bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Technique of Urethroplasty Could Reduce Urethra-Related Complications in Phalloplasty With Urethral Lengthening
Authors: Gao Hong , Wu Dan , Kong Xiangjing , Zhu Lie , Jie Xiang , Zhang Wenjun , Hu Zheyuan , Zhu Xiaohai
Published: September 2022

Introduction

Urethral lengthening in phalloplasty could bring many postoperative complications, such as urethra fistula and stricture, which greatly affects the patient's mental health and quality of life.

Aim

To describe a novel technique of vaginal mucosal graft for prelamination urethra (VMGPU) combined with modified urethral anastomosis (MUA) for the reconstruction of a neourethra.

Methods

A retrospective study of transgender men between January 2006 and March 2021 was conducted. Patients were divided into three groups according to the surgical methods : traditional group（TG，VMGPU group（VG） and VMGPU+MUA group (VMG).

Main Outcome Measure

The main outcomes measures were demographics, surgical characteristics, complications, International Prostate Symptom Score（IPSS，Quality of Life（QOL） score，and voiding frequency conditions.

Results

Of 80 eligible transgender men（TG:n = 39，VG:n = 31, VMG:n = 10), the urethral fistula developed in 19/39 (49%) patients in TG, 8/31 (26%) in VG, and 1/10 (10%) in VMG (P = 0.034). The urethral stricture formed in 15/39 (38%) patients in TG, 4/31 (13%) in VG, and 1/10 (10%) in VMG (P = 0.028). Compared with TG, the VG got more favorable IPSS. The QOL scores showed that patients in VG or VMG were more satisfied with their postoperative status.

Clinical Implications

VMGPU combined with MUA may help reduce urethral complications for transgender men who wish to undergo phalloplasty with urethral lengthening.

Strength & Limitations

VMGPU combined with MUA focuses on reducing the urethra-related complications in the anastomotic stoma between the fixed and the penile urethra, which has not been noticed in the past. The limitations of this study are that the retrospective study design is prone to bias; the study using VMGPU+MUA technique is only in the preliminary stage, and more cases are needed to prove its effectiveness; the median follow-up in VMG was only 2 years, and longer-term follow-up results are inconclusive; the IPSS, QOL, and the voiding frequency chart were not validated in transgender men.

Conclusion

Our pilot study suggests that VMGPU combined with MUA may reduce the urethra-related complications, especially the urethral fistula in the anastomosis stoma between the fixed and the penile urethra.
Cryopreserved, Irradiated Tracheal Homograft Transplantation for Laryngotracheal Reconstruction in Human Beings
Authors: Kunachak Somyos , Kulapaditharom Boonchu , Vajaradul Yongyudh , Rochanawutanon Mana
Published: September 2022

Subglottic tracheal stenosis is a common clinical entity. Management in severe cases is often problematic. Various techniques for tracheal replacement have been used with varying degrees of success. In this study we used cryopreserved, irradiated tracheal homografts, the use of which in human beings has not been reported previously. In a sterile setup, the tracheas were harvested from donor cadavers within 24 hours of death. The grafts were initially kept at 57°C for 20 minutes; they were then placed in a −70°C chamber for another 2 to 3 days or more and were irradiated to 25 kGy (2.5 million rad). Finally, the grafts were stored at −70°C until usage. Seven patients underwent the surgery, but only 4 are presented here. In the remaining 3 patients, the follow‐up time was too short to be evaluated. Four patients, 2 male and 2 female (aged 2‐40 years, mean 16 years), with severe subglottic tracheal stenosis underwent segmental tracheal graft reconstruction. Immunosuppressant medications were not given to any patient. Follow‐up ranged from 18 to 20 months. Three patients successfully underwent decannulation, and 1 patient had local infection and dislodgment of the intraluminal stent with subsequent restenosis. The postoperative tracheal lumen appeared to be near normal, with histologic evidence of normal respiratory epithelium at the grafted site. In conclusion, cryopreserved, irradiated tracheal homograft transplantation is a valuable alternative for subglottic tracheal reconstruction.
Bone Wax Prevents Nystagmus After Labyrinthine Fenestration in Guinea Pigs
Authors: Brockenbrough John M. , Marzo Sam , Wurster Robert , Young M. Rita I.
Published: September 2022

OBJECTIVE

We examined the effect of 3 methods of closure of labyrinthine fenestrations.

STUDY DESIGN AND SETTING

A guinea pig animal model was developed to examine the effect of 3 methods of closure of labyrinthine fenestrations. These methods included bone wax alone, fascia and fibrin glue, and fascia alone. Nystagmus, a reproducible sign of labyrinthine injury, was chosen as an end point for comparing materials commonly used in human ear surgery.

RESULTS

Animals repaired with bone wax showed no postoperative nystagmus, whereas animals repaired with other materials or that underwent canal fenestration without repair showed 3 to 5 days of postoperative nystagmus.

CONCLUSIONS

Although it is premature to extrapolate our results to human surgery, postoperative nystagmus can be eliminated in guinea pigs by sealing labyrinthine fenestrations with bone wax.

SIGNIFICANCE

Given the intimate relationship between the vestibular and cochlear systems, it is possible that prevention of vestibular irritation might be associated with preservation of cochlear function.
Acyclovir in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss
Authors: Uri Nechama , Doweck Ilana , Cohen‐Kerem Raanan , Greenberg Elhanan
Published: September 2022

BACKGROUND

Idiopathic sudden sensorineural hearing loss (ISSNHL) is a vexing problem that continues to pose a diagnostic and therapeutic enigma for the otologist. The aim of the study, adopting the viral theory, was to discover whether patients with ISSNHL would benefit from early treatment with acyclovir and hydrocortisone compared with patients treated by hydrocortisone alone.

