bluuebunny/crossref_metadata_2025 huggingface dataset:
False‐positive magnetic resonance imaging of small internal auditory canal tumors: A clinical radiologic, and pathologic correlation study
Authors: Arriaga Maj Moises A. , Carrier Ltc David , Houston Col Glenn D.
Published: September 2022

Magnetic resonance imaging with gadolinium facilitates the early diagnosis of internal auditory canal tumors at a small enough stage to permit increasing application of hearing preservation surgical techniques. Surgeons report successful removal of tumors as small as 3 mm, which are diagnosed with enhanced magnetic resonance imaging. A retrospective study was performed to determine the risk of false‐positive “tumor” diagnosis with enhanced magnetic resonance imaging. We reviewed the imaging records, office notes, and surgical records of 112 consecutive “tumors” involving the internal auditory canal treated by the Wilford Hall USAF Medical Center Neurotology Service between July 1991 and July 1994. Two categories of false‐positive magnetic resonance imaging were Identified: (1) surgically confirmed absence of internal auditory canal neoplasm and (2) spontaneous resolution of the internal auditory canal lesions on subsequent, enhanced magnetic resonance images. Overall, eight false‐positive scans were identified. Three were surgically confirmed as false‐positive, and five resolved on subsequent Imaging studies. All cases were smaller than 6 mm and involved the distal internal auditory canal (fundus). The surgically confirmed cases were approached through a middle fossa technique with successful hearing preservation. The overall rate of surgical false‐positive results was 3.5% (3 cases in 86 surgeries). However, the overall false‐positive rate for intracanalicular “tumors” was 32% (8 cases in 25 intracanalicular lesions). Although hearing preservation is more likely in small lesions, the surgeon must consider the possibility that an internal auditory canal lesion smaller than 6 mm may actually represent a nonneoplastic process. Enhancing lesions limited to the internal auditory canal fundus may be treated by reimaging the patient in 6 months after the first image rather than by prompt surgical exploration.
Comparison of tunable dye and ktp lasers in nonsurgical delay of cutaneous flaps
Authors: Odland Rick M. , Rice Reginald D.
Published: September 2022

PROBLEM: Reproducing the benefits of the delay phenomenon without the risks and cost of a surgical procedure has long been a goal of skin flap physiologists. After the success of the suture‐delay technique and argon tunable dye laser in improving survival in McFarlane skin flaps, important questions remained: (1) will laser delay be effective in dermal flaps, (2) can induction of collateral blood flow be documented, and (3) is the KTP laser, which is generally more available to otolaryngologists, more effective than the argon tunable dye laser.

METHODS: The KTP and argon tunable dye lasers were compared by use of the laser‐delay technique, with two outcome measures‐blood flow and survival. The laser‐delay procedure was accomplished with the laser in a noncutting mode in an attempt to coagulate cutaneous vessels at the periphery of a planned skin flap. The objective was to induce collateralization and improve skin flap survival. Patterns of blood flow were tested by use of the base occlusion test. Flap survival of an acute control flap group was compared with that of the laser delay groups.

RESULTS: Blood flowing to the distal flap area originated from the base of the flap area after laser delay. Flap survival of the laser delay groups was significantly improved over that of the control group.

CONCLUSION: Both lasers were able to effectively induce collateralization and improve flap survival.
Use of intraoperative neuromonitoring to prevent orbital complications in ethmoid sinus surgery
Authors: Keyser Jeffrey S. , Diaz‐Ordaz Ernesto , Samson Michael J. , Kartush Jack M.
Published: September 2022

Orbital injury is one of the most serious complications in sinus surgery. Although these injuries are generally infrequent, there is a considerable increased risk for orbital complications during procedures in which anatomic landmarks are distorted because of the severity of disease or prior surgery. Currently there are no methods to detect early defects in the lamina papyracea or to prevent continued resection until orbital fat or periorbita is seen. Thirteen New Zealand white rabbits were studied by use of a nerve monitor to identify the periorbita and orbital fat in surgically created lamina defects. Evoked potentials were measured at the medial orbit when the lamina papyracea, periorbita, and orbital fat were stimulated at current intensities ranging from 0.25 to 1.00 mA. Stimulation of the lamina at 0.8 and 1.0 mA resulted in response amplitudes that were significantly lower compared with those of periorbita stimulation (means at 1 mA, 38.26 μV vs. 117.85 μV; p < 0.01). Stimulation of the orbital fat also resulted in higher potentials (mean, 59.47 μV) than those of the lamina papyracea (mean, 38.26 μV) but did not reach statistical significance. The statistically significant difference in response amplitudes between the lamina papyracea and the periorbita indicate that intraoperative monitoring may be useful in identifying early lamina defects, which could in turn reduce the risk of orbital injury during sinus surgery. (OTOLARYNGOL HEAD NECK SURG 1995;113:99‐103.)
Essentials of Functional Endoscopic Sinus Surgery, by HeinzStammberger and MichaelHawke. 212 pages with illustrations. Mosby‐Year Book, St. Louis, 1993. $99.00
Authors: Smith Richard V.
Published: September 2022

