bluuebunny/crossref_metadata_2025 huggingface dataset:
Spironolactone Blocks Glucocorticoid‐Mediated Hearing Preservation in Autoimmune Mice
Authors: Gross Neil D. , Kempton J. Beth , Trune Dennis R.
Published: November 2003

Hypothesis Although autoimmune sensorineural hearing loss can be effectively treated with corticosteroids, little is known about how these drugs affect cochlear function. MRL/MpJ‐Faslpr autoimmune mice treated with a mineralocorticoid (aldosterone) have previously been shown to have hearing improvement equal to those treated with a glucocorticoid (prednisolone). This suggested that the restoration of hearing with steroids was the result of an effect on sodium transport rather than an antiinflammatory or immunosuppressive role. We hypothesized that corticosteroids reverse autoimmune hearing loss through the mineralocorticoid receptor and that blocking the mineralocorticoid receptor will prevent glucocorticoid effects.

Methods Spironolactone, a mineralocorticoid receptor antagonist, was administered to MRL/MpJ‐Faslpr autoimmune mice alone or in combination with corticosteroids. The four treatment groups were: spironolactone, spironolactone + aldosterone, spironolactone + prednisolone, and untreated water controls. Auditory brainstem response (ABR) thresholds were recorded before and during treatment (2, 3, and 4 mo) to measure the effect of steroids on hearing decline.

Results Hearing in spironolactone and spironolactone + prednisolone mice showed progressive decline in hearing similar to water controls. The hearing was preserved in spironolactone + aldosterone mice, presumably as a result of the fact that aldosterone has a higher affinity for the mineralocorticoid receptor than spironolactone. Thus, aldosterone was able to maintain cochlear function with autoimmune disease progression, similar to previous reports of aldosterone treatment effects.

Conclusions Spironolactone effectively blocked prednisolone from improving hearing in MRL/MpJ‐Faslpr autoimmune mice. This offers evidence that the inner ear mineralocorticoid receptor is the therapeutic target for corticosteroids used to treat autoimmune and sudden sensorineural hearing loss. Pharmacologic treatments that selectively target the mineralocorticoid receptor may provide greater clinical benefit with fewer systemic side effects than prednisone in patients with autoimmune sensorineural hearing loss.
The Evolution of Surgery on the Maxillary Sinus for Chronic Rhinosinusitis
Authors: Lund Valerie
Published: November 2003

Objective To examine the management of the maxillary sinus in chronic rhinosinusitis over the last 500 years.

Method A literature review was conducted.

Result The maxillary sinus was first recognized in the 16th century and its role as a source of infection became the focus of attention, beginning with Nathaniel Highmore in 1651 and continuing up until the 21st century. The surgical drainage of the sinus was achieved by a variety of routes, including the alveolar margin, anterior wall, and middle and inferior meati. The rationale for these procedures, developed in a pre‐antibiotic era, may be re‐examined in the context of our present understanding of the pathophysiology of chronic rhinosinusitis.

Conclusion The maxillary sinus has been the focus of surgical attention from the 17th century onward largely as a result of its size and accessibility, initially reinforced by plain x‐ray. However, in the 20th century, the advent of computed tomography and nasal endoscopy has reaffirmed the relationship of the maxillary sinus to the ostiomeatal complex in chronic rhinosinusitis, as originally demonstrated by pioneers such as Zuckerkandl, and redirected the focus of our therapeutic approaches.
Magnetic Resonance Determination of Tumor Thickness as Predictive Factor of Cervical Metastasis in Oral Tongue Carcinoma
Authors: Iwai Hiroshi , Kyomoto Ryoichi , Ha‐Kawa Sang Kil , Lee Shinryu , Yamashita Toshio
Published: November 2003

Objectives To establish an accurate and reproducible means of measuring tumor thickness as a preoperative prognostic factor for cervical metastasis in oral tongue carcinoma.

Study Design Retrospective review.

Methods Charts from 30 patients were reviewed, and the correlation between histopathological and magnetic resonance imaging (MRI) findings of actual tumor thickness or reconstructed tumor thickness measured between a reconstructed mucosal line and the deepest extent of the tumor was investigated. Magnetic resonance images were acquired on a 1.5 T‐scanner with a T2‐weighted sequence in the axial plane using 3‐mm‐thick sections and a 256 × 256 matrix. The correlation between N stage and tumor thickness acquired by histopathological scrutiny or MRI was also assessed.

Results The correlation between histopathological and MRI examinations was more significant in terms of reconstructed than actual tumor thickness. No cervical metastasis was detected in patients with tumors of less than 6 mm of reconstructed thickness in the MRI examination. The difference in cervical metastasis between the two groups, namely, less than 6 or more than 6 mm, was statistically significant (P = .0051).

