John T. Roland, M.D.

Implanting obstructed and malformed cochleae
Coelho, Daniel H; Roland, J Thomas Jr
2012 Feb;45(1):91-110, Otolaryngologic clinics of North America
Implantation of the ossified and dysplastic cochlea presents many unique challenges to both the surgeon and programming team. Altered embryology and physiology of these labyrinthine dysplasias may result in forms and functions unfamiliar to those casually involved with cochlear implants. Remarkable developments in diagnosis, surgical technique, electrode design, processing strategies, and programming have all contributed to the ability to successfully implant patient populations previously excluded from this life-changing intervention
— id: 150255, year: 2012, vol: 45, page: 91, stat: Journal Article,

An evidence-based algorithm for intraoperative monitoring during cochlear implantation
Cosetti, Maura K; Troob, Scott H; Latzman, Jonathan M; Shapiro, William H; Roland, John Thomas Jr; Waltzman, Susan B
2012 Feb;33(2):169-176, Otology & neurotology
OBJECTIVE: To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI). STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included. INTERVENTION: Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography. MAIN OUTCOME MEASURE: Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position. RESULTS: No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device. CONCLUSION: Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device
— id: 149959, year: 2012, vol: 33, page: 169, stat: Journal Article,

Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria
Heman-Ackah, Selena E; Roland, J Thomas Jr; Haynes, David S; Waltzman, Susan B
2012 Feb;45(1):41-67, Otolaryngologic clinics of North America
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population
— id: 141981, year: 2012, vol: 45, page: 41, stat: Journal Article,

Surgical techniques in cochlear implants
Mangus, Brannon; Rivas, Alejandro; Tsai, Betty S; Haynes, David S; Roland, J Thomas Jr
2012 Feb;45(1):69-80, Otolaryngologic clinics of North America
Cochlear implants have a remarkable history and a promising future. As the cochlear implant has evolved, so has the surgical technique. This review encompasses a history of the cochlear implant, a summary of the evolution of the implant incision and the methods used to secure the device and the electrode, the cochleostomy versus round window debate, and a discussion of the validity of intraoperative tests. Advanced technology, new surgical techniques, and refining established techniques are hallmarks of cochlear implant surgery. Advancements, including image-guided surgery, hearing preservation with full insertion, and telemetry-based advanced programming, are expected to be standard in the future
— id: 150256, year: 2012, vol: 45, page: 69, stat: Journal Article,

Cochlear implants: an evolving technology
Roland, J Thomas Jr; Haynes, David S
2012 Feb;45(1):xiii-xiii, Otolaryngologic clinics of North America
— id: 141984, year: 2012, vol: 45, page: xiii, stat: Journal Article,

Cochlear implantation in prelingually deafened adolescents
Zeitler, Daniel M; Anwar, Abbas; Green, Janet E; Babb, James S; Friedmann, David R; Roland, J Thomas Jr; Waltzman, Susan B
2012 Jan;166(1):35-41, Archives of pediatrics & adolescent medicine
OBJECTIVES: To determine the efficacy of cochlear implantation (CI) in prelingually deafened adolescent children and to evaluate predictive variables for successful outcomes. DESIGN: Retrospective medical record review. PARTICIPANTS: Children aged 10 to 17 years with prelingual hearing loss (mean length of deafness, 11.5 years) who received a unilateral CI (mean age at CI, 12.9 years). Intervention Unilateral CI. MAIN OUTCOME MEASURES: Standard speech perception testing (Consonant-Nucleus-Consonant [CNC] monosyllabic word test and Hearing in Noise [HINT] sentence test) was performed preoperatively, 1 year postoperatively (year 1), and at the last follow-up/end of the study (EOS). RESULTS: There was a highly significant improvement in speech perception scores for both HINT sentence and CNC word testing from the preoperative testing to year 1 (mean change score, 51.10% and 32.23%, respectively; P < .001) and from the preoperative testing to EOS (mean change score, 60.02% and 38.73%, respectively; P < .001), with a significantly greater increase during the first year (P < .001). In addition, there was a highly significant correlation between improvements in performance scores on the CNC word and HINT sentence speech perception tests and both age at CI and length of deafness at the year 1 testing (P </=.009) but not from the year 1 testing to EOS testing. Adolescents with progressive deafness and those using oral communication before CI performed significantly better than age-matched peers. CONCLUSIONS: Adolescents with prelingual deafness undergoing unilateral CI show significant improvement in objective hearing outcome measures. Patients with shorter lengths of deafness and earlier age at CI tend to outperform their peers. In addition, patients with progressive deafness and those using oral communication have significantly better objective outcomes than their peers
— id: 148736, year: 2012, vol: 166, page: 35, stat: Journal Article,

Development and evaluation of the modiolar research array--multi-centre collaborative study in human temporal bones
Briggs, Robert J S; Tykocinski, Michael; Lazsig, Roland; Aschendorff, Antje; Lenarz, Thomas; Stover, Timo; Fraysse, Bernard; Marx, Mathieu; Roland, J Thomas Jr; Roland, Peter S; Wright, Charles G; Gantz, Bruce J; Patrick, James F; Risi, Frank
2011 Aug;12(3):129-139, Cochlear Implants International
OBJECTIVE: Multi-centre collaborative study to develop and refine the design of a prototype thin perimodiolar cochlear implant electrode array and to assess feasibility for use in human subjects. STUDY DESIGN: Multi-centre temporal bone insertion studies. MATERIALS AND METHODS: The modiolar research array (MRA) is a thin pre-curved electrode that is held straight for initial insertion with an external sheath rather than an internal stylet. Between November 2006 and February 2009, six iterations of electrode design were studied in 21 separate insertion studies in which 140 electrode insertions were performed in 85 human temporal bones by 12 surgeons. These studies aimed at addressing four fundamental questions related to the electrode concept, being: (1) Could a sheath result in additional intra-cochlear trauma? (2) Could a sheath accommodate variations in cochlea size and anatomies? (3) Could a sheath be inserted via the round window? and (4) Could a sheath be safely removed once the electrode had been inserted? These questions were investigated within these studies using a number of evaluation techniques, including X-ray and microfluoroscopy, acrylic fixation and temporal bone histologic sectioning, temporal bone microdissection of cochlear structures with electrode visualization, rotational tomography, and insertion force analysis. RESULTS: Frequent examples of electrode rotation and tip fold-over were demonstrated with the initial designs. This was typically caused by excessive curvature of the electrode tip, and also difficulty in handling of the electrode and sheath. The degree of tip curvature was progressively relaxed in subsequent versions with a corresponding reduction in the frequency of tip fold-over. Modifications to the sheath facilitated electrode insertion and sheath removal. Insertion studies with the final MRA design demonstrated minimal trauma, excellent perimodiolar placement, and very small electrode dimensions within scala tympani. Force measurements in temporal bones demonstrated negligible force on cochlear structures with angular insertion depths of between 390 and 450 degrees . CONCLUSION: The MRA is a novel, very thin perimodiolar prototype electrode array that has been developed using a systematic collaborative approach. The different evaluation techniques employed by the investigators contributed to the early identification of issues and generation of solutions. Regarding the four fundamental questions related to the electrode concept, the studies demonstrated that (1) the sheath did not result in additional intra-cochlear trauma; (2) the sheath could accommodate variations in cochlea size and anatomies; (3) the sheath was more successfully inserted via a cochleostomy than via the round window; and (4) the sheath could be safely removed once the electrode had been inserted
— id: 150258, year: 2011, vol: 12, page: 129, stat: Journal Article,

Outcomes of direct facial-to-hypoglossal neurorrhaphy with parotid release
Jacobson J.; Rihani J.; Lin K.; Miller P.J.; Roland J.T.
2011 ;21(1):7-12, Skull base
Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face.
— id: 121345, year: 2011, vol: 21, page: 7, stat: Journal Article,

Auditory rehabilitation of patients with neurofibromatosis Type 2 by using cochlear implants
Roehm, Pamela C; Mallen-St Clair, Jon; Jethanamest, Daniel; Golfinos, John G; Shapiro, William; Waltzman, Susan; Roland, J Thomas Jr
2011 Oct;115(4):827-834, Journal of neurosurgery
OBJECT: The aim of this study was to determine whether patients with neurofibromatosis Type 2 (NF2) who have intact ipsilateral cochlear nerves can have open-set speech discrimination following cochlear implantation. METHODS: Records of 7 patients with documented NF2 were reviewed to determine speech discrimination outcomes following cochlear implantation. Outcomes were measured using consonant-nucleus-consonant words and phonemes; Hearing in Noise Test sentences in quiet; and City University of New York sentences in quiet and in noise. RESULTS: Preoperatively, none of the patients had open-set speech discrimination. Five of the 7 patients had previously undergone excision of ipsilateral vestibular schwannoma (VS). One of the patients who received a cochlear implant had received radiation therapy for ipsilateral VS, and another was undergoing observation for a small ipsilateral VS. Following cochlear implantation, 4 of 7 patients with NF2 had open-set speech discrimination following cochlear implantation during extended follow-up (15-120 months). Two of the 3 patients without open-set speech understanding had a prolonged period between ipsilateral VS resection and cochlear implantation (120 and 132 months), and had cochlear ossification at the time of implantation. The other patient without open-set speech understanding had good contralateral hearing at the time of cochlear implantation. Despite these findings, 6 of the 7 patients were daily users of their cochlear implants, and the seventh is an occasional user, indicating that all of the patients subjectively gained some benefit from their implants. CONCLUSIONS: Cochlear implantation can provide long-term auditory rehabilitation, with open-set speech discrimination for patients with NF2 who have intact ipsilateral cochlear nerves. Factors that can affect implant performance include the following: 1) a prolonged time between VS resection and implantation; and 2) cochlear ossification
— id: 141067, year: 2011, vol: 115, page: 827, stat: Journal Article,

Extracochlear electrode extrusion
Vaid, Neelam; Roland, J Thomas; Vaid, Sanjay
2011 Aug;12(3):177-180, Cochlear Implants International
Extracochlear electrode extrusion is a potentially under-recognized complication of cochlear implantation. As the age of implantation becomes younger, electrode extrusion is of concern due to future skull growth. Extrusion of several electrodes may compromise performance and thus require surgical reinsertion of the electrodes. Almost 60% of patients with electrode extrusion have required revision surgery. This paper presents a case report and literature review which discusses factors which contribute to electrode extrusion and emphasizes the need for a high degree of suspicion in certain situations. Surgical steps such as electrode fixation techniques are highlighted in order to attempt to reduce the occurrence of this complication
— id: 150257, year: 2011, vol: 12, page: 177, stat: Journal Article,

Flat-panel computed tomography versus multislice computed tomography to evaluate cochlear implant positioning
Zeitler, Daniel M; Wang, Kevin H; Prasad, Ravi S; Wang, Edwin Y; Roland, J Thomas
2011 Nov;12(4):216-222, Cochlear Implants International
OBJECTIVE: To evaluate and compare image quality between flat-panel volumetric computed tomography (fpVCT) and multislice CT (msCT) in temporal bones with cochlear implants (CIs), and to evaluate fpVCT imaging for accuracy in determining CI electrode positioning. METHODS: Six cadaveric temporal bones were imaged prior to CI using fpVCT. Each bone was implanted with an electrode array and rescanned in order to create radial reformatted images through each electrode contact. Electrode-modiolar interval (EMI) distances were measured. The bones were fixed and cut in order to grossly evaluate for CI intrascalar positioning and insertional trauma. MAIN OUTCOME MEASURE: To compare image quality between fpVCT and msCT in temporal bones with CI, and to evaluate the utility of fpVCT in post-implantation temporal bone analysis. RESULTS: The mean EMI distances did not differ significantly between fpVCT and msCT images, while the image quality was significantly better for fpVCT. Furthermore, information about intracochlear trauma and intrascalar electrode array positioning can be ascertained using this radiographic technique. CONCLUSION: fpVCT and msCT do not differ significantly in the evaluation of EMI distances in implanted temporal bones, but the image quality is significantly better using fpVCT. Additionally, useful information regarding intracochlear trauma, electrode depth of insertion, and intrascalar positioning can be gained from fpVCT imaging. Given the ease of use, superior image quality, improved convenience, reduced levels of radiation, and agreement with histology, fpVCT is a valuable option for post-implantation temporal bone imaging
— id: 150254, year: 2011, vol: 12, page: 216, stat: Journal Article,

Cochlear implant electrode insertion
Cosetti M.; Roland J.T.
2010 ;21(4):223-232, Operative techniques in otolaryngology, head & neck surgery
Electrode insertion is the most important step in cochlear implant (CI) surgery. Optimal electrode placement is a prerequisite for maximizing CI success. This article describes CI electrode insertion in the normal and abnormal cochlea, including technical considerations unique to cochlear malformations, dysplasia, ossification, and revision implantation. Currently available electrodes and device specific operative techniques are reviewed. 2010 Elsevier Inc
— id: 116261, year: 2010, vol: 21, page: 223, stat: Journal Article,

Intraoperative neural response telemetry as a predictor of performance
Cosetti, Maura K; Shapiro, William H; Green, Janet E; Roman, Benjamin R; Lalwani, Anil K; Gunn, Stacey H; Roland, John Thomas Jr; Waltzman, Susan B
2010 Sep;31(7):1095-1099, Otology & neurotology
OBJECTIVE:: To determine whether intraoperative neural response telemetry (tNRT) is predictive of postoperative speech perception. STUDY DESIGN:: Retrospective review. SETTING:: Tertiary referral center. PATIENTS:: Children (n = 24) aged between 5 and 17 years and adults 18 years and older (n = 73) with severe-to-profound hearing loss and implanted with the Nucleus Freedom device between 2005 and 2008 and observed at least 1 year were included. INTERVENTION:: Intraoperative neural response telemetry after insertion of the electrode array. MAIN OUTCOME MEASURE:: Measures included 1) intraoperative tNRT measurements and 2) preoperative and 1-year postoperative open-set word recognition scores using age-appropriate open-set tests for children and adults. Intraoperative neural response telemetry levels for electrodes E20, E15, E10, and E5 in each patient were correlated to performance at the 1-year evaluation interval. RESULTS:: No correlation existed between tNRT responses and open-set speech performance at the 1-year evaluation. Several patients had absent tNRT in the OR but developed speech recognition abilities, whereas the remaining patients had intraoperative responses with levels of postoperative performance ranging from 0% to 100%. CONCLUSION:: This study suggests that there is no significant correlation between intraoperative tNRT and speech perception performance at 1 year. At the time of surgery, tNRT provides valuable information regarding the electrical output of the implant and the response of the auditory system to electrical stimulation and preliminary device programming data; however, it is not a valuable predictor of postoperative performance. Furthermore, the absence of tNRT does not necessarily indicate a lack of stimulation
— id: 111965, year: 2010, vol: 31, page: 1095, stat: Journal Article,

Cochlear implantation in the very young child: issues unique to the under-1 population
Cosetti, Maura; Roland, J Thomas Jr
2010 ;14(1):46-57, Trends in amplification
Since the advent of cochlear implantation, candidacy criteria have slowly broadened to include increasingly younger patients. Spurred by evidence demonstrating both perioperative safety and significantly increased speech and language benefit with early auditory intervention, children younger than 12 months of age are now being successfully implanted at many centers. This review highlights the unique challenges involved in cochlear implantation in the very young child, specifically diagnosis and certainty of testing, anesthetic risk, surgical technique, intraoperative testing and postoperative programming, long-term safety, development of receptive and expressive language, and outcomes of speech perception. Overall, the current body of literature indicates that cochlear implantation prior to 1 year of age is both safe and efficacious
— id: 115355, year: 2010, vol: 14, page: 46, stat: Journal Article,

