Otolaryngologists
24 years of experience
Video profile
Accepting new patients
Dearborn
18181 Oakwood Blvd
Ste 202
Dearborn, MI 48124
(248) 218-5557
Locations and availability (1)

Education ?

Medical School Score Rankings
The Ohio State University (1986)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

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

Affiliations ?

Dr. Coticchia is affiliated with 29 hospitals.

Hospital Affilations

Score

Rankings

  • Mount Clemens Regional Medical Center
    Otolaryngology
    1000 Harrington St, Mount Clemens, MI 48043
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Grosse Pointe
    Otolaryngology
    468 Cadieux Rd, Grosse Pointe, MI 48230
    • Currently 4 of 4 crosses
    Top 25%
  • Crittenton Hospital Medical Center
    Otolaryngology
    1101 W University Dr, Rochester, MI 48307
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital,Troy
    Otolaryngology
    44201 Dequindre Rd, Troy, MI 48085
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Royal Oak
    Otolaryngology
    3601 W 13 Mile Rd, Royal Oak, MI 48073
    • Currently 3 of 4 crosses
    Top 50%
  • POH Medical Center
    Otolaryngology
    50 N Perry St, Pontiac, MI 48342
    • Currently 3 of 4 crosses
    Top 50%
  • Detroit Receiving Hospital & University Health Center
    Otolaryngology
    4201 Saint Antoine St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Oakwood Hospital and Medical Center
    Otolaryngology
    18101 Oakwood Blvd, Dearborn, MI 48124
    • Currently 3 of 4 crosses
    Top 50%
  • Harper University Hospital
    Otolaryngology
    3990 John R St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • St. Joseph Mercy Oakland
    Otolaryngology
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 3 of 4 crosses
    Top 50%
  • DMC - Sinai-Grace Hospital
    Otolaryngology
    6071 W Outer Dr, Detroit, MI 48235
    • Currently 3 of 4 crosses
    Top 50%
  • Huron Valley-Sinai Hospital
    Otolaryngology
    1 William Carls Dr, Commerce Township, MI 48382
    • Currently 2 of 4 crosses
  • Ingham Regional Medical Center
    Otolaryngology
    401 W Greenlawn Ave, Lansing, MI 48910
    • Currently 2 of 4 crosses
  • Royal Oak (7 Years
  • Children's Hospital of Michigan
    3901 Beaubien St, Detroit, MI 48201
  • Sinai-Grace Hospital
    6071 W Outer Dr, Detroit, MI 48235
  • Oakwood Hospital
  • Sinai-Grace
  • Pontiac Osteopathic Hospital
  • Karmanos Cancer Center
    4100 John R St, Detroit, MI 48201
  • POH Regional Medical Center
  • Detroit Receiving Hospital
  • Childrens Hospital of Pittsburgh
  • Detroit Receiving - UHC
  • Royal Oak
  • Harper Hospital
  • Detroit Receiving
  • Hutzel Women's Hospital
    3980 John R St, Detroit, MI 48201
  • Barbara Ann Karmanos Cancer Institute
  • Publications & Research

    Dr. Coticchia has contributed to 25 publications.
    Title Systematic Review of Endoscopic Airway Findings in Children with Gastroesophageal Reflux Disease.
    Date March 2011
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    We performed a systematic review of published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease.

    Title Identification of Adenoid Biofilms with Middle Ear Pathogens in Otitis-prone Children Utilizing Sem and Fish.
    Date October 2009
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Biofilms have been implicated in the development of several chronic infections. We sought to demonstrate middle ear pathogens in adenoid biofilms using scanning electron microscopy (SEM) and fluorescent in situ hybridization (FISH) with confocal laser scanning microscopy (CLSM).

    Title Correlating the Clinical Course of Recurrent Croup with Endoscopic Findings: a Retrospective Observational Study.
    Date August 2008
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    OBJECTIVES: We sought to correlate endoscopic findings with the clinical course of recurrent croup. METHODS: Children were classified as having recurrent croup if they had had 2 or more episodes of barky cough, inspiratory stridor, and hoarseness. All study participants underwent direct laryngoscopy and bronchoscopy and were started on an antireflux regimen. A telephone questionnaire assessed the child's symptoms and treatment response. RESULTS: Forty-seven children with recurrent croup were seen in our otolaryngology outpatient clinic. Demographics included a male-to-female ratio of 1.6 to 1 and an age range of 1 month to 11 years (median, 20 months). Thirty patients (63.8%) had a medical history of asthma, and 10 (21.3%) came with a prior diagnosis of gastroesophageal reflux. Gastroesophageal reflux-related laryngopharyngeal changes were seen during direct laryngoscopy and bronchoscopy in 87.2%. Of those with survey follow-up, 87.5% had improvement of respiratory symptoms after a 6- to 9-month course of antireflux medications. This finding was further reflected in a decreased number and duration of episodes (p < .0001). CONCLUSIONS: The underlying narrowing process of recurrent croup can be attributed to gastroesophageal reflux and should be considered in any child with persistent barky cough, inspiratory stridor, and hoarseness. To confirm the diagnosis, diagnostic methods should be correlated with symptom progression after treatment initiation.

