bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Macrophages on the Survival of Random Skin Flaps in Swine
Authors: Brewster Douglas , Cupp Craig , Wester Derin C.
Published: November 2003

Tissue macrophages play a critical role in neovascularization by releasing angiogenic cytokines. Macrophages normally arrive into a wound bed 48 to 96 hours following an injury.1 Introducing macrophages into a wound bed at the time of closure would theoretically stimulate neovascularization in the traumatized tissue prior to what is normally observed. The ability to promote early angiogenesis could be an important factor in the survival of an extended skin flap.

By taking advantage of advanced cell‐sorting techniques, the authors developed the first study to evaluate the effect of placing a purified autologous macrophage population into an extended skin flap. We created 72 dorsally based random skin flaps in Yorkshire pigs; 48 of these wounds received autologous macrophages while 24 flaps served as controls. The macrophages were obtained by utilizing monoclonal antibodies in conjunction with flow cytometry. The skin flaps were evaluated on postoperative day 6 for their viability. Analysis of the data showed no statistically significant difference between the control and treatment flaps. There was, however, a trend of increased survival for flaps treated with macrophages. This is the first study to investigate using a purified population of cells to improve the survival of random skin flaps.
Orbital Complications of Sinusitis in the Aspirin Triad Syndrome
Authors: McFadden Edith A. , Woodson B. Tucker , Massaro Bruce M. , Toohill Robert J.
Published: November 2003

Orbital complications are uncommon in adult sinusitis. In contrast, the sinusitis of the aspirin triad syndrome is often fulminate, expansive, and recurrent, and complications may be more frequent. Of 81 patients with aspirin triad who were treated surgically, 7 patients (8.6%) had orbital complications, including sinus mucoceles in 3 patients, lacrimal gland extension in 2 patients, inflammatory orbital mass in 1 patient, and proptosis from expansile sinonasal polyposis in 1 patient. All complications manifested within 2 years of prior surgery. Two patients suffered blindness. In a group of 120 consecutively treated sinus surgery patients without aspirin triad syndrome (51 of whom were followed for more than 2 years), no patient manifested nonoperative orbital complications. The results of this study suggest that aspirin triad patients are at significant risk for orbital complications and therefore should have long‐term follow‐up with aggressive treatment of persistent disease.
Lingual Tonsil Hypertrophy Producing Obstructive Sleep Apnea
Authors: Dündar Ahmet , Özünlü Adnan , Sahan Murat , Özgen Fuat
Published: November 2003

The hypertrophy of the lingual tonsil is a rare occurrence in adults. This disorder may cause obstructive sleep apnea (OSA) and also may lead to a life‐threatening obstruction of the upper airway. Diagnosis of lingual tonsil hypertrophy in patients with OSA requires a careful examination by advanced technologic methods. The sleep apnea is successfully treated by lingual tonsillectomy, with or without tracheotomy.

In this study the case of an adult with OSA caused by lingual tonsil hypertrophy which was treated with lingual tonsillectomy is presented, and the diagnosis and the treatment procedure of such cases are discussed.
Heterogeneity of Squamous Cell Carcinomas of the Head and Neck‐Analysis of Tumor Biologic Factors and Proliferation Rates
Authors: Jacob Roland , Welkoborsky Hans J. , Mann Wolf J. , Höfken Frank , Dienes Hans P. , Freije James E.
Published: November 2003

Specimens obtained from five different tumor regions in 12 patients who underwent surgery for squamous cell carcinoma (SCC) of the oropharynx were examined. The evaluation of each biopsy included quantitative DNA measurements based on image analysis, immunohistochemical assessment of proliferations markers (i.e., Ki67‐MIB1, proliferating cell nuclear antigen [PCNA]), and morphological tumorfront grading. From single cell measurements, several DNA indices were derived which are known to reflect tumor aneuploidy.

The results revealed a marked variation of proliferation and cellular differentiation in different regions of tumors and a wide intraindividual variation between particular tumors for all markers examined. There was good correlation between DNA data and proliferative cell fractions (Ki67 score, PCNA score). With the use of diagrams, three‐dimensional distribution of proliferation rates and markers reflecting tumor aggressiveness within each tumor was obtained.

The results confirmed previous clinical and histological observations that SCCs of the oropharynx are heterogeneous tumors. One might expect that the regions with increased proliferation and aggressiveness may predict the location of possible tumor recurrence.
Obliteration of the Eustachian Tube Using Hydroxyapatite Cement: A Permanent Technique
Authors: Kveton John F.
Published: November 2003

Permanent obliteration of the eustachian tube via the middle ear traditionally has met with limited success. Combinations of muscle, fascia, adipose tissue, bone fragments, and inert material such as Proplast have been used to seal the middle ear from the nasopharynx by inciting a fibrous reaction within the lumen of the eustachian tube. Long‐term follow‐up has demonstrated repneumatization of the middle ear cleft in the majority of cases, indicating failure of the obliteration technique. This report describes a technique for successful long‐term obliteration using hydroxyapatite cement. This new biomaterial possesses osseointegrative and osseoconductive properties that result in permanent obliteration by producing new bone formation within the lumen of the eustachian tube. This technique eliminates the complication of cerebrospinal fluid rhinorrhea in lateral skull base procedures that expose the eustachian tube to cerebrospinal fluid.

