bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of SPI‐1005 for Prevention of Noise‐Induced Hearing Loss: Phase 2 Clinical Trial Results
Authors: Kil Jonathan , Lynch Eric D. , Griffiths Scott , Lobarinas Edward , Spankovich Christopher , Antonelli Patrick J. , Prell Colleen Le
Published: September 2014

Objectives:

Determine the safety and efficacy of SPI‐1005, a novel oral glutathione peroxidase (GPx) mimic and inducer, in preventing and treating noise‐induced hearing loss (NIHL) in adults ranging from slight hearing loss (≤25 dBHL) to normal hearing.

Methods:

Randomized double blind placebo controlled Phase 2 clinical trial conducted December 2012 through November 2013. A total of 83 subjects at the University of Florida were enrolled and treated with either placebo or SPI‐1005 prior to a single iPod sound exposure lasting 4 hours that induced a slight temporary threshold shift (TTS). The incidence (≥10 dBHL), severity (dBHL), and duration (up to 1 week post sound) of the TTS were determined by serial pure tone audiometry. The intervention (200, 400, or 600 mg SPI‐1005 twice daily × 4 days) was compared with matching placebo in reducing the TTS. Significance was determined by 2‐tailed t tests comparing a specific SPI‐1005 treatment group versus placebo.

Results:

Oral SPI‐1005 treatment showed a significant reduction in TTS incidence (60% vs 20%, P <. 01), severity (4.2 vs 1.1 dBHL at 4 kHz, P <. 01), and duration (24 vs 1.3 hours, P <. 01). SPI‐1005 treatment was well tolerated with no drug‐related adverse events (CBC, Chem20, chest x‐ray).

Conclusions:

SPI‐1005 treatment demonstrated clinically relevant reductions in TTS induced by loud sound exposure. Multiday treatment with all SPI‐1005 dosages was well tolerated. These data support the continued development of SPI‐1005 in noise exposed populations and the GPx mechanism of action in preventing and treating NIHL.
The Envoy Esteem Hearing System: Single Surgeon Experience
Authors: Sappington Joshua M. , Marzo Sam J.
Published: September 2014

Objectives:

(1) Review the results of patients undergoing Envoy Esteem implantation from December 2010 through December 2013. All procedures were performed by the same senior surgeon (S.J.M.). (2) Analyze results following implantation of the Envoy Esteem System to determine if patients achieved statistically significant improvement in pure tone average (PTA).

Methods:

Patients undergoing implantation at Loyola University Medical Center were analyzed regarding preoperative, postimplantation audiometric data, complications, infections, and revision surgery. Study design: Institutional review board approved, retrospective study.

Results:

A total of 109 Esteem related procedures were performed. Seventy‐one primary implants were performed. A total of 51 were male and 20 were female. A total of 29 revision cases were performed. Additionally, 9 patients were explanted and 9 cases were aborted prior to implantation. The average age of the implant population was 62.8 years old. The average length of follow‐up was 20 months. A total of 43 primary implant patients had sufficient data available for analysis. The mean preoperative PTA was 63.4 dB and the mean postoperative PTA was 50.7 dB. Patients demonstrated a 9.90 dB average increase in PTA. A paired t test was used to determine if the difference was statistically significant. The difference proved to be statistically significant with a t‐stat of 5.87, which was statistically significant at the. 05 level of confidence.

Conclusions:

Initial results of The Envoy Esteem system demonstrated a significant hearing benefit in our study population. The revision surgery rate of 26.6% is concerning and patients need to be aware of this potential issue.
Evolution in Surgical Management of Glomus Tympanicum over 40 Years: A Review of 114 Cases
Authors: Carlson Matthew L. , Pelosi Stanley , Sweeney Alex D. , Wanna George B. , Bennett Marc L. , Rivas Alejandro , Haynes David S.
Published: September 2014

Objectives:

Report surgical management and outcomes among a large cohort of patients with glomus tympanicum (GT) managed by a single tertiary referral group over 4 decades.

Methods:

Retrospective chart review evaluating all patients that underwent surgical treatment of histopathologically confirmed GT between 1973 and 2013. Pre‐ and postoperative audiometric outcomes were reported according to American Academy of Otolaryngology—Head and Neck Surgery reporting guidelines and tumor stage was described using the Glasscock‐Jackson classification system.

Results:

A total of 114 patients (90.2% female, mean age 54.0 years) met inclusion criteria. Eleven cases were referred following recurrence, while the remaining 103 patients were treated primarily; 38 (33.3%) GTs were stage I, 52 (45.6%) stage II, 9 (7.9%) stage III, and 15 (13.2%) stage IV. A total of 105 (92.1%) patients underwent gross total removal, while 9 (7.9%) received subtotal resection for advanced disease adherent to the carotid artery and/or facial nerve. Two patients who underwent gross total resection experienced transient facial paresis and one suffered internal carotid injury with stroke. No patients have recurred at a mean follow‐up of 39 months.

Conclusions:

Surgical approach and extent of resection should be tailored to the patient. Gross total resection can be obtained in over 90% of patients, however leaving adherent tumor remnant on the facial nerve or carotid artery should be considered in patients with advanced infiltrative disease in order to prevent unnecessary morbidity. Microsurgical resection remains the treatment of choice for GT providing a high rate of tumor control and improvement in audiologic symptoms.
Expression of HDAC2 in Peripheral Blood Mononuclear Cells from Patients with Sudden Sensorineural Hearing Loss
Authors: She Wandong , Hou Jie , Dai Yanhong , Zhou Qiongqiong , Xie Lisheng
Published: September 2014

Objectives:

(1) Compare the expression of HDAC2 in peripheral blood mononuclear cells (PBMC) of refractory sudden sensorineural hearing loss (SSNHL) patients before and after intratympanic methylprednisolone perfusion (IMP). (2) Identify the relationship between the level of HDAC2 and the prognosis of patients.