METHODS

Sixty patients with ISSNHL were treated in a prospective controlled randomized manner. Patients were seen within 7 days of onset and were divided randomly into 2 groups. The study group patients were treated with acyclovir and hydrocortisone, whereas those in the control group were treated with hydrocortisone alone.

RESULTS

We compared the 2 groups before and after treatment regarding SRT, mean hearing level at each frequency, speech reception threshold improvement, gender, age, tinnitus, and balance complaints. The overall improvement was 78%.

CONCLUSION

We conclude that there probably is no benefit from the addition of acyclovir in the treatment of ISSNHL.
Bilateral Congenital Absence of Stapes and Oval Window in 2 Members of a Family: Etiology and Management
Authors: Yi Zixiang , Yang Jiangsun , Li Zhichune , Zhou Aidong , Lin Yefen
Published: September 2022

OBJECTIVE

To date, bilateral congenital absence of stapes and oval window in 2 members (brother and sister) of a family has not been reported in the literature. Carhart's notch as one of the indications for the diagnosis of this disease is proposed. The etiology and management of this condition are discussed.

MATERIALS AND METHODS

The older brother and younger sister of a family had severe bilateral hearing loss and concomitant speech disability since early childhood. Their parents are first cousins and have 2 sons and 1 daughter, but the younger son is in good health with normal hearing. No similar disease was found among other relatives. Physical examination showed that the older brother and the younger sister had normal external ears and tympanic membranes. Congenital bilateral absence of stapes and oval window were confirmed by history, audiologic examination, high‐resolution computed tomography scanning, and/or surgery. The modified Lempert's fenestration operation on the horizontal semicircular canal was performed on 1 ear of each patient.

RESULTS

Postoperative hearing threshold was 25 dB for speech frequencies with a gain of 47 dB for the older brother and 28 dB for speech frequencies with a gain of 52 dB for the younger sister. Follow up at 5 to 13 years individually, their hearing gains were steady. Both sister and brother now enjoy a normal life.

CONCLUSIONS

Bilateral congenital absence of stapes and oval window in the 2 family members may be related to inheritance. This report points out Car‐hart's notch as noted in otosclerosis as an important indication for diagnosis of this disease. The modified Lempert's fenestration operation of the horizontal semicircular canal is a safe and good choice for these patients and a better choice than a hearing aid throughout life.
Genioglossus advancement and hyoid myotomy under local anesthesia
Authors: Neruntarat Chairat
Published: September 2022

OBJECTIVE

Obstructive sleep apnea syndrome (OSAS) is a common chronic illness that results in significant morbidity in many patients. Upper airway obstruction of OSAS patients occurring during sleep can appear at multiple sites, including the hypopharynx. Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of hypopharyngeal obstruction have been reported when performed under general anesthesia. However, many patients have difficulty at induction of anesthesia and intubation. Patients are predisposed to specific complications, owing to anatomical abnormalities of the airway and existence of underlying syndrome. The purpose of this study was to assess the safety and efficacy of GAHM for the treatment of OSAS with the patient under local anesthesia.

METHODS

Thirty‐one OSAS patients with hypopharyngeal obstruction underwent GAHM under local anesthesia. The inferior alveolar nerve was blocked. The osteotomized mandibular segment was advanced and turned to lock the inner surface of the mandible and geniotubercle at the outer surface. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 46.2 ± 5.8 years and a body mass index of 28.8 ± 3.2 kg/m2. Most of the patients were male. Data on patients were compared between preoperative and postoperative assessment points. Statistical analysis was performed using Student'sttest.

RESULTS

All patients tolerated the procedure well. The mean follow‐up was 8 months (range, 6 to 10 months). The mean Respiratory Disturbance Index (RDI) decreased from 48.2 ± 10.8 to 14.5 ± 5.8, and the lowest oxygen saturation increased from 81.8 ± 3.8% to 88.8 ± 2.9%. The Epworth Sleepiness Scale score improved from 14.9 ± 2.3 to 8.2 ± 1.7 (P< 0.001), and the snoring scale improved from 8.1 ± 0.6 to 3.4 ± 0.9 (P< 0.001). Postoperative complications included wound dehiscence in 3%, transient dysphagia in 3%, and transient paresthesia of the lower jaw in 6%. Bleeding, infection, and airway obstruction were not observed. Most patients had mild‐to‐moderate pain (visual analog scale, ≤7) for 5 to 7 days after procedures. Responders were defined as OSAS patients who had a reduction in the RDI of ≥50% and an RDI of ≤20 after surgery. By these criteria, 70% of the patients were regarded as having responded to GAHM.

CONCLUSION

Significant reduction in RDI and clinical improvements in snoring and sleepiness were observed after GAHM. It appears to be a safe, inexpensive, and effective procedure that can be performed under local anesthesia with a low chance of complications in carefully selected OSAS patients.
Auditory steady‐state response testing in children: Evaluation of a new technology
Authors: Roberson Joseph B. , O'Rourke Carolann , Stidham Katrina R.
Published: September 2022

OBJECTIVE

The purpose of this study was to evaluate auditory steady‐state responses (ASSR) for determining frequency‐specific hearing impairment and to compare this technology with conventional auditory brainstem responses (ABR).

STUDY DESIGN

The study was a prospective clinical trial. Twenty‐eight pediatric patients ranging in age from 7 to 61 months who were undergoing sedated ABR testing for evaluation of hearing impairment were also evaluated using ASSR. Estimated audiograms of the ASSR are compared with the ABR results.

