Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose

A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.

Method

Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.

Results

In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.

Conclusions

Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastrointest Endosc. 2016 Jun 25;

Authors: Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, Dorwat S, Chaves DM, Artifon E, de Moura EG, Kumbhari V, Haito Chavez Y, Bukhari M, Hajiyeva G, Ismail A, Chen YI, Chung H

Abstract
BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been recently reported as minimally invasive therapy for gastroparesis. The aims of this study were to report the first multicenter experience with G-POEM and assess the efficacy and safety of this novel procedure for gastroparetic patients with symptoms refractory to medical therapy.
PATIENTS AND METHODS: All patients with gastroparesis who underwent endoscopic pyloromyotomy (G-POEM) at 5 medical centers were included. Procedures were performed following the same principles as esophageal POEM. Clinical response was defined as improvement in gastroparetic symptoms with absence of recurrent hospitalization. Adverse events (AEs) were graded according to the ASGE lexicon.
RESULTS: A total of 30 patients with refractory gastroparesis (11 diabetic, 12 post-surgical, 7 idiopathic) underwent G-POEM. Prior therapies included Botox injection in 12, transpyloric stenting in 3, and PEGJ in 1. Nausea/vomiting were the predominant symptoms in 25 patients. Weight loss was present in 27 patients with an average of 10% of body weight loss. G-POEM was completed successfully in all 30 (100%) patients with mean procedure time of 72 minutes (range 35-223). The mean myotomy length was 2.6±2.3 cm. The mean length of hospital stay was 3.3 days (range 1-12). Two AEs occurred in 2 (6.7%) patients, including 1 capnoperitoneum and 1 prepyloric ulcer and were rated as mild and severe, respectively. Clinical response was observed in 26 (86%) patients during a median follow-up of 5.5 months. Four patients (2 diabetic, 1 post-surgical, 1 idiopathic etiology) did not respond to G-POEM. Repeat GES was obtained in 17 patients, normalized in 8 (47%) and improved in 6 (35%) patients.
CONCLUSION: G-POEM is a technically feasible procedure. This small non-randomized study suggests the effectiveness of G-POEM for the treatment of patients with gastroparesis refractory to medical therapy. It concomitantly results in normalization of GES in a significant proportion of treated patients.

PMID: 27354102 [PubMed - as supplied by publisher]

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[Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas].

[Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas].

Laryngorhinootologie. 2016 Jun 29;

Authors: Psychogios G, Berlis A, Märkl B, Schaller T, Psychogios MN, Zenk J

Abstract
Introduction: Paragangliomas are rare tumors representing a therapeutic challenge. In particular, the surgical removal may lead to life-threatening bleeding. The preoperative percutaneous embolization is an alternative that allows a high closure rate of tumor-feeding vessels in a short intervention time and thus significantly reduces intraoperative bleeding probability. Complete tumor resection is facilitated thereby. The use of a new non-adhesive liquid embolic agent is presented here. Methods: A 50-year old patient presented with 4 cm large paraganglioma of the carotid body (Shamblin II). A percutaneous embolization with 7 ml PHIL™ (injectable precipitating hydrophobic liquid) was performed preoperatively. 24 h later the complete surgical resection of the tumor was performed. Results: A good distribution of the liquid embolic agent could be achieved over the entire tumor. Intraoperative resection of the tumor was much easier and faster due to low bleeding tendency over the entire surface of the tumor. Total blood loss was less than 50 ml. All adjacent nerve and arterial structures could be spared. Postoperative nerve function was normal and the patient was discharged on the 4(th) postoperative day. Conclusion: The combination of percutaneous embolization and surgical resection provides a safe combination in the treatment of advanced carotid body paragangliomas. The use of a novel liquid embolic agent may possibly further optimize the therapy.

PMID: 27355479 [PubMed - as supplied by publisher]

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[Management of Complex Tympanojugular Paragangliomas].

[Management of Complex Tympanojugular Paragangliomas].

