bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of Respiratory Mucin Proteins in Human Nasal Mucosa
Authors: Groneberg David A. , Peiser Christian , Dinh Q. Thai , Matthias John , Eynott Paul R. , Heppt Werner , Carlstedt Ingemar , Witt Christian , Fischer Axel , Chung K. Fan
Published: November 2003

Objectives/Hypothesis The upper respiratory tract is involved in many acute and chronic respiratory tract diseases that present with the symptom of mucus hypersecretion. Mucin genes that encode for the backbone of glycoproteins contribute to the viscoelastic property of airway mucus. We examined the cellular expression and distribution of two major respiratory mucus‐forming glycoproteins, MUC5AC and MUC5B, in normal human nasal tissues.

Methods Immunohistochemical analysis using polyclonal antibodies against the mucins MUC5AC and MUC5B was performed in normal human nasal tissues.

Results An abundant staining of submucosal mucus gland and epithelial goblet cells for MUC5B was found. Immunohistochemical analysis of MUC5AC showed staining of surface epithelium goblet cells, whereas there was no staining of glandular cells. Comparison of the expression to lower airways revealed a similar pattern of expression of both mucins.

Conclusions The data in the present study demonstrated the localization of the two major respiratory mucin proteins in human nasal mucosa with a similar distribution of expression of MUC5AC and MUC5B in normal upper and lower airways. Mucin protein expression parallels that of mucin messenger RNA expression.
Highlights in the Evolution of Diagnosis and Treatment of Laryngeal Cancer
Authors: Assimakopoulos Dimitrios , Patrikakos George , Lascaratos John
Published: November 2003

Objectives To present selected highlights from the evolution of diagnosis of laryngeal disease and treatment of laryngeal cancer from ancient Greece until the 20th century.

Study Design Historical study of diagnosis of laryngeal disease and treatment of laryngeal cancer from the ancient Greek medical scriptures until the most recent evolutional steps in the 20th century.

Methods Original Greek‐language texts of ancient and Byzantine medical writers were studied and literature on history of medicine was investigated to reveal early knowledge of diagnostic and therapeutic techniques for laryngeal disease and cancer of the larynx.

Results Diseases of the upper aerodigestive tract were known and treated by ancient Greek physicians, and, later, Byzantine doctors, apart from preserving ancient medical concepts, contributed their own ideas, mainly about surgery and postoperative care. The initial therapeutic approach for the disorders caused by laryngeal tumors was either tracheotomy or endotracheal intubation in an attempt to prevent suffocation. In more recent times, construction of the laryngoscope and other modern examination instruments, as well as the final acceptance of histological diagnosis based on tissue biopsy, has allowed for accurate diagnosis and successful treatment of laryngeal lesions. Preoperational biopsy, application of pharyngoesophageal speech and advanced vocal devices for the laryngectomees, and invention of antibiotic and anesthetic agents had led, by the middle of the 20th century, to the establishment of extended and radical surgical techniques as optional treatment for laryngeal cancer. In addition, the discovery of x‐rays and radium introduced radiotherapy as an alternative in the treatment procedure for cancer of the larynx.

Conclusion Progress in the evolution of laryngological diagnosis and practice demanded efforts by many daring and courageous investigators and surgeons, contributing new ideas and techniques in the development of modern laryn‐ gology.
Frozen Section in a Cytological Diagnosis of Thyroid Follicular Neoplasm
Authors: Alonso Núria , Lucas Anna , Salinas Isabel , Castella Eva , Sanmartí Anna
Published: November 2003

Objective/Hypothesis Fine‐needle aspiration biopsy is the most accurate diagnostic test for thyroid nodules, its only limitation being the diagnosis of follicular neoplasm that does not distinguish between benign and malignant follicular lesions.

Study Design To determine the utility of intraoperative frozen‐section analysis in cases of a cytological diagnosis of follicular neoplasm, a retrospective review of 66 patients with a solitary thyroid nodule and follicular neoplasm who underwent thyroid surgery was carried out.

Methods Fine‐needle aspiration was classified following the Papanicolaou Society of Cytopathology Classification, and frozen section was defined as malignant or “deferred.” If a malignant diagnosis was made by frozen‐section analysis, a total thyroidectomy was carried out. The extension of thyroid surgery in the deferred cases was based on the definitive histological diagnosis.

Results Sixty‐four cases were classified as deferred, and two as suspect for malignancy. Among the 64 deferred cases, 15 were malignant in the final pathological findings, and 49 were benign. The two suspect cases were papillary carcinoma. Frozen‐section analysis classified 2 of 17 (11.7%) cases as follicular variant of papillary carcinoma that could not be diagnosed by cytological study. However, these two cases had a strong clinical evidence of malignancy.

