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Khandalavala KR, Herberg HA, Kay-Rivest E, Moore LS, Yancey KL, Marinelli JP, Lund-Johansen M, Kosaraju N, Lohse CM, Kutz W, Santa Maria PL, Golfinos JG, Kondziolka D, Carlson ML, Tveiten ØV, Link MJ. Repeat Radiosurgery for Sporadic Vestibular Schwannoma After Primary Radiosurgical Failure: An International Multi-institutional Investigation. Otol Neurotol 2024; 45:587-593. [PMID: 38728563 DOI: 10.1097/mao.0000000000004189] [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: 05/12/2024]
Abstract
OBJECTIVE To describe outcomes of patients with sporadic vestibular schwannoma (VS) who underwent repeat stereotactic radiosurgery (SRS) after primary SRS failure. STUDY DESIGN Multi-institutional historical cohort study. SETTING Five tertiary care referral centers. PATIENTS Adults ≥18 years old with sporadic VS. INTERVENTION Primary and repeat treatment with SRS. MAIN OUTCOME MEASURE Microsurgery-free survival after repeat SRS. RESULTS Across institutions, 32 patients underwent repeat SRS after primary SRS. Most patients (74%) had tumors with cerebellopontine angle extension at primary SRS (median size, 13.5 mm [interquartile range, 7.5-18.8] mm). After primary SRS, patients underwent repeat SRS at a median of 4.8 years (interquartile range, 3.2-5.7 yr). For treatment modality, 30 (94%) patients received gamma knife for primary treatment and 31 (97%) patients received gamma knife as their repeat treatment. Median tumor volume increased from 0.970 cm3 at primary SRS to 2.200 cm3 at repeat SRS. Facial nerve function worsened in two patients after primary SRS and in two patients after repeat SRS. There were no instances of intracranial complications after repeat SRS. Microsurgery-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after repeat SRS were 97% (90-100%, 24), 84% (71-100%, 13), and 68% (48-96%, 6), respectively. There was one occurrence of malignancy diagnosed after repeat radiosurgery. CONCLUSION Overall, repeat SRS for sporadic VS has comparable risk profile, but lower rates of tumor control, compared with primary SRS.
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Affiliation(s)
- Karl R Khandalavala
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Hans A Herberg
- Department of Neurologic Surgery, Bergen University Hospital, Bergen, Norway
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Lindsay S Moore
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | | | | | - Nikitha Kosaraju
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - John G Golfinos
- Department of Neurologic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Douglas Kondziolka
- Department of Neurologic Surgery, NYU Langone Health, New York, New York, U.S.A
| | | | - Øystein V Tveiten
- Department of Neurologic Surgery, Bergen University Hospital, Bergen, Norway
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2
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Marinelli JP, Herberg HA, Moore LS, Yancey KL, Kay-Rivest E, Casale GG, Durham A, Khandalavala KR, Lund-Johansen M, Kosaraju N, Lohse CM, Patel NS, Gurgel RK, Babu SC, Golfinos JG, Roland JT, Hunter JB, Kutz JW, Santa Maria PL, Link MJ, Tveiten ØV, Carlson ML. Salvage Microsurgery Following Failed Primary Radiosurgery in Sporadic Vestibular Schwannoma. JAMA Otolaryngol Head Neck Surg 2024; 150:287-294. [PMID: 38358763 PMCID: PMC10870221 DOI: 10.1001/jamaoto.2023.4474] [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] [Received: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
Abstract
Importance Management of sporadic vestibular schwannoma with radiosurgery is becoming increasingly common globally; however, limited data currently characterize patient outcomes in the setting of microsurgical salvage for radiosurgical failure. Objective To describe the clinical outcomes of salvage microsurgery following failed primary stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) among patients with sporadic vestibular schwannoma. Design, Setting, and Participants This was a cohort study of adults (≥18 years old) with sporadic vestibular schwannoma who underwent salvage microsurgery following failed primary SRS/FSRT in 7 vestibular schwannoma treatment centers across the US and Norway. Data collection was performed between July 2022 and January 2023, with data analysis performed between January and July 2023. Exposure Salvage microsurgical tumor resection. Main Outcomes and Measures Composite outcome of undergoing less than gross total resection (GTR) or experiencing long-term facial paresis. Results Among 126 patients, the median (IQR) age at time of salvage microsurgery was 62 (53-70) years, 69 (55%) were female, and 113 of 117 (97%) had tumors that extended into the cerebellopontine angle at time of salvage. Of 125 patients, 96 (76%) underwent primary gamma knife SRS, while 24 (19%) underwent linear accelerator-based SRS; the remaining patients underwent FSRT using other modalities. Postoperative cerebrospinal fluid leak was seen in 15 of 126 patients (12%), hydrocephalus in 8 (6%), symptomatic stroke in 7 (6%), and meningitis in 2 (2%). Each 1-mm increase in cerebellopontine angle tumor size was associated with a 13% increased likelihood of foregoing GTR (64 of 102 patients [63%]) or long-term postoperative House-Brackmann grade higher than I (48 of 102 patients [47%]) (odds ratio, 1.13; 95% CI, 1.04-1.23). Following salvage microsurgery, tumor growth-free survival rates at 1, 3, and 5 years were 97% (95% CI, 94%-100%), 93% (95% CI, 87%-99%), and 91% (95% CI, 84%-98%), respectively. Conclusions In this cohort study, more than half of patients who received salvage microsurgery following primary SRS/FSRT underwent less than GTR or experienced some degree of facial paresis long term. These data suggest that the cumulative risk of developing facial paresis following primary SRS/FSRT by the end of the patient's journey with treatment approximates 2.5% to 7.5% when using published primary SRS/FSRT long-term tumor control rates.
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Affiliation(s)
- John P. Marinelli
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hans A. Herberg
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
| | - Lindsay S. Moore
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Kristen L. Yancey
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Emily Kay-Rivest
- Department of Otolaryngology–Head and Neck Surgery, New York University Langone Health, New York, New York
| | | | - Allison Durham
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Karl R. Khandalavala
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Nikitha Kosaraju
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Christine M. Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Neil S. Patel
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Richard K. Gurgel
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Seilesh C. Babu
- Department of Neurotology, Michigan Ear Institute, Farmington Hills
| | - John G. Golfinos
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - J. Thomas Roland
- Department of Otolaryngology–Head and Neck Surgery, New York University Langone Health, New York, New York
| | - Jacob B. Hunter
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - J. Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Peter L. Santa Maria
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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3
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Chang SD, Muacevic A, Klein AL, Sherman JH, Romanelli P, Santa Maria PL, Fuerweger C, Bossi Zanetti I, Beltramo G, Vaisbush Y, Tran E, Feng A, Teng H, Meola A, Gibbs I, Tolisano AM, Kutz JW, Wardak Z, Nedzi LA, Hong R, MacRae D, Sohal P, Kapoor E, Sabet-Rasekh P, Maghami S, Moncada PX, Zaleski-King A, Amdur R, Monfared A. Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-Center Study. World Neurosurg 2023; 178:e24-e33. [PMID: 37268187 DOI: 10.1016/j.wneu.2023.05.098] [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: 12/08/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration. METHODS Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms. RESULTS Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS. CONCLUSIONS Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.
