bluuebunny/crossref_metadata_2025 huggingface dataset:
Success of the modified epley maneuver in treating benign paroxysmal positional vertigo
Authors: Wolf Jeffrey S. , Boyev Kestutis P. , Manokey Brenda J. , Mattox Douglas E.
Published: November 2003

Objective: Benign paroxysmal positional vertigo (BPFV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. Study Design: Retrospective review. Methods: A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike‐Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike‐Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. Results: The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. Conclusion: The modified Epley maneuver is an excellent treatment for BPPV. Key Words: Vertigo, benign paroxysmal positional vertigo (BPPV), Epley maneuver, semicircular canal.
Intraoperative electromyography for predicting facial function in vestibular schwannoma surgery
Authors: Axon Patrick R. , Ramsden Richard T.
Published: November 2003

Objective: To assess the validity of intraoperative minimal stimulation threshold (MST) for predicting long‐term facial function after vestibular schwannoma surgery. Study Design: Prospective blinded study. Methods: MST after tumor dissection and postoperative clinical facial function, assessed using the House Brackmann grading system (HB), were used to predict long‐term clinical facial function, recorded at least 6 months after surgery. Results: Two hundred and nine consecutive patients fulfilled selection criteria and 184 had successful intraoperative electrophysiologic monitoring and were eligible for further study. MST of 0.05 mA had moderate accuracy for predicting good long‐term facial function, with 94% sensitivity, 91% positive predictive value (PPV), 60% specificity, and 70% negative predictive value (NPV). A more relevant group of 77 patients with poor postoperative facial function (HB III‐VI) were assessed for predicting good long‐term function. Applying this criteria, test accuracy fell, with 83% sensitivity, 64% PPV, 60% specificity, and 75% NPV. Postoperative clinical facial function had a greater accuracy for predicting good long‐term function, with 83% sensitivity, 79% PPV, 75% specificity, and 79% NPV. A model of predicted probabilities of good outcome (HB I and II) was derived from a logistic regression with two additive predictors (postoperative HB and MST). This demonstrated that for patients with postoperative HB grade V, MST aided prediction. Conclusions: Intraoperative stimulation thresholds, when assessed against a relevant group of patients with poor postoperative facial function, had poor predictive accuracy. The severity of immediate postoperative clinical facial function was the most accurate predictor of long‐term outcome. MST aided long‐term prediction in a small but relevant group of patients with postoperative HB grade V facial function. Key Words: Facial nerve, vestibular schwannoma, electromyography, EMG.
Roles of Cytokines and Cell Cycle Regulating Substances in Proliferation of Cholesteatoma Epithelium
Authors: Tanaka Yasuhiro , Kojima Hiromi , Miyazaki Hidemi , Koga Tomohiko , Moriyama Hiroshi
Published: November 2003

Objectives: It can be surmised that the cell cycle must be involved in cell proliferation of the epithelium of middle ear cholesteatoma. Thus a comparative study was conducted of the levels of expression of cyclin‐dependent kinase 2 (cdk2) and cyclin‐dependent kinase 4 (cdk4)—substances known to be involved in the cell cycle—in cholesteatoma epithelium and the normal epithelium of the bony region of the external ear canal. In addition, it has been reported that the expression of cytokines in the epithelium is accelerated in response to subepithelial inflammation. This suggests that an interaction between the epithelium and subepithelium, which is subject to paracrine regulation, is deeply involved in epithelial proliferation. Accordingly, attention was focused on interleukin−1α (IL‐1α) and keratinocyte growth factor (KGF), cytokines which are found in the subepithelium, and experiments were conducted to elucidate their effects on the expression of the substances known to be involved in the cell cycle. Methods: The expressions of cdk2 and cdk4 in the cholesteatoma epithelium and external ear canal epithelium were investigated by an immunohistochemical technique. In addition, cultured human keratinocytes were grown in medium containing IL‐1α or KGF at concentrations of 0, 20, and 100 ng/mL, and the differences in the expression of cdk2 and cdk4 were investigated and compared by Western blot analysis. Results: In the cholesteatoma epithelium specimens, cdk2 and cdk4 were observed to be expressed in the basal and parabasal layers and in the upper layer (prickle layer and granular layer). Their expression tended to be increased compared with their expression in the normal external ear canal epithelium, and this tendency was marked in subepithelial sites showing severe inflammation. In addition, exposure of cultured human keratinocytes to IL‐1α or KGF resulted in accelerated expression of both cdk2 and cdk4, and this was especially striking in the case of addition of KGF. Conclusion: It can be surmised that, in cholesteatoma, accelerated expression of IL‐1α and KGF by inflammatory cells at subepithelial sites of inflammation leads to upregulation of cdk2 and cdk4 in epithelial cells and to cell proliferation. It was concluded that this is at least one sequence of events involved in the mechanism causing epithelial proliferation in cholesteatoma.
The Posterior Thyroplasty Window: Anatomical Considerations
Authors: Maragos Nicolas E.
Published: November 2003

Objectives: Explain surgical technique of performing a posterior thyroplasty window.1 Describe the internal laryngeal anatomy and structures available through the posterior window approach. Describe posterior window approach.

Study Design: Review of lateral laryngeal anatomy and retrospective review of 125 cases involving a posterior thyroplasty window approach. Review mechanics of stress and stress concentration inherent with partial removal of rigid substance. Describe anatomical considerations and surgical complications.

