bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Evaluation of Audiometric Results After Stapes Surgery in Otosclerosis. I. The Effects of Using Different Audiologic Parameters and Criteria on Success Rates
Authors: De Bruijn Arthur J. G. , Tange Rinze A. , Dreschler Wouter A.
Published: February 2003

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology‐Head and Neck Surgery proposed guidelines to provide more uniformity in reporting hearing results after middle ear surgery. One of the proposals was to include the hearing thresholds at 0.5, 1, 2, and 3 kHz in a 4‐frequency pure‐tone average (PTA) and to use postoperative bone‐conduction (BC) levels rather than preoperative BC levels in describing postoperative air‐bone gaps (ABGs). The hearing results of 451 stapes operations were evaluated to analyze to what extent the choice of different audiologic criteria affects success rates. It appeared that choice of PTA significantly affects postoperative gain in air‐conduction thresholds and ABG levels. If one takes the improvements in speech‐reception thresholds as the gold standard, the gain in air‐conduction correlates best with a gain in speech‐reception threshold if a higher frequency, such as 3 or 4 kHz, is included in a 4‐frequency PTA. Also, choice of preoperative or postoperative BC in computing postoperative ABGs had a significant effect on the mean postoperative ABG levels, showing more favorable results with the use of preoperative BC thresholds. (Otolaryngol Head Neck Surg 2001; 124:76–83.)
Allergy Testing and Immunotherapy in an Academic Otolaryngology Practice: A 20‐year Review
Authors: Lane Andrew P. , Pine Harold S. , Pillsbury Harold C.
Published: February 2003

OBJECTIVE

Allergic disease plays a central role in the clinical practice of otolaryngology. The purpose of this study was to review the 20‐year experience of an allergy clinic integrated within an otolaryngology practice at a major academic institution. STUDY DESIGN: We performed a retrospective database review of over 3300 otolaryngology patients referred for allergy skin testing between 1979 and 1999.

RESULTS

Approximately 80% of patients referred for allergy testing in our clinic had positive test results, of which 75.7% went on to undergo desensitization. The most common allergen was house dust, with allergies to mites, ragweed, and grass also prevalent. Among current allergy immunotherapy patients, 30.8% have undergone nasal septal, turbinate, and/or endoscopic sinus procedures in addition to allergy management. Nasal obstruction was the symptom most frequently persistent despite immunotherapy and the one most frequently reported to be improved by surgery.

CONCLUSIONS

The otolaryngologist‐head and neck surgeon is uniquely qualified to perform comprehensive medical and surgical management for patients with complex disease processes involving a component of allergy. We believe that an integrated approach to allergy within an otolaryngology practice optimizes the treatment of such patients. (Otolaryngol Head Neck Surg 2001;124:9‐15.)
Academic Otolaryngology in the New Millennium: Are We Falling Behind?
Authors: Bhattacharyya Neil , Shapiro Nina L.
Published: February 2003

OBJECTIVE

To determine if differences in publication rates have evolved over the past 3 decades for academic otolaryngologists.

METHODS

Three random samples with 50 academic otolaryngologists each were studied. These otolaryngologists completed training in 1 of the 3 time periods (1970‐74, 1980‐84, 1990‐94) studied. Articles published within the first 5 years after graduation were tabulated and statistically analyzed.

RESULTS

Academic otolaryngologists graduating in the 1970s, 1980s, and 1990s averaged 8.7, 8.9, and 6.4 publications during their first 5 years of academic practice, respectively. The first 2 cohorts averaged 5.4 and 5.7 publications in the 4 major otolaryngology journals, versus 3.3 for 1990s graduates. Basic science publications increased for 1990s graduates over those of the 1970s and 1980s graduates. The percentage of first author articles remained stable. Despite these trends, only the drop in case reports was statistically significant (P = 0.023, ANOVA).

CONCLUSION

Trends may be developing that predict decreasing publication rates for newly trained otolaryngologists entering academic practice. (Otolaryngol Head Neck Surg 2001;124:4‐8.)
Outcomes of Acid Suppressive Therapy in Patients with Posterior Laryngitis
Authors: Ulualp Seckin O. , Toohill Robert J. , Shaker Reza
Published: February 2003

OBJECTIVE

To evaluate the results of acid suppressive therapy (AST) in posterior laryngitis (PL) patients with and without documented pharyngeal acid reflux (PAR).

METHODS

The charts of all patients with PL who received AST and who had undergone pharyngeal pH monitoring were reviewed. Results of AST in patients with PL with and without documented PAR were evaluated by laryngeal examination, symptom scores, and self‐reported overall benefit.

RESULTS

Thirty‐nine patients with PL had received AST and undergone pharyngeal pH monitoring. Follow‐up ranged from 2 to 27 months. Laryngeal findings were improved in patients with and without PAR. Pretreatment total symptom scores were significantly greater than that of posttreatment in patients with and without documented PAR. Overall benefit from AST was reported by the majority of PL patients with and without documented PAR.

