bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Early Identification and Intervention on Language Development in Japanese Children with Prelingual Severe to Profound Hearing Impairment
Authors: Kasai Norio , Fukushima Kunihiro , Omori Kana , Sugaya Akiko , Ojima Toshiyuki
Published: October 2014

Objectives:

Early identification and intervention for prelingual bilateral severe to profound hearing loss is supposed to reduce the delay in language development. Many countries have implemented early detection and hearing intervention and conducted regional universal newborn hearing screening (UNHS). However, the benefits of UNHS in later childhood have not yet been confirmed, although language development at school age has a lifelong impact on children's future. Our Research on Sensory and Communicative Disorders project attempted to reveal the effects of UNHS and those of early intervention on the development of verbal communication in Japanese children.

Methods:

In this study, 319 children with prelingual bilateral severe to profound hearing loss, 4 to 10 years of age, were evaluated with the Test of Question-Answer Interaction Development used as an objective variable. Participation in UNHS and early intervention were used as explanatory variables. The adjusted odds ratio (AOR) was calculated after adjusting several confounding factors with use of logistic regression analysis. In addition, caregivers' answers were obtained by a questionnaire, and the process of diagnosis with and without UNHS was analyzed retrospectively.

Results:

Early intervention was significantly associated with better language development (AOR, 3.23; p < 0.01). Participation in UNHS may contribute to better language development to some extent (AOR, 1.32), but not one that was statistically significant (p = 0.37). However, UNHS was significantly associated with early intervention (AOR, 20.21; p < 0.001). The questionnaire results indicated a lag in treatment after UNHS in more than 40% of screened cases.

Conclusions:

Early intervention strongly influenced language development. It is necessary to ensure that early identification leads directly to early intervention.
Language Ability in the Intermediate-Scoring Group of Hearing-Impaired Children
Authors: Sugaya Akiko , Fukushima Kunihiro , Kasai Norio , Fujiyoshi Akie , Taguchi Tomoko , Omori Kana , Ojima Toshiyuki , Nishizaki Kazunori
Published: October 2014

Objectives:

Language development is a key issue in hearing-impaired children. However, interpersonal differences complicate our understanding of the situation. The bimodal or trimodal distribution of language scores in our other reports in this publication imply the presence of fundamental differences among these groups. The characteristic aspects of each group were profiled according to language data.

Methods:

We divided 268 children with prelingual severe to profound hearing impairment into 3 groups according to their trimodal distribution observed on histogram-based analysis of their responses to the Test of Question-Answer Interaction Development. Test results in several language domains, including productive and comprehensive vocabulary, productive and comprehensive syntax, and academic achievement, were profiled and compared among these 3 groups.

Results:

Significant differences were observed in the results of the Word Fluency Test, the Picture Vocabulary Test–Revised, and the Syntax Test of Aphasia among the 3 groups. No significant difference was observed between groups who were lower-scoring and intermediate-scoring on the academic achievement tests referred to as Criterion Referenced Test–II and the Standardized Comprehension Test for Abstract Words. Only the higher-scoring group showed excellent results. The demographic factors were not significantly different among the 3 groups.

Conclusions:

Relatively poor academic achievement despite fair language production was the dominant feature of the intermediate-scoring group. This profile might correlate with academic failure in school.
Correlation of Nasal Obstruction with Nasal Cross-Sectional Area Measured by Computed Tomography in Patients with Nasal Septal Deviation
Authors: Cho Gye Song , Kim Jeoung Hyun , Jang Yong Ju
Published: October 2014

Objectives:

The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum.

Methods:

Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS).

Results:

Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation.

Conclusions:

This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.
Occult Lymph Node Metastases Increase Locoregional Recurrence in Differentiated Thyroid Carcinoma
Authors: Patron Vincent , Hitier Martin , Bedfert Cécile , Clech Guy Le , Jégoux Franck
Published: October 2014

Objectives:

The impact of occult lymph node metastasis (OLNM) on locoregional recurrence (LRR) and survival in patients with N0 differentiated thyroid carcinoma is unclear, because no large study has been carried out. A retrospective study was conducted in our department to assess the influence of OLNM.

Methods:

We included 201 patients treated by prophylactic neck dissection for N0 differentiated thyroid carcinoma between 1974 and 2006. The incidence of OLNM and predictive factors for recurrence and survival were assessed.

Results:

The incidence of OLNM was 20%. Necks were involved at levels VI, III, II, IV, V, and I, in decreasing order of frequency. After a mean follow-up of 9 years, the rate of LRR was 8.9% and the rate of distant metastasis was 3.4%. An age of greater than 55 years and the presence of OLNM were predictive factors for LRR. An age of greater than 55 years and the presence of LRR were predictive factors for distant metastasis. The presence of distant metastasis was the only factor that significantly and independently influenced the disease-specific survival.

Conclusions:

We found that OLNM occurred in only 20% of N0 patients. The presence and especially the number of OLNMs on neck dissection were major risk factors for LRR in this study, but did not affect the disease-specific survival.
Long-Term Quality of Life in Young Adults Treated for Oral Cavity Squamous Cell Cancer
Authors: Thomas Ligy , Moore Eric J. , Olsen Kerry D. , Kasperbauer Jan L.
Published: October 2014

Objectives:

We assessed the long-term quality of life (QOL) in patients who survived oral cavity squamous cell cancer when they were young and looked for any clinical factors that might adversely affect function and QOL.

