bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tissue Modeling in a Patient‐Specific Skull Base Surgical Simulator
Authors: Roberts Erik , Salisbury Kenneth , Chan Sonny , Blevins Nikolas H. 
Published: September 2011

ObjectivePatient‐specific surgical simulation is a new frontier that promises great benefits for surgical planning and rehearsal. However, it requires an efficient means of generating virtual anatomic models. Our objective is to develop a workflow to convert clinical imaging data into computational representations that support real‐time simulation and haptic interaction.MethodStandard computed tomography was obtained from 3 otologic patients. Key anatomy was segmented, cleaned by morphological operations, and converted into 3D polygonal meshes. These were reduced to the desired complexity and converted to solid tetrahedral meshes. Results were imported into the Simulation Open Framework Architecture (SOFA) for interactive simulation.ResultsUsing the workflow developed, we were able to create accurate patient‐specific virtual models of surgically relevant otologic anatomy. The resulting structures can be deformed and manipulated interactively through a haptic interface. Although still labor‐intensive, the workflow promises considerable time‐saving over purely manual segmentation and model creation. The resulting models are amenable to derivation and application of physical properties of specific tissues to improve behavioral realism.ConclusionOur prototype is an effective means of converting preoperative imaging into patient‐specific 3D models suitable for interactive physical simulation. We continue to make model creation more automated. The potential for adding tissue‐specific physical properties will augment realism and increase the utility of the simulation for surgical rehearsal.
TNF‐Alpha Expression on Acquired Cholesteatoma Behavior
Authors: Martin Cristina N. , Santos Ana Carolina S. , Castanheira Luis V. , Camera Marcela G. , Testa Jose R. , Testa Norma 
Published: September 2011

ObjectiveThis article aims to show the qualitative TNF‐alpha expression on acquired cholesteatoma behavior and the recurrence prognostic factor.MethodWe retrospectively selected 2 groups of patients with acquired cholesteatoma who underwent open tympanomastoidectomy to remove the disease: the first group had recurrence after at least 2 years, and the second group had the disease under control over 4 years.ResultsImmunohistochemistry was done using a TNF‐alpha receptor marker in both groups and was evaluated by 3 observers who followed the patterns according to the relationship between the reagent expression and the epithelium. The 0 level means no reagent expression, the + level means that a third were dyed, the ++ level means more than two thirds were dyed, and the +++ level means the fullest extent of the epithelium was dyed. The mean expression of TNF‐alpha was slightly higher in the group with recurrence than in the control group, respectively 1.7 + 1.4 +, but there was not detected a statistically significant difference between the groups (P =. 456).ConclusionAlthough several articles show TNF‐alpha action bone destruction in cholesteatoma cases in vitro, the qualitative expression of TNF‐alpha was not a good predictor in cholesteatoma recurrence.
Transient Low‐Tone AB Gaps after Canal Plugging Surgery
Authors: Uetsuka Satoru , Inohara Hidenori , Kamkura Takefumi , Sakata Yoshiharu , Horii Arata , Kitahara Tadashi 
Published: September 2011

ObjectiveThe present study aimed to determine the time course and frequency patterns of transient low‐tone air‐bone gaps (ABGs) after canal plugging for intractable BPPV.MethodWe investigated 8 patients with intractable BPPV who underwent canal plugging. Four cases had posterior semicircular canal type BPPV (pBPPV), and the other 4 had horizontal semicircular canal type BPPV (hBPPV). Pure‐tone audiometries (PTAs) were performed before surgery and 7 days, 1 month, and 6 months after surgery.ResultsThe ratio of the number of patients with ABGs (+) was 100.0% (8/8) on the 7th day and 1st month postoperatively, and it was 0.0% (0/8) in the 6th month postoperatively. There were no significant differences in the time course or frequency patterns of ABGs between pBPPV and hBPPV.ConclusionOur findings suggest that, during such a convalescence period, the plugged area might not be completely repaired yet and could still induce dizziness and low‐tone ABGs, since enlarged vestibular aqueduct syndrome and superior semicircular canal deficiency syndrome exhibit low‐tone ABGs because of a third mobile window into the inner ear.
Tympanostomy Tube Sequelae Related to Pathogens
Authors: Fulton Edward , Ojano‐Dirain Carolyn P. , Antonelli Patrick J. , Wingkun Niel‐Jeremy G. 
Published: September 2011

