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Minor salivary gland neoplasms are rare in children. Only 5% of pleomorphic adenomas of the minor salivary glands have been reported in patients under 20 years of age. We report a case of a 13-year-old female who presented with a rapidly growing hard palatal mass, confirmed to be a myoepithelial cell-rich pleomorphic adenoma with cytological atypia. Pleomorphic adenomas should be included in the differential diagnosis of rapidly growing palatal masses in children and adolescents. Surgical excision is curative, and long-term follow-up is indicated as recurrence is frequent.

Objectives: To report a case of posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis and to discuss its pathophysiology and management. Design: Case report and literature review. Setting: Pediatric intensive care unit in a tertiary-care center. Patients and Results: Twelve days after a motor vehicle accident causing a head injury and facial fractures, this patient presented with massive epistaxis due to a pseudoaneurysm of the intracavernous internal carotid artery . Nasal packing was performed and subsequent angiography demonstrated the vascular lesion that had dissected into the sphenoid sinus. Endovascular stent and coil occlusion of the vascular lesion was performed, and the patient’s condition improved without any ischemic or thromboembolic sequelae. Conclusion: Posttraumatic aneurysms of the intracavernous internal carotid artery can be associated with delayed and sometimes lethal massive epistaxis. This vascular lesion should be considered in patients with traumatic brain injury presenting with basal skull fractures in the region of the carotid canal or cavernous sinus and/or orbital fractures and compromise of the optical nerves. Knowledge of these risk factors and early diagnosis can minimize the high mortality risk.

Numerous authors have sought to describe genotype-phenotype correlations in cystic fibrosis (CF), notably to pancreatic insufficiency and lung disease. However, few studies have focused on the association between the F508del genotype and response to sinus surgery. The objective of this study is to assess the effect of the F508del genotype on sinonasal disease severity and outcomes following functional endoscopic sinus surgery (FESS) in a pediatric population.A retrospective chart review of 153 children with CF seen at a tertiary care pediatric hospital from 1995 to 2008 was performed. Patients were classified into one of three groups according to F508del genotype, either as homozygous, heterozygous or not carrying a F508del mutation. The sinonasal disease phenotype of the three groups was compared based on clinical and radiological findings, extent of endoscopic sinus surgery and rate of revision surgery.The relationship between the F508del genotype and pancreatic insufficiency was confirmed (p0.05). There was no association between the F508del genotype and increased need for FESS (p=0.75). Moreover, no association was established between F508del homozygosity and presence of nasal polyps, Lund-Mackay score, extent of surgery or length of postoperative hospitalization. The rates of revision surgery did not differ significantly among the three genotypes analyzed (p=0.59).There is no clear association between the F508del genotype and an increased need for FESS, extent of surgery, or revision surgery. Given the phenotypic variability of sinonasal disease in patients with CF, a prospective study is needed to better understand outcomes following FESS and the contribution of gene modifiers to this effect.

This paper presents in vivo experimental measurements of vibrations on the pars flaccida, along the manubrium and at several points on the pars tensa in the gerbil with open middle-ear cavity. The effects of progressive opening of the middle-ear cavity are presented, with up to five different extents of opening. In all manubrial, pars-tensa and pars-flaccida responses, opening the cavity causes an increase in the low-frequency magnitude and a shift of the main middle-ear resonance to lower frequencies and introduces an antiresonance. However, opening the cavity has little or no effect on either the mode of vibration of the manubrium or the breakup frequency of the pars tensa. When the opening is gradually widened, the antiresonance frequency moves to higher frequencies. When the opening is made as wide as anatomically possible, the antiresonance moves to almost 10 kHz. The main increase in the low-frequency response magnitude happens upon making the smallest hole in the cavity wall, and further progressive enlarging of the opening has little or no effect on the low-frequency magnitude. The antiresonance interferes with the response shapes. An identification method is suggested for eliminating the effect of the antiresonance in order to estimate the ideal open-cavity response. The method is validated and then applied to manubrial and pars-tensa responses. Estimating the ideal open-cavity responses will simplify comparison of the data with numerical models which do not include the air cavity. The data collected at intermediate stages of opening will be useful in validating models that do include the cavity.

We report an extremely unusual case of a 4-month-old boy who presented with a sudoriferous gland cyst of the orbit. Congenital sudoriferous cyst is extremely rare in both the adult and pediatric populations. The CT and MRI findings are presented and the pertinent literature reviewed.

Cisplatin is a commonly-used chemotherapeutic agent that is highly-effective against a variety of pediatric cancers. Unfortunately, it may lead to ototoxicity, with serious consequences on the quality of life of survivors. Patients remain at risk of progression of ototoxicity even after completion of treatment. We report the case of a medulloblastoma survivor with previously documented normal hearing, who developed significant hearing loss and tinnitus following exposure to excessive noise at a nightclub three years after completion of treatment. We highlight the importance of long-term audiological follow up and education about the increased risk of hearing loss in this population.

Patients that receive radiotherapy are at risk of late sensorineural hearing loss when the inner ear is included within the radiation field. Preclinical and human temporal bone studies have shown that there is differential damage to cochlear structures depending on the amount of dose delivered to the inner ear. In vitro studies have suggested that reactive oxygen species (ROS) are the main initial actors in radiation-induced damage. The interaction of ROS with different cellular components can result in different apoptotic pathways. Therefore, approaches to radioprotection are mainly aimed to reduce ROS production through antioxidants. This review summarizes recent research in the field that can improve the understanding and boost preventive efforts of this adverse effect.

