bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Approaches to Cerebellopontine Angle: A 17‐Year Experience of Our Skull Base Team
Authors: Correia Isabel A. , Sousa Vítor , Marques‐Pinto Luis , Gonçalves Victor , Barros Ezequiel 
Published: September 2014

Objectives:We give an overview of the current state of cerebellopontine angle (CPA) surgery, based on the recent evidence, and describe our center's experience in surgical approaches to these lesions.Methods:Retrospective review of cases who underwent surgery for CPA lesions at our hospital during the past 17 years (1996‐2013), with focus on the description of the currently most used technique‐extended retrosigmoid. We also conducted a brief review of the literature on CPA surgery, comparing the different approaches, their indications and complications.Results:During this period, 203 patients underwent surgery for CPA. The most frequent indication was vestibular schwannoma (84.7%). Other indications were meningiomas (8.4%), epidermoids (1%), vestibular neurectomies (1.5%), arteriovenous malformations (1%), anterior inferior cerebellar artery–posterior inferior cerebellar artery aneurysms (1%), trigeminal microscopic decompression (0.5%), and other more rare tumors (2%). The most used approach was extended retrosigmoid (71.9%), followed by the translabyrinthine (26.1%) and middle fossa approach (2%). Until 2004, the most used approach was the translabyrinthine; after 2004, the most used was the extended retrosigmoid.Conclusions:Currently, the preferred surgical approach used by our team is the extended retrosigmoid, because it allows a complete exposition of sigmoid sinus from the transverse sinus to the jugular bulb, enhances CPA vision, avoids cerebellar retraction, and is a simple way to get a wide route to the CPA. It also allows good functional outcomes (hearing and facial nerve preservation) in most cases. However, indications for approaches depend on the size of the lesion, its location and the quality of preoperative hearing, as well as a necessary familiarity with all approaches.
Temperature Changes Associated with Middle Ear Endoscopy in a Human Temporal Bone Model
Authors: Kozin Elliott D. , Lehmann Ashton E. , Carter Margaret S. , Hight Ed , Cohen Michael S. , Nakajima Hideko H. , Lee Daniel J. 
Published: September 2014

Objectives:Endoscopic ear surgery is rapidly gaining popularity as a minimally invasive approach to address chronic ear disease. However, little is known about the potentially damaging temperature increases associated with endoscopy in the middle ear. Specifically, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we aim to measure temperature changes throughout the middle ear during rigid endoscopy in a human temporal bone model.Methods:Fresh human temporal bones were maintained at physiologic temperature during middle ear endoscopy with a 3‐mm 0° Hopkins rod. Temperature changes were measured as a function of the distance between the endoscope tip and the round window membrane. Thermal gradient was determined by infrared imaging. Control studies conducted at room temperature were also performed.Results:An endoscope with a xenon or light‐emitting diode light source on maximal power induced a rapid temperature elevation up to 46°C within 0.5‐1 mm of the tip of the endoscope within 30‐124 seconds. Elevated temperatures occurred at distances up to 8mm from the endoscope tip. Temperatures rapidly returned to baseline within 20‐88 seconds after turning off the light source.Conclusions:Our findings have direct implications for endoscopic ear surgery and affirm the importance of avoiding excessive temperature elevation. We recommend employing submaximal light intensity and repositioning the endoscope frequently to provide rapid cooling. Ongoing studies use an animal model to explore the in vivo effects of prolonged middle ear endoscopy and evaluate for potential threshold shifts in auditory brainstem responses.
Clinical Utility of the Glasgow Prognostic Score in Patients with Advanced Head and Neck Cancer
Authors: Nakayama Masahiro , Tabuchi Keiji , Hara Akira 
Published: September 2014

