bluuebunny/crossref_metadata_2025 huggingface dataset:
An Animal Model for the Study of Genetic Predisposition in the Pathogenesis of Middle Ear Inflammation
Authors: Madison Clark J. , Brinson George , Newman Michael K. , Jewett Brian S. , Sartor Balfour R. , Prazma Jiri , Pillsbury Harold C.
Published: November 2003

Objectives Chronic otitis media with effusion (COME) is the most prevalent inflammatory disease in children and is associated with numerous adverse long‐term sequelae. Many factors have been associated with an increased risk of developing COME, one of which may be a genetic predisposition to the disease. To study the role that genetics play in the pathogenesis of COME, we used an animal model to compare the middle ear inflammatory responses in two different strains of rats (Lewis and Fisher).

Methods In earlier studies, we demonstrated that exposure of the middle ear to endotoxin caused early extensive exudation and, later, goblet cell hyperplasia and mucin hypersecretion. In the present study, the animals were divided into six groups. In each group the animals were given transtympanic injection with gram‐positive bacterial cell wall product (peptidoglycan‐polysaccharide [PG‐PS]). The middle ear bullae were studied at 1 week and 3 weeks after infection, and after systemic reinfection. Comparisons were made of the quantity of mucin exudate by enzyme‐linked immunosorbent assay and by histological evaluation of the middle ear epithelial thickness.

Results Our data demonstrate a statistically significant difference in middle ear inflammation and effusion formation between the two genetically different strains of rats.

Conclusions These data support the hypothesis that the middle ear response to PG‐PS may be genetically determined and therefore suggest that genetic predisposition may play a role in the pathogenesis of COME.
Effects of Benzalkonium Chloride on Innate Immunity Physiology of the Human Nasal Mucosa In Vivo
Authors: Storaas Torgeir , Andersson Morgan , G. A. Persson Carl , K. Steinsvåg Sverre , Marko‐Varga Gyorgy , Greiff Lennart
Published: November 2003

Objective Benzalkonium chloride (BC) is a preservative commonly used in nasal decongestant sprays. It has been suggested that BC may be harmful to the nasal mucosa. The present study, involving healthy volunteers, examines effects of BC on nasal mucosal end‐organ functions.

Methods Isotonic saline and BC (0.1 mg/mL) were administered acutely to the nasal mucosa using a nasal pool device. Nasal symptoms were determined. Nasal lavage fluid levels of α2‐macroglobulin and fucose were measured as indices of plasma exudation and glandular secretion, respectively. In addition, BC (0.1 mg/mL) was given as single actuations of 100 μL per nasal cavity three times daily for 10 days. The ability of histamine (0.4 mg/mL) to evoke nasal symptoms and plasma exudation responses was determined before and after the repeated BC administration series.

Results BC produced immediate nasal smart or pain (P < .05), but tolerance to this response developed by repeated administrations. BC increased nasal mucosal output of fucose (P < .05), whereas nasal lavage fluid levels of α2‐macroglobulin were unaffected. Histamine produced significant symptoms and mucosal exudation of α2‐macroglobulin (P values < .01), equally before and after the 10 days of BC exposure.

Conclusions BC in dosages commonly used as preservative in nasal decongestant sprays produced short‐term glandular secretion and nasal smart or pain. However, 10 days' frequent exposure to BC was not associated with untoward symptomatic effects, nor was a sensitive mucosal variable such as histamine‐induced exudative responsiveness affected by this repeated exposure to BC.
Optimal Technique to Diagnose Primary Ciliary Dyskinesia
Authors: Friedman Norman R. , Pachigolla Ravi , Deskin Ronald W. , Hawkins Hal K.
Published: November 2003

Objective To develop a cost‐effective protocol for diagnosing primary ciliary dyskinesia (PCD).

Study Design Retrospective chart review in a tertiary care academic medical center.

Methods A review of the electron microscopy logbook identified all patients who had a suspected diagnosis of PCD. Biopsy of respiratory tract mucosa was performed using a cytology brush or a cup forceps in the outpatient clinic or operating room (OR). Outcome measures were to determine the diagnostic adequacy of cytological evaluation compared with tissue biopsy and to determine whether an adequate nasal mucosa sample can be collected in the outpatient clinic setting as compared with the OR and the use of general anesthesia.

Results Twenty‐seven patients underwent 31 biopsies. Fifteen specimens were collected with a cup forceps, and 16 with a cytology brush. The sampling sites were nasal mucosa in 28 cases and trachea in the rest. Twelve specimens (39%) were collected in the clinic; the rest were obtained in the OR in conjunction with another procedure. Neither method of specimen collection nor mode of anesthesia made a significant difference in the probability of obtaining an adequate specimen. Ten samples were nondiagnostic: cytological evaluation, 31% (n = 16); tissue biopsy, 27% (n = 15); clinic, 42% (n = 12); and OR, 31% (n = 16). The cost of evaluating ciliary motion at our institution was $150, with an additional charge of $1297 for electron microscopic evaluation. The nonprofessional fee for an outpatient nasal biopsy was $98; in the OR the cost of anesthesia supplies, surgical suite, recovery room, and day‐surgery bed was at least $1860.

