bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of allergic fungal sinusitis: A comparison trial of postoperative immunotherapy with specific fungal antigens
Authors: Folker Randy J. , Marple Bradley F. , Mabry Richard L. , Mabry Cynthia S.
Published: November 2003

Objective: To determine the effect of immunotherapy (IT) with fungal antigens on clinical outcome in patients with allergic fungal sinusitis (AFS). Study Design: Prospective case control. Methods: In this comparison study, 22 patients meeting the diagnostic criteria of allergic fungal sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent sinusitis. Eleven patients received postoperative immunotherapy (IT) with fungal and nonfungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy. Results: The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P < .001) and a sinusitis‐specific quality‐of‐life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P < .001) and topical nasal (P = .043) corticosteroid therapy to control disease. Follow‐up was similar in the two groups and was not a determinant of differences in outcome (P = .7). Conclusions: Results from this study indicate that specific IT with fungal antigens improves patient outcome in AFS. Laryngoscope, 108:1623–1627, 1998
An anatomic approach to endoscopic intranasal ethmoidectomy
Authors: Schaefer Steven D.
Published: November 2003

Objectives: To develop an anatomic and functionally based approach to endoscopic intranasal ethmoidectomy. To develop such an approach using the salient features of the anterior to posterior (AP) and posterior to anterior (PA) intranasal sinus operations. To assess the safety of this form of ethmoidectomy in a patient population. Study Design: Retrospective chart review of patients undergoing ethmoidectomy by author or by residents under his direct supervision. Setting: University teaching hospital. In the 509 patients meeting study criteria, 168 anterior ethmoidectomies, 586 total ethmoidectomies, 264 sphenoidotomies, 290 frontal sinusotomies, and 838 antrostomies were performed between April 1992 and August 1997. Results: A complication rate of 0.98% and revision rate 2.9% were observed. Conclusions: Combining an AP approach to conserve sinus anatomy with a PA approach to avoid surgery directed toward the skull base provides a functional and safe procedure as demonstrated by the reported results. Laryngoscope, 108:1628–1634, 1998
Changes in nasal epithelium in patients with severe chronic sinusitis: A clinicopathologic and electron microscopic study
Authors: Al‐Rawi Mouwafak M. , Edelstein David R. , Erlandson Robert A.
Published: November 2003

Objective: Defective ciliary ultrastructure and impaired mucociliary clearance play an important role in the development of respiratory disease and sinusitis. Changes in the ciliary ultrastructure of the sinonasal epithelium have been documented in patients with primary ciliary dyskinesia. However, secondary ciliary dyskinesias and epithelial cytopathologic changes have been underappreciated as a consequence of respiratory dysfunction and chronic sinusitis. Study Design: Thirty‐two patients with severe chronic sinusitis were evaluated for ciliary and epithelial abnormalities. Materials and Methods: Fourteen patients (44%) were children who underwent full allergy, sweat, and immunologic workups. Eighteen patients (56%) were adults who had severe refractory sinusitis and had failed previous sinus surgery. All patients underwent nasal epithelium biopsies of the middle turbinate and evaluation by light and transmission electron microscopy. Results: Ciliated cells were found in 23 patients (72%) with 9 patients (28%) having no cilia. Foci of normal ciliated epithelium were found in only 19% of the patients, often in epithelial invaginations. Variable numbers (usually a minor population) of cilia in 20 cases (87%) exhibited ultrastructural defects including compound cilia and microtubule and dynein arm defects. All of the patients showed variable loss of differentiated epithelial cells ranging from denuded epithelium to basal cell hyperplasia often associated with squamous metaplasia, secondary to chronic sinonasal disease. The lamina propria was often edematous with dilated capillaries, plasma cells, lymphocytes, and hyperplastic seromucous glands. Conclusions: This study demonstrates that ciliary dyskinesias are primarily the result rather than the cause of chronic sinusitis. Patients with chronic sinusitis of uncertain origin exhibit a prominent loss of differentiated epithelial cells, as well as ciliary defects, most of which are likely to be secondary to the chronic disease process. These changes slow down mucociliary clearance and lead to a vicious cycle leading to chronicity.
Noise‐induced hearing loss in young adults: The role of personal listening devices and other sources of leisure noise
Authors: Mostafapour Sam P. , Lahargoue Kelli , Gates George A.
Published: November 2003

