bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Interstitial Brachytherapy in Oral and Oropharyngeal Carcinoma: Reflection of a Series of 1344 Patients Treated at the Time of Initial Presentation
Authors: Pernot Monique , Hoffstetter Sylvette , Peiffert Denis , Aletti Pierre , Lapeyre Michel , Marchal Christian , Luporsi Elisabeth , Bey Pierre
Published: September 2022

Our study focuses on a series of 1344 cases of carcinoma of the oral cavity and oropharynx treated between 1973 and 1992. Brachytherapy was always performed with iridium 192, either alone or in combination with external‐beam irradiation or with surgery for the treatment of the primary tumor. For the oral cavity, we studied 565 cases of mobile tongue. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 92% and 70%; for T2, 62% and 42%; and for T3, 50% and 29%. For the subgroup T1T2N0, there was a better prognosis for treatment by brachytherapy of the primary lesion alone (p < 0.0001). Two hundred seven cases of floor‐of‐mouth carcinoma have been reported. The T3T4 patients were not considered surgical candidates. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 97% and 71%; for T2, 72% and 42%; and for T3, 51% and 35%. Ninety‐seven patients were treated by postoperative brachytherapy. These were patients for whom the margins after surgery were positive or narrow. A technique termed the modified bridge is described for lesions located in the mandible. Carcinomas of the buccal mucosa are rare in our country; only 42 cases were treated in this comparison of two techniques, and the overall survival rate was 48%. Epidermoid carcinomas of the oropharynx have nearly always been treated by a combination of external‐beam irradiation and brachytherapy because of the bilateral node risk. Seventy‐two patients with epidermoid cancers of the base of the tongue had an overall survival rate of 44%. The tonsil, soft palate, and pillars benefited from the use of the loop technique of brachytherapy combined with external‐beam irradiation. Three hundred sixty‐one patients were treated. Among these patients were two groups with different prognoses. Patients with tonsil, soft palate, and posterior pillar carcinomas had a local control rate of 84% and an overall survival rate of 57%. Conversely, the anterior pillar and the pharyngoglossal sulcus have a local control rate of only 65% and an overall survival rate of 38%. Statistical analysis revealed the prognostic factors for local control. The complications were classified into four grades: minor (20%), moderate (9%), major (4%), or inducing death (0.2%). The bone complications of grade 2 or 3 are more frequent for the floor of the mouth than for other locations.
Laryngeal Biomechanics of the Singing Voice
Authors: Koufman James A. , Radomski Teresa A. , Joharji Ghazi M. , Russell Gregory B. , Pillsbury David C.
Published: September 2022

By transnasal fiberoptic laryngoscopy, patients with functional voice disorders often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termedmuscle tension dysphonias.Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty‐nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame‐by‐frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm‐up before singing, race, smoking, and alcohol consumption.
Endoscopic Treatment of Sphenoid Sinusitis
Authors: Metson Ralph , Gliklich Richard E.
Published: September 2022

Juxtaposed between the posterior nasal cavity and skull base, the diseased sphenoid sinus presents unique challenges when surgical drainage is required. Endoscopic techniques have gained widespread popularity for the treatment of sphenoid sinusitis, yet the efficacy of such treatment remains largely unknown. Thirty‐four patients who underwent endoscopic sphenoidotomy were monitored over a period of 6 months to 5 years. Surgery was performed with the superior turbinate used as the key landmark for identification and enlargement of the natural sphenoid ostium. Surgical access was through either a transnasal or transethmoid approach, depending on whether disease was limited to the sphenoid sinus. Prospective analysis of 26 patients with established outcome measures demonstrated a significant reduction in facial pain, nasal drainage, and congestion 6 months after surgery (p < 0.0001). Medication use was also reduced but to a lesser extent (p < 0.05). Endoscopic sphenoidotomy appears to be a safe technique that effectively reduces patient morbidity associated with sphenoid sinusitis.
If Functional Sinus Surgery Fails: A Radical Approach to Sinus Surgery
Authors: Kerrebijn Jeraen D. F. , Drost Hubertus E. , Spoelstra Hubert A. A. , Knegt Paul P.
Published: September 2022

Radical surgery of the nose and paranasal sinuses was performed in 56 patients as a last resort for severe recurrent treatment‐resistant rhinosinusitis. Surgery consists of removal of all walls between the nasal fossa and the paranasal sinuses, creating one cavity. All patients were permanently relieved of sinusitis and nasal obstruction, and other symptoms were greatly reduced. Morbidity is low in relation to preoperative symptoms. We conclude that radical sinus surgery is an effective last resort if functional sinus surgery repeatedly fails.
Pediatric Gunshot Wounds to the Head and Neck
Authors: Kountakis Stilianos E. , Rafie Jean‐Jacques , Ghorayeb Bechara , Sternberg Charles M.
Published: September 2022

