bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rhinophyma: Current Management
Authors: Singh Narinder , Roberts David N. 
Published: September 2011

Objective1) Describe and assess the results of our technique for the surgical management of rhinophyma. 2) Review contemporary concepts in rhinophyma management.MethodWe describe a relatively simple combined‐modality technique that addresses each of the 4 steps of rhinophyma surgery. The method allows accurate delineation of tissues whilst maintaining reduced operative times, excellent hemostasis, and an uncomplicated postoperative course, together with satisfactory cosmetic results. We present video of the technique.ResultsThe technique was used for 7 patients. There were no major complications. All patients were satisfied with the outcome and no patients requested revision. Assessment by an independent facial plastic surgeon indicated a mean cosmetic improvement in visual‐analogue score (1‐10) of 8.5 ± 0.7.ConclusionThe ideal technique for the surgical management of rhinophyma is yet to be found. We describe a method that is relatively simple, low cost, easy to learn, has a short operative time, requires minimal postoperative care and provides a satisfactory cosmetic outcome with minimal complications.
Interobserver Reliability of the “Clockface” Method of Describing the Site and Size of Tympanic Membrane Perforations
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat , Counter Paul R. 
Published: September 2011

ObjectiveAnalyze the interobserver reliability of a “clockface” method for describing the site and size of tympanic membrane perforations.MethodSix junior doctors (ENT experience 0‐3 months) and 6 ENT surgeons (ENT experience 4‐26 years) were asked to estimate the position, percentage size, and “clockface” position of perforations in 30 images of tympanic membrane perforations. Four juniors repeated the exercise 2 weeks later to investigate test‐retest reliability.ResultsResults were analyzed using intraclass correlation coefficients (95% confidence interval in brackets). With junior raters, perforation size percentage estimate gave 0.85 (0.77‐0.92), clockhand method site of perforation (CM1) gave 0.91 (0.87‐0.94), and clockhand method size of perforation (CM2) gave 0.82 (0.73‐0.90). With ENT surgeons, perforation size percentage estimate gave 0.85 (0.77‐0.92), CM1 gave 0.96 (0.94‐0.99), and CM2 gave 0.88 (0.78‐0.94). With all raters, perforation size percentage estimate gave 0.86 (0.78‐0.92), CM1 gave 0.93 (0.90‐0.95), and CM2 gave 0.84 (0.76‐0.91). In test‐retest reliability, using Pearson correlation coefficients, perforation size percentage estimate gave 0.94 (P <. 001), CM1 gave 0.91(P <. 001), and CM2 gave 0.92(P <. 001).ConclusionThe clockface method allows quick, detailed, and reliable recording of site and size of perforation at the time of clinical assessment. This may also become a valuable research and audit tool.
Largest CT‐Identifiable Hypotympanic Cell and Mastoid Size
Authors: Todd N. Wendell , Hoddeson Elizabeth K. , MacLean Jonathan 
Published: September 2011

ObjectiveThe hypotympanum is important, especially when the surgeon confronts cholesteatomas and tumors, and when a hypotympanic cell simulates the round window niche. Hypotympanic cell size is generally considered wide‐ranging and stochastic. We hypothesized that size of hypotympanic cells is not related to size of mastoid.MethodOf 41 clinically normal human crania, the 5 with the smallest mastoid pneumatization areas and the 5 with the largest areas were imaged by high‐resolution computed tomography, both direct axial and direct coronal. The diameter of each ear’s largest identifiable hypotympanic cell, on either axial or coronal imaging, was measured.ResultsWide ranges were found for the largest identifiable hypotympanic cell: 0‐11mm. Bilateral symmetry was found for both the largest hypotympanic cells (Spearman r = 0.68, P =. 03), and for mastoid pneumatization (Spearman r = 0.66, P <. 05). The diameter of the largest hypotympanic cell positively correlated with the extent of mastoid pneumatization: for left ears, Spearman r =. 73, P <. 03.ConclusionThe greatest diameter of largest CT‐identifiable hypotympanic cells ranged from 0 to 11 mm. Even in this small series of specimens, hypotympanic cell size positively correlated with mastoid size.
Laser‐Assisted Stapedotomy
Authors: Sergi Bruno , Parrilla Claudio , Paludetti Gaetano , Galli Jacopo 
Published: September 2011

