bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging Prevalence of Sigmoid Sinus Dehiscence among Patients with and without Pulsatile Tinnitus
Authors: Nicholas Brian D. , Schoeff Stephen S. , Mukherjee Sugoto , Kesser Bradley W. 
Published: August 2013

Objectives:1) Appreciate the incidence of sigmoid sinus diverticulum/dehiscence (SSDD) among patients with pulsatile tinnitus (PT) and its prevalence in patients undergoing high resolution temporal bone computed tomography (HRCT) for other reasons. 2) Understand comorbidities associated with SSDD.Methods:Retrospective chart review of patients undergoing temporal bone imaging between January 2003 and November 2012 at a tertiary care university medical center. Two groups were evaluated for evidence of SSDD. The first (“PT”) group included all patients whose radiology report mentioned a clinical history of PT (n = 38 symptomatic ears in 30 patients). The second group (“non‐PT”) included all patients undergoing temporal bone HRCT between November 2011 and November 2012 (n = 323 ears in 171 patients). Primary outcome measure was the radiographic presence of SSDD. Variables including age, gender, body mass index (BMI), and systemic hypertension were analyzed by two‐tailed Fisher's exact tests.Results:Within the PT group, SSDD was identified in 24% of ears (9/38) and 23% of patients (7/30); all SSDD patients were female (P =. 029). There were no differences in mean age, BMI, or presence of hypertension between those with and those without SSDD. In the non‐PT group, SSDD was identified in 2 (both female) of 171 patients (1.2%; 0.6% of ears). The difference in SSDD prevalence between the two groups was significant (P =. 0001).Conclusions:The prevalence of SSDD in patients with PT was 24%. The prevalence of SSDD among all patients undergoing HRCT in one year was 1.2%. In our study, SSDD affected females exclusively.
The Implications of Physical Injury on Otovestibular and Cognitive Symptomatology following Blast Exposure
Authors: Perez Colleen , Johnson Christopher M. , Hoffer Michael 
Published: August 2013

Objectives:Identify a potential difference in the spectrum of otovestibular and cognitive symptoms in blast‐exposed patients either with or without significant extremity injuries.Methods:A retrospective chart review of 100 consecutive blast‐exposed patients seen in the otolaryngology department vestibular clinic at a military tertiary care medical center in 2011 was performed. New patient encounters were identified in the electronic medical record, and all patients referred for otovestibular evaluation after a blast injury or exposure were included. A convenience sample of 100 consecutive patients meeting the criteria was studied. Data including presence of extremity injuries, diagnosis of mild traumatic brain injury, symptoms of imbalance, vertigo, headache, tympanic membrane perforation, hearing loss, tinnitus, insomnia, and memory loss were collected and analyzed.Results:Of 100 patients included, 38 suffered severe extremity injuries. Those patients with severe extremity injuries were more likely to suffer from tympanic membrane perforations (58% vs. 23%, P = 0.0004) and hearing loss (53% vs. 23%, P = 0.002), less likely to suffer from imbalance (32% vs. 79%, P = 0.000002) and vertigo (2% vs. 47%, P = 0.000003), and less likely to have been diagnosed with a mild traumatic brain injury (26% vs. 66%, P = 0.0001).Conclusions:Blast‐exposed individuals who sustained severe extremity injuries reported significantly fewer cognitive and vestibular symptoms. In the aftermath of a blast, those who can walk away may have still sustained a significant injury. Specifically, they may suffer more long‐term cognitive and vestibular symptoms than those with severe physical injuries.
Longitudinal Comparison of Quality‐of‐Life Outcomes in Vestibular Schwannoma Patients
Authors: Robinett Zachary N. , Walz Patrick C. , Miles‐Markley Beth A. , Spear Samuel A. , Welling D. Bradley 
Published: August 2013

