bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated Inflation Does Not Prevent Otitis Media With Effusion in a Monkey Model
Authors: Alper Cuneyt M. , Doyle William J.
Published: November 2003

Objective: Investigate the efficacy of repeated middle ear inflation with an inert gas (argon) for preventing the development of middle ear effusion in monkeys with functional eustachian tube obstruction.Study Design: Prospective controlled trial of daily middle ear inflation with five monkeys assigned to the inflation group and four to the control group.Methods: The right tensor veli palatini muscle of nine monkeys was paralyzed with botulinum toxin. Tympanometry was done before the procedure and then daily for 21 days. Presence and distribution of effusion were assessed before paralysis and on day 15 using magnetic resonance imaging (MRI). In five right ears inflation was done beginning at the first observation of negative middle ear pressure of ≤−200 mm H2O and repeated on all days with pressures ≤−100 mm H2O. Four right ears served as uninflated controls.Results: Right middle ear pressure decreased in all animals over the course of the study. Pressure returned to near‐ambient levels immediately following the argon inflation but was decreased to control levels at the subsequent observation on the following day. MRI at day 15 documented effusion in all right ears with no quantifiable differences in amount or distribution between ears that were and were not inflated with argon.Conclusions: Repeated inflation with an inert gas does not prevent middle ear effusion in monkeys with functional eustachian tube obstruction.
Surgical Management of Bell's Palsy
Authors: Gantz Bruce J. , Rubinstein Jay T. , Gidley Paul , Woodworth George G.
Published: November 2003

Objectives: Incomplete return of facial motor function and synkinesis continue to be long‐term sequelae in some patients with Bell's palsy. The aim of this report is to describe a prospective study in which a well‐defined surgical decompression of the facial nerve was performed in a population of patients with Bell's palsy who exhibit the electrophysiologic features associated with poor outcomes. In addition, management issues related to Bell's palsy including herpes simplex virus type1 etiology, the natural history, electrodiagnostic testing, and efficacy of surgical strategies are reviewed.

Study Design and Methods: A multicenter prospective clinical trial was designed utilizing electroneurography (ENOG) and voluntary electromyography (EMG) to identify patients with Bell's palsy who would most likely develop poor return of facial function, as suggested by Fisch and Esslen. Patients who displayed electrodiagnostic features of poor outcome, >90% degeneration on ENOG testing and no voluntary motor unit EMG potentials within 14 days of onset of total paralysis, were offered a surgical decompression of the facial nerve through a middle cranial fossa surgical exposure, including the tympanic segment, geniculate ganglion, labyrinthine segment, and meatal foramen. Control subjects were those who displayed similar electrodiagnostic features and time course.

Results: Subjects who did not reach 90% degeneration on ENOG within 14 days of paralysis all returned to House‐Brackmann grade I (n=48) or II (n=6) at 7 months after onset of the paralysis. Control subjects self‐selecting not to undergo surgical decompression when >90% degeneration on ENOG and no motor unit potentials on EMG were identified had a 58% chance of developing a poor outcome at 7 months after onset of paralysis (House‐Brackmann grade III or IV [n=19]). A group with similar ENOG and EMG findings undergoing middle fossa facial nerve decompression exhibited House‐Brackmann grade I (n=14) or II (n=17) in 91% of the cases. An exact permutation test confirmed that the surgical group had a significantly higher proportion of patients with a good outcome (House‐Brackmann grade I or II) (P = .0002).

Conclusion: Electroneurography in combination with voluntary EMG successfully identified patients who will most likely return to normal from those who had a greater chance of long‐term sequelae from Bell's palsy. Surgical decompression medial to the geniculate ganglion significantly improves the chances of normal or near‐normal return of facial function in the group that has a high probability of a poor result. Surgical decompression must be performed within 2 weeks of onset of total paralysis for it to be effective.
Analysis of a Critical Pathway in Osteoplastic Flap for Frontal Sinus Obliteration
Authors: Correa Alex J. , Reinisch Lou , Paty Victoria A. , Sanders David L. , Duncavage James A.
Published: November 2003

Objectives: A critical pathway was applied to patients undergoing osteoplastic flap (OPF) for frontal sinus obliteration to determine whether efficiency could be improved.

Study Design: A retrospective review of consecutive OPF procedures (n = 51) performed between 1992 and July 1997 was conducted.

Methods: The patient groups were subdivided into those who underwent OPF alone and those who had endoscopic sinus procedures performed in addition to OPF. Comparisons were made between the precritical pathway and post‐critical pathway groups, specifically noting operative time, total operating room (OR) time, estimated blood loss (EBL), length of hospital stay, and costs. We used a critical pathway that was developed for endoscopic sinus procedures at our institution through a multidisciplinary team approach. Preoperative evaluation and testing, intraoperative equipment and medications, and postoperative care including follow‐up clinic visits were all standardized. An unpaired, two‐tailed Student t test was used to evaluate the data.