CONCLUSION

These findings support the use of AST to reduce or eliminate signs and symptoms in PL regardless of documentation of PAR. (Otolaryngol Head Neck Surg 2001;124:16‐22.)
Management of Cancer of the Supraglottis
Authors: Scola Bartolomé , FernÁNdez‐Vega Manuel , MartÍNez Tomás , FernÁNdez‐Vega Susana , Ramirez Carlos
Published: February 2003

We present the results of a retrospective study of 903 patients treated with conservation surgery for carcinoma of the supraglottic larynx so we can evaluate our management of supraglottic cancer with different types of surgery. In 301 patients, an extended supraglottic laryngectomy was performed. The recent selective use of transoral laser resection appears to be a rational approach. The 5‐year uncorrected survival was 84%, 81%, 76%, and 55% for stages I, II, III, and IV, respectively. The most common site for local‐regional failure was the cervical lymphatics. The percentage of occult disease in the N0 neck was 21% and epilaryngeal supraglottic location, locally advanced and GIII tumors have a higher frequency of lymph node involvement. There were no differences between comprehensive and anterolateral elective neck dissections. A bilateral elective neck dissection is recommended. In histologically positive neck disease, the survival rates were better with postoperative radiotherapy only in cases of extracapsular spread.
Laser‐Assisted Uvulopalatoplasty: Short‐Term and Long‐Term Results
Authors: Neruntarat Chairat
Published: February 2003

OBJECTIVE

Snoring causes many problems for both snorers and family members. Significant improvement has been reported in subjective measures of snoring after laser‐assisted uvulopalatoplasty (LAUP). However, there were few studies of the long‐term results of LAUP from a large number of patients. The purpose of this study was to compare the short‐term versus long‐term results in patients undergoing this procedure.

METHODS

LAUP has been performed on 340 snorers. The majority of the patients were male with simple snoring by history and confirmed by polysomnographic study. Data on patients were compared from preoperative to the short‐term (6 months) and longterm (more than 3 years) postoperative assessment points. Statistic analysis was performed to assess the significance of differences between groups.

RESULTS

Significant improvement was observed in snoring scale at 6 months and long‐term. The mean follow‐up was 40.5 months with a range of 36 to 50 months. There were significant differences between short‐term and long‐term results (P < 0.05). The change in body mass index was significantly different in the patients with and without recurrence (1.9 vs 0.5 kg/m2, P < 0.01). Two hundred fifty‐five (75%) patients had long‐term clinical success, and 34 (12%) patients with short‐term success failed long‐term.

CONCLUSION

LAUP in the treatment of simple snoring results in long‐term success. However, patients are at risk of recurrence if they gain weight. (Otolaryngol Head Neck Surg 2001;124:90‐3.)
Tongue Lesions in the Pediatric Population
Authors: Horn Corinne , Thaker Harshwardhan M. , Tampakopoulou Dimitra A. , Serres Lianne M. De , Keller Jeffrey L. , Haddad Joseph
Published: February 2003

OBJECTIVE

To describe the spectrum of pediatric tongue lesions treated surgically at Columbia‐Presbyterian Medical Center from January 1990 to December 1999.

STUDY DESIGN AND SETTING

Retrospective case‐series at the pediatric hospital of a tertiary care, academic medical center.

RESULTS

Seventeen patients were identified. Their ages ranged from 1 to 132 months (median, 7 months). Eight lesions were located anteriorly: mucous cyst (1), polyp (1), chronic inflammatory mass (1), hamartoma (1), squamous papilloma (2), cavernous hemangioma (1), and vascular malformation (1). Four lesions were located posteriorly: teratoma (1), glial choristoma (1), osseous choristoma (1), and benign epithelial cyst (1). Finally, there were 5 diffuse lesions including macroglossia (4) and massively infiltrating congenital lymphatic malformation (1). Symptoms included respiratory distress (3) and dysarthria (3); all other children were asymptomatic.

CONCLUSIONS

This series revealed an interesting spectrum of rare solid tumors; compared with other large series, fewer lymphatic and vascular malformations were seen. Presenting symptoms, differential diagnosis, and surgical approach were differentiated according to lesion location.
Facial Translocation Approach to the Skull Base: The Viability of Translocated Facial Bone Graft
Authors: Hao Sheng‐Po
Published: February 2003

OBJECTIVES

A retrospective review of 56 patients who were operated through a facial translocation approach was carried out to assess the viability of the translocated facial bone segment.

METHODS

Eleven patients had preoperative radiotherapy, and 26 had postoperative radiotherapy. In 14 patients the translocated bone segment was kept attached to the anterior cheek, and in 42 patients the bone segment was detached and then implanted. A vascularized flap was used to obliterate the defect in the paranasal sinuses in 15 patients.

RESULTS

Twelve (21.4%) patients had devitalized bone segment and required sequestrectomy. The incidence of devitalized bone segment was higher in the patients who received postoperative radiotherapy (P = 0.04) and lower in the patients in whom the defect in the paranasal sinuses was reconstructed with a vascularized flap (P = 0.006).

CONCLUSIONS

The translocated facial bone segment should be kept attached to the cheek soft tissue when possible, or the defect in the paranasal sinuses should be reconstructed with a vascularized flap.
Transmastoid Decompression As a Treatment of Bell Palsy
Authors: Yanagihara Naoaki , Hato Naohito , Murakami Shingo , Honda Nobumitsu
Published: February 2003

OBJECTIVE

We sought to assess the efficacy of transmastoid decompression after steroid treatment.

