bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Quality of Life in Bilateral Cochlear Implants
Authors: Nahm Edmund A. , King Nancy , Liberatos Penny , Shi Qiuhu , Kim Ana H.
Published: February 2015

Objective

1) Validate a newly developed Comprehensive Cochlear Implant Questionnaire (CCIQ) as a tool for assessing changes in quality of life after receiving a second cochlear implant (CI) in the contralateral ear. 2) Correlate speech perception changes after the second CI with quality of life.

Method

CCIQ is a 28‐item, 5‐point Likert‐scale questionnaire that assesses physical and psychosocial benefits of CI. This was administered to patients who received bilateral CI at our center. Test‐retest reliability and Cronbach’s alpha were used to validate the CCIQ. Speech perception was tested using CNC, HINT, and AZBio.

Results

We identified 103 adult bilateral CI patients from 2004 to 2011. Of 58 respondents, 21 completed a retest CCIQ. Test‐retest reliability was satisfactory, with 60% of items greater than 0.6. Coefficients for 6 of the 9 subdomains exceeded 0.6. Data suggest that internal consistency was acceptable (>0.7) for domains speech perception in quiet and noise, localization, and music, and good (>0.80) for subdomain vestibular effects. Descriptive statistics for speech perception on CNC were 62.4 ± 22.5% and 70.5 ± 18.4% using one versus bilateral CI, respectively. HINT scores were 68.0 ± 36.8% and 83.7 ± 15.4%, and AZBio 63.5 ± 34.6% and 91.6 ± 8.6%.

Conclusion

Early CCIQ data indicate this as a promising measure in assessing quality of life specific to bilateral CI patients. Overall, patients reported improved quality of life. Quantitative data on speech perception demonstrate increased trend in audiometric scores after the second CI. However, further testing is needed to strengthen these findings.
Benign Paroxysmal Positional Vertigo: 16‐Year Experience
Authors: Prokopakis Emmannuel , Kaprana Antigoni , Vlastos Ioannis , Tsagournisakis Minas , Christodoulou Panagiotis , Velegrakis George A.
Published: February 2015

Objective

To assess the short and long‐term efficacy of canalith repositioning procedure (CRP) in the treatment of patients with benign paroxysmal positional vertigo (BPPV).

Method

Nine hundred sixty‐five patients (481 men and 484 women, from 18 to 84 years old) were enrolled in this prospective study during 1995‐2010. Inclusion criteria were patient history compatible with BPPV and positive provocative maneuver (either Dix‐Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. A variant of Epley and Barbeque maneuver was used. The Epley maneuver was used for posterior and anterior canal involvement, and “Barbeque roll” was used for horizontal canal involvement. Short‐term follow‐up was obtained 48 hours and 7 days after initial treatment, whereas long‐term follow‐up was obtained at repeated 6 month intervals.

Results

The posterior semicircular canal was involved in 849 (88%) patients treated, whereas the horizontal and anterior semicircular canals were involved in 96 (10%) and 20 (2%) patients, respectively. Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients’ mean follow‐up was 72 months; symptom recurrence was noted in 135 patients. The great majority of them were elderly patients (n = 33) or had a history of either vestibular neuropathy (n = 27) or head trauma (n = 58).

Conclusion

Our data, based on long‐term follow‐up, suggest that CRP remains an efficient and long‐lasting noninvasive treatment for BPPV.
Central Auditory Function Evaluation in 811 Individuals
Authors: Sanchez Maura L. , Chaves Adriana , Alvarez Ana Maria , Tangerina Rodrigo D. P.
Published: February 2015

Objective

To describe central auditory function results in individuals who presented with language impairment, learning disability, and/or attention deficit.

Method

Central auditory behavioral tests from 811 patients were retrospectively analyzed: 497 (61%) were males, and median age was 20 years.

Results

One hundred ninety‐one (24%) individuals had normal values; 197 (24%) presented signs of central auditory immaturity; 226 (28%) presented signs of central auditory immaturity in association with language, memory, and/or attention impairment; and 196 (24%) presented signs of isolated cognitive and language impairment. Auditory dysfunction was more frequently observed in patients aged between 6 and 8 years. Cognitive and language impairment signals were better detected in those aged more than 9 years.

Conclusion

The tests chosen to evaluate central auditory behavior were able to identify the existence of specific dysfunctions and to point out the existence of auditory deficit underlying cognitive and language impairments.
Immediate Flap Repair of Pediatric Dog Bite Lip Avulsions
Authors: Wong Timothy S. , Adelson Robert T.
Published: February 2015

Objective

1) Recognize the operative technique for performing the split orbicularis oris myomucosal flap. 2) Identifiy candidates for repair using split orbicularis myomucosal flap. 3) Understand the utility of the split orbicularis oris myomucosal flap in the repair of complex dog bites of the flap.

Method

Case series of full thickness pediatric lip avulsion injuries secondary to dog bites with immediate flap reconstruction. Cases were reviewed from the last 5 years at an academic institution. All procedures were performed by the same surgeon. Outcome measures included pre‐ and postoperative photographs as well as assessment of patient satisfaction.

Results

A total of 3 patients underwent immediate primary repair of complex dog bites of the lip using split orbicularis myomucoal flaps. All patients were admitted postoperatively for IV antibiotic therapy and were discharged within 1 to 2 days on a 7‐ to 10‐day course of augmentin. No patients developed a postoperative wound infection. None of the patients required a scar revision procedure, and only 1 patient developed postoperative milia, which was managed in the office. Oral competence was maintained in all patients without any evidence of microstomia.

