bluuebunny/crossref_metadata_2025 huggingface dataset:
Loop Overlay Myringoplasty versus Medial Myringoplasty: A Comparative Study
Authors: Gulia Joginder S. , Yadav Samar Pal S. , Basur Sukhdeep K.
Published: September 2014

Objectives:

One of the most important factors in the success of myringoplasty is the size of the perforation. The repair of subtotal and large central perforation is less likely to be successful compared with the repair of small perforations. Loop overlay technique of myringoplasty offers an advantage in these situations and can be a viable alternative.

Methods:

A prospective controlled study from January 2010 to December 2011 of inactive (mucosal) chronic otitis media with subtotal and large central perforations. Subjects: Forty cases of either sex in the age group of 18‐40 years. Pt. B.D.S Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Patients were randomly divided into 2 groups of 20 each. Group A underwent medial myringoplasty and Group B Loop overlay myringoplasty. The graft uptake rate and the preoperative and postoperative hearing thresholds in each group were analyzed. Independent variables: Size and location of the perforation, preoperative air bone gap, technique of myringoplasty used.

Results:

The overall graft take‐up rate in group A was 90% and in group B it was 95%. Further, the average postoperative gain in group A was 16.25 dB as compared to 18.5 dB of group B.

Conclusions:

Loop overlay myringoplasty is better than medial myringoplasty in subtotal and large central perforations.
Magnetic Resonance Imaging at 1.5 T after Pediatric Cochlear Implantation without Magnet Removal
Authors: Gupta Sachin , Isaacson Brandon , Roland Peter S. , Kutz Joe W. , Booth Tim N. , Jacob Roy , Morriss Michael C
Published: September 2014

Objectives:

(1) Assess the safety of 1.5 T magnetic resonance imaging (MRI) in pediatric patients with cochlear implants (CIs) and internal magnets. (2) Assess artifacts created by CI magnets.

Methods:

A retrospective chart review was performed of pediatric CI patients who underwent 1.5T MRI at a university children's hospital. Binding of the CI magnet was performed before MRI, using mold material and a compressive gauze dressing. Patients were assessed for ability to complete the MRI, imaging artifact from the CI magnet, magnet position, and CI function following MRI.

Results:

Four patients (mean age 65 months; range, 19‐108 months), and a total of 6 CIs (2 bilateral), underwent 1.5 T MRI scans. There were 3 brain MRI studies and 1 spine. Informed parental consent was obtained. Clinical indications included leukodystrophy (2), hypertonia (1) and dystonia (1). Devices from 2 manufacturers were scanned. A CT scan was performed before the MRI scan in three‐fourths of patients to assess bone thickness adjacent to the magnet. Three patients had MRI under anesthesia. The CI produced an artifact with a mean maximal AP dimension of 10.8 mm (range 7.5‐15 mm) and a transverse of 5.7 mm (range 5.5‐6 mm). Greatest image distortion occurred with bilateral implants. There was no change in magnet position or CI function after the MRI in all cases.

Conclusions:

Pediatric patients may safely undergo 1.5 T MRI after CI without removal of the magnet if the device is tightly bound beforehand and strict safety protocols are followed. There are limitations to brain imaging due to artifacts.
Micro‐CT Dimensions of the Stapes: Bilaterally Symmetrical, but Not Related to Mastoid Size
Authors: Calligas Jason P. , Todd Norman W.
Published: September 2014

Objectives:

(1) Measure stapes height, footplate height (diameter perpendicular the crural plane), and footplate width (diameter in the plane of the crura) and to correlate these metrics between right and left sides. (2) Correlate stapes measurements with mastoid size, an indicator of childhood otitis media.

Methods:

From a group of 41 clinically normal ear cadavers, tissue blocks from the five crania with the largest mastoid pneumatization and 5 with smallest mastoid pneumatization were selected for micro computed tomography imaging. Using the ImageJ software package, a 3‐dimensional model of each stapes was created to determine stapes height and footplate dimensions. Of 60 measurements sought, 52 were accomplished.

Results:

The mean stapes height was 3.43 mm (range, 3.18‐3.82 mm). The mean stapes footplate width was 1.23 mm (range, 1.10‐1.50 mm). The mean footplate height was 2.72 mm (range, 2.5‐2.98 mm). Bilateral symmetry of dimensions was found, but there was no correlation with mastoid size.

Conclusions:

A wide range of stapes dimensions is confirmed by these specimens. Bilateral symmetry suggests that genetic influences may play a role in development. No correlation was found between stapes dimensions and mastoid size, suggesting that this local environmental aspect may not be related to its development.
Myringotomy and Tympanostomy Tube Insertion Training Device: A Surgical Simulator
Authors: Villanueva Jose Carlo R. , Opulencia Alejandro P.
Published: September 2014

Objectives:

(1) Develop a task simulator for myringotomy and pressure equalizing tube insertion. (2) Develop a simulator that can be used to hone a participant's micro surgical skills.

Methods:

Study conducted from October to November 2013. A design for a model head with a core made up of wood and polyester body filling was made. The external facial features were replicated using molding clay. The pinna and the external auditory canal were then made from carved wood. The external auditory canals were continuous with the core of the head model. Rubber fittings were used to attach the wooden pinna to the head in order to allow some degree of mobility to the pinnae. A port at the occipital portion of the head was made that would accommodate a middle ear cartridge. A solution bottle's cap was used to fabricate the middle ear cartridge. The tympanic membrane was simulated using a single sheet of polyethelene film. Myringotomy, tube insertion, and evacuation of middle ear fluid was done several times.

