bluuebunny/crossref_metadata_2025 huggingface dataset:
The development of endolymphatic hydrops following cmv inoculation of the endolymphatic sac
Authors: Fukuda Satoshi , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2006

The effect of inoculation of cytomegalovirus (CMV) into the endolymphatic sac was examined in CMV‐seronegative and seropositive animals. Seronegative animals developed hearing loss, infection in the epithelial cells of the endolymphatic sac and perisaccular connective tissue, and endolymphatic hydrops. Control animals inoculated with inactivated CMV showed no hearing loss, viral infection, or endolymphatic hydrops.

Seropositive animals showed complete protection from hearing loss and viral infection, yet a monocytic infiltrate was seen surrounding the endolymphatic sac. Associated with this localized immune response was mild evidence of endolymphatic hydrops in 40% (2/5) of the animals. Control seropositive animals inoculated with inactivated CMV showed no hearing loss or morphological changes.

CMV then, can infect cells of the endolymphatic sac resulting in hearing loss and endolymphatic hydrops. The immune response to CMV in seropositive animals is protective, but is associated with endolymphatic sac inflammation.
Photoelectric measurement of laryngeal paralyses correlated with videostroboscopy
Authors: Trapp Terrence K. , Berke Gerald S.
Published: October 2006

Photoglottography and electroglottography are relatively noninvasive techniques that provide detailed information about vocal fold vibration. However, few significant clinical applications have been made by correlating photoelectric waveforms to specific pathologic changes in laryngeal vibration. Videostroboscopy has recently been used to document vibratory patterns of laryngeal paralyses in a canine model of phonation. A study of PGG and EGG waveforms correlated with videostroboscopy in an in‐vivo canine model of phonation with simulated unilateral recurrent or superior laryngeal nerve paralysis is presented. The shift quotient—a new glottographic parameter which identifies flaccid laryngeal paralyses—is presented.
Squamous cell carcinoma of the head and neck in patients 40 years of age and younger
Authors: Benninger Michael S. , Roberts Jay K. , Levine Howard L. , Wood Benjamin G. , Tucker Harvey M.
Published: October 2006

Squamous cell carcinoma of the head and neck is largely a disease of the middle‐aged and elderly. When it occurs in younger patients, the prognosis for long‐term survival appears to be worse than in the older age group. The records of 41 patients aged 40 years and younger who presented with squamous cell carcinoma of the head and neck were reviewed. Twenty‐eight of these patients (68%) developed recurrence; of these, 21 (51%) died with disease, and two are alive with disease. These results indicate a trend toward poorer survival than previous rates reported nationally for all patients with carcinoma of the head and neck over a similar time period. Lesions of the oral tongue, nasopharynx, and paranasal sinuses seem to have a particularly poor prognosis.
Tracheobronchial foreign bodies
Authors: Mcguirt W. Frederick , Holmes Keith D. , Feehs Robert , Browne J. Dale
Published: October 2006

A retrospective review of 88 cases of foreign body aspiration was undertaken. The patients ranged in age from 5 months to 73 years; the peak incidences of foreign body aspiration occurred in children less than 3 years of age and in adults older than 50 years. Sixty‐one of the 88 patients were male. Physical examination was abnormal in 61% of patients. The most common radiographic abnormality was inspiratory‐expiratory abnormality, seen in 27% of patients. Rigid endoscopy under general anesthesia was the preferred method for removal of the aspirated material. Multiple foreign bodies were found in 5% of the patients. Tracheobronchial foreign bodies should, therefore, be strongly suspected in susceptible patient populations who present with a suggestive history, even when no physical or radiographic evidence can be seen. Patients should be carefully examined for multiple foreign bodies at the time of rigid endoscopic removal.
Clinical application of the manofluorogram
Authors: Mcconnel M. S. Fred , Cerenko Danlo , Jackson Richard T. , Hersh Theodore
Published: October 2006

The purpose of this paper is to illustrate the clinical usefulness of simultaneous fluoroscopy and manometry, as analyzed by the manofluorogram, in the evaluation of dysphagia. Four quantitative parameters calculated from the manofluorogram are analyzed and compared in six representative cases of dysphagia. The manofluorogram adds diagnostic information which cannot be obtained by barium swallow or standard manometry.
Autologous fibrin tissue adhesive: Factors influencing bonding power
Authors: Siedentop Karl H. , Harris David M. , Sanchez Ben
Published: October 2006

Bonding power of Autologous Fibrin Tissue Adhesive (AFTA) is directly related to its fibrinogen concentration. By increasing the ammonium sulfate concentration 100% during fibrinogen precipitation, the bonding power of two glued 1‐cm2 pieces of human dura almost doubled. No relationship between blood fibrinogen level and bonding power was demonstrated. Comparing AFTA with Fibrin Sealant, the commercial fibrin tissue adhesive, shearing strength between two glued pieces of human dura with AFTA was less 10 minutes and greater 30 minutes after gluing. Gluing a TORP (Richards) to a 1‐cm2 piece of human dura yielded generally somewhat greater bonding power when using Fibrin Sealant.

