bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of WuScope for Exchange of Endotracheal Tube in a Patient With Difficult Airway
Authors: Sprung Juraj , Wright Laurie C. , Dilger John
Published: November 2003

Objective To describe a method for the exchange of a defective endotracheal tube using the WuScope in patients with difficult airways who cannot tolerate interrupted ventilation.

Study Design Case report.

Methods Detailed description of proposed modality for the endotracheal tube exchange.

Results Exchanging a defective endotracheal tube in patients with a “difficult airway” and compromised oxygenation can be a challenging task. Performing fiberoptic visualization with the WuScope and using a “double intubation” technique may be an acceptable method for endotracheal tube exchange in some clinical situations.

Conclusion By using our technique the exchange of an endotracheal tube in a patient with a difficult airway may be achieved without interrupting the ventilation.
Transoral Laser Microresection for Cancer of the Larynx Involving the Anterior Commissure
Authors: Pearson Bruce W. , Salassa John R.
Published: November 2003

Objective To share the authors' experience of transoral laser microresection in the treatment of squamous cell carcinoma of the anterior commissure of the larynx.

Study Design Retrospective review of 39 patients with squamous carcinoma involving the anterior commissure of the larynx, all managed with transoral laser microresection between September 1996 and December 2001. Twenty‐three patients had pT1 or pT2 cancers. Sixteen patients had pT3 or pT4 disease, two with N2b neck metastases. Twenty patients had cancers exhibiting spread to the subglottis. Twenty‐five patients had received prior treatment(s).

Methods Specific data points entered into a portable database were retrospectively verified against the patient's electronic medical record. Sorting and analysis were completed in a desktop spreadsheet. We evaluated tumor recurrence, cause of death, tracheostomy, hospital length of stay, and voice quality.

Results None of the 17 patients with early cancers (pT1 or pT2a) had local recurrence, and none received postoperative radiotherapy. Five of the 22 patients with intermediate or advanced disease (pT2b/pT3 or pT4 cancer) required second treatments for persistent or recurrent disease. Of these, two had small residual foci amenable to second‐stage resection by laser. One patient developed a prelaryngeal soft tissue recurrence and retained his larynx after wide local excision and radiotherapy. Two patients (both previously irradiated) developed delayed recurrences requiring total laryngectomy. Four retreated patients remained alive without disease. One patient died of other causes. Voice remained no worse after transoral laser microresection in 19 patients. It was one level worse (on a scale of 0 to 5) for 16 patients. Eleven patients received temporary tracheotomies, some for airway, some for exposure. Twelve patients left the hospital on a same‐day basis. The average hospital stay was 3.3 days.

Conclusion Transoral laser microsurgery is one of the options to be considered for the treatment of squamous cell cancer involving the anterior commissure of the larynx.
Delayed‐Onset Facial Paralysis After Vestibular Neurectomy
Authors: Vrabec Jeffrey T. , Coker Newton J. , Jenkins Herman A.
Published: November 2003

Objectives/Hypothesis Delayed‐onset facial paralysis (beginning more than 3 d after the procedure) has been described as a complication of many different types of otological procedures. The incidence of this problem in vestibular neurectomy and the relationship to surgical approach are detailed in the study.

Study Design Retrospective case review.

Methods In the setting of a tertiary referral center, vestibular neurectomy was performed in 70 individuals with disabling vertigo unresponsive to medical therapy who elected vestibular neurectomy. The main outcome measure was incidence of delayed onset facial paralysis.

Results Delayed‐onset facial paralysis was significantly more common after the middle fossa (18%) and translabyrinthine (11%) approaches compared with the retrosigmoid approach (0%)

Conclusions Surgical approach influences the incidence of delayed‐onset facial paralysis. Measures to prevent this complication such as prophylactic antiviral medication or labyrinthine segment decompression may be considered in middle fossa and translabyrinthine operations.
Unbiased Stereologic Type I and Type II Hair Cell Counts in Human Utricular Macula
Authors: Gopen Quinton , Lopez Ivan , Ishiyama Gail , Baloh Robert W. , Ishiyama Akira
Published: November 2003

Objective The objective of the study was to obtain unbiased estimates of the total number of type I and type II hair cells in human utricular macula from individuals with documented normal vestibular function.

Study Design Application of unbiased stereology using microdissected human temporal bone specimens was conducted in an observational study.

Methods Postmortem temporal bones were obtained from 10 normal patients (age range, 42–96 y; mean age, 82 y). The utricular maculae were microdissected, embedded in plastic, and cut into serial 2‐μm sections. Unbiased estimates of the total number of type I and type II hair cells were obtained using the physical fractionator technique of stereology.

Results The average total number of hair cells was 27,508 (CV = 11%) consisting of 17,326 (coefficient of variation [CV] = 11%) type I hair cells and 10,182 (CV = 13%) type II hair cells. The ratio of type I to type II hair cells was 1.70:1. In the age range of the study, there was no statistically significant correlation between hair cell counts and age.

