bluuebunny/crossref_metadata_2025 huggingface dataset:
Transoral Robotic versus Open Surgical Approaches to Oropharyngeal Squamous Cell Carcinoma by Human Papillomavirus Status
Authors: Ford Samuel E. , Brandwein‐Gensler Margaret , Carroll William R. , Rosenthal Eben L. , Magnuson J. Scott
Published: August 2013

Objectives:

1) Investigate oncologic survival outcomes. 2) Analyze the impact of human papillomavirus (HPV) status on prognosis in patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic (TORS) vs. open surgery.

Methods:

Retrospective case‐control study of 130 total patients treated for primary OPSCC with either TORS or open surgery and appropriate adjuvant therapy between October 2004 and March 2012 at the University of Alabama at Birmingham Hospital (tertiary care referral center). Cases and controls were matched based on TNM staging. Recurrence‐free survival was used to evaluate the impact of human papillomavirus‐mediated carcinogenesis and surgical intervention on prognosis. Kaplan‐Meier, chi‐square, and t‐test analyses were used.

Results:

Patients treated with transoral robotic surgery survived more frequently (94% and 89% at 1 and 3 years, respectively) than for those treated with open surgery (85% and 72% at 1 and 3 years, correspondingly) (Breslow P = 0.035). Patients with HPV‐positive cancers treated with either TORS or open approaches and patients with HPV‐negative tumors treated with TORS all survived at similar rates. Patients with HPV‐negative OPSCCs treated with open surgical approaches, however, survived without recurrence less frequently at 1 and 3 year rates of 58% and 25%, respectively (P = 0.001 and 0.001 vs. HPV‐positive TORS, respectively; P = 0.008 and 0.001 vs. HPV‐positive non‐TORS, respectively).

Conclusions:

These data suggest that TORS is at least equivalent to, if not better than, open surgical approaches to OPSCC in providing recurrence‐free survival at one‐ and three‐year post‐operative intervals to patients regardless of HPV status.
Comprehensive Dynamic Airway Assessment: Audit of a Novel Technique to Improve Rates of Tracheostomy Decannulation
Authors: Oakley Richard J. , Ashfield Tom , Clarke Lynne , Chaterjee Debamoy , Shephard Buzz , Ahmad Imran
Published: August 2013

Objectives:

Prolonged tracheostomy is associated with morbidity, mortality, and length of stay. Otolaryngologists are called upon to diagnose and manage patients who have failed to achieve decannulation through conventional protocols. Flexible nasendoscopy (FNE) is commonly used but examines only the supraglottic airway. The comprehensive dynamic airway assessment (CDAA) extrapolates the principles of awake fiber‐optic intubation, allowing a complete upper airway assessment, including the subglottis with decannulation under direct vision, if appropriate.

Methods:

A two‐cycle audit was performed on patients discharged from the intensive care unit with tracheostomy in situ. A retrospective 25 month audit of decannulation rates was performed to assess conventional management with ear, nose, and throat (ENT) review and standard FNE in cases that failed to achieve decannulation due to airflow problems. A prospective 8 month audit was then undertaken after the inception of CDAA.

Results:

Using conventional management, the number of patients discharged from intensive care unit (ICU) with tracheostomy in situ was 137, of which 17 failed to decannulate through protocol management alone. Five (31%) patients were eventually decannulated using a standard approach. After inception of CDAA, 76 were discharged from ICU. Eight underwent CDAA, of whom 6 (75%) were decannulated; a diagnosis for decannulation failure was made in the remaining 2 patients.

Conclusions:

CDAA is an essential diagnostic tool that can improve outcomes for complex patients with tracheostomies. It requires minimal resource, is versatile, and is a natural extension of the expert nasendoscopic skills of the otolaryngologist. CDAA should form an integral part of all decannulation protocols.
Does PPI Therapy Normalize pH in Laryngopharyngeal Reflux Patients?
Authors: Friedman Michael , Pott Thomas R. , Waxman Jonathan
Published: August 2013

Objectives:

Laryngopharyngeal reflux (LPR) is commonly treated with twice‐daily proton pump inhibitor (PPI) therapy. However, a significant number of patients do not achieve complete resolution of symptoms. In this study, we aimed to assess the effect of twice‐daily PPI treatment on the oropharyngeal pH environment in patients with pH‐probe confirmed LPR.

Methods:

LPR was identified in 56 symptomatic patients using 24 hour Dx‐pH probe monitoring at a single center. Following a period of treatment with twice‐daily PPI, a second 24 hour pH monitoring study was performed. Compliance was determined by self‐report. Outcomes included supine and upright Ryan scores, number of patients with normal Ryan scores post‐treatment, and reflux severity index. Reflux severity index (RSI) was assessed pre‐ and post‐treatment.

Results:

34 women and 22 men were assessed pre‐ and post‐treatment, with age of 51.9 ± 16.8 years and BMI of 30.8 ± 7.0 kg/m2 (mean ± SD). Pre‐treatment upright and supine Ryan scores were 142.3±161.9 and 14.21 ± 17.14, respectively (mean ±SD). Patients were treated with twice‐daily PPIs for a duration of 105.7 ± 88.2 days (mean ± SD). Post‐treatment upright and supine Ryan scores were 72.66±140.5 and 12.27 ± 21.1, respectively (mean ±S D). Paired T‐tests showed a significant decrease in mean post‐treatment upright Ryan scores (P = 0.0003). However, post‐treatment Ryan scores normalized in only 26 subjects (46.4%). RSI scores were higher in non‐responders.