Methods:

Twenty cases of refractory SSNHL patients were selected as therapy group and 10 volunteers were chosen as control group. All 20 SSNHL patients received one course of routine therapy or more, including GC, vasodilator, and neurotrophins. SSNHL patients‐PBMCs were collected in the morning before and after IMP, while volunteers were collected on the second day in hospital from January 2013 to September 2013. After therapy, the 20 SSNHL patients were divided into 2 groups (GC sensitive group and GC insensitive group) according to their hearing recovery. Real‐time polymerase chain reaction and HDAC2 Assay Kit were used to detect the expression level of HDAC2 mRNA and amount of HDAC2 protein in PBMCs. The data were analyzed with SPSS 17.0 software.

Results:

Before intratympanic methylprednisolone perfusion, the level of HDAC2 protein were significantly depressed in all SSNHL patients (F = 13.291,<.0001), while the HDAC2 mRNA expressing much higher than the control group (F = 6.047, =.007). The expression level of HDAC2 mRNA increased significantly after intratympanic methylprednisolone (GC sensitive group: t = 3.941, P =. 006; GC insensitive group: t = 2.57, P =. 026). The HDAC2 protein level in GC sensitive group increased significantly (t = 6.148, P <. 001).

Conclusions:

Knockdown of HDAC2 expression induces corticosteroid insensitivity. Glucocorticoids can increase the expression of HDAC2 mRNA. HDAC2 can be down‐regulated by posttranslational modifications.
Generation of a Novel Transgenic ChR2 Mouse to Investigate Cochlear Implant Model Based on Optogenetics
Authors: Meng Xiankai , Hight Ariel E. , Kozin Elliott D. , Brown Chris , Edge Albert S. , Lee Daniel J.
Published: September 2014

Objectives:

Optogenetics is a powerful new tool to use for the auditory system and involves the introduction of a light‐sensitive protein into neurons. This exciting approach may help to increase spatial resolution of auditory implants that are limited due to electrical current spread and to improve outcomes. Herein, we describe: (1) generation of a novel transgenic mouse expressing channelrhodopsin‐2 (ChR2+) in spiral ganglion cells (SGC), (2) auditory responses to optical stimulation of the cochlea in our ChR2+ transgenic mouse.

Methods:

A left cochleostomy was performed and the right inferior colliculus (IC) was exposed via craniotomy in adult ChR2+ mice. Optically evoked auditory brainstem responses (oABRs) and IC multi‐unit recordings were conducted in response to optical stimulation via a blue‐light laser fiber (473nm wavelength) placed into the cochleostomy. The expression of ChR2 in cochlea was histologically identified under confocal microscope.

Results:

ChR2 expression was observed in the soma, the peripheral and central axons of almost all SGCs in 1 to 7‐ month‐old ChR2+ mice. A single 1‐ms blue light pulse can evoke oABRs with peak magnitudes up to 10uV and latencies short as 2 ms. Evoked multi‐unit activity (~180 spikes/second) in the IC was substantially synchronized (0.9 synchronization index) to a 28‐Hz light pulse train applied in cochlea.

Conclusions:

We generated and characterized a novel ChR2 transgenic mouse line that is sensitive to light‐based stimulation in the peripheral auditory system. Our study may demonstrate the feasibility of using optogenetic technology as the basis for new neuronal stimulation paradigm for cochlear implants.
Osteocutaneous Radial Forearm Flap Reconstruction for Naso‐ethmoid‐orbital Defects
Authors: Cannady Steven B. , Newman Jason G. , Friedman Oren , Chalian Ara A. , Wax Mark K.
Published: September 2014

Objectives:

(1) Describe the usefulness of osteocutaneous forearm flaps in reconstruction of the naso‐ethmoid‐orbital (NOE) defect. (2) Describe a case series outlining the authors’ experiences with this reconstruction.

Methods:

A retrospective review and case series was conducted on patients between 2000 and 2014 who underwent NOE involving resections with reconstruction using radial forearm flap. All disease causes were included and all consecutive patients at 2 institutions were analyzed. Aesthetic results, nasal airway, diplopia, and enophthalmus were assessed in recent patients available. Technical feasibility and methods of reconstruction were assessed, including where bone was plated and which portions of the NOE structure were reconstructed. Patient disease outcomes were included to assess the durability of reconstruction for remaining survival period.

Results:

Fifteen patients underwent NOE reconstruction in the timeframe studied. Four recent patients reported poor nasal airway, but no diplopia, and no immediate enopthalmus after NOE reconstruction. Patients felt their appearance had been positively impacted by reconstruction. One‐third of patients succumbed to disease in the study period within 3 years of reconstruction, but without need for additional reconstructions.

Conclusions:

Ostteocutaneous radial forearm flap (OCRFF) is a cosmetically acceptable and functional method of reconstructing a variety of NOE defects. In NOE cancer patients with limited survival, a one‐step reconstruction can be serviceable and not require multiple additional procedures, while ensuring aesthetic results and prevention of ocular comorbidity.
Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Reconstruction Prostheses
Authors: Lupo J. Eric , Strickland Brian M. , House John W.
Published: September 2014

Objectives:

(1) Describe the use of total ossicular reconstruction prostheses (TORP) during revision stapedectomy in the setting of advanced incus erosion. (2) Analyze the short‐ and medium‐term audiometric results of TORP for revision stapedectomy.

