bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Compliance of Laryngectomized Patients With a Specialized Pulmonary Rehabilitation Device
Authors: Ackerstaff Annemieke H. , Hilgers Frans J.M. , Balm Alfons J.M. , Tan I. Bing
Published: November 2003

Previous studies have demonstrated the positive effect of a heat and moisture exchanger (HME) on the respiratory system in patients after laryngectomy. However, patient compliance with these devices was reduced by device‐related problems and troublesome combination with a voice prosthesis. Recently a more specialized device has become available. This is an HME combined with a valve for easy digital occlusion of the stoma (Provox Stomafilter; Hörby, Sweden). In the authors' initial study of this revised device, a clear improvement in short‐term compliance was demonstrated. To investigate long‐term compliance, 69 consecutive patients were interviewed by means of a structured questionnaire. The results show that all patients expressed their satisfaction with the valve used for digital occlusion of the stoma. Sixty‐three percent of the patients reported that voicing was facilitated. Subjective intelligibility improved in 55% of the patients. Previous problems with other devices(e.g., plaster adherence, skin irritation, and handling) were clearly diminished, increasing the long‐term compliance of the patients to 78%. This new HME can be considered as a beneficial pulmonary rehabilitation tool for laryngectomized patients.
Prognostic Value of Histopathologic Parameters and DNA Flow Cytometry in Squamous Cell Carcinoma of the Pyriform Sinus
Authors: Del Valle‐Zapico Adolfo , Fernández Fidel Fernández , Suárez Antonio Rubio , Angulo Carmelo Morales , Quintela Julio Rama
Published: November 2003

A retrospective study of a group of 51 patients who underwent surgery for squamous cell carcinoma of the pyriform sinus was performed. Primary tumors and lymph nodes were reviewed histologically. The primary tumors were also examined by flow cytometry for DNA ploidy and cell cycle analysis. Sixteen (33%) of the cases were aneuploid and 64% had a moderate or high S‐phase fraction. The overall 3‐year survival rate was 49% (25/51). In the univariate analysis, tumor size, lymphatic invasion, inflammatory infiltrate, presence of lymph node metastases, clinical and histologic N status, size and number of lymph nodes involved, and presence of extracapsular extension all correlated with survival. When multivariate analysis was used, the only independent prognostic factors were tumor size, lymphatic invasion, and histologic N status. Ploidy and S‐phase fraction did not contribute further prognostic information.
Vestibular Stimulation by Multichannel Cochlear Implants
Authors: Bance Manohar L. , O'Driscoll Martin , Giles Ellen , Ramsden Richard T.
Published: November 2003

The recipient of a Nucleus 22 multichannel cochlear implant began to experience severe vestibular stimulation related to the implant. This patient's experience initiated a study with the objective of determining the frequency of implant‐related vestibulo‐ocular stimulation. Subjects consisted of 17 randomly selected patients who use cochlear implants. Included in the study were 14 Nucleus 22 and three Med‐El Combi 40‐devices. Stimulation of the implants was performed both by individual channel and with sound field broad‐band 80‐dB noise using the users' normal device settings. Eye movements were monitored with infrared videonystagmography. Only one subject, who used a Med‐El Combi 40, showed a consistent and strong ocular response to cochlear stimulation but had no subjective symptoms. The authors conclude that vestibulo‐ocular activation is possible with multichannel cochlear implants but is infrequent and may not be clinically significant.
Combined Epstein‐Barr Virus and Human Papillomavirus Infection in Nasopharyngeal Carcinoma
Authors: Rassekh Christopher H. , Rady Peter L. , Arany Istvan , Tyring Stephen K. , Knudsen Sharen , Calhoun Karen H. , Seikaly Hadi , Bailey Byron J.
Published: November 2003

Epstein‐Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV‐positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c‐myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c‐myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV‐containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV‐negative and none of the nine HPV‐positive NPCAs. (All HPV‐positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV‐negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.
Mandibular Reconstruction With Transforming Growth Factor‐β1
Authors: Sherris David A. , Murakami Craig S. , Larrabee Wayne F. , Bruce A. Gregory
Published: November 2003

Hypothesis: Transforming growth factor‐β1 (TGF‐β1) plus demineralized bone matrix (DBM) will reconstruct a critical mandibular defect devoid of periosteum in a canine model.

Study Design: Randomized, blinded, placebo‐controlled, prospective animal pilot study.

Methods: Canine critical mandibular defects devoid of periosteum were reconstructed with DBM (group 1, n = 3) and DBM plus TGF‐β1 (250 μg TGF‐β1/g DBM) (group 2, n = 3). Radiologic, histologic, and biomechanical testing was performed on the test group and control group specimens at 12 weeks after implantation.

