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Jacono AA, Alemi AS. Response to: Platysma Hammock or Sling: Are They Different? Aesthet Surg J 2023; 43:NP393-NP398. [PMID: 36746774 PMCID: PMC10085543 DOI: 10.1093/asj/sjad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
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Jacono AA, Alemi AS, Harmon JJ, Ahmedli N. The Effect of a Novel Platysma Hammock Flap During Extended Deep Plane Facelift on the Signs of Aging in the Neck. Aesthet Surg J 2022; 42:845-857. [PMID: 35446382 DOI: 10.1093/asj/sjac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging changes in the neck including platysmal banding, skin laxity and submandibular gland visibility have a high degree of recurrence after rhytidectomy. OBJECTIVES To assess the long term (>12 month) improvement in platysma banding (PB), skin laxity (SL) and submandibular gland visibility (SGV) with addition of aplatysmal hammock flap to the extended deep plane facelift. To assess long term (>12 month) post-operative patient satisfaction. METHODS Prospective study of 123 consecutive patients undergoing extended deep plane facelift incorporating platysma hammock flap with or without midline platysmaplasty performed by a single surgeon (AAJ) between February 1st, 2017 and June 15th, 2017. Standard two-dimensional patient photographs were used to assess PB, SL, and SGV pre- and >12 months post-surgery. Severity of each was graded on a 4-point scale by an independent reviewer. One year postoperative patient satisfaction survey was conducted. RESULTS The platysmal hammock flap without midline platysmaplasty (PH) cohort had a statistically significant (p < .01) reduction in the mean preoperative PB, SL, and SGV scores from 1.03, 1.88 and 1.21, to 0.06, 0.03, and 0.15 at 21 months. The platysmal hammock flap with midline platysmaplasty (PHMP) cohort had a statistically significant (P < .01) reduction in the pre-operative PB, SL and SGV scores from 1.81, 2.43, and 1.81, to 0.10, 0.15, and 0.48 at 18 months. The PHMP cohort had a 96.2% satisfaction, and the PH cohort had an 88.9% satisfaction. CONCLUSIONS Extended deep place facelift with a platysmal hammock flap achieves long term, sustained improvements in PB, SL, and SGV. This procedure is well-tolerated and results in substantial patient satisfaction.
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Affiliation(s)
| | | | | | - Nigar Ahmedli
- Department of Otorhinolaryngology/Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Montefiore Medical Center , Bronx, NY , USA
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Abstract
BACKGROUND The vector of superficial musculoaponeurotic system (SMAS) redraping in rhytidectomy is often described in relation to the zygomaticus major muscle (ZMM), so that suspension prevents distortion of the mimetic musculature and a "facelifted appearance." There are no data describing the true orientation of this muscle in the midface. OBJECTIVES The aim of this study was to define the vector of the ZMM relative to the Frankfort horizontal plane. METHODS One hundred patients underwent deep plane rhytidectomy. As part of this procedure the tissues overlying the ZMM are elevated, allowing muscle orientation to be measured as an angle relative to the Frankfort horizontal plane. RESULTS Data for 200 hemifaces were aggregated. The average ZMM angle was 59° (standard deviation, 6°; range, 41-72°) relative to the Frankfort horizontal plane, and showed a statistically significant pattern of change with advancing age, becoming more acute with increasing age below the age of 60 years and more obtuse with age over 60 years. CONCLUSIONS The native vector of the ZMM varies significantly between rhytidectomy patients as demonstrated by the high variance in this cohort. Assumptions about its orientation should not be made in rhytidectomy techniques that do not identify its course. Standard vectors of SMAS redraping, such as superior-lateral, vertically oblique, and purely vertical, should be reconsidered and a customized vector implemented in each case. Aging affects the orientation of the muscle, which can potentially be explained by soft tissue and bony changes at its attachments. This furthers the variability of the SMAS vector in each individual case. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Andrew A Jacono
- Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, NY
- Division of Facial Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, New York, NY
| | | | - A Sean Alemi
- private facial plastic surgery practice in New York, NY