Concept: No consensus exists regarding the magnitude of the risk of noise‐induced hearing loss (NIHL) associated with leisure noise, in particular, personal listening devices in young adults. Objective: Examine the magnitude of hearing loss associated with personal listening devices and other sources of leisure noise in causing NIHL in young adults. Study Design: Prospective auditory testing of college student volunteers with retrospective history exposure to home stereos, personal listening devices, firearms, and other sources of recreational noise. Methods: Subjects underwent audiologic examination consisting of estimation of pure‐tone thresholds, speech reception thresholds, and word recognition at 45 dB HL. Results: Fifty subjects aged 18 to 30 years were tested. All hearing thresholds of all subjects (save one—a unilateral 30 dB HL threshold at 6 kHz) were normal, (i.e., 25 dB HL or better). A 10 dB threshold elevation (notch) in either ear at 3 to 6 kHz as compared with neighboring frequencies was noted in 11 (22%) subjects and an unequivocal notch (15 dB or greater) in either ear was noted in 14 (28%) of subjects. The presence or absence of any notch (small or large) did not correlate with any single or cumulative source of noise exposure. No difference in pure‐tone threshold, speech reception threshold, or speech discrimination was found among subjects when segregated by noise exposure level. Conclusion: The majority of young users of personal listening devices are at low risk for substantive NIHL. Interpretation of the significance of these findings in relation to noise exposure must be made with caution. NIHL is an additive process and even subtle deficits may contribute to unequivocal hearing loss with continued exposure. The low prevalence of measurable deficits in this study group may not exclude more substantive deficits in other popu lations with greater exposures. Continued education of young people about the risk to hearing from recreational noise exposure is warranted.
Effect of Steroids on Nasal Inflammatory Cells and Cytokine Profile
Authors: Kondo Hiroko , Nachtigal Dan , Frenkiel Saul , Schotman Elsa , Hamid Qutayba
Published: November 2003

Objectives: To assess the cellular and humoral effects of unilateral topical steroid application on the nasal mucosa of chronic sinusitis patients. Study Design: Cohort study with randomized grouping. Methods: Chronic sinusitis patients awaiting endonasal sinus surgery were randomly divided into a study group and a control group. All patients underwent allergy studies and categorized as allergic or nonallergic. Patients in the study group were exposed unilaterally to fluticasone propionate nasal spray, 100 μg/day for 4 to 6 weeks before the planned surgery. The control group was not exposed to steroids. At the time of surgery, anterior ethmoid mucosa specimens were obtained. The samples were immunostained for CD3, MBP, CD68, elastase, and tryptase. In situ hybridization was used for the detection of interleukin (IL)‐4, IL‐5, and interferon gamma (IFN‐γ) mRNA. The results were compared between the treated and untreated sides of exposed patients, as well as with non‐treated controls. Results: Twenty‐one patients consented to participate in the study. The number of CD3‐, MBP‐, and tryptase‐positive cells was significantly less in the treated and untreated sides of exposed patients, compared with unexposed controls. IL‐4 and IL‐5 mRNA were significantly downregulated in the treated side of allergic patients, as compared with nontreated patients. This effect could not be shown for IL‐4 in nonallergic patients. Conclusions: Topical steroid therapy had an anti‐inflammatory effect on both allergic and nonallergic chronic sinusitis patients. The unilateral application of the steroid spray affected the contralateral side as well.
A Preliminary Study of Cocaine Absorption From the Nasal Mucosa
Authors: Liao Been S. , Hilsinger Raymond L. , Rasgon Barry M. , Matsuoka Keith , Adour Kedar K.
Published: November 2003

Objective/Hypothesis: To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group II received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group III received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5,10,15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group III, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 min is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
Early outcome and complications of the extended subcranial approach to the anterior skull base
Authors: Fliss Dan M. , Zucker Gideon , Cohen Avi , Amir Aharon , Sagi Amiram , Rosenberg Lior , Leiberman Alberto , Gatot Albert , Reichenthal Eli
Published: November 2003

Objectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Methods: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. Results: Twenty‐six patients underwent oncologic resections, 22 patients had reduction of complex fronto‐naso‐orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontensisn pneumocephalus. The most common late complication in all three groups was anosmia. Conclusions: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.
Evaluation of Surgical Approaches to Endoscopic Auditory Brainstem Implantation
Authors: Friedland David R. , Wackym Phillip A.
Published: November 2003

Objectives: This study investigates the use of endoscopy for the placement of an auditory brainstem implant by translabyrinthine, retrosigmoid (suboccipital), and middle cranial fossa approaches. Study Design: Cadaver dissection and endoscope‐assisted placement of the auditory brainstem implant. Methods: Translabyrinthine, retrosigmoid, and middle cranial fossa dissections were performed bilaterally in five cadaveric heads. An auditory brainstem implant was placed within the lateral recess of the fourth ventricle under endoscopic visualization. The implantation was performed with all approaches and documented by digital image capture followed by production of dye‐sublimation photographic prints. Results: The lateral recess was visualized with the endoscope in all three approaches to the brainstem. The 30° endoscope provided the best visualization by translabyrinthine and retrosigmoid dissection and was essential for the middle cranial fossa approach. Refinement of implant position was readily achieved, as even the deepest portion of the recess could be seen with all three approaches. Conclusions: This study finds that endoscopy provides superior visualization of the lateral recess of the fourth ventricle than the operating microscope with all approaches. The retrosigmoid approach is recommended, as it provides the best view of the implantation site and the easiest angle for placement of the prosthesis. The use of the endoscope may allow for a smaller craniotomy than with conventional microscopic techniques, depending on tumor size. The translabyrinthine approach provides a good view of the lateral recess but had no advantage over other approaches. The middle cranial fossa approach is only possible with angled endoscopes; however, it is technically the most difficult and places the facial nerve at greatest risk.
Comparison of the Auditory‐Evoked Brainstem Response Wave I to Distortion‐Product Otoacoustic Emissions Resulting From Changes to Inner Ear Blood Flow
Authors: Telischi Fred F. , Mom Thierry , Agrama Mark , Stagner Barden B. , Ozdamar Ozcan , Bustillo Andres , Martin Glen K.
Published: November 2003

