Publications by authors named "Sarah E Mowry"

31 Publications

Mythbusters! The Truth about Common Misconceptions in Cochlear Implantation.

Semin Hear 2021 Nov 9;42(4):352-364. Epub 2021 Dec 9.

Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Cochlear implantation (CI) is the preferred method of hearing rehabilitation when patients cannot perform well with traditional amplification. Unfortunately, there are still significant misconceptions around this life-changing intervention. The goal of this article is to address some of the most common myths around CI surgery. After reading this article, the learner will be able to explain the utility of CI in patients with residual hearing and recognize that insurance coverage is widespread. The reader will be able to list common risks associated with this well-tolerated procedure including anesthetic risk and the risk of vestibular dysfunction. Additionally, the reader will be able to identify the significant positive impact of CI on patients' quality of life. Finally, the reader will identify that many patients can safely have an MRI scan after implantation, including nearly all contemporary recipients.
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http://dx.doi.org/10.1055/s-0041-1739368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8660170PMC
November 2021

A Rare Case of Myopericytoma in the Mastoid.

Otol Neurotol 2021 10;42(9):e1404-e1405

Case Western Reserve University School of Medicine.

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http://dx.doi.org/10.1097/MAO.0000000000003173DOI Listing
October 2021

The economic burden of vertigo and dizziness in the United States.

J Vestib Res 2021 ;31(2):81-90

Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Background: Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings.

Objective: Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities.

Methods: A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated.

Results: Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion.

Conclusion: Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
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http://dx.doi.org/10.3233/VES-201531DOI Listing
October 2021

Multi-institutional Comparison of Temporal Bone Models: A Collaboration of the AAO-HNSF 3D-Printed Temporal Bone Working Group.

Otolaryngol Head Neck Surg 2021 05 6;164(5):1077-1084. Epub 2020 Oct 6.

Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.

Objective: The American Academy of Otolaryngology-Head and Neck Surgery Foundation's (AAO-HNSF's) 3D-Printed Temporal Bone Working Group was formed with the goal of sharing information and experience relating to the development of 3D-printed temporal bone models. The group conducted a multi-institutional study to directly compare several recently developed models.

Study Design: Expert opinion survey.

Setting: Temporal bone laboratory.

Methods: The working group convened in 2018. The various methods in which 3D virtual models had been created and printed in physical form were then shared and recorded. This allowed for comparison of the advantages, disadvantages, and costs of each method. In addition, a drilling event was held during the October 2018 AAO-HNSF Annual Meeting. Each model was drilled and evaluated by attending-level working group members using an 15-question Likert scale questionnaire. The models were graded on anatomic accuracy as well as their suitability as a simulation of both cadaveric and operative temporal bone drilling.

Results: The models produced for this study demonstrate significant anatomic detail and a likeness to human cadaver specimens for drilling and dissection. Models printed in standard resin material with a stereolithography printer scored highest in the evaluation, though the margin of difference was negligible in several categories.

Conclusion: Simulated 3D temporal bones created through a number of printing methods have potential benefit in surgical training, preoperative simulation for challenging otologic cases, and the standardized testing of temporal bone surgical skills.
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http://dx.doi.org/10.1177/0194599820960474DOI Listing
May 2021

Cochlear Implantation in Patients With Menière's Disease: Does Disease Activity Affect the Outcome?

Otol Neurotol 2020 10;41(9):1296-1304

Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center.

Objective: Menière's disease (MD) is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of bilateral deafness due to MD alone or contralateral pathology, cochlear implantation (CI) improves hearing. Active MD is characterized by fluctuating auditory symptoms and vertigo; whereas remittance of vertiginous symptoms and severe, permanent sensorineural hearing loss characterizes the inactive disease state. This study evaluates outcomes for MD patients compared with the general CI population and assesses if disease activity affects implant outcomes.

Study Design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: Twenty-four patients with MD that received CI (7 active, 16 inactive, and 1 Probable Menière's), and 24 age-matched controls.

Interventions: Cochlear implantation.

Main Outcome Measures: Word Recognition Score, Sentence Recognition Score (SRS), and Speech Reception Threshold.

Results: Best-aided preoperative and postoperative audiometric data were compared per ear between MD patients and controls and stratified by disease status using descriptive statistics with mixed-effects modeling. Patients with MD derived significantly more benefit from CI than controls when comparing differences between preoperative and postoperative levels for Word Recognition Score (12.2%, p = 0.0236), SRS (12.8%, p = 0.0375), and Speech Reception Threshold (-14.4 dB, p = 0.0188). Active disease status does not negatively impact CI outcomes and patients with active MD may benefit from greater gains in SRS (23.5%, p = 0.0107).