Methods: Charts were reviewed and tabulated for surgical complications, efficacy and safety of surgical approach, specific anatomical variations, and variety of surgery available through the posterior window.

Results: Performance of 125 posterior thyroplasty windows revealed no evidence of entry into the piriform sinus. Three thyroid ala fractures ensued, two of the body and one of the inferior cornu. Operations available included arytenoid adduction,1 arytenoid fixation,2 lysis of joint adhesions, and access to the posterior cricoarytenoid muscle for botulinum toxin injections.

Conclusions: The posterior thyroplasty window affords easy, direct access to the internal, posterolateral larynx while preserving the cricothyroid joint, the action of the cricothyroid muscle, and the internal division of the recurrent laryngeal nerve.
Surgical Removal of Subglottic Hemangiomas in Children
Authors: Van Den Abbeele Thierry , Triglia Jean‐Michel , Lescanne Emmanuel , Roger Gilles , Nicollas Richard , Ployet Marie‐Josèphe , Garabédian Eréa‐Noël , Narcy Philippe
Published: November 2003

Objective: To examine the indications and the results of surgical excision of severe subglottic hemangiomas.

Design: Retrospective study and case series.

Setting: Four academic tertiary care centers of pediatric otolaryngology.

Patients: Twenty children were included from 1991 to 1997. All presented with severe subglottic hemangiomas resistant to classical treatments such as corticosteroids and/or CO2 laser.

Intervention: Six children were operated on using laryngotracheal reconstruction and prolonged stenting by a reinforced Silastic roll and 14 children were operated on by a single‐stage laryngotracheoplasty and post‐operative intubation in a pediatric intensive care unit.

Results: All patients were successfully decannulated or extubated and have been free from recurrent hemangiomas.

Conclusion: The surgery of severe subglottic hemangiomas is a reliable technique in selected patients and should be considered in corticoresistant or corticodependent, circular, or bilateral hemangiomas.
Systematic Management of Osteoradionecrosis in the Head and Neck
Authors: Hao Sheng‐Po , Chen Hung Chi , Wei Fu‐Chan , Chen Chao‐Yu , Yeh Albert Re‐Ming , Su Jen‐Liang
Published: November 2003

Objectives: Osteoradionecrosis is one of the most serious and devastating complications of radiotherapy. The proper management of osteoradionecrosis is currently undetermined. The objective of this study is to evaluate the treatment results of a systematic approach to osteoradionecrosis.

Study Design: A prospective study of a systematic approach to osteoradionecrosis in the head and neck area was undertaken.

Methods: From July 1993 to June 1998, 33 cases of osteoradionecrosis in the head and neck area were treated using a systematic approach that combined sequestrectomy and hyperbaric oxygen therapy.

Results: Seven (21%) had recurrent cancer. The control rate of the other 26 osteoradionecrosis cases was 77% (20/26).

Conclusions: Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicion of recurrent cancer. Extensive osteoradionecrosis with a multiple discharging fistula, a large area of exposed necrotic bone, or a coexistent fracture should be treated primarily with radical sequestrectomy and microvascular free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.
Otolaryngology Care Unit: A Safe and Cost‐Reducing Way to Deliver Quality Care
Authors: Strauss Melvin , Bellian Kenneth
Published: November 2003

Objectives: Patients undergoing treatment for head and neck cancer, obstructive sleep apnea, and potential airway obstruction are often unnecessarily admitted to an intensive care unit (ICU). This study determined the efficacy of an intermediate care unit (OtoCare Unit) for their management.

Methods: A mail survey was conducted of 110 academic institutions' experience with intermediate care units; a retrospective study was performed of our ICU use with analysis of the use of invasive monitoring, length of stay, and cost; and a retrospective study of our first 168 OtoCare Unit patients and their outcomes, complications, and charges was performed.

Results: There were 56 responses to 110 survey inquiries. Thirty institutions used some form of intermediate care, while five had a separate otolaryngology unit. Analysis of our 1‐year ICU experience showed that of 54 patients who underwent head and neck surgery, 36 patients were admitted to the ICU. Of these 36 admissions, only 9 patients required invasive monitoring and the majority had stable clinical courses. Guidelines were established for an OtoCare Unit: patients use non‐ICU beds, mobile noninvasive monitoring units are provided, and a 1:4 nurse‐to‐patient ratio is used. Phase I included 35 patients who required a mandatory post‐anesthesia care unit (PACU) stay of 4 hours. Three minor complications occurred in this group. Phase II included 133 patients who were permitted to enter the OtoCare Unit as soon as they recovered from anesthesia. There were nine minor complications and three major complications in this group. The charge savings compared with ICU usage for such patients was $35,762.00.

Conclusions: An OtoCare Unit is a safe and cost‐effective means of caring for this select group of patients.
Microneurovascular Allotransplantation of the Canine Tongue
Authors: Haughey Bruce H. , Beggs James C. , Bong Jeongpyo , Genden Eric M. , Buckner Allyson
Published: November 2003

Introduction: Reconstruction of the tongue with existing methods of tissue transfer often leaves glossectomy patients with significant deficits in speech and swallowing. The critical role of the tongue is implied by its unique structure and function. This paper reports the development of an animal model of hemitongue allotransplantation and documents functional and anatomic outcomes of this procedure.

