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Shohet J, Justeson D, Wilkins A. Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods. Otolaryngol Head Neck Surg 2023; 169:999-1004. [PMID: 36950871 DOI: 10.1002/ohn.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE External auditory exostosis (EAE) is a condition of progressive temporal bone growth into the external auditory canal most commonly from repeat cold water and wind exposure. Several tools have been utilized for EAE excision with varying implications for intra- and postoperative complications. However, comparisons of osteotome and microdrill are made difficult due to the few published cases and intervariability between surgeons. Furthermore, evidence is needed to analyze the safety of novel supplemental tools such as the piezoelectric bone-cutting device. STUDY DESIGN Retrospective chart review. SETTING Medical clinic and surgery center. METHODS A total of 413 subjects representing 472 ears met the inclusion criteria. Of which 159 ears were operated on using osteotome alone (OA), 271 using osteotome with a drill (OD), and 42 with osteotome with piezoelectric (OP). Charts were analyzed for the most reported intraoperative complications and postoperative symptoms and complications. RESULTS There were no significant differences in the rate of tympanic membrane perforations nor in total intraoperative complications between OA, OD, or OP. The OD group contained the only nonperforation intraoperative event. OA had the lowest or near lowest incidence of all symptoms analyzed. OA showed a significantly lower incidence of tinnitus when compared to OD and OP. CONCLUSION We found that OA performed the best, though not statistically significant in most measures, with regard to mitigating rates of complications postsurgery. Our findings suggest OA provides lower risk intraoperatively and postoperatively for patients undergoing transcanal exostosis excision.
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Affiliation(s)
- Jack Shohet
- Shohet Ear Associates Medical Group Inc, Orange County, California, USA
- University of California, Irvine College of Medicine, Irvine, California, USA
| | - Drew Justeson
- Virginia Commonwealth University College of Medicine, Richmond, Virginia, USA
| | - Allison Wilkins
- Shohet Ear Associates Medical Group Inc, Orange County, California, USA
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Shohet J, Bibee J, Gende D. Totally Implantable Hearing Implant Revision Surgery Indications and Outcomes. Otol Neurotol 2023; 44:367-372. [PMID: 36764704 DOI: 10.1097/mao.0000000000003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Analyze indications, findings, and outcomes of revision procedures for a totally implantable active middle ear implant (AMEI) over the past 17 years. STUDY DESIGN Retrospective review. SETTING Single institution, private practice setting. SUBJECTS Adult patients using a totally implantable AMEI called the Esteem middle ear implant by Envoy Medical who needed revision to their original implant between 2005 and 2022. Thirty-nine patients had 60 revision procedures. INTERVENTION History of a totally implantable AMEI revision procedure. Indications for revision were related to either surgical wound issues or reduced device function. OUTCOME MEASURES Device diagnostics, audiometric outcomes, and documented subjective report. RESULTS Surgical site wound issues were readily corrected in the majority of patients; most had risk factors for wound breakdown. For sterile wound dehiscence, it was not always necessary to remove the sound processor for an extended time to promote healing. Outcomes for revision procedures because of device issues ranged from 31 to 100% success rate, depending on the cause of issue. The most common indication for revision was reduced device function caused by scar band and/or fibrotic tissue accumulation in the middle ear. CONCLUSION Revision of fully implantable AMEI can be successful for many indications. Appropriate preoperative device troubleshooting and medical evaluation is helpful in identifying the issue and determining surgical approach. Suboptimal device function and feedback can sometimes be improved by removing tissue around the implant, although permanency of this procedure varies among patients.
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Affiliation(s)
- Jack Shohet
- Shohet Ear Associates, Newport Beach, California
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Shohet J, Bibee J. New Considerations for a Totally Implantable Active Middle Ear Implant. Front Neurol 2021; 12:747887. [PMID: 34721275 PMCID: PMC8548455 DOI: 10.3389/fneur.2021.747887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Totally implantable active middle ear implants (AMEI) provide full-time hearing amplification to those with moderate to severe sensorineural hearing loss. While technology in conventional hearing aids (CHA) has advanced greatly, limitations remain for people with active lifestyles, limited vision or dexterity, and hearing aid fit issues. Furthermore, direct-drive properties of AMEI are thought to provide those with inefficient middle ear transfer functions a distinct advantage in delivering prescribed sound to the cochlea, ultimately improving speech understanding with less distortion. AMEI safety, stability, and efficacy outcomes are well documented and fitting strategies continue to improve. Recent studies show how simple aided speech testing can help predict whether a patient struggling with CHA may instead benefit from an AMEI. Totally implantable AMEI continue to be a viable option for patients who cannot or will not utilize traditional hearing aids.
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Affiliation(s)
- Jack Shohet
- Shohet Ear Associates, Orange County, CA, United States
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Shohet J, Bibee J, Doherty J, Tanita C, Patzkowski G, Gende D. Comparing Light-Driven Contact Hearing Aids with Acoustic Hearing Aids: Data and Clinical Tips. Audiol Neurootol 2020; 25:283-290. [PMID: 32403110 DOI: 10.1159/000507273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Contact hearing aids (CHA) offer potential advantages over conventional acoustic hearing aids (AHA) in terms of sound quality, reduced occlusion, and increased high-frequency gain. This study evaluates objective and subjective outcome data for CHA compared to AHA. METHODS Clinical outcome data were retrospectively reviewed for patients wearing CHA. Individual and group data were analyzed and then compared to unaided and AHA data. Adverse effects, device complaints, and clinical utility were documented throughout the device fitting and follow-up process. RESULTS CHA outcomes were better than unaided hearing and AHA for all patients completing the 3-month CHA trial period (45%). However, CHA return rate was high (55%), most often due to device repair and fit issues. Two patients returned the devices due to poor hearing benefit, though both were off-label audiometric candidates. Significantly more clinical time was required from both audiologists and otolaryngologists to successfully fit and maintain maximum device benefit. CONCLUSIONS For proper audiometric and otologic candidates, this light-driven CHA can offer significant improvements in high-frequency sound fidelity, word recognition, and sound quality compared to AHA technology. Administering questionnaires was helpful in illuminating real-world improvements. Device fit, alignment, and quality control issues are improving, though still contributing to high device return rates at this time. Operational factors should be considered when incorporating CHA into a hearing health care practice.
