bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Comorbidity in Patients With Head and Neck Cancer
Authors: Hall Stephen F. , Rochon Paula A. , Streiner David L. , Paszat Lawrence F. , Groome Patti A. , Rohland Susan L.
Published: November 2003

Background Comorbidities are diseases or conditions that coexist with a disease of interest. The importance of comorbidities is that they can alter treatment decisions, change resource utilization, and confound the results of survival analysis.

Objective The objective of this study was to determine the best comorbidity index to use in survival analysis of patients with squamous cell carcinoma of the head and neck.

Method Four validated indexes, with very different methodologies (i.e., the Charlson Index, the Cumulative Illness Rating Scale, the Kaplan‐Feinstein Classification, the Index of Co‐existent Disease), were tested using data from 379 unselected consecutive patients with complete 3‐year follow‐up from the Kingston Regional Cancer Center. Kaplan‐Meier analysis and Cox Proportional Hazards Regression were used to stratify patients into three levels of increasing severity of comorbidity for each index. The Proportion of Variance Explained and Receiver Operating Characteristics curves were used to compare the performance of the indexes.

Conclusion The Kaplan‐Feinstein Classification was the most successful in stratifying patients in this population.
Pseudocyst of the Auricle
Authors: Lim C. M. , Goh Y. H. , Chao S. S. , Lynne Lim
Published: November 2003

Objective To study the epidemiological profile of patients with pseudocyst of the auricle and to review the effectiveness of surgical excision of the anterior cartilage with compression buttoning in this condition.

Study Design Medical records of patients with pseudocyst of the auricle treated in the Department of Otolaryngology of the Singapore General Hospital were reviewed retrospectively during the period from March 1, 2000, to November 30, 2001.

Methods A retrospective descriptive analysis of the epidemiological profile of patients with pseudocyst of the auricle was done. Surgical excision with compression buttoning was evaluated as the definitive treatment in this condition.

Results Eighty‐seven percent of our patients were male and the mean age was 38.9 years old. There was no racial predisposition. All 9 patients who had simple aspiration of the cyst had prompt re‐accumulation of the pseudocyst. None of the patients had recurrence following excision and compression buttoning of the pseudocyst. The complication rate in our study was 2.4%. Only one patient developed initial perichondritis with a resultant cauliflower deformity following surgical excision.

Conclusion Pseudocyst of the auricle typically presents as a painless unilateral swelling of the auricle in young adult males. Treatment options are varied. Excision of the anterior cartilage with compression buttoning yielded excellent results with no recurrence.
Detection of Fungal DNA in Effusion Associated With Acute and Serous Otitis Media
Authors: Kim Eugene J. , Catten Michael D. , Lalwani Anil K.
Published: November 2003

Objectives/Hypothesis Routine bacterial and viral cultures of middle ear fluid are often negative, suggesting that other infectious agents may be involved. Because of the similarities between the paranasal sinuses and middle ear space and the recent recognition of fungi as important pathogens in inflammation of the paranasal sinuses, we investigated the potential role of fungi in acute otitis media and serous otitis media using culture and polymerase chain reaction techniques.

Study Design Prospective study.

Methods Middle ear effusions of 29 patients who underwent myringotomy and pressure equalization tube placement for persistent serous otitis media or recurrent acute otitis media were collected. Fungal culture of the effusion samples was performed on potato flake agar. DNA from the effusion was isolated using standard techniques. Polymerase chain reaction, using radiolabeled universal fungus primer for internal transcribed spacer of 5.8s ribosomal DNA, was performed to detect the presence of any fungal DNA in the samples.

Results Culture of middle ear effusions showed no evidence of fungal growth. Polymerase chain reaction analysis was able to detect the constituent ribosomal DNA of a single fungal genome. Fungal DNA was present in 34% of middle ear effusion samples.

Conclusions Fungal DNA is present in recurrent acute otitis media and serous otitis media suggesting that it may play an etiological role in serous otitis media and acute otitis media. However, additional studies are necessary to delineate the role of fungi in the pathogenesis of otitis media.
Hearing Preservation in Acoustic Neuroma Surgery: The Impact of Different Patient Selection Criteria
Authors: Dugar Jay , Nikolopoulos Thomas P. , O'Donoghue Gerard M.
Published: November 2003

Objectives/Hypothesis The aim of the present study was to assess whether applying the various selection criteria for hearing preservation surgery on the same group of patients with acoustic neuroma leads to significantly different numbers of patients being considered suitable for this kind of surgery.

Study Design We used different selection criteria for hearing conservation surgery based on a range of studies in the published literature. We applied these criteria to a consecutive group of patients presenting to our unit with acoustic neuroma. We then calculated the numbers of patients deemed suitable for hearing preservation surgery as a function of these different selection criteria.