Processed allograft: novel use in facial nerve repair after resection of a rare racial nerve paraganglioma
Gunn, Stacey; Cosetti, Maura; Roland, J Thomas Jr
2010 ;120 Suppl 4:S206-S206, Laryngoscope
OBJECTIVES: To present a rare case of facial nerve paraganglioma and novel use of a processed allograft for facial nerve reconstruction. STUDY DESIGN: Case report and review of the literature. METHODS: A 34 year old female presented with progressive onset right sided facial palsy for 5 months. CT and MRI demonstrated an irregular mass in the right facial nerve canal from the intratympanic segment to the stylomastoid foramen. RESULTS: Following transmastoid resection, the defect was repaired using processed allograft. Pathologic analysis was consistent with a paraganglioma. Facial nerve paraganglioma is a rare entity that has been reported only 10 times in the literature. CONCLUSIONS: Traditional methods of facial nerve reconstruction, including autologous and cadaveric grafting, can lead to significant patient morbidity. Autologous nerve grafts are the 'gold standard' for superior regenerative capability, but are limited by the length and potential neuroma formation at the donor site. Allogenic grafts from donors or cadavers have shown some efficacy, but can require immunosuppression. The Avance nerve graft is a cadaveric graft, processed and decellularized to maintain an extracellular matrix with laminin and intact endoneural tubes, thus providing support for the growing axon without generating an immune response. Initial studies of the Avance graft in animals and humans have examined repair of peripheral nerves, but this is the first reported case of human facial nerve reconstruction
— id: 121325, year: 2010, vol: 120 Suppl 4, page: S206, stat: Journal Article,

Cochlear implantation following treatment for medulloblastoma
Roland, J Thomas Jr; Cosetti, Maura; Liebman, Tracey; Waltzman, Susan; Allen, Jeffrey C
2010 Jan;120(1):139-143, Laryngoscope
OBJECTIVES/HYPOTHESIS:: Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed. STUDY DESIGN:: Retrospective chart review. METHODS:: Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data. RESULTS:: Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients. CONCLUSIONS:: Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population. Laryngoscope, 2009
— id: 105538, year: 2010, vol: 120, page: 139, stat: Journal Article,

Pathology quiz case 2
Tajudeen, Bobby A; Zeitler, Daniel M; Yee, Herman; Roland, J Thomas; Roehm, Pamela C
2010 Jan;136(1):101-101, Archives of otolaryngology, head & neck surgery
— id: 106284, year: 2010, vol: 136, page: 101, stat: Journal Article,

Consensus panel on a cochlear coordinate system applicable in histologic, physiologic, and radiologic studies of the human cochlea
Verbist, Berit M; Skinner, Margaret W; Cohen, Lawrence T; Leake, Patricia A; James, Chris; Boex, Colette; Holden, Timothy A; Finley, Charles C; Roland, Peter S; Roland, J Thomas Jr; Haller, Matt; Patrick, Jim F; Jolly, Claude N; Faltys, Mike A; Briaire, Jeroen J; Frijns, Johan H M
2010 Jul;31(5):722-730, Otology & neurotology
HYPOTHESIS: An objective cochlear framework, for evaluation of the cochlear anatomy and description of the position of an implanted cochlear implant electrode, would allow the direct comparison of measures performed within the various subdisciplines involved in cochlear implant research. BACKGROUND: Research on the human cochlear anatomy in relation to tonotopy and cochlear implantation is conducted by specialists from numerous disciplines such as histologists, surgeons, physicists, engineers, audiologists, and radiologists. To allow accurate comparisons between and combinations of previous and forthcoming scientific and clinical studies, cochlear structures and electrode positions must be specified in a consistent manner. METHODS: Researchers with backgrounds in the various fields of inner ear research as well as representatives of the different manufacturers of cochlear implants (Advanced Bionics Corp., Med-El, Cochlear Corp.) were involved in consensus meetings held in Dallas, March 2005, and Asilomar, August 2005. Existing coordinate systems were evaluated, and requisites for an objective cochlear framework were discussed. RESULTS: The consensus panel agreed upon a 3-dimensional, cylindrical coordinate system of the cochlea using the 'Cochlear View' as a basis and choosing a z axis through the modiolus. The zero reference angle was chosen at the center of the round window, which has a close relationship to the basal end of the Organ of Corti. CONCLUSION: Consensus was reached on an objective cochlear framework, allowing the outcomes of studies from different fields of research to be compared directly
— id: 138160, year: 2010, vol: 31, page: 722, stat: Journal Article,

Inroads toward robot-assisted cochlear implant surgery using steerable electrode arrays
Zhang, Jian; Wei, Wei; Ding, Jienan; Roland, J Thomas Jr; Manolidis, Spiros; Simaan, Nabil
2010 Oct;31(8):1199-1206, Otology & neurotology
HYPOTHESIS: Robotic insertions of actively steerable perimodiolar electrode arrays can substantially reduce insertion forces and prevent electrode buckling. BACKGROUND: Perimodiolar electrodes have been proven to be effective in reducing insertion forces. However, the dedicated techniques of atraumatic electrode insertion require intensive surgeon training. Although some specialized medical robots have been developed to help surgeons in certain minimally invasive surgeries, none are applicable to electrode insertions. METHODS: A robot prototype capable of automatically inserting novel steerable electrode array and adjusting its approach angle toward the scala tympani has been constructed and tested. Comparisons of insertion forces using robotically assisted steerable and straight electrodes on scala tympani models are presented. Simulations and experiments are conducted to compare the robotic insertion outcomes and insertion forces. RESULTS: The use of robotically assisted steerable electrodes for insertions significantly reduces the insertion forces compared with straight electrodes. Based on the results from the experiments, a second-generation robot with insertion force-sensing capability and haptic control to be used in the operating room has been designed for cochlear implant surgery. CONCLUSION: Preliminary experimental results using robot-assisted steerable electrode prototype show that it is effective in reducing insertion forces and preventing electrode buckling. A second-generation robot has been designed and constructed for cochlear implant surgery under operating room conditions
— id: 115354, year: 2010, vol: 31, page: 1199, stat: Journal Article,

Effect of cochlear implant technology in sequentially bilaterally implanted adults
Budenz, Cameron L; Roland, J Thomas Jr; Babb, James; Baxter, Peter; Waltzman, Susan B
2009 Sep;30(6):731-735, Otology & neurotology
OBJECTIVE: Bilateral sequential cochlear implantation outcomes are dependent on many different factors. Newer technology in the second implanted ear may also contribute to outcome. This study examines the effect of cochlear implant technology on speech recognition outcomes in a population of adult patients who have undergone bilateral sequential implantation using different technologies in each ear. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Twenty adults who underwent bilateral sequential cochlear implantation with different technologies and processing strategies in each ear were patients for this study. Control Group A included patients (n = 8) who were simultaneously implanted, and Control Group B (n = 3) were patients who were sequentially implanted with the same technology. INTERVENTION: Bilateral sequential cochlear implantation. OUTCOME MEASURES: The outcome measure was the Consonant-Nucleus-Consonant monosyllabic word test administered in each implanted ear and in the binaural condition before and 1 year after operation. A multivariate analysis was performed to account for factors including duration of deafness, length of device usage, and severity of deafness. RESULTS: There was significant improvement from before to 1 year after the operation in word scores for the individual ears and in the binaural condition for all groups. All patients were consistent users of both devices, and the use of different technology in the second implanted ear did not affect the patients' ability to benefit from bilateral implantation despite the use of different devices and processing strategies. CONCLUSION: Bilateral sequential implantation with newer and/or differing technology in the second implanted ear did not reduce the benefits of bilateral stimulation and should not be considered a deterrent to second-sided implantation
— id: 101892, year: 2009, vol: 30, page: 731, stat: Journal Article,

Predictability of cochlear implant outcome in families
Lalwani, Anil K; Budenz, Cameron L; Weisstuch, Adam S; Babb, James; Roland, J Thomas Jr; Waltzman, Susan B
2009 Jan;119(1):131-136, Laryngoscope
OBJECTIVES: The purpose of this study is to determine if the performance of the first implanted member of a family predicts the performance of subsequently implanted family members. STUDY DESIGN: Retrospective chart review. METHODS: Seventy-one cochlear implant recipients, each belonging to a family with two or more implanted members, were the subjects of this study. Routine audiometric measurements and age-appropriate speech perception tests were performed pre- and postoperatively. In addition, length of deafness, age at implantation, etiology, and length of device usage were correlated to outcome. RESULTS: All implant recipients within a family showed improvement postimplantation, and the predictive component between family members was strong. Presence of GJB2 mutations and greater age at implantation were predictive of poorer rehabilitative outcome, while length of device usage was associated with improved speech perception scores. CONCLUSIONS: On average, if the first implanted family member performs well with a cochlear implant, those following will do well; however, GJB2-related deafness and increased age at implantation are associated with poorer outcome. These findings have important implications for members of families considering cochlear implantation
— id: 94220, year: 2009, vol: 119, page: 131, stat: Journal Article,

SWALLOWING PHYSIOLOGY AFTER SKULL BASE TUMOR RESECTION
Lazarus, C; Roland, J; Golfinos, J; DeLacure, M; Amin, M; Lalwani, A
2009 DEC ;24(4):465-465, Dysphagia
— id: 107740, year: 2009, vol: 24, page: 465, stat: Journal Article,

Cochlear implantation in the very young child: Long-term safety and efficacy
Roland, J Thomas Jr; Cosetti, Maura; Wang, Kevin H; Immerman, Sara; Waltzman, Susan B
2009 Nov;119(11):2205-2210, Laryngoscope
OBJECTIVES/HYPOTHESIS: Widespread universal newborn hearing screening has led to increased identification of infant hearing loss. Supported by improved diagnostic tools allowing more definitive diagnosis of profound sensorineural hearing loss in young children, cochlear implantation in children <12 months of age is now common. Literature supports short-term safety and improved auditory outcomes in these young children, however long-term data is lacking. The study examines issues of long-term safety and efficacy in cochlear implant patients implanted <1 year of age. STUDY DESIGN: Retrospective chart review. METHODS: Fifty children who received cochlear implants before 1 year of age were followed for up to 7 years. Age at implantation ranged from 5 to 11 months with a mean of 9.1 months. Three patients had simultaneous bilateral implantation at 8 to 9 months of age. Medical records were reviewed for complications incurred during length of device usage, including time of complication, management, and resolution. Auditory assessment included both the Infant-Toddler Meaningful Auditory Integration Scale and tests of speech perception. RESULTS: All 50 patients had full insertions of the electrode array. There were a total of eight complications (16%) in seven patients, three major (6%) and five minor (10%), which occurred at or before 10 months postoperatively. There were no perioperative anesthetic complications. CONCLUSIONS: Cochlear implantation in children <12 months of age is safe and efficacious over an extended period of time. Rates and nature of both major and minor complications are comparable to studies in adults and older children and support continued monitoring of these patients over the long-term
— id: 104892, year: 2009, vol: 119, page: 2205, stat: Journal Article,

Revision cochlear implantation
Zeitler, Daniel M; Budenz, Cameron L; Roland, John Thomas Jr
2009 Oct;17(5):334-338, Current opinion in otolaryngology & head & neck surgery
PURPOSE OF REVIEW: Cochlear implantation is a well tolerated and effective procedure in the rehabilitation of profoundly and severely hearing-impaired individuals. Cochlear reimplantation may be necessary for a variety of reasons. The recent literature regarding the indications, surgical considerations, and outcomes in revision cochlear implant (RCI) surgery is reviewed here. RECENT FINDINGS: A small but significant percentage (3-8%) of all cochlear implant procedures requires RCI surgery. The most common indication for RCI is hard failure (40-80%), but other common indications include soft failures, wound complications, infection, improper initial placement, and electrode extrusions. There is a high rate of surgical success in RCI with preservation or improvement of preoperative performance in the majority of patients, in addition to the alleviation of prereimplantation symptoms. Both children and adults benefit from RCI when indicated and experience similar auditory successes following RCI. SUMMARY: The need for RCI is uncommon, but the potential for restoration or improvement in speech perception and alleviation of symptoms exists. Regardless of indication, RCI surgery is well tolerated, and, with thoughtful preparation, individualized patient counseling, and proper surgical technique, most patients can expect successful outcomes
— id: 102397, year: 2009, vol: 17, page: 334, stat: Journal Article,

The effects of cochlear implant electrode deactivation on speech perception and in predicting device failure
Zeitler, Daniel M; Lalwani, Anil K; Roland, J Thomas Jr; Habib, Mirette G; Gudis, David; Waltzman, Susan B
2009 Jan;30(1):7-13, Otology & neurotology
OBJECTIVE: To examine speech perception outcomes as related to a reduction in the number of functional electrodes postimplantation and to determine the effect of electrode reduction on subsequent device failure. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic referral center. PATIENTS: Of 1,520 children and adults with full insertions of the Advanced Bionics, Med El, and Nucleus devices, 15 (1%) were patients. Patients were included in the study if all electrodes were functional at initial stimulation, but the number of electrodes in use was subsequently reduced at follow-up programming sessions. Exclusion criteria included partial and split-array electrode insertions. INTERVENTION(S): Patients with bilateral severe to profound sensorineural hearing loss underwent either unilateral or bilateral cochlear implantation. MAIN OUTCOME MEASURE(S): Postimplantation speech perception tests obtained with a full complement of functional electrodes were performed and the results compared to those obtained with 1 or more electrodes removed from the user program. Electrode deactivation was also correlated with device failure. RESULTS AND CONCLUSION: The results of this study indicate that deactivation of cochlear implant electrodes is relatively uncommon, and although the deactivation does not have a direct influence on speech performance outcomes, the loss of 5 or more electrodes can suggest impending device failure. Additionally, those patients with electrode deactivation coupled with a decline in speech perception scores should also be considered at risk for device failure
— id: 92769, year: 2009, vol: 30, page: 7, stat: Journal Article,

Optimal Path Planning for Robotic Insertion of Steerable Electrode Arrays in Cochlear Implant Surgery
Zhang, Jian; Roland, J. Thomas, Jr.; Manolidis, Spiros; Simaan, Nabil
2009 MAR ;3(1):-, Journal of medical devices
This paper presents an optimal path planning method of steerable electrode arrays for robot assisted cochlear implant surgery In this paper, the authors present a novel design of steerable electrode arrays that can actively bend at the up An embedded strand in the electrode array provides an active steering degrees of freedom (DoF) This paper addresses the calibration of the steerable electrode arrays and the optimal path planning for inserting it into planar and three dimensional scala tympani models The goal of the path planning is to minimize the intracochlear forces that the electrode array applies on the walls of the scala tympam during insertion This problem is solved by designing insertion path planning algorithms that provide best fit between the shape of the electrode aunty and the curved scala tympani during insertion Optimality measures that account fittape discrepancies between the steerable electrode array and the scala tympam are used to solve for the optimal path planning of the robot Different arrangements of DoF and insertion speed force feedback (ISFF) are simulated and experimentally validated in this paper A quality of insertion metric describing the gap between the steerable electrode array and the scala tympam model is presented and as correspondence to the insertion force is shown The results of using 1DoF 2DoF and 4DoF electrode array insertion setups are compared The 1DoE insertion setup fiver nonsteerable electrode arrays The 2DoF insertion setup uses single axis insertion with steerable electrode arrays. The 4DoF insertion setup allows full control of the insertion depth and the approach angle of the electrode with respect to the cochlea while using steerable electrode arrays It is shown that living steerable electrode arrays significantly reducer the maximal insertion force (59.6% or more) and effectively prevents buckling of the electrode array The 4DoF Insertion setup further reduces the maximal electrode insertion forces The results of using ISFF for steerable electrodes show a slight decrease in the insertion forcer in contrast to a slight increase for nonsteerable electrodes These results show that further research is required in order to determine the optimal ISFF control law and its effectiveness in reducing electrode invention fortes [DOI 10.1115/1.3039513]
— id: 114382, year: 2009, vol: 3, page: , stat: Journal Article,

