bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti–Heat Shock Protein 70 Antibodies in Meniere's Disease
Authors: Rauch Steven D. , Zurakowski David , Bloch Donald B. , Bloch Kurt J.
Published: November 2003

Objectives To determine the prevalence of anti–heat shock protein 70 (anti‐HSP70) antibodies in patients with Meniere's disease and healthy subjects and to probe the relationship between antibody status and clinical features of Meniere's disease.

Study Design Prospective cohort study of consecutive consenting patients with Meniere's disease.

Methods Serum samples were obtained prospectively from 134 patients with Meniere's disease and 124 blood donors. Serial samples were taken at 3‐month intervals in 38 of 134 patients with Meniere's disease. Demographic data and clinical characterization of vestibular and auditory status were acquired with each sample. Serum was assayed for anti‐HSP70 antibodies by Western blot using bovine renal extract, recombinant bovine HSP70, and recombinant human HSP70 antigens.

Results Immunoreactivity against bovine renal extract HSP70 was found in 38% of patients with Meniere's disease, compared with 25% of blood donors (P < .04). Reactivity with recombinant antigens was not significantly different between patients with Meniere's disease and healthy control subjects. Patients with Meniere's disease who reacted with all three antigens were more likely to have simultaneously active hearing and balance symptoms (P = .03). Neither univariate nor multivariate statistical analysis established any other association between serological findings and clinical features of Meniere's disease. Tests performed on serial samples of patients with Meniere's disease also showed no association of positive or negative test results with changes in clinical course.

Conclusions Because of the high prevalence of anti‐HSP70 antibodies in healthy subjects and the very limited association of anti‐HSP70 antibody status with clinical features or course of Meniere's disease, we conclude that, at present, the detection of anti‐HSP70 antibodies by Western blotting offers little clinically useful information in Meniere's disease.
Does Tongue Size Differ Between Patients With and Without Sleep‐Disordered Breathing?
Authors: Do Katherine L. , Ferreyra Henry , Healy John F. , Davidson Terence M.
Published: November 2003

Objectives/HypothesisTo determine whether there is a difference in the tongue size of patients with and without sleep‐disordered breathing (SDB) and to evaluate whether tongue volume correlates with body mass index (BMI), neck circumference, age, Epworth Sleepiness Scale score, or apnea‐hypopnea index (AHI).

Study DesignNineteen patients (9 with SDB; 10 without SDB) were enrolled in this prospective study.

MethodsAll patients completed a sleep questionnaire including the Epworth Sleepiness Scale and underwent a physical examination, portable sleep study, and magnetic resonance imaging (MRI) study. An examiner masked to the patients' disease status measured tongue volume from the MRI films.

ResultsThere was a trend for patients with SDB to have a larger tongue volume than patients without SDB (P= .065). Tongue volume only positively correlated with BMI (P= .005) and neck circumference (P= .013), but there was no correlation with age (P= .23) or AHI (P= .40).

ConclusionsThere is a statistical trend for patients with SDB to have larger tongue size compared with non‐SDB patients, but tongue size is independent of AHI and correlates significantly with BMI and neck circumference. We interpret these findings to suggest that variations in tongue size alone cannot account for disease severity and may simply reflect the larger body habitus often seen in patients with SDB.
A Clinicopathological Study of Sinonasal Neuroendocrine Carcinoma and Sinonasal Undifferentiated Carcinoma
Authors: Smith Shane R. , Som Peter , Fahmy Adham , Lawson William , Sacks Steve , Brandwein Margaret
Published: November 2003

Objective Sinonasal undifferentiated carcinoma (SNUC) and sinonasal neuroendocrine carcinoma (SNEC) are relatively newly recognized, rare entities requiring further clinicopathological analysis to advance our understanding and determine prognostic distinctions between them.

Study Design Retrospective chart review.

Methods Cases were retrieved from the Copath system. One patient was seen in consultation from an outside institution. Histological and immunohistochemical findings, patient demographics, treatment regimens, and outcomes were analyzed and compared.

Results Ten patients (7 men, 3 women) ranging in age from 17 to 58 years (mean age, 44.7 y) were included. Four patients were classified with SNEC, six as having SNUC. The predominant site was the superior nasal cavity or ethmoids (seven cases), followed by the maxilla (four cases). Disease in four patients was clinically staged as N1 (three with SNUC, one with SNEC), and in six patients as N0 (three with SNEC, three with SNUC). Of the nine patients who were treated initially with surgical resection, seven received postoperative radiation therapy alone, one received postoperative radiation and chemotherapy, and one had only limited postoperative chemotherapy. One patient was treated with radiation therapy and chemotherapy alone, without surgical resection. Follow‐up was obtained ranging from 6 to 108 months (mean period, 26.4 mo). Three patients died of disease 10, 14, and 41 months, respectively, after diagnosis. Three patients had persistent disease at 6, 9, and 21 months, respectively, two of them with distant metastases. Four patients were disease free after 6, 18, 31, and 108 months, respectively.