Conclusions: CI provides greater gains in functional hearing for patients with MD compared with age-matched controls. Patients with active MD seem to perform better with respect to SRS following CI than patients with inactive status.
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http://dx.doi.org/10.1097/MAO.0000000000002750DOI Listing
October 2020

A Multimodal Multi-institutional Solution to Remote Medical Student Education for Otolaryngology During COVID-19.

Otolaryngol Head Neck Surg 2020 10 9;163(4):707-709. Epub 2020 Jun 9.

Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

During the coronavirus 2019 pandemic, there has been a surge in production of remote learning materials for continued otolaryngology resident education. Medical students traditionally rely on elective and away subinternship experiences for exposure to the specialty. Delays and cancellation of clinical rotations have forced medical students to pursue opportunities outside of the traditional learning paradigm. In this commentary, we discuss the multi-institutional development of a robust syllabus for medical students using a multimodal collection of resources. Medical students collaborated with faculty and residents from 2 major academic centers to identify essential otolaryngology topics. High-quality, publicly available, and open-access content from multiple sources were incorporated into a curriculum that appeals to a variety of learners. Multimodal remote education strategies can be used as a foundation for further innovation aimed at developing tomorrow's otolaryngologists.
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http://dx.doi.org/10.1177/0194599820933599DOI Listing
October 2020

Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection.

Ann Otol Rhinol Laryngol 2020 Dec 4;129(12):1168-1173. Epub 2020 May 4.

Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods.

Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training.

Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS.

Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance.

Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
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http://dx.doi.org/10.1177/0003489420918273DOI Listing
December 2020

Otolaryngology Education in the Setting of COVID-19: Current and Future Implications.

Otolaryngol Head Neck Surg 2020 07 28;163(1):70-74. Epub 2020 Apr 28.

Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA.

The COVID-19 pandemic continues to garner extensive international attention. The pandemic has resulted in significant changes in clinical practice for otolaryngologists in the United States; many changes have been implemented to mitigate risks identified by otolaryngologists in other countries. COVID-19-induced limitations include social distancing and triaging of patient acuity. Additionally, a recent publication by Stanford University has drawn attention to the risks that otolaryngologists may face with regard to manipulation of the upper airway and mucosal disruption. As a result of COVID-19 recommendations, multiple institutions have overhauled resident clinical rotations and resident education. The result has been a rapid and significant change in resident education at most academic institutions. This commentary outlines the development of the otolaryngology resident education consortiums, with implications for future education within and outside of otolaryngology.
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http://dx.doi.org/10.1177/0194599820923621DOI Listing
July 2020

Cochlear Implant Surgery.

JAMA Otolaryngol Head Neck Surg 2020 01;146(1):92

Case Western Reserve University, Lerner College of Medicine Cleveland Clinic Foundation, Cleveland, Ohio.

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http://dx.doi.org/10.1001/jamaoto.2019.2274DOI Listing
January 2020

Reversible Auricular Necrosis Secondary to Systemic Thrombosis.

JAMA Otolaryngol Head Neck Surg 2018 09;144(9):848-849

Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.1001/jamaoto.2018.1370DOI Listing
September 2018

A simple assessment tool for evaluation of cadaveric temporal bone dissection.

Laryngoscope 2018 02 20;128(2):451-455. Epub 2017 Apr 20.

Department of Otolaryngology, University of Iowa, Iowa City, Iowa, U.S.A.

Educational Objective: Objective metrics in skilled-based educational courses allow trainees and instructors to assess performance and monitor progress. The objective is to validate a concise, easy-to-use instrument for assessment of resident skill during a timed cadaveric temporal-bone (CTB) dissection.

Study Design: Retrospective analysis.

Methods: An instrument was developed to assess resident performance on a yearly timed microdissection of CTB. Five neurotologists participated in the assessment. Each reviewer's score was compared to the score given by the senior neurotologist each year for every resident. Spearman's correlation analysis was then used to assess the reproducibility of the instrument in assessing resident performance. The ability of the instrument to distinguish among experienced and novice trainees and to demonstrate improvement with experience were also assessed.

Results: The instrument was created and used for 6 years. Thirty residents were assessed. Correlation of scores between the senior neurotologist and the other neurotologist together was very high (r = 0.883, P < 0.001). Three specific tasks distinguished novice from senior dissectors: posterior canal, opening the membranous labyrinth, and disruption of the ossicular chain.

Conclusion: A new instrument for assessment of resident skill on CTB dissection is presented. The instrument is easy to use, and scores derived from it are consistent across reviewers. The new instrument distinguishes experienced trainees from novice trainees, is sensitive to individual experience, and has proved useful in providing trainees with objective performance measures.