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Affiliation(s)
- Steven D Chang
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | | | - Andrea L Klein
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Jonathan H Sherman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | | | - Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | | | | | | | | | - Emma Tran
- Stanford University School of Medicine, Stanford, California, USA
| | - Austin Feng
- Stanford University School of Medicine, Stanford, California, USA
| | - Hao Teng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Antonio Meola
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Iris Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Antony M Tolisano
- Department of Otolaryngology, Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joe Walter Kutz
- Department of Otolaryngology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zabi Wardak
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lucien A Nedzi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Hong
- Virginia Hospital Center, Arlington, Virginia, USA
| | - Don MacRae
- Virginia Hospital Center, Arlington, Virginia, USA
| | - Preet Sohal
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elina Kapoor
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Parisa Sabet-Rasekh
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sam Maghami
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Paola X Moncada
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashley Zaleski-King
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashkan Monfared
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurosurgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Bekale LA, Sharma D, Bacacao B, Chen J, Santa Maria PL. Eradication of Bacterial Persister Cells By Leveraging Their Low Metabolic Activity Using Adenosine Triphosphate Coated Gold Nanoclusters. Nano Today 2023; 51:101895. [PMID: 37575958 PMCID: PMC10421611 DOI: 10.1016/j.nantod.2023.101895] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Bacteria first develop tolerance after antibiotic exposure; later genetic resistance emerges through the population of tolerant bacteria. Bacterial persister cells are the multidrug-tolerant subpopulation within an isogenic bacteria culture that maintains genetic susceptibility to antibiotics. Because of this link between antibiotic tolerance and resistance and the rise of antibiotic resistance, there is a pressing need to develop treatments to eradicate persister cells. Current anti persister cell strategies are based on the paradigm of "awakening" them from their low metabolic state before attempting eradication with traditional antibiotics. Herein, we demonstrate that the low metabolic activity of persister cells can be exploited for eradication over their metabolically active counterparts. We engineered gold nanoclusters coated with adenosine triphosphate (AuNC@ATP) as a benchmark nanocluster that kills persister cells over exponential growth bacterial cells and prove the feasibility of this new concept. Finally, using AuNC@ATP as a new research tool, we demonstrated that it is possible to prevent the emergence of antibiotic-resistant superbugs with an anti-persister compound. Eradicating persister cells with AuNC@ATP in an isogenic culture of bacteria stops the emergence of superbug bacteria mediated by the sub-lethal dose of conventional antibiotics. Our findings lay the groundwork for developing novel nano-antibiotics targeting persister cells, which promise to prevent the emergence of superbugs and prolong the lifespan of currently available antibiotics.
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Affiliation(s)
- Laurent A. Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road Stanford, CA 94305-5739, USA
| | - Devesh Sharma
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road Stanford, CA 94305-5739, USA
| | - Brian Bacacao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road Stanford, CA 94305-5739, USA
| | - Jing Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road Stanford, CA 94305-5739, USA
| | - Peter L. Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road Stanford, CA 94305-5739, USA
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Schiel V, Xia A, Santa Maria PL. Influence of CX3CR1 Deletion on Cochlear Hair Cell Survival and Macrophage Expression in Chronic Suppurative Otitis Media. Otol Neurotol 2023; 44:605-610. [PMID: 37315234 PMCID: PMC10275455 DOI: 10.1097/mao.0000000000003884] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Our objective was to determine whether the receptor CX3CR1 is necessary for the recruitment of macrophages to the cochlea in chronic suppurative otitis media (CSOM) and if its deletion can prevent hair cell loss in CSOM. BACKGROUND CSOM is a neglected disease that afflicts 330 million people worldwide and is the most common cause of permanent hearing loss among children in the developing world. It is characterized by a chronically discharging infected middle ear. We have previously demonstrated that CSOM causes macrophage associated sensory hearing loss. The receptor CX3CR1 is expressed on macrophages, which have been shown to be increased at the time point of outer hair cell (OHC) loss in CSOM. METHODS In this report, we examine the influence of CX3CR1 deletion (CX3CR1-/-) in a validated model of Pseudomonas aeruginosa (PA) CSOM. RESULTS The data show no difference in OHC loss between the CX3CR1-/- CSOM group and CX3CR1+/+ CSOM group (p = 0.28). We observed partial OHC loss in the cochlear basal turn, no OHC loss in the middle and apical turns in both CX3CR1-/- and CX3CR1+/+ CSOM mice at 14 days after bacterial inoculation. No inner hair cell (IHC) loss was found in all cochlear turns in all groups. We also counted F4/80 labeled macrophages in the spiral ganglion, spiral ligament, stria vascularis and spiral limbus of the basal, middle, and apical turn in cryosections. We did not find a significant difference in the total number of cochlear macrophages between CX3CR1-/- mice and CX3CR1+/+ mice (p = 0.97). CONCLUSION The data did not support a role for CX3CR1 macrophage associated HC loss in CSOM.
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Affiliation(s)
- Viktoria Schiel
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
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Kaufman AC, Bacacao BS, Berkay B, Sharma D, Mishra A, O’Toole GA, Saunders JE, Xia A, Bekale LA, Maria PLS. Povidone-Iodine Fails to Eradicate Chronic Suppurative Otitis Media and Demonstrates Ototoxic Risk in Mice. Otol Neurotol 2022; 43:e1121-e1128. [PMID: 36240734 PMCID: PMC10244885 DOI: 10.1097/mao.0000000000003726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
HYPOTHESIS Commercially available povidone-iodine solution can eliminate biofilms and persister cells rapidly in in vivo achievable concentrations without inducing ototoxicity. BACKGROUND Chronic suppurative otitis media (CSOM) is a substantial global problem. Current treatment options often induce a temporary remission without leading to a permanent cessation of symptoms secondary to the treatments' inability to eliminate persister cells. Povidone-iodine has been shown to be able to clear biofilm and planktonic cells in in vitro assays, but there are reports of ototoxic effects limiting its clinical utility. METHODS Bacterial and biofilm growth with quantification by spectrophotomer, murine auditory brainstem response (ABR), and distortion product otoacoustic emissions, immunohistochemistry, in vivo povidone-iodine treatment of murine CSOM, persister cell assay. RESULTS Commercially available 10% povidone-iodine solution is able to completely eradicate multiple clinical strains of Pseudomonas aeruginosa and Staphylococcus aureus in vitro with 10 minutes of exposure. Mice that have received a transtympanic injection of 1% povidone-iodine solution did not have significantly different auditory brainstem response or distortion product otoacoustic emission results compared with the control. Mice that received a povidone-iodine scrub or 10% povidone-iodine solution had significantly worsened hearing (25- and 13-dB increase in threshold, respectively; p < 0.05). In vivo CSOM infection recurred in all mice after the completion of treatment with 10% povidone-iodine solution, and there was no improvement in the bacterial load after treatment, indicating in vivo failure of therapy. CONCLUSION Povidone-iodine solution is effective at eliminating biofilm and persister cells in vitro at in vivo achievable concentrations but fails in vivo most likely because of kinetics of distribution in vivo. Even if drug distribution could be improved, the therapeutic window is likely to be too small given that the diluted solution does not have ototoxic potential, whereas while the scrub variant, which contains detergents, and the undiluted solution are ototoxic after a single treatment.
