bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fixation Methods in Pediatric Cochlear Implants
Authors: Alexander Nathan S. , Caron Eric , Woolley Audie L. 
Published: December 2010

ObjectiveTo review 3 techniques of cochlear implant (CI) fixation used by a single surgeon for the fixation of 320 consecutive CIs in a pediatric population and associated complications.Study DesignCase series with chart review.SettingTertiary referral children’s hospital.Subjects and MethodsPatients receiving CIs between July 1995 and July 2009 were reviewed. Clinical information obtained included age at implant, implant type, duration of follow‐up, method of implant fixation (intraosseous suture ligature, prolene mesh with titanium screws, and a small periosteal pocket with periosteal sutures), and postoperative complications of fixation (migration or extrusion).ResultsThree hundred twenty consecutive CIs were reviewed: 64 of which were bilateral (42 staged, 22 concurrent). The median age at implantation was 3.6 years (range, 8 months to 20 years). Manufacturers included Cochlear (223) and Advanced Bionics Corporation (97). Median follow‐up was 26 months (range, 1 month to 12.7 years). The intraosseous suture ligation method of fixation was used for 182 CIs. Ninety‐eight CIs were fixed using a small piece of polypropylene mesh and titanium screws. Forty implants were secured by using a tight periosteal pocket and placing the suture through the periosteum and soft tissue to collar the receiver in a modified well. No complications of device migration or extrusion were noted, nor were there any intracranial complications. Device failure occurred in 13 (4%) patients requiring explantation and reimplantation, but these were unrelated to surgical technique or fixation.ConclusionsThis study illustrates that with an evolution toward less invasive and less complex methods of fixation, there has not been an associated increase in fixation‐related complications.
Pediatric Chronic Rhinosinusitis Histopathology
Authors: Berger Gilead , Kogan Tatiana , Paker Miki , Berger‐Achituv Sivan , Ebner Yaniv 
Published: December 2010

ObjectiveTo compare the histopathology and immunohistochemistry of pediatric and adult chronic rhinosinusitis (CRS).Study DesignCross‐sectional study.SettingUniversity‐affiliated hospital.Patients and MethodsInflamed sinus‐mucosal samples of 16 children (mean age, 11.6 ± 2.9 years) with refractory CRS who underwent endoscopic sinus surgery were studied. Twenty‐nine diagnosis‐matched adults served as controls. Study analysis covered sinus computed tomography (CT) scores, general pathologic features, eosinophil and T‐lymphocyte population, and thickness and integrity of the epithelium.ResultsChildren had a lower CT score than adults did (P =. 005). The inflammatory response of the children, which differed greatly from that of adults, was dominated by cellular infiltration of the lamina propria with chronic inflammatory cells and fibrosis (8/16 had extensive fibrosis); eosinophils were scanty. Adult CRS was characterized by polypoid mucosa and eosinophilia (type A) or glandular hyperplasia (type B). Extensive fibrosis was shown in adult type‐B patients (7/13). Assessment of eosinophils in the lamina propria showed marginal statistical significance between children and adults (P =. 065). This difference was accentuated when pediatric and adult type A were compared (14.6 ± 25.3 vs 121.5 ± 174.2 cell/mm2; P =. 043). Complete epithelial shedding was less significant in children (9.4% ± 8.2% vs 25.4% ± 15.1%; P <. 001). The number of lamina propria and epithelial T lymphocytes was similar.ConclusionsThe marked differences in the inflammatory response of children and adults with CRS may attest to different pathophysiologic pathways. The significantly reduced epithelial shedding in children is probably associated with diminished tissue eosinophilia. Extensive fibrosis was found in half of adult type‐B patients; similar findings were found in children.
Initial Experience With a Multidisciplinary Strategy for Initiation of Propranolol Therapy for Infantile Hemangiomas
Authors: Cushing Sharon L. , Boucek Robert J. , Manning Scott C. , Sidbury Robert , Perkins Jonathan A. 
Published: December 2010

ObjectivesTo outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas.Study DesignRetrospective review.SettingAcademic tertiary care pediatric hospital.Subjects and MethodsForty‐nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3‐hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting.ResultsOutpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3‐hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure.ConclusionsIn most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.
PACU PTH Facilitates Safe Outpatient Total Thyroidectomy
Authors: Houlton Jeffrey J. , Pechter William , Steward David L. 
Published: December 2010