Conclusion Our results suggest that the optimal method for diagnosis of PCD is in the outpatient clinic with specimen collection by means of either a cup forceps or a cytology brush.
Deterioration of the Pharyngo‐UES Contractile Reflex in the Elderly
Authors: Ren Junlong , Xie Pengyan , Lang Ivan M. , Bardan Eytan , Sui Zhumei , Shaker Reza
Published: November 2003

Objectives/Hypothesis Deterioration of aerodigestive tract reflexes such as the esophagoglottal and pharyngoglottal closure reflexes and pharyngeal swallow has been documented in the elderly. However, the effect of aging on the contractile response of the upper esophageal sphincter (UES) to pharyngeal water stimulation has not been studied. The aim of this study was to characterize the pharyngo‐UES reflex in the healthy elderly.

Methods We studied nine healthy elderly (77 ± 1 y [SD]; four men, five women) and nine healthy young volunteers (26 ± 2 y [SD]; four men, five women). A UES sleeve sensor was used to measure the pressure. We tested pharyngeal stimulation induced by rapid pulse and slow continuous injection of water.

Results The volume of water required to stimulate the pharyngo‐UES contractile reflex by rapid pulse injection in the elderly (0.5 ± 34 0.1 mL) was significantly higher than that in the young (0.1 ± 0.02 mL) (P < .05). In contrast to young subjects, there was no pressure increase in resting UES pressure observed in the elderly for continuous pharyngeal water infusion. In both young and elderly, the threshold volume for the pharyngo‐UES contractile reflex was significantly lower than that for pharyngeal swallows.

Conclusions The pharyngo‐UES contractile reflex deteriorates with aging. This deterioration is primarily due to abnormalities of the afferent limb of the reflex.
Quantitative Study of Mucosal Wave Via Videokymography in Canine Larynges
Authors: Jiang Jack J. , Chang Ching‐I. B. , Raviv Joseph R. , Gupta Sameer , Banzali Franklin M. , Hanson David G.
Published: November 2003

Objectives Vocal fold mucosal wave movements are thought to be important in determining voice characteristics and quality. To see these movements, high‐speed cinematography and videostroboscopy have been used clinically; however, these techniques have disadvantages that make them impractical for quantitative measurement of mucosal wave movements. This study explored the feasibility of using line‐scan cameras for mucosal wave analysis.

Methods An excised larynx bench model was used to examine the effects of elongation and changes in subglottal pressure on the amplitude, frequency, and phase difference of vocal fold mucosal movements as calculated from line‐scan images.

Results The data showed a positive and linear relationship between an increase in subglottal pressure and amplitude of the mucosal wave; elongation of the vocal folds appeared to decrease the amplitude of mucosal wave upheaval at each level of subglottal pressure. Similarly, increase in subglottal pressure had a positive and linear relationship with increase in frequency of vibration; elongation of the vocal folds further increased the frequency at any given subglottal pressure. Phase difference between the movements of the upper and lower margins of the mucosal lips was estimated and did not appear to be significantly affected by changes in subglottal pressure and elongation.

Conclusion The data presented in this study are consistent with relationships that we would expect to be true from currently accepted models of vocal fold vibration.
Building the Powerful 10‐Minute Office Visit, Part I: Introduction to the New Section
Authors: Gail Neely J. , Hartman James M. , Wallace Mark S.
Published: November 2003

Objective This is the first of a planned progressive series of articles entitled “Tutorials in Clinical Research” written to assist those who would become more active in the application of scientific methods to their practices and to assist those who would seek to develop and publish new discoveries of their own. On completion of Tutorials, the reader should be able to 1) critically and efficiently read the literature and 2) use his or her personal practice as a laboratory for clinical investigation.

Study Design Tutorial.

Methods The Journal editor agreed to launch the series “Tutorials in Clinical Research,” which was conceived out of a need for an easily understandable and accessible collection of tutorials for the busy practitioner. The Clinical Research Working Group at Washington University, Department of Otolaryngology—Head and Neck Surgery, will write, edit, and solicit additional authors for the completion of this planned 22‐article series. The intended audience includes, among other groups, practitioners without research funds who are interested in the application of scientific methods to their practices.

Results This first article in the series outlines how to begin and three steps for the initial application of scientific methods to practice, including critical literature review, prospective analysis of practice, and specific project development.

Conclusions The application of scientific methods to practice can be fun, educational, and effective in the enhancement of quality care. The “value added” result is the development of the powerful 10‐minute patient office visit for the busy practitioner.
Endoscopic Sinus Surgery in Patients Infected With HIV
Authors: Friedman Michael , Landsberg Roee , Tanyeri Hasan , Schults Roman A. , Kelanic Stephen , Caldarelli David D.
Published: November 2003

Objectives To be able to plan appropriate surgical treatment for patients with HIV infection who have sinusitis refractory to medical therapy.

Design We retrospectively reviewed the charts of 186 patients with HIV who required surgical treatment for sinusitis between 1987 and 1998. One hundred sicharts provided the necessary information and an adequate follow‐up to be included in the study. Collected data included preoperative and postoperative symptoms, radiographic staging, CD4 count at the time of surgery when available, and type and e‐tent of surgery.

Results Surgical treatment evolved over the 12 years from limited surgery to standard endoscopic sinus surgery (ESS). Eighteen patients had invasive fungal disease or complications of sinusitis requiring radical surgery. Thirty‐six patients were treated with minimal procedures to address involved sinuses only. These patients were treated between 1987 and 1991. Recurrent disease or further complications occurred in 80.6% of the patients in this group. Since 1992, 52 patients were treated with standard ESS following the same indications for HIV− patients. This group had an improvement of symptoms in 75% of the cases, a rate comparable to the success rate in HIV− patients.

