bluuebunny/crossref_metadata_2025_split huggingface dataset:
Middle Ear Myoclonus: A Treatable Cause of Objective Tinnitus
Authors: Kolb Caroline M. , Fukuda Denby , Healy David Y. 
Published: September 2011

Objective1) Describe the presentation of an underdiagnosed cause of objective tinnitus. 2) Review the current literature and present an algorithm on diagnosis and management of middle ear myoclonus. 3) Use video to demonstrate surgical ablation of the stapedial and tensor tympani tendons to alleviate middle ear myoclonus.MethodThis retrospective study analyzes the presentation and management of 6 patients diagnosed with middle ear myoclonus from 2009 to 2011. A review of the literature revealed 15 additional cases of middle ear myoclonus. An algorithm for the diagnosis and management of these patients is presented.ResultsWe report on the diagnostic findings of 6 patients identified at a tertiary care military medical center with middle ear myoclonus. Four of the 6 patients had a significant history of loud, explosive noise exposure during military deployments. Patients were diagnosed based on history, examination findings, and standard audiometry testing using a nonstimulated, spontaneous acoustic reflex decay tracing. Fifteen additional reported cases of either stapedial or tensor tympani myoclonus were identified in the English language literature. Observation, medications, botulinum toxin, and surgical sectioning of the stapedius and/or tensor tympani are recognized treatments of this disorder.ConclusionMiddle ear myoclonus is an underdiagnosed cause of objective tinnitus likely due to lack of familiarity with diagnostic findings. For symptomatic myoclonus, middle ear exploration with transection of the stapedius tendon, tensor tympani tendon, or both demonstrated the best outcomes, with 100% of patients achieving complete relief of tinnitus.
Neurofeedback‐Based, Vestibular Rehabilitation in Ménière Disease
Authors: Ernst Hamid R. , Basta Dietmar 
Published: September 2011

ObjectiveReport on the effects of a neurofeedback‐based vestibular training (VT) with a recently developed vibrotactile prosthesis (VertiGuard RT) in patients with stage IV Ménière disease (due to AAO‐HNS) and resulting otolith disorders (ie, macular degeneration).MethodA total of 17 patients with long‐standing, bilateral Ménière disease were diagnosed with accompanying otolith (macular) disorders. The patients were free of vertiginous (Ménière) attacks but complained of an increased sway in roll/pitch (DHI 56.3 mean). Otolith diagnostics (VEMP, eccentric rotation) revealed combined sacculo‐utricular (12) and bilateral utricular (5) degeneration.ResultsAll patients were tested with the standard balance deficit test, and the 6 worst test conditions were used for the neurofeedback‐based training. Body sway could be reduced by 36% in roll and by 35% in pitch, and DHI scores were reduced by 25 points on average.ConclusionNeurofeedback‐based vestibular rehab with a recently developed, vestibular prosthesis (VertiGuard RT) gives long‐term, postural stability to patients with otolith degeneration as late sequaelae of Ménière disease.
Outpatient Labyrinthectomy
Authors: McKennan Kevin X. 
Published: September 2011

ObjectiveWith newly available anti‐nausea/vertigo medications, selected patients can undergo transmastoid labyrinthectomy as an outpatient procedure.MethodTen patients pretreated with a cocktail of Emend/Transderm Scop Patch/Decadron underwent a transmastoid labyrinthectomy. These patients were all treated as outpatients. These 10 patients will be compared with 10 similar patients hospitalized after surgery.ResultsSubstantial financial savings occurred to those patients treated as outpatients. No patients treated as outpatients required admission to the hospital.ConclusionSelected patients with Ménière can undergo a transmastoid labyrinthectomy as an outpatient operation when pretreated with a combination of Emend/Transderm Scop Patch/Decadron.
Predictors for Outcomes in Pediatric Stapedectomy
Authors: Zang Richard , Neilan Ryan E , Isaacson Brandon , Roland Peter S. , Lee Kenneth H. , Kutz J. Walter 
Published: September 2011