Results: Statistically significant (P < .05) reductions in operative times, total OR time, EBL, and length of hospital stay were observed in the post‐critical pathway group who underwent endoscopic sinus procedures as well as OPF. Costs to the OR were reduced 29% and 15% for OPF and for OPF with endoscopic surgery, respectively. Patient costs were reduced 5% and 4% in these groups, respectively.

Conclusions: With implementation of effective critical pathways, significant decreases in length of stay are seen, and cost reductions can be realized through the improved efficiency, shortened OR times, and decreases in redundancy of ordering materials.
Course of Proptosis in Patients With Graves' Disease After Endoscopic Orbital Decompression
Authors: Ulualp Seckin O. , Massaro Bruce M. , Toohill Robert J.
Published: November 2003

Aim: To evaluate the results of follow‐up and postoperative course of proptosis in patients with Graves' disease who underwent combined transconjunctival and transnasal endoscopic orbital decompression.

Methods: Charts of patients with Graves' disease who underwent orbital decompression using combined transconjunctival and transnasal endoscopic technique were reviewed. The surgical technique involved preservation of the strut of bone between the lamina papyracea of the ethmoid and floor of the orbit of the maxilla. Data pertaining to patient demographics, previous treatments for orbital manifestations of Graves' disease, and preoperative and postoperative otolaryngologic and ophthalmologic examination findings were obtained. Postoperative course of reduction in proptosis was evaluated based on Hertel exophthalmometry measurements obtained in four intervals: 1) 0 to 1 month, 2) 1 month to 3 months, 3) 3 to 6 months, 4) 6 to 12 months.

Results: Twenty‐eight orbital decompressions were performed on 15 patients. All patients were unresponsive to corticosteroids and orbital irradiation. Ten orbits exhibited preoperative and postoperative visual acuity of 20/20. Vision improved in nine orbits and did not change in six orbits. Proptosis was reduced in 25 orbits. Postoperative course of reduction in proptosis varied within year 1, with the smallest proptosis measurements documented between 6 and 12 months.

Conclusions: Combined transconjunctival and transnasal endoscopic orbital decompression with preservation of the strut resulted in regression of proptosis, marked reduction in postoperative diplopia development, and improvement of visual acuity in patients with Graves' disease. Course of reduction in proptosis varied within postoperative 1 year, with the biggest reduction occurring between 6 and 12 months.
Peripheral Nerve Regeneration in CNTF Knockout Mice
Authors: Yao Mike , Moir Melinda S. , Wang Michelle Z. , To Michael P. , Terris David J.
Published: November 2003

Objectives: To determine the role of ciliary neurotrophic factor (CNTF) in the regeneration of the mouse sciatic nerve following injury by studying the CNTF knockout mouse in a blinded, randomized and controlled evaluation.

Study Design: Fifty‐eight wild‐type and 57 CNTF knockout mice were randomly assigned to one of four treatment groups: sham surgery (sciatic nerve exposure), sciatic nerve crush, nerve transection without repair, and nerve transection followed by epineurial suture repair using 10‐0 monofilament suture. Walking track analysis was performed before and after surgery at weekly intervals for 7 weeks, using a previously described formula. At the completion of walking track analysis, morphometric histological analysis of axon number and axon diameter in the distal sciatic nerves was performed.

Results: The wild‐type and knockout mice that underwent only sham surgery had no change in their walking tracks during the study interval (P = .30 on postoperative day 49). The wild‐type mice that underwent sciatic nerve crush showed complete functional recovery (P = .66 on postoperative day 28), but the CNTF knockout mice whose sciatic nerves were crushed did not fully recover (P = .05 on postoperative day 49). The CNTF knockout and wild‐type mice showed similar levels of recovery after transection without repair (P = .78), and the rate of contracture formation was not significantly different (P = .40). The CNTF knockout and wild‐type mice showed similar levels of recovery after epineurial repair (P > .31), however the rate of severe contractures was greater in the CNTF knockout mice (6 of 13) than in the wild‐type mice (2 of 12) (P = .11).

Conclusion: The absence of CNTF impairs the ability of mice to recover from a sciatic nerve crush injury. There is also a trend toward a greater rate of contracture formation after sciatic nerve transection and epineurial suture repair when CNTF is unavailable. These findings suggest that CNTF is important for recovery of neuronal function following crush and transection nerve injuries.
Normal Cochlear Function in mdx and mdxCv3 Duchenne Muscular Dystrophy Mouse Models
Authors: Pillers De‐Ann M. , Duncan Nancy M. , Dwinnell Shannon J. , Rash Sean M. , Kempton J. Beth , Trune Dennis R.
Published: November 2003

Objectives/Hypothesis: Sensorineural hearing loss has been found in association with inherited muscular dystrophies in humans and in mouse models. An increased brainstem auditory evoked response threshold has been previously reported in the dystrophin‐deficient mdx mouse model for Duchenne muscular dystrophy, suggesting that full‐length dystrophin (Dp427) is involved in hearing. The objective of the present study was to confirm cochlear dysfunction with this gene defect and determine whether the shorter carboxyl terminus isoforms of dystrophin are also critical in maintaining normal hearing.

Study Design: Case controlled. Animal model.