Objectives:1) Compare long‐term quality of life (QOL) outcomes in vestibular schwannoma (VS) patients managed conservatively, with microsurgery, or with stereotactic radiation; 2) Evaluate factors contributing to their QOL.Methods:The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was administered to 645 patients treated for VS at a tertiary care center over 24 years. Patients in each treatment group were sub‐divided by years since diagnosis (0‐5, 6‐10, and >10). Composite QOL (cQOL) scores and sub‐scores in hearing, balance, facial symptoms, pain, anxiety, and energy were compared by ANOVA at each time interval. Regression analysis correlated QOL with tumor size, speech recognition threshold, and reported symptoms.Results:Survey return rate was 49%. Mean follow‐up was 7.6 years. The only significant difference in cQOL was at 1‐5 years, where stereotactic radiation was best and conservative treatment was worst (P =. 009). No significant differences in cQOL were detected at 6‐10 or >10 years. Significant differences between sub‐scores were found in hearing, balance, and facial symptoms. Overall tumor size was inversely proportional to QOL (R =. 54; P <. 001); this correlation decreased with time (1‐5 R =. 61, P <. 001 / 6‐10 R =. 40, P <. 001 / >10 R =. 16, P =. 02).Conclusions:1) We found no significant difference in long‐term QOL outcomes between treatment groups; however, patients treated by stereotactic radiation may experience better overall QOL up to 5 years post‐treatment. 2) Tumor size at presentation is a good prognostic tool in VS patients but may be limited in predicting long‐term QOL outcomes.
Magnetic Resonance Imaging as a Useful Tool in the Evaluation of Clinical Treatment of Otospongiosis
Authors: de Oliveira Vicente Andy , Chandrasekhar Sujana S. , Yamashita Helio K. , Cruz Oswaldo‐Laercio M. , Barros Flavia A. , Penido Norma O. 
Published: August 2013

Objectives:Evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment.Methods:Prospective, randomized, controlled, double‐ blind study involving 31 patients with clinical, audiometric, and tomographic diagnosis of otosclerosis. If computed tomography (CT) demonstrated active lesions, these patients underwent (MRI) in order to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into three groups and received treatment with placebo, alendronate sodium, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. The MRIs were evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Outcomes were assessed by comparing the MRI, clinical, and audiometric evaluations in the pre‐ and post‐treatment periods.Results:Otospongiosis was most predominantly identified in the region anterior to the oval window (RAOW), and this site was reliable for comparing pre‐ and post‐treatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations.Conclusions:MRI shows higher sensitivity for detecting reduction in inflammatory activity of otospongiosis compared to clinical and audiometric findings. The objective MRI evaluation was the most accurate method of monitoring clinical treatment response in otospongiosis.
Medication Associated with Hearing Loss: 25 Years of Medical Malpractice Cases in the United States
Authors: Martell David W. , Ruhl Douglas S. , Cable Benjamin B. 
Published: August 2013

Objectives:Many medications used today continue to have the potential for ototoxicity. To potentiate management of this risk, this study examines malpractice litigation trends of lawsuits involving hearing loss associated with medication use.Methods:Court records of legal trials from 1987 to 2012 were obtained from two major computerized databases: WESTLAW and LexisNexis. Data were compiled on the demographics of the defendant and plaintiff, use of otolaryngologists as expert witnesses, medication used, legal allegations, verdicts, and judgments.Results:Forty‐six unique cases met inclusion criteria and were selected for review. Antibiotics (72%), specifically aminoglycosides (47%), were the most common medications cited as causing hearing loss. Eleven (22%) cases were resolved through a settlement before a verdict was reached. Verdicts in favor of the plaintiffs (37%) were awarded an average of $1,134,242. Pediatric patients were more likely to win their lawsuits (P = 0.03) compared to adults. However, no statistical difference existed between average awards. Of the cases found in favor of the plaintiff, the most common reasons cited were inappropriate medication, dose or duration (39%), failure to properly monitor (36%), failure to choose a less toxic medication (18%), and an error in diagnosis or failure to diagnose or treat (18% each).Conclusions:Physicians must be aware of the potential effects of the medications they prescribe. An understanding of potential drug interactions, proper monitoring, and appropriate use of less toxic medications is important to improve patient care. Analyzing litigation trends may be used to prevent future lawsuits and improve physician awareness.
Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension in Tympanoplasty Surgery
Authors: House Laura K. , House James R. 
Published: August 2013

