Hearing Preservation Surgery for Cochlear Implantation-Hearing and Quality of Life After 2 Years
OTOLOGY & NEUROTOLOGY
2013; 34 (3): 526-531
Sigmoid sinus dehiscence resurfacing as treatment for pulsatile tinnitus.
The Journal of laryngology and otology
To study the benefits of hearing preservation surgery in cochlear implantation after 2 years.A retrospective cohort study.Performed at a single academic institution between 2008 and 2010Thirteen patients (1 bilateral): 43% male and 57% female subjects. Mean age at surgery was 51 years (range, 32-72 yr). Average duration of deafness was 25 years (range, 5-62 yr).Hearing preservation cochlear implantation surgery performed with the Med-El FlexEAS electrode.Pure tone thresholds, speech perception in quiet and noise and quality of life (Abbreviated Profile of Hearing Aid Benefit [APHAB] and Glasgow Hearing Aid Benefit [GHABP Scales] up to and including 2 years after surgery.At the first postoperative audiogram, the hearing preservation rate was 100% (complete (42.9%), partial (50%), and minimal (7.1%)). After 24 months, the breakdown was complete (25%), partial (12.5%), minimal (37.5%) and complete loss (12.5%). There was a trend in improvement in all areas of APHAB) with significant improvements in the background noise and reverberation categories as well as the global scores. The GHABP scores showed high levels of use, benefit, and low levels of residual disease.Hearing preservation can be achieved in the short term but deteriorates with time over the medium term at a rate greater than that can be expected with the natural progression of the disease. Patients show benefits in speech outcomes and quality of life regardless of whether hearing preservation was achieved in the medium term.
View details for DOI 10.1097/MAO.0b013e318281e0c9
View details for Web of Science ID 000316452300030
View details for PubMedID 23503094
Tympanic Membrane Wound Healing in Rats Assessed by Transcriptome Profiling
2011; 121 (10): 2199-2213
Aim: To report a case of sigmoid sinus dehiscence presenting with pulsatile tinnitus and treated successfully with resurfacing. Case report: This patient presented with pulsatile tinnitus due to sigmoid sinus dehiscence. This was successfully treated using only soft tissue resurfacing. Conclusion: Sigmoid sinus dehiscence is a rare but treatable cause of pulsatile tinnitus. It can occur in the absence of a diverticulum, and is not necessarily limited to the transverse sigmoid junction. When resurfacing, care must be taken not to significantly alter the extraluminal diameter of the sigmoid in a dominant sinus, as this raises the risk of post-operative hydrocephalus.
View details for PubMedID 23595093
Unique microbiology of chronically unstable canal wall down tympanomastoid cavities: considerations for surgical revision.
journal of laryngology and otology
2013; 127 (5): 458-462
The aim of this study is to elucidate transcriptional changes that occur in response to tympanic membrane (TM) perforation in rats and to infer key genes and molecular events in the healing process.A prospective cohort study of 393 male Sprague-Dawley (Rattus norvegicus) rats.Sprague-Dawley rats were randomly allocated into either control or perforation groups spanning a 7-day time period. Perforation groups consisted of 12-hour, 24-hour, 36-hour, 2-day, 3-day, 4-day, 5-day, six-day, and 7-day time points. The left TMs of all perforation groups were perforated and the RNA extracted at the specified time point postperforation. Subsequent analysis was performed using Agilent's 4 × 44 k whole rat genome arrays (40 in total) to assess wound-healing gene expression over a 7-day time period.Over a 7-day time course and at nine time points that encompassed the wounding and progression of healing, a total of 3,262 genes were differentially expressed. In this study the transcripts most upregulated occurred at 12 hours. These were Stefin A2 (344-fold), Stefin 2 (143-fold), and Natriuretic peptide precursor type B (222-fold). Those most downregulated also occurred at 12 hours. These were alcohol dehydrogenase 7 (13.1-fold) and gamma-butyrobetaine hydroxylase (10.4-fold). Results were validated by quantitative real-time polymerase chain reaction.The findings of this study provide a baseline against which to identify disease-related molecular signatures, biomarkers, and to develop new treatments for TM conditions based on molecular evidence.
