bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Gelfoam in the Middle Ear on In Vitro/Vivo Model
Authors: Goncalves Stefania , Chiossone‐Kerdel Juan A. , Bianco Andrea S. , Ercolino Jose M. , Hernandez Jorge 
Published: February 2015

Objective1) Determine the dissolution pattern of Gelfoam and Invotec with saline and low grade boric acid solution. 2) Measure the effect of both gelatins in animal model hearing in postoperative time. 3) Understand the direct effect of boric acid treated gel in the middle and inner ear.MethodsIn vitro, 1 cm2 of Gelfoam and Invotec colored with Congo Red and immersed in saline solution 0.9% and boric acid pH 6.3. Pixel density analysis was performed to determine degradation. Thirty live Sprague‐Dawley rats, females of 100 g, were anesthetized with ketamine/xilacine, divided into 5 groups. Preoperatory and postoperatory ABRs were measured. All bullas were processed for histopathology.ResultsInvotec dispersion and degradation was 25% sooner than Gelfoam. Boric acid treating resulted in rapid degradation of both gelatins by 18%. Hearing recovery by the Gelfoam group occurred in days 5 and 6, and Invotec treated between days 4 and 5. A shorter period of time of 4 to 5 days in boric acid treated Gelfoam. Boric acid treated Invotec results in 4 days. Mild histological inflammatory reaction was seen in all groups.ConclusionGelfoam and Invotec show important differences that could impact short term hearing result showing a shorter reabsorption period of the Invotec. Boric acid impacted significantly gelfoam reabsorption with less impact on Invotec. No major histological changes found. Boric acid reduces absorption time of the cheaper Gelfoam.
Efficacy of Commercial Earplugs in Preventing Water Exposure
Authors: Mahboubi Hossein , Lee Austin , Kiumehr Saman , Djalilian Hamid R. 
Published: February 2015

Objective1) To evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals. 2) To be able to provide an evidence‐based recommendation for use of ear plugs in patients with tympanostomy tubes to prevent otorrhea.MethodNine ear plugs were inserted in random order in ears of 10 healthy subjects. Three standardized head wetting protocols were instructed: surface swimming, upright head submersion to apply horizontal pressure, and 90 degrees tilted head submersion to apply vertical pressure. Color change in moisture indicator was evaluated after each protocol.ResultsWater penetration was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, ad vertical submersion, respectively. The results showed a significant difference in the waterproofing qualities of the various types of earplugs. Pillow Soft Silicone Earplugs had the lowest rate of water penetration in all 3 protocols (P <. 001). There was no significant difference between the 2 waterproof earplugs Pillow Soft and Aquaseal, during surface swimming and vertical submersion protocols. However, Pillow Soft was significantly more effective comparing to Aquaseal with horizontal submersion protocol (P =. 008).ConclusionCommercially available ear plugs are not as protective against water intrusion as generally expected. Water exposure is recommended to be limited in patients with tympanostomy tubes. Pillow Soft was the most effective method of ear sealant compared to other commercially available earplugs.
Healthcare Delivery for Sudden Sensorineural Hearing Loss
Authors: Nguyen Huynh Anh T. , Furin Mark J. 
Published: February 2015

Objective1) Determine how healthcare delivery for idiopathic sudden sensorineural hearing loss (ISSHL) is affected by delay in seeking care, initial response from healthcare provider, and timing of diagnostic audiogram and otolaryngologic consultation. 2) Determine how the above factors affect hearing recovery.MethodRetrospective analysis of 118 ISSHL cases at Kaiser Permanente Northwest, 2001‐2010. Hearing outcome was measured as percentage of recovery with pure‐tone average of the unaffected ear as benchmark for 100% recovery. Variables include timing of initial contact, type of provider, initial diagnosis, action, timing for audiogram, consultation, and steroid treatment.ResultsPatients with at least 50% recovery received steroid at 9.0 ± 15.2 days whereas those with less recovery received steroid at 13.9 ± 15.0 days. Delay in seeking care differed little between the 2 groups. 15% of initial encounters involved audiologists or otolaryngologists, and 85% involved other MDs, PAs, NPs, or RNs. The former were all diagnosed correctly and averaged 70% hearing recovery, whereas the latter averaged 50% recovery. In this group, only 29% were correctly diagnosed, 34% were diagnosed incorrectly with conductive hearing loss, and 31% did not receive referral for follow‐up with audiology or otolaryngology.ConclusionSince elapsed time adversely affects hearing recovery in ISSHL, we have identified areas in healthcare delivery where improvements can be made to facilitate timely diagnosis and management. A key objective would be better recognition of ISSHL vs conductive hearing loss among healthcare providers who triage hearing loss complaints.
Intratympanic Dexamethasone and Cisplatinum Ototoxicity
Authors: Marshak Tal , Shupak Avi 
Published: February 2015

