bluuebunny/crossref_metadata_2025 huggingface dataset:
In the mirror of AI: what is creativity?
Authors: Leach Neil
Published: September 2022

Many discussions about AI seem to end up addessing the question of creativity. Can computers be considered creative? Or is it impossible for any entity to be considered creative if it does not possess consciousness? Are human beings so creative, for that matter? Indeed, what exactly is creativity itself? Might AI even offer us some insights into the actual nature of creativity? This paper explores what we can perhaps begin to understand about the nature of creativity in the mirror of AI, with a particular reference to the now famous Go match between AlphaGo and Lee Sedol. It argues that one particular famous move in that match sheds some light on some of the crucial questions regarding creativity. It goes on to ask the provocative question, as to whether creativity even exists, or whether it is simply a myth that can now be debunked, thanks to our insights from the world of AI.
Recurrent malignant fibrous histiocytoma of the male breast: A case report
Authors: Alharbi Ashwag , Algarzaei Bashayer , Alrashed Rema , Alhajri Khalid , Alghamdi Abdullah , Alkharashi Eyad , Yousef Hussam Bin , Alzoman Khalid
Published: September 2022

Abstract

Introduction

Primary malignant fibrous histiocytoma (MFH) of the breast is a rare condition that typically occurs in middle-aged women. Its presentation in older men is extremely rare, and there is very little information about primary MFH of the male breast.

Presentation of case

We present the case of a 55-year-old Yemeni man who presented with recurrent MFH of the right breast. Computed tomography revealed a large heterogeneous solid soft tissue mass within the right breast region that measured 6.7 cm × 8.4 cm × 11.9 cm in size, without axillary lymph node involvement. He was treated with radical mastectomy, adjuvant radiotherapy, and chemotherapy. The postoperative histopathological findings were indicative of grade 3 undifferentiated pleomorphic sarcoma of the breast.

Discussion

MFH originates from undifferentiated mesenchymal cells. Primary MFH of the breast is rare, and the most common sites are the limbs, trunk, retroperitoneum, bone, head, and neck. It has a high recurrence and metastasis rate, but lymph node involvement is not common. MFH is typically treated with surgery and radiotherapy, and the benefits of chemotherapy and routine axillary dissection are unclear.

Conclusion

MFH is an aggressive tumour with a high risk of recurrence and metastasis. Its differential diagnosis is mainly reliant on analysis of the histomorphological features of the tumour. The treatment plan should be based on the size of the tumour. Simple mastectomy with a wide margin and adjuvant radiotherapy is the most common strategy that has been found to be beneficial if no invasion to the muscle.

Highlights
Mechanical and Dynamic Aspects of Voice Production as Related to Voice Therapy and Phonosurgery
Authors: Isshiki Nobuhiko
Published: September 2022

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch‐related dysphonias. Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx. Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.
Intraoral Removal of the Submandibular Gland: A New Surgical Approach
Authors: Hong Ki Hwan , Kim Young Ki
Published: September 2022

The transcervical procedure used for treating sialolithiasis in the submandibular gland has been generally accepted by head and neck surgeons. However, several clinical problems after surgery through the transcervical approach have been described. We introduce a new surgical approach for excision of the submandibular gland indicated in the chronically inflamed salivary gland with or without calculus and benign mixed tumor of the submandibular gland. Thirty‐one cases of submandibular gland excision through the intraoral approach were reviewed, analyzing surgical technique and morbidity. Early postoperative discomforts developed, such as a temporary lack of function of lingual nerve and a temporary limitation of tongue movement, but recovery was within a short period of time in all patients involved. No symptomatic late complications appeared, such as residual inflammation of Wharton's duct and neurologic sequelae. We suggest that this approach can be extended to the excision of the submandibular gland as an alternative to the transcervical approach. The major advantages of this approach are the avoidance of an external scar and injury to the marginal mandibular nerve or the hypoglossal nerve.
Evaluation of the Caloric Test by Combining 3 Response Parameters
Authors: Maire Raphael , Daoui Ben , Van Melle Guy
Published: September 2022

The slow‐phase velocity of nystagmus is one of the most sensitive parameters of vestibular function and is currently the standard for evaluating the caloric test. However, the assessment of this parameter requires recording the response by using nystagmography. The aim of this study was to evaluate whether frequency and duration of the caloric nystagmus, as measured by using a clinical test with Frenzel glasses, could predict the result of the recorded test. The retrospective analysis of 222 caloric test results recorded by means of electronystagmography has shown a good association between the 3 parameters for unilateral weakness. The asymmetry observed in the velocity can be predicted by a combination of frequency and duration. On the other hand, no relationship was observed between the parameters for directional preponderance. These results indicate that a clinical caloric test with frequency and duration as parameters can be used to predict the unilateral weakness, which would be obtained by use of nystagmography. We propose an evaluation of the caloric test on the basis of diagrams combining the 3 response parameters.
Malignancy of the Temporal Bone and External Auditory Canal
Authors: Lim Lynne H. Y. , Goh Yau Hong , Chan Yew Meng , Chong Vincent F. H. , Low Wong Kein
Published: September 2022