View details for DOI 10.1002/lary.22150
View details for Web of Science ID 000295228800029
View details for PubMedID 21919009
Pott's puffy tumour and intracranial complications of frontal sinusitis in pregnancy
JOURNAL OF LARYNGOLOGY AND OTOLOGY
2013; 127: S35-S38
Objective: To review the microbiology of open tympanomastoid cavities in patients who underwent revision surgery due to chronic instability. Methods: This paper describes a retrospective chart review of surgical revision cases of chronically unstable open mastoid cavities. Patient records from 2000 to 2010 were reviewed for the type of organism cultured, antimicrobial resistance and the presence of cholesteatoma. Results: In total, 121 revision surgical procedures were performed on 101 patients. Seventy-nine procedures involved culture specimen processing, 37 of which were positive. The most commonly cultured organism was Staphylococcus aureus, which was more than twice as common as any other pathogen. The presence of cholesteatoma had no impact on the likelihood of a positive culture or polymicrobial culture. Antimicrobial-resistant pathogens were uncommon. Conclusion: A positive culture was not an overwhelmingly common characteristic of unstable tympanomastoid cavities. Furthermore, antimicrobial resistance did not appear to play an essential role in leading patients towards revision open mastoid surgery.
View details for DOI 10.1017/S0022215113000583
View details for PubMedID 23552343
Keratinocyte growth factor 1, fibroblast growth factor 2 and 10 in the healing tympanic membrane following perforation in rats.
Journal of molecular histology
2011; 42 (1): 47-58
A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy.A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later.This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.
View details for DOI 10.1017/S0022215112001673
View details for Web of Science ID 000312461900008
View details for PubMedID 22892137
The role of epidermal growth factor in the healing tympanic membrane following perforation in rats.
Journal of molecular histology
2010; 41 (6): 309-314
The aim of this study was to provide a transcriptome profile of Keratinocyte Growth Factor (KGF)-1, Fibroblast Growth Factor (FGF) 2 and FGF10 (KGF2) in the healing rat tympanic membrane (TM) over 7 days and an immunohistochemical account over 14 days following perforation. KGF1, FGF2, and FGF10 play important roles in TM wound healing. The tympanic membranes of rats were perforated and sacrificed at time points over a 14-day period following perforation. The normalized signal intensities and immunohistochemical protein expression patterns at each time point for KGF1, FGF2, and FGF10 are presented. The primary role of both KGF1 and FGF2 appeared to be in the proliferation and migration of keratinocytes. Whereas the role of KGF1 appeared to be exclusively concerned with increased proliferation and migration at the perforation site, the continued expression of FGF2, beyond perforation closure, suggested it has an additional role to play. FGF10 (KGF2), whilst possessing the highest sequence homologous to KGF1, has a different role in TM wound healing. The effect of FGF10 on keratinocytes in wound healing appeared to emanate from the connective tissue layer.
View details for DOI 10.1007/s10735-010-9306-2
View details for PubMedID 21136143
Histology of the Healing Tympanic Membrane Following Perforation in Rats
2010; 120 (10): 2061-2070
Epidermal Growth Factor (EGF) has been identified as playing a critical role in the wound healing process. The objective of this study is to investigate the role that EGF plays in rat tympanic membrane (TM) wound healing using two techniques, microarray and immunohistochemistry. The tympanic membranes of rats were perforated using a sterile needle and sacrificed at time points during 2 weeks following perforation. The normalized signal intensities at the time points for EGF and associated genes are presented. The rat EGF mRNA did not change significantly between time points. Five associated proteins, including heparin-binding EGF-like growth factor were found to be differentially expressed above a two fold threshold at 12 h following perforation. EGF staining was found at low levels in the uninjured TM. Levels of EGF staining increased at 24 h in the basal keratinocyte layer, became diffusely elevated in the specimen at 36 h, before a second peak in staining of the keratinocyte layer at Day 4. The staining of EGF corresponds to its multiple roles in TM wound healing.
