bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of the Management of Hydrocephalus Associated with Acoustic Neuroma
Authors: Atlas Marcus D. , Perez de Tagle Juan Ramon V. , Cook James A. , Sheehy John P. , Fagan Paul A.
Published: November 2003

The management of hydrocephalus in association with a cerebellopontine angle tumor is controversial. There is a widely held belief that initial therapy should always be directed toward treatment of hydrocephalus before definitive surgery. The potential problems of cerebrospinal fluid (CSF) shunting and drainage have led to an evolution in the management of hydrocephalus at St. Vincent's Hospital. There is growing evidence that complete removal of cerebellopontine angle tumors will result in resolution of hydrocephalus without requiring other methods of CSF decompression. The authors present their experience of 14 patients with hydrocephalus found in a recent series of 104 consecutive cases of acoustic neuroma. This study has detected a significant correlation between hydrocephalus and increasing tumor size (P=.0234). The mean tumor size in this series was 3.8 cm. The series has also demonstrated that successful, safe, and complete tumor removal can be achieved without CSF drainage before surgery.
A Combined Endoscopic CO2 Laser and External Approach for Treatment of Glottic Cancer Involving the Anterior Commissure: An Animal Study
Authors: Shapshay Stanley M. , Wang Zhi , Rebeiz Elie E. , Perrault Donald F. , Pankratov Michail M.
Published: November 2003

Endoscopic laser resection usually has been discouraged for anterior commissure (AC) carcinoma because of inadequate exposure and close proximity to underlying cartilage. A new technique combining endoscopic CO2 laser incision and an external approach, creating a window in the thyroid cartilage, was tested in this in vivo study of six dogs. An en bloc specimen including adjacent cartilage was excised while preserving the thyroid framework. The glottic reconstruction was accomplished with external placement of a sternohyoid muscle flap, by either using a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa.

The results showed a satisfactory anatomic reconstruction and acceptable functions. The bipedicled muscle flap was superior to the unipedicled muscle flap due to a better AC reconstruction. It is believed that this new combined technique may overcome limited access with endoscopic technique and excessive cartilage resection with the external partial laryngectomy.
Basic Innervation Pattern and Distribution of Classic Autonomic Neurotransmitters in Human Nasal Mucosal Vasculature
Authors: Riederer Andreas , Fischer Axel , Knipping Stephan , Unger Jürgen , Lange Winfried , Kastenbauer Ernst
Published: November 2003

The neural control of human nasal vasculature is still not completely understood. This study was performed to demonstrate the innervation pattern of the different vessel types and to distinguish between nor‐adrenergic and cholinergic structures. General innervation was demonstrated using antibodies to neuron‐specific enolase and S‐100 protein. Autonomic structures were shown by using antibodies to tyrosine hydroxylase and choline acetyltransferase(ChAT). In addition, choline acetyltransferase (AChe) histochemistry was performed.

Nasal vasculature is controlled by a dense innervation that increases with the thickness of the tunica media. While all larger vessels show a mixed autonomic innervation, sympathetic structures seem to predominate in veins. These findings demonstrate that classic neurotransmitters play a major role in the regulation of nasal vasculature. The stronger innervation of arteries and cushion veins underlines their central position in the control of nasal air flow.
Effects of Botulinum Toxin Type A Injections on Aerodynamic Measures of Spasmodic Dysphonia
Authors: Adams Scott G. , Durkin Lisa C. , Irish Jonathan C. , Wong David L.H. , Hunt Elizabeth J.
Published: November 2003

The effects of botulinum toxin type A (BOTOX®) injections on aerodynamic measures of phonation were examined in 30 patients with adductor spasmodic dysphonia. Patients received bilateral injections of 2.5 U of botulinum toxin type A in each thyroarytenoid muscle. Measures of air pressure, average airflow, coefficient of variation (CV) of airflow, and laryngeal resistance were obtained before the injections and at 2 and 10 weeks after the injections. These measures were also obtained from 12 normal subjects.

Compared with normal subjects, the spasmodic dysphonia patients had significantly higher preinjection values for air pressure, CV of airflow, and laryngeal resistance. At 2 and 10 weeks after the botulinum toxin type A injections, the spasmodic dysphonia patients showed a significant increase in the average airflow values and a significant decrease in the CV of airflow values and the laryngeal resistance values. At 10 weeks after the injections, the values for the three measures began to approach the preinjection values. It is concluded that these aerodynamic measures of phonation can provide useful measures of treatment outcome in adductor spasmodic dysphonia.
Endoscopic Treatment of Tracheal Stenosis Using the Carbon Dioxide Laser and the Gianturco Stent: Indications and Results
Authors: Remacle M. , Lawson G. , Minet M. , Mayné A. , Watelet J.B. , Jamart J.
Published: November 2003

The self‐expandable Gianturco stent was used in 11 patients with tracheal stenosis who were treated from September 1992 through July 1994. Under optical control, the stent was placed through a bronchoscope with an outside diameter of 9 mm after cross‐section and dilation of the stenosis were performed with the carbon dioxide laser according to the Shapshay technique. The follow‐up period varied from 3 to 22 months, with a mean of 12±6 months.

