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ABSTRACT: OBJECTIVES/HYPOTHESIS: To assess and compare the effect of commonly used topical antimycotic agents and their solvents on the function of the vestibular and cochlear parts of the sand rat's inner ear. STUDY DESIGN: Prospective, controlled, animal study. METHODS: Forty-five fat sand rats were randomly assigned to five major groups, each receiving topical application of a different agent: saline (control), gentamicin (ototoxic control), and three antimycotic agents: nystatin, clotrimazole solution (Agisten), and bifonazole solution (Agispor). All animals underwent a right labyrinthectomy, and a polyethylene tube was inserted into the left middle ear followed by baseline recording of vestibular evoked potentials (VsEPs) and auditory nerve and brainstem responses (ABR). Subsequently, each animal received five consecutive daily applications of the specific agent into the left middle ear. Evoked potential recordings were repeated 3 and 10 days after the last application and compared to baseline. For clotrimazole and bifonazole solutions, the effect of the solvents was assessed by comparing ABR recordings at similar intervals. RESULTS: Administration of saline did not affect VsEPs or ABR. Both could not be recorded following gentamicin application. In all three antimycotic agents, no statistically significant difference was found between VsEPs recordings before and after application. Clotrimazole and bifonazole solutions caused a significant ABR threshold elevation similar to that caused by their solvents. Nystatin caused a less significant ABR threshold elevation. CONCLUSIONS: The three commonly used topical antimycotic agents investigated here did not affect vestibular function but had a toxic effect on inner ear cochlear function. It seems the main offenders were the solvents.
The Laryngoscope 09/2012; · 1.75 Impact Factor
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ABSTRACT: A 21 year old healthy parturient was diagnosed as having a fetus with micrognathia. She was scheduled for an ex-utero intrapartum treatment (EXIT) procedure. General anesthesia consisted of remifentanil, nitrous oxide, and midazolam. Intravenous nitroglycerin was used for uterine relaxation. This technique offered hemodynamic stability and provided uterine relaxation that may be rapidly terminated. For the fetus, it provided excellent transplacental anesthesia. Supplemental direct fetal anesthesia is recommended to prevent the rapid decline of analgesia/anesthesia that occurs after placental separation.
Journal of clinical anesthesia 03/2011; 23(2):142-4. · 1.32 Impact Factor
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ABSTRACT: A hole in the vestibule of the inner ear leads to augmentation of the hearing loss following noise exposure. Further research is needed to ascertain the mechanism.
The possible effects of a hole in the wall of the inner ear at the vestibule on noise-induced hearing loss were assessed.
The study was conducted on a total of 14 sand rats. Of these 14 animals, 10 underwent baseline auditory nerve and brainstem evoked response (ABR) threshold measurements in each ear separately (insert earphone), opening of middle ear bulla in both ears and drilling of a hole in the vestibule of one inner ear. The other ear was sham-operated. Following immediate re-assessment of ABR threshold, the 10 animals were exposed to 113 dB SPL broadband noise during 4 nights, and 3 days later ABR measurements were repeated. Four additional animals with a hole in one vestibule, not exposed to noise, served as controls.
Following noise exposure, ABR thresholds were elevated by 28.5 +/- 9.1 dB in the ears with the hole, and by 15.5 +/- 7.2 dB in the opposite ear without the hole (significant difference, p < 0.003). In the four control ears, ABR threshold was not elevated a week after drilling the hole.
Acta oto-laryngologica 12/2009; 130(6):659-64. · 0.98 Impact Factor
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The Laryngoscope 10/2009; 109(5):844 - 844. · 1.75 Impact Factor
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ABSTRACT: The aim of this study was to determine the trends in otorhinolaryngological (ORL) publications from 1993 to 2007.
In order to retrieve as many ORL-related articles as possible we used two strategies of literature analysis. Both were based upon ORL Medline articles from 1/1/1993 to 31/12/2007. In the first strategy, we attempted to retrieve as many ORL articles as possible from all Medline recorded journals (ORL-specific and non-ORL-specific journals indiscriminately); we thus used the key words: "otorhinolaryngology or ears or nose or throat". In the second strategy, we attempted to retrieve ORL-related articles in ORL-specific journals only; we thus evaluated all Medline articles from 1/1/1993 to 31/12/2007 from all 83 ORL journals reviewed by Medline. In both strategies we limited the search to "all adults" (i.e. adult ORL) and "all children" (i.e. pediatric ORL). We repeated the search by each time using one limit according to publication types as classified by the Medline, and collected the total number of publications per year for the 15 years of the specified period. We used regression analysis to determine the effect of year of publication upon the number of publications of each type.