Editors Note: The reviewers have rated the books on a scale of one to five stars. The highest ratings are given to books that fulfill their objectives and skillfully convey information to the chosen audience. Books are judged on appropriateness and completeness of detail for the targeted audience, quality of writing, editorial skill (especially multiauthored books), illustrations, and photography. It is hoped this code will aid the reader in selecting books for his or her permanent library. The rating scale is as follows: ∗∗∗∗∗ Outstanding, a classic, should be on the shelf of anyone interested in the subject; ∗∗∗∗ Strong, well‐written book with major contributions in some areas; ∗∗∗ Informative book that should be read, if not owned, by individuals with interest in the field; ∗∗ Some worthwhile information, but with deficiencies in writing style or completeness; ∗ Major shortcomings, not recommended.
Reduced mastoidectomy complications with an open meatoplasty stent
Authors: Vincent Daniel A. , Funcik Thomas , Adkins Warren Y.
Published: September 2022

Open‐tube stents were compared with standard petroleum gauze packs in meatoplasties after canal‐wall‐down mastoid surgery to determine whether any difference existed in postoperative complications. Tube stents were associated with much lower incidences of postoperative meatoplasty stenosis and postauricular wound complications in this series.
Superiority of the T and N Integer Score (TANIS) Staging System for Squamous Cell Carcinoma of the oral cavity
Authors: Snyderman Carl H. , Wagner Robin L.
Published: September 2022

An alternative to the TNM classification system has been proposed for patients with head and neck cancer. The T and N integer score (TANIS) system adds the integer values of T and N classifications. The TNM and TANIS staging systems were retrospectively evaluated for 186 patients with squamous cell carcinoma of the oral cavity (tongue and floor of mouth). The TANIS system was found to better separate the patients into prognostic groups and allowed a more accurate prediction of disease‐free survival.
Calvarial Bone Repair with Porous D,L‐Polylactide
Authors: Schwartz Ilsa , Robinson Burke P. , Hollinger Jeffrey O. , Szachowicz Edward H. , Brekke John
Published: September 2022

Bone is a storehouse of biologic factors enabling it to regenerate without scar formation. Recombinant technology has made many of these factors available in significant quantity for therapeutic applications. However, a system to deliver recombinant bone‐regenerating factors is needed. Biodegradable, biocompatible polymers have shown promise for delivering bone regenerative factors, such as bone morphogenetic protein. The polymer we selected to investigate was racemic d l‐polylactide. Our immediate objective was to engineer porous d l‐polylactide to promote bone ingrowth (osteoconduction). We tested the hypothesis that porous d, l‐polylactide implanted in a standard intraosseous calvarial wound would not hinder but would support bone regeneration. Therefore porous polylactide disks (65% void volume) were manufactured with pores ≤ 100 μm, ≤ 200 μm, and ≤ 350 μm; implanted in rabbits’ calvariae, and retrieved 1, 2, 4, and 6 months after insertion. Quantitative histomorphometry revealed a possible relationship in the amount of bone ingrowth with increasing pore size over time. The d l‐polylactide disks ≤350 μm had the greatest quantity of bone ingrowth (≤0.05). However, a disturbing finding was the multinucleated giant cell response associated with all implanted disks. We speculate these cells may have produced an inhospitable environment stifling osteoconduction. Consequently, postsynthesis engineering refinements of d l‐polylactide to eliminate the giant cell response are crucial before loading with bone morphogenetic protein.
Inhibition of Head and Neck Squamous Cell Carcinoma Cell Lines by Transforming Growth Factor‐β
Authors: Briskin Kenneth B. , Fady Catherine , Mickel Robert A. , Wang Marilene , Lichtenstein Alan
Published: September 2022

Transforming growth factor‐β is known to be a potent autocrine growth inhibitor produced by a wide variety of cells, including cells of the immune system. Other investigators have noted that the growth of nontransformed keratinocytes is inhibited by transforming growth factor‐β, whereas various carcinoma cell lines are resistant to these effects. Head and neck squamous cell carcinoma cells are known to have surface receptors for this cytokine. We thus assessed the effect of transforming growth factor‐β on the growth of head and neck squamous cell carcinoma cell lines. Four head and neck squamous cell carcinoma cell lines were incubated with varying concentrations of transforming growth factor‐β, and cytotoxicity was evaluated with a methylene blue colorimetric assay. After culturing in transforming growth factor‐β for 4 days, inhibition of growth was detected in CAL‐27 (maximal inhibition at 5.0 ng/ml), UMSCC‐1, and UMSCC‐19 (maximal inhibition at 50 ng/ml) cell lines. One other cell line, UMSCC‐8 was found resistant to the inhibitory effects of transforming growth factor‐β. Kinetics analysis experiments revealed minimal inhibition before day 2 of incubation, at which time inhibition increased linearly to day 4. Assessment of double‐stranded DNA fragmentation suggested that DNA fragmentation occurs before significant cytotoxicity. Electron microscopic analysis and gel electrophoresis of extracted DNA revealed morphologic features consistent with apoptotic cell death. Our findings indicate that transforming growth factor‐β significantly inhibits the growth of head and neck squamous cell carcinoma cell lines by inducing apoptotic cell death.
Effects of contralateral white noise stimulation on transitory evoked otoacoustic emissions in patients with acoustic neuroma
Authors: Maurer J. , Hinni M. , Beck A. , Mann W.
Published: September 2022