ObjectiveTo determine if a serum parathyroid hormone (PTH)–based discharge algorithm can be used to safely facilitate outpatient total thyroidectomy.Study DesignCase series with chart review of consecutive total and completion thyroidectomies performed by the senior author from March 2008 to November 2009.SettingAn academic tertiary care center.Subjects and MethodsAt the authors’ institution, patients undergoing total or completion thyroidectomy are subject to a same‐day discharge algorithm that incorporates postanesthesia care unit rapid PTH as the major discharge criterion. Patients with PTH >30 pg/mL are eligible for same‐day discharge without supplementation, patients with PTH between 20 and 30 pg/mL are eligible for discharge but receive calcium supplementation, and patients with PTH <20 pg/mL are observed overnight (23 hours) with calcium and vitamin D supplementation.ResultsOne hundred eighty patients (mean age, 48.9 years; 83.3% female) underwent total (77.2%) or completion (22.7%) thyroidectomy with or without node dissection. Forty‐two percent were performed with minimally invasive video‐assisted (MIVA) technique. Seventy‐six percent (137/180) of patients had a PTH >20 pg/mL, meeting the PTH discharge criterion. Sixty‐nine percent (95/137) of eligible patients were discharged on the same day (53.1% of total). Ten percent of discharge‐eligible patients were admitted due to drain placement. Of the 95 patients undergoing outpatient surgery, none were admitted, seen, or called for symptoms of hypocalcemia in the postoperative period. All 180 patients were eucalcemic at postoperative day (POD) 7 and POD 30 office visits. No patients were hypoparathyroid at POD 30. No significant difference in postoperative hypoparathyroidism existed between completion versus total thyroidectomy (11.1% vs 22.2%, P =. 28) or MIVA versus standard technique (P =. 37).ConclusionA PTH‐based discharge algorithm can safely facilitate outpatient total or completion thyroidectomy, with minimal risk of clinically significant outpatient hypocalcemia.
Compliance and Quality of Life in Patients on Prescribed Voice Rest
Authors: Rousseau Bernard , Cohen Seth M. , Zeller Amy S. , Scearce Leda , Tritter Andrew G. , Garrett C. Gaelyn 
Published: December 2010

ObjectivesTo determine patient compliance with voice rest and the impact of voice rest on quality of life (QOL).Study DesignProspective.SettingUniversity hospital.Subjects and MethodsDemographics, self‐reported compliance, QOL impact on a 100‐mm visual analog scale (VAS), and communication methods were collected from 84 participants from 2 academic voice centers.ResultsOf 84 participants, 36.9% were men, 63.1% were women, and 64.3% were singers. The mean age of participants was 47.2 years. The mean duration of voice rest was 8.8 days (range, 3‐28), and the median was 7 days. Overall compliance was 34.5%. Postoperative voice rest patients were more compliant than non‐postoperative patients (42.4% vs 16.0%, P =. 04, χ2). Voice rest had an impact on QOL (mean ± SD, 68.5 ± 27.7). Voice rest also had a greater impact on singers than nonsingers (mean VAS 77.2 vs 63.6, P =. 03, t test) and on those age <60 years than those age ≥60 years (mean VAS 74.4 vs 46.7, P <. 001, t test). More talkative patients and those with longer periods of voice rest had worse QOL scores (Spearman correlation = 0.35, P =. 001 and Spearman correlation = 0.24, P =. 03, respectively). Restrictions in personal and social life were noted in 36.9% of patients, 46.4% were unable to work, 44.0% felt frustrated, and 38.1% reported feeling handicapped while on voice rest.ConclusionsGiven poor patient compliance and the significant impact of voice rest on QOL, further studies are warranted to examine the efficacy of voice rest and factors that may contribute to patient noncompliance with treatment.
Medical Malpractice and Corticosteroid Use
Authors: Nash John J. , Nash Amanda G. , Leach Matthew E. , Poetker David M. 
Published: December 2010

