bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory Brain Stem and Midbrain Development after Cochlear Implantation in Children
Authors: Gordon Karen A. , Papsin Blake C. , Harrison Robert V.
Published: January 2017

Input to the central auditory system through a cochlear implant promotes psychophysical improvement of auditory skills. However, the developmental changes along the pathways have never been characterized in children with hearing loss who use implants. We aimed to measure auditory development in such children by using the electrically evoked auditory brain stem response (EABR). We made repeated measures of the EABR in 41 nonsedated children with implants before chronic stimulation and after 2, 6, and 12 months of consistent implant use. The results show that EABRs were present in all of the children even before chronic auditory stimulation, and that EABR wave latencies decreased from the time of initial activation throughout the first year of cochlear implant use. These findings reflect auditory development to the level of the midbrain as a result of the cochlear implant. The decreasing latencies likely reflect decreased neural conduction times at this level, in part because of increased synaptic efficacy.
Early Cochlear Implantation in Children Allows Normal Development of Central Auditory Pathways
Authors: Sharma Anu , Spahr Anthony , Dorman Michael , Todd N. Wendell
Published: January 2017

The goal of this study was to determine whether there is a sensitive period during early development when a cochlear implantation can occur into a minimally degenerate and/or highly plastic central auditory system. Our measure of central auditory deprivation was latency of the P1 auditory evoked potential, whose generators include auditory thalamocortical areas. Auditory evoked potentials were recorded in 18 congenitally deaf children who were fitted with cochlear implants by 3.5 years of age. The P1 latencies of the children with implants were compared with the P1 latencies of their age-matched peers with normal hearing. There was no significant difference between the P1 latencies of the children with implants and the children with normal hearing. The present results suggest that early implantation occurs in a central auditory system that is minimally degenerate and/or highly plastic. Studies are ongoing to assess the consequences to the developing central auditory system of initiating electrical stimulation at later ages.
Neural Response Telemetry in 12- to 24-Month-Old Children
Authors: Gordon Karen A. , Gilden Jan E. , Ebinger Kiara A. , Shapiro William H.
Published: January 2017

The minimum age for cochlear implantation has been reduced to 12 months in an effort to provide auditory stimulation to children with hearing loss during early development. Because behavioral measures in such young children are limited, objective measures such as the electrically evoked compound action potential (EAP) from the auditory nerve are needed to facilitate measurement of stimulation level requirements. We assessed EAPs recorded by the Nucleus 24 neural response telemetry (NRT) system in children who underwent implantation between 12 and 24 months of age. We recorded EAPs in 37 such children (mean age at implantation, 18.1 ± 3.6 months). The EAPs were of large amplitude, and thresholds fell between behavioral T and C levels. A correction factor applied to EAP thresholds provided useful predictions of T levels. The EAPs can be used to ensure that even very young children receive auditory stimulation with their cochlear implants upon device activation.
Infant Cochlear Implantation and Anesthetic Risk
Authors: Young Nancy M.
Published: January 2017

In light of the strong trends toward performing cochlear implantation in infants, it is necessary to consider anesthetic issues. Just as anesthetic risk may play an important role in surgical candidacy in the elderly population, anesthesia is also of special consideration in infants. Even healthy infants are known to be at increased risk for anesthetic complications; for this reason, most elective surgical procedures are not routinely done within the first year of life. Therefore, it is necessary to consider anesthetic issues when contemplating the use of cochlear implants in infants less than 12 months of age.
Role of Infant Vocal Development in Candidacy for and Efficacy of Cochlear Implantation
Authors: Moore Jan Allison , Bass-Ringdahl Sandie
Published: January 2017

Previous research has documented the importance of audition in the development of typical infant vocalization. Of particular interest is the development of canonical babbling, which is related to mastery of the timing elements of speech. Children with severe to profound hearing loss who use hearing aids have demonstrated both delayed and deviant canonical babbling. The vocal development of 12 children has been followed as they have been considered for cochlear implantation. Nine of these children have undergone implantation, and 5 of these children have been followed for more than 1 year after implantation. On average, canonical babbling emerged at 6.5 months after implantation. The time frame in which some children developed words was accelerated in terms of length of auditory experience as compared with normal-hearing peers. Mature oral-motor development is likely the primary contributing factor in this time course. One child who received a cochlear implant began to babble with hearing aids. It is not known whether normal canonical babbling is sufficient evidence on which to base candidacy decisions; however, our data suggest that children who produce canonical babbling maintain and build upon those skills after implantation.
Cochlear Implant Candidacy and Performance Trends in Children
Authors: Osberger Mary Joe , Zimmerman-Phillips Sue , Koch Dawn Burton
Published: January 2017

