bluuebunny/crossref_metadata_2025 huggingface dataset:
Free Tissue Reconstruction of the Hypopharynx After Organ Preservation Therapy: Analysis of Wound Complications
Authors: Teknos Theodoros N. , Myers Larry L. , Bradford Carol R. , Chepeha Douglas B.
Published: November 2003

Purpose Previous series have demonstrated a 77% rate of major wound complications in salvage surgery of the larynx following organ preservation protocols. The purpose of this study is to determine the incidence of wound complications in these patients when microvascular free tissue transfers are used for reconstruction of the hypopharynx.

Design Retrospective case series.

Setting Academic tertiary care center.

Patients and Method We reviewed the medical records of 42 patients with stage III and IV laryngeal squamous cell carcinoma treated with an organ‐sparing protocol consisting of induction chemotherapy followed by definitive radiation therapy. Ten of these patients who required surgical salvage were reconstructed using radial forearm free tissue or lateral arm transfer and constitute the study group.

Main Outcome Measures Wound complications.

Results Wound complications occurred in 2 patients (20%) undergoing free flap reconstruction of the hypopharynx after organ preservation protocols, which was significantly lower (P = .003) than previous reports using other forms of closure and/or reconstruction. One patient in this study group had a small pharyngocutaneous fistula that resolved with conservative therapy after 1 week. The other patient had a larger pharyngocutaneous fistula that resolved over 3 weeks. The mean interval from completion of the chemoradiation regimen to surgery was 21.3 months (range, 2–60 mo). The average free tissue flap size was 94.3 cm2 (range, 45–165 cm2). Average harvest and ischemia times were 59 minutes (range, 41–87 min) and 187.7 minutes (range, 120–240 min), respectively. All flaps survived, and one patient had a minor donor site wound dehiscence. The average hospital stay was 7.8 days. There were no mortalities in this series.

Conclusions Our results suggest that free tissue transfer reconstruction of the hypopharynx is the preferred method of reconstruction following combined chemotherapy and radiation therapy protocols. Surgical complications are significantly reduced and hospital stays are minimized.
Comparison of Wound Healing Using the CO2 Laser at 10.6 μm and 9.55 μm
Authors: Converse George M. , Ries William Russell , Reinisch Lou
Published: November 2003

Objectives/Hypothesis The wound healing characteristics of incisions made with the short pulsed CO2 laser tuned to 9.55 μm versus the traditional 10.6 μm were investigated. Previous studies have shown that at 9.55 μm, collagen is targeted more selectively than at 10.6 μm, which results in decreased acute thermal injury patterns. This study investigates the difference in wound healing over time between lasers and compares laser incisions with cold knife techniques .

Study Design Randomized controlled trial using a porcine model.

Methods Tissue from 10.6‐μm and 9.55‐μm incisions of 10 piglets was evaluated with histological analysis and tensiometry at 3, 7, 14, and 21 days postoperatively. A Bonferroni‐Dunn corrected analysis of variance analysis at a 95% significance level was used to compare the effect of wavelength.

Results The results demonstrate that although knife incisions are consistently stronger than laser incisions, the 9.55‐μm CO2 laser incisions are no stronger than incisions made with the conventional 10.6‐μm laser. Furthermore, histological analysis shows no difference in lateral thermal damage between lasers at 3, 7, 14, and 21 days postoperatively. The progression of collagen formation and inflammation does not differ over time.

Conclusion This study of wound healing using a porcine model demonstrates that the 9.55‐μm CO2 laser does not demonstrate an improvement in wound healing over the traditional 10.6‐μm CO2 laser. These results may be secondary to the common explosive vaporization mechanism produced by both lasers in the infrared spectrum.
Rhino‐Frontal Sinuseptotomy (RFS): A Combined Intra–Extra Nasal Approach for the Surgical Treatment of Severely Diseased Frontal Sinuses
Authors: Stennert Eberhard
Published: November 2003

Objectives Frontal sinus surgery is a challenge to those involved in the treatment of recurrent frontal sinusitis. The purpose of this report is to describe the technique and to present the results of a combined endoscopic and external approach to the frontal sinus (rhino‐frontal sinuseptotomy [RFS]).

Material RFS was performed in 45 patients by the author; 41 of these patients had a follow‐up over 12 months and were included in this series. Indications for RFS were severe chronic frontal sinusitis (n = 23), mucoceles (n = 12), in two cases each with osteoma, inverting papilloma, and malignant tumors of the frontal sinus, respectively. The surgical technique is started with an external approach according to Jansen‐Ritter and includes the resection of the interfrontal septum, partial resection of the nasal septum, bilateral subtotal resection of the middle turbinates, bilateral endoscopic ethmoidectomy, and resection of the frontal sinus floor. The nasofrontal communication is epithelialized with free mucosal grafts and fixed with fibrin clue.

Results After a mean follow‐up of 62 months, 40 patients (98%) had a widely patent epithelialized nasofrontal communication. Ninety‐one percent of the patients with chronic frontal sinusitis or mucoceles noted complete relief of their frontal discomfort within 1 week after RFS. No patient required revision surgery of the nasofrontal outflow tract after RFS. Only one severe complication was recognized (cerebrospinal fluid leakage).

