Otolaryngology–Head and Neck Surgery

To assess hearing results following primary stapes surgery in patients with otosclerosis, comparing local and general anesthesia.

PubMed, Embase, the Cochrane Library, CINAHL, and Scopus.

A systematic search was conducted, followed by assessment of directness of evidence and risk of bias. Studies reporting original data on the effect of local anesthesia, compared to general anesthesia, on closure of air-bone gap in patients undergoing stapes surgery for otosclerosis were included.

A total of 257 unique studies were retrieved, of which 3 (including 417 procedures) satisfied the eligibility criteria. Assessment showed that all studies carried high risk of bias, and only 1 study provided direct evidence.

There is no difference in postoperative air-bone gap, worsening of sensorineural hearing loss, and postoperative vertigo between the 2 groups. A statistically significant increased risk of immediate dead ear following stapes surgery performed under general anesthesia was reported in 1 study.

To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism.

Prospective study.

Multi-institutional Midwest Head and Neck Cancer Consortium.

Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings.

Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum.

Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.

To describe pediatric costochondral graft reconstruction of the absent mandibular condyle and to report the short-term and long-term outcomes and complications associated with performing this procedure in young children.

Case series with a retrospective chart review.

Pediatric otolaryngology clinic and tertiary children’s hospital in a metropolitan area.

All children treated for an absent mandibular condyle with a costochondral graft at Children’s Hospitals and Clinics of Minnesota were identified from 2002 through 2011, and a retrospective chart review was performed.

Ten patients aged 3 to 11 years were identified. The most common diagnosis, in 8 of 10 patients, was oculo-auriculo-vertebral syndrome. Three of the patients had a tracheostomy, of which 1 was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 of 10 patients. Five patients have required no further surgeries to date, with a mean follow-up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case, and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years, whereas resorption occurred after an average of 2.5 years.

Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short-term results show particular improvement in function and mandibular alignment. The mean follow-up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population.

To evaluate the impact of facial lesions on affect display in patients as compared with individuals without lesions.

Prospective randomized controlled experiment.

Academic tertiary referral center.

Forty-five normal observers viewed photographs of normal faces in repose and faces with lesions in repose. Observers classified the affect display of the patients and the normals using a survey containing choices of primary emotions and personal attributes. Latent class analysis was used to find the unmeasured or “latent” classes. Latent class regression was used to determine the impact of lesion size and location on class membership. Finally, lesion classes and normal classes were checked for differences.

Latent class analysis identified 4 independent latent classes for faces with lesions. The normal data were best fit by 3 latent classes. As a group, faces with lesions were most likely to be classified as either negative-sad or negative-angry, accounting for a combined probability of 44%. This was in contrast to the normal group, where 62% were classified as positive and only 13.9% as negative. Size and location significantly affected negative class membership. There were significant differences in the lesion classes as compared with the normal classes.

Faces with lesions were reported to display different affect in repose than normal faces in repose. The classification of the lesion faces was dependent on lesion size and location. These findings provide the first objective evidence of the affect display penalty caused by facial lesions.

To evaluate clinical and immunohistopathological effects of topical glycyl-histidyl-lysine-copper (GHK-Cu) on in vivo irradiated rat wounds.

Animal model.

Academic institution.

After dorsal irradiation and a 28-day recovery period, 2 × 8 cm cranially based dorsal flaps were created in Sprague-Dawley rats. Twice daily GHK-Cu gel (test) or aquaphilic ointment (control) was applied for 10 days. Animals were euthanized, digital images of flaps were taken, and harvested tissues were immunohistochemically stained for a vascular endothelium marker, caveolin-1, and vascular endothelial growth factor (VEGF). Digital image analysis was used for outcome measures. Unpaired t-tests were used for statistical analyses; significance of P < .01 accounted for multiple comparisons.

By digital analysis of clinical images, 13 test and 10 control animals showed mean ischemic areas of 5.0 cm² (SD = 0.9) for tests and 3.8 cm² (SD = 1.1; P = .011) for controls. Whole slide digitized images allowed quantification of caveolin-1-stained blood vessels and VEGF expression in fibroblasts at the interface of healing flaps. Caveolin-1 analyses showed a mean of 209.0 vessels (SD = 111.1) and a mean vessel luminal area of 525.7 um² (SD = 191.0) in tests and 207.4 vessels (SD = 109.4; P = .973) and 422.8 um² (SD = 109.7; P = .118) in controls. VEGF quantified as the percentage of pixels exceeding a colorimetric threshold, with higher fractions of positive pixels indicating more intense staining, showed a mean intensity score of 0.34 (SD = 0.19) in tests and 0.54 (SD = 0.41; P = .169) in controls.