Pulmonary function tests showed a mean improvement of the peak expiratory flow (50%), from 0.95±0.45 L/sec before the operation to 2.13±0.86 L/sec after the procedure. Radiologic and fibroscopic controls showed prosthesis stability. Three patients needed a second endoscopic procedure because of malposition of the stent, the formation of granuloma at the superior end of the prosthesis, and the development of a mucous membrane webbing between the two loops of a stent. Due to the lack of long‐term follow‐up, this technique is reserved for the treatment of severe tracheal stenosis with cartilage impairment in patients who have contraindications for external reconstructive surgery.
Late Sequelae of Cochlear Infection
Authors: Keithley Elizabeth M. , Harris Jeffrey P.
Published: November 2003

Inflammatory reactions within the inner ear are deleterious to cochlear function and can result in severe hearing loss that does not recover. This study investigated a guinea pig model of long‐term cytomegalovirus infection. At high doses active inflammation was still present after 35 days. At lower doses some ears showed partial resolution while others were still inflamed. Hearing was totally lost in all cases of persistent inflammation. There was some residual hearing in the cases that had resolved. Cochlear structures including the organ of Corti, stria vascularis, and spiral ganglion were partially degenerated. Fibrotic matrix within scala tympani was ossified in many cases. These changes are consistent with those described for human cochleas following putative viral infections.
Image‐Guided Surgery in a New Magnetic Resonance Suite: Preclinical Considerations
Authors: Fried Marvin P. , Hsu Liangge , Topulos George P. , Jolesz Ferenc A.
Published: November 2003

Surgical procedures require correct identification of exposed anatomy with concomitant localization amidst contiguous structures. In endoscopic procedures the surgeon is provided a real‐time endoscopic view and is prepared with radiologic images. Here we present an overview of a methodology of localization using intraoperatively acquired magnetic resonance(MR) images in preparation for magnetic resonance imaging‐guided endoscopic sinus surgery. The methodology centers around a unique prototype imaging device and operating environment. An “open” 0.5 Tesla MR unit has been created that allows complete access to the patient's head and neck while concomitant images are obtained. Illustrative examples of the localization technique from cadaver experiments are presented, as well as insights into the host of concerns for anesthesia, equipment, surgical instrumentation, communications, and documentation.
Laryngeal Muscle Activity During Speech Breaks in Adductor Spasmodic Dysphonia
Authors: Nash Eric Anthony , Ludlow Christy L.
Published: November 2003

To determine the laryngeal muscle activation abnormalities that are associated with speech symptoms in adductor spasmodic dysphonia (ADSD), electromyographic measures of extrinsic and intrinsic laryngeal muscles during speech compared 1) muscle activity when ADSD patients had breaks in words with when they produced the same words without breaks; and 2) muscle activity in ADSD patients during speech without voice breaks with normal controls producing phonetically similar words. Simultaneous electromyographic recordings were made from the thyroarytenoid (TA), cricothyroid (CT), sternothyroid (ST), thyrohyoid(TH) and the posterior cricoarytenoid (PCA) muscles during speech testing in 11 ADSD patients and 10 control subjects. Speech breaks were identified and mean muscle activity measured starting 100 ms preceding a voice break and for the remainder of the word. Mean muscle activity level was significantly greater on break than non break words in ADSD patients only for the thyroarytenoid muscle(p<.001). No significant differences were found between the ADSD and control subjects during non break words for any of the laryngeal muscles studied. The results demonstrated that 1) only the thyroarytenoid, of the muscles tested, was affected in ADSD, 2) that muscle activation abnormalities were spasmodic, only appearing when symptoms occurred and 3) no imbalances of muscle tone were evident when speech disruptions did not appear.
Primary Closure of Pharyngeal Remnant After Total Laryngectomy and Partial Pharyngectomy: How Much Residual Mucosa Is Sufficient?
Authors: Hui Y. , Wei W.I. , Yuen P.W. , Lam L.K. , Ho W.K.
Published: November 2003

After total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available. The aim of this study was to determine the minimum width of the pharyngeal remnant that could be safely closed primarily without causing difficulty in swallowing.

A total of 52 consecutive patients who underwent total laryngectomy were entered into the study. The relaxed and stretched widths of the pharyngeal remnant were measured after removal of the specimen. The widths of the pharyngeal mucosa ranged from 1.5 to 5.0 cm relaxed (mean, 3.24 cm) and from 2.5 to 8.0 cm stretched (mean, 4.83 cm). All neopharynx was reconstructed by closing the pharynx primarily.

Seven of the 52 patients developed recurrent tumor with concomitant dysphagia. Two of the 45 patients without recurrence presented with acute dysphagia from food bolus obstruction, and 1 patient developed benign inflammatory stricture following an episode of fish‐bone impaction.

The narrowest widths of the pharyngeal remnant in this group of 45 were 1.5 cm relaxed and 2.5 cm stretched. As these patients do not have swallowing difficulty, we conclude that in the absence of tumor recurrence, this amount of residual pharyngeal tissue is sufficient both for primary closure of the pharynx and in restoring swallowing function.
Laser Versus Cold Instruments for Microlaryngoscopic Surgery
Authors: Zeitels Steven M.
Published: November 2003

Controversy has arisen concerning the merits of the CO2 laser in microlaryngoscopic surgery because of the potentially harmful effects that the injudicious application of the laser could have on voice production. In an effort to develop a logical approach to instrument selection, the author examined the use of both cold instruments and the CO2 laser in the treatment of various benign and malignant lesions.

