bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Chronic Laryngeal Neuropathy in the United States versus Europe
Authors: Noordzij J. Pieter , Jang Minyoung , Depietro Joseph
Published: August 2013

Objectives:

Analyze differences in the evaluation of laryngeal neuropathy by laryngologists in the United States versus other countries.

Methods:

Members of the American Laryngology Society (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were emailed to 137 members of the ALA and 324 members of the ELS. As laryngology fellowships are less available outside the U.S., ELS members who devoted more than 50% of their practice to laryngology were identified as laryngologists for this study.

Results:

Of the ELS members surveyed, 72 (22.2%) responded, compared to 43 (24.5%) for ALA members. 56.9% of ELS respondents identified as devoting more than 50% of their practice to laryngology. Fellowship‐level training in laryngology was completed by 74.1% of ELS respondents and 79.5% of ALA respondents. 11% of ELS respondents commented on completing fellowships in phoniatry or phonosurgery, or the absence of formal fellowships in their country. When comparing comfort with the diagnosis of laryngeal neuropathy, ELS laryngologists’ average comfort level was 4.33 on the Leikert scale versus 6.1 for ALA laryngologists (P <.000002). When asked if they were concerned about over‐diagnosing gastroesophageal reflux disease (GERD)‐related laryngitis, 73% of ELS respondents vs. 40.9% of ALA respondents said yes (P = 0.0109).

Conclusions:

Laryngologists in the United States vs. Europe vary significantly in their familiarity with laryngeal neuropathy. This could lead to differences in the workup of patients with laryngopharyngeal symptoms, possibly resulting in ineffective treatments. These differences are likely amenable to further education.
The Mayo Clinic Arizona Spasmodic Dysphonia Experience: 24 Years and 686 Patients
Authors: Pollei Taylor R. , Bansberg Stephen F. , Adler Charles , Lott David G. , Patel Alpen B.
Published: August 2013

Objectives:

1) Outline onabotulinumtoxinA (onaBTX‐A) injection dose and frequency trends in adductor spasmodic dysphonia (AdSD) patients. 2) Assess correlations between onaBTX‐A injection dose, duration of breathiness, time to therapeutic onset, percent maximal benefit obtained, and duration of benefit.

Methods:

Retrospective chart review. Setting: Tertiary academic care center. Subjects and Methods: 686 patients with spasmodic dysphonia (SD) were treated with 6345 BTX injections between 1989 and 2013. This included 630 AdSD and 56 AbSD patients further subdivided into subgroups based on presence of vocal tremor (VT) and injection laterality. Injection frequency, dosing, laterality, and background demographic data were recorded in addition to subjective onaBTX‐A injection responses.

Results:

AdSD patients’ symptom onset and injections began at an older age than AbSD patients (52.5; 60.6 years vs. 43.7; 50.0 years respectively; P = 0.0008) and had VT more frequently (P= 0.0012). For the 380 AdSD patients (+/‐ VT) receiving over six injections, the average total onaBTX‐A dose was 5.0 units, which remained stable up to 15 years (year 15 dose mean= 5.29, std dev= 5.07). Using Pearson's correlation coefficients, there was no significant positive or negative correlation between onaBTX‐A dose and percent maximal benefit (p=0.760), duration of breathiness (P = 0.618), dysphagia duration (P = 0.142), benefit duration (P = 3622), or time to therapeutic onset (P = 0.618).

Conclusions:

Spasmodic dysphonia is effectively treated according to patient subjective response; however, more refined longitudinal analysis is needed to show if any objective correlation between injection dose and outcomes are present. Treatment methods and outcomes as described should aid others in developing best practice patterns.
A Novel Distending Laryngoscope: Implications in Transoral Surgery
Authors: Patel Alpen B. , Howard Brittany E. , Nagel Thomas H. , Hinni Michael L.
Published: August 2013

Objectives:

1) Describe an innovative laryngoscope developed to improve visualization, provide greater exposure, and enhance precision during transoral procedures. 2) Demonstrate improved proficiency and success with transoral surgery within the oropharynx, hypopharynx, and larynx. 3) Analyze and compare specific mechanical dimensions and exposure with that of currently available instrumentation. 4) Identify the advantages of use with minimally invasive surgical techniques and approaches, including transoral laser microsurgery and transoral robotic surgery.

Methods:

A retrospective review of 170 patients who underwent transoral surgery with a new distending laryngoscope was conducted. We compared and contrasted our exposure within the oropharynx, hypopharynx, and larynx using the new laryngoscope with that of currently available instrumentation. Specific mechanical dimensions of the laryngoscope along with the provided working field were calculated.

Results:

Experience with the new distending laryngoscope afforded better exposure than currently available instrumentation. This new prototype was manufactured using design elements from the Steiner, Weerda, and Lindholm laryngoscopes, including an anteriorly curved distal tip, distending capability, and lateral wings to protect against tongue herniation. The panoramic of view was increased when engaged. This design provided enhanced transoral visibility and working room, allowing for improved bimanual instrumentation.

Conclusions:

Direct laryngoscopic technique and instrumentation has continued to evolve. Over the last two decades, there has been a significant movement towards minimally invasive transoral surgical techniques fueling innovative concepts and advancement in laryngoscopic design and application. We present our experience with an innovative laryngoscope allowing for improved visualization, greater exposure, and enhanced precision with transoral technique.
PPI versus Placebo in the Treatment of LPR: A Meta‐analysis of Nine RCTs
Authors: Wineland Andre M. , Piccirillo Jay F.
Published: August 2013

Objectives:

Identify if proton pump inhibitors (PPIs) in the treatment of laryngopharyngeal Reflux (LPR) are superior to placebos. Study Design: Meta‐analysis of double‐blind randomized controlled trials (RCTs) of PPIs vs. placebo in adult participants with laryngeal symptoms and endoscopic findings of LPR.