Methods Studies with published selection criteria, total numbers of patients, and numbers of patients suitable for hearing preservation surgery were found in the literature. These selection criteria were applied to our patient data. A χ2 statistical analysis was used to assess whether applying different selection criteria to the same group of patients (the subjects of the present study) resulted in different numbers of patients suitable for hearing preservation surgery.

Results The numbers of patients suitable for hearing preservation showed wide variation, ranging from 8 (10%) to 45 (56%) patients (of the total number of 80 patients in the present study). The χ2 statistical analysis revealed that the various selection criteria did have an effect on the numbers of patients suitable for hearing preservation surgery, and the statistical significance reached the level of P <.001.

Conclusions Different selection criteria lead to significantly different numbers of patients being considered suitable for hearing preservation surgery. Consensus and agreed selection criteria would help set patient expectations, refine candidate selection, and facilitate the comparison of outcomes across centers.
HLA‐DR and ICAM‐1 Expression and Modulation in Epithelial Cells From Nasal Polyps
Authors: Papon Jean‐François , Coste André , Gendron Marie‐Claude , Cordonnier Catherine , Wingerstmann Laure , Peynègre Roger , Escudier Estelle
Published: November 2003

Objective/Hypothesis Through human leukocyte antigen–DR (HLA‐DR) and intercellular adhesion molecule‐1 (ICAM‐1) expression, nasal epithelial cells could actively participate in the chronic inflammation and eosinophil infiltration observed in nasal polyps. The objective of the study was to evaluate HLA‐DR and ICAM‐1 expression in polyp epithelium and in a culture model of polyp epithelial cells allowing ciliated and secretory differentiation.

Study Design Prospective non‐randomized controlled in vitro study.

Methods The in vitro HLA‐DR and ICAM‐1 expression was studied under basal conditions or after exposure to interferon‐γ, transforming growth factor‐β1, lipopolysaccharide, dexamethasone, or cetirizine. HLA‐DR and ICAM‐1 expression was investigated in situ by immunohistochemical staining of polyps and in vitro by immunofluorescent staining of cell cultures. HLA‐DR and ICAM‐1 were localized in cultured cells by confocal microscopy. Cultured cells expressing HLA‐DR and ICAM‐1 were quantified by flow cytometry.

Results Both HLA‐DR and ICAM‐1 showed significant immunostaining of nasal polyp epithelium. In nasal polyp epithelial cell cultures, less than 5% of cells were positive for HLA‐DR whereas 40% were positive for ICAM‐1 at day 3. In vitro, HLA‐DR was mainly located in the cytoplasm and ICAM‐1 predominated on the apicolateral cytoplasmic membrane. Comparison of in situ and in vitro results showed that well‐differentiated and poorly differentiated cells predominantly expressed HLA‐DR and ICAM‐1, respectively. Interferon‐γ significantly increased HLA‐DR and ICAM‐1 expression, whereas transforming growth factor‐β1 significantly decreased HLA‐DR expression and lipopolysaccharide significantly increased ICAM‐1 expression.

Conclusion HLA‐DR and ICAM‐1 epithelial expression in nasal polyps in situ and in vitro and their in vitro modulation reinforce the active role of epithelial cells in chronic inflammatory diseases of the upper airways.
Free Tissue Transfer Versus Pedicled Flap in Head and Neck Reconstruction
Authors: McCrory Allison Lee , Magnuson J. Scott
Published: November 2003

Objectives Free flaps are often criticized as being medically risky for the patient, expensive, and too time‐consuming when compared with the traditional rotational flap repair. Perhaps the costs do not outweigh the benefits. The study analyzes many aspects of resource utilization and patient outcome to determine whether these criticisms hold true.

Study Design Retrospective patient review.

Methods Sixty‐five patient charts were reviewed. The following data were abstracted: flap type, tumor location and stage, preoperative American Society of Anesthesiologists score, preoperative irradiation, postoperative medical complications, flap outcome, length of hospital stay, date of first intake by mouth, and date of decannulation. The data were analyzed for free flaps and rotational flaps. Then data were analyzed again for free and rotational flaps performed for only patients who underwent a composite resection, to further standardize the results.

Results For all defect types, free flap operative time was statistically greater (9 h 35 min for free flaps vs. 4 h 58 min for rotational flaps). Regarding hospital charges, only patients who had a free flap after composite resection differed in amount charged when free versus rotational flaps were compared ($53,585 for free flaps vs. $32,984 for rotational flaps). Length of intensive care unit stay differed between patients having composite resection of the two flap types (0.1 d after rotational flap vs. 1.4 d after free flap).