Laryngorhinootologie. 2016 Jun 29;

Authors: Harati A, Schultheiß R, Harati K, Rohde S, Weber W, Deitmer T

Abstract
Background: Tympanojugular paraganglioma (TJP) are benign, high vascularized, local destructive tumors. Despite many studies in the literature, the management of particularly complex TJP (e. g., posterior fossa and/or carotid artery invasion) remains controversial. In the current study we present our treatment strategies for complex TJP and long-term results. Patients and methods: Between 2003 and 2013, 17 patients with TJP Fisch types C and D were treated in our institution. Primary symptoms were hearing loss, followed by facial nerve palsy and lower cranial nerve impairments. 2 patients presented with recurrent tumors. Surgical treatment after endovascular tumor embolization was performed in 14 patients. 2 patients were treated by radiation therapy. Results: Gross tumor resection was achieved in 10 patients. A temporary postoperative facial nerve palsy occurred in 2 patients and permanent postoperative vocal cord palsy in 3 patients. During long term follow-up, one patient experienced regrowth of the residual tumor. No tumor progress was observed in both patients treated with radiation therapy. Outcome assessed by Karnofsky scale showed 100% functionality in 12 patients and 90% in 5 patients. Discussion: Surgical treatment of TJP after endovascular embolization is the treatment of choice in young and healthy patients. In older patients with premorbid conditions, radiation therapy is the main treatment option and is associated with high tumor control rates. Precise preoperative staging together with individualize risk-benefit assessment and interdisciplinary treatment strategy are essential for a favorable outcome.

PMID: 27355478 [PubMed - as supplied by publisher]

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[Objective Diagnostics and Therapie of Hearing Loss Several Years after Cochlear Implant].

[Objective Diagnostics and Therapie of Hearing Loss Several Years after Cochlear Implant].

Laryngorhinootologie. 2016 Jun 29;

Authors: Müller A, Feick J, Dziemba OC, Mir-Salim P

PMID: 27355477 [PubMed - as supplied by publisher]

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Simulation in neurology.

Related Articles

Simulation in neurology.

Neurol Sci. 2015 Oct;36(10):1967-71

Authors: Micieli G, Cavallini A, Santalucia P, Gensini G

Abstract
Simulation is a frontier for disseminating knowledge in almost all the fields of medicine and it is attracting growing interest because it offers a means of developing new teaching and training models, as well as of verifying what has been learned in a critical setting that simulates clinical practice. The role of simulation in neurology, until now limited by the obvious physical limitations of the dummies used to train students and learners, is now increasing since, today, it allows anamnestic data to be related to the instrumental evidence necessary for diagnosis and therapeutic decision-making, i.e., to the findings of neurophysiological investigations (EEG, carotid and vertebral echography and transcranial Doppler, for example) and neuroradiological investigations (CT, MRI imaging), as well as vital parameter monitoring (ECG, saturimetry, blood pressure, respiratory frequency, etc.). Simulation, by providing learners with opportunities to discuss, with experts, different profiles of biological parameters (both during the simulation itself and in the subsequent debriefing session), is becoming an increasingly important tool for training those involved in evaluation of critical neurological patients (stroke, Guillan Barrè syndrome, myasthenia, status epilepticus, headache, vertigo, confusional status, etc.) and complex cases. In this SIMMED (Italian Society for Simulation in Medicine) position paper, the applications (present and, possibly, future) of simulation in neurology are reported.

PMID: 25926070 [PubMed - indexed for MEDLINE]

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Muscle Tension Dysphagia: Symptomology and Theoretical Framework.

Muscle Tension Dysphagia: Symptomology and Theoretical Framework.

Otolaryngol Head Neck Surg. 2016 Jun 28;

Authors: Kang CH, Hentz JG, Lott DG

Abstract
OBJECTIVE: To identify symptoms, common diagnostic findings, pattern of treatments and referrals offered, and their efficacy in a group of patients with idiopathic functional dysphagia in an otolaryngology setting with multiple providers.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary academic center.
SUBJECTS AND METHODS: Following Mayo Clinic Institutional Review Board approval, a retrospective chart review was conducted of patients with dysphagia who had a videofluoroscopic swallow study between January 1, 2013, and April 30, 2015. Each patient's dysphagia symptomology, videofluoroscopic swallow study, flexible laryngoscopy, and medical chart were reviewed to identify the treatment paradigms that were utilized.
RESULTS: Sixty-seven adult patients met the inclusion criteria. Abnormal laryngeal muscle tension was present in 97% of patients. Eighty-two percent of patients also demonstrated signs of laryngeal hyperresponsiveness. Nonspecific laryngeal inflammation was evident in 52% of patients. Twenty-seven patients were referred to speech-language pathology for evaluation. Thirteen patients completed a course of voice therapy directed toward unloading muscle tension. All 13 patients self-reported resolution of dysphagia symptoms.
CONCLUSION: The study results suggest that laryngeal muscle tension may be a factor in the underlying etiology in patients with idiopathic functional dysphagia. We propose the diagnostic term muscle tension dysphagia to describe a subset of patients with functional dysphagia. Further prospective studies are needed to better evaluate potential gastroesophageal confounders in this group of patients and to identify an effective paradigm for treatment. In our limited series, speech-language pathology intervention directed toward unloading muscle tension appears effective.

