bluuebunny/crossref_metadata_2025_split huggingface dataset:
S225 – A New Meatoplasty Technique in Canal Wall Down
Authors: Kim Kwang‐Hyun , Choi Ik Joon , Chang Sun O , Song Jae‐Jin , Lee Jun Ho , Oh Seung‐ha , Kim Chong Sun 
Published: August 2008

ObjectivesAlthough it is well recognized that a small meatus after canal wall down tympanomastoidectomy can cause a lifetime problem, unsatisfactory results are frequently encountered. We introduce a new technique to maintain a large external auditory meatus, reduce the mastoid dead space, and improve the posterior auricular cosmetics outcome.MethodsFrom Jan 2005 through Dec 2006, 39 ears had undergone canal wall down tympanomastoidectomy with the perichondreial posterior fixation technique. 2 stitches were made to pull the perichondrium of the canvun conchal cartilage posteriorly to the periostium of the mastoid bone. Medical records were retrospectively reviewed for the postoperative complications, including infection. Postoperative size of the meatus and the extent of cavum conchal cartilage burying into the mastoid cavity were evaluated by taking digital photographs.Results15 males and 24 females were included; the mean age was 54 years (37yr‐66yr). The postoperative follow‐up duration was 9.5 months (6mo‐23mo) in average. All the ears maintained a clean and large external meatus. The posterior auricular cavum conchal cartilage was successfully prevented from being buried into the mastoid cavity in all the ears. The extent of burying was much improved compared to the conventional technique. 2 ears (5%) had a very mild postoperative inflammation but it was easily controlled by topical antibiotics.ConclusionsThe perichondreial posterior fixation, which is a new meatoplasty technique in canal wall down tympanomastoidectomy, seems to be effective in maintaining a large external auditory meatus and improving the cosmetic outcome with minimal risk of complications.
S226 – MRSA and Pseudomonas Infection in Chronic Otitis Media
Authors: Choi Young‐Seok , Shin See‐Ok , Yoo Seung‐Doo 
Published: August 2008

Objectives1) Compare postoperative healing process between otorrhea and non‐otorrhea group. 2) Evaluate the influence of MRSA and Pseudomonas infection on postoperative healing process. 3) Describe the affecting factors of postoperative reperforation and retroauricular abscess.MethodsRetrospective chart review of 392 patients who were operated with canal wall up procedures by one surgeon and followed up at least over 12 months. The patients were divided into control and study groups; 106 non‐otorrhea control group; 74 Pseudomonas infected group (P); 145 MRSA infected group (M); 61 other bacteria infected group (0). The following data were collected: 1) postoperative dressing frequency and duration; 2) the duration of oral antibiotics and intravenous antibitics use; 3) the incidence of postoperative otorrhea; 4) the incidence of reperforation and retroauricular abscess. The Mantel‐Haenszel test and ANOVA test were used for statistical analysis.ResultsStatistical analysis indicates a significant difference in frequency and duration of postoperative dressing and oral antibiotics using peroid (p<0.01). Nevertheless, there were no correlations in postoperative otorrhea and reperforation between the infected group and non‐otorreha group (p>0.05). The incidence of retroauricular abscess was high in the antibiotic‐changed group (p<0.01).ConclusionsMRSA and Pseudomonas infection in chronic otitis media indicated a significant difference in the duration of postoperative follow‐up and the antibiotic‐using period, compared with the control group. The isolated MRSA or Pseudomonas infection after surgery had more incidence of a retroauricular abscess.
S228 – Direct Round Window Drug Application and Ototoxicity in Rats
Authors: Rivera Teresa , Alcantara Fernando García , Suarez Jon Alexander Sistiaga , Silvia Murillo‐Cuesta , Elena Vacas , Rodríguez Julio Contreras , Varela‐Nieto Isabel 
Published: August 2008

