bluuebunny/crossref_metadata_2025 huggingface dataset:
A Genetically Modified Viral Vector for Head and Neck Cancer
Authors: Mouchli Anas , Han Ziying , Zheng Jun , Lajud Shayanne A. , Sanyal Samudra , O’Malley Bert W. , Li Daqing
Published: February 2015

Objective

1) To develop a novel genetically modified recombinant adenoviral vector that is expressing epidermal growth factor (EGF) and detargeting from natural coxsackie‐adenoviral receptor (CAR). 2) To apply this novel vector to head and neck cancer (HNC) as an epidermal growth factor receptor (EGFR)‐targeted approach.

Method

Wild‐type adenoviral fiber knobs were genetically modified with EGF, and a novel adenoviral vector with EGF and EGFR binding properties was constructed. This novel construct was tested in the HNC tumor cells expressing a high level of EGFR.

Results

The novel genetically modified recombinant adenoviral vector demonstrated EGFR‐targeted properties. The HNC tumor cells expressing high levels of EGFR showed much more viral targeted effects as compared to the cells with low or no EGFR. The nature CAR cell surface entering mechanism was not observed in the HNC tumor cells when the novel was vector applied.

Conclusion

Our study suggests that the novel genetically modified recombinant adenoviral vector has EGFR‐targeted properties that target the HNC tumor cells, which commonly express high levels of EGFR. This vector has a potential for targeted delivering of diagnostic or therapeutic agents not only for HNC but for any tumor expressing EGFR.
Soluble VEGFR‐2 Expression in Head and Neck Malignant Tumors
Authors: Silver Natalie , Brill Yolanda , Baffi Judit , Albuquerque Romulo , Ambati Jayarkrishna , Valentino Joseph
Published: February 2015

Objective

1) Define the spatial pattern of expression of soluble vascular endothelial growth factor receptor 2 (sVEGFR‐2), a recently discovered receptor that has an important role in tumor lymphangiogenesis, in head and neck malignant tumors. 2) Examine the relationship between sVEGFR‐2 expression and lymphatic vessel density in head and neck malignant tumors.

Method

One hundred ten paraffin‐embedded tissue samples from patients with malignant tumors were stained using immunohistochemistry for sVEGFR‐2 and podoplanin, a marker for lymphatic vessels. Tissues studied included: squamous cell carcinoma of the larynx (61), oral cavity (16), oropharynx (20), hypopharynx (5), nasopharynx (1). Papillary (4), medullary (2), and follicular (1) thyroid cancers were also examined.

Results

sVEGFR‐2 expression was identified in all squamous cell carcinomas of the head and neck. Expression was specific to the endothelial cells in blood vessels of both malignant tissue as well as adjacent normal tissues. sVEGFR‐2 was not expressed in lymphatic vessels. This secreted protein was also expressed in tissue stroma. Decreased expression of sVEGFR‐2 was correlated with increased lymphatic vessel density in tumors, as measured by podoplanin expression. sVEGFR‐2 was minimally expressed in normal thyroid tissue but was abundant in the basement membrane of papillary thyroid cancer cells.

Conclusion

We have provided the first evidence of sVEGFR‐2 expression in head and neck malignant tumors. Its expression correlates with lymphatic vessel density in head and neck malignant tumors and ongoing studies will reveal the precise function of sVEGFR‐2 in nodal metastasis and disease progression.
Surgical Treatment of Lingual Thyroid
Authors: Hall Francis T. , Ghanem Tamer A. , Stachler Robert J.
Published: February 2015

Objective

To describe 2 contrasting surgical approaches in the treatment of patients with a lingual thyroid.

Method

Case series from 2006 to 2008. Condition studied: lingual thyroid. Subjects and setting: Patients requiring surgery for lingual thyroid in a community hospital. Outcome measurements: recurrence, complications.

Results

A 33‐year‐old woman had a small lingual thyroid. Although she had no symptoms she was planning to become pregnant and it was felt that the lingual thyroid would increase in size with pregnancy and could result in airway obstruction. She therefore underwent transoral laser resection of the entire lingual thyroid. A 36‐year‐old woman had a large combined lingual and sublingual thyroid. She was unable to sleep lying down. She had previously undergone transoral debulking. She underwent a transcervical transhyoid partial pharyngectomy with resection of the entire lingual and sublingual thyroid. Both patients had no recurrence with mean follow‐up of 9 months. There were no complications.

Conclusion

The treatment of lingual thyroid needs to be tailored to the clinical presentation. Surgery can be performed either through a transoral or transcervical approach depending on the extent of disease.
A Novel Low Cost Task Trainer for Tonsillectomy Simulation
Authors: Gantwerker Eric , Toth Peter , Provenzano Matthew , Meinzen‐Derr Jareen , Myer Charles M. , Johnson Kaalan E.
Published: February 2015

Objective

1) Develop a novel low cost task trainer which appropriately simulates the basic steps involved in a tonsillectomy procedure for the novice trainee. 2) Assess this task trainer for feasibility, face validity, usability, and content validity using a group of expert observers.

Method

The task trainer was developed to reproduce all steps of the tonsillectomy procedure using pieces of steak with adherent connective tissue to simulate the tonsil for electrocautery dissection. Pediatric otolaryngology attendings and fellows were surveyed using a 5‐point Likert scale to assess ease of use, realism, and perceived utility.

