Otolaryngol Head Neck Surg Research Articles

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Stroke and dysphagia: fluids, diet and medication

Nursing and Residential CareVol. 19, No. 1 EditorialStroke and dysphagia: fluids, diet and medicationLinda NazarkoLinda NazarkoSearch for more papers by this authorLinda NazarkoPublished Online:12 Dec 2016https://doi.org/10.12968/nrec.2017.19.1.12AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Daniels SK, Anderson JA, Willson PC (2012) Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke 43(3): 892–7 Crossref, Google ScholarGeorge J, Majeed W, Mackenzie IS et al. (2013) Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study. BMJ 347: f6954 Crossref, Google ScholarHolland G, Jayasekeran V, Pendleton N et al. (2011) Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus 24: 476–80 Crossref, Google ScholarImm N (2014) Dysphagia. http://bit.ly/1WRsnOT (accessed 15 November 2016) Google ScholarNazarko L (2016) Dysphagia in primary care: a guide for practice nurses. Practice Nursing 27(2): 65–8 Link, Google ScholarRoyal College of Speech and Language Therapists (2014) RCSLT Manual for Commissioning and Planning Services for Dysphagia. http://bit.ly/1Ct4P7R (accessed 15 November 2016) Google ScholarSacco RL, Kasner SE, Broderick JP et al. (2013) An updated definition of stroke for the 21st century. Stroke 44:2064–89 Crossref, Google ScholarSaver JL (2006) Time is brain—quantified. Stroke 37(1): 263–6 Crossref, Google ScholarScottish Intercollegiate Guidelines Network (2010) Guideline 119: Management of Patients with Stroke: Identification and Management of Dysphagia. http://bit.ly/2eCiqXM (accessed 15 November 2016) Google ScholarSingh S, Hamdy S (2006) Dysphagia in stroke patients. Postgrad Med J 82(968): 383–91 Crossref, Google ScholarSmithard D (2015) Dysphagia: prevalence, management and side effects. http://bit.ly/1SHRII4 (accessed 15 November 2016) Google ScholarTurley R, Cohen S (2009) Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg 140(1): 33–6 Crossref, Google ScholarWorld Health Organization (1998) The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 41(2): 105–14 Google Scholar FiguresReferencesRelatedDetails 2 January 2017Volume 19Issue 1ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 12 December 2016 Published in print 2 January 2017 Information© MA Healthcare LimitedPDF download

Botulinum toxin injection in laryngeal dyspnea.

Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and lack of benefit without the side effects for the two others. This failure of effect was not related with BT-A doses injected. This study provides support for using BT-A injections as a symptomatic treatment of periodic laryngeal dyspnea, regardless of the etiologic context. From our data, we suggest that a small starting dose (of around 4 U BT-A Botox®) could be enough for a first injection to obtain a good benefit. The target muscle should be determined by the EMG analysis.

Abstract: What Is the Lobular Branch of the Great Auricular Nerve? Anatomical Description and Significance in Rhytidectomy

INTRODUCTION: Recent literature describes a distinct third branch of the great auricular nerve (GAN) named the lobular branch. Studies demonstrate preserving the lobular branch of the GAN has greater impact on sensory function at the auricle than preservation of the posterior branch during rhytidectomy.1,2 However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch. This study described the branching characteristics of the lobular branch and algorithmic surface markings to assist surgeons in preservation of this nerve during rhytidectomy flap elevation. MATERIALS AND METHODS: The lobular branch was dissected bilaterally in 50 cadaveric necks. Measurements were taken from the lobular branch to conchal cartilage, tragus, and antitragus. The anterior branch was measured to its SMAS insertion and the posterior branch was measured to the mastoid process. McKinney’s point was marked and the GAN diameter was recorded. Branching pattern and location of branches within the Ozturk 30-degree angle were documented. Basic statistics were performed. A student’s t-statistic was used to compare male and female GAN diameter difference. RESULTS: The anterior, posterior, and lobular branches were present in all specimens. In comparing nerve diameter between males and females a highly significant difference was identified (t=-2.780, p<0.01). The most common origin of the lobular branch was from a trifurcation with the anterior and posterior branches. The lobular branch always terminated in the lobular area, but may send accessory branches to the pre-auricular area or posterior inferior auricle. In 85% of specimens, the lobular branch resided directly inferior to the antitragus and in the remaining specimens it was located directly inferior to the tragus. Pre-operative markings consisting of two vertical lines from the tragus and antitragus to McKinney’s point can be used to outline the predicated location of the lobular branch. CONCLUSION: This study delineated the location of the lobular branch of the GAN. We translate these findings into a quick and simple intraoperative marking, which can assist surgeons in avoiding the lobular branch injury during rhytidectomy dissection. DISCLOSURE/FINANCIAL SUPPORT:None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Hu J, Ye W, Zheng J, Zhu H, Zhang Z. The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy. International journal of oral and maxillofacial surgery. Jul 2010;39(7):684–689. 2. Zumeng Y, Zhi G, Gang Z, Jianhua W, Yinghui T. Modified superficial parotidectomy: preserving both the great auricular nerve and the parotid gland fascia. Otolaryngol Head Neck Surg. 2006;135(3):458–462.