STUDY DESIGN

One hundred one adults with Bell palsy having denervation exceeding 95% after steroid treatment were divided into 2 groups. In 58 patients decompression from the labyrinthine segment to the stylomastoid foramen was performed, and the remaining 43 patients were only followed up. Using the Yanagihara score and House Brackmann grading system, the recovery from the palsy was assessed.

RESULTS

There was a statistically significant difference in the final facial score of the 2 groups. Within 60 days after the onset, the chance of better recovery from the palsy was higher in the patients with decompression.

CONCLUSION

In the era of steroid treatment, we cannot discard the transmastoid decompression of the facial nerve in the treatment of severe Bell palsy with profound denervation, although further effort is needed to obtain definitive evidence to show the benefit of the operation.
Auricular Pseudocysts: A Treatment with the Chulalongkorn University Vacuum Device
Authors: Supiyaphun Pakpoom , Decha Wittaya , Kerekhanjanarong Virachai , Hirunwiwatkul Prakobkiat
Published: February 2003

Auricular pseudocysts are rare lesions that present as an asymptomatic cystic swelling of the anterior surface of the auricle, particularly the antihelix. Typically, the pseudocysts contain viscous straw‐yellow fluid similar in appearance to olive oil; however, a clear pale yellow serous transudate may also be encountered. Various therapeutic approaches have been used with variable success. We describe a simple small vacuum device called the Chulalongkorn University vacuum device, which was developed in our center. The device can be easily made anywhere by any surgeon. We report the outcome in 17 patients treated by means of needle aspiration plus application of the Chulalongkorn University vacuum device for 5 days. A complete resolution of the lesion was obtained in 15 (88.2%) patients. Because the procedure is safe and effective and does not require an operating room setting, it may be accepted as an option in the treatment of auricular pseudocysts.
Injury to the Lacrimal Apparatus After Endoscopic Sinus Surgery: Surgical Implications From Active Transport Dacryocystography
Authors: Unlu H. Halis , Goktan Cihan , Aslan Asim , Tarhan Serdar
Published: February 2003

In order to evaluate the lacrimal drainage system injury after functional endoscopic sinus surgery, surgical records and postoperative active transport dacryocystography imaging of 31 patients were analyzed. Presence of the lacrimal bone dehiscence and no passage of the contrast material into the inferior meatus were noted as the signs of injury to the lacrimal canal on active transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the contrast material into the inferior meatus was observed in 14.9% of the operated sides. There were no cases of epiphora postoperatively. The lacrimal drainage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various extents during functional endoscopic sinus surgery. However, it does not necessarily result in postoperative epiphora. Performing the middle meatal antrostomy in posteroinferior direction, and uncinectomy with backbiting forceps or a shaver might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detection of the lacrimal injury.
Cannula Aspiration of Peritonsillar Abscesses
Authors: Olarinde O. , Choa D. I.
Published: February 2003

Peritonsillar abscesses may be treated by needle aspiration, incision and drainage, or abscess tonsillectomy. A modification of the technique of needle aspiration is described. This technique minimizes the risk of vascular damage during needle aspiration and is more reassuring to the patient.
Intracranial Metastases in Patients with Squamous Cell Carcinoma of the Head and Neck
Authors: Bree Remco De , Mehta Dinesh M. , Snow Gordon B. , Quak Jasper J.
Published: February 2003

BACKGROUND

Intracranial metastases are rarely clinically diagnosed in patients with head and neck squamous cell carcinoma. Only 7 patients with metastases to the cavernous sinus from head and neck squamous cell carcinomas have been reported.

METHODS

A retrospective study revealed 13 patients with intracranial metastases of head and neck squamous cell carcinoma. In a 53‐year‐old woman a cavernous sinus metastasis of a laryngeal carcinoma was histologically diagnosed by using a CT‐guided surgical navigation system and was treated with stereotactic radiotherapy.

RESULTS

The mean survival was 4.3 months. Predictive factors for longer survival were absence of extracranial disease, age younger than 60 years, and treatment with radiotherapy.

CONCLUSIONS

The prognosis for patients with intracranial disease is poor. The current development of computer‐assisted stereotactic navigation and stereotactic radiotherapy may facilitate surgical diagnostic exploration and improve treatment, especially in patients without extracranial disease.
Is Carotid Reconstruction for Advanced Cancer in the Neck a Safe Procedure?
Authors: Katsuno Satoshi , Takemae Toshiki , Ishiyama Tetsuya , Usami Shin‐Ichi
Published: February 2003

Head and neck surgeons hesitate to resect the carotid artery because of the postoperative risk of neurologic sequelae. On the other hand, there is no curative therapeutic option for head and neck cancer involving the carotid artery, except for complete tumor removal. A retrospective review of all published articles in the English literature dealing with carotid reconstruction for head and neck cancer from 1987 to 1998 was performed. There were only 11 articles, including our series, that reported outcomes of this procedure. Among the 148 patients of this series, major neuromorbidity was 4.7%, and mortality occurred in 6.8% of the patients. Combined major neuromorbidity and mortality was 10.1%. Because total removal of the advanced cancer is the only therapy that can offer the patients a chance for cure, head and neck surgeons should aggressively perform carotid resection and reconstruction.
Relationship between the Size of Neopharynx after Laryngectomy and Long‐Term Swallowing Function: An Assessment by Scintigraphy
Authors: Hui Yau , Ma Kwok‐Man , Wei William I. , Ho Wai‐Kuen , Yuen Po‐Wing , Lam Lai‐Kun , Chow Chun‐Man
Published: February 2003

OBJECTIVES

To study the relationship between the size of neopharynx after total laryngectomy and long‐term swallowing function by means of scintigraphy.