An unusual presentation and spread of an endolymphatic sac tumor
Coelho, Daniel H; Golfinos, John G; Roland, J Thomas Jr
2008 Jun;29(4):569-570, Otology & neurotology
— id: 80293, year: 2008, vol: 29, page: 569, stat: Journal Article,

Posterior fossa meningiomas presenting with Meniere's-like symptoms: case report
Coelho, Daniel H; Roland, J Thomas Jr; Golfinos, John G
2008 Nov;63(5):E1001-E1001, Neurosurgery
OBJECTIVE AND IMPORTANCE: In rare cases, posterior fossa meningiomas can involve the endolymphatic sac. Such involvement can result in endolymphatic hydrops and a constellation of symptoms suggestive of Meniere's disease. The diagnosis and management of patients with these tumors is discussed. CLINICAL PRESENTATION: Three patients, each of whom presented with symptoms consistent with Meniere's disease, were found to have posterior fossa meningiomas limited to the dura overlying the endolymphatic sac. INTERVENTION: All 3 patients were diagnosed by magnetic resonance imaging and underwent complete surgical resection. In all cases, the symptoms resolved after tumor removal. CONCLUSION: Clinicians should have a degree of suspicion of posterior fossa meningioma when patients present with symptoms suggestive of Meniere's disease. Failure to do so may result in delayed diagnosis or worse outcomes for an otherwise treatable tumor
— id: 91372, year: 2008, vol: 63, page: E1001, stat: Journal Article,

Small vestibular schwannomas with no hearing: comparison of functional outcomes in stereotactic radiosurgery and microsurgery
Coelho, Daniel H; Roland, J Thomas Jr; Rush, Stephen A; Narayana, Ashwatha; St Clair, Eric; Chung, Wayne; Golfinos, John G
2008 Nov;118(11):1909-1916, Laryngoscope
OBJECTIVES: To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium. By studying only patients with small tumors and no hearing, we sought to minimize confounding variables. STUDY DESIGN: A retrospective chart review and telephone questionnaire. METHODS: From 1998-2006, 31 patients with small (<1.5 cm) VS and nonserviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] Class C or D) were treated at our institution. Twenty-two were available for follow-up and telephone questionnaire, including the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ). Twelve underwent SRS and 10 underwent MS. All MS patients underwent the translabyrinthine approach to their tumors. Outcomes measurements included tumor control, facial nerve function, tinnitus, trigeminal function, and imbalance. RESULTS: Patients undergoing SRS had comparable rates of tumor control, facial nerve function, tinnitus, and trigeminal function to MS patients. However, SRS did result in statistically significantly worse long-term imbalance when compared with MS patients. Detailed comparisons of the two modalities are made. CONCLUSIONS: In our study population, patients with small tumors and no serviceable hearing, these data suggest that MS results in comparable minimal morbidity with SRS, though posttreatment dysequilibrium is significantly decreased. While the authors recommend translabyrinthine resection of small VS with no hearing in patients able to tolerate surgery, the need for further prospective investigation is clear
— id: 90720, year: 2008, vol: 118, page: 1909, stat: Journal Article,

Implanting common cavity malformations using intraoperative fluoroscopy
Coelho, Daniel H; Waltzman, Susan B; Roland, J Thomas Jr
2008 Oct;29(7):914-919, Otology & neurotology
OBJECTIVE: To describe a safe and effective technique for the implantation of common cavity cochleae. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fifteen cochleae in 9 adults and children with common cavity deformities implanted with and without the use of intraoperative fluoroscopy. INTERVENTION(S):: Fluoroscopically assisted cochlear implantation. MAIN OUTCOME MEASURE(S): Rates of extracochlear placement, bending, kinking, intrameatal placement, and complications were analyzed. Numbers of electrodes inserted, number of active electrodes, and speech performance were compared between the 2 groups. RESULTS: Half of the nonfluoroscopy group had suboptimal placement of their electrode arrays. This group also had a higher rate of complications, lower numbers of electrodes implanted, and lower number of active electrodes at follow-up. Results of speech perception testing suggest that fluoroscopically assisted implantation of the common cavity results in improved performance. CONCLUSION: Intraoperative fluoroscopy is an easy, safe, and effective technique that results in improved outcomes for cochlear implant patients with common cavity deformities
— id: 92768, year: 2008, vol: 29, page: 914, stat: Journal Article,

Reimplantation of hybrid cochlear implant users with a full-length electrode after loss of residual hearing
Fitzgerald, Matthew B; Sagi, Elad; Jackson, Michael; Shapiro, William H; Roland, J Thomas Jr; Waltzman, Susan B; Svirsky, Mario A
2008 Feb;29(2):168-173, Otology & neurotology
OBJECTIVE: To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing. BACKGROUND: Although electroacoustic stimulation is a promising treatment for patients with residual low-frequency hearing,a small subset of them lose that residual hearing. It is not clear whether these patients would be better served by leaving in the 10-mm array and providing electric stimulation through it, or by replacing it with a standard full-length array. METHODS: Word recognition and pitch-scaling abilities were measured in 2 users of hybrid cochlear implants who lost their residual hearing in the implanted ear after a few months. Tests were repeated over several months, first with a 10-mm array, and after, these patients were reimplanted with a full array. The word recognition task consisted of 2 50-word consonant nucleus consonant (CNC) lists. In the pitch-scaling task, 6 electrodes were stimulated in pseudorandom order, and patients assigned a pitch value to the sensation elicited by each electrode. RESULTS: Shortly after reimplantation with the full electrode array, speech understanding was much better than with the 10-mm array. Patients improved their ability to perform the pitch-scaling task over time with the full array, although their performance on that task was variable, and the improvements were often small. CONCLUSION: 1) Short electrode arrays may help preserve residual hearing but may also provide less benefit than traditional cochlear implants for some patients. 2) Pitch percepts in response to electric stimulation may be modified by experience
— id: 76765, year: 2008, vol: 29, page: 168, stat: Journal Article,

Speech perception and insertion trauma in hybrid cochlear implant users: A response to Gstottner and Arnolder
Fitzgerald, MB; Sagi, E; Jackson, M; Shapiro, WH; Roland, JT; Waltzman, SB; Svirsky, MA
2008 SEP ;29(6):881-882, Otology & neurotology
— id: 86665, year: 2008, vol: 29, page: 881, stat: Journal Article,

Using steered molecular dynamics simulations and single-molecule force spectroscopy to guide the rational design of biomimetic modular polymeric materials
Guzman DL; Roland JT; Keer H; Kong YP; Ritz T; Yee A; Guan Z
2008 Sep 26;49(18):3892-3901, Polymer
This article describes results on using steered molecular dynamics (SMD) simulations and experimental single molecule force spectroscopy (SMFS) to investigate the relationship between hydrogen bonding and mechanical stability of a series of homodimeric beta-sheet mimics. The dimers consisting of 4, 6, and 8 H-bonding sites were modeled in explicit chloroform solvent and the rupture force was studied using constant velocity SMD. The role of solvent structuring on the conformation of the dimers was analyzed and showed no significant contribution of chloroform molecules in the rupture event. The simulated stability of the dimers was validated by force data obtained with atomic force microscopy (AFM)-based SMFS in toluene. The computational model for the 8H dimer also offered insight into a possible mismatched dimer intermediate that may contribute to the lower than expected mechanical stability observed by single molecule AFM force studies. In addition, atomic level analysis of the rupture mechanism verified the dependence of mechanical strength on pulling trajectory due to the directional nature of chemical bonding under an applied force. The knowledge gained from this basic study will be used to guide further design of modular polymers having folded nanostructures through strategic programming of weak, non-covalent interactions into polymer backbones
— id: 106586, year: 2008, vol: 49, page: 3892, stat: Journal Article,

Partial and double-array implantation of the ossified cochlea
Roland, J Thomas Jr; Coelho, Daniel H; Pantelides, Harry; Waltzman, Susan B
2008 Dec;29(8):1068-1075, Otology & neurotology
OBJECTIVE: To review our experience with partial standard and double-array cochlear implantation in the ossified cochlea. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Twenty cochleae in 19 adult and pediatric patients with ossified cochleae. INTERVENTION(S): Patients underwent either partial insertion of a standard electrode array or double-array electrode insertion for their cochlear implantation. MAIN OUTCOME MEASURE(S): Number of electrodes inserted, number of active electrodes at follow-up, and open-set speech performance. RESULTS: Twelve patients (four children and eight adults) had partial insertion of standard array electrode. The mean number of electrodes inserted and active at follow-up was 14.8 and 11.3, respectively. Eight patients (four children and four adults) had a double-array electrode implanted. The mean number of electrodes inserted and active at follow-up was 18.1 and 16.3, respectively. Open-set speech recognition was better in children regardless of duration of deafness. There were no complications. CONCLUSION: These findings suggest that the double array allows for more usable electrodes than in partially inserted cochlear implant. Compared with adults, children with ossified cochlea do well both in partial standard and double-array insertion. Both insertion techniques are safe, with no complications occurring in our patients. Straight and double arrays should be available in the operating suite for any patient in whom suspected cochlear ossification is confronted
— id: 92770, year: 2008, vol: 29, page: 1068, stat: Journal Article,

Evaluation of the short hybrid electrode in human temporal bones
Roland, J Thomas Jr; Zeitler, Daniel M; Jethanamest, Daniel; Huang, Tina C
2008 Jun;29(4):482-488, Otology & neurotology
HYPOTHESIS: The current hybrid electrode can be inserted without trauma to the temporal bone and, after insertion, assumes a position within the scala tympani near the outer cochlear wall just beneath the basilar membrane. BACKGROUND: Conservation of residual hearing after cochlear implant electrode insertion requires a special insertion technique and an atraumatic short electrode. This allows electroacoustic stimulation in ears with significant residual hearing. METHODS: Human cadaveric temporal bones were implanted with soft surgical technique under fluoroscopic observation. Dehydrated and resin-impregnated bones are dissected. Real-time electrode insertion behavior and electrode position were evaluated. The bones are examined for evidence of insertion-related trauma. RESULTS: No gross trauma was observed in the implanted bones, and the electrode dynamics evaluation revealed smooth scala tympani insertions. CONCLUSION: Atraumatic insertion of the 10-mm hybrid electrode can be accomplished using an appropriate cochleostomy and insertion technique
— id: 80286, year: 2008, vol: 29, page: 482, stat: Journal Article,

Remote intraoperative monitoring during cochlear implant surgery is feasible and efficient
Shapiro, William H; Huang, Tina; Shaw, Theresa; Roland, J Thomas Jr; Lalwani, Anil K
2008 Jun;29(4):495-498, Otology & neurotology
OBJECTIVES: Intraoperative testing of cochlear implant devices, establishment of electrical threshold for acoustic reflex, and recording neural responses to electrical stimulation have traditionally required the presence of a cochlear implant audiologist in the operating room. The goal of this study was to determine the feasibility of remote testing to improve time efficiency and reduce cost. STUDY DESIGN: Prospective. METHODS: A standard PC with Tridia VNC software and either Cochlear Corporation or Advanced Bionics Corporation mapping software was configured to perform remote testing. The time required to perform on-site or remote testing was measured. RESULTS: With the availability of the laptop and internet access, there were no geographic restrictions regarding the site of remote testing. Remote testing was time efficient, requiring 9 minutes of audiologist's time compared with 93 minutes when the audiologist had to travel to the operating room. CONCLUSION: Remote testing of the cochlear implant device and patient's response to electrical stimulation is technically feasible. It is timesaving, practical, and cost efficient
— id: 105541, year: 2008, vol: 29, page: 495, stat: Journal Article,

Path planning and workspace determination for robot-assisted insertion of steerable electrode arrays for cochlear implant surgery
Zhang, Jian; Wei, Wei; Manolidis, Spiros; Roland, J Thomas Jr; Simaan, Nabil
2008 ;11(Pt 2):692-700, Medical image computing & computer-assisted intervention : MICCAI
In previous works, the authors showed that using robot-assisted steerable electrode array insertions can significantly reduce the insertion forces compared to non-steerable electrode arrays. In addition to steering the electrode array, it is possible to change its angle of approach with respect to the scala tympani. This paper focuses on determining the relevance of changing the angle of approach of the electrode array by comparing steerable electrode array insertions using a two Degrees-of-Freedom (DoF) robot versus a four DoF robot. Optimal insertion path planning strategies are presented for both two and four DoF insertions. Simulation results and experiments show that the four DoF insertions can improve over two DoF insertions. Moreover, changing the angle of approach can further reduce the insertion forces. The simulation results also provide the workspace requirements for designing a custom parallel robot for robot-assisted cochlear implant surgery
— id: 106587, year: 2008, vol: 11, page: 692, stat: Journal Article,

An Unusual Presentation and Spread of an Endolymphatic Sac Tumor
Coelho DH; Golfinos JG; Roland JT Jr
2007 Dec 28;:?-?, Otology & neurotology
— id: 91376, year: 2007, vol: , page: ?, stat: Journal Article,

The effect of perimodiolar placement on speech perception and frequency discrimination by cochlear implant users
Fitzgerald, Matthew B; Shapiro, William H; McDonald, Paulette D; Neuburger, Heidi S; Ashburn-Reed, Sara; Immerman, Sara; Jethanamest, Daniel; Roland, J Thomas; Svirsky, Mario A
2007 Apr;127(4):378-383, Acta oto-laryngologica
CONCLUSION: Neither speech understanding nor frequency discrimination ability was better in Nucleus Contour users than in Nucleus 24 straight electrode users. Furthermore, perimodiolar electrode placement does not result in better frequency discrimination. OBJECTIVES: We addressed three questions related to perimodiolar electrode placement. First, do patients implanted with the Contour electrode understand speech better than with an otherwise identical device that has a straight electrode? Second, do these groups have different frequency discrimination abilities? Third, is the distance of the electrode from the modiolus related to frequency discrimination ability? SUBJECTS AND METHODS: Contour and straight electrode users were matched on four important variables. We then tested these listeners on CNC word and HINT sentence identification tasks, and on a formant frequency discrimination task. We also examined X-rays and measured the distance of the electrodes from the modiolus to determine whether there is a relationship between this factor and frequency discrimination ability. RESULTS: Both speech understanding and frequency discrimination abilities were similar for listeners implanted with the Contour vs a straight electrode. Furthermore, there was no linear relationship between electrode-modiolus distance and frequency discrimination ability. However, we did note a second-order relationship between these variables, suggesting that frequency discrimination is worse when the electrodes are either too close or too far away from the modiolus
— id: 73408, year: 2007, vol: 127, page: 378, stat: Journal Article,