Abstract: Adipose Derived Stem Cells Improve Union Rates and Biomechanical Strength Following Fracture in the Irradiated Murine Mandible

INTRODUCTION: Pathologic fractures and associated non-unions arising in irradiated bone are complex management dilemmas for the reconstructive surgeon. These complications are commonly managed with debridement of necrotic bone and vascularized free tissue transfers. Unfortunately, free tissue transfers remain complex and invasive procedures which are fraught with additional risk and morbidity1-4. This study examines a novel treatment paradigm for the management of non-unions and pathologic fractures utilizing implanted adipose derived stem cells (ASCs). Herein, we hypothesize that ASCs will mitigate the detrimental effects of radiation induced injury to the murine mandible and improve clinical union rates and metrics of biomechanical strength. METHODS: Isogenic Lewis rats (n=36) were divided into 3 groups. Control fracture (n=5), radiated fracture (n=15), radiated fracture + ASCs (n=16). The radiated groups received fractionated, 35Gy (human dose equivalent of 70Gy) radiation over 5 days, two weeks prior to mandibular osteotomy. The radiated fracture + ASCs group received implantation of the ASCs at the time of surgery on a Surgifoam scaffold. Following a 40-day healing period, mandibles were assessed for bony-union and mechanically tested to failure. ANOVA was used for comparison of continuous variables (p<0.05) and Chi Square for categorical variables χ2< 0.05. RESULTS:Bony Union: A statistically significant increase in bony union rates was seen in the radiated fracture + ASCs group (94%) vs radiated fracture alone (20%) χ2=0.00003. Clinical union rates in the radiated fracture + ASCs group (94%) approximated that of the control fracture group (100%) χ2=0.57. Biomechanical Testing: Significant improvements were found between radiated fracture + ASCs group and radiated fracture group in the metrics of Yield (61.46 N vs 23.5 N, p=0.003), Energy (56.12 Nmm vs 9.97 Nmm p=0.001), and Ultimate Load (73.47 N vs 33.72 N, p=0.002). Additionally, metrics of Yield and Ultimate Load were not statistically different between the radiated fracture + ASCs group and control fracture whereas Energy was significantly improved with ASC treatment (56.12 Nmm vs 9.91 Nmm p=0.001) CONCLUSION: Our data demonstrate the in-vivo efficacy of adipose derived stems cells (ASCs) and their ability to improve clinical union rates and biomechanical properties in the irradiated murine mandible. We support the continued investigation of this novel treatment paradigm and its further translational development for the management of pathologic fractures and associated non-unions after radiotherapy. 1. Urken ML, Buchbinder D, Costantino PD, et al. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 1998; 124:46–55. 2. Peled M, El-Naaj IA, Lipin Y, Ardekian L. The use of free fibular flap for functional mandibular reconstruction. J Oral Maxillofac Surg 2005; 63:220–224. 3. Ross DA, Hundal JS, Son YH, et al. Microsurgical free flap reconstruction outcomes in head and neck cancer patients after surgical extirpation and intraoperative brachytherapy. Laryngoscope 2004; 114:1170–1176. 4. Shaari CM, Buchbinder D, Constantio PD, Lawson W, Biller HF, Urken ML. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998; 124:407–411.

Advances in Optogenetic-based Auditory Implants

Advances in Optogenetic-based Auditory Implants

Predicting Obstructive Sleep Apnea with Periodic Snoring Sound Recorded at Home.