Objectives:1) Determine the safety of using a commercially available suspension of polymycin B, neomycin, and hydrocortisone in tympanoplasty surgery.2) Apply evidence based medicine in tympanoplasty surgery when considering potential ototoxicity.Methods:Study Design: Retrospective chart review. Setting: Tertiary otology practice, single surgeon. Data were gathered on 277 consecutive type 1, underlay tympanoplasties for which both pre‐ and postoperative audiometric data were available over a 10 year period. In each surgery, gelatin sponge saturated in a commercially available suspension of polymycin B, neomycin, and hydrocortisone was placed in the middle ear to support the graft. Patients ranged from age 3y/o to 79y/o. Preoperative and postoperative bone conduction audiometric thresholds were measured at 500, 1000, 2000, 3000, and 4000Hz.Results:The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000Hz. The changes by frequencies were as follows: 500Hz (‐1.624dB), 1000Hz (‐1.399dB), 2000Hz (‐0.975), 3000Hz (‐0.596dB), and 4000Hz (+0.56dB). The five frequency average change was (‐0.545dB).Conclusions:The commonly used otic solution containing polymycin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.
Recurrent Vertigo after Intratympanic Gentamicin for Ménière's Disease: Long‐term Follow‐up of Two Regimens
Authors: Casani Augusto P. , Cerchiai Niccolò , Dallan Iacopo , Navari Elena , Franceschini Stefano S. 
Published: August 2013

Objectives:1) Analyze the recurrence rate of vertigo and the need for repeated injections of two different regimens of intratympanic gentamicin (ITG) (low dose and multiple daily dose). 2) Evaluate the efficacy of retreatment after long‐term recurrence of vertigo attacks.Methods:We retrospectively analyzed 2 series of patients suffering from unilateral Ménière's disease treated with low dose ITG (42) and multiple daily dose ITG (35) in a tertiary referral center. The mean period of follow‐up was 4.8 years, and the outcome measurements were a) control of vertigo attacks, b) need of repeated treatment for recurrent vertigo evaluated using the Kaplan‐Meyer method, and c) incidence of side effects (post‐treatment dizziness, hearing loss).Results:At 2‐year follow‐up, complete control of vertigo was obtained with only 1 round of treatment in 30 (71%) low dose patients and 28 (80%) multiple daily dose patients. Side effects of ITG were significantly higher in the multiple daily dose group. At long‐term follow‐up (> 4 years), the complete control vertigo rate decreased significantly, especially in the low dose group. 13 (31%) patients in the low dose group and 9 (25%) in the multiple daily dose group needed multiple rounds of treatment.Conclusions:Both regimen of ITG offered an excellent rate of vertigo control at 2‐year follow‐up. At long‐term follow‐up, the probability of recurrent vertigo attacks progressively increases, especially in the low dose group. The patients who experienced late recurrences of vertigo had less chance of achieving good results with additional rounds of ITG.
Retrospective Study Comparing Audiologic Performance and Surgeon Learning Curve between Cochlear Implant Devices
Authors: Mandour Mahmoud , Samy Ravi N. , Houston Lisa 
Published: August 2013

Objectives:1) Describe the challenges of using a new cochlear implant (CI) manufacturer in a well‐established CI program. 2) Recognize that a learning curve exists for all surgeons and audiologists using new CIs.Methods:A retrospective study was performed in a tertiary care center involving 25 consecutive CIs placed in post‐lingually deafened adults from January 2009 to September 2012. Audiological evaluations were compared at 3‐4 month and 12‐month follow‐up visits. Patients were divided into two groups: patients implanted using a new manufacturer to the institution (Med‐El, M group, n = 13) and patients implanted using an established manufacturer (Cochlear, C group, n = 12). Multiple linear regression analyses models used soundfield detection, Consonant Nucleus Consonant (CNC), and Hearing In Noise Test HINT) while adjusting for confounding factors (significance if P < 0.001).Results:A strong statistical correlation (r2 > 0.5) was observed among age at implantation, duration of deafness, pre‐implant speech perception score, and device type and the outcome measures at 3‐4 months and 1‐year follow‐up. However, none of them reached statistical significance (P value > 0.001). The device type (Cochlear against Med‐El) approached significance with SFD at 3‐4 months and at 1‐year follow‐up (P value = 0.003, 0.002 respectively).Conclusions:While the Cochlear system recipients initially seemed to perform better than the Med‐El recipients, this difference disappeared as experience with the newer implant system progressed. Other variables are more important than device type. However, sources of variability such as surgical and audiological inexperience with a new CI system highlight challenges facing a CI center attempting to modify an existing CI program.
Study of the Cochlear Function in Patients with Myotonic Dystrophy Type 1
Authors: Felekis Dimitrios , Balatsouras Dimitrios G. , Panas Marios , Korres Stavros , Xenelis John E. 
Published: August 2013