Methods: Ten pairs of unmatched dogs underwent reciprocal exchange of the left hemitongue with microneurovascular replantation. The unoperated hemitongue acted as the control. Under cyclosporine immunosuppression, animals surviving long term underwent clinical observation, before electromyography, force transduction studies, and histological evaluation being euthanized.

Results: Five animals survived between 6 and 13 months for long‐term evaluation. The remaining group were euthanized because of or died of overwhelming infection or uncontrollable transplant rejection. The latter sometimes resulted from difficulty in the delivery of the cyclosporine. Clinical recovery of tongue function was observed, as well as resumption of motor unit potential activity on electromyography. Contractile force recovery of the transplanted tongue averaged 68% of control (range, 47%‐97%), and histological study of the hypoglossal and lingual nerves demonstrated anatomic evidence of reinnervation. Preservation of muscle, mucosal, and stromal ultrastructure was seen with light microscopy of the transplanted tongue.

Conclusions: Allotransplantation of the hemitongue and associated neurovascular apparatus is possible in a large mammalian model, with long‐term survival of tissue being accompanied by partial recovery of contractile properties. Anatomical and clinical evidence also points to sensory recovery. These data support the future possibility of employing a similar technique in glossectomy patients.
A Passive‐Marker‐Based Optical System for Computer‐Aided Surgery in Otorhinolaryngology: Development and First Clinical Experiences
Authors: Klimek Ludger , Ecke Ulrich , Lübben Björn , Witte Jens , Mann Wolf
Published: November 2003

Objectives:To develop a new type of optical computer‐aided surgery (CAS) device that overcomes some of the restrictions of common systems and to examine its accuracy and usability under laboratory and intraoperative conditions.

Study Design:Prospective study using laboratory experiments and intraoperative data collection.

Methods:An optical CAS system applying passive optical markers for coordinate determination was developed. Laboratory accuracy measurements were obtained on a Plexiglas model with known coordinates of fiducial markers, before and after predefined table movements. Intraoperative accuracy measurements were recorded from 24 patients undergoing endonasal surgery of the paranasal sinuses with two different referencing techniques (fiducial markers and mouthpiece).

Results:The system demonstrated laboratory accuracy to within 0.86 mm (SD = 0.94 mm). After table movements, the accuracy decreased to 1.12 mm (SD = 0.99 mm), 1.05 mm (SD = 0.96 mm), 1.15 mm (SD = 1.04 mm), and 1.54 mm (SD = 1.25 mm), respectively, in four different positions. Intraoperative accuracy was within 1.14 mm (SD = 0.57 mm) (fiducial markers) and 2.66 mm (SD = 1.89 mm) (mouthpiece) (P< .05). One of the main advantages of the new technology was the possibility of using any common instrument or endoscope by adapting a marker array.

Conclusions:Passive‐marker technology has been demonstrated to be useful for optical position determination in computer‐aided surgery.
Effects of Environmental Tobacco Smoke on Objective Measures of Voice Production
Authors: Lee Linda , Stemple Joseph C. , Geiger Diane , Goldwasser Rebecca
Published: November 2003

Objective: The effects of passive smoking on the voice and laryngeal structures of 20 female passive smokers and 20 age‐matched nonsmokers were examined.

Methods: The voice evaluation consisted of acoustic, aerodynamic, and videostroboscopic analyses.

Results: Three passive smokers displayed mild edema or erythema. Passive smokers had higher mean flow rates and shorter mean maximum phonation times during sustained vowels at comfortable, low‐, and high‐pitch levels. However, means were only outside normal limits and significantly different from nonsmokers at high pitch. Variables such as the number of years and hours per day subjects were exposed to environmental tobacco smoke were considered.

Conclusion: The majority of the variables indicated that vocal fold structure and function were not adversely altered by exposure to passive smoke. Differences between these results and clinical observations are highlighted.
Laryngeal Contact Granuloma
Authors: Wani Manish K. , Woodson Gayle E.
Published: November 2003

Objective: To report outcomes of treatment for laryngeal contact granuloma.

Study Design: Prospective treatment of 21 patients with laryngeal contact granulomas using proton‐pump inhibitor (PPI) medication.

Methods: Patients were diagnosed and followed by office endoscopy and patient interview.

Results: Three patients did not tolerate PPI medication and were managed by treatment with type 2 histamine (H2) blockers. The lesion completely resolved in 14 of the 18 patients maintained on PPI medication, and significantly regressed in the other 4. Residual granulomas were surgically excised in one patient. Lesions resolved in two patients following injection of botulinum toxin into one thyroarytenoid muscle. One patient had a residual lesion, but symptoms were controlled by medication, and he declined treatment with botulinum toxin. Of the three patients treated with H2‐blocker medication, the lesion resolved in only one.

Conclusion: PPI medication is effective in the treatment of laryngeal contact granuloma, even in the absence of identifiable symptoms of gastroesophageal reflux.
Penetration of Cefuroxime Into Chronically Inflamed Sinus Mucosa
Authors: Dinis Paulo Borges , Monteiro Maria Conceição , Lobato Rosário , Martins Maria Luz , Gomes Augusto
Published: November 2003

Objectives: Despite its seeming relevance, limited information exists about antibiotic sinus tissue penetration and how it is affected by inflammation. Thus the reason for the present investigation.