RESULTS

ASSR estimated audiograms with frequency‐specific information were produced for all patients in whom an ABR recording was obtained. In 20 ears in which an ABR tracing was absent at the maximum level of 90 dB, 13 ears had measurable ASSR thresholds with an average threshold of 98.9 dB at 250 to 8000 Hz.

CONCLUSION

ASSR showed sensitivity equal to that of ABR for individuals with hearing levels (HL) from 0 to 90 dB HL. In patients with hearing impairment greater than 90 dB normal HL (nHL), ASSR showed distinct advantage over ABR testing in that recordings were reliably produced up to 127 dB nHL.
The Biochemical Analysis of Tympanosclerotic Plaques
Authors: Doner Fehmi , Yariktas Murat , Dogru Harun , Uzun Hafize , Aydin Seval , Delibas Namik
Published: September 2022

OBJECTIVE

We conducted a biochemical analysis of tympanosclerotic (TS) plaques.

METHODS

Forty‐five samples containing TS plaques were obtained from 45 patients. Qualitative and quantitative biochemical analyses were performed. TS plaques were evaluated macroscopically in respect to color and structure.

RESULTS

Phosphate, calcium, ammonium, and cholesterol were detected in 44, 43, 35, and 7 samples, respectively. Mean calcium and phosphate levels and protein levels of samples were 2.5 ± 2.6 mg/100 mg tissue, 0.16 ± 0.11 mg, and 3.4 ± 3.4 mg, respectively. TS plaques were dirty white in 20 samples, brunette in 13, yellowish in 4, white in 7, and brown in 1. The structure of TS plaques was hard in consistency in 23 samples, fibrous in 14 samples, and soft in 8 samples.

CONCLUSION

The wider range of values and different mineral contents in our series might be explained by the fact that we had a much larger variety of tissues in various stages of the TS process. The color and the consistency of TS plaques are due to the discrepancy in their content and the amount of mineral, cholesterol, and protein.
New Endoscopic Secondary Tracheoesophageal Voice Prosthesis Placement Technique
Authors: Costa Claudiney C. , Abrahão Marcio , Cervantes Onivaldo , Chagas José F. S.
Published: September 2022

OBJECTIVE

The aim of this study was to present a new technique of secondary vocal prosthesis placement on an outpatient basis without general anesthesia by means of digestive endoscopy.

METHODS

It is a prospective study, 35 laryngectomized patients were sedated with midazolam and underwent digestive endoscopy and tracheoesophageal punch with vocal prosthesis insertion.

RESULTS

A success rate of 94.2% was achieved with this surgical technique. The mean procedure time was estimated at 12 minutes, and no serious complications due to the prosthesis insertion were observed.

CONCLUSION

The advantages of this new technique over the classic technique are lack of use of general anesthesia, performance of procedure on an outpatient basis, lower complication risks (including hemorrhage, mediastinitis, vertebral fracture, esophageal perforation; and minor oropharyngeal, and esophageal mucosal trauma), and direct visualization of the prosthesis in the esophageal lumen.
Anxiety in the First Attack of Vertigo
Authors: Pollak Lea , Klein Colin , Rafael Stryjer , Vera Kossych , Rabey Jose Martin
Published: September 2022

BACKGROUND

Although psychiatric disturbances have been reported in chronic vestibular disorders, little is known about the psychological impact of an acute vertigo attack.

METHODS

We conducted a comparative questionnaire study in 30 patients with a first attack of vestibular dysfunction and in 35 patients with a nonvesicular neurologic deficit of acute onset.

RESULTS

Patients with vertigo reported more anxiety than patients with nonvestibular neurologic deficits (P = 0.002), despite the fact that premorbid anxiety was similar in both groups (P = 0.5). No difference in anxiety levels was found between vertigo patients who vomited and those who were free of vegetative symptoms (P = 0.97). Vertigo patients felt more disabled than nonvertigo patients (P = 0.06), irrespective of the objective restrictions caused by the disease. The rate of depression did not differ between the groups of patients (P = 0.09).

CONCLUSION

Patients with acute vertigo experience extreme anxiety, and this contributes to their feeling of disproportionate disability. The reason for emotional disturbances in vestibular dysfunction is probably the result of physiological connections between the vestibular and limbic system and deserves further neuroanatomic investigation.
Mitomycin‐C in the Postsurgical Ear Canal
Authors: Banthia Vishal , Selesnick Samuel H.
Published: September 2022

OBJECTIVE

Our goal was to evaluate the use of topical mitomycin‐C (MMC) in the prevention of scar tissue formation in the postsurgical external auditory canal (EAC).

STUDY DESIGN AND SETTING

We conducted a prospective pilot study at a tertiary care institution.

METHODS

Six patients with recurrent postoperative granulation tissue after canaloplasty, tympanomastoidectomy, or lateral temporal bone resection were included. MMC (0.5 mg/mL) was applied topically for 5 minutes to the EAC/mastoid cavity.

RESULTS

Outcomes were measured at initial MMC application and 1 and 3 months thereafter using a visual analog scale score based on the degree of EAC occlusion by granulation tissue. Need for debridement of recurrent granulation tissue on follow‐up was noted. Three (50%) patients had improved VAS 1 month after treatment. Two (33%) had improved visual analog scale score at 3 months. Five (83%) required at least one debridement procedure. Repeat MMC application was performed in 2 patients.

