bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory‐Vestibular Outcomes in Superficial Siderosis
Authors: Sydlowski Sarah
Published: September 2011

Objective

1) Identify otologic clinical presentation of superficial siderosis of the central nervous system (SSCN). 2) Use audiologic assessment batteries to analyze variable presentation of SSCN. 3) Highlight the importance of site of lesion testing to identify and develop clinical management plans for affected individuals.

Method

Ten participants with SSCN were recruited in 2009. Prospective study measures included audiologic and evoked potential battery, including audiometry, speech testing, immittance, otoacoustic emissions, auditory brainstem (ABR) testing, and vestibular evoked myogenic potential (VEMP). Analysis resulted in development of typical audiologic clinical presentation for this disorder.

Results

This is the largest prospective audiovestibular study of SSCN to date. SSCN is a neurodegenerative disorder resulting from chronic, episodic subarachnoid hemorrhage, and hemosiderin deposition. Diffuse symptoms, including hearing loss, tinnitus, gait ataxia, and disordered balance result from preferential demyelination of the auditory‐vestibular nerve and cerebellum. Sensorineural hearing loss was present in 100% of participants and may be due to cochlear and/or retrocochlear involvement. Study results suggest clinically characteristic findings that are relevant for otolaryngologists, otologists, and audiologists. SSCN may be underdiagnosed due to clinical presentation that resembles presbycusis and a long asymptomatic phase up to 30 years.

Conclusion

Characteristic otologic findings in SSCN include hearing loss, tinnitus, and balance and/or gait disorder. Despite proclivity for audiovestibular damage, SSCN is not well‐recognized by hearing health professionals. Due to certain involvement of central and peripheral auditory‐vestibular structures, understanding of clinical presentation, typical progression, and audiovestibular prognosis is critical.
Cervical VEMP: Its Sensitivity and Specificity
Authors: Isaradisaikul Suwicha , Navacharoen Niramon , Hanprasertpong Charuk
Published: September 2011

Objective

1) Analyze the sensitivity and specificity of cervical vestibular evoked myogenic potential (VEMP) in evaluation vestibular function. 2) Compare the cervical VEMP response in normal volunteers and vertiginous patients.

Method

A prospective study in 50 normal subjects and 50 vertigo patients was conducted at Chiang Mai University Hospital from February to December 2009. Cervical VEMP responses using air‐conducted 500‐Hz tone‐burst stimuli with the subjects in a sitting position and head turned to contralateral shoulder were analyzed.

Results

Average age and men‐to‐women ratio in the normal group (44.0 ± 9.3 years; 12:38) and in the vertigo group (44.7 ± 9.8 years; 17:33) were not different. The rate of absent response between normal ears (15%) and disease ears (47.4%) showed a significant difference (p value < 0.0001).

Conclusion

To identify vestibular dysfunction using cervical VEMP, the absence of response was the most diagnostic parameter. Other vestibular test batteries should be added to confirm the cervical VEMP responses.
Comparative Study between Epley and Semont Maneuvers to Treat Benign Paroxysmal Positional Vertigo
Authors: Duarte Juliana Antoniolli , Palombo Alexandre , Dorigueto Ricardo Schaffeln , Gananca Fernando Freitas , Chen Vitor Guo
Published: September 2011

Objective

Compare the efficacy of Epley and Semont maneuvers to treat benign paroxysmal positional vertigo (BPPV).

Method

Retrospective study conducted by analysis of medical records of 139 patients with a diagnostic hypothesis of ductolithiasis of posterior semicircular canal. Patients were treated by maneuvers repeated weekly until the abolition of nystagmus.

Results

It took an average of 1.29 Epley maneuvers and 1.13 Semont maneuvers to eliminate the positional nystagmus (P =. 086).

Conclusion

Semont maneuver tended to a lower average number of therapy sessions.
Radical Parotidectomy: Reconstruction and Facial Reanimation
Authors: Ramos Nadia Hassamo , Alexandre Carlos , Antunes Luis
Published: September 2011

Objective

1) Report a viable reconstructive alternative after parotid gland mucoepidermoid carcinoma resection, rendering a large facial defect and facial nerve paralysis. 2) Demonstrate the combination of temporalis muscle pedicled flap and microvascular fasciocutaneous radial forearm flap, fulfilling 3 purposes: bulk restitution, facial paralysis reanimation, and adequate skin replacement for acceptable aesthetics.

Method

Facial defect was left after radical parotidectomy with facial nerve sacrifice, as well as masseter muscle, mandibular periosteum, and skin removal. Reconstruction of the large defect was achieved recurring to temporalis muscle transposition combined with fasciocutaneous radial forearm flap. Facial artery and vein were used for microvascular sutures.

Results

The necessity of the head and neck surgeon to make aggressive interventions has enabled the usage of flaps for reconstruction of significant facial defects. Satisfactory results require careful 3‐dimensional thought, adequate texture matching as well as functional restoration. The results showed that temporalis muscle transposition was a successful method for bulk restitution and reanimation of permanent facial paralysis in the resting position, including both eyelid and mouth, by tension provided to orbicularis ori and orbicularis oculi muscles. Fasciocutaneous radial forearm flap provided the best possible tissue color and contour restoration of skin due to its thin, pliable tissue.

