Nikolaus E. Wolter

Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener's granulomatosis.

To describe our experience with the use of intralesional corticosteroid injection and dilatation (ILCD) in the management of subglottic stenosis (SGS).

Vestibular and Balance Impairment Contributes to Cochlear Implant Failure in Children.

Objective To determine the role of vestibular and balance dysfunction in children with cochlear implant (CI) failure. Study Design Retrospective case review. Setting Tertiary referral center. Patients Thirty-five children with CI failure were compared to 165 children who did not experience CI failure. Main Outcome Measures Vestibular function was compared between groups by horizontal canal function (measured by caloric, rotational, video Head Impulse Testing [vHIT]), saccular function (vestibular evoked myogenic potentials [VEMP]), and balance (measured by Bruininks-Oseretsky Test [BOT-2]). Results Twenty-one patients completed vestibular and balance testing. Patients with CI failure demonstrated significantly more abnormal horizontal canal function than those who did not experience CI failure (caloric: 81 vs. 47%, p = 0.004; rotational/vHIT: 71 vs. 35%, p = 0.001). Absence of bilateral horizontal canal function increased the odds of CI failure 7.6 times. A greater proportion of children with CI failure had abnormal saccular function compared to those without CI failure (81 vs. 46%, p = 0.003). Children with CI failure had significantly worse balance (BOT-2 score: 7.8) than children who did not experience CI failure (BOT-2 score: 12.2) (p < 0.0001). Conclusions Vestibular end-organ dysfunction and its resulting balance impairment have been identified as important risk factors for CI failure in children. Early identification and treatment of such impairments may avoid or delay implant failures and prevent children from experiencing periods of sound deprivation that could impact speech and language acquisition.

Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants.

Objectives: 1) To determine if bilateral vestibular dysfunction can be predicted by performance on standardized balance tasks in children with sensorineural hearing loss (SNHL) and cochlear implants (CI). 2) To provide clinical recommendations for screening for vestibular impairment in children with SNHL. Study Design: Retrospective cohort study. Setting: Tertiary care pediatric implant center. Patients: Pediatric patients (4.8–18.6 years) with profound SNHL using CIs. Interventions: Vestibular end-organ (horizontal canal and otoliths), and balance assessment. Main Outcome Measures: Comparison of balance skills, measured by the Bruininks Oseretsky Test of Motor Proficiency II (BOT-2), was performed between two groups of children with SNHL and CI: 1) total bilateral vestibular loss (TBVL) (n = 45), and 2) normal bilateral vestibular function (n = 20). Sensitivity, specificity, and suitability of each task as a screening tool for the detection of TBVL were assessed. Results: Balance as measured by the BOT-2 balance subtest was significantly poorer in children with TBVL then those with normal vestibular function (p < 0.0001). “Eyes closed” tasks best identified children with TBVL having the highest sensitivity and specificity. One-foot standing eyes closed was found to have the best performance as a screening tool for TBVL using a timed cutoff of 4 seconds. Conclusion: A brief in-office screen of balance function using one of the BOT-2 balance subtest tasks, one-foot standing eyes closed, is able to identify children at risk of TBVL with excellent sensitivity and specificity and should be used to screen for TBVL in all children presenting with SNHL.

Unilateral Hearing Loss Is Associated With Impaired Balance in Children: A Pilot Study

