bluuebunny/crossref_metadata_2025 huggingface dataset:
S156 – What Can Determine the Length of a Thyroidectomy Incision?
Authors: Vasan Nilesh R
Published: August 2008

Objectives

Patient expectations regarding cosmesis following surgical procedures have increased. Subsequently, many surgeons are now utilizing very small incisions when performing thyroidectomy. This study evaluated the association between patient weight, nodule size, and maximum thyroid diameter, and the length of a thyroidectomy incision.

Methods

Data from a cohort of 28 consecutive patients treated by a single surgeon was analyzed. Patient demographics, clinical exam, ultrasound findings, operative findings, and pathology were recorded. All incisions were measured pre‐operatively.

Results

Of the 28 patients (79% female), 24 underwent a hemithyroidectomy and isthmusectomy. One patient had papillary thyroid cancer and 7 (25%) required operation for compressive symptoms. The mean patient weight was 200.76 lbs (median=188 lbs; IQR 75lbs). The mean clinical nodule diameter was 3.64 cm (median=3.7 cm; IQR=1.7 cm), and the mean maximum thyroid diameter was 6.22 cm (median=5.25 cm; IQR=3.7 cm). The mean incision size was 5.32 cm (median=5.0 cm; IQR=2.0 cm). Independently, patient weight, maximum thyroid diameter, and maximum nodule diameter were shown in regression models to be statistically significant predictors of incision size. In stepwise regression analysis that included all three listed variables, only maximum thyroid diameter remained a significant predictor of incision size (p<0.0001).

Conclusions

The use of small incisions when performing thyroidectomy is becoming common. To further reduce incision size, video‐assisted thyroidectomy is now being advocated. For thyroidectomy, surgeon preference and comfort level are obviously important factors in deciding incision length. This retrospective study has shown that this decision is taken in context of the patients’ weight, maximum nodule diameter, and most importantly, maximum thyroid diameter.
S161 – Surgical Management of Dysphagia and Dysphonia
Authors: Lee Peng Grace , Sinha Uttam K
Published: August 2008

Objectives

Learn to surgically manage dysphonia and dysphagia.

Methods

22 patients treated for HNC between July 2004‐December 2005 received in‐clinic evaluation for dysphonia and modified barium swallow for dysphagia. Patients were divided into 4 groups based on function of their pharynx and larynx. All patients had a tracheotomy and gastric feeding tube (G‐tube). Treatment outcomes were determined by removal of both. Group I: Patients tolerated puree diet at the time of evaluation, and were placed on swallowing therapy protocol developed in our institution (n=53). Group II: Patients could not swallow due to obliteration of hypopharyngeal lumen but good glottic closure and cough reflex. They underwent pharyngeal reconstruction with preservation of the larynx through transcervical approach (n=5). Group III: Patients had obstruction at the hypopharynx with loss of supraglottic sensation and aspiration of saliva. These had no functional voice. They underwent laryngectomy and pharyngeal reconstruction using myocutaneous flap (n=10). Group IV: Patients had obliteration of the pharyngeal lumen and laryngeal inlet due to fusion of epiglottis and post‐cricoid area to the posterior pharyngeal wall. They underwent micro‐endoscopic laryngopharyngeal reconstruction (MELPR)(n=6).

Results

At the end of treatment, all tolerated a regular diet and were decannulated. In Group I, G‐tube was removed after completion of CRT. In Groups II‐IV, G‐tube was removed 3–6 weeks after all procedures. For dysphonia, all patients in Groups I, II, and IV recovered voice function. In Group III, 6/10 had voice rehabilitation with use of prostheses.

Conclusions

Surgical management of dysphagia and dysphonia is best attained through categorization of pharyngeal and laryngeal function.
S162 – Chronic Aspiration after Supracricoid Partial Laryngectomy
Authors: Gallo Andrea , Ruoppolo Giovanni , Di Mario Marco , Paola Calcagno , Valentina Manciocco , De Vincentiis Marco
Published: August 2008

Objectives

The aim of this study is to evaluate the long‐term swallowing status and the high resolution computed tomography (HRCT) pulmonary findings of chronic aspiration in patients who have undergone supracricoid partial laryngectomy (SCPL), to demonstrate that SCPL causes a mild and well‐tolerated degree of chronic aspiration, allowing the patient to avoid a nothing‐by‐mouth status.

Methods

Retrospective medical record review. Cohort study. Case series. The follow‐up period ranged from 3 to 13 years. 116 patients treated with SCPL were analyzed. The patients included in the study were NED, were followed for more than 3 years, were without tracheal cannula or nasogastric tube, and able to feed orally. A group of 20 patients with chronic obstructive pulmonary disease and normal deglutition was used as a control. Evaluation of postoperative swallowing disorders included a careful observation of the patients by the physician, fiberoptic endoscopic evaluation of swallowing (FEES), and videofluoroscopy (VFS). Clinical grading of postoperative aspiration was assessed according to the Leipzig and Pearson scale. The radiological manifestations of chronic aspiration were recorded at high resolution computed tomography (HRCT).

Results

A higher incidence of pulmonary consolidation was found in the patients affected by postoperative chronic aspiration, compared to the control group (p<0.001). No significant differences were noted between the control group and the dysphagic group regarding the remaining radiological findings.

