bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonmaleficence in the Management of Giant Cholesteatoma: A Case Series
Authors: Kazi Aasif A. , Van Beek‐king Jessica , Solares C. Arturo , Patel Sumir S. , McKinnon Brian J. 
Published: September 2014

Objectives:(1) Describe the disease process in giant cholesteatomas, a rare, destructive condition with significant morbidity. (2) Review recent experience in the management and outcomes of giant cholesteatoma.Methods:Retrospective case series at a tertiary hospital‐based academic medical referral center from 2004 to 2011. Three patients with giant temporal bone cholesteatoma who were surgically treated were identified. All 3 patients underwent surgical management with wide exteriorization and routine postoperative debridement. Control of disease was measured through recurrence as seen on follow‐up.Results:Three adult male patients presented with giant unilateral acquired petrous cholesteatomas over an 8‐year period. Two presented with anacusis and facial paralysis, and one with extension of disease to the sphenoid sinus. All were managed with mastoidectomy wide exteriorization; one required an additional staged endoscopic transsphenoidal approach. Hearing and facial function was preserved when present preoperatively. One patient died 5 months postoperatively from H1N1 infection unrelated to his cholesteatoma. Routine postoperative debridement maintained disease control. Follow‐up ranged from 5 months to 7 years.Conclusions:Exteriorization of giant petrous cholesteatoma combined with routine postoperative debridement is a safe and effective way of preventing long‐term complications and disease recurrence.
A Novel Functional Imaging Method of the Eustachian Tube
Authors: Alper Cuneyt M. , Rath Tanya J. , Swarts J. Douglas , Teixeira Miriam S. , Doyle William J. 
Published: September 2014

Objectives:(1) Image the Eustachian tube (ET) lumen by computed tomography (CT) scanning during ET function (ETF) testing, (2) characterize the differences in image quality for different scanning protocols, and (3) establish a novel research methodology for studying ET anatomy and physiology.Methods:In a cadaver head without craniofacial or otologic abnormalities, the tympanic membrane was perforated and ETF test was done using the forced response test (FRT) in a CT scanner. Opening (OP), steady (PS), and closing (CP) pressures were measured during forced air flow from the middle ear (ME) to the nasopharynx across the open ET. Temporal bone CT scans with continuous 0.625 mm thickness were done at a low and standard radiation doses before and during the steady flow (SF) phase of the FRT, after instilling iodinated contrast into the ME and ET, and after the FRT cleared the contrast from the ET. Image analysis was done using the CT scanner console software to view the ET and peritubal structures in standard views and after image reconstructions.Results:The average OP, PS, and CP values were 488 ± 249, 376 ± 101, and 211 ± 62 daPa. While a distinct ET lumen could not be demonstrated during the FRT done with air, CT with intra‐luminal contrast clearly demonstrated the entire ET lumen. Post‐contrast FRT demonstrated residual contrast outlining the lumen.Conclusions:Standard temporal bone CT doses provided a slightly better signal‐to‐noise than the low‐dose CT for the air but not for the contrast. Combining ETF testing and CT imaging has potential research applications.
The Acceptability of Nonvegetarian Medications in Vegetarian Patients in Otolaryngology
Authors: Haarer Francesca , Fu Bertram , Desai Ketan 
Published: September 2014