Conclusions HIV+ patients undergoing standard ESS enjoy a satisfactory success rate. HIV+ patients with surgical indication for endoscopic sinus surgery should be treated as non‐HIV+ patients. Apparently, low CD4 count (< 100) does not serve as a contraindication for definitive surgery.
Prudent Management of the Mid‐Cheek Mass: Revisiting the Accessory Parotid Gland Tumor
Authors: Klotz Darrell A. , Coniglio John U.
Published: November 2003

Objectives/Hypothesis The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid‐cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided.

Study Design This is a retrospective review of our experience with four accessory parotid gland neoplasms and five other masses mimicking this lesion.

Methods A literature review and retrospective chart review.

Results Over a 6‐year period, we have encountered four true accessory lobe tumors, all pleomorphic adenomas. These presented very similarly to four other more commonly encountered masses not of salivary origin and one normal but hyperplastic accessory parotid gland. All were removed through a wide parotidectomy‐style approach modified by extending incisions anterosuperiorly and inferoanteriorly. The only complication was a minor salivary fistula in one patient. There were no permanent facial paralyses.

Conclusions Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid‐cheek masses. A high index of suspicion, prudent diagnostic skills (including fine‐needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and meticulous surgical approach (extended parotidectomy‐style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.
Incidence of Unsuspected Metastases in Lateral Cervical Cysts
Authors: Gourin Christine G. , Johnson Jonas T.
Published: November 2003

Objective Solitary cystic squamous cell carcinoma metastases may be difficult to distinguish clinically from a benign cervical cyst. We sought to identify the incidence of solitary cystic squamous cell carcinoma metastasis in patients presenting with apparently benign cervical cysts.

Study Design Retrospective review.

Methods The records of all patients who presented with isolated lateral cervical cysts between 1983 and 1999 were reviewed. Patients with a clinically apparent primary malignancy, a history of head and neck cancer, a history of irradiation, or age less than 18 years were excluded from analysis, as were patients with a histological diagnosis of nonsquamous cell malignancy or those without a final histological diagnosis.

Results One hundred twenty‐one adult patients presented with an initial diagnosis of lateral cervical cyst. Metastatic squamous cell carcinoma was demonstrated histologically after surgical excision in 12 patients (9.9%). The incidence of malignancy was significantly greater in patients greater than 40 years of age (23.5%, P < .0001). Results of preoperative fine‐needle aspiration (FNA) were negative for malignancy in five cases of metastatic squamous cell carcinoma. Panendoscopy with directed biopsies revealed an occult primary in the base of tongue in three patients, tonsil in one patient, and nasopharynx in one. No primary was found in six patients, despite repeated examinations and close follow‐up.

Conclusions Solitary cervical cysts in patients older than 40 years of age should be presumed to be carcinoma until proven otherwise. A negative FNA result may be misleading, because of hypocellularity of the cyst fluid. Excisional biopsy should be undertaken with provisions made for frozen‐section analysis of the specimen and contingency panendoscopy with directed biopsies of Waldeyer's ring if frozen‐section histological examination reveals malignancy.
Value of Antral Puncture in the Intensive Care Patient With Fever of Unknown Origin
Authors: Vandenbussche T. , De Moor S. , Bachert C. , Van Cauwenberge P.
Published: November 2003

Objective To evaluate the use of maxillary sinus puncture as a routine diagnostic procedure to exclude or confirm purulent sinusitis in intensive care unit (ICU) patients presenting with fever or a septic state of unknown origin.

Study Design Retrospective.

Methods All patients admitted to the ICU at the University Hospital Ghent who required ENT examination to exclude acute sinusitis as possible cause of their otherwise inexplicable fever or septic state underwent maxillary sinus puncture via the inferior meatus. The results of clinical examination and the relation between the presence of foreign bodies (e.g., nasogastric tubes) and culture results from the middle meatus and sinuses were analyzed.

Results One hundred five punctures were performed in 53 patients. Macroscopic purulent effusions were obtained from 25 and nonpurulent effusions from 19 sinuses. The presence of a nasogastric tube did not influence puncture results but significantly increased colonization of the middle meatus. Staphylococcus aureus and Gram‐negative agents were frequently cultured from sinus aspirates. Although purulent secretions often reveal no growth, most patients present with a multibacterial (40%) or monobacterial (28%) infection. Simple anterior rhinoscopy reduces the need for antral puncture. Only 8% of punctures in patients with a normal clinical examination were positive.

Conclusions Antral puncture proves to be a simple, fast, safe, inexpensive, and effective procedure for immediate diagnosis of acute nosocomial sinusitis in ICU patients and is therefore recommended as first procedure in these patients, even when only minor clinical abnormalities are present.
Sinonasal Disease and Olfactory Impairment in HIV Disease: Endoscopic Sinus Surgery and Outcome Measures
Authors: Murphy Claire , Davidson Terence M. , Jellison William , Austin Shaun , Christopher Mathews W. , Ellison Dennard W. , Schlotfeldt Christina
Published: November 2003

Objectives To investigate the effects of ESS (ESS) on olfactory impairment, disease‐specific symptoms, and general quality of well‐being In HIV+ patients with sinonasal disease.