In reference to Orbital sequelae of rhinosinusitis after cochlear implantation in children
Hoffman, Ronald A; Parisier, Simon C; Roland, J Thomas Jr
2007 Aug;117(8):1505-1505, Laryngoscope
— id: 105543, year: 2007, vol: 117, page: 1505, stat: Journal Article,

Cochlear implantation in Children with CHARGE syndrome: therapeutic decisions and outcomes
Lanson, Biana G; Green, Janet E; Roland, J Thomas Jr; Lalwani, Anil K; Waltzman, Susan B
2007 Jul;117(7):1260-1266, Laryngoscope
OBJECTIVES: Ear anomalies and deafness are associated with CHARGE syndrome, which also presents with a cluster of features including coloboma of the eye, heart defects, atresia of the choanae, developmental retardation, and genitourinary abnormalities. The aim of this study is to explore the viability of cochlear implantation in children with CHARGE syndrome and to assess the outcome. STUDY DESIGN: Retrospective chart review. METHODS: Eleven children presenting with severe to profound sensorineural hearing loss associated with CHARGE syndrome were the subjects of this study. Routine audiometric measurements and the Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS) were performed pre- and postoperatively. In addition, the degree of the subjects' cochlear deformity were measured and correlated to outcome. RESULTS: All patients had varying degrees of ear anomalies, seven patients suffered from coloboma of the eyes, two had heart defects, five exhibited choanal atresia, eleven showed developmental retardation, and six had genitourinary abnormalities. Ten of the children underwent cochlear implantation with complete insertion of the electrode array without complication and were followed over a 3-month to a 7-year period. The eleventh child was not implanted because of severe retardation. All of the implanted children showed varying, but limited degrees, of auditory benefit as measured by routine audiometry and the IT-MAIS. CONCLUSIONS: Careful treatment planning for children with sensorineural hearing loss and CHARGE syndrome can lead to varying, but limited degrees, of auditory benefit with no increase in surgical complications. Although the implant enhanced the children's 'connectivity' to the environment, it did not promote the development of oral language skills in this population
— id: 73293, year: 2007, vol: 117, page: 1260, stat: Journal Article,

Implication of central asymmetry in speech processing on selecting the ear for cochlear implantation
Morris, Luc G; Mallur, Pavan S; Roland, J Thomas Jr; Waltzman, Susan B; Lalwani, Anil K
2007 Jan;28(1):25-30, Otology & neurotology
OBJECTIVE: Emerging evidence in auditory neuroscience suggests that central auditory pathways process speech asymmetrically. In concert with left cortical specialization for speech, a 'right-ear advantage' in speech perception has been identified. The purpose of this study is to determine if this central asymmetry in speech processing has implications for selecting the ear for cochlear implantation. STUDY DESIGN: Retrospective cohort study. SETTING: Academic university medical center PATIENTS: One hundred one adults with bilateral severe-to-profound sensorineural hearing loss INTERVENTION: Cochlear implantation with the Nucleus 24 Contour device. MAIN OUTCOME MEASUREMENTS: Patients were divided into two groups according to the ear implanted. Results were compared between left-ear- and right-ear-implanted patients. Further subgroup analysis was undertaken, limited to right-handed patients. Postoperative improvement on audiograms and scores on speech perception tests (Hearing in Noise test, City University of New York in quiet and in noise test, Consonant-Vowel Nucleus- Consonant words, and phonemes) at 1 year was compared between groups. Analysis of covariance was used to control for any intergroup differences in preoperative characteristics. RESULTS: The groups were matched in age, duration of hearing loss, duration of hearing aid use, percentage implanted in the better hearing ear, and preoperative audiologic testing. Postoperatively, there were no differences between left-ear- and right-ear-implanted patients in improvement on speech recognition tests. CONCLUSION: Despite central asymmetry in speech processing, our data do not support a right-ear advantage in speech perception outcomes with cochlear implantation. Therefore, among the many factors in choosing the ear for cochlear implantation, central asymmetry in speech processing does not seem to be a contributor to postoperative speech recognition outcomes
— id: 70860, year: 2007, vol: 28, page: 25, stat: Journal Article,

Emergency parotidectomy for penetrating zone III neck trauma
Morris, Luc G; Miglietta, Maurizio A; Sikora, Andrew G; Okun, Monica N; Roland, J Thomas Jr
2007 Dec;142(12):1206-1208, Archives of Surgery (Chicago)
Penetrating trauma to the face and upper zone III of the neck may present unique challenges when the parotid gland and associated neurovascular structures are involved. We report a case of massive hemorrhage from penetrating neck trauma that necessitated emergency parotidectomy for vascular exposure. Facial nerve repair was also necessary, underscoring the importance of this approach not only for successful vascular control but also for preservation of nearby vital structures. The management of penetrating trauma to the parotid region,and relevant anatomy, are discussed
— id: 105542, year: 2007, vol: 142, page: 1206, stat: Journal Article,

Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: An analysis of tumor control, complications, and hearing preservation rates - Comments
Pollock, BE; Golfinos, JG; Roland, JT; Narayana, A; Gutin, PH; Noren, G; Chen, JCT; Goodkin, R
2007 ;60(3):468-470, Neurosurgery
— id: 105550, year: 2007, vol: 60, page: 468, stat: Journal Article,

Modiolar coiling, electrical thresholds, and speech perception after cochlear implantation using the nucleus contour advance electrode with the advance off stylet technique
Huang, Tina C; Reitzen, Shari D; Marrinan, Michelle S; Waltzman, Susan B; Roland, J Thomas
2006 Feb;27(2):159-166, Otology & neurotology
OBJECTIVE: Perimodiolar electrode arrays were developed in an attempt to improve stimulation of specific neural populations and to decrease electrical thresholds, thereby decreasing power consumption. Postoperative radiographs show that coiling of the arrays is variable. Our previous study explored the relationship between the angle of coiling, threshold levels, and functional outcomes using the Nucleus Contour electrode array. This study compares coiling angle, electrical threshold levels, and speech perception measures with the Nucleus Contour Advance electrode array implanted using the new advance off stylet technique versus the Nucleus Contour electrode array implanted using the standard technique. STUDY DESIGN: Retrospective review. SETTING: University medical center. PATIENTS: Forty-two adults and children with normal cochlear anatomy implanted with the Nucleus CI24RCA electrode using the advance off stylet technique with at least 1-year follow-up. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURES: Computer-aided radiographic analysis of perimodiolar electrode placement, electrical threshold measurements, and speech perception outcome measures at 1 year postimplantation. RESULTS: The degree of modiolar coiling was tighter using the new electrode and technique in comparison with standard insertion technique using the Nucleus Contour electrode array. The tighter coiling tended to result in higher electrical thresholds. Lower speech perception outcome measures tended to correlate with a higher degree of coiling. CONCLUSION: The Nucleus Contour Advance electrode array combined with the advance off stylet technique resulted in a more consistent perimodiolar position. However, the tighter coiling resulted in statistically significant increased electrical thresholds and decreased speech perception outcomes. This finding may be secondary to multiple factors, not just coiling angle
— id: 70299, year: 2006, vol: 27, page: 159, stat: Journal Article,

Multichannel cochlear implantation in the scala vestibuli
Lin, Karen; Marrinan, Michelle S; Waltzman, Susan B; Roland, J Thomas Jr
2006 Aug;27(5):634-638, Otology & neurotology
OBJECTIVE: Sensorineural hearing loss resulting from otosclerosis, meningitis, chronic otitis media, autoimmune ear disease, and trauma can be associated with partial or total obstruction of the cochlear scalae. Multichannel cochlear implantation may be difficult in a cochlea with an obstructed scala tympani. The purpose of this study is to determine the safety and efficacy of scala tympani electrode insertion. STUDY DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Eight children and adults with profound sensorineural hearing loss who underwent cochlear implantation with known scala vestibuli electrode array insertion were subjects for this study. INTERVENTIONS: Eight study subjects underwent implantation: five with the Nucleus 24RCS (Contour) device and three with the Nucleus 24M device. OUTCOME MEASURES: Imaging findings, operative findings, and age-appropriate speech perception testing. RESULTS: All patients had full electrode insertion. Various obstructive patterns on computed tomography and magnetic resonance imaging were found, and there was a range of speech perception results. All but one patient improved based on age-appropriate monosyllabic word and sentence tests. CONCLUSION: Scala vestibuli multielectrode insertion is a viable alternative when scala tympani insertion is not possible because of abnormal anatomy or anatomical changes secondary to disease or previous implantation. We will also present an algorithm of options for decision making for implantation when encountering cochlear obstruction and difficult electrode insertion
— id: 94221, year: 2006, vol: 27, page: 634, stat: Journal Article,

Revision cochlear implantation
Roland, J Thomas Jr; Huang, Tina C; Cohen, Noel L
2006 Aug;39(4):833-9, viii, Otolaryngologic clinics of North America
Reoperation on a patient with an indwelling cochlear implant is uncommon. When necessary, surgery is performed for explantation of an existing device with immediate or delayed reimplantation, or for scalp flap revision and receiver-stimulator repositioning in the case of infection or device migration. Rarely, revision surgery is performed to reintroduce intracochlear electrodes that may have partly or entirely extruded from the cochlea or were placed inappropriately. Successful revision cochlear implant surgery requires attention to certain surgical principles. Good outcomes, asa measured by speech perception tests, are common, but are not guaranteed. This article outlines the indications for revision cochlear implant surgery, the recommended surgical principles, and published outcomes from reimplantation
— id: 105545, year: 2006, vol: 39, page: 833, stat: Journal Article,

Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release
Roland, J Thomas Jr; Lin, Karen; Klausner, Lee M; Miller, Philip J
2006 May;16(2):101-108, Skull base
Objective: Facial nerve paralysis or compromise can be caused by lesions of the temporal bone and cerebellopontine angle and their treatment. When the facial nerve is transected or severely compromised and primary end-to-end repair is not possible, hypoglossal-facial nerve anastomosis remains the most popular method for accomplishing three main goals: restoring facial tone, restoring facial symmetry, and facilitating return of voluntary facial movement. Our objectives are to evaluate the surgical feasibility and long-term outcomes of our technique of direct facial-to-hypoglossal neurorrhaphy with a parotid-release maneuver. Design: Prospective cohort. Setting: Academic tertiary care referral center. Patients: Ten patients with facial paralysis from proximal nerve injury underwent the facial-hypoglossal neurorrhaphy with a parotid-release maneuver. Main outcome measures: The Repaired Facial Nerve Recovery Scale, questionnaires, and photographs. Results: Facial-hypoglossal neurorrhaphy with parotid release was technically feasible in all cases, and anastomosis was performed distal to the origin of the ansa hypoglossi. All patients had good return of facial nerve function. Nine patients had scores of C or better, indicating strong eyelid and oral sphincter closure and mass motion. There was no hemilingual atrophy and no subjective tongue dysfunction. Conclusions: The parotid-release maneuver mobilizes additional length to the facial nerve, facilitating a tensionless communication distal to the ansa hypoglossi. The technique is a viable option for facial reanimation, and our patients achieved good clinical outcomes with continual improvement
— id: 105544, year: 2006, vol: 16, page: 101, stat: Journal Article,

Cochlear Implants
Waltzman, Susan B; Roland, J. Thomas
New York : Thieme, 2006,
— id: 1399, year: 2006, vol: , page: , stat: ,

Cochlear implant electrode insertion
Roland Jr JT
2005 ;16(2):86-92, Operative techniques in otolaryngology, head & neck surgery
Cochlear implant electrode insertion is the most important step in cochlear implant surgery. Optimal placement facilitates optimal results. This article describes cochlear implant electrode insertion techniques in normal and abnormal cochleae and the currently available electrodes. copyright 2005 Elsevier Inc. All rights reserved
— id: 57683, year: 2005, vol: 16, page: 86, stat: Journal Article,

Electrode insertion mechanics and outer wall forces with the Nucleus 24 Contour Advance(trade mark) electrode
Roland, J T; Shevla, M; Gibson, P; Treaba, C
2005 Sep;6 Suppl 1:5-8, Cochlear Implants International
— id: 105539, year: 2005, vol: 6 Suppl 1, page: 5, stat: Journal Article,

A model for cochlear implant electrode insertion and force evaluation: results with a new electrode design and insertion technique
Roland, J Thomas Jr
2005 Aug;115(8):1325-1339, Laryngoscope
OBJECTIVES AND HYPOTHESIS: This study has the specific aim of evaluating the insertion characteristics of a new cochlear implant electrode. Techniques for evaluation of fluoroscopic real time mechanical insertion dynamics, histologic electrode position and trauma results, hydraulic force, and mechanical insertion forces are presented. In addition, this study should serve to present a novel model for cochlear implant electrode insertion evaluations. STUDY DESIGN: Prospective analysis using a series of analytical techniques. METHODS: All studies are conducted in fixed cadaveric temporal bones. Real time fluoroscopic insertion evaluations, histologic evaluations for trauma and electrode position in embedded bones, hydraulic measures, and mechanical intracochlear force measurements are conducted with a current and new electrode. RESULTS: The Contour Advance electrode provides a more reliable and less traumatic insertion when deployed with the Advance Off Stylet technique. This is largely because of a reduction in intracochlear outer wall force generation. Fluoroscopic and histologic analysis reveal a smooth insertion without reliance on cochlear outer wall contact. No hydraulic forces were detected when measured from the superior semicircular canal ampulla. CONCLUSION: The model used for this study provides valuable information to cochlear implant surgeons and design engineers. The Contour Advance electrode, inserted with the Advance Off Stylet technique, represents an improvement over the Contour electrode inserted with the standard insertion technique
— id: 57723, year: 2005, vol: 115, page: 1325, stat: Journal Article,

Cochlear implantation in children younger than 12 months
Waltzman, Susan B; Roland, J Thomas Jr
2005 Oct;116(4):e487-e493, Pediatrics
OBJECTIVES: As a result of universal newborn hearing screening and improved evaluation tools, many children with severe to profound hearing loss are being diagnosed as infants. This affords the opportunity to provide these children access to cochlear implantation, although medical and audiologic challenges must be addressed. The purpose of this study was to investigate the safety and efficacy of cochlear implantation in children who are younger than 1 year. METHODS: A prospective study was conducted of 18 children who had confirmed severe to profound sensorineural hearing loss and received cochlear implants at our medical center before 12 months of age. The length of device usage ranged from 6 months to 4 years, 5 months. The main outcomes measured were perioperative and postoperative surgical/medical aspects, the Infant-Toddler Meaningful Auditory Integration Scale and age-appropriate phoneme, and word and sentence recognition tests, when appropriate. RESULTS: All children had full insertions of the electrode array without surgical complications and are developing age-appropriate auditory perception and oral language skills. CONCLUSIONS: Early implantation is feasible and beneficial in some children who are younger than 12 months and should be considered with attention to variables involved in the decision-making process, including possible increased surgical risk, skull size and scalp thickness, and mastoid development
— id: 61266, year: 2005, vol: 116, page: e487, stat: Journal Article,