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Affiliation(s)
- Adam C. Kaufman
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Brian S. Bacacao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Betul Berkay
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Devesh Sharma
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Anupam Mishra
- Department of Otorhinolaryngology, Head and Neck Surgery, King George’s Medical University, Lucknow, India
| | - George A. O’Toole
- Department of Microbiology and Immunology, Dartmouth University, Hanover, New Hampshire
| | - James E. Saunders
- Department of Microbiology and Immunology, Dartmouth University, Hanover, New Hampshire
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Laurent A. Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Peter L. Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
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Xia A, Thai A, Cao Z, Chen X, Chen J, Bacacao B, Bekale LA, Schiel V, Bollyky PL, Maria PLS. Chronic suppurative otitis media causes macrophage-associated sensorineural hearing loss. J Neuroinflammation 2022; 19:224. [PMID: 36096817 PMCID: PMC9465898 DOI: 10.1186/s12974-022-02585-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic suppurative otitis media (CSOM) is the most common cause of permanent hearing loss in children in the developing world. A large component of the permanent hearing loss is sensory in nature and our understanding of the mechanism of this has so far been limited to post-mortem human specimens or acute infection models that are not representative of human CSOM. In this report, we assess cochlear injury in a validated Pseudomonas aeruginosa (PA) CSOM mouse model. Methods We generated persisters (PCs) and inoculated them into the mouse middle ear cavity. We tracked infection with IVIS and detected PA using RT-PCR. We assessed cochlear damage and innate immunity by Immunohistochemistry. Finally, we evaluated cytokines with multiplex assay and quantitative real-time PCR. Results We observed outer hair cell (OHC) loss predominantly in the basal turn of the cochlear at 14 days after bacterial inoculation. Macrophages, not neutrophils are the major immune cells in the cochlea in CSOM displaying increased numbers and a distribution correlated with the observed cochlear injury. The progression of the morphological changes suggests a transition from monocytes into tissue macrophages following infection. We also show that PA do not enter the cochlea and live bacteria are required for cochlear injury. We characterized cytokine activity in the CSOM cochlea. Conclusions Taken together, this data shows a critical role for macrophages in CSOM-mediated sensorineural hearing loss (SNHL). Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02585-w.
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Lin J, Bekale LA, Molchanova N, Nielsen JE, Wright M, Bacacao B, Diamond G, Jenssen H, Santa Maria PL, Barron AE. Anti-persister and Anti-biofilm Activity of Self-Assembled Antimicrobial Peptoid Ellipsoidal Micelles. ACS Infect Dis 2022; 8:1823-1830. [PMID: 36018039 PMCID: PMC9469094 DOI: 10.1021/acsinfecdis.2c00288] [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] [Indexed: 01/29/2023]
Abstract
Although persister cells are the root cause of resistance development and relapse of chronic infections, more attention has been focused on developing antimicrobial agents against resistant bacterial strains than on developing anti-persister agents. Frustratingly, the global preclinical antibacterial pipeline does not include any anti-persister drug. Therefore, the central point of this work is to explore antimicrobial peptidomimetics called peptoids (sequence-specific oligo-N-substituted glycines) as a new class of anti-persister drugs. In this study, we demonstrate that one particular antimicrobial peptoid, the sequence-specific pentamer TM5, is active against planktonic persister cells and sterilizes biofilms formed by both Gram-negative and Gram-positive bacteria. Moreover, we demonstrate the potential of TM5 to inhibit cytokine production induced by lipopolysaccharides from Gram-negative bacteria. We anticipate that this work can pave the way to the development of new anti-persister agents based on antimicrobial peptoids of this class to simultaneously help address the crisis of bacterial resistance and reduce the occurrence of the relapse of chronic infections.
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Affiliation(s)
- Jennifer
S. Lin
- Department
of Bioengineering, School of Medicine & School of Engineering, Stanford University, Stanford, California 94305, United States
| | - Laurent A. Bekale
- Department
of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California 94305, United States
| | - Natalia Molchanova
- The
Molecular Foundry, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
| | - Josefine Eilsø Nielsen
- Department
of Bioengineering, School of Medicine & School of Engineering, Stanford University, Stanford, California 94305, United States,Department
of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Megan Wright
- Department
of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California 94305, United States
| | - Brian Bacacao
- Department
of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California 94305, United States
| | - Gill Diamond
- Department
of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky 40202, United States
| | - Håvard Jenssen
- Department
of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Peter L. Santa Maria
- Department
of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California 94305, United States,
| | - Annelise E. Barron
- Department
of Bioengineering, School of Medicine & School of Engineering, Stanford University, Stanford, California 94305, United States,
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9
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Cao Z, Chen X, Chen J, Xia A, Bacacao B, Tran J, Sharma D, Bekale LA, Santa Maria PL. Gold nanocluster adjuvant enables the eradication of persister cells by antibiotics and abolishes the emergence of resistance. Nanoscale 2022; 14:10016-10032. [PMID: 35796201 PMCID: PMC9578678 DOI: 10.1039/d2nr01003h] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Persister cells are responsible for relapses of infections common in cystic fibrosis and chronic suppurative otitis media (CSOM). Yet, there are no Food and Drug Administration (FDA) approved antibiotics to eradicate persister cells. Frustratingly, the global preclinical bacterial pipeline does not contain antibacterial agents targeting persister cells. Therefore, we report a nontraditional antimicrobial chemotherapy strategy based on gold nanoclusters adjuvant to eradicate persister cells by existing antibiotics belonging to that different class. Compared to killing with antibiotics alone, combining antibiotics and AuNC@CPP sterilizes persister cells and biofilms. Enhanced killing of up to 4 orders of magnitude in a validated mouse model of CSOM with Pseudomonas aeruginosa infection was observed when combining antibiotics and AuNC@CPP, informing a potential approach to improve the treatment of CSOM. We established that the mechanism of action of AuNC@CPP is due to disruption of the proton gradient and membrane hyperpolarization. The method presented here could compensate for the lack of new antibiotics to combat persister cells. This method could also benefit the current effort to slow resistance development because AuNC@CPP abolished the emergence of drug-resistant strains induced by antibiotics.
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Affiliation(s)
- Zhixin Cao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China
| | - Xiaohua Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
- Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450000, China
| | - Jing Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
| | - Brian Bacacao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
| | - Jessica Tran
- The Protein and Nucleic Acid Biotechnology Facility, Beckman Center Stanford University, 279 Campus Drive, West Stanford, CA 94305, USA
| | - Devesh Sharma
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
| | - Laurent A Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
| | - Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305-5739, USA.
