Otolaryngologist (ear, nose, throat)
27 years of experience
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Accepting new patients

Education ?

Medical School
University Of Alexandria (1983)
Foreign school

Awards & Distinctions ?

Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. El-Kashlan is affiliated with 4 hospitals.

Hospital Affilations

  • University of Michigan Health System
  • C.S. Mott Children's Hospital
    1500 E Medical Center Dr, Ann Arbor, MI 48109
  • University of Michigan Hospitals & Health Centers
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • Publications & Research

    Dr. El-Kashlan has contributed to 24 publications.
    Title Cochlear Implantation in the Presence of a Programmable Ventriculoperitoneal Shunt.
    Date November 2009
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    Document challenges of cochlear implantation in the presence of a ventriculoperitoneal shunt (VPS) with a programmable valve.

    Title Autoantibodies to Recombinant Human Ctl2 in Autoimmune Hearing Loss.
    Date June 2009
    Journal The Laryngoscope
    Excerpt

    Choline transporter-like protein 2 (CTL2), a 68-72 kDa inner-ear membrane glycoprotein, is a candidate target antigen in autoimmune hearing loss (AIHL). The objective of this study was to test recombinant human CTL2 as a potential target for the detection of human autoantibodies in patients with AIHL.

    Title Cochlin Isoforms and Their Interaction with Ctl2 (slc44a2) in the Inner Ear.
    Date January 2008
    Journal Journal of the Association for Research in Otolaryngology : Jaro
    Excerpt

    Choline transporter-like protein 2 (CTL2) is a multi-transmembrane protein expressed on inner ear supporting cells that was discovered as a target of antibody-induced hearing loss. Its function is unknown. A 64 kDa band that consistently co-precipitates with CTL2 from inner ear extracts was identified by mass spectroscopy as cochlin. Cochlin is an abundant inner ear protein expressed as multiple isoforms. Its function is also unknown, but it is suspected to be an extracellular matrix component. Cochlin is mutated in individuals with DFNA9 hearing loss. To investigate the CTL2-cochlin interaction, antibodies were raised to a cochlin-specific peptide. The antibodies identify several cochlin polypeptides on western blots and are specific for cochlin. We show that the heterogeneity of the cochlin isoforms is caused, in part, by in vivo post-translational modification by N-glycosylation and, in part, caused by alternative splicing. We verified that antibody to CTL2 co-immunoprecipitates cochlin from the inner ear and antibody to cochlin co-immunoprecipitates CTL2. Using cochlear cross-sections, we show that CTL2 is more widely distributed than previously described, and its prominent expression on cells facing the scala media suggests a possible role in homeostasis. A prominent but previously unreported ribbon-like pattern of cochlin in the basilar membrane was demonstrated, suggesting an important role for cochlin in the structure of the basilar membrane. CTL2 and cochlin are expressed in close proximity in the inner sulcus, the spiral prominence, vessels, limbus, and spiral ligament. The possible functional significance of CTL2-cochlin interactions remains unknown.

    Title Facial Nerve Outcomes in Middle Cranial Fossa Vs Translabyrinthine Approaches.
    Date January 2006
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach.

    Title Corticosteroid Response and Supporting Cell Antibody in Autoimmune Hearing Loss.
    Date September 2005
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To determine whether antibodies to supporting cells are associated with response to corticosteroids in patients with autoimmune sensorineural hearing loss. DESIGN: Prospective analysis of antibody to inner-ear antigens. SETTING: Collaborating otology practices in Pennsylvania, Michigan, and Indiana. PATIENTS: Sixty-three patients with rapidly progressive unilateral or bilateral sensorineural hearing loss of unknown cause suggestive of autoimmune sensorineural hearing loss. INTERVENTIONS: Pretreatment audiometry, serum analysis by Western blot (WB) and immunofluorescence (IF) tests, corticosteroid therapy, and follow-up audiometry. MAIN OUTCOME MEASURES: Antibody reactivity and audiogram changes were analyzed for association with response to treatment. RESULTS: More than half of the patients (37/63) had antibodies to both a 68- to 72-kDa protein and to inner-ear supporting cells, 16 patients had positive results on one assay only, and 10 had negative results on both. Twenty-eight patients improved and 35 did not. The WB findings did not correlate with response. Of the WB-positive patients, 49% (21/43) improved, as did 35% (7/20) of the WB-negative patients (P = .30). In contrast, 53% (25/47) of IF-positive patients improved, compared with only 19% (3/16) in the IF-negative group (P = .02). Of those who improved, 89% (25/28) were IF positive. CONCLUSIONS: Antibody to an inner-ear supporting cell antigen was significantly associated with hearing improvement after corticosteroid therapy (relative rate, 2.8). Patients with IF-positive serum are nearly 3 times more likely to experience improved hearing with corticosteroid treatment than those who are IF negative. Antibodies to inner-ear supporting cell antigen may have value in diagnosis and treatment of patients with autoimmune sensorineural hearing loss.