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I: Comparison of Nucleus banded and Nucleus Contour electrodes
Wardrop, Peter; Whinney, David; Rebscher, Stephen J; Roland, J Thomas Jr; Luxford, William; Leake, Patricia A
2005 May;203(1-2):54-67, Hearing research
In recent years, new designs of cochlear implant electrodes have been introduced in an attempt to improve efficiency and performance by locating stimulation sites closer to spiral ganglion neurons and deeper into the scala tympani. The goal of this study was to document insertion depth, intracochlear position and insertion trauma with the Nucleus Contour electrode and to compare results to those observed with the earlier generation Nucleus banded electrode. For this comparison eight Nuclears banded electrodes and 18 Contour electrodes were implanted in cadaver temporal bones using a realistic surgical exposure. Two experienced cochlear implant surgeons and two otology fellows with specialized training in cochlear implant surgery were selected for the study to represent a range of surgical experience similar to that of surgeons currently performing the procedure throughout the world. Following insertion of the electrodes, specimens were imaged using plain film X-ray, embedded in acrylic resin, cut in radial sections with the electrodes in place, and each cut surface was polished. Insertion depth was measured in digitized X-ray images, and trauma was assessed in each cross-section. The Contour electrode inserted more deeply (mean depth=17.9 mm or 417 degrees ) than the banded electrode (mean depth=15.3 mm or 285 degrees ). The incidence and severity of trauma varied substantially among the temporal bones studied. However, the nature and frequency of injuries observed with the two devices were very similar. The Contour electrode was clearly positioned closer to the modiolus than the banded model, and also appeared easier to use. Based on this difference in position and data from previous studies we conclude that the Contour electrode may provide lower thresholds and improved channel selectivity, but the incidence of trauma remains a problem with the newer design. The relative influences of electrode positioning and neural degeneration that may result from trauma are as yet unclear
— id: 105547, year: 2005, vol: 203, page: 54, stat: Journal Article,

Evaluation of the neural response telemetry (NRT) capabilities of the nucleus research platform 8: initial results from the NRT trial
Battmer, Rolf D; Dillier, Norbert; Lai, Wai K; Weber, Benno P; Brown, Carolyn; Gantz, Bruce J; Roland, J Thomas; Cohen, Noel J; Shapiro, William; Pesch, Joerg; Killian, Matthijs J; Lenarz, Thomas
2004 Dec;43 Suppl 1:S10-S15, International Journal of Audiology
The purpose of this study was to evaluate the performance of the new features of the Nucleus Research Platform 8 (RP8), a system developed specifically for research purposes The RP8 consists of a research implant, a speech processor and a new NRT software (NRT v4), and includes comparisons of the different artefact-cancellation methods, NRT threshold, and recovery function measurements. The system has new artefact-suppression techniques and new diagnostic capabilities; their performance has been verified in animal experiments. In this study, NRT data were collected from 15 postlingually deafened adult cochlear implant patients intraoperatively and up to 6 months postoperatively after switch-on. The initial investigation in two clinics in Europe focused primarily on the enhanced NRT capabilities Results from the trial in two European clinics indicate that NRT measurements can be obtained with lower noise levels. A comparison of the different artefact-cancellation techniques showed that the forward-masking paradigm implemented in the Nucleus 3 system is still the method of choice. The focus of this report is on recovery function characteristics, which may give insight into auditory nerve fiber properties with regard to higher stimulation rates
— id: 105546, year: 2004, vol: 43 Suppl 1, page: S10, stat: Journal Article,

Meningitis in cochlear implant recipients: the North American experience
Cohen, Noel L; Roland, J Thomas Jr; Marrinan, Michelle
2004 Jun;25(3):275-281, Otology & neurotology
INTRODUCTION: Until recently, postimplant meningitis was infrequently reported and felt to be uncommon. However, in the spring of 2002, there was a sudden increase in the number of reported cases of postimplantation meningitis in both Europe and North America. OBJECTIVE: Because complications of surgery often tend to be underreported, we decided to survey all cochlear implant centers in North America to determine the true incidence of postimplant meningitis and to learn more about the demographics and risk factors. STUDY DESIGN: We conducted a prospective study. A survey instrument was designed asking surgeons the number of implants performed and whether they had seen any cases of meningitis after implantation. If the answer was affirmative, they were asked to respond to a 20-point questionnaire. This instrument was sent to all 401 cochlear implant centers in North America. SETTING: Tertiary care referral centers. PATIENTS: We studied all patients having received cochlear implants in North America. MAIN OUTCOME MEASURES: Number of cases of postimplant meningitis, age of patients, device used, cochlear and temporal bone abnormalities, treatment, and outcomes. RESULTS: Meningitis is more common than previously thought. Risk factors included young age, cochlear dysplasia, temporal bone abnormalities, and the use of a two-part electrode system. This survey led to the involvement by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention in a much more intensive analysis of a subset of the cases. CONCLUSIONS: Postimplant meningitis is related to patient, surgical, and device factors. By being aware of the risk factors involved, adhering to sound surgical principles such as packing of the cochleostomy with soft tissue, appropriately vaccinating patients, and eliminating any potentially traumatic electrode arrays, the incidence of meningitis should be significantly diminished
— id: 46169, year: 2004, vol: 25, page: 275, stat: Journal Article,

Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery
Fishman, Andrew J; Marrinan, Michelle S; Golfinos, John G; Cohen, Noel L; Roland, J Thomas Jr
2004 Mar;114(3):501-505, Laryngoscope
OBJECTIVES/HYPOTHESIS: Postoperative cerebrospinal fluid (CSF) leak is reported in 2% to 30% of cases following vestibular schwannoma surgery. The authors' current surgical techniques for translabyrinthine, retrosigmoid transmeatal, and middle cranial fossa approaches have evolved from analysis of their prior experience in an effort to minimize their complication rate. The authors evaluated the efficacy of their current surgical technique in decreasing the postoperative CSF leak rate. STUDY DESIGN: Retrospective review. METHODS: The vestibular schwannoma database from the New York University Medical Center (New York, NY) neurotological service was reviewed. Data were extracted for type of approach, tumor size, and CSF leak rate. Liberal leak criteria were used. Surgical techniques and management of CSF leak were reviewed. RESULTS: Data from 215 patients who had surgery from 1995 to 2000 manifested a 6.6% CSF leak rate for primary surgeries. This compared favorably with the authors' 17% overall CSF leak rate in 555 total primary surgeries performed between 1979 and 1995. Translabyrinthine closure was performed with dural sutures used as a sling across the posterior fossa dura and abdominal fat placed as a series of corks through the sutures. Abdominal fat was used to obliterate the mastoid cavity in conjunction with aditus and mastoid obliteration. Attention must be paid to soft tissue obliteration of potentially open air cell tracts. Retrosigmoid transmeatal closure was performed with a soft tissue graft in the internal auditory canal drill-out held in position by a 'saloon-door' dural flap. Bone wax was used to block perimeatal cells in all cases. Watertight dural closure was achieved with a sutured temporalis fascia graft. Abdominal fat obliteration of the mastoidectomy cavity was performed with an additional firm pressure from the 'Palva' periosteal flap. Middle cranial fossa closure was performed with attention to potential air cell tracts of the internal auditory canal drill-out, as well as abdominal fat graft, tissue glue, and bone wax. Fibrin glue was used in all approaches to temporarily secure fat in situ. Management of CSF leaks starts with nonoperative measures including bed rest, oversewing of incisional wounds, and placement of a lumbar subarachnoid spinal fluid diversion drain. If these conservative measures fail, repeat exploration is necessary and is directed at identifying and corking the cell or cells (usually perimeatal or perilabyrinthine) opening directly into the posterior fossa. CONCLUSION: Evolution in surgical techniques, with particular attention to exposed air cell tracts, abdominal fat graft, and Palva periosteal flap for closure, has had a significant effect in decreasing the author's CSF leak rate after vestibular schwannoma surgery. Conservative management was successful in approximately 50% of cases. Repeat exploration, when needed, was directed at blocking the air cell tract (usually perimeatal or perilabyrinthine) responsible for the CSF leak
— id: 44805, year: 2004, vol: 114, page: 501, stat: Journal Article,

Auditory brainstem implantation in patients with neurofibromatosis type 2
Kanowitz, Seth J; Shapiro, William H; Golfinos, John G; Cohen, Noel L; Roland, J Thomas Jr
2004 Dec;114(12):2135-2146, Laryngoscope
OBJECTIVES: Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) and schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA), regardless of hearing loss (HL). The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. This study aims to review the surgical and audiologic outcomes in 18 patients implanted by our Skull Base Surgery Team from 1994 through 2003. STUDY DESIGN: A retrospective chart review of 18 patients with ABIs. METHODS: We evaluated demographic data including age at implantation, number of tumor resections before implantation, tumor size, surgical approach, and postoperative surgical complications. The ABI auditory results at 1 year were then evaluated for number of functioning electrodes and channels, hours per day of use, nonauditory side effect profile and hearing results. Audiologic data including Monosyllable, Spondee, Trochee test (MTS) Word and Stress scores, Northwestern University Children's Perception of Speech (NU-CHIPS), and auditory sensitivity are reported. RESULTS: No surgical complications caused by ABI implantation were revealed. A probe for lateral recess and cochlear nucleus localization was helpful in several patients. A range of auditory performance is reported, and two patients had no auditory perceptions. Electrode paddle migration occurred in two patients. Patient education and encouragement is very important to obtain maximum benefit. CONCLUSIONS: ABIs are safe, do not increase surgical morbidity, and allow most patients to experience improved communication as well as access to environmental sounds. Nonauditory side effects can be minimized by selecting proper stimulation patterns. The ABI continues to be an emerging field for hearing rehabilitation in patients who are deafened by NF2
— id: 47764, year: 2004, vol: 114, page: 2135, stat: Journal Article,

Degree of modiolar coiling, electrical thresholds, and speech perception after cochlear implantation
Marrinan, Michelle S; Roland, J Thomas Jr; Reitzen, Shari D; Waltzman, Susan B; Cohen, Lawrence T; Cohen, Noel L
2004 Jun;25(3):290-294, Otology & neurotology
OBJECTIVE: Perimodiolar electrode arrays were developed to improve stimulation of specific neural populations and to decrease power consumption. Postoperative radiographs suggest that some arrays are more tightly coiled than others. The purpose of this study was to evaluate whether the degree of modiolar coil correlates with electrical threshold and/or performance measures postimplantation with the Nucleus CI24RCS (Contour) device. STUDY DESIGN: Retrospective review. SETTING: Cochlear implant center and a tertiary care hospital. PATIENTS: Twenty-eight adult cochlear implant recipients with normal cochlear anatomy who underwent implantation with the Nucleus C124RCS perimodiolar electrode and are at least 1 year postimplantation. INTERVENTIONS: Therapeutic. MAIN OUTCOME MEASURES: Radiologic degree of perimodiolar electrode placement (determined by a computer algorithmic analysis) compared with electrical thresholds and standard speech perception outcome measures at 1 year postcochlear implantation. RESULTS: No significant correlations were found between the degree of modiolar coiling of the electrode array and electrical thresholds and speech perception outcome measures at 1 year postcochlear implantation. CONCLUSIONS: The degree of coiling of a modiolar hugging electrode array was not directly correlated with the level of electrical thresholds or postoperative speech perception outcome measures. Appearance of coil tightness on postoperative radiographs could reflect either differences in array placement or intrinsic variations in cochlear anatomy, and variations in speech perception performance can be influenced by other factors, including length of deafness
— id: 46168, year: 2004, vol: 25, page: 290, stat: Journal Article,

Cranial nerve preservation in surgery for large acoustic neuromas
Roland, J Thomas Jr; Fishman, Andrew J; Golfinos, John G; Cohen, Noel; Alexiades, George; Jackman, Alexis H
2004 May;14(2):85-90, Skull base
Facial nerve outcomes and surgical complication rates for other cranial nerves were evaluated retrospectively after the resection of large acoustic neuromas. The charts of all patients who underwent surgical removal of an acoustic neuroma between 1992 and 2001 at New York University Medical Center were reviewed. Fifty-four patients with tumors measuring 3 cm or larger were included in the study. Four patients had neurofibromatosis type 2, two of whom underwent bilateral removal of acoustic neuromas. Translabyrinthine microsurgical removal of tumor was performed in 47 of 56 cases (84%). In all cases, EMG monitoring, improved sharp microdissection, and ultrasonic aspiration were employed. Facial nerve function was assessed using the House-Brackmann facial nerve grading system immediately after surgery and at follow-up visits. A House-Brackmann grade III or better was achieved in 90% of patients, and a grade II or better was achieved in 84% of patients. Ultimate facial nerve outcome was excellent after the surgical resection of large acoustic neuromas. Preoperative cranial nerve palsies also improved after surgery. The translabyrinthine approach for tumor removal is our treatment of choice for acoustic neuromas 3 cm or larger
— id: 62125, year: 2004, vol: 14, page: 85, stat: Journal Article,

Retrolabyrinthine craniectomy: the unsung hero of skull base surgery
Russell, Stephen M; Roland, J Thomas Jr; Golfinos, John G
2004 Feb;14(1):63-71, Skull base
Despite being the foundation of, or supplement to, many skull base exposures, the retrolabyrinthine approach has not been adequately illustrated in the skull base literature. As an aid to skull base surgeons in training, this article provides a step-by-step description of the microsurgical anatomy and operative nuances of this important technique
— id: 62126, year: 2004, vol: 14, page: 63, stat: Journal Article,

Cochlear reimplantation in children: soft signs, symptoms and results
Waltzman, Susan; Roland, J Thomas Jr; Waltzman, Michael; Shapiro, William; Lalwani, Anil; Cohen, Noel
2004 Dec;5(4):138-145, Cochlear Implants International
OBJECTIVES: Cochlear implant device failures and reimplantation have mainly been reported on in adults. The purpose of this study was to isolate precursors of device failures and assess the effects of reimplantation in children. METHODS: From 1997 to 2003, 27 children underwent cochlear reimplantation at our institution. The pre-failure complaints were categorized and correlated with actual failure modes and postimplantation results. Speech-recognition tests were used to evaluate pre- and post-reimplantation performance. RESULTS: Pre-failure length of usage ranged from 0 to 12 years. Symptoms including pain, intermittence, reduced performance, noise and the need for frequent device adjustments were associated with device failures, although not with a particular mode of failure. Post reimplantation performance was equal to but not immediately better than pre-failure results in children who received upgraded devices. CONCLUSIONS: Specific complaints, frequent need for device adjustments and reduced speech recognition can be precursors to device failures, underscoring the need for routine follow-up evaluations. Reimplantation with newer technology does not guarantee improved speech understanding and often requires an adjustment period to reach pre-reimplantation levels.
— id: 105540, year: 2004, vol: 5, page: 138, stat: Journal Article,

