bluuebunny/crossref_metadata_2025_split huggingface dataset:
Growth Factor Delivered by a Bioabsorbable Polymer as Treatment for Chronic Tympanic Membrane Perforations
Authors: Santa Maria Peter L. , Kim Sungwoo , Varsak Kursad , Yang Yunhzi P. 
Published: September 2014

Objectives:(1) Test the efficacy of a novel topical growth factor (GF) treatment, delivered by a bioabsorbable polymer, in animal models of chronic tympanic membrane (TM) perforation, Eustachian tube (ET) obstruction, and chronic suppurative otitis media (CSOM). (2) Describe the preclinical work forming the basis for a proposed clinical trial of topical GF treatment.Methods:Bilateral chronic TM perforations were created in our novel mouse model (n = 50) and stable at 3 months, using an inhibitor of epidermal growth factor receptor. One ear received topical GF polymer treatment and the other received polymer only. Another mice cohort (n = 42) had chronic perforations created and also surgical obstruction of the ET. A further mice cohort (n = 35) had CSOM created through the above procedure and inoculation of pseudomonas aeruginosa. These perforations and treatments were evaluated microscopically, histologically, and using cytokeratin immunohistochemistry. Toxicity and safety of our polymer and GF were evaluated using auditory brain stem responses (ABR) and otoacoustic emissions (OAE) at 8 weeks following treatment.Results:In the chronic TM perforation cohort, 92% (22 of 24) healed compared with 38% (10 of 26) of controls (polymer only) at 4 weeks (P <. 01). In the chronic perforation cohort with ET obstruction, 94% (18 of 19) healed compared with 9% (2 of 23) of controls (polymer only) at 6 weeks (P <. 01). The ABR and OAE of our cohorts returned to control levels at 8 weeks.Conclusions:We demonstrate the efficacy, safety, and nontoxicity of a novel GF treatment in animal models.
Hydrophilic Hydroxyapatite Cement Cranioplasty: Preventing Cerebrospinal Fluid Leaks and Wound Complications in Translabyrinthine Acoustic Neuroma Surgery
Authors: Jackson Neal , Spear Samuel A. , Mehta Rahul , Ying Yu‐Lan Mary , Scrantz Kelly , Culicchia Frank , Arriaga Moises A. 
Published: September 2014

Objectives:(1) Examine the efficacy of quick‐setting, hydrophilic formulation of hydroxyapatite cement (HAC) used in cranioplasty for the prevention of cerebrospinal fluid (CSF) leaks and long‐term wound complications following translabyrinthine acoustic neuroma (TLAN) surgery. (2) Review evolution of HAC cranioplasty.Methods:Retrospective case review from 2006 to 2013 in atertiary referral center. Consecutive patients undergoing translabyrinthine approach for acoustic neuroma tumors were operated on by the senior author. Intervention: Therapeutic: Cranioplasty combining a medial abdominal fat graft with hydrophilic hydroxyapatite cement filling the mastoid. Main outcome measures: Incidence of cerebrospinal fluid (CSF) leaks and any wound complications.Results:Forty‐four patients met inclusion criteria. There were no CSF leaks or other wound complications in this series.Conclusions:Hydrophilic HAC appears to be safe and efficacious for cranioplasty following translabyrinthine acoustic neuroma surgery.
Incidence of Cisplatin Ototoxicity in Head and Neck Cancer Patients
Authors: Greene Joshua B. , Standring Robert T. , Hall Francis T. , Siddiqui Farzan , Ahsan Syed F. 
Published: September 2014

Objectives:Elucidate the incidence of cisplatin‐induced ototoxicity in patients treated for head and neck cancer.Methods:This was an institutional review board approved retrospective study of patients treated with cisplatin for cancer at a tertiary referral hospital. The charts of patients of any age that had undergone cisplatin therapy from 1995 to the present were reviewed. We then narrowed this group down to those who had a diagnosis of cancer of the head and neck (hypopharyngeal, laryngeal, nasopharyngeal, oropharyngeal, scalp/face skin cancer, temporal, thyroid) and had pre‐ and posttreatment audiologic testing.Results:There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014. Of those, 203 patients had pre‐ and posttreament audiologic testing. Twenty patients had diagnosis of cancer involving the head and neck. The cochlear radiation doses were also collected from these patients. Preliminary results demonstrate that patients with head and neck cancer that were treated with cisplatin and had a sizable cochlear radiation dose had significantly more permanent hearing loss following treatment.Conclusions:The incidence of cisplatin induced ototoxicity was significantly more prevalent in head and neck cancer patients. These patients should be thoroughly screened and protective precautions should be taken to limit ototoxicity in this population.
Injuries and Mechanisms Causing HSV1 Reactivation in Peripheral Neurons
Authors: Roehm Pamela C. 
Published: September 2014

Objectives:Herpes simplex type 1 (HSV1) reactivation in sensory neurons may underlie a number of idiopathic head and neck syndromes, including Bell's palsy and delayed facial palsy following traumatic injury. In this study we first measured whether modeled surgical nerve injury (hypoxia and heat) reactivated HSV1 in neurons harvested from different ganglia (geniculate, vestibular, trigeminal, and sympathetic). We also measured the phosphorylation status of mTOR pathway proteins in conditions that either did or did not cause HSV1 reactivation.Methods:Basic/translation science study of cultured neurons latently infected with HSV1. Primary neuronal cultures were either kept under hypoxic conditions or heated to 43°C for 2 hours to simulate intraoperative neuronal injury. Outcome measures included HSV1 reactivation measured by expression of green fluorescent protein under HSV1 promoter and HSV1 viral titers. Other outcome measures included measurement of phosphorylation of mTOR1, S6, and S6kinase by western blot and immunofluorescent microscopy.Results:All latently infected neurons demonstrated HSV1 reactivation following hypoxia. Trigeminal, vestibular, and geniculate neurons demonstrated brisk HSV1 reactivation after heat treatment, but sympathetic neurons did not. All conditions leading to HSV1 reactivation significantly affected phosphorylation status of mTOR pathway proteins.Conclusions:Conditions which reactivate latent HSV1 lead to changes in phosphorylation of mTOR pathway proteins. Conditions that do not lead to HSV1 reactivation do not affect the mTOR pathway.
Long‐term Dizziness Handicap in Patients with Vestibular Schwannoma: A Multicenter Cross‐Sectional Study
Authors: Carlson Matthew L. , Tveiten Øystein V. , Driscoll Colin , Neff Brian A. , Tombers Nicole M. , Lund‐Johansen Morten , Link Michael 
Published: September 2014

Objectives:Previous studies have demonstrated that ongoing dizziness is a powerful predictor of reduced quality of life for patients with vestibular schwannoma (VS). The purpose of the current study is: (1) to characterize long‐term dizziness following observation, microsurgery, and stereotactic radiosurgery (SRS) for small to medium sized VS using a validated self‐assessment inventory and (2) to identify clinical variables associated with long‐term dizziness handicap.Methods:All patients with sporadic <3 cm VS who underwent primary microsurgery, SRS, or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the Dizziness Handicap Inventory (DHI) and a VS symptom questionnaire.Results:A total of 642 respondents (mean age 56.2 years, 56.9% female) were analyzed and the average time interval between treatment and survey was 7.7 years. Female sex, older age, preexisting diagnosis of migraine, and symptoms of severe dizziness predating treatment were highly statistically significantly associated with a worse DHI score (P <. 001) while type of dizziness (vertiginous vs non vertiginous), tumor size, and treatment strategy were not (P >. 05). The 2 variables that were associated with the greatest deterioration in DHI scores were pre‐existing migraine (24.5 vs 15.9 points) and history of severe dizziness prior to treatment (31.1 vs 14.0 points).Conclusions:These data suggest that migraine may play a major role in long‐term dizziness in patients with VS. Factors including history of dizziness predating treatment and preexisting diagnosis of migraine most significantly influence dizziness handicap among subjects with VS, while management strategy is not associated with long‐term DHI outcome.
Middle Cranial Fossa Dehiscence as an Incidental Finding on CT
Authors: Valika Taher , Redleaf Miriam 
Published: September 2014

Objectives:Determine the prevalence of middle cranial fossa (MCF) dehiscence on computed tomography (CT) scans and establish its increase with age.Methods:All high‐resolution temporal bone CT scans completed at a tertiary care center from 2011 to 2013, ordered by 1 otologist for any reason, were reviewed. Scans showing soft tissue, fluid, trauma, or previous operations were excluded. A total of 183 patients (296 ears) were reviewed blinded for age. The MCF floor was divided into 7 regions and systematically inspected. Ages of the patients were subsequently extracted from the medical record.Results:Logistic regression analysis confirmed increasing MCF dehiscence with age (P <. 05, odds ratio [OR] 1.07, R = 0.584). Overall ages (1‐88 years; average 38.5 years), 32% of MCF floors were dehiscent at any one site. For age 60 years and over, 55% were dehiscent. For 226 paired ears, if one ear was dehiscent, there was a 66% chance the other ear was dehiscent as well. Superior canal dehiscence (SCD) was seen in 7% of all patients, and only in combination with MCF dehiscence. SCD occurred in 16% of dehiscent ears. The most common sites were directly above the malleus head and above the additus ad antrum (36% and 28%, respectively).Conclusions:The incidence of MCF dehiscence increases with age. Over all ages, approximately 32% of ears show dehiscence. Over 60 years, approximately 55% show dehiscence. The increase of dehiscence with age is statistically significant. The most common sites along the MCF floor are in the epitympanum over the malleus head and additus ad antrum.
Minimally Invasive Surgery for Osteointegrated Auditory Implants: A Comparison of Linear vs Punch Techniques
Authors: Coelho Daniel H. , Gordon Steven A. 
Published: September 2014

Objectives:(1) Describe the benefits of the minimally invasive Punch Method without soft tissue reduction (PM) for the placement of percutaneous osteointegrated auditory implants. (2) Compare and contrast techniques and outcomes from PM with the Linear Method with soft tissue reduction (LM).Methods:A retrospective chart review was conducted of all patients who received a percutaneous bone‐anchored auditory implant from 2009 to 2013 at a tertiary otology practice by a single surgeon. LM was used until 2011 when a switch was made for all patients to PM. Preoperative variables recorded included age, sex, body mass index (BMI), smoking status, indication, and device selected. Outcomes measures included surgical time, skin reaction grading by Holgers score at 1 week and at most recent follow‐up, and any other complications. Two‐sample t test was used to compare.Results:Fifty‐one patients (34 LM, 17 PM) were identified with an average follow‐up of 16.9 months (22.3 LM, 5.8 PM). Average surgical time was found to be significantly shorter for the PM group (10.2 minutes vs 48.8 minutes, P <. 01). There were no statistically significant differences between LM and PM for mean Holgers score at first (LM 0.24, PM 0.47 P =. 87) or most recent follow‐up (LM 0.62, PM 0.41, P =. 22). Additionally, there were no significant correlations with age, sex, BMI, smoking status, indication, or device selected.Conclusions:The Punch Method offers several potential surgical and cosmetic advantages over the Linear Method, without compromising skin‐reactivity outcomes. This study supports a growing trend towards minimally invasive percutaneous auditory implant surgery.
Dismal Economics: Robot‐Assisted Surgeries in Otolaryngology
Authors: McKinnon Brian J. , Cantwell Laureen 
Published: September 2014

Objectives:Determine the current cost impact and financial outcomes of robot‐assisted surgery in otolaryngology.Methods:A systematic review of the literature with a defined search strategy. Using keywords robotic or robot, ENT or otolaryngology, cost or economic, transoral robotic surgery or TORS, and thyroidectomy or parathyroidectomy, searches were performed on PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar, and reviewed by the authors for inclusion in the study.Results:A total of 4 papers were identified as being appropriate for analysis. Two addressed cost impact and financial outcome of robotic thyroidectomy, 1 the cost impact and financial outcome of transoral robotic surgery, and a fourth included otolaryngology robotic surgeries in the profitability analysis of robotic surgery but did not specify case or procedure types. Analyses found robotic thyroidectomy cost prohibitive, though transoral robotic surgery was financially sustainable, as overall costs of care are decreased from reduced length of stay.Conclusions:There are diverging cost impact and economic outcomes being reported in robot‐assisted surgery in otolaryngology. These trends should inform our decisions as to where robotic surgery should be focused to garner greatest cost and economic benefit.
A Novel High‐Throughput Ototoxicity Assay in Zebrafish: Platform for Drug Development Targeting Hearing Loss
Authors: Platto Terry , Hurbon Audriana , Igarashi Suzu , Meister Edward , Dunn Allison , Jacob Abraham 
Published: September 2014