Laryngoscope, 106:1241‐1243, 1996
Management of Embossment Following the Frontal Osteoplastic Operation
Authors: Lawson William , Reino Anthony J.
Published: November 2003

The deformity in the bony contour of the forehead following the osteoplastic flap procedure on the frontal sinus, termed embossment, occurs in a small but definite number of cases. This complication arises from the combined processes of resorption and deposition of bone following disturbance of the periosteum in performing the operation. A simple and highly reliable method of cosmetic correction employing acrylic cranioplasty has been successfully utilized in a series of cases without complications. The details of the operative technique will be outlined.

Laryngoscope, 106:1259‐1265, 1996
Peripheral Course of Genioglossal Motor Axons Within the Hypoglossal Nerve of the Rat
Authors: Lee Seung , Eisele David W. , Schwartz Alan R. , Ryugo David K.
Published: November 2003

The spatial compartmentalization of motor axons in cranial nerves has not been previously demonstrated. In the present study, motor axons in the medial lingual ramus of the hypoglossal nerve of rats were labeled using horseradish peroxidase and diaminobenzidine staining methods. Neuronal axons were segregated into fascicles within the main nerve trunk (average total length: 10.4 mm). Light microscopic examination of stained nerve sections revealed reaction product within individual axons and showed that the grouping of labeled nerve fibers in the medial ramus was maintained for at least the peripheral half of the nerve before the stain faded.

The authors propose that the fascicular anatomy of the rat hypoglossal cranial nerve resembles that of peripheral spinal nerves in humans. This functional and structural compartmentalization may have a clinical impact on the repair and treatment of cranial nerve pathologies.

Laryngoscope, 106:1274‐1279, 1996
Chronic Rhinocerebral Mucormycosis
Authors: Harrill Willard C. , Stewart Michael G. , Lee Andrew G. , Cernoch Patricia
Published: November 2003

Rhinocerebral mucormycosis is a well‐described fulminant fungal infection that typically presents acutely in patients with diabetic ketoacidosis or immunosuppression. Chronic presentations of rhinocerebral mucormycosis have also been described. In the chronic infection, the disease course is indolent and slowly progressive, often occurring over weeks to months. The authors report 2 cases of chronic rhinocerebral mucormycosis (CRM) treated at their institution and review 16 other cases reported in the English‐language literature. In these cases, the median time from symptom onset to diagnosis was 7 months.

The most common presenting features of CRM are ophthalmologic and include ptosis, proptosis, visual loss, and ophthalmoplegia. CRM occurs predominantly in patients with diabetes and ketoacidosis. The incidence of internal carotid artery and cavernous sinus thrombosis is higher in CRM patients than in those with the acute disease, although the overall survival rate for CRM patients is 83%. CRM is clinically distinct from chronic Entomophthorales infection.

Laryngoscope, 106:1292‐1297, 1996
Prechallenge Antibodies: Moderators of Infection Rate, Signs, and Symptoms in Adults Experimentally Challenged With Rhinovirus Type 39
Authors: Alper Cuneyt M. , Doyle William J. , Skoner David P. , Buchman Craig A. , Seroky James T. , Gwaltney Jack M. , Cohen Sheldon A.
Published: November 2003

This study determined the influence of serum neutralizing antibody titers on infection rate, symptom manifestations, and provoked signs and pathophysiologies in adults experimentally exposed to rhinovirus type 39(RV‐39). Antibody status was determined for 151 healthy volunteers who were then cloistered in a hotel for 6 days. At the end of the first cloister day, the volunteers were challenged with RV‐39 in a median tissue culture infective dose of 100. On each of the 6 days, a nasal examination was performed, symptoms were scored, and objective tests of nasal mucociliary function, nasal airway patency, secretion production, and middle ear pressures were completed. Both subjects and investigators were blinded to the prechallenge serum homotypic antibody titers of the subjects.

Four subjects presented with a wild virus and were excluded from the analysis. Of the 147 included subjects, prechallenge serum antibody titers to RV‐39 were low (under 2) in 56 subjects, intermediate (2 to 8) in 51 subjects, and high (above 16) in 40 subjects. The high‐titer group was significantly different from the low‐titer group with respect to viral shedding, symptom load, subjective extent of illness, and secretion production, as well as in the frequency of subjects with abnormal nasal mucociliary clearance and positive middle ear pressures. The study results document that for experimental RV‐39 exposure, high levels of homotypic serum neutralizing antibody titers are associated with protection from infection and a lessened degree of disease expression, but not with a reduction of otologic complications.

Laryngoscope, 106:1298‐1305, 1996
Laryngeal Activity During Swallow, Phonation, and the Valsalva Maneuver: An Electromyographic Analysis
Authors: McCulloch Timothy M. , Perlman Adrienne L. , Palmer Phyllis M. , Van Daele Douglas J.
Published: November 2003

To better understand the mechanisms of airway protection during swallow, the authors of this study performed an electromyographic (EMG) analysis on the thyroarytenoid (TA) and interarytenoid (IA) muscles during a variety of tasks. The tasks included high, low, and comfortable pitch phonation, the Valsalva maneuver, saliva swallow, and 5‐and 10‐mL water swallows. Raw EMG signals were analyzed to obtain root mean square data, which correspond to a relative magnitude of muscle activation.

