bluuebunny/crossref_metadata_2025 huggingface dataset:
Overview of Telemedicine Applications for Otolaryngology
Authors: Burgess Lawrence P.A. , Holtel Michael R. , Syms Mark J. , Birkmire‐Peters Deborah P. , Peters Leslie J. , Mashima Pauline A.
Published: November 2003

Objective/Hypothesis: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on‐line.

Study Design: Prospective.

Methods: The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in‐house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral.

Results: Video‐otoscopy captures the image of an eardrum that can be sent from a remote site in a store‐forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in‐house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology.

Conclusion: These efforts performed in a stepwise approach will lead to an otolaryngology‐head and neck surgery service that is on‐line for the next millennium, with telemedicine advances normalized to the standard of care.
Balance and Aging
Authors: Konrad Horst R. , Girardi Marian , Helfert Robert
Published: November 2003

Objectives/Hypothesis: To provide a basic science and clinical review of normal balance changes with age, and to provide a current review for the evaluation and treatment of elderly patients with balance disorders. As we age, we lose balance function through loss of sensory elements, the ability to integrate information and issue motor commands, and because we lose musculoskeletal function. Diseases common in aging populations lead to further deterioration in balance function in some patients. Treatment of balance dysfunction in aging populations is based on the knowledge of normal aging processes and on an evaluation of the individual's balance loss and remaining balance elements. Prevention and rehabilitation play a major role in treatment; medical and surgical therapy also have a place.

Study Design and Methods: Review of literature, personal research and observations.

Results and Conclusions: Although older patients may be subject to most of the common balance disorders of younger patients, they have more problems with chronic disequilibrium and falls. Prevention and rehabilitation play an important role in treating these patients.
Frey Syndrome Before Frey: The Correct History
Authors: Dulguerov Pavel , Marchal Francis , Gysin Claudine
Published: November 2003

Objective: To review the chronology of publications on gustatory sweating before Frey's landmark publication.

Methods: Reports on Frey syndrome were reviewed, and all references given to publications before 1950 were obtained and examined. References to prior publications in the obtained articles were similarly reviewed. The cases described in these publications were analyzed for their compatibility with the accepted clinical symptoms of Frey syndrome.

Results: Despite numerous references, the case described by Duphenix in 1757 is most probably a traumatic parotid fistula. The first reported case of Frey syndrome should be attributed to Baillarger in 1853.
Computer‐Aided Three‐Dimensional Reconstruction and Measurement of the Optic Canal and Intracanalicular Structures
Authors: Tao Hai , Ma Zhizhong , Dai Pu , Jiang Li
Published: November 2003

Objective: To reconstruct the human optic canal and its inner structures and to provide detailed knowledge of this region for optic nerve decompression.

Methods: Six optic canals and their inner structures were reconstructed using a computer‐aided three‐dimensional reconstruction system. Quantitative measurement of the canal wall thickness, bony canal transverse area, optic nerve transverse area, dural sheath transverse area, subarachnoid space transverse area, and subarachnoid space volume was done using the computer morphometric analysis system. The detailed spatial relationship among intracanalicular structures was also carefully identified on the three‐dimensional models.

Results: The thinnest portion of the canal was the middle part of the medial wall (0.45 ± 0.14 mm) and the narrowest space was in the middle part of the optic canal (the transverse area was 18.21 ± 1.20 mm2). The volume of subarachnoid space that can be considered the compensatory space for distention incurred by the hemorrhage, optic nerve edema, or hematoma was 21.16 ± 4.31 mm3. At the cranial opening, the middle part, and the orbital opening, its transverse area was 4.45 ± 0.46 mm2, 2.68 ± 0.54 mm2, and 1.23 ± 0.34 mm2 respectively.

Conclusions: Because the compensatory space was limited, even a tiny amount of blood or swelling of the nerve may cause optic nerve compression. Because the compensatory space for distention gradually decreases from cranial end to orbital end, the middle part and the anterior part of the optic canal and dural sheath are critical in optic nerve decompression.
Increased Expression of Keratinocyte Growth Factor Represents a Stereotypic Response to Tracheal Lumenal Insult Independent of Injury Mechanism
Authors: Hicks Wesley L.
Published: November 2003

Hypothesis: The author hypothesized that keratinocyte growth factor may play a role in mucosal epithelial repair in large conducting airway, and that the nature of the injury, denudation with disruption of the basement membrane by either mechanical or chemical means, versus exfoliation (loss of suprabasal cells only), would be reflected in the growth factor response.

Study Design: This study evaluated the interdependent relationship between respiratory epithelial cells and the surrounding extracellular matrix in response to injury. In human cutaneous models, both keratinocyte growth factor and basic fibroblast growth factor are important in repair process.

