bluuebunny/crossref_metadata_2025 huggingface dataset:
Single‐Stage Tympanosotomy Tube Insertion: Design Issues on a New Surgical Approach
Authors: Rimell Frank , Meyer Abby C. , Tibesar Robert J. , Sidman James D. , Levine Samuel C. , Lander Timothy , Yoon Daniel W.
Published: September 2014

Objectives:

Multiple efforts are under way to develop methodologies to allow tympanostomy tube (TT) placement in young children under conscious sedation where there can be significant head motion. This practice modification would provide an option for TT placement without the risk of general anesthesia and the potential for procedures being performed in an office.

Methods:

Investigators evaluated a tool designed to perform a quick, single pass tube delivery across the tympanic membrane with a downward force of motion in a moving child under conscious sedation. Training required bench evaluation and the use of general anesthesia before performing conscious sedation cases.

Results:

A total of 176 TTs were performed in 89 children at 3 institutions. Ninety‐one TTs in 46 children used general anesthesia, and 85 TTs in 43 children used conscious sedation. Conscious sedation included nitrous oxide in 35 children and midazolam plus nitrous oxide in 8 patients. All cases used phenol as a topical anesthetic. Twelve children were converted to general anesthesia for over‐insertions, design challenges, anatomy, or movement. The major complication encountered was delivery of the TT into the middle ear space. Multiple tubes were used, but a beveled medial flange tube with a lateral visualization tab to provide depth feedback proved most effective for attenuating patient movement without TT over‐insertion (64 children).

Conclusions:

Early results show that TT placement in children may be done safely under conscious sedation. Additional clinical experience is required to optimize the tool and the training to prevent complications of TT placement with a single‐pass device.
A Tangible Head Model for Physical Treatment of Benign Paroxysmal Positional Vertigo
Authors: Fujisaka Michiro , Shojaku Hideo
Published: September 2014

Objectives:

In this study, we developed a tangible head model for the physical treatment of benign paroxysmal positional vertigo (BPPV) and assessed the educational efficacy of this model for people. This model has a 10‐time‐scale mockup of the semicircular canal, which contains 10 canalith particles, located in a 1.5‐time‐scale mockup of the head.

Methods:

This was a prospective study involving 20 medical students just starting to study otolaryngology. At first, they learned the canalith repositioning procedure (CRP) from an article. After reading the article, they tried to move 10 canalith particles from the ampulla to the utricle using the model, during which they were not able to see inside. Second, they practiced the CRP using the model, and they could see the inside. Third, they tried to move 10 canalith particles from the ampulla to the utricle using the model, during which they could not see the inside. Compare the number of canalith particles, which students can move from the ampulla to the utricle, before and after practice using the model.

Results:

Before practice using the model, they could move 2.5 (mean value) canalith particles, after practice, they could move 6.6 (mean value) canalith particles. There was a statistical difference (P <. 01) between trials before and after practice using the model.

Conclusions:

It was suggested that a tangible head model for the physical treatment for BPPV is a useful educational tool for people such as resident doctors, medical students, and patients with BPPV.
Temporal Bone Osteoradionecrosis after External Beam Radiation Therapy for Head and Neck Cancer
Authors: Antonelli Patrick J. , Mendenhall William M. , Morris Christopher G. , Bhandare Niranjan
Published: September 2014

Objectives:

Radiation therapy (RT) for head and neck cancer (HNC) may be associated with osteoradionecrosis of the temporal bone (ORN‐TB). The goal of this study is to examine the incidence of ORN‐TB in HNC patients receiving RT ± chemotherapy (chemo) and its association with patient‐ and treatment‐related factors.

Methods:

Pre‐ and post‐RT records of 376 HNC patients were retrospectively assessed for the presence of possible ORN‐TB. Dose received by tympanic ring was estimated using the computed tomography‐based treatment plan for the patient. Uni‐ and multivariate analyses evaluated the association between various variables and incidence of ORN‐TB.

Results:

ORN‐TB was diagnosed in 27 (7.2%) patients over a median time of 9.5 years (range, 1‐17 years). Of these, localized ORN‐TB was observed in 18 (66.6%) patients, diffuse ORN‐TB in 9 (33.3%) patients. Dose received by temporal bone ranged from 35 to 80 Gy. RT dose was significantly associated with ORN‐TB (P =. 015) and adjuvant chemo (P =. 045), but age (>60), gender, and fractionation were not.

Conclusion:

RT dose appears to be the primary determinant of ORN‐TB in HNC patients. Further prospective investigation is needed to better understand the factors that might contribute to and protect from ORN‐TB.
Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome
Authors: Neto Natal J. B. , Bittencourt Aline G. , Monsanto Rafael C. , Beilke Sílvia C. A. S. B. , Salomone Raquel , Lorenzetti Fabio T. M.
Published: September 2014

Objectives:

Review the prognosis of facial palsy on Ramsay Hunt syndrome after the treatments proposed by different authors, based on a review of the literature.

Methods:

A search was performed in LILACS, SciELO, and PUBMED databases. The key words used on the search were: prognosis OR evolution AND ramsay‐hunt OR herpes zoster oticus AND facial palsy OR facial paralysis.

Results:

Studies showed 882 patients with facial palsy secondary to Ramsay Hunt syndrome. Six hundred and twenty one (70.4%) of those patients achieved improvement on the House‐Brackmann grade, achieving a grade score of I or II. Among the patients treated only with steroids, 68% got the same results, versus 70.5% of the patients treated with steroids plus antiviral agents. Of patients classified on the House‐Brackmann grade as V or VI before treatment, 51.4% improved facial nerve function, achieving I or II on the HB scale. The treatment with methylprednisolone associated with acyclovir showed better results when compared with acyclovir associated with prednisone, prednisolone or hydrocortisone (81.3% versus 69.2%, 61.4% and 76.3%, respectively).