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10
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Choi AM, Brenner MJ, Gorelik D, Erbele ID, Crowson MG, Kadkade P, Takashima M, Santa Maria PL, Hong RS, Rose AS, Ostrander BT, Rabbani CC, Morrison RJ, Weissbrod PA, Tate AD, Kain JJ, Lina IA, Shaffer SR, Ahmed OG. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2021. OTO Open 2022; 6:2473974X221126495. [PMID: 36171808 PMCID: PMC9511340 DOI: 10.1177/2473974x221126495] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate new medical devices and drugs pertinent to otolaryngology–head and neck surgery that were approved by the Food and Drug Administration (FDA) in 2021. Data Sources Publicly available FDA device and drug approvals from ENT (ear, nose, and throat), anesthesia, neurosurgery, plastic surgery, and general surgery FDA committees. Review Methods FDA device and therapeutic approvals were identified and reviewed by members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee. Two independent reviewers assessed the relevance of devices and drugs to otolaryngologists. Medical devices and drugs were then allocated to their respective subspecialty fields for critical review based on available scientific literature. Conclusions The Medical Devices and Drugs Committee reviewed 1153 devices and 52 novel drugs that received FDA approval in 2021 (67 ENT, 106 anesthesia, 618 general surgery and plastic surgery, 362 neurosurgery). Twenty-three devices and 1 therapeutic agent relevant to otolaryngology were included in the state of the art review. Advances spanned all subspecialties, including over-the-counter hearing aid options in otology, expanding treatment options for rhinitis in rhinology, innovative laser-safe endotracheal tubes in laryngology, novel facial rejuvenation and implant technology in facial plastic surgery, and advances in noninvasive and surgical treatment options for obstructive sleep apnea. Implications for Practice FDA approvals for new technology and pharmaceuticals present new opportunities across subspecialties in otolaryngology. Clinicians’ nuanced understanding of the safety, advantages, and limitations of these innovations ensures ongoing progress in patient care.
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Affiliation(s)
- Alexander M. Choi
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Michael J. Brenner
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel Gorelik
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Isaac D. Erbele
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Matthew G. Crowson
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Prajoy Kadkade
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, North Shore University Hospital, Sunnyside, New York, USA
| | - Masayoshi Takashima
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Peter L. Santa Maria
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Robert S. Hong
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Austin S. Rose
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Benjamin T. Ostrander
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Cyrus C. Rabbani
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University and University Hospitals, Cleveland, Ohio, USA
| | - Robert J. Morrison
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Philip A. Weissbrod
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Alan D. Tate
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Joshua J. Kain
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Ioan A. Lina
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R. Shaffer
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Marlton, New Jersey, USA
| | - Omar G. Ahmed
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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11
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Eltawil Y, Aaron KA, Santa Maria PL. When an MRI compatible cochlear implant magnet can hide important findings. Otolaryngology Case Reports 2022. [DOI: 10.1016/j.xocr.2022.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Brenner MJ, Shenson JA, Rose AS, Valdez TA, Takashima M, Ahmed OG, Weissbrod PA, Hong RS, Djalilian H, Wolf JS, Morrison RJ, Santa Maria PL, Erbele ID. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review 2020. OTO Open 2021; 5:2473974X211057035. [PMID: 34790883 PMCID: PMC8591653 DOI: 10.1177/2473974x211057035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/30/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate new drugs and devices relevant to otolaryngology–head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2020. Data Sources Publicly available device and therapeutic approvals from ENT (ear, nose, and throat), anesthesia, neurology (neurosurgery), and plastic and general surgery FDA committees. Review Methods Members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee reviewed new therapeutics and medical devices from a query of the FDA’s device and therapeutic approvals. Two independent reviewers assessed the drug’s or device’s relevance to otolaryngology, classified to subspecialty field, with a critical review of available scientific literature. Conclusions The Medical Devices and Drugs Committee reviewed 53 new therapeutics and 1094 devices (89 ENT, 140 anesthesia, 511 plastic and general surgery, and 354 neurology) approved in 2020. Ten drugs and 17 devices were considered relevant to the otolaryngology community. Rhinology saw significant improvements around image guidance systems; indications for cochlear implantation expanded; several new monoclonal therapeutics were added to head and neck oncology’s armamentarium; and several new approvals appeared for facial plastics surgery, pediatric otolaryngology, and comprehensive otolaryngology. Implications for Practice New technologies and pharmaceuticals offer the promise of improving how we care for otolaryngology patients. However, judicious introduction of innovations into practice requires a nuanced understanding of safety, advantages, and limitations. Working knowledge of new drugs and medical devices approved for the market helps clinicians tailor patient care accordingly.
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Affiliation(s)
- Michael J Brenner
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jared A Shenson
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Austin S Rose
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tulio A Valdez
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Masayoshi Takashima
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Omar G Ahmed
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Philip A Weissbrod
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Division of Otolaryngology, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Robert S Hong
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA.,Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Hamid Djalilian
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery and Biomedical Engineering, University of California-Irvine, Irvine, California, USA
| | - Jeffrey S Wolf
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Robert J Morrison
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Peter L Santa Maria
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Isaac D Erbele
- Medical Devices and Drugs Committee, American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.,Department of Otolaryngology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Abstract
OBJECTIVE To report health utilization patterns and outcomes of medical and surgical management in patients with chronic suppurative otitis media (CSOM). STUDY DESIGN Retrospective cohort. SETTING Academic otology clinic. METHODS This study included 175 patients with CSOM with a first clinic visit at our institution between March 2011 and November 2016. All patients displayed a diagnosis of CSOM by International Classification of Diseases code, had at least 1 episode of active CSOM (defined as perforation with otorrhea), and had a documented history of chronic ear infections. The mean age was 49.5 ± 1.5 years, 53% were female, and mean follow-up time was 3.5 ± 0.3 years. RESULTS Patients had an average of 9.5 ± 0.5 otology visits, 4.7 ± 0.4 prescriptions, and 1.7 ± 0.1 surgeries, with estimated per patient cost ranging from $3927 to $20,776. Under medical management, 69% of patients displayed recurrence of disease, with a median time to recurrence of 4 months. For tympanoplasty and tympanomastoidectomy, median time to recurrence was similar at 5 and 7 years, respectively (P = .73). At the most recent visit, the prevalence of all patients with CSOM displaying moderate or worse sensorineural hearing loss (SNHL) was 41%. CONCLUSIONS CSOM represents a major public health issue with high health care utilization and associated costs. Surgery is superior to medical therapy for achieving short- to medium-term inactive disease. Patients with CSOM display a high SNHL burden.