Objectives1) Manage to introduce ototoxic drugs, such as kanamycin and furosemide, directly on the round window in rats. 2) Use a purified gelatine sponge as a proper delivery vehicle. The purpose of the study is to assess the validity of this method to provoke local ototoxicity.MethodsWe carried out an experimental design with 3 groups of 6 male Wistar rats. The bulla and round window membrane were exposed using a ventral approach. In the first control group we only made a hole in the tympanic bulla. Second control group was treated with saline solution. The problem group was treated with 20 mg/kg of kanamycin and 5 mg/Kg of furosemide‐soaked gelatine sponge directly upon the round window membrane. Cochlear function was assessed through tone burst auditory brainstem response (ABR) threshold (dB) and peak latency (ms) measurements. Anova with bonferroni correction was used (p level=0.05).ResultsAll animals treated with kanamycin and furosemide exhibited significant increase in ABR threshold (x = 51.25 dB; SD = 6.29; p = 0,001) in contrast to the other groups, whose ABR thresholds did not show significant differences before and after treatment(x=31,50 dB; SD=5.53); and not significant increase in peak latencies I (x = 0.22 ms; SD = 0.12), II (x = 0.22 ms; SD = 0.20) and IV (x = 0.21 ms; SD = 0.18).ConclusionsThe ventral approach and placement of kanamycin and furosemide‐soaked gelatine sponge directly upon the round window membrane represents a reliable method for ototoxicity in rats.
S230 – MRI Findings in Delayed Facial Palsy after Stapedectomy
Authors: Cohen Marc , Kirsch Claudia , Mendelsohn Abie , Ishiyama Akira 
Published: August 2008

Objectives1) To retrospectively review the pathophysiology and radiologic features of delayed facial palsy after stapedectomy. 2) To discuss the management strategy of this unusual problem.Methods450 stapedectomies performed at our institution were retrospectively reviewed from 1997 to 2007. A total of 2 patients in this series developed a delayed facial paralysis postoperatively. The clinical presentation, radiographic characteristics on magnetic resonance imaging (MRI), and the management of these patients are presented.ResultsA total of 2 patients out of 450 stapedectomies within a 10‐year period developed the rare complication of delayed facial paralysis (postoperative days 12 and 41, respectively). Both patients developed rapidly progressive complete facial nerve paralysis preceded by periauricular pain and dysguesia. No sign of infection was present in the operated ear. MRI with gadolinium of the internal auditory canal demonstrated gadolinium enhancement of the labyrinthine portion of the facial nerve as seen in Bell's palsy. Both patients were treated with oral corticosteroids and antiviral medications. Subsequent imaging revealed decreased enhancement of the facial nerve with complete resolution of facial paralysis.ConclusionsIn the rare complication of delayed facial paralysis after stapedectomy, MR imaging is a useful diagnostic tool to dictate the treatment strategy. Delayed facial paralysis following stapedectomy can be treated medically when the MRI scan demonstrates enhancement of the facial nerve in the labyrinthine segment.
S231 – Middle Ear Carcinoma: A Population‐based Study
Authors: Gurgel Richard K , Hansen Marlan , Karnell Lucy 
Published: August 2008

ObjectivesCarcinoma of the middle ear is a rare clinical entity, best suited for evaluation using a large, population‐based database. The objective of this study was to utilize the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence, treatment patterns, and survival of middle ear carcinoma.MethodsUsing SEER*Stat software, data for patients diagnosed between 1973–2004 were extracted based on the middle ear's anatomic code (C30.1). 5‐year observed survival was analyzed with SPSS software, with significant differences determined by the Wilcoxon statistic.ResultsThe 5‐year survival rate for the 215 patients in this study was 36.4%. Histologic subtypes included squamous cell carcinoma (62.8%), adenocarcinoma (18.2%), other carcinomas (13.0%), and non‐carcinomas (6.0%), with 5‐year survival rates of 23.9%, 65.0%, 60.0%, and 38.6%, respectively (p=0.003). Of the 123 patients with known stage, 23.6% had local, 69.1% had regional, and 7.3% had distant disease, with their 5‐year survival rates being 64.9%, 34.2%, and 0%, respectively (p=<0.001). Treatment included surgery (31.2%), radiation (16.3%), surgery and radiation (38.6%), or no treatment (8.4%) with 5‐year survival of 69.2%, 14.6%, 26.4%, and 0%, respectively (p<0.001).ConclusionsPatients with middle ear carcinoma have a relatively poor prognosis, reflected by a 5‐year survival rate of 38.6%. However, subsets such as those with adenocarcinomas (65.0%) and with localized tumors (64.9%), demonstrated significantly better survival. Surgery alone had significantly better survival than the other treatment groups, presumably due to less advanced disease. These data are useful in counseling patients and understanding the natural history of middle ear carcinoma.
S232 – Hearing Gain Following Stapes Surgery Maintained Long‐term?
Authors: Sen Purushotam , Bhattacharyya Abir K 
Published: August 2008