The data show that both TA and IA muscles generate a similar level of relative activation, with the greatest electrical activity observed during swallow tasks followed by the Valsalva maneuver and phonation. The duration, onset, offset, and pattern of activity during the swallowing tasks also showed close synchronization between the two muscles. These data can be used in designing therapy for voice disorders and pharyngeal dysphagia.
Objective Assessment of Snoring Before and After Laser‐Assisted Uvulopalatoplasty
Authors: Walker Regina Paloyan , Gatti William M. , Poirier Nancy , Davis Jason S.
Published: November 2003

Laser‐assisted uvulopalatoplasty (LAUP) is an outpatient staged surgical procedure for the treatment of snoring. Each patient undergoes a series of procedures with the end point being patient and bed partner satisfaction in most cases.

The purpose of this study was to objectively evaluate the frequency, pattern, and volume of snoring in patients prior to and following each LAUP procedure. A sonographic device, SNAP®, which records oronasal respiration, was used to assess patients at home. A digital analysis of the frequency, pattern, and volume was then performed.

Twenty‐seven patients have been completely evaluated with this recording device. The findings demonstrate that the LAUP procedure alters the snoring sound. The maximum, average, and velumlike respiratory noise loudness all showed a statistically significant decrease when comparing the preoperative snoring to the final recording after treatment was completed. In addition, the fundamental frequency of the snoring increased significantly after each LAUP procedure. No change was seen in the snoring index following treatment. These objective results correlated well with the subjective responses of the patients and their bed partners. These findings are consistent with the hypothesis that the LAUP procedure alters snoring in a favorable manner by both objective data and subjective accounts.
MRI Evaluation of Vocal Fold Paralysis Before and After Type I Thyroplasty
Authors: Bryant Nancy Jones , Gracco L. Carol , Sasaki Clarence T. , Vining Eugenia
Published: November 2003

Magnetic resonance imaging (MRI) is a useful modality for three‐dimensional evaluation of laryngeal anatomy. The authors present data on patients with unilateral vocal fold paralysis both before and after type I thyroplasty for medialization. Videoendoscopic and acoustic measures were obtained. MRI was performed preoperatively and postoperatively. Three‐dimensional descriptive parameters were established to assess implant location. As well, vocal and endoscopic assessment were used to determine a successful result. Magnetic resonance images of two patients with satisfactory results were compared with images and vocal analysis of two dissatisfied patients. Use of MRI after type I thyroplasty provides additional information about implant location that can help determine the cause of poor results.
Asymmetry in the Nasal Mucociliary Transport Rate
Authors: Nuutinen Juhani
Published: November 2003

Several methods have been devised for measuring the nasal mucociliary transport rate (N‐MTR), but only one side of the nose has usually been studied. This study was conducted to determine whether there are side‐to‐side differences in N‐MTR. A radioisotopic method was used to investigate 185 patients with various respiratory symptoms. Bilateral measurements were performed in the 111 patients with an N‐MTR of under 7 mm per minute.

In 16 healthy control subjects, the N‐MTR ranged from 5.0 to 14.6 mm per minute (mean: 7.8 mm per minute) in the better nostril and from 1.2 to 11.0 mm per minute (4.3 mm per minute) in the poorer nostril (P<.001). In the 111 patients, the N‐MTR ranged from 0.0 to 12.0 mm per minute (3.5 mm per minute) in the better nostril and from 0.0 to 9.5 mm per minute (1.7 mm per minute) in the poorer nostril (P<.001). In the control subjects, the mean N‐MTR was better (P=.011) in the decongested nostril. Even when the N‐MTR was less than 5 mm per minute on the first measured side, it was normal on the opposite side in 18.9% of patients and in 18.8% of control subjects. The author concluded that if the N‐MTR is impaired in one nostril, it should also be measured in the opposite nostril.
Differential Effects of Retinoic Acid and N‐(4‐hydroxyphenyl)retinamide on Head and Neck Squamous Cell Carcinoma Cells
Authors: Eicher Susan A. , Lotan Reuben
Published: November 2003

Both retinoic acid (RA) and the synthetic retinoid N‐(4‐hydroxyphenyl)retinamide (4HPR) have shown efficacy in head and neck cancer chemoprevention trials. To compare their activity and mechanism of action, the 1483 oral head and neck squamous cell carcinoma (HNSCC) cell line was grown in organotypic culture, an in vitro system that allows cellular stratification and simulates carcinoma in situ, and was exposed to 10 μmol/L of either RA or 4HPR. Extensive apoptosis, as evidenced by in situ deoxyribonucleic acid end‐labeling, occurred in 4HPR‐treated cultures after 9 days, with >80% cell loss (P<.001). In contrast, the growth of cultures treated with RA was inhibited by only 32%, with no evidence of apoptosis. Because 4HPR has low systemic toxicity and is a potent inducer of apoptosis in HNSCC cells, its role in chemoprevention of head and neck cancers, including cancers that are resistant to RA‐induction therapy, warrants further investigation.
Update: Laryngeal Reinnervation for Unilateral Vocal Cord Paralysis With the Ansa Cervicalis
Authors: Zheng Hongliang , Li Zhaoji , Zhou Shuimiao , Cuan Yi , Wen Wu
Published: November 2003

