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Objective. To visually compare the Nitinol "smart" stapes prosthesis to conventional manual crimping stapes pistons in temporal bone cadaver specimens. Main Outcome Measures. 10 otolaryngologists were given a photograph of the randomly ordered stapes pistons and asked to use the pictures to answer questions about each stapes piston. The answers to the survey were then recorded for analysis. Results. 8 of 9 Nitinol pistons were described as circular, and 3 of 9 manual crimped pistons were described as circular (P<.05). 6 of 9 Nitinol pistons were considered to be in contact with >66% of the incus and 3 of 9 to be in contact with 34-66% of the incus. 3 of 9 manually crimped pistons were considered to be in contact with >66% of the incus, 3 with 34-66% contact and 3 with less than 34% contact. Conclusions. The Nitinol "smart" stapes pistons were considered to provide a more circular and circumferential crimping and to have greater contact with the long process of the incus than conventional stapes pistons. [ABSTRACT FROM AUTHOR]

We present a case in which a 23-year-old male patient diagnosed with nasoseptal chondrosarcoma with anterior cranial fossa extension underwent combined surgical approaches to optimize complete resection of the tumor. Surgery was followed by a 6-month course of proton-beam radiation therapy. Extensive tumors of this type with significant intracranial extension require surgical repair of the anterior fossa floor. We employed a repair technique not previously associated with the resection of these tumors, using a split-calvaria osteoplastic rotational flap. This method provided structural integrity while avoiding the risks associated with the use of free bone grafts and metallic meshes. [ABSTRACT FROM AUTHOR]

Objectives: Our objectives were to document the complication rates after total thyroidectomy or lobectomy for malignant thyroid disease and to compare these rates with previously documented complication rates after operations for benign thyroid disease. Methods: This is a retrospective chart review of patients diagnosed with thyroid carcinoma at a tertiary military medical center from 1996 to 2000. Results: Eighty-two patients were identified with thyroid carcinoma, of which 81 underwent surgical treatment. Nine patients had complications related to their treatment. four were permanent. This included two cases of permanent postoperative hypoparathyroidism, one case of phrenic nerve injury, and one case of unilateral vocal cord paralysis. There is a statistically significant higher overall complication rate of this series (10%) in comparison to a similar series of patients surgically treated for benign thyroid disease (2%) when comparing only recurrent laryngeal nerve injury and hypoparathyroidism (p = 0.02). There is also a higher overall complication rate (11% vs. 4.9%); however, this does not reach statistical significance (p = 0.16). Conclusion: Recurrent laryngeal nerve injury and hypoparathyroidism complication rates after operations for malignant thyroid disease are statistically higher in this series than complication rates after operations for benign thyroid disease. Overall complication rates are also higher for malignant thyroid disease as compared to benign thyroid disease. Before surgical treatment for malignant thyroid disease, patients should be counseled accordingly. [ABSTRACT FROM AUTHOR]

Military personnel are at increased risk of asymmetric hearing loss secondary to noise exposure. This report illustrates the importance of expeditiously evaluating for retrocochlear pathology even in young active duty service members with asymmetric or sudden hearing loss. A 36-year-old male presented with right-sided sudden hearing loss and dizziness. Audiometry revealed profound mid-to-high-frequency sensorineural hearing loss in the right ear. A 10-day course of oral steroid therapy and two intratympanic steroid injections were unsuccessful in restoring hearing. MRI revealed a 4.2 cm contrast-enhancing cerebellopontine angle tumor, consistent with a vestibular schwannoma (VS). Microsurgical resection utilizing a retrosigmoid craniotomy approach was performed with near-total resection of the tumor and preservation of the facial nerve but not the cochlear nerve. Despite preservation of the facial nerve, progression of post-operative facial weakness required gold weight placement to prevent exposure keratopathy. The patient had recovered partial function in all facial nerve branches at last follow-up. In light of the rising global incidence of VS, any asymmetric or sudden hearing loss in military service members should be evaluated with audiometry and referral to otolaryngology for workup of retrocochlear pathology. [ABSTRACT FROM AUTHOR]