STUDY DESIGN

The width of pharyngeal remnant was measured during surgery in 11 patients. Their swallowing function was assessed by scintigraphy 8 to 10 years after surgery.

METHODS

The width of pharyngeal remnant at its narrowest point in both relaxed and stretched state was measured during surgery. Postoperative scintigraphy data on swallowing were obtained and computed along 3 lines, (1) transit time through neopharynx, (2) percentage of bolus transferred, and (3) swallowing efficiency. The relationship between the 2 sets of data was analyzed by linear regression analysis.

RESULTS

(1) No statistically significant relationship was found between the size of neopharynx and swallowing function. (2) All patients are clinically asymptomatic.

CONCLUSIONS

The swallowing function is not affected by the size of the neopharynx in 11 patients with pharyngeal remnant width ranging from 3 to 8 cm (stretched).
Adductor Muscle Activity Abnormalities in Abductor Spasmodic Dysphonia
Authors: Cyrus Carlos B. , Bielamowicz Steven , Evans Frank J. , Ludlow Christy L.
Published: February 2003

OBJECTIVE

To determine laryngeal muscle activation abnormalities associated with speech symptoms in abductor spasmodic dysphonia (ABSD).

STUDY DESIGN

Bilateral laryngeal muscle recordings from the posterior cricoarytenoid, thyroarytenoid, and cricothyroid muscles were conducted in 12 ABSD patients. Patients' measures were compared during speech breaks and during speech without breaks and with 10 normal controls.

RESULTS

Significant group differences were found in the thyroarytenoid muscle; the patients had significantly greater activity on the right side both during speech breaks and nonbreaks in comparison with the controls. Cricothyroid muscle levels were also increased on the right in the patients.

CONCLUSION

An asymmetry in adductor muscle tone between the 2 sides in ABSD may account for difficulties with maintaining phonation and voice onset after volceless consonants.

SIGNIFICANCE

These abnormalities may indicate why PCA BOTOX Injections have not been as effective in ABSD as thyroarytenoid injections have been in adductor spasmodic dysphonia. (Otolaryngol Head Neck Surg 2001;124:23‐30)
Characteristics of Bony Erosion in Allergic Fungal Rhinosinusitis
Authors: Nussenbaum Brian , Marple Bradley F. , Schwade Nathan D.
Published: February 2003

OBJECTIVES

Erosion of bone with or without extension of disease into adjacent anatomic spaces is observed among some patients with allergic fungal rhinosinusitis (AFRS). The objective of this report is to further define these findings as they relate to this disease.

STUDY DESIGN

Retrospective chart review of 142 patients with AFRS diagnosed using the Bent‐Kuhn criteria. All patients were treated at a single institution.

RESULTS

Approximately 20% of patients with AFRS demonstrated bone erosion on CT scan. The ethmoid sinus was the most commonly eroded site. The orbit and anterior cranial fossa were the most common adjacent anatomic spaces to exhibit disease extension. Sinus expansion, not the specific organism identified, was associated with the presence of bone erosion. Surgical management with endoscopic techniques was successful for all patients without any major perioperative complications.

CONCLUSION

Bone erosion can be related to AFR. Recognition of this possibility is important because bone erosion can be interpreted as an indication of invasive pathosis. In the presence of bone erosion or disease extension, endoscopic techniques can be used to surgically manage this disease.
Effect of Interleukin‐2 and Selenium on the Growth of Squamous Cell Carcinoma Cells
Authors: Thikkurissy Sarath , Pavone Anthony , Rega Anthony , Bae Richard , Roy Martin , Wishe Harvey I. , Kiremidjian‐Schumacher Lidia
Published: February 2003

OBJECTIVES

The objectives of this study were to determine whether the expression of the interleukin‐2 (IL‐2) receptors on squamous cell carcinoma cells can be enhanced in the presence of selenium (Se) and contribute to a greater retardation of tumor growth after locoregional therapy with IL‐2.

STUDY DESIGN

The growth of the cells was studied after in vitro or dietary supplementation with Se in a murine model.

RESULTS

Treatment of established tumors in hosts supplemented with Se with peritumoral injections of IL‐2 resulted in 50% reduction of tumor size, whereas treatment of early tumors resulted in 72.4% reduction. The effect was most likely related to a combination of enhanced immune responsiveness and enhanced IL‐2 receptor expression on the tumor cells.