Methods:

A retrospective case review at a tertiary neurotological referral center was conducted of nineteen cases of revision stapedectomy where TORP reconstruction was performed due to advanced incus erosion. Pre‐ and postoperative bone conduction (BC‐PTA) and air conduction (AC‐PTA) pure tone averages (0.5, 1, 2, 3 kHz) including high tone bone conduction (1, 2, 3 kHz), air‐bone gap (ABG), and speech discrimination scores (SDS) were measured. Short‐term (3 weeks) and medium‐term (median, 12 months) hearing outcomes were measured.

Results:

Among 19 ears undergoing revision stapedectomy managed with TORP reconstruction, the average number of previous revision attempts was 1.2 (SD, 2; range, 1‐6). The preoperative BC‐PTA was 32.1 dB preoperatively while the preoperative AC‐PTA was 65.3 dB. The mean postoperative ABG significantly decreased to 16.6 dB (SD, 13.68; range, −2.5 to 46.3 dB, P <. 003) with mean follow‐up of 15 months (SD, 18.8; range, 0.75‐54 months). A nonsignificant mean high tone BC‐PTA decrement of 3.8 dB (SD = 5.9, range −8.33 to 18.33 dB, P =. 427) was observed including one ear with no responses postoperatively. No further revisions were noted in follow‐up.

Conclusions:

Total ossicular reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes but carries an increased risk of sensorineural hearing loss.
Intratympanic Dexamethasone after High‐Dose Intravenous Methylprednisolone in Idiopathic Sudden Sensorineural Hearing Loss
Authors: Espitia Elizabeth A. , Hernández‐García Estefanía , Hernando Monica , González‐Herranz Ramón , Plaza Guillermo
Published: September 2014

Objectives:

Investigate the therapeutic efficacy of intratympanic dexamethasone after high‐dose systemic corticosteroids in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Methods:

Prospective clinical trial at a university hospital. A total of 104 eligible patients with ISSNHL were treated consecutively. Patients in the severe group (>70 dB) were treated with intravenous high‐dose prednisolone (500 mg per day, 5 days), whereas the rest were treated with oral deflazacort (1 mg per kg per day, 10 days). Failures after 5 days of systemic treatment received an additional 3 intratympanic dexamethasone injections.

Results:

The differences between pretreatment and posttreatment pure‐tone audiometry averages (PTAs). Complete recovery was defined as PTA better than 25 dBs. Successful treatment was defined as a greater than 10 dB improvement in PTA. Results: Complete hearing recovery was achieved in 38 cases (36.53%), and significant hearing recovery in 86 cases (82.69%). After intravenous treatment of severe cases (initial PTA 83.15 dB), a median improvement of 13.61 dB was achieved; rescue intratympanic treatment obtained 18.49 dB of further improvement (final PTA 53.05 dB). Those less severe cases (initial PTA 68.38 dB) had a median improvement of 3.39 dB after oral treatment, and 9.00 dB after rescue (final PTA 56.00 dB). High‐dose treatment in severe cases showed a significant improvement compared with the less severe group (P <. 01).

Conclusions:

High‐dose intravenous corticosteroid treatment obtained significant hearing improvement in severe ISSNHL. The addition of intratympanic steroids to the conventional systemic steroid therapy may provide a safe and potentially effective therapeutic option.
Is the Extent of the Preoperative Air‐Bone Gap an Indicator of Potential Success in Stapedectomy?
Authors: Huins Charlie
Published: September 2014

Objectives:

Could preoperative air‐bone gap magnitude act as a predictor of postoperative outcome in patients undergoing stapedectomy for otosclerosis? If this were to occur, is it frequency specific?

Methods:

Retrospective case series from January 2010 to December 2012 in a tertiary London teaching hospital. Patients: Evaluation of 302 stapedectomy procedures under the care of a single consultant. Intervention: Laser stapedectomy using Smart Nitinol stapes prosthesis. Retrospective analysis comparing preoperative and postoperative air‐bone gap (ABG) in patients undergoing stapedectomy. Patients were stratified into subgroups according to their preoperative air‐bone gap and this was compared with their postoperative result of air‐bone closure. In addition, for each commonly tested frequency (0.5, 1, 2, 3, 4 kHz) the preoperative and postoperative air‐bone gap were analyzed in order to ascertain whether the preoperative ABG could act as a predictor. Having not passed normality testing, Wilcoxon matched paired signed rank test and Spearman's rank coefficient were used for analysis.

Results:

Throughout the statistical analysis, preoperative ABG correlated most strongly with net difference in postoperative ABG (P <. 0001). For each commonly tested frequency assessed this demonstrated a “very strong” positive correlation. As such, the greater the preoperative ABG, the greater the closure obtained through stapedectomy in this series.

Conclusions:

In performing stapedectomy for otosclerosis, our series suggested the preoperative ABG may have a role in preoperative patient counseling and consent, but is unable to predict success in stapedectomy surgery.
Lateralization Value of Video Head Impulse Test in Peripheral Vestibulopathy: Comparative Study with Caloric Test
Authors: Koo Ja‐Won , Choi Byung Yoon , Park Jae Hong , Park Pona
Published: September 2014

Objectives:

(1) Compare the lateralization value of video head impulse test (vHIT) with that of bithermal caloric test. (2) Analyze the influence of covert saccade on VOR gain and unilateral weakness (UW) of caloric test.

Methods:

Retrospective study from May 2012 through December 2013 in a tertiary referral center. There were 99 dizzy patients with peripheral vestibulopathy and 16 healthy volunteers. Caloric test parameters (UW and sum of warm and cold slow phase velocity [SPV] of each ear) were compared with VOR gain on vHIT. Cutoff point of vHIT was calculated using the receiver operating characteristic curve.