Conclusions:

Patients with Ramsay Hunt syndrome may achieve a good rate of facial recovery. The steroid associated with better results was methylprednisolone, and the association of steroids and acyclovir achieved better results than the patients who did not receive the antiviral agent.
Underwater Endoscopic Management of Labyrinthine Fistula in Congenital Cholesteatoma
Authors: Yamauchi Daisuke , Oshima Takeshi , Nomura Kazuhiro , Miyazaki Hiromitsu , Hidaka Hiroshi , Kawase Tetsuaki , Katori Yukio
Published: September 2014

Objectives:

We propose a novel technique to remove the matrix of cholesteatoma endoscopically after completely filling the mastoid cavity with saline water by perfusion for the appropriate management of labyrinthine fistulas. This “underwater” endoscopic ear surgery (UWEES) technique provides a clear operative field without requiring suction and protects the inner ear from unexpected aeration that may damage its function.

Methods:

A 3‐year‐old boy was diagnosed with congenital cholesteatoma in a group medical examination. Once the surgery was scheduled but suspended due to the Great East Japan Earthquake. At the age of 6 years, computed tomography revealed a fistula of the superior semicircular canal and surgery was performed for removal of the cholesteatoma and closure of the fistula. Retroauricular incision was chosen because of the extensive lesion, using an intact canal skin method with soft wall reconstruction. The cholesteatoma was extirpated except for the island lesion of the matrix over the fistula under the operating microscope. Subsequently, saline solution was infused into the mastoid cavity using Endo‐Scrub (Medtronic). The island residual matrix was exfoliated underwater endoscopically and closed with bone paste and covered with the fascia.

Results:

No particular complication occurred during the surgical procedure or postoperatively.

Conclusions:

Saline water perfusion cleared the surgical field and prevented refraction effects in the high‐definition endoscope, resulting in a clear surgical field and prevention of deterioration of cochlear function. UWEES is expected to prevent risk to inner ear function in other interventions such as cochlear implantation, stapes surgery, and temporal bone destruction corrective surgery.
Usefulness of 3D‐FLAIR MRI to Detect Inner Ear Abnormalities in Patients with Sudden SNHL
Authors: Tanigawa Tohru , Tanaka Hirokazu , Katahira Nobuyuki , Horibe Yuichiro , Ueda Hiromi
Published: September 2014

Objectives:

Three‐dimensional fluid‐attenuated inversion recovery magnetic resonance imaging (3D‐FLAIR MRI) has been used to detect alterations in the composition of the inner ear fluid. We aimed to investigate an association between the hearing level and the signal intensity of pre‐ and postcontrast 3D‐FLAIR MRI in patients with sudden‐onset sensorineural hearing loss (SNHL).

Methods:

3D‐FLAIR MRI was performed in 18 patients with sudden‐onset SNHL: 12 patients with mild‐to‐moderate SNHL (baseline hearing levels, ≤ 60 dB) and 6 patients with severe‐to‐profound SNHL (baseline hearing levels >60 dB).

Results:

High‐intensity signals in the inner ear were observed in 2 of 6 patients (33%) with severe‐to‐profound SNHL but not in those with mild‐to‐moderate SNHL (P <. 05). Signals were observed on MRI scans 6 or 18 days after SNHL onset.

Conclusions:

Our results indicate that 3D‐FLAIR MRI is not a useful tool for detecting inner ear abnormalities in patients with mild SNHL.
Trends in Pursuit of Otolaryngology Subspecialty Fellowship
Authors: Wilson Meghan N. , Kelley Kanwar S. , Carter John M. , Raol Nikhila P.
Published: September 2014

Objectives:

(1) Examine resident interest in otolaryngology subspecialty fellowship and factors affecting that interest over time and throughout residency. (2) Examine changes in fellowship availability and match rate over time.

Methods:

Data regarding fellowship interest, influencing factors, and demographics were extracted from the 2008‐2013 Section for Residents and Fellows‐in‐Training annual survey and examined in uni‐ and multivariate analyses. Historic fellowship match data available through match resources for pediatric otolaryngology, laryngology/broncho‐esophagology surgery, rhinology, and neurotology were collected.

Results:

Over 6 years, a total of 1958 residents and fellows responded to the survey. A statistically significant decrease in fellowship interest was seen between junior (PGY‐1 or PGY‐2/3) and senior residents (PGY‐4/5), with 79.9%, 73.3%, and 61.6% of PGY‐1, PGY‐2/3, and PGY‐4/5 residents, respectively, planning to pursue subspecialty training (P <. 001). Of the portion planning fellowship training, choice of the subspecialty did not change throughout residency. No difference was found in the percentage of residents interested in fellowship from 2008 to 2013. The most important factors in choosing a subspecialty were consistently type of surgical cases and nature of clinical problems. The number of fellowship positions in facial plastic surgery, pediatric otolaryngology, and rhinology have increased over the past decade.

Conclusions:

Interest in fellowship continues to be high, but desire to pursue fellowship training decreases with increased residency training. This decision is multivariate in nature. While most subspecialties have grown slowly over time, the match rate continues to be variable due to fluctuations in application numbers.
Visualization of Maculae and Membranous Semicircular Ducts in the Otic Capsule by Optical Coherence Tomography
Authors: Sakamoto Tatsunori , Tona Yosuke , Nakagawa Takayuki , Ito Juichi
Published: September 2014

Objectives:

(1) Show the possibility of using optical coherence tomography (OCT) to visualize the internal structure of the vestibule and semicircular canals with the bony capsule intact. (2) Study the effect of the decalcification. OCT is a nondestructive imaging modality that uses infrared light as it penetrates turbid biological tissue. Previously, OCT has been successfully used to visualize inside the cochlea in normal and abnormal inner ears.