Conclusions Morphometric studies of the human utricular sensory epithelium can be accomplished using unbiased stereology on microdissected specimens. There was no effect of age on total hair cell counts or on the ratio of type I to type II hair cells in the age range of the study. Further studies on younger subjects are needed to establish the effect of age. The results from the present study are closely aligned with prior studies that estimated total hair cell counts using surface mount preparations. The current data represent the first total type I and type II hair cell counts in human utricular neuroepithelium.
The Normal Inferior Turbinate: Histomorphometric Analysis and Clinical Implications
Authors: Berger Gilead , Balum‐Azim Marwa , Ophir Dov
Published: November 2003

Objective To study the histological and morphometric features of the normal inferior turbinate.

Study Design A prospective, nonrandomized study.

Methods Sixteen specimens were removed at autopsy and during septoplasty operations, stained with H&E, and investigated microscopically. The soft tissue and bony elements were measured. Morphometric analysis included measurements of the relative proportions of the soft tissue constituents.

Results The medial mucosal layer is thicker than the bone and the lateral mucosa; the difference between the mucosal layers is statistically significant. The inferior turbinate is almost exclusively covered with a pseudostratified ciliated columnar epithelium that houses more goblet cells on its lateral side. It has a well‐defined basement membrane zone that is significantly thicker on the medial side. The main bulk of the inferior turbinate is the lamina propria that is built of loose connective tissue and superficially harbors an inflammatory cell infiltrate. The area fraction of glands in the lateral mucosa significantly exceeds that of the medial and inferior mucosal layers, whereas that of venous sinusoids varies significantly, with the greatest difference inferiorly. Decreased proportion of glands and an increase in venous sinusoids are associated with advanced age. The cancellous central bony layer is made of interwoven trabeculae and houses the major arterial supply of the turbinate. After the major arteries exit the bone, they lie in the deepest portions of the medial and lateral mucosal layers but are missing from the inferior layer.

Conclusion In‐depth histomorphometric analysis can assist in developing new function‐preserving approaches to turbinate surgery.
Expression of the Extra Domain B of Fibronectin, a Marker of Angiogenesis, in Head and Neck Tumors
Authors: Birchler Manfred T. , Milisavlijevic Dusan , Pfaltz Madeleine , Neri Dario , Odermatt Bernhard , Schmid Stefan , Stoeckli Sandro J.
Published: November 2003

Objectives/Hypothesis The extra domain B (ED‐B) of fibronectin, a naturally occurring marker of tissue remodeling and angiogenesis, is expressed in the majority of aggressive solid human tumors, whereas it is not detectable in normal vessels and tissues.

Study Design In view of the diagnostic and therapeutic clinical applications of the L19 antibody, which is specific for the ED‐B domain of fibronectin, a prospective immunohistochemical analysis of different head and neck tumors was performed.

Methods In all, 82 head and neck tissue biopsy specimens were immunohistochemically analyzed using the L19 antibody. They consisted of 53 different malignant tumors, 8 benign tumors, 10 nontumoral lesions, and 11 normal control tissues.

Results A strong positive staining with the L19 antibody could be observed in 87% of the investigated malignant tumors, in only 38% of the benign tumors, and in 20% of the nontumoral lesions (P <.0001). The extra domain B was completely absent in the normal control tissue samples.

Conclusions The results show that ED‐B is abundantly expressed around the neovasculature and in the stroma of the majority of malignant tumors of the head and neck but is undetectable in normal tissues. The ED‐B domain of fibronectin is a good‐quality tumor‐stroma–associated antigen that warrants clinical trials with antibody‐based pharmaceuticals, including immunoscintigraphic investigations and radioimmunoguided surgery with the radiolabeled L19 antibody.
Tracheal Autotransplantation as a New and Reliable Technique for the Functional Treatment of Advanced Laryngeal Cancer
Authors: Delaere Pierre R. , Hermans Robert
Published: November 2003

Objectives/Hypothesis Tracheal autotransplantation allows for reconstruction of extended hemilaryngectomy defects (including half of the cricoid cartilage) after resection of laryngeal or hypopharyngeal cancer. A series of 38 patients underwent the operation. The technique involved a two‐stage procedure (stage 1, tracheal revascularization; stage 2, hemilaryngectomy and tracheal autotransplantation) because the trachea requires at least 2 weeks for revascularization. The objective was to improve the oncological reliability of the procedure by performing a one‐stage tumor resection.

Study Design Five patients who underwent a one‐stage tumor resection are presented. They had T2 (n = 3) to T3 (n = 2) N0 laryngeal tumors.

Methods Neck dissection, tumor resection, and tracheal revascularization were all performed during the first operation. The radial forearm fascia flap was designed with a distal fascial paddle and a proximal skin paddle. A 4‐cm segment of cervical trachea was wrapped with the fascial paddle for revascularization, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction consisted of tracheal autotransplantation and was performed 4 months after the first procedure. Medical records were reviewed to determine time to oral intake, time to decannulation, length of hospital stay, and postoperative complications.

