bluuebunny/crossref_metadata_2025 huggingface dataset:
Coinfection of HPV‐11 and HPV‐16 in a Case of Laryngeal Squamous Papillomas With Severe Dysplasia
Authors: Lin Ken‐Yu , Westra William H. , Kashima Haskins K. , Mounts Phoebe , Wu T.‐C.
Published: November 2003

Human papillomavirus (HPV) types 6 and 11 have been associated with benign laryngeal papilloma, while HPV‐16 is occasionally associated with laryngeal carcinoma. In this study, a case of laryngeal squamous papillomas with severe dysplasia was evaluated for the presence of HPV infection. The biopsy specimens were taken from a 58‐year‐old female patient at two different time points 3 months apart. Architecturally, the tumor showed papillary configuration reminiscent of squamous papilloma. Cytologically, the lesion showed morphologic features characteristic of severe squamous epithelial dysplasia. HPV infection was determined by DNA in situ hybridization using type‐specific HPV‐DNA probes. HPV‐11 probes demonstrated homogeneous nuclear staining, suggesting productive viral replication. In contrast, HPV‐16 probe produced a speckled pattern, suggesting HPV‐16 DNA integration. Normal laryngeal epithelium did not yield specific hybridization. The presence of HPV‐11 and HPV‐16 was confirmed by PCR using HPV type‐specific primers. Immunocytochemical staining was performed to detect Ki‐67, a proliferation marker, and p53. Ki‐67 expression was demonstrated throughout the whole thickness of epithelium. Staining for p53 was negative. This study suggests that multiple HPV infections can occur in the same lesion and that HPV‐16 infection and its DNA integration may contribute to the occurrence of severe dysplasia in the lesion described.
Treatment of Ventricular Dysphonia With Botulinum Toxin
Authors: Kendall Katherine A. , Leonard Rebecca J.
Published: November 2003

Ventricular dysphonia, traditionally known as dysphonia plica ventricularis, is a voicing disorder in which the false vocal folds are used as a vibratory source in addition to or instead of the true vocal folds. Traditional treatment of ventricular dysphonia has been voice therapy, which may be slow to produce results if the false fold activity masks an underlying problem of the true folds, is long standing, or has produced hypertrophy of the supraglottic structures. We present seven cases of ventricular dysphonia treated with botulinum toxin injection into the false vocal folds followed by speech therapy. The addition of botulinum toxin to the treatment regimen speeds recovery of normal voicing and allows immediate evaluation of dynamic true vocal fold function by the treating professional.
A Convenient and Efficient Moldable Dressing for Skin Grafts
Authors: Ducic Yadranko , Hilger Peter A. , Fish Frederick S. , Bartlett Andrew J.
Published: November 2003

In this paper we present our positive experience with use of Aquaplast thermoplastic as a tiedown dressing for securing and maintaining skin grafts in good position against their nutrient recipient beds. This unique polymer is safe to use, simple to apply, and maintains uniform pressure across the entire surface of the skin graft, no matter how contoured the shape of the anatomical region.
Biomechanical Effects of e‐PTFE Implant Structure on Soft Tissue Implantation Stability: A Study in the Porcine Model
Authors: Greene David , Pruitt Lisa , Maas Corey S.
Published: November 2003

Successful implantation of biocompatible materials depends on physical aspects of its structure. Meshed implants are stable but cannot be easily removed. Nonporous materials are easily removed, but subject to extrusion. We hypothesized that the microporous structure of expanded polytetrafluoroethylene(e‐PTFE) would permit limited fibrous ingrowth into the substance of the material, and that tubular implant shape would increase tissue integration while preserving ease of removal. A two‐tailed in vivo study was done comparing implant retention, strength of fixation, and removability between tubular and solid‐strip e‐PTFE implants. Differences in implant retention within tissues were assessed by implanting 396 implants subcutaneously in five swine for observation periods ranging from 3 weeks to 12 months. Strength of implant attachment to host soft tissues was measured at 52 sites by extraction with a tensiometer with forces both parallel and perpendicular to the implant used. Implant porosity was assessed with scanning electron micrography of tubular and solid‐strip e‐PTFE implants. Measurements of the force and stress tolerances of the implant‐tissue interface demonstrated significantly stronger attachment in tubular than strip‐shaped implants (P < 0.005). The 11 N (2.75 lb) force sustained by the tubular implant exceeded the 3.4 N(<1 lb) force for the e‐PTFE strip by a statistically significant margin on two‐tailed Student's t‐test (P < 0.005). Even greater forces were tolerated when applied at right angles to the axis of the tubular implant, emulating tissue suspension (21 N, 5.25 lb). The forces and stresses tolerated by both e‐PTFE implants far exceeded the fracture stress measured for the implants. Implant extrusion rates were significantly smaller in tubular (0.85%) than in strip‐shaped (4.4%) e‐PTFE implants (P< 0.05). Standard error of the mean (SEM) demonstrated lesser porosity in tubular than strip implants, suggesting lesser direct tissue attachment. Tubular e‐PTFE implant structure facilitates ingrowth of soft tissue through the tube's lumen. This increases the attachment to surrounding soft tissues, increasing fixation strength, decreasing extrusion rate, but still allowing easy removal. These properties may improve clinical applications in facial implantation.
Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery
Authors: Dew Leigh Anne , Shelton Clough , Harnsberger H. Ric , Thompson B. Gregory
Published: November 2003