Method: A sterile tracheal explant culture system was developed that allows for controlled wounding of the epithelial surface using either 1) NaOH, 2) mechanical debridement, or 3) suprabasal exfoliation. Control and injured bovine tracheas were studied by immunohistochemistry up to 24 hours after injury.

Results: Keratinocyte growth factor expression was strongly upregulated in epithelium and submucosa of denuded, but not exfoliation cultures, irrespective of means of injury. Disruption of the basement membrane by any means triggers a stereotypic growth factor response paradigm. This growth factor response has a consistent spatial, but variable, temporal relationship that is influenced by the type of injury‐mechanical versus chemical.

Conclusion: This work demonstrates that the type of injury (denudation vs. exfoliation) affects the expression patterns of growth factors that may be important for airways repair.
Head and Neck Computed Tomography Virtual Endoscopy: Evaluation of a New Imaging Technique
Authors: Gallivan Ryan P. , Nguyen Thong H. , Armstrong William B.
Published: November 2003

Objective: To evaluate a new radiographic imaging technique: computed tomography virtual endoscopy (CTVE) for head and neck tumors.

Study Design: Twenty‐one patients presenting with head and neck masses who underwent axial computed tomography (CT) scan with contrast were evaluated by CTVE. Comparisons were made with video‐recorded images and operative records to evaluate the potential utility of this new imaging technique.

Methods: Twenty‐one patients with aerodigestive head and neck tumors were evaluated by CTVE. One patient had a nasal cylindrical cell papilloma; the remainder, squamous cell carcinomas distributed throughout the upper aerodigestive tract. Patients underwent complete head and neck examination, flexible laryngoscopy, axial CT with contrast, CTVE, and in most cases, operative endoscopy. Available clinical and radiographic evaluations were compared and correlated to CTVE findings.

Results: CTVE accurately demonstrated abnormalities caused by intraluminal tumor, but where there was apposition of normal tissue against tumor, inaccurate depictions of surface contour occurred. Contour resolution was limited, and mucosal irregularity could not be defined. There was very good overall correlation between virtual images, flexible laryngoscopic findings, rigid endoscopy, and operative evaluation in cases where oncological resections were performed. CTVE appears to be most accurate in evaluation of subglottic and nasopharyngeal anatomy in our series of patients.

Conclusion: CTVE is a new radiographic technique that provides surface‐contour details. The technique is undergoing rapid technical evolution, and although the image quality is limited in situations where there is apposition of tissue folds, there are a number of potential applications for this new imaging technique.
Can Topical Mitomycin Prevent Laryngotracheal Stenosis?
Authors: Eliashar Ron , Eliachar Isaac , Esclamado Ramon , Gramlich Terry , Strome Marshal
Published: November 2003

Objectives/Hypothesis:Early topical application of mitomycin to a laryngotracheal lesion may prevent or reduce laryngotracheal stenosis (LTS).

Study Design:Prospective controlled animal study.

Methods:LTS was induced in 60 dogs randomly assigned to four groups. Controls received an immediate topical application of normal saline. The suction‐control group received an immediate application of normal saline followed by suction of secretions on day 2. The mitomycin group received immediate application of 0.7 mL mitomycin (0.2 mg/mL). The repeat‐mitomycin group received an immediate application of mitomycin and a second application on day 2, after secretions were suctioned. The laryngeal lumens were measured endoscopically at baseline, day 12, and day 21. Animals were euthanatized if stenosis approximated 95% or at day 21.

Results:All dogs in the mitomycin groups survived to day 21, compared with 12 in the suction group and only 2 controls. No side effects of mitomycin were observed. At day 21, surviving controls had 85% and 95% stenosis. In the mitomycin group, median stenosis was 27% (interquartile range, 29% to 42%); in the repeat‐mitomycin group, 30% (22% to 40%); and in the suction‐control group, 84.5% (72.5% to 93.5%). The mitomycin group differed significantly from controls on day 12 (median difference = 85%, 95% CI = 80%‐94%,P< .0001) and day 21 (difference = 63.9%, 95% CI = 58%‐85%,P= .031).

Conclusion:A single topical application of mitomycin significantly reduces the severity of LTS in dogs. Reapplication after 2 days does not improve results. Prospective clinical studies are warranted to assess the efficacy in humans.
Surgical Management of Obstructive Sleep Apnea in Children With Cerebral Palsy
Authors: Magardino Thomas M. , Tom Lawrence W.C.
Published: November 2003

Objectives: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy.

Study Design: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea.

Methods: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome.

Results: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea. Three of these children also had a uvulectomy. Six children had an adenoidectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow‐up was 34 months. Seventy‐six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four children ultimately required a tracheotomy.

