bluuebunny/crossref_metadata_2025 huggingface dataset:
Gas Exchange Function Through the Mastoid Mucosa in Ears After Surgery
Authors: Takahashi Haruo , Honjo Iwao , Naito Yasushi , Miura Makoto , Tanabe Makito , Hasebe Seishi , Toda Hiroshi
Published: November 2003

Gas exchange function through the mastoid mucosa was investigated in ears after surgery using nitrous oxide. Increase in the mastoid pressure was assessed by a micropressure sensor placed in the mastoid cavity during the second‐stage revision operation performed under general anesthesia using 67% nitrous oxide, 33% oxygen, and sevoflurane on 14 ears with chronic adhesive otitis media or cholesteatoma as well as on seven ears without inflammation as controls. All seven control ears showed pressure increase in the mastoid in various degrees. In the 14 postoperative ears, nine of the 10 ears on which the mastoid mucosa had previously been able to be preserved in various degrees showed pressure increase in the mastoid, but none of the remaining four ears, which had previously had mastoidectomy, showed any pressure increase. The presence or absence of the mastoid pressure increase of those ears was also found to be correlated well with the presence or absence of mastoid aeration on computed tomography examined just before the second‐stage operation. These results appear to indicate that, in ears after surgery, recovery of both the gas exchange function and aeration in the mastoid is expected only when the mastoid mucosa can be preserved even partially.
Foramen Thyroideum: A Comparative Study in Embryos, Fetuses, and Adults
Authors: León Xabier , Maranillo Eva , Mirapeix Rosa Maria , Quer Miquel , Sañudo José Ramón
Published: November 2003

The incidence and characteristics of foramen thyroideum (FT) in embryonic and/or fetal larynges have not been established. In the present study, 90 adult larynges and 53 embryonic‐fetal larynges were studied. The incidence of FT during the embryonic‐fetal period (57%) was statistically different from the adult period (31%) (P = 0.005). All the FT found in the adult period contained vessels and/or nerves, while in the embryonic and fetal period only 63% presented neurovascular elements (P < 0.001). The origin of FT in the embryonic period and its persistence during adult life is discussed.
Skin Grafting in Otology
Authors: Harvey Steven A.
Published: November 2003

Proper healing after surgery of the external auditory canal and open‐cavity mastoid depend on epithelialization of exposed surfaces. This may be retarded by the formation of abundant granulation tissue or cicatrix, which can be dealt with by the use of thin, split‐thickness skin grafts. This technique, which has received little attention in the literature, is described in detail and nine cases treated for various disorders are illustrated. Patient ages ranged from 5 to 80 years and the mean follow‐up was 17.2 years. Results, complications, and caveats for successful grafting are presented.
Ribonucleases May Limit Recovery of Ribonucleic Acids From Archival Human Temporal Bones
Authors: Lee Kenneth H. , McKenna Michael J. , Sewell William F. , Ung Feodor
Published: November 2003

Messenger ribonucleic acid (mRNA) for actin was detected in celloidin‐embedded archival human temporal bone sections with reverse transcription polymerase chain reaction (RT‐PCR). Actin mRNA was detected in 10% of sections analyzed. One possible reason for this modest detection incidence is enzymatic degradation of RNA by exogenously introduced ribonucleases (RNases). We have identified steps of the temporal bone processing protocol for archival storage in which exogenous RNases could be introduced to the tissue, and have verified that the bone sections are exposed to these enzymes. We have demonstrated that implementing precautions to minimize exogenous RNase contamination during processing improves recovery of intact RNA. This study indicates that although gene expression analysis of archival human temporal bones may be limited by enzymatic degradation of RNA, simple modification of processing protocol can improve yield of informative data.
Physiologic Effects of an External Nasal Dilator
Authors: Griffin John W. , Hunter Gary , Ferguson Drew , Sillers Michael J.
Published: November 2003

An external nasal dilator (Breathe Right, CNS, Inc., Bloomington, MN) has become popular with athletes. The dilator is an adhesive band with a central elastic strip. When applied across the nasal valve, the device theoretically increases nasal valve area. We used acoustic rhinometry (Hood Laboratories, Pembroke, MA) to measure the cross‐sectional area at the nasal valve with and without the device in 53 athletes. Thirty athletes were exercised on a cycle ergometer with and without the device while measuring physiologic parameters, including oxygen consumption (VO2), heart rate, and respiratory rate. The study was conducted in a randomized, double‐blind, placebo‐controlled manner. At rest, the external nasal dilator was found to significantly increase nasal valve area in all demographic groups measured. The device was also found to significantly decrease submaximal exercise perceived exertion, heart rate, ventilation, and VO2 when compared with placebo.
Survival, Function, and Quality of Life After Total Glossectomy
Authors: Ruhl Charles M. , Gleich Lyon L. , Gluckman Jack L.
Published: November 2003