A retrospective study of 18 patients with malignant tumors of the external auditory canal and temporal bone was undertaken to gain an Asian perspective of this rare disease. Of these patients, 15 (83%) had squamous cell carcinoma (SCC) and 61% had stage T3 tumors at presentation. The mean age was 56 years (range 38‐82 years). Seven (39%) of the 18 patients had radiation‐associated tumors (RATs), and all had undergone radiotherapy for treatment of nasopharyngeal carcinoma. The 1‐year cumulative recurrence for the RAT group was 100%, but there was no recurrence in the non‐RAT group (P = 0.001). In malignancies of the external auditory canal and temporal bone, a different classification and staging system for patients with RATs may be warranted to better guide treatment strategies.
Kikuchi's Disease: A Review and Analysis of 61 Cases
Authors: Lin Hsin‐Ching , Su Chih‐Ying , Huang Chao‐Cheng , Hwang Chung‐Feng , Chien Chih‐YEN
Published: September 2022

OBJECTIVE

Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, is a rare self‐limiting disorder that typically affects the cervical lymph nodes. It has occasionally been misdiagnosed as malignant lymphoma or another serious diseases; hence, clinicians should be made more aware of this disease.

METHODS

From January 1986 to January 2001, a series of 61 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KD were enrolled in this study. We retrospectively reviewed the clinical records and pathologic parameters of each patient. The patients were followed up from 6 months to 14.3 years (mean, 6.9 years).

RESULTS

There were 34 women and 27 men (1.26:1 ratio; age range, 6 to 46 years; mean age, 21 years). The affected cervical lymph nodes were commonly located in the posterior cervical triangle (54 of 61, or 88.5%). Unilateral and bilateral cervical lymph nodes were affected in 54 and 7 patients, respectively. The dimensions of affected lymph nodes were commonly in the range of 0.5 to 4 cm (57 of 61, or 93.4%). In 2 patients, the size of the enlarged lymph nodes was greater than 6 cm. Leukopenia was observed in 14 patients (23%); fever, in 18 patients (29.5%). Five patients had a past history of tuberculosis. Two patients developed systemic lupus erythematosus, 1 month and 5 years later, respectively. The cervical lymphadenopathy usually resolved without any medical treatment within 6 months after definite diagnosis was made. In 3 patients, the enlarged lymph nodes eventually disappeared after more than 1 year. No recurrence has since been noted.

CONCLUSION

The results of this study support the theory that KD is a self‐limiting disorder that does not require any specific management. The female predominance was not as striking as in the studies performed in Western countries. We suggest that the patients with KD require a systemic survey and regular follow‐up for several years; 2 of our patients developed systemic lupus erythematosus. An effective communication between the otolaryngologist and pathologist is needed because the clinical and pathologic characteristics of KD are essential in making an accurate diagnosis.
Transient Rise in Intact Parathyroid Hormone Concentration after Surgery for Parathyroid Adenoma
Authors: Ferrer‐Ramirez M. J. , Domingo M. Arroyo , López‐Mollá C. , Solá E. Izquierdo , Garzón S. Pastor , Morillas C. Ariño , Hernández A. Mijares
Published: September 2022

OBJECTIVE

Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur.

STUDY DESIGN AND SETTING

A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised.

RESULTS

This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 ± 0.6 mg/ dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant.

CONCLUSION

Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.
Scarless Lip Rehabilitation for the Adynamic Lip
Authors: Bloch Dov C. , Scheuller Michael C. , Maas Corey S.
Published: September 2022

OBJECTIVE

Paralysis of the marginal mandibular branch of the facial nerve can be a debilitating condition resulting in compromised speech and oral incompetence. We describe a static procedure performed to address the functional and cosmetic deficits seen with an adynamic lip.

METHODS

Three patients with complete facial nerve paralysis were evaluated after the scarless lip rehabilitation, a modification of the traditional wedge resection of the lower lip. The procedure is novel in that the removal of lip laxity and advancement of the contralateral innervated lip is achieved without an external facial skin incision.

RESULTS

All 3 patients in the study reported improvement in oral competence and lip symmetry; however, articulation was less consistently affected. All 3 patients were able to drink from a glass without leaking from their oral commissure. No complications were seen in this series of patients.

CONCLUSION

Oral incompetence and asymmetry are often the overlooked sequelae from complete facial nerve paralysis. Scarless lip rehabilitation of the adynamic lip is a novel, safe, and effective means to improve these functional and aesthetic deficits.
Ethmoid Mucocele as a Late Complication of Endoscopic Ethmoidectomy
Authors: Busaba Nicolas Y. , Salman Salah D.
Published: September 2022

OBJECTIVE

Our goal was to describe ethmoid mucocele as a late complication of endoscopic ethmoidectomy.

