bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional and Histological Evaluation following Canine Vocal Fold Reconstruction Using Combined Thyroid Ala Perichondrium Flaps
Authors: Glab Rachel C. , Gunderson McLean , Hoffman Matthew R. , Maytag Allison L. , Yang David , Jiang Jack J. , Dailey Seth H.
Published: September 2014

Objectives:

(1) Perform vocal fold reconstruction using composite thyroid ala perichondrium (CTAP) flaps in beagles following unilateral vocal fold stripping; (2) Evaluate aerodynamic, acoustic, vibratory, and histologic changes in canines undergoing CTAP‐based vocal fold reconstruction compared to a control group undergoing injury alone.

Methods:

Unilateral vocal fold stripping was performed on ten beagles. Dogs healed for 1 month and were divided into 2 groups. Dogs in the control group (n = 5) were sacrificed. Dogs in the experimental group (n = 5) underwent ipsilateral vocal fold augmentation with a CTAP flap and recovered for 1 month prior to euthanasia. After euthanasia, larynges were harvested for excised larynx evaluation of vocal fold vibration using aerodynamic, acoustic, and mucosal wave measurements. Histological analysis was then performed on anterior, middle, and posterior sections of the vocal fold. Changes in the injured fold were compared between the control and experimental groups. Comparisons with the contralateral normal fold were made within the control and experimental groups.

Results:

Phonation threshold pressure was significantly lower in the treatment group (P =. 005). Percentage jitter (P =. 010) and shimmer (P =. 007) were also lower in the treatment group. Open quotient was significantly higher in the control group (P =. 007). Histological staining results were inconsistent, and gross analysis revealed evidence of surgical implantation without restoration of normal vocal fold architecture.

Conclusions:

CTAP‐based vocal fold augmentation restored glottic closure and vibratory periodicity following vocal fold scarring. Additional investigation on biologic response is warranted. CTAP flaps offer an autologous, vascularized implant that can improve both vocal fold structure and function.
Laryngeal Reinnervation with Refined Nerve‐Muscle Pedicle Implantation Using Electromyography and Coronal Reconstructed Images
Authors: Sanuki Tetsuji , Yumoto Eiji , Nishimoto Kohei , Kodama Haruka , Minoda Ryosei
Published: September 2014

Objectives:

Evaluate the long‐term efficacy of laryngeal reinnervation with refined nerve‐muscle pedicle (NMP) flap implantation combined with arytenoid adduction for unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG), coronal images, and assessment of phonatory function.

Methods:

We retrospectively reviewed 16 UVFP patients who received refined NMP implantation with arytenoid adduction. Videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic analysis, LEMG, and coronal imaging were performed pre‐ and 2 years after surgery. For LEMG analysis, a four‐point scale was employed to grade motor unit (MU) recruitment where 4+ represented absent recruitment, 3+ represented greatly decreased recruitment, 2+ represented moderately decreased recruitment, and 1+ represented mildly decreased activity with less than full interference pattern. Coronal images were assessed for differences in thickness of the vocal folds during phonation and inhalation.

Results:

Phonatory function results were significantly improved postoperatively for all patients. In LEMG findings, preoperative MU recruitment evaluation results were 1 patient for 1+, 5 for 2+, 1 for 3+, and 3 for 4+. Postoperative MU recruitment evaluation results were 7 patients for 1+, 3 for 2+, and none for 3+ and 4+. Thinning of the affected fold was evident during phonation in 15 of 16 patients preoperatively. The affected fold was at an equal volume with the healthy fold in 8 of 16 patients postoperatively.

Conclusions:

LEMG findings and coronal imagine demonstrates that refined NMP implantation results in successful reinnervation of laryngeal muscles in UVFP patients. Refined NMP implantation may provide near‐normal voice function and restored laryngeal muscle tone and volume.
Long‐term Survival of Autologous Fat Grafts into the Vocal Folds
Authors: Campos Guillermo , Mantilla Natalia , Bermudez Sonia
Published: September 2014

Objectives:

Determine whether long‐term survival of fat implanted into the vocal folds is possible.

Methods:

Nine patients of those treated between 1992 and 2005 by means of bilateral fat injection into the vocal folds responded the call to assess long term results. Initial diagnosis was unilateral vocal fold palsy (6) and superficial sulcus (3). The graft was obtained by means of dissection of fat from the abdominal wall, and injected with an 18 G needle into the body of the vocal folds until 50% over correction was achieved. In palsy cases a higher fat volume was required on the paralyzed side. All patients underwent laryngostroboscopic examination preoperatively and postoperatively, along with postoperative magnetic resonance imaging (MRI) of the larynx, 4 to 14 years after surgery. As far as MRI is concerned, spine echo and fat‐suppressed sequences in axial coronal and sagittal planes were obtained, looking for high intensity areas in T1‐weighted images at the level of the vocal folds.

Results:

Laryngostroboscopy demonstrated permanent augmentation of the vocal folds with glottic closure improvement. MRI images in all cases showed the presence of enough fat in the body of the vocal folds, acting as support for good size and shape of the structure.

Conclusions:

Autologous fat cells injected into the vocal folds can survive years after surgery, acting as a permanent filler. Those conditions are in favor of fat grafts to be used as an inexpensive, easy to use, and long‐lasting implant for selected cases of glottic incompetence.
The Furnas‐Mustardé Combination Technique for the Treatment of the Prominent Pinna: Our 17‐Year Experience
Authors: Deleito Javier M. , Talwar Rishi , Garcia‐Purriños Francisco , Guillen Alberto , Delvasto Lorena , Barrios Andres
Published: September 2014

Objectives:

Report a method using a combination of the Furnas and the Mustardé techniques for the treatment of prominent pinna.