Results

The model consists of a Styrofoam head with cut‐out oropharynx and steak pieces suspended by metal clips and wired to an electrocautery unit. Surgeons use a headlight, grasp the muscle, and electro‐dissect it away from the fat. Cost of the model was twenty US dollars. Ten attending pediatric otolaryngologists and 4 pediatric otolaryngology fellows completed simulated tonsillectomies and surveys. Participants rated a median realism score of 4 out of 5 (very realistic) and ease of use a median 5 out of 5 (simple and intuitive). All participants agreed residents would be better prepared for real tonsillectomies after using the model.

Conclusion

Production and use of a tonsillectomy task trainer is a feasible and inexpensive endeavor for training programs and may provide appropriate usability and fidelity in simulating tonsillectomy for trainees. Face and content validity were confirmed by expert observers. Further study will assess validity and effectiveness for teaching and assessment.
The Effectiveness of Pregabalin on Tonsillectomy Pain
Authors: Hyun Kim Dong
Published: February 2015

Objective

This study was conducted to evaluate the effectiveness of premedication using pregabalin on postoperative pain control in patients undergoing tonsillectomy.

Method

Fifty adult patients were randomly divided into a control group and a pregabalin group. Patients in the control group received an oral placebo preoperatively, while those in the pregabalin group received an oral dose of pregabalin preoperatively. All participants were provided with patient controlled analgesia using fentanyl for 24 hours after surgery. The total amount of fentanyl injected and the number of injections of ketorolac tromethamine (30 mg each) requested by each of group was then compared. Pain assessment was performed using a visual analog scale during resting periods (rVAS) and during swallowing (sVAS) for 7 days after the operation.

Results

The number of ketorolac tromethamine injections and total amount of fentanyl injected decreased significantly in the pregabalin group (P <. 01). The sVAS of the pregabalin group was significantly lower than that of the control group throughout the postoperative 24 hours. But, there were no significant differences in the sVAS observed between the 2 groups after 24 hours of the postoperative period. The rVAS of the pregabalin group was significantly lower than that of the control group at 2.8 hours after surgery but there were no significant differences in the rVAS observed between the 2 groups for the remainder of the postoperative period.

Conclusion

The addition of pregabalin prior to tonsillectomy may have an adjunctive role in pain control.
The Role of Family Caregiver in Head and Neck Cancer
Authors: Garzaro Massimiliano , Airoldi Mario , Riva Giuseppe , Bartoli Claudia , Carnio Simona , Giordano Carlo , Pecorari Giancarlo
Published: February 2015

Objective

The family caregiver’s role (FCG) is largely un‐investigated among head and neck cancer patients. 1) To better detail the role of FCG. 2) To evaluate quality of life (QoL) and psychological distress of FCGs and patients. 3) To investigate relationships between FCG’s well being and patient’s QoL and emotional pattern.

Method

Sixty patients and their caregivers were enrolled in this observational cross‐sectional study between 2008 and 2011 at the ENT Division of the University of Turin. Inclusion criteria: diagnosis of HNSCC, stage III‐IV, completion of curative treatment and NED at the enrollment. Psycho‐oncological tests: Distress Thermometer, STAI‐Y1/Y2, Beck Depression Inventory (BDI) and Montgomery‐Asberg Depression Rating Scale (MDRS), EORTC‐QLQ‐C30+H&N35 module and Caregiver Quality of Life Index‐Cancer.

Results

Patients: state and trait anxiety are 46.7% (STAI‐Y1 mean value 40.2 ± 10.2; cutoff 40) and 36.7% (STAI‐Y2 mean value 36.7 ± 8.2; cutoff 40) respectively; self‐reported and clinician‐rated depression are 31.6% (BDI mean value 8.2 ± 5.3; cutoff 9) and 48.3% (MDRS mean value 7.9 ± 5.9; cutoff 6), respectively. CGs: state and trait anxiety are 50% (STAI‐Y1 mean value 42.5 ± 9.9; cutoff 40) and 41.7% (STAI‐Y2 mean value 39.1 ± 8.7; cutoff 40), respectively; self‐reported and clinician‐rated depression are 28.3% (BDI mean value 7.3 ± 4.7; cutoff 9) and 41.7% (MDRS mean value 7.6 ± 5.8; cutoff 6), respectively. Positive association among emotional scales of patients and caregivers was observed. Patients’ psychological aspects are negatively associated with CGs’ QoL and vice versa.

Conclusion

Anxiety and depression are often present in FCGs and cured HNC patients. Long‐term patients’ QoL is the result of a frail balance between FCG and patient emotional and psychological distress. A psychological support for FCG could improve patient well‐being.
Transfacial Ultrasound‐Guided Parotid Stone Removal
Authors: Carroll William R. , Walvekar Rohan R. , Gillespie M. Boyd
Published: February 2015

Objective

1) Describe a surgical technique of ultrasound‐guided, transfacial, gland‐preserving resection of difficult parotid stones. 2) Review outcomes in treated patients.

Method

Study design: Case series with chart review. Time frame: 2008 through 2011. Disease: Parotid sialolithiasis. Subjects: Patients with parotid sialolithiasis unmanageable with endoscopy alone. Setting: Tertiary care university hospital. Intervention: Ultrasound‐guided, transfacial resection. Outcome measurements: Stone size, stone location, complications, and symptom relief.