Conclusions Magnetic resonance imaging examination provides useful data for prognostic assessment and planning strategies with which to treat oral tongue carcinoma. The preoperative decision as to whether to attempt neck dissection could be based on a tumor thickness of 6 mm for patients with oral tongue carcinoma.
Pulmonary Function After Pectoralis Major Myocutaneous Flap Harvest
Authors: Talmi Yoav P. , Benzaray Shlomo , Peleg Michael , Eyal Ana , Bedrin Lev , Shoshani Yitzhak , Yahalom Ran , Horowitz Zeev , Taicher Shlomo , Kronenberg Jona , Shiner Robert J.
Published: November 2003

Objective The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck.

Methods Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack‐years), anesthesia duration, percentage predicted pre‐ and postoperative FEV1, percentage‐predicted pre‐ and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x‐rays were reviewed.

Results Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x‐rays demonstrated atelectasis.

Conclusions PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.
Otoacoustic Emissions and Tympanometry Screening Among 0–5 Year Olds
Authors: Ho Vu , Daly Kathleen A. , Hunter Lisa L. , Davey Cynthia
Published: November 2003

Objectives To determine the rate of otitis media (OM)‐associated transient evoked otoacoustic emissions (TEOAE) screening failure in a sample of preschool children, to evaluate concordance between TEOAE and tympanometry, to investigate risk factors for TEOAE failure, and to determine agreement between TEOAE failure and physician findings at referral.

Study Design Cross‐sectional.

Methods Children from birth to 5 years underwent screening by TEOAE and tympanometry, and those with one or more abnormal test result(s) were referred to their physician for further evaluation. Univariate associations between risk factors and TEOAE failure were determined using chi‐square analysis. Multiple logistic regression analysis was done to examine the relationship between specific risk factors and TEOAE failure.

Results A total of 664 children aged 2 weeks to 71 months were screened between September 1997 and May 1999. TEOAE and tympanometry failure was found in 25% and 35% of all subjects, respectively. The overall prevalence of OM‐associated hearing loss was 20%. Agreement between tympanometry and TEOAE was better for the youngest (<6 mo) and oldest ⩾36 mo) age groups. Of those who failed TEOAE, a physician saw 81% within 3 months, and 80% of these had a diagnosis consistent with hearing loss but only 18% had audiometric testing. Sibling history of OM was the only significant predictor for TEOAE failure.

Conclusions TEOAE screening failure was highly consistent with physician diagnosis at follow‐up. Failure of TEOAE in a screening program should be followed with diagnostic audiology testing to determine whether conductive or sensorineural hearing loss is present.
Increased Vulnerability of Auditory System to Noise Exposure in mdx Mice
Authors: Chen Tsan‐Ju , Chen Shun‐Sheng , Wang Dean‐Chuan , Hsieh Yueh‐Ling
Published: November 2003

Objectives Dystrophin is a cytoskeletal protein mainly found just beneath the sarcolemma. Lack of dystrophin is known to be the cause of Duchenne muscular dystrophy (DMD). Other tissues, including the brain, retina, and cochlear hair cells, also express dystrophin. Recently, a gene (Xp21.2) associated with sensorineural hearing impairment has been mapped within the localization site for dystrophin in two families. Thus, it is reasonable to assume that dystrophin may play a role in auditory function. However, animal studies have produced conflicting results.

Study Design An attempt was made to clarify the differences between the auditory systems of dystrophin‐deficient mdx mice and control B‐10 mice by exposure to noise.

Methods In the present study, mdx mice and B‐10 mice were used. Animals were exposed daily to noise for 1 month, and their auditory functions were evaluated by recording the brainstem auditory evoked potentials (BAEPs).

Results Before noise exposure, the mdx mouse demonstrated normal BAEP threshold when compared with the B‐10 mouse. After 1 month of noise exposure, the B‐10 mouse showed no apparent change in hearing threshold and BAEP latencies. In contrast, significantly increased hearing threshold and prolonged BAEP peak and interpeak latencies were observed in the mdx mouse after noise exposure.

Conclusions These results indicate that the mdx mice are more vulnerable to noise damage. This involves not only the peripheral auditory system, but also the brainstem central auditory pathway. Therefore, a significant role for dystrophin in the auditory system, especially under noise stress, is suggested.
Application of Unbiased Stereology on Archival Human Temporal Bone
Authors: Tang Yong , Lopez Ivan , Ishiyama Akira
Published: November 2003

Objective The current report presents unbiased stereological sampling and counting strategies for estimating the total number of neurons in the spiral and vestibular ganglia of the archival human temporal bone.

Study Design Application of unbiased stereology using archival human temporal specimens. Observational study.

Methods The practical sampling and counting strategies for estimating the number of neurons are presented. To illustrate the method described, the total number of neurons in spiral and vestibular ganglia from archival human temporal bone was estimated.

Results The study found, on average, 41,643 (coefficient of variation = 0.12) spiral ganglion neurons in the subjects with an average age of 35.6 years (age range, 22–60 y) and, on average, 27,635 (coefficient of variation = 0.10) vestibular ganglion neurons in the subjects with an average age of 28.6 years (age range, 2–58 y).

