http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Wed, 15 May 2013 17:29:46 +0000 http://www.hindawi.com/journals/ijol/2013/354725/ Objective. This study aimed to examine hearing function in children admitted with bacterial meningitis to determine the risk factors for sensorineural hearing loss. Setting. The study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital. Subjects and Methods. The study involved 83 children between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14. On discharge they underwent hearing testing to evaluate for presence and degree of hearing loss. Results. Thirty six of the 83 children (44.4%) were found to have at least a unilateral mild sensorineural hearing loss during initial audiologic testing. Of the children with hearing loss, 22 (26.5%) had mild or moderate sensorineural hearing loss and 14 (16.9%) had severe or profound sensorineural hearing loss. Significant determinants identified for hearing loss included coma score below eight, seizures, cranial nerve neuropathy, positive CSF culture, and fever above 38.7 degrees Celsius. Conclusions. Sensorineural hearing loss was found to be highly prevalent in children treated for bacterial meningitis. There is need to educate healthcare providers on aggressive management of coma, fever, and seizures due to their poor prognostic value on hearing. Benson Wahome Karanja, Herbert Ouma Oburra, Peter Masinde, and Dalton Wamalwa Copyright © 2013 Benson Wahome Karanja et al. All rights reserved. Wed, 08 May 2013 15:00:04 +0000 http://www.hindawi.com/journals/ijol/2013/973045/ Objectives. Clinical records of 27 patients with extracranial head and neck schwannoma were retrospectively reviewed. Methods. Ultrasonography (US) was performed in all cases. Seven patients underwent CT. Twenty-five patients underwent MRI. Fine needle aspiration cytology (FNAC) was performed for 12 of the 27 patients. Clinical history, surgical data, and postoperative morbidity were analyzed. Results. The images of US showed a well-defined, hypoechoic, primarily homogeneous solid mass. At CT, only one of 7 cases (14%) was able to suggest the diagnosis of schwannoma. At MRI, twenty of 25 cases (80%) suggested the diagnosis of schwannoma. Only three of 12 cases (25%) displayed a specific diagnosis of schwannoma rendered on FNAC. The distribution of 27 nerves of origin was 10 (37%) vagus nerves, 6 (22%) sympathetic trunks, 5 (19%) cervical plexuses, 3 (11%) brachial plexuses, 2 (7%) hypoglossal nerves, and 1 (4%) accessory nerve. Complete tumor resection was performed in 11 patients, and intracapsular enucleation of the tumor was performed in 16 patients. The rate of nerve palsy was 100 (11/11) and 31% (5/16). Conclusions. MRI is sensitive and specific in the diagnosis of schwannoma. Intracapsular enucleation was an effective and feasible method for preserving the neurological functions. Ryuji Yasumatsu, Torahiko Nakashima, Rina Miyazaki, Yuichi Segawa, and Shizuo Komune Copyright © 2013 Ryuji Yasumatsu et al. All rights reserved. Tue, 30 Apr 2013 11:47:40 +0000 http://www.hindawi.com/journals/ijol/2013/848021/ Background. RAS gene mutations have an impact on treatment response and overall prognosis for certain types of cancer. Objectives. To determine the prevalence and impact of K-RAS codons 12 and 13 mutations in patients with locally advanced HNSCC treated with primary or adjuvant chemo-radiation. Methods. 428 consecutive patients were treated with chemo-radiation therapy and followed for a median of 37 months. From these, 199 paraffin embedded biopsy or surgical specimens were retrieved. DNA was isolated and analyzed for K-RAS mutational status. Results. DNA extraction was successful in 197 samples. Of the 197 specimens, 3.5% presented K-RAS codon 12 mutations. For mutated cases and non-mutated cases, complete initial response to chemoradiation therapy was 71 and 73% (). LRC was respectively 32 and 83% (), DFS was 27 and 68% (), distant metastasis-free survival was 100 and 81% () and OS was 57 and 65% () at three years. K-Ras codon 13 analysis revealed no mutation. Conclusion. K-RAS codon 12 mutational status, although not associated with a difference in response rate, may influence the failure pattern and the type of therapy offered to patients with