bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging Correlation of DFNB1 vs Non‐DFNB1 Hearing Loss
Authors: Kochhar Amit , Angeli Simon I , Dave Sandeep , Liu Xue‐Zhong 
Published: August 2008

ObjectiveTo evaluate temporal bone computerized tomography (CT) findings in children with DFNB1 hearing loss (HL) and non‐DFNB1 deaf children, using absolute measurements and visual inspection.MethodsA retrospective case‐control series (1998 to 2005) was performed at an academic tertiary center. Children with non‐syndromic HL were diagnosed as DFNB1 or non‐DFNB1 after screening for GJB2 allele variants and the large GJB6 deletion. After matching for degree of HL, temporal bone CT images were compared in a cohort of 8 DFNB1 children (16 ears) to 9 non‐DFNB1 children (18 ears). Visual criteria and absolute measurements were compared against normative values established by Purcell (2003). Absolute measurements between groups were compared using the student t‐test. Non‐parametric statistical tests were used when appropriate. Significance level was 0.05.ResultsVisual inspection failed to identify 2 patients with abnormalities found using absolute measurements. There was a statistically significant difference in the prevalence of abnormal temporal bone CT findings between DFNB1 (1 of 16 ears) and non‐DFNB1 (10 of 18 ears) (p<0.0031, Fisher exact test). Of the absolute measurements, only the mean vestibule width in the non‐DFNB1 group (4.195 ± 0.5 mm) was significantly greater than in the DFNB1 group (3.65 ± 0.2 mm) (p < 0.001).ConclusionsVisual inspection of temporal bone CT images alone may not adequately identify anomalies and should be used in conjunction with absolute CT measurements. Abnormal temporal bone CT findings are significantly less likely in children with DFNB1 when compared to non‐DFNB1 children, despite matching for a similar degree of HL.
Optical Fiber for CO2 Laser Otosclerosis Surgery
Authors: Lesinski S George , Giesken Kylie 
Published: August 2008

ObjectiveTo determine the safety and efficacy of new handheld optical fibers for CO2 laser stapedotomy and stapedectomy revision. Advantages of the new CO2 optic fibers are: convenience, reliability and precision. Disadvantages are: special adaptor required for laser console, limited spot size and cost. Omniguides’ handheld optic fibers introduce a safe, effective, and precise delivery system for CO2 laser otosclerosis surgery.MethodsProspective study of 25 consecutive otosclerosis patients. Researchers at Massachusetts Institute of Technology have developed a flexible optical fiber (photonic bandgap reflector) which can deliver CO2 laser energy through a handheld probe with minimal loss of laser energy. Omniguide introduced a 0.9 mm (O.D.) fiber in 2007 specifically for otologic surgery. This clinical study analyzes the safety and effectiveness of this new technology for CO2 laser otosclerosis surgery. To determine appropriate energy parameters, stapedotomy was performed in the laboratory on human temporal bones. Subsequently, 25 consecutive otosclerosis patients underwent CO2 laser stapedotomy (21) or stapedectomy revision (4) employing these handheld fibers. 6‐month post op audiograms were analyzed for air/bone gaps and nerve loss according to AAO‐HNS guidelines.Results21/21 primary and 3/4 revision patients closed the air/bone gap to within 15 decibels (mean 0.5, 1, 2, 3 KHz). There was no nerve loss at these frequencies. Three patients demonstrated a slight loss at 4 KHz (2–15 db, 1–20 db) compared with their preop audiograMS These results compare favorably with previous otosclerosis surgery performed by the author with microscope mounted CO2 lasers.ConclusionsAdvantages of the new CO2 optic fibers are: convenience, reliability and precision. Disadvantages are: special adaptor required for laser console, limited spot size and cost. Omniguides’ handheld optic fibers introduce a safe, effective and precise delivery system for CO2 laser otosclerosis surgery.
Piezosurgery® in Otologic Surgery: Four Years’ Experience
Authors: Salami Angelo , Dellepiane Massimo , Mora Renzo 
Published: August 2008