Results:

(1) Correlation between UW/Sum of SPV and the gain of vHIT was statistically significant and correlation coefficient was 0.655 (P <. 0001) and 0.584 (P <. 0001), respectively. (2) Cutoff point of vHIT was 0.84 with the sensitivity of 0.91 and the specificity of 0.66 (abnormal value of UW >25%). (3) False negative rate was 34% and (4) UW scores of overt saccade only, overt+covert saccade, covert saccade only, and normal VOR were 69%, 66%, 53%, and 16%.

Conclusions:

Gain on vHIT was well correlated with UW on caloric test. However, both tests seem to be necessary since substantial proportion of patients showed conflicting results, which resulted from testing VOR of 2 extreme frequencies.
Outcomes in Open Structure Septorhinoplasty
Authors: Sharma Sunil D. , Jacques Tom , Abed Tarik , Gatland David
Published: September 2014

Objectives:

The aim of our study was to look at patient related outcome measures and complications post–open structure septorhinoplasty performed by the same experienced rhinologist and to look at any factors associated with increased risk for requirement of revision surgery.

Methods:

Retrospective review of case notes of all patients who underwent septorhinoplasty at the same institute, performed by the same rhinologist, between January 2009 and February 2013. Assessment of patient satisfaction was made using the Rhinoplasty Outcomes Evaluation (ROE) tool.

Results:

One hundred seventy patients were included in the study, with mean follow‐up of 28.2 months. The most common complication was residual deformity (10/170, 5.9%). Eleven patients required further revision nasal surgery (11/170, 6.5%). There was a statistically significant increase in the ROE scores pre‐ and postoperatively in all patients undergoing surgery (19.5 ± 9.41 vs 68.4 ± 23.7, P <. 001). There was a statistically significantly higher rate of revision surgery in patients who had complex surgery (4/16 vs 7/154, P =. 01), a higher rate of nasal tip deformity in the revision surgery group compared with the primary surgery group (10/24 vs 29/146, P =. 03), and a higher rate of augmentation surgery in the revision surgery group compared with the primary surgery group (13/24 vs 40/146, P =.02).

Conclusions:

Open structure septorhinoplasty results in a significant increase in patient satisfaction. Our rate of revision surgery is lower than the average reported in the literature. The rate of revision surgery is higher in cases judged to be more complex preoperatively.
Long‐term Cross‐Hatching Eustachian Tuboplasty Outcomes
Authors: Yanez Carlos , Velazquez Sandra
Published: September 2014

Objectives:

Review the long‐term outcomes of cross‐hatching Eustachian tuboplasty (ChEt) in patients with chronic obstructive Eustachian tube dysfunction (COETD), as well assess the clinical factors associated with surgical success.

Methods:

Case series with chart review in a tertiary health care institution. This is a retrospective review by the senior author of all cases of patients who had nonrevision ChEt for COETD. Follow‐up period was 5 years. The curvature of the posterior cushion was modified using an argon laser to alter the spring of the cartilage, alleviating the obstructed valve's aperture. Several clinical factors were reviewed in relation to the successful opening of Eustachian tube valve.

Results:

One hundred twenty patients, 72 males/48 females, average age 42.4 ± 2 years old, met inclusion criteria to the study. COETD patients/obstructive causes were: Posterior cushion hypertrophy, 68 (56.6%); tensor veli and levator veli palatini muscles hypertrophy, 15 (12.5%); and remarkable mucosal hypertrophic disease, 37 (30.8%). Total of ET tubes was 198. Bilateral 198 (72.2%), 55 unilateral (27.7) ET valve was seen more open postoperatively on simple endoscopy (SE) and slow motion video analysis (SMVEA). There were no complications. Mean pure tone average improved by 20 dB postoperatively; P =. 015. Mean immittance changes in tympanometric measurements improved postoperatively at least 0.10 mmhos in 91% of the patients (P =. 010). Resolution of symptoms was considered a successful outcome. Failure correlated with the severity of disease.

Conclusions:

A high rate of improvement (96%) was found. Therefore, ChEt is a promising technique for the treatment of COETD.
Middle Ear Function in Sinonasal Polyposis: A Case‐Control Study
Authors: Rajati Mohsen , Bakhshaee Mehdi , Movahed Rahman , Ardakani Hossein Payedar
Published: September 2014

Objectives:

Determine the effect of sinonasal polyposis on middle ear (ME) and Eustachian tube (ET) function.

Methods:

In a case‐control survey, 90 cases in 3 groups including 42 advanced stage sinonasal polyposis patients, 24 patients with chief complaint of nasal obstruction in the absence of polyposis, and 24 healthy cases (not suffering from nasal obstruction or allergic rhinitis) were studied. Subjective ear‐ and nose‐related complaints, tympanic membrane condition and movement during the Valsalva and Toynbee maneuvers, type of nasal secretions, polyposis staging both clinically (Lund Kennedy) and by imaging (Lund McKay), audiometric evaluation, and ET function tests were recorded.

Results:

Subjective hearing loss (P =. 017), impaired TM movement during Toynbee maneuver (P =. 027), Type B tympanogram (P = 0.025) showed significant difference in the polyposis group in comparison with the other 2. Furthermore, allergic rhinitis and nasal mucopurulent secretion were seen significantly more commonly among polyposis patients compared with other groups (P =. 026, P =. 000, respectively). TM movement during Toynbee maneuver (P =. 004), type B tympanogram (P =. 030), and Toynbee test (P =. 004) showed a significant difference between patients who had purulent secretion compared with those without.