Methods:

We performed a retrospective case series and questionnaire survey in a tertiary care center. The subjects were consecutive patients treated for oral cancers during a 25-year period, when they were 40 years of age or less. The patients completed the University of Washington Quality of Life questionnaire and the M. D. Anderson Dysphagia Inventory (MDADI). We made an overall descriptive report of swallowing and QOL measures in the study population and looked for any clinical factors associated with functional outcomes.

Results:

Among the 62 patients treated over the course of 25 years, 46 were alive and disease-free. Twenty-six participated. The median follow-up duration was 14.7 years (range, 3 to 27 years). Age at diagnosis and duration of follow-up did not correlate with overall QOL or health-related QOL. Seventy-seven percent rated their overall QOL as outstanding, very good, or good. The key domains affected by cancer were appearance, mood, saliva, and shoulder function. Radiotherapy significantly adversely affected the QOL. The median MDADI scores on all 4 subscales were at least 85%. Higher T-stage and radiotherapy were significantly associated with lower scores on all subscales.

Conclusions:

The long-term health-related QOL in this cohort was quite good. Radiotherapy and tumor stage correlated with swallowing outcomes, and only radiotherapy seemed to adversely affect the overall QOL.
Evaluation of Card-Type Odor Identification Test for Japanese Patients with Olfactory Disturbance
Authors: Fujio Hisami , Doi Kiyoshi , Hasegawa Shingo , Kobayakawa Tatsu , Nibu Ken-Ichi
Published: October 2014

Objectives:

A card-type odor identification test, Open Essence (OE), was recently developed in order to examine olfactory function in the Japanese population. The purpose of this study was to validate the efficacy of this new test by comparison with established olfactory examinations.

Methods:

We administered Jet Stream Olfactometry (JSO), an intravenous olfaction test (Alinamin test), a visual analog scale of symptoms of olfactory dysfunction, and the OE test to 50 patients with complaints of olfactory disturbance and 50 healthy volunteers. After comparison of the OE test results with those of existing olfactory examinations and the symptom scores, we tried to estimate a cutoff value compatible with the JSO threshold.

Results:

The scores on the OE test showed significant correlations with the average detection thresholds of JSO (r = −0.738; p < 0.0001), the average recognition thresholds of JSO (r = −0.708; p < 0.0001), the symptom scores (r = 0.827; p < 0.0001), and the duration scores of the intravenous olfactory test (r = 0.673; p < 0.0001). The area under the receiver operating characteristics curve between the OE test results and the average recognition thresholds of JSO was highest when the OE test's cutoff value was set at 8.

Conclusions:

The OE test proved to be a useful tool for screening olfactory disturbance in the Japanese population. Scores of 8 or higher on the OE test should be judged as normal for screening.
Potential Benefits of pH 8.8 Alkaline Drinking Water as an Adjunct in the Treatment of Reflux Disease
Authors: Koufman Jamie A. , Johnston Nikki
Published: October 2014

Objectives:

At the cellular level, tissue-bound pepsin is fundamental to the pathophysiologic mechanism of reflux disease, and although the thresholds for laryngeal damage in laryngopharyngeal reflux and for esophageal damage in gastroesophageal reflux disease differ, both forms of damage are due to pepsin, which requires acid for its activation. In addition, human pepsin remains stable at pH 7.4 and may be reactivated by hydrogen ions from any source. Thus, most tap and bottled waters (typically pH 6.7 to 7.4) would not be expected to affect pepsin stability. The purposes of these in vitro studies were to investigate whether artesian well water containing natural bicarbonate (pH 8.8) might irreversibly denature (inactivate) human pepsin, and to establish its potential acid-buffering capacity.

Methods:

Laboratory studies were performed to determine whether human pepsin was inactivated by pH 8.8 alkaline water. In addition, the buffering capacity of the alkaline water was measured and compared to that of the two most popular commercially available bottled waters.

Results:

The pH 8.8 alkaline water irreversibly inactivated human pepsin (in vitro), and its hydrochloric acid–buffering capacity far exceeded that of the conventional-pH waters.

Conclusions:

Unlike conventional drinking water, pH 8.8 alkaline water instantly denatures pepsin, rendering it permanently inactive. In addition, it has good acid-buffering capacity. Thus, the consumption of alkaline water may have therapeutic benefits for patients with reflux disease.
Characteristics of Vocal Fold Immobility following Endotracheal Intubation
Authors: Xu Wen , Han Demin , Hu Rong , Bai Yu , Zhang Li
Published: October 2014

Objectives:

We investigated the clinical and laryngeal electromyography (LEMG) characteristics and the outcome of closed reduction of arytenoid cartilage dislocation in patients with vocal fold immobility (VFI) following endotracheal intubation.

Methods:

Sixty patients with VFI following endotracheal intubation were included. Closed reduction was performed under local anesthesia in 54 cases. Another 6 patients did not undergo an intervention. Laryngeal behaviors and voice function were evaluated. Forty-five patients underwent LEMG testing.

