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Sudden sensorineural hearing loss in human monocytic ehrlichiosis

August 24, 2017  |  Vidur Bhalla, MD; Brian Rodgers, MD; James Lin, MD

Abstract

The hallmarks of symptomatic human monocytic ehrlichiosis (HME) include fever, headache, myalgia, nausea, malaise, transaminitis, and blood cell abnormalities. Previous case reports have described isolated cranial nerve palsies in infected patients but not hearing loss. We describe the onset of sudden sensorineural hearing loss in 2 patients with HME-a 31-year-old woman and an 82-year-old woman. The older patient experienced objective and subjective improvement in her hearing after treatment with an antibiotic and steroid taper; the younger patient was lost to audiologic follow-up. Additionally, we discuss the possible mechanisms of the hearing loss in these patients.

Assessment of discrimination ability in ipsilateral and contralateral ears with a unilateral bone-anchored hearing system

August 24, 2017  |  Bahtiyar Celikgun, MSc; M. Tayyar Kalcioglu, MD

Abstract

This study aimed to determine the speech discriminatory ability of the contralateral ear of users of a unilateral bone-anchored hearing system (BAHS). The Oticon Medical Ponto Pro/Ponto Pro Power device brand was used for all patients. Five BAHS users (3 men, 2 women) participated in the study. Pure-tone air-conduction thresholds at 250 to 6,000 Hz, masked and unmasked bone-conduction thresholds at 250 to 4,000 Hz, and participants' speech discrimination scores in both ears were determined. Speech discrimination tests were carried out in a silent environment with monosyllabic and trisyllabic word lists. After this, the ipsilateral ear (the BAHS side) was masked with wide-band noise using an insert earphone, and the word tests were repeated. A mild decrease was observed in monosyllabic words in ipsilateral masking; however, this was not found to be statistically significant. Conversely, a decrease was not observed in the repetition of trisyllabic words in any participants, even under high-level ipsilateral masking. These results suggested that unilateral BAHS application could prevent or reduce the neural deprivation of the contralateral ear.

Neonatal nasal septal deviation: Two cases of successful early surgical intervention

August 24, 2017  |  Claire M. Lawlor, MD; Maria Grant, MD; Joshua Levy, MD, MPH; Ashwin Ananth, MD, MBA; J. Lindhe Guarisco, MD

Abstract

Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature. Some authors advocate conservative observation, but no consensus on management has been reached. We present 2 cases of neonatal septal deviation that occurred during difficult deliveries. We repaired the defects with closed reduction in the operating room within the first 2 weeks of life to good effect.

Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena

August 24, 2017  |  Juan Luis Quesada, MD; Giovanni Cammaroto, MD; Lilla Bonanno, PhD; Francesco Galletti, MD; Pedro Quesada, MD

Abstract

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients-23 men and 15 women, aged 23 to 71 years (mean: 47)-who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

Prospective, randomized, controlled trial using best-selling smoking-cessation book

July 18, 2017  |  James P. Foshee, MD; Anita Oh, MD; Adam Luginbuhl, MD; Joseph Curry, MD; William Keane, MD; David Cognetti, MD

Abstract

Our prospective, randomized, controlled trial aimed to evaluate the efficacy of the self-help book, The Easy Way to Stop Smoking, by Allen Carr, in promoting smoking cessation in patients with head and neck cancer. We assessed active smokers for their willingness to read a smoking cessation book. Participants were randomized to either receive the book from our department or recommended to purchase the book. All patients received smoking cessation counseling at recruitment. Phone surveys were conducted at short- and long-term intervals to determine if the patients had purchased and/or read the book and whether they were still smoking. One hundred twelve patients were recruited, 52 of whom completed follow-up surveys. Those who received the book for free were more likely to read the book (p = 0.05). Reading the book did not correlate with successful smoking cessation (p = 0.81). Some 26% of the 27 patients who received the book quit smoking compared with 32% of the 25 patients who were recommended the book (p = 0.76). Patients who indicated motivation to quit smoking were more likely to succeed. In our study, smoking cessation did not appear to be influenced by reading The Easy Way to Stop Smoking. Despite 80.8% of the cohort indicating at least a readiness to quit smoking at recruitment, only 28.8% of patients managed to achieve successful smoking cessation at long-term follow-up. Patient motivation remains an important factor in achieving long-term smoking abstinence. Quitting smoking remains a daunting challenge for patients, with multiple interventions likely needed to achieve cessation.

