bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malleus Handle: Determinant of Success in Ossiculoplasty
Authors: Bared Anthony , Angeli Simon I 
Published: August 2008

ObjectiveIdentify prognostic factors affecting outcome in ossicular chain reconstruction (OCR).MethodsRetrospective case series of electronic database at an academic institution. We reviewed 209 cases of OCR performed from January 2000 through September 2007, and systematically collected demographic, clinical, audiologic, and outcome information. Univariate analyses of group differences in terms of postoperative air‐bone gap (ABG) changes were evaluated by ANOVA. Multiple regression analyses were used to examine the relationship between postoperative air‐bone gap (dependent variable) and the independent variables.ResultsThere were 107 cases of OCR which met inclusion criteria (45 primary and 62 revision tympanoplasties) with an average follow‐up of 19 months. There were 36 cases of chronic suppurative otitis media without cholesteatoma and 71 cases with cholesteatoma. The mean preoperative ABG was 32 ± 15 dB and the mean postoperative ABG was 23 ± 14 dB (P < 0.001). Of the independent variables analyzed, the type of procedure (i.e., tympanoplasty vs. canal‐wall up vs. canal‐wall down) and status of malleus handle were predictive of the success of OCR.ConclusionsFavorable prognostic factors in OCR include smaller preoperative ABG and the presence of an intact malleus handle. Our findings support the practice of performing OCR at the time of the second‐look procedure.
Performance and QOL after Geriatric Cochlear Implantation
Authors: Georgolios Alexandros , Dodson Kelley Melissa , Baldassari Cristina , Maiberger Patrick G , Sismanis Aristides 
Published: August 2008

ObjectiveTo assess audiologic performance and quality of life in geriatric cochlear implantation patients and to determine whether comorbid medical conditions, etiology, and duration of hearing loss impact audiologic and quality of life outcomes.MethodsGeriatric patients who underwent cochlear implantation between 1990 and 2006 were evaluated. Inclusion criteria were 55 years of age or older at time of implantation and post‐lingual hearing loss. Patients with primary language other than English were excluded. 49 cochlear implant recipients were identified. A group of younger implanted patients was used as a control. All patients completed standardized audiologic tests including the Hearing In Noise Test. Validated surveys, including the Glasgow Benefit Inventory and the Hearing Handicap Inventory for the Elderly, were used to assess quality of life.ResultsThe mean age at implantation was 69.5 (range 58–85) and the average time interval from the implantation to the completion of the surveys was 73.2 months (6 to 229). Identified comorbid conditions included hypertension, diabetes, and malignancies, among others. Audiologic performance and quality of life scores between the two groups were similar. In the geriatric group there was no difference in patient satisfaction between subgroups with 0–1, 2–3 or > 3 comorbid conditions.ConclusionsOur results suggest that the audiologic performance and quality of life scores between the older and younger age groups are similar. In the geriatric group associated comorbidities did not interfere with patient satisfaction as assessed by survey instruments.
Surgical Treatment of Tympanic Membrane Retractions
Authors: Srinivasan Venkat R , Rubasinghe Mihirangi Shamane , Low Christopher 
Published: August 2008

ObjectiveTo report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions.MethodsRetrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and temporalis fascia. Paired T test was used to compare the mean ABG before and after surgery.Results34 ears were operated on in 33 patients with an age range of 8 to 66 (mean 38). Full extent of the retraction was visible (Moderate) in 12 ears and not visible in 22 ears (Severe). Cholesteatoma was found in 10 ears (all in Severe group) and ossicular erosion was noticed in 29 ears. Follow‐up ranged from 12 to 66 months (mean of 36 months). The success rate was 97% with recurrence of retraction in 1 ear. Air‐bone gap improved in 31 ears, remained the same in 1 ear, and worsened in 2 ears. The pre‐ and postoperative mean ABG values were 24.3 (SD 9.5) and 17 (8.7). The difference was 7.3 p<0.0001(95% CI=4.8,9.9). Cholesteatoma recurred in 1 patient. Cholesteatoma presence and severity of retraction did not have any influence on the recurrence rate (Fisher's Exact Test).ConclusionsHigh incidence of per‐operative discovery of cholesteatoma (30%) in our series supports early, aggressive management of symptomatic retractions. Thinned cartilage is more effective with less chances of migration.
Tinnitus Suppression Using AM and FM Acoustic Stimuli
Authors: Rothholtz Vanessa S. , Djalilian Hamid R , Carroll Jeff , Fine Esther L. , Tang Qing , Zeng Fan‐Gang 
Published: August 2008

