"Int J Pediatr Otorhinolaryngol"[jour]; +38 new citations

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"Int J Pediatr Otorhinolaryngol"[jour]

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Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

J Oral Rehabil. 2016 Mar 9;

Authors: Park JS, Oh DH, Hwang NK, Lee JH

Abstract
Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.

PMID: 26969528 [PubMed - as supplied by publisher]

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Effects of high intensity noise on the vestibular system in rats.

Related Articles

Effects of high intensity noise on the vestibular system in rats.

Hear Res. 2016 Mar 9;

Authors: Stewart C, Yu Y, Huang J, Maklad A, Tang X, Allison J, Mustain W, Zhou W, Zhu H

Abstract
Some individuals with noise-induced hearing loss (NIHL) also report balance problems. These accompanying vestibular complaints are not well understood. The present study used a rat model to examine the effects of noise exposure on the vestibular system. Rats were exposed to continuous broadband white noise (0-24kHz) at an intensity of 116dB sound pressure level (SPL) via insert ear phones in one ear for three hours under isoflurane anesthesia. Seven days after the exposure, a significant increase in ABR threshold (43.3+1.9dB) was observed in the noise-exposed ears, indicating hearing loss. Effects of noise exposure on vestibular function were assessed by three approaches. First, fluorescein-conjugated phalloidin staining was used to assess vestibular stereocilia following noise exposure. This analysis revealed substantial sensory stereocilia bundle loss in the saccular and utricular maculae as well as in the anterior and horizontal semicircular canal cristae, but not in the posterior semicircular canal cristae. Second, single unit recording of vestibular afferent activity was performed under pentobarbital anesthesia. A total of 548 afferents were recorded from 10 noise-treated rats and 12 control rats. Noise exposure produced a moderate reduction in baseline firing rates of regular otolith afferents and anterior semicircular canal afferents. Also a moderate change was noted in the gain and phase of the horizontal and anterior semicircular canal afferent's response to sinusoidal head rotation (1 and 2Hz, 45 degrees/s peak velocity). Third, noise exposure did not result in significant changes in gain or phase of the horizontal rotational and translational vestibular-ocular reflex (VOR). These results suggest that noise exposure not only causes hearing loss, but also causes substantial damage in the peripheral vestibular system in the absence of immediate clinically measurable vestibular signs. These peripheral deficits, however, may lead to vestibular disorders over time.

PMID: 26970474 [PubMed - as supplied by publisher]

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Protective effects of the seaweed phlorotannin polyphenolic compound dieckol on gentamicin-induced damage in auditory hair cells.

Related Articles

Protective effects of the seaweed phlorotannin polyphenolic compound dieckol on gentamicin-induced damage in auditory hair cells.

Int J Pediatr Otorhinolaryngol. 2016 Apr;83:31-6

Authors: Chang MY, Byon SH, Shin HC, Han SE, Kim JY, Byun JY, Lee JD, Park MK

Abstract
OBJECTIVES: Drug-induced ototoxicity from compounds such as aminoglycosides and platinum can damage the inner ear resulting in hearing loss, tinnitus or balance problems and may be caused by the formation of reactive oxygen species (ROS). Dieckol is a phlorotannin polyphenolic compound with strong antioxidant effects found in edible brown algae. This study investigated the protective effects of dieckol on drug-induced ototoxicity in cochlear cultures obtained from neonatal mice.
METHODS: Cochlear explants were pretreated with dieckol and exposed to gentamicin for 48h. The explants were then fixed and stained with fluorescein isothiocyanate-phalloidin and the intact hair cells counted. The free radical scavenging activity of dieckol was assessed using a 1,1-diphenyl-2-picrylhydrazyl assay. E. coli (Escherichia coli) cultures were used to evaluate the effect of dieckol on the antibiotic activity of gentamicin.
RESULTS: Gentamicin treatment resulted in dose-dependent hair cell loss that was partially protected by dieckol. Moreover, at concentrations >67μM dieckol had significant radical scavenging activity. Dieckol did not compromise the antibiotic effect of gentamicin.
CONCLUSIONS: These findings suggest that dieckol can be used as a therapeutic agent that reduces the damage caused by drug-induced ototoxicity.

PMID: 26968049 [PubMed - in process]

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Sinus surgery: optimal surgery, optimal outcome?

Sinus surgery: optimal surgery, optimal outcome?

Rhinology. 2016 Mar 12;

Authors: Fokkens WJ

Abstract
Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness irrespective of BMI. The OSAS was also not correlated with the severity of rhinosinusitis, SNOT-20 score, nasal obstruction score, en- doscopic score, CT score, and smell function. It could be an argument for FESS although unfortunately the authors did not report whether the OSAS decreased after FESS.

PMID: 26970345 [PubMed - as supplied by publisher]

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Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge).

Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge).

Eur Arch Otorhinolaryngol. 2016 Mar 11;

Authors: Lassaletta L, Calvino M, Zernotti M, Gavilán J

Abstract
The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50-55), moderate (56-59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.

PMID: 26968179 [PubMed - as supplied by publisher]

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Tracheal exposure: Anticipatory management of the difficult airway.

