal fold vibration were analyzed; glottic closure, mucosal wave propagation, symmetry, phase shift, frequency difference, periodicity, and contact with false vocal fold. Postoperative examinations were also performed in 5 subjects.

Results:

HSDI revealed periodic or quasi‐periodic vibration, anterior‐posterior phase shift, and contact of true and false vocal folds in all patients before surgery. Distinct left‐right asymmetry of vibration was observed in 6 patients. The vocal fold vibrations could not be tracked in 4 with severe edema. After surgery the vibrations became periodic and synchronized with strobolights in all patients. Little left‐right asymmetry of vibration remained in all patients.

Conclusions:

Though the vocal fold vibrations with Reinke's edema were periodic or quasi‐periodic, they were often difficult to observe with videostroboscopy in severe cases. HSDI can be a very useful tool for examining the vocal folds of patients with severe Reinke's edema, especially before surgery to find scarring and tumor.
Binaural Interlevel Differences and Alternate Binaural Loudness Balance in Cochlear Implant Recipients
Authors: Praetorius Mark , Khabas Rösli , Hoth Sebastian
Published: August 2013

Objectives:

We analyzed the effect of a single sided cochlear implant in recipients with single sided deafness.

Methods:

Twenty adult recipients of a cochlear implant with an acoustically hearing ear on the other side were included in this 2012 study. We analyzed the binaural interlevel differences (BILD), the alternate binalural loudness balance (ABLB) and the pitch matching abilities of these subjects.

Results:

In the BILD, the speech reception threshold (SRT) improved by 6 dB (P = 0.0022) compared with single sided hearing without cochlear implants. At the ABLB, the mean of similar sensed loudness between acoustic and cochlear implant hearing was between 49 and 54 dB. The pitch matching was in the range of three pure tones in these patients.

Conclusions:

Patients with asymmetric hearing or single sided deafness have a clear benefit in the BILD test.
Body Balance Rehabilitation in Older Persons with Peripheral Chronic Vestibular Disease
Authors: Dorigueto Ricardo S. , Doná Flavia , Kasse Cristiane A. , Scharlach Renata C. , Branco‐Barreiro Fatima C. , Gazzola Juliana M. , Maia Denise
Published: August 2013

Objectives:

Evaluate the efficacy of a balance rehabilitation program in older persons with chronic vestibular disease.

Methods:

Prospective clinical trial conducted from September 2011 to December 2012. Setting: University center for balance disorders. Eligible patients (over 60 years old) with chronic vestibular disease underwent 12 to 16 sessions of individual body balance rehabilitation program (BRP). Each session lasted 60 minutes, twice per week, and was associated with diet orientation and daily exercises for labyrinth stimulation. Before and after therapy, the following data were collected: patient complaints, the Functional Gait Assessment, the Brazilian OARS Multidimensional Functional Assessment Questionnaire, the Dizziness Handicap Inventory (DHI) and static posturography parameters (limit of stability and balance functional reserve in ten visual, vestibular, and somatosensory conflicts).

Results:

Of 20 patients, 90.9% were female, with mean age of 71.70 years old. After BRP, there was reduction of most of symptoms (dizziness, imbalance and nausea), improvement in functional capacity (P < 0.05), gait stability (P = 0.003) and reduction in DHI scores (P = 0.001). The limit of stability measure increased (P = 0.001) and also the body balance functional reserve, mainly in conditions 2, 3 and 4 (P = 0.001) and 5 (P = 0.020).

Conclusions:

A body balance rehabilitation program was effective in reduction of symptoms, fall risk, and dizziness impact on quality of life in elderly patients with vestibular disorders, improving functional capacity, gait stability, and increasing the limit of stability and the balance functional reserve.
Cartilage Palisades in Type 3 Tympanoplasty: Functional and Hearing Results
Authors: Vashishth Ashish , Mathur Neeraj N. , Verma Deepak
Published: August 2013

Objectives:

Evaluate functional and hearing outcomes with use of full thickness broad cartilage palisades for tympanic membrane reconstruction in type 3 tympanoplasty using titanium prosthesis.