Methods:

The OCT system, OCS‐1300SS (Thorlabs, Inc, NJ) with a central wavelength of 1300 nm and a theoretical axial resolution of 9 µm, was employed for image acquisition. Normal and Slc26a4 mutant mice were used as experimental animals. Inner ears were isolated and fixed with 4% paraformaldehyde. Samples were scanned before and after decalcification with 10% ethylenediaminetetraacetic acid for 7 days.

Results:

The saccular and utricular maculae and membranous semicircular ducts were delineated with OCT before and after decalcification. Image quality and imaging depth was better after the decalcification. Signals from the otolith were well observed before decalcification. Normal and pathologically dilated endolymphatic ducts in the bony canal in the knock‐out mice were also visualized.

Conclusions:

OCT have the potential to visualize maculae, membranous semicircular ducts, and the endolymphatic duct through the bony capsule. It may also provide new strategy to evaluate the pathology of otolith.
Vitamin C Deficiency Impairs Mineralization of Ossicle in Mice
Authors: Hu Jinwei , Guthrie O'Neil , Dong Wei , Xing Weirong , Xu Helen , Mohan Subburaman , Jung Timothy T. K.
Published: September 2014

Objectives:

Vitamin C‐deficient (VCD) mice develop spontaneous bone fractures and exhibit hearing loss. However, the effects on the micro‐architecture of the ossicles and the underlying mechanisms have not been fully understood. In this study, we test the hypothesis that vitamin deficiency impairs osteoblast differentiation and function of the ossicles.

Methods:

The morphologic characteristics of the ossicles in VCD and wild‐type mice were evaluated with a stereoscopic microscope. Micro‐structure of the ossicles was analyzed by micro computed tomography (µCT). Osteoblast differentiation was determined by immunostaining of the bone marker gene, osteocalcin. Sound transmission along the ossicular chain was evaluated with laser Doppler vibrometer.

Results:

The ossicles in VCD mice demonstrated thinner bone in the manubrium of malleus and stapes footplate. µCT analyses further verified that the bone volume/total volume fraction (BV/TV) was significantly reduced in the stapes footplate (51.5 ± 3.9% vs 61.2 ± 1.5%; P <. 05) and the manubrium of malleus (24.9 ± 5.3% vs 39.0 ± 5.0%; P <. 05) in VCD mice. The expression of osteocalcin was significantly decreased in the ossicles of VCD mice (17.8 ± 3.3 vs 32.4 ± 4.7; P <. 05). However, the preliminary data revealed a modest change in sound transmission along the ossicular chain.

Conclusions:

These findings suggest that VCD decreased expression of osteoblast differentiation marker, osteocalcin, and reduced bone volume and of the ossicles without significantly altering sound transmission. These results may indicate that the pathogenesis of VCD‐induced hearing loss might be due to a deficiency at the inner ear or auditory neuron level. Further studies are warranted.
Worse Preoperative Hearing Thresholds and Younger Patients in Tomographic Retrofenestral Otosclerosis
Authors: Palma Camilo , Caro Carlos Stott , Delano Paul H. , Ojeda Alejandro , Gonzalez Gonzalo Miranda
Published: September 2014

Objectives:

Usually, the diagnosis of otosclerosis is based on clinical and audiometric findings, and its confirmation requires surgical exploration of the middle ear. More recently, it has been suggested that high‐resolution computed tomography of the temporal bone (TTB) could diagnose and classify otosclerosis into fenestra otosclerosis (FO) and retrofenestral or cochlear otosclerosis (RFO). However, there are relatively few studies that relate these tomographic features with clinical and surgical findings. The aims of the study were to: (1) classify otosclerosis patients with preoperative TTB into fenestra or retrofenestral otosclerosis, and (2) compare these image findings with pre‐ and postoperative auditory thresholds and epidemiological findings.

Methods:

Retrospective study by reviewing medical records of otosclerosis patients (2006‐2011) undergoing estapedostomy in the Clinical Hospital of the University of Chile (tertiary institution), who were evaluated with preoperative TTB and had full audiometric data. Descriptive statistics and t test or analysis of variance with Tukey post hoc test were used as necessary, considering a P value <.05 as significant.

Results:

A total of 74 estapedostomies from 56 patients were evaluated. The TTB study had 87% sensitivity for the surgical diagnosis of fenestral otosclerosis. Age and hearing thresholds were significantly lower in patients with tomographic RFO compared to FO otosclerosis (t test, P <. 05).

Conclusions:

The TTB is a useful imaging method to classify otosclerosis patients into RFO and FO varieties. In addition, the RFO corresponds to a more aggressive variety of otosclerosis (younger patients and lower auditory thresholds), and thus this method may be used as a prognostic tool.
The Effect of Sinus Balloon Catheter Dilation on the Management of Child Chronic Rhinosinusitis
Authors: Tan Guolin
Published: September 2014

Objectives:

Observe the effect and safety of sinus balloon catheter dilation (SBCD) on the management of chronic rhinosinusitis in children.

Methods:

Twenty‐seven children (8‐14 years old) with chronic rhinosinusitis were randomized into 2 groups: 13 cases were carried out SBCD, and 14 cases treated with medication. The effect was assessed by disease‐specific questionnaire (20‐items sino‐nasal outcome test, SNOT‐20) and visual analog score (VAS).

