bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Gastroesophageal Reflux on Base of the Tongue
Authors: Habesoglu Tulay E. , Habesoglu Mehmet , Toros Sema Z. , Gursel Ali O. , Oysu Cagatay
Published: February 2015

Objective

There are studies about the hypertrophy of the base of the tongue due to gastroesophageal reflux (GER), but there have been no reports explaining the effects of GER on the base of the tongue histopathologically. Therefore, we investigated the histopathologic changes of tongue base using an experimental model of reflux.

Method

The randomized study was conducted at Haydarpasa Numune Hospital. Eighteen rats were divided into 3 groups according to exposure time, and 4 rats were examined as controls. An experimental model of gastroesophageal reflux was induced. The histopathological changes in the base of the tongue were observed under a light microscope.

Results

At the end of the first week, only subepithelial edema was significantly different in the exposed group when compared to the control group. After 4 weeks in addition to subepithelial edema, submucosal gland hypertrophy was significantly different from the control group. When we assessed submucosal gland hypertrophy and subepithelial edema in the group exposed to refluxate for 12 weeks, they were found to be much increased compared with the 4‐week group. Also, inflamation, vascular dilatation, and achantosis were determined to be significantly increased compared with the control group.

Conclusion

The current study suggests that GER results in histopathological changes in the base of the tongue. Therefore, it suggests a new perspective to the relationship between GER and throat clearing, dry cough, and especially globus pharyngeus.
Ouabain‐Induced Cochlear Degeneration in Rat
Authors: Fu Yong , Wei Yan
Published: February 2015

Objective

To elucidate the neurodegenerative effects of ouabain in vitro and in vivo in rat.

Method

Ouabain applied in organotypic cultures. Phalloidin and neurofilament antibody used to label hair cells and nerve tissue. In vivo, 1 mM or 10 mM ouabain applied to round window. ABR and DPOAE were recorded 7 days posttreatment. Cochlea sections were used to count SGN and nerve fibers. TUNEL staining were used to assess apoptosis.

Results

In vitro, low concentrations of ouabain only damaged spiral ganglion neurons; however, high doses destroyed both spiral ganglion neurons and cochlear hair cells. Application of 1 mM ouabain to the rat round window membrane only altered ABR thresholds and DPOAE amplitudes at higher frequencies. In contrast, 10 mM ouabain significantly increased ABR thresholds and decreased DPOAE amplitudes at almost all frequencies. Consistent with physiological results, both spiral ganglion neurons and hair cells were missing or damaged in the basal turn of the cochlea and both hair cells and neurons showed signs of apoptotic cell death.

Conclusion

In vitro and vivo, ouabain damage was dose and time‐dependent; SGN were more vulnerable than HCs. ABR thresholds increased at high frequencies with 1mM ouabain and increased at all frequencies with 10 mM ouabain.DPOAE amplitude minimally affected with 1 mM ouabain and got large reduction at all frequencies with 10 mM oubain.
Persistent Petrosquamosal Sinus in Chronic Otitis Media
Authors: Hiraumi Harukazu , Yamamoto Norio , Sakamoto Tatsunori , Ito Juichi
Published: February 2015

Objective

The petrosquamosal sinus (PSS) is an emissary vein that connects the transverse sinus and the external jugular vein. Recent studies have shown that a PSS can be identified on high resolution CT scan when it is contained within a bony canal. The persistent PSS is a potential risk of bleeding in middle ear surgery. The aim of this study is to determine the prevalence of the PSS in patients with chronic otitis media.

Method

Between February 2011 and January 2012, 61 ears (47 patients) underwent CT scan before surgery for chronic otitis media. Patients younger than 10 years, showing congenital temporal bone anomaly, and having received prior ear surgeries, were excluded. The prevalence of persistent PSS was evaluated using CT scan. During the same period, 66 ears (33 patients) with peripheral facial palsy underwent CT scan. The frequency of a PSS was also examined in these patients.

Results

Among the 61 ears with chronic otitis media, a PSS was detected in 12 ears on CT scan (20.0%). Among them, the PSS was identified during surgery in 2 ears. The incidence was similar in the 2 ears (right ear: 6/32, left ear: 6/29). The PSS was more frequent in men than in women (men: 9/34, women: 3/27). In patients with facial palsy, a PSS was found in 7 of 66 ears.

Conclusion

The persisted PSS was frequently detected in patients with chronic otitis media. Care should be taken to avoid damaging this vein during the mastoid surgery.
Platelet‐Rich Fibrin for the Repair of Tympanic Membrane
Authors: Habesoglu Mehmet , Oysu Cagatay , Sahin Serap , Sahin‐Yilmaz Asli , Korkmaz Deniz , Tosun Ahmet
Published: February 2015

Objective

To investigate the effect of the Choukroun’s platelet‐rich fibrin (PRF) on the acute tympanic membrane perforations due to trauma without application of any classic tympanoplasty procedure.

Method

This prospective controlled study was conducted at Umraniye Hospital, between April and December 2011. Thirty‐two subjects with acute tympanic membrane perforations due to trauma were divided randomly into 2 groups (study: 14, control: 18). In the study group, PRF was used to repair tympanic membrane perforations. In the control group, no manipulation was performed.

Results

Mean area of perforation was 10.93 ± 3.58 mm2 in the study group and 10.05 ± 4.02 mm2 in the control group in the first examination. At the end of the first month the mean area of the perforation was 1.35 ± 2.53 mm2 in the study group and 4.44 ± 3.34 mm2 in the control group (P <. 01). Total closure rate of the tympanic rates was 64.3% for the study group and 22.2% for the control group (P <. 05) at the end of the first month. At the end of the second month, number of patients with a perforation was 1 for the study group, 4 for the control group (P >. 05).