Transitory evoked otoacoustic emissions are normal phenomena observed in most persons with hearing levels greater than 35 dB. Further, masking of the contralateral ear produces amplitude reductions in the transitory evoked otoacoustic emissions. We have undertaken a study of transitory evoked otoacoustic emissions in 20 patients with acoustic neuroma. All patients were assessed for transitory evoked otoacoustic emissions bilaterally, with and without contralateral masking with white band noise at 40, 50, and 60 dB. We found that transitory evoked otoacoustic emissions were present in 30% of ears with tumor and that the presence of transitory evoked otoacoustic emissions is associated with improved preoperative hearing levels, but that tumor size is not associated with the presence or absence of transitory evoked otoacoustic emissions. The amplitude of transitory evoked otoacoustic emissions from ears with tumor, when present, is decreased when compared with normal ears of normal patients. Further, with contralateral masking little of the amplitude reduction observed in normal patients is observed in the ears with acoustic neuroma. However, with masking of the contralateral ear, the ear without tumor demonstrated significantly greater amplitude reductions than normal ears from normal patients (p = 0.0006). Pertinent anatomy and possible explanations for these findings are discussed.
Perilesional interleukin‐2 in the VX‐2 carcinoma in rabbits: A preliminary investigation
Authors: Carroll William R. , Bunge Frederick R. , Wolf Gregory T. , Carey Thomas E. , Mcclatchey Kenneth D. , Poore Judy
Published: September 2022

Immune system amplification by perilesional injection of interleukin‐2 is a promising adjuvant approach for treating squamous cell carcinoma of the head and neck. A pilot study was designed to develop an animal model bearing squamous cell carcinoma in which to test the efficacy of perilesional interleukin‐2. Rabbits were inoculated intramuscularly with the papilloma virus‐induced squamous carcinoma VX‐2 cell line. Tumor regression and host lymphatic response after perilesional interleukin‐2 were measured. Variable responses were found. Growth of tumor cells implanted from cell culture was rapid in most animals. Tumor growth was prevented in animals receiving 10,000 units of interleukin‐2 per injection initiated 9 days after tumor inoculation. This inhibition approached statistical significance when compared with growth of saline controls. Histologic responses consisted primarily of plasma cell and eosinophil infiltration. The intensity of the inflammatory response did not correlate with interleukin‐2 dose. A trend toward enhanced tumor growth was seen with lower doses of interleukin‐2 and when inferleukin‐2 therapy was initiated simultaneously with tumor inoculation. These findings suggest that high‐dose recombinant interleukin‐2 can prevent tumor growth if initiated after tumor inoculation. Whether this effect was caused by direct tumor cytotoxicity or mediated by the immune system is unclear. These preliminary results underscore the importance of understanding the effects of dose and schedule in the design of immunotherapy models before Clinical use.
Role of posturography in the management of vestibular patients
Authors: Furman Joseph M.
Published: September 2022

Computerized dynamic posturography uses a force platform that can both translate and rotate. When combined with visual stimuli, it can be used to determine the relative importance of the various sensory inputs critical for balance, namely vision, somatosensation, and vestibular sensation. Studies to date have shown several patterns of abnormalities on posturography, the best recognized being the vestibular pattern. Many patients with a high suspicion of having a peripheral vestibular abnormality (based on other information) have such a pattern. Moreover, few normal subjects have such abnormalities. Although computerized dynamic posturography does not help in localizing a lesion or determining its etiology, such testing does provide a functional measure that can be helpful in understanding a patient's ability to properly use vestibular system information. Posturography is helpful in the management of patients with suspected vestibular disorders. In addition to suggesting the presence of a vestibular system abnormality, particularly an uncompensated peripheral vestibular deficit, a bilateral peripheral vestibular deficit, or a central vestibular abnormality, computerized dynamic posturography may help guide the clinician regarding choice of treatment and counseling of patients. Further studies are required to determine the ultimate role of computerized dynamic posturography in the management of patients with vestibular disorders.
Modulation of inner ear pressure in experimental endolymphatic hydrops
Authors: Andrews James C. , Strelioff David
Published: September 2022

Physiologic study of the guinea pig model of endolymphatic hydrops has been used to better understand the manifestations of Meniere's disease. Quantitative vestibular function testing demonstrates some changes in the hydrops subjects, especially if an additional stress such as postural inversion is imposed. Understanding the hydrodynamic changes on the endolymphatic and perilymphatic fluids by the hydrops condition as well as postural inversion may be useful in explaining the vestibular findings. These pressure effects may alter the micromechanics of the inner ear or possibly induce a relative vascular ischemia. Auditory dysfunction is speculated to occur through similar mechanisms.
Videolaryngoscopic Evaluation of Laryngeal Intubation Injury: Incidence and Predictive Factors
Authors: Ellis Steven F. , Pollak Alan C. , Hanson David G. , Jiang Jack J.
Published: September 2022

Bedside videolaryngoscopy of 73 cardiovascular surgical patients was performed before and after intubation to identify risk factors, incidence, and site of injury to the larynx. Nineteen of 44 patients with abnormal preintubation examination findings had granulation tissue present on a vocal process, compared with 3 of 20 patients who had normal findings on preintubation examination (p < 0.05). Recent smoking history was elicited from 2 of 20 patients who had normal findings on preintubation examination and from 20 of the 44 patients who had abnormal findings on preintubation examination (p < 0.01). Laryngeal nerve paresis was identified in 21 of 64 patients after extubation and was present in 7 patients before intubation. Videolaryngoscopy provides a high‐quality permanent record of the laryngeal examination and is easily obtained in the critical care setting. Preintubation videolaryngeal evaluation may identify those at risk for more significant intubation injury.
Inhibition of Cholesteatoma Migration in vitro with all‐Trans Retinoic Acid
Authors: Schwartz Ilsa , Minotti Americo M. , Stiernberg Charles M. , Cabral Fernando
Published: September 2022