ObjectiveTo analyze malpractice litigation trends related to the administration of corticosteroids and the reported complications.Study DesignRetrospective.SettingTertiary medical center.Subjects and MethodsThe WESTLAW database was reviewed from March 1996 to November 2008. Data were compiled on the demographics of the defendant, plaintiff, expert witness specialty, allegation, complication, indication for steroids, verdict, and judgment.ResultsEighty‐three cases met inclusion criteria and were selected for review. The most common conditions for which steroids were prescribed were pain (23%), asthma or another pulmonary condition (20%), a dermatologic condition (18%), a nondermatologic autoimmune condition (17%), and allergies (6%). Allegation of negligent use was the most common reason for a suit being filed (65%), followed by lack of proper informed consent (36%), failure to diagnose or misdiagnosis (22%), multiple allegations (25%), and wrongful death (4%). Verdicts for the defendant predominated (59%), whereas 24 cases (29%) were found for the plaintiff, and 10 cases (12%) settled out of court. The range of monetary awards was from $25 000 to $8.1 million. Complications reported were often multiple and included avascular necrosis (39%), mood changes (16%), visual complaints (14%), and infectious complications (14%). Three cases involved otolaryngologists.ConclusionAlthough other specialties were more often involved in suits, otolaryngologists frequently prescribe corticosteroids and must be diligent in explaining potential side effects of steroids. The informed consent process, documentation, and close monitoring of patients are critical to avoid potential litigation.
Association of Obstructive Sleep Apnea and Auditory Dysfunctions in Older Subjects
Authors: Hwang Juen‐Haur , Chen Jin‐Cherng , Hsu Chuan‐Jen , Liu Tien‐Chen 
Published: December 2010

ObjectiveDetermine the association between obstructive sleep apnea (OSA) and auditory dysfunction in older subjects.Study DesignCross‐sectional study.SettingHospital volunteer helpers undergoing questionnaire, morphometry measurement, auditory examinations, and polysomnography between 2008 and 2009.Subjects and MethodsIn total, 224 subjects older than 50 years were randomly sampled for above evaluation and testing. The effects of OSA on the peripheral auditory function, represented by averaged pure‐tone threshold of low frequencies (PTA‐low) and high frequencies (PTA‐high), and central auditory function, shown by pitch pattern sequence (PPS scores), were analyzed.ResultsThe mean ± SD age was 61.2 ± 6.7 years. OSA was confirmed in 6 of 98 women (6.1%) and 28 of 126 men (22.2%). After adjusting for age, gender, and other variables, OSA did not show a significant positive association with PTA‐low or PTA‐high for all subjects. Conversely, there was a significant negative association between OSA and PPS scores for all subjects, even after adjusting for age, gender, and other variables. When OSA and central obesity together were taken into account in the multivariate linear regression analysis, OSA still showed significant association with PPS score for all subjects.ConclusionOSA is independently associated with poorer central auditory function in older subjects.
Toll‐Like Receptor 2 Gene Polymorphisms in a Korean Population
Authors: Park Chan‐Soon , Cho Jin‐Hee , Park Yong‐Jin 
Published: December 2010

ObjectiveTo investigate the role of single‐nucleotide polymorphisms (SNPs) in the gene encoding Toll‐like receptor (TLR) 2 in Korean patients with chronic rhinosinusitis (CRS) and controls.Study Design and SettingA case‐control study.Subjects and MethodsSubjects (N = 214) were all adults (>20 years old) and were divided into patients with CRS (n = 106) and controls (n = 108). Five SNPs (rs1898830, rs3804099, rs3804100, R677W, and rs5743708) were selected and genotyped in a case‐control study with the single‐base‐pair primer extension (SNaPshot) assay.ResultsThe case‐control study revealed that 2 SNPs in TLR2, rs3804099 (odds ratio [OR] = 2.88; 95% confidence interval [CI] = 1.17‐7.09; P =. 022) and rs3804100 (OR = 3.76; 95% CI = 1.42‐9.96; P =. 008), showed significant differences in minor allele frequency between CRS patients and controls. These 2 SNPs were correlated with CRS risk in Korean patients.ConclusionsTwo SNPs in TLR2 may be associated with increased risk of CRS in Korean subjects.
Differences in Cochlear Nerve Cross‐Sectional Area between Normal Hearing and Postlingually Deafened Patients on MRI
Authors: Herman Björn , Angeli Simon 
Published: December 2010