Conclusion

PRF application in otologic interventions is a new subject and little information is currently available about its use in otology. Our study has shown that PRF is an autogenous, useful and easy to prepare biomaterial which accelerates the healing of the tympanic membrane.
Postauricular Cutaneous Mastoid Fistula Repair
Authors: Vira Darshni , Andrews James C.
Published: February 2015

Objective

1) To review traditional techniques for the closure of postauricular cutaneous mastoid fistulas. 2). To describe a novel double layer closure technique in the management of postauricular cutaneous mastoid fistulas.

Method

Retrospective review of patients diagnosed with postauricular cutaneous mastoid fistulas in an academic medical center over a 10‐year period.

Results

Four patients identified from January 2000 to August 2010 were treated for postauricular cutaneous mastoid fistulas. Follow‐up varied from 8 to 48 months. The etiologies of development of postauricular fistulas were all post‐mastoidectomies. All patients were treated using a similar surgical technique involving double layer closure of the fistula tract utilizing 2 rotational flaps of 1) temporalis muscle and fascia and 2) conchal cartilage. All patients had successful fistula closure with lasting results.

Conclusion

Cutaneous mastoid fistulas are often the result of repeated postauricular approaches for surgical treatment of mastoid infections, and can be difficult to surgically manage. These postauricular fistulas can be managed with long‐term success using a novel double layer closure technique using temporalis muscle and fascia and conchal cartilage with skin.
Posterior Tympanotomy/Endomeatal Combined Approach in Cochlear Implantation
Authors: Cantore Italo , Volpe Antonio Della , Valente Paola , Santandrea Michela , Santandrea Valentina , Cantore Rocco
Published: February 2015

Objective

An alternative posterior tympanotomy/endomeatal combined approach for cochlear implantation is presented. Surgical steps and our results in 64 patients, 32 submitted to combined posterior tympanotomy/endomeatal approach and 32 underwent to traditional surgery, are reported.

Method

Sixty‐four patients, 34 men and 30 women, mean age 28 years (range, 1‐81 years), 26 preverbal and 38 postverbal, were submitted to cochlear implantation, 32 by means of a combined posterior tympanotomy/endomeatal approach and 32 with traditional posterior tympanotomy alone approach.

Results

We reported good anatomic and functional results with intraoperative improvements in visibility and accessibility of cochleostomy site in difficult cases. At 12 months we did not observe any complication such as tympanic membrane perforation, external canal skin lesions, or extrusion. No significant differences were found with traditional technique complication rates excepting for partial insertion data, with statistically significant better results with combined access.

Conclusion

The combined posterior tympanotomy/endomeatal approach facilitates the array insertion in conditions of bad exposition/accessibility of promontory and round window. Moreover, this double way access hinders an incomplete or incorrect positioning. It should be always considered as an alternative to the traditional posterior tympanotomy 1‐way access.
Preoperative Hearing Estimation Using a BAHA Testband
Authors: Kim Do Yoon , Park Hong Ju , Ahn Joong Ho , Chung Jong Woo , Yoon Tae Hyun
Published: February 2015

Objective

It is desirable for patients to have realistic expectations before surgery with preoperative use of a BAHA test‐band. We aimed to investigate how much gain patients can obtain with preoperative use of a BAHA test‐band with full‐on gain and compared the results with those of BAHA users with the volume control at the comfortable level.

Method

Nineteen patients with single‐sided deafness were included. Sound‐field threshold and speech understanding were measured with naked ears under sound field (condition 1), with an ear‐plug on the intact ear (condition 2), and with an ear‐plug on the intact ear and a BAHA testband on the lesioned ear (condition 3).

Results

The speech reception thresholds (SRTs) at condition 2 were higher than those at condition 1 by 26 dB, which means that the sound attenuation by an ear‐plug was 26 dB. Although SRTs (17 ± 7 dB HL) at condition 3 were similar to those (19 ± 9 dB HL) at condition 1, tonal thresholds at condition 3 were better at 1 and 2 kHz and poorer at 250 Hz compared to those at condition 1. Those hearing gains with a BAHA testband with full‐on gain are similar to those of BAHA users with the volume level at the comfortable level.

Conclusion

Our findings suggest that the hearing gain by a BAHA testband with full‐on gain is similar to the postoperative gains of BAHA users with the volume control at the comfortable level. BAHA candidates can experience a postoperative audiologic gain by preoperative use of a BAHA test‐band with full‐on gain.
A Report of Microtia and Ipsilateral Scalp Hemangioma
Authors: Thakkar Punam G. , Butts Sydney C. , Lester Jenna
Published: February 2015

Objective

1) Describe the case of a patient with microtia who developed an infantile hemangioma of the ipsilateral occipital scalp. 2) Investigate possible embryological links between these 2 lesions found together in a common developmental field. 3) Discuss the surgical treatment of an infantile hemangioma of the scalp during the proliferative phase.

Method

A type III microtia and an infantile hemangioma of the ipsilateral scalp are reviewed in this case report, from a tertiary‐care medical center. The period of care from July 2010 to February 2012 is reviewed. Hemangioma excision is the main intervention. Surgical outcome and syndrome evaluation will be presented.

Results

The patient presented for evaluation at 8 months of age with a 4‐cm hemangioma of the right occipital scalp and a type III microtia. A mild marginal mandibular weakness was also observed. No heart murmur was present, and the neurologic examination was nonfocal. The hemangioma became ulcerated. Excision was performed when the patient was 10 months of age with a purse string closure of the defect. A review of the literature indicates no reports of concurrent scalp hemangioma with a classic microtia. In preparation for later microtia reconstruction, early excision of the scalp hemangioma was felt to be advantageous.