Conclusion

Radial forearm flap and temporalis muscle transposition combined offered a viable reconstructive option after radical parotidectomy resulting in acceptable aesthetic and functional outcomes. Radial forearm flap was a good choice for skin restoration. Temporalis muscle transposition proved to be adequate both for bulk restitution as for reanimation of facial paralysis.
Do‐It‐Yourself Grommet
Authors: Maung Kyaw Htin , Stafford Nicholas D , Tun Thein
Published: September 2011

Objective

In the absence of a health care budget enabling the import of ready‐made aural grommets, Myanmar (Burma) ENT surgeons have come up with an ingenious home‐grown solution. We describe how they make their grommets from raw materials, bought from the local market.

Method

A polythene tube is cut into 7.5 mm sections. Each piece is mounted on the tip of a 21‐gauge needle, gently touched against the side of a flame, partially melted, and rolled leading edge while maintaining lumen. The tube is turned around, and the process is repeated.

Results

It takes less than 3 minutes to make a grommet. As many as are required can be made instantly. Any defective grommet is discarded. Newly made grommets are threaded onto the needle and placed in a sterilizing solution for future use. Myanmar Audit data showed the average in‐situ life for the grommets ranged between 6 to 10 months. Incidence of otorrhea and persistent perforation after grommet extrusion are 5% and 3% respectively.

Conclusion

Local audit data confirms that these grommets are safe to use. In Myanmar (Burma), annual per capita spending on health care is $394 (2.8% of GDP). As survival and functionality are the main priorities, obviously there have not been any randomized controlled trials so far for clinical effectiveness.
Dysphonia and Hearing Loss: A Cross‐sectional Analysis
Authors: Bush Carrie , Postma Gregory , Weinberger Paul M. , McKinnon Brian J.
Published: September 2011

Objective

Although multiple theories in the past have linked hearing loss to dysphonia, clear evidence of an association is lacking. It is well known that both hearing loss and dysphonia contribute to decreased quality of life. The objective of this study is to elucidate the association of hearing loss with dysphonia.

Method

Patients presenting with hearing loss from March 2007 to present were included. All patients underwent formal audiologic testing and completed the Voice Handicap Index ‐ 10 (VHI‐10) survey. SPSS 13.0 software was then used to interrogate all gathered data. Statistical analysis was performed using the Mann‐Whitney test.

Results

A total of 48 patients are enrolled in the study to date. Fourteen of these patients were noted to have normal speech reception threshold on audiogram. Nineteen patients were noted to have a speech reception threshold consistent with mild hearing loss, 8 patients had a moderate hearing loss, and 7 patients had a severe hearing loss. On statistical analysis there was a trend toward association of hearing loss (P <.2) and dysphonia. Among groups of patients, those with moderate loss were noted to have the highest VHI‐10 scores (P =. 1).

Conclusion

At present, there is no statistically significant association with hearing loss and dysphonia in our study. Interestingly, there is a trend toward an increased VHI‐10 score in patients with hearing loss, most notably in patients with moderate hearing loss. Continued patient enrollment will improve statistical power.
Efficacy of Diffusion‐Weighted Magnetic Resonance Imaging in Middle Ear Cholesteatoma
Authors: Suzuki Mikio , Kyuuna Asanori , Meda Hiroyuki , Ganaha Akira
Published: September 2011

Objective

Evaluate the usefulness of diffusion‐weighted magnetic resonance imaging (DWI) in the diagnosis of middle ear cholesteatoma.

Method

We performed DWI on 73 patients suspected of having middle ear cholesteatoma, including 21 revision cases. Magnetic resonance imaging was performed with 1.5 T units using diffusion‐weighted spin‐echo‐type echo planar imaging.

Results

Of 73 participants, 59 had cholesteatoma. Positive DWI findings were observed in 42 subjects and negative findings in 31 subjects. The sensitivity, specificity, and positive and negative predictive values of DWI for cholesteatoma were 69.4%, 92.8%, 97.5%, and 41.9%, respectively. In the case of 34 patients who were positive for cholesteatoma on both otoscopic and CT examinations, 33 were diagnosed with cholesteatoma. Of the remaining 39 subjects with one or both negative results for cholesteatoma, the sensitivity, specificity, positive predictive value, and negative predictive value of DWI were 57.6%, 92.3%, 93.7%, and 52.1%, respectively.

Conclusion

Since DWI clearly showed high specificity and positive predictive value, it is useful for diagnosing middle ear cholesteatoma, including postoperative recurrent cholesteatoma of 5 mm diameter or larger. DWI could sufficiently detect cholesteatoma with one or both negative results on otoscopic and CT examinations.
Regional Flap Reconstruction of a Neck Defect in an Infant
Authors: Scott Andrew R. , Parekh Anish , Vecchiotti Mark A. , O’Leary Miriam A.
Published: September 2011

Objective

1) Describe the use of a lower island trapezius myocutaneous flap to reconstruct a large posterior neck and occiput wound in an 18‐month‐old child. 2) Review prior uses of regional myocutanous flaps for soft tissue reconstruction in infants and small children.

Method

Case report and literature review.

Results

While there is an increasing body of literature documenting the safe and effective use of free tissue transfer in the pediatric age group, there is little published on the use of regional myocutaneous flaps for reconstruction of larger ablative defects. We report on the use of a lower island trapezius myocutaneous flap to reconstruct a large posterior neck and occiput wound in an 18‐month‐old child. The case is described in detail and the literature reviewed.