Tracheal exposure: Anticipatory management of the difficult airway.

Head Neck. 2016 Mar 11;

Authors: Britt CJ, Rohrbach MR, McCulloch TM

Abstract
BACKGROUND: When a patient cannot be intubated or ventilated, cricothyrotomy is indicated. Risks associated with emergent cricothyrotomy are significant, and this procedure typically requires revision. Additional options for establishing an emergent airway are limited. Thus, elective tracheotomy to ensure a safe airway after procedures involving the upper aerodigestive tract is common. Although safe and effective overall, this procedure is not without additional risks, added resources, complex cares, and extended hospitalizations.
METHODS: We present a case in which exposure of the anterior trachea was performed without tracheotomy in a patient with a high-risk airway undergoing an open partial laryngectomy.
RESULTS: The patient did not develop respiratory distress postoperatively and was able to avoid a tracheostomy and its associated cares.
CONCLUSION: Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost-effective alternative to elective tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970139 [PubMed - as supplied by publisher]

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Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

J Oral Rehabil. 2016 Mar 9;

Authors: Park JS, Oh DH, Hwang NK, Lee JH

Abstract
Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.

PMID: 26969528 [PubMed - as supplied by publisher]

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Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement.

Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement.

Head Neck. 2016 Mar 11;

Authors: Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW

Abstract
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970554 [PubMed - as supplied by publisher]

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Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers.

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers.

Head Neck. 2016 Mar 11;

Authors: Peretti G, Piazza C, Penco S, Santori G, Del Bon F, Garofolo S, Paderno A, Guastini L, Nicolai P

Abstract
BACKGROUND: T3 laryngeal cancer encompasses heterogeneous lesions whose treatment is still debated. The purpose of this study was to evaluate transoral laser microsurgery (TLM) in management of selected T3 glottic and supraglottic cancers.
METHODS: Fifty-six patients with selected T3 glottic and supraglottic squamous cell carcinomas (SCCs) treated by TLM ± selective neck dissection ± adjuvant therapy were evaluated in terms of overall survival (OS), disease-free survival (DFS), and organ preservation rates.
RESULTS: For the entire cohort, 5-year OS and DFS were 63.3% and 72.4%, whereas they were 65.2% and 72.9% for glottic and 59.3% and 76.3% for supraglottic SCC, respectively. No patient required permanent tracheostomy and 1 patient was gastrostomy tube-dependent at last follow-up.
CONCLUSION: TLM ± selective neck dissection ± adjuvant (chemo)radiotherapy for selected T3 glottic and supraglottic SCC represents an effective alternative treatment to open partial laryngectomies and nonsurgical organ preservation protocols, particularly in elderly and frail patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970262 [PubMed - as supplied by publisher]

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Tracheal exposure: Anticipatory management of the difficult airway.

Tracheal exposure: Anticipatory management of the difficult airway.

Head Neck. 2016 Mar 11;

Authors: Britt CJ, Rohrbach MR, McCulloch TM

Abstract
BACKGROUND: When a patient cannot be intubated or ventilated, cricothyrotomy is indicated. Risks associated with emergent cricothyrotomy are significant, and this procedure typically requires revision. Additional options for establishing an emergent airway are limited. Thus, elective tracheotomy to ensure a safe airway after procedures involving the upper aerodigestive tract is common. Although safe and effective overall, this procedure is not without additional risks, added resources, complex cares, and extended hospitalizations.
METHODS: We present a case in which exposure of the anterior trachea was performed without tracheotomy in a patient with a high-risk airway undergoing an open partial laryngectomy.
RESULTS: The patient did not develop respiratory distress postoperatively and was able to avoid a tracheostomy and its associated cares.
CONCLUSION: Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost-effective alternative to elective tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970139 [PubMed - as supplied by publisher]

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Salient body image concerns of patients with cancer undergoing head and neck reconstruction.

Salient body image concerns of patients with cancer undergoing head and neck reconstruction.

Head Neck. 2016 Mar 11;

Authors: Teo I, Fronczyk KM, Guindani M, Vannucci M, Ulfers SS, Hanasono MM, Fingeret MC

Abstract
BACKGROUND: Patients with cancer undergoing head and neck reconstruction can experience significant distress from alterations in appearance and bodily functioning. We sought to delineate salient dimensions of body image concerns in this patient population preparing for reconstructive surgery.
METHODS: Participants completed self-report questionnaires evaluating numerous aspects of body image. We used Bayesian factor analysis modeling methods to identify latent factors emerging from the data.
RESULTS: We identified 2 latent factors: appearance distress and functional difficulties. The highest level of preoperative body image concerns were related to distress about appearance changes and its perceived social consequences. Appearance distress items displayed greater variability compared with functional difficulties.
CONCLUSION: Appearance and functional changes to body image are important areas of concern for patients with head and neck cancer as they prepare for reconstructive surgery. Knowledge regarding specific body image issues can be used to guide psychosocial assessments and intervention to enhance patient care. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970013 [PubMed - as supplied by publisher]

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Salvage transoral laser microsurgery for recurrent glottic carcinoma after primary laser-assisted treatment: Analysis of prognostic factors.