Objective1) Customize amplitude‐modulated (AM) and frequency‐modulated (FM) acoustic stimuli to suppress tinnitus. 2) Understand the theoretical mechanisms underlying tinnitus suppression.MethodsA double‐staircase adaptive procedure was utilized to match both the frequency and intensity of the tinnitus. Minimal masking levels for both noise and pure tones were acquired. In a double‐blinded procedure, sinusoidally amplitude‐ and frequency‐modulated stimuli were administered. Pre‐ and post‐stimulation tinnitus loudness levels were compared to quantify the effects of suppression and residual inhibition of tinnitus. Multivariate analysis was performed to evaluate independent predictors of tinnitus suppression. Different types and severity of tinnitus and hearing loss were correlated with the effective sounds.ResultsAt present, 18 patients aged 35 to 75 (mean 58.3) with Tinnitus Handicap Index (THI) scores ranging from 12 to 90 (mean 52.6) have been evaluated. Significant associations were found between the duration of the AM and FM stimuli and the effect on tinnitus suppression. 10 out of 18 (56%) patients had a reduction in their tinnitus loudness by 30% or more. Upon comparison with the masking level, reduction in the subjects’ tinnitus was observed when a lower intensity of the modulated stimuli was presented. Subject characteristics that correlated with a significant reduction of the tinnitus will be discussed in detail.ConclusionsAM and FM stimuli can decrease the percept of tinnitus significantly. It is postulated that AM and FM stimuli produce synchronized cortical responses to more efficiently compete against tinnitus‐induced synchrony.
TMS in Tinnitus Treatment: Enhancement by Dopamine Agonists?
Authors: Kleinjung Tobias , Vielsmeier Veronika , Landgrebe Michael , Steffens Thomas , Strutz Juergen , Langguth Berthold , Langguth Berthold 
Published: August 2008

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) of the temporal cortex revealed positive effects in patients with chronic tinnitus. Recent preclinical data in healthy controls suggest that effects of low frequency rTMS can be enhanced by application of dopamine agonists. Based on these data, we investigated whether application of a dopaminergic drug increases clinical effects of low frequency rTMS over the auditory cortex in tinnitus patients.Methods18 subjects with chronic tinnitus received sessions of 1Hz rTMS (2000 pulses/d, 110% motor threshold) applied to the left temporal cortex on 10 subsequent working days. Additionally, these subjects received one dosage of Madopar® (100mg Levodopa/ 25 mg Benserazide)1 hour prior to each TMS session. Treatment outcome was assessed over a 3‐month period with a tinnitus questionnaire (TQ). Treatment effects were compared to a control group matched for age, gender, tinnitus duration, and hearing loss, which received the same rTMS treatment without prior Levodopa application.ResultsTMS treatment resulted in a reduction of TQ scores in both groups. Improvement was slightly superior in the Levodopa group, but the difference did not reach statistical significance (p <0.05).ConclusionsThese results further support that rTMS has beneficial effects in treatment of chronic tinnitus. Levodopa resulted in a slight, but non‐significant, tendency towards better outcome. Further studies with larger sample sizes are needed.
Update: Auditory Brainstem Implant Outcomes In Children
Authors: Colletti Liliana , Carner Marco , Veronese Sheila , Colletti Vittorio 
Published: August 2008