Conclusions The differences between the two reconstruction methods are only a few. We do not think that longer operative time, longer length of intensive care unit stay, and increased hospital charges are significant enough to deny a patient a superior repair. We also think that as surgeons' experience increases, these differences may one day no longer hold true.
Synchronized Electrical Stimulation in Treating Pharyngeal Dysphagia
Authors: Leelamanit Vitoon , Limsakul Chusak , Geater Alan
Published: November 2003

Objective/Hypothesis The objectives were to test the hypothesis that synchronous contraction of the thyrohyoid muscle by electrical stimulation during swallowing would improve dysphagia resulting from reduced laryngeal elevation and to evaluate the effectiveness of the synchronous electrical stimulator.

Study Design Prospective study.

Methods Eleven male and 12 female patients (age range, 35–87 y) with moderate to severe degree of dysphagia resulting from reduced laryngeal elevation who did not respond to medical treatment were treated by stimulating synchronous contraction of the thyrohyoid muscle during swallowing with the synchronous electrical stimulator. Treatment was given daily for 4 hours until criteria for improved swallow were fulfilled or other intervention was deemed necessary. Follow‐up was performed monthly (range, 3–33 mo).

Results Of the 23 patients, 20 showed marked improvement at the first course of treatment. The duration of stimulation varied from 2 to 4 days (median duration, 2 d) in patients with moderate dysphagia and from 3 to 30 days (median duration, 6 d) in patients with severe dysphagia. Three patients showed failed synchronous electrical stimulator treatment, one owing to device failure and two requiring gastrostomy for feeding. Six patients who achieved improved swallow criteria relapsed at 2 to 9 months after the first treatment course and were successfully treated with an additional course of synchronous electrical stimulation.

Conclusions The study supports the hypothesis that stimulating synchronous contraction of the thyrohyoid muscle by synchronous electrical stimulator during swallowing improves dysphagia resulting from reduced laryngeal elevation. Synchronized electrical stimulation has the advantages of noninvasiveness and actively assisting swallowing and can be used as an alternative treatment. The synchronized feature of the synchronous electrical stimulator helps to restore normal swal‐ lowing mechanism and decreases the incidence of nasogastric tube insertion and gastrostomy.
Suspension Laryngoscopy for Endotracheal Stenting
Authors: Eckel Hans Edmund , Berendes Shahindocht , Damm Michael , Klussmann Jens Peter , Wassermann Klaus
Published: November 2003

Objectives/Hypothesis Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting.

Study Design Retrospective, single‐institution analysis of a case series treated by a multidisciplinary airway team.

Methods Ninety‐three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures.

Results Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting.

Conclusions Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs.
Neuropsychological Testing in the Screening for Cochlear Implant Candidacy
Authors: Kutz Walter , Wright Crystal , Krull Kevin R. , Manolidis Spiros
Published: November 2003

Objective To demonstrate the utility of neuropsychological assessment in the screening process for pediatric cochlear implant candidacy.

Study Design Prospective and ongoing evaluation of children with profound bilateral hearing loss using age‐specific neuropsychological test batteries.

Methods Eighteen children who met audiological criteria for cochlear implantation were evaluated by two age‐specific neuropsychological tests. The Vineland Adaptive Behavior Scales survey assesses several domains of behavioral functions (communication, daily living skills, socialization, and gross motor skills). The Mullen Scales of Early Learning assess the child's visual perception, speech and language, and motor abilities. The Leiter International Performance Scale–Revised assesses intellectual ability.

Results All patients underwent the Vineland Adaptive Behavior Scales survey. Overall scores were lower than normative means with a mean composite score in the 7th percentile. In addition, there was a strong inverse correlation between score and age of testing. Ten children were assessed using the Mullen Scales of Early Learning, and, again, there was a strong inverse correlation between score and age of testing. Intellectual ability was assessed in seven children using the Leiter International Performance Scale–Revised and was found to be lower than normative means with a mean score in the 13th percentile.

Conclusions Neuropsychological testing of profoundly deaf children provides a detailed and accurate assessment of the child's cognitive, behavioral, and motor functions. The profoundly deaf child does not develop at the same rate as normal children in cognitive and behavioral domains. Neuropsychological testing is a useful tool for screening for cochlear implant candidacy and has the potential to track changes before and after implantation.
Endoscopic Staple Diverticulostomy for Recurrent Zenker's Diverticulum
Authors: Scher Richard L.
Published: November 2003

Objectives The purpose of this study was to evaluate the technical feasibility, effectiveness, and morbidity of using endoscopic staple diverticulostomy (ESD) as treatment for Zenker's diverticulum (ZD) recurring after either prior endoscopic treatment or external diverticulectomy or diverticulopexy.

Study Design A retrospective review of a case series of 18 patients with recurrent ZD.

Methods All patients cared for with ZD were evaluated to identify those patients with recurrent ZD. The clinical records of patients with recurrent ZD were reviewed for: demographics, prior treatment, time to recurrence, factors associated with recurrence, technical feasibility of treatment, complications, effectiveness and duration of symptom relief.