Conclusions SNUC and SNEC are both aggressive tumors, usually presenting in middle age as a nasal mass. Both tumors have the capacity to metastasize locally and distantly, and both can result in poor outcomes. This small series precludes a demographic or prognostic distinction between the two groups.
Engineering Autogenous Cartilage in the Shape of a Helix Using an Injectable Hydrogel Scaffold
Authors: Saim Aminuddin B. , Cao Yilin , Weng Yulai , Chang Chia‐Ning , Vacanti Martin A. , Vacanti Charles A. , Eavey Roland D.
Published: November 2003

Objective Previous successful efforts to tissue engineer cartilage for an auricle have used an immunocompromised nude mouse xenograft model. Subsequent efforts in an immunocompetent autogenous animal model have been less successful because of an inflammatory response directed against the foreign scaffold polymer used to provide an auricular shape. We studied an alternative polymer material and surgical technique to engineer autogenous cartilage in the shape of a human ear helix using injectable hydrogel scaffolding, Pluronic F‐127 (polyethylene oxide and polypropylene oxide).

Subject Yorkshire swine.

Material and Methods Fresh autogenous chondrocytes were suspended in a biodegradable, biocompatible co‐polymer hydrogel, Pluronic F‐127, at a concentration of 3 × 107 cells/mL. To support the contour of the implant, a skin fold channel in the shape of the helix of a human ear was created in the skin in three sites on the ventral surface of the animal. The cell‐hydrogel suspension was injected through the skin fold channel. For controls, injections were made into identical channels using either cells alone or the Pluronic F‐127 without cells. After 10 weeks, the specimens were excised and examined both grossly and histologically.

Results Grossly, all implants retained a helical‐like shape. Excised specimens possessed flexible characteristics consistent with elastic cartilage. The specimens could be folded and twisted and on release of mechanical pressure would instantly return to the original shape. Histological evaluation of the implants using H&E, Safranin O, trichrome blue, and Verhoeff's stains demonstrated findings consistent with mature elastic cartilage. Control injection of hydrogel alone demonstrated no evidence of cartilage formation and control injection of chondrocytes alone showed evidence only of disassociated elastic cartilage.

Conclusion Injection of autologous porcine auricular chondrocytes suspended in a biodegradable, biocompatible hydrogel of Pluronic F‐127 resulted in the formation of cartilage tissue in the approximate size and shape of a human ear helix. This preliminary method extends the concept of auricular tissue engineering from an immunocompromised xenograft animal model to an immunocompetent autologous animal model.
Influenza A Virus Infection of Human Middle Ear Cells In Vitro
Authors: Buchman Craig A. , Fregien Nevis
Published: November 2003

Hypothesis
Human‐derived normal middle ear mucosal cells can be harvested and cultured and will support influenza A virus (INF A) infection.

Study Design
Protocols for the collection and in vitro culture of middle ear mucosal cells were developed and used to investigate the effects of INF A infection as it relates to the pathogenesis of otitis media.

Materials and Methods
Middle ear mucosa was harvested during surgeries that opened the normal middle ear. Middle ear mucosal cells were plated and grown in collagen‐coated dishes. Cells were characterized before and after INF A exposure using phase‐contrast and immunofluorescence microscopy as well as reverse transcriptase‐polymerase chain reaction (RT‐PCR) for cytokeratin 18 gene expression and INF A.

Results
Primary cultures of human middle ear epithelial cells were established. Prolonged growth of middle ear cells yielded a second cell type that failed to stain for cytokeratin on immunofluorescence but continued to produce positive RT‐PCR results on cytokeratin 18 analysis. After INF A exposure, cytological changes and immunofluorescence staining showed cellular infection. RT‐PCR analysis using INF A–specific primers showed positive results for up to 72 hours after viral exposure.

Conclusions
Primary cultures of human middle ear mucosal cells have been established. Two distinctly different cell culture systems have been developed: 1) middle ear epithelial cells and 2) either dedifferentiated epithelial cells or fibroblasts. Exposure of both cell types to INF A demonstrates that each can support cellular infection and viral replication. These models should be useful for studies of the pathogenesis of virus‐mediated otitis media.
Accuracy, Utility, and Cost of Frozen Section Margins in Head and Neck Cancer Surgery
Authors: DiNardo Laurence J. , Lin James , Karageorge Lampros S. , Powers Celeste N.
Published: November 2003

Objectives Intraoperative frozen section analysis of surgical margins is widely used in head and neck cancer surgery. This study evaluates frozen section accuracy relative to permanent controls and final margins from the entire specimen, the rate at which frozen sections impact intraoperative management, and the resultant cost.

Study Design Retrospective.

Methods From 1997 to 1999 the frozen section results, permanent controls, and final tumor margins from 80 consecutive patients undergoing 420 intraoperative frozen section margins for head and neck malignancy were reviewed.

Results A 98.3% accuracy rate (sensitivity, 88.8%; specificity, 98.9%) was found compared with permanent sections of the same tissue. However, 40% (8 of 20) of patients with positive final margins on the resection specimen, and 100% (15 of 15) with close (<5 mm) margins were not detected by frozen section analysis. The overall accuracy of frozen section in the evaluation of close or positive final margins was 71.3% (sensitivity, 34.3%; specificity, 100%). In addition, 5% (4 of 80) of patients potentially benefited from intraoperative frozen section by virtue of immediate margin revision. The estimated cost of intraoperative frozen section averaged as much as $3123 per patient, with a cost‐benefit ratio of 20:1.

