bluuebunny/crossref_metadata_2025 huggingface dataset:
Active High‐Frequency Vestibulo‐Ocular Reflex and Seasickness Susceptibility
Authors: Nachum Zohar , Gordon Carlos R. , Shahal Baruch , Spitzer Orna , Shupak Avi
Published: November 2003

Objectives/Hypothesis The vestibular autorotation test (VAT) examines responses to active head oscillations at frequencies between 2 and 6 Hz in the horizontal and vertical planes while the subject is fixating a visible target. At these frequencies, the vestibulo‐ocular reflex (VOR) is the main source of eye movement for ocular stabilization, although other visual and somatosensory information interacts with the response. Because the neural mismatch theory places emphasis on multimodal sensory interactions as the cause of motion sickness, using the VAT, which measures eye movements resulting from vestibular, visual, and, to a certain extent, proprioceptive information and depends on the conscious participation and cooperation of the subject, could be of advantage in evaluating individuals with differing susceptibility to motion sickness. The purpose of the present study was to evaluate high‐frequency VOR parameters in seamen at the two extremes of the seasickness susceptibility scale.

Study Design Cross‐sectional, parallel‐group design.

Methods Participants in the study were 35 healthy male volunteers aged 18 to 23 years, of whom 20 were highly susceptible to seasickness and 15 were nonsusceptible. The vestibulo‐ocular reflex was evaluated by the VAT at frequencies ranging from 2.0 to 5.9 Hz.

Results The lag of the vertical phase was significantly higher in the susceptible group. A significant interaction was also found between group and frequency, the vertical phase being significantly higher in the 3.9‐ to 5.9‐Hz range. Although no group effect was detected for the lag of the horizontal phase, there was a significant interaction between group and frequency, the horizontal phase being higher in the susceptible group at 5.5 and 5.9 Hz. No significant group differences were found for horizontal or vertical gain.

Conclusions The present findings support the contention that the VAT, which measures eye movements resulting from multimodal vestibular, visual, and, to a certain extent, proprioceptive information and depends on the conscious participation and cooperation of the subject, may produce different results in subjects at the two extremes of the seasickness susceptibility scale. Despite the statistical differences that were found, VAT measurements could not be used for practical purposes to categorize individual motion sickness susceptibility.
Recurrent Attacks of Facial Nerve Palsy as the Presenting Sign of Leukemic Relapse
Authors: Rhee Dukhee , Myssiorek David , Zahtz Gerald , Diamond Alan , Paley Carol , Shende Ashok
Published: November 2003

Objective To present an unusual case of recurrent facial palsy resulting from acute leukemic infiltration of the parotid gland.

Study Design Case report.

Methods An 11‐year‐old boy who had been treated for acute lymphoblastic leukemia (ALL) from 3 to 6 years of age presented with intermittent left facial nerve palsy with concurrent ipsilateral parotid fullness. The initial findings at diagnosis and workup are presented, and the disease progression and resolution with therapy are documented.

Results The patient had been off therapy when this finding developed. A workup for central and viral etiologies for the facial palsy was unrevealing. Biopsy of the parotid gland demonstrated a lymphoblastic leukemic infiltrate. The patient was placed on a chemotherapy protocol for relapsed leukemia, resulting in complete resolution of the facial palsy.

Conclusion Isolated facial nerve dysfunction, albeit rare, has been documented as a sign of central nervous system involvement in leukemia, but until now this presentation has not been described in the setting of leukemic relapse presenting with acute infiltration of the parotid gland.
The Potential Risk of Carotid Injury in Cochlear Implant Surgery
Authors: Gastman B. R. , Hirsch B. E. , Sando I. , Fukui M. B. , Wargo M. L.
Published: November 2003

Background The advent of cochlear implantation has revolutionized the options afforded to the deaf population. With the increase in the prevalence of this procedure have come larger experiences in the associated technical challenges and complications.

Results We present the evaluation and management of a patient with an unusual complication of improper placement of the implant electrode into the carotid canal and its management. We discuss the anatomy of the carotid artery and its proximity to the cochlea to emphasize the potential risk to this large vessel.

Conclusions Damage to the carotid canal and the carotid artery is a potential risk of cochlear implant surgery. When available, we recommend intraoperative electrical testing of the cochlear implant be performed. If there is doubt as to the placement of the electrode, a radiograph should be obtained before the patient is taken out of the operating room to avoid this complication.
Auditory Manifestations of Keratitis‐Ichthyosis‐Deafness (KID) Syndrome
Authors: Szymko‐Bennett Yvonne M. , Russell Laura J. , Bale Sherri J. , Griffith Andrew J.
Published: November 2003

Objective Evaluation of the auditory manifestations of Keratitis‐Ichthyosis‐Deafness (KID) syndrome, a rare genodermatosis characterized by follicular hyperkeratosis, vascularizing keratitis, and congenital hearing loss.

Study Design Five individuals with sporadic KID syndrome were evaluated in the outpatient audiology clinic at the Warren Grant Magnuson Clinical Center of the National Institutes of Health.

Methods Audiologic examinations included pure‐tone audiometry, speech audiometry, and middle ear immittance testing. Auditory brainstem responses and otoacoustic emissions were analyzed in 2 subjects.