Results Between March 1995 and July 2001, a total of 127 consecutive patients with ZD received care. Eighteen of these patients were treated for recurrent ZD: nine treated originally by ESD, and nine by external approach (seven by diverticulectomy and two by diverticulopexy), with three of these patients treated twice. Seventeen patients had partial or complete relief of symptoms after their initial treatment, with recurrence of symptoms noted 0 to 60 months later. Specific factors associated with recurrence of symptoms were identified in only one patient. Treatment of recurrent ZD by ESD was technically feasible in 16 of the patients. Complete or improved symptom relief has been reported by 16 of the patients after revision ESD, with follow‐up from 9 to 69 months. No significant treatment complications occurred. Fifteen patients resumed clear liquid diet on the day of surgery, and one on the day after surgery. All patients were discharged from the hospital by the second postoperative day (mean = 0.6 d).

Conclusions ESD is an effective, technically feasible, and safe treatment for patients with ZD recurring after prior endoscopic or external treatment, and it should be the initial treatment of choice for these patients.
Intraparotid Facial Nerve Neurofibromas
Authors: McGuirt W. Frederick , Johnson Paul E. , McGuirt Wyman T.
Published: November 2003

Objectives To provide an awareness of intraparotid facial nerve neurofibroma as a cause of parotid masses and to describe their characteristics and management considerations.

Study Design Case report with literature review.

Methods The medical records of three patients with intraparotid facial nerve neurofibromas are reviewed, and data concerning the patient's presentations, treatment, and disease course are presented with a review of the world's literature on intraparotid facial nerve neurofibromas.

Conclusions Tumors arising from the extratemporal course of the facial nerve are quite rare. The tumors arise from Schwann cells and include the schwannoma and the neurofibroma. The overwhelming benign nature of these lesions necessitates a conservative course of treatment. Histological diagnosis should be followed by a limited tumor excision with emphasis on retaining normal facial nerve function. Malignant lesions require wide excision with facial nerve grafting or facial nerve reanimation.
In Vitro Tissue Engineering to Generate a Human‐Sized Auricle and Nasal Tip
Authors: Kamil Syed H. , Kojima Koji , Vacanti Martin P. , Bonassar Lawrence J. , Vacanti Charles A. , Eavey Roland D.
Published: November 2003

Objectives/Hypothesis Tissue engineering has successfully generated cartilage in a xenograft and an autograft model. However, challenges remain with both of these in vivo techniques before clinical application can be realized. We hypothesized that a human‐sized cartilaginous structure could be generated completely in vitro as a complementary or an alternative technique.

Methods Scaffolds were created in the shape of five full‐sized human auricles and five nasal tip cartilaginous skeletons. Bovine shoulder chondrocytes at a concentration of 50 million cells/mL were seeded onto the scaffolds and were grown for 12 weeks in vitro. Two of the auricular scaffolds had internal support provided by soft acrylic sheets and were later implanted into nude rats.

Results All of the scaffolds maintained shape and size through 12 weeks of in vitro culture. On gross examination the scaffolds were progressively replaced by cartilage, which was confirmed by histological and biochemical analysis. The auricular scaffolds with the acrylic internal support had the most natural rigidity, which was observed by gentle palpation. The nasal scaffolds maintained excellent definition even without internal support.

Conclusion An adult human‐sized auricle and nasal tip cartilaginous structure can be grown entirely in vitro using principles of tissue engineering.
A Novel Technique for Peripheral Nerve Repair
Authors: Scharpf Joseph , Meirer Romed , Zielinski Maciej , Unsal Murat , Ramineni Praful , Nair Dileep , Siemionow Maria
Published: November 2003

Objective To evaluate a novel technique for the repair of neural deficits using a single fascicle to bridge an injury in the rat sciatic nerve.

Study Design Twenty‐four male Lewis rats were divided into four groups as follows: group 1 (control group), 1.5‐cm deficit without repair; group 2, conventional epineural repair with autografts (100% diameter); group 3, nerve repair with large single autograft fascicle (50% diameter); and group 4, nerve repair with small single autograft fascicle (25% diameter).

Methods Nerve regeneration was evaluated at 3, 6, and 12 weeks by somatosensory evoked potential (SSEP) evaluation and standardized pin‐prick and toe‐spread tests. Nerve samples were harvested at 12 weeks and stained with toluidine blue to assess the total number of myelinated axons, axon area, and myelin sheath thickness.

Results In group I, the pin‐prick and toe‐spread tests showed no response at 3, 6, and 12 weeks. Rats in groups 3 and 4 demonstrated significantly better pin‐prick test results and a trend toward better toe‐spread test responses compared with conventional‐repair animals. The SSEP evaluations displayed nondiagnostic waves in rats in group 1 rats. There was no evidence that the other surgery groups differed significantly in median SSEP latencies. Histological evaluation revealed fibrosis in rats in group 1 rats and a significantly higher median number of axons and myelin thickness in the small single fascicle (1296 axons and 4.22 μm, respectively) and large fascicle (2682 axons and 4.62 μm, respectively) groups compared with the conventional autograft group (630 axons and 2.93 μm, respectively). The small fascicle group had a significantly greater mean axon area (58.59 μm2) than the large fascicle (29.66 μm2) and conventional autograft (25.35 μm2) groups.

