Neck abscesses are difficult to diagnose and treat. Currently, contrast-enhanced computed tomography (CECT) is the imaging modality of choice. The study aims to determine the predictive value of CECT findings in diagnosing neck abscess, causes of neck abscess and the most common neck space involved in the local population. 84 consecutive patients clinically suspected to have neck abscess who underwent CECT and surgical confirmation of pus were included. Demographic and clinical data were recorded. 75 patients were diagnosed as having neck abscess on CECT; out of those 71 patients were found to have pus. Overall CECT findings were found to have a high sensitivity (98.6&#x25;) and positive predictive value (PPV) (94.7&#x25;) but lower specificity (67.2&#x25;) in diagnosing neck abscess. The CECT diagnostic criterion with the highest PPV is the presence of rim irregularity (96&#x25;). The most common deep neck space involved is the submandibular compartment, which correlates with the finding that odontogenic cause was the most common identifiable cause of abscess in the study population. Thus, in a patient clinically suspected of having neck abscess, CECT findings of a hypodense mass with rim irregularity are helpful in confirming the diagnosis and guiding clinical management.

Melisa Lim Seer Yee

Noraini Abdul Rahim

Ning Ajleaa Ngah

Yang Faridah Abdul Aziz

Sethu Subha

Predicting Neck Abscess with Contrast-Enhanced Computed Tomography

The aim of this work is to present a modified transcanal technique for cochlear implantation. It was a prospective study on 125 cochlear implant patients presenting to two tertiary referral hospitals between January 2010 and January 2013 and followed up for 6&#x2013;30 months. Their age range was 2&#x2013;56 (mean 3.4 years) and the male: female ratio was of 2.1&#x2009;:&#x2009;1. A modified transcanal technique was adopted through a small postauricular incision. A tympanomeatal flap is elevated, the middle ear is exposed, and the round window membrane is exposed by drilling the overhanging niche. The electrode is channeled in an open trough along the posterosuperior meatal wall, which is reconstructed by autologous cartilage. The round window was used for insertion in 110 patients and a cochleostomy in 15. The main outcome measures were technical steps, operative time, and ease and completeness of electrode insertion. The actual surgical time (excluding device testing) ranged between 25 and 40 minutes (mean 30.1&#x2009;min). There were 115 complete insertions and 10 partials. There were 6 chorda tympani injuries, 2 electrode exposures with 1 requiring revision, and 2 cases with a tympanic membrane perforation which were grafted uneventfully. One case had severe infection with extrusion of the device 1 year after successful implantation.

Badr Eldin Mostafa

Walid Farag Ezzat

Abdel Monem El Mogui

The Modified Transcanal Approach for Cochlear Implantation: Technique and Results

<i>Objectives</i>. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. <i>Method</i>. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. <i>Results</i>. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD &#x2212;2.72 days [95&#x25; CI &#x2212;5.34 to &#x2212;0.09]. <i>Conclusion</i>. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence.

Ashley Hay

Lisa Pitkin

Kurinchi Gurusamy

Early versus Delayed Oral Feeding in Patients following Total Laryngectomy

Cisplatin, one of the most effective and potent anticancer drugs, is used in the treatment of a wide variety of both pediatric and adult malignancies. However, the chemotherapeutic use of cisplatin is limited by its serious side effects, such as nephrotoxicity and ototoxicity. Ototoxicity produced by cisplatin is usually persistent, depending on the age of the patient, the cumulative number of doses, the number of chemotherapy cycles, the history of noise exposure, and deteriorating renal function. The mechanism of the ototoxicity caused by cisplatin is based on the generation of reactive oxygen species, which interfere with the antioxidant protection of the organ of Corti. Thus, protecting the cochlea with antioxidants ameliorates ototoxicity from cisplatin. In this context, melatonin appears as a therapeutic option for preventing the ototoxic effects of cisplatin, since the research in the last decade has proven its ability to be both a direct free radical scavenger and indirect antioxidant. In this sense, some of the evidence suggesting that melatonin is efficient for combating cisplatin-induced ototoxicity is summarized and discussed in this paper.

Juliana Gusm&#xe3;o de Araujo

Andr&#xe9; Luiz Lopes Sampaio

Alessandra Ramos Venosa

Carlos Augusto Costa Pires de Oliveira

The Potential Use of Melatonin for Preventing Cisplatin Ototoxicity: An Insight for a Clinical Approach

<i>Objectives</i>. (1) Evaluate safety of autogenous engineered septal neocartilage grafts and (2) compare properties of implanted grafts versus controls.<i> Study Design</i>. Prospective, basic science.<i> Setting</i>. Research laboratory.<i> Methods</i>. Constructs were fabricated from septal cartilage and then cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of constructs were evaluated.<i> Results</i>. No serious complications were observed. Implanted constructs contained more DNA (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M1" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z"></path></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z"></path></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z"></path></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z"></path></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z"></path></g>

		
	
</svg>) and less sGAG perDNA (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z"></path></g>

		
	
</svg>) when compared with in vitro controls. Confined compressive aggregate moduli were also higher in implanted constructs (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M3" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x35"></use></g>

		
	
</svg>) and increased with longer in vivo incubation time (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M4" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x31"></use></g>

		
	
</svg>). Implanted constructs displayed resorption rates of 20–45 percent. Calcium deposition in implanted constructs was observe.<i> Conclusion</i>. Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and less sGAG when compared with in vitro controls. Confined compressive aggregate moduli were higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage.