Data from Clarion cochlear implant pediatric clinical trials were examined retrospectively to uncover trends in candidacy and postimplant benefit over time. In particular, age at implantation, educational setting, and communication mode were examined with respect to speech perception performance after implantation. The results showed that 1) age at implantation is decreasing, 2) children in oral education programs obtain more benefit from a cochlear implant than children in total communication programs, 3) children who undergo implantation before 2 years of age show greater benefit than children who undergo implantation between 2 and 3 years of age, 4) more younger children are using oral communication than older children, and 5) more children with good auditory skills before implantation and more residual hearing are undergoing implantation. In sum, in the 11 years since implants have been available to children in the United States, candidacy criteria have evolved and benefit has increased as cochlear implant technology has advanced.
Early Identification and Cochlear Implantation: Critical Factors for Spoken Language Development
Authors: Hammes Dianne M. , Willis Mary , Novak Michael A. , Edmondson Danielle M. , Rotz Lee Ann , Thomas Jean F.
Published: January 2017

Documentation is lacking regarding the ability of congenitally deaf children to attain age-appropriate spoken language skills using a cochlear implant, and how early implantation must occur if such development is to be possible. Spoken language data are presented for infants who underwent implantation at 18 months of age or younger. Additional data are used to compare outcomes among children who differed in age at implantation. Data collected at Carle Clinic and Foundation Hospital were reviewed for 47 consecutively implanted children ranging in age from 9 to 48 months at implantation. These data were analyzed and compared by age-at-implantation groupings for speech perception skills, communication mode, and spoken language abilities. The groups differed dramatically in abilities. The best outcomes occurred in children who underwent implantation at or before 18 months of age. Several of these infants demonstrated age-appropriate spoken language skills. We conclude that early implantation is desirable. Children who undergo implantation as infants may develop language skills commensurate with those of their hearing peers.
Development of Speech Perception and Production in Children with Cochlear Implants
Authors: Kishon-Rabin Liat , Gehtler Inbal , Taitelbaum Riki , Kronenberg Jona , Muchnik Chava , Hildesheimer Minka
Published: January 2017

The purpose of the present study was twofold: 1) to compare the hierarchy of perceived and produced significant speech pattern contrasts in children with cochlear implants, and 2) to compare this hierarchy to developmental data of children with normal hearing. The subjects included 35 prelingual hearing-impaired children with multichannel cochlear implants. The test materials were the Hebrew Speech Pattern Contrast (HeSPAC) test and the Hebrew Picture Speech Pattern Contrast (HePiSPAC) test for older and younger children, respectively. The results show that 1) auditory speech perception performance of children with cochlear implants reaches an asymptote at 76% (after correction for guessing) between 4 and 6 years of implant use; 2) all implant users perceived vowel place extremely well immediately after implantation; 3) most implanted children perceived initial voicing at chance level until 2 to 3 years after implantation, after which scores improved by 60% to 70% with implant use; 4) the hierarchy of phonetic-feature production paralleled that of perception: vowels first, voicing last, and manner and place of articulation in between; and 5) the hierarchy in speech pattern contrast perception and production was similar between the implanted and the normal-hearing children, with the exception of the vowels (possibly because of the interaction between the specific information provided by the implant device and the acoustics of the Hebrew language). The data reported here contribute to our current knowledge about the development of phonological contrasts in children who were deprived of sound in the first few years of their lives and then developed phonetic representations via cochlear implants. The data also provide additional insight into the interrelated skills of speech perception and production.
Speech Perception Outcomes in Older Children Who Use Multichannel Cochlear Implants: Older is Not Always Poorer
Authors: Dowell Richard C. , Winton Elizabeth , Dettman Shani J. , Barker Elizabeth J. , Hill Katie , Clark Graeme M.
Published: January 2017

Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult. This study considered a number of factors in a group of 25 children who underwent implantation in Melbourne between the ages of 8 and 18 years. Each subject completed open-set speech perception testing with Bamford-Kowal-Bench sentences before and after implantation and preoperative language testing with the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implantation, age at hearing aid fitting, audiometric details, and preoperative and postoperative communication mode. Results were submitted to a stepwise multiple linear regression analysis with postoperative open-set sentence scores as the dependent variables. The analysis suggested that 3 factors have a significant predictive value for speech perception after implantation: preoperative open-set sentence score, duration of profound hearing loss, and equivalent language age. These 3 factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful speech perception before implantation, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. Consistent with other studies, a shorter duration of profound hearing loss is also advantageous. The mean sentence score for this group, 47%, was not significantly different from the mean result across all children in the Melbourne program.
Influence of Age at Implantation and of Residual Hearing on Speech Outcome Measures after Cochlear Implantation: Binary Partitioning Analysis
Authors: El-Hakim Hamdy , Abdolell Mohamed , Papsin Blake C. , Mount Richard J. , Harrison Robert V.
Published: January 2017