    Title Chronic Pseudomonas Infections of Cochlear Implants.
    Date September 2005
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To discuss chronic, refractory Pseudomonas infections of cochlear implants and their management. DESIGN: Retrospective case series. SETTING: Two university-based cochlear implant programs. PATIENTS: Twenty-eight-year-old (Case 1) and 4-year-old (Case 2), different devices. INTERVENTIONS: Medical and surgical management. MAIN OUTCOME MEASURES: Clinical course. RESULTS: Both patients had delayed presentations, 4 months and 3 years postimplantation, respectively, with fluctuating scalp edema and pain resistant to multiple courses of oral antibiotics. Infections began as localized granulation and progressed to complete encasement of both devices with rubbery, poorly vascularized tissue. In each case, two different strains of multiresistant Pseudomonas aeruginosa were cultured. Infections progressed despite local debridement and targeted antipseudomonal antibiotic coverage, and sensitive organisms continued to appear in cultures of refractory granulation tissue. Both patients underwent partial explantation, with the electrode array left in the cochlea, then received 2 to 3 more months of further medical therapy and observation and then were reimplanted successfully with new devices. Both have shown excellent performance and no sign of recurrent infection. CONCLUSIONS: Infections of cochlear implants are uncommon, and cases of successful conservative management without device explantation have been reported. However, our experience and the implanted device literature suggest that chronic Pseudomonas infections may represent a distinct clinical entity, likely to fail protracted therapy and ultimately require device removal. Fortunately, successful reimplantation is possible.

    Title Prediction of Long-term Facial Nerve Outcomes with Intraoperative Nerve Monitoring.
    Date September 2005
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: Evaluate the utility of a statistical equation using two independent intraoperative monitoring parameters in predicting long-term facial nerve function. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care hospital. PATIENTS: Sixty patients undergoing resection of vestibular schwannomas with intraoperative facial nerve monitoring at a single institution. INTERVENTION: All patients underwent microsurgical resection of vestibular schwannomas with the use of intraoperative cranial nerve monitoring. MAIN OUTCOME MEASURE: Final facial nerve outcome measured using the House-Brackmann scale at least 6 months after microsurgical resection. RESULTS: Five out of 60 (8.3%) patients demonstrated significant long-term weakness (i.e., House-Brackmann grade III or worse). Intraoperative monitoring parameters (proximal stimulation threshold, proximal-to-distal response amplitude ratio) were accurate in predicting increased risk of long-term facial nerve dysfunction when used in a logistic regression model. A Student's t test confirmed the equation result was statistically significant in differentiating long-term facial nerve outcomes. CONCLUSION: Patients with immediate weakness are at higher risk of having long-term poor facial nerve function. The use of intraoperative monitoring parameters was reliable in predicting facial nerve outcomes. Patients with permanent facial nerve dysfunction often require rehabilitative procedures. The ability to predict facial nerve outcomes with intraoperative monitoring may allow early rehabilitative procedures to improve quality of life and prevent ocular complications.

    Title Cochlear Implantation in the Chronically Diseased Ear.
    Date January 2005
    Journal Current Opinion in Otolaryngology & Head and Neck Surgery
    Excerpt

    PURPOSE OF REVIEW: The presence of chronic ear disease in patients with profound SNHL presents a challenge to the otologic surgeon and was considered, in the past, a contraindication to cochlear implantation. This review discusses options for cochlear implantation in patients with chronically diseased ears. RECENT FINDINGS: Several management options are available for cochlear implantation in patients with chronic suppurative otitis media (CSOM) and severe to profound sensorineural hearing loss (SNHL). CONCLUSION: Cochlear implantation can be safely achieved in patients with CSOM. The approach chosen should be individualized based on clinical findings.

