There is growing otologic interest in treating inner ear disorders, such as sudden sensorineural hearing loss and acute or unremitting Meniere's disease, with intratympanic dexamethasone (IT-DEX). Although anecdotally reported, there are no scientific clinical papers and few prior laboratory research publications on the subject. This study compares perilymph dexamethasone concentrations after systemic and intratympanic administration and assesses the role of 3 potential transport facilitators of IT-DEX into perilymph. Forty guinea pigs (79 ears) were randomly separated into 5 groups. Dexamethasone levels were measured by radioimmunoassay. IT-DEX resulted in higher perilymph steroid levels than intravenous dexamethasone (P < 0.05). Histamine facilitator resulted in significantly higher perilymph steroid levels than IT-DEX alone (P < 0.05). Neither hyaluronic acid nor dimethylsulfoxide was a potent facilitator. This study demonstrates that IT-DEX administration results in superior perilymph levels within 1 hour of administration and does not result in systemic absorption. Histamine is a potent facilitating agent. The clinical implications are considerable.

No abstract

There is growing otologic interest in treating inner ear disorders, such as sudden sensorineural hearing loss and acute or unremitting Meniere's disease, with intratympanic dexamethasone (IT-DEX). Although anecdotally reported, there are no scientific clinical papers and few prior laboratory research publications on the subject. This study compares perilymph dexamethasone concentrations after systemic and intratympanic administration and assesses the role of 3 potential transport facilitators of IT-DEX into perilymph. Forty guinea pigs (79 ears) were randomly separated into 5 groups. Dexamethasone levels were measured by radioimmunoassay. IT-DEX resulted in higher perilymph steroid levels than intravenous dexamethasone (P < 0.05). Histamine facilitator resulted in significantly higher perilymph steroid levels than IT-DEX alone (P < 0.05). Neither hyaluronic acid nor dimethylsulfoxide was a potent facilitator. This study demonstrates that IT-DEX administration results in superior perilymph levels within 1 hour of administration and does not result in systemic absorption. Histamine is a potent facilitating agent. The clinical implications are considerable.

Robotic surgery will likely become an integral part of otolaryngologic surgical practice. Training programs in robotic surgery need to be formally established in residency programs. We present a preliminary program for introducing robotic surgical skills in residency training.

Seven Otolaryngology residents at the UMDNJ residency program participated (all the PGY 2 -PGY 5 residents in the program except the first author who had previous experience using the dVSS). An interactive teaching module ( Figure 5) was designed and fabricated. This module tested the following tasks: 1) simultaneous bimanual carrying, 2) circular pin transfer, 3) precision bead drop, 4) suture tying, and 5) needle passing. Performance of these tasks was recorded and the proficiency of the resident rated based on time needed, and number of errors made. Prior to beginning the teaching module, each participant received a verbal explanation about the use of the dVSS and each specific task. No participants practiced any of the prearranged tasks. Five tasks were performed by each participant. Each task was completed three times. The performance was observed, video recorded and reviewed by one of the authors (J.M.), Each participant earned a composite score for each trial on each task.

Objective: To determine the effect of surfactant alone and with other medications delivered intranasally as a metered dose inhaler (MDI) aerosol on the resolution of experimentally induced otitis media with effusion (OME). Background: Eustachian tube dysfunction is a primary factor in the pathogenesis of OME. Intranasal surfactant via MDI has been shown in this laboratory to reduce passive opening pressure of the eustachian tube in normal gerbils and mice. Study Design: OME was developed in 35 gerbils by transtympanic injection of 10 g lipopolysaccharide from Klebsiella pneumoniae. Pretreatment otomicroscopy and tympanometry were performed to exclude pre-existing middle ear disease, and postinfection evaluations were performed on alternate days for a period of 30 days. Five animals received no treatment (control group); four were treated with propellant only (placebo); seven received surfactant alone; eight received surfactant and betamethasone; and six received surfactant with phenylephrine. All medications were sprayed intranasally as an aerosolized MDI and administered daily from postinfection day 2 onward. Results: OME resolved after 16.0 ؎ 0.44 days (mean ؎ SD) in controls. There was no difference seen in the placebo or the surfactant with phenylephrine groups. Treatment with surfactant yielded resolution in 10.57 ؎ 0.37 days; this was reduced to 8.57 ؎ 0.37 days with surfactant plus betamethasone. These differences are statistically significant. There was no recurrence of OME in any group. Conclusion: This study demonstrates that using an aerosolized MDI surfactant with and without betamethasone decreases the duration of OME in this in vivo gerbil model. Key Words: Surfactant, otitis media with effusion, gerbil, aerosolized metered dose inhaler, eustachian tube dysfunction.

Autonomy, job satisfaction, and quality improvement for advanced practice nurses are fostered by a review process that defines roles and competencies specific to advanced nursing practice. Peer review, a concept contributing to this process is explored as a means to monitor and improve practice.

Intranasal metered dose inhaler aerosolized surfactant is effective in reducing eustachian tube passive opening pressure.