Objectives:The modified Glasgow prognostic score (mGPS) is known to reflect the degree of tumor‐associated inflammation and cancer cachexia and is associated with survival in various malignancies. The prognostic value of mGPS in head and neck cancers remains unclear. The purpose of this study was to evaluate the prognostic potential of the mGPS in patients with advanced head and neck cancer.Methods:Patients with advanced head and neck cancer treated at the University of Tsukuba Hospital between January 2002 and December 2011 were retrospectively evaluated. They were divided according to their mGPS. The mGPS was calculated based on the admission data as follows: patients with an elevated level of C‐reactive protein (>1.0 mg/dL) and hypoabuminemia (<3.5 g/dL) were allocated a score of 2, patients with elevated C‐reactive protein serum levels without hypoalbuminaemia were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0. The utility of the mGPS as a prognostic indicator was evaluated.Results:A total of 210 patients enrolled. Patients with an mGPS of 0 had better overall survival and disease‐free survival than did those with an mGPS of 1 or 2. Multivariate analysis revealed that the mGPS was a significant risk factor for overall survival and disease‐free survival.Conclusions:The results that patients with a raised mGPS had a significantly higher risk of death suggest that the mGPS is useful for predicting outcome in patients with advanced head and neck cancer and should be included in their routine clinical assessment.
Therapeutic Proposal to Clinical Treatment for Tympanometric Improvement in Patients with Otitis Media Secretory
Authors: Almeida Emyle M. , Guercio Wilson B. , Baraky Leticia R. , Vilela Marcela M. P. , Chaves Kenia A. , Silva Renata F. , Vasconcelos Natália 
Published: September 2014

Objectives:Serous otitis media is very frequent in children, especially those between 3 and 6 years of age. The diagnosis of otitis media is often difficult. Otomicroscopy and tympanometry can improve diagnostic quality by the indication of fluid in the middle ear and thereby improve the quality of treatment. The aim of this ongoing study is to describe the variations in tympanometry in patients undergoing clinical treatment alone.Methods:This was a prospective study of 25 patients diagnosed with secretory otitis media, treated with oral antibiotics, nasal corticosteroid spray, and nasal N‐acetylcystein from January 2013 to January 2014 in the Otorhinolaryngology Department, Juiz de Fora University Medical School, Brazil. The inclusion criteria were age between 2 and 12 years and altered otoscopy and tympanometric examination. The exclusion criteria were antibiotic use during the previous month and history of chronic otologic disorder or congenital abnormalities. All were evaluated by tympanometry in the week of diagnosis and after treatment, at 30 days from the first review.Results:A total of 25 patients, of which 11 (44%) were girls, and 14 (56%) were boys (3 to 15 years old). Of the 50 ears assessed in the first week of diagnosis, 28 (56%) had curve B and 20 (40%) had curve C. At the last evaluation, only 8 ears (16%) remained with curve B. 12 (24%) had curve C and 30 (60%) had curve A.Conclusions:Treatment with corticosteroids via nasal spray combined with oral antibiotics and nasal N‐acetylcysteine can be a good therapeutic option for the treatment of secretory otitis media.
Three‐Dimensional Anatomic Analysis of Surgical Landmarks for Middle Fossa Approach
Authors: Jun Beom Cho , Kim Byung Guk , Kim Joon Hyun 
Published: September 2014

Objectives:The middle fossa approach needs the surgeon to have a 3‐dimensional anatomic knowledge of internal auditory meatus (IAM), which is located underneath the middle fossa bony plate. Our purpose was to describe microsurgical anatomy of the middle fossa approach using temporal bone computed tomography (CT) 3‐dimensional (3D) reconstruction.Methods:Thirty CT images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. 3D‐reconstructed images were obtained using high‐resolution axial temporal bone CT scans. IAM, semicircular canal (SCC), cochlea, tympanic segment of the facial nerve (FN), geniculate ganglion (GG), and malleus were reconstructed. The length and angle among these structures was measured.Results:The mean lengths between the center of IAM and bony surface of middle cranial fossa at the Porus level was 7.7 mm (±1.0). The mean length between the superior of point of IAM of porus and GG was 15.4 mm (±1.5). The mean length between superior of point of IAM of porus and medial end of cochlear basal turn 9.9 mm (±0.9). Angle between the axis of SCC and the axis of tympanic segments of FN was 105.9° (±5.4). The mean angle between the axis of SCC and axis of IAM was 47.2° (±6.5) The mean angle between the axis of IAM and axis of tympanic segments of FN 59.6° (±10.9), The mean angle of 3‐point malleus handle, GG, superior point of IAM of porus level was 113.8° (±9.8).Conclusions:The understanding of the 3D relationship in the microsurgical structure will help decide the drilling point for the IAM in case of lack of bony landmarks.
Total Vestibular Ablation and VEMPs after Intratympanic Gentamicine in Patients with Intractable Vertigo
Authors: Celis‐Aguilar Erika , Hinojosa‐González Ramón , Vales‐Hidalgo Olivia , Coutinho‐Toledo Heloisa 
Published: September 2014