Conclusion

A review of the literature indicates no reports of concurrent scalp hemangioma and microtia. Their co‐occurrence may indicate possible common errors in their pathogenesis. The consistent distribution of hemangiomas with embryological subunits of the face and mesenchymal cell populations unique to each zone could point to a common link.
Radiation‐Induced Sensorineural Hearing Loss
Authors: Mota Mario Mujica , Waissbluth Sofia , Daniel Sam
Published: February 2015

Objective

To systematically review the literature to characterize radiation‐induced sensorineural hearing loss for head and neck tumors.

Method

Seven databases were searched to identify studies assessing the characteristics of sensorineural hearing loss caused exclusively by radiotherapy for head and neck cancer.

Results

Fourteen articles were evaluated. The reported incidence of sensorineural hearing loss was higher on frequencies above 4 Hz (up to 95%) when compared to the speech frequencies. Radiation dose and follow‐up time were important factors affecting incidence rates.

Conclusion

Evidence demonstrates that the resulting SNHL is irreversible, progressive, and dose‐dependent. High‐quality literature regarding SNHL due to radiotherapy is lacking. Improved evaluation protocols should be adopted in the standard of care for patients undergoing radiotherapy.
Saccular Function after Stapedotomy
Authors: Majidi Mohammad Reza , Haghi Mohsen Rajati , Afzalzadeh Mohamadreza , Tale Mohammad R. , Hassanzadeh Nadia
Published: February 2015

Objective

To evaluate the effect of stapedotomy on saccular function.

Method

This clinical trial was conducted between October 2009 and September 2011. Bone‐conducted tone‐burst‐evoked vestibular‐evoked myogenic potential (VEMP) test was performed in patients with otosclerosis before and 1 week after stapedotomy.

Results

Twenty‐four patients with otosclerosis entered the study. Mean age of patients was 34.66 ± 13.16 years. Female to male ratio was 2:1. VEMP was recorded in 22 patients before surgery. There were no differences in VEMP test results before and after stapedotomy.

Conclusion

It seems that stapedotomy does not influence saccular function. Moreover, saccular function seems to be normal in majority of patients with otosclerosis.
Seasonality in Vestibular Neuronitis
Authors: Koors Paul D. , Thacker Leroy R. , Coelho Daniel H.
Published: February 2015

Objective

1) Determine the incidence of vestibular neuronitis at our institution over a 36‐month period. 2) Use statistical methods to assess the incidence of vestibular neuronitis for seasonal variation.

Method

A retrospective case review was performed to determine the incidence of vestibular neuronitis at our institution over the 36‐month period from May 1, 2008, to April 30, 2011. The c2 test and Rayleigh test for circular means were then used to assess the incidence for uneven distribution and seasonality, respectively.

Results

A total of 52 patients were diagnosed with vestibular neuronitis during the study period. The 2009‐2010 study year showed uneven distribution (c2 = 24.91, 11 df, P =. 009) as well as evidence of seasonality (R = 7.211, P <. 001). However, the other 2 study years did not show statistical significance by either the c2 test (2008‐2009: c2 = 7.95, 11 df, P =. 718; 2010‐2011: c2 = 11.85, 11 df, P =. 375) or Rayleigh test (2008‐2009: R = 0.320, P =. 732; 2010‐2011: R = 1.626, P =. 199). In addition, when incidence values were aggregated across all 3 study years, both the c2 test (c2 = 4.31, 2 df, P =. 116) and Rayleigh test (R = 1.472, P =. 229) failed to show statistical significance.

Conclusion

The present study found minimal evidence of seasonality in the incidence of vestibular neuronitis. However, due to small sample size, further study is warranted, as evidence of seasonality would lend further credit to a viral etiology of the disease.
Sound Localization after Canaloplasty
Authors: Cho Yang‐Sun , Moon Joon , Park Ga‐Young , Byun Ha‐Young , Youm Hye‐Youn , Chung Won‐Ho , Hong Sung Hwa
Published: February 2015

Objective

Unilateral congenital aural atresia (CAA) is much more common than bilateral atresia, and subsequent unilateral hearing loss usually leads to poor sound localization. The objective of this study was to investigate the change in sound localization after canaloplasty for correction of the unilateral hearing loss.

Method

Twenty patients with unilateral CAA, who underwent canaloplasty, were enrolled. Pure tone audiometry, sound localization test, and Speech, Spatial, and Quality (SSQ) questionnaire were administered preoperatively and 6 months postoperatively. For sound localization test, 8 loudspeakers were positioned around the patient, and patients were instructed to identify the sound source.

Results

Mean air‐bone gap decreased from preoperatively 54.6 dB to 25.3 dB 6 months after canaloplasty. In sound localization test, mean correct response rate and error degree at preoperative evaluation were 27.40% and 60.7°, respectively, and these were improved to 57.5% and 26.2° postoperatively. Mean correct response rate to ipsilesional stimuli following canaloplasty (left/right discrimination) improved from 29.5% to 88.2%, and that to contralesional stimuli improved from 90.0% to 98.7%. In addition, scores in the spatial domain of the SSQ questionnaire improved significantly from 6.6 to 7.5 after canaloplasty (P =. 014).