Results: A palpable bone bridge was present in the group 2 subjects 5 to 6 weeks after implantation and was never present in the group 1 subjects. Radiologic and histologic examination at the time of harvest (12 weeks after implantation) demonstrated a solid bone bridge in the group 2 subjects and a fibrous union in the group 1 subjects. Group 2 specimens demonstrated failure in four‐point bending testing at an average maximum moment of 9.9 ± 2.2 N‐m. This value was 9.4% of the maximum moment of the contralateral nonoperated side. Group 1 specimens were palpably flexible on plate removal and had a biomechanical strength of 0. The difference in strength between group 1 and group 2 was statistically significant (P < 0.02), supporting the hypothesis that the addition of TGF‐β1 to the DBM carrier resulted in the formation of significantly stronger bone in the critical gap.

Conclusion: The addition of TGF‐β1 to DBM results in healing of a critical bone defect devoid of periosteum in a higher mammalian model.
Effects of Phenylephrine on Ciliary Beat in Human Nasal Respiratory Epithelium: Quantitative Measurement by Video‐Computerized Analysis
Authors: Min Yang‐Gi , Yun Yeong‐Seok , Rhee Chae‐Seo , Sung Myung‐Whun , Lee Kang‐Soo , Ju Myung Sil , Park Kwang‐Suk
Published: November 2003

The in vitro effects of phenylephrine solution on ciliary beat frequency (CBF) in terms of different concentrations and exposure times were investigated using a video‐computerized analysis technique. Nasal epithelial cells were taken from inferior turbinate of 10 volunteers by scraping the nasal mucosa with a cytology brush. CBF was measured in five different concentrations including 0.125%, 0.25%, 0.5%, 1%, and 2.5%. Each specimen was incubated in different solution for 6 days and CBF was measured at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, and 6 days. CBF decreased significantly after 12‐hour incubation in 0.125% phenylephrine solution and after 8‐hour incubation in 0.25% phenylephrine solution, both clinically used concentrations. There were significant decreases in CBF after incubation in 0.5% phenylephrine for 2 hours, in 1% for 1 hour, and in 2.5% for 30 minutes (P < 0.05, repeated measure analysis of variance [ANOVA]). CBF of the nasal respiratory ciliated cells significantly decreased with increasing concentrations of phenylephrine solution and with increasing incubation times at the same concentration (P < 0.05, repeated measure ANOVA). The results of this study suggest that phenylephrine may inhibit ciliary beat in vitro by its pharmacological effect at lower concentrations than clinically used ones.
Combining Free Flap Reconstruction and Craniofacial Prosthetic Technique for Orbit, Scalp, and Temporal Defects
Authors: Gliklich Richard E. , Rounds Mark F. , Cheney Mack L. , Varvares Mark A.
Published: November 2003

Objectives: To identify factors leading to successful application of prosthetic techniques following free flap reconstruction of the orbit, scalp, and temporal region.

Study Design: Retrospective review.

Methods: Twenty‐eight patients who underwent free flap reconstruction for defects of these regions between 1989 and 1996 were reviewed for clinical parameters, flap loss, patient survival, and implant loss rate. Prosthetic usage rates were compared before and after introduction of a site‐specific reconstructive algorithm.

Results: Free flap success rate was 93%, whereas osseointegrated implant loss rate was 11%. In addition to implants, a reconstructive strategy that provided thin, vascular tissue between bone and skin, a flat platform in the temporal region, and preservation of orbital cavity depth led to increased prosthetic usage.

Conclusions: Craniofacial prosthetic techniques can significantly augment the results of free flap surgery for the orbit, scalp, and temporal region. Successful combination of these techniques requires a site‐specific surgical approach.
Identification of p53 and Human Papilloma Virus in Schneiderian Papillomas
Authors: Mirza Natasha , Montone Kathleen , Sato Yuichi , Kroger Hans , Kennedy David W.
Published: November 2003

Schneiderian papilloma of the nose is an unusual neoplasm with the propensity for local tissue destruction, recurrence, and malignant degeneration. Human papilloma virus (HPV) is related to a subset of sinonasal papillomas and has been implicated in the pathogenesis of cancer by interaction with the host p53 protein. Detection of p53 and HPV could be clinically useful as tumor markers for lesions with oncogenic potential. Thirty specimens for p53 were studied and nine (30%) stained positive. HPV was detected in six (20%). In the presence of p53, an odds ratio for carcinoma was 1.19:1, or 19% higher than expected. In the presence of HPV the odds ratio for carcinoma was 11.5:1, or 11.5 times higher than expected. In the presence of HPV an odds ratio for finding an elevated amount of p53 was 2.2:1. The data support the hypothesis that HPV and p53 may interact in a novel manner and elevate the risk for neoplasia.
Effect of Intratympanic Steroid Application on the Development of Experimental Cholesteatoma
Authors: Sennaroglu Levent , Özkul Ayhan , Gedikoglu Gökhan , Turan Ergin
Published: November 2003

By introducing certain irritants into the middle ear it is possible to produce cholesteatoma. Propylene glycol, the main agent used for this purpose, produces a long‐standing inflammation that causes hyperplasia and migration of the epithelium through an intact tympanic membrane. In the present investigation topical prednisolone was used in order to inhibit the production of cholesteatoma. The results indicate that there is a marked decrease in inflammation and hence experimental cholesteatoma production when prednisolone is administered into the middle ear.
Short‐ and Long‐term Results of Stapedectomy In Children
Authors: Lippy William H. , Burkey John M. , Schuring Arnold G. , Rizer Franklin M.
Published: November 2003