Eight patients underwent ansa cervicalis anastomosis to the adductor branch of the recurrent laryngeal nerve for unilateral vocal cord paralysis. They were followed long enough (at least 1 year) to determine if the procedure was successful. All cases have been subjected to preoperative and postoperative voice recording, acoustic analysis, and videolaryngoscopy. Some of them have been subjected to stroboscopy and electromyography (EMG). Data from these cases indicate that satisfactory phonatory quality may be achieved after the procedure. The reinnervated vocal cord neither abducted nor adducted, but it presented itself in midline for precise apposition with the normal cord. Synchronous mucosal waves in both vocal cords could be observed. EMG showed that the procedure produced satisfactory reinnervation of the adductory muscles. Therefore, the authors believe that the procedure could be proposed as an alternative to Teflon injection or thyroplasty in selected cases.
Effectiveness of Surgical Management of Epistaxis at a Tertiary Care Center
Authors: Barlow Darryk W. , Deleyiannis Frederic W.‐B. , Pinczower Eric F.
Published: November 2003

A retrospective review is presented of 44 consecutive patients requiring hospitalization for epistaxis at a tertiary care center. The study had the following objectives:1.to identify predictors of surgical treatment, and2.to compare the effectiveness of different surgical treatments. Length of stay, complications, and cost analysis are also presented. Eighteen patients were successfully treated nonsurgically, whereas 26 patients received surgical treatment. Posterior epistaxis (P<0.05) and an admission hematocrit less than 38% (P<0.05) were significant predictors of surgical treatment. The rebleed rate after first surgical therapy was 33% for embolization, 33% for endoscopic cautery, and 20% for ligation. Since embolization, ligation, and endoscopic cautery may have nearly equivalent failure rates, other factors, such as cost and institutional expertise, should guide the selection of surgical treatment.
Osteosarcoma of the Head and Neck: Meta‐analysis of Nonrandomized Studies
Authors: Kassir Ramtin R. , Rassekh Christopher H. , Kinsella John B. , Segas John , Carrau Ricardo L. , Hokanson James A.
Published: November 2003

To assess the role of adjuvant therapy in the treatment of osteogenic sarcoma of the head and neck, treatment and survival information from 173 patients with osteosarcoma of the head and neck was entered into a database. A meta‐analysis of the data was attempted with primary emphasis on the effect of adjuvant therapy on disease outcome. The overall 5‐year survival was 37%. Patients with mandibular and maxillary tumors had similar survival rates; both groups fared significantly better than patients with extragnathic tumors (P<0.001). Treatment with surgery alone was associated with significantly longer survival rates (P<0.03) than surgery with adjuvant therapy. In the majority of patients reported, information about surgical margins was not available. For this reason, the differences may not adequately represent the effect of adjuvant therapy. While there have been encouraging results with adjuvant treatment protocols for long bone osteosarcoma, the ultimate role of radiation and chemotherapy in the management of osteosarcoma of the head and neck remains unproven. Nevertheless, we recommend that adjuvant therapy be considered due to the poor prognosis in osteosarcoma of the head and neck.
Low‐Dose Intratympanic Gentamicin and the Treatment of Meniere's Disease: Preliminary Results
Authors: Driscoll Colin L. W. , Kasperbauer Jan L. , Facer George W. , Harner Stephen G. , Beatty Charles W.
Published: November 2003

The most disabling symptom for most patients with unilateral Meniere's disease is vertigo. Eradication of the diseased end organ is effective in eliminating the vertigo. Labyrinthectomy remains the “gold standard”; unfortunately, residual hearing is sacrificed to obtain this end. The purpose of this study is to evaluate low‐dose intratympanic gentamicin for the control of vertigo and for the preservation of hearing. A single dose of gentamicin(10‐80 mg) was injected into the middle ear space of 23 patients with unilateral Meniere's disease as an office procedure. Eighty‐four percent of the patients had no episodes of vertigo during the last 6 months of follow‐up. Pure tone average and word discrimination scores were unchanged as a group. Ninety‐five percent of patients had a hearing loss at 6 and 8 kHz that averaged 7.5 dB. Caloric function was reduced in 93%. Low‐dose intratympanic gentamicin is a safe, simple, office procedure that is effective in controlling the definitive vertiginous episodes in most patients with unilateral Meniere's disease. Control of vertigo can be obtained with preservation of hearing.
Ketorolac Tromethamine and Hemorrhage in Tonsillectomy: A Prospective, Randomized, Double‐Blind Study
Authors: Bailey Richard , Sinha Christopher , Burgess Lawrence P.A.
Published: November 2003

Ketorolac tromethamine (KT) is a nonsteroidal, antiinflammatory analgesic. Its nonsedating property makes it an attractive analgesic for sleep apnea patients undergoing uvulopharyngopalatoplasty, but its antiplatelet activity makes the potential for postoperative hemorrhage a concern. A prospective, randomized, double‐blind study was designed to evaluate the bleeding risk of KT using adult tonsillectomy patients as the model. Patients were randomized into two groups receiving Meperidine (MP) (controls) or KT for the first post‐operative day. Posttonsillectomy bleeding rates of 7% (3/43) in the MP group and 18.9% (7/37) in the KT group were demonstrated, but this difference was not statistically significant. The number of KT doses administered had no effect on the incidence of bleeding or the number of cases requiring return to the operative suite for hemostasis. Although this study did not attain statistical significance, the trend towards increased hemorrhage with KT is worrisome. This study and other reports in the literature support the manufacturer's warning that the use of KT is contraindicated in major surgery.
Hydrogen Peroxide in Acute Otitis Media in Guinea Pigs
Authors: Takoudes Thomas G. , Haddad Joseph
Published: November 2003