Objective/Hypothesis: Examine and compare in detail the time courses of the auditory brainstem response (ABR) wave I amplitude and latency to the distortion‐product otoacoustic emission (DPOAE) amplitude and phase measured in the rabbit model following deliberate obstruction of cochlear blood flow (CBF). Methods: Using a posterior fossa craniotomy in five rabbits, the internal auditory artery (IAA) was compressed with a probe. ABR and otoacoustic emission were continuously monitored before, during, and after the compressions. Results: ABR wave I amplitudes demonstrated measurable decreases at a mean of 28.3 s after IAA compression, whereas DPOAE amplitudes decreased after a mean of 14.8 s. Wave I latencies began to increase at a mean of 18.3 s after occlusion, while DPOAE phase measures changed after a mean of only 4.8 s following IAA compression. The time‐course patterns were similar for the amplitudes of both ABR wave I and DPOAE. Conclusions: ABR wave I amplitude follows a similar, though delayed (by approximately 10 s) time‐course pattern to that of the DPOAE following IAA compression. The implication of these findings for intraoperative auditory monitoring is that changes in many currently employed measures will lag actual surgically induced alterations in CBF by at least 20 to 30 s.
A Matched Control Study of Treatment Outcome in Young Patients With Squamous Cell Carcinoma of the Head and Neck
Authors: Verschuur Hendrik P. , Irish Jonathan C. , O'Sullivan Brian , Goh Christopher , Gullane Patrick J. , Pintilie Melania
Published: November 2003

Objectives/Hypothesis: To determine if there is a difference in overall survival, cause‐specific survival, and relapse‐free rate between young patients (<40 years of age) with head and neck squamous cell carcinoma (HNSCC) and older patients (>40 years of age). Study design: A matched control study describing the outcome of 185 previously untreated HNSCC patients less than 40 years of age treated at the Princess Margaret Hospital, Toronto, Ontario, Canada, between 1958 and 1992. The young patient group was compared with a control group of older patients (> 40 years of age) which was selected randomly from an entire cohort of patients (n = 10,072) and matched for site, sex, and date of presentation. Methods: The medical records were reviewed and data abstracted for demographic information, tobacco and alcohol use, family history, primary site, clinical stage, primary treatment, histology, the occurrence of residual or recurrent disease, salvage treatment, development of subsequent primaries, survival, and the eventual cause of death. The patient's TNM stage was reclassified according to American Joint Cancer Committee/Union Internationale Contre le Cancer (AJCC/UICC) 1992 criteria on the basis of the initial clinical description and staging investigations. A multivariate regression analysis was performed. To assess the importance of age as a prognostic factor for survival, the Cox proportion hazard model was used. Smoking status was also tested in the stratified Cox proportional hazard model. Results: Tumor stage and treatment modalities were comparable in both groups. The 5‐year, cause‐specific survival in both groups was not statistically different (72% vs. 68%, P = .91). The young patient group had a significantly better 5‐year overall survival compared with the older patient group (68% vs. 49%, P = .0011). Older patients developed more subsequent primary neoplasms than the younger patient population (18% vs. 8%, P = .005). There were significantly more females, an increased incidence of oral or oropharyngeal cancer, and fewer smokers in the young patient group. Smoking, however, had an important impact on outcome with all but one patient who developed a second primary in the upper aerodigestive tract having smoked. Multivariate analysis showed that only disease stage and cancer site were significant prognostic factors for survival. Conclusions: Young patients with HNSCC do not have a worse prognosis than a matched older patient group in this case‐controlled study (power > 0.75 for a minimal detectable difference of 10% disease‐free survival between the two groups).
Illness and Otological Changes During Upper Respiratory Virus Infection
Authors: Doyle William J. , Alper Cuneyt M. , Buchman Craig A. , Moody Stephanie A. , Skoner David P. , Cohen Sheldon
Published: November 2003

