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News Article | May 1, 2017

Francisco Goya was one of the most important Spanish artists of the late 18th and early 19th century. He was famed for his sensitive portraits, and many historians argue that he was the first truly modern painter. But he was not immune to tragedy. In 1793, at the height of his artistic powers, Goya, then 46, came down with a severe, undiagnosed illness. He was bedridden for months, suffered from hallucinations and constant headaches, and could hardly walk. Slowly he got better, but his hearing never returned. Perhaps in response to this, his work became increasingly dark. After closely examining a range of evidence about Goya’s condition, Ronna P. Hertzano, associate professor of Otorhinolaryngology-Head & Neck Surgery at the University of Maryland School of Medicine (UM SOM), has developed a diagnosis. She thinks that Goya likely suffered from an autoimmune disease called Susac’s syndrome; a second possibility is syphilis. Susac’s syndrome is an autoimmune disease whose main symptoms are impaired brain function, as well as loss of vision, balance and hearing. While the brain-related symptoms, as well as vision and balance problems, usually disappear with time, patients can suffer from permanent hearing loss; syphilis can also lead to severe hearing loss. And of course in the 19th century, there was no treatment for either of these illnesses. Hertzano delivered her diagnosis at the 24th annual Historical Clinicopathological Conference, held Friday, April 28 at UM SOM. The conference is devoted to the diagnosis of disorders that afflicted historical figures; in the past, experts have focused on the diseases of luminaries such as Lenin, Darwin, Eleanor Roosevelt and Lincoln. Hertzano, an expert on the cellular and genetic mechanisms of hearing loss, carefully reviewed the painter’s medical history. “This required real detective work,” she says. “The question of Goya’s ailment was a fascinating medical mystery. I think his case has several plausible possibilities.” Just as importantly, she notes that the outcome today would have been completely different. Even with his hearing loss, Goya would likely have been able to get effective treatment had he lived today. “He would have been able to restore his hearing by receiving a cochlear implant,” Hertzano said. Janis A. Tomlinson, director of special collections and museums at the University of Delaware, also spoke at the conference. Tomlinson is an expert on Goya’s art. Hertzano’s research has focused on how hair cells related to hearing develop. In a study published last year, she and her colleagues identified a new role for a particular group of proteins, in the development and survival of the hair cells. This work illuminated new facets of the genetics of hearing, and also pointed the way to eventual treatments for deafness. The conference was founded in 1995 by Philip A. Mackowiak, the Carolyn Frenkil and Selvin Passen History of Medicine Scholar-in-Residence at UM SOM. “This is a thought-provoking piece of medical detective work,” says Mackowiak. “If Dr. Hertzano had been around to restore Goya’s hearing in 1792, she would have had a profound effect on his life and possibly also on the character of his later works.”

Kalcioglu M.T.,Otorhinolaryngology
Clinical and Experimental Otorhinolaryngology | Year: 2013

Objectives. This experimental study investigated the possible protective effect of beta glucans on amikacin ototoxicity. Methods. Thirty-eight rats with normal distortion product otoacoustic emissions (DPOAEs) were divided into four groups. Group K was the control group. Group A was injected intramuscularly (i.m.) with amikacin 600 mg/kg/day between days 1-15. Group AB was given beta glucan gavage 1 mg/kg/day on days 0-15 and given amikacin 600 mg/kg/day i.m. on days 1-15. Group B was administered only beta glucan gavage, 1 mg/kg/day, on days 0-15.The DPOAEs were elicited in different frequency regions between 2,003 and 9,515 Hz, as distortion product diagrams (DPgrams), before and after the medication was administered, in all groups, on days 1, 5, 10, and 15. Results. No significant changes in the DPgrams were observed in group K. In group A, significant deterioration was observed at the 8,003 and 9,515 Hz frequencies on day 10, and at the 3,991, 4,557, 5,660, 6,726, 8,003, and 9,515 Hz frequencies on day 15. For group AB, statistically significant deterioration was observed at the 2,824, 8,003, and 9,515 Hz frequencies on day 15. The results for group B showed a significant improvement of hearing at the 2,378, 2,824, 3,363, and 3,991 Hz frequencies on day 1, at the 3,363, 3,991, and 8,003 Hz frequencies on day 10, and at the 8,003 Hz frequency on day 15. Conclusion. This study suggests that amikacin-induced hearing loss in rats may be limited to some extent by concomitant use of beta glucan. © 2013 by Korean Society of Otorhinolaryngology-Head and Neck Surgery.