    Title Recurrent Croup Presentation, Diagnosis, and Management.
    Date February 2008
    Journal American Journal of Otolaryngology
    Excerpt

    PURPOSE: The lack of clinical insight into recurrent croup often leads to underdiagnosis of an upper airway lesion, and subsequently, inadequate treatment. This study examined the underlying etiology, diagnosis, treatment, and clinical outcome of patients with a history of recurrent croup identified at initial presentation. The aim was to present common diagnostic features and suggest new diagnostic and management recommendations. MATERIALS AND METHODS: A retrospective chart review of 17 children diagnosed with recurrent croup. Demographic, historical, and intraoperative data as noted in clinic charts were collected. Specific collected data included age, sex, chief complaint, presenting symptoms, past medical history, previous medication history, number of emergency room visits and inpatient admissions, tests/procedures performed and corresponding findings, current treatment given, and posttreatment clinical outcome. RESULTS: Six (35.3%) patients presented initially with a past medical history of gastroesophageal reflux disease. Fourteen (82.3%) patients had positive endoscopic evidence of gastroesophageal reflux. For these 14 patients, 44 laryngopharyngeal reflux lesions were noted, with 32 (72.7%) occurring in the subglottis. All 14 patients demonstrated various degrees of subglottic stenosis ranging from 30% to 70% (Cotton-Myer grade I-II). All 17 patients (100%) demonstrated subglottic stenosis ranging from 15% to 70% airway narrowing. CONCLUSIONS: History suggestive of recurrent croup requires close monitoring and expedient direct laryngoscopy/bronchoscopy for diagnosis. Long-term follow-up and antireflux treatment are necessary as well as endoscopic documentation of significant reflux resolution.

    Title Management of Refractory Chronic Rhinosinusitis in Children.
    Date February 2007
    Journal American Journal of Otolaryngology
    Excerpt

    OBJECTIVE: Pediatric chronic rhinosinusitis (CRS) continues to be a difficult problem for the medical community. Traditionally, oral antibiotic therapy has been the cornerstone of treatment, but some patients, who are resistant to multiple trials of oral antibiotics, require alternative therapeutic modalities. One such option, the use of intravenous (IV) antibiotics, has shown a high success rate in a limited study. Our goal is to estimate the success of a therapy consisting of culture directed IV antibiotics, adenoidectomy, and sinus aspiration in ameliorating long-term (>12 months) clinical symptoms of CRS in pediatric patients who are resistant to oral antibiotic therapy. METHODS: We conducted a retrospective review of the medical records of 22 patients who received treatment, focusing on patient age, initial CRS presenting symptoms, computed tomography scan finding, length, duration, and type of prior oral antibiotic treatment, length and type of IV antibiotic treatment, and long-term follow-up of clinical symptom resolution. RESULTS: Initial clinical improvement after cessation of IV therapy was achieved in all 22 (100%) patients. Seventeen (77%) of the patients demonstrated long-term resolution of clinical symptoms of CRS. Excluding 4 immunocompromised patients, 16 of 18 (89%) of patients demonstrated long-term amelioration of CRS symptoms. CONCLUSIONS: The results suggest that IV antibiotics may prove beneficial for pediatric patients who demonstrate CRS not responsive to traditional oral therapy. Although other treatment options are currently available for this subpopulation of patients, this IV antibiotic therapy provides both a maximally effective outcome while using a relatively minimally invasive intervention.

