Hilton Head Island, United States
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Tarnutzer A.A.,University of Zürich | Lee S.-H.,Chonnam National University | Kaplan P.W.,Johns Hopkins University | Newman-Toker D.E.,Otolaryngology Head and Neck Surgery
Neurology | Year: 2015

Objective: Seizures can cause vestibular symptoms, even without obvious epileptic features. We sought to characterize epileptic vertigo or dizziness (EVD) to improve differentiation from nonepileptic causes, particularly when vestibular symptoms are the sole manifestation. Methods: We conducted a systematic review with electronic (Medline) and manual search for English-language studies (1955-2014). Two independent reviewers selected studies. Study/patient characteristics were abstracted. We defined 3 study population types: (1) seizures, some experiencing vertigo/dizziness (disease cohort); (2) vertigo/dizziness, some due to seizures (symptom cohort); (3) vertigo/dizziness due to seizures in all patients (EVD-only cohort). Results: We identified 84 studies describing 11,354 patients (disease cohort 8,129; symptom cohort 2,965; EVD-only cohort 260). Among 1,055 EVD patients in whom a distinction could be made, non-isolated EVD was present in 8.5%, isolated EVD in 0.8%. Thorough diagnostic workups (ictal EEG, vestibular testing, and brain MRI to exclude other causes) were rare (<0.1%). Ictal EEG was reported in 487 (4.3%), formal neuro-otologic assessment in 1,107 (9.7%). Localized EEG abnormalities (n 350) were most frequently temporal (79.8%) and uncommonly parietal (11.8%). Duration of episodic vestibular symptoms varied, but was very brief (<30 seconds) in 69.6% of isolated EVD and 6.9% of non-isolated EVD. Conclusions: Non-isolated EVD is much more prevalent than isolated EVD, which appears to be rare. Diagnostic evaluations for EVD are often incomplete. EVD is primarily associated with temporal lobe seizures; whether this reflects greater epidemiologic prevalence of temporal lobe seizures or a tighter association with dizziness/vertigo presentations than with other brain regions remains unknown. Consistent with clinical wisdom, isolated EVD spells often last just seconds, although many patients experience longer spells. © 2015 American Academy of Neurology.


Moore E.J.,Mayo Medical School | Hinni M.L.,Otolaryngology Head and Neck Surgery | Arce K.,Oral Maxillofacial Surgery
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2013

Purpose of Review: Resection of malignant disease often results in full-thickness segmental defects of the mandible and loss of dentition. Ideal rehabilitation of the patient requires replacement of the missing segment with vascularized bone that will receive dental implants, and allow osseointegrated prosthetic rehabilitation and restoration of dentition and proper occlusion. Inexact contouring of the bony reconstruction can result in both cosmetic and functional defects that can diminish the future quality of life of the patient. This review summarizes recent advances in preoperative planning and intraoperative techniques that can maximize the success of proper alveolar reconstruction and dental restoration of the patient suffering a segmental maxillary or mandibular defect. Recent Findings: Preoperative modeling can be achieved with computer software that utilizes patient imaging. From this imaging, anticipated surgical defects can be planned, models can be generated, and intraoperative templates can be produced. These can be used to improve reconstructive plate bending, relative positioning of bone to opposing jaw, contouring of the reconstructive bone, and even placement of osseointegrated implants in a single operative setting. Summary: In patients with complex mandibular defects, the use of computer-assisted three-dimensional planning and modeling can result in time-saving and improved outcomes during maxillary and mandibular reconstruction. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


