Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

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Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Otolaryngol Head Neck Surg. 2016 Feb 23;

Authors: Stevens SM, Rizk HG, McIlwain WR, Lambert PR, Meyer TA

Abstract
OBJECTIVES: (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.
SUBJECTS AND METHODS: A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.
RESULTS: Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.
CONCLUSIONS: An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

PMID: 26908549 [PubMed - as supplied by publisher]

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Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

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Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

Gastrointest Endosc. 2016 Feb 20;

Authors: Pannu D, Yang D, Abbitt PL, Draganov PV

Abstract
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a procedure with potential for serious adverse events. Postprocedure imaging is routinely done yet there is no consensus on the optimal imaging protocol. We describe a novel and simple CT esophagram protocol for post-POEM evaluation and report the full spectrum of radiographic findings and subsequent interventions.
METHODS: Single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram.
RESULTS: Eighty-four consecutive post-POEM patients underwent CT esophagram. Most common findings were pneumomediastinum (85.7%), pneumoperitoneum (66.7%), subcutaneous emphysema (52.4%) and pleural effusion (46.4 %). Other findings included retroperitoneal air (38.1%), pneumothorax (19%), atelectasis (14.3%), intramural air in the esophagus/stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In one patient, a leak was detected on CT esophagram before any clinical manifestation; facilitating prompt intervention and avoiding potential serious outcome. Four patients were diagnosed with pneumonia and treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all post-POEM cases.
CONCLUSION: CT esophagram is a simple and accessible imaging test for routine post-POEM evaluation. Numerous and dramatic postprocedure radiographic findings may be expected and demonstrated with this imaging modality. Although most of these findings may not require intervention, some are of potential significance, and early identification may help modify post-procedure management.

PMID: 26907745 [PubMed - as supplied by publisher]

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An appraisal of current dysphagia diagnosis and treatment strategies.

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An appraisal of current dysphagia diagnosis and treatment strategies.

Expert Rev Gastroenterol Hepatol. 2016 Feb 24;

Authors: Kaindlstorfer A, Pointner R

Abstract
Dysphagia is a common, serious health problem with a wide variety of etiologies and manifestations. This review gives a general overview of diagnostic and therapeutic options for oropharyngeal as well as esophageal swallowing disorders respecting the considerable progress made over recent years. Diagnosis can be challenging and requires expertise in interpretation of symptoms and patient history. Endoscopy, barium radiography and manometry are still the diagnostic mainstays. Classification of esophageal motor-disorders has been revolutionized with the introduction of high-resolution esophageal pressure topography and a new standardized classification algorithm. Automated integrated impedance manometry is a promising upcoming tool for objective evaluation of oropharyngeal dysphagia, in non-obstructive esophageal dysphagia and prediction of post fundoplication dysphagia risk. Impedance planimetry provides new diagnostic information on esophageal and LES-distensibility and allows controlled therapeutic dilatation without the need for radiation. Peroral endoscopic myotomy is a promising therapeutic approach for achalasia and spastic motility disorders.

PMID: 26906944 [PubMed - as supplied by publisher]

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Preoperative steroids for hearing preservation cochlear implantation: A review.

Preoperative steroids for hearing preservation cochlear implantation: A review.

Cochlear Implants Int. 2016 Feb 25;

Authors: Kuthubutheen J, Smith L, Hwang E, Lin V

Abstract
Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.

PMID: 26913646 [PubMed - as supplied by publisher]

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Cochlear implant assessment and candidacy for children with partial hearing.

Cochlear implant assessment and candidacy for children with partial hearing.

Cochlear Implants Int. 2016 Feb 25;

Authors: Wilson K, Ambler M, Hanvey K, Jenkins M, Jiang D, Maggs J, Tzifa K

Abstract
Children who have partial hearing (PH) in the low frequencies and profound sensorineural hearing loss in the high frequencies can present a challenge to cochlear implant (CI) teams in terms of referral, assessment, and candidacy. Neither clinical criteria nor optimal timing for implantation has been explored in the literature. Data from both the Hearing Implant Centres of Birmingham Children's Hospital and St Thomas' Hospital indicate that it is clinically appropriate to implant children with PH; they perform better with CIs than with hearing aids, even if their hearing is not fully preserved. We have also found that children need early access to high frequency sound in order to reach their full potential.

PMID: 26913562 [PubMed - as supplied by publisher]

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JAAA CEU Program.

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JAAA CEU Program.

J Am Acad Audiol. 2016 Feb;27(2):159-60

Authors:

PMID: 26905535 [PubMed - in process]

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Erratum.

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Erratum.

J Am Acad Audiol. 2016 Feb;27(2):157

Authors:

Abstract
[This corrects the article DOI: 10.3766/jaaa.14102.].

PMID: 26905534 [PubMed - as supplied by publisher]

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On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies.

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On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies.

