bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of Cochlear Damage With Three Perimodiolar Electrode Designs
Authors: Eshraghi Adrien A. , Yang Nathaniel W. , Balkany Thomas J.
Published: November 2003

Objective To describe intracochlear insertion trauma caused by three perimodiolar cochlear implant electrodes.

Study Design Descriptive histological study of 15 human cadaver temporal bones.

Methods Fifteen cadaver temporal bones underwent surface preparation and were implanted with one of the following perimodiolar electrode arrays: Combi 40+PM (MedEl Corporation), HiFocus II (Advanced Bionics Corporation), or Contour (Cochlear Corporation). A cryosectioning technique was used to study horizontal sections at 200‐μm intervals with the electrode in place. Image‐enhanced videofluoroscopy and computer‐assisted morphometrics were used to assess the mechanism of insertion trauma and to determine electrode position within the modiolus.

Results Histological examination revealed varying degrees of damage to the spiral ligament, basilar membrane, and osseous spiral lamina. Using a novel grading system for electrode trauma, there was no statistically significant difference among the three electrodes. A literature search of histological studies of a commonly used “standard” electrode showed damage equal to or greater than that seen in the current study.

Conclusions Insertion trauma caused by periomodiolar electrodes occurs to an acceptable degree. Refinement of electrodes based on mechanisms of trauma may be able to further reduce damage.
Expression of a Cathelicidin Antimicrobial Peptide Is Augmented in Cholesteatoma
Authors: Jung Hak Hyun , Chae Sung Won , Jung Seol Ki , Kim Seon Tae , Lee Heung Man , Hwang Soon Jae
Published: November 2003

Objectives/Hypothesis Antimicrobial peptides are active defense components of innate immunity. Their importance was confirmed at epithelial surfaces as immediate barrier effectors in preventing infection. Cathelicidins are peptide antibiotics that are receiving increasing attention. Several studies have shown that overexpression of cathelicidin results in augmented protection against bacterial infection and prevention of local infection and systemic invasion of microbes. The goal of the study was to investigate whether cathelicidin is upregulated in cholesteatoma epithelium compared with normal skin.

Study Design Twenty patients from a prospective study of cholesteatoma tissues and normal skins were enrolled in the study. The specimens were divided into two portions. One portion was used for subsequent RNA studies; the other was used for immunohistochemical staining.

Methods Reverse transcriptase–polymerase chain reaction was used to assess the expression levels of cathelicidin messenger RNA (mRNA) both in cholesteatoma and in normal skin. Presumptive concentration of cathelicidin mRNA and β2‐microglobulin mRNA was evaluated. Ratio of β2‐microglobulin to cathelicidin was analyzed in each group. The expressions of cathelicidin in cholesteatoma and normal skin epithelium were investigated by an immunohistochemical technique.

Results Cathelicidin mRNA in cholesteatoma epithelium was increased 5.5‐fold compared with normal skin of the ear canal. In cholesteatoma epithelium, cathelicidin was located in all the layers, but in the normal skin it was expressed only in the granular and prickle cell layers.

Conclusions Cathelicidin is augmented in cholesteatoma epithelium, and the data in the present study are in agreement with the hypothesis that cathelicidin is likely to act as a key component in the first line of defense at the surface epithelium.
Evidence Against Neonatal Aspiration of Keratinizing Epithelium as a Cause of Congenital Cholesteatoma
Authors: Bernal‐Sprekelsen Manuel , Sudhoff Holger , Hildmann Henning
Published: November 2003

Objectives/Hypothesis It has been suggested that congenital cholesteatoma may be caused by perinatal aspiration of squamous epithelium.

Study Design Microscopic study of fetal temporal bones.

Methods Thirty‐one temporal bones from infants who died of sudden infant death syndrome before 1 year of age and 27 temporal bones obtained from preterm fetal deaths aged 4 to 8 months of fetal development were studied to assess signs of aspiration of squamous epithelium in the middle ear.

Results None of the prenatal or postnatal temporal bones showed keratinizing epithelial cells or lanugo. A certain number of specimens displayed a nonspecific inflammatory lymphocytic infiltration.

Conclusion The data in the present study do not support the theory of amniotic fluid and squamous epithelial aspiration as an origin of congenital cholesteatoma.
Dog Bites of the Scalp, Face, and Neck in Children
Authors: Mitchell Ron B. , Nañez Gary , Wagner Jon D. , Kelly James
Published: November 2003

Objective To update the surgical management of injuries from dog bites of the scalp, face, and neck in children.

Study Design Retrospective case review.

Methods A retrospective review of 44 children with dog bites of the scalp, face, and neck was carried out at the University of New Mexico Health Sciences Center (Albuquerque, NM) between January 1, 1995, and December 31, 2000. Data on demographics, hospitalization, surgery, and outcome were collected and entered into an Access 2000 database.