ObjectivePiezosurgery® is a new instrument which is able to cut the bone without necrosis and non‐mineralized tissues damage. The aim of this work has been to report our experience with Piezosurgery® in otologic surgery.MethodsWe have performed Piezosurgery® in platinotomy, mastoidectomy, antroatticotomy, posterior tympanotomy, facial nerve decompression (in its tympanic segment) and excision of middle ear tumours (glomus tympanicum tumour and B‐cell non Hodgkin lymphoma). The piezoelectric device uses low frequency ultrasonic waves (24.7–29.5 kHz); the applied power can be modulated between 2.8 and 16W, and is programmed in accordance to the density of the bone. For platinotomy, a specific operative program was created to avoid involuntary error of the power regulation. The equipment consists of two hand‐pieces, two inserts, and two peristaltic pumps connected to the control unit; the width, the thickness and the angle of the inserts vary in relation to the power that is applied, the bone density, and the surgical techniques that they are used for.ResultsIn each surgical technique, Piezosurgery® provided excellent control without side effects on the adjacent structures of the middle and inner ear.ConclusionsPiezosurgery® is a new and revolutionary osteotomy technique utilizing the microvibrations of scalpels at ultrasonic frequency, so that soft tissue (nerve, vessel) will not be damaged even upon accidental contact with the cutting tip. The vibration frequency of Piezosurgery® is optimal for mineralized tissue and doesn't cut the adjacent soft tissue, minimizing the risk of harming the adjacent tissues: this renders the piezoelectric device ideal for otologic bone surgery.
Practice Guidelines for Sudden Sensorineural Hearing Loss
Authors: Friedland David Richard , Shemirani Nima L. 
Published: August 2008

ObjectiveTo identify and compare patterns of treatment for sudden sensorineural hearing loss among otolaryngologists and primary care physicians.MethodsA multiple choice and Likert scale survey was mailed to 1,306 otolaryngologists and primary care physicians throughout our state, regarding treatment and management approaches to SSNHL. Survey answers were analyzed by scope of practice and years of experience. Treatment protocols were compared among family practitioners, internists, general otolaryngologists, and otologists.ResultsA surprisingly large number of general practitioners treat SSNHL independent of an otolaryngologist. General practitioners as a group, however, are significantly less impressed than otolaryngologists that steroids are an effective treatment (p<0.0001). Over 99% of otolaryngologists start oral steroids at evaluation, as compared to approximately 30% of all general practitioners. Of those general practitioners treating on their own, without otolaryngology consultation, 78% use oral steroids. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone, while lower doses and Medrol dose packs are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond 1 week of hearing loss onset, while general practitioners overwhelmingly will only treat within the first week. Over 50% of otolaryngologists also add anti‐viral medications.ConclusionsSignificant differences exist in the management of SSNHL between otolaryngologists and general practitioners. The lack of strong evidence‐based guidelines for the treatment of SSNHL may underlie the variability in management by first‐line providers.
Prospective Study of the DizzyFIX for the Treatment of BPPV
Authors: Bromwich Matthew A. , Hughes Brian Donald , Raymond Marc Real , Sukerman Sydney , Parnes Lorne S 
Published: August 2008

Objective1) Develop and test a new dynamic visual device for the treatment of Benign Paroxysmal Positional Vertigo (BPPV). 2) Study the efficacy of self‐treatment using the DizzyFIX device compared with standard office treatment.MethodsA prospective cohort design was used to study a newly developed device for the improved performance of particle repositioning maneuver (PRM). From September 2007 to March 2008, patients with active BPPV were seen in 4 different clinical practices (n=40). Patients used the device as their only treatment modality. Subjective patient reports of resolution were recorded at one week. The Dix‐Hallpike maneuver was used to measure objective resolution at one week. Patient outcome using the device was compared with retrospective physician guided controls (n=40) using a Chi squared test.ResultsAll patients reported being able to use and understand the device. 100% of patients in the prospective cohort reported either a cure or some improvement. At one week, 90% of these patients had a negative Dix‐Hallpike test. This rate was comparable to that of the standard physician‐guided treatment group who had a success of 83%. A significant difference in success between groups was not demonstrated (p=0.174).ConclusionsThe use of this new device enabled patients to conduct an effective PRM on their own without physician training and to achieve success rates similar to those of an otolaryngologist.
The Effects of Cochlear Implantation on Vestibular Function
Authors: Melvin Thuy‐Anh N. , Migliaccio Americo , Carey John P , Della Santina Charles Coleman 
Published: August 2008