Results:

All patients complained of persistent hoarseness immediately following surgery. The LEMG results for 29 of 45 patients showed normal patterns (15 cases) or mildly abnormal patterns (14 cases) on the affected side. Sixteen cases displayed apparent abnormal LEMG patterns on the affected side. The voices of all 54 patients improved after reduction. The movement of the affected vocal folds recovered to normal in 51 cases. One month after reduction, neuromuscular function had improved in 29 of 30 cases. Among the 6 patients who did not undergo intervention, 3 had normal or slightly hoarse voices, and 3 experienced moderate hoarseness.

Conclusions:

Vocal fold immobility following endotracheal intubation is typically caused by arytenoid dislocation. Some instances were accompanied by an abnormality of the recurrent laryngeal nerve. A timely closed arytenoid reduction should be performed to restore patients' normal voices and vocal fold mobility. Our reduction technique under local anesthesia can be performed easily and obtains satisfactory outcomes within 6 weeks after endotracheal intubation.
Pilot Study Comparing Total Intravenous Anesthesia to Inhalational Anesthesia in Endoscopic Sinus Surgery: Novel Approach of Blood Flow Quantification
Authors: Gomez-Rivera Fernando , Cattano Davide , Ramaswamy Uma , Patel Chirag B. , Altamirano Alfonso , Man Li-Xing , Luong Amber , Chen Zhongxue , Citardi Martin J. , Fakhri Samer
Published: October 2014

Objectives:

We compared anesthesia with sevoflurane–remifentanil hydrochloride (SR) to total intravenous anesthesia with propofol–remifentanil hydrochloride (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in terms of sinonasal mucosal blood flow, the surgical field visualization score, and blood loss.

Methods:

We performed a double-blinded prospective study at a tertiary care center in 23 adults scheduled to undergo endoscopic sinus surgery for chronic rhinosinusitis. The patients were randomized to receive SR or PR. The sinonasal mucosal blood flow was measured by optical rhinometry. The surgical field visualization score was based on the Boezaart scale.

Results:

The groups had similar clinical characteristics. During the 60- to 90-minute and 90- to 120-minute operative time windows, the blood flow was significantly greater in the PR group than in the SR group (p = 0.04 and p = 0.03, respectively). The amounts of blood loss in the PR and SR groups were 152.9 ± 161.3 mL and 355.9 ± 393.4 mL, respectively (p = 0.12). The median ratios of the surgical field visualization score to the number of sinuses operated on in the PR and SR groups were 2.1 and 1.8, respectively (p = 0.52).

Conclusions:

The intraoperative blood flow, as determined by optical rhinometry, was significantly greater with anesthesia with PR than with anesthesia with SR, 1 hour into the procedure; however, this difference did not translate into differences in the amounts of operative blood loss or in the surgical field visualization scores.
Gene Profiles during Vestibular Compensation in Rats after Unilateral Labyrinthectomy
Authors: Park Moo Kyun , Lee Byung Don , Lee Jong Dae , Jung Hak Hyun , Chae Sung Won
Published: October 2014

Objectives:

The aims of this study were to determine changes in gene expression in the chronic state of vestibular compensation by microarray analysis and to validate the asymmetrical levels of gene expression in the ipsilateral and contralateral vestibular nucleus complexes (VNCs).

Methods:

Microarray analysis was used to examine the expression of genes up-regulated or down-regulated in the ipsilateral VNC at 1 and 7 days after unilateral labyrinthectomy. Up-regulated or down-regulated gene expression in the ipsilateral and contralateral VNCs was then validated by reverse transcriptase polymerase chain reaction at 1, 7, 14, and 28 days after labyrinthectomy.

Results:

The genes down-regulated at 1 day after labyrinthectomy and up-regulated at 7 days after labyrinthectomy as determined by microarray analysis and reverse transcriptase polymerase chain reaction were zinc finger protein 307, zinc metallopeptidase, P34, calcitonin receptor, insulin-like growth factor binding protein 5, GATA binding protein 3, and CD151. Expression of zinc finger protein 307, zinc metallopeptidase, P34, and calcitonin receptor was up-regulated even after 7 days in the contralateral VNC of rats that had labyrinthectomy.

Conclusions:

This study demonstrated changes in gene expression in rats during the chronic phase of vestibular compensation after unilateral labyrinthectomy and provided profiles of these changes in gene expression.
Association of Hearing Loss with Decreased Employment and Income among Adults in the United States
Authors: Jung David , Bhattacharyya Neil
Published: October 2014

Objectives:

We evaluated the association of hearing loss with employment and income in adults.

Methods:

Patients with a coded diagnosis of hearing loss were identified from the 2006 and 2008 Medical Expenditure Panel Survey linked household and medical conditions files and compared to patients without hearing loss. Differences in employment, wage income, and Supplemental Security Income were evaluated with multivariate regression models after adjustment for several demographic and Charlson comorbidity variables.