Anton Kushnaryov

Tomonoro Yamaguchi

Kristen K. Briggs

Van W. Wong

Marsha Reuther

Monica Neuman

Victor Lin

Robert L. Sah

Koichi Masuda

Deborah Watson

Evaluation of Autogenous Engineered Septal Cartilage Grafts in Rabbits: A Minimally Invasive Preclinical Model

Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50&#x25; of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.

Kourosh Parham

Benign Paroxysmal Positional Vertigo: An Integrated Perspective

<i>Purpose.</i> This paper reviews analyses for tracheostomy within our patient population over the last 6 years. <i>Methods.</i> We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at the tertiary Dicle University Medical hospital, Turkey, from January 2006 to December 2012. Patient age, sex, emergency, planned tracheostomy, indications, complications, and decannulation time were all assessed. <i>Results.</i> Fifty-six (34 male, 22 female) adult Pediatric patients undergoing tracheostomy between 2006 and 2013 were investigated. The most common indication for tracheostomy was upper airway obstruction (66.7%), followed by prolonged intubation (33.3%). Mean decannulation times after tracheostomy ranged between 1 and 131 days, the difference being statistically significant (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:66.875px;" id="M1" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z"></path></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z"></path></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z"></path></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z"></path></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z"></path></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x30"></use></g>

		
	
</svg>). There was no significant difference in terms of mean age (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-1.09097pt;width:58.049999px;" id="M2" height="11.4" version="1.1" viewBox="0 0 58.049999 11.4" width="58.049999">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.963)"><path id="x39" d="M244 635q90 0 143 -72t53 -177q0 -133 -65 -229.5t-171 -139.5q-79 -32 -140 -32l-5 30q109 18 185 91t101 186l-68 -36q-29 -16 -60 -16q-79 0 -129 51.5t-50 130.5q0 80 57 146.5t149 66.5zM228 602q-52 0 -78 -45.5t-26 -98.5q0 -69 36.5 -115.5t97.5 -46.5&#xA;q53 0 90 28q4 31 4 66q0 51 -9.5 95.5t-39 80.5t-75.5 36z"></path></g><g transform="matrix(.017,-0,0,-.017,8.222,10.963)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,12.098,10.963)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z"></path></g><g transform="matrix(.017,-0,0,-.017,24.031,10.963)"><path id="xB1" d="M535 290h-212v-206h-58v206h-213v50h213v193h58v-193h212v-50zM535 -22h-483v50h483v-50z"></path></g><g transform="matrix(.017,-0,0,-.017,37.783,10.963)"><path id="x36" d="M137 343l67 33q37 17 63 17q79 0 129.5 -53t50.5 -131q0 -92 -58 -156.5t-147 -64.5t-147 68t-58 182q0 63 17 119t43 95.5t61.5 72t69 52t67.5 31.5q62 22 128 33l6 -32q-56 -11 -108 -35q-149 -71 -184 -231zM227 337q-47 0 -95 -27q-6 -23 -6 -70q0 -93 36 -155.5&#xA;t96 -62.5q53 0 78 45.5t25 105.5q0 68 -35 116t-99 48z"></path></g><g transform="matrix(.017,-0,0,-.017,45.942,10.963)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,49.818,10.963)"><use xlink:href="#x30"></use></g>

		
	
</svg>; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:58.712502px;" id="M3" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z"></path></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x36"></use></g>

		
	
</svg>). There was also no statistical difference between emergency and planned tracheotomies (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:66.875px;" id="M4" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x36"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x36"></use></g>

		
	
</svg>). <i>Conclusion.</i> In our patient population, there was a significant decline in the number of tracheotomies performed for prolonged intubation and an increasing number of patient tracheostomy for upper airway obstruction. According to the literature, permanent decannulation rates were slightly higher with an increase in genetic diseases such as neuromuscular disease.

Mehmet Akdag

Zeynep Baysal

Ayfer Gozu Pirinccioglu

Aylin Gul

Faz&#x131;l Emre Ozkurt

Ismail Topcu

Retrospective Analysis of Pediatric Tracheostomy

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Advances in Otolaryngology