ISRN Otolaryngology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Evaluation of Reliability of Ultrasonographic Parameters in Differentiating Benign and Metastatic Cervical Group of Lymph Nodes Thu, 17 Apr 2014 13:04:50 +0000 The aim of the current study is to determine the efficacy of ultrasound in differentiating between benign and metastatic group of cervical lymph nodes. The study included forty-five subjects who were divided into three groups with 15 in each, by stratified random sampling method. Group 1 comprised fifteen patients without signs and symptoms of any infection and neoplasms in head and neck region (control group). Group 2 included fifteen patients with signs and symptoms of malignancy in head and neck region. Group 3 consisted of fifteen patients with signs and symptoms of odontogenic infections. “MY LAB-40” ultrasound machine with linear array transducer of 7.5 MHZ frequency was used for detecting cervical lymph nodes following Hajek’s classification. The patients further underwent ultrasound guided FNAC under standard aseptic protocol and samples were subjected to cytopathological evaluation. Chi square analysis and one way ANOVA test were applied to obtain the results. We concluded that ultrasound and USG FNAC can be used accurately to assess the status of lymph nodes. The ultrasonographic features of lymph nodes with round shape, absence of hilar echo, sharp nodal borders, hyperechoic internal echogenicity, and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes. Chintamaneni Raja Lakshmi, M. Sudhakara Rao, A. Ravikiran, Sivan Sathish, and Sujana Mulk Bhavana Copyright © 2014 Chintamaneni Raja Lakshmi et al. All rights reserved. Association of Auditory Steady State Responses with Perception of Temporal Modulations and Speech in Noise Mon, 14 Apr 2014 13:34:07 +0000 Amplitude modulations in the speech convey important acoustic information for speech perception. Auditory steady state response (ASSR) is thought to be physiological correlate of amplitude modulation perception. Limited research is available exploring association between ASSR and modulation detection ability as well as speech perception. Correlation of modulation detection thresholds (MDT) and speech perception in noise with ASSR was investigated in twofold experiments. 30 normal hearing individuals and 11 normal hearing individuals within age range of 18–24 years participated in experiments 1 and 2, respectively. MDTs were measured using ASSR and behavioral method at 60 Hz, 80 Hz, and 120 Hz modulation frequencies in the first experiment. ASSR threshold was obtained by estimating the minimum modulation depth required to elicit ASSR (ASSR-MDT). There was a positive correlation between behavioral MDT and ASSR-MDT at all modulation frequencies. In the second experiment, ASSR for amplitude modulation (AM) sweeps at four different frequency ranges (30–40 Hz, 40–50 Hz, 50–60 Hz, and 60–70 Hz) was recorded. Speech recognition threshold in noise (SRTn) was estimated using staircase procedure. There was a positive correlation between amplitude of ASSR for AM sweep with frequency range of 30–40 Hz and SRTn. Results of the current study suggest that ASSR provides substantial information about temporal modulation and speech perception. Venugopal Manju, Kizhakke Kodiyath Gopika, and Pitchai Muthu Arivudai Nambi Copyright © 2014 Venugopal Manju et al. All rights reserved. The Vestibular-Auditory Interaction for Auditory Brainstem Response to Low Frequencies Mon, 31 Mar 2014 07:34:24 +0000 Since saccular projection is sound sensitive, the objective is to investigate the possibility that the saccular projections may contribute to auditory brainstem response to 500 HZ tone burst (ABR500 HZ). During the case-control research, twenty healthy controls compared to forty selected case groups as having chronic and resistant BPPV were evaluated in the audiology department of Hamadan University of Medical Sciences (Hamadan, Iran). Assessment is comprised of audiologic examinations, cervical vestibular evoked myogenic potentials (cVEMPs), and ABR500 HZ. We found that forty affected ears of BPPV patients with decreased vestibular excitability as detected by abnormal cVEMPs had abnormal results in ABR500 HZ, whereas unaffected ears presented normal findings. Multiple comparisons of mean p13, n23 latencies, and peak-to-peak amplitudes between three groups (affected, unaffected, and healthy ears) were significant. In conclusion, the saccular nerves can be projective to auditory bundles and interact with auditory brainstem response to low frequencies. Combine the cVEMPs and ABR500 HZ in battery approach tests of vestibular assessment and produce valuable data for judgment on the site of lesion. Regarding vestibular cooperation for making of wave V, it is reasonable that the term of ABR500 HZ is not adequate and the new term or vestibular-auditory brainstem response to 500 HZ tone burst is more suitable. Seyede Faranak Emami and Nasrin Gohari Copyright © 2014 Seyede Faranak Emami and Nasrin Gohari. All rights reserved. The Occurrence of Laryngeal Penetration and