Results The children ranged in age from 1.0 to 12.1 years. The mean age of the study population was 5.2 years (±2.9 y standard deviation). Sixteen severely injured children (36%) were hospitalized to repair damage to the airway and blood vessels of the neck or to treat hemodynamic compromise. The length of stay in hospital ranged from 1 to 16 days. The most common injury in these children was a scalp laceration (57%). Twenty‐six less severely injured children (64%) were not hospitalized. The most common surgery in these children (88%) was repair of multiple facial lacerations. Attention deficit hyperactivity disorder was noted in the medical records of 12 children (29%). Complications occurred in five children (31%) who were hospitalized and nine children (35%) who were not hospitalized.

Conclusions The injured child is typically a 5‐year‐old boy attacked by a familiar dog at home or in the local neighborhood. Children with the diagnosis of attention deficit hyperactivity disorder appear to be at a higher risk of dog bite injuries and should be monitored during interactions with dogs. The goal of surgical management for severely injured children is to avoid immediate mortality and to establish a schedule of multiple‐staged procedures for revision surgeries. An optimal cosmetic result is the principal goal for less severely injured children.
Olfactory Neuroblastoma: Past, Present, and Future?
Authors: Lund Valerie J. , Howard David , Wei William , Spittle Margaret
Published: November 2003

Objective To consider the long‐term survival and outcomes in patients with olfactory neuroblastoma undergoing craniofacial resection.

Study Design A single‐center prospective cohort study.

Methods All patients with olfactory neuroblastoma treated in a 23‐year period with craniofacial resection (with or without radiotherapy) were analyzed; a multivariate analysis was included.

Results Forty‐two patients aged 12 to 70 years were assessed, 83% of whom had received no preceding treatment. Craniofacial resection was used in all cases, combined with radiotherapy in 24 patients (57%). Duration of follow‐up ranged from 2 to 206 months (mean follow‐up period, 57 mo). The disease‐free actuarial survival and overall survival were 77% and 61% at 5 years and 53% and 42% at 10 years, respectively. A Cox regression analysis identified intracranial extension and orbital involvement as independent factors affecting outcome.

Conclusion Craniofacial resection combined with radiotherapy offers the gold standard of care against which other approaches such as endoscopic resection must be judged.
Is the External Laryngeal Nerve an Exclusively Motor Nerve? The Cricothyroid Connection Branch
Authors: Maranillo Eva , León Xavier , Quer Miquel , Orús César , Sañudo Jose Ramón
Published: November 2003

Objectives To obtain an accurate morphological description of the nerve that provides communication between the external laryngeal nerve and the recurrent laryngeal nerve in a large sample of human larynges.

Study Design Morphological study of human larynges.

Methods Microdissection of 103 human larynges obtained from necropsies was performed. Both the external laryngeal nerve and the recurrent laryngeal nerve were identified and dissected. The existence of a communication between the two nerves was evaluated.

Results A neural communication between the external laryngeal nerve and the recurrent laryngeal nerve was found in 85% of the larynges studied (bilaterally in 44% and unilaterally in 41%). Two patterns of communication (with single or double branches) were found. The communication between the nerves can appear at different levels, giving off collateral branches to the cricothyroid muscle (23%), the cricothyroid joint capsule (49%), and the subglottic mucosa (50%).

Conclusions The nerve supply of the human larynx is more complex than classically considered. Our study does not support the classic neuroanatomical belief that the external laryngeal nerve is purely a motor nerve to the cricothyroid muscle. Our results reveal that it carries sensory and motor fibers on to other muscles (thyroarytenoid) or regions (subglottis mucosa and cricothyroid joint), as has been demonstrated in experimental studies in cats and dogs.
Intracordal Injection of Autologous Fat in Patients With Unilateral Laryngeal Nerve Paralysis: Long‐Term Results From the Patient's Perspective
Authors: Laccourreye Ollivier , Papon Jean‐François , Kania Romain , Crevier‐Buchman Lise , Brasnu Daniel , Hans Stéphane
Published: November 2003

Objective Based on 80 patients with a previously nonsurgically treated unilateral laryngeal nerve paralysis (ULNP) and according to the patient's self‐assessment, the authors document the long‐term results achieved with the intracordal injection of autologous fat.

Study Design Retrospective series, inception cohort.

Methods Kaplan‐Meier actuarial life table method and univariate analysis.

Results None of the 80 patients died in the immediate postoperative period. Morbidity included hematoma at the donor site (in three patients), development of an intracordal cyst at the injection site (in three patients), fat extrusion at the injection site (in one patient), and temporary tracheotomy (in one patient). The initial and ultimate overall success rates were 96.2% and 77.2%, respectively. In univariate analysis, none of the variables under analysis (gender, age, associated neurological lesions, associated pneumonectomy, associated neoplasia, cause of the ULNP, side of the ULNP, nerve involved, delay between the onset of the ULNP and the intracordal injection, severity of the symptoms, mode of harvesting the autologous fat, and surgeon who performed the injection) was statistically related to the ultimate outcome after the intracordal injection of autologous fat. Among the group of 45 patients in whom the intracordal injection was initially considered to be successful with no further recovery of motion of the true vocal cord and a minimum survival of 12 months, the ultimate overall success rate was 62.2%, and the 3‐month, 6‐month, and 12‐month Kaplan‐Meier actuarial estimates for success were 91.1%, 72.8%, and 63.1%, respectively.