Level Of Evidence: NA. Laryngoscope, 128:451-455, 2018.
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http://dx.doi.org/10.1002/lary.26578DOI Listing
February 2018

Cochlear implantation in chronic demyelinating inflammatory polyneuropathy.

Cochlear Implants Int 2017 03 23;18(2):116-120. Epub 2016 Dec 23.

c Department of Otolaryngology , Augusta University , GA , USA.

Objective: To describe a case of chronic inflammatory demyelinating polyneuropathy (CDIP) with bilateral sudden sensorineural hearing loss who subsequently benefited from unilateral cochlear implantation.

Methods: case history review and review of the literature for the terms CDIP, hearing loss, cochleovestibular dysfunction, and cochlear implantation.

Results: A 49-year-old woman presented with bilateral rapidly progressive sensorineural hearing loss (SNHL) 1 month after an upper respiratory tract infection. Hearing loss was not responsive to high-dose steroids and there were no other laboratory abnormalities or physical findings. Within 1 month, she developed ascending motor palsy, requiring long-term ventilator support. This neurologic condition was diagnosed as CDIP and she was successfully treated with plasmapheresis and intravenous immunoglobulin. Her hearing never recovered. At the time of cochlear implant, she had no response at the limits of the audiometer and obtained 0% on AzBio testing. No ABR could be recorded preoperatively. She underwent uneventful cochlear implantation with a perimodilar electrode. One year after activation, she had a PTA of 20 dB and 40% on AzBio sentence testing. Her eABR demonstrated a neuropathy pattern. Only two other cases of CDIP associated with dysfunction of the eighth nerve have been described, and neither had documented profound hearing loss.

Conclusions: Severe SNHL associated with CDIP is rare. Although this patient has good access to sound, speech discrimination is poor at 1-year post implantation. This outcome may be due to incomplete recovery of myelination of the eighth nerve. Other possibilities include loss of peripheral nerve fibers due to the initial viral upper respiratory infection, which may lead to less neural substrate to stimulate.
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http://dx.doi.org/10.1080/14670100.2016.1264115DOI Listing
March 2017

Content Validity of Temporal Bone Models Printed Via Inexpensive Methods and Materials.

Otol Neurotol 2016 09;37(8):1183-8

Medical College of Georgia at Augusta University, Augusta, Georgia.

Hypothesis: Computed tomographic (CT) scans of the 3-D printed temporal bone models will be within 15% accuracy of the CT scans of the cadaveric temporal bones.

Background: Previous studies have evaluated the face validity of 3-D-printed temporal bone models designed to train otolaryngology residents. The purpose of the study was to determine the content validity of temporal bone models printed using inexpensive printers and materials.

Methods: Four cadaveric temporal bones were randomly selected and clinical temporal bone CT scans were obtained. Models were generated using previously described methods in acrylonitrile butadiene styrene (ABS) plastic using the Makerbot Replicator 2× and Hyrel printers. Models were radiographically scanned using the same protocol as the cadaveric bones. Four images from each cadaveric CT series and four corresponding images from the model CT series were selected, and voxel values were normalized to black or white. Scan slices were compared using PixelDiff software. Gross anatomic structures were evaluated in the model scans by four board certified otolaryngologists on a 4-point scale.

Results: Mean pixel difference between the cadaver and model scans was 14.25 ± 2.30% at the four selected CT slices. Mean cortical bone width difference and mean external auditory canal width difference were 0.58 ± 0.66 mm and 0.55 ± 0.46 mm, respectively. Expert raters felt the mastoid air cells were well represented (2.5 ± 0.5), while middle ear and otic capsule structures were not accurately rendered (all averaged <1.8).

Conclusion: These results suggest that these models would be sufficient adjuncts to cadaver temporal bones for training residents in cortical mastoidectomies, but less effective for middle ear procedures.
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http://dx.doi.org/10.1097/MAO.0000000000001131DOI Listing
September 2016

Bony ankylosis of hydroxyapatite prostheses in the middle ear.

Am J Otolaryngol 2016 Mar-Apr;37(2):136-8. Epub 2015 Oct 9.

Georgia Regents University Department of Otolaryngology, Augusta, GA, USA. Electronic address:

Background: Ossiculoplasty is a commonly performed middle ear procedure. Ossicular chain reconstruction (OCR) prostheses should be made of a biocompatible material; one such common material is hydroxyapatite (HA).

Methods: 2 patients were identified who had HA OCR prostheses which had fused to the middle ear bony structures. One HA OCR had fused to the fallopian canal in the tympanic segment and represented a management dilemma. The other fused to the scutum.