Studies have indicated that stapedectomy can be an effective procedure in children for correcting conductive hearing losses due to juvenile otosclerosis. However, because childhood otosclerosis is rare and children commonly choose to use hearing aids in lieu of undergoing surgery, little outcome data are available. The purpose of this retrospective study was to provide additional outcome data in both the short and the long term. Stapedectomies were performed on 47 children. Preoperative hearing results were compared with 6‐month postoperative hearing results. Hearing results for the children who had long‐term follow‐up (5 years or more) were compared with the 6‐month postoperative results. Stapedectomy was successful (postoperative air conduction pure‐tone average [PTA] within 10 dB of the preoperative bone conduction PTA) in 91.7% of the cases. The mean over‐closure of the preoperative bone conduction PTA by the postoperative air conduction PTA was 0.2 dB. The mean PTA hearing improvement was 32.8 dB. Results from the 21 children (28 ears) who had long‐term follow‐up indicated an average 0.7 dB/year PTA worsening from the 6‐month postoperative PTA. Results from this study provide additional evidence that stapedectomy can be an effective procedure for correcting conductive hearing losses due to juvenile otosclerosis.
Is the Presence of Transient Evoked Otoacoustic Emissions in Ears With Acoustic Neuroma Significant
Authors: Ferber‐Viart Chantal , Colleaux Bernard , Laoust Laurent , Dubreuil Christian , Duclaux Roland
Published: November 2003

One hundred sixty‐eight patients admitted for acoustic neuroma removal were involved in this study. In all cases, the size of the tumor and the presence or absence of tinnitus and vertigo or dizziness were evaluated. Investigated functional procedures included bilateral measures of pure‐tone audiometry (PTA), auditory brainstem response (ABR), electronystagmography (ENG), and transient evoked otoacoustic emissions (TEOAEs). Thirty‐five patients (21%) had normal preoperative TEOAEs in the affected ear, whereas 133 patients (79%) failed to show reproducible responses. The aims of this study were 1. to evaluate what distinguishes patients with preoperative TEOAEs in the pathological ear (group A) from those who had no TEOAE (group B); and 2. to determine in cases of attempted hearing preservation whether preoperative TEOAE presence in the neuroma ear (group C) was predictive of postoperative hearing preservation compared with the group of patients without TEOAEs (group D). The presence of vertigo or dizziness was significantly less frequent, the age was lower, and preoperative mean PTA loss in both ears was lower in group A compared with group B. Frequency of the other studied parameters and ABR threshold were similar in both groups. When hearing preservation was attempted, the mean preoperative PTA loss of group C patients was lower in both ears compared with group D. However, postoperative mean PTA loss did not significantly differ in the two groups. In group C, the percentage of hearing preservation (66.6%) was significantly higher than the percentage of deafness (33.4%), whereas in group D the percentage of postoperative preserved audition and deafness did not significantly differ (respectively 44.4% and 55.6%). The findings suggest that 1. TEOAEs in ears with acoustic neuromas are found in younger patients with a lower preoperative mean PTA loss and are accompanied by fewer functional complaints, perhaps because preserved TEOAEs indicate a better preservation of inner ear vasculature; and, 2. along with radiological and electrophysiological investigations, TEOAE presence in the pathological ear could provide an additional criterion or predictive factor for the successful outcome of attempted hearing‐conservation surgery in ears with acoustic neuromas.
Functional Endoscopic Sinus Surgical Outcomes for Contact Point Headaches
Authors: Parsons David S. , Batra Pete S.
Published: November 2003

Headaches secondary to sinonasal anatomic abnormalities continue to remain a difficult entity to diagnose and to manage. This retrospective study analyzed the outcome of care for 34 patients who presented with headaches as one of their primary sinonasal complaints and were subsequently found to have contact points between the nasal septum and one or more turbinates on nasal endoscopy and/or computed tomography scan. Following functional endoscopic sinus surgery to relieve the contact points, these patients were interviewed regarding preoperative and postoperative intensity and frequency of the headaches and the overall response of the chronic sinusitis and headaches to surgery, after a mean follow‐up period of 13.9 months. After surgery, reduction in intensity and frequency of headaches was experienced in 91% and 85% of the patients, respectively. This investigation demonstrates that surgical management of contact point headaches can make a significant impact on the headache symptomatology in children and adults.
Primary Subglottic Cancer
Authors: Dahm J. David , Sessions Donald G. , Paniello Randal C. , Harvey Joseph
Published: November 2003