Conclusion

Techniques for regional reconstruction of large neck defects in infants have not been widely described. The lower island trapezius myocutaneous flap allowed for transfer of a large volume of skin and soft tissue, improving functional outcome and limiting development of scar contracture.
Evaluation of a New Coupler for the Floating Mass Transducer
Authors: Yamada Hiroyuki , Goode Richard L.
Published: September 2011

Objective

Optimal placement is an important factor in the acoustic performance of the Vibrant Soundbridge Floating Mass Transducer (FMT) in the round window niche (RW). The purpose of this study was to evaluate the acoustic performance of a new modified FMT designed to optimally contact the RW.

Method

Testing of the modified FMT without fascia and with fascia between the RW membrane and the device was performed in six human temporal bones. A small hole was made on the promontory to expose the endosteum. Cochlear fluid displacement was measured through the hole using a laser Doppler vibrometer.

Results

The mean cochlear fluid response of the FMT placed on the RW without fascia was equivalent to a 76.3 to 111.6 dB SPL input at the tympanic membrane at 0.5 to 8.0 kHz. The mean cochlear fluid response of the FMT placed on the RW with fascia produced a response of 87.5 to 119.1 dB SPL at the same frequencies. There was a tendency for the FMT placed on the RW with fascia to provide better transmission at several frequencies between 0.5 and 8.0 kHz than without fascia. However, this did not reach statistical significance.

Conclusion

In this temporal bone model, the modified FMT placed on the RW provide similar and reasonable performance both with and without fascia in the RW niche. It appears superior to a conventional FMT used in the RW and is easier to insert.
Facial Schwannoma Treatment via Cyberknife or Decompression
Authors: Herman Bjorn S. , Zeitler Daniel M. , Telischi Fred F. , Channer Gyan A. , Angeli Simon I.
Published: September 2011

Objective

Microsurgical excision of facial nerve schwannomas frequently results in facial paresis or paralysis of House‐Brackmann Grade III or higher. This study’s objectives are: 1) describe alternatives to microsurgical excision of facial nerve schwannomas, specifically wide fallopian canal decompression and Cyberknife radiosurgery; and 2) describe clinical outcomes of these alternative therapies.

Method

This is a case‐control study of all patients undergoing excision, wide fallopian canal decompression, or Cyberknife radiosurgery at a tertiary academic referral center between 2002 and 2011. Main outcome measures were pre‐ and posttreatment facial nerve function, tumor control, and speech reception thresholds.

Results

Eleven patients were identified (3 wide decompression, 2 Cyberknife treated, 4 observation, and 2 microsurgical excision), and mean posttreatment follow‐up was 35 months. When compared with excision, all of the cases undergoing nonexcision treatments resulted in facial nerve function stable or improved, no tumor growth, and no changes in speech reception thresholds.

Conclusion

While surgical excision of facial nerve schwannomas may be indicated in cases of poor facial function and impending complications, wide bony decompression, observation, and Cyberknife radiosurgery should be considered as alternative treatments to excision for patients with normal or good facial function who wish to maintain preoperative hearing thresholds.
Fascial and Periosteal Flaps for Postoperative Otitis Media
Authors: Yabe Tako
Published: September 2011

Objective

It is very important to maintain a stable reconstructed posterior canal wall in the posterior canal wall reconstructed tympanoplasty for the postoperative chronic otitis media (OM) case. The authors treat reconstructed posterior canal wall with the temporal fascial flap (TFF) and the temporal periosteal flap (TPF).

Method

In order to investigate the blood supplies of TFF and TPF, we employed Laser Doppler blood flow meters and measured that in 15 cases of postoperative chronic otitis media.

Results

Both blood supplies were comparatively well, and TFF’s blood supplies were statistically better than those of TPF.

Conclusion

These findings suggested that the TFF and TPF were reliable sources of local well‐vascularized tissue to be extremely pliable and facilitate creation of a stable posterior canal wall in the case of postoperative OM.
Hearing Loss and Cochlear Pathology in a Type II Diabetic Mouse Model
Authors: Miller Sean , Boettcher Flint , Phillips Grady , Anne Gratton Michael
Published: September 2011

Objective

1) Determine whether a type II diabetic mouse model demonstrates hearing loss. 2) Examine cochlear ultrastructure of a type II diabetic mouse model for evidence of pathology.

Method

The Leprdb/Leprdb (db/db) mouse has a leptin receptor point mutation which manifests as polyphagia, hyperglycemia, and obesity, mimicking type II diabetes. Db/db and wild type mice from the parent strain underwent auditory brainstem response measurements followed by cochlear ultrastructure analysis using scanning and transmission electron microscopy.

Results

At 12 weeks of age, the mutant animals demonstrate a profound hearing loss from 8 to 32 kHz, which is in contrast to published data of a 10 dB shift at 8 kHz and 30 dB shift at 16 to 32 kHz for age‐matched, wild type C57BL/6J counterparts. In addition, fine structure analysis reveals evidence of morphological alterations in multiple locations within the cochlea, including loss of neuron density in the spiral ganglion, stria vascularis edema, and endothelial abnormalities within strial capillaries. Age‐matched controls are without similar ultrastructural changes. Scanning electron microscopy reveals no evidence of hair cell loss or other identifiable abnormalities.

Conclusion

This is the first demonstration of cochlear pathophysiology in a genetically derived type II diabetic mouse model. Use of the db/db mouse provides an opportunity to investigate the underlying mechanism of type II diabetes associated hearing loss.
Hearing Outcomes in Canal Wall Down Mastoidectomy with Cartilage Tympanoplasty
Authors: Thorpe Eric , Marzo Sam J.
Published: September 2011

Objective

1) Measure the overall postoperative hearing after both canal wall down mastoidectomy and cartilage tympanoplasty. 2) Assess the air‐bone gap postoperatively in patients after both canal wall down mastoidectomy and cartilage tympanoplasty.

