bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Thyroidectomy with Miniature Tools in a Pig Model
Authors: Hain Moshe , Mintz Yoav , Halperin Doron
Published: February 2015

Objective

Assess the feasibility of direct endoscopic thyroidectomy in a porcine model using CO2 pneumodissection, miniature cameras and endoscopic tools.

Method

The study was conducted during the second half of 2011. Endoscopic thyroid dissection was performed in a porcine model with CO2 pneumodissection, using cameras and endoscopic tools ranging in diameter between 2 and 5 mm.

Results

Thyroid dissection was performed in a total of 10 pigs. Two were “open” procedures to learn the porcine anatomy. Eight were endoscopic procedures. Of them 5 used three 5‐mm incisions and 3 used three 2‐ to 3‐mm incisions for surgical tools and a 5‐mm incision for the endoscopic camera. In all cases the thyroid was completely dissected with the recurrent laryngeal nerve (RLN) identified and preserved. In 5 cases the thyroid was removed through the floor of the mouth. There was no major bleeding in the live pigs, and all the vital structures were identified and preserved.

Conclusion

Endoscopic thyroidectomy using miniature camera and tools in a porcine model seems to be feasible without major complications. The advantages of this approach include minimal scars and improved visualization. We believe that there is room for further development of minimal invasive techniques for thyroid surgery.
The Value of RLN Neurostimulation in Thyroid Surgery
Authors: Piccin Ottavio , Fernandez Ignacio J. , Sciascia Silvia , Marcantoni Alessandra , Cavicchi Ottavio , Caliceti Umberto
Published: February 2015

Objective

Neurostimulation with laryngeal palpation (NSLP) is an intermittent monitoring technique that facilitates nerve identification and permits an assessment of the recurrent laryngeal nerve (RLN) function during thyroid surgery. In this study we report our experience with NSLP, evaluating the predictive value of this technique for postoperative RLN deficit.

Method

We analyzed retrospectively a consecutive series of 1584 patients undergoing thyroid surgery from 2002 to 2011 at Sant’Orsola ‐ Malpighi Hospital of Bologna. Sensitivity, specificity, PPV, and NPV were calculated for NSLP, considering an absent laryngeal twitch (LT) at the end of the surgical procedure as predictive for RLN palsy.

Results

The incidence of nerve palsy, calculated on a total of 2917 nerves at risk, was 2.1% (64 cases). Sensitivity, specificity, and positive and negative predictive values resulted respectively: 53%, 96.5%, 34.9%, and 98.4%.

Conclusion

Our results indicate that NSLP is still a useful and economic tool for RLN monitoring during thyroid surgery. Moreover the high specificity and NPV of NSLP confirm that this technique provides important prognostic information regarding vocal cord function at the end of dissection of the first lobe during total thyroidectomy.
Tumor Volume Predicts Local Control in Head and Neck Cancer
Authors: Mansuri Mohamed‐Shaji , Alun‐Jones Tom , Pace‐Balzan Albert
Published: February 2015

Objective

Head and neck squamous cell carcinomas (HNSCC) are staged using the Tumor Node Metastasis (TNM) classification; however, limitations in its prognostic accuracy are recognized. The objective was to determine if pretreatment gross tumor volume (GTV) could be used as a predictor of primary site recurrence and therefore improve current staging.

Method

A retrospective analysis of 53 patients treated with non laryngeal primary HNSCC, diagnosed between 2006 and 2007, was performed. Pretreatment GTV was calculated using Medical Imaging Interaction Toolkit (MITK) analysis of the patients’ staging radiology. The time to local recurrence and the 24‐month actuarial local control rate were recorded.

Results

The overall local control rate for the study group was 66%. Mean GTV was lower in patients without primary site recurrence, 8.47 cm3 (SD 6.42 cm3, range 2.52‐8.36 cm3), compared with patients with primary site recurrence, 18.58 cm3 (SD 9.94 cm3, range 5.24‐36.78 cm3). Patients with a GTV of <7.0 cm3 or >7.01 cm3 achieved control rates of 86.2% and 41.7%, respectively. Kaplan‐Meier and coregression analyses demonstrate GTV as a prognostic indicator in oral cavity or oropharyngeal SCC, with GTV >7.01 cm3 having a significantly poorer local primary site control (P =. 009). Multivariate analyses for all possible prognostic factors for primary site recurrence was only significant for GTV (P =. 016).

Conclusion

In oral cavity and oropharyngeal SCC pretreatment GTV is a prognostic indicator for local control, with multivariate analysis showing it to be more significant than T staging within this study. GTV can be easily calculated using MITK software, raising the possibility of its inclusion into the current TNM staging system.
Laryngeal Biopsies: Are We Doing More? A Decade of Results
Authors: Lim Shueh Y. , Sau Phoebe Chung Y. , Cooper Lorna , McPhaden Allan , Mackenzie Kenneth
Published: February 2015

Objective

Laryngeal biopsies are frequently performed in current ENT head and neck practice. Over the past decade, we have observed an escalating trend in the biopsies performed. The aim of this study is to quantify the rate of laryngeal biopsies and to record the indications from 2001‐2010 in North Glasgow, Scotland.

Method

A retrospective analysis of laryngeal biopsies performed in North Glasgow, Scotland, between 2001 and 2010 was carried out through the North Glasgow Pathology Database. Data pertaining to the site and histopathological diagnoses were collected and analyzed for each biopsy incident. The diagnoses of the biopsies are categorized under 8 classifications.

