bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trigeminal Nerve Deficit in Large/Compressive Acoustic Neuromas (ANs) and Its Correlation with MRI Findings
Authors: Karkas Alexandre , Gay Emmanuel , Lamblin Elea , Meyer Mikael , Schmerber Sebastien 
Published: August 2013

Objectives:Evaluate the risk of pre‐ and postoperative trigeminal nerve (V) impairment in large ANs. Determine predictive risk factors on pre‐ and postoperative MRIs.Methods:Retrospective study (1994‐2009) including patients with stage 4 or 5 AN (classification of Zini‐Magnan). All underwent surgical resection (chiefly translabyrinthine approach). Pre‐ and postoperative trigeminal symptoms were sought. Pre‐ and 3‐month‐postoperative MRIs were obtained.Results:Fifty‐four patients (30 females, mean 51 years) were operated. Preoperatively, 3 patients (5.5%) had trigeminal neuralgia, 29 (54%) had trigeminal hypoesthesia (V1 < V2 = V3), and 16 (30%) had no corneal reflex (V1 branch). Postoperatively, 2 patients (4%) had trigeminal neuralgia, 1 (2%) had trigeminal anesthesia, 25 (46%) had trigeminal hypoesthesia (V1 = V2 = V3), 26 (48%) had no corneal reflex, and most also had House‐Brackmann ≥ grade IV facial paralysis. Keratitis occurred in 42% of patients with absent corneal reflex postoperatively. After analyzing preoperative MRI, there was only one predictive factor of preoperative trigeminal impairment: impaction of the tumor on cerebellar peduncles (P < 0.05). Postoperative trigeminal deficit was correlated with one finding on postoperative MRI: nonvisibility of V on MRI (P < 0.05). Postoperative trigeminal deficit was correlated with one finding on preoperative MRI: impaction of the tumor on cerebellar peduncles (P < 0.05).Conclusions:Trigeminal impairment in large/compressive ANs has to be sought particularly to avoid corneal complications. If the frequency of trigeminal hypoesthesia slightly diminishes after tumor removal, there is worsening of preoperative function of V1 and increased frequency of absent corneal reflex, also worsened by facial paralysis. We were able to correlate trigeminal involvement with pre‐ and postoperative MRI findings.
Using LDV and ECR Measurements in the Differential Diagnosis of Partial and Complete Ossicular Discontinuity
Authors: Ulku Cagatay H. , Roosli Christof , Merchant Gabrielle R. , Halpin Christopher F. , Rosowski John J. , Merchant Saumil N. , Nakajima Hideko H. 
Published: August 2013

Objectives:Evaluate the reability of laser doppler vibrometry (LDV) of the tympanic membrane (TM) and ear canal reflectance (ECR) measurements in the differential diagnosis of partial and complete ossicular discontinuity (OD).Methods:Patients, with surgically confirmed partial or complete OD and an intact TM, were recruited from the Otology clinic. Pre‐operative possible diagnosis were made by otoscopic examination, audiometry, LDV and ECR. Audiometry, LDV and ECR data in each of the two OD subgroups were evaluated in order to determine their use in differential diagnosis.Results:44 patients with surgically confirmed OD with intact TM (27 complete, 17 partial) were included in this study. Audiometry was performed in all cases. There were statistically significant differences in air‐bone gap (ABG) between the two subgroups below 1 kHz. LDV was performed in 29 (16 complete, 13 partial). An increase in LDV magnitude and a decrease in phase angle below 1 kHz were greater in the complete OD subgroup, but not significantly. ECR was performed in 11 (5 complete, 6 partial). ECR near 1 kHz was lower than the normal in both OD subgroups and the difference between the two subgroups was significant.Conclusions:A difference between the means of ECR measurements suggests a possible clinical utility. On the other hand, subgroup difference in LDV magnitude and phase angle were not significant. A combination of LDV, ECR and audiometry may help differentiate the two conditions. More patient data will enable better evaluation of the diagnostic significance of the observed differences.
Vestibular Compensation following Retrosigmoid Vestibular Schwannoma Surgery
Authors: Betka Jan , Chovanec Martin , Zverina Eduard , Profant Oliver , Cakrt Ondrej 
Published: August 2013

