James Naples

Neck recurrence and mortality in esthesioneuroblastoma: Implications for management of the N0 neck

To review the literature on neck recurrence in esthesioneuroblastoma.

Cisplatin-Induced Ototoxicity and the Effects of Intratympanic Diltiazem in a Mouse Model

Objective To evaluate whether the calcium-channel blocker diltiazem has protective effects against cisplatin-induced ototoxicity in a mouse model. Study Design Original basic science in vivo investigation. Setting Academic setting: Otolaryngology–Head and Neck Surgery laboratory at University of Connecticut Health Center. Subjects Thirty-nine female CBA/J mice. Methods Pure tone– or click-evoked auditory brainstem responses (ABRs) were recorded in CBA/J mice to determine auditory thresholds. All mice had baseline ABRs recorded. They were then given a single cisplatin bolus (14 mg/kg), followed by 5 consecutive days of intratympanic diltiazem or saline control. Follow-up thresholds were recorded on days 7, 14, and 21 postcisplatin. Tone-evoked ABRs evaluated the otoprotective effect of 2-mg/kg diltiazem in 9 mice, and dose effect was examined in response to click-evoked ABR with 2- or 4-mg/kg diltiazem in 2 groups of 15 mice. Results Saline-treated ears had significantly elevated tone-evoked auditory thresholds when compared with diltiazem-treated ears (P = .038) on day 7 postcisplatin only. Click-evoked ABR thresholds were significantly elevated in saline-treated ears versus diltiazem-treated ears for the 2-mg/kg group (P = .001) and 4-mg/kg group (P = .011) on days 7, 14, and 21 postcisplatin. Conclusion Intratympanic diltiazem has significant protective effects against cisplatin ototoxicity at 2 and 4 mg/kg. This is the first in vivo study to demonstrate that diltiazem offers a potentially novel therapy for cisplatin-induced ototoxicity.

Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal.

Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down‐beating, with a torsional component elicited by the Dix‐Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down‐beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms. Laryngoscope, 125:1965–1967, 2015

Opioid Prescribing Patterns among Otolaryngologists

Objectives To evaluate national trends in opioid prescribing patterns by otolaryngologists for postoperative pain control after common otolaryngologic procedures. Study Design Cross-sectional; survey. Subjects and Methods A survey to determine opioid prescribing patterns for the treatment of postoperative pain following common otolaryngologic procedures was distributed to all members of the American Academy of Otolaryngology–Head and Neck Surgery. Results The most common pain medication prescribed for adults postoperatively was hydrocodone-acetaminophen (73%), followed by oxycodone-acetaminophen (39%). The most common pain medication prescribed postoperatively for children was acetaminophen (67%), followed by nonsteroidal anti-inflammatory drugs (65%). Overall, there was a wide variation in quantity of opioids prescribed for each surgery, ranging from 0 to more than 60 doses. Mean opioid prescriptions were greatest for tonsillectomy (37 tablets) and least for direct laryngoscopy (5.3 tablets). Conclusion This study identifies nationwide variations in opioid prescribing patterns among otolaryngologists. While otolaryngology is a relatively small specialty, we still have an obligation to work with all physicians to help combat the current opioid epidemic. By evaluating nationwide postoperative pain regimens, we are moving closer toward understanding how to reduce the opioid burden.

Prestin as an Otologic Biomarker of Cisplatin Ototoxicity in a Guinea Pig Model

Objective To evaluate (1) whether changes in serum prestin aid in early detection of cisplatin ototoxicity, (2) the role of diltiazem as an otoprotectant, and (3) whether prestin levels are sensitive to effects of diltiazem. Study Design Experimental animal study. Setting Translational research laboratory. Subjects Twenty female guinea pigs. Methods Two groups of 10 guinea pigs were used. The relationship between serum prestin levels and auditory brainstem response (ABR) thresholds was compared between the groups. All animals had baseline blood draws and ABR thresholds recorded prior to cisplatin administration. Intraperitoneal cisplatin bolus (8 mg/kg) was administered followed by 5 consecutive days of intratympanic (IT) diltiazem (2 mg/kg) or sham IT-saline injection. Serum prestin levels and ABR thresholds were measured at days 1, 2, 3, 7, and 14 postcisplatin. Results In sham, IT-saline–treated animals, mean prestin levels were elevated above baseline on days 1 to 7. The prestin levels were significantly elevated from baseline on day 1 (P < .001), while significant ABR threshold elevations did not occur until day 2 (P = .028) for click-evoked ABRs and day 3 (P = .041) for tones. In diltiazem-treated animals, prestin levels were not elevated above baseline but ABR thresholds were elevated on days 1 to 3. However, the thresholds returned toward baseline on days 7 and 14. Conclusion Changes in serum prestin levels were detectable prior to shifts in ABR thresholds in a guinea pig cisplatin ototoxicity model. These changes did not occur in diltiazem-treated animals. Prestin may serve as a biomarker of cochlear injury that is sensitive to therapeutic interventions in cisplatin ototoxicity.