Conclusion

The split orbicularis oris myomucosal flap can be used to repair full thickness lip injuries secondary to dog bite injury. There is no evidence of increased postoperative infection when used for immediate reconstruction and oral competence is maintained. This flap provides good cosmetic outcomes without the need for scar revision.
Intratympanic Dexamethasone and HBO for Sudden Hearing Loss
Authors: Yang Chao‐Hui , Shao Chi‐Hsin , Wu Re‐Wen , Hwang Chung‐Feng
Published: February 2015

Objective

The objective of this study is to compare the efficacies of intratympanic dexamethasone (ITD), hyperbaric oxygen (HBO), and their combination (ITD plus HBO) as salvage therapies for sudden sensorineural hearing loss (SSNHL) patients after failure of systemic therapy.

Method

Ninety‐seven refractory SSNHL patients are enrolled in this study. Among them, 34 received ITD alone, 19 received HBO alone, 13 received a combination of ITD plus HBO, and 31 did not receive salvage therapies. The hearing outcome is determined by hearing gains between the audiometry before and after salvage therapies.

Results

Combination of ITD and HBO provides significantly greater hearing gain in 250 Hz and 500 Hz than the other 3 groups (P <. 05). Besides, in patients with initial profound hearing loss (>90 dBHL), the addition of HBO to ITD has a significantly larger hearing gain in mean thresholds of 500, 1000, 2000, and 4000 Hz (28.64 ± 3.49 dB) than ITD injection alone (15.75 ± 4.16 dB, P =. 029) and without any salvage therapies (13.64 ± 6.05 dB, P =. 015).

Conclusion

For patients with profound hearing loss, we recommend a combination of ITD injection and HBO as salvage therapies after failure of systemic steroid therapy. The benefit is greatest especially in lower frequencies.
Management of the Incus Body in Ossiculoplasty
Authors: Capra Gregory G. , Shah Anil N. , Ge Xianxi , Balough Ben J. , Pfannenstiel Travis J.
Published: February 2015

Objective

1) Evaluate the sound transfer impact of removal of the incus body in ossicular chain reconstruction (OCR) utilizing an incus strut prosthesis. 2) Provide basic science data to guide clinical decision making in ossiculoplasty.

Method

OCR with an incus strut prosthesis was performed on 7 human temporal bones with and without the incus body. The difference in round window membrane (RWM) peak‐ to‐peak displacements (90‐dB SPL, 250 to 8000 Hz) using single‐point laser Doppler vibrometry (LDV) was compared to observed baseline, intact ossicular chain values.

Results

For each of the 7 temporal bones, the average displacement decreased across most sound frequencies with OCR as compared with baseline. Median velocity differences (×10–3), with 95% confidence intervals in parentheses, from baseline for OCR with incus were 4.8 mm/s (2.1‐6.4), while median differences from baseline for OCR without incus were 3.0 mm/s (1.7‐4.2). A signed‐rank test yielded P =. 002, implying the median velocity is significantly lower when the incus body is removed. Secondarily, a variance ratio test showed no difference in variability between the 2 study arms (P =. 925).

Conclusion

Removal of the incus body in OCR utilizing an incus strut prosthesis significantly reduces the sound transfer function of the middle ear relative to its preservation. The finding suggests that preserving the incus body may stabilize the malleus and the tympanic membrane.
Ischemia and Wound Healing in a Cutaneous Flap Murine Model
Authors: Ludlow David , Lian Timothy S.
Published: February 2015

Objective

1) To establish a murine model to investigate cutaneous flap wound healing following ischemia reperfusion injury. 2) To characterize wound healing in a murine model with respect to tensile strength, blood flow, and tissue survival following varying periods of ischemia in a cutaneous flap.

Method

Twenty‐eight cutaneous flaps based on the inferior epigastric artery in C57BL/6J/CD11 mice were elevated. Ischemia up to 270 minutes was produced. Following ischemia, skin flaps were inserted then monitored for flap necrosis daily for 2 weeks using digital imaging. Wound tensile strength and blood flow were evaluated on day 14.

Results

Peak necrosis for flaps with ischemia times >210 minutes occurred on postoperative day 5 (necrosis M = 57%, CI: 52, 64%). Skin tensile strengths and blood flow for ischemic times >210 minutes were significantly less than tensile strengths for ischemic times <210 minutes.

Conclusion

The described cutaneous flap murine model establishes basic wound healing characteristics following ischemic injury that may be useful in further study of novel interventions that enhance wound healing and cutaneous flap survival ultimately resulting in improved patient outcomes.
Otoacoustic Emission in Noise‐Exposed Normal Hearing Workers
Authors: Sampaio Andre L.L. , Boger Marlene E. , Oliveira Carlos A.C.P.
Published: February 2015

Objective

Otoacoustic emission test is useful in monitoring hearing changes and cochlear damage by noise still not detectable in pure‐tone audiometry.The aim was to evaluate amplitude of the signal and signal/noise ratio of distortion product otoacoustic emissions (DPOAE) in normal hearing workers exposed to different noise doses.

Method

This is a cohort prospective study performed in metalworking industries, in 3 groups of normal hearing workers, GI not exposed (n = 50), GII sporadically exposed (n = 50), and GIII often exposed to occupational noise (n = 50). DPOAE were performed after 14 hours of hearing rest. “Pass‐fail” criterion was employed for analyses.