Introduction The Department of Defense Medical Examination Review Board (DoDMERB) plays a pivotal role in the assessment of medical fitness for aspiring military officers. A crucial component of this process is the screening audiogram, designed to evaluate hearing capabilities. However, recent observations of high disqualification rates following screening audiograms led to concerns about their accuracy. Materials and Methods This quality improvement project, conducted between 2017 and 2019, aimed to assess the concordance between screening audiograms and reference-standard audiometry, as well as to investigate the relationship between disqualification status and hearing thresholds at different frequencies. A sample of 134 candidates, drawn from various locations across the United States, was analyzed. Results Results revealed that the screening audiogram mean thresholds were twice that of the reference-standard audiogram, particularly in the lower frequencies. Additionally, we found that 84% of candidates were incorrectly disqualified by the screening exam when followed up by the reference-standard. Overall, Bland-Altman analysis revealed significant disagreement between these two tests. This discrepancy prompted a fundamental policy shift in 2020, where candidates who fail screening audiograms now automatically undergo reference-standard audiometry before any disqualification decision. This policy change reflects the commitment of DoDMERB to refining the medical screening process. It reduces the burden on candidates, provides a more comprehensive assessment, and ensures that qualified individuals are not erroneously disqualified. In addition to policy changes, this quality improvement project explored potential courses of action to enhance the screening audiogram process. Among these, improving contract specifications for testing facilities to minimize ambient noise emerged as the most practical and cost-effective approach. Conclusion In conclusion, the project underscores the importance of refining medical screening processes to accurately assess candidates' qualifications while retaining the utility of screening audiograms. These efforts not only benefit aspiring military officers but also contribute to maintaining the high standards required for military service. [ABSTRACT FROM AUTHOR]

Describes the case of a patient with bilateral bifid inferior turbinates. Case history; Embryological development of the nasal turbinates; Variation in the nasal cavity and paranasal sinuses associated with a higher incidence of inflammation, nasal obstruction and sinusitis.

Introduction There is no cure for tinnitus, which is a highly prevalent condition in service members and veterans. Battlefield acupuncture (BFA) can be used to manage pain and stress-related symptoms. We investigated BFA as a safe, low-cost treatment for tinnitus perception and coping in eight chronic tinnitus patients who were followed for 6 months after two BFA treatments to identify changes in tinnitus severity or impact. Materials and Methods Patients completed case history, Tinnitus Screener, Tinnitus Functional Index (TFI), Tinnitus Reaction Questionnaire (TRQ), and Hospital Anxiety and Depression Scale (HADS) questionnaires at baseline, at two BFA treatment sessions (2 weeks apart), and at four follow-up sessions (at 1, 2, 4 and 6 months after treatment). Questionnaire score changes were evaluated over time by using restricted maximum likelihood hierarchical regression modeling from baseline to 1-, 2-, 4-, and 6-month post-treatment follow-ups. Results TFI and TRQ group means were both significantly reduced at 1 month after treatment, and these reductions persisted through the 2- and 4-month follow-ups. The TRQ group mean remained significantly reduced after 6 months. Conclusions Findings from eight chronic tinnitus sufferers who received two BFA treatment sessions are reported here, suggesting at least short-term treatment benefits observed as reductions in tinnitus-related psychological distress and impact. Although these findings are constrained by the study's small sample size and limited treatment period, its findings underscore the need for further research to determine the potential benefits of BFA for individuals who suffer from chronic tinnitus. Future research should consider the possibility of more lasting benefits through extended BFA treatment, with a comparison of BFA treatment against other treatment methods. [ABSTRACT FROM AUTHOR]

Objectives: Our objectives were to document the complication rates after total thyroidectomy or lobectomy for malignant thyroid disease and to compare these rates with previously documented complication rates after operations for benign thyroid disease.Methods: This is a retrospective chart review of patients diagnosed with thyroid carcinoma at a tertiary military medical center from 1996 to 2000.Results: Eighty-two patients were identified with thyroid carcinoma, of which 81 underwent surgical treatment. Nine patients had complications related to their treatment, four were permanent. This included two cases of permanent postoperative hypoparathyroidism, one case of phrenic nerve injury, and one case of unilateral vocal cord paralysis. There is a statistically significant higher overall complication rate of this series (10%) in comparison to a similar series of patients surgically treated for benign thyroid disease (2%) when comparing only recurrent laryngeal nerve injury and hypoparathyroidism (p = 0.02). There is also a higher overall complication rate (11% vs. 4.9%); however, this does not reach statistical significance (p = 0.16).Conclusion: Recurrent laryngeal nerve injury and hypoparathyroidism complication rates after operations for malignant thyroid disease are statistically higher in this series than complication rates after operations for benign thyroid disease. Overall complication rates are also higher for malignant thyroid disease as compared to benign thyroid disease. Before surgical treatment for malignant thyroid disease, patients should be counseled accordingly. [ABSTRACT FROM AUTHOR]