News Article | February 15, 2017
Site: www.prweb.com

Dr. Benjamin Stong of Kalos Facial Plastic Surgery, LLC in Atlanta was recently recognized by Find Local Doctors as a Top Patient Rated Facial Plastic Surgeon for 2017. This honor is one of numerous awards and achievements that Dr. Stong has earned as a leading facial plastic surgeon in Atlanta. Find Local Doctors is an online directory that helps consumers find the most qualified and reputable physicians in their area. The Top Patient Rated Plastic Surgeon award is an acknowledgement that Dr. Stong has garnered five star ratings and excellent online reviews from his patients across multiple sources. His patients posted impressive remarks about their positive experience at Kalos Facial Plastic Surgery as well as their natural-looking and youthful results in advanced cosmetic procedures. Dr. Stong is dual board certified in Otolaryngology Head and Neck Surgery and Facial Plastic and Reconstructive Surgery by the American Board of Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). These distinguished credentials means that he brings the highest level of specialization, education, and certification in Facial Plastic and Reconstructive surgery. Dr. Stong has earned a strong reputation for his advanced techniques in facelifts, rhinoplasty and blepharoplasty. He also offers an expansive menu of non-surgical services in facial rejuvenation, ranging from bruise-free facial fillers and microneedling to laser treatments and highly advanced stem-cell facelifts. Dr. Stong offers his services in a state-of-the-art facility in Atlanta, where patient-centered care is paramount. Dr. Stong is committed to creating the most natural and balanced results by using innovative and proven techniques in plastic surgery. His methods include ways to improve patient comfort, minimize downtime and promote longer lasting results. He is one of the few plastic surgeons in the country to offer the deep plane facelift and the first in Atlanta to offer the extended deep plane facelift. With this facelift technique, patients can benefit from faster recovery time and the most natural-looking improvements within the neck, jawline and cheeks. “My success as a plastic surgeon is always determined by the satisfaction of my patients. Knowing my patients are pleased with their aesthetic results is the highest honor I could receive,” says Dr. Stong. Owner and facial plastic surgeon, Dr. Benjamin Stong is dual board certified in Head and Neck Surgery and Facial Plastic and Reconstructive Surgery. He completed his fellowship under one of the most nationally renowned plastic surgeons, Dr. Andrew Jacono in New York. He combines his reputable level of training with his own proven experience and talent to bring patients of Atlanta outstanding results in plastic surgery. Among his previous achievements are his consecutive wins as a "Top Doctor" by Castle Connolly. This is a highly respected recognition that is based on peer nomination and extensive review. Kalos Facial Plastic and Reconstructive Surgery specializes in providing the most advanced techniques in facial plastic surgery and other cosmetic services. If you would like to get more information about the services offered by Kalos Facial Plastic Surgery, LLC, please call their Atlanta office at (404) 963-6665 or visit their website at kalos-plasticsurgery.com.


Mokhtarinejad F.,Otolaryngology Head and Neck Surgery | Okhovat S.A.R.,Otolaryngology Head and Neck Surgery | Barzegar F.,Otolaryngology Head and Neck Surgery
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2012

Purpose: Circumferential elevation of the anullus away from its bony seat and extension of the graft onto the anterior bony canal increase the bed of the graft anteriorly but may be associated with anterior blunting, and so, a significant conductive hearing loss may result. The purpose of this study was to compare the surgical and audiologic success rates of circumferential subannular grafting with the conventional underlay tympanoplasty. Materials and Methods: A randomized clinical study was conducted from September 2007 to December 2010 at a tertiary referral center. Thirty-eight patients underwent circumferential subannular grafting (group A), and 25 patients underwent conventional underlay tympanoplasty with extension of the anterior edge of the graft forward against the lateral wall of the Eustachian tube, and therefore, the anterior sharp tympanomeatal angle remained unbroken (group B). All patients underwent preoperative and postoperative audiogram. Blunting and lateralization of the graft were evaluated 6 months after the surgery. Results: The surgical success rate was 97% in group A and 100% in group B patients. Improvement of the air conduction thresholds in all frequencies and closure of the mean air-bone gap were significant and similar among the 2 groups. There were no cases of significant blunting and tympanic membrane lateralization in the 2 groups. Conclusion: This study showed underlay tympanoplasty with elevation of the annulus away from the sulcus tympanicus in the anterior sharp tympanomeatal angle and placement of the graft between it and anterior bony canal is not associated with increased risk of blunting and lateralization of the graft, if that sharp angle is adequately restored. © 2012 Elsevier Inc. All rights reserved.