The antineoplastic agents cisplatin and carboplatin are widely-used and highly-effective against a variety of pediatric cancers. Unfortunately, ototoxicity is a frequently encountered side effect of platinum-based chemotherapy. There is currently no treatment or prevention for platinum-induced ototoxicity and development of hearing loss may lead to devastating consequences on the quality of life of pediatric cancer survivors. The objective of this study is to determine the incidence of platinum-induced ototoxicity in a large series of pediatric patients and to evaluate the incidence of progression of ototoxicity after completion of treatment.A retrospective chart review of pediatric patients treated with cisplatin or carboplatin between 2000 and 2012 was conducted. The incidence of ototoxicity was determined based on the American-Speech-Language-Hearing Association (ASHA) criteria and severity was based on the Chang classification.Four hundred and sixty-six patients received platinum-based chemotherapy. Patients were excluded due to congenital hearing loss (n = 1) and insufficient data for calculating the platinum dose (n = 24) or for assessing ototoxicity (n = 135). Three hundred and six patients were included in the analysis. Post-chemotherapy ototoxicity was detected in 148 (48%) patients, and clinically-significant ototoxicity was present in 91 (30%). In addition, based on the ASHA criteria, 48% of patients (97/204) with long-term follow-up had further deterioration of their hearing after completion of treatment.Ototoxicity following chemotherapy with cisplatin or carboplatin is common and can frequently progress after the completion of treatment. Long-term follow-up is strongly recommended.

Objective Bone-anchored hearing aid (BAHA™) is a proven tool to improve hearing. Nevertheless, there are patients who are candidates for BAHA™ implants that end up refusing the surgery. The objective of this study is to review our BAHA™ experience with particular emphasis on reasons behind the refusal of some candidates. Methods A prospective cohort of 100 consecutive new candidates referred to The BAHA™ program in a tertiary health care center. Candidates’ demographics, hearing status, Co-morbidities and audiometeric tests were all recorded. Patients’ acceptance or refusal was noted alongside the reasons to refuse BAHA™. Results 100 new candidates were seen for BAHA™ assessment, 10 patients were excluded due to incomplete data. There were 68 children and 22 adults. Unilateral Conductive Hearing Loss was the most common reason for consultation (40%), followed by unilateral SNHL (23.3%). Aural Atresia was the commonest clinical finding (36.6%). The commonest reason for refusal was social acceptance by the parents due to concern with cosmesis. Conclusion The main reason of BAHA™ surgery refusal, in otherwise eligible candidates, is related to cosmesis. Patients with congenital anomalies were the most likely candidates to accept BAHA™ implants.

Objectives:Determine whether wideband reflectance (WBR) measurements in babies who were born by vaginal delivery are different from those of babies born by C-section. Our working hypothesis is that babies delivered by Caesarian section have higher reflectance scores on WBR, as they have more fluid and debris in the outer and middle ear. This can have an impact on universal hearing screening passing rates.Methods:Following standard newborn hearing screening, WBR was measured in 225 healthy babies. Sixty-six babies were delivered by Caesarean section compared to 159 babies delivered vaginally. A total of 123 ears were included in the C-section group and were compared to a total of 288 ears in the second group. The results were obtained for 60 frequencies.Results:The mean screening age for babies in the C-section delivery group was 27.5 hours compared to 24.3 hours for babies in the vaginal delivery group. For both groups reflectance was high between 0.24 to 0.79 kHz and 2.50 to 4.80 kHz, with the highest at...

Objectives:There is controversy as to whether eye color has an effect on acquired sensorineural hearing loss. The objectives of this review were to analyze the literature evaluating the association between eye color and acquired causes of sensorineural hearing loss and to propose the potential mechanisms of this association.Methods:Six databases were searched to identify clinical studies relating eye color and acquired causes of sensorineural hearing loss such as noise, cisplatin ototoxicity, radiation, and presbycusis. Included articles were independently assessed for quality by two authors using the Downs and Black rating scale.Results:Seventeen articles were eligible for review. Eye color was not found to have an effect in the non-exposed population or in presbycusis. In noise-induced sensorineural hearing loss, light-eyed patients had more significant loss following noise exposure, although the variability reported due to eye color was modest (r2 = 1-14%). Two out of three studies reported that dark e...

Importance Noise-induced hearing loss is an increasingly worrisome problem. Although caffeine intake is common in people involved in noise-related environments, the effect of caffeine on the recovery of hearing after a temporary threshold shift requires further understanding. Objectives To determine whether caffeine impairs hearing recovery in a guinea pig model exposed to acoustic overstimulation. Design, Setting, and Subjects This experiment at the McGill University Auditory Sciences Laboratory used 24 female albino guinea pigs (age, 6 months; weight, 500-600 g) divided randomly into 3 groups of 8 animals each. Group 1 was exposed to caffeine; group 2, acoustic overstimulation events (AOSEs); and group 3, both. Data were collected from July 1, 2013, to March 30, 2014, and analyzed from April 1 to August 1, 2014. Interventions Daily caffeine dose for groups 1 and 3 consisted of 25 mg/kg administered intraperitoneally for 15 days. The AOSEs were administered on days 1 and 8 and consisted of 1 hour of 110-dB pure-tone sound. Main Outcomes and Measures Serial auditory brainstem response (ABR) tests to determine the audiological threshold shift and recovery were obtained at baseline and on days 1 (1 hour after the first AOSE), 4, 8 (before and 1 hour after the second AOSE), 11, and 15. Scanning electron and light microscopy of the cochleas were performed to determine morphologic changes. Results The day 1 post-AOSE measurement resulted in a similar threshold shift in all animals in groups 2 and 3 at all frequencies tested (8, 16, 20, and 25 kHz). The maximum threshold shift was at 16 kHz, with a mean of 66.12 dB. By day 8, the threshold shift in group 2 recovered completely at all frequencies except 20 kHz, where a mean threshold shift of 20.63 dB of sound pressure level (SPL) was present. Hearing impairment in group 3 persisted in 8-, 16-, and 25-kHz frequencies with thresholds of 21.88, 28.13, and 26.25 dB SPL, respectively ( P = .001). After a second AOSE at day 8, similar threshold shift and outcome were recorded on day 15 compared with day 8, with a mean threshold shift at 20 kHz of 29.38 dB SPL in group 2 and mean threshold shifts at 8, 16, 20, and 25 kHz of 29.38, 35.63, 40.63, and 38.75 dB SPL, respectively, in group 3. The difference in ABR threshold recovery was in concordance with scanning electronic and light microscopy findings for each group. Conclusions and Relevance A daily dose of caffeine was found to impair the recovery of hearing after an AOSE.