Conclusions:

It seems that sinonasal polyposis may change middle ear function to some extent, but the changes are related to the inflammation (allergic or infectious) associated with polyposis, rather than the nasal airway obstruction per se.
Natural History of Jugular Paragangliomas: A Review of 16 Patients Managed with Conservative Observation
Authors: Sweeney Alex D. , Carlson Matthew L. , Wanna George B. , Netterville James L. , Haynes David S.
Published: September 2014

Objectives:

Characterize radiologic growth and clinical disease progression in a cohort of observed, previously untreated, jugular paraganglioma tumors (JPT).

Methods:

Retrospective review evaluating all patients with primary JPTs that were observed with serial clinical examination and imaging between 1993 and 2013. Primary outcome measures included radiographic growth and progression of cranial neuropathy.

Results:

A total of 16 patients (75% female, median age 65.2 years) met inclusion criteria. One JPT was stage I, 7 stage II, 7 stage III, and 1 stage IV. Primary indications for observation included advanced age, minimal symptoms, contralateral paraganglioma(s), and patient preference. The most common presenting symptoms were hearing loss and pulsatile tinnitus; 6 patients were found to have lower cranial neuropathy at time of diagnosis (2 CN 9, 6 CN 10, 2 CN 11, 1 CN 12). At a mean clinical follow‐up of 67 months, 6 patients endured progressive cranial nerve deficits and 4 tumors demonstrated unequivocal growth; the average rate of tumor growth was 1.2 mm/year. Six patients underwent vocal cord medialization procedures for dysphonia. Notably, no patients required feeding tube placement or tracheostomy and there were no deaths attributable to tumor progression.

Conclusions:

In the absence of brainstem compression or concern of malignancy, initial observation of JPTs should be considered. A significant number of tumors do not grow after time of diagnosis, and symptoms frequently remain stable for many years. Even with disease progression, most JPTs exhibit indolent growth with slowly progressive cranial neuropathy affording satisfactory physiologic compensation in most patients.
Novel Radiographic Measurement Algorithm Demonstrating a Link between Obesity and Lateral Skull Base Attenuation
Authors: Stevens Shawn M. , McIlwain Wesley , Rizk Habib , Nguyen Shaun A. , Lambert Paul R. , Meyer Ted A.
Published: September 2014

Objectives:

(1) Describe a validated measurement instrument to quantify tegmen thickness on computed tomography (CT) images. (2) Compare tegmen thickness in 3 groups: patients with spontaneous cerebrospinal fluid (CSF) leaks, obese controls, and nonobese controls.

Methods:

Retrospective review from 2005 to present. Patients with a diagnosis of spontaneous CSF otorrhea and dedicated temporal bone CT scans were included. Matched obese (body mass index [BMI] >30) and nonobese (BMI <30) controls were selected from a pool of cochlear implant candidates. The tegmen was measured radiographically in all patients at pre‐defined points. Independent, blinded measurements were made by 3 of the authors and compared for interrater validity.

Results:

Ninety‐nine patients were measured: 39 in the CSF group (BMI 35.9), 29 in the obese group (BMI 34.6), and 31 in the nonobese group (BMI 24.2). The CSF group had a significantly thinner aggregate tegmen thickness (0.82 mm ± 0.19) compared with both obese controls (0.99 mm ± 0.18, P =. 007) and nonobese controls (1.26 mm ± 0.2, P <. 001). Obese controls were thinner than non obese controls (P <. 001). Signs/symptoms of benign intracranial hypertension (BIH) were most commonly found in the CSF group. No other factors significantly affected thickness. Good to excellent correlation of measurements was found between all 3 raters.

Conclusions:

This is the first study to (1) quantify lateral skull base thickness and (2) significantly correlate obesity with lateral skull base attenuation. Obese spontaneous CSF leak patients may have even greater attenuation of their skull base than matched obese controls. This finding may further support theories that an additional process, such as BIH, may play an important pathophysiologic role in skull base thinning.
OtoSeq Next‐Generation DNA Sequencing in the Evaluation of Congenital Sensorineural Hearing Loss
Authors: Goico Brian , Holle Jennifer , Manickam Vi , Johnson Judith , Sivakumaran Theru A , Zhang Kejian , Greinwald John H.
Published: September 2014

Objectives:

Congenital sensorineural hearing loss (SNHL) is relatively common, occurring in 2 to 4 per 1000 infants, with genetic etiologies accounting for nearly 67% of cases. The clinical presentation of patients with syndromic and nonsyndromic SNHL is often indistinguishable. Establishing specific genetic causes is imperative for clinical management and genetic counseling. Recent advances in next‐generation sequencing have allowed for facilitated multi‐gene testing in genetically heterogeneous conditions such as SNHL. The present study evaluates the clinical utility of one such assay, OtoSeq, in genotyping pediatric patients with SNHL.

Methods:

Demographic, audiometric, imaging, and genetic data were retrospectively collected from 70 patients with prelingual hearing loss who underwent clinical genetic testing of 23 well‐studied SNHL genes via OtoSeq, our next generation sequencing platform. The frequencies of pathogenic and likely pathogenic mutations were calculated and audiogram data were reviewed.

Results:

Of 70 patients studied, 15 patients (21%) were found to have an identifiable genetic etiology for their hearing loss, and 8 patients were found to have a previously undiagnosed genetic syndrome. Seven patients were diagnosed with nonsyndromic hearing loss. A total of 27 patients with mutations had adequate audiogram data available, of which 16 had mild to moderate hearing loss (59.3%) and 11 had severe to profound hearing loss (40.7%). Several unique combinations of deafness causing mutations in different genes were identified, including CDH23 and MYO7A, both Usher pathway of genes.

