Department of Otolaryngology—Head and Neck Surgery

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Executive Functioning Skills in Preschool-Age Children With Cochlear Implants
(ASHA Publications, 2014-08) Beer, Jessica; Kronenberger, William G.; Castellanos, Irina; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.; Department of Otolaryngology--Head & Neck Surgery, School of Medicine
Purpose The purpose of this study was to determine whether deficits in executive functioning (EF) in children with cochlear implants (CIs) emerge as early as the preschool years. Method Two groups of children ages 3 to 6 years participated in this cross-sectional study: 24 preschoolers who had CIs prior to 36 months of age and 21 preschoolers with normal hearing (NH). All were tested on normed measures of working memory, inhibition-concentration, and organization-integration. Parents completed a normed rating scale of problem behaviors related to EF. Comparisons of EF skills of children with CIs were made to peers with NH and to published nationally representative norms. Results Preschoolers with CIs showed significantly poorer performance on inhibition-concentration and working memory compared with peers with NH and with national norms. No group differences were found in visual memory or organization-integration. When data were controlled for language, differences in performance measures of EF remained, whereas differences in parent-reported problems with EF were no longer significant. Hearing history was generally unrelated to EF. Conclusions This is the first study to demonstrate that EF deficits found in older children with CIs begin to emerge as early as preschool years. The ability to detect these deficits early has important implications for early intervention and habilitation after cochlear implantation.
AUDIOVISUAL INTEGRATION OF SPEECH BY CHILDREN AND ADULTS WITH COCHEAR IMPLANTS
(Institute of Electrical and Electronics Engineers, 2002) Kirk, Karen Iler; Pisoni, David B.; Lachs, Lorin; Department of Otolaryngology--Head & Neck Surgery, School of Medicine
The present study examined how prelingually deafened children and postlingually deafened adults with cochlear implants (CIs) combine visual speech information with auditory cues. Performance was assessed under auditory-alone (A), visual- alone (V), and combined audiovisual (AV) presentation formats. A measure of visual enhancement, RA, was used to assess the gain in performance provided in the AV condition relative to the maximum possible performance in the auditory-alone format. Word recogniton was highest for AV presentation followed by A and V, respectively. Children who received more visual enhancement also produced more intelligible speech. Adults with CIs made better use of visual information in more difficult listening conditions (e.g., when mutiple talkers or phonemically similar words were used). The findings are discussed in terms of the complementary nature of auditory and visual sources of information that specify the same underlying gestures and articulatory events in speech.
Proton Therapy for Head and Neck Adenoid Cystic Carcinoma: Initial Clinical Outcomes
(Wiley, 2015-01) Linton, Okechukwu R.; Moore, Michael G.; Brigance, Joseph S.; Summerlin, Don-John; McDonald, Mark W.; Department of Otolaryngology Head & Neck Surgery, IU School of Medicine
Background The purpose of this study was to report outcomes of proton therapy in head and neck adenoid cystic carcinoma. Methods We conducted a retrospective analysis of 26 patients treated between 2004 and 2012. Twenty patients (77%) had base of skull involvement; 19 (73%) were treated for initial disease and 7 (27%) for recurrent disease. Twenty patients were treated postoperatively, 6 after biopsy alone and 24 had positive margins or gross residual disease. Median dose delivered was 72 Gy (relative biological effectiveness [RBE]). Results Median follow-up was 25 months (range, 7–50 months). The 2-year overall survival was 93% for initial disease course and 57% for recurrent disease (p = .19). The 2-year local control was 95% for initial disease and 86% for recurrent disease (p = .48). The 2-year distant metastatic rate was 25%. Late toxicity of grade 0 or 1 was seen in 17 patients, grade 2 in 5, grade 3 in 2, grade 4 in 1, and grade 5 in 1. Conclusion Initial outcomes of proton therapy are encouraging. Longer follow-up is required.
Synchrony, Complexity and Directiveness in Mothers’ Interactions with Infants Pre- and Post-Cochlear Implantation
(Elsevier, 2014-08) Fagan, Mary K.; Bergeson, Tonya R.; Morris, Kourtney J.; Department of Otolaryngology--Head & Neck Surgery, IU School of Medicine
This study investigated effects of profound hearing loss on mother-infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother-infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age = 13.6 months); and Time 2 (mean age = 23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers’ utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants’ access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants’ word use, all within seven months of cochlear implant activation.
Hearing versus Listening: Attention to Speech and Its Role in Language Acquisition in Deaf Infants with Cochlear Implants
(Elsevier, 2014-01-01) Houston, Derek M.; Bergeson, Tonya R.; Department of Otolaryngology--Head & Neck Surgery, IU School of Medicine
The advent of cochlear implantation has provided thousands of deaf infants and children access to speech and the opportunity to learn spoken language. Whether or not deaf infants successfully learn spoken language after implantation may depend in part on the extent to which they listen to speech rather than just hear it. We explore this question by examining the role that attention to speech plays in early language development according to a prominent model of infant speech perception – Jusczyk’s WRAPSA model – and by reviewing the kinds of speech input that maintains normal-hearing infants’ attention. We then review recent findings suggesting that cochlear-implanted infants’ attention to speech is reduced compared to normal-hearing infants and that speech input to these infants differs from input to infants with normal hearing. Finally, we discuss possible roles attention to speech may play on deaf children’s language acquisition after cochlear implantation in light of these findings and predictions from Jusczyk’s WRAPSA model.