    Title Identification of Helicobacter Pylori Biofilms in Human Gastric Mucosa.
    Date December 2006
    Journal Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
    Excerpt

    The purpose of this study was to use endoscopically directed biopsies and scanning electron microscopy (SEM) to document the existence of Helicobacter pylori biofilms in human gastric mucosa. Patients underwent flexible esophagogastroduodenoscopies with three gastric mucosal biopsies. Rapid urease testing was performed to determine the presence or absence of H pylori. Urease-positive and urease-negative control specimens were imaged with SEM to obtain detailed images of gastric mucosa for the identification of biofilm colonies. Samples were obtained from patients who underwent esophagogastroduodenoscopies. Eleven were found to be H pylori positive and nine were H pylori negative. These were imaged at 500x and 1000x with electron microscopy. Dense, mature biofilms were present and attached to the cell surface of H pylori-positive specimens and were absent in urease-negative controls. Photomicrographs were obtained. Biofilms are complex microbiological ecosystems where sessile bacteria surround themselves in a protective matrix. This lifestyle affords protection, allows for growth in hostile environments, and alters host physiology. Many have hypothesized that H pylori infections resulting in gastric ulcers may be a manifestation of biofilms. Our investigation is the first to photographically document the existence of H pylori biofilms on human gastric mucosa. This elucidation of the ecology and pathophysiology of the mucosa of the organism is important to our understanding of a potential mechanism of this organism's resistance to current therapy and how to better eradicate it in the future.

    Title Presence and Density of Helicobacter Pylori Biofilms in Human Gastric Mucosa in Patients with Peptic Ulcer Disease.
    Date November 2006
    Journal Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
    Excerpt

    Our purpose was to use endoscopically directed biopsies and scanning electron microscopy to quantify Helicobacter pylori biofilm density on the surface of human gastric mucosa in urease-positive and -negative patients. Participating patients underwent flexible esophago-gastro-duodenoscopies coupled with gastric mucosal biopsies. Rapid urease testing was performed on all specimens to determine the presence of H. pylori, followed by scanning electron microscopy to identify the existence of biofilms. Samples were then analyzed using Carnoy Image Analysis Software to determine percent biofilm coverage of the total surface area. These data were compared to control specimens that were urease negative. Of the patients who tested urease positive for H. pylori, the average percent of total surface area covered by biofilms was 97.3%. Those testing negative had an average surface area coverage of only 1.64%. These differences were determined to be statistically significant at the 0.0001 level. This study demonstrates that compared with controls, urease-positive specimens have significant biofilm formation, whereas urease-negative specimens have little to none. This was reflected in the significantly increased biofilm surface density in urease positive specimens compared with urease-negative controls.

    Title Temperature-controlled Radiofrequency Treatment of Tonsillar Hypertrophy for Reduction of Upper Airway Obstruction in Pediatric Patients.
    Date May 2006
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVES: To determine if temperature-controlled radiofrequency (TCRF) tonsil reduction and adenoidectomy (TCRF&A) and conventional tonsillectomy and adenoidectomy (T&A) are statistically similar in outcome and to compare morbidity between TCRF&A and conventional T&A. DESIGN: Randomized control trial. SETTING: Tertiary care children's hospital. PARTICIPANTS: The study population comprised 23 patients aged 2.6 to 12.5 years with symptoms of obstructive sleep apnea, hypertrophic tonsils with no other areas of upper airway obstruction with the exception of hypertrophic adenoids, and a body mass index (calculated as weight in kilograms divided by the square of height in meters) of less than 30. INTERVENTION: Temperature-controlled radiofrequency tonsil reduction (mean +/- SD, 12.6 +/- 1.5 ablations per patient and 994.68 +/- 91.88 J per insertion) and adenoidectomy or traditional bovie T&A. MAIN OUTCOME MEASURES: Primary outcomes were respiratory distress index and total volume reduction. Secondary outcomes include postoperative pain, daytime sleepiness, speech and swallowing problems, weight and diet, narcotic use, and analogue snoring scale. RESULTS: The respiratory distress index difference for TCRF&A was 5.63 vs 6.56 for standard T&A. On postoperative day 1 for the 13 patients who underwent TCRF&A, 0 reported severe pain, 11 (85%) had mild to moderate pain, and 2 (15%) had no pain. In the 10 patients who underwent standard T&A, 1 (10%) had severe pain and 9 (90%) had mild to moderate pain. By postoperative week 1, all TCRF&A patients experienced mild or no pain, whereas 1 (10%) of the standard T&A patients still had moderate pain. Mean visual analogue snore scores (0-10) 4 weeks after surgery were less than 1 for both groups. The mean +/- SD weight loss at postoperative week 1 for TCRF tonsil reduction patients was 1.0 +/- 3.5 lb (0.45 +/- 1.58 kg) vs 4.6 +/- 3.9 lb (2.07 +/- 1.76 kg) for standard T&A patients. Return to normal diet at postoperative week 1 occurred in 11 TCRF&A patients (85%) and 0 standard T&A patients. CONCLUSIONS: The respiratory distress indexes were similar for TCRF&A patients and standard T&A patients. In addition, there were similar analog snoring scales, decreased pain, and weight loss.