Using either strategy, there was a steady increase over time both in pediatric and adult ORL in total publications, with a sharper rise in the number of adult publications. Both strategies led to very similar findings, to a few exceptions. There might be a shift of ORL publications toward ORL-specific journals.
New medical information available to ORL specialists increases over time, increasing academic burden. The field of pediatric ORL has had a significant yearly increase of published studies but not to the same extent as the field of adult ORL.
International journal of pediatric otorhinolaryngology 09/2009; 73(12):1737-41. · 0.85 Impact Factor
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ABSTRACT: Acute mastoiditis (AM) is the most common intratemporal complication of acute otitis media in children. In the past decade, reports have indicated a rise in the incidence of AM in the pediatric population. A parallel rise in the use of computed tomography (CT) imaging has occurred. The rise in the use of CT scanning in the pediatric population, entraining with it a rise in pediatric brain irradiation, has led us to question the necessity of using CT for pediatric patients with AM.
We reviewed the medical files of pediatric patients who had AM in the years 2005 through 2007.
Fifty patients were identified. The gender distribution was equal, and the ages ranged from 4 months to 12 years. Of the 46 patients who were admitted to our institution "de novo," only 2 underwent CT scanning on admission, and 4 other patients had CT performed during hospitalization. The majority of patients (92%) with AM did not have a CT scan performed and were treated conservatively with no complications.
In most pediatric patients, CT does not seem to be indispensable in the diagnosis of AM. Conservative therapy and close follow-up seem to suffice for most.
The Annals of otology, rhinology, and laryngology 08/2009; 118(8):565-9. · 1.05 Impact Factor
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ABSTRACT: The aim of this study is to review the outcome of pediatric patients suffering from acute mastoiditis treated conservatively and to correlate this to the evolution of our understanding of the shift in which mastoiditis has been transformed from a surgical to a medial disease.
We performed a retrospective review patient files hospitalized in our tertiary-care center between 2005-2008. We examined the data concerning the infection which included: presenting signs/symptoms, prior otologic history, treatment (including both surgical and conservative) prior to hospitalization and during hospitalization, computed tomography (CT), hospital duration, complications and overall outcome. This data was analyzed and compared between different patients who underwent different treatment strategies.
Fifty-one patients were included in this retrospective review. Initially, forty-nine patients admitted to our hospital were treated conservatively. This treatment included intra-venous antibiotics, myringtomy and if needed subperiosteal abscess incision and drainage. Only 2 patients underwent CT scanning on admission. Further on, during hospitalization 4 additional patients underwent CT scanning due to continued fever or progression of local disease. All four CT scans showed no intra-cerebral complications, and so all continued with conservative treatment.
Most cases of acute mastoidits may be treated with a conservative therapy regime. This regime, in our opinion, should include three branches: the first intravenous antibiotic therapy using a broad spectrum antibiotic. The second is myringotomy and the third branch is incision and drainage of subperiosteal abscess when needed.
American journal of otolaryngology 08/2009; 31(6):467-71. · 0.77 Impact Factor
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Ear and hearing 03/2009; 30(1):147-8; author reply 148-9. · 2.06 Impact Factor
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Ear and Hearing 01/2009; 30(1):147-148. · 2.58 Impact Factor
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ABSTRACT: To assess the effects of occluding the round window on the degree of hearing loss following exposure to broad band noise.
Following opening of the middle ear bulla in both ears of ten sand rats, auditory nerve-brainstem evoked response (ABR) thresholds were determined in each ear separately using an insert earphone. The round window of one ear was then occluded with super-glue. The opposite ear was sham-operated. ABR thresholds were again assessed immediately. The animals were then exposed to 113 dB SPL broad band noise for 12 hours. 24 hours after the round window was occluded, which was 8-10 hours after the end of the noise exposure, ABR thresholds were again determined in each ear. In four control animals, the round window was blocked, but they were not exposed to noise.
Following the noise exposure, the mean ABR threshold elevation in the round window blocked ears (54.5 +/- 5.5 dB) was significantly (p < 0.004) greater than that in the sham-operated ear (40.5 +/- 8.6 dB). In the four control ears, there was no change in ABR threshold 24 hours after the round window was occluded.
Occluding the round window was not accompanied by a threshold elevation, but following noise exposure, the noise induced hearing loss was increased, probably by reducing the efficacy of an inherent protective mechanical mechanism.
Journal of basic and clinical physiology and pharmacology 01/2009; 20(3):197-205.