Objectives: Upper respiratory virus infection is associated with the expression of symptoms and signs of illness, and with the development of complications in anatomically contiguous structures. In most epidemiological studies, the frequency of the various complications is expressed as a fraction of the total population judged to be ill by report, signs, or symptoms. Because not all infected subjects become ill and because infected non‐ill subjects may develop complications, such risk estimates could be inaccurate. The objective of this study was to estimate the magnitude of the presentation bias during controlled, experimental infections. Study Design: This was a prospective, experimental study of the relationship between illness and otological complications during experimental upper respiratory virus infection in 316 adult volunteers. Methods: The data for illness and for abnormal middle ear underpressure in adult (18–54 y) volunteers experimentally infected with one of three viruses (rhinovirus type 39, rhinovirus strain hanks, influenza A virus) were analyzed and expressed as the relative frequencies of infected subjects reporting illness, developing abnormal middle ear pressure, and developing abnormal middle ear pressure in the absence of illness. Results: For all three viruses, illness was documented in approximately 50% of the infected subjects. While the frequency of persons developing abnormal middle ear underpressure was greater in the infected‐ill subjects, approximately one third of all infected subjects developing that complication did not report illness. Conclusions: These results support a large presentation bias in epidemiological surveys of viral upper respiratory infections, and infer that those surveys underestimate the true frequency of complications resulting from such infections.
Expression of γ‐Aminobutyric AcidA Receptor Subunits in the Vestibular System
Authors: Rezaee Ali , Robinson Alan M. , Pitovski Dimitri Z.
Published: November 2003

Objectives: Profile the expression of genes encoding GABAA receptor subunits in the vestibular end organs of a rat. Materials and Methods: Using a combination of reverse transcription followed by polymerase chain reaction (PCR) with gene‐specific primers, expression of mRNAs encoding 13 individual GABAAA receptor subunits was examined. Results: PCR amplification products representing subunit gene expression for α1–6, β‐3, and γ1–3, but not for δ, sub‐units were amplified, suggesting multiple molecular levels of regulation of vestibular GABAA receptor expression. Nucleotide sequencing confirmed the identity of rat vestibular end‐organs subunit cDNAs. Conclusion: These results give the most direct evidence to date that GABAA receptors composed of the detected subunits are expressed in the mammalian vestibular system, giving new support to previous investigations implicating GABA as a vestibular neurotransmitter.
Streptomycin ototoxicity and hair cell regeneration in the adult pigeon utricle
Authors: Frank Thomas C. , Dye Bradford J. , Newlands Shawn D. , Dickman J. David
Published: November 2003

Objective: The purpose of this study was to develop a technique to investigate the regeneration of utricular hair cells in the adult pigeon (Columba livia) following complete hair cell loss through administration of streptomycin. Study Design: Experimental animal study. Methods: Animals were divided into four groups. Group 1 received 10 to 15 days of systemic streptomycin injections. Animals in Groups 2 and 3 received a single direct placement of a 1‐, 2‐, 4‐, or 8‐mg streptomycin dose into the perilymphatic space. Animals in Groups 1 and 2 were analyzed within 1 week from injection to investigate hair cell destruction, whereas Group 3 was investigated at later dates to study hair cell recovery. Group 4 animals received a control injection of saline into the perilymphatic space. Damage and recovery were quantified by counting hair cells in isolated utricles using scanning electron microscopy. Results: Although systemic injections failed to reliably achieve complete utricular hair cell destruction, a single direct placement of a 2‐, 4‐, or 8‐mg streptomycin dose caused complete destruction within the first week. Incomplete hair cell loss was observed with the 1‐mg dose. Over the long term, regeneration of the hair cells was seen with the 2‐mg dose but not the 8‐mg dose. Control injections of saline into the perilymphatic space caused no measurable hair cell loss. Conclusions: Direct placement of streptomycin into the perilymph is an effective, reliable method for complete destruction of utricular hair cells while preserving the regenerative potential of the neuroepithelium.
Nasal alar reconstruction: A critical analysis using melolabial island and paramedian forehead flaps
Authors: Arden Richard L. , Nawroz‐Danish Myra , Yoo George H. , Meleca Robert J. , Burgio Don L.
Published: November 2003

Objectives: To qualitatively and quantitatively describe aesthetic and functional outcomes following Mohs ablative surgery involving the alar subunit, using a paramedian or subcutaneous melolabial island flap. Study Design: Retrospective review. Methods: A single surgeon's results in 38 consecutive patients were analyzed. Objective measures (alar rim thickness, donor scar width and length), subjective assessment (seven aesthetic parameters) by three academic otolaryngologists, and patient satisfaction questionnaires were evaluated. Student t test was used to ascertain statistically significant differences between reconstructive groups. Results: Questionnaire results demonstrate a significant (P = .026) difference in donor site rating favoring melolabial group responses. Objective scar measurements and subjective ratings of textural quality and alar notching also favored melolabial reconstructions. Conclusions: More favorable aesthetic and functional outcomes are seen with single subunit cutaneous alar defects reconstructed with the melolabial island flap than with deep composite or extensive unilateral nasal defects reconstructed with the paramedian forehead flap.
Auricular Rehabilitation With Bone‐Anchored Titanium Implants
Authors: Wazen Jack J. , Wright Robert , Hatfield Regina B. , Asher Eric S.
Published: November 2003

Objective: To evaluate the effectiveness of the bone‐anchored titanium implants in auricular reconstructions.

