bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Variation in Procedures and Charges for Ambulatory Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil , Kepnes Lynn J. 
Published: September 2014

Objectives:(1) Determine if there is significant geographic variation in surgical charges for endoscopic sinus surgery (ESS) across states. (2) Understand factors that influence charges.Methods:The State Ambulatory Surgery Databases (2010) for Florida, Iowa, New York, and North Carolina were analyzed, extracting cases of adult endoscopic sinus surgery. Demographic, diagnostic, procedural, insurance, and charge data were tabulated. Extent of surgery was quantified by number of sinusotomies and other nasal procedures (eg, septoplasty) performed. Variation in state‐to‐state total charges for ESS was determined adjusting for demographic and procedural parameters.Results:A total of 22,350 ambulatory ESS cases were examined across 4 states (mean age, 48.5 years; 51.6% female). Private insurance and Medicare were the primary payers in 69.5% and 19.3% of cases, respectively. Image guidance was utilized in 21.0% and polyps were present in 26.8% of cases. There was wide variation in the distribution of sinusotomies per case performed: Florida had the highest percentage of 5 sinusotomy cases (18.8%) versus 15.9% for New York and only 7.0% for Iowa (P <. 001). Adjusting for image guidance, polyposis, other nasal surgery, number of sinusotomies, and payer and median household income, there was a significant difference in mean total charges for ESS by state: Florida ($22,403), Iowa ($17,574), North Carolina ($14,650), and New York ($12,641; P <. 001 analysis of variance).Conclusions:Considerable state‐to‐state variation in charges for ambulatory ESS exists. These data will become increasingly important as mandates for charge and cost transparency for the healthcare consumer manifest nationally. Efforts to determine reasons for these cost variances should be undertaken.
Considering Statistical Logic in Otology
Authors: Blakley Brian W. 
Published: September 2014

Objectives:Illustrate strong and weak statistical concepts used in otolaryngologic papers submitted for publication regardless of acceptance.Methods:For 1 calendar year, the type and number of statistical concerns were recorded for 56 otologic papers submitted for publication to 1 of 5 journals.Results:Ninety‐nine concerns were found in 32 of the 56 papers. Reviewers identified several concerns in many papers. For some papers, data reanalysis was possible with different statistical tests, but in none was the conclusion altered. A summary of the findings with some overlap of the categories follows. Conclusions not supported by data – 13. Confusion of correlation with causation – 13. “Fishing trip” – 12. Overgeneralization – 9. Multiple t tests for related outcomes – 8. Multiple tests ‐ inappropriate tests – 8. Parametric tests were used but underlying assumptions clearly violated – 7. Conclusion inappropriate or absent – 7. Lack of required power analysis – 4. Inappropriate assignment to groups when assessing group differences – 3. Partial data analysis – 3. Reviewer requests power analysis when not needed – 2. Reviewer requests inappropriate tests ‐ 2.Conclusions:Application of statistics in otology papers was surprisingly good. The most common flaws in statistical interpretation in submitted papers were (1) that the conclusion reported was not supported by the data or (2) confusion between association and causation. Even if statistics were applied inappropriately, thoughtful reviewers were generally able to detect errors in statistical logic even if they did not feel that they were qualified as statisticians.
Current Landscape of Social Media and Blogosphere in the Cochlear Implant Community
Authors: Saxena Rajeev C. , Lehmann Ashton E. , Hight Ariel E. , Kozin Elliott D. , Lee Daniel J. 
Published: September 2014

