Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Otolaryngology
Total Results:
7602
International journal of pediatric otorhinolaryngology. 2017:101:158-163.DOI: 10.1016/j.ijporl.2017.08.007
The value of intraoperative EABRs in auditory brainstem implantation
OBJECTIVE: To compare the intraoperative electrically evoked auditory brainstem response (EABR) morphologies between neurofibromatosis II (NF2) adult auditory brainstem implant (ABI) recipients who had auditory percepts post-operatively and those who did not and between NF2 adult ABI recipients and non-NF2 pediatric ABI recipients. METHODS: This was a retrospective case series at a single tertiary academic referral center examining all ABI recipients from 1994 to 2016, which included 34 NF2 adults and 11 non-NF2 children. The morphologies of intraoperative EABRs were evaluated for the number of waveforms showing a response, the number of positive peaks in those responses, and the latencies of each of these peaks. RESULTS: 27/34 adult NF2 patients and 9/10 children had EABR waveforms. 20/27 (74.0%) of the adult patients and all of the children had ABI devices that stimulated post-operatively. When comparing the waveforms between adults who stimulated and those who did not stimulate, the proportion of total number of intraoperative EABR peaks to total possible peaks was significantly higher for the adults who stimulated than for those who did not (p < 0.05). Children had a significantly higher proportion of total number of peaks to total possible peaks when compared to adults who stimulated (p < 0.02). Additionally, there were more likely to be EABR responses at the initial stimulation than intraoperatively in the pediatric ABI population (p = 0.065). CONCLUSIONS: The value of intraoperative EABR tracing may lie in its ability to predict post-operative auditory percepts based on the placement of the array providing the highest number of total peaks.
PMID: 28964288
ISSN: 1872-8464
CID: 2719782
Effect of Stimulus Polarity on Physiological Spread of Excitation in Cochlear Implants
BACKGROUND:Contemporary cochlear implants (CIs) use cathodic-leading, symmetrical, biphasic current pulses, despite a growing body of evidence that suggests anodic-leading pulses may be more effective at stimulating the auditory system. However, since much of this research on humans has used pseudomonophasic pulses or biphasic pulses with unusually long interphase gaps, the effects of stimulus polarity are unclear for clinically relevant (i.e., symmetric biphasic) stimuli. PURPOSE/OBJECTIVE:The purpose of this study was to examine the effects of stimulus polarity on basic characteristics of physiological spread-of-excitation (SOE) measures obtained with the electrically evoked compound action potential (ECAP) in CI recipients using clinically relevant stimuli. RESEARCH DESIGN/METHODS:Using a within-subjects (repeated measures) design, we examined the differences in mean amplitude, peak electrode location, area under the curve, and spatial separation between SOE curves obtained with anodic- and cathodic-leading symmetrical, biphasic pulses. STUDY SAMPLE/METHODS:Fifteen CI recipients (ages 13-77) participated in this study. All were users of Cochlear Ltd. devices. DATA COLLECTION AND ANALYSIS/METHODS:SOE functions were obtained using the standard forward-masking artifact reduction method. Probe electrodes were 5-18, and they were stimulated at an 8 (of 10) loudness rating ("loud"). Outcome measures (mean amplitude, peak electrode location, curve area, and spatial separation) for each polarity were compared within subjects. RESULTS:Anodic-leading current pulses produced ECAPs with larger average amplitudes, greater curve area, and less spatial separation between SOE patterns compared with that for cathodic-leading pulses. There was no effect of polarity on peak electrode location. CONCLUSIONS:These results indicate that for equal current levels, the anodic-leading polarity produces broader excitation patterns compared with cathodic-leading pulses, which reduces the spatial separation between functions. This result is likely due to preferential stimulation of the central axon. Further research is needed to determine whether SOE patterns obtained with anodic-leading pulses better predict pitch discrimination.