Methods:

The retrospective study done at a tertiary referral institute included 30 patients with posterior mesotympanic retraction pockets or tympanic membrane perforations requiring tympanic membrane and a type 3 ossicular reconstruction. Patients with disease extending beyond aditus requiring canal wall down mastoidectomy were excluded. Disease removal from posterior mesotympanic and epitympanic recesses was confirmed using angled endoscopy and ossicular reconstruction performed using titanium partial or total ossicular replacement prosthesis. The tympanic membrane reconstruction was done, with or without attic reconstruction, using full thickness broad cartilage palisades harvested from the tragus with attached perichondrium laterally. Patients were assessed at 12 and 24 weeks for graft status and any evidence of implant extrusion. Hearing evaluation was done using subjective assessment and pure tone audiometry.

Results:

Twenty‐seven out of 30 patients had intact and completely healed grafts postoperatively at 24 weeks (success rate of 90%) displaying full union and epithelization of palisades, with 3 patients displaying small defects. The mean pure tone air bone gap pre and postoperatively was 32.4 dB and 8.8 dB respectively, with most patients reporting satisfactory postoperative hearing. No evidence of implant extrusion was found in the 24 week period.

Conclusions:

Tympanic membrane reconstruction using full thickness palisades of tragal cartilage provides good functional and hearing outcomes in type 3 tympanoplasty using titanium prosthesis.
Clinical Characteristics of Posttraumatic Benign Paroxysmal Positional Vertigo
Authors: Yamamoto Hidefumi , Sunami Kishiko , Yamane Hideo
Published: August 2013

Objectives:

Although head trauma is considered a common cause of benign paroxysmal positional vertigo (BPPV), only a few studies have investigated posttraumatic BPPV (PT‐BPPV). The aim of this study was to assess the clinical characteristics of PT‐BPPV.

Methods:

We reviewed the clinical records of 19 patients with PT‐BPPV during the years 2001 to 2012. Patients with an onset of positional vertigo within 3 days of well‐documented head trauma were included in the PT‐BPPV group. Their outcome was compared with that of 54 patients with idiopathic BPPV (i‐BPPV) who were treated during the first half of 2011. We investigated the clinical characteristics of PT‐BPPV and the clinical differences between the PT‐BPPV and i‐BPPV groups.

Results:

Members of the PT‐BPPV group required more treatment sessions than did the members of the i‐BPPV group (P < 0.05). The mean number of treatment sessions in the PT‐BPPV and i‐BPPV groups was 3.74 ± 3.07 and 2.22 ± 1.24, respectively. The recurrence rate in the PT‐BPPV group (42.1%) was significantly higher than that in the i‐BPPV group (18.5%; P < 0.05).

Conclusions:

Our findings suggest that, compared to i‐BPPV, PT‐BPPV requires more treatment sessions to achieve remission and has a greater tendency to recur. We suggest the use of frequent treatment sessions and canalith repositioning maneuver for patients with PT‐BPPV.
Cochlear Implantation in a Residency Training Program: The Kaiser Permanente Oakland Experience
Authors: Do Jennifer B. , Handler Ethan B. , Rasgon Barry M.
Published: August 2013

Objectives:

Assess the complications of cochlear implantation and determine whether resident physicians can perform this procedure safely.

Methods:

Retrospective chart review of consecutive cochlear implant recipients who underwent primary cochlear implantation performed with extensive resident surgeon involvement between January 1, 2005 and April 30, 2012. Setting: Tertiary care teaching hospital. One hundred and fifty‐nine adults and children collectively underwent a total of 194 primary cochlear implant operations (n = 194). Complications after cochlear implantation were classified into major and minor categories. Minor complications included those that either settled spontaneously or with conservative management. Major complications were defined as those requiring further surgery or hospitalization. Spontaneous failures of internal devices were reported separately.

Results:

The overall complication rate was 11.3% (22 of 194 cochlear implant cases). Minor complications occurred in 14 cases (7.2%). These included wound infection or dehiscence, hematoma formation, delayed facial paresis, and non‐auditory stimulation. Major complications were present in 8 cases (4.1%). These involved implant malposition or migration, incorrect device implantation, flap‐related problems, chronic infection with cholesteatoma, and severe vertigo requiring hospitalization. One of the 8 patients experiencing a major complication required device explantation. There were no post‐operative deaths, cases of meningitis, or persistent facial nerve palsies in this series. Device failures occurred in 4 cases (2.1%).