Retinoids have recently become of interest to clinicians because of their ability to inhibit migration and proliferation of premalignant squamous cells while enhancing growth and proliferation of normal cells. An in vitro investigation was undertaken to determine whether retinoic acid exhibits similar inhibitory effects on cholesteatoma cells. Cholesteatoma specimens were obtained intraoperatively from 10 patients undergoing mastoidectomy or revision mastoidectomy for chronic ear disease. Cholesteatoma explant growth and en mass migration were observed daily, and topographic maps were constructed at various time intervals to quantify rate and direction of expiant migration in the presence or absence of all‐trans retinoic acid. Before all‐trans retinoic acid administration, explants migrated very rapidly (1 to 2 mm/day). A maximum threefold inhibition of migratory rate occurred, with explants exposed to 0.1 μmol/L retinoic acid when compared with controls. A sixfold maximum inhibition was observed at higher retinoic acid concentrations (5 μmol/L). On removal of all‐trans retinoic acid, twofold and fourfold increases in migratory rates were observed. The direction of explant migration varied significantly for long periods of time and appeared not to be affected by retinoic acid. This investigation suggests that all‐trans retinoic acid has an inhibitory effect on cholesteatoma cell migration. Retinoids may have a role in controlling cholesteatoma disease in the future.
Partial Labyrinthectomy with Hearing Preservation: An Experimental Study in Guinea Pigs
Authors: Smouha Eric E. , Namdar Isaac , Michaelides Elias M.
Published: September 2022

Recent advances in neurotologic surgery have challenged the traditional belief that violating the labyrinth is incompatible with hearing. Our aim in this study was to define the conditions that result in hearing preservation and hearing loss after surgery on the labyrinth. A guinea pig model was developed. Click‐evoked auditory brain stem responses were used to determine hearing thresholds. Animals underwent surgical destruction of part or ail of the vestibular labyrinth. Transection and plugging of the lateral semicircular canal resulted in normal hearing. Transection of multiple semicircular canals also resulted in hearing preservation. Intentional suctioning of perilymph from a transected canal led to transient hearing loss with complete recovery. Sequential destruction of the entire lateral semicircular canal resulted in preserved hearing as long as the vestibule was not opened. Wide vestibulotomy resulted in hearing loss. Preliminary histologic studies showed that cochlear hair cells were preserved in most cases. The results of our experiments demonstrate the feasibility of preservation of hearing after partial labyrinthectomy and provide physiologic criteria for developing new operations on the inner ear in human subjects.
Impact of Air Pollution on Women's Health
Authors: Bryant Kathy
Published: September 2022

Despite the growing interest in exploring environmental impacts on the health of men and women, more attention needs to focus on assessing the effect of air pollution on women's health. Current research efforts have observed possible correlations between exposures to environmental toxins and the development of disease and illness, including cancer, reproductive dysfunction, and immunologic and neurologic impairment. However, this research has not gone far enough for us to understand and explain the harmful effect of these toxins on women's health and the unique way women respond to toxic exposure. To address these gaps in knowledge, the Society for the Advancement of Women's Health Research recommends the following: an aggressive research commitment to identify and understand the unique way environmental toxins in the air interact in women; a commitment to research to understand the impact of chemical exposures in the workplace on the health of women; and an interagency review to evaluate the federal risk assessment policy and its impact on women's health.
Paranasal Sinus Computed Tomography Scan Findings in Patients with Cystic Fibrosis
Authors: Nishioka Gary J. , Cook Paul R. , McKinsey Joel P. , Rodriguez Fabio J.
Published: September 2022

Seventy paranasal sinus computed tomography scans of patients with cystic fibrosis were compared with those of age‐matched control groups of randomly selected chronic sinusitis patients without cystic fibrosis to determine whether differences in disease patterns existed. In patients older than 10 years, frontal sinus agenesis and maxilloethmoid sinus opacification were significantly more prevalent in patients with cystic fibrosis than in chronic sinusitis patients without cystic fibrosis. Medial bulging of the lateral nasal wall was significantly greater in patients with cystic fibrosis than in chronic sinusitis patients without cystic fibrosis in patients older than 5 years. On the basis of these findings, a diagnostic triad of radiologic findings for cystic fibrosis detection is presented, as well as its clinical implications.
Glottic Carcinoma with a Fixed True Vocal Cord: Outcomes after Neoadjuvant Chemotherapy and Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy
Authors: Laccourreye Ollivier , Salzer Stephen J. , Brasnu Daniel , Shen Wei , Laccourreye Henri , Weinstein Gregory S.
Published: September 2022

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan‐Meier 3‐year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.
Hyperbaric Oxygen Treatment after rat Peroneal Nerve Transection and Entubulation
Authors: Santos Perry M. , Zamboni William A. , Williams Sherri L. , Covey Jim F. , Kienstra Matthew A.
Published: September 2022