Almeida J.P.,University of Campinas | De Albuquerque L.A.F.,Santa Casa de Belo Horizonte | Gomes E.,Otorhinolaryngology | Schops M.,Federal University of Ceará | Mota J.I.,General Hospital of Fortaleza
Journal of Neurosurgery | Year: 2015

Object With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. Methods In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: < 60 years (n = 289) and 60-69 years old (n = 30). Results Fifty-five patients ≥ 70 years of age (average age 72.5 years, range 70-84 years) underwent endoscopic surgery for treatment of PAs. The mean follow-up period was 50 months (range 12-144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion were treated surgically less frequently than in younger patients. Although patients with an American Society of Anesthesiologists score of 3 were more common in the elderly group (p < 0.05), no significant difference regarding surgical time, extent of resection, and hospitalization were observed. Elderly patients presented with more complications than patients < 60 years (32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%), 2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases (7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70 years old: 12.7%); however, there was no statistical difference. Conclusions Endoscopic transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs. © AANS, 2015.

Objective. To evaluate the effect of different bolus flavors in oral and pharyngeal transit duration of patients with stroke and normal volunteers. Method. The investigation had the participation of 36 patients (44-82 years, mean age: 63 years) with occurrence of stroke from 1 month to 84 months (median: 5.5 months) and 30 normal subjects (33-85 years, mean age: 59 years) who comprised the control group. The scintigraphic method was used to evaluate the oral and pharyngeal transit. Each subject swallowed in random sequence 5 mL of a liquid bolus of bitter, sour, sweet, and neutral taste, all labeled with 37 MBq of 99mTechnetium coupled with phytate. Results. Oral transit was longer in patients with stroke than in the control subjects for the sweet, bitter and sour tastes. Pharyngeal transit and clearance was longer in patients with stroke for the sweet and bitter tastes. In both groups there were no differences between neutral, sweet, sour or bitter tastes. Conclusion. Bolus tastes evaluated did not change oral and pharyngeal transit in normal subjects and patients with stroke.

PubMed | University of Tübingen, Martin Luther University of Halle Wittenberg, University of Würzburg, Institute of Medical Epidemiology and 7 more.
Type: Clinical Trial, Phase III | Journal: Journal of neurosurgery | Year: 2016

A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results.An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically.Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34-3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed.There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.