Conclusions

SCPL causes a mild and well‐tolerated degree of chronic aspiration, determining low functional impairment and allows the patient a good quality of life.
S164 – Comparison of Endoscopic and Conventional Parotid Surgeries
Authors: Yeh Shiou‐Yu , Chen Mu‐Kuan
Published: August 2008

Objectives

To compare the advantages and disadvantages between endoscopic and conventional parotid surgeries, and further evaluate the benefits of the new surgical approach ‐ endoscopic parotidectomy.

Methods

From January 2002 to August 2007 in Changhua Christian Hospital, 33 endoscopic parotid surgeries for selected patients presenting with benign parotid tail disease were compared with one hundred 99 conventional parotid surgeries for the patients with benign parotid tumors by age, gender, wound size, operation time, complication, admission length, and medical cost, retrospectively.

Results

There is no difference between endoscopic parotid surgeries and conventional parotid surgeries in gender and age. For the wound size, the mean length of the endoscopic parotid surgeries is only 3.1 centimeter and the wounds are almost invisible due to its concealed location behind the ear. Shorter operation time and hospital stay are discovered in the endoscopic parotid surgeries. Less complication rates and medical costs are also found in the endoscopic parotid surgeries.

Conclusions

Minimally invasive endoscopic parotid surgery provides a safer, less costly, and aesthetic choice for the treatment of benign lesions located in the parotid tail. The advantages of this procedure include smaller operative scar with cosmetic results, shorter operation time and hospital stay, less complication rates and medical costs.
S169 – Radiation‐Associated Dysphagia with Nasopharyngeal Carcinoma
Authors: Meier Jeremy D. , Leonard Rebecca , Farwell D Gregory , Belafsky Peter C
Published: August 2008

Objectives

We have observed that patients with dysphagia after radiotherapy (RT) for nasopharyngeal carcinoma (NPC) have substantially worse swallowing function than patients treated with RT of other sub‐sites. The purpose of this investigation was to describe swallowing dysfunction after RT for NPC and compare swallowing parameters to patients receiving RT for cancer from another site.

Methods

Fluoroscopic swallowing data of persons with dysphagia after RT for NPC was abstracted from a clinical database. Objective swallowing parameters were compared to age‐ and gender‐matched normal controls and to cancer stage‐matched patients treated with RT for oropharyngeal cancer (OPC).

Results

13 patients with NPC were compared to 13 controls and 13 patients with OPC. The average duration from RT to fluoroscopic study was 74 months for NPC and 24 months for OPC (p=.06). 62% of NPC and 47% of OPC were gastrostomy tube‐dependent. 92% of NPC patients aspirated or penetrated compared to 62% of OPC patients. The maximal average tolerated bolus was 10.6cc for NPC and 22.2cc for OPC (p<.02). Mean hyolaryngeal elevation was 4.02 (±1.27) for normals, 2.96 (±0.86) for OPC, and 2.45 (± 1.17) for NPC (p<.01). Opening of the pharyngoesophageal segment was lower than normal in both NPC and OPC. Pharyngeal constriction was 0.08 (±0.09) for normals, 0.40 (±0.24) for OPC and 0.45 (±0.27) for NPC (p<.001).

Conclusions

The data suggest that patients with dysphagia after radiotherapy for NPC present at a later date, have significantly less hyolaryngeal elevation, have weaker pharyngeal constriction, and cannot tolerate as large a bolus as patients treated with radiotherapy for OPC.
S171 – Head and Neck Microvascular Reconstruction: Changing Trends
Authors: Pena Rene M , Kim Paul Dae‐Gwon , Rowe Mark R
Published: August 2008

Objectives

The practice of head and neck reconstruction has been evolving over the past 15 years with the introduction of new surgical techniques, and increasing options for tissue harvest. We sought to investigate corresponding trends in the disciplines performing head and neck microvascular reconstruction.

Methods

2 specialties for the proportion of head and neck microvascular reconstruction were compared: those performed by otolaryngologists and those done by plastics surgery. A 3‐part study was performed to evaluate these trends: 1) Total case number of microvascular cases of otolaryngology residents and plastic surgery residents over the last 4 years was evaluated through the ACGME national data; 2) A poll of the percentage of otolaryngology residency programs that have their own microvascular reconstructive surgeon, and if that surgeon was hired within the last 5 years; and 3) The number of scientific articles published relating to microvascular head and neck reconstruction were systematically queried for 2 timeframes, (1995–2000) and (2002–2007).

Results

The national number of cases has steadily increased in the last 5 years. It has slowly increased compared to plastic surgery, but when all flaps are evaluated, it is not significant. We also found that the number of peer‐reviewed articles relating to microvascular free flaps authored by otolaryngologists has increased. The data from the polls are still pending.

Conclusions

There is an increasing trend emerging in the practice of head and neck microvascular reconstruction, with an increase number of articles being authored and increased number of surgeries being performed by otolaryngolo‐gists, compared to plastic surgeons.
S172 – Primary TE Puncture in Stapler‐Assisted Total Laryngectomy
Authors: Leahy Kevin , Tufano Ralph P
Published: August 2008

Objectives

1) To present a novel method for placement of a primary tracheoesophageal puncture (TEP) following stapler assisted laryngectomy. 2) To discuss the challenges and pitfalls of TEP placement following stapler‐assisted laryngectomy.