PMID: 27352887 [PubMed - as supplied by publisher]

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Impact of Endoscopic Indocyanine Green Fluorescence Imaging on Superselective Intra-arterial Chemotherapy for Recurrent Cancer of the Skull Base.

Impact of Endoscopic Indocyanine Green Fluorescence Imaging on Superselective Intra-arterial Chemotherapy for Recurrent Cancer of the Skull Base.

Anticancer Res. 2016 Jul;36(7):3419-24

Authors: Yokoyama J, Ishibashi K, Shiramizu H, Ohba S

Abstract
BACKGROUND/AIM: For advanced paranasal sinus cancer, intra-arterial (I-A) chemotherapy has been applied for improving prognosis and organ preservation. While computed tomographic angiography (CTA) is useful for identifying the tumor-feeding artery, CTA cannot always detect the precise artery. The aim of this study was to assess the feasibility of endoscopic ICG (indocyanine green) fluorescence technique during I-A chemotherapy for recurrent skull-base cancer.
PATIENTS AND METHODS: Seven patients with recurrent skull-base cancer were included in this study. Conventional CTA followed by ICG was administered. Additional information regarding tumor-feeding arteries attained via ICG was evaluated.
RESULTS: Out of seven cases, the blood supply to the cancer was detected in three by CTA alone. By adding the endoscopic evaluation, the blood supply to the tumor was confirmed without difficulty in all cases. The information from endoscopic fluorescence imaging was helpful in making decisions concerning the administration of drugs for skull-base cancer.
CONCLUSION: Endoscopic ICG fluorescence imaging combined with I-A chemotherapy compensated for deficiencies of CTA and generated more useful information about the feeders to tumors than was previously available.

PMID: 27354602 [PubMed - in process]

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Wooden foreign body in the skull base: How we missed it?

Wooden foreign body in the skull base: How we missed it?

World Neurosurg. 2016 Jun 21;

Authors: Jusué-Torres I, Burks SS, Levine CG, Bhatia RG, Casiano R, Bullock MR

Abstract
BACKGROUND: Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may not identify them in up to two thirds of initial scans and can miss wooden foreign bodies in almost one third of total cases.
CASE DESCRIPTION: A 66 year-old lady sustained a penetrating injury through her left upper eyelid with a small-tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial CT scan diagnosis was "post-traumatic sinusitis" and treated empirically with Vancomycin and Piperacillin/tazobactam. On the eighth day post injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left opthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus, to the contralateral sphenoid sinus which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection.
CONCLUSIONS: This case indicates that intraorbital and skull base wooden foreign bodies are elusive; demanding a high index of suspicion from both the clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies bone windows on CT should have a width of -1000 HU with a soft tissue window level of -500 HU.

PMID: 27354291 [PubMed - as supplied by publisher]

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Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes.

Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes.

Am J Otolaryngol. 2016 May 17;

Authors: Yawn RJ, Wright HV, Francis DO, Stephan S, Bennett ML

Abstract
PURPOSE: Reanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome.
MATERIALS AND METHODS: A retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House-Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House-Brackmann grade of ≤3.
RESULTS: Patients who underwent acute hypoglossal-facial anastomotic repair (0-14days from injury) were more likely to achieve House-Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5-16.9, p=0.01).
CONCLUSIONS: Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

PMID: 27353412 [PubMed - as supplied by publisher]

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Planum Sphenoidale and Tuberculum Sellae Meningiomas: Operative Nuances of a Modern Surgical Technique with Outcome and Proposal of a New Classification System.

Related Articles

Planum Sphenoidale and Tuberculum Sellae Meningiomas: Operative Nuances of a Modern Surgical Technique with Outcome and Proposal of a New Classification System.