Methods:

All the patients who underwent otoplasty under the supervision of a single surgeon between 1996 to 2013 were included. Surgical technique and complications were analyzed. Major complications were defined as those requiring revision surgery. Mustardé sutures were used to recreate the antihelix and correct upper/middle thirds of the pinna. In the conchal region, both conchal resection and the Furnas conchal‐mastoid sutures were frequently used. Prospective outcome measures included overall benefit and patient satisfaction.

Results:

A total of 130 patients with protruding ears were operated upon (126 bilateral, 4 unilateral). Therefore, there were 256 primary interventions. Fifteen required a pure Mustardé technique and 4 underwent a pure Furnas technique. Hence, the combined technique was applied to 237 ears. Mean follow‐up was 5 years (6 months‐17 years). Only 9 (3.5%) required revision surgery owing to unsatisfactory results and 1 (0.04%) due to bleeding. Minor complications included suture extrusion in 35 ears (13.6%), some up to 5 years postop, and 2 patients (0.07%) developed a retroauricular keloid (treated successfully with intralesional triamcinolone). Overall benefit perceived by the patients was reported as good in 77% and satisfactory in 18%.

Conclusions:

We present a technique that combines 2 previously well described techniques, using both cartilage resection in addition to permanent sutures. We believe that the good aesthetic results and acceptable number of complications make this technique an appropriate treatment option for patients with prominent ears.
New Algorithm for Supraglottitis Staging in Adults
Authors: Marom Tal , Tamir Sharon‐Ovnat , Barbalat Irina , Roth Yehudah
Published: September 2014

Objectives:

(1) Critically review the current staging systems of supraglottitis in adults. (2) Suggest a new algorithm for infections involving the supraglottis based on clinical staging considering anatomical subsites and outcome correlation.

Methods:

We retrospectively identified adult patients with acute supraglottitis during the years of 1990 through 2013 by using International Classification of Disease codes. Patients were graded by using 2 systems: the Scope grading system for epiglottitis, and our new suggested grading system, which relies on the edema in 3 subsites: the epiglottis, the aryepiglottic folds and arytenoids, and the larynx. Those subsites were given the following grades: 0 = no edema, 1 = mild edema, 2 = moderate edema, and 3 = severe edema. Summation of the 3 subsites scores was performed in order to assess the need for airway intervention.

Results:

A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiberoptic laryngoscopy (or by both modalities). One hundred seventy‐eight patients (62%) had Scope grades of 0 or 1, and 110 patients (38%) had Scope grades of 2 or 3. Of these, 24% required an airway intervention. According to our classification, 236 patients (82%) who had a score of ≤4 were less likely to undergo a securing airway intervention, when compared with the 52 patients (18%) who had a score of ≥5, 4% vs 33%, respectively (P =. 03). All patients graded with ≥8 score required airway intervention.

Conclusions:

Our new suggested flow chart of decisions is based on an easy grading system, which allows dynamic description of patient progression during sequential examinations, easy information transmission, and decision making.
Rehabilitation of Swallowing Functions by a New Concept of Intralaryngeal Prostheses
Authors: Schultz Philippe , Dupret‐Bories Agnès , Vrana Engin , Riehm Sophie , Guillere Florence , Lavalle Philippe , Debry Christian
Published: September 2014

Objectives:

Describe 2 intralaryngeal prostheses (ILP) designed to treat laryngeal sphincter incompetence. Present the development of these new devices and analyze the improvement of swallowing.

Methods:

Patients presented with moderate to severe swallowing disorders due to neurological disease or after head and neck cancer treatment were included in this study. All patients required a tracheostomy and a feeding tube to fulfill the inclusion criteria. Two ILP were evaluated: (1) a closed silicone prosthesis (CP), Novatech; (2) a silicon open prosthesis cover with a double flow valves (VP), opened during respiration and closed during swallowing (Newbreez, Protip, France). The devices were inserted under endoscopy. The swallowing functions were assessed from postoperative day 2 and scored using the swallowing performance status scale (SPS).

Results:

Nineteen patients were included. Eleven patients, presented with neurological disease, received CP. Eight patients suffering from neurological disease (n = 4) or from swallowing disorders after radiotherapy (n = 4) received a VP. CP stopped aspiration in 11 patients, allowing a partial oral feeding in 6 patients and the withdrawal of the prostheses after a partial neurological recovery in 4 patients. VP decreased laryngeal aspiration of food or saliva, allowing to continue partial oral feeding and to speak with a whispered voice.

Conclusions:

CP prevents laryngeal aspiration, allowing swallowing reeducation during the phase of neurological recovery. VP is still on assessment in order to propose to patients with moderate swallowing disorders to keep laryngeal phonation and respiration.
Grafts Are Superior to Sutures for Nasal Tip Projection: A Meta‐analysis of Goodes Ratio
Authors: Cole Eric , Natili Angelia S.
Published: September 2014

Objectives:

(1) Discuss relevant tip projection ratios involved in surgical planning of rhinoplasty. (2) Implement findings of meta‐analysis in cosmetic surgery planning.

Methods:

Meta‐analysis of journal articles through June 2013. Intervention: Cosmetic rhinoplasty for underprojected tip. Outcome Measurements: Pre‐ and postoperative Goode Ratio in cosmetic rhinoplasty patients. Null hypothesis: None of 3 techniques provides superior tip projection among: suture, internal graft, and external graft.