Conclusions: Eighty‐four percent of these children were successfully managed without a tracheotomy. We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.
Diagnosis and Management of Intralabyrinthine Schwannomas
Authors: Green J. Douglas , McKenzie John D.
Published: November 2003

Objectives/Hypothesis: Describe the symptoms, signs, radiographic findings, and treatment results for four patients with intralabyrinthine schwannoma beginning either primarily within the labyrinth or extending secondarily into the labyrinth from the internal auditory canal.

Study Design: Retrospective review.

Methods: Review of clinic records, operative records, imaging studies with follow‐up telephone interview, and when possible, repeat examination.

Results: Four patients with intralabyrinthine schwannoma treated by the first author were identified. Episodic vertigo, indistinguishable from Meniere's disease, was present in all but one of the patients in this study. A progressive unilateral hearing loss was also found in all of the patients. Magnetic resonance imaging revealed tumor isolated to the vestibule in two patients with the cochlea primarily involved in the other two patients. Intracochlear tumor extending into the internal auditory canal had been missed on preoperative imaging in one patient and was found during a translabyrinthine vestibular nerve section. In another patient with an intracanalicular schwannoma, tumor extending into the basal turn of the cochlea was not removed during a translabyrinthine approach to the internal auditory canal. The tumor subsequently recurred, necessitating a transotic approach for removal. A transmastoid/translabyrinthine approach was used to successfully remove tumor in one patient. Another patient with good hearing and no vestibular symptoms at time of this writing is being followed with serial imaging studies. As expected, the three patients who underwent surgery have anacusis in the operated ear and are free of vertigo at follow‐up intervals of 12, 26, and 65 months.

Conclusions: Intralabyrinthine schwannomas are rare tumors with optimal treatment being determined by the symptoms, tumor location, and hearing. Findings of an intralabyrinthine schwannoma on magnetic resonance imaging may be easily over‐looked and attributed to inflammatory changes.
A Review of Objective Methods of Evaluating Auditory Neural Pathways
Authors: Hood Linda J.
Published: November 2003

Objectives: Review physiological methods of evaluating function of the auditory neural pathways in infants, children, and adults. Present two case studies to demonstrate the usefulness of physiological measures in assessing abnormalities of the auditory neural pathways.

Study Design: Review of applications of physiological measures of auditory neural function.

Methods: Review otoacoustic emissions, auditory evoked potentials, and efferent reflexes, and discuss their use in identifying disorders of the auditory neural pathways from the cochlea to the cortex.

Results: Auditory disorders occur from peripheral to central areas of the neural system. Patients with disorders of the peripheral nerve and/or the input from the cochlear inner hair cells, such as the patients presently described as having auditory neuropathy, demonstrate abnormal efferent reflexes, including middle ear muscle reflexes and efferent suppression of otoacoustic emissions, as well as grossly abnormal brainstem evoked potentials. In contrast, patients with more central disorders can be differentiated by normal results on tests of the neural periphery and abnormal findings on cortical evoked potentials and other measures of central function.

Conclusions: Physiological measures are sensitive, objective, and less variable in assessing neural disorders than traditional behavioral measures such as pure‐tone or speech audiometry.
Computer‐Aided Surgery in the Petrous Bone
Authors: Gunkel Andreas R. , Vogele Michael , Martin Arno , Bale Reto J. , Thumfart Walter F. , Freysinger Wolfgang
Published: November 2003

Objectives: We demonstrate that computer‐assisted frameless stereotactic navigation with the ISG/ELEKTA Viewing Wand system in the petrous bone is routinely possible with sufficient application accuracy.

Methods: High‐resolution computed tomography imaging is done with a dedicated structure attached to the mouthpiece of the Vogele‐Bale‐Hohner (VBH) head holder, an integral part of our intraoperative patient fixation. The patient image registration can be reliably performed before surgery in an unsterile environment with the registration structure of the mouthpiece. For intraoperative navigation either the position‐sensitive articulated arm or the optical three‐dimensional digitizer of the ISG/ELEKTA system is used.

Results: In the operations of the petrous bone performed so far, i.e., mastoidectomy, cholesteatoma surgery, and lateral skull base revision surgery, the clinical value of three‐dimensional navigation was clearly demonstrated with an application accuracy, constant throughout surgery, mostly limited only by the resolution of the computed tomography.
Ototoxic Impact of Cisplatin in Pediatric Oncology Patients
Authors: Berg Abbey L. , Spitzer Jaclyn B. , Garvin James H.
Published: November 2003

Objective: To describe hearing changes in a group of 28 children (age range, 8‐180 mo) undergoing protocol‐based cisplatin therapy.

Methods: Conventional, play audiometry, visual reinforcement audiometry (VRA), immittance audiometry, transient click evoked otoacoustic emissions (OAEs), and auditory brainstem response (ABR) evoked potentials were used to assess peripheral sensitivity and for threshold determination.

Results: Bilateral symmetrical high‐frequency sensorineural hearing loss was noted in 9 of the 28 children (26%). Hearing loss was evident as early as 1 month after chemotherapy and as late as 50 months and was not dependent on individual or cumulative dosage of cisplatin.