STUDY DESIGN

This was a retrospective review of 14 patients who were diagnosed with ethmoid mucoceles after endoscopic ethmoidectomy. Reviewed data included patient demographics, indication for the original surgery, presenting symptoms, computed tomography results, surgical treatment, operative findings, and recurrence of disease.

RESULTS

The mucoceles were diagnosed 1 to 13 years after endoscopic ethmoidectomy. The most common presenting symptom was facial pressure or pain. Twelve patients had middle meatal adhesions. A round mass was seen by endoscopy in the ethmoid cavity in 5 patients. Nine mucoceles were located in the anterior ethmoid and 3 were located in the posterior ethmoid, and 2 involved both. The mucoceles were marsupialized via revision endoscopic ethmoidectomy in 12 patients, whereas 2 had both external and endoscopic approaches taken.

CONCLUSION

Ethmoid mucocele can form as a late complication of endoscopic ethmoidectomy. It is commonly associated with middle meatal adhesions.
Paper Patching for Chronic Tympanic Membrane Perforations
Authors: Golz Avishay , Goldenberg David , Netzer Aviram , Fradis Milo , Westerman S. Thomas , Westerman Liane M. , Joachims Henry Z.
Published: September 2022

OBJECTIVE

This study was designed to evaluate the results of paper‐patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes.

STUDY DESIGN AND SETTING: A retrospective survey of paper‐patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations.

RESULTS

Closure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure.

CONCLUSIONS AND SIGNIFICANCE

Paper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery.
Multiple‐Use Atomizers in Outpatient Otolaryngology Clinics are not Necessarily an Infectious Risk
Authors: Visosky Ann Marie B. , Murr Andrew H. , Ng Valerie , Dentoni Theresa , Weir Lucy , Haller Barbara L.
Published: September 2022

OBJECTIVE

We sought to determine the risk of bacterial transmission from multiple‐use atomizers in an outpatient otolaryngology clinic.

STUDY DESIGN AND SETTING

Atomizers in 6 examination rooms were analyzed for bacterial contamination. Sterility of associated tubing from 1 atomizer was assessed. Multidose drug solutions in the atomizers (phenylephrine and tetracaine) were cultured multiple times over a 2‐week period. Serial dilutions of the original sample were cultured to minimize inhibitory effects of antiseptic agents in the drug formulations.

RESULTS

No bacteria were recovered from tubing cultures. Only 2 (0.6%) of 336 cultures of the drug solutions yielded bacterial growth. In both cases, coagulase‐negative Staphylococcus was recovered in 1 of the dilutions prepared from original samplings.

CONCLUSION

Multiple‐use atomizers that contain phenylephrine and tetracaine solutions with bacteriostatic preservatives in an outpatient otolaryngology clinic do not yield significant bacterial growth and, when used as described, do not pose an infectious risk of bacterial transmission between patients.
Simple and Safe Puncture Technique for Voice Prosthesis Implantation
Authors: Lichtenberger György
Published: September 2022

OBJECTIVE

A simplified esophagotracheal (ET) puncture technique is described for use instead of the Blom‐Singer method for voice prosthesis implantation, with the aim to offer an easier alternative for the same purpose.

STUDY POPULATION

Of 68 study patients, there were 10 women and 58 men (age range, 46 to 80 years) who had been operated on during a 5‐year period with use of this technique. Of the 68 patients, 57 were able to learn to speak in a fluent voice acceptable for everyday communication after the implantation. Seven of the 57 patients had a spasm in the cricopharyngeus muscles and were able to speak only after myotomy.

METHODS

Sixty‐eight patients were implanted with voice prosthesis using the ET puncture technique as follows: through the laryngoscope, the distal bent blunt end of the endoextralaryngeal needle carrier is led into the esophagus. The needle with the leading thread (2–0 Prolene) is pushed through in the upper third of the tracheostoma from inside out. Afterward, the cone‐trocar catheter is pulled through the stitching canal in the upper third of the tracheostoma. Using the ET puncture technique, the puncture site is the same as with the use of the Blom‐Singer method, 5 to 8 mm below the mucocutaneous junction. Then the cone‐trocar is cut off from the 18 charrier catheter and the guide wire is pushed inside the catheter through the esophagus, pharynx, and mouth. The voice prosthesis will be fixed on the guide wire and then pulled back in the opening of the fistula.

RESULTS

There were no problems or complications with this technique. In 4 cases, the ET puncture could be performed on patients in whom it was not previously possible with the Blom‐Singer technique.