Olive oil is often used by patients to soften ear wax or to relieve ear canal obstruction. It is also sold in drugstores as a cerumenolytic. To date, no study has assessed the safety of ototopical olive oil on hearing in the presence of tympanic membrane perforation. The present study aimed to assess the safety of ototopic olive oil on hearing in the presence of tympanic membrane perforation.Prospective, randomized, controlled trial in a chinchilla animal model.Eleven chinchillas underwent bilateral myringotomy. In each animal, one ear was randomly assigned to receive olive oil (experimental ear), while the contralateral control ear received normal saline. Auditory brain response (ABR) test was performed at baseline and then 7, 14, and 30 days following the application.At 30 days follow-up, there was no significant change in auditory brain response thresholds at 8, 16, 20, or 25 kHz. Scanning electron microscope imaging showed no damage to the hair cells.Olive oil does not seem to cause hearing loss in chinchillas with perforated tympanic membranes. Future clinical studies are required.

Docusate sodium (Colace) is an off-label ceruminolytic agent used to soften ear wax and relieve ear canal obstruction. At present, its effect on hearing in the presence of tympanic membrane (TM) perforation is not clear. The present study aimed to assess the safety of ototopic docusate sodium on hearing in the presence of TM perforation.A prospective, randomized, controlled trial in a guinea pig animal model.Ten guinea pigs underwent bilateral myringotomy. In each animal, one ear received docusate sodium, serving as the experimental ear, and the other received normal saline as the control. Auditory brain response (ABR) was performed at baseline and then 1, 7, and 14 days following the application.At day 14 following application, there was no significant change in ABR thresholds at 8, 12, 16, 20, or 25 kHz.In guinea pigs with perforated TMs, docusate sodium does not seem to cause ototoxicity. Future clinical studies are required.

The effectiveness of amifostine in the prevention of cisplatin ototoxicity remains controversial. The objective of this meta-analysis was to determine whether amifostine is successful in preventing ototoxicity secondary to cisplatin chemotherapy.Meta-analysis.We conducted a systematic review of all randomized, controlled trials using amifostine in patients of all ages receiving cisplatin chemotherapy. Data extraction was performed by two independent reviewers using predefined data fields, including study quality indicators. Heterogeneity was evaluated using the I2 test. The meta-analysis was performed using the random effect method.Ototoxicity.Four randomized, controlled trials were included in this meta-analysis. The odds ratio of grade 2 or greater ototoxicity was 0.54 (95% CI 0.27-1.11), and the odds ratio of grade 3 ototoxicity or greater was 0.78 (95% CI 0.29-2.10). The side effects from amifostine use included hypocalcemia, hypotension, vomiting, and sneezing.This meta-analysis reveals a trend toward decreased ototoxicity in patients receiving amifostine infusion prior to receiving cisplatin chemotherapy. However, the results did not reach statistical significance. Further large randomized, controlled trials of amifostine use to prevent cisplatin-induced ototoxicity are needed.

Cisplatin is a potent antineoplastic agent widely used for a variety of cancer types. Unfortunately, its use leads to dose limiting side effects such as ototoxicity. Up to 93% of patients receiving cisplatin chemotherapy will develop progressive and irreversible sensorineural hearing loss which leads to a decreased quality of life in cancer survivors. No treatment is currently available for cisplatin-induced ototoxicity. It appears that cisplatin causes apoptosis by binding DNA, activating the inflammatory cascade as well as generating oxidative stress in the cell. Various studies have aimed to assess the potential protective effects of compounds such as antioxidants, anti-inflammatories, caspase inhibitors, anti-apoptotic agents and calcium channel blockers against the toxicity caused by cisplatin in the inner ear with variable degrees of protection. Nevertheless, the pathophysiology of cisplatin-induced ototoxicity remains unclear. This review summarizes all of the known transporters that could play a role in cisplatin influx, leading to cisplatin-induced ototoxicity. The following were evaluated: copper transporters, organic cation transporters, the transient receptor potential channel family, calcium channels, multidrug resistance associated proteins, mechanotransduction channels and chloride channels.

Patients receiving radiotherapy (RT) for head and neck tumors are at risk of developing sensorineural hearing loss. The objective of this study was to analyze the literature regarding sensorineural hearing loss after RT for head and neck cancer.Seven databases were searched to identify eligible studies. Eligible articles were independently assessed for quality by 2 authors.Fourteen articles were evaluated. There was considerable heterogeneity among studies. The reported incidence of sensorineural hearing loss (SNHL) varied from 0% to 85% for the speech frequencies and from 27% to 95% for high frequencies. As the follow-up increased, an increase in the incidence of SNHL was observed. The minimum cochlear dose reported to be a risk factor for SNHL was 45 Gy.High quality literature in the topic is lacking. Radiation-induced SNHL is progressive, permanent, and dose-dependent. Total dose and follow-up time are important factors affecting incidence rates.