Evidence has emerged that oxygen free radicals contribute to middle‐ear mucosa damage in acute otitis media (AOM). Streptococcus pneumoniae is the most common pathogen in AOM and produces hydrogen peroxide, a free radical intermediate, as it grows. To better characterize the mechanism of free radical damage in AOM, an experiment was conducted to examine the production of hydrogen peroxide.

Thirty‐two guinea pigs were injected transtym‐panically with bacteria in the left (infected) middle ear and sterile saline into the right (control) middle ear. Middle‐ear fluid was removed and analyzed for quantity of hydrogen peroxide. Results indicated significantly greater hydrogen peroxide levels in infected versus control middle‐ear fluid at 6, 12, and 24 h. Likely sources of hydrogen peroxide include both the neutrophil response to infection and pneumococcal growth and death.
Medial Microflap for Excision of Benign Vocal Fold Lesions
Authors: Courey Mark S. , Garrett C. Gaelyn , Ossoff Robert H.
Published: November 2003

The goal of microlaryngeal surgery is to treat the pathology while preserving or improving vocal function. The medial microflap technique was thus developed. An incision is made over or abutting the lesion, which is then dissected from the vocal ligament and overlying mucosa. Seventeen patients underwent medial microflap excision of their lesions. Postoperative videostroboscopic examinations revealed the presence of mucosal wave and improved glottic closure in 15 of the 17 patients. Acoustic and perceptual analyses revealed improved voice quality. The medial technique is a modification of the previously described lateral microflap technique. Patients whose stroboscopic examination implies lack of involvement of the vocal ligament are candidates for this technique. By identifying normal histologic planes without extensive dissection, lesions can be excised with minimal interruption of vibratory mechanics.
Middle Ear Pressure Variation: Effect of Nitrous Oxide
Authors: Chinn Kathleen , Brown Orval E. , Manning Scott C. , Crandell Carl C.
Published: November 2003

Previous studies examining middle ear pressure changes due to inhalant anesthesia, including nitrous oxide, have cited equivocal results. An investigation was performed to closely monitor changes in middle ear pressure during middle ear surgery. Baseline tympanometry was performed before anesthesia, and middle ear pressure was then documented in 1‐min time intervals. A total of 97 subjects were studied; 51 received nitrous oxide and halothane, and 46 received halothane alone. Results indicate that nitrous oxide causes significantly greater pressure fluctuations than halothane alone. There were no effects for time of surgery, type of fluid, or baseline. Pressure fluctuation was attributed to eustachian tube function. Case studies are presented to demonstrate subject variability, and suggestions for validation study procedures are presented.
Lipomas of the Internal Auditory Canal
Authors: Greinwald John H. , Lassen Lorenz F.
Published: November 2003

Lipomas of the internal auditory canal (IAC) are rare, benign neoplasms occurring in the third to fifth decade of life predominately in Caucasian males. Eleven cases of IAC lesions have been previously reported; we report four more. Two of four cases showed atypical findings on preoperative radiographic evaluation. These two patients had surgery. Two patients with small tumors elected for observation with close follow‐up. Fat suppression of T1‐weighted images on magnetic resonance imaging (MRI) offers the most precise preoperative diagnostic tool of IAC lipomas. Because of the infiltrative nature of these tumors, hearing conservation surgery is unlikely to succeed. We recommend observation for those patients with small tumors and serviceable hearing.
Tumor Necrosis Factor During Experimental Lipopolysaccharide‐Induced Otitis Media
Authors: DeMaria Thomas F. , Murwin Debra M.
Published: November 2003

Studies in our laboratory and others have indicated that endotoxin is present in a high percentage of human middle ear effusions, including those that are culture negative. Endotoxin has been identified as one of the most potent inducers of tumor necrosis factor (TNF), but this relationship has not been investigated in regard to the pathogenesis of otitis media. The purpose of this study was to determine whether endotoxin induces the production of TNF in the middle ear. Otitis media was induced in chinchillas by the injection of isolated lipopolysaccharide and middle ear fluids (MEFs) and serum harvested and assayed for TNF content by means of a cytolytic assay using L‐929 cells and the Cell Titer 96 assay (Promega, Madison, WI). The MEF pools' TNF concentration ranged from 200 to 1,100 pg/mL MEF. Serum pools did not contain any detectable TNF. The results of the present study suggest that endotoxin induces TNF production locally in the middle ear cleft, which may contribute to the pathogenesis of otitis media via any number of established inflammatory pathways.
Age‐Related Changes of the Globular Substance in the Otoconial Membrane of Mice
Authors: Suzuki Hideaki , Ikeda Katsuhisa , Takasaka Tomonori
Published: November 2003