Results

Six hundred eight workers underwent hearing thresholds, and 150 of them matched the inclusion criteria and had DPOAE recorded. DPOAE alterations in amplitude of signal and signal to noise ratio were found in groups II and III bilaterally, and the higher the frequency tested the lower were the results in GII and GIII (P <. 05). The greater the exposure to noise dose the lower the results (P <. 05). GI showed better results according to pass and fail criterion and higher amplitude of the signal and signal/noise ratio than GII and GIII (P <. 05).

Conclusion

DPOAE results are worse in the exposed groups according to occupational noise dose. It is important to search for undetectable hearing changes in all workers exposed to occupational noise even sporadically, and to encourage the use of hearing protectors, in order to prevent possible irreversible damage.
Microtia Reconstruction
Authors: Amali Amin , Yazdi Alireza Karimi , Sazgar Amir Arvin , Sadeghi Mohammad , Langeroudi Maziar Motiee , Firoozi Farzad , Emami Hamed
Published: February 2015

Objective

Reconstruction of microtia is a challenging issue in otology and reconstruction surgery. Autogenous costochondral reconstruction is the most widely accepted approach; however, it is time‐consuming and has some limitations. Irradiated homograft costal cartilage has been proposed as a suitable alternative. In this study we present our experience with this approach.

Method

A total of 19 ears were treated with irradiated homograft costal cartilage prepared from 18‐ to 40‐year‐old cadavers under a standardized processing method. The reconstruction was achieved by a 2‐stage procedure with at least 3 months’ interval.

Results

Study population included 9 (56.25%) males and 7 (43.75%) females with the mean age of 13.7 ± 5.1 years. Microtia was bilateral in 3, right‐sided in 8, and left‐sided in 5 subjects. Subjects were followed for 36.0 ± 9.9 months. Short‐term and long‐term complications were negligible.

Conclusion

Irradiated homograft costal cartilage resulted in relatively high satisfaction and low complication rates for auricular reconstruction. Aesthetic appearances of the reconstructed auricle were acceptable. The advantages of this approach are the elimination of additional incisions for graft harvesting and donor site morbidity.
Unilateral Enlarged Vestibular Aqueduct in Children
Authors: Provenzano Matthew , Greinwald John H. , de Alarcon Alessandro , Uwiera Trina , Meinzen‐Derr Jareen , Cohen Aliza
Published: February 2015

Objective

1) Describe the likelihood of contralateral hearing loss (HL) in patients with unilateral enlarged vestibular aqueduct (UEVA). 2) Detemine the positve predictive value of genetic testing in patients with UEVA. 3) Determine the correlation of temporal bone measurements in patients with UEVA.

Method

Patients were identified from a database of children with sensorineural hearing loss (HL) and enlarged vestibular aqueduct (EVA) between 1998 and 2010. A group of patients with unilateral HL without EVA was also identified. Outcomes measured were HL phenotype, laterality of EVA, midpoint and operculum measurements, and genetic tests.

Results

Fifty‐five percent of patients with UEVA had HL in the contralateral ear. There was no difference in the rate of HL progression in patients with bilateral and unilateral EVA (P =. 1). However, both EVA groups had higher rates of progression compared to patients with unilateral HL alone. A correlation was shown for the presence of HL at 250 Hz and the risk of more severe HL and progressive HL. Patients with bilateral EVA and SLC26A4 mutations had a higher rate of progression than patients who had no mutations (P =. 02). No patients with UEVA had Pendred syndrome.

Conclusion

Children with unilateral EVA have a significant risk of HL progression. Hearing loss in the contralateral ear is common, suggesting that unilateral EVA is a bilateral process. Temporal bone measurements, HL severity, and HL at 250 Hz were correlated with the risk of progressive HL.
CT vs MRI to Evaluate Hearing Loss in Children
Authors: Dedhia Kavita , Chi David , Pike Francis
Published: February 2015

Objective

1) To report the findings of both computed tomography (CT) and magnetic resonance imaging (MRI) in children with hearing loss. 2) To find if there is a significant difference between these 2 radiographic modalities and between hearing loss groups.

Method

Retrospective review of 120 children diagnosed with sensorineural hearing loss from 2005 to 2011 with both CT and MRI at a tertiary care center. Patients were divided into an asymmetric vs symmetric population and a mild/moderate hearing loss vs severe/profound hearing loss group. Radiographic findings were obtained via chart review.

Results

Asymmetric hearing loss was found in 55% of patients, while 45% had symmetric loss. Group 1 (mild and moderate loss) accounted for 60%,while group 2 (severe and profound loss) was found in 40% of patients. More abnormalities were found in the asymmetric compared to symmetric population on both CT (P =. 0001) and MRI (P =. 02). A significant difference was noted between the number of anomalies in group 2 vs group 1 hearing loss on the MRI (P =. 0002), but not CT (P =. 19). No significant difference was found between MRI and CT within any of the groups.

Conclusion

Both radiographic tests found more abnormalities in the asymmetric population. Only MRI found more abnormalities in group 2 vs group 1 with statistical significance. The decision to use CT vs MRI remains controversial because they are complementary. However, obtaining an MRI in severe and profound hearing loss may be beneficial.
Prelamination of Radial Forearm Free Flap with Buccal Mucosa
Authors: Kim Grace G. , Halvorson Eric G. , Hackman Trevor G.
Published: February 2015

Objective

1) To describe a new technique for prefabricating a fasciomucosal flap on the forearm. 2) To report initial outcomes of reconstruction using this technique for small oral defects. 3) To learn how to apply and customize the prelaminated radial forearm fasciomucosal flap for reconstruction of the head and neck.