The goal of this study was to evaluate speech understanding outcomes in prelingually deaf children who use a cochlear implant device. Specifically, we discuss investigations on 2 prognostic variables — age at implantation and degree of residual hearing — and use a novel method: binary partitioning analysis. Our outcome measures are standard speech perception evaluations, including the Word Intelligibility by Picture Identification (WIPI) test, the Phonetically Balanced–Kindergarten (PBK) test, and the Glendonald Auditory Screening Procedure (GASP). Regarding age at implantation, we definitely showed that growth rates of speech understanding do relate to age at implantation, but not in a simple fashion. We used binary partitioning in an attempt to find the age at implantation that best separates the performances of children with younger versus older ages at implantation. We found that there is no one “critical age”; much appears to depend on the nature and difficulty (eg, whether open- or closed-set) of the test used. Regarding residual hearing, binary partitioning analysis was unable to show that the amount of residual hearing (as shown by preimplantation audiometric data) has any significant bearing on speech outcome measures in congenitally or prelingually deaf children.
Grammatical Morphologic Development in Pediatric Cochlear Implant Users May Be Affected by the Perceptual Prominence of the Relevant Markers
Authors: Svirsky Mario A. , Stallings Lynne M. , Ying Elizabeth , Lento Cara L. , Leonard Laurence B.
Published: January 2017

The goal of this study was to test 2 hypotheses about language development in pediatric cochlear implant (CI) users. The “language instinct” hypothesis states that children with CIs will develop language in the same sequence as children with normal hearing, but in a delayed fashion. In other words, noun plurals will develop first, and the use of the uncontractible copula and regular past tense will follow. An alternative hypothesis (the “perceptual prominence” hypothesis) is that the pattern of language development in CI users will be strongly affected by the perceptual prominence of the relevant morphological markers. This hypothesis predicts that the uncontractible copula will develop first, followed by noun plurals, and then by regular past tense. A sentence completion task was used to measure the performance of 9 pediatric CI users and compare it to that of several groups of children with normal hearing. The results from the CI users were consistent with the perceptual prominence hypothesis. In particular, the scores for the copula probe were higher than those for the noun plural probe for 8 of the 9 CI users. This result represents a rather striking inversion with respect to the usual development pattern in children with normal hearing and even in children with specific language impairment. If the perceptual prominence hypothesis receives further support in future studies, clinicians who work in language rehabilitation of CI users may choose to target those aspects of grammar that are less acoustically prominent to these children. In addition, and from a theoretical standpoint, these results suggest that although there may well be an innate language acquisition mechanism, patterns of language development can be strongly affected by the acoustic input.
Cognitive Processing in Children Using Cochlear Implants: The Relationship between Visual Memory, Attention, and Executive Functions and Developing Language Skills
Authors: Surowiecki Vanessa N. , Maruff Paul , Busby Peter A. , Sarant Julia , Blamey Peter J. , Clark Graeme M.
Published: January 2017

We performed this study to determine whether children using a cochlear implant performed differently from age- and gender-matched hearing aid users on 8 neuropsychological measures of visual memory, attention, and executive functioning. The study also examined whether differences in cognitive skills could account for some of the observed variance in speech perception, vocabulary, and language abilities of hearing-impaired children. In contrast to previous studies, our results revealed no significant cognitive differences between children who use a cochlear implant and children who use hearing aids. Partial correlation analysis indicated that the children's visual memory skills, ie, their recognition memory, delayed recall, and paired associative learning memory skills, correlated significantly with their language skills. When examined at a significance level of.01, attention and executive functioning skills did not relate to the children's developing speech perception, vocabulary, or language skills. The results suggested that differences in visual memory skills may account for some of the variance seen in the language abilities of children using implants and children using hearing aids.
Rehabilitation Factors Contributing to Implant Benefit in Children
Authors: Geers Ann , Uchanski Rosalie , Brenner Chris , Tye-Murray Nancy , Nicholas Johanna , Tobey Emily
Published: January 2017

This study was performed to investigate factors contributing to auditory, speech, language, and reading outcomes after 4 to 6 years of multichannel cochlear implant use in children with prelingual deafness. The analysis controlled for the effects of child, family, and implant characteristics so that the educational factors most conducive to maximum implant benefit could be identified. We tested 136 children from across the United States and Canada. All were 8 or 9 years of age, had an onset of deafness before 3 years of age, underwent implantation by 5 years of age, and resided in a monolingual English-speaking home environment. Characteristics of the child and the family (primarily nonverbal IQ) accounted for approximately 20% of the variance in outcome after implantation. An additional 24% was accounted for by implant characteristics and 12% by educational variables, particularly communication mode. Oral education appears to be an important educational choice for children who have undergone cochlear implantation before 5 years of age.
Changing Expectations for Children with Cochlear Implants
Authors: Moog Jean Sachar
Published: January 2017