PMCID:5657495
PMID: 28972468
ISSN: 2157-3107
CID: 3979412
Oropharyngeal lymphoma: A US population based analysis
OBJECTIVES:To describe the epidemiology and analyze factors determinant of survival in patients with oropharyngeal lymphoma, using the Surveillance Epidemiology and End Results (SEER) database. METHODS:2504 patients with oropharyngeal lymphoma were identified using the most recent SEER database entry from 1976 to 2016. Demographic information, Ann Arbor stage, tumor histopathology and location were collected. Multivariate analysis was used to analyze patient and tumor characteristics associated with survival. RESULTS:The mean age of the patients studied was 60.5years, 58.4% of the subjects were male and 81% were white. Diffuse large B cell lymphoma (DLBCL) was the most common histologic subtype involving 56.9% of cases. The most common subsite of origin was the tonsil, with 71% of lymphomas originating from there. The association of survival with stage, age, tumor location, presence of B symptoms, tumor pathology, gender and race was analyzed using multivariate regression. Decreased survival was significantly associated with patient age p<0.0001, Ann Arbor staging p=0.005, the presence of B symptoms p=0.003 and tumor histopathology (T cell tumors) p=0.01. Patients with tumors originating from the soft palate were significantly more likely to die asa result of their disease p=0.03. CONCLUSION:Oropharyngeal lymphoma most commonly originates from the tonsil. DLBCL is the most common subtype and has a good prognosis. The presence of B symptoms, tumors originating from the soft palate and patients with T cell tumors have the worst prognosis. This information can potentially be of great utility to the head and neck surgeon discussing prognosis with patients suffering from oropharyngeal lymphoma.
PMID: 28939067
ISSN: 1879-0593
CID: 3217872
The 50 Most Cited Articles in Facial Plastic Surgery
Bibliometric analysis is a common method to determine the most influential articles in medical specialties, as it is an objective measure of peer recognition of scientific work. This study is the first bibliometric analysis of the literature in facial plastic surgery, to determine the most cited papers in the field. Bibliometric analysis was performed using the Science Citation Index from the Institute for Scientific Information, accessed through the Web of Science. Filter terms relevant to the field of facial plastic surgery were used to identify the 50 most cited journal articles between 1900 and 2016. The median number of citations was 150 (range 116-1091). The articles spanned a wide range of topics in the field, with the most common topics being free flap reconstruction (n = 10), nasal surgery (n = 9), and rhytidectomy (n = 6). The majority of these articles (n = 29) presented findings supported by level IV or V evidence. This analysis provides an overview of the most cited articles in facial plastic surgery, many of which introduced some of the most fundamental principles and techniques in the field. These landmark articles represent important educational points that should be reviewed by all clinicians and trainees in this field. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PMID: 28634701
ISSN: 1432-5241
CID: 2604322
Synaptic Transmission Optimization Predicts Expression Loci of Long-Term Plasticity
Long-term modifications of neuronal connections are critical for reliable memory storage in the brain. However, their locus of expression-pre- or postsynaptic-is highly variable. Here we introduce a theoretical framework in which long-term plasticity performs an optimization of the postsynaptic response statistics toward a given mean with minimal variance. Consequently, the state of the synapse at the time of plasticity induction determines the ratio of pre- and postsynaptic modifications. Our theory explains the experimentally observed expression loci of the hippocampal and neocortical synaptic potentiation studies we examined. Moreover, the theory predicts presynaptic expression of long-term depression, consistent with experimental observations. At inhibitory synapses, the theory suggests a statistically efficient excitatory-inhibitory balance in which changes in inhibitory postsynaptic response statistics specifically target the mean excitation. Our results provide a unifying theory for understanding the expression mechanisms and functions of long-term synaptic transmission plasticity.