Results

From 2001 to 2010, 3902 laryngeal biopsy episodes were identified with 888 (23%) diagnosed as squamous cell carcinoma (SCC), 705 (18%) as dysplasia, 831 (21%) as no tumor, and the remaining 1478 (38%) as benign pathology. Between 2001 and 2003, approximately 300 biopsies were performed annually. From 2004‐2010, over 400 biopsies were performed annually (χ2 = 115.0, P <. 01). Approximately 120 benign biopsy episodes and 90 SCC diagnostic biopsy episodes occurred annually. From 2004, there has been significant increase in dysplasia biopsy episodes and those for surveillance of SCC. The latter has increased 2‐ to 3‐fold and has remained constant (χ2 = 71.78, P <. 01).

Conclusion

There has been an increase in biopsy episodes after 2004 with the incidence of SCC remaining relatively constant. It is hypothesized that organ preservation strategies, endoscopic resection in early laryngeal cancer, and chemoradiotherapy in advanced head and neck cancer are responsible for the increase in overall biopsy episodes from 2004.
Resection Bed Margins following Laser Cordectomy
Authors: Marshak Tal , Uri Nechama , Ronen Ohad , Doweck Ilana
Published: February 2015

Objective

1) To evaluate our experience with transoral CO2 laser microsurgery (TLM) in patients with early glottic cancer. 2) To evaluate the effect of positive additional biopsies taken from the resection bed on the outcome of patients.

Method

Retrospective study of patients with early glottic cancer who were treated by TLM, between January 2001 and December 2009 at Carmel Medical Center. Resection bed margins (RBM) using cold instruments were taken from all patients. Local control rate, overall survival, and organ preservation rate were compared between patients with positive vs negative RBM.

Results

Sixty‐four (24 Tis; 23 T1a; 10 T1b; 7 T2) patients were included in the study. Mean follow‐up was 50 months ± 34 (12‐130). Overall local control rate (LCR) was 81%. Only 10/64 (15%) patients had local failure and were referred to radiotherapy, after which 3 underwent salvage laryngectomy. Twenty‐nine patients had positive RBM, and 35 had negative margins. Patients with positive RBM had poorer LCR (59% vs 100%, P =. 0001) and lower organ preservation rate (84% vs 100%, P =. 09) compared to patients with negative margins. However, overall survival was not different between the 2 groups.

Conclusion

TLM is an effective treatment modality in early glottic cancer. Positive RBM may indicate a residual disease and hence a poorer outcome. We recommend that patients with positive RBM should be treated with re‐resection or radiation and should have close follow‐up.
The Efficacy of N‐Acetyl Cysteine in Reflux Laryngitis
Authors: Dabirmoghadam Payman , Samavatifard Mohammad R.
Published: February 2015

Objective

Laryngopharyngeal reflux is a common disorder in otolaryngology patients. Some studies have shown that more than 50% of patients with hoarseness have evidence of laryngopharyngeal reflux. Because of mucosal dryness and mucus thickening in reflux laryngitis, we conducted a prospective study to evaluate the effects of N‐acetyl cysteine.

Method

Between 2009 and 2011, patients with a reflux symptom score of more than 10 were selected and underwent endoscopic examination. Patients were randomly allocated into 3 groups and received either omeprazole, N‐acetyl cysteine, or both of them. Patients were followed for 3 months, and examination was repeated after 1 and 3 months.

Results

Ninety patients entered the study (30 patients in each group). Forty‐five of them were male, and 45 were females. Before treatment the reflux symptom scores were 18 ± 6, 16.3 ± 5, and 19.1 ± 3 for omeprazole, N‐acetyl cysteine, and both drugs, respectively. These figures changed to 10.8 ± 4.6, 15.9 ± 5.3, and 7.6 ± 4.3 and showed a significant difference (P value <.001) in favor of omeprazole plus N‐acetyl cysteine. After 3 months of treatment, the endoscopic findings score improved in 3 groups, but this change was significant in group 3 (omeprazole plus N‐acetyl cysteine).

Conclusion

Our study showed that combination of omeperazole and N‐acetylcysteine had a better influence on patients’ symptoms and endoscopic findings in reflux laryngitis comparing to the other 2 groups. All patients completed the treatment course very well without any major side effects.
Auditory Effects of Cranial Irradiation in a Mouse Model
Authors: Prasad Kumar G. , Gratton Michael Anne , Boettcher Flint , Phillips Grady
Published: February 2015

Objective

1) Determine whether radiation exposure in mice leads to measurable hearing losses similar to those seen in patients exposed to radiotherapy for acoustic neuromas, temporal bone malignancies, and nasopharyngeal carcinoma. 2) Assess for any associated pathologic changes in cochleas exposed to radiation.

Method

Adult (11‐13 weeks) 129Sv/J mice were exposed to radiation using an animal irradiator, ranging from a single exposure of 10 Gy to 100 Gy. Pre‐ and postradiation audiometric brainstem response (ABR) data were recorded to document hearing loss, with subsequent analysis of cochlear ultrastructure using transmission and scanning electron microscopy.

Results

High‐frequency hearing loss was noted in exposures exceeding 40 Gy. Anorexia was observed by day 6 post‐ irradiation in all mice exposed to doses ≥20 Gy. Normal hearing following 20 Gy exposure suggests that hearing losses seen after ≥40 Gy exposures is secondary to radiation effects rather than any confounding metabolic disturbance. Ultrastructural analysis revealed dramatically decreased neuron density in Rosenthal’s canal and loss of the associated extracellular matrix. Negligible changes were seen in the outer and inner hair cells, with overall preservation of the stria vascularis and cochlear vasculature. Age‐matched controls failed to demonstrate similar histopathologic findings.