J Am Acad Audiol. 2016 Feb;27(2):141-56

Authors: Vermiglio AJ

Abstract
BACKGROUND: In the field of audiology a test protocol (index test) is used to determine the presence or absence of a target condition. The value of an index test rests in its diagnostic accuracy. Results from an index test must be verified through the use of a reference standard. The clinician and researcher should determine the quality and applicability of diagnostic accuracy studies. The Standards for Reporting of Diagnostic Accuracy (STARD) statement was published in response to the low quality of research conducted across many fields of study. It provides guidelines for the development and interpretation of diagnostic accuracy studies.
PURPOSE: The primary purpose of this article is to assess the degree to which the main principles of diagnostic accuracy studies are used for the detection of central auditory nervous system lesions and a central auditory processing disorder (CAPD). The secondary purpose is to compare the design of these studies to select key guidelines from the STARD statement. The third purpose of this article is to present an argument against the reassignment of diagnostic accuracy values of a particular index test for one target condition (e.g., a central site of lesion) to a different target condition (e.g., a CAPD).
RESULTS: A review of diagnostic accuracy literature on the detection of a central site of lesion reveals the use of a reference standard for the independent verification of the index test results. However, diagnostic accuracy studies involving index tests for the detection of a CAPD show that independent verification of index test results is nonexistent or at best questionable.
CONCLUSION: For a particular index test, while the diagnostic accuracy for detection of a central site of lesion may have been determined appropriately, it is inappropriate to reassign these diagnostic accuracy values to a different diagnostic target such as a CAPD.

PMID: 26905533 [PubMed - in process]

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Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists' Opinions and Practice.

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Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists' Opinions and Practice.

J Am Acad Audiol. 2016 Feb;27(2):126-40

Authors: Nelson MD, Akin FW, Riska KM, Andresen K, Mondelli SS

Abstract
BACKGROUND: The past decade has yielded changes in the education and training of audiologists and technological advancements that have become widely available for clinical balance function testing. It is unclear if recent advancements in vestibular instrumentation or the transition to an AuD degree have affected audiologists' vestibular clinical practice or opinions.
PURPOSE: The purpose of this study was to examine predominant opinions and practices for vestibular assessment (VA) and vestibular rehabilitation (VR) over the past decade and between master's- and AuD-level audiologists.
METHOD: A 31-question survey was administered to audiologists via U.S. mail in 2003 (N = 7,500) and electronically in 2014 (N = 9,984) with a response rate of 12% and 10%, respectively.
RESULTS: There was an increase in the number of audiologists providing vestibular services in the past decade. Most respondents agreed that audiologists were the most qualified professionals to conduct VA. Less than half of the surveyed audiologists felt that graduate training was adequate for VA. AuD-level audiologists were more satisfied with graduate training and felt more comfortable performing VA compared to master's-level audiologists. Few respondents agreed that audiologists were the most qualified professionals to conduct VR or that graduate training prepared them to conduct VR. The basic vestibular test battery was unchanged across surveys and included: calorics, smooth pursuit, saccades, search for spontaneous, positional, gaze and optokinetic nystagmus, Dix-Hallpike, case history, and hearing evaluation. There was a trend toward greater use of air (versus water) calorics, videonystagmography (versus electronystagmography), and additional tests of vestibular and balance function.
CONCLUSIONS: VA is a growing specialty area in the field of audiology. Better training opportunities are needed to increase audiologists' knowledge and skills for providing vestibular services. The basic tests performed during VA have remained relatively unchanged over the past 10 yr.

PMID: 26905532 [PubMed - in process]

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The Effects of FM and Hearing Aid Microphone Settings, FM Gain, and Ambient Noise Levels on SNR at the Tympanic Membrane.

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The Effects of FM and Hearing Aid Microphone Settings, FM Gain, and Ambient Noise Levels on SNR at the Tympanic Membrane.

J Am Acad Audiol. 2016 Feb;27(2):117-25

Authors: Norrix LW, Camarota K, Harris FP, Dean J

Abstract
BACKGROUND: Speech understanding in noise is challenging for individuals with hearing loss. Hearing aids (HAs) alone are typically unable to resolve these listening difficulties. Frequency modulation (FM) systems or other remote microphone accessories, coupled to HA, are intended to provide listeners with a good signal-to-noise ratio (SNR), thus improving signal audibility and speech understanding.
PURPOSE: The goal of this study was to assess variables that influence SNR at the tympanic membrane (TM) when using a remote microphone/HA combination. We examined microphone setting, transmission system gain, and background noise levels using (1) mathematical computations to manipulate variables and observe the outcomes and (2) behavioral testing.
RESEARCH DESIGN: This study used mathematical computations to estimate SNR at the TM and a mixed-model experimental design to confirm a subset of the calculations.
STUDY SAMPLE: Ten children with normal hearing (mean age, 13.7 yr) and ten adults with high-frequency sensorineural hearing loss (mean age, 49.6 yr) participated.
DATA COLLECTION AND ANALYSIS: Speech recognition thresholds were obtained using Bamford-Kowal-Bench sentences in the presence of noise. Participants used an FM system coupled to an HA in an FM-only and an FM + HA microphone condition.
RESULTS: Better performance was observed in the FM-only compared to FM + HA condition with the overall amount of the FM-only advantage slightly larger than the mathematical calculations predicted. Further calculations demonstrated that (1) when using an FM-only microphone setting, the SNR at the TM is determined primarily by the SNR at the FM microphone; (2) when both HA and FM microphones are active, the SNR is determined by the highest level of the speech, which is typically at the FM microphone, and the highest level of noise at either the FM or HA microphone; (3) increasing FM gain has no impact on SNR in an FM-only condition; and (4) in an FM + HA condition, increasing FM gain improves SNR. The amount of improvement depends on noise levels at the FM and HA microphones. When the noise levels are similar at the two microphones, an improvement in SNR of ∼2 dB is expected. Greater improvement is expected when the level of the noise at the FM microphone can be reduced relative to the level at the HA microphone.
CONCLUSIONS: When using a remote microphone system coupled with a listener's HA, several variables influence SNR at the TM. Two variables that can be manipulated by programming of either or both devices are the microphone setting and gain setting. Mathematical calculations were used to determine the specific influence of and interactions between these variables and showed the importance of (1) managing noise levels to optimize SNR; and (2) counseling clients regarding optimal use of and realistic expectations from their system. This information is useful in the clinical management of persons with hearing loss, especially with the advent and affordability of wireless microphone accessories to assist listeners in background noise.