Study Design: Six patients who received implants for an auricular reconstruction were followed prospectively. Four patients had lost their ears to cancer, and the other two had congenital aural atresia.

Methods: All patients were thoroughly evaluated by the reconstruction team, which included a surgeon, a prosthodontist, and a facial prosthetist. Three patients were evaluated audiologically for a bone‐anchored hearing aid. Four patients received implants in a single‐stage procedure, and two underwent a two‐stage procedure. A gold bar with retaining clips was used to anchor the prosthetic ear in four patients, and magnets were used in the remaining two.

Results: All six patients are completely satisfied with their reconstructions. No failures, extrusions, or bony complications were encountered. One patient had recurrent dermatitis, which subsided when his gold bar was replaced with magnets.

Conclusion: Implanted under the guidance of an appropriate prosthetic team, bone‐anchored titanium implants provide patients with a safe, reliable, adhesive‐free method to anchor auricular prostheses with recovery of their normal appearance.
Th‐2 Type Cytokine Receptors in Allergic Rhinitis and in Response to Topical Steroids
Authors: Wright Erin D. , Christodoulopoulos Pota , Small Peter , Frenkiel Saul , Hamid Qutayba
Published: November 2003

Objectives: Th‐2 type cytokine production (Interleukin‐4 [IL‐4] and interleukin‐5 [IL‐5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th‐2 type cytokines in vivo. However, the contribution and expression of Th‐2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL‐4 and IL‐5 receptors (IL‐4R and IL‐5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th‐1 type cytokine, interferon‐gamma receptor (IFN‐γR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors.

Study Design: Randomized prospective study involving 14 ragweed‐allergic subjects evenly divided between placebo and corticosteroid pretreatment.

Methods: Immunocytochemistry (alkaline phosphatase‐antialkaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti‐CD3, CD4, CD8, major basic protein (MBP), IL‐4R, IL‐5R, and IFN‐γR.

Results: Following allergen challenge, we observed a significant increase in the Th‐2 type cytokine receptors (IL‐4R and IL‐5R; P < .05), as well as a significant decrease in the expression of the Th‐1 type cytokine receptor (IFN‐γR; P < .05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL‐4R (P < .05) and IL‐4R (P < .05) and increased expression of IFN‐γR (P < .05). Further, IL‐4R and IL‐5R expression correlated with eosinophil infiltration in the tissues.

Conclusions: We have demonstrated that in AR, cytokine receptors for IL‐4, IL‐5, and IFN‐γ follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th‐2 profile more toward a Th‐1 profile.
Microvasculature, Blood Flow, and Vasoreactivity in Rabbit Sinus Mucosa After Surgery
Authors: Forsgren Karin , Otori Nobuyoshi , Stierna Pontus , Kumlien Jan
Published: November 2003

Objectives: To study the circulatory integrity of the sinus mucosa following surgery, the vascular anatomy, blood flow, and vasoconstrictor response of the regenerated microcirculatory network were analyzed.

Study Design: Forty‐six New Zealand White rabbits were operated on unilaterally with either a modified radical operation (MRO) or middle meatal antrostomy (MMA), using the nonoperated sinus for control purposes. After surgery, the animals were left to heal for 1 month.

Methods: Vascular casts were prepared with a low‐viscosity methyl methacrylate resin and studied by scanning electron microscopy. Blood flow was measured by means of radiolabeled microspheres (tin 113 [113Sn]). The vasoconstrictor response to oxymetazoline at increasing concentrations was measured with laser Doppler flowmetry.

Results: The number of vessels increased significantly in the regenerated mucosa. The vascular casts displayed a rich microcirculation with local signs of angiogenesis. However, there was no difference in blood flow between the operated cavities and their control sides. Following MRO the regenerated mucosa was more sensitive to the vasoconstrictor effect of oxymetazoline, compared with the control side. This difference was not evident in the MMA‐operated sinuses.

Conclusions: In this model, surgery does not seriously interfere with the sinus blood flow, although the regenerated mucosa did display an altered vasoreactivity. These findings should be considered in relation to the effects of surgery intended to limit local inflammation and to ensure the ventilation of the sinuses.
Reconstruction of the Ossicular Chain in the Middle Ear With Glass Ionomer Cement
Authors: Brask Torben
Published: November 2003

Objectives: The aim of this study is to describe a method to repair small defects (1 to 2 mm) of the ossicular chain by means of glass ionomer cement (GIC) alone. Larger defects can be repaired with a combination of GIC and a platinum wire prosthesis. GIC is a two‐component hybrid material consisting of inorganic glass particles surrounded by an insoluble hydrogel matrix. GIC has been used by dentists for many years, but only a few reports describe the use of GIC in human middle ear surgery. Many investigators have proved that most GICs are biocompatible, biostable, and well tolerated by bone and soft tissue.

