bluuebunny/crossref_metadata_2025 huggingface dataset:
Transnasal Esophagoscopy Findings: Interspecialty Comparison
Authors: Falcone Michael T , Garrett C Gaelyn , Vaezi Michael Fredrick , Ossoff Robert H , Slaughter James Christopher , Ekbom Dale C. , Mau I‐Fan Theodore
Published: August 2008

Objective

Otolaryngologists implement transnasal esophagoscopy (TNE) to assess esophageal pathology. Previous studies using TNE to evaluate esophageal pathology have been limited in various ways. These are largely retrospective and deal with select patient populations. There are currently no data on the prevalence of esophageal pathology in “all comers” to an otolaryngology voice center. The objectives are to assess the prevalence of esophageal pathology in this population and determine the inter‐observer variability of the findings reviewed by an otolaryngologist and a gastroenterologist.

Methods

Consecutive patients with throat symptoms presenting to the voice center were asked to undergo TNE. The findings were videotaped and reviewed by an otolaryngologist and a gastroesophagologist blinded to the patients’ presenting complaint.

Results

50 patients were selected prospectively to undergo TNE. Hoarseness was the most common presenting symptom (68%). According to the gastroesophagologist, the prevalence of esophageal findings was: Barrett's esophagus (12%), esophagitis (10%), hiatal hernia (32%), and esophageal stricture (10%). The percent agreement for a normal study was 72% (kappa 0.44). The percent agreement (kappa value) for various pathologic findings are as follows: Barrett's esophagus, 86% (0.45); esophagitis, 88% (0.43); hiatal hernia, 76% (0.39); and esophageal stricture, 96% (0.73). The frequency of an exact agreement between raters was 54%. For an abnormal study, the percent agreement was 80%. The reviewers were 7.11 times more likely to agree than disagree (p = 0.002).

Conclusions

Esophageal abnormalities are common in patients presenting to a voice subspecialty clinic. An interdisciplinary approach can provide this population with complementary patient care.
Cochlear Implantation in Autoimmune Inner Ear Disease
Authors: Stidham Katrina R , Roberson Joseph B
Published: August 2008

Objective

1) Evaluate the success of cochlear implantation (CI) in patients with autoimmune inner ear disease (AIED). 2) Discuss the impact of CI on consideration of immunosuppressive therapy for patients with fluctuating hearing loss due to AIED.

Methods

Retrospective chart review was conducted of patients undergoing CI with diagnosis of AIED between 6/02 and 6/07. Patients’ autoimmune and immunotherapy treatment history was explored. Non‐operative ear hearing thresholds and speech discrimination scores (SDS) were documented pre‐ and postoperatively. Objective and subjective implant success in setting of fluctuating hearing in non‐implant ear was evaluated.

Results

Four patients with AIED, aged 5–55, underwent CI. Two had isolated otologic symptoms and 2 had other systemic autoimmune diagnoses. All had been previously treated with steroids. Three had received other immunosuppressive therapy. One declined other treatment due to potential risks. At the time of implantation, 3 patients had functional hearing in the non‐implant ear and received benefit from a hearing aid. Each continued to have usable hearing, with fluctuating improvements post‐implant at times to much better SDS than would normally meet candidacy requirements for CI. All patients found the implant provided better hearing than the hearing‐aid ear.

Conclusions

CI is a viable option for patients with AIED. Implanting a profoundly deafened ear where opposite ear has fluctuating but usable hearing does not negatively impact outcomes. With the success of CI for AIED, the potential risks of long‐term immunosuppressive therapy may not warrant its use in patients with isolated hearing loss symptoms.
Delayed Facial Nerve Palsy after Middle Ear Surgery
Authors: Papanikolaou Panagiotis N , Xenelis John E , Bibas Thanos , Sengas John V
Published: August 2008

Objective

1) Report the incidence and outcome of delayed facial nerve palsy following middle ear surgery in our department, and 2) review the medical literature.

Methods

This is a retrospective chart review study of 833 patients who were operated for chronic otitis media with cholesteatoma (572 patients), otosclerosis (192 patients), and profound hearing loss who received a cochlear implant (68 patients) since 1993.

Results

Delayed facial nerve palsy was observed in 10 patients (1.2%). In all cases, immediate postoperative facial nerve function was normal and the palsy occurred 5 to 8 days postoperatively. Facial nerve function recovered in all patients within 6 months. Assessment and management issues are discussed.

Conclusions

Delayed facial nerve palsy may rarely occur following middle ear surgery and has an excellent recovery rate.
DPOAEs in High Altitude Disease at Mount Everest
Authors: Behnisch Axel Rolf , Rasp Gerd , Mees Klaus
Published: August 2008

Objective

The aim of this study was to measure DPOAEs in climbers on Mount Everest as a criterion for differential diagnosis of high altitude disease. The levels of distortion product otoacoustic emissions (DPOAEs) change at frequencies between 0,75 kHz and 1,5 kH along with intracranial pressure (ICP). DPOAEs are suggested for monitoring ICP changes.

