bluuebunny/crossref_metadata_2025 huggingface dataset:
HPV‐Positive Outcomes in an Access to Care Laryngeal Squamous Cell Cancer Cohort
Authors: Stephen Josena K. , Mei Lu , Harvard Shaleta , Gardner Glendon M. , Chen Kang‐Mei , Schweitzer Vanessa , Worsham Maria J.
Published: September 2011

Objective

Oncogenic human papillomavirus (HPV) has been established as a causative agent for 25% of head and neck squamous cell cancer (HNSCC), including laryngeal squamous cell cancer (LSCC). HPV‐positive oropharyngeal patients have improved prognosis. We determined outcomes in LSCC in the context of HPV infection.

Method

Seventy‐nine primary LSCC were examined for 21 risk factors. HPV status was determined using real‐time quantitative PCR. Chi‐square/Fisher exact test were used to test association of HPV‐positive with the other risk factors. Kaplan‐Meier and log rank test were used to study the risk of HPV‐positive status for overall survival.

Results

HPV‐16 was detected in 21 out of 77 (27%) primary LSCC, 16% (5/32) African American (AA) and 33% (15/45) Caucasian American (CA). Significance between race and HPV status was marginal (P =. 058). HPV‐positive status was significantly associated with male gender (P =. 017) and insurance type (P =. 001). HPV‐positive LSCC had longer median survival (6.64 years) when compared with HPV‐negative (6.25 years), but was not significant.

Conclusion

We found high prevalence of HPV in males vs females and lower prevalence of HPV infection in AA vs CA. Larger multi‐ethnic LSCC cohorts are needed to more clearly delineate HPV‐related survival outcomes across ethnicities.
Cartilage Tissue Engineering: Implications for Microtia Reconstruction
Authors: Dahl John P. , Pappa Andrew , Madan Gitanjali , Caballero Montserrat , van Aalst John , Shockley William W.
Published: September 2011

Objective

Nanofiber‐supported, in vitro‐generated cartilage may represent an optimal starting material for the development of a cartilage implant for use in microtia reconstruction. We aim to characterize the molecular composition of endogenous auricular cartilage and determine if human umbilical cord mesenchymal stem cells (hUCMSCs) can be differentiated into cartilage in vitro.

Method

Human ear cartilage from normal adults, patients with microtia, and pediatric patients with preauricular appendages were analyzed for collagen I, II, and X, and elastin expression. In parallel, hUCMSCs were cultured on nanofiber scaffolds for 21 days under chondrogenic conditions. Cells were harvested for histologic, biochemical, and quantitative PCR analysis.

Results

Histologic analysis of human ear cartilage revealed similar levels and distribution of collagens I, X, and elastin. Collagen II was not highly expressed in the microtia samples (P ≤. 0001). hUCMSC cultures stained positively for glycosaminosglycans and sulfated proteoglycans. Compared with control cells, hUCMSCs grown on PLGA nanofiber scaffolds had more extensive glycosaminosglycan production (P ≤. 03), a higher differentiation index (P ≤. 02), and higher levels of collagen X mRNA expression (P ≤. 005).

Conclusion

These data provide information regarding the composition of endogenous ear cartilage and suggest that hUCMSCs grown on PLGA nanofiber scaffolds may represent an optimal starting material for the development of a cartilage implant for use in microtia reconstruction.
Novel MicroRNA miR‐923 Is Dysregulated in Primary LSCC
Authors: Mei Chen Kang , Stephen Josena K. , Harvard Shaleta , Gardner Glendon M. , Schweitzer Vanessa , Shah Veena , Worsham Maria J.
Published: September 2011

Objective

MicroRNAs (miRNAs) are endogenous, small, noncoding RNAs of 17 to 25 nucleotides that regulate approximately 30% of human genes. They are differentially expressed in various types of cancers compared with noncancerous tissues, suggesting that they may have crucial roles in tumorigenesis. The objective of this study was to discover LSCC‐specific miRNAs.

Method

Global miRNA profiling (800 human miRNAs plus 10 endogenous control miRNAs) was performed on 8 formalin‐fixed archival LSCC samples and 5 normal laryngeal squamous epithelium (HTG, Tucson, AZ, USA). Quantitative real‐time PCR (qRT‐PCR) approach was employed to verify expression status of selected miRNAs that were significantly different from normal controls.

Results

Thirty‐one of the 800 human miRNAs were significantly differentially expressed (P <. 05) between LSCC vs normal tissues. Selected miRNAs (miR‐31, miR‐193b, miR‐663b, miR‐923, and miR‐1826), by qRT‐PCR, verified expression of consistently upregulated miR‐31 and miR‐193b as well as differentially expressed miR‐663b, miR‐923, and miR‐1826. Dysregulation of miR‐923 was newly observed and showed upregulation in 3 out of 8 and downregulation in 5 out of 8 LSCC.

Conclusion

We have identified a group of 31 aberrantly expressed miRNAs in LSCC. miR‐923 has not been previously reported in HNSCC, including LSCC. Further detailed examinations of this miRNA will provide opportunities to dissect the complex molecular abnormalities driving LSCC.
Proteomic Analysis of Decellularized Tissue Engineered Laryngeal‐Tracheal Scaffolds
Authors: Butler Colin , Hsuan Justin , Beaumont Nick , Janes Sam , Ansari Tahera , Birchall Martin
Published: September 2011

Objective

The clinical success of a fully tissue‐engineered tracheal transplant has indicated that there may be more to using decellularized tissue as a scaffold construct. It has been hypothesized that remnant polypeptides reside in these matrices. We sought to determine the proteome profile of a decellularized laryngeal‐tracheal scaffold construct.