ObjectiveTo examine the possible role of intratympanic dexamethasone (ITD) in the prevention of cisplatinum‐induced hearing loss in oncological patients receiving it in a cumulative dose greater than 300 mg as part of their treatment regimen.MethodEighteen patients were recruited since July 2011, to a prospective controlled cohort study. ITD was repeatedly delivered to one ear while the other served as the control immediately prior to each cisplatinum treatment. Audiometry and distortion‐product oto‐acoustic emissions (DPOAEs) parameters were compared between and within the study and control groups.ResultsSeven patients have received to date the minimal required cumulative dose of 300 mg cisplatinum, ranging from 345 to 888 mg (average of 527 + 155 mg). Pure‐tone thresholds at 8000 Hz recorded at the last follow‐up evaluation were significantly increased in both the study and control groups (P <. 04). Also, marginally statistically significant increase in 4000‐8000 Hz pure tone averages and decrease in the average DPOAEs SNR values at 4000‐8000 Hz f2 frequencies were documented in both groups. The variance between the groups in any of the measured parameters in the last follow‐up evaluation did not reach statistical significance.ConclusionHearing loss mainly affecting the 8000 Hz region was found in patients receiving cisplatinum. DPOAEs evaluation demonstrated ototoxic effect to outer hair cell responding to the 4000‐8000 Hz frequency range. We could not yet demonstrate any beneficial effect of ITD in the prevention of cisplatinum‐induced hearing loss.
Mining Immune Epitopes in Ménière’s Disease and Sudden Sensorineural Hearing Loss
Authors: Platt Michael P. , Elackattu Alphi P. , Dilwali Sonam , Parikh Jignesh , Stankovic Konstantina M. 
Published: February 2015

ObjectiveEtiologies for Ménière’s disease and sudden sensorineural hearing loss remain unknown. Indirect evidence exists for allergy‐mediated or autoimmune process. The purpose of this study is to determine whether immunogenic proteins share similar sequences with inner ear proteins, which may lead to cross‐reactivity and immune activation in inner ear disorders.MethodComprehensive bioinformatic primary sequence analyses of intact and mutated proteins associated with human syndromic and nonsyndromic hearing loss and proteins expressed in the human inner ear was performed. Comparison of sequences to epitopes in the Immune Epitope Database was performed by exact match, BLAST, and BLOSUM62 score computational algorithms.ResultsComputational analysis of primary protein sequence for 81 known inner ear proteins, 102 proteins from genes identified in syndromic and non‐syndromic hearing loss, and 438 protein sequences with known mutations that contribute to sensorineural hearing loss was compared to 151,086 epitopes previously implicated in allergic, autoimmune, and infectious disorders within the Immune Epitope Database. The exact match and BLAST algorithms identified 1925 and 97 unique epitope matches, respectively. Top BLOSUM62 score algorithm resulted in a single hit for the 47 kDa membrane antigen. Other epitopes included those seen in allergic rhinitis, infectious diseases, and autoimmune disorders.ConclusionAbnormal immune activation is suspected in Ménière’s disease and SSNHL. Candidate immune epitopes were identified that may contribute to pathogenesis of these disorders. While these epitopes await clinical validation, they present novel targets for diagnosis and treatment of sensorineural hearing loss.
Motion Sickness Treatment Analysis with OVAR
Authors: Knox Glenn W. 
Published: February 2015

ObjectiveEvaluation of transdermal scopolamine for motion sickness prophylaxis.MethodRandomized, prospective double blind. 2010‐11. Twelve patients, 7 male, 5 female, ages 21 to 57. Intervention(s): Off‐vertical axis rotation 20° in the dark after administration of transdermal scopolamine or placebo. Outcome measures: Duration of tolerated off‐vertical rotation; subjective symptom reporting at 1‐minute intervals on a 0 to 4 scale.ResultsPatients treated with transdermal scopolamine had statistically significant improved tolerance time to off‐vertical axis rotation. Reported symptomatology on the 0‐3 subjective symptom scale was significantly improved as compared to placebo and was dose‐dependent. These results were significant to the. 05 confidence level.ConclusionOff‐vertical axis rotation is a useful modality for the evaluation of motion sickness medications. Transdermal scopolamine showed statistically significant dose‐dependent effects in mitigating OVAR‐induced motion sickness symptomatology and was well tolerated.
Outcomes after Usage of Ponto Implant System
Authors: Babu Seilesh , McKinnon Brian J. , Fucci Michael J. 
Published: February 2015