Methods

In order to determine the etiology of DPOAE‐level changes obtained in 6 climbers with severe acute mountain sickness, blood oxygen saturation was measured simultaneously, and a standard request form of Lake‐Louis symptoms of high altitude disease was filled in with every DPOAE measurement. Data are presented from DPOAE measurements at frequencies of 1, 1.5, 2, 3 and 4 kHz during an ascent to Mount Everest (8848 m) up to an altitude of 7800 m.

Results

In all climbers, DPOA levels decreased at 4 kHz and 3 kHz with declining oxygen saturation (SaO2) at high altitude. That has been described in many prior animal studies. On the other hand, DPOAE at 1 kHz showed decreasing levels only with symptoms of high altitude disease (AMS). In one climber with severe symptoms of intracranial hypertension after the ascent to the high camp at 7800 m, decreasing DPOAE levels at 1 kHz were measured in the absence of declining blood oxygen saturation. The most pronounced decline of DPOAEs at 1 kHz was also seen on that occasion.

Conclusions

DPOAEs are suggested for detection of intracranial hypertension and early detection of high‐altitude cerebral edema.
Electronystagmography in Migraine Equivalent Syndrome
Authors: Dellepiane Massimo , Mora Renzo , Barettini Luciano , Crippa Barbara , Salami Angelo
Published: August 2008

Objective

The aim of the study was to determine the efficacy of electronystagmography testing in the diagnosis of vertigo in children with migraine equivalent syndrome.

Methods

The investigation included 20 patients, aged between 5 and 14 years and affected with an “migraine equivalent syndrome” (group A). The patients, head blocked, sat on a “Tönnies rotatory chair” which was placed in the middle of a rotatory cylindrical chamber (2 metres in diameter and 1.9 metres in height). The rotatory cylinder was driven by a direct current engine which turned it clockwise and counterclockwise, up to 200 degrees/sec., and its internal area was covered with 32 black vertical contrasts. As a control group, 50 healthy children were identified. All the subjects underwent the rotatory vestibular stimulation by Stop test, to optokinetic stimulation and to contemporary rotatory vestibular and optokinetic stimulation (VVOR).

Results

For the analysis of the results, we have considered nystagmus mean gain and direction of visual‐vestibular‐ocular‐reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular‐ocular‐reflex (VOR). In the control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus.

Conclusions

In the healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. Our data highlight a possible correlation between CNS disorders and migraine equivalent syndrome.
Endaural Atticotomy for pars flaccida Cholesteatoma
Authors: Leonetti John P , Marzo Sam J , Kircher Matthew L
Published: August 2008

Objective

To present our long‐term results using an endaural atticotomy approach for the management of 361 cases of pars flaccida cholesteatoma.

Methods

This is a retrospective chart review of 361 cases of attic cholesteatoma that were surgically managed at our tertiary care, academic medical center between 7/88 – 7/07.

Results

361 of the 2068 cholesteatomas treated at our institution were surgically managed with an endaural atticotomy approach. There were 201 females and 160 males who ranged in age from 17–77 years. The most common clinical symptoms were aural fullness, hearing loss, and otorrhea. Ossiculoplasty was necessary in 170 of 361 or 47% of the patients. Hearing levels were maintained or improved in 297 patients or 82%. Cholesteatoma recurred in 29 of 361 patients (8%) and 24 of these 29 patients failed to return for otoscopic evaluation and PE tube replacement. The mean follow‐up was 7.7 years.

Conclusions

The endaural approach for pars flaccida cholesteatoma is an option for limited retraction cholesteatomas in patients who will reliably be seen for ventilation tube replacement.
Global vs Regional HB Score: Reporting Facial Nerve Function
Authors: Reitzen Shari D. , Lalwani Anil K
Published: August 2008

Objective

To determine the reliability of the House‐Brackmann facial nerve grading scale in the setting of differential function across its branches.

Methods

14 physicians of different levels were provided with digital video clips of 11 patients with differential facial nerve functioning, and asked to report facial nerve function as a traditional global score and as a regional score based on the House‐Brackmann scale for the forehead, eye, nose, and mouth. Agreements between the traditional global score and the regional scores, as well as inter‐rater agreement, were analyzed.

Results

In patients with variable facial weakness, a single House‐Brackmann score did not fully communicate their facial function. The single House‐Brackmann score most strongly correlated with the regional scoring of the nose/midface (59%), followed by the mouth (51%), eye (48%), and forehead (35%). Overall inter‐reader reliability was relatively strong for the midface (kappa=0.503) and global scores (kappa=0.541), followed by the mouth (k=0.419), the forehead (k=0.330), and the eye (k=0.302). There was a marked tendency for reader agreement to increase among those with more clinical experience. Reader agreement of the forehead (k=0.597) and eye (k=0.469) were strong only among experienced readers.

Conclusions

In patients with differential facial function, a single global score is inadequate to describe facial function, and in this study, most directly correlated with the function of the midface. Regional assessment using the House‐Brackmann grading scale more fully communicates facial function and increases in reliability with experience.
Malleus Handle: Determinant of Success in Ossiculoplasty
Authors: Bared Anthony , Angeli Simon I
Published: August 2008

Objective

Identify prognostic factors affecting outcome in ossicular chain reconstruction (OCR).

