bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Eardrum Laser Doppler Interferometry as a Diagnostic Tool
Authors: Huber Alexander M. , Schwab Christoph , Linder Thomas , Stoeckli Sandro J. , Ferrazzini Mattia , Dillier Norbert , Fisch Ugo
Published: November 2003

Objectives Laser Doppler interferometry (LDI) of the eardrum allows noncontact optical analysis of its vibrations in response to sound. Although LDI has been widely used in research, it has not yet been introduced into clinical practice as an adjunctive test for otological workup. The aim of this study was to evaluate LDI as a diagnostic tool in the clinical sphere.

Study Design Prospective.

Methods A measurement system was developed based on a commercially available scanning He‐Ne laser Doppler interferometer. The study included 129 eardrums of 79 subjects that were divided into 3 groups: 1) normal subjects and 2) patients with sensorineural and 3) conductive hearing loss (HL). All the patients suffering from conductive HL underwent ossiculoplasty, which allowed confirmation of the final diagnosis, and patients were assigned accordingly to the subgroups malleus fixation, incus luxation, and stapes fixation.

Results The modified LDI system allowed bilateral evaluation of a subject within 30 minutes. No significant difference between normal subjects and patients having sensorineural HL were found. However, it was possible to distinguish between normal subjects and patients with conductive HL. Furthermore, the system had the ability to differentiate between various middle ear diseases. These groups differed statistically significantly in terms of manubrium vibration amplitude and resonance frequency. In malleus fixation significant differences in tympanic membrane movement patterns were found.

Conclusions Our LDI is applicable in clinical otological practice and serves as a valuable addition to the routine audiological investigations for preoperative evaluation of the mobility and integrity of the ossicular chain.
Second Malignant Neoplasms in Patients Under 40 Years of Age With Laryngeal Cancer
Authors: Albright James T. , Karpati Ronit , Topham Allan K. , Spiegel Joseph R. , Sataloff Robert T.
Published: November 2003

Objectives/Hypothesis To determine the incidence of second malignant neoplasms (SMN) in patients under 40 years of age with invasive squamous cell carcinoma (SCC) of the larynx.

Study Design Retrospective.

Methods Using a National Cancer Institute tumor registry database encompassing 1973–1996, the incidence of SMN in patients under 40 years of age with laryngeal cancer was determined and compared with that of the registry's older, more traditional laryngeal cancer population. Median follow‐up was 136 months.

Results Among the 364 patients under the age of 40 years with laryngeal cancer, 30 (8.2%) had developed a secondary malignancy to date. In comparison, 4876 (21.4%) of 22,786 patients 40 years or older with laryngeal cancer were affected by an SMN. Kaplan‐Meier analysis of the younger cohort projected 3.0%, 6.8%, and 10.7% relative risk of developing a SMN at any site over 5‐, 10‐, and 15‐year periods, respectively, after index tumor diagnosis. Similar results for the older cohort were 14.2%, 28.1%, and 39.4% at 5, 10, and 15 years, respectively. Further Kaplan‐Meier analysis demonstrated at least a fourfold increased risk for the development of secondary upper aerodigestive tract malignancies among older compared with younger patients.

Conclusion Patients under 40 years of age with invasive SCC of the larynx are significantly less likely to develop a second malignancy than their older counterparts.
Endoscopy‐Negative, Computed Tomography‐Negative Facial Pain in a Nasal Clinic
Authors: West Brian , Jones Nick S.
Published: November 2003

Objectives To establish the etiology of facial pain in individuals attending the nasal clinic of the Department of Otorhinolaryngology, University Hospital, Nottingham, U.K., with normal nasal endoscopy and computed tomography of the paranasal sinuses.

Study Design A retrospective analysis of a cohort of 973 patients consecutively presenting to the nasal clinic with symptoms of rhinosinusitis and/or facial pain.

Methods We reviewed the case notes of 973 consecutive patients who presented to the nasal clinic with either symptoms of rhinosinusitis or facial pain, and in particular 101 who had facial pain without any objective evidence of nasal disease as detected by nasal endoscopy or computed tomography. The diagnosis was based on the outcome and response to treatment after a mean of 2 years 2 months.