Objectives:Myotonic Dystrophy type 1 is a progressive autosomal dominant multisystem disorder, the second most common form of muscular dystrophy. The disease is associated with various vestibular, oculomotor, and auditory disorders. The aim of the present study was to undertake a detailed vestibular and audiological evaluation, and specifically to analyze the cochlear function using transiently evoked otoacoustic emissions.Methods:24 patients with genetically diagnosed myotonic dystrophy type 1 were studied during the past 4 years in Eginition hospital of Athens. Twenty‐one normal subjects were used as controls. Testing included pure‐tone audiometry, tympanometry, auditory brainstem responses (Abr), transiently evoked otoacoustic emissions, and nystagmography.Results:Tympanograms were normal in most patients. 15 (62.5%) patients had a varying degree of sensorineural hearing loss, with no conductive element. In 9 of them (37.5%), ABR abnormalities were found, such as absence of wave I or increased latencies of waves III and V, compatible with sensorineural hearing loss (5 patients), as well as increased I‐III and I‐V interpeak latencies, compatible with retrocochlear involvment of the auditory pathways (4 patients). Subclinical cochlear damage was found in all patients, as evidenced by absent otoacoustic emissions or lower otoacoustic emission amplitude. Vestibular hypersthesia was found in 9 patients (37.5%), accompanied by spontaneous nystagmus in 4 of them (15.6%).Conclusions:Audiovestibular abnormalities are quite common in patients with myotonic dystrophy type 1. We have found that subclinical cochlear damage is a common finding of the disease, as concluded from the absence or decrease of otoacoustic emissions in these patients.
Surgeon Behavior in a New Virtual Reality Temporal Bone Simulator Compared to Cadaveric Dissection
Authors: Szudek Jacek , Avery Alex , Ioannau Ioanna , Zhou Yun , Kennedy Gregor , O'Leary Stephen 
Published: August 2013

Objectives:The gold standard for teaching otologic surgery is cadaveric temporal bone (TB) dissection. However, learning may be enhanced by virtual reality (VR) simulation, which improves access and allows reproducibility. The main criticism of VR has been its lack of fidelity. The objectives of this study were to 1) assess the fidelity of a novel VR TB simulator, and 2) compare surgeon behavior to that in cadaveric TB dissection.Methods:A new 3D high‐fidelity force‐feedback VR simulator was developed for otologic procedures. Using prospective paired comparisons conducted in June 2012, 6 surgeons each performed a mastoidectomy, facial recess dissection, and a cochleostomy on a human cadaveric TB and in the VR simulator. Drill movements were then compared between cadaveric and VR trials.Results:Stroke number (P = 0.69), speed (P = 0.08), and rate (P = 0.74) did not differ significantly between VR and cadaveric environments for all 3 stages. Compared to cadaveric dissection, subjects in the VR simulator spent less time completing each stage (236s vs. 698s; P = 0.01); spent a greater percentage of time drilling (69.5% vs. 30.4%; P = 0.002); and used a larger percentage of long strokes (39.8% vs. 6.9%; P < 0.001).Conclusions:Drill stroke characteristics among surgeons in the VR simulator were similar to those in the cadaveric dissection. This suggests that real‐life drilling behavior was replicated in VR and that it may be a useful adjunct to traditional TB dissection.
Traumatic Hearing Loss in the Context of Blast‐Related Tympanic Membrane Perforation
Authors: Pusz Max D. , Robitschek Jon M. 
Published: August 2013

