bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral Skull Base Reconstruction: A Comparison of the Submental Flap to Free and Regional Flaps
Authors: Howard Brittany E. , Hayden Richard E. , Barrs David M. , Nagel Thomas H. , Hinni Michael L. , Donald Carrlene B. 
Published: September 2014

Objectives:(1) Recognize reconstructive options for lateral skull base defects. (2) Compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions.Methods:Retrospective review of surgical techniques used at a tertiary academic referral center between 2002 and 2014 to reconstruct lateral skull base composite defects involving facial skin, ear, and temporal bone. Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes.Results:Thirty‐one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions including squamous cell carcinoma (n = 22), basal cell carcinoma (n = 2), melanoma (n = 4), and sarcoma (n = 3). Defects were reconstructed with musculocutaneous free flaps (n = 9), pedicled latissimus dorsi flaps (n = 6), and pedicled submental flaps (n = 16). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time required for surgical resection was similar, time savings was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean 578 vs 455 minutes; P =. 0170) and duration of hospitalization (9 vs 4.9 days; P =. 0207). Submental flaps were significantly less likely to require revision debulking procedures (median = 0) compared to free flaps (median = 1.8; P =. 00002) and latissimus dorsi flaps (median = 1; P =. 0093). There was 100% flap survival.Conclusions:The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative times, duration of hospitalization, and flap revisions.
Encephaloceles of the Posterior Fossa: A Series of 10 Cases
Authors: Rereddy Shruthi K. , Mattox Douglas 
Published: September 2014

Objectives:(1) Describe 10 cases of posterior fossa encephaloceles. (2) Compare spontaneous posterior fossa encephaloceles to the more common middle fossa encephaloceles.Methods:This is a retrospective review of patients with surgically‐confirmed encephaloceles of the posterior fossa managed at a tertiary care center from 2006 to 2013. Clinical presentation, imaging, and operative findings were reviewed. Patient demographics were summarized with descriptive statistics.Results:Ten cases of surgically confirmed posterior fossa encephaloceles were identified. The median age of diagnosis was 45.5 years; 6 subjects were female, 4 were male. The median length of follow‐up was 18 months, with 2 subjects lost to follow‐up. Seven of 10 cases followed temporal bone surgery, craniotomy, or trauma. The remaining 3 out of 10 were spontaneous. Two of 3 subjects with spontaneous encephaloceles presented with pneumocephalus and 1 with cerebrospinal fluid otorrhea. Computed tomography scans in all cases showed bone loss and soft tissue protrusion from posterior fossa into the mastoid, with a radiologic differential of arachnoid granulation versus encephalocele. At surgical exploration, there was brain tissue protruding from a defect of the posterior fossa in all cases. One subject had a concomitant tegmen defect.Conclusions:Posterior fossa encephaloceles are much less common than middle fossa encephaloceles, only 23 have been reported to date. The difference is presumably due to intracranial pressure differences in the upright position. Given the location of these 3 spontaneous posterior fossa defects, as well as intraoperative findings of cerebral tissue within the mastoid, we suggest that these lesions are true encephaloceles and not just arachnoid granulations.
Hearing Loss in Patients with Inflammatory Bowel Disease
Authors: Shaul Chanan , Koslowsky Benjamin , Peleg Uri , Gross Menahem , Wengrower Dov 
Published: September 2014