Results One hundred one patients had pain as a predominant symptom with normal nasal endoscopy and computed tomography of the paranasal sinuses. None of these patients responded to either medical or surgical treatment for what some workers have hypothesized could be “occult” sinonasal disease. A neurological diagnosis was made in 99 patients. Eighty patients received successful medical treatment for “neurological” diagnoses, 8 patients experienced spontaneous resolution of their symptoms, 7 failed to respond to any treatment modality, 2 were lost to follow‐up, and 2 refused any treatment.

Conclusion The majority of patients presenting to a rhinologic clinic with facial pain and no objective evidence of sinus disease, as detected by endoscopy and computed tomography, responded well to neurological treatment and surgical intervention was unnecessary. These patients should receive a trial of medical therapy, such as low‐dose amitriptyline for 6 weeks in the first instance, before any surgical intervention is considered.
Certain Anatomical Relations and the Precise Morphometry of the Infraorbital Foramen–Canal and Groove: An Anatomical and Cephalometric Study
Authors: Kazkayasi Mustafa , Ergin Ahmet , Ersoy Mehmet , Bengi Osman , Tekdemir Ibrahim , Elhan Alaittin
Published: November 2003

Objectives To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures.

Study Design This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed.

Methods Thirty‐five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram.

Results Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 ± 1.39 mm, 33.94 ± 3.15, and 17.23 ± 2.64 mm, respectively. In cephalometric analysis, when S‐N (the distance between the center of the sella turcica and the nasion) and N‐ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant.

Conclusion While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.
Laryngotracheal Anastomosis: Primary and Revised Procedures
Authors: Wolf Michael , Shapira Yisgav , Talmi Yoav P. , Novikov Ilia , Kronenberg Jona , Yellin Alon
Published: November 2003

Objectives Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success.

Study Design A cohort study in a tertiary referral medical center.

Methods The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency).

Results Twenty‐two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily‐activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant.

Conclusions The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity.
Learning Curve for Translaryngeal Tracheotomy in Head and Neck Surgery
Authors: Giugliano Gioacchino , Venturino Marco , DePaoli Fiora , Andrle Jan , Calabrese Luca , Tradati Nicoletta , Chiesa Fausto , Scarpa Daniela , Susini Giuseppe
Published: November 2003

Objectives Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive‐care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long‐term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery.

Study Design Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999.

Methods Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short‐term and long‐term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed.

Results TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter‐cannu1a and stylet.

Conclusions In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter‐cannu1a and stylet.
Fascia Augmentation of the Vocal Fold: Graft Yield in the Canine and Preliminary Clinical Experience
Authors: Duke Sanford G. , Salmon Jay , Blalock P. David , Postma Gregory N. , Koufman James A.
Published: November 2003

Introduction Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host‐tissue tolerance have motivated the continued search for an ideal graft substance.

Study Design A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model.

Methods Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow‐up was 9 months.

Results In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%–84%) compared with autologous lipoinjection (47%; range, 7%–96%;P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise‐to‐harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation.

Conclusions Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.
Cochlear Structures After Implantation of a Perimodiolar Electrode Array
Authors: Richter Bernhard , Jaekel Katrin , Aschendorff Antje , Marangos Nikolaos , Laszig Roland
Published: November 2003

Objective A perimodiolar prototype electrode array has been evaluated on 12 human temporal bone specimens. To achieve modiolar proximity, a fine Teflon™ positioner is attached to the tip and base of a conventional Nucleus 22 electrode array.

Methods Intracochlear electrode position was examined by macroscopic preparation and confirmed by a cochlear view x‐ray after insertion into human temporal bones. The temporal bones were examined with light microscopy for intracochlear trauma after insertion, explantation, and re‐implantation of the perimodiolar array.

Results Macroscopic preparation and x‐ray confirmed close proximity of the intracochlear electrodes to the modiolar wall. In some bones, electrode insertion and positioning was performed without significant damage to intracochlear structures, but explantation caused varying degrees of trauma depending on the explantation technique used. Re‐implantation and repeat explantation appeared to destroy most of the intracochlear architecture.

Conclusions The perimodiolar electrode array prototype with Teflon positioner cannot be recommended for clinical use, especially in children in whom the possibility for re‐implantation is high.
Radiofrequency Is a Safe and Effective Treatment of Turbinate Hypertrophy
Authors: Coste André , Yona Laurent , Blumen Marc , Louis Bruno , Zerah Francoise , Rugina Michel , Peynègre Roger , Harf Alain , Escudier Estelle
Published: November 2003

Objective To evaluate the safety and efficacy of radiofrequency for reduction of inferior turbinate volume.

Study Design Prospective before‐and‐after trial.

Methods Fourteen patients complaining of chronic nasal obstruction and failing to respond to medical treatment were prospectively enrolled. All patients presented with inferior turbinate hypertrophy and no septal deformity. Radiofrequency inferior turbinate tissue reduction with three punctures in each turbinate (mean energy/puncture: 342 ± 36 J, mean duration: 69 ± 17 s, plateau tissue temperature: 75 ± 6.4°C). Patients were evaluated before and on days 3, 7, and 60 after intervention.

Results No postoperative pain or complications were reported. Evaluation of nasal obstruction, quantified by visual analogue scale, showed a significant decrease of day time and nighttime obstruction after surgery. Acoustic rhinometry measurements showed that turbinate hypertrophy was significantly reduced in the sitting and supine positions on day 60 after surgery. Saccharin transit times decreased significantly on day 60 compared with preoperative measurements. Ciliary beat frequency, measured in vitro in nasal epithelial cells sampled from the inferior turbinate by brushing, was not significantly different before surgery and on day 60 after surgery. In the same samples, ciliated cells were the most abundant epithelial cell type before and after surgery, although in five cases, moderate numbers of squamous cells were detected on either day 7 or day 60 after surgery.

Conclusion Radiofrequency is a safe surgical procedure capable of reducing turbinate volume without altering the nasal mucosa, and causing minimal discomfort for the patient.
Improved Postoperative Pain Control in Pediatric Adenotonsillectomy With Dextromethorphan
Authors: Dawson G. Stephen , Seidman Peggy , Ramadan Hassan H.
Published: November 2003

Design A prospective, randomized, double‐blinded, placebo‐controlled protocol.

Setting An academic, tertiary care referral center.

Patients Forty randomly selected children, ages 3 to 13 years, scheduled for adenotonsillectomy without other simultaneous procedures.

Intervention A single, oral dose of dextromethorphan pediatric cough syrup (1 mg/kg) or placebo given 30 minutes before surgery.

Main Outcome Measure Total dose requirement of intravenous morphine within a 6‐hour postoperative observation period.

Results During routine postoperative observation, significantly fewer patients in the dextromethorphan group required no intravenous morphine compared with the placebo group (P = .03). Of those children requiring morphine, the mean dose requirement was significantly lower in the dextromethorphan group (P = .02). There was no known drug‐related morbidity.

Conclusion Dextromethorphan syrup is a safe, non‐narcotic medication that significantly reduced the requirement of intravenous morphine after pediatric adenotonsillectomy. Its routine use in this manner is recommended.
Decreased Cochlear DNA Receptor Staining in MRL.MpJ‐Faslpr Autoimmune Mice With Hearing Loss
Authors: Kaylie David M. , Hefeneider Steven H. , Kempton J. Beth , Siess Don C. , Vedder Colleen T. , Merkens Louise S. , Trune Dennis R.
Published: November 2003

Objectives Previous studies of decreased cochlear DNA binding in autoimmune mice suggested that antibodies against a cochlear cell surface DNA receptor cause autoimmune hearing loss. However, the presence of a cochlear DNA receptor has not been determined. Therefore, immunohistochemistry with an anti‐DNA receptor antibody was performed on MRL.MpJ‐Faslpr (MRL/ lpr) autoimmune mice to determine 1) which inner ear structures contain DNA receptors and 2) whether the receptor staining pattern changes as autoimmune disease progresses and hearing thresholds increase.

Study Design A prospective study of the progression of hearing loss in autoimmune mice and correlated alterations in immunostaining for the inner ear DNA receptor.