Conclusions Peripheral nerve repair using a single fascicle graft resulted in better functional recovery and morphometric outcome without a significant difference in electrophysiological status compared with conventional nerve repair. This technique may provide expanded sources of nerve autografts and alleviate the morbidity of harvesting peripheral nerves from multiple sites for individuals with extensive peripheral nerve injuries.
The Pathogenesis of Nasal Polyposis by Immunoglobulin E and Interleukin‐5 Is Completed by Transforming Growth Factor‐β1
Authors: Hirschberg Andor , Jókúti Adrienn , Darvas Zsuzsa , Almay Krisztina , Répássy Gábor , Falus András
Published: November 2003

Objectives/Hypothesis Nasal polyps are benign mucosal protrusions into the nasal cavity of multifactorial origin and are characterized by chronic mucosal inflammation. The suggested multifactorial pathological mechanisms comprise several factors including cytokines and immunoglobulin E (IgE). The study was designed to examine the suggested roles of IgE, interleukin‐5 (IL‐5), and transforming growth factor‐β1 (TGF‐β1) in the pathogenesis of nasal polyposis.

Methods Nasal polyps (n = 34) and healthy nasal mucosa samples (n = 9) were taken during routine endonasal surgeries. Immunoglobulin E (n = 13), IL‐5 (n = 22), and TGF‐β1 (n = 27) concentrations were measured with enzyme‐linked immunosorbent assay technique in homogenized polyp tissue and in control mucosa. Atopic and nonatopic groups were selected and compared. Histomorphological examination and immunohistochemical analysis to detect IL‐5 and TGF‐β1 were performed in five specimens.

Results The level of tissue‐bound IgE was significantly higher in polyps compared with control specimens and in atopic compared with nonatopic polyps, but between nonatopic polyps and control specimens the difference was not significant. However, significant correlation was found between tissue and serum IgE in the complete polyp (P = .001) and atopic polyps group (P = .05). Tissue IL‐5 concentration was significantly higher in polyps compared with control specimens, in which it was below the limit (15 pg/mL), and there was no difference between atopic and nonatopic polyps. In atopic polyps there was significant correlation between tissue IgE and IL‐5. Transforming growth factor‐β1 concentration proved to be significantly higher in control mucosa than in polyps, with no difference between atopic and nonatopic polyps. Immunohistochemical analysis revealed numerous IL‐5‐positive eosinophil cells and TGF‐β1 positivity in the lamina propria of polyp samples, but none in control specimens.

Conclusions High tissue TGF‐β1 quantity in healthy nasal mucosa without its active form on the cell surface and its low quantity in polyps may reflect its essential role in the inhibitory mechanisms of nasal polyposis. Interleukin‐5 plays a key role in the eosinophil recruitment and activation, and both atopic and nonatopic pathways might activate this process. The main sources of IL‐5 and TGF‐β1 are the eosinophils and macrophages. Immediate hypersensitivity, besides other mechanisms, might be related to atopic polyps, but the involvement of other, local allergic mechanisms in IgE production of nonatopic polyp tissue cannot be excluded.
The Accuracy of Computed Tomography in the Diagnosis of Chronic Rhinosinusitis
Authors: Bhattacharyya Neil , Fried Marvin P.
Published: November 2003

Objective To determine the sensitivity, specificity, and diagnostic accuracy of paranasal sinus computed tomography (CT) in the diagnosis of chronic rhinosinusitis (CRS).

Study Design Prospective dual cohort study.

Methods One hundred seventy‐one consecutive patients undergoing endoscopic sinus surgery for CRS were evaluated with CT and staged according to the Lund system. Histopathological findings from sinus specimens were reviewed and graded. A second contemporaneous control group of 130 patients undergoing CT of the sinus regions for other reasons but without a diagnosis of CRS was also staged. Sensitivity, specificity, and the receiver–operator characteristic were determined for the sinus CT in the diagnosis of CRS. Positive and negative predictive values were also computed.

Results In the disease‐positive group of patients with CRS, the mean Lund score was 9.8 (95% confidence interval, 9.0–10.6). The mean inflammatory grade on histopathological study was 2.3 (range, 0–4). For the control group (without disease), the mean Lund score was 4.3 (95% confidence interval, 3.5–5.0). The AUC for the receiver–operator characteristic was 0.802 (P <.001). Selecting a Lund score cut‐off value of greater than 2 as abnormal, the sinus CT exhibited sensitivity and specificity of 94% and 41%, respectively. Increasing the cut‐off value to 4 changed the sensitivity and specificity to 85% and 59%, respectively.