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Affiliation(s)
- Jack Shohet
- Shohet Ear Associates, Newport Beach, California, USA,
| | | | - Joni Doherty
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Los Angeles, California, USA
| | - Cheryl Tanita
- Shohet Ear Associates, Newport Beach, California, USA
| | | | - Deanna Gende
- Shohet Ear Associates, Newport Beach, California, USA
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Curtin C, Nolan JC, Conlon R, Deneweth L, Gallagher C, Tan YJ, Cavanagh BL, Asraf AZ, Harvey H, Miller-Delaney S, Shohet J, Bray I, O'Brien FJ, Stallings RL, Piskareva O. A physiologically relevant 3D collagen-based scaffold-neuroblastoma cell system exhibits chemosensitivity similar to orthotopic xenograft models. Acta Biomater 2018; 70:84-97. [PMID: 29447961 DOI: 10.1016/j.actbio.2018.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/18/2022]
Abstract
3D scaffold-based in vitro cell culturing is a recent technological advancement in cancer research bridging the gap between conventional 2D culture and in vivo tumours. The main challenge in treating neuroblastoma, a paediatric cancer of the sympathetic nervous system, is to combat tumour metastasis and resistance to multiple chemotherapeutic drugs. The aim of this study was to establish a physiologically relevant 3D neuroblastoma tissue-engineered system and explore its therapeutic relevance. Two neuroblastoma cell lines, chemotherapeutic sensitive Kelly and chemotherapeutic resistant KellyCis83 were cultured in a 3D in vitro model on two collagen-based scaffolds containing either glycosaminoglycan (Coll-GAG) or nanohydroxyapatite (Coll-nHA) and compared to 2D cell culture and an orthotopic murine model. Both neuroblastoma cell lines actively infiltrated the scaffolds and proliferated displaying >100-fold increased resistance to cisplatin treatment when compared to 2D cultures, exhibiting chemosensitivity similar to orthotopic xenograft in vivo models. This model demonstrated its applicability to validate miRNA-based gene delivery. The efficacy of liposomes bearing miRNA mimics uptake and gene knockdown was similar in both 2D and 3D in vitro culturing models highlighting the proof-of-principle for the applicability of 3D collagen-based scaffolds cell system for validation of miRNA function. Collectively, this data shows the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. While neuroblastoma is the specific disease being focused upon, the platform may have multi-functionality beyond this tumour type. STATEMENT OF SIGNIFICANCE Traditional 2D cell cultures do not completely capture the 3D architecture of cells and extracellular matrix contributing to a gap in our understanding of mammalian biology at the tissue level and may explain some of the discrepancies between in vitro and in vivo results. Here, we demonstrated the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. The ability to test drugs in this reproducible and controllable tissue-engineered model system will help reduce the attrition rate of the drug development process and lead to more effective and tailored therapies. Importantly, such 3D cell models help to reduce and replace animals for pre-clinical research addressing the principles of the 3Rs.
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Affiliation(s)
- C Curtin
- Tissue Engineering Research Group, Dept. of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - J C Nolan
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - R Conlon
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Deneweth
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Gallagher
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Y J Tan
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B L Cavanagh
- Cellular and Molecular Imaging Core, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Z Asraf
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Harvey
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S Miller-Delaney
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Shohet
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, TX, United States
| | - I Bray
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Dept. of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - R L Stallings
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - O Piskareva
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Abstract
OBJECTIVE Stereotactic radiation treatment, also known as gamma knife surgery or radiosurgery, has come into acceptance as a treatment alternative to surgical removal for posterior fossa tumors. The purpose of this article is to describe the role of the neurotologist in the optimal management of neurotologic complications after stereotactic radiation, as illustrated by five patients. STUDY DESIGN Retrospective chart review. PATIENTS Five patients who underwent stereotactic radiation of posterior fossa tumors. MAIN OUTCOME MEASURES Presence or absence of neurotologic complications (tumor growth, hearing loss, imbalance/ataxia, vertigo, and facial paralysis) or neurosurgical complaints (facial numbness, motor weakness, headache, hydrocephalus, and subarachnoid cysts). RESULTS Postradiation neurotologic complaints included vertigo, imbalance/ataxia, and progressive hearing loss in four of the five patients. Continued tumor growth occurred in two patients; two patients had no growth; in one patient the tumor became smaller. The complications of facial nerve paralysis, facial numbness, motor weakness, headache, hydrocephalus, cerebellar edema, and posterior fossa arachnoid cyst formation occurred less frequently. CONCLUSIONS Stereotactic radiation of posterior fossa tumors can produce significant neurotologic problems. It is imperative that neurotologists remain involved in the follow-up care of patients with posterior fossa tumors to offer optimal treatment alternatives for the neurotologic disorders.
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Affiliation(s)
- C Jackson
- House Ear Center Newport, Newport Beach, California, USA
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