bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally Invasive Osseointegrated Hearing Implant Surgery
Authors: Hawley Karen A. , Haberkamp Thomas J. 
Published: February 2015

Objective1) To report on the results and complications arising from using a minimal tissue removal procedure for the placement of an osseointegrated hearing implant. 2) To understand the advantages and disadvantages for this technique compared to the more standard techniques.MethodRetrospective study in tertiary academic center of all patients undergoing minimally invasive single‐stage osseointegrated implant surgery (BAHA®) from 2008‐2010. Technique: A small incision (1.5 cm) with little to no soft tissue (fat only) removal with good skin to periosteum fixation after placement of a 4 mm screw and 8.5 mm abutment.ResultsThirty‐three patients were assessed (aged 16‐86, range of follow‐up 18‐45 months). No patients experienced hair loss, significant numbness, cosmetic defects, intraoperative complications, or audiologic complications. Seven patients required some combination of bactroban, steroid ointment, and/or oral antibiotic for mild erythema around the abutment in the first 2 months postop. Two patients required conservative management for delayed skin reactions (3.5 months and 2.5 years). Five of these 6 patients had 1 more episode requiring similar treatment. All reactions resolved in approximately 2‐4 weeks. Two additional patients required minor surgical soft tissue revision.ConclusionWe have demonstrated comparable outcomes to other surgical techniques with less cosmetic and other associated complaints. This study indicates that a less invasive approach for the surgical implantation of the osseointegrated auditory implant may have merit.
Monaural Hearing before/after Sequential Cochlear Implants
Authors: Pelosi Stanley , Wanna George B. , Sisler‐Dinwiddie Allyson , Rivas Alejandro , Labadie Robert F. , Bennett Marc L. , Haynes David S. 
Published: February 2015

ObjectiveThe relationship between pre‐ and postimplantation monaural auditory performance in patients undergoing bilateral sequential cochlear implantation (SCI) has not been clearly defined. A greater understanding of this relationship could potentially affect preoperative counseling to patients regarding choice of initial side to implant.MethodRetrospective review was performed of monaural auditory performance pre‐ and postimplantation in 90 SCI recipients between 1997 and 2011 at Vanderbilt University. A “better‐hearing ear” had lower pure tone average or speech awareness threshold by at least 10 dB, or open/closed‐set speech perception score at least 10% higher.ResultsA difference in preimplantation hearing status was identified in 35 patients. The first‐implanted ear was better‐hearing in 11 and worse‐hearing in 24. 28/35 patients had available data on post‐implantation monaural auditory performance. At last follow‐up (mean 24 months, range 1‐69), the first‐implanted ear exhibited better closed/open‐set speech perception scores in 19/28 (68%) patients. There were no differences when comparing patients grouped according to preimplantation hearing status (Fisher’s exact test, P <. 05). Median time between implant activations was 31 months when the first‐implanted ear exhibited better performance, and 17 when the second‐implanted ear performed better (difference NS, rank sum test).ConclusionA relationship between pre‐ and postimplantation monaural auditory performance in SCI recipients was not identified. The first implanted ear is more likely to exhibit better monaural auditory performance, even if this ear had worse pre‐implantation hearing. This finding highlights the plasticity of central auditory pathways in cochlear implant recipients.
Novel Completely‐in‐the‐Canal Magnet‐Drive Micro Hearing Aid
Authors: Mahboubi Hossein , Paulick Peyton , Kiumehr Saman , Merlo Mark , Bachman Mark , Djalilian Hamid R. 
Published: February 2015

ObjectiveTo describe a novel magnet‐drive micro hearing aid (MMHA), a 3.5‐mm wide device, that fits entirely into the bony canal and drives the tympanic membrane (TM) using a magnet in a noncontact fashion. To test the effectiveness and optimal positioning of the magnet on the TM.MethodCadaveric temporal bones were prepared for laser Doppler vibrometry (LDV) of the stapes. MMHA was placed at 1 and 2 mm away from the TM, and the magnets were glued to umbo and lateral process of the malleus. Frequency sweeps between 300 Hz to 12 kHz were performed.ResultsThe MMHA showed frequency response from 300 Hz to 12 kHz at loudness levels from 60 to 120 dBA at 10 dBA steps. Placement of magnet on the umbo resulted in higher amplitudes and lower power requirements than placement on the lateral process. The same results were observed when the device was placed at 1‐mm distance from the TM.ConclusionMMHA is a small completely‐in‐the‐canal hearing aid that drives the TM in a noncontact fashion through a magnet. This novel device has a frequency output wider than air conduction devices. The device’s ability to directly drive the TM enables it to potentially sound more naturally and similar to implantable devices.
Pack or No Pack after Ear Surgery: A Randomized Controlled Trial
Authors: Javed Faisal , Whitwell Russell , Macleod Ian , Hajioff Daniel , Robinson Philip , Rea David , Nunez Desmond 
Published: February 2015