Objectives:Balance problems following vestibular schwannoma (VS) surgery are most apparent in the acute stage and usually improve over time. Persisting vestibular symptoms are related to significant morbidity and decreased quality of life.Methods:Eighty‐nine patients undergoing unilateral VS resection via a retrosigmoid approach during 2008‐2010 were prospectively analyzed. Definitive assessment of vestibular compensation was performed 24 months postoperatively. Persistent vertigo or spontaneous nystagmus and deviation of subjective visual vertical were classified as non‐compensated vestibular pathology. We performed multivariate statistic analysis (Anova) of patient (age, gender), tumor (size – Koos and international classification), preoperative vestibular pathology (ipsilateral/contralateral peripheral, central), and intraoperative (conventional or minimally‐invasive approach, tumor adherence, consistency, bleeding, cystic, origo, cerebellar injury) factors. To assess impact of vestibular symptoms on quality of life, we employed Dizziness Handicap Inventory (DHI) and SF36 questionnaires.Results:Twelve of 89 patients undergoing VS surgery suffered from disordered vestibular compensation. Among the factors analyzed, the advanced age seems to be a crucial negative prospective factor of vestibular compensation (P =0.006) (55 ± 10 years in noncompensated vs. 44 ± 13 years in compensated patients). Disbalance was more prevalent in the group of uncompensated patients (P = 4 x 10‐7). Surprisingly, poor compensation did not correlate with worse DHI and SF36 scoring.Conclusions:Identification of factors that may contribute to a poor vestibular compensation is crucial for both VS management planning and proper postoperative vestibular rehabilitation. Employment of biofeedback and vestibular prehabituation represent promising methods to improve and speed up postoperative vestibular compensation.
Caregiver Quality of Life Is Related to Severity of Otitis Media in Children
Authors: Blank Sarah I. , Grindler David J. , Lieu Judith E.C. 
Published: August 2013

Objectives:Otitis media (OM) in children is the most frequent reason for physician visits in developed countries and burdens caregivers and society, as well as the child. Our objective was to describe the impact of OM severity on caregiver quality of life (QoL).Methods:Multi‐institutional prospective cross‐sectional study. Setting: Otolaryngology, family practice, and pediatrics clinics. Children 6‐24 months old with and without a primary diagnosis of recurrent OM and their caregivers. Physicians provided patient history, and parents/caregivers completed a Family Information form, the PedsQL Family QoL survey, the PROMIS survey, and the 6‐item child with OM QoL survey (OM‐6).Results:A total of 2414 patients were enrolled. The average age was 16 months, and 58% were male. The mean OM‐6 score was 3.26, slightly more severe than the reported 2.8 for the average child with OM. The mean PedsQL Family score was 68.63, worse than the reported mean of 81.00 of parents with children with chronic disease in a convalescent hospital. Higher OM‐6 scores correlated significantly with worse PedsQL Family scores, Pearson r ‐0.502, P < 0.01. Similarly, more severe OM‐6 scores strongly correlated with increased parental anxiety, depression, fatigue, and decreased satisfaction, all P < 0.01.Conclusions:Parents of children ages 6‐24 months with OM had mean PedsQL scores similar to parents of chronically ill children requiring full time home care. Worse PedsQL Family scores were highly correlated with elevated OM‐6 scores, suggesting that severity of OM significantly affects parental QoL.
Children with Deep Space Neck Infections: Our Experience with 178 Children and Proposed Management Strategy
Authors: Elden Lisa M. , Cheng Jeffrey 
Published: August 2013

Objectives:Identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNI). Propose a clinical decision‐making algorithm, which may avoid radiation exposure from computed tomography (CT) imaging, based on clinical features found to be associated with surgical intervention for DSNI and those at highest risk for complicated clinical courses.Methods:Consecutive case series with chart review at a tertiary‐care, academic children's hospital. One hundred and seventy‐eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012.Results:Median age was 34.5 months (2.9 years, range 2 to 142 months); two‐thirds were male. Increased surgical drainage was found in children age ≤ 15 months (P = 0.002) and for abscesses greater than 2.2 cm (P = 0.0001). Risk factors associated with increased likelihood of medical therapy failure included ≤ 51 months, ICU admission, and CT findings consistent with abscess size greater than 2.2 cm. Methicillin‐resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤ 15 months of age (P = 0.001). All children had resolution of infection.Conclusions:Deep space neck infections in children can often be successfully managed with medical therapy alone, but life‐threatening complications may occur. We recommend that young patients be managed cautiously. A proposed decision making algorithm is presented, but caution and careful clinical judgment need to be exercised as further prospective study is warranted.
Cochlear Reimplant Rates in Children: Twenty‐Year Experience in a Quaternary Pediatric Cochlear Implant Center
Authors: Trozzi Marilena , Sharp James , Toma Shamim , Powell Harry , Broxholme Catherine , Jephson Christopher G. , Cochrane Lesley‐Ann 
Published: August 2013