Conclusions:

The rate of complications is comparable to those published by other institutions. Residents can safely and successfully perform cochlear implant surgery. With close supervision, satisfactory results can be achieved.
Cochlear Implantation in the Very Elderly
Authors: Wong Daniel J. , Moran Michelle , O'Leary Stephen
Published: August 2013

Objectives:

Evaluate the outcomes following cochlear implantation in the very elderly population (age ≥ 85), with a particular emphasis on peri‐operative surgical course, mobility, dizziness, and speech perception outcomes.

Methods:

A retrospective cohort study was conducted from June 2001 to May 2012 comparing groups aged 85+ to 80‐84, and 75‐79 at the time of first cochlear implantation. Retrospective collection of parameters was done by reviewing medical records and outpatient notes at the RVEEH in Melbourne. Parameters of interest included: speech recognition testing pre‐ and post‐implantation, symptomatic dizziness and effects upon independent living post‐operatively, pre‐operative vestibular tests, and post‐operative tests if symptomatic, presence of dementia in medical records, and incidence of perioperative medical and surgical complications.

Results:

Two hundred twenty‐six patients over age 70 at the time of surgery were identified to have a CI512 or CI24RE implanted. The oldest patient was 93 at the time of surgery. Speech recognition testing gradually improved after implantation in this population with a low incidence of postoperative complications.

Conclusions:

Geriatric patients can still benefit from cochlear implantation, and age should not be a limitation for cochlear implantation (CI) surgery. The population ≥ 85 years tend to have greater difficulty with mobility and are at greater risk of dementia and cognitive impairment, but they still benefit, with improved speech perception following cochlear implantation. Although the presence of co‐morbidities increases the risk of perioperative complications with age, cochlear implantation can be done safely and provides significant patient benefits.
Delayed Surgical Treatment for Long Onset Facial Paralysis
Authors: Rivas Jose A. , Garcia Laura , Forero Victor H. , Rivas Alejandro
Published: August 2013

Objectives:

Present qualitative evidence that supports surgical intervention to those patients with long onset facial paralysis.

Methods:

Retrospective study of clinical and surgical records of patients operated from July 2006 to September 2012. Twenty‐two patients with long onset facial paralysis were operated at a specialized center. Patients underwent surgical facial nerve decompression. Preoperatory and outcomes were recorded with the House‐Brackmann facial function score (HBs). Intraoperative stimulation response was obtained as indicator prognostic outcome for facial nerve function.

Results:

Patients who undergo surgical decompression obtain reduction in the HBs when intraoperative stimulation is obtained.

Conclusions:

Surgical decompression of the facial nerve is an option for subjects with long onset facial nerve paralysis with improvement of facial function through time.
Does Mastoid Obliteration following Mastoidectomy Offer an Improvement in Quality of Life?
Authors: Kurien George , Gomaa Nahla , Greeff Kate , Ho Allan
Published: August 2013

Objectives:

1) Recognize the impact mastoidectomy with obliteration has on quality of life (QOL). 2) Describe the QOL change with primary or secondary mastoid obliteration with autologous bone graft. 3) Review of the literature on mastoid obliteration.

Methods:

This retrospective observational study was conducted to determine if mastoid obliteration with autologous cranial bone graft following mastoidectomy improves QOL. Patients with cholesteatoma who had mastoidectomy with primary or secondary mastoid obliteration by a tertiary otologist were surveyed using the validated Glasgow Benefit Inventory (GBI), our primary outcome measure. Our secondary outcomes were recurrence rates.

Results:

Fifty‐five patients were interviewed: 44 were primary obliterations, and 11 were secondary obliterations of an existing mastoid cavity. Overall GBI scores were improved, with average scores of 25. Average general subscale scores were 26, physical health scores were 22, and social health scores were 24. The primary obliteration group had average scores of 22, general subscale scores of 23, physical health scores of 21, and social health scores of 19. Those with secondary obliteration scored higher, with average scores of 37, general subscale scores of 40, physical health scores of 21, and social health scores of 42. Recurrence rates were comparable with the current literature.