Method

This is a case series of 3 patients who underwent reconstruction with a prelaminated radial forearm fasciomucosal flap for small lip or oropharyngeal defects at a tertiary referral center from September 2011 to December 2011. Initial clinical outcomes are described and patient photographs are shown.

Results

We prelaminated and successfully transferred 3 flaps in 3 male patients ranging in age from 46 to 53 years. These patients required reconstruction of a lip (n = 1) or oropharyngeal (n = 2) defect after removal of a head and neck arteriovenous malformation (n = 2) or cancer (n = 1). All flaps were prelaminated utilizing morcelized buccal mucosa grafts. Second stage transfer typically occurred approximately 2 to 3 weeks after prelamination. There were no intraoperative complications and no postoperative bleeding, infection, or flap failures. Reconstruction was stable and satisfactory at a range of 2‐5 months following surgery.

Conclusion

The prelaminated radial forearm fasciomucosal flap using morcelized buccal mucosa for aerodigestive defects minimizes donor site morbidity and allows for mucosal restoration. A larger multisite study will provide more information on clinical outcomes.
Epidemiology of Chronic Rhinosinusitis in Children
Authors: Smith David F. , Arnaoutakis Demetri , Ishman Stacey L. , Boss Emily F.
Published: February 2015

Objective

Although chronic rhinosinusitis (CRS) is common in children, the role of race/socioeconomic status (SES) has not been evaluated. We describe the epidemiology of children with CRS in an urban pediatric otolaryngology clinic and evaluate demographic differences compared to a group representative of the general pediatric otolaryngology population.

Method

Observational study (retrospective cohort with comparison group) of all new/consult patients (March 3, 2008, to July 1, 2011) in an urban tertiary pediatric otolaryngology clinic with diagnosis of CRS. The comparison group consisted of all new/consult patients seen in the same clinic over a 3‐month period. Records were evaluated for demographics/insurance. Characteristics were compared between groups using Mann‐Whitney and Fisher’s exact tests.

Results

177 children with CRS were compared to 430 control patients. Compared to the general pediatric otolaryngology population, children with CRS were younger (5.9 ± 4.8 vs 8.2 ± 4.4, P <. 0001) and more commonly male (62% vs 52%, P =. 025). Compared to controls, more children with CRS were white (CRS 77% white; 10% black; 13% other vs control 47% white; 33% black; 20% other, P <. 0001). Likewise, children with CRS were less commonly insured with Medical Assistance (CRS 14% vs control 43%, P <. 0001).

Conclusion

Compared to the general population of children seen in this setting, children with CRS were more likely to be white/privately insured. This study is the first to evaluate race/SES in relation to pediatric CRS. Future research should employ nationally representative data to assess true variation of demographic factors in children with CRS.
Hearing Evaluation for Pediatric Cochlear Implant with ASSR
Authors: Beck Roberto , Tsuji Robinson K. , Ramos Henrique F. , Brito Neto Rubens V. , Almeida Edigar R. , Grasel Signe S. , Rossi Amanda C.
Published: February 2015

Objective

The aim of this study was to evaluate Auditory Steady‐State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral test responses.

Method

This prospective study evaluated 54 children with severe‐to‐profound hearing loss, aged from 3 to 72 months, between January and December 2011. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dBHL with a 10 dB‐down seeking procedure. ASSR and behavioral test results were compared.

Results

Forty‐two subjects completed both ASSR and behavioral evaluation. In 13 children behavioral tests were not available, 1 had inconclusive ASSR. Among 42 children with absent ABR and OAE, 11 (26.1%) had bilateral ASSR, 10 correlated well to behavioral results. Four (9.5%) showed unilateral responses in at least 2 frequencies, all confirmed by behavioral results. Among 27 subjects with absent ASSR, 8 had no behavioral responses; 12 had responses only in low frequencies >110 dBHL, 7 showed behavioral responses at all frequencies in medium to high intensities. No spurious ASSR responses were observed at 100 or 110 dBHL in any frequency.

Conclusion

ASSR is a valuable tool to detect residual hearing in young children with absent ABR and OAE. No false‐positive ASSR results were observed, but in 7 cases with absent ASSR, the test underestimated residual hearing as compared to the behavioral responses.
Otoendoscopy in the Management of Congenital Cholesteatoma
Authors: Kanotra Sohit P. , James Adrian L.
Published: February 2015

Objective

To evaluate the use of otoendoscopy in the surgical management of congenital cholesteatoma.

Methods

All patients with congenital cholesteatomas were reviewed from a 10‐year prospective pediatric otological database. Otoendoscopy was primarily used to identify and remove any intraoperative residual disease after otomicroscopic excision of cholesteatoma.

Results

A total of 27 patients with congenital cholesteatoma were included. The mean age of the population was 6.9 years (range 3‐15 years); 39.2% of the cases were stage I with 35.7% stage II and 25% stage III. After surgical resection of the cholesteatoma under otomicroscopy, 4 (14.8%) were found to have involvement of the sinus tympani on endoscopy while 1 had involvement of the anterior epitympanum. The overall rate of detection of intraoperative residual cholesteatoma using the otoendoscope was 18.5%. In 2 cases the otoendoscope helped in preservation of the ossicles by facilitating dissection in the attic.

Conclusion

This is the first study to define the role of otoendoscopes in congenital cholesteatoma. The enhanced access to the medial epitympanum and recesses of the mesotympanum provided by endoscopy are ideally suited to the typical locations of congenital cholesteatoma. We have found it especially beneficial in identifying and removing cholesteatoma left after otomicroscopic resection and in preserving the integrity of the ossicular chain. Consequently, lower residual disease rates and better hearing results can be anticipated as a result of endoscopic surgery.
Outcomes of Cartilage Tympanoplasty in Pediatric Patients
Authors: Friedman Adva B. , Dornhoffer John L.
Published: February 2015

Objective

To determine whether a relationship exists between successful outcomes of cartilage tympanoplasty and age at repair.

