bluuebunny/crossref_metadata_2025 huggingface dataset:
Localization of a Specific Inward Rectifying Potassium Channel Protein in the Human Cochlea
Authors: Moore Michael W. , Conaway LaShardai , Hao Xingping , Schulte Bradley A. , Meyer Ted A. , Dubno Judy R. , Lang Hainan
Published: September 2014

Objectives:

Our study aims to determine the immunostaining pattern of Kir4.1 channels in human cochlear tissues. Potassium recycling pathways critical for maintaining cochlear ion homeostasis and the endocochlear potential have been defined largely in animal models. Potassium effluxed from sensory hair cells is taken up by supporting cells and returned to the stria vascularis via two distinct transcellular syncytial networks consisting of epithelial cells and spiral ligament fibrocytes. The inward rectifying potassium channel Kir4.1 appears to be an essential component of this process, as evidenced by murine knockout models lacking an endocochlear potential. Animal models have demonstrated robust Kir4.1 expression in several cell types along the cochlear potassium recycling pathway. However, Kir4.1 immunostaining patterns in the human cochlea remain undefined.

Methods:

Postmortem human temporal bones were collected through the Hearing Research Program at the Medical University of South Carolina. Temporal bones were fixed within 6 to 11 hours of death and underwent microwave decalcification prior to immunohistochemical staining for Kir4.1.

Results:

Robust Kir4.1 immunoreactivity was present in strial intermediate cells, outer sulcus root processes and glial cells in Rosenthal's canal. The distribution of Kir4.1 in the human cochlea was generally similar to that reported in animal models.

Conclusions:

Our findings suggest that Kir4.1 channels play a critical role in the regulation of potassium recirculation in the human cochlea. Further immunohistochemical analyses are necessary to fully delineate the precise location of Kir4.1 in the complex potassium recycling pathway and elucidate its potential role in lateral wall degeneration and associated hearing loss.
Mastoid Reduction in Combination with Corner‐Tag Meatoplasty: Refining Mastoidectomy and Canalplasty Outcomes
Authors: Zhang Edward Z. , Tan Leonard , Soon Sue Rene , Yuen Heng‐Wai
Published: September 2014

Objectives:

Prevention of “a problem cavity” following modified radical mastoidectomies (MRM) and canalplasties requires careful preoperative consideration and an adept surgical technique. We aim to describe our technique of a superiorly‐based middle temporal artery flap, with an inferiorly‐based musculoperiosteal flap, in combination with a Corner‐Tag‐meatoplasty, and to evaluate the surgical outcomes on a semi‐quantitative scale.

Methods:

Retrospective consecutive case review from 2010‐2013. Primary end‐point measure of creating a low maintenance dry mastoid cavity was graded using Merchant's grading system.

Results:

Twenty‐four patients (13 males and 11 females) with a mean age of 42.6 years (range, 17‐76 years) were included. All except 3 cases were primary ear cases. None had previous reduction procedures done. Nineteen cases were MRMs, 3 were revision mastoidectomies, and 2 were canalplasties. A well‐epithelized, dry mastoid cavity was achieved in 12 patients by 1‐month post surgery, with another 9 achieving this by 3‐months. Twenty‐three cases (96%) resulted in cavities with adequate control of infection based on Merchant's summary grade. The cavities took an average of 1.75 months to epithelize. Three patients had recurrent tympanic membrane perforation with one requiring revision surgery. None had disease recurrence at mean 15.8 months follow‐up (range, 6‐25 months). Our technique of meatoplasty allowed excellent visualization of the mastoid bowl affording bimanual instrumentation in the clinic setting.

Conclusion:

The middle temporal artery and inferior musculoperiosteal flap in combination with the Corner‐Tag meatoplasty is an effective technique in reducing the mastoid cavity, aiding epithelization, has low complication rates, and allows good surveillance postoperatively.
Microtopographical Features Recruit RhoA/ROCK through TRPV1 Channels to Direct Cell and Neurite Growth
Authors: Polacco Marc A. , Li Shufeng , Tuft Bradley , Xu Linjing , Clarke Joseph C. , Guymon Allan , Hansen Marlan R.
Published: September 2014

Objectives:

(1) Identify intracellular signaling pathways required for translating biophysical cues into directed neurite growth. (2) Describe the role of TRPVI channels as mediators of cell response to microtopographical features.

Methods:

Microscopic parallel grooves were generated on methacrylate polymers using photopolymerization. Spiral ganglion neurites (SGNs) were cultured on the polymers, and alignment to grooves was quantified using a ratio of aligned length to total neurite length. Control alignment was compared with that of SGNs treated with RhoA activator, RhoA inhibitor, ROCK inhibitors, cAMP and cGMP analogs, and TRPV channel inhibitors. RNA interference was used to reduce expression of ROCK and TRPVI to confirm that activity of each was required for alignment. Alignment of NIH3T3 fibroblasts was compared to fibroblasts transfected with TRPVI.

Results:

Neurites aligned preferentially to micropattern grooves. RhoA activator and cGMP analogs increased alignment, while RhoA inhibitor and cAMP analogs decreased alignment. ROCK inhibitors decreased neurite alignment, and SGNs transfected with ROCK‐targeted oligonucleotides also displayed reduction in alignment. Neurites exposed to TRPV inhibitors exhibited poor alignment, as did TRPVI knockdown cells. TRPVI‐transfected fibroblasts aligned more strongly than NIH3T3 fibroblasts. For all alignment comparisons, P <. 05.