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Affiliation(s)
- Anthony Thai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ksenia A Aaron
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Adam C Kaufman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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14
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Santa Maria PL, Kaufman AC, Bacacao B, Thai A, Chen X, Xia A, Cao Z, Fouad A, Bekale LA. Topical Therapy Failure in Chronic Suppurative Otitis Media is Due to Persister Cells in Biofilms. Otol Neurotol 2021; 42:e1263-e1272. [PMID: 34149028 DOI: 10.1097/mao.0000000000003222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/27/2022]
Abstract
OBJECTIVE Chronic suppurative otitis media (CSOM) is characterized by a chronically draining middle ear. CSOM is typically treated with multiple courses of antibiotics or antiseptics which are successful in achieving quiescence; however, the disease is prone to relapse. Understanding why these treatment failures occur is essential. STUDY DESIGN The minimum inhibitory concentration (MIC), minimal biofilm eradication concentration, and the inhibitory zone were determined for ototopicals and ofloxacin for the laboratory strains and CSOM-derived isolates. The percentage of persister cells and bacterial biofilm formation were measured. Disease eradication was tested in a validated in-vivo model of CSOM after treatment with ofloxacin. SETTING Microbiology Laboratory. METHODS Basic science experiments were performed to measure the effectiveness of a number of compounds against CSOM bacteria in a number of distinct settings. RESULTS The minimal biofilm eradication concentration is higher than is physiologically achievable with commercial preparations, except for povo-iodine. Clincial isolates of CSOM have equivalent biofilm-forming ability but increased proportions of persister cells. Ofloxacin can convert to inactive disease temporarily but fails to eradicate disease in an in-vivo model. CONCLUSIONS Higher percentages of persister cells in clinical CSOM isolates are associated with resistance to ototopicals. Current ototopicals, except povo-iodine, have limited clinical effectiveness; however, it is unknown what the maximum achievable concentration is and there are ototoxicity concerns. Fluoroquinolones, while successful in producing inactive disease in the short term, have the potential to encourage antimicrobial resistance and disease recalcitrance and do not achieve a permanent remission. Given these limitations, clinicians should consider surgery earlier or use of clinically safe concentrations of povo-iodine earlier into the treatment algorithm.
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Affiliation(s)
- Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Adam C Kaufman
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Brian Bacacao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Anthony Thai
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Xiaohua Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
- Department of Otolaryngology, Head and Neck Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Zhixin Cao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, China
| | - Ayman Fouad
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
- Department of Otolaryngology, Head and Neck Surgery, Tanta University, Tanta, Eqypt
| | - Laurent A Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
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15
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Chen J, Bekale LA, Khomtchouk KM, Xia A, Cao Z, Ning S, Knox SJ, Santa Maria PL. Locally administered heparin-binding epidermal growth factor-like growth factor reduces radiation-induced oral mucositis in mice. Sci Rep 2020; 10:17327. [PMID: 33060741 PMCID: PMC7567084 DOI: 10.1038/s41598-020-73875-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023] Open
Abstract
Oral mucositis refers to lesions of the oral mucosa observed in patients with cancer being treated with radiation with or without chemotherapy, and can significantly affect quality of life. There is a large unmet medical need to prevent oral mucositis that can occur with radiation either alone or in combination with chemotherapy. We investigated the efficacy of locally administered heparin-binding epidermal growth factor-like growth factor (HB-EGF), a potent epithelial proliferation and migration stimulator of the oral mucosa as a potential therapy to prevent radiation induced oral mucositis. Using a single dose (20 Gy) of radiation to the oral cavity of female C57BL/6 J mice, we evaluated the efficacy of HB-EGF treatment (5 µl of 10 µg/ml) solution. The results show that HB-EGF delivered post radiation, significantly increased the area of epithelial thickness on the tongue (dorsal tongue (42,106 vs 53,493 µm2, p < 0.01), ventral tongue (30,793 vs 39,095 µm2, *p < 0.05)) compared to vehicle control, enhanced new epithelial cell division, and increased the quality and quantity of desmosomes in the oral mucosa measured in the tongue and buccal mucosa. This data provides the proof of concept that local administration of HB-EGF has the potential to be developed as a topical treatment to mitigate oral mucositis following radiation.
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Affiliation(s)
- Jing Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA
| | - Laurent A Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA.
| | - Kelly M Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA
| | - Zhixin Cao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shoucheng Ning
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, 94305-5739, USA.
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16
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Khomtchouk KM, Kouhi A, Xia A, Bekale LA, Massa SM, Sweere JM, Pletzer D, Hancock RE, Bollyky PL, Santa Maria PL. A novel mouse model of chronic suppurative otitis media and its use in preclinical antibiotic evaluation. Sci Adv 2020; 6:eabc1828. [PMID: 32851190 PMCID: PMC7428333 DOI: 10.1126/sciadv.abc1828] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 05/06/2023]
Abstract
Chronic suppurative otitis media (CSOM) is a neglected pediatric disease affecting 330 million worldwide for which no new drugs have been introduced for over a decade. We developed a mouse model with utility in preclinical drug evaluation and antimicrobial discovery. Our model used immune-competent mice, tympanic membrane perforation and inoculation with luminescent Pseudomonas aeruginosa that enabled bacterial abundance tracking in real-time for 100 days. The resulting chronic infection exhibited hallmark features of clinical CSOM, including inhibition of tympanic membrane healing and purulent ear discharge. We evaluated the standard care fluoroquinolone ofloxacin and demonstrated that this therapy resulted in a temporary reduction of bacterial burden. These data are consistent with the clinical problem of persistent infection in CSOM and the need for therapeutic outcome measures that assess eradication post-therapeutic endpoint. We conclude that this novel mouse model of CSOM has value in investigating new potential therapies.
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Affiliation(s)
- Kelly M. Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
| | - Ali Kouhi
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
- Department of Otolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
| | - Laurent Adonis Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
| | - Solange M. Massa
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
| | - Jolien M. Sweere
- Department of Medicine, Infectious Diseases, Stanford University, Stanford, CA, USA
| | - Daniel Pletzer
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Robert E. Hancock
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Paul L. Bollyky
- Department of Medicine, Infectious Diseases, Stanford University, Stanford, CA, USA
| | - Peter L. Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
- Corresponding author.
