Faculty Bibliography

PURPOSE OF REVIEW/OBJECTIVE:To review the recent European studies on sublingual immunotherapy (SLIT). SLIT is currently widely used in Europe and is gaining popularity in the United States. RECENT FINDINGS/RESULTS:Longer treatment with SLIT compared with subcutaneous immunotherapy (SCIT) is needed to reduce the rhinitis symptoms in house dust mite (HDM) allergic children. SLIT appears to be well tolerated and effective for treating rhinitis and asthma in children, adults, and the elderly. Studies on HDM, grass, and ragweed have demonstrated posttreatment efficacy in both monosensitized and polysensitized patients. SUMMARY/CONCLUSIONS:SLIT has been shown to be an effective treatment for airway allergies, and recent studies give support for the use of SLIT as the first choice for allergy treatment compared with medication and SCIT. The use of SLIT may potentially improve the compliance of allergen immunotherapy and may make allergy treatment more accessible and well tolerated.

IMPORTANCE/OBJECTIVE:Laboratory and clinical studies have shown that vacuum-assisted closure (VAC) therapy increases wound blood flow and granulation tissue formation and decreases accumulation of fluid and bacteria. Many publications outline the use of VAC dressings in the treatment of sternal, sacral, upper and lower extremity, perineal, and abdominal wounds, but few describe its use in the head and neck region. No report to date has addressed the use of VAC therapy in helping to preserve facial nerve integrity. OBSERVATIONS/METHODS:We present a case of a 64-year-old woman who underwent tissue debridement for necrotizing fasciitis of the left face, neck, and upper chest. She subsequently had exposed facial nerve that was covered with a VAC dressing and demonstrated complete granulation by postoperative day 7 with preservation of function. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:This case highlights the effectiveness of VAC in eliminating infectious material and promoting granulation tissue formation. This is the first time that VAC therapy has been shown to maintain neural function when placed directly on functioning cranial nerves.

OBJECTIVE:To develop a comprehensive cochlear implant questionnaire (CCIQ) as a tool for assessing changes in quality of life (QoL) after receiving a second cochlear implant (CI2) and to correlate the QoL with speech perception changes after CI2. STUDY DESIGN/METHODS:Retrospective case series with planned data collection. SETTING/METHODS:Academic cochlear implant center. PATIENTS/METHODS:Ninety-eight English-speaking adults who received CI2 between 2000 and 2011. INTERVENTION/METHODS:CCIQ is a 28-item, 5-point Likert-scale questionnaire that assesses the physical and psychosocial benefits of CI2. MAIN OUTCOME MEASURES/METHODS:Test-retest reliability and Cronbach's alpha internal consistency were used to assess the reliability of the CCIQ. Speech perception was tested using CNC and HINT. RESULTS:Fifty-four patients completed the CCIQ, and 26 were retested. Respondents reported a subjective improvement in all domains. Test-retest reliability was satisfactory, with 64% of items achieving an intraclass correlation coefficient of greater than 0.6. Internal consistency reliability was excellent for the overall measure and was satisfactory for 6 of 9 subdomains. Speech perception data were available for 22 patients. Average CNC scores improved 13 ± 16%, and HINT scores improved 42 ± 16%. No statistically significant correlation was found between QoL scores and audiometric data or duration of CI2 use. CONCLUSION/CONCLUSIONS:Our preliminary data indicate that this CCIQ is a promising tool in assessing QoL specific to CI2 patients. Overall, patients reported improved QoL, independent of speech perception scores. Further refinements of the questionnaire with larger patient numbers are needed to strengthen the CCIQ.

A petroclival meningioma represents a challenging tumor to resect in the cerebellopontine angle and ventral to the brain stem. Multiple cranial nerves and blood vessels may be intimately involved with the tumor. A partial labyrinthectomy presigmoid transpetrosal approach can facilitate resection while preserving hearing. This approach allows for a direct line of sight along the petrous bone while sealing the canals can preserve hearing. In this video operative manuscript, we demonstrate a step-by-step illustration of a partial labyrinthectomy presigmoid transpetrosal resection of a petroclival meningioma. This approach affords the best chance of hearing preservation and an opportunity for maximum tumor resection. The video can be found here: http://youtu.be/29I4KEXz1vY .