Conclusions:

Microtopographic features generated via photopolymerization of methacrylate polymers activate RhoA and ROCK through TRPVI channels to direct cell and neurite alignment.
Osteonecrosis of the Temporal Bone Secondary to Bisphosphonates: A Potentially Life‐Threatening Complication
Authors: Amiraraghi Natasha , Yaneza May M. C. , Husami Yahya , Iyer Arunachalam
Published: September 2014

Objectives:

(1) Describe how osteonecrosis of the temporal bone can present as a potentially life‐threatening side effect of bisphosphonates. (2) Recognize that bisphosphonates are commonly prescribed and as such many of our patients could potentially experience these complications. (3) Apply this knowledge to achieve a timely diagnosis and to ensure patients are counseled regarding the risk of temporal bone osteonecrosis.

Methods:

Case study of 2 patients presenting to our clinic in Lanarkshire, Scotland, from 2012‐2013: Patient A: A 53‐year‐ old female with cholesteatoma was also receiving intravenous bisphosphonate therapy for osteoporosis. Patient B: A 57‐year‐ old female on bisphosphonates presented with a left‐sided facial palsy.

Results:

Patient A: During mastoidectomy the whole of the tegmen was noted to be brittle. A large piece of tegmen was found detached from the surrounding bone but was not affected by cholesteatoma. The tegmen defect was repaired and the patient is being followed up. Patient B had examination findings in keeping with otitis externa. A computed tomography scan demonstrated bone erosion involving the descending facial nerve. Comorbidities have prevented surgical management and despite discontinuing the bisphosphonate. The facial palsy has not resolved.

Conclusions:

Bisphosphonates can cause osteonecrosis of the temporal bone, including lower doses used to treat osteoporosis, especially in presence of localized infections. The otolaryngologist should be aware that complications such as tegmen erosion and facial palsy may occur. Patients with known infectious ear conditions considering treatment with bisphosphonates for osteoporosis should be counseled regarding the risk of osteonecrosis of the temporal bone.
Otitis Media with Effusion: Effectiveness of Clinical Treatment Assessed with Tympanometry
Authors: Almeida Emyle M. , Guercio Wilson B. , Vilela Marcela M. P. , Gomes Erika F. , Silva Renata F. , Chaves Kenia A. , Vasconcelos Natália
Published: September 2014

Objectives:

Otitis media with effusion (OME) is a common problem that generally affects children ages 6 months to 3 years. There are various otoscopic signs that indicate effusion, and the findings on tympanometry may help to diagnose OME. The aim of this ongoing study is to evaluate response to clinical treatment based on tympanometry.

Methods:

Prospective noncontrolled clinical assay of 25 patients with OME diagnosis, treated with oral antibiotics and nasal topical steroids from January 2013 to January 2014 in the otolaryngology department of Juiz de Fora Medical School in Brazil. The inclusion criteria were age from 2 to 12 years and signs of effusion on otoscopy and tympanometry. The exclusion criteria were antibiotic use during the previous month and history of chronic otologic disorder or congenital anomalies. The subjects were evaluated by tympanometry at the time of diagnosis and on day 30.

Results:

A total of 25 patients included 11 girls and 14 boys (3‐15 years old). Of the 50 ears assessed at the time of diagnosis, 28 (56%) had curve B and 22 (44%) had curve C. After 30 days, only 8 ears (16%) remained with curve B, 12 (24%) had curve C and 30 (60%) had curve A.

Conclusions:

Tympanometric results show that oral antibiotics associated with nasal topical steroids was effective in treating OME. Although watchful waiting is a recommendation of guidelines, there was a need for antibiotics because of upper airway infection. In developing countries access to medical attention could limit frequent consultations and lead to higher morbidity of untreated children.
Racial/Ethnic and Socioeconomic Disparities in Hearing Care among Older Americans
Authors: Nieman Carrie L. , Marrone Nicole , Szanton Sarah L. , Thorpe Roland J. , Lin Frank R.
Published: September 2014

Objectives:

Although hearing impairment is prevalent in older adults and may carry implications for cognitive, social, and physical functioning, little is known about hearing care among older minority adults. The aims of this study were: (1) describe factors that are associated with disparities in hearing health care among older adults and (2) assess the current reach of hearing care delivery to older adults.

Methods:

We analyzed nationally‐representative, cross‐sectional data from 1544 older adults ≥70 years with audiometry and hearing health care data from the 2005‐2006, 2009‐2010 National Health and Nutritional Examination Surveys. The 2 primary outcomes were recent hearing screening (≤4 years) and, for those with hearing loss, regular hearing aid use (≥5 h/wk in the past 12 months). Disparities‐related covariates included demographics, insurance status, general health, and health care utilization.

Results:

Adjusting for age and better ear speech‐frequency (0.5‐4 kHz), pure tone average (PTA), race (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.21‐2.33, Blacks compared with Whites) and education (OR = 1.63, 95% CI: 1.05‐2.52 ≥college versus <high school), were associated with having a recent hearing screening. However, hearing aid use was associated with socioeconomic status (higher education, income, poverty‐to‐income ratios, having private insurance), and with race (Blacks OR = 0.42 [95% CI: 0.19‐0.91] and Mexican Americans OR = 0.22 [95% CI: 0.06‐0.74] versus Whites). In a multivariate analysis, adjusting for age, hearing loss, race/ethnicity, and socioeconomic status, Blacks were not more likely than Whites to use hearing aids despite higher levels of hearing screening (OR = 0.74, 95% CI: 0.28‐1.93).