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17
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Cao Z, Chen J, Tran J, Chen X, Bacacao B, Bekale LA, Santa Maria PL. Antimicrobial Gold Nanoclusters Eradicate Escherichia coli Biofilms and Are Nontoxic by Oral Administration. ACS Appl Bio Mater 2020; 3:5275-5286. [PMID: 35021702 DOI: 10.1021/acsabm.0c00641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Zhixin Cao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Jing Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
| | - Jessica Tran
- The Protein and Nucleic Acid Biotechnology Facility, Beckman Center Stanford University, 279 Campus Drive West, Stanford, California 94305, United States
| | - Xiaohua Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450000, China
| | - Brian Bacacao
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
| | - Laurent A. Bekale
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
| | - Peter L. Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, California 94305-5739, United States
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Santa Maria PL, Shi Y, Gurgel RK, Corrales CE, Soltys SG, Santa Maria C, Murray K, Chang SD, Blevins NH, Gibbs IC, Jackler RK. Long-Term Hearing Outcomes Following Stereotactic Radiosurgery in Vestibular Schwannoma Patients-A Retrospective Cohort Study. Neurosurgery 2019; 85:550-559. [PMID: 30247723 PMCID: PMC7137466 DOI: 10.1093/neuros/nyy407] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/01/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An understanding of the hearing outcomes is needed for treatment counseling for patients with vestibular schwannomas (VS). OBJECTIVE To determine long-term hearing results following stereotactic radiosurgery (SRS) for VS and identify any influential variables. METHODS Tertiary hospital retrospective cohort. RESULTS There were 579 tumors (576 patients) treated with SRS. Eighty-two percent (473) of tumors had ≥1 yr and 59% (344 ≥3 yr follow-up. In the 244 tumor ears, with measurable hearing before SRS who were followed ≥1 yr, 14% (31) had improved hearing, 13% (29) unchanged hearing, and 74% (158) had worsened hearing. In 175 patients with ≥3 yr follow-up and who had measurable hearing pretreatment, 6% (11 ears) improved hearing, 31% (54 ears) unchanged hearing, and 63% (110 ears) had worsened hearing. Patients with tumors with larger target volumes (P = .040) and with neurofibromatosis type 2 (NF2; P = .017) were associated with poorer hearing (P = .040). Patients with word recognition scores (WRS) of 50% or poorer had tumors with a larger volume (P = .0002), larger linear size (P = .032), and NF2 (P = .045). Traditionally reported hearing outcomes using the Gardner Robertson maintenance of PTA ≤50 db or WRS ≥50% were 48% at 3 yr, which overestimates hearing outcomes compared to the above reporting standards. CONCLUSION Hearing declines over time in VS treated with SRS in a high proportion of cases. The frequency and magnitude of long-term hearing decline following SRS argues against prophylactic radiation for small tumors in hearing ears with undetermined growth behavior.
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Affiliation(s)
- Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
- Department of Ear Sciences, The University of Western Australia, Nedlands, Australia
- Ear Science Institute Australia, Subiaco, Australia
| | - Yangyang Shi
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Richard K Gurgel
- Department of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, Utah
| | - C Eduardo Corrales
- Division of Otolaryngology—Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Chloe Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
- Department of Ear Sciences, The University of Western Australia, Nedlands, Australia
- Ear Science Institute Australia, Subiaco, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Nedlands, Australia
| | - Steven D Chang
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Nikolas H Blevins
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Robert K Jackler
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California
- Department of Neurosurgery, Stanford University, Stanford, California
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Smulders YE, Hendriks T, Stegeman I, Eikelboom RH, Sucher C, Upson G, Chester Browne R, Jayakody D, Santa Maria PL, Atlas MD, Friedland PL. Predicting sequential bilateral cochlear implantation performance in postlingually deafened adults; A retrospective cohort study. Clin Otolaryngol 2018; 43:1500-1507. [DOI: 10.1111/coa.13193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/17/2018] [Accepted: 07/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yvette E. Smulders
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
- Department of Otorhinolaryngology; Rivas Zorggroep; Gorinchem The Netherlands
| | - Thomas Hendriks
- Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck surgery; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Robert H. Eikelboom
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
- Department of Speech-Language Pathology and Audiology; University of Pretoria; Pretoria South Africa
| | - Cathy Sucher
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Gemma Upson
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Ronel Chester Browne
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Dona Jayakody
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Peter L. Santa Maria
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
- Department of Otolaryngology, Head and Neck Surgery; Stanford University; Stanford California
| | - Marcus D. Atlas
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
| | - Peter L. Friedland
- Ear Science Institute Australia; Subiaco Western Australia Australia
- Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- Ear Sciences Centre; The University of Western Australia; Nedlands Western Australia Australia
- School of Medicine; University of Notre Dame; Fremantle Western Australia Australia
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Smulders YE, Hendriks T, Eikelboom RH, Stegeman I, Santa Maria PL, Atlas MD, Friedland PL. Predicting Sequential Cochlear Implantation Performance: A Systematic Review. Audiol Neurootol 2018; 22:356-363. [PMID: 29719297 DOI: 10.1159/000488386] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/23/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022] Open
Abstract
This systematic review of the literature reveals which pre-operative factors affect sequential cochlear implantation outcomes in adults. The findings can help health care prof-essionals provide evidence-based advice on the expected benefits from a second cochlear implant (CI). We searched PubMed, EMBASE, and the Cochrane database from November 1977 to August 26, 2017, using the terms "sequential cochlear implantation"; the most frequently cited predictors for unilateral cochlear implantation performance and other potential predictors for sequential implantation outcome; and "speech perception," "localization" as well as synonyms of all of the above. Ten studies were included. The effects of age, duration of hearing loss, time between implantations, preoperative hearing, etiology of hearing loss, hearing aid use and duration of follow-up on sequential cochlear implantation performance were studied. The literature has shown that duration of deafness, age at onset of deafness, etiology of hearing loss, and preoperative speech perception score are (inversely) related to unilateral cochlear implantation outcome in adults. One would expect that these factors would also affect sequential bilateral implantation outcome. However, the best available evidence to date shows that advanced age, a long duration of deafness, or a long interval between implantations should not be considered negative factors when considering sequential bilateral cochlear implantation.
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Affiliation(s)
- Yvette E. Smulders
- Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Otorhinolaryngology, Rivas Zorggroep, Gorinchem, the Netherlands
| | - Thomas Hendriks
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Robert H. Eikelboom
- Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Peter L. Santa Maria
- Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Marcus D. Atlas
- Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Peter L. Friedland
- Ear Science Institute Australia, Subiaco, Western Australia, Australia.,Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Washington, Australia
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Jackler RK, Santa Maria PL, Blevins NH. In reference to Evidence against the mucosal traction theory in cholesteatoma. Laryngoscope 2018; 128:E269-E270. [PMID: 29392724 DOI: 10.1002/lary.27097] [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: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Abstract
CONCLUSION The present study demonstrates a mouse model of chronic Eustachian tube (ET) dysfunction using a surgical technique that is reproducible and effective with low mortality and morbidity. OBJECTIVE To create a reproducible and effective mouse model of ET obstruction with a low operative morbidity. METHODS Forty healthy, male CBA/CaJ mice underwent the procedure. ET obstruction was performed on one side under general anesthesia; A small piece of dental material (Gutta Percha Points, Meta Biomed, Chungbuk, Korea) was placed via the tympanic orifice of the ET to occlude the entire ET. The contralateral ears of animals served as a control. One month after the operation, all ears were inspected under an operating microscope for signs of ET dysfunction. Primary outcome measures were the signs of ET dysfunction inspected through tympanic membrane (TM) 4 weeks after the operation and confirmation of ET occlusion by post-mortem dissection. RESULTS Forty (100%) of the treated mice ears developed ET dysfunction, as confirmed by the middle ear appearance on otoscopy and dissection post-mortem and 0% of the control ears at 4 weeks. The most common otoscopic signs were thickened TMs and middle ear effusions. No mortality or morbidity occurred either from anesthesia or surgery.