World Neurosurg. 2016 Feb;86:270-86

Authors: Mortazavi MM, Brito da Silva H, Ferreira M, Barber JK, Pridgeon JS, Sekhar LN

Abstract
BACKGROUND: The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking.
OBJECTIVES: We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome. A new classification system that can guide the surgical approach and may predict surgical risk is proposed.
METHODS: We conducted a retrospective review of the patients who between 2005 and March 2015 underwent a craniotomy or endoscopic surgery for the resection of meningiomas involving the suprasellar region. Operative nuances of a modified frontotemporal craniotomy and orbital osteotomy technique for meningioma removal and reconstruction are described.
RESULTS: Twenty-seven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae; 25 underwent frontotemporal craniotomy and tumor removal with orbital osteotomy and bilateral optic canal decompression, and 2 patients underwent endonasal transphenoidal resection. The most common presenting symptom was visual disturbance (77%). Vision improved in 90% of those who presented with visual decline, and there was no permanent visual deterioration. Cerebrospinal fluid leak occurred in one of the 25 cranial cases (4%) and in 1 of 2 transphenoidal cases (50%), and in both cases it resolved with treatment. There was no surgical mortality.
CONCLUSION: An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.

PMID: 26409085 [PubMed - indexed for MEDLINE]

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Sinonasal extramedullary plasmacytoma: a population-based incidence and survival analysis.

Related Articles

Sinonasal extramedullary plasmacytoma: a population-based incidence and survival analysis.

Int Forum Allergy Rhinol. 2015 Sep;5(9):862-9

Authors: Patel TD, Vázquez A, Choudhary MM, Kam D, Baredes S, Eloy JA

Abstract
BACKGROUND: Sinonasal extramedullary plasmacytoma (SN-EMP) is a rare plasma cell neoplasm. Published literature on this tumor largely consists of case reports and case-series with small sample sizes. This study analyzed population-based data on SN-EMP patients to understand demographic and clinical features as well as incidence and survival trends.
METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was queried for SN-EMP and other head and neck EMP (HN-EMP) cases from 1973 to 2011. Cases were analyzed to determine patient demographics, initial treatment modality, and survival outcomes.
RESULTS: Of 778 patients identified with EMP in the head and neck region, 367 patients had SN-EMP and 411 had other HN-EMP. There was a strong male predilection found, with a male-to-female ratio of 3.65:1 in the SN-EMP group and 1.87:1 in the other HN-EMP group. The majority of the patients presented with localized disease in both SN-EMP (84.4%) and other HN-EMP (81.0%) groups. The most common treatment modality reported in this database was surgery with adjuvant radiotherapy in both SN-EMP (46.3%) and other HN-EMP (38.9%) groups, followed by radiotherapy alone (SN-EMP: 40.7%; other HN-EMP: 34.2%). Five-year and 10-year disease-specific survival rates were comparable between SN-EMP (88.2% and 83.3%, respectively) and other HN-EMP (90.0% and 87.4%, respectively) (p = 0.6016 and p = 0.4015, respectively).
CONCLUSION: This study analyzed the largest cohort of SN-EMP patients to date. There was no statistically significant survival advantage found for any 1 particular treatment modality over other treatment modalities in both SN-EMP and other HN-EMP.

PMID: 25951123 [PubMed - indexed for MEDLINE]

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Endoscopic endonasal resection of clival xanthoma: case report and literature review.

Related Articles

Endoscopic endonasal resection of clival xanthoma: case report and literature review.

Neurosurg Rev. 2015 Oct;38(4):765-9

Authors: González-García L, Asenjo-García B, Bautista-Ojeda MD, Domínguez-Páez M, Romero-Moreno L, Martín-Gallego Á, Arráez-Sánchez MÁ

Abstract
Bone xanthoma is an extremely rare and benign tumor in terms of its nature and growth over time. We describe the first case coexisting with ventriculomegaly secondary to aqueduct stenosis (non-tumoral hydrocephalus), the second xanthoma of the clivus described to date. The patient was a 51-year-old woman with headaches and absence seizures. Axial T1-weighted MRI showed a well-demarcated, hypointense, osteolytic, 25 × 18 × 15 mm lesion with cortical erosion located at the right margin of the clivus. Sagittal T2-weighted MRI demonstrated a hypointense mass without associated edema. Sagittal gadolinium-enhanced T1-weighted MRI showed contrast uptake with a partially hypointense rim. The increased ventricular size without periventricular edema was associated with aqueduct stenosis, and there was no contiguity with the tumor. A neuronavigation image-guided transsphenoidal approach was chosen to perform a macroscopically complete resection. Intraoperative histopathological study showed a chordoma of the clivus. Exhaustive postsurgical study revealed the benign nature of a bone xanthoma. Given the finding of a clival lesion, the differential diagnosis is essentially with other malignant entities with a rapidly fatal outcome, such as metastases, or with a possible invasive evolution, such as clivus chordomas. This report describes the clinical, radiological, and pathological keys for such differentiation in order to avoid unnecessarily aggressive treatment with ablative surgery and radiotherapy.