Aspiration in Patients with Glottal Closure Insufficiency Tue, 11 Mar 2014 09:27:01 +0000 Glottal closure during the pharyngeal phase of swallowing is one of the important steps in protecting the airway. Generally, it is believed that any deficiency in this process can lead to laryngeal penetration and aspiration. This study investigated the incidence of laryngeal penetration and aspiration among 44 patients with glottal closure insufficiencies that were referred for voice and swallowing evaluation to our institution. The videostroboscopy and 3 oz water swallow test were performed for all of the patients and dysphagic patients were screened and referred for videofluoroscopy. Overall, 15.90% of patients demonstrated signs of laryngeal penetration (13.63%) and aspiration (2.27%). The patients with the pattern of incomplete closure illustrated the highest percentage of penetration-aspiration (21.73%, 4.34%) among other GCI patterns. Thus, early interventions for these patients’ swallowing condition seem necessary. Ali Rajaei, Ebrahim Barzegar Bafrooei, Fariba Mojiri, and Mohammad Hussein Nilforoush Copyright © 2014 Ali Rajaei et al. All rights reserved. Oral Tongue Squamous Cell Carcinoma in Young Women: A Matched Comparison—Do Outcomes Justify Treatment Intensity? Mon, 10 Mar 2014 09:10:45 +0000 Background. The incidence of oral tongue squamous cell carcinoma (OTSCC) in young women is increasing with uncertain outcomes compared to traditional patients. Published outcomes data are at odds in this cohort of young women. Methods. Retrospective analysis comparing demographic, clinicopathologic, and outcomes data of women OTSCC patients younger than 45 years old matched 1 : 2 by stage with men both younger and older than 45 and women older than 45. Results. No disease-free or overall survival differences were found between cohorts. Young women were significantly more likely to receive radiation therapy, particularly in stage I disease, even when controlling for common pathologic indications. Conclusions. OTSCC in young women was not associated with worse outcomes compared to a matched cohort of other patients. Increased frequency of radiation treatment for this cohort may not be justified. Ryan P. Goepfert, Eric J. Kezirian, and Steven J. Wang Copyright © 2014 Ryan P. Goepfert et al. All rights reserved. Feasibility of Endoscopic Treatment of Middle Ear Myoclonus: A Cadaveric Study Mon, 10 Mar 2014 00:00:00 +0000 Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope. Natasha Pollak, Roya Azadarmaki, and Sidrah Ahmad Copyright © 2014 Natasha Pollak et al. All rights reserved. Hypersensitivity of Vestibular System to Sound and Pseudoconductive Hearing Loss in Deaf Patients Mon, 03 Mar 2014 11:58:02 +0000 The objective of this cross-sectional study is to compare bone-conducted low-frequency hearing thresholds (BClf) to cervical vestibular evoked myogenic potentials (cVEMPs) findings in prelingual adult deaf patients. The fifty participants (100 ears) included twenty healthy controls and thirty other subjects selected from patients who presented with bilateral prelingual deafness to Department of Audiology of Hamadan University of Medical Sciences and Health Services (Hamadan, Iran). Assessments comprised of audiological evaluations, cVEMPs, and computerized tomography scans. Twenty deaf patients (forty affected ears) with bilateral decreased vestibular excitability as detected by abnormal cVEMPs revealed that BClf hearing thresholds were completely absent. Ten deaf patients (twenty unaffected ears) with normal cVEMPs reported a sensation of the sound at BClf hearing thresholds (the mean for and for ). Multiple comparisons of mean p 13 latencies, mean n23 latencies and peak-to-peak amplitudes between three groups were significant (P = 0.01 for all, one-way ANOVA test). Multiple Comparisons of mean BClf between three groups were significant (P = 0.00, One-way ANOVA test). Conclusion. Hypersensitivity of vestibular system to sound augments BClf hearing thresholds in deaf patients. The sensation of the sound at low frequencies may be present in patients with total deafness and normal vestibular function (predominantly saccule). This improvement disappears when saccular function is lost. Seyede Faranak Emami Copyright © 2014 Seyede Faranak Emami. All rights reserved. Sunitinib Improves Some Clinical Aspects and Reverts DMBA-Induced Hyperplasic Lesions in Hamster Buccal Pouch Thu, 13 Feb 2014 16:08:29 +0000 Oral squamous cell carcinoma (OSCC) is a public health problem. The hamster buccal pouch model is ideal for analyzing the development of OSCC. This research analysed the effects of sunitinib (tyrosine kinase inhibitor) in precancerous lesions induced by 7,12-dimethylbenz(a)anthracene (DMBA) in this model. Thirty-four male hamsters, divided into six groups: control—C , acetone—A , carbamide peroxide—CP , acetone and CP—A+CP , 1% DMBA in acetone and CP—DA+CP , and 1% DMBA in acetone and CP and 4-week treatment with sunitinib—DA+CP+S . The aspects evaluated were anatomopathological features (peribuccal area, paws, nose, and fur), histological