The cost-effectiveness of diagnosing obstructive sleep apnea (OSA) could be improved by using a preliminary screening method among subjects with no suspicion of other sleep disorders. We aimed to evaluate the diagnostic value of periodic snoring sound recorded at home. We included 211 subjects, aged 18-83 (130 men), who were referred to our laboratory for suspicion of OSA, and had a technically successful overnight polygraphy, measured with the Nox T3 Sleep Monitor (Nox Medical, Iceland) with a built-in microphone. We analyzed the percentage of periodic snoring during the home sleep apnea study. Apnea-hypopnea index (AHI) ranged from 0.1 to 116 events/h and the percentage of periodic snoring from 1% to 97%. We found a strong positive correlation (r = 0.727, p < 0.001) between periodic snoring and AHI. The correlation was slightly stronger among female, younger, and obese subjects. The best threshold value of the periodic snoring for predicting an AHI > 15 events/h with as high sensitivity as possible was found to be 15%. There, sensitivity was 93.3%, specificity 35.1%, and negative predictive value 75.0%. According to our results, it is possible to set a periodic snoring threshold (15% or more) for the subject to advance to further sleep studies. Together with medical history and prior to more expensive studies, measuring periodic snoring at home is a simple and useful method for predicting the probability of OSA, in particular among women who are often unaware of their apnea-related snoring.

Correlates of Pediatric CPAP Adherence.

Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

Ethnic and Gender Diversity in Radiology Fellowships.

The purpose of the study is to assess ethnic and gender diversity in US radiology fellowship programs from 2006 to 2013. Data for this study was obtained from Journal of the American Medical Association supplements publications from 2005 to 2006 to 2012-2013 (Gonzalez-Moreno, Innov Manag Policy Pract. 15(2):149, 2013; Nivet, Acad Med. 86(12):1487-9, 2011; Reede, Health Aff. 22(4):91-3, 2003; Chapman et al., Radiology 270(1):232-40, 2014; Getto, 2005; Rivo and Satcher, JAMA 270(9):1074-8, 1993; Schwartz et al., Otolaryngol Head Neck Surg. 149(1):71-6, 2013; Simon, Clin Orthop Relat Res. 360:253-9, 1999) and the US census 2010. For each year, Fisher's exact test was used to compare the percentage of women and under-represented minorities in each Accreditation Council for Graduate Medical Education (ACGME)-certified radiology fellowship to the percentage of women and under-represented minorities in (1) all ACGME-certified radiology fellowships combined, (2) radiology residents, (3) ACGME-certified fellows in all of medicine combined, (4) ACGME-certified residents in all of medicine combined, and (5) graduating medical students. Chi-Squared test was used to compare the percentage of women and under-represented minorities and the 2010 US census. p<0.05 was used as indicator of significance. Interventional radiology and neuroradiology demonstrated the highest levels of disparities, compared to every level of medical education. Abdominal and musculoskeletal radiology fellowships demonstrated disparity patterns consistent with lack of female and URM medical graduates entering into radiology residency. All radiology fellowships demonstrated variable levels of gender and ethnic disparities. Outreach efforts, pipeline programs, and mentoring may be helpful in addressing this issue.

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children.

This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y). This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded. The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001). This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position.

Traitement de la stérilité et mélanome : question non résolue en 2016

The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass—a review. Head Neck Surg 1980;2:222–33.1]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa.A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082–3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795–800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163–70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid—a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464–71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745–54 [discussion 755–56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208–15.2, 3, 7, 9, 11, 18]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119–23.26].We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.

The Benefits of Social Support for Listeners with Impaired Hearing

The Benefits of Social Support for Listeners with Impaired Hearing

Myxoid Chondrosarcoma of Nasomaxilloethmoid Region with Intracranial Extension.

Chondrosarcoma of the faciomaxillary area constitute only 4% of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rare malignancy (Indian J Otolaryngol Head Neck Surg 60(3):284-286, [1]), with its myxoid variety still rarest. It is a slow-growing tumour, occurring mostly in middle-aged men. Primary chondrosarcoma of the nasal and paranasal sinus region, including the nasal septum, rarely extends into the cranial or intracranial areas unless there is recurrence (Indian J Ophthalmol 41(4):189-191, [2]. When it does occur, early diagnosis is difficult because patients generally present with common, nonspecific sinonasal complaints. A 45year male patient came to ENT OPD with complaints of epistaxis, diplopia, facial swelling and loosening of teeth. On examination extensive swelling was present involving right maxilla, palate and ethmoid with shifting of Rt eye laterally. FNAC of swelling was non specific infected cystic lesion. On endoscopic examination there was erosion of Rt lateral wall of nose with mucoid material filling maxilla. Its wall was expanded & lined with velvety red mucosa. Maxillary antral biopsy report was myxoid chondrosarcoma. CT scan revealed extensive lesion of maxilla, ethmoid going up to optic nerve and brain. This case of myxoid chondrosarcoma is presented as it is a rare diagnosis. It presented with advanced disease involving nasomaxilloethmoid region and extended up to optic canal and middle cranial fossa. In a thorough review of Indian literature this was a rarely diagnosed tumour.