Results Four subjects had prelingual, bilateral, profound sensorineural hearing loss, whereas the fifth subject had significant residual hearing that exhibited no progression on serial audiograms. All 5 subjects had a history of non‐erosive keratosis obturans and cutaneous cysts in the external ear canals that prevented continuous use of ear molds.

Conclusions The sensorineural hearing loss in KID syndrome is generally prelingual and profound. This combination of auditory and cutaneous phenotypes is similar to those previously reported for KID syndrome. KID syndrome presents a difficult challenge for communication rehabilitation because keratitis may impair the perception of sign and spoken language, and the cutaneous manifestations routinely curtail use of external amplification devices.
Phenotype of DFNA11: A Nonsyndromic Hearing Loss Caused by a Myosin VIIA Mutation
Authors: Tamagawa Yuya , Ishikawa Kazuhiro , Ishikawa Kotaro , Ishida Takashi , Kitamura Ken , Makino Shinji , Tsuru Tadahiko , Ichimura Keiichi
Published: November 2003

Objectives/Hypothesis To characterize the audiovestibular phenotype of DFNA11, an autosomal dominant nonsyndromic hearing impairment caused by a mutation in the myosin VIIA gene (MYO7A), including whether DFNA11‐affected subjects have retinal degeneration as is characteristic of Usher syndrome type 1B, caused by different MYO7A mutations.

Study Design Retrospective study of audiovestibular and ophthalmological data in a Japanese family linked to DFNA11.

Methods Otoscopic examination and pure‐tone audiometry were performed in all participants in the family. Selected subjects underwent additional examinations including speech discrimination scoring, acoustic reflex measurements, Békésy audiometry, evoked and distortion‐product otoacoustic emissions, auditory brainstem responses, and bithermal caloric testing; visual acuity, ocular tonometry, slit‐lamp examination, ophthalmoscopy, and electroretinography; and computed tomography of the temporal bone.

Results Most affected individuals had moderate cochlear hearing loss beginning in the second decade and progressing at all frequencies. Variable degrees of asymptomatic vestibular dysfunction were present. Computed tomography showed normal inner and middle ear structures. No evidence suggested retinitis pigmentosa.

Conclusions The phenotype of DFNA11 is postlingual, nonsyndromic sensorineural hearing loss with gradual progression. Showing moderate hearing loss with asymptomatic variable vestibular dysfunction and no retinal degeneration, the DFNA11 phenotype is mildest among phenotypes caused by MYO7A mutations.
Validity of the Western Blot Immunoassay for Heat Shock Protein‐70 in Associated and Isolated Immunorelated Inner Ear Disease
Authors: García Berrocal José Ramón , Ramírez‐Camacho Rafael , Arellano Beatriz , Vargas Juan Antonio
Published: November 2003

Objective To assess the validity of the Western blot immunoassay for heat shock protein‐70 (hsp‐70) for diagnosis of autoimmune inner ear disease.

Study Design Retrospective study of 53 patients affected by sudden deafness (n = 19), idiopathic progressive sensorineural hearing loss (n = 24), and Meniere's disease (n = 10) who were treated from 1995 to 1999. The clinical course and response to corticosteroid were evaluated.

Methods A purified hsp‐70 antigen from bovine kidney cell line was used for the Western blot immunoassay.

Results Only five patients (9.4%) showed anti–hsp‐70 antibodies: Two presented a sudden sensorineural hearing loss (sudden deafness group), two showed an idiopathic progressive sensorineural hearing loss (idiopathic progressive sensorineural hearing loss group), and one was affected by fluctuating hearing loss (Meniere's disease group). A systemic autoimmune condition was observed in 29.1% of patients with idiopathic progressive sensorineural hearing loss.

Conclusions The low sensitivity of Western blot immunoassay for patients affected by idiopathic progressive sensorineural hearing loss and Meniere's disease may result from either the long time elapsed from the hearing loss and vertigo to the initial examination or from the increased percentage of cases of systemic autoimmune disease present in patients with idiopathic progressive sensorineural hearing loss. More studies to detect the immune‐mediated inner ear disease in Western blot immunoassay–negative patients are required.
The Effect of Neuromuscular Stimulation of the Genioglossus on the Hypopharyngeal Airway
Authors: Mann Eric A. , Burnett Theresa , Cornell Sonia , Ludlow Christy L.
Published: November 2003

Objectives To determine the effects of neuromuscular stimulation (NS) of the genioglossus muscle on hypopharyngeal airway size.

Study Design Fourteen consecutively recruited healthy volunteers underwent percutaneous electrical NS of the genioglossus muscle.

Methods Bipolar hooked wires were inserted percutaneously into the genioglossus muscle and used for NS. The anterior–posterior diameter of the hypopharynx was measured at the level of the superior edge of the epiglottis at baseline and during NS from recorded video endoscopic examinations.

Results NS of the genioglossus muscle resulted in a significant increase in the diameter of the hypopharyngeal airway (P = .002) compared with baseline, ranging from a 33% to 284% increase in airway diameter. Three of the 14 patients demonstrated modest decreases in airway diameter, likely the result of faulty electrode placement in surrounding tongue retrusive muscles.