CONCLUSIONS AND SIGNIFICANCE

The data suggested that local immunotherapy with IL‐2 in hosts supplemented with Se may represent an effective modality of treatment for the prevention of recurrences at the site of conventionally treated primary tumors, including tumors that do not express IL‐2 receptors.
Supracricoid Laryngectomy with CHEP: Functional Results and Outcome
Authors: Lima Roberto A. , Freitas Emilson Q. , Kligerman Jacob , Dias Fernando L. , Barbosa Mauro M. , Sa Geraldo M. , Santos Izabella C. , Farias Terence
Published: February 2003

OBJECTIVES

To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy.

STUDY DESIGN

A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan‐Meyer method.

RESULTS

Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease‐free survival was 75% for T2 and 79% for T3.

CONCLUSIONS

This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near‐total laryngectomy, regarding the extent of the lesion.
Extrathyroid Spread in Papillary Carcinoma of the Thyroid: Clinicopathological and Prognostic Study
Authors: Ortiz S. , Rodríguez J. M. , Soria T. , Pérez‐Flores D. , Piñero A. , Moreno J. , Parrilla P.
Published: February 2003

INTRODUCTION

The extrathyroid spread (ETS) is one of the risk factors that influence mortality and recurrence in patients with papillary carcinoma of the thyroid (PCT). The aim of this study is to analyze the clinical and histologic features and follow‐up of a series of patients with ETS undergoing surgery for PCT and to identify patients with a greater risk of presenting with ETS.

MATERIAL AND METHODS

Retrospective study of a series of 200 patients undergoing surgery for PCT, of whom 47 (23.5%) presented with ETS. The clinical and histologic features and follow‐up of the patients with ETS were compared with those without ETS using the Pearson χ2 test. We used a logistics regression model to perform a multivariant analysis for ETS. The survival and disease‐free interval rates were calculated using the Kaplan‐Meier method.

RESULTS

ETS is most associated with patients over 50 years of age, with tumors over 4 cm that are not encapsulated, with lymph node metastasis, and with certain PCT histologic subtypes after the multivariant analysis. The overall rate of recurrence and mortality in patients with ETS was much higher than in patients without ETS.

CONCLUSIONS

PCT patients with ETS have a greater risk of tumor‐related recurrence and mortality than patients without ETS. There are patients with certain clinical and histologic features who have a greater risk of presenting with ETS.
A Tongue Suspension Suture for Obstructive Sleep Apnea and Snorers
Authors: Woodson B. Tucker
Published: February 2003

OBJECTIVE

A tongue suture is postulated to prevent tongue base collapse in obstructive sleep apnea (OSA) and snoring. This procedure uses a permanent tongue base suture to support the pharynx and lessen collapse. This study evaluates 2‐month results in 28 OSA and snoring patients.

STUDY DESIGN AND SETTINGS

Forty‐three patients have been enrolled in a multi‐institutional prospective open enrollment study using the “Repose” bone screw system. Subjects were evaluated using polysomnography measures of general health (SF‐36), snoring, and sleep (Epworth Sleepiness Scale and Functional Outcomes of Sleep) performed before and again 2 months after treatment.

RESULTS

In 14 OSA patients (Apnea + Hypopnea (AHI) > 15) and 14 snorers (AHI <15), no change was noted in sleep architecture or lowest oxygen saturation. AHI decreased in OSA (35.4 + 13.7 to 24.5 + 14.5, P < 0.00), but not in snorers. AHI decreased in the lateral (16.5 + 16.5 to 3.8 + 6.4, P < 0.01) but not the supine position. Epworth Sleepiness Scale, Functional Outcomes of Sleep, and snoring scales improved. Snoring decreased but remained bothersome to the bed partner.

CONCLUSIONS

A tongue suspension suture partially reduces the respiratory severity of OSA. Small changes are noted in symptoms of sleepiness, snoring, and functional outcomes. Demonstration of efficacy of the technique and device will require further controlled trials.
Meta‐Analysis of Tympanostomy Tube Sequelae
Authors: Kay David J. , Nelson Magalie , Rosenfeld Richard M.
Published: February 2003

OBJECTIVE

To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies.

DATA SOURCES

English‐language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines.

STUDY SELECTION

Cohort studies with otitis media as the primary indication for tube placement.

DATA EXTRACTION

Two reviewers independently extracted data from 134 articles.

DATA SYNTHESIS

Transient otorrhea occurred in 16% of patients in the postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%), and medial displacement (0.5%). Sequelae after tube extrusion included tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%), cholesteatoma (0.7%), and perforation (2.2% with short‐term tubes, 16.6% with long‐term tubes). Meta‐analysis showed that long‐term tubes increased the relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6 (95% CI, 1.5 to 4.4). Similarly, intubation increased the relative risk of tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI, 1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy rates of 10% and 14%, respectively).

CONCLUSIONS

Sequelae of tympanostomy tubes are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, focal atrophy). Nonetheless, the high incidence suggests a need for ongoing otologic surveillance of all patients with indwelling tubes and for a reasonable time period after tube extrusion. Long‐term tubes should be used on a selective and individualized basis.
A New Laser Treatment for Vocal Cord Papilloma—585‐nm Pulsed Dye
Authors: Valdez Tulio A. , Mcmillan Kathleen , Shapshay Stanley M.
Published: February 2003

OBJECTIVES

Microvascular targeting with the 585‐nm pulsed dye laser (PDL) may provide a new form of therapy to control symptoms caused by recurrent respiratory papillomatosis (RRP).