A retrospective review of 307 microlaryngeal procedures performed over a 3‐year period revealed that 263 (86%) were glottal and 44 (14%) were supraglottal. Of the 263 glottal procedures, 203 (77%) employed cold instruments alone and 60 (23%) used both cold instruments and the CO2 laser. The laser was used to assist in all 44 supraglottal procedures. Therefore, 203 (66%) of 307 procedures were done with cold instruments alone, and 104 (34%) of 307 procedures were performed using the CO2 laser with cold instruments. Lesions were stratified on the basis of pathology and size, as well as surgical approach.

A primary phonomicrosurgical principle in glottal surgery is to maximally preserve the vocal fold's layered microstructure (laminae propria and epithelium). Precise tangential dissection was necessary for achieving this goal. For limited lesions, this dissection was best accomplished with cold instruments alone. The CO2 laser facilitated hemostatic surgical dissection for all supraglottal lesions and for selected larger glottal lesions in which bleeding would obscure visualization of the microanatomy of the musculomembranous vocal fold.

Laryngoscope, 106:545‐552, 1996
Epithelial Cell Proliferation in Nasal Polyps Could Be Up‐Regulated by Platelet‐Derived Growth Factor
Authors: Coste André , Wang Qiu‐Ping , Roudot‐Thoraval Françoise , Chapelin Catherine , Bedbeder Philippe , Poron Françoise , Peynègre Roger , Escudier Estelle
Published: November 2003

The modifications of epithelial differentiation and proliferation observed in nasal polyps (NP) could be related to local secretion of growth factors, among which platelet‐derived growth factor (PDGF) could play a key role. We therefore prospectively studied, by immunohistochemistry, proliferating cell nuclear antigen (PCNA, an S‐phase cell marker), PDGF, and CD‐68 (activated macrophages marker) expression in NP and inferior turbinate mucosa (NM) in 11 patients. Our data show that PCNA and PDGF expression are increased in NP epithelium, while CD‐68 expression is increased in NP epithelium and lamina propria when compared to NM. Increased local PDGF secretion by numerous activated macrophages could therefore be involved in epithelial cell proliferation up‐regulation in NP. PDGF could also be involved in the pathogenesis of NP via its connective tissue remodeling actions.

Laryngoscope, 106:578‐583, 1996
An Application of Telemedicine Technology for Otorhinolaryngology Diagnosis
Authors: Crump William J. , Driscoll Brian
Published: November 2003

Applications of interactive video communications for providing remote telemedicine consultations are under study. Most of these applications use “off the shelf” medical peripheral devices that are not specifically designed for telemedicine examinations.

This study reports a field trial of the telemedicine instrument pack (TIP), a small self‐contained unit under development by the National Aeronautics and Space Administration for use in spaceflight. Patients with otorhinolaryngology problems were selected from a primary care practice and examined with the TIP by a technician under the direction of a remote consultant. The equipment proved adequate for examination of the posterior nose, hypopharynx, and larynx. Examinations of the ear and oropharynx with the TIP were not optimal, suggesting a need for further modifications of this prototype unit.

Laryngoscope, 106:595‐598, 1996
Early Otitis Media and Phonological Development at Age 2 Years
Authors: Abraham Suzanne S. , Wallace Ina F. , Gravel Judith S.
Published: November 2003

The effect of early otitis media on phonology and articulation in the presence of expressive language delay was investigated in 16 2‐year‐olds followed prospectively from birth. Eight of the children were designated otitis‐positive and 8 were considered otitis‐negative as determined by bilateral pneumatic otoscopy outcomes during year 1 of life. The groups differed significantly on measures of expressive, not receptive, language development. All members of the otitis‐positive group were expressive language delayed. Phonological analyses were completed on spoken language samples elicited from each child at age 24 months. Results showed similar developmental tendencies in speech sound acquisition between the groups, but the otitis‐positive group had established significantly fewer initial consonant phones and produced them less accurately than the otitis‐negative subject group. The otitis‐positive group acquired significantly fewer consonants with back place of articulation. Similar phonological error patterns of deletion and phoneme class deficiency were used by the groups, but the otitis‐positive group used the error patterns more frequently. Findings here lend support to the otitis media effect as one of interaction among risk factors.
Extracorporeal Electromagnetic Shock‐Wave Lithotripsy for Salivary Gland Stones
Authors: Ottaviani Francesco , Capaccio Pasquale , Campi Michela , Ottaviani Antonio
Published: November 2003

Sialoadenectomy for sialolithiasis is necessary when the stone cannot be removed through the salivary duct. In addition, extracorporeal shock‐wave lithotripsy has recently become available for this purpose. The safety and efficacy of this method was assessed in 52 outpatients bearing stones with an average diameter of 6.76 mm in the submandibular or parotid gland. Anesthetics, sedatives, and analgesics were not required. Twenty‐four of the 36 patients with submandibular gland calculi and all 16 with parotid sialolithiasis had complete stone disintegration or fragmentation of the calculi, with possible spontaneous clearance. Untoward effects were observed in 15 patients, namely localized skin petecchiae, transitory swelling of the gland, and self‐limiting bleeding from the duct. No persistent damage of the salivary glands or adjacent structures was noted during a mean follow‐up period of 10 months.
Diltiazem Does Not Protect the Ear From Noise‐Induced Hearing Loss in Mongolian Gerbils
Authors: Boettcher Flint A.
Published: November 2003