Salvage transoral laser microsurgery for recurrent glottic carcinoma after primary laser-assisted treatment: Analysis of prognostic factors.

Head Neck. 2016 Mar 11;

Authors: Lucioni M, Bertolin A, Lionello M, Giacomelli L, Rizzotto G, Marioni G

Abstract
BACKGROUND: Treatment for local glottic cancer recurrences after primary transoral laser microsurgery (TLM) has not been standardized.
METHODS: In 33 consecutive cases of salvage TLM after laser surgery for early glottic carcinoma failed, we retrospectively considered the potential clinicopathological prognostic factors in univariate statistical setting.
RESULTS: Patient age <65 years and pathological involvement of the deep margins were associated with a higher second recurrence rate and shorter disease-free survival.
CONCLUSION: The age of the patient and the pathological status of surgical margins after salvage TLM could be useful for planning a closer endoscopic/radiological follow-up in selected patients at high risk of recurrence. Other appropriately designed studies are needed to see if an open surgical approach should be considered for younger patients (<65 years old) with recurrent glottic carcinoma after primary TLM. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26969869 [PubMed - as supplied by publisher]

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Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer.

Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer.

Head Neck. 2016 Mar 11;

Authors: Kono T, Saito K, Yabe H, Uno K, Ogawa K

Abstract
BACKGROUND: This study was designed to comparatively assess laryngeal function and quality of life (QOL) of patients after laser surgery (LS) or radiotherapy (RT) for early glottic cancer.
METHODS: Sixty-four patients with T1 glottic cancer treated with RT or type II cordectomy underwent both subjective and objective vocal assessments. The LS group was divided into the following: (1) vaporization with defocused mode (laser surgery [LS]-Vap); and (2) excision with focused mode using lower power (LS-Ex).
RESULTS: Auditory-perceptual evaluation and videostroboscopic images in the LS-Ex group worsened shortly after treatment and time-dependent recovery was quicker than in the LS-Vap group. The LS-Ex group showed equivalent posttherapeutic vocal function with the RT group by acoustics, aerodynamics, and self-assessment questionnaire analysis, whereas the LS-Vap group showed statistically significant worse function.
CONCLUSION: The multidimensional assessment showed that early glottic cancer could be successfully treated by either RT or LS-Ex with equivalent posttherapeutic laryngeal function and QOL. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26969802 [PubMed - as supplied by publisher]

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Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base.

Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base.

Cancer. 2016 Mar 11;

Authors: Amini A, Jones BL, McDermott JD, Serracino HS, Jimeno A, Raben D, Ghosh D, Bowles DW, Karam SD

Abstract
BACKGROUND: The overall survival (OS) benefit of concurrent chemoradiotherapy (CRT) for head and neck squamous cell carcinoma patients older than 70 years is debated. This study examines the outcomes of elderly patients receiving CRT versus radiotherapy (RT) alone.
METHODS: The National Cancer Data Base was queried for patients older than 70 years with nonmetastatic oropharyngeal, laryngeal, or hypopharyngeal cancer (T3-4 or N(+)). CRT was defined as chemotherapy started within 14 days of the initiation of RT. Univariate analysis, multivariate analysis (MVA), propensity score matching (PSM), and recursive partitioning analysis (RPA) were performed.
RESULTS: The study included 4042 patients: 2538 (63%) received CRT. The median follow-up was 19 months. The unadjusted median OS was longer with the addition of CRT (P < .001). OS was superior with CRT in the MVA (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.58-0.68; P < .001) and PSM analyses (HR, 0.73; 95% CI, 0.66-0.80; P < .001) in comparison with RT alone. According to RPA, CRT was associated with longer OS for patients 81 years or younger with low comorbidity scores and either T1-2/N2-3 disease or T3-4/N0-3 disease. The survival benefit with CRT disappeared for 2 subgroups in the 71- to 81-year age range: those with T1-2, N1, and Charlson-Deyo 0-1 (CD0-1) disease and those with T3-4, N1+, and CD1+ disease. Patients who were older than 81 years did not have increased survival with CRT. The receipt of CRT was associated with a longer duration of RT (odds ratio, 1.74; 95% CI, 1.50-2.01; P < .001).
CONCLUSIONS: Patients older than 70 years should not be denied concurrent chemotherapy solely on the basis of age; additional factors, including the performance status and the tumor stage, should be taken into account. Cancer 2016. © 2016 American Cancer Society.

PMID: 26969811 [PubMed - as supplied by publisher]

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New endoscopic classification of the cardiac orifice in esophageal achalasia: " Champagne glass sign".

New endoscopic classification of the cardiac orifice in esophageal achalasia: " Champagne glass sign".

Dig Endosc. 2016 Mar 9;

Authors: Gomi K, Inoue H, Ikeda H, Bechara R, Sato C, Ito H, Onimaru M, Kitamura Y, Suzuki M, Nakamura J, Hata Y, Maruyama S, Sumi K, Takahashi H

Abstract
BACK GROUND AND AIM: Endoscopy, barium esophagram and manometry are used in the diagnosis of achalasia. In the case of early achalasia, characteristic endoscopic findings are difficult to recognize. As a result, the diagnosis of achalasia is often made several years after symptom onset. Therefore, we examined the endoscopic findings of the cardiac orifice in achalasia and propose a new classification.
METHODS: A total of the 400 patients with spastic esophageal motility disorders whom underwent peroral endoscopic myotomy (POEM) at our hospital between March 2014 and August 2015 were screened for this study. The "Champagne Glass sign" (CG) was defined as when the distal end of LESRF was proximal to the SCJ and the SCJ was dilated in the retroflex view. Specifically, CG-1 was defined as a distance from the SCJ to the lower end of LESRF of less than 1 cm, and CG-2 was defined as a distance that was greater than 1 cm or more.
RESULTS: CG-0 was seen in 73 patients (28.0%), while the Champagne Glass sign was seen in 186 patients (71.3%), of whom 170 (65.1%) were CG-1 and 16 (6.1%) were CG-2 (table 2).
CONCLUSIONS: The "champagne glass sign" was often observed in the esophageal achalasia patients. "CG-0" (equal to "Maki-tsuki") was only observed in 28.0% of achalasia patients. Its absence with dilated SCJ cannot be used to rule out achalasia. We should perform an examination of barium esophagram and manometry if strongly suspected of an esophageal achalasia. This article is protected by copyright. All rights reserved.

PMID: 26969481 [PubMed - as supplied by publisher]

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Effects of pulsatile electrical stimulation of the round window on central hyperactivity after cochlear trauma in guinea pig.

Effects of pulsatile electrical stimulation of the round window on central hyperactivity after cochlear trauma in guinea pig.

Hear Res. 2016 Mar 9;

Authors: Mulders WH, Spencer TC, Robertson D

Abstract
Partial hearing loss induced by acoustic trauma has been shown in animal models to result in an increased spontaneous firing rate in central auditory structures. This so-called hyperactivity has been suggested to be involved in the generation of tinnitus, a phantom auditory sensation. Although there is no universal cure for tinnitus, electrical stimulation of the cochlea, as achieved by a cochlear implant, can result in significant reduction of the tinnitus percept. However, the mechanism by which this tinnitus suppression occurs is as yet unknown and furthermore cochlear implantation may not be an optimal treatment option for tinnitus sufferers who are not profoundly deaf. A better understanding of the mechanism of tinnitus suppression by electrical stimulation of the cochlea, may lead to the development of more specialised devices for those for whom a cochlear implant is not appropriate. This study aimed to investigate the effects of electrical stimulation in the form of brief biphasic shocks delivered to the round window of the cochlea on the spontaneous firing rates of hyperactive inferior colliculus neurons following acoustic trauma in guinea pigs. Effects during the stimulation itself included both inhibition and excitation but spontaneous firing was suppressed for up to hundreds of ms after the cessation of the shock train in all sampled hyperactive neurons. Pharmacological block of olivocochlear efferent action on outer hair cells did not eliminate the prolonged suppression observed in inferior colliculus neurons, and it is therefore likely that activation of the afferent pathways is responsible for the central effects observed.

PMID: 26970475 [PubMed - as supplied by publisher]

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Disrupted Functional Brain Connectome in Unilateral Sudden Sensorineural Hearing Loss.

Disrupted Functional Brain Connectome in Unilateral Sudden Sensorineural Hearing Loss.

Hear Res. 2016 Mar 8;

Authors: Xu H, Fan W, Zhao X, Li J, Zhang W, Lei P, Liu Y, Wang H, Cheng H, Shi H

Abstract
Sudden sensorineural hearing loss (SSNHL) is generally defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies and within a three-day period. This hearing loss is usually unilateral and can be associated with tinnitus and vertigo. The pathogenesis of unilateral sudden sensorineural hearing loss is still unknown, and the alterations in the functional connectivity are suspected to involve one possible pathogenesis. Despite scarce findings with respect to alterations in brain functional networks in unilateral sudden sensorineural hearing loss, the alterations of the whole brain functional connectome and whether these alterations were already in existence in the acute period remains unknown. The aim of this study was to investigate the alterations of brain functional connectome in two large samples of unilateral sudden sensorineural hearing loss patients and to investigate the correlation between unilateral sudden sensorineural hearing loss characteristics and changes in the functional network properties. Pure tone audiometry was performed to assess hearing ability. Abnormal changes in the peripheral auditory system were examined using conventional magnetic resonance imaging. The graph theoretical network analysis method was used to detect brain connectome alterations in unilateral sudden sensorineural hearing loss. Compared with the control groups, both groups of unilateral SSNHL patients exhibited a significantly increased clustering coefficient, global efficiency, and local efficiency but a significantly decreased characteristic path length. In addition, the primary increased nodal strength (e.g., nodal betweenness, hubs) was observed in several regions primarily, including the limbic and paralimbic systems, and in the auditory network brain areas. These findings suggest that the alteration of network organization already exists in unilateral sudden sensorineural hearing loss patients within the acute period and that the functional connectome of unilateral SSNHL patients is characterized by a shift toward small-worldization. Additionally, we hope that these findings will help to elucidate unilateral SSNHL through a new research perspective and provide insight for the potential pathophysiology of unilateral SSNHL.

PMID: 26969260 [PubMed - as supplied by publisher]

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Auditory hallucinations in cognitive neurology.

Auditory hallucinations in cognitive neurology.

Neurologia. 2016 Mar 8;

Authors: Robles Bayón A, Tirapu de Sagrario MG, Gude Sampedro F

Abstract
INTRODUCTION: Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH).
METHOD: These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded.
RESULTS: Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n=2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n=3), traumatic brain injury (n=1), and surgical brainstem lesion (n=1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n=6), a predisposing drug (n=9), and polypharmacy (n=9).
CONCLUSIONS: Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum.

PMID: 26968826 [PubMed - as supplied by publisher]

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Double Jeopardy: Hearing Loss and Tinnitus Among Noise-Exposed Workers.

Double Jeopardy: Hearing Loss and Tinnitus Among Noise-Exposed Workers.

Workplace Health Saf. 2016 Mar 11;

Authors: Hong O, Chin DL, Phelps S, Joo Y

Abstract
The purpose of this study was to determine the prevalence and characteristics of tinnitus and assess the relationship between tinnitus and hearing loss among firefighters and operating engineers, who are exposed to noise on-the-job. The study analyzed existing data from two different populations (154 firefighters and 769 operating engineers) who completed a survey and audiometric tests as part of a hearing loss prevention intervention study. Approximately 40% of both groups reported tinnitus; 34% of firefighters and 59% of operating engineers showed hearing loss at noise-sensitive frequencies (4 kHz and 6 kHz). Firefighters with high frequency hearing loss (odds ratio [OR] = 2.31; 95% confidence interval [CI] = [1.05, 5.11]) and those with perceived impaired hearing status (OR = 3.53; 95% CI = [1.27, 9.80]) were significantly more likely to report tinnitus. Similarly, operating engineers who had hearing loss at both low (OR = 2.10; 95% CI = [1.40, 3.15]) and high frequencies (OR = 2.00; 95% CI = [1.37, 2.90]), and perceived impaired hearing status (OR = 2.17; 95% CI = [1.55, 3.05]) were twice as likely to report tinnitus. This study demonstrated that tinnitus is a considerable problem for noise-exposed workers. Workers with hearing loss demonstrated significantly higher rates of tinnitus. Comprehensive workplace hearing conservation programs should include tinnitus management for noise-exposed workers, along with other key elements such as noise control and hearing protection.

PMID: 26968456 [PubMed - as supplied by publisher]

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Protective effects of the seaweed phlorotannin polyphenolic compound dieckol on gentamicin-induced damage in auditory hair cells.

Protective effects of the seaweed phlorotannin polyphenolic compound dieckol on gentamicin-induced damage in auditory hair cells.

Int J Pediatr Otorhinolaryngol. 2016 Apr;83:31-6

Authors: Chang MY, Byon SH, Shin HC, Han SE, Kim JY, Byun JY, Lee JD, Park MK

Abstract
OBJECTIVES: Drug-induced ototoxicity from compounds such as aminoglycosides and platinum can damage the inner ear resulting in hearing loss, tinnitus or balance problems and may be caused by the formation of reactive oxygen species (ROS). Dieckol is a phlorotannin polyphenolic compound with strong antioxidant effects found in edible brown algae. This study investigated the protective effects of dieckol on drug-induced ototoxicity in cochlear cultures obtained from neonatal mice.
METHODS: Cochlear explants were pretreated with dieckol and exposed to gentamicin for 48h. The explants were then fixed and stained with fluorescein isothiocyanate-phalloidin and the intact hair cells counted. The free radical scavenging activity of dieckol was assessed using a 1,1-diphenyl-2-picrylhydrazyl assay. E. coli (Escherichia coli) cultures were used to evaluate the effect of dieckol on the antibiotic activity of gentamicin.
RESULTS: Gentamicin treatment resulted in dose-dependent hair cell loss that was partially protected by dieckol. Moreover, at concentrations >67μM dieckol had significant radical scavenging activity. Dieckol did not compromise the antibiotic effect of gentamicin.
CONCLUSIONS: These findings suggest that dieckol can be used as a therapeutic agent that reduces the damage caused by drug-induced ototoxicity.

PMID: 26968049 [PubMed - in process]

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Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement.

Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement.

Head Neck. 2016 Mar 11;

Authors: Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW

Abstract
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26970554 [PubMed - as supplied by publisher]

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Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model.

Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model.