Objectives:Over 200,000 individuals worldwide have received a cochlear implant (CI). Social media websites may provide a paramedical community for CI users, although their utilization patterns have not been thoroughly investigated. Herein, we aim to (1) analyze how CI users exchange information online and (2) quantify and characterize participation in social media.Methods:Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned 1 of 6 functional categories based on its description. Using standard search engines, such as Google, we used the search terms cochlear implant, auditory implant, forum, and blog to identify relevant blogs and online forums. Website participation was quantified.Results:Over 350 sources were identified, including 122 YouTube videos, 111 blogs and forums, 57 Facebook groups, 32 Facebook pages, and 50 Twitter accounts. The most active online communities were Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum had ~9500 topics with ~127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%).Conclusions:This is the first known comprehensive review of utilization patterns of social media in the CI community. CI users engage in a wide range of online platforms predominately to provide general information and share personal stories. Analyses of how CI users participate in social media may enable clinicians to identify key concerns of this specialized patient population.
Defaulters of Universal Newborn Hearing Screening Program at Tertiary Hospital, Malaysia: The Associated Factors
Authors: Abdullah Asma , A. Madzhi Dayang S. , Jaafar Rohana , Sazari Fatimah , Rahman Roslenda A. , Ying Lim Bee , Ismail Aniza 
Published: September 2014

Objectives:Describe the sociodemographic of defaulters in the Universal Newborn Hearing Screening Program at UKMMC and to identify the associated factors.Methods:A cross‐sectional study was conducted at UKMMC from December 2011 until May 2013. Defaulter was defined as a patient who failed to attend the first stage hearing screening at UKMMC and also defaulted follow‐up at the Audiology Unit between January 2010 and May 2011. The information was obtained through telephone inquiries to parents using the set of questionnaires. The factors studied were awareness of hearing loss, distance to the hospital, appointment date, and financial and transportation difficulties.Results:A total of 280 respondents were interviewed. The majority of the respondents were Malays (71.79%) in the middle income category. Nonawareness of the child's hearing loss was the main associated factor (n = 205, 73.21%). The other associated factors were: appointment date was not given (n = 173, 61.8%), distance to the hospital (n = 126, 45%), appointment date given is too far away (n = 57, 20.4%), financial difficulties (n = 59, 21.1%), followed by respondents who do not have their own transport (n = 46, 16.4%).Conclusions:Nonawareness of the child's hearing loss by his or her parents was the major factor to the high default rate. Therefore, education and empowerment programs should be introduced and implemented at UKMMC in order to improve awareness among parents.
Does Endolymphatic Sac Decompression Surgery with Local Steroids Prevent Bilateral Development of Ménière's Disease?
Authors: Kitahara Tadashi , Inohara Hidenori 
Published: September 2014

Objectives:Elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Ménière's disease (MD) from becoming bilateral.Methods:Prospective case‐control study. Between 1996 and 2008, we performed a glycerol test (G‐test) and electrocochleography (ECoG) on 237 patients with intractable MD at a tertiary referral center. We performed ESDS on 179 patients (144 without endolymphatic hydrops and 35 with silent endolymphatic hydrops in the contralateral ear). The other 58 patients (40 without endolymphatic hydrops and 18 with silent endolymphatic hydrops in the contralateral ear) were given available medical treatments. All underwent regular follow‐up for at least 5 years.Results:Altogether, 22.4% (53/237) of patients with clinically diagnosed unilateral intractable MD had silent endolymphatic hydrops in the contralateral ear using G‐test and ECoG. In the nonsurgical group, 6 of 40 patients with unilateral MD without endolymphatic hydops in the contralateral ear developed bilateral disease, whereas in the surgical group, 12 of 144 patients did so (P >. 05). In the nonsurgical group, 9 of 18 patients with unilateral MD and silent endolymphatic hydrops developed the disease in the contralateral ear, whereas in the surgical group, 6 of 35 patients developed bilateral disease (P <. 05).Conclusions:The present findings suggest that ESDS may decrease the incidence of developing MD in silent endolymphatic hydronic contra lateral ears diagnosed with G‐test and ECoG within the first 5 postoperative years.
The Effect of Transplantation of Tissue‐Engineered Cell‐Sheets after Middle Ear Surgery in a Rabbit Model
Authors: Yamamoto Kazuhisa , Kojima Hiromi , Yaguchi Yuichiro , Hama Takanori 
Published: September 2014