Conclusion The results reported here with the RFS technique are superior to those reported on external procedures and endoscopic drill‐out procedures. The key to successful management is the creation of a large nasofrontal communication, and direct epithelialization with free mucosal grafts obtained from the septum and turbinates.
Use of Dexamethasone on the Prophylaxis of Nausea and Vomiting After Tympanomastoid Surgery
Authors: Liu Yun‐Hou , Li Min‐Jia , Wang Pa‐Chun , Ho Shung‐Tai , Chang Ching‐Fong , Ho Chiu‐Ming , Wang Jhi‐Joung
Published: November 2003

Objective The aim of this study was to evaluate the prophylactic effect of dexamethasone on postoperative nausea and vomiting (PONV) in patients undergoing tympanomastoid surgery.

Study Design Eighty patients (n = 40 in each of two groups) undergoing tympanomastoid surgery under general anesthesia were enrolled in this randomized, double‐blind, placebo‐controlled study.

Methods After tracheal intubation, group 1 received 10 mg dexamethasone intravenously, whereas group 2 received saline intravenously. Several parameters concerning with the occurrence of PONV were evaluated.

Results We found that dexamethasone reduced the total incidence of nausea and vomiting by 45%, with a 95% confidence interval of 26% to 64% (P <.001). Furthermore, dexamethasone reduced the incidence of vomiting episodes >4 times and the incidence of patients requiring rescue antiemetics (P <.05).

Conclusion Dexamethasone at a dosage of 10 mg administered intravenously is effective in preventing PONV in patients undergoing tympanomastoid surgery.
Motility‐Related Proteins as Markers for Head and Neck Squamous Cell Cancer
Authors: Abraham Manoj T. , Kuriakose M. Abraham , Sacks Peter G. , Yee Herman , Chiriboga Luis , Bearer Elaine L. , Delacure Mark D.
Published: November 2003

Hypothesis Increased cell motility is a hallmark of cancer cells. Proteins involved in cell motility may be used as molecular markers to characterize the malignant potential of tumors.

Methods Molecular biology and immunohistochemistry techniques were used to investigate the expression of a selected panel of motility‐related proteins (Rho A, Rac 2, Cdc42, PI(3)K, 2E4, and Arp2) in normal, premalignant, and squamous cell cancer cell lines of human head and neck origin. To assess the clinical potential of these proteins as molecular markers for cancer, immunohistochemistry was performed on paraffin‐fixed head and neck cancer specimens (n = 15).

Results All six motility‐associated proteins were overexpressed in the premalignant and squamous cell cancer cell lines relative to normal keratinocytes. Immunohistochemistry with Rho A and Rac 2 showed increased staining in areas of cancer but not in normal tissue.

Conclusion Proteins involved in cell motility can be used as markers for head and neck squamous cell carcinoma. The head and neck cell lines used in this study may be used as a model to further investigate cell motility. Molecular markers of motility could have a significant impact on the diagnosis and staging of cancers originating from differentiated non‐motile cells.
Quality of Life After Treatment for Advanced Laryngeal and Hypopharyngeal Cancer
Authors: Major M. Scott , Bumpous Jeffrey M. , Flynn Michael B. , Schill Kathleen
Published: November 2003

Objectives To compare health‐related quality of life measures after treatment for advanced (stages III and IV) laryngeal and hypopharyngeal cancers.

Study Design Retrospective chart review and patient response to Health Status Questionnaire‐12 (HSQ‐12).

Methods Our study included 54 patients identified from the Tumor Registry of the University of Louisville Brown Cancer Center who were diagnosed and treated between 1995 and 2000. Demographics, tumor data, and treatment information were obtained from the Tumor Registry database. Questionnaires were mailed to all patients and included telephone follow‐up. Comparative data and responses were analyzed for the 24 patients who responded to the survey.

Results Fifteen patients were treated with chemotherapy and radiation therapy (CRT). Six patients underwent surgery with postoperative radiation therapy (SRT). The remaining three patients were treated with radiation therapy but were not used in this analysis. The average follow‐up was 35 months after treatment. The CRT and SRT groups were statistically similar regarding age, sex, duration of follow‐up, tumor grade, and tumor stage. Laryngeal primary tumors were more common in the SRT group than in the CRT group (P = .005). Eight domains were assessed by the HSQ‐12: physical functioning, role‐physical, bodily pain, health perception, energy/fatigue, social functioning, role‐mental, and mental health. No statistical differences were found between the CRT and SRT groups, except for role limitations attributable to physical health (P = .007).

Conclusions These results indicate that only one of eight domains differs significantly between treatment groups when using the HSQ‐12. Two‐year survival end‐point analysis of global health assessment may represent a simplified and meaningful way to compare treatment modalities in patients with advanced‐stage head and neck cancer.
A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part II: Longitudinal Data
Authors: Bjordal Kristin , Ahlner‐Elmqvist Marianne , Hammerlid Eva , Boysen Morten , Evensen Jan F. , Biörklund Anders , Jannert Magnus , Westin Thomas , Kaasa Stein
Published: November 2003

Objectives To evaluate the health‐related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy.

Study Design Prospective, descriptive study.

Methods All new patients in four institutions in Norway and Sweden were asked to participate. Health‐related quality of life was assessed at baseline and at 1, 2, 3, 6, and 12 months after start of treatment by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC head and neck cancer–specific questionnaire. Baseline results are described elsewhere; longitudinal results are presented in the current article. Three hundred fifty‐seven patients with cancer in the oral cavity, pharynx, larynx, nose, sinuses, and salivary glands and neck node metastases from unknown primaries filled in the questionnaires at baseline.