Results

Eleven cases of transfacial ultrasound‐guided gland‐preserving surgery were performed from 2008 to 2011. There were 8 palpable stones and 3 nonpalpable stones. Mean stone size was 8 mm. Eight patients had single stones and 3 had multiple stones. Localization was performed by ultrasound in 5 cases, by endoscopy in 2 cases and combined in 4 cases. The facial nerve was visualized in 2 cases. One patient developed a postoperative salivary fistula. Seventy‐five percent (9/12) were symptom free at follow‐up, and 25% (3/12) were improved with mild obstruction.

Conclusion

Transfacial ultrasound‐guided surgery for parotid sialoliths provides a safe and effective method of treating difficult parotid stones while avoiding total parotidectomy.
Strategic Plan for CBM’s Work in Ear and Hearing Care
Authors: Santana‐Hernandez Diego , Brenes Monika
Published: February 2015

Objective

1) Work with communities to improve the quality of life of people with, or at risk of, ear and hearing problems in disadvantaged societies. 2) Empower developing countries to provide all services required, at community, primary, secondary, and tertiary level, by persons affected by ear disease, hearing impairment/deafness, or deafblindness.

Method

This strategy is the result of a multidisciplinary team workshop in Germany in 2010, later reviewed by CBM advisors, approved by Senior Leadership Team, and presented to regional directors on June 24, 2011. It will be further developed for roll‐out in a joint meeting in Zimbabwe on June 7‐9, 2012.

Results

The following areas were identified as priorities: 1) Awareness and Knowledge: The implementation of effective and sustainable measures to address the burden of EHC problems will require moving from basic awareness to fully understanding its magnitude. 2) Prevention: The most effective (and cost‐efficient) interventions in public health are those implemented to impact at primary prevention level. 3) Resources: Equipping professionals with adequate tools to deliver good quality services and emphasizing local capacity building. 4) Access: Accessibility to EHC services includes local availability at the primary healthcare level. 5) Advisory Work: into a platform to advise at global, regional, and local levels in EHC matters.

Conclusion

A global consensus for best practice is desirable. CBM is currently strategically positioned where it can play a key role in the facilitation of a joint international forum for agencies and stakeholders to reach that consensus. Together with WHO and the WFD, CBM could develop a global strategy.
Cordotomy by Coblation in Bilateral Vocal Fold Immobility
Authors: Osborne Kyra M. , Bryson Paul C. , Benninger Michael S.
Published: February 2015

Objective

1) Understand the presentation, etiology, and management of bilateral vocal fold immobility. 2) Understand the utility, technique, and advantage of endoscopic coblation vocal cordotomy for patients with bilateral vocal fold immobility. 3) Compare the use of the laryngeal coblator with the laser.

Method

Case series using endoscopic coblation to perform vocal cordotomy in patients with bilateral vocal fold immobility is presented. Seven patients underwent suspension microlaryngoscopy with either initial or revision vocal cordotomy with or without partial arytenoidectomy. Routine follow‐up was performed and wound healing was documented via distal chip videolaryngoscopy.

Results

Seven patients underwent suspension microlaryngoscopy with vocal cordotomy as part of airway management for bilateral vocal fold immobility. The laryngeal coblator was used to perform a transverse cordotomy. The procedure was completed in approximately 5 minutes. No laser protection is required reducing operative set‐up and procedure time versus the laser. Two patients had a prior tracheotomy. No patients required a tracheotomy with this procedure. Patients were seen between 1 day and 1 month postoperatively. Patients had minimal granulation tissue at the cordotomy site and appeared to have quicker healing. The glottic airway and stridor were improved in all patients.

Conclusion

Initial outcomes of endoscopic coblation vocal cordotomy reveal this technique to be safe and efficient. Coblation increased the glottic airway with minimal granulation tissue and rapid healing. This represents the first described use of coblation for bilateral vocal fold immobility. Long‐term data will be forthcoming.
Newly Devised 3D Videolaryngoscopy for Laryngomicrosurgery
Authors: Umezaki Toshiro
Published: February 2015

Objective

In order to overcome the drawback of 2D videolaryngoscopy, we have developed a newly devised 3D videolaryngoscope, and we evaluated the usefulness of this device.

Method

A 3D high vision camera of 5 mm in diameter was attached to a usual 2D laryngoscope. Real time images were monitored by a dome‐shaped 3D monitor (Panasonic Health Care). We performed endolaryngeal microsurgery on some patients with voice disorders, and compared usefulness between 2D, 3D, and conventional binocular system.

Results

Using 3D videolaryngoscope allowed better and easier manipulation in grasping and cutting the lesion, and even in suturing the laryngeal mucosa because of its stereoscopic visual effect, as compared to 2D scope. In comparison to the conventional binocular microscopy, 3D videoscope offered equivalent stereoscopic imaging and an advantage in nearer positioning to the patient, resulting accurate operation.

Conclusion

Our study indicates that 3D imaging offers significant advantages in the performance of endolaryngeal microsurgical skills to every surgeon.
Reproducibility of Salivary Pepsin: Clinic versus Home
Authors: Laohasiriwong Supawan , Johnston Nikki , Woodson B. Tucker
Published: February 2015

Objective

Pepsin immunoassay of saliva samples is a potential objective test for reflux and extra‐esophageal reflux (EER). This study aims to assess the reproducibility of pepsin samples in a clinical cohort study.