Objectives:(1) Find out the proportion of vegetarian patients in our department and their knowledge, views, and preferences in receiving nonvegetarian medications. (2) Describe commonly prescribed ear, nose, and throat (ENT) medications in our department and whether they are suitable for vegetarians.Methods:A questionnaire survey was performed in the ENT department of a large southeast England university teaching hospital in the United Kingdom between January and February 2013. A list of commonly prescribed ENT medications in our department was drafted, and their constituents were confirmed with corresponding manufacturers.Results:Forty patients responded to the questionnaire in this period. Responses for the following questions were collected and results were analyzed: (1) Are you vegetarian? Religious/lifestyle choice/others; (2) Do you ask your doctor if he/she is prescribing medication containing animal products?; (3) If you are a vegetarian, would you take any prescribed medication containing animal products?; (4) Do you think a patient should be offered a vegetarian alternative if they prefer/choose?Conclusions:We have found a significant proportion of our patients are vegetarian and that they prefer to have a choice of medications that are suitable for vegetarians if available. We have tabulated a list of commonly prescribed medicines in our department and contacted the relevant pharmaceutical companies, inquiring if their medicines contain any excipients from an animal source. Although the majority of medicines contained no animal‐sourced active components or excipients, a significant proportion did. One of the most common excipients used was gelatine (E441).
Otological Effects of Low‐Frequency Noise: Case of Wind Turbine Syndrome from a Successful Plaintiff
Authors: Farboud Amir , Trinidade Aaron 
Published: September 2014

Objectives:Symptoms including tinnitus, otalgia, and vertigo have been reported following exposure to wind turbine noise; a condition termed wind turbine syndrome (WTS). We describe a case of an individual suffering following exposure and analyze the evidence for the detrimental physiologic effects of infrasound and low‐frequency noise, thereby questioning the existence of WTS.Methods:Case report (2013) and literature analysis on articles published within the past 10 years, conducted using the PubMed database and Google Scholar search engine, which included in their title or abstract the terms “wind turbine,” “infrasound,” or “low frequency noise.”Results:In our case the patient suffered with the symptoms of WTS and was able to challenge the wind turbine company in court. There is evidence that infrasound has a physiologic effect on the ear, but the overwhelming opinion emerging is that there is no clear evidence that WTS exists, and that the overriding factor is annoyance and the fiscal implications of living near a turbine or wind farm. The literature lacks any convincing evidence that low frequency noise causes significant physiological effects.Conclusions:We present a case of a successful plaintiff with all the symptoms of WTS. Although there is some evidence of symptoms in patients exposed to wind turbine noise, our group feels that the symptoms of WTS are vague and can be attributed to psychosomatic factors and annoyance due to the proximity to low frequency whirring, rather than a true physiological impairment.
Ototoxic Effect of Anti‐fog Solution Applied to the Guinea Pig Middle Ear
Authors: Nomura Kazuhiro , Oshima Hidetoshi , Yamauchi Daisuke , Kawase Tetsuaki , Katori Yukio 
Published: September 2014

Objectives:Recent advances in endoscopic technology have allowed an application to middle ear surgery. Anti‐fog agent is necessary for endoscopy because moisture and blood may cause obscured vision. Ultrastop is one of the most commonly used anti‐fog agents. The current study examined the ototoxic effect of topical application of Ultrastop in the guinea pig ear.Methods:A preliminary experimental animal study. in a university hospital. Eighteen male Hartley guinea pigs (weight, 480‐620 g) were divided into 3 groups to be treated with Ultrastop, gentamicin (50 mg/mL, positive control), or saline solution (negative control). After auditory brainstem responses were measured, topical solutions of 0.2 mL were applied through a small hole made at the tympanic bulla. Posttreatment auditory brainstem responses were obtained 14 days after the treatment. The extent of middle ear damage was investigated and scored.Results:The saline‐treated group showed no deterioration in auditory brainstem response threshold. The anti‐fog‐treated and gentamicin‐treated groups showed severe deterioration in auditory brainstem response threshold. Middle ear examination revealed extensive changes in the anti‐fog‐treated group and medium changes in the gentamicin‐treated group.Conclusions:Anti‐fog solution (Ultrastop) applied topically to the guinea pig middle ear caused significant middle ear inflammation and hearing impairment. Great care must be taken to prevent anti‐fog solution reaching the middle ear.
Pax2 and Sox2 Cooperate to Promote Hair Cell Fate in Inner Ear Stem Cells
Authors: Kempfle Judith S. , Edge Albert S. 
Published: September 2014