Methods: Auditory brainstem response (ABR) audiometry to pure tones was used to evaluate cochlear function. Fourteen mdx, 4 mdxCv3, and 13 age‐matched control (C57BL/6J and C57BL/10ScSn) male mice were tested at 5 weeks and 11 weeks of age. The ABR thresholds to tone‐burst stimuli at 4, 8, 16, and 32 kHz were obtained for each ear and statistically compared (ANOVA) for potential group differences.

Results: Both mdx and mdxCv3 mice demonstrated normal ABR thresholds when compared with controls.

Conclusions: Both mdx and mdxCv3 mouse models have normal hearing by ABR. The authors' data suggest that dystrophin and its carboxyl terminus isoforms do not play a critical role in hearing in the mouse. This was unexpected, as previous studies using the brainstem auditory evoked response method suggested that the mdx mouse has an increased threshold for hearing.
Eosinophilic Cationic Protein as a Marker of Nasal Inflammation in Patients With Cystic Fibrosis
Authors: Weber Alexander , Kiefer Jan , Peters Silke , Schneider Markwart , Bargon Joachim , May Angelika
Published: November 2003

Objectives: Evaluation was made of eosinophilic cationic protein (ECP) in nasal secretion for measuring the degree of nasal inflammation and monitoring response to therapy in cystic fibrosis (CF) patients with chronic rhinosinusitis. Symptoms and findings in regard to ECP levels before and after treatment were described.

Study Design: Study was prospective, with 21 CF patients aged 4 to 19 years; 20 healthy volunteers served as controls. Collection of nasal secretion by a sponge was performed, and blood samples were obtained for serum. Cystic fibrosis (CF) patients were classified according to nasal symptoms and findings.

Methods: ECP was measured by fluoroimmunoassay. Age, sex, nasal symptoms, and endoscopic and histological findings were obtained, and examinations were conducted before and after treatment; recurrences were recorded.

Results: In CF patients with chronic nasal inflammation, increased nasal levels of ECP were detected when compared with asymptomatic CF patients or healthy nonatopic subjects. ECP concentrations were strongly related to the extent of nasal disease; patients with nasal polyps had higher levels than those without. Checked at 1 and 4 months after treatment, ECP levels declined with regression of symptoms, and in patients with exacerbation of nasal disease, ECP levels rose.

Conclusions: According to our study, there is a relationship between levels of ECP in nasal secretions and the degrees of nasal inflammation. In addition, the measurement of ECP could be useful in monitoring nasal disease in CF patients.
Clinical Significance of Rebound Nystagmus
Authors: Lin Chao‐Yu , Young Yi‐Ho
Published: November 2003

Objective/Hypothesis: Magnetic resonance imaging (MRI) examination is performed in cases of rebound nystagmus to elucidate the responsible site for rebound nystagmus.

Methods: Patients with vertigo or tinnitus received a battery of audiological and neuro‐otological tests. Those who had rebound nystagmus were rechecked by electronystagmography and examined by MRI.

Results: Ten patients had a second‐degree nystagmus evoked by changing direction of fixation, from the lateral to the forward gaze. All patients displayed positive MRI findings in cerebellum or brainstem, including tumor in seven cases and stroke in three cases. Moreover, in seven of eight cases with unilateral lesions, rebound nystagmus was ipsilateral with respect to the side of the lesion.

Conclusion: Rebound nystagmus implies a lesion in cerebellum or brainstem for which MRI examination is 100% sensitive. It has a certain lateralizing value, with its direction away from the lesioned side.
Effect of Laser Uvulopalatoplasty on Middle Ear Function
Authors: Marais Joe , Armstrong Michael W.J.
Published: November 2003

Objectives: Palatal musculature is known to be responsible for the active opening of the eustachian (auditory) tube. Because laser‐assisted uvulopalatoplasty (LAUP) may involve partial division of these muscles, the effect of this procedure on middle ear pressures (MEPs) and middle ear volumes (MEVs) was investigated.

Study Design: A controlled interventional trial with one limb receiving treatment and the other none. Preoperative and postoperative measurements were carried out in both groups.

Methods: A control group of 15 normal volunteers and a study group of 22 patients undergoing LAUP all of whom had normal ears and type A tympanograms before the trial were recruited. Repeat tympanometry was carried out after 3 months in both groups. The results of MEP and MEV were recorded for both groups and analyzed by the Mann‐Whitney U test.

Results: A trend toward reduced MEP and MEV was noted in the LAUP group, but did not achieve statistical significance. A study with more patients may achieve significance.

Conclusions: No significant effects on middle ear pressures or volumes 3 months after LAUP were demonstrated. A much larger study may, however, arrive at a statistically significant result and further work is warranted. Relevant palatal and tubal anatomy is discussed and a brief review of the relevant literature is given.
Antimicrobial Activity of Synthetic Salivary Peptides Against Voice Prosthetic Microorganisms
Authors: Elving G. Jolanda , van der Mei Henny C. , Busscher Henk J. , Amerongen Arie van Nieuw , Veerman Enno C. I. , van Weissenbruch Ranny , Albers Frans W. J.
Published: November 2003

Objectives: To investigate whether synthetic salivary antimicrobial peptides have an inhibitory effect on the growth of bacteria and yeasts isolated from used silicone rubber voice prostheses.