Seventeen students with cochlear implants who were between 5 and 11 years of age and attended the Moog Center for Deaf Education school program were tested just before exiting the program. The Moog program is an intensive oral program that provides very focused instruction in spoken language and reading. Children leave the program when they are ready for a mainstream setting or when they are 11 years of age, whichever comes first. All of the children demonstrated open-set speech perception ranging from 36% to 100%. On a test of speech intelligibility, all students scored 90% or better. On language and reading tests, compared with the performance of normal-hearing children their age, more than 65% scored within the average range for language and more than 70% scored within the average range for reading. These data demonstrate what is possible for deaf children who benefit from a combination of a cochlear implant and a highly focused oral education program.
Voice and Treatment Outcome from Phonosurgical Management of Early Glottic Cancer
Authors: Zeitels Steven M. , Franco Ramon A. , Hillman Robert E. , Bunting Glenn W.
Published: January 2017

Phonosurgical management of early glottic cancer has evolved considerably, but objective vocal outcome data are sparse. A prospective clinical trial was done on 32 patients with unilateral cancer (T1a in 28 and T2a in 4) who underwent ultranarrow-margin resection; 15 had resection superficial to the vocal ligament, and 17 deep to it. The subepithelial infusion technique facilitated selection of these patients for the appropriate procedure. All are cancer-free without radiotherapy or open surgery. Involvement of the anterior commissure (22/32) or the vocal process (15/32) of the arytenoid cartilage did not influence local control. Nine of 17 patients had resection of paraglottic musculature, and all underwent medialization reconstruction by lipoinjection and/or Gore-Tex laryngoplasty. Eight of the 17 had resections deep to the vocal ligament, but without vocalis muscle, and 1 of the 8 underwent medialization. Posttreatment vocal function measures were obtained for all patients. A clear majority of the patients displayed normal values for average fundamental frequency (72%) during connected speech, and normal noise-to-harmonics ratio (75%) and average glottal airflow (91%) measures during sustained vowels. Smaller majorities of patients displayed normal values for average sound pressure level (SPL; 59%) during connected speech and for maximum ranges for fundamental frequency (56%) and SPL (59%). Fewer than half of the patients displayed normal values for sustained vowel measures of jitter (45%), shimmer (22%), and maximum phonation time (34%). Almost all patients had elevated subglottal pressures and reduced values for the ratio of SPL to subglottal pressure (vocal efficiency). There were significant improvements in a majority of patients for most vocal function measures after medialization reconstruction. Normal or near-normal conversation-level voices were achieved in most cases, regardless of the disease depth, by utilization of a spectrum of resection and reconstruction options. These favorable results are based on establishing aerodynamic glottal competency and preserving the layered microstructure of noncancerous glottal tissue.
Optimizing Cochlear Implant Speech Performance
Authors: Skinner Margaret W.
Published: January 2017

Results of studies performed in our laboratory suggest that cochlear implant recipients understand speech best if the following speech processor parameters are individually chosen for each person: minimum and maximum stimulation levels on each electrode in the speech processor program (MAP), stimulation rate, and speech coding strategy. If these and related parameters are chosen to make soft sounds (from approximately 100 to 6,000 Hz) audible at as close to 20 dB hearing level as possible and loud sounds not too loud, recipients have the opportunity to hear speech in everyday life situations that are of key importance to children who are learning language and to all recipients in terms of ease of communication.
Signal Coding in Cochlear Implants: Exploiting Stochastic Effects of Electrical Stimulation
Authors: Rubinstein Jay T. , Hong Robert
Published: January 2017

Speech perception in quiet with cochlear implants has increased substantially over the past 17 years. If current trends continue, average monosyllabic word scores will be nearly 80% by 2010. These improvements are due to enhancements in speech processing strategies, to the implantation of patients with more residual hearing and shorter durations of deafness, and to unknown causes. Despite these improvements, speech perception in noise and music perception are still poor in most implant patients. These deficits may be partly due to poor representation of temporal fine structure by current speech processing strategies. It may be possible to improve both this representation and the dynamic range of electrical stimulation through the exploitation of stochastic effects produced by high-rate (eg, 5-kilopulse-per-second) pulse trains. Both the loudness growth and the dynamic range of low-frequency sinusoids have been enhanced via this technique. A laboratory speech processor using this strategy is under development. Although the clinical programming for such an algorithm is likely to be complex, some guidelines for the psychophysical and electrophysiological techniques necessary can be described now.
Technology and the Future of Cochlear Implants
Authors: Clopton Ben M. , Spelman Francis A.
Published: January 2017