PMID: 25820465 [PubMed - indexed for MEDLINE]

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4D Flow Preliminary Investigation for Anterior Fossa Dural Arteriovenous Fistula.

Related Articles

4D Flow Preliminary Investigation for Anterior Fossa Dural Arteriovenous Fistula.

Can J Neurol Sci. 2014 Sep;41(5):656-8

Authors: Murai Y, Takagi R, Amano Y, Sekine T, Morita A, Teramoto A

PMID: 25373819 [PubMed - indexed for MEDLINE]

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Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography.

Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography.

Ann Otol Rhinol Laryngol. 2016 Jun 28;

Authors: Sharma GK, Chin Loy A, Su E, Jing J, Chen Z, Wong BJ, Verma S

Abstract
OBJECTIVES: To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS).
METHODS: Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software. Pre-intervention and postintervention airway dimensions were compared. Three-dimensional volumetric airway reconstructions were generated using medical image processing software (MIMICS).
RESULTS: Intraoperative LR-OCT imaging was performed in 3 patients undergoing endoscopic management of SGS. Statistically significant differences in mean anteroposterior diameter (P < .01), transverse diameter (P < .001), and CSA (P < .001) were noted between pre-intervention and postintervention data. Three-dimensional airway models were viewed in cross-sectional format and via virtual "fly through" bronchoscopy.
CONCLUSIONS: This is the first report of intraoperative LR-OCT of the subglottic and tracheal airway before and after surgical management of SGS in humans. Long-range optical coherence tomography offers a practical means to measure the dimensions of SGS and acquire objective data on the response to endoscopic treatment of SGS.

PMID: 27354215 [PubMed - as supplied by publisher]

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Partial Superficial Parotidectomy With Retrograde Dissection of the Facial Nerve for Clinically "Benign" Parotid Tumors.

Partial Superficial Parotidectomy With Retrograde Dissection of the Facial Nerve for Clinically "Benign" Parotid Tumors.

Ann Otol Rhinol Laryngol. 2016 Jun 28;

Authors: Patel DK, Ahmad Z, Morton RP

Abstract
BACKGROUND: To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors.
METHODS: Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery.
RESULTS: There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection (P < .001), deeper tumors (P = .05), and close tumor proximity to the facial nerve (P = .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin (P = .034).
CONCLUSION: Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.

PMID: 27354214 [PubMed - as supplied by publisher]

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Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model.

Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model.

Clin Spine Surg. 2016 Jun 28;

Authors: Ghobrial GM, Maulucci CM, Viereck MJ, Beygi S, Chitale A, Prasad S, Jallo J, Heller J, Sharan AD, Harrop JS

Abstract
STUDY DESIGN: Open-label Laboratory Investigational Study; Non-animal Surgical Simulation OBJECTIVES:: The authors perform a comparison of dural closure strength in a durotomy simulator across two different suture materials.
SUMMARY OF BACKGROUND DATA: Incidental durotomy leading to persistent cerebrospinal fluid (CSF) leak adds considerable morbidity to spinal procedures, often complicating routine elective lumbar spinal procedures. Using an experimental durotomy simulation, the authors compare the strength of closure using Gore-tex™ with other suture types and sizes, using various closure techniques.
METHOD: A comparison of dural closures was performed through an analysis of the peak pressure at which leakage occurred from a standardized durotomy closure in an established CSF repair model with a premade L3 laminectomy. Nurolon™(Ethicon, Somerville, NJ) was compared to Gore-tex™ (Goremedical, Flagstaff, AZ) sutures sizes (for Gore-tex™, CV-6™/5-0 and CV-5™/4-0 was compared to Nurolon™ 4-0, 5-0, and 6-0).
RESULTS: 36 trials were performed with Nurolon™ 4-0, 5-0, and 6-0, while 21 trials were performed for 4-0 and 5-0 Gore-tex™. The mean peak pressure at which fluid leakage was observed was 21 cm H20 for Nurolon™ and 34 cm H20 for Gore-tex™. Irrespective of suture choice, all trials were grouped by closure technique: running suture, locked continuous, and interrupted suture. No significant difference was noted between the groups. For each of the three trials groups by closure technique, running, locked continuous, and interrupted, Gore-tex™ closures had a significantly higher peak pressure to failure. Interrupted Gore-tex™ was significantly higher than Interrupted Nurolon™ (P=0.007), running Gore-tex™ was significantly higher than running Nurolon ™(P=0.034), and locked Gore-tex™ was significantly higher than locked Nurolon™(P=0.014).
CONCLUSIONS: Durotomy closure in the lumbar spine with Gore-tex™ suture may be a reasonable option for providing a watertight closure. In this laboratory study, Gore-tex™ suture provided watertight dural closures that withstood higher peak pressures.