Results Seventy‐eight percent of the patients who were alive after 12 months filled in all questionnaires (218/280). The general trend was that HRQL deteriorated significantly during treatment, followed by a slow recovery until the 12‐month follow‐up with few exceptions (senses, dry mouth, and sexuality). Patients who later died reported worse HRQL at each assessment point compared with patients who filled in all six questionnaires, whereas those who dropped out of the study for other reasons were quite similar to patients who filled in all questionnaires. The patients with pharyngeal cancer in general reported worse HRQL compared with the other groups and did not reach pretreatment values in several domains. Stage was also an important factor for HRQL in patients with head and neck cancer.

Conclusion Detailed knowledge about the differences between groups and changes over time may aid us in the communication with patients and in the design of intervention studies focusing on improvement of the support and rehabilitation of patients with head and neck cancer.
All‐trans‐retinoic Acid Enhances the Effect of Adenovirus‐Mediated Wild‐Type p53 Gene Transfer in Head and Neck Squamous Cell Carcinoma
Authors: Nakashima Torahiko , Sun Shi‐Yong , Lotan Reuben , Fujiwara Toshiyoshi , Yasumatsu Ryuji , Komiyama Sohtaro , Clayman Gary L.
Published: November 2003

Objectives Adenovirus‐mediated p53 (AdCMVp53) gene therapy for cancer is currently undergoing phase III clinical trials. One problematic aspect of this therapy is that the current protocols result in low transduction of the therapeutic virus in vivo. To search new modalities that can enhance the effect of AdCMVp53 gene therapy, we focused on retinoids.

Methods To study the effect of ATRA in combination with AdCMVp53 gene therapy, we pretreated head and neck squamous cell carcinoma (HNSCC) cells for 72 hours with a low‐dose All‐trans‐retinoic acid (ATRA) (10−7 M‐10−8 M) which will not affect the in vitro cell growth, and then infected the cells with low MOI (30MOI) AdCMVp53. In vitro cell proliferation assays, cell cycle assays were performed. Expression of p53 and p53‐related gene products, BAX and p21, were examined.

Results The combined treatment with ATRA and Ad‐p53 suppressed cell growth and induced apoptosis significantly more than AdCMVp53 treatment alone (P <.05). p53 expression significantly increased more after the combined treatment than after either treatment alone, at both the transcription and protein levels. In addition, increased expression of p21 and BAX, which are downstream gene products of p53, was observed in the combination. ATRA also enhanced the expression of green fluorescent protein (GFP) transduced by an adenovirus‐cytomegalovirus (CMV)‐GFP vector suggesting ATRA enhances adenovirus‐CMV‐promoted vectors through transcription.

Conclusions Our results indicate that ATRA enhances AdCMVp53 expression through transcriptional mechanisms and can synergistically induce apoptosis in HNSCC cells. ATRA has a potential to enhance the effect of adenovirus‐mediated p53 gene therapy for HNSCC.
Pediatric Autoimmune Neuropsychiatric Disorders and Streptococcal Infections: Role of Otolaryngologist
Authors: Orvidas Laura J. , Slattery Marcia J.
Published: November 2003

Objective To increase awareness and understanding of the putative role of streptococcal infection in the development of neuropsychiatric disorders in children and to discuss therapeutic options in this group of patients.

Methods Case illustration and literature review.

Results Two siblings, one with obsessive‐compulsive disorder (OCD) and one with a tic disorder, had tonsillectomy for recurrent streptococcal pharyngitis. At the latest follow‐up visit (11 mo postoperatively), both patients exhibited significant improvement in their psychiatric illnesses. We discuss these cases as well as the diagnosis, pathophysiology, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Conclusion PANDAS is an active area of research investigating the relationship between streptococcal infections and the development of obsessive‐compulsive disorder or tic disorders (or both) in children. The etiopathogenesis of PANDAS is thought to reflect autoimmune mechanisms and involvement of the basal ganglia of susceptible hosts. Because otolaryngologists evaluate a large portion of pediatric patients with recurrent streptococcal pharyngitis, it is important to be aware of this association and to manage these patients appropriately.
Immediate Mobilization Following Fixation of Mandible Fractures: A Prospective, Randomized Study
Authors: Kaplan Brian A. , Hoard Martin A. , Park Stephen S.
Published: November 2003

Objectives To compare outcomes of open reduction and internal fixation of displaced mandible fractures followed by either immediate mobilization or 2 weeks of mandibular‐maxillary fixation.

Study Design A prospective, randomized, single‐blinded study was performed.

Methods The study was performed between January 1, 1997, and March 30, 2000. Inclusion criteria were displaced fractures between the mandibular angles, age greater than 16 years, and no involvement of the alveolus, ramus, condyles, or maxilla. All fractures were repaired by means of open reduction and internal fixation using 2.0‐mm titanium plates secured either in transoral fashion or percutaneously. Data were collected at 6‐week and 3‐ and 6‐month postoperative examinations. Variables were assessed by a surgeon blinded to the history of immobilization and included pain, malunion or nonunion, occlusion, trismus, wound status, infection rates, dental hygiene, and weight loss. Twenty‐nine consecutive patients were enrolled, 16 patients to immediate function and 13 patients to 2 weeks of mandibular‐maxillary fixation.