ObjectiveIdentify predictive factors for successful stapedectomy in children under 17 years old.MethodA retrospective chart review was performed from January 1, 1999 until January 1, 2011, to identify patients under 17 years old who underwent a stapedectomy. Age, gender, pre‐ and postoperative audiograms, intraoperative findings including cause of stapes fixation, type of prosthesis used, and complications were recorded.ResultsEighteen children were identified who had undergone a stapedectomy. The cause of fixation included otosclerosis (n = 7), congenital footplate fixation (n = 9), and unknown cause (n = 2). The overall mean preoperative air‐bone gap (ABG) was 35.7 dB (±10.4), compared with a postoperative mean ABG of 15.1 (±15.6) (P < 000.1). The mean postoperative ABG of 14.5 (±5.3) in the congenital footplate fixation group was lower than the mean postoperative ABG of 24.25 dB (±5.8) in children with otosclerosis, although this did not reach statistical significance (P = 0.236). One patient developed profound sensorineural hearing loss three weeks after surgery.ConclusionPediatric stapedectomy has comparable results with stapedectomy in adults regardless of the cause of stapes fixation.
Quantifying Tinnitus: Measurement of Cortical Thickening
Authors: Natt Ravinder Singh , Aldhafeer F. , Sluming V. , Mackenzie Ian J. 
Published: September 2011

ObjectiveTinnitus is an auditory phenomenon categorized by perception of sound without external stimuli. The purpose of this study is to investigate radiological brain structural changes in tinnitus patients, in particular cortical thickness changes, and correlate these with severity of tinnitus as measured by the Newman Tinnitus Handicap Inventory score.MethodLiverpool Research Ethics Committee provided approval. Patients were recruited from audiology clinics. Cortical thicknesses of tinnitus patients were measured using a 1.5T MRI‐scanner. In total 8 patients with bilateral tinnitus and 7 healthy control subjects without tinnitus were recruited for comparison. Data were analyzed using Brain Voyager QX.ResultsThe 8 bilateral tinnitus patients had a mean Newman‐score of 60. Right hemisphere: significant cortical thinning found in middle temporal gyrus (P =. 0081), inferior temporal gyrus (P =. 052), precentral gyrus (P =. 032), postcentral gyrus (P =. 031), and temporal lobe (P = 0.023) in tinnitus patients compared with controls using the t test. Left hemisphere: significant cortical thinning was found in prefrontal gyrus (P =. 058), middle frontal gyrus (P =. 058), and posterior cingulate cortex (P =. 045). Individual cortical thickness results analysis did not reveal correlation between tinnitus severity and cortical thinning.ConclusionPreliminary evidence is presented, establishing a quantitative measure for tinnitus‐related structural changes in cortical thickness. Reduced cortical thickness may contribute to negative emotions experienced by tinnitus sufferers. Findings are consistent with posttraumatic stress disorder studies. Similar treatment strategies may be employed for tinnitus patients. A larger population size is being assessed.
Facial Artery Mucosa Muscular Flap: Possible after Oral Chemoradiotherapy
Authors: Valette Gerald , Rogez Florence , Potard Gael , Delahaye Laurent , Marianowski Remi , Abgral Ronan , Gauvin Yves 
Published: September 2011

ObjectiveThe Facial Artery Mucosa Muscular (FAMM) Flap, described by Pribaz in 1992, can be used in oral surgery on different indications. The primary reconstruction after the resection for an oral cancer is the most evaluated indication.MethodThirty‐five cases from the University Hospital of Brest Head and Neck Surgery Center between April 2007 and November 2010 were analyzed in a retrospective study. The indication, the status of treatment (post chemoradiotherapy or not), complications (hematoma, infection, necrosis), the weaning delay of the pedicula, and time to an oral feeding were all analyzed.ResultsTwelve cases for primary reconstruction, 7 cases for buccosinusis defect and 16 cases in osteoradionecrosis. One case of hematoma, no infection and no necrosis were observed. One case did not give a good result. There is no difference in terms of viability between postchemoradiotherapy surgery. The weaning delay and the time delay to an oral feeding is twice longer after radiotherapy.ConclusionThis flap can be used after radiotherapy with a precaution of care. The FAMM flap represents a good solution event after chemoradiotherapy for the loss of medium size substance, it represents a good solution between directed healing and more consistent skin flaps.
Symptom Timeline Preceding Cochlear Implant Failure
Authors: Roby Brianne Barnett , Ferrello Melissa , Rimell Frank L. , Levine Samuel C. , Huang Tina C. 
Published: September 2011