Conclusions: 1) Presence of sensorineural hearing loss was independent of individual and/or cumulative dosage of cisplatin; 2) audiologic assessment should be incorporated into a child's periodic medical evaluations after chemotherapy treatment, as onset of sensorineural hearing loss cannot be predicted; 3) personal hearing aids may be indicated for those children with hearing loss affecting the low‐ to mid‐frequencies; a personal assistive listening device (frequency modulated system) may be more appropriate for losses above 3000 Hz; and 4) evaluation and intervention by a speech‐language pathologist may be indicated to address possible articulation or language development problems consequent to hearing loss.
Endotoxin and Tumor Necrosis Factor‐α in Middle Ear Effusions in Relation to Upper Airway Infection
Authors: Nell Marja J. , Grote Jan J.
Published: November 2003

Objectives/Hypothesis: This study was performed to elucidate the role of endotoxin and tumor necrosis factor‐α (TNF‐α) in the middle ear effusions (MEEs) of children with otitis media with effusion (OME) in relation to the chronicity of the disease and the presence of upper respiratory tract infection (URTI).

Study Design: In a retrospective study 140 MEEs were collected from 101 children between 2 and 12 years of age, and evaluated for the cytokine TNF‐α and the lipopolysaccharide endotoxin. The amounts were quantified and correlated with the type of MEE, OME duration, and the presence of URTI.

Methods: Endotoxin levels were measured using a limulus amebocyte lysate assay and TNF‐α levels were measured with an enzyme‐linked immunosorbent assay (ELISA). Means of the different variables were compared using the one‐way ANOVA least significance difference test with P < .05

Results: In MEEs classified as mucopurulent (22.8%) both endotoxin and TNF‐α levels (11.9 ± 3 ng/mg total protein and 61.1 ± 21 pg/mg total protein, respectively) were significantly higher compared with serous‐ (23.6%) or mucoid‐ (53.6%) type effusions. Fifty‐five percent of the children who were classified as having chronic OME also had significantly higher amounts of endotoxin and TNF‐α. The majority of the children (61%) had no URTI, although children with URTI (36%) did also have significantly higher levels of endotoxin and TNF‐α in their middle ears.

Conclusions: These results indicate that there is a strong correlation between the endotoxin and the TNF‐α concentration in the middle ear and the type of MEE, the presence of URTI, and the chronicity of the disease.
A Safe, Alternative Technique for Inferior Turbinate Reduction
Authors: Friedman Michael , Tanyeri Hasan , Lim Jessica , Landsberg Roy , Caldarelli David
Published: November 2003

Objective: Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates.

Study Design: A prospective study of 120 consecutive patients who underwent submucous resection of the inferior turbinates with a microdebrider.

Methods: Patient questionnaires were used for subjective assessment of symptoms before and after the procedure. We graded each patient's inferior turbinates for size from I to III before and 6 weeks after surgery for objective analysis.

Results: The common complications of standard submucous resection of inferior turbinates include excessive resection, postoperative bleeding, and crusting. The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue that is removed on a submucosal plane. The complications encountered with this technique are limited to postoperative bleeding that occurred in 1.6% of patients. There was no crusting or excessive removal of tissue.

Conclusion: The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.
Videostrobokymography: A New Method for the Quantitative Analysis of Vocal Fold Vibration
Authors: Sung Myung‐Whun , Kim Kwang Hyun , Koh Tae‐Yong , Kwon Tae‐Young , Mo Ji‐Hun , Choi Seung‐Ho , Lee Jae Sung , Park Kwang Seok , Kim Eom Joon , Sung Mee Young
Published: November 2003

Objectives: To develop a new analysis method for the quantitative assessment of vibration of the vocal folds, using conventional videostroboscopic image data.

Methods: We used prerecorded videostroboscopic images to evaluate quantitatively the vibration of the vocal folds. Successive images were converted as digital images by means of an image‐grabbing board, processed for analysis, and reconstructed as kymograms by rearranging the same lines of all processed images along the time axis.

Results: We developed a new technique for evaluating the vibration of the vocal folds. The vibrations of multiple vocal fold regions were easily and objectively evaluated by this technique. The objective parameters, such as open quotient and asymmetry index, could be obtained easily using this technique.

Conclusions: Videostrobokymography demonstrated objectively the vibrations of several vocal fold regions at the same time. This technique has the potential to be a new tool to analyze and monitor the pathological changes and treatment results of vocal fold movement in a more refined quantitative fashion, using videostroboscopic images.
Clinical Predictors of Obstructive Sleep Apnea
Authors: Friedman Michael , Tanyeri Hasan , La Rosa Manuel , Landsberg Roy , Vaidyanathan Krishna , Pieri Sara , Caldarelli David
Published: November 2003

Objective: To identify physical findings that can be standardized to predict the presence and the severity of obstructive sleep apnea (OSA).