Advanced tongue cancer is associated with poor survival despite aggressive therapy. In an attempt at cure, many patients undergo total glossectomy, which significantly affects function and quality of life (QOL). This study was designed to determine the survival rate and QOL of patients who had undergone total glossectomy. A total of 54 patients underwent total glossectomy, with or without total laryngectomy, for advanced tongue cancer from 1970 to 1996. Patient outcomes were assessed for the following: 1. disease‐free survival, 2. function, utilizing the Performance Status Scale (PSS), and 3. QOL, using two general cancer questionnaires (FACT‐G and EORTC QLQ‐C30) and a series of questions specific for head and neck cancer patients. Corrected actuarial survival was 51% and 41% at 3 and 5 years, respectively. Functional assessment using the PSS demonstrated significant deficits in speech and deglutition. QOL questionnaires revealed problems with eating, speaking, socializing, and shoulder function. However, the over‐all responses demonstrated that these patients have adjusted to their deficits and have a good QOL. It was concluded that total glossectomy, with or without total laryngectomy, can result in meaningful survival and an adequate QOL can be achieved in selected patients.
Fibrous Dysplasia of the Temporal Bone: Reversal of Sensorineural Hearing Loss After Decompression of the Internal Auditory Canall
Authors: Morrissey David D. , Michael Talbot J. , Schleuning Alexander J.
Published: November 2003

When fibrous dysplasia affects the temporal bone, it most often presents with conductive hearing loss attributable to stenosis of the external auditory canal. Sensorineural hearing loss has usually been attributed to involvement of the otic capsule. We present a patient with bilateral fibrous dysplasia of the temporal bones who complained of unilateral hearing loss, facial tingling, and facial twitching. The audiogram showed severe sensorineural hearing loss. The hearing markedly improved and facial twitching and tingling ceased after decompression of the internal auditory canal via a middle fossa approach. This is the only case of which we are aware showing reversal of sensorineural hearing loss caused by fibrous dysplasia.
Inner and Middle Ear Hyperbaric Oxygen‐Induced Barotrauma
Authors: Beuerlein Matthew , Nelson Richard N. , Bradley Welling D.
Published: November 2003

Patients receiving hyperbaric oxygen (HBO) therapy can sustain inner and middle ear barotrauma. The purpose of this study is to define the incidence and significance of HBO‐related barotrauma, in addition to establishing guidelines for prophylactic myringotomy or tympanostomy tube placement. Thirty patients were stratified into two groups (those able to autoinflate and those unable to autoinflate the middle ear) and barotrauma was assessed by otoscopy, tympanometry, high‐frequency audiometry, and distortion product otoacoustic emission (DPOAE) testing. Ten of 11 patients (91%) from the noninflater group suffered middle ear barotrauma, and seven of 19 patients (37%) from the autoinflater group sustained middle ear barotrauma. Patients unable to autoinflate the middle ear were shown to have a higher incidence and greater severity of barotrauma than patients able to autoinflate. Pretreatment pressure‐equalizing tubes or myringotomies should be considered for patients undergoing HBO therapy who have an artificial airway or have eustachian tube dysfunction and have failed conservative medical intervention. A significant change in DPOAEs (loss of emissions over a 1‐kHz range) was found in four of 15 autoinflaters (27%) and two of seven noninflaters (29%). There was no significant difference between the groups. The decrease in DPOAEs was not associated with a change in conventional audiometry.
Translacrimal Transnasal Laser‐Assisted Dacryocystorhinostomy
Authors: Pearlman Steven J. , Michalos Peter , Leib Martin L. , Moazed Kambiz T.
Published: November 2003

Chronic dacryocystitis is due to an obstruction in the nasolacrimal duct, with subsequent infection of the lacrimal sac. The goal of surgery is to reestablish intranasal drainage of the lacrimal sac. Classic dacry‐ocystorhinostomy (DCR) requires an external incision and drilling through the lacrimal bone into the middle meatus. In our study a 600‐micron neodymium:YAG (Nd:YAG) fiber with a blunt hemispherical tip is inserted via the lacrimal puncta. An intranasal ostium is created with the laser under intranasal endoscopic control. Silicon tubes are then left in place for 6 months. We have performed 49 procedures over the past 2 1/2 years, with a success rate of 85% after one surgical procedure, which is commensurate with standard DCR. This procedure provides a simple, bloodless, incisionless alternative to standard DCR.
Effects of Systemic Hyperoxia on Eustachian Tube Ventilatory Function
Authors: Shupak Avi , Tabari Reza , Swarts Douglas J. , Bluestone Charles D. , Doyle William J.
Published: November 2003