Conclusion: Bony ankylosis of a HA containing OCR prosthesis should be considered in the differential diagnosis of a failed ossiculoplasty. Depending on the location of the fusion, special measures may be needed to free the prosthesis from the underlying middle ear structures.
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http://dx.doi.org/10.1016/j.amjoto.2015.10.001DOI Listing
December 2016

A Novel Temporal Bone Simulation Model Using 3D Printing Techniques.

Otol Neurotol 2015 Sep;36(9):1562-5

*Department of Otolaryngology, Georgia Regents University, Augusta, Georgia †Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, and Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.

Hypothesis: An inexpensive temporal bone model for use in a temporal bone dissection laboratory setting can be made using a commercially available, consumer-grade 3D printer.

Background: Several models for a simulated temporal bone have been described but use commercial-grade printers and materials to produce these models. The goal of this project was to produce a plastic simulated temporal bone on an inexpensive 3D printer that recreates the visual and haptic experience associated with drilling a human temporal bone.

Methods: Images from a high-resolution CT of a normal temporal bone were converted into stereolithography files via commercially available software, with image conversion and print settings adjusted to achieve optimal print quality. The temporal bone model was printed using acrylonitrile butadiene styrene (ABS) plastic filament on a MakerBot 2x 3D printer. Simulated temporal bones were drilled by seven expert temporal bone surgeons, assessing the fidelity of the model as compared with a human cadaveric temporal bone. Using a four-point scale, the simulated bones were assessed for haptic experience and recreation of the temporal bone anatomy.

Results: The created model was felt to be an accurate representation of a human temporal bone. All raters felt strongly this would be a good training model for junior residents or to simulate difficult surgical anatomy. Material cost for each model was $1.92.

Conclusions: A realistic, inexpensive, and easily reproducible temporal bone model can be created on a consumer-grade desktop 3D printer.
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http://dx.doi.org/10.1097/MAO.0000000000000848DOI Listing
September 2015

Canal wall reconstruction and conductive hearing preservation for temporal bone paraganglioma.

Laryngoscope 2016 Apr 30;126(4):988-91. Epub 2015 Jul 30.

Departments of Otolaryngology-Head and Neck Surgery, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.

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http://dx.doi.org/10.1002/lary.25514DOI Listing
April 2016

Long-term results of canal wall reconstruction tympanomastoidectomy.

Otol Neurotol 2014 Jul;35(6):954-60

Objectives: This study was designed to evaluate the long-term results using the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma.

Study Design: Institutional review board-approved retrospective case review.

Setting: Tertiary referral center.

Patients: Retrospective review was performed on consecutive patients undergoing CWR tympanomastoidectomy with mastoid obliteration at a single institution from 1997 to 2011.

Main Outcome Measures: Status of tympanic membrane and ear canal anatomy, preoperative and postoperative audiometry,residual cholesteatoma at second look surgery, postoperative complications, recurrence rate, and location.

Results: Two hundred eighty-five ears in 273 patients underwent CWR tympanomastoidectomy with a mean age of 35 years with average follow-up of 4.29 years (median, 3.16 yr).A second-look ossiculoplasty was performed in 253 (89%). Recurrent retraction pocket formation occurred in 34 ears (13%). A secondary endaural atticotomy only was required to improve access for debridement in 16 of these 34 ears (5.8% of total ears).Only 7 ears (2.6%) required a revision open cavity mastoidectomy(n = 5) or subtotal petrosectomy (n = 2) for recurrent cholesteatoma. Those undergoing second-look ossiculoplasty demonstrated a small improvement in preoperative versus postoperative air-bone gap (ABG), 28 dB versus 23 dB, respectively.Postoperative infection occurred in 16 patients(5.6%) with 1 patient requiring conversion to open cavity mastoidectomy.

Conclusion: A CWR tympanomastoidectomy provides excellent intraoperative exposure of the middle ear and mastoid without the long-term disadvantages of a canal wall down mastoidectomy. Long-term follow-up demonstrates that there were only 2.6% failures requiring conversion to an open cavity or subtotal petrosectomy.
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July 2014

Long-term results of canal wall reconstruction tympanomastoidectomy.

Otol Neurotol 2014 Jan;35(1):e24-30

Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Hospital and Clinic, Iowa City, Iowa, U.S.A.

Objectives: This study was designed to evaluate the long-term results using the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma.

Study Design: Institutional review board-approved retrospective case review.

Setting: Tertiary referral center.

Patients: Retrospective review was performed on consecutive patients undergoing CWR tympanomastoidectomy with mastoid obliteration at a single institution from 1997 to 2011.

Main Outcome Measures: Status of tympanic membrane and ear canal anatomy, preoperative and postoperative audiometry, residual cholesteatoma at second look surgery, postoperative complications, recurrence rate, and location.