Results:

We were able to construct a simulator for doing myringotomy, evacuation of middle ear fluid, and tympanostomy tube insertion. The simulator was sturdy, easy to use, and economical.

Conclusions:

Simulators allow constant practice and objective evaluation of skills without risks to the patient under the hands of the surgeon still on the learning curve. The creation of this simulator is a step towards the improvement of surgical training, evaluation of residents, better health economics, and patient safety.
The New Technology: Canal Wall Up Tympanoplasty with Transplantation of Tissue‐Engineered Cell Sheets
Authors: Kojima Hiromi , Yamamoto Kazuhisa , Yaguchi Yuichiro , Hama Takanori
Published: September 2014

Objectives:

The likelihood of recurrent retraction and adhesion of newly formed tympanic membrane is high when normal middle ear mucosa is extensively lost during intractable middle surgery. If rapid postoperative regeneration of the mucosa on the exposed bone surface can be achieved, prevention of recurrent tympanic membrane adhesion and cholesteatoma formation can be expected. The aim of this study was to develop a new method to transplant autologous cell‐sheets to promote postoperative regeneration of the middle ear mucosa.

Methods:

We harvested 10‐by‐10‐mm specimens of inferior turbinate mucosal tissue from the patient with acquired middle ear cholesteaoma. Tissue‐engineered epithelial‐cell sheets were fabricated ex vivo by culturing harvested cells for 3 weeks on temperature‐responsive culture dishes in a cell‐processing center (CPC) according to good manufacturing practice guidelines. After canal wall up tympanoplasty with mastoidectomy had been performed, sheets of cultured autologous cells that had been harvested with a simple reduced‐temperature treatment were transplanted directly into the exposed bone surface of middle ear cavity from which normal mucosa had been absent.

Results:

During the cultivation, the sterile environment in the CPC was confirmed. Autologous cell sheets were successfully transplanted to human middle ear.

Conclusions:

This is the first clinical study approved from the Ministry of Health, Labour and Welfare in Japan. Furthermore this is a first‐in‐man study in the world in which cultured cells were transplanted to the human ear. This novel technology of transplantation might be an effective alternative to the surgical operation on intractable otitis media in the near future.
Nonmaleficence in the Management of Giant Cholesteatoma: A Case Series
Authors: Kazi Aasif A. , Van Beek‐king Jessica , Solares C. Arturo , Patel Sumir S. , McKinnon Brian J.
Published: September 2014

Objectives:

(1) Describe the disease process in giant cholesteatomas, a rare, destructive condition with significant morbidity. (2) Review recent experience in the management and outcomes of giant cholesteatoma.

Methods:

Retrospective case series at a tertiary hospital‐based academic medical referral center from 2004 to 2011. Three patients with giant temporal bone cholesteatoma who were surgically treated were identified. All 3 patients underwent surgical management with wide exteriorization and routine postoperative debridement. Control of disease was measured through recurrence as seen on follow‐up.

Results:

Three adult male patients presented with giant unilateral acquired petrous cholesteatomas over an 8‐year period. Two presented with anacusis and facial paralysis, and one with extension of disease to the sphenoid sinus. All were managed with mastoidectomy wide exteriorization; one required an additional staged endoscopic transsphenoidal approach. Hearing and facial function was preserved when present preoperatively. One patient died 5 months postoperatively from H1N1 infection unrelated to his cholesteatoma. Routine postoperative debridement maintained disease control. Follow‐up ranged from 5 months to 7 years.

Conclusions:

Exteriorization of giant petrous cholesteatoma combined with routine postoperative debridement is a safe and effective way of preventing long‐term complications and disease recurrence.
A Novel Functional Imaging Method of the Eustachian Tube
Authors: Alper Cuneyt M. , Rath Tanya J. , Swarts J. Douglas , Teixeira Miriam S. , Doyle William J.
Published: September 2014

Objectives:

(1) Image the Eustachian tube (ET) lumen by computed tomography (CT) scanning during ET function (ETF) testing, (2) characterize the differences in image quality for different scanning protocols, and (3) establish a novel research methodology for studying ET anatomy and physiology.

Methods:

In a cadaver head without craniofacial or otologic abnormalities, the tympanic membrane was perforated and ETF test was done using the forced response test (FRT) in a CT scanner. Opening (OP), steady (PS), and closing (CP) pressures were measured during forced air flow from the middle ear (ME) to the nasopharynx across the open ET. Temporal bone CT scans with continuous 0.625 mm thickness were done at a low and standard radiation doses before and during the steady flow (SF) phase of the FRT, after instilling iodinated contrast into the ME and ET, and after the FRT cleared the contrast from the ET. Image analysis was done using the CT scanner console software to view the ET and peritubal structures in standard views and after image reconstructions.

Results:

The average OP, PS, and CP values were 488 ± 249, 376 ± 101, and 211 ± 62 daPa. While a distinct ET lumen could not be demonstrated during the FRT done with air, CT with intra‐luminal contrast clearly demonstrated the entire ET lumen. Post‐contrast FRT demonstrated residual contrast outlining the lumen.