Conclusions:

While PPI therapy resulted in a significant decrease in mean upright Ryan score, the Ryan score was normalized in only 46.4% of patients. This suggests that twice‐daily PPIs may be insufficient to completely eliminate reflux and symptoms of LPR.
The Incidence of Premalignant and Malignant Disease in Reinke's Edema
Authors: Lim Shueh Y. , Sau Phoebe C.Y. , Cooper Lorna , McPhaden Allan , Mackenzie Kenneth
Published: August 2013

Objectives:

Reinke's Edema is a benign lesion of the vocal folds affecting the subepithelial space. This condition occurs almost exclusively in moderate to heavy smokers. As part of a study of the management of Reinke's Edema, we aimed to determine the prevalence of dysplasia and malignancy in histologically proven Reinke's Edema.

Methods:

A retrospective analysis of all laryngeal biopsies performed in North Glasgow, United Kingdom, between 2001 and 2010 was carried out through the North Glasgow Pathology Database. Clinical and pathological data from all patients with histologically confirmed Reinke's Oedema were recorded with specific respect to the reporting of dysplasia and malignancy.

Results:

From the 10 year cohort, a total of 3902 laryngeal biopsies were performed. 190 patients (19 males and 171 females) had histologically proven Reinke's Edema. Of this cohort, the pathologist commented on dysplasia in 172 (91%) of patients. The remaining 18 (9%) patients subsequently had their pathology reviewed. In the 190 patients who had Reinke's Edema, 13 (8%) patients had mild dysplasia, 2 (1%) had moderate dysplasia, and 1 (0.5%) had severe dysplasia. There was no malignancy reported in the cohort.

Conclusions:

In our predominantly female smoking population, the epithelium appears to differentiate to benign Reinke's Edema rather than malignancy. Patients can be reassured with regard to the very low risk of malignancy in classical Reinke's Edema. The principle indication for surgical intervention should be the patient's desire to improve their voice.
Laryngeal Muscle Activity in Unilateral Vocal Fold Paralysis Patients Using Electromyography and Coronal Reconstructed Images
Authors: Sanuki Tetsuji , Yumoto Eiji , Kumai Yoshihiko , Nishimoto Kohei
Published: August 2013

Objectives:

Assess laryngeal muscle activity in patients with unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG) and coronal multi‐planar reconstructed images (coronal images).

Methods:

Twenty‐one patients suffering from paralytic dysphonia, who had had onset of UVFP more than 6 months previously, underwent LEMG, phonatory function, and coronal images. For LEMG analysis, a four‐point scale was employed to grade motor unit (MU) recruitment; 4+: absent, 3+: greatly decreased, 2+: moderately decreased, and 1+: mildly decreased (less than full interference). Maximum phonation time (MPT) and mean airflow rate (MFR) were employed. Coronal images during phonation and inhalation were assessed focusing on differences in thickness and vertical position between the vocal folds during phonation.

Results:

MU recruitment results were three patients for 1+, five for 2+, six for 3+, and seven for 4+. MPT was positively correlated with the MU recruitments (P = 0.011). The thinning of the affected fold was evident during phonation in 20 of the 21 subjects. All 8 subjects with MU recruitments 1+ and 2+ showed the affected fold located at an equal level to the healthy fold. Twelve of 13 subjects with MU recruitments 3+ and 4+ showed the affected fold located at a higher level than the healthy fold. There was a significant difference between MU recruitment and vertical position of the affected fold (P = 0.001).

Conclusions:

MU recruitments in patients with UVFP may be related to phonatory function and the vertical position of the affected fold. Synkinetic reinnervation may occur in some cases with UVFP.
Laryngopharyngeal Reflux: Paradigms for Evaluation, Diagnosis, and Treatment
Authors: Gooi Zhen , Ishman Stacey L. , Bock Jonathan M. , Blumin Joel H. , Akst Lee M.
Published: August 2013

Objectives:

Describe current otolaryngologic paradigms for diagnosis and treatment of laryngopharyngeal reflux (LPR) and analyze differences between laryngologists and non‐laryngologists.

Methods:

American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) and American Bronchoesophageal Association (ABEA) members were invited to complete a 23‐question online survey regarding evaluation, diagnosis, and treatment of LPR in 2012. Subgroup analysis was performed to identify differences between respondents who completed laryngology fellowships (LL) and those who did not (NL).

Results:

Of 159 respondents, 40 completed laryngology fellowships. NL respondents had been practicing longer than LL (19.6 vs. 11.4 years, P = 0.0001). Video‐documentation of laryngopharyngeal exams was almost universal in the LL group (97% vs 38%, P < 0.0001); similarly, use of rigid (100%, P = 0.002) and flexible distal‐chip technologies (94%, P = 0.004) were far more common in the LL group. Diagnostic criteria were otherwise similar between the groups, with symptoms of heartburn, globus, and throat clearing thought most suggestive of LPR. Adjunctive tests most commonly used were barium esophagram, dual‐probe pH testing with impedance, and esophagoscopy, although most ordered no initial testing. NL used dual pH probe with impedance more often than LL (P = 0.004). LL were significantly more likely to perform transnasal esophagoscopy in their office (P < 0.0001), to prescribe twice‐daily proton pump inhibitors with concurrent H2‐blocker medication initially (P = 0.004), and to treat for longer than 4 weeks (P = 0.0003).