Results After the first operation the skin paddle of the radial forearm flap succeeded in a restoration of the sphincteric function. The mean time to oral intake for solids was 9.0 days (SD = 2.6 d) and the mean length of hospital stay was 11.2 days (SD = 2.2 d). All patients were able to speak with the tracheal cannula in place. All laryngeal functions were restored after the second operation. The mean time to oral intake for solids was 8.2 days (SD = 5.2 d). The mean time to oral intake for liquids was 16.6 days (SD = 6.3 d), and the mean length of hospital stay was 9.6 days (SD = 2.3 d). The mean time to closure of the tracheostomy and removal of the gastric tube was 27.0 days (SD = 5.8 d).

Conclusion Tracheal autotransplantation allows for a functional treatment of advanced laryngeal cancers and is compatible with a one‐stage tumor resection.
Hypothermia During Head and Neck Surgery
Authors: Agrawal Nishant , Sewell Duane A. , Griswold Michael E. , Frank Steven M. , Hessel: Todd W. , Eisele David W.
Published: November 2003

Objective To determine the predictors and incidence of hypothermia in patients undergoing head and neck surgery.

Study Design Retrospective analysis.

Methods Patients were either not warmed (n = 43) or actively warmed with forced‐air warming (n = 25). Clinical variables that were assessed as predictors of core body temperature included age, body mass, duration of procedure, estimated blood loss, amount of intravenous fluids administered, and the use of forced‐air warming. The incidence of severe intraoperative hypothermia and potential hypothermia‐related complications was also examined.

Results The study demonstrated that advanced age is a risk factor for hypothermia and decreased body mass is associated with lower final body temperatures in the groups of patients that was not warmed. After adjusting for differences in the ages and weights between the two groups, the mean core body temperature was found to be 0.4°C lower in the patients who were not warmed. Severe intraoperative hypothermia occurred in 5 of 38 patients (11.6%) who were not warmed and 2 of 23 patients (8.0%) who were warmed. The complications associated with hypothermia included delayed time to extubation, the development of neck seromas, and flap dehiscence.

Conclusions Patients undergoing head and neck surgery are at risk for the development of intraoperative hypothermia and require careful temperature monitoring. Elderly patients and patients with low body mass are more prone to develop low intraoperative core body temperatures. Active warming with forced‐air warmers should be considered for patients at risk for intraoperative hypothermia and for patients who develop hypothermia intraoperatively, to avoid hypothermia‐related complications.
Subglottic Stenosis Associated With Wegener's Granulomatosis
Authors: Gluth Michael B. , Shinners Patrick A. , Kasperbauer Jan L.
Published: November 2003

Objective To evaluate the outcomes of subglottic stenosis in patients with Wegener's granulomatosis.

Study Design Retrospective chart review.

Methods A retrospective chart review was undertaken to review all patients evaluated in an otolaryngology—head and neck surgery department between 1993 and 2001 for active symptoms attributed to subglottic stenosis who had undergone cytoplasmic staining antineutrophil cytoplasm antibody and perninuclear staining antineutrophil cytoplasm antibody testing and who had a clinical diagnosis of Wegener's granulomatosis.

Results Twenty‐seven patients were identified with Wegener's granulomatosis and subglottic stenosis. Among these, 11 of 27 (40.7%) underwent tracheotomy; 13 of 27 (48.1%) required multiple surgical procedures. A history of open laryngotracheal repair was present in 7 of 27 patients (25.9%). CO2 laser resection and dilation was used in 12 of 27 patients (44.4%). Three of 27 patients (11.1%) had a tracheotomy at last follow‐up. Patients were followed for an average duration of 76.8 months (6.4 y) from the onset of symptoms attributed to subglottic stenosis. All patients who underwent open laryngotracheal reconstruction had successful decannulation.

Conclusions Wegener's granulomatosis is a necrotizing vasculitis that can involve the subglottis. Our approach to airway management in these patients involves a tracheotomy if obstruction occurs during acute inflammatory activity. We recommend minimizing airway manipulation during episodes of systemic disease activity. Once control of the disease process is obtained, consideration is given to either an endoscopic or an open approach based on the extent of stenosis. Either laryngotracheal reconstruction or CO2 laser resection and dilation may be undertaken with safety and should result in favorable outcomes.
Complete Laryngotracheoesophageal Cleft: Complicated Management Issues
Authors: Chitkara Ajay E. , Tadros Monica , Kim H. Jeffrey , Harley Earl H.
Published: November 2003

Objectives/Hypothesis Laryngotracheoesophageal clefts are rare developmental anomalies of the upper aerodigestive tract. They range in severity from being virtually asymptomatic throughout life (type I) to being incompatible with life (type IV). The timing of diagnosis is crucial to the successful treatment of severe clefts. Treatment is complicated and requires a multiteam approach. The case report discusses the elements involved in diagnosing and treating this severe airway anomaly.

Study Design Case report.

Methods Review of a case at a tertiary care center.

Results A case of a complete laryngotracheoesophageal cleft with left‐side pulmonary agenesis in a newborn is reported. Rigid bronchoscopy revealed a common tracheoesophageal lumen from the larynx to the stomach with a single bronchus supplying the right‐side lung. Management of this patient included establishment and maintenance of a tenuous airway, maintenance of nutrition, and anesthetic and surgical planning for upper aerodigestive tract reconstruction.