Conclusions:

Standard temporal bone CT doses provided a slightly better signal‐to‐noise than the low‐dose CT for the air but not for the contrast. Combining ETF testing and CT imaging has potential research applications.
The Acceptability of Nonvegetarian Medications in Vegetarian Patients in Otolaryngology
Authors: Haarer Francesca , Fu Bertram , Desai Ketan
Published: September 2014

Objectives:

(1) Find out the proportion of vegetarian patients in our department and their knowledge, views, and preferences in receiving nonvegetarian medications. (2) Describe commonly prescribed ear, nose, and throat (ENT) medications in our department and whether they are suitable for vegetarians.

Methods:

A questionnaire survey was performed in the ENT department of a large southeast England university teaching hospital in the United Kingdom between January and February 2013. A list of commonly prescribed ENT medications in our department was drafted, and their constituents were confirmed with corresponding manufacturers.

Results:

Forty patients responded to the questionnaire in this period. Responses for the following questions were collected and results were analyzed: (1) Are you vegetarian? Religious/lifestyle choice/others; (2) Do you ask your doctor if he/she is prescribing medication containing animal products?; (3) If you are a vegetarian, would you take any prescribed medication containing animal products?; (4) Do you think a patient should be offered a vegetarian alternative if they prefer/choose?

Conclusions:

We have found a significant proportion of our patients are vegetarian and that they prefer to have a choice of medications that are suitable for vegetarians if available. We have tabulated a list of commonly prescribed medicines in our department and contacted the relevant pharmaceutical companies, inquiring if their medicines contain any excipients from an animal source. Although the majority of medicines contained no animal‐sourced active components or excipients, a significant proportion did. One of the most common excipients used was gelatine (E441).
Otological Effects of Low‐Frequency Noise: Case of Wind Turbine Syndrome from a Successful Plaintiff
Authors: Farboud Amir , Trinidade Aaron
Published: September 2014

Objectives:

Symptoms including tinnitus, otalgia, and vertigo have been reported following exposure to wind turbine noise; a condition termed wind turbine syndrome (WTS). We describe a case of an individual suffering following exposure and analyze the evidence for the detrimental physiologic effects of infrasound and low‐frequency noise, thereby questioning the existence of WTS.

Methods:

Case report (2013) and literature analysis on articles published within the past 10 years, conducted using the PubMed database and Google Scholar search engine, which included in their title or abstract the terms “wind turbine,” “infrasound,” or “low frequency noise.”

Results:

In our case the patient suffered with the symptoms of WTS and was able to challenge the wind turbine company in court. There is evidence that infrasound has a physiologic effect on the ear, but the overwhelming opinion emerging is that there is no clear evidence that WTS exists, and that the overriding factor is annoyance and the fiscal implications of living near a turbine or wind farm. The literature lacks any convincing evidence that low frequency noise causes significant physiological effects.

Conclusions:

We present a case of a successful plaintiff with all the symptoms of WTS. Although there is some evidence of symptoms in patients exposed to wind turbine noise, our group feels that the symptoms of WTS are vague and can be attributed to psychosomatic factors and annoyance due to the proximity to low frequency whirring, rather than a true physiological impairment.
Ototoxic Effect of Anti‐fog Solution Applied to the Guinea Pig Middle Ear
Authors: Nomura Kazuhiro , Oshima Hidetoshi , Yamauchi Daisuke , Kawase Tetsuaki , Katori Yukio
Published: September 2014

Objectives:

Recent advances in endoscopic technology have allowed an application to middle ear surgery. Anti‐fog agent is necessary for endoscopy because moisture and blood may cause obscured vision. Ultrastop is one of the most commonly used anti‐fog agents. The current study examined the ototoxic effect of topical application of Ultrastop in the guinea pig ear.

Methods:

A preliminary experimental animal study. in a university hospital. Eighteen male Hartley guinea pigs (weight, 480‐620 g) were divided into 3 groups to be treated with Ultrastop, gentamicin (50 mg/mL, positive control), or saline solution (negative control). After auditory brainstem responses were measured, topical solutions of 0.2 mL were applied through a small hole made at the tympanic bulla. Posttreatment auditory brainstem responses were obtained 14 days after the treatment. The extent of middle ear damage was investigated and scored.

Results:

The saline‐treated group showed no deterioration in auditory brainstem response threshold. The anti‐fog‐treated and gentamicin‐treated groups showed severe deterioration in auditory brainstem response threshold. Middle ear examination revealed extensive changes in the anti‐fog‐treated group and medium changes in the gentamicin‐treated group.

Conclusions:

Anti‐fog solution (Ultrastop) applied topically to the guinea pig middle ear caused significant middle ear inflammation and hearing impairment. Great care must be taken to prevent anti‐fog solution reaching the middle ear.
Pax2 and Sox2 Cooperate to Promote Hair Cell Fate in Inner Ear Stem Cells
Authors: Kempfle Judith S. , Edge Albert S.
Published: September 2014

Objectives:

Sensorineural hearing loss (SNHL) is a common problem of our generation and has increased over the past decades. Normal function of inner ear hair cells is crucial for hearing. In mammals, inner ear hair cells cannot regenerate after damage. A single transcription factor, Atoh1, is sufficient and essential for the formation of a hair cell from a sensory progenitor cell. Two early otic transcription factors, Pax2 and Sox2, play a role in activation of Atoh1 and hair cell fate in inner ear progenitors. The aims of the study were (1) understand molecular basics of hair cell development; (2) learn about the underlying mechanisms that can regenerate hair cells from stem cells.