Gunshot wounds to the head and neck in the pediatric population have become alarmingly common. They often result in death of the victim, devastate families, and inflict a considerable financial burden to hospitals and society. We present a retrospective study of cases treated at a level I trauma center in Houston, Texas, from July 1990 to July 1993. We identified 115 cases of gunshot wounds in children, 32 of which were exclusively confined to the head and neck region. There were 26 male and 6 female patients. Ages ranged from 3 to 17 years. The cranial cavity was involved in 13 cases, leading to 9 deaths and 1 institutionalization. The shootings took place at home in 11 cases, and they involved play in 12 cases. The shooter was known to 11 of the victims, and the wounds were self‐inflicted in 7 cases. The most common type of weapon was the. 22 caliber pistol, which caused four of the deaths. Two of our cases involved BB air rifles, one of which mandated a craniotomy for the evacuation of an epidural hematoma. Our findings indicate that gunshot wounds to head and neck in children are in most instances preventable and result in high fatality rates because of common intracranial involvement, even when low‐energy missiles are used.
Assessing the Clinical Utility of the Magnetic Stimulator for Measuring Response Latencies in the Laryngeal Muscles
Authors: Sims H. Steven , Yamashita Toshiyuki , Rhew Karen , Ludlow Christy L.
Published: September 2022

Our purpose was to assess the use of magnetic stimulation for measuring conduction time of the recurrent and superior laryngeal nerves in 10 normal volunteers (7 male, 3 female). Subjects underwent laryngeal electromyography and magnetic stimulation of the vagus nerve bilaterally at the mastoid tip with a figure 8 coil. Mean muscle response latencies were measured and examined for consistent differences. Thyroarytenoid muscle response latencies were consistently longer than those in the cricothyroid muscle. Left thyroarytenoid muscle latencies were consistently longer than those on the right in agreement with bilateral asymmetry of these nerves. No appreciable differences were observed in cricothyroid muscle latencies when the right side was compared with the left. Results were consistent and reproducible within a broad range, but appreciable intersubject variability was observed. The limited sample size was unable to support a correlation with anthropometric variables, although an association was indicated. Magnetic stimulation with this technique has great potential for use in neurolaryngologic studies.
Effects of Air Pollution on the Upper Aerodigestive Tract
Authors: Holt G. Richard
Published: September 2022

The main route of contamination of the human body with airborne pollutants is through the upper air and food passages. Because of the delicate balance of the mucous membranes and special sensory organs of these passages with respect to mucociliary activity, local and recruited immune responses, rapid uptake of chemicals, and carcinogenic potential, the ingestion or inhalation of pollutants in the air can be harmful to these internal body barriers. The particular target organs for air pollution effects on the upper aerodigestive tract include the mucosa, olfactory epithelium, auditory receptor cells, glottic epithelium, and adjacent neural and muscular tissues. Hearing loss caused by noise exposure may be aggravated by the concomitant inhalation of solvents. The strongest evidence for the carcinogenic effect of occupational inhalants in the nasal cavity and paranasal sinuses is seen with exposure to hardwood dust, tobacco smoke, furniture making, and leather tanning. With the exception of tobacco smoke, which produces squamous cell carcinomas, the majority of the occupationally related cancers are adenocarcinomas, usually of the intestinal variety. Tobacco smoke, passive or active, may lead to end‐artery obliteration at the level of the otic end organ, causing a progressive sensorineural hearing loss. Further environmental research in the upper aerodigestive tract should aim at developing biologic markers to determine early, premalignant tissue changes; identifying the effects of chronic, low‐dose toxic exposure on mucous membranes and neurosensory organs; providing field‐tested tools for the standardized screening of large at‐risk populations.
Air Pollution and its Effect on the Upper Respiratory Tract and on Allergic Rhinosinusitis
Authors: Trevino Richard J.
Published: September 2022

The nose is the first organ system encountered by inhaled air and its associated pollutants. Pollutants are deposited during inspiration through the nose. They accumulate on mucus and are absorbed in the nasal mucosa, resulting in a number of deleterious effects on the body. Irritation of the nose and sinus from these pollutants, resulting from direct contact with the nasal mucosa, leads to inflammation, edema, swelling, and blocked sinuses. The result is acute and chronic sinusitis. Absorption of these chemicals into the body produces systemic effects. Their effect on the immune system, although subtle, leads to dramatic changes In the allergic diathesis. The T suppressor cell is the most sensitive cell of the immune system and the first to be affected by exposure to chemical pollutants. Diminution of the suppressor activity and the relative increase in helper activity in turn lead to increased immunoglobulin production and the manifestation of allergy symptoms. The underlying biochemical reaction is caused by the effects of pollutants on the T suppressor cell. Patients with existing allergies become brittle and difficult to treat with the exacerbation of the allergic diathesis. Removal of these chemical pollutants from the body as quickly as possible is essential for effective treatment of this problem. Dietary antioxidants help reduce the oxidizing effect of the pollutants and act as conjugators to remove the pollutants from the body.
Role of Tumor Necrosis Factor and Granulocyte‐Macrophage Colony‐Stimulating Factor in the Late Allergic Response in Human Nasal Mucosa
Authors: Belser Robert B. , Fine Edward D. , Boehm Keith D.
Published: September 2022

Cytokines play an integral role in the allergic response of the nasal mucosa. The ideal model for analysis of this interaction has yet to be perfected. We present a model for such evaluation and present results of experiments on the release of several cytokines. Freshly harvested human nasal turbinate mucosa was placed on a Gelfoam (Upjohn Co., Kalamazoo, Mich.) raft in a liquid medium to simulate the in situ environment. The allergic response was initiated by exposing the nasal mucosa to various combinations and amounts of human immunoglobulin E and antihuman immunoglobulin E antibody. The supernatants were collected and analyzed by enzyme‐linked immunosorbent assay techniques for various cytokines. Histopathologic evaluation of the mucosa was performed throughout the exposure period, confirming normal cellular and tissue architecture and viability. This model was used to monitor the release of interleukin‐3, granulocyte‐macrophage colony‐stimulating factor, tumor necrosis factor‐α, and soluble tumor necrosis factor receptors after exposure to immunoglobulin E and immunoglobulin E antibody. Interleukin‐3 did not show significant increases during the experiment testing period of 48 hours. Tumor necrosis factor‐α and soluble tumor necrosis factor receptors demonstrated time‐dependent increases in concentration after immunoglobulin E stimulation. Granulocyte‐macrophage colony‐stimulating factor showed the greatest time‐dependent increases. Their impact on the understanding of the allergic response will be discussed.
Recovery after tonsillectomy: Electrodissection vs. Sharp dissection techniques
Authors: Wexler David B.
Published: September 2022

Previous studies have suggested that electrodissection tonsillectomy is associated with increased pain and delayed healing in comparison with sharp techniques for tonsillectomy. To better define the clinical significance of this difference, a detailed study of the time course of recovery was undertaken in adults and children after tonsillectomy or adenotonsillectomy by the sharp or electrodissection method. For electrodissection tonsillectomy, electrocautery set to 20 W was used for dissection and hemostasis, and after sharp dissection the suction electrocautery was used only selectively at bleeding sites. Daily pain scores were recorded for 2 weeks, and return to normal diet and activities was monitored. In adults the electrodissection tonsillectomy (n= 26) resulted in an average delay of 2 days in recovery from pain (p< 0.05) and a 2‐day delay in return to a normal diet (p< 0.05) compared with sharp tonsillectomy (n= 24). In children (aged 2 to 12 years) the electrodissection technique (n= 26) resulted in an average delay trend of 1 to 1.5 days (not significant) compared with the sharp method (n= 24). Electrodissection tonsillectomy results in an average delay in recovery of 2 days for adults and in a lesser delay in pediatric patients.
Tinnitus Reclassified: New Oil in an Old Lamp
Authors: Nodar Richard H.
Published: September 2022

This article represents a compilation of study, research, and patient care during a 30‐year period. Its development was based on two tenets: (1) keep it simple and (2) be inclusive. The purpose of the classification system was to provide professionals with a vehicle for describing tinnitus and its location, probable cause, loudness, degree of annoyance, and pitch. The system uses two mnemonics to follow the word tinnitus: (1) A, B, or C for tinnitus Aurium, Binaural, or Cerebri; and C‐CLAP for Cause, Composition, Loudness, Annoyance, and Pitch. Four descriptions are presented on how this classification system may be used in the clinician's report.
An Objective Evaluation Method for Facial Mimic Motion
Authors: Isono M. , Murata K. , Tanaka H. , Kawamoto M. , Azuma H.
Published: September 2022

This technique was designed to establish a simple, objective evaluation system for facial paralysis through the use of a personal computer. A total of 24 marks were placed on the faces of subjects for the following procedures. Movements of the face were photographed with a videocamera and fed continuously into the computer. Ten frames per movement representing facial movement from rest to maximum movement were selected for analysis. By means of a digital Image‐processing technique, only the marks placed on the face were extracted, and the movement of these marks was quantitatively analyzed. A total of 44 healthy subjects with no history of facial paralysis were used as a normal control group. The patients with facia! paralysis consisted of nine subjects with Bell's palsy and three with Ramsay Hunt syndrome. In the eye‐closing motions, no significant differences were found between the sum of the movement distances on the left and right sides in each normal subject. However, the patients with facial paralysis showed distinct differences from those obtained in the normal subjects. The improvement process was also evaluated with a ratio of affected‐ and normal‐side facial movements.
Fast spin Echo Magnetic Resonance Imaging: Clinical Application in Screening for Acoustic Neuroma
Authors: Shelton Clough , Harnsberger H. Ric , Allen Robert , King Brian
Published: September 2022

The advent of magnetic resonance imaging has greatly improved our ability to diagnose acoustic tumors, but it is a relatively expensive imaging modality. In the present climate of medical cost restraints, methods that reduce costs but maintain quality are extremely desirable. We report a new magnetic resonance imaging technique that uses fast spin echo without gadolinium. It provides ultrahigh‐resolution images of the internal auditory canal and cerebellopontine angle. The sensitivity of this technique for the detection of acoustic tumors is equivalent to conventional gadolinium‐enhanced magnetic resonance imaging, but the global cost is comparable with that of brain stem audiometry. In our practice fast spin echo magnetic resonance imaging has replaced brain stem audiometry as a screening modality to evaluate most acoustic tumor suspects. Also, the intricate detail of the internal auditory canal anatomy provided by this technique is useful in planning surgical removal of acoustic tumors.
Staging for Rhinosinusitis
Authors: Lund Valerie J. , Kennedy David W.
Published: September 2022

Interest in the surgical treatment of chronic rhinosinusitis has increased, primarily because rigid endoscopy and, more particularly, computed tomographic scanning have facilitated the visualization of disease. At the same time it has become both scientifically and financially imperative to audit therapeutic outcome. Consequently, a staging system for nonneoplastic sinus disease is needed. It is clear that any assessment of medical or surgical therapeutic response requires a method of quantifying disease severity that will be widely accepted by practitioners in the field. This acceptance will largely depend on how easy the method is to apply. With computed tomographic scanning it is possible to more accurately determine the extent of the pathologic condition in rhinosinusitis, a disease in which the severity of symptoms and the appearances on nasal endoscopy have a significantly more unpredictable correlation with the extent of disease. One goal of the Task Force on Rhinosinusitis of the American Academy of Otolaryngology‐Head and Neck Surgery was to recommend a system for outcomes research that combines quantification with ease of application.
Lipoinjection in the Paralyzed Feline Vocal Fold: Study of Graft Survival
Authors: Saccogna Phillip W. , Wernimg John W. , Setrakian Sebouh , Strauss Melvin
Published: September 2022

Six adult domestic strain cats were used to study the long‐term histologic outcome of injected autologous fat for augmentation of the paralyzed vocal fold. Each animal had surgically induced left vocal cord paralysis via sectioning of the recurrent laryngeal nerve, followed by injection of 0.1 to 0.2 ml of autologous fat into the paralyzed vocal fold. The animals were killed at 6 weeks, and at 4, 6, 8, and 12 months after the injection. Photographic and videolaryngoscopic data were obtained. Histologic studies of the larynges were performed. The results documented histologic viability and persistence of a portion of the injected adipose tissue graft at 8 months after the injection, but only minimal graft survival at 12 months. The outcome suggests that autologous lipoinjection has potential use for short‐term (several months) augmentation of the paralyzed vocal cord. Further investigation is warranted before recommending this technique for such use or as an alternative to currently available long‐term injectable laryngeal biomaterials.
Nebulized Surfactant for Experimentally Induced Otitis Media with Effusion
Authors: Nemechek Andrew J. , Pahlavan Nima , Cote Donald N.
Published: September 2022

Eustachian tube dysfunction frequently results in clinical evidence of otitis media with effusion (OME). Surface active substances, surfactants, are hypothesized to play a role in normal eustachian tube function. Recent work in a rodent model has demonstrated improved eustachian tube function with topical application of surfactants to the middle ear. A novel, noninvasive, and clinically practical method of delivering surfactant to the eustachian tube was studied in a gerbil model of OME. Otitis media with effusion was experimentally induced in 20 gerbils by transtympanic inoculation of heat‐killed Streptococcus pneumoniae. This represents a well established model for creating a serous effusion in the gerbil that significantly increases eustachian tube opening pressure. Effusion developed in 27 of 40 ears (67.5%) after inoculation. An inhaled nebulized surfactant was used to treat the animals with microscopically confirmed OME in one or both ears. The treatment period was 5 days. Eustachian tube opening studies were performed on both affected and nonaffected animals. Successful eustachian tube opening pressures were obtained in 30 of 36 ears (83.3%). The mean opening pressure for ears without effusion (healthy ears) was 42.8 mmHg. The mean opening pressure for ears with effusion in animals treated with nebulized surfactant was 41.4 mmHg. The difference between these mean values was not statistically significant (t = 0.32; p > 0.50). This pilot study suggests that inhaled nebulized surfactant may be efficacious in treating eustachian tube dysfunction when manifested in disorders such as OME.
Comparison of Five Agents in Protecting the Cochlea Against the Ototoxic Effects of Cisplatin in the Hamster
Authors: Kaltenbach James A. , Church Michael W. , Blakley Brian W. , McCaslin Devin L. , Burgio Don L
Published: September 2022

The purpose of this investigation was to study the ameliorating effects of four agents on cis‐platin‐induced ototoxicity. Hamsters were given a series of five cisplatin injections either alone or in combination with sodium thiosulfate (STS), diethyldihydrothiocarbamate (DDTC), and S‐2(3‐aminopropylamino) ethylphosphorothiolc acid (WR‐2721), or fosfomycin. Ototoxicity was assessed anatomically by quantifying the extent of cochlear damage with the scanning electron microscope and physiologically with measures of the auditory brain stem response. When administered alone, cisplatin induced widespread loss of outer hair cells (OHCs) along much of the cochlea in the hamster, especially in the basal and middle turns, with an average survival of only 56% of the OHC population. In contrast, inner hair cells resisted cisplatin ototoxicity in the hamster. Thus the ameliorative effects of the different test agents were assessed by counting the number of surviving OHCs in each treatment group and comparing with cisplatin‐treated controls. STS provided the most effective protection against the ototoxic effects of cisplatin, yielding 91% survival of OHCs. DDTC also reduced the ototoxic effects of cisplatin, yielding 68% survival of OHCs. Cotreatment with WR‐2721 and fosfomycin yielded 45% and 52% OHC survival, respectively, and thus did not provide any chemoprotection. The results closely paralleled those based on auditory brain stem response recordings in that the magnitude of threshold shift was proportional to the amount of OHC loss; also, the amount of threshold shift at each frequency was in good agreement with the pattern of hair cell loss along the cochlear spiral. Thus both histologic and physiologic results suggest that STS and DDTC hold promise for ameliorating the ototoxic effects of cisplatin chemotherapy.
Breakdown of Stria Vascularis Blood‐Labyrinth Barrier in C3H/lpr Autoimmune Disease Mice
Authors: Lin David W. , Trune Dennis R.
Published: September 2022

Sensorineural hearing loss related to autoimmune disease is a well‐recognized condition, although the exact pathophysiologic mechanisms remain unclear. One current theory postulates immune complex‐induced interference with blood‐labyrinth barrier integrity in the stria vascularis. The C3H/lpr autoimmune mouse was chosen to study the permeability of capillaries in the stria vascularis because this mouse model has demonstrated abnormalities of the stria vascularis and shifts in the auditory brain stem response threshold during active disease. C3H/lpr mice with active disease were compared with younger mice without disease, as well as age‐matched C3H/HeJ control mice. The mice were injected with the tracer ferritin and examined by transmission electron microscopy to evaluate the integrity of the capillary tight junctions in the stria vascularis. Four of five mice with active disease were noted to have extensive leakage of ferritin into the perivascular tissues. Neither the young, disease‐free autoimmune mice nor the nonautoimmune control mice demonstrated vessel leakage. Thickening of the basement membrane was also noted in the diseased animals. The results imply that active disease leads to a breakdown in the blood‐endolymph barrier, which could underlie the hearing loss accompanying autoimmune and other immune diseases.
Serial Gadolinium‐Enhanced Magnetic Resonance Imaging and Assessment of Facial Nerve Function in Bell's Palsy
Authors: Engström Mats , Abdsaleh Shahin , Ahlström Håkan , Johansson Lars , Stålberg Erik , Jonsson Lars
Published: September 2022

Eleven patients with mild or moderate acute idiopathic peripheral facial palsy, so‐called Bell's palsy, were serially examined by gadolinium‐DTPA‐enhanced MRI on mean days 11, 40, and 97 (third examination, n = 10) after the onset of palsy. Results of the clinical and neurophysiologic assessment of facial nerve function were compared with the gadolinium‐enhanced MRI findings. Eight of the 11 patients demonstrated contrast enhancement of the facial nerve at the initial examination, but in 7 of them, the enhancement had disappeared by the time of the serial follow‐up gadolinium‐enhanced MRI scans. The disappearance of facial nerve enhancement was found to be related to clinical and neurophysiologic improvements in facial nerve function during recovery from Bell's palsy. The three patients whose scans were negative at the initial gadolinium‐enhanced MRI examination had the same clinical severity of palsy, but initially they had milder neurophysiologic involvement than those who demonstrated enhancement; these three patients did not exhibit enhancement at serial follow‐up scans. These findings indicate that the presence of enhancement at the initial MRI scan is not necessarily indicative of a poor prognosis for recovery.
Expert Opinion on the Diagnosis of Acoustic Tumors
Authors: Mangham Charles A.
Published: September 2022

Ideally, clinicians recommend diagnostic tests when the patient's risk of disease is sufficient to justify putting numerous similar patients through the morbidity required to diagnose disease in one patient. In the case of acoustic tumor diagnosis, there are few published data available to the clinician to help assess risk in an individual patient. The purpose of this study was to obtain information by an opinion poll of a group of experts. We used the Delphi method to poll clinicians trained at the House Ear Clinic. We asked these experts 20 questions related to acoustic tumor diagnosis. Some of the expert opinion presented herein is the only data related to acoustic tumor diagnosis available to clinicians. These data are a first step in elevation of decision‐making for tumor diagnosis above the level of speculation. However, the experts, responses displayed a pattern of inaccuracy that limits the clinical application of their opinion. Exposing this pattern was instructive for identifying desirable features of protocols for diagnosing tumors. We recommend that protocols not depend on clinicians estimating probability of tumor. Instead, protocols may list specific findings, such as unilateral distortion on the telephone, to indicate, when present, that the risk of tumor is sufficient to order a diagnostic test.
Obstructive Sleep Apnea Surgery: Risk Management and Complications
Authors: Riley Robert W. , Powell Nelson B. , Guilleminault Christian , Pelayo Rafael , Troell Robert J. , Li Kasey K.
Published: September 2022

BACKGROUND

Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk‐management outcome.

METHODS

One hundred eighty‐two consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty‐four factors were analyzed.

RESULTS

Group characteristics included a mean age of 48.2 years, a mean respiratory disturbance index of 42.3, and a mean low oxyhemoglobin desaturation (LSAT) of 77.5%. Surgery included a combination of uvulopalatopharyngoplasty (162 patients; 77%) and maxillofacial procedures (173 patients; 82%). Patients with a respiratory disturbance index greater than 40 and an LSAT less than 80% (117 patients; 64%) were maintained on nasal continuous positive airway pressure. Thirty‐nine patients (18.6% had difficult intubations. There was a positive correlation (p> 0.001) of difficult intubations, neck circumference (>45.6 cm) and skeletal deficiency (Sella‐Nasion‐Point B < 75 degrees). All tubes were removed with the patient awake in the operating room with two transient episodes of airway obstruction. One hundred forty‐eight of the patients (70.5%) required postoperative intravenous antihypertensive medications. Patients with a preoperative history of hypertension had a significantly increased risk (p> 0.01) of requiring intraoperative and postoperative intravenous antihypertensive medications. The mean hospital stay was 2.2 days (SD ± 0.9). Analgesia was achieved with intravenous morphine sulfate or meperidine HCI (intensive care unit) and oral oxycodone (non‐intensive care unit). There were no significant oxyhemoglobin desaturations, irrespective of severity of OSAS or obesity (mean LSAT day 1, 94.8% (SD ± 2.4); mean LSAT day 2, 95.5% (SD ± 1.6)). Complications Included postoperative bleeding (n= 4), infection (n= 5), seroma (n= 3), arrhythmia (n= 4), angina (n= 1), and loss of skeletal fixation (n= 1).

CONCLUSION

Intraoperative airway risks can be reduced by use of fiberoptic intubation in patients with increased neck circumference and skeletal deficiency. Patients with OSAS are at a significantly increased risk for hypertension. Nasal continuous positive airway pressure eliminated the postoperative risk of hypoxemia, which allowed the use of adequate parenteral or oral analgesics.
A Cadaveric Study of the Motor Nerves to the Levator Scapulae Muscle
Authors: Frank Douglas K. , Wenk Eugene , Stern Jordan C. , Gottlieb Ron D. , Moscatello Augustine L.
Published: September 2022

Understanding the surgical anatomic relationships of the motor nerves to the levator scapulae muscle is imperative for reducing postoperative shoulder dysfunction in patients undergoing neck dissection. To elucidate this relevant anatomy, cervical (C3, C4) and brachial (C5 via dorsal scapular nerve) plexi contributions to the levator scapulae were assessed with respect to posterior triangle landmarks in 37 human cadaveric necks. An average of approximately 2 (actual 1.92) nerves from the cervical plexus (range 1 to 4 nerves) emerged from beneath the posterior border of the sternocleidomastoid muscle in a cephalad to caudad progression to enter the posterior triangle of the neck on their way to innervating the levator scapulae. These cervical plexus contributions exhibited a fairly regular relationship to the emergence of cranial nerve XI and the punctum nervosum along the posterior border of the sternocleidomastoid muscle. After emerging from the posterior border of the sternocleidomastoid to enter the posterior triangle of the neck, cervical plexus contributions to the levator scapulae traveled for a variable distance posteriorly and interiorly, sometimes branching or coming together. Ultimately these nerves crossed the anterior border of the levator scapulae as 1 to 3 nerves (average 1.94) in a regular superior to inferior progression. The dorsal scapular nerve from the brachial plexus exhibited highly variable anatomic relations in the inferior aspect of the posterior triangle, and was found to penetrate or give branches to the levator scapulae in only 11 of 35 neck specimens. We have found that the levator scapulae receives predictable motor supply from the cervical plexus. Our data elucidate surgical anatomy useful to head and neck surgeons.
Endoscopic Laser Resection of Supraglottic Carcinoma
Authors: Eckel Hans edmund
Published: September 2022

Forty‐six patients with infiltrating supraglottic carcinoma were treated prospectively for cure between 1986 and 1992 with transoral laser resection of the primary. Nine primaries were classified as T1, and 37 as T2. Thirty‐three had staged unilateral or bilateral neck dissections, and 16 had postoperative radiotherapy. All patients were followed up for 2 to 8 years unless they died. Of the 46 patients, 33 are alive without disease, 8 died with disease, and 5 died of intercurrent disease. Among the 8 patients who died with disease, 4 had uncontrollable local or regional recurrences, and 4 had distant metastases but were free of local or regional recurrence. Calculated overall survival was 59% and adjusted survival was 72% after 5 years. Four patients had tracheostomies perioperatively, and 2 required temporary postoperative tracheostomies. The remaining 40 patients needed no artificial airway other than orotracheal intubation for the endolaryngeal intervention. Thirty‐seven patients relearned undisturbed deglutition within 2 weeks from surgery, and 4, within 4 weeks. However, 5 (10.9%) patients failed to relearn swallowing and consecutively underwent “completion” total laryngectomy. Among them were the two patients who had previously had unsuccessful surgical or radiologic treatment of their primaries and the patient with a history of oral cavity carcinoma. This study confirms that transoral laser resection can effectively control early supraglottic carcinoma. Tracheostomies are not routinely required, and phonatory function is not compromised. However, transoral laser resection could not steadily preserve undisturbed deglutition in the patients included In this study. Patients with histories of unsuccessful attempts of other larynx‐sparing therapeutic modalities or of previous major head and neck interventions were not successfully managed with transoral laser resection in this series. Criteria for patient selection remain to be established.
High‐resolution ultrasound associated with aspiration biopsy in the follow‐up of patients with differentiated thyroid cancer
Authors: Rodriguez J. M. , Reus M. , Moreno A. , Martinez M. , Soria T. , Carrasco L. , Parrilla P.
Published: September 2022

OBJECTIVE

To assess the value of ultrasound in the follow‐up of patients undergoing surgery for differentiated thyroid carcinoma.

SUBJECTS

The study included 89 patients (70 women and 19 men) with differentiated thyroid carcinoma (76 papillary and 13 follicular cancer).

METHODS

High‐frequency ultrasound (US) was used in the evaluation of 89 subjects who underwent surgery for thyroid carcinoma. Fine‐needle aspiration was performed in cases with positive US. In addition, determinations of thyroglobulin (Tgb) in serum, scintigraphy with 131I, and cervical palpation were evaluated. We determined sensitivity, specificity, and overall accuracy for each of these diagnostic methods.

RESULTS

Ultrasonography was positive in 22 subjects, 16 in the nodal area and 6 in the thyroid bed. Twenty‐two subjects received fine‐needle aspiration with US control; 13 (59%) of 22 were positive for cancer. The results of the US for detecting neoplastic disease showed a sensitivity of 65%, specificity of 86%, and overall accuracy of 82%. The overall accuracy for scintigraphy was 88% and for Tgb, 91%.

CONCLUSION

We concluded that US can be included in the follow‐up protocol for patients undergoing surgery for differentiated cancer of thyroid, as a valuable tool to localize the recurrence. This technique is particularly useful in the evaluation of patients who are found to have elevated Tgb levels.

The treatment of differentiated thyroid cancer includes surgery and, in some cases, the ablation of residual thyroid tissue with therapeutic doses of iodine 131I.1 The posttreatment search for recurrence or metastases is based on periodic body scanning with 131I and determination of serum thyroglobulin (Tgb) levels.2,3

High‐resolution ultrasound (US; 10 MHz) has been found to have a high sensitivity in diagnosing nonpalpable cervical masses.4–6 Thus the possibility exists that including it in the protocols for follow‐up of differentiated thyroid cancer may be valuable.

The aim of our study was to assess the value of high‐resolution US (associated with directed fine‐needle aspiration [FNA] biopsy) in the follow‐up of patients undergoing surgery for papillary and follicular thyroid cancer.
Electronic Access to Tinnitus Data: The Oregon Tinnitus Data Archive
Authors: Meikle Mary B.
Published: September 2022

The recently published Oregon Tinnitus Data Archive can be viewed by anyone with Internet access and World Wide Web browser software. A dynamically changing document to be amplified and upgraded in future versions, at present the Archive summarizes records from 1630 patients with tinnitus seen between 1982 and 1992 at the Tinnitus Clinic of the Oregon Health Sciences University. The Archive has many features of standard journal publications but also has added advantages of extensive appendixes and other background information, as well as the ease of use and flexibility offered by hypertext documents. The data in the Archive can be used for a variety of clinical and research purposes such as development of prevalence estimates for medical conditions or etiologic circumstances associated with tinnitus, testing of clinical impressions and other hypotheses, and efforts to identify risk factors and possible causal agents for tinnitus.
Laryngeal Melanosis: Report of Four Cases and Literature Review
Authors: Gonzalez‐vela M. carmen , Fernandez Fidel A. , Mayorga Marta , Rodriguez‐iglesias Julio , Val‐bernal J. fernando
Published: September 2022

OBJECTIVE

Laryngeal melanosis is a rare condition defined by the presence of melanocytes within the laryngeal epithelial lining. Our aims were (1) to review our cases together with those in the literature, and (2) to determine whether melanocyte incidence is increased with exposure to irritant stimuli such as tobacco.

METHODS

A retrospective study of all cases diagnosed with laryngeal melanosis in our hospital from January 1, 1990, to December 31, 1996, was accomplished. To determine the melanocyte incidence in the normal larynx as well as the influence of tobacco in development of laryngeal melanosis, 16 age‐matched controls, 8 of whom were smokers and 8 of whom were not, were chosen, and a histochemical and immunohistochemical study was performed. The following antibodies were used: S‐100 protein, CD 1a, and HMB‐45. A comparative study of the melanocyte incidence between patients with laryngeal melanosis and the controls was carried out. Also, a comparative study between smoking and nonsmoking patients was performed.

RESULTS

Laryngeal melanosis was diagnosed in 4 patients at our hospital during this period of time. In the comparative study, the number of melanocytes in the 4 patients with laryngeal melanosis was higher than in the 8 smoking (p< 0.01, Mann‐Whitney U test) and 8 nonsmoking (p< 0.01) controls, and there was a trend toward a higher number of melanocytes in the 8 smoking patients than in the 8 nonsmoking (p= 0.064) controls.

CONCLUSIONS

Laryngeal melanosis was more frequent in smoking men older than 50 years. Our observations underline the association of LM with larynx carcinoma and its relation to a stimulus such as tobacco. In fact, we have found activated melanocytes in our cases of laryngeal melanosis. They were identified by immunoreactivity for HMB‐45.
Prognosis for allergic fungal sinusitis
Authors: Kupferberg Stephen B. , Bent John P. , Kuhn Frederick A.
Published: September 2022

Allergic fungal sinusitis is a recently described clinical entity that has gained increased attention as a cause of chronic sinusitis. The diagnosis can be established by demonstrating (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic CT scan; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed intraoperatively or during office endoscopy. The exact pathogenesis of allergic fungal sinusitis remains controversial, and no treatment modality has proved to be consistently effective. Several reports during the last decade have suggested that allergic fungal sinusitis recurs more frequently than chronic bacterial sinusitis, but no studies have specifically addressed the prognosis of allergic fungal sinusitis. During the past two and a half years, we have treated 26 patients with allergic fungal sinusitis. The treatment always included functional endoscopic sinus surgery, topical nasal steroids, postoperative nasal saline irrigations, and endoscopic cleaning in the office. Adjuvant medical therapy included systemic steroids, oral antifungals, a combination of systemic steroids and oral antifungals, or in some cases, no additional treatment. Outcome was graded subjectively as improved, unchanged, or worse. Mean follow‐up was 14.5 months. Twenty‐two of 26 patients were improved. In reviewing postoperative outcomes, we observed endoscopic recurrent disease that generally preceded patient symptoms. Consequently, we developed an endoscopic staging system to record postoperative clinical status. Use of this staging system allowed evaluation of various treatments and enabled classification of patient outcome. Nineteen of 24 patients examined with extensive follow‐up had objective signs of recurrent disease. It appears that this is a chronic disease characterized by physical signs that appear before the return of subjective clinical symptoms.
Current perspective on temporal bone trauma
Authors: Nosan David K. , Benecke James E. , Murr Andrew H.
Published: September 2022

The improved survival of patients sustaining massive head injuries has increased the number of temporal bone fractures being managed by otolaryngologists and neurosurgeons. We performed a prospective analysis of 35 patients with head injury with temporal bone trauma. The major emphasis of this study was to investigate the incidence, management, and outcome of facial nerve injury in such patients and to evaluate the importance of electrodiagnostics in the surgical management of the facial nerve. The results of this study indicate an incidence of fracture type, hearing loss, and facial nerve paralysis similar to that already recorded in the literature. This study underscores the importance of evoked electromyography, or electroneuronography, in assessing facial nerve function. Electroneuronography provided the indications for surgical intervention for facial paralysis. All patients having surgery for facial paralysis as determined by electroneuronographic findings had pathology of the facial nerve. (Otolaryngol Head Neck Surg 1997;117:67–71.)
Ameloblastoma of the Maxilla: A Series of Three Cases
Authors: Kieserman Stefan P. , Baker Paul , Eberle Robert
Published: September 2022

Ameloblastoma is an aggressive tumor of the maxilla. We reviewed several ameloblastomas of the maxilla that had been surgically removed. The English literature was reviewed to evaluate the appropriate treatment and success with these aggressive tumors.

Maxillary ameloblastoma is a tumor that can behave malignantly. There is a definite correlation between histopathologic appearance and tumor activity. The unicystic type of ameloblastoma responds well to complete resection. The treatment for an ameloblastoma of the maxilla is radical resection. Limited removal of the cyst/tumor initially is not adequate, and a secondary operation will be required. Ameloblastoma of the maxilla requires aggressive radical excision at the time of initial diagnosis.
Suppressive Factor or Factors Derived from Head and Neck Squamous Cell Carcinoma Induce Apoptosis in Activated Lymphocytes
Authors: Billings Kathleen R. , Wang Marilene B. , Lichtenstein Alan K.
Published: September 2022

Our laboratory has previously identified a soluble factor derived from head and neck squamous cell carcinoma that impairs lymphocyte proliferative responses in vitro. This study further investigates the nature of the interaction between these factors and T lymphocytes. The proliferative activity of phytohemagglutinin‐stimulated peripheral blood lymphocytes and the Jurkat T‐cell line was significantly suppressed (>50%) by the supernatants of 13 (41.9%) of 31 recently explanted head and neck squamous ceil carcinoma samples. A characteristic morphologic appearance of these suppressed cells and ladderlike pattern of DNA fragmentation on gel electrophoresis indicated that the suppressive supernatants were inducing or predisposing T cells to apoptotic death. This apoptosis‐inducing activity may be similar to that previously described in a suppressive supernatant obtained from an esophageal carcinoma cell line. These results shed further light on the mechanism behind a soluble immunosuppressive factor or factors produced by head and neck squamous cell carcinoma.