Conclusions In the present study, data confirm that the intracordal injection of autologous fat is a useful and safe procedure in patients with ULNP. However, the impossibility of exactly predicting the amount of resorption of the injected fat and the lack of predictability of the duration of the results, together with the good and stable results achieved at the authors' department with the medialization thyroplasty led the authors to reduce its current use.
Variability of the Nerve Supply Patterns of the Human Posterior Cricoarytenoid Muscle
Authors: Maranillo Eva , León Xavier , Ibañez Marta , Orús César , Quer Miguel , Sañudo José Ramón
Published: November 2003

Objectives/Hypothesis To achieve a successful selective reinnervation of the larynx, an accurate knowledge of the nerve supply of each individual muscle is required. The posterior cricoarytenoid muscle, the only abductor or respiratory muscle of the larynx, plays a vital role in cases of recurrent palsy and orthotopic transplantation. Descriptions of the posterior cricoarytenoid muscle nerve supply pattern vary considerably. The goal of the present study was to establish an accurate morphological description of the posterior cricoarytenoid muscle nerve supply in a large sample of human larynges.

Study Design Morphologic study of human larynges.

Methods The posterior cricoarytenoid muscle nerve supply was studied in a total sample of 75 human larynges obtained from necropsies (47 male and 28 female samples; age range, 41–95 y) and examined by careful dissection using a surgical microscope.

Results The posterior cricoarytenoid muscle nerve supply in all cases (100%) came from the anterior division of the recurrent nerve. However, in six cases (4%) a small branch also arose from the ramus anastomoticus. The number of branches coming from the anterior division varied, ranging from one to six. The two‐branch pattern was the most frequent (42.7%), followed by the three‐branch pattern (34%) and the one‐branch pattern (7.3%). The remaining 16% of cases showed patterns of four, five, or six branches. When two or more branches were present, a connection between them was observed in 64% of cases. Five different types of origin of the various branches were observed along the course of the recurrent nerve in relation to the cricothyroid joint: type a, vertical segment below the cricothyroid joint (7.5%); type b) vertical segment behind the cricothyroid joint (40.5%); type c) vertical segment just above the cricothyroid joint (16%); type ) from the genu, in common with the arytenoid branch, above the cricothyroid joint and just below the cricoarytenoid joint (34%); and type e) oblique segment (2%).

Conclusion Despite the variability of the innervation of the posterior cricoarytenoid muscle and its strong connection with the interarytenoid nerve, this should not preclude successful reinnervation.
Corticosteroid Treatment in Nasal Polyposis With a Three‐Year Follow‐Up Period
Authors: Bonfils Pierre , Norès Jean‐Marc , Halimi Philippe , Avan Paul
Published: November 2003

Objectives/Hypothesis The management of nasal polyposis is undoubtedly a controversial subject. The part played by surgery seems to be steadily growing, if the number of published reports dedicated to this approach is any yardstick. Although the medical treatment remains the undisputed therapeutic mainstay, trials dedicated to the long‐term assessment of its overall efficacy are scarce.

Study Design Retrospective medical record review.

Methods The aim of the study is focused on the evaluation of a dual modality, topical and systemic, over a follow‐up period of 3 years. In all, 100 patients were treated according to a standardized therapeutic protocol combining short‐term oral administration of prednisolone and daily intranasal spray of beclomethasone.

Results Over the follow‐up period of 3 years, this dual modality proved to be successful in 85% of the patients; only 15% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 58% to 80%, according to the symptom type. The daily dosage of prednisolone and beclomethasone was progressively decreased while the gain in nasal comfort was being preserved.

Conclusions Management of nasal polyps should be primarily medical. Resorting to surgical procedures should not be envisaged before a trial is conducted of dual steroid therapy under a regimen of strict compliance to treatment.
Neuropsychological Testing in the Screening for Cochlear Implant Candidacy
Authors: Kutz Walter , Wright Crystal , Krull Kevin R. , Manolidis Spiros
Published: November 2003

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

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

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

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

Conclusions Neuropsychological testing of profoundly deaf children provides a detailed and accurate assessment of the child's cognitive, behavioral, and motor functions. The profoundly deaf child does not develop at the same rate as normal children in cognitive and behavioral domains. Neuropsychological testing is a useful tool for screening for cochlear implant candidacy and has the potential to track changes before and after implantation.
Gene Expression Analysis of Human Middle Ear Cholesteatoma Using Complementary DNA Arrays
Authors: Tokuriki Masaharu , Noda Ichiro , Saito Takehisa , Narita Norihiko , Sunaga Hiroshi , Tsuzuki Hideaki , Ohtsubo Toshio , Fujieda Shigeharu , Saito Hitoshi
Published: November 2003

Objective To identify genes regulated in human cholesteatoma compared with normal skin tissue using complementary DNA arrays.