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Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthet Surg J 2019; 39:927-942. [PMID: 30768122 DOI: 10.1093/asj/sjz045] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/27/2019] [Accepted: 02/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection. OBJECTIVES The authors sought to aggregate and summarize data on complications among different SMAS facelift techniques. METHODS A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P < 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P < 0.01). CONCLUSIONS There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Andrew A Jacono
- Section Head of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, NY
- Associate Clinical Professor in the Division of Facial Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - A Sean Alemi
- Surgical fellow at a private facial plastic surgery practice in New York, NY
| | - Joseph L Russell
- Facial plastic surgeon in private practice in North Charleston, SC
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Alemi AS, Mazur CM, Fowler TW, Woo JJ, Knott PD, Alliston T. Glucocorticoids cause mandibular bone fragility and suppress osteocyte perilacunar-canalicular remodeling. Bone Rep 2018; 9:145-153. [PMID: 30306100 PMCID: PMC6176786 DOI: 10.1016/j.bonr.2018.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/06/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023] Open
Abstract
Osteocytes support dynamic, cell-intrinsic resorption and deposition of bone matrix through a process called perilacunar/canalicular remodeling (PLR). In long bones, PLR depends on MMP13 and is tightly regulated by PTH, sclerostin, TGFβ, and glucocorticoids. However, PLR is regulated differently in the cochlea, suggesting a mechanism that is anatomically distinct. Unlike long bones, the mandible derives from neural crest and exhibits unique susceptibility to medication and radiation induced osteonecrosis. Therefore, we sought to determine if PLR in the mandible is suppressed by glucocorticoids, as it is in long bone. Hemimandibles were collected from mice subcutaneously implanted with prednisolone or vehicle containing pellets for 7, 21, or 55 days (n = 8/group) for radiographic and histological analyses. Within 21 days, micro-computed tomography revealed a glucocorticoid-dependent reduction in bone volume/total volume and trabecular thickness and a significant decrease in bone mineral density after 55 days. Within 7 days, glucocorticoids strongly and persistently repressed osteocytic expression of the key PLR enzyme MMP13 in both trabecular and cortical bone of the mandible. Cathepsin K expression was significantly reduced only after 55 days of glucocorticoid treatment, at which point histological analysis revealed a glucocorticoid-dependent reduction in the lacunocanalicular surface area. In addition to reducing bone mass and suppressing PLR, glucocorticoids also reduced the stiffness of mandibular bone in flexural tests. Thus, osteocyte PLR in the neural crest-derived mandible is susceptible to glucocorticoids, just as it is in the mesodermally-derived femur, highlighting the need to further study PLR as a target of drugs, and radiation in mandibular osteonecrosis.
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Affiliation(s)
- A Sean Alemi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of California San Francisco, United States of America
| | - Courtney M Mazur
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America.,UC Berkeley-UCSF Graduate Program in Bioengineering, United States of America
| | - Tristan W Fowler
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Jonathon J Woo
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - P Daniel Knott
- Department of Otorhinolaryngology, Head and Neck Surgery, University of California San Francisco, United States of America
| | - Tamara Alliston
- Department of Otorhinolaryngology, Head and Neck Surgery, University of California San Francisco, United States of America.,Department of Orthopaedic Surgery, University of California San Francisco, United States of America.,UC Berkeley-UCSF Graduate Program in Bioengineering, United States of America