INTRODUCTION Systemic drug application for the treatment of inner ear diseases is restricted because of the blood-labyrinthine barrier and the limited blood supply to the inner ear. Local drug delivery to the inner ear can be an alternative method to overcome the problems with systemic application. The purpose of the present study was to describe the anatomic orientation of the round window membrane (RWM) and to examine the use of a microendoscope for transtympanic drug delivery to the RWM in the chinchilla animal model. MATERIALS AND METHODS Fourteen female chinchillas were used for anatomic dissections (n = 4, 8 ears) and comparison of otomicroscopy (n = 5, 10 ears) with otoendoscopy (n = 5, 10 ears) for visualization and transtympanic application of methylene blue to the RWM of the animals. RESULTS The external auditory meatus in chinchillas is S-shaped, and the RWM is not accessible through the tympanic membrane in otomicroscopy. The use of a special microendoscope makes it relatively easy to have an accurate transtympanic access to the RWM. The working channel of the microendoscope permitted successful delivery of methylene blue to the RWM in all tested chinchillas. CONCLUSION The present study is the first published study that shows the feasibility of a microendoscope for transtympanic drug delivery to the RWM in animal models. Minor technical modifications are recommended, which will make the microendoscope an easy tool for future studies on local drug delivery to the RWM in the chinchilla animal model.

The purpose of this study is to identify the clinical characteristics of children above 6 years of age with chronic otitis media with effusion (COME) who have required pressure equalizing tube (PET) insertions.A retrospective chart review was performed of all children above the age of 6 years, who underwent PET insertion due to chronic OME, between 2000 and 2009 at a tertiary care institution. Children were also divided into those with a single PET and those with ≥ 2 PET. Comparison of various characteristics between the two groups was undertaken.290 children were identified as having at least one PET insertion after the age of 6 years. 45.5% of the children underwent a single PET insertion while 54.5% underwent 2 procedures or more. No significant gender-based difference was observed. In those patients requiring ≥ 2 PET, 65.2% also underwent tonsillectomy and/or adenoidectomy compared to only 53.8% of children with a single PET intervention (p0.05). Asthma, trisomy 21 and cleft palate, were more common in those children who had undergone ≥ 2 PET (p0.001, p0.01 and p0.05, respectively).Children above 6 years of age who have undergone ≥ 2 PET insertions for COME demonstrated an increased rate of tonsillectomy and adenoidectomy. Trisomy 21, cleft palate and particularly, asthma, were also found to be risk factors for COME necessitating ≥ 2 PET insertions.

Objective: To systematically review the literature to characterize radiation-induced sensorineural hearing loss for head and neck tumors.Method: Seven databases were searched to identify studies assessing the characteristics of sensorineural hearing loss caused exclusively by radiotherapy for head and neck cancer.Results: Fourteen articles were evaluated. The reported incidence of sensorineural hearing loss was higher on frequencies above 4 Hz (up to 95%) when compared to the speech frequencies. Radiation dose and follow-up time were important factors affecting incidence rates.Conclusion: Evidence demonstrates that the resulting SNHL is irreversible, progressive, and dose-dependent. High-quality literature regarding SNHL due to radiotherapy is lacking. Improved evaluation protocols should be adopted in the standard of care for patients undergoing radiotherapy.

Objective: 1) Evaluate the commonly used ototoxicity criteria. 2) Develop a method for establishing comparisons among studies using different criteria. 3) Use this comparison method to evaluate the effect of treatment and assessment factors (ie, chemotherapy agent, cumulative dose, head and neck radiotherapy, and follow-up period) on the reported incidence of ototoxicity.Method: A review was performed on studies regarding platinum compounds and hearing loss published between January 1, 2000, and July 15, 2011. A total of 47 pediatric and 42 adult studies were evaluated. Data analyzed included patient demographics, treatment modalities (surgery, radiotherapy and chemotherapy), and auditory outcomes.Results: Ten methods for defining ototoxicity were identified, and each was critically reviewed. Grades within each criteria were then classified as either “mild/moderate” or “severe” ototoxicity, based on their definitions and on the agreement between these criteria in the literature. The total incidence of oto...

Objective Bone-anchored hearing aid (BAHA™) is a proven tool to improve hearing. Nevertheless, there are patients who are candidates for BAHA™ implants that end up refusing the surgery. The objective of this study is to review our BAHA™ experience with particular emphasis on reasons behind the refusal of some candidates. Methods A prospective cohort of 100 consecutive new candidates referred to The BAHA™ program in a tertiary health care center. Candidates’ demographics, hearing status, Co-morbidities and audiometeric tests were all recorded. Patients’ acceptance or refusal was noted alongside the reasons to refuse BAHA™. Results 100 new candidates were seen for BAHA™ assessment, 10 patients were excluded due to incomplete data. There were 68 children and 22 adults. Unilateral Conductive Hearing Loss was the most common reason for consultation (40%), followed by unilateral SNHL (23.3%). Aural Atresia was the commonest clinical finding (36.6%). The commonest reason for refusal was social acceptance by the parents due to concern with cosmesis. Conclusion The main reason of BAHA™ surgery refusal, in otherwise eligible candidates, is related to cosmesis. Patients with congenital anomalies were the most likely candidates to accept BAHA™ implants.

The traditional treatment of cricoid cartilage fractures concurrent with subglottic stenosis in pediatric patients usually requires an open approach with a high rate of complications and morbidity. We present here a case report of a successful treatment of a cricoid cartilage fracture concurrent with a subglottic stenosis in an adolescent patient using balloon dilation. The mentioned procedure reduced the fracture and allowed us to prevent a tracheostomy and its complications.

Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity presenting with ear discharge or otorrhea through a non-intact tympanic membrane. CSOM is the most common cause of childhood hearing impairment in developing countries. Accurate diagnosis depends on a high index of suspicion, micro-otoscopic examination, and judicious use of imaging as required. CSOM can be classified into 3 types: tubotympanic, atticoantral, and post-tympanostomy tube insertion. Aerobes, anaerobes and fungi are all potential pathogens in CSOM. This review summarizes the results of recent studies on the bacteriology of CSOM, biofilms, and the role of the nasopharynx pathogens that may have important implications for the treatment of this important pathology; that is often associated with misdiagnosis or delayed diagnosis. Particular emphasis will be placed on topical treatment options including choices of antibiotic, antifungal, and antiseptic agents, delivery technique, spectrum of activity, and risk of ototoxicity.

Objective Baby oil is commonly used to soften ear wax in order to aid its removal. The aim of this study was to determine the potential ototoxicity of baby oil. Method A prospective controlled animal study was conducted using ten chinchillas with normal hearing function. Each had bilateral myringotomies. One ear was randomly assigned to receive 1 ml of baby oil while the other ear received an equal volume of 0.45% NaCl. Distortion product otoacoustic emissions (DPOAEs) and Auditory Brainstem Response (ABR) measurements were recorded at baseline (post myringotomy and pre application of product) and on days 5 and 15 after application. Two months after application of baby oil, the cochleae were processed for light microscopy and qualitative comparisons were made between the cochleae of both control and experimental ears. Results There was no statistically significant difference in DPOAE between experimental and control ears at 5 and 15 days after treatment. ABR results did not reveal ototoxicity at days 5 and 15 post treatment. None of the animals developed facial paralysis or any signs of vestibular toxicity. There were no overt mucosal changes in the middle ear of the ears exposed to baby oil compared to the control ears. Light microscopy showed comparable features in the organ of Corti, stria vascularis, spiral ligament and the spiral ganglion cells of both groups of cochleae. Conclusion Baby oil did not produce ototoxic effects when applied ototopically in chinchillas with non-intact tympanic membrane.

NHL usually presents with lymphadenopathy or symptoms related to compression by the primary tumor of surrounding structures. While the head and neck region is a common site of involvement, blindness is rarely a presenting symptom. We report here the case of a child who presented to the emergency room with acute bilateral loss of vision and no other symptoms. Cranial imaging studies revealed a solid mass of the skull base with compression on optic nerves. Diagnosis of Burkitt's lymphoma was confirmed after biopsy. The patient had partial vision improvement two days after optic nerve decompression which was done immediately at the night of presentation.

Almond oil is frequently prescribed as a ceruminolytic, to soften ear wax or relieve ventilation tube occlusion. Ceruminolytics could lead to ototoxicity in the presence of a tympanic perforation. Reports on the safety of almond oil as a ceruminolytic is limited. The present study aimed to assess the effect of ototopic almond oil on hearing.Prospective, randomized, controlled trial in a chinchilla animal model.Bilateral myringotomies were performed in 19 female chinchilla. One randomly selected ear received almond oil, whereas the other ear received saline applied transtympanically. Auditory Brainstem Response (ABR) testing was performed prior to application and at 14 and 30 days following application. Postmortem Scanning Electron Microscopy (SEM) images were obtained to assess cochlear hair cell status.At 30 days following application, there was no significant change in ABR thresholds at 16, 20, or 25 kHz. No cochlear hair cell loss was observed with SEM.In the chinchilla, when a tympanic perforation is present, almond oil does not seem to cause ototoxicity. Further studies are needed to better assess the effect of almond oil on hearing in humans.

Cisplatin is a commonly used chemotherapeutic agent. One of its major dose-limiting side effects is ototoxicity. No treatment has yet been approved for this condition. The objective of this study was to determine the potential protective effect of a systemic administration of erdosteine against cisplatin-induced ototoxicity.A prospective controlled trial conducted in an animal model.Animal care research facilities of The Montreal Children's Hospital Research Institute.A total of 27 guinea pigs were assigned to 4 groups, each receiving a different concentration of intraperitoneal erdosteine: group 1 (control group; n = 9) did not receive erdosteine, group 2 (n = 6) received 100 mg/kg/d, group 3 (n = 6) received 200 mg/kg/d, and group 4 (n = 6) received 500 mg/kg/d. The animals in the experimental groups received the erdosteine injection daily for 4 days. All of the animals received 12 mg/kg of intraperitoneal cisplatin. Auditory brainstem response threshold shifts were measured at 4 frequencies (8, 16, 20, and 25 kHz) for all groups. Scanning electron microscopy and outer hair cell counts were performed to assess the protective effect of erdosteine.Significant protection was observed in groups 3 and 4 at 25 kHz. These findings are supported by outer hair cell counts by scanning electron microscopy.A systemic administration of erdosteine appears to provide an otoprotective effect at high frequencies for cisplatin-induced ototoxicity.

In this prospective controlled animal study, the authors investigated the potential ototoxic effects of ototopical application of nystatin through a tympanostomy tube, using their established chinchilla animal model. Each of the 10 animals used had ventilation tubes inserted in both ears; 1 ear was randomly assigned to receive nystatin suspension, whereas the other ear did not receive any medication, serving as control. Distortion product otoacoustic emissions (DPOAEs) were measured in each animal before application of nystatin and at 45 and 60 days after application. Each cochlea was also processed for scanning electron microscopy (SEM) at the end of the experiment. There was no significant difference in the DPOAEs and SEM appearances of the experimental and control ears over the 60-day period of the experiment. The authors conclude that transtympanic nystatin did not produce any long-term ototoxic effects detectable by DPOAEs or SEM.

