Arie Gordin

Fluorodeoxyglucose-positron emission tomography/computed tomography imaging in patients with carcinoma of the larynx: diagnostic accuracy and impact on clinical management.

Objectives: The objectives of this study were to assess the value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of the larynx as compared with PET and CT alone and to assess the impact of PET/CT on further clinical management.

The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care.

BACKGROUND: To assess the value of positron emission tomography/computed tomography (PET/CT) with 18 F-Fluorodeoxyglucose (FDG) in patients with head and neck carcinoma as compared with PET and conventional imaging alone, and to assess the impact of PET/CT on further clinical management. STUDY DESIGN: Prospective nonrandomized study. SETTING: Ninety patients with head and neck tumors had 107 PET/CT examinations. RESULTS: The study analysis showed that PET/CT had a sensitivity of 89%, specificity 95%, PPV 94%, NPV 90%, and accuracy of 92%. PET/CT altered management in 51 patients (56%). PET/CT eliminated the need for previously planned diagnostic procedures in 24 patients, induced a change in the planned therapeutic approach in 21 patients and guided biopsy in 6 patients. CONCLUSIONS: PET/CT is an imaging modality with high diagnostic performance in the assessment of head and neck cancer, and induced a change in further clinical management in more than half of the study population.

Magnesium: a new therapy for idiopathic sudden sensorineural hearing loss.

Objective To determine whether treatment with Mg2+ improves the outcome of idiopathic sudden hearing loss and to investigate which variables influence its prognosis. Study Design Prospective randomized study. Setting Department of Otolaryngology–Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. Patients The study group included 133 patients. Sixty patients were treated with carbogen inhalation, and 73 were treated with a combination of carbogen inhalation and intravenous MgSO4. Results The mean improvement rate was 66.4% in the Mg2+ group and 49.9% in the carbogen group (p < 0.01). Recovery was achieved in 35 patients (48%) in the Mg2+ group and only in 19 patients (31.6%) in the carbogen group (p < 0.01). Significant improvement was seen in 20 patients (27.4%) in the Mg2+ group and in 14 patients (23.3%) in the carbogen group. Partial improvement was seen in eight patients (10.9%) in the Mg2+ group and in 12 patients (20%) in the carbogen group. No improvement was achieved in 10 patients (13.6%) in the Mg2+ group and in 15 patients (25%) in the carbogen group. Patients with vestibular symptoms had a poorer hearing outcome compared to those without vertigo (p < 0.04). Patients who commenced the treatment 8 days or more after onset had poorer recovery as compared with those who started treatment earlier (p < 0.03), regardless of the treatment regimen. Age, sex, and tinnitus had no significant impact on hearing recovery. Conclusion We found that Mg2+ improved hearing recovery in cases of idiopathic sudden hearing loss. Vertigo and treatment delay beyond 8 days were poor prognostic factors for recovery.

Evolution of Cochlear Implant Arrays Result in Changes in Behavioral and Physiological Responses in Children

Objectives: To determine whether a change in cochlear implant technology and electrode array design affects electrophysiological, behavioral, and functional measures of audition in pediatric cochlear implant users. Design: Prospective nonrandomized control study over 6 months postimplantation. Setting: Tertiary referral pediatric hospital. Patients: A total of 115 children using unilateral cochlear implants were included in this study. Subjects were divided into 3 groups: 1) 38 using the Nucleus 24M straight array device, 2) 20 using the perimodiolar Nucleus 24RCS Contour array, and 3) 57 using the perimodiolar Nucleus 24RE array with advance off stylet insertion. The mean ages at implantation were 4.85 ± 4 (24M), 3.88 ± 3.4 (24RCS), and 5.41 ± 4.36 years (24RE; not significant, p > 0.05). Main Outcome Measures: The electrically evoked compound action potential (ECAP) and the electrically evoked stapedius reflex and behavioral measures of stimulation threshold were evoked by stimulation of basal, mid, and apical electrodes. These measures were completed at regular intervals over 6 to 12 months of implantation. Age-appropriate speech perception skills were also assessed during this period. Results: The 24RE array group had significantly lower ECAP and behavioral thresholds compared with the 24M and 24RCS array groups. The largest reductions of ECAP thresholds in the precurved array group were observed upon apical and basal electrode stimulation. Electrically evoked stapedius reflex thresholds were significantly higher in the 24RE group as compared with 24M and 24RCS groups. Comparing age-matched groups, open- and closed-set speech perception test scores were significantly higher in the 24RE array group. Conclusion: The precurved Freedom 24RE cochlear implant potentially provides a wider range of stimulation levels and better functional results than the straight electrode 24M and the precurved 24RCS devices in profoundly hearing impaired children.