Methods:

Biochemical analysis (chromatin‐immunoprecipitation and luciferase assays) of the Atoh1 regulatory region responsible for hair cell fate and the upstream regulators Sox2 and Pax2. In vitro stem cell assay (cell culture) to induce hair cell fate from inner ear progenitors by manipulation of Sox2 and Pax2.

Results:

In hair cell progenitors, Sox2 and Pax2 are needed simultaneously in the same cell, where they co‐bind to the regulatory region of Atoh1 to activate Atoh1 expression. Activation of Atoh1 transcription leads to a hair cell phenotype.

Conclusions:

We show for the first time that Pax2 and Sox2 have a role in cell fate specification and that both factors act together to activate Atoh1 expression. Our data provide a mechanism that could be used in the future to regenerate hair cells after trauma in the inner ear.
Permeability of Otowicks and Bacterial Penetration
Authors: Bola Sumrit , Rashid Mamun , Hickey Simon
Published: September 2014

Objectives:

Otowicks are used to treat otitis externa with significant ear canal oedema. They ensure close contact between administered drops and the canal skin. How well drops penetrate through to reach the deep canal has not been accurately investigated. This in vitro study aims to investigate: (1) the permeability of otowicks to commonly used ear drops; (2) The ability of bacteria to penetrate through the otowick.

Methods:

Sterile otowicks were inserted into mock ear canals fabricated from plastic pipettes. These were held vertically over pseudomonas‐seeded agar plates while Gentisone HC or CiloxinTM drops were administered; 4 drops, TDS for 5 days. Time taken for the drops to penetrate through the otowick was recorded. Separately, pseudomonas‐seeded otowicks were inserted into plastic pipettes and treated with saline or antibacterial drops. The penetrating drops were observed for bacterial growth on sterile agar.

Results:

It took 6‐8 drops before penetration occurred for both ear drops. Thereafter, otowicks treated with Ciloxan showed delayed penetration after 5 days (60‐240 seconds) when compared with Gentisone (50‐91 seconds). When sterile saline drops were applied to bacterially‐contaminated otowicks, the penetrating drops displayed bacterial growth on agar, indicating that pseudomonas penetrated through the otowicks. However, when Gentasone or Ciloxan were applied, penetrating drops showed no bacteria growth on the corresponding agar plate.

Conclusions:

Bacteria can penetrate otowicks but this can be prevented by continuous application of antibacterial ear drops. Ear wicks need priming with 8 drops before starting a regime as the initial dose is fully absorbed by the otowick.
Positive Outcomes and Surgical Strategies for Bilateral Cochlear Implantation in a Child with X‐Linked Deafness
Authors: Kim Leslie , Wisely Clayton E. , Lucius Shana , Weingarten Jori , Dodson Edward E.
Published: September 2014

Objectives:

(1) Recognize that bilateral cochlear implantation (CI) in X‐linked deafness is surgically feasible and safe. (2) Recognize that improvement in hearing as well as language acquisition is an achievable goal.

Methods:

This is a retrospective case review at a tertiary care center of one patient who presented with bilateral profound sensorineural hearing loss at age 6 months. He lacked auditory brainstem responses in both ears and was confirmed to have congenital X‐linked deafness secondary to POU3F4 gene mutation. Because of lack of benefit from amplification, he underwent bilateral CI in a staged fashion at 12 (right ear) and 15 months (left ear) of age.

Results:

The patient underwent transmastoid‐facial recess approach and received Nucleus Freedom implants (Cochlear Ltd) in both ears, utilizing perimodiolar electrodes. High‐flow gushers were encountered bilaterally and resolved with temporalis muscle plugs. C‐arm fluoroscopy was used during insertion of electrodes in both ears. Follow‐up data were available for 12 months. No complications were encountered, including no postoperative CSF leakage or facial stimulation. Postoperative audiograms in aided conditions showed hearing thresholds <40 dB. At 11 months following activation of his second CI, he scored in the normal range for his chronological age on standardized language measures, the Receptive Expressive Emergent Language Test‐3 and the Preschool Language Scale‐5.

Conclusions:

With careful preparation and the assistance of intraoperative fluoroscopy, cochlear implantation in patients with congenital X‐linked deafness can be done safely. Performing bilateral CI followed by dedicated auditory‐verbal rehabilitation may allow patients to trend toward normal language development.
Postoperative Middle Ear Aeration and Hearing Results after Canal Wall Down Tympanoplasty with Soft‐Wall Reconstruction
Authors: Haginomori Shin‐Ichi , Ichihara Takahiro , Mori Atsuko , Kanazawa Atsuko , Nishikado Akira , Kawata Ryo
Published: September 2014

Objectives:

(1) Estimate the degree of postoperative aeration in the middle ear after canal wall down tympanoplasty with soft‐wall reconstruction (CWD tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD tympanoplasty with SWR.

Methods:

This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy‐eight ears with cholesteatoma treated surgically at our hospital by planned two‐stage CWD tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second‐stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air‐bone (A‐B) gaps: 0‐10, 11‐20, 21‐30, and >30 dB.

