B E Hirsch

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (102)183.74 Total impact

  • Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 11/2014; 151(5):890-1.
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    ABSTRACT: Objectives/HypothesisThe eustachian tube (ET) is an important landmark in skull base surgery, which has a close relationship with the petrous segment of the internal carotid artery (ICA). The goal of the current study was to establish the detailed anatomic relationship of the ET and petrous segment of the ICA.Study DesignAnatomical study.Methods Six silicon-injected adult cadaveric heads (12 sides) were dissected using a lateral infratemporal fossa approach (type C) and endoscopic endonasal approach. The ET and ICA were exposed; their detailed relationships were demonstrated. High-quality pictures were obtained.ResultsIn the anterior genu/foramen lacerum segment of the ICA, the vidian nerve was an important landmark. The cartilaginous ET was divided into four segments, from anterior to posterior: nasopharyngeal, pterygoid, lacerum, and petrosal segment. The anterior and inferior wall of the carotid canal was consistently between the horizontal ICA and petrous segment of the cartilaginous ET. In the posterior genu of the ICA, the bony part of the ET, and the tendon of the tensor tympani muscle were paramount landmarks. The posterior genu of the ICA was imbedded in the carotid canal. The landmarks of the junction of the cartilaginous ET and bony ET were the sphenoid spine and foramen spinosum.Conclusions The anatomical segmentation of the ET provides the basis for safe and effective transection of the ET in skull base surgery. An understanding of the complex relationships of the ET and petrous segment of the ICA is paramount for surgically dealing with disease located within the region of the ET and petrous segment of the ICA.Level of EvidenceNA Laryngoscope, 2014
    The Laryngoscope 10/2014; · 1.98 Impact Factor
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    ABSTRACT: Malignant otitis externa (MOE) is an invasive infection of the temporal bone that is classically caused by Pseudomonas aeruginosa. Increasingly, however, nonpseudomonal cases are being reported. The goal of this study was to evaluate and compare the clinical presentation and outcomes of cases of MOE caused by Pseudomonas versus non-Pseudomonas organisms. Retrospective case series with chart review. Tertiary care institution. Adult patients with diagnoses of MOE between 1995 and 2012 were identified. Charts were reviewed for history, clinical presentation, laboratory data, treatment, and outcomes. Twenty patients diagnosed with and treated for MOE at the University of Pittsburgh Medical Center between 1995 and 2012 were identified. Nine patients (45%) had cultures that grew P aeruginosa. Three patients (15%) had cultures that grew methicillin-resistant Staphylococcus aureus (MRSA). Signs and symptoms at presentation were similar across groups. However, all of the patients with Pseudomonas had diabetes, compared with 33% of MRSA-infected patients (P = .046) and 55% of all non-Pseudomonas-infected patients (P = .04). Patients infected with MRSA were treated for an average total of 4.7 more weeks of antibiotic therapy than Pseudomonas-infected patients (P = .10). Overall, patients with non-Pseudomonas infections were treated for a total of 2.4 more weeks than Pseudomonas-infected patients (P = .25). A high index of suspicion for nonpseudomonal organisms should be maintained in patients with signs and symptoms of MOE, especially in those without diabetes. MRSA is an increasingly implicated organism in MOE.