Results:

At 3‐ and 6‐month follow‐up, the scores of SNOT‐20 and VAS were significantly decreased compared with baseline in both SBCD group and controls (P <. 05), and significantly lower in SBCD group than in the control group (P <. 05). The overall effect demonstrated that the rate of much‐improved and improved was 92.3% in SBCD group, and significantly higher than control group.

Conclusions:

SBCD is an effective and minimally invasive method for child chronic rhinosiunusitis
Evading Detection and Antibiotics: Internalization Rates of Different Strains of Group A Streptococcus
Authors: Jiang Zi Yang , Nair Vidhya , Wasserzug Oshri , Mitchell Ron B. , Shiloh Michael
Published: September 2014

Objectives:

(1) Determine the internalization rates of different strains of Group A Streptococcus (GAS). (2) Determine whether statistically different internalization rates occur in patients who receive a tonsillectomy for sleep‐disordered breathing/sleep apnea versus chronic/recurrent tonsillitis. (3) Facilitate the development of GAS vaccine

Methods:

In vitro microbiology/tissue culture study at an academic tertiary referral center. All tonsillectomy specimens (performed for sleep disordered breathing spectrum and recurrent/chronic tonsillitis spectrum) were collected at the authors’ institution from September 2013 to November 2013. Each specimen was swabbed and bacteria cultured and emm typed. Only specimens with GAS were included in the study. The strains were grown in brain heart infusion (BHI) media to an optic density at 600 nm of 0.5. HeLa and nasopharyngeal carcinoma Detroit 562 cells were grown in tissue culture and subsequently infected with individual strains of GAS at a multiplicity of infection (MOI) of 1:10 for 2 hours. Cells were then washed with Dulbecco's Modified Eagle Media (DMEM) and reincubated with DMEM plus gentamycin. The cells were then lysed, serial dilutions performed, and the lysate plated. Bacteria were counted and percent internalizations were calculated. This was repeated in triplicate for each strain.

Results:

Out of 396 eligible patients, 66 strains of GAS have been isolated. Both the Detroit and HeLa cells have been successfully grown in BHI. The bacterial strains have been subcultured. The authors plan on infecting the cells in March 2014 and will have have conclusive results by April 2014.

Conclusions:

None provided.
Experience and Outcomes of New Developments in Bone Conduction Hearing Technologies in Children
Authors: Felton Mark , Gaskin Julian , Eltham Penny , O'Driscoll Martin , Woolford Timothy J. , Nichani Jaya , Bruce Iain
Published: September 2014

Objectives:

(1) Recognize that percutaneous implant stability in children can be measured using radio frequency analysis (RFA) to generate Implant Stability Quotients (ISQs) and guide sound processor loading. (2) Discuss sound processor loading of the Cochlear BahaÒ (BIA300, BA400) transcutaneous implants at 4‐6 weeks in selected children and potential advantages of the transcutaneous ATTRACT implant.

Methods:

We collected data prospectively on all children undergoing implantable BC implants at surgery and follow up appointments. We aimed to assess implant stability over time in children undergoing 1‐stage surgery using RFA measurements and investigate the possible implications for earlier loading following surgery. Our experience and outcomes with the ATTRACT transcutaneous device as part of the controlled market release (3+ cases) will also be reviewed.

Results:

Nine children underwent 10 BI300 implants with a mean age of 9 years 4 months. 7 children received the BA400 percutaneous device without soft tissue reduction, with a mean age of 7 years 11 months. Using RFA the mean ISQ at surgery for BI300 implants was 60 and the corresponding unadjusted value for BA400 implants was 50. Changes in ISQs over time are discussed, showing the potential for processor loading at 4‐6 weeks.

Conclusions:

Greater implant stability has been demonstrated using the BI300 and BA400 implants, which would subsequently enable early Baha loading. The transcutaneous ATTRACT system potentially offers further improvement in cosmesis and skin inflammation and is likely to have greater acceptance in children with microtia and canal atresia and those who would have previously declined Baha.
Hemifacial Mircrosomia: A New Classification System?
Authors: Neumann Colin , Sidman James D. , Lander Timothy , Tibesar Robert J.
Published: September 2014

Objectives:

(1) Analyze associated findings in patients with hemifacial microsomia. (2) Determine if a new classification of hemifacial microsomia is possible.

Methods:

A retrospective chart of all patients diagnosed with hemifacial microsomia treated at Children's Hospital of Minnesota. Each chart was reviewed for the presence of facial paralysis, microtia/anotia, aural atresia, mandibular hypoplasia, midface hypoplasia, dermoids, vertebral abnormalities, ocular abnormalities, sensorineural hearing loss, laterality, renal abnormalities, developmental delay, and skin tags.

Results:

A total of 75 patients with hemifacial microsomia were included in this study. There were 43 males and 32 females with an average age of 8.51 ± 5.45 years at the time of chart review. Occurrences for each defect were: facial paresis/paralysis (26.7%), microtia/anotia (73.3%), mandibular hypoplasia (72%), midface hypoplasia (57.3%), vertebral deformities (21.3%), ocular abnormalities (24%), dermoids (21.3%), renal abnormalities (12%), SNHL (17.3%), skin tags (42.7%), bilateral and developmental delay (24%). Regression models were used that showed the odds of having a spinal defect are 3.13 (P =. 001) times higher for each additional craniofacial defect present; furthermore if a patient has 2 or more craniofacial defects, the odds of having spinal defect were 31.6 (P =. 001) times as high as in patients with 1 or fewer. The odds of developing a renal defect were 36.0 (P =. 001) times as high as in patients with 1 or fewer craniofacial defects.