PMCID:5626823
PMID: 28957667
ISSN: 1097-4199
CID: 2717532
Proceedings of the National Academy of Sciences of the United States of America (PNAS). 2017:114(37):9972-9977.DOI: 10.1073/pnas.1712305114
Top-down modulation of sensory cortex gates perceptual learning
Practice sharpens our perceptual judgments, a process known as perceptual learning. Although several brain regions and neural mechanisms have been proposed to support perceptual learning, formal tests of causality are lacking. Furthermore, the temporal relationship between neural and behavioral plasticity remains uncertain. To address these issues, we recorded the activity of auditory cortical neurons as gerbils trained on a sound detection task. Training led to improvements in cortical and behavioral sensitivity that were closely matched in terms of magnitude and time course. Surprisingly, the degree of neural improvement was behaviorally gated. During task performance, cortical improvements were large and predicted behavioral outcomes. In contrast, during nontask listening sessions, cortical improvements were weak and uncorrelated with perceptual performance. Targeted reduction of auditory cortical activity during training diminished perceptual learning while leaving psychometric performance largely unaffected. Collectively, our findings suggest that training facilitates perceptual learning by strengthening both bottom-up sensory encoding and top-down modulation of auditory cortex.
PMCID:5604044
PMID: 28847938
ISSN: 1091-6490
CID: 2679842
Notch signaling regulates metabolic heterogeneity in glioblastoma stem cells
Glioblastoma (GBM) stem cells (GSCs) reside in both hypoxic and vascular microenvironments within tumors. The molecular mechanisms that allow GSCs to occupy such contrasting niches are not understood. We used patient-derived GBM cultures to identify GSC subtypes with differential activation of Notch signaling, which co-exist in tumors but occupy distinct niches and match their metabolism accordingly. Multipotent GSCs with Notch pathway activation reside in perivascular niches, and are unable to entrain anaerobic glycolysis during hypoxia. In contrast, most CD133-expressing GSCs do not depend on canonical Notch signaling, populate tumors regardless of local vascularity and selectively utilize anaerobic glycolysis to expand in hypoxia. Ectopic activation of Notch signaling in CD133-expressing GSCs is sufficient to suppress anaerobic glycolysis and resistance to hypoxia. These findings demonstrate a novel role for Notch signaling in regulating GSC metabolism and suggest intratumoral GSC heterogeneity ensures metabolic adaptations to support tumor growth in diverse tumor microenvironments.
PMCID:5630302
PMID: 29029402
ISSN: 1949-2553
CID: 2738172
Therapeutic and Prognostic Implications of BRAF V600E in Pediatric Low-Grade Gliomas
Purpose BRAF V600E is a potentially highly targetable mutation detected in a subset of pediatric low-grade gliomas (PLGGs). Its biologic and clinical effect within this diverse group of tumors remains unknown. Patients and Methods A combined clinical and genetic institutional study of patients with PLGGs with long-term follow-up was performed (N = 510). Clinical and treatment data of patients with BRAF V600E mutated PLGG (n = 99) were compared with a large international independent cohort of patients with BRAF V600E mutated-PLGG (n = 180). Results BRAF V600E mutation was detected in 69 of 405 patients (17%) with PLGG across a broad spectrum of histologies and sites, including midline locations, which are not often routinely biopsied in clinical practice. Patients with BRAF V600E PLGG exhibited poor outcomes after chemotherapy and radiation therapies that resulted in a 10-year progression-free survival of 27% (95% CI, 12.1% to 41.9%) and 60.2% (95% CI, 53.3% to 67.1%) for BRAF V600E and wild-type PLGG, respectively ( P < .001). Additional multivariable clinical and molecular stratification revealed that the extent of resection and CDKN2A deletion contributed independently to poor outcome in BRAF V600E PLGG. A similar independent role for CDKN2A and resection on outcome were observed in the independent cohort. Quantitative imaging analysis revealed progressive disease and a lack of response to conventional chemotherapy in most patients with BRAF V600E PLGG. Conclusion BRAF V600E PLGG constitutes a distinct entity with poor prognosis when treated with current adjuvant therapy.