Conclusions:

Otolaryngologists are in broad agreement on symptoms and physical features of LPR; however, significant differences exist between laryngologists and non‐laryngologists on the use of adjunctive testing and treatment strategy.
Lessons Learned from Endoscopic Treatment of Early Glottic Carcinomas: A Primer for the General Otolaryngologist
Authors: Sofer Elazar , Jamal Nausheen , Chhetri Dinesh
Published: August 2013

Objectives:

1) Identify technical considerations involved in performing oncologic resection while maintaining laryngeal function. 2) Analyze on a case‐by‐case basis what type of treatment protocol to implement and when lesions persist or recur.

Methods:

A retrospective review was performed to identify all endoscopic laser resections of glottic carcinomas performed over a 4‐year period. Records were reviewed to identify technical factors that led to cure vs. recurrent disease; disadvantages of extensive resection vs. adjuvant radiation; when and how often patients returned to the operating room for further resection; how to push surgical limits while maintaining good functional results; and what to expect on examination in the post‐operative healing process.

Results:

Twelve patients were treated during the study period. Difficult exposure was not a contraindication to endoscopic resection, if the lesion did not extend to the anterior commissure. For patients with deeply invasive disease who cannot afford lengthy vocal downtime, radiation therapy is the answer. However, radiation leads to dysphagia and contralateral vocal fold injury that is avoided with surgery. Additionally, good voice can be achieved in patients undergoing intramuscular cordectomy, but it does cause longer vocal downtime compared to radiation. The key to optimal vocal results is achieving glottal closure. Patients should be counseled pre‐operatively regarding the possibility of additional surgery.

Conclusions:

Endoscopic resection can be tailored on an individual basis based on both cancer stage and the patient's personal needs. Patients should be counseled pre‐operatively regarding the advantages and disadvantages of surgery vs. radiation, including side effects and voice results.
Management of Voice Prosthesis Leakage with Blom‐Singer Large Esophageal and Tracheal Flange Voice Prostheses
Authors: Choussy Olivier , Paviot Alexandre , Beulque Emilie , Hibon Renaud , Dehesdin Daniele
Published: August 2013

Objectives:

Voice rehabilitation after total laryngectomy is a major socio‐economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo‐esophageal puncture is a frequent complication and can be difficult to manage.

Methods:

A prospective study was conducted from November 2010 to October 2011 on 28 Blom‐Singer large esophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo‐esophageal puncture, causing leakage around the voice prosthesis.

Results:

Leakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis.

Conclusions:

The Blom‐Singer large esophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage, ensuring similar voice quality and an identical lifespan to that of other voice prostheses.
Effects of Aging on Rat Pedicled Fasciocutaneous Flap Survival
Authors: Roy Sudeep , Heffelfinger Ryan , Hota Salini , Duddy Beth , Pribitkin Edmund A.
Published: August 2013

Objectives:

Characterize the effects of aging on rat pedicled fasciocutaneous flap survival and associated ischemia‐induced vascular proliferation and inflammation.

Methods:

After approval from the Institutional Animal Care and Use Committees, three cohorts containing six young rats, six intermediate‐aged rats, and six old rats were created. A fasciocutaneous flap based axially on the inferior epigastric vessel was raised on each rat and rotated 60 degrees into a contralateral defect. Animals were sacrificed seven days postoperatively and flaps harvested. Each flap was evaluated for degree of gross necrosis, and samples were sent for both histopathological evaluation of vessel density as well as protein analysis for levels of vascular endothelial growth factor (VEGF), heme‐oxygenase 1 (HO‐1), and pyruvate dehydrogenase kinase (PDH‐K) to assess angiogenesis and cellular response to ischemic injury.

Results:

There was a clear and scaled distinction between the three groups (0% of the young rats, 33% of the intermediate rats, and 100% of the old rats) in terms of observable necrosis of the distal flap on gross examination. Histology showed decreased vascular density as well as increased fibrosis, apoptosis, and inflammation in specimens collected from the old rats compared to the younger groups, and this correlated with expected variations in VEGF, HO‐1, and PDH‐K levels.

Conclusions:

Age correlates inversely with flap survival, angiogenesis, and resistance to ischemic injury in this rat pedicled fasciocutaneous flap model. Accordingly, this flap model can be used to explore the effects of interventions designed to ameliorate the effects of aging on these variables.
The Quantified‐Self: Mobile Analysis to Facilitate Research and Empower Patients with Voice Problems
Authors: Hughes Owain R. , Forth Oscar , Alexander Anil
Published: August 2013

Objectives:

1) Build into a commonly available mobile device the ability to accurately measure the acoustic characteristics of normal and abnormal voices. 2) Build a user interface that allows untrained patients to reproducibly measure the quality of their voice and track changes over time.

Methods:

Apple mobile devices (iPhones, iPads, iPod Touches) were chosen as the platform since they are equipped with microphones of consistent good quality for reliable acoustic voice analysis. Novel implementations of state of the art acoustic analysis algorithms best suited for these devices were developed. The algorithms and user interface were refined following usability tests on patients at University College London Hospitals from June 2012 to December 2012.