Objectives:Inflammatory bowel disease (IBD) has many characteristics of autoimmune diseases. Sensorineural hearing loss has been reported in many autoimmune diseases. Little is known about hearing loss in patients with IBD.Methods:A prospective blinded comparative study was conducted over a 3‐year period. IBD patients and controls underwent a complete otolaryngology examination and audiometry test.Results:A total of 105 participants (76 patients and 29 controls) took part in this study. A total of 59 (77%) had Crohn's disease (CD) and 17 (23%) had ulcerative colitis (UC). Mean age was 36 years, 51% were males and 40% of the patients were presently hospitalized due to IBD exacerbation. Sixteen of 76 (21%) of the IBD patients complained of hearing loss since first IBD diagnosis and 13% had current hearing disabilities. Audiometric examination revealed that any hearing loss (mild to severe) was found in 23 (30%) of the IBD population, compared with 3 (10%) of the control group (P <. 05). Sensorineural was the hearing deficiency type in 93% of them. Out of 46 patients, whose extraintestinal manifestation (EIM) status was clearly documented, 43% (n = 20) had EIMs. Hearing loss was present in 5 out of 20 (25%) of these patients, compared with 0 out of 23 who did not have EIMs (P <. 01). IBD phenotype, current hospitalization, and disease type were not different between these groups.Conclusions:Sensorineural hearing loss may be another EIM of IBD. It is found in 30% of IBD patients, and in up to 43% of patients with other EIMs. Early hearing evaluation should be recommended to IBD patients who have other EIMs.
Hearing Preservation after Middle Fossa Vestibular Schwannoma Removal: Are the Results Durable?
Authors: Quist Tyler , Givens Daniel J. , Gurgel Richard K. , Chamoun Roukoz , Shelton Clough 
Published: September 2014

Objectives:(1) Describe hearing preservation rates following microsurgical excision of vestibular schwannoma (VS) via middle cranial fossa (MCF) approach. (2) Evaluate long‐ term hearing outcomes after hearing preservation.Methods:This is a retrospective case series of patients with VS who underwent resection via a MCF approach between February 1998 and December 2009 at a tertiary care academic medical center. Audiograms including pure tone average (PTA) and word recognition score (WRS) were obtained preoperatively, immediately postoperatively, and at 5‐year follow‐up.Results:Sixty patients underwent MCF during the study period. Preoperative serviceable hearing (American Academy of Otolaryngology—Head and Neck Surgery class A/B) was present in 52 (86%) of the 60 subjects, with an average PTA of 22 dB (range, 1‐50 dB) and an average WRS of 97% (range, 76‐100%). Immediate postoperative serviceable hearing was maintained in 29 (55%) of the subjects, with an average PTA and WRS of 31 dB (5‐50 dB) and 96% (70‐100%), respectively. Five‐year follow‐up was obtained for 18 of the 29 subjects. After 5‐year follow‐up, 14 (78%) of the 18 subjects maintained serviceable hearing with an average PTA and WRS of 33 dB (4‐49 dB) and 95% (84‐100%), respectively. Of the 4 patients who did not maintain class A/B hearing, average change in PTA and WRS was 17 dB (5.5‐23 dB) and 16% (0%‐40%), respectively. The patient with the most dramatic change in 5‐year hearing had a tumor recurrence.Conclusions:For patients with VS in whom serviceable hearing is preserved following MCF approach, the long term hearing outcome remains durable in the majority of patients.
Learning Curves of Syllabus Otological Procedures: Monitoring Trainee Progress and Understanding Competence
Authors: Awad Zaid , Hayden Lindsay , Muthuswamy Keerthini , Ziprin Paul , Darzi Ara , Tolley Neil S. 
Published: September 2014

Objectives:Otolaryngology trainees in the United King‐dom undergo regular procedure‐based assessments (PBAs) throughout training, however, these are rarely used to monitor progress or measure competence. The assessment tool is procedure specific and produced by the Joint Committee of Surgical Training. It consists of 6 domains: consent, planning, preparation, exposure/closure, operative technique, and postoperative care. The aim of the study was to validate PBA in assessing otolaryngology trainees and to identify the level and pace at which trainees show competence in syllabus otological procedures.Methods:This is a longitudinal study from October 2008 to October 2013. We analyzed all PBAs submitted by North‐Thames London otolaryngology trainees, including junior or core trainees (CT) and senior specialty trainees (ST). We calculated and used the overall score (oS) mean and standard deviations to draw procedure‐specific learning curves for common otological operations.Results:A total of 3306 PBAs from 46 trainees were analyzed, 621 were otological. PBA was highly reliable showing internal consistency (Cronbach's Alpha: 0.921) and discriminated between different grades (CT and ST, Mann‐Whitney‐U: P <. 001) and levels within each grade (CT1‐2 and ST3‐8, Kruskal Wallis: P <. 001). All domains contributed to the calculated score and the most predictive was operative technique. Three procedures achieved sufficient power (n > 100, 90% confidence) to draw learning curves. The procedures were: ventilation tubes, tympanoplasty, and mastoidectomy.Conclusions:PBA is valid for assessing ENT trainees. Procedure‐specific competency curves can be drawn to set milestones and deliver targeted training. They can help understand the pace and level at which trainees master individual otological procedures replacing arbitrary numbers currently in use.
Long‐term Hearing Outcomes in Patients with Enlarged Endolymphatic Duct and/or Sac on MRI
Authors: York Christopher A. , Booth Tim N. , Johnson Romaine F. , Isaacson Brandon , Roland Peter S. 
Published: September 2014