Results No statistically significant differences were found between groups for any of the variables. Immediate release and temporary immobilization showed mean weight loss of 10 and 8 pounds and trismus of 4.2 and 4.6 cm, respectively. One wound separation and one infection were seen in the immobilization population, and no wound separation or infection was seen in the immediate‐release group. Dental hygiene was similar between the groups. No malunion or nonunion was noted in either group.

Conclusions In this prospective and randomized study, no significant differences were noted between the groups receiving either immediate release or 2 weeks of mandibular‐maxillary fixation. The findings support the treatment of selective mandible fractures with 2.0‐mm miniplates and immediate mobilization.
Tympanic Membrane Grafting With AlloDerm
Authors: Benecke James E.
Published: November 2003

Objective/Hypothesis The purpose of this work is to evaluate the performance of an acellular dermal allograft (AlloDerm; LifeCell Corp., The Woodlands, TX) in tympanic membrane (TM) grafting.

Study Design A retrospective review of 20 consecutive tympanoplasty surgeries using temporalis fascia and 20 consecutive procedures using AlloDerm.

Methods The charts of 20 consecutive adults who underwent tympanoplasty surgery were reviewed to evaluate graft take and hearing results. Similarly, 20 consecutive patients who had TM grafting with AlloDerm were reviewed. Pre‐ and postoperative air–bone gaps (ABG) at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared.

Results There were no graft failures in either the temporalis fascia group or the AlloDerm group. No statistically significant difference was noted in hearing results when comparing the residual conductive loss in both postoperative groups.

Conclusions AlloDerm is a suitable material for TM grafting. This product is especially valuable in revision surgery in which the availability of appropriate autologous grafting material is limited.
Fine‐Needle Aspiration Biopsy
Authors: Amedee Ronald G. , Dhurandhar Nina R.
Published: November 2003

Objectives: Fine‐needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered. It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors. FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment.

Study Design/Methods: This clinical state‐of‐the‐art review article is intended to provide an overview of the clinical use of FNAB in the management of head and neck masses. Relevant case histories are used to illustrate this point.

Results: Fine‐needle aspiration biopsy has a high overall diagnostic accuracy of 95% for all head and neck masses, 95% for benign lesions, and 87% for malignant ones.

Conclusions: There are virtually no contraindications, and complications are minimal. Advantages of FNAB are that it is safe and simple, it can be performed as an outpatient procedure, and it is well tolerated by patients. In the present managed care environment, it also proves cost‐effective. The diagnosis is readily known to the clinician, and appropriate treatment modalities can be discussed with the patient. It is recommended as a first line of investigation in palpable head and neck masses.
Functional Outcomes After Supracricoid Laryngectomy
Authors: Zacharek Mark A. , Pasha Raza , Meleca Robert J. , Dworkin James P. , Stachler Robert J. , Jacobs John R. , Marks Steven C. , Garfield Ilene
Published: November 2003

Objectives Local control and 5‐year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced‐stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking.

Study Design Cohort study.

Methods This investigation provides objective voice laboratory data, skilled listener impressions of voice samples, swallowing evaluations, and patient self‐perceptions of speech ability obtained from 10 supracricoid laryngectomees.

Results Results demonstrated variable acoustic and speech aerodynamic disturbances, hoarse‐breathy vocal quality, and speech dysfluency. Patients' self‐perceptions of voice revealed severe dysphonia that induced certain emotional, physical, and functional setbacks. However, blinded judges rated these individuals as possessing intelligible speech and communication skills. All patients demonstrated premature spillage of the bolus and varying degrees of laryngeal penetration, aspiration, and retention during swallowing studies. However, each patient used a compensatory strategy to protect the airway. Voice and swallowing abilities appeared to depend on the mobility of the arytenoid cartilages, base of tongue action, and residual supraglottic tissue for the creation of a competent neoglottal sphincter complex that vibrated during phonation efforts and protected the airway during deglutition.

Conclusions Supracricoid laryngectomy avoids the potential complications, limitations, and emotional problems associated with a permanent tracheostoma. All patients demonstrated intelligible voice and effective swallowing function postoperatively, supporting supracricoid laryngectomy as a suitable alternative surgical approach to the total laryngectomy in select patients.
Mutation and Abnormal Expression of the Fragile Histidine Triad Gene in Nasopharyngeal Carcinoma
Authors: Deng Yan‐Fei , Tian Fang , Lu Yong‐De , Chen Zhu‐Chu , Xie Ding‐Hua , Yang Xin‐Ming , Shao Xi‐Yun
Published: November 2003

Objective To determine alterations of fragile histidine triad (FHIT) gene in nasopharyngeal carcinoma and the correlation of FHIT gene with nasopharyngeal carcinogenesis.

Study Design Prospective study.

Methods A total of 28 nasopharyngeal carcinoma and 16 normal nasopharyngeal epithelium specimens were examined for abnormalities of FHIT gene by nested reverse‐transcriptase–polymerase chain reaction and DNA sequencing.