Methods: The antimicrobial activities of six synthetic salivary peptides (histatin 5, dhvar1, dhvar4, dhvar5, lactoferrin b 17–30 [LFb 17–30], and cystatin S1–15) at concentrations of 2 and 4 mg/mL were determined against different oropharyngeal yeast (four) and bacterial (eight) strains and against a “total microflora” isolated from explanted voice prostheses using agar diffusion tests. The spectrum of susceptible microorganisms was determined qualitatively.

Results: Histatin 5 and cystatin S1–15 did not show any antimicrobial activity against the microorganisms involved in this study. Dhvar1 was active against some of the oropharyngeal microorganisms tested, including the yeast strains, but not against Rothia dentocariosa, Staphylococcus aureus, Escherichia coli, and the total microflora. Dhvar4 was active against all microorganisms tested, including the total microflora. Dhvar5 lacked activity against E coli and the total microflora. LFb 17–30 did not inhibit the growth of any of the yeast strains involved and showed only minor activity against some of the bacterial strains. LFb 17–30 slightly inhibited the growth of the total microflora from an explanted prosthesis.

Conclusions: The synthetic salivary peptide dhvar4 has a broad antimicrobial activity against all microorganisms that are commonly isolated from explanted voice prostheses, including yeasts. Therewith, it may represent a useful drug, as an alternative for antibiotics and antimycotics employed in various ways to prolong the lifetime of voice prostheses in laryngectomees.
Role of the Specialty Society in Outcomes Assessment: The Development of COGENT
Authors: Monsell Edwin M. , Holzer Susan Sedory
Published: November 2003

The Cooperative Outcomes Group for ENT (COG*ENT), a clinical outcomes project of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, was established to assess clinical outcomes of otolaryngological care of patients with two diseases, otitis media and rhinosinusitis. COG*ENT has produced an assessment tool with many potential applications. The development and early experience of the Foundation with this project are described, emphasizing the factors the authors believe are important for success.
A Transgenic Insertional Inner Ear Mutation on Mouse Chromosome 1
Authors: Friedman Rick A. , Adir Yardit , Crenshaw E. Bryan , Ryan Allen F. , Rosenfeld Michael G.
Published: November 2003

Objectives/HypothesisTo clone and characterize the integration site of an insertional inner ear mutation, produced in one of fourteen transgenic mouse lines. The insertion of the transgene led to a mutation in a gene(s) necessary for normal development of the vestibular labyrinth.

Study DesignMolecular genetic analysis of a transgene integration site.

MethodsMolecular cloning, Southern and northern blotting, DNA sequencing and genetic database searching were the methods employed.

ResultsThe integration of the transgene resulted in a dominantly inherited waltzing phenotype and in degeneration of the pars superior. During development, inner ear fluid homeostasis was disrupted. The integration consisted of the insertion of a single copy of the transgene. Flanking DNA was cloned, and mapping indicated that the genomic DNA on either side of the transgene was not contiguous in the wild‐type mouse. Localization of unique markers from the two flanks indicated that both were in the proximal region of mouse chromosome 1. However, in the wild‐type mouse the markers were separated by 6.3 cM, indicating a sizable rearrangement. Analysis of the mutant DNA indicated that the entire region between the markers was neither deleted nor simply inverted.

ConclusionsThese results are consistent with a complex rearrangement, including at least four breakpoints and spanning at least 6.3 cM, resulting from the integration of the transgene. This genomic rearrangement disrupted the function of one or more genes critical to the maintenance of fluid homeostasis during development and the normal morphogenesis of the pars superior.
A Clinicopathological Study of 15 Patients With Neuroglial Heterotopias and Encephaloceles of the Middle Ear and Mastoid Region
Authors: Gyure Kymberly A. , Thompson Lester D.R. , Morrison Alan L.
Published: November 2003

Objectives/Hypothesis Heterotopic masses of neuroglial tissue involving non‐midline structures, specifically, the middle ear region, are exceptional. The pathogenesis of these lesions and, in particular, their relation to encephaloceles, is uncertain.

Study Design and Methods H&E‐stained sections from 15 lesions diagnosed as neuroglial heterotopias or encephaloceles involving the middle ear region were reviewed. Radiographic or operative evidence of a central nervous system (CNS) relation and clinical factors possibly related to pathogenesis were analyzed.

Results All 15 lesions (from six men and nine women; mean age, 49 y; range, 16–67 y), regardless of their relation to the CNS, were composed of varying proportions of neurons and glia with associated chronic inflammatory cells and reactive gliosis. No significant ependymal or choroid plexus component was present. Operative findings revealed that two lesions had definite CNS connections and two were unrelated to the CNS; this relation could not be determined in the remaining cases. Seven of 10 patients for whom clinical information was available had a history of chronic otitis media or mastoiditis or both; four of these seven patients also had a history of previous trauma or surgery. Three patients, including both patients whose lesions had no demonstrable CNS attachment, had no predisposing factors.