Methods

Retrospective case series of electronic database at an academic institution. We reviewed 209 cases of OCR performed from January 2000 through September 2007, and systematically collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air‐bone gap (ABG) changes were evaluated by ANOVA. Multiple regression analyses were used to examine the relationship between postoperative air‐bone gap (dependent variable) and the independent variables.

Results

There were 107 cases of OCR which met inclusion criteria (45 primary and 62 revision tympanoplasties) with an average follow‐up of 19 months. There were 36 cases of chronic suppurative otitis media without cholesteatoma and 71 cases with cholesteatoma. The mean preoperative ABG was 32 ± 15 dB and the mean postoperative ABG was 23 ± 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (i.e., tympanoplasty vs. canal‐wall up vs. canal‐wall down) and status of malleus handle were predictive of the success of OCR.

Conclusions

Favorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle. Our findings support the practice of performing OCR at the time of the second‐look procedure.
Performance and QOL after Geriatric Cochlear Implantation
Authors: Georgolios Alexandros , Dodson Kelley Melissa , Baldassari Cristina , Maiberger Patrick G , Sismanis Aristides
Published: August 2008

Objective

To assess audiologic performance and quality of life in geriatric cochlear implantation patients and to determine whether comorbid medical conditions, etiology, and duration of hearing loss impact audiologic and quality of life outcomes.

Methods

Geriatric patients who underwent cochlear implantation between 1990 and 2006 were evaluated. Inclusion criteria were 55 years of age or older at time of implantation and post‐lingual hearing loss. Patients with primary language other than English were excluded. 49 cochlear implant recipients were identified. A group of younger implanted patients was used as a control. All patients completed standardized audiologic tests including the Hearing In Noise Test. Validated surveys, including the Glasgow Benefit Inventory and the Hearing Handicap Inventory for the Elderly, were used to assess quality of life.

Results

The mean age at implantation was 69.5 (range 58–85) and the average time interval from the implantation to the completion of the surveys was 73.2 months (6 to 229). Identified comorbid conditions included hypertension, diabetes, and malignancies, among others. Audiologic performance and quality of life scores between the two groups were similar. In the geriatric group there was no difference in patient satisfaction between subgroups with 0–1, 2–3 or > 3 comorbid conditions.

Conclusions

Our results suggest that the audiologic performance and quality of life scores between the older and younger age groups are similar. In the geriatric group associated comorbidities did not interfere with patient satisfaction as assessed by survey instruments.
Surgical Treatment of Tympanic Membrane Retractions
Authors: Srinivasan Venkat R , Rubasinghe Mihirangi Shamane , Low Christopher
Published: August 2008

Objective

To report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions.

Methods

Retrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and temporalis fascia. Paired T test was used to compare the mean ABG before and after surgery.

Results

34 ears were operated on in 33 patients with an age range of 8 to 66 (mean 38). Full extent of the retraction was visible (Moderate) in 12 ears and not visible in 22 ears (Severe). Cholesteatoma was found in 10 ears (all in Severe group) and ossicular erosion was noticed in 29 ears. Follow‐up ranged from 12 to 66 months (mean of 36 months). The success rate was 97% with recurrence of retraction in 1 ear. Air‐bone gap improved in 31 ears, remained the same in 1 ear, and worsened in 2 ears. The pre‐ and postoperative mean ABG values were 24.3 (SD 9.5) and 17 (8.7). The difference was 7.3 p<0.0001(95% CI=4.8,9.9). Cholesteatoma recurred in 1 patient. Cholesteatoma presence and severity of retraction did not have any influence on the recurrence rate (Fisher's Exact Test).

Conclusions

High incidence of per‐operative discovery of cholesteatoma (30%) in our series supports early, aggressive management of symptomatic retractions. Thinned cartilage is more effective with less chances of migration.
Tinnitus Suppression Using AM and FM Acoustic Stimuli
Authors: Rothholtz Vanessa S. , Djalilian Hamid R , Carroll Jeff , Fine Esther L. , Tang Qing , Zeng Fan‐Gang
Published: August 2008

Objective

1) Customize amplitude‐modulated (AM) and frequency‐modulated (FM) acoustic stimuli to suppress tinnitus. 2) Understand the theoretical mechanisms underlying tinnitus suppression.

Methods

A double‐staircase adaptive procedure was utilized to match both the frequency and intensity of the tinnitus. Minimal masking levels for both noise and pure tones were acquired. In a double‐blinded procedure, sinusoidally amplitude‐ and frequency‐modulated stimuli were administered. Pre‐ and post‐stimulation tinnitus loudness levels were compared to quantify the effects of suppression and residual inhibition of tinnitus. Multivariate analysis was performed to evaluate independent predictors of tinnitus suppression. Different types and severity of tinnitus and hearing loss were correlated with the effective sounds.

Results

At present, 18 patients aged 35 to 75 (mean 58.3) with Tinnitus Handicap Index (THI) scores ranging from 12 to 90 (mean 52.6) have been evaluated. Significant associations were found between the duration of the AM and FM stimuli and the effect on tinnitus suppression. 10 out of 18 (56%) patients had a reduction in their tinnitus loudness by 30% or more. Upon comparison with the masking level, reduction in the subjects’ tinnitus was observed when a lower intensity of the modulated stimuli was presented. Subject characteristics that correlated with a significant reduction of the tinnitus will be discussed in detail.