Results:

We have built into these devices the capability for performing analysis of (a) fundamental frequency (F0), formant frequencies (F1‐F4), jitter and shimmer (b) maximum phonation time (c) reading and singing pitch ranges. Obtaining standardized recordings was hindered initially by excessive ambient noise. To minimize ambient noise, a volume level sensor that prevented the patient from completing an analysis outside of a quiet environment was implemented. Furthermore, visual and auditory feedback with spectrograms and playback was provided to the patient to check recording quality. Initial testing shows moderate to strong correlation and agreement to existing clinical voice quality measurement equipment.

Conclusions:

We have demonstrated that standardized acoustic analyses can be obtained on mobile devices without additional hardware or patient training. In this way, patients can be empowered to monitor their voice quality and engage with researchers and clinicians.
Role of Human Papillomavirus (HPV) in the Pathogenesis of Laryngeal Dysplasia
Authors: Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Greco Antonio , Fusconi Massimo , Gallipoli Camilla , Gallo Andrea
Published: August 2013

Objectives:

A synergistic effect between smoking and alcohol intake is the major cause of premalignant and malignant lesions of the larynx, but the risk factors and pathogenesis of the neoplastic transformation in non‐smokers remain poorly‐defined. The aim of this retrospective study is to establish the relationship between smoking habits and HPV infection in laryngeal dysplasia.

Methods:

HPV DNA was amplified from 30 paraffin‐embedded laryngeal dysplasia tissue specimens by the polymerase chain reaction (PCR) using 2 groups of different consensus primers (MYO9/MY11 AND LCRF1, LCRF2, LCRF3, LCRF4, E7R1, E7R2, E7R3, E7R4). 15 samples were taken from smokers and 15 from non‐smokers. To select these tissue samples, we reviewed the medical charts of 164 patients who underwent suspension microlaryngoscopy between 1992 and 2012.

Results:

The present investigation failed to demonstrate HPV genome in all samples of laryngeal precancerous lesions, whereas HPV was detected in 4 laryngeal papilloma samples used as control to confirm the reliability of our method on paraffin‐embedded samples.

Conclusions:

The absence of viral genomes in laryngeal dysplasia specimens of smokers as well as non‐smokers suggests that other factors play a more important role than HPV infection in the carcinogenesis of these lesions.
Stem‐Cell Tracheal Reconstruction in a Canine Model
Authors: Wood Megan W. , Wright Stephen C. , Feng Xin
Published: August 2013

Objectives:

Advance the science of stem‐cell based tracheal reconstruction.

Methods:

Tracheal reconstruction is an evolving field with recent success using a stem‐cell based ex‐vivo engineered trachea. Taking this idea a step further, an in‐vivo method requiring less time and fewer procedures would be optimal. We performed a pilot study using 18 rabbits in 2012 at Wake Forest Institute of Regenerative Medicine. The tracheal replacements in the adipose study arm exhibited superior survival when compared to the bone marrow derived stem cell group. In this follow‐up study, we performed tracheal replacement in a canine model using 4 experimental animals. We used a segment of fixed, cell‐free donor trachea, and stem cells harvested from adipose tissue in the recipient animals. Acellular conduits were seeded with stem cells and implanted.

Results:

The live‐animal procedures were successful, with stable oxygenation and vital signs at extubation. The animals were able to demonstrate comfortable and spontaneous respiration and were bright and active for the first post‐operative week. They were then euthanized to evaluate the early phase of stem cell survival and differentiation. The complete histologic categorization is ongoing and will be reported.

Conclusions:

We will report the early findings of a single stage stem cell based tracheal replacement—the next evolution of this exciting potential reconstructive option.
Evaluation of Autogenous Engineered Septal Cartilage Grafts in Rabbits: A Minimally Invasive Preclinical Model
Authors: Kushnaryov Anton , Yamaguchi Tomonori , Briggs Kris , Reuther Marsha S. , Watson Deborah , Masuda Koichi , Sah Robert L.
Published: August 2013

Objectives:

1) Evaluate safety of autogenous engineered septal neocartilage grafts. 2) Compare properties of implanted grafts versus in vitro controls.

Methods:

Constructs were fabricated from septal cartilage and serum harvested from adult rabbits. Constructs were cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of implanted and in vitro constructs were evaluated and compared.

Results:

No systemic or serious local complications were observed. Implanted constructs contained more DNA (p=0.00, p=0.003) and a higher ratio of total collagen to GAG (p=0.015, p=0.091) when compared with in vitro controls. Confined compressive moduli were also higher in implanted constructs when compared with in vitro controls (p=0.092, p=0.122). No significant differences were detected between the 30 and 60 day cohorts. Implanted constructs displayed resorption rates of 20‐45 percent. Calcium deposition in implanted constructs was observed using alizarin red histochemistry and microCT analyses.

Conclusions:

Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and had a higher ratio of total collagen to GAG when compared with in vitro controls. Confined compressive moduli were also higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage. The basis for observed calcification in implanted constructs and its effect on long‐term graft efficacy is unknown at this time and will be a focus of future studies.
Tracheocutaneous Fistula Closure in the Pediatric Population: Should Secondary Closure Be the Standard of Care?
Authors: Osborn Alexander J. , Rutter Michael J. , Hart Catherine K. , de Alarcon Alessandro , Cotton Robin T.
Published: August 2013

Objectives:

Tracheocutaneous fistula (TCF) closure is achieved by excision followed either by primary closure or healing by secondary intention. Although primary closure provides immediate resolution of the fistula, it is associated with more severe potential complications. Healing by secondary intention minimizes these potential complications; however, it is inconvenient for the patient and may be more likely to require revision surgery. We have had two life‐threatening complications after primary closure, and this has raised the question of whether we should change our practice pattern. We wish to compare complication and success rates of the two methods in order to guide this decision.