Conclusions Most neuroglial heterotopias of the middle ear are probably acquired encephaloceles. These lesions occur in older patients than do their midline counterparts. Determination of the relation of these lesions to adjacent CNS structures must be done radiographically or using operative findings, because histology alone cannot be reliably used to render an accurate diagnosis.
Reliability of the Muller Maneuver and Its Association With Sleep‐Disordered Breathing
Authors: Terris David J. , Hanasono Matthew M. , Liu Yung C.
Published: November 2003

Objectives/Hypothesis Use of the Muller maneuver (MM) in the evaluation of patients with obstructive sleep apnea is controversial. One criticism of this test is that it is somewhat subjective. Our objective is to explore the reliability of this technique and its association with sleep‐disordered breathing.

Study Design Prospective study performed in an academic tertiary care center.

Methods An analysis of MM scores from 180 consecutive patients obtained independently by two examiners was completed. These scores were compared with each other and with the apnea‐hypopnea index (AHI) obtained from polysomnographic studies.

Results Collapse of the soft palate (PAL), lateral pharyngeal wall (LPW), and base of the tongue (BOT) was rated on a five‐point scale (0–4). The mean scores determined by the faculty examiner were 2.47, 2.06, and 1.58, respectively; the mean scores determined by the resident examiner were 2.34, 2.25, and 1.48, respectively. The scores of the two examiners correlated to within ±1 unit 83.9% of the time at the PAL, 91.1% at the LPW, and 85.0% at the BOT. The degree of correlation was not influenced by year of training of the resident. When the AHI was converted to a four‐point scale based on severity, the score correlated within ±1 of the average MM score 72.1% of the time.

Conclusions Despite the subjective nature of the MM, the five‐point scale can be used by independent examiners to achieve an evaluation of the upper airway that is reproducible. The preoperative severity of sleep‐disordered breathing based on the AHI is moderately correlated with the MM score.
Quantitative Impact of Pediatric Sinus Surgery on Facial Growth
Authors: Senior Brent , Wirtschafter Ari , Mai Charlie , Becker Cristy , Belenky Walter
Published: November 2003

Objective/Hypothesis To quantitatively evaluate the long‐term impact of sinus surgery on paranasal sinus development in the pediatric patient.

Study Design Longitudinal review of eight pediatric patients treated with unilateral sinus surgery for periorbital or orbital cellulitis with an average follow‐up of 6.9 years. Control subjects consisted of two groups, 9 normal adult patients with no computed tomographic evidence of sinusitis and 10 adult patients with scans consistent with sinusitis and a history of sinus‐related symptoms extending to childhood.

Methods Application of computed tomography (CT) volumetrics, a technique allowing for precise calculation of volumes using thinly cut CT images, to the study and control groups.

Results Paired Student t test analyses of side‐to‐side volume comparisons in the normal patients, patients with sinusitis, and patients who had surgery revealed no statistically significant differences. Comparisons between the orbital volumes of patients who did and did not have surgery revealed a statistically significant increase in orbital volume in patients who had surgery.

Conclusions Only minimal changes in facial volume measurements have been found, confirming clinical impressions that sinus surgery in children is safe and without significant cosmetic sequelae.
Eustachian Tube Endoscopy in Patients With Chronic Ear Disease
Authors: Linstrom Christopher J. , Silverman Carol A. , Rosen Arie , Meiteles Lawrence Z.
Published: November 2003

Objectives/Hypothesis A paucity of research exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy.

Study Design Twenty‐two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans–eustachian tube endoscopic investigation.

Methods Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx.

Results The 0.5‐mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmüller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long‐standing disease (≥20 y) than for persons without long‐standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa.

Conclusions The findings of trans–eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).
Analysis of Local Cytokine Gene Expression in Patients With Allergic Rhinitis Treated With CO2 Laser Surgery
Authors: Takeno Sachio , Osada Rika , Furukido Kyosuke , Yajin Koji
Published: November 2003

Objectives/Hypothesis Laser surgery of the inferior turbinates has become a popular surgical treatment for patients with allergic rhinitis, particularly for those who have persistent nasal obstruction and do not respond well to pharmacological therapy. The aim of this study was to investigate the effects of the laser surgery on local cytokine gene expression at the mucosal surface in relation to the improvement of nasal symptoms.

Study Design A prospective analysis of 25 patients with allergic rhinitis caused by the house dust mite who underwent laser surgery twice with a 1‐month interval on an outpatient basis. Fifteen healthy volunteers served as normal control subjects.

Methods Improvement of the nasal symptoms was evaluated on a graded scale. Nasal mucosal cells were obtained by brushing from the inferior turbinate at each visit. The expression of messenger RNA (mRNA) encoding granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), interleukin (IL)‐6, IL‐8, RANTES (regulated on activation, normal T‐cell expressed and secreted), and eotaxin was semiquantitatively analyzed by reverse transcription–polymerase chain reaction (RT‐PCR).