Irradiated dorsal rat flaps treated with topical GHK-Cu gel demonstrated no difference in flap ischemia, blood vessel number or area, or VEGF expression compared to controls.

This study explored the outcomes of epistaxis treatment modalities to optimize management and enable the development of a therapeutic algorithm.

Case series with chart review.

Tertiary care hospital.

Adult patients presenting between 2005 and 2011 with epistaxis underwent cauterization, tamponade, and/or proximal vascular control. Outcomes of treatment modalities were compared. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for coagulopathy, hypertension, and bleeding site.

The population included 147 patients (94 men, 53 women). For initial epistaxis, nondissolvable packing demonstrated the highest initial treatment failure rate of 57.4% (OR, 3.37; 95% CI, 1.33-8.59 compared with cautery). No significant differences were noted among initial posterior epistaxis treatment modalities. Length of nondissolvable pack placement for 3, 4, or 5 days had no significant impact on recurrence. Among patients who failed initial management, those who next underwent cautery or proximal vascular control required a significantly shorter inpatient stay of 5.3 vs 6.8 days compared with those who underwent packing (OR, 0.16; 95% CI, 0.04-0.68). There were no treatment failures following surgical arterial ligation.

Initial management of anterior epistaxis with chemical cautery had a higher success rate and a lower number of total required interventions than did nondissolvable packing. Duration of packing did not affect recurrence. In patients who failed initially, progression to cautery or proximal vascular control led to significantly shorter inpatient stays than did packing.

To describe the epidemiology and determine the clinicopathologic predictors of recurrence and survival in patients with head and neck mucoepidermoid carcinoma (MEC).

Case series with chart review.

Tertiary care hospital.

The medical records of 101 patients who underwent surgical treatment at the University of Michigan for head and neck MEC between 1985 and 2010 were reviewed. Main outcome measures were disease-free survival (DFS), disease-specific survival (DSS), and overall survival. Clinicopathologic parameters evaluated were age, sex, subsite, histological grade, adjuvant therapy, T stage, nodal status with/without extracapsular spread, and margin status.

Of the 101 patients, 38 parotid, 33 palate, 17 oral, 8 submandibular/sublingual, 4 orbital, and 1 parapharyngeal carcinomas were identified. All patients underwent surgical resection, 23 had postoperative radiation, and 2 had postoperative chemoradiation. The 5-year OS and DSS was 79% and 95% with a median follow-up of 72 and 45 months, respectively. Five-year DFS was 76%. On univariate analysis, histological grade was a statistically significant predictor of disease-free survival (P = .001) and overall survival (P = .04). Positive nodal status was a significant predictor of DSS (P = .004). There was no statistically significant difference in DFS, DSS, or OS based on sex, age, anatomic subsite, T stage, adjuvant therapy, and margin status.

Advanced histological grade and positive nodal status are the strongest independent predictors of prognosis in head and neck MEC patients. Further studies into the molecular biology of MEC that may account for such clinicopathological features are currently underway.

Human papilloma virus (HPV) positive and HPV negative head and neck squamous cell cancer (HNSCC) are biologically distinct with a prognostic advantage for HPV positive patients compared to HPV negative cases. DNA promoter methylation is central to human diseases such as cancer, including HNSCC, with reported genome-wide hypomethylaton and promoter hypermethylation in HPV positive HNSCC tumors. The goal of this study was to identify differentially methylated genes in HPV positive versus HPV negative primary HNSCC genomes with clues to signaling networks.

Laboratory-based study.

Primary care academic health care system.

DNA from 4 HPV positive and 4 HPV negative freshly frozen primary HNSCC were subject to comprehensive genome-wide methylation profiling. Differentially methylated gene lists were examined using the Signal Transduction Pathways (canonical) filter in the Genomatix Pathway System (GePS).

Twofold methylation differences were observed between HPV positive and HPV negative cases for 1168 genes. Pathway analysis applied to investigate the biological role of the 1168 differentially methylated genes revealed 8 signal transduction pathways forming a network of 66 genes, of which 62% are hypermethylated.

Our study reveals a predominant hypermethylation profile for genes in signal transduction pathways of HPV positive HNSCC tumor genomes. Because signaling events in the cell play a critical role in the execution of key biological functions, insights into how complex cellular signaling cascades and networks may be programmed in HNSCC are likely to be critical in the development of new biological agents designed to hit multiple targets.