Conclusions:

With increasing populations of older minority adults and growing evidence of the detrimental effects of hearing loss, disparities in hearing health care represent critical areas for research and intervention.
RNA‐Seq Analysis of Allele‐Specific Expression in the Mouse Cochlea
Authors: Ho Maria K. L. , Hasin Yehudit , Lusis Aldons J. , Friedman Rick A.
Published: September 2014

Objectives:

Age‐related hearing impairment or presbycusis is one of the most common sensory abnormalities in the world. Mouse models have been widely used in studies of hearing loss to separate genetic and environmental influences. We will describe novel cis‐ and trans‐regulation and dominance patterns in gene expression levels from cochlea of mice.

Methods:

Next‐generation sequencing (RNA‐Seq) data has been acquired from cochlea of three F1 mouse hybrid strains (n = 4) from parental strains C57BL/6J, DBA/2J, C3H/HeJ.

Results:

An analysis of allele‐specific expression will be reported and novel transcripts, isoforms, cis and trans‐regulation, long non‐coding RNAs, and dominance patterns will be discussed in relation to known genes.

Conclusions:

This will help to elucidate mechanisms and better understand the genetic backdrop of age related hearing impairment.
The Tuning Fork Examination: Are You Performing It Correctly?
Authors: Stevens Jayne R. , Pfannenstiel Travis J.
Published: September 2014

Objectives:

The tuning fork remains a useful diagnostic tool in modern otolaryngology practice. Two important variables help describe the sound generated by the tuning fork: frequency and amplitude. We sought to determine whether the manner in which a tuning fork is activated affects its vibrational response.

Methods:

A Polytec OFV‐5000 single point laser Doppler vibrometer was used to obtain direct velocity measurements after activation of 256 Hz, 512 Hz, and 1024 Hz tuning forks with several striking methods: striking the parietal bone, striking the pisiform bone, striking a wood table, and striking a metal surface. Each method was tested using three separate subjective intensities: softly, medium force, and significant force. Data were analyzed using the Polytec Vibrometer Software to produce a velocity spectrum and measurements of frequency and velocity amplitude.

Results:

The predominant frequency of motion of all tuning forks was their expected fundamental frequency. Additional nonharmonic frequencies were recorded when striking the 256 Hz and the 512 Hz tuning forks against metal or wood. The aberrant frequencies were of lower intensity relative to the fundamental frequency of the tuning fork.

Conclusions:

No additional frequencies were seen with activation on the head or pisiform bone or with the 1024 Hz fork using any method. For the 256 Hz and 512 Hz tuning forks, striking a hard surface produced additional and potentially misleading frequencies. As some providers use this test to guide surgical candidacy decisions in stapes surgery, this could have significant impact in clinical decisions.
Unilateral Cochlear Delivery of Virally Mediated Gene Therapy Demonstrates Bilateral Expression in VGLUT3 Knockout Mice
Authors: Kiringoda Ruwan , Akil Omar , Lustig Lawrence R.
Published: September 2014

Objectives:

(1) Examine whether unilateral round window membrane injection of adeno‐associated virus‐1 carrying vesicular glutamate transporter‐3 (AAV1‐VGLUT3) in congenitally deaf VGLUT3 knockout (KO) mice results in bilateral VGLUT3 expression. (2) Quantify hearing recovery in ipsilateral versus contralateral cochleae following VGLUT3 rescue.

Methods:

Five wild‐type (WT) and 7 VGLUT3 rescued KO mice were used; 2 VGLUT3 KO mice served as deaf controls. Postnatal‐day 1 (P1)‐P3 VGLUT3 KO mice to be rescued underwent left‐ear fixed‐volume round window injection of AAV1‐VGLUT3. On P21‐28, auditory brainstem responses (ABRs) were performed to determine bilateral hearing thresholds. Immunofluorescence was used to count inner hair cells (IHCs) expressing VGLUT3.

Results:

The 2 VGLUT3 KO mice were completely deaf and showed no IHC expression of VGLUT3. Rescued mice demonstrated VGLUT3 IHC expression in the injected side (85.8 ± 4.6% relative to WT) that was greater than the contralateral side (31.1 ± 22.7% relative to WT; P =. 03). ABR thresholds were 33.1 (±2.7) dB ipsilaterally and 46.0 (±14.1) dB contralaterally (P =. 03).

Conclusions:

The cochlea represents an attractive target for gene therapy due to its bony compartmentalization, but the extent of transfection outside the cochlea has yet to be fully studied. Our study suggests that hearing restoration and IHC transfection occurs bilaterally after unilateral injection, although contralateral changes are significantly less. This supports a model of extracochlear viral spread via cerebrospinal fluid and perilymph, and has important potential implications for future implementation of cochlear gene therapy. This preliminary study provides the basis for a larger, future project examining cochlear and brain expression following VGLUT3 rescue.
Acute Mastoiditis in the Pneumococcal Conjugate Vaccines Era
Authors: Tamir Sharon‐Ovnat , Roth Yehudah , Dalal Ilan , Goldfarb Abraham , Marom Tal
Published: September 2014

Objectives:

(1) Describe the changing trends in mastoiditis incidence and bacteriology in the pneumococcal conjugate vaccine (PCV) era.

Methods:

PCV‐7 and PCV‐13 have been gradually implemented in the Israeli national immunization program in 2009 and 2010, respectively. We retrospectively identified children aged 0‐6 years who had middle ear cultures obtained from “severe” acute otitis media (AOM) episodes, defined as AOM requiring tympanocentesis or presenting with spontaneous otorrhea, during the years 2008‐2013. Of those, we identified children with acute mastoiditis. Data were extracted for demographic, clinical and microbial information.