Results:

An estimated 933,921 ± 88,474 adults were identified with hearing loss (54.7% of whom were male; mean age for all, 51.0 years). Patients with hearing loss were more likely to be unemployed or partly unemployed than those without hearing loss (adjusted odds ratio, 2.2; p < 0.001). Similarly, adults with hearing loss were less likely to have any wage income than those without hearing loss (adjusted odds ratio, 2.5; p < 0.001). The population with hearing loss earned a mean wage of $23,481 ± $3,366, versus $31,272 ± $517 for the population without hearing loss (difference in wages, $7,791; p < 0.001). The association between hearing loss and receiving Supplemental Security Income was not significant (p = 0.109).

Conclusions:

Adults with hearing loss are more likely to be unemployed and on average earn significantly less wage income than adults without hearing loss. Further work is needed to determine the potential impact of treatment on these differences.
Amitriptyline for Symptomatic Treatment of Idiopathic Chronic Laryngeal Irritability
Authors: Stein Daniel J. , Noordzij J. Pieter
Published: October 2014

Objectives:

We evaluated the safety and efficacy of amitriptyline hydrochloride in treating idiopathic chronic laryngeal irritability.

Methods:

A retrospective chart review identified patients treated with amitriptyline for laryngeal irritability in an academic otolaryngology practice. Subjects who had documented medication compliance and a follow-up evaluation performed within 3 months after initiation of treatment were included. Symptoms, demographic information, and response to therapy were abstracted from the records.

Results:

Sixty-six subjects were identified, comprising 48 women and 18 men. The ethnicities were black, 42%; Hispanic, 27%; white, 20%; Asian, 6%; and other or unspecified, 5%. The response to treatment was judged complete in 32% of subjects, partial in 24%, and without improvement in 36%; the remaining 8% were unable to tolerate treatment. Overall, 56.1% of subjects improved (95% confidence limit, 43.3% to 68.3%). No significant differences in response rates were seen based on gender (p = 0.484), age (p = 0.590), or race (p = 0.846). Sedation was reported by 23% of individuals.

Conclusions:

We found that more than 50% of subjects who received amitriptyline for chronic laryngeal irritability experienced improvement, and most subjects tolerated this treatment. No differences in efficacy were seen among racial, age, and gender subgroups. A prospective randomized trial of this therapy appears warranted.
Potential for Respiratory Epithelium Regeneration from Induced Pluripotent Stem Cells
Authors: Otsuki Koshi , Imaizumi Mitsuyoshi , Nomoto Yukio , Wada Ikuo , Miyake Masao , Sugino Takashi , Omori Koichi
Published: October 2014

Objectives:

In cases of laryngeal inflammatory lesions and tracheal invasion of a malignant tumor, autologous tissue implantation techniques using skin or cartilage are often applied. However, these techniques are both invasive and unstable. The purpose of this study was to evaluate the potential use of induced pluripotent stem (iPS) cells in the regeneration of respiratory epithelium.

Methods:

We seeded iPS cells on low-attachment plates in serum-free media to generate embryoid bodies (EBs). After a 3-day culture, the EBs were transferred to a gelatin-coated dish supplemented with activin A alone or with basic fibroblast growth factor (induction groups). As a control, EBs were cultured without these growth factors (control group). Cultured tissues from all groups were histologically examined for 2 weeks.

Results:

In the induction groups, the presence of respiratory epithelium-like tissue was observed with hematoxylin and eosin staining after 14 days of culture.

Conclusions:

This study demonstrated the potential use of iPS cells in regeneration of the respiratory epithelium.
Recurrent Laryngeal Nerve Regeneration through a Silicone Tube Produces Reinnervation without Vocal Fold Mobility in Rats
Authors: Kumai Yoshihiko , Aoyama Takashi , Nishimoto Kohei , Sanuki Tetsuji , Minoda Ryosei , Yumoto Eiji
Published: October 2014

Objectives:

We established an animal model of recurrent laryngeal nerve reinnervation with persistent vocal fold immobility following recurrent laryngeal nerve injury.

Methods:

In 36 rats, the left recurrent laryngeal nerve was transected and the stumps were abutted in a silicone tube with a 1-mm interspace, facilitating regeneration. The mobility of the vocal folds was examined endoscopically 5, 10, and 15 weeks later. Electromyography of the thyroarytenoid muscle was performed. Reinnervation was assessed by means of a quantitative immunohistologic evaluation with anti-neurofilament antibody in the nerve both proximal and distal to the silicone tube. The atrophy of the thyroarytenoid muscle was assessed histologically.

Results:

We observed that all animals had a fixed left vocal fold throughout the study. The average neurofilament expression in the nerve both distal and proximal to the silicone tube, the muscle area, and the amplitude of the compound muscle action potential recorded from the thyroarytenoid muscle on the treated side increased significantly (p < 0.05) over time, demonstrating regeneration through the silicone tube.

Conclusions:

Recurrent laryngeal nerve regeneration through a silicone tube produced reinnervation without vocal fold mobility in rats. The efficacy of new laryngeal reinnervation treatments can be assessed with this model.
Salvage Transoral Laser Supraglottic Laryngectomy after Radiation Failure: A Report of Seven Cases
Authors: Hong Jong Chul , Kim Sung Won , Lee Hyoung Shin , Han Young Jin , Park Heon Soo , Lee Kang Dae
Published: October 2014

Objectives:

We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer.