Method

Saliva samples were obtained following a standardized protocol on 3 occasions. Subjects expectorated pharyngeal secretions in an upright position in clinic, and on 2 mornings following recumbence and sleep. All samples were frozen for storage and Western blot immunoassay for pepsin was performed.

Results

From 70 subjects, 59 first samples completed showed the prevalence of pepsin (+) was 26%. Of 34 subjects who returned the home collected sample, only 6% of the 2nd samples were positive and none of the 3rd samples were positive. 46.3% of the subjects had elevated Reflux Symptom Index (RSI) but the correlation with pepsin (+) was not significant.

Conclusion

Our study was unable to produce consistent results of pepsin assays in a nonlaryngology clinical setting. Salivary pepsin assay is a conceptually promising non‐invasive test for EER; however the timing and logistics of sample collection in order to be a feasible clinical test may need further studies and adjustments.
Tyramine‐Based Hyaluronan as a Tracheal Cartilage Substitute
Authors: Revenaugh Peter C. , Seth Rahul , Calabro Anthony , Knott Daniel
Published: February 2015

Objective

To investigate and characterize a novel tyramine‐based hyaluronan/gelatin (THA/G) composite material. First, we demonstrate the ability of THA/G to adhere and maintain respiratory epithelial cells in an in vitro model. Second, we assess the feasibility of THA/G as a biologic cartilage substitute in a rabbit model of tracheal reconstruction.

Method

Immortalized human tracheal epithelial cells were grown on various concentrations of THA/G composites in vitro. Cricotracheal resection with replacement by THA/G was performed in 4 New Zealand white rabbits with auricular cartilage as control in 2 animals. Tracheal patency, graft retention, and mucosalization were evaluated via endoscopy, imaging, and histopathology.

Results

Epithelial cell growth was demonstrated on THA/G composites in vitro. In the rabbit model, all composites remained intact within the tracheal resection. However, the limited shear strength of the THA/G posed difficulties in securing the construct. At 3 and 6 weeks postimplantation, composites revealed minimal histologic evidence of macrophage or lymphocyte infiltration and were without apparent degradation. Tracheal lumen diameter was preserved in all animals. No experimental animals had evidence of dynamic airway collapse or chondromalacia. On endoscopy, there was no evidence of tracheal inflammation or granulation. However, at 6 weeks there was limited respiratory mucosa present on histology.

Conclusion

THA/G composites are a promising material for cartilage substitution. We demonstrate an ability to support epithelial cells and maintain tracheal structure. Improvements to increase the material’s shear strength are necessary so that it may have potential as an airway cartilage substitute.
A Computerized Closed‐Response Speech Test in the ENT Clinic
Authors: Tringali Stephane , Dubreuil Christian , Moulin Annie
Published: February 2015

Objective

1) To assess the feasibility of a computer‐based closed‐response speech test (CRST) in the ENT clinic. 2) To compare a closed response speech test to standard speech audiometry.

Method

Thirty patients underwent otoscopy, tympanometry, pure‐tone audiometry, speech audiometry and a closed‐response speech test (CRST). For the CRST, patients were asked to choose, on a tactile computer screen, the words that were presented to their ear, amongst a choice of 4 words. Fifteen sets of 4 words were used.

Results

The CRST was well accepted by all patients, whatever their computer literacy, but took significantly longer (10 to 15 minutes per ear) than speech audiometry did. Pure transmission hearing losses showed a translation of the performance intensity function toward greater intensities, without change in slope, as in standard speech audiometry. Correlations between auditory thresholds and speech recognition thresholds were greater for the CRST (r = 0.70, P <. 01) than for speech audiometry (r = 0.46, P <. 05). Several cases of patients showing very similar speech audiometry performance intensity functions, but different CRST scores were identified.

Conclusion

Although the closed‐set computerized test took substantially longer than speech audiometry, it was well accepted by patients. It was more sensitive to minor alterations of hearing than speech audiometry and shows promise as a longitudinal assessment tool of speech perception.
Balance Study in Parkinson’s Disease Patients
Authors: Edionwe Susan , Makishima Tomoko , Bryant Mon , Wood Scott
Published: February 2015

Objective

1) To understand the role of vestibular dysfunction in Parkinson’s disease (PD) postural instability. 2) To investigate whether vibrotactile stimulation (VTS) to the trunk can be a tangible form of remediation therapy in patients with postural instability of Parkinson’s disease.

Method

Prospective pilot study; July 2011‐ongoing. Postural instability in PD investigated. Clinical study of 10 to 15 mild to moderate PD patients. Vibration therapy (independent variable) applied to the trunk to remediate posture during directional tasks. Rotary chair used to evaluate vestibular function. Data compared to controls with T test and suggested improvement.

Results

Improvements in postural instability with vibration therapy: Patients’ postural performances were compared pre‐ and posttherapy. Only 1 of 11 of the Parkinson’s patients had a statistically significant improvement of posture after vibration therapy (P =. 0126284). One patient had a statistically lower performance (P =. 0109707), and the remaining had an overall subjective but no statistically significant improvement. Similarly, only 1 control had significant improvement (.0404138) while 5 had statistically decreased performance and the remaining had no statistically significant change. Overall, no statistical significance was seen between PD patients and controls. Rotary chair data: analysis pending.