Methods

A case series of 10 consecutive patients treated with stapler‐assisted laryngectomy who underwent primary tracheoesophageal puncture at the time the initial surgery was conducted. Because stapler‐assisted total laryngectomy poses a unique challenge for the placement of concurrent TEP, we developed a novel technique whereby flexible esophagoscopy was performed and under direct visualization, a modified Seldinger technique was employed with a Russel percutaneous gastrostomy placement kit to allow creation of a TEP. This series was performed at a single academic institution. The primary outcome measured was ability of alaryngeal speech.

Results

10 consecutive cases of primary tracheoesophageal puncture in stapler‐assisted laryngectomy achieved alaryngeal speech.

Conclusions

The method described provides simple, safe, and repeatable results that facilitate alaryngeal speech in patients undergoing primary tracheoesophageal puncture and stapler‐assisted laryngectomy.
S174 – Therapeutic Selective Neck Dissection Outcomes
Authors: Shepard Peter M , Jordan Olson , Leverson Glen E , Harari Paul M , Hartig Gregory K
Published: August 2008

Objectives

To examine the efficacy of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma.

Methods

A retrospective chart review was performed on a cohort of 156 subjects with clinically positive regional nodal metastases, whose initial management included neck dissection by a single surgeon from 1994–2007. 69 subjects underwent selective neck dissection (SND), while 87 underwent radical or modified radical neck dissection (R/MRND). The majority of subjects (81%) received postoperative radiotherapy. Primary outcomes included 3‐year regional recurrence and 5‐year overall survival, using Kaplan‐Meier analysis.

Results

Following exclusion of subjects with local recurrence before or concurrent with regional recurrence, there were 4 (8.6%) regional recurrences in the SND group and 15 (22%) in the R/MRND group. 2 and 6 of these recurrences involved the contralateral neck in each group, respectively. Using multivariate analysis we adjusted for differences in nodal and primary tumor stage, primary tumor site, year of surgery, extracapsular spread, and postoperative radiotherapy rates. The lower regional recurrence rate in the SND group remained statistically significant (p=0.02). Overall 5‐year survival was 46% in the SND group vs. 34% in the R/MRND group (p=0.23).

Conclusions

These results demonstrate excellent regional disease control following SND in patients with neck node metastases. SND with adjunctive radiotherapy remains our preferred approach for most patients undergoing therapeutic neck dissection.
S176 – Level II‐B and V‐A Lateral Neck Dissection in PTC
Authors: Farrag Tarik Y , Lin Frank , Brownlee Noel , Kim Matthew , Sheth Shiela , Tufano Ralph
Published: August 2008

Objectives

1) Patterns of cervical metastasis in PTC. 2) Importance of elective dissection of levels II‐B & V‐A.

Methods

Charts were reviewed of 53 consecutive patients (February 2002‐December 2007) with PTC who underwent lateral neck dissection that included at least levels II (A and B), and V (A and B).

Results

53 patients underwent lateral neck dissection for FNA‐confirmed nodal metastasis of PTC. 46 patients underwent unilateral neck dissection, while 7 had bilateral neck dissection, resulting in a total of 60 neck dissection specimens which were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 out of 59 specimens (33/59–%60) positive for metastasis. Level II‐B was positive 5 times (5/59, 8.5%–95% CI: 2.4, 20.4); and each time level II‐B was positive, level II‐A was also positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58–66%). Level IV was excised 58 times and was positive in 29 specimens (29/58–50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16‐40‐40%). Level V‐A did not account for any of the positive level V results.

Conclusions

Patients with PTC undergoing lateral neck dissection for FNA‐confirmed nodal metastases might harbor disease in level II‐B, especially if level II‐A is involved. Elective dissection of level V‐B should also be considered in this scenario, while routine level V‐A dissection is not necessary.
S178 – Utility of CT‐Sestamibi Fusion in Parathyroid Exploration
Authors: Clark Michael J , Pellitteri Phillip
Published: August 2008

Objectives

1) Delineate the role of CT‐technetium 99m sestamibi (CT‐MIBI) fusion in directed parathyroidectomy. 2) Determine the clinical situations where CT‐MIBI fusion would be strongly recommended.

Methods

Charts from 190 patients with primary hyperparathyroidism who underwent CT‐MIBI mage fusion as a part of a scan directed, minimally invasive parathyroid exploration protocol were reviewed. The results of conventional sestamibi imaging and CT‐MIBI image fusion were compared with operative findings.

Results

CT‐MIBI image fusion accurately localized solitary hyperfunctional parathyroid glands in 70% of patients imaged; 55% of patients were localized with conventional sestamibi imaging. CT‐MIBI fusion imaging was most accurate and predictive when conventional images suggested that the solitary gland was separated from the thyroid or when the adenoma was located in the retro‐thyroidal/ retro‐esophageal plane or mediastinum.