    Title Characteristics of Sensorineural Hearing Loss in Children with Inner Ear Anomalies.
    Date April 2006
    Journal American Journal of Otolaryngology
    Excerpt

    PURPOSE: To determine whether hearing loss in children with inner ear anomalies has some distinctive characteristics when compared to children with hearing loss but without inner ear anomalies. METHODS: Temporal bone computed tomography scans of 69 patients with sensorineural hearing loss were examined for inner ear abnormalities of which 17 were identified. The medical histories of these patients were reviewed for the characteristics of their hearing loss, including initial presentation, natural history, and nature of loss, as well as the family history of hearing loss and risk factors for hearing loss. These were compared to age-matched controls with hearing loss but without inner ear anomalies. RESULTS: Seventeen patients had inner ear anomalies. Records of 14 of these patients were compared to patients without inner ear anomalies. Regarding age of onset, 71.4% of patients with anomalies had onset of their hearing loss at less than 2 years old vs 78.6% without anomalies. Regarding unilateral vs bilateral, 42.9% of patients with anomalies were unilateral vs 28.6% of patients without anomalies. For patients with anomalies, 85.7% were stable and 14.3% were progressive; without anomalies, 71.4% were stable, 21.4% were progressive, and 7.1% were fluctuating. Regarding family history, only 14.3% of patients without anomalies had a positive family history vs 56% of patients with anomalies. CONCLUSIONS: Children with inner ear anomalies and sensorineural hearing loss have an increased incidence of unilateral hearing loss and stable hearing loss as compared to controls with sensorineural hearing loss without inner ear anomalies. In addition, children with inner ear anomalies and sensorineural hearing loss are less likely to have a family history of hearing loss.

    Title Tracheomalacia Secondary to Obstructive Sleep Apnea.
    Date March 2006
    Journal American Journal of Otolaryngology
    Excerpt

    Tracheomalacia (TM) is abnormal flaccidity of the trachea caused by inadequate cartilaginous support by the C-shaped tracheal rings. This defect generally results in various degrees of dynamic narrowing of the airway lumen. TM usually presents with expiratory stridor, wheeze, and respiratory obstruction. TM is usually associated with tracheoesophageal fistula and esophageal atresia or with other thoracic lesions of vascular rings and tumors. We report a well-documented case of a 20-month-old boy who presented to our institution with a severe history of obstructive sleep apnea and adenotonsillar hypertrophy. On direct laryngoscopy/bronchoscopy, severe TM was noted. Tonsillectomy and adenoidectomy was performed, and by the 37th postoperative day, the TM had completely resolved. We review the literature, discuss the differential diagnosis and clinical evaluation, and propose a new pathophysiological mechanism by which obstructive sleep apnea causes TM.

    Title Methicillin-resistant Staphylococcus Aureus Otorrhea After Tympanostomy Tube Placement.
    Date November 2005
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To compare a retrospective cohort of nonhospitalized children with methicillin-resistant Staphylococcus aureus (MRSA) otorrhea with those with methicillin-sensitive S aureus (MSSA) otorrhea to determine the risk factors predisposing to MRSA otorrhea and the treatments used. DESIGN: Retrospective case-controlled series. SETTING: Tertiary pediatric care facility. PATIENTS: Seventeen children with MRSA otorrhea after bilateral myringotomy with tympanostomy tube insertion (BM&T) and 19 age- and sex-matched control subjects who demonstrated MSSA otorrhea. The average age at culture in MRSA patients was 52 months; in MSSA patients, 54 months. There were 8 boys and 3 girls in the MRSA group and 8 boys and 4 girls in the MSSA group. INTERVENTIONS: Oral, topical, and intravenous antimicrobial agents. MAIN OUTCOME MEASURES: Antibiotic exposure and history of otitis media and routine antibiotic administration (topical, oral, or intravenous). RESULTS: The following findings were statistically significant (P < or = .06, Mann-Whitney test): (1) longer duration of antibiotic treatment after BM&T for patients with MRSA vs those with MSSA; (2) increased number of episodes of acute otitis media before BM&T in patients with MRSA vs those with MSSA; and (3) increased number of courses of antibiotics after BM&T in patients with MRSA vs those with MSSA. CONCLUSIONS: Methicillin-resistant S aureus otorrhea is commonly seen as a community-acquired infection in otherwise healthy pediatric outpatients. Risk factors for development of MRSA otorrhea include the number of episodes of acute otitis media before BM&T and number of treatment courses and duration of antibiotic therapy after BM&T.

