bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental Status in Patients with Vestibular Schwannoma
Authors: Hio Sachiko , Inohara Hidenori , Kamakura Takefumi , Sakata Yoshiharu , Horii Arata , Kitahara Tadashi 
Published: September 2011

ObjectiveTo perform treatment with higher quality of life, we need to understand the psychological condition of each patient with vestibular schwannoma (VS). In the present study, we examined the pre‐treatment mental status of patients with VS by using Cornell Medical Index (CMI) and Self‐rating Depression Scale (SDS).MethodBetween 1997 and 2010, we enrolled and assigned 30 patients with unilateral VS in the present study. Before the treatment, we examined CMI and SDS to evaluate patients’ psychological condition and also sex, age, tumor size, hearing level in bilateral sides, CP%, and House‐Brackmann score to learn patients’ backgrounds.ResultsAccording to the data of CMI (>stage III, IV) and SDS (>40), psychological disturbances were pointed out only in 20.0% of patients with VS (6/30). VS patients with hearing deterioration (>30dB) in the contralateral side were significantly depressed (66.7%: 4/6) more than those with normal hearing (th/8th nerve function in the tumor side did not make any influence, but hearing level in the contra‐lateral side significantly affected psychological condition.ConclusionIt is important for physicians to give patients with an only/better hearing in the tumor side adequate informed consents about the possibility of profound bilateral hearing loss and about what he or she can do for communications with others in such situations, hearing aid + lip reading and cochlear/brainstem implant.
Molecular Crosstalk between Nrf2/Keap1 Signaling Pathway, Autophagy and Necrosis in Auditory Cells
Authors: Hayashi Ken , Ogawa Kaoru , Goto Fumiyuki , Kanzaki Sho 
Published: September 2011

ObjectiveOxidative stress affects auditory cellular functions. The Nrf2/Keap1 signaling pathway is the main pathway responsible for cell defense against oxidative stress. The purposes of this study were to elucidate how Keap1 and Nrf2 provide molecular foundation for a possible crosstalk between autophagy and necrosis pathways in auditory cells.MethodWe used auditory cell line (HEI‐OC1) in this study. The viability of HEI‐OC1 was determined by cell viability assays. The samples after treatment of HEI‐OC1 were analyzed by a flow cytometer. Immunofluorescent confocal laser microscopy was used. Western blot was performed. HEI‐OC1 was transfected with Nrf2, Keap1, and p62 siRNA.ResultsAfter H2O2 treatment, not apoptotic cells but necrotic cells were detected by FAC scan analysis. The pretreatment of HEI‐OC1 with rapamycin protects against H2O2‐induced necrotic cell death. After treatment with rapamycin, the accumulation of LC3‐I/II ratio and the expression of GFP‐LC3 were observed in HEI‐OC1. The knockdown of p62 by siRNA, which loses its ability to interact with Keap1, had no effect on Nrf2 stability, demonstrating that p62‐mediated Nrf2 up regulation is Keap1 dependent. These findings demonstrate that autophagy deficiency activates the Nrf2 pathway in auditory cells.ConclusionWe demonstrated a promotion of autophagy through the mTOR signaling pathway to enhance cell survival in auditory cells under oxidative stress. A crosstalk between Nrf2/Keap1 pathway in the autophagy related p62 are also presented. The selective autophagy substrate p62 activates the oxidative stress responsive factor Nrf2 through inactivation of keap1.
Multimodal Assessment of Normal Eustachian Tube Function
Authors: Alper Cuneyt M. , Singla Alok , Banks Juliane , Swarts J. Douglas , Doyle William J. 
Published: September 2011

ObjectiveEvaluate normal human Eustachian tube (ET) function during swallowing and other maneuvers that open the ET using a variety of modalities including EMG of the Tensor veli palatini (mTVP), Levator veli palatini (mLVP), and submental muscles, videoendoscopy, and sonotubometry; and compare these results with ET function tests in a pressure chamber.MethodIn adult volunteers surface electrodes and needle EMG electrodes were placed into the mTVP and mLVP muscles. A 45° telescope was used to video‐record the ET orifice, and sonotubometry recorded the ET openings. A subset was also tested in a pressure chamber.ResultsSeventeen subjects were enrolled. EMG data was recorded from both the mTVP and mLVP in 15 subjects but from only one muscle in 2 subjects. In 9 subjects ET functions tests were performed in the pressure chamber. Video recording of ET opening was consistent with the EMG activity and ET openings by sonotubometry. mTVP activity had a shorter duration but a greater amplitude than mLVP activity. mLVP activity occurs before that of mTVP and the submental muscle group. Tests conducted in the pressure chamber demonstrated ET function consistent with the multimodal test results.ConclusionMultimodal assessment of ET openings by monitoring the EMG of the paratubal and submental muscles, video recordings of the ET, and sonotubometry with ET function testing in the pressure chamber in adult volunteers is a novel and promising method for expanding our knowledge of middle ear physiology and pathophysiology.
Novel Maneuver for Benign Paroxysmal Positional Vertigo
Authors: Natt Ravinder Singh , Tahery Jawed 
Published: September 2011