Objective1) Review cochlear explants and determine the incidence of device and medical failures. 2) Develop a pattern of symptoms indicating probable implant failure.MethodThis is a retrospective chart review at a tertiary referral center. Subjects were selected if they underwent cochlear explantation. A total of 847 implants were performed from 1988 to 2008, with 128 devices explanted. Data were reviewed to determine initial symptom and symptom timeline preceding implant failure.ResultsOf total implants, 72% were Advanced Bionic devices, 28% were Nucleus. Overall failure rate was 128 out of 847 (15%). Patients with Advanced Bionic devices underwent 102 explants (16.7% failure rate), with 35% medical failures and 65% device failures. Patients with Nucleus devices underwent 26 explants (11% failure rate), with 58% medical failures and 42% device failures. Medical failures included infected devices and wound dehiscence, the pattern averaging 4.5 months to explantation. Hard device failures included sudden malfunction and slow decline in function, with pattern of failure over 4.2 months. Soft failures included tinnitus and discomfort, with failure over 8 months.ConclusionThere were common patterns when evaluating both medical and device failures. By recognizing patterns of symptoms that may indicate probable implant failure, otolaryngologists can better counsel patients on what to expect with their implants when they present with certain symptoms.
The Incidence and Clinical Course of Facial Nerve Paresis following Contemporary Cochlear Implant Surgery
Authors: Thom Joshua , Neff Brian A. , Beatty Charles W. , Driscoll Colin L. W. , Carlson Matthew 
Published: September 2011

ObjectiveIn contemporary otologic surgery, iatrogenic facial nerve paresis is an uncommon but distressing complication. This study will describe our institutional experience with facial nerve injury following cochlear implantation. We report the incidence, clinical presentation, course, and possible mechanisms of facial nerve paresis following implantation surgery and review the relevant literature.MethodA retrospective chart review at a tertiary otologic referral center (teaching hospital) including all patients who underwent cochlear implant surgery between 2000 and 2010. Patients experiencing postoperative facial nerve weakness were identified, and data were gathered with respect to intraoperative findings, onset, severity, management strategy, and level of recovery.ResultsIn the past decade, 815 implant surgeries were performed at our institution. All patients underwent a limited mastoidectomy with posterior tympanotomy (facial recess) approach, and intraoperative electromyographic facial nerve monitoring was routinely employed. No patients experienced immediate paresis while 5 implantees (0.6%) developed delayed onset weakness. All 5 patients were treated with steroid therapy, and all but one recovered to a House‐Brackmann grade 1 (of 6) facial nerve function within 6 months of surgery.ConclusionThe incidence of temporary facial nerve paresis following cochlear implantation at a tertiary teaching hospital was 0.49% while the incidence of permanent incomplete paralysis was 0.12%. Thermal injury and/or reactivation of latent virus with progressive neuroedema and subsequent delayed weakness are the most likely mechanisms of injury.
Three‐Week Loading for Baha BI‐300 Implant System
Authors: Wazen Jack J. , Wycherly Benjamin , Darley David S. , Babu Seilesh , Daugherty Julie 
Published: September 2011

ObjectiveLoading of titanium craniofacial implants is dependent upon osseointegration, the bonding of titanium oxide and bone. The purpose of this study seeks to determine the safety of early loading of the Baha BI‐300 implant system (Cochlear Limited, Englewood, Colorado), which has been modified with novel surface texture and geometric design.MethodThis prospective multi‐institutional study follows implant stability as determined by clinical evaluation and resonance frequency analysis (RFA) at implantation, 1, 3, 6, 12, and 24 weeks postopative, in 20 patients who underwent single‐stage implantation and exteriorization of the BI‐300. The processor was loaded at 3 weeks postoperative.ResultsImplant stability and the incidence of implant loss was compared with patients loaded at 6 weeks and the traditional 12 weeks postoperative. Our preliminary results confirm implant stability at 3 weeks postoperative. No increase in implant loss or postoperative complications were encountered as a result of the early loading.ConclusionThree‐week loading of the BI‐300 implant did not result in any failure of osseointegration. Earlier activation of the external processor with earlier hearing rehabilitation resulted in improved patient satisfaction.
Tumor Necrosis Factor Alpha Ototoxicity Is Associated with Upregulation of Smac/Diablo Gene Expression in Rat Organ of Corti Explants
Authors: Dinh Christine Thuyvan , Dinh John , Vu Ly , Yan Denise , Liu Xue‐Zhong , Van De Water Thomas 
Published: September 2011