Method

A laryngeal‐tracheal construct was fabricated using standard decellularization protocols and underwent immunohistochemistry, electron microscopy, biomechanical analysis, and qPCR for total DNA content. Samples from anatomical subsites were prepared for proteomic analysis. Tandem mass‐spectrometry (LC‐MS/MS) was used to identify peptide sequences and validated using multicolor immunohistochemistry and western blotting.

Results

Decellularization of laryngea‐tracheal scaffold airway construct effectively removed cells, MHC components, and DNA while maintaining similar biomechanical properties to native (nondecellularized) tissue. We identified variable expression of polypeptides in the anatomical subsites of the airway scaffold construct. A minimum core set of polypeptides was identified with a subset of proteins with putative roles beyond structural integrity. Of particular interest were small molecular weight polypeptides known to have significant roles in epithelialization and angiogenesis.

Conclusion

We demonstrate that mass spectrometry can be used as a tool to accurately identify residual proteins in a laryngeal‐tracheal scaffold. The identification of signaling proteins may be of crucial importance in designing the next generation of “intelligent” off‐the‐shelf scaffolds.
Symptoms of Laryngopharyngeal Reflux: Is It Really Reflux?
Authors: Friedman Michael , Kelley Kanwar , Fischer Michelle , Taylor David , Maley Alex
Published: September 2011

Objective

1) Report the accuracy of subjective Reflux Symptom Index scores (RSI) and objective Reflux Finding Scores (RFS) in identifying patients with laryngopharyngeal reflux (LPR) using ambulatory pH monitoring as confirmation. 2) Present clinical recommendations for the use of subjective and objective tools in the diagnosis of LPR.

Method

Retrospective chart review of 300 adult outpatients from January 3, 2009 to December 30, 2010 in a tertiary care setting. Patients with a diagnosis of LPR based on abnormal RSI and positive findings on laryngeal endoscopic examination using RFS were tested for confirmation with a 24‐hour oropharyngeal pH study using the Restech Dx‐pH system.

Results

Among 300 consecutive patients with an RSI score >5, 58.6% were confirmed to have reflux after undergoing 24‐hour oropharyngeal pH‐monitoring. Of these 300 patients, 146 had an RFS score >5. Among patients with a RSI >5 and a RFS 5 and RFS>5 the positive predictive value (PPV) increased to 71.9% (105 of 146). Therefore, when combined, an RSI>5 and RFS>5 yields significantly higher PPV than RSI alone.

Conclusion

Patients with clinical signs and symptoms of LPR based on RSI alone do not demonstrate significant positive predictive value when confirmed with oropharyngeal pH testing, but predictive value is increased greatly when RSI and RSF are combined.
The Effect of Nebulized Normal Saline for Postoperative Pain following Therapeutic Microlaryngoscopy
Authors: Das‐Purkayastha Prodip K. , Scott Maskell , Harries Mereddyd
Published: September 2011

Objective

Compare the effectiveness of immediate postoperative nebulized saline, following a therapeutic microlaryngoscopy, for pain relief.

Method

Forty patients undergoing microlaryngoscopy were blindly randomized into 2 groups. Twenty‐one patients received no immediate postoperative nebulizers, and 19 patients received nebulized saline. Following surgery a blinded observer assessed pain related to the procedure using a visual analogue scale at 1, 2, and 4 hours.

Results

Age of patients, size of lesions, and postoperative pain were recorded and statistically analyzed. The age of the patients in either group was not statistically significant. The size of lesions operated on in each group was not statistically significant. The pain at 1 hour and 2 hours postoperation were both statistically highly significant.

Conclusion

The results of our randomized controlled trial have shown that following a therapeutic microlaryngoscopy, by immediately administering nebulized normal saline, pain can be easily and safely reduced.
Transoral CO2 Laser‐Resection of Early Laryngeal Cancer
Authors: Csanády Miklós , Czigner Jenö , Jóri József
Published: September 2011

Objective

Authors report their experience (1987‐2010) with transoral CO2 laser surgery of early glottic and supraglottic cancer. A total of 375 laser cordectomies were performed in 324 patients with Tis‐T2 vocal cord tumors, and 63 patients with T1, T2 supraglottic tumour underwent transoral supraglottic laser resection.

Method

Laser cordectomy of Tis (21), T1a (179), T1b (57), and T2‐3 (32) tumors and supraglottic laser resection of 40 epiglottis (36 T1, 4 T1N1), 4 vestibular fold (T1), 13 vallecula (10 T2, 3 T2N1), and 6 aryepiglottic fold (3 T2, 3 T2N1) tumors with 10 ND was evaluated.

Results

There was no recurrence after a single laser cordectomy in 87.5% of the patients (253/289 patients). Laser‐specific survival is 92.7% (268/289). Five‐year survival is 92.2% (214/232). “Local recurrence” was found in 36 of 289 patients (12.5%). In the supraglottic group, 47 patients are free of tumor after primary laser excision so far. Sixteen patients with local recurrence underwent salvage treatments. Late neck metastasis required 5 radical neck dissections (RND). Tumor‐free survival is 75%. Survival after salvage therapy is 98%. The voice improved during the healing.

Conclusion

Transoral CO2 laser surgery of the early vocal cord and supraglottic cancer proved to be a primary treatment option with success: good oncological and acceptable functional results.
Association between Hepatitis B and Hearing Status
Authors: Shayaninasab Mohammad , Alizamir Azam , Fatoloomi Mohammad Reza
Published: September 2011

Objective

Viral diseases are one of the common causes of hearing loss. Inner ear may be involved directly or by secondary reaction (eg, poly arthritis nodosa). This goal was to investigate the relation between positive HBS‐Ag (hepatitis B disease) and hearing loss.