ObjectiveA simplified and shorter version of the Epley maneuver for successful canalith repositioning and deposition from the posterior semicircular canal (SCC) into the utricle of the vestibular labyrinth in the treatment of benign paroxysmal positional vertigo (BPPV) as confirmed by a positive Dix‐Hallpike test is described.MethodAdjustable head‐set positioned patients providing 3D representation of vestibular apparatus. Three latex free tubes positioned at 90‐degree angles to one another representing SCC arrangement in both ears. Communication via hollow plastic‐cavity representing the utricle. Mobile metal ball bearing representing the canalith placed into the lumen posterior SCC tube of the affected ear determined following positive Dix‐Hallpike test.ResultsAs described by Epley, the head is placed over the end of the table and turned 45 degrees to the affected ear so the canalith gravitates to the center of the posterior SCC. While the head is tilted below the horizontal it is rotated 45 degrees toward the other ear so the canalith reaches the common crus. At this stage the patient is then turned prone, looking directly at the floor, and subsequently the canalith enters the utricle. This method has 85% success rate in BPPV patients with a positive Dix‐Hallpike test.ConclusionThe method incorporates fewer steps than the Epley maneuver and is less time consuming in busy otolaryngology clinics achieving the desired outcome, with the advantage of educating patients and junior doctors about canalith movement through SCCs with head‐set resembling valuable visual aid‐memoire. The senior author successfully used this technique for 10 years for short term resolution of BPPV‐associated symptoms.
Pirymethamine and HEX Gene Expression in Cholesteatoma
Authors: Olszewski Slawomir , Olzewska Ewa 
Published: September 2011

Objective1) Evaluate the expression of hexosoaminidases (HEXA and HEXB) genes in cholesteatoma fibroblasts (CF) and in the inflamed synoviocytes obtained from patients who suffered from rheumatoid arthritis; and 2) Evaluate in vitro inhibition potential of pyrimethamine.MethodCholesteatoma fibroblasts (study group), synoviocytes (comparison group), and retroauricular skin fibroblasts (control group) were used. The following solutions of the selected inhibitor (pyrimethamine) were added to the cell culture: 20 mcg/mL, 10 mcg/mL, 3 mcg/mL, and 1.5 mcg/mL. RT‐PCR was carried out before and after adding pyrimethamine.ResultsRT‐PCR established elevated expression of HEXA and HEXB mRNA in cholesteatoma. HEXA mRNA in CF was 6 times higher than in controls. HEX mRNA expression is regulated by pyrimethamine. Inhibition of HEXA and HEXB mRNA expression was achieved when the highest concentration of PYR was used. Low concentrations of pyrimethamine upregulated HEX gene in CF. A difference in HEXA and HEXB expression was observed in synoviocytes. The highest concentration of pirymethamine (10 and 20 mcg/mL) caused the least elevation of HEXA expression. A slight decrease of HEXB expression was observed under the concentration of pirymethamine: 1.3 and 3 mcg/mL.ConclusionPyrimethamine, depending on its concentration, contributes to regulating HEX gene expression in CF and controls. Our preliminary data do not let us establish the concentration of pyrimethamine that may significantly inhibit HEXA and HEXB expression. Further study may put new insight into the usefulness of investigating the localized inflammation in cholesteatoma.
Postauricular Twin Flap for Canal Wall Reconstruction after Canal Wall Down in Chronic Otitis Media with Small Canal
Authors: Cho Yongbeom , Jang Chul‐Ho , Cho Hyong‐Ho , Yang Hyung Chae , Kim Jae Young , Kim Jun Sung 
Published: September 2011