Study Design: One hundred seventy‐two patients who answered questionnaires with responses that suggested they might have OSA were included in this prospective study.

Methods: All patients underwent a physical examination and polysomnography. The physical examination included the measurement of four parameters used by anesthesiologists to identify patients likely to have difficult intubation to determine if these same parameters predict OSA. We recorded modified Mallampati grade (MMP), tonsil size, and body mass index (BMI) and measured thyroid‐mental distance (TMD) and hyoid‐mental distance (HMD) in the study population.

Results: When the physical findings were correlated singly with the respiratory disturbance index (RDI), we found that MMP (P < .001), tonsil size grading (P = .008), and BMI (P = .003) were reliable predictors of OSA. A greater correlation with OSA emerged when an “OSA score” was formulated by factoring the MMP, tonsil grade, and BMI grade (RDI = 7.816 × MMP + 3.988 × Tonsil Size + 4.675 × BMI − 7.544). A high score was not only predictive of OSA but also correlated well with OSA severity. Neither HMD nor TMD correlated with the severity of RDI.

Conclusions: An OSA score may help identify those patients who should have a full sleep evaluation.
Advantages of a New Miniature Hearing Aid for Mild to Moderate Hearing Loss
Authors: Goode Richard L. , Krusemark Jodi
Published: November 2003

Objectives/Hypothesis: To evaluate the performance of a new, miniature, behind‐the‐ear hearing aid designed for individuals with mild to moderate high‐frequency hearing loss who need an aid but are reluctant to try one. The aid is essentially invisible, leaves the ear canal open, and can be fit in less than 30 minutes without an ear impression. The cost is less than $500.

Study Design: A 4‐week trial of the aid in 63 ears (62 subjects) with mild to moderate bilateral hearing loss.

Methods: A questionnaire was completed at the end of the study by each subject asking them to evaluate several features of the aid (cosmesis, comfort, understanding speech, amplification, and so forth) and to compare their unaided performance in quiet and in noise with the test hearing aid. A rating scale of 1 to 10 was used, with 10 being excellent and 1 poor.

Results: Subjective improvement in understanding speech in both quiet (5.8→7.3) and noise (4.6→5.9) occurred with the aid. Cosmesis, comfort, and appearance were highly rated (mean scores, > 8).

Conclusions: This aid appears to have several features (comfort, cost, performance, and cosmesis) that make it ideal as a first aid for patients with mild to moderate losses.
Role of Aerating Mastoidectomy in Noncholesteatomatous Chronic Otitis Media
Authors: Ruhl Charles M. , Pensak Myles L.
Published: November 2003

Objective: To assess the success rate of revision tympanoplasty with aerating mastoidectomy in patients with noncholesteatomatous chronic otitis media who had failed at least one prior tympanoplasty.

Study Design: Retrospective chart review.

Methods: Data were analyzed from 135 patients available for clinical and audiometric studies with a minimum of 18 months' follow‐up. All patients had failed at least one prior tympanoplasty and presented with: 1) a persistent tympanic membrane perforation with intermittent drainage, or 2) a wet draining ear, unresponsive to systemic antibiotic and topical management. All patients underwent 1.5‐mm, high‐density, bone window computed tomography (CT) scanning to assess middle ear, epitympanic, and mastoid air cell pneumatization. All patients underwent revision tympanoplasty with aerating mastoidectomy via a post‐auricular approach. Patient charts were reviewed for information regarding preoperative radiographic findings, mucosal and ossicular findings at the time of surgery, and success or failure of revision tympanomastoidectomy.

Results: The tympanic membrane graft take rate for the entire group of 135 patients was 90.4% (13 grafts failed). A majority of the patients were found to have radiographic and intraoperative evidence of middle ear/mastoid disease.

Conclusion: For patients with noncholesteatomatous chronic otitis media who have failed prior tympanoplastic reconstruction, an aerating mastoidectomy may be indicated and may improve the success rate of the surgery.
A Comparison of Asian and White Patients With Obstructive Sleep Apnea Syndrome
Authors: Li Kasey K. , Powell Nelson B. , Kushida Clete , Riley Robert W. , Adornato Bruce , Guilleminault Christian
Published: November 2003

Objective: To evaluate the possible differences between Asian and white patients with obstructive sleep apnea syndrome.

Methods: A retrospective review of Asian and white patients during a 12‐month period was conducted. Patients with respiratory disturbance index (RDI) ≥ 15 based on polysomnography were included in the study. Variables examined include age, sex, body mass index (BMI), RDI, lowest oxygen saturation (LSAT), and cephalometric analysis data.