Conclusion

Preliminarily, no improvements in postural instability have been seen yet. This is inconsistent with case reports. However, patients and controls reported fatigue at the end of testing and this may account for the decreased performance. Rotary chair analysis is pending, thus, no conclusion drawn for this at this time.
Bone‐Anchored Hearing Aid: Why Do Some Patients Refuse It?
Authors: Zawawi Faisal , Kabbach Ghassan , Lallemand Marie , Daniel Sam
Published: February 2015

Objective

BAHA is a proven tool to improve hearing. Nevertheless, there are patients who are candidates for BAHA implants who end up refusing the surgery. The objective of this study is to review our BAHA experience with particular emphasis on reasons behind the refusal of some candidates.

Method

A retrospective chart review conducted in December 2011 of the most recent 100 consecutive new patients referred to the BAHA program in a tertiary health care center. Candidates’ demographics, hearing status, co‐morbidities, and audiometeric tests were all recorded. Patients’ acceptance or refusal was noted alongside the reasons to refuse BAHA.

Results

One hundred new patients were seen for BAHA assessment, 10 patients were excluded because of incomplete tests. There were 68 children and 22 adults. Unilateral conductive hearing loss was the most common reason for consultation (40%), followed by unilateral SNHL (23.3%). Aural atresia was the most common clinical finding (36.6%). Seventy patients were candidates for BAHA (77.8%) as per our candidacy rules. Ten candidates refused BAHA (14.3%). The most common reason for refusal in adults was lack of sound localization in patients with unilateral SNHL.

Conclusion

The main reason for refusal of BAHA was lack of sound localization in adults, whereas the main reason for refusal in children was cultural and social acceptance by the family. Patients with congenital anomalies were the most likely candidates to accept BAHA implants.
Comfort Level Managing Common Head and Neck Disease
Authors: Wiedermann Joshua P. , Zapanta Philip E.
Published: February 2015

Objective

1) Assess comfort levels in managing common, primary care head and neck disease during the 4 years of medical school and the 3 years of primary care residency. 2) Learn where participants would refer if comfort levels were low.

Method

Cross‐sectional survey using Survey Monkey (www.surveymonkey.com) of George Washington University medical students (n = 256), George Washington University medicine residents (n = 15), and Children’s National Medical Center residents (n = 50). Common head and neck diagnoses were surveyed (n = 24) using a Likert scale. Data were analyzed with Microsoft Excel.

Results

Throughout all years, respondents were most comfortable with the management of rhinitis/seasonal allergies, otitis media/externa, sinusitis, and epistaxis. Respondents were least comfortable in the management of tracheotomy care, persistent salivary gland swelling, and sudden hearing loss. Among all years, the majority of respondents would refer all conditions to an otolaryngologist with the exception of sleep apnea (pulmonology), vertigo (neurology), cleft lip (plastic surgery), facial nerve palsy (neurology), and thyroid nodules (general surgery).

Conclusion

Although there is a correlation between training year and comfort, there remains a number of conditions that respondents do not feel comfortable managing. In addition, although there is much debate as to which specialty is best to handle management, there tends to be a consensus across all training levels.
Diagnostic Accuracy of Otoneurology Testing
Authors: Hijano Rafael , Fuste Joan , Fontane‐Ventura Joan
Published: February 2015

Objective

1) Compare the cervical vestibular evoked myogenic potential (cVEMP) responses and the ocular VEMP (oVEMP) responses in normal volunteers and patients suffering from vertigo. 2) Analyze the similarities between the evoked responses and the results obtained by videonystagmography (VNG).

Method

A prospective study in 126 patients (60 men, 66 women) was conducted at Hospital del Mar Barcelona from January to November 2011. cVEMP responses using click stimuli at 5 Hz monoaural 110 dB nHL intensity with the subjects in a sitting position and head turned to contralateral shoulder were analyzed. oVEMP responses were recorded using surface electrodes below the inferior eyelid. VNG was done using caloric stimulation.

Results

VNG was altered in 23%. The cVEMP response was altered in 29%. The oVEMP responses were classified either as altered or absent in 31%. The sensitivity was similar for both the oVEMP and the cVEMP.

Conclusion

The little difference in sensitivity found between the cVEMP and the oVEMP can be explained due to the different neural pathways. The same can be said for the results in the VNG. These current tests may complete the information about the physiology and integrity of the vestibular neural pathways and are easy and quick methods of evaluation.
Effects of Oxiconazole and Alcohol Boric to the Inner Ear
Authors: Özdemir Süleyman , Tuncer Ülkü , Tarkan Özgür , Akar Funda , Sürmelioğlu Özgür
Published: February 2015

Objective

Topical preparations are widely used in the treatment of infections of the external auditory canal and middle ear. However, they can pass through the round window and effect the inner ear. The aim of this study is to evaluate the ototoxicity of topical oxiconazole and boric acid in alcohol solutions.

Method

Five groups of 10 male Wistar albino rats. The right tympanic membranes of all of the rats were perforated and baseline and posttreatment distortion product otoacoustic emission (DPAOE) measurements were performed. Oxiconazole, boric acid in alcohol, salin, and gentamicin solutions were applied to the right external ears.

Results

The solutions were applied through the external ear canal to the middle ear twice a day for 15 days. The rats in group I and group II received oxiconazole and boric acid in alcohol solutions, respectively. Group III received gentamicin (ototoxic control), group IV received saline solution, and group V was followed without any medication. The baseline DPOAE results of the right ears of all animals tested were normal. Animals in groups I, II, IV, and V showed no statistically significant change in the DPOAE values. The rats in the gentamicin group showed a significant decrease.