Conclusions:

This study shows that mastoidectomy with obliteration using autologous cranial bone graft offers a significant QOL benefit. The GBI scores compare favorably with other otology procedures. Secondary obliterations after revision mastoidectomy scored much higher than primary obliterations. This is currently the only QOL study comparing these two patient groups.
Early Molecular Mechanisms Involved Post Cochlear Implant Electrode Insertion Trauma
Authors: Eshraghi Adrien A. , Gupta Chhavi , Granham Carolyn , Van De Water Thomas , Telischi Fred F. , Lang Dustin
Published: August 2013

Objectives:

Cochlear implant electrode insertion trauma (EIT), not only causes direct tissue trauma and cell losses by necrosis, but also generates programmed cell death (PCD) and can lead to a loss of residual hearing. We aimed to: 1) Analyze the molecular mechanisms involved in PCD of hair cell (HCs) and support cells (SCs). 2) Compare the time of onset of these events in HCs and SCs.

Methods:

Guinea pigs were categorized in three groups: EIT; pre‐treated with AM‐111 at round window ½ hr before EIT, and unoperated contralateral ears as controls. Immunostaining for phospho‐c‐Jun, activated Caspase‐3, CellROX, HNE and Reactive nitrogen species (RNS) were performed at 6hrs, 12hrs and 24hrs post‐EIT.

Results:

At 6 hrs Post‐EIT immunostaining SCs is positive for phosphorylation of c‐Jun and activation of caspase‐3. p‐c‐Jun labeling was observed at 12 hrs in both HCs and SCs of middle and basal turn. Caspase‐3 activation was not observed in HCs of any turn. Lipid peroxidation starts 12hrs post EIT in both HCs and SCs of basal turn, and reaches up to apex turn at 24hrs post EIT.

Conclusions:

PCD starts initially in the SCs post EIT, followed by PCD in HCs. Caspase 3 activation is observed only in SCs. Protecting SCs with selective otoprotective drugs at early stage post implantation may help to preserve HCs and residual hearing.
Effect of Using Earphones on Music‐Induced Hearing Impairment
Authors: Lin Cheng‐Yu , Guo Yueliang L. , Guo Nai‐Wen , Wu Jiunn‐Liang
Published: August 2013

Objectives:

Noise‐induced hearing loss (NIHL) has become more common among adolescents due to increased exposure to personal music players. Many adolescents listen to music on headphones. We aimed to assess whether the use of earphones has a significant effect on music‐induced hearing impairment among teenage students.

Methods:

This cross‐sectional study recruited students who habitually listen to music in a quiet environment. Listeners with the use of earphone and desktop speaker were included. Pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), and questionnaires were obtained. Cumulative noise exposure (CNE) was calculated by listening time and volume of using portable players.

Results:

A total of 105 subjects were analyzed. Mean age was 17.03 years. Sixty‐eight subjects (67.76%) used earphones, and the others used desktop speakers. Mean of PTA at high frequency (average of 3000, 4000 and 6000 Hz) was 8.97 dB HL (SD = 5.71). DPOAE amplitude level at high frequency was 19.87 dB SPL (SD = 5.11). Mean of CNE was 86.66 dB‐year (SD = 12.14). There was a good dose‐response relationship between CNE and DPOAE amplitude levels at high frequency (P < 0.01). Under the similar CNE status, subjects with earphones had worse DPOAE amplitude levels than those with desktop speakers (P < 0.05).

Conclusions:

This study identified that the use of earphones may affect the relationship between music exposure dose and NIHL at high frequency. To preserve hearing, teenage students should avoid using earphones to listen music for long periods of time.
Epidemiological Factors Influencing Access to Cochlear Implantation and Language Skills of Deaf and Hard‐of‐Hearing Children
Authors: Wu Edward C. , Mahboubi Hossein , Zardouz Shawn , Yau Yuk‐Yee A. , Rothholtz Vanessa S. , Djalilian Hamid R.
Published: August 2013

Objectives:

Determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) and deaf and hard‐of‐hearing (DHH) children's language skills.

Methods:

More than 200 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on family (income, insurance status, education level, hearing status, primary language) and children characteristics (school type, language skills, rehabilitation measures) were solicited.

Results:

Sixty‐six surveys were included in the analysis. Six children had already undergone CI. Of those children without CI, 62% had been presented with the option of CI by a healthcare professional and 24% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with at least one normal hearing parent (P =. 04), annual income less than $15,000 or more than $75,000 (P =. 01), and children enrolled in specialized schools for DHH (P =. 01). Risks of surgery (17%) and negative feedback from others(14%) were the leading reasons for unwillingness to undergo CI. Number of spoken words was greater among DHH children who attended public schools (P =. 04) or had more than one form of curriculum (P =. 04).

