Shawn Zardouz

Optical coherence tomography of cholesteatoma.

Objectives: To image cholesteatoma using optical coherence tomography (OCT) and correlate the results with clinical findings and conventional observations obtained using binocular microscopy and histology. OCT is a high-resolution optical imaging modality that generates cross-sectional images of turbid media, such as tissue with resolution approaching that of light microscopy. OCT relies on intrinsic differences in tissue optical properties for image contrast. Study Design: In vivo prospective clinical study. Setting: University Medical Center. Patients: Patients with cholesteatoma undergoing otologic surgery. Intervention: Using a commercial OCT imaging system, we obtained cross-sectional images (resolution, ∼10 &mgr;m; depth penetration, ∼1 mm) of cholesteatomas. Main Outcome Measures: Images are obtained by raster scanning a single mode fiber across the interior of the probe. The imaging probe is sterilized and inserted into the middle ear or mastoid under microscopic guidance, and still images of the middle ear or mastoid mucosa and cholesteatoma when present were obtained. Results: OCT images of cholesteatomas demonstrate differences in signal intensity, which are distinct from those of normal or inflamed middle ear/mastoid mucosa. Identification of keratin in cholesteatoma, even if very thin, distinguished it from inflamed mucosa. Conclusion: This is the first study that systematically used OCT to image cholesteatoma during otologic surgery. Cholesteatomas can be distinguished from normal or inflamed adjacent mucosa.

Personality types of otolaryngology resident applicants as described by the Myers-Briggs Type Indicator.

Objective. To assess the personality types of applicants to a single otolaryngology residency program using the Myers-Briggs Type Indicator. The personality types were compared with those of the general population and with physicians in other medical specialties. Study Design. Cross-sectional survey. Setting. University hospital. Subjects and Methods. A personality survey was emailed to 327 resident physician applicants over 2 consecutive years (2008-2009). Analysis was accomplished by calculating prevalence estimates. Results. Of the 327 anonymous surveys, 137 were completed (response rate = 42%). The Introverted/Sensing/Thinking/ Judging personality type was the most prevalent (14.6%), representing 13% of the general population. Prospective applicants displayed mostly Extroverted (E; 58%), Sensing (S; 54%), Thinking (T; 62%), and Judging (J; 61%) personality traits. Of the 16 personality types, statistically significant differences were found between otolaryngology resident applicants and the general population only for the Extroverted/Sensing/Thinking/ Perceiving (P = .002) personality type after correcting for multiple comparisons. The Intuitive (N; 46%) and Feeling (F; 38%) types correlated closely with the reported personality types of those individuals in non–primary care specialties, 47% and 28%, respectively. Extroverted (E) and Thinking (T) individuals appeared to prefer surgical specialties, which occurred in 58% and 62% of the applicants, respectively. There were no significant differences between male and female applicants. Conclusion. This study examines the personality types of medical students applying to an otolaryngology residency. The results support a highly structured, data-driven teaching preference among applicants. These results may allow for a better understanding of the personalities of medical students who are interested in otolaryngology.

A novel method to determine standardized anatomic dimensions of the osseous external auditory canal.

Objective To introduce a novel method for measuring the dimensions of the osseous external auditory canal (OEAC) on computed tomographic images of the temporal bone. Study Design Radiology case series. Setting Tertiary care medical center. Patients A retrospective review of high-resolution computed tomographic images of the temporal bones of 69 patients (120 ears) between the ages of 5 and 85 years (mean, 29.1 yr) was performed. Main Outcome Measures Using a novel method to measure dimensions of the OEAC in the parasagittal planes, 6 defined dimensions as well as length and shape of the OEAC were studied at the annulus, midcanal, and the border of the bony cartilaginous junction. Results There was no statistically significant difference in OEAC dimensions between the male and female subjects or patients with and without a history of chronic otitis media within similar age groups. The length of the OEAC was significantly different between age groups of 5 to 12 and older than 13 years. The 6 defined dimensions were statistically different between the age groups of 5 to 8 years and older. These dimensions were not statistically different between the age groups of 9 to 12, 13 to 18, and older than 18 years. The most prevalent shape of the OEAC was conical (64%). Conclusion Standardized anatomic dimensions of the OEAC provide important measurements for design of novel in-the-canal hearing aids and specialized earplugs and assist in defining average sizes for canalplasty procedures.

Systematic Assessment of Noise Amplitude Generated by Toys Intended for Young Children

Objective To systematically evaluate the noise generated by toys targeted for children and to compare the results over the course of 4 consecutive holiday shopping seasons. Study Design Experimental study. Setting Academic medical center. Subjects and Methods During 2008-2011, more than 200 toys marketed for children older than 6 months were screened for loudness. The toys with sound output of more than 80 dBA at speaker level were retested in a soundproof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker. Results Ninety different toys were analyzed. The mean (SD) noise amplitude was 100 (8) dBA (range, 80-121 dBA) at the speaker level and 80 (11) dBA (range, 60-109 dBA) at 30 cm away from the speaker. Eighty-eight (98%) had more than an 85-dBA noise amplitude at speaker level, whereas 19 (26%) had more than an 85-dBA noise amplitude at a 30-cm distance. Only the mean noise amplitude at 30 cm significantly declined during the studied period (P < .001). There was no significant difference in mean noise amplitude of different toys specified for different age groups. Conclusion Our findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise-induced hearing loss in this age group, warranting promotion of public awareness and regulatory considerations for manufacture and marketing of toys.