Method

This case‐study research was done on 95 hepatitis B patients as case group and 97 normal cases as control group. They were selected sequentially, and audiologic tests were performed on them. The hearing thresholds of the 2 groups were compared using t test.

Results

According to our audiometry results, pure tone average (mean thresholds of 500, 1000, and 2000 Hz) were 22.1 dB for left ear and 23.95 dB for right ear in the hepatitis B group, and 8.4 dB for left ear and 8.95 dB for right ear in the control group (HBSAg negative). Difference between 2 groups was statistically significant, with P <. 05.

Conclusion

The results show that hepatitis B patients are more prone to hearing loss. In other words, hepatitis B disease can cause hearing loss. This study suggests that hepatitis B prophylaxis is important in decreasing hepatitis B involvement and, therefore, hearing loss.
Audiovestibular Dysfunction Associated with Adoptive Cell Therapy for Melanoma
Authors: Seaman Bradley J. , Guardiani Elizabeth , Zalewski Christopher K. , Kim Hung Jeff J. , Brewer Carmen C. , Vanwaes Carter
Published: September 2011

Objective

1) Understand the audiologic and vestibular toxicity associated with Adoptive Cell Therapy (ACT) for melanoma, which utilizes T‐cells engineered with receptors to target the tumor‐associated antigens MART‐1 and gp100. 2) Investigate the use of intratympanic steroid injections in the treatment of audiovestibular dysfunction associated with ACT for melanoma.

Method

Retrospective review of 33 patients with metastatic melanoma nonresponsive to conventional therapy who underwent ACT with modified T‐cells targeting MART‐1 (n = 19) or gp100 (n = 14) from 2007 to 2008. All patients received serial audiometric testing. Vestibular testing was performed on patients with vestibular complaints. Patients with significant hearing loss received intratympanic steroid injections.

Results

Out of 33 patients, 16 had no hearing loss, 9 had mild hearing loss, and 8 had moderate hearing loss posttreatment. Ten patients received intratympanic steroid injections for mild (n = 3) or moderate (n = 7) hearing loss. Of those with mild hearing loss all but one recovered fully. Five of 8 patients with moderate hearing loss recovered to baseline hearing levels and 3 had partial recovery. There was vestibular dysfunction in 7 patients who underwent vestibular testing, one recovered fully, and the others showed partial recovery or no recovery. The number of modified T‐cells infused for therapy correlated with the degree of audiovestibular deficit.

Conclusion

ACT targeting pigmented cell antigens is a novel therapy for melanoma that is associated with hearing loss and vestibular dysfunction. The presumed mechanism of autoimmune attack on normal melanocytes in the stria vascularis of the cochlea and vestibular organs demonstrates the importance of melanocytes in normal inner ear function.
Biofilm in Human Temporal Bones with Otogenic Meningitis
Authors: Yildirim‐Baylan Muzeyyen , Schachern Patricia A. , Cureoglu Suanar M. , Meric Faruk , Paparella Michael M. , Cureoglu Sebahattin , Yoda Shigetoshi
Published: September 2011

Objective

To detect biofilm structures in the temporal bones (TB) with otogenic meningitis.

Method

Twenty‐two TB from 12 patients with otogenic meningitis and 27 TB from 17 patients with otitis media without meningitis were histopathologically examined. The presence, the amount, and localization of biofilm, fluid, and pathologic diagnosis have been noted. Data were compared between the groups with and without otogenic meningitis.

Results

Biofilm formation has been observed in 19 of 22 TB with otogenic meningitis group and 7 of 27 TB with otitis media/without otogenic meningitis group (P. 05). The most common localization of biofilm was in the round window, and it was least common in the Eustachian tube. Biofilm was also present in other areas, including the oval window, facial recess, sinus tympani, mastoid, and inner ear.

Conclusion

Biofilm is a very frequent finding in patients with otogenic meningitis. It seems that the eradication of the biofilm from the hidden areas of the middle ear cleft could be important to prevent any complications such as meningitis.
Biofilm in Human Temporal Bones with Pneumococcal Otitis Media
Authors: Yildirim‐Baylan Muzeyyen , Schachern Patricia A. , Cureoglu Suanar M. , Topcu Ismail , Paparella Michael M. , Cureoglu Sebahattin , Tsuprun Vladimir , Juhn Steven K.
Published: September 2011

Objective

Evaluate biofilm formation in the middle ear and mastoid and correlate the clinical data with the histopathologic findings in human temporal bones (TB) from patients with Streptococcus pneumonia positive chronic otitis media (COM).

Method

Thirty‐seven TB from 20 cases with COM were selected based on positive blood cultures for Streptococcus pneumonia. The presence, amount, and localization of biofilm, and fluid, type of inflammatory cells, labyrinthitis, use of antibiotics, and coinfection of H influenza were noted. Data were compared between the groups with/without biofilm.

Results

Biofilms were observed in 22 (59%) of the 37 TB with COM. The most common anatomic localization of biofilm was facial recess, the least common was the Eustachian tube. When comparing biofilm positive and negative groups there was statistical significance in the correlation regarding type of inflammatory cells (P. 05).

Conclusion

There is higher incidence of biofilm in chronic otitis media with pneumococcal infection. Because biofilms can be found more commonly in obscure areas such as facial recess and sinus tympany and less localized in well aerated areas such as the Eustachian tube, radical cleaning of those areas and optimum aeration seem essential to avoid recurrence of infection.
Body Stabilization in Benign Paroxysmal Positional Vertigo
Authors: Kasse Cristiane A. , Barreiro Fatima Branco , Santana Graziela , Gazzola Juliana , Dona Flavia , Scharlach Renata Coelho
Published: September 2011

Objective

Evaluate the influence of Benign Paroxysmal Positional Vertigo (BPPV) in the balance control of the elderly after Epley’s maneuver and understand whether a reposition maneuver is enough to recover balance control.