CONCLUSION

This management approach offers an alternative to the Blom‐Singer technique. The advantage of the ET puncture is that it is simple and safe and that the back wall of the pharynx or esophagus cannot be damaged. Using the ET puncture technique, the possibility of complications is eliminated.
The Clinical Effects of Hyaluronic Acid Ester Nasal Dressing (Merogel) on Intranasal Wound Healing after Functional Endoscopic Sinus Surgery
Authors: Miller Robert Sean , Steward David L. , Tami Thomas A. , Sillars Michael J. , Seiden Allen M. , Shete Mona , Paskowski Christopher , Welge Jeff
Published: September 2022

OBJECTIVES

We sought to determine the efficacy of MeroGel, an absorbable hyaluronic acid nasal dressing (HA) in reducing synechia after functional endoscopic sinus surgery (FESS) compared with Merocel, a nonabsorbable packing (NAP) requiring removal.

METHODS

We conducted a blinded, randomized, controlled trial of 37 patients requiring bilateral FESS for chronic sinusitis. Patients were randomized to placement of HA within the right or left middle meatus and NAP on the other side. Patients were evaluated at 2, 4, 6, and 8 weeks postoperatively.

RESULTS

Blinded evaluation revealed 5 patients (14%) with synechia at last follow‐up: 3 sides (8%) with HA and 3 (8%) with NAP. Thirteen patients (35%) had synechia at any visit, 10 sides (27%) with HA and 9 (24%) with NAP. Seven patients (19%) required lysis of synechia, 5 sides (14%) with HA and 3 (8%) with NAP.

CONCLUSION

We found no statistically significant difference between HA and NAP dressings.
Influence of sensitization to inhalative allergens on adenotonsillar disease
Authors: Hofmann Thiemo , Lackner Andreas , Berghold Andrea , Lang‐Loidolt Doris
Published: September 2022

OBJECTIVE

We sought to determine the influence of IgE‐mediated sensitization on adenotonsillar disease in children. We compared follow‐up after tonsillectomy/adenoidectomy of atopic and nonatopic children.

STUDY DESIGN AND SETTING

A prospective study of 293 children consecutively undergoing tonsillectomy/adenoidectomy was conducted at a university hospital center. Preoperative and postoperative (1‐year follow‐up) allergy‐related symptom scores were obtained by parents. Intraoperative total serum IgE, the screening test sx1 (Pharmacia), and, if positive, serum specific IgE to inhalative allergens were carried out.

RESULTS

Sixty‐seven children (22.9%) showed positive RAST results to inhalative allergens (class 1 to 6). In both sensitized and nonsensitized groups, the general health was improved in more than 89% at 1 year postoperatively. No significant difference of postoperative nasal symptoms between the atopic and nonatopic groups was found.

CONCLUSION

Both atopic and nonatopic children with adenotonsillar disease improve health after adenoidectomy or adenotonsillectomy. In our opinion, routine allergy tests before adenotonsillectomy or adenoidectomy are not justified. Only if allergy is suspected due to clinical findings or family history should an allergy test be carried out.
Clinical Effectiveness of Coblation Inferior Turbinate Reduction
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: September 2022

OBJECTIVE

We sought to determine the safety and clinical effectiveness of coblation (short for “cold ablation”) inferior turbinate reduction for turbinate hypertrophy.

METHODS

A consecutive series of adult patients with inferior turbinate hypertrophy were treated with the coblation technique in the office setting. Subjective symptoms were assessed prior to treatment and at the 3‐ and 6‐month intervals after treatment with the Rhinosinusitis Symptom Inventory (RSI) and a short nasal symptom questionnaire.

RESULTS

Twenty‐four of 26 treated patients completed the protocol. At the 3‐month follow‐up, statistically significant decreases in the nasal and overall symptom domains of the RSI were noted (changes of −10.5 and −8.7, with P = 0.018 and P = 0.015, respectively). These improvements were also significant at the 6‐month follow‐up (‐20.1 and −15.8 with, P < 0.001 and P < 0.001, respectively). At the 3‐month interval, nasal obstruction and amount of time with nasal obstruction were significantly decreased (P = 0.006 and P = 0.011, respectively). These decreases remained statistically significant and slightly larger in magnitude at 6 months (P = 0.001 and P = 0.006, respectively). Postoperative epistaxis occurred in 2 of 24 (8.3%) of patients.

CONCLUSION

Coblation inferior turbinate reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit persists at 6 months after the procedure.
Transtympanic Iontophoresis of Gadopentetate Dimeglumine: Preliminary Results
Authors: Christodoulou Panagiotis , Doxas Panagiotis G. , Papadakis Chariton E. , Prassopoulos Panos , Maris Thomas , Helidonis Emmanuel S.
Published: September 2022

OBJECTIVE

We sought to demonstrate the feasibility of using iontophoresis to deliver pharmaceutical agents into the middle and inner ear for the treatment of middle and inner ear diseases, which is proved in this study by the successful iontophoresis of the ferromagnetic contrast agent gadopentetate dimeglumine.