Objectives:Even today, treatment of intractable vertigo remains a challenge. The objective of this study was to control intractable vertigo through complete vestibular ablation with intratympanic gentamicin treatment. Complete vestibular ablation was confirmed by zero response on ice water (ENG) and an absent response on vestibular evoked myogenic potentials (VEMPs).Methods:Retrospective case study design in a tertiary care center. Subjects were patients with refractory episodic vertigo. The inclusion criteria were unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to respond to other treatments. Included patients underwent 0.5‐0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Audiometry, electronystagmography with ice water, and vestibular evoked myogenic potentials were performed in all patients. Outcome measurements: VEMPs response and vertigo control.Results:Ten patients were included; 9 patients with Ménière's disease and 1 patient with delayed endolymphatic hydrops. Nine patients showed an absent response on VEMPs. The only patient with low amplitude on VEMPs had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30 dB.Conclusions:VEMPs confirmed complete vestibular ablation. High‐grade vertigo control was due to total vestibular ablation.
Transcanal Micro‐osteotome Technique for Excision of Exostoses
Authors: Ghavami Yaser , Maducdoc Marlon M. , Yau Amy , Mahboubi Hossein , Djalilian Hamid R. 
Published: September 2014

Objectives:This study was conducted to evaluate the outcomes and complications of transcanal excision of exostoses using micro‐osteotomes without a post‐auricular incision or the use of the drill.Methods:A retrospective chart review of patients undergoing exostoses excision by the senior author from January 2007 to January 2014 was carried out. All patients underwent surgical removal of the exostoses using a 1 or 2 mm micro‐osteotome. Patients were followed postoperatively and complications were evaluated.Results:One‐hundred‐thirty‐eight ears in 106 patients were treated for exostosis. Average age of patients was 43 ± 16 year old. Of these, 99 were males (93%) and 7 were females (7%). A majority of the patients had 90% to 100% obstruction of the ear canal. Complete ear canal healing was seen in 80% of patients by 3 weeks. All but one patient had healed by 6 weeks postoperatively. There were 9 (6.5%) slit tympanic membrane perforations that all healed. One patient had an anterior canal mobilization which required Xeroform packing for 3 weeks for stabilization. There was no postoperative vertigo, facial paresis, conductive/sensorineural hearing loss, soft tissue stenoses, and no skin grafting was required.Conclusions:A transcanal approach using micro‐osteotomes for removing exostoses is feasible. The transcanal approach afforded shorter healing times than the post‐auricular approach as reported in the literature. Patients with 100% obstruction can have this procedure performed with no significant increase in morbidity.
Combined Sialendoscopic and Transoral Approach for Large Submandibular Intraparenchimal Stones
Authors: Gallipoli Camilla , Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Fusconi Massimo , Greco Antonio , Gallo Andrea 
Published: September 2014

Objectives:(1) Describe a combined sialendoscopic and transoral approach to remove large intraparenchymal submandibular sialoliths. (2) Assess functional results after stone removal.Methods:Eighteen consecutive patients with large submandibular hilar stones with intraparenchymal extension were enrolled in this prospective study at the ENT University Unit of the “A. Fiorini” Hospital, “Sapienza” University of Rome, from April 2011 to June 2013. In all cases the size of sialoliths (median diameter 1.8 cm, range 0.9‐2.2 cm) prevented sialendoscopic intraductal removal even after lithotripsy. The diagnosis was confirmed by ultrasound examination and, in selected cases, by computed tomography imaging. In all cases a combined sialendoscopic and transoral approach was accomplished by performing a deep incision of the mouth floor at the submandibular hilus level after endoscopic visualization of the stone. Three months after surgery an ultrasound examination was re‐run to detect the presence of residual sialoliths. Pre‐ and intraoperative findings, surgical times, follow‐up data, and functional results were analyzed.Results:Intraparenchymal stones were successfully removed using the combined technique in all cases. Fifteen patients (83.5%) were symptom‐free after 6 months of follow‐up. Two out of 3 still‐symptomatic patients showed residual sialolithiasis at postoperative ultrasonography.Conclusions:The outcomes of this preliminary study suggest that combined sialoendoscopic and transoral approach is an efficient technique for the removal of large intraparenchymal calculi, which may avoid resorting to sialoadenectomy and thus decrease risk of nerve damage or salivary fistulae.
Assisted Reproduction Is Not Associated with Increased Risk of Congenital Head and Neck Defects
Authors: Neumann Colin , Thompson Dane A. , Sidman James D. 
Published: September 2014