Conclusion The routine use of frozen‐section analysis is useless in cases of cytological diagnosis of follicular neoplasm on fine‐needle aspiration biopsy, because of the low probability of achieving the diagnosis of follicular carcinoma and the inability to provide additional information apart from the clinical and the cytological data.
Empiric Esomeprazole in the Treatment of Laryngopharyngeal Reflux
Authors: DelGaudio John M. , Waring J. Patrick
Published: November 2003

Objective Objectives were to determine the efficacy of empiric treatment with esomeprazole for patients diagnosed with laryngopharyngeal reflux and to determine a treatment paradigm for this patient population.

Study Design Prospective study.

Methods Patients were treated with a once‐daily dose of 40 mg esomeprazole for 8 weeks. All patients completed a subjective symptom scale (rating laryngeal symptoms and esophageal symptoms) and scoring of flexible fiberoptic examination before treatment and at 4 and 8 weeks of treatment. Nonresponders (<50% reduction in symptom score) were recommended to undergo 24‐hour dual‐probe pH study while on a regimen of 40 mg esomeprazole once a day, to evaluate for the adequacy of acid suppression.

Results Thirty patients completed the course of therapy. After 4 weeks of treatment, only 8 of 30 patients had significant improvement of their overall symptoms (8 of 30 improved on laryngeal score, and 11 of 18 improved on esophageal score). At 8 weeks of treatment, 19 of 30 patients had significant improvement on their overall symptoms (18 of 30 on laryngeal score, and 13 of 18 on their esophageal score). Five of seven nonresponders who agreed to be tested had positive findings on pH studies (on medication regimen) at 1 cm above the upper esophageal sphincter. Four of 10 nonresponders improved further after increasing their dosage to 40 mg twice a day. Laryngeal examination scores were statistically improved in responders after 8 weeks of treatment.

Conclusions Laryngopharyngeal reflux symptoms require at least 8 weeks of treatment for significant improvement in the majority of patients. Esophageal symptoms improve sooner. Nonresponders at a daily dose of 40 mg should be treated with a dosage of 40 mg twice daily, and pH study on medication reserved for nonresponders at this higher dose. Laryngeal examination scores showed mild but statistically significant improvement at 8 weeks of therapy in responders.
Squamous Cell Carcinoma of the Head and Neck in Ontario, Canada, and in Southeastern Norway
Authors: Hall Stephen F. , Boysen Morten , Groome Patti A. , Mackillop William
Published: November 2003

Objectives/Hypothesis Reports comparing case mix, treatments, and outcomes between different countries are uncommon in head and neck oncology. Prospective databases of unselected patients from regional cancer centers in southeastern Ontario, Canada, and southeastern Norway were compared.

Study Design Retrospective comparative study of two prospective databases.

Methods The case mix, treatments, and disease‐specific mortality were compared using frequency tables, Kaplan‐Meier survival curves, and the log rank test.

Results The case mix, except for differences in oral cavity, oropharynx, and the recorded tumor (T) category, was similar, and the treatments were different. There was no statistical difference in overall survival for all patients, as well as for some sites.

Conclusions The results of treatments, based on different overall treatment polices, for all patients were similar. The differences in recorded T category with no statistical difference in overall survival suggest a difference in staging assignment and raises a question about the reliability of the TNM staging process.
Tuberculosis of the Nasopharynx: A Rare Entity Revisited
Authors: Tse Gary M. K. , Ma Tony K. F. , Chan Amy B. W. , Ho Fiona N. Y. , King Ann D. , Fung Kitty S. C. , Ahuja Anil T.
Published: November 2003

Objectives Tuberculosis of the nasopharynx is uncommon. A large series of 17 cases is reported, and the clinical and pathological features are discussed.

Study Design A retrospective review.

Methods Seventeen archived cases of biopsy‐proven nasopharyngeal tuberculosis were reviewed for patient age and sex, presenting complaint and duration, systemic symptoms, cervical lymphadenopathy, and chest x‐ray findings. These findings were compared with a compilation of 40 cases reported in the English literature.

Results There was a female predominance (13 women and 4 men), with age range of 20 to 74 years (mean age, 38 y). The most common presentation was enlargement of the cervical lymph nodes (53%), followed by hearing loss (12%), tinnitus, otalgia, nasal obstruction, and postnasal drip (6% each). The duration of the presenting symptoms ranged from 1 week to 1 year (mean duration, 16 wk). Ten patients (59%) had cervical lymphadenopathy, two (12%) had systemic symptoms (fever, weight loss, night sweats), and one patient (6%) had miliary pulmonary tuberculosis. Direct endoscopic examination showed nasopharyngeal mucosal irregularity or mass in the majority of patients (12 patients [70%]). These features were similar to those reported in the literature.