ObjectiveBone‐anchored hearing systems have proven to be an effective amplification solution for conductive, mixed, and profound unilateral sensorineural hearing losses. The Ponto bone‐anchored hearing system has been available in the United States for 2 years.MethodThis multicenter study was performed to review our experience with the Ponto system in 99 patients from 3 medical centers. The mean follow‐up was 6 months and the average loading time was 80 days. The linear surgical technique was used in 95% of cases. Clinical outcomes were measured.ResultsOf the 99 cases, there were no implant losses. Factors such as gender, hypertension, diabetes, body mass index (BMI), and smoking were investigated to determine any correlation between skin reactions that were found. Smoking was the only factor to be found significant in correlating to skin reactions (P <. 05).ConclusionThe Ponto bone‐anchored hearing system is an effective and successful treatment option for conductive and single sided deafness. Factors were evaluated to determine skin reactions and implant survival. These include gender, hypertension, diabetes, tobacco usage, and BMI. Only tobacco usage seemed to be a significant factor in skin reactions.
Rinne Revisited: Steel versus Aluminum Tuning Forks
Authors: Greenberg Jesse J. , Raz Yael , MacKechnie Cheryl A. , McCall Andrew A. , Hirsch Barry E. , Gerkin Richard C. , Durrant John D. 
Published: February 2015

Objective1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). 2) Determine the acoustic and mechanical impedance properties of 512 Hz tuning forks made of aluminum and stainless steel.MethodProspective, randomized observational study of 38 subjects presenting to outpatient clinic May 2011 through February 2012 with negative or equivocal Rinne and same‐day audiogram. Laboratory tuning fork impedance measurements were obtained using sound‐level meter and artificial mastoid (simulating air and bone conduction). Outcome: Sensitivity of negative Rinne in predicting air‐bone gap at 500 Hz.ResultsPatients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at 20.3 (±2.5) dB air‐bone gap for stainless steel versus 27.5 (±2.6) dB with aluminum. In a supporting laboratory study, steel forks exhibited comparable air and bone conduction efficiencies while aluminum forks favored air conduction. This results in a larger CHL being required to overcome aluminum forks’ increased air conduction efficiency before producing a negative Rinne.ConclusionWe have found steel tuning forks are more sensitive in detecting the presence of an air‐bone gap. This is substantiated by significant differences in the relative acoustic versus mechanical impedances of steel and aluminum forks. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.
Round Window Reinforcement for Superior Canal Dehiscence
Authors: Silverstein Herbert , Kartush Jack M. , Parnes Lorne S. , Poe Dennis S. , Babu Seilesh , Levenson Mark J. 
Published: February 2015

ObjectiveTo evaluate the outcome of round window (RW) with or without oval window (OW) tissue reinforcement in the management of superior canal dehiscence (SCD).MethodChart reviews were perfomed for patients with symptomatic SCD that underwent this window reinforcement procedure. Preoperative and postoperative audiometry, vestibular myogenic evoked potentials (VEMP), and presence of a positive Tullio and Hennebert’s sign were recorded. Patient questionnaires were administered to assess symptomatic relief following the procedure.ResultsTwenty‐five chart reviews from 5 tertiary centers revealed that most patients experienced reduction of symptoms and were satisfied with the results. A comprehensive analysis will be presented.ConclusionTissue reinforcement of the windows(s) may reduce some of the symptoms associated with SCD, perhaps by mitigating some of the presumed “third window” effect of the dehiscence. Most patients were grateful for the benefits provided by the procedure and the avoidance of a craniotomy or mastoidectomy.
Surgery for Otosclerosis: Results on 508 Patients
Authors: Sionis Sara , Puxeddu Roberto 
Published: February 2015