sections of the hamster buccal pouches (qualitatively analyzed), epithelium thickness, and the rete ridge density (estimated). Sunitinib was unable to attenuate the decrease in weight gain induced by DMBA; no increase in volume was detected in the pouch and/or ulceration, observed in 43% of the animals in the DA+CP group. DA+CP groups presented a significant increase in rete ridge density compared to the control groups () which was reverted by sunitinib in the DA+CP+S group. Sunitinib seems to have important benefits in early stage carcinogenesis and may be useful in chemoprevention. Fernanda Lopes de Souza, Mariana Oliveira, Marianne Brochado Nunes, Lucas Horstmann Serafim, Alan Arrieira Azambuja, Luisa Maria G. de M. Braga, Lisiani Saur, Maria Antonieta Lopes de Souza, and Léder Leal Xavier Copyright © 2014 Fernanda Lopes de Souza et al. All rights reserved. Value and Efficacy of Foley Catheter Removal of Blunt Pediatric Esophageal Foreign Bodies Thu, 30 Jan 2014 09:20:55 +0000 Objective. To discuss the safety and efficacy of Foley catheter removal of blunt pediatric esophageal foreign bodies. Methods. Analyzing our first 17 cases of pediatric esophageal foreign bodies removed by Foley catheter method in respect of the efficacy, removal methods, and complications. We also reviewed related literature and discussed the background, current status, and technical matters that need attention of this method. Results. In three-year period between May 2010 and May 2013, in 16 out of 17 children blunt radiopaque foreign bodies impacted in the esophagus were successfully removed by a Foley catheter. There were no complications. In one patient, the foreign body was advanced into stomach and came out with stool 2 days later. Conclusions. The technique is safe, rapid, and cost-effective procedure and applicable for blunt, flat foreign bodies impacted in the esophagus. Yasin Abdurehim, Yalkun Yasin, Qu Yaming, and Zhang Hua Copyright © 2014 Yasin Abdurehim et al. All rights reserved. Maxillofacial Fractures in the Province of Pescara, Italy: A Retrospective Study Thu, 23 Jan 2014 12:13:14 +0000 The aim of the present study was to assess the etiology and pattern of maxillofacial fractures in the Province of Pescara, Abruzzo, Central Italy. Was performed a retrospective review of patients treated at the Department of Maxillofacial Surgery of Spirito Santo Hospital from January 2010 to December 2012. Data collected and analyzed included sex, age, cause of injury, site of fracture, monthly distribution, and alcohol misuse. A total of 306 patients sustaining 401 maxillofacial fractures were treated. There were 173 males (56.5%) and 133 females (43.5%). Most of the patients (36.9%) were in the age group of 18–44 years. The most common causes of injuries were road traffic accidents (26.4%); the second leading cause was interpersonal violence (23.2%), followed by injuries associated with falls (19.2%). Fractures of the mandible (31%) and zygoma (23%) were the most common maxillofacial fractures in our study. The monthly distribution peaked in the summer (July and August, 30.4%) and in October (13.1%). In conclusion, this study confirms the close correlation between the incidence and etiology of facial fractures and the geographical, cultural, and socioeconomic features of a population. The data obtained provide important information for the design of future plans for injury prevention and for education of citizens. Giuliano Ascani, Francesca Di Cosimo, Michele Costa, Paolo Mancini, and Claudio Caporale Copyright © 2014 Giuliano Ascani et al. All rights reserved. The Relationship between Personality Type and Acceptable Noise Levels: A Pilot Study Thu, 14 Nov 2013 14:28:29 +0000 Objectives. This study examined the relationship between acceptable noise level (ANL) and personality. ANL is the difference between a person’s most comfortable level for speech and the loudest level of background noise they are willing to accept while listening to speech. Design. Forty young adults with normal hearing participated. ANLs were measured and two personality tests (Big Five Inventory, Myers-Briggs Type Indicator) were administered. Results. The analysis revealed a correlation between ANL and the openness and conscientious personality dimensions from the Big Five Inventory; no correlation emerged between ANL and the Myers-Briggs personality types. Conclusions. Lower ANLs are correlated with full-time hearing aid use and the openness personality dimension; higher ANLs are correlated with part-time or hearing aid nonuse and the conscientious personality dimension. Current data suggest that those more open to new experiences may accept more noise and possibly be good hearing aid candidates, while those more conscientious may accept less noise and reject hearing aids, based on their unwillingness to accept background noise. Knowing something about a person’s personality type may help audiologists determine if their patients will likely be good candidates for hearing aids. Cliff Franklin, Laura V. Johnson, Letitia White, Clay Franklin, and Laura Smith-Olinde Copyright © 2013 Cliff Franklin et al. All rights reserved. Low-Level Laser on Hearing: Is There an Effect? Mon, 11 Nov 2013 09:43:58 +0000 Jan Tunér and Lars Hode Copyright © 2013 Jan Tunér and Lars Hode. All rights reserved. Benign Paroxysmal Positional Vertigo in Irradiated Nasopharyngeal Carcinoma Survivors Thu, 24 Oct 2013 11:31:41 +0000 Purpose. It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to benign paroxysmal positional vertigo (BPPV). The purpose of this study was to better understand this clinical entity. Materials and Methods. From September 2003 to June 2011, we conducted a retrospective study of 11 irradiated NPC patients with BPPV in our institute. During the same period, 11 irradiated NPC patients without BPPV were randomly selected and enrolled as the control group. All medical records of these patients were evaluated. Results. The risk of BPPV rises significantly when the patient undergoes radiotherapy (RT) twice and the threshold radiation dose is >120 Gy (). The occurrence of postirradiated BPPV was significantly related to incidences of otitis media and sensorineural hearing loss (SNHL) ( and 0.009, resp.). All the patients responded well to repositioning maneuvers. Conclusion. A second course of RT, postirradiated otitis media, or SNHL is associated with the potential risk of radiation-induced BPPV. Repositioning maneuvers were safe and effective for relief of this disease. Shaoyan Feng, Yunping Fan, Liqing Guo, Zibin Liang, and Jiaoping Mi Copyright © 2013 Shaoyan Feng et al. All rights reserved. Sound Sensitivity of the Saccule for Low Frequencies in Healthy Adults Thu, 24 Oct 2013 08:13:06 +0000 Approximately 80 years ago John Tait speculated about a possible auditory role for the otolith organs in humans those days, there was no direct evidence for that idea. This time is for us to review and research. Then, the objective of our study was to investigate saccular hearing in healthy adults. We selected twenty healthy controls and twenty-four dizzy cases. Assessment comprised of audiologic evaluations, cervical vestibular evoked myogenic potentials (cVEMPs), and recognition of spoken phonemes in white noise (Rsp in wn). In the case group (a total of 48 ears), the cVEMPs abnormalities were all unilateral (24 affected ears and 24 contralateral unaffected ears). Affected ears with decreased vestibular excitability as detected by abnormal cVEMPs had decreased Rsp in wn (), whereas both unaffected () and control ears () presented normal results. The correlation between RSP in wn and p13 latencies was significant (, ). The peak-to-peak amplitudes showed significant correlation to RSP in wn (, ). The correlation between RSP in wn and the latencies of n23 was significant (, ). We concluded in presence of severe competing noise, saccule has a facilitating role for cochlea and can improve to detection of loud low-frequencies. Seyede Faranak Emami, Akram Pourbakht, Ahmad Daneshi, Kianoush Sheykholeslami, Hessamedin Emamjome, and Mohammad Kamali Copyright © 2013 Seyede Faranak Emami et al. All rights reserved. Postthyroidectomy Throat Pain and Swallowing: Do Proton Pump Inhibitors Make a Difference? Wed, 09 Oct 2013 14:46:08 +0000 Objectives. Following thyroid surgery patients complain from swallowing disability and throat pain resembling symptoms of laryngopharyngeal reflux (LPR). The purpose of this study is to assess whether proton pump inhibitors (PPIs) given to patients in the first postoperative week relieve the swallowing disability and throat pain complaints. Materials and Methods. A questionnaire was given to 523 patients who had thyroid surgery between October 2010 and August 2011. In the first postoperative clinic visit each patient was approached to fill out a questionnaire. 208 patients met criteria, 100 of which were on PPIs (study group) and 108 were not on PPIs (control group). Results. When comparing the study group to the control group, the average pain level was 2.57 compared to 3.9 during the first postoperative week, and 1.27 compared to 2.41 at day 7 ( value = 0.001). Swallowing disability was also lower in the study group when compared to the control group, 1.87 and 3.12, respectively, during the first postoperative week and 0.87 and 1.76, respectively, at day 7 ( value = 0.007). Conclusion. Patients treated with PPIs had less pain and swallowing disability in the first week following thyroid surgery, when compared to patients not treated with PPIs. Faisal Zawawi, Keith Richardson, Rickul Varshney, Jonathan Young, Alex M. Mlynarek, Michael P. Hier, and Richard J. Payne Copyright © 2013 Faisal Zawawi et al. All rights reserved. Influence of Body Position on Severity of Obstructive Sleep Apnea: A Systematic Review Tue, 08 Oct 2013 16:38:39 +0000 Aim. The aim of this review is to determine the relationship between sleeping body posture and severity of obstructive sleep apnea. This relationship has been investigated in the past. However, the conclusions derived from some of these studies are conflicting with each other. This paper intends to summarize the reported relationships between sleep posture and various sleep indices in patients diagnosed with sleep apnea. Methods and Materials. A systematic review of the published English literature during a 25-year period from 1983 to 2008 was performed. Results. Published data concerning the sleep apnea severity and posture in adults are limited. Supine sleep posture is consistently associated with more severe obstructive sleep apnea indices in adults. However, relationship between sleep apnea severity indices and prone posture is inconsistent. Akshay Menon and Manoj Kumar Copyright © 2013 Akshay Menon and Manoj Kumar. All rights reserved. Periorbital Ecchymosis and Subconjunctival Hemorrhage following Ear Surgery Mon, 30 Sep 2013 09:02:22 +0000 Objective. To evaluate the occurrence of two periorbital complications of surgery for Chronic Suppurative Otitis Media (CSOM) and discuss the potential pathophysiologic mechanisms. Materials and Methods. This is a retrospective review of the CSOM surgeries performed between Oct, 2005, and Jan, 2011, in our hospital. The early postoperative conditions of the patients were scrutinized to identify periorbital ecchymosis and subconjunctival hemorrhage. Results. Eight cases out of 756 patients were noted to have periorbital ecchymosis, and two of the patients also had simultaneous subconjunctival hemorrhage. All cases in which the complications occurred had undergone tympanoplasty, and in three patients mastoidectomy had also been performed. The age of the affected patients ranged from 24 to 70 years old. In all of them the condition ensued the day after the surgery and became better within 5 to 10 days. Complete recovery took approximately 1 month. Conclusion. Periorbital ecchymosis and subconjunctival hemorrhage are rare but safe complications of ear surgeries. The conditions are self-limiting and no management is necessary. Mohsen Rajati, Mehdi Bakhshaee, and Kamran Khazaeni Copyright © 2013 Mohsen Rajati et al. All rights reserved. DPOAE Intensity Increase at Individual Dominant Frequency after Short-Term Auditory Exposure Thu, 05 Sep 2013 08:44:22 +0000 Previous experiments suggested the possibility of a short-term sound stimulus-evoked and transient increase in DPOAE amplitudes. This phenomenon is possibly due to the complexity of the outer hair cells and their efferent control system and the different time scales of regulatory processes. A total of 100 healthy subjects ranging from 18 to 40 years of age with normal hearing and normal DPOAE values in the range of 781–4000 Hz were recruited in the study. Diagnostic DPOAE measurements were performed after short-term sound exposure. We proposed a 10 sec, 50 dB sound impulse as the most effective stimulus for clinical practice between 40 and 60 sec poststimulus time to detect the aforementioned transient DPOAE increase. We developed a procedure for detection of this transient increase in DPOAE by the application of a short-term sound exposure. The phenomenon was consistent and well detectable. Based on our findings, a new aspect of cochlear adaptation can be established that might be introduced as a routine clinical diagnostic tool. A mathematical model was provided that summarizes various factors that determine electromotility of OHCs and serves as a possible clinical application using this phenomenon for the prediction of individual noise susceptibility. Judit Bakk, Tamás Karosi, Tamás József Batta, and István Sziklai Copyright © 2013 Judit Bakk et al. All rights reserved. Clinical Study of Graft Selection in Malaysian Rhinoplasty Patients Tue, 03 Sep 2013 08:22:52 +0000 Graft selection remains the greatest challenge for surgeons performing rhinoplasty. The preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of infection and extrusion as it does not induce an immune response. We have evaluated 26 patients who underwent open structured rhinoplasty at our center and compared our experience regarding the operative technique, graft availability, indications, and limitations. The racial distribution was 18 Indians, 5 Chinese, and 3 Malays with a mean age, hospitalization, and followup of 30.5 years, 16.9 months, and 4.4 days, respectively. Majority of the patients (57.6%) presented with twisted nose and 30.7% of the patients presented with history of nasal trauma. All the patients had deviated septum of varying severity. The most common graft used was quadrangular cartilage graft and the common complications noted were ala deformity and tip anaesthesia in 7.6% patients respectively. Balwant Singh Gendeh Copyright © 2013 Balwant Singh Gendeh. All rights reserved. Correlation of Tinnitus Loudness and Onset Duration with Audiological Profile Indicating Variation in Prognosis Mon, 02 Sep 2013 10:35:41 +0000 Purpose. Subjective tinnitus has different forms and degrees of severity. Many studies in the literature have assessed psychoacoustic characteristics of tinnitus but hardly any of them had focused on the association of audiological profile with onset duration and loudness perception. The aim of this study was to evaluate existence of any association between tinnitus loudness/onset duration and audiological profile to explain differences in prognosis. Method. Study design was prospective. The sample consisted of 26 subjects having tinnitus, which was divided into tinnitus and nontinnitus ears. Audiological profile included pure-tone audiometry, speech audiometry, tympanometry, acoustic reflex test, and auditory evoked potentials (early and middle latency). Unpaired t-test was applied to compare two subgroups. Correlation and association between tinnitus onset duration/loudness perception and audiological profile were also assessed by calculating Spearman’s coefficient and Fischer exact value. Results. The two subgroups had significant differences for pure-tone and speech audiometry hearing thresholds. A significant association was observed between the high frequency/extended high frequency and tinnitus loudness/onset duration. Conclusion. The changes in hearing thresholds and auditory pathway are associated with an increase in tinnitus loudness and its onset duration. This knowledge would be helpful to differentiate between severity and chronicity of the patients for planning therapeutic management and predicting prognosis. Sunita Gudwani, Sanjay K. Munjal, Naresh K. Panda, and Roshan K. Verma Copyright © 2013 Sunita Gudwani et al. All rights reserved. Effects of Cardiopulmonary Bypass Surgery on Auditory Function: A Preliminary Study Thu, 29 Aug 2013 08:29:23 +0000 Hearing loss has been reported as a complication following cardiac surgery with extracorporeal circulation. Preoperative hearing testing is not commonly done in these procedures, so preoperative and postoperative hearing loss, if any, may occur unnoticed. 30 subjects in the age range of 50–70 with a mean age of 60.16 years with myocardial infarction and scheduled to undergo cardiopulmonary bypass surgery underwent detailed audiological assessment comprising of pure tone audiometry with extended high frequency audiometry, speech audiometry and otoacoustic emissions (OAE) testing. The audiological testing was done preoperatively and at 2 weeks after the surgery. On pure tone audiometry, the difference between pre- and postsurgery mean values for both ears at 10, 12, and 16 KHz showed highly significant differences (). On OAE testing, a significant difference () between pre- and postvalues of signal to noise ratio (SNR) was found. It is hypothesised that CPB surgery makes blood redistribution to other organs easy, deviating from internal ear, which is highly susceptible as it lacks collateral circulation and its cells have high energy metabolism. Epithelial damage on internal ear microcirculation causes reduction of the cochlear potentials and hence hearing loss. Sanjay Kumar Munjal, Parul Malik, Anuradha Sharma, Naresh Kumar Panda, and Shyam K. Singh Thingnum Copyright © 2013 Sanjay Kumar Munjal et al. All rights reserved. Epidemiological and Clinical Aspects and Therapy of Chronic Otitis Media in the “ENT” and Cervicofacial Surgery Ward in the University Hospital of Ouagadougou Mon, 26 Aug 2013 13:17:26 +0000 Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009–February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people. Y. M. C. Gyebre, R. W.-L. Ouedraogo, A. Elola, B. P. Ouedraogo, M. Sereme, M. Ouattara, and K. Ouoba Copyright © 2013 Y. M. C. Gyebre et al. All rights reserved. Ocular Vestibular Evoked Myogenic Potential Using Different Test Stimuli Tue, 06 Aug 2013 13:06:03 +0000 Aim. Ocular Evoked Myogenic Potential (oVEMP) are short latency potentials evoked by higher acoustic stimulation. In this study, we aimed at comparing the click, 500 Hz mixed modulated, and 500 Hz short duration tone burst stimuli using oVEMP. Material. Click, 500 Hz mixed modulated and 500 Hz short duration tone burst stimuli were used for the study. Method. Conventional sampling and conveneint study design were used. Sixty healthy subjects underwent contralateral oVEMP testing maintaining 30 degrees upward gaze. Single channel electrode montage was applied to record oVEMP response. Results. On statistical analysis the three stimuli evoked equal response rates (100%), and when latency of n1 and p1 and peak-peak amplitude were compared, the click evoked showed significantly early latency and lower peak-peak amplitude than the 500 Hz stimuli. Five hundred Hz stimuli did not show significant difference in latency and peak-peak amplitude of n1-p1. Discussion. Thus, 500 Hz stimuli can evoke better latency and peak-peak amplitude. oVEMP has good clinical significance in diagnosing subjects with vestibular dysfunction. To add to the sensitivity of the oVEMP test, 500 Hz stimuli may also be used as it can evoke better oVEMP responses in clinical population with good morphology. Dessai Teja Deepak, Jayashree S. Bhat, and Kaushlendra Kumar Copyright © 2013 Dessai Teja Deepak et al. All rights reserved. Changing Trends in Oesophageal Endoscopy: A Systematic Review of Transnasal Oesophagoscopy Thu, 01 Aug 2013 10:47:13 +0000 The safety, efficacy, and economic implications of using transnasal oesophagoscopy (TNE) are compared with conventional rigid or flexible oesophagoscopy for oesophageal disorders in otorhinolaryngology (ORL) clinics in this systematic review. Eleven electronic databases were searched for articles on transnasal oesophagoscopy. A total of 67 relevant titles were identified and 39 abstracts were screened of which 17 full- text articles were included in this report. There was fair level of evidence to suggest that TNE was effective for screening examination in patients with dysphagia, globus pharyngeus, and reflux symptoms and for detection of metachronous oesophageal carcinoma. TNE can also be used to biopsy suspicious lesions in the upper aerodigestive tract, placement of wireless pH capsule, transnasal balloon dilation of the oesophagus, secondary tracheoesophageal puncture, and management of foreign bodies. TNE was well tolerated and can be safely performed in an office setting with topical anaesthesia. Complications associated with TNE were mild and uncommon. There was evidence to suggest potential cost savings by performing TNE in the office setting compared with conventional investigation and examination for dysphagia. TNE may lead to a change in practice from investigation and treatment in the operating theatre or day care center to an office-based practice. Junainah Sabirin, Maharita Abd Rahman, and Philip Rajan Copyright © 2013 Junainah Sabirin et al. All rights reserved. Effectiveness of 7.5 Percent Povidone Iodine in Comparison to 1 Percent Clotrimazole with Lignocaine in the Treatment of Otomycosis Thu, 25 Jul 2013 08:33:27 +0000 Objectives. Otomycosis is a common ENT disease frequenting the tropics. Its recurrent nature poses a great challenge to the treating physician. In spite of a number of antifungals in the market, the frequent nature of this disease warrants repeated use of these drugs, contributing to drug resistance and financial burden on the rural population. Our primary aims were to evaluate the effectiveness of povidone iodine in the treatment of otomycosis and to identify the most common fungal isolate in our population. Study Design and Setting. A single blinded prospective longitudinal study was done over a period of 12 months in a tertiary referral center. 34 patients in the age group 15–70 years clinically diagnosed with otomycosis were included in this study. These individuals were divided into two groups selected randomly. One arm received 7.5% povidone iodine otic drops and the other 1% Clotrimazole and lignocaine drops. Evaluation was based on resolution of symptoms and signs after treatment. Result. Both arms showed improvements which were comparable thus suggesting the role of povidone iodine in the management of otomycosis. Conclusion. Povidone iodine is an effective antifungal in the treatment of otomycosis. Ajay Philip, Regi Thomas, Anand Job, V. Rajan Sundaresan, Shalini Anandan, and Rita Ruby Albert Copyright © 2013 Ajay Philip et al. All rights reserved. The Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis: A Radiological Study of the Frontal Recess Area Wed, 24 Jul 2013 13:45:15 +0000 Background. The frontal recess area represents a challenge to ENT surgeons due to its narrow confines and variable anatomy. Several types of cells have been described in this area. The agger nasi cells are the most constant ones. The frontal cells, originally classified by Kuhn into 4 types, have been reported in the literature to exist in 20%–41% of frontal recesses. Aim of the Study. To identify the prevalence of frontal recess cells and their relation to frontal sinus disease. Methods. Coronal and axial CT scans of paranasal sinuses of 70 patients admitted for functional endoscopic sinus surgery (FESS) were reviewed to identify the agger nasi, frontal cells, and frontal sinus disease. Data was collated for right and left sides separately. Results. Of the 140 sides reviewed, 126 (90%) had agger nasi and 110 (78.571%) had frontal cells. 37 frontal sinuses were free of mucosal disease, 48 were partly opacified, and 50 were totally opacified. There was no significant difference found in frontal sinus mucosal disease in presence or absence of frontal cells or agger nasi. Conclusions. The current study shows that frontal cells might be underreported in the literature, as the prevalence identified is noticeably higher than previous studies. Ahmed Z. Eweiss and Hisham S. Khalil Copyright © 2013 Ahmed Z. Eweiss and Hisham S. Khalil. All rights reserved. Can Axial-Based Nodal Size Criteria Be Used in Other Imaging Planes to Accurately Determine “Enlarged” Head and Neck Lymph Nodes? Wed, 24 Jul 2013 11:41:46 +0000 Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as “enlarged” if equal to or exceeding size criteria. Results. 222 lymph nodes were “enlarged” in one imaging plane; however, 53.2% (118/222) of these were “enlarged” in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = −0.09 and −0.07, resp., ). The McNemar test showed systematic misclassification when comparing axial versus coronal () and axial versus sagittal () planes. Conclusion. Classification of “enlarged” lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data. Eric S. Bartlett, Thomas D. Walters, and Eugene Yu Copyright © 2013 Eric S. Bartlett et al. All rights reserved. Laryngeal Aerodynamics in Children with Hearing Impairment versus Age and Height Matched Normal Hearing Peers Thu, 18 Jul 2013 10:08:20 +0000 Lack of proper auditory feedback in hearing-impaired subjects results in functional voice disorder. It is directly related to discoordination of intrinsic and extrinsic laryngeal muscles and disturbed contraction and relaxation of antagonistic muscles. A total of twenty children in the age range of 5–10 years were considered for the study. They were divided into two groups: normal hearing children and hearing aid user children. Results showed a significant difference in the vital capacity, maximum sustained phonation, and fast adduction abduction rate having equal variance for normal and hearing aid user children, respectively, but no significant difference was found in the peak flow value with being statistically significant. A reduced vital capacity in hearing aid user children suggests a limited use of the lung volume for speech production. It may be inferred from the study that the hearing aid user children have poor vocal proficiency which is reflected in their voice. The use of voicing component in hearing impaired subjects is seen due to improper auditory feedback. It was found that there was a significant difference in the vital capacity, maximum sustained phonation (MSP), and fast adduction abduction rate and no significant difference in the peak flow. Barshapriya Das, Indranil Chatterjee, and Suman Kumar Copyright © 2013 Barshapriya Das et al. All rights reserved. Interferon Inducible IFI16 Expression in p16 Positive Squamous Cell Carcinoma of the Oropharynx Thu, 11 Jul 2013 13:42:34 +0000 Human-papillomavirus- (HPV-) positive oropharyngeal squamous cell carcinomas (OPSCC) are reported to be more responsive to treatment and to be related to a favorable prognosis compared with non-HPV carcinomas. However, the molecular basis of the responsiveness is unclear. Interferon inducible IFI16, which is implicated in the control of cell growth, apoptosis, angiogenesis, and immunomodulation in various types of cancers, is reported to be frequently expressed in the HPV-positive head and neck SCC and to correlate with a better prognosis. In this study, we hypothesized that HPV related OPSCC expresses IFI16 resulting in favorable prognosis. To clarify the relationship between the prognosis of HPV related OPSCC patients and IFI16 status, we examined immunohistologically the pretreatment specimens of OPSCC for the expression of p16 as a surrogate marker of HPV infection and IFI16. We could not show that the expression of IFI16 is associated with that of p16. There was no significant difference in the survival rate between IFI16 positive and negative groups. Patients with p16 negative tumor exhibited worse survival rate regardless of IFI16 status. In this limited case series, we could not conclude that IFI16 expression is altered in p16 positive OPSCC and that it would be a new predictive marker or a useful therapeutic tool. Moriyasu Yamauchi, Takafumi Nakano, Torahiko Nakashima, Ryuji Yasumatsu, Kazuki Hashimoto, Satoshi Toh, Hideki Shiratsuchi, Yoshinao Oda, and Shizuo Komune Copyright © 2013 Moriyasu Yamauchi et al. All rights reserved. Gastrostomy Tube Use after Transoral Robotic Surgery for Oropharyngeal Cancer Mon, 08 Jul 2013 13:07:10 +0000 Objective. To evaluate factors that influence gastrostomy tube (g-tube) use after transoral robotic surgery (TORS) for oropharyngeal (OP) cancer. Study Design/Methods. Retrospective review of TORS patients with OP cancer. G-tube presence was recorded before and after surgery at followup. Kaplan-Meier and Cox hazards model evaluated effects of early (T1 and T2) and advanced (T3, T4) disease, adjuvant therapy, and free flap reconstruction on g-tube use. Results. Sixteen patients had tonsillar cancer and 13 tongue base cancer. Of 22 patients who underwent TORS as primary therapy, 17 had T1 T2 stage and five T3 T4 stage. Seven underwent salvage therapy (four T1 T2 and three T3 T4). Nine underwent robotic-assisted inset free flap reconstruction. Seventeen received adjuvant therapy. Four groups were compared: primary early disease (PED) T1 and T2 tumors, primary early disease with adjunctive therapy (PEDAT), primary advanced disease (PAD) T3 and T4 tumors, and salvage therapy. Within the first year of treatment, 0% PED, 44% PEDAT, 40% PAD, and 57% salvage patients required a g-tube. Fourteen patients had a temporary nasoenteric tube (48.3%) postoperatively, and 10 required a g-tube (34.5%) within the first year. Four of 22 (18.2%) with TORS as primary treatment were g-tube dependent at one year and had received adjuvant therapy. Conclusion. PED can be managed without a g-tube after TORS. Similar feeding tube rates were found for PEDAT and PAD patients. Salvage patients have a high rate of g-tube need after TORS. Samer Al-khudari, Scott Bendix, Jamie Lindholm, Erin Simmerman, Francis Hall, and Tamer Ghanem Copyright © 2013 Samer Al-khudari et al. All rights reserved.