Method

A retrospective chart review of patients between ages 4 and 13 who underwent cartilage tympanoplasty for tympanic membrane perforations from August 2005 to November 2011 was preformed. Demographics, complication data, and auditory outcomes were collected.

Results

Patients were subdivided into 3 age groups. Group 1 consisted of patients less than 7 years of age (n = 43), group 2 ages 7 to 10 (n = 40), and group 3 ages 10 to 13 (n = 36). Mean follow‐up was 595 days (range = 48‐1742). Complication rates respective to the 3 groups were as follows: Eustachian tube dysfunction (ETD) or fluid causing a conductive hearing loss (9.3%, 10%, 5.6%), need for tympanostomy tubes (4.7%, 2.5%, 0%), remnant perforation (7%, 5%, 2.8%), and revision tympanoplasty (2.3%, 2.5%, 0%). Resolution of ETD or fluid on subsequent visits precluded tube placement. A 1‐way analysis of variance (ANOVA) was performed to evaluate complication rates between groups. No significant differences were found (remnant perforation, P =. 70, repeat tympanoplasty, P =. 64, tympanostomy tubes, P =. 42, and ETD or fluid, P =. 76). Improvement in pure tone average was 10.23, 12.5, and 3.95, respectively.

Conclusion

A trend for slight increase in complications in children under the age of 10 was found but was not statistically significant. There were significant group differences in hearing improvement with younger patients demonstrating better outcomes. The implications for these findings will be discussed. These data suggest cartilage tympanoplasty can be performed effectively in young children when appropriate conditions exist.
Shape Fidelity of Human Nasal Septal Neocartilage Constructs
Authors: Reuther Marsha S. , Briggs Kristen K. , Sah Robert L. , Watson Deborah
Published: February 2015

Objective

1) To show that human septal neocartilage constructs possess comparable shape fidelity to native human septal tissue. 2) To demonstrate that the biochemical properties of human septal neocartilage constructs are unaffected by imposed bending and are equivalent to those of free‐swelling controls.

Method

Human septal chondrocytes from 9 donors were used to create 12‐mm constructs. These were cultured for a total of 10 weeks and subjected to bending for 6 days. Free‐swelling controls and native tissue were used for comparison. Shape retention, photo documentation, live‐dead staining, and biochemical properties were measured.

Results

Live‐dead staining showed no difference in cell survival between shaped constructs and free‐swelling controls. The immediate shape retention of the constructs was 39.0% versus 23.5% for native tissue (P =. 06). After 2 hours of relaxation, the constructs possessed similar shape retention to native tissue (26.9% and 20.6%, respectively; P =. 073). There was a significant decrease in shape retention from immediately after release to 2 hours of relaxation (23.5% and 18.9%, respectively; P =. 01). However, the retention did not change significantly between 2 and 24 hours of relaxation (18.9%; P =. 11). There was no significant difference in biochemical properties between shaped constructs and free‐swelling controls.

Conclusion

The shape retention properties of human septal neocartilage constructs are similar to human native septal cartilage. In addition, bending of neocartilage constructs does not adversely affect cell viability or biochemical properties. This study demonstrates that neocartilage constructs possess adequate shape fidelity for use as septal cartilage graft material.
Prevalence of MT‐RnR1 in the General Population
Authors: Ibekwe Titus Sunday , Bhimrao Sanjiv K. , Westerberg Brian D. , Kozak Frederick K.
Published: February 2015

Objective

Review the prevalence of MT‐RNR1 genetic mutation and assess the need for neonatal screening prior to gentamicin therapy. A comprehensive search of MEDLINE, EMBASE, Cochrane Library, Clinical Evidence, and Cochrane Central Register of Trials was performed. The reference lists were cross‐referenced. Review was restricted to human studies in English language.

Method

Studies describing the prevalence/incidence of MT‐RNR1 gene mutations (A1555G, C1494T, A7445G) in the population. Relevant studies screening for presence for MT‐RNR1 in patients receiving aminoglycoside therapy were included.

Results

Twenty‐two articles out of 67 full papers and 206 abstracts from 1948 to November 2011 met the inclusion criteria. These included 9 prospective case‐control studies, 12 case series, and a case report. There is weak evidence that MT‐RNR1 is globally prevalent with racial bias especially in Chinese and Spanish populations. The prevalence/incidence ranged from 0.09%‐2.9% in general population to 17% in the high‐risk population. Weak evidence of neonatal sensorineural hearing loss following aminoglycoside exposure was also seen.

Conclusion

There is a need for large national epidemiological studies to assess the prevalence of MT‐RNR. Some evidence of a global prevalence of MT‐RNR1 with racial bias and link between aminoglycoside exposure and NSHL among at risk group. It is difficult to justify routine screening of patients for MT‐RNR1 with the available literature.
Specific versus Generic Outcome Measure in Adeno‐Tonsil Pathology
Authors: Awad Zaid , Rennie Catherine E.
Published: February 2015

Objective

1) Compare the disease specific T14 outcome measure score to the generic quality of life CHQPF28 score in children with adenotonsillar pathology. 2) Investigate the relation of number of episodes of tonsillitis and presence of sleep apnea to both scores.