Conclusions Intraoperative frozen section margins are accurate, but they are costly and cannot reliably eradicate positive final margins. Patients with early‐stage lesions and those undergoing re‐resection for recurrence or salvage surgery after radiation failure derived the greatest potential benefit from frozen section margins.
Laryngotracheal Reconstruction and the Hidden Airway Lesion
Authors: Rutter Michael J. , Thompson Link Dana , Liu James H. , Cotton Robin T.
Published: November 2003

Objective Single‐stage laryngotracheal reconstruction (SSLTR) is an increasingly common technique to achieve decannulation of patients with laryngotracheal stenosis. In a proportion of cases airway distress on extubation may be attributed to a dynamic second airway lesion not diagnosed before surgery. Our aim is to describe our recent experience with these frustrating patients.

Methods Between July 1997 and July 1999 we prospectively followed patients who underwent SSLTR and experienced difficulty after extubation owing to an unsuspected second airway lesion.

Results During this 24‐month period we performed 80 SSLTRs. In six surgeries performed on five patients, a second airway lesion complicated extubation. In five patients the second lesion was not diagnosed before surgery because there was significant airway stenosis and tracheotomy. The sixth patient was transferred to our care intubated. In all cases the airway surgery for the dominant lesion was technically successful, but revealed a second dynamic lesion. There were three cases of tracheomalacia, two cases of laryngomalacia, and one case of arytenoid prolapse. All patients required intervention. Tracheotomy was required in four patients.

Conclusions Failure to achieve extubation after SSLTR may be caused by a dynamic second airway lesion that was previously disguised by a more dominant airway lesion. Surgical repair of the dominant lesion will allow manifestation of the dynamic lesion due to the Bernoulli effect. The combination of a tracheotomy and a dominant airway lesion limits airflow and potentially disguises the situation.
Assessment of Real‐Time Clinical Facial Function During Vestibular Schwannoma Resection
Authors: Axon Patrick R. , Ramsden Richard T.
Published: November 2003

Objectives To describe a technique for quantifying residual facial function after vestibular schwannoma surgery. The intraoperative electrophysiological results are correlated with immediate postoperative clinical facial function to assess technique validity.

Study Design Prospective blinded study.

Methods Thirty‐two patients undergoing translabyrinthine resection of vestibular schwannoma were included. Compound muscle action potential (CMAP) amplitude was calculated to suprama‐imal stimulation of the facial nerve, proximal to vestibular schwannoma compression, at the brain stem. The procedure was repeated after tumor removal. Comparison of the two CMAP amplitudes enabled estimation of change in facial function during surgery. The data were correlated with intracranial tumor diameter and immediate postoperative clinical facial function.

Results CMAP amplitude recorded after tumor resection correlated with immediate postoperative clinical facial function (0.879, P < .01). Correlation was improved when residual facial function was calculated (0.944, P < .01). In contrast, preoperative tumor size had relatively poor correlation with immediate postoperative facial function (0.688, P < .01).

Conclusions Comparison of electrophysiological data before and after tumor removal reduces intersubject variability resulting from intersubject variation in facial muscle morphology. Residual facial function closely correlates with immediate postoperative clinical facial function, assessed using the House‐Brackmann grading system. From the data presented, the technique can inform the surgeon of current clinical facial function at any point during the dissection process.
Changing Trends in Clinical Manifestations of Laryngeal Tuberculosis
Authors: Shin Jung‐Eun , Yuhl Nam Soon , Joo Yoo Seung , Yoon Kim Sang
Published: November 2003

Objectives/Hypothesis Despite the dramatic decrease in the incidence of laryngeal tuberculosis, the disease has gained new interest as a result of claims that it has changed its clinical patterns. The aim of this study is to evaluate the changing trends in clinical manifestations of laryngeal tuberculosis.

Study Design Retrospective clinical analysis.

Methods Clinical analysis of 22 patients with pathologically confirmed laryngeal tuberculosis was carried out retrospectively.

Results Patients' ages ranged from 22 to 75 years. The male‐to‐female ratio was 2.14 to 1. The most frequent chief complaint was hoarseness. The true vocal cord and the false vocal cord were commonly involved, and 11 patients showed single lesions. Among 22 patients, only 7 had active pulmonary tuberculosis, and 9 were proven to have normal lung status. The patients with active pulmonary tuberculosis showed more ulcerative and multiple lesions. The patients with normal lung status showed nonspecific, polypoid, and single lesions. All patients responded satisfactorily to antituberculous medication.

Conclusions The clinical manifestations of laryngeal tuberculosis have changed and seem to be different from those of classic reports. It can even occur without pulmonary tuberculosis, and the characteristics of lesions seem to be more nonspecific. It might be important to consider tuberculosis in the differential diagnosis of nonspecific laryngeal disease.
Dimensions of the Cricoid Cartilage and the Trachea
Authors: Randestad Åke , Lindholm Carl‐Eric , Fabian Peter
Published: November 2003

Objective Important dimensions of the cricoid cartilage and trachea have been studied. Knowledge of size, variations in size, and configuration of these structures is important when tracheal intubation, stenting, endoscopy, and transplantation are to be performed.

Methods In 34 male and 27 female adult human specimens, 1861 measurements of the cricoid cartilage and trachea were performed.

Results The smallest dimension was found in the frontal plane. The mean inner diameter of the cricoid in this plane with mucous membrane in situ was in women 11.6 mm (range, 8.9–17.0 mm) and in men 15.0 mm (range, 11.0–21.5 mm). The configuration varied more than expected. For example, the angle between the longitudinal axes of the cricoarytenoid joint facets ranged from 42° to 74° in women and from 37° to 75° in men. The mean distance between these joint facets was 10.3 mm (range, 7.4–13.0 mm) in women and 12.6 mm (range, 8.0–18.2 mm) in men. The cross‐section of the trachea varied much in configuration, the smallest frontal diameter being as little as 9.9 mm in women and 12 mm in men.