Cochlear implants are one of the dramatic success stories of the bioengineering enterprise. Although these prostheses are used extensively, they still can be improved substantially. We suggest that high-density electrode designs will permit field shaping and field steering to an extent not presently possible with the arrays that are used today. Those opportunities will make it possible to make use of the phase information that is richly available to normal listeners. Although this information makes possible more precise location of sound sources in the auditory environment, and will likely improve the recognition of intelligent sound in noise, it will require the consumption of additional power in future cochlear prostheses. Those opportunities and trade-offs provide the designers of cochlear implants with exciting goals for the future.
Aberrant Internal Carotid Artery in the Middle Ear
Authors: Windfuhr Jochen P.
Published: January 2017

This study was undertaken to evaluate the incidence, typical clinical signs, and proper management of patients with an aberrant internal carotid artery in the middle ear as presented in a case report and review of the relevant literature. A total of 86 cases were reviewed concerning gender, affected side, presenting symptoms, findings on clinical and radiologic examination, and further treatment. About two thirds of the patients (68.6%) were female. The right side was affected in 40 patients, and both sides were affected in 13 patients. Hearing loss (41 patients) and pulsatile tinnitus (26 patients) were the most common symptoms. Preponderances of affected side and gender seem to be reduced by the increasing number of reports. Bilateral findings are not unusual, indicating meticulous examination of both sides. Glomus tumors often mimic an aberrant internal carotid artery. If vascular malformations in the middle ear are suspected, high-resolution computed tomography or magnetic resonance angiography is required before any surgical intervention to exclude vascular malformations. Brisk bleeding, hemiparesis, aphasia, deafness, Horner's syndrome, and intractable vertigo may result if the lesion is injured unintentionally. Once the disorder is correctly diagnosed, yearly follow-up is advisable.
Epidemiology and Economic Impact of Rhinosinusitis
Authors: Anand Vijay K.
Published: January 2017

Rhinosinusitis is highly prevalent in the United States, affecting an estimated 16% of the adult population annually. The prevalence of the illness is increased in women and, relative to other US regions, in individuals living in the South. The direct costs associated with chronic rhinosinusitis are higher than the background costs in managed care patients because of increased office visits and medication prescriptions, and the indirect costs due to restricted activity days are enormous. Rhinosinusitis poses an immense economic burden in the United States. Data concerning the epidemiology and economic impact of the disease are reviewed.
Pathogenesis of Chronic Rhinosinusitis
Authors: Kennedy David W.
Published: January 2017

Chronic rhinosinusitis (CRS) is a multifactorial disease. Predisposing factors can be divided into environmental and non-host factors, such as pollution, viral infections, smoking, fungus, and bacteria; general host factors, including genetic factors and immune deficiency; and local host factors, including persistent focal inflammation within the ostiomeatal complex. Evidence suggests that the underlying bone in the ostiomeatal complex is actively involved in the disease process of CRS. The evidence concerning a broad range of predisposing factors for CRS is reviewed.
Imaging for Staging of Rhinosinusitis
Authors: Zinreich S. James
Published: January 2017

Although clinical judgment is sufficient to diagnose rhinosinusitis in many cases, a number of patients with recurrent or complicated sinus disease require imaging studies. Advances in the field of diagnostic imaging techniques such as computed x-ray tomography (CT) and magnetic resonance imaging have enhanced our understanding and management of the disease. Magnetic resonance imaging excels in displaying soft tissue resolution and is superior in demonstrating the presence of neoplasia and fungal sinusitis, but has limited advantages over CT scanning in demonstrating the regional anatomy (bony structure) and in the diagnosis of chronic rhinosinusitis. Computed tomography provides greater detailed information about the paranasal sinuses than do plain radiographic films. Rhinosinusitis staging systems utilizing CT techniques are reviewed. Although results from the Lund-Mackay system appear to be easily reproducible, there are still clinical challenges not addressed by this method of classification. Considering the patency of specific ostiomeatal channels and quantifying the volume of disease may add to the clinical value of future classification systems.
Etiology of Chronic Rhinosinusitis: The Role of Fungus
Authors: Hamilos Daniel L. , Lund Valerie J.
Published: January 2017