Results:

External graft techniques, such as Sheen shield grafting, were found to significantly increase tip projection over suture only techniques. External vs suture: P =. 017. (2) Internal graft techniques, such as columellar strut grafting, approached significance in increased tip projection over suture only technique. Internal vs suture: P =. 053. (3) Internal and external graft techniques did not differ significantly, but external graft techniques displayed a tendency to increase tip projection more. External vs internal: P =. 360.

Conclusions:

(1) Meta‐analysis of the Goode Ratio has never been reported in the literature. (2) No technique has been proven to have significance in the past. (3) External grafts produce a significant change in nasal tip projection over suturing, and internal grafts approach significance. (4) This research allows the surgeon to rank techniques in order of magnitude of change desired.
Thyroid Cartilage Implantation for Unilateral Vocal Fold Paralysis: Voice Assessment and Surgical Outcomes
Authors: Hsu Cheng‐Ming
Published: September 2014

Objectives:

Medialization laryngoplasty is a standard surgical treatment for unilateral vocal fold paralysis (UVFP). This study presents the surgical outcome of thyroid cartilage implantation (TCI), an external medialization laryngoplasty, using thyroid cartilage as the implant.

Methods:

This retrospective clinical series study aimed to analyze the surgical outcomes and safety of laryngoplasty with TCI for UVFP. Seventeen patients with UVFP who underwent laryngoplasty with TCI were examined preoperatively and at 1, 3, and 6 months postoperatively by video laryngostroboscopy. Their voice was evaluated by subjective evaluation and acoustic analysis.

Results:

After surgery, 16 of the 17 (94.1%) patients reported their subjective and objective improvements in voice quality after a follow‐up period of at least 6 months. Glottal incompetence and vocal performance were markedly improved after this surgery. There was a significant decrease in voice grading (from 2.47 to 1.29, subjective improvement) (P =. 002), and the maximum phonation time was significantly longer after surgery (from 3.63 to 7.80 seconds, objective improvement) (P =. 001).

Conclusions:

Laryngoplasty with TCI represents a simple, safe, and effective surgical treatment for UVFP. The advantages include voice improvement, low cost and minimal invasiveness.
Transnasal Office‐Based Laryngeal Surgery Using a Distal‐Chip Endoscope with a Working Channel
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan
Published: September 2014

Objectives:

The advanced technology of distal‐chip flexible naso‐endoscope (“chip‐on‐the‐tip” processor), with high resolution digital video recording, allows for more accurate diagnosis, treatment, and follow‐up of patients with laryngeal disease. Using this instrument with a working channel introduces a new surgical tool, allowing for a variety of transnasal surgical procedures under topical anesthesia. The aims of the study were to: (1) Describe the spectrum of treatment options for laryngeal pathologies using distal‐chip flexible naso‐endoscope. (2) Describe the variety of accessories that can be used. (3) Assess the relative advantages, limitations and risks.

Methods:

A retrospective series reviewing medical files of patients treated with the distal‐chip endoscope during 2010 through 2013 for benign laryngeal conditions. Compliance, complications, surgical notes and long term outcome were documented.

Results:

Forty‐six patients were treated by office‐based laryngeal surgery during the study period. Surgeries performed: Diagnostic biopsies of the glottis, subglottis, and trachea and treatment of papillomatosis, fibrovascular lesions, granulation tissue, keratosis, stenosis, vocal cord paralysis, and cysts. Instruments used: anesthesia catheter, grasping forceps, injection needles, and lasers. No significant adverse effects or complications were documented. The only factor influencing procedure success was patient cooperation and ability to resist gag reflex. Most patients had transnasal surgery; few had combined transnasal and transoral procedures.

Conclusions:

The distal chip endoscope with a working channel enables the laryngeal surgeon to perform relatively complex procedures as an office‐based surgery while avoiding the consequences of general anesthesia and operating room costs.
Trends in Utilization of Vocal Fold Injection Procedures
Authors: Rosow David E.
Published: September 2014

Objectives:

Office‐based laryngeal procedures, vocal fold injections in particular, have become increasingly popular over the past 15 years. The purpose of this study was to examine trends in the use of different vocal fold injection techniques in the United States from 2000 to 2012 and see if they reflect this shift.

Methods:

The United States Part B Medicare claims database was queried from the years 2000 through 2012. The Current Procedural Terminology codes for indirect laryngoscopy with injection (31513), direct laryngoscopy with injection (31570), and direct laryngoscopy with injection, aided by telescope or operating microscope (31571) were used. For comparison, data for medialization laryngoplasty (31588) were also examined. The volume of procedures performed was tabulated for each code by year.

Results:

Over the time period studied, the number of non‐operative laryngoscopic injections (31513, 31570) and operative medialization laryngoplasties remained constant. Operative vocal fold injection (31571) demonstrated significant, linear growth over the 12‐year study period, from 744 procedures in 2000 to 4788 in 2012, an increase of over 640%.

Conclusions:

The dramatic increased incidence in the use of code 31571 reflects an increasing share of vocal fold injections being performed in the operating room and not in an office setting, which runs counter to the prevailing trend within laryngology of awake, office‐based injection procedures. This may indicate that these procedures have become more popular over time within the otolaryngology community and are being performed increasingly by providers more comfortable with the controlled operating room setting.
The Adenoid Microbiome in Recurrent Acute Otitis Media and Obstructive Sleep Apnea
Authors: Ojano‐Dirain Carolyn P. , Silva Rodrigo C. , Collins William O. , Antonelli Patrick J.
Published: September 2014

Objectives:

Compare the microbial flora of adenoids from patients with recurrent acute otitis media (AOM) and patients with obstructive sleep apnea (OSA).