Autologous Fibrin Tissue Adhesive provides bonding power adequate for middle‐ear surgery, eliminates transmission of viral diseases and, unlike Fibrin Sealant, AFTA is available in the United States.
Multicentric parotid cysts and cervical adenopathy in aids patients. A newly recognized entity: CT and MR manifestations
Authors: Shugar Joel M. A. , Som Peter M. , Jacobson Alan L. , Ryan John R. , Bernard Peter J. , Dickman Steven H.
Published: October 2006

Patients with AIDS or ARC may present with parotid gland enlargement either initially or during the course of their disease. Of nine such patients, eight had unilateral gland enlargement, and one had bilateral disease. CT and MR scanning revealed that all patients except one had bilateral multiple intraparotid cysts. In addition, four of the nine patients clinically had cervical adenopathy, while all patients had adenopathy on scanning. We believe that the association of parotid cysts and cervical adenopathy is another manifestation of AIDS or ARC and, when found on scanning, should alert the clinician to the probable underlying condition.
A clinical prospective study of peritonsillar abscess in children
Authors: Brodsky Linda , Sobie Stephen R. , Korwin Debbie , Stanievich John F.
Published: October 2006

Distinguishing peritonsillar abscess from cellulitis is an important clinical problem, particularly in children, who may require a general anesthetic for drainage of these abscesses. In order to identify those clinical factors most significant for peritonsillar abscess, we did a prospective study of 21 patients who presented with sore throat, fever, trismus, and tonsillar bulge; all symptoms that are consistent with the diagnosis of peritonsillar abscess. On admission, the following parameters were recorded: patient age, duration of sore throat, fever, white blood cell count, drooling, the degree of trismus (measured exactly as incisor‐incisor distance), the degree of pharyngotonsillar bulge, and change in voice. After 24 to 48 hours of parenteral antibiotics, 12 patients (57%) had improved sufficiently and were continued on antibiotics until resolution (cellulitis group). Nine patients (43%) had no improvement and underwent surgery for drainage of the peritonsillar abscess (abscess group).

At the end of the 18‐month study period, the cellulitis and abscess groups were compared. On admission, no significant difference was found in age, duration of sore throat, fever, or white blood cell count. The pharyngotonsillar bulge was mild in 58% and moderate in 42% of the cellulitis group, while in the abscess group, the pharyngotonsillar bulge was mild in only 33% and moderate in 67%. After 24 to 48 hours of parenteral antibiotics, all patients in the cellulitis group had improvement of at least one symptom; whereas, all patients in the abscess group had no change or worsening of at least one symptom, including trismus, dysphagia, voice change, drooling, or pharyngotonsillar bulge. On admission, the precise measurement of trismus was not significantly different in the two groups (24.7 mm in cellulitis group vs. 22.5 mm in abscess group). However, after 24 hours of antibiotics, trismus averaged 7 mm more in the abscess group versus the cellulitis group (p<0.05).

The above data strongly correlate the precise clinical evaluation of disease progression following a trial of parenteral antibiotic therapy with the correct diagnosis of peritonsillar abscess in children.
Wound prophylaxis with metronidazole in head and neck surgical oncology
Authors: Robbins K. T. , Byers R. M. , Fainstein V. , Schantz S. P. , Wolf P. , Cole R. , Guillamondegui O. M. , Weber R. S. , Goepfert H.
Published: October 2006

Anaerobic organisms are thought to be an important source of wound infection in head and neck oncologic surgery. Antibiotic prophylaxis consisting of agents specific for anaerobes combined with broad‐spectrum agents that provide coverage for other well‐recognized pathogens should be an effective combination regimen for this group of patients.

We conducted a prospective, randomized study comparing the efficacy of prophylaxis using combination of metronidazole and cefazolin—designated group A, to prophylaxis using cefazolin alone—group B, for patients undergoing oncologic procedures of the head and neck.

The rate of wound infection in the cefazolin‐metronidazole group (158 patients) was 9.5%, compared with 18.6% in the cefazolin group (172 patients) (p=0.03). Patients undergoing clean procedures had a 4.9% infection rate overall, compared with 17.9% for clean‐contaminated procedures, and 33.3% for contaminated procedures. The average length of hospitalization was 20.7 days for patients who developed infections, compared with 8.9 days for patients without infection. Anaerobic organisms were cultured in 12 of 26 patients, ten of whom did not receive metronidazole.

The lower rate of wound infection among patients who received metronidazole suggests that anaerobic organisms are an important source of wound infection in head and neck oncologic surgery. Chemoprophylaxis for these patients should, therefore, include specific anaerobic coverage in addition to the broad‐spectrum agents that cover the more familiar aerobic organisms.
Presentation and management of neck abscess: A retrospective analysis
Authors: Tom Michael B. , Rice Dale H.
Published: October 2006

A retrospective analysis of deep neck abscesses managed at the Los Angeles County‐USC Medical Center was performed. Fifty‐one patients met the criteria and were reviewed as to presentation, etiology, location, and microbiology. Hemolytic streptococci and anaerobic species, especially Bacteroides and peptostreptococci, were the most common organisms isolated. Intravenous drug abuse was the most common etiology, and was an important source of primary carotid space infection. This group was most commonly infected with Streptococcus species (50%).
Intraoperative electrophysiologic monitoring of laryngeal muscle during thyroid surgery
Authors: Lipton Richard J. , McCaffrey Thomas V. , Litchy William J.
Published: October 2006

A technique is described for intraoperative electrophysiologic monitoring of laryngeal muscles. This technique has been used to identify the laryngeal nerves during surgery for recurrent tumors of the thyroid gland, when direct visualization of the nerves is difficult or impossible.