Study Design Study 1: Nasal cytology, rhinomanometry, nasal examination including endoscopy, disease‐specific sinonasal symptoms, olfactory threshold sensitivity, and odor identification testing were performed before and after ESS in HIV+ patients with sinonasal complaints. Study 2: Quality of well‐being was assessed before and after ESS in HIV+ patients with sinonasal complaints and controls.

Results Significant olfactory sensitivity loss persisted for patients with chronic sinusitis after ESS, suggesting that the impairment in these patients may be due to viral disease rather than inflammation. Significant improvement in other disease‐specific symptom scores (nasal obstruction, nasal congestion, headache, sinus pain, etc.) and results of the general quality of well‐being assessment showed ESS to be beneficial in the extended health management of HIV illness.

Conclusions The current study indicated both olfactory dysfunction and subjective negative symptoms in HIV+ patients with chronic sinusitis. Although olfactory dysfunction remained, ESS was successful in providing marked alleviation of symptomatology in HIV+ patients with chronic sinusitis. The results support ESS as an appropriate treatment option for HIV+ patients with chronic sinusitis.
Clinical Course of Pediatric Congenital Inner Ear Malformations
Authors: Park Albert H. , Kou Brenda , Hotaling Andrew , Azar‐Kia Behrooz , Leonetti John , Papsin Blake
Published: November 2003

Objective To determine any factors that could improve the early detection and management of congenital inner ear malformations.

Study Design A retrospective review was performed of all patients with a diagnosis of inner ear malformation at Loyola University Medical Center (LUMC) and the Hospital for Sick Children (HSC) between 1987 and 1995. Clinical records and audiometric data were accumulated. One neuroradiologist reviewed every temporal bone computed tomography (CT) scan.

Methods Forty‐six pediatric patients with congenital inner ear anomalies evaluated at two tertiary care hospitals.

Results The average patient age at initial assessment was 25.7 months. A family history of hearing loss was noted in only five patients (12.8%). A major nonotological deformity was seen in 41% of patients. The average hearing threshold was 88 dB. All three patients with sudden hearing loss had vestibular aqueduct enlargement. Two of the three patients with common cavity anomalies had a history of recurrent meningitis. Twenty‐seven patients had a vestibular aqueduct deformity, the most frequent radiographic abnormality in the series.

Conclusions Because inner ear malformation was diagnosed after 24 months of age in a significant percentage of patients, we recommend increased parental education and vigilance by primary care practitioners. Universal newborn screening may be the key to earlier detection of these infants. For children with idiopathic sensorineural hearing loss, we recommend a temporal bone CT scan. Patients with vestibular aqueduct enlargement must be counseled about the risk of progressive sensorineural hearing loss, meningitis, and the need to avoid contact sports. Patients with common cavity abnormalities should be considered for exploratory tympanotomy and also educated about the risk for meningitis.
New Options for Aerodigestive Tract Replacement After Extended Pharyngolaryngectomy
Authors: Succo Giovanni , Mioli Pierroberto , Merlino Giorgio , Sartoris Alberto
Published: November 2003

Objectives Assess the results of a new type of reconstruction of the aerodigestive tract after extended pharyngolaryngectomy.

Study Design Follow‐up of a total of eight patients who had surgery using ileocolic free graft.

Methods The surgical technique is described. Five patients underwent pharyngolaryngectomy/cervical esophagectomy, and three patients had total laryngectomy with subtotal pharyngectomy. Patients were monitored to assess complications and recovery of satisfactory swallowing and speech.

Results The technique, thanks to the use of material from the colon, proved to be extremely useful for the reconstruction of the digestive tract. At the same time, ileal anastomosis with the tracheal stump enabled aerodigestive crossing restoration, protected by the ileocecal valve. All patients recovered good swallowing capacity and phoniatric expression, which were obtained by digital occlusion of the tracheostomy, forcing the expiratory air through the ileum and ileocecal valve. Manometric tests also showed that after a while there was a gradual synchronization of swallowing between the transplanted colic segment and the residual esophagus.

Conclusions The technique described in the present study may be regarded, also in the light of possible further applications, as a new and interesting option for the reconstruction of the aerodigestive tract.
Raman Spectroscopy for Early Detection of Laryngeal Malignancy: Preliminary Results
Authors: Stone Nicholas , Stavroulaki Pela , Kendall Catherine , Birchall Martin , Barr Hugh
Published: November 2003

Objective Raman spectroscopy, the analysis of scattered photons after monochromatic laser excitation, is well established in nonbiological sciences. Recently this method has been used to differentiate premalignant and malignant lesions from normal tissue. Its application for early diagnosis has been explored in a variety of sites (e.g., esophagus, cervix), but not, to date, in laryngeal cancer. The objective of this study was to perform a feasibility study of the use of Raman spectroscopy for early diagnosis of laryngeal malignancy.

Methods Biopsy specimens were snap‐frozen, and top sections were sent for histopathological analysis. Only homogenous samples with clearly defined pathological findings were used in this study: seven histologically normal samples, four exhibiting dysplasia, and four with carcinoma. Samples were defrosted and placed under a Renishaw (Wotton‐Under‐Edge, UK) System 1000 Raman microspectrometer for analysis. Between 5 and 12 spectra were acquired from each sample, with an excitation wavelength of 830 nm. Average characteristic spectra for each disease or condition were compared. Further multivariate statistical analysis of the data was carried out to evaluate and maximize the differences in the spectra for each disease or condition.