Methods:

Between December 1999 and May 2011, 7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery.

Results:

All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of follow-up after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery.

Conclusions:

Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.
Optimal Level of Continuous Positive Airway Pressure: Auto-Adjusting Titration versus Titration with a Predictive Equation
Authors: Choi Ji Ho , Jun Young Joon , Oh Jeong In , Jung Jong Yoon , Hwang Gyu Ho , Kwon Soon Young , Lee Heung Man , Kim Tae Hoon , Lee Sang Hag , Lee Seung Hoon
Published: October 2014

Objectives:

The aims of the present study were twofold. We sought to compare two methods of titrating the level of continuous positive airway pressure (CPAP) — Auto-adjusting titration and titration using a predictive equation — With full-night manual titration used as the benchmark. We also investigated the reliability of the two methods in patients with obstructive sleep apnea syndrome (OSAS).

Methods:

Twenty consecutive adult patients with OSAS who had successful, full-night manual and auto-adjusting CPAP titration participated in this study. The titration pressure level was calculated with a previously developed predictive equation based on body mass index and apnea-hypopnea index.

Results:

The mean titration pressure levels obtained with the manual, auto-adjusting, and predictive equation methods were 9.0 ± 3.6, 9.4 ± 3.0, and 8.1 ± 1.6 cm H2O, respectively. There was a significant difference in the concordance within the range of ±2 cm H2O (p = 0.019) between both the auto-adjusting titration and the titration using the predictive equation compared to the full-night manual titration. However, there was no significant difference in the concordance within the range of ±1 cm H2O (p > 0.999).

Conclusions:

When compared to full-night manual titration as the standard method, auto-adjusting titration appears to be more reliable than using a predictive equation for determining the optimal CPAP level in patients with OSAS.
Bioluminescent Imaging of Pneumococcal Otitis Media in Chinchillas
Authors: Johnson Alan W. , Sidman James D. , Lin Jizhen
Published: October 2014

Objectives:

Bioluminescent imaging has emerged as a powerful tool for monitoring the pathological process of infections in animals. The purpose of this study was to harness this new tool for objective assessment of acute otitis media (AOM) in animals with and without antibiotic interventions.

Methods:

Thirty-six healthy chinchillas, free of middle ear infections, were randomly divided into a control group and a group that received amoxicillin treatment. Bioluminescent Streptococcus pneumoniae (Xen 10) was injected into the epitympanic bullae of chinchillas (50 colony-forming units each) for induction of AOM. The infectious process of Xen 10 in the bullae of living animals with and without antibiotic interventions was monitored in real time with bioluminescence equipment.

Results:

A dynamic change of bioluminescent signals in the bullae of chinchillas from days 1 to 14 was observed after Xen 10 injection. Amoxicillin treatment reduced the bioluminescent signals in the bullae of chinchillas compared with controls. The AOM persisted for 14 days, and middle ear effusion for 6 weeks, in the control animals, whereas AOM lasted for 2 days, and effusion for 6 to 12 days, in the antibiotic-treated animals.

Conclusions:

Bioluminescent imaging provides an innovative method for assessment of the bacterial loads in the middle ear of chinchillas in a real-time manner and is very useful for objective evaluation of the efficacy of therapeutic interventions.
Balloon Dilation Complication during the Treatment of Subglottic Stenosis: Background of the FDA Class 1 Recall for the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System
Authors: Achkar Jihad , Dowdal Jayme , Fink Daniel , Franco Ramon , Song Phillip
Published: October 2014

Objectives:

Balloon dilation for subglottic stenosis allows for a controlled radial expansion of the airway and is considered superior to older techniques of airway dilation. We report the case of a 39-year-old woman with idiopathic subglottic stenosis who had entrapment of an inflated balloon in her subglottis due to device failure while undergoing balloon dilation of the stenotic area.

Methods:

We present a case report and a review of the literature.

Results:

As a result of this and other reported incidents, on March 13, 2012, the US Food and Drug Administration issued a class 1 recall of the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System (Acclarent Inc, Menlo Park, California).

Conclusions:

This is the first report describing a dislodged inflated balloon in the subglottis as a complication of dilation for idiopathic subglottic stenosis. Awareness of this possibility, as well as preparedness with the proper instruments, is vital for prevention of a catastrophic emergency during an otherwise low-risk procedure.
Preoperative Computed Tomography Scan May Fail to Predict Perilymphatic Gusher
Authors: Krouchi Lydia , Callonnec Françoise , Bouchetemblé Pierre , Tollard Eleonore , Dehesdin Danièle , Marie Jean-Paul
Published: October 2014

Objectives:

A stapes gusher is a very rare event in ear surgery, but the consequences for hearing can be dramatic. It can usually be predicted by characteristic radiologic abnormalities. We report 2 cases of gusher without any abnormalities seen on the preoperative computed tomography scans.

Methods:

The first case was in a 30-year-old man with a bilateral mixed hearing loss. The gusher occurred after a stapedotomy performed with a microdrill. The oval window was plugged with a vein graft, and a fluoroplastic piston was inserted. The second case was in a 39-year-old woman with a family history of hearing loss who presented with a bilateral mixed hearing loss. The footplate was fractured during the stapedotomy drilling and was covered with a temporalis fascia graft that was fixed with a fluoroplastic piston.