To evaluate the feasibility of positron emission tomography combined with computed tomography (PET-CT)–guided ¹²⁵I seed implantation in the treatment of patients with refractory nasopharyngeal carcinoma after repeated traditional radiochemotherapy.

Case series with chart review.

University medical center.

A total of 26 patients (18 men, 8 women; mean age, 51.3 ± 10.8 years; totaling 53 lesions with an average diameter of 2.86 ± 1.61 cm) were treated by PET-CT–guided ¹²⁵I seed implantation. All of the patients received a PET-CT scan 2 months after the treatment. Follow-up was conducted for ~2 to 43 months (median, 28.2 months) to observe the local control rate, overall survival rate, and clinical complications.

The local control rates of refractory nasopharyngeal carcinoma after repeated traditional radiochemotherapy after 3, 6, 12, 24, and 36 months were 90.6% (48/53), 79.3% (42/53), 71.7% (38/53), 62.3% (33/53), and 56.6% (30/53), respectively. The overall 1-, 2-, and 3-year survival rates were 87.2%, 71.3%, and 56.5%, respectively, with a median survival time of 28.2 months. Of all patients, 19.2% (5/26) died of local recurrence and 15.4% (4/26) died of metastases. One patient died of hypertensive cerebral hemorrhage, and another patient died from cachexia and infection. The long-term complications included hyperpigmentation at operative sites (n = 5), insensible feeling on the lateral cheek (n = 2), dryness of the oral cavity (n = 1), and headache (n = 1).

PET-CT–guided ¹²⁵I seed implantation is an acceptable and feasible method for treating refractory nasopharyngeal carcinoma with minimal damage and few complications.

To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).

Case series with chart review.

Patients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers.

NER was tailored to the NPT extension and classified as follows: type 1 NER, resection of the posterior nasopharyngeal wall; type 2 NER, resection superiorly extended to the sphenoid; type 3 NER, trans-pterygoid approach to the postero-lateral nasopharynx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal-petrous-cavernous segments of the internal carotid artery.

Thirty-six consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs were enrolled. The lesions were staged as follows: stage I, 16 (44.4%); stage II, 3 (8.4%); stage III, 15 (41.6%); and stage IVA, 2 (5.6%). Type 1 NER was performed in 6 cases, type 2 NER in 12, type 3 NER in 16, and bilateral-extended type 3 NER in 2. No perioperative mortality or major complications were observed. Postoperatively, 11 patients received intensity-modulated radiotherapy, with or without chemotherapy. Follow-up ranged from 2 to 173 months (mean: 38 months). Five years overall, disease-specific, and disease-free survivals were 75.1% ± 9.13%, 80.9% ± 7.79%, and 58.1% ± 14.8%, respectively.

NER is a feasible and minimally invasive surgical approach for the management of selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional procedures. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of the technique.

Nasal polyps can be categorized as eosinophilic or non-eosinophilic, depending on inflammatory cell infiltration. There are geographical differences in the prevalence of types of pathologic polyps. The aim of this study was to evaluate the change in the prevalence of histological subtypes of polyps over time in a Korean population.

A retrospective cross-sectional study with histologic analysis.

A single academic medical center.

A total of 230 patients with nasal polyps were enrolled between 1993-1994 (group A) and 2010-2011 (group B). Specimens were fixed in formalin and embedded into paraffin blocks. Slides were stained with hematoxylin-eosin (H&E) and were subsequently reviewed by 2 of the authors. The numbers of eosinophils per high power field (HPF), as well as other cellular, epithelial, and stromal markers, were recorded.

We compared nasal polyp eosinophil counts according to time period. The average eosinophil count/HPF increased from 6.8 in group A to 19.3 in group B (P = .006). The prevalence of eosinophilic polyps also increased from 24.0% in group A to 50.9% in group B (P < .001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hyperplasia showed significant differences between groups.

After comparison of histopathologic findings of nasal polyps from 1993 and 2011 at 1 academic medical center in Korea, the prevalence of eosinophilic nasal polyps, which are known to be rare among Asians, has significantly increased.

To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results.

Prospective, clinical study.

Otorhinolaryngology department of a tertiary hospital.

The preoperative dermal thickness of 50 consecutive patients undergoing “external approach” septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores.

There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P > .05). However, men healed significantly better than women (P < .05).

The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing.

To analyze the complications and preliminary oncologic results of microscopic diode laser surgery.

Prospective research.

Ankara Oncology Education and Research Hospital.