Fluoroscopically assisted cochlear implantation
Fishman, Andrew J; Roland, J Thomas Jr; Alexiades, George; Mierzwinski, Jozef; Cohen, Noel L
2003 Dec;24(6):882-886, Otology & neurotology
HYPOTHESIS: Real-time intraoperative fluoroscopy is a useful adjunct to cochlear implantation in selected cases. The advantages include the avoidance of complications such as extracochlear array placement, intrameatal array insertion, and avoidance of significant bending or kinking. This is particularly useful when implanting a severely abnormal cochlea. BACKGROUND: The technique was initially developed for laboratory study of electrode prototypes in cadaver temporal bones to evaluate insertion dynamics and mechanisms of intracochlear trauma. The technique was subsequently adapted for use in live surgeries. METHODS: Live surgeries were performed using fluoroscopic guidance on nine patients. RESULTS: Five patients were implanted with the Nucleus 24 RCS during preclinical trials. Two patients with severe cochlear malformations were implanted with a Nucleus CI24M straight array. Two patients with severe cochlear ossification were implanted with the Nucleus CI24 double array. Appropriate insertions were achieved without electrode damage in all cases. CONCLUSIONS: Intraoperative fluoroscopy is a useful adjunct to cochlear implantation, which can be performed with minimum risk to the patient and operating room staff if the outlined precautions are taken. Intraoperative fluoroscopy is indicated in cases where the intracochlear behavior of the electrode array cannot be predicted, a condition encountered when implanting new electrode designs, cases with severely malformed inner ears, or cases of severe intraluminal obstruction requiring a double-array insertion
— id: 46078, year: 2003, vol: 24, page: 882, stat: Journal Article,

Tumors of the cerebellopontine angle
Golfinos JG; Russell S; Roland JT
Textbook of neurological surgery : principles and practice Philadelphia : Lippincott, 2003,
— id: 3146, year: 2003, vol: , page: ?, stat: Chapter,

Sphenoid sinus cerebrospinal fluid leak: Diagnosis and management
Kortbus MJ; Roland Jr JT; Lebowitz RA
2003 ;14(3):207-211, Operative techniques in otolaryngology, head & neck surgery
— id: 46353, year: 2003, vol: 14, page: 207, stat: Journal Article,

Cochlear implantation in human immunodeficiency virus-infected patients
Roland, J Thomas Jr; Alexiades, George; Jackman, Alexis H; Hillman, Dean; Shapiro, William
2003 Dec;24(6):892-895, Otology & neurotology
OBJECTIVE: To evaluate the efficacy of cochlear implants in human immunodeficiency virus-infected individuals and correlate these results with a proposed pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. STUDY DESIGN: Retrospective case series and temporal bone analysis of deceased human immunodeficiency virus-positive patients. SETTING: Tertiary care hospital. PATIENTS: Seven human immunodeficiency virus-positive individuals with profound sensorineural hearing loss. INTERVENTION: Cochlear implantation at New York University Medical Center. METHODS: The surgical outcomes and complications were analyzed. Additionally, electron microscopic and immunohistochemical findings of cadaver temporal bone specimens of other known human immunodeficiency virus-positive individuals were reviewed. The performance results of the human immunodeficiency virus-positive cochlear implant patients were then correlated with the previously hypothesized pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. RESULTS: The patients had a varied performance with cochlear implantation, and as a group performance was good. There were no surgical complications or postoperative complications. The good performance of these patients supports the hypothesis that the mechanism of human immunodeficiency virus-associated deafness involves infiltration, malfunction, and premature degeneration of the hair cells and supportive cells of the cochlea. CONCLUSIONS: Human immunodeficiency virus-positive individuals benefit from cochlear implantation without increased surgical risk
— id: 46077, year: 2003, vol: 24, page: 892, stat: Journal Article,

Surgical technique for the Nucleus Contour cochlear implant
Cohen, Noel L; Roland, J Thomas Jr; Fishman, Andrew
2002 Feb;23(1 Suppl):59S-66S, Ear & hearing
This paper deals with the Nucleus C124R (CS) (Contour) cochlear Implant: its characteristics, differences compared with the previous generation of devices, the perimodiolar electrode, and the surgical technique used for safe insertion. We also discuss the rationale behind perimodiolar electrodes in general, as well as the results of laboratory studies validating the design and safety of this particular electrode array. The differences in surgical technique between this device and prior Nucleus cochlear implants are as follows: the incision and the size of the well, or recess, for the electronics are smaller; the cochleostomy is larger; the posterior portion is placed in a subpericranial pocket, not tied down, before electrode insertion; and the insertion process itself is quite different, due to the nature of the electrode, its size, shape, and stylet. The technique described is that used by one experienced cochlear implant center, and reflect the authors' practice. Clearly, there are other possible variations on this theme, which may be equally satisfactory in other hands. Most surgeons find this device to be easier to place than previous generations: complications to date have been uncommon
— id: 105548, year: 2002, vol: 23, page: 59S, stat: Journal Article,

Long-term effects of cochlear implants in children
Waltzman, Susan B; Cohen, Noel L; Green, Janet; Roland, J Thomas Jr
2002 May;126(5):505-511, Otolaryngology, head & neck surgery
OBJECTIVE: Since 1987, when the use of multichannel cochlear implants was initiated in children, candidacy has expanded; many thousands of children have received these devices, and results have revealed a wide range of performance. However, few long-term studies exist on a large population of these children. There have been concerns expressed that cochlear implant function might degrade over time, that devices and electrodes might migrate and extrude in the growing child, or that there might even be a deleterious effect of long-term stimulation of the cochlear nerve. The purpose of this study was to explore the long-term effects of implantation as a function of performance over time, reimplantation, and educational factors. STUDY DESIGN AND SETTING: We studied 81 children who received implants at a major academic medical center and were followed for 5 to 13 years. RESULTS: Results revealed significant gains in speech perception, use of oral language, and ability to function in a mainstream environment. There was no decrease in performance over time and no significant incidence of device or electrode migration or extrusion, and device failure did not cause a deterioration in long-term outcome. CONCLUSIONS: Multichannel cochlear implants in children provide perception, linguistic, and educational advantages, which are not adversely affected by long-term electrical stimulation
— id: 32132, year: 2002, vol: 126, page: 505, stat: Journal Article,

Delayed implantation in congenitally deaf children and adults
Waltzman, Susan B; Roland, J Thomas Jr; Cohen, Noel L
2002 May;23(3):333-340, Otology & neurotology
OBJECTIVE: To determine the efficacy of cochlear implants with current processing strategies in children and adults with long-term congenital deafness, and to determine whether the growth of auditory perceptual skills in these patients is similar to the data reported for patients who have undergone implantation with earlier devices and coding strategies. STUDY DESIGN: A prospective study of children and adults fulfilling the study inclusion criteria. SETTING: University medical center. PATIENTS: Thirty-five congenitally deaf children who received implants after the age of 8 years and 14 congenitally deaf adults who received implants as adults participated in this study. Length of device use ranged from 6 months to 3 years. MAIN OUTCOME MEASURES: Open set phoneme, word recognition tests, and sentence recognition tests were administered in quiet and noise auditory only conditions preoperatively and postoperatively. Changes in test scores were examined by paired t tests, and differences between groups were compared by Student's t tests. Spearman correlation coefficients were calculated to identify associations between scores and subject characteristics. A two-sided alpha of less than 0.05 was considered statistically significant. RESULTS: The results indicated significant improvement in open set speech perception skills in the children after implantation; the adults demonstrated improved mean scores on both word and sentence recognition. A shorter length of deafness correlated with better postoperative performance, but all subjects continued to improve over time. The improvement in test scores was similar between the devices, and no significant differences were detected between the different processing strategies. CONCLUSION: Children and adults with long-term congenital deafness can obtain considerable open set speech understanding after implantation. Length of deafness (age at implantation), length of device use, and mode of communication contribute to outcome
— id: 39660, year: 2002, vol: 23, page: 333, stat: Journal Article,

Cochlear reimplantation: surgical techniques and functional results
Alexiades G; Roland JT Jr; Fishman AJ; Shapiro W; Waltzman SB; Cohen NL
2001 Sep;111(9):1608-1613, Laryngoscope
OBJECTIVES/HYPOTHESIS: The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of 'upgrades' (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist. STUDY DESIGN: Retrospective chart review. METHODS: The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single-channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation. RESULTS: Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation. CONCLUSIONS: Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases
— id: 24631, year: 2001, vol: 111, page: 1608, stat: Journal Article,

Use of the LandmarX (TM) surgical navigation system in lateral skull base and temporal bone surgery - Comments for publication
Golfinos, JG; Roland, JT
2001 ;11(4):253-254, Skull base
— id: 105551, year: 2001, vol: 11, page: 253, stat: Journal Article,

Cell cycle regulation of myosin-V by calcium/calmodulin-dependent protein kinase II
Karcher, R L; Roland, J T; Zappacosta, F; Huddleston, M J; Annan, R S; Carr, S A; Gelfand, V I
2001 Aug 17;293(5533):1317-1320, Science
Organelle transport by myosin-V is down-regulated during mitosis, presumably by myosin-V phosphorylation. We used mass spectrometry phosphopeptide mapping to show that the tail of myosin-V was phosphorylated in mitotic Xenopus egg extract on a single serine residue localized in the carboxyl-terminal organelle-binding domain. Phosphorylation resulted in the release of the motor from the organelle. The phosphorylation site matched the consensus sequence of calcium/calmodulin-dependent protein kinase II (CaMKII), and inhibitors of CaMKII prevented myosin-V release. The modulation of cargo binding by phosphorylation is likely to represent a general mechanism regulating organelle transport by myosin-V
— id: 106588, year: 2001, vol: 293, page: 1317, stat: Journal Article,

Atypical and low-grade malignant vestibular schwannomas: clinical implications of proliferative activity
Light JP; Roland JT Jr; Fishman A; Miller DC; Cohen NL
2001 Nov;22(6):922-927, Otology & neurotology
OBJECTIVE: To examine the relationship between histopathology, immunohistochemistry, and clinical behavior in atypical and low-grade malignant vestibular schwannomas. STUDY DESIGN: The study design was a retrospective case review in conjunction with a histopathologic and immunohistochemical proliferation marker study of archival specimens. DATA SOURCES: A tertiary referral center's anatomic pathology and vestibular schwannoma computerized databases. METHODS: The diagnosis of atypical or low-grade malignant vestibular schwannoma was based on the number of mitotic figures present per tumor slide. MIB1 labeling indices were used to compare the proliferative activity of the atypical and low-grade malignant groups with that in an age-matched and size-matched control group. RESULTS: Eight cases of atypical and six cases of low-grade malignant vestibular schwannoma were diagnosed from 1990 to 1998. In the atypical and low-grade malignant groups, respectively, the average patient age was 54.3 years (range, 38-74 yr) and 50 years (range, 38-72 yr), and the average total tumor size was 1.53 cm (range, 0.7-3.5 cm) and 1.55 cm (range, 1.5-2 cm). Two recurrences were identified from the low-grade malignant group, and there was one postoperative House-Brackmann Grade III facial weakness. There were no recurrences or facial palsies in the atypical group. No distant metastasis or aggressive local invasion was observed in either group. MIB1 labeling indices were significantly (p < or = 0.001) higher in the atypical (4.69%) and low-grade malignant (5.23%) groups than in the control group (1.99%). CONCLUSIONS: These findings suggest a tendency for recurrence in proliferative tumors; however, the designation of malignancy should be reconsidered
— id: 25659, year: 2001, vol: 22, page: 922, stat: Journal Article,

Histopathology of cochlear implants in humans
Nadol JB Jr; Shiao JY; Burgess BJ; Ketten DR; Eddington DK; Gantz BJ; Kos I; Montandon P; Coker NJ; Roland JT Jr; Shallop JK
2001 Sep;110(9):883-891, Annals of otology rhinology & laryngology
The insertion of an intrascalar electrode array during cochlear implantation causes immediate damage to the inner ear and may result in delayed onset of additional damage that may interfere with neuronal stimulation. To date, there have been reports on fewer than 50 temporal bone specimens from patients who had undergone implantation during life. The majority of these were single-channel implants, whereas the majority of implants inserted today are multichannel systems. This report presents the histopathologic findings in temporal bones from 8 individuals who in life had undergone multichannel cochlear implantation, with particular attention to the type and location of trauma and to long-term changes within the cochlea. The effect of these changes on spiral ganglion cell counts and the correlation between speech comprehension and spiral ganglion cell counts were calculated. In 4 of the 8 cases, the opposite, unimplanted ear was available for comparison. In 3 of the 4 cases, there was no significant difference between the spiral ganglion cell counts on the implanted and unimplanted sides. In addition, in this series of 8 cases, there was an apparent negative correlation between residual spiral ganglion cell count and hearing performance during life as measured by single-syllable word recognition. This finding suggests that abnormalities in the central auditory pathways are at least as important as spiral ganglion cell loss in limiting the performance of implant users
— id: 23745, year: 2001, vol: 110, page: 883, stat: Journal Article,

Synthesis of the spirocyclic cyclohexadienone ring system of the schiarisanrins
Coleman RS; Guernon JM; Roland JT
2000 Feb 10;2(3):277-280, Organic letters
[structure: see text] Studies on the synthesis of the spirocyclic cyclohexadienone ring system 2 of the schiarisanrin family of natural products 1 are described and were based on the Lewis acid-promoted C-alkylation of the corresponding phenolic precursor
— id: 23748, year: 2000, vol: 2, page: 277, stat: Journal Article,

Autoimmune inner ear disease
Roland JT
2000 Apr;2(2):171-174, Current rheumatology reports
The known etiologies of acquired sensorineural hearing loss include acoustic trauma, physical trauma, ototoxicity, genetic predisposition, infections, Meniere's disease, aging, and autoimmune disease. Treatments are directed at eliminating or managing the underlying disease process and aiding hearing with amplification. Rarely is it possible to improve unaided hearing after sensorineural loss except when the severe to profound level of loss is reached and cochlear implantation becomes an option. Autoimmune inner ear disease, however, is a treatable cause of sensorineural hearing loss and it is important for physicians and hearing health professionals to recognize that proper early diagnosis and management strategies may result in stabilization and possibly improvement in hearing
— id: 23747, year: 2000, vol: 2, page: 171, stat: Journal Article,

Complications of cochlear implant surgery
Roland JT Jr
Cochlear implants New York: Thieme, 2000,
— id: 2644, year: 2000, vol: , page: 171, stat: Chapter,

Electrode to modiolus proximity: a fluoroscopic and histologic analysis
Roland JT Jr; Fishman AJ; Alexiades G; Cohen NL
2000 Mar;21(2):218-225, American journal of otology
HYPOTHESIS: This study was conducted to evaluate the electrode to modiolus proximity of two commonly used electrodes (Nucleus and Clarion) and a new prototype electrode. BACKGROUND: Theoretical advantages of modiolus-hugging cochlear implant electrodes include reduced stimulus energy requirements, more efficient power management and longer battery life, more discreet ganglion cell population stimulation, and reduced facial nerve stimulation. METHODS: Fluoroscopic analysis and histologic surface preparation analysis of electrode position and trauma. RESULTS: The Nucleus straight electrode occupied an outer wall position in the scala tympani. The Clarion electrode occupied a more intermediate position. The actively coiling prototype electrode was modiolus hugging but caused more trauma than the other two electrodes tested. CONCLUSIONS: The optimal modiolus-hugging atraumatic intracochlear electrode does not currently exist
— id: 8521, year: 2000, vol: 21, page: 218, stat: Journal Article,

Bipolar stimulating probe for cochlear nucleus localization in auditory brain stem
Roland JT Jr; Fishman AJ; Cohen NL
Cochlear implants New York: Thieme, 2000,
— id: 2645, year: 2000, vol: , page: 373, stat: Chapter,