PMID: 27355713 [PubMed - as supplied by publisher]

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Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

World Neurosurg. 2016 Jun 21;

Authors: Da R, Wu Y, Liu W, Shi H, Wang W

Abstract
OBJECTIVE: Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing post-operative central nervous system (CNS) infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty to differentiate infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis.
METHODS: Adult neurosurgical patients with CoNS who recovered via the use of CSF culture in BacT/ALERT Pediatric FAN blood culture bottles and were admitted from September 2013 to July 2015 were enrolled. The demographics, clinical and microbiological data, and treatment were reviewed, and the TTP of each culture was retrieved.
RESULTS: Thirty-nine adult patients with CoNS recovered from CSF culture were included. The TTP ranged from 7.68 to 57.36 hours (hrs). A univariate logistic regression analysis indicated patients with rapid TTP (<21.5 hrs) compared with those with longer TTP were more likely to be female, demonstrate an effective response to antibiotic therapy within 7 days, have clean-contaminated surgical incisions, and exhibit CSF leak. A multivariate logistic regression analysis indicated that being female, an effective antibiotic therapy within 7 days, and clean-contaminated surgical incisions were independent predictors of rapid TTP.
CONCLUSIONS: Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP would represent the pathogen of CNS infection rather than contamination in neurosurgical patients.

PMID: 27354293 [PubMed - as supplied by publisher]

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Use of fat-suppressed T2 -weighted sagittal images after infusion of excess saline into the subarachnoid space as a new diagnostic modality for cerebrospinal fluid hypovolemia: technical note.

Related Articles

Use of fat-suppressed T2 -weighted sagittal images after infusion of excess saline into the subarachnoid space as a new diagnostic modality for cerebrospinal fluid hypovolemia: technical note.

J Neurosurg. 2016 Feb;124(2):580-3

Authors: Nakai E, Takemura M, Nonaka M, Kawanishi Y, Masahira N, Ueba T

Abstract
The diagnosis of CSF hypovolemia remains controversial. The primary diagnostic factor relies on confirmation of leakage of the CSF based on reduced spinal fluid pressure. Determining the specific leakage site is the most important issue for effective treatment but remains a difficult task. Although CT myelography, radioisotope cisternography, and MRI are commonly performed in the diagnosis of CSF hypovolemia, these techniques can rarely identify the precise leakage site. Therefore, an epidural blood patch is performed in the lumbar spine in many cases. This study reports a new diagnostic modality that can help to confirm the leakage site. Fat-suppressed T2-weighted sagittal images were compared before and after the infusion of 20 ml of saline into the subarachnoid space of the lumbar region to detect the specific leakage site with high probability. Three patients were successfully treated by the epidural blood patch based on data obtained with the new diagnostic modality. Two patients were treated in the cervical region and 1 in the lumbar region. The use of fat-suppressed T2-weighted sagittal images after saline infusion could be a relevant diagnostic modality compared with images obtained by CT myelography, radioisotope cisternography, and ordinary MRI to achieve accurate diagnosis and effective treatment of patients with CSF hypovolemia.

PMID: 26381250 [PubMed - indexed for MEDLINE]

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Finite element analysis of periventricular lucency in hydrocephalus: extravasation or transependymal CSF absorption?

Related Articles

Finite element analysis of periventricular lucency in hydrocephalus: extravasation or transependymal CSF absorption?

J Neurosurg. 2016 Feb;124(2):334-41

Authors: Kim H, Jeong EJ, Park DH, Czosnyka Z, Yoon BC, Kim K, Czosnyka M, Kim DJ

Abstract
OBJECTIVE: Periventricular lucency (PVL) is often observed in the hydrocephalic brain on CT or MRI. Earlier studies have proposed the extravasation of ventricular CSF into the periventricular white matter or transependymal CSF absorption as possible causes of PVL in hydrocephalus. However, there is insufficient evidence for either theory to be conclusive.
METHODS: A finite element (FE) model of the hydrocephalic brain with detailed anatomical geometry was constructed to investigate the possible mechanism of PVL in hydrocephalus. The initiation of hydrocephalus was modeled by applying a transmantle pressure gradient (TPG). The model was exposed to varying TPGs to investigate the effects of different geometrical characteristics on the distribution of PVL. The edema map was derived based on the interstitial pore pressure.
RESULTS: The model simulated the main radiological features of hydrocephalus, i.e., ventriculomegaly and PVL. The degree of PVL, assessed by the pore pressure, was prominent in mild to moderate ventriculomegaly. As the degree of ventriculomegaly exceeded certain values, the pore pressure across the cerebrum became positive, thus inducing the disappearance of PVL.
CONCLUSIONS: The results are in accordance with common clinical findings of PVL. The degree of ventriculomegaly significantly influences the development of PVL, but two factors were not linearly correlated. The results are indicative of the transependymal CSF absorption as a possible cause of PVL, but the extravasation theory cannot be formally rejected.