This prospective study was conducted on a series of 64 patients with glottic carcinoma (Tis, T1, T2) treated with microscopic endolaryngeal diode laser surgery.

Four patients had local recurrence (6.2%). Local control and larynx preservation rates were 93.8% and 100%, respectively, for all groups of patients. Two-year disease-free survival after primary surgery was 100% for the Tis group, 96.4% for the T1 group, and 89.7% for the T2 group. When considering anterior commissure involvement, 2-year disease-free survival after primary surgery was 100% for the AC0 group, 85.7% for the AC1 group, and 85.7% for the AC2 group.

Our study of microscopic diode laser resection of Tis, T1, and T2 glottic tumors showed similar oncologic results to previous reports about CO₂ laser surgery. In anterior commissure tumors, both techniques had high complication and recurrence rates.

To present a new method of quantifying arytenoid movement during inspiration and determine if it can be used to distinguish arytenoid dislocation from vocal fold paralysis.

Case series with chart review.

Retrospective study conducted in a university laboratory based on university hospital data.

Endoscopic videos from 8 patients with dislocation and 5 patients with vocal fold paralysis diagnosed by electromyography were included. Vector analysis measured cuneiform movement, an indirect measurement of arytenoid movement, during 1 inspiration. Measurements normalized and not normalized to vocal fold length were evaluated. Interrater reliability (2 raters) and intrarater reliability (1 rater performing the analysis twice) were evaluated using intraclass correlation coefficient (ICC) analysis. Raters were blinded to subject group during analysis.

Pixel-valued cuneiform movement was 81.16 ± 25.62 for dislocation and 30.22 ± 23.60 for paralysis (P = .019). Unitless cuneiform movement was 0.58 ± 0.17 for dislocation and 0.24 ± 0.18 for paralysis (P = .030). Interrater ICC was 0.942 for pixel-valued measurements and 0.962 for unitless measurements. Intrarater ICC was 0.909 for pixel-valued measurements and 0.881 for unitless measurements.

Both pixel-valued and unitless measures of arytenoid movement were significantly greater in arytenoid dislocation than vocal fold paralysis. Pixel-valued measurements were included to demonstrate the ability to make quantitative comparisons across subjects without precise knowledge of camera precision, provided position is approximately stable, as each measurement is inherently normalized by vocal tract length. Future studies will apply this new method of evaluating vocal fold immobility disorders on a larger scale and incorporate a more diverse group of etiologies.

To constitute an animal model of laryngeal allergy and evaluate the laryngeal effects of inhaled corticosteroids and ß₂-agonists on the laryngeal mucosa in an allergic rat model.

Prospective randomized.

The Experimental Medical Research Institute (DETAE) at Istanbul University.

Wistar Albino rats (n = 32) were sensitized with ovalbumin. Unsensitized rats (n = 8) served as controls. The rats were exposed to aerosolized ovalbumin (1%). On days 28 through 42, every 2 days preceeding ovalbumin exposure, rats were further exposed to aerosolized phosphate buffered saline (n = 8), fluticasone propionate (n = 8), salbutamol (n = 8), and combined salbutamol+fluticasone propionate (n = 8). Inflammatory cell infiltration was graded semi-quantitatively. The quantitative data included mast cell count and degranulation. Ultrathin sections were investigated under transmission electron microscope.

The simultaneous and pairwise comparison of groups (Kruskal-Wallis) revealed statistically significant difference among groups at supraglottic level (critical P < .05, <.01) and no difference at glottic level. In ovalbumin+phosphate buffered saline exposed rats, the light microscopy of supraglottic mucosa revealed regular epithelium with severe inflammatory cell infiltration and increased mast cell count. Electron microscopy revealed increased mast cell degranulation. Increased inflammatory cell infiltration was detected along with reduced mast cell count among fluticasone propionate treated rats. Mild inflammatory cell infiltration was encountered in combined salbutamol+fluticasone propionate treated rats.

This study supported the presence of localized allergic reaction in the supraglottic laryngeal mucosa through the observation of increased mast cell number and degranulation. It was also shown that inhaled corticosteroids increase inflammation whereas combined inhaled corticosteroids and ß₂-agonists minimize allergic and inflammatory reactions in supraglottic laryngeal mucosa providing a safer therapeutic option.

This study was designed to evaluate the effectiveness of topical lidocaine in attenuating the laryngeal reflex and blunting hemodynamic response by inhibition of the superior laryngeal nerve in laryngeal microsurgery, which would be helpful in preventing potential complications.