Objectives:Determine the incidence and risk factors for cochlear re‐implantation in children.Methods:Retrospective case review in a quaternary pediatric cochlear implant (CI) center. Subjects studied: Pediatric CI patients requiring cochlear re‐implantation. Interventions: Cochlear explantation/re‐implantation. Outcome measures: Etiology and timing of device re‐implantation, risk factors for revision surgery. Independent variables: patient age, side, surgeon, etiology of deafness, co‐morbidities, CI manufacturer, incidence of re‐implantation, timing of re‐implantation.Results:Seven hundred and fifty‐two pediatric cochlear implants were performed in 619 children between 1993 and 2013. 37 patients underwent 39 explanation/re‐implantation procedures (5.2%). The most common reason for explantation/re‐implantation was device failure in 21 (2.8%). Risk factors for device failure were preceding head trauma and known manufacturing defect/recalled device. Medical/surgical issues accounted for 18 (2.4%) re‐implantations and changed over the study period. The mean time to re‐implantation surgery was 4 years. Etiology of deafness did not correlate with the need for revision surgery.Conclusions:The incidence of re‐implantation in our pediatric cochlear implant population is comparable to other published studies. However the etiology of deafness, in particular meningitis, does not appear to increase the risk of failure as described in previous series. The most common reason for re‐implantation remains device failure.
Comparison of MMR and Cidofovir as Adjuncts for Recurrent Respiratory Papillomatosis
Authors: Meacham Ryan K. , Thompson Jerome W. 
Published: August 2013

Objectives:1) Describe experience at a single institution using measles, mumps, rubella (MMR) vaccine and cidofovir as adjunct treatments after CO2 laser ablation for recurrent respiratory papillomatosis (RRP) in children. 2) Compare outcome measures and remission rates between MMR and cidofovir.Methods:Retrospective review from 2004‐2012 at a tertiary referral children's hospital. Subjects were younger than 18 years and required at least 1 year of follow‐up to be included for review. Remission rate was determined by a Derkay score of 0 for at least 6 months.Results:Of 20 subjects identified with RRP, 15 had been followed for at least 1 year. Five subjects were treated with cidofovir, 6 patients with MMR, and 3 with a combination of the above. One did not receive adjunct injections. Initial Derkay score was 12.6 for the cidofovir group and 11.0 for the MMR group (P =. 61). Average number of debridements received was 11.8 for the cidofovir group and 17.6 for the MMR group (P =. 33). Average days between treatments was 63.0 for cidofovir and 81.3 for MMR (P =. 43). Total months observed was 44.0 for cidofovir and 64.6 for MMR (P =. 29). Remission rate was 20% with the cidofovir group and 50% for the MMR group (P =. 54).Conclusions:There is no statistically significant difference in number of debridements needed, average number of days between debridements, or remission rates between MMR and cidofovir as adjunctive treatments for recurrent respiratory papillomatosis in children.
Higher Rates of Adenotonsillectomy or Adenoidectomy for Upper Airway Obstruction in Infants with Severe Laryngomalacia
Authors: Durvasula Venkata S. , Lawson Bradley , Bower Charles M. , Richter Gresham T. 
Published: August 2013