CONCLUSION

Topical MMC was ineffective in preventing scar formation in the postsurgical EAC.
Facial F wave recording: A novel and effective technique for extra‐ and intraoperative diagnosis of facial nerve function in acoustic tumor disease
Authors: Wedekind Christoph , Klug Norfrid
Published: September 2022

OBJECTIVE

To investigate the diagnostic yield of facial F wave recording in patients with acoustic neurinomas intraoperatively and extraoperatively.

STUDY DESIGN AND SETTING

Prospective study, comparative evaluation of facial F waves, transcranial magnetic stimulation of the facial motor cortex, blink reflex, and intraoperative online electromyographic activity. The study was performed in the neurosurgical department of a university hospital.

RESULTS

Extraoperatively, only F wave latencies were closely correlated to tumor diameter as an independent variable. Intraoperatively, loss of F waves was specific for the development of a severe to total facial paresis postoperatively. A transient loss of F waves heralds an imminent danger of severe facial dysfunction.

CONCLUSION

Facial F wave recording provides valuable information on the functional status of the nerve intra‐ and extraoperatively.

SIGNIFICANCE

Facial F wave recording should be used as a standard electrodiagnostic technique in addition to transcranial magnetic stimulation and blink reflex recording. It seems particularly useful for intraoperative facial nerve monitoring.
Cost analysis of employing multi‐test allergy screening to guide serial endpoint titration (SET) testing versus SET alone
Authors: Shah Saurabh B. , Emanuel Ivor A.
Published: September 2022

OBJECTIVE

We analyzed the cost differences between 2 different modalities of allergy testing.

STUDY DESIGN AND SETTING

Material costs, labor costs, and overhead expenditures were compared for 2 different allergy‐testing algorithms. Fifty patients were placed in each group. The first group was tested for 14 allergens and 2 control substances by using multi‐test II. These patients were compared with 50 patients tested for similar allergens and control substances by using serial end‐point titration.

RESULTS

The initial round of tests with serial endpoint titration was nearly 3 times as costly as the multi‐test for the 14 allergens and 2 control substances.

CONCLUSION AND SIGNIFICANCE

Multi‐testing is a cost‐effective initial testing modality that can screen out negative results and enable the identification of positive reactions. These results could then be further investigated by using serial endpoint titration or RAST to quantify the patient's sensitivity and establish a starting dose for immunotherapy.
Pharyngeal Flap Surgery: Protocols, Complications, and Outcomes at the University of Iowa
Authors: Canady John W. , Cable Benjamin B. , Karnell Michael P. , Karnell Lucy Hynds
Published: September 2022

OBJECTIVE

We sought to assess complication rates and speech outcomes in patients undergoing pharyngeal flap surgery.

STUDY DESIGN AND SETTING

We conducted a retrospective chart and database review at a tertiary craniofacial center.

PATIENTS

Eighty‐seven patients were identified as having pharyngeal flaps between January 1990 and December 2000.

RESULTS

Complications were rare, with an overall rate of 3.4% for all children. Craniofacial database records were identified with a follow‐up examination between 2 and 5 years. Forty‐four patients were identified. Of this group, 81.8% demonstrated no evidence of hypernasality or mild hypernasality, and 84.1% demonstrated no evidence of hyponasality or only mild hyponasality. Preoperative and postoperative assessments showed a statistically significant difference in hypernasality at P < 0.001 with no significant difference in hyponasality.

CONCLUSIONS

Although sphincter pharyngoplasty procedures have gained a great deal of attention in the recent otolaryngologic literature, pharyngeal‐flap procedures remain a valuable tool in the hands of surgeons dealing with velopharyngeal incompetence. (Otolaryngol Head Neck Surg 2003;129:321–6.)
Normal Features of Tissue‐Engineered Auricular Cartilage by Flow Cytometry and Histology: Patient Safety
Authors: Kamil Syed H. , Woda Marcia , Bonassar Lawrence J. , Novitsky Yuri W. , Vacanti Charles A. , Eavey Roland D. , Vacanti Martin P.
Published: September 2022

BACKGROUND

Cytokinetic abnormalities in DNA content, such as aneuploidy, haploidy, and tetraploidy, have been found to occur in human cartilaginous tumors. The high number of chondrocytes needed for tissue‐engineered cartilaginous implants requires the cells to be passaged repeatedly. The theoretical risk of changes in the normal diploid state of these cells during their growth in vitro and after generation of tissue‐engineered cartilage in vivo is not known.

MATERIALS AND METHODS

Auricular chondrocytes were obtained from 6 patients and cultured in vitro. Chondrocyte number was increased by repeated passaging. The passaged cells were implanted in nude mice for 8 weeks to generate tissue‐engineered cartilage. Fresh control chondrocytes along with the passaged cells and cells obtained from the tissue‐engineered constructs were collected and compared for DNA content by flow cytometry.

RESULTS

Flow cytometry demonstrated 100% diploidy with no evidence of aneuploidy, haploidy, or tetraploidy in all groups of cells. Histology of the tissue‐engineered cartilage also showed no evidence of cellular atypia.

CONCLUSION

The number of human auricular chondrocytes can be increased by repeated passaging and passaged chondrocytes can be safely used for implantation to generate tissue‐engineered constructs without a change in the normal diploid state of the cells. Histology of the cartilage generated showed normal features without atypia. (Otolaryngol Head Neck Surg 2003;129:390–6.)
Classification of Fungal Sinusitis in Immunocompetent Patients
Authors: Uri Nechama , Cohen‐Kerem Raanan , Elmalah Irit , Doweck Illana , Greenberg Elhanan
Published: September 2022

OBJECTIVE

The objective of this study was to review the subgroup classification of fungal sinusitis in immunocompetent patients.