When exposing the horizontal petrous carotid artery in preparation for intrapetrous carotid by‐pass, the surgeon has no definite landmarks to localize the perimeter of the cochlea. The results of this study provide a practical, consistent, and safe method to maximize carotid artery exposure while minimizing cochlear injury. We measured the carotid‐cochlea distance (mean, 4.3 mm) and the carotid‐cochlear angle (mean, 10.8°) in 33 temporal bones in which the extended middle fossa approach had been performed. We correlated this distance to the width of a Sheehy weapon knife, which can be easily measured intraoperatively. Twenty‐five temporal bones were imaged prior to surgical exposure using a new computed tomography (CT) protocol that can be used for preoperative assessment of the carotid‐cochlear anatomy. The carotid‐cochlea distance and carotid‐cochlear angle measured on CT are compared with postsurgical measurements.
Simultaneous Treatment With BDNF and CNTF After Peripheral Nerve Transection and Repair Enhances Rate of Functional Recovery Compared With BDNF Treatment Alone
Authors: Lewin Sheryl L. , Utley David S. , Cheng Elbert T. , Verity A. Neil , Terris David J.
Published: November 2003

The objective was to investigate the effects of brain‐derived neurotropic factor (BDNF) and ciliary neurotropic factor (CNTF) on peripheral nerve regeneration. Thirty Sprague‐Dawley rats underwent left sciatic nerve transection and repair according to three experimental groups: epineurial coaptation (EC), EC with BDNF delivered by an osmotic pump (EC‐BDNF), and EC with BDNF and CNTF delivered similarly (EC‐BDNF/CNTF). Nerve regeneration was assessed using sciatic functional indices, quantitative histomorphology, and molecular analysis for proteins associated with nerve regeneration. Analysis of variance (ANOVA) comparing all groups at each time point demonstrated significant differences between groups on days 20, 30, 40, 50, 60, and 80. A paired, two‐tailed Student's t‐test with the Bonferroni correction for multiple comparisons demonstrated that at 40 days postoperatively, animals in the EC‐BDNF/CNTF group (n = 7) manifested superior functional recovery compared with those in the EC group (n = 9) and those in the EC‐BDNF group (n = 9) (P < 0.001 and P < 0.05, respectively). At 80 days, the animals in both the EC‐BDNF (P < 0.01) and EC‐BDNF/CNTF (P < 0.05) groups demonstrated greater functional recovery compared with those in the EC group, with no significant difference between the two factor groups at the endpoint. Morphometric analysis demonstrated that nerves from animals in the EC‐BDNF/CNTF group had the largest mean axon diameters as compared with those from the EC (proximal: P < 0.001, distal: P < 0.05) and EC‐BDNF(proximal: P < 0.01) groups. No significant differences were seen in nerve cross‐sectional area. In distal nerve segments, Western blot analysis revealed that expression of myelin‐associated glycoprotein was higher than control for the EC group and lower than control for both the EC‐BDNF and EC‐BDNF/CNTF groups. We conclude that BDNF/CNTF combined treatment increases the early rate of functional sciatic nerve regeneration over treatment with BDNF alone, although the degree of maximal recovery was similar at the conclusion of the experiment.
Safety of Direct Laryngoscopy As an Outpatient Procedure
Authors: Armstrong Michael , Mark Lynette J. , Snyder Douglas S. , Parker Stephen D.
Published: November 2003

The safety of outpatient direct laryngoscopy has recently been challenged in the literature. We reviewed the first 589 direct laryngoscopies performed at a new outpatient surgery center. There were nine unplanned admissions to the hospital, including five airway emergencies that developed within the first 30 min after extubation. Three patients required reintubation before leaving the operating room. On postoperative telephone follow‐up, 9% complained of mild to moderate sore throat. There were no major complications after discharge. We conclude that the risk of airway emergencies after direct laryngoscopy is less than 1% in carefully selected patients. The procedure can be safely performed as an outpatient procedure as long as transportation to a hospital is readily available for the few patients in whom complications arise.
Sodium Ipodate (Oragrafin) in the Preoperative Preparation of Graves' Hyperthyroidism
Authors: Tomaski Sharon M. , Mahoney Eileen M. , Burgess Lawrence P.A. , Raines Kristen B. , Bornemann Michael
Published: November 2003

Fourteen Graves' hyperthyroid patients who had been prepared for surgery with sodium ipodate (SI) 500 mg orally twice daily for 3 days were retrospectively studied. SI was administered in combination with propylthiouracil (10 cases) and beta blockers (all cases), which had been previously initiated. Free serum thyroxine (T4) and total triiodothyronine (T3) concentrations were measured before and after SI therapy on the morning of surgery. SI treatment significantly reduced total T3 concentration from 445.9 to 193.4 ng/dL (P < 0.0001) and free T4 concentration from 3.874 to 2.800 ng/dL (P = 0.0003). Preoperatively, only one patient had persistent tachycardia, and intraoperatively this same patient required beta blockers. Blood loss was unremarkable or reduced (average blood loss, 121 mL). On clinical examination glands were firm with normal or somewhat decreased vascularity. On histologic study all glands demonstrated changes consistent with treated Graves' disease. Preoperative treatment with SI appears to be a safe and efficacious method of preparing hyperthyroid patients for surgery.
Endoscopic Sinus Surgery Complications in Residency
Authors: Gross Rick D. , Sheridan Mark F. , Burgess Lawrence P.
Published: November 2003