ObjectiveAssess and compare the functional results obtained by means of multiple‐shot Erbium: yttrium‐aluminum‐garnet (Er:YAG) laser to those obtained using “one‐shot” CO2 laser stapedotomy in patients affected by otosclerosis. Study Design: A retrospective case review was performed. Setting: The study was conducted at the Catholic University of Rome.MethodWe compared the results obtained in 2 series. From January 2004 to January 2006, a Er:YAG laser stapedotomy was performed on 101 patients. From January 2008 to December 2009, 110 subjects underwent “one‐shot” CO2 laser stapedotomies for otosclerosis. Pure‐tonal audiometric test was performed preoperatively and after surgery during the follow‐up.ResultsIn both groups the closure of air‐bone gap began in the early postoperative period and continued to improve through the late postoperative period. Bone‐conduction hearing thresholds were stable even in the early postoperative follow‐up and remained stable trough the course of the study.ConclusionOur findings confirm that laser stapedotomy is a safe and effective surgery. Respect to Er:YAG laser, the improvement of the CO2 laser and the development of the “one‐shot” technique justify a larger use of this equipment that allows one to achieve the stapedotomy with less manipulations and a reduced acoustic trauma.
Limiting Hazardous Noise Exposure from Noisy Toys
Authors: Jabbour Noel , Weinreich Heather , Levine Samuel C. , Yueh Bevan 
Published: September 2011

Objective1) Assess the decibel (dB) level of toys from the Sight & Hearing Association 2010 Noisy Toys List. 2) Evaluate the change in dB level of these toys after covering the speakers with tape or glue.MethodSight & Hearing Association 2010 Noisy Toys List (n = 18) toys were tested at a distance of 0 cm and 25 cm from the sound source in a soundproof booth using a digital sound‐level meter. Toys with speakers (n = 16) were tested before and after covering the speakers with packing tape or non‐toxic glue.ResultsMean dB level for nontaped toys at 0 cm and 25 cm was 107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB Mean dB level for non‐taped toys at 0 cm and 25 cm was 107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB (P <.001). With glue, there was a statistically significant decrease in loudness at 0cm and 25 cm (P <. 001). The average duration of sound produced was 9.2 seconds.ConclusionAdding tape or glue to cover the speakers of noisy toys can significantly limit the dB level of these toys. These are simple measures that parents can perform to limit hazardous noise exposure from noisy toys.
Long‐term Outcomes and Reliability of Jahn Ventilating Tube
Authors: Sajan Javad A. , Hilton Christopher W. , Levine Samuel C. 
Published: September 2011

ObjectiveThe Jahn ventilating tube (JVT) is an osseointegrated middle ear ventilating tube that is used internationally in the treatment of Eustachian tube dysfunction (ETD). Little long‐term data exists quantifying the functions and complications of this device. This study aims to assess the long‐term outcomes with use of the JVT.MethodRetrospective chart review of 22 patients (24 ears) with ETD managed with JVT (1994‐2008) with at least 3 years of follow‐up, or documented JVT failure at any time point. Main outcome measures were duration of patency, time to extrusion, middle ear aeration, audiogram, Sade score, and complication rate.ResultsTwelve out of 24 JVTs were patent at last follow‐up. Mean duration of retention of a patent tube was 6 years. Aeration of the middle ear with a patent JVT was excellent, with mean Sade score at last visit of 1.08. Mean improvement in air bone gap between the preoperative and last visit was 3 dB. Twelve out of 24 JVTs extruded during the study period. The mean time to extrusion was 21 months. There was no difference in age at insertion between the 2 groups (P =. 113). Two complications were identified, which were persistent tympanic membrane perforations.ConclusionJVTs are a safe alternative to traditional pressure equalization tubes. When successful, they can establish a well‐aerated middle ear for extended periods of time. However, early extrusion undermines reliability.
Management of Hearing in Pediatric Neurofibromatosis 2
Authors: Shepard Taylor H. , Kaylie David , Tucci Debara L. 
Published: September 2011