Conclusions Nasopharyngeal tuberculosis is uncommon, usually occurring without pulmonary or systemic involvement. Cervical lymphadenopathy occurs in more than half of the patients and is the most common presenting complaint; this, together with the nasopharyngeal findings of mass or mucosal irregularity, makes differentiation from carcinoma on clinical examination difficult, necessitating histological evaluation.
Endoscopic Surgery for Juvenile Angiofibroma: When and How
Authors: Nicolai Piero , Berlucchi Marco , Tomenzoli Davide , Cappiello Johnny , Trimarchi Matteo , Maroldi Roberto , Battaglia Giuseppe , Antonelli Antonino R.
Published: November 2003

Objectives/Hypothesis In recent years, the indications for endoscopic surgery of the sinonasal tract, originally introduced for the treatment of inflammatory diseases, have been expanded to include selected cases of benign and malignant neoplastic lesions. The aim of the present study was to establish the efficacy of endoscopic surgery in the management of small and intermediate‐sized juvenile angiofibromas.

Study Design Retrospective study.

Methods We reviewed the clinical records and the preoperative and postoperative imaging studies of 15 patients with juvenile angiofibroma who were treated with an endoscopic approach after embolization in the period from January 1994 to April 2000. All patients were prospectively followed by endoscopic and magnetic resonance imaging evaluations performed at regular intervals (every 4 months during the first year and, subsequently, every 6 months).

Results According to a staging system reported in 1989, there were two patients with a type I, nine with a type II, three with a type IIIA, and one with a type IIIB juvenile angiofibroma. Angiography demonstrated that the vascular supply was strictly unilateral in 11 patients and bilateral in 4. Intraoperative blood loss ranged from 80 to 600 mL (mean blood loss, 372 mL). During follow‐up (range, 24–93 mo; mean follow‐up, 50 mo [SD ± 19.9 mo]), only one patient presented a residual lesion on magnetic resonance imaging, which was 16 mm in diameter and was detected 24 months after surgery.

Conclusions The endoscopic approach is a safe and effective technique that allows removal of small and intermediate‐sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.
Branching of Spiral Ganglion Neurites Is Induced by Focal Application of Fibroblast Growth Factor‐1
Authors: Aletsee Christoph , Brors Dominik , Mlynski Robert , Ryan Allen F. , Dazert Stefan
Published: November 2003

Objectives/Hypothesis During the terminal innervation of the developing organ of Corti, fibroblast growth factor‐1 (FGF‐1) messenger RNA has been shown to be transiently expressed in the sensory epithelium of the rat, suggesting that this growth factor may contribute to developmental processes such as innervation and synaptogenesis of the inner and outer hair cells. In a previous study it has been demonstrated that exogenous FGF‐1 supports rat spiral ganglion neurite extension in vitro, whereas a secreted form of FGF‐1 produced by transfected fibrocytes induces neurite branching and targeting.

Study Design Response of spiral ganglion neurites to FGF‐1–coupled beads was compared with the response to noncoupled control beads.

Methods Effects of multiple focal sources of FGF‐1 to outgrowing spiral ganglion neurites were investigated on explants from postnatal day 4 rat spiral ganglion samples that were cultured in the presence of FGF‐1 covalently coupled to polybead microspheres. After fixation and immunocytochemical labeling of the explants the growth patterns of the extending neuronal processes were evaluated.

Results When spiral ganglion neurites were observed near clusters of FGF‐1 beads, they formed a plexus‐like network characterized by significantly higher branching in the vicinity of the beads. However, fibers did not appear to terminate on the beads. Plexus‐like formations were not seen at a distance from FGF‐1 coupled beads or in the vicinity of control beads lacking FGF‐1 on their surface.

Conclusion The results of the study indicate that spiral ganglion neurites branch in response to focal sources of FGF‐1, suggesting an important role of this growth factor for hair cell innervation during the terminal development of the sensory epithelium.
Clinical Associations of Serum Antiendothelial Cell Antibodies in Patients With Sudden Sensorineural Hearing Loss
Authors: Cadoni Gabriella , Agostino Stefania , Manna Raffaele , De Santis Antonella , Fetoni Anna Rita , Vulpiani Paola , Ottaviani Fabrizio
Published: November 2003

Objectives/Hypothesis The role of antiendothelial cell antibodies in systemic vasculitis has been reported. The aim of the study was to define the clinical associations of serum antiendothelial cell antibodies in patients with sudden sensorineural hearing loss.

Study Design A prospective study in patients with sudden sensorineural hearing loss.

Methods Serum samples were taken from 59 consecutive patients with sudden sensorineural hearing loss at time of presentation and from 28 normal control subjects. Indirect immunofluorescence assay was used to detect antiendothelial cell antibodies.

Results The prevalence of antiendothelial cell antibody detection was 54% (32 of 59 patients), with a statistically significant difference between patients and control subjects (P = .0004). Antiendothelial cell antibody positivity was significantly associated with absent recovery of hearing loss (P = .0020).