Conclusions:

This study demonstrates that OtoSeq is a valuable tool for determining genetic causes of SNHL in pediatric patients, which has direct implications for their clinical management.
Proteomic Analysis of Human Stapes in Otosclerosis
Authors: Randall Derrick R. , Park Phillip S. , Chandarana Shamir P. , Chau Justin
Published: September 2014

Objectives:

(1) Identify nascent candidate proteins producing the molecular dysregulation responsible for increased bone matrix deposition in otosclerosis compared to healthy control ossicles. (2) Evaluate the potential for active viral protein presence in otosclerosis. (3) Assess the utility of relative protein abundance quantification in bone tissue.

Methods:

Pooled bone homogenate protein samples from 50 human stapes collected from patients with otosclerosis between January 2012 and June 2013 were produced in a multistage bone isolation protocol. Control samples including ossicles acquired from nonotosclerotic patients and axial bone from fibula reconstruction procedures were prepared by identical protocols. All samples were subjected to concurrent isotope tagged relative abundance quantification (iTRAQ) proteome deep sequencing analysis.

Results:

iTRAQ analysis revealed multiple proteins with altered translation levels representing possible candidate proteins for the bony deposition involved in otosclerosis. Literature review and functional assessment of candidate proteins is undertaken.

Conclusions:

Proteomic analysis of otosclerotic bone samples provides novel potential agents in the development of otic capsule overgrowth and hearing loss. Further evaluation of these proteins may provide additional understanding of the pathophysiology of otosclerosis and develop additional treatment modalities.
Steady‐State Free Precession MRI Imaging as a Screening Evaluation for Vestibular Schwannoma
Authors: Patel Anju K. , Pacicco Thomas A. , Madan Neel , Bedi Harprit S. , Heilman Carl B. , Sillman Jonathan S.
Published: September 2014

Objectives:

(1) Compare noncontrast steady‐state free precession (SSFP, also called FIESTA, CISS, and bFFE) magnetic‐resonance imaging (MRI) to contrast‐enhanced full sequence MRI for initial evaluation of retrocochlear pathology. (2) Assess the sensitivity and specificity of SSFP alone versus complete contrast‐enhanced MRI as the gold standard.

Methods:

Retrospective review of a tertiary care center radiology imaging database from 2006 to present was performed. Based on statistical power analysis, 50 studies with identified vestibular schwannomas and 53 studies with normal internal auditory canal (IAC) findings were included. Four expert reviewers performed blinded, randomized evaluation of non‐contrast SSFP sequence and contrast‐enhanced MRI studies to evaluate for retrocochlear pathology. MRI reports from the original studies were used as the gold standard. Using XLSTAT™ statistical software, data were analyzed using a 2‐sided z‐test of one proportion for each reviewer's sensitivity and specificity against a 95% standard. Inter‐reader reliability was determined using kappa analysis.

Results:

Four reviewers, including 2 neuroradiologists, one neurotologist, and one neurosurgeon had 100% specificity. Average sensitivity was 96% (range, 94‐100%). There was no statistically significant difference when each sensitivity and specificity was compared against a 95% standard or in results between reviewers. Tumors eccentric in the IAC or with significant artifact were more likely to not be identified.

Conclusions:

Noncontrast SSFP sequence MRI may be an effective initial study to perform for evaluation of vestibular schwannomas. Given its shorter duration (5 minutes versus 25 minutes) as well as the noncontrast method, clear advantages exist for this method.
Transcranial Magnetic Stimulation as a Treatment for Tinnitus
Authors: Folmer Robert , Theodoroff Sarah
Published: September 2014

Objectives:

This presentation describes a Phase II clinical trial that was conducted to assess transcranial magnetic stimulation (TMS) as a treatment for chronic tinnitus. (1) Interpret the results of this clinical trial. (2) Describe the issues that need to be addressed before TMS can be implemented clinically as a treatment for tinnitus.

Methods:

This is a randomized, subject and clinician/observer blind, placebo‐controlled parallel‐group clinical trial of repetitive TMS (rTMS) for chronic tinnitus that was conducted from January 2011 to December 2014 at Portland VA Medical Center. 60 subjects (average age 61.2 years) who experienced chronic tinnitus for 1 year or longer were randomly assigned to receive either active rTMS treatment or placebo treatment to either the left or right side of the head. Subjects received 2000 pulses of 1 Hz rTMS therapy daily on 10 consecutive work days. The primary outcome measure is the Tinnitus Functional Index (TFI), a 25‐item questionnaire that assesses tinnitus severity. Independent variables: Beck Depression Inventory score; State Anxiety Inventory score. Preliminary analysis: Change in TFI score from baseline at 6 post‐treatment time points.

Results:

Fifteen of 30 subjects in the active rTMS group exhibited significant improvement in TFI score that persisted for 6 months posttreatment. Seven of 30 subjects in the placebo rTMS group exhibited significant improvement in TFI score.

Conclusions:

While rTMS demonstrates potential as a treatment option for tinnitus patients, additional clinical trials should be conducted to confirm the efficacy of this method.
Secondary Rhinoplasty
Authors: Elachkar Ibrahim Y.
Published: September 2014

Objectives:

Natural sculpturing of the nose during secondary rhinoplasty is the common goal of every rhinoplastic surgeon. Even for the most experienced surgeons, rhinoplasty remains the most challenging of all aesthetic surgeries. The aim of this study is to assess secondary rhinoplasty surgery on patients by presenting the functional and aesthetic techniques, and evaluating the results of the surgical interventions.