Shaw scalpel in revision cochlear implant surgery
Roland JT Jr; Fishman AJ; Waltzman SB; Cohen NL
2000 Dec;185(9):23-25, Annals of otology rhinology & laryngology. Supplement
The use of traditional electrocautery is prohibited in revision or replacement cochlear implant surgery because of the concern for end organ tissue damage. Additionally, electrical current spread to the malfunctioning device could interfere with an accurate cause-of-failure analysis. Clinical reports have confirmed the utility of the Shaw scalpel for dermatologic, ophthalmic, and head and neck surgery. The Shaw scalpel is a thermally activated cutting blade that provides a bloodless field through immediate capillary and small vessel hemostasis. Avoidance of wound and flap complications is of primary concern in cochlear implant surgery. The long-term wound healing compared favorably to that of other surgical cutting instruments in several experimental reports. We have routinely used the Shaw scalpel in revision cochlear implant surgery and in primary surgery whenever electrocautery was contraindicated. We have retrospectively evaluated 22 cases in which the Shaw scalpel was used for cochlear implant revision and primary surgery. The chart review included patient demographics, the indication for surgery, the contraindication for electrocautery, intraoperative surgical notes, the wound healing evaluation, the evaluation for alopecia, and postoperative speech understanding. No significant complications occurred intraoperatively, and the long-term wound healing results were no different from those obtained with conventional surgical techniques. The explanted devices were undamaged, and valuable diagnostic information could be obtained. All patients performed at or better than their preoperative levels on speech recognition testing. Our results indicate that the Shaw scalpel is a relatively safe, easy-to-use, and effective instrument
— id: 23746, year: 2000, vol: 185, page: 23, stat: Journal Article,

Comparison of electrode position in the human cochlea using various perimodiolar electrode arrays
Tykocinski M; Cohen LT; Pyman BC; Roland T Jr; Treaba C; Palamara J; Dahm MC; Shepherd RK; Xu J; Cowan RS; Cohen NL; Clark GM
2000 Mar;21(2):205-211, American journal of otology
OBJECTIVE: This study was conducted to evaluate the insertion properties and intracochlear trajectories of three perimodiolar electrode array designs and to compare these designs with the standard Cochlear/Melbourne array. BACKGROUND: Advantages to be expected of a perimodiolar electrode array include both a reduction in stimulus thresholds and an increase in dynamic range, resulting in a more localized stimulation pattern of the spiral ganglion cells, reduced power consumption, and, therefore, longer speech processor battery life. METHODS: The test arrays were implanted into human temporal bones. Image analysis was performed on a radiograph taken after the insertion. The cochleas were then histologically processed with the electrode array in situ, and the resulting sections were subsequently assessed for position of the electrode array as well as insertion-related intracochlear damage. RESULTS: All perimodiolar electrode arrays were inserted deeper and showed trajectories that were generally closer to the modiolus compared with the standard electrode array. However, although the precurved array designs did not show significant insertion trauma, the method of insertion needed improvement. After insertion of the straight electrode array with positioner, signs of severe insertion trauma in the majority of implanted cochleas were found. CONCLUSIONS: Although it was possible to position the electrode arrays close to the modiolus, none of the three perimodiolar designs investigated fulfilled satisfactorily all three criteria of being easy, safe, and atraumatic to implant
— id: 23752, year: 2000, vol: 21, page: 205, stat: Journal Article,

Early results using the nucleus CI24M in children
Cohen NL; Waltzman SB; Roland JT Jr; Staller SJ; Hoffman RA
1999 Mar;20(2):198-204, American journal of otology
OBJECTIVE: To report early postimplantation speech recognition results in children who received Nucleus CI24M cochlear implants. STUDY DESIGN: The study group consisted of 19 consecutively implanted children. PATIENTS AND SETTING: Congenitally deaf children (20 months to 15 years old) were implanted with the Nucleus CI24M and followed-up at New York University Medical Center for a period of 3 to 12 months. MAIN OUTCOME MEASURES: Speech perception was evaluated preoperatively and postoperatively using the Early Speech Perception (ESP) test, the Glendonald Auditory Screening Procedure (GASP) word and sentence tests, Phonetically Balanced Kindergarten (PBK) monosyllabic word lists, Common Phrases test, the Multisyllabic and Lexical Neighborhood (MLNT, LNT) tests, and the Banford-Kowal-Bench (BKB) sentence test. RESULTS: One-way analyses of variance revealed significant improvement in open-set speech recognition in children able to perform measurement tasks. CONCLUSIONS: The Nucleus CI24M cochlear implant provides significant benefit to children after short-term use
— id: 8517, year: 1999, vol: 20, page: 198, stat: Journal Article,

Cochlear implants: Do they benefit children?
Cohen, NH; Waltzman, SB; Roland, JT
1999 SEP ;104(3):729-730, Pediatrics
— id: 53839, year: 1999, vol: 104, page: 729, stat: Journal Article,

Regulation of melanosome movement in the cell cycle by reversible association with myosin V
Rogers SL; Karcher RL; Roland JT; Minin AA; Steffen W; Gelfand VI
1999 Sep 20;146(6):1265-1276, Journal of cell biology
Previously, we have shown that melanosomes of Xenopus laevis melanophores are transported along both microtubules and actin filaments in a coordinated manner, and that myosin V is bound to purified melanosomes (Rogers, S., and V.I. Gelfand. 1998. Curr. Biol. 8:161-164). In the present study, we have demonstrated that myosin V is the actin-based motor responsible for melanosome transport. To examine whether myosin V was regulated in a cell cycle-dependent manner, purified melanosomes were treated with interphase- or metaphase-arrested Xenopus egg extracts and assayed for in vitro motility along Nitella actin filaments. Motility of organelles treated with mitotic extract was found to decrease dramatically, as compared with untreated or interphase extract-treated melanosomes. This mitotic inhibition of motility correlated with the dissociation of myosin V from melanosomes, but the activity of soluble motor remained unaffected. Furthermore, we find that myosin V heavy chain is highly phosphorylated in metaphase extracts versus interphase extracts. We conclude that organelle transport by myosin V is controlled by a cell cycle-regulated association of this motor to organelles, and that this binding is likely regulated by phosphorylation of myosin V during mitosis
— id: 23749, year: 1999, vol: 146, page: 1265, stat: Journal Article,

A comparison of the growth of open-set speech perception between the nucleus 22 and nucleus 24 cochlear implant systems
Waltzman SB; Cohen NL; Roland JT Jr
1999 Jul;20(4):435-441, American journal of otology
OBJECTIVE: To compare the short-term development of open-set speech perception between implementations of the spectral peak (SPEAK) strategy in adults using the Nucleus 22 (N22) Spectra processor and the Nucleus 24 (N24) system with the SPrint processor. STUDY DESIGN: Two sets of patients with a follow-up period of 3 months were compared. SETTING: This study was conducted at the New York University (NYU) Medical Center. PATIENTS: Thirty-six profoundly hearing-impaired adults were included in this study. INTERVENTION: Sixteen adults received the N22 cochlear implant with the Spectra speech processor and twenty adults received the N24 cochlear implant with the SPrint speech processor. MAIN OUTCOME MEASURES: Open-set speech perception for the patients with N22 implants was evaluated preoperatively and postoperatively using the following measures: NU-6 monosyllabic words, Iowa sentences, and CID sentences. CNC words, CUNY sentences, and HINT sentences were used to assess the patients with N24 implants. RESULTS: Results revealed that the N22 and N24 cochlear implant recipients had significant open-set speech recognition 3 and 6 months after implantation. The apparent favorable absolute scores for the patients with N24 implants were equalized when a multivariate analysis was performed to account for their younger age at time of implantation and shorter length of deafness. CONCLUSIONS: The growth of open-set word and sentence recognition in similar between the N22 and N24 cochlear implants. Longitudinal studies are needed to determine if higher ceiling scores are present in the N24. Further exploration of monopolar versus bipolar stimulation is warranted
— id: 11973, year: 1999, vol: 20, page: 435, stat: Journal Article,

Paradoxical spread of renal cell carcinoma to the head and neck
Gottlieb MD; Roland JT Jr
1998 Sep;108(9):1301-1305, Laryngoscope
OBJECTIVES: To present cases of renal cell carcinoma presenting with only head and neck metastases, to review theories of physiology and anatomy describing this phenomenon, and to discuss the role of the otolaryngologist in the treatment of these lesions. STUDY DESIGN: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases over the 3-year period from 1992 to 1995. METHODS: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases. In addition, English-language literature was reviewed with special focus on the anatomic and physiologic pathways possible to allow for such a phenomenon. CONCLUSIONS: Renal cell carcinoma has an occasional presentation as a head and neck mass without evidence of disease elsewhere. Various routes of spread have been postulated. Batson's venous plexus, as postulated by Nahum and Bailey, is an anatomic route through which emboli could navigate to the head and neck and avoid pulmonary vascular filtration. Interactions on the cellular level may also be responsible for the seemingly paradoxical spread. We recommend local excision of head and neck metastases of renal cell carcinoma without sacrifice of vital structures as a sound treatment regimen
— id: 12073, year: 1998, vol: 108, page: 1301, stat: Journal Article,

Stability of the cochlear implant array in children
Roland JT Jr; Fishman AJ; Waltzman SB; Alexiades G; Hoffman RA; Cohen NL
1998 Aug;108(8 Pt 1):1119-1123, Laryngoscope
OBJECTIVE: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re-evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. STUDY DESIGN: Prospective radiographic analysis of electrode position of cochlear implants in young children. METHODS: Twenty-seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multi-channel cochlear prostheses were subjects for this study. Follow-up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. RESULTS: An analysis of the data revealed no migration of the electrode array over time. CONCLUSIONS: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children
— id: 7765, year: 1998, vol: 108, page: 1119, stat: Journal Article,

Vestibular and auditory ototoxicity
Roland JT; Cohen NL
Otolaryngology head and neck surgery St. Louis : Mosby Year Book, 1998,
— id: 2646, year: 1998, vol: , page: 3186, stat: Chapter,

Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma
Singh B; Bhaya M; Zimbler M; Stern J; Roland JT; Rosenfeld RM; Har-El G; Lucente FE
1998 Jan;20(1):1-7, Head & neck
BACKGROUND: Comorbid conditions have a significant impact on the actuarial survival of patients with head and neck cancer. However, no studies have evaluated the impact of comorbidity on tumor- and treatment-specific outcomes. This study was performed to evaluate the impact of comorbidity, graded by the Kaplan-Feinstein comorbidity index (KFI) on the incidence and severity of complications, disease-free interval, and tumor-specific survival in patients undergoing curative treatment for head and neck cancer. METHODS: A multi-institutional, retrospective cohort of 70 patients 45 years of age and under with head and neck squamous cell carcinoma (SCC) presenting over an 11-year period was studied. RESULTS: Advanced comorbidity (KFI grade 2 or 3) was present in 21 patients (30%). Patients with advanced comorbidity did not differ from patients with low-level comorbidity (KFI grades 0 or 1) in sex distribution, race, presence of human immunodeficiency virus (HIV) infection, tobacco use, location of primary lesion, stage at presentation, pathologic differentiation of the tumor, or type of initial treatment. The overall incidence of treatment-associated complications was similar between the groups (57% versus 49%; p > 0.05), but a higher proportion of patients with advanced comorbidity developed high-grade complications (24% versus 6%; p = .04). The median disease-free interval (11.1 months versus 21.6 months; p = .045) and tumor-specific survival (13.7 months versus 57.6 months; p = .03) was poorer for patients with advanced comorbidity. The effects of comorbidity on survival remained significant even after adjusting for the confounding effects of HIV status and tumor stage (p = .05). CONCLUSIONS: The presence of comorbid conditions has a significant impact on tumor- and treatment-specific outcomes. Although the presence of advanced comorbid conditions is not associated with an increase in the rate of treatment-associated complications, complications tend to be more severe in this population. More importantly, advanced comorbidity has a detrimental effect on the disease-free interval and tumor-specific survival in patients with head and neck cancer, independent of other factors. This suggests that comorbidity may impact on tumor behavior, presumably by altering the host's response to cancer. Accordingly, to be more predictive and reliable, the current staging system for head and neck cancer should include a description of the patient's comorbidity
— id: 23750, year: 1998, vol: 20, page: 1, stat: Journal Article,

Sphenoid cranial base defects in siblings presenting with cerebrospinal fluid leak
Bernstein, J M; Roland, J T; Persky, M S
1997 ;7(4):193-197, Skull base surgery
Two sisters presented to our medical center with nontraumatic cerebrospinal fluid (CSF) fistulas from left sphenoid sinocranial junction defects. One sister had recurrent meningitis over a 20-year period that prompted a skull base evaluation. Four years later, her younger sister presented with profuse CSF rhinorrhea. Transethmoid sphenoidotomy with sinus obliteration and lumbar-subarachnoid temporary CSF diversion successfully treated one sister, while the other required reoperation and permanent lumbar-peritoneal shunting. In both cases the skull base defect was identically located in the posterolateral left sphenoid sinus. Embryological considerations, evaluation and management are presented
— id: 105549, year: 1997, vol: 7, page: 193, stat: Journal Article,

Results of speech processor upgrade in a population of Veterans Affairs cochlear implant recipients
Cohen NL; Waltzman SB; Roland JT Jr; Bromberg B; Cambron N; Gibbs L; Parkinson W; Snead C
1997 Jul;18(4):462-465, American journal of otology
OBJECTIVE: This study aimed to evaluate the change in performance when the Speak processing strategy replaced the Mpeak strategy. SUBJECTS: Twenty-one veterans who participated in the original Department of Veterans Affairs Multicenter Cochlear Implant Study, received the Nucleus F0F1F2 processor (Cochlear Corp., Englewood, CO, U.S.A.) (WSP) and were subsequently upgraded to the Mpeak (MSP) processing strategy. METHODS: Closed- and open-set speech recognition in quiet and in noise in auditory only conditions at the phoneme, word, and sentence levels were evaluated. RESULTS: Changes in audiologic parameters were evaluated using a paired t-test for related samples. Statistically significant improvements in mean scores were found for all tests and were greatest for the speech-in-noise conditions. An examination of individual data revealed that 61% of the subjects improved for tests administered in quiet, whereas up to 69% of the subjects had improved performance in noise. Subjects with no open set speech discrimination using the Mpeak strategy showed no improvement with the Speak strategy. CONCLUSIONS: Cochlear implants can provide improved performance using modifications to external speech processor hardware and software without changing the internal implant
— id: 12307, year: 1997, vol: 18, page: 462, stat: Journal Article,

Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study
Singh B; Bhaya M; Stern J; Roland JT; Zimbler M; Rosenfeld RM; Har-El G; Lucente FE
1997 Nov;107(11 Pt 1):1469-1475, Laryngoscope
Comorbid conditions are medical illnesses that accompany cancer. The impact of these conditions on the outcome of patients with head and neck cancer is well established. However, all of the comorbidity studies in patients with head and neck cancer reported in the literature have been performed using the Kaplan-Feinstein index (KFI), which may be too complicated for routine use. This study was performed to introduce and validate the use of the Charlson comorbidity index (CI) in patients with head and neck cancer and to compare it with the Kaplan-Feinstein comorbidity index for accuracy and ease of use. Study design was a retrospective cohort study. The study population was drawn for three academic tertiary care centers and included 88 patients 45 years of age and under who underwent curative treatment for head and neck cancer. All patients were staged by the KFI and the CI for comorbidity and divided into two groups based on the comorbidity severity staging. Group 1 included patients with advanced comorbidity (stages 2 or 3), and group 2 included those with low-level comorbidity (stages 0 or 1). Outcomes were compared based on these divisions. The KFI was successfully applied to 80% of this study population, and the CI was successfully applied in all cases (P < 0.0001). In addition, the KFI was found to be more difficult to use than the CI (P < 0.0001). However, both indices independently predicted the tumor-specific survival (P = 0.007), even after adjusting for the confounding effects of TNM stage by multivariate analysis. Overall, the CI was found to be a valid prognostic indicator in patients with head and neck cancer. In addition, because comorbidity staging by the CI independently predicted survival, was easier to use, and more readily applied, it may be better suited for use for retrospective comorbidity studies
— id: 23751, year: 1997, vol: 107, page: 1469, stat: Journal Article,