PMID: 26905531 [PubMed - in process]

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The Effect of Contralateral Pure Tones on the Compound Action Potential in Humans: Efferent Tuning Curves.

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The Effect of Contralateral Pure Tones on the Compound Action Potential in Humans: Efferent Tuning Curves.

J Am Acad Audiol. 2016 Feb;27(2):103-16

Authors: Najem F, Ferraro J, Chertoff M

Abstract
BACKGROUND: The compound action potential (CAP) has been suggested in the literature as an alternative to otoacoustic emissions for evaluating the efferent auditory system. However, very few studies have examined efferent influence on auditory nerve potentials in humans.
PURPOSE: This study examines the effects of presenting contralateral pure tones on the ipsilateral CAP onset and offset amplitudes as a potential clinical tool for the assessment of efferent auditory function.
RESEARCH DESIGN: CAPs for 1- and 4-kHz tone pips (TPs) and clicks were recorded from 9, 9, and 8 participants, respectively. Contralateral tones were presented at levels ranging from 20 to 70 dB HL in 10-dB steps. The frequencies of the contralateral tones were 0.5, 1, 2 kHz for the 1-kHz TP CAP; 2, 4, 8 kHz for the 4-kHz TP CAP; and 0.5, 1, 2, 4, 8 kHz for the click CAP.
DATA ANALYSIS: The CAP onset and offset amplitudes in all experimental conditions were analyzed and compared to the CAP amplitude without contralateral stimulation (i.e., baseline).
RESULTS: Maximum suppression of 1-kHz TP CAP onset amplitude was obtained in seven out of nine participants by the 1-kHz contralateral pure tone at 40 dB HL. The 4-kHz TP CAP onset amplitude was maximally suppressed in eight out of nine participants by the 8-kHz contralateral pure tone at 30 dB HL. The click CAP offset amplitude was maximally suppressed in four out of eight participants by the 8-kHz contralateral tone presented at 40 dB HL. The 1- and 4-kHz TP CAP offset and click CAP onset amplitudes were not affected by contralateral stimulation.
CONCLUSIONS: These results along with the previous studies may suggest that the efferent system is maximally stimulated by moderate signal-level tones (i.e., 30-40 dB HL), and that efferent activity is dependent on frequency cues of both the stimulus and suppressor tones. Other factors that might be affecting efferent influence on the CAP in humans such as sound duration, phase, bandwidth, and periodicity need to be further investigated.

PMID: 26905530 [PubMed - in process]

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The Effects of Preprocessing Strategies for Pediatric Cochlear Implant Recipients.

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The Effects of Preprocessing Strategies for Pediatric Cochlear Implant Recipients.