Conclusions The total number of primary auditory and vestibular ganglion neurons from the current study differs significantly from the previously published data using assumption‐based methods. The unbiased stereological technique presented in the current report thus would be invaluable for future studies on such specimens, including the study of the changes of neurons during aging and various pathological conditions.
Digital Image Processing of Laryngeal Lesions by Electronic Videoendoscopy
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: November 2003

Objectives To present electronic videoendoscopy of the larynx with digital image processing and to discuss this endoscopic technique from the standpoint of diagnostic usefulness of laryngeal lesions.

Study Design Electronic videoendoscopic evaluation of laryngeal lesions with digital image processing.

Methods Seventy patients underwent electronic videoendoscopy without digital image processing and, subsequently, with the digital image processing function. Of these, 15 patients with white lesion of the vocal fold and laryngeal neoplasms were assessed in the study. Clinical assessments made before enhancement of digital image processing function were compared with those after enhancement in 15 patients.

Results Of the 15 patients observed, the clinical diagnoses of two patients were changed after enhancement. Both patients underwent endolaryngeal microsurgery with histopathological examination of the removed lesions, which confirmed the definitive diagnosis. The clinical diagnoses of both patients after enhancement were compatible with histopathological diagnoses.

Conclusions The enhanced color images provided by this system are superior in both quality and resolution to those obtained by conventional flexible fiberoptic endoscopy with a video camera. This system should be a valuable tool for the diagnosis of laryngeal lesions.
Nasal Mucociliary Transport: New Evidence for a Key Role of Ciliary Beat Frequency
Authors: Boek Wilbert M. , Graamans Kees , Natzijl Hanny , van Rijk Peter P. , Huizing Egbert H.
Published: November 2003

Objectives/Hypothesis Mucociliary transport is an important defense mechanism of the respiratory tract. Nonetheless, the factors determining mucociliary transport are only partially understood. Ciliary beat frequency is assumed to be one of the main parameters, although the experimental evidence remains inconclusive.

Study Design Comparing influences on mucociliary transport to influences on ciliary beat frequency.

Methods The present study measures the effects on mucociliary transport of two ciliary beat frequency‐inhibiting compounds (0.1% xylometazoline and 0.9% NaCl) and a ciliary beat frequency enhancer (0.1% salbutamol). The measurements were performed by a technetium‐99m nebulizing scintigraphic method. The experiments were carried out in 15 healthy young volunteers.

Results The 0.1% xylometazoline appeared to slow ciliary transport, although the decrease was not significant (P = .44). The 0.9% NaCl did reduce mucociliary transport significantly (P = .033). The 0.1% salbutamol resulted in a highly significant increase of mucociliary transport (P = .009). Xylometazoline brings about drastic changes in the nasal cavity, both anatomically and physiologically. Any comparison of mucociliary transport before and after using this vasoconstrictive agent must take this effect into account.

Conclusions The present study demonstrates a significant similarity in the effects of NaCl and salbutamol on ciliary beat frequency in vitro and on mucociliary transport in vivo. The evidence from our experiments suggests that ciliary beat frequency is a determining factor in the mucociliary transport rate in the nose.
Alar Batten Grafting for Management of the Collapsed Nasal Valve
Authors: Millman Brad
Published: November 2003

Objective The purpose of the study is to describe a commonly overlooked etiology of nasal airway obstruction. Collapse of the nasal valve can be corrected with precise placement of cartilage grafts. This study demonstrates the surgical technique, rarely described in the literature, of placing a contoured cartilage graft in the nasal valve region for the improvement of the nasal airway.

Study Design Retrospective review of surgical results of the 21 patients who underwent alar batten grafting performed over a 3‐year period at the Geisinger Medical Center (Danville, PA).

Methods A retrospective review was conducted of 21 patients surgically treated with alar batten grafts for nasal valvular collapse between the 1997 and 1999. The surgical technique is described, and our results are analyzed including for both functional and aesthetic outcome.

Results All patients treated with alar batten grafting at the nasal valve improved with regard to their airway obstruction. There were no complications, and there was only minor aesthetic fullness in six cases.

Conclusions Alar batten cartilage grafting is an easy, highly effective therapeutic measure in the treatment of nasal valve collapse. The surgical technique is demonstrated.
Analysis of Treatment Results for Oral Tongue Cancer
Authors: Sessions Donald G. , Spector Gershon J. , Lenox Jason , Haughey Bruce , Chao Clifford , Marks James
Published: November 2003

Objective The study reports the results of treatment of oral tongue cancer with five different treatment modalities with long‐term follow‐up.

Study Design Retrospective study of 332 patients with oral tongue cancer treated in the Departments of Otolaryngology–Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from 1957 to 1996.