PMID: 26274984 [PubMed - indexed for MEDLINE]

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Effort and Displeasure in People Who Are Hard of Hearing.

Effort and Displeasure in People Who Are Hard of Hearing.

Ear Hear. 2016 Jul-Aug;37 Suppl 1:28S-34S

Authors: Matthen M

Abstract
Listening effort helps explain why people who are hard of hearing are prone to fatigue and social withdrawal. However, a one-factor model that cites only effort due to hardness of hearing is insufficient as there are many who lead happy lives despite their disability. This article explores other contributory factors, in particular motivational arousal and pleasure. The theory of rational motivational arousal predicts that some people forego listening comprehension because they believe it to be impossible and hence worth no effort at all. This is problematic. Why should the listening task be rated this way, given the availability of aids that reduce its difficulty? Two additional factors narrow the explanatory gap. First, we separate the listening task from the benefit derived as a consequence. The latter is temporally more distant, and is discounted as a result. The second factor is displeasure attributed to the listening task, which increases listening cost. Many who are hard of hearing enjoy social interaction. In such cases, the actual activity of listening is a benefit, not a cost. These people also reap the benefits of listening, but do not have to balance these against the displeasure of the task. It is suggested that if motivational harmony can be induced by training in somebody who is hard of hearing, then the obstacle to motivational arousal would be removed. This suggests a modified goal for health care professionals. Do not just teach those who are hard of hearing how to use hearing assistance devices. Teach them how to do so with pleasure and enjoyment.

PMID: 27355767 [PubMed - as supplied by publisher]

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Red blood cell distribution width predicts prognosis in idiopathic sudden sensorineural hearing loss.

Red blood cell distribution width predicts prognosis in idiopathic sudden sensorineural hearing loss.

Acta Otolaryngol. 2016 Jun 29;:1-4

Authors: Nonoyama H, Tanigawa T, Shibata R, Nakao Y, Horibe Y, Katahira N, Nishimura K, Murotani K, Murohara T, Ueda H

Abstract
CONCLUSION: Red cell distribution width (RDW) can predict outcome in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Further studies are required to clarify the potential pathophysiological explanations for these findings.
OBJECTIVES: RDW is one of the parameters reported in a complete blood count, and is elevated in direct proportion to variation in red cell size (anisocytosis). High RDW values are strongly associated with poor clinical outcomes in various diseases, including inflammatory and thrombotic diseases. To identify a prognostic biomarker that better predicts outcomes after ISSNHL, the association between RDW values at hospitalization and prognosis in patients with ISSNHL was assessed.
METHOD: This study measured RDW and performed hearing assessments in 89 consecutive patients with ISSNHL. Patients were then divided into two groups ('recovered' and 'unrecovered'), according to their response to the treatment, and further analysis undertaken.
RESULTS: Mean RDW was significantly higher in the unrecovered group (13.2% ± 1.0% compared with 12.7% ± 0.7% in the recovered group, p = 0.031). After adjusting for potentially confounding factors in a binary logistic regression model, only RDW was associated with recovery from ISSNHL (odds ratio = 2.33, 95% confidence interval = 1.20-4.51, p = 0.012).

PMID: 27355976 [PubMed - as supplied by publisher]

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Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue.

Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue.