Results: Two hundred eighty-five ears in 273 patients underwent CWR tympanomastoidectomy with a mean age of 35 years with average follow-up of 4.29 years (median, 3.16 yr). A second-look ossiculoplasty was performed in 253 (89%). Recurrent retraction pocket formation occurred in 34 ears (13%). A secondary endaural atticotomy only was required to improve access for debridement in 16 of these 34 ears (5.8% of total ears). Only 7 ears (2.6%) required a revision open cavity mastoidectomy (n = 5) or subtotal petrosectomy (n = 2) for recurrent cholesteatoma. Those undergoing second-look ossiculoplasty demonstrated a small improvement in preoperative versus postoperative air-bone gap (ABG), 28 dB versus 23 dB, respectively. Postoperative infection occurred in 16 patients (5.6%) with 1 patient requiring conversion to open cavity mastoidectomy.

Conclusion: A CWR tympanomastoidectomy provides excellent intraoperative exposure of the middle ear and mastoid without the long-term disadvantages of a canal wall down mastoidectomy. Long-term follow-up demonstrates that there were only 2.6% failures requiring conversion to an open cavity or subtotal petrosectomy.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/MAO.0b013e3182a446daDOI Listing
January 2014

Resident participation in cadaveric temporal bone dissection correlates with improved performance on a standardized skill assessment instrument.

Otol Neurotol 2014 Jan;35(1):77-83

*Department of Otolaryngology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia; and †Department of Otolaryngology, University of Iowa Hospital and Clinics, Iowa City, Iowa, U.S.A.

Hypothesis: Increasing numbers of cadaveric temporal bone (CTB) dissection translates to improved scores on a timed microdissection of a CTB.

Background: Recent literature regarding resident education has focused on virtual learning. However, advocates for virtual temporal bone drilling admit that there is not yet a substitute for drilling a CTB.

Methods: Retrospective review of resident performance on a standardized instrument during a timed microdissection of CTBs. Resident performance on the graded dissection was compared with the number of CTBs drilled during the year. Graded performance was also compared with the total number of CTBs dissected over 4 years of residency. Faculty assessed intraoperative skill of the senior residents. These rankings were compared with the number of CTBs drilled. Comparisons were made using Pearson's and Spearman's correlations.

Results: Comparison of test scores from the most recent resident year to the number of CTBs drilled during the corresponding year correlated well (r = 0.41, p = 0.002). The correlation between the score during the highest year of training and the cumulative number of CTB drilled during residency was even stronger (r = 0.604, p = 0.005). Faculty rankings correlated well comparing general surgical skills with TB surgical skills (r = 0.655, p = 0.008). Comparing faculty rankings of TB surgical skill with the number of CTB drilled during the final year of residency yielded a negative correlation (r = -0.8) but was not significant (p = 0.1).

Conclusion: Greater exposure to CTB dissection correlates with improved scoring on a standardized instrument. Residents who struggle with temporal bone surgery tend to use CTB dissection more than those who are more facile.
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http://dx.doi.org/10.1097/MAO.0b013e31829c1106DOI Listing
January 2014

Is electroneurography beneficial in the management of Bell's palsy?

Laryngoscope 2013 May;123(5):1066-7

Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

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http://dx.doi.org/10.1002/lary.23560DOI Listing
May 2013

Facial and lower cranial neuropathies after preoperative embolization of jugular foramen lesions with ethylene vinyl alcohol.

Otol Neurotol 2012 Sep;33(7):1270-5

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin 53792-7375, USA.

Objective: To report 3 unique cases of cranial neuropathy after super-selective arterial embolization of jugular foramen vascular tumors with ethylene vinyl alcohol.

Study Design: Clinical capsule report.

Setting: Three tertiary academic referral hospitals.

Patients: Three patients who underwent superselective arterial embolization (SSE) of head and neck paragangliomas with ethylene vinyl alcohol are described. One individual was treated with primary SSE, whereas the remaining tumors were treated with preoperative SSE followed by surgical extirpation within 72 hours. All patients were found to have new cranial nerve deficits after SSE.

Results: One patient with isolated complete cranial nerve VII palsy demonstrated partial return of function at 8 months. One individual experienced cranial nerve VII, X, and XII palsies and demonstrated partial recovery of function of the involved facial nerve after 19 months. One subject experienced ipsilateral cranial nerve X and XI palsies after SSE and recovered full function of the spinal accessory nerve within 1 week but failed to demonstrate mobility of the ipsilateral true vocal fold.