Study Design: A randomized, open, multiple‐dose, pharmacological study, employing cefuroxime axetil, an approved oral antimicrobial for the treatment of acute bacterial rhinosinusitis, was developed.

Methods: Twenty subjects, selected for surgery because of chronic rhinosinusitis, were randomly allocated to receive either a short (3‐8 d) or a long (9‐14 d) preoperative treatment regime with 500 mg cefuroxime axetil BID, the last dosage being taken 3 to 4 hours before surgery. At the operation, tissue samples were collected at specific sinonasal sites for both pharmacological determination of antibiotic levels and histopathological assessment of the degree of inflammation. The blood levels of the drug were simultaneously assayed.

Results: Cefuroxime kinetic behavior on chronically inflamed mucosa was shown to be, for the most part, dependent on the blood levels, regardless of the inflammatory state. Distribution was even throughout the different sinus cavities, and the tissue levels were still, 3 to 4 hours after dosing, above the reported minimum inhibitory concentration (MIC) values for some of the most prevalent sinus pathogens. The extended treatment course did not seem to add any extra histopathological or pharmacological benefit.

Conclusions: Cefuroxime penetrates adequately and uniformly into chronically inflamed sinus mucosa, apparently unaffected by the degree of inflammation, in a way not dissimilar to its pharmacokinetic behavior in the normal state. Persistent MIC levels for common pathogens still warrant antimicrobial efficacy for a significant period of time after dosing.
Combined Arytenoid Adduction and Laryngeal Reinnervation in the Treatment of Vocal Fold Paralysis
Authors: Chhetri Dinesh K. , Gerratt Bruce R. , Kreiman Jody , Berke Gerald S.
Published: November 2003

Objective/Hypothesis: Glottal closure and symmetrical thyroarytenoid stiffness are two important functional characteristics of normal phonatory posture. In the treatment of unilateral vocal cord paralysis, vocal fold medialization improves closure, facilitating entrainment of both vocal folds for improved phonation, and reinnervation is purported to maintain vocal fold bulk and stiffness. A combination of medialization and reinnervation would be expected to further improve vocal quality over medialization alone.

Study Design: A retrospective review of preoperative and postoperative voice analysis on all patients who underwent arytenoid adduction alone (adduction group) or combined arytenoid adduction and ansa cervicalis to recurrent laryngeal nerve anastomosis (combined group) between 1989 and 1995 for the treatment of unilateral vocal cord paralysis. Patients without postoperative voice analysis were invited back for its completion. A perceptual analysis was designed and completed.

Methods: Videostroboscopic measures of glottal closure, mucosal wave, and symmetry were rated. Aerodynamic parameters of laryngeal airflow and subglottic pressure were measured. A 2‐second segment of sustained vowel was used for perceptual analysis by means of a panel of voice professionals and a rating system. Statistical calculations were performed at a significance level of P = .05.

Results: There were 9 patients in the adduction group and 10 patients in the combined group. Closure and mucosal wave improved significantly in both groups. Airflow decreased in both groups, but the decrease reached statistical significance only in the adduction group. Subglottic pressure remained unchanged in both groups. Both groups had significant perceptual improvement of voice quality. In all tested parameters the extent of improvement was similar in both groups.

Conclusion: The role of laryngeal reinnervation in the treatment of unilateral vocal cord paralysis remains to be established.
Penicillin Reduces New Bone Formation in Acute Otitis Media
Authors: Cayé‐Thomasen Per , Tos Mirko
Published: November 2003

Objective: Previous studies have shown that acute otitis media alters modeling dynamics in bone tissue structures surrounding the middle ear cavity. Initial resorption is followed by formative activity, which is seen as massive osteoneogenesis. However, neither resorptive nor formative activity occurs in the otic capsule, supporting the theory on existence of a perilymphatic barrier of specialized bone.

Study Design: To investigate the effect of penicillin administration on the pathological bone modeling in acute otitis media, we employed a rat model of acute pneumococcal otitis media.

Methods: Five rats were sacrificed on postinoculation days 4, 8, 16, 90, and 180, preceded by oral administration of penicillin V 100 mg/kg per day, initiated on day 2 and lasting 5 (2) days. Using a light microscope, bone histomorphology was registered and the thickness measured in four well‐defined localities, followed by comparison with a previous study of untreated animals.

Results: Measured bone thickness was unaffected by treatment on day 4, but significantly reduced in two localities on day 8 and in all localities on following days of sacrifice. Bone cytomorphology and histomorphology were otherwise unaffected by penicillin administration.

Conclusion: Penicillin reduces new bone formation in acute otitis media, leaving other features of histomorphology unchanged.
Cochlear Microphonics for Hearing Preservation in Vestibular Schwannoma Surgery
Authors: Noguchi Yoshihiro , Komatsuzaki Atsushi , Nishida Hiroaki
Published: November 2003

Objectives: To determine whether cochlear function is beneficial in decision‐making concerning the selection of hearing preservation surgery for vestibular schwannoma.

Study Design: Retrospective review of 44 patients undergoing tumor resection with a middle fossa approach.