Conclusions The cytotoxicity to endothelial cells of the inner ear by antiendothelial cell antibody–positive sera might play a role in causing the stria vascularis damage in immune‐mediated sudden sensorineural deafness. The appearance of antiendothelial cell antibody is related to the poor outcome of hearing loss, and its detection could be helpful in the selection of particular patients with sensorineural hearing loss for specific immunosuppressive treatments.
A Randomized Trial of the Canalith Repositioning Procedure
Authors: Yimtae Kwanchanok , Srirompotong Somchai , Srirompotong Supaporn , Sae‐seaw Patchareeporn
Published: November 2003

Objective To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo.

Study Design A randomized, controlled trial in the setting of a neurotological clinic in Thailand.

Methods Fifty‐eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti‐vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began.

Results The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P = .03). The CRP group used significantly fewer drugs than the control group (P = .001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients.

Conclusions The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.
Autograft Ossiculoplasty in Cholesteatoma Surgery: Is It Feasible?
Authors: Ng Siu Kwan , Yip William W. L. , Suen Michael , Abdullah Victor J. , van Hasselt C. Andrew
Published: November 2003

Objective To investigate whether autologous ossicles can be safely used in ossicular reconstruction in cholesteatoma surgery after attempting cholesteatoma removal under the operating microscope.

Study Design A prospective fine‐section histological study of formalin‐stored ossicles, harvested from cholesteatomatous ears, to evaluate for existence of residual cholesteatoma after surface disease clearance under the operating microscope.

Methods One hundred four ossicles were harvested from 76 patients with cholesteatoma for the study. These malleus heads and incudes were categorized into three groups: group 1, ossicles with retained shape and useful bulk, treated by microscopic stripping alone; group 2, ossicles with retained shape and useful bulk, treated by microscopic stripping and drilling; and group 3, badly eroded ossicles, treated by microscopic stripping alone. These treated ossicles were then subjected to 4‐μm histopathological study.

Results Residual disease was identified in 6 of the 104 ossicles. Residual disease was found only in badly eroded ossicles that are not suitable for reconstruction. All the usable ossicles were free of disease.

Conclusions Autologous ossicles that have retained body and bulk are safe to use for reconstruction after surface stripping under the operating microscope. Additional burring probably adds a further margin of safety.
Ventricular Dysphonia: Clinical Aspects and Therapeutic Options
Authors: Maryn Youri , De Bodt Marc S. , Van Cauwenberge Paul
Published: November 2003

Objective/Hypothesis Ventricular dysphonia, also known as dysphonia plica ventricularis, refers to the pathological interference of the false vocal folds during phonation. Despite its low incidence and prevalence, Vd is a well‐known phenomenon in voice clinics. The present report reviews symptoms, etiology, diagnosis, and therapeutic options regarding this voice disorder.

Study Design Literature review and case studies.

Methods The literature pertaining to all clinical aspects of VD was reviewed to define diagnostic and therapeutic clinical decision making.

Results Ventricular dysphonia is characterized by a typical rough, low‐pitched voice quality resulting from false vocal fold vibration. Ventricular dysphonia may be compensatory when true vocal folds are affected (resection, paralysis). Noncompensatory types may be of habitual, psychoemotional, or idiopathic origin. Because perceptual symptoms may vary considerably, diagnosis should rely on a meticulous voice assessment, including laryngeal videostroboscopic, perceptual, aerodynamic, and acoustic evaluation. Various therapeutic approaches for the noncompensatory type of ventricular dysphonia may be considered: voice therapy, psychotherapy, anesthetic or botulinum toxin injections, or surgery.

Conclusion The study presents the state of the art with respect to ventricular dysphonia and may be helpful in diagnosis and therapeutic decision‐making.
Functional Outcomes After Primary Oropharyngeal Cancer Resection and Reconstruction With the Radial Forearm Free Flap
Authors: Seikaly Hadi , Rieger Jana , Wolfaardt John , Moysa Gerald , Harris Jeffery , Jha Naresh
Published: November 2003

Objective To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer.

Study Design Prospective cohort study.

Methods Acoustical, aeromechanical, and perceptual speech data and swallowing data were gathered at three evaluation times (preoperatively and before and after radiation therapy) for patients treated for oropharyngeal cancer by means of primary resection and reconstruction with a radial forearm free flap. Degree of involvement of the soft palate and base of tongue, along with reconstructive techniques, were entered as between‐group factors in the analysis.

