bluuebunny/crossref_metadata_2025 huggingface dataset:
Connection Between the Inner Ear and the Lymphatic System
Authors: Yimtae Kwanchanok , Song Haitao , Billings Peter , Harris Jeffrey P. , Keithley Elizabeth M.
Published: November 2003

Objective The aim of this study was to identify the lymphatic drainage of the inner ear in guinea pigs.

Study Design Prospective study.

Methods The prospective study was performed in guinea pigs by injection of keyhole limpet hemocyanin (KLH) into either the right‐side scala tympani or the middle ear cavity. The left side was not injected and served as a control. Fifteen minutes after injection, the animals were killed by intracardiac perfusion with paraformaldehyde and tissue specimens (right and left temporal bones, cervical lymph nodes, and the spleen) were collected. The presence of KLH in each specimen was determined by immunohistochemical assay of frozen sections using polyclonal mouse anti‐KLH antibodies.

Results After injection into the middle ear, labeled cells were identified in the parotid, superficial ventral, mandibular, and deep cranial cervical lymph nodes. However, after inner ear injections KLH was present in only the parotid and superficial ventral cervical nodes. The spleen contained KLH‐positive cells following injection into either the middle or inner ear, but not all animals contained labeled spleen cells.

Conclusions The inner ear has a connection to the lymphatic drainage system. Because fewer lymph nodes contained labeled cells after inner ear injection than after middle ear injection, it is concluded that the inner ear does not simply drain to the middle ear and subsequently to the lymph nodes but seems likely to have its own connections.
Timing of Endoscopic Sinus Surgery in Children: Is There an Impact on Outcome?
Authors: Ramadan Hassan H.
Published: November 2003

Objectives/Hypothesis Endoscopic sinus surgery in children continues to be a controversial issue. Major factors in determining when to operate are the duration of the disease and duration of medical treatment.

Study Design Prospective study of children referred to a tertiary center.

Patients and Methods Eighty‐three patients underwent endoscopic sinus surgery for refractory chronic sinusitis. All patients were followed prospectively to evaluate their response to surgery for a mean follow‐up period of at least 1 year. A χ2 analysis and logistic regression analysis were performed to determine statistical difference between duration of symptoms and outcome.

Results The overall success rate of endoscopic sinus surgery was 80%. Children who had surgery between 6 and 12 months of symptoms despite continued medical therapy had an 84% success rate, those who had surgery between 12 and 18 months had a 74% success rate, and those with more than 18 months of treatment for symptoms had an 81% success rate (P >.05).

Conclusions Duration of the symptoms of chronic sinusitis in children of more than 6 months was not a predictor of success of endoscopic sinus surgery in these children. Although there seemed to be a trend toward having a more successful procedure in children who had surgery between 6 and 12 months of medical treatment versus those who had surgery after more than 12 months of medical treatment, this did not reach statistical significance. A prospective study with more patients may shed more light on this subject.
The Temporalis Muscle Flap for Reconstruction After Head and Neck Oncologic Surgery
Authors: Hanasono Matthew M. , Utley David S. , Goode Richard L.
Published: November 2003

Objective To explain the applications, technique, and potential complications of the temporalis muscle flap used for immediate or delayed reconstruction of head and neck oncologic defects.

Study Design Fresh cadaver dissection and 5‐year retrospective chart review.

Methods A fresh cadaver dissection was performed to illustrate the surgical anatomy of the temporalis muscle flap with attention to specific techniques useful in avoiding donor site morbidity (facial nerve injury and temporal hollowing). A chart review was performed for 13 consecutive patients from the last 5 years who underwent temporalis muscle flap reconstruction after oncologic resection of the lateral and posterior pharyngeal wall, hard and soft palate, buccal space, retromolar trigone, and skull base.

Results Patient follow‐up ranged from 2 to 45 months. Nine patients had radiation therapy. There were no cases of flap loss. Resection of the zygomatic arch followed by wire fixation facilitates flap rotation and minimizes trauma to the flap during placement into the oropharynx. Preservation of the temporal fat pad attachment to the scalp flap decreases temporal hollowing and protects the facial nerve. Replacing the zygoma and preserving the anterior third of the temporalis muscle in situ further diminishes donor‐site hollowing.

Conclusions Compared with other regional flaps, such as the pectoralis myocutaneous flap, the temporalis muscle flap is associated with low donor‐site esthetic and functional morbidity and offers great flexibility in reconstruction. The temporalis muscle flap is a useful, reliable flap that belongs in the armamentarium of surgeons who are involved with reconstruction of head and neck tissue defects.
The Microbiology of Mucopyocele
Authors: Brook Itzhak , Frazier Edith H.
Published: November 2003

Objective To evaluate the aerobic and anaerobic microbiology of mucopyocele.

Study Design Retrospective review of clinical and microbiologic records of patients with mucopyocele between June 1982 and September 1997.