ObjectivePosttympanostomy tube (TT) sequelae have been associated with a wide range of middle ear pathogens. Though microbes commonly bind to TTs, it is unclear what leads to clinical pathology. The goal of our study was to investigate the role of middle ear pathogens in post‐TT sequelae.MethodTTs were explanted for a range of indications and analyzed for biofilm formation using electron microscopy (EM) and quantitative polymerase chain reaction (qPCR) with specific primers for otopathogens. Results were correlated with the otologic status.ResultsNone of the 18 TTs demonstrated Aspergillus niger, Candida parapsilosis, or Candida albicans. Streptococcus pneumonia was found in one TT with recurrent otorrhea. Pseudomonas aeruginosa was found in 44.4% of TTs, 2 out of 2 TTs with active otorrhea, and 87.5% with recent or current otorrhea. Staphylococcus aureus was found in 78% of TTs and 6 out of 6 TTs with granulation tissue. Haemophilus influenza was found in 72% of TTs, irrespective of clinical status. EM revealed that TTs commonly have complex topographical features, which may serve as reservoirs for microbial growth and biofilm formation.ConclusionPost‐TT sequelae, such as otorrhea and granulation tissue, are more common with P aeruginosa and S aureus colonization and/or biofilm development. H influenza is also prevalent, but less clearly related to clinical pathology. These findings may have implications related to the pathogenesis and treatment of post‐TT sequelae.
Unilateral Sensorineural Deafness: BAHA vs TransEar Device
Authors: Rivas Adriana , Bernal Elizabeth , Usaquen Francy , Forero Victor H. , Rivas Alejandro , Rivas Jose A. 
Published: September 2011

ObjectiveCompare the audiological and quality of life assessment in 2 groups of patients: users of BAHA and users of TransEar devices.MethodRetrospective study of 20 patients with unilateral sensorineural hearing loss. Group number 1, 10 patients using TransEar. Group number 2, 10 patients using BAHA. Prefitting Pure Tone Average (PTA) 0.25 to 4kHz compared with postfitting PTA 0.25‐ 3kHz between groups. Survey results of the Hearing Device Satisfaction Scale tool.ResultsFunctional hearing gain was observed in both groups. The BAHA system showed higher hearing benefit than the TransEar system. When mean thresholds of each system were compared, mean functional response was 41dBSPL with the TransEar and 25dBSPL with the BAHA. The satisfaction level of sound category was slightly better for the BAHA device. TransEar is preferred over BAHA in fitting, cosmesis, and management issues. BAHA showed better scores for quality of life aspects.ConclusionIn this group of patients, higher hearing benefit of osseointegrated implant regarding the effectiveness over the intracanal system was observed. When satisfaction level is analyzed related to fitting, management, and quality of life, an intracanal device is preferred.
Vagal Palsy Following Cerebellopontine Angle Surgery
Authors: Best Simon R. , Starmer Heather M. , Hillel Alexander T. , Francis Howard W. , Akst Lee M. , Chien Wade W. , Agrawal Yuri 
Published: September 2011

Objective1) Understand that the vagus nerve is at risk during excision of lesions of the cerebellopontine angle (CPA), with a potential impact on voice and swallowing function. 2) Describe the incidence and risk factors for vagal palsy in patients undergoing excision of CPA tumors.MethodRetrospective chart review of 181 consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Unilateral vagal palsy was identified by laryngoscopy or cine‐esophagram, and clinical variables were collected from medical records.ResultsUnilateral vagal palsy was identified in 19 out of 181 (10%) patients. Vocal fold motion impairment (VFMI) in combination with pharyngeal palsy was more common than VFMI or pharyngeal palsy alone. Those with vagal palsy had a larger mean tumor size (30 mm) than those without vagal palsy (20 mm, pp with vagal palsy (67%).ConclusionVoice and swallowing function can be affected by surgical excision of pathology of the CPA. Tumor size is an independent risk factor for postoperative vagal palsy, with consequences for prolonged hospital stay, aspiration, and voice, and swallowing impairment.
Vertebrobasilar Artery Aneurysms: An Uncommon Cause of Vertigo
Authors: Hart Catherine , Pensak Myles L. 
Published: September 2011