Objective1) To see if there is a difference in patient and clinician reported outcomes between patients randomized to postoperative ear packing, compared to those who did not have the ear packed after middle ear surgery. 2) To see if there is a also a difference in hearing outcome between both groups.MethodRandomized controlled trial of adult patients to have either Bismuth Iodoform Paraffin Paste pack or no ear pack postoperatively after primary canal wall up middle ear surgery. Setting: tertiary teaching hospital, UK (2011). Outcome measures: clinicians/patients recorded visual analogue scale scores at 3 weeks and 3 months postoperatively. Audiometry was recorded at 3 months.ResultsThirty‐two patients of similar sex and age were randomized to the 2 treatment arms. There was no statistically significant inter‐group difference in 3‐week composite clinician and patients mean visual analogue scores (146 mm versus 184 mm [P =. 3]). The graft take rates and the appearance of the ear canals at 3 months were similar in both groups (P = 1.0 for both outcomes). There was also no significant inter‐group difference in the change in mean air conduction thresholds in response to surgery (11.3 dB and 3.5 dB) in the ear pack and no pack groups, respectively (P =. 08).ConclusionNo differences in total patient symptoms and clinician findings or hearing were demonstrated between patients with a postoperative pack compared to those without a postoperative pack following middle ear surgery. This pilot study provides justification for a larger clinical trial to investigate the need for postoperative ear canal packing.
Prevention of Biofilm Formation by Polyquaternary Polymer
Authors: Ojano‐Dirain Carolyn , Antonelli Patrick J. , Silva Rodrigo C. , Bashir Usman 
Published: February 2015

ObjectiveBiofilm formation has been linked to otologic implant infection and extrusion. The purpose of this study was to determine if a microbicidal polyquaternary polymer (PP) could prevent biofilm development by common otopathogens, Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA).MethodPolyurethane tubes (20 per treatment) with and without a PP were briefly exposed to plasma or saline, then to SA or PA. Tubes were incubated in growth media. After 4 days, antibiotics were added to kill planktonic bacteria. Biofilm formation was assessed by bacterial counts and scanning electron microscopy.ResultsSA biofilm was reduced by 8 logs on tubes with the PP compared to the control tubes (P <. 0001). PA biofilm formation was also less on tubes with the PP (P <. 0001), but the reduction was only 1 log. Plasma promoted SA and PA biofilm on the control tubes (P <. 0001) but not on the tubes with the PP (P =. 07 and. 40 for SA and PA, respectively).ConclusionIncorporation of a microbicidal PP into polyurethane dramatically inhibits SA biofilm formation. Further research is warranted to evaluate the efficacy and safety of this technology in otologic implants.
Regulated Chitosan‐Based Inner‐Ear Drug Delivery
Authors: Lajud Shayanne A. , Han Zhao , Bur Andres , Sanyal Samudra , Bezpalko Orysia , O’Malley Bert W. , Li Daqing 
Published: February 2015

Objective1) To evaluate a novel system for regulating the chitosan‐glycero‐phosphate (CGP)‐based hydrogel drug delivery to the inner ear. 2) To understand the distribution of gentamicin in the inner ear following CGP drug delivery with and without regulation.MethodChitosanase, specifically targeting CGP, was identified and purified for its use as a CGP regulation system. In vitro and in vivo studies were conducted to evaluate the effect of the chitosanase on the inner ear drug delivery and distribution. Gentamicin‐Texas Red (GTTR) was used for tracking the drug distribution.ResultsPurified chitosanase was confirmed with Western blot. The in vitro study showed that the chitosanase‐based regulation system effectively controlled the gentamicin releasing. The in vivo data concur with in vitro findings and demonstrated that the gentamicin concentration in the inner ear can be successfully regulated by applying the chitosanase. Moreover, the gentamicin inner ear distribution can also be regulated by changing its inner ear concentration.ConclusionOur study suggests that the chitosanase‐based regulation system can be effectively used for controlled inner ear drug delivery. This system has a potential to stop inner ear drug application when side effects or drug‐related toxicities start to occur and should be used for safe drug application in the inner ear.
Repair of Big Drum‐Head Defect by Underlay Fascia and STSG
Authors: Ahmed Hamza E. 
Published: February 2015