Rat peroneal nerves were transected and entubulated with a Silastic channel. The experimental group was treated with hyperbaric oxygen to evaluate changes in acute edema, functional recovery, and histology. Hyperbaric oxygen was administered with 100% O2 at 2.5 atmospheres absolute for 90 minutes twice a day for 1 week and then four times a day for 1 week. Acute edema changes based on nerve water weight and transfascicular area measurements were greater in injured than in uninjured nerves but demonstrated no differences between hyperbaric oxygen–treated and –untreated groups 2, 8, and 16 days after surgery. Functional evaluation with gait analysis demonstrated significant changes between injured and uninjured groups 1,3,7, and 13 weeks after injury but no differences between hyperbaric oxygen‐treated and –untreated groups. Thirteen weeks after the initial injury, elicited muscle force measurements demonstrated no significant improvement from hyperbaric oxygen treatment of injured nerves. Histologic evaluation of nerve area, myelinated axon number, myelinated axon area, myelin thickness, and blood vessel number and area revealed no significant differences between hyperbaric oxygen–treated and –untreated groups. Hyperbaric oxygen was not associated with improvement of nerve regeneration with any of the outcome variables in this model.
Hearing Results after Posterior fossa Vestibular Neurectomy
Authors: Rosenberg Seth I. , Silverstein Herbert , Hoffer Michael E. , Thaler Erica
Published: September 2022

The effect of posterior fossa vestibular neurectomy on postoperative hearing levels of 172 patients was studied at 1 week, 1 month, 1 year, and 18 to 24 months. According to the 1985 American Academy of Otolaryngology—Head and Neck Surgery guidelines for reporting treatment outcome, 66% of patients had improved or unchanged hearing at 18 to 24 months. One‐week postoperative hearing was poorer than at 1 month or later follow‐up. Permanent profound hearing loss occurred in 4.7% of patients. In patients who had worse than 80 dB pure‐tone average and 20% speech discrimination score hearing loss before surgery, 68% improved above this hearing level, and 16% improved to better than 50 dB pure‐tone average and 50% speech discrimination after surgery. This suggests that it may be worthwhile to preserve the cochlear nerve in certain patients who may otherwise be candidates for labyrinthectomy. These hearing results are comparable with other treatment modalities including endolymphatic sac surgery.
Accuracy of High‐Resolution Computed Tomography in Cochlear Implantation
Authors: Langman Alan W. , Quigley Suzanne M.
Published: September 2022

Multichannel cochlear implants are a proven method for the auditory rehabilitation of individuals who have severe‐to‐profound sensorineural hearing loss. These devices typically require insertion into the scala tympani of the cochlea to provide auditory stimulations. A patent scala provides the best chance for an adequate insertion of the electrode array. Preoperative high‐resolution computed tomography imaging has traditionally been used to determine the patency of the scala tympani. Its ability to accurately predict the patency of the cochlea has been questioned in several retrospective studies. A prospective study was undertaken in 28 consecutive individuals undergoing cochlear implant surgery to compare the findings on high‐resolution computed tomography with the surgical findings in an attempt to determine high‐resolution computed tomography's accuracy. Cochlear obstruction caused by ossification was accurately predicted in six of six individuals but overestimated in the round window region in three individuals. High‐resolution computed tomography accurately predicted patent cochleas in 19 individuals. No false‐negative results were encountered. In this study sensitivity of high‐resolution computed tomography was 100%, and specificity was 86%. High‐resolution computed tomography appears to be more helpful than previously reported for determining cochlear patency.
Otocephalus: Histopathology and Three‐Dimensional Reconstruction
Authors: Hinojosa Raul , Green J. Douglas , Brecht Kathryn , Robb Richard A.
Published: September 2022

Otocephaly is a lethal malformation of the first and second branchial arches, which consists of ventromedial displacement of the external ear structures (synotia), mandibular aplasia (agnathia), absence of the tongue (aglossia), and microstomia. We present the first complete description of the temporal bone findings in a case of otocephalus. A three‐dimensional computer‐assisted reconstruction of the right temporal bone was performed, allowing a unique graphic analysis. An extremely low‐lying middle fossa tegmen was noted with malrotation of the middle ear structures. Severe ossicular malformations were also found. An anomalous course of the internal carotid artery was noted with indentation of the basal turn of the cochlea. All three layers of the otic capsule were incompletely developed. Cochlear bony dehiscences were noted. These findings are consistent with early arrest of fetal development and malrotation caused by lack of growth pressure from the mandibular arch. Implications of these findings in the embryologic development of the ear are discussed.
Altered Regulation of Cell Surface Peptidases in Human Cholesteatoma
Authors: Desloge Rosemary B. , Finstad Connie L. , Sassoon Jodie , Han Jin C. , Parisier Simon C. , Albino Anthony P.
Published: September 2022

Cholesteatoma is a destructive process involving an accumulation of desquamated keratin arising from squamous epithelium that pathologically has invaded the middle ear or mastoid process. The clinical hallmarks of cholesteatomas, namely invasion of healthy tissues, migration, unrestrained proliferation, aggressiveness, recidivism, and uncoordinated differentiation predict the existence of defects in the normal biology and biochemistry of the cellular constituents that compose a cholesteatoma, as well as in the cellular interactions between these cells, the surrounding normal tissue, and the host. In the current report, we analyzed 11 cholesteatomas and matched healthy tissue for altered expression in four different cell surface peptidases, aminopeptidase A, aminopeptidase N, dipeptidyl peptidase IV, and neutral endopeptidase. We suggest that peptidases may modulate cell growth and differentiation by inactivating stimulatory signals (or conversely, by activating inhibitory signals).
Comparison of mRAST and CAP with Skin end Point Titration for Altemaria Tenuis and Dermatophagoides Pteronyssinus
Authors: Chambers David W. , Cook Paul R. , Nishioka Gary J. , Erhart Phyllis
Published: September 2022