Study Design In vitro analysis.

Methods Eight cholesteatoma and retroauricular skin samples were obtained from the same patients during surgery. Upregulated and downregulated genes were highlighted using complementary DNA arrays for screening. Reverse transcriptase‐polymerase chain reaction and immunohistochemical staining were performed to confirm the results of the complementary DNA array.

Results Twelve genes were found to be induced or upregulated in cholesteatoma compared with skin samples. These included genes involved in cell proliferation and differentiation (eg, calgranulin A, calgranulin B, psoriasin, thymosin β‐10) and cell invasion (eg, cathepsin C, cathepsin D, cathepsin H). Analyses by means of reverse transcription‐polymerase chain reaction showed enhanced expression of several genes including calgranulin A, calgranulin B, psoriasin, thymosin β‐10, cathepsin C, cathepsin D, and cathepsin H in cholesteatoma, supporting the findings from the gene array. In addition, it was verified by immunohistochemical analysis that the expressions of Calgranulin A, Calgranulin B, and Cathepsin D were mainly located in cholesteatoma epithelium.

Conclusion The observed alteration in gene expression may play a role in various mechanisms of pathogenesis in cholesteatoma.
Development of a Novel Eighth‐Nerve Intraneural Auditory Neuroprosthesis
Authors: Badi Arunkumar N. , Kertesz Thomas R. , Gurgel Richard K. , Shelton Clough , Normann Richard A.
Published: November 2003

Objectives/Hypothesis Cochlear nerve stimulation using a linear array of electrodes, the cochlear implant, has become an accepted treatment for profound deafness. Major limitations of this technology are high threshold of stimulation, poor performance in a noisy background, cross‐talk between electrodes, unsatisfactory channel selectivity, and variable reconstruction of frequency space. A novel auditory neuroprosthesis is proposed that is expected to overcome these problems by implanting an array of three‐dimensional microelectrodes, the Utah Electrode Array, directly into the cochlear nerve.

Study Design We have conducted acute, extending for up to 12 hours and semichronic, extending for up to 52 hours, electrophysiological experiments, radiologic and histologic studies in 12 cats.

Methods The electrically evoked auditory brainstem response was used as a means to characterize the threshold, dynamic range, and stability of cochlear nerve stimulation through the implanted Utah Electrode Array neuroprosthesis. Plain film, computed tomographic, and histological studies were conducted to determine the result of the implant.

Results The electrically evoked auditory brainstem response thresholds were approximately one to two orders of magnitude lower than those evoked with conventional cochlear implants. We were able to close the cochleostomy, bring the cat into normal anatomical position, and obtain stable electrically evoked auditory brainstem responses for up to 52 hours. Plain film and computed tomographic studies indicated that the Utah Electrode Array neuroprosthesis was in the intended position in the nerve. Histological studies did not reveal hemorrhage or significant damage to the nerve.

Conclusion Because the presented stimulation paradigm appears to significantly mitigate some of the problems of conventional cochlear implants, it may offer a new therapeutic approach to profound deafness.
Endoscopic Removal of Sinonasal Inverted Papilloma Including Endoscopic Medial Maxillectomy
Authors: Wormald Peter John , Ooi Eng , van Hasselt C. Andrew , Nair Salil
Published: November 2003

Objectives/Hypothesis Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results.

Study Design A prospective study and an integrated literature review.

Methods Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded.

Results Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty‐five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure.

Conclusions Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow‐up of patients is mandatory because recurrence may be associated with malignancy.
Radiofrequency Tonsil Reduction: Safety, Morbidity, and Efficacy
Authors: Friedman Michael , LoSavio Phillip , Ibrahim Hani , Ramakrishnan Vidyasagar
Published: November 2003

Objectives To evaluate the safety, morbidity, and efficacy of radiofrequency tissue volume reduction of tonsils using two different surgical techniques and to compare these two techniques with each other and with classic tonsillectomy.

Study Design A nonrandomized retrospective review of tonsil reductions was made between 2000 and 2002 using in vivo studies associated with tonsil reduction and tonsillectomy performed either in the hospital operating room or in the outpatient treatment area.

Methods We studied 150 patients and divided them into three main groups based on surgical technique. Group A consisted of 50 consecutive patients who underwent tonsil “ablation,” Group B contained another 50 consecutive individuals who received tonsil “coblation,” and Group C consisted of 50 patients who underwent classic tonsillectomy (cold dissection). Each group consisted of two subcategories of children (age range, 1–12 y) and adults (age range, 12–60 y) with chronic tonsillar hypertrophy. Most of the pediatric patients underwent adenoidectomy during the same surgical procedure. Indications for tonsillectomy were those listed by the American Academy of Otolaryngology—Head and Neck Surgery. A retrospective chart review was used to assess procedures, safety, morbidity, and efficacy of tonsil reduction and tonsillectomy. Four specific end points of morbidity were investigated: pain, return to normal diet, return to normal activity, and use of pain medication. Efficacy of tonsillectomy was determined by the clinical observation of the remaining tonsillar tissue and compared with pretreatment photographs of the tonsils.