ObjectiveThe objective of our paper is to evaluate the hearing results after surgical treatment of otosclerosis from a retrospective analysis of 649 procedures performed by the same surgeon (484 stapedotomies, 69 total stapedectomies, 26 partial stapedectomies, and 70 revisions). We also evaluated the hearing improvement in patients with far‐advanced otosclerosis.MethodWe conducted a retrospective study on 649 operations performed on 508 patients between 1998 and 2005. The approach was endoaural under local anesthetic. Audiological evaluation has been performed according to the Committee on Hearing and Equilibrium–AAO‐HNS guidelines.ResultsWe found results better after stapedotomy than stapedectomy with a postoperative ABG within 10 dB in 89.67% after stapedotomy, in 85.51% after total stapedectomy, and in 84.62% after partial stapedectomy. Stapedotomy was most reliable in the variation of the BC for high tones; we had a worsening of BC in 17.56% after stapedotomy and in 21.74% after stepedectomy. After revision surgery the outcomes were worse than primary surgery, with an ABG within 10 dB in 85.36% after revision of stapedotomy and in 82.76% after revision of stapedectomy. In far advanced otosclerosis, we obtained a mean postoperative ABG within 10 dB in 86.32%.ConclusionThis study confirmed stapes surgery allows for a good restoration of hearing function in a high percentage of cases with slightly better results after stapedotomy. Time of surgery is fundamental for recovery of hearing function since the outcomes are better in patients without sensorineural hearing loss.
The Socioeconomic Impact of Revision Otologic Surgery
Authors: Nadimi Sahar , Leonetti John P. 
Published: February 2015

ObjectiveTo estimate the socioeconomic impact of revision canal wall down (CWD) mastoidectomy.MethodRetrospective chart analysis from our tertiary care medical center that evaluated all adult patients who underwent CWD mastoidectomy by the senior surgeon between 2006 to 2011. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery at state (Illinois) and national levels.ResultsOne hundred eighty‐nine CWD mastoidectomies were reviewed, of which 89 were primary and 100 were revision procedures. The total charge for this group of revision cases was $2,783,700, and the net reimbursement (collections) was $843,245. Using Illinois Hospital Consortium data, the estimated cost of reimbursement for revision CWD mastoidectomy for 387 cases in FY 2011 was nearly $3.3 million. An additional $2160 per patient in lost wages was predicted to have been related to time away from work. The 9214 patients who underwent revision CWD mastoidectomy in the U.S. represented a national healthcare cost of roughly $80 million.ConclusionKnown causes for failed CWD mastoidectomy include inadequate meatoplasty, high facial ridge, and residual or recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, thereby resulting in a positive impact on the socioeconomic strain related to this procedure at local, state, and national levels.
Multidisciplinary Management of Infiltrating Lipomatosis
Authors: Tracy Jeremiah C. , Dezube Aaron , Klement Giannoula L. , Scott Andrew R. 
Published: February 2015

ObjectiveTo present a novel paradigm in the management of congenital infiltrating lipomatosis (CIL) using surgical intervention combined with perioperative chemotherapy.MethodCase study and review of literature.ResultsCIL is a benign yet locally invasive lipomatous tumor. Current treatment involves subtotal resection and recontouring. Invasion of vital structures often prohibits complete excision; there is currently no consensus on the most appropriate timing or scope of resection. We present the case of a teenager with extensive CIL involving the left face who had undergone multiple previous surgeries with limited success. In this case, preoperative thalidomide and celecoxib was given followed by an aggressive soft tissue resection. Postoperatively, imatinib was started based on immunohistochemical findings. At 6 months the patient has improved facial symmetry without evidence of disease progression.ConclusionThis multidisciplinary approach to treatment of CIL represents a completely new paradigm. Current algorithms advocating early surgical resection or observation alone lead to unacceptably high rates of recurrence and potential morbidity; combining surgical and medical interventions may provide a synergistic approach to controlling this rare disease.
Airway Management following Pediatric Cardiothoracic Surgery
Authors: Wilson Meghan N. , Bergeron Lauren M. , Kakade Anagha , Simon Lawrence M. , Caspi Joseph , Pettitt Timothy W. , Kluka Evelyn A. 
Published: February 2015