An Animal Model for Endotracheal Tube–Related Laryngeal Injury Using Hypoxic Ventilation

Objectives. To explore whether hypoxic ventilation could allow a practical animal model of laryngotracheal injury secondary to endotracheal intubation. Study Design. Randomized controlled animal study. Setting. Animal laboratory in a tertiary pediatric hospital. Subjects and Methods. Eight Sus scrofa piglets (15-18 kg) were anesthetized and intubated for 4 hours, with a 6-mm cuffed endotracheal tube. They were randomly assigned to either constant hypoxic ventilation (oxygen saturation under 70%) or nonhypoxic ventilation. Endotracheal tube cuff pressure was manually controlled and maintained at a constant level. After 4 hours, fluorescein dye was administered intravenously to highlight areas of hypoperfusion within the larynx. The animals were euthanized at the end of the procedure, and the larynx and trachea were harvested for gross and histological examination. The pathologist was blinded to the ventilation group. The severity of laryngeal injury was graded between 0 and 4 by a senior pathologist. Results. The experiment protocol was successfully completed in all animal subjects. The animals undergoing hypoxic ventilation showed a significantly higher median injury grade than the nonhypoxic animals (2 vs 1, respectively; P = .003). Damage was significantly worse in the hypoxic group at all anatomical sublevels. Conclusions. Endotracheal tube–related laryngeal injury was demonstrated after only 4 hours of intubation using this animal model, and hypoxic ventilation increased the severity of injury. This study therefore provides an animal model that may be suitable for future investigation and prevention of intubation injury.

Packing of the cochleostomy site affects auditory nerve response thresholds in precurved off-stylet cochlear implants.

Objectives: To determine whether packing of the cochleostomy site influences electrically evoked compound action potential (ECAP) thresholds. Design: Prospective nonrandomized control study. Setting: Tertiary referral pediatric hospital. Patients: Eleven consecutive children who received unilateral or bilateral cochlear implants (16 Nucleus 24RE Freedom precurved advanced off-stylet electrode arrays [Cochlear Corp., Lane Cove, New South Wales, Australia]) between June and September 2008. Main Outcome Measures: Electrically evoked compound action potential thresholds were evoked by stimulation of basal (electrode 3), mid (electrode 9), and apical (electrode 20) electrodes during cochlear implant surgery in the operating room. The first recording was completed immediately after insertion of the electrode array before cochleostomy packing, and the same measures were collected immediately after the packing. The time between recordings was 5 minutes. Results: Electrically evoked compound action potential thresholds evoked by the apical electrode did not significantly change from pre- to post-cochleostomy packing, but ECAP thresholds increased significantly after packing when evoked by the mid-array electrode (mean, +10 clinical units; p < 0.001) and decreased significantly when evoked by the basal electrode (mean, -5.6 clinical units; p = 0.023). These changes were unrelated to passive changes occurring over the first 5 minutes after insertion of the electrode array. Conclusion: Packing of the cochleostomy causes changes in ECAP thresholds evoked by mid and basal areas of the implant electrode array. These findings suggest that packing shifts the electrode array in the cochlea, increasing the distance from the modiolus in the mid array and decreasing this distance at the basal end. This study is concerned with a single electrode array from a single manufacturer and a single insertion method (precurved off-stylet electrode). These conclusions may be too broad to apply to all precurved electrode arrays.

Extension of nasopharyngeal lymphoma to the middle and external ear.