Middle ear negative pressure and effusions, decreased middle ear compliance, and abnormal tympanometry results have been described after diving on oxygen. Middle ear gas hyperoxia has been shown to down‐regulate the eustachian tube ventilatory function (ETVF). The purpose of the present study was to investigate to what extent systemic hyperoxia in the face of air‐equivalent middle ear gas composition might interfere with the ETVF. ETVF was investigated in four young adult female cynomolgus monkeys by the forced‐response and inflation‐deflation tests using air while the animals breathed either room air or 100% normobaric oxygen. Higher opening, closing, and steady‐state pressures were observed under systemic hyperoxia. The percentage of the applied pressure equalized, and the maximal pressure change on a single swallow in the deflation test were both lower under hyperoxic conditions. The results show that systemic hyperoxia might impair ETVF. This observation adds to our understanding of the pathophysiology of middle ear dysfunction observed after diving on oxygen.
Sphenopalatine Blocks in the Treatment of Pain in Fibromyalgia and Myofascial Pain Syndrome
Authors: Janzen Victor D. , Scudds Roger
Published: November 2003

Sphenopalatine blocks have been used to treat pain for more than 80 years. Anecdotal support for sphenopalatine ganglion blocks has been very strong in those who believe in the technique, but the research results have been inconclusive. Therefore, a double blind, placebo‐controlled study was performed on 61 patients, 42 with fibromyalgia and 19 with myofascial pain syndrome. Pain was measured using visual analogue scales prior to treatment, during treatment, and 28 days after the treatment. Headaches were evaluated in frequency and location prior to and after treatment. Sphenopalatine ganglion blocks were performed under direct vision using 4% lidocaine and sterile water as a placebo. Analysis of the results showed no statistical differences between the lidocaine and the placebo groups.
A Classification Scheme for Paradoxical Vocal Cord Motion
Authors: Maschka Donald A. , Bauman Nancy M. , McCray Paul B. , Hoffman Henry T. , Karnell Michael P. , Smith Richard J.H.
Published: November 2003

Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder:
1
. brainstem compression;
2
. cortical or upper motor neuron injury;
3
. nuclear or lower motor neuron injury;
4
. movement disorder;
5
. gastroesophageal reflux;
6
. factitious or malingering disorder;
7
. somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well‐directed diagnostic evaluation and treatment.
Stapedectomy Training With the Carbon Dioxide Laser
Authors: Beatty Todd W. , Haberkamp Thomas J. , Khafagy Yasser W. , Bresemann Jon A.
Published: November 2003

All primary carbon dioxide (CO2) laser stapedectomies supervised by the senior author since 1986 were retrospectively reviewed and reported according to 1995 American Academy of Otolaryngology‐Head and Neck Surgery Committee on Hearing guidelines. Sixty‐three cases had more than 6 weeks of follow‐up with an average residual gap of 6.49 dB (SD = 5.55 dB) and an 89% success rate. Thirty cases had more than 1 year of follow‐up with the average hearing result of 6.58 dB (SD = 5.93 dB) and an 87% success rate. In 11 cases, 14 operative problems or complications occurred. Suctioning the vestibule occurred in five cases. Because suction is required to evacuate laser smoke, these cases are attributed to the laser. One of these patients had delayed sensorineural hearing loss. One patient had profound delayed sensorineural hearing loss as a result of granuloma formation. These were the only major complications. The laser is a tool that gives reproducible technique and good success rates.
Thermal Effects of Laser Stapedectomy in an Animal Model: CO2 Versus KTP
Authors: Kodali Satish , Harvey Steven A. , Prieto Thomas E.
Published: November 2003

Although use of the laser for stapedectomy has become common in recent years, controversy remains regarding whether the CO2 or visible‐spectrum lasers (argon and KTP) are best suited for this operation. The main concern has been the potential for thermal injury to the inner ear with the visiblespectrum lasers attributable to their absorption characteristics. To further investigate this issue, the author performed 20 laser stapedectomies on adult chinchillas. Following placement of a 0.127‐mm‐diameter copper/constantan thermocouple (sampling at 12 Hz) beneath the footplate on the medial wall of the vestibule via a distant fenestration site, thermal changes with a micromanipulator‐based CO2 and fiberoptic KTP system were compared. This was the first live animal model comparison of these two lasers. There was no statistical difference in the mean temperature elevation between the two systems (
P
= 0.395).
Validation of the Charlson Comorbidity Index in Patients With Head and Neck Cancer: A Multi‐institutional Study
Authors: Singh Bhuvanesh , Bhaya Mahesh , Stern Jordan , Roland J. Thomas , Zimbler Marc , Rosenfeld Richard M. , Har‐El Gady , Lucente Frank E.
Published: November 2003