    Title Value of Rigid Bronchoscopy in the Management of Critically Ill Children with Acute Lung Collapse.
    Date September 2004
    Journal Pediatric Emergency Care
    Excerpt

    OBJECTIVE: To describe the potential uses of a rigid bronchoscopy in pediatric patients, as well as explaining the advantage of a rigid bronchoscopy versus a flexible bronchoscopy in pediatric patients with acute lung collapse. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 16-month-old male infant with a 5-day history of cough, congestion, and "wheezing" that progressively worsened. INTERVENTIONS: A rigid bronchoscopy. MEASUREMENTS AND MAIN RESULTS: The evolution of the patient's acute lobar collapse to his final discharge is described. This includes the initial presentation, primary methods employed to improve the patient's condition, the use of a rigid bronchoscopy in removing a mucous plug, and the patient's results up to his final discharge. CONCLUSION: This report demonstrates the value of rigid bronchoscopy in pediatric patients with severe atelectasis and pneumonia. Although bronchoscopy may not be indicated as an initial procedure to remove respiratory tract secretions, it may provide a beneficial option in cases where less invasive methods prove ineffective in removing secretions and mucous plugs.

    Title Age-, Site-, and Time-specific Differences in Pediatric Deep Neck Abscesses.
    Date March 2004
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To clarify presentations, organisms, and locations of deep neck abscesses in children. DESIGN: Retrospective review. SETTING: Tertiary children's hospital. The study population comprised 169 patients younger than 19 years who were surgically treated for deep neck abscesses between 1989 and 1999. MAIN OUTCOME MEASURE: Resolution of abscess. RESULTS: Neck mass (91%), fever (86%), cervical adenopathy (83%), poor oral intake (66%), and neck stiffness (59%) were common in all ages. Patients younger than 4 years, compared with patients 4 years or older, presented with agitation (50% vs 14%), cough (35% vs 14%), drooling (27% vs 12%), lethargy (46% vs 33%), oropharyngeal abnormalities (45% vs 60%), respiratory distress (5% vs 2%), retractions (5% vs 2%), rhinorrhea (53% vs 15%), stridor (4% vs 2%), and trismus (14% vs 53%). Children younger than 1 year were infected with Staphylococcus aureus (79%) vs group A streptococcus (6%). Children 1 year or older were infected with group A streptococcus (29%) vs S aureus (16%). Retropharyngeal or parapharyngeal regions were involved in children 1 year or older (49%) vs younger than 1 year (21%). Anterior or posterior triangles and submandibular or submental regions were involved in 39% and 36%, respectively, of children younger than 1 year vs 30% and 23%, respectively, of children 1 year or older. Retropharyngeal and parapharyngeal abscesses yielded group A streptococcus (34%) vs S aureus (11%). Anterior and posterior triangle abscesses yielded S aureus (35%) vs group A streptococcus (19%), as did submandibular and submental abscesses (42% vs 19%). CONCLUSIONS: Abscesses in children younger than 1 year affected anterior or posterior triangles and submandibular or submental regions, yielding S aureus. Abscesses in children 1 year or older affected retropharyngeal or parapharyngeal regions, yielding group A streptococcus.

    Title Presentation, Diagnosis, and Management of Deep-neck Abscesses in Infants.
    Date January 2003
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To clarify the presenting signs and symptoms, clinical course, pathogenic organisms, and management of deep-neck-space abscesses in infants. DESIGN: Retrospective chart review. SETTING: Tertiary care academic children's hospital. PATIENTS: Records of 25 patients 9 months or younger with deep-neck-space abscesses from July 1989 through May 1999 were reviewed. MAIN OUTCOME MEASURE: Resolution of abscess. RESULTS: Presenting symptoms included neck mass, 92% (n = 23); fever, 60% (n = 15); and dysphagia and/or poor intake by mouth, 36% (n = 9). Overall, patients were symptomatic for a mean duration of 3.8 days before presenting to the hospital; 21 of 22 evaluated patients had elevated white blood cell counts. Imaging included 68% computed tomographic scan (n = 17) and 44% plain radiographs (n = 11). On the basis of radiology and operative findings, locations of the abscesses were as follows: anterior triangle, 8; parapharyngeal, 5; posterior triangle, retropharyngeal, and undefined, 3 each; submandibular, 2; and parotid, 1. Of 17 scanned patients, 13 had some degree of airway compromise evident on computed tomography. All were treated with incision and drainage, 3 of 25 intraorally and 22 of 25 externally. Pus was identified in all 25; 20 of these grew Staphylococcus aureus, 1 grew group A Streptococcus, and 4 grew no organism. All patients received intravenous antibiotics for a mean of 4.8 days and oral antibiotics for a mean of 11 days. Only 1 patient required a second procedure. CONCLUSIONS: Deep-neck-space abscesses in infants are rapidly progressive, often cause airway compromise, and usually present with fever and neck mass. The most common pathogen is S aureus. Patients are effectively treated with incision and drainage coupled with intravenous followed by oral antibiotics.