Conclusion

This study demonstrates that topically used oxiconazole and boric acid in alcohol solutions to the middle ear have no effect on the inner ear of rats. In our opinion, ear drops should be chosen more carefully in an external ear infection with a tympanic membrane perforation to avoid ototoxicity.
Effects of Stimulation Rate on Musical Instrument Identification
Authors: Zhang Howie , Runge Christina , Friedland David R.
Published: February 2015

Objective

To compare the differences in musical instrument identification at different stimulation rates between older and younger cochlear implant (CI) users.

Method

All subjects used Advanced‐Bionics CII or HighRes90k devices. There was a younger (age less than 65; n = 7) and older (age greater than 64; n = 5) group. They used a novel 5‐channel map with stimulation rates of 800, 1200, 2000, and 3000 pps. Subjects underwent music testing with 10 instruments played at 65dB SPL.

Results

Scores ranged from 22% to 70%. In the younger group, performance significantly increased with increasing stimulation rate (P =. 0003). A significant difference in performance was noted in the younger group between 3000 pps and 800 pps (P =. 0254). Younger subjects performed best at 3000 pps and worst at 1200 pps. In the older group, there was no significant correlation between stimulation rate and performance. Older subjects performed best at 2000 pps and worst at 800 pps. There was no significant difference between performance at any rates within the older group. There was no significant difference between the scores in the younger and older group at any stimulation rate.

Conclusion

We found that stimulation rate affects musical instrument identification for younger CI users, who benefit from higher rates. Older subjects performed best at 2000 pps but generally showed no difference across stimulation rates. Older users may benefit from individualized maps for speech and music with differing stimulation rates.
Evaluation of Hearing in Hypertensive Subjects
Authors: Sahin‐Yilmaz Asli , Habesoglu Mehmet , Korkmaz Deniz , Karaaslan Ahmet , Tosun Ahmet , Oysu Cagatay
Published: February 2015

Objective

To find out the effect of systemic hypertension on 1) pure tone audiometry (PTA), 2) distortion product emissions (DPOAE) in adults.

Method

A clinical controlled prospective study was conducted between January 2011 and December 2011 at Umraniye Education and Research Hospital Otolaryngology Clinic. Thirty subjects with systemic hypertension and 30 controls were included. All subjects underwent a physical examination, including fundus examination, PTA, and DPOAE.

Results

Percentage of tinnitus in subjects with hypertension and in controls was 90% and 40%, respectively (P =. 001). PTA revealed a significantly higher sensorineural hearing loss in all frequencies above 500 Hz in the hypertensives (P <. 05). In the right ear DPOAE revealed response at 4000 and 6000 Hz in 80% of hypertensive patients and 96.7% of controls (P =. 103) and 20% of hypertensive patients and 96.7% of controls, respectively. In the left ear, DPOAE revealed response at 4000 and 6000 Hz in 73.3% of hypertensive patients and 96.7% of controls (P =. 026) and 26.7% of hypertensive patients and 93.3% of controls (P =. 001), respectively.

Conclusion

Isolated hypertension affects vascular psychodynamics of cochlea and results in a hearing loss at and over 4000 Hz at pure tone audiometry and significant loss of distortion product otoacoustic emissions at 4000 to 6000 Hz.
Facial Nerve Function in Postoperative of Glomus Jugulare
Authors: Kitice Adriano T. , Silva Evandro M. , Abreu Cassiana B. , Weber Raimar , Barauna Iulo , Stamm Aldo E.C.
Published: February 2015

Objective

Describe the facial nerve function (FNF) in preoperative and postoperative time of patients with glomus jugulare tumors trying to correlate the relationship with functional outcome with epidemiological variables (age and sex) or variables related to the tumor (extent, location, and relationship to the facial nerve and internal carotid artery).

Method

Retrospective review of 53 patients with glomus jugulare submitted to surgical treatment (1987 to 2010) in Edmundo Vasconcelos Hospital. The FNF was analyzed preoperatively and at initial PO (until 7 days), PO of 6 months, and PO of 1 year. Results of FNF were compared with tumor aspects and epidemiological features.

Results

In a preoperative time we observed FNF decreased in 11 patients (20.75%) in which the average of facial function by House Brackmann scale degree was 2.54. Most of those (7%‐63.64%) scaled as HB II. Intraoperative findings demonstrated anatomic invasion in 5 patients. In the immediate PO time (1 to 7 days) a decrease of facial nerve function in 83.02% of the patients (avgHB = 3.32) was noted. In PO of 6 and 12 months, some degree of FNF was observed in 32 (60.37%/avgHB 2.09) and 25 (47.17%/avgHB 1.86). There was no observed relation (P <. 05) between kinds of facial nerve manipulation or epidemiological features with FNF with in 1 year postoperatively.

Conclusion

FNF is a common feature in PO of patients with jugulare foramen tumors, and its recovery is expected for the majority after initial PO time. For the group of patients with preoperative compromise of VII nerve, poorer outcomes were were observed.
Functional Connectivity Networks in Nonbothersome Tinnitus
Authors: Wineland Andre , Burton Harold , Piccirillo Jay
Published: February 2015

Objective

To capture resting state functional connectivity in a group of nonbothered tinnitus patients in order to assess the impact of tinnitus in cortical neuroplasticity.