Comorbid conditions are medical illnesses that accompany cancer. The impact of these conditions on the outcome of patients with head and neck cancer is well established. However, all of the comorbidity studies in patients with head and neck cancer reported in the literature have been performed using the Kaplan‐Feinstein index (KFI), which may be too complicated for routine use. This study was performed to introduce and validate the use of the Charlson comorbidity index (CI) in patients with head and neck cancer and to compare it with the Kaplan‐Feinstein comorbidity index for accuracy and ease of use. Study design was a retrospective cohort study. The study population was drawn for three academic tertiary care centers and included 88 patients 45 years of age and under who underwent curative treatment for head and neck cancer. All patients were staged by the KFI and the CI for comorbidity and divided into two groups based on the comorbidity severity staging. Group 1 included patients with advanced comorbidity (stages 2 or 3), and group 2 included those with low‐level comorbidity (stages 0 or 1). Outcomes were compared based on these divisions. The KFI was successfully applied to 80% of this study population, and the CI was successfully applied in all cases (
P
< 0.0001). In addition, the KFI was found to be more difficult to use than the CI (
P
< 0.0001). However, both indices independently predicted the tumor‐specific survival (
P
= 0.007), even after adjusting for the confounding effects of TNM stage by multivariate analysis. Overall, the CI was found to be a valid prognostic indicator in patients with head and neck cancer. In addition, because comorbidity staging by the CI independently predicted survival, was easier to use, and more readily applied, it may be better suited for use for retrospective comorbidity studies.
Lost Airway During Anesthesia Induction: Alternatives for Management
Authors: Sofferman Robert A. , Johnson David L. , Spencer Robert F.
Published: November 2003

Pediatric and adult patients with upper airway obstruction pose several challenges to the anesthesiologist and otolaryngologist‐head and neck surgeon. The initiation of general anesthesia and endotracheal intubation may progress to complete life‐threatening respiratory decompensation with failure to achieve endotracheal intubation or mask ventilation. Hurried invasive maneuvers such as large‐bore needle tracheal entry and cricothyrotomy are recognized salvage techniques, but other modes of extratracheal ventilation are now possible before surgical airway procedures are required. The laryngeal mask airway and esophagotracheal Combitube (Kendall Sheridan Health Care Products Co., Argyle, NY) are described, with examples of their clinical application. The combined technique of anterior commissure laryngoscopy and intubation with the gum elastic bougie is the preferred alternative for achieving tracheal entry when extratracheal ventilation cannot be accomplished. An algorithm for joint management of the problem airway by anesthesiologist and otolaryngologist‐head and neck surgeon is illustrated.
Interaction Between Hypertension and Diabetes Mellitus in the Pathogenesis of Sensorineural Hearing Loss
Authors: Duck Sigsbee W. , Prazma Jiri , Bennett P. Scott , Pillsbury Harold C.
Published: November 2003

The purpose of this study is to support the hypothesis that diabetic end‐organ damage of the cochlea is augmented in the setting of hypertension. A historical perspective reviewing the effects of diabetes and hypertension as causative factors in the development of sensorineural hearing loss, as well as the basic epidemiology and pathophysiology of the renal and vascular effects of diabetes and hypertension, is presented. The results of audiologic findings in insulin‐dependent diabetic patients, both normotensive and hypertensive, were analyzed and correlated with the results of animal studies to support the hypothesis that sensorineural hearing loss in patients and cochlear hair cell loss in animal studies result from the effects of hypertension in conjunction with insulin‐dependent diabetes mellitus.
Cerebellopontine Angle Tumor Outcomes in Patients With Hazardous Occupations
Authors: Yu Kenneth C.Y. , Arriaga Moisés A. , Chen Douglas A.
Published: November 2003

Cerebellopontine angle (CPA) tumor surgery can produce a spectrum of sensory and motor deficits that can alter a patient's lifestyle and occupation. An important consideration is whether patients can return to full occupational status especially when hazardous duties are involved. Outcome data in CPA tumor surgery usually report that most patients are able to return to preoperative function; however, whether these patients can return to hazardous duties is not specified. A retrospective study of 380 consecutive, operated CPA tumor patients was performed and 37 were identified who engaged in hazardous occupations including active military service, working at dangerous heights, piloting jet aircraft, aircraft navigating, and factory work with high‐impact machinery. Overall, patients were able to resume full‐time work in their previous occupations and 86% of patients reported that they were able to resume hazardous duties. CPA tumor surgery is compatible with continued full occupational duties after surgery, even for patients employed in hazardous situations.
Complications of Gold Weight Eyelid Implants for Treatment of Fifth and Seventh Nerve Paralysis
Authors: Dinces Elizabeth A. , Mauriello Joseph A. , Kwartler Jed A. , Franklin Mark
Published: November 2003