    Title Use of Distortion Product Otoacoustic Emissions to Assess Middle Ear Transducers in Rhesus Monkeys.
    Date March 1996
    Journal The American Journal of Otology
    Excerpt

    Distortion product otoacoustic emissions (DPOAEs) can provide an objective and noninvasive assessment of the peripheral cochlear function. Auditory brainstem responses measured from implanted rhesus monkeys have shown that middle ear transducers, coupled directly to the incus, are capable of delivering the signals to the central auditory system. The DPOAEs were used as a noninvasive method of assessing the frequency specificity of this mechanical transduction. In two rhesus monkeys implanted with the middle ear transducers, one primary stimulating tone (f1) was presented acoustically, and the other primary tone (f2) was presented by the transducer, which converted the signal into a mechanical motion of the probe tip attached to the body of the incus. The nonlinear characteristics of the cochlea produced the distortion product responses at the expected frequencies (2f1 - f2). This demonstrates the fidelity of the middle ear implant signal transduction in vivo. The DPOAEs also indicate minimal changes in the post-implant middle ear transmission. This study demonstrates that the DPOAEs can be used to assess the function of implanted middle ear transducers objectively and noninvasively.

    Title Computer-stimulated Test Fitting of an Implantable Hearing Aid Using Implantable Hearing Aid Using Three-dimensional Ct Scans of the Temporal Bone: Preliminary Study.
    Date March 1996
    Journal The American Journal of Otology
    Excerpt

    In preparation for future implantation of the implantable middle ear transducer in patients, a method was sought for preoperatively test fitting a model of the device, using computer generated three-dimensional (3-D) temporal bone images derived from spiral computed tomography (CT) data. A 3-D model of the implantable middle ear transducer was designed using NIH Image software on a Macintosh computer. High resolution human temporal bone CT scans were obtained using a spiral CT scanner (Siemens Somatom Plus S). The 3-D transducer model was superimposed onto 3-D reconstructions of the temporal bone using ANALYZE software on a computer graphics workstation (Sun SPARCstation 10), showing the transducer "implanted" in the temporal bone. Measurements were validated using a cadaver temporal bone. This process produced images demonstrating the "fit" of the current transducer design in the mastoid region of the adult temporal bone. It permitted assessment of the proximity of surrounding structures such as the external auditory meatus, dura, or sigmoid sinus. Preliminary cadaver validation measurements confirmed the accuracy of this method. Three-dimensional CT is a feasible method for preoperative planning of the surgical implantation of devices in the temporal bone. This method of 3-D test fitting will be used in the future to determine optimum orientation and size limitations for human implantable devices.

    Title Distortion Product Otoacoustic Emissions in Rhesus (macaca Mulatta) Monkey Ears: Normative Findings.
    Date March 1996
    Journal Hearing Research
    Excerpt

    Distortion product otoacoustic emissions (DPOAEs) in rhesus monkeys were characterized and the optimal parameters for their generation were determined. Robust DPOAEs were readily measurable from the ear canals of six rhesus monkeys (n = 12 ears). The nonmonotonic behavior of the f2/f1 ratio functions in rhesus monkeys was found to be similar to other animals and humans. The optimal mean f2/f1 ratio of 1.21 and the effect of the primary frequency and level on the optimal f2/f1 ratios were also similar to human measurements. The contour of the rhesus monkey DPOAE 'audiograms' and their behavior were also comparable to human measurements with slight differences in peak frequencies. The rhesus monkey DPOAE input/output (I/O) functions were generally monotonic with a slope approaching unity with increasing frequency. Therefore, our study shows that many basic DPOAE characteristics are remarkably similar in the two species and emphasizes the appropriateness of the rhesus monkey as a model for DPOAE research. Detailed studies of the behavior of DPOAEs can be carried out in a model that is phylogenetically close to human both in hearing and in the gross structure and histology of the inner ear.