J Am Acad Audiol. 2016 Feb;27(2):85-102

Authors: Rakszawski B, Wright R, Cadieux JH, Davidson LS, Brenner C

Abstract
BACKGROUND: Cochlear implants (CIs) have been shown to improve children's speech recognition over traditional amplification when severe-to-profound sensorineural hearing loss is present. Despite improvements, understanding speech at low-level intensities or in the presence of background noise remains difficult. In an effort to improve speech understanding in challenging environments, Cochlear Ltd. offers preprocessing strategies that apply various algorithms before mapping the signal to the internal array. Two of these strategies include Autosensitivity Control™ (ASC) and Adaptive Dynamic Range Optimization (ADRO(®)). Based on the previous research, the manufacturer's default preprocessing strategy for pediatrics' everyday programs combines ASC + ADRO(®).
PURPOSE: The purpose of this study is to compare pediatric speech perception performance across various preprocessing strategies while applying a specific programming protocol using increased threshold levels to ensure access to very low-level sounds.
RESEARCH DESIGN: This was a prospective, cross-sectional, observational study. Participants completed speech perception tasks in four preprocessing conditions: no preprocessing, ADRO(®), ASC, and ASC + ADRO(®).
STUDY SAMPLE: Eleven pediatric Cochlear Ltd. CI users were recruited: six bilateral, one unilateral, and four bimodal.
INTERVENTION: Four programs, with the participants' everyday map, were loaded into the processor with different preprocessing strategies applied in each of the four programs: no preprocessing, ADRO(®), ASC, and ASC + ADRO(®).
DATA COLLECTION AND ANALYSIS: Participants repeated consonant-nucleus-consonant (CNC) words presented at 50 and 70 dB SPL in quiet and Hearing in Noise Test (HINT) sentences presented adaptively with competing R-Space(TM) noise at 60 and 70 dB SPL. Each measure was completed as participants listened with each of the four preprocessing strategies listed above. Test order and conditions were randomized. A repeated-measures analysis of was used to compare each preprocessing strategy for the group. Critical differences were used to determine significant score differences between each preprocessing strategy for individual participants.
RESULTS: For CNC words presented at 50 dB SPL, the group data revealed significantly better scores using ASC + ADRO(®) compared to all other preprocessing conditions while ASC resulted in poorer scores compared to ADRO(®) and ASC + ADRO(®). Group data for HINT sentences presented in 70 dB SPL of R-Space(TM) noise revealed significantly improved scores using ASC and ASC + ADRO(®) compared to no preprocessing, with ASC + ADRO(®) scores being better than ADRO(®) alone scores. Group data for CNC words presented at 70 dB SPL and adaptive HINT sentences presented in 60 dB SPL of R-Space(TM) noise showed no significant difference among conditions. Individual data showed that the preprocessing strategy yielding the best scores varied across measures and participants.
CONCLUSIONS: Group data reveal an advantage with ASC + ADRO(®) for speech perception presented at lower levels and in higher levels of background noise. Individual data revealed that the optimal preprocessing strategy varied among participants, indicating that a variety of preprocessing strategies should be explored for each CI user considering his or her performance in challenging listening environments.

PMID: 26905529 [PubMed - in process]

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Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

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Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

J Am Acad Audiol. 2016 Feb;27(2):72-84

Authors: McDermott EE, Smart JL, Boiano JA, Bragg LE, Colon TN, Hanson EM, Emanuel DC, Kelly AS

Abstract
BACKGROUND: Large discrepancies exist in the literature regarding definition, diagnostic criteria, and appropriate assessment for auditory processing disorder (APD). Therefore, a battery of tests with normative data is needed.
PURPOSE: The purpose of this study is to collect normative data on a variety of tests for APD on children aged 7-12 yr, and to examine effects of outside factors on test performance.
RESEARCH DESIGN: Children aged 7-12 yr with normal hearing, speech and language abilities, cognition, and attention were recruited for participation in this normative data collection.
STUDY SAMPLE: One hundred and forty-seven children were recruited using flyers and word of mouth. Of the participants recruited, 137 children qualified for the study. Participants attended schools located in areas that varied in terms of socioeconomic status, and resided in six different states.
DATA COLLECTION AND ANALYSIS: Audiological testing included a hearing screening (15 dB HL from 250 to 8000 Hz), word recognition testing, tympanometry, ipsilateral and contralateral reflexes, and transient-evoked otoacoustic emissions. The language, nonverbal IQ, phonological processing, and attention skills of each participant were screened using the Clinical Evaluation of Language Fundamentals-4 Screener, Test of Nonverbal Intelligence, Comprehensive Test of Phonological Processing, and Integrated Visual and Auditory-Continuous Performance Test, respectively. The behavioral APD battery included the following tests: Dichotic Digits Test, Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test, Compressed and Reverberated Words Test, Auditory Figure Ground (signal-to-noise ratio of +8 and +0), and Listening in Spatialized Noise-Sentences Test. Mean scores and standard deviations of each test were calculated, and analysis of variance tests were used to determine effects of factors such as gender, handedness, and birth history on each test.
RESULTS: Normative data tables for the test battery were created for the following age groups: 7- and 8-yr-olds (n = 49), 9- and 10-yr-olds (n = 40), and 11- and 12-yr-olds (n = 48). No significant effects were seen for gender or handedness on any of the measures.
CONCLUSIONS: The data collected in this study are appropriate for use in clinical diagnosis of APD. Use of a low-linguistically loaded core battery with the addition of more language-based tests, when language abilities are known, can provide a well-rounded picture of a child's auditory processing abilities. Screening for language, phonological processing, attention, and cognitive level can provide more information regarding a diagnosis of APD, determine appropriateness of the test battery for the individual child, and may assist with making recommendations or referrals. It is important to use a multidisciplinary approach in the diagnosis and treatment of APD due to the high likelihood of comorbidity with other language, learning, or attention deficits. Although children with other diagnoses may be tested for APD, it is important to establish previously made diagnoses before testing to aid in appropriate test selection and recommendations.

PMID: 26905528 [PubMed - in process]

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Celebrating the Accomplishments of Those Special Individuals Who Have Contributed Significantly to Our Profession: The Academy Honors.

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Celebrating the Accomplishments of Those Special Individuals Who Have Contributed Significantly to Our Profession: The Academy Honors.

J Am Acad Audiol. 2016 Feb;27(2):70-1

Authors: McCaslin DL, Saunders G

PMID: 26905527 [PubMed - in process]

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Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

BMC Med Educ. 2016;16(1):70

Authors: Dziewas R, Glahn J, Helfer C, Ickenstein G, Keller J, Ledl C, Lindner-Pfleghar B, G Nabavi D, Prosiegel M, Riecker A, Lapa S, Stanschus S, Warnecke T, Busse O

Abstract
BACKGROUND: Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established.
RESULTS: The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well.
CONCLUSION: The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.