Conclusion: We present the first report documenting facial and lower cranial neuropathies after super-selective embolization of head and neck paragangliomas with EVA. Although it is difficult to draw conclusions from this small number of cases, it is plausible that the use of ethylene vinyl alcohol during SSE may result in a higher risk of permanent cranial neuropathy than the use of other well-established and more temporary agents. Knowledge of the arterial supply to the cranial nerves can help the clinician to choose the embolization agent that will provide maximal occlusion while minimizing the risk of complications.
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http://dx.doi.org/10.1097/MAO.0b013e31825f2365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581607PMC
September 2012

New frontiers in cochlear implantation: acoustic plus electric hearing, hearing preservation, and more.

Otolaryngol Clin North Am 2012 Feb;45(1):187-203

Department of Otolaryngology, University of Iowa Hospital and Clinics, 200 Hawkins Drive, PFP 21212, Iowa City, IA 52249, USA.

As cochlear implant technology has changed, so have implantation criteria. In addition to profoundly deaf individuals, candidacy has expanded to include those with significant remaining acoustic hearing. This article describes the devices that are now in clinical trial, discusses the rationale as to why residual hearing preservation is important, details the surgical techniques for hearing preservation, and shares the clinical results of electric plus acoustic processing. That a video is available online.
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http://dx.doi.org/10.1016/j.otc.2011.09.001DOI Listing
February 2012

Bilateral vascular supply in juvenile nasopharyngeal angiofibromas.

Laryngoscope 2011 Mar 26;121(3):639-43. Epub 2010 Oct 26.

Division of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.

Objectives: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign tumor of the nasopharynx, exclusively affecting males in their teens and twenties. Historically, it has been thought that JNAs primarily receive their blood supply from the ipsilateral external carotid system. We demonstrate in our case series and literature review that bilateral vascular supply in these tumors is, in fact, very common.

Study Design: Case series and literature review.

Methods: We present four consecutive cases of JNA in a three-year period from a major tertiary care center. A literature review on the topic of vascular supply in JNA was performed.

Results: The first patient's preoperative angiogram demonstrated only right-sided blood supply. However, significant bleeding was encountered, and an intraoperative angiogram showed significant new vascularization from the left ascending pharyngeal artery (APA), which was embolized. The surgery was completed successfully without further significant hemorrhage after converting to an open approach. Preoperative angiograms from the next three patients demonstrated bilateral vascular supply. Embolization and endoscopic resection was successful in these cases. Review of the literature demonstrates that bilateral vascular supply is not commonly documented; however, it may be more frequent than previously thought. Other series demonstrate bilateral vascularity from 0% to 100%. Combining patients from nine studies, including our own, we found that 57 of 157 (36%) patients had tumors with bilateral vascular supply.

Conclusions: Bilateral vascular supply may be an underappreciated factor in JNA, and thorough radiographic investigation via angiography of bilateral carotid systems should be routinely done preoperatively.
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http://dx.doi.org/10.1002/lary.21337DOI Listing
March 2011

The influence of support groups on quality of life in head and neck cancer patients.

ISRN Otolaryngol 2011 3;2011:250142. Epub 2011 Nov 3.

Division of Head and Neck Surgery (Otolaryngology), David Geffen School of Medicine at the University of California, Los Angeles, CA 90095-1624, USA.

Objective. To compare quality of life in head and neck cancer (HNC) patients following treatment. Methods. The Short Form-36 Version 2 (SF-36v2) was utilized to measure patient quality of life. Results. For all 8 parameters measured by the SF-36V2, HNC patients had lower mean scores than the US population means. Support group patients had significantly worse scores than US population norms in role-physical, social functioning, and role-emotional. There were no significant differences between support group and control patients for the 8 parameters measured by the SF-36v2. Conclusions. HNC patients report significantly worse quality of life than US population norms in several physical and emotional areas. Our study did not demonstrate improved quality of life for support group patients. The increased incidence of oropharyngeal cancer and chemotherapy treatment in the support group patients in our study were factors which were likely to have lowered the overall scores in these patients.
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http://dx.doi.org/10.5402/2011/250142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658805PMC
June 2013

Lingual tonsil hypertrophy causing severe dysphagia: treatment with plasma-mediated radiofrequency-based ablation (Coblation).

Ear Nose Throat J 2010 Mar;89(3):134-6

Division of Otolaryngology-Head and Neck Surgery, UCLA SURG-HD & NK, Box 951624, 62-158A CHS, Los Angeles, CA 90095-1624, USA.

Lingual tonsil hypertrophy is an uncommon cause of upper aerodigestive tract pathology. We present the case of a 17-year-old boy who developed severe dysphagia and subsequent weight loss as a result of lingual tonsil hypertrophy. He was successfully treated with plasma-mediated radiofrequency-based ablation (Coblation). In the past, traditional surgical procedures for lingual tonsil hypertrophy were difficult to perform and recovery was difficult, but the introduction of Coblation has made lingual tonsillectomy much easier.
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March 2010

Standard chemoradiation versus intensity-modulated chemoradiation: a quality of life assessment in oropharyngeal cancer patients.