The globular substance, which occurs in the vestibular macula as a precursor of otoconia, was examined in aged mice in comparison with young adult mice. Dissected otoconial membrane from the utricular macula of C57BL/6J mice was loaded with fluo‐3‐AM, and directly observed under a confocal laser scanning microscope. Internal free Ca2+ concentration([Ca2+]i) of the globular substance was determined through in situ calibration performed by superfusion with ionomycin and Mn2+. Total area of the otoconial membrane, average diameter of the globular substance, and [Ca2+]i showed no significant differences between young adult and aged groups. However, the number of globular substances in young adult mice was significantly larger than those of aged mice. These results suggest a reduced rate of otoconial formation in the aged vestibule, which would result in the sparseness of otoconia in the aged vestibule and lead to balance disorders commonly seen in elderly persons.
Evaluation of Swallowing Safety With Fiberoptic Endoscope: Comparison With Videofluoroscopic Technique
Authors: Chih‐Hsiu Wu , Tzu‐Yu Hsiao , Jiann‐Chyuan Chen , Yeun‐Chung Chang , Shiann‐Yann Lee
Published: November 2003

Videofluoroscopy has long been viewed as the “gold standard” of swallowing examination for the comprehensive information it provides. However, it is not very efficient and accessible in some practical situations. In this study, we tried to use a modified technique of fiberoptic endoscopic examination of swallowing (FEES) in evaluating dysphagic patients. For each examination, a spoonful of pudding and dyed water were fed in sequence three times. The pharyngeal swallowing events were observed with fiberscope panoramically and videotaped. Twenty‐eight chronic dysphagic patients underwent both videofluoroscopy and FEES in 2 weeks. Comparison of the results revealed that disagreements in premature oral leakage to the pharynx, pharyngeal stasis, laryngeal penetration, aspiration, effective cough reflex, and velopharyngeal incompetence were 39.3%, 10.7%, 14.3%, 14.3%, 39.3%, and 32.1%, respectively. FEES was found to be more sensitive in detecting these risky features of swallowing, except with respect to premature leakage. Possible causes of the discrepant results are discussed, and the limitation of videofluoroscopy in practical usage is discussed. FEES is conclusively a safer, more efficient, and sensitive method than videofluoroscopy in evaluating swallowing safety.
Necrotizing External Otitis in Patients with AIDS
Authors: Ress Bradford D. , Luntz Michal , Telischi Fred F. , Balkany Thomas J. , Whiteman Michelle L. H.
Published: November 2003

In a retrospective review of seven patients with AIDS who were diagnosed with necrotizing external otitis between 1990 and 1995, it was found that the presentation of necrotizing external otitis in patients with AIDS differed from the classic description of malignant external otitis in several respects. The patient population was significantly younger and nondiabetic. Granulation tissue was usually absent from the external auditory canal and Pseudomonas aeruginosa was not the predominant pathologic organism. Also, outcome was found to be significantly worse. Thus a high index of suspicion must be entertained and vigorous local and systemic treatment initiated early in the course of disease to achieve a satisfactory outcome.
Exophytic Brain Tumors Mimicking Primary Lesions of the Cerebellopontine Angle
Authors: Ahn Min S. , Jackler Robert K.
Published: November 2003

The vast majority of cerebellopontine angle (CPA) tumors are extraaxial masses arising from either the eighth nerve (acoustic neuroma) or meninges (meningioma). Rarely, a tumor that arises from the brain parenchyma may protrude laterally to present with a clinical and radiographic picture simulating that of the much more common extraaxial lesions. Three individuals with CPA lesions that ultimately proved at operation to be exophytic brain tumors (pontine medulloblastoma, cerebellar astrocytoma, and fourth ventricular ependymoma) are described. The clinical manifestations of these lesions, although not entirely typical, fell well within the possible range of presentation of benign tumors primary to the CPA. In two of these cases the tumor actually penetrated into the internal auditory canal. As the optimal management strategy for treating parenchymal tumors differs substantially from that for extraaxial lesions, it is essential that the surgeon have a preoperative awareness of the lesion's nature before embarking on a surgical endeavor. Critical to arriving at the correct diagnosis is the close examination of preoperative imaging studies. The clinician should be alerted to the possibility that a CPA tumor is of intraaxial origin when the preoperative magnetic resonance imaging scan shows 1) blurring of the margin between the tumor and brainstem or cerebellum; 2) a degree of peritumoral hyperintensity on T2‐weighted scans disproportionate to the size of the extraaxial mass; and 3) dilation of the lateral recess of the fourth ventricle.
Noninvasive Tracking of Patient's Head Movements During Computer‐Assisted Intranasal Microscopic Surgery
Authors: Hauser Rolf , Westermann Birgit , Probst Rudolf
Published: November 2003

A noninvasive system designed for patient tracking during image‐guided intranasal sinus surgery is described. It is based on optical digitizing with a custom‐made registration and reference system, locatable surgical instruments, and a self‐localizing operating microscope. Experimental and clinical results reveal a high degree of accuracy for the system. A mean spatial error of 0.82 ± 0.31 mm was determined for repositioning of the reference system in a plastic model of the skull. For the positioning of the microscope, a mean error of 2.3 ± 0.83 mm was calculated. Measurements of repositioning accuracy in 24 patients who received surgery for various sinus diseases had a mean spatial error of 1.56 ± 0.76 mm. The 95% error interval for locating intranasal structures using the surgical instrument was 2.05 mm, and it was 4.92 mm using the microscope. These results suggest that the use of our noninvasive registration and reference system may be effective, accurate, and useful for noninvasive tracking of patient movements in computer‐assisted intranasal surgery.
Long‐Term Outcome Analysis of Functional Endoscopic Sinus Surgery: Correlation of Symptoms With Endoscopic Examination Findings and Potential Prognostic Variables
Authors: Chambers David W. , Davis William E. , Cook Paul R. , Nishioka Gary J. , Rudman David T.
Published: November 2003