Results There were no complications in any of the groups. Efficacy was assessed based on the mean tonsil reduction and was found to be 100% for tonsillectomy, 86% for the tonsil coblation technique, but only 53.6% for the ablation technique. Morbidity was minimal in groups A and B and significantly greater in Group C. The number of pain days, narcotic‐use days, and days before return to normal diet and activity were greatly reduced in groups A and B when compared with classic tonsillectomy (group C). Pain levels on day 1 were less than 3 (on a scale of 1–10) in groups A and B. The number of pain days and narcotic‐use days was less than 4 days in groups A and B. Similarly, most patients returned to solid diet and normal activity by day 4. Pain levels, number of narcotic‐use days, and number of days to return to normal diet and activity were significantly higher for classic tonsillectomy.

Conclusions Tonsil coblation has distinct advantages when compared with tonsil ablation and standard tonsillectomy. Tonsil coblation resulted in greater than 86% elimination of tonsillar tissue in both children and adults. In most patients, pain levels were minimal and limited to the first 48 hours after surgery. Return to normal diet and activity was much earlier in the coblation group versus classic tonsillectomy.
Detection of Occult Cervical Micrometastases in Patients With Head and Neck Squamous Cell Cancer
Authors: Barrera Jose E. , Miller Mark E. , Said Sherif , Jafek Bruce W. , Campana John P. , Shroyer Kenneth R.
Published: November 2003

Objective The incidence of occult nodal metastases associated with head and neck squamous cell carcinoma (HNSCC) and the clinical significance of nodal micrometastases by cytokeratin immunohistochemical analysis are examined.

Study Design In all, 1012 lymph nodes from 50 patients treated between 1992 and 2001 at the University of Colorado Health Sciences Center (Denver, CO) were evaluated retrospectively for micrometastases.

Methods Serial sectioning in 5‐to 6‐μm interval specimens stained either with hematoxylin and eosin (H&E) or immunostaining for cytokeratins using the monoclonal antibody cocktail AE1/AE3 was performed in 21 N0, 11 N1, and 14 N2 patient cases. Cases that showed scattered cells with suspect staining qualities but without morphological features consistent with HNSCC were further evaluated by epithelial membrane antigen (EMA) immunohistochemical analysis.

Results H&E‐stained and cytokeratin‐stained sections revealed occult nodal micrometastases in 3.8% of N0 and 5% of N1 cases. Overall, 26 micrometastases were identified in N0 and N1 patients, causing 29% of N0 patients and 45% of N1 patients to be upstaged. Cytokeratin immunostaining detected micrometastases in eight cases that were negative on H&E serial sectioning. Serial sectioning by H&E alone identified three additional micrometastases. Negative EMA immunostaining confirmed the absence of malignant cells in lymph node sections that were equivocal on cytokeratin staining.

Conclusions The use of serial sectioning with H&E and cytokeratin immunohistochemical analysis increases the detection of micrometastases that are often elusive by routine processing in patients with HNSCC. Improved methods of detecting micrometastases may provide a basis for improved planning of postoperative therapy for patients already at risk for tumor recurrence.
Voice Quality After Laser Surgery or Radiotherapy for T1a Glottic Carcinoma
Authors: Tamura Etsuyo , Kitahara Satoshi , Ogura Masami , Kohno Naoyuki
Published: November 2003

Objective To compare the effect on phonation of radiotherapy and endoscopic laser surgery for stage T1a glottic squamous cell carcinoma.

Study Design Retrospective.

Methods Patients treated for stage T1a glottic carcinoma from August 1994 to March 2000 and who had been followed for at least 1 year were candidates. Eight patients who underwent radiotherapy and 22 who underwent laser surgery were enrolled. Indirect laryngoscopy and stroboscopic examination were performed, and voice quality was analyzed using standard parameters.

Results Maximum phonation time, average airflow rate, sound pressure level, and average fundamental frequency during unconditional phonation were similar after laser surgery and radiotherapy. However, compared with normal men who were 50 years of age or older, the average fundamental frequency was higher after laser surgery.

Conclusions Contrary to some reports, the voice quality is minimally affected by laser surgery for T1a glottic carcinoma, and outcome is similar to radiotherapy. The average fundamental frequency is higher than normal after laser surgery, but the effect on the quality of life was trivial.
Airway Management After Maxillectomy: Routine Tracheostomy Is Unnecessary
Authors: Lin Ho‐Sheng , Wang David , Fee Willard E. , Goode Richard L. , Terris David J.
Published: November 2003

Objectives/Hypothesis There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management.

Study Design Retrospective analysis at a university hospital.

Methods We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty‐four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split‐thickness skin graft being the most common reconstructive option.

Results Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year‐old man with oxygen‐dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise.