To investigate possible ototoxic effects of a one-time application of oxymetazoline drops in a chinchilla animal model with tympanostomy tubes. Study Design. A prospective, controlled animal study.The Research Institute of the Montreal's Children Hospital, McGill University Health Centre.Ventilation tubes were inserted in both ears of 12 animals. One ear was randomly assigned to receive oxymetazoline drops (0.5 mL). The contralateral ear did not receive any drops, serving as a control ear.Distortion product otoacoustic emissions were measured bilaterally for a wide range of frequencies (between 1 and 16 kHz) before and 1 day after the application of oxymetazoline in the experimental ears. Two months later, the animals were sacrificed and all cochleae were dissected out and processed for scanning electron microscopy.In this established chinchilla animal model, the measured distortion product otoacoustic emission amplitudes and the morphological appearance on scanning electron microscopy were similar for both control and experimental ears.Oxymetazoline did not cause ototoxicity in a chinchilla animal model 2 months after a single application via a tympanostomy tube.

Objective: Determine the prevalence of asthma in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (sFBA) in the tracheobronchial tree, and to identify characteristics of patients who could benefit from a trial of anti-asthma treatment prior to undergoing a diagnostic bronchoscopy.Method: Retrospective chart review of children with sFBA in the tracheobronchial tree who underwent RB at the Montreal Children’s Hospital (2001-2009). Patient characteristics such as delay between initial choking episode and first otolaryngology evaluation, clinical findings, radiologic findings, bronchoscopic findings, and history of asthma were analyzed.Results: A total of 55 children underwent a RB for sFBA. Foreign bodies (FB) were found in 36 of these, one of which was asthmatic (2.78%, P < .05). In the 19 children who had a negative bronchoscopy (no FB), four were asthmatics (21.1%, P < .05). The mean time from the suspected initial choking event to the first otolaryngology evaluation ...

Objective: Conduct an updated systematic review on the outcome of Bell Palsy (BP) in children following steroid treatment.Method: Medline, Embase, Cochrane Library, and BIOSIS Previews databases were searched obtaining articles from years 2000 to 2010 without any language restriction. Articles describing children aged 0 to 18 years with BP treated solely with corticosteroids were included. The outcome measure was facial movements based on clinical scales.Results: A total of 2293 papers were initially identified. Following review by 2 authors, 68 papers were analyzed in a hard-copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies exclusively included children with BP where in 2; various etiologies of facial palsy were described. The nontreated groups were smaller than the treated groups. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House-Brackmann scale, Yanagihara grading system, and clinical...

Objective: Cisplatin is a commonly used chemotherapeutic agent. One of its major dose limiting side effects is ototoxicity. No treatment has yet been approved for this condition. The objective of this study was to determine the potential protective effect of a systemic administration of erdosteine against cisplatin-induced ototoxicity.Method: Guinea pigs were assigned to 4 groups, each receiving a different concentration of intraperitoneal erdosteine: 0, 100, 200, and 500 mg/kg/d for 4 days. All of the animals received 12 mg/kg/d of intraperitoneal cisplatin. Auditory brainstem response (ABR), scanning electron microscopy, and outer hair cell counts were performed.Results: Significant otoprotection was observed in groups receiving 200 and 500 mg/kg/d of erdosteine as demonstrated by high frequency (25 kHz) ABR threshold shifts. These findings are supported by outer hair cell counts by scanning electron microscopy. Guinea pigs receiving 100 mg/kg/d did not present otoprotection.Conclusion: A systemic admin...

Objective. To determine whether intratympanic administration of dexamethasone reduces ototoxicity from systemic cisplatin. Study Design. Prospective animal study. Setting. Cisplatin chemotherapy induces ototoxicity manifest- ing as irreversible, sensorineural hearing loss. This is due to damage to the inner ear structures by free radicals. Steroidal anti-inflammatories have been shown to reduce the forma- tion of free radicals and protect hearing in animal models. Subjects and Methods. Pure tone auditory brainstem responses were obtained in 58 female albino guinea pigs before and 3 days after intraperitoneal (IP) cisplatin chemotherapy. Audi- tory brainstem responses were also taken up to 1 month after a low dose of cisplatin. Part I consisted of a dosing study to determine the optimal ototoxic dose of cisplatin. In part II, auditory brainstem response thresholds were compared after bilateral intratympanic dexamethasone doses to act as con- trols. For part III, the otoprotection of dexamethasone against cisplatin was tested in separate bilateral and unilateral studies. Results. IP injection of 12 mg/kg of cisplatin induced significant hearing loss (57.2 ± 4.4 dB, P < .01) with 0% mortality. Ears treated with intratympanic dexamethasone alone showed no significant threshold changes. Ears that received IP cisplatin and intratympanic dexamethasone showed reduced thresh- old shifts at 8 kHz when the greatest concentration of dexa- methasone was administered. Conclusion. Modest intratympanic dexamethasone otoprotec- tion of the guinea pig ear was greatest at the highest con- centration tested and occurred in a frequency-dependent manner. Intratympanic dexamethasone presents as a safe, simple, and effective treatment modality to minimize cisplatin ototoxicity without interfering with the chemotherapeutic effects of cisplatin.