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Affiliation(s)
- Yasin K Varsak
- a Department of Otolaryngology , Head and Neck Surgery, Stanford University , Palo Alto , CA , USA and
- b Department of Otolaryngology , Head and Neck Surgery, Konya Numune Hospital , Konya , Turkey
| | - Peter L Santa Maria
- a Department of Otolaryngology , Head and Neck Surgery, Stanford University , Palo Alto , CA , USA and
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Jackler RK, Santa Maria PL, Varsak YK, Nguyen A, Blevins NH. A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 125 Suppl 4:S1-S14. [PMID: 26013635 DOI: 10.1002/lary.25261] [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] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES/HYPOTHESIS Although the migration of its squamous outer surface of the tympanic membrane has been well characterized, there is a paucity of data available concerning the migratory behavior of its medial mucosal surface. Existing theories of primary acquired cholesteatoma pathogenesis do not adequately explain the observed characteristics of the disease. We propose a new hypothesis, based upon a conjecture that mucosal membrane interactions are the driving force in cholesteatoma. STUDY DESIGN A retrospective chart review and a prospective observational cohort study in rats. METHODS After developing the new theory, it was tested through both clinical and experimental observations. To evaluate whether impairment of middle ear mucociliary migration would influence cholesteatoma formation, a retrospective chart review evaluating cholesteatoma occurrence in a sizable population of patients with either primary ciliary dyskinesia (PCD) or cystic fibrosis (CF) was performed. To study mucosal migration on the medial aspect of the tympanic membrane, ink tattoos were monitored over time in a rat model. RESULTS No cholesteatomas were identified in either PCD patients (470) or in CF patients (1,910). In the rat model, mucosa of the posterior pars tensa migrated toward the posterior superior quadrant, whereas the mucosa of the anterior pars tensa migrated radially toward the annulus. CONCLUSION Mucosal coupling with traction generated by interaction of migrating opposing surfaces provides the first comprehensive theory that explains the observed characteristics of primary acquired cholesteatoma. The somewhat counterintuitive hypothesis that cholesteatoma is fundamentally a mucosal disease has numerous therapeutic implications.
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Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Yasin K Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Santa Maria PL, Kim S, Varsak K, Yang YP. Growth Factor Delivered by a Bioabsorbable Polymer as Treatment for Chronic Tympanic Membrane Perforations. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Test the efficacy of a novel topical growth factor (GF) treatment, delivered by a bioabsorbable polymer, in animal models of chronic tympanic membrane (TM) perforation, Eustachian tube (ET) obstruction, and chronic suppurative otitis media (CSOM). (2) Describe the preclinical work forming the basis for a proposed clinical trial of topical GF treatment. Methods: Bilateral chronic TM perforations were created in our novel mouse model (n = 50) and stable at 3 months, using an inhibitor of epidermal growth factor receptor. One ear received topical GF polymer treatment and the other received polymer only. Another mice cohort (n = 42) had chronic perforations created and also surgical obstruction of the ET. A further mice cohort (n = 35) had CSOM created through the above procedure and inoculation of pseudomonas aeruginosa. These perforations and treatments were evaluated microscopically, histologically, and using cytokeratin immunohistochemistry. Toxicity and safety of our polymer and GF were evaluated using auditory brain stem responses (ABR) and otoacoustic emissions (OAE) at 8 weeks following treatment. Results: In the chronic TM perforation cohort, 92% (22 of 24) healed compared with 38% (10 of 26) of controls (polymer only) at 4 weeks ( P < .01). In the chronic perforation cohort with ET obstruction, 94% (18 of 19) healed compared with 9% (2 of 23) of controls (polymer only) at 6 weeks ( P < .01). The ABR and OAE of our cohorts returned to control levels at 8 weeks. Conclusions: We demonstrate the efficacy, safety, and nontoxicity of a novel GF treatment in animal models.
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Santa Maria PL, Abuzeid WM, Nayak JV, Chang SD, Blevins NH. A case of stereotactic radiation in skull base solitary fibrous tumor: more harm than good? J Neurol Surg Rep 2014; 75:e214-6. [PMID: 25485216 PMCID: PMC4242816 DOI: 10.1055/s-0034-1387196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/15/2014] [Accepted: 06/08/2014] [Indexed: 10/31/2022] Open
Abstract
Objective Due to its location, total resection of a skull base solitary fibrous tumor (SFT) can lead to morbidity with injury to lower cranial nerves, and a decision must be made between subtotal resection with possible stereotactic radiotherapy or total resection with cranial nerve morbidity. We report the long-term outcomes and review the literature of a case of stereotactic radiation in SFT to provide evidence for making this decision. Design A retrospective case review. Setting An academic tertiary referral center. Results We present a case with > 10 years follow-up of radiation following skull base SFT, initially misdiagnosed as schwannoma, where radiotherapy did not improve recurrence or metastatic behavior and led to complications during subsequent surgical resection. Conclusions SFT often masquerades as schwannoma, especially in the skull base. Careful immunohistochemistry, including CD34 expression, is critical to the diagnosis and management. This case highlights that total tumor resection of SFT remains the gold standard of treatment. Stereotactic radiation is not recommended in the management of skull base SFT.
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Affiliation(s)
- Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, United States
| | - Waleed M Abuzeid
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, United States
| | - Jayakar V Nayak
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, United States
| | - Steven D Chang
- Department of Neurosurgery, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, United States
| | - Nikolas H Blevins
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, United States
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Santa Maria PL, Oghalai JS. When is the best timing for the second implant in pediatric bilateral cochlear implantation? Laryngoscope 2013; 124:1511-2. [PMID: 24122858 DOI: 10.1002/lary.24465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/08/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Peter L Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, U.S.A
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Santa Maria PL, Oghalai JS. Is office-based myringoplasty a suitable alternative to surgical tympanoplasty? Laryngoscope 2013; 124:1053-4. [PMID: 24114573 DOI: 10.1002/lary.24221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/24/2013] [Accepted: 05/03/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California, U.S.A
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Santa Maria PL, Sader C, Preston NJM, Fisher PH. Neck dissection for squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2011; 136:S41-5. [PMID: 17398340 DOI: 10.1016/j.otohns.2006.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 10/17/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone. STUDY DESIGN A retrospective, 14-year surgical audit. METHODS The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model. RESULTS The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year. CONCLUSIONS Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease-Free Survival
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/etiology
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Logistic Models
- Male
- Medical Records
- Middle Aged
- Mouth Neoplasms/surgery
- Multivariate Analysis
- Neck Dissection
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Retrospective Studies
- Smoking/adverse effects
- Treatment Outcome
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Affiliation(s)
- Peter L Santa Maria
- Department of Ear, Nose, and Throat Surgery, Fremantle Hospital, Perth, Western Australia, Australia.