Influence of early linguistic experience on regional dialect categorization by an adult cochlear implant user: a case study
(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2014-05) Tamati, Terrin N.; Gilbert, Jaimie L.; Pisoni, David B.; Department of Otolaryngology--Head & Neck Surgery, IU School of Medicine
To investigate the ability of a cochlear implant user to categorize talkers by region of origin and examine the influence of prior linguistic experience on the perception of regional dialect variation. A postlingually deafened adult cochlear implant user from the Southern region of the United States completed a six-alternative forced-choice dialect categorization task. The cochlear implant user was most accurate at categorizing unfamiliar talkers from his own region and another familiar dialect region, and least accurate at categorizing talkers from less familiar regions. Although the dialect-specific information made available by a cochlear implant may be degraded compared with information available to normal-hearing listeners, this experienced cochlear implant user was able to reliably categorize unfamiliar talkers by region of origin. The participant made use of dialect-specific acoustic-phonetic information in the speech signal and previously stored knowledge of regional dialect differences from early exposure before implantation despite an early hearing loss.
Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy.
(BMC, 2016) McDonald, Mark W.; Liu, Yuan; Moore, Michael G.; Johnstone, Peter A. S.; Department of Otolaryngology--Head & Neck Surgery, IU School of Medicine
Background: To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). Methods: Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. Results: In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. Conclusions: Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.
Current Status of Fractional Laser Resurfacing
(JAMA, 2015) Carniol, Paul J.; Hamilton, Mark M.; Carniol, Eric T.; Department of Otolaryngology Head & Neck Surgery, IU School of Medicine
Fractional lasers were first developed based on observations of lasers designed for hair transplantation. In 2007, ablative fractional laser resurfacing was introduced. The fractionation allowed deeper tissue penetration, leading to greater tissue contraction, collagen production and tissue remodeling. Since then, fractional erbium:YAG resurfacing lasers have also been introduced. These lasers have yielded excellent results in treating photoaging, acne scarring, and dyschromia. With the adjustment of microspot density, pulse duration, number of passes, and fluence, the surgeon can adjust the treatment effects. These lasers have allowed surgeons to treat patients with higher Fitzpatrick skin types (types IV to VI) and greater individualize treatments to various facial subunits. Immunohistochemical analysis has demonstrated remodeling effects of the tissues for several months, producing longer lasting results. Adjuvant treatments are also under investigation, including concomitant face-lift, product deposition, and platelet-rich plasma. Finally, there is a short recovery time from treatment with these lasers, allowing patients to resume regular activities more quickly. Although there is a relatively high safety profile for ablative fractionated lasers, surgeons should be aware of the limitations of specific treatments and the associated risks and complications.
Update on the Evidence for Functional Rhinoplasty Techniques
(Lippincott Williams & Wilkins, 2015-08) Chan, David; Shipchandler, Taha Z.; Department of Otolaryngology Head & Neck Surgery, IU School of Medicine
Purpose of review: Functional rhinoplasty is a term that is commonly used to describe any technique used to address nasal obstruction in the nasal valve region. The cause of nasal valve collapse differs based on the site. Internal valve collapse may be idiopathic or associated with previous rhinoplasty, trauma, or weakened cartilage in older patients. External valve collapse is usually idiopathic and less likely to be associated with previous surgery. Various techniques have been developed over time, and the data in support of functional rhinoplasty continue to increase. Recent findings: This article discusses popular techniques currently in use, as well as newer techniques that have been described over the past several years. In addition, there is a trend toward utilizing objective testing and validated assessment scales to assess postoperative changes. Summary: Functional rhinoplasty utilizes a multitude of techniques to address nasal valve collapse. Although high-level data are lacking, the current literature is in support of nasal valve correction to improve nasal breathing. Most importantly, the technique employed is unique for each patient.
Stem cell-derived tissue-engineered constructs for hemilaryngeal reconstruction
(Sage Publications, 2014-02) Halum, Stacey L.; Bijangi-Vishehsaraei, Khadijeh; Zhang, Hongji; Sowinski, John; Bottino, Marco C.; Department of Otolaryngology--Head and Neck Surgery, IU School of Medicine
OBJECTIVES: As an initial step toward our goal of developing a completely tissue-engineered larynx, the aim of this study was to describe and compare three strategies of creating tissue-engineered muscle-polymer constructs for hemilaryngeal reconstruction. METHODS: Cartilage-mimicking polymer was developed from electrospun poly(D,L-lactide-co-ε-caprolactone) (PCL). Primary muscle progenitor cell cultures were derived from syngeneic F344 rat skeletal muscle biopsies. Twenty F344 rats underwent resection of the outer hemilaryngeal cartilage with the underlying laryngeal adductor muscle. The defects were repaired with muscle stem cell-derived muscle-PCL constructs (5 animals), myotube-derived muscle-PCL constructs (5 animals), motor end plate-expressing muscle-PCL constructs (5 animals), or PCL alone (controls; 5 animals). The outcome measures at 1 month included animal survival, muscle thickness, and innervation status as determined by electromyography and immunohistochemistry. RESULTS: All of the animals survived the 1-month implant period and had appropriate weight gain. The group that received motor end plate-expressing muscle-PCL constructs demonstrated the greatest muscle thickness and the strongest innervation, according to electromyographic activity and the percentage of motor end plates that had nerve contact. CONCLUSIONS: Although all of the tissue-engineered constructs provided effective reconstruction, those that expressed motor end plates before implantation yielded muscle that was more strongly innervated and viable. This finding suggests that this novel approach may be useful in the development of a tissue-engineered laryngeal replacement.

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