Faculty Bibliography

The last 10 years have seen the development of numerous strategies for the delivery of genes to the inner ear. Besides being a useful research tool,gene therapy has significant promise as a potential clinical treatment. The human inner ear is easily accessible through either the round window or the stapes footplate. It is now possible to choose a variety of vectors to target a variety of different tissues. Modification of promoters yields different expression patterns as well as differences in degree of expression. Several animal studies have also demonstrated that expression of exogenous genes in the cochlea does not result in loss of hearing function. A variety of potential clinical applications are already evident from these early studies. Protective strategies such as prevention of neuronal degeneration and protection of auditory hair cells from oxidative stress are potential examples where gene therapy may be useful. As the understanding of gene therapy improves, investigators will be able to move toward targeted single-gene replacement to treat disorders such as connexin mutations and applying gene therapy to sensory cell replacement.

Objective: To develop and validate a mouse model of implantation trauma. Study design: Adult CBA mice were anesthetized and a basal turn cochleostomy created. Using a micromanipulator varying amounts of sterile phosphate-buffered saline were injected into the cochleostomy. The cochleostomy was sealed and bearing was then tested by ABR. Animals were also treated with cell death inhibitors prior to injection. Hearing was tested after 24 h allowing the elucidation of cell death pathways after cochlear trauma. Results: Volume changes under 4% of the perilymph volume of the mouse cochlea were well tolerated. Greater volume injections resulted in progressively larger hearing losses with profound bearing loss occurring at 30% of perilymph volume injection. There was a correlation between volume delivered, hearing loss, and histological findings with higher volumes resulting in tears of Reisner's membrane and blood in the perilymph. Addition of caspase inhibitors to the injection mix significantly improved hearing outcomes in high volume injections. Conclusion: This animal model allows evaluation of a cochlear injury in a quantitative fashion. Use of cell death pathway inhibitors significantly improved hearing outcome, suggesting that these substances may play a role in cases where bearing preservation is planned in implant surgery. This mouse model of hydraulic trauma may be used to test a variety of potential protective substances. (c) 2004 Elsevier B.V. All rights reserved.

Blepharoplasty is one of the most common facial cosmetic surgical procedures. When done properly, this relatively simple operation can result in a dramatic improvement for the patient with relatively little downtime. However, when it is performed improperly, the results can be crippling for the patient and often difficult for the surgeon to correct. Standard treatments for upper eyelid dermatochalasis include surgical excision of skin, muscle, and fat. Several techniques have been described for removing some or all of these components, depending on the patients' anatomic requirements. In particular, the "pinch" technique can be used to remove either the upper eyelid skin alone or a combination of skin, muscle, and fat. While this technique is not new, its appearance in the literature is sparse. We demonstrate herein how a modified version of the pinch technique can be used to remove the central orbital fat pad by "sliding" the pad through the medial fat pad incision. This procedure maintains the integrity of the central orbital septum and the delicate structures that lie beneath.