Results The deletion of FHIT gene was not observed in 16 normal nasopharyngeal epithelium specimens. In 28 cases of nasopharyngeal carcinoma tissues, 12 (42.9%) exhibited FHIT aberrant transcripts. Complementary DNA sequencing revealed exonic deletion, small DNA insertion, synonymous mutation in exon 8, or frameshift mutation in exon 5.

Conclusions The present results suggest that the FHIT gene may play an important role in the pathogenesis of nasopharyngeal carcinoma and may be one of the candidate tumor suppressor genes in nasopharyngeal carcinoma.
Surgical Anatomy of the Natural Ostium of the Sphenoid Sinus
Authors: Kim Hyun‐Ung , Kim Sung‐Shik , Kang Seong Seok , Chung In Hyuk , Lee Jeung‐Gweon , Yoon Joo‐Heon
Published: November 2003

Objectives This study was undertaken to measure the distance and the angle between the anterior part of nasal cavity and the natural ostium of the sphenoid sinus. The anatomical location of the natural ostium according to the direction of surgeon's operating view toward the anterior wall of the sphenoid sinus was also analyzed.

Study Design This study used careful cadaver dissection under a surgical microscope.

Methods One hundred sagittally sectioned adult cadaveric heads were used. We measured the distances and angles for identifying the natural ostium of the sphenoid sinus using several reference points such as the limen nasi, the sill, and the posteroinferior end of the superior turbinate. In addition, we tried to identify whether the location of the natural ostium is medial or lateral to the posterior end of the superior turbinate.

Results The natural ostium of the sphenoid sinus was located at an angle of 35.9° with a distance of 56.5 mm from limen nasi and at an angle of 34.3° with a distance of 62.7 mm from nasal sill. It was located approximately 1 cm above the posteroinferior end of the superior turbinate and at a medial aspect to the posterior end of the superior turbinate in 83% of specimens.

Conclusions We speculate that the posteroinferior end of the superior turbinate is the best landmark for identifying the natural ostium of the sphenoid sinus. Furthermore, the natural ostium should ideally be searched from a superior and medial aspect in relation to the posteroinferior end of the superior turbinate.
Detection of Macrophage Migration Inhibitory Factor (MIF) in Human Cholesteatomas and Functional Implications of Correlations to Recurrence Status and to Expression of Matrix Metalloproteinases‐3/9, Retinoic Acid Receptor‐β, and Anti‐apoptotic Galectin‐3
Authors: Choufani Georges , Ghanooni Rose , Decaestecker Christine , Delbrouck Karine , Simon Patricia , Schüring Max‐Peter , Zick Yehiel , Hassid Sergio , Gabius Hans‐Joachim , Kiss Robert
Published: November 2003

Objectives To investigate whether the expression of the macrophage migration inhibitory factor (MIF) 1) is detectable, 2) changes in relation to recurrence and infection status, and 3) relates to the levels of expression of growth regulators/differentiation markers, including galectin‐1, ‐3, and ‐8, retinoid acid receptors (RAR)]‐α, ‐β, and ‐γ, binding sites for sarcolectin, and invasion markers (cathepsins ‐B and ‐D, and matrix metalloproteinases [MMP]‐2, ‐3, and ‐9) in human cholesteatomas.

Study Design An analysis of 56 cholesteatomas resected by the same surgeon using canal wall up and canal wall down surgical procedures.

Methods The immunohistochemical levels of expression of MIF and the proteases were quantitatively determined (using computer‐assisted microscopy) on routine histologic slides by specific antibodies, and statistically correlated to parameters of the other markers determined previously in conjunction with data on apoptosis/proliferation.

Results MIF expression was detected. It was significantly higher in the epithelium (P = .002) and vessels (P = .04) of the connective tissues (but not in the connective tissue itself) of recurrent as opposed to non‐recurrent cholesteatomas. The MIF expression is significantly correlated (P = .006) to the RARβ expression in non‐infected cholesteatomas, and to MMP‐3 (P <.01) and anti‐apoptotic galectin‐3 (P = .01) in infected cholesteatomas. The level of MIF expression was also correlated significantly to MMP‐9 (P = 0.003), RARβ (P <.001), and galectin‐8 (P = .003) expression in the cholesteatomas regardless of their infection status.

Conclusions MIF expression in human cholesteatomas is related to the levels of biologic aggressiveness reflected in their recurrence status and MMP expression, and to the differentiation status reflected in their galactin and RARβ expressions. Together with galectin‐3, it could cooperate to form an anti‐apoptotic feedback loop.
Symptoms, Laryngeal Findings, and 24‐Hour pH Monitoring in Patients With Suspected Gastroesophago‐Pharyngeal Reflux
Authors: Ylitalo Riitta , Lindestad Per‐Åke , Ramel Stig
Published: November 2003

Objectives To investigate the laryngeal signs and symptoms associated with gastroesophago‐pharyngeal reflux (GEPR).

Study Design A prospective controlled study.

Methods Nineteen healthy control subjects and 43 patients, 26 with posterior laryngitis (PL) and 17 with a normal larynx and suspected GEPR, were examined using videolaryngoscopy and 24‐hour ambulatory dual‐probe pH monitoring.