Conclusions In some women the inner diameter of the cricoid ring does not permit passage of a standard‐size (7 mm, internal diameter [ID]) tracheal tube or a standard‐size rigid endoscope through the larynx without mucosal damage. The small distance between the cricoarytenoid joints in many women and some men is the basis for of the clinical observation that women, especially, receive pressure necroses at the medial sides of the arytenoid cartilages attributable to tracheal intubation with standard tubes. The large difference in almost all sizes and shapes of the cricoid cartilage and trachea makes it impossible to standardize the rigid stents used in these organs. When transplantation to the larynx is planned, this variation of the anatomy must be considered.
Use of Computer‐Aided Surgery for Frontal Sinus Ventilation
Authors: Loehrl Todd A. , Toohill Robert J. , Smith Timothy L.
Published: November 2003

Objectives To review our experience and evaluate the utility of computer‐aided surgery for frontal sinus and frontal recess disease.

Study Design A retrospective review of 31 consecutive patients undergoing computer‐aided surgery for frontal sinus ventilation.

Methods The hospital charts of 31 patients were reviewed. Previous sinonasal procedures, etiology of sinonasal disease, preoperative computed tomography (CT) scan findings, preoperative symptoms, endoscopic and intraoperative findings, type of frontal sinus ventilation procedure, complications, imaging system registration method or accuracy, and postoperative course were noted.

Results In all 31 patients the surgery was successfully completed, and no intracranial or orbital complications were encountered during or after surgery. Six patients required additional surgery including revision transnasal endoscopic frontal sinus ventilation or osteoplastic flaps with fat obliteration. In the six cases requiring additional surgery, disease severity, most commonly, aspirin triad disease, predisposed to failure of frontal sinus ventilation.

Conclusions Computer‐aided surgery is a useful adjunctive device for safe, efficient identification and surgery of the frontal sinus. However, it is not a replacement for sound surgical technique, anatomical knowledge, and experience. In particular, patients with aspirin triad disease with frontal recess and frontal sinus involvement are highly suited for computer‐aided surgery and thorough removal of disease, although failures occur despite this technique. The long‐term benefit of computer‐aided surgery of the frontal sinus has not yet been demonstrated by this or other studies.
Diagnosis and Management of the Lateralized Tympanic Membrane
Authors: Sperling Neil M. , Kay David
Published: November 2003

Objective Lateralization of the tympanic membrane (TM) is associated with significant morbidity. In a series of 14 patients, we make observations to illuminate this condition for the diagnosing and treating physician.

Study Design Chart review of 14 consecutively treated patients.

Methods We analyzed the presenting signs and symptoms, etiology, audiometric data, and operative findings of patients with a lateralized tympanic membrane (TM).

Results The etiology was postsurgical in 13 patients (there were four aural atresia repairs and nine tympanoplasties), with 2 patients having had multiple previous surgeries. Presentation averaged more than 5 years after the latest surgery. Presenting symptoms included hearing loss in 10, tinnitus in 3, vertigo in 3, and otorrhea in 2 patients; 3 patients were nonsymptomatic at the time of presentation. The average air–bone gaps were 39 dB before treatment and 29 dB after treatment. Operative findings included cholesteatoma in six patients. Eight patients healed with the TM in the normal position; one had TM retraction, one had a TM perforation, and three had a recurrent lateralization.

Conclusion The lateralized TM is primarily, but not necessarily, a complication of otological surgery. It may be associated with considerable morbidity, including hearing loss and cholesteatoma. Patients may present several years after their surgery, occasionally as an incidental finding. Surgical repair is often necessary for significant underlying disease, but re‐establishment of a normal TM can be challenging.
Effects of β‐Toxin of Staphylococcus aureus on Ciliary Activity of Nasal Epithelial Cells
Authors: Seop Kim Chung , Jeon Sea‐Yuong , Min Yang‐Gi , Rhyoo Chan , Kim Jeong‐Whun , Bock Yun Ja , Park Seok‐Won , Kwon Tae‐Young
Published: November 2003

Objectives To investigate the in vitro effects of staphylococcal β‐to‐in on ciliary activity and the in vivo effects on sinusitis induction.

Study Design The in vitro effects of staphylococcal β‐to‐in on ciliary activity were investigated at different concentrations and e‐posure times. E‐perimental sinusitis was induced in rabbits with application of β‐to‐in and confirmed 7 days later.

Methods Ciliated epithelial cells were taken from the ma‐illary sinus mucosa of 10 rabbits. Five culture dishes from each rabbit were used for the e‐perimental group, and one culture dish from each rabbit was used for the control group. In the experimental group, ciliary beat frequency (CBF) was measured at concentrations of 0.1, 1, 2, 5 and 10 U/mL of β‐toxin using a video‐computerized analysis technique, while in the control group, culture medium containing no toxin was used. CBF was measured 1, 2, 4, 6, 8, 12, 24, and 48 hours after administration of β‐toxin. To induce experimental sinusitis, 2 U/mL of β‐toxin was percutaneously applied to the maxillary sinus of 10 rabbits without occlusion of the natural ostium, while normal saline was percutaneously applied to the right‐side maxillary sinus of 4 rabbits in the control group. At 7 days, mucosal membranes were taken from the inferomedial wall of the maxillary sinus for light microscopic study.