Method

Cross‐sectional study carried out in 2011. Parents of 146 children undergoing tonsillectomy or adenotonsillectomy at 3 London hospitals completed both T14 and CHQPF28 questionnaires. We also inquired about the number of episodes of acute tonsillitis a child suffers from each year and whether they have obstructive sleep apnea (OSA). Their scores were analyzed to measure the relation between the 2 tests and investigate the usefulness of the T14 as a measure of the impact of adenotonsillar pathology on children’s health.

Results

The T14 infective and total score correlated well with the number of episodes of tonsillitis children have (Spearman rs = 0.5 and rs = 0.64). The obstructive element differentiated between children with OSA and no OSA (t test P <. 001). However, the overall T14 score, its infective and obstructive components, did not correlate well with the children CHQPF28 scores (rs = −0.01, P =. 95; rs = −0.08, P =. 53; rs = −0.09, P =. 47; respectively).

Conclusion

The T14 performs well in predicting patients with significant adenotonsillar pathology with its infective and obstructive component and is a good outcome measure for treatment. It is not a good indicator of the impact of adenotonsillar disorder on the child’s overall well‐being as a static measure when compared to a generic quality of life test.
Use of Endoscopic Vascularized Nasoseptal Flap in Children
Authors: Giannoni Carla , Whitehead William
Published: February 2015

Objective

1) Determine ability to achieve 100% coverage of sellar skull base defects with the vascularized nasal septal flap in pediatric patients. 2) Identify the rate of residual CSF leaks following this repair technique in these pediatric patients. 3) Review the demographics and perioperative course in these children.

Method

Study design: Retrospective case series. Study conducted: January 1, 2006, to January 1, 2012. Condition studied: Repair of skull base defects after resection of sellar lesions. Subjects: Children. Setting: Children’s hospital. Intervention: Endonasal repair of skull base defects with a vascularized nasoseptal flap. Outcome measurement(s): 1) Complete coverage of defect. 2) Postoperative CSF leak.

Results

Demographics: Ten children were identified, and 11 flaps were performed. The average patient age was 12.6 years old (range of 5.1‐17.4 years). Total coverage was achieved in all cases. The technique was particularly challenging in the younger patients. A brisk CSF leak was observed during closure in 3 cases, but no CSF leaks were observed after balloon packing removal (day 5). No lumbar drains were used. Only minor complications were observed. A second look with debridement of packing material due to poor cooperation with office endoscopy was done in 7 children (70%).

Conclusion

The endonasal vascularized nasal septal flap is a feasible and reliable method of repair of dural defects after resection of sellar lesions in children. Despite active CSF leak in 3 children, there were no residual CSF leaks. Unlike adult patients, children may require operative nasal debridement after repair has healed.
Turbinate Surgery in Rhinoplasty: Randomized Clinical Trial
Authors: Lavinsky‐Wolff Michelle , Camargo Humberto L. , Barone Carolina , Rabaioli Luisi , Petersen Sara , Dolci Jose E. L. , Polanczyk Carisi A.
Published: February 2015

Objective

Evaluate the role of turbinate reduction during rhinoplasty in quality‐of‐life outcomes and nasal airway cross‐sectional area.

Method

Adults with nasal obstruction, functional and aesthetics primary rhinoseptoplasty candidates were randomized to rhinoseptoplasty with or without inferior turbinate reduction. Study was conducted from December 2010 through January 2011 at the facial plastic clinic of a tertiary center in Brazil. Changes in Nasal Obstruction Symptom Evaluation (NOSE) and WHOQOL‐bref scores and acoustic rhinometry (AR) were assessed.

Results

Fifty were included, mainly Caucasians with moderate/severe allergic rhinitis symptoms. Mean age was 32 ± 12 years. Baseline characteristics were similar between groups. Rhinoseptoplasty improved specific and general quality‐of‐life scores irrespective of turbinate intervention group (P <. 001). There was no difference in relative change of NOSE score (–75% vs –73%; P =. 893); WHOQOL‐bref score domains (Physical: 7% vs 6% [P =. 10]; Psychological: 6% vs 7% [P =. 158]; Social: 0% vs 0% [P =. 99]; Environment 7% vs 5% [P =. 77]), NO‐VAS (–88% vs –81%; P =. 89), and all AR recordings (P >. 05) between turbinate reduction and no turbinate reduction groups, respectively.

Conclusion

Turbinate reduction during primary rhinoplasty did not improve short‐term general and specific quality‐of‐life outcomes or acoustic rhinometry recordings.
Flaps for Craniofacial Reconstruction
Authors: Chaaban Mohamad R. , Chaudhry Ajaz , Woodworth Bradford A.
Published: February 2015

Objective

Skull base reconstruction is one of the most challenging aspects of anterior skull base surgery, especially in the context of previous radiation treatment. The objective of the current study is to describe a novel strategy utilizing pericranial flap (PCF) and nasoseptal flap (NSF) closure following endoscopic‐assisted craniofacial resection (EA‐CFR) of sinus/skull base tumors.

Method

Review of a prospectively collected database containing patients treated with combined PCF/NSF closure was performed between January 2008 and December 2011 at the University of Alabama at Birmingham. Demographics, pathology, surgical goals, location, technique, length of hospital stay, adjuvant treatments, and clinical status were assessed.

Results

Four patients (average age 42.7 ± 5.2 years) had EA‐CFRs utilizing the PCF/NSF reconstructive technique. Tumor histopathology included esthesioneuroblastoma (n = 2), mixed adenocarcinoma/esthesioneuroblastoma (n = 1), and sinonasal undifferentiated carcinoma (n = 1). Surgical goals were curative intent in all patients. The average length of stay following surgery was 3 days (range of 2‐4). There were no postoperative CSF leaks or other complications. Three patients had received neoadjuvant chemo/radiation therapy. The NSF was utilized to cover the PCF at the junction of the planum sphenoidale and PCF in all patients. All patients have complete locoregional control with an average follow up of 26 months (17‐41), although 1 patient is alive with metastases.