Objectives:Sensorineural hearing loss (SNHL) is a common problem of our generation and has increased over the past decades. Normal function of inner ear hair cells is crucial for hearing. In mammals, inner ear hair cells cannot regenerate after damage. A single transcription factor, Atoh1, is sufficient and essential for the formation of a hair cell from a sensory progenitor cell. Two early otic transcription factors, Pax2 and Sox2, play a role in activation of Atoh1 and hair cell fate in inner ear progenitors. The aims of the study were (1) understand molecular basics of hair cell development; (2) learn about the underlying mechanisms that can regenerate hair cells from stem cells.Methods:Biochemical analysis (chromatin‐immunoprecipitation and luciferase assays) of the Atoh1 regulatory region responsible for hair cell fate and the upstream regulators Sox2 and Pax2. In vitro stem cell assay (cell culture) to induce hair cell fate from inner ear progenitors by manipulation of Sox2 and Pax2.Results:In hair cell progenitors, Sox2 and Pax2 are needed simultaneously in the same cell, where they co‐bind to the regulatory region of Atoh1 to activate Atoh1 expression. Activation of Atoh1 transcription leads to a hair cell phenotype.Conclusions:We show for the first time that Pax2 and Sox2 have a role in cell fate specification and that both factors act together to activate Atoh1 expression. Our data provide a mechanism that could be used in the future to regenerate hair cells after trauma in the inner ear.
Permeability of Otowicks and Bacterial Penetration
Authors: Bola Sumrit , Rashid Mamun , Hickey Simon 
Published: September 2014

Objectives:Otowicks are used to treat otitis externa with significant ear canal oedema. They ensure close contact between administered drops and the canal skin. How well drops penetrate through to reach the deep canal has not been accurately investigated. This in vitro study aims to investigate: (1) the permeability of otowicks to commonly used ear drops; (2) The ability of bacteria to penetrate through the otowick.Methods:Sterile otowicks were inserted into mock ear canals fabricated from plastic pipettes. These were held vertically over pseudomonas‐seeded agar plates while Gentisone HC or CiloxinTM drops were administered; 4 drops, TDS for 5 days. Time taken for the drops to penetrate through the otowick was recorded. Separately, pseudomonas‐seeded otowicks were inserted into plastic pipettes and treated with saline or antibacterial drops. The penetrating drops were observed for bacterial growth on sterile agar.Results:It took 6‐8 drops before penetration occurred for both ear drops. Thereafter, otowicks treated with Ciloxan showed delayed penetration after 5 days (60‐240 seconds) when compared with Gentisone (50‐91 seconds). When sterile saline drops were applied to bacterially‐contaminated otowicks, the penetrating drops displayed bacterial growth on agar, indicating that pseudomonas penetrated through the otowicks. However, when Gentasone or Ciloxan were applied, penetrating drops showed no bacteria growth on the corresponding agar plate.Conclusions:Bacteria can penetrate otowicks but this can be prevented by continuous application of antibacterial ear drops. Ear wicks need priming with 8 drops before starting a regime as the initial dose is fully absorbed by the otowick.
Positive Outcomes and Surgical Strategies for Bilateral Cochlear Implantation in a Child with X‐Linked Deafness
Authors: Kim Leslie , Wisely Clayton E. , Lucius Shana , Weingarten Jori , Dodson Edward E. 
Published: September 2014