Methods:

This study was prospective and controlled. Adenoids were obtained from children undergoing adenoidectomy for recurrent AOM or OSA. Specimens were processed for total deoxyribonucleic acid (DNA) isolation; 16s DNA 454‐pyrosequencing was performed on AOM (n = 5) or OSA (n = 5) specimens.

Results:

All adenoid specimens had evidence of microbes. Haemophilus influenzae was detected in almost all of the specimens. Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae were also among the most dominant species in all samples. Streptococcus salivarius, Prevotella sp, and Terrahaemophilus aromaticivorans were more common on adenoids from OSA patients (P <. 05). Bradyrhizobium sp. was more common on adenoids from patients with recurrent AOM (p < 0.05). The microbial profiles associated with recurrent AOM were different from, but overlapped with, OSA.

Conclusions:

Microbes are present on all adenoid specimens, however, the microbial profile differs between recurrent AOM and OSA. The clinical significance of these differences remains to be determined.
Antivirals for Idiopathic Sudden Sensorineural Hearing Loss
Authors: Awad Zaid , Huins Charlie , Pothier David D.
Published: September 2014

Objectives:

Determine the effectiveness and side effect profile of antivirals in the treatment of idiopathic sudden sensorineural hearing loss (ISSHL).

Methods:

We systematically searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), PubMed, EMBASE, CINAHL, and other databases to June 12, 2012. Reference lists of identified studies for further trials were also scanned. Selection criteria: Randomized controlled trials (RCTs) comparing different antivirals versus placebo (both with or without other treatment). Two authors independently extracted data. Meta‐analysis was considered inappropriate and ultimately not possible due to differing treatment protocols and differing inclusion criteria and outcome measures between studies.

Results:

Four RCTs (257 participants) were identified. Two trials compared the addition of intravenous acyclovir with a steroid (prednisolone). Neither demonstrated any hearing improvement with ISSHL. Another showed no benefit with the addition of valacyclovir to prednisolone on hearing outcome. Comparing intravenous acyclovir plus hydrocortisone with hydrocortisone alone, the final trial did not show any statistically significant difference between groups. Even though no meta‐analysis was possible, evidence from 4 RCTs has demonstrated no statistically significant advantage in the use of antivirals in the treatment of ISSHL.

Conclusions:

There is no evidence to support the use of antiviral drugs in the treatment of ISSHL. Further randomized controlled trials are needed for adequate meta‐analysis to be performed to reach definitive conclusions. A uniform definition of ISSHL should also be established, together with what constitutes adequate recovery.
Audiological Evaluation of the Contralateral Ear in Patients with Cholesteatoma
Authors: da Costa Sady S. , Rosito Leticia S. , Canali Inesangela , Netto Luciana , Jung Larissa P. , Pauletti Marcos G.T. , Ronchi Andre D.
Published: September 2014

Objectives:

Evaluate the contralateral ear (CLE) audiometric findings in patients with middle ear cholesteatoma. (2) Correlate the audiometric thresholds to videotoscopic findings.

Methods:

Cross‐sectional study. Videotoscopies and audiometries of 300 patients with cholesteatoma at a tertiary hospital were analyzed. The CLE videotoscopy, bone conduction, air conduction, and air‐bone gap pure tone average (PTA) were analyzed.

Results:

The mean patient age was 32.35 ± 19.26 years, and 52.2% were female. The CLE was abnormal in 60.8% of cases: 5.6% had perforation, 39.9% had moderate or severe retraction, and 15.6% had cholesteatoma. The CLE bone conduction PTA was 16.75 ± 16.1 dB, the air conduction PTA was 47.1 ± 22.8 dB, and the air‐bone gap PTA was 32.2 ± 18.7 dB. The CLE prevalence of severe and profound sensorineural hearing loss was 1.7%. Severe hearing impairment did not occur in patients with a normal CLE, whereas it did occur in 2.7% of patients with an abnormal CLE (P =. 02). Bone conduction PTA was similar between normal and abnormal CLE (P =. 82), but the air conduction and air‐bone gap PTA were higher in abnormal CLE (P <. 001 and P <. 001, respectively).

Conclusions:

In patients with cholesteatoma, the CLE had a high prevalence of abnormalities and hearing impairment. Severe and profound sensorineural hearing loss was only observed in abnormal CLE. The air bone gap and air conduction PTA were also higher in the abnormal CLE.
Body Mass Index and Imaging Abnormalities in Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone
Authors: Rivera Andrew M. , Jethanamest Daniel , Angeli Simon I.
Published: September 2014

Objectives:

Determine if (1) increased body mass index (BMI) is associated with spontaneous cerebrospinal fluid leak (SCSFL) of the temporal bone when compared with NSCSFL; (2) if body mass index (BMI) is a prognostic factor in the management of SCSFL; (3) if aberrant arachnoid granulations and empty sella are associated with SCSFL when compared to NSCSFL.

Methods:

Retrospective chart review of patients from 2002 to 2013 of all patients treated for CSFL.

Results:

Eighteen patients were treated for SCSFL and 17 for NSCSFL between 2002 and 2013. The mean BMI of the SCSFL group was 32.86 (median 33.53). The mean BMI of the NSCSFL group was 28.54 (median 29) (P =. 0683). The average BMI of patients requiring revision surgery was 37.88 compared to patients who only required a single intervention 30.35 (P =. 012). 100% of patients with SCSFL had ectopic arachnoid granulations identified on CT temporal bone while none of the patients with NSCSFL had these (P <. 001). 66% (8/12) of patients with SCSFL had empty sella on MRI compared to 16 % (2/12) of those with NSCSFL (P =. 04).