Results The most visible differences in the spectra occur between 850 and 950 cm−1 and 1200 and 1350 cm−1. The later peaks are directly related to protein conformation and C‐H bond stretch in nucleic acid bases. The relative intensity of the nucleic acid peak increases with progression to malignancy. Use of linear discriminant analysis made it possible to separate the spectra with disease to a greater degree of accuracy than using empirical peak ratio methods alone. Classification results obtained from cross‐validation of the discriminant model showed prediction sensitivities of 83%, 76%, and 92% and specificities of 94%, 91%, and 90% for normal, dysplastic, and squamous cell carcinoma of the larynx, respectively.

Conclusions There was strong evidence to support spectral identification of malignancy and earlier abnormal changes. More substantive studies of the spectral differences between malignant and non‐neoplastic tissue are warranted. Raman spectroscopy may become a useful adjunct to pathological diagnosis allowing directed or guided biopsies and assessment of adequacy of resection margins.
Incidence of Carcinoma in Incidental Tonsil Asymmetry
Authors: Syms Mark J. , Birkmire‐Peters Deborah P. , Holtel Michael R.
Published: November 2003

Objective To determine the incidence of malignancy in patients with incidentally discovered unilateral tonsillar enlargement with an otherwise normal physical examination.

Study Design A retrospective review of our institution's experience with unilateral tonsillar enlargement.

Results During a five‐year period, 570 patients underwent tonsillectomy at our institution. Of patients undergoing tonsillectomy, 49 patients (8.6%) underwent tonsillectomy with normal mucosa, no lymphadenopathy, and asymmetry of the tonsils. Two (4.8%) of the 49 patients with unilateral enlargement had the presence of malignancy. The two adult patients had B‐cell lymphoma. Of all of the patients undergoing tonsillectomy, 0.35% had occult malignancy. In additional, the ability of the clinically assessed size (1+, 2+, 3+, and 4+) to predict volume was evaluated. The clinically assessed size and pathologically measured volume were significantly correlated (R = 0.333, P < .013). In 60.5% of the patients, the clinically assessed size and the pathologically measured volume agreed with the asymmetry reported on physical examination.

Conclusion A relatively high number of tonsillectomies will be performed to yield an approximately 5% positive rate of malignancy within removed tonsils that are asymmetrical with normal mucosa and no cervical adenopathy.
Pursestring Closure of Radial Forearm Fasciocutaneous Donor Sites
Authors: Winslow Catherine P. , Hansen Juliana , Mackenzie Doug , Cohen James I. , Wax Mark K.
Published: November 2003

Background The radial forearm fasciocutaneous free flap has become one of the most common methods of reconstructing defects after head and neck ablative surgery. The fasciocutaneous flap is an excellent replacement for the tissue that has been removed. Unfortunately, donor site morbidity remains a problem. Donor site morbidity is primarily related to poor skin graft take, cosmesis, and neural dysfunction. Decreasing the size of the donor site defect may allow for improved cosmesis with decreased morbidity.

Material and Methods Prospective evaluation of a pursestring closure of radial forearm fasciocutaneous donor sites over a 16‐month period.

Results Seventy‐one radial forearm free flaps were used. Sixty‐seven had a pursestring closure of the donor site. After flap elevation the mean size of the defect was 61 cm2 (range, 28–140 cm2). Pursestring closure decreased the mean of the defect to 34 cm2 (range, 10–104 cm2) (P <.0001). Defect size was decreased by a mean of 44.5% (range, 24.5%–66.7%) (P <.0001).

Complications The rate of skin graft loss (>25%) (9% of patients) was less than that reported in the literature. No patient required a second surgical procedure. Neural morbidity was equal in both groups. Cosmesis was much improved.

Conclusions Pursestring closure allowed for a significantly decreased donor defect, associated with better cosmesis and less skin graft loss.
Autonomic Nervous System Evaluation of Patients With Vasomotor Rhinitis
Authors: Jaradeh Safwan S. , Smith Timothy L. , Torrico Laura , Prieto Thomas E. , Loehrl Todd A. , Darling Ronald J. , Toohill Robert J.
Published: November 2003

Objective To demonstrate the utility of quantitative neurological laboratory testing of autonomic nervous system dysfunction and to apply this methodology to further study the relation of chronic vasomotor (nonallergic) rhinitis to the autonomic nervous system.

Methods It has been suspected that vasomotor rhinitis is due either to a hyperactive parasympathetic nervous system or an imbalance between it and the sympathetic nervous system. The exact relation has not been determined. Recently neurological laboratories have been developed in which a battery of tests can be performed to determine reactivity of the autonomic nervous system.

Results Autonomic nervous system testing was performed on 19 patients with symptoms fulfilling the diagnostic criteria for vasomotor rhinitis and the results were compared with 75 sex‐ and age‐matched control subjects. Patients with vasomotor rhinitis had significant abnormalities of their sudomotor, cardiovagal, and adrenergic subscores. Their composite autonomic scale score was significantly impaired at 2.43, as compared with 0.11 for controls (P < .005).