Results:

Data from 295 eligible AOM episodes reported in 279 children were collected. Of those, 56 children with 57 episodes of acute mastoiditis were identified. Of these 36 were boys (64%) and 37 (66%) were <2 years old. During the pre‐PCV and the PCV introduction period (January 2008‐November 2010), mastoiditis incidence rate was significantly higher than the post‐PCV introduction era (December 2010‐December 2013) incidence, 0.23 versus 0.16/“severe” AOM episode, respectively (P =. 04). Mastoiditis developed despite adequate systemic antibiotic therapy for AOM in 28 (49%) patients. Of the 21 (37%) positive cultures, Streptococcus pneumoniae was the most common bacteria, which was solely isolated in 17 (81%) episodes and in combination of Haemophilus influenzae in 1 (5%) episode. Notably, there were no isolates of S pneumoniae from mastoiditis patients following the first year after PCV‐13 introduction.

Conclusions:

Mastoiditis incidence complicating “severe” AOM decreased after the introduction of PCVs, which can be directly attributed to their effectiveness in reducing pneumococcal‐related AOM burden and complications.
Consultant Perceptions of Electronic Online Workplace‐Based Assessment Training for Surgical Trainees in the United Kingdom
Authors: Fu Bertram , Hampton Tom , Haarer Francesca , Das Prodip
Published: September 2014

Objectives:

(1) Describe the online electronic Work‐Based Assessments (WBAs) tools (run by Intercollegiate Surgical Curriculum Programme [ISCP]) used by consultant trainers in surgical training in the United Kingdom. (2) Describe the current perceptions and prior training (TrACE‐Training and Assessment in the Clinical Environment) received by consultant trainers of such training tool.

Methods:

An anonymous electronic survey was circulated to all surgical educational supervisors within a large southeast England university teaching hospital in the period of August‐December 2013.

Results:

Twenty‐one consultants were identified. Seventeen responded (81%), all using WBAs in ISCP. Only 1 supervisor had heard of TrACE, and 17% had received no formal training in verifying themselves as competent in their assessor role. Thirty‐five percent felt they would like to receive formal ISCP training, with the remainder happy to self‐certify their competency.

Conclusions:

The GMC specifies that trainers must be competent in the use of WBAs and the ISCP cites a need for systematic accreditation of supervisors. The RCSEng runs TrACE course, which explains roles/responsibilities of a trainer/supervisor with regard to the use of WBAs. Supplementary to the “Training the Trainers” course, it offers a structured forum to discuss recent changes in postgraduate training. We conducted this study to assess awareness/uptake/thought regarding changes in surgical supervision to identify whether the guidelines are being implemented. We recommend increased publicity for this and similar courses providing consultants for this training. The alternative is a more formal adoption of current status quo whereby consultants appointed as supervisors and assessors self‐certify their competency in supervising juniors.
Facial Plastic Surgery in Pediatric Otolaryngology: Outcomes and Satisfaction
Authors: Vincent Richard L. , Pereira Kevin D. , Ambro Bryan T.
Published: September 2014

Objectives:

Highlight the role of facial plastic and reconstructive surgery in the surgical management of pediatric head and neck lesions and assess cosmetic outcomes.

Methods:

Retrospective case series of 13 pediatric head and neck lesions managed at a tertiary care children's hospital. The charts of all patients were reviewed for clinical presentation, radiologic findings, surgical technique used for excision and reconstruction, preoperative and postoperative photography, pathology and cosmetic outcomes.

Results:

A total of 13 pediatric patients with ages ranging from 18 months to 12 years had adequate documentation for review. There were 4 naso‐frontal dermoids, 4 head and neck skin lesions, 3 midface/orbital bony lesions, and 2 parotid/facial soft tissue lesions. Six patients were managed by soft tissue advancement flaps, 2 required complex linear closure and 2 had a surgical exposure achieved with cosmetically placed incisions. Two patients needed a midface degloving approach for exposure, one required medial osteotomies and bone pate for reconstruction and 2 were managed with calvarial bone grafts. At last follow‐up cosmetically acceptable outcomes were photographically documented in all 13 patients. This was confirmed by parental satisfaction.

Conclusions:

The involvement of facial plastic and reconstructive surgery is an important adjunct in the management of pediatric head and neck lesions. It leads to better cosmetic outcomes that can be documented and confirmed by parental satisfaction.
Frequency‐Specific Hearing Outcomes after Use of a Powered Drill in Pediatric Type I Tympanoplasty
Authors: Kent David T. , Chi David H. , Wine Todd M. , Kisto Dennis
Published: September 2014

Objectives:

(1) Describe factors related to frequency‐specific hearing outcomes after type I tympanoplasty in pediatric patients. (2) Describe the effect of powered bone drilling on frequency‐specific hearing outcomes after type I tympanoplasty.

Methods:

Retrospective medical chart review (February 2006 to October 2011) of 492 consecutive pediatric otolaryngology patients undergoing type I tympanoplasty for tympanic membrane (TM) perforation of any etiology at a tertiary‐care pediatric otolaryngology practice. Data collected included air conduction at 250 to 8000 Hz, speech reception thresholds, bone conduction at 500 to 4000 Hz, and air‐bone gap at 500 to 4000 Hz. Demographic data obtained included sex, age, size, mechanism, location of perforation, and operative repair technique, as well as the use of a powered bone drill during surgery.