Objectives:(1) Recognize that bilateral cochlear implantation (CI) in X‐linked deafness is surgically feasible and safe. (2) Recognize that improvement in hearing as well as language acquisition is an achievable goal.Methods:This is a retrospective case review at a tertiary care center of one patient who presented with bilateral profound sensorineural hearing loss at age 6 months. He lacked auditory brainstem responses in both ears and was confirmed to have congenital X‐linked deafness secondary to POU3F4 gene mutation. Because of lack of benefit from amplification, he underwent bilateral CI in a staged fashion at 12 (right ear) and 15 months (left ear) of age.Results:The patient underwent transmastoid‐facial recess approach and received Nucleus Freedom implants (Cochlear Ltd) in both ears, utilizing perimodiolar electrodes. High‐flow gushers were encountered bilaterally and resolved with temporalis muscle plugs. C‐arm fluoroscopy was used during insertion of electrodes in both ears. Follow‐up data were available for 12 months. No complications were encountered, including no postoperative CSF leakage or facial stimulation. Postoperative audiograms in aided conditions showed hearing thresholds <40 dB. At 11 months following activation of his second CI, he scored in the normal range for his chronological age on standardized language measures, the Receptive Expressive Emergent Language Test‐3 and the Preschool Language Scale‐5.Conclusions:With careful preparation and the assistance of intraoperative fluoroscopy, cochlear implantation in patients with congenital X‐linked deafness can be done safely. Performing bilateral CI followed by dedicated auditory‐verbal rehabilitation may allow patients to trend toward normal language development.
Postoperative Middle Ear Aeration and Hearing Results after Canal Wall Down Tympanoplasty with Soft‐Wall Reconstruction
Authors: Haginomori Shin‐Ichi , Ichihara Takahiro , Mori Atsuko , Kanazawa Atsuko , Nishikado Akira , Kawata Ryo 
Published: September 2014

Objectives:(1) Estimate the degree of postoperative aeration in the middle ear after canal wall down tympanoplasty with soft‐wall reconstruction (CWD tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD tympanoplasty with SWR.Methods:This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy‐eight ears with cholesteatoma treated surgically at our hospital by planned two‐stage CWD tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second‐stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air‐bone (A‐B) gaps: 0‐10, 11‐20, 21‐30, and >30 dB.Results:Postoperative middle ear aeration was significantly greater in the smaller A‐B gap bins (0‐10 and 11‐20 dB) compared with the larger A‐B gap bins (21‐30 and >30 dB). In contrast to the larger A‐B gap bins, those with smaller A‐B gaps showed reaeration of the antrum and mastoid cavity.Conclusions:Promoting postoperative aeration of the entire middle ear is necessary to achieve better hearing outcome in patients undergoing CWD tympanoplasty with SWR for cholesteatoma. The ventilation tube insertion and placement of the large silicone sheet from the protympanum to the mastoid cavity in the first‐stage tympanoplasty are candidate procedures to promote postoperative aeration.
Revision Cochlear Implantation Using a Double‐Array Device in the Post‐meningitis Ossified Cochlea
Authors: Shaul Chanan , Roland J. Thomas , Sichel Jean‐Yves , Perez Ronen 
Published: September 2014

Objectives:Describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double‐array or split electrode device. All patients had an ossified cochlea due to meningitis and were functioning poorly with a standard electrode cochlear implant.Methods:Four patients between the ages of 4‐15 years underwent revision with 5 double‐array cochlear implant devices in our center during the years 2010‐2012. One patient underwent bilateral revision surgery. All patients suffered from meningitis with computed tomography and magnetic resonance imaging studies that demonstrated an ossified cochlea. The time interval between the disease and initial cochlear implantation was 4 months to 4 years. Patients data were retrospectively analyzed with emphasis on the surgical technique, number of electrodes inserted, and number of active electrodes at follow‐up. In addition, pre and post revision surgery function was compared.Results:The revision surgery was carried out 4 to 10 years after the initial surgery. Two tunnels, basal and apical, were drilled in the ossified cochlea. In each of the tunnels 5 to 12 electrodes were inserted. While the number of active electrodes before revision was 0‐5, after revision with the double array it increased to 8‐16. This resulted in increased auditory and speech function.Conclusions:The double‐array device can provide good outcome in the post‐meningitis ossified cochlea. In many of these cases function can be better than with a single electrode device.
Sensing Nerve Regeneration with Implantable Flexible Electronics
Authors: Nguyen Linda T. , Bajema Michael , Chung Jaehoon , Weissbrod Philip A. , Coleman Todd P. , Nguyen Quyen T. 
Published: September 2014