Objective1) Measure vestibular function before and after cochlear implantation (CI) using a battery of tests covering the full range of stimulus frequencies over which the normal angular vestibulo‐ocular reflex (VOR) stabilizes gaze.MethodsSemicircular canal (SCC) function was assayed using head impulse test during 3‐dimensional scleral search coil eye movement recordings (HIT), dynamic visual acuity during rapid head movements (DVA), head‐shake nystagmus (HSN), and caloric electronystagmography (ENG). Saccular function was determined using vestibular‐evoked myogenic potentials (VEMP). Patient self‐assessment via the dizziness handicap inventory (DHI) and clinical head impulse testing (cHIT) were also measured.ResultsOne of 28 post‐implanted ears (4%) suffered severe loss of vestibular function in all 3 SCCs. HSN revealed no change in 11 subjects. ENG revealed new hypofunction in 1 of 16 ears (6%). Passive DVA revealed no significant change for 16 implanted ears. VEMP revealed significant increase or disappearance in threshold in 5 of 16 ears (31%). DHI scores were variable and correlated poorly with objective tests. The cHIT performed by one otolaryngologist in 14 subjects exhibited 44% sensitivity and 94% specificity for detection of severe hypofunction confirmed via quantitative HIT.ConclusionsCI carries a small but nontrivial risk of iatrogenic vestibular hypofunction in the implanted ear. For bilateral simultaneous‐CI, the risk of bilateral vestibular hypofunction is ∼0.16%, comparable to the likelihood of meningitis. The cHIT was highly specific for vestibular hypofunction in this study, but likely depends heavily on the examiner's threshold for abnormal.
Update of ABI Outcomes in Non‐tumor Adults
Authors: Colletti Vittorio , Shannon Robert V. , Carner Marco , Veronese Sheila , Colletti Liliana 
Published: August 2008

ObjectiveThe traditional indication for auditory brainstem implants (ABIs) is neurofibromatosis type 2 (NF2) in subjects older than 12 years. In our department, the indications for ABIs have been extended to non‐tumor children and adults with cochlear or cochlear nerve injuries or malfunctions who would not benefit from a cochlear implant. The results obtained in non‐tumor adults are reported in this study.MethodsIn our department, from April 1997 to February 2008, ABIs have been implanted in a total of 114 patients (83 adults and 31 children) for different tumor and non‐tumor diseases. 15 patients out of 114 have elsewhere previously had a CI with no sound detection. The retrosigmoid‐transmeatal approach was used in all tumor patients and the retrosigmoid approach was used in all non‐tumor patients.ResultsAll patients had a functioning implantation, and reported auditory sensations with activation of various numbers of electrodes. At 1 year after implantations, non‐tumor adults scored from 10% to 100% in open set speech perception tests (average 57%), and tumor patients scored from 5% to 30% (average 11%). The difference between these results is statistically significant (p < 0.01).ConclusionsHearing outcomes are better in non‐tumor than tumor patients, with a significant number of non‐tumor patients that are able to understand speech at a level comparable to that of the most successful cochlear implant users, including conversational telephone use.
Airway Management of Epiglottitis: A National Perspective
Authors: Acevedo Jason L , Lander Lina , Choi Sukgi S , Shah Rahul K 
Published: August 2008

ObjectiveTo describe demographics and utilization in the treatment of epiglottitis.MethodsThe Kids’ Inpatient Database (KID) was used to extract data for patients 7 years old and younger with a diagnosis of epiglottitis; children undergoing airway intervention (intubation or tracheostomy) were studied.Results33 patients were identified that were either intubated (n=31) or had a tracheotomy (n=3); 1 patient that had a tracheotomy was intubated prior. The mean age of patients was 1.7 years old; 58% being 2 years older or less. 52% were male, and 42% were Caucasian. Average length of stay was 17.7 days (range=0–199). January and October were the most common months for admission (n=5, each). Of admissions ‐ Texas and Massachusetts handled the most (n=4, each). Average total charges were $83860. Private insurance was the primary payor in 55% of cases; 18% patients were discharged to shortterm care facilities. 73% of cases were managed at teaching hospitals; all tracheotomies were at teaching hospitals. There were no mortalities.ConclusionsIn the post‐HiB era, epiglottitis has become a rare entity. Of children under 7 years of age, only 33 required airway intervention in the 36 states sampled in 2003. More than half of affected children were, on average, 2 years old and younger. Airway intervention for epiglottitis is associated with high total charges and prolonged hospitalization. Epiglottitis is a rare, expensive, and protracted disease to treat in the HiB vaccine era. The infrequency of this disease has significant implications for resident education and training.
Arytenoid Prolapse following Laryngotracheoplasty
Authors: Hart Catherine K. , Richter Gresham T. , Cotton Robin T , Rutter Michael J 
Published: August 2008