Conclusion

This study demonstrates that the mouse is a viable model for the study of radiation‐induced hearing loss. The initial impact of the radiation appears to focus on the eighth nerve cell body and the axonal projections to the organ of Corti. Future studies should incorporate fractionation of the radiation dose.
Combination Therapy for the Treatment of Idiopathic SSNHL
Authors: Battaglia Alex , Lualhati Annette , Burchette Raoul , Cueva Roberto A.
Published: February 2015

Objective

To determine whether combination therapy (high‐dose prednisone taper [HDPT]+intratympanic dexamethasone [IT‐Dex]) improves pure tone average scores (PTA) and speech discrimination scores (SDS) relative to HDPT alone or intratympanic steroid (IT‐S) alone in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Method

From June 2008 to January 2012, 84 (15 dropouts) patients diagnosed with ISSNHL were administered IT‐De (10 mg/cc) once‐a‐week for 3 weeks + HDPT (60 mg/day for 7 days with 7‐day taper). Final audiogram results are compared to previously published results of combination therapy, HPDT alone, and IT‐S alone.

Results

Treatment began on average 6.6 days after onset of ISSNHL. The average pretreatment 3‐tone PTA was 83.2, and the average pretreatment SDS was 16%. The overall PTA improved significantly by an average of –38. The overall SDS improved significantly by an average of 49%. The average overall posttreatment SDS was 65%. 60/69 (87%) patients started with an SDS score less than or equal to 50%, and 38 (63%) of these ended above 50%. 24/42 (57%) of the profound patients recovered with an SDS above 50%. According to published reports, HDPT and IT‐S alone improve SDS by only 39%.

Conclusion

ISSNHL patients treated with IT‐De+ HDPT experienced statistically significant PTA and SDS improvements, comparable to previously published combination therapy results. The audiologic data indicate that combination therapy improves hearing recovery relative to HDPT or IT‐S alone, possibly by improving hair cell and spiral ganglion survival.
Effect of Gelfoam in the Middle Ear on In Vitro/Vivo Model
Authors: Goncalves Stefania , Chiossone‐Kerdel Juan A. , Bianco Andrea S. , Ercolino Jose M. , Hernandez Jorge
Published: February 2015

Objective

1) Determine the dissolution pattern of Gelfoam and Invotec with saline and low grade boric acid solution. 2) Measure the effect of both gelatins in animal model hearing in postoperative time. 3) Understand the direct effect of boric acid treated gel in the middle and inner ear.

Methods

In vitro, 1 cm2 of Gelfoam and Invotec colored with Congo Red and immersed in saline solution 0.9% and boric acid pH 6.3. Pixel density analysis was performed to determine degradation. Thirty live Sprague‐Dawley rats, females of 100 g, were anesthetized with ketamine/xilacine, divided into 5 groups. Preoperatory and postoperatory ABRs were measured. All bullas were processed for histopathology.

Results

Invotec dispersion and degradation was 25% sooner than Gelfoam. Boric acid treating resulted in rapid degradation of both gelatins by 18%. Hearing recovery by the Gelfoam group occurred in days 5 and 6, and Invotec treated between days 4 and 5. A shorter period of time of 4 to 5 days in boric acid treated Gelfoam. Boric acid treated Invotec results in 4 days. Mild histological inflammatory reaction was seen in all groups.

Conclusion

Gelfoam and Invotec show important differences that could impact short term hearing result showing a shorter reabsorption period of the Invotec. Boric acid impacted significantly gelfoam reabsorption with less impact on Invotec. No major histological changes found. Boric acid reduces absorption time of the cheaper Gelfoam.
Efficacy of Commercial Earplugs in Preventing Water Exposure
Authors: Mahboubi Hossein , Lee Austin , Kiumehr Saman , Djalilian Hamid R.
Published: February 2015

Objective

1) To evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals. 2) To be able to provide an evidence‐based recommendation for use of ear plugs in patients with tympanostomy tubes to prevent otorrhea.

Method

Nine ear plugs were inserted in random order in ears of 10 healthy subjects. Three standardized head wetting protocols were instructed: surface swimming, upright head submersion to apply horizontal pressure, and 90 degrees tilted head submersion to apply vertical pressure. Color change in moisture indicator was evaluated after each protocol.

Results

Water penetration was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, ad vertical submersion, respectively. The results showed a significant difference in the waterproofing qualities of the various types of earplugs. Pillow Soft Silicone Earplugs had the lowest rate of water penetration in all 3 protocols (P <. 001). There was no significant difference between the 2 waterproof earplugs Pillow Soft and Aquaseal, during surface swimming and vertical submersion protocols. However, Pillow Soft was significantly more effective comparing to Aquaseal with horizontal submersion protocol (P =. 008).

Conclusion

Commercially available ear plugs are not as protective against water intrusion as generally expected. Water exposure is recommended to be limited in patients with tympanostomy tubes. Pillow Soft was the most effective method of ear sealant compared to other commercially available earplugs.
Healthcare Delivery for Sudden Sensorineural Hearing Loss
Authors: Nguyen Huynh Anh T. , Furin Mark J.
Published: February 2015

Objective

1) Determine how healthcare delivery for idiopathic sudden sensorineural hearing loss (ISSHL) is affected by delay in seeking care, initial response from healthcare provider, and timing of diagnostic audiogram and otolaryngologic consultation. 2) Determine how the above factors affect hearing recovery.

Method

Retrospective analysis of 118 ISSHL cases at Kaiser Permanente Northwest, 2001‐2010. Hearing outcome was measured as percentage of recovery with pure‐tone average of the unaffected ear as benchmark for 100% recovery. Variables include timing of initial contact, type of provider, initial diagnosis, action, timing for audiogram, consultation, and steroid treatment.