A prospective, randomized, double-blind study.

Tertiary medical center.

Fifty-four patients requiring glottic and supraglottic laryngeal microsurgery were randomly assigned to 1 of 2 groups, with equal numbers. Before surgery, 10% lidocaine was topically applied to the laryngeal surface of the epiglottis and vocal folds under direct vision in the study group and saline aerosol was applied in the control group. Heart rates, arterial blood pressure, and SPO₂ were recorded at baseline, after induction, immediately before and after intubation, during the surgery, and upon extubation. Laryngospasm, agitation, and coughing were recorded during the recovery period.

Heart rates, arterial pressure, and SPO₂ did not differ significantly from baseline to postintubation period among the groups. SPO₂ values measured similar in the remaining study. Heart rates and blood pressures were slightly decreased in the study group after lidocaine administration, but only blood pressure at pre- and post-extubation was significantly decreased in the study group (P < .05). Also laryngospasm and coughing were not statistically different between the 2 groups. There was an obvious gap between the 2 groups for agitation. Study group agitation was noted significantly lower (P < .05).

These findings indicate that preoperative topical lidocaine application may be helpful in attenuating airway-circulatory reflexes in laryngeal microscopic surgery.

To describe and evaluate a novel technique for the implantation of bone conduction hearing devices as compared with a common, conventional technique.

Case series with chart review.

Tertiary referral otology and neurotology practice.

Individuals who underwent the implantation of bone-anchored hearing devices between January 1, 2004, and December 31, 2011, were identified. Demographic data, surgical indications, surgical technique used, surgical time, and complications were recorded. Soft tissue complications were graded on the Holgers classification scheme. Group 1 was defined as those undergoing a traditional technique using a dermatome with subcutaneous tissue reduction. Group 2 was defined as those undergoing the described technique for implantation of the coupling hardware with minimal subcutaneous soft tissue reduction.

Forty patients underwent the procedure, with 11 patients comprising group 1 and 29 patients comprising group 2. Group 2 required a shorter operative time (32.3 vs 56.1 minutes, P < .0001). Of patients in group 1, 2 of 11 developed soft tissue complications, whereas 5 of 29 in group 2 developed soft tissue complications (P = 1.000). Most soft tissue complications were reversed with conservative wound care.

Surgery was performed faster with similar postoperative outcomes in individuals undergoing implantation of bone-anchored hearing devices using the described technique that necessitated minimal soft tissue reduction.

To identify the genetic cause of prelingual sensorineural hearing loss in Pakistani families using a next-generation sequencing (NGS)–based mutation screening test named OtoSeq.

Prospective study.

Research laboratory.

We used 3 fluorescently labeled short tandem repeat (STR) markers for each of the known autosomal recessive nonsyndromic (DFNB) and Usher syndrome (USH) locus to perform a linkage analysis of 243 multigenerational Pakistani families segregating prelingual hearing loss. After genotyping, we focused on 34 families with potential linkage to MYO7A, CDH23, and SLC26A4. We screened affected individuals from a subset of these families using the OtoSeq platform to identify underlying genetic variants. Sanger sequencing was performed to confirm and study the segregation of mutations in other family members. For novel mutations, normal hearing individuals from ethnically matched backgrounds were also tested.

Hearing loss was found to co-segregate with locus-specific STR markers for MYO7A in 32 families, CDH23 in 1 family, and SLC26A4 in 1 family. Using the OtoSeq platform, a microdroplet PCR-based enrichment followed by NGS, we identified mutations in 28 of the 34 families including 11 novel mutations. Sanger sequencing of these mutations showed 100% concordance with NGS data and co-segregation of the mutant alleles with the hearing loss phenotype in the respective families.

Using NGS-based platforms like OtoSeq in families segregating hearing loss will contribute to the identification of common and population-specific mutations, early diagnosis, genetic counseling, and molecular epidemiology.

To evaluate the prevalence of the persistent petrosquamosal venous sinus in patients with chronic otitis media using a high-resolution CT scan.

Retrospective chart review.

Tertiary referral center.

Eighty-four patients older than 6 years of age underwent surgery (in a total of 92 ears) for chronic otitis media at Kyoto University Hospital, Department of Otolaryngology-Head and Neck Surgery. We used high-resolution CT scans to evaluate the prevalence and size of persistent petrosquamosal sinuses, as well as their relative position to the middle fossa.