STUDY DESIGN AND SETTING

Eight rabbits were iontophoresed using gadopentetate dimeglumine solution 469 mg/mL. Then, all rabbits underwent magnetic resonance imaging for the detection of gadopentetate dimeglumine in the middle and inner ear structures. The study was conducted in the tertiary referral center the University Hospital of Crete.

RESULTS

The high signal intensity of the gadopentetate dimeglumine solution was demonstrated within the middle ear cavity and inner ear structures of all iontophoresed ears and in none of the non‐iontophoresed ones.

CONCLUSIONS

Transtympanic iontophoresis could be an effective method for the passage of pharmaceutical agents into the middle and inner ear for the treatment of middle and inner ear diseases. (Otolaryngol Head Neck Surg 2003;129:408–13.)
Intracapsular Tonsillar Reduction (Partial Tonsillectomy): Reviving a Historical Procedure for Obstructive Sleep Disordered Breathing in Children
Authors: Koltai Peter J. , Solares C. Arturo , Koempel Jeffery A. , Hirose Keiko , Abelson Tom I. , Krakovitz Paul R. , Chan James , Xu Meng , Mascha Edward J.
Published: September 2022

OBJECTIVE

We sought to reintroduce a historical procedure—intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)—for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery.

STUDY DESIGN

We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB.

RESULTS

Two hundred forty‐three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery.

CONCLUSION

Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.
Mandibular Reconstruction with an Alloplastic Bone Tray in Dogs
Authors: Strong E. Bradley , Rubinstein Brian , Pahlavan Nima , Martin Bruce , Kuntsi‐Vaattovaara Helena , Verstraete Frank J. M.
Published: September 2022

OBJECTIVE

Mandibular alloplastic bone trays have an unacceptably high rate of extrusion. The introduction of resorbable mesh has renewed interest in such trays. This study evaluates the effect of resorbable trays on bone graft healing in a dog model.

DESIGN

Unilateral, 20‐mm mandibular body defects were created in 10 dogs, and repaired with cancellous bone grafts. A resorbable mesh bone tray was applied to 5 animals. All mandibles underwent gross examination, 4‐point stress testing, and histologic and radiographic analysis.

RESULTS

All animals had excellent bony unions. There was one intraoral mesh exposure. There was no difference between the control and treatment groups with regard to clinical findings, radiologic analysis, stress testing (P = 0.17), or histologic analysis (P = 0.66).

CONCLUSION

The metabolic breakdown products of the resorbable mesh do not inhibit bone healing or strength. Resorbable mesh trays are a viable modality for reconstruction of segmental mandibular defects in a dog model.
Salivary Duct Carcinoma
Authors: Hosal A. Sefik , Fan Chunyang , Barnes Leon , Myers Eugene N.
Published: September 2022

Salivary duct carcinoma (SDC) is a highly malignant tumor that is histologically similar to ductal carcinoma of the breast. This article presents the clinicopathologic features of 15 patients with SDC arising in the salivary glands. The majority of patients were male and aged 65 years or older. The tumor was most often located in the parotid gland. Pain, facial palsy, and presence of calcification in the CT scan were diagnostic features suggestive of SDC. Histologically, 27% of the tumors arose from pre‐existing pleomorphic adenoma. Perineural and lymphatic invasion were common findings. There was an extensive cervical lymph node involvement (73%). Distant metastasis was the most common cause of failure. Although SDC exhibits an unpredictable clinical course, total parotidectomy with neck dissection and adjunctive radiation therapy appear to be appropriate for local and regional control of this aggressive neoplasm. (Otolaryngol Head Neck Surg 2003;129:720‐5.)
Dose‐Response Relationship of Topically Applied Mitomycin C for the Prevention of Laser Myringotomy Closure
Authors: Jassir David , Odabasi Onur , Gomez‐Marin Orlando , Buchman Craig A.
Published: September 2022

OBJECTIVE

We sought to determine a dose‐response curve for topical mitomycin C when used to prolong the patency of laser‐assisted myringotomies.

STUDY DESIGN AND SETTING

Bilateral myringotomies were performed using the argon laser in 40 guinea pigs with normal ears. Pledgets with (0.05, 0.2, 0.4, or 2.0 mg/mL) mitomycin C were applied topically. Monitoring consisted of weekly or biweekly otomicroscopy.

RESULTS

As in previous studies, all saline‐treated myringotomies closed by day 7. By day 14, all myringotomies (100%) in the 0.05 mg/mL group were closed. By contrast, all myringotomies (100%) remained patent in the 0.2 and 0.4 mg/mL treatment groups, and 56% of the myringotomies remained patent in the 2.0 mg/mL group at day 14. By day 56, all myringotomies were closed in the 2.0 mg/mL group, 5 (50%) myringotomies were patent in the 0.4 mg/mL group, and 1 (11%) myringotomy was patent in the 0.2 mg/mL group. The study was terminated on day 84 (12 weeks). At that time, only the 0.4 mg/mL group had patent myringotomies (n = 3; 30%). The highest dose (2.0 mg/mL) of mitomycin was significantly associated with otorrhea. Otorrhea also appeared to be associated with earlier myringotomy closure.