Conclusion

Sound localization performance including right‐left discrimination ability improved significantly 6 months following canaloplasty. Canaloplasty could restore a binaural hearing ability and may be a good treatment option to improve sound localization ability in unilateral CAA patients.
Superior Canal Dehiscence in Spontaneous Cerebrospinal Fluid Otorrhea
Authors: Allen Kyle P. , Kutz Joe W. , Isaacson Brandon , Duong Thao , Roland Peter S.
Published: February 2015

Objective

Determine the incidence of superior semicircular canal dehiscence in patients with spontaneous cerebrospinal fluid (CSF) otorrhea.

Method

This is a retrospective case review at a tertiary care referral center. Patients included underwent a middle fossa craniotomy for repair of spontaneous CSF otorrhea between January 2007 and December 2011. The main outcome measure is the presence or absence of a dehiscent semicircular canal observed during spontaneous CSF leak repair.

Results

Thirty‐three ears in 31 patients underwent surgical repair for spontaneous CSF otorrhea via a middle fossa craniotomy. The average age at the time of repair was 60.5 years and 80.6% of patients were women. The left ear was more commonly involved in 66.7% of cases. An encephalocele was observed in 69.7% of ears. A dehiscence of the superior canal was observed in 15.2% of ears (16.1% of individuals). All ears with a dehiscent superior canal were also observed to have an encephalocele. No significant difference in age, BMI, or gender was noted between those patients with or without a superior canal dehiscence.

Conclusion

The incidence of superior semicircular canal dehiscence in ears with spontaneous otorrhea is 15.2%. This incidence is greater than that reported in a temporal bone study of ears not selected for CSF otorrhea.
The Continuum of Biofilms in Different Types of Otitis Media
Authors: Shibata Dai , Schachern Patricia A. , Tsuprun Vladimir , Harada Tamotsu , Paparella Michael M. , Cureoglu Sebahattin
Published: February 2015

Objective

It is recognized that the various types of otitis media (OM) follow a continuum with early forms of the disease leading to more chronic forms over time. This study investigates if biofilms play a role in conjunction with the continuum of pathological changes in different stages of OM.

Method

Thirty human temporal bones of each type, sero‐ purulent OM (SPOM), purulent OM (POM), chronic OM with purulent effusion (PCOM), and fourteen mucoid OM (MOM), were selected. We defined “web‐like structures” with host defense cells and bacterial bodies as biofilm. We examined the occurrence, frequency, and anatomic locations of biofilms.

Results

Biofilms were observed in 10 (33.3%) of the 30 temporal bones with SPOM, 19 (63.3%) with POM, and 20 (66.7%) with PCOM. A significant difference of biofilms’ frequency between SPOM and POM (P =. 038), and SPOM and PCOM (P =. 017), was observed. The most common anatomic location was mastoid antrum and mastoid cells (35 of 49 temporal bones, 71.4%). The number of anatomic locations with biofilms was 2.20 ± 1.03 in SPOM, 2.89 ± 1.70 in POM, and 4.15 ± 1.60 in PCOM. There was a significant difference of locations between PCOM and SPOM (P <. 001), and PCOM and POM (P =. 022).

Conclusion

The frequency of biofilms suggests that the presence of biofilms is associated with the severity of OM. The growth and development of biofilms may play an important role in the progression of chronicity of OM.
The Efficacy of Combined Medical Therapy for Tinnitus
Authors: Chung Ji Hyun , Lee Sun Kyu , Lee Ho Yun , Byun Jae Yong , Park Moon‐Suh , Yeo Seung Geun
Published: February 2015

Objective

Little is known about the mechanism that causes tinnitus and there is no definite treatment. In practice, a combination of drugs is preferred over a single drug regimen. The aim of this study is to evaluate and compare the effectiveness of 3 kinds of combination regimen for tinnitus.

Method

We reviewed the records of 128 patients (157 ears) with tinnitus. Fifty of these patients were treated with ginkgo biloba extract, antiplatelets and anxiolytics. Another 50 patients were treated with ginkgo biloba extract, anxiolytics, and vasodilator. Twenty‐eight patients were treated with anxiolytics and vasodilator. Pre‐ and posttreatment statuses were analyzed by tinnitus handicap inventories.

Results

Subjective tinnitus was improved in all 3 groups with no significant difference in tinnitus handicap inventory scores between the 3 observed groups (P =. 2). The response group had a tendency to have longer periods of medication intake and lower Beck Depression Index scores compared to the nonresponse group. There was no difference between the response group and the nonresponse group in age, sex, or tinnitus characteristics.

Conclusion

From the analysis of this study, combined medical therapy is effective for tinnitus regardless of regimen.
The Multiplicity of Chronic Otitis Media Foci
Authors: Zhang Jiaxiong
Published: February 2015

Objective

To observe the multiplicity of chronic otitis media mastoiditis foci and to explore their treatment through functional surgery.

Method

Sixty patients with chronic otitis media mastoiditis were hospitalized and given functional surgeries that consisted of modified radical mastoidectomy, tympanoplasty, and ossicular chain reconstruction between January 2008 and December 2009. The operation emphasized the preservation and reconstruction of the ear function.

Results

The foci found during operation were cholestoma, cholesterol cyst, sclerosis, mucosa inflammation, and bone pathological changes. Three cases were found to involve only 1 type of foci; 15 cases were found to have 2 types of foci coexisted; 3 kinds of foci were found to coexist in 37 cases, and more than 3 kinds of foci were found to coexist in 5 cases. There were defects in facial nerve canal in 19 cases, and fistula on labyrinth in 3 cases. Postsurgery follow‐up showed the dry ear time ranged from 1 to 3 months, 1.5 months on average. The difference of the air‐bone conduction gap between preoperation 34.95 ± 7.52 dB and postoperation 15.27 ± 5.00 dB was statistically significant (t = 3.68, P <. 01).