Method

A retrospective review of all patients who underwent canal wall down mastoidectomy with a cartilage tympanoplasty during the time period of 2000 to 2010. Cases of the appropriate surgery were chosen by operative reports. Indications for surgery largely included cholesteatoma, chronic otitis media, or both.

Results

A total of 39 patients were found to have the procedure in question with 30 patients having full audiograms for review. Pre‐ and postoperative pure tone averages (PTA) along with air‐bone gaps (ABG) were reviewed at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Postoperative PTA showed an improvement of 7.2 dB over preoperative PTA. Postoperative ABG showed an improvement of 4.53 dB over preoperative ABG. The ABG improvement was found to be statistically significant with a P value of. 0285.

Conclusion

The results of this study demonstrate that hearing results following a canal wall down mastoidectomy along with a cartilage tympanoplasty not only have acceptable hearing results but also actually show an improvement over preoperative audiological function.
High and Ultra High Hearing Loss in Tinnitus Patients
Authors: Yeo Sang‐Won , Bae Seong‐Cheon , Park Kyong‐Ho , Park Shi‐Nae
Published: September 2011

Objective

Investigate the incidence of high‐ (>2 kHz; HFHL) and ultra‐high‐frequency (>8 kHz; UHFHL) hearing loss in tinnitus patients with subjectively normal hearing, and to evaluate their effects on the clinical and audiological features of the patients.

Method

The sample included 85 patients with sensorineural tinnitus who had normal hearing sensitivity in frequencies from 250 Hz to2 kHz, and who had received extended high‐frequency audiometry between July 2009 and February 2010. We investigated the incidence of HFHL and UHFHL in the subjects and analyzed their significance.

Results

The incidence of HFHL and UHFHL in the subjects was 88%. The proportion of patients with UHFHL, in the subjects who had normal hearing sensitivity up to 8 kHz, was about 74%. The patients with normal hearing sensitivity at all test frequencies were significantly younger and had greater otoacoustic emission responses, and mean loudness of tinnitus as measured by tinnitus matching was significantly lower than the patients with HFHL and UHFHL. However, other analysis about clinical aspects of HFHL and UHFHL did not show any significance.

Conclusion

Even if the patients with tinnitus do not feel any hearing impairment subjectively, most of them have high‐ and ultra‐high‐frequency hearing loss. But their effects on the clinical features of the patients are vague.
Improvement in Hyperacusis with Tinnitus Retraining Therapy
Authors: Thong Jiun Fong , Wong Mei Ching , Junaidah S. , Chan Yew Meng
Published: September 2011

Objective

Decreased sound tolerance and hyperacusis are frequently found in patients who complain of tinnitus. This study aims to investigate the efficacy of Tinnitus Retraining Therapy (TRT) in patients with hyperacusis.

Method

Prospective study of patients with hyperacusis presenting to the tinnitus clinic in a tertiary referral otorhinolaryngology unit. Hyperacusis was confirmed with loudness discomfort level (LDL) measurements. Audiometry was performed in all patients. Improvement of hyperacusis following TRT was measured by structured interview with aid of questionnaires and visual analogue scores.

Results

A total of 197 patients were studied. Improvement was achieved in 39%. Environmental sound (70%), Viennatone broadband noise generator (18%) and Marsona sound generator (5%) were used. 18% had hearing aids (HA) fitted even though 73% had hearing loss. Patients who opted for HA complained of worse effects of hyperacusis on life. Age, gender, and presence of hearing loss were similar in patients who did and did not improve. Duration of treatment was longer in patients that improved (P <. 01). Improvement with Viennatone was significantly higher than with environmental sounds alone (49% vs 35%, P <. 05), especially when used in presence of hearing loss (61%).

Conclusion

Modest proportion of patients with hyperacusis improved with TRT. Use of broadband noise generators and longer duration of therapy appear to give better success rates. Overall success of TRT in patients with hyperacusis may also be related to underlying medical problems such as thyroid conditions and multiple sclerosis.
Influence of VA Hemodynamics on Orthostatic Vertigo
Authors: Sawai Yachiyo , Hosoi Hiroshi , Fujita Nobuya , Yamanaka Toshiaki
Published: September 2011

Objective

Orthostatic vertigo (OV) is believed to occur because of hypoperfusion of the brain with orthostatic decrease in blood pressure (BP). We investigated the relationship between the orthostatic hypotension (OH) and orthostatic decrease in vertebral artery blood flow velocity (VAFV) in order to determine whether these 2 factors could trigger OV.

Method

In 251 subjects, BP and extracranial doppler sonography spectrum of the VA were recorded in the supine and standing positions. Subjects were categorized into the OH and non‐OH groups, and the orthostatic decrease in VAFV in patients with and without OV was evaluated in each group.

Results

The OH and non‐OH group comprised 40 and 211 patients, respectively. The OH group included 29 patients with OV and 11 patients without OV. The non‐OH group included 150 patients with OV and 62 patients without OV. In the OH group, the OV patients exhibited a marked orthostatic decrease in VAFV as compared with those without OV. In the non‐OH group, the orthostatic decrease in VAFV was significantly greater in OV patients than in those without OV.