CONCLUSION

There is a dose‐response curve for topical mitomycin C when used for prolonging my‐ringotomy patency in doses up to 0.4 mg/mL. Higher doses do not appear to prolong patency and are associated with greater otorrhea, suggesting middle ear toxicity.
Immunology of Delayed Food Allergy
Authors: Breneman James C.
Published: September 2022

Studies here and abroad are stockpiling evidence that immunoglobulin E explains only a small part of food allergy. Involvement of the entire immune system is evident if the more prevalent delayed‐type food allergy is to be explained. To adequately diagnose food hypersensitivity a testing technique must be used that identifies delayed food allergy, such as the patch test here described, along with a test that diagnoses immediate immunoglobulin E‐mediated food allergy.
Radioallergosorbent Microscreen and Total Immunoglobulin E in Allergic Fungal Sinusitis
Authors: Mabry Richard L. , Manning Scott
Published: September 2022

One of the commonly held concepts regarding allergic fungal sinusitis is that patients with this disorder also demonstrate allergy to other inhalants. However, few published investigations have confirmed this. In this study serum from 16 consecutive patients with histologically proven allergic fungal sinusitis was tested with a seasonal and a perennial radioallergosorbent microscreen disk. The seasonal radioallergosorbent microscreen combines on one disk antigens for two grasses, two weeds, and two trees, and the perennial disk contains Alternaria and dust mite antigens. Total immunoglobulin E was also determined for each sample. Fifteen of the 16 samples demonstrated a radioallergosorbent class II or greater response to one of the two disks, and 11 showed a radioallergosorbent class II or greater response to both. The total immunoglobulin E level was greater than 100 units/ml in 14 samples (> 1000 in 4 cases) and 97 units/ml in another. This study addresses the presence of inhalant allergy in patients with allergic fungal sinusitis previously described in case reports. The results support the concept that allergic fungal sinusitis is a true allergic (rather than infectious) disease.
Role of Allergy in Nasal Polyposis: A Review
Authors: Bernstein Joel M. , Gorfien Janet , Noble Bernice
Published: September 2022

We propose a multivariate theory for the pathogenesis of nasal polyps. Turbulent flow of air in the lateral wall of the nose or viral‐bacterial‐host interactions produce an inflammatory change in the mucosa of the lateral wall of the nose. Ulceration and prolapse of the submucosa with reepithelialization and new gland formation may then follow. The structural cells of the nasal polyp, including epithelial cells and fibroblasts, have the ability to produce messenger RNA for granulocyte‐monocyte colony‐stimulating factor and other cytokines. Stimulation of such an effector capability by structural cell‐derived cytokines would undoubtedly represent a major amplification pathway of the inflammatory response in nasal polyps. Allergy may be one mechanism for the development of this cascade of events. This microenvironmental structural inflammatory response in the nasal polyp, in turn, can affect the bioelectric integrity of the Na+ and Cl− channels at the luminal surface of the respiratory epithelial cell. The change in the Na+ absorption, which has been demonstrated in our studies, may result in an increased movement of water into the cell and into the interstitial fluid. The resultant edema can lead to growth and enlargement of the nasal polyp. Finally, the rapid recurrence of nasal polyps despite adequate surgery may reflect some intrinsic phenotypic characteristic of nasal epithelial cells in the lateral wall of the nose, which is likely to be under genetic control.
Technology transfer: Where to begin
Authors: Cusick Patrick W.
Published: September 2022

Editors Note: We hear a lot about “technology transfer” with little explanation of what is involved. I have asked Patrick Cusick to write a brief editorial to explain what it takes to bring an idea to market. Unless good ideas become commercially available, most of us can't use them for ourselves and our patients.
Transoral‐transpharyngeal approach to the craniocervical junction
Authors: Kingdom Todd T. , Nockels Russ P. , Kaplan Michael J.
Published: September 2022