Recent data suggest that diltiazem reduces noise‐induced hearing loss. Our study was designed to replicate and extend the results of Maurer et al. by using the gerbil as a model. In experiment A, subjects received diltiazem (30 mg/kg/day intraperitoneally) or saline for 3 days. After peripheral thresholds were measured, each subject was exposed to a 4‐kHz tone (90‐dB sound pressure level) for 20 minutes. Similar amounts of temporary threshold shifts (TTS) were measured in the saline and diltiazem groups. In experiment B, subjects were given saline or diltiazem (30 mg/kg/day intraperitoneally) for 3 days and then exposed to an octave band of noise centered at 4 kHz for 5 days, during which time the subjects continued to receive the drug or saline. The TTS and permanent threshold shifts were similar in the two groups. Measures of cochlear nonlinearities also showed no effect of diltiazem, suggesting that diltiazem does not protect the ear from the effects of noise.
Association of Mitochondrial DNA Deletions and Cochlear Pathology: A Molecular Biologic Tool
Authors: Seidman Michael D. , Bai Uma , Khan Mumtaz J. , Murphy Michael P. , Quirk Wayne S. , Castora Frank J. , Hinojosa Raul
Published: November 2003

The purpose of these experiments was to develop a method of isolation, amplification, and identification of cochlear mitochondrial DNA (mtDNA) from minute quantities of tissue. Additionally, studies were designed to detect mtDNA deletions (mtDNA del) from the cochlea that previously have been amplified from other organ systems and tissues. MtDNA del have been associated with many pathologies, including neurological disorders, sensorineural hearing loss, ischemia, cardiomyopathies, and aging.

DNA was extracted from rat and human tissues, and polymerase chain reaction was used to amplify mtDNA sequences. A 360 base pair (bp) cytochrome‐b gene product and the highly conserved ND1‐16S ribosomal ribonucleic acid regions found only in mtDNA were amplified from all tissues. Preliminary studies have identified a 4834 bp mtDNA del in aged rats and a corresponding 4977 bp mtDNA del in aged humans. Additionally, preliminary results in human archival temporal bone studies reveal the presence of the 4977‐bp mtDNA deletion in two out of three patients with presbycusis. The deletion was not evident in age‐matched control patients without a history of presbycusis. This technique of mtDNA identification makes it possible to investigate specific mtDNA defects from a single cochlea, promoting the study of hereditary hearing loss and presbycusis at a molecular biologic level.
Acoustic Reflexes, Auditory Brainstem Response, and MRI in the Evaluation of Acoustic Neuromas
Authors: Burkey John M. , Rizer Franklin M. , Schuring Arnold G. , Fucci Michael J. , Lippy William H.
Published: November 2003

Patient records were reviewed to determine whether persons with absent acoustic reflexes have a higher incidence of abnormal auditory brainstem response (ABR) results in the absence of a cerebellopontine angle (CPA) tumor than those with normal acoustic reflexes. Results showed patients with absent reflexes to have borderline or abnormal ABR results in 45.2% of the cases. Patients with normal reflexes had borderline or abnormal ABR results in 14.2% of the cases. Results indicate that magnetic resonance imaging is a more appropriate test for patients with absent reflexes, since ABR was often nondiagnostic for a CPA tumor in this group.

Laryngoscope, 106:839‐841, 1996
Postoperative Irradiation of Patients with Malignant Tumors of the Skull Base
Authors: Paulino Arnold C. , Marks James E. , Leonetti John P.
Published: November 2003

To better understand how to irradiate patients after skull‐base surgery, the authors of this study analyzed the tumor recurrence patterns in 22 patients with various malignancies. Of these patients, 13 underwent craniofacial resection, 6 had infratemporal fossa resection, and 3 had temporal bone resection. The entire operative field was irradiated in 8 patients (total‐field group), and part of the operative field was irradiated in 14 patients(partial‐field group).

Tumor regrew within the irradiated area in 25% of the total‐field group and 14% of the partial‐field group. Tumor appeared outside the operative field in 13% of the total‐field group and 57% of the partial‐field group. Recurrences appeared in contiguous sites in 5 patients, in the unirradiated scar in 5 patients, and in the lymph nodes in 4 patients. Based on the study findings, the authors state that irradiation of the entire operative field, including scars and potential areas of contiguous spread, may be necessary to maximize local control after skull‐base surgery.

laryngoscope, 106:880‐883, 1996
Endoscopic Staple‐Assisted Esophagodiverticulostomy for Zenker's Diverticulum
Authors: Scher Richard L. , Richtsmeier William J.
Published: November 2003

We have used a new technique, endoscopic staple‐assisted esophagodiverticulostomy (ESED), for the treatment of Zenker's diverticulum. This technique is a modification of the endoscopic approach first described by Mosher1 in 1917 and popularized by Dohlman and Mattsson2 in which the common wall between the esophagus and diverticulum was divided without mucosal closure. ESED differs in that an endosurgical stapler is used to create an esophagodiverticulostomy by dividing the common wall between the esophagus and diverticulum, with the mucosal and muscular edges sealed by the staples. We have performed this procedure in six patients, with no perioperative morbidity in any patient. All patients resumed oral intake on either the first or second postoperative day, with no evidence of fistula formation or mediastinitis. Hospital stay has averaged 2 days (range, 1 to 3 days). Patient follow‐up after ESED averages 6 months and is available for five of the six patients treated. There has been complete resolution of pretreatment symptoms in these five patients, with resumption of regular diet between postoperative day 3 and day 14 (average, day 9). Our results demonstrate that ESED is a safe and effective treatment for Zenker's diverticulum. This endoscopic approach offers a number of advantages over previously used treatments for Zenker's diverticulum, including reduced morbidity, rapid convalescence, short hospitalization, brief operative time, and predictable resolution of symptoms.
Endoscopic Sinus Surgery With Partial Middle Turbinate Resection: Effects on Olfaction
Authors: Friedman Michael , Caldarelli David D. , Venkatesan T.K. , Pandit Rajiv , Lee Young
Published: November 2003