ObjectiveThis study illustrates the auditory perceptual development and the non‐verbal cognitive abilities in young deaf children fitted with auditory brainstem implant (ABI).MethodsIn our department, from 2000 to 2008, 31 children, aged 9 months to 16 years, received an ABI for different tumor and non‐tumor diseases. Six children have elsewhere previously had a CI with no sound detection. 14 out of 31 children had associated disabilities. The retrosigmoid‐transmeatal approach was used in tumor patients and the retrosigmoid approach was used in non‐tumor patients. Perceptual auditory abilities were evaluated with the CAP and EARS battery tests. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale‐Revised (LEITERS‐R) test battery. Intraoperative EABRs and postoperative EABRs and EMLRs were performed.ResultsNo postoperative complications were observed. All children consistently use their devices for more than 75% of waking hours and have environmental sound awareness. Their CAP scores ranged from 2 to 7 (average: 4); at MAIS they scored 2%–98.5% (average: 39%); MUSS scores ranged from 5% to 100% (average: 51%) and LIP scores from 5% to 100% (average: 46%). Scores on 2 of the 4 subtests considered for cognitive evaluation in this study increased significantly (from 2 to 10; p>0.01) during the first year of ABI use in all 10 children.ConclusionsThe findings of the present study indicate that children with cochlear or cochlear nerve abnormalities, with or without associated cognitive deficits, should not be excluded from ABI implantation.
Childhood Epistaxis: Naseptin and Cautery vs Naseptin Alone
Authors: Fraser Lyndsay , Calder Nick , Kang Swee K. , Kunanandam Thushitha , Montgomery Jennifer , Mphil Haytham Kubba 
Published: August 2008

ObjectiveEstablish whether selective application of combined silver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.MethodsWe performed a prospective randomised controlled trial. All children referred with recurrent epistaxis were seen in a research clinic. Patients with visible anterior septal vessels were invited to participate and were randomised to receive either treatment or control. Allocation was made using opaque, sealed and shuffled sequentially numbered envelopes.Treatment patients received silver nitrate cautery followed by 4 weeks of Naseptin. Control patients received sham cautery (using the inactive end of the caustic applicator) followed by Naseptin for 4 weeks. The patients were reviewed after 8 weeks and the outcome measure was ‘no reported bleeding’ in the preceding 4 weeks. Any reported bleeding was defined as treatment failure. A power calculation was made based on a previous study by the department: 108 participants were required.Results229 children attended and 109 met the inclusion criteria and were randomised. Complete data is currently available for 80. Of those receiving cautery and Naseptin, 18/38 (47.4%) had no bleeding in the preceding 4 weeks and of those receiving only Naseptin, 12/42 (28.6%) had no bleeding. (Chi‐squared=3, p=0.08). This gives a relative risk reduction of 26% and a number needed to treat of 5.5.ConclusionsSilver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.
Cochlear Implants in Pediatric Bacterial Meningitis
Authors: Isaacson Brandon , Lee Kenneth H , Kutz Joe W , Roland Peter S 
Published: August 2008

Objective1) To determine pediatric cochlear implant performance outcomes for hearing loss secondary to bacterial meningitis. 2) To determine if a performance difference exists in pediatric cochlear implant patients with and without labyrinthitis ossificans.MethodsA retrospective case review was performed at a tertiary care multi‐disciplinary cochlear implant program. 45 children were implanted from 1991 to 2006 whose hearing loss resulted from bacterial meningitis. Mode of communication, school placement and performance were reviewed.Results21 patients(52%) were in a mainstream educational enviroment and 19 (48%) were in a special needs enviroment. 24 subjects (58%) used an auditory‐verbal mode of communication, while 17 (42%) used total communication. The mean speech reception threshold was 28dB with a range from 5 to 65dB. 14 subjects (56%) had labyrinthis ossifcans, while 11 subjects (44%) did not.ConclusionsThe present study demonstrated that over half of our subjects developed labyrinthitis ossificans. Despite the presence of cochlear ossification, patients with bacterial meningitis‐induced hearing loss can often perform in a main‐stem classroom with auditory‐verbal communication.
Current Indications for Pediatric Endoscopic Sinus Surgery
Authors: Shah Rahul K , Zalzal George H , Pena Maria T 
Published: August 2008