Eur Arch Otorhinolaryngol 2010 Jul 29;267(7):1111-6. Epub 2009 Dec 29.

Division of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, 62-132 CHS, BOX 951624, Los Angeles, CA 90095-1624, USA.

This study is based on the context that many patients with advanced oropharyngeal carcinoma are being treated with primary chemoradiation. The aims of this study are to identify differences in quality of life (QOL) between patients with advanced oropharyngeal cancer following traditional chemoradiation versus chemotherapy with intensity-modulated radiation therapy (CIMRT). This research is designed on a cohort study from an academic tertiary referral center. Fifty patients were identified from an institutional database of patients who had undergone primary chemotherapy and radiation (traditional or IMRT) for advanced oropharyngeal carcinoma. Patients responded via mail using the University of Washington quality of life instrument version 4. Statistical analysis of data was performed using Chi-square and Wilcoxon tests. The results comprise the responses of 17 CRT (57%) and 14 CIMRT (70%) patients. The patients completed the survey between 9 and 44 months following end of treatment. When adjusted for tumor stage and time since treatment, CIMRT patients reported improved appearance (p = 0.05), chewing (p = 0.02), and mood (p = 0.01). There was a trend toward significance for improved activity (p = 0.07), recreation (p = 0.07), and anxiety (p = 0.08). There were no differences between the two groups for saliva, taste, shoulder function, speech, and swallowing. But there was a trend for significance for improved overall QOL in patients who had undergone CIMRT (p = 0.06). In conclusion, CIMRT results in improved QOL for some domains but surprisingly not for swallowing or saliva. Patients undergoing CIMRT also report slightly better QOL overall when compared to patients receiving more traditional forms of radiation therapy.
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http://dx.doi.org/10.1007/s00405-009-1183-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874032PMC
July 2010

Immunohistochemical distribution of basement membrane proteins in the human inner ear from older subjects.

Hear Res 2009 Aug 5;254(1-2):1-14. Epub 2009 Apr 5.

Department of Surgery, Division of Head and Neck, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1769, USA.

The immunolocalization of several basement membrane (BM) proteins was investigated in vestibular endorgans microdissected from temporal bones obtained from subjects with a documented normal auditory and vestibular function (n=5, average age=88 years old). Fluorescent immunostaining using antibodies directed at collagen IV alpha 2, nidogen-1, laminin-beta2, alpha-dystroglycan, and tenascin-C was applied to cryosections from human cochlea, cristae ampullares, utricular and saccular maculae. Collagen IV alpha 2, nidogen-1, and laminin-beta2 localized to all subepithelial cochlear BMs, Reissner's membrane, strial and spiral ligamental perineural and perivascular BMs, and the spiral limbus. Tenascin-C localized to the basilar membrane and the osseous spiral lamina. alpha-Dystroglycan localized to most cochlear BMs except those in the spiral ligament, basilar membrane and spiral limbus. Collagen IV, nidogen-1, and laminin-beta2 localized to the subepithelial BMs of the maculae and cristae ampullares, and the perineural and perivascular BMs within the underlying stroma. The BM underlying the transitional and dark cell region of the cristae ampullares also expressed collagen IV, nidogen-1, and laminin-beta2. Tenascin-C localized to the subepithelial BMs of the utricular maculae and cristae ampullares, and to calyx-like profiles throughout the vestibular epithelium, but not to the perineural and perivascular BMs. alpha-Dystroglycan colocalized with aquaporin-4 in the basal vestibular supporting cell, and was also expressed in the subepithelial BMs, as well as perivascular and perineural BMs. This study provides the first comprehensive immunolocalization of these ECM proteins in the human inner ear. The validity of the rodent models for inner ear disorders secondary to BM pathologies was confirmed as there is a high degree of conservation of expression of these proteins in the human inner ear. This information is critical to begin to unravel the role that BMs may play in human inner ear physiology and audiovestibular pathologies.
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http://dx.doi.org/10.1016/j.heares.2009.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758085PMC
August 2009

Immunohistochemical analysis and Epstein-Barr virus in the tonsils of transplant recipients and healthy controls.

Arch Otolaryngol Head Neck Surg 2008 Sep;134(9):936-9

Division of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA.

Objective: To compare lymphocyte immunohistochemical markers and staining for Epstein-Barr virus (EBV) in tonsillectomy specimens from healthy children and pediatric transplant recipients.