    Otolaryngology Head and Neck Surgery 03/2014; · 1.73 Impact Factor
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    ABSTRACT: To assess intracranial pressure (ICP), body mass index (BMI), surgical repair, and cerebrospinal fluid (CSF) diversion in patients presenting with spontaneous CSF otorrhea. Retrospective series review. Tertiary referral center. Thirty-two patients were treated surgically from 2004 to 2013 for spontaneous CSF otorrhea by the principal investigators. Patients with a history of chronic ear disease and cholesteatoma, previous mastoid surgery, head trauma, or iatrogenic injury were excluded. Average age was 56 years. Twenty-two patients (69%) were female. Middle fossa repair, transmastoid repair, lumbar puncture, V-P shunt, L-P shunt, and magnetic resonance imaging. Patients underwent middle fossa or transmastoid repair of tegmen defects. Intracranial pressures were determined with lumbar puncture at time of surgical repair or shortly after surgery. CSF diversion procedures were performed in patients who were found to have elevated ICP, which was not controlled medically, presented with recurrent leak or had ICP of 25 cm or greater of H2O. Preoperative BMI was calculated. Thirty-two patients underwent 37 operations. Average BMI was 35.0 kg/m (median, 34.7; range, 18.7-53.2 kg/m). There were 21 repairs on the left and 16 on the right. The majority underwent a middle fossa craniotomy for repair (27/32). Two patients had bilateral repairs. Three patients (8%) underwent revision surgery, of which, 2 had untreated intracranial hypertension (ICP 24.5 and 24 cm H2O). ICP measurements were available for 29 patients. The mean ICP was 23.4 cm H2O (median, 24; range, 13-36 cm H20). Twenty-two patients (69%) had ICP of 20 cm or greater of H20; of those, 13 had an ICP of 25 cm or greater of H20. Seventeen patients (53%) underwent CSF diversion procedures. Our findings of elevated ICP and BMI in patients presenting with spontaneous CSF otorrhea are consistent with previous reports in the literature. The percentage of patients that underwent CSF diversion procedures was high at 53% and represents an aggressive stance in managing elevated ICP in a population that may be at risk for subsequent leaks.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 02/2014; 35(2):344-7. · 1.44 Impact Factor
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    ABSTRACT: To evaluate tumor control, hearing, tinnitus, and balance outcomes of patients treated with CyberKnife (CK) radiosurgery for vestibular schwannoma (VS). Retrospective series review. Tertiary referral center. All patients treated with CK radiosurgery for vestibular schwannoma by a multidisciplinary radiosurgical team from August 2005 to November 2011. The median age was 59 years, and mean follow-up was 40 months. Seventy-three patients were treated (63 primary radiosurgery and 10 postsurgical). CK radiosurgery, serial MRI imaging, comprehensive audiometry, Tinnitus Handicap Inventory (THI) scores, and Activities-Specific Balance Confidence Scale (ABC). Tumor control defined as 2 mm linear growth or lower or less than 20% increase in tumor volume (TV), measured in cubic centimeter, after a minimum of 12 months of monitoring, audiogram profiles, THI, and ABC surveys. Of those treated with CK as primary modality, 83% had 0- to 2-mm growth (tumor control or stable) and 17% grew greater than 2 mm. Of the tumors that were stable, 29% shrank 2 mm or greater. Volumetric analysis found that 74% of tumors had less than 20% TV growth, whereas 26% exhibited 20% or greater increase in TV. Of those deemed stable, 65% shrank 20% or greater TV; 95% of patients did not need additional surgical intervention, 3 required salvage surgery and 1 underwent additional radiosurgery. The majority of patients started with Class D hearing, but of those with Class A or B hearing before treatment, 53.5% maintained serviceable hearing at 3 years of follow-up. The pretreatment and posttreatment median THI Grades were both 1. The pretreatment and posttreatment ABC scores were unchanged at 81%. The LINAC-based CK (18 Gy over 3 fractions at 80% isodose line) provides tumor control rates comparable to other forms of radiosurgery. Analysis for tumor growth was positive for 17% using maximum linear diameters and 26% with a volumetric workstation. This discrepancy is consistent with previous reports where volumetric models were found to be more sensitive in establishing growth. Serviceable hearing was comparable to previous SRS and SRT reports with an overall hearing preservation of 53.5%. This number was 77% in those with pre-Class A hearing. SRS did not affect pretreatment tinnitus or vestibular function.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 01/2014; 35(1):162-170. · 1.44 Impact Factor
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    ABSTRACT: Objective(1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). (2) Determine the relative acoustic and mechanical outputs of 512-Hz tuning forks made of aluminum and stainless steel.Study DesignProspective, observational.SettingOutpatient otology clinic.Subjects and Methods Fifty subjects presenting May 2011 to May 2012 with negative or equivocal Rinne in at least 1 ear and same-day audiometry. Rinne test results using aluminum and steel forks were compared and correlated with the audiometric air-bone gap. Bench top measurements using sound-level meter, microphone, and artificial mastoid.ResultsPatients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at a 19 dB air-bone gap for stainless steel versus 27 dB with aluminum. Bench top testing revealed that steel forks demonstrate, in effect, more comparable air and bone conduction efficiencies while aluminum forks have relatively lower bone conduction efficiency.Conclusion We have found that steel tuning forks can detect a lesser air-bone gap compared to aluminum tuning forks. This is substantiated by observations of clear differences in the relative acoustic versus mechanical outputs of steel and aluminum forks, reflecting underlying inevitable differences in acoustic versus mechanical impedances of these devices, and thus efficiency of coupling sound/vibratory energy to the auditory system. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.