Objectives:Develop a functional assay of zebrafish (Danio rerio) swimming behavior correlated with anatomic studies of hair cells along the lateral line as a platform for high‐throughput drug development against hearing loss.Methods:In vivo animal study at university animal care facilities. Five‐day postfertilization (dpf) zebrafish were treated with 0 (control)‐1000 µM concentrations of cisplatin. In darkness, swimming behavior was analyzed using infrared video systems housed within a novel, multilane, high throughput apparatus to calculate the rheotaxis index (RI). The RI, which represents the ability of fish to properly orient relative to water current, allowed direct comparison of various cisplatin doses to controls simultaneously. Hair cells of zebrafish exposed to cisplatin were also stained with Yo‐Pro1 and imaged using confocal microscopy in order to correlate anatomic changes with changes in swimming behavior.Results:A dose‐dependent relationship between cisplatin concentration and RI was found. 0 µM (control): RI 39.85%; 250 µM: RI 38.11%; 500 µM: RI 25.12%; 750 µM: RI 22.97%; 1000 µM: RI 17.84%. The decline in rheotaxis performance correlated directly with increasing dosage of cisplatin.Conclusions:There are currently no Food and Drug Administration–approved pharmacological treatments for hearing loss. Using a validated behavioral assay to test ototoxic dose of cisplatin against varying concentrations of potentially otoprotective/otoregenerative compounds establishes a first‐ever, high‐throughput biologic platform for drug development against hearing loss.
Ossicular Erosion and Air‐Bone Gap in Attic and Tensa Cholesteatomas
Authors: da Costa Sady S. , Rosito Leticia S. , Canali Inesangela , Selaimen Fábio André , Jung Yuri P. , Pauletti Marcos G. T. , Freitas Luiza A. 
Published: September 2014

Objectives:(1) Compare the air‐bone gap between patients with posterior epitympanic (attic) and posterior mesotympanic (tensa) cholesteatomas. (2) Correlate the air‐bone gap and intraoperative ossicular chain findings.Methods:Cross‐sectional study. In total, 262 patients with attic and tensa cholesteatomas treated at a tertiary hospital were included. Audiometry was performed, and the pure tone average air‐bone gap (PTA‐ABG) was compared between the 2 groups. In addition, ossicles were classified as normal, eroded, or absent based on intraoperative evaluation. Data were compared using the Mann‐Whitney and Chi‐square tests, and statistical analysis was performed using SPSS.Results:Attic cholesteatoma was diagnosed in 51.1% of patients and tensa cholesteatoma in 48.9%. The mean patient age was 33 ± 18.7 years, and 52.3% were male patients. The PTA‐ABG was higher in tensa cholesteatoma cases than in attic cholesteatoma (30.25 ± 12.82 dB and 26.73 ± 13.08 dB, respectively, P =. 031). There were no differences in the malleus erosion or absence prevalence and the stapes suprastructure prevalence (P =. 09 and P =. 17, respectively). The incus was normal in 17.6% of the attic and 6.3% of tensa cholesteatoma cases; eroded in 79.4% of tensa and 48.6% of attic cases; and absent in 33.8% of attic and 14.3% of tensa cholesteatoma cases (P <. 01).Conclusions:The PTA‐ABG was higher in tensa cholesteatoma cases and correlated with a lower normal incus prevalence and a higher eroded incus prevalence compared to attic cholesteatoma cases.
Preoperative Systemic Antimicrobial Prophylaxis in Contaminated Middle Ear Surgery for Cholesteatoma
Authors: Pierce Nathan , Antonelli Patrick J. 
Published: September 2014

Objectives:Evaluate the efficacy of combined anti‐staphylococcal and anti‐pseudomonal preoperative antibiotics for preventing surgical site infections following tympanoplasty and mastoidectomy (TM) with contaminated cholesteatoma.Methods:Study Design: Retrospective chart review Method: Medical records of patients who underwent TM for cholesteatoma were reviewed. Only cases considered to have contaminated or dirty/infected surgical fields were included. Patients were excluded if there was preexisting infection or intraoperative finding requiring systemic antibiotic therapy. The primary outcome measure was postoperative perichondritis, pinna abscess, peri‐otic cellulitis, and peri‐otic abscess requiring systemic antibiotics or surgical intervention.Results:The charts of 362 patients who underwent TM were reviewed. 195 met inclusion criteria. Preoperative antibiotics included clindamycin and ceftazidime or gentamicin. Patients treated with no perioperative antibiotics had an infection rate of 11% and those treated with perioperative antibiotics had a rate of 1% (P =. 02).Conclusions:The use of preoperative antibiotics to cover staphylococcal and pseudomonal species prevented surgical site infections as compared to no perioperative antibiotics.
Protocol for Auditory Brainstem Implants in Children
Authors: Colletti Giacomo , Shannon Robert V. , Mandala Marco , Colletti Liliana , Colletti Vittorio 
Published: September 2014