Results:

Postoperative middle ear aeration was significantly greater in the smaller A‐B gap bins (0‐10 and 11‐20 dB) compared with the larger A‐B gap bins (21‐30 and >30 dB). In contrast to the larger A‐B gap bins, those with smaller A‐B gaps showed reaeration of the antrum and mastoid cavity.

Conclusions:

Promoting postoperative aeration of the entire middle ear is necessary to achieve better hearing outcome in patients undergoing CWD tympanoplasty with SWR for cholesteatoma. The ventilation tube insertion and placement of the large silicone sheet from the protympanum to the mastoid cavity in the first‐stage tympanoplasty are candidate procedures to promote postoperative aeration.
Revision Cochlear Implantation Using a Double‐Array Device in the Post‐meningitis Ossified Cochlea
Authors: Shaul Chanan , Roland J. Thomas , Sichel Jean‐Yves , Perez Ronen
Published: September 2014

Objectives:

Describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double‐array or split electrode device. All patients had an ossified cochlea due to meningitis and were functioning poorly with a standard electrode cochlear implant.

Methods:

Four patients between the ages of 4‐15 years underwent revision with 5 double‐array cochlear implant devices in our center during the years 2010‐2012. One patient underwent bilateral revision surgery. All patients suffered from meningitis with computed tomography and magnetic resonance imaging studies that demonstrated an ossified cochlea. The time interval between the disease and initial cochlear implantation was 4 months to 4 years. Patients data were retrospectively analyzed with emphasis on the surgical technique, number of electrodes inserted, and number of active electrodes at follow‐up. In addition, pre and post revision surgery function was compared.

Results:

The revision surgery was carried out 4 to 10 years after the initial surgery. Two tunnels, basal and apical, were drilled in the ossified cochlea. In each of the tunnels 5 to 12 electrodes were inserted. While the number of active electrodes before revision was 0‐5, after revision with the double array it increased to 8‐16. This resulted in increased auditory and speech function.

Conclusions:

The double‐array device can provide good outcome in the post‐meningitis ossified cochlea. In many of these cases function can be better than with a single electrode device.
Sensing Nerve Regeneration with Implantable Flexible Electronics
Authors: Nguyen Linda T. , Bajema Michael , Chung Jaehoon , Weissbrod Philip A. , Coleman Todd P. , Nguyen Quyen T.
Published: September 2014

Objectives:

(1) Translate epidermal electronic systems (EES) into an implantable electrode system (IES) with the potential to detect electric activity from growing axons distal to the site of nerve repair. (2) Demonstrate baseline and stimulated activity in intact nerves using IES. (3) Demonstrate nerve activity using IES following nerve regeneration across a surgical repair site.

Methods:

EES consists of thin flexible electronic circuitry that is capable of sensing and wirelessly transmitting multiple modalities including electrical activity, temperature, and stretch following transfer to skin. We have modified EES technology into an implantable electrode system consisting of biocompatible components that can detect nerve activity in vivo in a rodent model. We obtained recordings of intact sciatic nerve activity following pulsed stimulation applied via the proximal portion of the electrode array. Future experiments will focus on detection of activity following nerve transection and repair.

Results:

A first‐generation IES sensor was tested on intact mouse sciatic nerves. Proximal electrodes were used to stimulate the nerve, and distal electrodes recorded the stimulus. Action potentials were successfully recorded. Recorded activity was abolished following nerve transection.

Conclusions:

We demonstrate the adaptation of EES technology with the ability to stimulate and record nerve activity in a rodent model. An implantable device capable of sensing nerve regeneration would provide crucial information on the status of nerve repair and at much earlier time points allowed by clinical exam and electromyography. This technology has the potential to improve clinical decision‐making and patient outcomes.
Sinus Tympani: A Practical Classification
Authors: Abou‐Bieh Alaa A. , Haberkamp Thomas J.
Published: September 2014

Objectives:

(1) Describe a classification for the sinus tympani (ST) different types based on their otoendoscopic and surgical anatomy in relation to their development theories. (2) Evaluate possible approaches to each of its types. (3) Eliminate the discrepancy between the various methods used to describe it in literature.

Methods:

Fifty‐five temporal bones were dissected, and the anatomic details were studied using an operating microscope and otoendoscopes of different angles. In addition, the ST anatomy and relations were studied in 200 temporal bones’ computed tomography scans.

Results:

Four distinct types of ST could be observed. Type 1, the most common type, was pneumatized and consisted of an orifice and cavity. In Type 2, the well‐pneumatized type, the cavity was deep enough posteriorly to exceed the level of the mastoid segment of the facial nerve in any direction. In Type 3, the common posterior tympanic sinus, ST communicated with the upper posterior tympanic sinus proper or with a retro‐ponticulus up‐ward extension. Type 4, the nonpneumatized type, was shallow with no true orifice and cavity. Types 1 and 4 were mainly approached via the transcanal route. Types 2 and 3 required a combined transcanal and transmastoid approach. Endoscopic transcanal approach alone was satisfactory for types 1 and 4 but to a lesser extent in type 3.