    Title Effects of Trigeminal Ganglion Stimulation on the Central Auditory System.
    Date September 2004
    Journal Hearing Research
    Excerpt

    A projection from the trigeminal ganglion to the ventral cochlear nucleus (VCN) of the guinea pig was recently described. The synaptic terminals of this projection terminate in the granule and magnocellular regions of the VCN. Stimulation of this projection has been shown to result in activation of neurons of the ventral cochlear nucleus. We investigated the effect of electrically stimulating the trigeminal ganglion on the central auditory system activity using 2-deoxyglucose (2-DG) autoradiographic techniques. Electrical stimuli were applied to the left trigeminal ganglion as bipolar pulses, 100 micros per phase, at intervals of 200 ms and an amplitude of 100 microA. Negative control animals were not stimulated. A positive control animal was stimulated in the left ear using a 1 kHz tone burst with 200 ms duration and an amplitude of 80 dB SPL. 2-DG was administered by intramuscular injection. Following a 1 h incorporation period, animals were sacrificed, the brains rapidly harvested, and prepared for autoradiography using standard techniques. Autoradiographs were analyzed using computer-assisted video densitometry to determine film optical density in the central auditory regions of interest. The cerebellum was also sampled as a gray matter indifferent intra-brain control region. Results showed systematic and significant differences between 2-DG uptake in the cochlear nucleus and higher auditory centers between control and stimulated animals. Trigeminally stimulated animals showed significantly higher uptake than unstimulated animals in all auditory centers examined, especially ipsilateral to the stimulation site. The activation pattern differs qualitatively from that seen with sound stimulation in that mainly contralateral pathways are activated with sound stimulation. These results demonstrate that a projection from the predominantly somatosensory trigeminal ganglion can influence the activity of central auditory neurons in a manner distinct from acoustic stimulation, suggesting activation of non-classical auditory pathways.

    Title Pediatric Cochlear Implant Patient Performance As a Function of Age at Implantation.
    Date July 2004
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: The objective of this study was to examine the effect that age at implantation has on performance of children who received multichannel cochlear implants. STUDY DESIGN: This is a retrospective study of 295 children who were broken down into 5 age groups based on age at implantation: 1-3 years, 3-5 years, 5-7 years, 7-9 years, and 9-11 years. Speech perception test scores obtained 12, 24, and 36 months postactivation were compared for the 5 groups using repeated-measures analysis of variance. SETTING: This study was carried out at a tertiary academic medical center. PATIENTS: Subjects consisted of 295 children who ranged in age from 12 months to 10 years 11 months at the time they obtained their cochlear implant. INTERVENTION: All patients received their cochlear implant at a single implant facility. MAIN OUTCOME MEASURES: Performance on several speech perception tests was compared 12, 24, and 36 months postactivation. Performance was evaluated as a function of age at implantation. RESULTS: Patients in all 5 groups demonstrated improved scores when compared with scores obtained preoperatively with hearing aids. Repeated-measures analysis of variance (ANOVA) revealed a significant group by time interaction for 3 of the 5 measures. For all three of these measures, children implanted at younger ages demonstrated greater gains in speech perception over time than children implanted at older ages. CONCLUSIONS: These results are in agreement with those of previous studies indicating that early implantation facilitates improved development of speech perception skills in profoundly deaf children.

    Title Identification and Characterization of Choline Transporter-like Protein 2, an Inner Ear Glycoprotein of 68 and 72 Kda That is the Target of Antibody-induced Hearing Loss.
    Date May 2004
    Journal The Journal of Neuroscience : the Official Journal of the Society for Neuroscience
    Excerpt

    The Kresge Hearing Research Institute-3 (KHRI-3) antibody binds to a guinea pig inner ear supporting cell antigen (IESCA) and causes hearing loss. To gain insight into the mechanism of antibody-induced hearing loss, we used antibody immunoaffinity purification to isolate the IESCA, which was then sequenced by mass spectroscopy, revealing 10 guinea pig peptides identical to sequences in human choline transporter-like protein 2 (CTL2). Full-length CTL2 cDNA sequenced from guinea pig inner ear has 85.9% identity with the human cDNA. Consistent with its expression on the surface of supporting cells in the inner ear, CTL2 contains 10 predicted membrane-spanning regions with multiple N-glycosylation sites. The 68 and 72 kDa molecular forms of inner ear CTL2 are distinguished by sialic acid modification of the carbohydrate. The KHRI-3 antibody binds to an N-linked carbohydrate on CTL2 and presumably damages the organ of Corti by blocking the transporter function of this molecule. CTL2 mRNA and protein are abundantly expressed in human inner ear. Sera from patients with autoimmune hearing loss bind to guinea pig inner ear with the same pattern as CTL2 antibodies. Thus, CTL2 is a possible target of autoimmune hearing loss in humans.