Objectives:Postoperative regeneration of the middle ear mucosa and pneumatization of the middle ear cavity are of great importance after middle ear surgery. This study developed a new method to transplant autologous nasal mucosal epithelial cell‐sheets into the damaged middle ear cavity. The aim of this study was to evaluate postoperative healing after the transplantation of the cell sheets in rabbits.Methods:Rabbit nasal mucosal epithelial cell‐sheets were fabricated from a temperature‐responsive culture dish and transplanted into the damaged middle ear of the rabbit, which was surgically created. The healing of middle ears was evaluated with histological methods and computed tomography findings at 8 weeks after transplantation. Functional evaluation was performed by measuring the maximum middle ear total pressure reflecting a trans‐mucosal gas exchange function. Two control groups were used: the normal control group and the mucosa‐eliminated control group.Results:Transplantation of nasal mucosal epithelial cell‐sheets suppressed the bone hyperplasia and the narrowing of pneumatic space in the middle ear cavity more clearly than the mucosa‐eliminated control group. The mucosal gas exchange function was also found to be good in the cell sheet‐transplanted group. These results suggest that posttransplanted middle ear cavity is not only morphologically but also functionally similar to the normal middle ear cavity.Conclusions:Nasal mucosal epithelial cell‐sheet is confirmed to be useful as an effective graft material after middle ear surgery, and will hopefully become a novel therapy in the future.
Effective Management of Ménière's and Vestibular Disorders with Photo‐Biostimulation Light Laser
Authors: Hack Eugenio , Prosper Joaquin 
Published: September 2014

Objectives:Laser irradiation applied inside the inner ear has been investigated to observe the therapeutic effectiveness in cochlear injury and vestibular dysfunction. The positive influence of light irradiation with low level laser therapy on the treatment of vascular disorders, ischemic arteriolar disease, activation of microcirculation, and tissue regeneration is well known and has been published by several authors from medical research groups. The aim of this study was to determine the effects and benefits for patients with Ménière's disease and other vestibulopathies who received an irradiation dose into the inner ear by using a protocol of irradiation.Methods:A laser device with double wavelength and independent light beams was used to irradiate through the ear canal with power irradiance of 90 to 300 mw/cm2 at different dose rate according to patient symptoms. A prospective study of a group of sixty five (65) patients who were suffering peripheral vestibular disorder were treated from January 2010 to July 2011 in a random selection with no exclusions for other pathologies. Method of irradiation was direct beam over “meatus acusticus” at 1.5 cm distance of ear drum membrane.Results:Fifty patients of the 65 were considered final group control. According to American Academy of Otolaryngology—Head and Neck Surgery guideline criteria, 64% were classified as Category A on their vertigo management and 36% were Category A+B. After the treatment period, both categories confirmed that crises were shorter, less severe and with lower intensity.Conclusions:Laser irradiation has no risk for patients and can be considered both effective and an alternative therapy.
Hyperacusis and Other Inner Ear Disorders Are Improving after Light Irradiation with Photobiostimulation Laser
Authors: Prosper Joaquin , Hack Eugenio 
Published: September 2014

Objectives:There are several theories about pathophysiologic mechanisms involved in hyperacusis as an inner ear disease. Several authors discuss and focus hyperacusis around neurophysiological processes currently against the cochlear poor condition. This research describes effects of treatment by laser light irradiation on hyperacusis and recognizes that hyperacusis is a poor cochlear disorder instead of other auditory or neurophysiologic processes.Methods:A prospective study of a group of 58 patients who were suffering hyperacusis from several inner ear disorders (Ménière's, tinnitus, and other disorders) was made with laser irradiation therapy based upon a photobiostimulation energy protocol. Patients were treated twice a week for 6 weeks by irradiation of a dose of low‐level laser light. A laser device with double wavelength and independent light beams were used to irradiate through the ear canal with light power irradiance of 90 to 300 mw/cm2.Results:Hyperacusis significantly improved in all patients. Ninety‐nine percent of observations had a large improvement of auditory capacity and 78.9% of them reached normal discomfort levels (no hyperacusis). Dynamic range of each ear was measured before and after treatment.Conclusions:Irradiation of the cochlea with a specific dose of light laser energy produces an obvious improvement in hyperacusis and other auditory disorders. This can be evaluated by comparing the audiometric dynamic range before and after the treatment period. The results confirm that hyperacusis as a disorder is more susceptible to a poor cochlear condition than other known neurophysiological processes.
Immunohistochemical Study of the Possible Role of Osteoprotegrin OPG in Inhibition of Otic Capsule Remodeling
Authors: Shewel Yasser G. 
Published: September 2014