ObjectivePediatric patients with neurofibromatosis type 2 (NF2) present a unique and difficult challenge to the neurotologist. The participants should be able to discuss the various approaches to pediatric patients with NF2 in regard to hearing preservation techniques and individualized management strategies.MethodCase study format. Five unique clinical scenarios demonstrate various surgical approaches and management techniques for hearing preservation.ResultsPatients with NF2 are still developing physically, mentally, and socially. They generally have a poorer prognosis and diminished life expectancy compared to adult patients. Considerations of utmost importance include management of the tumor with the goal of minimizing outcomes such as significant bilateral hearing loss, facial paralysis, and injury to other cranial nerves. This review provides insight into clinical challenges associated with NF2 and illuminates the therapeutic options for hearing preservation and optimized quality of life in these patients. Each case clearly demonstrates important management principles that provide a framework for care of the pediatric NF2 patient.ConclusionEach patient with NF2 is unique. Methods to preserve hearing must be individually tailored in order to preserve optimal hearing and avoid disruption of the development of the pediatric patient.
Management of Intracranial Complications of Otitis Media: Clinical Perspective from a Regional Otolaryngology Program
Authors: Lin James , Nuss Daniel W. , Walvekar Rohan R. 
Published: September 2011

ObjectiveAnalyze the problems, methods, and outcomes encountered in treating intracranial complications of otitis media in an underserved region by an otolaryngology program distributed over 3 cities up to 130 miles apart with limited neurosurgical availability. Suggest systems‐based improvements in optimizing care and cost‐effectiveness of complicated otologic patients.MethodA retrospective review of intracranial complications of otitis media managed by the LSUHSC Otolaryngology program in public and private hospitals with variable neurosurgical availability from July 2008 to January 2011. Limitations of access to sub specialty evaluations, medical therapy, and surgical therapy are discussed. Outcomes for 8 patients with intracranial otologic complications are described.ResultsIn our retrospective review, 2 patients with petrous apicitis (25%), 3 patients with meningitis (37.5%), 2 patients with brain abscess (25%), and 1 patient with sigmoid sinus thrombophlebitis (12.5%) were encountered. A total of 75% of patients (6/8) received intravenous antibiotics as initial treatment, while 2 patients (25%) underwent urgent otologic surgery. All patients initiated on conservative protocol improved clinically. Of these, 3 patients underwent outpatient combined otologic‐neurosurgical surgery and 1 patient required an urgent neurosurgical intervention, while 2 patients could be managed without surgical intervention. Three of 8 patients (37.5%) were lost to long‐term follow‐up. There were no known patient deaths.ConclusionIn a regional otolaryngology program, concerns in managing emergent otologic conditions include limited access to subspecialty surgeons, diagnostic studies, and patient transportation. Antibiotic therapy is often effective as a single treatment modality or in stabilizing patients until definitive elective surgery, which may reduce the need for costly urgent patient transportation.
Role of Postoperative Aspirin in Free Tissue Transfer
Authors: Lighthall Jessyka G. , Bell Rachel A. , Wax Mark K. , Ghanem Tamer Abdel‐Halim 
Published: September 2011

ObjectiveExamine if flap outcomes and complication rates in free tissue transfer surgery performed by a single microvascular surgeon vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation.MethodA retrospective chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, re‐exploration, and salvage. Chi square analysis was performed to identify differences based on type of postoperative antithrombotic therapy.ResultsA total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received only aspirin, and 54 received a combination of agents. The overall complication rate was 38% with significantly more complications in the aspirin group compared with no prophylaxis (P =. 002). There was no significant difference in bleeding complications (P =. 192) or flap failure (P =. 839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group (P =. 039) with a trend toward a higher salvage rate in these cases (P =. 058) when compared with the no prophylaxis group.ConclusionPostoperative thromboprophylaxis with aspirin after microvascular free tissue transfer is associated with a higher complication rate without an increase in bleeding or improvement in free flap survival in our series. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.
Management of Inverted Papilloma of the Temporal Bone
Authors: Rowan Nicholas , Kalyoussef Evelyne , Liu James K. , Jyung Robert W. 
Published: September 2011