The transoral‐transpharyngeal approach is a reliable and technically sound method for gaining anterior extradural exposure to the craniocervical junction. We report 23 patients undergoing this approach for pathology lying between the inferior clivus and third cervical vertebra. Pathology included 6 patients with congenital malformations of the odontoid process, 4 patients with basilar invagination caused by rheumatoid arthritis, 2 patients with atlantoaxial subluxation caused by Down's syndrome, and 1 each with Chiari I malformation, pseudogout of C1/C2, ossification of the posterior longitudinal ligament, and chronic dens dislocation caused by trauma. Malignant tumors included 4 chordomas, 2 giant cell tumors of C1‐C3, and 1 chondrosarcoma. Orotracheal intubation without tracheotomy was used in 22 patients. Sixteen of these 22 patients were extubated either immediately or within 24 hours. Six complications occurred in 5 patients and included a palatal dehiscence in 2, delayed oropharyngeal hemorrhage, prolonged endotracheal intubation because of severe tongue edema, and 1 case each of meningitis and aspiration pneumonia responsive to intravenous antibiotics. No deaths, local infections, or postoperative cerebrospinal fluid leaks occurred. Neurologic symptoms of cord compression improved or stabilized in all patients. The transoral‐transpharyngeal approach is an effective means for extradural decompression of the anterior craniocervical junction and for exposure of selected tumors at this site.
Clinical and pathologic distinction between primary and metastatic mucosal melanoma of the head and neck
Authors: Billings Kathleen R. , Wang Marilene B. , Sercarz Joel A. , Fu Yao S.
Published: September 2022

Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated from those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease.
Effects of halothane on mucociliary activity in vivo
Authors: Cervin Anders , Lindberg Sven , Mercke Ulf
Published: September 2022

The effect of halothane on mucociliary activity in the rabbit maxillary sinus in vivo was recorded photoelectrically. Administration of halothane (1%, 2% or 4%) into the maxillary sinus induced a temporary acceleration of mucociliary activity. The peak increase (39.1% ± 9.1%, p < 0.05, n = 5) was seen after the 4% concentration. Long‐term exposure (60 minutes) of the maxillary sinus to halothane (2%) first induced an increase of 28.4% ± 4.6% (p < 0.05, n = 6), lasting approximately four minutes, and followed after about 15 minutes by a decrease of mucociliary activity. The maximum decrease during the 60‐minute period was 19.6% ± 2.8% (p < 0.05, n = 6). Mucociliary activity returned to its baseline level approximately 25 minutes after withdrawal of halothane. Halothane delivered to the rabbit through a tracheal cannula at 1.1% for 60 minutes did not impair mucociliary activity in the maxillary sinus. On the contrary, it initially stimulated mucociliary activity, 19.9% ± 2.7% (p < 0.05, n = 5). There was also an initial increase in respiratory rate from 62 ± 7.3 to 89 ± 12.9 breaths per minute (p < 0.05), which was noticeable after approximately 10 seconds and lasted 4 to 5 minutes. The dose‐dependent increase in mucociliary activity seen after short‐term exposure to halothane is probalby due to stimulation of afferent C fibers, because halothane may be considered an airway irritant. The reversible depressant effect seen after 15 minutes of exposure is in accordance with findings in previous studies in vitro. The mechanism by which halothane impairs mucociliary activity is at present not known. However, halothane administered to the lower airways does not impair mucociliary activity in the maxillary sinus, indicating that halothane affects the ciliated epithelium directly and that the state of anesthesia itself has no effect on mucociliary activity.
Autologous fibrin tissue adhesive in endoscopic sinus surgery
Authors: Gleich Lyon L. , Rebeiz Elie E. , Pankratov Michail M. , Shapshay Stanley M.
Published: September 2022

Endoscopic sinus surgery may be complicated by bleeding, formation of synechia, and infection. This study investigated the application of autologous fibrin tissue adhesive during endoscopic sinus surgery in an attempt to avoid packing, to decrease complications, and to improve healing. Fibrin tissue adhesive from pooled human blood is a hemostatic and bacteriostatic agent. Autologous fibrin tissue adhesive avoids the potential infectious and immunologic risks of the pooled blood product. Twelve patients undergoing bilateral endoscopic sinus surgery participated in the study. Phlebotomy and preparation of the adhesive were performed during the procedure. Fibrin tissue adhesive was applied to only one side, with the contralateral side used as a control. Bacitracin ointment was applied to the adhesive‐treated side, and packing coated with bacitracin was placed on the contralateral side. Patients were observed for a minimum of 3 months, and results were documented with photographic and video recordings. A uniformly high degree of patient satisfaction was achieved because of the elimination of packing and a sensation of increased nasal airway patency on the fibrin‐treated side. Fibrin tissue adhesive provided hemostasis, decreased crusting, accelerated mucosal healing, and diminished synechia. Autologous fibrin tissue adhesive is beneficial in endoscopic sinus surgery, and its application should be considered, especially when the risk of hemorrhage or synechia is increased.
Rhabdomyosarcoma of the nose and paranasal sinuses in adults and children
Authors: Callender Troy A. , Weber Randal S. , Janjan Nora , Benjamin Robert , Zaher Mona , Wolf Pat , El‐Naggar Adel
Published: September 2022

OBJECTIVE

To determine the biologic behavior, risk factors for recurrence, and influence of multimodality therapy on outcome for children and adults with rhabdomyosarcoma of the nose and paranasal sinuses.

DESIGN

Retrospective review of medical records.

