Selena E. Heman-Ackah

A combination antioxidant therapy prevents age-related hearing loss in C57BL/6 mice

OBJECTIVE: Age-related hearing loss (ARHL) is characterized by gradual, progressive sensorineural hearing loss, which impairs communication, lending to clinical depression and social withdrawal. There are currently no effective treatments for ARHL. The purpose of this study is to evaluate the potential of a combination antioxidant therapy in preventing ARHL. STUDY DESIGN: Randomized controlled trial. SETTING: Animal study. SUBJECTS AND METHODS: C57BL/6 mice, a recognized animal model of ARHL, were assigned to one of three groups: early treatment (n = 12), late treatment (n = 9), or control group (n = 9). Treatment groups of mice were fed with a combination agent comprising six antioxidant agents that target four sites within the oxidative pathway: L-cysteine-glutathione mixed disulfide, ribose- cysteine, NW-nitro-L-arginine methyl ester, vitamin B12, folate, and ascorbic acid. Auditory brainstem response (ABR) thresholds were recorded at baseline and every three months following initiation of treatment. RESULTS: Threshold shifts from baseline were decreased in the treatment groups when compared to the control group at all tested frequencies (P < 0.001). The ABR threshold shift at 12 months of age for the control group was 34.7 dB with a 95% confidence interval (CI) of ± 1.6. The mean threshold shifts for the early and late treatment groups were 7.5 dB (±0.87, 95% CI) and 9.2 dB (±1.6, 95% CI). CONCLUSION: Combination antioxidant therapy effectively decreased threshold shifts on ABR within an animal model of ARHL. Combination antioxidant therapy, with further research and investigation, may provide a safe and cost-effective method of preventing presbycusis in the growing elderly population.

Asymmetric sudden sensorineural hearing loss: is all this testing necessary?

OBJECTIVE A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely, patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The objective of this study was to assess the utility of this diagnostic evaluation in elucidating a cause of an ASSNHL and to assess the average cost associated with this battery of testing. STUDY DESIGN Retrospective chart review. SETTING Tertiary care facility. SUBJECTS AND METHODS Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between December 1, 2002, and November 30, 2007, with ASSNHL confirmed by audiometric evaluation were reviewed. Diagnostic tests included in the workup of ASSNHL and test results were recorded. The percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. RESULTS The battery of testing performed for sudden sensorineural hearing loss included antineutrophil antibody, cholesterol, creatinine, anti-DNA antibody, erythrocyte sedimentation rate, blood glucose, Lyme titer, rheumatoid factor, rapid plasmin reagent, triiodothyronine, thyroid-stimulating hormone, and magnetic resonance imaging with gadolinium. The average cost associated with the full diagnostic evaluation is greater than

Conscious sedation in pediatric speech endoscopy

2000. The diagnostic impact of these tests is extremely low. CONCLUSIONS The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.

R442 – Antioxidant Therapy Prevents Presbycusis In C57BL6 mice

OBJECTIVE Speech nasoendoscopy is one of the gold standards for evaluating velopharyngeal insufficiency. The vast majority of pediatric patients are able to tolerate this procedure within the clinic under local anesthetic. However, a select group of pediatric patients is unable to cooperate with the examination. Conscious sedation is commonly used in pediatrics to aid in patient tolerance and cooperating with selected procedures. Conscious sedation has never been reported in the literature for use in speech endoscopy. The purpose of this study is to describe a technique for performing sedated speech endoscopy and to review our experience with sedated speech endoscopy in a selected group of patients who were unable to cooperate with examination under local anesthesia alone. METHODS A retrospective chart review was performed of pediatric patients between the ages of 2 and 15 who underwent conscious sedation for the speech nasoendoscopy. All examinations were performed at a tertiary care pediatric hospital. Sedation agent, tolerance of procedure, success of procedure, and complications associated with the procedure were recorded. RESULTS Fifty-seven sedated speech endoscopies were evaluated. Adequate examinations were obtained in 93% of patients overall and 100% of the patients evaluated while sedated with nitrous oxide. Complication rates and post-endoscopy speech management are reported. CONCLUSIONS Sedated speech endoscopy is a promising modality for evaluating velopharyngeal insufficiency in the pediatric population that may not otherwise be able to cooperate with examination in the clinic.

Severe nasal frostbite injury from nasal cannula supplemental oxygen malfunction.

Problem Presbycusis, or age-related hearing loss, is characterized by gradual, progressive sensorineural hearing loss which accompanies aging with associated decreased speech recognition in noisy environments, slowed central processing of acoustic stimuli and impaired sound localization. In addition to impairing ones ability to communicate effectively, presbycusis jeopardizes ones autonomy, presents a safety concern and has been correlated with an increased incidence of clinical depression and social withdrawal. By 2025, it is estimated that approximately 25 million Americans will be affected, thus this presents a major public health concern. The purpose of this study is to evaluate the potential of antioxidant therapy, including two novel antioxidants, in the prevention of presbycusis. Methods C57BL6 mice were assigned to treatment or control groups. Treatment groups of mice were fed with a combination of two novel antioxidants, L-cysteine-glutathione mixed disulfide and ribose cysteine, as well as vitamin B12, folic acid, and ascorbic acid. Auditory brainstem response thresholds were recorded at baseline and on a monthly basis following initiation of treatment. Results Threshold shifts were observed according to the established pattern of age related loss associated with C57BL6 mice. Threshold shifts were decreased in the treatment group. Statistically significant differences (p<0.001) in threshold shifts were observed between the treatment and control groups for click stimulus and pure tones at 4, 8, 12, 16 and 32 kHz. The treatment group was found to have a smaller degree of shift in association with aging. Conclusion Combination antioxidant therapy effectively decreased threshold shifts on auditory brainstem responses within the established animal model for presbycusis. Significance Combination antioxidant therapy may prove a safe and cost-effective method of preventing presbycusis in our growing elderly population. Support American Academy of Otolaryngology – Head and Neck Surgery Foundation Resident Research Grant.

S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

We describe the presentation and management of a patient who presented to our institution with severe nasal frostbite from nasal cannula supplemental oxygen malfunction. This rare complication has not previously been reported in the English Literature. We describe the physical properties of compressed oxygen release that may contribute to these malfunctions and the role of the otolaryngologist in the management of the resulting injuries.

Chapter-17 Presbycusis

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than

Paraganglioma presenting as cholesterol granuloma of the petrous apex.

1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.