Results Pharyngeal acid reflux occurred in 18 (69%) patients with PL, in 9 (53%) patients with a normal larynx, and in 5 (26%) healthy control subjects. Multiple‐comparison procedure showed that pharyngeal reflux was significantly more prevalent in patients with PL than in the healthy control subjects (P <.05). The laryngoscopic findings in patients with pharyngeal reflux varied from normal mucosa to thickening or edema of the posterior wall of the glottis, which was the most frequent finding in the PL group. Erythema was uncommon; it was found only in patients with verified pharyngeal reflux. There was no difference in symptom profile between the patients with PL and patients with a normal larynx or patients with or without pharyngeal reflux.

Conclusions Pharyngeal reflux is significantly more prevalent in patients with posterior laryngitis than in healthy control subjects. Moreover, a certain degree of pharyngeal reflux appears to be a normal phenomenon. The most common laryngeal finding in patients with posterior laryngitis is thickening or edema of the posterior wall of the glottis. GEPR does not yield specific laryngeal symptoms. Thus, it is unreliable to base the reflux diagnosis on symptoms alone.
Clinical Assessment of Intralaryngeal Ultrasonography
Authors: Tamura Etsuyo , Kitahara Satoshi , Kohno Naoyuki
Published: November 2003

Objectives To assess the clinical use of intralaryngeal ultrasonography.

Study Design A retrospective study was conducted of 16 patients with laryngeal lesions treated by laryngomicrosurgery.

Methods An intraluminal ultrasonic tomography apparatus was connected to a radial scanning 30‐MHz miniaturized probe. Under general anesthesia, ultrasonic images were obtained using the filling method.

Results In cases of benign disease, such as vocal cord nodules or polyps, the layers of the mucosa could be identified. Characteristic internal echoes were noted in cases of hemorrhagic polyps, vocal cord cysts, and vocal cord cancer. In case of hemorrhagic polyps, hyperechoic regions were noted within the lesions. In cases of vocal cord cysts, internal echoes were absent, and posterior echoes were mildly enhanced. In cases of vocal cord cancer, infiltration beyond the mucosa could be visualized.

Conclusions Laryngeal lesions can be diagnosed by intralaryngeal ultrasonography using the filling method. Although it does not replace the combination of conventional endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Intralaryngeal ultrasonography can help in determining the extent of tumor involvement during microscopic laser surgery performed under general anesthesia. Confirmation of the results of this pilot study with a larger series of patients is desirable.
Significance of Computed Tomography Pathology in Chronic Rhinosinusitis
Authors: Arango Pablo , Kountakis Stilianos E.
Published: November 2003

Objectives/Hypothesis Multiple reports show that the extent of disease on computer tomography (CT) of the sinuses does not correlate with patients' subjective sinus symptom scores. In the current study, sinus symptom scores of patients with normal findings on sinus CT scans are compared with sinus symptom scores of patients with chronic rhinosinusitis and with disease on CT of the sinuses. The objective is to determine the significance of CT disease in patients with chronic rhinosinusitis.

Study Design Prospective collection of data of consecutive patients seen for possible sinusitis.

Methods Prospective data at a tertiary medical center were collected over an 8‐month period. Computed tomography scans were graded according to Lund and MacKay, and patients were asked to grade each of the major and minor rhinosinusitis symptoms listed by the Rhinosinusitis Task Force from 0 to 10. A score of 0 was given for no symptom at all, and 10 indicated the most severe extent of a symptom.

Results Twenty‐seven patients with sinus complaints had normal findings on sinus CT scans. The average scores for major and minor rhinosinusitis symptoms were 18.6 and 15, respectively. Twenty‐six patients with sinus complaints had disease on CT of their sinuses. The average scores for major and minor rhinosinusitis symptoms for these patients were 42.9 and 22, respectively. Higher symptom scores were seen in the patients with CT disease, and the differences between these two groups were statistically significant (major symptom, P = .000001; minor symptom, P = .02). Patient symptom scores did not correlate with extent of disease on CT as previously reported (r = 0.16).

Conclusion The presence of CT disease translates to higher patient symptom scores compared with symptom scores of patients without CT disease.
Smoking and Tympanoplasty: Implications for Prognosis and the Middle Ear Risk Index (MERI)
Authors: Becvarovski Zoran , Kartush Jack M.
Published: November 2003

Objectives/Hypothesis The objectives of this study are to review the effects of smoking on preoperative middle ear disease severity, long‐term surgical outcome, type and extent of surgery required, the need for ossicular chain reconstruction, and the long‐term hearing results.

Study Design A retrospective chart review.

Materials and Methods The charts of 74 smokers and non‐smokers who underwent over–under tympanoplasty were reviewed. An analysis of the disease severity (using the Middle Ear Risk Index [MERI]) at presentation and type of surgery was performed. A review of graft take and delayed failure (late perforation or atelectasis after 6 mo) and audiologic data were performed.

Results Fifteen patients smoked a mean of 20 cigarettes daily for a mean of 15 years. The MERI was well matched for both groups. There was a trend toward smokers having a higher incidence of otorrhea preoperatively and requiring a more extensive surgical procedure. All patients had full take of the tympanic membrane graft at 6 months; however, delayed surgical failure was seen in 20% of non‐smokers compared with 60% of smokers (P = .050). No statistically significant difference was seen in hearing outcome.