METHODS

Ten patients with RRP underwent 13 procedures under general anesthesia with the 585‐nm PDL. A micromanipulator (11 procedures) and a flexible nasolaryngoscope (2 procedures) were used to deliver the laser pulses. Patients were followed postoperatively according to protocol.

RESULTS

Clinical examination revealed regression of papillomas in all patients. Seven patients had complete regression after PDL surgery, and 2 patients had partial response to treatment. One patient was lost to follow‐up. No complications were present during this prospective nonrandomized pilot study.

CONCLUSION

Patients treated with PDL experienced regression of their papillomas. PDL may provide patients with RRP with an alternative treatment without the risks associated with CO2 laser surgery. This procedure also has potential to be delivered on an outpatient basis with flexible fiberoptic laryngoscopes.
Potent Effector Function of Tumor‐Sensitized L‐Selectinlow T Cells against Subcutaneous Tumors Requires LFA‐1 co‐Stimulation
Authors: Seeley Brook M. , Barthel Steve W. , To Wyatt C. , Kjaergaard JØrgen , Plautz Gregory E.
Published: February 2003

OBJECTIVE

Animal tumor models have demonstrated that adoptive transfer of tumor‐draining lymph node (TDLN) T lymphocytes can cure established tumors in many anatomic sites. However, subcutaneous tumors are relatively refractory and have required maximally tolerated doses of cells. The goals of this study were to determine whether a subset of TDLN T lymphocytes varying in expression of the cell adhesion molecule L‐selectin (CD62L) had augmented therapeutic efficacy and to determine the co‐stimulatory requirements for trafficking and anti‐tumor effector function.

STUDY DESIGN

TDLNs were recovered from mice bearing progressive MCA 205 fibrosarcomas, and the T lymphocytes were segregated into CD62Llow and CD62Lhigh subsets and activated ex vivo with anti‐CD3 mAb and IL‐2. Mice bearing established subcutaneous MCA 205 tumors were treated with activated T cell subsets and in some experiments with additional mAb against cell adhesion molecules.

RESULTS

Adoptive transfer of as few as 5 × 106 activated cells cured mice bearing 3‐day subcutaneous MCA 205 tumors initiated with 6 × 106 cells, and the tumors demonstrated a dense infiltrate of CD62Llow cells. In marked contrast, adoptive transfer of 10 times as many T cells derived from the reciprocal CD62Lhigh compartment had no effect on tumor growth. The effector function of the CD62Llow T cells was clearly dependent on co‐stimulation through the cell adhesion molecule LFA‐1, because anti‐LFA‐1 mAb completely abrogated the antitumor reactivity of the transferred cells against subcutaneous tumors and inhibited tumor infiltration. In contrast, blockade of ICAM‐1, VLA‐4, or VCAM‐1 had no inhibitory effect on the anti‐tumor function.

CONCLUSION

These studies demonstrate the high therapeutic activity of the CD62Llow subset of tumor‐draining LN T cells against subcutaneous tumors, a relatively refractory site, and confirm the essential role of LFA‐1 for effector T cell function.

SIGNIFICANCE

Identification of the phenotype and requirements for effector function of T lymphocytes sensitized to tumor antigens has implications for clinical trials of adoptive immunotherapy for head and neck carcinoma using a similar approach.
A Prospective Observational Study of 5‐, 7‐, and 10‐day Antibiotic Treatment for Acute Otitis Media
Authors: Pichichero Michael E. , Marsocci Steven M. , Murphy Marie Lynd , Hoeger William , Francis Anne B. , Green John L.
Published: February 2003

OBJECTIVE

To compare 5‐, 7‐ and 10‐day duration of antibiotic therapy for acute otitis media (AOM) in children.

STUDY DESIGN AND SETTING

Prospective nonrandomized 1‐year evaluation of 3 treatment durations for AOM in a private pediatric setting. Outcomes assessed at 14 ± 4 days after start of therapy with clinical response categorized as cure, improvement, or failure.

RESULTS

A total of 2172 children were studied; 46.4% were ≤2‐years‐old. Antibiotics used were amoxicillin (61.9% of patients), trimethoprim/sulfamethoxazole (11.7%), cephalosporins (14.2%), amoxicillin/clavulanate (5.2%), and macrolides/azalides (4.8%). No overall difference in outcome was observed comparing the 5‐day (n = 707), 7‐day (n = 423), or 10‐day (n = 1042) treatments, including children ≤2‐years‐old. However, in the subset who had an episode of AOM in the preceding month, outcome differed; 5‐day treatment was followed by more frequent failure than 10‐day treatment (P < 0.001). In logistic regression analysis, variables identified as contributing to a cure were: >2‐years‐old (P < 0.0001), no AOM in the preceding month (P = 0.07), or preceding 12 months (P = 0.03).