Results:

A downtrend in sensorineural hearing at 2000 and 4000 Hz was noted with the use of a powered drill during surgery, although no significant difference in sensorineural hearing or air‐bone gap was detected at 500, 1000, 2000, or 4000 Hz (P >. 05). No significant change was detected in conductive hearing at 1000, 2000, 4000 Hz, or 8000 Hz (P >. 05). Significant improvement was noted in lower‐frequency conductive hearing at 250 and 500 Hz (P <. 001).

Conclusions:

No correlation between high‐frequency hearing loss and use of a powered drill during type I tympanoplasty was found in this pediatric population. Surgery was found to significantly improve conductive hearing at 200 and 500 Hz. Based on these results, use of a powered bone drill is not contraindicated during type I tympanoplasty.
Dissolution of Salivary Calculi with Chemolysis and Ultrasound
Authors: Schatton Robert , Kempf Hans‐Georg , Schatton Helmut
Published: September 2014

Objectives:

(1) Investigate whether treatment with an ultrasound probe can reduce the weight of salivary calculi in vitro. (2) Determine the effect of ultrasound application on chemolysis of salivary gland stones with diluted acetic acid.

Methods:

Ten submandibular calculi (mean weight 159 ± 80.2 mg) were halved. After randomization these halves were each placed in a beaker containing saline solution (0.9%, pH5.3) or diluted acetic acid (0.6%, pH 2.78), respectively. An ultrasound probe (1‐mm diameter, 30 kHz) was dipped into the solution with a tip‐to‐calculi distance of 5mm. Ultrasound was applied in a continuous mode for 3 hours. To determine the extent of dissolution, the calculi were weighed and photographed before and after the treatment.

Results:

The mean weight reduction of salivary calculi after ultrasound treatment was 2 ± 1.1 mg in isotonic saline solution and 19.1 ± 13.7 mg in diluted acetic acid, respectively. The differences were statistically significant (P <. 005).

Conclusions:

A weight reduction of salivary calculi can be achieved by ultrasound application in vitro. Ultrasound treatment enhances the effect of chemolitholysis with diluted acetic acid. This could be helpful to diminish the size of salivary calculi within the scope of minimally invasive therapy of sialolithiasis.
National Trends in Pediatric Basilar Skull Fractures
Authors: Capra Gregory G. , Johnson Christopher M. , Wilson Justin D. , Brigger Matthew T.
Published: September 2014

Objectives:

(1) Identify the current public health burden of pediatric temporal bone fractures. (2) Determine if the introduction of bicycle helmet and child safety seat laws has resulted in a change in national patterns.

Methods:

The 2000 and 2009 Kids’ Inpatient Databases were used to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009. Children diagnosed with basilar skull fractures were identified by corresponding ICD‐9 codes. Database analyses generated national estimates of summary statistics and comparison of trends over the 9‐year period.

Results:

The estimated prevalence of pediatric skull base fractures requiring hospitalization in the United States has remained essentially stable with 9641 (95% confidence interval [CI]: 8782, 10,501) admissions in 2000 and 10,581 (95% CI: 9532, 11,630) in 2009. Likewise, the mean age is unchanged from 10.02 (95% CI: 9.66, 10.38) years to 9.76 (95% CI: 9.44, 10.07). The proportion of female patients is the same (33%) (95% CI: 0.031, 0.34) and (95% CI: 0.0.32, 0.35) respectively. Total charges increased from $25,900,000 (95% CI: $22,200,000, $29,600,000) to $60,300,000 (95% CI: $53,100,000, $67,600,000) with a mean charge per admission increasing from $28,958 (95% CI: $26,302, $31,615) in 2000 to $57,596 (95% CI: $53,134, $62,058) in 2009. The mean length of stay remained stable at 6.04 (95% CI: 5.60, 6.48) to 5.31 (95% CI: 5.00, 5.62) hospital days.

Conclusions:

The public health impact of pediatric skull base fractures continues to be substantial. Despite the institution of bicycle helmet and child safety seat laws, national trends demonstrate a stable prevalence of hospital admissions, age at admission, sex distribution, and mean hospital stays with an increasing economic burden over the past decade.
Neonatal Tracheostomies: Changing Trends
Authors: Fisher Kelly , Isaiah Amal , Pereira Kevin D.
Published: September 2014

Objectives:

(1) Examine the current trends in neonatal tracheostomies and compare them to historic cohorts. (2) Determine and stratify the current risk factors for failed extubation in the neonatal intensive care unit (NICU).

Methods:

We conducted a retrospective review of 34 consecutive neonatal tracheostomies performed over a 5‐year period (2008‐2012) in a university‐based tertiary care hospital. Risk factors for failed extubation were identified and analyzed.

Results:

Sixty‐two percent of the infants had identifiable anatomic causes of airway obstruction, whereas the remaining (38%) had significant isolated pulmonary disease (P <. 05; χ2 test). The vast majority (95%) of the tracheostomies were performed at age ≥30 days (mean = 129d, SD = 101). Within anatomic risk factors, subglottic obstruction represented the largest group (33%). Risk of extubation failure was not systematically related to either birth weight (P =. 3 to. 9; n‐way analysis of variance) or age (P =. 1 to. 5) separately. Within a small group (n = 5) both anatomic causes as well as pulmonary disease were present. No procedure‐related complications were encountered.