Results

Patients with at least 50% recovery received steroid at 9.0 ± 15.2 days whereas those with less recovery received steroid at 13.9 ± 15.0 days. Delay in seeking care differed little between the 2 groups. 15% of initial encounters involved audiologists or otolaryngologists, and 85% involved other MDs, PAs, NPs, or RNs. The former were all diagnosed correctly and averaged 70% hearing recovery, whereas the latter averaged 50% recovery. In this group, only 29% were correctly diagnosed, 34% were diagnosed incorrectly with conductive hearing loss, and 31% did not receive referral for follow‐up with audiology or otolaryngology.

Conclusion

Since elapsed time adversely affects hearing recovery in ISSHL, we have identified areas in healthcare delivery where improvements can be made to facilitate timely diagnosis and management. A key objective would be better recognition of ISSHL vs conductive hearing loss among healthcare providers who triage hearing loss complaints.
Intratympanic Dexamethasone and Cisplatinum Ototoxicity
Authors: Marshak Tal , Shupak Avi
Published: February 2015

Objective

To examine the possible role of intratympanic dexamethasone (ITD) in the prevention of cisplatinum‐induced hearing loss in oncological patients receiving it in a cumulative dose greater than 300 mg as part of their treatment regimen.

Method

Eighteen patients were recruited since July 2011, to a prospective controlled cohort study. ITD was repeatedly delivered to one ear while the other served as the control immediately prior to each cisplatinum treatment. Audiometry and distortion‐product oto‐acoustic emissions (DPOAEs) parameters were compared between and within the study and control groups.

Results

Seven patients have received to date the minimal required cumulative dose of 300 mg cisplatinum, ranging from 345 to 888 mg (average of 527 + 155 mg). Pure‐tone thresholds at 8000 Hz recorded at the last follow‐up evaluation were significantly increased in both the study and control groups (P <. 04). Also, marginally statistically significant increase in 4000‐8000 Hz pure tone averages and decrease in the average DPOAEs SNR values at 4000‐8000 Hz f2 frequencies were documented in both groups. The variance between the groups in any of the measured parameters in the last follow‐up evaluation did not reach statistical significance.

Conclusion

Hearing loss mainly affecting the 8000 Hz region was found in patients receiving cisplatinum. DPOAEs evaluation demonstrated ototoxic effect to outer hair cell responding to the 4000‐8000 Hz frequency range. We could not yet demonstrate any beneficial effect of ITD in the prevention of cisplatinum‐induced hearing loss.
Mining Immune Epitopes in Ménière’s Disease and Sudden Sensorineural Hearing Loss
Authors: Platt Michael P. , Elackattu Alphi P. , Dilwali Sonam , Parikh Jignesh , Stankovic Konstantina M.
Published: February 2015

Objective

Etiologies for Ménière’s disease and sudden sensorineural hearing loss remain unknown. Indirect evidence exists for allergy‐mediated or autoimmune process. The purpose of this study is to determine whether immunogenic proteins share similar sequences with inner ear proteins, which may lead to cross‐reactivity and immune activation in inner ear disorders.

Method

Comprehensive bioinformatic primary sequence analyses of intact and mutated proteins associated with human syndromic and nonsyndromic hearing loss and proteins expressed in the human inner ear was performed. Comparison of sequences to epitopes in the Immune Epitope Database was performed by exact match, BLAST, and BLOSUM62 score computational algorithms.

Results

Computational analysis of primary protein sequence for 81 known inner ear proteins, 102 proteins from genes identified in syndromic and non‐syndromic hearing loss, and 438 protein sequences with known mutations that contribute to sensorineural hearing loss was compared to 151,086 epitopes previously implicated in allergic, autoimmune, and infectious disorders within the Immune Epitope Database. The exact match and BLAST algorithms identified 1925 and 97 unique epitope matches, respectively. Top BLOSUM62 score algorithm resulted in a single hit for the 47 kDa membrane antigen. Other epitopes included those seen in allergic rhinitis, infectious diseases, and autoimmune disorders.

Conclusion

Abnormal immune activation is suspected in Ménière’s disease and SSNHL. Candidate immune epitopes were identified that may contribute to pathogenesis of these disorders. While these epitopes await clinical validation, they present novel targets for diagnosis and treatment of sensorineural hearing loss.
Motion Sickness Treatment Analysis with OVAR
Authors: Knox Glenn W.
Published: February 2015

Objective

Evaluation of transdermal scopolamine for motion sickness prophylaxis.

Method

Randomized, prospective double blind. 2010‐11. Twelve patients, 7 male, 5 female, ages 21 to 57. Intervention(s): Off‐vertical axis rotation 20° in the dark after administration of transdermal scopolamine or placebo. Outcome measures: Duration of tolerated off‐vertical rotation; subjective symptom reporting at 1‐minute intervals on a 0 to 4 scale.

Results

Patients treated with transdermal scopolamine had statistically significant improved tolerance time to off‐vertical axis rotation. Reported symptomatology on the 0‐3 subjective symptom scale was significantly improved as compared to placebo and was dose‐dependent. These results were significant to the. 05 confidence level.

Conclusion

Off‐vertical axis rotation is a useful modality for the evaluation of motion sickness medications. Transdermal scopolamine showed statistically significant dose‐dependent effects in mitigating OVAR‐induced motion sickness symptomatology and was well tolerated.
Outcomes after Usage of Ponto Implant System
Authors: Babu Seilesh , McKinnon Brian J. , Fucci Michael J.
Published: February 2015

Objective

Bone‐anchored hearing systems have proven to be an effective amplification solution for conductive, mixed, and profound unilateral sensorineural hearing losses. The Ponto bone‐anchored hearing system has been available in the United States for 2 years.