PMID: 26911194 [PubMed - in process]

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A Case of Discontinued Proximal Limb of a Ventriculoperitoneal Shunt With Patent Fibrous Tract.

A Case of Discontinued Proximal Limb of a Ventriculoperitoneal Shunt With Patent Fibrous Tract.

Clin Nucl Med. 2016 Feb 24;

Authors: Bermo M, Leung AS, Matesan M

Abstract
Radionuclide shuntogram is important in the evaluation of cerebrospinal fluid (CSF) shunts complications such as mechanical failure, malpositioning, pseudocyst, or overdrainage. We present here a case of congenital hydrocephalus and posterior fossa cyst with multiple shunt procedures and revisions with breakage of the proximal tube of the ventriculoperitoneal shunt but preserved CSF drainage through the patent fibrous tract. Careful correlation with SPECT/CT images helped confirm the breakage and exclude CSF leak outside of the tract, which was suspected on planar images.

PMID: 26914568 [PubMed - as supplied by publisher]

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Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment.

Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment.

Clin Neurol Neurosurg. 2016 Feb 16;143:95-98

Authors: Sartip K, McKenna G, Spina M, Grahovac S

Abstract
Spinal pathology resulting in cerebrospinal fluid (CSF) leak and intracranial hypotension is an infrequently reported and a potentially severe cause of headaches. We present a case of cerebrospinal fluid (CSF) leak caused by a thoracic disk herniation successfully treated with two targeted epidural blood patches. Although patients typically present with orthostatic headaches, the imaging findings of intracranial hypotension should prompt investigation of the spine for site and cause of the CSF leakage. Treatment includes autologous blood patch and surgery in refractory cases.

PMID: 26914140 [PubMed - as supplied by publisher]

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Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Related Articles

Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Otolaryngol Head Neck Surg. 2016 Feb 23;

Authors: Stevens SM, Rizk HG, McIlwain WR, Lambert PR, Meyer TA

Abstract
OBJECTIVES: (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.
SUBJECTS AND METHODS: A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.
RESULTS: Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.
CONCLUSIONS: An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

PMID: 26908549 [PubMed - as supplied by publisher]

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Construction and in vitro testing of a cellulose dura mater graft.

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Construction and in vitro testing of a cellulose dura mater graft.

Neurol Res. 2016 Feb 23;:1-7

Authors: Goldschmidt E, Cacicedo M, Kornfeld S, Valinoti M, Ielpi M, Ajler PM, Yampolsky C, Rasmussen J, Castro GR, Argibay P

Abstract
INTRODUCTION: Cerebrospinal fluid (CSF) leaks are a common complication after cranial and spinal surgery and are associated with increased morbidity. Despite continuous research in this field, this problem is far from solved. In this paper, we describe the construction and testing of a bacterial cellulose (BC) membrane as a new dural patch.
MATERIALS AND METHODS: The synthesis of BC was performed using Gluconacetobacter hansenii (ATCC 23769) and films were sterilized by autoclaving. The membranes were seeded with human dural fibroblasts. Growth, shape, and cell viability were assessed after 4 weeks.
RESULTS: Normally shaped fibroblasts were seen on the BC grafts; confocal microscopy showed cells inside the structure of the mesh. Both viable and nonviable cells were present. Cellular attachment and viability were confirmed by replating of the membranes.
DISCUSSION: BC membranes are used in clinical practice to improve skin healing. In the presence of water, they form an elastic, nontoxic, and resistant biogel that can accommodate collagen and growth factors within their structure, thus BC is a good candidate for dural graft construction.

PMID: 26905484 [PubMed - as supplied by publisher]

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Aberrant cerebellar development in mice lacking dual oxidase maturation factors.

Aberrant cerebellar development in mice lacking dual oxidase maturation factors.

Thyroid. 2016 Feb 25;

Authors: Amano I, Takatsuru Y, Toya S, Haijima A, Iwasaki T, Grasberger H, Refetoff S, Koibuchi N

Abstract
BACKGROUND: Thyroid hormone (TH) plays a key role in the developing brain including the cerebellum. TH deficiency induces organizational changes of the cerebellum, causing cerebellar ataxia. However, the mechanisms causing these abnormalities are poorly understood. Various animal models have been used to study the mechanism. Lacking dual oxidase (DUOX) and its maturation factor (DUOXA) are major inducers of congenital hypothyroidism. Thus, we examined the organizational changes of the cerebellum using knockout mice of Duoxa gene (Duoxa-/-).
METHODS: We analyzed the morphological, behavioral, and electrophysiological changes in wild-type (Wt) and Duoxa deficient (Duoxa-/-) mice from postnatal day (P) 10 to P30. To detect the changes in the expression levels of presynaptic proteins, Western blot analysis was performed.
RESULTS: The proliferation and migration of granule cells was delayed after P15 in Duoxa-/- mice. However, these changes disappeared by P25. Although the cerebellar structure of Duoxa-/- mice was not significantly different from that of Wt mice at P25, motor coordination was impaired. We also found that the amplitude of paired-pulse facilitation at parallel fiber-Purkinje cell synapses decreased in Duoxa-/- mice, particularly at P15. There were no differences among expression levels of presynaptic proteins regulating neurotransmitter release at P25.
CONCLUSIONS: Our results indicate that the anatomical catch-up growth of the cerebellum did not normalize its function because of the disturbance of neuronal circuits by the combined effect of hypothyroidism and functional disruption of Duox/Duoxa complex.