Results CBF dropped significantly after an 8‐hour incubation at 2, 5, and 10 U/mL of β‐to‐in. No ciliary activity was observed after a 24‐hour incubation at 2 and 5 U/mL and a 12‐hour incubation at 10 U/mL of β‐to‐in. Mucoid, purulent discharge was observed in the ma‐illary sinuses of the β‐to‐in–applied group. Prominent epithelial disruption and infiltration of inflammatory cells into the epithelium and lamina propria were observed in the β‐to‐in–applied group.

Conclusions Staphylococcal β‐to‐in may reduce ciliary activity and induce sinusitis without occlusion of the natural ostium of the ma‐illary sinus in rabbits. This study provides another animal model of sinusitis for understanding the pathogenesis of sinusitis induced by bacterial e‐oto‐ins.
Post‐traumatic Olfactory Dysfunction
Authors: Kern R. C. , Quinn B. , Rosseau G. , Farbman A. I.
Published: November 2003

Objectives This study demonstrates histopathologic and immunocytochemical changes in the olfactory bulb of a patient with post‐traumatic olfactory dysfunction. These results are analyzed in light of current understanding of the pathophysiology of anosmia and dysosmia following head trauma. Emphasis is placed on potential mechanisms of human regeneration and recovery.

Study Design The current study documents the history of a patient with the initial complaint of complete anosmia following minor head trauma. Two months after the injury the patient developed persistent, severe dysosmia with debilitating weight loss. Neurosurgical treatment, including removal of the olfactory bulbs and tracts, resulted in permanent resolution of dysosmia.

Methods Histopathologic and immunocytochemical analysis of the olfactory bulbs was undertaken and compared with age‐matched control tissue.

Results Pathological analysis of the olfactory bulb revealed a marked reduction in the number of nerve processes with few intact olfactory glomeruli compared with an age‐matched control. Specific immunohistochemical staining for the olfactory neuron‐specific protein OMP, however, demonstrated the presence of intact axonal projections between the olfactory mucosa and the bulb.

Conclusions These results support the hypothesis that post‐traumatic anosmia involves, at least in part, damage to peripheral olfactory nerve fibers with histological changes in the olfactory bulb. Potential mechanisms for the development of post‐traumatic dysosmia are also discussed.
The Management of Laryngeal Fractures Using Internal Fixation
Authors: de Mello‐Filho Francisco V. , Carrau Ricardo L.
Published: November 2003

Background Laryngeal fracture is a rare injury with the potential to affect all functions of the larynx. Restoration of the laryngeal framework is critical for the rehabilitation of laryngeal function.

Objective To ascertain the efficacy of adaptation plate fixation (APF) to repair the laryngeal skeleton.

Study Design Retrospective review of the clinical data of all patients who underwent APF of laryngeal fractures from January 1989 to September 1999.

Results Our series consisted of 16 men and 4 women presenting with laryngeal fractures caused by blunt (n = 16) or penetrating (n = 4) trauma. Most of these patients presented with severe fractures classified as category III (n = 6), IV (n = 10), or V (n = 1), according to the Schaefer‐Fuhrman classification.

All patients who required a tracheotomy (n = 13) were de‐cannulated. Nineteen of the 20 patients recovered a social voice. The e‐ception was a patient with aphasia secondary to head trauma. No patient had aspiration problems. We encountered no complication associated with the use of APF.

Conclusion APF is an effective and well‐tolerated method to repair laryngeal fractures.
Outcome Analysis of Cochlear Implant Reimplantation in Children
Authors: Parisier Simon C. , Chute Patricia M. , Popp Amy L. , Suh Gerald D.
Published: November 2003

Objectives We review our e‐perience gained in performing cochlear reimplantation in 25 children who have had multichannel cochlear implant device failure at the Cochlear Implant Center of the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital (New York, NY), to assess the feasibility of cochlear reimplantation in children and the effect of reinsertion on audiological performance.

Study Design We retrospectively analyzed the outcome of 27 consecutive multichannel cochlear implant reinsertions performed in 25 children at the Manhattan Eye, Ear and Throat Hospital and Leno‐ Hill Hospital. These reimplantations were performed between 1990 and 1999, with a minimum follow‐up of 6 months for both surgical and audiological performance.

Methods Charts were reviewed for patient factors, findings at the time of initial operation and repeat operation, and results of audiological testing both before and after reimplantation.

Results Surgical complications of reimplantation included two intraoperative cerebral spinal fluid leaks and two late postoperative flap breakdowns with implant e‐trusions. For the most part, depth of electrode insertion was unchanged. Open‐set speech recognition scores and speech perception abilities remained stable or improved compared with results before reimplantation.

Conclusion Our results confirm that cochlear implant reimplantation is technically feasible and allows for continued auditory development for the child who has a cochlear implant device failure.
Building the Powerful 10‐Minute Office Visit: Part II. Beginning a Critical Literature Review
Authors: Neely J. Gail , Hartman James M. , Wallace Mark S.
Published: November 2003

Objective This is the second part in a series of sequential Tutorials in Clinical Research. The objective of this tutorial is to introduce methods of searching the vast stores of information now available, to review some of the computer resources available, to reintroduce the concept of an a priori design for the search, and to reveal the need for assessment of the clinical importance and validity of each pertinent article found.

Study Design Tutorial.