PATIENTS

During a 36‐year period 37 patients (median age, 23.0 years) with histologically confirmed rhabdomyosarcoma of the nose and paranasal sinuses were treated for cure. Median follow‐up was 28 months (range, 1 to 260 months). Histologic subtypes included embryonal, 16; alveolar, 15; mixed, 1; and unclassified, 5. Cervical metastases were present in 38%. Patients were treated with surgery, 4; radiotherapy, 3; chemotherapy, 3; surgery and radiotherapy, 1; surgery and chemotherapy, 1; chemotherapy and radiotherapy, 24; and chemotherapy, radiotherapy, and surgery, 1.

RESULTS

The overall 5‐year survival was 44%. For patients treated with chemotherapy and radiotherapy or chemotherapy, radiotherapy, and surgery, the 5‐year survival was 60%, compared with 19% for patients treated with the other forms of therapy. Factors associated with poorer survival were adult onset of disease, alveolar histology, and treatment with systemic chemotherapy for less than 1 year. Patients receiving chemotherapy for greater than 1 year had a 5‐year survival of 82%, compared with 71 % for those with less than 1 year of treatment. Improved survival was associated with a lower incidence of distant metastasis.

CONCLUSIONS

A combination of chemotherapy and radiotherapy may provide the best means of obtaining local‐regional control for rhabdomyosarcoma arising in the nose and paranasal sinuses. The risk of regional disease is high, requiring comprehensive radiotherapy to the neck in addition to the primary site. Surgical resection should be reserved for patients with residual disease after chemotherapy and radiotherapy, Administration of chemotherapy for more than 1 year is associated with improved survival because of a decreased incidence of metastatic disease.
Aesthetic Reconstruction of the Nose, by Gary C.Burget and Frederick J.Menick. 600 pages with illustrations. Mosby—Year Book, St. Louis, 1994. $175.00
Authors: Abidin Michael R.
Published: September 2022

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

Acquired cholesteatoma is associated with an intense inflammatory reaction with resuitant tissue and bone destruction. Cytokines are molecules released by inflammatory cells at the site of infection and are potent mediators of inflammation and the immune response. Five cytokines, tumor necrosis factor‐α, transforming growth factor‐β1 and 2, and interleukin‐1 and 6, were immunolocalized in human cholesteatoma epithelium and subepithelial stroma, with greater intensity of staining compared with noninflamed external auditory canal skin. Increased interleukin‐6 activity in cholesteatoma epithelium and stroma correlated significantly with the presence of ossicular and bony erosion and granulation tissue noted intraoperatively. Transforming growth factor‐β2 activity in cholesteatoma epithelium correlated significantly with bony erosion at surgery. Additionally, transforming growth factor‐β1 activity in cholesteatoma epithelium correlated significantly with increased length of disease. Tumor necrosis factor‐a, interleukin‐1, and interleukin‐6 appear to be involved in the inflammation and resultant remodeling associated with cholesteatoma. We hypothesized a protective function of transforming growth factor‐β1 and 2 in the presence of cholesteatoma. The antiinflammatory and osteoclast and keratinocyte inhibitory actions of the transforming growth factor‐βs could potentially slow the proliferation and resultant tissue destructiveness associated with Cholesteatoma.
Database for vertigo
Authors: Kentala E. , PyykkÖ I. , Auramo Y. , Juhola M.
Published: September 2022

An interactive database has been developed to assist the diagnostic procedure for vertigo and to store the data. The database offers a possibility to split and reunite the collected information when needed. It contains detailed information about a patient's history, symptoms, and findings in otoneurologic, audiologic, and imaging tests. The symptoms are classified info sets of questions on vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The otoneurologic tests involve saccades, smooth pursuit, posturography, and a caloric test. In addition, findings from specific antibody tests, clinical neurotologic tests, magnetic resonance imaging, brain stem audiometry, and electrocochleography are included. The input information can be applied to workups for vertigo in an expert system called ONE. The database assists its user in that the input of information is easy. It not only can be used for diagnostic purposes but is also beneficial for research, and in combination with the expert system, it provides a tutorial guide for medical Students.
Auditory and vestibular function in experimental hydrops
Authors: Horner Kathleen C.
Published: September 2022

Endolymphatic hydrops is the characteristic morphopathology observed at postmortem examination of temporal bones of Meniere's disease. Surgical induction of endolymphatic hydrops in the guinea pig provides a reproducible animal model for the investigation of some effects of endolymphatic hydrops on inner ear function. Episodic and incapacitating vertigo are classic features of Meniere's disease, although very limited vestibular dysfunction has ever been described for the animal model. On the other hand, the auditory deficits peculiar to Meniere's disease, including fluctuant sensitivity losses and a peak audiogram, are also observed at different stages in the development of experimental hydrops. In future studies the model is likely to provide a means of investigating osmoregulatory function of the inner ear.