Conclusions Although severe laryngotracheoesophageal clefts are rare, they require prompt, team‐oriented management for the best outcome possible. The diagnosis, sustenance, and treatment options of these patients depend on varied and complicated factors, which are discussed.
The Superior Petrosal Triangle as a Constant Anatomical Landmark for Subtemporal Middle Fossa Orientation
Authors: Miller Robert Sean , Pensak Myles L.
Published: November 2003

Objectives/Hypothesis Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach.

Methods We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior–lateral lip of the foramen spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy–middle fossa approach to evaluate the consistency of localizing the head of the malleus.

Results We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the foramen spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the foramen spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm).

Conclusions The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.
Expression of Extracellular Matrix Metalloprotease Inducer in Laryngeal Squamous Cell Carcinoma
Authors: Rosenthal Eben L. , Shreenivas Satya , Peters Glenn E. , Grizzle William E. , Desmond Renee , Gladson Candece L.
Published: November 2003

Objectives/Hypothesis Head and neck cancer tumor cell invasion is responsible for both local destruction and distant metastasis. Invasion is largely mediated by matrix metalloproteases that are thought to be induced by tumor cell derived extracellular matrix metalloprotease inducer (EMMPRIN) in surrounding fibroblasts. We hypothesize that EMMPRIN is overexpressed in laryngeal cancer.

Study Design Retrospective analysis of patients with supraglottic laryngeal cancer.

Methods Total protein immunoblotting and immunohistochemical analysis of normal and malignant tissue were performed to determine EMMPRIN expression. EMMPRIN immunoreactivity in 33 patients was correlated with clinicopathological features and survival.

Results Whole‐tissue lysates of tumors (n = 8) and metastatic lymph nodes (n = 2), but not normal skin (n = 8) or mucosa (n = 6), expressed significant amounts of EMMPRIN by immunoblotting. EMMPRIN membrane immunoreactivity (transmembrane EMMPRIN score) was associated with nodal positivity (P = .07), and it was a borderline significant predictor of survival (Hazards Ratio = 2.4; 95% CI, 0.88–6.55). As a categorical variable, higher transmembrane EMMPRIN score was associated with higher mortality.

Conclusions The present study helps to establish EMMPRIN as a widely expressed protein in dysplastic mucosa and supraglottic laryngeal cancer, but not in normal epithelial counterparts.
Parotid Carcinoma: Impact of Clinical Factors on Prognosis in a Histologically Revised Series
Authors: Godballe Christian , Schultz Joyce H. , Krogdahl Annelise , Møller‐Grøntved Ågot , Johansen Jørgen
Published: November 2003

Objective To analyze clinical data and possible prognostic factors of patients with primary carcinoma of the parotid gland.

Study Design A retrospective study was made of 85 patients with suspected parotid cancer who were admitted to the Center of Head and Neck Oncology at Odense University Hospital (Odense, Denmark) from 1975 to 1994.

Methods Patient records were retrospectively reviewed and tabulated for relevant clinical parameters. A complete revision of histological examination was performed by the same pathologist and the tumors were classified according to the 1991 international guidelines from the World Health Organization. Five tumors (6%) did not fulfill the criteria of malignancy and were reclassified as benign. In another five cases the assumed primary parotid carcinomas were found to be metastatic disease from cancers of the breast, prostate, skin, and lungs. Ten patients (12%) were excluded from the analysis, leaving 75 individuals for the study.

Results Twenty‐four percent of patients were classified as T1, 32% as T2, 15% as T3, and 28% as T4. One patient (1%) was not classifiable (TX). Regional lymph node metastases were found in 17 cases (23%). Two of these were classified as N1 (3%), 2 as N2A (3%) and 13 as N2B (17%). Four patients were registered as not classifiable (NX) (5%). No patients were classified as N3. Distant metastases were found in four patients (5%) (one patient had bone and liver metastases and three patients had lung metastases). Five‐year recurrence‐free survival of the entire study group was 63%, disease‐specific survival was 69%, and crude survival was 52%. In univariate analysis, tumor size, histological appearance, T status, stage, the presence of lymph node metastases, distant metastases, pain, and facial nerve dysfunction had a significant influence on survival.

Conclusions A thorough histological revision is pivotal in retrospective parotid carcinoma studies, and tumor size; histological appearance; T, N, and M status; stage; facial nerve dysfunction; and pain from the face and/or neck seem to be significant prognostic indicators for patients with primary parotid carcinoma.
Surgery of the Inner Ear With Hearing Preservation: Serial Histological Changes
Authors: Smouha Eric E.
Published: November 2003

Objectives/Hypothesis Surgery of the inner ear can result in hearing preservation under certain conditions, but the mechanisms responsible for hearing preservation or loss are not well understood. The specific aim of the study is to examine histological sections obtained at different time intervals after varying degrees of surgical entry into the inner ear, to understand how the cochlea is protected. The hypothesis is that internal partitioning occurs.

Study Design Histologic examination of guinea pig inner ears by light microscopy.