ObjectivesTo analyse whether the hearing gain following stapes surgery is maintained long‐term.MethodsDatabases (PubMed, EMBASE and MEDLINE) were searched systematically, with no limits on the year or language of publications, for observational studies on the long‐term hearing results of stapedectomy (>10 years). References identified from pertinent reviews and articles were also retrieved. 2 reviewers independently searched the databases and selected the studies using pre‐specified standardized criteria. These criteria included appropriate adjustments for confounding factors in the analyses. The terms used in the search included stapes surgery, stapedectomy, stapedotomy, long‐term results, hearing gain. Data extraction and study quality evaluation were performed independently and results were pooled quantitatively.ResultsEarly studies noted that both air conduction (AC) and bone conduction (BC) deteriorated with time, resulting in a return to baseline pre‐operative hearing in the long‐term. More recent studies showed that in the long term, the hearing gain was maintained by 75% of patients despite the advent of presbycusis. Surgeons' experience may play a more important role than the type of stapes surgery. On average, studies have shown that the air bone gap tended to increase at a rate of 0.9 dB per year.ConclusionsThough some earlier studies were equivocal, recent studies indicate that most stapes surgery patients maintain good hearing long‐term, even though there is a gradual decline in the air conduction and bone conduction thresholds. Longitudinal studies are required to better understand this subject.
S234 – The Immune System in Immunomediated Inner Ear Disease
Authors: Olarieta Javier , Rivera Teresa , Suarez Jon Alexander Sistiaga , Eduardo Reyes , de Mon Melchor Alvarez 
Published: August 2008

Objectives1) To assess the different clinical varieties and the evolution of the patients. 2) To assess the clinical impact of the use of high dose corticotherapy. 3) To analyze the phenotype of the lymphocyte populations in peripheral blood. 4) To study the proliferative answer of mononuclear cells in peripheral blood under polyclonal mitogen stimulus.MethodsA prospective study in patients with immunomediated inner ear disease was carried out, dividing them in 4 different clinical presentations: Sudden deafness, fluctuant hearing loss, Meniere's disease, and rapidly progressive hearing loss. We analysed 22 patients, controlling their clinical evolution and response to corticotherapy. We also made an immunophenotypical and functional characterization of the T lymphocytes in patients before and after treatment and comparing them with healthy controls. Mann‐Whitney U and Wilcoxon range tests were used as statistical resources.Results59.09% of the patients treated with corticotherapy improved, with a 95% of treatment fulfillment. The T lymphocyte compartment's proliferative response was significantly lower in these patients (p value less than 0.05) and there was a higher CD56+ (p value less than 0,01) and CD8+ CD45RO+(p value less than 0.01) lymphocyte subpopulations expression in absolute and percentage numbers.ConclusionsImmunomediated inner ear disease is related to T, B, and especially NK lymphocytosis associated to a redistribution of the T cell subpopulations.
S239 – Labyrinthine Changes in Otitis Media
Authors: Joglekar Shruti Siddharth , Deroee Armin Farajzadeh , Morita Norimasa , Cureoglu Sebahattin , Patricia Schachern , Paparella Michael M , Juhn Steven K 
Published: August 2008