Otolaryngology has seen a rapid proliferation of functional endoscopic sinus surgery, and there is variability in the teaching of the procedure, in part because of the seriousness of the complications. A retrospective review of 106 consecutive cases was conducted at a teaching program to evaluate complications. Complication rates were combined and compared with the reported complication rates of other teaching programs and practicing otolaryngologists. The complication rate in our program was 13.9%; all were minor complications. This compared favorably with the rates of other programs (6% to 29%). The combined complication rate for residency training programs (16.6%) was significantly greater than the nonresident complication rate (10.5%). When divided into major and minor complications, the resident minor complication rate (15.9%) was significantly greater than the nonresident rate (8%), yet the major complication rates were significantly less for the resident group (0.7%) than for the nonresident group (2.5%). In addition, complications were significantly greater when procedures were performed under general anesthesia as compared with local anesthesia, and estimated blood loss was significantly greater under general anesthesia.
Tumor‐Associated Glycoprotein (TAG‐72) in Chronic Submandibular Sialadenitis and Normal Minor Salivary Glands Defined by Monoclonal Antibody B72.3
Authors: Epivatianos Apostolos , Poulopoulos Athanasios , Kayavis Ioannis , Papanayotou Panayotis
Published: November 2003

Formalin‐fixed, paraffin‐embedded samples of three normal minor salivary glands, 10 chronic submandibular sialadenitis, and three normal submandibular glands were studied immunohistochemically using the monoclonal antibody (Mab) B72.3 in order to have a better understanding of the distribution of tumor‐associated glycoprotein (TAG‐72). Diffuse expression of TAG‐72 was observed in the mucous cells of normal minor salivary glands, and in the ducts with goblet cell metaplasia and/or hyperplasia of chronic submandibular sialadenitis (eight of 10). Focal expression of TAG‐72 was seen in the acinar mucous cells of normal submandibular gland (three of three), and in the mucous cells of normal or atrophic acini of chronic submandibular sialadenitis (eight of 10). These results should be considered in the cytologic diagnosis of the mucoepidermoid carcinoma using the Mab B72.3 as a diagnostic aid, as well as in future studies for the radiation immunolocalization and immunotherapy of submandibular gland tumors.
Molecular Temporal Bone Pathology: II. Ramsay Hunt Syndrome (Herpes Zoster Oticus)
Authors: Wackym Phillip A.
Published: November 2003

In 1907 J. Ramsay Hunt suggested that herpes zoster oticus resulted from a geniculate ganglionitis; however, many contemporary authors believe that this disorder represents a neuritis or polycranial neuropathy. Herpes varicella‐zoster viral (VZV) DNA was identified, using the polymerase chain reaction, in archival celloidin‐embedded temporal bone sections from two patients who clinically had Ramsay Hunt syndrome (herpes zoster oticus). The presence of VZV was confirmed by sequencing the PCR products. These experiments demonstrated that VZV genomic DNA was present in the geniculate ganglion of the side with facial paralysis and cutaneous recrudescence in both patients and in the clinically unaffected side in patient 1. In addition, patient 2 had a sudden hearing loss and was found to have VZV genomic DNA in sections from the affected side containing the spiral ganglion, Scarpa's ganglion, organ of Corti, and macula of the saccule. No VZV genomic DNA was identified in temporal bone sections from five patients with Bell's palsy and ten patients without evidence of otologic disease. In this study, the histopathology of these two cases yielded complementary information regarding the role of VZV in herpes zoster oticus. These data suggest that in patients with Ramsay Hunt syndrome, latent VZV is located in the geniculate ganglia and may be present in the auditory and vestibular primary afferent ganglia in some patients.
Familial Occurrence of Unilateral Vestibular Schwannoma
Authors: Bikhazi Nadim B. , Slattery William H. , Lalwani Anil K. , Jackler Robert K. , Bikhazi Paul H. , Brackmann Derald E.
Published: November 2003

Vestibular schwannoma (VS) may present clinically in one of two forms: sporadic unilateral or hereditary bilateral. Almost all cases of familial transmission have been associated with the diagnosis of neurofibromatosis type II (NF‐2). In this report, we describe nine families (18 individuals) presenting with unilateral VS without evidence of NF‐2. In four of the nine families, the affected individuals were of parent‐offspring relationship, in three families they were cousin‐cousin, and in the remaining two families, they were sibling‐sibling and aunt‐nephew. No other members of the families were diagnosed with NF‐2. There was no evidence for gender predilection or genomic imprinting among affected individuals. This study suggests that familial occurrence of unilateral VS may be genetically inherited as it occurs more commonly than would be estimated by chance alone. Future genetic studies will elucidate whether occurrence of unilateral VS in these families represents a variable expression of NF‐2, chance occurrence of unilateral VS in families, or a new genetic disorder.
Practical Use of Total and Partial Ossicular Replacement Prostheses in Ossiculoplasty
Authors: Slater Patrick W. , Rizer Franklin M. , Schuring Arnold G. , Lippy William H.
Published: November 2003