Conclusions NS of the genioglossus muscle was effective in increasing the hypopharyngeal airway and may provide a useful alternative to direct stimulation of the hypoglossal nerve with a nerve cuff electrode in the development of neuroprosthetic treatments for obstructive sleep apnea.
The Mechanical Stability Under Load of Tracheal Anastomoses After Various Phases In Vivo
Authors: Behrend Matthias , Kluge Eva , Schüttler Wolfgang , Klempnauer Jürgen
Published: November 2003

Objective The objective of our study was to postoperatively examine the mechanical stability under load of tracheal anastomoses over different periods in time and to compare these with native tracheae.

Study Design A randomized experimental study on animals.

Method We performed tracheal anastomoses on sheep with three different suturing techniques and different resection lengths (3, 6, and 9 cm): These anastomoses were subjected to a breaking test at different intervals in vivo (1, 2, 4, 8, and 24 wk) and compared with the tracheae of healthy sheep.

Results After 1 week in vivo, the anastomosis itself tore off from the remaining trachea under tension, regardless of the suturing technique used and the length of resection. With all animals that survived for a longer period, the trachea broke a greater distance away from the anastomosis. The necessary breaking forces were only minimally lower than those required for breaking healthy tracheae and the difference is statistically insignificant. When all operated tracheae are combined and the forces compared with native tracheae, this reveals that the operated tracheae are significantly more stable (P = .015) and present a lower longitudinal elasticity (P = .004).

Conclusion During the first postoperative days, the stability under load of tracheal anastomoses is slightly lower than that of healthy trachea. This difference is, however, far from those values that can be measured intraoperatively on tracheal anastomoses. Thus, supplementary measures for the mechanical protection against suture line separation do not seem necessary.
FDG PET for Mucosal Malignant Melanoma of the Head and Neck
Authors: Goerres Gerhard W. , Stoeckli Sandro J. , von Schulthess Gustav K. , Steinert Hans C.
Published: November 2003

Objectives/Hypothesis To evaluate imaging findings using positron emission tomography (PET) and 18F‐fluorodeoxyglucose (FDG) in mucosal malignant melanoma (MMM) of the head and neck.

Study Design Retrospective evaluation.

Methods Eighteen PET examinations were performed for initial staging and/or follow‐up in 10 patients with MMM. Medical records of 6 male and 4 female patients (age range, 43–81 y; mean, 67 y) were reviewed retrospectively with regard to the patients' history, symptoms, and clinical course. Primary melanoma elsewhere in the body was excluded at the time of diagnosis.

Results All MMM were visible in staging PET examinations, but FDG uptake depended on lesion size and anatomic site. Big lesions with a nodular growth, as seen in pathologic specimens, were better visible compared with lesions with a more superficial spread within the mucous membranes. Lesions in the anterior part of the nasal cavity were more difficult to detect than those in the posterior sinonasal complex because of possible interference with nonspecific uptake in muscles of the mouth and pronounced appearance of the skin when imaging was performed using filtered back projection without attenuation correction.

Conclusion We found that MMM of the head and neck can be visualized using FDG PET. Furthermore, locoregional and distant metastases can be evaluated much like those of cutaneous malignant melanoma. Therefore, PET may be suitable for the staging and/or restaging of these patients. Further studies have to elucidate the potential role of FDG PET in patient management.
Autofluorescence Endoscopy in the Diagnosis of Early Laryngeal Cancer and Its Precursor Lesions
Authors: Malzahn Karin , Dreyer Thomas , Glanz Hiltrud , Arens Christoph
Published: November 2003

Objectives Because early detection and preoperative assessment of laryngeal cancer and its precursor lesions are essential for curative and function‐preserving surgical treatment, autofluorescence endoscopy has been developed to gain more information about the biologic character of these lesions. The aim of the present study is to investigate a high, representative number of patients and to evaluate the diagnostic potential and the limitations of this method.

Methods In a prospective study, 127 patients were investigated during microlaryngoscopy. A total of 111 patients were suspected of having precancerous or cancerous lesions, 12 had benign lesions, and 4 patients had normal epithelium. Autofluorescence was induced by filtered blue light (380–460 nm) of a xenon short arc lamp and processed by a CCD camera system (D‐light‐AF system; Storz, Tuttlingen, Germany). Autofluorescence endoscopic images were immediately assessed for diagnosis, correlated to the dysplasia grading system and compared with the histopathologic findings.

Results Normal laryngeal mucosa displayed a typical green fluorescence signal. Moderate and high epithelial dysplasia, carcinoma in situ, and invasive carcinoma showed a diminished green fluorescence. False‐negative results (n = 2) were the result of extreme hyperkeratosis. False positive cases (n = 8) either showed mild dysplasia with inflammatory reactions or scarring of the vocal folds. In 105 of 111 cases (94.6%), we found concordant results (sensitivity, 97.3%; specificity, 83.8%).