Methods Guinea pigs underwent lateral semicircular canal transection and plugging, ampullectomy, or vestibulotomy, and tone‐burst auditory brainstem response thresholds at 2, 8, and 24 kHz were measured at intervals before and after surgery. Animals were killed after 1, 3, 7, or 21 or more days, and temporal bones were examined histologically.

Results The histological response to surgical trauma consists of fibrosis and varying amounts of inflammation near the site of surgical entry. Cochlear hair cells are nearly always preserved, even when hearing loss occurs. Extension of the inflammatory response to the cochlea is associated with greater degrees of hearing loss.

Conclusion The guinea pig inner ear is capable of withstanding surgical trauma to the semicircular canals and vestibule without complete loss of cochlear function. Fibrosis creates an effective partition between the site of surgical entry and the rest of the inner ear. Cochlear preservation might be enhanced if the inflammatory response can be contained.
Symposium: Masters in Otolaryngology—Update in Rhinology
Authors: Metson Ralph
Published: November 2003

The past few years have witnessed several noteworthy advances in the field of rhinology in general and in the treatment of chronic sinusitis in particular. Many of these advances can be classified into three major trends: technology, techniques, and tissue eosinophilia.
Dietary Antioxidant Intake in Patients at Risk for Second Primary Cancer
Authors: Steward David L. , Wiener Frida , Gleich Lyon L. , Falciglia Grace
Published: November 2003

Objectives To analyze dietary antioxidant intake for head and neck cancer patients at risk for development of second primary cancers.

Study Design Prospective observational study.

Methods Twenty‐four patients underwent three random, unscheduled, 24‐hour dietary recalls over a 15‐day period within 6 to 60 months after successful treatment for stage I or II oral cavity squamous cell carcinoma.

Results The study sample had a lower mean daily dietary intake of fruits and vegetables and antioxidant nutrients, including vitamins A, C, E, and total carotenes than age‐ and sex‐matched historic control subjects (all P < .05 except vitamin A). A positive linear correlation was noted between daily servings of F&V and dietary intake of vitamins A, C, E, and total carotenoids (all P < .05 except vitamin A). Compared to current recommendations, the study sample had lower mean daily dietary intake of vitamins A, C, and E (P = .81, .06, and <.01) and servings of fruits and vegetables (P < .01). When vitamin supplements were included in the analysis, mean daily intake exceeded recommended dietary allowance (RDA) for vitamins A, C, and E (all P < .05).

Conclusion This study suggests that patients treated for early‐stage oral cavity carcinoma, at risk for second primary cancers, have a statistically significant deficiency in dietary (food) sources of antioxidant nutrients when compared with both historic control subjects and cur‐rent recommendations. Vitamin supplementation significantly exceeded current RDAs. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.
Otolaryngological Manifestations of Cleidocranial Dysplasia, Concentrating on Audiological Findings
Authors: Visosky Ann Marie B. , Johnson Jacob , Bingea Becky , Gurney Theresa , Lalwani Anil K.
Published: November 2003

Objectives/Hypothesis Cleidocranial dysplasia is an autosomal dominant skeletal syndrome characterized by open skull sutures and clavicular hypoplasia or aplasia. It results from mutations in the transcription factor CBFA1 required for osteoblast differentiation and normal bone formation. Therefore, mutations in CBFA1 would be expected to cause conductive or sensorineural hearing loss, or both. The objective of the study was to evaluate the auditory function and head and neck manifestations of patients with cleidocranial dysplasia.

Study Design Case series.

Methods Patients with cleidocranial dysplasia who were identified from the case records of the Craniofacial Anomalies Center at the University of California San Francisco (San Francisco, CA) gave medical and developmental history, underwent a general physical examination and a thorough head and neck examination, and completed a comprehensive audiological evaluation.

Results Four families with eight affected individuals in all and one sporadic case were studied. The nine patients showed highly variable expression of abnormalities. Head and neck examination demonstrated abnormal cranial sutures, broad nasal root, clavicular hypoplasia or aplasia, and abnormally high arched palate. Although seven of nine patients showed eustachian tube dysfunction, recurrent otitis media in childhood requiring surgical intervention was not common. Hearing loss was present in three of nine patients (33%). One patient had a 40‐dB mixed hearing loss, the second had a 25‐dB low‐frequency conductive hearing loss, and the third had a 45‐dB high‐frequency sensorineural hearing loss.

Conclusion In patients with cleidocranial dysplasia, eustachian tube dysfunction, conductive hearing loss, and sensorineural hearing loss are common because of structural and functional changes of the temporal bone and palate. Therefore, patients with cleidocranial dysplasia should be evaluated routinely by an otolaryngologist and undergo complete audiological testing.
Predictive Factors in Pediatric Stapedectomy
Authors: Welling D. Bradley , Merrell James A. , Merz Meredith , Dodson Edward E.
Published: November 2003

Objective/Hypothesis The objective of the study was to investigate predictive factors in the postoperative hearing outcomes in pediatric stapedectomy.

Study Design Retrospective case series. The study was performed in a tertiary academic otological practice.