ObjectiveDynamic arytenoid prolapse (AP) is a potential and often late source of upper airway obstruction in children following laryngotrachoplasty (LTP). Reasons for this occurrence remain unclear. We examined the incidence and clinical features of AP in patients following LTP to explore the etiology and optimal surgical approach to this problem.MethodsRetrospective database and chart review of children diagnosed with AP after LTP at a pediatric tertiary care institution from 1981–2007.Results120 patients with no history of AP were diagnosed with AP following LTP (incidence 7.3% = 120/1634). 63 patients had unilateral prolapse, while 57 had bilateral AP. Average time from LTP to presentation was 44 months. Common symptoms were dyspnea on exertion, tracheostomy‐dependence, and sleep‐disordered breathing. Posterior cricoid interventions and revision LTP were most frequently associated with postoperative AP. 64% (n=77) of patients required surgical intervention. Endoscopic arytenoid reduction (AR) was performed in 54 patients, while 13 underwent AR during revision LTP. 2 patients underwent AR with cordotomy. Tracheostomy was performed with AR in another 2 patients. 28 patients required a second procedure for persistent prolapse. 36%(n=42) of patients did not require surgery. Airway complaints were relieved, or tracheostomy decannulation was achieved, in all patients after AR in which AP was the source of obstruction (avg. f/u=34.4mos).ConclusionsDynamic AP is a notable cause of airway obstruction following LTP. Subtle airway complaints and decannulation failures are common clinical features. Both endoscopic and open AR procedures are successful in relieving AP. Potential etiology for AP after LTP is discussed.
Does Adenotonsillectomy Cure Pediatric Sleep Apnea?
Authors: Friedman Michael , Soans Rohit , Bozkurt Ziya , Lin Hsin‐Ching , Joseph Ninos J 
Published: August 2008

Objective1) Perform an updated meta‐analysis to determine the cure rate of adenotonsillectomy for pediatric sleep apnea. 2) Report the findings of 5 years of experience with standardized coblation intracapsular tonsillectomy for the treatment of pediatric sleep apnea.MethodsA thorough literature search of multiple databases was performed. Inclusion criteria for studies were: 1) Adenotonsillectomy as the primary treatment of sleep apnea (age<18). 2) Pre‐and postoperative polysomnography data was included. 20 studies fit the inclusion criteria and a metaanalysis was performed to determine the overall success. A 5–year retrospective analysis of coblation tonsillectomy performed by a single surgeon for sleep apnea was also performed.ResultsThe meta‐analysis included 904 subjects with average follow‐up time of 21.6 weeks. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k= 20 studies) with T/A based on pre‐and postoperative PSG data. Random‐effects model estimated the treatment success of adenotonsillectomy was 61.1%. When “cure” was defined as an AHI of <1, the cure rate was 53.8%. 200 adenotonsillectomy cases performed with coblation technique were reviewed. The mean preoperative was AHI 28.3 and mean postoperative AHI was 3.8. Surgical cure, as defined as a postoperative AHI <1, was achieved in 51.7% of patients.Conclusions1) Contrary to popular belief, meta‐analysis of current literature and a review of 200 cases demonstrates that pediatric sleep apnea is often not cured by adenotonsillectomy. 2) Although complete resolution is not achieved in most cases, adenotonsillectomy still offers significant improvements in AHI.
Ear Malformations: Surgical Considerations
Authors: Granstrom Gosta , Salen Joachim , Schubertsson Katharina 
Published: August 2008