Conclusion

Chronic otitis media and mastoiditis have foci including cholestoma, cholesterol cyst, sclerosis, mucosa inflammation, and bone pathological changes. Most of the cases show more than 1 focus and some even involve all of the 5 foci. Skillful microscopic technique is the key to treatment and functional surgery.
The Voices and Speech in Patient with Cochlear Implants
Authors: Ruiz Hector E. , Dotto Gabriela , Sanchez Bibiana , Ruiz Beltran
Published: February 2015

Objective

This work aims to link the technological advances (cochlear implant) in prosthetic equipment for the deaf to their impact on voice and speech in profound hearing loss.

Method

Thirty‐three patients between 6 and 30 years old with bilateral profound sensorineural congenital hearing loss, with cochlear implants. The recorded patient voices have been digitally processed with an Acoustic Analysis of Voice and Speech Program ANAGRAF and have also been analyzed and registered by the segmental and suprasegmentals features of voice and speech.

Results

Regarding voice quality, 48% reported a slight improvement and the other 48% a significantly improvement. The remaining 4% did not show changes. A total of 83% of patients tested so far shows a better improvement from personal calibrations between the 1° and 2° sample. Considering all the tested values for voice quality, improvement is observed in almost all subjects tested (32/33).

Conclusion

It was observed that patients showing better hearing performance as a result of prosthetic equipment use (cochlear implant), personal adjustment of the acoustic parameters and voice quality in each case, have improved with aspects of vocal quality and articulation precision necessary to achieve good communication.
Treatment of Hearing Gain in Failed Idiopathic Sudden Sensorineural Hearing Loss
Authors: Choi Young‐Seok
Published: February 2015

Objective

To evaluate the effectiveness of intratympanic steroid injection on patients with a history of idiopathic sudden sensorineural hearing loss (ISSNHL) and failure of steroid therapy compared with patients who receive second oral steroids alone.

Method

Retrospective review of 70 patients with a history of ISSNHL and failure of hearing gain who receive intratympanic steroid injection or oral steroid as a second treatment modality.

Results

Seventy patients met inclusion criteria and were included in the study. The number of patients with improvement in pure tone average in the injection group was 12 (33%) compared with 6 (18%) in the oral group. Fifteen (41.7%) of the injected patients did have improvement in speech discrimination scores of greater than 15% compared with only 4 (11.8%) in the oral group.

Conclusion

Patients with ISSNHL who have failed oral steroid therapy can obtain better hearing results with intratympanic steroids injection in comparison to oral steroids.
Use of Image‐Guidance to Access the Endolymphatic Sac
Authors: Tsai Betty S. , Balachandran Ramya , Kahrs Lueder A. , Labadie Robert F.
Published: February 2015

Objective

One of the challenges in endolymphatic sac (ELS) decompression is the reliable identification of the ELS with minimal injury to surrounding structures. Here we propose to: 1) Demonstrate the feasibility of using imaging technology to identify the ELS. 2) Define a direct pathway from the lateral skull to the ELS.

Method

The location of the ELS was approximated in a CT scan using its anatomic relationship to nearby structures, and a linear path was manually selected from the mastoid cortex to the predicted ELS. The path was visually verified to determine its relationship to the actual location of the ELS.

Results

CT scans of 6 cadaveric temporal bones with bone‐implanted fiducial markers were analyzed. The location of the ELS was predicted using traditional surgical landmarks. A custom Microtable (microstereotactic frame) was manufactured for each bone to target the ELS via a linear path (selected manually by CT). The bone was drilled to decompress the ELS. The Microtable was then mounted on the fiducial markers and the drill bit passed through its target hole to determine the actual targeted path. The drill bit coincided with the ELS in all specimens and did not transect any critical structures along its pathway.

Conclusion

Current imaging technology allows for reliable identification of the ELS and generation of linear trajectories to reach the ELS without injury to adjacent structures. This work is the first step in the development of minimally invasive image‐guided techniques to safely access the ELS in the treatment of Ménière’s disease.
Ventilation Tube Treatment in Children with Otitis Media with Effusion
Authors: Ichihara Takahiro , Haginomori Shin‐Ichi , Mori Atsuko , Kanazawa Atsuko , Nishikado Akira , Kawata Ryo
Published: February 2015

Objective

1) Discuss the effects of ventilation tube placement on postoperative mastoid growth in children with otitis media with effusion (OME). 2) Show an incidence of postoperative complication, for example, spontaneous extrusion, permanent tympanic membrane perforation.

Method

In total, 177 tubes were inserted in 148 ears in 81 children with OME with a mean age of 5.5 years at our hospital from 2001 to 2009. Long‐term tubes were used: The T‐Tube (Goode) in 87 cases or the Type II tube (Paparella) in 90 cases.

Results

The tubes fell out spontaneously in 46%: 61% in the T‐Tube group and 32% in the Type II tube group. Postoperative permanent tympanic membrane perforation occurred in 10%. No relationship was observed between the incidence of tympanic membrane perforation and tube type or duration of tube insertion. Postoperative mastoid growth compared to preoperative condition estimated from X‐rays was 42%, 55%, 59%, and 65% at 1, 2, 3, and 4 years after surgery, respectively. Retaining the tube in place for more than 3 years was more efficient than doing so for 1 year in terms of mastoid growth statistically.

Conclusion

These results indicate that the mastoid air cells grow favorably in children with OME after ventilation tube insertion. The ventilation tube should be removed from the tympanic membrane 3 years or more after insertion from the viewpoint of the mastoid cells growth.
Vestibular Disorders in Childhood and Adolescence
Authors: Duarte Juliana A.
Published: February 2015

Objective

1) Assess diagnostic and therapeutic aspects in an neurotology ambulatory children’s department. 2) Assess diagnosis by age group, risk factors, previous related treatment given, and response to treatment.