Methods The outcome of 66 stapedectomies in children 17 years of age and younger were analyzed according to the 1995 American Academy of Otolaryngology—Head and Neck Surgery Committee on Hearing and Equilibrium guidelines. Factors evaluated included patient age, underlying diagnosis (tympanosclerosis, otosclerosis, congenital fixation), type of footplate graft and type of prosthesis used, associated ossicular abnormalities, and revision surgery.

Results The mean postoperative air–bone gap following stapedectomy in children with tympanosclerotic footplate fixation (24.9 dB [±11 dB]) was significantly worse than in patients with an underlying diagnosis of congenital stapes fixation (15.7 dB [±9 dB]) or otosclerosis (13.1 dB [±3 dB]) (P = .024). Revision stapedectomy was also associated with a poorer outcome, but patient age and prosthesis and graft type did not contribute to the outcome in a statistically significant manner.

Conclusions Pediatric patients with stapes fixation resulting from tympanosclerosis showed poorer outcomes from stapedectomy than patients with congenital or otosclerotic fixation. Outcomes for congenital or otosclerosis fixation more nearly matched the outcomes in the literature for adult series.
Revision Stapes Surgery: The Malleus to Oval Window Wire‐Piston Technique
Authors: Kohan Darius , Sorin Alexander
Published: November 2003

Objective To determine the effectiveness of the malleus to oval window wire‐piston revision stapes surgery technique.

Study Design A retrospective analysis of 243 stapes procedures performed by the senior author over a 10‐year period identified 15 revisions. Five patients underwent a malleus to oval window wire‐piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted.

Methods Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire‐piston prosthesis.

Results Among revision stapes procedures, there was no significant difference in the air‐bone gap closure or complication rate between the incus to oval window and the malleus to oval window techniques. The average preoperative air‐bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss.

Conclusions In experienced hands, revision stapes surgery using the malleus to oval window stapes wire‐piston prosthesis is safe and effective.
Tympano‐Ossiculoplasty Utilizing the Spiggle and Theis Titanium Total Ossicular Replacement Prosthesis
Authors: Neff Brian A. , Rizer Franklin M. , Schuring Arnold G. , Lippy William H.
Published: November 2003

Objective Since 1993, titanium prostheses have been used in Europe as a biocompatible implant for ossicular reconstruction. More recently, the titanium ossicular prosthesis has become more widely available in the United States as a newer means of surgical restoration of hearing. We will review the hearing results of patients who have undergone tympano‐ossiculoplasty using a titanium total ossicular replacement prosthesis (TOP). We will compare these results to our previously published results using the porous polyethylene TOP.

Methods Retrospective review in a tertiary otologic practice.

Results Eighteen patients underwent tympano‐ossiculoplasty with a titanium TOP. Among these patients, 10 cases involved revision of a previously placed ossicular prosthesis. Hearing results showed that 16 of 18 patients (89%) had closure of the postoperative air‐bone gap to within 20 dB, and the average air‐bone gap improvement was 23 dB. The average follow‐up time was 8 months (range, 2–21 months). The results of this initial evaluation compare favorably with the results that we obtained using a porous polyethylene TOP in which 67% of 133 patients closed the air‐bone gap to within 20 dB.

Conclusion We have recently begun using the titanium TOP, which has resulted in improved postoperative hearing when compared with the porous polyethylene TOP. In the future, longer follow‐up and increased patient numbers will strengthen our conclusions.
Long‐Term Follow‐Up of Pediatric Recurrent Respiratory Papillomatosis Managed with Intralesional Cidofovir
Authors: Pransky Seth M. , Albright James T. , Magit Anthony E.
Published: November 2003

Objective Cidofovir is an acyclic nucleotide phosphonate antiviral medication that has been used intralesionally for the treatment of severe respiratory papillomatosis (RRP) in pediatric patients. The long‐term efficacy of this medication was assessed in 11 children with severe RRP who previously required operative debulking every 2 to 6 weeks to maintain airway patency.

Study Design Clinical case series.

Results Ten of these children have completed therapy. Five are disease free over a mean follow‐up period of 51.6 months. Five other patients with active RRP decreased their mean severity scores from 17.8 (range 11–26) to 4.0 (range 2–6) and no longer require cidofovir. One patient continues to receive cidofovir for recurrent disease after an initial favorable response. Throughout the 6‐year observational period, no patients demonstrated any adverse effects, laboratory abnormalities, or evidence of carcinogenesis.

Conclusion Intralesional cidofovir is a useful adjunct for managing children with tenuous airways caused by previously uncontrolled papilloma.
Lipotransfer as an Adjunct in Head and Neck Reconstruction
Authors: Ducic Yadranko , Pontius Allison T. , Smith Jesse E.
Published: November 2003

Objectives To present our technique of lipotransfer and to evaluate a single center's experience in the use of lipotransfer as an adjunct to head and neck reconstruction.

Study Design A retrospective review of all patients undergoing lipotransfer over a 5‐year period by the senior author was undertaken. A total of 23 patients with a minimum follow‐up of 1 year were available for analysis.

Methods Patient records were retrospectively reviewed to assess functional (in the case of palate augmentation) and esthetic outcomes.