Objectives:Recognize the differential expression of osteoprotegrin (OPG) in the otic capsule of adult male mice compared with other selected skeletal bones, both in nearby locations such as the temporal bone, and in distant bones, such as the tibia.Methods:The experimental study was conducted in 2011 on 20 normal adult male albino mice with average weight 50 to 60 g.  Animal housing at the physiology department (Alexandria Faculty of Medicine) followed the rules of research ethics for experimental animals approved by Faculty of Medicine, University of Alexandria, Egypt. The following bone specimens were harvested from normal adult male albino mice by microdissection: (1) temporal bone, (2) otic capsule bone surrounding the cochlea, and (3) tibia and stained immunohistochemically for anti‐OPG monoclonal antibody. Positive staining was graded and analyzed using image software that measured the staining intensity as units of pixels/microscopic field examined at 400 magnification. Quantitative data were described using mean, standard deviation, median, minimum and maximum. Comparison between different sites were analyzed using F‐test (analysis of variance) and post hoc test (least significant difference) for pairwise comparison.Results:OPG was detected as a brown DAB chromogen staining of tissue components expressing a positive OPG monoclonal antibody immune reactivity. Statistical analysis of the results revealed that high OPG level concentrations were found in otic capsule followed by temporal bone and finally the tibia.Conclusions:The findings highlight the role of a OPG in inhibition of otic capsule remodeling.
The Impact of Perioperative Oral Steroid Use on Low‐Frequency Hearing Preservation after Cochlear Implantation
Authors: Sweeney Alex D. , Zuniga M. Geraldine , Wanna George B. , Haynes David S. , Rivas Alejandro 
Published: September 2014

Objectives:(1) Investigate factors that impact low frequency hearing preservation following cochlear implantation. (2) Evaluate the efficacy of a perioperative oral steroid taper in this setting.Methods:Retrospective series from a single surgeon at a tertiary academic referral center. Patients were candidates for a hearing preservation protocol based on their preoperative pure tone thresholds. The tympanic space was bathed in steroids prior to opening the round window membrane in all cases, and all patients were implanted using electrodes designed for atraumatic insertion. One group of patients received a 2‐week oral prednisone taper beginning 3 days prior to surgery. The primary outcome measure was the preservation of low frequency pure tone hearing on a 1‐month postoperative audiogram.Results:Twenty‐two hearing preservation candidates were implanted during an 18‐month period (mean age 50 years; range 3‐80) ending in December 2013. Thirteen patients (59.1%, mean age 45.6 years) received the oral prednisone taper while 9 (40.9%, mean age 56.3 years) did not. There was no significant age difference between the groups (P =. 18). Within the oral prednisone group, 84.6% of patients had at least a partial hearing preservation (23.1% complete preservation) compared with 33.3% (0% complete preservation) in those not taking prednisone (P <. 01).Conclusions:Oral steroids may play a role in low‐frequency hearing preservation following cochlear implantation. Though the optimal protocol has yet to be identified, a 2‐week oral prednisone taper given 3 days before surgery appears to positively impact the rate of and degree of preservation.
The Importance of the Individual Adjustments in Sound Therapy
Authors: Suzuki Flavia A. B. , Suzuki Fabio A. , Yonamine Fernando K. , Onishi Ektor T. , Penido Norma O. 
Published: September 2014