Otolaryngol Head Neck Surg. 2016 Jun 28;

Authors: Garcia JA, Benboujja F, Beaudette K, Rogers D, Maurer R, Boudoux C, Hartnick CJ

Abstract
OBJECTIVE: Vocal fold scarring, a condition defined by increased collagen content, is challenging to treat without a method of noninvasively assessing vocal fold structure in vivo. The goal of this study was to observe the effects of vocal fold collagen content on optical coherence tomography imaging to develop a quantifiable marker of disease.
STUDY DESIGN: Excised specimen study.
SETTING: Massachusetts Eye and Ear Infirmary.
SUBJECTS AND METHODS: Porcine vocal folds were injected with collagenase to remove collagen from the lamina propria. Optical coherence tomography imaging was performed preinjection and at 0, 45, 90, and 180 minutes postinjection. Mean pixel intensity (or image brightness) was extracted from images of collagenase- and control-treated hemilarynges. Texture analysis of the lamina propria at each injection site was performed to extract image contrast. Two-factor repeated measure analysis of variance and t tests were used to determine statistical significance. Picrosirius red staining was performed to confirm collagenase activity.
RESULTS: Mean pixel intensity was higher at injection sites of collagenase-treated vocal folds than control vocal folds (P < .0001). Fold change in image contrast was significantly increased in collagenase-treated vocal folds than control vocal folds (P = .002). Picrosirius red staining in control specimens revealed collagen fibrils most prominent in the subepithelium and above the thyroarytenoid muscle. Specimens treated with collagenase exhibited a loss of these structures.
CONCLUSION: Collagen removal from vocal fold tissue increases image brightness of underlying structures. This inverse relationship may be useful in treating vocal fold scarring in patients.

PMID: 27352894 [PubMed - as supplied by publisher]

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Rhinocerebral Mucormycosis of the Optic Nerve.

Rhinocerebral Mucormycosis of the Optic Nerve.

Otolaryngol Head Neck Surg. 2016 Jun 28;

Authors: Mattingly JK, Ramakrishnan VR

PMID: 27352893 [PubMed - as supplied by publisher]

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Medical Information Exchange: Pattern of Global Mobile Messenger Usage among Otolaryngologists.

Medical Information Exchange: Pattern of Global Mobile Messenger Usage among Otolaryngologists.

Otolaryngol Head Neck Surg. 2016 Jun 28;

Authors: Siegal G, Dagan E, Wolf M, Duvdevani S, Alon EE

Abstract
OBJECTIVE: Information technology has revolutionized health care. However, the development of dedicated mobile health software has been lagging, leading to the use of general mobile applications to fill in the void. The use of such applications has several legal, ethical, and regulatory implications. We examined the experience and practices governing the usage of a global mobile messenger application (WhatsApp) for mobile health purposes in a national cohort of practicing otolaryngologists in Israel, a known early adaptor information technology society.
METHODS: Cross-sectional data were collected from practicing otolaryngologists and otolaryngology residents via self-administered questionnaire. The questionnaire was composed of a demographic section, a section surveying the practices of mobile application use, mobile health application use, and knowledge regarding institutional policies governing the transmission of medical data.
RESULTS: The sample included 22 otolaryngology residents and 47 practicing otolaryngologists. Of the physicians, 83% worked in academic centers, and 88% and 40% of the physicians who worked in a hospital setting or a community clinic used WhatsApp for medical use, respectively. Working with residents increased the medical usage of WhatsApp from 50% to 91% (P = .006). Finally, 72% were unfamiliar with any institutional policy regarding the transfer of medical information by personal smartphones.
DISCUSSION: Mobile health is becoming an integral part of modern medical systems, improving accessibility, efficiency, and possibly quality of medical care.
IMPLICATIONS FOR PRACTICE: The need to incorporate personal mobile devices in the overall information technology standards, guidelines, and regulation is becoming more acute. Nonetheless, practices must be properly instituted to prevent unwanted consequences.

PMID: 27352892 [PubMed - as supplied by publisher]

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A Prospective Assessment of Nasopharyngolaryngoscope Recording Adaptor Use in Residency Training.

A Prospective Assessment of Nasopharyngolaryngoscope Recording Adaptor Use in Residency Training.

Otolaryngol Head Neck Surg. 2016 Jun 28;

Authors: Liu YF, Kim CH, Bailey TW, Hondorp BM, Nguyen K, Krishnan M, Simental AA, Inman JC

Abstract
Flexible fiberoptic nasopharyngolaryngoscope (FN) examinations are important to the practice of otolaryngology (ENT). We sought to assess whether a portable recording adaptor for the FN can enhance resident learning and improve patient management. The adaptor was used prospectively on consultations by first- and second-year ENT residents, and changes in diagnosis and management were recorded in the patient care workflow. In 43 patients, we found a 23% change in diagnosis, 44% change in management, and 19% change in surgical management after an attending reviewed recorded videos. Residents and attendings reported that discussing the video enhanced learning in 88% and 81% of cases, respectively. A portable FN recording adaptor has the potential to improve resident training and perhaps lead to more prompt health care delivery.

PMID: 27352891 [PubMed - as supplied by publisher]

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