Conclusions

AM and FM stimuli can decrease the percept of tinnitus significantly. It is postulated that AM and FM stimuli produce synchronized cortical responses to more efficiently compete against tinnitus‐induced synchrony.
TMS in Tinnitus Treatment: Enhancement by Dopamine Agonists?
Authors: Kleinjung Tobias , Vielsmeier Veronika , Landgrebe Michael , Steffens Thomas , Strutz Juergen , Langguth Berthold , Langguth Berthold
Published: August 2008

Objective

Repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex revealed positive effects in patients with chronic tinnitus. Recent preclinical data in healthy controls suggest that effects of low frequency rTMS can be enhanced by application of dopamine agonists. Based on these data, we investigated whether application of a dopaminergic drug increases clinical effects of low frequency rTMS over the auditory cortex in tinnitus patients.

Methods

18 subjects with chronic tinnitus received sessions of 1Hz rTMS (2000 pulses/d, 110% motor threshold) applied to the left temporal cortex on 10 subsequent working days. Additionally, these subjects received one dosage of Madopar® (100mg Levodopa/ 25 mg Benserazide)1 hour prior to each TMS session. Treatment outcome was assessed over a 3‐month period with a tinnitus questionnaire (TQ). Treatment effects were compared to a control group matched for age, gender, tinnitus duration, and hearing loss, which received the same rTMS treatment without prior Levodopa application.

Results

TMS treatment resulted in a reduction of TQ scores in both groups. Improvement was slightly superior in the Levodopa group, but the difference did not reach statistical significance (p <0.05).

Conclusions

These results further support that rTMS has beneficial effects in treatment of chronic tinnitus. Levodopa resulted in a slight, but non‐significant, tendency towards better outcome. Further studies with larger sample sizes are needed.
Update: Auditory Brainstem Implant Outcomes In Children
Authors: Colletti Liliana , Carner Marco , Veronese Sheila , Colletti Vittorio
Published: August 2008

Objective

This study illustrates the auditory perceptual development and the non‐verbal cognitive abilities in young deaf children fitted with auditory brainstem implant (ABI).

Methods

In our department, from 2000 to 2008, 31 children, aged 9 months to 16 years, received an ABI for different tumor and non‐tumor diseases. Six children have elsewhere previously had a CI with no sound detection. 14 out of 31 children had associated disabilities. The retrosigmoid‐transmeatal approach was used in tumor patients and the retrosigmoid approach was used in non‐tumor patients. Perceptual auditory abilities were evaluated with the CAP and EARS battery tests. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale‐Revised (LEITERS‐R) test battery. Intraoperative EABRs and postoperative EABRs and EMLRs were performed.

Results

No postoperative complications were observed. All children consistently use their devices for more than 75% of waking hours and have environmental sound awareness. Their CAP scores ranged from 2 to 7 (average: 4); at MAIS they scored 2%–98.5% (average: 39%); MUSS scores ranged from 5% to 100% (average: 51%) and LIP scores from 5% to 100% (average: 46%). Scores on 2 of the 4 subtests considered for cognitive evaluation in this study increased significantly (from 2 to 10; p>0.01) during the first year of ABI use in all 10 children.

Conclusions

The findings of the present study indicate that children with cochlear or cochlear nerve abnormalities, with or without associated cognitive deficits, should not be excluded from ABI implantation.
Childhood Epistaxis: Naseptin and Cautery vs Naseptin Alone
Authors: Fraser Lyndsay , Calder Nick , Kang Swee K. , Kunanandam Thushitha , Montgomery Jennifer , Mphil Haytham Kubba
Published: August 2008

Objective

Establish whether selective application of combined silver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.

Methods

We performed a prospective randomised controlled trial. All children referred with recurrent epistaxis were seen in a research clinic. Patients with visible anterior septal vessels were invited to participate and were randomised to receive either treatment or control. Allocation was made using opaque, sealed and shuffled sequentially numbered envelopes.

Treatment patients received silver nitrate cautery followed by 4 weeks of Naseptin. Control patients received sham cautery (using the inactive end of the caustic applicator) followed by Naseptin for 4 weeks. The patients were reviewed after 8 weeks and the outcome measure was ‘no reported bleeding’ in the preceding 4 weeks. Any reported bleeding was defined as treatment failure. A power calculation was made based on a previous study by the department: 108 participants were required.

Results

229 children attended and 109 met the inclusion criteria and were randomised. Complete data is currently available for 80. Of those receiving cautery and Naseptin, 18/38 (47.4%) had no bleeding in the preceding 4 weeks and of those receiving only Naseptin, 12/42 (28.6%) had no bleeding. (Chi‐squared=3, p=0.08). This gives a relative risk reduction of 26% and a number needed to treat of 5.5.

Conclusions

Silver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.
Cochlear Implants in Pediatric Bacterial Meningitis
Authors: Isaacson Brandon , Lee Kenneth H , Kutz Joe W , Roland Peter S
Published: August 2008

Objective

1) To determine pediatric cochlear implant performance outcomes for hearing loss secondary to bacterial meningitis. 2) To determine if a performance difference exists in pediatric cochlear implant patients with and without labyrinthitis ossificans.