The use of porous polyethylene total and partial ossicular replacement prostheses (TOPs and POPs) for ossicular reconstruction in middle ear surgery was retrospectively reviewed at the Warren Otologic Group, a tertiary referral center for otologic problems. Extrusion rates, lower than those previously reported, and improvement in hearing results were found in 250 cases. Follow‐up ranged from 6 months to 8 years. This paper details the optimal placement and relationships of the prosthesis, the interposed tragal cartilage, and the drum. Modifications to the prosthesis have increased stability and ease of reconstruction. The hearing results of both TOP and POP reconstruction, and comparison with the literature, will be presented. With TOPs, the air‐bone gap was closed to within 20 dB in 67% of cases. With POPs, similar results were obtained in 81% of cases.
Preoperative Evaluation of Patients With Primary Hyperparathyroidism: Role of High‐Resolution Ultrasound
Authors: Koslin D. Bradley , Adams Jeffery , Andersen Peter , Everts Edwin , Cohen James
Published: November 2003

Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is an accepted surgical approach for the treatment of patients with primary hyperparathyroidism. This study prospectively evaluated the ability of high‐resolution sonography to localize adenomas preoperatively and the effect of this localization on operative time and cost in 37 previously untreated patients undergoing surgical treatment for primary hyperparathyroidism. The sensitivity and positive predictive value of the sonographic examination were 84% and 90%, respectively. A true positive sonographic examination decreased surgical time by an average of 40 minutes and reduced operative charges by $564, including the cost of the test ($156). In experienced hands high‐resolution sonography can be a cost‐effective means of localizing parathyroid adenomas where unilateral exploration is considered an accepted surgical approach.
Adenoid Cystic Carcinoma of the Salivary Glands: A Review of 10 Years
Authors: Sur Ranjan K. , Donde Bernard , Levin Victor , Pacella Juan , Kotzen Jeff , Cooper Kum , Hale Martin
Published: November 2003

A retrospective analysis was performed of 50 patients with adenoid cystic carcinoma who were seen in the Department of Radiation Oncology, University of Witwatersrand, Johannesburg, South Africa, in the past 10 years. There were 25 men and 25 women with a mean age of 52 years (age range, 21 to 88 years). Five patients had metastatic disease, and 17 had neural invasion. Thirty‐four patients had surgery (11, complete; 23, microscopic residual). Sixteen patients had radiotherapy as initial management. The disease‐free survival was 26%, overall survival was 29%, and local control was 30% at 10 years. Most recurrences occurred in the first 3 years. Nine patients had metastasis following treatment. The mean survival after metastasis was 15 months. Seven prognostic variables were analyzed using the log‐rank test. There was no impact of age, site, type of salivary gland (major vs. minor), tumor stage, node positivity, or neural invasion on disease‐free survival, overall survival, or local control. Extent of surgical resection (complete vs. microscopic residual) had a significant impact on disease‐free survival and local control (P < 0.05) but no impact on overall survival (P > 0.05) because of the slow‐growing nature of these tumors. Similarly, patients who had microscopic residual after surgery and were treated with radiotherapy did better than those who had biopsy and radiotherapy, although this was not significant statistically (P > 0.05). Thus, whenever possible, every attempt must be made to remove all microscopic tumor by surgery. Addition of postoperative radiotherapy with high‐energy photons did not improve the locoregional control or survival in our series. There is a place for neutrons in the treatment of adenoid cystic carcinomas in advanced cases of inoperable or recurrent tumors, as a review of literature shows.
Management of Nasopharyngeal and Oropharyngeal Stenosis in Children
Authors: McLaughlin Kevin E. , Jacobs Ian N. , Wendell Todd N. , Gussack Gerald S. , Carlson Grant
Published: November 2003

Nasopharyngeal stenosis and oropharyngeal stenosis are rare and challenging problems in the pediatric population. The most common etiology is currently the surgical trauma associated with ade‐notonsillectomy. Stenosis can vary from a thin band to a complete obstructing cicatrix. Presenting symptoms range from mild hyponasal speech to severe airway obstruction. We present a series of eight children with varying degrees of stenosis and associated symptoms. Choice of treatment varied with the severity of disease. In our series, successful interventions included triamcinolone acetonide injection, lysis of adhesions, rotational and advancement mucosal flaps, and jejunal free flap. Preoperative evaluation and individualized surgical repair are essential for successful treatment.
Interinterpreter Variability in Determining the SP/AP Ratio in Clinical Electrocochleography
Authors: Roland Peter S. , Roth Lisa
Published: November 2003

Calculating the SP/AP ratio in electrocochleography requires the interpreting audiologist to unequivocally identify the peak of the SP wave form. If different points are selected, different SP/AP ratios will result. To investigate this effect, 50 electrocochleographic tracings were sent to 10 different audiologists (500 tracings). Twenty of the wave forms sent to each audiologist were identified as “easy,” 10 as “somewhat difficult,” 10 as “very difficult,” and 10 as “no response.” The ranges and standard deviations of the resulting SP/AP ratios were quite high. Analysis of variance showed statistically significant differences in the very difficult and no response group. There is significant interinterpreter difference among SP/AP ratios calculated from the same tracing. This variability affects clinical patient management and investigational projects.
Ansa Cervicalis Nerve: Review of the Topographic Anatomy and Morphology
Authors: Chhetri Dinesh K. , Berke Gerald S.
Published: November 2003