Methods:

Articles were identified by searching MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov without date limits. Relative risks were reported with 95% confidence intervals using a random‐effects model. Publication bias, heterogeneity, and sensitivity analysis were also conducted. Modified PRISMA guidelines were used to assess data quality. The primary outcome measure was defined as the proportion of patients with 50% reduction in self‐reported laryngeal symptoms.

Results:

Nine RCTs examining PPI vs. placebo (n = 402; 226 PPI/176 placebo) suggest PPI therapy is superior to placebo (relative risk [RR] 1.36; 95% confidence interval [CI] 1.02, 1.81; P = 0.036). Additional sensitivity analysis suggests PPIs provide a greater benefit for those < 50 years old or to those who receive therapy for > 8 weeks. Moderate heterogeneity was found (I2 = 41.1%, X2 = 13.57, d.f. = 8, P = 0.094) among the studies. Significant publication bias was detected through Egger's test (coefficient 2.06; 95% CI ‐0.41, 4.54; P = 0.09).

Conclusions:

PPI therapy appears to provide superior symptomatic relief for LPR when compared to placebo. Significant publication bias and pharmaceutical association was found among included studies. Future research should focus on identifying those patients who would benefit most from medical therapy.
Total Laryngeal Transplant Explanted in 2012: 14 Years of Lessons Learned
Authors: Lorenz Robert R. , Strome Marshall
Published: August 2013

Objectives:

In 1998, the first successful total laryngeal transplant was performed at the Cleveland Clinic. The patient was a 40 year‐old‐man who had suffered an MVA, which left him aphonic. Not only was his larynx completely replaced with a vascularized graft, but also his pharynx, thyroid, parathyroids, and a portion of his trachea. Over the subsequent 14 years, much was learned about tolerance of a transplanted laryngeal complex, marking this surgery as the longest surviving maiden transplanted organ system when immunosuppression was applied.

Methods:

Outstanding voice quality and swallowing function were achieved, although volitional vocal cord movement was not attempted, and therefore the patient remained stoma dependent for breathing. The scientific advancement of understanding around laryngeal transplantation was concurrently conducted in the laboratory via animal models, which translated into gradual reduction in the level of immunosuppression for the patient without acute rejection.

Results:

After approximately a decade, a slowly progressive, chronic rejection process gradually rendered the organ non‐functional, and the patient and his providers deemed him appropriate for explantation with free‐flap reconstruction and tracheoesophageal puncture voice restoration. Pre‐operative functional studies showed a reversion back to his original thyroidal tissue as the source of his circulating thyroid hormone. Post‐explantation histologic studies demonstrated loss of tissue cellularity and organ architecture.

Conclusions:

On routine explantation follow‐up, the patient was found to have an asymptomatic early stage, human papillomavirus‐related oropharyngeal neoplasm that was successfully treated with surgical resection alone. Voice results will be demonstrated over the patient's 14 year experience, as well as his own perspective on this landmark experience.
Trends of Total Laryngectomy: Analysis of California Patient Discharge Data 1996‐2010
Authors: Verma Sunil P. , Mahboubi Hossein
Published: August 2013

Objectives:

Determine if the number of total laryngectomies (TL) performed in California has changed over the last fifteen years. We also sought to investigate if the location of surgery, length of stay, and use of rotational/free flaps changed over this time period.

Methods:

All patient records enlisting ICD‐9‐CM procedural codes for laryngectomy were extracted from the California Patient Discharge Data sets of 1996‐2010. Patients’ demographics were evaluated. Teaching otolaryngology hospitals were coded as academic. Population‐adjusted surgery rates, percentage of surgeries with rotational/free flap and/or percutaneous endoscopic gastrostomy (PEG), length of stay, total charges, and disposition status were then analyzed and compared between academic and non‐academic centers.

Results:

A total of 4,145 TLs were performed from 1996‐2010. The overall number of surgeries declined from 1.3 surgeries per 100,000 California residents to 0.6 per 100,000 California residents. The number of surgeries performed in non‐academic medical centers dropped by 70% during this time period (P <. 01). The median length of stay increased from 10 to 12 days, and the median total charges increased from $45000 to $192000 (P <. 01). The use of rotational/free flaps more than doubled, and the use of PEG tubes increased seven folds (P <. 01).

Conclusions:

The total number of patients undergoing TL in California has declined, and the surgery is increasingly being performed at academic medical centers. The use of rotational and free flaps has increased over the last 15 years.
Ablation of Bone without Thermal or Acoustic Injury via a Novel Ultrafast Picosecond Infrared Laser
Authors: Jowett Nathan , Wollmer Wolfgang , Wiseman Paul , Mlynarek Alex M. , Lorincz Balazs B. , Knecht Rainald , Miller R.J.D.
Published: August 2013

Objectives:

A precise method to ablate bone without significant thermal or acoustic injury has remained elusive. A novel non‐ionizing ultrafast pulsed picosecond infrared laser (PIRL) may provide the solution. The PIRL ablates tissue through purely photomechanical means, via a thermoelastic front spallation effect, with near complete thermal and acoustic transient confinement. In contrast, the Er:YAG laser ablates tissue via a micro‐explosive vaporization mechanism. This study compares PIRL and Er:YAG laser ablation of bone by infrared thermography (IRT), digital microscopy, and electron microscopy.