    Otolaryngology Head and Neck Surgery 09/2013; · 1.73 Impact Factor
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    ABSTRACT: Object The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for hemifacial spasm (HFS). Methods Preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 94 patients who underwent MVD for HFS were analyzed. Pure tone audiometry at 0.25-2 kHz, 4 kHz, and 8 kHz was calculated for all individuals pre- and postoperatively ipsilateral and contralaterally. Intraoperative neurophysiological data were reviewed independently. An HFHL was defined as a change in pure tone audiometry of more than 10 dB at frequencies of 4 and 8 kHz. Results The incidence of HFHL was 50.00% and 25.53% ipsilateral and contralateral to the side of surgery, respectively. The incidence of HFHL adjusted for conductive and nonserviceable hearing loss was 26.6% ipsilaterally. The incidence of HFHL at 4 and 8 kHz on the ipsilateral side was 37.23% and 45.74%, respectively, and it was 10.64% and 25.53%, respectively, on the contralateral side. Maximal change in interpeak latency Waves I-V compared with baseline was the only variable significantly different between groups (p < 0.05). Sex, age, and side did not increase the risk of HFHL. Stepwise logistic regression analysis did not find any changes in intraoperative BAEPs to increase the risk of HFHL. Conclusions High-frequency hearing loss occurs in a significant number of patients following MVD surgery for HFS. Drill-induced noise and transient loss of CSF during surgery may impair hearing in the high-frequency ranges on both the ipsilateral and contralateral sides, with the ipsilateral side being more affected. Changes in intraoperative BAEPs during MVD for HFS were not useful in predicting HFHL. Follow-up studies and repeat audiological examinations may be helpful in evaluating the time course and prognosis of HFHL. Prospective studies focusing on decreasing intraoperative noise exposure, as well as auditory shielding devices, will establish causation and allow the team to intervene appropriately to decrease the risk of HFHL.
    Journal of Neurosurgery 02/2013; · 3.15 Impact Factor
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    ABSTRACT: The aim of this study was to investigate and compare the surgical anatomy of two different routes to access and drain petrous apex (PA) cholesterol granulomas: the expanded endonasal approach (EEA) and the transcanal infracochlear approach (TICA). Anatomic and radiologic study. The EEA and TICA to the PA were performed in 11 anatomic specimens with the assistance of imaging guidance. The PA was categorized into three zones: superior PA, anterior-inferior PA, and posterior-inferior PA. The maximum drainage window achieved by each approach was calculated using the imaging studies of each anatomic specimen. The EEA was able to reach superior PA and anterior-inferior PA in all specimens and posterior-inferior PA in 90%. The TICA did not provide access to superior PA in any case. The TICA was suitable to reach anterior-inferior PA in 80% of specimens and posterior-inferior PA in 60%. Based on the radiologic study, the EEA provided a drainage window three times larger than the TICA. The transnasal approach provides reliable access to the PA when combined with internal carotid artery exposure and allows for large drainage window. The transcanal approach is less versatile and more limited than the transnasal approach but provides access to the most posterior and inferior portion of the PA without Eustachian tube transection. Here we propose a new surgical classification that may help to decide the most suitable approach to the PA according to the location and extension of the lesion.