Laryngeal muscle electrical activity is monitored with endoscopically placed wire‐hook electrodes inserted into the vocal folds bilaterally. Neurotonic discharges are detected when the recurrent laryngeal nerves are manipulated during surgical dissection. Precise localization of the recurrent nerves is possible using a hand‐held bipolar stimulator.
Trigeminal trophic syndrome
Authors: Arasi Richard , Kay Marilynne Mc , Grist William J.
Published: October 2006

Trigeminal trophic syndrome is an unusual condition also known as trigeminal neurotrophic ulceration or trigeminal neuropathy with nasal ulceration. The diagnosis is suggested when ulceration of the face, especially of the ala nasi, occurs in a dermatome of the trigeminal nerve that has been rendered anesthetic by a surgical or other process involving the trigeminal nerve or its central sensory connections. A history of paresthesias and self‐induced trauma to the area further support the diagnosis.

Neurological deficits causing trigeminal trophic syndrome may result from surgical trigeminal ablation, vascular disorders and infarction of the brainstem, acoustic neuroma, postencephalitic parkinsonism, and syringobulbia. The following etiologies of nasal ulceration should be excluded: postsurgical herpetic reactivation and ulceration, syphilis, leishmaniasis, leprous trigeminal neuritis, yaws, blastomycosis, paracoccidioidomycosis, lethal midline granuloma, pyoderma gangrenosum, Wegener's granulomatosis, and basal cell carcinoma.

In the case reported here, the diagnosis of TTS was made primarily as a result of previous experience with the syndrome, underscoring the importance of physician recognition of this unusual disorder.
Small fenestra stapedotomies with and without ktp laser: A comparison
Authors: Silverstein Herbert , Rosenberg Seth , Jones Raleigh
Published: October 2006

The results of 33 small fenestra stapedotomies performed using conventional techniques were compared with the results of 33 stapedotomies performed using the argon or KTP laser. The ossicular chain was reconstructed using a Teflon® wire piston of 0.6 mm diameter, and follow‐up was at least 1 year. Over‐closure of the air‐bone gap or closure to within 10 dB was accomplished in 91% of the laser‐treated group versus 72% of the conventionally treated group (p<0.10). The hearing results were statistically better in the laser group (p<0.05). Transient delayed vestibular symptoms, lasting from 1 to 3 weeks, were present in 39% of the laser‐treated group and in 12% of the patients treated by conventional techniques (p<0.05).

The KTP laser stapedotomy, using a micromanipulator mounted on the microscope, is a safe, efficient technique that reduces some of the technical difficulties associated with conventional stapes surgery. The main advantage of the laser is that it enables the surgeon to make an atraumatic, bloodless opening in a fixed or mobile stapes footplate without mechanical manipulation of the stapes. Using a lower wattage to vaporize the footplate and waiting several seconds between laser bursts may decrease the incidence of postoperative vestibular symptoms.

The use of the KTP laser in stapes surgery represents a major advance in surgery for otosclerosis.
Evaluation of prostaglandin E1 therapy for sudden deafness
Authors: Nakashima Tsutomu , Kuno Kayao , Yanagita Noriyuki
Published: October 2006

Prostaglandin E1, a vasodilator and potent inhibitor of platelet aggregation, was administered by intravenous drip infusion to 51 patients who had sudden deafness. The results were compared with results from 362 patients who received no prostaglandin E1 therapy. There was no significant difference in outcome between patients who received prostaglandin E1 therapy and those who did not receive prostaglandin E1 therapy.
The effects of peritonsillar infiltration on the reduction of intraoperative blood loss and post‐tonsillectomy pain in children
Authors: Broadman Lynn M. , Patel Ramesh I. , Feldman Bruce A. , Sellman Gloria L. , Milmoe Gregory , Camilon Felizardo
Published: October 2006

Improved hemostasia and reduction of postoperative pain are desired goals when performing tonsillectomy. This is especially true in children, who may be reluctant to receive intramuscular injections for pain relief and who may lose a higher percentage of total blood volume during surgery than adults. This study evaluated the effects of peritonsillar infiltration upon operative blood loss and postoperative pain in 42 children. For the purpose of infiltration, patients were randomly assigned to one of four groups. Children in groups I, II, and III had their peritonsillar infiltrations performed with the contents of a coded vial which contained bupivacaine 0.25% with epinephrine (1:200,000), normal saline with epinephrine (1:200,000), and normal saline, respectively. Group IV children (controls) received no infiltration. All solutions were prepared in the hospital pharmacy to assure blinding of the operator and observer. All infiltrations were performed following the induction of general anesthesia and 5 minutes prior to the onset of surgery. Anesthetic agents, end‐tidal carbon dioxide levels, and the administration of intravenous fluids were carefully regulated. Surgery was performed by one of two attending otolaryngologists or a senior otolaryngology fellow using the same dissection and snare technique. Hemostasia was managed by suction‐electrocautery and packs.