Method

This multicenter study was performed to review our experience with the Ponto system in 99 patients from 3 medical centers. The mean follow‐up was 6 months and the average loading time was 80 days. The linear surgical technique was used in 95% of cases. Clinical outcomes were measured.

Results

Of the 99 cases, there were no implant losses. Factors such as gender, hypertension, diabetes, body mass index (BMI), and smoking were investigated to determine any correlation between skin reactions that were found. Smoking was the only factor to be found significant in correlating to skin reactions (P <. 05).

Conclusion

The Ponto bone‐anchored hearing system is an effective and successful treatment option for conductive and single sided deafness. Factors were evaluated to determine skin reactions and implant survival. These include gender, hypertension, diabetes, tobacco usage, and BMI. Only tobacco usage seemed to be a significant factor in skin reactions.
Rinne Revisited: Steel versus Aluminum Tuning Forks
Authors: Greenberg Jesse J. , Raz Yael , MacKechnie Cheryl A. , McCall Andrew A. , Hirsch Barry E. , Gerkin Richard C. , Durrant John D.
Published: February 2015

Objective

1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). 2) Determine the acoustic and mechanical impedance properties of 512 Hz tuning forks made of aluminum and stainless steel.

Method

Prospective, randomized observational study of 38 subjects presenting to outpatient clinic May 2011 through February 2012 with negative or equivocal Rinne and same‐day audiogram. Laboratory tuning fork impedance measurements were obtained using sound‐level meter and artificial mastoid (simulating air and bone conduction). Outcome: Sensitivity of negative Rinne in predicting air‐bone gap at 500 Hz.

Results

Patients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at 20.3 (±2.5) dB air‐bone gap for stainless steel versus 27.5 (±2.6) dB with aluminum. In a supporting laboratory study, steel forks exhibited comparable air and bone conduction efficiencies while aluminum forks favored air conduction. This results in a larger CHL being required to overcome aluminum forks’ increased air conduction efficiency before producing a negative Rinne.

Conclusion

We have found steel tuning forks are more sensitive in detecting the presence of an air‐bone gap. This is substantiated by significant differences in the relative acoustic versus mechanical impedances of steel and aluminum forks. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.
Round Window Reinforcement for Superior Canal Dehiscence
Authors: Silverstein Herbert , Kartush Jack M. , Parnes Lorne S. , Poe Dennis S. , Babu Seilesh , Levenson Mark J.
Published: February 2015

Objective

To evaluate the outcome of round window (RW) with or without oval window (OW) tissue reinforcement in the management of superior canal dehiscence (SCD).

Method

Chart reviews were perfomed for patients with symptomatic SCD that underwent this window reinforcement procedure. Preoperative and postoperative audiometry, vestibular myogenic evoked potentials (VEMP), and presence of a positive Tullio and Hennebert’s sign were recorded. Patient questionnaires were administered to assess symptomatic relief following the procedure.

Results

Twenty‐five chart reviews from 5 tertiary centers revealed that most patients experienced reduction of symptoms and were satisfied with the results. A comprehensive analysis will be presented.

Conclusion

Tissue reinforcement of the windows(s) may reduce some of the symptoms associated with SCD, perhaps by mitigating some of the presumed “third window” effect of the dehiscence. Most patients were grateful for the benefits provided by the procedure and the avoidance of a craniotomy or mastoidectomy.
Surgery for Otosclerosis: Results on 508 Patients
Authors: Sionis Sara , Puxeddu Roberto
Published: February 2015

Objective

The objective of our paper is to evaluate the hearing results after surgical treatment of otosclerosis from a retrospective analysis of 649 procedures performed by the same surgeon (484 stapedotomies, 69 total stapedectomies, 26 partial stapedectomies, and 70 revisions). We also evaluated the hearing improvement in patients with far‐advanced otosclerosis.

Method

We conducted a retrospective study on 649 operations performed on 508 patients between 1998 and 2005. The approach was endoaural under local anesthetic. Audiological evaluation has been performed according to the Committee on Hearing and Equilibrium–AAO‐HNS guidelines.

Results

We found results better after stapedotomy than stapedectomy with a postoperative ABG within 10 dB in 89.67% after stapedotomy, in 85.51% after total stapedectomy, and in 84.62% after partial stapedectomy. Stapedotomy was most reliable in the variation of the BC for high tones; we had a worsening of BC in 17.56% after stapedotomy and in 21.74% after stepedectomy. After revision surgery the outcomes were worse than primary surgery, with an ABG within 10 dB in 85.36% after revision of stapedotomy and in 82.76% after revision of stapedectomy. In far advanced otosclerosis, we obtained a mean postoperative ABG within 10 dB in 86.32%.

Conclusion

This study confirmed stapes surgery allows for a good restoration of hearing function in a high percentage of cases with slightly better results after stapedotomy. Time of surgery is fundamental for recovery of hearing function since the outcomes are better in patients without sensorineural hearing loss.
The Socioeconomic Impact of Revision Otologic Surgery
Authors: Nadimi Sahar , Leonetti John P.
Published: February 2015

Objective

To estimate the socioeconomic impact of revision canal wall down (CWD) mastoidectomy.

Method

Retrospective chart analysis from our tertiary care medical center that evaluated all adult patients who underwent CWD mastoidectomy by the senior surgeon between 2006 to 2011. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery at state (Illinois) and national levels.