ObjectiveTherapy of ear malformations has changed considerably the last two decades when new surgical techniques are available. This study aimed to evaluate different approaches to improve hearing and esthetics in ear malformations.MethodsAll patients who underwent rehabilitation for ear malformations between 1960 and 2007 at a University Hospital were investigated. Patients underwent clinical, audiological and x‐ray examinations. Attempts to improve hearing were undertaken by ear canal and middle ear reconstruction, and/or bone anchored hearing aid (BAHA). Attempts to improve esthetics of the external ear were undertaken by autogenous reconstruction (AR) and bone anchored episthesis (BAE).ResultsThere were 211 patients (117 male, 94 female) with ear malformations representing 255 ears. 103 of these were syndromic patients. The degree of ear malformation was generally severe, Meurman stage 3 (external ear) and Altman Creemers stage 2B (middle ear). AR (n=64) was successful to a higher degree in milder malformations (93% for Meurman grade 1, 18% for Meurman grade 3). BAE (n=109) was successful to a high degree independent of Meurman degree (92–100%). A mean of 17 dB closure of air‐bone gap was obtained by ear canal and middle ear reconstruction (n=111). A mean of 46 dB closure of air‐bone gap for BAHA was obtained (n=106).ConclusionsWith the high degree of success for BAE, this option is valuable for children where AR has failed. With the high degree of success for BAHA, children can be supplied with BAHA early and middle ear reconstruction postponed until adolescence.
Etiology of Pediatric Recurrent Croup
Authors: Muntz Harlan R , VanWoerkom Ryan 
Published: August 2008

ObjectiveOften pediatric croup is viral in etiology. Children with recurrent croup (greater than 3 episodes a year) may have underlying pathology making them more prone to these episodes. This study was done to define the frequency of these pathologies.Methods80 consecutive children with the diagnosis of recurrent croup underwent diagnostic endoscopy at a pediatric tertiary care hospital. We carried out a retrospective chart review of these cases.ResultsOf the 80 children, 26 (33%) were found to have subglottic stenosis. The average narrowing was 32 ± 9% in these children. Of the 26 with subglottic stenosis, 19 (73%) also manifested laryngopharyngeal reflux. Of the 15 (19%) patients previously intubated as neonates or infants, 8 (53%) also had subglottic stenosis. 45 (56%) were felt to have laryngopharyngeal reflux by either laryngotracheal findings or other testing. 26 (58%) of these had concomitant subglottic stenosis. Allergies or asthma were found in 31 (39%) of the patients. Another 16 (20%) were found to have tracheomalacia and an additional 7 (9%) were noted to have innominate artery compression. Many had more than one risk factor.ConclusionsThe most common factors associated with recurrent croup are laryngopharyngeal reflux and subglottic stenosis. This study will assist the clinician in discussion of possible etiologies with families and insurers. Defining underlying pathology can then assist in the defining treatment options.
Hoarseness in Children with Cleft Palate
Authors: Hamming Katherine K , Finkelstein Marsha , Sidman James D 
Published: August 2008

Objective1) To determine the rate of hoarseness in children with cleft palate (CP). 2) To understand the relationship between velopharyngeal insufficiency (VPI) and hoarseness in children with CP.MethodsRetrospective chart review of 98 patients treated for CP by a tertiary care Children's Hospital Cleft Team and born between 1990 and 2001.ResultsOf the 98 patients, 59 were male and 39 female. All types of CP were represented. 89% received speech therapy. 41.6% had VPI. The overall rate of hoarseness was 22.4% and of dysphonia was 55.9%. The presence of VPI did not correlate with the presence of hoarseness or dysphonia. However, while VPI decreased when comparing ages 3–4 (58.1%) with ages 6–7 (32.1%) (p <0.001), the hoarseness rates did not change as children got older. Additionally, there was a trend toward higher hoarseness and dysphonia rates in children with Pierre Robin Syndrome (PRS).ConclusionsBoth VPI and hoarseness are common findings in patients with CP. VPI improves as children get older in the setting of a tertiary care cleft team and a high rate of speech therapy. However, hoarseness and dysphonia do not appear to improve. These findings suggest that the theory that VPI causes hoarseness due to compensatory speech mechanisms may be incorrect. Even when resonance problems have improved, CP patients should continue to be evaluated by speech therapists for voice disturbances, as well as evaluated by otolaryngologists for treatable causes of hoarseness. Further, patients with PRS may be at additional risk for voice disturbances and should be treated accordingly.