    The Laryngoscope 04/2012; 122(4):751-61. · 1.98 Impact Factor
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    ABSTRACT: Facial nerve microvascular decompression (MVD) for hemifacial spasm (HFS) provides relief to most patients. Due to the proximity of the cochlear and facial nerves, hearing loss is a potential MVD complication, however, there is a wide range in the reported incidence of hearing loss (HL) in the literature. In order to better understand the HL incidence in our MVD population, we utilized the combination of speech discrimination scores (SDS) and air and bone pure tone threshold averages (PTA) to identify patients with no hearing change, sensorineural hearing loss, or conductive hearing loss. We also assessed the predictive value of patient-reported hearing deficits on the ultimate audiometric diagnosis of hearing loss. One hundred and fifty one patients underwent facial nerve MVD at the University of Pittsburgh Medical Center between January 2000 and December 2007. Peri-operative audiometric data, including changes in air and bone pure tone thresholds and speech discrimination scores, were analyzed retrospectively. Criteria from the 1995 American Academy of Otolaryngology Committee on Hearing and Equilibrium consensus were used to analyze post-operative hearing loss. Patient-reported hearing disturbances obtained in the immediate post-operative period were compared to seven-day post-operative conductive and sensorineural HL status. Non-functional, non-serviceable HL (Class D) occurred in 6.6% of patients, while 10.6% developed cumulative non-functional HL (Class C and D). Twenty-nine patients (18.7%) exhibited conductive HL. While patient-reported complaints were predictive of Class C/D HL (<0.0001) with a 56.3% sensitivity and 92.6% specificity, patient-reported complaints were not strongly associated with conductive HL status (p = 0.369) with 17.2% sensitivity and 88.5% specificity. Perioperative hearing evaluations, in conjunction with careful scrutiny of patient complaints and air-bone pure tone testing enables the physician to more precisely quote complication rates and rapidly distinguish potentially reversible conductive hearing pathologies from permanent sensorineural disorders.
    Clinical neurology and neurosurgery 03/2012; 114(6):673-7. · 1.30 Impact Factor
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    ABSTRACT: To determine the current common practices and techniques used to fixate and stabilize internal receivers. Retrospective, anonymized, cross-sectional survey. William House Cochlear Implant Study Group Meeting in September 2008. A total of 62 surveys were received of the 106 people who had signed in. In adults, 83.3% of the respondents said that they always, 6.7% usually, 3.3% sometimes, 3.3% rarely, and 3.3% never drilled wells for the internal receiver. In pediatric patients, respondents said that they would always 78.6%, usually 8.9%, sometimes 3.6%, rarely 5.4%, and never 3.6% drill wells. Regarding the securing of the internal receiver, 56.1% always, 10.5% usually, 3.5% sometimes, 12.3% rarely, and 17.5% never secured the internal receiver in adults. In the pediatric patient population, 50% always, 12.5% usually, 7.1% sometimes, 12.5% usually, and 17.9% never secured the device. In adults, 50% reported using bone holes, 30% fascial sutures, and 20% screws. In the pediatric population, 45.5% indicated that they used bone holes, 34.5% fascial sutures, and 20% screws. Most respondents rarely or never drilled down to the dura for bone holes. Whereas the majority of respondents do drill wells for the internal receiver in both adults and children, those that did not were represented. The result of this survey emphasizes that alternatives are available and acceptable. There is no significant evidence in the literature to support 1 specific method of fixation.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2010; 31(8):1211-4. · 1.44 Impact Factor
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    ABSTRACT: Glomus jugulare tumors are rare, typically benign, tumors that arise from the neural crest cells that are associated with the autonomic ganglia in and around the jugular bulb. Treatment options for glomus jugulare tumors include embolization followed by resection, fractionated external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), and/or stereotactic body radiation therapy (SBRT). 18 patients were treated with linear-accelerator based stereotactic body radiation therapy (SBRT) between May 2002 and November 2008. Fifteen patients (83%) had single glomus jugulare tumors and 3 patients had bilateral glomus jugulare tumors (although each of these patients had a single tumor targeted). The median tumor volume was 5.83 cm(3) (range, 0.32-35.47 cm(3)). Ten tumors (56%) were previously untreated, and 8 (44%) tumors were persistent after previous surgical resection. One patient had undergone previous EBRT and 2 patients were previously treated with Gamma Knife radiosurgery to the intracranial portion of their tumor, with planned SBRT to the extracranial portion 2-4 months later at our institution. The median prescribed dose was 20 Gy in 3 fractions (range: 16-25 Gy in 1-5 fx) to the 80% isodose line. The median prescription coverage of the tumor was 93.6% (range: 83-98.72%). Median follow-up for the entire cohort was 22 months. All the patients were alive at the time of the last follow-up with imaging available for review. The tumor was stable in 17 patients and decreased in size in one patient--yielding a local control rate of 100%. No patients experienced any new or worsening treatment-related neurologic deficits. SBRT is a safe and efficacious treatment modality for glomus jugulare tumors.