Methods:

Between January 2000 and January 2014, 1242 secondary rhinoplasty surgeries were performed on 162 males and 1080 females with a mean age of 26 years. Open rhinoplasty surgery was performed on 1170 patients, and closed rhinoplasty surgery was performed on 252 patients. A total of 108 surgeries were performed with local anesthesia and 1134 surgeries under general anesthesia, with or without submucosal reduction of septal deviation and inferior turbinectomy. Septal, auricular, or costal cartilage graft reconstruction was also performed. The reconstructive and aesthetic techniques were performed on 9 different categories. The patients’ functional and aesthetic results were then evaluated.

Results:

All patients reported significant aesthetic, olfactory, and respiratory improvement: 990 excellent results, 216 good results, 36 average results, 0 mediocre results.

Conclusions:

Advances in rhinoplasty techniques allow satisfactory results in secondary rhinoplasty that were not possible in the past. Furthermore, the choice of a qualified surgeon is of paramount importance. Only the surgeon that has great skills, and who is experienced, careful, and artistic, will make all the difference in achieving great results in the surgical procedure.
Vestibular Dysfunction in Patients with Enlarged Vestibular Aqueduct
Authors: Chien Wade W. , Zalewski Chris K. , King Kelly A. , Muskett Julie A. , Butman John A. , Brewer Carmen C. , Griffith Andrew J.
Published: September 2014

Objectives:

Enlarged vestibular aqueduct (EVA) is the most common inner ear malformation. While a strong correlative relationship between EVA and hearing loss exists, its association with vestibular dysfunction is less well established. In this study, we characterize the vestibular phenotype in patients with EVA.

Methods:

This was a prospective, cross‐sectional study of 106 patients with unilateral (n = 26) or bilateral (n = 80) EVA, defined as a midpoint diameter greater than 1.5 mm, who were referred or self‐referred to participate in a study of the clinical and molecular analysis of EVA at the National Institutes of Health. We obtained a clinical history focused on vestibular dysfunction, and specifically asked about age of independent walking, history of vertigo, head tilt with vomiting, and clumsiness. Based on tolerance and availability, participants underwent videonystagmography (VNG), cervical vestibular evoked myogenic potentials (cVEMP), and rotary vestibular chair testing (RVT) to objectively assess their vestibular function.

Results:

Forty‐five percent of patients with EVA reported vestibular symptoms. A total of 44% (28 out of 66) of those completing VNG testing had abnormal results, as defined by abnormalities in caloric, ocular motor, and positional testing. An increased number of vestibular symptoms is correlated with the presence of bilateral (rather than unilateral) EVA (P =. 008) and a history of head injury (P <. 001). Abnormal VNG results also correlated with a history of head injury (P =. 01).

Conclusions:

Vestibular dysfunction is common in patients with EVA. To our knowledge, this is one of the largest prospective EVA studies which specifically address the vestibular manifestations.
Button Battery Injuries in the Pediatric Aerodigestive Tract
Authors: Ettyreddy Abhinav R. , Georg Matthew W. , Mehta Deepak , Chi David H. , Yellon Robert F. , Gaines Barbara A. , Simons Jeffrey P.
Published: September 2014

Objectives:

(1) Describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children. (2) Evaluate the long‐term morbidity associated with button battery impaction.

Methods:

This study is a retrospective medical record review involving 23 consecutive patients who presented to a tertiary care childrens hospital between January 1, 2000, and July 31, 2013, with button batteries impacted in the nasal cavity (n = 7), esophagus (n = 9), and stomach (n = 7). Battery type/size, duration of impaction, presenting symptoms, treatment, and outcomes were examined.

Results:

Average time of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. 3V lithium batteries accounted for 84% of battery injuries and were responsible for all cases of esophageal impaction. Most common presenting symptoms were vomiting (30.4%), fever (26%), and cough (21%). Presenting signs and symptoms did not predict severity of injury or outcomes. Average length of hospitalization was greater for esophageal impactions (43.0 days) than for nasal or stomach impactions (2.0 days; P =. 009). Batteries in the esophagus for >15 hours led to a longer postoperative hospital course and were associated with higher rates of transmural necrosis compared with those impacted for <15 hours (P =. 04). Esophageal complications included perforation (n = 3), tracheoesophageal fistula formation (n = 2), and strictures (n = 4).

Conclusions:

Button battery impactions in children present with nonspecific symptoms that may account for the delay in medical care. Clinicians must consider battery impaction in the upper aerodigestive tract as a surgical emergency that may lead to significant long‐term morbidity.
Does Montelukast Have an Effect on Posttonsillectomy Pain Control in Children?
Authors: Ince Ilker , Yoruk Ozgur , Ahıskalıoglu Ali , Aksoy Mehmet , Dostbil Aysenur , Celik Mine
Published: September 2014

Objectives:

Investigate the efficacy of preemptive montelukast, which is leukotreine receptor blocker for pediatric posttonsillectomy pain management. This is the first time montelucast has been used in posttonsillectomy pain control.

Methods:

A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist (ASA) class I‐II, scheduled for elective tonsillectomy were enrolled in this double‐blinded and controlled study from April of 2013 until January of 2014. The patients were randomized into 2 groups: Montelukast group (Group M, n:30) and control group (Group C, n:30). Group M received 5 mg oral montelukast tablet and Group C received placebo at 24:00 pm the night before surgery. The posttonsillectomy pain was evaluated with Wong‐Baker Face Scale during the 24 hours after surgery. Postoperative complications were recorded. The data were analyzed using the Student t test. Data were presented as a mean + SD, and differences were considered significant at P <. 05.