Methods:

We conducted a retrospective study of 216 patients who underwent TCF closure in our academic tertiary care pediatric otolaryngology practice between 2004 and 2012.

Results:

Seventy percent of all fistulas closed by secondary intention. The complication and revision rates were not significantly different between the two methods (9% vs 11% and 9% vs 14%, respectively).

Conclusions:

TCF closure is accomplished by more than one method. In our study, we did not see any statistical differences between the two methods studied. We have only experienced life‐threatening complicaitons when performing primary closure. Even though these complications are very rare, they are potentially disastrous. Given that both methods are equally efficacious, we recommend secondary closure as the standard of care for management of pediatric TCF.
Tracking Myoblasts in the Development of Laryngeal Cellular Engineering Using Fluorescence Nanoparticles (“Quantum Dots”)
Authors: Fishman Jonathan M. , Urbani Luca , Ramesh Bala , Loizidou Marilena , Seifalian Alex M. , de Coppi Paolo , Birchall Martin A.
Published: August 2013

Objectives:

Stem‐cell based techniques have previously been successfully used to replace patients’ tracheae, but using similar techniques to replace an entire larynx remains challenging. Additionally, non‐immunogenic labelling techniques are required to track cells in vivo to determine the relative contribution of the implanted/donor stem cells with respect to the regeneration seen.

Methods:

We have developed and synthesized two quantum‐dots (QDs) using gold and mercury‐cadmium‐telluride (HgCdTe) that emit at near‐infrared wavelength (>700nm). Labelled C2C12 myoblasts were characterized with both QDs at different concentrations and incubation times. Labelled cells were visualized by confocal microscopy and transmission electron microscopy (TEM). Toxicity in vitro was determined using Alamar Blue assays and Ki67‐immunofluorescence. Myosin heavy chain and MyoD‐immunofluorescence were used to determine the effect of QDs on cellular differentiation.

Results:

We show that myoblasts can be optimally labelled with 800nm‐emitting gold‐nanoparticles that are non‐toxic and do not affect cell proliferation or differentiation in vitro (P > 0.05). Some toxicity‐related effects were seen with HgCdTe QDs, which led to smaller, less‐mature myofibers (P < 0.05). On TEM, QDs were seen early on adhering to cell membranes and within phagosomes at later time points.

Conclusions:

We present new data demonstrating that cells may be optimally labelled with QDs for tracking cells in organ development using tissue‐engineering approaches. Labelling with gold‐nanoparticles is associated with minimal associated toxicity and may provide an immunomodulatory influence, thereby preventing cell rejection. Such cell‐labelling techniques may be useful in tracking cells in real time in vivo to better understand the contribution of such cells towards regeneration.
Cholesteatoma Growth Patterns: Are There Audiometric Differences between Posterior Epitympanics and Mesotympanics?
Authors: Rosito Leticia S. , Selaimen Fábio A. , Pinto Bruno S. , Giugno Claudia S. , Tibes Pauletti Marcos G. , Smith Alessandra L. , da Costa Sady S.
Published: August 2013

Objectives:

Verify if there are differences in hearing impairment between posterior epitympanic and posterior mesotympanic cholesteatomas.

Methods:

This cross‐sectional study evaluated 278 ears with cholesteatoma and no previous surgery between August 2000 and January 2013. Otoendoscopy and pure tone audiometry were performed at the first evaluation. The video‐otoscopys were later analyzed and classified between the two main possible routes involved in cholesteatoma formation (posterior epitympanic and posterior mesotympanic). To compare the audiometric thresholds, we employed the Student t test.

Results:

The mean age was 33.7 years old, and 51.1% were male. The posterior epitympanic cholesteatoma was found in 51.4%. There were no differences in air and bone conduction thresholds between the two groups (P > 0.05). When the air‐bone gaps were compared, however, the posterior mesotympanics had greater thresholds in 500 Hz, 2000Hz, and tritonal mean (P = 0.003, P = 0.03, and P = 0.02, respectively)

Conclusions:

The posterior mesotympanic cholesteatomas had greater air‐bone gap thresholds in the speech frequencies when compared with posterior epitympanic cholesteatomas. However, the two growth patterns were very similar in the other audiometric parameters.
Clinical Efficacy and Safety of AM‐101 in the Treatment of Acute Tinntius
Authors: Staecker Hinrich , Morris John R. , Maxwell Kenneth , Van de Heyning Paul , Morawski Krzysztof F. , Muehlmeier Guido
Published: August 2013

Objectives:

Glutamate excitotoxicity following cochlear trauma can trigger aberrant excitation of the auditory neurons, resulting in tinnitus. AM‐101, a small molecule NMDA receptor antagonist, has shown evidence of preventing onset of tinnitus in animal models of cochlear trauma after intratympanic delivery. We present the results of the European and U.S. phase II clinical trials.

Methods:

Three hundred and twenty subjects with persistent tinnitus were enrolled in a double blind placebo controlled trial of AM‐101. Efficacy endpoints included change in subjective tinnitus loudness, annoyance, sleep difficulties, the THI‐12 questionnaire, and minimum masking level and loudness match. A patient global impression of change assessed the change in tinnitus severity over the study duration.

Results:

A dose dependent and statistically significant improvement of tinnitus loudness, annoyance, sleep difficulties, and the THI‐12 over placebo could be demonstrated in subjects with tinnitus following acute noise trauma or otitis media. The improvement was most pronounced in the AM‐101 810 µg/mL treatment group and continued to increase to Day 90 of the study. In contrast, the subgroup of sudden hearing loss related tinnitus did not show an improvement in tinnitus. The study drug was well tolerated.

Conclusions:

The study established human proof of concept for application of AM‐101 in the treatment of tinnitus arising from cochlear glutamate excitotoxicity. Local delivery of AM‐101 in a defined patient population in the acute stage of injury allows for a substantial and persisting attenuation of tinnitus with minimal systemic exposure and side effects.
Clinical Use of a Novel, Single‐Dose Treatment for Bacterial or Fungal Otitis Externa
Authors: Branch Matthew P. , Oglesbee Vance J.
Published: August 2013

Objectives:

To assess the efficacy of a novel, single‐dose, physician‐administered viscous suspension for treatment of either acute bacterial otitis externa (ABOE) or fungal otitis externa (FOE).

Methods:

Eighty‐nine consecutive patients seen by a single author in an outpatient, private practice clinic were diagnosed empirically with either ABOE (n = 52) or FOE (n = 37) based on patient symptoms, appearance of the external auditory canal, and presence or absence of fungal elements. All external auditory canals were debrided when necessary under microscopy, then filled with a viscous otic suspension containing clotrimazole 1%, ciprofloxacin 0.3%, and dexamethasone 0.1%. The canal was occluded with a cotton ball, and patients were followed up at various intervals.

Results:

Of the 52 ABOE patients, 48 experienced complete symptom resolution at 2.5 days on average and all patients had complete resolution on exam (2 patients had cellulitis requiring systemic antibiotics, 1 patient was nonverbal, and 1 patient had temporal‐mandibular joint arthralgia pain that persisted despite treatment). All 37 FOE patients experienced complete symptom relief at 3 days on average and normal exam at follow‐up. No patient experienced adverse effects from treatment, required debridement at follow‐up, or experienced recurrence.

Conclusions:

The novel suspension used in this study was capable of achieving a very high rate of clinical cure and complete symptom relief in three days or less on average for patients with ABOE or FOE using a single physician administered dose without adverse reactions.
Cochlear Trajectory in Pediatric Patients
Authors: Jackson Neal , Givens Victoria , Carpenter Clelie , Hurth Charles , Arriaga Moises , Ying Yu‐Lan Mary , Jeyakumar Anita S.
Published: August 2013

Objectives:

1) Study pediatric temporal bone anatomy using high resolution temporal bone imaging. 2) Analyze the anatomical differences in infant (< 2 years old) versus toddler (2‐5 years old) versus child (6‐10 years old) versus preadolescent and adolescent (>10 years old) as it pertains to cochlear implantation

Methods:

A retrospective chart and radiologic review was done of pediatric patients at our institution undergoing high resolution computed tomography (CT) scan of the temporal bones from April 2001 to February 2013. Charts were reviewed for clinical and demographic information. Scans were reviewed by experienced surgeons, radiologists, or both to study the Cobb angle between an ideal trajectory of a cochlear implant into the basal turn of the cochlea and a realistic approach for surgical insertion.

Results:

Seven hundred fifty patients were identified. Seven hundred and twenty‐three charts and scans (1446 ears) were reviewed, and 27 patients were eliminated due to poor scan quality. The age range was 8 days to 22 years. Fifty‐six point three percent (n = 407) of patients were male. Each group of patients was evaluated. One hundred and five patients were < 2 years old, with Cobb's angle ranging 22.3‐36.4°. One hundred and forty‐seven patients were 2‐5 years old, with Cobb's angle ranging 14.6‐31.7°. Two hundred four patients were 6‐10 years old, with Cobb's angle ranging 7.7‐22.3°. Two hundred and fifty‐seven patients were >10 years old, with Cobb's angle ranging 7.7‐27.2°.

Conclusions:

Despite considerable variations, there is a substantial difference in the Cobb's angle among the age groups. The largest difference is between infancy (< 2 years old) and toddler (2‐5 years old). These differences are surgically relevant for round window identification and facial nerve safety during cochlear implant surgery in infants.
The Correlation between Hearing Loss and Obesity in Adolescents
Authors: Ahmed Sameer , Shapiro Nina L. , Bhattacharyya Neil
Published: August 2013

Objectives:

Understand the relationship between obesity and hearing loss (HL) in adolescents.

Methods:

Adolescents (ages 12‐19) were examined in the National Health and Nutrition Examination Survey from 2007‐08 and 2009‐10. Extracted data included age, sex, ethnicity, poverty‐income ratio, and body mass index (BMI). Obesity was assessed according to age/sex specific criteria. Patients underwent formal audiometry as part of the survey protocol. The “low” pure tone average (PTA at 500, 1000, and 2000 Hz) and “high” PTA (3000, 4000, 6000, and 8000 Hz) were computed. Patients were classified as having low and/or high tone HL if the respective PTA was greater than 15 dB. Multivariate analyses were conducted to determine the relationship between obesity and hearing loss.