One hundred eighty‐two patients were evaluated after functional endoscopic sinus surgery. The goal was to establish whether any anatomical finding correlated with symptoms and to find any historical predictors of symptomatic failure. Of all physical findings reviewed, only scarring of middle meatal antrostomy and scarring of the ethmoids approached significance in predicting poor outcome. Surprisingly, of the historical factors reviewed, only gastroesophageal reflux disease was statistically significant as a predictor of poor symptomatic outcome.
Contemporary Management of the Aging Brow and Forehead
Authors: Koch R. James , Troell Robert J. , Goode Richard L.
Published: November 2003

Management of the aging brow and forehead has recently evolved based on available innovative technologies. Likewise, procedure‐specific indications have changed based on collective surgical experiences. No longer is the approach based solely on hair pattern or degree of brow ptosis. Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline‐preserving forehead elevation. Some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows). We present a 3‐year experience using a problem‐specific approach. This incorporates endoscopic technology, botulinum toxin type A purified neurotoxin complex (Botox, Allergan, Irvine, CA) intramuscular injection, and traditional procedures such as the coronal, pretrichial, midforehead, and direct browlift. Current indications, patient selection, and results are also discussed.
Resorbable Fixation Plates in Head and Neck Surgery
Authors: Weisberger Edward C. , Eppley Barry L.
Published: November 2003

A skeletal fixation system employing plates made of polylactic and polyglycolic acid has been employed at Indiana University Medical Center since July 1993 in 105 craniofacial reconstructions, 45 cases of maxillofacial trauma, 10 craniotomy flap repairs, and five cases involving reconstruction of the laryngotrachea. Because these plates eventually resorb, they offer significant theoretical advantages. No inhibition of structural growth should occur when using this system in children. Tissue tolerance of these plates has been excellent. The technical details of using heat to allow reshaping of the plates as well as the methods of fixation of the plates are discussed.
Retropalatal Airway Characteristics in Uvulopalatopharyngoplasty Compared With Transpalatal Advancement Pharyngoplasty
Authors: Woodson B. Tucker
Published: November 2003

Uvulopalatopharyngoplasty (UPPP) is reported successful in treatment of obstructive sleep apnea for approximately 50% of patients. Several modifications of the procedure have been described, including transpalatal advancement pharyngoplasty, which resects a portion of posterior hard palate and advances the soft palate anteriorly. Comparing effectiveness of different techniques based on sleep and respiratory data is confounded by multiple variables including clinical failure at nonsurgical sites and imprecise patient selection techniques. Since pharyngeal surgical procedures prevent collapse and obstruction by structurally modifying the upper airway, measuring structural changes in size and collapsibility provides a method to compare techniques. To evaluate whether transpalatal advancement pharyngoplasty is more effective in modifying upper airway characteristics than UPPP, upper airway cross‐sectional size and collapsibility were measured after UPPP and transpalatal advancement pharyngoplasty. Six patients were evaluated using a quantitative endoscopic technique. After transpalatal advancement pharyngoplasty maximal retropalatal airway size increased 321% from 29.7 ± 9.9 to 95.3 ± 16 mm2 (P < 0.01), and retropalatal closing pressure decreased from 4.7 ± 1.6 to ‐3.8 ± 0.7 cm/H2O (P < 0.01) compared with UPPP. Respiratory disturbance index decreased from 74.5 ± 13.5 to 29.2 ± 9 events/hour postoperatively (P < 0.05). Results support the conclusion that transpalatal advancement pharyngoplasty increases retropalatal size and decreases retropalatal collapsibility compared with UPPP. Since these characteristics are postulated to contribute to increased stability during sleep, transpalatal advancement pharyngoplasty may potentially improve UPPP outcome in selected patients with small retropalatal airway areas after traditional surgery.
Correlation Between Vocal Functions and Glottal Measurements in Patients With Unilateral Vocal Fold Paralysis
Authors: Inagi Katsuhide , Khidr Aliaa A. , Ford Charles N. , Bless Diane M. , Heisey Dennis M.
Published: November 2003

Observations and analysis of glottal characteristics are critical in choosing the best modality for surgery in patients with unilateral vocal fold paralysis (UVP). This study suggests that multiple glottal characteristics influence the vocal product in patients with UVP. In addition to the horizontal position of the paralyzed vocal fold (deviation from the midline), the glottal area, degree of bowing of the paralyzed and contralateral vocal folds, maximum separation between vocal folds, compensatory glottal maneuvers, and the vertical glottic closure plane significantly influenced the quality of the voice. Clinicians should be aware of these observations to facilitate treatment planning and assessment of the results of surgical procedures used to improve voice quality in cases of UVP.
Surgical Experience With Bone‐Anchored Hearing Aids In Children
Authors: Papsin Blake C. , Sirimanna Tony K.S. , Albert David M. , Bailey C. Martin
Published: November 2003