CONCLUSIONS

Our study supports the transition from 10 to 5 days for standard AOM antibiotic treatment duration in most patients. A 10‐day regimen may be superior in children who have experienced an episode of AOM within the preceding month, a known risk factor for resistant bacterial infection in the otitis‐prone patient.
A Novel CD44 v3 Isoform is Involved in Head and Neck Squamous Cell Carcinoma Progression
Authors: Franzmann Elizabeth J. , Weed Donald T. , Civantos Francisco J. , Goodwin W. Jarrard , Bourguignon Lilly Y.W.
Published: February 2003

OBJECTIVES

CD44 comprises a family of isoforms involved in tumorigenesis. Here we investigate the role of CD44 isoforms in head and neck squamous cell carcinoma (HNSCC) progression.

MATERIALS AND METHODS

HNSCC specimens underwent reverse transcriptase‐polymerase chain reaction (RT‐PCR) followed by Southern blot analysis. After surface biotinylation, FaDu (hypopharyngeal HNSCC) and CD44v3‐transfected COS‐7 cells were CD44 antibody‐precipitated and compared by Western blot analysis. FaDu cells underwent double immunofluorescence staining and growth assays.

RESULTS

Southern blot analysis suggested differential CD44v3 isoform expression in tumor and normal tissue. Cloning and sequencing revealed 2 novel CD44v isoforms. Western blot analysis suggested CD44v3 expression in COS‐7 transfectants and FaDu. Double immunofluorescence staining revealed colocalization of CD44v3 and actin in FaDu projections. Anti‐CD44v3 antibody decreased FaDu growth.

CONCLUSION

HNSCC tissue and FaDu appear to express CD44v3 isoforms. These isoforms may promote tumorigenesis.

CLINICAL SIGNIFICANCE

CD44v3 isoforms may be effective tumor markers and targets for HNSCC therapy.
Accuracy of Terminology and Methodology in Economic Analyses in Otolaryngology
Authors: Kezirian Eric J. , Yueh Bevan
Published: February 2003

OBJECTIVE

Economic studies increasingly guide health care resource allocation decisions. Because rigorous adherence to accepted definitions and research techniques is critical to ensure accuracy, we evaluated the terminology and methods of otolaryngology economic analyses.

STUDY DESIGN

A total of 71 articles published from 1990 to 1999 in 6 peer‐reviewed otolaryngology journals with terms such as “cost‐effective” in their title or representing economic analyses were reviewed for terminology and use of established methodology guidelines.

RESULTS

Over half (35 of 66) of terms such as “cost‐effective” were used incorrectly, and 60% of articles (39 of 64) confused “charge” and “cost” data. Eleven percent (7 of 64) of papers specified the perspective of their analysis. About half (17 of 30) reported a summary measure such as a cost‐effectiveness ratio. Only one third (23 of 63) performed sensitivity analyses.

CONCLUSION

Adherence to accepted definitions and research methods is inconsistent, although we did note moderate improvements in making the distinction between costs and charges, defining of study perspective, and performing sensitivity analysis.

SIGNIFICANCE

Greater attention to both terminology and methodology can enhance the quality of economic analyses and ultimately improve certain resource allocation decisions.
Long‐Term Histologic Effects of Inferior Turbinate Laser Surgery
Authors: Wexler David B. , Berger Gilead , Derowe Ari , Ophir Dov
Published: February 2003

OBJECTIVE

In this study we sought to define the histologic changes produced by laser treatment of inferior turbinates.

STUDY DESIGN

Eight inferior turbinates with prior laser treatment (mean, 26.8 months) were analyzed by light microscopy after turbinectomy for relief of refractory nasal obstruction. Histologic findings were compared with those of a group of 8 hypertrophic inferior turbinates that had no previous laser surgery.

RESULTS

Laser‐treated areas of the inferior turbinates demonstrated a histologically bland appearance, with marked diminution of seromucinous glands and relative preponderance of connective tissue matrix. Prominence of venous sinusoids was also significantly reduced in the laser‐treated areas. Surface epithelium including goblet cells was reconstituted over the areas of laser application.

CONCLUSION

Clinical laser surgery of the inferior turbinate produces striking long‐term histologic changes.

SIGNIFICANCE

The data suggest a differential response of turbinate histologic components to application of laser energy, with the glandular component being particularly sensitive. Further correlative study is needed to clarify the clinical significance of laser‐induced histologic changes in inferior turbinates.
Association of 8p23 Deletions with Poor Survival in Head and Neck Cancer
Authors: Bockmühl Ulrike , Ishwad Chandramohan S. , Ferrell Robert E. , Gollin Susanne M.
Published: February 2003

OBJECTIVE

Allelic loss at 8p23 occurs frequently in head and neck squamous cell carcinoma. The objective of this study was to determine the prognostic importance of 8p23 loss.

STUDY DESIGN AND SETTINGS

We tested 51 primary tumors and 19 lymph node metastases for loss of heterozygosity with 7 microsatellite polymorphisms at 8p23 and correlated the results with disease‐free interval and disease‐specific survival.

RESULTS

The Kaplan‐Meier analysis demonstrated statistically significant association of 8p23 allelic loss with both shorter disease‐free interval and disease‐specific survival. For the pN stage, the log‐rank test indicated significance in correlation with the disease‐free interval, whereas the pT stage showed a significant correlation with disease‐specific survival. Multivariate analysis identified loss of heterozygosity at 8p23 as independent prognostic marker for disease‐free interval.