Conclusions:

A significant gap exists between the number of CI candidates and families aware of the option. Willingness to undergo CI is related to familial income and hearing status. On average, DHH children in public schools enrolled in a mainstream curriculum appear to have better language skills.
Eustachian Tube Function in Children with Normal Middle Ear and with Tympanic Membrane Retraction
Authors: Canali Inesangela , Rosito Leticia S. , Da Costa Sady S. , Siliprandi Bruno , Giugno Claudia
Published: August 2013

Objectives:

Identify the variation in middle ear pressure (MEP) after tubal function tests performed in normal children and in ears with retraction disease. Variability over time was analyzed.

Methods:

Observational cross‐sectional study. A total of 38 subjects were studied between March and November of 2012. Subjects were classified into three groups: group1‐normal ears (36 ears); group2‐mild tympanic membrane (TM) retractions (23 ears); group3‐moderate/severe TM retractions (17 ears). All patients had Valsalva maneuver, sniff test and Toynbee maneuver done sequentially in both ears twice with 15 days interval. MEP was measured with an Interacoustics AT235h tympanometer before and after the maneuvers. For analysis, MEP mixed effects models was used. For evaluation over time, Bland and Altman and intra‐class correlation (ICC) were used. Significance of the study was ± = 0.05.

Results:

The mean ± SD age was 11 ± 2.72 years (8‐17 years). At first time of the Valsalva maneuver, there was a trend of increasing pressures in the three groups (P = 0.012), and the mean pressures of the groups were different (P <0.001). For the sniff test and Toynbee there was no statistically significant difference between basal pressure and pressure after the maneuvers in three groups of ears (P >0.05) at the two times. We found a moderate degree of replicability over the two times of measurement.

Conclusions:

The average MEP increased in the Valsalva maneuver in the three groups. Pressure had more variability in ears with moderate/severe retraction.
Evaluation of Patients Treated by Facial Nerve Decompression via Transmastoid Approach for Traumatic Facial Paralysis
Authors: Hyoung Lee Ju , Jung Joo Hyun , Cho Chang‐Hyun , Kwak Bokyung , Ju Youn Hee
Published: August 2013

Objectives:

Evaluate outcomes and prognosis of patients operated on for traumatic facial paralysis.

Methods:

The authors retrospectively reviewed 20 patients with temporal bone fractures resulting in facial paralysis, who were treated by surgical facial nerve decompression with transmastoid approach from 2004 to 2012.

Results:

In 14 patients, HB grade improved as 1, 2, 3. Facial paralysis degree improved from preoperative average HB grade 4.95 to postoperative average HB grade 3.15. Statistically significant improvements were found in both groups where the operation was performed within 3 weeks and after 3 weeks.

Conclusions:

Postoperative results of facial nerve decompression in traumatic temporal bone fracture can be excellent. And as surgeons can expect better outcomes with early diagnosis and lesser nerve damage, early surgical decompression should be carried out.
Eye Color as a Risk Factor for Acquired Sensorineural Hearing Loss: A Systematic Review
Authors: Mujica‐Mota Mario A. , Schermbrucker Jonah , Daniel Sam J.
Published: August 2013

Objectives:

There is controversy as to whether eye color has an effect on acquired sensorineural hearing loss. The objectives of this review were to analyze the literature evaluating the association between eye color and acquired causes of sensorineural hearing loss and to propose the potential mechanisms of this association.

Methods:

Six databases were searched to identify clinical studies relating eye color and acquired causes of sensorineural hearing loss such as noise, cisplatin ototoxicity, radiation, and presbycusis. Included articles were independently assessed for quality by two authors using the Downs and Black rating scale.

Results:

Seventeen articles were eligible for review. Eye color was not found to have an effect in the non‐exposed population or in presbycusis. In noise‐induced sensorineural hearing loss, light‐eyed patients had more significant loss following noise exposure, although the variability reported due to eye color was modest (r2 = 1‐14%). Two out of three studies reported that dark eye color is associated with cisplatin ototoxicity. In one study, green‐eyed patients were found to be at higher risk of radiation‐induced hearing loss.