Methods Aspirates of 36 mucopyocele were processed for aerobic and anaerobic bacteria.

Results One hundred six bacterial isolates, 42 aerobic and facultatives and 64 anaerobic, were recovered. The predominant aerobic isolates were Staphylococcus aureus (6 isolates), alpha‐hemolytic streptococci (6), Hemophilus spp. (5), and Gram‐negative bacilli (6). The predominant anaerobes were Peptostreptococcus sp. (22), Prevotella sp. (15), Fusobacterium sp. (5), and Propionibacterium acnes (5). Thirty‐three β‐lactamase‐producing bacteria were isolated from 23 patients.

Conclusions These findings illustrate the polymicrobial aerobic and anaerobic bacteriology of mucopyocele.
Endoscopic Removal of the Antral Portion of Antrochoanal Polyp by Powered Instrumentation
Authors: Hong Soon Kwan , Min Yang‐Gi , Kim Chong Nahm , Byun Sung Wan
Published: November 2003

Objectives To introduce a new surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by measures of relevant patient outcome.

Study Design Prospective study in 28 patients undergoing endoscopic sinus surgery for ACP by our surgical technique.

Methods Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow‐up period ranging from 12 to 52 months. All symptom scores on a 100‐mm visual analogue scale before operation were compared with those at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three‐point scale ranging from 0 to 2. In surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa.

Results Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow‐up period. There were no major complications specific to this technique.

Conclusion Our technique provides an attractive alternative to other methods for removing the antral portion of an ACP and is associated with excellent outcomes and minimal morbidities.
Radiofrequency Treatment of Turbinate Hypertrophy in Subjects Using Continuous Positive Airway Pressure: A Randomized, Double‐Blind, Placebo‐Controlled Clinical Pilot Trial
Authors: Powell Nelson B. , Zonato Adriane I. , Weaver Edward M. , Li Kasey , Troell Robert , Riley Robert W. , Guilleminault Christian
Published: November 2003

Objectives To estimate the treatment effect of temperature‐controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep‐disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate.

Study Design Prospective, randomized, double‐blind, placebo‐controlled clinical pilot trial.

Methods Twenty‐two CPAP‐treated patients with SDB with turbinate hypertrophy were randomly assigned to either TCRF turbinate treatment (mean energy 415 ± 37 J/turbinate; n = 17) or placebo control (n = 5). Changes in nasal obstruction were evaluated between pretreatment and 4 weeks post‐treatment. The primary outcome assessed changes in the blinded examiners' findings of nasal obstruction on a visual analogue scale (VAS). Secondary outcomes included blinded patients' and unblinded examiner assessments of nasal obstruction (VAS), nightly CPAP use, adherence, and tolerance, along with sleepiness and general health status scales. The treatment group findings were subtracted from the changes in the placebo group to yield treatment effect.

Results The primary outcome treatment effect by VAS was ‐0.9 cm (95% confidence interval [CI], ‐2.4, 0.7), and beyond the placebo effect of ‐1.5 cm (95% CI: ‐3.4, 0.3). The secondary treatment effect of the unblinded examiner was ‐3.0 cm (95% CI, ‐4.9, ‐1.1). A beneficial treatment effect was also seen on every secondary outcome except general health status, but only self‐reported CPAP adherence (P = .03) was statistically significant.

Conclusions TCRF turbinate treatment appears to benefit nasal obstruction and CPAP treatment for SDB. Placebo control and double blinding are critical for establishing the true treatment effect. A future definitive trial is feasible to establish statistical significance of these findings.
Complications in Pediatric Tracheostomies
Authors: Carr Michele M. , Poje Christopher P. , Kingston Lucille , Kielma Donna , Heard Christopher
Published: November 2003

Objective To examine complications of pediatric tracheostomy.

Study Design Retrospective.

Methods Chart review of children undergoing tracheotomy or laryngeal diversion between 1990 and 1999.

Results Charts of 142 children were examined. Average age was 2.64 years (standard deviation [SD], 4.73 y) at surgery. Duration of tracheostomy was 2.08 years (SD, 1.72 y) for those decannulated, 3.12 years (SD, 2.5 y) for those still with a stoma, and length of follow‐up for the whole group was 4.14 years (SD, 8.69 y). At last follow‐up, 56% had a tracheostomy, 29% had none, and 15% had died; one death was tracheostomy‐related. Three percent had intraoperative complications, 11% had complications before the first tracheostomy tube change, and 63% had complications after the first tube change. Thirty‐four percent had a trial of decannulation; 85% of these were successful. Fifty‐four percent of those decannulated had complications. Number of complications was not related to duration of follow‐up. In‐hospital mortality was congruent to mortality predicted by PRISM (Pediatric Rate of Mortality) scores.