Objective1) Understand the clinical presentation, etiology, and histopathology of inverted papilloma of the temporal bone. 2) Discuss current treatment and management of inverted papilloma of the temporal bone as well as considerations for future management.MethodInverted papilloma (IP), a benign neoplasm typically arising within the sinonasal tract, has rarely been reported occurring outside the sinonasal tract. Only 18 cases of temporal bone IP have been reported. We review our 2 cases of temporal bone IP and discuss their management.ResultsOur cases demonstrate both primary and secondary temporal bone involvement. The first case was a primary lesion with atypical otoscopic appearance of a granular mass extending from the middle ear through a tympanic membrane perforation. This was managed with a tympanoplasty, canal wall up mastoidectomy, and facial recess approach. The second case presented as a subepithelial mass extending from the posterior wall of the ear canal after 3 resections of a sinonasal IP. Because of advanced bone destruction, extensive resection similar to a retrolabyrinthine approach was required, followed by tympanomastoid obliteration. Recurrence was monitored with baseline and follow‐up PET‐CT scans.ConclusionTemporal bone IP is a rare neoplasm with no definitive treatment algorithm. We recommend aggressive surgical resection with close postoperative follow‐up. PET‐CT may be useful for identifying multicentric disease at presentation or for early identification of recurrent disease. HPV detection may identify IPs at risk for multicentric or recurrent disease.
Middle Ear Cholesteatoma and Its Complications
Authors: Cosgarea Marcel , Maniu Alma , Necula Violeta 
Published: September 2011

ObjectiveCholesteatoma is still one of the most challenging ear diseases, its evolution leading sometimes to serious complications (facial palsy, vestibular disorders, meningitis, intracranial abscesses, sigmoid sinus thrombosis, etc). Surgical treatment is always required to heal the disease.MethodWe reviewed the surgical reports of 534 patients treated in the ENT Clinic from Cluj between 2003 to 2010. Patients’ ages ranged from 3 to 81 years, with a mean age of 30 years. The surgical procedure was to follow the cholesteatoma extension from the tympanic cavity to the mastoid cavity.ResultsMost of the cases were operated in closed technique. We have used for ossicular reconstruction incus body without osteitis, the head of the malleus, and cortical of temporal bone. For tympanic membrane and canal wall reconstruction we have used perichondrium cartilage with or without perichondrium. Patients with complications underwent open technique. Recurrence of suppuration was noticed in 28% of cases, requiring a second intervention. Hearing improvement was obtained in 58% of patients, satisfactory results were obtained in 19% of patients, and 23% of patients showed no improvement of hearing.ConclusionAutologous materials remain a useful alternative for middle ear reconstruction, improving the hearing in most of the cases. The treatment in cholesteatoma is always surgical, requiring a careful removal of the infection. The surgical technique should be individualized from case to case.
Middle Ear Irrigations Decrease the Density of Mucosal Biofilms in an Animal Model of Acute Otitis Media
Authors: Walker Thomas J. , Abi Hachem Ralph , Angeli Simon I. , Liu Zue‐Zhong 
Published: September 2011

ObjectiveBacteria in biofilms are extremely resistant to antibiotics. Recurrent acute otitis media appears to be a disease related to biofilm formation. The goal of this study is to determine if middle ear irrigations with saline or baby shampoo could eradicate mucosal biofilms in a chinchilla model of acute otitis media.MethodAfter a baseline ABR, middle ears of 10 chinchillas were inoculated with Haemophilus influenzae. On day 5, the ears were irrigated with saline or 1% baby shampoo using a syringe or hydrodebrider. A final ABR was obtained before the animals were euthanized and middle ear mucosa were harvested for SEM analysis.ResultsBiofilm formation on middle ear mucosa in chinchillas was in nonuniform distribution. SEM analysis by a blinded microscopist showed a statistically significant decrease in biofilm densities of middle ear mucosa after normal saline or 1% baby shampoo irrigations when compared with nonirrigated ears using Wilcoxon/Kruskal‐Wallis Tests (P <. 01). No statistically significant difference in biofilm densities between normal saline and 1% baby shampoo irrigations was seen. The hearing thresholds on auditory brainstem responses (ABR) at frequencies 16 kHz, 4 kHz, 1 kHz, and 500 Hz were unchanged two days after normal saline or 1% baby shampoo irrigations.ConclusionMiddle ear irrigations with 1% baby shampoo or normal saline lead to a statistically significant decrease in biofilm densities. One percent baby shampoo or normal saline are non‐ototoxic and can be safely used for middle ear irrigations. Future work in our laboratory will study the effect of a hydrodebrider prototype.
One Stage BAHA Surgery in Children: Two Centers Experience
Authors: Rivas Alejandro , Forero Victor H. , Rivas Adriana , Haynes David S. , Rivas Jose A. , Hall Joseph E. , Labadie Robert F. 
Published: September 2011