Knowledge and education of primary care physicians on management of children with hearing loss and pediatric cochlear implantation

Author(s): Wu, Edward C; Zardouz, Shawn; Mahboubi, Hossein; Ashtiani, Ali K; Shahriari, Shawhin; Ziai, Kasra; Rothholtz, Vanessa S; Djalilian, Hamid R

Epidemiological Factors Influencing Access to Cochlear Implantation and Language Skills of Deaf and Hard-of-Hearing Children

Objectives: Determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) and deaf and hard-of-hearing (DHH) children’s language skills. Methods: More than 200 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on family (income, insurance status, education level, hearing status, primary language) and children characteristics (school type, language skills, rehabilitation measures) were solicited. Results: Sixty-six surveys were included in the analysis. Six children had already undergone CI. Of those children without CI, 62% had been presented with the option of CI by a healthcare professional and 24% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with at least one normal hearing parent (P = .04), annual income less than

Efficacy of Commercial Earplugs in Preventing Water Intrusion during Swimming

15,000 or more than

Primary Care Physicians' Knowledge of Cochlear Implantation

75,000 (P = .01), and children enrolled in specialized schools for DHH (P = .01). Risks of surgery (17%) and negative feedback from others(14%) were the leading reasons for unwillingness to undergo CI. Number of spoken words was greater among DHH children who attended public schools (P = .04) or had more than one form of curriculum (P = .04). Conclusions: A significant gap exists between the number of CI candidates and families aware of the option. Willingness to undergo CI is related to familial income and hearing status. On average, DHH children in public schools enrolled in a mainstream curriculum appear to have better language skills.

Noise-induced hearing threshold shift among US adults and implications for noise-induced hearing loss: National Health and Nutrition Examination Surveys

Objective To evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals. Study Design Experimental study. Setting Tertiary care medical center. Subjects and Methods Ten subjects (20 ears) were assessed. After insertion of the earplugs, subjects underwent 3 standardized head-wetting protocols, including (1) surface swimming for 10 minutes, which entailed no head submersion and moderate splashing; (2) head submersion at a 90-cm depth for 20 seconds with their head upright; and (3) head submersion at a 90-cm depth with head tilted 90 degrees left and then tilted 90 degrees right for 10 seconds on each side to apply vertical pressure. Color change of a wetness indicator was used to determine water intrusion after each protocol. The same protocol was repeated for all 9 earplugs. Results Water intrusion was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, and vertical submersion, respectively. The results revealed a significant difference in the waterproofing qualities of the various types of earplugs. The soft silicone type (Pillow Soft) earplug had the lowest rate of water penetration during all 3 protocols (P < .001). The difference between the most effective earplugs, Pillow Soft and Aquaseal, were only significant during the horizontal submersion protocol (P = .008). Conclusion Water intrusion occurred even with the use of earplugs. The intrusion was more significant with horizontal or vertical head submersion. The soft silicone Pillow Soft earplug was the most effective earplug for preventing water intrusion in surface swimming.

Stereotactic radiosurgery for vestibular schwannomas: a survey of current practice patterns of neurotologists.

facial nerve response range. A commercially available stimulating drill was utilized and the facial nerve responses were recorded in reference to depth of drilling while drilling through the facial nerve canal via a trans-mastoid approach. The drill was advanced using a motorized actuator set at a rate of 0.1 mm/sec. The facial nerve response was measured and recorded in real-time. Once the facial nerve canal was violated, speed and time data was used to back calculate thickness of bone over the facial nerve and correlated it with stimulation thresholds. EMG recordings were noted at different distances from the facial nerve with bone intact, bone removed, and via direct stimulation of the facial nerve. RESULTS: Noticeable increases were recorded in EMG output as the facial nerve was approached. When one millimeter of bone remained the EMG millivotage output increased by 3.3 /1.1% from baseline. When no bony covering remained, the EMG increased by 10.5 /0.6 % from baseline. During this study a voltage increase of 2.66 /0.11 mV corresponded to 0.1 millimeter of bone thickness remaining over the nerve. CONCLUSION: The current study shows that the facial nerve can be stimulated through intact bone and correlates thickness of bone with facial nerve monitoring output. Specifically, we utilized a stimulating drill with EMG recording to correlate the drills position in relationship to the facial nerve. When 0.1 millimeter of bone remained over the facial nerve in this model, there was a large voltage increase from baseline (increase of 2.6mV). Ultimately this research could be incorporated into drill technology to disable a drill prior to a facial nerve transgression.