Objective1) Describe the technique of grafting total and near‐total tympanic membrane perforations using underlay temporalis‐ fascia graft augmented by split‐thickness skin graft from the ear lobule. 2) Evaluate the procedure in terms of graft take, hearing outcomes, and complications.MethodThis clinical study was conducted on 91 patients (93 perforations) having total (6) or near‐total (87) tympanic‐membrane perforation from January 2005 till December 2010 in a teaching university hospital. Myringoplasty utilizing temporalis‐fascia graft underlay supported externally by split‐thickness lobular‐skin graft. Graft take, early and late PTA changes, and complications were evaluated.ResultsGraft take was achieved in 86 out of 93 operations (92%), with 7 cases of graft failure (8%). PTA improvement was 16.3 dB at 3‐month postoperative versus 15.5 dB at 1 year. Other complications noticed were prolonged graft swelling with discharge (3 cases), 2 of them ended by graft breakdown and the third improved. Bleeding from the jugular bulb during abrasion of middle‐ear floor mucosa occurred twice, and in one of them bleeding stopped with surgicel. In the other extraluminal packing of the sigmoid sinus was necessary. The procedure was completed. No blunting or donor site complications were noticed.ConclusionLarge TM perforations can be managed successfully by underlay temporalis‐fascia graft supported externally by STSG from the ear lobule laid in part over the deep meatal skin and in the other part over the graft. One can expect >90% graft take, >15 dB PTA improvement, and a limited number of complications.
Risk for Complications from CPA Surgery due to BMI
Authors: Mantravadi Avinash V. , Leonetti John P. , Marzo Sam J. , Burgette Ryan C. 
Published: February 2015

ObjectiveTo determine the relationship between body mass index (BMI) and risk for complications from transtemporal surgery for non‐malignant disease processes of the cerebellopontine angle (CPA). To determine the threshold BMI above which risk is increased.MethodRetrospective review of 106 patients undergoing transtemporal CPA surgery for non‐malignant disease processes from 2010 to 2011 (tertiary‐care academic center). Preoperative BMI, approach, hospital stay, and complications including cerebrospinal fluid (CSF) leak, wound complications, and brachial plexopathy. Data were analyzed to determine whether BMI affects postoperative CSF leak, wound infection, or brachial plexopathy.ResultsA total of 106 patients were included, with a mean BMI of 28.17. Statistical analysis demonstrated an increased incidence of CSF leak in patients with a preoperative minimum BMI of 31.4 (rpb = 0.216, df = 101, P <. 05). There was no clear relationship between BMI and the development of postoperative wound complications. An increased risk for postoperative brachial plexopathy was found in patients with a BMI > 29.97.ConclusionRisk of CSF leak and brachial plexopathy after transtemporal CPA surgery for non‐malignant processes are increased in patients with an elevated BMI. Consideration should be given to preoperative dietary/lifestyle modifications and exercise programs and/or perioperative lumbar drain placement and intraoperative upper extremity evoked potential monitoring to decrease these risks.
The Inferior Vestibular Nerve and Posterior Canal BPPV
Authors: Shupak Avi 
Published: February 2015