Methods:

Ten cuts were made in fresh ex‐vivo cortical bone via PIRL and Er:YAG laser ablation under IRT imaging. Lasers were operated using similar average power settings (68 mW) at fluence levels (0.78 J/cm2 and 8.15 J/cm2) in the treatment window above the ablation threshold and below ionization threshold for the PIRL and Er:YAG laser respectively. Digital and electron microscopy were used to image the ablation zones.

Results:

Peak temperature was negligible and significantly lower for PIRL in comparison to Er:YAG laser ablation (1.56 ± 2.71°C vs. 12.99 ± 2.71°C, P = 0.008). Digital microscopy revealed similar cortical surface ablation volumes for both lasers. Electron microscopy demonstrated well delineated ablation zone margins with no sign of micro‐fracture or thermal injury for PIRL ablation.

Conclusions:

The PIRL provides a means of bone ablation without acoustic shockwave induced micro‐fractures or thermal injury. This novel laser has great potential in advancing surgical techniques and outcomes in otologic, neurotologic, implant, cranio‐maxillofacial, and head and neck reconstructive surgery.
Audiovestibular Characteristics of Small Cochleovestibular Schwannomas in Neurofibromatosis Type 2
Authors: Holliday Michael A. , Zalewski Christopher K. , Wafa Talah , Dewan Ramita , Butman John , Asthagiri Ashok R. , Kim Hung J.
Published: August 2013

Objectives:

Describe the relationship between cochleovestibular schwannoma (CVS) volume, audiovestibular changes, and magnetic resonance imaging (MRI) findings in patients with neurofibromatosis Type 2 (NF‐2).

Methods:

Subgroup analysis of NF‐2 prospective natural history study from June 2008 to June 2011. Subjects: NF‐2 patients with small treatment‐ naïve CVS (volume < 1cm3) by ear. N = 49 ears, 32 patients. Setting: Quaternary medical research institute. Intervention: None. Outcome Measurements: Tumor size, auditory brainstem response (ABR), audiogram (4‐frequency PTA ‐ 0.5, 1, 2, 4KHz), vestibular evoked myogenic potential (VEMP), caloric videonystagmography (VNG), rotary chair testing (240°/sec velocity step test), and magnetic resonance imaging (MRI) findings.

Results:

Larger tumor volume (mean 0.489cm3; 95% confidence interval [CI] 0.313‐0.664) correlated with abnormal ABR findings, compared to smaller tumors with normal ABR (mean 0.151cm3; 95%CI 0.89‐0.213). Larger tumors also correlated with weak caloric response (mean 0.520cm3; 95%CI 0.300‐0.741 vs. mean 0.199cm3; 95%CI 0.102‐0.296). Tumor volume was not significantly correlated with PTA, VEMP, or rotary chair testing. Elevated intralabyrinthine protein on MRI fluid‐attenuated inversion recovery sequences was correlated with larger tumor size (mean volume 0.331cm3; 95%CI 0.246‐0.419 vs. 0.055cm3; 95%CI 0.008‐0.103) and abnormal ABR and PTA (P < 0.05), but it did not correlate with VEMP or caloric responses.

Conclusions:

In our sample, ABR, caloric response, and intralabyrinthine protein correlated with tumor volume, but PTA, VEMP, and high velocity step testing did not. Abnormal ABR and PTA were correlated with elevated protein. These findings may provide insight on the effect of small CVS on the inner ear and cochleovestibular nerves, which may aid in their management.
Auditory Brainstem Implantation after Unsuccessful Cochlear Implantation in Children with Cochlear Nerve Deficiency
Authors: Colletti Vittorio , Mandala Marco , Colletti Liliana
Published: August 2013

Objectives:

To compare perceptual auditory abilities in 31 children with cochlear nerve deficiency (CND) and surgically verified absent cochlear nerve absence (ACN), receiving first a cochlear (CI) and subsequently an auditory brainstem implant (ABI).

Methods:

Thirty children initially received a CI at outside institutions and failed to progress in perceptual auditory abilities between 2000 and 2013. Explantation of the CI and ABI placement were performed on the same side. Revision of all surgical videos to determine presence or absence of the cochlear nerve. Perceptual auditory abilities obtained after the CI and after the ABI were converted to the Category of Auditory Performance (CAP) scale.

Results:

All children had severe to profound sensorineural hearing loss (SNHL) and CND. Magnetic resonance imaging documented ACN in 18 and small cochlear nerve (SCN) in 13 children. The internal auditory canal (IAC) was atretic in 8 and of reduced diameter in 12 children. At surgery, all patients demonstrated ACN. With cochlear implants, all patients had a CAP less than or equal to 2. With ABI, All patients had a CAP greater than or equal to 2. The complication rate was similar between CI and ABI patients.

Conclusions:

Children with a clinical diagnosis of CND and imaging of ACN and SCN, fitted with CIs have an extremely poor prognosis. In these children the opportunity for developing open set speech perception and acquiring speech may be better achieved with ABI placement. The overall complication rate of ABI is not greater than that of CI.
Blood Albumin and Alpha‐Fetoprotein Levels Play a Protective Role in Development of Age‐Related Hearing Impairment
Authors: Moon Il Joon , Cho Yang‐Sun , Byun Hayoung , Woo Sook‐Young , Chung Won‐Ho , Hong Sung Hwa
Published: August 2013

Objectives:

There are few epidemiological surveys that have examined risk factors longitudinally for age‐related hearing impairment (ARHI). This study aims to identify risk factors that predict the development of age‐related hearing impairment (ARHI), using survival analysis.