Methods Patients with biopsy‐proven squamous cell carcinoma of the oral tongue who were previously untreated and were treated with curative intent by one of five modalities and who were eligible for 5‐year follow‐up were included. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance.

Results The overall 5‐year disease‐specific survival rate (DSS) was 57% with death due to tumor in 43%. The 5‐year cumulative disease‐specific survival probability (CDSS) was 0.61 (Kaplan‐Meier) with a mean of 17.5 years and a median of 30.1 years. The DSS by treatment modality included local resection (73%), composite resection (61%), radiation therapy (46%), local resection and radiation therapy (65%), and composite resection with radiation therapy (CR/RT) (44%). Overall, local resection had a significantly improved DSS and CR/RT had a decreased DSS that was related to the stage of disease being treated. In treating stage IV disease, CR/RT produced a more significantly improved CDSS than the other treatment modalities. Recurrence at the primary site was as common as recurrence in the neck. Eighty‐nine percent of recurrences occurred within the first 60 months. Recurrence significantly decreased survival. DSS was significantly improved in patients with clear margins of resection. Metastasis to a distant site occurred in 9.6% of patients. Twenty‐one percent of patients had second primary cancers, and 54% of these patients died of their second primary cancer.

Conclusions Significant improvement in DSS was seen in patients with clear margins, early stage grouping and clinical (pretreatment) tumor stage, and negative nodes. Significant decrease in DSS was seen in patients with close or involved margins, advanced stage grouping and clinical (pretreatment) tumor staging, positive clinical (pretreatment) node staging, and tumor recurrence. Obtaining clear margins of resection is crucial because it significantly affects survival. A minimum of 5 years of close monitoring is recommended because of the high incidence of second primary cancers.
Expression of Bcl‐2 Family Proteins in Advanced Laryngeal Squamous Cell Carcinoma: Correlation With Response to Chemotherapy and Organ Preservation
Authors: Trask Douglas K. , Wolf Gregory T. , Bradford Carol R. , Fisher Susan G. , Devaney Kenneth , Johnson Mark , Singleton Timothy , Wicha Max
Published: November 2003

Objectives/Hypothesis Induction chemotherapy and definitive radiation therapy in advanced laryngeal cancer has been shown to achieve survival rates that are similar to total laryngectomy and postoperative radiation therapy. In patients with advanced laryngeal cancer, quality of life can be significantly enhanced by treatment regimens that preserve the larynx. However, which patients will respond best to organ preservation protocols remains unknown. The Bcl‐2 family proteins are involved in control of apoptosis and, potentially, tumor response to chemotherapy.

Study Design Retrospective analysis of immunohistochemical tumor characteristics and clinical outcome.

Methods To determine whether Bcl‐2 family proteins were predictive of successful organ preservation, immunohistochemical analysis of tissue specimens from 47 patients with advanced laryngeal cancer from the U.S. Department of Veterans Affairs Cooperative Study Program (VA CSP‐268) were evaluated for the expression of Bcl‐2, Bcl‐XL, and Bax protein expression. Tumor response was classified as either complete or partial/nonresponse after induction chemotherapy. Protein expression was correlated with tumor response, organ preservation, and overall patient survival.

Results The Bcl‐2 protein was expressed at high levels in only 15% of specimens, but five of seven tumors with high Bcl‐2 showed complete response (P = .10). The majority of tumors expressed high levels of Bcl‐XL (74%). Reduced expression of Bcl‐XL was associated with a complete response (P = .143) and with larynx preservation (P =.06). Most patients (81%) had increased levels of Bax expression. Reduced expression of Bax was associated with a complete response rate (P = .074), but there was no correlation between Bax expression and larynx preservation.

Conclusions The findings indicate that laryngeal cancer cells typically produce high levels of only one of the apoptosis protective proteins, Bcl‐2 or Bcl‐XL. Prospective studies of larger numbers of patients are under way to determine whether Bcl‐XL expression will be a useful marker predicting larynx preservation.
Ventilation Time of the Middle Ear in Otitis Media With Effusion (OME) After CO2 Laser Myringotomy
Authors: Sedlmaier Benedikt , Jivanjee Antonio , Gutzler Rico , Huscher Dörte , Jovanovic Sergije
Published: November 2003

Objective The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan.

Study Design Prospective clinical study.

Materials and Methods In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter.

Results None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion‐skin‐like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow‐up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation‐free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37;P <.05).

Conclusion The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self‐healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.
Polypoid Mucosa With Eosinophilia and Glandular Hyperplasia in Chronic Sinusitis: A Histopathological and Immunohistochemical Study
Authors: Berger Gilead , Kattan Avi , Bernheim Joelle , Ophir Dov
Published: November 2003

Objective To evaluate the histopathological and immunohistochemical characteristics of chronic sinusitis, with reference to the extent of sinus involvement.

Study Design A nonrandomized, retrospective, controlled qualitative and quantitative study.