Conclusions Forty‐three percent had serious complications involving loss of the tracheostomy airway (tube occlusion or accidental decannulation) or requiring a separate surgical procedure. Deaths directly attributable to tracheostomy complications occurred in 0.7%.
A Unique Case of Bezold's Abscess Associated With Multiple Dural Sinus Thromboses
Authors: Zapanta Philip E. , Chi David H. , Faust Russell A.
Published: November 2003

Objectives/Hypothesis Bezold's abscess and dural sinus thromboses are rare complications of otitis media in the era of antibiotics. Although potentially fatal, they are treatable. We present a unique case report of Bezold's abscess in association with multiple dural sinus thromboses.

Study Design Single case report.

Methods A young female patient's clinical course is presented and discussed. We review the anatomy, incidence, pathogenesis, and treatment of Bezold's abscess and dural sinus thrombosis.

Results After mastoidectomy, neck exploration, broad‐spectrum intravenous antibiotics, and anticoagulation therapy, the patient recovered fully and has remained asymptomatic since her discharge from the hospital at 12 months' follow‐up.

Conclusions This is the first reported case of Bezold's abscess associated with a cavernous sinus thrombosis and the third reported case of Bezold's abscess associated with lateral sinus thrombosis. Despite its rarity, Bezold's abscess must be recognized and treated aggressively. Dural sinus thrombosis is relatively more common, and treatment of the underlying cause is essential. The diagnosis and rapid, aggressive treatment of these conditions are essential for an optimal clinical outcome.
Top 10 Reasons for Endoscopic Maxillary Sinus Surgery Failure
Authors: Richtsmeier William J.
Published: November 2003

Objective/Hypothesis Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell‐Luc procedure for correction of problems with the maxillary sinus. Unfortunately, a significant number of patients have persistent maxillary symptoms after one or more endoscopic sinus operations. Existing reviews of this issue have identified only a few general causes for surgical failure.

Methods The records of 85 patients presenting to the author over a 5‐year period with persistent maxillary sinus symptoms were reviewed.

Results In reviewing the causes of persistent disease requiring revision surgery, the author identified 10 categories of reasons for failure to improve. Many patients have multiple causes that could be individually or sequentially identified. Some problems associated with surgical failure were likely present at the time of initial presentation, whereas others were undoubtedly caused by the first surgical procedure. Ten reasons for maxillary sinus surgical failure identified were clustered into the following categories: 1) obstructed natural ostia, 2) disease in the anterior ethmoid or frontal sinus, 3) resistant organisms, 4) intrasinus foreign body, 5) incurable mucosal disease, 6) noncompliant patient, 7) wrong primary diagnosis, 8) maxillary osteitis, 9) mucus maltransport, and 10) fundamental immunodeficiency.

Conclusions A careful assessment of each patient with persistent maxillary sinus disease is central to understanding each specific patient and should include a careful history, a detailed endoscopic examination, repeat computed tomography imaging, culture of secretions, and possible revision surgery.
Ambulatory 24‐Hour Double‐Probe pH Monitoring: The Importance of Manometry
Authors: Johnson Paul E. , Koufman James A. , Nowak Lisa J. , Belafsky Peter C. , Postma Gregory N.
Published: November 2003

Objective Historically, manometry has been used for sphincter localization before ambulatory 24‐hour double‐probe pH monitoring to ensure accurate placement of the probes. Recently, direct‐vision placement (DVP), using transnasal fiberoptic laryngoscopy (TFL), has been offered as an alternative technique. Presumably, DVP might be used to precisely place the proximal (pharyngeal) pH probe; however, using DVP, there appears to be no way to accurately position the distal (esophageal) probe. The purpose of this study was to evaluate the accuracy of DVP for pH probe placement using manometric measurement as the gold standard.

Methods Thirty patients undergoing pH monitoring participated in this prospective study. Each subject underwent manometric examination of the esophagus to determine the precise location of the upper and lower esophageal sphincters (UES and LES). In addition, external anatomic landmarks were used to estimate interprobe distances. A physician blinded to the manometry results then placed a pH catheter using DVP so that the proximal probe was located just above the UES. The results were recorded and compared with those obtained by manometry.

Results Accurate DVP of the proximal pH probe was achieved in 70% (23 of 30) of the subjects. The use of external anatomic landmarks to estimate interprobe distance resulted in accurate positioning of the distal probe in only 40% (12 of 30) of the subjects. Using fixed interprobe distances of 15 cm and 20 cm, distal probe position accuracy was 3% (1 of 30) and 40% (12 of 30), respectively. Therefore, using DVP, the distal esophageal probe was in an incorrect position in 60% to 97% of subjects.