Results

One hundred eighty‐nine CWD mastoidectomies were reviewed, of which 89 were primary and 100 were revision procedures. The total charge for this group of revision cases was $2,783,700, and the net reimbursement (collections) was $843,245. Using Illinois Hospital Consortium data, the estimated cost of reimbursement for revision CWD mastoidectomy for 387 cases in FY 2011 was nearly $3.3 million. An additional $2160 per patient in lost wages was predicted to have been related to time away from work. The 9214 patients who underwent revision CWD mastoidectomy in the U.S. represented a national healthcare cost of roughly $80 million.

Conclusion

Known causes for failed CWD mastoidectomy include inadequate meatoplasty, high facial ridge, and residual or recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, thereby resulting in a positive impact on the socioeconomic strain related to this procedure at local, state, and national levels.
Multidisciplinary Management of Infiltrating Lipomatosis
Authors: Tracy Jeremiah C. , Dezube Aaron , Klement Giannoula L. , Scott Andrew R.
Published: February 2015

Objective

To present a novel paradigm in the management of congenital infiltrating lipomatosis (CIL) using surgical intervention combined with perioperative chemotherapy.

Method

Case study and review of literature.

Results

CIL is a benign yet locally invasive lipomatous tumor. Current treatment involves subtotal resection and recontouring. Invasion of vital structures often prohibits complete excision; there is currently no consensus on the most appropriate timing or scope of resection. We present the case of a teenager with extensive CIL involving the left face who had undergone multiple previous surgeries with limited success. In this case, preoperative thalidomide and celecoxib was given followed by an aggressive soft tissue resection. Postoperatively, imatinib was started based on immunohistochemical findings. At 6 months the patient has improved facial symmetry without evidence of disease progression.

Conclusion

This multidisciplinary approach to treatment of CIL represents a completely new paradigm. Current algorithms advocating early surgical resection or observation alone lead to unacceptably high rates of recurrence and potential morbidity; combining surgical and medical interventions may provide a synergistic approach to controlling this rare disease.
Airway Management following Pediatric Cardiothoracic Surgery
Authors: Wilson Meghan N. , Bergeron Lauren M. , Kakade Anagha , Simon Lawrence M. , Caspi Joseph , Pettitt Timothy W. , Kluka Evelyn A.
Published: February 2015

Objective

Little is currently known regarding outcomes in airway management of pediatric patients following cardiothoracic surgery (CTS). This study aims to 1) review airway management in a large cohort of pediatric patients undergoing CTS and 2) determine the incidence of airway related complications of CTS in this population.

Method

All patients who underwent CTS at a single, tertiary care, dedicated children’s hospital between June 1, 2007, and May 31, 2011, were retrospectively reviewed; those <18 years old who had open CTS were included. Statistical analysis examined the relationships of intubation length, tracheotomy, and complications compared to patient characteristics, comorbidities, and type of surgery.

Results

Nine hundred five admissions in 762 patients met inclusion criteria. Mean postoperative intubation duration was 7.2 days (d), and the median was 3 d. Significantly longer postoperative intubation requirements were found in patients <2 years (mean 9.7 d, median 4 d) vs >2 years (mean 2.4 d, median 2 d, P <. 001) and those with comorbidities (mean 11.0 d, median 4 d) or history of prematurity (mean 8.8 d, median 4 d) vs those without comorbidity (mean 5.5 d, median 3 d, P <. 001). Additionally, preoperative intubation and surgical incision type significantly affected intubation duration. Vocal cord paralysis occurred in 3 patients, and phrenic nerve palsy occurred in 5. Twenty‐four patients required tracheotomy. Five patients developed airway stenosis.

Conclusion

After reviewing a large cohort of patients, this study finds CTS in the pediatric population is associated with few long term or permanent airway related complications. Patients with a history of prematurity, medical comorbidity, and/or younger age at the time of surgery require longer periods of postoperative intubation.
Childhood Obesity as a Risk for Development of Otitis Media
Authors: Sidell Douglas R. , Shapiro Nina L. , Bhattacharyya Neil
Published: February 2015

Objective

To determine if obesity is a significant risk factor for acute suppurative otitis media (AOM), allergic rhinitis (AR), or adenoid/tonsillar hypertrophy (ATH) in children, and to understand the potential otolaryngological implications of childhood obesity.

Method

The Medical Expenditure Panel Survey was utilized to identify children diagnosed with AOM, AR, and/or ATH. Risk factors for these diagnoses extracted included demographics and the presence or absence of childhood obesity. Multivariate statistical analyses were conducted for the associations between childhood obesity and AOM, AR, and ATH.

Results

A total of 84.5 million children (mean age, 12.2 years) were studied within the 2006 and 2008 MEPS data sets. Of these patients, 4.3 million (5.1%) reported a diagnosis of AOM, 8.0 million (9.5%) reported a diagnosis of AR, and 0.31 million (0.4%) reported a diagnosis of ATH; 18.7 million children (22.2%) were obese. Utilizing a demographically adjusted multivariate model, childhood obesity was found to be associated with AOM (P =. 01; odds ratio, 1.45). Significant associations between obesity and AR or ATH were not identified (P =. 60 and P =. 79, respectively).

Conclusion

Childhood obesity appears to be significantly associated with the development of AOM, but does not seem to influence AR or ATH. Given that in the United States nearly one‐fourth of all children seeking healthcare are obese, these data may have important preventative care implications.
FloSeal with Adenotonsillectomy to Prevent Adverse Outcomes
Authors: Dyer Steven R. , Durvasula Phani , Bathula Samba , Sana Saidshoib , Haupert Michael , Madgy David , Dworkin James
Published: February 2015

Objective

The aim of study was to compare the postoperative complications associated with adenotonsillectomy with or without the application of FloSeal at the completion of the procedure in 2 similar groups.