Conclusion

Our results suggest that decrease in VAFV induced by standing could trigger OV, irrespective of OH status.
Is Mastoid Pressure Dressing Necessary?
Authors: Okur Erdogan , Aycicek Abdullah , Altuntas Ali , Isikli Huseyin , Yidiz Huseyin , Cem Miman Murat , Kahveci Orhan K.
Published: September 2011

Objective

Assess whether mastoid pressure dressing is necessary after ear surgery to prevent complications such as hematoma or protruding ear.

Method

Thirty‐seven patients were included in the study. Of the 37 patients, 17 were in the mastoid dressing group and 20 were in the no‐mastoid dressing group. We measured the distance from mastoid scalp to helix rim at the most posterior level of upper auricular rim in the operated and non‐operated ears.

Results

For mastoid to helix distance of the operated ears of the patients, there was no statistically significant difference between the mastoid dressing group and the no‐mastoid dressing group. We found a significant difference for the measured distance between operated and nonoperated ears of the mastoid dressing group, the mean value of distance in the operated ears being lower than that in the nonoperated ones (P >. 05).

Conclusion

This study showed that mastoid to helix distance did not change significantly when the mastoid dressing was not applied, while mastoid dressing seemed to decrease the mastoid‐to‐helix distance. For his reason, the application of a mastoid pressure dressing following ear surgery seems to be unnecessary and may contribute to increased wound morbidity.
Lower Cranial Nerve Function Following Jugular Foramen Tumor Resection
Authors: Porter Ryan G. , Chan David , Ravindra Vijay M.
Published: September 2011

Objective

Describe the presentation, tumor characteristics, and postoperative lower cranial nerve function following surgery for jugular foramen tumors.

Method

Thirty jugular foramen tumor resections performed between 1989 and 2009 were reviewed. The mean age was 48.2 years (range, 18.6‐77.7 years) at time of presentation. Surgical approaches included infratemporal fossa (70%), retrosigmoid (23%), transtemporal (20%), transcondylar (17%), and transcervical (17%). The mean follow‐up was 4.6 years.

Results

Combined surgical approaches were used in over 50% of the cases, and 60% underwent preoperative tumor embolization. Tinnitus was the most common presenting symptom, and middle ear or neck mass was the most common presenting sign. The most common diagnosis was paraganglioma. Six patients required tracheotomy, and 8 had feeding tubes at discharge. Fifty‐seven percent of patients underwent speech or swallow therapy, 43% were treated with vocal cord injections, and 17% underwent medialization thyroplasty. Cerebrospinal fluid leak was uncommon (13%), and meningitis occurred in 1 patient. Normal or near‐normal facial nerve function was maintained in 89% of patients.

Conclusion

Resection of jugular foramen tumors carries a significant risk of lower cranial nerve dysfunction; however, long‐term speech, airway, and swallowing morbidity can be minimized with contemporary ancillary surgical procedures.
Mental Status in Patients with Vestibular Schwannoma
Authors: Hio Sachiko , Inohara Hidenori , Kamakura Takefumi , Sakata Yoshiharu , Horii Arata , Kitahara Tadashi
Published: September 2011

Objective

To perform treatment with higher quality of life, we need to understand the psychological condition of each patient with vestibular schwannoma (VS). In the present study, we examined the pre‐treatment mental status of patients with VS by using Cornell Medical Index (CMI) and Self‐rating Depression Scale (SDS).

Method

Between 1997 and 2010, we enrolled and assigned 30 patients with unilateral VS in the present study. Before the treatment, we examined CMI and SDS to evaluate patients’ psychological condition and also sex, age, tumor size, hearing level in bilateral sides, CP%, and House‐Brackmann score to learn patients’ backgrounds.

Results

According to the data of CMI (>stage III, IV) and SDS (>40), psychological disturbances were pointed out only in 20.0% of patients with VS (6/30). VS patients with hearing deterioration (>30dB) in the contralateral side were significantly depressed (66.7%: 4/6) more than those with normal hearing (th/8th nerve function in the tumor side did not make any influence, but hearing level in the contra‐lateral side significantly affected psychological condition.

Conclusion

It is important for physicians to give patients with an only/better hearing in the tumor side adequate informed consents about the possibility of profound bilateral hearing loss and about what he or she can do for communications with others in such situations, hearing aid + lip reading and cochlear/brainstem implant.
Molecular Crosstalk between Nrf2/Keap1 Signaling Pathway, Autophagy and Necrosis in Auditory Cells
Authors: Hayashi Ken , Ogawa Kaoru , Goto Fumiyuki , Kanzaki Sho
Published: September 2011

Objective

Oxidative stress affects auditory cellular functions. The Nrf2/Keap1 signaling pathway is the main pathway responsible for cell defense against oxidative stress. The purposes of this study were to elucidate how Keap1 and Nrf2 provide molecular foundation for a possible crosstalk between autophagy and necrosis pathways in auditory cells.

Method

We used auditory cell line (HEI‐OC1) in this study. The viability of HEI‐OC1 was determined by cell viability assays. The samples after treatment of HEI‐OC1 were analyzed by a flow cytometer. Immunofluorescent confocal laser microscopy was used. Western blot was performed. HEI‐OC1 was transfected with Nrf2, Keap1, and p62 siRNA.

Results

After H2O2 treatment, not apoptotic cells but necrotic cells were detected by FAC scan analysis. The pretreatment of HEI‐OC1 with rapamycin protects against H2O2‐induced necrotic cell death. After treatment with rapamycin, the accumulation of LC3‐I/II ratio and the expression of GFP‐LC3 were observed in HEI‐OC1. The knockdown of p62 by siRNA, which loses its ability to interact with Keap1, had no effect on Nrf2 stability, demonstrating that p62‐mediated Nrf2 up regulation is Keap1 dependent. These findings demonstrate that autophagy deficiency activates the Nrf2 pathway in auditory cells.