News Article | February 15, 2017

Dr. Michael Schwartz, a dedicated plastic surgeon, has received the Maintenance of Certification in Facial Plastic and Reconstructive Surgery. This honor, awarded by the American Board of Facial Plastic and Reconstructive Surgery, is for those who have passed all the necessary examinations, completed a graduate study under the authority and approval of the Accreditation Council for Graduate Medical Education and have undergone peer-reviewed clinical practice experience. Having obtained the ABFPRS MOC honor means that Dr. Schwartz will able to refer to himself as a Board-certified Facial Plastic Surgeon or a Diplomat of the American Board of Facial Plastic and Reconstructive Surgery Inc. based on the rules set by the Draft Guidelines for Truthful Advertising of Physician Services. Dr. Schwartz has been a dedicated physician for over three decades. In 1981, he received his degree as a doctor of medicine from Baylor College in Houston. Since then, he has practiced medicine in the states of Texas, New York, New Jersey and Florida. Dr. Schwartz has operated his private practice, Palm Beach Face, in West Palm Beach since 1989. He is also strongly involved with the local medical community, as he has been an active staff member with Good Samaritan Medical Center, St. Mary's Hospital and North Point Surgery & Laser Center, all in West Palm Beach. He is also active with JFK Medical Center in Atlantis, Fla. In addition to his certification as a Diplomat of the American Board of Facial Plastic and Reconstructive Surgery, Dr. Schwartz is also a Diplomat of the American Board of Otolaryngology since 1986. He is also a member of six professional societies, including the Fellow American College of Surgeons, the Fellow American Academy of Facial Plastic and Reconstructive Surgery and the Fellow American Rhinologic Society. Dr. Schwartz has provided many stimulating lectures on a variety of medical topics since obtaining his license. These include a presentation on "Metastatic Disease to the Mandible," at the Eastern Section of the Triological Society in Boston in 1987 and a presentation on "Non-neoplastic Supraglottic Stenosis of Adult Onset" at XIII World Congress of Otorhinolaryngology in Miami Beach in 1985. As a facial plastic surgeon, Dr. Schwartz is trained in a wide variety of important procedures. These include rhinoplasty, eyelid surgery, neck lifts, chin implants and a variety of face-lifts. We are thrilled and honored to learn of Dr. Schwartz's certification. As a dedicated and well-trusted medical professional, we know that Dr. Schwartz has earned his certification and will continue to use his medical knowledge to better the world around him.

PubMed | Otorhinolaryngology, University of Kansas Medical Center and CavCom Inc.
Type: Journal Article | Journal: Journal of the American Academy of Audiology | Year: 2017

Exposure to both occupational and nonoccupational noise is recognized as a risk factor for noise-induced hearing loss (NIHL). Although audiologists routinely inquire regarding history of noise exposure, there are limited tools available for quantifying this history or for identifying those individuals who are at highest risk for NIHL. Identifying those at highest risk would allow hearing conservation activities to be focused on those individuals.To develop a detailed, task-based questionnaire for quantifying an individuals annual noise exposure (ANE) arising from both occupational and nonoccupational sources (aim 1) and to develop a short screening tool that could be used to identify individuals at high risk of NIHL (aim 2).Review of relevant literature for questionnaire development followed by a cross-sectional descriptive and correlational investigation of the newly developed questionnaire and screening tool.One hundred fourteen college freshmen completed the detailed questionnaire for estimating ANE (aim 1) and answered the potential screening questions (aim 2). An additional 59 adults participated in data collection where the accuracy of the screening tool was evaluated (aim 2).In study aim 1, all participants completed the detailed questionnaire and the potential screening questions. Descriptive statistics were used to quantify participant participation in various noisy activities and their associated ANE estimates. In study aim 2, linear regression techniques were used to identify screening questions that could be used to predict a participants estimated ANE. Clinical decision theory was then used to assess the accuracy with which the screening tool predicted high and low risk of NIHL in a new group of participants.Responses on the detailed questionnaire indicated that our sample of college freshmen reported high rates of participation in a variety of occupational and nonoccupational activities associated with high sound levels. Although participation rates were high, ANE estimates were below highest-risk levels for many participants because the frequency of participation in these activities was low in many cases. These data illustrate how the Noise Exposure Questionnaire (NEQ) could be used to provide detailed and specific information regarding an individuals exposure to noise. The results of aim 2 suggest that the screening tool, the 1-Minute Noise Screen, can be used to identify those participants with high- and low-risk noise exposure, allowing more in-depth assessment of noise exposure history to be targeted at those most at risk.The NEQ can be used to estimate an individuals ANE and the 1-Minute Noise Screen can be used to identify those participants at highest risk of NIHL. These tools allow audiologists to focus hearing conservation efforts on those individuals who are most in need of those services.