Objectives:(1) Analyze the longitudinal hearing outcomes in children with evidence of dilated endolymphatic duct (ED) or endolymphatic sac (ES) on high resolution magnetic resonance imaging (HRMRI). (2) Correlate severity of hearing loss with ED/ES size and fluid‐attenuated inversion recovery (FLAIR) signal.Methods:This retrospective chart review examined medical records from 2000 to 2013 at a tertiary pediatric referral center to identify patients with evidence of enlarged ED and/or ES by HRMRI. Longitudinal audiometric data (pure tone averages [PTA]) was analyzed using chi‐squared and simple linear regression analysis. Significance was set at P =. 05.Results:Seventy‐four patients were identified with an enlarged ED or ES in at least one ear (normal ears used as controls). Audiometric data were available for 106 ears. In our patient population, increasing ED (linear regression, P <. 01, R2 = 0.35) and ES size (linear regression, P <. 01, R2 = 0.28) predicted severity of hearing loss. Increased FLAIR signal, more common in patients with abnormal ED and ES, predicted poorer hearing outcomes (linear regression, P <. 01, R2 = 0.16). Combining ED, ES, and FLAIR signal had a more pronounced effect (linear regression, P <. 01, R2 = 0.47). However, there was no evidence of progression in our data set over a mean of 32 months.Conclusions:Contrary to our current understanding, our data does not support a progressive nature for the hearing loss associated with enlargement of the ED and/or ES. It also introduces increased FLAIR signal as an additional predictor of poorer hearing outcomes.
Long‐term Results of Adult Cholesteatoma Surgery Using Canal‐Wall‐Down Approach with Primary Obliteration: 5‐Year Observational Study
Authors: Trinidade Aaron , Yung Matthew 
Published: September 2014

Objectives:Present the results of a 5‐year longitudinal study in an adult population undergoing cholesteatoma surgery using a canal‐wall‐down (CWD) approach with obliteration.Methods:Prospective longitudinal study from 1999 to 2013 in a district general hospital. Subjects studied: Adults (≥16 years) with cholesteatoma (256 ears). Interventions: Surgery for cholesteatoma. (1) Residual, recurrence, and recidivist cholesteatoma rates at 5 years postsurgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgeries required. Independent variables: Age and sex.Results:The follow‐up rate at 5 years was 81.5% (n = 195). Using Kaplan‐Meier analysis, the residual cholesteatoma rates at 5 years postsurgery was 2.1% at a rate of 6.5 per 1000 years of adult follow‐up (95% confidence interval [CI]: 2.4‐17.3), representing 4 cases of residual cholesteatoma and no recurrences. The otorrhea rate was 5.6% at 12 months and the rate of definitive waterproofing was 89.8% at 12 months. There was a reoperation rate of only 6.7% at 5 years which included second stage ossiculoplasty. Regarding hearing, 62.2% preserved their hearing (change between −10 to = 10 dB), 36.5% had hearing gain (>10 dB), and 16.9% had hearing reduction at 12 months postoperation. Forty‐eight percent (48%) achieved a postoperative air‐bone gap of ≤20 dB.Conclusions:Use of a CWD approach with obliteration of the mastoid cavity to surgically treat cholesteatoma results in a low recurrence rate and high rate of a trouble‐free ear in the long term.
Minimally Invasive Repair of Posterior‐Superior Retraction Pockets in Children with Lysis of Middle Ear Adhesions
Authors: Neff Laura , Poe Dennis S. , Chao Wei‐Chieh 
Published: September 2014