Results:

There were statistically significant differences between Wong‐Baker Face Scale scores of the Group C and Group M (P <. 05). The first time, analgesic requirement was higher in group C than in group M (P <. 05). There was no significant difference in demographic parameters and postoperative complications (P >. 05 for both).

Conclusions:

Preemptive montelukast usage is more effective than the control group in posttonsillectomy pain relief.
Incidence and Grading of Subglottic Stenosis and Associated GERD/LPR in Recurrent Croup
Authors: Hodnett Benjamin L. , Katherine Riera , Mehta Deepak , Simons Jeffrey P. , Maguire Raymond C.
Published: September 2014

Objectives:

(1) Determine incidence/grading of subglottic stenosis on endoscopic evaluation in recurrent croup. (2) Determine incidence of reflux on bronchoalveolar lavage (BAL) and esophageal biopsy (EBx) in pediatric population of recurrent croup.

Methods:

A retrospective chart review was conducted of pediatric patients (age ≤ 18 years) who underwent endoscopic evaluation with a diagnosis of recurrent croup over a 10‐year period (2002‐2012). A total of 1825 charts were reviewed, of which 269 were identified for inclusion, with preliminary results completed for the first 80 patients. Endoscopic findings, BAL cytology results, and EBx pathology were collected. Subglottic stenosis (SGS) was graded on Myer‐Cotton scale. Lipid‐laden macrophages (LLM) on BAL were noted as none/small/moderate/large with evidence of reflux noted as moderate or large. Bx specimens were evaluated for evidence of reflux esophagitis.

Results:

Mean age at endoscopy was 56 ± 5 months. SGS was noted in 19 of 80 patients (24%) and all were grade I. Moderate‐large LLM were noted on 0 out of 14 BAL in SGS group. Moderate‐large LLM were noted on 5 out of 48 BAL (10%) in non‐SGS group. Evidence of reflux was noted on 6 out of 19 (32%) EBx in SGS group. Evidence of reflux was noted on 5 out of 57 (9%) EBx in non‐SGS group. There was no difference between the groups on preliminary data analysis (LLM P =. 58, EBx P =. 07).

Conclusions:

Recurrent croup is a risk factor for subglottic stenosis. Evidence of reflux may be noted on BAL or esophageal biopsy but this may not correlate with SGS in recurrent croup patients.
iPad Audiometry in Canada's North: A Portable and Cost‐Effective Method for Hearing Screening
Authors: Rourke Ryan , Bromwich Matthew , Chan David
Published: September 2014

Objectives:

Access to hearing health care is limited in many parts of the world. Specifically, many risk factors for hearing loss are present in the First Nations people of Canada's North. No research has been done to assess this populations hearing in over 3 decades. The aims of the study were: (1) Determine the prevalence of hearing loss in children in Baffin Island. (2) Demonstrate the use of asynchronous tele‐audiometry. (3) Conduct a cost‐benefit analysis of iPad audiometry in the Canadian Arctic.

Methods:

iPad audiometers were used to test hearing in 220 children ages 5‐11 years in Iqaluit, Nunavut, during 1 week in January 2014. Air conduction pure tones were obtained from each ear at frequencies of 500, 1000, 2000, and 4000 Hz. Children with hearing loss greater than 25 dB in at least 1 frequency were considered to have failed the hearing test and will be further tested with standard sound booth audiometry.

Results:

Preliminary analysis reveals a hearing loss prevalence of 15.5%. These children then received standard testing by an audiologist using standard sound booth audiometry and the results analyzed. A cost‐benefit analysis assessed the use of iPad audiometry in this remote location.

Conclusions:

This is the first study in over 30 years assessing the hearing of children in this region, and the first telemedicine audiometry in Canada using iPads. This type of testing is valuable for providing hearing health care for high risk populations in rural and remote areas at an affordable cost.
Pediatric Tympanostomy Tube Removal: Does Technique Affect the Rate of Persistent Tympanic Membrane Perforation?
Authors: Vercillo Natalie , Agrawal Nidhi , Nardone Heather C.
Published: September 2014

Objectives:

Determine whether various techniques used to promote tympanic membrane (TM) perforation closure at the time of ventilation tube removal impact the likelihood of TM perforation healing in children.

Methods:

A retrospective chart review was conducted of 265 children (341 ears) who underwent tympanostomy tube removal at a tertiary care pediatric hospital between January 2010 and November 2013. Techniques performed at the time of ventilation tube removal included tube removal only, freshening the perforation edges, performing paper patch myringoplasty, or both freshening edges and paper patch myringoplasty.

Results:

The persistent TM perforation rate was 9.97% (34/341). Technique was not found to significantly influence the likelihood for the TM to heal (P =. 81), with 11/86 (12.7%) having persistent perforations with tube removal only, 6/62 (9.7%) with freshened perforation edges, 7/50 (14.0%) with paper patch myringoplasty and 10/109 (9.2%) with both edges freshened and paper patch myringoplasty. There was no significant interaction between technique and age, tube retention length, number of previous ventilation tubes placed, or type of tube removed. Additionally, no significant difference in TM perforation rate was observed for number of previous tympanostomy tubes, tube duration, previous adenoidectomy, or indication for tube removal. Factors associated with higher rates of persistent perforation included older age, longer‐acting ventilation tubes, and trisomy 21.

Conclusions:

There is no reduction in persistent TM perforation rate following ventilation tube removal if edges are freshened and/or a paper patch myringoplasty is performed. Increased pediatric age, longer‐acting tympanostomy tubes and history of trisomy 21 may negatively influence the likelihood of closure.