Open-set speech perception in congenitally deaf children using cochlear implants
Waltzman SB; Cohen NL; Gomolin RH; Green JE; Shapiro WH; Hoffman RA; Roland JT Jr
1997 May;18(3):342-349, American journal of otology
OBJECTIVE: To assess and document the development of open-set speech recognition in congenitally deaf children implanted with the Nucleus multichannel cochlear prosthesis at < 5 years of age. STUDY DESIGN: The study group consisted of 38 consecutively chosen children in whom the decision to proceed with implantation had already been made. PATIENTS AND SETTING: Congenitally profoundly deaf children were implanted with the Nucleus multichannel cochlear implant at < 5 years of age and followed at NYU Medical Center for a period of 1-5 years. MAIN OUTCOME MEASURES: Open-set speech perception was evaluated preoperatively and postoperatively using the following: the Glendonald Auditory Screening Procedure (GASP) word subset, the GASP sentence subtest, Phonetically Balanced Kindergarten monosyllabic word lists, Common Phrases test, Multisyllabic Lexical Neighborhood test, and Lexical Neighborhood test. RESULTS: Correlation coefficients were calculated between scores at each interval and age at implantation; one-way analyses of variance were performed independently. Results showed that all subjects had significant open-set speech recognition at the time of the last postoperative evaluation. Thirty-seven of the children use oral language as their sole means of communication. CONCLUSIONS: Multichannel cochlear implants provide significant and usable open-set speech perception in congenitally deaf children given implants at < 5 years of age
— id: 12321, year: 1997, vol: 18, page: 342, stat: Journal Article,

Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery
Fishman AJ; Hoffman RA; Roland JT Jr; Lebowitz RA; Cohen NL
1996 Aug;106(8):1002-1004, Laryngoscope
A retrospective analysis was performed on 174 patients operated on from 1992 to 1995 to evaluate the safety and efficacy of continuous lumbar cerebrospinal fluid drainage (CLCFD) in the management of cerebrospinal fluid (CSF) leaks following acoustic neuroma surgery. There was a 17% incidence of CSF leak. CLCFD stopped the leak in 87% of cases. There were no cases of meningitis associated with CLCFD. One deep vein thrombosis was treated without sequelae. It is concluded that CLCFD is safe and efficacious. The authors recommend that CLCFD be implemented immediately when indicated, foregoing a trial of conservative therapy. Indications and precautions are discussed
— id: 6992, year: 1996, vol: 106, page: 1002, stat: Journal Article,

Complications of tympanostomy tubes in an inner city clinic population
Goldstein NA; Roland JT Jr; Sculerati N
1996 Jan;34(1-2):87-99, International journal of pediatric otorhinolaryngology
While both prophylactic antibiotics and tympanostomy tube insertion have a role in the treatment of recurrent acute otitis media (AOM) and otitis media with effusion (OME) in children previous work has shown that patients in our urban clinic are not compliant with prophylactic antibiotics. Concerned about the potential for decreased compliance in a non-compliant population, we performed a retrospective review to assess the incidence of complications from the insertion of tympanostomy tubes in the same pediatric clinic population. A total of 391 tubes were placed in 165 patients. Follow-up ranged from 0-49.4 months with a mean of 21.3 months. Three ears (1.14%) had persistent perforations. Tympanosclerosis was found in 30 ears (11.1%). No ear showed a chronic retraction or cholesteatoma. Six ears (1.70%) developed postoperative otorrhea. Thirty-five patients had at least one episode of otorrhea outside of the perioperative period, and a total of 60 episodes (19.6% of ears) occurred during the study period. The mean pure tone average prior to tube placement was 25.0 dB, with tubes in place was 2.44 dB and after the last set of tubes had extruded was 6.97 dB. Our study shows that the incidence of complications of tympanostomy tubes was minimal in our inner city clinic population
— id: 56815, year: 1996, vol: 34, page: 87, stat: Journal Article,

Intracranial inverting papilloma
Miller PJ; Jacobs J; Roland JT Jr; Cooper J; Mizrachi HH
1996 Sep-Oct;18(5):450-453, Head & neck
BACKGROUND: Inverting papillomas usually originate from the lateral wall of the nose and sporadically from the ethmoid, maxillary, sphenoid, or frontal sinuses. Intracranial extension and dural penetration is rare and often associated with recurrent disease that has degenerated into squamous cell carcinoma. A case of inverting papilloma with dural penetration in the absence of malignant degeneration has prompted an investigation into the incidence and treatment of dural invasion by benign inverting papilloma. METHODS: A literature search revealed 1468 cases of inverting papilloma. A detailed analysis was performed to obtain data on the incidence of intracranial invasion. RESULTS: Of the 1468 cases, 5 were noted to be associated with intracranial extension without histologic evidence of malignancy (0.34%). Treatment consisted of surgery alone in 3, radiotherapy in 1, and combined therapy in the last patient. Dural invasion was documented histopathologically in one case. CONCLUSION: Intracranial extension and dural penetration of benign inverting papilloma is extremely rare, and a uniform treatment plan has not been established. Further investigation is necessary in the pathophysiology and management of intracranial inverting papilloma
— id: 12554, year: 1996, vol: 18, page: 450, stat: Journal Article,

Clinically unsuspected venous malformations limited to the submandibular triangle: CT findings
Fine MJ; Holliday RA; Roland JT
1995 Mar;16(3):491-494, AJNR. American journal of neuroradiology
PURPOSE: To present the CT characteristics of histologically confirmed venous vascular malformations limited to the submandibular triangle in patients without clinical stigmata of venous vascular malformations. METHODS: The clinical records and CT scans of five women with venous vascular malformations limited to the submandibular triangle were reviewed. Patients ranged from 39 to 70 years of age. None of the patients had a history of malignant tumors. All patients presented with a solitary suprahyoid neck mass. None of the patients demonstrated cutaneous manifestations of venous vascular malformation. RESULTS: Contrast-enhanced CT scans in all five patients demonstrated a lobulated, heterogeneously enhancing, well-circumscribed solid mass, separable from the submandibular gland. Areas of contrast enhancement within each mass were isodense to the internal jugular vein in four of five cases. Only two of five lesions demonstrated focal calcifications. Excisional biopsy (two patients) demonstrated pathologic features compatible with venous vascular malformation. Fine needle aspirations (three patients) yielded venous blood or blood-tinged fluid. CONCLUSIONS: Venous vascular malformations may present as isolated neck masses in adults without typical clinical stigmata. Clues to the CT diagnosis include a lobulated appearance to the mass with intense but heterogeneous contrast enhancement. This appearance, in combination with results of fine needle aspiration, may be sufficiently diagnostic to preclude excisional biopsy
— id: 6616, year: 1995, vol: 16, page: 491, stat: Journal Article,

Autologous fibrin glue in the prevention of cerebrospinal fluid leak following acoustic neuroma surgery
Lebowitz RA; Hoffman RA; Roland JT Jr; Cohen NL
1995 Mar;16(2):172-174, American journal of otology
Postoperative cerebrospinal fluid (CSF) leak is a serious complication of acoustic neuroma surgery. The authors retrospectively reviewed the charts of 492 patients who underwent acoustic neuroma surgery to determine the efficacy of fibrin glue in preventing postoperative CSF leak. Thirteen of 92 patients (14%) undergoing retrosigmoid/transmeatal surgery experienced CSF leak when fibrin glue was used; 29 of 199 patients (15%) when it was not used. Nineteen of 85 patients (22%) experienced CSF leak when fibrin glue was used following translabyrinthine surgery; 23 of 116 patients (20%) when it was not used. No decrease was noted in the incidence of CSF leak following acoustic neuroma surgery with the use of autologous fibrin glue
— id: 6670, year: 1995, vol: 16, page: 172, stat: Journal Article,

Ultrastructural findings in the vestibular end-organs of AIDS cases
Pappas DG Jr; Roland JT Jr; Lim J; Lai A; Hillman DE
1995 Mar;16(2):140-145, American journal of otology
Neurotologic manifestations are apparent in human immunodeficiency virus (HIV) infection, but are poorly understood. Symptoms related to the vestibular system include episodes of vertigo, imbalance, ataxia, and nausea. Although patients present more often with hearing impairment, vestibular complaints are described and electrophysiologic studies indicate vestibular dysfunction in HIV-infected patients. Whether the disease involvement includes the central, or the peripheral nervous system has not been established. Ultrastructural analysis of vestibular end-organs obtained from HIV autopsy cases revealed pathologic changes in the labyrinth wall, the epithelial lining, and the receptor maculae and cristae. Cytologic changes in hair cells included inclusion bodies, viral-like particles, and hair bundle malformations. Epithelial lining cells, supporting cells, and connective tissue cells had inclusions and viral-like particles. These findings are consistent with those of a previous cochlear study demonstrating intracellular viral-like particles with the morphologic characteristics of HIV. Further cytologic evaluation of decalcified temporal bones and immunohistochemical analysis of freshly harvested HIV-infected temporal bones may provide further insight into the pathogenesis of viral-induced hearing loss and vestibular impairment
— id: 6709, year: 1995, vol: 16, page: 140, stat: Journal Article,

Retrofacial approach to the hypotympanum
Roland JT Jr; Hoffman RA; Miller PJ; Cohen NL
1995 Feb;121(2):233-236, Archives of otolaryngology, head & neck surgery
Otologic disease often extends into the hypotympanum, posterior mesotympanum, and infralabyrinthine compartments. Surgical access to these areas can be difficult because of the proximity of the facial nerve. In patients with a normal bone anatomy, these regions can be accessed by a retrofacial approach, which spares the posterior canal wall and avoids transposition of the facial nerve. The anatomy of the hypotympanum, posterior mesotympanum, and infralabyrinthine compartments will be reviewed emphasizing gross anatomic documentation. We will detail the surgical approach to these areas along the retrofacial air cell tract, and will present an appropriate case history
— id: 12806, year: 1995, vol: 121, page: 233, stat: Journal Article,

Effects of glycerin, hyaluronic acid, and hydroxypropyl methylcellulose on the spiral ganglion of the guinea pig cochlea
Roland JT Jr; Magardino TM; Go JT; Hillman DE
1995 Sep;166:64-68, Annals of otology rhinology & laryngology. Supplement
A cochlear lubricant may facilitate the surgeon's ability to place the electrode array deep within the cochlea. Patient performance with the multichannel cochlear implant may be enhanced with a deeper electrode insertion. Theoretically, deeper insertion and stimulation will recruit and activate more surviving spiral ganglion neurons. Several studies have shown that neuron survival is a factor for cochlear implant success, especially in the postmeningitis patient. We studied the histologic and electrophysiologic effects of the intracochlear injection of three potential lubricants in the guinea pig: glycerin, hyaluronic acid, and hydroxypropyl methylcellulose. All three have approved medical uses, reduce friction, and are readily available. Results show that when compared to surgical controls (cochleostomy without injection), there is no significant reduction in the spiral ganglion neuronal count at 2 and 8 weeks postinjection, and the dendrite and axon histology is well preserved. Injection of any of the substances within the cochlea causes severe hearing loss (detected by direct round window electrocochleographic responses to auditory stimuli) that only partially recovers with time. These findings suggest that any of the three tested substances could be considered as lubricants for intracochlear electrode insertion
— id: 7907, year: 1995, vol: 166, page: 64, stat: Journal Article,

Postoperative imaging of the multichannel cochlear implant
Shpizner BA; Holliday RA; Roland JT; Cohen NL; Waltzman SB; Shapiro WH
1995 Aug;16(7):1517-1524, AJNR. American journal of neuroradiology
PURPOSE: To present the postoperative radiographic appearance of the multichannel cochlear implant and to suggest criteria for the radiographic evaluation of postimplant patients. METHODS: One hundred forty-one patients, 73 female and 68 male, had multichannel cochlear implants inserted. One hundred thirty-five intraoperative radiographs, 31 postoperative radiographic examinations, and 10 postoperative CT examinations were retrospectively reviewed. RESULTS: In 135 patients, a Stenver's or anteroposterior projection confirmed the normal placement of the implant by demonstrating the electrodes to be regularly spaced and gently curved within the first turn of the cochlea. The insertion depth was determined by counting the number of electrodes that projected medial to the cochlear promontory. In 5 patients in whom intracochlear placement of the electrode array could not be confirmed on plain radiographs, CT demonstrated the location of the electrode array. In 3 patients with postoperative infections, CT either correctly identified or excluded the presence of a collection beneath the implant. CONCLUSION: Plain radiographs of the temporal bone are sufficient for the postoperative treatment of the majority of postimplant patients. CT should be performed when plain radiographs cannot adequately show the location of the electrode array or if postoperative infection is suspected
— id: 6867, year: 1995, vol: 16, page: 1517, stat: Journal Article,

Management of traumatic facial nerve paralysis with carotid artery cavernous sinus fistula
Roland JT Jr; Hammerschlag PE; Lewis WS; Choi I; Berenstein A
1994 ;251(1):57-60, European archives of oto-rhino-laryngology
Massive skull base injuries require detailed preoperative neurological and neurovascular assessment prior to undertaking surgical repair of isolated cranial nerve deficits. We present the management of a patient with traumatic facial paralysis, cerebrospinal fluid leak, and carotid artery cavernous sinus fistula as the result of a gunshot wound to the skull base. The carotid artery cavernous sinus fistula was ultimately controlled with super-selective embolization via the vertebral artery. The facial nerve injury was then safely treated with mobilization of the labyrinthine and vertical segments to allow a primary anastomosis
— id: 13018, year: 1994, vol: 251, page: 57, stat: Journal Article,

Squamous cell carcinoma in HIV-positive patients under age 45
Roland JT Jr; Rothstein SG; Mittal KR; Perksy MS
1993 May;103(5):509-511, Laryngoscope
Eight patients 45 years of age and under (range, 29 to 45) with squamous cell carcinoma of the head and neck and infection with the human immunodeficiency virus are reported. Primary tumor sites include nasopharynx, oral cavity, oropharynx, and larynx. Probes for the human papillomavirus were positive in two of the patients. Therapy consisted of surgery followed by radiation therapy in five patients, surgery alone in one patient, and radiation therapy in the remaining two patients. Follow-up ranged up to 2 years and revealed four deaths, three patients alive without disease, and one patient recently posttreatment with residual disease. The significance of the presence of the human papillomavirus in these individuals remains to be determined. The incidence of squamous cell carcinoma of the head and neck under age 45 is low, and whether there may be a higher incidence in HIV-positive patients cannot be determined from this small series
— id: 13174, year: 1993, vol: 103, page: 509, stat: Journal Article,

Assessment of families from the deaf community
Roland JT; Miner ID; Sculerati N
1991 ;630:308-309, Annals of the New York Academy of Sciences
— id: 14181, year: 1991, vol: 630, page: 308, stat: Journal Article,