Objectives:The difficulty in choosing appropriate therapy for chronic tinnitus lies in its various forms of impact on the quality of life of patients and requires personalization. The aim of the study was to evaluate the efficacy of the use of sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous drug treatment.Methods:This was a prospective study of 10 patients, 5 male and 5 female, ages ranging from 41 to 78 years with chronic tinnitus who were resistant to previous drug treatments. Bilateral sound generators Reach62 or Mind 9 models were used for at least 6 daily hours for 18 months. Audiometrics testing, pitch, loudness, minimum masking level (MML), Tinnitus Handicap Inventory (THI), Visual Analogue Scales (VAS), and Hospital Anxiety and Depression Scale (HADS) questionnaires were given. Sound generators were used before 1 month and, sequentially every 3 months up to 18 months. The sound generators were individually adjusted, according to criteria of personal complaints in each visit.Results:There was an important reduction in tinnitus in 9 patients using an protocol with a personalized approach, independent of its psychoacoustic characteristics, when THI and VAS were applied. Patients with more than one specific kind of tinnitus concomitantly showed more reduction in pure tone tinnitus. Only 1 patient was indicative of depression in HADS and did not respond to sound therapy.Conclusions:We observed an importance in the individual adjustments in therapy, regardless the equipment used. There was an improvement in tinnitus disturbance and quality of life of these patients.
Intraoperative Nerve Monitoring Crisis: Sounding the Alarm
Authors: Kartush Jack M. 
Published: September 2014

Objectives:Otolaryngology was one of the first specialties to use intraoperative nerve monitoring (IOM) to reduce the risk of facial and recurrent laryngeal nerve paralysis. Unfortunately, many external changes have occurred in the field that impact standards of care and correct coding. The objective is to identify these new external standards so AAO members can describe and apply new regulations to reduce adverse medicolegal and coding abuse risks.Methods:Rigorous, newly published standards in neurophysiologic monitoring created by neurologic and electrodiagnostic associations are reviewed and compared with the more lax procedures commonly used by otolaryngologists with informal, on‐the‐job IOM training. Similarly, new third party payor changes in billing and coding are reviewed and compared to common IOM coding practices.Results:A comparison of routine IOM methods performed by otolaryngologists reveals marked differences in procedure and documentation compared to published standards in neurophysiological monitoring. In addition, many otolaryngologists have failed to change their IOM coding strategies to comply with new third party payor guidelines.Conclusions:(1) The absence of specialty‐specific American Academy of Otolaryngology Practice Guidelines on IOM places otolaryngologists at risk for noncompliance with external standards published in the neurophysiology field. Failure to observe national standards of IOM also compromises the quality of the monitoring provided to our patients. (2) Because “ignorance of the law is no excuse,” failure to identify and comply with new IOM coding regulations places the otolaryngologist at risk for charges of “fraud and abuse” billing. Implementing both clinical and coding changes will benefit patient and physician alike.
Intratympanic Steroid Treatment for Acute Low‐Frequency Sensorineural Hearing Loss without Vertigo: Prospective Controlled Study
Authors: An Yong‐Hwi , Yu Kwang‐Kyu , Yoon Sang Won , Shim Hyun Joon 
Published: September 2014

Objectives:Compare the effectiveness of treatment for acute low frequency sensorineural hearing loss (LFHL) with tinnitus and without vertigo between intratympanic dexamethasone injections (ITDI) and oral diuretics.Methods:A total of 35 tinnitus patients with LFHL that had developed within previous 2 weeks were enrolled and randomly assigned into 2 groups: (1) treated with ITDI 4 times on each of 4 consecutive days (19 patients) and (2) treated with diuretics orally for 2 weeks (16 patients). The group assignments and the process of treatments were double‐blinded. After 8 weeks, we analyzed treatment outcomes of LFHL using subjective symptom score and audiometric change.Results:The cure rate of ITDI group (42.1%) was significantly higher than that of diuretics group (25.0%). For subjective symptom score, there were no statistically significant differences of improvement rate in both groups (ITDI 63.2%, diuretics 56.3%). In pure tone audiometry, the improvement rate of ITDI group (73.7%) was significantly higher than that of diuretics group (62.5%). There was a significant correlation between the cure rate and duration of symptoms.Conclusions:ITDI is a more effective treatment modality than oral diuretics for LFHL within 2 weeks of development. Duration of symptom affects the cure rate of acute LFHL with tinnitus and without vertigo.