Study Design: From 1994 to 1996 GIC was used in 97 middle ear operations. In 44 cases small defects of the ossicular chain were reconstructed with GIC alone. The observation period ranged from 1 to 4 years.

Methods: Nearly all operations were performed with the patient under local analgesia.

Results: The postoperative air‐bone gap was less than 20 dB in 83.3%. Compared with results from comparable operations, the GIC results are significantly better. One patient had reoperation because the cement had loosened from the bone as a result of faulty GIC operation technique.

Conclusions: Repair of defects of the ossicular chain with GIC is an easy, efficient, quick, and inexpensive method, which ought to be kept in mind for future middle ear surgery. No complications in the middle ear were related to GIC.
Localization of Static Positional Nystagmus With the Ocular Fixation Test
Authors: Maire Raphael , Duvoisin Bertrand
Published: November 2003

Objective: Characteristics of static positional nystagmus (SPN) (i.e., persistency, direction fixed, direction changing) are observed in both peripheral and central disturbances and possess no localizing value for vestibular lesions. Our objective was to investigate whether the ocular fixation test as applied to SPN could assist in localizing vestibular lesions.

Study Design: A 3‐year prospective study that included 43 patients with SPN.

Methods: All patients underwent a standard vestibular test battery and cerebral imaging (7, computed tomography scan; 36, magnetic resonance imaging). The ocular fixation index (OFI) was calculated by the ratio of the mean slow component velocity of SPN (measured with red light‐emitting diode fixation) to that measured in darkness, multiplied by 100. An OFI less than 50 was considered normal.

Results: In 33 of 35 patients whose OFI was less than 50, the cerebral imaging was normal and a peripheral vestibular lesion was diagnosed (two benign tumors of the fourth ventricle were missed). In all eight patients whose OFI was greater than 50, the cerebral imaging was abnormal and a central vestibular lesion was noted.

Conclusions: These results indicate that the visual suppression of SPN does, indeed, permit the localization of vestibular lesions. The predictive value of the ocular fixation test on the origin of SPN is greater than 94% for peripheral lesions and 100% for central disorders.
Expression of Fas/APO‐1 and Apoptosis of Keratinocytes in Human Cholesteatoma
Authors: Park Hong‐Joon , Park Keehyun
Published: November 2003

Objectives: The Fas/APO‐1 is a cell surface receptor protein known to trigger apoptosis when conjugated with Fas ligand or specific agonistic antibodies. The present study investigated the expression of Fas/APO‐1 and apoptotic cell death in both normal and cholesteatoma epithelia.

Study Design: Ten cholesteatomas and retroauricular skins were taken during middle ear operations in the Ajou University Hospital for this study.

Methods: In situ terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP nick end‐labeling (TUNEL) staining and agarose gel electrophoresis of genomic DNA were used for detection of apoptosis. The expression patterns of Fas/APO‐1 protein were confirmed by immunoblot and immunohistochemical analysis.

Results: In situ TUNEL staining revealed many positively stained nuclei in 9 of 10 suprabasal layers of cholesteatoma epithelium, whereas few positively stained cells were found on the granular layer of retroauricular skins. Typical “ladder pattern” was seen on the gel electrophoresis of the genomic DNA of cholesteatoma. Immunoblot analysis and immunohistochemical studies revealed that Fas/APO‐1 protein was expressed in 8 of 10 cholesteatoma epithelia, whereas retroauricular skin showed negative reaction.

Conclusion: These results show the upregulated expression of Fas/APO‐1 and increased apoptotic cell death in cholesteatoma epithelium. Because Fas/APO‐1 is known as an apoptosis‐triggering protein, it is suggested that the accumulation of keratin debris is due to increased apoptotic cell death related to Fas/APO‐1 protein.
Mutational Analyses of Candidate Genes in Human Squamous Cell Carcinomas
Authors: Petroianu Andy , Boson Wolfanga L. , Bale Allen E. , Friedman Eitan , De Marco Luiz
Published: November 2003

Objectives and Study Design: Squamous cell carcinomas are common malignancies and a major cause of mortality. The molecular mechanisms involved in tumorigenesis remain largely unknown, but sequence alterations have been identified in coding regions of several genes. Primary squamous cell carcinomas of various tissues (skin, head and neck, esophagus, lung, penis, uterus, and vagina) from 52 patients were analyzed for the presence of mutations within several candidate genes presumably involved in tumorigenesis: Gsα, Gi2α, GTPase activating protein (GAP), and patched (PTCH) genes.