Results Two months after treatment, the nasal symptom scores significantly decreased from baseline. The decrease was most apparent in nasal obstruction. RT‐PCR analysis revealed that a significant decrease in IL‐8 and RANTES expression (P < .001 and P = .012, respectively) was observed after successive laser treatment, and the reduction in these cytokines was significantly correlated. On the other hand, mRNA expression of GM‐CSF, IL‐6, and eotaxin remained unchanged.

Conclusions This study provided evidence that the expression of local inflammatory cytokines can be attenuated in part by CO2 laser treatment, which may be closely related to the clinical effectiveness of this procedure.
Management of Acute Pulmonary Hemorrhage in Children
Authors: Sidman James D. , Wheeler William B. , Cabalka Allison K. , Soumekh Benhoor , Brown Carl A. , Wright Gregory B.
Published: November 2003

Objective Acute pulmonary hemorrhage can result from a variety of causes. This report offers a diagnosis and treatment plan for children with acute, life‐threatening pulmonary hemorrhage resulting from a variety of causes.

Methods Retrospective review of children with acute pulmonary hemorrhage cared for at a tertiary care children's hospital during from January 1, 1993 to September 1, 1999.

Patients Fourteen children were identified with life‐threatening pulmonary hemorrhage during the study period.

Interventions Bronchoscopy was the keystone to diagnosis of pulmonary hemorrhage in this series. All of the children underwent multiple procedures to stabilize the airway and control blood loss. These interventions included CO2 laser bronchoscopy, Nd‐YAG laser bronchoscopy, endoscopic balloon occlusion of a lobe or main bronchus, topical airway vasoconstrictors, endoscopic tumor excision, transcatheter embolization of bronchial vessels, and lobectomy.

Outcomes Three children died and 11 survived without neurological sequelae.

Conclusions Control of acute pulmonary hemorrhage is a difficult problem and often requires multiple procedures. Endoscopic control is usually required for palliation until more definitive therapy can be undertaken.
Overexpression of p53‐Related Proteins Predicts Rapid Growth Rate of Head and Neck Cancer
Authors: Edström Staffan , Cvetkovska Elisabet , Westin Thomas , Young Cecilia
Published: November 2003

Objectives/Hypothesis The p53 tumor suppressor gene plays an important role for cell cycle regulation and is the most frequent mutated gene in head and neck cancer. Controversy remains regarding the biological and clinical value of immunohistochemical identification of the proteins accumulated in association with inactivation of the p53 gene and increased tumor growth. Therefore, the objective of the present study was to perform a cell kinetic analysis of cases with untreated squamous cell carcinoma and to compare the result with immunostaining for p53‐related proteins in the tumor cells.

Study Design A prospective series of 32 patients presenting with various stages of untreated squamous cell carcinoma of the head and neck were included. Bromodeoxyuridine (BrdU) was injected as a tracer dose before tumor biopsy for cell kinetic analysis, and p53 protein accumulation was detected using two antibodies (DO7 and PAb 1801).

Results Antibody DO7 showed the highest and the optimal immunoreactivity. Diploid tumors were found in 27 cases (84%), and the mean potential doubling time (Tpot)was 55 ± 7 hours for these tumors. Positivity of DO7 (>1%) was demonstrated in 85% of the cases. However, a discrimination level exceeding 20% was required to obtain a significant negative relationship (Spearman's rank correlation coefficient test, P ≤.03) between Tpot and DO7 positivity. At that level, 33% of the tumors remained DO7‐positive. The corresponding Tpot was not significantly different from the overall mean. The rates of metastatic disease and survival were not dependent on DO7 immunoreactivity or cancer cell kinetics.

Conclusion Accumulation of p53‐related proteins is associated with an unrestrained growth of head and neck cancer.
Detection of Fungi in the Nasal Mucosa Using Polymerase Chain Reaction
Authors: Catten Michael D. , Murr Andrew H. , Goldstein Jayne A. , Mhatre Anand N. , Lalwani Anil K.
Published: November 2003

Hypothesis Fungi have been increasingly recognized as important pathogens in sinusitis. However, detection of fungus with conventional culture techniques is insensitive and unreliable. Polymerase chain reaction (PCR) is an exquisitely sensitive assay that can detect the DNA of 10 or less fungal elements. The aim of this study was to compare the sensitivity of conventional culture techniques using PCR analysis.

Methods Nasal swabs and DNA samples were collected from the nasal cavities of control subjects and patients with chronic sinusitis. Fungal‐specific PCR analysis and standard cultures were performed on every sample. χ2 analysis was used to test for statistical differences between groups.

Results PCR analysis detected fungal DNA in 42% and 40% of control subjects and patients with chronic sinusitis while standard cultures were positive in 7% and 0%, respectively. There was no statistically significant difference in the prevalence of fungi in the normal volunteers and patients with chronic rhinosinusitis.

Conclusion PCR is significantly more sensitive than nasal swab cultures in detecting the presence of fungi in nasal mucosa. In addition, our study suggests that the presence of fungi alone is insufficient to implicate it as the pathogen in chronic sinusitis.
Sleep‐Disordered Breathing: Radiofrequency Thermal Ablation Is a Promising New Treatment Possibility
Authors: Bäck Leif , Palomäki Maarit , Piilonen Anneli , Ylikoski Jukka
Published: November 2003

Objectives The aim of this study was to assess the efficacy and morbidity of radiofrequency thermal ablation of the soft palate in subjects with sleep‐disordered breathing.