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Surgical Clinics of North America 05/2006; 86(2):383-92, ix. · 2.14 Impact Factor
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ABSTRACT: Halofuginone is a low-molecular weight quinazolinone alkaloid coccidiostat that inhibits collagen type I synthesis, extracellular matrix deposition, and angiogenesis. This study was conducted to assess its potential in preventing subglottic stenosis (SGS).
We induced SGS in 10 dogs randomly divided into 2 groups. Each group received treatment between 3 days before and 21 days after the induction of SGS. One group received oral halofuginone 40 microg/kg, and the other was given placebo. The area of the subglottic lumen was measured at baseline and 3 months later. In addition, human tracheal fibroblasts were cultured. The inhibitory effect of halofuginone was compared to the effect of mitomycin.
All dogs survived throughout the study with no side effects. Three months after the operation, no halofuginone-treated dog had SGS, in contrast to a 66% to 80% stenosis rate (mean, 72%) in controls (p < .008). Thick fibrotic tissue was found in the placebo-treated larynges, whereas an almost normal architecture was observed in halofuginone-treated larynges. Halofuginone inhibited the growth of human tracheal fibroblasts by 75%, in comparison with 60% inhibition by mitomycin (no statistically significant difference).
This preliminary study shows that halofuginone is effective in preventing SGS caused by an acute injury. Halofuginone has a potential therapeutic role in preventing SGS in humans.
The Annals of otology, rhinology, and laryngology 05/2006; 115(5):382-6. · 1.05 Impact Factor
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ABSTRACT: Our intent was to review the clinical signs, computed tomography (CT) scans, treatment, and outcome of parapharyngeal space infections (PPIs), and to define 2 types of infections of the parapharyngeal space (PPS) according to the location of the infectious process.
We performed a retrospective analysis of patients hospitalized in a tertiary university hospital with a diagnosis of PPI, abscess, or deep neck abscess between 1988 and 2004. Files and CT scans were reviewed after classification into 2 groups: 1) infection located in the posterior part of the PPS (PostPPI); and 2) infection located in the anterior part of the PPS (AntPPI).
Twenty-two patients had a PostPPI; their ages ranged from 10 months to 24 years. Five patients underwent surgical drainage, and 17 others were treated solely with intravenous antibiotic therapy. No pus was found during surgery in 2 patients. The average time of hospitalization was 10 days. Only 1 complication (aspiration pneumonia) was observed. Seven patients had an AntPPI; their ages ranged from 1.5 years to 65 years. All patients underwent surgical drainage, and pus was detected in all cases. The average time of hospitalization was 35 days. Complications (septic shock, respiratory arrest, mediastinitis, pleural empyema, pericarditis) were observed in 4 patients.
The term "parapharyngeal abscess" was assigned long before the CT scan era, and was based on physical examination and plain film radiology. In essence, the entity PPS "abscess" or "infection" is composed of 2 different disorders. Infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and with no extension into other cervical spaces except the adjacent retropharyngeal space may be termed posterior parapharyngeal infection or parapharyngeal lymphadenitis. This is a relatively benign condition, and nonsurgical treatment should be considered. Infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. Urgent surgical drainage is therefore mandatory.
The Annals of otology, rhinology, and laryngology 03/2006; 115(2):117-23. · 1.05 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the routine use of packing or local hemostatic agents in endoscopic sinus surgery (ESS).
Packing and/or hemostatic agents were used only when necessary in 100 consecutive adult ESS patients in a tertiary academic hospital. Necessity for packing the nose after excessive bleeding was analyzed in relation to demographic characteristics, medical history, previous surgeries, current surgical procedure, type of anesthesia, and amount of intraoperative bleeding.
Three patients who required packing because of other reasons (such as bolstering of mucosa) were excluded from the study. The remaining 97 patients included 61 males and 36 females between the ages of 16 to 86 (mean 44). Forty-nine patients underwent only ESS, 40 ESSs associated with nasal polypectomy, and 8 underwent other endoscopic procedures. Fifty-four underwent the operation under general anesthesia and 43 under local anesthesia. Intraoperative blood loss was less than 30 mL in 82 patients (85%), 30 to 50 mL in 11 (11%), and more than 50 mL in 4 (4%). In 89 patients (92%), packing or a hemostatic agent was not used. No patient had bleeding complications postoperatively. A comparison between patients who required packing to those who did not showed that the only statistically significant associations related to general anesthesia (P = 0.0082) and to the amount of intraoperative bleeding (P < 0.001).
Most ESS procedures can be managed without packing or any other hemostatic measures. Local anesthesia, use of local vasoconstrictors, and careful operative technique minimize the need for nose packing, thus reducing patient's discomfort, postoperative complications, and cost of surgery.