Method

Prospective study of 33 elderly patients with vertical canal BPPV seen in a tertiary center. Dizziness Handicap Inventory (DHI) and static posturography were determined before and after Epley’s maneuver. The parameters of the Balance Rehabilitation Unit (BRU) static posturography analyzed were: the limit of stability (LOS) and body sway velocity (VOS).

Results

The DHI total and the subscale scores improved (P =. 001) after the treatment in all aspects. There was statistically significant improvement of the LOS pre‐ and posttreatment (P =. 001). Eight of 10 visual‐vestibular stimuli had statistically significant improvement after treatment: with eyes closed (P =. 001); over foam and eyes closed (P =. 002); saccadic stimulation (P =. 043); horizontal optokinetic stimulation (P =. 015); 2 different verticaloptokinetic stimulations (P =. 003, P =. 009); two different visual‐vestibular stimulations (P =. 003, P =. 047). The VOS showed statistical significance after treatment for eyes closed (P =. 001); on foam and eyes closed (P =. 005); horizontal optokinetic stimulus (P =. 042); vertical optokinetic stimulus (P =. 027); horizontal visual vestibular stimulus (P =. 002); vertical visual vestibular stimulus (P =. 018).

Conclusion

Elderly patients with BPPV present impairment of static postural control in vestibular conflicts. The maneuver promotes remission of symptoms, increases the limit of stability, and improves the control of postural balance in the conditions of somatosensory, visual, and visual‐vestibular conflicts.
Can VEMPs Help Differentiate Ménière Disease from Vestibular Migraine?
Authors: Zuniga M. Geraldine , Janky Kristen , Schubert Michael C. , Carey John P.
Published: September 2011

Objective

To determine if results from cervical vestibular evoked myogenic potential and ocular (oVEMP) testing can help differentiate Ménière’s disease (MD) from vestibular migraine (VM).

Method

Subjects: Age‐matched controls (n = 16), unilateral definite MD patients (n = 23), VM patients (n = 9) by Neuhauser’s criteria. Intervention(s): Click and 500‐Hz tone‐evoked c‐ and oVEMPs. VM patients were further classified based on localization of symptoms. Outcome measure(s): CVEMP: corrected peak‐to‐peak amplitudes; oVEMP: n10 amplitudes.

Results

Five VM patients were able to localize their symptoms to one ear. Relative to controls, MD and VM groups both showed reduced click‐evoked cVEMP (P <. 002) and oVEMP (P <. 026) amplitudes. Only the MD group showed reduction in tone‐evoked amplitudes for cVEMP (P =. 011). Tone‐evoked oVEMPs differentiated MD from VM patients (P =. 027), but only for VM patients who did not localize their symptoms to one ear (P =. 013).

Conclusion

C‐ and oVEMP amplitudes are reduced in response to clicks in VM. 500‐Hz tone‐evoked oVEMPs may differentiate VM patients without localizing ear symptoms from MD, but those with localizing symptoms may have a similar pathophysiology to MD.
Cholesteatoma Localization in the Contralateral Ear
Authors: Rosito Leticia P. S. , Selaimen Fabio A. , Da Costa Sady S. , Dornelles Cristina
Published: September 2011

Objective

Acquired cholesteatoma has been extensively studied. Theories that involve previous tympanic membrane retractions in the cholesteatoma pathogenesis are the most accepted. However we do not know what happens in the contralateral ear. We want to evaluate and compare the localization of acquired cholesteatomas in patients with bilateral disease.

Method

This is a transversal study. We evaluated 1,015 patients with chronic otitis media in at least one ear and no previous surgery between August 2000 and January 2011. Otoendoscopy was carried out and recorded on the affected ear just as in the contralateral, which was classified.

Results

Two hundred and sixty patients with chronic otitis media with cholesteatoma were included. The mean age was 31.7 years, and 52.7% were male. Cholesteatoma was found in 17% of the contralateral ears. In the case of an epitympanic cholesteatoma in one ear, the cholesteatoma in the other ear was in the same site in 92% of patients. On the other hand, if it was mesotympanic posterior in one ear, the cholesteatoma in the contralateral ear was in the same location in 80%.

Conclusion

The results suggest that patients with acquired cholesteatoma have a greater probability of having a cholesteatoma in the same site in the contralateral ear. This corroborates the idea that chronic otitis media with cholesteatoma is not only an isolated event but a constitutional process with a high prevalence of bilaterality.
Does Cleft Palate Width Impact Success of Cleft Repair?
Authors: Morris Lisa M. , Kuang Anna , Milczuk Henry A. , Beaulieu Kameron , Wang Tom , Brockman Janet
Published: September 2011

Objective

Compare surgical and speech outcomes between the double‐opposing Z‐plasty (Furlow) palatoplasty vs the 2‐flap palatoplasty based on the width of the palatal cleft.

Method

A prospective study of 232 patients with cleft palate repair from April 1995 to March 2010 at a tertiary care institution. The cleft palate was measured (mm) and repaired with a Furlow or 2‐flap palatoplasty. Outcome measurements include fistula rate and secondary velopharyngeal insufficiency (VPI) repair.

Results

Primary cleft palate repair was performed on 232 patients by Furlow palatoplasty (n = 96) or 2‐flap palatoplasty (n = 136). Patients were subdivided into 4 groups based on width: Group A 1 to 5 mm (n = 57), Group B 6 to 10 mm (n = 38), Group C 11 to 15 mm (n = 72), Group D 16 to 30 mm (n = 4). Fistula rates increase as the width of the palatal cleft increases. Fistula rates are similar between the Furlow and the 2‐flap palatoplasty for each palatal width, except for clefts greater than 16mm. Two‐flap palatoplasty has a higher rate of velopharyngeal insufficiency for all groups of cleft patients.