Methods Twenty‐nine adults with refractory chronic sinusitis underwent functional endoscopic sinus surgery. The score of computed tomography scans was used to determine the extent of disease. Six patients with normal sinus mucosae served as control subjects. Specimens underwent routine histological processing and hematoxylin‐eosin and periodic acid–Schiff staining. Immunohistochemistry for T and B lymphocytes was applied. Low‐magnification microscopy was designed to yield typical pathological features, and high magnification to count various inflammatory cells.

Results Patients were divided into two groups according to their dominant pathological features: 16 had polypoid mucosa and eosinophilia, and 13 had glandular hyperplasia. The number of eosinophils, T and B lymphocytes in the lamina propria was significantly higher in patients with polypoid mucosa and eosinophilia, compared with those with glandular hyperplasia and with normal control subjects, whereas the difference between patients with glandular hyperplasia and control subjects was insignificant. Although the overall inflammatory reaction was relatively modest, nasal polyposis was more prevalent in patients with polypoid mucosa and eosinophilia; likewise, computed tomography revealed a significantly more extensive disease in these patients compared with the patients with glandular hyperplasia.

Conclusion Two pathophysiological pathways, inducing prolonged obstruction to the outflow of sinus secretion and ultimately causing chronic inflammation, are suggested: 1) swollen polypoid mucosa with activation of eosinophils that damage the epithelium and 2) continued increased mucus secretion originated from hyperplastic submucosal seromucous glands.
Hereditary Hemorrhagic Telangiectasia: A Review of 76 Cases
Authors: Shah Rahul K. , Dhingra Jagdish K. , Shapshay Stanley M.
Published: November 2003

Objectives/Hypothesis Hereditary hemorrhagic telangiectasia has long been viewed as a rare condition. Recent evidence indicates that the disorder is more frequent than previously thought. Recalcitrant epistaxis is a salient feature of this disease, and the otolaryngologist is often called on to make the diagnosis and guide the primary management of patients with hereditary hemorrhagic telangiectasia. Wider recognition of this condition, awareness of the natural history and associated findings, appropriate workup and screening for arteriovenous malformations (lungs, brain, liver), and knowledge of appropriate interventions can help avoid the considerable morbidity associated with hereditary hemorrhagic telangiectasia.

Study Design Retrospectivereview.

Methods Records of patients treated by the senior author (s.m.s.) for hereditary hemorrhagic teleangiectasia from 1993 to 2000 were reviewed.

Results Seventy‐six patients were identified, 98% of whom had epistaxis as their presenting complaint, with 75% having a family history of hereditary hemorrhagic telangiectasia. The severity of epistaxis varied in the patients: 66% had mild, 21% moderate, and 13% severe epistaxis. Sixty‐four percent of patients had no transfusions, 25% had 1 to 10 transfusions, and 11% of patients had more than 10 transfusions. Complications of hereditary hemorrhagic telangiectasia were documented in 30% of patients. Screening for arteriovenous malformations was performed in only 34% of patients. Eighty‐two percent of patients received a variable number of Nd:YAG laser treatments.

Conclusions The study presents the largest retrospective review of patients treated for hereditary hemorrhagic telangiectasia by a single otolaryngologist. The importance of a multidisciplinary approach facilitated by the otolaryngologist for evaluation of concomitant complications and morbidity (arteriovenous malformations) from hereditary hemorrhagic telangiectasia is demonstrated. An algorithm for controlling the epistaxis is presented.
Nasalance, Nasality, Voice, and Articulation After Uvulopalatopharyngoplasty
Authors: Van Lierde Kristiane M. , Van Borsel John , Moerman Mieke , Van Cauwenberge Paul
Published: November 2003

Objectives/Hypothesis The main purpose of the study was to determine the impact of uvulopalatopharyngoplasty (UPPP) on nasalance and nasality. It was hypothesized that nasalance would change from the presurgical to the postsurgical condition because the surgical protocol involves removal of palatal tissue. An additional objective of the study was to provide objective and subjective data about changes in voice and articulation after UPPP. Because the surgical procedure of UPPP does not involve laryngeal tissue, it was hypothesized that the voice characteristics remain relatively stable. Because of removal of effective velar length, articulation problems of the uvular /R/ can occur in the Dutch language.

Study Design Prospective study in which 26 men were studied before (1 week before UPPP) and after (3 weeks after UPPP) surgery.

Methods The Nasometer was used to obtain nasalance scores. The mirror‐fogging test, a perceptual evaluation of each subject's readings, and the Gutzmann and the Bzoch hypernasality tests were used for the assessment of nasality. For the assessment of articulation, a phonetic analysis was performed. Voice assessment included a perceptual rating of the voice and a determination of fundamental frequency.

Results No significant differences were found between the conditions before and after surgery regarding nasalance (except for the vowel /i/), nasality, and voice. Regarding articulation, only 1 patient showed a derhotacized /R/.

Conclusions The findings of the study indicate that UPPP does not have an impact on nasality, voice, and articulation. Regarding nasalance, no significant nasalance change occurred after UPPP, except for the high vowel /i/.
The Efficacy of Resorbable Plates in Head and Neck Reconstruction
Authors: Bhanot Sumeet , Alex James C. , Lowlicht Roger A. , Ross Douglas A. , Sasaki Clarence T.
Published: November 2003

Objective/Hypothesis The advent of malleable macroporous resorbable plates has allowed the surgeon a greater range of reconstructive options and has decreased the morbidity of conventional plating procedures. Completely malleable after warming to 55°C, resorbable plates can readily conform to most morphologic appearances of fractures or defects and provide rigid fixation when cooled. The plating systems used in head and neck reconstruction are described.

Study Design Nine patients were selected for reconstruction using a resorbable plating system. The resorbable system was tested under a variety of clinical situations including frontal sinus fractures (three patients), midface fractures (two patients), mandibular defects (two patients), and laryngeal fractures (two patients).

Methods Each case was evaluated for rigidity of fixation, and ease of plate contouring and application. Furthermore, the postoperative functional and cosmetic results and complications were contrasted between the resorbable plating systems and each surgeon's vast experience with traditional plating systems.

Results The resorbable plating system was found to be as effective as traditional plating systems with respect to rigidity of fixation, functional results, and complications. In addition, the resorbable system was far easier to contour and, consequently, to apply, while producing higher cosmetic satisfaction after plate resorption than traditional plating.

Conclusions Based on our experience, resorbable plates appear to be safe, easy to contour and apply, as well as effective for a wide range of head and neck reconstructive applications. In addition, the shortcomings of permanently retained plates such as plate migration, bone growth restriction, and imaging artifact are avoided.
Defining Tympanostomy Tube Plugs
Authors: Westine John G. , Giannoni Carla M. , Antonelli Patrick J.
Published: November 2003

Objectives To define the composition of tympanostomy tube plugs because selecting or developing effective solvents depends on such knowledge.

Study Design Prospective, in vitro laboratory study.

Methods Luminal contents of 105 plugged, microscopically removed tympanostomy tubes were expressed, pooled, acid hydrolyzed, and passed through a high‐performance liquid chromatography column. Retention times were compared with high‐performance liquid chromatography standards to develop free amino acid and monosaccharide profiles. Cerumen, blood, and chronic mucoid effusion (collected during myringotomy) were pooled and subjected to the same analysis. The elution profiles of each substance were compared to determine which substance most closely matched the plugs.

Results High‐performance liquid chromatography amino acid and monosaccharide analysis demonstrated greatest similarity between tympanostomy tube plugs and mucoid effusion.

Conclusions Tympanostomy tube plug composition is more similar to mucoid effusion than to blood or cerumen. Solvents to open plugged tympanostomy tubes should be directed against the components of mucoid effusion.
Gastroesophageal Reflux and Eustachian Tube Dysfunction in an Animal Model
Authors: White David R. , Heavner S. Brett , Hardy Stuart M. , Prazma Jiri
Published: November 2003

Objective To explore the possible relationship between gastroesophageal reflux and eustachian tube dysfunction in an animal model.

Study Design Randomized trial.

Methods Twenty Sprague‐Dawley rats were randomly assigned into two groups, the control (phosphate‐buffered saline, n = 10) and experimental (hydrochloric acid [HCl]/pepsin, n = 10) groups. All rats underwent an operation to implant a polyethylene tube into the posterior nasopharynx, through which phosphate‐buffered solution or simulated gastric juice (0.5 mg/mL pepsin in 0.01 HCl) was infused at a rate of 0.1 mL/h for 20 minutes three times a day for 7 days. Passive opening pressure (POP), passive closing pressure (PCP), active clearance of positive pressure (ACPP) and active clearance of negative pressure (ACNP) were measured before catheter implantation, on postoperative day 5, and after days 1, 3, 5, and 7 of infusion. Mucociliary clearance time (MCCT) was measured after day 7 of infusion. Statistical analysis used a two‐way analysis of variance (POP, PCP, ACPP, and ACNP) and Mann‐Whitney rank sum test (MCCT).

Results Significant increases in POP (P = .004), PCP (P <.001), ACPP (P <.001), ACNP (P <.001), and MCCT (P <.001) were demonstrated in the HCL/pepsin group compared with the control group. No significant difference was seen between preoperative and postoperative values.

Conclusions Nasopharyngeal exposure to simulated gastric juice causes eustachian tube dysfunction in rats. Specifically, middle ear pressure regulation and mucociliary clearance of middle ear contents were disabled. These results support recent reports in the literature linking nasopharyngeal reflux to eustachian tube dysfunction and secondary development of otitis media.
Obstructive Supraglottic Schwannoma: A Case Report and Review of the Literature
Authors: Rosen Frederick S. , Pou Anna M. , Quinn Francis B.
Published: November 2003

Objective At the conclusion of the current presentation, the participants should be able to describe the etiology, presentation, histopathologic identification, and treatment options for schwannoma of the larynx.

Objectives Nerve sheath tumors rarely occur within the larynx. The goal of the current report is to acquaint the clinician with the presentation and treatment options for this disease.

Study Design Retrospective case report and review of the literature.

Methods We report one case of schwannoma of the supraglottic larynx at the Department of Otolaryngology, University of Texas Medical Branch (Galveston, TX). In addition, we review English‐language publications regarding laryngeal nerve sheath tumors.

Results Laryngeal nerve sheath tumors have an insidious course, commonly involve the supraglottic larynx, and can lead to upper airway obstruction. Cure is achieved by complete surgical excision.

Conclusions Median thyrotomy has proven to be safe and successful in the treatment of supraglottic schwannoma.
Dedifferentiated Chondrosarcomas of the Larynx: A Report of Two Cases and Review of the Literature
Authors: Garcia Roberto E. , Gannon Francis H. , Thompson Lester D. R.
Published: November 2003

Objective To analyze the long‐term clinical outcome of dedifferentiated chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component (CAMMC) of the larynx and compare the results with those of axial chondrosarcomas.

Study Design/Methods Two patients with CAMMC of the larynx (0.03%) were retrospectively identified within the archives of the Armed Forces Institute of Pathology between 1970 and 2001. We compared the clinical and histologic features of these two cases with those reported in the English literature (Medline 1966–2001) (Table I).

Results Patient no. 1 was a 67‐year‐old man who presented with a 12‐month history of hoarseness and was found to have a 4‐cm mass involving the cricoid cartilage. Enucleation was performed and histologically demonstrated a dedifferentiated chondrosarcoma. Without additional intervention, the patient died after 136 months without evidence of disease. Patient no. 2 was a 41‐year‐old man who also presented with a 12‐month history of hoarseness and dysphagia and was found to have a 5‐cm mass involving the cricoid cartilage. A total laryngectomy was performed for the dedifferentiated chondrosarcoma. He is alive without evidence of disease at last contact (91 mo).

Conclusion CAMMC of the larynx are rare tumors but have a better prognosis than their axial counterparts (mean, 6 mo). Initial voice‐sparing surgery can be followed with more aggressive surgery if recurrences develop.
Patterns of Cartilage Structural Protein Loss in Human Tracheal Stenosis
Authors: Mankarious Leila A. , Adams Allison B. , Pires Valerie L.
Published: November 2003

Objectives The study sought to identify which of the major structural proteins in tracheal cartilage are lost in the inflammatory process, and to determine whether damaged cartilage shows signs of regeneration and whether this is an age‐dependent phenomenon.

Study Design Immunohistochemical analysis.

Methods Archival human tracheal and subglottic stenosis segments removed for the treatment of airway compromise were investigated by means of immunohistochemical analysis for differential loss of collagen type I or type II or aggrecan.

Results Specimens were found to have preferentially lost collagen I and aggrecan in areas of severe disruption of the cartilage ring. Collagen II was preserved. In addition, areas of apparent cartilage regeneration were identified based on increased collagen II and aggrecan relative to baseline levels in uninjured sections of the rings. Regenerative capacity was present in most of the specimens investigated and was not age specific.

Conclusions Collagen I and aggrecan are lost in areas of severe ring compromise, indicating that at least one of these two molecules is responsible for structural integrity. The remaining cartilage has some regenerative capacity, but it is small relative to the degree of cartilage damage. No new collagen I was identified in the cartilage ring, indicating that, although an intense inflammatory reaction occurred, fibroblasts did not deposit new collagen I as seen in other scar tissues.
Velopharyngeal Function After Microsurgical Reconstruction of Lateral and Superior Oropharyngeal Defects
Authors: Kimata Yoshihiro , Uchiyama Kiyotaka , Sakuraba Minoru , Ebihara Satoshi , Hayashi Ryuichi , Haneda Tatsumasa , Onitsuka Testuro , Asakage Takahiro , Nakatsuka Takashi , Harii Kiyonori
Published: November 2003

Objectives/Hypothesis Defects of the lateral and superior oropharyngeal wall are difficult to reconstruct because of their complicated anatomy and the possibility of causing velopharyngeal incompetence. The objective was to investigate problems of reconstruction and postoperative velopharyngeal function.

Study Design Defects were classified into three types (I, II, and III) according to their extent. Four operative procedures were performed: the Patch, Jump, Denude, and Gehanno methods, which include a lateral–posterior pharyngeal advancement flap. Speech intelligibility, velopharyngeal function, and wound dehiscence between the flap and the remaining soft palate were evaluated.

Methods Forty patients who had undergone resection of the lateral and superior oropharyngeal walls and subsequent reconstruction were reviewed.

Results Most patients with type I or II defects had satisfactory velopharyngeal function. However, in patients with type III defects, speech function was worse and severe velopharyngeal incompetence was more common. The type of defect and the presence of wound dehiscence were related to postoperative function. The rates of wound dehiscence were lower with the Patch and Gehanno methods.

Conclusions Postoperative function in patients with type III defects can be affected by various factors. We suggest that the Gehanno method be the treatment of choice for reconstruction of extensive defects of the oropharynx. However, patients in whom more than two‐thirds of the superior and posterior oropharyngeal walls has been resected are poor candidates for reconstruction because of the difficulty of maintaining both nasal airway patency and velopharyngeal function.
Otolaryngologic Aspects of the Lewis & Clark Expedition, 1803–1806
Authors: Eisen Marc D. , Lustig Lawrence R.
Published: November 2003

Medical difficulties related to otolaryngology that occurred during the Lewis & Clark Expedition (1803–1806) are highlighted. These difficulties included ear and face frostbite, upper respiratory infections, temporal vessel laceration from an air gun accident, neck scrofula, and a pediatric neck mass. The custom of Clatsop Indian head flattening is also described. These descriptions also aim to illustrate the state of otolaryngology during the early 19th century in America.
Endoscopic‐Assisted Transcolumellar Approach to the Clivus: An Anatomical Study
Authors: Puxeddu Roberto , Lui Matt W.M. , Chandrasekar Kalavakonda , Nicolai Piero , Sekhar Laligam N.
Published: November 2003

Objective Surgical exposure of the clivus and retroclival region is a challenging problem. Several extracranial and intracranial approaches using microsurgical techniques have been proposed in the search to optimize the exposure of the clival region. The objective of the present study was to develop an endoscopic‐assisted transcolumellar approach to the anterior clivus.

Study Design Experimental anatomic study.

Methods The approach was studied in 10 consecutive cadaveric preparations. It included a preliminary external rhinoplasty technique with a septal displacement procedure, which gives a wide intranasal route to the posterior wall of the nasopharynx. By use of a drill system and instruments specially designed for endoscopic sinus surgery, the clivus and retroclival region were appropriately managed. Direct morphometric measurements were obtained during all steps of the procedure.

Results The endoscopic‐assisted transcolumellar approach developed in the present experimental study allowed a good exposure of the clivus area and anterior cranial‐cervical junction. By performing a preliminary septoplasty, the nostrils were turned into a single passage with adequate space for endoscopic insertion and manipulation of one or two instruments. The authors were able to completely expose the posterior wall of the sphenoid sinus and clival dura after the thick bone of the vomer, the floor of the sphenoid, and the clivus were removed by a drill. Angled endoscopes provided a comprehensive view of the retrosellar area.

Conclusions The endoscopic‐assisted transcolumellar approach, besides offering a wide opening for endoscopic management of the clivus, also allowed the surgeon to perform a double‐handed procedure and to associate the use of a microscope if needed. The use of endoscopes, although lacking the three‐dimensional view, gave a thorough and closer exposure of the surgical field with the advantage of a multiangled perspective.
Distinguishing Non‐Hodgkin Lymphoma From Squamous Cell Carcinoma Tumors of the Head and Neck by Computed Tomography Parameters
Authors: Urquhart Andrew C. , Hutchins Lawrence G. , Berg Richard L.
Published: November 2003

Objective Computed tomography (CT) remains the first‐line imaging procedure for pre‐therapeutic staging of head and neck tumors. Non‐Hodgkin lymphoma (NHL) is not easily distinguished from squamous cell carcinoma (SCC), especially because NHL often appears in extranodal locations. We sought to explore whether specific CT characteristics could be used to distinguish these tumor types.

Method Cases of NHL and SCC involving the head and neck were retrospectively identified. Of 165 subjects (110 NHL, 55 SCC) identified, 45 patients (19 NHL, 26 SCC) had complete CT scan records. The scans with no group identifiers were randomly presented to the radiologist for blinded review. Radiologic distribution, size, and tumor characteristics were recorded. Descriptive summaries of the data were analyzed by standard univariate statistical procedures.

Results Significant differences between NHL and SCC tumors were observed: stage IV tumors (17% vs. 85%;P <.001), extranodal occurrence in the oral cavity (0% vs. 38%;P = .002), evidence of primary or extranodal tumor (11% vs. 73%;P <.001), tumor necrosis (5% vs. 54%;P <.001), non‐isodensity nodes (16% vs. 50%;P = .03), and nodes in zones 5–7 (32% vs. 4%;P = .03). No significant difference was seen in the total number of nodes, the number of large nodes, or the maximum nodal diameter.

Conclusion While none of these features can be considered pathognomonic for either type of tumor, the distinctions may assist in distinguishing NHL from SCC of the head and neck until more sophisticated imaging techniques become widely available.