Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing

xlomafota13 shared this article with you from Inoreader Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing Via Journal of the Association for Research in Otolaryngology Abstract Acoustic hearing can be preserved after cochlear implant (CI) surgery, allowing for combined electric-acoustic stimulation (EAS) and superior speech understanding compared to electric-only hearing. Among patients who initially retain useful acoustic hearing, 30–40 % experience a delayed hearing loss that occurs 3 or more months after CI activation. Increases in electrode impedances have been associated with delayed loss of residual acoustic hearing, suggesting a possible role of intracochlear inflammation/fibrosis as reported by Scheperle et al. (Hear Res 350:45–57, 2017) and Shaul et al. (Otol Neurotol 40(5):e518–e526, 2019). These studies measured only total impedance. Total impedance consists of a composite of access resistance, which reflects resistance of the intracochlear environment, and polarization impedance, which reflects resistive and capacitive properties of the electrode–electrolyte interface as described by Dymond (IEEE Trans Biomed Eng 23(4):274–280, 1976) and Tykocinski et al. (Otol Neurotol 26(5):948–956, 2005). To explore the role of access and polarization impedance components in loss of residual acoustic hearing, these measures were collected from Nucleus EAS CI users with stable acoustic hearing and subsequent precipitous loss of hearing. For the hearing loss group, total impedance and access resistance increased over time while polarization impedance remained stable. For the stable hearing group, total impedance and access resistance were stable while polarization impedance declined. Increased access resistance rather than polarization impedance appears to drive the increase in total impedances seen with loss of hearing. Moreover, access resistance has been correlated with intracochlear fibrosis/inflammation in animal studies as observed by Xu et al. (Hear Res 105(1–2):1–29, 1997) and Tykocinski et al. (Hear Res&n bsp;159(1–2):53–68, 2001). These findings thus support intracochlear inflammation as one contributor to loss of acoustic hearing in our EAS CI population. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Elusive Cochlear Filter: Wave Origin of Cochlear Cross-Frequency Masking

xlomafota13 shared this article with you from Inoreader The Elusive Cochlear Filter: Wave Origin of Cochlear Cross-Frequency Masking Via Journal of the Association for Research in Otolaryngology Abstract The mammalian cochlea achieves its remarkable sensitivity, frequency selectivity, and dynamic range by spatially segregating the different frequency components of sound via nonlinear processes that remain only partially understood. As a consequence of the wave-based nature of cochlear processing, the different frequency components of complex sounds interact spatially and nonlinearly, mutually suppressing one another as they propagate. Because understanding nonlinear wave interactions and their effects on hearing appears to require mathematically complex or computationally intensive models, theories of hearing that do not deal specifically with cochlear mechanics have often neglected the spatial nature of suppression phenomena. Here we describe a simple framework consisting of a nonlinear traveling-wave model whose spatial response properties can be estimated from basilar-membrane (BM) transfer functions. Without invoking jazzy details of organ-of-Corti mechanics, the model accounts well for the peculiar frequency-dependence of suppression found in two-tone suppression experiments. In particular, our analysis shows that near the peak of the traveling wave, the amplitude of the BM response depends primarily on the nonlinear properties of the traveling wave in more basal (high-frequency) regions. The proposed framework provides perhaps the simplest representation of cochlear signal processing that accounts for the spatially distributed effects of nonlinear wave propagation. Shifting the perspective from local filters to non-local, spatially distributed processes not only elucidates the character of cochlear signal processing, but also has important consequences for interpreting psychophysical experiments. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐Term Outcome of a cohort of 272 patients undergoing sialendoscopy.