HNSCC. Our study did not reveal any mutation of K-RAS codon 13. Eric Bissada, Olivier Abboud, Zahi Abou Chacra, Louis Guertin, Xiaoduan Weng, Phuc Félix Nguyen-Tan, Jean-Claude Tabet, Ève Thibaudeau, Louise Lambert, Marie-Lise Audet, Bernard Fortin, and Denis Soulières Copyright © 2013 Eric Bissada et al. All rights reserved. Sun, 28 Apr 2013 08:01:04 +0000 http://www.hindawi.com/journals/ijol/2013/308509/ Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being) is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1) early identification of persons with chronic hearing impairment; (2) appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss. Catherine M. McMahon, Bamini Gopinath, Julie Schneider, Jennifer Reath, Louise Hickson, Stephen R. Leeder, Paul Mitchell, and Robert Cowan Copyright © 2013 Catherine M. McMahon et al. All rights reserved. Wed, 24 Apr 2013 13:47:32 +0000 http://www.hindawi.com/journals/ijol/2013/437815/ Background. HPV is a positive prognostic factor in HNSCC. We studied the prevalence and prognostic impact of HPV on survival parameters and treatment toxicity in patients with locally advanced HNSCC treated with concomitant chemoradiation therapy. Methods. Data on efficacy and toxicity were available for 560 patients. HPV was detected by PCR. Analysis was performed using Kaplan-Meier survival curves, Fisher’s test for categorical data, and log-rank statistics for failure times. Results. Median follow-up was 4.7 years. DNA extraction was successful in 255 cases. HPV prevalence was 68.6%, and 53.3% for HPV 16. For HPV+ and HPV−, median LRC was 8.9 and 2.2 years (), median DFS was 8.9 and 2.1 years (), and median OS was 8.9 and 3.1 years (). Survival was different based on HPV genotype, stage, treatment period, and chemotherapy regimen. COX adjusted analysis for T, N, age, and treatment remained significant (). Conclusions. Oropharyngeal cancer is increasingly linked to HPV. This study confirms that HPV status is associated with improved prognosis among H&N cancer patients receiving CRT and should be a stratification factor for clinical trials including H&N cases. Toxicity of CRT is not modified for the HPV population. E. Thibaudeau, B. Fortin, F. Coutlée, P. Nguyen-Tan, X. Weng, M.-L. Audet, O. Abboud, L. Guertin, A. Christopoulos, J. Tabet, and D. Soulières Copyright © 2013 E. Thibaudeau et al. All rights reserved. Thu, 04 Apr 2013 09:05:21 +0000 http://www.hindawi.com/journals/ijol/2013/734795/ Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15 mm and 88 mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes. J. C. Bewick, M. A. Buchanan, and A. C. Frosh Copyright © 2013 J. C. Bewick et al. All rights reserved. Sun, 17 Mar 2013 09:12:26 +0000 http://www.hindawi.com/journals/ijol/2013/107186/ Background. Electric-acoustic stimulation (EAS) is an excellent choice for people with residual hearing in low frequencies but not high frequencies and who derive insufficient benefit from hearing aids. For EAS to be effective, subjects' residual hearing must be preserved during cochlear implant (CI) surgery. Methods. We implanted 6 subjects with a CI. We used a special surgical technique and an electrode designed to be atraumatic. Subjects' rates of residual hearing preservation were measured 3 times postoperatively, lastly after at least a year of implant experience. Subjects' aided speech perception was tested pre- and postoperatively with a sentence test in quiet. Subjects' subjective responses assessed after a year of EAS or CI experience. Results. 4 subjects had total or partial residual hearing preservation; 2 subjects had total residual hearing loss. All subjects' hearing and speech perception benefited from cochlear implantation. CI diminished or eliminated tinnitus in all 4 subjects who had it preoperatively. 