Conclusion Autofluorescence endoscopy facilitates the detection and delineation of precancerous lesions, carcinoma in situ, and microinvasive cancer of the larynx more accurately than clinical observation alone. Scarring, marked hyperkeratosis, and inflammation can limit the predictive value of the method.
Swallowing Disorders in the Elderly
Authors: Schindler Joshua S. , Kelly James H.
Published: November 2003

Changes that occur as a natural part of senescence in the complex action of deglutition predispose us to dysphagia and aspiration. As the “baby‐boomers” begin to age, the onset of swallowing difficulties will begin to manifest in a greater number of our population. Recent advances in the evaluation of normal and abnormal swallowing make possible more precise anatomical and physiological diagnoses. Coupled with an understanding of swallowing physiology, such detailed evaluation allows greater opportunity to safely manage dysphagia with directed therapy and appropriate surgical intervention. The current study is a discussion of the changes that occur in deglutition with normal aging, contemporary evaluation of swallowing function, and some of the common causes of dysphagia in elderly patients.
Secondary Tracheoesophageal Puncture With Local Anesthesia
Authors: Eerenstein Simone E. J. , Schouwenburg Paul F.
Published: November 2003

Objectives To present a new technique for secondary tracheoesophageal puncture (TEP) in laryngectomized patients. The technique is performed on an outpatient basis under local anesthesia.

Study Design Laryngectomized patients waiting for secondary TEP procedures were given the choice between the new technique under local anesthesia on an outpatient basis and the traditional technique under general anesthesia requiring hospitalization.

Methods Using basic implements available in an outpatient clinic, the traditional TEP technique was modified with the oral introduction of an intubation tube with an illuminated, inflatable cuff at the puncture site. The illuminated, inflated cuff serves as a beacon during the procedure and the tube protects the posterior tracheal wall.

Results Nine patients underwent the procedure under local anesthesia. In 8 of them the procedure went smoothly, but in 1 of them the inflatable cuff could not be satisfactorily placed as a result of the local anatomy and the procedure was canceled. All patients were pleased with the technique and said the procedure was painless.

Conclusions With some modifications, the traditional TEP technique has been rendered suitable for selected outpatient use under local anesthesia, and the necessary hospitalization for secondary TEP can thus be avoided.
Intentional Ablation of Vestibular Function Using Commercially Available Topical Gentamicin‐Betamethasone Eardrops in Patients With Meniere's Disease: Further Evidence for Topical Eardrop Ototoxicity
Authors: Kaplan Daniel M. , Hehar Sukhminderjit S. , Bance Manohar L. , Rutka John A.
Published: November 2003

Objective To determine whether the controversial findings of suspected ototoxicity from commercially available gentamicin sulfate and betamethasone sodium phosphate eardrops can be used in a therapeutic fashion to ablate (or attenuate) vestibular function in patients with unilateral Meniere's disease.

Study Design Prospective case review.

Methods At a tertiary care dizziness unit at the University Health Network, Toronto General Hospital, University of Toronto (Toronto, Ontario, Canada), adults with unilateral Meniere's disease undergoing intratympanic ablation therapy were studied. After insertion of a tympanostomy tube with the patient under local anesthesia, patients instilled gentamicin containing eardrops three times daily until they became vertiginous for longer than 24 hours and then for an additional 2 days longer or for 1 month, whichever came first. Electronystagmographic caloric test responses were measured before treatment using bithermal water caloric and after treatment using air caloric tests. Main outcome measures included clinical titration of drops to the onset of prolonged vertigo. As well, post‐treatment findings on electronystagmography and audiometry were compared with pretreatment testing.

Results Twenty patients were available for review. Fifteen patients had a significant reduction in caloric test responses compared with pretreatment values; among them, 10 patients had absent air caloric test responses on the treated side. In 10 patients hearing worsened according to the 1995 American Academy of Otolaryngology—Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for reporting in Meniere's disease.

Conclusions Topical gentamicin‐betamethasone eardrops can pass through a tube into the middle ear, where they may prove primarily vestibulo‐ototoxic patients with Meniere's disease. The study further confirms clinical observations that gentamicin‐containing eardrops might prove ototoxic, especially in noninflamed ears with a tympanic membrane defect.
Intralesional Cidofovir Therapy for Laryngeal Papilloma in an Adult Cohort
Authors: Bielamowicz Steven , Villagomez Vicente , Stager Sheila V. , Wilson William R.
Published: November 2003

Objectives To confirm the safety and efficacy of intralesional cidofovir in the management of laryngeal papilloma and to identify variables that correlate with number of injections needed to achieve remission.

Study Design An open‐trial prospective evaluation of the efficacy of intralesional cidofovir in subjects with laryngeal papilloma.

Methods Fourteen adult subjects with biopsy‐proven laryngeal papilloma were enrolled in a treatment study of intralesional cidofovir. Preprotocol disease duration ranged from 1 to 30 years with a mean duration of 7 years. Subjects received monthly injections of cidofovir with a maximum dose of 37.5 mg per injection in 6 cc saline (6.25 mg/mL). Injections were repeated until no papilloma could be visually identified during an intraoperative evaluation. After disease remission was achieved, subjects received an additional injection. All injections occurred during suspension microlaryngoscopy.

Results All subjects have achieved disease remission using an injection‐only treatment protocol. No additional laryngeal scarring or systemic toxicity was identified. On average, 6 injections were required to achieve remission. Preprotocol disease duration and anatomical staging correlated positively with the number of injections required for disease remission.

Conclusions Intralesional injection of cidofovir is an excellent treatment option with limited local and systemic toxicities. The injection therapy regimen requires perseverance from both patient and surgeon. Remission of disease can be achieved in adults with laryngeal papilloma.
Human Papillomavirus in Larynx
Authors: Aaltonen Leena‐Maija , Rihkanen Heikki , Vaheri Antti
Published: November 2003

Objectives The core of the present clinical and basic research knowledge of laryngeal human papillomavirus (HPV) infection is described.