Few studies have investigated the effects of endoscopic sinus surgery (ESS) on olfaction. In particular, the effect of surgical manipulation of the middle turbinate on olfaction has not been established. Using the University of Pennsylvania Smell Identification Test (UPSIT) and patient questionnaires, the authors performed a prospective study of olfaction in 64 patients undergoing ESS. Thirty‐eight patients (59%) underwent partial middle turbinate resection; in the remaining 26 patients (41%), the middle turbinate was preserved. All patients were reevaluated approximately 8 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. Patients who underwent no resection had a median decrease in UPSIT score of 1.4, and those who underwent resection had a median decrease of 0.5; this difference was not statistically significant. Further, no correlation was found between changes in UPSIT score and follow‐up time, sex of the patient, or the patient's subjective assessment of postoperative olfaction. It is concluded that middle turbinate resection has no effect on olfaction.
Regional Spread of Auricular and Periauricular Cutaneous Malignancies
Authors: Lee Dennis , Nash Michael , Har‐El Gady
Published: November 2003

Over 90% of all cutaneous malignancies occur in the head and neck. Malignancies involving the external auditory meatus, auricle, and periauricular region are notoriously difficult to control. The morbidity and mortality associated with extension of these malignancies underscore the importance of complete initial removal.

We present 14 patients who underwent excision of periauricular lesions. All lesions were less than 2 cm in diameter and previously excised with negative margins. These patients were subsequently referred for regional disease. Twenty‐nine percent of the patients failed definitive surgical therapy. We examine the indications for regional lymphadenectomy in the treatment of auricular and periauricular cutaneous malignancies.
Cerebrospinal Fluid Drainage in the Management of CSF Leak Following Acoustic Neuroma Surgery
Authors: Fishman Andrew J. , Hoffman Ronald A. , Roland J. Thomas , Lebowitz Richard A. , Cohen Noel L.
Published: November 2003

A retrospective analysis was performed on 174 patients operated on from 1992 to 1995 to evaluate the safety and efficacy of continuous lumbar cerebrospinal fluid drainage (CLCFD) in the management of cerebrospinal fluid (CSF) leaks following acoustic neuroma surgery. There was a 17% incidence of CSF leak. CLCFD stopped the leak in 87% of cases. There were no cases of meningitis associated with CLCFD. One deep vein thrombosis was treated without sequelae. It is concluded that CLCFD is safe and efficacious. The authors recommend that CLCFD be implemented immediately when indicated, foregoing a trial of conservative therapy. Indications and precautions are discussed.
Patterns of Sinusitis in Cystic Fibrosis
Authors: Gentile Victor G. , Isaacson Glenn
Published: November 2003

It has been pediatric dogma that most children with cystic fibrosis (CF) have pansinusitis and few are symptomatic. To reassess this premise, we compared symptoms, clinical examinations, radiographic and surgical findings, and results of treatment in 19 children with cystic fibrosis who had undergone computed tomography at St. Christopher's Hospital (Philadelphia) from 1991 to 1994. We found two distinct patterns of sinus disease: chronic sinusitis (n = 3) and polyposis (n = 12). Two of the patients with polyposis had ethmoid mucoceles and 1 child had no sinus disease at all. Children with chronic sinusitis had headache as a major complaint, while those with polyposis suffered nasal obstruction alone unless a mucocele was present. Surgery provided marked and lasting improvement in the 14 patients who were operated on.
Inflammation in the Uvula Mucosa of Patients With Obstructive Sleep Apnea
Authors: Sekosan Marin , Zakkar Mohamed , Wenig Barry L. , Olopade Christopher O. , Rubinstein Israel
Published: November 2003

This study was conducted to determine whether inflammation is present in the uvula mucosa of patients with obstructive sleep apnea (OSA). Uvulas were obtained by uvulopalatopharyngoplasty in 21 patients with moderate OSA (mean apnea/hypopnea index and standard error of the mean: 32±4) and by autopsy in 5 individuals not known to have OSA.

Using point counting in five randomly selected high‐power microscopic fields (×100), the authors found that the number of leukocytes in the lamina propria of the uvula mucosa was significantly higher in patients with OSA than in the controls (179±12 cells vs. 71±4 cells, respectively;P<.05). This was due to a significant increase in the number of plasma cells in patients with OSA as compared with controls (89±15 cells vs. 21±5 cells, respectively; P<.05). The thickness of the lamina propria (an index of interstitial edema) was also significantly increased in patients with OSA compared with controls (0.99±0.12 mm vs. 0.27±0.02 mm, respectively; P<0.05).