Conclusion Autonomic nervous system dysfunction is significant in patients with vasomotor rhinitis. Possible factors that trigger this dysfunction including nasal trauma and extraesophageal manifestations of gastroesophageal reflux are discussed.
A New Pathogenesis of Mesotympanic (Congenital) Cholesteatoma
Authors: Tos Mirko
Published: November 2003

Objectives To introduce a new, acquired pathogenetic theory of mesotympanic cholesteatoma behind an intact eardrum in children and to present some doubts on congenital pathogenesis.

Study Design Literature review.

Methods The incidence and origination of mesotympanic cholesteatoma in children were thoroughly analyzed in the world literature and correlated to the histopathological studies on human middle ear epithelia and to epidemiological studies on secretory otitis, tubal occlusion, and acute suppurative otitis media.

Results The new, acquired theory is based on the fact that that the place of origin of the anterosuperior mesotympanic cholesteatoma is the area of the malleus handle and malleus neck, and of the posterosuperior cholesteatoma, the long process of the incus. During the common pathological conditions there is a great risk of retractions and adhesions of the eardrum to these ossicles. After subsequent loosening of the retracted eardrum some cells of the keratinized squamous epithelium may be left behind and become included into the tympanic cavity, eventually causing an inclusion cholesteatoma. Four basic mechanisms of inclusions are proposed and the presence of great dynamics in middle ear disease in children, with high incidence of tubal dysfunction, retractions, secretory otitis, and acute suppurative otitis, is documented, making the acquired pathogenesis probable. The place of origin does not fit with the congenital pathogenesis of epithelial formation localized on the lateral wall of the eustachian tube close to the annulus. The origination around the malleus and incus fits better with the proposed acquired pathogenesis.

Conclusions There are no definitive proofs for the acquired pathogenesis of the mesotympanic cholesteatoma, nor is there e‐perimental research to prove or disprove it.
Role of Topical Steroids in Reducing Dysfunction After Nerve Injury
Authors: Galloway Edgar B. , Jensen Randy L. , Dailey Andrew T. , Gregory Thompson B. , Shelton Clough
Published: November 2003

Objective To determine the efficacy of topical dexamethasone in reducing nerve dysfunction after axonotmesis injury.

Study Design A three‐armed, blinded study including sham, control, and test groups was designed using the rat sciatic nerve crush injury model.

Methods Twenty‐two rats were randomly assigned to a control group or a topical steroid group. A standardized sciatic nerve crush injury was performed under sterile conditions on each animal. A separate group of five rats underwent a sham operation to isolate the crush injury as the source of postoperative dysfunction in the control and steroid groups. All animals underwent walking track analysis with calculation of the sciatic functional index (SFI) before surgery and through the postoperative recovery period. Dexamethasone saturated Gelfoam was placed at the site of injury in the topical steroid group. The functional performance of each group was compared throughout the recovery period.

Results No morbidity associated with topical application of steroids at the injury site was noted. The topical steroid group had improved recovery at postoperative days 14, 18, and 22. This difference was statistically significant at day 14. At the termination of the study, there was a clear trend toward superior recovery for the steroid group compared with controls (90% vs. 73%), but this difference did not reach statistical significance.

Conclusions Clinical use of topical steroids to reduce postoperative nerve dysfunction warrants further study.
An Evaluation of Fibrin Tissue Adhesive Concentration and Application Thickness on Skin Graft Survival
Authors: O'Grady Kevin M. , Agrawal Amit , Bhattacharyya Tapan K. , Shah Ami , Toriumi Dean M.
Published: November 2003

Objectives To e‐amine the effects of fibrinogen concentration and application thickness of fibrin tissue adhesive on skin graft survival.

Study Design Prospective controlled study.

Methods Ten domestic pigs were included in the study. A 20 − 5‐cm area of skin was harvested bilaterally along the flanks of the animals using a Padgett dermatome. The harvested grafts were trimmed into four 4 − 4‐cm squares. Donor sites were treated according to group assignment and the non‐meshed grafts were placed on the side opposite their initial orientation and secured with staples. Both single‐ and multiple‐donor human fibrin tissue adhesive preparations, with low and high average fibrinogen concentrations of 30 mg/mL and 60 mg/mL, were used. Adhesive preparations were applied in either a thin layer (0.015 mL/cm2) or a thick layer (0.06 mL/cm2) using a spray applicator. A constant thrombin concentration of 10 U/mL was used in the study. No adhesive was used in the control group and grafts were stabilized with staples. No topical dressings were applied to any of the treatment sites. Animals were sacrificed 4 weeks after graft application.

Results Based on statistical analysis, thickness of adhesive application had a significant effect on skin graft survival. Percent mean graft survival in the control and thin application groups was found to be 92% and 97.8% respectively; the mean survival rate in the thick application group was 63.1%. Fibrinogen concentration, when evaluated independently within the thin and thick application groups, was found to have no significant effect on graft survival.

Conclusion Independent of fibrinogen concentration, a thin layer of fibrin tissue adhesive, when applied between two opposing surfaces, does not interfere with and may support the healing process, whereas a thick layer of adhesive inhibits skin graft healing.
Rationale for Intralesional Valrubicin in Chemoradiation of Squamous Cell Carcinoma of the Head and Neck
Authors: Wani Manish K. , Koseki Yoshihiro , Yarber Robert H. , Sweatman Trevor W. , Ahmed Asif , Samant Sanjiv , Hengesteg Arne , Israel Mervyn , Thomas Robbins K.
Published: November 2003

Objectives/Hypothesis With some advanced squamous cell carcinomas (SCCs) of the head and neck, chemoradiation therapy may obviate the need for surgical intervention. However, both modalities are known to produce organ to‐icities, and tumor insensitivity remains problematic. Thus there is a clear need for the development of new treatment strategies. Accordingly, preclinical studies to evaluate the use of valrubicin, a contact‐safe, mechanistically novel antitumor agent, combined with low‐dose radiation for the therapy of SCC have been conducted.