Study Design Review.

Methods A computer‐aided search of MEDLINE database supplemented by hand searches of key journals was conducted.

Results One of the tumor‐promoting factors in the larynx is the HPV found both in normal laryngeal epithelium and in laryngeal tumors. The most important manifestation of laryngeal HPV infection is laryngeal papillomatosis, a rare disease caused by HPV types 6 and 11. In laryngeal carcinogenesis, the role of HPV remains uncertain. The means of transmission of HPV are partly unknown, and the course of laryngeal HPV infection is unpredictable and variable. Treatment of laryngeal papillomatosis is based on surgery, especially on CO2 laser and shaver. Alpha‐interferon is the drug of choice in patients whose response to surgery is poor. However, neither interferon nor other antiviral drugs are able to eradicate the virus from laryngeal mucosa. Little is known about immunological mechanisms involved in laryngeal HPV infection, but in defense against HPV cellular immunity is considered a more important mechanism than humoral immunity. A good experimental model of HPV infection is lacking in which the entire viral life cycle can take place. Organotypic cell cultures (collagen rafts) are useful, but the rate‐limiting step in this method is the difficulties in culturing HPV‐positive epithelial cells.

Conclusions Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.
Airway Assessment by Volumetric Computed Tomography in Snorers and Subjects With Obstructive Sleep Apnea in a Far‐East Asian Population (Chinese)
Authors: Chen Ning‐Hung , Li Kasey K. , Li Shia‐Yu , Wong Chao‐Reng , Chuang Ming‐Lung , Hwang Chung‐Chi , Wu Yao‐Kaung
Published: November 2003

Objectives To evaluate the airway dimension of simple snorers and subjects with obstructive sleep apnea (OSA) in a Far‐East Asian population (Chinese).

Study Design Prospective study of 117 near‐consecutive patients evaluated for snoring and possible OSA from January 1998 to December 1998 in a sleep laboratory. Overnight polysomnography (PSG) was performed on all patients and the sleep parameters, including respiratory disturbance index (RDI), snoring index, minimal oxygen saturation (min O2), percentage of slow wave sleep (SWS), and rapid eye movement (REM) were recorded. Three‐dimensional computerized tomography (CT) during awake periods was performed. The anteroposterior (AP) and the lateral distance of the retropalatal (RP) region in the oropharynx, the smallest area of RP, and retroglossal (RG) regions, and the total volume of the oropharynx were measured.

Result Ninety‐eight patients were diagnosed with OSA (mean RDI, 41.48 ± 26.45 events per hour; min O2, 72.82 ± 12.86%), whereas 19 were simple snorers. The AP and the lateral distance of the RP region, as well as the smallest area of the RP region, are significantly smaller in subjects with OSA. However, no differences in the RG region and the total volume of the oropharynx were found between the two groups. Linear regression analysis demonstrated that the lateral dimension and the smallest RP area in overweight subjects inversely correlated with the RDI, but only the AP dimension of the RP area was found to have an inverse correlation with the RDI in the underweight subjects.

Conclusion In Far‐East Asians (Chinese), the RP airway was found to be the primary site of narrowing in subjects with OSA, and the narrowest RP area was inversely correlated with RDI. Furthermore, weight may influence the pattern of RP narrowing by contributing to lateral collapse.
Dimensional Stability of the Free Fascia Grafts: An Animal Experiment
Authors: Indorewala Shabbir
Published: November 2003

Objectives/Hypothesis It appears that autologous free fascia grafts (fascia lata and temporal fascia) change their dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations. There has been no study regarding this dimensional instability.

Study Design Prospectively dimensional instability of the free fascia grafts was studied in 14 mongrel dogs.

Methods Fourteen healthy Mongrel dogs were operated on twice. During the first surgery, fascia lata and temporal fascia grafts of measured dimensions (length, breadth, and thickness) were implanted in the subcutaneous pockets on the thoracoabdominal wall of the same dog (autograft). Five dogs were operated on again after 2 days, and 7 dogs were operated on again after 5 days to harvest the implanted grafts. The dimensions of the harvested grafts were noted. Changes with respect to their implant dimensions after 2 days and after 5 days were calculated.

Results It was found that free fascia lata exhibits significantly superior dimensional stability when compared with free temporal fascia during the early healing phase, before graft integration has occurred. Shrinking and thickening of temporal fascia are greater and are also most unpredictable.

Conclusions Poor dimensional stability of temporal fascia may compromise a well‐sealed perforation at the time of surgery, and it may reopen by the 5th day. This must be one of the causes of failure of tympanoplasty, which needs to be studied further.
Hypopharyngeal Cancer: Results of Treatment Based on Radiation Therapy and Salvage Surgery
Authors: Godballe Christian , Jørgensen Karsten , Hansen Olfred , Bastholt Lars
Published: November 2003

Objectives The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with hypopharyngeal squamous cell carcinoma (HPC).

Study Design A consecutively admitted series of 110 patients was analyzed retrospectively. The female:male ratio was 29:81. The sites of the tumors were: pyriform fossa (72%), postcricoid area (18%), and posterior pharyngeal wall (10%). T‐status was T1: 15%, T2: 26%, T3: 28%, and T4: 37%. N‐status was N0: 27%, N1: 33%, N2: 26%, and N3: 14%.