The authors conclude that inflammation, characterized by plasma cell infiltration and interstitial edema, is present in the uvula mucosa of patients with moderate OSA. They also suggest that soft palate inflammation contributes to upper airway occlusion observed during sleep in these patients.
Supracricoid Laryngectomy With Cricohyoidopexy (CHP) in the Treatment of Laryngeal Cancer: A Functional and Oncologic Experience
Authors: de Vincentiis Marco , Minni Antonio , Gallo Andrea
Published: November 2003

Subtotal laryngectomy with cricohyoidopexy (CHP) results in a satisfactory cure rate in selected T1b, T2, and T3 supraglottic and glottic cancers. The clinical, oncologic, and functional results of this type of surgery have led to an ever‐increasing number of patients undergoing this procedure. This study involved 70 patients operated on from 1984 to 1993 using this surgical procedure. This report also discusses the clinical (cTNM) and pathologic (pTNM) classifications of CHP cases. Fifty‐two of these patients were evaluated after a follow‐up of more than 3 years. Lymph node treatment protocol comprised 51 functional ipsilateral neck dissections (FNDs), 9 bilateral FNDs, 1 radical ipsilateral dissection, and 1 radical ipsilateral and contralateral FND. There were 6 recurrences (5 local, 1 neck); after CHP physiologic deglutition was recovered in most of the patients (95.5%), and all but 6 (92%) were decannulated. Results were excellent after phoniatric rehabilitation. This surgical procedure may be indicated for selected laryngeal cancers and allows for the preservation of laryngeal functions even when the neoplastic lesions are advanced. However, care must be taken when evaluating the infiltration of the paraglottic space, as that infiltration represents the main cause of failure in this type of surgery.
Endoscopic Repair of Cerebrospinal Fluid Fistulae and Encephaloceles
Authors: Lanza Donald C. , O'Brien Douglas A. , Kennedy David W.
Published: November 2003

The authors review their experience with endoscopic repair of skull base defects associated with cerebrospinal fluid (CSF) rhinorrhea and/or encephaloceles involving the paranasal sinuses. Between January 1991 and December 1995, 51 patients were evaluated for anterior and middle cranial fossa defects at a tertiary care facility. Of these patients, 36 underwent endoscopic repair of skull base defects.

Factors related to surgical success were analyzed. These factors included etiology, defect location, number of prior attempts at repair, type of graft(s) used, fluorescein use, complications, durations of lumbar drain placement, and duration of CSF leakage prior to repair. During the first attempt, successful endoscopic repair was accomplished in 34 (94.4%) of the 36 patients. The mean duration of follow‐up was 24.6 months, with a range of 2 to 57 months. The authors conclude that an endoscopic approach provides a safe and effective means for repairing many skull base defects.
Syndromal Vertigo Identified by Magnetic Resonance Imaging and Angiography
Authors: Welsh Louis W. , Welsh John J. , Jaffe Stephen C. , Healy Michael P.
Published: November 2003

The advent of magnetic resonance imaging and angiography has clarified the location and vascular basis for vertigo of a syndromal type. The composite presentation of a vestibular symptom with evidence of cranial nerve or cerebellar dysfunction suggests a lesion within the pons, medulla, or cerebellum. The location may be exactly defined by noninvasive techniques and appropriate therapy can be initiated. Clinical examples are presented; the syndromes of vertebrobasilar artery perfusion disorder are described, and appropriate images are illustrated for confirmation.
Potential Success of Near‐Total Laryngectomy Despite Postoperative Radiation Therapy
Authors: Terris David J. , Fee Willard E. , Goffinet Donald R.
Published: November 2003

Advanced laryngeal cancers frequently require total laryngectomy (TL). Some of these cancers, however, are suitable for near‐total laryngectomy (NTL). We review our experience with NTL over a 14‐year period and compare the functional results with those obtained over the same period using TL followed by tracheoesophageal puncture (TEP). One particular interest was the results achieved when surgery was preceded or followed by radiation therapy.

From January 1980 through December 1994, 22 patients underwent NTL. The mean age of the 19 men (86.4%) and 3 women (13.6%) was 61.1 ± 9.9 years. Follow‐up ranged from 4 to 109 months, with a mean of 26.5 months. The local control rate was 90.9% (i.e., 20 of the 22 patients). Over the same time period, 11 TEPs were performed in 7 men (63.6%) and 4 women (36.4%) who had a mean age of 60.4 ± 7.2 years.

Compared with the TEP group, the patients in the NTL group had higher mean scores for swallowing, aspiration, and voice quality evaluations, although the differences were not statistically significant. Notably, 21 of 22 patients (95.5%) received preoperative or postoperative radiotherapy. Complications in the NTL group included aspiration, dilated shunt appendix, and inadequate tracheopharyngeal shunt function.

Slight modifications of the NTL technique, including routine entrance into the vallecula in uninvolved larynges, the use of contralateral pyriform mucosa flaps, and the performance of an H‐flap tracheostomy are described. The NTL is a sound on‐cologic procedure for tumors causing vocal cord fixation, and it can be successful even when post‐operative radiotherapy is administered. The quality of speech, the ease of swallowing, and the incidence of aspiration are similar to those in patients who have had a TEP following TL.
Swallowing Disorders in Head and Neck Cancer Patients Treated With Radiotherapy and Adjuvant Chemotherapy
Authors: Lazarus Cathy L. , Logemann Jeri A. , Pauloski Barbara Roa , Colangelo Laura A. , Kahrilas Peter J. , Mittal Bharat B. , Pierce Margaret
Published: November 2003

The nature of swallowing problems was examined in nine patients treated primarily with external‐beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent videofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorders, residue, and aspiration; temporal analyses; and biomechanical analyses. Oropharyngeal swallow efficiency was calculated for the first swallow of each bolus.