Methods

A retrospective case review was performed at a tertiary care multi‐disciplinary cochlear implant program. 45 children were implanted from 1991 to 2006 whose hearing loss resulted from bacterial meningitis. Mode of communication, school placement and performance were reviewed.

Results

21 patients(52%) were in a mainstream educational enviroment and 19 (48%) were in a special needs enviroment. 24 subjects (58%) used an auditory‐verbal mode of communication, while 17 (42%) used total communication. The mean speech reception threshold was 28dB with a range from 5 to 65dB. 14 subjects (56%) had labyrinthis ossifcans, while 11 subjects (44%) did not.

Conclusions

The present study demonstrated that over half of our subjects developed labyrinthitis ossificans. Despite the presence of cochlear ossification, patients with bacterial meningitis‐induced hearing loss can often perform in a main‐stem classroom with auditory‐verbal communication.
Current Indications for Pediatric Endoscopic Sinus Surgery
Authors: Shah Rahul K , Zalzal George H , Pena Maria T
Published: August 2008

Objective

To describe current indications, sinonasal pathologies, and outcomes of endoscopic sinus surgeries (ESS) in children.

Methods

Retrospective chart review of children that underwent ESS at a children's tertiary care facility from July 2004 to June 2007 was performed. Demographic data, clinical profiles, surgical procedures including revisions, and complications were analyzed.

Results

117 ESS were performed on 88 children (mean age 9.6 years) and 4 adults; 64 were male. The most common indications for ESS in descending order were: chronic rhino‐sinusitis (CRS) (n=29), subperiosteal periorbital abscess (n= 20), sinonasal neoplasm (n= 11), intracranial complication from acute sinusitis (n=8), CRS with cystic fibrosis (n=8), complicated acute sinusitis (n=6), allergic fungal sinusitis (n=5), antrochonal polyps (n=2), invasive fungal sinusitis (n=1), and other pathologies (n=2). 21 children underwent an average of 2.2 sinus procedures. Majority of revisions were on patients with tumors (46%), allergic fungal sinusitis (40%), intracranial complication from acute sinusitis (38%), complicated acute sinusitis (33%), subperiosteal periorbital abscess (15%), CRS with cystic fibrosis (13%), and CRS (10%). Two children had excessive bleeding requiring another anesthetic to complete the procedure; 1 patient had airway obstruction from a tracheal blood clot requiring bronchoscopy.

Conclusions

More than 2/3rds of patients had ESS for indications other than uncomplicated CRS. Approximately 1/4 required revision surgeries reflecting the complexity of sinonasal pathologies seen in children compared with adults. Otolaryngologists performing pediatric ESS must not only be skilled in sound surgical technique, but must have appropriate interdisciplinary professional support to address the associated clinical problems seen in children.
Outcomes of Pediatric Posterior Graft Laryngotracheoplasty
Authors: Rizzi Mark , Thorne Marc C. , Zur Karen B , Jacobs Ian N
Published: August 2008

Objective

1) Determine the operation specific decannulation rate of patients who required posterior costal cartilage grafting (PCCG) in the management of laryngeal stenosis. 2) Describe the complications associated with PCCG laryngotracheoplasty. 3) Describe voice outcomes for selected patients.

Methods

A retrospective review was performed on all cases of posterior graft laryngotracheoplasty (LTP) performed by the 2 senior authors over a 9‐year period at a tertiary care children's hospital.

Results

There were 42 total patients. The operation specific decannulation rates were 100% (3/3) for Myer‐Cotton grade II SGS, 75% (20/26) for grade III, and 60% (3/5) for grade IV. For posterior glottic stenosis (PGS), it was 57% (4/7) and for PGS with grade II SGS, it was 60% (6/10). There was no significant difference (p=0.727) among these groups. The overall decannulation rates were 100% (3/3), 96% (25/26), and 100% (5/5) for Myer‐Cotton grades II, III and IV. For PGS, it was 83% (5/6), and for PGS with grade II SGS, it was 100% (8/8). There was no significant difference (p=0.527) among these groups. The relative risk for complications was higher among children who had a sutured vs. a sutureless posterior graft (RR= 2.7, p<.01). The most commonly seen compensatory vocal behavior was supraglottic dysphonia.

Conclusions

Operation‐specific decannulation rates are not significantly different with increasing disease severity, although the power to detect small differences in this study is low. PCCG via a sutureless technique is associated with a lower complication rate. Supraglottic dysphonia is a common compensatory vocal behavior after PCCG LTP.
Pediatric Laryngotracheal Stenosis: Where Are We Heading
Authors: Sandu Kishore
Published: August 2008

Objective

We compare decannulation rates after Laryngotracheal Reconstruction(LTR) and Cricotracheal Resection(CTR) in matched patients. Glottic Stenosis remains a challenge and can be treated by Extended Partial Cricotracheal Resection(PCTR). The objective of the paper is to systematically classify patients to be treated by these different techniques.