Patients in group IV, the control group, lost twice as much blood as did those who had infiltrations performed with normal saline, group III (p<0.001). However, patients in group III lost 1.5 times more blood than did those children in either of the two groups whose infiltrations were performed with an epinephrine solution, groups I and II (p<0.01). No postoperative bleeding was noted in any patient. Infiltration of the peritonsillar space with epinephrine (1:200,000) was shown to be more effective in reducing blood loss than infiltration with normal saline.

Because of the small sample size we were unable to evaluate the beneficial effects of peritonsillar infiltration performed with bupivacaine upon the reduction of the severity of pain and the requirement for narcotic analgesics following tonsillectomy. Therefore, until further studies demonstrate such efficacy, all peritonsillar infiltrations should be performed solely for the purpose of reducing operative blood loss. As such, infiltrations should be performed with either normal saline containing epinephrine (1:200,000) or lidocaine containing epinephrine (1:200,000).
Surfer's ear in Japan
Authors: Umeda Yoshio , Nakajima Mikiko , Yoshioka Hirohide
Published: October 2006

Fifty‐one Japanese professional surfers were examined in order to analyze surfer's ear. Forty‐one cases (80%), 71 ears, were diagnosed as surfer's ear. In 19 cases (37%), 30 ears, the external auditory canals had stenosed by more than 50%. In general, surfer's ear begins to appear after 5 years and is further aggravated by continued surfing. The age at which surfing is taken up has no influence on the appearance of surfer's ear. Surfers who surf on northern (colder) coasts have severer surfer's ear than those who frequent the southern (warmer) coasts.
Complications in endoscopic intranasal ethmoidectomy: An update
Authors: Stankiewicz James A.
Published: October 2006

A previous publication by this author discussing complications of endoscopic intranasal ethmoidectomy indicated an overall complication rate of 29% in 90 patients (17% in 150 ethmoidectomies). Compared to published complications rates for traditional intranasal ethmoidectomy (2.7% to 3.7%), 17% is alarming and of concern.

The complication results in 300 ethmoidectomies performed on 180 patients are presented. The overall complication rate was 9.3%. Only two further complications have occurred since the first reported series: a cerebrospinal fluid leak and one case of subcutaneous emphysema.

Methods and techniques that have led to the reduction of complications are briefly discussed. Endoscopic ethmoidectomy is a valid, safe procedure in experienced hands.
Comparative analysis of the safety of endotracheal tubes with the KTP laser
Authors: Fried Marvin P. , Mallampati S. Rao , Caminear David S.
Published: October 2006

The KTP laser has been used increasingly to treat various disorders of the upper aerodigestive tract. To establish the relative safety of the endotracheal tubes that are currently available, we performed laboratory testing of these tubes by exposing them to the KTP laser in an oxygen‐rich environment. Based on our observations, tubes that were all metal or metal‐wrapped endotracheal tubes were determined to be the safest. The advantage of using the all‐metal tube was that it did not need wrapping. This tube also has a second distal cuff, which would allow for continued ventilation if the proximal cuff becomes disrupted. However, under these circumstances, insertion of a new non‐disrupted tube is advised.
Aided auditory thresholds in children with postmeningitic deafness
Authors: Brookhouser Patrick E. , Auslander Martha C.
Published: October 2006

Postmeningitic hearing loss is often bilateral, profound, and rapid in onset. Children with postmeningitic hearing loss may be identified as potential candidates for cochlear implantation. The length of time required for a definitive trial with conventional amplification, which must precede a final decision regarding cochlear implant surgery, has been the subject of debate. Twenty‐five children with bilateral severe‐to‐profound postmeningitic sensorineural hearing loss were fitted with appropriate amplification and results of serial‐aided tests were analyzed to determine the degree of benefit and changes in aided thresholds over time. Twelve children gave aided responses that clearly indicated the presence of residual hearing and good aided benefit. Ten youngsters have responded consistently in the vibrotactile range when aided, thus receiving limited benefit from conventional amplification. Of particular interest are three children who initially exhibited limited or no auditory responses but who, after a period of 16 to 25 months, showed excellent benefit with binaural hearing aids. These children are all in total communication programs and have received good auditory training. Caution should be exercised when concluding that such a child does not benefit from amplification.
Glomus tympanicum tumors: Comtemporary concepts in conservation surgery
Authors: Jackson C. Gary , Welling D. Bradley , Chironis Phillip , Glasscock Michael E. , Woods Charles I.
Published: October 2006

The management of glomus tympanicum tumors is not a new subject. A review of the contemporary management concept is, however, needed for two reasons: 1. the recent literature has suggested radiation therapy as a treatment option in this surgical disease, and 2. patients who are referred to us for management of these tumors continue to exhibit errors in diagnosis and surgical approaches that are unnecessarily radical.

The purpose of this paper is to review the diagnosis of these lesions and to prospectively differentiate them from the more extensive jugulare tumors. When type and extent of the tumor are properly determined, a surgical procedure can be planned that conserves as much normal ear anatomy and function as possible.