Methods: Cochlear microphonics in electrocochleography together with tumor size, pure‐tone average (PTA), speech discrimination score (SDS), auditory brainstem response (ABR), and compound action potentials were examined. As acoustic stimuli, short tone‐bursts with frequencies of 0.5, 1, and 2 kHz were employed to measure cochlear microphonics and a click was used to obtain compound action potentials. We determined detection thresholds of cochlear microphonics and action potentials.

Results: The overall rate of preservation of serviceable hearing was 59.1% (26/44). There were significant differences between patients with and without serviceable postoperative hearing in PTA, SDS, finding of ABR, compound action potential detection threshold, and mean cochlear microphonic detection threshold (at 0.5, 1, and 2 kHz). However, tumor size was unrelated to hearing outcome. Serviceable hearing was preserved in 23 (76.7%) of 30 patients, with a mean cochlear microphonic detection threshold of 40 dB nHL or less, suggesting normal or slightly impaired cochlear function. Hearing recovery was recognized in three patients, who also had a mean cochlear microphonic detection threshold of 40 dB nHL or less. Of the three patients, two had lower cochlear microphonic detection thresholds than audiometric thresholds, demonstrating the existence of a retrocochlear component in their hearing loss.

Conclusions: The cochlear microphonic detection threshold predicts not only hearing preservation but also hearing improvement in patients with vestibular schwannomas.
Increased Expression of Inducible Nitric Oxide Synthase in Nasal Epithelial Cells in Patients With Allergic Rhinitis
Authors: Kawamoto Hiroko , Takeno Sachio , Yajin Koji
Published: November 2003

Objectives: Although ciliated epithelial cells of human nose and paranasal sinuses have recently been reported to be the major source of locally detected nitric oxide (NO), changes to the NO production by these cells and their functional roles remain uncertain in relation to allergic rhinitis. The objective of this study is to investigate differences in the ability of induction of nitric oxide synthase (NOS) isoforms by nasal epithelial cells.

Study Design: Epithelial cells of the inferior turbinate taken from 12 normal subjects and 12 allergic patients against house dust mite were used. Samples from the house dust group were taken both before and after antigen provocation.

Methods: Immunoreactivity for two NOS isoforms, inducible NOS (iNOS) and endothelial NOS (eNOS), was examined by the laser scanning confocal microscope. The labeled cells were processed into digital images, and the fluorescence intensity was assessed quantitatively.

Results: The degree of iNOS expression of the epithelial cells was significantly elevated in the house dust group compared with that of the control group. The expression appeared identical both before and after antigen provocation in the house dust group. On the other hand, there was no significant difference in eNOS expression between the two groups.

Conclusions: We assume that the increased iNOS expression of the epithelial cells in the house dust group might result from stimulated secretion of proinflammatory cytokines during allergic responses. This further suggests profound contribution of nasal epithelial cells to modifying the airway clearance through the production of high levels of NO.
Accessory Nerve Function After Modified Radical and Lateral Neck Dissections
Authors: Köybasioglu Ahmet , Tokcaer Ayse Bora , Uslu S. Sabri , Ileri Fikret , Beder Levent , Özbilen Suat
Published: November 2003

Objectives: Evaluate preoperative and postoperative electrophysiological changes related to the accessory nerve with reference to dissection technique, modified radical neck dissection, and lateral neck dissection.

Study Design: Prospective electrophysiological analysis of accessory nerve function in a total of 20 laryngeal carcinoma patients after neck dissection, 12 being lateral neck dissection (4 bilateral) and 8 being modified radical neck dissection.

Methods: Distal latencies, compound muscle action potentials, and electromyography findings were investigated before surgery and, in early and late postoperative periods in 20 laryngeal carcinoma patients. Results were evaluated by Student t test and χ2 test for intragroup and intergroup differences.

Results: In the lateral neck dissection group, postoperative distal latencies were longer, without statistical significance, whereas in the modified radical neck dissection group postoperative latencies were statistically longer. Postoperative compound muscle action potentials were significantly lower in both groups. Electromyographic work‐up showed deterioration in early postoperative periods and improvement in late postoperative periods. When intergroup differences were compared, both postoperative compound muscle action potential and electromyographic findings were worse in the lateral neck dissection group.

Conclusions: The accessory nerve function after modified radical neck dissection is better than function after lateral neck dissection because of increased stress applied to the nerve during retraction of the sternocleidomastoid muscle for achievement of a better exposed surgical field in lateral neck dissection.
Characteristic Distribution Patterns of Tenascin in Laryngeal and Hypopharyngeal Cancers
Authors: Juhász Attila , Bárdos Helga , Répássy Gábor , Ádány Róza
Published: November 2003

Objectives: Progression of malignant neoplasias is accompanied by alteration of the extracellular matrix (ECM) composition. Tenascin is known as a member of the adhesion‐modulating family of ECM macromolecules; thus its expression and distribution may have significant influence on tumor cell proliferation and invasiveness.

Study Design: The present study was carried out to determine the distribution pattern of tenascin in laryngeal and hypopharyngeal cancer samples.

Methods: In double and triple immunofluorescent staining reactions the detection of tenascin was combined with labelings for cytokeratin (marker protein of epithelial cells), for CD‐34 (endothelial cell surface glycoprotein), and for a reaction with Ki‐67 monoclonal antibody (nuclear antigen in proliferating cells).