Conclusions:

Eye color does not appear to play a role in hearing loss in non‐exposed individuals or presbycusis. It is possible that dark‐eyed individuals, with greater inner ear melanin content, are better protected against noise‐induced hearing loss. Evidence suggests that melanin can be protective against radiation‐induced sensorineural hearing loss, but that it may predispose individuals to cisplatin ototoxicity. Future studies are required to support these conclusions.
Genotype of Staphylococcus aureus Isolated from Otorrhea of Chronic Otitis Media
Authors: Komori Masahiro , Kobayashi Taisuke , Hyodo Masamitsu
Published: August 2013

Objectives:

Staphylococcus aureus (SA) causes about 50% of cases of chronic otitis media (COM). Specific characteristics of a geographical region and diseases such as impetigo and atopic dermatitis were identified as factors in the molecular epidemiology of SA. We compared the genotype of SA isolated from otorrhea of patients with COM with the genotype isolated from the nasal inhabitants of healthy subjects.

Methods:

Forty SA isolates, including 11 methicillin‐resistant SA (MRSA) isolates, were collected from patients with COM who underwent tympanoplasty between April 2009 and July 2012. Multilocus sequence typing was performed on these isolates. First, PCR and DNA sequencing were performed on seven housekeeping genes of SA. A clonal complex (CC) was defined as the coincidence of a gene among five of the seven genes. In patients with MRSA, the period until the ears became dry postoperatively was investigated.

Results:

The proportion of CC8 and CC5 SA strains of COM were greater than that of nasal inhabitants, possibly because the CCs included MRSA stains. The proportion of CC188 and CC508 SA strains, which are major strains in nasal inhabitants, was smaller. The proportion of CC121, CC509, and CC59 SA strains, which are minor strains in nasal inhabitants, was greater. The periods were 207 days for the CC8 MRSA strain (n=4), 189 days for the CC5 MRSA strain (n = 4), and 95 days for the CC 95 MRSA strain (n=1); no significant difference was found.

Conclusions:

This study revealed discrepancies in CCs between SA from COM and SA from nasal inhabitants.
H2O2 Treatment Accelerates Autophagy and Cellular Senescence in Auditory Cell Line
Authors: Tsuchihashi Nana A. , Hayashi Ken , Goto Fumiyuki , Fujioka Masato , Kanzaki Sho , Ogawa Kaoru
Published: August 2013

Objectives:

Age‐related hearing disorder is known to be elicited by mitochondrial dysfunction caused by various stresses including reactive oxygen species. Recent studies have found that autophagy plays an important role in maintenance of cellular function sequestering damaged, oxidized or dysfunctional intracellular components and organelles, and is also associated with aging. However, the role of autophagy on senescence of inner ear and age‐related hearing loss remains unclear. In this study, we investigated the molecular mechanism of autophagy and senescence in auditory cells.

Methods:

We used auditory cell line HEI‐OC1. After treatment with H2O2, cell viability and population doubling time were counted. We detected autophagy related proteins with western blotting. SA‐b‐gal staining was performed for detecting cellular senescence. Atg7 and AMPKa siRNA were transfected into HEI‐OC1 cells with electrophoration.

Results:

The cell viability of H2O2‐treated HEI‐OC1 was decreased in a time‐ and dose‐dependent manner. While senescent cells are characterized by its ceased proliferation, the cell doubling time was delayed in H2O2‐treated HEI‐OC1. The activity of SA‐b‐gal was increased in H2O2‐treated HEI‐OC1 cells. The expression of LC3‐II, a monitoring marker of autophagy, was induced after treatment with H2O2. The protein level of p‐AMPK, known as a key gene of life span elongation, also was increased in H2O2‐treated HEI‐OC1. The premature senescence was significantly induced in AMPK and Atg7 KD HEI‐OC1, compared with control cells.

Conclusions:

Our results suggested that autophagy and AMPK activation play a crucial role of cellular senescence in auditory cell under oxidative stress.
Implementing Genomic Medicine in Care of Patients with Impaired Hearing
Authors: Liu Xue Zhong , Blanton Susan , Angeli Simon I. , Eshraghi Adrien A. , Telischi Fred F. , Tekin Mustafa
Published: August 2013

Objectives:

The Miami Otogenetic Program has provided a unique platform to carry out translational research on delivering genetic services to deafness patient care. Using target‐enrichment/NGS, we will 1) determine the overall frequencies of different forms of genetic deafness, 2) identify new genes for ARSNHL and ADNSHL, and 3) create a Genomic Deafness Database (GDD) and Personalized Sequence Profile (PSP) for the clinical care of deaf patients.