Titanium osseointegrated implants for boneanchored hearing aids (BAHAs) have been in use since 1977. A series of 32 children who received implantation since 1990 is reported. The report focuses on the surgical aspects of BAHAs, predisposing factors, and prevention of complications in an unusual pediatric population. The records of 32 children who had undergone two‐stage implantation of a BAHA were retrospectively reviewed. The majority of the patients had craniofacial abnormalities. Of the 32 implantees, 29 use their BAHA at present. Five children failed to achieve osseointe‐gration, and eight patients have had revision surgery for lost abutments, trauma, or chronic skin problems. There were no differences between preimplantation and postimplantation bone or air conduction thresholds. The pediatric BAHA carries with it a unique set of challenges and problems but can be successfully implanted and maintained.
Rhinocerebral Mucormycosis: Evolution of the Disease and Treatment Options
Authors: Peterson K. Linnea , Wang Marilene , Canalis Rinaldo F. , Abemayor Elliot
Published: November 2003

Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuses and orbit. Mucormycosis is most commonly seen in association with diabetic ketoacidosis, but disease demographics have changed with the onset of AIDS and the advent of powerful immunosuppressive drugs. Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. Although surgical intervention remains essential, advances in medical therapy have permitted a more limited surgical approach to minimize functional loss without compromising survival. We present the UCLA experience with rhinocerebral mucormycosis from 1955 to 1995, with emphasis on the evolution of disease presentation and alternative treatment options.
Intracranial Complications of Sinusitis
Authors: Giannoni Carla M. , Stewart Michael G. , Alford Eugene L.
Published: November 2003

Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.
Can Sensitized Lymphocytes Retain Reactivity to Inner Ear Antigens After Retrieval From Frozen Storage?
Authors: Hughes Gordon B. , Paulic Zlatko M. , Shu Suyu , Fairchild Robert L. , Barna Barbara P.
Published: November 2003

Immune inner ear disease results in rapidly progressive, bilateral sensorineural hearing loss and is one of the few forms of sensorineural hearing loss that can be treated medically. The purpose of this study is to identify and preserve several populations of sensitized lymphocytes from patients with immune inner ear disease as a first step toward cloning autoreactive T cells, in order to study the pathogenesis of disease. Lymphocytes from four patients with high reactivity (stimulation index of 2.5 or greater) were placed in frozen storage. At 8 to 14 months they were thawed and restimulated. All four samples were viable. Two reacted again to inner ear homogenate, but with different intensities. Some lymphocytes sensitized to inner ear antigens can retain reactivity after frozen storage. This methodology may be useful to clone highly reactive T cells.
Hyperparathyroidism Associated With a Chronic Hypothyroid State
Authors: Walker Regina Paloyan , Kazuko Ernst , Gopalsami Chellam , Bassali Joanne , Lawrence Ann M. , Paloyan Edward
Published: November 2003

Reports of the coexistence of hyperparathyroidism and thyroid disease have raised the issue of a possible etiologic relationship. The present study tests the hypothesis that chronic elevation of thyroid‐stimulating hormone (TSH) is related to the development of hyperparathyroidism. Four groups of 60 female rats were treated as follows: group 1, control; group 2, propylthiouracil (PTU) 0.0025%; group 3, PTU 0.0025% plus thyroxine, 5 μg two times per week; and group 4, only thyroxine. The animals' serum calcium, phosphorus, TSH, thyroxine, and parathyroid hormone (PTH) levels were evaluated at 0, 6, 12, and 18 months. Significant elevation of TSH was sustained throughout the 18 months in groups 2 and 3. The PTH levels were also significantly elevated in both group 2 and group 3 animals (P = 0.02). The histopathologic features of the parathyroids were evaluated at 18 months. In the group 2 (PTU only) animals, which had profound hypothyroid, 44% developed parathyroid adenomas. In the group 3 (PTU plus thyroxine) animals, who had mildly elevated TSH levels, 53% developed parathyroid adenomas. These findings are consistent with the hypothesis that prolonged TSH stimulation may lead to hyperparathyroidism in the rat model.
Congenital Encephalocele of the Medial Skull Base
Authors: Mulcahy Maureen M. , McMenomey Sean O. , Talbot J. Michael , Delashaw Johnny B.
Published: November 2003

Meningoencephaloceles of the temporal bone are rare. Although most often seen following otologic surgery or trauma, congenital meningoencephaloceles can exist. The clinical presentation, diagnostic evaluation, and surgical management of three patients with congenital meningoencephalocele are presented. Two of the three patients presented to our institution with recurrent episodes of meningitis; one presented with partial complex seizures. Diagnostic evaluation included temporal bone computed tomography with magnetic resonance imaging. In two patients, defects were imaged following high‐pressure subarachnoid cisternography with computed tomography. All three patients were found to have congenital defects in the area of Meckel's cave. Early recognition of congenital meningoencephalocele is important to avoid delay of definitive surgical management and neurologic sequelae.
Management of Laryngotracheobronchial Sequelae and Complications of Relapsing Polychondritis
Authors: Spraggs Paul D.R. , Tostevin Philippa M.J. , Howard David J.
Published: November 2003

Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.