Methods:

This retrospective cohort study reviewed the records of the adult subjects (mean age = 55.6 years) who consecutively underwent health checkup including pure‐tone audiometry at the Health Promotion Center in Samsung Medical Center between 2001 and 2010. In this period, a total of 2,577 subjects (2,148 males and 429 females) underwent pure‐tone audiometry more than twice. A pure‐tone average (PTA: 0.5, 1, 2, 4 kHz) was calculated for each subject, and development of ARHI was defined as a PTA at follow‐up more than 5 dB greater than the baseline PTA. Kaplan‐Meier and Cox regression analysis were used to examine the effects of various factors, including laboratory profiles, in the development of ARHI. Multivariable analysis was performed with the variables that are associated with the outcome in the univariable analysis.

Results:

Kaplan‐Meier analysis reveals that ARHI occurs in 1,060 (41.1%) subjects at 6 years. Blood albumin (hazard ratio [HR] 0.341; confidence interval [CI] 0.245‐0.474) and alpha‐fetoprotein (HR 0.752; CI 0.705‐0.802) levels are the most potent protective factors for the development of ARHI in Cox regression analysis. In contrast, total bilirubin (HR 1.232; CI 1.091‐1.391) and glycated hemoglobin (HR 1.182; CI 1.092‐1.280) are potential risk factors.

Conclusions:

Worsening of hearing over time is common in the adult population. Results highlight the protective role of blood albumin and alpha‐fetoprotein levels in the development of ARHI.
Bone Conduction Hearing: Device Auditory Capability to Aid in Device Selection
Authors: Syms Mark J. , Hernandez Kelly E.
Published: August 2013

Objectives:

1) Obtain measures of six current bone conduction devices that use a surgically implanted osseointegrated post (Baha Intenso, Baha BP100, Baha BP110, Ponto, Ponto Pro) or a non‐surgical module on the teeth (SoundBite). 2) Describe how the measures relate to auditory performance.

Methods:

Compare measures of the six devices on the same laboratory system using identical standards (ANSI, IEC). Outcome Measurements: Maximum vibratory output, maximum gain, linear dynamic range, and frequency range. Independent Variables: Six devices.

Results:

Measures for all devices were highly repeatable (sd of test‐retest measures < 0.5 dB) and equivalent to available published results. Maximum output, gain, and linear dynamic range at full‐on gain settings were similar for all devices but differed by frequency region. For the frequency range necessary for processing speech (500‐2000 Hz), all of the devices have sufficient output, gain, and linear dynamic range. For the frequency range optimal for providing the spatial hearing benefits of understanding speech in noise and speech localization (1500‐8000 Hz), the dental device will have 10‐20 dB more gain and linear dynamic range than the implantable devices.

Conclusions:

All devices had sufficient output, gain, and linear dynamic range to reach a normal cochlea over a frequency range to provide benefit for processing speech. The dental device has a higher output and larger dynamic range (~20 dB) in the high frequency range (>2000 Hz) that relates to spatial hearing benefits.
Functional Outcome Predictors following Mandibular Reconstruction with Free Fibula Flap, Clinical and Videofluoroscopic Correlation
Authors: Hobbs Bradley A. , Balou Matina , McCullough Gary H. , Moreno Mauricio A
Published: August 2013

Objectives:

Identify outcome predictors by correlating clinical variables with postoperative videofluoroscopic swallow study (VFSS).

Methods:

Retrospective chart review of 36 patients treated at an academic tertiary center between September 2009 and November 2012.

Results:

Fifteen females and 21 males with a mean age of 54 years (range 7‐81); 17 cases were treated for malignancy. Tongue resection was grouped in 4 categories: no resection (n=6, 16.7%); 0‐25% (n=19, 52.8%); 25‐50% (n=7, 19.4%) and 50% or more (n=4, 11.1%). The mandibular defect was classified by HCL classification: H (n=6,16.7%); HC (n=2, 5.6%); L (n=8, 22.2%); LC (n=10, 27.8%); LCL (n=10, 27.8%). The size of the bony defect ranged from 3‐15cm (mean=9 cm). The flap was osseous only in 10 cases; the cutaneous paddle ranged from 10‐125 cm2 (mean=52). A gastrostomy tube was present preoperatively in 8 cases, and postoperatively at least transitorily in 14 cases; X‐ray tube (XRT) was used in 17 cases. Postoperative VFSS showed penetration in 13 cases and aspiration in 7. Overall, 29 patients (80.6%) achieved unrestricted diet and this was statistically correlated with: age (p=0.04); XRT (p=0.01); Preoperative G‐tube (p=0.12) and penetration or aspiration on VFSS (p=0.01).

Conclusions:

Age, radiation treatment, preoperative G‐tube dependency, and abnormal postoperative swallowing study are predictors for poor functional outcome in patients undergoing mandibular reconstruction with a free fibula flap. Skin paddle size and defect extension/location were not correlated with swallowing outcomes.
Complications of Vestibular Schwannoma Surgery
Authors: Ahmed Omar H. , Lin Jonathan K. , Mahboubi Hossein , Yaug Yuk Y.A. , Djalilian Hamid R.
Published: August 2013

Objectives:

1) Examine postoperative complications of patients who underwent vestibular schwannoma excision. 2) Determine significant clinical predictors of postoperative complications.

Methods:

Case data for vestibular schwannoma excisions performed in California from 1996‐2010 were examined using the California Hospital Inpatient Discharge Database (CHIDD). Cases were identified if they contained the principle procedure ICD‐9‐CM code 04.01. Postoperative complications were identified if cases contained ICD‐9‐CM codes for specific diagnoses and procedures.