5 subjects reported great satisfaction with their new device. Conclusions. When we have more experience with our surgical technique we are confident we will be able to report increased rates of residual hearing preservation. Hopefully, our study will raise the profile of EAS in Brazil and Latin/South America. Guilherme Machado de Carvalho, Alexandre C. Guimaraes, Alexandre S. M. Duarte, Eder B. Muranaka, Marcelo N. Soki, Renata S. Zanotello Martins, Walter A. Bianchini, Jorge R. Paschoal, and Arthur M. Castilho Copyright © 2013 Guilherme Machado de Carvalho et al. All rights reserved. Wed, 06 Mar 2013 10:39:06 +0000 http://www.hindawi.com/journals/ijol/2013/539642/ Objective. To study the clinical and pathological characteristics of patients with organized hematoma with malignant features in maxillary sinuses. Subjects and Methods. This was a retrospective study of five patients who were treated surgically for organized hematoma. The preoperative CT and MRI findings were studied clinically. The expressions of CD31, CD34, and periostin in surgical samples were investigated by immunohistochemistry. Results. The clinical features of organized hematoma, such as a mass expanding from the maxillary sinus with bone destruction, resembled those of maxillary carcinoma. However, CT and MRI provided sufficient and useful information to differentiate this condition from malignancy. Surgical resection was the first-line treatment because of the presence of a firm capsule. Characteristic histopathological findings were a mixture of dilated vessels, hemorrhage, fibrin exudation, fibrosis, hyalinization, and neovascularization. The expressions of periostin, CD31, and CD34 were observed in organized hematoma of the maxillary sinus. Conclusion. The expressions of periostin, CD31, and CD34 were observed in organized hematoma of the maxillary sinus. Organized hematoma is characterized pathologically by a mixture of bleeding, dilated vessels, hemorrhage, fibrin exudation, fibrosis, hyalinization, and neovascularization. CT and MRI show heterogeneous findings reflecting a mixture of these pathological entities. Nobuo Ohta, Tomoo Watanabe, Tsukasa Ito, Toshinori Kubota, Yusuke Suzuki, Akihiro Ishida, Masaru Aoyagi, Atsushi Matsubara, Kenji Izuhara, and Seiji Kakehata Copyright © 2013 Nobuo Ohta et al. All rights reserved. Wed, 27 Feb 2013 15:29:27 +0000 http://www.hindawi.com/journals/ijol/2013/707910/ The objective of this study was to further develop the Ida Institute model on communication partners’ (CPs) journey through experiences of person with hearing impairment (PHI), based on the perspectives of CPs. Nine CPs of hearing aid users participated in this study, recruited through the Swansea hearing impaired support group. Semi-structured interviews were conducted, the data were analysed using qualitative thematic analysis and presented with the use of process mapping approach. Seven main phases were identified in the CP journey which includes: (1) contemplation, (2) awareness, (3) persuasion, (4) validation, (5) rehabilitation, (6) adaptation, and (7) resolution. The Ida Institute model (based on professionals’ perspective) was compared with the new template developed (based on CPs’ perspectives). The results suggest some commonalities and differences between the views of professionals and CPs. A new phase, adaptation, was identified from CPs reported experiences, which was not identified by professionals in the Ida Institute model. The CP’s journey model could be a useful tool during audiological enablement/rehabilitation sessions to promote discussion between the PHI and the CP. In addition, it can be used in the training of hearing healthcare professionals. Vinaya K. C. Manchaiah, Dafydd Stephens, and Thomas Lunner Copyright © 2013 Vinaya K. C. Manchaiah et al. All rights reserved. Wed, 20 Feb 2013 15:52:37 +0000 http://www.hindawi.com/journals/ijol/2013/263043/ Aims. To evaluate thirteen years of hyoid suspension experience in multilevel OSAHS surgery, for which hyoidthyroidpexia represented the exclusive hypopharyngeal approach applied. Materials and Methods. From 1998 to 2011, a bicentric retrospective study was conducted: all adult patients with a diagnosis of OSAHS were enrolled. Specific eligible criteria were established. Pre-/postoperative data concerning ENT and sleep findings were recorded. Recruited subjects were surveilled for a follow-up range from 6 to 18 months. Results. A total of 590 hyoid suspensions were evaluated, but only 140 patients met the specific inclusion criteria. A success rate of 67% was obtained. No intraoperative adverse events or major complications occurred. Excessive daytime sleepiness was observed in 28% of nonresponders. Despite the homogeneous candidate