Ann Otol Rhinol Laryngol. 2016 Mar 11;

Authors: Bhatt NK, Park AM, Al-Lozi M, Paniello RC

Abstract
OBJECTIVE: The compound motor action potential (CMAP) is the summated action potential from multiple muscle fibers activated by a single nerve impulse. The utility of laryngeal muscle CMAP for quantifying innervation following recurrent laryngeal nerve (RLN) injury was investigated.
METHOD: In a series of 21 canine hemi-laryngeal preparations, RLNs were exposed and a stimulating electrode placed. Maximum CMAP amplitudes and area under the curve from the thyroarytenoid (TA) muscles were obtained at baseline and at 6 months following injury to the RLN. Injury mechanisms included crush, stretch, cautery, and complete transection with microsuture repair.
RESULTS: Prior to injury, baseline CMAP amplitudes and area under the curve were 15.81 mV and 15.49mVms, respectively. Six months following injury, CMAP amplitude and area under curve were 105.1% and 102.1% of baseline for stretch, 98.7% and 112.7% for crush, 93.3% and 114.3% for cautery. The CMAP amplitude and area under the curve in the transection/repair group had a 54.3% and 69.4% recovery, respectively, which were significantly different than baseline (P < .01, P < .05). These values were correlated with vocal fold motion.
CONCLUSION: The CMAP is a measure of RLN innervation of vocal fold innervation. The technique could be further developed for clinical and experimental applications.

PMID: 26969454 [PubMed - as supplied by publisher]

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Laryngeal schwannoma as an acute airway presentation.

Laryngeal schwannoma as an acute airway presentation.

BMJ Case Rep. 2016;2016

Authors: Markou K, Dova S, Poulios C, Karkos P

Abstract
A schwannoma is a neurogenic tumour arising from nerve sheaths. Between 25% and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare. They usually occur in women during the fourth and fifth decades of life. We present a case of a laryngeal schwannoma in a 76-year-old patient with acute stridor, hoarseness and dysphagia. Laryngeal conservation surgery was performed without the need for a tracheostomy. One year later, the patient remains symptom-free with no evidence of recurrence. Clinical presentation, diagnosis and management are discussed and the literature is reviewed.

PMID: 26969364 [PubMed - as supplied by publisher]

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The role of polysomnography in tracheostomy decannulation of the paediatric patient.

The role of polysomnography in tracheostomy decannulation of the paediatric patient.

Int J Pediatr Otorhinolaryngol. 2016 Apr;83:132-6

Authors: Lee J, Soma MA, Teng AY, Thambipillay G, Waters KA, Cheng AT

Abstract
INTRODUCTION: Tracheostomy decannulation in the paediatric patient is usually considered when there is resolution or significant improvement in the original indication for the tracheostomy. The child's cardiorespiratory function needs to be optimized and assessment of the readiness for decannulation is generally by endoscopic evaluation to confirm airway patency and vocal cord mobility. Functional airway assessment procedures include downsizing the tracheostomy, adding fenestration, speaking valves and capping the tracheostomy tube. Few objective measures have been demonstrated to accurately predict the likelihood of successful decannulation. This study aims to evaluate the usefulness of polysomnography (PSG) with a capped tracheostomy tube, as an adjunct to airway endoscopy and traditional decannulation procedures, to predict decannulation outcome.
METHODS: A retrospective review was conducted for patients who underwent "capped" PSG prior to a trial of tracheostomy decannulation at the Sydney Children's Hospitals Network. The charts were reviewed for clinical data and PSG results.
RESULTS: 30 children with a total of 40 PSG reports were included in this study. There was a statistically significant difference in mean oxygen saturation, minimum oxygen saturation, total apnoea/hypopnoea index, desaturations >3%, and desaturations >3% index between those that had successful decannulation compared to failed decannulation. The measures with the greatest significance, and therefore, the best predictors of decannulation outcome were total apnoea/hypopnoea index (3.35events/h vs. 18.5events/h, p=0.004) and desaturation events (20.33 events vs. 192 events, p=0.001).
CONCLUSIONS: PSG with a capped tracheostomy tube is a useful, objective tool to complement endoscopy and functional airway assessment in the consideration of decannulation in the paediatric population.

PMID: 26968066 [PubMed - in process]

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Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model.

Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model.

Ann Otol Rhinol Laryngol. 2016 Mar 11;

Authors: Bhatt NK, Park AM, Al-Lozi M, Paniello RC

Abstract
OBJECTIVE: The compound motor action potential (CMAP) is the summated action potential from multiple muscle fibers activated by a single nerve impulse. The utility of laryngeal muscle CMAP for quantifying innervation following recurrent laryngeal nerve (RLN) injury was investigated.
METHOD: In a series of 21 canine hemi-laryngeal preparations, RLNs were exposed and a stimulating electrode placed. Maximum CMAP amplitudes and area under the curve from the thyroarytenoid (TA) muscles were obtained at baseline and at 6 months following injury to the RLN. Injury mechanisms included crush, stretch, cautery, and complete transection with microsuture repair.
RESULTS: Prior to injury, baseline CMAP amplitudes and area under the curve were 15.81 mV and 15.49mVms, respectively. Six months following injury, CMAP amplitude and area under curve were 105.1% and 102.1% of baseline for stretch, 98.7% and 112.7% for crush, 93.3% and 114.3% for cautery. The CMAP amplitude and area under the curve in the transection/repair group had a 54.3% and 69.4% recovery, respectively, which were significantly different than baseline (P < .01, P < .05). These values were correlated with vocal fold motion.
CONCLUSION: The CMAP is a measure of RLN innervation of vocal fold innervation. The technique could be further developed for clinical and experimental applications.