ObjectiveLittle is currently known regarding outcomes in airway management of pediatric patients following cardiothoracic surgery (CTS). This study aims to 1) review airway management in a large cohort of pediatric patients undergoing CTS and 2) determine the incidence of airway related complications of CTS in this population.MethodAll patients who underwent CTS at a single, tertiary care, dedicated children’s hospital between June 1, 2007, and May 31, 2011, were retrospectively reviewed; those <18 years old who had open CTS were included. Statistical analysis examined the relationships of intubation length, tracheotomy, and complications compared to patient characteristics, comorbidities, and type of surgery.ResultsNine hundred five admissions in 762 patients met inclusion criteria. Mean postoperative intubation duration was 7.2 days (d), and the median was 3 d. Significantly longer postoperative intubation requirements were found in patients <2 years (mean 9.7 d, median 4 d) vs >2 years (mean 2.4 d, median 2 d, P <. 001) and those with comorbidities (mean 11.0 d, median 4 d) or history of prematurity (mean 8.8 d, median 4 d) vs those without comorbidity (mean 5.5 d, median 3 d, P <. 001). Additionally, preoperative intubation and surgical incision type significantly affected intubation duration. Vocal cord paralysis occurred in 3 patients, and phrenic nerve palsy occurred in 5. Twenty‐four patients required tracheotomy. Five patients developed airway stenosis.ConclusionAfter reviewing a large cohort of patients, this study finds CTS in the pediatric population is associated with few long term or permanent airway related complications. Patients with a history of prematurity, medical comorbidity, and/or younger age at the time of surgery require longer periods of postoperative intubation.
Childhood Obesity as a Risk for Development of Otitis Media
Authors: Sidell Douglas R. , Shapiro Nina L. , Bhattacharyya Neil 
Published: February 2015

ObjectiveTo determine if obesity is a significant risk factor for acute suppurative otitis media (AOM), allergic rhinitis (AR), or adenoid/tonsillar hypertrophy (ATH) in children, and to understand the potential otolaryngological implications of childhood obesity.MethodThe Medical Expenditure Panel Survey was utilized to identify children diagnosed with AOM, AR, and/or ATH. Risk factors for these diagnoses extracted included demographics and the presence or absence of childhood obesity. Multivariate statistical analyses were conducted for the associations between childhood obesity and AOM, AR, and ATH.ResultsA total of 84.5 million children (mean age, 12.2 years) were studied within the 2006 and 2008 MEPS data sets. Of these patients, 4.3 million (5.1%) reported a diagnosis of AOM, 8.0 million (9.5%) reported a diagnosis of AR, and 0.31 million (0.4%) reported a diagnosis of ATH; 18.7 million children (22.2%) were obese. Utilizing a demographically adjusted multivariate model, childhood obesity was found to be associated with AOM (P =. 01; odds ratio, 1.45). Significant associations between obesity and AR or ATH were not identified (P =. 60 and P =. 79, respectively).ConclusionChildhood obesity appears to be significantly associated with the development of AOM, but does not seem to influence AR or ATH. Given that in the United States nearly one‐fourth of all children seeking healthcare are obese, these data may have important preventative care implications.
FloSeal with Adenotonsillectomy to Prevent Adverse Outcomes
Authors: Dyer Steven R. , Durvasula Phani , Bathula Samba , Sana Saidshoib , Haupert Michael , Madgy David , Dworkin James 
Published: February 2015

ObjectiveThe aim of study was to compare the postoperative complications associated with adenotonsillectomy with or without the application of FloSeal at the completion of the procedure in 2 similar groups.MethodThis retrospective study was performed at a tertiary care pediatric hospital between January 2007 and December 2008, for OSA and chronic tonsillitis in patients between 1 and 18 years old. Eight hundred patients underwent adenotonsillectomy in an identical manner, with half reciving FloSeal intraoperatively. Outcomes measured were: hemorrhage, return to OR, and dehydration.ResultsAge ranged from 1 to 18 years. Male gender was found to have a slight predominance without statistical significance (χ2 = 0.01, P =. 93). Preoperative diagnosis was more commonly OSA (79.9%) compared to chronic tonsillitis (20.1%). Primary bleed rate was found to occur in 2 subjects (0.3%); 1 FloSeal and 1 No FloSeal subject (χ2 = 0.004, P =. 95). Secondary bleeding was seen in 18 subjects (2.5%); 11 FloSeal and 7 No FloSeal (χ2 = 1.32, P =. 25). Dehydration was seen in 51 subjects (7.1%); 24 FloSeal and 27 No FloSeal (χ2 = 0.01, P =. 92). The need for return to OR was seen in 7 subjects (1%); 5 FloSeal and 2 No FloSeal (χ2 = 1.59, P =. 21).ConclusionIn our experience, the application of FloSeal hemostatic matrix after monopolar adenotonsillectomy demonstrates no additional reduction in postoerative complications encountered in the pediatric population.