Methods: Mutational analysis scheme included polymerase chain reaction (PCR), denaturing gradient gel electrophoresis (DGGE), single stranded conformational polymorphism (SSCP), and selected sequence analysis.

Results and Conclusion: No tumor had any evidence of mutations in any of these analyzed genes. Mutations within these genes do not occur frequently in an unselected population of patients with squamous cell carcinomas.
Tympanic membrane/middle ear pathologic correlates in chronic otitis media
Authors: Jaisinghani Vikram J. , Paparella Michael M. , Schachern Patricia A. , Le Chap T.
Published: November 2003

Objective: To correlate pathologic findings of the tympanic membrane with pathologic changes in the middle ear cleft in chronic otitis media. Study Design: Retrospective. Material and Methods: One hundred‐fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear pathologic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correlate the presence of these middle ear pathologies with histopathologic changes of the tympanic membrane. The tympanic membrane pathologies included perforation, myringosclerosis, retraction, hemorrhage, fluid‐filled cystic spaces, or dilated vessels. Temporal bones were also assessed for atelectasis. Fifty‐six normal temporal bones were taken as controls for measurements. Results: Significant correlations between tympanic membrane and middle ear pathology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossicular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying multiple pathologic changes in the middle ear. Conclusion: When tympanic membrane pathology is detected otoscopically, its presence, alone or in combination, can be a strong indicator of underlying middle ear pathology. However, a normal‐appearing tympanic membrane does not exclude the possibility of middle ear pathology. These findings suggest the need for other diagnostic tools such as multifrequency tympanometry and otoacoustic emissions to complement otoscopy for diagnosis of middle ear pathology, especially in a tympanic membrane that appears “normal.”
Efficacy of endoscopic static pressure/area assessment of the passive pharynx in predicting uvulopalatopharyngoplasty outcomes
Authors: Isono Shiroh , Shimada Akiko , Tanaka Atsuko , Tagaito Yugo , Utsugi Makoto , Konno Akiyoshi , Nishino Takashi
Published: November 2003

Objectives/Hypothesis: Although uvulopalatopharyngoplasty (UPPP) is an attractive surgical treatment for obstructive sleep apnea (OSA), the unpredictable outcome limits application of the procedure. Since UPPP corrects only retropalatal airway (RP) patency, we hypothesized that response to UPPP is determined by collapsibility of the retroglossal airway (RG), where UPPP does not correct. Methods: We estimated closing pressure (Pclose) for each pharyngeal segment by endoscopically obtaining the static pressure/area relationship of the passive pharynx in completely paralyzed and anesthetized patients with sleep‐disordered breathing (n = 41) before UPPP. Preferable response to UPPP was defined as the number of oxygen dips (ODI), obtained by nocturnal oximetry, less than 10 h−1 after UPPP. Results: Patients with negative Pclose at RG responded to UPPP significantly better than those with positive Pclose at RG (22/30 [73%] vs. 3/11 [27%], P < .05). ODI after UPPP was significantly correlated with age, Pclose at RP, and Pclose at RG. Conclusions: Endoscopic assessment of anatomic abnormality of the pharynx in paralyzed patients with sleep‐disordered breathing under general anesthesia has clinical value for the improvement of UPPP outcome.
Comparison of the sensitivity of lateral neck radiographs and computed tomography scanning in pediatric deep‐neck infections
Authors: Nagy Mark , Backstrom James
Published: November 2003

Objective: To compare the sensitivity of lateral neck films and computed tomography (CT) scanning with contrast in evaluating children with a high index of suspicion for a deep‐neck infection, either retropharyngeal, parapharyngeal, or combined based in clinical presentation. Study Design: A retrospective chart review of children presenting to the Children's Hospital of Buffalo, New York, with the diagnosis of a deep‐neck infection between January 1991 and November 1997 was conducted. In total, 57 children were included in the study, ranging in age from 12 to 119 months (1–10 y). Methods: Charts were reviewed for presenting signs, symptoms, and laboratory values and included only those children with the presence of fever, limited neck range of motion, a lateral neck mass, dysphagia, and a leukocyte count greater than 15,000 cells/mm3. Results of lateral neck radiographs and CT scanning with contrast were evaluated and compared when available. Results: Lateral neck radiographs were found to have a sensitivity of 83% for determining the presence of a pediatric deep‐neck infection, whereas CT scanning with contrast had a sensitivity of 100%. Conclusion: Lateral neck radiographs were found to offer no benefit in the workup of children strongly suspected of having a deep‐neck infection based on clinical presentation. Despite the higher cost, CT scanning with contrast is the recommended radiologic test in such cases. This single study allows the determination of size, type, and location of the infectious process and is invaluable in treatment planning for pediatric patients with infection in deep‐neck spaces.
Nasal dilator strips increase maximum inspiratory flow via nasal wall stabilization
Authors: Di Somma Emily M. , West Stephen N. , Wheatley John R. , Amis Terence C.
Published: November 2003