PMID: 26969454 [PubMed - as supplied by publisher]

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Long-term Voice Outcomes of Early Thyroplasty for Unilateral Vocal Fold Paralysis Following Aortic Arch Surgery.

Long-term Voice Outcomes of Early Thyroplasty for Unilateral Vocal Fold Paralysis Following Aortic Arch Surgery.

Ann Otol Rhinol Laryngol. 2016 Mar 11;

Authors: Kwak PE, Tritter AG, Donovan DT, Ongkasuwan J

Abstract
OBJECTIVE: To describe this institution's experience with and the long-term outcomes of early type 1 thyroplasty for unilateral vocal fold paralysis (UVFP) following surgery on the aortic arch.
STUDY DESIGN: Retrospective chart review with telephone questionnaire.
SETTING: Academic tertiary care center.
SUBJECTS AND METHODS: Three hundred forty-eight patients with UVFP following surgery on the aortic arch since 1999 were identified; 40 were available for follow-up. The number of revision procedures following initial thyroplasty was ascertained, and the Voice Handicap Index (VHI) was administered by telephone. The hypothesis that early thyroplasty produced voice outcomes and revision rates comparable to injection laryngoplasty was established prior to the initiation of data collection.
RESULTS: Six out of the 40 patients (15%) required revision thyroplasty following their initial procedure. Mean VHI of all patients was 36.0 (SD, 27.2). Mean VHI was significantly different in the 18 to 39 age group (13.1) when compared to the 40 to 59 (51.8) and 60+ (37.7) age groups (P = .013). Mean follow-up since initial thyroplasty was 46.5 months (SD, 42.2).
CONCLUSIONS: In the setting of aortic arch surgery with injury to the recurrent laryngeal nerve, early thyroplasty produces voice outcomes comparable to those achieved in the literature with repeated injection and delayed thyroplasty and can be considered in select populations.

PMID: 26969453 [PubMed - as supplied by publisher]

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Microsurgical management of craniopharyngiomas via an unilateral subfrontal approach - a retrospective study of 177 continuous cases.

Microsurgical management of craniopharyngiomas via an unilateral subfrontal approach - a retrospective study of 177 continuous cases.

World Neurosurg. 2016 Mar 9;

Authors: Du C, Feng CY, Yuan XR, Liu Q, Peng ZF, Jiang XJ, Li XJ, Xiao GL, Li YF, Xiong T

PMID: 26970477 [PubMed - as supplied by publisher]

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Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes.

Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes.

Neurol Neurochir Pol. 2016 Mar-Apr;50(2):75-82

Authors: Czernicki T, Kunert P, Nowak A, Wojciechowski J, Marchel A

Abstract
OBJECTIVE: To report clinical characteristics, treatment outcomes and risk of recurrence in patients with surgically treated cerebellopontine angle epidermoids.
METHODS: In 1994-2013, we operated 17 patients, including 7 with tumor limited to the cerebellopontine angle, 7 with cerebellopontine angle tumor penetrating supratentorially, and 3 with cerebellopontine angle tumor extending along skull base to contralateral cerebellopontine angle. All patients were followed-up for the mean duration of 126 months.
RESULTS: On admission cranial nerve symptoms predominated. Total tumor removal was achieved in 5 patients, and incomplete removal (with small tumor remnants left on vessels, nerves, or brainstem) in 12 patients. Postoperatively, preoperative deficits worsened in 2 and new postoperative deficits occurred in 10 patients. The extent of tumor expansion had no effect on postoperative morbidity and risk of recurrence. During long-term follow-up, improvement or resolution of preoperative deficits was seen in 11 of 17 patients, and new postoperative deficits in 8 of 10 patients. Symptomatic recurrences after an average of more than 9 years were noted in 5 patients, 3 of whom were reoperated. Recurrences occurred in some younger patients and always in area of primary tumor. No effect of extent of tumor removal on risk of recurrence was found.
CONCLUSIONS: The extent of tumor removal had no effect on the risk of recurrence, and thus it may be acceptable to leave tumor capsule fragments adhering closely to nerves, vessels, or brainstem. During long-term follow-up, resolution or improvement of present preoperatively and new postoperative neurological deficits may be expected in most patients.

PMID: 26969562 [PubMed - as supplied by publisher]

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Ectopic recurrence of pediatric craniopharyngiomas after gross total resection: a report of two cases and a review of the literature.

Ectopic recurrence of pediatric craniopharyngiomas after gross total resection: a report of two cases and a review of the literature.