Methods One hundred three patients (94%) were treated with curative intent. Two of these received primary surgery; the remaining 101 patients had primary radiotherapy. Seven patients (6%) received no or only palliative treatment.

Results The 5‐ and 10‐year estimates for crude survival (CS) were 16% and 7% and disease‐specific survival (DSS) 28% and 23%, respectively. In the group of patients treated with curatively intended radiotherapy, 71 recurrences were observed at the time of analysis. The 5‐ and 10‐year RFS estimates were both 17%. The values for CS were 18% and 8% and the values for DSS were 31% and 26%, respectively. Univariate survival analyses of age, sex, T‐status, N‐status, and TNM staging did not show any significant influence on survival.

Conclusions We conclude that the survival of patients with HPC treated with primary radiotherapy and salvage surgery is poor and that other treatment modalities have to be considered.
Intrasinus Administration of Topical Budesonide to Allergic Patients With Chronic Rhinosinusitis Following Surgery
Authors: Lavigne François , Cameron Lisa , Renzi Paolo M. , Planet Jean François , Christodoulopoulos Pota , Lamkioued Bouchaib , Hamid Qutayba
Published: November 2003

Objective Whether instillation into the maxillary sinus of topical budesonide affected the immune response and improved allergic patients with chronic rhinosinusitis that had persistence of symptoms despite appropriate surgical intervention was assessed.

Study Design Double‐blind placebo‐controlled.

Methods Twenty‐six patients with allergy to house dust mites who had previously had surgery and who had persistent symptoms of disabling rhinorrhea or pressure‐pain resistant to oral antibiotics and intranasal corticosteroids were recruited. During the double‐blind study, patients instilled 256 μg budesonide daily or placebo through an intubation device (maxillary antrum sinusotomy tube) into one of the maxillary sinuses for 3 weeks before clinical assessment and a second biopsy.

Results We found an improvement in the symptom scores in 11 of the 13 patients who received budesonide; we also found a decrease in CD‐3 (P = .02) and eosinophils (P = .002), and a decrease in the density of cells expressing interleukin‐4 (P = .0001) and interleukin‐5 messenger RNA (P = .006) after treatment.

Conclusion Topical budesonide delivered through a maxillary antrum sinusotomy tube can control chronic rhinosinusitis that persists after surgery.
End‐to‐Side Neurorrhaphy and Lateral Axonal Sprouting in a Long Graft Rat Model
Authors: Goheen‐Robillard B. , Myckatyn T. M. , Mackinnon S. E. , Hunter D. A.
Published: November 2003

Objective/Hypothesis Controversy exists regarding collateral axonal sprouting across an end‐to‐side neurorrhaphy to provide functional motor reinnervation of a target organ without compromise of the donor nerve. Rat models may be limited in the study of end‐to‐side repair given potential contamination from the proximal nerve stump of the recipient distal nerve and the use of antagonistic muscle groups for donor and recipient. The current study attempts to address these issues by using a rat model in which an end‐to‐side coaptation is performed with a long graft interposed between the intact donor tibial nerve and the divided, distal contralateral tibial nerve.

Materials and Methods The graft used in proximal end‐to‐side coaptation consisted of both sciatic nerves in a donor syngeneic animal. The distal repair to the contralateral tibial nerve was done immediately or in a delayed fashion to allow potential motor axons to transverse the graft before division of the recipient tibial nerve.

Results After 24 weeks, axons were noted to transverse the entire distance of the graft and into the contralateral distal posterior tibial nerve. A significant increase in axonal numbers was observed in the immediate repairs compared with the delayed. No animal recovered functional motor ability on the contralateral side as assessed by walking tracks.

Conclusions These findings suggest the importance of immediate distal neurotrophic factors in encouraging nerve regeneration even in a long graft end‐to‐side repair. Our model is successful in demonstrating innervation through an end‐to‐side coaptation but questions its use given the lack of motor recovery.
Videomanofluorometric Study in Amyotrophic Lateral Sclerosis
Authors: Higo Ryuzaburo , Tayama Niro , Watanabe Takeshi , Nitou Takaharu
Published: November 2003

Objective To elucidate the time‐course changes of swallowing function in amyotrophic lateral sclerosis (ALS) by videomanofluorometry.

Study Design Videomanofluorometry was conducted on 21 patients with ALS, who were divided into five groups according to type of disease and according to the length of time following the appearance of bulbar symptoms.

Methods Videomanofluorometry, which is videofluoroscopic and manometric study conducted simultaneously, was performed on patients in the five groups, and swallowing function in each group was evaluated. Some of the patients were followed up by videomanofluorometry performed several times, and their swallowing function changes over time were investigated.

Results A decrease of swallowing pressure first appeared in the oropharynx, then the hypopharynx became involved. Oropharyngeal swallowing pressure had already decreased to approximately 50 mm Hg within 6 months after the appearance of bulbar symptoms; however, hypopharyngeal swallowing pressure was relatively maintained until 1 year after the onset of bulbar symptoms. Most of the patients with ALS maintained normal upper esophageal sphincter relaxation, but upper esophageal sphincter spasm was seen in some patients with ALS. Aspiration was seen in eight cases, five of which showed upper esophageal sphincter spasm.