    Title Cochlear Implantation in Prelingually Deaf Children with Ossified Cochleae.
    Date September 2003
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To evaluate the effects that degree of cochlear ossification has on performance of prelingually deafened children who receive cochlear implants. STUDY DESIGN: A matched-pairs analysis comparing speech perception results obtained 6 and 24 months after implant by children with ossified and nonossified cochleae. Additionally, long-term performance was evaluated in patients with follow-up periods longer than 24 months. Comparisons were also performed within the ossified cochleae group to determine if degree of cochlear ossification and surgical technique affected outcome with the cochlear implant.SETTING Large cochlear implant program in an academic tertiary care medical center. PATIENTS: Twenty-one pairs of prelingually deaf children with and without cochlear ossification. Meningitis was the etiology of hearing loss in children with ossified cochleae. The control group had nonmeningitic etiology for the hearing loss. INTERVENTIONS: Multichannel cochlear implantation and routine postoperative auditory rehabilitation and performance evaluation. MAIN OUTCOME MEASURES: Speech perception category ratings based on scores obtained on a battery of closed- and open-set speech recognition tests 6 and 24 months after implant. Longer follow-up period is also reported. RESULTS: As a group, children with cochlear ossification showed significant improvement in their speech perception abilities 6 and 24 months after implant. Children with cochlear ossification performed at a significantly lower speech perception category than a group of matched controls with nonossified cochleae at both the 6- and 24-month postimplant intervals. With longer implant use, open-set speech recognition was possible in some children with ossification. Within-group analysis of the children with ossified cochleae revealed that degree of ossification and surgical procedure used for implantation did not significantly affect outcome. CONCLUSIONS: Prelingually deafened children with postmeningitic hearing loss and ossified cochleae receive significant benefit from cochlear implants. Their performance is frequently poorer, however, than children with nonossified cochleae.

    Title External Auditory Canal Closure in Cochlear Implant Surgery.
    Date August 2003
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To evaluate surgical techniques and complications associated with external auditory canal (EAC) closure in cochlear implant surgery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with a large cochlear implant program. PATIENTS: Twenty-eight patients (8 adults and 20 children) underwent multichannel cochlear implantation with EAC closure. The follow-up periods ranged between 1 and 10 years. Closure of the EAC was performed in conjunction with implantation of ears with chronic suppurative otitis media or cochlear drill-out procedures for ossification, or for access to the cochlea in patients with abnormal temporal bone anatomy. A modified Rambo technique was used for EAC closure in all but one case. INTERVENTIONS: Cochlear implantation with EAC closure and subsequent clinical and radiologic follow-up. MAIN OUTCOME MEASURES: Postoperative complications or the development of cholesteatoma in the implanted ear. RESULTS: Cholesteatoma developed in the implanted ear in two patients. Breakdown of EAC closure occurred in one of these patients. The details of these patients are reviewed. CONCLUSION: Closure of EAC can be done with relatively low risk. Close and careful follow-up is required for early detection of a developing cholesteatoma.

    Title Cochlear Implantation in Chronic Suppurative Otitis Media.
    Date June 2002
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To evaluate management options for cochlear implantation in patients with chronic suppurative otitis media. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with a large cochlear implant program. PATIENTS: Ten patients with chronic suppurative otitis media who received cochlear implants were identified. Case history, etiology of hearing loss, and management of the ear with the implant were evaluated. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. MAIN OUTCOME MEASURES: Early and late complications were evaluated. RESULTS: No early or late complications were identified in this group of patients after an average follow-up period of about 4 years. CONCLUSION: Cochlear implantation can be safely achieved in patients with chronic suppurative otitis media. There are several options for the management of these patients, and the approach chosen should be individualized on the basis of clinical findings.