Childs Nerv Syst. 2016 Mar 11;

Authors: Du C, Feng CY, Yuan J, Yuan X

Abstract
INTRODUCTION: Ectopic recurrent craniopharyngioma is rare. We reported two pediatric cases and reviewed the related literature.
METHOD: We retrospectively studied 177 craniopharyngioma cases treated by the senior author (Yuan X) between years 2003 and 2013. Two ectopic recurrent craniopharyngiomas were identified. One was discovered under the right frontal lobe and the other was found in the fourth ventricle. Both patients underwent a second radical resection without complications. Then we conducted an extensive review of peer-reviewed, English-language literatures in the US National Library of Medicine, focusing on the treatment modalities, recurrent sites, and clinical outcomes.
RESULTS: Sixty ectopic recurrent tumors have been reported so far (including this study). Thirty-three tumors were located in the previous surgical corridors and 27 were disseminated along the cerebrospinal fluid pathway. All recurrent tumors were surgically removed. The gross total resection (GTR) rates were 87 and 63 %, respectively.
CONCLUSION: The natural course of recurrent ectopic craniopharyngiomas is progressive. GTR is the treatment of choice. Regular follow-ups are strongly recommended to detect any further recurrence.

PMID: 26969175 [PubMed - as supplied by publisher]

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Decreased risk of stroke in patients receiving Traditional Chinese Medicine for vertigo: a population-based cohort study.

Decreased risk of stroke in patients receiving Traditional Chinese Medicine for vertigo: a population-based cohort study.

J Ethnopharmacol. 2016 Mar 8;

Authors: Tsai TY, Li CY, Livneh H, Lin IH, Lu MC, Yeh CC

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Patients with vertigo are reported to exhibit a higher risk of subsequent stroke. However, it remains unclear if Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of stroke for these patients. So the aim of the study was to investigate the effects of TCM on stroke risk among patients with vertigo.
MATERIALS AND METHODS: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 112,458 newly diagnosed vertigo patients aged ≧20 years who received treatment between 1998 and2007. Among these patients, 53,203 (47.31%) received TCM after vertigo onset (TCM users), and the remaining 59,201 patients were designated as a control group (non-TCM users). All enrollees received follow-up until the end of 2012 to measure stroke incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of stroke in recipients of TCM services.
RESULTS: During 15-year follow-up, 5,532 TCM users and 12,295 non-TCM users developed stroke, representing an incidence rate of 13.10% and 25.71% per 1,000 person-years. TCM users had a significantly reduced risk of stroke compared to non-TCM users(adjusted HR = 0.64; 95% confidence interval CI= 0.59-0.74). The predominant effect was observed for those receiving TCM for more than 180 days (adjusted HR= 0.52; 95% CI= 0.49-0.56). Commonly used TCM formulae, including Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Ling-Gui-Zhu-Gan-Tang, Bai Zhi (Angelica dahurica (Hoffm.) Benth. & Hook.f. ex Franch. & Sav., root), Ge Gen (Pueraria lobata (Willd.) Ohwi, root) and Hai Piao Xiao (Endoconcha Sepiae, Cuttlefish Bone) were significantly associated with lower risk of stroke.
CONCLUSIONS: Results of this population-based study support the effects of TCM on reducing stroke risk, and may provide a reference for stroke prevention strategies. The study results may also help to integrate TCM into clinical intervention programs that provide a favorable prognosis for vertigo patients.

PMID: 26969404 [PubMed - as supplied by publisher]

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Vestibular neuritis in children and adolescents: Clinical features and recovery.

Vestibular neuritis in children and adolescents: Clinical features and recovery.

Int J Pediatr Otorhinolaryngol. 2016 Apr;83:104-8

Authors: Brodsky JR, Cusick BA, Zhou G

Abstract
OBJECTIVE: Describe the clinical presentation and recovery of vestibular neuritis in children and adolescents.
STUDY DESIGN: Retrospective case series.
SETTING: Pediatric tertiary care center.
SUBJECTS AND METHODS: Eleven patients diagnosed with vestibular neuritis were identified from a database of 301 patients evaluated at our pediatric vestibular clinic from January 2012 through January 2015. Medical records were reviewed to determine clinical presentation, vestibular testing results, treatment, and recovery. Incomplete recovery was defined as residual dizziness or imbalance at most recent follow-up >30 days from symptom onset.
RESULTS: Patients were 5-19 years old (mean 13.1±5.34) and included 6 boys and 5 girls. All presented with a sudden rotational vertigo, imbalance, and nausea for an average of 10 days without other associated symptoms. Testing included rotary chair (8 of 9 abnormal), caloric (2 of 2 abnormal), video head impulse (5 of 8 abnormal), subjective visual vertical (4 of 8 abnormal), and cervical vestibular evoked myogenic potential (0 of 6 abnormal) tests. All patients with incomplete recovery (n=4; 36%) were ≥15 years old at symptom onset. All patients with incomplete recovery that underwent vestibular rehabilitation (n=2) initiated it ≥90 days from symptom onset, while 3 out of 4 patients with complete recovery that underwent vestibular rehabilitation initiated it ≤14 days from symptom onset. Two patients received oral steroids, neither of whom had incomplete recovery.
CONCLUSION: Vestibular neuritis should be considered in pediatric patients with vertigo and may result in longstanding symptoms, particularly in adolescents. The treatment of pediatric vestibular neuritis with rehabilitation and steroids deserves further study.

PMID: 26968063 [PubMed - in process]

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