    Radiotherapy and Oncology 10/2010; 97(3):395-8. · 4.52 Impact Factor
  • George S Conley, Barry E Hirsch
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    ABSTRACT: Stereotactic radiation treatment is an increasingly performed procedure for patients with vestibular schwannoma and other benign skull base tumors. During the past 30 years, advancements in stereotactic imaging, radiation delivery techniques, and dose planning have improved overall patient outcomes. The specific role of radiation in current management strategies for vestibular schwannoma continues to evolve as long-term outcome data are analyzed and standardized studies are performed. The recent literature regarding the indications, limitations, and outcomes for stereotactic radiation treatment is reviewed. Systematic reviews of the Gamma Knife literature demonstrate improved overall outcomes with radiation doses below 13 Gy. Observation of small vestibular schwannomas is recommended over early radiation or microsurgical intervention. Radiation may be used as adjunctive therapy for large tumors and in certain postradiation treatment failures. Stereotactic radiosurgery and fractionated radiotherapy are equally effective treatment modalities. Long-term outcome data will ultimately define future indications and limitations for the use of stereotactic radiation with benign skull base lesions. Current evidence supports its use for small to medium sized primary and recurrent vestibular schwannomas with optimal dosing below 13 Gy. It is also recommended for adjunctive therapy, recurrent tumors, in poor surgical candidates, and for those who do not desire observation or surgery.
    Current opinion in otolaryngology & head and neck surgery 10/2010; 18(5):351-6.
  • Jason C Fowler, Barry E Hirsch, Peter F White
    JAAPA: official journal of the American Academy of Physician Assistants 06/2010; 23(6):65.
  • Howard S Moskowitz, Ronald Jaffe, Barry E Hirsch
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    ABSTRACT: The differential diagnosis of middle ear masses encompasses a wide variety of pathologic conditions. In this report, we describe the case of a 6-year-old girl who presented with facial nerve weakness and was found to have a middle ear mass. The mass was excised, and final pathology revealed hemangioendothelioma. This report describes the youngest patient with this diagnosis presenting as a middle ear mass in the Western literature. This article provides this patient's presentation, imaging and histopathologic findings, and clinical course and reviews the current literature on this unique pathologic diagnosis.
    American journal of otolaryngology 05/2010; 32(3):259-62. · 0.77 Impact Factor
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    ABSTRACT: To summarize the current literature on the surgical management of cavernous malformations of the cerebellopontine angle in accordance with the experience at our institution. A systematic literature review on cavernous malformations of the cerebellopontine angle yielded 14 case reports relevant to the disease. In addition, the authors include their own report of a 16-year-old girl with such a lesion cured by surgical resection. The most common clinical signs associated with this tumor are hearing loss (86.7%), followed by facial paresis (53.8%). Symptoms may be rapidly progressive. Cavernous malformations range from isointense to hyperintense to brain on noncontrasted T1 magnetic resonance imaging. In general, outcomes for patients with this tumor are favorable, with most patients cured by surgical resection. One of the rarest lesions of the cerebellopontine angle is a cavernous malformation. An understanding of the clinical and radiographic differences between this lesion and a vestibular schwannoma helps to minimize perioperative morbidity. Surgical resection should be performed with special attention to preserving facial nerve function.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2009; 31(2):294-8. · 1.44 Impact Factor
  • Yu-Lan Mary Ying, Barry E Hirsch
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    ABSTRACT: Cogan's syndrome is a rare presumed autoimmune disorder characterized by nonsyphilitic interstitial keratitis and progressive audiovestibular symptoms. The initial report by David G. Cogan in 1945 was modified by Haynes et al in 1980 who proposed diagnostic criteria for patients with other ocular or vestibular symptoms and suggested this to be atypical Cogan's syndrome. In a more typical presentation of Cogan's syndrome, ocular and audiovestibular signs and symptoms usually appear alone and are bilateral. We report a case of 50-year-old woman with an atypical Cogan's syndrome manifested by unusual relatively rapid clinical deterioration.
    American journal of otolaryngology 06/2009; 31(4):279-82. · 0.77 Impact Factor
  • Noriko Yoshikawa, Barry E Hirsch
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    ABSTRACT: The purpose of this study is to present follow-up on a previously reported case of successful cochlear implantation in a patient with superficial siderosis. Retrospective case review. For the first 6 years after implantation, the patient had maintained a successful result; however, she developed a progressive decline in the benefit from her implant. Benefit from cochlear implants in patients with superficial siderosis is variable and may not be long standing.