METHODS

The study design included 19 immunocompetent patients with fungal sinusitis who were operated on between 1993 and 1998.

RESULTS

Ten of 19 patients showed a fungus ball. They underwent a limited surgical endoscopic procedure, and no further treatment was needed. Four patients had allergic fungal sinusitis and were treated postoperatively with irrigation, topical steroids, and oral steroids in 2 patients as well. Five patients had chronic sinusitis with significant bone erosion. All 5 underwent an extensive endoscopic procedure and were treated postoperatively by repeated irrigation, endoscopic cleaning, and no antifungal preparation. Two patients of this group are reported broadly.

CONCLUSIONS

Fungal sinusitis in immunocompetent patients is not a rare condition and can be divided into 3 categories: 1) fungus ball, 2) chronic erosive (noninvasive) fungal sinusitis, and 3) allergic fungal sinusitis. The symptomatology, treatment, and prognosis varied significantly among the 3 different categories. (Otolaryngol Head Neck Surg 2003;129:372–8.)
Evaluation of Palatal Snoring Surgery in an Animal Model
Authors: Lafrentz John R. , Brietzke Scott E. , Mair Eric A.
Published: September 2022

OBJECTIVE

We introduce an animal model to reproduce and measure palatal snoring and to assess the effectiveness of cautery‐assisted palatal stiffening operation and injection snoreplasty versus a control (no palatal intervention) on treatment of palatal flutter snoring.

STUDY DESIGN AND SETTING

An anesthetized laboratory canine model uses 2 simultaneous temporary tracheotomies. An inferior tracheotomy is cannulated with an endotracheal tube for ventilation. A superior tracheotomy is cannulated with a tube passed cephalad and seated in the hypopharynx. Negative pressure applied to the upper tube leads to partial collapse of the upper airway with palatal fluttering, and the anesthetized dog snores. Videostroboscopy records palatal flutter frequency before and after surgical intervention. Preoperative and postoperative palatal assessments are made on 15 beagles.

RESULTS

Cautery‐assisted palatal stiffening operation and injection snoreplasty objectively stiffen the canine soft palate with diminished snoring compared with controls.

CONCLUSION AND SIGNIFICANCE

We provide a reproducible animal model to experimentally measure new interventions to treat palatal flutter snoring. (Otolaryngol Head Neck Surg 2003;129:343–52.)
Head and Neck Reconstruction with Anterolateral Thigh Flap
Authors: Mäkitie Antti A. , Nigel J. P. , Neligan Peter C. , Lipa Joan , Gullane Patrick J. , Gilbert Ralph W.
Published: September 2022

OBJECTIVE

Our goal was to present our experience with the free anterolateral thigh flap for reconstruction of various cutaneous and mucosal defects of the head and neck.

STUDY DESIGN

We conducted a retrospective review of 37 patients who underwent reconstruction between 1994 and 2002. Outcome measures included ethnicity, flap harvest technique, vascular anatomy, flap success, general surgical complications, and donor site morbidity.

RESULTS

The majority of our patients were white (n = 33). The size of the 39 free anterolateral thigh flaps varied from 24 to 252 cm2. There was 1 arterial failure and flap loss (2.6%) and 2 venous occlusions that were both salvaged. The donor site was closed primarily in 37 cases and with a split‐thickness skin graft in 2 cases.

CONCLUSIONS

This is the first report on using the free anterolateral thigh flap in whites. This free transfer has proved to be a versatile and reliable flap for reconstruction of the head and neck.
Resolution of Facial Stimulation in Otosclerotic Cochlear Implants
Authors: Rayner Mark G. , King Timothy , Djalilian Hamid R. , Smith Sharon , Levine Samuel C.
Published: September 2022

OBJECTIVES

We examined the incidence of facial nerve stimulation in a population of patients with otosclerosis implanted with the Nucleus 22, Clarion 1.2, or Clarion High Focus (CHF) device.

STUDY DESIGN AND SETTING

A retrospective chart review was used for 147 patients who had been implanted with electronic cochlear devices at the University of Minnesota between June 1986 and February 2001. Seventy‐four patients were implanted with the Nucleus 22, 41 patients were implanted with the Clarion 1.2 (without a positioner), and 32 patients were implanted with the CHF I or II.

RESULTS

Eleven (14.9%) of the 74 patients implanted with the Nucleus 22 device had facial stimulation. There were 9 patients with otosclerosis. Seven (78%) of the 9 patients with otosclerosis had facial stimulation. One (2.4%) of the 41 patients implanted with the Clarion 1.2 device (without a positioner) had facial stimulation and that 1 (100%) patient in the group had otosclerosis. There were 4 patients in the CHF group with otosclerosis. One patient experienced stimulation, but it was possible to decrease maximum current levels and still use the electrode pair.

CONCLUSION

Facial stimulation appears to be less problematic in patients with otosclerosis implanted with the CHF devices.
Clinical Predictors of Long‐Term Success After Endoscopic Sinus Surgery
Authors: Dursun Engin , Korkmaz Hakan , Eryilmaz Adil , Bayiz Ünal , Sertkaya Durdu , Samim Erdal
Published: September 2022

OBJECTIVE

Determining the clinical predictors of long‐term success after endoscopic sinus surgery (ESS) would better guide the management of patients.