Conclusions

CT‐MIBI image fusion is not superior to conventional sestamibi imaging when utilized for routine localization of hyperfunctional parathyroid glands. CT‐MIBI fusion is of greatest benefit in guiding the directed approach to solitary glands, which are separate from the thyroid or ectopically located, regions where conventional imaging has proven to be less accurate. This imaging technique will augment the minimally invasive surgical approach in selected patients with primary hyperparathyroidism in order to further refine the focused technique. Its utility as the standard preoperative localization modality is not yet established and requires further investigation. Evaluation of differences in facility utilization with CT‐MIBI image fusion and conventional sestamibi imaging may be helpful in determining its role in preoperative localization for hyperparathyroidism.
S188 – Development of Laryngoscope with a Built‐in Laser Ruler
Authors: Lee Jin‐Choon , Wang Soo‐Geun , Goh Eui‐Kyung , Kim Yong‐Wan , Lee Jin‐Woo , Lee Young‐Ok , Lee Jong‐Kil
Published: August 2008

Objectives

The endoscope for inspection of body cavities has improved the accuracy of diagnosis. However, the magnification changes as the distance between the scope and object is varied. Changes in magnification make it impossible to measure surface distances for staging of lesion or to determine the displacement of structures. The objective of this invention is to develop a new device that provides a simple and noninvasive method of measuring accurate lesion size through an endoscope.

Methods

The invention incorporates a built‐in laser diode that projects auto‐parallel beams into the optical path of the rigid laryngoscope to form 2 spots in the field of view.

Results

The interspot distance is constant despite changes in focal plane, magnification, or viewing angle of laryngoscope. The interspot distance of being projected to even surface is constantly 4 mm.

Conclusions

This device enables the laryngologist to easily measure the distance between landmarks, or the size of vocal fold lesions in the outpatient setting.
S190 – Voice Spectral Analysis After Surface Electrical Stimulation
Authors: Hapner Edie Renee , Gorham‐Rowan Mary , Morris Richard J. , Fowler Linda P
Published: August 2008

Objectives

The purpose of this study was to measure changes in vocal fold closure associated with surface electrical stimulation (VitalStim®).

Methods

30 participants, 15 male and 15 female, ages 20–56 years, were included in the study. Participants underwent 1 hour of surface electrical stimulation, per guidelines reported in the VitalStim® manual. 3 trials of the vowel /ae/ were analyzed pre‐ and post‐stimulation. Indirect estimates of glottal closure were obtained from the recorded vowels, as follows: 1) H1–H2: the amplitude of the first harmonic to the second harmonic (open quotient); 2) H1–A1: the ratio of the amplitude of the first harmonic to the amplitude of the first formant (glottal width); and 3) H1–A3: the ratio of the amplitude of the first harmonic to the amplitude of the third formant (spectral tilt).

Results

The direction and magnitude of change for all 3 parameters varied widely across participants. No significant difference occurred pre‐ vs. post‐stimulation for any of the parameters.

Conclusions

VitalStim® did not systematically affect open quotient, glottal width, or spectral tilt. These results do not support the concept that VitalStim® has a direct effect upon vocal fold closure.
S195 – Laryngeal Observation of Early Cancer with NBI System
Authors: Higashikawa Masahiko
Published: August 2008

Objectives

The Narrow Band Imaging (NBI) is an illumination method for medical endoscopes that can visualize the micro‐vascular structure of the organ surface. The effectiveness of NBI has been reported in detecting the oropharyngeal and hypopharyngeal neoplasm lesion. The aim of this study is to identify the usefulness of NBI in laryngeal lesion, especially in observing cases of post‐operated or post‐irradiated early laryngeal cancers.

Methods

16 patients of early laryngeal cancer after treatment for at least 6 months were entered in this study: 1 case of T1s, 8 cases of T1a, 3 cases of T1b, and 4 cases of T2. 3 cases of T1a underwent cordectomy under direct laryngoscope using KTP laser. 13 cases were treated with irradiation.

Results

The cases for which NBI was suggested to be useful were: T1b, undergoing laser surgery, supra‐glottic carcinoma, appearing hyper‐adduction of the false vocal fold during phonating, and causing severe mucosal edema after irradiation.

Conclusions

NBI system may play an important role in the observation of post‐therapy of early laryngeal cancer.
S198 – Muscle Pedicle Thyroplasty for Difficult or Revision Cases
Authors: Christenson Thomas , Goyal Neerav , Spiegel Joseph R
Published: August 2008

Objectives

1) Describe a modification of the type I thyroplasty procedure of Isshiki, incorporating a pedicled muscle flap which is rotated through the thyroid cartilage window into a pocket lateral to the thyroarytenoid muscle. The muscle flap is used to replace or augment an alloplastic implant. 2) Be able to understand the applications and indications for this procedure.

Methods

Our series describes 6 patients undergoing primary or revision thyroplasty since January 2006. In primary cases, the muscle pedicle was utilized after initial dissection resulted in an injury to the endolaryngeal mucosa, or to augment an implant that did not produce adequate medialization. In the revision cases, the muscle pedicle was utilized to replace a Silastic implant at the time of removal. Pre‐operative and postoperative videostroboscopy was performed on all patients.

Results

Postoperative videostroboscopy revealed satisfactory glottic closure in all 6 patients between 1 and 3 months after their operations.