Conclusion

We demonstrated a promotion of autophagy through the mTOR signaling pathway to enhance cell survival in auditory cells under oxidative stress. A crosstalk between Nrf2/Keap1 pathway in the autophagy related p62 are also presented. The selective autophagy substrate p62 activates the oxidative stress responsive factor Nrf2 through inactivation of keap1.
Multimodal Assessment of Normal Eustachian Tube Function
Authors: Alper Cuneyt M. , Singla Alok , Banks Juliane , Swarts J. Douglas , Doyle William J.
Published: September 2011

Objective

Evaluate normal human Eustachian tube (ET) function during swallowing and other maneuvers that open the ET using a variety of modalities including EMG of the Tensor veli palatini (mTVP), Levator veli palatini (mLVP), and submental muscles, videoendoscopy, and sonotubometry; and compare these results with ET function tests in a pressure chamber.

Method

In adult volunteers surface electrodes and needle EMG electrodes were placed into the mTVP and mLVP muscles. A 45° telescope was used to video‐record the ET orifice, and sonotubometry recorded the ET openings. A subset was also tested in a pressure chamber.

Results

Seventeen subjects were enrolled. EMG data was recorded from both the mTVP and mLVP in 15 subjects but from only one muscle in 2 subjects. In 9 subjects ET functions tests were performed in the pressure chamber. Video recording of ET opening was consistent with the EMG activity and ET openings by sonotubometry. mTVP activity had a shorter duration but a greater amplitude than mLVP activity. mLVP activity occurs before that of mTVP and the submental muscle group. Tests conducted in the pressure chamber demonstrated ET function consistent with the multimodal test results.

Conclusion

Multimodal assessment of ET openings by monitoring the EMG of the paratubal and submental muscles, video recordings of the ET, and sonotubometry with ET function testing in the pressure chamber in adult volunteers is a novel and promising method for expanding our knowledge of middle ear physiology and pathophysiology.
Novel Maneuver for Benign Paroxysmal Positional Vertigo
Authors: Natt Ravinder Singh , Tahery Jawed
Published: September 2011

Objective

A simplified and shorter version of the Epley maneuver for successful canalith repositioning and deposition from the posterior semicircular canal (SCC) into the utricle of the vestibular labyrinth in the treatment of benign paroxysmal positional vertigo (BPPV) as confirmed by a positive Dix‐Hallpike test is described.

Method

Adjustable head‐set positioned patients providing 3D representation of vestibular apparatus. Three latex free tubes positioned at 90‐degree angles to one another representing SCC arrangement in both ears. Communication via hollow plastic‐cavity representing the utricle. Mobile metal ball bearing representing the canalith placed into the lumen posterior SCC tube of the affected ear determined following positive Dix‐Hallpike test.

Results

As described by Epley, the head is placed over the end of the table and turned 45 degrees to the affected ear so the canalith gravitates to the center of the posterior SCC. While the head is tilted below the horizontal it is rotated 45 degrees toward the other ear so the canalith reaches the common crus. At this stage the patient is then turned prone, looking directly at the floor, and subsequently the canalith enters the utricle. This method has 85% success rate in BPPV patients with a positive Dix‐Hallpike test.

Conclusion

The method incorporates fewer steps than the Epley maneuver and is less time consuming in busy otolaryngology clinics achieving the desired outcome, with the advantage of educating patients and junior doctors about canalith movement through SCCs with head‐set resembling valuable visual aid‐memoire. The senior author successfully used this technique for 10 years for short term resolution of BPPV‐associated symptoms.
Pirymethamine and HEX Gene Expression in Cholesteatoma
Authors: Olszewski Slawomir , Olzewska Ewa
Published: September 2011

Objective

1) Evaluate the expression of hexosoaminidases (HEXA and HEXB) genes in cholesteatoma fibroblasts (CF) and in the inflamed synoviocytes obtained from patients who suffered from rheumatoid arthritis; and 2) Evaluate in vitro inhibition potential of pyrimethamine.

Method

Cholesteatoma fibroblasts (study group), synoviocytes (comparison group), and retroauricular skin fibroblasts (control group) were used. The following solutions of the selected inhibitor (pyrimethamine) were added to the cell culture: 20 mcg/mL, 10 mcg/mL, 3 mcg/mL, and 1.5 mcg/mL. RT‐PCR was carried out before and after adding pyrimethamine.

Results

RT‐PCR established elevated expression of HEXA and HEXB mRNA in cholesteatoma. HEXA mRNA in CF was 6 times higher than in controls. HEX mRNA expression is regulated by pyrimethamine. Inhibition of HEXA and HEXB mRNA expression was achieved when the highest concentration of PYR was used. Low concentrations of pyrimethamine upregulated HEX gene in CF. A difference in HEXA and HEXB expression was observed in synoviocytes. The highest concentration of pirymethamine (10 and 20 mcg/mL) caused the least elevation of HEXA expression. A slight decrease of HEXB expression was observed under the concentration of pirymethamine: 1.3 and 3 mcg/mL.