Conclusions Cigarette smoking is associated with more severe middle ear disease preoperatively. More extensive surgery is often needed in smokers to eradicate the disease. Most significantly, smoking is associated with a threefold increase in the chance of long‐term graft failure. Based on the results of this study, the MERI has been revised to include smoking as a risk factor.
Sound‐Evoked Myogenic Potentials and Responses With 3‐ms Latency in Auditory Brainstem Response
Authors: Ochi Kentaro , Ohashi Toru
Published: November 2003

Objectives The vestibular‐evoked myogenic potential (VEMP) has shed new light on vestibular testing. A large negative deflection with a 3‐ms latency within the auditory brainstem response (ABR) has been reported in some patients with deafness. This negative deflection has been termed the N3 potential and it is assumed to be a vestibular‐evoked potential. This study investigated the relationship between the VEMP and the N3 potential.

Study Design Prospective evaluation of the VEMP and the N3 potential in 21 patients.

Methods The oto‐neurological tests, including caloric test, hearing sensitivity test, VEMP, and ABR, were performed and data were analyzed.

Results The average hearing threshold ranged from 65 to above 110 dB, which includes 9 (37.5%) totally deaf ears. The N3 potentials were recorded in 10 (41.7%) ears. A normal VEMP was detected in 16 (66.7%) ears. Canal paresis was observed in 11 (45.8%) ears.

Conclusions Both the VEMP and the N3 potential appear to originate from the sacculus, but because the characteristics of these two responses are not identical, additional factors might be involved in the generation of the N3 potential.
Morphologic Correlates for Laryngeal Reinnervation
Authors: Gacek Richard R.
Published: November 2003

Objective To describe morphologic correlates for laryngeal reinnervation.

Study Design Review of anatomic experiments dealing with laryngeal innervation performed over a 25‐year period.

Methods Description of results from experimental studies on the cat and human laryngeal muscles and nerve supply.

Results Despite separation of abductor and adductor laryngeal motor neurons in the central nervous system, the mixture of abductor and adductor axons in the recurrent laryngeal nerve indicates that selective re‐innervation of an individual laryngeal muscle must be accomplished at the neuromuscular junction (NMJ) of the muscle. The optimal time for a reinnervating neural source to re‐occupy vacated NMJ is at the time of denervation. If the reinnervation procedure is attempted long (>1 mo) after denervation, extraneous end plates of other neural systems must be eliminated to provide vacant NMJ. The nerve muscle pedicle (NMP) concept is an effective model for reinnervation of a laryngeal muscle provided its activity pattern is similar to that of the denervated muscle and its insertion into vacated NMJ is timely.

Conclusion NMP offers a logical method for selective laryngeal muscle reinnervation. Critical to the success of NMP are the physiological input to the NMP and timing of NMP implantation.
Nitric Oxide Improves Cisplatin Cytotoxicity in Head and Neck Squamous Cell Carcinoma
Authors: Azizzadeh Babak , Yip Helena T. , Blackwell Keith E. , Horvath Steve , Calcaterra Thomas C. , Buga Georgette M. , Ignarro Louis J. , Wang Marilene B.
Published: November 2003

Objective To test whether nitric oxide (NO) enhances the cytotoxicity of cisplatin in a head and neck squamous cell carcinoma (HNSCC) cell line.

Background Cisplatin is one of the most frequently used chemotherapeutic agents in the treatment of HNSCC. NO has been shown to play an important role in regulating tumor growth. Previous studies demonstrate that NO can enhance the cytotoxicity of cisplatin in Chinese hamster lung fibroblasts. In this report, we examined the in vitro interaction of NO and cisplatin in a HNSCC cell line.

Materials and Methods CCL23 cells were pretreated with three different NO donors: PAPA/NO (t 1/2 = 15 min), DPTA/NO (t 1/2 = 3 h), and DETA/NO (t 1/2 = 20 h). The cells were rinsed and exposed for 6 hours to a culture medium containing cisplatin. Cell survival and LD50 of cisplatin were calculated with and without NO pretreatment.

Results PAPA/NO and DPTA/NO did not show any cytotoxic activity and did not change the LD50 of cisplatin. DETA/NO when used alone resulted in 25.6% cell death at its peak dose (100 μM). Pretreatment with DETA/NO resulted in almost a threefold reduction of the LD50 of cisplatin (6.8 vs. 2.4 μg/mL). Pretreatment with DETA/NO sensitized the HNSCC cells to subsequent cisplatin activity (two‐sided P = .00016).

Conclusion Pretreatment of HNSCC cells with long‐acting NO donors enhances cisplatin activity. Short‐ and medium‐acting NO donors do not exert a toxic effect and do not augment the activity of cisplatin. NO agonists should be considered in the future as a possible adjunct to cisplatin in the treatment of HNSCC. Further studies with animal models are necessary to further clarify this relationship.
Methylene Blue and Sestamibi: Complementary Tools for Localizing Parathyroids
Authors: Orloff Lisa A.
Published: November 2003

Objective To determine the value and correlation between sestamibi scan and methylene blue staining for localization of parathyroid glands in patients with primary hyperparathyroidism.

Study Design Nonrandomized convenience sample, followed prospectively.

Methods Twenty‐three consecutive patients underwent 24 operations for primary hyperparathyroidism. All patients underwent preoperative technetium 99m–sestamibi planar scintigraphy, preoperative administration of 7.5 mg/kg methylene blue initiated within 60 minutes of surgical incision, and surgical neck exploration supervised by a single surgeon.