This retrospective study reviews 39 patients with primary subglottic cancer seen between 1955 and 1988 by the Department of Otolaryngology at Washington University. This number constitutes 1.8% of laryngeal cancer cases diagnosed during this period. Twenty‐eight patients (71.8%) had epidermoid cancer, of which 19 (67.9%) had “early” disease (stages I and II), and nine (32.1%) had “advanced” (stages III and IV). Overall 5‐year survival was 57.7%. Disease‐free survival was 46.2%. Patients treated with radiotherapy alone, surgery alone, or both had disease‐free 5‐year survivals of 22.2%, 41.7%, and 100%, respectively. Combination therapy showed a significantly higher (P < .01) disease‐free survival than radiotherapy alone.
Radiation Therapy for Early Stage (T1‐T2) Sarcomatoid Carcinoma of True Vocal Cords: Outcomes and Patterns of Failure
Authors: Ballo Matthew T. , Garden Adam S. , El‐Naggar Adel K. , Gillenwater Ann M. , Morrison William H. , Goepfert Helmuth , Ang K. Kian
Published: November 2003

Sarcomatoid carcinoma of head and neck mucosal sites is a rare high‐grade malignancy that may cause diagnostic and therapeutic controversies. A characteristic of this entity consistently reported but not entirely validated is its relative radioresistance and the general belief is that surgery is the treatment of choice. The objective of this retrospective study was to determine if patients treated with radiation for early glottic sarcomatoid carcinoma had worse outcomes than those achieved with irradiation for the more typical squamous cell carcinoma. Twenty‐eight cases of early stage (T1‐T2) sarcomatoid carcinoma of the larynx treated with definitive doses of megavoltage irradiation between 1969 and 1995 at The University of Texas M. D. Anderson Cancer Center form the cohort for this analysis. All pathologic material was reviewed to confirm the diagnosis. All tumors manifested spindle cell features with marked cytomorphologic abnormalities characteristic of this entity. Sixteen tumors (57%) had the more typical polypoid gross morphology of sarcomatoid carcinoma. Twenty‐one patients (75%) were staged T1 and seven patients (25%) had stage T2 disease. All patients were treated with small laryngeal fields, median size 20 cm2, and to a median dose of 65 Gy. Follow‐up ranged from 1.5 to 24 years (median, 10 years). Four patients (14%) had local disease recurrence, and all had salvage total laryngectomies and remained free of local disease. The 5‐year actuarial local control rates for patients with T1 and T2 lesions were 94% and 54%, respectively. Only one patient developed regional and distant disease. The 10‐year actuarial disease‐specific and overall survival rates were 92% and 63%, respectively. Patients with early stage sarcomatoid carcinoma of the glottis treated with radiation had similar control rates to irradiated patients with similar volume disease with the more typical squamous cell carcinoma. The authors contend that the histologic diagnosis of sarcomatoid carcinoma by itself should not influence the decision to treat a patient with early stage glottic disease with irradiation.
Dr. Miller Goes to Washington: You Should, Too
Authors: Miller Robert H.
Published: November 2003

Otolaryngologists, like most physicians, tend to avoid local, state, and national politics for a variety of reasons. Although physicians and their patients are frequently affected by policies made in these political arenas, physicians tend to avoid active participation because of inexperience, lack of time, lack of knowledge about ways to influence policy development, and a general distaste for the political process. Otolaryngologists need to participate in the process to ensure that their particular perspectives and concerns are heard. However, otolaryngologists also need to look beyond their personal or specialty interests to influence the broader health care debate. Before we are specialists, we are first physicians who have a fiduciary responsibility to mankind (our patients) to improve the health care system for all Americans. We have a moral and ethical obligation to address, influence, and support health care beyond the specialty level. Health policy developed in an absence of physician input is missing the insight of expertise and experience.
Relationship Between Quality of Life and Depression in Patients With Head and Neck Cancer
Authors: D'Antonio Linda L. , Long Steven A. , Zimmerman Grenith J. , Peterman Amy H. , Petti George H. , Chonkich George D.
Published: November 2003

Objective: This study describes the relationship between health‐related quality of life (HRQOL) and depression in patients following major surgery for head and neck cancer.

Design: Cross‐sectional study using medical chart review, patient interview, and test administration.

Method: Fifty patients were evaluated 6 months to 6 years following surgery using one global HRQOL measure (The Functional Assessment of Cancer Therapy‐General [FACT‐G]); three disease‐specific measures of HRQOL (the HN module of the FACT [FACT‐HNS], The University of Washington Quality of Life Scale [UWQOL], and The Performance Status Scale for Head and Neck Cancer); and one measure of depression (The Beck Depression Inventory [BDI]).

Results: The study population showed a high occurrence of depressive symptoms (22%). A negative correlation existed between the BDI and HRQOL as measured by the FACT‐G (r = −0.49, P < .001) and the UWQOL (r = −0.44, P = .003). When somatic symptoms of depression were removed, the BDI remained correlated with HRQOL and was most highly correlated with the Emotional Well‐Being (EWB) subscale of the FACT‐G (r = −0.42, P = .003). There was no correlation between clinician judgments of EWB and any patient‐rated measures of HRQOL or depression.