Swallow motility disorders were observed in both the oral and pharyngeal stages. Seven of the nine patients demonstrated reduced posterior tongue base movement toward the posterior pharyngeal wall and reduced laryngeal elevation during the swallow. Oropharyngeal swallow efficiency measures were significantly lower in the nine irradiated patients than in age‐matched normal subjects. Between patients and normal subjects, significant differences were found in the measures of timing and distance of pharyngeal structural movements during the swallow, as well as in the measures of coordination during the swallow.

Although treatment of head and neck cancer with external‐beam radiation is designed to provide cancer cure and preserve organ functioning, oral and pharyngeal motility for swallow can become compromised if external‐beam radiation treatment is provided to either the larynx or tongue base regions.
Impaired Ranvier Node Sodium‐Potassium Adenosine Triphosphatase May Induce Facial Palsy
Authors: Kanoh Naoyuki , Sakagami Masafumi
Published: November 2003

To clarify the part of the neuron essential for myelinated nerve conduction, the cytochemical localization of potassium ion (K+)‐dependent p‐nitrophenylphosphatase (K‐NPPase) activity was investigated in the normal and reserpine‐treated facial nerve of guinea pigs. In the normal animals, K‐NPPase activity was localized to the internodal axolemma and Schmidt‐Lanterman incisures. In the Ranvier nodes, enzyme activity was observed along the paranodal and nodal axolemma. In reserpinized nerves, K‐NPPase activity was absent along the internodal axolemma and Schmidt‐Lanterman incisures. In the Ranvier nodes, however, enzyme activity was detectable only in the nodal axolemma. The reserpinized animals demonstrated no evidence of facial palsy. Because K‐NPPase is essential for nerve conduction, these results indicate that the location of enzyme activity in reserpinized animals, namely the nodal axolemma, may be of prime importance in saltatory nerve conduction.
Aging of the Normal Nose in Adults
Authors: Edelstein David R.
Published: November 2003

Like other organs, the nose changes as the body ages. A review of the literature reveals a basic understanding of the aging process in the nose but a paucity of documentation and few organized studies. This study was designed to identify systematically the age‐related changes in the normal, nondiseased adult nose.

A nasal‐sinus laboratory was created, and a computerized patient database was developed. Four separate investigations were conducted. First, 111 subjects ranging in age from 21 to 94 years of age were studied prospectively using 135 variables. The following data were collected: history, symptoms, physical examination, rhinomanometry, ciliary beat frequency, smell testing, and incentive spirometry. Second, photographs of a separate group of 105 subjects 20 to 86 years of age were studied to ascertain the facial cephalometric changes that occur with aging. Third, a histopathologic examination of the nasal septum was performed in 20 additional subjects to evaluate the cellular changes that accompany aging. Finally, an epidemiologic study analyzing the prevalence of various nasal complaints by age was conducted, based on a review of more than 11,000 patient charts from surgeries and office visits.

A number of specific age‐related changes in the nose were identified, including an increased likelihood of certain nasal complaints, a pattern of increasing airflow resistance, and a decrease in physical abnormalities in the nasopharynx. The appearance of the nose, as measured by the nasolabial angle and the height/length ratio, was also found to change with age.

Laryngoscope, 106:(suppl 81):1‐25, 1996
Pediatric Neurotologic Skull Base Surgery
Authors: Jackson C. Gary , Pappas Dennis G. , Manolidis Spiros , Glasscock Michael E. , Von Doersten Peter G. , Hughes C. Anthony , Marrero Rafael J.
Published: November 2003

The objectives of neurotologic skull base surgery are complete resection of the lesion and high‐grade function following surgery. There is a perception that these goals are more difficult to achieve in children than in adults. Skull base disease in children and adolescents is rare. Of the 292 skull base tumors treated from 1970 to 1995 by The Otology Group in Nashville, 15 were in patients 21 years of age or younger, with only 5 patients under 10 years old. In this retrospective study, the authors review these 15 cases and compare them to their adult series.

The pathology encountered in the 15 young patients with skull base tumors included 8 glomus lesions and 4 schwannomas. In these patients, 13 tumors occurred sporadically, and 2 tumors were related to neurofibromatosis type 2. Advanced‐stage disease and malignancy were prevalent in this younger patient group. All patients underwent excision of their skull base tumor, with one procedure considered a subtotal resection.

As compared with an adult glomus tumor series, postoperative cranial nerve function and complication rates were generally worse in the young glomus patients. However, postoperative function and complications were consistent with the extensive procedures required for the treatment of advanced disease. Despite the advances that have been made in imaging and treatment modalities, this study illustrates the need for more timely diagnosis in younger patients with skull base tumors.

Laryngoscope, 106:1205‐1209, 1996
Extended Middle Meatal Antrostomy: The Treatment of Circular Flow
Authors: Coleman John R. , Duncavage James A.
Published: November 2003

Intranasal surgery has changed significantly over the years. The inferior meatal antrostomy has lost favor to the more physiologic middle meatal antrostomy which includes the natural ostium. Difficult‐to‐cure patients may exhibit mucous stasis due to circular flow between ostomies. Kennedy described circular flow in both the experimental model and the clinical arena. We have enlarged his definition of circular flow to include the flow of mucus from the natural ostium or a surgically created ostium to any accessory ostium, either natural or surgically created. We present the extended middle meatal antrostomy, a technique which prevents circular flow and allows the mucociliary system to provide for physiologic drainage of the maxillary sinus. This technique is demonstrated in this report to be safe and effective in the treatment of chronic maxillary sinusitis.