Study Design Prospective, nonrandomized study. Outpatient treatment and an extended follow‐up time of 12 months.

Methods Twenty‐one healthy men who were 18 to 60 years of age (median age, 44 y) with sleep‐disordered breathing were enrolled to the study. All the patients had habitual snoring for at least 1 year that was associated with excessive daytime sleepiness interfering with social or professional activities. Radiofrequency energy was delivered to the soft palate in two treatment sessions separated by 1 week at 460 ± 1 kHz with an energy delivery of 600 and 300 J. Snoring Score, Epworth Sleepiness Scale, and cephalometric analysis were measured preoperatively and postoperatively. Certain inflammatory laboratory parameters and visual analogue scale scores of symptoms were measured related to the procedure.

Results The changes in Snoring Score and Epworth Sleepiness Scale scores were statistically significant. The change in the length of the soft palate was statistically significant, whereas the change in palatal width was not. There were no notable changes in the laboratory parameters. The symptom visual analogue scores were low and transient, resolving within days.

Conclusions The radiofrequency thermal ablation of the soft palate in patients with sleep‐disordered breathing seems to be effective. It is safe and associated with only a low morbidity. The promising results must be confirmed in a placebo‐controlled study with a larger sample size and a long‐term follow‐up.
Unilateral Palate Paralysis in Patients With Nasopharyngeal Carcinoma: Imaging and Clinical Correlations
Authors: Su Chih‐Ying , Lui Chun‐Chung
Published: November 2003

Objective Neck masses, hearing impairment, and blood‐tinged nasal discharges are three major clinical manifestations of nasopharyngeal carcinoma (NPC). Because of the relationship between the anatomic structures of the fossa of Rosenmüller and the levator veli palatini muscle, NPC arising in the fossa can invade the levator muscle, limiting movement or causing paralysis of the ipsilateral soft palate. It is well known that NPC originates commonly from the fossa of Rosenmüller. We therefore hypothesize that the clinical signs of unilateral palate paralysis in patients with NPC must be far more common than usually realized. This issue is, as yet, not fully addressed in the literature.

Study Design A prospective study of all patients with newly diagnosed NPC.

Methods Two hundred sixty‐four patients with newly diagnosed NPC were studied. Clinical records included the details of their clinical presentations and the results of physical and neurological examinations. The degree of elevation of the soft palate during phonation was carefully evaluated. Magnetic resonance imaging (MRI) of the head and neck region with a particular emphasis on the levator veli palatini muscles was then performed. The degree of paralysis of the palate was correlated with the degree of invasion of the levator muscles by the tumor, as seen with imaging. The incidence of paralysis of the palate in the patients with NPC was also determined.

Results At the time of diagnosis, ipsilateral paralysis of the palate was observed in 137 (52%) of the 264 patients with NPC. The results of imaging indicated that 62% (163 of 264) of the patients had radiological evidence of tumor invasion of the levator muscle. The degree of paralysis of the palate corresponded well to the extent of tumor invasion of the levator muscle. Paralysis of the palate was not evident in 26 patients with early perimuscular infiltration of the levator muscle.

Conclusion This study revealed that ipsilateral invasion of the levator veli palatini muscle by NPC is common and typically presents with signs of unilateral palate paralysis. This subtle sign is relatively common in patients with NPC. Consequently, we think palate function should be routinely tested when diagnosing NPC, particularly when the patient has unilateral aural symptoms or a neck lump.
Histopathological Changes of Chorda Tympani in Chronic Otitis Media
Authors: Gedikli Orhan , Doğru Harun , Aydin Gülsen , Tüz Mustafa , Uygur Kemal , Sari Aliye
Published: November 2003

Objective To investigate whether histopathological changes of chorda tympani might exist in patients with chronic otitis media without facial paralysis.

Study Design The study was designed as a prospective trial.

Methods Twenty of 107 patients with chronic otitis media, in whom the chorda tympani were injured inadvertently during middle ear surgery, were enrolled into the study. The cases were divided into two groups based on the activity of chronic infection at the time of surgery. Twelve cases with suppurative disease were included in group I, and 8 cases with dry ear in group II.

Results Histopathological examinations of the specimens revealed findings such as thickening of perineural and epineural connective tissue, vacuolar degeneration of Schwann cells, and proliferation of fibroblasts in endoneurium. Disorganization of the axons of some nerve fibers was also determined.

Conclusion Based on the histopathological changes of chorda tympani in chronic middle ear disease, it is postulated that chronic otitis media may give rise to functional loss of the nerve.
Delayed, Reversible Hearing Loss Caused by Difluoromethylornithine (DFMO)
Authors: Doyle Karen Jo
Published: November 2003

Objectives/Hypothesis Difluoromethylornithine (DFMO) is an anticancer experimental drug that is ototoxic. The objectives of these three experiments were to: 1) determine a dose and dosing schedule of DFMO that produces significant hearing loss (HL) in newborn gerbils; 2) compare the HL level for control and newborn gerbils receiving daily subcutaneous injections of DFMO; and 3) to determine if DFMO‐related HL is significantly reversible following discontinuation of DFMO treatment.