Objectives:Identify associated clinical factors and characterize the various forms of hearing loss in the context of blast related traumatic tympanic membrane perforation sustained in the combat setting.Methods:A prospective study of 41 patients who sustained a perforation secondary to blast injury between 2010‐12 while serving in combat. Clinical exams and audiograms were obtained for all patients by a single institution ear, nose, and throat (ENT) service with comparative data generated from review of pre‐ and post‐trauma hearing screens. Follow‐up clinical and audiogram data were obtained on all available subjects.Results:Fifty‐nine tympanic membrane (TM) perforations were documented with audiograms. A conductive hearing loss of 14.8dB, 22.4dB, 20.3dB, and 18.9dB and sensorineural hearing loss of 18.0dB, 13.5dB, 19.9dB, and 22.0dB at 500, 1000, 3000, and 4000 Hz respectively was observed. Forty‐nine percent of all hearing loss was SNHL. Clinical factors did not correlate to hearing loss (P > 0.05). Follow‐up data were available in 33 patients at an average of 11.8 months. Eighty‐eight percent of patients still had tinnitus, and 11% had continued vertigo. Forty‐nine percent of perforations healed spontaneously, and 42% had surgical correction. On average, patients demonstrated a 51% improvement in SNHL at time of follow‐up.Conclusions:In the subacute setting, patients with traumatic TM perforations secondary to combat blast injury demonstrate conductive and sensorineural hearing loss, with 49% of all loss being sensorineural. An average sensorineural hearing loss improvement of 51% was seen at follow‐up. Clinical factors did not correlate with hearing loss. 49% of perforations healed spontaneously, and 42% were surgically corrected.
Acetaminophen plus Ibuprofen for Treatment of Post‐tonsillectomy Pain in Children
Authors: Mattos Jose L. , Robison Jacob G. , Yellon Robert F. 
Published: August 2013

Objectives:Determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post‐tonsillectomy pain compared to acetaminophen plus opioids in children.Methods:A retrospective medical record review was performed of children (n = 575) who underwent adenotonsillectomy at a tertiary care children's hospital between September 2012 and January 2013. All patients received acetaminophen. 342 (59%) received ibuprofen, and 233 (41%) received opioids (oxycodone or hydrocodone) without ibuprofen. In the ibuprofen group, 109 (32%) received opioids. None received codeine. Descriptive analysis, two‐tailed t‐tests, and multivariate regression controlling for age and diagnosis analyzed differences of outcomes: 1) postoperative hemorrhage, 2) nurse phone calls from families, and 3) emergency department (ED) visits for pain, dehydration, or bleeding.Results:For the entire group, 7% had postoperative hemorrhage. 43% of these required operative intervention. There were 73 ED visits and 216 nurse calls. No significant difference was found in bleeding, ED visits, or nurse calls (P = 0.2, 0.8, and 0.3, respectively) between groups. No difference was found in operative intervention for hemorrhage (P = 0.9). No further difference was found when adjusting for age and/or diagnosis. After excluding the children who received ibuprofen plus opioids, there was still no significant difference in outcomes.Conclusions:There appears to be no difference in incidence of hemorrhage, operative intervention for bleeding, ED visits, or nurse calls between children receiving acetaminophen plus ibuprofen and those who received acetaminophen plus narcotics with/without ibuprofen. These data suggest that safety and pain control profiles are similar when using ibuprofen instead of opioids in post‐adenotonsillectomy patients.
A Comparison of Postoperative Tramadol versus Acetaminophen with Codeine in Children Undergoing Tonsillectomy
Authors: Friedrichsdorf Stefan J. , Nugent Andrea P. , Foster Laurie P. , Lu Yi , Sidman James D. 
Published: August 2013

Objectives:1) Evaluate the effectiveness of tramadol compared to codeine/acetaminophen for post‐tonsillectomy pain management. 2) Describe the safety and side effects of tramadol compared to codeine/acetaminophen during the post‐tonsillectomy recovery period.Methods:Prospective, double‐blinded, randomized controlled clinical trial of children ages 4‐15 who underwent routine tonsillectomy (with or without adenoidectomy) surgery at Children's Hospitals and Clinics of Minnesota in 2011 and 2012. Children were randomized to receive scheduled—followed by PRN—dosing of either tramadol or codeine/acetaminophen. Primary outcomes were assessed during a 10‐day postoperative follow‐up period with parent diaries and chart review. Diaries captured the following domains: physical recovery; pain (multiple pain scales); sleep; side effects; need for medical attention; and global satisfaction with treatment.Results:The final sample of 74 children was mostly white (92%), female (65%), and 6 years of age (range 4‐14). Most parents completed diaries for ≥ 4 days (92%). There were no significant differences between groups in terms of medication efficacy or overall experience with side effects. Groups did not differ in terms of days with a mean pain score >4 (P = 0.85) (tramadol = 1 day; codeine = 1.5 days).Conclusions:There were no differences between groups in terms of postoperative medication efficacy or safety in this small trial. Due to codeine's declining acceptability for use in children and risks associated with its efficacy and safety, tramadol should be considered as a first line prescription for children undergoing this common procedure. Further evaluations of oral pain medications for post‐tonsillectomy care should be conducted.