Conclusions Patients with ALS gradually face the danger of aspiration as decreases of oropharyngeal and hypopharyngeal swallowing pressure progress. Upper esophageal sphincter spasm occurs in some patients with ALS, and it is an important cause of aspiration. Both videofluoroscopic and manometric evaluation are necessary to assess these conditions, and they are quite useful for follow‐up of swallowing function in patients with ALS.
An Interpretation Method for Objective Assessment of Nasal Congestion With Acoustic Rhinometry
Authors: Mamikoglu Bulent , Houser Steven M. , Corey Jacquelynne P.
Published: November 2003

Objectives Acoustic rhinometry is a relatively new modality for evaluating the status of the nose. It assesses the geometry of the nasal cavity by analyzing reflected sound waves. Despite its expanding use, there is no established interpretation method. Our aims in the present descriptive study were to develop and test a protocol as a possible method to read these graphs for clinical use.

Study Design We formulated a reading protocol to grade the congestion state of the nasal cavity. The percentile difference of cross‐sectional area and volume values between the baseline and decongested states were classified into five categories based on normative values.

Methods Fifty‐six patients with allergic rhinitis were used. All the acoustic rhinometry readings were performed in blinded fashion according to the protocol; later, the clinical information was paired with the interpretation of the graph.

Results The mean percentile differences of baseline and decongestion values in patients with allergic rhinitis were in the mild to moderate range difference according to our reading system. The range of nasal congestion in patients with allergic rhinitis patients was increased with additional pathological conditions such as sleep apnea.

Conclusion The percentile difference between the baseline values and values for maximally decongested state reflect mucosal congestion as a “congestion factor,” which can be graded as mild, moderate, severe, or markedly severe, for objective evaluation of nasal congestion.
Proliferation Potential in Recurrent Acoustic Schwannoma Following Gamma Knife Radiosurgery versus Microsurgery
Authors: Lee Frank , Linthicum Fred , Hung Gene
Published: November 2003

Objective To evaluate the proliferation potential of recurrent acoustic schwannoma following gamma knife radiosurgery (GKR) versus microsurgery.

Study Design Retrospective study.

Methods A review of surgical records of the House Ear Clinic revealed 8 patients who had undergone GKR and 15 patients who had undergone microsurgery who had unilateral acoustic schwannoma recurrences. Immunohistochemical studies were performed to evaluate the expression of proliferating cell nuclear antigen (PCNA) on archival paraffin‐embedded blocks.

Results All 8 GKR and 15 microsurgical tumors had positive staining for PCNA. The recurrent GKR tumors had significantly lower proliferation levels than in the microsurgical group (P = .03). Two GKR tumors had high proliferation levels.

Conclusions Our study indicates that recurrent vestibular schwannomas treated with GKR have lower proliferation potential as assessed by PCNA compared with recurrences following microsurgery. Radiation‐induced apoptosis is thought to contribute to the lower tumor cell proliferation in GKR tumor. The two GKR tumors with high proliferation potential could be a result of radiation‐induced sporadic mutation, resulting in high tumor cell proliferation.
Immediate Reconstruction of Extruded Alloplastic Nasal Implants With Irradiated Homograft Costal Cartilage
Authors: Clark J. Madison , Cook Ted A.
Published: November 2003

Objective To describe a novel surgical protocol for the management of patients presenting with extruded nasal implants.

Study Design Retrospective chart review.

Methods Analysis of consecutive patients presenting with extruded nasal implants from 1986 to 2000. Patients were selected from a large database of revision rhinoplasty cases. Inclusion criteria were: 1) at least one previous rhinoplasty procedure, 2) an extruded nasal implant that was documented preoperatively, 3) immediate reconstruction that was carried out with irradiated homograft costal cartilage (IHCC), and 4) at least 1 year of follow‐up recorded, including standard postoperative rhinoplasty photographs. A total of 18 patients met the inclusion criteria and form the basis of this study. Data gathered from the charts included date of surgery, last date of follow‐up, location of implant extrusion, alloplastic material, specific use of IHCC for reconstruction, percent of clinical IHCC resorption at last follow‐up, and presence of warping of the IHCC.

Results All 18 patients were satisfied with the cosmetic outcomes of their nasal reconstructions. The most common extruded alloplast was Silastic, followed by Gore‐Tex (W.L. Gore & Associates, Inc., Flagstaff, AZ). There were no cases of extrusion or infection of the IHCC implant subsequent to immediate reconstruction of the extruded alloplast. Clinical resorption of the IHCC was minimal, with a mean follow‐up of 26 months. Only one patient had a complication, warpage, resulting in removal of the IHCC. In that patient, the IHCC still had carving markings on the implant after 2 years in vivo.

Conclusions In this series of patients, a novel surgical protocol was used. The extruded implant was removed and immediate reconstruction with irradiated rib cartilage was done. All patients were evaluated for postoperative infection, graft extrusion, and satisfaction with cosmetic result. There was one major complication in this series of 18 patients, warping of the IHCC, which necessitated removal and replacement. This approach appears to be a reasonable method for reconstruction of extruded nasal alloplasts.
Identification of Upper Respiratory Bacterial Pathogens With the Electronic Nose
Authors: Lai Stephen Y. , Deffenderfer Olivia F. , Hanson William , Phillips Marguerite P. , Thaler Erica R.
Published: November 2003

Objective To use an electronic nose to identify common upper respiratory bacterial pathogens.

