The effect of insomnia on tinnitus.

OBJECTIVE: The objective is to see how chronic tinnitus sufferers who are unmanageable to maximized medical therapy can benefit by decreasing their subjective complaints from a sleep evaluation and treatment. However, the proper identification of these particular patients has not been described well in the literature when attempting to correlate these 2 diagnoses. Thus, tinnitus patients with and without insomnia, based on ICD-9 diagnosis, were evaluated using the Tinnitus Reaction Questionnaire and Insomnia Severity Index to determine correlations between insomnia and tinnitus. METHODS: Patients with a diagnosis of tinnitus and tinnitus along with insomnia who were treated at our institution from 2009 to 2011 were identified. Tinnitus Reaction Questionnaire and Insomnia Severity Index responses were obtained through written and telephone interviews. A Pearson product moment correlation was used to determine the effect of insomnia on tinnitus. Additional analyses identified whether Tinnitus Reaction Questionnaire scores were associated with a possible benefit from an evaluation for insomnia in tinnitus patients. RESULTS: A total of 117 patients met inclusion criteria. A significant correlation was found between the Insomnia Severity Index score and Tinnitus Reaction Questionnaire severity (r = 0.64; P = .001). Tinnitus Reaction Questionnaire severity was shown to be a good predictor of sleep disturbance and good in predicting group association, especially the "emotional" subscore component (sensitivity 96.9% and specificity 55.3% for identifying tinnitus patients with insomnia). The greater the insomnia disability as exhibited by an elevated Insomnia Severity Index score, the more severe the patient's complaints were regarding the tinnitus. CONCLUSION: Results suggest that if the emotional score on the Tinnitus Reaction Questionnaire is ≥ 15, the Insomnia Severity Index may be useful to identify patients who may benefit from further treatment and evaluation of insomnia. The robust correlation between the Tinnitus Reaction Questionnaire and Insomnia Severity Index objectively showed that patients with insomnia have an increased emotional distress associated with their tinnitus. Both questionnaires can be used together with a high degree of specificity and sensitivity in predicting tinnitus patients with an underlying sleep disturbance.

The subcutaneous melolabial island flap for nasal alar reconstruction: a clinical review with nuances in technique.

OBJECTIVES/HYPOTHESIS: To describe our experience with surgical reconstruction of whole subunit nasal alar skin losses following Mohs ablative surgery, using a subcutaneous melolabial island flap with emphasis on a simplified technique to minimize facial scarring and optimize facial contour. STUDY DESIGN: Retrospective review of case series. METHODS: A single surgeon's results in 48 consecutive patients spanning 7 years were analyzed by comprehensive chart review. Details of wound site and flap-specific complications were noted. Favorable nuances in surgical technique differing from standard approaches are graphically described. RESULTS: Loss of melolabial sulcal depth was the most commonly seen donor-site complication (8%). No cases of flap compromise were seen. An unexpectedly high frequency of subjective nasal obstruction was seen (37%) after the second stage, more common when cartilage grafts were underutilized, and with through-and-through defects at inception. External contour was uniformly good to excellent. CONCLUSIONS: The described variation in subcutaneous melolabial island flap transfer provides reliable soft tissue replacement for whole subunit alar skin losses with favorable donor-site scarring and resultant contour. Attention to proper utilization of supportive cartilage grafts and ancillary debulking procedures is often necessary to optimize functional outcomes.

Aesthetic parotid surgery: evolution of a technique.

OBJECTIVES/HYPOTHESIS: Described is a technique adopted for surgical management of benign parotid neoplasms with an emphasis on facial reconstruction and prevention of postparotidectomy sequelae. STUDY DESIGN: Observation/surgical technique. METHODS: Patients chosen in the last 10 years with benign parotid neoplasms with the application of this technique. RESULTS: In over 150 cases of benign parotid neoplasms performed in the last 10 years by the senior author using this technique, no cases of clinically significant Frey syndrome were identified. Two cases of marginal nerve paresis transpired, but spontaneously resolved within several months. No cases of postoperative hematoma, wound infection, salivary fistula, or hypertrophic scar formation were noted. Subjectively, patient satisfaction was uniformly high relating to scar appearance and facial contour. There have been no local recurrences to date despite six cases of nonviolated tumor capsule abutting the resection margin. CONCLUSIONS: The application of a superficial musculoaponeurotic system-platysma flap can alleviate the depression in the retromandibular region following superficial parotidectomy for moderately sized benign neoplasms. It has also shown to help prevent postparotidectomy sequelae of Frey syndrome.

Synthesis and aggregation behavior of thermally responsive star polymers.

To mimic the three-dimensional (3-D) globular architecture resulting from the precise positioning of hydrophobic/hydrophilic domains (blocks) of naturally occurring proteins, water-soluble linear and star homopolymers of N,N'-dimethylacrylamide (DMA) were synthesized with prescribed molecular weights via reversible addition-fragmentation chain transfer (RAFT) polymerization and subsequently used as macro chain transfer agents for block copolymerization with N-isopropylacrylamide (NIPAM). For the star block copolymers, the interior block consisted of NIPAM while the exterior block was DMA. Since polyNIPAM thermally switches from hydrophilic to hydrophobic, the 3-D solution conformations of the polymers were studied as a function of temperature using differential scanning calorimetry (DSC), static light scattering (SLS), and dynamic light scattering (DLS). The polymers were observed to form monodisperse aggregates in an aqueous pH 4 buffer solution when heated above the lower critical solution temperature (LCST) of polyNIPAM. The temperature at which the polymers aggregated and the size of the aggregates were dependent on the NIPAM block length and the core architecture. A simple model based on an optimal area per headgroup was used to analyze our experimental findings and was useful for predicting the final size and molecular weight of the aggregates formed.