Conclusions:

Neonatal tracheostomies are currently being performed for anatomic airway abnormalities more frequently than primary pulmonary disease as previously documented. It suggests that current respiratory therapies have lowered the burden of chronic lung disease. Even as more low‐birth‐weight neonates are being rescued, the presence of multiple concurrent risk factors did not appear to increase the chances of extubation failure or need for tracheostomy within this population.
Pain Control after Tonsillectomy: A Survey of Membership of the American Society of Pediatric Otolaryngologists
Authors: Jensen Daniel R. , Brown David J. , Thorne Marc C.
Published: September 2014

Objectives:

(1) Describe current prescribing practices and opinions of membership of the American Society of Pediatric Otolaryngologists (ASPO) regarding analgesia after pediatric adenotonsillectomy. (2) Understand prevailing opinions about opioids and nonsteroidal anti‐inflammatory drugs (NSAIDs) that influence medication selection in this setting.

Methods:

Pain management after pediatric adenotonsillectomy is controversial. We conducted a web‐based survey of ASPO membership to understand current post‐adenotonsillectomy prescribing practices, with emphasis on attitudes regarding opioids and NSAIDs.

Results:

A total of 110 responses were received. Seventy‐eight percent of respondents indicated that they sometimes or always prescribe an opioid as first line analgesic. A majority (74%) indicated they frequently prescribe NSAIDs, while 11% indicated they avoid them entirely. A total of 76% agreed or strongly agreed that opioids increase risk of respiratory events after tonsillectomy, versus 19% in regard to NSAIDs increasing risk of post‐tonsillectomy hemorrhage. More than 10 years in practice was associated with increased concern that NSAIDs increase bleeding risk (24% vs 4%, P =. 018), but was not associated with increased concerns about opioid‐related respiratory suppression. A slight majority (54%) indicated they believed NSAIDs to be either equally or more effective than opioids at controlling pain. Additional areas of inquiry included preferred medications, factors influencing medication choice, respondent confidence in their regimen, and influence of Food and Drug Administration warning on codeine use.

Conclusions:

Significant heterogeneity exists among pediatric otolaryngologists regarding optimal pain management after adenotonsillectomy. Most respondents indicated they frequently prescribe opioids, though most expressed concern about respiratory suppression. We also found broad support for NSAID use among respondents, with comparatively few expressing concern regarding bleeding risk.
Preliminary Study on the Application of Upper‐Airway Model Construction with 3DMIA in OSAHS of Children
Authors: Chao Cheng , Dabo Liu
Published: September 2014

Objectives:

Investigate the applicability of 3DMIA software to upper airway modeling in children with obstructive sleep apnea hypopnea syndrome (OSAHS).

Methods:

A total of 12 children diagnosed with OSAHS by polysomnography were included in this study. Data regarding upper airway structure were collected via spiral computed tomography (CT) while sleeping and awake, from which a 3‐dimensional model of the upper respiratory tract from the nasopharynx to the supraglottic region using 3DMIA software was constructed. The upper airway volume and airway minimum cross‐sectional area were measured employing software algorithms.

Results:

The upper airway volume and airway minimum cross‐sectional area of the 12 children during sleep were significantly less than while awake (P <. 01).

Conclusions:

3DMIA software modeling and software algorithm measurement were more objective than traditional radiology with respect to evaluation of the extent of the upper airway narrowing in OSAHS children, and showed good applicability to studying upper airway morphology and function in children with OSAHS.
Tracheocutaneous Fistula Closure in Pediatric Tracheostomy Patients: A Systematic Review
Authors: McCormick Michael E. , Preciado Diego A.
Published: September 2014

Objectives:

Compare success and complication rates of primary tracheocutaneous fistula closure compared with fistulectomy with secondary fistula healing.

Methods:

A systematic literature search was performed on PubMed. All prospective and retrospective studies of tracheocutaneous fistula (TCF) closure techniques in pediatric patients were included for initial analysis. The authors’ unpublished cohort of 13 fistulectomy patients was also included in the overall analysis. Primary outcomes were surgical success rate and major complication rate. Fisher exact test was used for statistical analysis.

Results:

Thirteen studies were identified for inclusion in the systematic review; 8 studies reported both success rates and complications. The total number of patients in all included studies was 259 (median, 19; range, 8‐98). Techniques included fistulectomy with multilayer closure (197), primary closure alone (2), and fistulectomy alone with healing by secondary intention (60). Success rates were comparable between fistulectomy alone (95.0%) and primary closure techniques (97.5%) (P =. 275). There was a statistically significant increased rate of reported major complications among patients treated with primary closure techniques compared to fistulectomy (0.0% vs 8.5%, P =. 038).

Conclusions:

While both primary closure techniques and secondary healing techniques for pediatric TCF closure have excellent success rates, fistulectomy with healing by secondary intent is associated with less reported major complications.
Comparison of Mometazon Furoate to Cetirizin for Symptom Severity Control and QOL in Allergic Rhinitis
Authors: Cetin Bilal , Saglam Omer , Dursun Engin , Karapinar Ugur
Published: September 2014

Objectives:

Evaluate and compare nasal symptom scores and quality of life (QOL) findings in allergic rhinitis patients.

Methods:

A total of 426 adult allergic rhinitis patients’ medical records were evaluated retrospectively. Group A consisted of 188 patients and received mometasone furoate nasal spray (100 mcg daily/nostril). Group B consisted of 238 patients receiving cetirizine (10 mg oral/daily) for 30 days. Nasal symptoms (watery discharge from the nose, nasal congestion, sneezing and nasal pruritus) and QOL (Short Form‐36) were recorded before and after treatment.