In recent years, there has been a proliferation of techniques utilizing the ansa cervicalis nerve to reinnervate the paralyzed larynx. The anatomic course and morphology of the ansa cervicalis are complicated by the variable course and location along the great vessels of the neck, as well as the significant differences observed in the arrangement of its contributing roots and regional branching patterns. Herein, we review the surgical anatomic course of ansa cervicalis and its innervation of the muscles of the neck, and develop specific recommendations with respect to the use of this nerve in laryngeal reinnervation.
Do Systemic Corticosteroids Effectively Treat Obstructive Sleep Apnea Secondary to Adenotonsillar Hypertrophy?
Authors: Al‐Ghamdi Saleh A. , Manoukian John J. , Morielli Angela , Oudjhane Kamaldine , Ducharme Francine M. , Brouillette Robert T.
Published: November 2003

To determine if pediatric obstructive sleep apnea syndrome (OSAS) caused by adenotonsillar hypertrophy (ATH) could be treated by a short course of systemic corticosteroids, we conducted an openlabel pilot study in which standardized assessments of symptomatology, OSAS severity, and adenotonsillar size were performed before and after a 5‐day course of oral prednisone, 1.1 ± 0.1(± SE) mg/kg per day. Outcome measures included symptom severity, adenotonsillar size, and polysomnographic measures of OSAS. Selection criteria included age from 1 to 12 years, ATH, symptomatology suggesting OSAS, an apnea/hypopnea index (AHI) ≥ 3/hour, and intent to perform adenotonsillectomy. Only one of nine children showed enough improvement to avoid adenotonsillectomy. Symptomatology did not improve after corticosteroid treatment but did after removal of tonsils and adenoids. Polysomnographic indices of OSAS severity did not improve after corticosteroid treatment. After corticosteroids, tonsillar size decreased in only two patients, adenoidal size was only marginally reduced, and the size of the nasopharyngeal airway was not significantly increased. These results suggest that a short course of prednisone is ineffective in treating pediatric OSAS caused by ATH.
Clinical Applications of Otoacoustic Emissions in Sudden Hearing Loss
Authors: Schweinfurth John M. , Cacace Anthony T. , Parnes Steven M.
Published: November 2003

Sudden hearing loss (SHL) is a controversial topic for which no definitive practical guidelines exist. Studies employing vasodilators, plasma expanders, anticoagulants, and carbogen inhalations have shown
no
improvement over the rate of spontaneous recovery. At present, there is insufficient evidence to support medical treatment for SHL, except steroid therapy in selected patients. Distortion product otoacoustic emissions (DPOAEs) are sensitive to cochlear disorders and are absent in ischemic injury to the cochlea, but can persist in cochlear neuritis. In a prospective study of 10 patients who presented to Albany Medical Center from 1995 to 1996, three patients with intact DPOAEs at presentation had an average improvement of 33 dB in the pure‐tone average (PTA) of 0.5, 1.0, and 2.0 kHz with steroid therapy, whereas five of seven patients with absent DPOAEs had no improvement in hearing despite steroid therapy in six patients. The presence of DPOAEs may be a useful prognostic factor that positively correlates with recovery from SHL.
Laryngofissure and Cordectomy for Glottic Carcinoma Limited to the Mid Third of the Mobile True Vocal Cord
Authors: Muscatello Luca , Laccourreye Ollivier , Biacabe Bernard , Hans Stéphane , Ménard Madeleine , Brasnu Daniel
Published: November 2003

The objective of this study was to analyze the long‐term results of laryngofissure with cordectomy for invasive glottic squamous cell carcinoma limited to the mid third of the mobile true vocal cord. The authors conducted a retrospective review of the medical charts and operative files of 33 patients with invasive glottic carcinoma limited to the mid third of the mobile true vocal cord managed with laryngofissure and cordectomy. A 10‐year follow‐up was achieved in 30 patients (90.9%). Kaplan‐Meier actuarial analysis of survival, local control, nodal recurrence, distant metastasis, and second primary metachronous tumor was performed. The 5‐year actuarial survival, local control, nodal recurrence, and distant metastasis estimates were 97%, 100%, 0%, and 0%, respectively. Tracheotomy was never performed. The overall laryngeal preservation rate was 100%. The 5‐ and 10‐year actuarial metachronous second primary tumor estimates were 3% and 11.5%, respectively. The authors' experience suggested that laryngofissure and cordectomy should still be considered a valuable oncologic option for the management of invasive glottic carcinoma limited to the mid third of the mobile true vocal cord.
Quantitative Study of Nasal Secretory Cells in Normal Subjects and Patients With Chronic Sinusitis
Authors: Majima Yuichi , Masuda Sawako , Sakakura Yasuo
Published: November 2003

The contribution of nasal secretory cells to mucus hypersecretion in chronic sinusitis was investigated. The mucosae of the inferior turbinate were obtained from 18 normal control subjects and 65 patients with chronic sinusitis. Histochemical quantitation showed that there was no significant difference in the number of goblet cells between normal controls and chronic sinusitis. On the other hand, the number of submucosal acinar cells in chronic sinusitis was significantly higher than that in normal controls (
P
< 0.01). The area occupied by the acini in lamina propria was also increased in chronic sinusitis (
P
< 0.01). There was no significant difference in the distribution of the intra‐acinar glycoproteins between normal control subjects and patients with chronic sinusitis. Results suggest that hyperplasia and hypertrophy of nasal acinar cells may have an important role in mucus hypersecretion in chronic sinusitis.
An Accurate, Cost‐Effective Approach for Diagnosing Retrocochlear Lesions Utilizing the T2‐Weighted, Fast‐Spin Echo Magnetic Resonance Imaging Scan
Authors: Linker Seth P. , Ruckenstein Michael J. , Acker James , Gardner Gale
Published: November 2003