xlomafota13 shared this article with you from Inoreader Long‐Term Outcome of a cohort of 272 patients undergoing sialendoscopy. Via Clinical Otolaryngology ABSTRACT Objectives To assess the cohort of patients undergoing sialendoscopic intervention for improvement of symptoms and gland-related quality of life at long-term follow up. Methods This is a retrospective review of medical records with a prospective follow-up by questionnaire. All patients undergoing sialendoscopy between March 2008 and June 2020 were analyzed in detail regarding indications, technical aspects and postoperative course. To maximize follow-up, patients also received a questionnaire by e-mail. Results 272 sialendoscopies were performed in 221 patients. Median follow-up time was 37 months. The sialendoscopies were performed in 130 patients for lithiasis, in 66 for stenosis, in 14 for recurrent parotitis of childhood, in 8 for recurrent sialadenitis of unknown origin and in 3 for radio-iodine induced sialadenitis. Complications occurred in 11 of 272 sialendoscopies (4%). Those were iatrogenic perforations, temporary lingual nerve paresthesia and swelling of the floor of the mouth. 53% of patients returned the questionnaire, for a total of 146 evaluable sialendoscopies. The majority of the responders indicated that sialendoscopy had improved their symptoms (83.6%). Salivary glands could be preserved in 89% of the responder group. The highest percentage of patients reporting residual symptoms was found in the RPC group (81.3%) and the lowest in the lithiasis group (16.2%). Besides age, no statistical differences in demographic and pathological features between the responder and non -responder groups were found, supporting generalization of the responders' results to the entire cohort. Conclusions This study confirms the good long-term outcomes of sialendoscopic interventions in patients with chronic sialadenitis of different etiologies and a high rate of gland preservation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use of an Autoinflation Device Does Not Lead to a Clinically Meaningful Change in Hearing Thresholds in Children With Otitis Media With Effusion

xlomafota13 shared this article with you from Inoreader Use of an Autoinflation Device Does Not Lead to a Clinically Meaningful Change in Hearing Thresholds in Children With Otitis Media With Effusion Via Clinical Otolaryngology Abstract Objectives The objective of this study was to establish whether autoinflation was an effective intervention in a paediatric audiology service. The aims were to evaluate whether there was improvement in hearing thresholds following introduction of an autoinflation device, and whether there was a reduction in further audiology follow-ups, and in referrals to an ear, nose and throat specialist for consideration of ventilation tube insertion. Design This was a pragmatic retrospective study with historical controls using a paired availability design at a single paediatric audiology service in England. Participants All children seen in the clinic over a two-year period who were aged between 3 and 11 years and who had a type B tympanogram in at least one ear were included. The Otovent autoinflation device was available as a treatment option over the second year (Cohort B) but not the first (Cohort A). There were 976 children included in the study: Cohort A comprised 513 children, Cohort B comprised 463 children. Results There was a statistically significant improvement in hearing thresholds in Cohort B compared to Cohort A, however the improvements were clinically minimal with small effect sizes. There was no significant difference in improvement of tympanometry results between the two cohorts. Significantly more children in Cohort B (autoinflation group) were referred to an ear, nose and throat specialist after their second appointment compared to Cohort A. Conclusions It was feasible to introduce autoinflation into the care pathway, however there was no evidence of clinically meaningful improved outcomes for patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Utility Of The Exoscope Compared To The Operating Microscope in Simulated Temporal Bone Surgery

xlomafota13 shared this article with you from Inoreader The Utility Of The Exoscope Compared To The Operating Microscope in Simulated Temporal Bone Surgery Via Clinical Otolaryngology Abstract Objective To objectively assess the utility of an exoscope during simulated otological surgery. Design Cohort study. Setting Tertiary referral otolaryngology centre. Participants Seven experienced otologists undertook simulated temporal bone surgery on plastic temporal bones using the Zeiss Kinevo microscope with both a microscope and exoscope facility. Outcome measures The utility of microscope and exoscope was compared using a Likert scale from 1 to 10 with and without PPE. Attributes assessed included image quality, depth perception, adequacy of view, exoscope positioning, surgeon comfort, surgeon safety and adequacy of image and protection for assistants and observers. Results The exoscope in 3D mode performed as well as or better than the microscope for image quality, field of view and manoeuvrability. It outperformed the microscope for compatibility with PPE, surgeon comfort and assistant/observer experience. It scored almost as highly as the microscope for depth perception. Conclusion There is likely to be a learning curve but this initial assessment of the exoscope shows significant potential as an alternative to the operating microscope in otological surgery but with the advantage of allowing the use of appropriate PPE and better ergonomics for both surgeon and assistant/observer. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis

xlomafota13 shared this article with you from Inoreader Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis Via Clinical Otolaryngology ABSTRACT Objectives The present meta-analysis sought to assess further evidence for the efficacy of steroids in vestibular neuritis (VN). Methods The PubMed, EMBASE and Cochrane Library databases were searched through August 30, 2019. The main outcome measure was dizziness handicap inventory (DHI) and secondary outcomes included complete caloric recovery and improvement of canal paresis (CP). The follow-up times were divided into short, mid, and long-term. Results Among 276 records identified, 5 studies (n = 253) were included in the analysis. The therapeutic effect of steroid on VN was confirmed (Hedges' g = 0.172, 95% CI 0.05 to 0.30, p = .006). Although there was no significant difference between steroids and control in the DHI score (Hedges' g = -0.323, 95% CI -0.533 to -0.113, p < 0.01), significant effect was seen on complete caloric recovery and improvement in CP (Hedges' g = 0.364, 95% CI 0.18 to 0.55, p < 0.0001; Hedges' g = 0.592, 95% CI 0.32 to 0.59, p < .0001) Conclusions The results suggest that corticosteroids have an effect on the results of caloric tests for VN recovery, especially in long-term follow-up. However, in the term of dizziness handicap, we did not find any evidence of positive effect of corticosteroid. More data are required before recommendations can be made regarding management in patients on corticosteroids. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Adenoidectomy Training System