Results Twenty‐three patients undergoing lipotransfer as part of their reconstructive effort included (1) eight patients undergoing temporal fossa augmentation following temporalis muscle flap reconstruction for extirpative skull base surgery, (2) six patients undergoing facial defect augmentation following traumatic atrophy, (3) three patients undergoing palatal augmentation for correction of velopharyngeal insufficiency, and (4) six patients undergoing soft tissue augmentation following flap reconstruction of the face. Twenty of the 23 patients had excellent maintenance of graft volume. An adequately vascularized recipient bed appears to be an important factor in determining ultimate graft survival using our technique.

Conclusions Lipotransfer of the head and neck represents a simple, effective adjunctive technique providing for large amounts of readily available, well‐tolerated soft tissue filler material. Patient selection is important, specifically in regard to determining that there is adequate vascularity of the recipient bed.
Inner Ear Extension of Vestibular Schwannomas
Authors: Falcioni Maurizio , Taibah Abdelkader , Trapani Di Giuseppe , Khrais Tarek , Sanna Mario
Published: November 2003

Objective Inner ear extension of vestibular schwannomas (VSs) is a rare finding but has important clinical implications. This report reviews the treatment options and presents the experience of the Gruppo Otologico, Piacenza, Italy, in this field.

Study Design Case report and literature review.

Methods Five cases of VSs with inner ear extension were surgically removed. In all of them, the cochlea was partially or completely invaded by the lesion.

Results In 4 cases, the inner ear extension was preoperatively identified on magnetic resonance imaging, and the surgical removal was planned through a transotic approach. In the last case, the cochlear invasion was not detected preoperatively, and the lesion was removed during a second surgery performed to seal a cerebrospinal fluid fistula.

Conclusions VSs with inner ear extension should be distinguished from pure intralabyrinthine schwannomas because of differences in clinical significance. Cochlear involvement is more frequent than vestibular involvement and is often accompanied by a dead ear. Dead ear caused by small VSs should alert the surgeon to the possibility of a cochlear extension. The presence of an intracochlear involvement requires the adoption of an approach that allows control of the cochlear turns, and we found the transotic approach to be the most suitable. Undetected cochlear extensions that are left in place may grow with time.
Familial Auditory Neuropathy
Authors: Wang Qiuju , Gu Rui , Han Dongyi , Yang Weiyan
Published: November 2003

Objectives/Hypothesis Auditory neuropathy is a sensorineural hearing disorder characterized by absent or abnormal auditory brainstem responses and normal cochlear outer hair cell function as measured by otoacoustic emission recordings. Many risk factors are thought to be involved in its etiology and pathophysiology. Four Chinese pedigrees with familial auditory neuropathy were presented to demonstrate involvement of genetic factors in the etiology of auditory neuropathy.

Study Design Probands of the above‐mentioned pedigrees, who had been diagnosed with auditory neuropathy, were evaluated and followed in the Department of Otolaryngology‐Head and Neck Surgery, China People Liberation Army General Hospital (Beijing, China). Their family members were studied, and the pedigree maps established.

Methods History of illness, physical examination, pure‐tone audiometry, acoustic reflex, auditory brainstem responses, and transient evoked and distortion‐product otoacoustic emissions were obtained from members of these families. Some subjects received vestibular caloric testing, computed tomography scan of the temporal bone, and electrocardiography to exclude other possible neuropathic disorders.

Results In most affected patients, hearing loss of various degrees and speech discrimination difficulties started at 10 to 16 years of age. Their audiological evaluation showed absence of acoustic reflex and auditory brainstem responses. As expected in auditory neuropathy, these patients exhibited near‐normal cochlear outer hair cell function as shown in distortion product otoacoustic emission recordings. Pure‐tone audiometry revealed hearing loss ranging from mild to profound in these patients. Different inheritance patterns were observed in the four families. In Pedigree I, 7 male patients were identified among 43 family members, exhibiting an X‐linked recessive pattern. Affected brothers were found in Pedigrees II and III, whereas in pedigree IV, two sisters were affected. All the patients were otherwise normal without evidence of peripheral neuropathy at the time of writing.

Conclusion Patients with characteristics of nonsyndromic hereditary auditory neuropathy were identified in one large and three smaller Chinese families. Pedigree analysis suggested an X‐linked, recessive hereditary pattern in one pedigree and autosomal recessive inheritances in the other three pedigrees. The phenotypes in the study were typical of auditory neuropathy; they were transmitted in different inheritance patterns, indicating clinical and genetic heterogeneity of this disorder. The observed inheritance and clinical audiological findings are different from those previously described for nonsyndromic low‐frequency sensorineural hearing loss. This information should facilitate future molecular linkage analyses and positional cloning for the relative genes contributing to auditory neuropathy.
Objective vestibular tests as outcome measures in head injury patients
Authors: Gottshall Kim , Drake Angela , Gray Nicola , McDonald Eric , Hoffer Michael E.
Published: November 2003