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Formeister EJ, Sean Alemi A, El-Sayed I, George JR, Ha P, Daniel Knott P, Ryan WR, Seth R, Tamplen ML, Heaton CM. Shorter interval between radiation therapy and salvage laryngopharyngeal surgery increases complication rates following microvascular free tissue transfer. Am J Otolaryngol 2018; 39:548-552. [PMID: 29908709 DOI: 10.1016/j.amjoto.2018.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/16/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate how the interval between radiation and salvage surgery for advanced laryngeal cancer with free tissue transfer reconstruction influences complication rates. MATERIALS AND METHODS This is a retrospective series of 26 patients who underwent salvage laryngectomy or laryngopharyngectomy with vascularized free tissue reconstruction (anterolateral thigh or radial forearm) following radiation or chemoradiation between 2012 and 2017 at a single academic center. The primary outcome was incidence of postoperative complications, including pharyngocutaneous fistula. Secondary outcomes included the need for a second procedure, time to resumption of oral feeding, feeding tube dependence, and hospital length of stay. RESULTS Salvage surgery was performed for persistence (7/26, 27%), recurrence/new primary (12/26, 46%), and dysfunctional larynges (7/26, 27%). Twenty-two (85%) defects were reconstructed with an anterolateral thigh free flap and 4/26 with a radial forearm free flap (15%). There were no flap failures. There were significantly more complications in patients undergoing surgery within 12 months of completion of radiation therapy (7/12, 58%) versus those undergoing surgery after 12 months (1/14, 7%; p = .02). Patients experiencing complications more often required a second procedure (4/7 vs. 0/1; p = .02), experienced a longer delay to initiation of oral diet (61 vs. 21 days; p = .04), and stayed in the hospital longer (28 vs. 9 days; p = .01). CONCLUSIONS Shorter intervals between definitive radiation and salvage laryngopharyngeal surgery with free tissue reconstruction increases postoperative complications, hospital length of stay, and the likelihood of feeding tube dependence. Reconstructive surgeons can use these findings to help guide preoperative patient counseling and assess postoperative risk.
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Affiliation(s)
- Eric J Formeister
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - A Sean Alemi
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Ivan El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Jonathan R George
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Patrick Ha
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - P Daniel Knott
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - William R Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Rahul Seth
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Matthew L Tamplen
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Chase M Heaton
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA.
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Alemi AS, Seth R, Heaton C, Wang SJ, Knott PD. Comparison of Video and In-person Free Flap Assessment following Head and Neck Free Tissue Transfer. Otolaryngol Head Neck Surg 2017; 156:1035-1040. [DOI: 10.1177/0194599816688620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Compare the efficiency of remote telehealth flap assessments with traditional in-person flap assessments. Study Design Observational study with retrospective review. Setting Tertiary academic medical center. Subjects and Methods All patients undergoing head and neck free tissue transfer were included in the study. All patients whose surgery was performed at hospital A underwent an in-person flap check overnight. Those at hospital B received a remote flap assessment. The primary outcome was total time spent performing the midnight flap assessment, including travel time. Data were gathered prospectively using an online survey. Results Sixty consecutive patients met inclusion criteria. On the night of the surgery, 31 had an in-person flap check while 29 had a video telehealth flap check. There were no partial or total flap losses or take-backs resulting from the flap checks. Mean (SD) times for in-person and remote assessments were 34 (16) minutes (range, 10-60 minutes) and 13 (8) minutes (range, 5-35 minutes), respectively ( P < .001). House staff unanimously felt the remote telehealth system improved their quality of life without affecting their perception of the quality of the flap assessment ( P = .001). Conclusion Compared with in-person flap assessments in this cohort, telehealth assessments allowed more efficient examination of free tissue reconstructions while yielding seemingly equivalent information. Therefore, remote telehealth flap checks may provide useful information supporting the use of high-fidelity remote data-streaming technology in the delivery of complex care to patients distant from their care provider.