Conclusions:

The number of craniofacial defects, not just type or severity, increase the risk of having extracranial abnormalities in patients with hemifacial microsomia.
High‐Speed Video or Video Stroboscopy in Children: Which Sheds More Light?
Authors: Shinghal Tulika , Campisi Paolo
Published: September 2014

Objectives:

(1) Compare the utility of high‐speed video (HSV) versus videostroboscopy (VS) in the assessment of children with normal voices and glottic pathologies. (2) Evaluate the ease of assessment of children with HSV.

Methods:

This study involved a retrospective assessment of 7 children who had previously undergone HSV and VS in the past 5 years. The 14 videos of these 7 patients were then randomized and presented to 4 groups of blinded evaluators: 2 trained laryngologists, 2 speech language pathologists (SLP) with voice training and experience in a voice clinic, 2 pediatric otolaryngologists, and 2 otolaryngology residents. Raters were asked to evaluate the videos using a standardized scoring tool and to complete a questionnaire assessing their opinion of HSV and VS.

Results:

Evaluators required more time to complete their assessment of VS (2.95 minutes ± 2.41 minutes) than HSV (2.31 minutes ± 1.92 minutes; P =. 004). There was no difference with respect to ease of evaluation (P =. 878), diagnostic accuracy across evaluator groups or in recording modality accuracy (P =. 5). The overall agreement between VS and HSV was moderate. (Kappa [SE]: 0.446 [0.029]). The debrief questionnaire revealed that 5 out of 8 (62.5%) preferred VS to HSV.

Conclusions:

This is the first comparative study between HSV and VS in patients under 18 years of age. HSV permitted faster evaluation than VS with similar diagnostic accuracy between the 2 modalities. However, the evaluators in this study preferred VS to HSV.
Improving Handoffs for Tracheotomy Patients: Introducing the Connecticut Airway Risk Evaluation to Otolaryngologists
Authors: Kavanagh Katherine R. , Kelly Raeanne , Hughes Amy L. , Valdez Tulio A. , Murray Nicole
Published: September 2014

Objectives:

(1) Describe the Connecticut Airway Risk Evaluation (CARE) system, an airway grading system describing the risk of a patient's airway above the tracheotomy tube. The CARE was designed to improve handoffs between caregivers for tracheotomized patients. (2) Analyze the reliability of teaching and ease of learning the CARE system for otolaryngologists.

Methods:

The CARE system is a simple, easy to use scale that divides patients into the following groups: 1, easily intubatable; 2, intubatable with specialized techniques or equipment; or 3, not intubatable. A brief tutorial was designed to introduce the system and was presented to a group of otolaryngologists. A 30‐point questionnaire was administered in which patients’ airways and airway management techniques were described, and the participant was asked to grade each example according to the CARE system.

Results:

Fifteen participants completed the study, including 9 attending physicians and 6 resident physicians. Overall interrater reliability was calculated for all participants with a 90.3% agreement (Kappa = 0.837). Attending physicians had a 86.1% agreement (Kappa = 0.766). Resident physicians showed 98.9% agreement (Kappa = 0.981).

Conclusions:

The CARE system is a reliable method of classifying airway risks in the event of an airway emergency in a tracheotomized patient. We have shown that the CARE system can be easily taught to otolaryngologists with high interrater reliability. The CARE system may help simplify handoffs between caregivers while emphasizing the important aspects of a patient's airway. Adequate implementation of the CARE system may improve the understanding of airway management options in complex tracheotomized patients.
Incidence of Congenital CMV
Authors: Jeyakumar Anita S. , Warrington Stephanie , Seybolt Lorna , Zabaleta Jovanny
Published: September 2014

Objectives:

Congenital cytomegalovirus (CMV) is the most common cause of newborn infections in developed countries, affecting up to 1% of newborn babies. Symptomatic CMV can occur in up to 10% of viral positive babies, including manifestations ranging from sensorineural hearing loss, microcephaly, developmental delays, and others. The aim of the study was to evaluate the incidence of congenital CMV in a general population of newborn babies.

Methods:

Institutional review board approval was obtained. Newborn blood spots were obtained. The blood spots were evaluated using quantitative real time polymerase chain reaction (PCR) for CMV. The PCR primers and probes were purchased from Life Technologies and based on the sequences published by Schovoerer et al. A CMV standard curve was generated for each PCR run with a human cytomegalovirus (AD169) and a quantitated viral DNA PCR control (Advanced Biotechnologies, Inc). The DNA was serially diluted to obtain a quantitative curve.

Results:

Six hundred blood spots were analyzed: 50% were male; 50% were Caucasian; 50% were African American. One female African American baby was found to have CMV.

Conclusions:

Our local data suggest a smaller incidence of CMV than the general population. The study is a small study and the implications are unclear. Further study is needed.
Management of Sudden‐Onset Sensorineural Hearing Loss in Children
Authors: Dedhia Kavita K. , Chi David H.
Published: September 2014

Objectives:

(1) Report our experience in children with sudden‐onset sensorineural hearing loss (SSNHL). (2) Describe the etiology and management of children with SSNHL.

Methods:

Retrospective review of 20 children with SSNHL, from 2000‐2013 at a tertiary pediatric facility. Patients had the following inclusion criteria: history of normal hearing, hearing loss occurring in less than 3 days, and audiogram documentation.