ObjectiveReview our experience with vertebrobasilar artery aneurysms and discuss factors which may enable clinicians to distinguish between these potentially life‐threatening posterior circulation aneurysms and other conditions with similar presentations.MethodCase series with chart review. The charts of patients who underwent surgical management of posterior circulation aneurysms at a tertiary care center between December 1995 and February 2008 were reviewed.ResultsA total of 57 patients (40 females, 17 males) with an average age of 52.8 years (range, 27‐79 years) were included. A total of 44 patients were white, 5 were African American, and 8 were unspecified. Aneurysms of the posterior communicating artery and posterior inferior cerebellar artery were most common, occurring in 28 (49%) and 26 (46%) of patients, respectively. The most common initial symptoms were headache in 31 patients (54%) and acute mental status changes in 18 patients (32%). Eight patients (14%) presented acutely with dizziness or vertigo. 26 patients (46%) underwent suboccipital craniotomy with aneurysm clipping. Fifteen (26%) underwent frontotemporal craniotomy, and 5 (9%) underwent a combined neurosurgical‐neurotologic approach. There were 8 deaths.ConclusionVertebrobasilar aneurysms are uncommon and typically present emergently after rupture. A small number of patients with such aneurysms may present with neurotologic symptoms, such as vertigo and disequilibrium. Given the potentially grave consequences of a ruptured aneurysm, it is essential that otolaryngologists remain cognizant of the presentation of posterior circulation aneurysms.
Vestibular Rehabilitation in Postural Control of the Elderly
Authors: Kasse Cristiane Akemi , Maia Denise , Gazzola Juliana , Thomaz Juliana Q. 
Published: September 2011

ObjectiveAnalyze the effectiveness of personalized vestibular rehabilitation therapy (VRT) associated with body balance training in postural control of elderly patients with chronic peripheral vestibular disorders assessing the Dynamic Gait Index (DGI) and static posturography (Balance Rehabilitation Unit‐BRUTM) before and after the treatment.MethodProspective study of 20 elderly with chronic peripheral vestibulopathy. The BRUT M parameters were the limit of stability and the area of body center of pressure in the followed conditions(C): C1‐stable surface/open eyes; C2‐stable surface/closed eyes; C3‐unstable surface/closed eyes; C4‐5 stable surface/visual‐vestibular interaction. The VRT consisted of personalized vestibular exercises associated with static and dynamic body balance training.ResultsAll patients improved their symptoms after 12 to 16 sessions of VRT associated with balance training (50 minutes). The outcomes (mean; standard deviation) after therapy were: the limit of stability increased (Pre‐VRT: 133.8;51.9 cm2; Post‐VRT: 178.45;47.3 cm2; P =. 001), the area of body center of pressure in C2 (Pre‐VRT: 5.70; 6.31 cm2; Post‐VRT: 2.60; 1.95 cm2; P =. 01), C3 (Pre‐VRT: 13.48;8.69 cm2; Post‐VRT: 7.67; 3.86 cm2; P =. 001) and C4 (Pre‐VRT: 6.11; 4.67 cm2; Post‐VRT: 4.38; 2.57 cm2; P =. 053) decreased, and fall risk was reduced (DGI: Pre‐VRT=19.42; 4.07 points; Post‐VRT=22.21; 2.74 points; P =. 003).ConclusionVestibular rehabilitation therapy associated with body balance training improved the postural control of elderly patients with chronic vestibular dysfunction, increasing the value of limit of stability with reduction of body oscillation in conditions without visual inputs and with somatosensory and visual‐vestibular conflicts, and reducing the fall risk.
Vibrant Soundbridge Middle Ear Implant in Romanian Patients
Authors: Cosgarea Marcel , Necula Violeta 
Published: September 2011

ObjectiveThe Vibrant Soundbridge (VSB) system helps hearing impaired people who, for various reasons, are unable to use conventional hearing aids. This study presents our experience and outcomes with the first eight patients we implanted with this device.MethodEight patients were implanted with a VSB in our department from 2006 to 2010. Seven of them had sensorineural hearing loss, while one case involved otosclerosis with mixed hearing loss. All patients received a VSB from Med‐El.ResultsSeven patients, aged between 18 and 72 years, were implanted with the VSB’s floating mass transducer attached to the incus, while the patient with otosclerosis underwent implantation at the round window. Preoperative pure‐tone audiograms, acoustic immittance tests, and speech intelligibility tests were conducted on all patients and compared with postoperative results. The postoperative PTA outcomes indicated no loss of residual hearing. Mean PTA have increased from a 60.20 ± 2.80 dB mean value to a 26.67 ± 2.60 dB mean value at 6 months after activation. All patients noticed improved high‐frequency perception and clearer sound quality with the VSB comparing to conventional hearing aids.ConclusionVibrant Soundbridge middle ear implant is improving the hearing in patients who are unsatisfied with or cannot wear conventional hearing aids for different reasons. Poor sound quality and ear occlusion were the most important complaints that lead patients to decide on the surgery.
Adenoid Microbiology: Expanded Role of Resistant S. Aureus
Authors: Prosser John Drew , Patel Sagar , Borders Jack 
Published: September 2011