Conclusion

Reconstruction of anterior skull base defects following EA‐CFR utilizing the combined PCF/NSF technique resulted in effective closure in all patients in this series. Providing a double layer of vascularized tissue is a reasonable strategy particularly in the setting of neoadjuvant radiation treatment.
Histopathological Characteristics of Nasal Polyps in Smokers
Authors: Kule Zeynep G. , Habesoglu Tulay E. , Somay Adnan , Deveci Hande S. , Kule Mustafa , Gursel Ali O.
Published: February 2015

Objective

Cigarette smoking causes squamous metaplasia in upper and lower airways. We hypothesized that in patients with nasal polyposis, nasal polyps of smokers might reveal histopathological changes, and there might be an increased neoplasia risk. Therefore, we aimed to explore the effects of smoking on nasal polyp histopathology and clinical measures.

Method

This retrospective chart review consists of 30 smoker and 47 nonsmoker patients with nasal polyposis who underwent endoscopic sinus surgery between 2007 and 2011. We aimed to assess the effect of smoking on histopathological characteristics of nasal polyps and clinical measures. They were compared according to light microscopic findings.

Results

No statistically significant differences were found between smoker and nonsmoker groups with regard to histopathological findings (P >. 05). Also, there were no significant correlation defined by endoscopy, computed tomography, and Nasal Obstruction Symptom Evaluation (NOSE) scores of patients between the 2 groups (P >. 05). Smoking did not have significant effect on the presence of allergy or asthma. But blood eosinophil levels were found to be significantly higher in the smoker group (P <. 05).

Conclusion

This is the first clinical study that investigates the effect of smoking on nasal polyp histopathology. In spite of the fact that smoking is associated with histopathological changes in respiratory mucosa, we did not find any significant change in histopathological characteristics of nasal polyps in smokers.
Is MRI Indicated in the Workup of Olfactory Loss?
Authors: Hoekman Peter K. , Houlton Jeffrey J. , Seiden Allen M.
Published: February 2015

Objective

To understand the utility and cost‐effectiveness of magnetic resonance imaging (MRI) in the evaluation of patients with postviral and idiopathic olfactory loss.

Method

A retrospective review of consecutive patients presenting with olfactory disorders at a university‐based taste and smell center from July 1998 through October 2011 was performed in an attempt to identify patients with postviral and idiopathic olfactory loss and to determine the diagnostic utility of MRI in their evaluation.

Results

Eight hundred thirty‐nine patients (average age 53 years, 62% female gender) presented with olfactory loss with a mean University of Pennsylvania Smell Identification Test (UPSIT) score of 21.0. The most common etiologies were postviral (27%), obstructive (13%), traumatic (10%), and idiopathic (29%) olfactory loss. MRI was used in the evaluation of idiopathic and postviral loss 54.9% and 26.4% of the time, respectively, and abnormalities were identified in 4.6% and 3.4% of patients. However, only 2.3% and 1.7% of patients had olfactory loss attributable to imaging abnormalities on MRI.

Conclusion

The most commonly identifiable etiology of olfactory loss in this series was viral infection; the cause often remained unknown. Brain MRI, though frequently performed, demonstrated a very low diagnostic yield. Based on these data, we recommend against the routine use of MRI in patients with idiopathic and postviral olfactory loss.
Microbial Contaminants in Irrigation Devices
Authors: Nguyen Shaun A. , Psaltis Alkis J. , Schlosser Rodney J.
Published: February 2015

Objective

Irrigation devices used by patients suffering from chronic rhinosinusitis become contaminated after use. The purpose of this study was to see whether such devices can also become contaminated when used by patients with allergic rhinitis (AR).

Method

Ten AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus irrigation system and instructed on its proper use, cleaning, and storage. Bottles were analyzed at 4 weeks and 8 weeks for microbial growth.

Results

Irrigation devices (14/20) from all individuals in this study grew bacteria commonly in the nozzles. Twenty‐five bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus. No fungal organisms were cultured using the above techniques. In addition no correlation was apparent between the length of bottle use and the degree of contamination. During the study period, no patient developed acute sinus infections.

Conclusion

Bacterial contamination of the irrigation system occurs commonly, even in uninfected AR patients; however, no evidence exists linking this to sinus cross‐infection.
Oral Itraconazole as an Adjunct to Steroids in AFRS
Authors: Panda Naresh K. , Francis Abhilash A. , Chakrabarti Arunaloke , Virk Ramandeep S.
Published: February 2015

Objective

To evaluate itraconazole therapy in allergic fungal rhinosinusitis.

Method

Prospective randomized study in 75 cases of allergic fungal rhinosinusitis. The subjects were randomized to 2 groups. All the patients were subjected to endoscopic sinus surgery. The specimen was analyzed for mycological profile and histopathological characteristics. Those assigned to group A were given oral steroids and those in group B were given oral steroids and itraconazole for 3 months. These patients underwent follow‐up examination at 6 weeks, 12 weeks, and 24 weeks with postoperative nasal endoscopic examination and computerized tomography. Random blood sugar estimation and liver function tests were done to watch for side effects. Ten patients were lost to follow‐up during the study period. Hence statistical analysis was done in 65 patients; 39 subjects in group A and 26 in group B.