Method

This retrospective study was performed at a tertiary care pediatric hospital between January 2007 and December 2008, for OSA and chronic tonsillitis in patients between 1 and 18 years old. Eight hundred patients underwent adenotonsillectomy in an identical manner, with half reciving FloSeal intraoperatively. Outcomes measured were: hemorrhage, return to OR, and dehydration.

Results

Age ranged from 1 to 18 years. Male gender was found to have a slight predominance without statistical significance (χ2 = 0.01, P =. 93). Preoperative diagnosis was more commonly OSA (79.9%) compared to chronic tonsillitis (20.1%). Primary bleed rate was found to occur in 2 subjects (0.3%); 1 FloSeal and 1 No FloSeal subject (χ2 = 0.004, P =. 95). Secondary bleeding was seen in 18 subjects (2.5%); 11 FloSeal and 7 No FloSeal (χ2 = 1.32, P =. 25). Dehydration was seen in 51 subjects (7.1%); 24 FloSeal and 27 No FloSeal (χ2 = 0.01, P =. 92). The need for return to OR was seen in 7 subjects (1%); 5 FloSeal and 2 No FloSeal (χ2 = 1.59, P =. 21).

Conclusion

In our experience, the application of FloSeal hemostatic matrix after monopolar adenotonsillectomy demonstrates no additional reduction in postoerative complications encountered in the pediatric population.
Foreign Body as Initial Symptom of Eosinophilic Esophagitis
Authors: Hudson Scott K. , Sampson Chris , Muntz Harlan R. , Grimmer Fredrick , Park Albert H. , Jackson W. Daniel , Smith Marshall
Published: February 2015

Objective

1) Determine characteristics common in the presentation of esophageal foreign body that indicate presence of underlying esophageal pathology. 2) Provide clinical guidelines to consider esophageal mucosal biopsy during foreign body removal.

Method

Three hundred twelve cases of pediatric patients with an esophageal foreign body requiring esophagoscopy for removal were reviewed. Patients were excluded if a history of esophageal surgery or pathology was present. Factors common to those patients subsequently diagnosed with eosinophilic esophagitis (EE) were identified.

Results

Eligibility criteria were met in 271 cases. Of these, 27 underwent esophageal biopsy and 18 were diagnosed with EE. The following factors were compared between the EE population and the group as a whole: food impaction (89% of EE patients, 11% of non‐EE patients), older age (average EE age 11.9, overall average age 4.5), atopic disease (61.1% of EE, 17.0% non‐EE), abnormalities on esophagoscopy (94.4% of EE, 8.9% overall), and previous esophageal foreign body or frequent dysphagia (83.3% of EE, 5.9% non‐EE). Eighteen percent of EE patients had 2 or more impactions requiring esophagoscopy prior to a biopsy being taken.

Conclusion

Older age, food impaction, history of atopic disease or previous esophageal foreign body, and abnormalities on esophagoscopy are all associated with EE. Patients meeting these criteria should be strongly considered for mucosal biopsy during foreign body removal. Failure to do so may lead to repeated foreign body events.
Sensorineural Hearing Loss with Neomycin Ear Drops
Authors: Winterstein Almut G. , Antonelli Patrick J. , Xu Dandan , Liu Wei
Published: February 2015

Objective

Neomycin ear drops are contraindicated with non‐intact TMs (NITM), either perforation (TMP) or tube (TT) because of the risk of ototoxicity. The aim of this study was to evaluate the comparative risk of sensorineural hearing loss (SNHL) with neomycin and quinolone ear drops and NITMs.

Method

Pediatric Medicaid beneficiaries from 29 states, 1999‐2006, were studied if they received a study drug within 12 months of TMP or TT, and were continuously enrolled ≥6 months before and 12 months after first dispensing. We compared the 12‐month risk of SNHL using Cox regression adjusted for SNHL risk factors.

Results

We found 1935 SNHL cases in 139,906 children treated with neomycin or quinolone eardrops (1‐year incidence = 1.38). Within those with neomycin, 76.3% received 1 dose and 17.4% received 2. The adjusted hazard ratio (HR) for 1, 2, and ≥3 prescriptions of neomycin was 0.99 (95% CI 0.89‐1.12), 1.32 (1.05‐1.67), and 1.34 (0.89‐2.01), respectively, when adjusted for SNHL risk factors and total number of otic antimicrobial prescriptions.

Conclusion

Short‐term use of neomycin ear drops in patients with NITMs does not appear to carry a significant risk of SNHL. Repeated doses of topical neomycin are associated with an increased SNHL risk.
Supraglottic Appearance and Severity in Laryngomalacia
Authors: Landry April M. , Rutter Michael J. , Cotton Robin T. , Thompson Dana M.
Published: February 2015

Objective

1) Compare flexible laryngoscopy findings between infants presenting with mild, moderate, and severe laryngomalacia. 2) Examine and understand the predictive valve of the initial laryngoscopy exam in those infants whose disease increases in severity from initial presentation.

Method

The flexible laryngoscopy exams of 201 infants with laryngomalacia from 2 separate institutions were recorded. The laryngeal findings were graded by the senior examiners. The infants were stratified into mild, moderate, and severe groups based on clinical severity. Laryngeal findings were then compared between the 3 groups.