Conclusions: Results demonstrate an inverse relationship between patient‐reported HRQOL and depression. The lack of correlation between physician and patient ratings of HRQOL and EWB stresses the importance of obtaining patient ratings in addition to traditional clinician ratings when assessing outcomes. Finally, the multidimensional construction of the FACT with its specific subscales may make it a useful clinical tool for assessing patient status and augmenting patient interviews.
Effect of Pulse Duration on Wound Healing Using a CO2 Laser
Authors: Fortune D. Scott , Huang Shan , Soto Joe , Pennington Brent , Ossoff Robert H. , Reinisch Lou
Published: November 2003

The authors investigated wound healing of incisions in the buccal mucosa of a canine model created using a CO2 laser with a short pulse structure (60 μs, 100 μs, and 120 μs) rather than a conventional continuous wave structure in a shuttered mode. The tissue from 10 animals was evaluated histologically and with tensiometry acutely and at postoperative days 3, 7, and 14. A Bonferroni‐Dunn corrected ANOVA analysis at a 95% significance level was used to compare the effect of pulse duration on histologic morphology and wound tensile strength. The data indicate that shorter laser pulse durations create less lateral thermal injury (p < .009) and wounds with greater tensile strength (p < .005), resulting in earlier wound healing. The results also show that heat, sufficient to damage tissue, was conducted to adjacent tissue during laser pulses of 100 μs and longer. These results demonstrate that surgical CO2 lasers with a short pulse structure of approximately 60 μs or less could offer more prompt wound healing while maintaining the advantages of a 10.6‐μm wavelength laser.
Tracheal Transplantation: Superior and Inferior Thyroid Artery Perfusion Territory
Authors: Salmeron Jesse , Gannon Patrick J. , Blackwell Keith E. , Shaari Christopher M. , Urken Mark L.
Published: November 2003

Objective: To determine the perfusion territories of the superior and inferior thyroid arteries in humans. Tracheal transplantation is a potential option for management of long‐segment tracheal stenosis. However, the maximum length of vascularized trachea that can be reliably transplanted has not been established.

Study Design: The tracheal vascular territory of individual superior and inferior thyroid arteries was determined separately in 10 humans postmortem.

Methods: India ink was infused unilaterally under controlled pressure into the superior (n = 5) and inferior (n = 5) thyroid arteries of cadaveric tracheas. Tracheas were sectioned longitudinally and the caudalmost extent of mucosal dye staining was determined via microscopic assessment.

Results: The tracheal perfusion territory of the superior thyroid artery was two to five rings (1.7 ± 0.5 cm) and the inferior thyroid artery, nine to 13 rings (6.5 ± 1.1 cm). In both cases, the tracheal mucosa on the contralateral side was stained to the same caudal level.

Conclusions: The inferior thyroid artery was shown to perfuse the trachea maximally to the 13th ring (8.1 cm). As such, the unilateral inferior thyroid artery would serve as a suitable vascular component for long‐segment tracheal transplantation in humans.
Correlation of Laryngeal Chemoreflex Severity With Laryngeal Muscle Response
Authors: Goding George S.
Published: November 2003

Objectives: To examine the relationship between the severity of the laryngeal chemoreflex (LCR) and the pattern of laryngeal muscle activity during an LCR‐induced apnea.

Methods: The laryngeal mucosa of 20 piglets aged 17 to 20 days was stimulated under both hypoxic and normoxic conditions. Respiration, blood pressure, and activity of the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were monitored during the LCR‐induced apnea.

Results: Hypoxemia resulted in a shorter average apnea duration but a greater degree of hypotension. All piglets recovered spontaneously following normoxic LCR stimulation. Hypoxic stimulation resulted in two divergent apneic responses: transient with a spontaneous recovery (17 piglets) or profound requiring resuscitation (three piglets). An increase in TA muscle activity and a decrease in PCA muscle activity was the most common response to LCR stimulation. The response of the TA and PCA muscles was maintained in piglets destined for spontaneous recovery. Decreasing TA activity and increasing PCA activity correlated with the development of a profound response.

Conclusions: The piglet demonstrates two distinct responses to hypoxic laryngeal chemostimulation that correlate with the activity of the intrinsic laryngeal muscles. Failure to maintain the activity of the TA and PCA muscles during a profound response is associated with the development of severe cardiovascular instability. This study suggests that the critical event involving the LCR is the development of complications secondary to hypoxia.
Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children
Authors: Dodson Edward E. , Hashisaki George T. , Hobgood Todd C. , Lambert Paul R.
Published: November 2003

Objective/Hypothesis: Cases of cholesteatoma in pediatric patients were reviewed to determine which factors influence the outcome of surgical treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed, as comparisons of different surgical technique. Study Design: A retrospective analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years was conducted. Methods: Patient information was collected from an otology database, patient records, and audiology files. Results: Sixty‐six patients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12. 5 y). ICW mastoidectomy with tympanoplasty was the primary surgical treatment in 41 patients. Nineteen percent had residual disease at a planned second stage surgery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%. A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with tympanoplasty initially. Two patients (12%) had residual cholesteatoma found at a planned second state procedure, and no recurrent cholesteatoma was encountered. Seventy‐two percent maintained a SRT of less than 30 dB HL. Conclusions: These results support the continued use of ICW mastoidectomy with tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long‐term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with tympanoplasty provides a safe ear and good hearing results. Mastoid cavity care must be maintained indefinitely in many cases.
Surgical technique for implantation of the totally ossified cochlea
Authors: Balkany Thomas , Bird Philip A. , Hodges Annelle V. , Luntz Michal , Telischi Fred F. , Buchman Craig
Published: November 2003