Results:

27.7 +/‐ 1.2 million adolescents (unweighted n = 2,062) were examined. 13.1 +/‐ 2.1% of obese adolescents had low tone HL versus 8.5 +/‐ 1.0% of non‐obese adolescents. Similarly, 20.0 +/‐ 2.6% of obese adolescents had high tone HL versus 13.4 +/‐ 1.3% of non‐obese adolescents. On multivariate analysis, low tone HL was not associated with obesity (P = 0.074). However, obesity was associated with high tone HL in either ear with an increased odds ratio of 1.58 (95% confidence interval 1.12‐2.22; P = 0.011). Similarly, obesity was associated with bilateral high tone HL with an increased odds ratio of 1.88 (1.15‐3.07; P = 0.013). Both low and high PTAs in the better hearing ear increased with increasing BMI (P = 0.001 and P = 0.006, respectively).

Conclusions:

Obesity has a notable relationship with the presence and degree of HL in adolescents, particularly in the high frequencies, and further investigation is warranted.
Effect of Alcohol Consumption on Balance as Measured by Posturography
Authors: Stansifer Kyle J. , Moran‐Hansen Jessica , Aberle Katherine , Morrow Trish , Moore Gary , Jones Dwight T.
Published: August 2013

Objectives:

Evaluate the effect of increasing blood alcohol concentration (BAC) on the vestibular system as measured by abnormal body sway on posturography. Determine if there is a consistent level of BAC during which sway becomes adversely affected, as suggested by legal state limits of BAC for driving.

Methods:

Prospective study of 30 healthy adults randomized to alcohol versus no alcohol who consumed one beverage hourly followed by BAC measurement by BACtrack Select S80 Breathalyzer and posturography on both firm/soft surfaces with eyes open/closed. Primary outcome was dose‐response rate of BAC on mean body sway. Nonlinear growth models were used to control for covariates.

Results:

The experimental (alcohol) group had 20 adults, and the control (no alcohol) group had 10 adults. BAC levels measured by breathalyzer ranged from 0 to 0.12. Overall analysis showed no statistically significant difference between male and female performance (P > 0.05). Increased alcohol consumption was associated with increased abnormal body sway (P < 0.05); however, the exact level of BAC inducing abnormal sway was variable from individual to individual. An ANOVA model demonstrated a trend toward a learning curve with repeat posturography for the control group.

Conclusions:

This study demonstrated increasing vestibular dysfunction from increasing alcohol ingestion as measured with abnormal body sway by posturography. While all participants eventually showed increased sway with increased BAC, the point at which abnormal sway became evident was highly variable between individuals. Therefore, using strict state legal BAC limits do not always correlate with balance impairment.
Effects of Gonadal Steroids and Electrical Stimulation on Cell Survival following Intracranial Facial Nerve Injury
Authors: Amine Muhamad , Monaco Gina N. , Burgette Ryan C. , Benscoter Brent J. , Marzo Sam J. , Foecking Eileen
Published: August 2013

Objectives:

The purpose of this study was to assess 1) the degree of motoneuron cell loss and 2) the combinatorial effects of electrical stimulation (ES) and testosterone propionate (TP) on cell survival following an intracranial facial nerve crush injury and 3) to compare these results to distal injuries.

Methods:

Study Design: Prospective, randomized, controlled animal study. Sprague‐Dawley rats were randomly divided into three groups: intracranial sham surgery or intracranial crush injury with or without ES and TP treatments. The intracranial sham group underwent exposure of the meatal segment of the right facial nerve. The intracranial crush groups underwent a crush of the meatal segment following exposure with or without ES and TP treatment immediately following the injury and were followed for 8 weeks. Brain sections were thionin‐stained, and facial motoneurons were counted using light microscopy. Results were compared to intratemporal and extracranial facial nerve crush injuries.

Results:

Intracranial crush injury resulted in a significant decrease in cell survival of 65.6% as compared to the sham group (99.4%). The treatments increased cell survival to 93.8%. The cell loss in the intracranial facial nerve injury is more substantial than the intratemporal (85.8%) and extracranial (103.3%) injuries.

Conclusions:

Intracranial injury results in a more profound cell loss compared to the distal injuries; however, combinatory treatments improve facial motoneuron survivability regardless of injury location. These data suggest the important clinical implication that this combinatorial treatment may significantly improve cell survival and therefore facial nerve function following even the most severe facial nerve injuries.
Endolymphatic Periductal Channels: Possible Role in Ménière's Disease
Authors: Doherty Joni K. , Richard Celine , Fayad Jose N. , Linthicum Frederick H.
Published: August 2013

Objectives:

Characterize the osseous periductal channels surrounding the human endolymphatic duct. Endolymphatic hydrops is the fundamental pathophysiology underlying Ménière's disease. Elucidating the regulation of endolymphatic circulation is central to understanding the cause of Ménière's disease attacks of vertigo and hearing loss.

Methods:

Formalin‐fixed, celloidin‐embedded human temporal bones were sectioned to 20 microns, and every section was stained with hematoxylin & eosin. Amira software was used to construct a three dimensional image of the periductal channels. We performed immunohistochemical analysis using antibodies directed against vascular, lymphatic, and neural crest markers. The microanatomy was investigated with electron microscopy of the periductal channel epithelium. Finally, we injected horseradish peroxidase into the scala media of guinea pigs to investigate the flow patterns involving these peri‐ductal channels.

Results:

Surrounding the human endolymphatic duct is a group of small channels that originate in the proximal cisternal area of the endolymphatic sac and terminate in the supporting tissue of the saccule, as demonstrated by 3D reconstructions. Endolymphatic hydrops was found in eight bones with blocked ducts and blocked or absent periductal channels. Proliferation of channels was evident in temporal bones when the channels were disrupted on one side. Immunohistochemical analysis results suggest a neuroectodermal origin, similar to the cells of the cochlear spiral ligament. Some contain micro‐vessels with single endothelial walls that could represent lymphatics or empty capillaries while others suggest a complex absortive epithelium.