Study Design Controlled in vitro analysis.

Methods Swabs of bacteria were obtained from in vitro samples. The specimens were vaporized and analyzed over the organic semiconductor‐based electronic nose (Cyranose 320). Data from the 32‐element sensor array were subjected to principal component analysis for depiction in two‐dimensional space and differences in odorant patterns were assessed by calculating Mahalanobis distances.

Results The electronic nose was able to distinguish between control swabs and bacterial samples. Furthermore, calculation of the Mahalanobis distances among the various bacteria demonstrated distinct odorant classes (Mahalanobis distance ⩾3). This demonstrates that the electronic nose could differentiate among various common bacterial pathogens of the upper respiratory tract, including Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenza, and Pseudomonas aeruginosa.

Conclusions The electronic nose represents a novel method to identify potential upper respiratory infections and to discriminate among common upper respiratory bacterial pathogens. This technology could provide a rapid means to identify organisms causing upper respiratory infections.
Management of Multiple Spontaneous Nasal Meningoencephaloceles
Authors: Schlosser Rodney J. , Bolger William E.
Published: November 2003

Objectives/Hypothesis Multiple spontaneous nasal meningoencephaloceles in the same patient are rare lesions. Although many skull base defects occur after prior trauma or surgery, otolaryngologists must be aware of the potential for spontaneous encephaloceles. We present our experience with this unusual condition and discuss its pathophysiology and unique management issues.

Study Design Retrospective.

Methods Review of medical records, radiographic images, and cerebrospinal fluid pressures.

Results We identified 5 patients with multiple, simultaneous, spontaneous encephaloceles: 4 patients with 2 encephaloceles and 1 patient with 3 encephaloceles (11 in all). Locations of the 11 encephaloceles were sphenoid lateral recess (6), frontal sinus with supraorbital ethmoid extension (2), ethmoid roof (1), frontal sinus (1), and central sphenoid (1). Three patients had bilateral sphenoid lateral recess encephaloceles, accounting for all six in that location. All four patients with available radiographic studies demonstrated empty sella turcica. Surgical approaches included endoscopic transpterygoid approach to the lateral sphenoid recess (3), endoscopic approach to ethmoid and central sphenoid (3), and osteoplastic flap with frontal sinus obliteration (2). We had 100% success at latest endoscopic follow‐up (mean period, 17 mo). Three patients had postoperative lumbar punctures with mean cerebrospinal fluid pressure of 28.3 cm water (range, 19–34 cm; normal range, 0–15 cm).

Conclusions Multiple spontaneous encephaloceles can be managed safely and successfully using endoscopic and extracranial approaches. A high index of suspicion for this diagnosis must be maintained, especially in patients with radiographic evidence of laterally pneumatized sphenoid sinuses or empty sella. Spontaneous encephaloceles and cerebrospinal fluid leaks represent a form of intracranial hypertension.
The Transcaruncular Approach to the Medial Orbital Wall
Authors: Graham Scott M. , Thomas Robert D. , Carter Keith D. , Nerad Jeffrey A.
Published: November 2003

ObjectiveTo demonstrate the safety and use of the transcaruncular approach as a surgical technique that provides rapid exposure of the medial orbital wall and apex through a small cosmetic conjunctival incision.

MethodsThe transcaruncular anterior orbitotomy incision is made through the conjunctiva, between the plica and caruncle, with dissection to a subperiorbital plane along the medial orbital wall. This technique was used in 49 patients (58 orbits) between July 1995 and December 2000. The patients' ages ranged from 5 to 89 years (mean, 50 y).

ResultsThe transcaruncular anterior orbitotomy approach provided appropriate surgical exposure in all cases of orbital decompression for thyroid‐related orbitopathy (in 33 orbits [26 patients]); for biopsy of medial orbital or orbital apex masses in 12 patients; and for drainage of an orbital abscess or marsupialization of a mucocele in 7 orbits (6 patients). Five patients (6 orbits) underwent a transcaruncular approach for release of medial rectus entrapment after fracture. The single complication was 1 patient who required a revision procedure for treatment of medial fornix scarring with resolution of diplopia.

ConclusionsThe transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach to the medial orbital wall and orbital apex. This technique can be used for a variety of indications.
Cystic Metastasis Versus Branchial Cleft Carcinoma: A Diagnostic Challenge
Authors: Briggs Russell D. , Pou Anna M. , Schnadig Vicki J.
Published: November 2003

Objectives There is controversy regarding the existence of branchial cleft carcinomas. The objectives are to familiarize the clinician with the presentation and treatment of cystic metastases from head and neck primary sites and differentiate these from primary branchial cleft cyst carcinomas.

Study Design Retrospective case study and literature review.

Methods Published reports of branchial cleft carcinomas were reviewed in conjunction with a unique case presenting at the University of Texas Medical Branch (Galveston, TX).

Results Most cases of branchial cleft carcinomas are probably cystic metastases from head and neck primary sites. Cutaneous involvement with primary branchial cleft carcinomas is rare but may occur in recurrent lesions.

Conclusions The diagnosis of a primary branchial cleft cyst carcinoma requires the fulfillment of strict criteria. Cystic metastases from head and neck primaries can mimic branchial cleft carcinomas histologically. Correct diagnosis is important so that appropriate surgical and radiotherapeutic treatment can be delivered.