Objectives: Among the technical challenges of cochlear implant surgery is electrode insertion into the fully ossified cochlea. Earlier drill‐out techniques have two significant drawbacks: 1. up to one half fail when the electrode pulls away from the cochlea; and 2. extended radical mastoidectomy, abdominal fat graft for obliteration, and closure of the external auditory meatus are required. A simplified technique is described that allows positive fixation of the cochlear implant electrode and in selected cases avoids a radical cavity with obliteration. Study Design: Technical description with case reports and hearing outcomes. Methods: Ten cadaver temporal bones were dissected to determine middle ear landmarks that overlie the basal turn of the cochlea from the transcanal approach and to establish the feasibility of the intact canal wall procedure. Surgery was performed on four patients who had preoperative imaging evidence of full ossification, two with the canal wall down, and two with canal wall up. Standard measures of speech recognition were used to evaluate hearing. Results: Critical surgical landmarks are the round window, carotid artery, cochleariform process, and oval window. The procedure was successfully performed on four patients and open‐set speech recognition is present in each. Conclusions: This canal wall up procedure allows long electrode insertion without radical cavity/obliteration in patients with fully ossified cochleas and prevents distraction of the electrode from the cochlea. While open‐set word recognition was achieved by all subjects, results are poorer than expected for patients with limited or no ossification.
Dysphagia in patients with inclusion body myositis
Authors: Houser Steven M. , Calabrese Leonard H. , Strome Marshall
Published: November 2003

Objectives: Inclusion body myositis (IBM) is an inflammatory myopathy with a 40% reported incidence of dysphagia. A protracted course, refractory to medical therapy, frequently leads to consultation with an otolaryngologist for dysphagia management. We studied the incidence, symptoms, and mechanisms of dysphagia in patients with IBM. Study Design: Retrospective study of medical records and self‐reported follow‐up survey; dysphagia is defined as difficulty in swallowing. Materials: Twenty‐two patients with biopsy‐proven IBM. Results: The rate of dysphagia was more than 80% (16 of 19), twice as high as previously reported. Progressive dysphagia was associated with a significantly worse functional class. Relevant management guidelines are established, including the timing for appropriate surgical intervention. Conclusion: Progressive dysphagia may signify more aggressive IBM or an episodic worsening in status. Recognition of the disease manifestations will afford proper patient management. Informed otolaryngologists can have a favorable impact on the dysphagia associated with IBM.
Expected neurologic outcomes for surgical treatment of cervical neurilemomas
Authors: Valentino Joseph , Boggess Michael A. , Ellis Jeffrey L. , Hester T. Oma , Jones Raleigh O.
Published: November 2003

Objective: Neurilemomas are classically described as fusiform tumors that eccentrically displace the undisturbed neural fascicles. The authors seek to clarify the relationship of cervical neurilemomas to their nerve of origin and assess the functional outcome of surgical extirpation. Study Design: A retrospective review of clinical, intraoperative, and histopathologic data of six patients with cervical extracranial neurilemomas. Methods: Additional histochemical staining of the pathologic specimens was performed to evaluate the tumor for neurites. A comprehensive literature review of cervical neurilemoma cases and meta‐analysis of clinical outcomes in these cases were performed. Results: In the series of five consecutive cervical neurilemomas, only one was an eccentric mass pushing the undisturbed nerve aside. In the five other cases, excision of the neurilemoma required complete nerve excision. Neural elements traveling through the central portions of the tumor were clearly demonstrated histologically. Collective analysis of the literature on cervical neurilemomas revealed that although some cases allow nerve preservation, preservation of function is frequently poor. Conclusions: This experience and that reported in the literature suggest that it is frequently impossible to preserve the function of the nerve of origin with surgical treatment of cervical neurilemomas.
Surgery versus radiation therapy as single‐modality treatment of tonsillar fossa carcinoma: The roswell park cancer institute experience (1971–1991)
Authors: Hicks Wesley L. , Kuriakose M. Abraham , Loree Thorn R. , Orner James B. , Schwartz Gary , Mullins Alan , Donaldson Craig , Winston Janet M. , Bakamjian Vahram Y.
Published: November 2003

Objective: To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single modality therapy. Methods: From 1971 to 1991 239 patients with oral pharyngeal cancer were treated at Roswell Park Cancer Institute. Of these patients 90 had tonsillar carcinoma. Seventy‐six of these patients received either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single‐modality therapy and are the subject of this review. All patients in the radiation arm of this review were surgical candidates who declined primary surgical therapy. Results: Sixty‐three percent of the SA and 80% of the RA treatment groups presented with either stage III or stage IV disease (P ⩽ .05). Forty‐seven percent of the SA group and 52% of the RA patients had clinically positive regional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved region. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA group was 75%, compared with 60% in the RA group (P value was not significant). The disease‐specific survival (all stages) was 61% in the SA group and 37% in the RA group (P ⩽ .05). The disease‐free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P ⩽ .05). Survival measured against clinical response to radiation therapy, in complete responders (all stages) was 83%; by contrast there were no survivors past 24 months in the partial response group (P ⩽ .001). Conclusion: The results from this study suggest that for early disease (stage I/II), surgery or radiation therapy as single‐modality treatment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single‐modality treatment, as measured by ultimate survival and the local control of disease. There is, however, a subset of patients with advanced disease who respond to radiation therapy and whose survival is equivalent to our surgical cohort of patients.
Increased acute and chronic mitotic activity in rat laryngeal muscles after botulinum toxin injection
Authors: Inagi Katsuhide , Connor Nadine P. , Schultz Edward , Ford Charles N. , Cook Crist H. , Bless Diane M. , Heisey Dennis M.
Published: November 2003

Objectives: To characterize the acute and chronic cellular effects of botulinum toxin (BT) injection into rat laryngeal muscles. A complete characterization of these effects is important because patients with focal dystonias of the head and neck are commonly treated with BT injection. Further, potential muscular changes in the larynx must be carefully delineated owing to the critical phonatory and airway protective functions of these muscles. Study Design: The acute and chronic cellular effects of BT injection were studied using 5′‐bromo 2′‐deoxyuridine (BrdU) following single and repeated BT injection into rat laryngeal muscles. BrdU is incorporated into mitotically active nuclei such that changes in cell proliferative behavior following BT injection can be monitored. Results: Increased mitotic activity was detected in the tissue samples studied following BT injection. Differences in the times of the peak distribution of BrdU‐labeled cells in each laryngeal muscle were observed. This may be related to the diffusion effects of BT. Prolonged muscle fiber changes, including splitting, were also observed as the result of repeated BT injection. Conclusions: The results of this study suggest that BT may induce a proliferative response in muscle tissue.
Transforming growth factor‐β expression in otitis media with effusion
Authors: Cooter Michael S. , Eisma Roselle J. , Burleson Joseph A. , Leonard Gerald , Lafreniere Denis , Kreutzer Donald L.
Published: November 2003

Objective: To characterize the existence and role of transforming growth factor‐β (TGF‐β) in otitis media with effusion (OME). Study Design: Retrospective. Methods: The levels of two major TGF‐β isoforms, TGF‐β1 and TGF‐β2, in the middle ear effusions (MEEs) of 44 children were evaluated using enzyme‐linked immunospecific assays (ELISAs). Forty‐eight MEEs were separated into three clinically relevant groups (i.e., serous, mucoid, and purulent), and TGF‐β levels were correlated with clinical parameters of disease for these MEEs. Results: Both TGF‐β1 and TGF‐β2 were present in the samples. Mean levels of TGF‐β1 (920.36 ± 437.75 pg/mg total protein) were generally 100‐fold greater than those of TGF‐β2 (9.65 ± 11.19 pg/mg total protein). TGF‐β1 levels were elevated in association with a history of previous tympanostomy tube placements (TTPs) (P = .029) and mucoid effusions (P = .042). TGF‐β2 levels were elevated in association with a history of previous TTPs (P = .100) and chronic (i.e., serous or mucoid) effusions (P = .003). Conclusions: TGF‐β1 is present in the MEEs of children with OME. Furthermore, TGF‐β1 and TGF‐β2 levels were elevated differentially in the presence of chronic disease indicators in OME, suggesting that these isoforms may have differing roles in the inflammatory processes that characterize OME.
Short‐term tympanostomy in conjunction with hyperbaric oxygen therapy
Authors: Vrabec Jeffrey T. , Clements Kelly S. , Mader Jon T.
Published: November 2003

Objective: To determine the most effective method of short‐term middle ear aeration in patients unable to tolerate hyperbaric oxygen (HBO) therapy. Study Design: Prospective study comparing two methods of short‐term tympanostomy in each patient. Methods: Seventeen adult patients were referred for management of barotitis and inability to tolerate hyperbaric oxygen therapy (HBO). Each patient underwent CO2 laser tympanostomy on the right ear and tympanostomy with T‐tube placement in the left ear. The tube was removed on completion of HBO. Patients were asked to rate pain and their satisfaction with each method of tympanostomy using a visual analog scale. Otorrhea, persistent perforation, recurrent barotitis, hearing loss, and otalgia occurring during the study period were documented. Results: Laser tympanostomy was associated with a significantly lower incidence of otorrhea but was attended by recurrent barotitis in four of 16 patients. Laser tympanostomy was perceived as being less painful and was rated higher in overall satisfaction. Conclusions: Laser tympanostomy is an effective method for management of barotitis in patients unable to tolerate HBO. Otorrhea is significantly reduced, although a risk of recurrent barotitis exists if the laser perforation closes prior to completion of HBO. Both methods of short‐term tympanostomy reduce complications when compared with a retrospective cohort.
Neck dissection with simultaneous carotid endarterectomy
Authors: Rechtweg Jay , Wax Mark K. , Shah Rasesh , Granke Kenneth , Jarmuz Theresa
Published: November 2003

