bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Facial Nerve Grading Systems: House‐Brackmann to Automated
Authors: Lee Linda N. , Henstrom Douglas , Cheney Mack , Hadlock Tessa 
Published: September 2011

Objective1) Evaluate the feasibility of an automated zonal facial function grading system through comparison with the House‐Brackmann II (HBII) scale. 2) Determine whether such a computerized tool for facial analysis patients can provide objective, accurate, and reproducible assessment in both global and zonal regions of the face.MethodA prospective clinical trial was performed with 77 consecutive new facial paralysis patients undergoing standardized facial videography. Videos were independently scored by 3 facial nerve specialists using the HBII scale. Subsequent digital analysis was performed with Facogram software, and computer‐generated scores were recorded and compared.ResultsInterobserver correlation was high using the HBII scale, with correlation coefficients of 0.81, 0.86, and 0.84. Automated Facogram scores correlated well with manual HBII (scores were within 1.0 ± 0.59, 1.4 ± 1.1, 1.1 ± 1.0, 1.1 ± 0.8, and 1.4 ± 0.8 for overall grade, brow, eye closure, nasolabial fold, and oral commissure, respectively). The HBII required more clinician time to calculate, with an average of 72 ± 21 seconds per case, compared with the Facogram which did not require any clinician time. Specific patient characteristics and video techniques that improved accuracy of the software were identified.ConclusionAn automated, zone‐specific facial analysis tool would eliminate inter‐rater subjectivity and allow assessment of facial paralysis patients in a standardized manner across geographic regions and medical specialties. Facogram correlates well with the HBII system. Clinicians should understand the ideal patient population and videotaping technique to optimize accuracy of the program.
A Study of Antibacterial and Antifungal Properties of Human Cerumen
Authors: Singh Rohit , Bairey Indira , Gupta Sumit 
Published: September 2011

ObjectiveThis study investigates the effect of human cerumen on the growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans and describes the order of inhibition of the bacteria and fungi.MethodProspective study on 100 cerumen samples using Nutrient agar and SDA as culture medium was performed. Serial 10‐fold dilutions using 3.5% cerumen suspension was incubated at 37°C for 12 hours. Ten microliters of each dilution were inoculated on blood agar and incubated for 24 hours.ResultsOf 100 samples, only sterile samples were taken. At dilutions of 103 there was no growth of Escherichia coli and Pseudomonas aeruginosa in all samples, no growth of Staphylococcus aureus in 81.25% samples, and Candida albicans in 87.50% samples. After analysis, the order of inhibition was noted as Escherichia coli greater than Pseudomonas aeruginosa greater than Staphylococcus aureus greater than Candida albicans.ConclusionHuman cerumen has antibacterial and antifungal properties in descending order as shown: Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans. Hence, wax acts as a protective coating over the external auditory canal. Thus, routine wax removal is not mandatory unless impacted wax is leading to earache or conductive hearing loss.
Audiometric Protocols for MRI Screening of Acoustic Tumors
Authors: Cheng Teddy C. , Wareing Michael 
Published: September 2011

Objective1) Evaluate audiometric protocols and recommend the protocol with best sensitivity and specificity for MRI Screening of acoustic neuroma and meningioma tumors. 2) Determine the clinical “risks” of missing tumors and financial “wastes” in screening nonacoustic tumors and nonpathological cases. 3) Identify decision‐making parameters in best‐performing protocols.MethodRetrospective review of 3‐year cohort (September 2006 to October 2009) of 1,751 ENT patients who underwent puretone audiometry and acoustic‐tumor MRI‐screening in a tertiary center. Audiometric protocols were ranked— sensitivity to acoustic tumors; specificity (A and B rates) to nonacoustic tumors and nonpathologies. False negatives indicated clinical risks; false positives determined financial wastes.ResultsNo audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved >90% sensitivity rates—the AMCLASS‐A‐Urben protocol (93.16%) and the Mangham protocol (91.58%). Eleven of 15 protocols for Specificity‐A and 12 of 15 protocols for Specificity‐B achieved ≥ 50%. Clinical risks were 6.84% to 18.95% while financial wastes were 33.56% to 68.37% for Specificity‐A and 31.76% to 66.86% for Specificity‐B. Interaural difference parameters indicating highest mean sensitivity rates in the order of ≥ 10dB, ≥ 15dB, and ≥ 20dB, while frequency‐comparison parameters were in the order of “two adjacent frequency,” “single frequency,” and “averaged multi‐frequency” comparison. Mean specificity patterns were the exact opposite.ConclusionMangham protocol, proposing ≥ 10dB interaural difference averaged 1 to 8khz, is the preferred recommendation (sensitivity 91.58%; specificity‐A 44.23%; specificity‐B 44.91%). As representation of the local patient population and clinical resource allocation priorities, each center is encouraged to conduct audiometric protocol and symptomatology analysis of its own clinical cohort in deciding diagnostic protocol policy.
Biofilm Potential of Common Otopathogens
Authors: Ojano‐Dirain Carolyn P. , Antonelli Patrick J. 
Published: September 2011