Objectives:(1) Compare the rate of head and defects between children conceived via assisted reproductive technology (ART) versus those conceived via natural methods. (2) Determine the risk of congenital head and neck abnormalities associated with ART.Methods:A retrospective chart review was conducted of all patients admitted to the neonatal intensive care unit over 10 years at Children's Hospital of Minneapolis. The patients were divided into 2 groups: patients who were conceived via ART and patients who were conceived naturally. Each chart was evaluated for 15 different head and neck malformations, 11 of which were included in data analysis due to statistical significance.Results:There were a total of 14,857 charts examined; 2288 patients were conceived via ART, while 12,569 patients were conceived via natural methods. There were 40 patients born with defects via ART, while there were 681 patients born with defects via natural conception. There were a total of 9039 males and 6637 females. The total occurrence of congenital malformations was higher for patients not conceived with artificial reproduction versus those conceived with artificial reproduction (4.58% vs 0.27%). The odds ratio was 0.31 with a 95% confidence interval (CI) of 0.23 to 0.43, P value of <.0001; the relative risk of having any one of the aforementioned defects with ART was 1.04 with a 95% CI of 1.03 to 1.05, P value <.0001.Conclusions:There appears to be no increased risk of congenital head and neck defects in children conceived via ART versus those conceived via natural methods.
Association of Pediatric Obstructive Sleep Apnea Severity with Sleep Endoscopy Findings: A Pilot Study
Authors: Lam Derek J. , Weaver Edward M. , O'Neill Eleni I. , Milczuk Henry A. , MacArthur Carol J. , Shea Steven A 
Published: September 2014

Objectives:(1) Determine the association of a sleep endoscopy rating scale with pediatric obstructive sleep apnea (OSA) severity. (2) Assess the reliability of this rating scale.Methods:This was a retrospective cohort study of pediatric patients who underwent drug‐induced sleep endoscopy (DISE) from January to December 2013 at a tertiary care children's hospital. DISE recordings were reviewed by 2 blinded senior pediatric otolaryngologists. Severity of obstruction was scored 0, 1, or 2 for no, partial, or complete obstruction at 6 levels: nasal airway, nasopharynx, velum, oropharynx, tongue base, and arytenoids. Ratings at each level were summed for a total score from 0‐12. Associations of DISE scores with obstructive apnea‐hypopnea index (OAHI) and OSA‐18 scores were assessed using linear regression. Interrater and intrarater reliability were calculated using a kappa statistic with linear weighting.Results:Twenty patients were included (mean age 8.4 ± 5.1 years, 55% obese, mean OAHI 16.5 ± 15.6). Associations between OAHI and DISE scores were strongest for the nasopharynx (beta = 12.3, P =. 09) and total score (beta = 4.7, P =. 06). Associations between OSA‐18 and DISE ratings were strongest for the nasopharynx (beta = 11.1, P =. 08) and velum (beta = 12.8, P =. 07). There was fair‐moderate interrater reliability (kappa 0.24‐0.63) and moderate‐almost perfect intrarater reliability (kappa 0.52‐0.88) at individual anatomic sites.Conclusions:Although observed associations did not reach statistical significance, this pilot study suggests clinically important associations between DISE ratings and OSA severity and showed promising interrater and intrarater reliability.
Comparative Analysis of Transient Otoacoustic Emission in At‐Risk and Well Neonates
Authors: Akinola Moronke D. , Onakoya Paul A. , Tongo Olukemi O. , Lasisi Olawale A. , Adeniji Adedotun A. 
Published: September 2014