Conclusion

Pyrimethamine, depending on its concentration, contributes to regulating HEX gene expression in CF and controls. Our preliminary data do not let us establish the concentration of pyrimethamine that may significantly inhibit HEXA and HEXB expression. Further study may put new insight into the usefulness of investigating the localized inflammation in cholesteatoma.
Postauricular Twin Flap for Canal Wall Reconstruction after Canal Wall Down in Chronic Otitis Media with Small Canal
Authors: Cho Yongbeom , Jang Chul‐Ho , Cho Hyong‐Ho , Yang Hyung Chae , Kim Jae Young , Kim Jun Sung
Published: September 2011

Objective

Propose the postauricular twin flap consisting of an anteriorly based periosteal flap and soft tissue flap for reconstruction of the canal wall in patients with chronic otitis media and small ear canal in which a canal down procedure is required.

Method

A retrospective review was performed in patients undergoing canal wall reconstruction with postauricular twin flap and type I tympanoplasty after canal wall down from 2009 to 2010. Shape of the canal after reconstruction, pre‐ and postoperative audiogram, and postoperative complications such as infection, delayed healing, and dehiscence of the wall were evaluated.

Results

Seven ears of 7 patients underwent the canal wall reconstruction procedure after canal down and type I tympanoplasty. The ages of the patients ranged from 19 to 63 years. The mean duration of follow‐up was 13.3 months with a range of 9 to 18 months. The shape of the canal was maintained in all ears, and no dehiscence of the canal wall was found in all seven ears. Postoperative hearing was variable depending on the hearing of preoperation, but no worsening was observed. Mean improvement of postoperative air conduction was 21.8 dB, and that of postoperative air‐bone gap was 16.4 dB.

Conclusion

The postauricular twin flap is thin and flexible enough to support the posterior surface of the canal skin and to fill the space remaining after surgery. The twin flap procedure for the reconstruction of the external ear canal showed a high success rate.
Prevalence of Jugular Bulb Abnormalities and Resultant Inner Ear Dehiscence: a Histopathologic and Radiologic Study
Authors: Friedmann David R. , Winata Leon Shin‐han , Lalwani Anit K. , Pramanik Bidyut K. , Eubig Jan A. , Merchant Saumil N.
Published: September 2011

Objective

Jugular bulb (JB) abnormalities including high riding JB and JB diverticulum can erode inner ear structures and cause hearing loss, dizziness, and tinnitus. This study investigates 1) the prevalence of JB abnormalities, and 2) their erosion into inner ear structures using temporal bone histopathology and computed tomography (CT).

Method

A total of 1579 temporal bones and 100 CT of the temporal bones (200 ears) were reviewed. The presence of a high JB was recorded as was its erosion into inner ear structures. Accompanying demographic and clinical information was reviewed.

Results

High JB was noted in 8.2% (130/1579) of temporal bone specimens, and in 8.5% (17/200) of cases radiologically. Histologically, high JB were more common on the left side, in women, and in those greater than 40 years old. There was no significant increase in the prevalence of high JB over age 40 years. High JB eroded inner ear structures in 34% (44/130) of cases histologically and 18% (3/17) radiologically. The vestibular aqueduct was most frequently dehiscent histologically (n = 41) and radiologically (n = 3). Posterior semicircular canal and facial nerve were infrequently dehiscent. Only 2 out of 41 histological cases of vestibular aqueduct dehiscence had hydrops or a clinical history of Ménière’s disease.

Conclusion

JB abnormalities are common. They are present in 8% to 9% of individuals and are acquired by age 40 years. In 1/3 of cases, high riding JB erodes the inner ear, most frequently involving the vestibular aqueduct. Contrary to expectation, dehiscence of the vestibular aqueduct is infrequently associated with endolymphatic hydrops clinically or histologically.
Prognostic Factors in Sudden Sensorineural Hearing Loss
Authors: Hamamoto Masakazu , Tanaka Hiroki , Fukushima Hisaki , Morita Norimasa , Harada Tamotsu , Tachi Toshihiro
Published: September 2011

Objective

1) Assess the prognostic factors possibly affecting hearing recovery, such as age, severity of hearing loss, definitive episode of vertigo, tinnitus, and ear fullness. 2) Assess the effect of corticosteroids in sudden sensorineural hearing loss (SSHL).

Method

We reviewed the medical records of 117 patients seen at the outpatient clinic of Kawasaki Medical School Hospital between 2004 and 2008. Hearing loss was graded from 1 to 4 according to the grading system by the Research Committee on acute profound deafness of the Japanese Ministry of Health and Welfare.

Results

Eighty‐five patients were Grade‐1 (under 40 dB hearing thresholds at the average of 0.25, 0.5, 1, 2, and 4 KHz), 22 were Grade‐2 (40 to 60 dB), 9 were Grade‐3 (60 to 90 dB), and one was Grade‐4 (90 dB and over). The recovery rates after the treatment of hydrocortisone (300 mg/d for 3 days, 100 mg/d for 3 days) were 88.2% in Grade‐1, 50% in Grade‐2, and 30% in Grade‐3 and ‐4. The recovery rate was significantly higher in Grade‐1 and in cases in which that treatment was started within 7 days from the onset.

Conclusion

Our study indicates that the prognostic factors affecting hearing recovery are the severity of hearing loss and the duration of disease between the onset and the initial treatment of corticosteroid. The age, presence of vertigo, tinnitus, and ear fullness did not influence the recovery rate.
Quality Improvement in Universal Newborn Hearing Screening
Authors: Deem Kenneth C. , Diaz‐Ordaz Ernesto A.
Published: September 2011

Objective

Hospital‐based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality improvement protocols, but many hospitals lack the time and resources to initiate this process. A practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs was studied.