    Title Selective Cricothyroid Muscle Reinnervation by Muscle-nerve-muscle Neurotization.
    Date October 2001
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To determine if selective reinnervation of the cricothyroid muscle could be achieved with muscle-nerve-muscle neurotization. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Three consecutive patients with high vagal lesions that resulted in unilateral laryngeal paralysis. INTERVENTIONS: Patients underwent laryngeal reinnervation with ansa hypoglossi to recurrent laryngeal nerve anastomosis. In addition, patients underwent selective cricothyroid muscle reinnervation by muscle-nerve-muscle neurotization technique. MAIN OUTCOME MEASURES: Objective and subjective improvement in voice quality and electromyographic evidence of selective reinnervation of the cricothyroid muscle. RESULTS: All patients recovered normal or near-normal speaking voice and had normal objective measures of voice quality. They also showed electromyographic evidence of cricothyroid muscle reinnervation. CONCLUSION: The muscle-nerve-muscle neurotization technique was successful in providing selective reinnervation of the cricothyroid muscle in our 3 patients.

    Title Multichannel Cochlear Implantation in Visually Impaired Patients.
    Date August 2001
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To evaluate the outcome of cochlear implantation in patients with severe to profound hearing loss and visual impairment. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with a large cochlear implant program. PATIENTS: Six adults and two children with severe or profound hearing loss and significant visual impairment underwent multichannel cochlear implantation. Follow-up period ranged from 6 months to 9 years. Case history, etiology of visual and hearing loss, and benefit from cochlear implant were evaluated. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. MAIN OUTCOME MEASURES: Speech perception measures were selected based on the patient age and cognitive abilities. Identical measures were used in each patient before and after implantation. RESULTS: As a group, patients did well after cochlear implantation. There was significant improvement in speech perception when compared with the score before implantation. CONCLUSIONS: Cochlear implants can play a significant rehabilitative role in patients with severe visual and auditory impairment. Additional skills are required by the implant team for rehabilitation of patients with multiple sensory deficits.

    Title Auditory Brain Stem Response in Small Acoustic Neuromas.
    Date November 2000
    Journal Ear and Hearing
    Excerpt

    OBJECTIVE: The auditory brain stem response (ABR) has been criticized recently as an insensitive measure for the detection of small acoustic neuroma (AN). This study was undertaken to evaluate our experience with the efficacy of ABR in detection of small tumors. STUDY DESIGN: Retrospective case review. Twenty-five patients with surgically proven small ANs measuring 1 cm or less were reviewed. In addition, 568 patients who underwent screening ABR were reviewed to evaluate the rate of false positive results at our institution. RESULTS: ABR was abnormal in 92% of patients with small AN in this series. Screening ABR was abnormal in approximately 19% of cases, one-third of which were found to have AN on magnetic resonance imaging testing. CONCLUSION: With strict adherence to optimal technique and evaluation criteria, the ABR remains a viable option for AN screening, especially in elderly patients or when there is a low index of suspicion.

    Title Diagnosis and Initiating Treatment for Peripheral System Disorders: Imbalance and Dizziness with Normal Hearing.
    Date August 2000
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Disorders affecting the peripheral vestibular system commonly involve the peripheral auditory system causing hearing loss. There are a number of disorders, however, that selectively involve the peripheral vestibular system causing dizziness without hearing loss. These disorders include benign paroxysmal positional vertigo, vestibular neuritis, recurrent vestibulopathy, familial vestibulopathy, and bilateral idiopathic vestibulopathy. This article reviews these disorders and their diagnosis and management.

    Title Recurrence of Acoustic Neuroma After Incomplete Resection.
    Date August 2000
    Journal The American Journal of Otology
    Excerpt

    OBJECTIVE: To determine the risk of recurrent tumor in patients after incomplete resection of acoustic neuroma. STUDY DESIGN: Retrospective case review. SETTING: A tertiary referral center. PATIENTS: Thirty-nine patients were identified who underwent incomplete resection of acoustic neuroma between January 1988 and December 1993, and had a minimum follow-up of 3.5 years, at a mean of 6.2 years (range 3.5-10.2 years). INTERVENTION: Regular follow-up. using either computed axial tomography or magnetic resonance imaging yearly. MAIN OUTCOME MEASURES: Growth of residual tumor as determined by the increase in its greatest dimension on follow-up imaging studies and the necessity for additional treatment. RESULTS: Tumor regrowth occurred in 17 patients (44%). Ten patients (26%) required additional treatment during the follow-up period. CONCLUSION: This study suggests that incomplete resection of acoustic neuroma is associated with a significant risk of recurrent tumor requiring subsequent intervention.

    Title Jugular Diverticulum: Clinical Significance.
    Date May 2000
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Minimizing Wound Complications in Cochlear Implant Surgery.
    Date September 1999
    Journal The American Journal of Otology
    Excerpt

    OBJECTIVE: An extended postauricular incision has replaced the standard C-shaped scalp flap for cochlear implant surgery at our institution. The postoperative wound complication rates of the two incisions were evaluated. STUDY DESIGN: This study was a retrospective case review. SETTING: This study was performed in a tertiary referral center. PATIENTS: A total of 256 adult and pediatric patients who underwent cochlear implantation during a 10-year period (1986 to 1996) were reviewed. MAIN OUTCOME MEASURE: Postoperative wound complications were identified. Major complications included flap necrosis, wound dehiscence with or without implant exposure, and wound infection requiring hospitalization. Hematoma, seroma, or superficial wound infections were considered minor complications. RESULTS: There were 6 major and 6 minor complications among 116 patients with the standard scalp flap (complication rate, 10.3%). There was only 1 minor complication among 140 implants using the postauricular incision (0.7%). CONCLUSION: The extended postauricular incision appears to significantly reduce the incidence of wound complications in cochlear implant surgery.

    Title Disability from Vestibular Symptoms After Acoustic Neuroma Resection.
    Date April 1998
    Journal The American Journal of Otology
    Excerpt

    OBJECTIVE: This study aimed to evaluate the recovery of balance function after acoustic neuroma resection. STUDY DESIGN: This study was a retrospective case review with patient survey. SETTING: The surgery was conducted at a tertiary referral center. PATIENTS: Patients who underwent surgical resection of acoustic neuroma and had preoperative vestibular function testing were eligible for entering the study. INTERVENTIONS: All patients received surgical resection of acoustic neuroma. Patients treated since 1990 received postoperative vestibular habituation exercises. MAIN OUTCOME MEASURES: These included postoperative symptom and disability scores, dizziness handicap inventory (DHI) total and subset scores, time after surgery at which patients were able to walk independently, whether patients returned to their usual professional responsibility, and time to return to full activities at work. RESULTS: Significant correlation was found between several preoperative symptoms and vestibular testing results and the resulting postoperative disability from dizziness. CONCLUSIONS: This information may be helpful in counseling patients before surgery with respect to the degree of postoperative dysequilibrium and may suggest that the clinician should initiate more aggressive vestibular rehabilitation exercises in patients who may be at greater risk of having persistent dysequilibrium develop after surgery.

    Title Evaluation of Clinical Measures of Equilibrium.
    Date March 1998
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities. STUDY DESIGN: Cross-sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients. SETTING: Academic tertiary care referral center. PARTICIPANTS: Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction. RESULTS: Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction. CONCLUSION: Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.

    Title Role of Electrically Evoked Auditory Brainstem Response in Cochlear Implantation of Children with Inner Ear Malformations.
    Date
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To evaluate the usefulness of promontory electric auditory brainstem response (EABR) testing in children with inner ear malformations before cochlear implantation indicated by postoperative speech performance. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary academic cochlear implant center. PATIENTS: Forty-three children with congenital inner ear malformations, of which 39 received a cochlear implant. Age at implant ranged from 12 months to 13 years. Patients were categorized into 3 groups based on the type of malformations. Groups 1 and 2 involved malformations of the cochlea and/or vestibular organ. Group 3 consisted of children with narrow internal auditory canal. INTERVENTIONS: Preoperative EABR testing with threshold, Wave V amplitude, and latency determination. MAIN OUTCOME MEASURES: Postoperative speech perception performance was measured using Glendonald Auditory Speech Perception Tests for words and sentences, Northwestern University-Children's Perception of Speech test, and minimal pairs test. Patients were further categorized into a speech perception category based on these test results. RESULTS: Mean values for EABR threshold, Wave V amplitude, and latency for Group 1 (11 patients) were 485 microA, 0.21 microV, and 4.51 milliseconds, respectively. Mean values for Group 2 (20 patients) were 556 microA, 0.26 microV, and 4.45 milliseconds, respectively. Mean values for Group 3 (8 patients) were 500 microA, 0.11 microV, and 4.65 milliseconds, respectively. Open-set sentence recognition was possible in 73% in Group 1, 30% in Group 2, and 38% in Group 3 by 36 months after implant activation. Patients with lower preoperative EABR threshold (<600 microA) had better postoperative speech performance (p < 0.05). Larger Wave V amplitude and shorter latency were associated with better speech performance. CONCLUSION: Preoperative EABR is useful in determining cochlear implant candidacy in children with inner ear malformations. Results of this study indicate that the EABR accurately predicts outcome when cochlear implant efficacy is uncertain.

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