Objective1) Review the role of tumor necrosis factor alpha (TNFa) in programmed cell death of auditory hair cells (AHCs) in organ of Corti (OC) explants in vitro. 2) Understand effects of TNFa on Smac/Diablo gene expression in TNFa‐induced apoptosis of OC explants in vitro.MethodOC explants were dissected from 3‐day‐old rat pups and cultured in (1) no treatment – control and (2) TNFa (2ug/mL) for 96 hours in vitro for hair cell count studies and 24 and 48 hours in vitro for gene expression studies for GAPDH and Smac/Diablo genes.ResultsThere are statistically significant decreases in the numbers of viable inner and outer hair cells in TNFa‐treated OC explants, when compared with the control group. Gene expression of pro‐apoptotic Smac/Diablo is significantly increased at 48 hours in vitro (but not at 24 hours), when compared with controls. On‐going studies are evaluating the expression of Smac/Diablo gene at 72 and 96 hours in vitro.ConclusionThe role of Smac/Diablo gene expression has not previously been studied in TNFa‐challenged OC explants. These results suggest late up regulation of Smac/Diablo expression in TNFa ototoxicity, which may be important for the propagation of the apoptosis pathway in OC explants in vitro. (NIDCD RO1‐05575)
Fibula Flap Donor Site Wound Healing with Compression Stockings
Authors: Seaman Bradley J. , Budacki Ross , Reilly Michael J. 
Published: September 2011

ObjectiveInvestigate the efficacy of graduated compression stockings (GCSs) at improving donor site skin graft take after fibula free flap (FFF).MethodRetrospective review of 12 patients (13 donor sites) that underwent FFF for mandibular reconstruction over a 1‐year period. One‐third of the patients were instructed to use graduated compression stockings after removal of the initial wound‐vac dressing. Wound healing was followed closely for all patients. Operative and comorbid factors were reviewed.ResultsTwo patients reported regular GCS use and 2 were non‐compliant. Both patients with regular use had excellent wound healing and 90% to 100% skin graft take. Of the remaining 11 donor sites, 3 had no wound complications, 4 had minor wound complications, 3 had major wound complications, and 1 was lost to follow‐up. Skin graft area varied with an average of 25 cm2 for GCS patients and 60 cm2 for non‐GCS. Cardiovascular disease, alcohol use, and smoking were more common among the non‐GCS group with strong tendency toward patients with major wound complications. Other operative and comorbid factors were similar between groups.ConclusionGraduated compression stocking use demonstrates some promise for use in fibula free flap donor site healing. Patients wearing GCSs had excellent wound healing and no morbidities related to their use. Further studies are warranted to determine if improvement in fibular donor site wound healing occurs with GCS use.
Type of Electrode Insertion and Hearing Preservation Outcomes
Authors: Rivas Alejandro , Forero Victor H. , Rivas Adriana , Haynes David S. , Rivas Jose A. , Wanna George 
Published: September 2011

ObjectiveAssess the levels of hearing preservation during cochlear implant surgery by comparing different electrode insertion techniques (standard cochleostomy, soft surgery, round window).MethodRetrospective chart review looking at levels of hearing preservation after cochlear implantation in children and adults, using different electrode insertion techniques (N = 144 ears from 32 patients). Pre‐ and postoperative pure tone thresholds at 250, 500, and 1000 Hz frequencies were measured. Statistical analysis was performed using nonparametric method (Kruskal Wallis test).ResultsOne hundred and four (72%) procedures were performed using standard cochleostomy, 25 (17 %) procedures were performed using soft surgery, and 15 (11 %) procedures were performed using round window insertion. Postoperative hearing thresholds were used as the main outcome measure. In all groups, residual hearing was preserved in different degrees (total: 30 %, moderate: 27 %, marginal: 37 %, none: 6 %). Statistically significant differences were encountered between the 3 groups. Soft surgery technique and round window insertion had better hearing preservation results compared to standard cochleostomy (P <. 008 and P <. 009, respectively). No difference between round window and soft surgery techniques was encountered (P =. 07).ConclusionAlthough cochlear implants are a revolutionary technology, they carry the risk of destroying residual hearing. Our study demonstrates that the use of soft surgery or round window techniques warrants better residual hearing when compared to standard cochleostomy.
A Double‐Blind, Randomized, Placebo Controlled Trial Evaluating the Effects of a 5‐Day Course of Postoperative Prednisolone following Pediatric Tonsillectomy
Authors: Dawes Patrick J. D. , McCassey Emily 
Published: September 2011

