bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.