Objective1) Learn the most common bacteria cultured from diseased adenoid tissue, 2) learn the resistance patterns of these bacteria, and 3) compare growth patterns between different patient diagnoses.MethodAdenoid bacteriology has been implicated in multiple infectious diseases of the head and neck. We examined core adenoid tissue from patients undergoing adenoidectomy for chronic adenotonsillitis, hypertrophy with obstruction, or chronic/recurrent otitis media for aerobic and anaerobic bacteria. Further we compared the bacteria isolated (both qualitatively and quantitatively) between groups.ResultsMultiple potentially pathogenic organisms were grown, including S pneumoniae (22.4%), M catarrhalis (19.2%), and H influenzae (13.2%). Interestingly Staph aureus (32.4%) was grown in higher numbers than S pneumoniae, H influenzae, and M catarrhalis. 24.5% of S aureus isolates were methicillin resistant (MRSA, 7.8% of all patients), and 60% were penicillin resistant (19.2% of all patients). Therefore 84% of the S aureus cultured were MRSA or penicillin resistant. Qualitative and quantitative analysis of potentially pathogenic bacteria revealed no significant differences between groups. However, there was a trend for a higher number of MRSA in patients with chronic adenoiditis versus those with hypertrophy.ConclusionKnowledge of common bacteria and resistance patterns guides antimicrobial therapy. Amoxicillin is currently the first‐line treatment for many conditions tied directly to adenoid microbiology. Therefore, the bacteria and resistance patterns of diseased adenoid tissue should be revisited with particular attention to the expanding role of resistant strains of S aureus.
Adenotonsillectomy Bleeding: Microdebrider vs Electrocautery
Authors: Stansifer Kyle J. , Barazsu Lindsay , Szramowski Molly , Buchinsky Farrel J. , Post James C. 
Published: September 2011

Objective1) Describe the intraoperative blood loss during adenotonsillectomy in a pediatric population during the transition to a new technique. 2) Confirm or refute the suspicion that intraoperative blood loss is greater when using the microdebrider than when using traditional curette and electrocautery techniques.MethodRetrospective evaluation of 148 children who underwent tonsillectomy and/or adenoidectomy by a single surgeon transitioning from curette and electrocautery to microdebrider in 2008. Primary outcome was percentage of circulating blood volume lost. Surgical methods were compared by multiple linear regression and chi‐squared to evaluate incidence of “bleeders” (>5% loss).ResultsMedian age was 6.8 years (range, 2.2‐20.6 years). 84 had adenotonsillectomy, 39 had adenoidectomy, and 25 had tonsillectomy. Blood loss ranged from 0% to 15% (median = 2%) blood volume. Sixteen of 148 patients (11%) lost >5% blood volume. A total of 2.3% of blood volume was lost with adenoidectomy by curette or microdebrider compared to no adenoidectomy (P = 6e‐07). Microdebrider tonsillectomy was associated with more blood loss than electrocautery; an additional 1.7% of blood volume (P = 9e‐06). A total of 15 of 84 (18%) who had adenotonsillectomy lost >5% blood volume. 26% of microdebrider patients lost >5% blood volume compared to 12% of electrocautery tonsillectomy patients (P =. 16).ConclusionAdenoid and/or tonsil surgery can result in significant blood loss (>5% of blood volume), which occurred in 11% of our cases. Most of the blood loss is from the nasopharynx. Tonsillectomy by electrocautery is associated with significantly lower intraoperative blood loss than the microdebrider.
Airway System of Care Assessment with High Fidelity Simulation
Authors: Johnson Kaalan E. , Pio Brian , Oehler Jennifer L. , Kerrey Benjamin , Geis Gary , Houlton Jeffrey J. 
Published: September 2011

Objective1) Determine the capacity of high‐fidelity simulation in critical airway obstruction to assess the existing system of care at a pediatric institution. 2) Inform the development of a protocol for the multidisciplinary management of critical airway obstruction in the emergency department (ED) and the operating room (OR).MethodDesign was a prospective assessment, using simulation, of critical airway obstruction management at a pediatric referral center. Subjects were ED, OR, and otolaryngology (ENT) providers. We developed a novel simulation scenario of foreign body aspiration. Measures assessed included ED airway maneuvers, time to ENT arrival, and subject survey responses.ResultsOver 3 months, 67 providers participated in 6 simulations (3 complete in ED and 3 partial obstructions from ED to OR). The mean rating of simulation realism was 6.3 out of 7 (range, 4‐7). Twenty‐one of 67 (31%) providers stated they would apply something learned in the simulation to a real case. In 2 simulations, laryngoscopy was inappropriately performed and resulted in patient deterioration. In all simulations there was confusion about subspecialty consultation. ENT was consulted in all cases; the median time to ENT arrival was 6.8 minutes (range, 5.7‐9 minutes). Identified system deficiencies included a lack of ENT equipment in the ED.ConclusionHigh‐fidelity medical simulation is a safe, feasible, and effective method to assess current systems of care in high acuity, low frequency events. We will use the findings from these simulations to develop, implement, and reassess a protocol for the multidisciplinary management of pediatric critical airway obstruction at our institution.
Asthma and Foreign Body Aspiration
Authors: Saliba Joe , Mijovic Tamara , Nguyen Lily H. , Manoukian John J. , Daniel Sam J. 
Published: September 2011

ObjectiveDetermine the prevalence of asthma in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (sFBA) in the tracheobronchial tree, and to identify characteristics of patients who could benefit from a trial of anti‐asthma treatment prior to undergoing a diagnostic bronchoscopy.MethodRetrospective chart review of children with sFBA in the tracheobronchial tree who underwent RB at the Montreal Children’s Hospital (2001‐2009). Patient characteristics such as delay between initial choking episode and first otolaryngology evaluation, clinical findings, radiologic findings, bronchoscopic findings, and history of asthma were analyzed.ResultsA total of 55 children underwent a RB for sFBA. Foreign bodies (FB) were found in 36 of these, one of which was asthmatic (2.78%, P <. 05). In the 19 children who had a negative bronchoscopy (no FB), four were asthmatics (21.1%, P <. 05). The mean time from the suspected initial choking event to the first otolaryngology evaluation was 27 days in asthmatics (range, 5 hours‐90 days; median, 14 days), whereas it was 7.2 days in nonasthmatics (range, 0.5 hours‐120 days; median, 16 hours). Otherwise, clinical and radiological findings were not significantly different in the asthmatic and non‐asthmatic groups.ConclusionAsthmatic children with sFBA are significantly more likely to have a negative bronchoscopy than non‐asthmatics, especially when there is a delay between the suspected choking episode and the first otolaryngology evaluation. Therefore, a trial of anti‐asthma treatment prior to performing a diagnostic bronchoscopy in this subgroup of patients is justified.
Utility of IMAP Flap in Hypopharyngeal Reconstruction
Authors: Young Lindsay E. , Argo Jimmy , Myers Larry L. , Neilan Ryan E. 
Published: September 2011

Objective1) Describe a novel use of the internal mammary artery perforator (IMAP) fasciocutaneous rotation flap for hypopharyngeal reconstruction.MethodCase series at university‐based tertiary care hospitals. We report 2 cases using the IMAP flap for hypopharyngeal reconstruction. We describe flap elevation and inset and the clinical course of the patients. Outcome measures were flap viability, pharyngocutaneous salivary fistula, and postoperative swallow function.ResultsCase 1 was a 59 year‐old male who underwent organ sparing protocol 5 years prior. He underwent laryngectomy for nonfunctioning larynx. Case 2 was a 58‐year‐old male with T4 squamous cell carcinoma of the larynx with pyriform sinus involvement. We performed a single flap in both cases. Each flap was based on the dominant internal mammary artery perforator vessels at the second and third intercostal spaces. There were no full or partial flap deaths. Both patients developed minor salivary fistulae that healed with conservative, nonoperative management. Both patients tolerated an oral diet within 5 weeks postoperatively.ConclusionThe IMAP flap is ideally suited for hypopharyngeal reconstruction and should be included in the armamentarium of reconstruction options. It is easy to harvest, thin, and pliable, and the arc of rotation allows for tension‐free hypopharyngeal reconstruction. Salivary fistulas may occur.