Objectives:(1) Translate epidermal electronic systems (EES) into an implantable electrode system (IES) with the potential to detect electric activity from growing axons distal to the site of nerve repair. (2) Demonstrate baseline and stimulated activity in intact nerves using IES. (3) Demonstrate nerve activity using IES following nerve regeneration across a surgical repair site.Methods:EES consists of thin flexible electronic circuitry that is capable of sensing and wirelessly transmitting multiple modalities including electrical activity, temperature, and stretch following transfer to skin. We have modified EES technology into an implantable electrode system consisting of biocompatible components that can detect nerve activity in vivo in a rodent model. We obtained recordings of intact sciatic nerve activity following pulsed stimulation applied via the proximal portion of the electrode array. Future experiments will focus on detection of activity following nerve transection and repair.Results:A first‐generation IES sensor was tested on intact mouse sciatic nerves. Proximal electrodes were used to stimulate the nerve, and distal electrodes recorded the stimulus. Action potentials were successfully recorded. Recorded activity was abolished following nerve transection.Conclusions:We demonstrate the adaptation of EES technology with the ability to stimulate and record nerve activity in a rodent model. An implantable device capable of sensing nerve regeneration would provide crucial information on the status of nerve repair and at much earlier time points allowed by clinical exam and electromyography. This technology has the potential to improve clinical decision‐making and patient outcomes.
Sinus Tympani: A Practical Classification
Authors: Abou‐Bieh Alaa A. , Haberkamp Thomas J. 
Published: September 2014

Objectives:(1) Describe a classification for the sinus tympani (ST) different types based on their otoendoscopic and surgical anatomy in relation to their development theories. (2) Evaluate possible approaches to each of its types. (3) Eliminate the discrepancy between the various methods used to describe it in literature.Methods:Fifty‐five temporal bones were dissected, and the anatomic details were studied using an operating microscope and otoendoscopes of different angles. In addition, the ST anatomy and relations were studied in 200 temporal bones’ computed tomography scans.Results:Four distinct types of ST could be observed. Type 1, the most common type, was pneumatized and consisted of an orifice and cavity. In Type 2, the well‐pneumatized type, the cavity was deep enough posteriorly to exceed the level of the mastoid segment of the facial nerve in any direction. In Type 3, the common posterior tympanic sinus, ST communicated with the upper posterior tympanic sinus proper or with a retro‐ponticulus up‐ward extension. Type 4, the nonpneumatized type, was shallow with no true orifice and cavity. Types 1 and 4 were mainly approached via the transcanal route. Types 2 and 3 required a combined transcanal and transmastoid approach. Endoscopic transcanal approach alone was satisfactory for types 1 and 4 but to a lesser extent in type 3.Conclusions:ST shape and extension both depend mainly on the extent of its pneumatization, which in turn influences its relation to the surrounding structures in the retrotympanic area. Extensively or unusually pneumatized types need special or combined approaches.
Squamous Cell Carcinoma of the Temporal Bone: Our Experience
Authors: Hajiyev Yusif , Talishinskiy Azizaga M. , Akberova Leman 
Published: September 2014

Objectives:Squamous cell carcinoma of the temporal bone is a rare and invariably aggressive tumor with an estimated incidence of one per million per year. Tm1 squamous cell carcinoma (SCC) is the most frequent primary malignant tumor of the temporal bone, but the incidence is as rare as <0.2% of all tumors of the head and neck. It is a rare but threat eningly aggressive tumor, with poor prognosis. Because of the rarity of this disease, there is no large prospective series on staging, treatment, and outcomes. Surgical treatment remains a challenge in the hands of skull base surgeons. The prognosis for patients with this disease has remained poor despite advances in surgical and radio‐therapeutic techniques.Methods:A retrospective review of the medical records of the patients diagnosed with squamous cell carcinoma of the temporal bone from 2000 to 2007 was performed. This study included 14 patients with unilateral temporal bone tumors.Results/Conclusions:Factors evaluated included patient demographics, presenting symptoms, physical examination findings, radiographic findings, surgical treatment, method of reconstruction, surgical complications, histopathologic findings, and the use of postoperative radiation therapy.