Conclusions:

Patients with SCSFL of the temporal bone have an elevated BMI when compared with NSCSFL. The presence of arachnoid granulations and empty sella on diagnostic imaging is associated with SCSFL when compared to NSCSFL. Patients with SCSFL requiring multiple interventions demonstrated a higher BMI than those treated successfully with a single intervention, indicating that this may be a poor prognostic factor.
Caloric Test and Video‐Head‐Impulse (v‐HIT): Usefulness as Screening Tool of Vestibular Pathology
Authors: Espitia Elizabeth A. , García Estefania Hernández , Parez‐Martan Nuria , Plaza Guillermo
Published: September 2014

Objectives:

Investigate the horizontal vestibulo‐ocular reflex (VOR) by means of vHIT in peripheral vestibular disorders.

Methods:

Prospective clinical trial at a university hospital. Using 2 vHIT equipments (Otometrics(R) and Ullmer(R)), and the caloric response as gold standard, we examined the VOR in a group of 73 patients, and a control group of 18 healthy subjects. The group of patients included BPPV (n = 26), vestibular neuritis (VN) (n = 12), Ménière's disease (MD) (n = 10), and idiopatic vestibulopathy (IV) (n = 25).

Results:

An abnormal VOR gain (less than 0.60) was found in 70.4% of all cases, whereas healthy subjects showed a normal gain in 94.44% of cases. An abnormal vHIT was found more commonly in VN (91.66%) and MD (80%), P <. 05. Isolated covert saccades and/or isolated overt saccades were present in all cases showing poor VOR gain. Caloric responses were paretic in 75% of cases showing poor VOR gain in vHIT, showing good correlation.

Conclusions:

The vHIT detects abnormal VOR changes in the combination of gain assessment and refixation saccades. vHIT might be a good screening tool to assess vestibular disorders, avoiding caloric stimulation in certain patients.
Central Auditory Gain Secondary to Hearing Deprivation and Its Role in Hyperacusis
Authors: Chiossone‐Kerdel Juan A. , Graterón Eleazar E. , Goncalves Stefania , Ceballos Sinay A. , Gonzalez‐Abascal Daniel , Baguley David
Published: September 2014

Objectives:

Determine the characteristics of the auditory central gain due to bilateral hearing deprivation, and its relationship with circadian variations as a function of cortical activity.

Methods:

The study was designed as a prospective observational research, in a national referral center. A total of 28 volunteers ranging between 18 and 30 years old underwent bilateral earplugging with Merocel, previous medical examination, anthropometry, author developed questionnaire, Hamilton anxiety and depression inventory, speech and pure tone audiometry, tympanometry and middle ear reflex (MER), distortion products otoacoustics emissions input/output(DPOAE‐I/O), and uncomfortable loudness levels (ULLs) in 0.5‐4 kHz. Subjects were randomly divided in 2 groups: Group A, starting at 8:00 am and finishing at 8:00 pm; Group B, starting at 4:00 pm ending at 4:00 am. Serum cortisol levels and audiological test were obtained at the beginning and at the end of the session. A 24‐hour free urinary cortisol levels were measured.

Results:

We observed an air conduction drop in right ears (AD) at 1 kHz (P =. 036) and 0.125, 4 y 8 kHz frequencies in left ears(AS) (P =. 013,. 003,. 003), respectively. The ULLs in Group A showed a decline in AD/AS thresholds in all frequencies. Contralateral AD MER thresholds presented a decline on 0.5 to 1 kHz. AS DPOAE‐I/O fell by 25 and 45 dB (P =. 046,. 461) in group B, and 25 dB in Group A (P =. 047). In group B, serum cortisol levels increased by 19.28 ± 4.37 µg/µL (P =. 018).

Conclusions:

We report an association between the increase of serum cortisol and auditory gain and an indirect relationship with normal cortical activity. Thus, bilateral hearing deprivation can potentially be used as a convenient model for the study of hyperacusis.
Chiari Type I Malformations in Patients with Dizziness
Authors: Mostovych Nadia K. , Willcox Thomas O. , Artz Gregory J.
Published: September 2014

Objectives:

(1) Investigate the association between magnetic resonance imaging (MRI) findings of Chiari Type I malformation and symptoms of dizziness in patients presenting to a neurotology clinic. (2) Recommend indications for intervention for Chiari Type I malformation in patients presenting with dizziness.

Methods:

A retrospective chart review was conducted for 16 patients presenting to our neurotology clinic between 2002 and 2009 found to have Chiari Type I malformation on MRI. All patients presented with symptoms of disequilibrium and/or vertigo. Charts were reviewed for demographics, symptoms, surgical procedures, videonystagmography, and degree of malformation based radiographic measurements.

Results:

The prevalence of Chiari Type I malformation in patients presenting to the neurotology clinic with dizziness is 16 out of 6427 (0.2%). During this time period, 16 patients were found to have radiographically confirmed Chiari Type I malformations. The mean herniation was 6.3 mm with a range of 5 to 13mm. Videonystagmography testing was done on 12 out of 16 patients and 7 out of 12 were abnormal with a mean RVR of 38%. Two of 16 patients (12.5%) underwent posterior fossa decompression. Surgical patients tended to have more severe symptoms.