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Affiliation(s)
- A. Sean Alemi
- Department of Otolaryngology, Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology, Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Chase Heaton
- Department of Otolaryngology, Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology, Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - P. Daniel Knott
- Department of Otolaryngology, Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Alemi AS, Heaton CM, Ryan WR, El-Sayed I, Wang SJ. Volumetric Growth of Cervical Schwannoma as a Predictor of Surgical Intervention. Otolaryngol Head Neck Surg 2016; 156:152-155. [DOI: 10.1177/0194599816669500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Cervical schwannomas are benign tumors that commonly present as asymptomatic masses and are managed with observation, radiation, or surgery. To our knowledge, the rate of volumetric change seen on serial imaging is not currently used to determine surgical candidacy. We assess average growth rates and determine whether growth rate of cervical schwannoma predicts having undergone surgery. Study Design Case series with chart review. Setting Quaternary academic medical center. Subjects and Methods Patients were identified with at least 2 imaging studies and pathologic or imaging characteristics of cervical schwannoma. Volume was calculated with the formula 4/3π xyz, with x, y, and z representing the 3 orthogonal dimensions. Volume and rate of volume change were compared among observed, surgical, and gamma knife groups. Results Thirteen patients were identified and divided into subgroups: surgical (n = 5), observation (n = 6), and gamma knife (n = 2). Mean follow-up time was 21 months (range, 1-80 months) and not significantly different among subgroups. The average changes in volume were 3.61 cm3/mo (entire group), –2.75 cm3/mo (observation), 11.97 cm3/mo (surgery), and 1.78 cm3/mo (gamma knife). Average initial volume for the entire group was 124.4 cm3 (range, 5-608 cm3) and 142 cm3 (range 5-613) at follow-up. The surgical group had a statistically significant change in volume ( P = .03). A statistically significant difference in growth rate was seen between the surgical and observation groups ( P = .016) and between the surgical group and all nonsurgical patients ( P = .011). Conclusions Rate of tumor growth can be used in the evaluation of patients with cervical schwannoma, and it may predict surgical intervention.
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Affiliation(s)
- A. Sean Alemi
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Chase M. Heaton
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - William R. Ryan
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ivan El-Sayed
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
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Affiliation(s)
- A Sean Alemi
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco
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Alemi AS, Rosbe KW, Chan DK, Meyer AK. Airway response to sirolimus therapy for the treatment of complex pediatric lymphatic malformations. Int J Pediatr Otorhinolaryngol 2015; 79:2466-9. [PMID: 26549380 DOI: 10.1016/j.ijporl.2015.10.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
Head and neck lymphatic malformations can create airway management challenges requiring tracheotomy. Sirolimus, an inhibitor of mammalian target of rapamycin (mTOR), may inhibit growth of lymphatic malformations. We describe two patients born with large lymphatic malformations with improved airway symptoms following sirolimus therapy. Patient #1 underwent tracheotomy and multi-modal therapy including sirolimus with reduction in airway involvement but regrowth after discontinuation of sirolimus. Patient #2 also experienced a significant response to sirolimus allowing for extubation and discharge without tracheotomy. Early initiation of sirolimus therapy should be considered as a means to avoid tracheotomy in complex head and neck lymphatic malformations.
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Affiliation(s)
- A Sean Alemi
- Department of Otolaryngology - Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Kristina W Rosbe
- Department of Otolaryngology - Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Otolaryngology, Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dylan K Chan
- Department of Otolaryngology - Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Otolaryngology, Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Anna K Meyer
- Department of Otolaryngology - Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Otolaryngology, Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
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Abstract
Objective Enlarged vestibular aqueduct is the most common radiographically identified cause of congenital sensorineural hearing loss and is frequently progressive. Imaging is often ordered during the workup of children with congenital sensorineural hearing loss in part to identify enlarged vestibular aqueduct given concern for progression with head trauma. However, this association has not been systematically evaluated. We aimed to determine the rate of progression and association with head trauma in individuals with enlarged vestibular aqueduct. Data Sources Systematic review of primary studies identified through PubMed, Embase, Cochrane, and Web of Science. Review Methods Meta-analysis was performed on patient-level data describing enlarged vestibular aqueduct, progressive sensorineural hearing loss, and head trauma extracted from articles identified on systematic review according to PRISMA guidelines. Results Twenty-three studies (1115 ears with enlarged vestibular aqueduct) met inclusion criteria. Progressive sensorineural hearing loss was found in 39.6% of ears, with trauma-associated progression in 12%. Limited case-control data show no difference in the incidence of progression between patients with and without head trauma. Conclusions Long-term progressive sensorineural hearing loss is common in enlarged vestibular aqueduct, but its association with head trauma is not strongly supported.
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Affiliation(s)
- A. Sean Alemi
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Dylan K. Chan
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
- Division of Pediatric Otolaryngology, University of California, San Francisco, California, USA
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