Methods:

We collected a unique cohort of multiplex families derived from three unique sources from the U.S., China, and Turkey, suitable for determination of molecular epidemiology of hereditary deafness and for new gene identification using “target‐enrichment,” methods and next generation sequencing (NGS). Our interdisciplinary and collaborative team will conduct outcomes evaluation of genetic service on deaf patient care in our diverse populations.

Results:

The infrastructure of our multidisciplinary otogenetics team is presented along with our use of testing algorithms when evaluating patients with sensorineural hearing loss (SNHL). A total of 60% of small multiplex families are identified to have mutations in the known deafness genes in a pilot study and the remaining 40% have mutations in other yet‐unidentified deafness‐causing genes. We have identified several new genes for SNHL.

Conclusions:

The combined target‐enrichment/NGS is a powerful tool in the identification of new deafness genes in small multiplex families and large multi‐generational families. The multidisciplinary team approach is an effective way to bring the sequencing data to clinical practice for the clinical diagnosis and management of deaf and hard‐of‐hearing families.
Evaluation of New Treatment in Patients Suffering from Trismus following Radiotherapy
Authors: Finizia Caterina A.
Published: August 2013

Objectives:

Trismus (maximum interincisal opening less than 36 mm) impacts on activities of daily living and adversely affects patient quality of life (QoL). This study aims to investigate the effectiveness of mouth‐opening tools in the rehabilitation of trismus in patients with head and neck cancer as well as any improvement in patients’ health‐related quality of life (HRQL).

Methods:

Thirteen study patients suffering from trismus following radiotherapeutic treatment for head and neck cancer were identified in 2010 at Sahlgrenska University Hospital, Gothenburg, Sweden. An additional 13 patients constituted a control group. The study patients were enrolled in a mouth opening training program in contrast to the control patients who did not receive any systematic training. All patients reported HRQL via validated questionnaires including EORTC C30, EORTC H&N35, and S‐SECEL.

Results:

Twelve months after completion of the mouth opening training program, none of the study patients demonstrated trismus, whereas 62% of patients in the control group suffered from trismus. The study cohort reported a clinically significant improvement after mouth opening exercises with regard to social function and global QoL. No clinically significant change was observed with regard to these scales in the control group.

Conclusions:

This study indicates a positive relationship between systematic mouth‐opening training, reduction of trismus, and improved QoL. Systematic mouth opening exercises should be implemented as standard treatment for cancer patients demonstrating trismus once larger trials have confirmed the results from this study.
Morphological Features of the Membranous Labyrinth in Ménière‘s Disease
Authors: Tanioka Hisaya , Kaga Kimitaka , Tanioka Sayaka
Published: August 2013

Objectives:

Vertigo, the sensation of motion without true motion, is secondary to lesions or dysfunction within vestibular systems. The aim of this study was to determine morphological features within the vestibular systems and cochlear duct in Ménière's disease.

Methods:

Three patients who were diagnosed with Ménière's disease were enrolled. Two cases were studied in attack and recovery period. One case was followed by pre‐attack, attack and recovery period. Axial temporal thin sectional computed tomography (CT) data were applied to create 3D volume rendering membranous images on the CT work station for post processing with the use of current software.

Results:

In attack period, the saccule, utricle and cochlear duct were enlarged in comparison with pre‐attack and recovery period. Also, we could see thickening changing features of ductus reuniens, saccular duct, and utricular duct during attack period.

Conclusions:

We can evaluate conditions of the membranous labyrinth in Ménière's disease. The pathological images showed enlarged shape of the end‐organs and cochlear duct. We can know conditions of the membranous labyrinth in Ménière's disease.
A Novel Regulated Nanohydrogel Delivery System for Inner Ear Application
Authors: Lajud Shayanne A. , Nagda Danish , Mouchli Anas , Qiao Peter , O'Malley Bert W. , Li Daqing
Published: August 2013

Objectives:

1) Develop a novel chitosan‐hydrogel‐based nanoparticle delivery system (nanohydrogel) for inner ear application and to evaluate its structures and release kinetics in vitro. 2) Evaluate if the nanohydrogel delivery system can be turned off using an enzymatic regulator for inner ear delivery. 3) Evaluate the inner ear distribution of nanoparticles following round window membrane application in a mouse model.