Results: Fifty‐eight Asian patients (53 men) and 293 white patients (260 men) were studied. The Asians were younger (44.1 ± 9.8 vs. 47.5 ± 11.6 y, P = .02), and the mean BMI (kg/m2) was 26.6 ± 3.7 in the Asians and 30.7 ± 5.9 in the whites (P < .001). The mean RDI was similar (56.6 ± 34.9 vs. 55.6 ± 26.9, P = NS), but the mean LSAT was lower in the whites (77.7 ± 9.9% vs. 70.0 ± 15.6%, P < .001). Based on the cephalometric data, the Asians have maxillomandibular protrusion, narrower cranial base angle, larger posterior airway space, and more superiorly positioned hyoid bone compared with the whites.

Conclusions: Although male gender was found to be an important risk factor for obstructive sleep apnea syndrome in both Asian and white patients, obesity may be a less significant risk factor in the Asians because the majority of our Asian patients were nonobese. There was also variability in the craniomandibular factors that contributed to obstructive sleep apnea syndrome in the two groups.
Impact of Steroids on Recovery After Uvulopalatopharyngoplasty
Authors: Williams Paul M. , Strome Marshall , Eliachar Isaac , Lavertu Pierre , Wood Benjamin G. , Vito Kenneth J.
Published: November 2003

Objective: To determine whether perioperative systemic corticosteroid administration can reduce uvulopalatopharyngoplasty (UPPP) postoperative morbidities (e.g., pain, anorexia, sleep disturbance, mouth odor, and fatigue) or reduce narcotic analgesic usage.

Study Design: A prospective, double‐blinded study with random assignment of treatment agent (placebo or corticosteroid).

Methods: From 1995 to 1998, a consecutive sample of 48 adults presenting for elective UPPP surgery alone or in combination with tonsillectomy or septoplasty, or both, were enrolled. Twenty‐eight subjects completed the protocol and were equally distributed by random assignment to intramuscular (IM) and intravenous (IV) doses of placebo (saline) or corticosteroid (60 mg methylprednisolone IM and 12 mg dexamethasone IV). Acetaminophen with codeine analgesic was available to both groups as needed. Subjects recorded a diary of symptom severity scores over the first postoperative week relating to eight commonly reported morbidities (1‐4 points) and the daily quantity of narcotic consumed.

Results: Statistical comparison (Wilcoxon's rank sum test) showed no significant differences between subjects treated with placebo or corticosteroid on postoperative day 1 or 7. Three subjects (21%) in each treatment group reported no postoperative use of narcotic analgesic.

Conclusions: No statistically or clinically significant benefits were derived from perioperative systemic corticosteroid treatment in this sample of 28 adults treated with UPPP alone or in combination with tonsillectomy or septoplasty, or both. Some individuals tolerate post‐UPPP discomfort without a narcotic analgesic.
Role of Sensation in Swallowing Function
Authors: Bastian Robert W. , Riggs Landon C.
Published: November 2003

Objectives: Sensation in the oral cavity and laryngopharynx has long been believed to be crucial for normal swallowing. One illustration of this belief has been intense interest in reconstruction after cancer resection using sensate tissue transfer as a means of improving swallowing function. A contrarian view is that mucosal sensation, by itself, is, in fact, relatively unimportant to swallowing function.

Study Design: A prospective study was designed to test the hypothesis that normal swallow function can occur with anesthesia of the upper aerodigestive tract mucosa.

Methods: Baseline (sensate) swallowing function of 13 healthy adults was assessed via video endoscopic swallow studies (VESS). Each subject was then topically anesthetized with lidocaine applied to the oral cavity, oropharynx, hypopharynx, and larynx. Swallowing was then reassessed via VESS and compared to the baseline examination to look for differences in function.

Results: There was little difference in swallowing ability between sensate and anesthetized states, even though all the subjects felt that their swallowing had been profoundly disrupted after lidocaine was applied. The main difference was a small increase in the time from food administration to swallowing. A few experienced trace aspiration, which was instantly eliminated on subsequent swallows with simple coaching.

Conclusion: Normal swallowing can occur spontaneously or with simple coaching even with complete anesthesia of the upper aerodigestive tract mucosa. Current beliefs about the value of sensate free flaps and the importance of sensation in swallowing in general may need refinement.
Audiologic Evaluation of Neonates With Severe Hyperbilirubinemia Using Transiently Evoked Otoacoustic Emissions and Auditory Brainstem Responses
Authors: Rhee Chung‐Ku , Park Hyun‐Min , Jang Yong‐Ju
Published: November 2003

Objectives: To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates.

Study Design: Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3‐year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow‐up visit after discharge. Follow‐up ABR tests were performed when infants showed significant hearing loss.

Methods: ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow‐up ABR tests were carried out in 3‐month intervals in the four neonates who showed abnormal or no response on initial ABR.