ObjectiveTo describe current indications, sinonasal pathologies, and outcomes of endoscopic sinus surgeries (ESS) in children.MethodsRetrospective chart review of children that underwent ESS at a children's tertiary care facility from July 2004 to June 2007 was performed. Demographic data, clinical profiles, surgical procedures including revisions, and complications were analyzed.Results117 ESS were performed on 88 children (mean age 9.6 years) and 4 adults; 64 were male. The most common indications for ESS in descending order were: chronic rhino‐sinusitis (CRS) (n=29), subperiosteal periorbital abscess (n= 20), sinonasal neoplasm (n= 11), intracranial complication from acute sinusitis (n=8), CRS with cystic fibrosis (n=8), complicated acute sinusitis (n=6), allergic fungal sinusitis (n=5), antrochonal polyps (n=2), invasive fungal sinusitis (n=1), and other pathologies (n=2). 21 children underwent an average of 2.2 sinus procedures. Majority of revisions were on patients with tumors (46%), allergic fungal sinusitis (40%), intracranial complication from acute sinusitis (38%), complicated acute sinusitis (33%), subperiosteal periorbital abscess (15%), CRS with cystic fibrosis (13%), and CRS (10%). Two children had excessive bleeding requiring another anesthetic to complete the procedure; 1 patient had airway obstruction from a tracheal blood clot requiring bronchoscopy.ConclusionsMore than 2/3rds of patients had ESS for indications other than uncomplicated CRS. Approximately 1/4 required revision surgeries reflecting the complexity of sinonasal pathologies seen in children compared with adults. Otolaryngologists performing pediatric ESS must not only be skilled in sound surgical technique, but must have appropriate interdisciplinary professional support to address the associated clinical problems seen in children.
Outcomes of Pediatric Posterior Graft Laryngotracheoplasty
Authors: Rizzi Mark , Thorne Marc C. , Zur Karen B , Jacobs Ian N 
Published: August 2008

Objective1) Determine the operation specific decannulation rate of patients who required posterior costal cartilage grafting (PCCG) in the management of laryngeal stenosis. 2) Describe the complications associated with PCCG laryngotracheoplasty. 3) Describe voice outcomes for selected patients.MethodsA retrospective review was performed on all cases of posterior graft laryngotracheoplasty (LTP) performed by the 2 senior authors over a 9‐year period at a tertiary care children's hospital.ResultsThere were 42 total patients. The operation specific decannulation rates were 100% (3/3) for Myer‐Cotton grade II SGS, 75% (20/26) for grade III, and 60% (3/5) for grade IV. For posterior glottic stenosis (PGS), it was 57% (4/7) and for PGS with grade II SGS, it was 60% (6/10). There was no significant difference (p=0.727) among these groups. The overall decannulation rates were 100% (3/3), 96% (25/26), and 100% (5/5) for Myer‐Cotton grades II, III and IV. For PGS, it was 83% (5/6), and for PGS with grade II SGS, it was 100% (8/8). There was no significant difference (p=0.527) among these groups. The relative risk for complications was higher among children who had a sutured vs. a sutureless posterior graft (RR= 2.7, p<.01). The most commonly seen compensatory vocal behavior was supraglottic dysphonia.ConclusionsOperation‐specific decannulation rates are not significantly different with increasing disease severity, although the power to detect small differences in this study is low. PCCG via a sutureless technique is associated with a lower complication rate. Supraglottic dysphonia is a common compensatory vocal behavior after PCCG LTP.
Pediatric Laryngotracheal Stenosis: Where Are We Heading
Authors: Sandu Kishore 
Published: August 2008

ObjectiveWe compare decannulation rates after Laryngotracheal Reconstruction(LTR) and Cricotracheal Resection(CTR) in matched patients. Glottic Stenosis remains a challenge and can be treated by Extended Partial Cricotracheal Resection(PCTR). The objective of the paper is to systematically classify patients to be treated by these different techniques.MethodsIn 61% of patients, single‐stage PCTR with peroperative resection of the tracheostoma was chosen if no more than 5 tracheal rings were resected with the SGS. If the location of the tracheostoma requires the resection of 6 or more tracheal rings, then PCTR was performed in 2 stages. 13% of children in this group sustained an anastomotic dehiscence, compared to 4.5% of children who had a shorter tracheal resection. 17 patients who weighed under 10 kg of body weight and were less than 1 year old underwent CTR and have all been decannulated.ResultsIt is noteworthy that more than a single procedure was necessary in 68% of the cases to reach the aforementioned results with LTRs, whereas only 18% of the cases needed a second open procedure to achieve decannulation with PCTR. Extended PCTR with LT mold for complex frozen larynges has proven to have promise. Complications included anastomotic granulations, minor dehiscence. No patient had a recurrent laryngeal nerve palsy.ConclusionsLTR is a less extensive procedure and is preferred for some grade II and less severe grade III stenoses. CTR is reserved for severe grade III and IV stenosis. Stenosis close to the vocal cords remains a challenge and can be treated by extended PCTR.
SurgiSIS vs. Autologous Fascia Myringoplasty in Children
Authors: D'Eredita Riccardo 
Published: August 2008