Method

Retrospective study, case series, held in otoneurology pediatric ambulatory children’s department through evaluated medical records of all patients seen from 2006 to 2010.

Results

Eighty‐eight patients were included. The average age was 9.87 years. There were 46 girls (52.27%). The most prevalent diagnosis was VPBI in 48 (54.54%) cases, followed by vestibular cause metabolic syndrome (SVM), 21 (23.86%), and vestibular migraine in 10 (11.36%) patients. The majority (77.27%) had poor eating habits. The majority, 48 (54.54%), complained of vertigo. The vectoelectronystagmography (VENG) showed no changes in 22 (41.51%). In 30 (43.47%) patients improvement was noted with vestibular rehabilitation and dietary counseling, and dietary counseling alone was administered in 27 (39.13%) patients.

Conclusion

There was a predominance of diagnostic VPBI. Its close relationship with a history of migraine and its benign nature of evolution were noted. We noted the importance of monitoring, dietary counseling, and the role of vestibular rehabilitation in childhood and adolescence dizziness.
“Stuck”: Removal of Embedded Distal Airway Foreign Bodies
Authors: Hoff Stephen
Published: February 2015

Objective

1) Describe a novel technique for removal of embedded distal airway foreign bodies. 2) Apply the proximal endoscopic balloon dilation technique for removal of embedded distal airway foreign bodies in 2 patients. 3) Discuss the evolution, operative considerations, and future applications of the technique

Method

Report of 2 cases in 2011. Condition studied: Embedded, symptomatic distal airway foreign bodies. Subjects studied: Pediatric airway patients. Setting: Tertiary care pediatric hospital. Intervention: Rigid bronchoscopy with endoscopic balloon dilation of the proximal bronchial segment to facilitate access to the foreign body. Outcomes: Successful foreign body removal.

Results

Case 1: A 23‐month‐old patient with recurrent pneumonia. Rigid bronchoscopy showed a cashew piece in the distal airway with proximal edema preventing removal. Dilation of the proximal bronchial segment with a Fogarty catheter allowed for access and removal with optical forceps. Case 2: Two‐year‐old unrestrained passenger in a motor vehicle accident with tooth aspiration causing intermittent respiratory distress. At bronchoscopy, the tooth was in the distal airway and embedded in granulation tissue which prevented removal. A Fogarty catheter was used to dilate the bronchial segment proximal to the foreign body which was then removed with optical forceps.

Conclusion

Embedded airway foreign bodies are associated with edema and granulation tissue which may prevent removal due to proximal airway narrowing. We present a novel technique using a Fogarty balloon catheter to dilate the airway proximal to the foreign body. This allows for removal of otherwise stuck distal airway foreign bodies.
Accuracy of Preoperative Diagnosis of Pediatric Neck Masses
Authors: Hopewell Bridget , Schneider Rebecca , Gov‐Ari Eliav
Published: February 2015

Objective

Diagnosing pediatric neck masses is challenging, often requiring open biopsy. Epidemiology and diagnostic tests utility have been described, but accuracy of clinicians’ judgment has not. We will describe/analyze preoperative diagnostic accuracy and identify the relative contributions from clinical, radiological, and pathological data.

Method

Retrospective review of pediatric patients’ charts with an undiagnosed neck mass who underwent open biopsy from January 1986 to December 2011. 248 charts were reviewed, with approximately 30 more to review prior to presentation. Data collection identified preoperative accuracy and relative contributions of clinical clues, imaging studies, and FNA.

Results

Preoperative accuracy varied for each category of diagnoses. Congenital masses were diagnosed with 76% (n = 98) accuracy. Nodal inflammatory masses were correct in 55% (n = 85) of cases, whereas non‐nodal inflammatory were correct in only 13% (n = 8). Benign tumors were diagnosed in 71% (n = 17), yet only 64% (n = 14) in malignant cases. For miscellaneous diagnoses, accuracy was 35% (n = 26). Chi‐squared test indicates accuracy of diagnosis is significantly different between categories. Thirty‐eight percent of patients underwent preoperative CT scan, 11% had ultrasound, and 12% had an FNA of the suspicious mass. Sixteen percent of patients had no ancillary tests and all had correct diagnoses.

Conclusion

Clinical and radiographic clues often establish accurate diagnoses in pediatric neck masses. Most inaccuracies occurred in masses with nonspecific clinical clues as in inflammatory lymphadenopathy and malignancies. Delaying diagnosis of malignancies is unacceptable; therefore, a certain percentage of unnecessary open biopsies should be accepted despite the most judicious preoperative workup.
Branchial Cleft Cysts in a Pediatric Asian Population
Authors: Teo Neville , Ibrahim Shahrul I. , Tan Kun Kiaang
Published: February 2015

Objective

Branchial cleft anomalies present fairly commonly in children as lateral neck masses. However, the diagnosis of such anomalies may not always be straightforward. This study seeks to review the distribution of branchial cleft anomalies in an Asian pediatric population, and highlight the challenges involved in diagnosis.

Method

A retrospective chart review was performed of all pediatric patients who underwent surgery for branchial cleft anomalies between 2007 to 2011 in a tertiary pediatric hospital. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings, and histology. Classification of the branchial cleft anomalies was attempted from the results.