Recent data indicate that the auditory brainstem response (ABR) fails to identify a significant number of retrocochlear lesions. Although the magnetic resonance imaging (MRI) scan with paramagnetic enhancement is highly accurate at detecting these lesions, it is time consuming and expensive. We report on our prospective evaluation of a cohort of 155 patients who underwent T2‐weighted, fastspin echo MRI scans designed to screen for retrocochlear lesions. This imaging technique is rapidly performed and provides superb visualization of the relevant anatomic structures at a global cost of $475. Four tumors were identified with this technique. Cost analysis indicates that supplanting ABR with this limited MRI may well represent a cost‐effective approach for evaluating patients with suspected retrocochlear lesions.
Nucleus 22 Cochlear Implantation Results in Postmeningitic Deafness
Authors: Rauch Steven D. , Herrmann Barbara S. , Davis Lynne A. , Nadol Joseph B.
Published: November 2003

Cochlear implant surgery was performed on 13 patients with postmeningitic deafness (seven adults, six children). Two adults and two children (30.8%) had severe labyrinthitis ossificans requiring radical “drill‐out.” Five of 13 (38.5%) had some bone growth requiring partial drill‐out, and four of 13 (30.8%) had normal insertion with no drill‐out. Hearing results for patients with no bone growth were similar to nonmeningitic patients; three of four (75%) had open‐set speech recognition. Performance of patients with total drill‐out was poor; “auditory only” performance was limited to detection and pattern perception of speech, and no patients had open‐set speech recognition. Results for patients with partial drill‐out were similar to results in patients with no bone growth. Labyrinthitis ossificans not only presents surgical challenges to cochlear implantation but may also adversely affect hearing outcome.
Extended Canine Laryngeal Preservation for Transplantation
Authors: Kevorkian Kevin F. , Sercarz Joel A. , Ye Ming , Kim Young‐Mo , Hong Ki‐Hwan , Berke Gerald S.
Published: November 2003

The goal of successfully transplanting the larynx has motivated researchers since the 1960s. Early laryngeal transplant techniques limited the donor larynx to 45 minutes of ischemia. In this study, a method of prolonged laryngeal preservation is employed in three canines. In vivo cold laryngeal perfusion with University of Wisconsin Solution (UWS) was performed. The larynx was removed and placed into cold storage in 4°C UWS. After 24 hours of storage, the same canines underwent laryngeal reimplantation. The animals were sacrificed 7 days after reimplantation. No evidence of necrosis or vascular insufficiency was identified histologically. The results indicate that canine larynges can be successfully reimplanted after 24 hours of preservation. Future studies will assess the application of this technique to laryngeal transplantation.
Deep Neck Infections in Children: A New Approach to Diagnosis and Treatment
Authors: Nagy Mark , Pizzuto Michael , Backstrom James , Brodsky Linda
Published: November 2003

Forty‐seven children presented with the diagnosis of a deep neck infection‐either cellulitis or abscess‐between January 1991 and July 1996. Forty‐four (94%) had contrast‐enhanced computed tomography (CT) imaging consistent with this diagnosis. Three patients with no CT scan had confirmation of an abscess at surgical drainage. Parenteral antibiotics alone were effective in the treatment of 24 of 47 infections (51%): seven parapharyngeal, one retropharyngeal, and 16 combined. By CT scan these infections represented cellulitis in 17 of 24 (71%), an abscess in three of 24 (13%), and incomplete abscess in four of 24 (17%). The average duration of hospitalization for this group was 4.8 days, with symptomatic improvement usually seen within 24 hours. Surgical drainage was performed on 23 of 47 infections (49%): three parapharyngeal, 17 combined, and three of unknown specific location. In 22 of these 23 children (96%), transoral drainage of the abscess was used as the primary surgical approach. In 21 of these 22 (95%) there was complete resolution without complications or recurrence; one abscess required a subsequent external approach. CT scanning with contrast revealed that all deep neck infections were located medial (usually anteromedial) to the great vessels. Abscesses with volumes estimated to be greater than 2000 mm3 were more likely to undergo surgery, but these differences were not statistically significant. The use of contrast‐enhanced CT scanning provides information regarding abscess size, location, and relative position of the great vessels for safe and successful transoral drainage. Thus we recommend CT‐assisted transoral drainage for combined retropharyngeal/parapharyngeal abscesses and selected isolated parapharyngeal abscesses that do not respond to parenteral antibiotics.
Characterization of Smoking‐Induced Nasopharyngeal Lymphoid Hyperplasia
Authors: Finkelstein Yehuda , Malik Zvi , Kopolovic Juri , Bernheim Jöelle , Djaldetti Meir , Ophir Dov
Published: November 2003