Methods The comparative in vitro antitumor activities of valrubicin with or without irradiation versus cisplatin were evaluated using human‐derived sensitive and cisplatin‐resistant SCC cell lines. A hamster cheek pouch model of SCC was used to assess the efficacy of weekly intratumoral valrubicin injections with and without concurrent low‐dose irradiation.

Results Valrubicin cytoto‐icity was found to be comparable in both sensitive and platinum‐resistant cell lines and superior to cisplatin. The addition of minimally cytoto‐ic cell irradiation (300–450 cGy) resulted in prolonged G2/M cell cycle arrest and a supra‐additive increase in apoptotic cell death. In hamsters, once a week × 3 intratumoral drug injections (3, 6, or 9 mg) were growth inhibitory; however, when valrubicin (6 mg) was combined with minimally cytotoxic irradiation (150, 250, or 350 cGy) significant tumor shrinkage was observed.

Conclusions Valrubicin produces supra‐additive effects against SCC when combined with low‐dose irradiation. This effect appears to correlate with the ability of valrubicin, a cytoplasmic‐localizing drug, to inhibit protein kinase C. Therapeutic use of valrubicin against SCC could provide for reduced radiation doses with consequent improved efficacy and reduction in host to‐icity.
Reliability of Frozen Section in Determining Tumor Thickness Intraoperatively in Laryngeal Cancer
Authors: Dadaş Burhan , Başak Tülay , Özdemir Tuncay , Polat Nedim , Turgut Suat
Published: November 2003

Objectives The relationship between locoregional lymph metastasis and tumor thickness in head and neck cancer has been well documented in recent years. Determining tumor thickness by frozen section may help the surgeon decide intraoperatively whether to perform elective neck dissection, whereas paraffin section results could be obtained at a later time for this decision. The aim of this study was to evaluate the accuracy of tumor thickness measurements obtained by macroscopic measurement and by frozen section intraoperatively in laryngeal cancer.

Study Design Prospectively we compared the tumor thickness results obtained by gross visual examination, by frozen section, and by paraffin section in 20 total, near‐total, and horizontal supraglottic laryngectomy specimens.

Methods The sections were stained with hematoxylin and eosin and tumor thickness was measured under a light microscope with an ocular micrometer.

Results A strong correlation was found between frozen section and paraffin section tumor thickness measurements (Pearson correlation coefficient = 0.993, P <.001). Paired t test showed a 4.59 mm mean difference between macroscopic and paraffin section measurements, and a 0.76 mm mean difference between frozen and paraffin section measurements.

Conclusion Assessment of tumor thickness in laryngeal cancer intraoperatively by frozen section is a reliable method.
Vocal Fold Vibrations: High‐Speed Imaging, Kymography, and Acoustic Analysis: A Preliminary Report
Authors: Larsson Hans , Hertegård Stellan , Lindestad Per‐Åke , Hammarberg Britta
Published: November 2003

Objectives To evaluate a new analysis system, High‐Speed Tool Box (H. Larsson, custom‐made program for image analysis, version 1.1, Department of Logopedics and Phoniatrics, Huddinge University Hospital, Huddinge, Sweden, 1998) for studying vocal fold vibrations using a high‐speed camera and to relate findings from these analyses to sound characteristics.

Study Design A Weinberger Speedcam + 500 system (Weinberger AG, Dietikon, Switzerland) was used with a frame rate of 1904 frames per second. Images were stored and analyzed digitally. Analysis included automatic glottal edge detection and calculation of glottal area variations, as well as kymography. These signals were compared with acoustic waveforms using the Soundswell program (Hitech Development AB, Stockholm, Sweden).

Methods The High‐Speed Tool Box was applied on two types of high‐speed recordings: a diplophonic phonation and a tremor voice. Relations between glottal vibratory patterns and the sound waveform were analyzed.

Results In the diplophonic phonation, the glottal area waveform, as well as the kymogram, showed a specific pattern of repetitive glottal closures, which was also seen in the acoustic waveform. In the tremor voice, fundamental frequency (F0) fluctuations in the acoustic waveform were reflected in slow variations in amplitude in the glottal area waveform. For studying details of mucosal movements during these kinds of abnormal vibrations, the glottal area waveform was particularly useful.

Conclusions Our results suggest that this combined high‐speed acoustic‐kymographic analysis package is a promising aid for separating and specifying different voice qualities such as diplophonia and voice tremor. Apart from clinical use, this finding should be of help for specification of the terminology of different voice qualities.
Expression of Fibroblast Growth Factor‐2 in the Nucleus Ambiguus Following Recurrent Laryngeal Nerve Injury in the Rat
Authors: Sanuki Tetsuji , Yumoto Eiji , Komori Masahiro , Hyodo Masamitsu
Published: November 2003

Objectives To examine fibroblast growth factor‐2 (FGF‐2) immunoreactivity in the nucleus ambiguus (NA) after three different recurrent laryngeal nerve (RLN) injuries.