Objectives:Synchronous airway anomalies below the supraglottis are thought to compound the symptoms of laryngomalacia (LM). Upper aerodigestive obstructive lesions may also be present but have not been discussed. This study examines other sources of upper airway obstruction in infants with severe LM requiring supraglottoplasty (SGP).Methods:Data were compiled on infants who received SGP between 2004 and 2011. Those with neurological conditions, syndromes, or major comorbidities were excluded. The incidence, type, and timing of procedures to relieve upper airway obstruction above the larynx were examined in each infant within 4 years after SGP.Results:One hundred fifty‐six infants were included. Forty‐two (26.9%) had other sources of upper airway obstruction necessitating a surgical procedure beyond SGP. Thirty‐two patients required an adenoidectomy alone, either during or within 30 months of SGP. Nine patients required adenotonsillectomy. One patient required tonsillectomy alone. Among the patients who underwent adenoidectomy, tonsillectomy was required later in 6 patients. Age at the time of SGP significantly affected the incidence of additional procedures. Infants receiving SGP at an age greater than 6 months were more likely to require management of adenotonsillar hypertrophy (82.1%) than their younger counterparts (14.8%) (P < 0.05).Conclusions:Accessory upper airway obstruction due to adenoidal or adenotonsillar hypertrophy, both synchronous and non‐synchronous (occurring after) is more common in patients with severe laryngomalacia. Infants older than 6 months receiving SGP are more likely to require additional procedures to relieve upper airway symptoms. Management of accessory sources of upper airway obstruction should be explored in infants with laryngomalacia.
Incidence of Otitis Media in Preterm Infants
Authors: Shah Priyanka , Nation Javan J. , Cortez Josef , Sachdeva Livjot , Cohen David S. , Romero Roberto , Coticchia James M. 
Published: August 2013

Objectives:1) Determine if objective tympanometry findings correlate with the subjective endoscopy finding in diagnosing middle ear disease (AOM or OME) in premature infants. 2) Determine if the incidence of middle ear disease increases with lower gestational weight in premature infants.Methods:Our prospective study includes 76 preterm infants, (< 36wks) admitted to the Neonatal Intensive Care Unit (NICU) at Harper Hospital. Endoscopic otoscopy and tympanometry were performed to detect the presence of otitis media within the first 4 days of birth. The Fisher exact test was used for statistical analysis.Results:1) 44 ears had normal otoendoscopic findings, of which 35 had normal tympanometry findings (79.54 %). 63 ears had middle ear disease, of which 48 showed abnormal reading on tympanometry (76.19 %). 2) 26 babies weighed less than 1300 grams at birth (average gestational age 26.99 weeks), 23 of which had middle ear disease on otoendoscopy. 25 babies weighed more than 1300 grams (average gestational age 31.85 weeks), 12 of which had middle ear disease on otoendoscopy. A P value of 0.0025 suggests a significant correlation between low birth weight and middle ear disease.Conclusions:We demonstrate that endoscopic otoscopy technique correlates with objective tympanometry data, although there are several limitations to comparing these techniques. We provide evidence that the incidence of otitis media in LBW preterm infants is higher based on otoendoscopy.
Long‐term Safety of Tympanomastoid Obliteration for Children with Suppurative Cholesteatomatous Ears
Authors: Kuo Chin‐Lung , Shiao An‐Suey , Lien Chiang‐Feng , Liao Wen‐Huei 
Published: August 2013

Objectives:Analyze long‐term prognosis and safety in children with suppurative cholesteatomatous ears following tympanomastoidectomy with cartilage obliteration.Methods:During a 30‐year period (1982‐2012), the medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies with cartilage obliteration were analyzed. The recidivism rates were calculated using Kaplan‐Meier survival analysis. Potential predictors of recidivism were entered into a Cox's regression model as covariates for multivariate analysis. These factors were sex, tympanomastoid obliteration, eardrum perforation, ossicular destruction, facial nerve dehiscence, history of ventilation tube insertion, craniofacial abnormality, surgical technique, and extent of disease.Results:Among a total of 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow‐up period was 11.6 ± 8.1 years. Recidivism was observed in 16 years in the CO group (12 recurrent and 4 residual) and 4 in the WO group (2 recurrent and 2 residual). The 10‐year cumulative recidivism rates were comparable between CO and WO groups (19% vs. 25%, P = 0.762, log‐rank). Multivariate analysis indicated that tympanomastoid obliteration was not a negative predictor of recidivism (P = 0.760), while surgical technique (canal wall up vs. down; hazard ratio = 5.86, P = 0.011) was a significant predictor. Major long‐term complications were not observed.Conclusions:This study provides long‐term evidence supporting the safety, feasibility, and effectiveness of tympanomastoid cartilage obliteration for children with suppurative cholesteatomatous ears.
Management of Pediatric Mandible Fractures
Authors: Sowder Justin C. , Friedman Adva B. , Key J. Michael , Richter Gresham T. 
Published: August 2013