Method

Cross‐sectional study to examine differences in functional connectivity (FC) in a nonbothered tinnitus group compared to a healthy control group. Enrollment ranged from October 2010 to April 2011. Tinnitus participants were recruited from Washington University. FC differences between the 2 groups were studied by examing 58 seed regions of interest.

Results

The median age for the 18 subjects was 54 years (interquartile range [IQR] 52 to 57), 66% were men, 90% were white, median Tinnitus Handicap Inventory (THI) score was 8 (IQR 4 to 14), and a median Beck Depression Index score of 1 (IQR 0 to 5). The median age for the control group was 46 (IQR 39 to 54) and 52% were men. Of the 58 seeds analyzed, no regions were significantly different in functional connectivity among the nonbothered tinnitus group when compared to the control group.

Conclusion

Among non‐bothered tinnitus patients, the tinnitus percept does not appear to alter the functional connectivity of the auditory corte or other key cortical regions.
Lower Cranial Nerves Compromise in Glomus Jugulare Tumors
Authors: Silva Evandro M. , Kitice Adriano T. , Pascoto Gabriela R. , Weber Raimar , Barauna Iulo , Stamm Aldo E.C.
Published: February 2015

Objective

Describe lower cranial nerve compromise (IX to XII) in preoperative and postoperative time of patients with glomus jugulare tumors trying to correlate the relationship with functional outcome with epidemiological variables (age, sex) or variables related to the tumor (extent, location, and relationship to the facial nerve and internal carotid artery).

Method

Retrospective chart review of 53 patients with glomus jugulare submitted to surgical treatment. We searched for lower cranial nerve compromise (LCNC) in preoperative time and at initial PO (until 7 days), PO of 6 months and 1 year. Results of LCNF were compared with tumor aspects and epidemiological features.

Results

The LCNC in preoperative time observed was IX (7/13, 21%), X (11/30, 19%), XI (7/13, 21%), and XII (11/20, 75%). All showed decreased function postoperatively as expected but also recovery with 1 year of PO. Vagus nerve (X) was the most affected at 12 months, showing some degree of symptoms in 23 patients (43.39%). There was no epidemiological evidence of relationship of age and gender with the prevalence of cranial nerve compromise. Patients classified as Fisch‐Matto C3/C4 had a higher prevalence of CN involvement preoperatively compared to patients C1/C2 (P <. 05). There was statistical significance between the presences of deficits in lower cranial nerves with the degree of tumor extension in the internal carotid artery.

Conclusion

Functional impairment of the lower cranial nerves was observed in the pre‐ and the postoperative time of patients undergoing surgery for resection of the glomus jugulare tumors and that its frequency was directly proportional to the extent of the tumor and its relationship with internal carotid artery.
Necrotizing Otitis Externa
Authors: Barbosa Maria H. , Cruz Fabiana C. , Felix Fellipe , Tomita Shiro , Marques Marise P. , Sousa Sergio , Quintanilha Jaqueline
Published: February 2015

Objective

Evaluate the cases of necrotizing otitis externa (NOE) with regard to gender, mean age, comorbidities, clinical presentation, involvement of cranial nerve and its resolution, isolated germs at culture of swabs or biopsies of EAM, and findings at image evaluation.

Method

The patient presented severe otalgia, auricular plenitude and right peripherical facial palsy. He submitted to a swab test and also to a biopsy of the external auditory meatus. Other examinations were requested: a complete blood count, C‐reactive protein, a mastoid computer tomography, and mastoid scintigraphy.

Results

Ten patients were evaluated, 4 of them were women and 6 men. All of them had type II diabetes. The most common initial finding was external meatus polyps (90% of the cases), followed by cranial nerve palsy (50% of the cases). There was complete remission of that palsy in 51% of the cases, incomplete remission in 16%, and no remission in 33% after treatment. In most of the cases, Pseudomonas aeruginosa was found (60%). Mastoid and external auditory meatus alterations were the most common disturbance in computed tomography.

Conclusion

This case reports a patient with a cellular immunosuppression disease which appeared to have an NOE complicated by cranial nerve paralysis based on his clinical picture and complementary evaluation except for the scintigraphy study. The histopathological analysis revealed a neoplastic etiology for the ear involvement.
Postural Response to Unexpected Changes
Authors: de Abajo Jorge , Perez Nicolas
Published: February 2015

Objective

1) Determine the characteristics of postural responses to unexpected changes in the support‐surface in patients with unilateral peripheral vestibular deficit and analyze differences between patients achieving a clinical compensated status and those without. 2) Find out which is the best clinical data to predict the vestibular compensation status.

Method

Twenty‐seven adults suffering unilateral peripheral vestibular deficits (vestibular neuritis, Ménière’s disease, neurinoma, trauma and benign recurrent vertigo) were included. Neurocom equipment was used to create pulses unexpectedly. Sway Star system was used to measure the angle and the angular velocity of the body during the stimulus.

Results

The range of peak to peak excursion, the area of the displacement angle, the range of peak to peak velocity excursion in pitch and roll directions and the mean path velocity were studied. When using the caloric test results to classify the patients as compensated or not compensated significant differences (p minor to 0.001) of the body angle in the roll direction were found, although all the stimuli were made in the pitch direction. However, when using the caloric test, the cardiovascular risk or the patient’s clinical course to classify the groups, no differences were found.