Results:

The first patient had no cerebrospinal fluid leakage and no vertigo or tinnitus. He did have a sensorineural hearing loss. The second patient had dizziness and tinnitus. Postoperative magnetic resonance imaging scans were performed, but again no features were identified that might have predicted these cases.

Conclusions:

Surgeons should be reminded that a preoperative computed tomography scan may fail to detect the risk of a perilymphatic gusher.
Topical Bethanechol for the Improvement of Esophageal Dysmotility: A Pilot Study
Authors: O'Rourke Ashli , Weinberger Paul , Morrison Michele , Conklin Jeffrey , Postma Gregory
Published: October 2014

Objectives:

We studied a case series to evaluate the effect of topical bethanechol chloride on esophageal function in individuals with ineffective esophageal motility.

Methods:

Five subjects with ineffective esophageal motility underwent high resolution esophageal manometry. Ten 5 mL liquid swallows were performed to establish a baseline. Five milligrams of topical bethanechol was then administered. After 10 minutes, the subjects completed 10 additional liquid swallows. This procedure was repeated with 10 mg of bethanechol in 4 subjects.

Results:

After administration of 5 mg of topical bethanechol, the mean (±SD) distal contractile integral, an index of esophageal contractility, increased from 178.3 ± 83.1 mm Hg·s·cm to 272.3 ± 216.9 mm Hg·s·cm (p = 0.69). The percentage of failed swallows decreased from 52.8% ± 33.2% to 29.4% ± 18.3% (p = 0.14). The percentage of peristaltic swallows increased from 28.0% ± 26.8% to 67.2% ± 15.3% (p = 0.04). The contractile front velocity was essentially unchanged. After administration of 10 mg of bethanechol, the distal contractile integral decreased from 349.3 ± 371.0 mm Hg·s·cm to 261.8 ± 293.5 mm Hg·s·cm (p = 0.72). The percentage of failed swallows increased from 57.5% ± 37.7% to 66.8% ± 24.9% (p = 0.46). The percentage of peristaltic swallows increased from 17.5% ± 23.6% to 28.3% ± 19.1% (p = 0.29). The contractile front velocity decreased from 11.6 ± 5.2 cm/s to 4.9 ± 3.0 cm/s (p = 0.32). No adverse side effects occurred.

Conclusions:

The results of this pilot study support the need for further investigation with larger sample sizes and dose escalation.
Otologic Iontophoresis: A No-Papoose Technique
Authors: Syms Charles A. , Grantham Mary Lou
Published: October 2014

Objectives:

We describe a new iontophoresis solution, used in conjunction with a new iontophoresis system for achieving anesthesia of the tympanic membrane before myringotomy and insertion of pressure equalization tubes in an office setting.

Methods:

We selected 50 patients (86 ears) who met standard indications for myringotomy only or myringotomy and pressure equalization tube insertion for a single-site consecutive series trial (Institutional Review Board-approved; informed consent and assent) in the authors' clinical practice. Topical anesthesia was obtained with a new US Food and Drug Administration–cleared iontophoresis system (Acclarent, Inc, Menlo Park, California) and a novel iontophoresis solution mixture. The Wong-Baker FACES Pain Rating Scale was used to assess the tolerability of the iontophoresis system with the new solution and of the otologic procedure after topical anesthesia was obtained.

Results:

Iontophoresis success was obtained in 78 of 86 ears (90.7%). The average pain score for patients after iontophoresis was 1.07 on a 0-to-5 scale of increasing pain. The ear treatment was successful in 70 of 78 ears (89.7%). The average pain score for the surgical procedure was 1.19.

Conclusions:

This study demonstrates the safety and clinical effectiveness of the Acclarent iontophoresis system in conjunction with a new iontophoresis solution for anesthesia of the tympanic membrane in an office setting. This solution and device enable otologic procedures in children as young as 12 months of age without the use of a papoose, premedication, or general anesthesia.
Effect on Auditory Threshold of Air and Water Pockets Bordering the Pathway between Soft Tissue Stimulation Sites and the Cochlea
Authors: Adelman Cahtia , Perez Ronen , Sohmer Haim
Published: October 2014

Objectives:

Auditory sensation can be elicited by applying a bone conduction vibrator to skin sites on the head, neck, and thorax over soft tissues. This is called soft tissue conduction (STC). We hypothesized that introducing substances with acoustic impedances that sharply deviate from those of soft tissues, such as air pockets, into the soft tissues beneath soft tissue stimulation sites would have an effect on the auditory threshold to stimulation at skin sites over soft tissue.

Methods:

In human subjects, we assessed the auditory threshold with a bone vibrator applied to several STC sites, especially the cheek, and to several bone conduction sites on the skull. The subjects were equipped with bilateral earplugs. The subject then filled his or her cheek with either air or water, and the auditory threshold was again determined. We also recorded the auditory brain stem response to STC stimulation under the chin in fat sand rats in the absence and presence of subcutaneous air or saline solution pockets (0.4 mL) under the chin.