Conclusions:

A small subset of patients who present to neurotology clinics with vertigo and/or disequilibrium will have radiographic findings of Chiari Type I malformation without the traditional symptoms of headaches and neurologic disturbances. The dilemma for clinicians is to determine if the radiographic findings are contributing to the patients symptoms or are an incidental finding. Intervention should only be considered if the herniation is greater than 10 mm, a cervical syrinx is present, or patients have the classic Chiari‐type symptoms.
Correlation between DWI‐MRI and Findings at Cholesteatoma Surgery: Should DWI‐MRI Be Standardized Prior to Surgery?
Authors: Deleito Javier M. , Ray Jaydip , Twigg Victoria , Wu Kenneth
Published: September 2014

Objectives:

Evaluate the accuracy of diffusion‐weighted imaging magnetic resonance imaging (DWI‐MRI) in diagnosis of cholesteatoma and the planning of surgery in our hospital.

Methods:

We conducted a retrospective study of all patients who had cholesteatoma surgery in our hospital from November 2007 until September 2013 that had undergone a DWI‐MRI previous to the surgery.

Results:

A total of 24 patients were found. A total of 22 DWI‐MRI findings were correctly correlated to findings in operation. There was 1 false positive where cholesteatoma was identified on imaging and mucosal disease was found in surgery; and 1 false negative that failed to identify a small cholesteatoma found during surgery. Of the 22 accurate correlations, 4 were of mucosal disease and the rest were correctly diagnosed as cholesteatomas. The DWI‐MRI was able to localize the location of the cholesteatoma (from middle ear, attic, mastoid, aditus, hypotympanium and Eustachian tube) in 78% of the cases (14/18).

Conclusions:

DWI MRI is highly sensitive in the identification of the presence of cholesteatoma. Negative findings should be followed up because imaging sequences can miss cholesteatomas smaller than 3 mm. There is still a learning curve in the diagnosis and use of DWI MRI.
Development and Characterization of Chemical Cochleostomy in the Guinea Pig
Authors: Alyono Jennifer C. , Corrales Eduardo , Blevins Nikolas H. , Ricci Anthony
Published: September 2014

Objectives:

Creation of an atraumatic, hearing‐preservation cochleostomy is integral to the future of minimally invasive inner ear surgery. Current techniques generally take 1 of 2 approaches: mechanical or thermal. The goal of this study was to develop and characterize a novel chemical approach to cochleostomy.

Methods:

Experimental animal study in which phosphoric acid gel (PAG) was used to decalcify the otic capsule in 25 Hartley guinea pigs. Five animals in each of 5 groups were studied: (1) mechanically opening the auditory bulla alone, (2) PAG thinning of the basal turn otic capsule, leaving endosteum covered by a layer of bone, (3) micro‐pick manual cochleostomy, (4) PAG chemical cochleostomy, exposing the endosteum, and (5) combined PAG/micro‐pick cochleostomy, with initial chemical thinning and subsequent manual removal of the last osseous layer. Preoperative and postoperative auditory brainstem responses and otoacoustic emissions were obtained at 2, 6, 10, and 16 kHz. Hematoxylin and eosin stained paraffin sections were compared.

Results:

Surgical and histologic findings confirmed that application of PAG provided reproducible local bone removal, and cochlear access was enabled. Statistically significant auditory threshold shifts were observed at 10 and 16 kHz following cochleostomy using PAG alone (group 4), and at 16 kHz using manual cochleostomy (group 3) (P <. 05). No statistically significant postoperative auditory threshold shifts were observed in the other groups, including PAG thinning with manual completion cochleostomy (group 5).

Conclusions:

Hearing preservation cochleostomy can be performed in an animal model using a novel technique of thinning cochlear bone with PAG and manually completing cochleostomy.
Efficacy of L‐N‐Acetyl Cysteine in the Prevention of Gentamicin Vestibulotoxicity in Rats
Authors: Chokkalingam Venkatakarthikeyan , Bas Esperanza , Goncalves Stefania , Adams Michelle , Rajguru Suhrud , Van De Water Thomas R. , Angeli Simon I.
Published: September 2014

Objectives:

Determine the effect of L‐N‐acetylcysteine (LNAC) on gentamicin (GM) initiated vestibulotoxicity.

Methods:

Wistar rats were divided into 4 groups: Group A (n = 7) had intratympanic (IT) GM (20 mg in 40 µL); group B (n = 6) had IT GM and intraperitoneal (IP) LNAC (350 mg/kg) at 24 hours and 1 hour before GM administration; group C (n = 6) had IT GM and IT LNAC (5 mg in 40 µL); and group D (n = 6) had only IT saline (40 µL). Rats were tested by ABR and cervical vestibular evoked myogenic potentials (VEMP) pretreatment, and at 1 week and 1 month posttreatment. Morphological analysis of the inner ears was performed at 1 month. Main outcome measures were the mean change in VEMP P1 latency at sound stimulation from 80 to 110 dB SPL, and hair cell count in the saccule.

Results:

Rats treated with IT LNAC exhibited the least change in mean VEMP latencies, although the intergroup differences were not statistically significant except for 80 dB stimulation at 1 week posttreatment. IP and IT LNAC resulted in preservation of the VEMP response in all rats, whereas 42% of rats not receiving LNAC had absent responses. Morphological analysis of the saccule revealed lower mean hair cell counts in rats not receiving LNAC.