Conclusion

The rotatory test is the best diagnostic method to predict vestibular compensation status of patients with vestibular deficits. Patients suffering vestibular deficit with an uncompensated status, have more difficulties to give an appropriate postural response in the roll direction to unexpected support‐surface movements.
Recurrence in Cholesteatoma Surgery and the Use of Laser
Authors: Son Hwa Jung , Samy Ravi N. , Meinzen‐Derr Jareen
Published: February 2015

Objective

Cholesteatomas have a high‐rate of recurrence, regardless of the surgical approach used. Our hypothesis was that use of the handheld CO2 laser would reduce recurrence of cholesteatoma by removing microscopic disease, particularly in challenging or difficult to treat areas.

Method

A total of 384 mastoidectomies performed by a single‐surgeon between 2006 and 2011 were reviewed (22 in the non‐laser and 23 in the laser group that met the inclusion criteria). Outcome measures included recurrence rate and complication rates. Independent variables included smoking status, bilaterality and the extent of disease as assessed by Marres staging (1984).

Results

Average follow‐up was 25 months; average separation between the first and second stage was 8 months. There were 1 Marres stage 1, 29 stage 2, 1 stage 3, and 13 stage 4 patients and the distribution between the 2 groups was similar. There were no facial nerve paralysis cases, and 1 sensorineural (SNHL) hearing loss after the first procedure in the nonlaser group. There was no difference in the rate of recidivism noted at the second stage between the laser group (34.8%) and nonlaser group (30.4%). There was no apparent correlation between smoking status or bilaterality of disease and recurrence.

Conclusion

While the safety of cholesteatoma surgery with handheld laser is confirmed without any incidence of SNHL or facial nerve paresis, in this retrospective study, there does not appear to be any reduction in the rate of recidivism. A prospective study is clearly warranted to demonstrate efficacy.
Electroacoustic/Clinical Study of Inexpensive Hearing Aid
Authors: Babu Seilesh
Published: February 2015

Objective

1) Understand whether a new low‐cost (<$200) hearing aid has adequate technical specifications. 2) Learn if patients with mild to moderately severe hearing loss report satisfaction scores comparable to those reported in the literature while using this hearing aid.

Method

An analysis of the hearing aid was performed evaluating critical electroacoustic parameters. A prospective study was performed on 9 patients from August 2010 to July 2011 who wore the device for 30 days and completed 2 surveys: “International Outcome Inventory–Hearing Aids” and “Satisfaction with Amplification in Daily Living.”

Results

The hearing aid met gain and output targets previously described in the literature. All 9 participants completed the study. The device met the range of norms for all 7 items in the IOI‐HA (P <. 05) and for 3 of the 5 categories of SADL.

Conclusion

The low‐cost hearing aid was found to be electroacoustically adequate and a reasonable low‐cost solution to meet the needs of those value‐ and cost‐conscious patients with up to moderately severe hearing loss who were not using amplification via a custom hearing device due to cost considerations.
The Association of Anterior Inferior Cerebellar Artery in IAC with Tinnitus and Hearing Loss
Authors: Cho Yong Hee , Lee Seung‐Hwan , Park Chul‐won , Min Hyun Jung , Choi Eui Je , Oh Jae Ho , Lee Dong Won
Published: February 2015

Objective

Tinnitus is a common disorder, but the etiology of this disorder remains unknown. The objective of this study was to assess the correlation between anatomic type and the thickness of the anterior inferior cerebellar artery (AICA) loop with tinnitus, using 3D‐fast imaging employing steady state acquisition magnetic resonance image (MRI).

Method

Seventy‐four patients with tinnitus and 82 asymptomatic controls were included in this study. Otologic symptoms, which were measured based on the results of a pure tone audiometry, were reviewed. We evaluated the position and thickness of the AICA vascular loop in 3D‐FIESTA MRI using 2 scoring systems. The first system was Chavda classification based on the anatomic location of the AICA loop. The second scoring system was used to measure the thickness of the AICA loop. The AICA loops were classified into 2 groups based on thickness, thinner than adjacent facial nerve and thicker than the facial nerve.

Results

Ears with type I, II AICA loops showed significantly higher rates of tinnitus than those with type III. There was no association between the type of AICA loop and subtype of tinnitus (pulsatile, nonpulsatile). There was no association between the type of tinnitus and hearing loss. Ears with thinner AICA loop had a higher rate of tinnitus than those with thicker AICA loop.

Conclusion

The type I, II and thinner AICA loop was significantly correlated with tinnitus. Compression of VIIIth cranial nerve by AICA loops at a cerebellopontine angle and impaired blood flow through thevessel may be the pathophysiology of tinnitus.
Vestibulopathy in Childhood and Adolescence
Authors: Duarte Juliana A. , Ganança Fernando F. , Chen Vitor G. , Almeida Roberta R. , Campos Roberto A. , Silva Maria Laura S. , Pires Anna Paula B. A.
Published: February 2015

Objective

Evaluate diagnosis and treatment aspects at a clinic for children with otoneurology disorders.

Method

Retrospective case series, held in otoneurology pediatric service. We evaluated the charts of all patients seen from 2006 to 2010.

Results

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

Conclusion

There was a predominance of the diagnosis of BPVC. Its close relationship with a history of migraine and its benign nature of evolution were noted. We noted the importance of monitoring, dietary counseling, and the role of vestibular rehabilitation on vestibular childhood and adolescence.