ObjectiveEvaluate the effect of a 5‐day course of oral prednisolone vs matched placebo on postoperative recovery following tonsillectomy in a pediatric population.MethodA total of 195 children undergoing tonsillectomy were randomly allocated to 5 days oral prednisolone or placebo. These were presented in identical bottles and tasted similar. Pain and return of function were assessed on each of the first 8 postoperative days using a validated face pain scale and daily symptom questionnaires.ResultsThere are no significant differences seen between placebo and control groups for any of the parameters assessed. These include; pain scores, nausea and vomiting, time to return to normal activity and oral intake, bedtime and sleep disturbance.ConclusionThere is no significant difference in early outcomes following pediatric tonsillectomy between those given a postoperative oral steroid course compared to placebo.
A New Algorithm for Pediatric Airway Management Using the Intubating Laryngeal Airway
Authors: Barch Bennett E. , Jagannathan Narasimhan , Rastatter Jeffery 
Published: September 2011

Objective1) Evaluate the use of the intubating laryngeal airway (ILA) in providing safe endotracheal intubations in pediatric patients with difficult airways. 2) Present a management algorithm using direct laryngoscopy, rigid bronchoscopy, and the ILA for evaluating and securing the airway in pediatric patients with difficult airways.MethodThe medical records of patients in whom the ILA was used to secure the airway from January 2009 to January 2011 were reviewed. We documented the circumstances necessitating airway management, success of the ILA, airway evaluation findings, and medical conditions contributing to the difficult airway.ResultsA total of 50 patients had an ILA placed for airway management. Nine out of 50 (18%) were performed emergently. The median age was 59.8 months (range, 0.3‐244.1 months), and the median weight was 19.0 kg (range, 2.6‐86 kg). Four cases (8%) were unanticipated difficult airways, and 46 out of 50 (92%) were anticipated difficult airways. Comorbid conditions included craniofacial syndromes (n = 36), cervical spine instability or immobility (n = 9), and airway hemorrhage (n = 3). A total of 48 out of 50 (96%) patients were intubated on the first attempt through the ILA. In 2 patients intubation required a second attempt. The overall success rate using the ILA to secure the airway was 100%.ConclusionILA is safe and effective in pediatric patients with a difficult airway as a conduit for tracheal intubation. Our proposed algorithm for difficult pediatric airway provides a safe means for anesthesiologists and otolaryngolgists to evaluate and secure the airway in these patients.
A Retrospective Review of Ventilation Tube Removal in Children
Authors: Arshad Faisal Ahmed , Mirza Showkat , Eng Chee‐Yean 
Published: September 2011

ObjectiveVentilation tube insertion is the primary surgical intervention in persistent otitis media with effusion. Around 7% of ventilation tubes require elective removal. The objective is to discover the tympanic membrane healing rate after ventilation tube removal and identify measures that improve this.MethodRetrospective case note review performed for patients who had elective ventilation tube removed over an 8‐year period. Information gathered included if any concomitant procedure was performed to repair the tympanic membrane and final outcome of the tympanic membrane status.ResultsA total of 113 cases were included in this study. The average age at grommet insertion and removal was 5.8 years old and 8.3 years old, respectively. After ventilation tube removal the perforation edges were freshened in all cases. The majority of patients (84.1%) subsequently had an intact tympanic membrane. Additional procedures were performed on 19 ears, 6 with insertion of overlay absorbable material and 14 with a fat plug. Closure rate in these patients was 100%. Shah and Sheperd grommets had a significantly lower residual tympanic membrane perforation rate compared to T‐Tube and Titanium grommets.ConclusionTympanic membrane closure rate after ventilation tube removal was 84.1%. Additional procedures, ie, overlaying of absorbable material, appear to improve the closure rate. We therefore advocate the technique. In selected cases such as T‐tube removal a concurrent fat plug myringoplasty may be appropriate.