Methods An open working group has been formed with the specific aim of surveying and translating the large volume of complex information on research design and statistics into easily understood, useable, and non‐threatening tutorials for the busy practitioner. The hypotheses under which this work is conducted are highly intelligent, but extremely busy, surgeons are interested in evidence‐based medicine and will increase personal participation in critical reading of the literature, pending an expanded familiarity with clinical research design and statistics.

Results Available resources for literature searching, methods of quick personal overviews, and quick question‐specific reviews are discussed. Additionally, the methods, with examples, of beginning a critical literature review are presented.

Conclusions Rapid, personal, critical literature review requires succinct formulation of the question, efficient search for the best available evidence, and critical appraisal of the pertinent individual articles to determine if sufficient evidence exists to support a clinical contention.
A New Clinical Classification for Usher's Syndrome Based on a New Subtype of Usher's Syndrome Type I
Authors: Otterstedde Christian R. , Spandau Ulrich , Blankenagel Anita , Kimberling William J. , Reisser Christoph
Published: November 2003

Objectives Usher's syndrome is an autosomal recessive disorder characterized by sensorineural hearing loss and progressive visual loss secondary to retinitis pigmentosa. Usher's syndrome is both clinically and genetically heterogeneous. Three clinical types are known today.

Methods We conducted a study on 74 patients with Usher's syndrome, performing complete audiological and neurotological e‐aminations.

Results Twenty‐si‐ patients had total profound hearing loss and retinitis pigmentosa (Usher's syndrome type I), and 48 patients had moderate to severe sensorineural hearing loss and retinitis pigmentosa (Usher's syndrome type II). We identified 9 of the 26 Usher's syndrome patients with profound hearing loss who showed a normal response to bithermal vestibular testing.

Conclusions The combination of profound hearing loss and normal response to bithermal vestibular testing has not been previously described in Usher's syndrome. Therefore we describe a new subtype of Usher's syndrome type I and suggest a modified clinical classification for Usher's syndrome.
Spontaneous Otoacoustic Emissions in Humans With Endolymphatic Hydrops
Authors: Haginomori Shin‐Ichi , Makimoto Kazuo , Tanaka Hitoshi , Araki Michitoshi , Takenaka Hiroshi
Published: November 2003

Objective/Methods The origin and clinical implications of spontaneous otoacoustic emissions (SOAEs) have not been well revealed. To investigate the relationship between the ear with endolymphatic hydrops and SOAE, SOAEs were measured in 31 patients with unilateral endolymphatic hydrops and 10 volunteers with normal hearing levels that had less than 25 dB hearing level (HL) on average for five frequencies (0.25, 0.5, 1, 2, and 4 kHz).

Results SOAEs were detected in 18 (58%) of the 31 ears with hydrops. In 15 hydropic ears in which the hearing levels were less than 25 dB HL on average, SOAEs were observed in 11 (73%). The results of examining the relationship between changes in hearing level after administering the glycerol test and SOAE frequency showed that four (50%) of eight hydropic ears had SOAEs that were detectable between the frequency in which hearing level improved more than 5 dB and the frequency with no hearing level change in the audiogram. In 28 contralateral ears, except for three cases of delayed endolymphatic hydrops, SOAEs were detected in 17 (61%). In 14 contralateral ears in which the hearing levels were less than 25 dB HL on average for the five frequencies noted above, SOAEs were observed in nine ears (64%). In 20 normal ears, SOAEs were detected in eight (40%). Prevalence of SOAEs in hydropic ears and contralateral ears of the patients with unilateral hydrops tended to be greater than that in normal ears; however, there was no significant statistical difference between them.

Conclusion The present results suggest that it is not possible to mention the characteristics of SOAE in the hydropic ear only in terms of the prevalence of SOAEs. SOAEs may occur in a specific portion of the basilar membrane corresponding to the frequency in which hearing levels improve after the glycerol test, in some cases with endolymphatic hydrops.
A Prospective Study of p53 Expression and Its Correlation With Clinical Response of Radiotherapy in Nasopharyngeal Carcinoma
Authors: Ho Kuen‐Yao , Kuo Wen‐Rei , Chai Chee‐Yin , Tsai Shih‐Meng , Sheu Sheng‐Hsiung , Wu Shu‐Chuan , Juan Kai‐Hui
Published: November 2003

Objectives/Hypothesis Nasopharyngeal carcinoma (NPC) is a common malignant neoplasm of the head and neck that occurs in people in the southeastern Asian area, including Taiwan. The significant association of p53 expression in NPC suggested that p53 overexpression seemed to occur at an early stage in the development of NPC. Alterations of p53 status were probably the most commonly encountered in head and neck carcinomas, and there was extensive evidence that p53 status might determine tumor response to therapy. Ionizing radiation was studied extensively for the relationship between its damaging effect and p53 status in human cancer cells.

Study Design This study was carried out to investigate whether there was any correlation between overexpression of p53 protein and locoregional tumor response in patients with NPC treated with 7000 cGy of radiotherapy.

Methods Sixty‐eight patients (50 males, 18 females) with NPC who were diagnosed and treated with radiotherapy were studied prospectively. Before they had received a radiation dose of 7000 cGy in 35 fractions, five fractions a week, p53 status from a nasopharyngeal biopsy was studied using immunohistochemical staining (IHC).

Results The locoregional response rate of primary tumor was analyzed statistically. Forty‐seven patients (69.1%) showed positive p53 staining in their tumors. There were 5 positive stains in 6 squamous cell carcinomas (SCC; 83.3%), 34 positive in 53 non‐keratinizing carcinomas (NKC; 64.2%), and 8 positive in 9 undifferentiated carcinomas (UC; 88.9%). The mean ages for patients with three different histopathologies were 48.5, 46.1, and 61.1 years. There were 8 patients (7 positive stains, 1 negative stain) with residual tumor after radiotherapy and all were NKC (6 males, 2 females). Therefore, the clinical response rate of primary tumor was 85.1% in positive p53 immunostaining (40 of 47 cases), 95.2% in those with no immunostaining (20 of 21 cases); the former was poorer in locoregional tumor response than the latter, but there was no significant difference (P >.05, ξ2 test).

Conclusions We conclude that there is no statistically significant correlation in locoregional response of primary tumor between p53 overexpression and radiotherapy in patients with NPC (P >.05, Fisher exact test).
Cancer Induction in the DMBA Hamster Cheek Pouch: A Modified Technique Using a Promoter
Authors: Wani Manish K. , Yarber Robert H. , Ahmed Asif , Hengesteg Arne , Robbins K. T.
Published: November 2003

Objective To evaluate a modified method of carcinogenesis induction using the 9,10‐dimethyl‐1,2‐benzanthracene (DMBA) sustained‐release suture technique followed by arecaidine promotion in the hamster cheek pouch model.

Study Design Prospective, controlled animal study.

Methods Number 3‐0 cotton sutures were impregnated with DMBA and coated with silicone elastomer. These sutures were placed in the cheek pouch of Syrian hamsters in the submucosal space to a length of approximately 1.5 cm. The suture placement was confirmed every 2 weeks and replaced if lost. After 12 weeks, the DMBA‐coated sutures were removed. The cheek pouches were everted and painted with a solution of arecaidine three times weekly for up to an additional 4 weeks or until the tumor reached a size of 100 mm2.

Results We placed sutures in 165 Syrian hamster cheek pouches. Of these, 133 hamsters (80.6%) produced squamous cell carcinomas that reached a size of 100 mm2 and then were randomly selected for treatment in a new drug trial. Twenty‐six hamsters (15.8%) were found dead and 6 (3.6%) were killed because of severe inflammation.

Conclusions The DMBA hamster cheek pouch model is a reliable and efficient animal model for inducing squamous cell carcinoma and can be used to study upper aerodigestive tract tumors.
Changes in Serum Interferon‐γ, Interleukin‐4, and Interleukin‐12 Cytokine Levels in Anti‐Histamine Type 2–Treated Allergic Rhinitis Patients
Authors: Testa Benedetto , Mesolella Carlo , Mosti Maria R. , Mesolella Massimo , Testa Domenico , Motta Gaetano
Published: November 2003

Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon‐γ (IFN‐γ) and interleukin‐4 (IL‐4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T‐cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL‐4 in T‐cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNγ and IL‐4 that occurs in vivo in anti‐H2–treated patients with allergic rhinitis (AR).

Methods Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment.

Results A comparison of the serum cytokine values recorded before and after anti‐H2 treatment showed a significant increase in INF‐γ serum level (P = .003) and a decrease in IL‐4 (P = .016). Negligible variations were found in the placebo‐treated group.

Conclusion H2 antagonists probably induce their effects by enhancing the amount of IFN‐γ and by reducing IL‐4 cytokines, which, respectively, induce a decrease and an increase in the IgE synthesis.
Regulation of Mucociliary Motility by Nitric Oxide and Expression of Nitric Oxide Synthase in the Human Sinus Epithelial Cells
Authors: Kim Jeong‐Whun , Min Yang‐Gi , Rhee Chae‐Seo , Lee Chul‐Hee , Koh Young Yull , Rhyoo Chan , Kwon Tae‐Young , Park Seok‐Won
Published: November 2003

Objectives This study was performed to investigate the changes in ciliary beat frequency (CBF) after treatment with L‐arginine in the human sinus mucosa and to determine the distribution of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) in the healthy sinus mucosa.

Study Design/Methods CBF was measured in the sphenoid sinus mucosa of 12 patients who underwent trans‐septal trans‐sphenoidal hypophysectomy for the treatment of pituitary gland tumor. CBF was measured over 24 hours in Dulbecco's modified Eagle's medium (DMEM) after treatment with L‐arginine, its inactive spatial isomer D‐arginine, or an NOS inhibitor, NG‐nitro‐L‐arginine methyl ester (L‐NAME). DMEM without treatment with these materials was used as a control. Other pieces of the mucosa were exposed to L‐NAME and its inactive spatial isomer D‐NAME after preincubation with L‐arginine. The specimens were immunohistochemically stained for iNOS and eNOS.

Results CBF increased 24 hours after treatment with L‐arginine as compared with control groups. CBF increased in proportion to the increasing concentrations of L‐arginine. There was no significant change after treatment with D‐arginine or L‐NAME. CBF increased after treatment with L‐arginine at 30 minutes and maintained for 24 hours. L‐NAME inhibited the increase in CBF by L‐arginine, but D‐NAME showed no such effect. Immunoreactivity to both iNOS and eNOS was frequently observed in the ciliated epithelial cells and was stronger to eNOS than to iNOS.

Conclusions From the results of this study it is suggested that nitric oxide (NO) produced by iNOS and eNOS using L‐arginine may increase CBF in the healthy sinus mucosa and that NO may have a regulatory function in ciliary motility in the human sinus mucosa.
Effectiveness of Adenoidectomy and Laser Tympanic Membrane Fenestration
Authors: Cook Steven P. , Brodsky Linda , Reilly James S. , Deutsch Ellen , Waner Milton , Brookhouser Patrick , Pizzuto Michael , Poje Christopher , Nagy Mark , Shaha Steven H. , Chait David , Bower Charles
Published: November 2003

Objective Adenoidectomy alone or with tonsillectomy (A±T) is an effective surgical intervention in the management of otitis media in children, especially when it is performed in conjunction with insertion of pressure equalization tubes (PETs). Otorrhea and persistent tympanic membrane (TM) perforation are frequent complications. This study evaluates the effectiveness of intermediate duration middle ear ventilation using laser tympanic membrane fenestration (LTMF) without tube insertion and as an adjunct to adenoidectomy in resolving middle ear disease within the first 90 days after surgery.

Study Design This pilot study was a multicenter, prospective clinical cohort trial. Institutional review board approval and informed consent were obtained. The study involved four tertiary care pediatric otolaryngology departments. Fifty children (96 ears) were treated with LTMF in conjunction with A±T from June 1, 1998, through March 30, 1999. Ages ranged from 9 months to 12 years. Patients undergoing A±T who would have been recommended for PET insertion instead underwent middle ear ventilation with LTMF using the OtoLAM™ device (ESC/Sharplan, Yokneam, Israel). Patients were seen at 30, 60, and 90 days postoperatively. Resolution of otitis media with effusion was determined by clinical examination, which included pneumatic otoscopy, audiometry, and tympanometry.

Results Of the treated ears, 88%, 86%, and 83% had clinical resolution of middle ear disease at 30, 60, and 90 days, respectively. Preoperatively, 45% (n = 85) of ears had normal hearing; 92% (n = 49) had normal hearing at 90 days. Eighty‐nine percent (n = 92) had type C2 or B tympanograms preoperatively, and 12% (n = 60) had type C2 or B at 90 days.

Conclusion Laser tympanic membrane fenestration in conjunction with adenoidectomy was effective in restoring normal middle ear function at 90 days post‐treatment in greater than 80% of children who otherwise may have had placement of PETs.
Prevention of Vomiting After Tonsillectomy in Children: Granisetron Versus Ramosetron
Authors: Fujii Yoshitaka , Saitoh Yuhji , Kobayashi Noriaki
Published: November 2003

Objective/Hypothesis Granisetron, a selective 5‐hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting after tonsillectomy in children. Ramosetron (Nasea; Yamanouchi; Tokyo, Japan), another new antagonist of 5‐hydroxytryptamione type 3 receptor, has more potent and longer‐acting properties than granisetron (Kytril; Smith Kline Beecham, London, UK) against cisplatin‐induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting after pediatric tonsillectomy.

Study Design Prospective, randomized, double‐blinded study.

Methods Ninety pediatric patients, aged 4 to 10 years, received intravenously granisetron 40 μg/kg or ramosetron 6 μg/kg (n = 45 each) at the end of surgery. The same standard general anesthetic technique and postoperative analgesia were used throughout. Emetic episodes and safety assessment were performed during the first 24‐hour period and the next 24‐hour period after anesthesia.

Results The rates of patients being emesis‐free during the period from 0 to 24 hours after anesthesia were 89% with granisetron and 93% with ramosetron, respectively (P = .357); the corresponding rates during the period from 24 to 48 hours after anesthesia were 71% and 93%, respectively (P = .006). No clinically serious adverse events attributable to the study drugs were observed in any of the groups.

Conclusion Ramosetron is a better antiemetic than granisetron for the long‐term prevention of postoperative vomiting in children undergoing general anesthesia for tonsillectomy.
A Simple Method to Estimate the Secretion of Saliva From Minor Salivary Glands Using Iodine‐Starch Reaction
Authors: Inamura Tatsuya , Ino Chiyonori , Katoh Mako , Kishimoto Asako , Kumazawa Hirobumi , Matsumoto Ayumi , Yamashita Toshio
Published: November 2003

Objective/Hypothesis This study was undertaken to detect the faculty of secretion of saliva from minor salivary glands by analyzing a color reaction on a test tape containing iodine and starch that was applied on the lower lip.

Study Design A study involving 63 patients with oral dryness, 7 patients with Sjögren syndrome, and 70 healthy individuals was performed.

Methods A test tape (1 × 1 cm) containing iodine and starch was set on the mucosal area anterior to the labia frenulum for 30 seconds. Because the number of blue spots was considered to correspond to the number of ostia of the salivary gland on the lower lip that was examined, the number of blue spots occurring as a reaction of iodine and starch on the test tape was counted and was compared among three groups. In addition, the relationship between the histopathological findings and the number of spots was analyzed.

Results The average number of spots in the patients with oral dryness (4.52 ± 3.18 [mean ± SD]) was lower than that in healthy individuals (9.49 ± 2.52, P <.01), and that in the patients with Sjögren syndrome (2.14 ± 1.35) was the lowest among all groups in the study. Moreover, this reduction in the number of spots in those patients was accompanied by histopathological changes of the minor salivary glands.

Conclusion These findings suggest that this simple, noninvasive method can be successfully used for the estimation of the faculty of secretion of saliva from the minor salivary glands.