Results:

When compared before and after treatment, each group's total nasal symptom scores reduced significantly (Group A, P =. 001; Group B, P =. 002), and QOL scores improved significantly (Group A, P =. 001, Group B, P =. 001). But when compared between groups, Group A results were better than Group B (total nasal symptom scores P =. 001, QOL scores P =. 003).

Conclusions:

Although intranasal mometasone furoate is a better choice than oral cetirizine, both of these medicines can be used to control allergic rhinitis symptoms and improve patient QOL.
Inhibitory Effect of Prostaglandin E2 on the Migration of Nasal Fibroblasts
Authors: Shin Jae‐Min , Park Il‐Ho , Park Joo‐Hoo , Kim Jin Ah , Lee Heung‐Man
Published: September 2014

Objectives:

Fibroblast migration is crucial for normal wound repair after sinonasal surgery. Prostaglandin E2 (PGE2) is a potent inhibitor of fibroblast functions including chemotaxis, proliferation, and matrix production. The purpose of this study was to determine whether PGE2 affects the migration of nasal fibroblasts and to investigate the mechanism of action of PGE2 on nasal fibroblasts.

Methods:

Primary cultures of nasal fibroblasts were established from inferior turbinate samples. Fibroblast migration was evaluated with scratch assays. Reverse transcription‐polymerase chain reaction was performed for E‐prostanoid (EP)1, EP2, EP3 and EP4 receptors. EP receptor‐selective agonists and antagonists were used to evaluate receptor functions. Stimulatory G (Gs) proteins were activated to evaluate mechanisms. Intracellular cyclic adenosine monophosphate (cAMP) levels were measured by enzyme‐linked immunosorbent assay, and fibroblast cytoskeletal structures were visualized with immunocytochemistry.

Results:

PGE2 significantly reduced the migration of nasal fibroblasts. Agonists selective for the EP2 and EP4 receptors significantly reduced the nasal fibroblast migration. Antagonists of the EP2 and EP4 receptors inhibited the effect of PGE2 on nasal fibroblast migration. Activation of Gs protein and adenyl cyclase reduced nasal fibroblast migration.

Conclusions:

PGE2 inhibited the migration of nasal fibroblasts via the EP2 and EP4 receptors, and this inhibition was mediated by cAMP elevation. Targeting specific EP receptors could offer therapeutic opportunities for conditions such as delayed wound healing after nasal surgery.
Successful Endoscopic Dacryocystorhinostomy: What Factors Make Revision Surgery More Likely?
Authors: Liu Zi Wei , Jayaraj Samuel , Subak‐Sharpe Ian
Published: September 2014

Objectives:

Endoscopic dacryocystorhinostomy (DCR) is indicated for treatment of nasolacrimal duct obstruction, which manifests as a watery eye. Endoscopic techniques have gained popularity in recent years compared to open DCR, which leaves a facial scar. Success rates have been reported to be between 65‐95%. We report the success rate of endoscopic DCR at our institution and analyze factors leading to revision surgery.

Methods:

This is a retrospective analysis of endoscopic DCR performed at a district general hospital between August 2010 and December 2013. We perform this as a day case procedure using a DCR burr and leave silastic stents in situ. We do not routinely use anti‐mitotic agents. We collected and analyzed demographic data (age, co‐morbidity, medications), technical notes, rate of symptom resolution at follow‐up, and need for revision surgery.

Results:

A total of 33 endoscopic DCRs were performed in this time period. The overall success rate (satisfactory resolution of symptoms at minimum 3 months follow up) was 76%. Rate of revision surgery was 15%. In 50% of cases scar tissue obstructing the DCR opening was the cause of surgical failure. Previous surgery (external DCR/punctoplasty) was not associated with a higher rate of endoscopic DCR failure (P =. 616).

Conclusions:

Endoscopic DCR is a safe technique for treating nasolacrimal duct obstruction with local success rates of 76%. A common reason for failure is scar tissue obstructing the rhinostomy opening and greater attention is being given to surgical techniques that maintain wide patency of the opening, as this may reduce rates of failure.
Cardiopulmonary Coupling Analysis: Changes before and after Treatment with a Mandibular Advancement Device
Authors: Lee Woohyun , Ahn Jae‐Cheul , Rhee Chae‐Seo , Lee Chul Hee , Kim Jeong‐Whun
Published: September 2014

Objectives:

Evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC).

Methods:

A total of 52 patients (mean age, 53.7 ± 9.6 years; range, 33‐74 years) were included in this study. Of them, there were 47 males (90.4%). All subjects were diagnosed with OSA after in‐laboratory full‐night polysomnography and re‐evaluated after 3‐month use of a MAD. At baseline, apnea‐hypopnea index (AHI) was 33.6 ± 17.0. We compared CPC parameters at baseline with those after 3 month use of a MAD.

Results:

Low frequency coupling (59.5 ± 16.1 to 47.7 ± 14.8%, P <. 001) and elevated low frequency coupling (44.6 ± 18.4 to 32.6 ± 15.7%, P <. 001) significantly decreased. High frequency coupling (28.6 ± 16.0 to 36.5 ± 15.7%, P =. 004) and very low frequency coupling (11.7 ± 7.2 to 15.3 ± 6.6%, P =. 028) significantly increased. The change of AHI significantly correlated with changes of the CPC parameters: negatively correlated with high frequency coupling change (r = –0.572, P <. 001); positively correlated with low frequency and elevated low frequency coupling changes (r = 0.604 and 0.497, respectively; P <. 001 in both).