ObjectivePropose the postauricular twin flap consisting of an anteriorly based periosteal flap and soft tissue flap for reconstruction of the canal wall in patients with chronic otitis media and small ear canal in which a canal down procedure is required.MethodA retrospective review was performed in patients undergoing canal wall reconstruction with postauricular twin flap and type I tympanoplasty after canal wall down from 2009 to 2010. Shape of the canal after reconstruction, pre‐ and postoperative audiogram, and postoperative complications such as infection, delayed healing, and dehiscence of the wall were evaluated.ResultsSeven ears of 7 patients underwent the canal wall reconstruction procedure after canal down and type I tympanoplasty. The ages of the patients ranged from 19 to 63 years. The mean duration of follow‐up was 13.3 months with a range of 9 to 18 months. The shape of the canal was maintained in all ears, and no dehiscence of the canal wall was found in all seven ears. Postoperative hearing was variable depending on the hearing of preoperation, but no worsening was observed. Mean improvement of postoperative air conduction was 21.8 dB, and that of postoperative air‐bone gap was 16.4 dB.ConclusionThe postauricular twin flap is thin and flexible enough to support the posterior surface of the canal skin and to fill the space remaining after surgery. The twin flap procedure for the reconstruction of the external ear canal showed a high success rate.
Prevalence of Jugular Bulb Abnormalities and Resultant Inner Ear Dehiscence: a Histopathologic and Radiologic Study
Authors: Friedmann David R. , Winata Leon Shin‐han , Lalwani Anit K. , Pramanik Bidyut K. , Eubig Jan A. , Merchant Saumil N. 
Published: September 2011

ObjectiveJugular bulb (JB) abnormalities including high riding JB and JB diverticulum can erode inner ear structures and cause hearing loss, dizziness, and tinnitus. This study investigates 1) the prevalence of JB abnormalities, and 2) their erosion into inner ear structures using temporal bone histopathology and computed tomography (CT).MethodA total of 1579 temporal bones and 100 CT of the temporal bones (200 ears) were reviewed. The presence of a high JB was recorded as was its erosion into inner ear structures. Accompanying demographic and clinical information was reviewed.ResultsHigh JB was noted in 8.2% (130/1579) of temporal bone specimens, and in 8.5% (17/200) of cases radiologically. Histologically, high JB were more common on the left side, in women, and in those greater than 40 years old. There was no significant increase in the prevalence of high JB over age 40 years. High JB eroded inner ear structures in 34% (44/130) of cases histologically and 18% (3/17) radiologically. The vestibular aqueduct was most frequently dehiscent histologically (n = 41) and radiologically (n = 3). Posterior semicircular canal and facial nerve were infrequently dehiscent. Only 2 out of 41 histological cases of vestibular aqueduct dehiscence had hydrops or a clinical history of Ménière’s disease.ConclusionJB abnormalities are common. They are present in 8% to 9% of individuals and are acquired by age 40 years. In 1/3 of cases, high riding JB erodes the inner ear, most frequently involving the vestibular aqueduct. Contrary to expectation, dehiscence of the vestibular aqueduct is infrequently associated with endolymphatic hydrops clinically or histologically.
Prognostic Factors in Sudden Sensorineural Hearing Loss
Authors: Hamamoto Masakazu , Tanaka Hiroki , Fukushima Hisaki , Morita Norimasa , Harada Tamotsu , Tachi Toshihiro 
Published: September 2011

Objective1) Assess the prognostic factors possibly affecting hearing recovery, such as age, severity of hearing loss, definitive episode of vertigo, tinnitus, and ear fullness. 2) Assess the effect of corticosteroids in sudden sensorineural hearing loss (SSHL).MethodWe reviewed the medical records of 117 patients seen at the outpatient clinic of Kawasaki Medical School Hospital between 2004 and 2008. Hearing loss was graded from 1 to 4 according to the grading system by the Research Committee on acute profound deafness of the Japanese Ministry of Health and Welfare.ResultsEighty‐five patients were Grade‐1 (under 40 dB hearing thresholds at the average of 0.25, 0.5, 1, 2, and 4 KHz), 22 were Grade‐2 (40 to 60 dB), 9 were Grade‐3 (60 to 90 dB), and one was Grade‐4 (90 dB and over). The recovery rates after the treatment of hydrocortisone (300 mg/d for 3 days, 100 mg/d for 3 days) were 88.2% in Grade‐1, 50% in Grade‐2, and 30% in Grade‐3 and ‐4. The recovery rate was significantly higher in Grade‐1 and in cases in which that treatment was started within 7 days from the onset.ConclusionOur study indicates that the prognostic factors affecting hearing recovery are the severity of hearing loss and the duration of disease between the onset and the initial treatment of corticosteroid. The age, presence of vertigo, tinnitus, and ear fullness did not influence the recovery rate.
Quality Improvement in Universal Newborn Hearing Screening
Authors: Deem Kenneth C. , Diaz‐Ordaz Ernesto A. 
Published: September 2011