View details for DOI 10.1007/s10735-010-9287-1
View details for PubMedID 20967565
Chronic tympanic membrane perforation: a better animal model is needed
WOUND REPAIR AND REGENERATION
2007; 15 (4): 450-458
The aim of this study was to provide a detailed cytological account on the healing tympanic membrane (TM) over 14 days and to complement existing research into TM wound healing.The study is a prospective cohort study of 19 male Sprague-Dawley (Rattus norvegicus) rats.Rat TMs were perforated using a sterile needle and sacrificed at time points during the 14 days following perforation.The healing of the TM resembles cutaneous wound healing except that the TM is unique in the lack of a supportive matrix beneath the regenerating epithelia. This prevents the influx of reparative cells and nutrients and the in growth of the usual fibroblastic reaction.TM wound healing contrasts with cutaneous wound healing in that keratinocytes are the first cells to close the wound and not the last. A keratin scaffold may not be important in the healing process. The malleus plays a crucial role in the healing of the TM and is the site of significant mitotic activity during the healing process. Migration across layers of the TM appears to account for the closure of the perforation.
View details for DOI 10.1002/lary.20998
View details for Web of Science ID 000282743100027
View details for PubMedID 20824636
Neck dissection for squamous cell carcinoma of the head and neck.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
2007; 136 (4): S41-5
Developments in the treatment of chronic tympanic membrane perforation have been hindered by the lack of an ideal animal model. It is not appropriate to test such treatments on acute perforations as the majority of these heal spontaneously. An ideal animal model would be one that most closely resembles the human clinical situation. It should be inexpensive, readily available, and easy to create. There have been a number of attempts to create a chronic tympanic membrane perforation model with limited success. All published attempts at chronic tympanic membrane perforations have been reviewed and the limitations of each model are discussed. A number of areas for research exist for further developing a chronic tympanic membrane perforation model. These areas include a perforation model in the presence of bacteria and eustachian tube dysfunction. Understanding the molecular and genetic mechanisms of chronic otitis media and potential treatments will also be useful.
View details for DOI 10.1111/j.1524-475X.2007.00251.x
View details for Web of Science ID 000248754800003
View details for PubMedID 17650087
Cardiac surgery in Australian octogenarians: 1996-2001
ANZ JOURNAL OF SURGERY
2003; 73 (9): 749-754
To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone.A retrospective, 14-year surgical audit.The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model.The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year.Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.
View details for PubMedID 17398340
The number of octogenarians receiving cardiac surgery is increasing. Concerns regarding the outcomes and significant expense required to provide this service have not been addressed because no prospective medium term outcomes of Australian octogenarians have been published.Prospective analysis was undertaken of octogenarians having cardiac surgery from 1996 to 2001 in three hospitals of moderate case volume (400 patients per year) by: in-hospital audit and data acquisition, 1-year direct patient follow up in rooms, and a final follow up in late 2001 directly with the patient either in rooms or via telephone questionnaire.Sixty-four patients had cardiac surgery. All patients were severely disabled by symptoms (CCVS: III-IV, NYHA: III-IV) preoperatively, 14% were advised not to proceed with a surgical option but did so. Total operative in-hospital mortality was 6.3% (elective: 0%, urgent: 10.5%, P = 0.05), major complications were few 10.9% (seven patients; stroke: 1.6%, deep sternal infection: 1.6%, myocardial infarction: 1.6%, reoperation: 4.8%). At 1 year, despite 95% being free of significant cardiovascular symptoms (CCVS/NYHA: I-II), nearly one in five (19%) would not have proceeded with the surgery. However, at the final follow up (mean time: 2.8 years), freedom from cardiovascular symptoms remained high (95%), 94% remained independent and their quality of life was significantly better than before surgery. Although 59% suffered worsening of additional medical conditions, these conditions had a minor impact on their quality of life. Ninety-eight per cent would recommend cardiac surgery. Actuarial survival for all patients and for hospital survivors at 4 years was 67.9 +/- 4.1% and 74.2 +/- 4%, respectively.Medium-term follow up of Australian octogenarians who were offered cardiac surgery revealed that 94% remain independent and with an excellent quality of life. Age alone must not be a barrier to access to cardiac surgery.
View details for Web of Science ID 000185196800016
View details for PubMedID 12956792