Results There were no significant differences in speech intelligibility between the patient groups based on the degree of palate and tongue resected. However, patients with resections of half or more than half of the soft palate had significantly higher nasalance values and larger velopharyngeal orifice areas than individuals who had less than half of the soft palate resected. Significant within‐subject differences were revealed across evaluation times for the dependent variables nasalance, velopharyngeal orifice area, and word intelligibility. Ninety‐four percent of the patients were able to resume a normal or soft diet. There was a 6% incidence of aspiration in 128 swallows that were analyzed. The amount of base of tongue resected did not significantly affect any of the speech or swallowing parameters.

Conclusions Radial forearm free flaps are a good reconstructive option after oropharyngeal cancer extirpation. Our acoustic and aeromechanical results indicated that issues related to quality of the speech signal require further study for resections of half or more than half of the soft palate.
Association of Systematic Head and Neck Physical Examination With Severity of Obstructive Sleep Apnea—Hypopnea Syndrome
Authors: Zonato Adriane I. , Bittencourt Lia Rita , Martinho Fernanda Louise , Júnior João Ferreira Santos , Gregório Luiz Carlos , Tufik Sergio
Published: November 2003

Objectives/Hypothesis To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea–hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea–hypopnea index (AHI).

Study Design Consecutive patients with obstructive sleep apnea–hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied.

Methods Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy.

Results Two hundred twenty‐three patients (142 men and 81 women) were included (mean age, 48 ± 12 y; body mass index, 29 ± 5 kg/m2; AHI, 23.8 ± 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P <.000), modified Mallampati classification (P = .002), and ogivale–palate (P <.001). The retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P = .05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P = .027), but not between craniofacial landmarks and AHI. The combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity.

Conclusions Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal anatomical abnormalities are related to both presence and severity of obstructive sleep apnea–hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. The frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.
Studies in the Quality of Life of Head and Neck Cancer Patients: Results of a Two‐Year Longitudinal Study and a Comparative Cross‐Sectional Cross‐Cultural Survey
Authors: Morton Randall P.
Published: November 2003

Objectives To examine quality‐of‐life (QL) changes that occur over time among patients treated for head and neck cancer and to compare QL outcomes in two geographically separate and culturally distinct populations.

Study Design A prospective, observational longitudinal study was made of QL changes over time in head and neck cancer patients, and a matched‐pairs cross‐sectional study was conducted for comparison of QL outcomes between groups of head and neck cancer patients from two different sociocultural environments.

Methods Patients attending a tertiary head and neck cancer center in Auckland, New Zealand, were interviewed using a validated questionnaire before treatment and at 3, 12, and 24 months after treatment. Changes over time were assessed according to gender, site and stage of primary tumor, and type of treatment received. A second group of patients from Toronto, Ontario, Canada, were matched to the first group for age, gender, site and stage of tumor, and time since treatment and interviewed using the same questionnaire. The group comparison was followed by a matched‐pairs analysis for the 12‐month follow‐up interval.

Results In the longitudinal study, combined modality treatment resulted in greater physical and somatic dysfunction than single modality treatment. Patients learned to cope well with dysfunction and disability and with adjusting their lifestyle so that overall QL was not related to treatment received. Even so, pain scores and measures of psychological distress were related to overall QL. Otherwise there was no consistent correlation between specific symptoms and QL. An illustration of patients' adaptation to dysfunction was evident in scores for perceived difficulty swallowing, which decrease despite the ongoing need for a soft or liquid diet. In the comparative study, significantly different global QL scores were evident in the two clinical groups studied, despite similar social, somatic, and physical functioning. There was also a significant but inconstant difference in emotional functioning. Although the clinical groups received significantly different treatment regimens, the observed differences in global QL were independent of treatment received.

Conclusions Patients with head and neck cancer generally managed well despite disability and dysfunction after treatment. Patients' expectations, emotional responses, and desired outcomes seemed to be determined by sociocultural factors, causing different patient groups to view their overall QL outcome somewhat differently.
Volume Analysis of Preadipocyte Injection for Vocal Cord Medialization
Authors: Glatz Frank R. , Kalkanis James , Neumeister Michael , Suchy Hans , Lyons Sharon , Mowlawi Arian
Published: November 2003

Objective To compare the volume retention of injected preadipocytes with that of standard fat injection in a paralyzed rabbit true vocal cord.

Study Design Prospective analysis with blinded data collection.

Methods Thirteen New Zealand white rabbits were divided into two groups. Group 1 consisted of seven animals undergoing left‐side vocal cord paralysis by resection of a 1‐cm segment of the left‐side recurrent laryngeal nerve and abdominal fat harvest for isolation of preadipocytes. Preadipocytes were cultured under sterile conditions in cell culture media. Animals in group 2 also underwent left‐side vocal cord paralysis without fat harvest. After 10 to 14 days, in a second procedure, group 1 underwent injection of 0.1 mL cultured autologous preadipocytes, and group 2 underwent routine injection of 0.1 mL abdominal fat harvested during the same procedure. At 6 and 12 months, volumetric analysis was performed.