The frequency of smoking‐induced nasopharyngeal lymphoid hyperplasia in heavy smokers and its potential clinical implications are still unknown. Precise criteria to differentiate this entity from other types of nasopharyngeal lymphoid hyperplasia are needed. A prospective clinicopathological study of smoking‐induced nasopharyngeal lymphoid hyperplasia was conducted in 17 heavy smokers. Ten nonsmoking patients, five of them with chronic sinusitis, three with adult‐onset adenoid hypertrophy, and two children with adenoidal hypertrophy served as a control group. Both in smokers and in nonsmokers, lymphocytic infiltration of the mucosa was characterized immunohisto‐chemically as T cells. In smokers, semithin (1 micron) sections revealed deformed and migrating cytotoxic lymphocytes in the nasopharyngeal mucosa. The lymphocytes were attached to epithelial, ciliated, and goblet cells, resulting in cell damage. Transmission electron microscopy of biopsies from smokers revealed emperipolesis, characterized by mucosal invasion and epithelial cell damage by an unusual population of migrating T lymphocytes that penetrate them. These findings confirm a direct effect of smoking on the nasopharyngeal lymphoid tissue, which forms part of the immune system. It is concluded that the diagnostic evaluation and therapeutic approach of heavy smokers with otological and airway symptoms should be based on thorough endoscopic examination of the nasopharynx. When the diagnosis is not clear‐cut, selective tele‐endoscopic biopsy and electron microscopic examination are recommended. This entity should be added to the list of known clinical manifestations of the smoking habit.
Overlay Versus Underlay Tympanoplasty. Part I: Historical Review of the Literature
Authors: Rizer Franklin M.
Published: November 2003

The history of otology is the history of the successful treatment of infections of the middle ear and the eardrum. Otologists have sought to restore hearing lost to infections of the eardrum since the 1600s. The development of instruments, techniques, and materials to treat infection is fascinating because of the serendipitous nature of the discoveries and the insight of the discoverers. This historical review describes the history of the treatment of infections of the ear and the development of modern techniques of ear surgery. Two contemporary methods of tympanic membrane repair are then described.
Practice of Otolaryngology via Telemedicine
Authors: Blakeslee Don B. , Grist William J. , Stachura Max E. , Blakeslee Betsey S.
Published: November 2003

Teleotolaryngology is becoming a reality as a result of improvements in technology and telecommunications. This prospective, clinical trial was designed to demonstrate the utility of three telemedicine systems in an otolaryngology practice. Optel is a desktop system used in the office. Picasso is a mobile system used from various locations throughout the hospital. The Georgia Statewide Telemedicine Program (GSTP) is a large, sophisticated system used from a fixed site within a rural hospital. Patients with a wide variety of ear, nose, and throat problems were presented to consultants at two medical teaching centers in Georgia. Fifty‐four consults were completed over a 24‐month period. In addition, three teleconsultations demonstrated enhanced capabilities for continuing medical education (CME) and health care networks. Nine different specialty fields were accessed by the otolaryngologist. Five consults were completed via the Optel system; 13 via the Picasso system; and 36 via GSTP. Overall, teleotolaryngology provided quality audio and visual communication between the physicians that significantly improved diagnostic capabilities and treatment options for the patient.
Histologic Study of Oral Mucosa Wound Healing: A Comparison of a 6.0‐ to 6.8‐µm Pulsed Laser and a Carbon Dioxide Laser
Authors: Bryant Grady L. , Davidson Jeffrey M. , Ossoff Robert H. , Garrett C. Gaelyn , Reinisch Lou
Published: November 2003

Incisional wound healing in the canine oral mucosa was histologically monitored at 3, 7, and 14 days after incision. Healing was compared from a scalpel, a carbon dioxide (CO2) laser at 10.6µm, and the Vanderbilt free‐electron laser tuned to 6.0, 6.45, and 6.8µm. A significant delay in wound healing was observed when incisions were made with the CO2 laser, probably attributable to the excess thermal damage caused by the continuous‐wave laser beam. When using the short pulsed, free‐electron laser, a much smaller delay comparable to the scalpel wound healing was observed. This smaller delay tended to decrease with increasing tissue absorption. The results emphasize the greater importance of laser pulse duration rather than wavelength in relation to the subsequent wound healing.
Vocal Fold Augmentation by Injection of Autologous Fascia
Authors: Rihkanen Heikki
Published: November 2003

Vocal fold augmentation by injection under direct visual control is a quick and simple operation. However, when autologous fat or bovine collagen is used, resorption creates a problem. The low metabolic requirements and the relatively stable histologic character of free fascial grafts make autologous fascia a fascinating material in vocal fold augmentation. This research project was carried out to establish a suitable method to transplant fascia into a vocal fold and to assess its impact on the voice. A piece of fascia lata was chopped with a scalpel. The material was injected in the lateral aspect of the thyroarytenoid muscle using a pressure syringe. Nine subjects with a paralyzed vocal fold were analyzed after the injection. The postoperative voice, rated by a panel of experienced listeners, was significantly better than the preoperative (
P
< 0.05). Five of nine voices were rated normal or near normal after the procedure. The mean maximal phonation time increased significantly (
P
< 0.01). All patients considered that their voice had improved, and eight of nine regarded it as good. No one reported deterioration of the result during the follow‐up (mean duration, 10 months; range, 3 to 18 months).
Postnatal Persistence of Epidermoid Rests in the Human Middle Ear
Authors: Levine Jonathan L. , Wright Charles G. , Pawlowski Karen S. , Meyerhoff William L.
Published: November 2003