    American journal of otolaryngology 06/2009; 31(5):390-1. · 0.77 Impact Factor
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    ABSTRACT: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear. This guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction. The primary purpose of this guideline is to improve diagnostic accuracy for cerumen impaction, promote appropriate intervention in patients with cerumen impaction, highlight the need for evaluation and intervention in special populations, promote appropriate therapeutic options with outcomes assessment, and improve counseling and education for prevention of cerumen impaction. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology-head and neck surgery, and pediatrics. The panel made a strong recommendation that 1) clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when warranted. The panel made recommendations that 1) clinicians should diagnose cerumen impaction when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both; 2) clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy; 3) the clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months, however, is not deemed necessary); 4) clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation; and 5) clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should prescribe additional treatment. If full or partial symptoms persist despite resolution of impaction, alternative diagnoses should be considered. The panel offered as an option that 1) clinicians may observe patients with nonimpacted cerumen that is asymptomatic and does not prevent the clinician from adequately assessing the patient when an evaluation is needed; 2) clinicians may distinguish and promptly evaluate the need for intervention in the patient who may not be able to express symptoms but presents with cerumen obstructing the ear canal; 3) the clinician may treat the patient with cerumen impaction with cerumenolytic agents, irrigation, or manual removal other than irrigation; and 4) clinicians may educate/counsel patients with cerumen impaction/excessive cerumen regarding control measures. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing cerumen impaction. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
    Otolaryngology Head and Neck Surgery 09/2008; 139(3 Suppl 2):S1-S21. · 1.73 Impact Factor
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    ABSTRACT: To describe the pattern and duration of high frequency sensorineural hearing loss after stapedectomy. Retrospective case series. Tertiary referral center. All patients who underwent stapedectomy by the senior author during the period between January 1, 1998, and October 1, 2005, with preoperative, 4- to 6-week postoperative, and at least 9-month postoperative audiograms were included. Fifty-three patients met the inclusion criteria, with surgeries performed on 61 ears. Stapedectomy was performed using a CO2 laser. Mean preoperative and postoperative pure-tone bone thresholds, mean preoperative and postoperative pure-tone air thresholds, and hearing outcomes for 4,000 Hz bone conduction (BC) and 8,000 Hz air conduction (AC) based on the patient's age and interval after the operative procedure. : Mean BC thresholds at 4,000 Hz BC worsened by 6 dB at 4 to 6 weeks and improved by 3 dB by 9 months. There was an 8-dB average loss at 8,000 Hz AC at 4 to 6 weeks with a gain of 4 dB by 9 months. Patients older than 40 years were 4 times more likely to experience early loss at 4,000 Hz BC when preoperative thresholds were held constant. The late outcome for hearing loss was dependent more on the preoperative threshold than was the age of the patient. At 8,000 Hz AC, the preoperative hearing threshold was a predictor of early and late hearing loss at 8,000 Hz. High-frequency sensorineural hearing loss is initially seen after stapes surgery, and improvement does occur over time. When preoperative hearing threshold is held constant, patients older than 40 years are more likely to experience short-term hearing loss at high frequencies than patients younger than 40 years. Age was not a predictor of postoperative high-frequency hearing loss in the long term.
    Ontology & Neurotology 06/2008; 29(4):447-52. · 2.01 Impact Factor
  • Rebecca E Fraioli, Barry E Hirsch, Amin B Kassam
    American Journal of Otolaryngology 03/2008; 29(2):135-7. · 1.23 Impact Factor

Publication Stats

995 Citations
183.74 Total Impact Points


  • 1988–2014
    • University of Pittsburgh
      • • Department of Otolaryngology
      • • Department of Radiology
      • • School of Medicine
      Pittsburgh, Pennsylvania, United States
  • 2008
    • University of Florida
      • Department of Otolaryngology
      Gainesville, FL, United States
  • 2000
    • Oregon Health and Science University
      Portland, Oregon, United States
  • 1996
    • Naval Medical Center Portsmouth
      Portsmouth, Virginia, United States