Results Volume analysis at 6 months showed a mean volume of 0.029 mL retained fat in group 2 representing a retention of approximately 29% (SD = 0.023) of the original injected volume. Retention in group 1 animals approximated 0.002 mL (SD = 0.0024) or 2% of the injected volume. Analysis at 12 months showed a mean volume of 0.008 mL (SD = 0.0078) in group 2 and of 0.002 mL (SD = 0.0015) in group 1. Group 2 showed significantly higher volumes of the injected fat at 6 and 12 months (P <.033).

Conclusion Volumes obtained with standard fat injection were superior to those obtained with preadipocyte injection at both 6 and 12 months.
Surgical Robotic Applications in Otolaryngology
Authors: Haus Brian M. , Kambham Neeraja , Le David , Moll Frederic M. , Gourin Christine , Terris David J.
Published: November 2003

Objectives To explore the feasibility of performing endo‐robotic neck surgery in a porcine model and to compare the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique.

Study Design Prospective, nonrandomized experimental investigation in a porcine model.

Methods We performed a consecutive series of endoscopic neck surgeries using the daVinci surgical system (Intuitive Surgical Inc.). The length of time required to establish the operative pocket and to assemble the robotic components, as well as the total duration of each operation, was recorded. The animals were continuously monitored for heart rate, blood pressure, and end‐tidal CO2 pressure, and evaluation for presence of pneumothorax and subcutaneous emphysema was undertaken postoperatively. The specimens were examined histologically.

Results Four different types of neck surgery were successfully performed on both sides of the neck of four animals using the daVinci surgical system. Creation of the operative pocket took, on average (±SD), 18.1 ± 11.9 minutes, and assembly of the robot required 12.5 ± 9.9 minutes, resulting in a mean preparation time for all procedures of 30.6 ± 21.0 minutes. The mean operative time for submandibular resection (n = 3) was 19.0 ± 6.6 minutes, with a total procedure time of 39.0 ± 10.2 minutes. Selective neck dissections (n = 3) required a mean operative time of 66.0 ± 18.5 minutes and a total procedure time of 85.7 ± 16.7 minutes. One partial parotidectomy and one thymectomy were also performed. The median estimated blood loss was 0 mL (range, 0–10 mL). The end‐tidal CO2 pressure fell from the start to the end of the procedures by a mean of 4.4 ± 7.9 mm Hg. The blood pressure fell by a mean of 1.9 ± 7.5 mm Hg. There was one case of modest subcutaneous emphysema, and there were no cases of pneumothorax or air embolism. No conversions to open resection were necessary.

Conclusions Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.
Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device
Authors: Zealear David L. , Billante Cheryl R. , Courey Mark S. , Netterville James L. , Paniello Randal C. , Sanders Ira , Herzon Garrett D. , Goding George S. , Mann Wolf , Ejnell Hasse , Habets Alfons M. M. C. , Testerman Roy , Van de Heyning Paul
Published: November 2003

Objectives/Hypothesis Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment.

Study Design A prospective study of six patients.

Methods The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values.

Results The optimum stimulus paradigm was a 1‐ to 2‐second train of 1‐millisecond pulses delivered at a frequency of 30 to 40 Hz and amplitude of 2 to 7 V. Posterior cricoarytenoid stimulation produced a large dynamic abduction (3.5–7 mm) in three patients and moderate abduction (3 mm) in a fourth patient. The fifth patient showed a large but delayed response of 4 mm to stimulation with some lateralization of the vocal fold. In the sixth patient, stimulated abduction was noted on device implantation but was lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients subsequently had decannulation. Long‐term stimulation of the posterior cricoarytenoid muscle had no appreciable effect on voice quality.

Conclusions Electrical stimulation of the posterior cricoarytenoid muscle shows potential as an improved therapy for bilateral vocal fold paralysis.
Laser‐Assisted Uvulopalatoplasty and Tonsillectomy for the Management of Obstructive Sleep Apnea Syndrome
Authors: Kern Robert C. , Kutler David I. , Reid Kathryn J. , Conley David B. , Herzon Garrett D. , Zee Phyllis
Published: November 2003

Objectives/Hypothesis Laser‐assisted uvulopalatoplasty (LAUP) is a widely accepted procedure for the management of snoring, but its role in the treatment of obstructive sleep apnea syndrome is currently unclear. The objective of the study was to evaluate the role of LAUP in treating moderate and severe obstructive sleep apnea syndrome.

Study Design Retrospective review of a surgical treatment protocol for obstructive sleep apnea syndrome.