Results:

Overall, 7,002 cases were examined. Most patients (76.2%) were 35‐64 years old, 40.5% had ≥ 1 comorbidity, and 86.5% were at high volume centers (≥ 100 excisions performed during 1996‐2010). Additionally, 24.4% had ≥ 1 of 34 pre‐defined postoperative complications and 0.2% died. Cerebrospinal fluid (CSF) leakage occurred in 2.8%, intracranial hemorrhage occurred in 0.4%, and ventriculostomy was required in 0.7%. Differences in complications between different volume centers (high, medium, and low) will be described. In 2006‐2010, there were significantly more postoperative complications compared to 1996‐2000. Presence of comorbidities was a significant predictor of having any postoperative complications (odds ratio [OR] 2.58, 95% confidence interval [CI]: 2.11‐3.17, P < 0.001).

Conclusions:

Postoperative complication rates increased over the study period, likely reflecting larger tumors that are not being treated with radiosurgery. Presence of comorbidities was a positive predictor of postoperative complications.
Detection Rates of the Labyrinthine Artery in Patients with ISSHL by 7‐T MRI
Authors: Sato Hiroaki , Kawagishi Kazuaki
Published: August 2013

Objectives:

Disturbance of inner ear blood flow has been considered to be one of the possible causes of idiopathic sudden sensorineural hearing loss (ISSNHL); however, imaging evaluation of the labyrinthine artery has not been reported to date. The aim of this study was to compare the detection rates of labyrinthine artery in subjects with and without ISSNHL using 7‐T magnetic resonance imaging (MRI).

Methods:

In 10 patients (5 males and 5 females) with ISSHL (ISSNHL group) and 14 volunteers (8 males and 5 females) with normal hearing (Control group), 7‐T MRI (Discovery MR950, GE Medical Systems) was performed with 3D time‐of‐flight spoiled gradient echo (3D TOF SPGR) sequence for the comparison of detection rates of the labyrinthine artery.

Results:

MRI scan was performed from 11 days to 49 days after onset. Among 10 patients with ISSNHL, 3 showed complete recovery and the rest showed partial recovery. The labyrinthine artery was depicted in 20 of 20 ears (100%) in the ISSHL group and 27 of 28 (96.4%) ears in the Control group. There was no significant difference in detection rates.

Conclusions:

The present study is the first to report depiction of the labyrinthine artery by 7‐T MRI. Our preliminary results indicate occlusion of the labyrinthine artery would be rare in the pathogenesis of ISSNHL and also demonstrate the labyrinthine artery could be detected by ultra‐high field MRI.
Device Failures, Complications, and Reoperation in a Cochlear Implant Program
Authors: Brill Kaitlin F. , Volsky Peter G. , Antonio Stephanie M.
Published: August 2013

Objectives:

1) Determine the incidence of complications of cochlear implants (CIs) in our small program; 2) Compare device failures and medical failures between types of implants; 3) Describe minor and major complications and patterns of CI device malfunction/failure.

Methods:

A chart review of CI patients in an academic medical center was performed in January 2013. Major complications included infections, tissue breakdown, or device failure requiring surgical management, including explantation. Device failure was determined by the CI surgeon, audiologist, or both. Minor complications included infections managed medically or with office procedures. Preliminary review included known patients with complications, device failures, and revision surgery and non‐users.

Results:

Between 1990 and 2012, 232 CI patients received care at our institution, including 16 implanted elsewhere. Nine patients (4%) experienced only minor complications, and 28 patients (12%) experienced a major complication. There were 20 cases of device failure in 19 patients (8%). Twenty‐three explants were performed in 22 patients (9%), indicated for device malfunction in 18 cases (17 patients, 7%); infection and extrusion in 2 patients (1%); headache in 2 patients (1%), and facial nerve stimulation in 1 patient. Magnet extrusion without acute infection occurred in 2 patients (1%), requiring 3 surgeries with the device in vivo. There were 3 non‐users (1%), one of whom was explanted for headache. Three patients (1%) had more than 1 revision surgery.

Conclusions:

Our complication rates are similar to those reported in the literature. Device testing post‐explantation is rarely received by the manufacturer; device failure appears to be a clinical diagnosis.
Direct‐Drive Acoustic Amplification Using a Tympanostomy Tube
Authors: Yau Yuk Y.A. , Mahboubi Hossein , Malley Melinda J.D. , Conderman Christian P. , Paulick Peyton , Bachman Mark , Djalilian Hamid R.
Published: August 2013

Objectives:

Determine whether a tympanostomy tube with a ferromagnetic cap can be actuated to deliver sound to the cochlea.

Methods:

A ferromagnetic mixture of nickel powder and epoxy was glued to the outer flange of an Armstrong V Grommet tympanostomy tube. The tube was then placed into the pars tensa portion of a cadaveric temporal bone. The Direct‐Drive Hearing Device (DHD), a completely‐in‐the‐canal hearing aid prototype developed in our lab, was coupled to the nickel‐epoxy flange and fixed inside the ear canal. The displacements of the posterior crus of the stapes were then measured using a Laser Doppler Vibrometer. The range of displacements induced by the device was compared to those of natural sound.

Results:

A 200 mV input to the device produced a range of displacements equivalent to those of sound at 70 dB sound pressure level (SPL; mean 0.44 nm; range 0.01‐2.80). A 400 mV input produced a range of displacements equivalent to those of sound at 80 dB SPL (mean 1.34 nm; range 0.02‐8.87).