Otolaryngology Head and Neck Surgery 02/2006; 134(2):276-9. · 1.72 Impact Factor
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ABSTRACT: Oto-acoustic emissions (OAEs) are low intensity sounds which can be recorded in the external ear canal with a sensitive microphone. They are initiated by the activated motility of the outer hair cells which provide mechanical feedback (the cochlear amplifier) to the basilar membrane, enhancing its displacement. Therefore it has been thought that the OAEs are propagated toward the base as a backward mechanical traveling wave along the basilar membrane. Such a wave would be accompanied by pressure differences across the cochlear partition in the closed cochlear system, filled with incompressible fluid. In order to test this OAE propagation mechanism, holes were made in several places in the bony wall of the inner ear, reducing such possible pressure differences. In experiments in which it was possible to avoid damage to the organ of Corti, there was no change in detection thresholds of distortion product OAEs. This result provides further support for the suggestion that oto-acoustic emissions are not propagated as mechanical vibrations backward along the basilar membrane. Instead it is more likely that they are transmitted through the cochlear fluids to the stapes footplate as alternating condensation/ rarefaction fluid pressures.
Journal of basic and clinical physiology and pharmacology 02/2006; 17(3):143-57.
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ABSTRACT: The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls.
The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS).
The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics.
Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 12/2005; 100(5):539-44. · 1.50 Impact Factor
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Otolaryngology Head and Neck Surgery 08/2005; 133(1):166-7. · 1.72 Impact Factor
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ABSTRACT: This manuscript reports on our experience with purulent chondritis of the laryngeal cartilages (PCLC), an entity that has not yet been described. Three patients had a diagnosis of PCLC. The probable causes were relapsing polychondritis, a previous prolonged intubation, and an idiopathic cause. The patients suffered from hoarseness and inspiratory stridor for 1 to 3 months before diagnosis. None complained of pain in the neck. Laryngoscopy showed supraglottic edema. A computed tomography scan revealed abscess formation between the intact inner and outer perichondria of the thyroid cartilage. The treatment included rigid endoscopy, external incision and drainage, and prolonged medical therapy. The culture results were Staphylococcus aureus in the first 2 cases and Aspergillus fumigatus in the third. The second patient (in whom the cricoid cartilage was also affected) required emergency tracheotomy. The other 2 patients did not require airway intervention. The rarity of PCLC and the relatively mild symptoms require a high index of suspicion for its diagnosis.
The Annals of otology, rhinology, and laryngology 04/2005; 114(3):219-22. · 1.05 Impact Factor
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ABSTRACT: In order to assess the mechanisms of cochlear activation, the cochlear fluids of one cochlea of a guinea-pig (I) were coupled to those of a cochlea of a second guinea-pig (II) by means of a saline-filled narrow bore tube, the ends of which were placed in the fluids around the opened round windows of both cochleae, thus joining the two cochleae from two different animals into a single, larger, unsealed fluid system. In response to air-conducted sound stimulation of cochlea I, auditory nerve-brainstem evoked responses could be recorded in animal II, not only when the coupling tube was filled with saline, but also when it was filled with ultrasound gel (viscosity 100,000 greater than that of water), when there was a very large hole encompassing a relatively large expanse of the cochlear shell of animal I, and even when animal I was no longer alive. The necessary control experiments were performed. Therefore, it is suggested that at low stimulus intensities, the passive, incoming basilar membrane traveling wave may not activate the cochlea. Instead the fluid pressures (condensation/rarefactions) induced in the cochlear fluids by vibrations of the stapes footplate may be adequate to directly activate the outer hair cells, which then generate an active component of basilar membrane displacement.
Journal of basic and clinical physiology and pharmacology 02/2005; 16(2-3):81-99.
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ABSTRACT: To delineate a technique that avoids the complications associated with surgical closure of long-term or permanent tracheostomy (LTT). Study design A case series that describes the technique and clinical outcomes.
Thirty-seven of 300 patients with a previously established LTT underwent primary surgical closure of their stoma after their underlying disease had been resolved. The surgical technique combined a turnover flap with medialization of fibroadipose tissue, followed by additional closure with an advancement skin flap.
After a mean follow-up of 3.2 years, no patient developed major complications. Four patients developed minor complications, which responded to conservative treatment. In all patients, the functional results were satisfactory, as were the cosmetic results, with the exception of 1 case. None required re-tracheostomy.
This simple and reliable new surgical technique for closing LTT avoids the potential failures and complications encountered in previously published procedures.
Otolaryngology Head and Neck Surgery 02/2005; 132(1):115-8. · 1.72 Impact Factor