Conclusions

The procedure of muscle pedicle thyroplasty provides adequate glottic closure in cases of revision thyroplasty and in cases where it was used to augment another implant. It represents an alternative medialization technique in difficult and unusual cases, or when an alloplastic implant is contraindicated. Long‐term durability of the medialization is not assessed in this series.
S202 – Patterns of Dysphagia in Hospital Inpatients
Authors: Lotfizadeh Ali , Chhetri Dinesh K
Published: August 2008

Objectives

To evaluate the patterns of dysphagia, aspiration, and vocal cord motion abnormality (VCMA) among inpatients at a tertiary care referral hospital.

Methods

The medical records of all patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES) between July 2005 and June 2007 were reviewed retrospectively. Demographic information, and presence of aspiration or VCMA was documented. Patients were categorized according to indication for hospitalization as well as into surgical and non‐surgical categories. Dysphagia severity was assessed and variations in the prevalence of aspiration and VCMA were ascertained using correlation analysis.

Results

418 inpatients underwent FEES. Commonly observed patient categories included: 1) neurological/neurosurgical, 2) liver disease/transplant, 3) cardiac surgery, 4) medicine, 5) other surgical. The overall prevalence of aspiration and VCMA were 51% and 21% respectively. VCMA was observed twice as frequently in surgical patients (p = 0.0005), while aspiration was seen at similar rates (p = 0.85) among surgical and non‐surgical patients. Dysphagia was most severe in neurological/neurosurgical patients. The prevalence of VCMA was highest in cardiac surgery patients (p = 0.007), but the incidence of aspiration did not differ markedly among the groups (p = 0.18).

Conclusions

Swallowing dysfunction is associated with a multitude of medical and surgical conditions. The severity of dysphagia, and the prevalence of associated VCMA vary among different patient categories, while aspiration occurs at similar rates. Understanding these patterns is crucial in guiding the diagnosis and management of inpatients with dysphagia.
S203 – The STAMP Registration for Image‐guided Otologic Surgery
Authors: Matsumoto Nozomu , Hong Jaesung , Makoto Hashizume , Komune Shizuo
Published: August 2008

Objectives

1) Develop a less invasive but accurate enough registration strategy for otological surgical navigation. 2) Evaluate the new system in phantom study. 3) Evaluate the new system in cochlear implant surgeries.

Methods

A new registration method was developed for otologic surgery. Previously, the registration for accurate image‐guided surgery often required invasive fiducial markers attached on patient's bone. We utilized the template of the bone surface to transfer the pre‐made virtual bone‐anchored markers to the patient's bone intraoperatively and eliminated the necessity for preoperative marker positioning or preoperative additional CT scan.

Results

We tested this Surface Template‐Assisted Marker Positioning (STAMP) method using 5 temporal bone replicas, and in 5 ear surgeries (2 cochlear implants, 3 translabyrinthine acoustic neuroma surgeries) to investigate whether this method improves, or at least retains, the accuracy of image‐ guided surgery (IGS). The fiducial registration errors and target registration errors in the phantom study was ∼0.7 mm and ∼1.5 mm, respectively. The target registration errors in replicas were always less than 2 mm. In actual ear surgeries the fiducial registration errors were ∼0.6 mm and the target registration errors were less than 2 mm in 4 of 5 surgeries. All patients received successful cochlear implantation or tumor removal.

Conclusions

The new method reduced the preoperative procedures for patients but did not reduce the accuracy of the surgical navigation. Our method would be a useful IGS method in the field of otology where both accuracy and non‐invasiveness are required.
S206 – Efficacy of MRI for Management of Labyrinthine Fistulae
Authors: Sone Michihiko , Mizuno Terukazu , Otake Hironao , Nakashima Tsutomu
Published: August 2008

Objectives

Surgical management of cholesteatomas with labyrinthine fistulae has been reported and several techniques have also been advocated, however, no uniform surgical technique can be adopted in all cases with fistulae. We examined the efficacy of MRI evaluation for surgical management of cholesteatoma with a labyrinthine fistula.

Methods

The case histories of 23 patients who had undergone surgery for middle ear cholesteatoma with a labyrinthine fistula were examined. Imaging analysis was performed using a 3‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging (MRI) sequence. Clinical symptoms, presence of fistulae, surgical management, and postoperative outcomes were compared between groups who had or had not undergone preoperative 3D‐FLAIR MRI.

Results

Safe surgical management was achieved in the group without MRI evaluation. The group with MRI evaluation contained cases with larger fistulae and more severe clinical symptoms; however, MRI provided precise information concerning the degree of labyrinthitis, which enabled adequate surgical management and successful outcomes including improvement of sensorineural hearing loss in some cases.

Conclusions

Information provided by 3D‐FLAIR images is valuable in the surgical management of cholesteatoma with a labyrinthine fistula, especially in cases with large fistulae and severe symptoms related to inner ear disturbances.
S207 – Split Light Reflex in Retraction of the Tympanic Membrane
Authors: Grant David G , Pothier David Douglas , Canter Richard J , Jardine Annette Hillegonda
Published: August 2008

Objectives

It is difficult to reliably diagnose the early stages of retraction on a purely clinical basis. This is of particular importance where a diagnosis needs to be made in a setting, such as in primary care or a clinical dataset, where tympanometry is not always available. Although a split light reflex is sometimes used clinically, it has not been shown to be of definite diagnostic value.

