bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Liquid Type, Delivery Method, and Bolus Volume on Penetration-Aspiration Scores in Healthy Older Adults during Flexible Endoscopic Evaluation of Swallowing
Authors: Butler Susan G. , Stuart Andrew , Case L. Douglas , Rees Catherine , Vitolins Mara , Kritchevsky Stephen B. 
Published: October 2014

Objectives: The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES. Methods: We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows. Results: The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively. Conclusions: These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.
Determination of Predictive Factors of Tracheobronchial Prosthesis Removal: Stent Brands are Crucial
Authors: Buiret Guillaume , Colin Carole , Landry Guillaume , Poupart Marc , Pignat Jean-Christian 
Published: October 2014

Objectives: We sought to describe in a retrospective study our experience in the endoscopic management of tracheobronchial stenoses over 20 years and to determine prognostic factors of stent removal. Methods: We analyzed the medical records of 166 patients (111 male and 55 female) who underwent the placement of a prosthesis for all causes of tracheobronchial stenosis between 1990 and 2009. Results: Overall, 34% of the patients had their stents removed. The incidence of complications for the first stent was 0.08 per patient-month. One hundred five patients (63%) had no complications. In univariate analysis, stent removal was significantly linked with the stent brand. In multivariate analysis, taking into account the causes of stenosis, the stent brand appeared to be the only factor that significantly influenced stent removal. Finally, stenosis with more than 1 stent replacement was most prone to repeat endoscopies. Conclusions: Even though endoscopic stent placement is a relatively safe and effective treatment for tracheobronchial stenoses, particularly in cases with malignancy, complications led to stent removal in about one third of cases. The type of stent chosen is crucial.
Effects of Fenestra Size and Piston Diameter on the Outcome of Stapes Surgery for Clinical Otosclerosis
Authors: Gristwood Ronald Edward , Venables William Norman 
Published: October 2014

Objectives: We determined the effect of piston diameter (0.8 or 0.6 mm) and fenestra size (total, three-quarter, or half removal or calibrated stapedotomy) on hearing gains after stapes surgery for clinical otosclerosis. Methods: We analyzed the mean air conduction hearing gains at various frequencies in a sample of 911 strictly consecutive patients who underwent 1,168 stapes procedures with piston reconstruction carried out by the same surgeon between 1963 and 1979. Assiduous follow-up of patients was attempted for at least 10 years, and in some cases for 20 years. Results over time at the various audiometric frequencies were stored for computer analysis. Results: There is no apparent advantage of one piston diameter (0.8 or 0.6 mm) over another for hearing gains at 0.25, 0.5, 1, 2, 3, and 4 kHz. The slim piston appeared to have a significant advantage for 6 and 8 kHz at 5 to 10 years after operation, but interpretation here requires caution, because the slim piston was usually chosen for cases with a small fenestra. Of the various sizes of footplate fenestras, total removal of the stapes footplate had significantly worse air conduction results, most clearly demonstrated at higher frequencies. Below 2 kHz, there is only weak evidence that the means differ significantly at all for the different sizes of fenestra. Small fenestras (stapedotomies) appear to offer advantages for hearing gains, particularly at the higher frequencies of 3 to 8 kHz, and for at least 10 years. Conclusions: The diameter (0.6 or 0.8 mm) of the pistons selected for reconstruction after stapes surgery appears to have little effect on the outcome, except perhaps at 6 and 8 kHz, where the slim piston appeared to have a significant advantage. The size of the footplate fenestra is of paramount importance to the outcome. A small footplate fenestra has statistically significant advantages for hearing gain over all other sizes of fenestra (ie, total, three-quarter, or half removal of the footplate), at least for the first 10 years after surgery, at frequencies of 2 kHz and above. Total stapedectomy has given the worst results for hearing gain at frequencies above 2 kHz, and the rate of deterioration of gain over time seems to be more rapid than after small-fenestra techniques. Small fenestras are recommended as the preferred technique in all cases of surgically treatable otosclerosis.
Fitting of an 8.5-Millimeter Abutment for Bone Conduction Devices: Indications and Postintervention Course
Authors: Dun Catharina A. J. , Hol Myrthe K. S. , Mylanus Emmanuel A. M. , Cremers W. R. J. 
Published: October 2014

Objectives: We present indications and clinical outcomes of fitting an 8.5-mm abutment for bone conduction devices. Methods: In 39 cases with a follow-up time of more than 12 months after fitting of an 8.5-mm abutment, the preintervention and postintervention courses were retrospectively evaluated. The outcome measures were indications for fitting and complications during the preintervention and postintervention courses (local skin reaction, skin level, revision surgery, and implant loss). Results: Soft tissue overgrowth was the most frequent reason (31 of 39 cases) for fitting the 8.5-mm abutment. Severe skin reactions decreased by 7.9% after fitting, and the number of fixtures that remained free of any skin reaction increased by 32.2%. In 7 cases, soft tissue overgrowth required revision surgery before placement of the 8.5-mm abutment; further surgical intervention was needed only once. In 1 case, the 8.5-mm abutment was removed because of recurring soft tissue problems. No spontaneous abutment or implant loss occurred. Conclusions: This retrospective evaluation showed that fitting an 8.5-mm abutment is an easy step in managing soft tissue problems and preventing revision surgery. Also, it is of value in patients with a thick scalp that interferes with bone conduction device coupling. In these cases, we advise placing the 8.5-mm abutment during primary surgery.
Complications of Cochlear Implantation in Adults
Authors: Stamatiou Georgios A. , Kyrodimos Efthimios , Sismanis Aristides 
Published: October 2014

Objectives: We describe our experience of intraoperative and postoperative complications of cochlear implantation in an adult population. Methods: Between April 1986 and June 2010, the senior author (A.S.) performed 449 cochlear implantations in two different institutions. Of these, 212 implantations were in adults. The operative techniques were similar in all cases. Results: Complications were observed in 12 of the 212 adult cases (5.7%), of which 10 were major (4.7%) and 2 minor (1%). In 7 cases, reimplantation was necessitated by device failure (6 cases; 2.8%) or device extrusion (1 case; 0.5%). In 2 elderly patients (1%), a minor dural injury with a cerebrospinal fluid leak was controlled during the operation with temporalis fascia grafting. In 1 patient (0.5%), a subdural hematoma was observed after bipolar cauterization of a prominent diploic vein. In 2 subjects (1%), a wound infection was noted soon after implantation and was treated successfully on an outpatient basis. Conclusions: Cochlear implantation is generally a safe procedure. The most common complication was device failure. Although complications in this adult population were rather uncommon, some of them were serious, and an immediate intervention was necessary for a successful outcome.
Outcomes of Conventional Amplification for Pediatric Unilateral Hearing Loss
Authors: Briggs Lauren , Davidson Lisa , Lieu Judith E. C. 
Published: October 2014

Objectives: Although children with unilateral hearing loss (UHL) are at risk for educational difficulties and behavioral problems, the research on treatment outcomes is limited. Previous studies suggested that children with UHL would benefit from frequency-modulated assistive devices only. The objective of this study was to examine whether children with UHL would benefit from using a conventional hearing aid in the poorer-hearing ear. Methods: Eight children, 7 to 12 years of age, with mild to moderately severe UHL and their parents and teachers participated in this study. The participants were fitted with digital hearing aids by use of pediatric prescriptive targets. The primary outcome measures were speech perception tests in quiet and noise and subjective assessments from participants, parents, and teachers, administered before hearing aid fitting and after 3 months of hearing aid use. Results: The group average speech perception scores showed no significant aided benefit or detriment in any of the conditions tested. However, subjective assessments showed large significant aided benefits at home and school according to the children and their parents, and in quality of life as reported by the children with UHL. Conclusions: Overall, the results suggest that a hearing aid trial should be considered for children with mild to moderately severe UHL, with individual monitoring for benefit.
Epiglottic Repositioning Procedure for Supraglottic Stenosis/Collapse
Authors: Varghese Ajoy M. , Cheng Alan T. 
Published: October 2014

Objectives: Supraglottic stenosis/collapse is an uncommon condition. It can be difficult to detect and may be a cause of failed decannulation following tracheostomy. We present a novel technique to correct supraglottic stenosis/collapse. Methods: We performed a retrospective analysis of the records of patients in whom attempts at decannulation had failed at our center between 2003 and 2007. A subgroup with supraglottic stenosis/collapse with posterior displacement of the base of the epiglottis was identified. Our epiglottic repositioning procedure was performed in these patients. Through an external incision, the epiglottis was divided above the anterior commissure and attached to the superior border of the thyroid cartilage. Results: Eight decannulation failures out of 36 attempted decannulations were identified. Three of these 8 cases involved supraglottic stenosis/collapse due to posterior displacement of the base of the epiglottis. Correction of the supraglottic stenosis/collapse led to successful decannulation in all cases. Conclusions: Diagnosis-directed laryngoscopy is required to identify this condition. We describe precisely a technique of repositioning the epiglottis to correct supraglottic stenosis/collapse.
Comparison of Purified Plant Polysaccharide (HemoStase) versus Gelatin-Thrombin Matrix (FloSeal) in Controlling Bleeding during Sinus Surgery: A Randomized Controlled Trial
Authors: Beyea Jason A. , Rotenberg Brian W. 
Published: October 2014

Objectives: Purified plant polysaccharide (HemoStase) is a plant-derived hemostatic agent that has not previously been used in sinus surgery. This study was conducted to evaluate the effectiveness of this novel agent in the control of nasal bleeding during endoscopic sinus surgery. The volume of bleeding during endoscopic sinus surgery was hypothesized to not be statistically significantly different between a control group (gelatin-thrombin matrix; FloSeal) and an experimental group (purified plant polysaccharide; HemoStase). Methods: Eighteen patients with a history of chronic rhinosinusitis in whom maximal medical therapy failed who underwent endoscopic sinus surgery were randomized into one of two groups (control FloSeal group or experimental HemoStase group). In the control group, sites in the nose that were actively bleeding during the operation were controlled with FloSeal. In the experimental group, sites in the nose that were actively bleeding during the operation were controlled with HemoStase. The main outcome measure was total operative blood loss. Blood loss was the sum of blood removed by suction during the surgery (recorded in milliliters) and blood on surgical sponges (weighed and converted to milliliters). Statistical analysis was performed with the t-test and the Mann-Whitney U test. Results: The amounts of blood loss (mean ± SEM) were not significantly different between the FloSeal (262 ± 15 mL) and HemoStase (265 ± 33 mL) groups (p = 0.93). Conclusions: The results of this study demonstrate the use of a novel product for the control of intraoperative bleeding during endoscopic sinus surgery.
Balloon Dilation of the Frontal Recess: A Randomized Clinical Trial
Authors: Plaza Guillermo , Eisenberg Gustavo , Montojo José , Onrubia Tomás , Urbasos María , O'Connor Carlos 
Published: October 2014

Objectives: We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus. Methods: We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months. Results: Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed. Conclusions: Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.
Effect of Surgical Technique on Electrode Impedance after Cochlear Implantation
Authors: Jia Huan , Venail Frédéric , Piron Jean-Pierre , Batrel Charlène , Pelliccia Pierfrancesco , Artières Françoise , Uziel Alain , Mondain Michel 
Published: October 2014

Objectives: We compare the evolution of electrode impedance values (IVs) following either conventional cochlear implantation or implantation by the soft surgery (SS) technique. Methods: We performed a retrospective chart review of 20 consecutive adult patients who underwent implantation with the Nucleus CA 24 device between 2004 and 2007. Five patients with preoperative residual hearing at the frequencies 256, 512, and 1,024 Hz underwent implantation by an SS cochlear implantation technique (SS group), and the 15 other patients underwent a conventional implantation technique (conventional cochleostomy [CC] group). The active electrodes were classified as distal (17 to 22), middle (10 to 16), or proximal (3 to 9) according to their position in relation to the tip of the electrode array. Their IVs were collected at 1, 3, 12, 24, and 36 months after implantation. Changes in auditory thresholds at 3 and 24 months were reported for patients in the SS group. Results: The postoperative IVs of both the CC and SS groups decreased significantly between 1 and 3 months after implantation (p < 0.05) and then remained stable. The IVs after 12 months were significantly lower (p < 0.05) in the SS group than in the CC group. Conclusions: Patients who underwent the SS technique displayed lower long-term electrode IVs than did their counterparts in the CC group. If electrode IVs are indeed an indirect representation of cochlear fibrosis, the use of the SS technique in lieu of the CC technique could reduce fibrotic development.
Randomized Study Comparing Fascia and Cartilage Grafts in Myringoplasty
Authors: Yung Matthew , Vivekanandan Senthilnathan , Smith Philip 
Published: October 2014

Objectives: The study compares the medium-term outcomes of myringoplasty procedures using fascia and cartilage grafts. Methods: Patients with chronic otitis media with perforations larger than 50% of the size of the tympanic membrane were included in a randomized, controlled, prospective clinical trial. The perforations were repaired with either temporalis fascia (20 ears) or cartilage (18 ears) grafts selected randomly. A search of the literature was performed to look for other randomized studies comparing fascia and cartilage. Results: The graft take rates of fascia and cartilage grafts at 24 months were 84.2% and 80%, respectively. The postoperative air-bone gaps and hearing gains at 24 months were 16.97 dB and 13.63 dB, respectively, in the fascia group and 20.63 dB and 12.60 dB, respectively, in the cartilage group. There was no significant difference in the graft take rates or postoperative hearing between the two groups. The literature search identified one other randomized study comparing fascia and cartilage grafts in the repair of large perforations. The pooled data from the two studies did not show a difference in the graft take rates or hearing gains between cartilage and fascia. Conclusions: There was no statistical difference in the outcomes of fascia and cartilage grafts in the repair of large perforations.
Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology
Authors: Bhattacharyya Neil 
Published: October 2014

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.
Nasal Packing with Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient with Glanzmann Thrombasthenia
Authors: Humphreys Ian , Saraiya Sonal , Belenky Walter , Dworkin James 
Published: October 2014

Objectives: Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery, laser coagulation, septoplasty, and embolization) have been described with various degrees of success. Methods: We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances. Results: Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment. Conclusions: To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.
Protective Effect of Systemic Administration of Erythropoietin on Auditory Brain Stem Response and Compound Action Potential Thresholds in an Animal Model of Cochlear Implantation
Authors: Quesnel Stéphanie , Nguyen Yann , Campo Pierre , Hermine Olivier , Ribeil Jean-Antoine , Elmaleh Monique , Grayeli Alexis Bozorg , Ferrary Evelyne , Sterkers Olivier , Couloigner Vincent 
Published: October 2014

Objectives: An animal model of cochlear implantation has been developed, and the hearing threshold was evaluated after different surgical procedures. The effect of perioperative systemic administration of erythropoietin on the hearing loss induced by cochlear implantation was tested. Methods: Twenty-nine guinea pigs with normal hearing underwent implantation of a 254-μm-diameter array through a cochleostomy. The effects on hearing of cochleostomy and transient and long-term array implantation (21 days) were assessed by testing of the auditory brain stem responses and compound action potentials. Eleven implanted animals received intraperitoneal administration of erythropoietin. Selected computed tomographic scans and cochlear histologic studies were performed 1 month after implantation to confirm proper placement of the array. The erythropoietin concentration at the time of surgery was assessed in samples of perilymph, cerebrospinal fluid, and blood. Results: The cochleostomy and transient array insertion had no effect on hearing thresholds. Long-term array implantation induced a stable decrease of hearing threshold (30 dB), a decrease that was reduced by 12 dB in erythropoietin-treated animals. The erythropoietin-treated animals had better hearing preservation at higher frequencies. Fibrosis surrounding the array was seen in both groups. Conclusions: The hearing loss observed was probably due to the presence of the array in the cochlea. The intraperitoneal injection of erythropoietin improved the hearing threshold shift induced by implantation.