Conclusions:

DHD, a small completely‐in‐the‐canal hearing aid prototype, is capable of actuating the TM through a ferromagnetic tympanostomy tube and producing range of displacements equivalent to moderate to severe levels of hearing loss.
Direct Monitoring of ABIs Evoked Potentials on the Cochlear Nuclei and Neighboring Cranial Nerves
Authors: Colletti Vittorio , Mandala Marco , Colletti Liliana
Published: August 2013

Objectives:

The potentials evoked with Auditory Brainstem Implant (ABI) on the cochlear nuclei (CN) and on the neighboring cranial nerves are traditionally evaluated with Electrical Auditory Brainstem Response (E‐ABR) and electromyography (EMG). To obtain a more precise evaluation of ABI insertion, a near field monitoring procedure that records electrical compound action potentials (E‐CNAPs) directly from the CN and from each individual cranial nerve is presented.

Methods:

Between January 1997 and September 2012, 184 patients were fitted with ABI by the Verona team, 155 in Verona and 29 (13 children and 16 adults) elsewhere. The E‐CNAPs utilizes a cotton‐wick recording electrode locate on different anatomical structures: CN, root entry zone of the cranial nerve VII, IX, X, XI, and V. All subjects were monitored with E‐ABR and 18 of them underwent also E‐CNAPs recording.

Results:

Systematic significant lower E‐CNAPs thresholds were observed compared with E‐ABRs. The evaluation of the threshold for inducing extra‐auditory effects with E‐CNAPs on the neighboring cranial nerves allowed a more precise selection of the active electrodes to be used in the fitting. For the same electrical intensity value utilized for obtaining ABI responses, E‐ABRs and E‐CNAPs showed potentials of neighboring cranial nerves respectively on 4 and 10 electrodes.

Conclusions:

The adoption of near‐field recordings offered the chance to improve the correct placement of the array and post‐operative outcomes. E‐CNAPs recorded on neighboring cranial nerves can replace EMG giving an on line demonstration of the effects on nerves on which electrodes induce myogenic responses.
Improved Resource Use following Vascularized Tissue Transfer: Mandatory Intensive Care Unit Stay Is Unnecessary
Authors: Panwar Aru , Militsakh Oleg N. , Lydiatt Daniel D. , Wieland Aaron M. , Lydiatt William M.
Published: August 2013

Objectives:

1) Analyze the impact of elimination of mandatory intensive care stay for patients following vascularized tissue transfer for reconstruction of defects following major head and neck surgical procedures. 2) Propose efficient, cost effective hospital pathways for care of patients following vascularized tissue transfer. 3) Demonstrate portability of such pathways between academic and community based practices.

Methods:

We performed a retrospective study involving two groups of adult patients who underwent vascularized free tissue transfer at a head and neck oncology practice at an academic and a community based hospital between July 2007 and June 2012. The first group of patients mandatorily received their immediate postoperative care in an intensive care unit. Following the institution of a specialized head and neck surgical unit, group 2 was cared for in a protocol driven, non intensive care unit setting. Outcomes and costs were compared between the two patient groups.

Results:

There was no adverse impact on rate of flap failure, inpatient mortality, and overall length of hospitalization. In contrast, a significant reduction in healthcare costs was observed when patients were routinely admitted to the head and neck surgery floor, instead of mandatory postoperative intensive care stay.

Conclusions:

1) Mandatory admission to intensive care following vascularized free tissue transfer for flap monitoring is unnecessary. 2) Results can be replicated in both an academic and community hospital setting.
Features of Music That Affect Its Enjoyment following Cochlear Implantation
Authors: Kohlberg Gavriel D. , Mancuso Dean , Chari Divya , Lalwani Anil K.
Published: August 2013

Objectives:

Enjoyment of music remains an elusive goal following cochlear implantation (CI). We assessed the hypothesis that reducing the complexity of music has the potential to enhance the listening experience for the cochlear implantee.

Methods:

Normal hearing adults (n = 17) were asked to evaluate an original and modified 20‐second piece of country music for its musicality, pleasantness, and naturalness before and after it was processed through CI simulation software. The music was modified by removing the vocals and/or changing the type of musical instruments playing (rhythmic only, melodic only, or combined rhythmic and melodic). Linear regression analysis with analysis of variance was used to assess the impact of music variation on music appreciation.

Results:

Without CI simulation, music segments that included the vocals, melodic instruments only, or combined rhythmic and melodic instruments sounded more pleasant, natural, and musical. In contrast, music segments processed through the CI simulation sounded more pleasant, natural, and musical when the vocals were removed and when only rhythmic instruments were included (all P values < 0.005).

Conclusions:

Musical enjoyment with or without CI is influenced by the complexity of the original music. Our study offers preliminary evidence that reduction of music complexity has the potential to make listening more enjoyable for the CI listener. Thus, in addition to improvement in software and hardware, engineering of music specifically for a CI listener may be an alternative means to enhance their listening experience.
Fibrous Incudostapedial Joint in Congenital Aural Atresia
Authors: Balaker Ashley E. , Roberson Joseph B. , Goldsztein Hernan
Published: August 2013

Objectives:

1) Determine the prevalence of a non‐bony or fibrous incudostapedial (IS) joint in the setting of congenital aural atresia. 2) Assess this anomaly's impact on surgical management and associated hearing outcomes.

Methods:

Operative reports and audiometric data of patients who underwent congenital aural atresia repair by a single surgeon from 2007‐2011 were reviewed for operative anatomic findings and audiometric outcomes.

Results:

Two hundred and twenty‐eight operations on 206 ears were performed. Median age was 5 years old. Fifty‐five (26.7%) of these ears had a fibrous IS joint. The severity of this anomaly was graded as mild in 23 ears, moderate in 20 ears, and severe in 12 ears. Average postoperative PTA2 in the severely fibrous group was 51 compared to 46 in the moderate group (P = 0.03) and 41 in the mild group (P = 0.006). Patients with a fibrous IS joint who underwent successful ossicular chain reconstruction (OCR) had an average postoperative PTA2 of 30, which was a significantly better outcome than in patients with moderately or severely fibrous IS joints who did not have OCR (P < 0.05).