Chronic rhinosinusitis (CRS) is a multifactorial disease. Predisposing factors can be divided into environmental and non-host factors, such as pollution, viral infections, smoking, fungus, and bacteria; general host factors, including genetic factors and immune deficiency; and local host factors, including persistent focal inflammation within the ostiomeatal complex. Evidence suggests that the underlying bone in the ostiomeatal complex is actively involved in the disease process of CRS. The evidence concerning a broad range of predisposing factors for CRS is reviewed. Chronic rhinosinusitis is an inflammatory disorder with numerous predisposing factors, including genetics, pollution, anatomic anomalies, bacteria, and fungus. In some studies, fungi have been cultured from nearly 100% of patients with rhinosinusitis and nasal polyposis. T-cell sensitization to fungus with production of the T-helper 2 (Th2) cytokine interleukin-5 has been proposed as a key step in the initiation of the disease. Interleukin-5 also plays an important role in the effector phase of the disease through its effects on eosinophilopoesis and eosinophil survival. There is considerable controversy concerning the role of fungi as the cause of “chronic eosinophilic rhinosinusitis” and whether this even represents a distinct clinical entity. Further study is also required to define the optimal treatment for the disease.
Consensus Statements on the BAHA System: Where Do We Stand at Present?
Authors: Snik F. M. , Mylanus Emmanuel A. M. , Proops David W. , Wolfaardt John F. , Hodgetts William E. , Somers Thomas , Niparko John K. , Wazen Jack J. , Sterkers Olivier , Cremers W. R. J. , Tjellström Anders
Published: January 2017

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.
Technical Innovations and the Evolution of Endoscopic Sinus Surgery
Authors: Kennedy David W.
Published: January 2017

Since the introduction of endoscopic sinus surgery, a number of significant technological advances, as well as an improved understanding of disease pathogenesis and management, have enabled major evolutions in surgical techniques. Modifications to surgical instruments, imaging, the development of the microdebrider, and other newer instrumentation have all contributed to the current level of patient success associated with endoscopic intranasal techniques. At the same time, it has become evident that anatomic variations are less important in the pathogenesis of chronic rhinosinusitis than was previously thought, and that ventilation alone is insufficient to resolve well-established disease. This paper reviews the changes that have occurred in endoscopic sinus surgery over the past 20 years since the techniques were first introduced into the United States, and the technologies that have enabled these changes and the development of extended endoscopic techniques. Continuing developments of interactive computer-guided surgery, endoscopic 3-dimensional imagery, robotics, and improved adjunctive therapies will further extend the role of endoscopic transnasal approaches to an expanded number of skull base and intracranial lesions.
Frontal Sinus Surgery: Its Evolution, Present Standard of Care, and Recommendations for Current Use
Authors: Chiu Alexander G.
Published: January 2017

From a historical perspective, frontal sinus surgery has evolved from radical, highly invasive, disfiguring approaches to function-preserving, minimally invasive, and non-disfiguring intranasal procedures. Most sinus surgeons would agree that a sound surgical procedure is one that relieves patients' symptoms and provides a safe sinus in which future intracranial and orbital complications will not occur. For the future, sinus surgeons are searching for the ideal procedure, ie, one that is minimally invasive, reversible, and ensures the patient a safe frontal sinus for the long term. The ideal surgery will also leave minimal morbidity, will leave no cosmetic defect, and will allow for easy postoperative surveillance. To achieve this new standard in frontal sinus surgery, continuous refinements are required in the medical management and understanding of the disease processes that undermine long-term surgical success. Further advancements in instrumentation and visualization techniques are also necessary to enhance surgical precision, spare mucosa, and prevent the scarring and neo-osteogenesis that may cause surgical failures. Perhaps the most important development may be in the selection criteria for appropriate candidates who will benefit most from frontal sinus surgery.
Fungus and Chronic Rhinosinusitis: From Bench to Clinical Understanding
Authors: Lanza Donald C. , Dhong Hun-Jong , Tantilipikorn Pongsakorn , Tanabodee Jirayu , Nadel Douglas M. , Kennedy David W.
Published: January 2017

Although fungus-related sinusitis has been described for at least 2 centuries, a more detailed pathologic description of the problem as it relates to eosinophilic disease was not detailed until 1983, when “allergic fungal sinusitis” was described histopathologically. Until then, most fungal sinus disease was perceived to occur in immunosuppressed diabetic patients with invasive fungus. It is now acknowledged that depending upon the immune status of the host, fungus-related sinus disease can take several forms. Interest in this subject matter was intensified in 1999, when it was suggested that fungi might be an important cause of most cases of chronic rhinosinusitis. This hypothesis remains controversial, and there is mounting evidence to support the multifactorial nature of chronic rhinosinusitis, which may include fungus. In fact, etiologic factors for all forms of fungus-related sinus disease are still poorly understood. The prevalence of the disease and the dominant fungal pathogen appear to vary in different geographic regions and probably are related to individual host conditions. Immunoglobulin E-mediated allergic reactions to mold appear to be associated with disease in some patients, but not in all. Although antifungal therapy is known to be lifesaving for invasive disease, its role in extramucosal disease is less well defined. Preliminary trials suggest that some systemic and topical antifungal agents are of clinical benefit in extramucosal disease. Since sinus fungi are rarely invasive in immunocompetent individuals, it is not clear whether the effects of the antifungal treatments are a result of the antifungal action itself, or due to additional properties these drugs possess. This review summarizes the available data and presents some of our clinical and experimental findings as to the role of fungus in chronic rhinosinusitis.
Bacterial Biofilms in Chronic Rhinosinusitis
Authors: Palmer James
Published: January 2017