    Title Ongoing Investigations into an Implantable Electromagnetic Hearing Aid for Moderate to Severe Sensorineural Hearing Loss.
    Date June 1995
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Over 20 million Americans have a hearing loss that produces problems in communication. The majority of these hearing-impaired individuals would benefit from conventional hearing aids, yet only about 15% use amplification devices. Many of the reasons for the lack of use of conventional hearing aids can be resolved by an implantable middle ear device directly coupled to the ossicular chain. This article presents the advantages of the implantable middle ear device.

    Title Effect of Ktp Laser Ablation of Endochondral Bone on Bone Healing.
    Date October 1993
    Journal The American Journal of Otology
    Excerpt

    The advantages of using a laser to cut a hole in the ossicular chain include increased precision, decreased likelihood of disarticulation, and elimination of noise-induced threshold shift associated with conventional drills. This study was designed to determine optimal energy settings and cooling technique to minimize tissue injury. Laser ablated holes were cut in rabbit femurs with different endostat fibers at power settings of 1.6 to 5.0 watts. Comparable burr holes were cut by a high-speed drill and the animals were sacrificed at different time intervals. Specimens were evaluated microscopically for tissue injury by the amount of cell necrosis of the surrounding osteocytes, bone marrow changes, and denaturation of bone matrix. Changes in healing were assessed by the production and ossification of the granulation tissue. Laser ablated holes created with 1.6 to 2.0 watts at 2 to 7 days demonstrated thermal damage comparable to conventionally drilled holes. At 14 to 28 days these holes demonstrated advanced healing and integrated lamellar bone. In contrast, higher power (> 3.5 watts) at 2 to 7 days demonstrated Significantly more osteocyte loss, marked bone marrow fibrosis, and bone matrix denaturation. At 14 to 28 days these holes showed evidence of delayed healing and osseous plugs not integrated with the surrounding bone.

    Title Effect of Influenza A Virus on Ciliary Activity and Dye Transport Function in the Chinchilla Eustachian Tube.
    Date August 1993
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Previous studies have shown that influenza A virus inoculated via a transbullar approach can cause severe disorders of the chinchilla eustachian tube. In this study, we inoculated chinchillas both intranasally and transbullarly with influenza A virus (A/Alaska/6/77) to assess the effect of this virus on both the ciliary activity of eustachian tube epithelium and eustachian tube transport function. Data indicated that while the nature of the major lesions was indistinguishable, the differing routes of inoculation did influence the time course and initial location of virus-induced histopathology. Analysis of ciliary beat frequency and dye transport function indicated a maximal decrease approximately 7 to 14 days postinoculation, with return to normal function by 28 days postinoculation. Light and transmission electron microscopic observations of the evolution of histopathology and return to normal histology correlated well with functional assessment data.

    Title Surface Active Substances in the Chinchilla Tubotympanum. A Biochemical Study.
    Date February 1992
    Journal Acta Oto-laryngologica
    Excerpt

    It has been demonstrated that the eustachian tube and middle ear epithelium produce Tubal Surface Active Substances (TSAS), which facilitate the opening of the eustachian tube. In order to characterize the biochemical contents of chinchilla TSAS, the tubal washings were analyzed using 2-D thin layer chromatography. The results indicate that phosphatidylcholine was the predominant phospholipid, followed by sphingomyelin, phosphatidylinositol phosphatidylethanolamine, and phosphatidylserine. In comparison, pulmonary lavage showed phosphatidylcholine to be highest allowed by phosphatidylethanolamine and sphingomyelin. Phosphatidylcholine/phosphatidylethanolanim ratios were 5:1 in the tubal lavage, and 8:1 in the pulmonary lavage. Phosphatidylcholine/sphingomyelin ratios were 2:1 in the tubal lavage, and 67:1 in the pulmonary lavage. It is concluded that the biochemical content of TSAS is similar but not identical to that of pulmonary surfactants.