Objectives:(1) Treat adhesive tympanic membrane (TM) retractions in children by lysis of middle ear adhesions during insertion of tympanostomy tubes (TT). (2) Analyze the ability to improve conductive hearing loss and to prevent progression of retraction pockets, incus erosion, and avoid future tympanoplasty.Methods:A retrospective review from 2005 to 2013 was performed in 22 ears of 18 patients who were candidates for cartilage tympanoplasty to correct a progressive posterior‐superior retraction pocket, with or without incus erosion. Lysis of middle ear adhesions using angled picks was performed through the myringotomy before insertion of a TT. The hypothesis was that the released redundant TM, wrapped around the barrel of the TT to maintain it under tension, could allow regeneration of a healthy tympanic membrane in children.Results:TM retractions were elevated and adhesions lysed in 22 ears. Mean age was 11.3 years (range, 4‐22 years). Follow‐up ranged from 3 to 72 months (mean, 23.2 months). Preoperatively, there were 15 Sade grade III and 7 grade IV atelectatic TMs. Postoperatively, there were 14 without retraction, 6 grade I, 1 grade III, and 1 grade IV TMs. Grade I and nonretracted TMs healed without dimers. Mean AB gap improved from 19.94 to 3.88 dB. Two ears required a revision procedure and a third ear developed a cholesteatoma.Conclusions:Lysis of middle ear adhesions through a myringotomy at the time of TT insertion allows for healing of the tympanic membrane, improved hearing, and can be effective in preventing progression of atelectasis and incus erosion in children.
Myringotomy and Ventilation Tube Insertion: Endoscopic versus Microscopic Technique
Authors: Martellucci Salvatore , Pagliuca Giulio , De Vincentiis Marco , Gallipoli Camilla , De Virgilio Armando , Scaini Ettore , Gallo Andrea 
Published: September 2014

Objectives:(1) Assess the feasibility of endoscopic‐assisted myringotomy and ventilation tube insertion in patients affected by chronic otitis media with effusion (COME). (2) Describe advantages and disadvantages of the endoscopic technique. (3) Compare the outcomes of the endoscopic‐assisted approach with those obtained with the traditional microscopic technique.Methods:The study was conducted from May 2010 to September 2013 at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome. A total of 24 patients (average age 46 ± 4.5 years; 9 males, 15 females) affected by unilateral or bilateral COME (27 ears, 12 right, 15 left) were enrolled in this prospective controlled trial. The diagnoses were confirmed by otoendoscopic examination, tympanometric and pure‐tone audiometric measurements. Patients were randomly divided in 2 groups. Group A patients underwent myringotomy and ventilation tube insertion under endoscopic viewing, whereas in Group B the same procedure was performed using a surgical microscope. All cases were evaluated 1 week after surgery and then monthly until tube extrusion. Complications and tube extrusion times were recorded during follow‐up. Audiometric measurements were carried out 2 months after tube extrusion.Results:The outcomes of surgery, assessed with endoscopy and audiometric measurements, were similar in the 2 groups. There were no significant differences in mean operative times, tube extrusion times, or complication rates (P >. 05).Conclusions:The endoscopic technique seems to be a viable alternative to the traditional microscopic approach for myringotomy and ventilation tube positioning in patients affected by COME in the era of endoscopic ear surgery.
Reconstruction of Parotidectomy Defects
Authors: Peck Jessica J. , Petrisor Daniel , Cannady Steven B. , Wax Mark K. 
Published: September 2014