ObjectiveSurgiSIS is a new bioactive material derived from porcine small intestinal mucosa (SIS). This acellular, easily absorbable collagen matrix promotes early and new vessel growth, and provides scaffolding for the remodeling tissues. This is an inexpensive and ready‐to‐use alternative to autologous grafts. We evaluated the efficacy, safety, and surgery time of SIS myringoplasty, and compared clinical outcomes with patient's temporalis fascia (PTF) repair in children.MethodsProspective, 2‐group (SIS, and PTF) randomized, blinded study in a tertiary‐care pediatric institution. 82 children for whom tympanic membrane (TM) repair was indicated were randomly assigned to receive either SIS or PTF myringoplasty. Patients and examining physician were blinded to surgical modality. Primary outcomes were the healing of the TM and surgical time; secondary outcome was presence of any reaction or inflammation of the TM. 2‐year follow‐up was obtained in all enrolled children.ResultsA total of 82 TM (43 in the SIS and 39 in the ATF groups) perforations were treated. There were 42 stable TM closures in the SIS (97.6%) and 37 (94.8%) in the PTF arm. TM closure was higher in the SIS arm, but results were not statistically significant (OR=04, 95% CI 0.12–1.41). SIS myringoplasty yielded reduced surgical time. No clinical evidence of reaction to SIS was encountered.ConclusionsSIS myringoplasty is a safe and effective method for TM closure in children, with reduced surgical time. As compared with PTF, the SIS myringoplasty is not associated with significant decrease in the incidence of residual perforations.
Symptom Duration and CT Findings in Pediatric Neck Infection
Authors: Meyer Abby C , Kimbrough Tyler G , Finkelstein Marsha , Sidman James D 
Published: August 2008

ObjectiveTo test the hypothesis that children with less than 48 hours of localized symptoms of deep space neck infections are less likely to have an abscess on CT than children with at least 48 hours of localized symptoms.MethodsChildren seen in a tertiary hospital between 2000 and 2007 with infections of the head and neck region, excluding peritonsillar abscess, were identified. Data regarding presentation, physical exam findings, radiographic findings, and treatment were extracted.ResultsOf 179 children identified, 167 (93.3%) underwent a CT scan of the neck, of which 102 (61.1%) were positive for abscess. The median duration of symptoms in children with and without abscess on CT were the same (48 hours). There was no significant difference in the rate of abscess on CT between children with less than 48 hours of localizing symptoms and 48 or more hours of symptoms at 58.1% and 57.7% respectively (p=0.96). Furthermore, there were no significant difference in gender, C‐reactive protein levels, or disease location between children with and without abscess on CT. White blood cell counts were significantly higher in the abscess group (p=0.01), however the median white blood cell count in both groups was above normal.ConclusionsBecause duration of symptoms does not predict finding of abscess on CT scan in pediatric deep neck space infections, it is appropriate to obtain a CT scan upon presentation in all children with symptoms concerning for deep neck space abscess.
Early Tracheotomy in the Elderly Results in Less Pneumonia
Authors: Schneider Glenn Todd , Christensen Nathan P. , Doerr Timothy D 
Published: August 2008

ObjectiveTo determine if early tracheotomy in elderly patients (age > 65) results in less ventilator associated pneumonia, mortality and morbidity.MethodsThis is a retrospective chart review of 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographic data, admission criteria, medical comorbidities, disposition, outcome, and ventilation data were collected and analyzed.Results158 patients were included in the study. 43 patients were included in the early tracheotomy group (continuous intubation time <7 days), and 115 patients were included in the late tracheotomy group. There were no statistically significant differences in the demographics of the 2 groups including age, gender, race, reason for intubation (respiratory failure, airway obstruction, etc), or medical comorbidities including COPD. A highly statistically significant difference in the rate of ventilator associated pneumonia was noted in the early vs. late tracheotomy group (23.3% vs 52.6%, p<0.0009). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (2.2 vs 1.5, p<0.0001). The total admission time was also shorter in the early tracheotomy group (27.0 days vs 39.0 days, p<.0171). There was no difference noted in mortality, although there was a general trend of lower mortality in the early tracheotomy group (20.1% vs 32.1%, p<0.1683).ConclusionsEarly tracheotomy in elderly patients is associated with less ventilator associated pneumonia, more frequent intubations, less total admission time, and a trend towards lower mortality.