Between May 1970 and July 1988, 60 patients with glomus tympanicum tumors were treated at the Otology Group, P.C, in Nashville, Tennessee. In 47 patients (78%), the tumors were removed using an extended facial recess approach. The external auditory canal wall was removed in seven patients (12%), and six patients underwent a transcanal approach. Total tumor removal was obtained in 90% of patients. Surgical management remains the mainstay of treatment for glomus tympanicum tumors.
Endoscopic sinus surgery for mucoceles: A viable alternative
Authors: Kennedy David W. , Josephson Jordan S. , Mattox Douglas E. , Goldsmith Manning M. , Zinreich S. James
Published: October 2006

Functional endoscopic surgery affords the potential for dramatically reducing operative morbidity of surgery for paranasal sinus mucoceles by offering a minimally invasive approach under local anesthesia. Following surgery, direct endoscopic visualization of the area enables accurate follow‐up. Unlike sinus obliteration, the ability to accurately image the sinus by CT is also preserved. This paper presents our preliminary experience with 18 mucoceles in which endoscopic sinus surgery was attempted. Five patients had preoperative proptosis and diplopia, three had Pott's puffy tumor and five had erosion of the posterior table of the frontal sinus. Fifteen patients were satisfactorily treated endoscopically, two lesions could not be satisfactorily approached and required external surgery, and one patient had persistent disease, No disease recurrence has been noted to date with endoscopic follow‐up of up to 42 months.
Computed tomography of laryngeal cancer with histopathological correlation
Authors: Archer Carol R. , Yeager Vernon L.
Published: October 2006

The results of a correlative study between computed tomography (CT) and transaxial histopathologic sections from cancerous larynges are presented. CT has proved highly reliable in accurately delineating the extent of tumor, but there remain problems of which the interpreter must be aware. This paper is designed to illustrate application of CT examination to the problem of cancer of the larynx.
Renal clear cell carcinoma metastatic to the nose and paranasal sinuses
Authors: Matsumoto Yasushi , Yanagihara Naoaki
Published: October 2006

Two cases of metastatic renal clear cell carcinoma to the nose and the paranasal sinuses are reported. Case 1 was a 73‐year‐old man with metastases to the bilateral maxillas and left cervical lymph nodes. These metastatic lesions were surgically eliminated together with the primary renal cancer. Case 2 was a 48‐year‐old man with a right maxilloethmoidal metastasis. Because of severe repeated bleeding and profound necrosis, conclusive diagnosis was hard to obtain. In both cases primary renal carcinoma was detected after the nasal tumors were confirmed to be a metastatic clear cell carcinoma. Early diagnosis and surgical removals of both primary and metastatic tumors are important to prolong the patient's life. When persistent epistaxis with intranasal necrotic mass occurs, the possibility of metastatic renal clear cell carcinoma should be considered.
Management of osteomyelitis of the skull base
Authors: Benecke James E.
Published: October 2006

Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4‐year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate anti‐pseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.
High‐resolution computed tomography: Determination of the cause of pediatric sensorineural hearing loss
Authors: Pappas Dennis G. , Simpson L. Clark , Mckenzie Randolph A. , Royal Stuart
Published: October 2006

High‐resolution computed tomograms (HRCT) reveal strikingly little variation in the dimensions of inner ear structures among people with normal hearing. However, a subgroup of people exist who have a sensorineural hearing loss (SNHL) and morphologically normal HRCT scans, yet have subtle radiographic aberrations based on measurements of inner ear dimensions. These changes might have resulted from teratogenic influences during the late first to mid second trimester, a time when the inner ear has achieved adult form, yet continues to enlarge to adult size.

A retrospective study of HRCTs on three groups of ears was performed to determine inner ear structure dimensions. Group I, the control group, consisted of 50 ears with no SNHL and no discernible abnormalities on HRCT. In group II, there were 70 ears with SNHL and obvious abnormalities on HRCT. Group III, the test group, was composed of 140 ears with SNHL and “normal” HRCTs. Groups II and III were analyzed, applying the normal dimensions derived from group I. When compared to the control group (I), all of the ears in group II were abnormal. Moreover, 75% of the ears in group III had subtle differences not apparent unless measurements were made. Two or more abnormal dimensions were found in 32%. Findings and implications are thoroughly discussed.
Detection of human papillomavirus dna in laryngeal squamous cell carcinomas by polymerase chain reaction
Authors: Hoshikawa Tomohide , Nakajima Takashi , Uhara Hisashi , Gotoh Masahiro , Shimosato Yukio , Tsutsumi Kouichiro , Ono Isamu , Ebihara Satoshi
Published: October 2006

The presence of human papillomavirus genomes‐16 and ‐6b in metastatic cervical lymph nodes was examined in 34 cases of laryngeal carcinomas by means of polymerase chain reaction, which had been fixed in formalin and embedded in paraffin. Human papillomavirus DNAs extracted from paraffin‐embedded tumor tissues were used for polymerase chain reaction with amplification of the E6 region of human papillomavirus genome‐16 and the El region of human papillomavirus genome‐6b. Human papillomavirus genome‐16 sequences were positively amplified in six (17.6%) metastatic tumors; ‐6b sequence was positively amplified in one (2.9%) metastatic tumor. Laryngeal carcinomas of glottic origin showed high human papillomavirus genome‐16 DNA‐positive rates (4 of 9 cases, 44.4%) compared to those of other sites. These results suggest that human papillomavirus genome‐16 infection might be closely associated with the development of some laryngeal squamous cell carcinomas of glottic origin similar to uterine cervical carcino‐genesis.
Deep neck infections in patients at risk for acquired immunodeficiency syndrome
Authors: Lee Kelvin C. , Tami Thomas A. , Echavez Michael , Wildes Thomas O.
Published: October 2006