PMID: 26914863 [PubMed - as supplied by publisher]

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Clinical Manifestations and Gene Expression in Patients with Conventional Papillary Thyroid Carcinoma Carrying the BRAFV600E Mutation and BRAF Pseudogene.

Clinical Manifestations and Gene Expression in Patients with Conventional Papillary Thyroid Carcinoma Carrying the BRAFV600E Mutation and BRAF Pseudogene.

Thyroid. 2016 Feb 25;

Authors: Lin JD, Fu SS, Chen JY, Lee CH, Chau WK, Cheng CW, Wang YH, Lin YF, Fang WF, Tang KT

Abstract
BACKGROUND: The association of BRAFV600E with the clinical manifestations of papillary thyroid carcinoma (PTC) remains controversial. Recent studies have shown that the BRAF pseudogene can activate the MAPK pathway and induce tumorigenesis. In this study, we investigated the association of BRAFV600E, the BRAF pseudogene, and their mRNA levels with clinical features and thyroid-specific gene expression in conventional PTCs.
MATERIALS AND METHODS: A total of 78 specimens were collected from patients with conventional PTCs. RNA was isolated, and quantitative polymerase chain reaction (PCR) was performed to measure the mRNA levels of BRAF, the BRAF pseudogene, and thyroid-specific and tumor-related genes. Immunohistochemical (IHC) staining of BRAF, ERK, sodium-iodide symporter (NIS), thyroid-stimulating hormone receptor (TSHR), glucose transporter 1 (GLUT1), and Ki67 was also performed.
RESULTS: BRAFV600E and the BRAF pseudogene were detected in 73.0% (57/78) and 91.7% (44/48), respectively, of the conventional PTCs. The presence of BRAFV600E was not associated with the multiple clinical features assessed or the recurrence rate during 76.9  47.2 months of follow-up. Neither was it associated with IHC staining or tumor-related/thyroid-specific gene expression, except for decreased NIS gene expression. The BRAF pseudogene was not associated with clinical characteristics or thyroid-specific gene expression, except for decreased decoy receptor 3 (DCR3) expression. High BRAF mRNA levels were associated with bilateral and multifocal lesions, and BRAF-pseudogene mRNA levels were positively correlated with BRAF mRNA levels (r = 0.415, p = 0.009).
CONCLUSION: Our results do not support the use of the BRAFV600E mutation as a prognostic marker of conventional PTC. However, the association of high BRAF mRNA levels with more advanced clinical features suggests that BRAF mRNA levels might be a more useful clinical marker of PTCs, independent of the BRAFV600E mutation status. The correlation between BRAF-pseudogene mRNA levels and BRAF mRNA levels in PTCs is in agreement with the hypothesis that the BRAF pseudogene regulates BRAF expression during tumorigenesis by acting as competitive noncoding RNA. However, additional studies with larger sample sizes are required to confirm these findings.

PMID: 26914762 [PubMed - as supplied by publisher]

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Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.

JAMA Otolaryngol Head Neck Surg. 2016 Feb 25;

Authors: Friedland DR, Tarima S, Erbe C, Miles A

Abstract
Importance: Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians.
Objective: To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire.
Design, Setting, and Participants: Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015).
Interventions: Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness.
Main Outcomes and Measures: Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine.
Results: Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%.
Conclusions and Relevance: A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.

PMID: 26913615 [PubMed - as supplied by publisher]

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Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature.

Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature.

Ann Gen Psychiatry. 2016;15:6

Authors: Karaoulanis SE, Syngelakis M, Fokas K

Abstract
BACKGROUND: Lamotrigine is an effective anticonvulsant drug that has also been demonstrated to be effective in the treatment of bipolar disorder. We report a case of rhabdomyolysis after intentional overdose in a woman aged 48.
CASE PRESENTATION: A 48-year-old female presented to the emergency department after an acute ingestion of 6 g of lamotrigine. The patient suffered from bipolar disorder, and she was taking lamotrigine and olanzapine. At that point, she had a major depressive episode, and she wanted to commit suicide. Activated charcoal was administered in the emergency department. Her vital signs were still normal, and she entered the Medical clinic, where she had been there for 2 days in a good condition. The hematological and biochemical results were normal. On the fourth day, the levels of creatine phosphokinase (CPK) showed remarkable increase (2500 IU/ml). Fluid and bicarbonate intravenous administration was performed, and CPK levels returned to normal after 3 days.
CONCLUSION: The majority of patients exposed to lamotrigine in overdose experienced no toxic clinical effects. The most common clinical effects are drowsiness and lethargy, vomiting, nausea, ataxia, dizziness/vertigo, and tachycardia. In this case report, the patient was alert and did not have any serious complications, except for mild rhabdomyolysis, which was the main consequence of lamotrigine overdose.

PMID: 26913053 [PubMed]

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[Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss: a Meta-analysis].

[Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss: a Meta-analysis].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1970-7

Authors: Chen P, Wang S, Zhang Y, Huang H, Zhang C, Xiao Z

Abstract
OBJECTIVE: To assess the efficacy and safety of glucocorticoid in initial treatment of sudden hearing loss with intratympanic (IT) and systemic ways.
METHOD: We searched the database of PubMed, Cochrane, Embase,CBM, CNKI, VIP, Wanfang systematically. Literatures were screened according to the preestablished inclusion and exclusion standards,and all the RCT literatures associated with intratympanic and systemic glucocorticoid in the initial treatment of sudden hearing loss before may 2015 were collected. All the data, which meet the inclusion standards, were analyzed by using Meta-analysis software.
RESULT: Among all the qualified literatures, 11 randomized controlled trials were included. A total of 1298 cases were involved, including 521 cases with intratympanic administration, 410 with IV-therapy, and 201 with oral therapy. Meta analysis results showed that there was significant difference of the total effective rate and improvement rate between the intratympanic and systemic administration. Intratympanic injection (P > 0.05) was more effective than systemic administration. There was no significant difference between intratympanic group and oral group (RR = 1.15, 95% CI: 0.92-1.42, P > 0.05). A significant difference of the effective rate occurred between intratympanic group and IV therapy group (RR = 1.17, 95% CI: 1.02-1.34, P < 0.05). The major complications of intratympanic were pain, dizziness/vertigo, which occurred more frequently than systemic therapy group; The major complications of systemic therapy group were hyperglycaemia, loss of appetite and insomnia.
CONCLUSION: This study shows that the intratympanic (IT) glucocorticoid for sudden deafness is more effective than the systemic administration. But it was not the first choice in clinical treatment. Further studies are warranted.

PMID: 26911061 [PubMed - in process]

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[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo].

[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1963-5, 1969

Authors: Gong N, Zhang X, Ge L, Xu D

Abstract
OBJECTIVE: To explore the clinical characteristics and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo.
METHOD: By analyzing the clinical data of 271 ISSHL patients, they were divided into without vertigo group (n = 169) and vertigo group (n = 102). In vertigo group, 34 cases were patients with benign paroxysmal positional vertigo (BPPV) secondary to the ISSHL. All patients received conventional treatment. According to the types of BPPV, patients with secondary BPPV received Epley maneuver or Barbecue roll maneuver. By analyzing the results of the pure tone audiometry test and treatment outcomes of the patients, we summarized the clinical characteristics of ISSHL patients with vertigo.
RESULT: The audiometric curves of ISSHL with vertigo group were mainly at high frequency. The degrees of hearing loss of these patients were severe and profound. After treatment, the improvement of hearing threshold for ISSHL with vertigo group was lower than that for ISSHL without vertigo group. What's more, the rate of recovery, success and total effective of audition for ISSHL with vertigo group was also obviously lower than that for ISSHL without vertigo group. Of all the patients with BPPV, 27 cases of posterior semicircular canal and 7 cases of lateral semicircular canal were identified. All patients with BPPV were diagnosed as the same ears as the ISSHL.
CONCLUSION: ISSHL with vertigo group lost hearing more severely than ISSHL without vertigo group. Also, the improvement of hearing and the effective after treatment were really poor. The symptoms of ISSHL with BPPV group improved and eased significantly than that of ISSHL without BPPV group. The major of BPPV secondary to the ISSHL occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.

PMID: 26911059 [PubMed - in process]

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[Prognostic factors of sudden sensorineural hearing loss in children].

[Prognostic factors of sudden sensorineural hearing loss in children].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1931-5

Authors: Li F, Xue X, Wang L, Yang F, Wang H, Guan J, Du W, Xiong W, Wu K, Wu M, Yin Z, Lan L, Wang D, Wang Q

Abstract
OBJECTIVE: The aim of this retrospective study was to analyze the recovery rate of sudden sensorineural hearing loss in children, and explore the prognostic factors in order to guide the clinical diagnosis and treatment.
METHOD: A retrospective review was conducted for the prognosis of children with sudden sensorineural hearing loss during the past 5 years (from November 2010 to May 2015) in Chinese PLA General Hospital. This paper have a complete clinical data of 101 patients (113 ears)with sudden hearing loss, ranging from 0 to 18 years old Patients were divided into four groups according to hearing recovery and eight putative prognostic factors were analyzed.
RESULT: Among 101 patients (113 ears), the ratio of male and female was 60:53. Treatment was initiated from 1 to 183 days after disease onset, with an average of (18.5 ± 22.1) d. Bilateral and unilateral hearing loss were 24 ears and 89 ears, respectively. The proportion of mild hearing loss, moderate hearing loss, severe hearing loss and profound hearing loss were 7.1%, 6.2%, 23.9% and 62.8%, respectively. Vertigo and tinnitus occurred in 54.9% and 77.9% of the patients, respectively. After the treatment, the complete recovery rate was 9.7% and the overall recovery rate was 36.3%. The degree of hearing loss, earlier treatment onset, sex and bilateral involvement were significantly associated with hearing recovery (P < 0.05).
CONCLUSION: Sudden sensorineural hearing loss in children was generally identified as severe and profound hearing loss, but after positive and timely treatment, it can be improved or even cured. The mild hearing loss, earlier treatment onset, unilateral hearing loss and female were positive prognostic factors. The concurrence of tinnitus or vertigo, the results of ABR and DPOAE had no significant influence on prognosis.