Results:

In humans, the threshold to stimulation on the cheek was elevated (13 to 18 dB) in the presence of an air-inflated cheek, but not with a water-filled cheek. In animals, in the presence of an air pocket, the auditory brain stem response threshold was elevated by 10 to 20 dB; no threshold change occurred with a saline solution pocket.

Conclusions:

The introduction of air (but not water) into the soft tissues beneath the soft tissue stimulation sites led to a threshold elevation in both humans and animals. This was not the case when an identical volume of water was introduced, which would also have interrupted a possible parallel bone conduction pathway. These results provide evidence that soft tissue stimulation at low intensities induces tissue vibrations that are transmitted to the cochlea along a series of soft tissues with similar acoustic impedances.
Prospective Evaluation of Office-Based Injection Laryngoplasty with Hyaluronic Acid Gel
Authors: Upton David C. , Johnson Matthew , Zelazny Sherri K. , Dailey Seth H.
Published: October 2014

Objectives:

The role of Juvederm Ultra Plus hyaluronic acid gel for use in injection laryngoplasty has not been well examined. The aim of this study was to prospectively assess the safety and clinical effectiveness of office-based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency.

Methods:

Thirty patients met the criteria for study inclusion and were treated with unsedated office-based injection laryngoplasty of Juvederm Ultra Plus gel over a 20-month period. The preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months after injection.

Results:

Data for 27 patients were available for follow-up analysis at 1 month, and 12 patients' data were available at 4 months. Significant improvements, compared to preinjection levels (p < 0.02), were shown in all outcome measures at 1 and 4 months. One patient required intravenous steroid therapy for delayed glottic inflammation that resolved without permanent sequelae.

Conclusions:

The injection of Juvederm Ultra Plus gel is a relatively safe procedure that allows for short-term improvements in objective and subjective outcome measures of vocal function in patients with glottic insufficiency, provided the surgeon remains alert to the possibility of postprocedural injection site inflammation.
Cardiovascular and Blood Glucose Parameters in Infants during Propranolol Initiation for Treatment of Symptomatic Infantile Hemangiomas
Authors: Puttgen Katherine B. , Summerer Barbara , Schneider Jeremy , Cohen Bernard A. , Boss Emily F. , Bauman Nancy M.
Published: October 2014

Objectives:

We sought to determine the effect of propranolol on cardiovascular and blood glucose parameters in infants with symptomatic infantile hemangiomas who were hospitalized for initiation of treatment, and to analyze adverse effects of propranolol throughout the course of inpatient and outpatient treatment.

Methods:

A retrospective cohort analysis was performed on 50 infants (age less than 12 months) with symptomatic infantile hemangiomas who were hospitalized for propranolol initiation between 2008 and 2012. Demographic data and disease characteristics were recorded. Systolic and diastolic blood pressures, heart rate, blood glucose values, and adverse events recorded during hospitalization were analyzed. An additional cohort of 200 consecutively treated children was also assessed for adverse events associated with outpatient propranolol use.

Results:

The median age among the inpatient cohort was 3.4 months (range, 0.8 to 12.0 months). Infants older than 6 months were more likely to exhibit bradycardia than were younger infants (p < 0.001). Hypotensive and/or bradycardic periods were infrequent and were not associated with observable clinical symptoms. The mean systolic and diastolic blood pressures and the mean heart rate decreased significantly from day 1 of hospitalization to day 2 (p = 0.004; p = 0.008; p < 0.001), but not from day 2 to day 3, when the propranolol dose was increased to target. Hypoglycemia was rare (0.3% incidence.) Among the 250 outpatients, 2 infants developed lethargy and hypoglycemia during a viral illness and recovered without sequelae. One infant experienced recurrent bronchospasm with viral illnesses and required concomitant bronchodilator therapy.

Conclusions:

Frequent deviations from normal ranges of blood pressure and heart rate occur upon initiation of propranolol, but are clinically asymptomatic. These findings support that outpatient initiation of propranolol in healthy, normotensive infants appears to be a relatively safe alternative to inpatient initiation. Hypoglycemia is rare, but can occur throughout the treatment period; parent counseling is of paramount importance.
Laryngeal Obstruction by Cervical and Endolaryngeal Lymphatic Malformations in Children: Proposed Staging System and Review of Treatment
Authors: Berg Eric E. , Sobol Steven E. , Jacobs Ian
Published: October 2014

Objectives:

We review and stage a series of congenital lymphatic malformations (LMs) that caused laryngeal obstruction according to a proposed staging system, review the treatment modalities utilized, and correlate the stage of disease with clinical outcomes and tracheotomy statuses.

Methods:

We present a detailed description of the clinical presentation, management approach, and clinical outcome and tracheotomy status of a series of patients with laryngeal obstruction by LMs. A 4-part staging system (stages I to IV) for congenital LMs obstructing the larynx, based upon our clinical experience, is proposed. The patients were retrospectively reviewed and staged according to the proposed system, and clinical management and outcomes were correlated with the stage of disease.