METHODS One hundred‐thirty chronic rhinosinusitis (CRS) patients were evaluated retrospectively. Overall subjective improvement was 83% with a mean follow‐up of 60 months. Eighty percent had anatomic variations; 36.2%, allergy; 55.4%, nasal polyps; and 26.9%, history of previous operation. The improvement was 100%, 94%, 79.5%, and 69.7% in stages 0, I, II, and III, respectively. With other parameters, the success rates were 68.1% and 91.6% with and without allergy, 73.6% and 94.8% with and without polyps, 54.3% and 93.7% with and without previous history of surgery, 84.4% and 82.7% with and without anatomic variations, and 23.8% and 94.4% with and without recurrent polyps.

CONCLUSION

In multivariate Cox regression analysis, allergy (P < 0.05; relative risk, 4.6) and previous polypectomy (P < 0.05; relative risk, 9.9) were found to be predictors of poor prognosis in the long‐term follow‐up.
Ketoprofen for Postoperative Pain After Uvulopalatopharyngoplasty and Tonsillectomy: Two‐week Follow‐up Study
Authors: Nikanne Elina , Virtaniemi Jukka , Aho M. , Kokki Hannu
Published: September 2022

OBJECTIVE

In our previous study, we reported that both uvulopalatopharyngoplasty (UPPP) and tonsillectomy are associated with unacceptable intense pain during the first 24 hours after surgery. To investigate the pain progression at home, we followed the same 53 patients for 14 days after surgery. Twenty‐two patients underwent tonsillectomy and 31 patients underwent UPPP.

STUDY DESIGN

A prospective, longitudinal, parallel‐group study was conducted.

METHODS

Beginning on the first postoperative day, the patients were allowed to use 50 mg ketoprofen capsules at a dosage of 5 mg/kg/24 hr. The patients evaluated their own pain four times a day for the first 5 days. Two weeks after the surgery during a follow‐up visit patients reported the present pain; and a total consumption of analgesics, and all adverse events for 14 days.

RESULTS

Patients in both study groups had significant pain, especially in the morning, for the first week after surgery. In half of the patients, severe pain interfered with eating and sleeping, and in one third of the patients, the pain lasted 2 weeks or longer. The need for ketoprofen was significantly higher after UPPP than that after tonsillectomy (P = 0.001). One patient after tonsillectomy and 3 patients after UPPP needed electrocautery to stop secondary bleeding.

CONCLUSIONS

Both UPPP and tonsillectomy are associated with intense postoperative pain. Standard ketoprofen capsules are too short‐acting to ensure undisturbed sleep.
Consumption of a High‐Galactose Diet Induces Diabetic‐Like Changes in the Inner Ear
Authors: Raynor Eileen , Robison W. Gerald , Garrett C. Gaelyn , McGuirt Wyman T. , Pillsbury Harold C. , Prazma Jiri
Published: September 2022

Diabetes mellitus is a disease that affects multiple organ systems. In our laboratory it has been shown that there is a significant loss of outer hair cells in genetically diabetic rats. Galactosemia can also produce diabetic‐like changes. This study was performed to demonstrate whether these changes also occur in the cochlea. Three groups of Sprague‐Dawley rats were used and fed either a control diet, a 50% galactose diet, or a 50% galactose diet with the addition of an aldose reductase inhibitor. After 6 months the animals were killed, and the cochleas were removed, fixed, and stained. Diabetes‐induced damage was assessed by counting the hair cells and calculating the neuroganglion cell density. The histopathologic changes induced by galactose were manifested as outer hair cell loss and a decrease in neuroganglion cell density. Control animals had the least amount of hair cell loss and the greatest neuroganglion cell density of all three groups. Galactose‐only animals demonstrated the most pronounced changes in both hair cell loss and neuroganglion cell degeneration; however, only changes of neuroganglion cell density in the basal turn were significant. The addition of an aldose reductase inhibitor provided inconclusive results in both hair cell determination and neuroganglion cell density; however, generally the inhibitor partially prevented the damage produced by galactose. These results suggest that a high‐galactose diet can induce diabetic‐like changes in the cochlea.
An Investigation of Acute Facial Paralysis in Animals Induced by Exposure of the Tympanic Membrane to Cold Air
Authors: Zealear David L. , Bryant Grady L. , Logan Mark B. , Schwaber Mitchell K.
Published: September 2022

The goal of this investigation was to test the hypothesis that tympanic membrane exposure to cold air is a cause of acute facial palsy. A series of acute invasive experiments and a series of chronic noninvasive experiments were conducted in both cats and dogs. In the acute studies, stimulation was applied intracranially to the facial nerve root through a stereotaxically placed microelectrode and recordings of compound action potentials obtained extracranially from the facial nerve. Nerve conduction was monitored continuously during the application of cold air to the tympanic membrane. Nerve conduction disturbances were observed in all animals tested (8), and reduction in compound action potential amplitude ranged from 33% to 96%. Histologic analysis of the infratemporal portion of the facial nerve was performed in the animal exhibiting the greatest block in conduction, representative of a near‐total paralysis. Axon swelling, demyelinization, and degeneration (Bungner's bands) without inflammation were apparent along the entire tympanic membrane segment. Interstitial swelling of nerve endoneurium was also present at the second genu and vertical segment. In the chronic studies, animals were exposed to cold air and monitored daily for facial paralysis after recovery from anesthesia. None of the animals demonstrated any detectable behavioral facial paralysis.
Sound Pressure Gain Produced by the Human Middle Ear
Authors: Kurokawa Hironobu , Goode Richard L.
Published: September 2022