Conclusion For double‐probe pH monitoring, the proximal probe can be accurately positioned by DVP; however, there is no precise way to determine the interprobe distance required to correctly position the distal pH probe. Failure to accurately position the distal probe results in grossly inaccurate esophageal acid‐exposure times. Thus, manometry is needed to ensure valid double‐probe pH monitoring data.
Preoperative Computed Tomography Scans for Parotid Tumor Evaluation
Authors: Urquhart Andrew , Hutchins Lawrence G. , Berg Richard L.
Published: November 2003

Objective We sought to determine whether an advantage is obtained in the routine use of computed tomography (CT) scans in preoperative assessments of parotid tumors.

Methods A prospective study of 32 consecutive cases of patients who underwent evaluation for parotidectomies was performed. Twenty‐nine received preoperative CT scans. The scans were systematically reviewed to see if they correlated with the clinical findings. Specifically, we compared clinical and CT assessments of tumor size, location, density, and malignancy. Further comparisons were performed based on postoperative tissue pathology.

Results In our series of patients, routine preoperative CT scans resulted in the discovery of details not revealed on clinical examination: some masses were found to be extra‐parotid rather than primary parotid tumors, some tumors deemed to be deep were superficial, tumor density was more clearly identified, and certain pathology correlates were clarified. Most importantly, there were instances of detection of additional tumors in the same lobe, and in one instance in the opposite lobe, that were not otherwise noticed.

Conclusions To reduce errors of omission in the treatment of suspected parotid tumors, it would seem appropriate to consider the inclusion of CT scans for the routine preoperative evaluation of all parotid masses.
Value of Fine‐Needle Aspiration Cytology of Parotid Gland Masses
Authors: Zbären Peter , Schär Catherine , Hotz Michel A. , Loosli Heinz
Published: November 2003

Objective To evaluate the usefulness and accuracy of fine‐needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.

Study Design Retrospective chart review of patients undergoing FNAC.

Methods Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology–Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis.

Results Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true‐negative in 146 (64%), true‐positive in 39 (17%), false‐negative in 22 (9.8%) and false‐positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true‐positive) and 123 of 146 (84%) benign lesions (true‐negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively.

Conclusions Fine‐needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.
Mycobacterial Infection of the Head and Neck: Presentation and Diagnosis
Authors: Al‐Serhani Awad M.
Published: November 2003

Objective To increase the awareness of the different presentations of head and neck mycobacteriosis, especially in apparently immunocompetent patients, and discuss its diagnostic difficulties.

Study Design A retrospective analysis from an otolaryngology service in a university hospital.

Methods Retrospective analysis of head and neck mycobacterial infections diagnosed at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 1983 and 1997.

Results The study group consisted of 75 apparently immunocompetent patients (41 female and 34 male patients). The mean age at presentation was 32.6 years. Mycobacterial cervical lymphadenitis constituted 62 cases (82.7%); pharyngeal tuberculosis, 8 cases (10.7%); and sinonasal disease, 5 cases (6.7%). The presenting complaints were neck mass in 86.3%, nasal obstruction in 5.3%, sore throat or discomfort in 5.3%, and external nasal lesion in 4% of patients. There was a history of previous tuberculosis in 10 patients (13.3%), and 5 patients (6.7%) had history of contact with infected individuals. Constitutional symptoms were recorded in 24 cases (32%). The diagnosis was established on the basis of positive smear in 26.5% of patients and on the basis of positive culture in 33.3% of patients, and caseating granuloma consistent with tuberculosis was found in all patients.

Conclusion The present study is a report of a series of cases of mycobacterial infection of the head and neck in non‐immunocompromised patients. It presents diagnostic and therapeutic problems. Awareness of the different presentations, as well as development of modern, efficient diagnostic methods, is required.
A Hearing Preservation Technique for the Resection of Extensive Jugular Foramen Tumors
Authors: Kim Chang Jin , Yoo Seung Joo , Nam Soon Yuhl , Kim Sang Yoon
Published: November 2003

Objective To describe a modified surgical approach for patients who maintain hearing function with jugular foramen tumors that extend to the posterior cranial fossa and the neck.

Study Design A retrospective review of 6 patients with jugular foramen tumors that were resected by a combined suboccipital and infralabyrinthine–transcervicomastoid approach.

Methods A combined suboccipital and infralabyrinthine–transcervicomastoid approach is characterized as follows: 1) There is no ablation of ear structures except the infralabyrinthine mastoid bone; the auricle is retracted anteriorly while preserving the bony wall and skin of the ear canal. 2) After superficial parotidectomy, a limited length of nerve VII from the intratemporal vertical segment is rerouted to divisions of the parotid portion. 3) The tumor is removed along with the internal jugular vein and sigmoid sinus, then the extended intracranial mass is resected through an additional suboccipital approach.

Results Five of the 6 patients had complete removal of all gross tumors. There were no major complications or mortalities. The preoperative levels of hearing were preserved in 5 of the 6 patients. Favorable facial function in the immediate postoperative period was noted in 4 of the 6 patients. Incomplete paralysis of 2 patients recovered eventually.