Methods:

Nanoparticles labeled with fluorescence were constructed and loaded into a chitosan‐based hydrogel to form a nanohydrogel delivery system. In vitro studies were performed to evaluate the thermosensitivity, structure, and nanoparticle release kinetics of the nanohydrogel with/without chitosanase enzymatic regulation. Morphologic studies were performed to evaluate the nanoparticle delivery and distribution within the inner ear structures in a mouse model.

Results:

After obtaining a homogeneous, viscous and thermosensitive nanohydrogel system, in vitro studies showed that the nanohydrogel can carry and release nanoparticles in a controlled and sustained manner, and chitosanase can effectively regulate this release if needed. A matrix‐like ultrastructure containing nanosized particles was confirmed. In vivo findings further confirm that the nanohydrogel delivered nanoparticles into the perilymphatic system and reached cellular structures of the inner ear in our mouse model.

Conclusions:

Our study suggests that the nanohydrogel system has the potential to safely deliver drugs or biomaterials in a controlled and sustained manner for inner ear application. This system could be used for targeted therapy for inner ear diseases that require safe and non‐invasive delivery approaches.
Optimizing Otoscopy Competency in Students through Supplementary Otoscopy Training
Authors: Masterson Caleb , Kaf Wafaa
Published: August 2013

Objectives:

Determine the effectiveness of the otoscopy training model on clinical competency and confidence level of students in performing and interpreting otoscopy.

Methods:

Thirty‐two first and second year audiology graduate students and six nursing students enrolled in pediatric audiology class participated. Students were randomly assigned to the control (n = 19, 14 females) and experimental groups (n =19; 14 females). The experimental group received supplementary otoscopy training including didactic otoscopy lectures and clinical training using manikin ears. The control group received the same pre‐test and post‐test and then completed a third assessment (post‐test 2) after receiving the same training. An evaluation of knowledge and skills regarding otoscopy between groups and time was conducted at three times: a) pre‐training, b) experimental group post training, c) control group post training. Evaluation involved a written and clinical exam and a self‐perception rating of confidence. Scores were analyzed via two‐way analysis of variances (ANOVAs), whereas Chi Square (X2) was conducted to evaluate confidence.

Results:

Experimental and control groups demonstrated significant increased overall competency in otoscopy following training model with didactic and laboratory components. Post‐test confidence ratings increased in all groups, and there were no significant differences between groups.

Conclusions:

The need for supplementary otoscopy training was warranted by low knowledge and clinical competency in otoscopy skills of students as measured by pre‐test mean scores. After training, both groups showed significant improvement in knowledge and competency. Results also suggest that perceived confidence ratings may be misleading in determining students’ clinical otoscopy skills.
Fine Needle Biopsy: Comparison of Aspiration versus Nonaspiration Techniques in Head and Neck Tumors
Authors: Ashimori Naoki , Hashimoto Ayako , Suzuki Takahiro
Published: August 2013

Objectives:

Fine needle aspiration (FNA) has been adopted as a simple and cost‐effective method for cytological studies of head and neck tumors. Recently the fine needle nonaspiration (FNNA) is reported to provide good specimens. In this study, we compare the efficacy of the two techniques.

Methods:

During a 3‐year period, 297 cytological examinations were conducted in patients with head and neck tumor. Sites of biopsy studied included thyroid tumor (n=200), lymph node (n=75), and salivary tumor (n=22). Fine needle biopsies were performed in each lesion with 23‐gauge needles, and results were analyzed by a single pathologist.

Results:

Overall, specimens from 21 patients (7.1%) of 297 were inadequate with both techniques together. Forty‐three (14.5%) were insufficient specimens with FNA alone and 33 (11%) with FNNA alone. Insufficient specimens were obtained at 30 (15%) and 21 (10.5%) of 200 thyroid tumors and 2 (9.1%) and 1 (4.5%) of 22 salivary tumors with and without aspiration, respectively. The inadequacy rates were the same (14.6%) in the lymph nodes with each technique. The causes of insufficient specimens were blood contamination with FNA and the absence of cellular material with FNNA. No statistically significant difference was noted in the diagnostic yield between the two techniques.

Conclusions:

We concluded that FNNA is equal to FNA in the cytological studies in head and neck tumors. Double sampling may reduce inadequacy rates to low levels and be useful as a routine policy.