Hypothesis: Dynamic visual acuity testing (DVAT) and the Dizziness Handicap Index (DHI) can be used as reliable outcome measures in patients after head injury. Background: Balance disorders are a significant disability after mild traumatic brain injury (TBI). Assessing when individuals can perform activities of daily living, return to work, and begin to play sports can be difficult to determine. Objective outcome measures that correlate with successful life skills can be useful in managing these patients. Methods: Fifty‐three active duty individuals who suffered mild TBI underwent weekly DVAT testing and were administered a weekly DHI. Results in this group were compared with 46 control subjects who had not experienced TBI. In addition, weekly scores were compared with the patient's functional level, time to return to work, and time to perform all job related activities. Results: Individuals with TBI showed an overall increase of 42% in DVAT function over the first 4 weeks of testing, whereas controls showed an 8% increase. Concurrently, individuals with TBI averaged a 18‐point improvement in DHI function, whereas control subjects showed no significant change in this score. Improvement in DVAT and DHI function correlated closely at the 1‐week time point. Improvement in the patient's cognitive function, ability to return to activities of daily living, and ability to return to work gradually improved continuously. Conclusion: DVAT and the DHI can be used as reliable outcome measures in evaluating the progress of patients with balance disorders associated with TBI. These measures allow providers to make more reliable recommendations regarding such activities as returning to work.
Multilevel temperature‐controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea
Authors: Fischer Yvonne , Khan Martin , Mann Wolf J.
Published: November 2003

Objectives/Hypothesis: The concept of two‐level pharyngeal collapse in patients with obstructive sleep apnea is too simplified. Aggressive multilevel surgeries addressing several airway segments, including skeletal surgery, demonstrate improved success rates. Study Design: The study aimed to evaluate the safety and efficacy of multilevel radiofrequency application to soft palate, tonsils, and base of tongue in 16 white patients (mean age, 56.9 ± 11.1 y; mean body mass index, 27.3 ± 2.6 kg/m2) with obstructive sleep apnea. There was one dropout. Therapeutic effects after one treatment session were assessed 20.6 ± 12.6 weeks postoperatively. Treatment outcome measurements were based on Epworth Sleepiness Scale, Likert scales, and polysomnography. Methods: Every patient received 16 treatment sites with a total dose of 9750 J radiofrequency energy into soft palate, base of tongue, and tonsils. Success was defined as respiratory disturbance index equal to or less than 20 or at least 50% improvement if baseline respiratory disturbance index was less than 20. Statistical analysis was determined with the Spearman rank test. Results: Mean score on Epworth Sleepiness Scale decreased from 11.1 to 8.2 (P = .0001). Of the patients, 53.3% reported improvement of their daytime sleepiness. Snoring was assessed with 10‐point Lickert scale, and score decreased from 7.5 to 4.9 (P = .08). Mean respiratory disturbance index decreased from 32.6 δ 17.4 to 22.0 δ 15.0 (P = .003). By our definition of success, 5 of 15 patients (33%) have been treated successfully surgically and 4 of 15 (27%) had remarkable improvement after one treatment session; 1 patient (6.6%) demonstrated deterioration. There were two adverse effects, one superficial ulceration of the soft palate and one unilateral tonsillar abscess formation, with an overall complication rate of 13.3% for our patients and 0.41% for all treatment sites (n = 240). Conclusion: Moderate to severe obstructive sleep apnea usually requires multilevel pharyngeal surgery. Radiofrequency offers the potential of altering the upper airway on different sites.
Hemicricoidectomy as the primary diagnosis and treatment for cricoid chondrosarcomas
Authors: Cohen Jacob T. , Postma Gregory N. , Gupta Sumeer , Koufman James A.
Published: November 2003

Objectives/Hypothesis: The objective was to present a new approach for the diagnosis and treatment of chondrosarcoma involving the cricoid cartilage. The technique involved an extramucosal resection of the ipsilateral half of the involved cricoid cartilage, providing enough tissue to be sent for pathological study, and resulted in good laryngeal function without jeopardizing patients' long‐term survival. Study Design: Retrospective study. Methods: A retrospective study of eight patients who underwent hemicricoidectomy for cricoid chondrosarcoma was performed at the Center for Voice Disorders, Wake Forest University (Winston‐Salem, NC). One patient was a woman and seven were men. The mean age at diagnosis was 64 years (age range, 53‐72 y). Results: All patients had a low‐grade tumor. Primary treatment included hemicricoidectomy in all cases. In six (75%) of the patients, tracheotomy was required at the initial surgery. The mean time for decannulation was 3.2 months (range, 5 d‐1 y). In four cases a second procedure was required because of recurrence. The second procedure included two total laryngectomies and two endoscopic carbon dioxide laser excisions. The mean follow‐up time was 3 years (range, 2 mo‐10 y). At the time of writing, six patients were alive without recurrence, one patient was alive with disease; and one patient had died of unrelated causes. Conclusion: The authors recommended unilateral hemicricoidectomy as the diagnosis and treatment of choice. This procedure allows sufficient tissue for histological study and provides good long‐term breathing and phonatory function without compromising long‐term survival. This procedure is appropriate for patients with 1) mobility of one vocal fold, 2) dysphonia or aphonia, and 3) an adequate subglottic airway.