Conclusion

At our institution the Furlow and 2‐flap methods of palatoplasty have similar fistula rates for all cleft widths; however the Furlow method has decreased risk for subsequent velopharyngeal insufficiency compared with the 2‐flap method. These data should encourage performance of the Furlow palatoplasty whenever feasible.
Electrocochleography in Round Window Vibrant Soundbridge Implantation
Authors: Colletti Vittorio , Colletti Liliana , Mandalà Marco
Published: September 2011

Objective

Determine the efficacy of electrocochleography (ECoG) monitoring to optimize the fitting of the floating mass transducer (FMT) of the Vibrant Soundbridge (VSB) on the round window membrane (RWm) niche in patients with conductive and mixed hearing loss.

Method

Intraoperative ECoG monitoring in 41 patients with conductive and mixed hearing losses during surgery for VSB FMT RWm placement. Threshold and amplitude of click evoked compound action potentials (CAPs) were evaluated as a function of different middle ear locations and procedures for fitting the FMT on the RW niche.

Results

Successful FMT/RWm coupling with optimal CAPs responses requires: 1) removing part of the bony lip to obtain a complete view of the RWm, a full RWm/FMT contact; 2) drilling on the bony floor facing the RW to facilitate a perpendicular FMT/RWm; 3) interposing fascia between the FMT and RWm and all around the FMT to avoid contact with the surrounding bone; 4) locating the FMT approximately 1 mm inside the RW niche and placing a cartilage disk on the lateral face of the FMT to ensure stability of the coupling; 5) verifying that the footplate is not fixed.

Conclusion

Intraoperative ECoG monitoring verified that if the FMT is not in full close contact with the RWm and not free to vibrate without any contact with bone structures, the transfer of the FMT vibratory energy supplied to the cochlea will be incomplete and insufficient to fully compensate for sensorineural loss.
Endoscopic Dilatation of the Eustachian Tube
Authors: Dalchow Carsten , Muenscher Adrian , Knecht Rainald
Published: September 2011

Objective

An obstructive dysfunction of the Eustachian tube often leads to chronic otitis media, which must be treated with excessive surgery. The use of probes, tubes, or grommets are not always satisfying in the long term. With the use of modified balloon catheters, a safe and reliable treatment now becomes feasible.

Method

A total of 107 patients with a history of tubal dysfunction were examined by otoscopy, pure‐tone‐audiometry, impedance audiometry, and tube manometry between July 2010 and January 2011. 20 patients were treated with endonasal endoscopic tube dilatation by inserting a ballon catheter into the Eustachian tube, which was then enlarged with 10 bar for 2 minutes.

Results

Twenty patients (14 male and 6 female; age 14‐71 years) were treated. All patients showed an obstructive dysfunction of the Eustachian tube in their preoperative diagnostics. A checkup one day and 3 months’ postdilatation verified an improved tube function in 14 patients, while all patients reported a subjective benefit after dilatation.

Conclusion

The use of endonasal endoscopic tube dilatation provides otologists with a safe and reliable method to enlarge the cartilaginous part of the Eustachian tube. All patients benefited from treatment, while no complications such as total obstruction or open tube occurred.
Facial Nerve Decompression Surgery with Gelatin Containing bFGF
Authors: Hato Naohito , Nota Jumpei , Yamada Hiroyuki , Gyo Kiyofumi
Published: September 2011

Objective

Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. Our experimental study suggested that bFGF‐impregnated biodegradable gelatin hydrogel facilitates regeneration of the facial nerve in guinea pigs due to the sustained release of bFGF. Clinically, this therapeutic regimen may be useful for facial nerve decompression surgery.

Method

Twenty‐five patients with severe facial paralysis were treated with the new procedure. The facial nerve was decompressed tympanic and mastoid portions via mastoid. A bFGF‐impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated once per month by observing the facial movement.

Results

Patients were followed until complete recovery occurred, or for more than 6 months in cases with a poor prognosis. All patients with severe Bell’s palsy and Ramsey Hunt syndrome showed early recuperation and milder sequelae compared to conventional decompression surgery. Recovery from the palsy was defined as House‐Brackmann grading 1 and 2. The rates of recovered patients with novel surgery and conventional surgery were 92.0% (n = 25) and 70.7% (n = 58), respectively; the former was significantly better than the latter (P <. 05).

Conclusion

This is the first study to reveal the efficacy of a bFGF‐impregnated biodegradable gelatin hydrogel as a drug‐delivery medium in the paralyzed facial nerve surgery. Advantages of this decompression surgery are low risk of hearing impediment and long effective period after onset of paralysis.
Gentamicin Ototoxicity Requires Functional Mechanotransducer Channels
Authors: Huth Markus , Alharazneh Abdelrahman M. , Ricci Anthony , Luk Lauren , Cheng Alan G.
Published: September 2011

Objective

Test the hypothesis that open mechanotransducer (MET) channels are required for aminoglycoside entry and toxicity in auditory hair cells.

Method

Cochlear cultures from postnatal 4‐day‐old rats were treated with gentamicin with and without MET channel blockers. The effects of MET channel blockers on hair cell survival were assessed by cell counts after immunohistochemistry. Two‐photon imaging was used to quantify uptake of Texas‐Red‐conjugated gentamicin (GTTR) into live hair cells.

Results

Gentamicinalone (0.1mM) caused 76.5% hair cell loss in the basal cochlear turn. Cotreatment with MET channel blockers, 1.0 mM curare, and 0.5 mM quinine conferred protection (0.4% and 7.4% hair cell loss, both P <. 001); whereas treatment with endocytosis inhibitors, 2.6 μM conconavalin A and 80 µM dynosore, did not (63.7% and 76.0% hair cell loss). Two‐photon imaging showed that GTTR uptake (3 µM) into live hair cells was rapid and selective. Quinine and curare, but not concanavalin A, reduced GTTR uptake. Furthermore, as low calcium increases the open probability of MET channels, hypocalcemia showed facilitated GTTR uptake.