Study Design Immunohistochemical analysis of FGF‐2.

Methods Thirty adult rats underwent left‐sided RLN crush (group A). The left RLN was transected in groups B (n = 30) and C (n = 30); in group C, both nerve stumps were covered with silicone caps. FGF‐2 in the NA was assessed as the ratio of the positive areas on the left (operated [O]) and right (unoperated [U]) sides. The ratio (O/U) was measured 1, 3, 7, 14, and 28 days after the procedure. Three rats underwent left‐sided RLN exposure and were killed 7 days later (control).

Results Left‐sided RLN paralysis occurred until day 28 in group A. In the control group, O/U was approximately 1. In group A, O/U was significantly elevated on day 7; in group B, on days 3, 7, and 14; and in group C, on day 3. O/U in group B was significantly greater than that in group A on days 14 and 28. Maximal FGF‐2 immunoreactivity was significantly lower in group C than in groups A and B.

Conclusions We demonstrated elevated production of FGF‐2 in the NA after RLN injury. This endogenous FGF‐2 might contribute to preventing lesion‐induced neuronal death. Blockage of axonal regeneration might suppress FGF‐2 production in the NA. Further understanding of the roles of FGF‐2 after RLN in‐jury may contribute to the prevention of neuronal death and facilitation of axonal regeneration.
Pediatric Fluctuating Sensorineural Hearing Loss: Problems in Medical Management
Authors: Dinces Elizabeth A. , Yang Steven , Balogun Anifat O.
Published: November 2003

Objectives To discuss the diagnosis and management of children with fluctuating sensorineural hearing loss, especially focusing on those problems dealing with autoimmune inner ear disease.

Study Design A retrospective chart review of a large pediatric otolaryngology practice. A series of 40 children with progressive hearing losses was identified. Of that group, 22 children, aged 1.5 to 12.2 years at first audiogram, were considered to have fluctuating sensorineural hearing loss (FSNHL). Criteria for inclusion in the FSNHL group were threshold variations of 15 dB or more in at least one ear at two or more of the standard audiometric frequencies on at least 2 testing days.

Methods Charts were reviewed for age, sex, otologic history, laboratory evaluations, medical or surgical treatments, significant medical history, and family medical history.

Results Twenty‐two children met the criteria for fluctuating sensorineural hearing loss. Of those with fluctuating hearing loss, 15 were idiopathic, 3 had positive lymphocyte transformation tests (LTT) suggestive of autoimmune inner ear disease (AIED), and 4 had fistula on middle ear exploration. Average fluctuation for all groups was 29.1 dB. Average duration of fluctuations was 4.95 years.

Conclusions The majority of pediatric FSNHL cases (15 of 22) were idiopathic in nature. Of those FSNHL children with positive LTTs, only one was treated with steroid therapy. In the other patients with positive LTTs, parents or other physicians were often reluctant to treat, or the patient was lost to follow‐up. Mean fluctuations varied substantially across all standard audiometric frequencies for all groups.
A Histologic Analysis of Three‐Dimensional Versus Two‐Dimensional Tissue Expansion in the Porcine Model
Authors: Alex James C. , Bhattacharyya Tapan K. , Smyrniotis George , O'Grady Kevin , Konior Raymond J. , Toriumi Dean M.
Published: November 2003

Objective Recently, a two‐dimensional Silastic Dacron stretching skin device has been developed for scalp reduction surgery. Attached subgaleally, this device stretches skin over time, while avoiding the visible volumetric distention that is typical of three‐dimensional tissue expanders. Unlike three‐dimensional expanders, the histological changes observed with a two‐dimensional stretching device have not been described in the literature. The present study compares the histological effects of two‐dimensional and three‐dimensional skin tissue expansion in the porcine model.

Study Design A university Institutional Review Board–approved study in which 16 domestic piglets were used. The 16 piglets were divided evenly into four cohorts as follows: 1, 1‐week control cohort; 2, 1‐week experimental cohort; 3, 4‐week control cohort; and 4, 4‐week experi‐mental cohort.

Methods Tissue expanders (three‐dimensional) and Dacron Silastic tissue stretchers (two‐dimensional) were surgically inserted into the lateral skin of 16 domestic pigs. Animals were killed at either 1 or 4 weeks based on group assignment. Light microscopic ocular micrometry and stereological point counting were used to determine the depth of the epidermis, dermis, and subdermal adipose tissue layer; width of the panniculus muscle; diameter of sweat gland follicles; percentage ratio of dermal collagen, blood vessels, and tissue space; and epidermal mitotic index in 100 specimens. One‐way ANOVA was used to evaluate statistical differences.

Results Both tissue expanders yielded increased values compared with control subjects, with respect to epidermal, dermal, and fat widths and blood vessel counts, whereas adnexal structures in the panniculus muscle width were unaltered.

Conclusions Although statistically the two types of expansion produced histologically similar changes, the degree of change varied according to the type of expander that was used and the duration of tissue expansion. Most notably, three‐dimensional expansion produced more tissue gain per unit area expanded at both the 1‐week and the 4‐week time intervals, and early (1‐week) two‐dimensional tissue expansion stimulated a greater angiogenic response than three‐dimensional expansion. These findings will assist the surgeon in understanding the physical changes that occur with these two forms of tissue expansion, as well as the potential clinical advantages and shortcomings of each method.