The acoustic function of the middle ear is to match sound passing from the low impedance of air to the high impedance of cochlear fluid. Little information is available on the actual middle ear pressure gain in human beings. This article describes experiments on middle ear pressure gain in six fresh human temporal bones. Stapes footplate displacement and phase were measured with a laser Doppler vibrometer before and after removal of the tympanic membrane, malleus, and incus. Acoustic insulation of the round window with clay was performed. Umbo displacement was also measured before tympanic membrane removal to assess baseline tympanic membrane function. The middle ear has its major gain in the lower frequencies, with a peak near 0.9 kHz. The mean gain was 23.0 dB below 1.0 kHz, the resonant frequency of the middle ear; the mean peak gain was 26.6 dB. Above 1.0 kHz, the sound pressure gain decreased at a rate of −8.6 dB/octave, with a mean gain of 6.5 dB at 4.0 kHz. Only a small amount of gain was present above 7.0 kHz. Significant individual differences in pressure gain were found between ears that appeared related to variations in tympanic membrane function and not to variations in cochlear impedance.
Liposuction‐assisted excision of cervicofacial lipomas
Authors: Calhoun Karen H. , Bradfield Joseph J , Thompson Christopher
Published: September 2022

A technique is described for use of liposuction‐assisted removal of even large lipomas through small Skin incisions.
Positron emission tomography in the detection of residual laryngeal carcinoma
Authors: Austin John R. , Wong Franklin C. , Kim E. Edmund
Published: September 2022

Positron emission tomography measures the metabolic activity of tissue. Because metabolism rates are higher in tumors than in normal tissue, positron emission tomography can be used to identify abnormal tissue. Positron emission tomography has proved useful in detecting residual or recurrent tumor in the brain and gastrointestinal tract after definitive treatment. We selectively used positron emission tomography in a preliminary trial to examine patients with laryngeal cancer who had previously been treated with organ‐preservation therapy with radiation therapy alone or in combination with induction chemotherapy. These patients are often difficult to examine both clinically and radiographically because of posttreatment edema and fibrosis. From 1991 to 1993 patients at our institution who were treated with either radiation therapy or a combination of induction chemotherapy and radiotherapy for laryngeal carcinoma were evaluated after treatment. If clinical examination was suspicious for residual tumor or recurrence, a computed tomography or magnetic resonance imaging scan was obtained. In 10 patients neither clinical examination nor conventional imaging could absolutely rule out residual/recurrent carcinoma. In these patients positron emission tomography with 2‐fluoro‐2‐deoxy‐D‐glucose was used to detect disease. The results from positron emission tomography were compared with the results from subsequent biopsy (five patients) or clinical follow‐up. Positron emission tomography had a sensitivity of 67% and a specificity of 57%. The positive predictive value of positron emission tomography was 67%. The negative predictive value of positron emission tomography was 80%. Positron emission tomography may offer the clinician a useful diagnostic tool for cancer surveillance in organ‐sparing treatment protocols for patients with laryngeal cancer.
Acoustic neuroma (vestibular schwannoma): Growth and surgical and nonsurgical consequences of the wait‐and‐see policy
Authors: Charabi Samih , Thomsen Jens , Mantoni Margit , Charabi Birgitte , Bjarne J⊘rgensen , Sven Erik B⊘rgesen , Gyldensted Carsten , Tos Mirko
Published: September 2022

A prospective study of the consequences of the wait‐and‐see policy in patients with neuroradiologic diagnostic evidence of having vestibular schwannoma was conducted in a series of 123 patients (127 tumors) over a 20‐year period, from 1973 to 1993. The mean follow‐up period was 3.4 years, mean annual growth rate was 3.2 mm/year, mean annual volume growth rate was 0.72 ml/year, and mean annual relative growth rate was 41%. Tumor growth was observed in 90 (74%) patients (94 tumors), no growth was seen in 23 (18%) patients (23 tumors), and negative tumor growth was seen in 10 (8%) patients (10 tumors). Surgery due to tumor growth was performed in 35 (28%) patients (35 tumors), 7 (6%) patients (7 tumors) were treated with γ‐radiation and/or shunt insertion, 7 (6%) patients died of brain stem herniation induced by tumor compression, 9 (7%) patients died of non‐tumor‐related causes, 28 patients were classified as candidates for hearing preservation surgery, and 21 (75%) patients lost their candidacy during the observation period due to tumor growth and/or deterioration of hearing. The results may limit indications for allocation of patients with vestibular schwannoma to the wait‐and‐see group.
Brain stem auditory evoked potentials: Effects of ovarian steroids correlated with increased incidence of bell's palsy in pregnancy
Authors: David Yaacov Ben , Tal Joseph , Podoshin Ludwig , Fradis Milo , Sharf Mordecai , Pratt Hillel , Faraggi David
Published: September 2022

To investigate the effect of ovarian steroids on the brain stem during changes of estrogen and progesterone blood levels, we recorded brain stem auditory evoked potentials with increased stimulus rates from 26 women treated for sterility by menotropins (Pergonal and Metrodin). These women were divided into three groups according to their estrogen and progesterone blood levels. The brain stem auditory evoked potential results revealed a significant delay of peak III only, with an increased stimulus rate in the group with the highest estrogen level. Estrogen may cause a brain stem synaptic impairment, presumably because of ischemic changes, and thus also may be responsible for a higher incidence of Bell's palsy during pregnancy.
Presence of human papillomavirus predicts ecurrence of inverted papilloma
Authors: Beck Jill C. , Mcclatchey Kenneth D. , Lesperance Marci M. , Esclamado Ramon M. , Carey Thomas E. , Bradford Carol R.
Published: September 2022