Complications occurred in six patients after gold weights were implanted into the upper eyelid tissues for fifth and seventh nerve palsies. These complications included implant infection without extrusion (in one patient); entropion with trichiasis and presumed inflammatory reaction to the gold weight material (in one patient); upper eyelid distortion and poor eyelid contour with corneal ulceration and scarring (in one patient); significant residual lagophthalmos with exposure keratitis (in one patient); and blepharoptosis obscuring the pupillary access (in two patients). Resolution of the complications required 1. implant removal in four of six patients without reinsertion of a second weight, 2
. recession of the retractors of the upper eyelids with medial and lateral canthoplasty (in four patients), and
3
. permanent tarsorrhaphy (in one patient). The authors conclude that complications may be minimized by careful preoperative determination of the optimum implant size, weight, and placement within the eyelid as well as meticulous attention to the surgical technique of implantation. The use of other eyelid protective procedures is often necessary to augment corneal protection especially in patients with combined fifth and seventh cranial nerve palsies. Endogenous implant infection without extrusion of the gold weight may be distinguished from presumed inflammation due to gold allergy by clinical response to antibiotics in the former and requirements of steroids or removal of the implant in the latter.
Evaluation of the Bone Resistance of the Sphenoid and Ethmoid Sinuses
Authors: Waridel François , Monnier Philippe , Agrifoglio Arido
Published: November 2003

Functional endoscopic sinus surgery can be associated with iatrogenic complications. Some anatomical structures have been identified this clinically as specific danger sites. The aim of this study was to confirm and to compare these clinical data with measurements of the bone resistance of the sphenoid and ethmoid walls and to point out regions that have increased bony fragility. Critical dynamometric evaluation of the resistance to breakage of these bony structures was made on 21 anatomic specimens. This study allowed the authors to localization of surgical complications, to demonstrate that other regions renowned for their fragility can be relatively robust, and to point out that robust sites can be dangerously fragile as a result of individual morphological variations. Results from this study provide a supplement to the guidelines for novice surgeons to use in identifying dangerous areas.
Needle Placement With Transtympanic Electrocochleography
Authors: Krueger Wesley W.O. , Wagner Allison P.
Published: November 2003

Electrocochleography (ECoG) is an objective, electrophysiologic test useful in the clinical diagnosis of endolymphatic hydrops, or Meniere's disease. The purpose of this study was to determine if the position of the needle, using transtympanic methodology, gives a variable SP/AP (summating potential/action potential) response. SP/AP ratios were obtained during routine tympanoplasty procedures. After the tympanic membrane remnant was removed using a lateral graft technique, precise needle placement was obtained at the medial and lateral round window niches, as well as on the promontory. SP/AP ratios were obtained in these three needle positions. There was no significant difference in the SP/AP ratio responses despite the location of needle placement. The use of transtympanic electrocochleography can give very good wave form morphology and consistent results. Therefore, if elevated SP/AP ratios do occur, they are thought to be due to a pathologic process of the ear and not needle placement.
Overlay Versus Underlay Tympanoplasty. Part II: The Study
Authors: Rizer Franklin M.
Published: November 2003

This report compares two contemporary techniques of tympanic membrane repair. The prospective comparison study included 712 cases over 9 years. Whether the tympanic membrane was repaired by an underlay or an overlay technique, results were reliable. By making a postauricular incision, greater visibility of the operative site can be obtained. Larger perforations can be closed more reliably when greater exposure is obtained. The placement of the graft above or below the annulus is not the issue. Careful technique and precise work are the keys to successful tympanoplasty. Thus otologic surgeons should cultivate effective techniques, attempting to continuously improve their results to achieve perfection.
Glottographic Signal Perturbation in Biomechanically Different Types of Dysphonia
Authors: Lin Emily , Jiang Jack , Hanson David G.
Published: November 2003

Glottographic signals may be superior to acoustic signals for tracking glottal source perturbations, since supraglottal vocal tract effects on glottographic signals are relatively minimal compared with the acoustic signal as measured beyond the lips. This study compared the ability of differing signals to differentiate among normal voices and abnormal voices that were due to two categories of biomechanical disease. Acoustic, electroglottographic, and photoglottographic signals recorded during vowel phonation sustained by 26 normal subjects and 65 patients were measured for perturbations of frequency and amplitude. One‐way analysis of variance (ANOVA) revealed that amplitude perturbation measures from photoglottographic signals significantly differentiated neuromuscular from mass lesion sources of dysphonia. Acoustic and electroglottographic signal perturbations differentiated between normal and abnormal voices but did not distinguish between the dysphonic characteristics of neuromuscular disorders and those of mass lesions of the vocal folds.
Age‐Related Glycine Receptor Subunit Changes in the Cochlear Nucleus of Fischer‐344 Rats
Authors: Krenning Judyann , Hughes Larry F. , Caspary Donald M. , Helfert Robert H.
Published: November 2003