anatomy, ENT awake findings changed differently after surgery. Statistical analysis revealed multilevel surgery to be more effective when AHI < 30. Postoperative AHI was statistically not influenced by preoperative BMI. Conclusions. Hyoid suspension in multilevel treatment is effective when short-term results are considered. The necessity of a more valuable anatomic-based diagnostic approach is crucial to guide the patient selection. Long-term followups and randomized prospective trials with case-control series are needed to increase the level of evidence of this surgery. Pietro Canzi, Anna Berardi, Carmine Tinelli, Filippo Montevecchi, Fabio Pagella, Claudio Vicini, and Marco Benazzo Copyright © 2013 Pietro Canzi et al. All rights reserved. Wed, 30 Jan 2013 13:13:16 +0000 http://www.hindawi.com/journals/ijol/2013/604729/ Hearing aid technology has improved dramatically in the last decade, especially in the ability to adaptively respond to dynamic aspects of background noise. Despite these advancements, however, hearing aid users continue to report difficulty hearing in background noise and having trouble adjusting to amplified sound quality. These difficulties may arise in part from current approaches to hearing aid fittings, which largely focus on increased audibility and management of environmental noise. These approaches do not take into account the fact that sound is processed all along the auditory system from the cochlea to the auditory cortex. Older adults represent the largest group of hearing aid wearers; yet older adults are known to have deficits in temporal resolution in the central auditory system. Here we review evidence that supports the use of the auditory brainstem response to complex sounds (cABR) in the assessment of hearing-in-noise difficulties and auditory training efficacy in older adults. Samira Anderson and Nina Kraus Copyright © 2013 Samira Anderson and Nina Kraus. All rights reserved. Mon, 21 Jan 2013 11:04:08 +0000 http://www.hindawi.com/journals/ijol/2013/496138/ Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm. Study Design. Retrospective case series. Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data. Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections. Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution. Russel Kahmke, Walter T. Lee, Liana Puscas, Richard L. Scher, Michael J. Shealy, Warner M. Burch, and Ramon M. Esclamado Copyright © 2013 Russel Kahmke et al. All rights reserved. Mon, 31 Dec 2012 15:20:18 +0000 http://www.hindawi.com/journals/ijol/2012/157630/ On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. Jose Granell, Laura Garrido, Teresa Millas, and Raimundo Gutierrez-Fonseca Copyright © 2012 Jose Granell et al. All rights reserved. Tue, 18 Dec 2012 10:24:02 +0000 http://www.hindawi.com/journals/ijol/2012/518202/ Background. Functioning of nonlinear hearing aids varies with characteristics of input stimuli. In the past decade, aided speech evoked cortical auditory evoked potentials (CAEPs) have been proposed for validation of hearing aid fittings. However, unlike in running speech, phonemes presented as stimuli during CAEP testing are preceded by silent intervals of over one second. Hence, the present study aimed to compare if hearing aids process phonemes similarly in running speech and in CAEP testing contexts. Method. A sample of ten hearing aids was used. Overall phoneme level and phoneme onset level of eight phonemes in both contexts were compared at three input levels representing conversational speech levels. Results. Differences of over 3 dB between the two contexts were noted in one-fourth of the observations measuring overall phoneme levels and in one-third of the observations measuring phoneme onset level. In a majority of these differences, output levels of phonemes were higher in the running speech context. These differences varied across hearing aids. Conclusion. Lower output levels in the isolation context may have implications for calibration and estimation of audibility based on CAEPs. The variability across hearing aids observed could make it challenging to predict differences on an individual basis. Vijayalakshmi Easwar, David W. Purcell, and Susan D. Scollie Copyright © 2012 Vijayalakshmi Easwar et al. All rights reserved. Tue, 