Conclusions:

A fibrous IS joint was seen in 27% of patients undergoing repair of congenital aural atresia. The severity of this anomaly has important implications for postoperative hearing results. These findings suggest that ossicular chain reconstruction should be performed in moderately or severely fibrous cases.
First Clinical Results of the Dilatation of the Eustachian Tube in Patients with Tubal Dysfunction
Authors: Dalchow Carsten V. , Jowett Nathan , Kappo Nathalie , Boettcher Arne
Published: August 2013

Objectives:

One of the main causes for chronic otitis media is a tubal dysfunction which can now be treated with the endonasal dilatation of the Eustachian tube with the help of a novel balloon catheter.

Methods:

Since July 2010, we treated patients with a tubal dysfunction with a balloon dilatation of the Eustachian tube with the help of an endoscope through an endonasal approach. Such a dilatation was done in patients in whom we found a tubal dysfunction in the tube manometry and impedance audiometry. In 55 patients, a single‐sided and in 50 patients a bilateral treatment was performed by inserting a specially designed balloon catheter into the cartilage of the Eustachian tube and inflating it with 10 bar for 2 minutes.

Results:

Between July 2010 and November 2011, 105 patients (age 9‐71; 45 female, 60 male) were treated because of a tybal dysfunction. The dilatation was performed under general anesthesia using an endoscope and a specially designed applicator. The postoperative check‐up showed improved function in 69 patients, while 36 patients still showed a limitation of the tubal function. All patients reported a subjective improvement of middle ear pressure equalization.

Conclusions:

The endonasal dilatation of the Eustachian tube using the balloon catheter set to enlarge the cartilage is a safe and reliable method in patients with a tubal dysfunction. Our first clinical results confirm functional improvement after one year.
Forces and Trauma Associated with Minimally‐Invasive, Image‐Guided Cochlear Implantation
Authors: Rohani Pooyan , Pile Jason , Kahrs Lueder , Balachandran Ramya , Blachon Gregoire , Simaan Nabil , Labadie Robert F.
Published: August 2013

Objectives:

Minimally‐invasive, image‐guided cochlear implantation (CI) uses a patient‐customized microstereotactic frame to access the cochlea via a single drill‐pass. We investigated the average force and trauma associated with the insertion of lateral wall CI electrodes using this technique.

Methods:

Microstereotactic frames for 6 fresh cadaveric temporal bones were built using computed tomography (CT) scans to determine an optimal drill path, following which drilling was performed. A tympanomeatal flap was raised, the round window (RW) overhang was taken down, and the RW membrane was reflected posteriorly. CI electrodes were inserted using surgical forceps to manually advance the CI electrode array, via the drilled tunnel, into the cochlea. Forces were recorded using a 6‐axis load sensor placed under the temporal bone during insertion of lateral wall electrode arrays (2 each of Nucleus CI422, MED‐EL standard, and MED‐EL standard with stiffeners). Tissue histology was performed by removing the lateral wall of the cochlea allowing photo‐documentation of electrode position and microscopic assessment of intracochlear tissue.

Results:

After drilling, CT scanning demonstrated successful access to cochleae in all 6 bones. Average insertion forces were 0.0088‐0.0780N. Peak forces were 0.0564‐0.4688N. Single factor analysis of variance was not statistically significant comparing average forces of different electrodes (P = 0.77). Tissue histology showed complete scala tympani insertion in all specimens with depth of insertion ranging from 360‐600°. No intracochlear trauma was identified.

Conclusions:

In this cadaver model with a minimally‐invasive, image‐guided CI approach, the use of lateral wall electrodes was associated with insertion forces comparable to traditional CI surgery. Deep insertions were obtained without identifiable trauma.
Heptanol Application to the Mouse Round Window: A Novel Model for Studying Cochlear Regenerative Potential
Authors: Stevens Shawn M. , Xing Yazhi , Hao Xinping , Zhu Juhong , Hensley Christopher , Lang Hainan
Published: August 2013

Objectives:

1) Introduce a novel model for studying cochlear lateral wall regeneration. 2) Describe implications of this study on research and treatment of human presbycusis. Background: Human presbycusis likely occurs secondary to senile degeneration of the stria vascularis (SV) and spiral ligament fibrocytes (SLFs). SLFs have a limited regenerative capacity. Augmenting this process may play a role in hearing preservation, recovery, or both. Few models currently exist, however, that can selectively and temporarily damage the cochlear lateral wall to study SLF regeneration.

Methods:

Heptanol, a gap junction uncoupler, was surgically applied to the round window of 25 normal hearing mice, with sacrifice at points 12 hours ‐ 14 days post‐treatment. Auditory brainstem response testing, electron microscopy, and immunostaining techniques were used to assess treatment response.

Results:

Click tone thresholds were significantly elevated (mean +40.5 dB sound pressure level) in all treated mice. Hearing loss plateaued on days 1‐7, followed by near complete recovery thereafter. Ultrastructural analysis revealed selective SV injury and SLF apoptosis at the apical, middle, and basal turns. A marked reduction in ion channel immunostaining intensity occurred throughout the lateral wall but resolved by 2 weeks. 3‐4 days, SLFs stained positive for EdU, a labeled thymidine analog and marker of cellular proliferation.