Conclusions:

ST shape and extension both depend mainly on the extent of its pneumatization, which in turn influences its relation to the surrounding structures in the retrotympanic area. Extensively or unusually pneumatized types need special or combined approaches.
Squamous Cell Carcinoma of the Temporal Bone: Our Experience
Authors: Hajiyev Yusif , Talishinskiy Azizaga M. , Akberova Leman
Published: September 2014

Objectives:

Squamous cell carcinoma of the temporal bone is a rare and invariably aggressive tumor with an estimated incidence of one per million per year. Tm1 squamous cell carcinoma (SCC) is the most frequent primary malignant tumor of the temporal bone, but the incidence is as rare as <0.2% of all tumors of the head and neck. It is a rare but threat eningly aggressive tumor, with poor prognosis. Because of the rarity of this disease, there is no large prospective series on staging, treatment, and outcomes. Surgical treatment remains a challenge in the hands of skull base surgeons. The prognosis for patients with this disease has remained poor despite advances in surgical and radio‐therapeutic techniques.

Methods:

A retrospective review of the medical records of the patients diagnosed with squamous cell carcinoma of the temporal bone from 2000 to 2007 was performed. This study included 14 patients with unilateral temporal bone tumors.

Results/Conclusions:

Factors evaluated included patient demographics, presenting symptoms, physical examination findings, radiographic findings, surgical treatment, method of reconstruction, surgical complications, histopathologic findings, and the use of postoperative radiation therapy.
Surgical Approaches to Cerebellopontine Angle: A 17‐Year Experience of Our Skull Base Team
Authors: Correia Isabel A. , Sousa Vítor , Marques‐Pinto Luis , Gonçalves Victor , Barros Ezequiel
Published: September 2014

Objectives:

We give an overview of the current state of cerebellopontine angle (CPA) surgery, based on the recent evidence, and describe our center's experience in surgical approaches to these lesions.

Methods:

Retrospective review of cases who underwent surgery for CPA lesions at our hospital during the past 17 years (1996‐2013), with focus on the description of the currently most used technique‐extended retrosigmoid. We also conducted a brief review of the literature on CPA surgery, comparing the different approaches, their indications and complications.

Results:

During this period, 203 patients underwent surgery for CPA. The most frequent indication was vestibular schwannoma (84.7%). Other indications were meningiomas (8.4%), epidermoids (1%), vestibular neurectomies (1.5%), arteriovenous malformations (1%), anterior inferior cerebellar artery–posterior inferior cerebellar artery aneurysms (1%), trigeminal microscopic decompression (0.5%), and other more rare tumors (2%). The most used approach was extended retrosigmoid (71.9%), followed by the translabyrinthine (26.1%) and middle fossa approach (2%). Until 2004, the most used approach was the translabyrinthine; after 2004, the most used was the extended retrosigmoid.

Conclusions:

Currently, the preferred surgical approach used by our team is the extended retrosigmoid, because it allows a complete exposition of sigmoid sinus from the transverse sinus to the jugular bulb, enhances CPA vision, avoids cerebellar retraction, and is a simple way to get a wide route to the CPA. It also allows good functional outcomes (hearing and facial nerve preservation) in most cases. However, indications for approaches depend on the size of the lesion, its location and the quality of preoperative hearing, as well as a necessary familiarity with all approaches.
Temperature Changes Associated with Middle Ear Endoscopy in a Human Temporal Bone Model
Authors: Kozin Elliott D. , Lehmann Ashton E. , Carter Margaret S. , Hight Ed , Cohen Michael S. , Nakajima Hideko H. , Lee Daniel J.
Published: September 2014

Objectives:

Endoscopic ear surgery is rapidly gaining popularity as a minimally invasive approach to address chronic ear disease. However, little is known about the potentially damaging temperature increases associated with endoscopy in the middle ear. Specifically, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we aim to measure temperature changes throughout the middle ear during rigid endoscopy in a human temporal bone model.

Methods:

Fresh human temporal bones were maintained at physiologic temperature during middle ear endoscopy with a 3‐mm 0° Hopkins rod. Temperature changes were measured as a function of the distance between the endoscope tip and the round window membrane. Thermal gradient was determined by infrared imaging. Control studies conducted at room temperature were also performed.

Results:

An endoscope with a xenon or light‐emitting diode light source on maximal power induced a rapid temperature elevation up to 46°C within 0.5‐1 mm of the tip of the endoscope within 30‐124 seconds. Elevated temperatures occurred at distances up to 8mm from the endoscope tip. Temperatures rapidly returned to baseline within 20‐88 seconds after turning off the light source.

Conclusions:

Our findings have direct implications for endoscopic ear surgery and affirm the importance of avoiding excessive temperature elevation. We recommend employing submaximal light intensity and repositioning the endoscope frequently to provide rapid cooling. Ongoing studies use an animal model to explore the in vivo effects of prolonged middle ear endoscopy and evaluate for potential threshold shifts in auditory brainstem responses.
Clinical Utility of the Glasgow Prognostic Score in Patients with Advanced Head and Neck Cancer
Authors: Nakayama Masahiro , Tabuchi Keiji , Hara Akira
Published: September 2014

Objectives:

The modified Glasgow prognostic score (mGPS) is known to reflect the degree of tumor‐associated inflammation and cancer cachexia and is associated with survival in various malignancies. The prognostic value of mGPS in head and neck cancers remains unclear. The purpose of this study was to evaluate the prognostic potential of the mGPS in patients with advanced head and neck cancer.