Objectives:Describe common cosmetic deformities and options for reconstruction following parotidectomy.Methods:The authors reconstructed parotid defects in 50 patients and will present an algorithm for reconstruction based on volume, location, and coexisting defects.Results:The parotid gland is the largest salivary gland in the head and neck, occupying a significant tissue volume. While not every parotidectomy requires reconstruction, excision of large parotid lesions, especially those involving the preauricular area, produce sizeable concavity and skeletonization of the mandible. The resulting cosmetic deformity can significantly affect patients’ self‐image and negatively impact their quality of life. Free fat, alloderm, superficial musculoaponeurotic system, rotational sternocleidomastoid flap, and free tissue transfer are possible reconstructive options. Choosing an appropriate donor site requires consideration of the volume, location, and coexisting defects. Free fat grafts are best suited for small lateral parotid defects. In larger volume defects the amount of fat reabsorption is variable, making long‐term results less reliable. Similarly, the muscle atrophy of rotational sternocleidomastoid flaps limits their use to filling medium‐ sized defects, and the arch of rotation allows for only middle and inferior filling of the gland. Finally, large volume reconstruction of total parotidectomy defects, with or without skin, is best accomplished with free tissue transfer.Conclusions:Reconstructing parotid defects slightly increases operative time and blood loss, but patient satisfaction with the cosmetic outcome is high. Regardless of method used, same‐stage reconstruction of parotidectomy defects is advocated and of benefit to the patient. An algorithm for choosing one of several reconstructive options is presented.
The Nervus Intermedius in Children with Cochlear Nerve Deficiency Submitted to Auditory Brainstem Implantation
Authors: Colletti Giacomo , Mandala Marco , Colletti Liliana , Colletti Vittorio 
Published: September 2014

Objectives:Anatomical distortions of the neural structures surrounding the foramen of Luschka (FL) characterize children with cochlear nerve deficiency (CND). Our goal was to investigate the anatomical features of the nervus intermedius (NI) and cranial nerve 7 (CN) VII in children with CND and verify if the NI can provide an additional landmark during auditory brainstem implantation (ABI) surgery, preventing intraoperative injuries of the nearby vessels and nerves.Methods:Sixty‐four CND children ranging in age from 8 months to 16 years (2.92 ± 1.54) were video‐recorded during retrosigmoid surgery for fitting the ABI and retrospectively examined with particular reference to the number and variety of NI bundles, the associated malformations of CN VII, the relationship with CN VII, and the possibility that NI might represent a landmark for ABI insertion.Results:Absence of CNs VI, VII, and VIII was observed respectively in 3, 8, and all children. Eighteen children showed several abnormalities of CN VII in the cerebellopontine angle. The identification of CN VII and of the bundles comprising NI was possible anatomically in 46 children. In 12 the identification was obtained with the assistance of intraoperative monitoring. The number of bundles comprising the NI varied from 1 to 6. The NI and CN IX were useful landmarks for identifying the FL of the lateral recess.Conclusions:NI provides an additional landmark during ABI microsurgery. Knowledge of NI anatomy and its topographical relationship with the neurovascular structures around the FL may prevent iatrogenic injuries and ABI electrical stimulation of the surrounding cranial nerves.
Quality of Life Assessment in Patients with Neurofibromatosis Type II
Authors: Cosetti Maura , Golfinos John , Roland J. Thomas 
Published: September 2014

Objectives:(1) Develop a multidimensional metric for assessing quality of life (QoL) in patients with NF2. (2) Compare NF2 results with reference values for the general population and patients with head and neck or brain cancer.Methods:Structured interviews with NF2 providers and patients identified relevant domains. Items in these domains were extracted from validated EORTC modules, combined with items unique to NF2 and pre‐tested on NF2 providers and patients (N = 118). The questionnaire included 61 items assessing overall QoL and 10 additional domains including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain and vocal communication. Responses were compared to reference values for the general population and head and neck cancer and brain cancer patients.Results:QoL in NF2 patients was lower than that of the general population (P <. 01) and similar to that of patients with cancer. NF2 patients whose treatment included radiation therapy had worse overall QoL than patients who did not undergo radiation. Patients with more facial weakness, hearing loss and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty and pain. When compared to patients with head and neck and brain cancer, NF2 patients demonstrated significantly higher levels of psychosocial stressors, including disease‐related anxiety, personal and financial stress, and lack of social support (P <. 01).Conclusions:Psychosocial stress and pain significantly impact QoL in NF2 indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.