Previous studies have shown that levels of binding for the strychnine‐sensitive glycine receptor in the cochlear nucleus (CN) of Fischer(F344) rats decrease with age. Given the major role glycine plays in normal CN function, changes in glycine‐receptor activity may contribute to central presbycusis. To further evaluate the impact of age on glycine receptors, in situ hybridization was used to assess, in three age groups of F344 rats, changes in levels of gene expression for four of its subunits. When compared with the 3‐month‐old rats, expression of mRNAs for α1 and β subunits in the anteroventral CN decreased significantly in the 18‐ and 27‐month‐old age groups, while mRNA expression for the α2 subunit increased. If protein expressions are similar, these subunit changes may alter the function of glycine receptors, thereby affecting binding to its ligands.
Adult Epiglottitis in a Canadian Setting
Authors: Hébert Paul C. , Ducic Yadranko , Boisvert Denis , Lamothe André
Published: November 2003

The objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested casecontrol study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/105 population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (
P
< 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.
The Facial Ridge and the Discharging Mastoid Cavity
Authors: Wormald Peter John , Nilssen Erik L.K.
Published: November 2003

This study evaluates the causes for a persistently discharging mastoid cavity and attempts to weight the importance of each identified factor. It consists of a temporal bone dissection to evaluate the anatomy of the facial nerve and a clinical prospective study measuring the factors that contribute to a wet cavity. The factors measured were height of the facial ridge, the size of the meatus, state of the tympanic membrane, and size of the mastoid cavity. The height of the facial ridge and the kidney shape of the cavity were found to be the most significant factors contributing to the state of the cavity. The tympanic membrane and size of the meatus were also found to significantly influence the state of the cavity, whereas the size of the cavity was not significant. These results illustrate the importance of the facial ridge in mastoid surgery and that most poor results in mastoid surgery are due to the surgeon, not the disease.
Osteologic Classification of the Sphenopalatine Foramen
Authors: Wareing Michael J. , Padgham Nigel D.
Published: November 2003

Textbook descriptions and illustrations of the opening of the sphenopalatine foramen (SPF) into the nasal cavity place it above and behind the posterior end of the middle turbinate (i.e., within the superior meatus). Although true for some skulls, this is not the situation for the majority and may be of importance, because the major blood supply to the nasal cavity enters via this route. Having studied 238 lateral nasal walls, the authors propose a classification of the osteology of the sphenopalatine foramen. In class I (35%) the opening of the SPF is purely into the superior meatus with a notch or foramen in the middle turbinate/ethmoidal crest of the palatine bone. In class II (56%) the SPF spans the ethmoidal crest (i.e., opens into both the superior and middle meati). In class III (9%) there are two separate openings into the superior and middle meati. These findings may explain the route of the artery to the inferior turbinate and indicate the need for care in dealing with the posterior end of the middle turbinate. They may also suggest a potential site for dealing with “difficult” epistaxis via an intranasal route.
Medical Management of Migraine‐Related Dizziness and Vertigo
Authors: Johnson Glenn D.
Published: November 2003

Historically, review of migraine‐related vestibular symptoms has focused on the various clinical presentations that occur and the results of diagnostic studies of vestibular function. Treatment of vestibular symptoms related to migraine has been proposed similar to that used for headache control, but few examples of the effectiveness of this therapy have been published. The purpose of this study is to present the various approaches that can be used to manage vestibular symptoms related to migraine, and to evaluate the overall effectiveness of these treatment approaches. This was a retrospective review of 89 patients diagnosed with migraine‐related dizziness and vertigo. The character of vestibular symptoms, pattern of cochlear symptoms, results of auditory and vestibular tests, and comorbidity factors are presented. Treatment was individualized according to symptoms and comorbidity factors, and analyzed regarding effectiveness in control of the major vestibular symptoms of episodic vertigo, positional vertigo, and nonvertiginous dizziness. Medical management included dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture. Complete or substantial control of vestibular symptoms was achieved in 68 (92%) of 74 patients complaining of episodic vertigo; in 56 (89%) of 63 patients with positional vertigo; and 56 (86%) of 65 patients with non‐vertiginous dizziness. Similarly, aural fullness was completely resolved or substantially improved in 34 (85%) of 40 patients; ear pain in 10 (63%) of 16 patients; and phonophobia in 17 (89%) of 19 patients. No patient reported worsened symptoms following medical management. The conflicting concept of a central disorder (migraine) as the cause of cochlear and vestibular dysfunction that often has peripheral features is discussed.
Clinical Manifestations of Mutations in the Neurofibromatosis Type 2 Gene in Vestibular Schwannomas (Acoustic Neuromas)
Authors: Welling D. Bradley
Published: November 2003