13 Nov 2012 08:19:12 +0000 http://www.hindawi.com/journals/ijol/2012/764573/ Sylvia Taylor, Paola Marchisio, Anne Vergison, William P. Hausdorff, and Mark Haggard Copyright © 2012 Sylvia Taylor et al. All rights reserved. Thu, 08 Nov 2012 10:50:37 +0000 http://www.hindawi.com/journals/ijol/2012/864069/ Travis T. Tollefson, David White, James Brookes, and Steven Goudy Copyright © 2012 Travis T. Tollefson et al. All rights reserved. Tue, 06 Nov 2012 09:19:40 +0000 http://www.hindawi.com/journals/ijol/2012/216592/ The acute-phase inflammatory response in the peripheral bloodstream can be an expression of transient cerebral ischaemia in idiopathic sudden deafness. For this, a neurological and otorhinolaryngological examination of each patient, performing tests on audiometry, and tympanometry, haemogram, and cranial magnetic resonance were performed. The acute-phase inflammatory response manifests as an increased neutrophil/lymphocyte ratio that is detected 48–72 hours after the appearance of sudden deafness. This study shows that there is an acute-phase response in the peripheral bloodstream with an increased neutrophil/lymphocyte ratio as an expression of an inflammatory process that can be caused by transient cerebral ischaemia in sudden deafness. In addition, the increased neutrophil/lymphocyte ratio can rule out a viral origin of sudden deafness, since a viral infection lowers the neutrophil count and increases the lymphocyte count, thus reducing the neutrophil/lymphocyte ratio. These findings aid in understanding the pathogenic mechanisms involved in sudden deafness and offer better treatment to the patient. Miguel A. López-González, Antonio Abrante, Carmen López-Lorente, Antonio Gómez, Emilio Domínguez, and Francisco Esteban Copyright © 2012 Miguel A. López-González et al. All rights reserved. Wed, 31 Oct 2012 16:22:33 +0000 http://www.hindawi.com/journals/ijol/2012/386542/ In a previous study, we investigated slow cortical potential (SCP) N1-P2 amplitudes and N1 latencies in aided and unaided conditions, with the finding that despite being set to provide 20 or 40 dB of gain, none of the hearing aids resulted in a reliable increase in SCP response amplitude relative to the unaided (Marynewich et al., in press). The current study investigates the effects of hearing-aid processing on acoustic measures for two 1000-Hz tonal stimuli: short (60 ms) and long (757 ms), presented at three intensities (30, 50, 70 dB SPL) in aided and unaided conditions using three hearing aids (Analog, DigitalA, DigitalB) with two gain settings (20, 40 dB). Acoustic results indicate that gain achieved by the hearing aids, measured at 30 ms after stimulus onset, for both the short and long stimuli, was less than real-ear insertion gain measured with standard hearing aid test signals. Additionally, the digital hearing aids altered the rise time of the stimuli such that maximum gain was reached well past 30 ms after stimulus onset; rise times differed between the digital aids. These results indicate that aided SCP results must be cautiously interpreted and that further research is required for clinical application. Lorienne M. Jenstad, Susan Marynewich, and David R. Stapells Copyright © 2012 Lorienne M. Jenstad et al. All rights reserved. Wed, 31 Oct 2012 09:54:49 +0000 http://www.hindawi.com/journals/ijol/2012/982894/ Background. This study investigated whether cortical auditory evoked potentials (CAEPs) could reliably be recorded and interpreted using clinical testing equipment, to assess the effects of hearing aid technology on the CAEP. Methods. Fifteen normal hearing (NH) and five hearing impaired (HI) children were included in the study. NH children were tested unaided; HI children were tested while wearing hearing aids. CAEPs were evoked with tone bursts presented at a suprathreshold level. Presence/absence of CAEPs was established based on agreement between two independent raters. Results. Present waveforms were interpreted for most NH listeners and all HI listeners, when stimuli were measured to be at an audible level. The younger NH children were found to have significantly different waveform morphology, compared to the older children, with grand averaged waveforms differing in the later part of the time window (the N2 response). Results suggest that in some children, frequency compression hearing aid processing improved audibility of specific frequencies, leading to increased rates of detectable cortical responses in HI children. Conclusions. These findings provide support for the use of CAEPs in measuring hearing aid benefit. Further research is needed to validate aided results across a larger group of HI participants and with speech-based stimuli. Danielle Glista, Vijayalakshmi Easwar, David W. Purcell, and Susan Scollie Copyright © 2012 Danielle Glista et al. All rights reserved. Thu, 18 Oct 2012 13:33:53 +0000 http://www.hindawi.com/journals/ijol/2012/628578/ Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients. Jacqueline C. Junn, Irene A. Kim, Marianna L. Zahurak, Marietta Tan, Katherine Y. Fan, Spencer T. Lake, David Zaboli, Barbara P. Messing, Karen Ulmer, Karen B. Harrer, Dorothy Gold, Keri L. Ryniak, Eva S. Zinreich, Mei Tang, Marshall A. Levine, Ray G. Blanco, John R. Saunders, Joseph A. Califano, and Patrick K. Ha Copyright © 2012 Jacqueline C. Junn et al. All rights reserved. Thu, 18 Oct 2012 08:16:18 +0000 http://www.hindawi.com/journals/ijol/2012/921513/ Slow cortical potentials (SCPs) are currently of great interest in the hearing aid fitting process for infants; however, there is conflicting evidence in the literature concerning the use of SCPs for this purpose. The current study investigated SCP amplitudes and latencies in young normal-hearing listeners in response to a 60 ms duration tonal stimulus (1000 Hz) presented at three intensities (30, 50, and 70 dB SPL) in aided and unaided conditions using three hearing aids (Analog, DigitalA, and DigitalB) with two gain settings (20 and 40 dB). Results showed that SCP amplitudes were smaller for the digital hearing aids compared with the analog hearing aid, and none of the hearing aids resulted in a reliable increase in response amplitude relative to the unaided across conditions. SCP latencies in analog conditions were not significantly different from latencies in the unaided conditions; however, both digital hearing aids resulted in significantly delayed SCP latencies. The results of the current study (as well as several previous studies) indicate that the SCP may not accurately reflect the amplified stimulus expected from the prescribed hearing aids. Thus, “aided-SCP” results must be interpreted with caution, and more research is required concerning possible clinical use of this technique. Susan Marynewich, Lorienne M. Jenstad, and David R. Stapells Copyright © 2012 Susan Marynewich et al. All rights reserved. Tue, 16 Oct 2012 09:46:16 +0000 http://www.hindawi.com/journals/ijol/2012/501896/ Objective. Determining the indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease. Study Design. Retrospective case series from a single tertiary care facility. Methods. Thirty-four patients who underwent OFSO for chronic frontal sinusitis () and frontal sinus mucocele () comprised our study group. Data reviewed included demographics, history of prior frontal sinus operation(s), imaging, diagnosis, and operative complications. Results. The age range was 19 to 76 years. Seventy percent of patients with chronic frontal sinusitis underwent OFSO as a salvage surgery after previous frontal sinus surgery failures, while 30% underwent OFSO as a primary surgery. For those in whom OFSO was a salvage procedure, the failed surgeries were endoscopic approaches to the frontal sinus (69%), Lynch procedure (12%), and OFSO outside this study period (19%). For patients with frontal sinus mucocele, 72% had OFSO as a first-line surgery. Within the total study population, 15% of patients presented for OFSO with history of prior obliteration, with a range of 3 to 30 years between representations. Conclusions. Osteoplastic frontal sinus obliteration remains a key surgical treatment for chronic inflammatory frontal sinus disease both as a salvage procedure and first-line surgical therapy. Joshua B. Silverman, Stacey T. Gray, and Nicolas Y. Busaba Copyright © 2012 Joshua B. Silverman et al. All rights reserved. Wed, 10 Oct 2012 08:23:13 +0000 http://www.hindawi.com/journals/ijol/2012/765271/ A single-stage fitting of a bone-anchored hearing aid (BAHA) implant and abutment with mastoid