Laryngoscope

The correlation between symptoms of definite Meniere's disease and endolymphatic hydrops visualized by magnetic resonance imaging Objective/Hypothesis This study aimed at investigating the correlation between a battery of diagnostic symptoms of definite Meniere's disease (MD) and the degree of endolymphatic hydrops (EH) in the inner ear. Study Design Prospective study. Methods Fifty-four patients diagnosed with unilateral definite MD were enrolled in the study. The hearing levels of all patients at the low, middle, and high frequencies were evaluated. Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) magnetic resonance imaging (MRI) were performed 24 hours after bilateral intratympanic injection of gadolinium to assess the presence and grading of EH. Results Various degrees of EH were observed in the vestibule and/or each turn of the cochlea in the affected ears of all patients. The duration of MD disease and low-tone and middle-tone hearing thresholds were proportional to the extent of EH in the vestibule and cochlear. However, no significant correlation was demonstrated between EH and other aspects of symptoms such as high-tone hearing loss, tinnitus, and aural fullness. Of all subjects, 16.7% exhibited bilateral EH on MRI exam who were diagnosed with unilateral MD based on diagnostic criteria. Conclusions EH in the inner ear of MD patients exhibits a progressive deteriorative trend over time. Low-tone and middle-tone hearing thresholds can indirectly reflect the severity of EH in the cochlea. EH may not be the primary cause of tinnitus and aural fullness in patients with MD. Patients diagnosed with unilateral MD should maintain long-term regular follow-ups for the possibility of developing bilateral EH. Level of Evidence 4 Laryngoscope, 2015

A systematic review of the effect of different crimping techniques in stapes surgery for otosclerosis Objectives/Hypothesis To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry. Data Sources PubMed, EMBASE, and the Cochrane Library. Methods A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss. Results Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB). Conclusion Moderate to high risk of bias and inconsistent results characterize the current evidence. Laryngoscope, 2015

Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer Objectives/Hypothesis Tumor volume has been postulated to be an important prognostic factor for oncological outcome after radiotherapy or chemoradiotherapy. This postulate was retrospectively investigated in a consecutively treated cohort of T3–T4 larynx cancer patients. Study Design Retrospective cohort study. Methods For 166 patients with T3–T4 larynx cancer (1999–2008), pretreatment computed tomography and magnetic resonance imaging scans were available for tumor volume delineation. Patients were treated with radiotherapy, chemoradiotherapy, or total laryngectomy with postoperative radiotherapy. Both a dedicated head and neck radiologist and the first author determined all tumor volumes. Statistical analysis was by Kaplan-Meier plots and Cox proportional hazard models. Results Patients with T3 larynx cancer had significantly smaller tumor volumes than patients with T4 larynx cancer (median = 8.1 cm3 and 15.8 cm3, respectively; P < .0001). In the group treated with total laryngectomy and postoperative radiotherapy, no association was found between tumor volume and local or locoregional control or overall survival. In the group treated with radiotherapy, a nonsignificant trend was observed between local control and tumor volume. In the chemoradiotherapy group, however, a significant impact of tumor volume was found on local control (hazard ratio = 1.07; 95% confidence interval = 1.01-1.13; P = .028). Conclusions Tumor volume was not significantly associated with local control, locoregional control, or overall survival in the surgically treated group. In the group treated with radiotherapy, there was no statistically significant association, but a trend was observed between local control and tumor volume. Only in patients treated with concurrent chemoradiotherapy was a significant impact of tumor volume on local control found. Level of Evidence 4. Laryngoscope, 2015

The effectiveness of different neuroprotective agents in facial nerve injury: An experimental study Objectives/Hypothesis To examine and compare the neuroprotective effects of dexamethasone, oxytocin, and resveratrol administration on regeneration after facial nerve crush injury in a rat model. Study Design Prospective, randomized, controlled animal study. Methods A crush-type facial nerve injury was performed on the right side of all rats (injury group [IG]), whereas there was no injury on the left side (sham group [SG]). These main groups were divided into five subgroups: 1) no medicine (control); 2) physiological serum; 3) dexamethasone; 4) oxytocin; and 5) resveratrol (Res) administered (intraperitoneal injection) for 28 days. Functional recovery was evaluated by daily eye-blink reflex and facial electromyography. Nerve–muscle degeneration and regeneration, apoptosis, and intercellular connections were evaluated in histopathological and immunohistochemical examinations. Results Recovery time of the postinjury eye-blink reflex demonstrated faster recovery in IG + Res when compared with the other subgroups. In peak-to-peak amplitude values, a significant increase was observed in the dexamethasone (P = 0.007) and oxytocin subgroups (P = 0.004) and was even more apparent in the resveratrol subgroup (P < 0.001). Nerve regeneration is apparent in the resveratrol subgroup. Apoptotic changes were evaluated immunohistochemically with TUNEL and Caspase 3 and 6 antibodies staining. Caspase 3 and 6 immunoexpressions of resveratrol and oxytocin subgroups were moderate when compared with dexamethasone subgroup. Except for the resveratrol subgroup, which had an increase in expression, the majority of subgroups were similar to SG in terms of intercellular connections (Connexin 32 and 43). Conclusion Resveratrol leads to the best outcome after facial nerve crush injury in rats when compared with dexamethasone and oxytocin, even though these agents demonstrate a significant improvement in facial nerve regeneration. Level of Evidence N/A. Laryngoscope, 2015

Quantitative assessment of vestibular otopathology in otosclerosis: A temporal bone study Objectives/Hypothesis To determine if peripheral vestibular otopathology is present in human temporal bones with otosclerosis. Study Design Comparative human temporal bone study. Methods Seventy-four human temporal bones from 46 subjects with otosclerosis (mean age of 61 ± 18 years) and 20 within histologically normal limits from 17 subjects (mean age of 59 ± 14 years) were included in this study. Temporal bones with otosclerosis were divided into those with and without endosteal involvement. Using differential interference contrast microscopy at 1008× magnification, type I and type II vestibular hair cell counts were performed on each vestibular sense organ in which the neuroepithelia was oriented perpendicular to the plane of section. The organ-specific cell densities (cells/0.01 mm2 surface area) were compared between the groups with and without endosteal involvement, and also compared to counts in the nonotosclerosis control group using Student's t-test. Results Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were significantly lower compared to the group without endosteal involvement. Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were also significantly lower compared to the control group, but they were not in the group without endosteal involvement compared to the control group. Conclusion Endosteal involvement of otosclerotic foci is associated with vestibular hair cell loss to be consistent with the conclusion section of the manuscript, change applied to the abstract that may contribute to the vestibular symptoms in otosclerosis. Level of Evidence N/A. Laryngoscope, 2015

Safety of cochlear implantation before 12 months of age: Medical University of South Carolina and Pediatric American College of Surgeons–National Surgical Quality improvement program outcomes Objectives/Hypothesis The primary objective of this study was to determine the safety profile of cochlear implantation (CI) in infants <12 months old. Study Design Retrospective review of institutional (Medical University of South Carolina [MUSC]) and national data (Pediatric American College of Surgeons–National Surgical Quality Improvement Program [ACS-NSQIP]). Methods Cases were subdivided into two groups according to age at CI: <12 months and 12 to 18 months. The primary outcome measure of interest was occurrence of a postoperative medical or surgical complication. Operative time, anesthesia time, time in the postoperative anesthesia care unit, and length of stay were also assessed. Results In infants <12 months of age, the incidence of a 30-day postoperative surgical complication using the ACS-NSQIP database was 3.6%; this did not differ from the rate observed in the 12- to 18-month-old group (3.2%, P = 1.0). In the MUSC series, the occurrence of a 30-day postoperative complication in children <12 months old was comparable (2.7%). At longer-term follow-up (mean = 3.7 years), the incidence of a postoperative surgical complication in infants <12 months old using MUSC data was 13.5%. When compared to older children at longer-term follow-up, no difference was noted (12.7%, P = 1.0). The incidence of a postoperative medical or anesthetic complication in children <12 months of age was extremely rare in both MUSC and ACS-NSQIP series (0% and 1.3%, respectively). Conclusions Institutional and national data demonstrate that CI in children <12 months of age is a safe procedure. Although infants <12 months old are at risk for postoperative complications, the rates of surgical and medical complications were no different compared to children 12 to 18 months of age. Level of Evidence 4 Laryngoscope, 2015

A newborn with three cochlear turns: Case report and literature review Objectives/Hypothesis The human cochlea is most commonly considered to have two and a half turns. Although the causes of cochlear hypoplasia are well described, cochlear hyperplasia is a rarer entity that is poorly understood. We describe rare anatomic cochlear malformations identified in a 4-month-old male originally referred for evaluation after a failed newborn hearing screening. The full diagnostic evaluation, imaging findings, treatment, and follow-up are described in detail. Cochleae with three turns are an uncommon malformation that is not included in current classifications schemes and may represent a distinct type of anomaly not caused by developmental arrest. Laryngoscope, 2015

Methylprednisolone use during radiotherapy extenuates hearing loss in patients with nasopharyngeal carcinoma Objectives/Hypothesis To investigate the hearing protective effects of methylprednisolone use during radiotherapy in patients with nasopharyngeal carcinoma. Study Design Prospective, controlled clinical study. Methods Fifty-three patients with nasopharyngeal carcinoma (106 ears). Twenty-five patients (50 ears) received radiotherapy with intravenous methylprednisolone for 14 days, and another 28 patients (56 ears) received radiotherapy alone. Pure tone audiometry, distortion product otoacoustic emission (DPOAE), and auditory brainstem responses (ABR) results were reviewed before and 1 year after radiotherapy. Result One year after radiotherapy, the air-and-bone conduction pure tone hearing thresholds increased, and the DPOAE levels decreased in the control group. There was no difference in the ABR wave I, III, and V latencies and the I to V interwave latencies before and 1 year after radiotherapy. The pure tone air conduction thresholds decreased, and the DPOAE levels increased in the treatment group compared with the control group. Conclusion Early sensorineural hearing loss after radiotherapy primarily affected the outer hair cells. The use of methylprednisolone during radiotherapy can extenuate early sensorineural hearing loss caused by irradiation. Level of Evidence 4. Laryngoscope, 2015

Characteristics of patients treated for orbital cellulitis: An analysis of inpatient data Objectives/Hypothesis Orbital cellulitis represents a spectrum of diseases, some of which may progress to potentially serious complications. The authors used the Nationwide Inpatient Sample (NIS) database to analyze the epidemiologic features of pediatric and adult patients admitted for the treatment of orbital cellulitis and to examine associations with surgical management. Methods The NIS was queried for patients admitted for treatment of orbital cellulitis from 2002 to 2010. Patient demographics, length of stay, hospital charges, and concomitant diagnoses were analyzed. Results There were 14,149 cases of orbital cellulitis identified with 1,717 (12.1%) having undergone surgical management. Surgical patients were older (29.6 ± 23.4) and more commonly male (62.0%) (P = 0.004 and < 0.001, respectively). Patients who had surgical intervention had longer length of stay and higher hospital charges than nonsurgical patients (P < 0.001). Our study showed that the proportion of pediatric patients age 10 to 19 years (22.1%) undergoing surgery was four times that of patients < 5 years of age (5.1%) (P < 0.001). Patients with concomitant diagnoses of acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema had significantly increased odds ratio of surgical intervention. Frontal sinusitis was the site most commonly associated with surgical intervention among sinusitis patients. Conclusion This study describes the characteristics of pediatric and adult patients admitted for orbital cellulitis from a national perspective. Patients 10 to 19 years of age were most likely to undergo surgical management. Acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema were concomitant diagnoses associated with significantly increased odds ratio of surgical intervention. Level of Evidence 2C. Laryngoscope, 2015

Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy Objectives/Hypothesis Patients with a history of sinonasal malignancy can develop chronic rhinosinusitis (CRS) as a consequence of their oncologic treatment. Some patients will fail medical management and require endoscopic sinus surgery (ESS). This study reviews the use of ESS in the management of CRS in patients previously treated for sinonasal malignancy. Study Design Retrospective review. Methods All patients with a history of sinonasal malignancy who developed CRS and underwent ESS were reviewed. Preoperative and postoperative imaging and symptoms were collected. Major complications (bleeding, orbital injury, and cerebrospinal fluid leak) and minor complications (adhesion formation) and postoperative healing were reviewed. Results Eighteen patients were identified. All patients presented with symptoms of CRS and sinonasal crusting. Additionally, five patients presented with recurrent facial cellulitis, and six patients had mucoceles. No major complications were encountered. Postoperatively, all patients reported a subjective improvement in their sinonasal symptoms. Comparison of pre- and post-ESS imaging revealed a significant improvement in Lund-Mackay scores after ESS (P < 0.001) from 12.8 (range 5–22) to 7 (range). Despite symptomatic improvement, all patients continued to have nasal crusting. All patients who initially presented with recurrent facial cellulitis had no further episodes after ESS. None of the endoscopically drained mucoceles recurred. Conclusion For patients previously treated for sinonasal malignancy with refractory CRS, ESS appears to be a safe and effective treatment option. ESS in these patients results in subjective improvement in sinonasal symptoms as well as objective improvement in radiographic CRS disease burden, although sinonasal crusting will likely not resolve. Level of Evidence 4. Laryngoscope, 2015