Methods:

Patients with advanced head and neck cancer treated at the University of Tsukuba Hospital between January 2002 and December 2011 were retrospectively evaluated. They were divided according to their mGPS. The mGPS was calculated based on the admission data as follows: patients with an elevated level of C‐reactive protein (>1.0 mg/dL) and hypoabuminemia (<3.5 g/dL) were allocated a score of 2, patients with elevated C‐reactive protein serum levels without hypoalbuminaemia were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0. The utility of the mGPS as a prognostic indicator was evaluated.

Results:

A total of 210 patients enrolled. Patients with an mGPS of 0 had better overall survival and disease‐free survival than did those with an mGPS of 1 or 2. Multivariate analysis revealed that the mGPS was a significant risk factor for overall survival and disease‐free survival.

Conclusions:

The results that patients with a raised mGPS had a significantly higher risk of death suggest that the mGPS is useful for predicting outcome in patients with advanced head and neck cancer and should be included in their routine clinical assessment.
Therapeutic Proposal to Clinical Treatment for Tympanometric Improvement in Patients with Otitis Media Secretory
Authors: Almeida Emyle M. , Guercio Wilson B. , Baraky Leticia R. , Vilela Marcela M. P. , Chaves Kenia A. , Silva Renata F. , Vasconcelos Natália
Published: September 2014

Objectives:

Serous otitis media is very frequent in children, especially those between 3 and 6 years of age. The diagnosis of otitis media is often difficult. Otomicroscopy and tympanometry can improve diagnostic quality by the indication of fluid in the middle ear and thereby improve the quality of treatment. The aim of this ongoing study is to describe the variations in tympanometry in patients undergoing clinical treatment alone.

Methods:

This was a prospective study of 25 patients diagnosed with secretory otitis media, treated with oral antibiotics, nasal corticosteroid spray, and nasal N‐acetylcystein from January 2013 to January 2014 in the Otorhinolaryngology Department, Juiz de Fora University Medical School, Brazil. The inclusion criteria were age between 2 and 12 years and altered otoscopy and tympanometric examination. The exclusion criteria were antibiotic use during the previous month and history of chronic otologic disorder or congenital abnormalities. All were evaluated by tympanometry in the week of diagnosis and after treatment, at 30 days from the first review.

Results:

A total of 25 patients, of which 11 (44%) were girls, and 14 (56%) were boys (3 to 15 years old). Of the 50 ears assessed in the first week of diagnosis, 28 (56%) had curve B and 20 (40%) had curve C. At the last evaluation, only 8 ears (16%) remained with curve B. 12 (24%) had curve C and 30 (60%) had curve A.

Conclusions:

Treatment with corticosteroids via nasal spray combined with oral antibiotics and nasal N‐acetylcysteine can be a good therapeutic option for the treatment of secretory otitis media.
Three‐Dimensional Anatomic Analysis of Surgical Landmarks for Middle Fossa Approach
Authors: Jun Beom Cho , Kim Byung Guk , Kim Joon Hyun
Published: September 2014

Objectives:

The middle fossa approach needs the surgeon to have a 3‐dimensional anatomic knowledge of internal auditory meatus (IAM), which is located underneath the middle fossa bony plate. Our purpose was to describe microsurgical anatomy of the middle fossa approach using temporal bone computed tomography (CT) 3‐dimensional (3D) reconstruction.

Methods:

Thirty CT images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. 3D‐reconstructed images were obtained using high‐resolution axial temporal bone CT scans. IAM, semicircular canal (SCC), cochlea, tympanic segment of the facial nerve (FN), geniculate ganglion (GG), and malleus were reconstructed. The length and angle among these structures was measured.

Results:

The mean lengths between the center of IAM and bony surface of middle cranial fossa at the Porus level was 7.7 mm (±1.0). The mean length between the superior of point of IAM of porus and GG was 15.4 mm (±1.5). The mean length between superior of point of IAM of porus and medial end of cochlear basal turn 9.9 mm (±0.9). Angle between the axis of SCC and the axis of tympanic segments of FN was 105.9° (±5.4). The mean angle between the axis of SCC and axis of IAM was 47.2° (±6.5) The mean angle between the axis of IAM and axis of tympanic segments of FN 59.6° (±10.9), The mean angle of 3‐point malleus handle, GG, superior point of IAM of porus level was 113.8° (±9.8).

Conclusions:

The understanding of the 3D relationship in the microsurgical structure will help decide the drilling point for the IAM in case of lack of bony landmarks.
Total Vestibular Ablation and VEMPs after Intratympanic Gentamicine in Patients with Intractable Vertigo
Authors: Celis‐Aguilar Erika , Hinojosa‐González Ramón , Vales‐Hidalgo Olivia , Coutinho‐Toledo Heloisa
Published: September 2014

Objectives:

Even today, treatment of intractable vertigo remains a challenge. The objective of this study was to control intractable vertigo through complete vestibular ablation with intratympanic gentamicin treatment. Complete vestibular ablation was confirmed by zero response on ice water (ENG) and an absent response on vestibular evoked myogenic potentials (VEMPs).

Methods:

Retrospective case study design in a tertiary care center. Subjects were patients with refractory episodic vertigo. The inclusion criteria were unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to respond to other treatments. Included patients underwent 0.5‐0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Audiometry, electronystagmography with ice water, and vestibular evoked myogenic potentials were performed in all patients. Outcome measurements: VEMPs response and vertigo control.