We describe a patient with nasopharyngeal lymphoma who was admitted for chemotherapy. At admission, otoscopic examination revealed a large polyp occluding the left external ear canal. The polyp was removed, and histopathologic examination showed the same tumor that was found previously in the nasopharynx. Magnetic resonance imaging showed an infiltrative process that involved the left side of the nasopharynx and extended toward the left middle and external ear. To our knowledge, this is the first case report of a direct extension of nasopharyngeal lymphoma into the middle and external ear.

Hybrid Imaging of Head and Neck Malignancies

Head and neck cancer represents approximately 2–4% of all malignancies in the United States, with an annual incidence of 38,000 new cases.1 The majority of these malignancies (over 90%) are squamous cell carcinoma (SCC) of the larynx, oropharynx, and oral cavity. Early detection and accurate staging of head and neck tumors are critical for selecting the appropriate treatment and therefore are of prognostic significance. After therapy, early detection of recurrence has been shown to improve patient outcome.2

P150: An Open Safety Pin in the Esophagus: Challenging Treatment

OBJECTIVES: To characterize the phenotype of neonatal variant of Bartter’s syndrome with deafness (BSND). METHODS: A 20-year period follow-up of 17 patients with BSND, from a Bedouin Arab tribe from the south of Israel. The disease was due to a single mutation (G28A mutation in exon 1). Relevant clinical data from neonatal intensive care unit, renal and blood chemistry at birth and during childhood were included. All patients underwent an audiological work-up in the first year of life. Two patients underwent high-resolution CT scan of the temporal bone (TBHRCT). RESULTS: All pregnancies were complicated by polyhydramnion and premature birth. Nine infants developed serious bacterial infections (urinary tract infection, 3; bacterial sepsis, 6). The average length of hospital stay after birth was 9.3 3.1 weeks. Two infants died of respiratory failure and sepsis. Hypokalemia was common during follow-up visits (as low as 1.8 mmol/L), in spite of potassium chloride supplementation. All children had been treated with indomethacin (2 mg/kg/day) and potassium supplementation (1.5-3 meq/kg/day). The current average serum creatinine and calculated creatinine clearance from the older group (n 8; mean age: 8.8 1.4 years) is 60.8 16.5 mmol/L and 95 20 ml/min/1.73m2, respectively. CONCLUSIONS: Profound SNHL was diagnosed in all but one case. The latter exhibited flat audiogram with thresholds of around 70dB and developed normal speech. TBHRCTs were completely normal. Profound SNHL is evident in almost all patients with BSND. This finding is mostly attributed to the genetic effects on cochlear development and possibly also to additional postnatal insults to the cochlea.

Antioxidants: A new armament in the treatment of idiopathic sudden hearing loss

Abstract Problem: Assuming that superoxide anion radicals (-O2) may play a role in damage to the inner ear hair cell, this study investigated the possible benefit of vitamin E as an antioxidant in the treatment of idiopathic sudden hearing loss (ISHL). Methods: A prospective, double-blind study was conducted on a total of 66 patients with the diagnosis of ISHL of less than 7 days’ duration during the years 1998–2001. All patients were treated with bed rest, steroids, magnesium intravenously, and carbogen inhalation. In addition, the study group patients received vitamin E. Results: The recovery rate, calculated as hearing gain in the affected ear following treatment divided by the difference in hearing level between the affected and the unaffected ear multiplied by 100, was better than 75% in 41 of the 66 patients (66.1% of the patients). This rate was achieved in 26 patients (78.8%) from the study group treated with vitamin E, as compared with 15 patients (45.5%) in those patients who were not treated with vitamin E. Conclusion: Patients with ISHL treated with the addition of vitamin E achieved better recovery rate than did those who did not get this additional treatment. Further studies should be directed toward a better understanding of the role of antioxidants in the treatment of ISHL, and the most effective antioxidant and its optimal dose should be determined. Significance: The results of this study seem to open a new direction in the investigation of another mechanism involved in the etiology of ISHL. Antioxidants should be considered as an additional treatment in the armamentarium of treatments for patients with ISHL. Support: No grants and no support