Vestibular schwannomas (acoustic neuromas) continue to cause significant facial nerve and hearing morbidity, despite marked improvement in diagnosis and treatment. Mutation of a tumor‐suppressor gene on human chromosome 22 has been found to be associated with vestibular schwannoma formation. The central hypothesis of this study is that specific mutations in the neurofibromatosis type 2 (NF2) gene may produce specific clinical characteristics or phenotypic expressions. The purposes of this investigation are: 1. to determine what proportion of vestibular schwannomas from patients with spontaneous unilateral and familial bilateral schwannomas have mutations present within the NF2 gene; 2. to determine whether specific types of mutations are associated with a specific clinical manifestation of this disease; and 3. to further define the relationship between newly discovered mutations within the NF2 tumor‐suppressor gene and possible clinical applications of this knowledge to advance diagnosis and treatment of patients with NF2 and spontaneous vestibular schwannomas. DNA from 61 schwannomas (29 unilateral vestibular schwannomas and 32 from patients with bilateral vestibular schwannomas[NF2]) were examined, and 33 unique mutations were identified. Significant differences were found in the frequency, distribution, and type of mutation between the NF2 schwannomas and the spontaneous vestibular schwannomas. Three clinical subtypes of NF2 were identified. In tumors from 28 patients, no mutations were identified. Of the 33 mutations identified in the NF2 gene, 30 were likely to result in loss of tumor‐suppressor function from protein truncation; however, three milder mutations termed missense mutations were associated with milder clinical manifestations of the disease and had a slower estimated growth rate. Variable clinical presentation in patients whose tumors had severe or truncating types of mutations suggest that factors in addition to the mutation class are likely to be responsible for a portion of the clinical expression of disease. New diagnostic options are now available for NF2 that will improve the likelihood of hearing and facial nerve preservation and ultimately have significant impact on the management of vestibular schwannomas.
Treatment of External Auditory Canal Exostoses
Authors: Whitaker Samuel R. , Cordier Aldo , Kosjakov Serge , Charbonneau Ronald
Published: November 2003

Exostoses of the external auditory canal can occur in patients living in coastal, southern California communities with a history of cold‐water aquatic activities such as ocean surfing and swimming. Although most canal exostoses are asymptomatic, patients with canal obstruction greater than 80% can have recurrent episodes of external otitis and a related conductive hearing loss. In most cases, medical treatment resolves the symptomatic external otitis and related hearing loss. Patients recalcitrant to medical treatment are candidates for surgical removal of the exostoses. This report reviews the authors' surgical experience with 18 patients (27 ears) who have undergone surgical removal of exostoses. Their preferred surgical technique of transmeatal removal of exostoses with a specialized mallet and thin chisel under local anesthesia is described.
Malignant Melanoma of the Head and Neck
Authors: Peralta Elizabeth A. , Yarington C. Thomas , Glenn Michael G.
Published: November 2003

This study compared outcomes for intermediate‐thickness(1.5 to 3.99 mm) head and neck melanomas treated with or without elective lymph node dissection (ELND). The records of all head and neck melanomas treated at Virginia Mason Medical Center from 1974 through 1995 were reviewed and analyzed for outcome by stage and elective or therapeutic lymph node dissection. One hundred seventy‐four patients with head and neck melanomas were treated in the study period, of which only 25% had intermediate‐thickness lesions. Of 38 clinically node‐negative patients with intermediate‐thickness lesions followed more than 3 years, 10 underwent ELND, yielding two positive dissections (20%). The rate of distant metastases and the mortality rate were 44% and 35% lower in patients undergoing ELND compared with stage II patients who did not undergo ELND, but the difference did not achieve statistical significance(P = 0.12 and 0.21, respectively). The role of ELND in head and neck melanoma is uncertain. This retrospective study is limited by the small number of intermediate‐thickness lesions, yet there appears to be a survival advantage to ELND in head and neck melanoma, even in negative dissections. Conventional histologic stains miss micrometastases detected by immunohistological and polymerase chain techniques. Removal of such micrometastases may explain the improved outcome. A multicenter prospective trial in head and neck melanomas, incorporating the latest techniques of sentinel node biopsy and immunohistological staining of node specimens, is needed to clarify definitive therapy for this increasingly common diagnosis.
Alloplastic and Microvascular Restoration of the Mandible
Authors: Mandpe Aditi H. , Singer Mark I. , Kaplan Michael J. , Greene David
Published: November 2003

The evolution of mandibular reconstruction following composite resection is advanced by improved alloplastic prosthesis and reliable microvascular free tissue transfers. A 42‐case, 6‐year experience is presented using both methods at the University of California, San Francisco. The advantages and complications of both are discussed. The authors conclude that the success rate for lateral defect restoration is equivalent with either technique, and that the anterior defects are more reliably reconstructed with free tissue transfer. The advantage of microvascular flaps in the anterior defect must be gauged against the physical status of the patient, disease extent, and likelihood of dental rehabilitation by interosseous fixation.
Effect of Melatonin on Tinnitus
Authors: Rosenberg Seth I. , Silverstein Herbert , Rowan P. Todd , Olds Michael J.
Published: November 2003

Objective: Evaluate melatonin as a treatment for subjective tinnitus.