Results All patients were cured of hypercalcemia. Sensitivity for sestamibi and for methylene blue staining was 76% and 79%, respectively. Specificity for sestamibi and for methylene blue was 98% and 93%, respectively. Agreement between sestamibi and methylene blue was 96%.

Conclusions Sestamibi scanning and methylene blue staining are useful, complementary localizing tools for patients undergoing surgery for primary hyperparathyroidism. When used together, these studies decrease operative time, justify unilateral exploration in patients with parathyroid adenoma, and increase the ease of identification of hyperplastic parathyroid glands.
Vocal Function Following Radiation for Non‐Laryngeal Versus Laryngeal Tumors of the Head and Neck
Authors: Fung K. , Yoo J. , Leeper H. A. , Hawkins S. , Heeneman H. , Doyle Phil C. , Venkatesan V. M.
Published: November 2003

Objective The larynx may receive high doses of radiation even in the absence of disease. Preliminary investigation has provided evidence that significant voice alterations exist in patients who received radiotherapy (RT) for non‐laryngeal tumors of the head and neck. This study evaluates subjective and objective parameters of vocal function in this patient population compared with a control group of patients irradiated for early glottic tumors.

Study Design Retrospective cohort study.

Methods Vocal function in patients irradiated for non‐laryngeal and early glottic tumors was assessed in a comprehensive manner and compared. Microanalytical and macroanalytical acoustic analyses, aerodynamic measurements, and videostroboscopy were performed on vowel production data. The Voice Handicap Index was administered for self‐assessment of voice quality. All subjects were male, smokers, and greater than 12 months post‐RT.

Results Seventeen patients with non‐laryngeal tumors and 13 patients with early glottic tumors were evaluated. Microanalytical acoustic parameters were worse for 75% (6 of 8) of the acoustic measures of vowel production in the non‐laryngeal group. These include jitter, relative amplitude perturbation, amplitude perturbation quotient, normalized noise energy, pitch amplitude, and spectral flatness ratio. Macroanalytical acoustic analyses revealed no difference in fundamental frequency but numerically smaller phonational frequency range in the non‐laryngeal group. All aerodynamic measures, including mean phonation time, mean airflow, and vocal fold diadochokinetic rate, were decreased in the non‐laryngeal group. Videostroboscopy demonstrated increased supraglottic activity in the non‐laryngeal group. Voice handicap was significantly greater in the non‐laryngeal group.

Conclusions When compared with patients receiving RT for early glottic tumors, there is objective and subjective evidence of vocal dysfunction in patients treated with wide‐field RT for non‐laryngeal tumors.
Endoscopic Inferior Turbinate Reduction: An Outcomes Analysis
Authors: Gupta Ashmit , Mercurio Eduardo , Bielamowicz Steven
Published: November 2003

Objectives/Hypothesis In a previous publication, we introduced an endoscopic technique for the treatment of nasal obstruction caused by inferior turbinate hypertrophy. The technique, a modification of the procedure popularized by Mabry, involves resecting the inferior and lateral aspects of the inferior turbinate with a microdebrider under endoscopic guidance. Our preliminary postoperative results were favorable. All 20 patients experienced improvement by postoperative day 5 and the incidence of complications over the first 6 months after surgery was low. The objective of this study is to perform a long‐term outcomes analysis of patients undergoing the procedure.

Study Design Follow‐up survey questionnaire and analysis.

Methods We sent questionnaires to 60 patients, ranging from 6 to 40 months after surgery, inquiring about continued use of nasal medications, need for further surgery, presence of adverse effects, and improvement in symptoms. Nasal airway obstruction was assessed on a subjective scoring scale from 1 (no obstruction) to 6 (complete obstruction).

Results Of the 28 (47%) patients who returned questionnaires, the severity of daytime nasal obstruction was rated as 2.3 and nighttime nasal obstruction as 2.7. The use of nasal steroids and oral decongestants was 25% and 21%, respectively. Adverse effects were minimal and all but one patient (96%) experienced improvement in their nasal airway.

Conclusion These results confirm the long‐term effectiveness of this procedure for the relief of nasal obstruction.
Olfactory Epithelium Grafts in the Cerebral Cortex: An Immunohistochemical Analysis
Authors: Holbrook Eric H. , DiNardo Laurence J. , Costanzo Richard M.
Published: November 2003

Objective To develop an alternative model for studying the regenerative capacity of olfactory neurons.

Study Design An immunohistochemical analysis of mouse olfactory epithelium transplanted to the cerebral cortex.

Methods Strips of olfactory epithelium removed from donor mice at postnatal day 5 to day 20 were inserted into the parietal cortex of adult mice. Recipient animals were allowed to survive for 25 to 120 days and then perfused with 4% paraformaldehyde 1 hour after bromodeoxyuridine injection. The brains were processed, and frozen sections were obtained. Sections through transplant tissue were analyzed using immunohistochemistry and compared with normal olfactory epithelium.

Results Graft survival approached 85% with mature olfactory neurons detected in 35% of the transplants stained for olfactory marker protein. Transplant epithelium resembled normal olfactory epithelium containing mature olfactory neurons and axon bundles.

Conclusions Studies of olfactory neuron regeneration have been limited by the inability to produce cultures with long‐term viability. Olfactory epithelial grafts to the cerebral cortex provide an alternative approach to the study of olfactory neuron regeneration.