Conclusions:

Systemic and IT administration of LNAC of rats treated with GM resulted in minimal variations in VEMP latencies and greater preservation of vestibular hair cells. The protective effect of LNAC in GM‐initiated vestibulotoxicity is promising and warrants further research.
Endoscopic Cochlear Implant: A Series of Cases
Authors: Leite Janaina , Lobo Raquel , Cabral Ticiana , Nogueira João F.
Published: September 2014

Objectives:

Cochlear implant is traditionally performed using a mastoidectomy, posterior tympanotomy and cochleostomy using a surgical microscope. Because of the anatomical and physiological understanding of the mastoid cells and their role in maintaining ventilation and pressure equalization in the middle ear, and the possible risk of facial nerve injury, some techniques without mastoidectomy and without posterior tympanotomy have been introduced as an alternative approach, showing excellent results. The aim of the study was to describe totally endoscopic technique without mastoidectomy in 6 patients with bilateral profound hearing loss who underwent cochlear implantation from January 2012 to February 2013, showing its viability and the advantages and disadvantages.

Methods:

All cases were selected based on computed tomography, magnetic resonance, audiological tests and psychological evaluation. Surgical steps, intra‐ and postoperative complications were analyzed. Each procedure duration was recorded. Surgical procedure was described step by step focusing on the anatomy of the round window (RW) niche.

Results:

The mean duration of the procedure was 62 minutes. No facial nerve injury was observed. All cases showed a normal RW conformation and endoscopic cochleostomy was conducted. No difficult insertion of the IC electrode was observed. The longest follow‐up is 2 years. No postoperative complications were observed in this series.

Conclusions:

Totally endoscopic cochlear implantation is safe and allows a direct approach to the RW and cochlea. A larger series is paramount to evaluate its total benefits and may represent a breakthrough in the ongoing process of developing scientific knowledge.
Endoscopic Stapes Surgery: A Prospective, Controlled Study
Authors: Gallo Andrea , Martellucci Salvatore , Gallipoli Camilla , De Vincentiis Marco , Greco Antonio , Rosato Chiara , Pagliuca Giulio
Published: September 2014

Objectives:

(1) Describe basic and essential surgical steps of the endoscopic‐assisted approach to stapedotomy. (2) Analyze advantages and disadvantages of the endoscopic technique. (3) Compare the outcomes of the endoscopic‐assisted stapedotomy with those obtained with the traditional microscopic approach.

Methods:

The study was conducted from September 2011 to September 2013 at the ENT University Unit of the “A. Fiorini” Hospital, Sapienza University of Rome. Thirty patients (average age 47.5 years, 11 males, 19 females, 30 ears) with clinical otosclerosis undergoing stapedotomy under general anesthesia were enrolled in this prospective, controlled trial. Patients were randomly divided into 2 groups. Group A patients underwent stapedotomy under endoscopic viewing, whereas in Group B the same procedure was traditionally performed using a surgical microscope. The endoscopic set, originally used for endoscopic sinus surgery, included a 3 mm 0° endoscope, a 3CCD camera, and a video monitor. All procedures were performed by the same surgeon and the surgical steps were recorded. Videos were analyzed to compare the details of the anatomical structures in the operative field. Surgical times, functional results, and complications were recorded.

Results:

Functional results were comparable in both groups (air‐bone gap ≤20 dB). No complications occurred. Surgical times were significantly longer in Group A (P <. 05).

Conclusions:

Endoscopic stapedotomy is a feasible, viable alternative to traditional stapes surgery performed with the microscopic approach. The use of endoscopes improve the visualization of the operative field and allow a detailed view of the anatomical structures in an educational perspective.
Growth Factor Delivered by a Bioabsorbable Polymer as Treatment for Chronic Tympanic Membrane Perforations
Authors: Santa Maria Peter L. , Kim Sungwoo , Varsak Kursad , Yang Yunhzi P.
Published: September 2014

Objectives:

(1) Test the efficacy of a novel topical growth factor (GF) treatment, delivered by a bioabsorbable polymer, in animal models of chronic tympanic membrane (TM) perforation, Eustachian tube (ET) obstruction, and chronic suppurative otitis media (CSOM). (2) Describe the preclinical work forming the basis for a proposed clinical trial of topical GF treatment.

Methods:

Bilateral chronic TM perforations were created in our novel mouse model (n = 50) and stable at 3 months, using an inhibitor of epidermal growth factor receptor. One ear received topical GF polymer treatment and the other received polymer only. Another mice cohort (n = 42) had chronic perforations created and also surgical obstruction of the ET. A further mice cohort (n = 35) had CSOM created through the above procedure and inoculation of pseudomonas aeruginosa. These perforations and treatments were evaluated microscopically, histologically, and using cytokeratin immunohistochemistry. Toxicity and safety of our polymer and GF were evaluated using auditory brain stem responses (ABR) and otoacoustic emissions (OAE) at 8 weeks following treatment.

Results:

In the chronic TM perforation cohort, 92% (22 of 24) healed compared with 38% (10 of 26) of controls (polymer only) at 4 weeks (P <. 01). In the chronic perforation cohort with ET obstruction, 94% (18 of 19) healed compared with 9% (2 of 23) of controls (polymer only) at 6 weeks (P <. 01). The ABR and OAE of our cohorts returned to control levels at 8 weeks.

Conclusions:

We demonstrate the efficacy, safety, and nontoxicity of a novel GF treatment in animal models.
Hydrophilic Hydroxyapatite Cement Cranioplasty: Preventing Cerebrospinal Fluid Leaks and Wound Complications in Translabyrinthine Acoustic Neuroma Surgery
Authors: Jackson Neal , Spear Samuel A. , Mehta Rahul , Ying Yu‐Lan Mary , Scrantz Kelly , Culicchia Frank , Arriaga Moises A.
Published: September 2014

Objectives:

(1) Examine the efficacy of quick‐setting, hydrophilic formulation of hydroxyapatite cement (HAC) used in cranioplasty for the prevention of cerebrospinal fluid (CSF) leaks and long‐term wound complications following translabyrinthine acoustic neuroma (TLAN) surgery. (2) Review evolution of HAC cranioplasty.