Results:

The average age of patients presenting with SSNHL was 11 years 2 months (22 months‐18 years). Only 6 (30%) presented prior to 2 weeks. Tinnitus (55%) was the most common associated symptom, followed by otalgia (25%), and vertigo (20%). Eight patients had bilateral hearing loss, 6 only right and 6 only left. Hearing loss severity ranged from profound (45%) being most common to mild. Etiology was unknown (30%), viral (30%), due to an anatomic abnormality (20%), endolymphatic hydrops (10%), autoimmune (5%), perilymphatic fistula (5%), and suppurative labyrinthitis (5%). Eight patients had initial treatment with oral steroids of which 50% had improvement on audiograms. Two patients underwent intratympanic injections, and both showed improvement. Of the 12 patients with no treatment, only 1 had improved hearing.

Conclusions:

The true incidence of SSNHL is unknown. Younger children may be unable to express hearing loss. Unique aspects of pediatric SSNHL are delayed presentation and higher percent of anatomic findings. In our study, 70% presented more than 2 weeks after experiencing symptoms. Anatomic abnormalities are in 20% of patients. Hearing improvement occurred in 50% of children treated with oral steroids. Intratympanic steroid treatment is another option but may have practical limitation in the pediatric population.
Neonatal Macroglossia: Demographics, Cost of Care, and Associated Comorbidities
Authors: Patel Anju K. , Mildenhall Nicholas R. , Mader Nicholas S. , Scott Andrew R.
Published: September 2014

Objectives:

(1) Examine the birth prevalence of macroglossia, assessing for differences across sex, race, socioeconomic status, and geographic location. (2) Identify comorbidities associated with isolated and syndromic forms of macroglossia and determine how such factors may influence length of stay (LOS) and cost of admission.

Methods:

Retrospective cross‐sectional study using the 2006 and 2009 Kids’ Inpatient Databases (KID).

Results:

The national birth prevalence of macroglossia was 3.4 out of 10,000 births (n = 556) with a higher rate in females (3.9/10,000, P =. 001) and blacks (4.5/10,000, P =. 01). Patients were classified as isolated (n = 423, 76%) or syndromic (n = 133, 24%) based on associated diagnoses. Syndromic cases were more prevalent in the West (P =. 01). LOS and cost were increased in the syndromic group (26.2 days vs 4.8 days, P <. 01; $30.1k vs $3.9k, P <. 01), while LOS and cost for isolated macroglossia were similar to the general population. The rate of concurrent cardiac anomalies, cleft palate, and Down syndrome was increased in patients with macroglossia compared to unaffected newborns (P <. 01). Rates of respiratory distress, feeding problems, GERD, endotracheal intubation, and prolonged ventilator support were higher in the syndromic group (P <. 01). Newborns with isolated macroglossia suffered these conditions at the same rate as the general population.

Conclusions:

The birth prevalence of macroglossia varies by sex, race, and geographic location. Prolonged LOS and increased cost are associated with syndromic forms of macroglossia. Syndromic comorbidities rather than enlargement of the tongue in and of itself appear to be the chief contributors to increased LOS and cost in this population.
A Novel Technique for Endoscopic Type I Laryngeal Cleft Repair
Authors: Raol Nikhila P. , Rogers Derek J. , Hersh Cheryl , Hartnick Christopher J.
Published: September 2014

Objectives:

(1) Describe a novel technique for repair of type I laryngeal clefts. (2) Review the current literature on various techniques for repair of type I laryngeal clefts.

Methods:

A retrospective review of patients under 18 years with a type I laryngeal cleft who underwent endoscopic laryngeal cleft repair (LCR) by a single surgeon at a tertiary care otolaryngology specialty hospital using a successful novel technique from July 1, 2013, to February 14, 2014, was conducted. This technique uses electrocautery to demucosalize the cleft on a setting of 6, followed by repair of the cleft with 2 endoscopically placed sutures. Charts were assessed for age at surgery, comorbidities, diet, length of stay, complications, and outcomes.

Results:

Eleven patients were identified, with an average age of 28 months (range, 9‐68 months). Eight of 11 (73%) of patients were restricted to nectar thick‐diet preoperatively, 2 out of 11 (19%) to honey thick‐diet, and 1 out of 11 (9%) to half‐strength honey thick‐diet. Postoperative swallow results were available for 7 patients. Five of 7 patients demonstrated clinical or radiographic evidence of resolution of aspiration. One had improvement of aspiration but persistent penetration, and another had continued aspiration and is being evaluated for a neurologic disorder.

Conclusions:

Although type I laryngeal clefts have traditionally been endoscopically addressed using either a cold technique or a laser to demucosalize the cleft, our technique offers an advantage over cold knife by providing improved hemostasis and broader demucosalization. In addition, when compared with the laser technique, it offers similar broad demucosalization without deeper thermal damage.
Does Tube Type Matter in Posttympanostomy Tube Otorrhea?
Authors: Cheng Leah , Chen Sharon , Cheng Jeremiah
Published: September 2014

Objectives:

The objective of this study was to review consecutive tympanostomy tube surgeries for the past 8 years, paying particular attention to the type of tube inserted at the time of surgery.

Methods:

Retrospective chart analysis of the last 3046 consecutive ears for tympanostomy tube surgery from 2005 to 2013.

Results:

Out of 3046 total ears reviewed, the total rate of otorrhea was 3.78% with 0.0% otorrhea in titanium tubes, 0.0% otorrhea in Sheehy activent tubes, 2.19% otorrhea in Donaldson tubes, 2.72% otorrhea in Sheehy collar button tubes, 3.28% otorrhea in Shepard tubes, 3.88% otorrhea in fluoroplastic tubes, 6.9% otorrhea in stainless steel tubes, 18.52% otorrhea in Goode tubes, and 25.0% otorrhea in triune tubes.

Conclusions:

Early posttympanostomy tube otorrhea is a frequent complication of tympanostomy tube insertion with a complication rate of 3.8%, and the type of tubes placed at time of surgery seems to make a difference in the incidence of posttympanostomy otorrhea.
Optimizing Postoperative Analgesia for Children
Authors: Cheng Yew Song , Powell Catrin , Koch Hasnaa I. , Burgess Andrea
Published: September 2014

Objectives:

(1) Analyze the difference between prescribed doses and manufacturer recommended doses of acetaminophen and ibuprofen for pediatric otolaryngology patients in the postoperative setting. (2) Highlight a problem with manufacturer dosing advice for over‐the‐counter analgesics.

Methods:

We selected 53 consecutive children who had otolaryngology operations requiring general anesthesia in 2013. These children were discharged with instructions to use over‐the‐counter analgesia, as per current departmental practice. We compared the manufacturer recommended doses of generic over‐the‐counter acetaminophen and ibuprofen with doses of the same analgesics that they would have had as inpatients during the postoperative period.

Results:

Manufacturers often recommend a range of doses. With acetaminophen, even when assuming the highest recommended doses were used, we found that children would have received on average 16% less acetaminophen than they would have had in hospital. (P =. 048). With ibuprofen, assuming the lowest recommended doses were used, children would receive 25% less ibuprofen than as inpatients (P =. 037). If the highest recommended doses were used, they would have taken 7% more ibuprofen than we would have found safe to prescribe (P =. 06).

Conclusions:

Over‐the‐counter acetaminophen and ibuprofen come with dosing advice guided by age. Our analysis demonstrated that this could often be substantially different from the ideal dose, which is based on the child's weight. With the global trend of increasing body weight, we can expect this disparity to get bigger in the future. Good pain management is important in pediatric otolaryngology, but this result is relevant to all clinicians caring for children.
Safety and Efficacy of Infant Transoral Flexible Laryngoscopy in the Office Setting
Authors: Wexler Sonya J. , Isaacson Glenn C.
Published: September 2014

Objectives:

The technique of transoral infant laryngoscopy was described a decade ago, but has not gained wide acceptance. We present a 10‐year experience with the method as an alternative to transnasal examination in newborns and edentulous infants, focusing on practicality, safety, and quality of examination.

Methods:

We queried a prospectively accrued database of 22,000 office examinations to identify all transoral flexible laryngoscopy examinations performed from 2001 to 2011 by the senior author. Records were reviewed for patient age, indication for laryngoscopy, diagnoses, and adverse events.

Results:

One hundred forty infants, aged 2 days to 10 months, were evaluated. Fifty‐seven patients were female and 83 were male. Stridor was the most common indication for laryngoscopy (90.7%) and 89 (63.6%) patients were diagnosed with laryngomalacia. The larynx was well seen in 99.3% of examinations. There were no episodes of airway obstruction or bleeding. Two children experienced emesis (1.4%).

Conclusions:

Transoral flexible laryngoscopy is a safe method for examining the infant larynx. It permits rapid, comfortable examination using a conventional‐sized office fiberscope in most infants prior to dental eruption. It avoids the need for topical anesthesia, vasoconstrictors, sedation, or general anesthesia for most children. Office examination is not advised for infants with severe upper airway obstruction.
Surgical Intervention for Congenital Absent Oval Window
Authors: Eu Donovan , Loh Woei Shyang , Yeo Seng Beng
Published: September 2014

Objectives:

Congenital absent oval window is an uncommon condition that results in significant conductive hearing loss in the pediatric population. Treatment outcomes and results following surgery are still not well established in light of the limited cases that have been published in the literature. This study aims to evaluate the outcomes following surgical intervention of patients with congenital absent oval window in a single institution.

Methods:

This is a retrospective review of patients who underwent surgical exploration and treatment for congenital absent oval window from 2000 to 2013 in a single institution.

Results:

Twelve patients were diagnosed with congenital absent oval window. Six of these patients were affected bilaterally. Of the 19 ears affected, 13 were operated on. Eight ears were successfully treated following stapedotomy and insertion of prosthesis. The average pure‐tone audiogram for these patients was 62.6 prior to the operation. Following surgery, the average pure‐tone level was 22.4. Five of the ears that were operated on showed minimal improvement. Of these 5 ears, 3 were unsuitable for insertion of prosthesis due to unfavorable position of the incus. Two patients underwent stapedotomy with Teflon wire prosthesis insertion. However, this failed to improve hearing levels.

Conclusions:

Congenital absence of oval window is an uncommon condition that can lead to significant disruption to hearing. Surgical intervention by means of stapedotomy and prosthesis insertion may lead to significant improvement in hearing levels selected patients. However, it may be technically unsuitable for others.
Effects of Oral Prednisolone on Recovery after Tonsillectomy
Authors: Choi Young Seok
Published: September 2014

Objectives:

Evaluate the effects of postoperative steroids compared with no steroids following tonsillectomy.

Methods:

This study was a prospective double‐blinded, randomized trial from April 2013 to September 2013. Forty patients age 5 years or older who were scheduled for elective tonsillectomy with or without adenoidectomy were enrolled. Patients were randomly assigned to receive a postoperative course of prednisolone powder or tablet over 7 days (dosage: 0.25 mg/kg/d). The primary outcomes of this study were comparing degree of postoperative pain using a validated pain scale and estimation of healing process based on the percentage of total area of reepithelization of tonsillar area. The second day outcomes were comparing bleeding rate, presence and severity of nausea and vomiting, returning to a normal diet, returning to normal daily activity, and sleep disturbance.

Results:

Mean ages were 23.55 (prednisolone group) and 25.25 (control group). Postoperative pain score showed no difference at day 1 and 14, but much less pain in the prednisolone group at day 7 (P =. 056). Mean percentage of reepithelization area was higher in the prednisolone group (P <. 001). There were significant differences in the bleeding rate, severity of nausea and vomiting, and sleep disturbance. But there was a significant difference in the rate of return to eating a normal diet and normal daily activities.

Conclusions:

Oral prednisolone may offer improvement in the recovery phase from tonsillectomy without serious complications.
Bilateral Encephaloceles and CSF Rhinorrhea after Facial Advancement in Craniofacial Dysostoses: Considerations for Repair
Authors: Panuganti Bharat A. , Leach Matthew E. , Antisdel Jastin L.
Published: September 2014

Objectives:

(1) Describe the first reported case in otolaryngology literature of a patient with Crouzon syndrome with late cerebrospinal fluid (CSF) rhinorrhea and encephalocele formation after prior Le Fort III facial advancement surgery. (2) Review the literature pertaining to the incidence and management of this complication in craniofacial dysostoses (CD). (3) Analyze issues surrounding repair of these complications, including occult elevations in intracranial pressure (ICP), the use of perioperative CSF shunts, and the importance of considering alternative repair schemes.

Methods:

Literature review of studies describing CSF rhinorrhea and encephalocele formation following facial advancement in CD, focusing on management strategies.

Results:

CSF rhinorrhea and encephalocele formation are rare complications of craniofacial advancement procedures. Occult elevations in ICP complicate the prospect of permanent surgical repair, necessitating the use of transcranial repair and CSF shunts in addition to the now more common endoscopic approach. Though no consensus exists regarding the use of perioperative CSF drains, strong associations exist between elevated ICP and failed surgical repair. Additionally, the anatomic changes in the frontal and ethmoid sinuses after facial advancement present a challenge to endoscopic management.

Conclusions:

Otolaryngologists should be aware of the possibility of occult elevations in ICP as well as sinonasal anatomic abnormalities when repairing CSF rhinorrhea in patients with CD. Clinicians should consider CSF shunt placement and carefully weigh the advantages of the open, transcranial approach versus endonasal, endoscopic techniques.
The Effect of Adipose Tissue on Atrophic Rhinitis: An Animal Model
Authors: Balur Mehmet B. , Oktay Mehmet F. , Taskin Umit , Aydin Salih , Yucebas Kadir , Altnay Serdar , Celik Duygu S.
Published: September 2014

Objectives:

Investigate the histopathological effects of fat grafting harvested from lipoaspirate adipose tissue on atrophic rhinitis in an animal model.

Methods:

An animal model of atrophic rhinitis was obtained by application of pasturella multocida toxin diluted with 0.9% NaCl into nasal cavities for 3 weeks. Eleven Wistar Hanover rats were included in this study and divided into 2 groups. The study group was composed of one side of nasal cavity with atrophic rhinitis. The fat grafting harvested from lipoaspirate adipose tissue was applied into nasal cavity submucosally. After 2 weeks of follow‐up, rats were decapitated and nasal cavities were resected totally. A histopathological examination was done.

Results:

There was a significant improvement in the study group compared with other groups according to basal membrane degeneration and glandular atrophy. The vacuolar degeneration, squamous metaplasia, keratinization, vascular proliferation, inflammatory infiltration, and congestion were not significantly different between groups.

Conclusions:

Our study showed that fat grafting harvested from lipoaspirate adipose tissue has a positive healing effect over degenerated mucosa on atrophic rhinitis, in addition to the volume enhancer effect of tissue itself. The adipose tissue may normalize the volume of large nasal cavities caused by atrophic rhinitis. In addition, histopathological disorders of atrophic rhinitis, such as glandular atrophy and basal membrane degeneration, are reversed significantly.
The Effect of Smoking on Eosinophilic Rhinosinusitis with Nasal Polyp in Mouse Model
Authors: Lee Ki , Mo Ji‐Hun
Published: September 2014

Objectives:

Chronic rhinosinusitis with nasal polyp is a clinically common disease, and cigarette smoking is a major risk factor for airway inflammation. However, little is known about the effects of smoking on eosinophilic rhinosinusitis (ERS) with nasal polyp. A histopathologic and molecular study was performed to investigate the effects of smoking using mouse model of ERS with nasal polyp.

Methods:

Mice were divided into 4 groups: control group, smoking group, ERS group, and ERS + smoking group (N = 8, each). Histopathologic changes were investigated using several special stainings: Hemotoxylin and eosin for overall inflammation and polyp‐like lesions, Sirius red for eosinophils, Toluidine blue for mast cells, Alcian blue for secretory goblet cells, and Masson's trichrome for collagen fiber. Serum IgE levels and systemic cytokines were determined using enzyme‐linked immunosorbent assay. The expression of vascular endothelial growth factor (VEGF) and HIF‐1a were evaluated by immunohistochemical staining.

Results:

Smoking enhanced the degree of polyp‐like lesions, eosinophil infiltrations, goblet cell deposition, and subepithelial fibrosis in ERS model. Total and OVA‐specific IgE levels were increased in both ERS groups, however, smoking had no additive effect on them. The systemic cytokines (IL‐4, IL‐6, IL‐17, and IFN‐γ) were also elevated significantly by smoking. Smoking enhanced VEGF expression in nasal epithelial cells, suggesting underlying mechanism of increased polyp formation.

Conclusions:

Smoking exposure had additive effects on experimental ERS. It resulted from increased local and systemic inflammation, and airway remodeling. Increased VEGF might be its underlying mechanism.