Faculty Bibliography

This study examined the interaction between polarity and electrode-activation order on loudness in cochlear implant users. Pulses were presented with the polarity of the leading phase alternating or constant across channels. Electrode-activation order was either consecutive or staggered. Staggered electrode-activation orders required less current for equal loudness than consecutive orders with constant polarity. Consecutive electrode-activation orders required less current than staggered orders with alternating polarity. The results support the hypothesis that crosstalk between channels can interfere with or facilitate neuronal activation depending on polarity.

OBJECTIVES/OBJECTIVE:(1) Identify laryngeal patterns axiomatic to exercise-induced laryngeal obstruction (EILO) and (2) investigate the role of autonomic function in EILO. METHODS:Twenty-seven athletic adolescents (13 EILO, 14 control) underwent laryngoscopy at rest and exercise. Glottal configurations, supraglottic dynamics, systolic blood pressure responses, and heart rate recovery were compared between conditions and groups. RESULTS:Inspiratory glottal angles were smaller in the EILO group than the control group with exercise. However, group differences were not statistically significant ( P > .05), likely due to high variability of laryngeal responses in the EILO group. Expiratory glottal patterns showed statistically greater abductory responses to exercise in the control group ( P = .001) but not the EILO group ( P > .05). Arytenoid prolapse occurred variably in both groups. Systolic blood pressure responses to exercise were higher in the control group, and heart rate recovery was faster in the EILO group. However, no significant differences were seen between the 2 groups on either autonomic parameter ( P > .05). CONCLUSIONS:"Paradoxical" inspiratory and blunted expiratory vocal fold pattern responses to exercise best characterize EILO. Group differences were only seen with exercise challenge, thus highlighting the utility of provocation and control groups to identify EILO.

BACKGROUND AND PURPOSE/OBJECTIVE:Few studies have shown MR imaging features and ADC correlating with molecular markers and survival in patients with glioma. Our purpose was to correlate MR imaging features and ADC with molecular subtyping and survival in adult diffuse gliomas. MATERIALS AND METHODS/METHODS:promoter methylation, and overall survival. RESULTS:wild-type glioma. Other MR imaging features were not statistically significant predictors of survival. CONCLUSIONS:wild-type gliomas.

BACKGROUND:Quality improvement (QI) in the management of chronic rhinosinusitis (CRS) is garnering increasing attention. Defining frameworks and metrics to assess the quality of key components in CRS management could assist in reducing unwarranted practice variation and increase high-quality care. METHODS:A panel of the American Rhinologic Society (ARS) QI committee reviewed the literature to determine important presurgical components of CRS care that warrant QI. The evidence was organized into 4 categories: (1) diagnosis, (2) medical management, (3) appropriate patient selection for surgery, and (4) patient-centered discussion. The combination of these categories was used to develop a framework termed the CRS Appropriate Presurgical Algorithm (CAPA). RESULTS:Prior to offering surgery for CRS, the best available evidence support the following quality metrics: (1) a guideline-based diagnosis should be confirmed; (2) appropriate medical management, including a minimum of topical corticosteroid therapy and saline irrigations, should have been attempted (assuming patient tolerance); (3) a computed tomography (CT) scan should be obtained (to confirm the presence of sinus inflammation and for surgical planning); and (4) a patient-centered discussion regarding treatment options for refractory CRS (ie, alternative medical therapies vs surgery vs observation) while focusing on risks and benefits, the need for long-term medical compliance, and understanding of patient preferences and expectations. CONCLUSION/CONCLUSIONS:Defining metrics that assess key components to CRS care prior to offering surgery has the potential to further improve upon an already successful treatment paradigm, reduce unwarranted practice variation, and to ensure that patients are receiving a similar level of high-quality care.

OBJECTIVE:To assess auditory brainstem implant (ABI) outcomes in children with a prospective study. METHODS:Twelve patients with cochlear nerve deficiency received an auditory brainstem implant. Patients were evaluated with age appropriate speech perception and production assessments, and health related quality of life (HRQoL) surveys for parents of subjects and for subjects if age appropriate. RESULTS:Twelve patients received an ABI without major complications. Eleven out of twelve received some auditory benefit from their ABI. Parental HRQoL ratings were positive for all domains with the exception of communication. Self reported overall HRQoL metrics from two subjects were also positive. CONCLUSIONS:ABI is a good option for patients who are not eligible for or fail CI. Our findings show that despite varying degrees of postoperative performance, HRQoL ratings were positive. The presence of additional disabilities and health problems resulted in less positive HRQoL outcomes. Our results emphasize the need to assess outcomes in these patients beyond speech perception and communication.

Introduction Photobiomodulation (PBM Therapy) formerly known as Low Level Laser Therapy (LLLT) is an effective treatment for reducing the incidence and severity of oral mucositis (OM) after high dose chemotherapy and/or radiotherapy. However, reported PBM irradiation parameters, dose per point, number of treatment points or treatment intervals vary widely Objectives To systematically review randomized clinical trials (RCTs), summarise the PBM parameters and detain the most effective treatment regimen. Methods Online databases were searched for RCTs comparing efficacy of PBM verses controls for prevention or treatment cancer therapy induced OM. Papers were scored for quality and effect size for the primary outcome, irradiation parameters and dose were compared with outcomes. Results There was lots of mistakes and missing treatment data (i.e. laser wavelength ranges, power, beam sizes, energy applied and treatment duration) on the reported data, however the majority of the randomized clinical trials reported positive effects: PBM reduced pain, onset of OM, and improved overall quality of life of the patients that received PBM. Conclusions Although no precise conclusion can be drawn due to a large variation on the reported data, PBM used for OM confidently recommend an optimal treatment guideline for this condition

AIM/OBJECTIVE:Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS:Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS:28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS:Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.

BACKGROUND:The purpose of this study was to investigate the association between isolated serous otitis media (SOM) and/or conductive hearing loss (CHL) and nasopharyngeal carcinoma (NPC) in a low-to-intermediate endemic area. METHODS:Medical records of all adult patients (≥17 years) with SOM/CHL who underwent endoscopic-guided nasopharyngeal biopsy to exclude NPC during a 10-year period were reviewed. Statistical analyses were conducted to identify significant predictors for NPC. RESULTS:A total of 195 patients were included (121/195; 62.1% men), among whom 169 (86.7%) presented with isolated SOM/CHL. Overall, 12 patients were diagnosed with NPC (12/195; 6.2%), however, only 1 patient (1/169; 0.6%) had isolated SOM/CHL. Coexisting clinical manifestations and suspicious nasopharyngeal findings on fiber-optic nasopharyngoscopy were found to be significant predictors for NPC on univariate and multivariate analyses (P < .05). CONCLUSION/CONCLUSIONS:Patients with isolated SOM/CHL and without coexisting clinical manifestations or suspicious findings on nasopharyngoscopy may avoid a routine nasopharyngeal biopsy.