News Article | November 10, 2016

One in a thousand children suffers deafness or hearing loss, and hearing is the most common sense to be affected by congenital disease. Deafness at birth is often caused by mutations in a specific gene known as Gap Junction Beta 2 (GJB2), which codes for the protein connexin 26. In some populations mutations of this gene are responsible for as many as half the instances of congenital hearing loss. Now, Kazusaku Kamiya and the co-authors of his recent report demonstrate a means of producing supplies of these cells on demand for use in therapeutic studies. “Human cochlear cells are not readily accessible for biopsy or direct drug administration because of anatomical limitations,” state the researchers in their report. “Therefore, ES/iPS [embryo stem/induced pluripotent stem] cells are an important tool for studying the molecular mechanisms underlying inner-ear pathology as well as for generating cells for replacement therapies.” To culture the cells the researchers followed standard protocol for the first seven days at which point specific proteins were added to increase mRNA expression of connexins. On day 7-11 the cells were transferred to a flat 2D culture with inner-ear cells that are especially resistant to enzymes that break down proteins. They successfully cultured induced pluripotent stem cells that differentiated into gap junction plaque cells expressing connexin 26. The researchers were also able to demonstrate that their stem-cell-derived gap junction cells were functionally and structurally characteristic of developing cochlear cells. Importantly the cells differentiated from mice that were deficient in connexin 26 reproduced cellular characteristics of congenital hearing loss. The researchers conclude, “It is expected, then, that these iPS derived cells, which can be obtained from patients, will be particularly useful for drug screening and inner-ear cell therapies targeting GJB2-related hearing loss.” Stem cells are a type of cell that can change into another type of more specialised cell through a process described as differentiation. They occur in embryos (embryonic stem cells), and adults as repair cells. Embryonic stem cells can differentiate into a several different types of specialised cells to form the range of cells needed in the human body. The ability to differentiate into several different types of cell is described as pluripotency and can be induced in adult cells as well by reprogramming non-reproductive system cells (somatic cells) to produce “induced pluripotent stem cells”. The ear comprises three main parts: outer, middle and inner. The ear canal in outer ear channels sound vibrations to the ear drum in the middle ear. The middle ear contains three bones or ossicles that transfer the vibrations of the ear drum to the cochlea, a fluid filled spiral cavity in the inner ear. The movement of the fluid in the cochlea in response to these vibrations is detected by thousands of hair cells in the cochlea that convert this motion into electrical signals that are then communicated by nerve cells to the brain, which senses them as sound. Connexins 26 and 30 form gap junctions that facilitate the movement of ions needed to maintain a balance in conditions - homeostasis – as well as developmental organization in the cochlea. The researchers were able to demonstrate that their stem-cell-derived gap junction cells were functional for forming gap junction intercellular communication networks typical of the developing cochlea. The cells differentiated from mice that were deficient in connexin 26 demonstrated a disruption in the formation of gap junction plaques. Reference Ichiro Fukunaga1, 2, Ayumi Fujimoto1, Kaori Hatakeyama1, Toru Aoki1, Atena Nishikawa1, Tetsuo Noda3, 4, Osamu Minowa3, 4, Nagomi Kurebayashi5, Katsuhisa Ikeda1, Kazusaku Kamiya1, In vitro models of GJB2-related hearing loss recapitulate Ca2+ transients via a gap junction characteristic of developing cochlea, Stem Cell Reports, Published online 11 Nov. 2016. 1.    Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan 2.    Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan 3.    Department of Cell Biology, Japanese Foundation for Cancer Research, Cancer Institute, Tokyo 135-8550, Japan 4.    Team for Advanced Development and Evaluation of Human Disease Models, RIKEN BioResource Center, Tsukuba 305-0074, Japan 5.     Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan The mission of Juntendo University is to strive for advances in society through education, research, and healthcare, guided by the motto “Jin – I exist as you exist” and the principle of “Fudan Zenshin - Continuously Moving Forward”. The spirit of “Jin”, which is the ideal of all those who gather at Juntendo University, entails being kind and considerate of others. The principle of “Fudan Zenshin” conveys the belief of the founders that education and research activities will only flourish in an environment of free competition. Our academic environment enables us to educate outstanding students to become healthcare professionals patients can believe in, scientists capable of innovative discoveries and inventions, and global citizens ready to serve society. About Juntendo Juntendo was originally founded in 1838 as a Dutch School of Medicine at a time when Western medical education was not yet embedded as a normal part of Japanese society. With the creation of Juntendo, the founders hoped to create a place where people could come together with the shared goal of helping society through the powers of medical education and practices. Their aspirations led to the establishment of Juntendo Hospital, the first private hospital in Japan. Through the years the institution’s experience and perspective as an institution of higher education and a place of clinical practice has enabled Juntendo University to play an integral role in the shaping of Japanese medical education and practices. Along the way the focus of the institution has also expanded, now consisting of four undergraduate programs and three graduate programs, the university specializes in the fields of health and sports science and nursing health care and sciences, as well as medicine. Today, Juntendo University continues to pursue innovative approaches to international level education and research with the goal of applying the results to society.