A petrosquamosal sinus was detected in 42 (45.7%), a higher frequency than in ears without chronic otitis media (10.3%). The diameter of the sinuses was <1.0 mm in 20 ears, 1.0 mm to 2.0 mm in 17 ears, and >2.0 mm in 5 ears. The petrosquamosal sinus was positioned inferior to the lowest part of the middle fossa in 10 ears.

The petrosquamosal sinus was detected frequently in high-resolution CT scans in patients with chronic otitis media. In approximately half of the patients, the sinus was larger than 1 mm in diameter and may be encountered during mastoidectomy.

Determine whether auditory cortex (AC) organization changed following eighth cranial nerve surgery in adults with vestibular-cochlear nerve pathologies. We examined whether hearing thresholds before and after surgery correlated with increased ipsilateral activation of AC from the intact ear.

During magnetic resonance imaging sessions before and 3 and 6 months after surgery, subjects listened with the intact ear to noise-like random spectrogram sounds.

Departments of Radiology and Otolaryngology of Washington University School of Medicine.

Three patients with acoustic neuromas received Gamma Knife radiosurgery (GK); 1 patient with Meniere’s disease and 5 with acoustic neuromas had surgical resections (SR); 2 of the latter also had GK. Hearing thresholds in each ear were for pure tone stimuli from 250 to 8000 Hz before and after surgery (3 and 6 months). At the same intervals, we imaged blood oxygen level–dependent responses to auditory stimulation of the intact ear using an interrupted single-event design.

Hearing thresholds in 2 of 3 individuals treated with GK did not change. Five of 6 individuals became unilaterally deaf after SRs. Ipsilateral AC activity was present before surgery in 6 of 9 individuals with ipsilateral spatial extents greater than contralateral in 3 of 9. Greater contralateral predominance was significant especially in left compared to right ear affected individuals, including those treated by GK.

Lateralization of auditory-evoked responses in AC did not change significantly after surgery possibly due to preexisting sensory loss before surgery, indicating that less than profound loss may prompt cortical reorganization.

The objective of this study was to evaluate the outcomes of endonasal microplasty in treating empty nose syndrome by comparing the use of costal and conchal cartilage implants to construct neoturbinates.

Case series with chart review.

Tertiary referral center.

A total of 31 patients who were diagnosed with empty nose syndrome and underwent endonasal microplasty with conchal cartilage (n = 17) or costal cartilage implants (n = 14) were included. Each patient’s clinico-demographic profile was reviewed to compare the conchal cartilage group and the costal cartilage groups. Pre- and postoperative Sino-Nasal Outcome Test (SNOT-25) scores were also compared.

Both groups showed a significant improvement in SNOT-25 scores following surgery (P < .05). The group who received costal cartilage implants demonstrated more significant improvements than the conchal cartilage group in terms of the mean difference between pre- and postoperative SNOT-25 scores (P = .023). Symptom outcomes related to depression demonstrated significant improvements in the conchal cartilage group (P < .05), while in the costal cartilage group, in addition to these 3 variables, 7 items related to functional problems also demonstrated significant improvements (P < .05).

Costal cartilage is a more useful material than conchal cartilage as implants for the treatment of empty nose syndrome patients.

To examine the effect of positional dependency on surgical success among patients with severe obstructive sleep apnea (OSA) following modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty.

Case series with planned data collection.

Tertiary referred center.

Standard nocturnal polysomnography was used to compare the apnea-hypopnea index (AHI) in different sleep positions before and after relocation pharyngoplasty in 47 consecutive patients with severe OSA (AHI, 59.5 ± 18.2 events/hour; Epworth Sleepiness Scale [ESS] scores, 12.2 ± 4.4) who failed continuous positive airway pressure therapy. Positional (dependency) OSA was defined when the supine:non-supine AHI ratio was >2, otherwise it was defined as nonpositional OSA. Surgical success was defined as a ≥50% reduction in AHI and a postoperative AHI of ≤20 events/hour. Polysomnographic parameters, ESS, and surgical success following surgery were recorded.

Of the 47 patients, 27 (57%) had positional OSA and 20 (43%) nonpositional OSA. The nonpositional OSA patients had higher AHI and ESS scores than the positional OSA patients (P = .002 and .104, respectively). Relocation pharyngoplasty significantly improved AHI and ESS scores in both positional and nonpositional OSA groups 6 months postoperatively (P < .05). The overall surgical success rate was 49%; however, positional OSA patients had a significantly higher success rate than nonpositional OSA patients (67% vs 25%, P = .008).

The presence of positional dependency at baseline was a favorable outcome predictor of surgical success among severe OSA patients undergoing relocation pharyngoplasty.