Objective: To determine if children with unilateral sensorineural hearing loss (UHL) demonstrate impaired balance compared with their normal hearing (NH) peers. Study Design: Prospective, case-control study. Methods: Balance was assessed in14 UHL and 14 NH children using the Bruininks-Oseretsky Test-2 (BOT-2) and time to fall (TTF) in an immersive, virtual-reality laboratory. Postural control was quantified by center of pressure (COP) using force plates. The effect of vision on balance was assessed by comparing scores and COP characteristics on BOT-2 tasks performed with eyes open and closed. Results: Balance ability as measured by the BOT-2 score was significantly worse in children with UHL compared with NH children (p = 0.004). TTF was shorter in children with UHL compared with NH children in the most difficult tasks when visual and somatosensory inputs were limited (p < 0.01). Visual input improved postural control (reduced COP variability) in both groups in all tasks (p < 0.05) but postural control as measured by COP variability was more affected in children with UHL when visual input was removed while performing moderately difficult tasks (i.e., standing on one foot) (p = 0.02). Conclusion: In this pilot study, children with UHL show poorer balance skills than NH children. Significant differences in TTF between the two groups were only seen in the most difficult tasks and therefore may be missed on routine clinical assessment. Children with UHL appear to rely more on vision for maintaining postural control than their NH peers. These findings may point to deficits not only in the hearing but also the vestibular portion of the inner ear.

Separating the contributions of olivocochlear and middle ear muscle reflexes in modulation of distortion product otoacoustic emission levels.

Objectives: Mediated by the medial olivocochlear system (MOCS), distortion product otoacoustic emission (DPOAE) levels are reduced by presentation of contralateral acoustic stimuli. Such acoustic signals can also evoke a middle ear muscle reflex (MEMR) that also attenuates recorded DPOAE levels. Our aim is to clearly differentiate these two inhibitory mechanisms and to analyze each separately, perhaps allowing the development of novel tests of hearing function. Methods: DPOAE were recorded in real time from chinchillas with normal auditory brainstem response thresholds and middle ear function. Amplitude reduction and its onset latency caused by contralateral presentation of intermittent narrow-band noise (NBN) were measured. Stapedius and tensor tympani muscle tendons were divided without disturbing the ossicular chain, and DPOAE testing was repeated. Results: Peak reduction of (2f1 - f2) DPOAE levels occurred when the center frequency of contralateral NBN approximated the primary tone f2, indicating an f2-frequency-specific response. For a 4.5-kHz centered NBN, DPOAE (f2 = 4.4 kHz) inhibition was 0.1 dB (p < 0.001). This response remained present after tendon division, consistent with an MOCS origin. Low-frequency NBN (center frequency: 0.5 kHz) reduced otoacoustic emission levels (0.1 dB, p < 0.001) across a wide range of DPOAE frequencies. This low-frequency response was abolished by division of the middle ear muscle tendons, clearly indicating MEMR involvement. Conclusions: Following middle ear muscle tendon division, DPOAE inhibition by contralateral stimuli approximating the primary tone f2 persists, whereas responses evoked by lower contralateral frequencies are abolished. This distinguishes the different roles of the MOCS (f2 frequency specific) and MEMR (low frequency only) in contralateral modulation of DPOAE. This analysis helps clarify the pathways involved in an objective test that might have clinical benefit in the testing of neonates.

Surgical efficiency in bilateral cochlear implantation: A cost analysis

Abstract Objective (1) Compare the non-device-related costs of bilateral simultaneous cochlear implantation (BSiCI) vs. unilateral, and (2) establish a dollar amount for potential cost savings in direct costs for BSiCI vs. sequential cochlear implantation (CI). Methods Data from all CI cases performed during the fiscal year 2010–2011 were retrospectively reviewed without exception. Fifty-four patients received unilateral CI and 36 received BSiCI. Demographics and data regarding direct costs associated with the operation and immediate in hospital post-operative period were collected. Results The total operating room (OR) time for unilateral and BSiCI was 3 hours 00 minutes and 4 hours 37 minutes, respectively, with a mean difference of 1 hour and 36 minutes (SD = 0 hours:06 minutes). The cost of OR and post-anesthetic care unit supporting staff was

Topical MMP beacon enabled fluorescence-guided resection of oral carcinoma.

3102 and

Pediatric ossiculoplasty with titanium total ossicular replacement prosthesis

4240 for unilateral and BSiCI, respectively, with a mean difference of

Infant Sleep Machines and Hazardous Sound Pressure Levels

1138 (SD = 216). Unilateral CI supplies totaled

Non-accidental caustic ear injury: Two cases of profound cochleo-vestibular loss and facial nerve injury

1348 compared to