Methods

Digital photographs were taken of the tympanic membrane of 50 sequential ears for which a type C tympanogram had been recorded and 50 ears for which a type A tympanogram had been recorded. Each photograph was cropped to an area that incorporated the light reflex only. 3 otologists examined each image and recorded the status of the light reflex as split, not split, or ‘unable to determine.’

Results

The sensitivity of the split light reflex in diagnosing mild retraction of the tympanic membrane ranged from 83% to 87% with a ‘majority value’ sensitivity of 91%. The specificity ranged from 84% to 98%. The positive predictive value ranged from 84% to 90%. The Krippendorff's alpha statistic for inter‐rater reliability between all three raters was 0.61.

Conclusions

The split light reflex is a sensitive and specific sign in the diagnosis of a mildly retracted tympanic membrane. This finding has important implications in the construction of a reliable system for the staging of retractions of the pars tensa.
S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?
Authors: Heman‐Ackah Selena E. , Ryan Dunn , Huang Tina C.
Published: August 2008

Objectives

A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost‐effectiveness of the diagnostic screening for ASSNHL.

Methods

The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work‐up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed.

Results

All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA‐ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA‐ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low.

Conclusions

The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.
S212 – Sensitivity of Pseudomonas in Malignant External Otitis
Authors: Felix Felippe , De Oliveira Barros Thiago , Muneroli Emilio Jonatas , Tomita Shiro
Published: August 2008

Objectives

1) To evaluate if there has been an increase in resistance of bacteria from genus Pseudomonas to ciprofloxacin in patients with malignant external otitis (MEO), and 2) if this has increased the morbidity of the disease.

Methods

Study Design: retrospective. Setting: tertiary referral center. Patients: 21 patients with MEO over 15 years. The records of these patients were reviewed. Samples taken from the external auditory meatus using sterile swabs were sent to the laboratory for processing, where sensitivity of the microorganisms was tested using the agar diffusion method for 15 different antibacterial agents.

Results

As of 2006, no cases of ciprofloxacin resistance had been detected in patients with MEO treated at this institution. 2 cases (9,5%) of ciprofloxacin resistance were identified in 2007, obtaining a good response with the use of cefepime at a dose of 4g/day. None of the cases presented resistance to amikacin, imipenem, meropenem, cefepime, or ceftazidime. All cases of resistance were in elderly coming from the community, diabetics who had already used systemic or topical ciprofloxacin with no improvement in their condition. No increase in morbidity and mortality was observed in this group.

Conclusions

Ciprofloxacin resistance was found in 9.5% of the samples isolated over the years. No increase in morbidity was observed.
S215 – The Effects of Topical Halofuginon on Myringotomy in Rats
Authors: Cincik Hakan , Ozdemir Taner , Çekin Engin , Dogru Salim , Gungor Atila , Poyrazoglu I. Ethem
Published: August 2008

Objectives

1) To investigate the role of halofuginone hydrobromide on myringotomy incision healing time. 2) To investigate the role of halofuginone hydrobromide on formation of myringosclerosis.

Methods

40 rats with normal eardrums were involved in this study to determine if topical halofuginone application had an impact on prolonging the time for healing of myringotomy incision and its histopathological consequences. The study group and control group consisted of 30 and 10 rats, respectively. A posterior incision 1 mm in diameter was made on randomly selected healty eardrums of the rats. After making incision in the study group, gelfoam soaked in halofuginone hydrobromide of 30 mg/dl was applied on the perforation, while gelfoam dipped in isotonic saline was introduced to perforation in the control group. On days 1, 3,7,10,14,18,21, 24, 27 and 30, otoendoscopic evaluation of eardrums under general anesthesia was conducted and perforations were screened. On control days, one randomly selected rat from each group was sacrified and temporal bones were dissected in order to evaluate the tympanic membranes histopathologically.

Results

The average times for patency of perforation in study and control groups were 21.43 and 7.50 days, respectively. The difference was found to be statistically significant (p<0.05).

Conclusions

Histopathological evaluation revealed that halofuginone seems to result in low hyalinization and fibrosis on eardrum compared to the control group.
S217 – Neurotologic Features of Temporomandibular Joint Tumors
Authors: Leonetti John P , Marzo Sam , Porter Ryan G
Published: August 2008

Objectives

To present the clinical and radiographic findings in 8 patients with unusual primary tumors of the temporomandibular joint (TMJ).

Methods

This was a retrospective chart review of all patients with neurotologic manifestations caused by primary TMJ tumors seen at our tertiary care, academic medical center between 7/88‐; 7/07.

Results

8 patients were identified with primary TMJ tumors that caused a variety of neurotologic manifestations, including trismus, otalgia, tinnitus, hearing loss, aural fullness, headache, facial pain, and otorrhea. Tumor histology included chondroma, chondroblastoma, osteoma, giant cell tumor, synovial chondromatosis, and osteosarcoma. Anterior external auditory canal involvement required partial petrosectomy in all 8 patients. Despite aggressive surgical resection and radiotherapy, only 5 of 8 patients are disease‐free, with a mean follow‐up of 7.2 years.