Sequeira S.M.,Otolaryngology Head and Neck Surgery | Whiting B.R.,Mallinckrodt Institute of Radiology | Shimony J.S.,Mallinckrodt Institute of Radiology | Vo K.D.,Mallinckrodt Institute of Radiology | And 2 more authors.
Otology and Neurotology | Year: 2011

Hypothesis: High-resolution temporal bone computed tomography (CT) may erroneously demonstrate a superior semicircular canal dehiscence (SSCD) where none exists and inaccurately display the size of a dehiscence. Background: CT is an integral component of the diagnosis of SSCD. The prevalence of dehiscence as measured on computed tomographic scan is approximately eightfold higher than that on histologic studies, suggesting that CT may have a relatively low specificity for identifying canal dehiscence. This, in turn, can lead to an inappropriate diagnosis and treatment plan. Methods: We quantified the accuracy of CT in identifying a dehiscence of the superior semicircular canal in a cadaver model using microCT as a gold standard. The superior canals of 11 cadaver heads were blue lined. Twelve of the 22 ears were further drilled to create fenestrations of varying sizes. Heads were imaged using medical CT, followed by microCT scans of the temporal bones at 18-μm resolution. Diagnosis of dehiscence and measurements of dehiscence size were performed on clinical CT and compared with that of microCT. Results: Clinical CT identified 7 of 8 intact canals as dehiscent and tended to overestimate the size of smaller fenestrations, particularly those surrounded by thin bone. Conclusion: These findings confirm that medical CT cannot be used as the exclusive gold standard for SSCD and that, particularly for small dehiscences on CT, clinical symptoms must be clearly indicative of a dehiscence before surgical treatment is undertaken. Preoperative counseling for small dehiscences may need to include the possibility that no dehiscence may be found despite radiologic evidence for it. © 2011, Otology & Neurotology, Inc.


Cabin J.A.,Otolaryngology Head and Neck Surgery | Bassiri-Tehrani M.,Otolaryngology Head and Neck Surgery | Sclafani A.P.,Mount Sinai School of Medicine | Romo T.,New Hill
Facial Plastic Surgery Clinics of North America | Year: 2014

Microtia represents a spectrum of maldevelopment of the external ear. Reconstructive techniques may utilize an autogenous rib cartilage framework and require 2-4 stages; alternatively, an alloplastic framework can be used and typically requires 1-2 stages. Successful reconstruction of microtia with either technique can provide a significant quality of life improvement, and both techniques are described in this article. © 2014 Elsevier Inc.


Ozgursoy O.B.,Otolaryngology Head and Neck Surgery | Salassa J.R.,Otolaryngology Head and Neck Surgery
Otolaryngology - Head and Neck Surgery (United States) | Year: 2010

OBJECTIVE: To investigate the manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy (ELCPM) for cricopharyngeal (CP) bar. STUDY DESIGN: Case series with chart review. SETTING: Academic medical center. SUBJECTS AND METHODS: Review of patients undergoing ELCPM between 2001 and 2007 was undertaken to determine the demographic, clinical, and manofluorographic findings before and six months after surgery. Two groups were established according to pharyngeal driving pressures: normal pressure group (55 mm Hg) and low pressure group (55 mm Hg). RESULTS: Fourteen patients underwent ELCPM for CP bar without a concomitant head and neck or Zenker's procedure. There were no major surgical complications. All 14 patients improved at least one stage on the Functional Outcome Swallowing Scale (FOSS) after surgery. There was a statistically significant decrease in the FOSS stages after surgery. Videofluoroscopy demonstrated a significant postoperative increase in the mean cross-sectional CP opening (CP-area) from 32.75 to 123.52 mm2. Manofluorographic pressure recordings showed a significant postoperative decrease in the intrabolus pressure gradient across the cricopharyngeal region (IB-Gra) from 25.44 to 13.22 mm Hg. Despite significant overall results, the change in the IB-Gra showed no difference between the patient groups. CONCLUSION: Subjective (FOSS) and objective manofluorographic (CP-area, IB-Gra) improvement in CP bar patients occurred after ELCPM. We suggest IB-Gra as a reliable objective indicator for patients who might benefit from ELCPM and as an appropriate parameter for follow-up after surgery. However, continued research on a larger patient population is required to enhance our understanding of CP bar and predictors of outcome after treatment of CP bar dysphagia. © 2010 American Academy of Otolaryngology-Head and Neck-Surgery Foundation. All rights reserved.