Human nasal epithelial cells derived from multiple subjects exhibit differential responses to H3N2 influenza virus infection in vitro

Human nasal epithelial cells derived from multiple subjects exhibit differential responses to H3N2 influenza virus infection in vitro

Frequency Tuning of the Efferent Effect on Cochlear Gain in Humans.

Cochlear gain reduction via efferent feedback from the medial olivocochlear bundle is frequency specific (Guinan, Curr Opin Otolaryngol Head Neck Surg 18:447-453, 2010). The present study with humans used the Fixed Duration Masking Curve psychoacoustical method (Yasin et al., J Acoust Soc Am 133:4145-4155, 2013a; Yasin et al., Basic aspects of hearing: physiology and perception, pp 39-46, 2013b; Yasin et al., J Neurosci 34:15319-15326, 2014) to estimate the frequency specificity of the efferent effect at the cochlear level. The combined duration of the masker-plus-signal stimulus was 25 ms, within the efferent onset delay of about 31-43 ms (James et al., Clin Otolaryngol 27:106-112, 2002). Masker level (4.0 or 1.8 kHz) at threshold was obtained for a 4-kHz signal in the absence or presence of an ipsilateral 60 dB SPL, 160-ms precursor (200-Hz bandwidth) centred at frequencies between 2.5 and 5.5 kHz. Efferent-mediated cochlear gain reduction was greatest for precursors with frequencies the same as, or close to that of, the signal (gain was reduced by about 20 dB), and least for precursors with frequencies well removed from that of the signal (gain remained at around 40 dB). The tuning of the efferent effect filter (tuning extending 0.5-0.7 octaves above and below the signal frequency) is within the range obtained in humans using otoacoustic emissions (Lilaonitkul and Guinan, J Assoc Res Otolaryngol 10:459-470, 2009; Zhao and Dhar, J Neurophysiol 108:25-30, 2012). The 10 dB bandwidth of the efferent-effect filter at 4000 Hz was about 1300 Hz (Q(10) of 3.1). The FDMC method can be used to provide an unbiased measure of the bandwidth of the efferent effect filter using ipsilateral efferent stimulation.

Anatomy, physiology, and genetics of paragangliomas

Paragangliomas arise from an extra-adrenal paraganglionic cells, derived from the neural crest of the autonomic nervous system and make up the most common class of benign vascular neoplasms of the neck. PGLs of the head and neck originate most commonly from the paraganglia within the carotid body, the jugular foramen, the middle ear and the vagus nerve. Knowledge of the embryology, anatomy and genetics of these rare tumors is paramount to successful diagnosis and treatment of head and neck paragangliomas.

Impact, Not Just Impact Factor: Responding to the Manila Declaration on the Availability and Use of Health Research Information

Impact, Not Just Impact Factor: Responding to the Manila Declaration on the Availability and Use of Health Research Information

Laryngeal clefts

Laryngeal clefts

Customizable rigid head fixation for infants: technical note.

The need and advantages of rigid fixation of the head in cranial surgeries are well documented (Berryhill et al., Otolaryngol Head Neck Surg 121:269-273, 1999). Head fixation for neurosurgical procedures in infants and in early years has been a challenge and is fraught with risk. Despite the fact that pediatric pins are designed, rigid head fixation involving direct application of pins to the head of infants and slightly older children is still generally not safe (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). Yet, there are some surgeries in which some form of rigid fixation is required (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). We describe a simple technique to achieve rigid fixation of the head in infants for neurosurgical procedures. This involves applying a head band made of Plaster of Paris (POP) around the head and then applying the fixation pins of the fixation frame directly on to the POP. We have used this technique of head fixation successfully for infants with no complications.

Bone-Conduction Hearing Aids

Bone-Conduction Hearing Aids