There has been a recent explosion of new in vitro tests for the diagnosis of allergies. At present there is no general agreement on which type of in vitro test is best. Recently our hospital switched in vitro testing from the modified radioallergosorbent system (mRAST) to the Pharmacia CAP system (CAP). While changing in vitro testing techniques, 47 patients were tested with both the mRAST and CAP tests. Comparisons were made between the mRAST and CAP results of Alternaria tenuis and Dermatophagoides pteronyssinus allergens. These results were then compared with the results of patients who also underwent intradermal skin testing based on end point titration techniques.
Tympanoplasty in Young Patients: The Role of Adenoidectomy
Authors: Vartiainen Eero , Vartiainen Jukka
Published: September 2022

A retrospective study of 60 pediatric patients with dry tympanic membrane perforation undergoing type I tympanoplasty during a 15‐year period was carried out. Seventy‐seven percent of patients were followed up for 5 years. The overall success rate was 90%. All failures occurred in patients who previously had undergone adenoidectomy or adenotonsillectomy. However, sex was found to be the only statistically significant prognostic factor of tympanoplasty success: female patients had higher success rates than male patients. Neither patient age, prior ventilation tube placement, size of perforation, status of the contralateral ear, surgical technique (underlay or overlay), nor competence of the surgeon (resident or senior) affected the success rate. The possible reasons for these findings will be discussed.
Thermal Imaging of the Temporal Bone in CO2 Laser Surgery: An Experimental Model
Authors: Wong Brian J. F. , Lee Jon , Hashisaki George T. , Berns Michael W. , Neev Joseph
Published: September 2022

The unique properties of lasers create an enormous potential for specific treatment of chronic ear disease. Despite the widespread acceptance and use of the laser, however, a complete understanding of the time‐ and space‐dependent temperature distribution in otic capsule bone immediately after pulsed laser exposure has not been elucidated. Using a liquid nitrogen‐cooled mercury‐cadmium telluride infrared detector, the temperature distribution in human cadaveric otic capsule bone was determined immediately after pulsed (100 msec) carbon dioxide laser exposure (0.3 to 4.0 W; 200 urn spot diameter). The time‐ and space‐dependent temperature increases and thermal diffusion were determined as a function of the laser power density and were found to vary linearly.
Use of a Screening RAST in a Large Neuro‐Otologic Practice
Authors: Howard Brian K. , Mabry Richard L. , Meyerhoff William L. , Mabry Cynthia S.
Published: September 2022

Evidence in the literature emphasizes the role of the immune system in disorders of the inner ear and eustachian tube. We initially investigated the presence of inhalant allergy in selected patients seen for otologic problems by means of a screening radioallergosorbent test (RAST), using either a microscreen or a limited antigen panel. This study analyzed the results of tests performed over a 2‐year period on 186 patients seen by one of us (WLM) for treatment of vertigo (66%), tinnitus (63%), hearing loss (49%), aural fullness (48%), Meniere's quadrad (27%), balance disturbance other than true vertigo (21%), and eustachian tube dysfunction (4%). We found an Incidence of immunoglobulin E‐mediated hypersensitivity of nearly 40% in a patient population selected solely for neuro‐otologic symptoms and not for sinonasal symptoms. This figure is more than double that quoted for the general population. We also found a surprisingly high incidence of mold antigen atopy in this selected population. Allergy can contribute to a number of otologic symptoms, including eustachian tube dysfunction, vertigo, tinnitus, hearing loss, aural fullness, and nonspecific balance disturbance. Allergy also has been emphasized as an etiologic factor in a portion of patients diagnosed with Meniere's syndrome. A screening RAST, combined with clinical evaluation, appears to be an excellent tool for evaluating these patients for inhalant allergy as part of a comprehensive workup.
Solitary neurofibroma of the larynx
Authors: Puri Rajeev , Berry Sandeep , Srivastava Gita
Published: September 2022

Neurofibromas of the larynx occur sporadically or in association with von Recklinghausen's disease. The first reported case of isolated endolaryngeal neurofibroma in 19251 has been followed by occasional reports.2–4 The aryepiglottic folds are the usual sites of occurrence, and the tumor frequently obscures the endolarynx. Following is a case of solitary neurofibroma of the larynx; preoperative diagnosis was difficult to make, and the tumor was treated surgically.
Eosinophilic ulcer of the tongue
Authors: Gerber Mark E. , Myer Charles M.
Published: September 2022

Eosinophilic ulcer of the tongue is a rarely reported clinical entity characterized histologically by a dense inflammatory infiltrate with extensive tissue eosinophilia. Clinically, this lesion can mimic squamous cell carcinoma, lymphoma, and other malignancies, as well as inflammatory or infectious processes, including Langerhans' cell histiocytosis and polymorphic reticulosis. Eosinophilic ulcers of the tongue have a benign, self‐limited course; accurate histopathologic evaluation is needed to prevent unnecessary treatment.
Cardiopulmonary compromise after use of topical and submucosal α‐agonists: Possible added complication by the use of β‐blocker therapy
Authors: Kalyanaraman Meena , Carpenter Richard L , McGlew Mary Jo , Guertin Stephen R.
Published: September 2022