Objectives:(1) Describe the referral rate of hearing loss in well and at‐risk neonates as assessed with transient otoacoustic emission (TEOAE) audiometry. (2) Analyze the association between risk factors for hearing loss and TEOAE referrals.Methods:This was a 2‐staged cross‐sectional evaluation of hearing loss among 386 neonates; 276 well babies without any risk factors and 110 babies with at least 1 risk factor at the University College Hospital, Ibadan. Data were collected from January 2010 to April 2010. Their ears were evaluated for presence of TEOAE with wideband click of 80‐microseconds’ duration at 6 frequencies within 1.5‐kHz to 4‐kHz at 83 dB pe SPL (±3). Results were automatically displayed as pass or refer. Chi‐square test and logistic regression were used to determine the association between the risk factors and hearing loss. The level of significance was P <. 05.Results:The overall referral rate with TEOAE was 8.5%, 5.2% among the at‐risk and 3.3% for those not at‐risk (P =. 001). The following risk factors were found to be significant with a referral outcome with TEOAE; prematurity (P =. 001), multiple births (P =. 030), jaundice (P =. 001), and birth weight less than 1.5 kg (P =. 003). Logistic regression showed that prematurity was a significant predictor of hearing screening outcome with TEOAE (P =. 017).Conclusions:This study demonstrated that the prevalence of congenital hearing loss in newborns is high in our environment and those at‐risk have a higher probability of developing hearing loss.
Contact Laser and Skeeter Microdrill Repair of Choanal Atresia in Low‐Birth Weight Neonates: 10‐Year Study
Authors: D'Eredita Riccardo 
Published: September 2014

Objectives:Describe and demonstrate by video the transnasal endoscopic repair of bilateral mixed or bony choanal (BMCA/BBCA) in low‐weight newborns using 1.7‐mm diameter telescope and a 0.3‐ to 06‐mm diameter fiber‐delivered contact diode laser (CDL) at 810‐nm wavelength and combined use of Skeeter stapes microdrill.Methods:Prospective study at a tertiary‐care pediatric institution of 11 neonates with BMCA or BBCA, aged 3 to 11 days, weighing 1.8 kg to 2.5 kg. A transnasal endoscopic approach with contact diode laser and/or combined use of skeeter microdrill was applied in all children. All patients were stented bilaterally from 4 to 13 weeks. Patients were followed by serial weekly clinical examinations, rigid endoscope examination at stents removal and/or revision surgery, with subsequent revision surgery if needed. Second surgical revision was performed in 5 children, while 1 child required a third procedure. Five children required 1 procedure only. Further postoperative endoscopic examinations were scheduled for 3, 6, 12 months, and then an annual endoscopic examination was performed.Results:No complication after surgery was encountered, and all children were discharged the second day after surgery. Follow‐up time frame ranged from 1 to 10 years. Neither restenosis nor craniofacial growth abnormality was seen.Conclusions:BMCA/BBCA was successfully repaired using this narrow endoscopic contact combined microdrill/laser approach, with no complications and a reduced need for revision surgery compared with prior reports. This new surgical technique is demonstrated to treat BMCA/BBCA in small birth weight neonates. Further studies are warranted.
Delayed‐Onset Hearing Loss: Prevalence in Early School‐Aged Children
Authors: Pritchett Cedric , Pan Warren , Thorne Marc C. , Dakers Jennifer 
Published: September 2014

Objectives:(1) Demonstrate the prevalence rate of delayed‐onset hearing loss in the early school‐aged population for the academic year 2010‐2011 in a single county of southeastern Michigan, and the state at large. (2) Describe the statewide hearing screening program used in the above population.Methods:Audiometric records of the Oakland County Health Department and the Michigan Department of Community Health for children participating in school‐based hearing screening during academic year 2010‐2011 were identified. Cross‐sectional review of school‐based hearing screening results of children in kindergarten, first, second, and fourth grades was performed. Failures were identified and audiograms analyzed confirming hearing loss type. In individuals with sensorineural loss, state newborn screening registries were queried to determine those with true delayed‐onset. Demographics and degree of hearing loss on these individuals were collected. Prevalence using official state‐level enrollment and census data was calculated.Results:A total of 46,501 children (~83% of grade‐based cohort) participated in school‐based hearing screening. Of the 1701 children who failed screening pure tone audiometry, 119 were found to have delayed‐onset sensorineural or mixed hearing loss. Male predominance was slight (53%), and 46% had bilateral losses. Newborn hearing screening occurred in the first week of life in the majority (85%). A prevalence of 1.7 to 2.1 out of 1000 in Oakland County was calculated. Delayed‐onset hearing loss is projected to have affected between 1325 and 1347 children in this grade cohort statewide during the study period.Conclusions:Delayed‐onset hearing loss remains a not infrequent condition. School‐aged hearing screening programs offer a valid mechanism to identify children with this condition.