Changes in Serum Prestin Concentration After Exposure to Cisplatin

HYPOTHESIS There are temporal changes in the outer-hair-cell-specific protein, prestin, in the blood after administration of low-dose cisplatin. METHODS Two rodent models of ototoxicity were used. After control and baseline data collection, mice (n = 30) and guinea pigs (n = 10), respectively, were treated with cisplatin at 8 mg/kg. Auditory brainstem responses were recorded on Days 1, 3, 7, and 14 after treatment. Five mice were sacrificed at each time point and serum samples were obtained. A group of 10 guinea pigs were tested and serum samples were collected at each time point. Serum prestin concentrations were measured using separate enzyme-linked immunosorbent assays for each species. RESULTS Auditory brainstem responses thresholds changed relatively little in mice, but gradually increased in guinea pigs, as a function of time after cisplatin exposure. In contrast, serum prestin concentrations rose, reaching a peak on Days 3 and 7 after cisplatin treatment in mouse and guinea pig, respectively, before declining back to or below baseline/control levels 14 days after treatment. CONCLUSION There was a time-dependent pattern of change in serum prestin after exposure to low-dose cisplatin in a resistant (mouse) and sensitive (guinea pig) rodent models. These comparative results suggest prestin may serve as a biomarker for cisplatin ototoxicity.

The History and Evolution of Surgery on the Vestibular Labyrinth

The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality.

Fostering Interest without Intimidation in Otolaryngology

I am currently a fellow in otolaryngology, and I have never reviewed Electronic Residency Application Service applications. However, I hope for an academic career, so I am likewise concerned with the recent trends in otolaryngology applications. I am writing to suggest a potential avenue for increasing future otolaryngology residency applications. My path to otolaryngology started with something simple: an interest. As an early medical student, I was not thinking about board scores and publications. I simply enjoyed surgery and the anatomy of the head and neck. As a student, I did not have any publications or presentations on my curriculum vitae. I let my interest guide me. Fortunately, my interest superseded my lack of publications, and those who helped foster my interest became my mentors. As a resident, I reciprocated this mentorship by creating an otolaryngology interest group (IG) for medical students at my institution. The IG scheduled events and demonstrations (eg, laryngoscopy, otomicroscopy) for students to learn about otolaryngology. The IG was designed to provide what Dr Chang refers to: it was organized by residents and students, offered to all students, and not elitist; it removed barriers by avoiding in-depth discussions of “necessary” qualifications for applicants. It offered an unintimidating environment for students to learn about the specialty without the pressures an authority. Students came to meetings because they were interested, not because they had a certain board score. We surveyed residency programs around the country to see how active the concept of an IG was and found that, unfortunately, IG played only an minor role in influencing residents’ interest in the specialty. It is difficult to quantify interest on an application. However, fostering interest in lieu of intimidation through otolaryngology IGs might reverse the recent trends in otolaryngology residency applications.

Subcutaneous Emphysema and Pneumomediastinum after Eustachian Tube Balloon Dilation

E ustachian tube dysfunction (ETD) is caused by abnormalities of the eustachian tube and its ability to aerate the middle ear. Recent techniques to address ETD include eustachian tube balloon dilation (ETBD), laser, and microdebrider tuboplasty. ETBD is indicated after patients fail medical management, and it involves catheterizing the eustachian tubes with a balloon dilator. The procedure is often well tolerated with few complications. We report a case of subcutaneous emphysema and pneumomediastinum after ETBD.

Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control: Intratympanic Therapy in Ménière Disease

To evaluate outcomes of intratympanic (IT) dexamethasone and gentamicin in Ménière Disease (MD).