ObjectivesOtitis media causes labyrinthine changes and subsequent sensorineural hearing loss. The aim of this histopathologic study was to evaluate the extension of inflammation to the inner ear and its effects.MethodsOut of 614 temporal bones with otitis media, 47 (30 cases) with chronic and 35 (21 cases) with purulent were selected for histopathologic study. Subjects with a history of acoustic trauma, head trauma, ototoxic drugs and other otologic and systemic diseases affecting the inner ear were excluded. The pattern of labyrinthine inflammation was classified as localized purulent, localized serous, generalized seropurulent and generalized serous. Inner ear findings were compared to age‐matched controls.Results19% of temporal bones with chronic and 9% of temporal bones with purulent otitis media showed labyrinthine inflammatory changes. In chronic otitis media, inflammatory changes were: 56% localized purulent; 22% localized serous; 11% generalized seropurulent; and 11% generalized serous. Inflammatory changes in temporal bones with purulent otitis media included: 67% localized purulent; and 33% generalized seropurulent. Pathological findings included: serofibrinous precipitates and inflammatory cells in the scala tympani of basal turn and cochlear aqueduct; significant decrease in area of stria vascularis (p = 0.033); and loss of hair cells in the organs of Corti. No significant difference was found in area of spiral ligament area or number of fibrocytes in diseased and control bones.ConclusionsMiddle ear/inner ear interaction in otitis media can result in labyrinthine inflammation and cochlear damage. Early diagnosis and treatment of otitis media is important in preventing inner ear damage.
S240 – Human Cochlear Implant Histopathology
Authors: Xu Helen , Pollak Natasha , Cureoglu Sebahattin , Paparella Michael M 
Published: August 2008

Objectives1) To exam the histopathology of multichannel cochlear implant temporal bones. 2) To evaluate the relationship of residual spiral ganglion cell counts to clinical hearing performance.Methods8 temporal bones from 4 cochlear implant patients were examined histologically. Paired comparisons were made between implanted and nonimplanted temporal bones. Clinical performance data was obtained from patient charts.ResultsThere were varying amounts of inflammation (fibrosis and ossification) in the basal turn of the cochlear in all implanted temporal bones. Trauma to the facial nerve at facial recess site was noticed in 1 case. Compared with nonimplanted ears, 2 implanted bones with less than 10‐year duration of implantation had no significant changes of spiral ganglion cell population. One case with prolong implant duration (15 years) showed about 36% decrease of spiral ganglion cells at the implanted site. The case with best speech recognition (89% with CID sentence) had the highest residual spiral ganglion cells (30% of normal spiral ganglion cell population). 2 cases with poor clinical performance (< 10% with CID sentence) had the residual spiral ganglion cells at 11% and 22%. The case with moderate clinical performance (30% with CID sentence) had 14% of normal spiral ganglion cell population. Surviving dendrites varied from 5% to 30% among 4 cases with no relationship to clinical performance.ConclusionsOur findings suggest prolonged implantation may affect spiral ganglion cell population. There is no reverse relationship between residual spiral ganglion cells in implanted temporal bones to clinical speech performance observed from our limited cases.
S244 – Intraoperative ABR after Myringotomy and Tube Placement
Authors: Sturgill Nanette , Yorgason Joshua G , Park Albert H 
Published: August 2008

ObjectivesUnderstand the utility of intraoperative ABR testing after myringotomy and tube placement.MethodsWe performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t‐tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery.Results15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABRConclusionsPatients who undergo ioABR testing show a significant improvement of dB level on follow‐up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.
S245 – Pulmonary Complications after Coblation Tonsillectomy
Authors: Wilhelm Michael J , Boseley Mark E 
Published: August 2008