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Santa Maria PL, Redmond SL, McInnes RL, Atlas MD, Ghassemifar R. Tympanic membrane wound healing in rats assessed by transcriptome profiling. Laryngoscope 2011; 121:2199-213. [PMID: 21919009 DOI: 10.1002/lary.22150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/14/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study is to elucidate transcriptional changes that occur in response to tympanic membrane (TM) perforation in rats and to infer key genes and molecular events in the healing process. STUDY DESIGN A prospective cohort study of 393 male Sprague-Dawley (Rattus norvegicus) rats. METHODS Sprague-Dawley rats were randomly allocated into either control or perforation groups spanning a 7-day time period. Perforation groups consisted of 12-hour, 24-hour, 36-hour, 2-day, 3-day, 4-day, 5-day, six-day, and 7-day time points. The left TMs of all perforation groups were perforated and the RNA extracted at the specified time point postperforation. Subsequent analysis was performed using Agilent's 4 × 44 k whole rat genome arrays (40 in total) to assess wound-healing gene expression over a 7-day time period. RESULTS Over a 7-day time course and at nine time points that encompassed the wounding and progression of healing, a total of 3,262 genes were differentially expressed. In this study the transcripts most upregulated occurred at 12 hours. These were Stefin A2 (344-fold), Stefin 2 (143-fold), and Natriuretic peptide precursor type B (222-fold). Those most downregulated also occurred at 12 hours. These were alcohol dehydrogenase 7 (13.1-fold) and gamma-butyrobetaine hydroxylase (10.4-fold). Results were validated by quantitative real-time polymerase chain reaction. CONCLUSIONS The findings of this study provide a baseline against which to identify disease-related molecular signatures, biomarkers, and to develop new treatments for TM conditions based on molecular evidence.
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Affiliation(s)
- Peter L Santa Maria
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Australia.
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Santa Maria PL, Redmond SL, Atlas MD, Ghassemifar R. Keratinocyte growth factor 1, fibroblast growth factor 2 and 10 in the healing tympanic membrane following perforation in rats. J Mol Histol 2010; 42:47-58. [PMID: 21136143 DOI: 10.1007/s10735-010-9306-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/19/2010] [Indexed: 11/24/2022]
Abstract
The aim of this study was to provide a transcriptome profile of Keratinocyte Growth Factor (KGF)-1, Fibroblast Growth Factor (FGF) 2 and FGF10 (KGF2) in the healing rat tympanic membrane (TM) over 7 days and an immunohistochemical account over 14 days following perforation. KGF1, FGF2, and FGF10 play important roles in TM wound healing. The tympanic membranes of rats were perforated and sacrificed at time points over a 14-day period following perforation. The normalized signal intensities and immunohistochemical protein expression patterns at each time point for KGF1, FGF2, and FGF10 are presented. The primary role of both KGF1 and FGF2 appeared to be in the proliferation and migration of keratinocytes. Whereas the role of KGF1 appeared to be exclusively concerned with increased proliferation and migration at the perforation site, the continued expression of FGF2, beyond perforation closure, suggested it has an additional role to play. FGF10 (KGF2), whilst possessing the highest sequence homologous to KGF1, has a different role in TM wound healing. The effect of FGF10 on keratinocytes in wound healing appeared to emanate from the connective tissue layer.
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Affiliation(s)
- Peter L Santa Maria
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, WA, Australia.
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Abstract
Developments in the treatment of chronic tympanic membrane perforation have been hindered by the lack of an ideal animal model. It is not appropriate to test such treatments on acute perforations as the majority of these heal spontaneously. An ideal animal model would be one that most closely resembles the human clinical situation. It should be inexpensive, readily available, and easy to create. There have been a number of attempts to create a chronic tympanic membrane perforation model with limited success. All published attempts at chronic tympanic membrane perforations have been reviewed and the limitations of each model are discussed. A number of areas for research exist for further developing a chronic tympanic membrane perforation model. These areas include a perforation model in the presence of bacteria and eustachian tube dysfunction. Understanding the molecular and genetic mechanisms of chronic otitis media and potential treatments will also be useful.
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Affiliation(s)
- Peter L Santa Maria
- Ear Sciences Centre, School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia
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Tan J, Kejriwal N, Vasudevan A, Maria PLS, Alvarez JM. Coronary Bypass Surgery for Patients with Chronic Poor Preoperative Left Ventricular Function (EF<30%): 5-year Follow-up. Heart Lung Circ 2006; 15:130-6. [PMID: 16574536 DOI: 10.1016/j.hlc.2005.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 03/13/2005] [Accepted: 09/07/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal therapy for patients with coronary artery disease and chronic poor left ventricular function, given the absence of randomized trials, is unclear. Although coronary surgery has been performed in such patients for 25 years, it is perceived as high risk and unproven long-term benefit, especially if thallium scanning fails to demonstrate large areas of viability. We report the results of coronary surgery in these patients. METHODS Retrospective analysis by a standardized patient questionnaire, of 107 such consecutive patients offered coronary surgery. RESULTS Mean follow-up was 3.3 years (range, 0.5-5.5); average patient age was 64.4+/-1 years. Preoperative thallium scans were performed solely on 31 patients with none or mild angina, of which 10 (32%) demonstrated large areas of viable myocardium. Perioperative mortality was 1.9%. On multivariate analysis, factors predictive of increased perioperative death were recent myocardial infarction (p<0.001) and nonelective surgery (p<0.001). Kaplan-Meier 5-year survival and freedom from major adverse cardiac events were 72.3 and 82.3%, respectively. In 21 patients, with preoperative nil-to-mild angina and nil-to-small areas of myocardial viability, thallium scanning failed to predict a successful outcome. CONCLUSION Offering coronary surgery to these patients irrespective of thallium testing is safe and effective in the medium term. Early surgery is recommended.
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Affiliation(s)
- Jeremy Tan
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Verdun Street, Perth, WA 6010, Australia
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Abstract
BACKGROUND The number of octogenarians receiving cardiac surgery is increasing. Concerns regarding the outcomes and significant expense required to provide this service have not been addressed because no prospective medium term outcomes of Australian octogenarians have been published. METHODS Prospective analysis was undertaken of octogenarians having cardiac surgery from 1996 to 2001 in three hospitals of moderate case volume (400 patients per year) by: in-hospital audit and data acquisition, 1-year direct patient follow up in rooms, and a final follow up in late 2001 directly with the patient either in rooms or via telephone questionnaire. RESULTS Sixty-four patients had cardiac surgery. All patients were severely disabled by symptoms (CCVS: III-IV, NYHA: III-IV) preoperatively, 14% were advised not to proceed with a surgical option but did so. Total operative in-hospital mortality was 6.3% (elective: 0%, urgent: 10.5%, P = 0.05), major complications were few 10.9% (seven patients; stroke: 1.6%, deep sternal infection: 1.6%, myocardial infarction: 1.6%, reoperation: 4.8%). At 1 year, despite 95% being free of significant cardiovascular symptoms (CCVS/NYHA: I-II), nearly one in five (19%) would not have proceeded with the surgery. However, at the final follow up (mean time: 2.8 years), freedom from cardiovascular symptoms remained high (95%), 94% remained independent and their quality of life was significantly better than before surgery. Although 59% suffered worsening of additional medical conditions, these conditions had a minor impact on their quality of life. Ninety-eight per cent would recommend cardiac surgery. Actuarial survival for all patients and for hospital survivors at 4 years was 67.9 +/- 4.1% and 74.2 +/- 4%, respectively. CONCLUSION Medium-term follow up of Australian octogenarians who were offered cardiac surgery revealed that 94% remain independent and with an excellent quality of life. Age alone must not be a barrier to access to cardiac surgery.
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Affiliation(s)
- Timothy D Hewitt
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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