ObjectivesTo demonstrate that parasagittal constructive interference in steady state (CISS) magnetic resonance imaging (MRI) can be used to accurately measure cochlear nerve cross‐sectional area and thereby evaluate for statistically significant differences in the cochlear nerve cross‐sectional areas of postlingually deafened and normal‐hearing adults.Study DesignCross‐sectional study.SettingTertiary care medical center.Subjects and MethodsParasagittal CISS MRIs of postlingually profoundly deafened cochlear implant candidates and normal‐hearing patients at a tertiary care academic medical center between 2006 and 2009 were retrospectively identified. Two independent and blinded investigators measured the cochlear nerve height and width and calculated the cross‐sectional area [π(H/2)(W/2)] at the fundus of the internal auditory canals. Measurements of both investigators were analyzed for reliability and agreement with an Altman plot, and deafened patient measurements were compared with results of the normal‐hearing patients via Wilcoxon rank sum tests.ResultsThe cochlear nerve cross‐sectional area of postlingually deafened patients (mean ± SD = 0.61 ± 0.16 mm2) was less than normal‐hearing patients (0.94 ± 0.28 mm2). The difference was statistically significant (P =. 002). There was good agreement between independent observer measurements.ConclusionParasagittal CISS MRI can be used to measure the cochlear nerve with good interobserver agreement, and there is a significant difference between the cross‐sectional area of postlingually deafened and normal‐hearing adults. The cross‐sectional area may correlate with residual spiral ganglion cells and provide a prognostic indicator for post–cochlear implant performance, which is the focus of our ongoing research.
Preliminary Study on the Stability of Beta‐2 Transferrin in Extracorporeal Cerebrospinal Fluid
Authors: Bleier Benjamin S. , Debnath Indranil , O’Connell Brendan P. , Vandergrift W. Alexander , Palmer James N. , Schlosser Rodney J. 
Published: December 2010

ObjectiveDetection of beta‐2 transferrin in rhinorrhea fluid is a sensitive and specific method for the diagnosis of a cerebrospinal fluid (CSF) leak. Patients may be asked to collect this fluid at home to obtain an adequate volume for detection, and thus the age and storage conditions of these specimens may be variable upon analysis. The purpose of this study is to understand how age, storage temperature, and exposure to mucus affect the ability to detect beta‐2 transferrin in CSF.Study DesignCase series with planned data collection.SettingTertiary care university hospital.Subjects and MethodsThis study consists of 6 patients undergoing endoscopic CSF leak repair. CSF was collected directly from a lumbar drain (n = 4) or from nasal drainage (n = 2). Specimens were stored at 4°C (n = 3) or room temperature (n = 3). Samples were tested for the presence of beta‐2 transferrin for up to 7 days using standard immunofixation electrophoresis techniques.ResultsBeta‐2 transferrin was detected in all specimens through day 7 regardless of storage temperature or collection site (95% exact binomial confidence interval of 0%‐46%).ConclusionsBeta‐2 transferrin remains detectable in extracorporeal CSF for up to 7 days regardless of storage at room temperature or exposure to nasal mucus. Negative detection in patient specimens up to a week old is therefore not likely to be caused by protein degradation.
The Effects of Potential Neuroprotective Agents on Rat Facial Function Recovery Following Facial Nerve Injury
Authors: Vakharia Kalpesh T. , Lindsay Robin W. , Knox Christopher , Edwards Colin , Henstrom Doug , Weinberg Julie , Hadlock Tessa A. , Heaton James T. 
Published: December 2010