Study Design Prospective, non‐randomized experimental design with placebo controls.

Methods Click‐evoked auditory brainstem response (ABR) testing was performed for 21‐day‐old Mongolian gerbils following daily subcutaneous injections of DFMO or saline. Three experiments were carried out using different injection schedules and doses of DFMO. In experiment 3, animals were retested at 42 days of age following a 3‐week recovery from DFMO.

Results Animals administered an 18‐day regimen of DFMO at 1 g/kg per day (from day 3 to day 20) had click thresholds of 25 to 65 dB nHL, whereas animals receiving daily injections of saline had thresholds of 5 to 20 dB nHL. Animals retested after 3 weeks of recovery from DFMO treatment had thresholds ranging from 5 to 20 dB nHL. Differences were statistically significant.

Conclusions DFMO causes mild to moderate HL in neonatal gerbils that recovers after discontinuation of the drug.
Inhibition of Motor Nerve Regeneration in a Rabbit Facial Nerve Model
Authors: Yian Christopher H. , Paniello Randal C. , Gershon Spector J.
Published: November 2003

Objectives/Hypothesis We hypothesized that intramuscular injection of vincristine into the upper lip selectively prevents reinnervation of the target muscle (quadratus labii superioris) after facial nerve transection.

Study Design Prospective controlled experiment.

Methods Transection injuries with primary neurorrhaphy were performed just proximal to the buccal and zygomatic branches of both facial nerves in 20 rabbits. The left (experimental) quadratus labii superioris muscle was injected with 200 μg vincristine 72 hours after injury; the right (control) side was injected with saline. Functional, electrophysiological and histological studies were performed 6 weeks after surgery.

Results After 6 weeks, the control side had a mean axon count (distal buccal branch) of 1160, conduction velocity of 50.4 m/s, reduction of compound action potential amplitude of 44%, and functional index of 1.67 units. The experimental side had a mean axon count of 265, conduction velocity of 16.5 m/s, reduction of compound action potential amplitude of 88%, and a functional index of 0.176 units. All parameters were significantly reduced by vincristine blockade (P <.05). The zygomatic division (not exposed to vincristine) displayed a trend toward increased axon counts, but this was not statistically significant (P = .131).

Conclusions These results demonstrate that reinnervation of a selected muscle can be prevented by injection of vincristine. Enhanced reinnervation of adjacent muscle groups may also occur. Thus, nerve blockade by vincristine may be useful for the prevention of synkinesis.
Inverted Papilloma: A Review of 53 Cases
Authors: Thorp M. A. , Oyarzabal‐Amigo M. F. , du Plessis J. H. , Sellars S. L.
Published: November 2003

Objective To assess the surgical management of patients with inverted nasal papilloma over a 14‐year period.

Study Design Retrospective study.

Setting Tertiary health care center.

Results Fifty‐three patients (38 males, 15 females) with an average age of 49.8 years were treated. Overall recurrence rate was 28% and a malignant association of 9% was shown. Recurrence rates varied from 27% in patients with more extensive disease involvement treated by lateral rhinotomy and medial maxillectomy, to 30% in patients with less extensive disease treated conservatively. Of the 5 patients with associated malignancy, 3 (6% of all patients) are likely to have undergone malignant transformation.

Conclusion Aggressive initial management remains the therapeutic aim in this condition.
In Vivo Diagnosis of Nasopharyngeal Carcinoma Using Contact Rhinoscopy
Authors: Pak Martin Wai , To Ka Fai , Leung Sing Fai , van Hasselt Charles Andrew
Published: November 2003

Objectives To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC).

Study Design Prospective study to examine the nasopharynx of 30 patients with nasopharyngeal carcinoma and 18 subjects with normal nasopharynx in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany, 7215 AA, 00 and 7215 BA, 300; 23 cm long; 4 mm in diameter).

Methods The superficial cells of the normal nasopharynx and the nasopharyngeal tumors were stained with 1% methylene blue and examined with contact rhinoscopes at high magnifications (×60 and ×150). The areas under examination were then biopsied. The contact endoscopic images were compared with the corresponding hematoxylin and eosin‐stained histologic sections of the biopsied tissues.

Results Sixty‐six procedures were performed in 48 patients. The images of normal pseudostratified ciliated epithelium and squamous epithelium were readily recognized by contact endoscopy in all subjects with normal nasopharynx (10 men and 8 women; mean age, 51.9 y). Twenty‐six of 30 patients with NPC (86.6%; 18 men and 8 women; mean age, 50.6 y) were successfully examined by contact endoscopy under local anesthesia. In these 26 patients, two patterns of malignant cells were identified with contact endoscopy. The patterns of contact endoscopic images corresponded well with the histologic findings.

Conclusion Contact endoscopy is an accurate and reliable office‐based procedure, which allows for in‐vivo diagnosis of nasopharyngeal carcinoma.