Results: In laryngeal cancers, in early stages of tumor growth a markedly enhanced production of tenascin at the tumor host interphase was observed. In the later stages of tumor progression, a high number of blood vessels located in the tumorous tissues were also strongly labeled for tenascin. Around these vessels a significant number of proliferating tumor cells could be detected. In contrast, in hypopharyngeal cancers this vasculature‐associated staining pattern could be observed from the very early stage of tumor development. In laryngeal and in hypopharyngeal cancers, tenascin upregulation strongly correlated with metastasis formation, early tumor recurrence, and lethal outcome of the disease.

Conclusions: Clinical and immunohistologic data indicate that the accumulation of tenascin in the tumor blood vessels is an unfavorable prognostic indicator in laryngeal and hypopharyngeal cancers.
Aspiration of Nasal Secretions Into the Lungs in Patients With Acute Sinonasal Infections
Authors: Özagar Altuğ , Dede Fuat , Turoğlu H. Turgut , Üneri Cüneyt
Published: November 2003

Objectives: To compare the amounts of nasal secretions aspirated into the lower airway by patients with acute sinonasal infection with that aspirated by healthy adults during sleep.

Study Design: Sixteen patients who had received a diagnosis of acute sinonasal infections by accurate history, anterior rhinoscopic examination, and radiological assessment and 13 healthy volunteers, aged 14 to 45 years.

Methods: A 10‐mCi dose of technetium 99m‐labeled macroaggregated albumin (Tc‐99m MAA) with a concentration of 1 mCi/mL was prepared at midnight, just before sleep. Each subject was administered two puffs of this spray. At 8 AM the next morning transmission and emission views of the thorax were taken with a gamma camera.

Results: No significant difference between the two groups was observed in the amounts of nasal secretions aspirated into the lungs.

Conclusions: The amount of nasal secretions aspirated does not increase during acute sinonasal infection. However, by irritating the mucosa of the lower respiratory tracts, bacteria, toxins, and inflammatory products existing in purulent secretions may play a major role in the pathophysiology of asthma and sinusitis.
Apoptosis and Phagocytosis of Tissue‐Dwelling Eosinophils in Sinonasal Polyps
Authors: Davidsson Åke , Andersson Tina , Hellquist Henrik B.
Published: November 2003

Objective: Sinonasal polyps contain numerous tissue‐dwelling eosinophils, but the mechanisms causing their accumulation, functional activities, and resolution are largely unknown.

Study Design: Nasal polyp tissue from 14 patients was evaluated for cellular expression of CD95, CD68, and Annexin‐V, for the degree of apoptosis, and for phagocytosis of eosinophils.

Material and Methods: Histological sections were immunostained as single stains for CD95, CD68, and Annexin‐V, and as an immunostaining for CD68 combined with a modified Vital New Red staining. The latter staining is specific for eosinophils. Other sections were stained by terminal d‐UTP nick end labeling (TUNEL) assay and routinely stained for H&E. Evaluation of the amount of stained cells was performed by counting the average number in 10 randomly chosen high‐power fields. The TUNEL positivity was in all cases confirmed with apoptotic morphology.

Results: The inflammatory infiltrate consisted of numerous eosinophils but also a considerable amount of lymphocytes, mast cells, and macrophage‐like CD68+ cells. CD95 was frequently expressed on eosinophils, on numerous other inflammatory cells, and also on morphologically apoptotic cells. Annexin‐V‐positive eosinophils were not as frequent as CD95+ cells, but numerous Annexin‐V‐positive eosinophils were found. CD68+ cells approximately equalled the number of eosinophils. The number of cells phagocytosing eosinophils varied between polyps. Apoptosis of eosinophils (as evaluated by TUNEL combined with apoptotic morphology) was a common finding in six of the polyps.

Conclusions: Previous in vitro and ex vivo findings of CD95 on eosinophils are now supported by demonstration of CD95 on eosinophils in this in vivo study. This investigation revealed a switch of the membrane‐bound phosphatidylserine of apoptotic cells, which is a novel observation. The study has demonstrated apoptosis of tissue‐dwelling eosinophils, and that CD68+ macrophage‐like cells phagocytose eosinophils within the sinonasal polyps.
A Multicenter Trial of Specific Local Nasal Immunotherapy
Authors: Motta Giovanni , Passali Desiderio , De Vincentiis Italo , Ottaviani Antonio , Maurizi Maurizio , Sartoris Alberto , Pallestrini Eugenio , Motta Sergio , Salzano Francesco A.
Published: November 2003

Objective: To assess the efficacy and safety of specific local nasal immunotherapy (LNIT) in powder form in patients with allergic rhinitis, using subjective and objective parameters.

Study Design: A double‐blind randomized multicenter trial of 102 patients with allergic rhinitis who were treated with specific LNIT for 8 consecutive months.

Methods: After identifying allergens with the skin prick test and sensitization threshold dose with the specific nasal provocation test, 102 patients were selected, of whom 55 were allergic to mites and 47 were allergic to Graminaceae or Parietaria pollen. The specific treatments were self‐administered using an insufflator in two phases (phase 1: increasing doses; phase: 2, maintenance dose). Patients were evaluated before and after 32 weeks of treatment by subjective analysis of their self‐reported symptoms and by objective analysis of nasal provocation test, nasal resistance by anterior rhinomanometry, and mucociliary clearance time.