Method

Screening processes and quality indicators for UNHS programs at 4 hospitals were determined through site visits and a 2‐year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital‐specific quality indicators. Improvement opportunities were discussed, and system changes were proposed for immediate implementation.

Results

Hospitals screened 21,957 newborns for hearing loss. Rates of screening were greater than 95% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust inpatient screening processes to reduce potential false‐negative screening results. Two other hospitals addressed poor diagnostic follow‐up by changing the referral process to include additional family contact information. Hospitals also recognized that referral to Early Intervention Child‐Find services increased the likelihood of diagnostic follow‐up four‐fold (P =. 03). Documentation of hearing aid eligibility and enrollment in Early Intervention services was insufficient for retrospective determination of these quality indicators.

Conclusion

Review of nursery and audiology records successfully established most quality indicators for the UNHS programs studied. Feedback of quality indicators identified multiple improvement opportunities and led to immediate system changes. This study demonstrates a practical and data‐driven approach to quality improvement that can be used by any UNHS program.
Resident Education of Documentation and Coding
Authors: Boyle Kristen R. , Gooi Adrian , Kacmarynski Deborah Sue Follmer , Pagedar Nitin A. , Smith Richard J. H.
Published: September 2011

Objective

1) Develop resident billing/coding education based on a needs‐based assessment; 2) Expand systems‐based practice competency; 3) Empower residents with a broader skill set; 4) Minimize risk exposure via adequate documentation; 5) Examine resident billing practices and estimate potential billing errors.

Method

A sample of residents and attendings from our otolaryngology program were administered a pretest/written survey on knowledge/opinions of documentation and coding for physician services. Responses were used to create multi‐modality educational intervention. Resident billing was used to assess pre/post‐intervention ability to bill for physician services in an outpatient clinic setting.

Results

A total of 12 out of 13 staff reported that residents did not demonstrate ability to document and code. No residents currently perform billing, but 12 of 14 assume that they will be in the future. All the residents believed billing training was useful, although 2 did not think it should be taught during residency. A total of 17% of 60 pre‐intervention encounters were accurately coded. A total of 68% of total encounters resulted in underbilling by an average of $22/encounter and 15% of total encounters resulted in overbilling by an average of $35/encounter. Total lost charges across all encounters were estimated at $909.00 due to inappropriate coding and $710.00 due to insufficient documentation.

Conclusion

Residents are not currently educated regarding documentation and coding for physician services. Therefore, they have a limited understanding of documentation/coding for physician services as evidenced by inaccurate shadow billing. All residents acknowledge that this topic is important to their career with a majority of them interested in learning this information while in residency training.
Role of Prostaglandin D2 Receptor in Otitis Media
Authors: Kariya Shin , Okano Mitsuhiro , Eguchii Motocharu , Makihara Seiichiro , Higaki Takaya , Nishizaki Kazunori , Morita Norimasa
Published: September 2011

Objective

Prostaglandin D2 is the major prostanoid involved in infection and allergy. D prostanoid receptor (DP) and chemoattractant receptor‐homologous molecule expressed on T helper type 2 (Th2) cells (CRTH2) are major prostaglandin D2 receptors. The purpose of this study is to disclose the role of prostaglandin D2 receptors in otitis media.

Method

Experimental otitis media was induced by middle ear injection of lipopolysaccharide. DP single gene‐deﬁcient (DP‐/‐) mice, CRTH2 single gene‐deﬁcient (CRTH2‐/‐) mice, and DP/CRTH2 double gene‐deﬁcient (DP‐/‐ CRTH2‐/‐) mice also received lipopolysaccharide. Concentrations of cytokines in middle ear effusion were measured by ELISA.

Results

Signiﬁcant production of cytokines and chemokines was detected in lipopolysaccharide‐treated wild‐type mice. CRTH2‐/‐ mice also showed significant up regulation of inflammatory reactions. In contrast to CRTH2‐/‐ mice, inﬁltration of inﬂammatory cells and expression of macrophage inﬂammatory protein 2, IL‐1‐beta, and IL‐6 induced by lipopolysaccharide were reduced signiﬁcantly in DP‐/‐ mice and DP‐/‐CRTH2‐/‐ mice.

Conclusion

These findings indicate that DP may play significant roles in pathogenesis of experimental otitis media.
Sensorineural Hearing Loss in the Setting of Systemic Autoimmune Disease: A Temporal Bone Study
Authors: Balaker Ashley Erin , Ishiyama Akira , Lopez Ivan A.
Published: September 2011

Objective

Determine if temporal bone specimens from patients with different systemic autoimmune diseases and sensorineural hearing loss will show similar histologic findings, including endolymphatic hydrops, strial atrophy, loss of hair cells, neuronal loss, and/or evidence of vasculitis.

Method

This is a histopathologic study of 34 temporal bones from 21 patients with autoimmune disorders and sensorineural hearing loss. Specimens were studied under light microscopy, and pathologic changes were graded, including degree of endolymphatic hydrops, strial atrophy, hair cell loss, neuronal loss, and presence of vasculitis.

Results

Strial atrophy was the most common finding and correlated with the degree of hearing loss. Only patients with Cogan syndrome or primary autoimmune sensorineural hearing loss had endolymphatic hydrops. Cochlear hair cell loss and neuronal loss were seen in some specimens but not universally. Vasculitis was only seen in polyarteritis nodosa.

Conclusion

Strial atrophy may represent the underlying etiology of sensorineural hearing loss in patients with systemic autoimmune diseases. However, the age of these patients makes presbycusis a possible confounding factor in these specimens.