Laryngoscope, 106:1214‐1217, 1996
Temporal Bone Carcinoma: Contemporary Perspectives in the Skull Base Surgical Era
Authors: Pensak Myles L. , Gleich Lyon L. , Gluckman Jack L. , Shumrick Kevin A.
Published: November 2003

Historically, malignant tumors that arose within the temporal bone or that intimately juxtaposed the petrous ridge portended an ominous prognosis. Perusal of the surgical literature from 1950 to 1975 strongly supports the impression that despite heroic surgical efforts many of these patients sustained significant morbidity and a high mortality rate.

This report reviews data accumulated over a 10‐year period study from July 1984 to June 1994 that examines the changing clinical approach to these lesions from both a diagnostic and therapeutic perspective. Analysis of data from 46 patients cared for at the University of Cincinnati Medical Center is presented with a minimum follow‐up of 16 months to a long‐term follow‐up of 11 years. A management algorithm is presented that reflects our contemporary approach to assessment and management of this select patient population.

Laryngoscope, 106:1234‐1237, 1996
Manometric Study of Complete Ostial Occlusion in Chronic Maxillary Atelectasis
Authors: Kass Erik S. , Salman Salah , Montgomery William W.
Published: November 2003

The effect of complete ostial occlusion on static pressure within the human maxillary sinus has not been previously studied. In this study, a novel way to directly determine maxillary sinus pressure is described. Maxillary sinus pressures were measured in five patients with chronic maxillary atelectasis (CMA); these values were compared to values obtained from the contralateral side and from patients with chronic sinusitis.

Measurements were made by introducing an 18‐gauge needle probe through the membranous fontanel of the maxillary sinus and recording the pressure value with an amplified, pressure‐sensitive transducer. The average value recorded in five patients with atelectasis of the maxillary sinus and complete ostial occlusion was ‐8.4 ± 2.6 cm H2O (mean ± standard deviation). Static pressure measurements of the contralateral antrum were isobaric, as were measurements found in patients with chronic sinusitis.

This study reports for the first time the sinus pressure of completely occluded maxillary ostia in patients with CMA. These results may improve our understanding of the development of ostial occlusion and its role in the pathogenesis of CMA and sinusitis.

Laryngoscope, 106:1255‐1258, 1996
Retrospective DNA Ploidy Analysis by Image and Flow Cytometry in Head and Neck Cancer
Authors: Epp Robert A. , Justice William M. , Garcia Fernando U. , McGregor Douglas H. , Giri Shankar P.G. , Kimler Bruce F.
Published: November 2003

A retrospective analysis of DNA content (DNA ploidy) was conducted in formalin‐fixed specimens from patients with advanced, unresectable head and neck cancer who were treated on a single defined protocol with accelerated fractionation radiation therapy and concomitant cisplatin(Platinol®) chemotherapy. Specimens from 31 tumor sites were analyzed by image cytometry using the Feulgen staining method. Fifteen specimens were analyzed by flow cytometry after deparaffinization, nuclear disaggregation, and staining with propidium iodide.

By image analysis, 10 (32%) of 31 specimens contained only diploid tumor cells, while 21 (68%) specimens exhibited at least one aneuploid tumor component. Seven of the eight tumors with a single G0/G1 peak by image analysis had a single peak by flow analysis. Five of the seven tumors with multiple peaks by image analysis had multiple peaks by flow analysis.

Histology was also reevaluated, and tumor grade was determined, reflecting tumor cell differentiation based on keratinization, mitotic activity and the degree of nuclear polymorphism. For this well‐defined patient population managed according to a uniform therapeutic approach, DNA ploidy status and histology provided a suggestion of prognostic separation; however, statistical significance was not obtained, most likely due to the small number of patients.

Laryngoscope, 106:1306‐1313, 1996
Alternating Unilateral Botulinum Toxin Type A (BOTOX®) Injections for Spasmodic Dysphonia
Authors: Koriwchak Michael J. , Netterville James L. , Snowden Todd , Courey Mark , Ossoff Robert H.
Published: November 2003

Injection of botulinum toxin type A (BOTOX®) into both thyroarytenoid muscles is an accepted treatment for spasmodic dysphonia. The authors of this study identified patients who could not tolerate the interval of breathy voice that immediately follows bilateral injections. These patients were offered a protocol in which the injection side was alternated on subsequent treatments. Eighteen patients who received at least two bilateral injections and two unilateral injections were reviewed.

Alternating unilateral injections yielded a shorter breathy interval by an average of 12.7 days (P=.0007) and a shorter duration of return of spasmodic symptoms by an average of 26.0 days (P=.0006). Compared with bilateral injections, alternating unilateral injections yielded an average(median) of 3.2 more days of strong voice per day of breathy voice (P=.001). However, unilateral injections had a shorter average interval of strong voice (27.4 days; P=.007), as well as a slightly higher failure rate (4.9% vs. 1.1%). The authors conclude that alternating unilateral botulinum toxin type A injections are useful in patients with spasmodic dysphonia who have difficulty with the breathy voice that follows bilateral injection.