Results:

We identified 16 patients with laryngeal obstruction by LMs. Eighty-one percent (13 of 16) received sclerotherapy, and 50% (8 of 16) underwent operative excision or debridement. Forty percent (2 of 5) of stage I lesions, 75% (3 of 4) of stage II lesions, 100% (4 of 4) of stage III lesions, and 100% (3 of 3) of stage IV lesions were in patients who required tracheotomy. All patients who had stage I and II lesions and required tracheotomy have been decannulated, whereas only 2 of the 4 patients with stage III lesions and no patients with stage IV lesions have been successfully decannulated.

Conclusions:

Lymphatic malformations obstructing the larynx require a careful and often staged management approach. A proposed staging system helps to predict the need for tracheotomy and the likelihood of long-term tracheotomy dependence.
Subjective and Objective Parameters of the Adult Female Voice after Cricotracheal Resection and Dilation
Authors: Bryans Linda , Palmer Andrew D. , Schindler Joshua S. , Andersen Peter E. , Cohen James I.
Published: October 2014

Objectives:

We compared the voice outcomes after cricotracheal resection (CTR) and airway dilation in adult women.

Methods:

We performed long-term comprehensive voice assessments in 23 adult women treated for laryngotracheal stenosis, including acoustic and perceptual measurements of voice, videostroboscopy, the Voice Handicap Index, and an open-ended subjective questionnaire.

Results:

Voice measures were abnormal in both groups. Objective pitch and loudness measurements were significantly more impaired after CTR than after dilation. Perceptual ratings of voice were worse after CTR than after dilation, particularly with regard to breathiness, pitch, and loudness. The CTR group was more likely to report a voice disorder, reported significantly more voice symptoms, and had higher voice handicap scores. Videostroboscopy was frequently abnormal in both groups, with more evidence of vocal hyperfunction after CTR. Self-ratings of breathing and swallowing were generally high in both groups, but voice satisfaction was rated lower after CTR.

Conclusions:

Voice was more significantly negatively impacted by CTR than by dilation. Surprisingly, many individuals in both groups reported improvements — A finding that possibly highlights the impact of laryngotracheal stenosis on airflow and vocal function before surgery. The importance of patient selection and preoperative counseling is emphasized, along with the potential need for voice therapy.
Open Staple Diverticulectomy for a Large Recurrent Zenker's Diverticulum: Still a Valid Procedure
Authors: Courson Andy M. , Landry April M. , Lott David G. , Hinni Michael L.
Published: October 2014

Objectives:

We demonstrate indications for external mechanical stapler diverticulectomy in the modern era of endoscopic treatment. We review treatment of a large diverticulum and discuss considerations that should be made in deciding on the type of surgical treatment.

Methods:

The index case was in a 75-year-old man who had undergone open cricopharyngeal myotomy with diverticulopexy 35 years earlier. He presented with 25 years of recurrent symptoms. A swallow study showed a 6.5 × 5.0-cm diverticulum. The diverticulum was deemed too large for standard endoscopic myotomy, so diverticulectomy was performed with a stapler.

Results:

The patient was discharged on postoperative day 3 without complications. A swallow study on postoperative day 5 demonstrated no diverticulum or extravasation of barium. The patient resumed a normal diet with resolution of dysphagia. Two additional patients with large Zenker's diverticula that were managed similarly are also discussed.

Conclusions:

Although endoscopic laser cricopharyngeal myotomy and stapler diverticulostomy have become standard treatments for Zenker's diverticulum, this case of a large recurrent diverticulum illustrates a situation in which older techniques may be preferred. Use of the mechanical stapler allowed for a shorter surgery time than traditional suture techniques, and the potential for an earlier return to a normal diet.
Ossicular Replacement Prosthesis
Authors: Marlowe Frank I.
Published: October 2014

A fixed footplate in a well aerated middle ear devoid of ossicles is generally acknowledged to be a difficult otologic reconstructive problem. A rapid method employing readily available materials is presented with several case reports. The method employs a combined alloplastic-tissue prosthesis which is easily assembled and inserted.
Permeability of the Organ of Corti
Authors: Goldstein Allan J.
Published: October 2014

The technique of fluorochromasia has been used to study cellular permeability of the inner ear tissues. The hair cells of the organ of Corti show variations in permeability which are dependent on the previous history of in vivo exposure to physiologically normal levels of sound. Permeability was also sensitive to oxygen deprivation. Gross mechanical stimulation of the hair cells is sufficient to render the hair cell permeable to large molecules. The cilia of the hair cells seem to have a membrane structure independent of the hair cell itself.
Patients with Bilateral Loss of Caloric Response
Authors: Simmons F. Blair
Published: October 2014

Forty-three of 2500 consecutive ENG monitored caloric-induced nystagmus examinations gave no response to 5 cc of ice water in either ear. Among these, nine had CNS neoplasms, of which six were in the midline posterior fossa, six had autoimmune or collagen disease, six were caused by infections (meningitis, otitis, syphilis), five were congenital involving only the ear, five were drug induced, four had combined visual and eighth nerve hereditary disorders. Infection excepted, hearing losses were an irregular associated finding in roughly 50% and were less common in the CNS and systemic disease categories. Neither clinical symptoms nor other ENG findings were good predictors for finding no response to caloric tests.