Conclusions The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.
Correlation Between Facial Pain or Headache and Computed Tomography in Rhinosinusitis in Canadian and U.S. Subjects
Authors: Shields Gordon , Seikaly Hadi , LeBoeuf Matthew , Guinto Faustino , LeBoeuf Herve , Pincus Thomas , Calhoun Karen
Published: November 2003

Objectives Objectives were 1) to determine whether a correlation exists between facial pain or headache and sinus disease severity by computed tomography (CT) scan in patients with rhinosinusitis and 2) to compare disease severity and pain perception in two geographically diverse North American patient populations.

Study Design Prospective patient questionnaire before CT scan of the paranasal sinuses.

Methods Patients with refractory rhinosinusitis were recruited at the University of Texas Medical Branch (Galveston, TX) and the University of Alberta (Edmonton, Alberta, Canada). Before CT scanning, patients completed a pain questionnaire. All scans were interpreted by one neuroradiologist and were scored using the Lund‐McKay, Harvard, and Kennedy staging systems for rhinosinusitis.

Results Fifty‐one patients completed questionnaires (27 were Canadian). There was no correlation between pain severity and disease severity reflected by any of the three staging systems used (P >.05). The mean pain score for the U.S. patients was 7.3, and for Canadian patients, 5.2. The mean CT scores for U.S. versus Canadian patients were as follows: Lund‐McKay, 2.6 versus 6.6; Harvard, 0.7 versus 1.0; and Kennedy, 1.4 versus 2.2. The Canadian patients had more severe disease on CT scan (Lund‐McKay, P ≤.001; Harvard, P ≤.005; and Kennedy, P ≤.007) while reporting less severe pain (P ≤.004).

Conclusions There was no correlation between pain severity and disease severity by sinus CT scan as graded by the Lund‐McKay, Harvard, or Kennedy staging system. Facial pain and headache, although frequent complaints of patients with rhinosinusitis, are not useful predictors of sinus disease severity. There appears to be a difference in pain perception between the two North American populations.
A Novel Model for Rapid Induction of Apoptosis in Spiral Ganglions of Mice
Authors: Lee Ji Eun , Nakagawa Takayuki , Kim Tae Soo , Iguchi Fukuichiro , Endo Tsuyoshi , Dong Youyi , Yuki Kazuo , Naito Yasushi , Lee Sang Heun , Ito Juichi
Published: November 2003

Objectives/Hypothesis The survival of the spiral ganglion (SG) is a critical issue in preservation of hearing. Research on topics related to this issue requires a mouse experimental model because such a model has advantages including use of genetic information and knockout or “knockin” mice. Thus, the aim of the study was to establish a mouse model for induction of apoptosis of SG neurons with a definite time course.

Study Design Laboratory study using experimental animals.

Methods C57BL/6 mice were used as experimental animals and were subjected to direct application of cisplatin into the inner ear. Terminal deoxynucleotidyl transferase–mediated dUTP nick‐end labeling (TUNEL) assay and immunostaining for Neurofilament 200‐kD (NF) and peripherin were used for analysis of SG degeneration. In addition, generation of peroxynitrite in affected spiral ganglions was examined by immunostaining for nitrotyrosine. Cellular location of activated caspase‐9 and cytochrome‐c in dying SG neurons were examined for analysis of cell death pathway.

Results The TUNEL assay and immunohistochemical analysis for NF and peripherin indicated that type I neurons in spiral ganglions were deleted through the apoptotic pathway over time. Spiral ganglion neurons treated with cisplatin exhibited expression of nitrotyrosine, indicating induction of peroxynitrite by cisplatin. In dying SG neurons, expression of activated caspase‐9 and translocation of cytochrome‐c from mitochondria to cytoplasm were observed, indicating the mitochondrial pathway of apoptosis.

Conclusion The predictable fashion of induction of apoptosis in SG neurons over a well‐defined time course in the model in the study will aid studies of the molecular mechanism of cell death and elucidation of a strategy for prevention of SG degeneration.
Estimation of the Endolymphatic Sac and Vestibular Aqueduct Using Magnetic Resonance Imaging
Authors: Kobayashi Mari , Tsunoda Atsunobu , Akita Keiichi , Yamada Ichiro
Published: November 2003

Objective To evaluate the diagnostic accuracy of magnetic resonance imaging for assessment of the endolymphatic sac and vestibular aqueduct.

Study Design Imaging and histological study of the cadaver.

Methods Five cadavers were studied by a 1.5‐T magnetic resonance imaging system with a 3‐inch‐diameter surface coil. Magnetic resonance imaging scans were obtained with proton density‐weighted and T2‐weighted fast spin‐echo sequences. Histological sections were made with an epoxy resin–embedding method and were compared with magnetic resonance imaging scans.