Conclusions

Primary tumors of the TMJ, although rare, can cause a variety of common neurotologic manifestations. A complete physical examination with appropriate radiographic assessment will guide the proper treatment plan. Earlier diagnosis may lead to improved overall control rates.
S220 – Characteristics of Fluid and Tympanometry Profiles in OME
Authors: Lee Seung‐Hwan , Lee Youngseok , Kim Yunjeong , Kim Bum‐Suk , Jeong Seung‐Won , Jeong Jin Hyeok , Park Chul‐Won
Published: August 2008

Objectives

The aim of this study was to compare the characteristics of the type B tympanogram curve (maximum admittance, tympanometric peak pressure) to the volume and viscosity of middle ear fluid.

Methods

We conducted preoperative tympanometry from 175 ears in 94 children with otitis media with effusion. The volume and viscosity of middle ear fluid collected during myringotomy were classified into 3 groups respectively. We analysed the correlations between the characteristcs of middle ear fluid and tympanometric profiles such as maximum admittance, tympanometric peak pressure. Student t test was used for statistical analysis.

Results

No correlation was found between peak pressure of the tympanogram and the characteristics of middle ear fluid. However, as the volume of middle ear fluid increases, the viscosity and the straight type B tympanogram increased significantly (p<0.001, p=0.002 respectively). And as the volume and the viscosity of the middle ear fluid increased, the Admmax significantly decreased (p<0.001).

Conclusions

Characteristics of type B tympanogram curve were correlated with the volume and viscosity of middle ear fluid. And it can be suggested that tympanometry may be used as an objective measure to estimate the characteristics of the middle ear fluid.
S221 – The Postero‐superior Quadrant of the Tympanic Membrane
Authors: Branco Carla , Paco Joao‐Carlos Lopes Simoes , Carmo Diogo O. , Estibeiro Hugo
Published: August 2008

Objectives

The purpose of this study was to document the anatomic relationship of the postero‐superior segment of the tympanic membrane and its clinical implications.

Methods

100 temporal bones from adults without history of otologic pathology were studied. The morphological and anatomical details of the tympanic membrane were observed in 70 bones, which implied the use of macroscopic sections of the bones. The histological results were documented in 30 serially sectioned bones, stained previously with hematoxylin‐eosin.

Results

We established that the postero‐superior quadrant was the largest in size, with a mean dimension of 21.05 mm2, which represents 28.7% of the total area of the tympanic membrane. This feature implies that this quadrant is more exposed to pressure changes. We also verified that the posterosuperior part of the tympanic sulcus, above the chorda tympanic nerve, lost its depth in an unexpected way (60%) or that it gradually diminished from 0.9 to 0.5 mm until it disappeared near the posterior tympanic spine. In association, we established that at this level there was a decrease in the annulus caliber. Additionally, in 25% of cases, given the absence of the circular fibers of lamina propria, the postero‐superior quadrant had only the radial fiber layer.

Conclusions

Anatomic and morphologic details in the postero‐superior quadrant were newly described and may explain the greater incidence of retraction pockets and marginal perforations that provide the origin of cholestheatoma.
S222 – Sound Localization in Subjects with Tinnitus
Authors: Shin Il Ho
Published: August 2008

Objectives

Sound localization in subjects with normal hearing is done by recognition of interaural difference of time, intensity, and phase of sound source. The defect of sound localizing ability may increase the chance of accident, decrease public conversation. Individuals with tinnitus, deprived of the binaural cues, are expected to have difficulty in localizing sound. The purpose of the research is to investigate the sound localizing ability in subjects with tinnitus to localize sound in horizontal plane by comparing with normal control group.

Methods

3 groups of subjects participated in this study. The first group consisted of 30 subjects with unilateral tinnitus without hearing disturbance, the second group consisted of 30 subjects with unilateral tinntus, hearing disturbance. Control group was 20 normal hearing adults. Sound localization ability was assessed by means of an array of 8 loudspeakers positioned at the azimuth of 45°each in the horizontal plane at a distance of 100 cm from the subject.

Results

The localization score increased significantly as tinnitus with hearing disturbance as compared with control group(p<0.05). In the tinnitus without hearing disturbance group as compared with the control group, the localization score increased but there is no stastical significance.

Conclusions

In the tinnitus without hearing disturbance group, the sound localization ability was decreased but there is no stastical significance. This means that tinnitus has relatively small effect of interaural intensity difference in usual living. It needs further study with similar tinnitus intensity, pitch.
S223 – Effect of Myopia on the Caloric Test
Authors: Thakar Alok
Published: August 2008

Objectives

To assess the impact of corrected myopia on the caloric test. Correction of myopia with spectacles or contact lenses results in alteration of the size of the retinal image. Previous laboratory experiments have demonstrated that gross changes in the size of the retinal image can result in recalibration or suppression of the vestibulo‐ocular reflex (VOR).

Methods

Case‐control study. 17 evaluable healthy volunteers with myopia corrected either by spectacles or contact lenses (case group) compared to 17 volunteers with no refractive error (control group). Complete Electro‐Nystagmography inclusive of bithermal caloric testing undertaken for cases and controls. Assessment of hypoactive caloric responses based on normative laboratory values.

Results

7 of 17 cases and 1 of 17 controls demonstrated hypoactive caloric responses. In the spectacle users group, 6 of 11 (55%) had hypoactive responses. Spectacle users were significantly more likely than emmetropic controls to have hypoactive caloric responses (p<0.01; relative risk 9.3 {95 % Confidence Interval 1.3 to 66.9}).