ObjectiveDetermine the incidence of postoperative complications associated with bone anchored hearing aid—BAHA—implantation in one surgical time frame for children and adolescents.MethodRetrospective study at 2 tertiary referral centers. A total of 84 patients less than 18 years old (104 BAHA procedures) with conductive, mixed, and single sided deafness between 2003 and 2010.ResultsPostoperative complications occurred in 21 (20.2%) implants placed. Complications related to skin in 11 (10.5%) cases, implant extrusion occurred in 7 (6.7%) cases, and loss of abutment occurred in 3 (2.8%) cases. 40 dB average functional hearing gain was observed in the whole group of patients.ConclusionWe found overall incidence (20.2%) of postoperative complications for this group involving 2 different centers and implantations in one surgical time frame, which is not higher than that reported in the 2 stage procedure. These results support the feasibility and safety of single‐stage surgery for BAHA implantation in this group of patients.
Ossicle Erosion and Conductive Hearing Loss in Cholesteatoma
Authors: Martins Olga , Selesnick Samuel H. , Victor Jonathan 
Published: September 2011

ObjectiveInvestigate and analyze the relationship between individual ossicular erosion and ABG among patients with cholesteatoma. Data from patients undergoing initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative PTA data, intraoperative assessment of individual ossicular destruction, and clinical characterization of cholesteatoma.MethodFor each patient, the cholesteatoma was categorized as primary acquired, secondary acquired, congenital, or unable to discern. Ossicular destruction was graded, and ABG was calculated. For each ossicle, the relationship between degree of cholesteatoma involvement and ossicular erosion and the ABG were analyzed using univariate and multivariate linear regression.ResultsA total of 158 primary cholesteatoma surgeries were performed by the senior author between 1992 and 2009 that met our inclusion criteria. The status of each ossicle was significantly associated with the ABG in a graded and independent manner; this association was most significant for the incus. Cholesteatoma abutting an intact ossicle did not significantly affect the ABG. Clinical categorization of cholesteatoma was not significantly associated with the ABG.ConclusionVia the use of a new and detailed grading scale, this study reveals that the erosion of each ossicle contributes in a graded and independent manner to the increase in ABG, with the status of the incus having the most statistically significant association with ABG.
Ossiculoplasty Efficacy Monitored by ECoG‐Laser‐Doppler Technique
Authors: Niemczyk Kazimierz , Bartoszewicz Robert , Sokolowski Jacek , Morawski Krzysztof F. 
Published: September 2011

Objective1) Understand changes in the acoustic conductivity of the ossicular chain reconstruction during ossiculoplasty. 2) Assess the need to change shape and positioning of the prosthesis during surgery.MethodSix patients underwent a “second look” procedure 12 months after closed tympanoplasty. A prosthesis was positioned between the stapes plate and graft. Laser Doppler Vibrometer (LDV) was used to assess prosthesis moveability. Simultaneously round window electrocochleography (RW‐ECoG) was recorded to evaluate hearing threshold. LDV and RW‐ECoG were recorded following acoustic stimulation.ResultsThe average value of LDV‐speed at 500 Hz is 0.29 m/s (SD 0,19), at 1000 Hz is 0.16 m/s (SD 0.084), at 2000 Hz is 0.043 m/s (SD 0.026), at 4000 Hzis 0.047 m/s (SD 0.0093) and at 8000 Hz is 0.018 m/s (SD 0.0093). The prosthesis revealed a significantly higher mobility at 500 to 1000 Hz than at 2000 Hz. Ossicular movability measured on the prosthesis compared to intraoperatively measured hearing thresholds. Both techniques showed its utility in assessment of efficacy of acoustic energy transfer after ossiculoplasty, though in patients with affected bone curve, discrepancies between hearing thresholds and LDV results were observed.ConclusionIntraoperative assessment of amplitudes and thresholds of ossicular chain movability informs the surgeon about efficiency of the acoustic energy transfer through the reconstructed ossicular chain. LDV technique with RW‐ECoG led to achievement of the optimal position and tension of reconstructed ossicles.