Background: Patients with metastatic neck disease from upper aerodigestive tract carcinomas have an extensive history of tobacco and alcohol abuse. These patients are predisposed to develop atherosclerotic vascular disease. Objective: An increased incidence and severity of carotid stenosis in patients receiving radiotherapy for head and neck cancers is known. Management of patients with severe carotid stenosis who require surgical treatment of their neck disease has not been described. The authors describe our experience with simultaneous carotid endarterectomy and neck dissection. Study Design: Prospective data collection. Methods: From 1991 to 1997 at West Virginia University Hospitals, Morgantown, West Virginia, and State University of New York (SUNY) at Buffalo, three patients with severe carotid stenosis required surgery for metastatic neck disease. Preoperative evaluation revealed a bilateral carotid stenosis greater than 90% in all patients. All patients underwent modified radical neck dissections and simultaneous carotid endarterectomies with saphenous vein grafting. Two patients, one undergoing partial pharyngectomy and laryngectomy and the other a laryngectomy and neck dissection, had coverage of the carotid artery with the myogenous component of a pectoral major graft. One patient had only a neck dissection. Results: Two patients healed with no local morbidity, no neck recurrence, and a patent carotid artery by Doppler. No strokes were encountered. One patient died of a myocardial infarction. Conclusion: Severe carotid stenosis that requires revascularization may have endarterectomy performed simultaneously with treatment of head and neck primary with no increase in morbidity.
Thyroglossal duct carcinoma: A rational approach to management
Authors: Kennedy Thomas L. , Whitaker Mark , Wadih George
Published: November 2003

Objective: To discuss the authors' experience with thyroglossal duct carcinoma and present a rational approach to the management of this entity. Study Design and Methods: A retrospective review of the cytopathology and pathology records of all patients with the diagnosis of a thyroglossal duct remnant from 1965 to 1997 was performed. Results: Three cases of papillary thyroglossal duct carcinoma were identified, with one suspected squamous cell carcinoma by needle aspiration. The papillary carcinomas are discussed in detail to illustrate the difficulty encountered in managing the thyroid gland in the setting of a thyroglossal duct carcinoma. Fine‐needle aspiration proved effective in making the diagnosis preoperatively. Conclusions: The authors recommend that a thyroglossal duct cyst with a microscopic focus of papillary carcinoma, without cyst wall invasion, be managed with a Sistrunk procedure. Treatment of all other thyroglossal duct papillary carcinomas should include removal of all thyroid tissue followed by radioactive iodine treatment.
Persistent otitis media with effusion: A new experimental model
Authors: Russell John D. , Giles Shay J.
Published: November 2003

Objectives/Hypothesis: Numerous mechanical animal models for the creation of otitis media with effusion (OME) have been described since the 1920s. However, there are many problems associated with these models, including high infection rates, unreliability, and high resolution rates. The aim of the current study was to create a suitable mechanical animal model that would produce a sterile and long‐lasting effusion. Study Design: A new technique using an external surgical approach on specific pathogen–free rats is described. Method: The eustachian tubes of 56 rats were obstructed in the mid portion along the skull base with gutta percha. Results: All animals developed an effusion within 1 week of the procedure. The resolution rate was 8%, with 80% maintaining sterile effusions for up to 1 year. Conclusions: This new procedure for an OME model has proved consistently reliable in creating a persistent and long‐lasting effusion. It has a low infection rate and should benefit future studies on the prolonged effects of OME on the tympanic membrane and middle ear.
Posttransplant lymphoproliferative disorder presenting in the head and neck
Authors: Lattyak Bruce V. , Rosenthal Philip , Mudge Christine , Roberts John P. , Renze John F. , Osorio Robert W. , Emond Jean C. , Lalwani Anil K.
Published: November 2003

Objective: To determine the incidence of focal head and neck posttransplant lymphoproliferative disorder (PTLD) in children, its clinical presentation, associated risk factors, and outcome following treatment.Study Design: Retrospective.Methods: The authors conducted a 5‐year retrospective study of 61 children with liver transplants at the University of California, San Francisco. Suspected head and neck lesions were evaluated and biopsies were performed by an otolaryngologist. Diagnosis was made via histologic and immunohistochemical features and in situ Epstein‐Barr virus (EBV) localization.Results: Eight patients (13.1%) developed PTLD, five (8.2%) in the head and neck. Four patients had large tonsils, and one presented with airway obstruction from a supraglottic mass. Negative pretransplant EBV serology was a risk factor for PTLD. Treatment consisted of antiviral therapy and decreased immunosuppression. All patients with head and neck PTLD are disease free with excellent liver function.Conclusions: A high incidence of PTLD was found, with 63% presenting in the head and neck. While Waldeyer's ring is most commonly involved, PTLD may also present in the supraglottis. Adjunctive antiviral therapy and decreased immunosuppression are effective forms of treatment. Given the increasing number of pediatric liver transplants being performed, otolaryngologists should be familiar with PTLD and have a high index of suspicion in this at‐risk population.