Objectives1) Evaluate an institutional experience with postoperative pulmonary complications using the Coblator (ArthroCare Corp, Sunnyvale, CA), for pediatric tonsillectomy. 2) Understand how to minimize and prevent pulmonary complications following coblation tonsillectomy.MethodsCase series of 4 tonsillectomy patients who developed clinical signs of aspiration following surgery, from October 2006 to January 2008.Results4 pediatric patients were reported in this case series. All 4 experienced perioperative fever, tachycardia, pulmonary desaturation, and cough following tonsillectomy using the Coblator. In 1 case, the patient had course respirations, a chest x‐ray demonstrating diffuse pulmonary infiltrates, and was unable to maintain his oxygen saturations without supplemental oxygenation. In all cases, the symptoms, to include fever, resolved by post‐operative day 2. No long‐term sequelae were noted. In all cases, the patients were intubated using an uncuffed endotracheal tube.ConclusionsPulmonary aspiration is a possible adverse consequence of oropharyngeal pooling of saline while performing a tonsillectomy using the Coblator. Pediatric patients in whom an uncuffed endotracheal is used are more likely to aspirate the irrigation. Recognition of this potential complication allows the surgeon to take the necessary precautions to avoid this complication by using a throat pack, trendelenberg positioning, and avoidance of pooling of irrigation in the oropharynx.
S247 – Mediastinitis in Infants: Role of the Otolaryngologist
Authors: Shah Rahul K , Choi Sukgi S 
Published: August 2008

ObjectivesTo describe mediastinitis from retropharyngeal abscess in 3 infants.MethodsCase reports of 3 patients.Results3 patients presented in a span of 2 winter months to a tertiary care, pediatric, inner‐city hospital. The patients were 8 months, 9 months, and 18 months old. All presented with retropharyngeal phlegmon on CT scan, were started on clindamycin and cefotaxime, and monitored as in‐patients for 2–4 days prior to surgery. Interval CT scans revealed progression to retropharyngeal abscess with mediastinal extension. One patient's retropharyngeal abscess was drained trans‐orally, one externally, and one required a combined approach. 2 of the 3 patients required video‐assisted thoracoscopic debridement of the mediastinitis. 2 cultures grew out methicillin‐resistant staphylococcus aureus, while one grew out methicillin‐sensitive staphylococcus aureus (all were clindamycin sensitive). The patients' peak white blood cell counts were 18.4, 30.2, and 44.9 thousand. All 3 patients survived and were discharged on long‐term antibiotics.ConclusionsDespite appropriate initial empiric antibiotic therapy, all 3 patients developed retropharyngeal abscess with mediastinal extension. The otolaryngologist should maintain vigilance when treating infants with intravenous antibiotics for a deep neck space infection, liberal use of imaging studies should be performed to monitor progression of the infection, a significantly elevated white blood cell count should be interpreted with caution, and initial empiric therapy should include clindamycin. Despite the adult literature that quotes a 50% mortality rate from mediastinitis, infant mediastinitis may be a different disease process, as all 3 of our patients survived.
S250 – Otogenic Lateral Sinus Thrombosis: A Review of 7 Cases
Authors: Ryan Jesse T. , Preciado Diego A , Pena Maria T , Zalzal George H 
Published: August 2008

ObjectivesOtogenic lateral sinus thrombosis (LST) is a rare but serious intracranial complication of acute or chronic otitis media (OM). Mortality rates for LST are quoted as 8–25% in most recent larger case series. Controversy exists regarding the surgical and medical management of LST. We sought to clarify this by reviewing our experience in patients who presented with otogenic LST in the past 5 years.MethodsA retrospective chart review was conducted. 7 patients were identified and charts were examined for presentation, co‐existing intracranial complications, treatment, cultured organisms, and outcome.ResultsPatients most commonly presented with fever (5/7), otalgia (5/7), and mastoid tenderness (4/7). Co‐existing intracranial complications were present in 4/7 patients, including meningitis (1/7), epidural abscess (2/7), otitic hydrocephalus (2/7), and cavernous sinus thrombosis (1/7). All patients received IV antibiotics and underwent mastoidectomy with unroofing of the sigmoid sinus, and tympanostomy tube placement. Thrombectomy was not performed on any patient. Anticoagulation was used on 5/7 patients without complication. Streptococcus sp. was the most common organism isolated (2/7). All patients recovered well without major sequelae. One patient with cavernous sinus thrombosis and otitic hydrocephalus had a persistent right visual field deficit.ConclusionsIn this limited series, we demonstrate good outcomes by emergently treating LST from an otitic source with mastoidectomy and unroofing of the sigmoid sinus, IV antibiotics, and selective anticoagulation. We did not find thrombectomy to be necessary.