OBJECT/OBJECTIVE:Endoscopic endonasal treatment of petrous apex cholesterol granulomas allows for a natural drainage pathway into the nasopharynx. Because of the limited number of case series in the literature, there is limited evidence of recurrence rates and outcomes following endoscopic endonasal management. The purpose of this study was to determine the surgical outcomes of endoscopic endonasal approaches in the treatment of cholesterol granulomas of the petrous apex. METHODS:A systematic literature review was performed using PubMed for articles published from January 1980 to April 2014 to identify all studies reporting outcomes for endoscopic endonasal surgical management of cholesterol granulomas of the petrous apex. Operative approach, use of a stent, symptom outcome, restenosis, cyst recurrence, reoperation, and complications were extracted from included studies. RESULTS:A total of 53 patient cases were included from 22 relevant studies. The mean age was 41 years, and 26 patients (49%) were female. Stents were used in 45.1% of cases. Symptom resolution or improvement was seen in 98.6% of cases at follow-up (mean follow-up 20 months). Complications were reported in 13.2% of cases, with the most common complication being epistaxis. Restenosis on follow-up office endoscopic examination occurred in 9 of 45 cases (20.0%). Only 4 of these restenosis cases resulted in symptomatic cyst recurrence, resulting in an overall recurrence rate of 7.5%. The mean time from surgery to cyst recurrence was 13.5 months. The rate of symptomatic cyst recurrence was 10.7% in cases without the use of a stent compared with 4.3% in cases with stent placement (p = 0.6). CONCLUSIONS:Based on current literature, endoscopic endonasal approaches result in a high rate of symptom improvement or resolution. Complication rates are lower than prior case series that have utilized open approaches. Asymptomatic restenosis can be managed conservatively, since it is associated with symptomatic cyst recurrence less than half of the time. This study revealed a nonsignificant trend toward a decrease in symptomatic cyst recurrence when a stent was used, but further work is needed to clarify its impact.

A novel method of common-path imaging interferometry, the White Light Spatial-Phase-Shift (WLSPS) for object surface measurements, is discussed here. Compared to standard White Light Interferometry (WLI), which uses a reference mirror, the interferometry of WLSPS is obtained by creating manipulations to the light wavefront reflected from an object's surface. Using this approach, surface measurements can be obtained from any real object image, and do not need to be taken directly from the object itself. This creates the ability for a surface measurement tool to be attached to any optical system that generates a real image of an object. Further, as this method does not require a reference beam, the surface measurement system contains inherent vibration cancelation.

An extension of the white light spatial-phase-shift (WLSPS) for object surface measurements is described. Using WLSPS, surface measurements can be obtained from any real object image without the need of a reference beam, thus achieving inherent vibration cancellation. The surface topography is obtained by acquiring multiple images of an object illuminated by a spectrally modulated white light source and using an appropriate algorithm. The modulation of the light source obviates the need for the continuous phase delay to obtain the interferograms.

OBJECTIVES/OBJECTIVE:Prior research has demonstrated poor correlation between the obstructive apnea-hypopnea index (AHI) on full-night polysomnogram (PSG) and quality-of-life (QOL) scores. We aim to examine the association between rapid eye movement (REM) AHI and QOL scores in children with sleep-disordered breathing (SDB). STUDY DESIGN/METHODS:Prospective trial. SETTING/METHODS:Two tertiary children's hospitals. SUBJECTS AND METHODS/METHODS:Children between 3 and 16 years of age with suspected SDB who were undergoing PSG were eligible. Children with craniofacial anomalies were excluded. Subjects' caregivers completed the Obstructive Sleep Apnea-18 (OSA-18), a validated QOL survey. Power analysis determined a group size of 34. RESULTS:One hundred twenty-seven patients were enrolled. The mean (SD) age was 6.3 (3.3) years. Most subjects (52%) were black and 26% were obese. The mean (SD) obstructive AHI of the subject population was 5.4 (11.9), while the mean (SD) REM AHI was 13.1 (23.7). The mean total OSA-18 score was 65.2, indicating a moderate impact of SDB on QOL. Neither the obstructive AHI (P = .73) nor the REM AHI (P = .49) correlated with total OSA-18 scores. However, lower nadir oxygen saturation was associated with significantly poorer QOL (P = .02). The sleep disturbance OSA-18 subset score significantly correlated with both the obstructive AHI (r (2) = 0.22; P = .01) and the REM AHI (r (2) = 0.22; P = .01); the remaining 4 subset scores did not correlate with either factor. CONCLUSION/CONCLUSIONS:Neither obstructive AHI nor REM AHI correlates with total OSA-18 QOL scores. With the exception of nadir oxygen saturation, PSG parameters do not reflect the burden of SDB on QOL in children.

OBJECTIVES/HYPOTHESIS/OBJECTIVE:Hypocalcemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for postlaryngectomy hypocalcemia at our institution. STUDY DESIGN/METHODS:Retrospective review of 65 consecutive total laryngectomies. METHODS:Clinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcemia. Risk factors for hypocalcemia were studied. RESULTS:Five cases were excluded due to concomitant abdominal surgery (3), preoperative hypocalcemia (1), and no postoperative calcium levels (1). A total of 43% of patients had postoperative biochemical hypocalcemia. On univariate analysis, bilateral neck dissection was significant for hypocalcemia (P = 0.02), with pT4 classification having borderline significance (P = 0.07). On multivariate analysis, bilateral neck dissection (P = 0.02) and salvage surgery were significant (P = 0.03), with pT4 stage again having borderline significance (P = 0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcemia. There were no significant risk factors for severe hypocalcemia identified. CONCLUSIONS:Hypocalcemia is common after total laryngectomy, particularly in the postradiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.