Methods

In 61% of patients, single‐stage PCTR with peroperative resection of the tracheostoma was chosen if no more than 5 tracheal rings were resected with the SGS. If the location of the tracheostoma requires the resection of 6 or more tracheal rings, then PCTR was performed in 2 stages. 13% of children in this group sustained an anastomotic dehiscence, compared to 4.5% of children who had a shorter tracheal resection. 17 patients who weighed under 10 kg of body weight and were less than 1 year old underwent CTR and have all been decannulated.

Results

It is noteworthy that more than a single procedure was necessary in 68% of the cases to reach the aforementioned results with LTRs, whereas only 18% of the cases needed a second open procedure to achieve decannulation with PCTR. Extended PCTR with LT mold for complex frozen larynges has proven to have promise. Complications included anastomotic granulations, minor dehiscence. No patient had a recurrent laryngeal nerve palsy.

Conclusions

LTR is a less extensive procedure and is preferred for some grade II and less severe grade III stenoses. CTR is reserved for severe grade III and IV stenosis. Stenosis close to the vocal cords remains a challenge and can be treated by extended PCTR.
SurgiSIS vs. Autologous Fascia Myringoplasty in Children
Authors: D'Eredita Riccardo
Published: August 2008

Objective

SurgiSIS is a new bioactive material derived from porcine small intestinal mucosa (SIS). This acellular, easily absorbable collagen matrix promotes early and new vessel growth, and provides scaffolding for the remodeling tissues. This is an inexpensive and ready‐to‐use alternative to autologous grafts. We evaluated the efficacy, safety, and surgery time of SIS myringoplasty, and compared clinical outcomes with patient's temporalis fascia (PTF) repair in children.

Methods

Prospective, 2‐group (SIS, and PTF) randomized, blinded study in a tertiary‐care pediatric institution. 82 children for whom tympanic membrane (TM) repair was indicated were randomly assigned to receive either SIS or PTF myringoplasty. Patients and examining physician were blinded to surgical modality. Primary outcomes were the healing of the TM and surgical time; secondary outcome was presence of any reaction or inflammation of the TM. 2‐year follow‐up was obtained in all enrolled children.

Results

A total of 82 TM (43 in the SIS and 39 in the ATF groups) perforations were treated. There were 42 stable TM closures in the SIS (97.6%) and 37 (94.8%) in the PTF arm. TM closure was higher in the SIS arm, but results were not statistically significant (OR=04, 95% CI 0.12–1.41). SIS myringoplasty yielded reduced surgical time. No clinical evidence of reaction to SIS was encountered.

Conclusions

SIS myringoplasty is a safe and effective method for TM closure in children, with reduced surgical time. As compared with PTF, the SIS myringoplasty is not associated with significant decrease in the incidence of residual perforations.
Symptom Duration and CT Findings in Pediatric Neck Infection
Authors: Meyer Abby C , Kimbrough Tyler G , Finkelstein Marsha , Sidman James D
Published: August 2008

Objective

To test the hypothesis that children with less than 48 hours of localized symptoms of deep space neck infections are less likely to have an abscess on CT than children with at least 48 hours of localized symptoms.

Methods

Children seen in a tertiary hospital between 2000 and 2007 with infections of the head and neck region, excluding peritonsillar abscess, were identified. Data regarding presentation, physical exam findings, radiographic findings, and treatment were extracted.

Results

Of 179 children identified, 167 (93.3%) underwent a CT scan of the neck, of which 102 (61.1%) were positive for abscess. The median duration of symptoms in children with and without abscess on CT were the same (48 hours). There was no significant difference in the rate of abscess on CT between children with less than 48 hours of localizing symptoms and 48 or more hours of symptoms at 58.1% and 57.7% respectively (p=0.96). Furthermore, there were no significant difference in gender, C‐reactive protein levels, or disease location between children with and without abscess on CT. White blood cell counts were significantly higher in the abscess group (p=0.01), however the median white blood cell count in both groups was above normal.

Conclusions

Because duration of symptoms does not predict finding of abscess on CT scan in pediatric deep neck space infections, it is appropriate to obtain a CT scan upon presentation in all children with symptoms concerning for deep neck space abscess.
Early Tracheotomy in the Elderly Results in Less Pneumonia
Authors: Schneider Glenn Todd , Christensen Nathan P. , Doerr Timothy D
Published: August 2008

Objective

To determine if early tracheotomy in elderly patients (age > 65) results in less ventilator associated pneumonia, mortality and morbidity.

Methods

This is a retrospective chart review of 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographic data, admission criteria, medical comorbidities, disposition, outcome, and ventilation data were collected and analyzed.

Results

158 patients were included in the study. 43 patients were included in the early tracheotomy group (continuous intubation time <7 days), and 115 patients were included in the late tracheotomy group. There were no statistically significant differences in the demographics of the 2 groups including age, gender, race, reason for intubation (respiratory failure, airway obstruction, etc), or medical comorbidities including COPD. A highly statistically significant difference in the rate of ventilator associated pneumonia was noted in the early vs. late tracheotomy group (23.3% vs 52.6%, p<0.0009). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (2.2 vs 1.5, p<0.0001). The total admission time was also shorter in the early tracheotomy group (27.0 days vs 39.0 days, p<.0171). There was no difference noted in mortality, although there was a general trend of lower mortality in the early tracheotomy group (20.1% vs 32.1%, p<0.1683).