Conclusion

Functional MET channels are required for aminoglycoside uptake into hair cells and its toxicity. Results suggest that limiting permeation of aminoglycosides through MET channels is a potential therapeutic target for preventing hair cell death.
Habituation following Tinnitus Retraining Therapy in Tinnitus Sufferers
Authors: Thong Jiun Fong , Wong Mei Ching , Junaidah S. , Chan Yew Meng
Published: September 2011

Objective

Evaluate the efficacy of Tinnitus Retraining Therapy (TRT) in habituating patients with tinnitus.

Method

Prospective study of patients presenting to the tinnitus clinic at a tertiary referral otorhinolaryngology unit in Singapore over a 13‐year period (1997 to 2010). Patients who underwent Tinnitus Retraining therapy were followed up with structured interviews with the aid of questionnaire forms. Habituation following TRT was evaluated.

Results

A total of 702 patients were studied (55% male, 45% female). Average age was 51 years. Habituation of reaction to tinnitus and habituation of perception were analyzed. Average duration of follow‐up was 33 months (range, 0.25‐151 months). A total of 68% of patients described improvement in annoyance following TRT. Of these, 80% described habituation of perception as well. There was no statistical difference in gender and age between patients who did and did not respond to TRT. However, duration of treatment was significantly longer in patients who habituated.

Conclusion

The goal of TRT is to achieve habituation of reaction to tinnitus. Habituation of perception is often a secondary result of sufficiently habituated response. From our study, more than two‐thirds of patients with tinnitus achieved habituation of reaction, and of these, the majority also habituated to awareness of the tinnitus.
Inner Ear Effects of Canal Wall Down Mastoidectomy: A Prospective Study
Authors: Benscoter Brent J. , Marmora Joseph , Leonetti John P. , Kircher Matthew L. , Jaber James J. , Feustel Paul J.
Published: September 2011

Objective

Evaluate the inner ear effects of canal wall down (CWD) mastoidectomy in the treatment of chronic otitis media (COM) in regard to bone conduction hearing and reported tinnitus and dizziness related disability.

Method

Prospective study of 86 consecutive patients treated by CWD mastoidectomy for COM with or without cholesteatoma. Patients underwent preoperative audiogram and completion of 2 surveys: Dizziness Handicap Inventory (DHI) and Tinnitus Handicap Inventory (THI), which were repeated 4 to 6 months postoperatively.

Results

No significant change in bone‐conduction hearing scores occurred postoperatively. DHI and THI scores improved in the vast majority of patients. Thirteen patients, 13 out of 34 (38%), had DHI improvement greater than 18 points, indicating a significant patient‐perceived improvement in dizziness‐related disability. Sixteen patients, 16 out of 43 (37%), had THI improvement greater than 20 points, indicating a significant patient‐perceived improvement in tinnitus‐related disability. Three patients developed new‐onset postoperative dizziness, and 5 patients developed new‐onset postoperative tinnitus. The odds ratio for improving DHI and THI scores relative to or worsening scores is 6.6 in DHI (95% CI: 1.8 to 25.0) and 4.2 in THI (95% CI: 1.45 to 12.2).

Conclusion

Canal wall down mastoidectomy did not result in new‐onset sensorineural hearing loss. In addition, using the Dizziness Handicap Inventory and Tinnitus Handicap Inventory measures, patient‐perceived disability from dizziness and tinnitus was shown to decrease after mastoid surgery.
Is There a “Biological Gear” in the Human Middle Ear?
Authors: Puria Sunil , Steele Charles , Cai Hongxue , Jackson Ryan
Published: September 2011

Objective

A mammal’s ability to hear high‐frequency sound is due to unique structures such as 3 distinct middle‐ear (ME) ossicles. In larger mammals such as humans, the ME features a cylindrical malleus cross section, differing eardrum areas on each side of the malleus handle, and a mobile saddle‐shaped malleus‐incus joint (MIJ).

Method

Based entirely on 3D reconstructions of micro‐CT images, a finite element biocomputation model was constructed, which includes the ear canal, eardrum, ossicles, suspensory soft tissue attachments, and ME joints modeled as mobile and fluid‐filled. Frequency responses of acoustics‐structure interactions were calculated using COMSOL Multiphysics solvers.

Results

Results indicate that at low frequencies, hinge‐like motion is dominant as expected, and that the orthotropy of the eardrum boosts the ME gain due to increased peak displacement. However, at high frequencies we observe multi‐resonance vibration modes at the eardrum and a bevel‐gear‐like motion at the MIJ, and the orthotropy of the eardrum makes the rotation axis of the malleus more coincident with its long axis. This supports the hypothesis that a “twisting” motion of the malleus and incus is required in larger mammals at high frequencies in order to compensate for larger moments‐of‐inertia of the larger ossicular masses.

Conclusion

We argue that a new “twisting” gear‐like motion is necessary for efficient high‐frequency sound transmission in larger mammals, due to higher moments of inertia for hinge‐like motion in these species. These features favor the existence of the twisting motion of the malleus‐incus complex in addition to the classical hinge‐like motion.
Is There an Age Limit for Cochlear Impantation?
Authors: Sanchez‐Cuadrado Isabel , Perez‐Mora Rosa , Gavilan Javier , Lassaletta Luis , Zernotti Mario E.
Published: September 2011

Objective

Evaluate quality of life following cochlear implantation in older postlocutive adults.