The acquired immunodeficiency syndrome epidemic has introduced an increasing population of immune‐compromised patients susceptible to infections by unusual pathogens. To evaluate the role of traditional antibiotic therapy for deep neck infections in high‐risk patients, we reviewed the records of 73 patients with deep neck infections. Forty‐six had or were at risk for acquired immunodeficiency syndrome, and nine were diabetics. Staphylococcal infections were more common in the at‐risk group, and 24% of staphylococcal isolates in intravenous drug abusers were methicillin‐sodium resistant. In addition, Klebaiella was isolated in two of nine diabetic patients. No other clinical differences were noted, and no unusual organisms were isolated from any other patients. Although traditional antibiotic therapy is appropriate for deep neck infections in patients at risk for acquired immunodeficiency syndrome, vancomycin hydrochloride should be considered when staphylococcal infections are suspected in intravenous drug abusers. Since diabetics appear to be susceptible to infections by gram‐negative rods, broader antibiotic coverage must be considered in this population.
Structural changes in the round window membrane following exposure to escherichia coli lipopolysaccharide and hydrocortisone
Authors: Hellstrom Sten , Spandow Odd , Anniko Matti
Published: October 2006

The present study focused on structural changes of the round window membrane (RWM) from agents that evoke transient or permanent impairment of the auditory brain‐stem response when applied into the RW niche. Escherichia coli (E. coli) lipopolysaccharide (LPS) in sterile water (SW) and a 2% suspension of hydrocortisone (CORT), micronized in SW, were instilled into the round window (RW) niche of Sprague‐Dawley rats. The morphology of the RWM was analyzed 3 to 21 days after instillation of either substance.

Both substances caused minor structural alterations at the light microscopic level. The RWM showed a slight thickening and an invasion of inflammatory cells. At the ultra‐structural level, the CORT‐treated specimens showed an increased epithelial height and numerous microviUi, whereas the epithelium of the LPS‐treated specimens was extended and contained few microvilli resembling those in the normal RWM.

We postulate that the RWM may undergo dynamic structural changes when exposed to various agents. The structural alterations per se can influence the passage of substances from the middle ear to the inner ear.
Electromyographic study on end‐to‐end anastomosis of the recurrent laryngeal nerve in dogs
Authors: Mu Liancai , Yang Shilin
Published: October 2006

The effectiveness of anastomosis of a divided recurrent laryngeal nerve was studied with electromyography as well as visual observation. Results obtained through this investigation permitted the following conclusions:

Regenerated potentials were recorded from both the involved thyroarytenoid and posterior cricoarytenoid muscles for an average of 5 to 6 weeks postoperatively.

Average onset of recovery of spontaneous adduction was 10 weeks following surgery, and four dogs regained complete recovery of adduction in 13 to 14 weeks. Average onset of recovery of spontaneous abduction was 11.8 weeks postoperatively, and none of the four dogs displayed complete recovery.

The time delay between the onset of regenerated potentials and onset of recovery of cord mobility averaged 4.2 weeks for adduction and 6.4 weeks for abduction.

Incomplete recovery of movements of the reinnervated vocal cord might be due to an inadequate number of effective motor units.

End‐to‐end anastomosis of the recurrent laryngeal nerve can be performed as one method of reinnervating the denervated intrinsic laryngeal muscles, and further histo‐logical studies should be carried out to determine if the regenerated nerve fibers actually have decreased.
Evaluation of neonatal subglottic stenosis: A 3‐year prospective study
Authors: Nicklaus P. J. , Crysdale W. S. , Conley S. , White A. K. , Sendi K. , Forte V.
Published: October 2006

Subglottic stenosis is the most common cause of chronic airway obstruction. It results in prolonged tracheal cannu‐lation of infants and children. Following the widespread adoption over the past 20 years of prolonged intubation for respiratory support in neonates, the incidence of acquired subglottic stenosis increased dramatically. On January 1, 1987, we began a 3‐year prospective study to delineate potential etiologic factors involved in the development of subglottic stenosis in neonates. The present study analyzes data from 289 infants. Relationships between birth weight, gestational age, endotracheal tube size, duration of intubation and ventilation, number and difficulty of intubations, and the subsequent need for medical and surgical therapy are discussed. Whole organ larynges from autopsy specimens provide histological correlation.
Esthesioneuroblastoma: Surgical treatment without radiation
Authors: Biller Hugh F. , Lawson William , Sachdev Ved P. , Som Peter
Published: October 2006

This study compares the treatment of two groups of patients diagnosed with esthesioneuroblastoma limited to the nasal cavity without evidence of cribriform plate erosion. Five patients were treated with radiation and extra‐cranial excision, and eight patients were treated by cranio‐facial resection only. The incidences of local recurrence were 60% and 12%, respectively. The paper also presents a new staging classification for these tumors.
Variations on the temporoparietal fascial flap
Authors: Matsuba Howard M. , Hakki Ayman R. , Romm Sharon , Little John W. , Spear Scott L.
Published: October 2006