Methods Between October 1993 and January 1999, 80 patients with moderate or severe obstructive sleep apnea syndrome and a significant component of retropalatal obstruction were treated with surgery at the Department of Otolaryngology at Northwestern University Medical School (Chicago, IL). Surgery consisted of LAUP with tonsillectomy (if tonsils were present) with the patient under general anesthesia or LAUP alone with local anesthesia (if the tonsils were absent). No patients received traditional uvulopalatopharyngoplasty. Sixty‐four of the 80 patients underwent both preoperative and postoperative polysomnograms. Surgical “response” was defined as a 50% decrease in the apnea‐hypopnea index (AHI) (the total number of apneic and hypopneic events per hour of sleep); surgical “cure” was defined as a 50% decrease in AHI and a final AHI of less than 20.

Results The surgical response rate was 59% (38 of 64 patients), and the surgical cure rate was 39% (25 of 64 patients). Twelve patients (18.8%) had a higher AHI after surgery. The AHI (mean ± SD) changed significantly from 51.4 ± 30.9 preoperatively to 26.3 ± 20.8 on postoperative polysomnogram (P = 7.0 × 10−9). Laser‐assisted uvulopalatoplasty alone was performed in 33 patients with a response rate of 61% and a cure rate of 42%. Laser‐assisted uvulopalatoplasty with tonsillectomy was performed in 31 patients with a response rate of 58% and a cure rate of 35%. The overall incidence of nasopharyngeal insufficiency was 0%.

Conclusion The results of the study suggested that LAUP with adjunctive tonsillectomy is an effective treatment for patients with obstructive sleep apnea syndrome and retropalatal obstruction with a lower complication rate than standard surgical therapy (uvulopalatopharyngoplasty).
The Epidemiology of Chronic Rhinosinusitis in Canadians
Authors: Chen Yue , Dales Robert , Lin Mei
Published: November 2003

Objective To study the prevalence of chronic rhinosinusitis and its risk factors among Canadians.

Study Design Complex survey design incorporating stratification, multiple stages of selection, and unequal probabilities of selection of respondents.

Methods We used the cross‐sectional data from 73,364 subjects (34,241 male and 39,123 female subjects) 12 years of age or older who participated in the second cycle of the National Population Health Survey, which was conducted from 1996 to 1997. All these individuals were asked whether they had certain chronic health conditions that had lasted or were expected to last 6 months or longer, including rhinosinusitis.

Results The prevalence of rhinosinusitis was higher in female (5.7%) than in male (3.4%) subjects. The sex difference was consistent across age groups. The prevalence increased with age and leveled off after the age of 60 years. In female but not in male subjects, the prevalence was slightly higher among those living the eastern region or among native Canadians as compared with those living in the central or western regions or immigrants. Cigarette smoking and low income were associated with a higher prevalence of rhinosinusitis in both sexes. The smoking effect was modified by allergy history in male subjects. Rhinosinusitis was more common among subjects with allergy history, asthma, or chronic obstructive pulmonary disease. The prevalence of rhinosinusitis was similar in subjects with or without reporting regular alcohol drinking and exercise.

Conclusion Previous data indicating an increased susceptibility of women to asthma and chronic obstructive pulmonary disease, together with the similar finding for rhinosinusitis, suggest that women have a general increase in susceptibility to respiratory tract disease.
The Expression of Proto‐Oncogene eIF4E in Laryngeal Squamous Cell Carcinoma
Authors: Liang Zhou , Lei Tao , LuYing Zheng , YuPing Gao
Published: November 2003

Objectives/Hypothesis The translation initiation factor eukaryotic initiation factor 4E (eIF4E) binds to the cap of messenger RNA in the first step of messenger RNA recruitment. Overexpression of eIF4E results in the upregulation of specific angiogenic factor basic fibroblast growth factor (bFGF). The study aims to demonstrate that the overexpression of eIF4E could facilitate recognizing initiation start sites for the translation of bFGF and play an important role in the tumorigenesis of laryngeal squamous cell carcinoma.

Study Design Retrospective.

Methods Paraffin‐embedded sections of 37 samples of laryngeal squamous cell carcinoma, 10 samples of vocal cords polyps, and 20 fresh samples of laryngeal squamous cell carcinoma were analyzed using immunohistochemical streptavidin peroxidase technique, Western blot analysis, and reverse transcriptase–polymerase chain reaction.

Results The overexpression of eIF4E was observed in all 37 paraffin‐embedded samples of laryngeal squamous cell carcinoma, whereas no staining was noticed in vocal cords polyps samples. There were significant correlations between the overexpression of protein eIF4E and TN stages, histological grades, local recurrence, and the states of metastasis (P <.01). Moreover, the overexpressions of both bFGF protein and bFGF messenger RNA correlated with the histological grades and the states of metastasis (P <.01), but the overexpression of eIF4E and bFGF did not correlate with age, sex, and tumor sites (P >.05).