Method

Postlingually deaf adults 60 years or older who underwent implantation in 3 institutions were included. Data concerning demographics and audiometric evaluation were collected and studied. Patients were divided in 2 groups (< 70 and ≥ 70 years). GBI was used to quantify quality of life.

Results

Eighty‐one patients were included. The mean age at implantation was 68 years (range, 60‐82 years). A significant improvement in speech recognition after cochlear implantation was observed (P <. 01). The results of the GBI questionnaire showed an important benefit on the total scale (mean, 40) and on the 3 different subscales (53, 24, and 4, respectively). These results were similar to those of younger postlocutive candidates. However, particular cases with decreased quality of life were identified, in spite of acceptable audiologic results. The difference between the <70 and ≥70 years groups was not significant.

Conclusion

Elderly CI users improve their quality of life, with similar outcomes to those achieved by younger adults. Because of particular conditions of this population, care must be taken when indicating a CI. Cochlear implantation should not be denied on the basis of age alone.
Meningitis Following Lateral Skull Base Surgery
Authors: Isaacson Brandon , Purcell Patricia L. , Roland Peter S. , Kutz J. Walter , Allen Kyle P.
Published: September 2011

Objective

1) Determine the clinical course of meningitis in the following lateral skull base surgery. 2) Examine risk factors leading to meningitis following lateral skull base surgery.

Method

Retrospective review of patients undergoing lateral skull base surgery between February 1999 and March 2010. All subjects had culture‐proven meningitis in the postoperative period. Medical records were compared with the lateral skull base patients who did not develop meningitis.

Results

Fourteen of 508 patients (2.8%) developed meningitis following lateral skull base surgery. The most common diagnosis was acoustic neuroma in 78.5%. A total of 64.3% of patients had a CSF leak prior to meningitis onset, and 42.9% received a lumbar drain. The mean time to onset of meningitis was 16.1 days. The most common pathogens were staphylococcus, streptococcus, and enterococcus species; each in 14.3% of cases. A total of 10.3% of patients with postoperative CSF leakage and 9.2% with lumbar drains developed meningitis. The odds ratio of developing meningitis in the setting of a postoperative CSF leak is 7.3. There were no meningitis associated mortalities.

Conclusion

Postoperative meningitis was seen in 2.8% of lateral skull base surgeries. As expected a CSF leak and placement of a lumbar subarachnoid drain are significant risk factors for developing meningitis. No mortality was associated with meningitis.
Occlusion of the Round Window: A Novel Way to Treat Hyperacusis Symptoms in Superior Semicircular Canal Dehiscence
Authors: Banerjee Anirvan , Nikkar‐Esfahani Ali
Published: September 2011

Objective

Conductive hyperacusis in SSCDS occurs because of presence of a “third window.” This can cause an increased imbalance in the impedances looking out of the cochlear windows. Reversible blocking of the round window can minimize symptoms of conductive hyperacusis.

Method

The tympanomeatal flap is elevated through a permeatal approach. The round window niche is identified, and the round window membrane is identified and occluded with bone wax and fascia in layers. Finally the tympanomeatal flap is reflected, and an ear wick is inserted.

Results

Two patients who have undergone the above procedure have reported great reduction in symptoms. Importantly, no Tullio phenomenon has been noted postoperatively.

Conclusion

In patients with SSCD syndrome who present with symptoms of conductive hyperacusis, blocking of the round window can be used to control symptoms. It provides an alternative to the plugging and resurfacing techniques. This procedure is simple to perform, is reversible, and can be undertaken as a day case.
Outcome of Intratympanic Gentamicin Injection for Ménière Disease
Authors: Huon Leh‐Kiong , Fang Te‐Yung , Wang Pa‐Chun
Published: September 2011

Objective

Intratympanic genemicin (ITG) is an option for the treatment of intractable Ménière disease (MD). The aim of this study is to investigate the outcomes of ITG for MD using evidence‐based methodology.

Method

The MedLine database (1985~2010) was searched for original articles (level I or II in evidence strength) published in peer‐reviewed journals concerning ITG for MD. Data extracted from these articles were reviewed and analyzed using meta‐analysis technology.

Results

A total of 15 articles were clitically appraised; 2 prospective, double‐blinded randomized control trials (level I) and 13 prospective noncontrolled clinical trials (level II) were indentified. The pooled vertigo control rates (American Academy of Otolaryngology Head and Neck Surgery guidelines for Ménière disease) from 15 studies are: overall control rate 78% (class A, 95% CI 0.67‐0.85), substantial control rate 56 % to 98% (class A and B, 95% CI 0.25‐1.0) following ITG treatment (P =. 0001). Hearing is worse in 0% to 61% (95% CI 0.02‐0.83) after gentamicin treatment, which was neither clinically nor statistically significant (P = 1.000).

Conclusion

The critical literature and meta‐analyses show that ITG can control vertigo for MD patients with limited injury to hearing. Quality of research has improved remarkably over the years. However, a large scale, randomized controlled trial is warranted to confirm the predicting factors for the true effectiveness of ITG in treating MD.
Relation between Serum Iron Level and Amikacin Ototoxicity
Authors: Shayaninasab Mohammad , Alizamir Azam , Behnoud Fatholah , Khoeinipourfar H. , Fatoloomi Mohammad Reza
Published: September 2011

Objective

Aminoglycosides are highly effective against bacteria but have serious side effects including ototoxicity and nephrotoxicity. Iron‐aminoglycoside complex causes ototoxicity by creating free radicals. We study the relation between serum iron level and amikacin ototoxicity to learn whether more iron results in more ototoxcity.

Method

We examined burned patients with amikacin prescription. Patients were divided into Group 1 (89 patients with serum ferritin above 150 ng/mL) and Group 2 (92 patients with serum ferritin below 150 ng/mL). Their hearing thresholds and red blood cell indices were compared using t and paired t test.