Conclusions

1) A significant proportion of myopes using spectacles have suppression of the vestibulo‐ocular reflex as demonstrated by the caloric test. This has implications for the interpretation of ENG results, and also as a cause of vestibular impairment. 2) Further studies in myopes are warranted for precise and direct evaluation of the VOR by rotation or impulse testing.
S227 – Investigation of the Prion Protein in Subjects with Tinnitus
Authors: Kleinjung Tobias , Langguth Berthold , Veronika Vielsmeier , Landgrebe Michael , Sand Philipp
Published: August 2008

Objectives

The prion protein (PrP) plays a major role in central nervous excitability, cellular adhesion, and neurite outgrowth. We hypothesized that PrP variants may act as a modulator of chronic tinnitus, a condition frequently associated with states of overexcitability in the auditory pathway.

Methods

139 Caucasian patients who presented with tinnitus lasting more than 6 months were recruited from a tinnitus clinic, underwent detailed neuro‐otological examinations and donated venous blood for the extraction of genomic DNA from lymphocytes. Subjects with a history of vestibular schwannoma, Meniere's disease, or pathological middle ear conditions were excluded. Tinnitus severity was graded using the Tinnitus Questionnaire (TQ). A polymorphism encoding residue 117 of PrP was genotyped by PCR‐based RFLP.

Results

When carriers of the minor PrP allele were compared to the remaining subjects, we noted only a moderate difference in mean TQ scores (33.4 ± 4.9 vs. 37.4 ± 1.5, p > 0.05).

Conclusions

The present results thus do not support a significant effect of PrP variant rs8124214 on subjective ratings of tinnitus. However, functional PrP variants may act on additional outcome parameters, e.g., on the response to treatment. Future studies will need to address the interplay of these variants, and their effects on specific subgroups.
S233 – Diagnostic Role of Electrocochleography after Glycerol Test
Authors: Majidi Mohammadreza , Nematollah Mokhtari , Mohammadreza Tale , Aliasghar Rauf , Shakeri Mohammad Taghi
Published: August 2008

Objectives

Response to dehydrating agents such as glycerol in Meniere's disease is evaluated by audiometric shifts after substance administration. Since the major pathogenic event in this disease is endolymphatic hydrops, evidenced by elevated SP/AP ratio, this study was conducted to determine the value of electrochochleography in assessment of response to glycerol administration in patients with definite Meniere's disease.

Methods

Between October 2006 and December 2007, 12 women and 10 men with definite Meniere's disease, based on AAO‐HNS guidelines during acute phase, were included in this study. Pure tone audiometry (before and 1,2,3 hours after glycerol administration) and extratympanic electrocochleography (before and 3 hours after test) were performed; improvement in tinnitus, aural fullness, and vertigo symptoms were recorded after glycerol administration. Chi‐square test was used to compare the sensitivity of electrocochleography and pure tone audiometry for detection of response to glycerol test.

Results

22 patients, mean age of 40.18±8.8 years, were included in this study. Of 16 patients with tinnitus complaint, 9 patients reported significant improvement after glycerol test. Of 22 patients with vertigo and aural fullness symptoms, 19 reported significant clinical improvement. The SP/AP ratio was significantly reduced and reached to less than 80% of pretest values in 17 of these patients, but improvement in pure tone thresholds was observed in 8 patients. The difference between 2 methods was significant (p<0.05).

Conclusions

It seems that significant reduction in SP/AP ratio in patients with Meniere's disease might be a more sensitive indicator of the response to glycerol test than pure tone threshold shifts.
S235 – Diagnostic Test Validation: CHAMP in Endolymphatic Hydrops
Authors: Rojas Eveling Y , Ordoñez Leonardo , Hernandez Victor , Guzman Jose E , Izquierdo Juan , Lora Jose Gabriel , Prieto Jose
Published: August 2008

Objectives

The Cochlear Hydrops Analysis Masking Procedure (CHAMP) has been reported with a high sensibility and specificity for the diagnosis of endolymphatic hydrops (ELH). Nevertheless, a complete validation of CHAMP with precise methods has not been done. Our objectives: To determine whether CHAMP has a diagnostic value in patients with definite, probable/possible diagnosis of Meniere's disease or endolymphatic hydrops, based on the criteria of the AAO‐HNS.

Methods

Prospective validation study for a diagnostic test: phase II. Latency of wave V was assessed using CHAMP. We classified subjects in 5 groups: 1‐Definite ELH, 2‐Probable ELH, 3‐Possible ELH, 4‐subjects with other otovestibular symptoms, 5‐normal hearing subjects. We included cases (groups 1–4) with an episode of vertigo with duration equal or longer than 20 minutes, with or without other otovestibular symptoms.

Results

We included 67 cases (132 ears). 38 cases (76 ears) completed the follow up and their results are presented. In group 1, the sensibility of CHAMP was 43% and its specificity was 100%. In groups 2–3, the sensitivity was 20% and the specificity 100%, with 0% false positive and 80% false negative results. Other indicators of validity for this diagnostic test are presented.

Conclusions

CHAMP has a high specificity and low sensibility for the diagnosis of ELH when the delay in wave V latency is used. Future studies may assess the relationship between wave amplitudes to improve the clinical value of CHAMP.