Conclusions:

Low frequency coupling decreased as AHI improved while high frequency coupling increased as AHI improved. The CPC parameters showed that the sleep quality was improved by MAD therapy.
Internet Usage and eHealth Literacy of Patients in an Otolaryngology–Head and Neck Surgery Clinic
Authors: Saffarzadeh Areo G. , Verma Sunil P. , Billimek Jon
Published: September 2014

Objectives:

(1) Investigate whether otolaryngology–head and neck surgery (OHNS) outpatients consult health‐related online resources and establish baseline levels of perceived eHealth literacy. (2) Determine which resources patients use to investigate their disease and research treating physicians. (3) Explore relationships between perceived eHealth literacy, demographic data, and internet usage.

Methods:

A questionnaire was administered to 79 patients in a tertiary care OHNS outpatient setting between December 2013 and February 2014. The questionnaire recorded (1) demographic data, (2) health‐related Internet use, and (3) eHealth Literacy Scale (eHEALS), a tool used to measure perceived eHealth literacy.

Results:

Seventy‐five of 79 patients completed the questionnaire. Seventy‐six percent (n = 57) of patients had consulted online resources regarding their disease. The most commonly used resources were prompted by search engine results such as Google (88%, n = 51) and health websites such as WebMD (71%, n = 41). Only 14% of this group used the American Academy of Otolaryngology—Head and Neck website. Fifty percent (n = 38) of patients consulted online resources regarding their otolaryngologist prior to their visit. The mean eHEALS score was 3.65/5.0 (95% confidence interval [CI], 3.46‐3.84). For patients who search for health‐related information online, the odds of using dedicated health websites were 90.8% lower for patients with an eHEALS score below the mean versus above the mean (P =. 017; 95% CI, 35%‐98.7%).

Conclusions:

The majority of patients in this study consulted online resources to learn about their disease and physician. In this cohort, the perceived eHealth literacy influenced the type of website consulted. Patients with lower perceived eHealth literacy were less likely to consult dedicated health websites.
The Patient's Perioperative Perspective during Treatment for Obstructive Sleep Apnea
Authors: Rudolph Megan , Zapanta Philip E.
Published: September 2014

Objectives:

(1) Describe each patient's preoperative and postoperative experience in the treatment of obstructive sleep apnea (OSA). (2) Understand how the patients’ perceptions may influence their postoperative outcome and satisfaction.

Methods:

To analyze the differences between quantitative and qualitative postoperative results, we developed a modified phenomenological qualitative study of OSA patients who failed continuous positive airway pressure use and underwent surgery. From May to August 2012, patients were interviewed using a semi‐structured approach until thematic saturation was reached (n = 17). Of these interviews, 13 were held in‐person while 4 were performed by phone. Through Moustakas’ analysis, the transcribed interviews were broken down into codes. These were grouped into overarching themes. Upfront debriefing, investigator triangulation, epoche, reciprocal coding, member checks, and thick, rich description ensured data trustworthiness. Additionally, the patient's preoperative sleep studies and postoperative sleep studies were analyzed and compared to the subjective results.

Results:

The study identified 5 themes relating to patients and their OSA surgery: (1) Importance of OSA on personal and professional life; (2) Motivating factors for choosing surgery; (3) Patient knowledge; (4) Postoperative challenges; (5) Impact of OSA surgery.

Conclusions:

Patients’ experiences going into the surgery can largely influence their perceived outcome and satisfaction. These experiences are individual and subjective, and the postoperative sleep studies do not capture the whole outcome of the patients’ response to surgery. This suggests when patient reported outcomes are combined with postoperative sleep studies, otolaryngologists can gain a much better perspective about their patients.
Sleep Surgery Variations: The Evolution of Surgery for Obstructive Sleep Apnea at an Academic Hospital
Authors: Russell Jonathon O , Anderson Jared , Bae Charles , Kominsky Alan
Published: September 2014

Objectives:

(1) Identify surgeon dependent and temporal variations in indications and surgical interventions for obstructive sleep apnea (OSA) at a tertiary academic hospital. (2) Clarify if volume of sleep surgeries performed affects outcomes. (3) Determine if surgical volume correlates with technical variation (ie, do surgeons who perform more surgeries for OSA perform additional procedures beyond uvulopalatopharyngoplasty [UPPP]).

Methods:

Retrospective chart review: Adult patients who had undergone UPPP since 2003 and had electronic medical records available were included. Quality of life (QOL) instruments included in the electronic medical record such as the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ) were included. Pre‐ and postoperative results were compared using standard statistical analysis.

Results:

A total of 247 patients met inclusion criteria. Median AHI of all patients with available postoperative PSG decreased from 39.4 to 21.4. Patients of high‐volume surgeons (>10 UPPP per year) were more likely to have a lower preoperative Friedman score (P <. 02), complete a postoperative PSG (P <. 0001 by the 2‐tailed Fisher exact test), have a decreased postoperative ESS (P <. 01), and have a PSG completed sooner after surgery (P <. 01). Postoperative AHI and change in AHI did not differ between groups, however (P =. 21 and P =. 14, respectively).

Conclusions:

UPPP contributes to objective improvement in PSG measures and quality of life. Nuances in patient selection and patient management are apparent between high volume surgeons and others, and may contribute to quality of life variations. Standardization of patient selection, timing of postoperative PSG, and increased utilization of QOL instruments may improve QOL outcomes among surgeons who do not perform UPPP regularly.