ObjectivePosttympanostomy tube (TT) otorrhea has been linked to microbial biofilms. TTs may be exposed to a wide range of microbes. The purpose of this study was to compare the TT‐biofilm forming propensity of common otopathogens, Pseudomonas aeruginosa (PA), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Streptococcus pneumoniae (SP).MethodFluoroplastic coupons were exposed to plasma and cultured with 3 strains of PA, SA, HI, or SP for 2, 4, or 7 days. Half of the coupons were treated with antibiotics to kill planktonic bacteria. Total and biofilm colony counts and electron microscopy were performed.ResultsSA formed mature biofilm after 2 days, not different from 4‐ or 7‐day biofilms (P >. 05), and was most tolerant to antibiotic treatment. PA also formed biofilms at 2 days, reached a plateau at 4 days (P >. 05), and decreased at 7 days (P <. 01). HI formed biofilm only after 4 days (P ≤. 04). SP did not form biofilm without catalase supplementation. With catalase, one SP strain showed a delay in biofilm formation similar to HI (P <. 0001) while the other 2 strains formed biofilms after 2 days.ConclusionTT biofilm formation occurs with common middle ear pathogens, but most readily with SA and PA. Further investigation is needed to determine if these findings may in part explain the occasionally refractory nature of post‐TT otorrhea associated with SA and PA.
Cadaveric Percutaneous CI with AB, Cochlear, and Medel Electrodes
Authors: McRackan Theodore R. , Dawant Benoit , Blachon Grégoire S. , Labadie Robert F. , Noble Jack , Balachandran Ramya 
Published: September 2011

Objective1) Describe advances made in percutaneous cochlear implantation (PCI) that involves a minimally invasive approach to the cochlea via a single, image‐guided drill pass from the lateral cranium through the facial recess. 2) Demonstrate implementation of PCI in cadavers using Advanced Bionics (AB), Cochlear, and Medel electrodes.MethodPCI was performed on 7 cadaveric temporal bones with 2 AB, 2 Cochlear, and 3 Medel electrodes. This included preoperative CT scanning and PCI trajectory planning, placement of bone‐implanted fiducial markers, intraoperative CT, CT registration, creation and attachment of customized microstereotactic frame, drilling from cortex to cochlea, and CI insertion.ResultsPCI was successfully performed on all 7 specimens using the AB insertion tool for AB electrodes and via manually threading and endaural advancement for Cochlear and Medel electrodes. Postoperative electrode position was assessed by CT scanning and histopathology. CT correctly predicted 6 of the 7 electrodes to be in scala tympani and 1 in scala vestibuli. Histopathology revealed minimal insertion trauma with preservation of the osseous spiral lamina and basilar membrane and complete scala tympani insertion in 6 of 7 specimens. One specimen, due to violation of the basilar membrane at the round window cochleostomy, had complete scala vestibuli insertion.ConclusionThis is the first description of complete PCI using AB, Cochlear, and Medel electrodes. Using various insertion techniques, atraumatic electrode insertion was achieved in the majority of specimens, similar to results clinically reported for traditional CI surgery. Building on this, we anticipate clinical implementation of PCI in the near future.
Can Computerized Tests Serve as an Objective Measure and Improve Cognitive Abilities in Tinntius?
Authors: Kallogjeri Dorina , Katta Nikta , Wineland Andre , Piccirillo Jay F. 
Published: September 2011