Conclusion We propose that a combined suboccipital and infralabyrinthine–transcervicomastoid approach to the jugular foramen can provide sufficient exposure to resect most dumbbell‐shaped tumors, and it could be the initial treatment of choice for patients with remnant hearing.
Early Versus Late Gold Weight Implantation for Rehabilitation of the Paralyzed Eyelid
Authors: Snyder Mary C. , Johnson Perry J. , Moore Gary F. , Ogren Frederic P.
Published: November 2003

Objectives/Hypothesis The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid.

Study Design A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period.

Methods The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into “early” or “late” groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups.

Results Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates.

Conclusions Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.
Complications of Static Facial Suspensions With Expanded Polytetrafluoroethylene (ePTFE)
Authors: Constantinides Minas , Galli Suzanne K. Doud , Miller Philip J.
Published: November 2003

Background Expanded polytetrafluoroethylene (ePTFE) is a synthetic porous material that has been used for static suspension in facial paralysis. It is manufactured in thin (1‐mm or 2‐mm) sheets that can be cut into strips and implanted through keyhole facial incisions. Regional deformities are addressed by multiple suspensions that provide cosmetic and functional therapy. The use of ePTFE eliminates donor site morbidity associated with the traditional harvest of fascia from either the temporal area or fascia lata. However, properties unique to this alloplast contribute to the complications that have occurred after its use in facial reanimation.

Objective To describe complications with the use of ePTFE for facial suspension.

Setting Academic medical center.

Method Retrospective chart review and review of literature.

Results Six patients with facial paralysis who were treated with the ePTFE sling procedure had complications. Five slings failed because of stretch despite prestretching at implantation. One patient developed a late wound infection requiring removal of the sling.

Conclusion An ePTFE facial sling is an option for static facial suspension that can be therapeutic for patients with seventh nerve damage. There is a high rate of complications leading to revision surgery. Future studies are needed to evaluate alloplastic alternatives to ePTFE.
Gastroesophageal Reflux and Obstructive Sleep Apnea
Authors: Senior Brent A. , Khan Mumtaz , Schwimmer Craig , Rosenthal Leon , Benninger Mike
Published: November 2003

Objective To determine the extent to which gastroesophageal reflux (GER)‐initiated laryngeal chemoreflexes contribute to obstructive sleep apnea (OSA).

Methods Prospective, nonrandomized clinical trial of an antireflux treatment protocol as a means of reducing the severity of OSA. Population consisted of 10 males aged 20 to 64 years with confirmed OSA (by overnight polysomnography) and GER (by ambulatory pH probe monitoring). Patients were treated with omeprazole and standard antireflux protocol for 30 days and pre‐ and posttreatment polysomnography variables were compared.

Results Mean apnea index declined 31% (45–31, P = .04); mean respiratory disturbance index declined 25% (62–46, P = .06). Three patients (30%) are “treatment responders” as defined by traditional OSA treatment definitions.

Conclusions These results suggest a potential relationship between OSA and GER, the treatment of which may be an effective adjunctive in those with both disorders. Treatment of GER may significantly impact OSA in select individuals.
Pediatric Adenoidectomy Under Vision Using Suction‐Diathermy Ablation
Authors: Walker Paul
Published: November 2003

Objectives To compare adenoidectomy using suction‐diathermy ablation with adenoidectomy by way of curettage in a pediatric tertiary care setting.

Study Design A prospective series of 68 children undergoing adenoidectomy (without tonsillectomy) under vision using a suction‐diathermy ablation technique over 2 years was compared with an historical control group of 58 children undergoing adenoidectomy (without tonsillectomy) by way of curettage over 2 years.

Method Intraoperative blood loss was recorded and compared. Efficacy in improving nasal symptomatology was compared between the two groups using an ordinal “nasal symptom score” preoperatively and postoperatively. Complications were recorded and compared. Analysis was performed using two‐tailed t tests.

Results The two groups were well matched for age, weight, and adenoid size (P >.4). Follow‐up ranged from 4 to 48 months. Adenoidectomy using suction‐diathermy resulted in significantly less blood loss (P <.001). The technique was no less efficacious in terms of reducing the nasal symptom score than conventional adenoidectomy by way of curettage (P = .07). Complication rates were no different. No recurrences were identified and no instances of nasopharyngeal stenosis were recognized.

Conclusions Routine use of suction‐diathermy ablation for adenoidectomy converts a difficult, often bloody procedure into a surgically precise operation. It is especially applicable to children. It may have additional advantages in aiding the prevention of the spread of the human form of bovine spongiform encephalopathy (variant Creutzfeldt‐Jakob disease [CJD]). Compared with other recently introduced techniques for adenoidectomy, it is considerably less expensive.
The Use of Buccal Mucosa Graft at Posterior Cricoid Splitting for Subglottic Stenosis Repair
Authors: Thomé Robert , Thomé Daniela Curti , Behlau Mara
Published: November 2003

Background Since 1955, when Réthi established the posterior cricoid split augmentation (PCSA) method, several authors have published supporting reports of the validity and proven efficacy of its basic principles. A 27‐year prospective, retrospective study.