Results: Clinical efficacy of LNIT for allergy to mites and pollens was confirmed by the differences in the symptoms score between the active group and the placebo group. The nasal provocation test results confirmed that this difference was statistically significant. The rhinomanometric analysis gave positive results for the treated group mainly in LNIT for mites. No differences in mucociliary clearance time were found.

Conclusions: Specific LNIT is effective for allergic rhinitis and appears to offer considerable advantages over other hyposensitization methods. It can be done at home, patient compliance is good, and the treatment is safe.
Acuteness of Preoperative Factors to Predict Hearing Preservation in Acoustic Neuroma Surgery
Authors: Ferber‐Viart Chantal , Laoust L. , Boulud B. , Duclaux R. , Dubreuil C.
Published: November 2003

Objectives: To determine in patients with acoustic neuromas the predictive factors of hearing preservation according to clinical, radiological, and electrophysiological parameters and to evaluate, for each of these predictive factors, the percentage of patients with preserved hearing.

Study Design: The study involved 107 candidates for hearing preservation attempt. Mean age was 49.7 ± 11.4 years. Quantitative and qualitative parameters were prospectively studied. Quantitative parameters were age, duration of functional complaints, hearing loss assessed by pure tone and speech audiometry, and auditory brainstem responses (ABRs). Qualitative parameters (expressed in percentage of presence) were sex, functional complaints, vestibular deficit revealed by vestibular testings, well‐shaped ABRs, wave I, III, or V of ABRs, and transient evoked otoacoustic emissions (TEOAEs).

Methods: Patients were divided into two groups according to whether their hearing was preserved (52.3%) or not preserved (47.7%). First, quantitative and qualitative factors were compared between both groups to identify predictive factors. Second, all patients were considered together and the percentage of hearing preservation was determined according to the presence of each predictive factor.

Results: The results confirmed the predictive value of classic parameters such as preoperative hearing level, radiological data, and trace of ABRs. They also emphasized the predictive role of other parameters such as short duration of hearing loss, presence of wave III in ABRs, and presence of TEOAEs.

Conclusions: The size of the tumor and the preoperative hearing levels are longstanding predictive factors of hearing preservation in acoustic neuroma surgery, and candidates for hearing preservation are therefore now selected according to these factors. This study added more recent predictive factors and, among the 10 factors identified as predictive, the most relevant to hearing preservation were the presence of TEOAEs (69.7%), short duration of hearing loss (66.7%), and presence of wave III in ABRs (66.7%).
Levels of Intracellular Protein and Messenger RNA of Mucin and Lysozyme in Normal Human Nasal and Polyp Epithelium
Authors: Kim Sung‐Shik , Kim Kyung‐Su , Lee Jeung‐Gweon , Park In Yong , Koo Ja Seok , Yoon Joo‐Heon
Published: November 2003

Objectives: Mucus hypersecretion is a characteristic feature in chronic sinusitis with nasal polyps. The objective of this study is to examine whether the polyp epithelium itself contributes to a certain extent to the increased mucous secretions in chronic sinusitis with nasal polyps, and if it does, to determine which mucin genes are responsible for the increased mucin secretion.

Methods: Three pooled samples of normal nasal epithelial cells from each subject were obtained by scrapings from the inferior turbinates of 30 healthy adult volunteers and nasal polyps from 6 patients who underwent intranasal ethmoidectomy and polypectomy. Isolated epithelial cells were used for total RNA isolation for reverse transcriptase polymerase chain reaction and cell lysates for immunoblotting.

Results: The intracellular level of mucin from polyp epithelium was 2.9 times higher than that of normal nasal epithelium (P < .05). Interestingly, MUC2 and MUC8 messenger RNA (mRNA) levels were clearly upregulated in polyp epithelium compared with those of normal turbinate epithelium.

Conclusions: Polyp epithelium can be considered to contribute in part to increased secretion in chronic sinusitis with polyps, and increased mucous secretion might be related to the increased mRNA level of MUC2 or MUC8 or both.
Percutaneous Magnetic Resonance Image–Guided Biopsy and Aspiration in the Head and Neck
Authors: Merkle Elmar M. , Lewin Jonathan S. , Aschoff Andrik J. , Stepnick David W. , Duerk Jeffrey L. , Lanzieri Charles F. , Strauss Melvin
Published: November 2003

Objective/Hypothesis To test the hypotheses that 1) magnetic resonance imaging (MRI)–guided biopsy and aspiration with an open 0.2‐T system (Magnetom Open, Siemens, Erlangen, Germany) in the head and neck is feasible and successful and 2) procedure times can be sufficiently short to be well tolerated by the patient.

Methods Sixty‐one MRI‐guided procedures were performed in 47 patients (ages, 6 mo–88 y) in the head and neck, including the mucosal sites and masticator and parapharyngeal spaces (n = 23), parotid space (n = 6), submandibular space (n = 2), cervical vertebral column/paraspinal tissues (n = 8), skull base (n = 3), larynx or hypopharynx (n = 3), and infrahyoid nodal chains and surrounding tissues (n = 16). A clinical C‐arm imaging system was used, supplemented by an in‐room radiofrequency–shielded liquid crystal monitor, rapid gradient echo sequences for needle guidance, and MRI‐compatible anesthesia, monitoring, and surgical lighting equipment. Tissue sampling included fine‐needle aspiration (n = 58) and cutting‐needle core biopsy (n = 27), with 24 patients undergoing both procedures. Procedures were evaluated for success of needle placement, procedure time, and complications.