Conclusions Eukaryotic initiation factor 4E can enhance the expression of bFGF at translation level. The eIF4E and bFGF collaborate in tumorigenesis, development, invasion, and metastasis of laryngeal squamous cell carcinoma, in view of which the former can be considered as a tumor molecular marker and an independent prognostic molecular marker of laryngeal squamous cell carcinoma.
Analysis of Treatment Results for Base of Tongue Cancer
Authors: Sessions Donald G. , Lenox Jason , Spector Gershon J. , Chao Clifford , Chaudry Omer Ahmad
Published: November 2003

Objective The study reported the results of treatment for base of tongue cancer with five different treatment modalities with long‐term follow‐up.

Study Design This was a retrospective study of 262 patients with base of tongue cancer treated in the Departments of Otolaryngology—Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from July 1955 to January 1998.

Methods The study population included previously untreated patients with biopsy‐proven squamous cell carcinoma of the base of tongue who were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone, radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance.

Results The overall 5‐year disease‐specific survival (DSS) was 49.6% with death due to tumor in 50.4%. The 5‐year cumulative disease‐specific survival probability (CDSS) was 0.526 (Kaplan‐Meier) with a mean of 7.8 years and a median of 5.6 years. Patients with early disease had significantly improved DSS compared with patients with more advanced disease (stages I and II; TN stages T1N0, T2N0, and T2N1; and T stages T1 and T2.). Patients with N0 had better DSS than patients with positive lymph nodes (P = .010). The DSS for all stages by treatment modality included local resection (70.0%), composite resection (47.6%), radiation therapy (40.4%), local resection and radiation therapy (50.0%), and composite resection with radiation therapy (51.5%). Overall and within the stages there was no significant difference in either DSS or CDSS by treatment modality. Local–regional recurrence occurred in 26% of patients, and overall salvage was 10.5%. Patients with clear resection margins did better than patients with close or involved margins (DSS and CDSS). Patients treated with radiation therapy alone had improved capacity to swallow (P = .001), speak (P = .01), and work (P = .001) compared with patients treated with the other modalities.

Conclusions Cancer of the base of tongue is a lethal disease, and its treatment results in significant disability. No treatment produced a significantly improved survival advantage. Focus on improving local–regional control might improve overall survival. All treatment modalities were associated with major treatment‐related complications. Radiation alone produced significantly improved post‐treatment function and quality of life compared with the other modalities. Because of the recurrence rates at the primary and neck sites and the high rates of development of distant metastasis and second primary cancers, patients should be monitored for a minimum of at least 4 years.
Facial Nerve Paralysis Following Cochlear Implant Surgery
Authors: Fayad Jose N. , Wanna Georges B. , Micheletto Jennifer N. , Parisier Simon C.
Published: November 2003

Objectives Facial nerve paralysis is a rare but devastating complication of cochlear implant surgery. The aims of the study were to define the incidence of facial nerve paralysis in our series and understand possible mechanisms of injury.

Study Design Retrospective chart review and case reports.

Methods Charts were reviewed of all 705 patients implanted between 1980 and 2002 at the authors' institutions to identify those with postoperative facial nerve weakness and determine incidence. For patients with facial nerve weakness, onset, degree, and timing of paralysis were noted; clinical findings were correlated to operative report findings. The method of treatment was noted, and the final facial nerve function outcome was recorded.

Results Five patients (one child and four adults) were found to have postoperative facial nerve weakness, for an incidence of 0.71%. This complication was delayed in all cases, ranging from 18 hours to 19 days postoperatively. All patients were treated with steroids or steroids combined with antiviral medication, and all ultimately recovered normal facial function.

Conclusions In the study series, the incidence of facial nerve paralysis following cochlear implant surgery was 0.71%. Possible mechanisms of injury included heating injury and viral reactivation. All patients presented with a delayed facial nerve paralysis and did recover normal facial nerve function.
Embolic Inner Ear Decompression Illness: Correlation With a Right‐to‐Left Shunt
Authors: Klingmann Christoph , Benton Peter John , Ringleb Peter Arthur , Knauth Michael
Published: November 2003

Objectives/Hypothesis Inner ear decompression illness is thought to be a rare phenomenon in recreational divers, isolated signs and symptoms of inner ear dysfunction usually being attributed to inner ear barotrauma.

Study Design We present 11 cases of inner ear dysfunction in nine divers with inner ear decompression illness.

Results All nine divers had significant right‐to‐left shunt as diagnosed by transcranimal Doppler sonography.

Conclusions The authors thought that mechanism of causation in these cases may have been intravascular bubble emboli and that inner ear decompression illness may be more common among recreational divers than currently recognized. Failure to treat inner ear decompression illness with recompression therapy can result in permanent disability. Because the differential diagnosis between inner ear barotrauma and inner ear decompression illness can be impossible, the authors suggested that divers who present with inner ear symptoms following a dive should have recompression immediately after having undergone bilateral paracentesis.