It is widely believed that congenital cholesteatoma originates from epidermoid cell rests in the temporal bone. Congenital cholesteatomas of the anterior‐superior middle ear may arise from such a rest, known as the
epidermoid formation (EF), which has been described by Michaels and others. The EF is thought to disappear by 33 weeks' gestation in most cases; however, if it persists beyond fetal life, it may provide a nidus for cholesteatoma formation. The authors studied human temporal bones from individuals ranging from 20 weeks' gestation to 5 years of age to investigate pre‐ and postnatal occurrence of the EF. A total of 106 temporal bones were surveyed; 76 of these were fetal specimens and 30 were postnatal. EFs were present in 14 (18.4%) of the fetal specimens; they were identified in four(13.3%) of the postnatal temporal bones, with the oldest being 2 years, 7 months of age. Multiple EFs within a single temporal bone were also present in some cases. Although the EFs were composed of cells morphologically identical to those of the external ear canal epidermis, none of the specimens showed keratinization. These findings support the contention that EFs do occasionally persist into postnatal life and may be a source of cholesteatoma. However, a clear transition from epidermoid formation to unequivocal cholesteatoma has not yet been demonstrated.
Myringotomy: A Prerequisite for the Development of Myringosclerosis?
Authors: Mattsson Cecilia , Magnuson Karin , Hellström Sten
Published: November 2003

Streptococcus pneumoniae
was inoculated into the left middle‐ear cavity in two groups of rats, resulting in purulent otitis media. After 3 days, one group of infected animals and a third group of noninfected animals were subjected to left‐sided myringotomy. The tympanic membranes were examined both otomicroscopically and histologically 1 and 3 months later. On otomicroscopic examination the noninfected myringotomized animals had developed extensive myringosclerotic lesions, whereas only minimal sclerotic deposits were noted in the myringotomized animals with acute otitis media (AOM). On histologic examination both the noninfected myringotomized animals and the myringotomized animals with AOM were similar in the frequency and extension of sclerotic lesions in the tympanic membrane. The nonmyringotomized rats with AOM were free of sclerotic lesions, except for minor changes found in one animal.
Use of Antibiotic Prophylaxis in Ear Surgery
Authors: Govaerts Paul J. , Raemaekers Jan , Verlinden Arnout , Kalai Moulud , Somers Thomas , Offeciers F. Erwin
Published: November 2003

A prospective, double‐blind, randomized, placebo‐controlled study was performed to evaluate the effect of antibiotic prophylaxis in ear surgery. The present study reports on the results of 750 patients, half of whom received cefuroxime for 1 day, the other half, placebo. All postoperative infections occurring within 2 weeks after the intervention were recorded, together with several preoperative and perioperative parameters. It is concluded that exploratory tympanoplasties (including stapedotomy) and “dry perforation” tympanoplasties should be considered “clean” operations according to the American National Research Council and do not benefit from antibiotic prophylaxis. On the other hand, tympanoplasties performed on draining ears and on ears with cholesteatoma should be considered “dirty” operations for which antibiotic prophylaxis may decrease the postoperative infection rate by factor 3. All postoperative infections healed without sequels under proper treatment, except for three that resulted in graft necrosis‐one in the placebo group and two in the cefuroxime group. In consequence, prophylaxis may not be mandatory in the dirty group, although the authors advocate its use for the sake of patient and surgeon comfort.
Expression of Human Papillomavirus 6 in Inverted Papilloma Arising in a Renal Transplant Recipient
Authors: Harris Monte O. , Beck Jill C. , Terrell Jeffrey E. , McClatchey Kenneth D. , Carey Thomas E. , Bradford Carol R.
Published: November 2003

A 36‐year‐old renal transplant recipient taking cyclosporin A presented with bilateral nasal polypoid lesions involving the nasal septum and lateral nasal walls. Pathologic findings from surgical excision demonstrated inverted papilloma (IP) with focal atypia and mild dysplasia. DNA extracted from the tissue was tested with the polymerase chain reaction (PCR) using human papillomavirus (HPV) E6 and L1 consensus primers. This revealed amplification of the expected size fragment consistent with the presence of HPV DNA. Hybridization of PCR products with HPV type‐specific oligonucleotide probes revealed a strong signal with only HPV 6. This result was confirmed by PCR amplification with HPV 6 type‐specific primers. RNA extracted from the tissue was subjected to reverse transcription PCR (RT‐PCR) with a primer pair specific for viral E6/E7 transcripts. The HPV early proteins, E6 and E7, are the transforming proteins implicated as critical for tumorigenesis. RT‐PCR experiments generated products representing the E1/E4 spliced transcript originating from the E6/E6 promoter and a smaller unclassified fragment. These results provide evidence for HPV 6 E6/E7 expression in IP, lending credence to the concept that HPV may play a role in the origin of this neoplasm. Histologically normal nasal tissue from the same patient contained HPV DNA and similar transcripts to those described in the IP specimen.
Long‐term Results of Functional Endoscopic Sinus Surgery
Authors: Senior Brent A. , Kennedy David W. , Tanabodee Jirayu , Kroger Hans , Hassab Mohammed , Lanza Donald
Published: November 2003

Although much has been reported on the short‐term outcomes of functional endoscopic sinus surgery (FESS), little has been reported with regard to its long‐term impact on chronic sinusitis. The senior author (D.W.K.) previously reported detailed subjective and endoscopic follow‐up on 120 patients at a mean of 18 months following surgery. This current study represents a long‐term follow‐up (average, 7.8 years) of 72 patients (60%) from the same cohort. Of patients responding to a question about overall symptoms, 98.4% (n = 66) reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow‐up, but the changes did not reach statistical significance. Thirteen patients (18%) required subsequent surgical procedures. Preoperative stage, prior surgery, and other factors that might affect outcome were evaluated. The study demonstrates that excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery