bluuebunny/crossref_metadata_2025_split huggingface dataset:
Images on the Way to the Cochlear Nucleus Complex for Auditory Brainstem Implantation in Children
Authors: Colletti Giacomo , Mandala Marco , Colletti Liliana , Colletti Vittorio 
Published: September 2014

Objectives:Identify and differentiate among the cranial nerves (CN) and vessels close to the foramen of Luschka (FL) and improve the understanding of the normal and abnormal microanatomy in children with cochlear nerve deficiency (CND) fitted with auditory brainstem implants (ABI).Methods:From 2000 to 2013, 64 children ranging in age from 8 months to 16 years (2.92 ± 1.54) with CND and several degrees of cochlear abnormalities were video‐recorded during retrosigmoid surgery for ABI fitting. Four independent experts retrospectively examined all the videos. CNs VI, VII, IX, X, XI and the vascular structures around the FL were identified either by surgical inspection and/or intraoperative neurophysiological monitoring.Results:Cranial nerves VI, VII, VIII were absent respectively in 3, 8 and 64 children; CN VII had an aberrant course in the CPA in 18 children; bifurcated in 4 and trifurcated in 3; CNs IX, X and XI were observed in all children; a double CN XI was observed in 2 children; and the nerve root bundles of the cranial and spinal segment of CN XI were identified in 48 and 52 children, respectively. Landmarks useful in identifying the FL included the nervus intermedius, CNs VII and IX, and the choroid plexus of the lateral recess.Conclusions:The collection of surgical images allowed a successful display of the detailed normal and abnormal anatomy of the CNs and vessels around the area of the FL. These data have the potential to facilitate an uneventful approach to the FL and a correct insertion of the ABI array.
The Impact of Diving on Hearing of Industrial and Recreational Divers
Authors: Gurpinar Berk 
Published: September 2014

Objectives:This study aims to determine the negative effects of diving on hearing and to compare the hearing levels of the industrial divers to the recreational ones.Methods:The study was conducted among industrial divers (ID) and recreational divers (RD) between June 2012 and November 2013. A total of 30 industrial divers and 30 recreational divers were recruited. The participants received a self‐structured questionnaire, detailed otolaryngologic, otologic, and radiologic examinations. The continuous variables were compared using the Student t test or analysis of variance.Results:The mean age of the ID group was 28.3 ± 4.4 and RD was 32.7 ± 5.2. Hearing levels above 25 dB were considered as normal. No significant hearing loss was obtained in the ID group while the RD group had mild to moderate hearing loss (P <. 001). Divers older than 30 years of age had higher hearing losses.Conclusions:Although IDs dive more frequently than RDs, their age, physical capacity, and diving depth plays a major saving role on their hearing levels. It is a well‐known fact that RD are older and dive deeper. To best of our knowledge and from our results, older age and deeper depths are believed to worsen the hearing levels.
Role of Vastus Lateralis Myofascial Free Flap in Reconstruction of Head and Neck Defects
Authors: Robb Philip , Boyette Jennings R. 
Published: September 2014

Objectives:There is a paucity of data regarding the role of the vastus lateralis free flap (VLFF) in head and neck reconstruction. Our objectives were to (1) describe the flap outcomes in this setting and (2) identify ideal clinical scenarios for its use.Methods:Retrospective review of 7 patients undergoing reconstruction with a VLFF at an academic tertiary institution between 2009 and 2013. Demographics, indications, complications, and outcomes were retrieved.Results:There were 4 males and 3 females with a mean age of 54.7 years. Indications included skull base reconstruction (n = 3/43%), scalp/calvarial defect (n = 2/28%), maxillary (n = 1), and exposed pharyngeal cervical spine hardware (n = 1). The myofascial component length ranged from 7 to 20 cm, and width ranged from 6 to 11 cm, with a mean area of 102 cm2 (range, 35‐240). The mean pedicle length was 11.3 cm. Handheld (n = 3) or implantable (n = 4) Doppler was used for monitoring, and there were no flap losses. The flap was skin grafted in 3 cases with no reported graft loss. The mean intensive care unit stay was 1.1 days (0‐3) and length of stay was 7.8 days (5‐13). Complications included wound infection (n = 1) and myocardial infarction (n = 1) in a patient with significant comorbidities. The donor site was closed primarily in all cases, with no significant donor site morbidity reported.Conclusions:The VLFF is an underutilized option in head and neck reconstruction. This flap provides a large amount of soft tissue that can be harvested in supine position and with minimal donor site morbidity. Given its long pedicle and variable myofascial component that can be tailored to a wide range of defects, the VLFF appears ideal for skull base reconstruction.
Indications, Results, and New Frontiers of Auditory Brainstem Implants in Children
Authors: Monsanto Rafael C. , Bittencourt Aline G. , Neto Natal J. B. , Beilke Silvia C. A. S. B. , Salomone Raquel , Lorenzetti Fabio T. M. 
Published: September 2014

Objectives:Review the literature regarding auditory brainstem implant (ABI) indications, surgical techniques, activation methods, and postsurgery follow‐up in children.Methods:A search was performed in LILACS, MEDLINE, SciELO, and PubMed databases from January to March 2013, and the key words used in the search were brainstem AND implant OR implantation AND children OR child. Studies that referred to results of the ABI fitting process in children were selected.Results:Seventy‐two studies that met the criteria were read in full; 17 studies referred to the ABI fitting process in children and were selected for appraisal. The studies showed the cases of 49 children (younger than 18 years old) fitted with ABIs. Evaluation after surgery showed that 47 (95.9%) of the patients improved in their ability to recognize environmental sounds and speech perception. Patients with tumors or those with cochlear or cochlear nerve malformations had good outcomes as well. Two of the children achieved no sound perception upon ABI activation.Conclusions:The US Food and Drug Administration (FDA) only approves the auditory brainstem implant for children older than 12 years old, but good outcomes in children younger than that age were achieved, improving environmental sound awareness and oral language development. The FDA only recently approved clinical trials for patients younger than 12 years old. We propose that the FDA auditory brainstem implant indications should be extended to patients with nontumoral diseases of the cochlea and cochlear nerve and younger than 12 years old.
Intraoperative Round Window Electrocochleography and Speech Perception Outcomes in Pediatric Cochlear Implant Recipients
Authors: Formeister Eric J. , McClellan Joseph H. , Merwin William H. , Iseli Claire E. , Buchman Craig A. , Fitzpatrick Douglas , Adunka Oliver F. 
Published: September 2014

Objectives:(1) Understand how intraoperative electrocochleograpy (ECoG) is used for assessing residual cochlear function in pediatric implant recipients. (2) Appreciate the utility of electrocochleograpy in predicting speech perception outcomes.Methods:A prospective cohort study of pediatric cochlear implant patients at a tertiary hospital was conducted starting in July 2011 and is ongoing. ECoG recordings were obtained from 77 children (89 ears) during cochlear implantation and provided a total response metric that can quantify the underlying hair cell and neural health. Follow‐up speech perception tests were conducted at ≥7 months postoperatively with the phonetically balanced kindergarten (PB‐k) word lists (n = 24). PB‐k scores were compared to ECoG total response and other clinical and audiologic variables using multiple linear regression analysis in order to construct a parsimonious model for predicting speech outcomes.Results:Postoperative PB‐k scores were significantly correlated with ECoG total response (r2 = 0.32, P =. 006) and preoperative pure tone averages (PTA; r2 = 0.41, P =. 001). ECoG total response was weakly and inversely correlated with PTA (r2 = 0.14, P =. 001, n = 89). Hierarchical multiple linear regression identified a model for speech perception performance that included preoperative PTA, duration of cochlear implant use, and ECoG total response that predicted about half of the variance in PB‐k performance (adjusted r2 = 0.49, P =. 002).Conclusions:Intraoperative ECoG recordings are significantly correlated with speech perception outcomes in pediatric cochlear implant recipients and alone can account for a similar proportion of variance in speech perception when compared to other bioaudiometric factors. ECoG provides useful prognostic information about attainment of open set speech perception in children.
Intratympanic Dexamethasone in the Treatment of Ménière's Disease
Authors: Gupta Sachin , Isaacson Brandon , Kutz Joe W. , Roland Peter S. 
Published: September 2014

Objectives:Describe vertigo control outcomes when intratympanic steroid injections are used for medically refractory Ménière's disease.Methods:A retrospective chart review was performed of patients diagnosed with unilateral Ménière's disease at a tertiary academic center. Patients were included who underwent intratympanic (IT) dexamethasone therapy after failing initial medical treatment between July of 2007 and July of 2013. Vertigo control was defined as when patients were satisfied and did not progress to further nonablative or ablative treatment.Results:Forty‐one patients with Ménière's disease underwent IT dexamethasone injections after failing medical therapy. Twenty‐six patients (63%) underwent more than 1 injection, with a median of 2 injections in the study population. Fifteen patients (37%) had vertigo control, at a mean follow‐up time of 9 months after the last injection. Vertigo control required 1 injection in 6 patients (40%), 2 in 2 patients (13%), 3 in 5 patients (33%), 4 in 1 patient (7%), and 5 in 1 patient (7%). Nineteen patients (46%) underwent further treatment that included endolymphatic sac surgery (9), IT gentamicin (5), betahistine therapy (4), and labyrinthectomy (1). No complications of infection or tympanic membrane perforation from the injections were observed.Conclusions:IT dexamethasone injection therapy can control vertigo symptoms in patients with Ménière's disease. However, this retrospective study reports a lower control rate than that reported in previous studies. Further studies are necessary to clarify specific patient factors that would predispose towards vertigo control with IT dexamethasone.
Linear Acceleration Response Variation in Inbred Strains of Mice: The Requisite for Gene Discovery
Authors: Lavinsky Joel 
Published: September 2014

Objectives:(1) Evaluate gravity receptor function using vestibular evoked potentials (VsEPs) recordings in different strains of mice. (2) Indicate functional variation in VsEPs response parameters across strains for the Genome‐Wide Association Study (GWAS) mapping of the vestibular system.Methods:Mice (6 weeks old) were anesthetized with ketamine 100 mg/kg and xylazine 10 mg/kg and were positioned supine with the head mount coupled and the cranium securely fastened to a mechanical shaker. Stimuli consisted of linear acceleration (17 pulses/s) applied to the cranium in the naso‐occipital axis. The first (P1) and second (P2) positive and negative response peaks were measured as phenotypes. Mice were selected based on a combined set of classic inbred (CI) and recombinant inbred (RI) strains from the Hybrid Mouse Diversity Panel (HMDP). A total of 13 CI (C57BL/6J, FVB/NJ, Balb/cJ, C3H/HeJ, Balb/cByJ, AKR/J, 129x1/SvJ, A/J, DBA/2J, SJL/J, CBA/J, SEA/GnJ, and NOD/ShiLtJ) and 10 RI (BXA14/PgnJ, BXD84/RwwJ, BXH19/TyJ, BXH22/KccJ, BXH9/TyJ, BXH10/TyJ, BXA14/PgnJ, BXA4/PgnJ, BXA16/PgnJ, and CXB9/HiAJ) were evaluated with an average of 2.7 mice/strain.Results:A wide range of phenotypic responses was observed. The mean threshold (–8.73 ± 5.1 dB re: 1 g/ms) and P2‐N2 amplitude at +6 dB re: 1 g/ms (0.682 ± 0.51 mV) both demonstrated statistical significant variation (analysis of variance) in VsEP thresholds (P =. 008) and P2‐N2 amplitude (P =. 001).Conclusions:These data demonstrate significant variation in VsEP response parameters across strains, strongly suggesting the hypothesis that there exists functional variation of vestibular function among strains of mice and the genetic determinants of such variation can be mapped using GWAS.
Long‐term Use of Cochlear Implants in Older Adults: Results from a Large Consecutive Case Series
Authors: Choi Janet S. , Contrera Kevin J. , Betz Joshua F. , Blake Caitlin R. , Niparko John K. , Lin Frank R. 
Published: September 2014

Objectives:Investigate rates of long‐term use of cochlear implants (CI) in a large, consecutive case series of older adults (≥ 60 years) and characteristics associated with continuing CI use.Methods:From 1999‐2011, 447 individuals ≥60 years received their first CI at Johns Hopkins, and we successfully contacted 397 individuals (89%) to ascertain data on the individual's daily CI use averaged over the past 4 weeks. Regular CI use was defined as ≥8 hours/d. We investigated the time from implantation to the date when an individual reported discontinuing regular CI use with Kaplan‐Meier and Cox proportional hazard analyses.Results:The overall rate of regular CI use at 13.5 years of follow‐up was 82.6% (95% confidence interval: 72.5‐89.3%). Individuals who received a CI at 60‐74 years had significantly higher rates of regular CI use at 13.5 years of follow‐up (91.1%, [95% confidence interval: 83.2‐95.4%], n = 251) than individuals who received a CI at ≥75 years (55.7%, [95% confidence interval: 24.9‐78.1%], n = 146). The rate of discontinuing regular CI use (<8 hours per day) increased on average by 7.8% (95% confidence interval: 3.0‐12.8%) per year of age at implantation.Conclusions:Rates of long‐term CI use in older adults at >10 years of follow‐up exceed 80%. The rate of discontinuing regular CI use was strongly associated with older age at implantation. These results suggest that the earlier implantation of older adults, once critically low levels of speech recognition are present, is associated with greater usage of the device.
Loop Overlay Myringoplasty versus Medial Myringoplasty: A Comparative Study
Authors: Gulia Joginder S. , Yadav Samar Pal S. , Basur Sukhdeep K. 
Published: September 2014

Objectives:One of the most important factors in the success of myringoplasty is the size of the perforation. The repair of subtotal and large central perforation is less likely to be successful compared with the repair of small perforations. Loop overlay technique of myringoplasty offers an advantage in these situations and can be a viable alternative.Methods:A prospective controlled study from January 2010 to December 2011 of inactive (mucosal) chronic otitis media with subtotal and large central perforations. Subjects: Forty cases of either sex in the age group of 18‐40 years. Pt. B.D.S Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Patients were randomly divided into 2 groups of 20 each. Group A underwent medial myringoplasty and Group B Loop overlay myringoplasty. The graft uptake rate and the preoperative and postoperative hearing thresholds in each group were analyzed. Independent variables: Size and location of the perforation, preoperative air bone gap, technique of myringoplasty used.Results:The overall graft take‐up rate in group A was 90% and in group B it was 95%. Further, the average postoperative gain in group A was 16.25 dB as compared to 18.5 dB of group B.Conclusions:Loop overlay myringoplasty is better than medial myringoplasty in subtotal and large central perforations.
Magnetic Resonance Imaging at 1.5 T after Pediatric Cochlear Implantation without Magnet Removal
Authors: Gupta Sachin , Isaacson Brandon , Roland Peter S. , Kutz Joe W. , Booth Tim N. , Jacob Roy , Morriss Michael C 
Published: September 2014

Objectives:(1) Assess the safety of 1.5 T magnetic resonance imaging (MRI) in pediatric patients with cochlear implants (CIs) and internal magnets. (2) Assess artifacts created by CI magnets.Methods:A retrospective chart review was performed of pediatric CI patients who underwent 1.5T MRI at a university children's hospital. Binding of the CI magnet was performed before MRI, using mold material and a compressive gauze dressing. Patients were assessed for ability to complete the MRI, imaging artifact from the CI magnet, magnet position, and CI function following MRI.Results:Four patients (mean age 65 months; range, 19‐108 months), and a total of 6 CIs (2 bilateral), underwent 1.5 T MRI scans. There were 3 brain MRI studies and 1 spine. Informed parental consent was obtained. Clinical indications included leukodystrophy (2), hypertonia (1) and dystonia (1). Devices from 2 manufacturers were scanned. A CT scan was performed before the MRI scan in three‐fourths of patients to assess bone thickness adjacent to the magnet. Three patients had MRI under anesthesia. The CI produced an artifact with a mean maximal AP dimension of 10.8 mm (range 7.5‐15 mm) and a transverse of 5.7 mm (range 5.5‐6 mm). Greatest image distortion occurred with bilateral implants. There was no change in magnet position or CI function after the MRI in all cases.Conclusions:Pediatric patients may safely undergo 1.5 T MRI after CI without removal of the magnet if the device is tightly bound beforehand and strict safety protocols are followed. There are limitations to brain imaging due to artifacts.
Micro‐CT Dimensions of the Stapes: Bilaterally Symmetrical, but Not Related to Mastoid Size
Authors: Calligas Jason P. , Todd Norman W. 
Published: September 2014