Since the advent of the Haemophilus influenzae type B vaccine, no North American case series has described periorbital cellulitis extensively as the main focus in the otolaryngology literature has been the management of orbital abscesses. The aim of this study was to describe the epidemiology, underlying causes, clinical presentation, and medical management of periorbital cellulitis.Retrospective observational case series.Montreal Children's Hospital, McGill University Health Centre, a tertiary pediatric referral center in Montreal, Quebec.The medical charts of all pediatric patients hospitalized from January 2000 to August 2006 with a discharge ICD-9 code indicating a diagnosis of periorbital cellulitis without abscess were reviewed. One hundred seventeen cases were identified.Periorbital cellulitis in the pediatric population affects mainly preschool-aged patients (mean age 4.1 ± 4.2 years [SD]) and is more frequent among males than females (1.3:1). The most common predisposing conditions are sinusitis (24.8%), trauma (23.1%), and ocular conditions (13.7%). All patients were successfully managed with intravenous antibiotics for a mean period of 3.4 ± 2.6 days and oral antibiotics for 8.1 ± 4.4 days and recovered fully without complications.Our results are consistent with the literature on the subject and show that timely identification of periorbital cellulitis cases and appropriate medical management result in resolution of the condition without complications.

We report the first documented case of a laryngeal abscess after injection laryngoplasty with hyaluronic acid. Hyaluronic acid injection is generally considered a safe procedure with the occurrence of local self-limited side effects. The patient of interest developed acute signs of distress and shortness of breath 6 days post-injection of the laryngeal cleft. This is the first case report of an abscess post-laryngoplasty treatment in the pediatric population. This raises the importance of close monitoring of the patients during the first week after surgery.

Objective To assess the long-term ototoxicity effect of platinum chemotherapy in a series of pediatric patients. Design A prospective cohort study. Methods Patients who received platinum chemotherapy were identified through review of the pharmacy records from 2000 to 2005. Audiograms pre- and post-treatment with cisplatin were noted. The patients were brought back long after treatment for a repeat audiogram and a questionnaire to assess the impact of ototoxicity on their quality of life. Results Forty-nine patients received platinum chemotherapy. Patients’ exclusion: two had no pre-chemo audiograms, one had retinoblastoma with congenital hearing loss, three were lost to follow up, five deceased, and seven refused participation. The total number of patients included was 31 with long-term follow up total of 21 patients. The follow up period ranged from 1.5 to 6.6 years (median of 3.4 years). Fourty-two percent (13/31) of the patients suffered from otoxicity (3 mild, 3 moderate, 7 severe-profound). Thirty-three (7/21) of audiograms worsened on long-term follow up. Questionnaire revealed 70% subjective hearing loss with 40% requiring hearing aids. Conclusion Ototoxicity after platinum chemotherapy can present or worsen years after completion of therapy. Therefore, we recommend long-term follow up.

BACKGROUND Nontuberculous mycobacteria (NTM) infections appear to be increasing in number and severity in developed countries worldwide. Surgical excision has been considered the standard treatment for NTM lymphadenitis, but the use of medical therapy seems to be increasing. OBJECTIVE To determine the disease characteristics as well as the current therapeutic management of NTM infections in Canadian children. METHODS Cases of definite or probable NTM infections were identified prospectively in children up to 18 years of age seen in 10 Canadian paediatric tertiary care centres from September 2005 to August 2006. Clinical, microbiological and pathological data were collected. RESULTS A total of 60 cases were identified. Data were complete for 45 patients, including 34 cases of lymphadenitis, four cases of skin and soft tissue infection, and seven cases of pulmonary NTM infection. Seventy-nine per cent of children (27 of 34) with lymphadenitis had an unsuccessful course of antibiotics before diagnosis. Sixty-eight per cent of purified protein derivative tests (15 of 22) were positive. NTM was detected in 76% of samples (29 of 38), of which 62% were Mycobacterium avium complex. All patients with lymphadenitis underwent surgical therapy and most patients (74%) also received antimicrobials. CONCLUSIONS Current trends indicate that the majority of the study centres are using medical therapy with variable regimen and duration as an adjunct to surgical excision in the treatment of NTM lymphadenitis. Larger numbers and longer follow-up times are needed to better evaluate the efficacy of medical therapy and outcome of disease. A randomized controlled study comparing surgical therapy alone and chemotherapy for NTM lymphadenitis is required.

Objective Ototoxicity is currently the most frequent dose-limiting side effect of cisplatinum chemotherapy. To date, there is no protocol to prevent dose-related ototoxicity, despite its prevalence and predictability. Previous animal studies have found lactate to be effective in the prevention of cisplatinum-induced ototoxicity. The objective of this study was to test the protective benefits of transtympanic Ringer's lactate in the prevention of cisplatinum-induced ototoxicity. Study Design A randomized prospective controlled trial was conducted in an animal model. Setting Animal care research facilities of The Montreal Children's Hospital Research Institute. Subjects and Methods A total of 44 chinchillas were exposed to systemic cisplatinum injected intraperitoneally in divided cycles to reach the targeted cumulative dosage of 16 mg/kg. Ototopical application of Ringer's lactate solution 0.2 mL twice per day during the chemotherapy cycles was performed. Each animal had one experimental (Ringer's) and one control ear. Distortion product otoacoustic emissions (DPOAEs) were collected for a wide range of frequencies (between 1 and 16 kHz), and scanning electron microscopy was performed to evaluate the protective effects of Ringer's lactate. Results Ototopical application of Ringer's lactate solution in our established chinchilla animal model did not provide an otoprotective effect as measured by the DPOAE response and electron microscopy. Conclusion In our study, the intratympanic application of Ringer's lactate solution through a tympanostomy ventilation tube did not provide an otoprotective effect. Further studies are needed to better assess the otoprotective or ototoxic effects of Ringer's lactate and other antioxidants on animal and human hearing.

Objective To characterize the presentation, treatment, and outcome of neonates presenting with facial nerve palsy resulting from forceps use. Design Retrospective medical chart review. Setting Two tertiary care pediatric hospitals. Patients Neonates with facial nerve palsy caused by forceps use born during the period of April 1, 1989, to April 1, 2005. Main Outcome Measure Resolution of facial nerve palsy. Results Twenty-eight cases of facial nerve palsy caused by forceps use were identified. The palsy was classified as mild to moderate according to the House-Brackman scale. Except in 1 neonate, no treatment was initiated in any of the patients. All 21 neonates with adequate long-term follow-up recovered fully after an average period of 24 days. Conclusion Because facial nerve palsy caused by forceps use is generally mild and is associated with a favorable outcome, treatment with corticosteroids or surgery is generally not required.