Conclusions The paranasal sinus CT scan exhibits good sensitivity and above‐average specificity for the diagnosis of CRS. When added to the history and physical findings, CT may add to the diagnostic accuracy of CRS.
Effects of Steel Scalpel, Ultrasonic Scalpel, CO2Laser, and Monopolar and Bipolar Electrosurgery on Wound Healing in Guinea Pig Oral Mucosa
Authors: Sinha Uttam K. , Gallagher Laura A.
Published: November 2003

ObjectiveThe study's objective was to compare instrument performance and tissue healing when steel scalpel, ultrasonic scalpel, monopolar or bipolar electrosurgical instruments, or CO2laser was used in an animal oral surgery model.

Study DesignProspective, blinded, randomized.

MethodsAdult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2‐cm, full‐thickness oral mucosa using steel scalpel, ultrasonic scalpel, monopolar or bipolar electrosurgical instruments, or CO2laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re‐epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance.

ResultsThe ultrasonic scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P<.05) was noted at day 7 for monopolar and CO2laser groups. Greatest tensile strength was seen in the steel scalpel and ultrasonic scalpel groups at the end of 28 days. Tissue re‐epithelialization was fastest for the steel scalpel and ultrasonic scalpel groups (complete by day 7). Complete re‐epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel scalpel and ultrasonic scalpel groups only.

ConclusionUse of the ultrasonic scalpel produced faster re‐epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel scalpel.
Acoustic Rhinometry and Paranasal Cavities: A Systematic Study in Box Models
Authors: Mlynski Robert , Grützenmacher Stefan , Lang Christian , Mlynski Gunter
Published: November 2003

Objective/Hypothesis Acoustic rhinometry (AR) is a well‐established diagnostic tool in rhinology. The aim of the study was to test the hypothesis that the paranasal sinuses are a main cause for inaccuracy of AR in the posterior part of the nose.

Study Design Experimental study to evaluate the influence of simulated paranasal sinus volume and of the contralateral side of the nose on AR measurements in “box models.”

Methods Models were measured with paranasal sinus volume simulated between 0 and 25 mL and with the junction between the models and the paranasal sinuses varying in length and diameter.

Results Moderate but distinct modification of the posterior area–distance curve was found within the models after changing size of the paranasal sinuses and its junction to the cavity. The apparent cross‐sectional area (CSA) measured in the posterior cavum decreased with the volume of the paranasal sinuses. This effect was limited by the length and the diameter of the paranasal junction, as well as by the concha. No influence of the contralateral side on AR measurements was seen.

Conclusions Acoustic rhinometry reveals reproducible measurements up to 4 cm from the nostril that correspond with the actual model CSA. Simulated paranasal sinuses appear to partially contribute to the inaccuracy in the posterior part of the area–distance curve.
Vertigo From Herpes Zoster Oticus: Superior or Inferior Vestibular Nerve Origin?
Authors: Lu Ying‐Chih , Young Yi‐Ho
Published: November 2003

Objective/Hypothesis This study aims to analyze which division of vestibular nerve in the internal auditory canal is responsible for inducing vertigo in patients with herpes zoster oticus (HZO).

Methods Eight patients (three men and five women) suffered from auricular vesicles, otalgia, and facial palsy, and five of them also had vertigo. Each patient received a battery of tests, including neurological examination, blood examination, audiometry, caloric test, electronystagmography, and vestibular evoked myogenic potential (VEMP) test.

Results All five HZO patients with vertigo had facial palsy on the lesioned side and spontaneous nystagmus beating toward the healthy side. Absent VEMPs were noted in five patients, absent caloric response was noted in four, and sensorineural HL was noted in three. Compared to another three HZO patients without vertigo, all revealed normal responses in both the caloric test and the VEMP test. On MRI scan, two out of four had abnormal gadolinium enhancement along the nerve segments within the internal auditory canal. Six months after treatment, a follow‐up caloric test and VEMP test in these eight patients did not alter the results compared with before treatment.

Conclusion The nerve trunks within the internal auditory canal are widely affected in HZO patients with vertigo. Both superior division and inferior division of the vestibular nerve attribute to the vertiginous attack. Further, large numbers of HZO patients undergoing caloric testing and VEMP testing are required to support this tentative conclusion.
Sudden Deafness and Lyme Disease
Authors: Lorenzi Maria Cecília , Bittar Roseli S. M. , Pedalini Maria Elisabete B. , Zerati Fabio , Yoshinari Natalino H. , Bento Ricardo F.
Published: November 2003

Objectives/Hypothesis Otolaryngological manifestations are common in Lyme disease, affecting up to 75% of patients. One of these symptoms is sudden deafness. Hearing loss has been frequently described in Lyme disease; on the other hand, titers seropositive for Borrelia burgdorferi, the causal agent of this disease, have been found in almost 20% of cases of sudden deafness. No consensual information exists on the outcome of Borrelia‐seropositive patients or on the importance of determining Borrelia antibody titers. The present study aimed to determine the prevalence of seropositivity for Borrelia in sudden deafness, describing clinical characteristics and outcomes.