xlomafota13 shared this article with you from Inoreader A Novel Adenoidectomy Training System Via The Laryngoscope Objectives/Hypothesis Young residents find mirror-guided adenoidectomy difficult. Inexperienced trainees must learn to focus a headlight beam, work upside-down and backward in a small space and thoroughly ablate adenoid tissue—all new skills. We present an adenoidectomy training system that is low-cost, easy to construct, and is focused on these basic adenoidectomy skills. Study Design Prospective experimental study. Methods This training suite includes three stations each targeting a different skill. The first employs a mannequin head with exposed nasopharynx. It trains the student to coordinate a headlight and mirror while touching a series of targets with a curved probe. At the second station participants electrodessicate (or microdebride) an anchored piece of veal thymus. The third station combines both sets of skills as participants ablate thymus in a simulated nasopharynx (30 mm rectangular aluminum tube) constrained within a Crow-Davis retractor, using a headlight, mirror, and suction electrosurgical electrode (or microdebrider). To evaluate the training system's efficacy, we assessed the performance of 10 surgically naïve medical student volunteers before and after 15 minutes of practice using a validated rating scale used for adenoidectomy. Results There was significant improvement in adenoidectomy skill scores after practicing. Overall scores were higher, time taken to touch a series of targets with a headlight and mirror was less and amount of tissue ablated at the final station was greater (P < .05). Conclusion This novel adenoidectomy training system is inexpensive and easy to build. Practice with the model resulted in statistically significant improvement in adenoidectomy skill scores for inexperienced student surgeons. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction

xlomafota13 shared this article with you from Inoreader Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction Via The Laryngoscope Objectives/Hypothesis Current methods of assessing rib cartilage dimensions for laryngotracheal reconstruction (LTR) are inexact, making surgical planning difficult. The purpose of this study was to determine the most appropriate rib for costal cartilage graft LTR to minimize the number of ribs harvested and improve surgical outcomes. Study Design Retrospective review. Methods Computed tomography imaging of chest scans in 25 children aged 1 to 18 years was evaluated. The lengths and widths of medial and lateral cartilaginous segments of ribs 4 to 7 were measured bilaterally. Right and left cartilaginous rib dimensions were compared using a two-sample t-test. Linear mixed-effect regression was performed to develop models quantifying the relationship between rib size and patient height, rib side, and rib number. Results Regression analysis established strong models for medial rib length (R 2 = 0.89) and for medial and lateral rib width (R 2 = 0.71, 0.77, respectively). There was no difference in rib dimensions across chest sides. Rib length and width increased with child height. Total cartilaginous rib length increased from superiorly to inferiorly, primarily due to an increase in the dimensions of the medial portion of each rib. Conclusion Cartilaginous rib lengths and widths were associated with patient height, with taller children having longer ribs. Inferior ribs were longer than superior ribs, suggesting that inferior ribs may be preferred for LTR. There was no difference in cartilaginous rib length across chest side. Results may help surgeons with preoperative planning. Level of Evidence Not applicable Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effects of Remote Signal Transmission and Recording on Acoustical Measures of Simulated Essential Vocal Tremor: Considerations for Remote Treatment Research and Telepractice

xlomafota13 shared this article with you from Inoreader The Effects of Remote Signal Transmission and Recording on Acoustical Measures of Simulated Essential Vocal Tremor: Considerations for Remote Treatment Research and Telepractice Via Journal of Voice Studies on medical and behavioral interventions for essential vocal tremor (EVT) have shown inconsistent effects on acoustical and perceptual outcome measures across studies and across participants. Remote acoustical and perceptual assessments might facilitate studies with larger samples of participants and repeated measures that could clarify treatment effects and identify optimal treatment candidates. Furthermore, remote acoustical and perceptual assessment might allow clinicians to monitor clients' treatment responses and optimize treatment approaches during telepractice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lateral border and scapular tip free flaps: Old school versus new school