PMID: 26911052 [PubMed - in process]

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[St. John's Wort for aura and vertigo].

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[St. John's Wort for aura and vertigo].

MMW Fortschr Med. 2015 Sep 24;157(16):24

Authors: Fueßl HS, Stiefelhagen P

PMID: 26783610 [PubMed - indexed for MEDLINE]

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EEG based evaluation of stereoscopic 3D displays for viewer discomfort.

Related Articles

EEG based evaluation of stereoscopic 3D displays for viewer discomfort.

Biomed Eng Online. 2015;14:21

Authors: Malik AS, Khairuddin RN, Amin HU, Smith ML, Kamel N, Abdullah JM, Fawzy SM, Shim S

Abstract
BACKGROUND: Consumer preference is rapidly changing from 2D to 3D movies due to the sensational effects of 3D scenes, like those in Avatar and The Hobbit. Two 3D viewing technologies are available: active shutter glasses and passive polarized glasses. However, there are consistent reports of discomfort while viewing in 3D mode where the discomfort may refer to dizziness, headaches, nausea or simply not being able to see in 3D continuously.
METHODS: In this paper, we propose a theory that 3D technology which projects the two images (required for 3D perception) alternatively, cannot provide true 3D visual experience while the 3D technology projecting the two images simultaneously is closest to the human visual system for depth perception. Then we validate our theory by conducting experiments with 40 subjects and analyzing the EEG results of viewing 3D movie clips with passive polarized glasses while the images are projected simultaneously compared to 2D viewing. In addition, subjective feedback of the subjects was also collected and analyzed.
RESULTS: A higher theta and alpha band absolute power is observed across various areas including the occipital lobe for 3D viewing. We also found that the complexity of the signal, e.g. variations in EEG samples over time, increases in 3D as compared to 2D. Various results conclude that working memory, as well as, attention is increased in 3D viewing because of the processing of more data in 3D as compared to 2D. From subjective feedback analysis, 75% of subjects felt comfortable with 3D passive polarized while 25% preferred 3D active shutter technology.
CONCLUSIONS: We conclude that 3D passive polarized technology provides more comfortable visualization than 3D active shutter technology. Overall, 3D viewing is more attractive than 2D due to stereopsis which may cause of high attention and involvement of working memory manipulations.

PMID: 25886584 [PubMed - indexed for MEDLINE]

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N-acetyl-L-leucine accelerates vestibular compensation after unilateral labyrinthectomy by action in the cerebellum and thalamus.

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N-acetyl-L-leucine accelerates vestibular compensation after unilateral labyrinthectomy by action in the cerebellum and thalamus.

PLoS One. 2015;10(3):e0120891

Authors: Günther L, Beck R, Xiong G, Potschka H, Jahn K, Bartenstein P, Brandt T, Dutia M, Dieterich M, Strupp M, la Fougère C, Zwergal A

Abstract
An acute unilateral vestibular lesion leads to a vestibular tone imbalance with nystagmus, head roll tilt and postural imbalance. These deficits gradually decrease over days to weeks due to central vestibular compensation (VC). This study investigated the effects of i.v. N-acetyl-DL-leucine, N-acetyl-L-leucine and N-acetyl-D-leucine on VC using behavioural testing and serial [18F]-Fluoro-desoxyglucose ([18F]-FDG)-μPET in a rat model of unilateral chemical labyrinthectomy (UL). Vestibular behavioural testing included measurements of nystagmus, head roll tilt and postural imbalance as well as sequential whole-brain [18F]-FDG-μPET was done before and on days 1,3,7 and 15 after UL. A significant reduction of postural imbalance scores was identified on day 7 in the N-acetyl-DL-leucine (p < 0.03) and the N-acetyl-L-leucine groups (p < 0.01), compared to the sham treatment group, but not in the N-acetyl-D-leucine group (comparison for applied dose of 24 mg i.v. per rat, equivalent to 60 mg/kg body weight, in each group). The course of postural compensation in the DL- and L-group was accelerated by about 6 days relative to controls. The effect of N-acetyl-L-leucine on postural compensation depended on the dose: in contrast to 60 mg/kg, doses of 15 mg/kg and 3.75 mg/kg had no significant effect. N-acetyl-L-leucine did not change the compensation of nystagmus or head roll tilt at any dose. Measurements of the regional cerebral glucose metabolism (rCGM) by means of μPET revealed that only N-acetyl-L-leucine but not N-acetyl-D-leucine caused a significant increase of rCGM in the vestibulocerebellum and a decrease in the posterolateral thalamus and subthalamic region on days 3 and 7. A similar pattern was found when comparing the effect of N-acetyl-L-leucine on rCGM in an UL-group and a sham UL-group without vestibular damage. In conclusion, N-acetyl-L-leucine improves compensation of postural symptoms after UL in a dose-dependent and specific manner, most likely by activating the vestibulocerebellum and deactivating the posterolateral thalamus.

PMID: 25803613 [PubMed - indexed for MEDLINE]

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