Design: Analysis of pathology specimens.

Setting: Tertiary care medical center.

Patients: Consecutive sample of tonsillectomy specimens from 60 pediatric solid organ transplant recipients and 60 healthy children.

Intervention: Immunohistochemical staining of tonsillectomy specimens for kappa and lambda light chains, B and T lymphocytes, EBV-encoded small nuclear RNA (EBV-EBER), and EBV-encoded latent membrane protein (EBV-LMP).

Main Outcome Measure: Detection of a difference in EBV activity in transplant recipients vs healthy controls.

Results: There was 1 case of posttransplantation lymphoproliferative disorder (PTLD). All other tonsillectomy specimens from both groups demonstrated follicular hyperplasia. Tonsillectomy specimens from both groups were polyclonal, expressing kappa and lambda light-chain activity, including the case of PTLD. The number of specimens staining positive for CD3 activity, a marker of T lymphocytes, was reduced in the transplant group (85%), compared with 100% in the control group (P < .01). EBV-EBER is a nuclear stain indicating active EBV infection, whereas EBV-LMP staining denotes latent infection. Twenty-seven of 60 transplant specimens (45%) demonstrated EBV-EBER activity compared with 0 of 60 control specimens (P < .001). EBV-LMP activity was equal in both groups.

Conclusions: Adenotonsillar hypertrophy in transplant recipients with no prior exposure to EBV may be a sign of active EBV infection. A high incidence of EBV-EBER was found in the tonsils of transplant recipients. Active adenotonsillar EBV infection in the setting of T-lymphocyte suppression in transplant recipients may be a potential early precursor of PTLD.
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http://dx.doi.org/10.1001/archotol.134.9.936DOI Listing
September 2008

Quality of life outcomes in laryngeal and oropharyngeal cancer patients after chemoradiation.

Otolaryngol Head Neck Surg 2006 Oct;135(4):565-70

Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.

Objective: The purpose of this study was to compare quality of life issues in patients with advanced laryngeal versus oropharyngeal cancer after treatment with chemoradiation.

Design: A cohort study of 31 patients with laryngeal or oropharyngeal squamous cell carcinoma treated with chemoradiation completed the University of Washington quality of life instrument version 4 (UW-QOL v4). Statistical analysis was performed with Wilcoxon rank sum and chi-square tests.

Setting: Academic tertiary care center.

Results: Both groups reported similar impairment in the domains of swallowing, chewing, and taste. Oropharyngeal cancer patients reported significantly worse quality of life in the domain of saliva (P < 0.007).

Conclusion: Swallowing, chewing, and taste were adversely affected by chemoradiation for both groups. Oropharyngeal patients experienced significantly worse problems with saliva than laryngeal patients. These patients reported high levels of satisfaction with health-related quality of life issues.

Significance: Specific head and neck subsites have different morbidities when treated with primary chemoradiation for advanced tumors.
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http://dx.doi.org/10.1016/j.otohns.2006.06.1266DOI Listing
October 2006

Quality of life in advanced oropharyngeal carcinoma after chemoradiation versus surgery and radiation.

Laryngoscope 2006 Sep;116(9):1589-93

Division of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Objective: The objective of this cohort study from a tertiary academic university practice was to identify differences in patients' perceived quality of life after either chemoradiation or surgery and radiation for advanced-stage oropharyngeal carcinoma.

Methods: From institutional databases, thirty-five patients were identified who had undergone either primary chemoradiation or primary surgery and postoperative radiation for advanced oropharyngeal cancer (stage II-IV). Patients voluntarily responded by mail using the University of Washington quality-of-life instrument version 4 (UW-QOL). Data were analyzed using chi and Wilcoxon tests.

Results: There were 17 patients who underwent chemoradiation and 18 patients who underwent surgery and postoperative radiation. All surgical patients had undergone free-flap reconstruction. Patients completed the UW-QOL an average of 25 months after treatment. There was no statistically significant difference between the two groups with regard to any specific domain, including pain, appearance, swallowing, chewing, speech, saliva, or mood. There was a trend toward significance for taste (P = .07) with chemoradiation patients reporting poorer taste function. The lack of difference in the patients' perception of appearance and swallowing was rather surprising given the vastly different treatment modalities. Respondents reported equivalent overall quality of life in response to global quality-of-life questions.

Conclusion: Most patients with advanced oropharyngeal carcinoma report good quality of life after treatment, regardless of treatment modality. Although the short-term side effects of treatment may be different between the groups, long-term quality of life is remarkably similar whether the patients choose primary chemoradiation or surgery with postoperative radiation.
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http://dx.doi.org/10.1097/01.mlg.0000233244.18901.44DOI Listing
September 2006
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