We report the specifics of 12 cases of severe hypertension after the intraoperative use of topical phenylephrine, submucosal epinephrine, or both. Ten of these 12 patients also developed severe pulmonary edema. Seven of the twelve were treated with β blockers; 3 of whom suffered cardiac arrest. We propose a common mechanism: the vasoconstrictors caused systemic hypertension, increased left ventricular afterload, decreased left ventricular compliance, and decreased cardiac output. In those patients treated with β blockers, decreased contractility and inability to increase heart rate further compromised cardiopulmonary function. (Otolaryngol Head Neck Surg 1997;117:56–61.)
A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient
Authors: St. Charles Christopher S. , Matt Bruce H. , Hamilton Mark M. , Katz Barry P.
Published: September 2022

OBJECTIVE

To compare the use of ibuprofen with the use of acetaminophen with codeine for posttonsillectomy management.

BACKGROUND

We were not satisfied with our traditional pain‐management practice for tonsillectomy patients. We hoped to find a new approach for improved patient comfort and avoid scheduled, abusable drugs such as codeine.

DESIGN

Intervention, prospective, randomized control trial. Follow‐up was 1 month.

SETTING

University referral center; institutional pediatric practice, ambulatory.

PATIENTS

110 children undergoing tonsillectomy with or without other procedures. Consecutive patients were offered participation. Enrollees were randomly assigned to one of two classes and analyzed with the initial assignment. No patients withdrew for adverse effects, although 12 in group 2 used codeine and 5 of those used acetaminophen, whereas 2 in group 1 received ibuprofen.

INTERVENTIONS

Patients received either acetaminophen with codeine (group 1) or ibuprofen (group 2) for postoperative pain control.

MAIN OUTCOME MEASURES

The main outcomes, determined before initiation of the study, were assessment of (1) postoperative bleeding, (2) pain, (3) efficacy of relief of pain by drug, (4) nausea, (5) emesis, (6) readmission to hospital, (7) average temperature, and (8) highest temperature after surgery.

RESULTS

The only statistically significant difference is less nausea in patients receiving ibuprofen (p = 0.0049). Of note, no difference existed in postoperative bleeding, pain, or temperature control.

CONCLUSIONS

Ibuprofen is at least as effective as acetaminophen with codeine for postoperative pain control in children after tonsillectomy. (Otolaryngol Head Neck Surg 1997;117:76–82.)
Immunoglobulin G Subclass Response to Major outer Membrane Proteins of NontypableHaemophilus Influenzaein Children with Acute Otitis Media
Authors: Bernstein Joel M. , Bronson Paul M. , Wilson Mark E.
Published: September 2022

Children with acute otitis media as the result of nontypableHaemophilus influenzaeoften develop serum bactericidal and/or opsonic IgG antibodies to this organism during convalescence. Outer membrane proteins appear to be the principal targets for such antibodies. In this study we characterized the IgG subclass responses to major outer membrane proteins of nontypableH. influenzaein otitis‐prone children in whom this organism had colonized. Three of the major outer membrane proteins (P2, P5, and P6) were isolated from the homologous nontypableH. influenzaestrain recovered from the middle ear at the time of acute infection. Sera were obtained during the acute phase and at 1 and 6 months thereafter. The outer membrane proteins, which were isolated by preparative sodium dodecylsulfate‐polyacrylamide gel electrophoresis, were used as test antigens in a quantitative IgG subclass enzyme immunoassay. The results of this analysis indicate that the temporal characteristics and distribution of IgG subclass antibodies were found to differ for each of the outer membrane proteins. Moreover, substantial variation between patients was observed with respect to both temporal characteristics and subclass distribution of the IgG response to the three outer membrane proteins. Significantly, sera from two of three otitis‐prone subjects contained detectable levels of IgG antibody to the conserved P6 outer membrane protein at the time of acute infection, with serum from one subject also containing detectable levels of lgG3antibody to this same protein. Nevertheless, the organism persisted in the middle ears of these patients. The results of this study indicate that otitis‐prone children manifest a highly variable IgG subclass response to both conserved (P6) and variable (P2) outer membrane proteins of nontypableH. influenzae.Further study is required to ascertain whether these IgG subclass antibodies are biologically efficacious and whether otitis‐prone children possess the immunologic maturity to respond to nontypableH. influenzaeouter membrane protein‐based vaccines in a predictable manner.
Papillary Carcinoma Arising in a Thyroglossal Duct Cyst
Authors: Wigley Terry L , Chonkich George D. , Wat Bo Ying
Published: September 2022

The thyroglossal duct cyst (TDC) is a congenital anomaly appearing as an asymmetric midline neck mass. The TDC is the most common cyst in the neck and is thought to originate from epithelial remnants of the thyroglossal tract.1 Generally the TDC is benign, but about 1% contain a malignant neoplasm.1,2 About 125 cases of malignant neoplasm arising in the TDC have been reported in the literature.3–6 We present an additional case of papillary carcinoma arising in a TDC and discuss appropriate management.
Max Goldstein and deaf education: A century of progress
Authors: Bailey Byron J.
Published: September 2022

