Faculty Bibliography

Hearing aids and cochlear implants are two major hearing enhancement technologies but yet share little in research and development. The purpose of this study was to determine whether hearing aid directional microphones and noise reduction technologies could enhance cochlear implant users' speech understanding and ease of listening. Digital hearing aids serving as preprocessors were programmed to omni-directional microphone, directional microphone, and directional microphone plus noise reduction conditions. Three groups of subjects were tested with the hearing aid processed speech stimuli. Results indicated that hearing aids with directional microphones and noise reduction algorithms significantly enhanced speech understanding and listening comfort. (C) 2004 Acoustical Society of America

OBJECT: Conventional wisdom regarding skull base surgery says that more extensive bone removal equals greater exposure. Few researchers have quantitatively examined this assertion, however. In this study the authors used a frameless stereotactic system to measure quantitatively the area of petroclival exposure and surgical freedom for manipulation of instruments with successive steps of temporal bone removal. METHODS: With the aid of high-power magnification and a high-speed drill, 12 cadaveric specimens were dissected in four predetermined, successive bone removal steps: 1) removal of the Kawase triangle; 2) removal of the Glasscock triangle; 3) removal of the cochlea together with skeletonization of the anterior internal auditory canal; and 4) inferior displacement of the zygoma. Step 1 offered 62 +/- 43 mm2 of exposed petroclival area, with 84 +/- 69 mm2 of surgical freedom; Step 2, 61 +/- 22 and 76 +/- 58 mm2; Step 3, 128 +/- 47 and 109 +/- 87 mm2; and Step 4, 135 +/- 38 and 102 +/- 69 mm2, respectively. CONCLUSIONS: The middle fossa approach provided a means surgically to expose the petroclival area. When examined quantitatively by using a frameless stereotactic device, the authors determined that the removal of the cochlea and skeletonization of the anterior internal auditory canal (Step 3) provided the most significant increase in both exposure and surgical freedom. Removal of the zygoma improved neither exposure nor surgical freedom.

It is relatively uncommon to document sinusitis as a cause of fever with much certainty. Therefore, investigation for sinusitis should be undertaken only after more likely causes have been excluded. and the actions taken should reflect the individual patient's circumstances. Aggressive evaluation and treatment should be geared to minimizing the patient's overall morbidity and to identifying the more aggressive forms of sinusitis and their potential complications

BACKGROUND: Oral transmucosal fentanyl citrate (OTFC; ACTIQ) incorporates fentanyl into a lozenge allowing drug delivery through the oral mucosa resulting in rapid pain relief. OTFC is effective for breakthrough pain and could be particularly useful in patients with mucositis. METHODS: This randomized, double-blind, crossover study assessed two formulations of OTFC for tolerability in 14 patients with radiation-induced mucositis. On four separate days, patients with grade 3 or 4 mucositis received an OTFC unit 45 min before radiation treatment. Two units had a sweetened matrix formulation and two had a compressed powder formulation. One unit of each formulation contained 200 microg fentanyl and one was placebo. Tolerability, mucositis pain, and formulation preference were evaluated. Changes in oral mucosa were recorded. RESULTS: Both formulations of OTFC were well tolerated. There were no significant differences between formulations in tolerability, patient preference, or VAS pain scores. No changes in oral mucosa were noted. Common treatment-related adverse events included a burning sensation in the mouth, nausea, and vomiting. CONCLUSIONS: Both formulations of OTFC are well tolerated. The presence of fentanyl in either the sweetened matrix or the compressed powder did not alter tolerability or safety. The dose of fentanyl tested did not yield analgesia greater than placebo; future studies of OTFC efficacy in mucositis should evaluate higher doses than 200 microg.