ObjectiveExamine the relationship between severity of tinnitus, as measured by the Tinnitus Handicap Inventory (THI), and performance on a computer‐based objective test of cognition (ie, Brain Speed Test (BST)) and investigate the impact of a Brain Fitness Program (BFP) on tinnitus patients.MethodCross‐sectional study of 60 adults with tinnitus. BST was completed by all participants. Results were transformed to z scores (BSTZ) based on age‐matched control data. Fifteen subjects continued in a longitudinal study using BFP. Attention, memory, and bother scores were assessed in addition to THI score and BST post‐training.ResultsDuration of tinnitus for the 60 participants (average age, 54 years; 51% males) ranged from 6 months to 47 years (median, 7 years). THI ranged from 0 to 80 (median, 26). Severe tinnitus was present in 27 (46%) of participants. A significant relationship between severity of tinnitus and BSTZ was identified in the group of participants with severe tinnitus (Spearman rho = 0.52, P =. 006). Thirteen subjects completed BFP. All subjects with bothersome tinnitus (n = 6) reported a subjective improvement in attention and memory.ConclusionThese results suggest that BST could serve as the first objective measure of the cognitive impairment associated with tinnitus. These data also suggest that Brain Fitness Program can be a potential aid to patients with severe tinnitus, as it seems to improve attention, memory, and ability to comprehend.
Composite Mandibulectomy: A Novel Animal Model
Authors: Sidell Douglas R. , Bezouglaia Olga , Tetradis Sotririos , Aghaloo Tara , St. John Maie 
Published: September 2011

ObjectiveThe safe and reliable reconstruction of composite mandibulectomy defects is a topic of significant interest. Unfortunately, a well‐established small‐animal model of the segmental composite mandibulectomy does not exist. We describe a reliable animal model that can be utilized to study mandibular reconstruction techniques, including atuogenous bone grafts and biomaterials.MethodProspective analysis of survival‐operations in the rat model (4‐month Sprague Dawley Rattusnorvegicus). A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented, utilizing photographic and radiographic images. Postoperative management, early pitfalls, surgical complications and future applications are discussed.ResultsA total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and seven postoperative complications were recognized. There were 4 orocutaneous fistulas, 1 abscess, and 1 seroma. There were 3 fatalities; deaths were attributed to anesthetic complications (2, intraoperative) and foreign‐body aspiration (1, postoperative).ConclusionThe novel animal model described here, reliably replicates the en‐bloc segmental mandibular defects seen in our patient population. It can be manipulated to achieve a wide variety of research objectives, including the evaluation of biomaterials and tissue engineering techniques.
Characteristics of Distortion‐Product Otoacoustic Emissions Level Decrease at High Altitude
Authors: Olzowy Bernhard , Gleichenstein Gregor , Ripfel Simon , Mees Klaus 
Published: September 2011

Objective1) Understand the characteristics of Distortion‐Product Otoacoustic Emissions (DPOAE) level decrease during ascent to high altitudes. 2) Learn whether DPOAE might provide information about the state of acclimatization and the risk of acute mountain sickness (AMS).MethodFrom March 12, 2006, until April 23, 2006, DPOAE (f2 = 1, 1.5, 2, 3, and 4kHz), blood oxygen saturation (SaO2), and the Lake Louise score (LLS) to assess AMS were measured in 187 trekking tourists on the Mt Everest trek in Nepal at 2610 m and 5170 m.ResultsMean DPOAE level decrease at 5170 m compared with 2610 m was ‐5.1dB (1kHz), ‐3.7dB (1.5kHz), ‐4.0dB (2kHz), ‐4.6dB (3kHz) and ‐3.7dB (4kHz). Mean SaO2 was 94.8% at 2610 m and 79.0% at 5170 m. The LLS indicates AMS when >2. While at 2610 m none of the study subjects had AMS (mean LLS 0.04), and at 5170 m 82 (43.9%) had AMS (mean LLS 2.8). Low SaO2 correlated with high LLS.ConclusionDPOAE levels decrease during ascent to high altitudes across all frequencies. This phenomenon might be due to cochlear hypoxia. While low SaO2 seems to indicate an increased risk of AMS, a decrease of DPOAE levels is not correlated with AMS.
Characterization of Vestibulocerebellar Degeneration
Authors: Pothier David D. , Ranalli Paul , Rutka John A. 
Published: September 2011

Objective1) Report the largest series to date of patients with cerebellar ataxia with bilateral vestibulopathy (CABV). 2) Understand the unique balance problems in this disorder; we studied the eye movements crucial for gaze stabilization.MethodFrom over 16 years at a multidisciplinary neuro‐otology clinic, 32 patients (mean age, 51.7 (SD = 19.3)) with symptoms of CABV syndrome over a median of 5 (IQR = 2‐10) years were selected for both clinical and oculographic analysis of their central and peripheral vestibular function.ResultsVestibulo‐ocular reflex (VOR) function was impaired on Halmagyi head thrust testing in 74% of patients; patients studied by oculography revealed a subnormal mean VOR gain of 0.67. Impaired dynamic visual acuity was abnormal in 88%. Importantly, this impairment would have been underestimated by bithermal caloric testing, in which only 22% were subnormal. Gaze‐evoked nystagmus (70%), impaired smooth pursuit (88%), and impaired cancellation of the VOR (93%) revealed the associated vestibulocerebellar dysfunction. Impaired saccular otolithic function (44% abnormal VEMP) added to patient imbalance. 77% of patients displayed obvious gait ataxia, and a further 41% had dysmetric limb function.ConclusionThe unique double‐pathway balance impairments in patients with CABV are evident in the high prevalence of subnormal function of both peripheral and central vestibular signals seen in their dysfunctional eye movements. This is an easily missed clinical entity that is often associated with normal caloric investigations.
Cochlin Expression in Patients with Ménière Disease
Authors: Calzada Audrey , Beltran‐Parrazal Luis , Ishiyama Akira , Ishiyama Gail , Lopez Ivan A. 
Published: September 2011

Objective1) Determine the distribution of cochlin in the vestibular endorgans of patients with Ménière disease (MD) through quantitative immunohistochemistry and real‐time PCR (RT‐PCR). 2) Compare cochlin expression in the vestibular endorgans in normal vs MD patients. 3) Correlate changes in cochlin expression with underlying pathophysiology in MD.MethodVestibular endorgans were obtained from 8 patients with MD who underwent ablative labyrinthectomy from 1997 to 2010. Control specimens were obtained from 8 patients undergoing labyrinthectomy for acoustic neuroma excision and 5 autopsy specimens with normal audiovestibular function. Quantitative immunohistochemistry of cochlin expression and RT‐PCR were performed in vestibular endorgans.ResultsIn the normal control specimens, cochlin immunoreactivity (IR) was found evenly distributed in the stroma of the cristae ampullaris and maculae of the utricle. In the MD specimens, cochlin IR was markedly increased and intense. Diffuse cochlin precipitate was found within the stroma and basement membrane underlying the sensory epithelium in both the maculae of the utricle and the cristae ampullaris in vestibular endorgans from MD patients. Increased cochlin expression in MD specimens was confirmed with RT‐PCR.ConclusionCochlin upregulation has been implicated in DFNA9, a hereditary audiovestibulopathy with similar symptomatology to MD. The overexpression of cochlin in vestibular endorgans of MD patients may contribute to dysfunctional inner ear homeostasis. These findings warrant the future study of cochlin and its associated extracellular matrix molecules in MD pathology.
Computed Tomography in 15 Patients with Congenital Aural Atresia Treated with Floating Mass Transducer on the Round Window
Authors: Carner Marco , Colletti Liliana , Barillari Marco , Cerini Roberto , Mucelli Roberto Pozzi , Colletti Vittorio 
Published: September 2011

ObjectiveIllustrate preoperative (to assess radiological landmarks useful for diagnosis and surgery) and postoperative (to visualize complications and evaluate the correct positioning of the FMT) imaging features in patients with congenital aural atresia (CAA) treated with the floating mass transducer (FMT) of the Vibrant Soundbridge on round window (RW).MethodFifteen patients, aged from 2 months to 54 years, treated with FMT on the RW for bilateral (11 patients) and monolateral (4 patients) CAA, underwent high resolution computed tomography (HRCT) scans and/or cone‐beam CT scans (CBCT) preoperatively and postoperatively at 12‐to‐60‐month follow‐up times. The first 4 patients had plain‐film X‐rays.ResultsThe tympanic cavity was reduced in size in 20 out of 26 ears (76.9%). Ossicular chain abnormalities were present in all ears. These consisted most frequently of a fusion of the malleus to the incus, as observed in 15 ears (61.5%). The RW area was normal in all patients, while the oval window (OW) was stenotic in 7 ears (26.9%). The facial nerve had an abnormal course and/or caliber in 15 ears (61.5%). The mastoid was reduced in size in 9 ears (34.6%). Correct positioning of the FMT on the RW was observed in all patients at the last follow‐up.ConclusionPlain‐film x‐rays are not adequate. HRCT and CBCT scans permit a complete understanding of the CAA anatomy and a precise determination of the location of the FMT on RW. CBCT has a lower administered radiation dose: a very important feature as the FMT is fitted on RW in infancy.
Correlation of Measured vs Averaged 3kHz Pure Tone Averages
Authors: Gurgel Richard K. , Oghalai John S. , Chang Kay W. , Blevins Nikolas H. , Jackler Robert K. , Popelka Robert K. 
Published: September 2011

ObjectiveAAO‐HNS reporting guidelines for hearing results recommend a pure tone average (PTA) using thresholds at 0.5, 1, 2, and 3 kHz. 3 kHz measurements, however, are not always included in routine audiometry. We determined the magnitude of PTA errors using 3 kHz thresholds interpolated from 2 and 4 kHz measurements.MethodRetrospective analysis of audiogram data from an academic, tertiary referral center from April to August 2010. All patients (N = 1,204) in our clinic having audiograms for any reason were eligible for inclusion. Audiograms missing threshold data at any of the frequencies evaluated were excluded.ResultsThe difference between calculated and measured 3 kHz was within 5 dB, 10dB, and 20dB in 89.5%, 68.9%, and 98.6% of audiograms respectively. When the 3kHz level varied more than 10 dB from actual, the error underestimated the degree of hearing loss by a 3:1 margin (7.9% vs 2.6%). The steeper the slope of the hearing loss, the greater the divergence of the interpolated value from actual. When factored into the PTA, however, measured verses interpolated thresholds at 3 kHz showed a difference within 5 dB in 98.6%, R = 0.996, with a mean difference of 0.6 dB (SD = 1.7dB).ConclusionWhile interpolation of 3 kHz introduces a degree of error in measurement of this specific frequency, the effect on PTA is minor. These data suggest that 3 kHz thresholds can be reliably interpolated using available 2 and 4 kHz thresholds when utilized in PTAs.
CT or MRI before Cochlear Implantation
Authors: Hajioff Daniel , Joy Rajive , Robinson Philip J. , MacKeith Samuel A. 
Published: September 2011

ObjectivePrevious studies of CT and MRI before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.MethodClinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.ResultsA total of 27.9% (95% CI: 21.0 ‐ 35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9 ‐ 18.9). All of these were detected by MRI. They were missed by CT in 6.3% (3.1 ‐ 11.3). A total of 6.3% also had noncritical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children, but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone is estimated to miss no critical abnormalities (95% CI: 0 ‐ 2.3%).ConclusionMRI can detect all abnormalities critical to patient management. Most candidates for cochlear implantation can therefore be assessed by MRI initially. CT is most likely to be helpful in those with a history of severe middle ear disease, meningitis, or dysmorphic syndromes, who should undergo both CT and MRI.
Customized Web‐Based Sound/Music Therapy for Tinnitus
Authors: Djalilian Hamid R. , Ziai Kasra , McGuire John 
Published: September 2011

ObjectiveLearn whether customized sound therapy can be delivered via the Web. Understand the efficacy of customized Internet‐based therapy in reducing tinnitus loudness.MethodThirty‐two subjects were enrolled. The patients matched their tinnitus frequency using a Web‐based protocol. A customized harmonic sound therapy file was downloaded by the patient onto an MP3 player. The subjects listened to the sound file for 1 hour using open‐ear headphones at a level equal to tinnitus loudness (mixing‐point).ResultsThe age ranged between 32 and 67 years. Prior to harmonic sound therapy, tinnitus loudness mean was 6 (range, 0‐10) which decreased to 3.3 (range, 0‐6) after 1 hour of sound therapy. Some reduction in loudness was seen in 88%, while 72% experienced a reduction of 25% or more. Tinnitus annoyance decreased from an average of 6.1 (range, 1‐10) to 3.1 (range, 0‐8). Median duration of residual inhibition was 60 minutes, with an average of 86 minutes (range, 0‐720). The harmonic masking protocol and some characteristics associated with a significant reduction of the tinnitus will be discussed.ConclusionCustomized sound therapy can be delivered via the internet. Harmonic sound therapy is effective in reducing the loudness and annoyance of tinnitus in a diverse group of subjects. Advantages and limitations of this method of tinnitus therapy will be discussed.