ObjectiveHospital‐based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality improvement protocols, but many hospitals lack the time and resources to initiate this process. A practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs was studied.MethodScreening processes and quality indicators for UNHS programs at 4 hospitals were determined through site visits and a 2‐year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital‐specific quality indicators. Improvement opportunities were discussed, and system changes were proposed for immediate implementation.ResultsHospitals screened 21,957 newborns for hearing loss. Rates of screening were greater than 95% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust inpatient screening processes to reduce potential false‐negative screening results. Two other hospitals addressed poor diagnostic follow‐up by changing the referral process to include additional family contact information. Hospitals also recognized that referral to Early Intervention Child‐Find services increased the likelihood of diagnostic follow‐up four‐fold (P =. 03). Documentation of hearing aid eligibility and enrollment in Early Intervention services was insufficient for retrospective determination of these quality indicators.ConclusionReview of nursery and audiology records successfully established most quality indicators for the UNHS programs studied. Feedback of quality indicators identified multiple improvement opportunities and led to immediate system changes. This study demonstrates a practical and data‐driven approach to quality improvement that can be used by any UNHS program.
Resident Education of Documentation and Coding
Authors: Boyle Kristen R. , Gooi Adrian , Kacmarynski Deborah Sue Follmer , Pagedar Nitin A. , Smith Richard J. H. 
Published: September 2011

Objective1) Develop resident billing/coding education based on a needs‐based assessment; 2) Expand systems‐based practice competency; 3) Empower residents with a broader skill set; 4) Minimize risk exposure via adequate documentation; 5) Examine resident billing practices and estimate potential billing errors.MethodA sample of residents and attendings from our otolaryngology program were administered a pretest/written survey on knowledge/opinions of documentation and coding for physician services. Responses were used to create multi‐modality educational intervention. Resident billing was used to assess pre/post‐intervention ability to bill for physician services in an outpatient clinic setting.ResultsA total of 12 out of 13 staff reported that residents did not demonstrate ability to document and code. No residents currently perform billing, but 12 of 14 assume that they will be in the future. All the residents believed billing training was useful, although 2 did not think it should be taught during residency. A total of 17% of 60 pre‐intervention encounters were accurately coded. A total of 68% of total encounters resulted in underbilling by an average of $22/encounter and 15% of total encounters resulted in overbilling by an average of $35/encounter. Total lost charges across all encounters were estimated at $909.00 due to inappropriate coding and $710.00 due to insufficient documentation.ConclusionResidents are not currently educated regarding documentation and coding for physician services. Therefore, they have a limited understanding of documentation/coding for physician services as evidenced by inaccurate shadow billing. All residents acknowledge that this topic is important to their career with a majority of them interested in learning this information while in residency training.
Role of Prostaglandin D2 Receptor in Otitis Media
Authors: Kariya Shin , Okano Mitsuhiro , Eguchii Motocharu , Makihara Seiichiro , Higaki Takaya , Nishizaki Kazunori , Morita Norimasa 
Published: September 2011

ObjectiveProstaglandin D2 is the major prostanoid involved in infection and allergy. D prostanoid receptor (DP) and chemoattractant receptor‐homologous molecule expressed on T helper type 2 (Th2) cells (CRTH2) are major prostaglandin D2 receptors. The purpose of this study is to disclose the role of prostaglandin D2 receptors in otitis media.MethodExperimental otitis media was induced by middle ear injection of lipopolysaccharide. DP single gene‐deﬁcient (DP‐/‐) mice, CRTH2 single gene‐deﬁcient (CRTH2‐/‐) mice, and DP/CRTH2 double gene‐deﬁcient (DP‐/‐ CRTH2‐/‐) mice also received lipopolysaccharide. Concentrations of cytokines in middle ear effusion were measured by ELISA.ResultsSigniﬁcant production of cytokines and chemokines was detected in lipopolysaccharide‐treated wild‐type mice. CRTH2‐/‐ mice also showed significant up regulation of inflammatory reactions. In contrast to CRTH2‐/‐ mice, inﬁltration of inﬂammatory cells and expression of macrophage inﬂammatory protein 2, IL‐1‐beta, and IL‐6 induced by lipopolysaccharide were reduced signiﬁcantly in DP‐/‐ mice and DP‐/‐CRTH2‐/‐ mice.ConclusionThese findings indicate that DP may play significant roles in pathogenesis of experimental otitis media.
Sensorineural Hearing Loss in the Setting of Systemic Autoimmune Disease: A Temporal Bone Study
Authors: Balaker Ashley Erin , Ishiyama Akira , Lopez Ivan A. 
Published: September 2011

ObjectiveDetermine if temporal bone specimens from patients with different systemic autoimmune diseases and sensorineural hearing loss will show similar histologic findings, including endolymphatic hydrops, strial atrophy, loss of hair cells, neuronal loss, and/or evidence of vasculitis.MethodThis is a histopathologic study of 34 temporal bones from 21 patients with autoimmune disorders and sensorineural hearing loss. Specimens were studied under light microscopy, and pathologic changes were graded, including degree of endolymphatic hydrops, strial atrophy, hair cell loss, neuronal loss, and presence of vasculitis.ResultsStrial atrophy was the most common finding and correlated with the degree of hearing loss. Only patients with Cogan syndrome or primary autoimmune sensorineural hearing loss had endolymphatic hydrops. Cochlear hair cell loss and neuronal loss were seen in some specimens but not universally. Vasculitis was only seen in polyarteritis nodosa.ConclusionStrial atrophy may represent the underlying etiology of sensorineural hearing loss in patients with systemic autoimmune diseases. However, the age of these patients makes presbycusis a possible confounding factor in these specimens.
Sudden Sensorineural Hearing Loss: Evaluation of Steroid Therapy
Authors: Fukushima Hisaki , Hamamoto Masakazu , Morita Norimasa , Harada Tamotsu , Tachi Toshihiro 
Published: September 2011

ObjectiveDetermine the efficacy of a steroid regimen for patients with idiopathic sudden sensorineural hearing loss (SSNHL) and evaluate the relationship between outcome and initial steroid dose.MethodA retrospective review of patients with SSNHL was conducted at our hospital from 2004 to 2008. The study group consisted of 272 patients in whom SSNHL was diagnosed. Patients received tapering courses of intravenous hydrocortisone (HC) with an initial dose of either 500 mg/d for 3 days or 300 mg/d.ResultsThe overall recovery rates after treatment were 68% in total group. The time interval from onset of SSNHL to start of treatment was important for the outcome of hearing improvement. There is significant difference between the under and over 50 years old groups in improvement of HL. A total of 47% (n = 128) were treated with high dose (500 mg/d) HC, and 53% (n = 144) were treated with low dose (300 mg/d) HC. There were no significant differences between the high dose and low dose groups in terms of hearing outcome.ConclusionHigh dose steroid therapy had the same outcome as low dose steroid therapy against patients with SSNHL.
The Combination Effects of Early Intratympanic Dexamethasone Injection for Patients with Sudden Sensorineural Hearing Loss
Authors: Min Hyun Jung , Kim Jong Min , Kim Kuk , Park Chul‐Won , Jeong Jin‐Hyeok , Lee Seung‐Hwan 
Published: September 2011

ObjectiveIntratympanic dexamethasone injection (ITDI) was generally used as salvage treatment for sudden sensorineural hearing loss (SSNHL) patients who failed initial systemic treatment or for patients who considered to have a hazard risk on systemic steroids. We investigated the effectiveness of combination therapy, early ITDI accompanied by systemic therapy on SSNHL.MethodWe gathered the data of 151 SSNHL patients who were refractory to systemic treatment for 5 days. The injection group was administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. The control group only received traditional treatment. We compared the last concrete hearing level and recovery rate.ResultsOverall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) injection patients (P =. 034). On the basis of Siegel criteria, 7 of 47 (14.9%) injection patients were recovered in Siegel criteria 1, and 10 of 47 (21.3%) and 13 of 47 (27.7%) injection patients were respectively recovered in Siegel criteria 2 and 3. In the control group, 15.4%, 8.7%, and 21.2% patients were recovered in Siegel criteria 1, 2, and 3, respectively. Depending on the degree of initial hearing loss, patients with severe hearing loss who were treated with ITDI showed significantly higher recovery rates than patients in the control group (83.8% vs 50.0%) (P =. 049).ConclusionEarly combination therapy of intratympanic dexamethasone injection within 2 weeks accompanied by initial systemic treatment is effective for patients with refractory sudden sensorineural hearing loss, especially for patients with severe hearing loss.