ObjectiveThe aim of the study was to learn whether normal ipsilateral cervical vestibular myogenic potential (cVEMP) responses, for which functional integrity of the inferior vestibular nerve is required, are present in all patients having the clinical picture of posterior canal benign paroxysmal positional vertigo (PCBPPV).MethodTwenty‐four patients with PCBPPV participated in a prospective open study, conducted between November 1, 2009, and November 30, 2011. All had cVEMP after the completion of canal repositioning procedure. Follow‐up 1, 3, 6, and 12 months after the initial treatment included the Dizziness Handicap Inventory (DHI) questionnaire and otoneurological bed‐side examination.ResultsNormal cVEMPs were recorded in 20 (83%) and were pathological in 4 (17%) subjects. The average DHI score in patients with normal cVEMP was 13.9 + 16.6 vs 0.7 + 1.1 among those with pathological cVEMP (N = 4 in the pathological VEMP group too small to allow statistical analysis). 14 (58%) patients had recurrent PCBPPV (rPCBPPV). Twelve (86%) of the subjects with rPCBPPV had normal and 2 (14%) had pathological cVEMP. The proportions of subjects having abnormal cVEMP did not differ significantly between the recurrence and non‐recurrence groups (Fisher exact test).ConclusionMost patients suffering from PCBPPV had normal cVEMP. Reduced symptomatology as quantified by the DHI score was found when the cVEMP was pathological. This finding suggests that functional integrity of the inferior vestibular nerve is required for the complete clinical picture of PCBPPV to take place.
Type II and Type III Tympanoplasties: A 10‐Year Revision
Authors: Silva Clara N. , Mesquita Pedro , Silvestre Natercia , Ribeiro Joao C. , Amorim Ana M. , Paiva António 
Published: February 2015

ObjectivePortmann’s type II (T2) and III (T3) tympanoplasties are often performed for the treatment of chronic ear pathology. This study aims to assess the epidemiological and functional differences between type II and III tympanoplasties, trying to find functional predictors of success.MethodObservational retrospective study of 171 patients undergoing a T2 or T3 surgery in a tertiary hospital between 2000 and 2009. Age, gender, side, surgical technique, type of prosthesis, disease activity, malleus presence, type and use of cartilage, preoperative and postoperative air‐bone gap (ABG), and pure tone average (PTA) were recorded.ResultsA total of 171 cases (119 T2 and 52 T3) were pooled with a mean age of 38.6 ± 16.0 years. T2 had a preoperative ABG of 28.1 ± 8.5 dB and PTA of 47.1 ± 15.2 dB, while T3 showed a 32.8 ± 8.0 dB ABG and a 51.4 ± 20 dB PTA (P <. 05), suggesting that preoperative ABG and PTA are predictors of the type of surgery to perform. The average improvement was 9.69 ± 13.8 dB and 7.0 ± 11.8 dB for tympanoplasty type II and III, respectively (P <. 05). Functional success was significantly different between T2 (82%) and T3 (63%, P <. 05). We found no predictors of functional success relatively to epidemiological factors or otological characteristics in the multivariate analysis.ConclusionOur data suggest that the preoperative ABG and PTA are predictors of the type of what tympanoplasty to perform as well as predictors of functional success in both T2 and T3. Functional success is greater in T2 rather than T3.
Vibrant Soundbridge in Children
Authors: Wolf‐Magele Astrid , Schnabl Johannes V. , Koci Viktor , Riechelmann Herbert , Sprinzl Georg M. 
Published: February 2015

ObjectiveThe VSB is an AMEI which is approved for children. It is also used for patients with aural atresia or chronic otitis media (COM), with limited hearing rehabilitation solutions. The aim for this study is to investigate the hearing rehabilitation in children using VSB suffering from atresia or COM.MethodStandard audiological tests were performed pre‐ and postoperatively. CT images were acquired to assess feasibility of the FMT placement in the middle ear and to determine the Jahresdorfer score in patients with atresia. Functional gain and speech improvement are analyzed.ResultsThirteen children (median age 9.1) with congenital aural atresia or COM were implanted with the VSB. The average Jahresdorfer scale was 5.9. There were no pre‐ or postoperative medical complications observed, and hearing levels were preserved. The surgical technique is safe, due to the unchanged pre‐ versus postsurgery BC levels. CT images provide crucial information about the accessibility for the attachment of the FMT. Patients with atresia showed a functional gain of 40 dB and an improvement of 60% in speech. Patients with COM showed a functional gain of 38 dB and an improvement of 50% in speech.ConclusionIn these cases, the audiological outcome shows an effective gain in hearing and an improvement in speech. The VSB therefore offers an excellent audiological rehabilitation intact skin solution for children suffering with congential aural atresia or COM.
A National Survey of Pediatric Sleep‐Disordered Breathing
Authors: Gudnadottir Gunnhildur , Hellgren Johan 
Published: February 2015