Conclusions:

This temporal bone study suggests a role for the periductal channels in absorption of endolymph.
Endolymphatic Shunt Surgery in the Era of Intratympanic Gentamycin
Authors: Moon Il J. , Golub Justin S. , Rubinstein Jay T.
Published: August 2013

Objectives:

Report hearing and vertigo outcomes of endolymphatic shunt surgery (ESS) patients with American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) definite Ménière's disease.

Methods:

We retrospectively reviewed charts of medically intractable Ménière's patients who underwent ESS at the University of Washington Medical Center. Thirty patients underwent ESS between 2005 and 2012. The surgical outcome was evaluated based on the 1995 guidelines of the American Academy of Otolaryngology—Head and Neck Surgery. Frequency of major vertiginous episodes was measured, and successful control of vertigo is considered as Class A or B (reduced by 60% to 100%). Pure‐tone average (PTA; 0.5, 1, 2, and 4 kHz) and word recognition score (WRS) that were obtained before and after treatment are compared.

Results:

Mean age was 46.9 years, and mean follow‐up duration was 23.1 months. Mean symptom duration prior to ESS was 5.3 years. Control of vertigo was achieved in 77.8% of the patients at the last follow‐up. Seven (25.9%) patients underwent secondary treatment, such as vestibular neurectomy or labyrinthectomy, for definite vertigo control. The mean PTA before and after surgery changed from 43.9 dB to 40.0 dB (P = 0.097), and the mean WRS significantly improved from 68.6% to 77.8% (P = 0.003). Three (10%) patients showed hearing deterioration following treatment.

Conclusions:

Endolymphatic shunt surgery provided successful vertigo control with a low rate of hearing deterioration associated with the surgery. Despite the good results reported by some authors with intratympanic gentamycin, ESS remains a valuable intervention after failure of medical management.
The Diaspora of Otolaryngologists after Residency Training
Authors: Thompson Christopher R. , Otto Randal A. , Miller Frank R.
Published: August 2013

Objectives:

1) Describe the transition of otolaryngologists from residency to clinical practice. 2) Provide data to state and local communities who could be sources of supplementary funding for graduate medical education.

Methods:

Cross sectional data from the 2009‐2010 Member Directory of the American Academy of Otolaryngology‐Head and Neck Surgery were analyzed. The sample included fellows of the AAO‐HNS practicing within the US and graduating from residency programs accredited by the ACGME. First year fellows, fellows of greater than thirty‐five years, and military fellows were excluded. Data from 5,870 otolaryngologists were analyzed. To evaluate trends within generations and career paths, subsets were divided by academic or non‐academic practice and by decade of completion of residency.

Results:

Relative to their residency program, 1/3 of otolaryngologists practice within 100 miles, 1/3 practice within 100‐500 miles, and 1/3 practice greater than 500 miles away. This was relatively constant for those in academic and non‐academic practice. This was also relatively constant across decades of graduation. Approximately 1/3 of otolaryngologists practice in the same state as their residency program whether in academic or non‐academic practice.

Conclusions:

Proposed reductions in federal funding of graduate medical education could result in the closure of approximately 18.4% of all ACGME training programs. This should stimulate otolaryngology leaders to explore alternative sources of funds from their state and local community, ie, those who most benefit from retaining valuable practitioners. Our data demonstrate a substantial portion of otolaryngologists practice within the area and state surrounding their residency program.
How Much Additional Information Is Provided by High‐Frequency‐Audiometry in Tinnitus Patients with Normal Standard Audiogram?
Authors: Kleinjung Tobias , Lehner Astrid , Fiedler Isabella , Steffens Thomas , Strutz Jurgen , Langguth Berthold , Vielsmeier Veronika
Published: August 2013

Objectives:

The majority of tinnitus patients suffer from hearing loss. However, a significant proportion of tinnitus patients show normal hearing thresholds in the standard pure tone audiogram (PTA, 125Hz – 8kHz). It has been argued that PTA is not sensitive for all forms of hearing impairment and the additional measurement of high frequencies (9 – 16 kHz) should complete the diagnostic set‐up. Here we aimed to investigate whether the results of high frequency audiometry (HFA) provide relevant additional information in tinnitus patients with normal standard PTA.

Methods:

From the database of the Tinnitus Clinic of the University of Regensburg we identified 75 patients with normal hearing thresholds in the standard PTA. We then contrasted patients with normal and pathological HFA and compared these two groups with respect to tinnitus severity, laterality, duration, tinnitus pitch, the presentation of selected somatic symptoms, and triggers of tinnitus onset.

Results:

Patients with pathological HFA were significantly older and had higher scores on the Tinnitus Questionnaire and the Tinnitus Handicap Inventory in comparison to patients with normal HFA. Furthermore, there was an association of high frequency audiograms and the laterality of tinnitus: patients with left and bilateral tinnitus had more pronounced high frequency hearing loss in the left ear.

Conclusions:

In summary, our data indicate that in patients with normal hearing in standard PTA, some additional information is provided by HFA. The association between tinnitus laterality and asymmetry of HFA suggests a potential causal role for the high frequency hearing loss in tinnitus etiopathogenesis.