Chronic sinusitis is a prevalent, debilitating condition, and a subpopulation of patients fails to respond to either medical or surgical intervention. Bacterial biofilms are 3-dimensional aggregates of bacteria that have special properties due to their group structure, including increased resistance to antibiotics in some forms. They have been shown to play a major role in many chronic infections, including cystic fibrosis, endocarditis, and otitis media. Evidence now suggests that they may play an important role in chronic sinusitis. Our laboratory has identified the presence of biofilms in sinonasal mucosa isolated from human patients and on stents removed after frontal sinus surgery. In addition, biofilms have been found on the sinus epithelium of rabbits infected with Pseudomonas aeruginosa, but not in rabbits infected with non-biofilm-forming P aeruginosa mutants. This animal model can provide opportunities to address the functional significance of biofilm production in the sinus cavities. A further understanding of the role of bacterial biofilms may lead to the development of more appropriate therapies for the treatment and prevention of chronic sinusitis.
The Sequential Bithermal Binaural Caloric Test
Authors: Black Franklin O.
Published: January 2017

Three tests for the determination of caloric nystagmus response abnormalities have been developed, based upon analysis of intrasubject normal responses, obtained by using a statistical model that provided an exact fit with clinical procedures. Normal Emits derived from interaural, stimulus temperature, and nystagmus direction responses should provide a more sensitive index of abnormality than limits based on percentage based response criteria. A retrospective examination of caloric responses from Ménière's disease patients provided preliminary support for clinical feasibility and increased sensitivity of the statistical methods advocated for clinical usage.
Vocal Rehabilitation in the Laryngectomized Patient with a Tracheoesophageal Shunt
Authors: Komorn Robert M.
Published: January 2017

A tracheoesophageal shunt was used for vocal rehabilitation in 29 laryngectomized patients. Twenty-three patients had the shunt constructed at the time of laryngectomy. Radiation therapy or radical neck dissection did not limit the usefulness of the shunt. Twenty of the 29 patients acquired useful speech (69%). T-E shunt speech equals or exceeds other forms of alaryngeal speech when measured against the parameters of rate, duration, and intelligence. Failure to acquire useful speech occurred in nine patients because of either stenosis of the shunt (10%), aspiration (7%), or wound probems (14%). Stenosis of the shunt was primarily a problem in patients who received postoperative radiation therapy without a stent in the shunt. Wound problems were related to either our previous use of a lateral based flap or diabetes mellitus. Since January 1973 there has only been one failure in fourteen shunts constructed. The technique as now used is simple, applicable in a wide variety of clinical situations and associated with a low incidence of complications.
A Technique for Improving Esophageal and Tracheopharyngeal Speech
Authors: Montgomery William W. , Lavelle William G.
Published: January 2017

Phonation in both excellent and poor esophageal and tracheopharyngeal speakers was studied radiographically and was recorded to evaluate volume and pitch. Sphincteric function usually occurred at the inferior constrictor level in those speakers with satisfactory phonation; a lack of sphincteric function was noted as cause for poor esophageal and tracheopharyngeal speech. An operative procedure, the sternomastoid muscle swing operation, is introduced as a method of providing the laryngectomee with an additional mechanism for improving both the volume and the pitch of esophageal and tracheopharyngeal speech. In addition, the presence of the muscle above the mucosal tube and anterior to the reconstructed hypopharynx adds support and blood supply. The presence of the muscle bulk anterior to the reconstructed pharynx definitely reduces the incidence of salivary leakage through the mucosal tube.
Experiences with the Carbon Dioxide Laser in the Larynx
Authors: Andrews Albert H. , Moss Harold W.
Published: January 2017

Techniques for the application of the carbon dioxide laser to laryngeal surgery are outlined and include operative and anesthetic management. Laser surgery teaches improved surgical judgment in and application of conventional procedures. The lack of trauma, the degree of precision and the speed of healing as seen in one year of experience indicate the results of laser surgery to be superior to conventional techniques in the treatment of papilloma, polyps, polypoid degeneration, hyperkeratosis and carcinoma in situ. A family of laryngeal retractors is introduced whose utilization with intralaryngeal mirrors makes essentially all areas of the larynx accessible for lasing.
Total Reconstruction of the Hypopharynx with Tongue Flap and Dermal Graft
Authors: Loré John M.
Published: January 2017