obliteration both obviates the need for two separate procedures and utilises the BAHA soft tissue reduction in the mastoid obliteration. Such a procedure has good outcomes in terms of osseointegration and achieving a dry ear. We present a 6-patient case series report highlighting the technique of combined BAHA insertion and mastoid obliteration in six patients. All patients at twelve-month followup have a good degree of sound localisation and hearing thresholds with their BAHA and are free from the social stigma associated with a foul smelling discharging ear. Ajith George, Chris Coulson, Elizabeth Ross, and Ranit De Copyright © 2012 Ajith George et al. All rights reserved. Mon, 08 Oct 2012 11:03:17 +0000 http://www.hindawi.com/journals/ijol/2012/365752/ The clinical usefulness of aided cortical auditory evoked potentials (CAEPs) remains unclear despite several decades of research. One major contributor to this ambiguity is the wide range of variability across published studies and across individuals within a given study; some results demonstrate expected amplification effects, while others demonstrate limited or no amplification effects. Recent evidence indicates that some of the variability in amplification effects may be explained by distinguishing between experiments that focused on physiological detection of a stimulus versus those that differentiate responses to two audible signals, or physiological discrimination. Herein, we ask if either of these approaches is clinically feasible given the inherent challenges with aided CAEPs. N1 and P2 waves were elicited from 12 noise-masked normal-hearing individuals using hearing-aid-processed 1000-Hz pure tones. Stimulus levels were varied to study the effect of hearing-aid-signal/hearing-aid-noise audibility relative to the noise-masked thresholds. Results demonstrate that clinical use of aided CAEPs may be justified when determining whether audible stimuli are physiologically detectable relative to inaudible signals. However, differentiating aided CAEPs elicited from two suprathreshold stimuli (i.e., physiological discrimination) is problematic and should not be used for clinical decision making until a better understanding of the interaction between hearing-aid-processed stimuli and CAEPs can be established. Curtis J. Billings, Melissa A. Papesh, Tina M. Penman, Lucas S. Baltzell, and Frederick J. Gallun Copyright © 2012 Curtis J. Billings et al. All rights reserved. Wed, 03 Oct 2012 19:23:09 +0000 http://www.hindawi.com/journals/ijol/2012/865731/ It is often assumed that the benefit of hearing aids is not primarily reflected in better speech performance, but that it is reflected in less effortful listening in the aided than in the unaided condition. Before being able to assess such a hearing aid benefit the present study examined how processing load while listening to masked speech relates to inter-individual differences in cognitive abilities relevant for language processing. Pupil dilation was measured in thirty-two normal hearing participants while listening to sentences masked by fluctuating noise or interfering speech at either 50% and 84% intelligibility. Additionally, working memory capacity, inhibition of irrelevant information, and written text reception was tested. Pupil responses were larger during interfering speech as compared to fluctuating noise. This effect was independent of intelligibility level. Regression analysis revealed that high working memory capacity, better inhibition, and better text reception were related to better speech reception thresholds. Apart from a positive relation to speech recognition, better inhibition and better text reception are also positively related to larger pupil dilation in the single-talker masker conditions. We conclude that better cognitive abilities not only relate to better speech perception, but also partly explain higher processing load in complex listening conditions. Thomas Koelewijn, Adriana A. Zekveld, Joost M. Festen, Jerker Rönnberg, and Sophia E. Kramer Copyright © 2012 Thomas Koelewijn et al. All rights reserved. Tue, 25 Sep 2012 19:38:24 +0000 http://www.hindawi.com/journals/ijol/2012/802715/ The multiple auditory steady-state response (multiple-ASSR) technique, where thresholds for up to 8 