The Sophono bone-conduction system: Surgical, audiologic, and quality-of-life outcomes

July 18, 2017  |  Timothy Mclean, MBBS; Irumee Pai, FRCS; Andrew Philipatos, BSc; Michael Gordon, FRACS

Abstract

We prospectively evaluated the surgical, audiologic, and quality-of-life outcomes in 5 patients-2 men and 3 women, aged 22 to 64 years (mean: 41.8)-who were implanted with the Sophono Alpha 2 MPO Processor. The indications for implantation of this bone-conduction device included recurrent ear canal infections with hearing aids (n = 3), single-sided deafness (n = 1), and patient preference in view of difficulty using a conventional hearing aid (n = 1). In addition to the patient with single-sided deafness, 3 patients had a bilateral mixed hearing loss and 1 had a bilateral conductive hearing loss. Outcomes measures included surgical complications, functional gain (FG), speech discrimination in quiet and noise, and patient satisfaction as determined by the Glasgow Benefit Inventory (GBI) and the Entific Medical Systems bone-anchored hearing aid questionnaire (BAQ). The only postsurgical complication noted was a minor skin reaction and pain in 1 patient that resolved with conservative management. In the 3 patients with the mixed hearing loss, the mean FG was 13.3, 20.0, 11.7, and 11.7 dB at 0.5, 1, 2, and 4 kHz, respectively; in the patient with the bilateral conductive hearing loss, the FG was 10, 25, 10, and 15 dB at the same frequencies. Speech discrimination scores with the Sophono device were comparable to those seen with conventional hearing aids. After implantation, all 5 patients experienced a positive quality-of-life outcome according to the GBI, although 1 of them had only a marginal improvement. On follow-up, all patients reported that they remained satisfied with their implant and that they used their device all day long. We conclude that the Sophono bone-conduction system is a safe and effective option that should be considered for patients with a mixed or conductive hearing loss who are unable to use a conventional hearing aid, as well as for those with single-sided deafness.

Cochlear implant electrode array exposure: A delayed complication

July 18, 2017  |  Christina Mishu, AuD; David A. Klodd, PhD; Miriam Redleaf, MD, FACS

Abstract

Exposure of the cochlear implant electrode array as a late complication has been reported rarely in the literature. A retrospective analysis revealed 4 patients presenting with exposure of their cochlear implant electrode arrays from 2 to 17 years after implantation. Data collected from these 4 patients were surgical implantation approach, type of implant, age at implant, interval between implant and complication, surgical correction of the problem, pathology at the time of correction, and length of follow-up after intervention. All 4 patients presented with otitis or mastoiditis. Each had undergone a transmastoid approach with facial recess and cochleostomy and full implant insertion. In 3 cases, the tympanic membrane had retracted to expose the electrode array. In 1 patient, the electrode array had eroded through the external canal, lateral to the facial recess. The exposed arrays were addressed surgically, including explantation/reimplantation for 1 patient. Cochlear implant electrode arrays can become exposed by relative migration of the array and the tympanic membrane. Implant surgeons and audiologists need to be aware of the possibility of this complication. Closure of the ear canal appears to be the most effective surgical intervention.

Thyrocervical trunk pseudoaneurysm presenting as a neck mass

July 18, 2017  |  Taha A. Mur, BS; Mursalin M. Anis, MD, PhD; Ahmed M. Soliman, MD

The typical “yin-yang” appearance of a pseudoaneurysm on ultrasound is readily identified.

An embedded earring backing in the tragus

July 18, 2017  |  Ta-Chin Wang, MD; Kai-Chieh Chan, MD

If signs of infection occur, the earring(s) should be removed and antiseptics or antibiotics applied.

Choanal polyp originating from the superior meatus: An endoscopic view

July 18, 2017  |  Jae Hoon Lee, MD

In most cases, a choanal polyp is identified as an ipsilateral polypoid mass on endoscopy. Therefore, the main symptom of CP is unilateral nasal obstruction.

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