A one stage procedure utilizing a posterior tongue flap and dermal graft for reconstruction of the hypopharynx following total laryngopharyngectomy is described. The operation has been performed upon four patients, with satisfactory to excellent results as far as deglutition is concerned: one patient had some dysphagia initially, was dilated and then progressed to excellent deglutition: two patients with satisfactory to excellent deglutition: one patient with excellent deglutition initially, but finally developed a stricture, which has been treated with dilatation with satisfactory results. Follow-up reveals: one patient is alive and well two years and four months; another patient is alive with recurrent disease in the contralateral neck, while two patients have expired 22½ months and seven months, without evidence of local disease.
Adenocarcinoma of the Larynx
Authors: Whicker James H. , Neel H. Bryan , Weiland Louis H. , Devine Kenneth D.
Published: January 2017

From 1949 to 1974, 27 patients with adenocarcinoma of the larynx were treated at the Mayo Clinic. Histologically, the cancers were classified as indeterminate adenocarcinoma (12 tumors), cylindroma (9 tumors), and mucoepidermoid carcinoma (6 tumors). Patients with cylindromas tended to differ from patients with other adenocarcinomas in respect to sex, symptoms, origin of the cancer, and length of survival. The prognosis of patients with any form of adenocarcinoma of the larynx is very poor.
The Presence of Melanocytes in the Nasal Cavity
Authors: Zak Frederick G. , Lawson William
Published: January 2017

Dendritic cells containing melanin pigment have been demonstrated with silver impregnation and bleaching techniques in the nasal cavities of both Caucasians and Negroes. They were found in the respiratory epithelium, nasal glands and commonly in the superficial and deep stroma of the septum and middle and inferior turbinates, particularly in adult Negroes. The presence of melanocytes explains the histogenesis of melanomas of the nasal cavity as primary neoplasms at this site.
Tracheostome Maintenance by Obturator for Prolonged or Future Need
Authors: Friedberg Stanton A. , Azem Khalil , Wallner Linden J.
Published: January 2017

Maintenance of a tracheostome by obturator is a valuable adjunct in airway-related problems of long duration. Obturators have hitherto been used principally for infants and children during decannulation efforts. Synthetic obturators are useful in adults who may not require a conventional tracheal cannula for breathing for prolonged periods or when the probability exists of need for a repeat tracheostomy in the future. Patients with chronic lung disease, vocal cord paralysis with polypoid corditis, lupus erythematosus, pemphigus, myasthenia gravis and head and neck cancer have had their tracheostomes maintained by synthetic obturators during symptom-free periods. It is simple to substitute conventional tracheal cannulas or cuff tubes when needed. Synthetic obturators are simply made, inexpensive, easily cleaned, cause no tissue reaction and permit speech without finger occlusion.
A Report of Four Cases and a Review of the Literature
Authors: Becker Gary D. , Wernicke Alexander M.
Published: January 2017

Four cases of gonococcal pharyngotonsillitis have been presented, along with a review of the world literature. This entity is most commonly seen in those individuals practicing fellatio, i.e., females and homosexual males. The infection may be passed to the newborn by the infected genitals of the mother during birth, to the infant from adult molestation, or among sexually promiscuous children. Most gonococcal pharyngeal infections result in a carrier state, and as such, are possible reservoirs of propagated infections. When symptomatic, the most frequent complaint is a sore throat. Physical finding among symptomatic patients reveal a wide spectrum ranging from mild hyperemia of the pharynx or tonsils, to exudative tonsillitis with tender cervical lymph nodes and moderate elevation of temperature. Most authorities agree that the preferred treatment is 4.8 million units of procaine penicillin G I.M., with one gm of probenecid by mouth thirty minutes before the injection. If allergic to penicillin, tetracycline should be given, 1.5 gm by mouth stat, then 0.5 gm four times a day for a total of 9 gm. A routine blood agar culture of the throat will not reveal the presence of the gonococcus. Thayer-Martin (or Transgrow) media must be used. Failure to detect pathogenic bacteria in a routine culture may lead to either no treatment or improper treatment of a gonococcal pharyngotonsillar infection. This may result in a carrier state, or even worse, to a disseminated gonococcal infection.
Glaucoma and Idiopathic Endolymphatic Hydrops
Authors: Berkowitz Wallace P. , Sessions Donald G. , Stroud Malcolm H.
Published: January 2017

Present concepts concerning endolymphatic hydrops and glaucoma production are similar. A study was undertaken to evaluate the possibility of identifying early glaucomatous changes in patients with symptoms suggesting endolymphatic hydrops. Precise tests are available for glaucoma but lacking for endolymphatic hydrops. The results obtained indicate no correlation between the two disorders.
Postoperative Pneumothorax Secondary to Hypopharyngeal Perforation during Anesthetic Intubation
Authors: Hawkins Donald B. , House John W.
Published: January 2017

A case is reported of an eleven-year-old male who sustained a perforation of the hypopharynx while undergoing routine anesthetic intubation in the operating room. This resulted in severe respiratory distress due to a tension pneumothorax in the immediate postoperative period.