Objective: Determine whether an electronic tablet-based Wireless Automated Hearing-Test System can perform high-quality audiometry to assess schoolchildren for hearing loss in the field in Nicaragua. Study Design: Cross-sectional. Setting: A school and hospital-based audiology clinic in Jinotega, Nicaragua. Subjects and Methods: Second and third graders (n = 120) were randomly selected for hearing testing in a school. Air conduction hearing thresholds were obtained bilaterally using a Wireless Automated Hearing-Test System at 1000, 2000, and 4000 Hz. Referral criteria were set at more than 25 dBHL at one or more frequencies. A cohort of children was retested with conventional audiometry in a hospital-based sound booth. Factors influencing false-positive examinations, including ambient noise and behavior, were examined. Results: All children with hearing loss were detected using an automated, manual, or two-step (those referred from automated testing were tested manually) protocol in the school (sensitivity = 100%). Specificity was 76% for automated testing, 97% for manual testing, and 99% for the two-step protocol. The variability between thresholds obtained with automated testing was greater than manual testing when compared with conventional audiometry. The percentage of participant responses when no stimulus tone was presented during automated testing was higher in children with false-positive examinations. Conclusion: A Wireless Automated Hearing-Test System identified all children with hearing loss in a challenging field setting. A two-step protocol (those referred from automated testing are tested manually) reduced false-positive examinations and unnecessary referrals. Children who respond frequently when no tone is presented are more likely to have false-positive automated examinations and should be tested manually.

Treatment of throat cancers have improved due to minimally-invasive trans-oral approaches. Surgeons rely on preoperative imaging to guide their resection; however, large tissue deformations occur during trans-oral procedures due to placement of necessary retractors and laryngoscopes which hinders the surgeon's ability to accurately assess tumor extent and location of critical structures. We propose an image-guided framework utilizing intraoperative imaging and deformation modeling to improve surgeon accuracy and confidence. A CT-compatible laryngoscopy system previously developed was evaluated in this framework. Intraoperative images were acquired during laryngoscopy; force-sensing capabilities were enabled in the laryngoscope; and tracking of the scope and anatomic features was trialed. Tissue deformation and displacement were quantified and determined to be extensive, with values < 4.6 cm in the tongue, < 1.8 cm in bony structures, and < 108.9 cm 3 in airway volume change. Surgical navigation using intraoperative imaging and tracking was evaluated. Preliminary assessment of deformation modeling showed potential to supplement intraoperative imaging. Future work will involve streamlined integration of the components of this framework.

In our experiments we implanted Palacos-cubes of 1 cm3 to both hind legs of 31 (bastard-)dogs. Circulation of one leg was stopped by means of a tourniquet and the temperature of the cement was registered while polymerizing. Evaluation of the temperature measurements showed results which were nearly identical on both sides. The histological findings revealed that necrosis of bone and the thickness of the fibrous tissue built at the bone-cement interface was subject only to the maximum temperature. In our opinion an increased damage caused by the interruption of blood flow during operation is not to be expected.

Objective To demonstrate the feasibility of a novel procedure whereby a suture is placed transorally in the tensor veli palatini muscle to tighten it, thereby dilating the cartilaginous portion of the eustachian tube (ET). Study Design The study design was a prospective cadaveric experiment to examine the feasibility of a novel treatment for ET dysfunction. Setting Academic medical center in a research-oriented operating room with intraoperative computed tomography (CT) capabilities. Methods Seven fresh-frozen cadaver heads were obtained, each of which was thawed for 36 hours prior to use. The preprocedural volumes of the cartilaginous ET were measured by filling the ET with an iodine-containing radiocontrast agent via the nasopharynx and then obtaining CT images. Submucosal flaps in the soft palate were raised, and sutures were placed in the tensor veli palatini bilaterally to increase tension. After completion of the procedure, contrast placement and CT imaging were repeated. Three-dimensional models of the ETs were created, and the volumes were measured and compared. Results Of the 14 ETs evaluated, 13 showed an increase in postprocedure volume. On average, postprocedure volumes showed a 57% increase from preprocedure volumes (mean relative change, 57.1%; P = .013). Conclusion Placement of a tension-holding suture in the tensor veli palatini muscle can reliably dilate the cartilaginous portion of the ET. Such a procedure may be useful in the treatment of ET dysfunction.

BackgroundPrior therapeutic radiation exposure in the setting of head and neck malignancies is associated with difficult airway instrumentation. We sought to characterize the anatomic changes that produce this phenotype.Study DesignRetrospective review.MethodsFive individuals with prior radiation therapy to the upper aerodigestive tract (previously irradiated) and 10 with no prior history of therapeutic radiation exposure (nonirradiated) were enrolled. Computed tomography images obtained before and during laryngoscope insertion (“uninstrumented” and “instrumented”, respectively) were used to reconstruct three‐dimensional representations of the pharyngeal airway, hyoid, and mandible.ResultsIn the instrumented state, pharyngeal airway volumes were significantly greater in nonirradiated subjects relative to previously irradiated subjects (P = .01), and overall translation of both the hyoid and mandible was also greater in nonirradiated subjects (P = .01 and .04, respectively).ConclusionIndividuals with prior therapeutic radiation exposure to the upper aerodigestive tract differ from nonirradiated subjects with respect to airway deformation and bony structure translation during laryngoscopy.Level of Evidence4