Objective: Inspiratory flow limitation associated with collapse of the nasal vestibular walls is a feature of nasal breathing at high ventilatory levels. We examined whether an external nasal dilator strip (ENDS) device (Breathe Right, CNS Inc., Chanhassen, MN) influences maximum inspiratory and expiratory flow rates. Study Design: Prospective, randomized. Methods: We studied 20 Caucasian subjects (13 female, 7 male; age range, 16–49 y) performing maximum‐effort nasal flow‐volume loop studies with (ENDS) and without ENDS (control) and following topical nasal decongestant (oxymetazoline hydrochloride, 0.2 mg per nostril). Results: ENDS increased peak inspiratory flow from 2.55 ± 0.24 L/s (mean ± standard error [SE]) to 2.86 ± 0.25 L/s and forced inspiratory flow at 50% of vital capacity from 2.23 ± 0.24 L/s to 2.53 ± 0.24 L/s (both, P < .0001), but had no effect on maximum expiratory flows. Nasal decongestant increased the forced expiratory volume in 1 second from 3.39 ± 0.22 L/s to 3.59 ± 0.22 L/s and the average forced expiratory flow over 25% to 75% of vital capacity from 3.31 ± 0.31 L/s to 3.61 ± 0.28 L/s (both, P ⩽ .008), but had no effect on maximum inspiratory flows. The combination of decongestant and ENDS increased both inspiratory and expiratory maximum flows. Conclusion: Since ENDS selectively increases maximum nasal inspiratory flow rates, we conclude that ENDS increases inspiratory nasal patency during maximum inspiratory efforts through the nose by supporting the lateral nasal vestibular walls and making them more resistant to collapse.
Approaches to the sellar and parasellar region: Anatomic comparison of the microscope versus endoscope
Authors: Spencer William R. , Das Kaushik , Nwagu Chedioze , Wenk Eugene , Schaefer Steven D. , Moscatello Augustine , Couldwell William T.
Published: November 2003

Objective: Traditionally, surgical approaches to the sellar region require the use of the operating microscope. Over the past decade endoscopic surgery has gained much popularity because of advances in optics and illumination. Endoscopic surgery of the sellar region has been performed successfully. The goal of the present study was to quantify the amount of exposure to the sellar and suprasellar region that the endoscope provides versus the microscope, with three different anterior approaches to the sellar region. Methods: The transethmoidal, endonasal‐transsphenoidal, and sublabial‐transsphenoidal approaches were performed on 14 formalin‐fixed cadaver heads with a 0° endoscope and repeated with the operative microscope. The distances of relevant surgical landmarks and the amount of exposure superior and anterior to the dorsum sella, as well as the lateral exposure, were measured. The mean distances were then used to calculate the volume of exposure for each of the approaches. Results: It was found that the endoscope provided greater view than the operating microscope in all three approaches. The difference was statistically significant using a paired Student t test and a signed‐rank test (P < .001). Conclusion: The authors believe that endoscopic surgery of the sellar region can be performed safely and effectively, while providing the surgeon with a view that is superior to that afforded by the operating microscope
A retrospective comparison of the morbidity and cost of different reconstructive strategies in oral and oropharyngeal carcinoma
Authors: Smeele Ludwig E. , Irish Jonathan C. , Gullane Patrick J. , Neligan Peter , Brown Dale H. , Rotstein Lorne E.
Published: November 2003

Purpose: Evaluate and compare the morbidity and costs of different reconstructive strategies in oral and oropharyngeal carcinoma. Study Design: Retrospective cross‐sectional. Patients and Methods: One hundred twenty‐seven consecutive patients treated surgically for oral and oropharyngeal carcinoma between 1990 and 1996 were evaluated. Sixty‐three patients had segmental mandibulectomies with 30 plate–soft tissue reconstructions and 33 bone–soft tissue flaps. Sixty‐four patients had soft‐tissue‐only reconstructions. The following outcome parameters were analyzed: operative time, intraoperative blood loss, postoperative admission length, ICU and coronary care unit admission length, surgical interventions for complications, re‐admissions, and prolonged (> 6 mo) gastrostomy tube feeding, and all costs within the disease‐free interval. Means and standard deviations were calculated for continuous parameters. Differences among the three groups were analyzed using one‐way analysis of variance. For discontinuous parameters, the chi‐square test was applied. Results: Longer operative time (1.8 h) and more blood loss (150 mL) for bone‐soft tissue flaps were the only statistically significant findings (P < .05) between the three groups. Conclusion: There is no rationale for allowing presumed factors of morbidity or cost select for type of reconstruction in patients with oral and oropharyngeal carcinoma.