Objectives To report on experience in performing the PCSA method for subglottic and/or posterior–glottic stenosis repair using buccal mucosa interposition grafting at posterior cricoid split and stenting for 8 weeks, and to assess the impact on vocal function.

Methods From 1972 on, 60 patients (45 adults, 15 children, aged 8 mo to 72 y) with subglottic and/or posterior–glottic stenosis were operated on using a modified PCSA method. The surgical technique consisted of posterior cricoid splitting, including or not the interarytenoid muscle; wide lateral retraction of the posterior cricoid halves; buccal mucosa interposition grafting and stenting for 8 weeks. The factors evaluated included the subglottic remodeling rate, donor and recipient sites morbidity, time to decannulation, rate of graft take, and phonatory function tests.

Results The modified PCSA procedure resulted in a decannulation rate of 90%, 18 (30%) of which had further procedure to achieve decannulation, and 6 adult patients (10%) were considered failures because of restenosis. The rate of take of the mucosa graft was 100% in both children and adults, with complete epithelialization of the grafted area, the mucosa not becoming dry and crusty. No interarytenoid muscle division resulted in near‐normal to normal glottic voicing. Interarytenoid muscle division determined supraglottic voicing with inspiratory noise and pneumophonic incoordination, breathy and hoarse voice, low fundamental frequency, limited dynamic range, and shortened phonation time.

Conclusion The PCSA procedure with buccal mucosa graft is reliable, safe, and highly successful with respect to the graft incorporation and subglottic remodeling. The division or not of the interarytenoid muscle is the most important factor influencing the postoperative vocal function.
Histopathology of Pleomorphic Adenoma in the Parotid Gland: A Prospective Unselected Series of 100 Cases
Authors: Stennert Eberhard , Guntinas‐Lichius Orlando , Klussmann Jens Peter , Arnold Georg
Published: November 2003

Objectives/Hypothesis Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule‐free regions, capsule penetration, satellite nodules, and pseudopodia in the different subtypes, are described.

Study Design Prospective unselected series of 100 consecutive cases from 1997 to 2000.

Methods Light microscopic examination and semiquantitative analysis of the pleomorphic adenomas.

Results Fifty‐one (51%) pleomorphic adenomas were classified as myxoid (stroma‐rich) type, 35 (35%) specimens as cellular type, and 14 (14%) as classic subtype. Ninety‐seven percent of all tumors showed areas with thin (<20 μm) capsule independent of the tumor subtype. Tumors of myxoid subtype showed the absolute greatest regions of a thin capsule. Especially, tumors of myxoid type (71%) often had a distinct focal absence of encapsulation with tumor merging into normal parotid gland tissue; 11% of the cellular subtype and 43% of the classic subtype presented capsule‐free areas. Thirty‐three percent of the myxoid pleomorphic adenomas, 23% of the cellular subtype, and 21% of the classic subtype had satellite nodules or pseudopodia.

Conclusions Almost all pleomorphic adenomas have focally thin capsules. One‐fourth of all pleomorphic adenomas contain abnormalities such as satellite nodules or pseudopodia. More than two‐thirds of pleomorphic adenomas of the myxoid (stroma‐rich) subtype and at least half of all tumors show a focal absence of the capsule. Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. We recommend, depending on the location of the tumor, a lateral or total parotidectomy as the treatment of choice.
The Prevalence of Occult Carotid Artery Stenosis in Patients With Head and Neck Squamous Cell Carcinoma
Authors: Cote Christopher R. , Goff James , Barry Patricia , Casler John
Published: November 2003

Objectives/Hypothesis Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population.

Study Design A cross‐sectional study was performed to identify the prevalence of clinically significant ASCAD in the specific population of patients with a diagnosis of HNSCCA using noninvasive color flow duplex imaging. In addition, the demographic variables and risk factors for head and neck cancer and for carotid disease, as identified in the literature, were recorded with the use of a questionnaire.

Methods Forty‐nine patients with a diagnosis of HNSCCA completed the questionnaire and then had a duplex screening examination.

Results The most common risk factor identified was tobacco smoking in 41 of 49 patients (84%). ASCAD was identified in one patient (2%). The stenosis in that patient was less than 60%.