xlomafota13 shared this article with you from Inoreader Lateral border and scapular tip free flaps: Old school versus new school Via Head & Neck Abstract Free tissue transfer from the subscapular system provides a wide array of options for both soft tissue and bony reconstruction. When bone stock is required for head and neck reconstruction, both the lateral scapular border free flap (LSBFF), supplied by the circumflex scapular artery, and the scapular tip free flap (STFF), supplied by the angular artery, are excellent options. Issues with positioning had previously prevented the widespread use of these bony subscapular system flaps. However, through the use of a Spider Limb Positioner, current clinical practice patterns allow for two team approaches in both of these free flaps. The following pictorial essay compares and contrasts the specific positioning and harvesting technique used for both the LSBFF and STFF, while discussing the clinical advantages and drawbacks of each. Both the lateral border scapula and scapular tip free flaps provide excellent bone stock for head and neck reconstruction. By positioning with currently avail able technology, both of these free flaps can be harvested through a two team approach. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Late recurrence of post-dural puncture headache

xlomafota13 shared this article with you from Inoreader Late recurrence of post-dural puncture headache Via leak of cerebrospinal fluid Agri. 2021 Oct;33(4):261-264. doi: 10.14744/agri.2019.44711. ABSTRACT The term post-dural puncture headache (PDPH) refers to a common complication that occurs after accidental dural puncture. One of the diagnostic symptoms of PDPH is a postural headache, which worsens dramatically while sitting or standing and is relieved mostly by lying down. This symptom is caused by a cerebrospinal fluid (CSF) leak, leading to decreased CSF pressure or low CSF volume, which provokes a shift of intracranial contents and traction on pain-sensitive structures in the upright position. PDPH is commonly a self-limited condition and remits spontaneously within 2 weeks, or becomes less severe after surgical intervention to seal the leak with autologous epidural blood patch (EBP). Although recurrence of spontaneous intracranial hypotension following an EBP is not rare, spontaneously late recurrence of PDPH has been rarely reported. The purpose of this paper is to d iscuss this case with late recurrence of PDPH after 10 months following EBP. PMID:34671953 | DOI:10.14744/agri.2019.44711 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Posterior fossa decompression for children with Chiari I malformation and hydrocephalus

xlomafota13 shared this article with you from Inoreader Posterior fossa decompression for children with Chiari I malformation and hydrocephalus Via leak of cerebrospinal fluid Childs Nerv Syst. 2021 Oct 20. doi: 10.1007/s00381-021-05377-4. Online ahead of print. ABSTRACT INTRODUCTION: Chiari I malformation (CMI) and hydrocephalus often coexist, with no clear understanding of the cause-and-effect relationship. In the absence of other associated etiologies, the traditional teaching has been to treat the hydrocephalus first, partly to minimize the risk of cerebrospinal fluid (CSF) leak from CMI decompression in the setting of elevated ICP. We describe a series of consecutive pediatric patients with CMI and hydrocephalus, the majority of whom were managed with posterior fossa decompression. METHODS: A retrospective review was conducted on consecutive children who presented to the senior author with both hydrocephalus and CMI, with emphasis on rationale for and outcomes of surgical intervention, including the need for additional surgery. RESULTS: There were 14 patients aged 2 weeks to 16 years (median 2 year s) who presented with Chiari I and hydrocephalus. Four of these underwent posterior fossa decompression without duraplasty (PFD) as first-line therapy (one of whom eventually required duraplasty), 7 had PFD with duraplasty (PFDD), 1 received a ventriculoperitoneal shunt (VPS), and two had endoscopic third ventriculostomy (ETV). Of the 11 who had PFD/D, 9 (90%) had significant symptom improvement/resolution, 7 (55%) showed decrease in ventricle size, and 1 (10%) required VPS placement for persistent hydrocephalus. Both ETV patients improved clinically, and 1 showed decrease in ventricle size. There were no pseudomeningoceles, infections, or neurological deficits. One CSF leak occurred after an ETV and was successfully treated with wound revision. CONCLUSION: In patients with both CMI and hydrocephalus, treating the CMI first in an effort to avoid a shunt can be safe and effective. In this series, PFDD in the setting of hydrocephalus did not result in CSF leak or pseudomeningoce le. While limited by a small sample size, these data support a causative relationship between CMI and hydrocephalus. PMID:34671850 | DOI:10.1007/s00381-021-05377-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.