    Title Glycoconjugates in the Chinchilla Tubotympanum.
    Date January 1992
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Various biotinylated lectins were used to characterize and semiquantitate glycoconjugate residues in the tubotympanum. Epithelial goblet cells were stained predominantly by WGA, LFA, SNA, RCA-I, Con-A, LCA, SBA, PHA-E, and UEA; this finding suggests they contain alpha-neuraminic acid, beta-galactose, alpha-mannose, N-acetyl alpha-galactosamine, and alpha-fucose. Glandular mucous cells were stained predominantly by WGA, LFA, SNA, and RCA-I; this finding suggests that they contain alpha-neuraminic acid and beta-galactose. The glandular serous cells were stained predominantly by Con-A, WGA, and LFA; this finding suggests that they produced alpha-mannose and alpha-neuraminic acid that represented serum-type glycoprotein. The positive staining of epithelial goblet cells and glandular mucous cells with PNA after neuraminidase digestion suggests that they produced mucin-type glycoproteins. The staining of the mucous blanket by WGA, LFA, SNA, RCA-I, LCA, PNA, SBA, PHA-E, and UEA suggests the presence of alpha-neuraminic acid, beta-galactose, N-acetyl alpha-galactosamine, and alpha-fucose. The epithelial cell (nonsecretory) surface was stained largely by WGA, LFA, SNA, RCA-I, Con-A, and LCA; this finding suggests the presence of alpha-neuraminic acid, beta-galactose, and alpha-mannose.

    Title Peritoneal Fluid in Human Acute Pancreatitis Blocks Hepatic Mitochondrial Respiration.
    Date December 1986
    Journal Surgery
    Excerpt

    Peritoneal fluid may be the source of multi-system failure during the initial stages of acute pancreatitis. The toxicity of human pancreatic ascitic fluid (HPAF) collected under sterile conditions from 12 patients with acute pancreatitis was investigated with the use of an in vitro preparation of mitochondria. Hepatocyte mitochondria from Sprague-Dawley rats were prepared by standard techniques. Mitochondrial oxidative activity was determined in glutamate-malate medium, with micromodification of the YSI Model 53 (Yellow Springs, Ohio) oxygen electrode system. The oxygen uptake of 150 to 200 microliter samples of mitochondria suspension (20 to 25 mg/ml) was monitored for 3 minutes, after which 3 microliter of 0.1 M adenosine diphosphate (ADP) was added to the chamber to induce state 3 respiration. Two minutes after the oxygen trace returned to state 4 respirations, 20, 40, or 80 microliter of the HPAF sample was introduced into the reaction vessel and the oxygen measurement continued for an additional 3 minutes. After this, 3 microliter of 0.1 M ADP again was added to the reaction chamber and the oxygen measurement continued. Control runs were made with reconstituted pooled human serum used in place of the HPAF samples. A significant (p less than 0.05) increase in state 4 respiration occurred in all 12 samples of HPAF. Addition of ADP showed a significant decline (p less than 0.05) in respiratory control ratio in all specimens. A dose-response curve was observed in 8 of 12 HPAF samples tested.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Mitochondrial Dysfunction Induced by Pancreatitis-associated Ascitic Fluid.
    Date June 1983
    Journal Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (new York, N.y.)
    Excerpt

    Acute hemorrhagic pancreatitis (AHP) involves multiple organ failure probably caused by the toxic factor(s) released in pancreatitis-associated ascitic fluid (PAAF). We found that PAAF interferes with hepatic mitochondrial respiration resulting in severe disturbances in respiratory control (RCR) and ADP/O ratios. Pancreatitis was induced in dogs by retrograde pancreatic duct infusion and the resultant PAAF was centrifuged, filtered, and frozen until used. Two human PAAFs collected from AHP patients were treated in a similar manner. Rat liver mitochondrial oxygen uptake was measured at 30 degrees C before and after addition of ADP and PAAF. Paired control runs were made using pooled heat-inactivated dog serum. Tests with nine canine PAAFs showed a mean increase of 120% in state 4 respiration (P less than 0.0001). After exposure to PAAF, addition of ADP to previously coupled mitochondria did not induce state 3 respiration. The human PAAFs both showed significant increases in state 4 respiration (P less than 0.01) and a marked decrease in RCR. Dose-response tests with human and canine PAAFs showed a positive correlation between percentage increase in state 4 respiration and the concentration of PAAF used. These results confirm the presence in PAAF of mitotoxic substance(s) which cause irreversible mitochondrial damage. Inhibition of coupled mitochondrial respiration by PAAF with the resultant fall in ATP may be the causative agent for the tissue and organ damage observed in AHP.

    Title Craniocervical Necrotizing Fasciitis with and Without Thoracic Extension: Management Strategies and Outcome.
    Date
    Journal American Journal of Otolaryngology
    Excerpt

    OBJECTIVE: First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors. METHODS: Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension. RESULTS: Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived. CONCLUSION: This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.


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