Objectives:Auditory brainstem implants (ABIs) have been implanted in 64 children with no permanent major complications. We detail the protocol for ABI patient selection, ABI surgery and intra‐operative monitoring, and device fitting and rehabilitation with children.Methods:Sixty‐four children received the ABI between 2000 and 2013. The follow‐up ranged from 6 months to 8 years. A protocol is presented for acoustic and electrophysiological assessment of ABI candidacy. A retrosigmoid‐transmeatal approach was used in the Neurofibromatosis type 2 (NF2) and a retrosigmoid approach in the nontumor children. Tests for assessing auditory and cognitive development and rehabilitation are recommended.Results:All children, except NF2 subjects, scored 0 before ABI implantation on all tests, even the 31 children previously fitted with a cochlear implant. Perceptual outcomes showed statistically significant improvements over time. At the last follow‐up no significant postoperative complications were observed.Conclusions:ABIs have been shown to be beneficial for children who cannot use a cochlear implant. However, implanting an ABI in a child requires special care and expertise and should only be undertaken by an experienced pediatric implant team. This paper presents a comprehensive protocol for application of ABIs in children.
Safety of Topical Mitomycin C after Keloid Excision: A Pilot Study
Authors: Teti Virginia P. , Liu Michelle F. , Lim Alan A. , Cilento Benjamin W. , Gallagher Thomas Q. 
Published: September 2014

Objectives:(1) Ascertain the safety of topical mitomycin C in the prevention of recurrent keloid scars after surgical excision. (2) Determine the efficacy of mitomycin C in keloid prevention.Methods:This was a prospective pilot study of 10 patients. Between August 2009 and September 2011, subjects underwent surgical excision of keloids located in the head and neck region with a one‐time, intraoperative, topical application of mitomycin C. Patients were followed for 12 months postoperatively. During this period, laboratory values reflecting complete metabolic profile and coagulation studies were drawn preoperatively and postoperatively (at 2 weeks and the first, second, and third months). Additionally, photo‐documentation was obtained at regular intervals to ascertain the efficacy in prevention of keloid recurrence.Results:Twelve patients enrolled in the study. Nine patients completed the protocol. Three patients dis‐enrolled prior to surgical excision. No patients were lost to follow‐up. Analysis of variance performed demonstrating no statistical significance in the variance of the laboratory values. Additionally, no patient demonstrated abnormality of any laboratory value beyond the reference range. Next, clinical examination of the wounds demonstrated no evidence of necrosis or dehiscence. Finally, no wound demonstrated recurrence at the one‐year follow‐up visit.Conclusions:Mitomycin C appears safe for topical use after excision of keloids in the head and neck region. This study demonstrates no evidence of recurrence in all patients enrolled and followed for one year.
Radiosurgical Trends for Treatment of Vestibular Schwannomas in the United States
Authors: Maducdoc Marlon M. , Ghavami Yaser , Linskey Mark E. , Djalilian Hamid R. 
Published: September 2014

Objectives:(1) Analyze the recent trends in radiosurgery for vestibular schwannomas (VS). (2) Determine the number of VS treated with radiosurgery since 1990 in the United States.Methods:Large databases were obtained by contacting the manufacturers of the 2 main radiosurgical machines used to treat VS in the United States. Analysis of de‐identified data from Leksell Gamma Knife reporting was carried out to investigate the treatment trends for VS. The main variable investigated was the number of VS treated by radiosurgery in the United States. Extrapolations were made to the available data to estimate the trends of radiosurgical treatment.Results:The number of VS treated by radiosurgery has been increasing. In the US, radiosurgery for treatment of VS was approximately 150 to 200 per year from 1991 to 1993. However, VS cases treated by radiosurgery were approximately 1520 and 1490 in 2011 and 2012, respectively. This indicates an approximate average annual rate of increase of about 4.7% (SD: 8.6%). Currently, treatment of VS accounts for 8.4% of all head and neck radiosurgical procedures in the United States. Since 1991, the approximate number of patients undergoing radiosurgery for VS is 16,000 in the United States and 70,000 worldwide.Conclusions:The current study shows a possible changing trend in the management of VS. Our findings support the conclusion of other studies that suggest a growing number of patients are opting to receive radiosurgical treatment. Additionally, the data highlights the growing population of VS treated with radiosurgery.