Kelleher J.E.,Purdue University | Zhang K.,Purdue University | Siegmund T.,Purdue University | Chan R.W.,Otolaryngology Head and Neck Surgery
Journal of the Mechanical Behavior of Biomedical Materials | Year: 2010

The vocal ligament is known to have nonlinear variation in geometry, yet this is rarely considered in empirical or computational studies. This paper investigates the effects of a nonlinear variation of the anterior-to-posterior geometry and the corresponding spatial variation in elastic modulus on the fundamental frequency of vibration for the vocal ligament. Uniaxial tensile tests were performed on a vocal ligament specimen dissected from an excised 60-year-old male larynx. Digital image correlation (DIC) was used to obtain the spatial deformation field for the entire ligament specimen. DIC results revealed that the tensile deformation was very heterogeneous, with the least amount of deformation occurring in the region of smallest cross-sectional area. The elastic modulus was calculated locally and was found to be approximately 10 times higher at the midpoint of the vocal ligament than in the anterior and posterior macula flavae regions. Based on the spatially varying material properties obtained, finite element models (isotropic and transversely isotropic) were created to investigate how the effects of varying cross-section, heterogeneous stiffness, and anisotropy could affect the fundamental frequency of vibration. It was found that the spatial cross-section variation and the spatially varying anisotropy (i.e. modulus ratio) are significant to predictions of the vibration characteristics. Fundamental frequencies predicted with a finite element model are discussed in view of rotatory inertia and contribution of transverse shear deformation. © 2010 Elsevier Ltd.


Buss E.,Otolaryngology Head and Neck Surgery
Proceedings of Meetings on Acoustics | Year: 2013

Auditory frequency discrimination is a basic ability that may limit the maturation of speech and language skills in some listeners. Despite its importance, the factors affecting frequency discrimination in school-aged children are poorly understood. The goal of the present study was to evaluate effects related to memory for pitch, musical training, and the utilization of temporal fine-structure cues. Listeners were normal-hearing children, 5.1 to 13.6 years old, and adults. One subgroup of children had musical training (>150 hours) and the other did not. The standard stimulus was either a 500- or a 5000-Hz pure tone, and the target stimulus was either a tone of higher frequency or a frequency-modulated tone (2- or 20-Hz rate) centered on the standard frequency. As commonly observed, mean frequency discrimination thresholds tended to be elevated in younger listeners. This developmental effect was smaller for FM detection than for pure-tone frequency discrimination, consistent with an effect of memory for pitch. The child/adult difference tended to be smaller for musically trained than untrained children. Children were not particularly poor at 2-Hz FM detection for the 500-Hz standard, a condition thought to rely on temporal fine-structure cues. © 2013 Acoustical Society of America.


Pitman M.J.,Voice and Swallowing Institute | Cabin J.A.,Otolaryngology Head and Neck Surgery | Iacob C.E.,New York Eye and Ear Infirmary of Mount Sinai
Annals of Otology, Rhinology and Laryngology | Year: 2016

Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy. Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically. Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks. Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required. © The Author(s) 2015.

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