Conclusions

Early tracheotomy in elderly patients is associated with less ventilator associated pneumonia, more frequent intubations, less total admission time, and a trend towards lower mortality.
Esophagoscopy: Complications in an Academic Training Program
Authors: Tsao Gabriel J , Damrose Edward J
Published: August 2008

Objective

To assess the efficacy and safety of flexible vs. rigid esophagoscopy in an academic training setting.

Methods

A retrospective medical record review was performed on all adult patients undergoing esophagoscopy in a tertiary care academic training center from 2002 to 2007.

Results

A total of 546 procedures were performed using both flexible (n=276) and rigid (n=270) endoscopes. 7 esophageal perforations occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Perforation occurred in 3 patients while searching for a metastatic or synchronous tumor, in 3 patients undergoing dilation or tracheoesophageal puncture, and in 1 patient prior to biopsy of a known esophageal mass. There were no deaths. Esophageal perforation rates were associated with attending level of experience. In 370 patients undergoing esophagoscopy for an unknown primary workup or as part of panendoscopy for the initial evaluation of a head and neck cancer, no synchronous esophageal cancers were found.

Conclusions

The 2.6% esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. All injuries occured in patients with a history of upper aerodigestive tract cancer. The safety of rigid esophagoscopy was commensurate with the experience of the attending physician. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. As fiberoptic techniques are associated with lower complication rates, these should be employed until the novice operator attains some degree of proficiency in esophagoscopy.
Harm and Adverse Events in Otolaryngology Journals
Authors: Bibawy Haidy , Cossu Anne , Sophia Kogan , Rosenfeld Richard M
Published: August 2008

Objective

To identify the frequency and quality of harm and adverse events reporting in otolaryngology journals.

Methods

Four major otolaryngology journals from 2006 and 1996 were reviewed. Clinical research studies offering therapeutic recommendations were evaluated for frequency and quality of harm and adverse events reporting.

Results

Of 1835 total articles reviewed, 576 (31%) offered therapeutic recommendations. Only 65% provided any mention of harm or adverse events; 47% explicitly defined the events and 24% described methodology for collecting harm data. The median number of harms or adverse events reported was 3. Studies concluding a beneficial effect of therapy were more likely to not mention adverse events (odds ratio 2.99, p= 0.007), compared to studies concluding no benefit. Studies of surgical therapy were more likely to report harm or adverse events (odds ratio 1.46, p= 0.046) than medical therapy.

Conclusions

Harm and adverse events are under‐reported and poorly described in otolaryngology journals, with about 1/3 of clinical research not mentioning adverse events at all. Most authors do not explicitly describe harm or adverse events (53%), or the methodology behind collecting adverse events data (76%). Under‐reporting is more likely when a therapeutic effect is found to be beneficial.
An Adjustable Implant for the Nasal Valve: 3‐Year Experience
Authors: Hurbis Charles G
Published: August 2008

Objective

1) Measure the effectiveness of the Monarch implant in correcting nasal valve dysfunction. 2) Determine the longevity of effectiveness.

Methods

This study consists of a prospective, cumulative, three‐year experience with the Monarch adjustable nasal implant for correcting nasal valve dysfunction in a total of 46 patients. Implantation success was determined by the use of acoustic rhinomanometry and a subjective NOSE‐type quality of life scale. Data was subjected to the student‐t test.

Results

In the series of 46 patients spanning 36 months there is a mean 150% improvement in the internal nasal valve areas at 3 years as measured by acoustic rhinomanometry (p<.0001). Using a NOSE‐type questionnaire, patients also noted significant improvements in daytime (p<.0004) and nighttime (p<.0002) nasal airways, a decrease in apnea (p<.01) and snoring (p<.05), and a decrease in the propensity for daytime oral breathing (p<.0002).

Conclusions

The Monarch Implant provides a simple, consistent, adjustable and apparently long‐term correction of the nasal airway in patients suffering from nasal valvular dysfunction.
Computed Tomography Anatomy of the Optic Canal
Authors: Hart Catherine K , Zimmer Lee A
Published: August 2008

Objective

(1) Analyze the radiographic anatomy of the optic canal in relationship to the sphenoid sinus. (2) Understand the role variation in optic canal anatomy may have in the variability of outcomes in optic nerve decompression.

Methods

Fine cut computed tomography images of the sinuses were obtained with an IRB waiver. Optic canal dimensions were measured on sinus computed tomography images of 96 patients. 191 optic canals were analyzed (111 females, 80 males). Student T‐test calculations were performed for statistical analysis on computer software.

Results

The average medial canal wall length was 1.48 centimeters (range 0.7–2.3). The length in males was 1.61 centimeters (1.1–2.3) as compared to 1.39 centimeters (0.7–2.0) in females (p=8.0–7). The average degree of exposure of the optic canal exposed to the sphenoid sinus was 101.3 degrees (56–176). The degree of exposure was 105.6 in males versus 98.2 in females (p=.01). The potential area of canal exposed to the sphenoid sinus was 0.66 centimeters squared or 28% of the total surface area. The potential area exposed to the sphenoid sinus in males was 0.76cm2 (28%) and 0.58 centimeters squared (27%) in females.