Results: Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3‐ or 6‐month follow‐up ABR.

Conclusion: The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.
Evaluation of Airway Obstruction Using Virtual Endoscopy
Authors: Burke Alan J. , Vining David J. , McGuirt William F. , Postma Gregory , Browne J. Dale
Published: November 2003

Objectives: This study examines the use of virtual endoscopy (VE) in the evaluation of patients with upper airway obstruction. The utility of VE compared with actual endoscopy was investigated with respect to accuracy of diagnosis and reproduction of endoscopic images.

Study Design: A random cohort of 30 patients with various causes of airway obstruction was examined.

Methods: The computed tomography (CT) data were reconstructed using a proprietary VE software program, FreeFlight, blind to the actual endoscopic findings. The cause of obstruction was identified and compared with actual endoscopic findings. This included 21 patients with airway stenoses, 8 patients with laryngotracheomalacia, 3 tracheal tumors, 2 glottic webs, 5 patients with innominate artery compression, 2 tracheal granulomas, and 7 patients with impaired true vocal cord mobility.

Results: Virtual endoscopic evaluation was accurate in assessing stenosis width and length of fixed airway lesions. Correlation of stenosis shape and contour between actual endoscopy and VE was excellent. The stenosis‐to‐lumen ratios were compared between VE and actual endoscopy and were found to be within 10% (SD = 8). However, virtual endoscopic evaluation could not illustrate one of the glottic webs, half of the cases of tracheomalacia, or any of the cases of impaired true vocal cord mobility.

Conclusions: Virtual endoscopy was not as sensitive as actual endoscopy in detecting the cause of airway obstruction that was based on dynamic movement. However, VE was excellent for the measurement and definition of fixed airway lesions.
Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection
Authors: Prim María P. , de Diego Juan I. , Fernández‐Zubillaga Amelia , García‐Raya Pilar , Madero Rosario , Gavilán Javier
Published: November 2003

Objectives: To assess the patency and flow of the internal jugular vein after functional neck dissection.

Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997.

Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography.

Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery.

Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.
Detection of Squamous Cell Carcinoma of the Oral Cavity by Imaging 5‐Aminolevulinic Acid‐Induced Protoporphyrin IX Fluorescence
Authors: Leunig Andreas , Betz Christian S. , Mehlmann Michael , Stepp Herbert , Arbogast Susanne , Grevers Gerhard , Baumgartner Reinhold
Published: November 2003

Objectives: Early cancer detection is the best way to improve the prognosis of patients with oral cancer. Therefore this study presents quantitative fluorescence measurements and results in the visualization of cancerous oral mucosa with 5‐aminolevulinic acid (5‐ALA)‐induced protoporphyrin IX (PPIX).

Methods: Time progression and type of porphyrin accumulation were analyzed in neoplastic and surrounding healthy tissue of 58 patients with a suspected cancer of the oral cavity by measuring emission spectra of 5‐ALA‐induced PPIX fluorescence. Fluorescence images in the red and green spectral range from the tumor tissue were recorded with a charge‐coupled device camera.

Results: After topical application of 0.4% 5‐ALA and incubation for 1 to 2.5 hours, all patients revealed higher intensities of red fluorescence in neoplastic tissue compared with the surrounding normal tissue. Maximum contrast was reached after 1.5 hours of incubation. In 13.8% (n = 8) of the patients, additional findings like dysplasia, carcinoma in situ, primary tumor, secondary carcinomas, and tumor branches were found by means of fluorescence marking in contrast to white light examination. An evaluation of the biopsy specimens resulted in a specificity of 60% and a sensitivity of 99%.

Conclusions: As a fluorescent marker, PPIX could represent a possible new diagnostic tool to detect early malignant and secondary lesions in the oral cavity. In addition, 5‐ALA‐induced PPIX fluorescence is promising as a useful intraoperative tool for determining adequate surgical margins of resection. Further investigations aim to assess this diagnostic procedure as a sensitive and clinically reliable method for patients with oral cancer.
Expression of Angiogenic Growth Factors in Paragangliomas
Authors: Jyung Robert W. , LeClair Elizabeth E. , Bernat Richard A. , Kang Thomas S. , Ung Feodor , McKenna Michael J. , Tuan Rocky S.
Published: November 2003

Objective/Hypothesis: To determine if angiogenic growth factors including vascular endothelial growth factor (VEGF) and platelet‐derived endothelial cell growth factor (PD‐ECGF) are expressed in human paragangliomas.

Study Design: A histopathologic and molecular examination of paraganglioma specimens obtained from surgical cases or retrieved from the Pathology Department of the Massachusetts Eye and Ear Infirmary.

Methods: Fresh tumor or archival, paraffin‐embedded paraganglioma specimens were analyzed by immunohistochemistry, Western blotting, and ELISA.