Laryngopharyngeal reflux (LPR) was recently implicated in the etiology of otitis media with effusion (OME). To study the hypothesis that gastric juice reaches the middle ear through the nasopharynx and eustachian tube, we evaluated the presence of pepsinogen in the adenoid tissues of children with otitis media with effusion (OME) and compared them with the tissues of a control group of children without OME.In the study group, middle ear effusions (MEEs) and adenoidal tissue biopsies were obtained from patients undergoing simultaneous tympanostomy tube placement and adenoidectomy. In the control group, adenoid specimens were taken during adenoidectomy (+/- tonsillectomy) from children with no history of OME. The adenoid tissues were analyzed immunohistochemically to confirm the presence of pepsinogen. Normal gastric tissue was used as a positive control and lymphatic tissue as a negative control. Total pepsinogen levels of MEE were measured with enzyme-linked immunosorbent assay.Adenoid tissue of the OME group (n = 25) demonstrated significantly higher pepsinogen immunoreactivity when compared with the adenoid tissue of the control group (n = 29), specifically in staining of both the epithelia (p.0001) and the subepithelia, (p.001). The presence of pepsinogen was detected in 84% of MEEs from the OME group, at concentrations 1.86 to 12.5 times higher than that of serum. Pepsinogen messenger ribonucleic acid was not demonstrated in any of the adenoid tissues of the OME group.LPR plays an important role in the pathogenesis of OME as gastric reflux reaches the middle ear through the nasopharynx and eustachian tube to cause OME.

A three-dimensional static nonlinear finite-element model of a 22-day-old newborn middle ear is presented. The model includes the tympanic membrane (TM), malleus, incus, and two ligaments. The effects of the middle-ear cavity are taken into account indirectly. The geometry is based on a computed-tomography scan and on the published literature, supplemented by histology. A nonlinear hyperelastic constitutive law is applied to model large deformations. The middle-ear cavity and the Young's modulus of the TM have significant effects on TM volume displacements. The TM volume displacement and its nonlinearity and asymmetry increase as the middle-ear cavity volume increases. The effects of the Young's moduli of the ligaments and ossicles are found to be small. The simulated TM volume changes do not reach a plateau when the pressure is varied to either -3 kPa or +3 kPa, which is consistent with the nonflat tails often found in tympanograms in newborns. The simulated TM volume displacements, by themselves and also together with previous ear-canal model results, are compared with equivalent-volume differences derived from tympanometric measurements in newborns. The results suggest that the canal-wall volume displacement makes a major contribution to the total canal volume change, and may be larger than the TM volume displacement.

Objective: Ciprofloxacin is currently the only proven nonototoxic topical antibiotic. However, its widespread use has resulted in the emergence of antimicrobial resistance. There are also concerns that there is currently no safe alternative to ciprofloxacin for patients with a nonintact eardrum. We thus wished to evaluate whether a moxifloxacin solution is ototoxic when used topically in chinchilla ears in the presence of a pressure-equalizing tube (PET). Study Design: A prospective, randomized, controlled trial was conducted in an animal model. Methods: Twenty chinchillas were included in this study. After bilateral insertion of PETs, four drops of a moxifloxacin solution were delivered twice daily for 7 days in the randomly assigned experimental ear. The control ear received an equal amount of a solution of Ringer's lactate. Distortion product otoacoustic emissions (DPOAE) were recorded at baseline (after PET insertion) and at days 1, 3, 7, 14, and 28 after treatment initiation. Results: When baseline DPOAE measurements were compared with the final measurements at day 28, moxifloxacin caused a statistically significant (P < .05) hearing loss (HL) in the experimental ears for the frequencies between 3.7 and 15 kHz. There was no significant change in hearing in the control ears. Conclusion: This represents the first study on the ototoxicity of topical moxifloxacin. Our results demonstrate that moxifloxacin causes HL when used with a nonintact tympanic membrane in a chinchilla animal model.

The use of earwax softeners and cerumenolytics to unblock the external auditory canal is increasing. Although reports on their effectiveness are available, data about their effect on hearing are limited. Objective: To assess the effect of ototopic triethanolamine polypeptide oleate condensate 10% (Cerumenex) on hearing. Study Design: Prospective, randomized, controlled trial in a chinchilla animal model. Methods: Tympanostomy tubes were inserted in five chinchillas, and hearing was assessed with distortion product otoacoustic emissions (DPOAE) between 1 and 9 kHz prior to application and at days 1, 4, 30, and 100 postototopic application of Cerumenex. One ear received Cerumenex; the other ear served as control. Postmortem scanning electron microscopy was performed to assess the cochlear hair cells. Results: A reduction in the mean DPOAE signal was shown in the ears treated with Cerumenex from the first day after treatment and throughout the study. Almost all tested frequencies were affected. Swelling, crusting, and fluid were observed in four of the five experimental ears. One animal also developed facial paralysis in the experimental side. Electron microscopy showed damage of the outer and inner hair cells in the Cerumenex-treated ears. Conclusions: In the chinchilla, when a tympanic perforation is present, Cerumenex causes a reduction in DPOAE signal and damage to the cochlear hair cells. Caution should be observed when prescribing this agent if the status of the tympanic membrane is unknown. Furthermore, its use without medical prescription should be discouraged because of the risk of ototoxicity and severe inflammatory reaction.