Objectives:The use of conservative measures, mandibulomaxillary fixation (MMF), and closed reduction in children with mandible fractures has been advised due to developing dentition. Open reduction and internal fixation (ORIF) of mandible fractures with non‐resorbable plates has been the preferred procedure in young children at our institution. This study evaluates the outcomes of ORIF in the management of pediatric mandible fractures.Methods:A six year retrospective chart review of children, ages 18 years and younger, treated at a tertiary pediatric hospital for mandible fractures. Demographics, fracture site, mode of treatment, and complications were evaluated.Results:A total of 303 records of children evaluated for facial fractures were reviewed. Complete records of 62 patients who suffered from a mandible fracture were identified (M = 48, F = 14, mean age = 15 years (range 2‐18)). The most common fracture sites were angle (37%) and parasymphyseal (35%). Assault (53%) was the most common cause. Three patients were treated conservatively, and 1 was placed in MMF only. Fifty‐eight patients (93.8%) underwent ORIF, 6 of which were placed in MMF concurrently. Average follow‐up was 141 days (14‐800). Complications included plate removal in 11 patients (18.9%; 6 for extruded hardware), malocclusion in 8 patients (12.9%), and infection in 1 patient.Conclusions:Management of mandibular fractures in the pediatric population can be both challenging and controversial. Many authors advocate the use of MMF whenever possible secondary to the known potential complications of ORIF. This study suggests that conservative management or ORIF of selected displaced fractures, avoiding the need for MMF, has favorable outcomes.
Molecular Resonance Tonsillectomy in Children: Comparative Study over Standard Techniques in an 11‐Year Study
Authors: D'Eredita Riccardo 
Published: August 2013

Objectives:Learn the quantum molecular resonance (QMR) technology. An analysis of outcomes of QMR compared to standard cold‐knife (CK) and monopolar cautery (MPC) for pediatric tonsillectomy offers new possibilities, lowering postoperative morbidity.Methods:Eleven‐year, prospective, three‐group trial in a tertiary care pediatric institution. 857 children undergoing tonsillectomy were randomly assigned to QMR (n = 287), CK (n = 285) or MPC (n = 285) techniques. Main outcome measures included intraoperative time, blood loss, postoperative pain, weight loss, and random histopathologic examination on excised tonsils.Results:Histopathologic evaluation revealed reduced thermal injury with QMR over MPC (43 microns vs. 186, P <. 001) and was statistically associated with reduced muscular, blood vessel, and nerve fiber damage compared to CK (P <. 001). No intraoperative blood loss was observed in QMR. Significant reduced pain scores were related to QMR (P <. 002). The QMR patients regained normal diet and weight gain during the 10‐day postoperative period. One QMR, 15 CK, and 12 MPC patients experienced delayed bleeding.Conclusions:Molecular resonance for pediatric tonsillectomy resulted in reduced histopathologic thermal injury, lower pain scores, and reduced postoperative morbidity compared with CK and MPC techniques in an 11‐year study.
Peptide‐Based Hydrogels for Cranial Nerve Reinnervation
Authors: Abelardo Edgardo , Mahmoud Zahra , Birchall Martin A. , Woolfson Dek 
Published: August 2013

Objectives:Functionalize proteinogenic scaffold hydrogels with biomimetic peptides to enhance cell‐matrix interactions. Hydrogels are recently being tapped as adjuncts in tissue engineering. Rationally designed polypeptide‐based materials have advantage over other biomaterials for their ability to be engineered from the bottom up, tailored to the needs of specific potential application. We previously reported coiled‐coil fibrillar hydrogel networks called hydrogelating self‐assembling fibers SAF (hSAF), which were shown to support growth and differentiation of neural cells.Methods:Short biomimetic peptides were conjugated to hSAF fibres using biorthogonal copper‐based click chemistry.Results:The resulting functionalized hSAF hydrogel was shown to promote preferential direction of axonal growth, more mature fibroblast formation, and early angiogenesis.Conclusions:We have demonstrated in this study a chemically defined bottom‐up approach in biologic scaffold synthesis with straightforward technique in incorporating specific biomolecular signal under physiologic conditions, which promises a robust platform in tissue engineering such as cranial nerve reinnervation.