Conclusions:

This is one of the first models described to reliably and selectively induce lateral wall toxicity followed by full hearing recovery and SLF regeneration. Future study of the molecular and genetic expression profiles governing this process will be greatly facilitated by this technique.
High‐Resolution Microendoscope Images of Middle Ear Cholesteatoma and Surrounding Tissue: Evaluation of Interobserver Concordance
Authors: Bradley James A. , Jiang Nancy , Levy Lauren L. , Richards‐Kortum Rebecca , Sikora Andrew , Smouha Eric E.
Published: August 2013

Objectives:

High‐resolution microendoscopy (HRME) has great potential to detect residual cholesteatoma in patients. This study investigated how accurately otolaryngologists could differentiate between images obtained with HRME of ex vivo cholesteatoma specimens and surrounding middle ear epithelium.

Methods:

Cholesteatoma and surrounding middle ear epithelium were resected from patients. Tissues were stained with a contrast agent, proflavine. The HRME was placed directly on each specimen, and images were captured. Specimens were sent for standard histopathology and were subsequently compared with HRME images. Images were evaluated for quality control, and a training set was assembled. After viewing training images, 8 otolaryngologists without prior cholesteatoma HRME experience reviewed and classified test images.

Results:

Ten cholesteatoma and 9 middle ear specimens were collected, of which 17 representative cholesteatoma and 19 middle ear epithelium images were extracted for a testing set. Qualitative analysis for concordance between HRME images and histological images yielded a strong correlation between modalities. The mean accuracy of all reviewers in correctly identifying images was 95% [95% confidence interval [CI]: 92, 98]. The sensitivity to correctly detect cholesteatoma images was 98% [95% CI: 93, 100], and the specificity was 92% [95% CI: 87, 97]. The Fleiss kappa inter‐rater reliability score was 0.83 [95% CI: 0.77, 0.89].

Conclusions:

Medical professionals can quickly be trained to accurately distinguish between HRME images of cholesteatoma and normal middle ear epithelium, both of which have distinct imaging characteristics. Real‐time HRME optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease.
Introducing the Tibial‐Dorsalis Pedis Osteocutaneous Shin Flap: A New Option for Oromandibular Reconstruction
Authors: Chandler Ashley R. , Tanna Neil , Costantino Peter D. , Boyd J. Brian , Mulholland R. Stephen
Published: August 2013

Objectives:

The authors investigate the possibility of incorporating a well vascularized, partial corticotomy of the anterolateral aspect of the tibia in‐series with a dorsalis pedis fasciocutaneous free flap for oromandibular reconstruction.

Methods:

The study consisted of three components. A cadaveric perfusion study was performed to characterize the vascular territory of the anterior tibial artery in regard to the surrounding osseous and soft tissue. A two‐point breaking strength of the tibia was examined with fracture strain gauge analysis to determine the threshold of tibia corticotomy that would lead to a pathological fracture. Finally, the authors performed an in‐vivo prospective clinical examination of the tibial‐dorsalis pedis osteocutaneous shin flap.

Results:

The perfusion study revealed that the anterior tibial artery provided a rich matrix of myofascial periosteal blood supply to the anterolateral cortex of the tibia that could support free osseous tibial transfer. Two‐point osteotomy fracture strain gauge analysis demonstrated that the threshold of tibia corticotomy that would lead to fracture of the remaining tibia was 30%. The osteocutaneous shin flap was performed in eight patients for recurrent, radiation failure, oral cavity T4 squamous cell carcinomas. The mean follow‐up was 61 months. There were no cases of flap loss, salivary fistula, nonunion, or tibia pathologic fracture. All patients achieved ambulation.

Conclusions:

The authors introduce the osteocutaneous tibial‐dorsalis pedis free vascularized flap as a viable option for oromandibular reconstruction. Its most notable advantage is the independent mobility of the skin paddle, in combination with an osseous reconstruction of the mandibular arch that facilitates primary osseointegration or denture rehabilitation.
Idiopathic Sudden Sensorineural Hearing Loss: Vascular or Viral?
Authors: Linthicum Frederick H. , Doherty Joni K. , Berliner Karen I.
Published: August 2013

Objectives:

Idiopathic unilateral sudden sensorineural hearing loss (ISSNHL) has been debated to arise from either a vascular or viral etiology. Recent studies citing evidence of a vascular etiology have been correlational in design without examination of histopathological data. It has been well established that vascular compromise results in fibrosis and/or neo‐osteogenesis within the scala tympani of the cochlea. Conversely, sudden hearing loss due to viral infections, such as measles and mumps, has been demonstrated to lead to degeneration of the stria vascularis, organ of Corti, and tectorial membrane. Abundant other research has indicated a probable viral etiology, including cochlear nerve enhancement on magnetic resonance imaging, suggesting an inflammatory process.

Methods:

A retrospective case review including clinical history, audiometry, and temporal bone histopathology of 7 temporal bones with known vascular impairment due to surgical intervention was compared to that of 11 bones with a history of ISSNHL with attention to the spiral ligament, stria vascularis, organ of Corti hair cells, tectorial membrane, ganglion cell population, and degree of perilymph fibrosis and/or neo‐osteogenesis.

Results:

Compared to 6 out of 7 vascular cases (86%) with fibrosis (P ≤. 001), ISSNHL cases exhibited more widespread tectorial membrane abnormalities, no perilymph fibrosis, less loss of ganglion cells (P ≤. 035), greater survival of spiral ligament (P ≤. 029), and twice the survival of hair cells on average.

Conclusions:

Analysis of human temporal bones from patients with sudden sensorineural hearing loss does not support a vascular insufficiency but rather suggests a viral etiology.