Conclusions

A wide range in medial canal wall length and exposure of the bony optic canal to the sphenoid sinus exists on CT images. The variation in medial canal wall length and in optic canal exposure to the sphenoid sinus may contribute to the variability in success rates of endoscopic optic nerve decompression for optic neuropathy.
Endoscopic Closure of CSF Rhinorrhea: 193 cases in 21 years
Authors: Banks Caroline Amber , Kennedy David W , Palmer James N , Chiu Alexander G , O'Malley Bert W , Woodworth Bradford A.
Published: August 2008

Objective

Over the past 2 decades, endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine treatment. The goal of this study is to describe endoscopic closure of a large series of traumatic and spontaneous CSF leaks over a 21‐year period, focusing on perioperative management, surgical technique, and long‐term outcomes.

Methods

Retrospective chart review of CSF leak patients treated by the senior author and at the Hospital of the University of Pennsylvania from 1987 to 2008. The data analyzed included BMI, etiology, defect location, graft material, presence of encephalocele, use of lumbar drain, history of meningitis, evidence of intracranial hypertension, recurrence rates, and follow‐up.

Results

193 cases were identified. Follow‐up ranging from 1 month to 9 years (mean 20 months) was available on 166 patients. The etiology was spontaneous in 77 patients (40%), traumatic in 109 (56%), and congenital in 7 patients (4%). The average BMI of spontaneous CSF leak patients (35) was significantly greater (p<0.001) than both traumatic (30) and congenital patients (23). Defects were most commonly located in the sphenoid sinus (n = 62, 32%) and the ethmoid roof (n = 60, 31%). The initial success rate was 88% (n = 170) and the overall success rate was 98% (n = 190). 45 patients (23%) had a history of meningitis, and 4 patients (2%) developed meningitis after repair.

Conclusions

The overall success rate (98%) and low incidence of morbidity in this large series strongly support the endoscopic approach as standard of care for CSF leak closure.
Endoscopic Repair of Supraorbital CSF Leaks
Authors: Purkey Michael , Chiu Alexander G , Woodworth Bradford A. , Palmer James N
Published: August 2008

Objective

The supraorbital ethmoid and lateral frontal sinus are difficult to approach endoscopically. Their location, superior and lateral to the orbit, can make access technically challenging. In this study, we examined clinical and anatomical characteristics of patients with supraorbital CSF leaks and encepholeceles and identified specific considerations unique to their management.

Methods

Retrospective review of patients who underwent repair of supraorbital CSF leaks at our institution from 2003–2007.

Results

Eight patients were surgically treated. Seven were spontaneous leaks with an associated encepholecele and one was post‐craniotomy. The majority of patients were women (5/8), middle‐aged (mean: 54.9 years), and had a mean BMI of 42.3 kg/m2. Intracranial pressures were elevated in 6/8 patients and an empty sella was present in each of the 7 patients with a spontaneous leak. Anatomically, 6/8 patients had defects medial to a sagittal plane drawn through the medial orbital wall (mean distance: 4.15 mm) and 2/8 patients had defects lateral to the sagittal plane (mean distance: 8.14 mm). 7/8 were successfully repaired endoscopically and one patient with a lateral defect required conversion to a supra‐orbital trephination. All defects were repaired successfully with a mean follow‐up of 27.8 months.

Conclusions

Patients with supraorbital CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Endoscopic repair produces acceptable results with low morbidity. Extension of a skull base defect lateral to a sagittal plane through the medial orbital wall is a technical obstacle to endoscopic repair and may require an adjunctive external approach.
Endoscopic Transnasal Study of the Infratemporal Fossa
Authors: Germani Ross M. , Herzallah Islam , Casiano Roy R
Published: August 2008

Objective

1)Introducing a new endoscopic orientation to the medial portion of the infratemporal fossa (ITF) which is not infrequently involved in sinonasal and related skull base pathologies. 2) Describing the anatomical details and measurement variations of some key ITF landmarks from the unique transnasal endoscopic perspective.

Methods

Using an extended endoscopic approach, the pterygopalatine and infratemporal fossae were dissected in 10 sides of 5 adult cadaver heads. After an extended transethmoid and transmaxillary approach, a plane of dissection along the pterygoid base and the infratemporal surface of the greater sphenoid wing was developed. The related masticatory muscles were dissected through the endoscopic approach. High quality images have been produced by coupling the video camera to a digital recording system.

Results

The foramen rotundum, ovale and spinosum were identified and new landmarks were described from the surgical endoscopic point of view. The sphenomandibularis muscle, recently named in anatomic literature, was also highlighted. Along with various neurovascular structures, the maxillary and mandibular divisions of the trigeminal nerve as well as the middle meningeal artery were identified. Columellar measurements to the foramen rotundum and ovale ranged from 6.1 to 8.0 cm for the former and 7.0 to 9.1 cm for the latter, with a mean of 6.75 cm and 7.78 cm respectively.

Conclusions

The current study provides a novel endo‐scopic orientation to the medial ITF. Such knowledge should provide an anatomic basis for experienced surgeons to endo‐scopically address this complex region with more safety and efficacy.