PMCID:5791837
PMID: 28727518
ISSN: 1527-7755
CID: 2640512
Triple-modality treatment in patients with advanced stage tonsil cancer
BACKGROUND: Concurrent chemoradiation (CCRT) and upfront surgery followed by adjuvant therapy both are recommended treatment options for patients with advanced stage squamous cell carcinoma (SCC) of the tonsil. To the authors' knowledge, the question of whether surgical-based treatments can achieve better survival compared with CCRT has never been compared in a clinical trial. The authors analyzed the National Cancer Data Base to measure the impact of different treatment modalities on overall survival (OS). METHODS: All patients aged
PMID: 28440876
ISSN: 1097-0142
CID: 2758522
Patterns of Change in Facial Skeletal Aging
Importance: Research in facial aging has focused on soft-tissue changes rather than bony changes despite evidence of the importance of underlying bony structural changes. Research has also been limited by comparing different patients in separate age groups rather than the same patients over time. Objective: To longitudinally document patterns of change in the facial skeleton and determine a consistent methodology for measuring these changes. Design, Setting, and Participants: Case series study of university hospital system records using facial computed tomographic (CT) images timed at least 8 years apart in adults initially aged 40 to 55 years with no history of facial surgery who required repeated facial imaging that included the entire midface and cranium. Main Outcomes and Measures: Face CTs were analyzed for 3-dimensional constructions and 2-dimensional measurements to document changes in glabellar, piriform, and maxillary angles and piriform height and width. Results: Fourteen patients (5 men, 9 women; mean [SD] age, 51.1 [5.8] years) with mean (SD) follow-up of 9.7 (1.4) years were eligible for 2-dimensional analysis, which revealed statistically significant decreases in mean (SD) glabellar angles (from 68.8 degrees [7.6 degrees ] to 66.5 degrees [8.6 degrees ]) and maxillary angles on both the right (from 82.5 degrees [6.3 degrees ] to 81.0 degrees [7.1 degrees ]) and left (from 83.0 degrees [5.8 degrees ] to 81.0 degrees [7.0 degrees ]), as well as increases in mean (SD) piriform width (from 24.5 [1.6] mm to 25.5 [1.3] mm). Nine patients (3 men, 6 women; mean [SD] age, 51.4 [6.3] years) with mean (SD) follow-up imaging at 9.6 (1.5) years were eligible for 3-dimensional analysis, which revealed statistically significant decreases in mean (SD) maxillary angles (from 56.5 degrees [6.6 degrees ] to 51.6 degrees [7.6 degrees ]) and piriform angles (from 50.8 degrees [3.4 degrees ] to 49.1 degrees [3.4 degrees ]). Statistically significant differences between the sexes were also noted: Initial mean (SD) glabellar angle for men was 61.7 degrees (5.7 degrees ) vs 72.7 degrees (5.4 degrees ) for women, with final values of 57.9 degrees (4.9 degrees ) vs 71.2 degrees (6.0 degrees ). Mean (SD) maxillary angle initial values were 87.8 degrees (6.1 degrees ) (right) and 87.1 degrees (4.9 degrees ) (left) for men, with 79.6 degrees (4.3 degrees ) and 80.6 degrees (5.0 degrees ) for women, respectively. Final values were 87.0 degrees (4.4 degrees ) and 86.9 degrees (4.1 degrees ) for men and 77.7 degrees (6.1 degrees ) and 77.7 degrees (6.2 degrees ) for women, respectively. Mean (SD) piriform height for men was 35.0 (2.0) mm initially and 35.5 (2.1) mm finally, vs 31.3 (2.8) and 31.6 (3.0) mm for women, respectively. Conclusions and Relevance: Our pilot study of repeated CT images of patients over several years supports previous studies of bony facial aging and further characterizes these changes. This study is the first, to our knowledge, to document bony changes of the face in the same group of patients at different time points to better characterize facial aging. We also detail an improved methodology to study bony aging to contribute to additional research in the field. Level of Evidence: NA.
PMCID:5710626
PMID: 28796853
ISSN: 2168-6092
CID: 2664132