Results

Fungal smear was positive in 84.6% of subjects. Aspergillus flavus was commonly isolated. Patients receiving adjunct itraconazole therapy had a better cavity healing at 12‐24 weeks of follow‐up compared to those receiving steroids (P =. 027). Patients with intraorbital extension had lesser chance of recurrences on oral itraconazole compared to steroids (P =. 018). Itraconazole therapy was found to be beneficial in recalcitrant cases (P =. 050). No side effects were observed with itraconazole.

Conclusion

Itraconazole as an adjunct to corticosteroids has no advantage at 6 months of follow‐up. However, it results in better cavity healing. Itraconazole was found to be beneficial in preventing recurrences in recalcitrant cases and patients with intraorbital extension.
Quality of Life after Balloon Sinuplasty
Authors: El‐Guindy Ahmed S.
Published: February 2015

Objective

To compare the quality of life of chronic sinusitis patients treated with FESS and those treated by balloon sinuplasty through a randomized prospective study.

Method

Study design: prospective cohort. Time frame: August 2009 to December 2011. Disease: Chronic rhinosinusitis. Setting: Tanta University Hospitals. Subjects and methods: Twenty patients suffering from chronic rhinosinusitis were randomly distributed into 2 equal groups: group A treated with FESS and group B treated with balloon sinuplasty. Outcome measurements: Preoperative and postoperative evaluation by SNOT‐20 questionnaire, endoscopic examination, and Lund‐Mackay CT staging.

Results

The balloon catheters dilated all ostia successfully (17 maxillary, 5 sphenoid, and 3 frontal recesses). No adverse effects were recorded. At 12 months, overall patency in 88%, non‐patency rate of 4%, and “indeterminate” in 8%. In 2 sinuses, a revision procedure was required (8%) based on clinical and CT findings, compared to 3 sinuses in FESS group. There was a significant improvement over baseline measures in the SNOT‐20 in both procedures. As for the patients satisfaction with the interventions; 100% answered “yes, they would undergo the procedure again,” for sinuplasty, against 40% of the patients submitted to FESS.

Conclusion

Balloon sinuplasty is safe and effective and improves patients’ quality of life. It may be used as a stand‐alone or as a hybrid procedure. Candidates are patients with chronic sinusitis limited mostly to ostial obstruction. Cases of isolated sphenoid, maxillary, and frontal sinusitis are particularly attractive to avoid resection of normal ethmoid sinuses.
Validating the Sheep Model in Rhinology Skills Training
Authors: Awad Zaid , Arora Asit , Touska Philip , Tolley Neil S. , Darzi Ara
Published: February 2015

Objective

1) Investigate face and content validity of the sheep model in operative rhinology skills training. 2) Investigate the applicability and transferability of skills acquired in otolaryngology training curriculum.

Method

An evaluation study conducted in February 2012. Fifteen otolaryngology trainees (level: 3‐5) and 5 experts completed 9 operative rhinology tasks on a pre‐prepared sheep model and assessed face and content validity using a Likert scale across 20‐item questionnaire. Participants also evaluated the model in teaching individual tasks and globally as training tool.

Results

The model achieved face validity of 4.1 with no significant difference between expert and intermediate groups (4.0 and 4.3, Wilcoxon P =. 14). Content validity score was 4.2, with experts scoring higher than the intermediate group (4.0 and 4.5, Wlicoxon P =. 043). The highest scoring skills were improving hand‐eye‐coordination and operative skills (4.7 and 4.6), and the worst was anatomy teaching (3.4). The highest scoring tasks were foreign‐body removal and cerebrospinal fluid leak repair (4.4 and 4.0), and the worst was middle‐meatal‐antrostomy and septoplasty (3.3 and 3.6). Two data points were missing (99.5% completion). All agreed on transferability, incorporation into curriculum, and recommending to colleagues (4.2, 4.5, and 4.4).

Conclusion

The sheep model achieved face and content validity and is recommended by experts and trainees for teaching rhinology skills. Advantages include availability, realism, and applicability of acquired skills in rhinology procedures. The model achieved >4/5 Likert scale in teaching endoscopic examination, foreign‐body removal, cerebrospinal fluid leak repair, and sphenopalatine artery ligation.
Effects of Surgery on Quality of Life in Obstructive Sleep Apnea Syndrome
Authors: Kizilbulut Gultekin , Ark Nebil , Ugur Kadriye S. , Yuksel Alper , Kurtaran Hanifi , Gunduz Mehmet
Published: February 2015

Objective

To understand the influence of surgical treatment on quality of life and depression score in simple snorers and in mild, moderate, severe obstructive sleep apnea syndrome (OSAS) patients.

Method

This prospective cohort study involved 65 patients who underwent surgery with the diagnosis of simple snoring and OSAS between years 2007‐2011. Short‐form health survey (SF‐36) and Beck Depression Inventory were used before and 18 months following surgery together with nocturnal polysomnography. Kruskal‐Wallis test was used for statistical analysis.

Results

There was a statistically significant difference in apnea‐hypopnea indexes (AHI) of moderate and severe apnea groups following surgery (P <. 001). There was an increase in general health level of SF36 in mild apnea group (P =. 009). There were increases in general health level and vitality level of SF36 in the moderate apnea group (P <. 001). There was no difference among groups in Beck Depression Inventory scores postoperatively (P >. 0125).

Conclusion

Despite the favorable differences in apnea‐hypopnea index scores, there is a limited favorable effect of surgical treatment on quality of life scores and no influence on depression scores in simple snorers and OSAS patients.