Conclusions We conclude from this study that even though patients with HNSCCA usually have risk factor(s) associated with ASCAD, the rate of occult ASCAD was not different from that found in the general population. Thus, routine screening of patients with HNSCCA with color flow duplex imaging to detect occult ASCAD is not warranted.
Use of Laboratory Evaluation and Radiologic Imaging in the Diagnostic Evaluation of Children With Sensorineural Hearing Loss
Authors: Mafong Derek D. , Shin Edward J. , Lalwani Anil K.
Published: November 2003

Objective Laboratory testing and radiologic imaging are commonly used to delineate syndromic from nonsyndromic sensorineural HL (SNHL). The aim of this study was to examine the yield of laboratory tests and radiologic imaging commonly used in the diagnostic evaluation of SNHL in children.

Study Design Retrospective analysis of 114 (54 female, 60 male) consecutively investigated children with SNHL between 1998 and 2000 at a tertiary‐care university hospital.

Methods Results of routine laboratory testing to assess autoimmunity, blood dyscrasias, endocrine abnormalities, renal function, infection, and cardiac testing were reviewed. Results of radiologic evaluation were also reviewed. In general, computed tomography (CT) was obtained in patients with symmetric SNHL, whereas magnetic resonance imaging (MRI) with or without CT was obtained in asymmetric SNHL.

Results Laboratory evaluation of the blood did not yield the etiology of SNHL in any patient. Blood tests for autoimmune disease were often positive but did not correlate with clinical disease. Nonspecific elevation of erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) was present in 22% of cases. An abnormal electrocardiogram with a prolonged QT interval resulted in the diagnosis of Jervall and Lange‐Nielsen syndrome. In the 97 patients who underwent radiologic studies, abnormalities were present in 38 of 97 studies (39%). Isolated inner ear malformations were twice as common as multiple abnormalities with large vestibular aqueducts as the most common isolated finding.

Conclusion In the evaluation of children with unexplained SNHL, routine laboratory evaluation should be reconsidered given its low diagnostic yield. However, radiologic abnormalities of the inner ear are common. Identification of inner ear malformations has direct impact on management of these children, suggesting that all children should undergo radiologic imaging as an integral component of evaluation of SNHL.
Eosinophilia and Cell Activation Mediators in Nasal Secretions
Authors: Besançon‐Watelet Clotilde , Béné Marie C. , Montagne Paul , Faure Gilbert C. , Jankowski Roger
Published: November 2003

Objectives/Hypothesis In rhinologic disorders such as polyposis or rhinitis, nasal cytology allows differentiation between patients according to the degree of eosinophilia in nasal secretions. The egress of eosinophil and/or neutrophil polymorphonuclears from the underlying mucosa might correlate with the release of soluble mediators of cell activation such as the chemokine IL‐8, and such molecules of the innate immunity as the LPS‐receptor CD14 or lysozyme. We assayed the levels of these three molecules in nasal secretions in correlation with cytologic findings and especially the degree of eosinophilia.

Study Design Fifty‐four patients from a prospective study of nasal secretions were enrolled in this work. They constituted two groups of 27 patients each, respectively, with or without more than 20% eosinophils in nasal secretions. Nasal secretions were collected by aspiration, weighed and diluted in a fixed amount of buffer. Classic cytologic analyses were performed on the pelleted cells and IL‐8, sCD14, and lysozyme levels were assayed in the cell‐free supernatants.

Methods Cytologic analyses included cell‐enumeration in Neubauer's chambers, and differentials performed on May‐Grünwald Giemsa‐stained cytospins. ELISA tests were used to assay the levels of IL‐8 and sCD14. Lysozyme concentrations were assayed in immuno‐nephelometry.

Results Significantly lower levels of IL‐8 and sCD14 were observed in patients with eosinophilia than in patients with a predominance of neutrophils, whereas no difference was observed in lysozyme concentrations.

Conclusion These data show that the egress of neutrophils in nasal secretions is associated with high levels of IL‐8 and sCD14.
Effects of Intranasal Azelastine on the Response to Nasal Allergen Challenge
Authors: Saengpanich Supinda , Assanasen Paraya , deTineo Marcy , Haney Lauran , Naclerio Robert M. , Baroody Fuad M.
Published: November 2003

Objectives/Hypothesis Azelastine, a second‐generation H1‐receptor antagonist, is available for topical administration. The aim of the study was to evaluate the effects of topical intranasal azelastine on the early‐phase and the late‐phase allergic responses and on nasal hyper‐responsiveness to methacholine.

Study Design Double‐blind, placebo‐controlled, two‐way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season.

Methods Subjects were randomly assigned to receive either placebo or two puffs of azelastine twice a day (548 μg/d) for 2 weeks followed by nasal challenge with allergen. Twenty‐four hours later, while still receiving treatment, subjects underwent a nasal lavage and a nasal challenge with methacholine. End points included symptom scores, levels of mediators and number of eosinophils in nasal lavages, and the weight of secretions after methacholine challenge.

