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Objective To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital. Methods This retrospective study identified patients treated for early-stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992-2007) or after (current treatment group, 2008-2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups. Results Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time. Conclusion Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early-stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified. Level of evidence 2c Laryngoscope, 129:1816-1821, 2019.

Objectives/Hypothesis To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED). Study Design Retrospective chart review. Methods Charts of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo to a large health system's ED between January 2008 and January 2011 were reviewed. Patient demographics, signs/symptoms, and CT and MRI results were assessed. CT and MRI charges were determined based on positive versus unremarkable findings. Data analysis included stepwise logistic regressions. Results Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan. Conclusions In the 3-year period studied, CT scans for ED patients with dizziness and vertigo yielded a low predictive value for significant pathology. These data reveal a great opportunity for cost savings by developing stricter guidelines for ordering CT scans for this set of ED patients. The use of MRI in all cases of dizziness was found to be neither practical nor useful. However, appropriately directed MRI of the brain is recommended in patients with dizziness and other neurological signs or symptoms. Level of Evidence 4. Laryngoscope, 123:2250–2253, 2013

Objectives/Hypothesis: The purpose of the study was to determine the effect of electrical stimulation of the auditory cortex in patients with tinnitus. Study Design: Nonrandomized clinical trial. Methods: Two patients with debilitating tinnitus refractory to conventional therapies were treated. Patients were evaluated with validated questionnaires and psychoacoustic measures to determine the frequency and pitch of their tinnitus. Tones at these frequencies were then presented to the first patient (RP) under magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) to determine the tonotopic map for these frequencies in Heschl's gyrus. These tonotopic sites were targeted for implant with a quadripolar electrode. In the second patient (MV), only the fMRI tonotopic map was performed. These fMRI results detected an area of increased activity, which was selected as the site for the implanted bipolar electrode. Results: Patient RP (bilateral tinnitus for 2 years) has experienced a sustained reduction to near elimination of tinnitus with intracerebral implanted electrodes, whereas patient MV (unilateral tinnitus for 7 years) had an unsustained reduction in her tinnitus. Conclusion: These findings suggest that the perception and annoyance of tinnitus may be modulated or reduced through electrical stimulation of the auditory cortex. These unsustained effects for patient MV may have been influenced by the longstanding nature of her tinnitus or by another reason as yet undetermined.

The widespread interest in and use of complementary and alternative medicine (CAM) by patients in the United States has been established by multiple surveys. One-third of the U.S. population uses some form of CAM, and an estimated 23 billion dollars is spent annually on these therapies. Because of prevalent usage of CAM among patients, it is important that physicians have some knowledge of this subject. With this purpose in mind, this report reviews the current research on CAM as it relates to common disorders of the head and neck: rhinitis, sinusitis, tinnitus, vertigo, and head and neck oncology.

Methods of monitoring the facial nerve during posterior fossa surgery continue to evolve. In an effort to predict acute and final facial nerve function following acoustic neuroma resection, the lowest current applied to the facial nerve at the brainstem necessary to elicit facial muscle response was measured using strain gauge and electromyographic facial nerve monitors. A retrospective analysis of 121 patients who had undergone acoustic neuroma surgery was performed. Sixty-five patients had intraoperative facial nerve monitoring and 44 had sufficient data for inclusion in this study. The acute and final facial nerve functions, according to the House-Brackmann classification, were assessed with regard to intraoperative stimulation-current thresholds. Nineteen of 20 patients who required 0.10 mA or less to elicit a facial muscle response had a House-Brackmann grade I facial nerve outcome. The upper limit of the 95% confidence interval of stimulation threshold for patients with a final grade I facial nerve function is 0.17 mA. All of the patients in this study, with stimulation thresholds ranging up to 0.84 mA, had a final grade III or better result. A poor outcome in our series, a final grade III facial nerve function, is best predicted by a poor acute result, specifically an acute grade VIA facial nerve function. We suggest that it is possible to predict the facial nerve function based on intraoperative threshold testing.

Objectives/Hypothesis: To evaluate the indications for observation versus surgery in the management of cotton swab-induced tympanic membrane perforations (TMP). Study Design: Institutional review board-approved retrospective cohort study of 1,540 patients with a diagnosis of TMP from 2001 to 2010. Patients with a cotton swab injury were subdivided into two groups: observation and surgery. Methods: Data collection included demographics, symptoms, surgery type, and pre- and postintervention audiometry. Successful outcomes were defined as healed TMP; resolution/improvement of vertigo, tinnitus, or facial nerve paralysis; and/or closure of the air-bone gap (ABG). Results: Fifty-four of 1,540 patients presented with a cotton swab-induced TMP. Four of the 54 patients (7.4%) underwent delayed surgical repair with 100% success. Preoperatively, one patient had a facial nerve paralysis and two had vertigo with confirmed perilymphatic fistulae (PLF). Postoperatively, the facial nerve paralysis resolved, and one patient had mild vertigo. Fifty of 54 patients opted to forego surgery with 35 patients available for follow-up. Thirty-four (97%) of the 35 patients had spontaneous healing. The average time to perforation closure was 1.75 months. Twelve of 35 patients had no ABG after healing. Conclusions: Observation is an appropriate consideration for patients who have a TMP due to a cotton swab injury. Surgical intervention should be offered early when a PLF is suspected, or if facial paralysis, severe vertigo, and/or profound sensorineural hearing loss are present. As otolaryngologists, we should be reluctant to offer surgical intervention of an acute injury without significant symptoms as most patients will heal spontaneously within 2 months.