ObjectiveThis study estimated the national childhood prevalence of sleep‐disordered breathing in a random population sample from The Swedish Population Register including all residents and compared it to data from The National Board of Health and Welfare where all tonsillectomies are registered.MethodThe validated OSA 18 questionnaire was mailed twice to the caretakers of 1320 randomly selected children aged 0‐11 stratified by gender, age group, and area of residence. The OSA 18 includes questions regarding sleep disordered breathing, physical and emotional symptoms, daytime function, and caretakers’ concerns during the last month.ResultsThe questionnaire was answered by 754 subjects (57%); 3.5% of the children had an OSA 18 score >60 indicating OSAS, and in this group 63% were not assessed by the healthcare. The highest prevalence was found in the 3‐5 year olds, and it was higher in boys than girls. Area of residence and age adjusted BMI did not affect the results. Loud snoring “always” or “often” was reported among 4.8% of the children and was significantly associated with male gender and night sweats. In Sweden, 7000 tonsillectomies are performed each year in this age group, representing 0.4% of the population.ConclusionThis general population study shows that sleep disordered breathing is common in children and that many symptomatic children are undiagnosed. Comparison with the national tonsillectomy registry indicates that less than 15% of the children at risk of having OSAS are treated with tonsillectomy in Sweden.
Accuracy of Office Laryngoscopy in Children with Dysphagia
Authors: Sowder Justin C. , Richter Gresham T. , Bower Charles M. , Hartzell Larry 
Published: February 2015

ObjectiveAirway endoscopy is often performed in older and developmentally normal children to rule out laryngeal sources of orpharyngeal dysphagia. This study examines whether office‐based flexible laryngoscopy (FL) can accurately identify laryngeal factors involved in dysphagia.MethodNine‐year retrospective chart review of children >2 years old who underwent microscopic laryngoscopy and rigid bronchoscopy (MLB) at a tertiary pediatric hospital. FL documentation was reviewed, and the findings were compared to MLB results. Children who did not undergo FL prior to MLB were excluded.ResultsFrom the 763 records reviewed, 59 children over the age of 2 years underwent FL in clinic followed by MLB under anesthesia (M = 36, F = 23, mean age = 5.05 years, median age = 3 years). Diagnoses in clinic prior to MLB included oropharyngeal dysphagia (41%), chronic respiratory symptoms (ie, asthma, stridor, chronic cough; 37%), obstructive sleep apnea (25%), hoarseness (14%), and hemoptysis (2%). No patient was found to have a laryngeal cleft on either FL or MLB. However, laryngomalacia, airway erythema/edema, and subglottic stenosis were the most common laryngeal findings on FL (27%, 25%, 22%) and MLB (25%, 27%, 25%), respectively.ConclusionFlexible laryngoscopy may be sufficient to rule out laryngeal cleft in older children with oropharyngeal dysphagia. Similarly, laryngomalacia, laryngeal edema, and subglottic stenosis are accurately diagnosed by FL when compared to MLB in children.
Changing Breathing Pattern in Laryngomalacia after Surgery
Authors: Trozzi Marilena , Dotta Andrea , Savignoni Ferdinando , Bottero Sergio 
Published: February 2015

ObjectiveMost of the studies on the surgical treatment of severe laryngomalacia have aimed to describe the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. The aim of this study is to analyze the changes in breathing patterns following aryepiglottoplasty for severe laryngomalacia.MethodA series of retrospective cases at a tertiary referral children’s hospital. Between 2005 and 2010, 40 infants with severe laryngomalacia were studied before (T1) and after surgery (T2). Breathing patterns were studied using an ultrasonic flow‐meter measuring: tidal volume, respiratory rate, time to peak and mean expiratory flow/expiratory time ratio.ResultsThe surgical procedure was well tolerated in all the infants and no perioperative and long‐term complications were present. In T1, the breathing pattern is characterized by low tidal volume and high flow/expiratory time ratio (tPTEF/Te) and mean expiratory/mean inspiratory flow ratio (MEF/MIF), suggesting a severe reduction in upper airways patency for all patients. After surgery (T2), all above mentioned variables significantly improved, reaching normal values for the age.ConclusionPulmonary function test in this study showed the diagnostic value of testing respiratory functionality in severe laryngomalacia and comparing them to clinical and endoscopic data. Moreover, we also propose the use of this available test to verify the therapeutic effects and to monitor future respiratory development in these infants.