Results Compared with placebo, treatment with intranasal azelastine resulted in significant reductions in allergen‐induced sneezing, rhinorrhea, itching, nasal congestion, and levels of albumin during the early‐phase response (P <.05). Azelastine had no effect on levels of histamine or tryptase during the early‐phase response. There was a significant eosinophil influx 24 hours after challenge, which was not inhibited by azelastine. Treatment with azelastine had no effect on the levels of albumin, interleukin‐4, interleukin‐5, intercellular adhesion molecule‐1, tumor necrosis factor‐α, and eosinophil cationic protein during the late‐phase response. However, azelastine did show a significant inhibitory effect on the methacholine response 24 hours after nasal allergen challenge (P <.05).

Conclusions The effects of intranasal azelastine are similar to those of oral second‐generation antihistamines.
Histopathological Features of Occult Metastasis Detected by Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma
Authors: Stoeckli Sandro J. , Pfaltz Madeleine , Steinert Hans , Schmid Stephan
Published: November 2003

Objectives Sentinel lymph node biopsy has been introduced for head and neck cancer with promising results. Research in breast cancer has revealed different histopathological features of occult lymph node metastasis with possibly different clinical and prognostic implications. The aim of the study was to evaluate the histopathological features of occult metastasis detected by sentinel lymph node in oral and oropharyngeal squamous cell carcinoma.

Study Design Prospective.

Methods According to Hermanek, 5 occult metastasis was differentiated into isolated tumor cells and infiltration of lymph node parenchyma smaller than 2 mm in diameter (micrometastasis) and larger than 2 mm in diameter (metastasis).

Results Occult metastases were found in 6 of 19 (32%) sentinel lymph nodes. Three patients showed micrometastasis with a mean size of 1.4 mm (range, 1.2–1.5 mm), the first with three separate micrometastases within the same sentinel lymph node, the second with an additional cluster of isolated tumor cells within the same sentinel lymph node, and the third with an additional micrometastasis in one lymph node of the elective neck dissection. Two patients had macrometastasis (3.4 and 8 mm), both with multiple metastases in the elective neck dissection. One patient had two clusters of isolated tumor cells in the sentinel lymph node and an additional cluster of isolated tumor cells in one lymph node of the elective neck dissection.

Conclusions Occult metastasis can be subdivided histopathologically in isolated tumor cells, micrometastasis, and macrometastasis. We present the first study describing a great variety of these subtypes in sentinel lymph nodes from head and neck squamous cell carcinoma. Because the independent prognostic factor and clinical relevance of these subtypes is still unclear, we emphasize the importance of reporting these findings uniformly and according to well‐established criteria.
Chondrosarcoma of the Skull Base
Authors: Neff Brian , Sataloff Robert Thayer , Storey Leslie , Hawkshaw Mary , Spiegel Joseph R.
Published: November 2003

Objectives Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base.

Study Design Single case report and literature review.

Results Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative.

Conclusion There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective.
The Treatment of Horizontal Canal Positional Vertigo: Our Experience in 66 Cases
Authors: Casani Augusto P. , Vannucci Giovanni , Fattori Bruno , Berrettini Stefano
Published: November 2003

Objectives/Hypothesis The horizontal semicircular canal variant of paroxysmal positional vertigo (HSC‐PPV) shows three subtype nystagmic patterns: 1) bilateral geotropic nystagmus, 2) bilateral apogeotropic nystagmus that may switch into bilateral geotropic, and 3) bilateral apogeotropic nystagmus that never switches into bilateral geotropic. In recent years, many methods of physical treatment have been proposed for HSC‐PPV, yet no standard protocol has been defined. We studied the effects of different methods according to each different form of HSC‐PPV after a precise definition of the nystagmic and clinical features.

Study Design A prospective trial of 66 patients with horizontal canal paroxysmal positional vertigo treated with a combination of rotational maneuver and forced prolonged position.

Methods We evaluated 66 patients with HSC‐PPV in its three subtypes. For patients with bilateral geotropic nystagmus, the “barbecue” method was combined with “forced prolonged position.” Patients with bilateral geotropic nystagmus were submitted to maneuvers aimed at a switch to bilateral geotropic. The cases that did not switch were submitted to a modified fourth step of the Semont maneuver.

Results Eighty percent of the patients with bilateral geotropic nystagmus became symptom free within the second session, and in 90% of the patients, symptoms were resolved by the third session. In the bilateral apogeotropic cases, the modified fourth step of the Semont maneuver resulted in 75% of the patients being symptom free.

Conclusions The correct identification of both nystagmic pattern and site of the lesion is crucial for the choice of physical treatment of HSC‐PPV and its success. We have standardized the treatment protocol consisting of a “barbecue” maneuver followed by “forced prolonged position” in cases of geotropic nystagmus and a modified fourth step of the Semont maneuver for apogeotropic nystagmus. Our results appear encouraging because 90% of the entire study group was symptom free after three sessions.