frequencies (4 in each ear) are obtained simultaneously, is currently of great interest for audiometric assessment of infants. Although threshold estimates using the multiple-ASSR appear to be reasonably accurate, it is not currently known whether it is more efficient to use multiple stimuli or single stimuli when testing individuals with sensorineural hearing loss (SNHL). The current study investigated the effect of single versus multiple simultaneous stimuli on the 80- and 40-Hz ASSRs in adults with normal hearing or SNHL. Results showed significant interactions (i.e., decreased amplitudes) for both ASSRs going from single to multiple stimuli in one ear. Going from multiple one ear to multiple two ears did not further reduce the amplitude of the 80-Hz ASSR. At the 40-Hz rate, however, there was a further amplitude decrease going from one-ear multiple to two-ear multiple stimuli. Importantly, these interactions did not differ between the normal-hearing and SNHL groups. Although supportive of the multiple-ASSR technique, there are likely situations where it is more efficient to use single stimuli. Future studies are required to assess these interactions in infants with varying degrees and configurations of hearing loss. Ieda M. Ishida and David R. Stapells Copyright © 2012 Ieda M. Ishida and David R. Stapells. All rights reserved. Mon, 24 Sep 2012 11:42:50 +0000 http://www.hindawi.com/journals/ijol/2012/954203/ Introduction. Optimal therapy for patients with metastatic neck disease remains controversial. Neck dissection following radiotherapy has traditionally been used to improve locoregional control. Methods. A retrospective review of 28 patients with node-positive head and neck malignancy treated with planned neck dissection following radiotherapy between January 2002 and December 2005 was performed to assess treatment outcomes. Results. Median interval to neck dissection was 9.6 weeks with a median number of 21 + 9 lymph nodes per specimen. Ten of 31 (32%) neck dissection specimens demonstrated evidence of residual carcinoma. Overall survival at two years was 85%; five-year overall survival was 65%. Concurrent chemotherapy did not impact the presence of residual neck disease. Conclusion. Based on the frequency of residual malignancy in the neck of patients treated with primary radiotherapy, a planned, postradiotherapy neck dissection should be strongly advocated for all patients with advanced-stage neck disease. J. F. Dautremont, M. K. Brake, G. Thompson, J. Trites, R. D. Hart, and S. M. Taylor Copyright © 2012 J. F. Dautremont et al. All rights reserved. Wed, 19 Sep 2012 10:47:43 +0000 http://www.hindawi.com/journals/ijol/2012/590206/ Mark A. Fletcher and Bernard Fritzell Copyright © 2012 Mark A. Fletcher and Bernard Fritzell. All rights reserved. Tue, 18 Sep 2012 11:49:10 +0000 http://www.hindawi.com/journals/ijol/2012/163691/ Perilymph fistula is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semicircular canal from cholesteotoma and the superior canal dehiscence syndrome. First recognized as a complication of stapedectomy, it then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause. Descriptions of “spontanenous” perilymph fistulas with no trauma history followed. It is likely that most perilymph fistula patients have a congential potential weakness of the otic capsule at the round or oval window. The vestibular symptoms have been assumed to be due to endolymphatic hydrops, but there is poor evidence. Their unilateral disequilibrium, nausea, and subtle cognitive problems suggest they are due to otolith disfunction and that these patients have a specific balance abnormality, unlike subjects with unilateral vestibular hypofuction. In this series of twenty patients with a confirmed fistula a logical simplification of Singleton's “eyes-closed turning” test predicted a PLF in twelve with a trauma history. In four no cause was found. In three a prior traumatic event was later recalled, but one patient had concealed it. Jeremy Hornibrook Copyright © 2012 Jeremy Hornibrook. All rights reserved. Thu, 06 Sep 2012 07:50:38 +0000 http://www.hindawi.com/journals/ijol/2012/926806/ Petros D. Karkos, Wolfgang Issing, Oliver Reichel, and Marcus Hess Copyright © 2012 Petros D. Karkos et al. All rights reserved.