Personally, I know of no other field so fraught with controversy as education of the hearing impaired. Staunch advocates of oralism, of total communication, and of cued speech alternately inspire and terrify parents with various tales of triumph and tragedy1.
Pass/fail Rates for Repeated Click‐Evoked Otoacoustic Emission and Auditory Brain Stem Response Screenings in Newborns
Authors: McNellis Edward L. , Klein Alan J.
Published: September 2022

The click‐evoked otoacoustic emission (EOAE) recording procedure is a simple and quick test to perform. Some suggest that the EOAE is a more efficient newborn hearing screening procedure than the auditory brain stem response (ABR). However, one shortcoming of the EOAE is a high false‐positive rate in newborns, which is attributed to ear‐canal debris. The purposes of this study were to assess the initial pass/fail rates of ABR and EOAE measurements and the effectiveness of repeated EOAE measurements as a method of reducing the false‐positive rate. Fifty healthy, low‐risk newborns sequentially underwent ABR, repeated EOAE, otoscopy, EOAE, and ABR if necessary. The initial ABR passing rate was 98%, whereas the EOAE passing rate was 61%. The EOAE passing rate improved with each retest and approximated the ABR rate by the fourth test. EOAE failures and the overall level of the EOAE were found to be significantly related to the amount of ear‐canal debris. These results indicate that some newborns will require four or more tests before they eventually pass. Further study is needed to determine the overall cost‐effectiveness of the EOAE as compared with the ABR before specific recommendations for a universal hearing screening program are proposed.
Platysma Myocutaneous Flap: Use for Intraoral Reconstruction
Authors: Özçelik Tuncay , Aksoy Selçuk , Gökler Ayhan
Published: September 2022

Twenty patients were treated for intraoral epidermoid carcinoma with a single‐stage reconstructive technique using a myocutaneous flap based on the platysma muscle. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tissue. The superior vascular pedicle, the submental branch of the facial artery, was used. The platysma skin flap will survive if the blood supply from at least one region is preserved. In addition, it may be beneficial to include the external jugular and/or the communicating veins in the flap. Only three minor complications were seen and healed spontaneously. The flap has proved to be highly reliable and has significant benefits over many other techniques commonly used for head and neck reconstruction. (Otolaryngol Head Neck Surg 1997;116:493–6.)
Prospective Randomized Study of Thrice Weekly Six‐Month and Nine‐Month Chemotherapy for Cervical Tuberculous Lymphadenopathy
Authors: Yuen Anthony‐Po‐Wing , Wong Simon Hon Wai , Tam Cheuk Ming , Chan Shiu Lun , Wei William Ignace , Lau Sai Kit
Published: September 2022

The aim of this study is to compare the efficacy of a thrice weekly 6‐month regimen, 4S3H3R3Z3/2H3R3 (which consists of an initial 4 months of streptomycin (S), isoniazid (H), rifampicin (R), and pyrazinamide (Z) followed by 2 months of isoniazid and rifampicin), with a thrice weekly 9‐month regimen, 4S3H3R3Z3/5H3R3 (which consists of an initial 4 months of streptomycin, isoniazid, rifampicin, and pyrazinamide followed by 5 months of isoniazid and rifampicin), in the treatment of cervical tuberculous lymphadenopathy. A total of 113 patients were recruited between August 1987 and December 1993. Twenty‐two patients were excluded from the analysis because of defaulting treatment or modification of regimen. Ninety‐one patients were included in the analysis. Forty‐three patients were given the 6‐month regimen, and 48 patients were given the 9‐month regimen. Two (5%) patients of the 6‐month regimen and one (2%) patient of the 9‐month regimen had primary failure after completion of treatment (relative risk, 2.23; 95% confidence interval, 0.21 to 23.76). Of the 88 patients who had initial clinical remission after completion of treatment, the 5‐year actuarial remission rates were 89% for the 6‐month regimen and 90% for the 9‐month regimen (Wilcoxon, p = 0.44). There were no significant differences of both primary failure rate and 5‐year actuarial remission rate of the two regimens. The 6‐month regimen is recommended as the initial treatment of tuberculous lymphadenopathy.
Microbiology of Otitis Externa
Authors: Clark William B. , Brook Itzhak , Bianki David , Thompson David H.
Published: September 2022

Microbiologic and clinical data from 26 patients with otitis externa were prospectively evaluated. Specimens were processed for aerobic and anaerobic bacteria. Bacterial growth was noted in 23 specimens. A total of 33 aerobic and 2 anaerobic bacteria were recovered. Aerobic bacteria only were isolated in 21 (91%) patients, anaerobic bacteria only in 1 (4%), and mixed aerobic and anaerobic bacteria in 1 (4%). The most common isolates were Pseudomonas aeruginosa (14 instances), Staphylococcus aureus (7), Acinetobacter calcoaceticus (2), Proteus mirabilis (2), Enterococcus faecalis (2), Bacteroides fragilis (1), and Peptostreptococcus magnus (1). One isolate was recovered in 13 (57%) patients, 2 isolates in 8 (35%), and 3 isolates in 2 (9%). These data illustrate the polymicrobial nature of otitis externa in about half of the patients and the role of anaerobic bacteria in 8% of them. Further studies are warranted to evaluate the therapeutic implications of these findings.