Results Successful needle placement was accomplished in all cases without complication, with tissue sufficient for pathological diagnosis obtained for all but five patients with an average of 2.1 passes per patient. For fine‐needle aspiration, average instrument time was 7.8 minutes per pass, and average cutting‐needle core biopsy time was 9.2 minutes.

Conclusions Interactive MRI guidance for needle biopsy and aspiration of deep head and neck lesions is feasible, successful, and safe. Procedure times are sufficiently short to be well tolerated by the patient.
Peripheral Blood T‐Lymphocyte and Monocyte Function and Survival in Patients With Head and Neck Carcinoma
Authors: Heimdal John H. , Aarstad Hans J. , Olofsson Jan
Published: November 2003

Objectives/Hypothesis To determine if the T‐lymphocyte and monocyte functions of peripheral blood mononuclear cells (PBMCs) from patients with head and neck squamous cell carcinomas (HNSCC) are predictive factors for outcome.

Study Design A prospective study describing the outcome, as to total survival and death by disease after at least 40 months observation, of 81 previously untreated male HNSCC patients in relation to PBMC T‐lymphocyte and monocyte function.

Methods T‐lymphocyte mitogenesis and the cytokine level in culture supernatants of PBMC as well as monocytes were analyzed. These parameters were related to survival by Cox regression and Kaplan‐Meier survival analysis.

Results When patients with high versus low T‐lymphocyte mitogen–stimulated proliferations were compared, a decreased proliferation was seen to be related to worse outcome. The predictive value of T‐lymphocyte proliferation was shown to be an independent prognostic factor when adjusted for stage and stratified for anatomic location in survival analysis. The predictive value was also retained when the serum values of the major serum proteins and hormones and scores based on the smoking and alcohol history were added to the survival analysis with lymphocyte proliferation. Supernatant levels of γ‐interferon, interleukin (IL)‐2, or IL‐4 in PBMC cultures were not related to outcome. Monocyte function measured by endotoxin‐stimulated IL‐1β, IL‐6, IL‐12, and tumor necrosis factor‐α secretion did not relate to outcome of the patients.

Conclusion The PBMC T‐lymphocyte–stimulated proliferation is an independent prognostic factor for male HNSCC patients.
Conservative Surgery in T3–T4 Pharyngolaryngeal Squamous Cell Carcinoma: An Alternative to Radiation Therapy and to Total Laryngectomy for Good Responders to Induction Chemotherapy
Authors: Lecanu Jean‐Baptiste , Monceaux Guy , Périé Sophie , Angelard Bruno , St. Guily Jean Lacau
Published: November 2003

Objective To evaluate the possibility of preservation of the larynx after neoadjuvant chemotherapy by performing a conservative surgery instead of total laryngectomy initially planned, in patients with previously untreated laryngeal and piriform sinus squamous cell carcinoma (SCC).

Study Design Retrospective study.

Methods A total of 115 patients treated at Tenon Hospital with induction chemotherapy from 1985 to 1995, all with initial indication of radical surgery, were available for the study. The clinical tumor response was evaluated after three cycles of chemotherapy. According to this response, to preserve laryngeal functions, some patients had a modification of the treatment initially planned: radiation therapy essentially for complete responders, and conservative surgery for some partial responders.

Results Of 69 patients with laryngeal cancer, 14 were treated by partial laryngectomy and 19 by radiation therapy; of 46 patients with piriform sinus cancer, 8 were treated by partial surgery and 12 by radiation therapy; the other patients were treated as was initially planned (total laryngectomy with partial pharyngectomy). Overall survival rates, estimated by the Kaplan‐Meier method, were not statistically different between the three treatment groups. The laryngeal functions were preserved in 54% of the patients who were alive at 3 years.

Conclusion This report is a retrospective study, but these results suggest the possibility of using conservative surgery, instead of initially planned total laryngectomy, for good responders to induction chemotherapy with a small residual tumor.
Lateral Thyrotomy Approach on the Paraglottic Space for Laryngocele Resection
Authors: Thomé Robert , Thomé Daniela Curti , De La Cortina Rodrigo A. C.
Published: November 2003

Objective To report on the results of using a lateral thyrotomy approach on the paraglottic space to gain greater access for laryngocele resection under direct vision.

Study Design A 26‐year prospective and retrospective study. The study was conducted on 10 adult patients (5 men and 5 women) who had laryngocele of varying size on the paraglottic space. Six of the patients had internal laryngocele and four had exteriorized laryngocele. Five laryngoceles were left‐sided, three were right‐sided, and two were bilateral.

Methods A V‐shaped, full‐thickness thyroid lamina resection with the triangle base at the superior border and the apex at a point midway of the thyroid lamina vertical extent was performed.

Results A V‐shaped lateral thyrotomy made exposure to the paraglottic space possible for direct submucosal laryngocele dissection. This approach has presented no complications to date. Postoperative minor edema or hematoma was found in the aryepiglottic and ventricular folds, but this disappeared within a few days. There was no recurrence; the minimum follow‐up was 1 year.

Conclusion The triangular lateral thyrotomy approach provided access to the paraglottic space and superb visibility for resection of laryngocele of any size under direct vision, thus avoiding recurrence, morbidity, and complications.