An improved understanding of the vascular supply of the layers of the temporal fossa has increased the potential of this region for new and ingenious reconstructive techniques. Separate and independently vascularized layers of this region include hair‐bearing scalp, glabrous skin, tem‐pororoparietal fascia (and galea aponeurotica), temporalis muscle and fascia, and pericranium. Island flaps of glabrous skin and scalp provided esthetically appropriate tissue to cover a variety of defects. The malleable bulk of the subcutaneous fascial layers were combined with skin grafts to restore thin lining, and used as a vascularized bed for cartilage grafts in otherwise unsatisfactory recipient sites. Illustrative cases from our 5‐year clinical experience are presented to demonstrate various combinations of the temporoparietal fascial pedicle with tissues from the temporal region to reconstruct the eyebrows, eyelids, orbits, cheeks, and lips.
Whole‐blood filterability in sudden deafness
Authors: Ciuffetti Giovanni , Lombardini Rita , Mannarino Elmo , Scardazza Alessandro , Serafini Giovanni , Simoncelli Costantino
Published: October 2006

Sixteen patients with sudden deafness (SD), diagnosed on the basis of a battery of audiometric tests, but with no other medical or surgical pathology requiring drug treatment, underwent monitoring of their hemorheological profiles to see whether disturbances in the microcirculation could be linked to SD. Plasma viscosity, the filterabilities, (using a low‐shear positive pressure system) through 5‐μm‐diam‐eter pore Nuclepore filters, of whole blood and red and unfractionated white cells were monitored in 16 SD patients and 32 controls matched for age, sex and socioeconomic status. Whole blood filterability and the filterability of the red blood cells were significantly impaired in the SD patients, which suggests that alterations in the microcirculation are linked, in some way, to sudden deafness.
Laser midline glossectomy as a treatment for obstructive sleep apnea
Authors: Fujita Shiro , Woodson B. Tucker , Clark Jack L. , Wittig Robert
Published: October 2006

Multiple site specific procedures have been proposed to treat obstructive sleep apnea syndrome (OSAS). Midline glossectomy (MLG) is a procedure that directly enlarges the hypopharyngeal airspace using the carbon dioxide laser. The initial experience of 12 patients is presented. Midline glossectomy as the sole procedure was performed on 11 patients who had failed uvulopalatopharyngoplasty (UPPP) and who were felt to have significant hypopharyngeal collapse on physical examination and Müller's maneuver. One patient with primary hypopharyngeal narrowing underwent MLG. Five (42%) were considered responders with Respiratory Disturbance Index (RDI) decreasing from 60.6 per hour to 14.5 per hour. In seven nonresponders, there was no significant change in the RDI (62.6 events per hour to 48.4 events per hour). Cephalometric analysis showed that responders tended to be more retrognathic (sella‐nasion‐supramentale (S‐N‐B = 74.4° )) than nonresponders (S‐N‐B = 79.3° ). Responders were significantly less obese (body mass index (BMI = 30.6)) than nonresponders (BMI = 37.9). There were five minor complications including minor bleeding (n = 3), prolonged odynophagia (n = 1), and minor change in taste (n = 1). There were no major complications, and no persistent difficulties with speech or swallowing. These results demonstrate that direct surgical modification of the tongue base and associated structures can significantly impact obstructive apnea. Midline glossectomy or similar procedures may be useful in a subset of patients with OSAS.
Stapedectomy: Long‐term hearing results
Authors: Langman Alan W. , Jackler Robert K. , Sooy Francis A.
Published: October 2006

The initial improvement in hearing following stapedectomy usually deteriorates with the passage of time. We studied the long‐term results of stapedectomies performed on 42 patients (49 ears) between 1959 and 1969 who had a minimum follow‐up of 18 years. Both air conduction (AC) and bone conduction (BC) thresholds progressively deteriorated over the long term. The degree of BC loss paralleled that expected from presbycusis alone. A greater deterioration was noted in the AC levels, producing a recurrent conductive hearing loss in the speech frequencies. Age at the time of surgery had no effect on the long‐term outcome. Comparison of the average preoperative speech discrimination scores (SDS) to the 1‐year postoperative SDS and the long‐term SDS revealed a 1.1% and 16.7% drop, respectively. The improvement in the average speech reception threshold (SRT) obtained 1 year postoperatively deteriorated by less than 1 dB per year over the long term. Patients with a higher SDS (more than 95%) preoperatively fared better in the maintenance of speech discrimination than those with a lower SDS (less than 95%). The preoperative SRT level was predictive of the timing for the requirement of hearing amplification. The postoperative hearing deterioration appeared to be caused by presbycusis, combined with a recurrent conductive loss in the speech frequencies rather than cochlear otosclerosis. Although the decline in hearing following stapedectomy exceeds the rate of hearing loss due to presbycusis, many individuals, after successful stapes surgery, are able to delay the need for hearing amplification for longer periods than had been previously reported.
Lightning and its effects on the auditory system
Authors: Jones Dwight T. , Ogren Frederic P. , Roh Lynn H. , Moore Gary F.
Published: October 2006

Patients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss.

Four patients who incurred various otologic problems, including one patient with previously unreported bilateral oval window fistulas following lightning injury, are presented. Audiologic, otologic, and surgical findings are reviewed as well as patient follow‐up and outcome.
The role of the posterior cricoarytenoid muscle in phonation: An electromyographic investigation in dogs
Authors: Mu Liancai , Yang Shilin
Published: October 2006

The activity of the posterior cricoarytenoid muscle during respiration has been well investigated electromyographically. Its activity during phonation, however, has not been studied systematically. We, therefore, focused our attention on the phonatory activity of the posterior cricoarytenoid muscle to confirm whether it also contracts during phonation, as has been reported by some researchers. In our series of 12 adult dogs, the posterior cricoarytenoid was active in 11 dogs and inactive in one dog during phonation. Our present study also showed that the posterior cricoarytenoid activity was stronger for phonation than for inspiration in 6, stronger for inspiration than for phonation in 3, and the same for phonation and inspiration in 2 dogs. The results obtained from the present electromyographic evaluation demonstrated that the posterior cricoarytenoid is activated during phonation. The authors believe that the posterior cricoarytenoid muscle has phonatory function and that the phonatory effect of this muscle on the vocal cord may play an important role in precise glottis control.
Singular neurectomy update. II. Review of 102 cases
Authors: Gacek Richard R.
Published: October 2006

During the past 18 years, 102 singular neurectomies (SN) were performed on 95 patients with chronic cupulolithiasis of the posterior canal sense organ. Bilateral sequential singular neurectomies were performed in 7 patients and unilateral singular neurectomies in 88 patients. Ninety‐nine (97%) of the 102 singular neurectomies completely eliminated the positional nystagmus and vertigo produced by the involved (undermost) ear in the Hallpike maneuver. Following three singular neurectomies (3%), there was improvement but incomplete relief from the positional nystagmus. A sensorineural hearing loss caused by the singular neurectomies occurred in four patients (4%). A thorough knowledge of the surgical and histologic anatomy of the round window niche and singular canal, together with the use of local anesthesia to allow monitoring of a vestibular response to singular neurectomy are essential for effectiveness and safety.
The nasal septum in relation to the development of the nasomaxillary complex: A study in identical twins
Authors: Grymer Luisa F. , Pallisgaard Carsten , Melsen Birte
Published: October 2006

The influence of the nasal septum and respiration, evaluated by the total nasal resistance (TR) on the development of the nasomaxillary complex, was studied in 42 identical twins. An understanding of this influence is important for a determination of whether surgery involving the nose should be performed in children.

Comparison within and between twins with different septal deformities indicated that the cartilaginous nasal septum influences the development of the nose and the anteroposterior dimensions of the maxilla. Anterior septal deformities resulted in underdeveloped cartilaginous noses and a shorter anteroposterior dimension for the maxilla. No relation was found with regard to posterior septal deformities, which may be considered as part of the development of the midface. Vertical dimensions of the face were related to TR. Increased values of TR were significantly related to a shorter maxillary height. This may not express a causal relationship but rather genetically determined shorter facial dimensions.
Soft‐tissue complications of laser surgery for recurrent respiratory papillomatosis
Authors: Ossoff Robert H. , Werkhaven Jay A. , Dere Huseyin
Published: October 2006

Twenty‐two patients with recurrent respiratory papillomatosis underwent 105 carbon dioxide (CO2) laser microlaryngoscopic and tracheobronchoscopic operations from July 1986 through February 1990. All soft‐tissue complications, whether intraoperative or delayed secondary to laser surgery, were retrospectively analyzed. The intraoperative laser‐related soft‐tissue complication rate was zero. Two of the 22 patients acquired slight unilateral true vocal cord scar tissue and 1 patient developed a small posterior laryngeal web. The delayed soft‐tissue complication rate was 13.6%, which compares favorably with published reports of 28.7% and 45%. This low complication rate has resulted from the selection of appropriate CO2laser emission parameters and the use of the microspot micromanipulator, which help minimize lateral and/or deep thermal damage at the site of laser impact.
Study of the normal and insufficient velopharyngeal valve by the “forced sucking test”
Authors: Finkelstein Yehuda , Talmi Yoav P. , Kravitz Klara , Bar‐Ziv Jacob , Nachmani Ariela , Hauben Daniel J. , Zohar Yuval
Published: October 2006

A thorough assessment of the velopharyngeal (VP) closure dynamics is important for therapeutic planning in patients with nasal speech. An additional diagnostic tool to the standard endoscopic examination of the VP valve, the “Forced Sucking Test” (FST) is presented. In this study, 110 patients with a normal VP valve and 40 patients with VP insufficiency were subjected to a comprehensive endoscopic examination. When existent, Passavant's ridge clearly appears in 80% of these cases during the FST. This is advantageous, since the ridge is often unseen during routine nasendoscopy. Passavant's ridge appears indistinguishable in shape and level during speech and FST. During FST, the bulge of the uvular ridge is clearly seen on the flat or concave nasal surface of the velum. In cases of diastasis of the velar musculature, the midline V‐defect of the velum is clearly seen. The test is particularly important in children with concomitant adenoid hypertrophy. The findings are discussed in terms of their implications for the anatomy and physiology of the VP valve. FST is recommended as an additional and complementary part of the endoscopic examination of the VP valve.