Results

In comparing the 2 groups, thresholds of Group 1 were more than Group 2 at all frequencies, and the difference was statistically significant with P <. 001. Maximum threshold shift in Group 1 was greater than 20 dB and in Group 2 was less than 10 dB, at 8000Hz. Again, this result was statistically and clinically significant with a P <. 001. Finally, mean corpuscular volume was greater in Group 1 than Group 2, and the P‐value for the test was around. 001.

Conclusion

Our results suggest that iron level is related to aminoglycoside ototoxicity. More iron can create more ototoxicity, and iron deficiency may inhibit aminoglycoside ototoxicity. An increase in MCV may be due to higher serum ferritin and an indication of more ototoxicity.
Relationship between Audiogram and Pitch in Tonal Tinnitus
Authors: Kleinjung Tobias , Schecklmann Martin , Langguth Berthold , Landgrebe Michael , Vielsmeier Veronika , Steffens Thomas
Published: September 2011

Objective

It still remains a matter of debate whether the main responsible mechanism for tinnitus generation is reduced lateral inhibition or feed forward inhibition. On a perceptual level these different mechanisms should be reflected by the relation between the individual hearing curve and the perceived tinnitus frequency.

Method

We investigated in a large sample of 320 patients with unilateral (145 right, 175 left) tonal tinnitus the relationship between the perceived tinnitus pitch and the individual audiogram. The tinnitus frequency as determined by pitch matching was compared with an audiogram of the ear where the tinnitus was perceived.

Results

The perceived tinnitus pitch depended to a greater extent on the frequency of maximum hearing loss than on the edge frequency.

Conclusion

Results of our study confirm the relevance of absolute hearing loss for tinnitus generation as compared with the edge frequency, suggesting that tinnitus is rather a fill‐in phenomenon, eg, generated by altered gain control, than the result of deficient lateral inhibition.
Role of Vestibular Function Tests in Cochlear Implantation
Authors: Hajioff Daniel , Wilkinson Andrew , Savage Julian , Robinson Philip J. , Parmar Amit , Nunez Desmond A.
Published: September 2011

Objective

Vestibular function tests are often undertaken before cochlear implantation, in part to help select the side of surgery. We aim to determine whether implantation on the side of better vestibular function leads to greater dizziness than implantation on the side of worse or similar function.

Method

A total of 177 unilateral implant recipients were reviewed in 2 groups. A: Those implanted in the ear with worse or similar caloric function. B: Those implanted in the ear with greater (>20%) caloric function. All were assessed with the Dizziness Handicap Inventory and supplementary questions after a minimum 2 months.

Results

A total of 57% of both groups reported dizziness in the first 7 days postoperatively. At 2 months 20% of group A and 34% of group B experienced some dizziness. A total of 14% of group A and 10% of group B felt that cochlear implantation had resulted in impaired balance. The DHI scores of 86% of group A (median score 0) and 76% of group B (median score 10) corresponded with low handicap. None of these results differed significantly between groups A and B.

Conclusion

While cochlear implantation may result in dizziness it is almost always short‐lived and mild, even when the ear with a stronger caloric response is implanted.
Saccular Otoconia as a Cause of Ménière Disease
Authors: Yamane Hideo , Takayama Masahiro
Published: September 2011

Objective

Idiopathic endolymphatic hydrops can be caused by disturbance of the longitudinal flow of the endolymph in Ménière disease. This study investigated a possibility that the dislodged otoconia from the saccule could be a cause of Ménière disease by occluding the pathway of the endolymph.

Method

We examined the ears of 65 patients with definitely diagnosed unilateral Ménière disease based on the criteria proposed by the AAO‐HNS and the ears of normal control subjects and cadavers using three‐dimensional (3D) cone beam CT by focusing on the vestibule.

Results

The images of the reuniting duct and the saccular duct could be categorized by their patency. In the case of Ménière ears, both the reuniting duct and the saccular duct were occluded significantly compared with those of normal ears. The ears of the nonlesional side of Ménière patients also showed the occluded aspects of these ducts. The endolympatic sinus, which connects to the saccular duct, suggested relations with Ménière attack.

Conclusion

Patients with Ménière disease often show a significantly higher incidence of blockage of the reuniting duct and saccular duct. There is a big probability that radiodense substances such as saccular otoconia falling into these ducts may be one of the etiologies of Ménière disease.
Systemic Erdosteine against Cisplatin‐Induced Ototoxicity
Authors: Waissbluth Sofia , Dupuis Isabelle , Daniel Sam J.
Published: September 2011

Objective

Cisplatin is a commonly used chemotherapeutic agent. One of its major dose limiting side effects is ototoxicity. No treatment has yet been approved for this condition. The objective of this study was to determine the potential protective effect of a systemic administration of erdosteine against cisplatin‐induced ototoxicity.

Method

Guinea pigs were assigned to 4 groups, each receiving a different concentration of intraperitoneal erdosteine: 0, 100, 200, and 500 mg/kg/d for 4 days. All of the animals received 12 mg/kg/d of intraperitoneal cisplatin. Auditory brainstem response (ABR), scanning electron microscopy, and outer hair cell counts were performed.

Results

Significant otoprotection was observed in groups receiving 200 and 500 mg/kg/d of erdosteine as demonstrated by high frequency (25 kHz) ABR threshold shifts. These findings are supported by outer hair cell counts by scanning electron microscopy. Guinea pigs receiving 100 mg/kg/d did not present otoprotection.

Conclusion

A systemic administration of erdosteine appears to provide a significant otoprotective effect at the basal area of the cochlea for cisplatin‐induced ototoxicity in a guinea pig model.