Results:

Ten patients were included; 9 patients with Ménière's disease and 1 patient with delayed endolymphatic hydrops. Nine patients showed an absent response on VEMPs. The only patient with low amplitude on VEMPs had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30 dB.

Conclusions:

VEMPs confirmed complete vestibular ablation. High‐grade vertigo control was due to total vestibular ablation.
Transcanal Micro‐osteotome Technique for Excision of Exostoses
Authors: Ghavami Yaser , Maducdoc Marlon M. , Yau Amy , Mahboubi Hossein , Djalilian Hamid R.
Published: September 2014

Objectives:

This study was conducted to evaluate the outcomes and complications of transcanal excision of exostoses using micro‐osteotomes without a post‐auricular incision or the use of the drill.

Methods:

A retrospective chart review of patients undergoing exostoses excision by the senior author from January 2007 to January 2014 was carried out. All patients underwent surgical removal of the exostoses using a 1 or 2 mm micro‐osteotome. Patients were followed postoperatively and complications were evaluated.

Results:

One‐hundred‐thirty‐eight ears in 106 patients were treated for exostosis. Average age of patients was 43 ± 16 year old. Of these, 99 were males (93%) and 7 were females (7%). A majority of the patients had 90% to 100% obstruction of the ear canal. Complete ear canal healing was seen in 80% of patients by 3 weeks. All but one patient had healed by 6 weeks postoperatively. There were 9 (6.5%) slit tympanic membrane perforations that all healed. One patient had an anterior canal mobilization which required Xeroform packing for 3 weeks for stabilization. There was no postoperative vertigo, facial paresis, conductive/sensorineural hearing loss, soft tissue stenoses, and no skin grafting was required.

Conclusions:

A transcanal approach using micro‐osteotomes for removing exostoses is feasible. The transcanal approach afforded shorter healing times than the post‐auricular approach as reported in the literature. Patients with 100% obstruction can have this procedure performed with no significant increase in morbidity.
Combined Sialendoscopic and Transoral Approach for Large Submandibular Intraparenchimal Stones
Authors: Gallipoli Camilla , Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Fusconi Massimo , Greco Antonio , Gallo Andrea
Published: September 2014

Objectives:

(1) Describe a combined sialendoscopic and transoral approach to remove large intraparenchymal submandibular sialoliths. (2) Assess functional results after stone removal.

Methods:

Eighteen consecutive patients with large submandibular hilar stones with intraparenchymal extension were enrolled in this prospective study at the ENT University Unit of the “A. Fiorini” Hospital, “Sapienza” University of Rome, from April 2011 to June 2013. In all cases the size of sialoliths (median diameter 1.8 cm, range 0.9‐2.2 cm) prevented sialendoscopic intraductal removal even after lithotripsy. The diagnosis was confirmed by ultrasound examination and, in selected cases, by computed tomography imaging. In all cases a combined sialendoscopic and transoral approach was accomplished by performing a deep incision of the mouth floor at the submandibular hilus level after endoscopic visualization of the stone. Three months after surgery an ultrasound examination was re‐run to detect the presence of residual sialoliths. Pre‐ and intraoperative findings, surgical times, follow‐up data, and functional results were analyzed.

Results:

Intraparenchymal stones were successfully removed using the combined technique in all cases. Fifteen patients (83.5%) were symptom‐free after 6 months of follow‐up. Two out of 3 still‐symptomatic patients showed residual sialolithiasis at postoperative ultrasonography.

Conclusions:

The outcomes of this preliminary study suggest that combined sialoendoscopic and transoral approach is an efficient technique for the removal of large intraparenchymal calculi, which may avoid resorting to sialoadenectomy and thus decrease risk of nerve damage or salivary fistulae.
Assisted Reproduction Is Not Associated with Increased Risk of Congenital Head and Neck Defects
Authors: Neumann Colin , Thompson Dane A. , Sidman James D.
Published: September 2014

Objectives:

(1) Compare the rate of head and defects between children conceived via assisted reproductive technology (ART) versus those conceived via natural methods. (2) Determine the risk of congenital head and neck abnormalities associated with ART.

Methods:

A retrospective chart review was conducted of all patients admitted to the neonatal intensive care unit over 10 years at Children's Hospital of Minneapolis. The patients were divided into 2 groups: patients who were conceived via ART and patients who were conceived naturally. Each chart was evaluated for 15 different head and neck malformations, 11 of which were included in data analysis due to statistical significance.

Results:

There were a total of 14,857 charts examined; 2288 patients were conceived via ART, while 12,569 patients were conceived via natural methods. There were 40 patients born with defects via ART, while there were 681 patients born with defects via natural conception. There were a total of 9039 males and 6637 females. The total occurrence of congenital malformations was higher for patients not conceived with artificial reproduction versus those conceived with artificial reproduction (4.58% vs 0.27%). The odds ratio was 0.31 with a 95% confidence interval (CI) of 0.23 to 0.43, P value of <.0001; the relative risk of having any one of the aforementioned defects with ART was 1.04 with a 95% CI of 1.03 to 1.05, P value <.0001.

Conclusions:

There appears to be no increased risk of congenital head and neck defects in children conceived via ART versus those conceived via natural methods.