Study Design This was a prospective observational study.

Methods Forty‐seven consecutive patients with sudden deafness were enrolled in the study. Demographic data, the presence of tinnitus and vertigo, and low‐ and high‐frequency pure‐tone averages were recorded. The percentage of hearing recovery was determined. Data obtained from Borrelia‐seropositive patients were described and compared with those from the seronegative group.

Results Titers positive for B burgdorferi antibodies were present in 21.3% of the cases. Seropositive and seronegative groups of patients were homogeneous concerning age, sex distribution, the presence of tinnitus and vertigo, and high‐ and low‐frequency hearing thresholds. Hearing outcome was not significantly different between the groups of patients.

Conclusions No distinctive clinical characteristic was found between seropositive and seronegative subjects. The hearing outcome of treated Borrelia‐seropositive patients was similar to that of the seronegative group.
Hearing Impairment and Tinnitus Pitch in Patients With Unilateral Tinnitus: Comparison of Sudden Hearing Loss and Chronic Tinnitus
Authors: Ochi Kentaro , Ohashi Toru , Kenmochi Mutsumi
Published: November 2003

Objectives The objectives were to analyze the results of pitch‐matching and loudness‐balance testing in patients with unilateral tinnitus and to evaluate the relationship between audiological findings based on the tinnitus‐affected and tinnitus‐unaffected threshold differences and tinnitus pitch by using linear interpolation methods. In addition, the effects of the duration of the tinnitus on this relationship were investigated. Sudden sensorineural hearing loss with tinnitus was selected for the “acute tinnitus” group, and unilateral tinnitus with unknown disease and a duration of more than 3 months was selected for the “chronic tinnitus” group.

Study Design Retrospective study of the clinical records of patients.

Methods One hundred thirty‐two patients with unilateral tinnitus (comprising 68 female [51.5%] and 64 male [48.5%] patients) were investigated as subjects. Their mean age was 50.4 years (SD = 15.8 y). All patients underwent otoneurological testing, including the pure‐tone audiogram and pitch‐matching and loudness‐balance tests.

Results The mean difference in the hearing threshold between the tinnitus‐affected ear and the tinnitus‐unaffected ear was largest near the tinnitus pitch in both the acute and the chronic tinnitus groups. However, the relationship between hearing impairments and tinnitus pitch was somewhat different in the two groups: It exhibited a single smooth peak in the acute tinnitus group but a bimodal peak in the chronic tinnitus group.

Conclusion The results suggest that tinnitus is related to hearing impairment in the same frequency region in patients with sudden sensorineural hearing loss with tinnitus or in patients with chronic tinnitus, whereas some instances of chronic tinnitus are caused by reorganization in cortical cells.
Management of Cholesteatoma: Status of the Canal Wall
Authors: Syms Mark J. , Luxford William M.
Published: November 2003

Objective/Hypothesis Management of chronic otitis media with cholesteatoma remains controversial. The purpose of the study is to examine factors associated with the surgical approach to manage cholesteatoma.

Study Design A retrospective review.

Methods A retrospective review was made of all primary cases of mastoid surgery for cholesteatoma performed at an otological center between 1995 and 2000. During the study period, 486 ears underwent surgery for cholesteatoma. Data included procedures performed, location and extent of the disease, residual and recurrent disease, complications, reasons for staging the surgery, and duration of follow‐up.

Results The canal wall remained intact in 68.5% of ears. The majority of the remainder of the patients underwent a canal wall down technique with mastoid obliteration. Residual cholesteatoma was found in 26.9% of second procedures and in 2.7% of third procedures.

Conclusions The majority of patients with cholesteatoma can be adequately managed with a canal intact tympanomastoidectomy with staging. Otolaryngologists should consider a two‐staged procedure as a viable management approach for chronic otitis media with cholesteatoma.
Intratympanic Gentamicin for Intractable Meniere's Disease
Authors: Perez Nicolas , Martín Eduardo , García‐Tapia Rafael
Published: November 2003

Objective The study aimed to analyze the results of the intratympanic injection of gentamicin as a treatment option for patients with unilateral Meniere's disease who were refractory to medical treatment.

Study Design Prospective study in the setting of a tertiary care medical center.