Results

Twenty‐six children underwent surgery for 27 branchial cleft anomalies in the 4‐year period; 1 child had excision of bilateral fourth branchial cleft sinuses. There were 7 patients (25.9%) with first, 5 patients (18.5%) with second, 2 patients (7.4%) with third, and 3 patients with 4 (14.8%) fourth branchial cleft anomalies. Six patients (22.2%) had branchial anomalies that were thought to be originating from the pyriform sinus, but we were unable to tell if these were from the third or fourth branchial clefts. The remaining 3 patients (11.1%) did not have adequate information for us to classify the level of anomaly.

Conclusion

The incidence of second branchial cleft anomalies appears to be lower in our Asian pediatric population, with a higher incidence of third and fourth branchial cleft anomalies. Knowledge of the embryology and related anatomy of branchial clefts is crucial in helping to identify the type of branchial cleft anomaly present.
Consistency of Voice Frequency and Perturbation in Children
Authors: Hill Courtney A. , Ojha Shilpa , Bunting Glenn W. , Maurer Rie , Hartnick Christopher J.
Published: February 2015

Objective

1) Evaluate normal pediatric voice frequency and perturbation measures with Voice Evaluation Suite (VES) and the Multi Dimensional Voice Program (MDVP). 2) Determine consistency of these measures over time. 3) Understand which measures might be most useful for evaluating children with voice disorders.

Method

Prospective, longitudinal study of normal voices of 50 children aged 4 to 17 years. Two tests of sustained utterances from each child were evaluated by 2 computerized voice analysis programs for frequency and perturbation. Intraclass correlation coefficient (ICC) assessed the reliability between the samples.

Results

Children (M:F 1.08:1) with a mean age of 8.34 years were tested on an average of 54.2 minutes apart. Each test included 4 utterances; 1 was analyzed by MDVP and 3 grouped utterances were averaged and evaluated by VES. Fundamental frequency had excellent reliability (ICC > 0.75) in both VES and MDVP. Jitter, shimmer, and noise to harmonic ratio were poorly reliable (ICC ≤ 0.4) in MDVP but had good reliability (ICC 0.4‐0.75) in VES.

Conclusion

Consistent measures of frequency can be derived from single, sustained utterances in children. Averaging multiple samples improves consistency of perturbation. Future work is needed to evaluate whether evaluating acoustic measure stability in spontaneous speech and in sustained utterances cued by tuning frequencies may provide further insight on pediatric voice consistency.
EGFR Inhibitor Therapy for Laryngeal Papillomatosis
Authors: Moldan Matthew , Bostrom Bruce , Liu Meixia , Tibesar Robert , Lander Timothy , Sidman James D.
Published: February 2015

Objective

1) Study efficacy of epidermal growth factor receptor (EGFR) inhibitor adjuvant therapies in recurrent respiratory papillomatosis by comparing surgical treatment intervals and modified Derkay score prior to and following initiation of medical therapy. 2) Understand factors which affect patient responses to EGFR inhibitor adjuvant therapy.

Method

We performed a retrospective case series of 4 pediatric patients with life threatening recurrent respiratory papillomatosis. Patient charts were reviewed to determine time between surgical procedures and Derkay severity score during operative procedures prior to and following initiation of EGFR inhibitors.

Results

Prior to therapy many of the patients’ median Derkay scores were worsening. Following initiation of EGFR inhibitor therapy, the median Derkay score decreased for all 4 patients. In one patient, in whom a limited response was observed, there was no significant change in the time interval between surgical procedures. In 2 patients there was a greater than 25% increase and in the remaining case the interval between procedures more than doubled the original time.

Conclusion

EGFR inhibitors appear to be a potential effective adjunct therapy for the treatment of recurrent respiratory papillomatosis. Beneficial results were observed in 3 patients as evidenced by Derkay score and interval between operative interventions. One patient exhibited no response to the EGFR inhibitors for reasons which are being investigated.
Evaluation of 2‐Stage Hearing Screening Model in Children
Authors: Arora Vipin , Singh P. P.
Published: February 2015

Objective

1) To know the incidence of hearing impairment in children up to the age of 2 years in an apparently healthy urban population in India. 2) To evaluate the efficacy of 2‐stage hearing screening using repeat otoacoustic emissions (OAE) and brain stem evoked response audiometry (BERA).

Method

A total of 2579 children up to the age of 2 years were screened in the pediatrics and ENT departments of a tertiary care university hospital for a duration of 1 year. TEOAE’s were used to screen hearing in response to an 80 dB SPL click, whereas DPOAE’s were measured in responses to stimulus condition with L1 = 65 dB SPL and L2 = 50 dB SPL. Those children who failed the initial OAE screening test were rescreened using OAE with similar parameters on a subsequent day. Children who failed the repeat testing by OAE were further subjected to BERA testing for confirmation of hearing loss.

Results

The mean age of children undergoing screening was 4.2 months. A total of 6.14% children failed on the initial OAE screening test, and 32.4% of children who failed the repeat test with OAE were subjected to BERA test. This 2‐stage testing by OAEs and BERA was collectively able to pick 0.17% of hearing impaired children in an apparently healthy pediatric population.

Conclusion

The present 2‐stage model using OAE and BERA is successful in mass screening for hearing loss. Repeated hearing screening by OAE used in this study is beneficial in decreasing the number of referrals for BERA and hence decrease the cost of screening programme.
H2O2 Irrigation in Children undergoing Adenoidectomy
Authors: Ugur Kadriye S. , Ark Nebil , Kurtaran Hanifi , Yuksel Alper , Gunduz Mehmet , Canbal Metin
Published: February 2015

Objective

To evaluate the effectiveness of 0.5% hydrogen peroxide (H2O2) irrigation in hemostasis after adenoidectomy.