Objectives:(1) Measure stapes height, footplate height (diameter perpendicular the crural plane), and footplate width (diameter in the plane of the crura) and to correlate these metrics between right and left sides. (2) Correlate stapes measurements with mastoid size, an indicator of childhood otitis media.Methods:From a group of 41 clinically normal ear cadavers, tissue blocks from the five crania with the largest mastoid pneumatization and 5 with smallest mastoid pneumatization were selected for micro computed tomography imaging. Using the ImageJ software package, a 3‐dimensional model of each stapes was created to determine stapes height and footplate dimensions. Of 60 measurements sought, 52 were accomplished.Results:The mean stapes height was 3.43 mm (range, 3.18‐3.82 mm). The mean stapes footplate width was 1.23 mm (range, 1.10‐1.50 mm). The mean footplate height was 2.72 mm (range, 2.5‐2.98 mm). Bilateral symmetry of dimensions was found, but there was no correlation with mastoid size.Conclusions:A wide range of stapes dimensions is confirmed by these specimens. Bilateral symmetry suggests that genetic influences may play a role in development. No correlation was found between stapes dimensions and mastoid size, suggesting that this local environmental aspect may not be related to its development.
Myringotomy and Tympanostomy Tube Insertion Training Device: A Surgical Simulator
Authors: Villanueva Jose Carlo R. , Opulencia Alejandro P. 
Published: September 2014

Objectives:(1) Develop a task simulator for myringotomy and pressure equalizing tube insertion. (2) Develop a simulator that can be used to hone a participant's micro surgical skills.Methods:Study conducted from October to November 2013. A design for a model head with a core made up of wood and polyester body filling was made. The external facial features were replicated using molding clay. The pinna and the external auditory canal were then made from carved wood. The external auditory canals were continuous with the core of the head model. Rubber fittings were used to attach the wooden pinna to the head in order to allow some degree of mobility to the pinnae. A port at the occipital portion of the head was made that would accommodate a middle ear cartridge. A solution bottle's cap was used to fabricate the middle ear cartridge. The tympanic membrane was simulated using a single sheet of polyethelene film. Myringotomy, tube insertion, and evacuation of middle ear fluid was done several times.Results:We were able to construct a simulator for doing myringotomy, evacuation of middle ear fluid, and tympanostomy tube insertion. The simulator was sturdy, easy to use, and economical.Conclusions:Simulators allow constant practice and objective evaluation of skills without risks to the patient under the hands of the surgeon still on the learning curve. The creation of this simulator is a step towards the improvement of surgical training, evaluation of residents, better health economics, and patient safety.
The New Technology: Canal Wall Up Tympanoplasty with Transplantation of Tissue‐Engineered Cell Sheets
Authors: Kojima Hiromi , Yamamoto Kazuhisa , Yaguchi Yuichiro , Hama Takanori 
Published: September 2014

Objectives:The likelihood of recurrent retraction and adhesion of newly formed tympanic membrane is high when normal middle ear mucosa is extensively lost during intractable middle surgery. If rapid postoperative regeneration of the mucosa on the exposed bone surface can be achieved, prevention of recurrent tympanic membrane adhesion and cholesteatoma formation can be expected. The aim of this study was to develop a new method to transplant autologous cell‐sheets to promote postoperative regeneration of the middle ear mucosa.Methods:We harvested 10‐by‐10‐mm specimens of inferior turbinate mucosal tissue from the patient with acquired middle ear cholesteaoma. Tissue‐engineered epithelial‐cell sheets were fabricated ex vivo by culturing harvested cells for 3 weeks on temperature‐responsive culture dishes in a cell‐processing center (CPC) according to good manufacturing practice guidelines. After canal wall up tympanoplasty with mastoidectomy had been performed, sheets of cultured autologous cells that had been harvested with a simple reduced‐temperature treatment were transplanted directly into the exposed bone surface of middle ear cavity from which normal mucosa had been absent.Results:During the cultivation, the sterile environment in the CPC was confirmed. Autologous cell sheets were successfully transplanted to human middle ear.Conclusions:This is the first clinical study approved from the Ministry of Health, Labour and Welfare in Japan. Furthermore this is a first‐in‐man study in the world in which cultured cells were transplanted to the human ear. This novel technology of transplantation might be an effective alternative to the surgical operation on intractable otitis media in the near future.