Objectives/Hypothesis: The purpose of this study was to investigate possible preventive effects of anti-intercellular adhesion molecule-1 antibody (anti-ICAM-1 Ab) on noise-induced cochlear damage as assessed by changes in auditory thresholds and cochlear blood flow. Study Design: A controlled animal study. Pretreated rats with anti-ICAM-1 Ab or saline control, followed with exposure to 72 continuous hours of broad band noise (107 dB SPL), and 24 hours after noise exposure treated again with anti-ICAM-1 Ab or saline. Methods: Eighteen healthy male Fischer rats (200–250 g) were used. Sixteen were randomly selected to study noise-induced temporary threshold shifts. The remaining two rats were used to study cochlear blood flow (CBF), using laser Doppler flowmetry and blood pressure measurements. Results: Rats treated with anti-ICAM-1 Ab (1.875 mg/kg, intravenously) showed attenuated temporary threshold shifts (TTS) compared to controls. Both groups showed a partial threshold recovery 72 hours following noise exposure, normal for this noise exposure paradigm. Comparisons of baseline and post-treatment measurements of CBF and mean arterial blood pressure revealed no significant changes. Anti-ICAM-1 Ab animals displayed significantly lower mean auditory threshold shifts at all five test frequencies (P < .05) when compared to control. Conclusions: Blocking the cascade of reactive oxygen species (ROS) generation by using anti-ICAM-Ab protects against noise-induced hearing loss. Laryngoscope, 2009

The premise of this study is that the membrane hypothesis of aging, also known as the mitochondrial clock theory of aging, is the basis for presbyacusis. Furthermore, it is proposed that treatment with antioxidants or dietary restriction can attenuate age-related hearing loss. Many studies have demonstrated a reduction in blood flow to specific tissues, including the cochlea, with aging. Hypoperfusion leads to the formation of reactive oxygen metabolites (ROM). ROM are highly toxic molecules that directly affect tissues including inner ear structures. In addition, ROM can damage mitochondrial DNA (mtDNA), resulting in the production of specific mtDNA deletions (mtDNA del4977 [human] or mtDNA del4834 [rat]; also known as the common aging deletion]. Previous corroborating data suggest that the common aging deletion mtDNA4834 may be associated not only with aging but also with presbyacusis, thus further strengthening the basis of the current studies. In this study, experiments provide compelling evidence that long-term treatment with compounds that block or scavenge reactive oxygen metabolites attenuate age-related hearing loss and reduce the impact of associated deleterious changes at the molecular level.Prospective randomized study.One hundred thirty rats were randomly assigned to one of six groups with appropriate controls. Animals were divided into the following treatment arms: group 1, 30% caloric restriction; group 2, vitamin E oversupplementation; group 3, vitamin C over-supplementation; group 4, melatonin treatment; group 5, lazaroid treatment; and group 6, placebo. In addition, 10 animals were used to determine the appropriate caloric restriction. All subjects underwent baseline and every-3-month testing until their health failed (range, 18-28 mo; average, 25 mo). This testing included auditory sensitivity studies using auditory brainstem response (ABR) testing, as well as tissue analysis for mtDNA deletions using molecular biological techniques. At the conclusion of the study, animals underwent a final ABR test and were tested for mtDNA deletions in brain and inner ear tissues, and the opposite ear was used for histological analysis.Results indicated that the 30%-caloric-restricted group maintained the most acute auditory sensitivities, the lowest quantity of mtDNA deletions, and the least amount of outer hair cell loss. The antioxidant-treated subjects had improved auditory sensitivities, and a trend for fewer mtDNA deletions was observed compared with the placebo subjects. The placebo subjects had the poorest auditory sensitivity, the most mtDNA deletions, and the greatest degree of outer hair cell loss.Intervention designed to reduce reactive oxygen metabolite damage appears to protect against age-related hearing loss specifically and aging in general. This is reflected by an overall reduction in mtDNA deletions. These data also suggest that the common aging deletion appears to be associated with presbyacusis, as demonstrated by an increased frequency of the mtDNA del4834 in the cochleae with the most significant hearing loss. Nutritional and pharmacological strategies may very well provide rational treatment options that would limit the age-associated increase in ROM generation, reduce mtDNA damage, and reduce the degree of hearing loss as the organism advances in age.

The purpose of these experiments was to develop a method of isolation, amplification, and identification of cochlear mitochondrial DNA (mtDNA) from minute quantities of tissue. Additionally, studies were designed to detect mtDNA deletions (mtDNA del) from the cochlea that previously have been amplified from other organ systems and tissues. MtDNA del have been associated with many pathologies, including neurological disorders, sensorineural hearing loss, ischemia, cardiomyopathies, and aging. DNA was extracted from rat and human tissues, and polymerase chain reaction was used to amplify mtDNA sequences. A 360 base pair (bp) cytochrome-b gene product and the highly conserved ND1-16S ribosomal ribonucleic acid regions found only in mtDNA were amplified from all tissues. Preliminary studies have identified a 4834 bp mtDNA del in aged rats and a corresponding 4977 bp mtDNA del in aged humans. Additionally, preliminary results in human archival temporal bone studies reveal the presence of the 4977-bp mtDNA deletion in two out of three patients with presbycusis. The deletion was not evident in age-matched control patients without a history of presbycusis. This technique of mtDNA identification makes it possible to investigate specific mtDNA defects from a single cochlea, promoting the study of hereditary hearing loss and presbycusis at a molecular biologic level.