ObjectiveTo evaluate whether a series of pharmacologic agents with potential neuroprotective effects accelerate and/or improve facial function recovery after facial nerve crush injury.Study DesignRandomized animal study.SettingTertiary care facility.MethodsEighty female Wistar‐Hannover rats underwent head restraint implantation and daily conditioning. Animals then underwent unilateral crush injury to the main trunk of the facial nerve and were randomized to receive treatment with atorvastatin (n = 10), sildenafil (n = 10), darbepoetin (n = 20), or a corresponding control agent (n = 40). The return of whisking function was tracked throughout the recovery period.ResultsAll rats initiated the return of whisking function from nerve crush by day 12. Darbepoetin‐treated rats (n = 20) showed significantly improved whisking amplitude and velocity across the recovery period, with several days of significant pairwise differences vs comparable control rats (n = 16) across the first 2 weeks of whisking function return. In contrast, rats treated with sildenafil (n = 10) and atorvastatin (n = 10) did not show significant improvement in whisking function recovery after facial nerve crush compared to controls. By week 8, all darbepoetin‐treated animals and comparable nerve crush control animals fully recovered whisking function and were statistically indistinguishable.ConclusionAmong the 3 potentially neuroprotective agents evaluated, only darbepoetin administration resulted in accelerated recovery of whisking parameters after facial nerve crush injury. Further efforts to define the mechanism of action and translate these findings to the use of darbepoetin in the care of patients with traumatic facial paralysis are needed.
Improving Hearing in Stapedectomy With Intraoperative Auditory Brainstem Response
Authors: Hsu Griffith S. 
Published: December 2010

ObjectiveTo determine the efficacy of using intraoperative auditory brainstem response (ABR) in improving immediate hearing results of patients undergoing primary laser stapedotomy.Study DesignCase series with chart review.SettingCommunity hospital.Subjects and MethodsThe study included 32 consecutive patients, with 34 ears undergoing primary stapedotomy by a single surgeon at a single institution using a single prosthesis design. Intraoperative ABR was performed at the beginning of each surgery and after the stapes prosthesis was inserted. Surgical adjustments were made if initial ABR results did not demonstrate hearing improvement. ABR then was repeated at the conclusion of the procedure. Audiometry was performed postoperatively in all patients.ResultsThere were 22 left ears and 12 right ears studied. Two patients underwent bilateral staged surgery. Eight patients, or 23% of the group, had intraoperative adjustments made to improve hearing results. Hearing was improved in 33 of 34 ears, or 97%. The surgical revision rate was 3%. The average preoperative air‐bone gap (ABG, calculated as an average from 250, 500, and 1000 Hz) was 29.0 dB HL in the left ear group and 26.6 dB HL in the right ear group. The average postoperative ABG was 9.9 dB HL in the left ear group and 9.4 dB HL in the right ear group. All patients had postoperative audiometric results consistent with final intraoperative ABR results.ConclusionIntraoperative ABR may significantly improve immediate hearing results in patients and greatly reduce the need for revision surgery.
Patterns of Regional Metastasis in Advanced Stage Cutaneous Squamous Cell Carcinoma of the Auricle
Authors: Peiffer Nicholas , Kutz J. Walter , Myers Larry L. , Isaacson Brandon , Sumer Baran D. , Truelson John M. , Ahn Chul , Roland Peter S. 
Published: December 2010

ObjectiveTo determine patterns of regional metastasis in patients with advanced stage cutaneous squamous cell carcinoma of the auricle.Study DesignCase series with chart review.SettingUniversity‐based tertiary care hospitals.Subjects and MethodsWe analyzed 41 patients with stage III and IV squamous cell carcinoma of the auricle.ResultsThe mean age was 74.2 years (range, 20.6‐91.7 years). Thirty‐five patients (85.4%) were stage IV. Twenty‐nine patients (70.7%) had a prior history of nonauricular, nonmelanotic skin carcinoma. Twenty‐four patients (58.5%) had regional metastasis to either the cervical or parotid nodal basin. In patients with cervical metastasis, the involvement by level was 6.7% (n = 1), 80.0% (n = 12), 46.6% (n = 7), 13.3% (n = 2), and 40.0% (n = 6), respectively. Of the 6 patients with a level 5 metastasis, 3 had primaries in the preauricular region, 2 had primaries of the auricle, and 1 had a primary of the postauricular region. Occult disease was present in 2 patients (9.1%) with cervical metastasis and in 4 patients (18.2%) with periparotid lymph node metastasis. Perineural invasion was seen in 84.4% of the study population. The recurrence rate was 46.3% (n = 19). The median time to recurrence was 28.3 months.ConclusionPatients with advanced stage auricular cutaneous squamous cell carcinoma have a high rate of regional metastasis and recurrence. When planning neck dissections for these patients, level 5 should be included in the resection. Patients demonstrating locally advanced disease without clinical or radiographic evidence of metastasis to the parotid or cervical drainage basin should undergo a parotidectomy and comprehensive neck dissection.