Method

A cross‐sectional study was conducted on 80 children undergoing adenoidectomy. Children were randomized into either 0.5% H2O2 or control (25 0C serum physiologic) irrigation groups after adenoidectomy. Adenoid volume, size, location were recorded. Hemostasis and operation times were measured. Bleeding and hemostasis visual analog scale (VAS) values were scored.

Results

The ages ranged from 3 to 9 years (mean ± SD, 4.9 ± 1.8 years). There were 29 boys and 8 girls in the control group and 22 boys and 21 girls in the H2O2 group. The average hemostasis time for H2O2 group (4 minutes) was shorter than control group (5 minutes), but there was no correlation between control and H2O2 groups with respect to operation (P =. 854) or hemostasis time (P =. 065), or VAS values of subjective bleeding (P =. 961) and hemostasis (P =. 346). Significant positive correlation was found between adenoid volume and operation time (r = 0.269; P =. 016). But correlation between adenoid volume and hemostasis was not significant (r = 0.213; P =. 058).

Conclusion

We may recommend to surgeons a higher concentration than 0.5% H2O2 in the hemostasis of post‐ adenoidectomy, especially for those confronted with significant bleeding following adenoidectomy.
Impact of ASA and Body Mass Index in Pediatric Tonsillectomy
Authors: Roehm Corrie , Marino Jeffrey , Weiss Jessica , Naples James , Valdez Tulio A.
Published: February 2015

Objective

To identify the impact of body mass index and ASA classification on complications, PICU stay and length of hospitalization following tonsillectomy.

Method

Retrospective chart review of all tonsillectomies performed from July 2008 to December 2009 at a tertiary pediatric institution, including BMI, length of stay, length of intubation, ASA status, hemorrhage, and PICU stay.

Results

A total of 677 patients were identified, with complete data in 607, 4.4% underweight, 49% normal, 45% overweight or obese. No significance difference between BMI categories for hospitalization, length of intubation or postoperative hemorrhage, or between ASA for hemorrhage or length of intubation. BMI normal to obese (P =. 0006) and overweight to obese patients (P =. 0253) showed significant difference in PICU stay. ASA classification showed significant difference in length of hospitalization in ASA 1 and 2 (P <. 001), 2 and 3 (P =. 0002), and 1 and 3 (P =. 0002), and in PICU stay between ASA 1 and 3 (P <. 0001), 1 and 2 (P =. 0095) and 2 and 3 (P <. 0001).

Conclusion

Overweight and obese patients are a significant percentage of patients undergoing tonsillectomies in this country. Patients with higher ASA status (2 and 3) show higher use of PICU resources and longer hospitalizations, and patients of overweight and obese categories require PICU care more often than patients with normal weight.
Osteogenesis Imperfecta and Hearing Loss
Authors: Moran‐Hansen Jessica , Esposito Paul , Sewell Ryan K.
Published: February 2015

Objective

1) Determine the incidence and prevalence of hearing loss in the pediatric population with osteogenesis imperfecta. 2) Determine the average age of onset of hearing loss. 3) Determine the type and severity of hearing loss.

Method

This is a retrospective chart review of audiological data from 127 patients, 19 years or younger, with osteogenesis imperfecta who were seen in the orthopedic clinic at Childrens Hospital. Data in the form of pure tone audiometry, sound field audiometry, tympanometry, and otoacoustic emissions was collected and reviewed. The prevalence, incidence, age of onset, type, and severity of hearing loss were determined.

Results

The prevalence of hearing loss was 24% and the incidence was 9%. The mean age of onset was 5.8 years. A conductive hearing (50‐56%) loss was more common than sensorineural (39‐44%) or mixed (11%) hearing loss. The majority of patients had a mild hearing loss (67%).

Conclusion

Hearing loss was found in 24% of patients. The average age of onset was 5.8 years. Our data supports screening children with osteogenesis imperfecta for hearing loss starting at a young age.
Pediatric Parotidectomy: Postoperative Facial Nerve Function
Authors: Owusu James A. , Parker Noah P. , Rimell Frank
Published: February 2015

Objective

The purpose of this study was to analyze the incidence of postparotidectomy facial nerve dysfunction in pediatric patients and to evaluate the association between patient demographics or underlying pathology and functional outcomes.

Method

We retrospectively reviewed charts of patients under 18 years who underwent parotidectomy between 1999 and 2011 at a tertiary pediatric center by a pediatric otolaryngologist. Distribution of dysfunction and timing of recovery were noted. Chi‐square and t‐test analyses were conducted to determine association between demographics or pathology and functional outcomes.

Results

Forty‐three patients met inclusion criteria. Forty‐one underwent superficial parotidectomy, and 2 underwent total parotidectomy. Leading indications for surgery were atypical mycobacterium (16/4 [37.2%]) and branchial cleft anomaly (8/43 [18.6%]). The incidence of immediate facial nerve paralysis was 2% (1/43).The incidence of facial nerve paresis was 21% (9/43), distributed in the marginal mandibular nerve (n = 7), buccal branch (n = 1), and marginal mandibular nerve and frontal branch (n = 1). Full recovery of nerve function in patients with paresis occurred by 1 month (n = 2), 2 months (n = 1), 6 months (n = 3), or 10 months (n = 2). No association was revealed between age, gender, or pathology and postoperative facial nerve function.

Conclusion

Transient postparotidectomy paresis of distal branches of the facial nerve is common in the pediatric population and should be discussed in the preoperative evaluation. The risk is comparable to that of the adult population. Although malignant disease would seem to portend greater risk of dysfunction, underlying pathology was not predictive.