Results

The mild group had 15.0% incidence of tight omega epiglottis while there was 27.7% and 34.2% in moderate and severe groups, respectively (P >. 05). A retroflexed epiglottis seen in 39.5% of severe group, but 2.5% and 9.6% of mild and moderate, respectively (P <. 05). Good visualization of vocal cords was seen in 35% of mild but 7.2% and 0% of moderate and severe, respectively (P <. 05). Ventricular effacement was seen in 20.0% of mild group but 85.5% of moderate group (P <. 05). The 47 infants with increasing severity of disease had the following rates: tight epiglottis, 31.9%; retroflexed epiglottis, 12.6%; good cord visualization, 10.6%; and ventricular effacement, 63.8%.

Conclusion

The laryngoscopic findings differ with disease severity. The infants who increased in severity had characterics associated with a higher severity of disease at initial presentation. The flexible laryngoscopic exam may be helpful in predicting which infants need will have an increase in severity of their disease and warrant closer follow‐up.
The Segmental Mandibular Critical Size Defect in the Rat
Authors: DeConde Adam S. , Sidell Douglas R. , Aghaloo Tara , Bezouglaia Olga , Lee Min , Tetradis Sotirios , St. John Maie
Published: February 2015

Objective

Advances in tissue engineering offer potential alternatives to current mandibular reconstructive techniques. However, prior to clinical translation of this technology, a relevant animal model must be used to validate possible interventions. This study aims to establish the critical size segmental mandibular defect that does not heal spontaneously in the rat.

Method

Thirty rats underwent creation of 1 of 4 segmental mandibular defects: 0 mm, 2 mm, 3 mm, and 5 mm. All mandibular wounds were internally fixated with 1‐mm microplates and screws. Rats were allowed to heal for 12 weeks, and then all mandibles were analyzed with micro‐computed tomography (CT).

Results

One rat was exsanguinated intraoperatively, and 1 mandible was fractured by the drill and the animal was euthanized. This resulted in 7 animals per group. No 5‐mm segmental defects successfully healed, whereas all 0‐mm and 1‐mm defects had continuous bony growth across the original defect on micro‐CT. Three of the 3‐mm defects had bony continuity, and 3 had no healing of the bony wound.

Conclusion

The rat animal model cannot heal a 5‐mm segmental mandibular defect. Successful healing of 0‐, 1‐, and 3‐mm defects confirms adequate stabilization of bony wounds with internal fixation with 1‐mm microplates. The rat segmental mandibular critical size defect provides a clinically relevant testing ground for translatable mandibular tissue engineering efforts.
A Snapshot of Endoscopic Sinus Surgery in the Western US
Authors: Sewell Ryan K. , Roberson David W. , Zappia John J. , Troxel David , Shah Rahul K.
Published: February 2015

Objective

Endoscopic sinus surgery is a commonly performed procedure. Despite its prevalence, few data exist regarding the characteristics of the typical endoscopic sinus surgery. At the conclusion of the presentation participants should be able to discuss the following: 1) typical patient characteristics, and 2) types of cases being performed by otolaryngologists.

Method

A survey was mailed by The Doctors Company to 500 insured otolaryngologists in the western United States. The survey queried characteristics of the last endoscopic sinus surgery performed.

Results

One hundred ninety‐six surveys were returned. Chronic sinusitis was the predominant indication for surgery (89%). Revision cases constituted 18% of the cases. Maxillary antrostomies and ethmoidectomies (partial or total) were performed in 94% and 90% of cases, respectively. Powered instrumentation was utilized in 77% of the cases. The majority (71%) did not use image guidance. The surgeon rated the case as technically difficult in 25% of cases. Complications included bleeding (3), septal hematoma (1), check numbness (1), recurrence of polyposis (1), pneumonia (1), and entry into medial orbit (1). Physician reports of technical difficulty did not correlate with reported complications.

Conclusion

The present study provides insight into “typical” endoscopic sinus surgery performed in the western United States. The typical patient has chronic sinusitis and is undergoing an initial procedure that involves at least the maxillary and ethmoid sinuses. Further research into practice patterns and risk stratification in endoscopic sinus surgery is warranted.
Drug‐Eluting Catheter as Treatment of Sinonasal Polyposis
Authors: Plaza Guillermo , Eisenberg Gustavo , Onrubia Tomas , Montojo Jose , O’Connor‐Reina Carlos‐Luis
Published: February 2015

Objective

Chronic rhinosinusitis with polyposis is currently treated with intranasal steroids. The study objective was to assess the safety and effectiveness of a drug‐eluting catheter to be inserted into the ethmoid sinuses to release triamcinolone during FESS in patients with sinonasal polyposis.

Methods

Preliminary results from a prospective, randomized, double blinded, clinical trial enrolling 40 patients. In every case, after polypectomy was done to expose the ethmoid bulla, a drug‐eluting catheter to deliver triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional functional endoscopic sinus surgery. Outcome measures were visual analogue scales, RSDI, endoscopy, and olfactometry assessment at baseline and 3 months. Safety assessment included ocular exams at baseline and 30 days.

Results

After randomization was performed, unilateral devices were successfully placed in all patients, and they were also easily removed after 4 weeks. When comparing both nasal fossae, mean inflammation scores were minimal at all time points. At 3 months, the prevalence of polypoid edema, adhesions and rhinorrhea was statistically similar in both sides. Changes from baseline in patient‐reported outcomes were statistically significant (P <. 0001). No clinically significant changes from baseline in intraocular pressure occurred. CT imaging will be done after 12 months of follow‐up.

Conclusion

This randomized controlled trial provides clinical evidence of the safety, effectiveness, and clinical utility of a drug‐eluting catheter in patients with nasal polyposis.