Results: Positive immunohistochemical staining for VEGF was observed in five of nine surgical specimens and in six of eight archival specimens (11/17, or 65%). PD‐ECGF immunoreactivity was detected in four of five surgical specimens and six of eight archival specimens (10/13, or 77%). The presence of PD‐ECGF was confirmed by Western blot assay and ELISA confirmed the presence of VEGF in tumor extract.

Conclusions: Both VEGF and PD‐ECGF are expressed in paragangliomas and may contribute to the extreme vascularity of these tumors.
Documentation of Variations in Sinonasal Anatomy by Intraoperative Nasal Endoscopy
Authors: Joe John K. , Ho Steven Y. , Yanagisawa Eiji
Published: November 2003

Objectives: Functional endoscopic sinus surgery (FESS) requires a thorough understanding of the variability in sinonasal anatomy. Previous reports have relied primarily on anatomic studies of cadaveric specimens or skulls, or on radiographic analysis. Relatively few comparative anatomic data have been accumulated with endoscopic examination of living patients.

Study Design: Retrospective review of video recordings of 119 consecutive patients undergoing intraoperative nasal endoscopy at the time of sinonasal surgery.

Methods: At the beginning of each surgical procedure, endoscopic examination of the nasal cavities was performed with 0° and 30° telescopes and recorded with a three‐chip video camera on 3/4‐inch U‐matic videotape. These video records were then reviewed with attention to variations in anatomical configuration of different sinonasal structures.

Results: Data demonstrating variations in the anatomical configuration of the following structures of the lateral nasal wall are presented. Middle turbinate: typical (63%), concha bullosa (15%), sagittal cleft (6%), laterally displaced (4%), “L” shaped (3%), medially bent (3%), laterally bent (3%), medially displaced (2%), and transverse cleft (0.5%). Uncinate process: typical (85%) and medially rotated (15%). Ethmoid bulla: typical or balloon (45%), sausage‐shaped (34%), and flat (21%). Accessory ostium: round (50%), oval (46%), and kidney‐shaped (4%). Sphenoid sinus ostium: oval (42%), slit (32%), and round (26%). The classification system for the anatomical categories is illustrated with digitized images.

Conclusions: This study attempts to provide statistical data regarding variations in sinonasal anatomy in living subjects. Familiarity with such anatomy is important in differentiating normal variants from pathological conditions to optimize surgical treatment of sinus disease, while avoiding complications.
Update on Intratympanic Gentamicin for Meniere's Disease
Authors: Blakley Brian W.
Published: November 2003

Objective: To review the literature relating to intratympanic gentamicin injection therapy for Meniere's disease to detect consistencies and differences that might suggest optimal technique.

Design: Retrospective literature review.

Methods: Eighteen papers from the literature regarding clinical experience with intratympanic gentamicin injections for treatment of Meniere's disease were reviewed and tabulated.

Results: All papers reported high success rates in treating episodic vertigo of Meniere's disease, but technique, dose, duration, and treatment philosophy varied considerably. Hearing loss was typically reported in about 30% of patients.

Conclusion: No single technique of gentamicin injection has a significant medical advantage over the others. Until controlled studies indicate otherwise, nonmedical needs such as convenience and safety may be considered when choosing a technique.
Fontanelle and Uncinate Process in the Lateral Wall of the Human Nasal Cavity
Authors: Yoon Joo‐Heon , Kim Kyung‐Su , Jung Dong Hak , Kim Sung‐Shik , Koh Ki Seok , Oh Chang Seok , Kim Hee Jin , Lee Jeung‐Gweon , Chung In‐Hyuk
Published: November 2003

Objectives: Although a complete anatomic knowledge of the fontanelle is a prerequisite to perform a surgical antrostomy opening, little is known about the boundary, shape, and size of the fontanelle. The purpose of this paper is to determine the best site for maintaining the patency of a surgical antrostomy opening by defining the anatomic boundaries, shape, and size of the fontanelle as well as its histological structure.

Materials and Methods: One hundred sagittally divided heads were utilized. Mucosa overlying the lateral nasal wall was carefully removed with an operating microscope under 6× magnification. In some cases, a double mucous membrane, including the posteroinferior portion of the uncinate process, was cut as a whole and embedded in paraffin. The sections were stained with H&E.

Results: The boundary of the fontanelle and the location of the natural ostium were described in detail. Eight patterns of the posteroinferior portion of the uncinate process were observed. There were three major fontanelle shapes when observed from the medial aspect to the lateral: triangular, pencil‐like, and oval. The triangular type was the most common. The anterior portion of the fontanelle was shorter than the posterior when observed medially and was wider than the posterior portion when observed inferiorly.

Conclusions: The anterior portion of the fontanelle is more prone to stenosis than the posterior portion. An antrostomy in the posterior fontanelle may be more ideal for a middle meatal antrostomy of the maxillary sinus.