Methods:

Retrospective case review from 2006 to 2013 in atertiary referral center. Consecutive patients undergoing translabyrinthine approach for acoustic neuroma tumors were operated on by the senior author. Intervention: Therapeutic: Cranioplasty combining a medial abdominal fat graft with hydrophilic hydroxyapatite cement filling the mastoid. Main outcome measures: Incidence of cerebrospinal fluid (CSF) leaks and any wound complications.

Results:

Forty‐four patients met inclusion criteria. There were no CSF leaks or other wound complications in this series.

Conclusions:

Hydrophilic HAC appears to be safe and efficacious for cranioplasty following translabyrinthine acoustic neuroma surgery.
Incidence of Cisplatin Ototoxicity in Head and Neck Cancer Patients
Authors: Greene Joshua B. , Standring Robert T. , Hall Francis T. , Siddiqui Farzan , Ahsan Syed F.
Published: September 2014

Objectives:

Elucidate the incidence of cisplatin‐induced ototoxicity in patients treated for head and neck cancer.

Methods:

This was an institutional review board approved retrospective study of patients treated with cisplatin for cancer at a tertiary referral hospital. The charts of patients of any age that had undergone cisplatin therapy from 1995 to the present were reviewed. We then narrowed this group down to those who had a diagnosis of cancer of the head and neck (hypopharyngeal, laryngeal, nasopharyngeal, oropharyngeal, scalp/face skin cancer, temporal, thyroid) and had pre‐ and posttreatment audiologic testing.

Results:

There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014. Of those, 203 patients had pre‐ and posttreament audiologic testing. Twenty patients had diagnosis of cancer involving the head and neck. The cochlear radiation doses were also collected from these patients. Preliminary results demonstrate that patients with head and neck cancer that were treated with cisplatin and had a sizable cochlear radiation dose had significantly more permanent hearing loss following treatment.

Conclusions:

The incidence of cisplatin induced ototoxicity was significantly more prevalent in head and neck cancer patients. These patients should be thoroughly screened and protective precautions should be taken to limit ototoxicity in this population.
Injuries and Mechanisms Causing HSV1 Reactivation in Peripheral Neurons
Authors: Roehm Pamela C.
Published: September 2014

Objectives:

Herpes simplex type 1 (HSV1) reactivation in sensory neurons may underlie a number of idiopathic head and neck syndromes, including Bell's palsy and delayed facial palsy following traumatic injury. In this study we first measured whether modeled surgical nerve injury (hypoxia and heat) reactivated HSV1 in neurons harvested from different ganglia (geniculate, vestibular, trigeminal, and sympathetic). We also measured the phosphorylation status of mTOR pathway proteins in conditions that either did or did not cause HSV1 reactivation.

Methods:

Basic/translation science study of cultured neurons latently infected with HSV1. Primary neuronal cultures were either kept under hypoxic conditions or heated to 43°C for 2 hours to simulate intraoperative neuronal injury. Outcome measures included HSV1 reactivation measured by expression of green fluorescent protein under HSV1 promoter and HSV1 viral titers. Other outcome measures included measurement of phosphorylation of mTOR1, S6, and S6kinase by western blot and immunofluorescent microscopy.

Results:

All latently infected neurons demonstrated HSV1 reactivation following hypoxia. Trigeminal, vestibular, and geniculate neurons demonstrated brisk HSV1 reactivation after heat treatment, but sympathetic neurons did not. All conditions leading to HSV1 reactivation significantly affected phosphorylation status of mTOR pathway proteins.

Conclusions:

Conditions which reactivate latent HSV1 lead to changes in phosphorylation of mTOR pathway proteins. Conditions that do not lead to HSV1 reactivation do not affect the mTOR pathway.
Long‐term Dizziness Handicap in Patients with Vestibular Schwannoma: A Multicenter Cross‐Sectional Study
Authors: Carlson Matthew L. , Tveiten Øystein V. , Driscoll Colin , Neff Brian A. , Tombers Nicole M. , Lund‐Johansen Morten , Link Michael
Published: September 2014

Objectives:

Previous studies have demonstrated that ongoing dizziness is a powerful predictor of reduced quality of life for patients with vestibular schwannoma (VS). The purpose of the current study is: (1) to characterize long‐term dizziness following observation, microsurgery, and stereotactic radiosurgery (SRS) for small to medium sized VS using a validated self‐assessment inventory and (2) to identify clinical variables associated with long‐term dizziness handicap.

Methods:

All patients with sporadic <3 cm VS who underwent primary microsurgery, SRS, or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the Dizziness Handicap Inventory (DHI) and a VS symptom questionnaire.

Results:

A total of 642 respondents (mean age 56.2 years, 56.9% female) were analyzed and the average time interval between treatment and survey was 7.7 years. Female sex, older age, preexisting diagnosis of migraine, and symptoms of severe dizziness predating treatment were highly statistically significantly associated with a worse DHI score (P <. 001) while type of dizziness (vertiginous vs non vertiginous), tumor size, and treatment strategy were not (P >. 05). The 2 variables that were associated with the greatest deterioration in DHI scores were pre‐existing migraine (24.5 vs 15.9 points) and history of severe dizziness prior to treatment (31.1 vs 14.0 points).

Conclusions:

These data suggest that migraine may play a major role in long‐term dizziness in patients with VS. Factors including history of dizziness predating treatment and preexisting diagnosis of migraine most significantly influence dizziness handicap among subjects with VS, while management strategy is not associated with long‐term DHI outcome.