Recent evidence suggests that human papillomavirus may play a role in the pathogenesis of inverted papilloma, a benign but locally aggressive neoplasm with a high recurrence rate and an association with squamous cell carcinoma. Histologic features of inverted papilloma have not been useful in discriminating lesions at high risk for recurrence. We studied archival pathology specimens from 32 patients with inverted papilloma treated at the University of Michigan between 1980 and 1994 with polymerase chain reaction techniques and human papillomavirus E6 and L1 consensus primers. Twenty (63%) specimens tested positive for human papillomavirus. The clinical status of the remaining 25 patients was reviewed after seven patients with recent diagnosis or who were lost to follow‐up were excluded. A significant association was identified between the presence of human papillomavirus DNA in inverted papilloma and recurrence after surgical excision. Thirteen of 15 patients whose tumors tested positive for HPV recurred, whereas none of the 10 patients whose tumors were human papillomavirus negative recurred (p < 0.00002). This strongly suggests that the presence of human papillomavirus predicts recurrence of inverted papilloma.
Vestibular adaptation exercises and recovery: Acute stage after acoustic neuroma resection
Authors: Herdman Susan J. , Clendaniel Richard A. , Mattox Douglas E. , Holliday Michael J. , Niparko John K.
Published: September 2022

The use of exercises in the treatment of patients with vestibular deficits has become increasingly popular, and evidence exists that these exercises are beneficial in patients with chronic vestibular deficits. The question as to whether patients with acute unilateral vestibular loss would benefit from vestibular adaptation exercises is particularly compelling, however, because animal studies have demonstrated that the acute stage after unilateral vestibular loss is a critical period for recovery. Deprivation of visuomotor experience during that period can delay the onset of recovery as well as prolong the recovery period. Patients often avoid movement during the early stage because, with movement, they experience an increase in dysequilibrium and nausea. We examined the recovery of postural stability in patients during the acute stage after resection of acoustic neuroma to determine whether vestibular adaptation exercises facilitate the onset of recovery and improve the rate of recovery. The results suggest that vestibular adaptation exercises result in improved postural stability and in a diminished perception of dysequilibrium.
Immunologic defects in patients with chronic recurrent sinusitis: Diagnosis and management
Authors: Sethi Dharambir S. , Winkelstein Jerry A. , Lederman Howard , Loury Mark C.
Published: September 2022

Twenty patients with chronic refractory sinusitis or rhinitis were identified to have immune defects on the basis of total immunoglobulin level, immunoglobulin G subclass, and vaccine response. Eight patients were immunoglobulin A deficient, five had low immunoglobulin levels with vaccine hyporesponse, and four had low immunoglobulin levels with normal vaccine responses. Three subjects showed isolated immunoglobulin G1 deficiency. Demographic variables such as age, sex, infection pattern, and any other related disorders were studied retrospectively, which may have contributed to the diagnosis. An immunologic screen was essential for the diagnosis of immunodeficiency in these patients. Treatment options included prophylactic antibiotics, management of associated allergies, functional endoscopic sinus surgery, and replacement therapy with immunoglobulin in selected patients.
Identification of problem foods using food and symptom diaries
Authors: Kueper Theodore , Martinelli Dean , Konetzki Wayne , Stamerjohn Ralph W. , Magill Jeanne B.
Published: September 2022

Food and symptom diaries were used to identify problem foods for each of 164 patients with chronic medical problems such as headache, fatigue, congestion, abdominal pain, and sinus problems. A statistical analysis related the total load of 90 biologic families, as well as caffeine, alcohol, and lactose, to changes in symptom intensity during a 2‐week diary. The results helped 75% of the patients when used as a guide for elimination diets. Open challenges confirmed 47% of the identified food components. This study required a database and software to estimate recipe components for an average of 243 foods per patient. The analysis of each patient's diary produces a main report that lists suspect food components for each symptom. The report lists components in decreasing order of statistical confidence and gives lag times between food ingestion and symptom change. This report also shows the initial direction of the symptom change as a direct or masking effect. Foods that appear “safe“ or unrelated to the symptoms are also listed. A second report lists the patient's food sources for each of the suspected food components. The report shows the percentage contribution of source foods and is useful for patient education and the design of elimination diets.
Evaluation of vestibular and visual oculomotor function
Authors: Demer Joseph L.
Published: September 2022

The visual system interacts synergistically with the vestibular system. A normally functioning vestibulo‐ocular reflex is necessary but not sufficient for optimum visual acuity during head motion. Studies of dynamic visual acuity, the acuity achieved during relative motion of visual targets or of the observer, indicate that motion of images on the retina markedly compromises vision. The vestibulo‐ocular reflex normally provides a substantial measure of stabilization of the retina during head movements, but purely vestibular compensatory eye movements are not sufficiently precise for optimal vision under all circumstances. Other mechanisms, including visual tracking, motor preprogramming, prediction, and mental set, interact synergistically to optimize the gain (eye velocity divided by head velocity) of compensatory head movements. All of these mechanisms are limited in their capacity to produce effective visual‐vestibular interaction at higher rotational frequencies and velocities. It is under these conditions that vestibular deficits give rise to symptoms of oscillopsia. Patients having vestibular lesions exploit mechanisms of visual‐vestibular interaction to compensate by substitution for deficient vestibular function. Thus, for accurate topographic clinical diagnosis of vestibular lesions, testing conditions should isolate purely vestibular responses. This may be done by testing reflex eye movements during passively generated rotations in darkness, or perhaps by testing during other types of motion under conditions of extreme frequency and velocity sufficient to attenuate the effects of visual‐vestibular interaction. This article reviews clinical tests of vestibular function in relation to synergistic interactions with vision.