Results The visibility of the endolymphatic sac on both sequences corresponded well to the presence of the endolymphatic sac on histological sections. On the histological sections, the width of the external aperture of vestibular aqueduct (endolymphatic sac including surrounding connective tissue) was 0.96 ± 0.18 mm (mean ± SD) and the width of lumen of endolymphatic sac at the same point was 0.47 ± 0.17 mm. The width of the endolymphatic sac was 1.02 ± 0.19 mm on proton density‐weighted images and was 0.81 ± 0.15 mm on T2‐weighted images. The widths of endolymphatic sac measured on proton density‐weighted image and those of vestibular aqueduct on histological section did not show statistically significant differences (P >.05). On the other hand, the endolymphatic sac as measured on T2‐weighted image tended to be smaller than the vestibular aqueduct (P <.05) and tended to be larger than the lumen of the endolymphatic sac (P <.0005).

Conclusion Both sequences can precisely depict the endolymphatic sac; however, the proton density‐weighted image is a more appropriate indicator of the actual anatomical configuration of the endolymphatic sac with surrounding connective tissue and vestibular aqueduct.
Increased Expression of Interleukin‐9, Interleukin‐9 Receptor, and the Calcium‐Activated Chloride Channel hCLCA1 in the Upper Airways of Patients With Cystic Fibrosis
Authors: Hauber Hans‐Peter , Manoukian John J. , Nguyen Lily H. P. , Sobol Steven E. , Levitt Roy C. , Holroyd Kenneth J. , McElvaney Noel G. , Griffin Siobhan , Hamid Qutayba
Published: November 2003

Objectives/Hypothesis Mucus overproduction is commonly found in airway disease in patients with cystic fibrosis. Interleukin‐9 (IL‐9) has been shown to mediate airway hyper‐responsiveness and mucus overproduction. Recently, the calcium‐activated chloride channel hCLCA1 has been described to be upregulated by IL‐9 and has been thought to regulate the expression of soluble gel‐forming mucins. We sought to examine the expression of IL‐9, interleukin‐9 receptor (IL‐9R), and hCLCA1 in the upper airway of patients with cystic fibrosis in comparison to healthy control subjects and to demonstrate the relationship of IL‐9, IL‐9R, and hCLCA1 expression with mucus production.

Study Design Prospective design.

Methods Biopsy samples from nasal polyps of four patients with cystic fibrosis, nasal mucosa of six patients with cystic fibrosis, sinus mucosa of eight patients with cystic fibrosis, and nasal mucosa of six healthy control subjects were stained with periodic acid‐Schiff (PAS) to identify mucus glycoconjugates. IL‐9, IL‐9R, and hCLCA1 expression was determined by immunocytochemical study.

Results We demonstrated significant increases in IL‐9, IL‐9R, and hCLCA1 immunoreactivity in the mucosa of patients with cystic fibrosis compared with that found in control subjects (P <.05). There were no significant differences between the different locations (nasal polyps, nasal mucosa, and sinus mucosa) in the patient group (P >.05). We also observed a significant increase in the number of mucus‐producing cells in biopsy specimens from patients with cystic fibrosis in comparison to control subjects. A positive correlation was found between hCLCA1‐positive cells and IL‐9‐positive cells (correlation coefficient [r] = 0.79, P <.05) or IL‐9R‐positive cells (r = 0.92, P <.05). Moreover, a positive correlation was also present between PAS‐positive (mucus‐producing) cells and hCLCA1‐positive cells (r = 0.64, P <.05) or IL‐9R‐positive cells (r = 0.64, P <.05).

Conclusions Increased expression of IL‐9 and IL‐9R, as well as upregulation of hCLCA1, in mucus‐overproducing epithelium of patients with cystic fibrosis supports the hypothesis that IL‐9 contributes to mucus overproduction in cystic fibrosis. Expression of hCLCA1 may also be responsible, in part, for the overproduction of mucus. These preliminary findings suggest that hCLCA1 might be an interesting new therapeutic target to control mucus overproduction in airway disease in patients with cystic fibrosis.
Detection of Epstein‐Barr Virus–Derived Latent Membrane Protein‐1 Gene in Various Head and Neck Cancers: Is It Specific for Nasopharyngeal Carcinoma?
Authors: Tsang Ngan‐Ming , Chang Kai‐Ping , Lin Shinn‐Yn , Hao Sheng‐Po , Tseng Chen‐Kan , Kuo Tseng‐tong , Tsai Ming‐Hsui , Chung Tsao‐Chuen
Published: November 2003

Objective The object of the study was to determine the incidence of the presence of Epstein‐Barr virus–derived latent membrane protein‐1 (LMP‐1) gene in various head and neck cancers by polymerase chain reaction method.

Study Design Prospective study.

Methods During a 5‐year period, polymerase chain reaction was used to investigate the presence of LMP‐1 gene in various head and neck cancers from different locations and histopathological types, noncancerous nasopharyngeal biopsy samples, and tonsillectomy specimens from patients with chronic hypertrophic tonsillitis.