What is the time course of human attention in a simple auditory detection task? To investigate this question, we determined the detectability of a 20-msec, 1000-Hz tone presented at expected and unexpected times. Twelve listeners who expected the tone to occur at a specific time after a 300-msec narrowband noise rarely detected signals presented 150-375 msec before or 100-200 msec after that expected time. The shape of this temporal-attention window depended on the expected presentation time of the tone and the temporal markers available in the trials. Further, though expecting the signal to occur in silence, listeners often detected signals presented at unexpected times during the noise. Combined with previous data, these results further clarify the listening strategy humans use when trying to detect an expected sound: Humans seem to listen specifically for that sound, while ignoring the background in which it is presented, around the time when the sound is expected to occur

Most models suggest that the cell of origin of papillary carcinoma is the mature thyroid follicular epithelial cell. In a recent study, p63 was detected in papillary carcinoma, Hashimoto's thyroiditis, and in squamoid aggregates and solid cell nests (SCNs), embryonic remnants found sporadically in the fully developed thyroid. In the present study, the relationship between solid cell nests and papillary carcinoma was investigated further. Four-micrometer sections from 88 routinely fixed and processed archival thyroidectomy specimens were pretreated with citric acid pH 6.0 for antigen retrieval, then incubated overnight with anti-p63 monoclonal antibody 4A4. Slides were stained with a streptavidin-biotin kit and diaminobenzidine as chromogen and were counterstained with hematoxylin. Squamoid aggregates or SCNs were noted in 21 specimens. Several morphologic variants of SCNs were found, all of which displayed p63 positivity. These included undifferentiated SCNs and those displaying commitment toward squamoid and ciliated glandular differentiation. Small, morphologically inconspicuous aggregates of p63-positive cells were commonly found in Hashimoto's thyroiditis. Commitment of p63-positive undifferentiated cells toward thyroid follicular epithelial differentiation was occasionally noted. One SCN variant, also associated with Hashimoto's thyroiditis, was a floretlike arrangement of p63-positive cells with fusiform nuclei. p63 staining was strong and uniform in some SCNs, but in other SCNs it was compartmentalized and homologous to stem cell-staining patterns in normal squamous or bronchial epithelia. Stem cell-like staining, associated with compartmentalized p63 staining or p63-positive undifferentiated cells, was noted in 7 of 27 papillary carcinomas. p63 immunostaining is a highly sensitive means of detecting SCNs. p63 expression patterns in SCNs and a subset of papillary carcinomas are closely homologous to stem cell-associated p63 staining patterns that have been described elsewhere in squamous and bronchial epithelia. We propose a stem-cell-associated model of papillary carcinoma oncogenesis that suggests that (1) p63-positive embryonal remnants rather than mature follicular cells are the cells of origin of a subset of papillary carcinomas; (2) these p63-positive cells are pluripotent and may stay undifferentiated or undergo benign squamoid or glandular maturation, may undergo thyroid follicular epithelial differentiation, may undergo oncogenic change leading to papillary carcinoma, or may trigger an immune reaction, resulting in lymphoid infiltration and Hashimoto's thyroiditis; and (3) Hashimoto's thyroiditis and papillary carcinoma may therefore be linked etiologically, because both disorders may be initiated by the same population of pluripotent p63-positive embryonal stem cell remnants

OBJECTIVE: To demonstrate that the midfacial degloving (MFD) approach can provide the proper exposure to successfully reduce naso-orbital-ethmoid (NOE) and midfacial fractures while eliminating the need for external skin incisions. DESIGN: A retrospective review of patients with NOE and concomitant midfacial fractures that were repaired via the MFD approach for exposure. SETTING: Tertiary care academic medical center. METHODS: The MFD approach was used to access NOE and concomitant midfacial fractures for repair in 9 patients with facial trauma. Physical examination and imaging studies were used for preoperative evaluation. Functional and cosmetic results were assessed during follow-up with serial physical examinations and postreduction films. RESULTS: No significant technical problems were encountered in the treatment of NOE and concomitant fractures, which included 5 Le Fort I, 1 Le Fort II, 1 Le Fort III, 6 orbital rim (1 superior, 4 inferior, and 1 lateral), and 4 zygomatic complex fractures. Physical examination and imaging studies showed adequate reduction in all patients, and all patients were satisfied with their short- and long-term functional and cosmetic results. CONCLUSION: The MFD approach can provide the necessary exposure to properly reduce NOE and midfacial fractures without the need for external skin incisions