Study Design: Randomized, prospective, double‐blind, placebo‐controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7‐day washout period between medications.

Setting: Outpatient, private, neurotology practice.

Patients: Thirty patients with subjective tinnitus.

Main Outcome Measures: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview.

Results: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02).

Conclusion: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus.
Evaluation of Clinical Measures of Equilibrium
Authors: El‐Kashlan Hussam K. , Shepard Neil T. , Asher Anna Marie , Smith‐Wheelock Michael , Telian Steven A.
Published: November 2003

Objective: Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities.

Study Design: Cross‐sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients.

Setting: Academic tertiary care referral center.

Participants: Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction.

Results: Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction.

Conclusion: Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.
Surgical Management of the Substernal Thyroid Gland
Authors: Pulli Ronald S. , Coniglio John U.
Published: November 2003

From 1992 to 1996, 19 patients had surgical resection of a substernal thyroid gland at the University of Rochester Medical Center, Rochester, New York. Based on a retrospective review of the 21 procedures performed, an algorithm for evaluation and surgical intervention is proposed. A limited medical workup is indicated and consists of a chest x‐ray, thyroid function tests, computed tomography scan, and, possibly, fine‐needle aspiration. Given a modestly high malignancy rate (16%) and a 37% reoperative rate, total thyroidectomy should be performed. When extensive mediastinal disease is encountered, a median sternotomy affords excellent access to the substernal thyroid gland.
Motor Innervation of the Guinea Pig Interarytenoid Muscle: Reinnervation Process Following Unilateral Denervation
Authors: Kawakita Seiji , Aibara Ryuichi , Kawamura Yuji , Yumoto Eiji , Desaki Junzo
Published: November 2003

The authors investigated the process of denervation and reinnervation of the interarytenoid (IA) muscle in the guinea pig using transmission electron microscopy and glycogen depletion technique after unilateral transection of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve to clarify the innervation pattern of the unpaired IA muscle. Anastomosis between the bilateral arytenoid branches was confirmed in the belly of the IA muscle. Five weeks after transection, all of the IA muscle fibers appeared to have been reinnervated by the contralateral RLN. As the arytenoid branch of the RLN runs together with that of the contralateral RLN in a single intramuscular nerve funiculus, it is possible that collateral sprouting branches grow and extend into the adjacent denervated Schwann's sheaths. The authors conclude that the unpaired IA muscle, as a whole, receives specific motor nerve supply from the bilateral RLNs, although each muscle fiber is innervated unilaterally.
Type I Posterior Laryngeal Clefts
Authors: Parsons David S. , Stivers F. Edward , Giovanetto Donald R. , Phillips Scott E.
Published: November 2003

Posterior laryngeal clefts (PLCs) are described in the literature as rare laryngeal abnormalities. The authors believe type I clefts are much more common than previously reported. In two busy pediatric tertiary care centers, such clefts are the second most common congenital laryngeal finding at rigid endoscopy, second only to laryngomalacia. PLCs frequently present with symptomatology that can be attributed to other common disease processes and are often undiagnosed unless the surgeon maintains a high index of suspicion and specifically examines the posterior glottis by palpation during microlaryngoscopy. This report presents a series of 41 patients with type I PLCs, reviews their subtle and often confusing presenting signs and symptoms, and describes a simple yet reliable method of diagnosis.
Habitual Snorers and Sleep Apnoics Have Abnormal Vascular Reactions of the Soft Palatal Mucosa on Afferent Nerve Stimulation
Authors: Friberg Danielle , Gazelius Bertil , Lindblad Lars Erik , Nordlander Britt
Published: November 2003

A local disturbance in the afferent nerves involved in the reflexogenic dilation of the upper airways (UAs) could contribute to the increased collapsibility seen in patients with obstructive sleep apnea (OSA). Laser Doppler perfusion monitoring, combined with electrical stimulation, is a method for investigating the afferent nerve regulation of the microcirculation. It was used in the mucosa of the soft palate in 35 patients with various degrees of UA obstruction and in 13 control subjects, all nonsmoking men. In a majority of snorers and patients with mild OSA, stimulation induced an exaggerated vasodilation, compared with controls. In contrast, in patients with severe OSA, the vasodilation was significantly reduced, compared with controls. These signs of disturbances in the microcirculation support the hypothesis of a local progressive afferent nerve lesion in heavy snorers with or without OSA.