CONCLUSION

Our data suggest that 8p23 allelic loss is associated with poor prognosis in head and neck squamous cell carcinoma and could be useful refining diagnosis of these tumors.
Kawasaki Disease Presenting as Cervical Lymphadenitis or Deep Neck Infection
Authors: Kao Hsiu‐Tsun , Huang Yhu‐Chering , Lin Tzou‐Yien
Published: February 2003

OBJECTIVE

To describe a group of patients with Kawasaki disease who had cervical lymphadenopathy as their dominant initial presentations.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 14 children who were admitted to Chang‐Gung Children's Hospital between May 1996 and July 1998 with the initial impression of cervical lymphadenitis, cellulitis, and/or deep neck infection but for which a diagnosis of Kawasaki disease was established later.

RESULTS

Five (35.7%) patients were less than 5 months of age, and 8 (57.1%) patients were more than 53 months of age. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.2 (6 to 20) days. Initially, empiric antibiotics were prescribed in each case with unsatisfactory response. Intravenous immune gamma globulin (2 g/kg) was administered in 13 patients. Three (21.4%) patients developed coronary artery lesions.

CONCLUSION

If a child less than 6 months or more than 4 years of age has a fever and an enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.
Short‐Lasting Drop Attacks in Meniere's Disease
Authors: Kentala E. , Havia M. , Pyykkö I.
Published: February 2003

OBJECTIVES

To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD).

STUDY DESIGN AND SETTING

Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system.

RESULTS

DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non‐DA subjects.

CONCLUSION

DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated.

SIGNIFICANCE

DA are more common in advanced MD.
Ventral Approach to the Rat Middle Ear for Otologic Research
Authors: Pinilla Mayte , Ramírez‐Camacho Rafael , Jorge Eduardo , Trinidad Almudena , Vergara José
Published: February 2003

OBJECTIVE

To describe a simple approach to the rat middle ear because there are few clear descriptions of this technique with minimal morbidity and mortality.

STUDY DESIGN AND SETTING

Six male Long‐Evans rats were used in this study. We designed a cervical approach to the middle ear with the purpose of creating an experimental model of ossiculoplasty that permits the postoperative survival of the animal.

RESULTS

It was possible in all cases to visualize the majority of structures of the tympanic cavity: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane. There were no cases of postoperative infection or facial paralysis.

CONCLUSIONS AND SIGNIFICANCE

The ventral approach to the rat middle ear is a rapid and simple technique that makes the rat the animal of choice for many otologic investigations.
Diagnostic Accuracy of Fine‐Needle Aspiration and Frozen Section in Nodular Thyroid Disease
Authors: Mandell David L. , Genden Eric M. , Mechanick Jeffrey I. , Bergman Donald A. , Biller Hugh F. , Urken Mark L.
Published: February 2003

OBJECTIVE

To assess the diagnostic accuracy of fine‐needle aspiration (FNA) and frozen section (FS) in nodular thyroid disease.

SETTING

Tertiary care academic medical center.

STUDY DESIGN

Retrospective review of 139 consecutive patients undergoing surgery for nodular thyroid disease. FNA and FS sensitivity, specificity, and accuracy were calculated with respect to permanent section histology.

RESULTS

Among 63 patients with an FNA interpreted as either benign (n = 38) or malignant (n = 25), FNA was accurate (sensitivity 89%, specificity 97%, accuracy 94%). FS identified only one case of carcinoma missed by FNA. Among 76 patients with a “suspicious” FNA, FS was reasonably accurate (sensitivity 67%, specificity 100%, accuracy 89%), but was deferred in 50% of cases.

CONCLUSION

Given high FNA accuracy, more selective use of FS is suggested.

SIGNIFICANCE

The study results will assist with intra‐institutional patient counseling and intraoperative decision‐making with respect to FNA and FS results in patients with nodular thyroid disease.
Practice Patterns versus Practice Guidelines in Pediatric Otitis Media
Authors: Stewart Michael G. , Manolidis Spiros , Wynn Rhoda , Bautista Marilyn
Published: February 2003

OBJECTIVE

To study the practice patterns of physicians and their adherence to an evidence‐based practice guideline (PG) on pediatric otitis media with effusion. We hypothesized that overall knowledge of the recommendations from the guidelines would be less than 75%, and that specialist physicians would have better knowledge of the recommendations than generalist physicians.

METHODS

We performed a survey study of 1167 otolaryngologists, pediatricians, and pediatric otolaryngologists. Each physician was sent a 6‐item survey asking about their practice patterns and treatment preferences for young children with otitis media with effusion. We compared responses between different specialties.

RESULTS

The overall response rate was 48%. Only 8 (1.4%) of the 558 responding physicians answered all 6 items congruent with the PG. Overall, pediatricians, otolaryngologists, and pediatric otolaryngologists had similar total scores, but different scores on individual items.

CONCLUSIONS

These results indicate that the practice patterns of pediatricians, otolaryngologists, and pediatric otolaryngologists differ from the recommendations of an evidence‐based PG. In particular, 2 items covering key treatment recommendations were answered in agreement with the PG by fewer than half of the physicians. It is not clear from this study whether these discrepancies were due to poor dissemination or knowledge concerning the PG, or disagreement with its recommendations.