Jacobi C.,Otorhinolaryngology | Ayx I.,Otorhinolaryngology | Fritsche K.,Otorhinolaryngology | Piontek G.,Otorhinolaryngology | And 3 more authors.
Oncotarget | Year: 2015

Objectives: Basaloid-squamous-carcinomas (BSCC) have been considered as aggressive variants of common squamous-cell-carcinomas (HNSCC). Recent studies demonstrated a different clinical course depending on the tumour site. The aim of the study is to analyze the histopathologic/clinical features of BSCC/HNSCC resolved by the HPV-status. Methods: We analysed the histopathologic/clinical features of BSCC (n=59) and HNSCC (n=981), subdivided due to the HPV status. Differences were analysed using Chi square, Fisher exact, and student's t-test. Survival rates were calculated by Kaplan-Meier and log-rank test. Prognostic variables were subsequently evaluated by Cox regression. Results: Our cohort was congruent with the literature regarding sex, age, metastases, and a predilection in the oropharynx. HNSCC/BSCC did not show a different disease-specific-survival. After UICC matching, univariate analysis revealed a better survival of UICC stage IVa BSCC compared to HNSCC (69% vs. 42%, p=0.022) that was associated with a better response to radio-chemotherapy (p = 0.009). These results referred to the high prevalence of HPV+ (86%) oropharyngeal BSCC. Subgroup analysis demonstrated a better survival of HPV+ oropharyngeal BSCC than HPV- BSCC (p=0.017). Conclusion: The clinical outcome in BSCC depends on the tumour site and HPV-status. Prospective studies have to evaluate the beneficial application of postoperative radio-chemotherapy in HPV+ BSCC.

Moreira D.A.,Federal University of São Paulo | Gananca M.M.,Otorhinolaryngology | Caovilla H.H.,Otology and Neurotology
Brazilian Journal of Otorhinolaryngology | Year: 2012

The use of illicit drugs and alcohol can affect body balance. Aim: To evaluate balance control with static posturography in individuals addicted to illicit drugs, with or without alcohol abuse. Study design: Case-control, prospective. Methods: 47 users of illicit drugs, with or without alcohol abuse, and a homogeneous control group consisting of 47 healthy individuals were submitted to a neurotological evaluation including Balance Rehabilitation Unit posturography. Results: The stability threshold mean values were significantly lower (p < 0.0001) in users of illicit drugs, with or without alcohol abuse when compared to the control group; the mean values for sway velocity and ellipse area in all evaluated conditions were significantly higher (p <0.05) in the experimental group when compared to the control group, except for the ellipse area in static force surface and opened eyes (p = 0.168). Conclusion: The balance control of individuals addicted to illicit drugs with or without alcohol abuse could present stability threshold, sway velocity and ellipse area abnormalities in static posturography.

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