Results Of 202 patients enrolled in the study, 53 were diagnosed by pathological study with oropharyngeal carcinoma, 45 with nasopharyngeal carcinoma, 26 with oral cavity carcinoma, 26 with laryngohypopharyngeal carcinoma, 31 with nasopharyngeal lymphoid hyperplasia, and 21 with tonsils with lymphoid hyperplasia. After the application of polymerase chain reaction, the LMP‐1 gene was not detected in any sample from oral cavity carcinoma, laryngohypopharyngeal carcinoma, or nasopharyngeal lymphoid hyperplasia or from tonsillectomy specimens but was detected in only one case of tonsillar carcinoma. On the contrary, the LMP‐1 gene was detected in 43 (95.6%) of 45 samples from patients with nasopharyngeal carcinoma. The statistical analysis shows a significant association (P <.001) between the presence of LMP‐1 gene and tumor localization in the nasopharynx.

Conclusions The study shows that the presence of LMP‐1 gene detected by polymerase chain reaction in the tumor cell is only significantly associated with tumor located in the nasopharynx, implying that Epstein‐Barr virus plays a trifling role in the tumorigenesis of carcinomas arising from other head and neck locations. The polymerase chain reaction method that was used is a potential tool for screening nasopharyngeal carcinoma.
Primary and Metastatic Cancer of the Parotid: Comparison of Clinical Behavior in 232 Cases
Authors: Bron Luc P. , Traynor Sean J. , McNeil Edward B. , O'Brien Christopher J.
Published: November 2003

Objectives/Hypothesis Parotid malignancy may develop as a primary cancer of salivary tissue or by metastatic involvement of parotid lymph nodes. The aim of the study was to compare the clinical behavior of primary and metastatic parotid cancers by analyzing patterns of treatment failure and clinical outcomes.

Study Design Retrospective review of clinical and pathologic data prospectively accessioned onto a computerized database.

Methods A prospectively documented series of 232 parotidectomies carried out for treatment of cancer from 1988 to 1999 was reviewed. There were 177 male and 55 female patients with a median age of 65 years (age range, 17–97 y). Median follow‐up time was 4 years. Pathological groups included 54 patients with primary parotid cancer, 101 with metastatic cutaneous squamous cell carcinoma, 69 with metastatic melanoma, and 8 with other metastatic cancers.

Results Neck nodes were clinically positive in 12 patients with primary cancer, 24 patients with squamous cell carcinoma, 16 with melanoma, and 2 with other metastatic malignancies. Conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 185 patients, and 47 patients had a radical parotidectomy sacrificing the facial nerve. There were 54 therapeutic and 110 elective neck dissections. Adjuvant radiotherapy was given to 39 patients with primary cancer, 86 with squamous cell carcinoma, 50 with melanoma, and 8 in the other metastatic group (78% of the patients in the series). Local control rates at 5 years in the four groups were 86%, 75%, 94%, and 100%, respectively (P <.01). Survival rates at 5 years were 77%, 65%, 46%, and 56%, respectively (P <.01).

Conclusions The pattern of parotid malignancy is unique in Australia because of the high incidence of skin cancer, which can metastasize to the parotid gland. Metastatic cutaneous malignancy predominates. The pattern of failure and outcome varied depending on histological findings. Local failure occurred most often in metastatic squamous cell carcinoma, whereas patients with melanoma had the highest incidence of distant spread.
A Randomized Controlled Trial of Early Oral Feeding in Laryngectomized Patients
Authors: Seven Huseyin , Calis Asli Batur , Turgut Suat
Published: November 2003

Objective To evaluate the safety and efficacy of early oral feeding by comparing it with feeding through primary tracheoesophageal puncture after total laryngectomy with primary pharyngeal closure.

Study Design A prospective, randomized, controlled study.

Methods Patients who underwent total laryngectomy with primary pharyngeal closure and who were candidates for primary voice restoration (an in whose cases primary tracheoesophageal puncture [TEP] was created) were included. After total laryngectomy, patients were randomly assigned to either the oral group (study group) or the TEP group (control group). Patients in the oral group were fed orally with a clear liquid diet on the first postoperative day, then advanced to a regular diet, whereas patients in the TEP group were fed through tracheoesophageal puncture and received nothing orally until the seventh postoperative day; then they were fed orally if fistula had not occurred. Standard criteria for discharge were used for all the patients.

Results During a 3‐year period, 67 patients were enrolled in the trial, and complete data were available for 65 patients (32 patients in the oral group, 33 patients in the TEP group). The two groups were similar for factors reported to influence the rate of pharyngocutaneous fistula. In three (9%) patients in the TEP group, fistula occurred on the 5th, 7th, and 14th postoperative days, respectively. Two (6.2%) fistulas occurred in the oral group on the sixth and eighth postoperative days, respectively. In patients without fistula, the mean length of hospital stay was 7.6 days (range, 4–19 d [SD = 3.1 d]) for the oral group and 8.2 days (range, 7–18 d [SD = 2.6 d) for the TEP group. There was no significant difference between two groups for either the incidence of fistula or the length of hospital stay.

Conclusions Initiation of oral feeding on the first postoperative day in patients undergoing total laryngectomy with primary pharyngeal closure is a safe clinical practice. However, it does not shorten the length of hospital stay for these patients.