Methods Seventy‐one patients with unilateral Meniere's disease according to 1995 American Academy of Otolaryngology—Head and Neck Surgery 1995 guidelines who had been unresponsive to medical therapy for at least 1 year were studied. Intratympanic injections of a prepared concentration of 27 mg/mL gentamicin were performed at weekly intervals until the development of symptoms and signs indicative of vestibular hypofunction in the treated ear. As the main outcome measure, the 1995 American Academy of Otolaryngology—Head and Neck Surgery criteria for reporting treatment outcome in Meniere's disease were used. The results of treatment were expressed in terms of control of vertigo, disability status (functional level and degree of overall impairment evaluated by the Dizziness Handicap Inventory and the University of California Los Angeles Dizziness Questionnaire), hearing level, and quantitative measurement of vestibular function.

Results Vertigo was controlled in 83.1% of the 71 patients. Recurrence of vertigo spells after initially complete control was noted in 17 patients. In 13 of these patients, this was cured by another course of intratympanic injections of gentamicin. Functional level and measures of self‐reported handicap were significantly and promptly lowered after treatment in the patients who attained control of vertigo. Hearing level as pure‐tone average was unchanged 2 years after treatment, but hearing loss as a result of gentamicin injections occurred in 23 patients at the end of treatment and in 9 and 11 patients at 3 months and 2 years after the treatment, respectively. Vestibular function was kept normal or reduced in 49.3% of the patients, whereas in the rest of the patients vestibular areflexia was observed. Control of vertigo did not depend on the amount of vestibular damage.

Conclusions Ending weekly intratympanic injections when clinical signs of vestibular deafferentation appear can control vertigo in the majority of patients, and it is a useful alternative, together with other surgical options, for the treatment of patients with Meniere's disease who do not respond to medical treatment.
Development of the First Force‐Controlled Robot for Otoneurosurgery
Authors: Federspil Philipp A. , Geisthoff Urban W. , Henrich Dominik , Plinkert Peter K.
Published: November 2003

Objective In some surgical specialties (eg, orthopedics), robots are already used in the operating room for bony milling work. Otological surgery and otoneurosurgery may also greatly benefit from the enhanced precision of robotics.

Study Design Experimental study on robotic milling of oak wood and human temporal bone specimen.

Methods A standard industrial robot with a six‐degrees‐of‐freedom serial kinematics was used, with force feedback to proportionally control the robot speed. Different milling modes and characteristic path parameters were evaluated to generate milling paths based on computer‐aided design (CAD) geometry data of a cochlear implant and an implantable hearing system.

Results The best‐suited strategy proved to be the spiral horizontal milling mode with the burr held perpendicular to the temporal bone surface. To reduce groove height, the distance between paths should equal half the radius of the cutting burr head. Because of the vibration of the robot's own motors, a high oscillation of the SD of forces was encountered. This oscillation dropped drastically to nearly 0 Newton (N) when the burr head made contact with the dura mater, because of its damping characteristics. The cutting burr could be kept in contact with the dura mater for an extended period without damaging it, because of the burr's blunt head form. The robot moved the burr smoothly according to the encountered resistances.

Conclusion The study reports the first development of a functional robotic milling procedure for otoneurosurgery with force‐based speed control. Future plans include implementation of ultrasound‐based local navigation and performance of robotic mastoidectomy.
Cochlear Implantation Concurrent With Translabyrinthine Acoustic Neuroma Resection
Authors: Ahsan Syed , Telischi Fred , Hodges Annelle , Balkany Thomas
Published: November 2003

Objectives/Hypothesis Cochlear implants provide successful auditory rehabilitation for patients with profound sensorineural hearing loss who do not derive at least marginal benefit from conventional hearing aids. Patients with neurofibromatosis type 2 can present with bilateral profound sensorineural hearing loss caused by bilateral vestibular schwannomas. Auditory rehabilitation in these patients can be challenging. We present the case of one such patient who underwent a concurrent translabyrinthine vestibular schwannoma resection and cochlear implantation in the same ear.

Study Design A case report and review of the literature.

Methods Review the patient's medical record and MEDLINE literature search.

Results The patient presented with a relatively small tumor that was situated in the fundus of the internal auditory canal with intralabyrinthine extension. Postoperative performance with implant stimulation was in the higher range of that for other cochlear implant patients.

Conclusions To the best of our knowledge, this is the first case reported of simultaneous cochlear implant and translabyrinthine acoustic neuroma resection in the same ear of a patient with neurofibromatosis type 2.
Endoscopic and Transconjunctival Orbital Decompression for Thyroid‐Related Orbital Apex Compression
Authors: Schaefer Steven D. , Soliemanzadeh Peyman , Della Rocca David A. , Yoo Gu‐Pei , Maher Elizabeth A. , Milite James P. , Della Rocca Robert C.
Published: November 2003

Objective To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid‐related orbitopathy with orbital apex compression.

Study Design Retrospective review.

Methods A sequential series of patients with thyroid‐related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3‐ to 55‐month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed.

Results Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis.

Conclusions The study supports the treatment of thyroid‐related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid‐related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).