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Objectives/Hypothesis To determine whether Mallampati class correlates with Cormack-Lehane grade in obese adults, and investigate a novel airway trajectory measurement (ATM) to anticipate difficult laryngoscopy. Study Design Retrospective cohort plus a pilot study. Methods One hundred eighty-four nonobese and 160 obese adults underwent laryngoscopy. Spearman correlations, gamma coefficients (G), and Kendall's τ investigated body mass index (BMI):Mallampati, BMI: Cormack-Lehane, and Mallampati:Cormack-Lehane. A z test compared the two groups. Twenty-six volunteers had neck x-rays taken in the sniffing position to examine trajectories to the larynges (ATM). Results Positive predictive value of high Mallampati for difficult laryngoscopy was 8.57%. BMI did not correlate with Mallampati ( r = 0.055 [nonobese], r = −0.056 [obese]) or Cormack-Lehane [ r = −0.014 [nonobese], r = −0.022 [obese]). Among nonobese adults, gamma coefficients for BMI:Mallampati was 0.039 ( P = .63), for BMI:Cormack-Lehane was 0.02 ( P = .85), and for Mallampati:Cormack-Lehane was 0.43 ( P = .004). Among obese adults, gamma coefficients for BMI:Mallampati was −0.127 ( P = .16), for BMI:Cormack-Lehane was 0.014 ( P = .88), and for Mallampati:Cormack-Lehane was 0.365 ( P = .01). Kendall's τ were comparable to gamma coefficients in all analyses. When comparing gamma coefficients for Mallampati:Cormack-Lehane among the nonobese and obese, z = 0.04 ( P = .98). In the ATM study, only Mallampati and upper lip bite test had a significant relationship (G = 1.00, P < .001). Conclusions Mallampati correlates poorly with Cormack-Lehane, regardless of BMI. Pilot data suggest that ATM is feasible. Level of Evidence 4. Laryngoscope, 125:161-166, 2015 [ABSTRACT FROM AUTHOR]

Background: Ear infection or otitis media (OM) accounts for most bacterial respiratory infections in children in both developed and developing nations. Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the major OM pathogens. However, little is known about the genetic basis of bacterial OM largely due to practical difficulties in conducting research in ear infection models and genetically manipulating clinical isolates. Here, we report the first genome-scale in vivo screen for bacterial genes required for ear infection in a chinchilla model by signature tagged mutagenesis (STM), a high throughput mutant screen technique. Methodology/Principal Findings: STM strains were constructed with a multi-drug resistant OM isolate ST556 (serotype 19F) and screened in a chinchilla OM model. Out of 5,280 mutants tested, 248 mutants were substantially underrepresented in the mutant pools recovered from the middle ear fluids of the infected chinchillas, indicating the impaired ability to survive and replicate in the middle ears due to genetic disruptions in the chromosome of strain ST556. Further DNA sequencing analysis mapped the mutations to 169 pneumococcal genes. Surprisingly, only 52 of these genes were required for pneumococcal nasopharyngeal colonization in a murine model. This infection site-specific gene requirement was verified by targeted mutagenesis in the selected genes. Conclusions/Significance: These findings suggest that there are a subset of pneumococcal genes required for ear infection and that these may be distinct from those required for nasal colonization. Our data thus provide comprehensive gene targets for mechanistic understanding of pneumococcal ear infection. Finally, this study has also developed a model for future genome-scale search for virulence determinants in other pathogens associated with ear infections. [ABSTRACT FROM AUTHOR]

Objective: Available evidence suggests tinnitus arises from excessive spontaneous activity in the left superior temporal gyrus, and repetitive transcranial magnetic stimulation (rTMS) may suppress this activity. Our hypothesis is that rTMS applied to this region would decrease tinnitus complaints in veterans., Study Design: Prospective, nonrandomized trial., Subjects and Methods: Eight patients with tinnitus received 5 consecutive days of rTMS (0.5 Hz, 20 minutes) to the left temporoparietal area. Tinnitus Handicap Inventory (THI) measures before sessions 1 and 3 and after session 5 were used to evaluate efficacy., Results: Patient 1's THI decreased 40 to 34 to 26, patient 4 reported a subjective improvement, patient 8 withdrew, and the remaining patients reported no improvement. Adverse effects included temporary soreness, restlessness, and photophobia., Conclusion: The parameters for this rTMS study are different from those that reported success with its use. With these current parameters, rTMS did not improve tinnitus in veterans. There were no permanent adverse outcomes.

Background: Ear infection or otitis media (OM) accounts for most bacterial respiratory infections in children in both developed and developing nations. Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the major OM pathogens. However, little is known about the genetic basis of bacterial OM largely due to practical difficulties in conducting research in ear infection models and genetically manipulating clinical isolates. Here, we report the first genome-scale in vivo screen for bacterial genes required for ear infection in a chinchilla model by signature tagged mutagenesis (STM), a high throughput mutant screen technique., Methodology/principal Findings: STM strains were constructed with a multi-drug resistant OM isolate ST556 (serotype 19F) and screened in a chinchilla OM model. Out of 5,280 mutants tested, 248 mutants were substantially underrepresented in the mutant pools recovered from the middle ear fluids of the infected chinchillas, indicating the impaired ability to survive and replicate in the middle ears due to genetic disruptions in the chromosome of strain ST556. Further DNA sequencing analysis mapped the mutations to 169 pneumococcal genes. Surprisingly, only 52 of these genes were required for pneumococcal nasopharyngeal colonization in a murine model. This infection site-specific gene requirement was verified by targeted mutagenesis in the selected genes., Conclusions/significance: These findings suggest that there are a subset of pneumococcal genes required for ear infection and that these may be distinct from those required for nasal colonization. Our data thus provide comprehensive gene targets for mechanistic understanding of pneumococcal ear infection. Finally, this study has also developed a model for future genome-scale search for virulence determinants in other pathogens associated with ear infections.