Sara Immerman

Cochlear implantation in the very young child: Long-term safety and efficacy†‡

Widespread universal newborn hearing screening has led to increased identification of infant hearing loss. Supported by improved diagnostic tools allowing more definitive diagnosis of profound sensorineural hearing loss in young children, cochlear implantation in children <12 months of age is now common. Literature supports short‐term safety and improved auditory outcomes in these young children, however long‐term data is lacking. The study examines issues of long‐term safety and efficacy in cochlear implant patients implanted <1 year of age.

The effect of perimodiolar placement on speech perception and frequency discrimination by cochlear implant users

Conclusion. Neither speech understanding nor frequency discrimination ability was better in Nucleus Contour™ users than in Nucleus 24 straight electrode users. Furthermore, perimodiolar electrode placement does not result in better frequency discrimination. Objectives. We addressed three questions related to perimodiolar electrode placement. First, do patients implanted with the Contour™ electrode understand speech better than with an otherwise identical device that has a straight electrode? Second, do these groups have different frequency discrimination abilities? Third, is the distance of the electrode from the modiolus related to frequency discrimination ability? Subjects and methods. Contour™ and straight electrode users were matched on four important variables. We then tested these listeners on CNC word and HINT sentence identification tasks, and on a formant frequency discrimination task. We also examined X-rays and measured the distance of the electrodes from the modiolus to determine whether there is a relationship between this factor and frequency discrimination ability. Results. Both speech understanding and frequency discrimination abilities were similar for listeners implanted with the Contour™ vs a straight electrode. Furthermore, there was no linear relationship between electrode–modiolus distance and frequency discrimination ability. However, we did note a second-order relationship between these variables, suggesting that frequency discrimination is worse when the electrodes are either too close or too far away from the modiolus.

Techniques for early diagnosis and management of cervicofacial necrotising fasciitis

BACKGROUND Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis. METHODS Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis. RESULTS In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patients diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths. CONCLUSION The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases.

Cartilage Grafting in Nasal Reconstruction

Nasal reconstruction after resection for cutaneous malignancies poses a unique challenge to facial plastic surgeons. The nose, a unique 3-D structure, not only must remain functional but also be aesthetically pleasing to patients. A complete understanding of all the layers of the nose and knowledge of available cartilage grafting material is necessary. Autogenous material, namely septal, auricular, and costal cartilage, is the most favored material in a free cartilage graft or a composite cartilage graft. All types of material have advantages and disadvantages that should guide the most appropriate selection to maximize the functional and cosmetic outcomes for patients.

Ischemic Necrosis of the Tongue in Patients With Cardiogenic Shock

Ischemic necrosis of the tongue is a rare entity generally associated with vasculitis. Critically ill patients with shock might experience hypoperfusion of head and neck end organs including the tongue.

Face-lift complications.

Avoiding complications of rhytidectomy requires meticulous technique, anatomic knowledge, and insight into perioperative risks. The surgeon must provide a swift diagnosis to resolve any potential complications. The surgeons goal is to deliver the best results while minimizing procedural risks.

Osteotomies in the Crooked Nose

The crooked nasal pyramid and upper third of the nose can be straightened with various osteotomes. Appropriate solutions to maximize successful nasal straightening require a thorough knowledge of the anatomy, a comprehensive preoperative plan, and the appropriate osteotomy choice.

Nasal soft tissue trauma and management.

The nose is the most prominent of all facial structures and is susceptible to many types of trauma. All soft tissue injuries of the nose have the potential to distort its appearance and adversely affect the patients self-image and self-esteem. Once life-threatening injuries are stabilized, a careful history and physical exam should be completed and treatment individualized. The ultimate objective of treatment is to achieve both functional and cosmetic restoration with timely diagnosis and repair. Immediate nasal reconstruction is ideal when medically possible because this decreases long-term sequelae.

Correlating Participation in Team Sports and Resident Success

Objective: We hypothesize that participation in “team sports” as an undergraduate or in high school fosters development of a skill set improving interactions between the resident and other members of the healthcare team. The objective is to determine the utility of team sports participation as a criterion in resident selection. Method: Retrospective review of applications to an otolaryngology residency program and scores on evaluations of otolaryngology residents. Results: Residents who participated in organized team sports tended to have higher overall rankings on their evaluations as compared with co-residents without such past involvement. No correlation was seen with objective measures such as performance on in-service or Board certification examinations. Conclusion: Involvement in team sports activities is a marker of skills and social attributes that correlates with improved scores on resident evaluations. Involvement in team sports can potentially be used during the resident selection process to select for similar individuals.