Methods One group of MRL/ lpr mice (n = 10) was allowed to develop autoimmune disease, and auditory brainstem response (ABR) audiometry was performed at 4, 6, and 9 months of age to measure the progression of hearing loss. A second group (n = 5) was tested for ABR thresholds at 2 months of age and immediately killed to assess receptor staining before the onset of autoimmune disease and hearing loss. The inner ears from all mice were immunohistochemically stained with an anti‐DNA receptor antibody, and a qualitative analysis of the staining of cochlear structures was performed.

Results Auditory brainstem response audiometry revealed a significant 20‐ to 30‐dB elevation of thresholds as systemic disease progressed. Anti‐DNA receptor staining was heaviest in the spiral ligament and less intense in the spiral ganglion and cochlear nerve. Both groups showed a similar pattern of staining in these structures. The stria vascularis and hair cells also stained in both groups. However, the stria cells of normal‐hearing mice showed diffuse intracellular immunoreactivity, whereas older mice displayed less staining that was confined to the cell membranes.

Conclusions The inner ears of MRL/ lpr mice contain DNA receptors. Autoimmune hearing loss was correlated with weaker overall intracellular staining in the stria vascularis and hair cells but increased staining of the cell membranes. This suggested DNA receptors have impaired endocytosis and more receptors remain on the cell membrane, possibly as a result of binding by circulating autoantibodies.
Adenovirus Calcium Phosphate Coprecipitates Enhance Squamous Cell Carcinoma Gene Transfer
Authors: Min P. Yi Su , Lee John H. , Graham Scott , Zabner Joseph , Welsh Michael J.
Published: November 2003

Objectives/Hypothesis Adenoviral‐mediated gene transfer offers a potential new treatment strategy for squamous cell cancer of the head and neck (SCCHN). Initial studies on some SCCHN cell lines have shown that these cells can be resistant to adenovirus‐mediated gene transfer, requiring large amounts of vector and long infection times. The objectives of this study were to identify the barriers to gene transfer in three SCCHN lines, FaDu, SCC‐9, and SCC‐15, and to develop a method to circumvent the obstacles. We hypothesized that a low expression of adenovirus receptors may limit adenovirus infection and this may be overcome by using adenovirus complexed with calcium phosphate coprecipitates.

Methods Using standard cell and molecular biology techniques, infectively of SCCHN cells was investigated.

Results Using Cy3‐labeled adenovirus, we found minimal binding of adenovirus to FaDu cells and variable levels of binding among SCC‐9 and SCC‐15 cells. Northern blot analysis indicated that messenger RNA (mRNA) transcripts for coxsackie‐adenovirus receptor, which binds adenovirus, were absent in FaDu cells but present in SCC‐9 and SCC‐15 cells. Integrin αvβ5, which binds and facilitates internalization of adenovirus, were expressed at low levels in all three cell types. We overcame these barriers by using adenovirus complexed with calcium phosphate precipitates. Total transgene expression and the number of cells expressing transgene were increased in all three cancer lines using adenovirus complexed with calcium phosphate precipitates compared with adenovirus that was not complexed.

Conclusions Data in the present study suggest that adenovirus‐mediated gene transfer to SCCHN cell lines is a result of limited viral receptors. Delivering adenovirus in a calcium phosphate coprecipitate enhanced gene transfer and, perhaps, the therapeutic index.
Variability of Genetic Alterations in Different Sites of Head and Neck Cancer
Authors: Rodrigo Juan P. , Suárez Carlos , González Maria V. , Lazo Pedro S. , Ramos Sofía , Coto Eliecer , Alvarez Ignacio , García Luis A. , Martínez José A.
Published: November 2003

Objective Tumors arising from different sites of the head and neck area have different clinical behavior. However, most of the studies on genetic alterations in head and neck squamous cell carcinomas do not make a distinction between the sites within this area. The objective of this study is to compare the genetic alterations in three different sites of the head and neck (larynx, oropharynx, and hypopharynx).

Study Design Prospective study.

Methods Thirty‐eight laryngeal, 29 oropharyngeal, and 37 hypopharyngeal carcinomas were studied. DNA from tumor and healthy tissue was evaluated for amplification of the oncogenes at 11q13 region (CCND1, FGF3, FGF4 and EMS1) and of the oncogenes MYC and ERBB1; for integration of the human papillomavirus (HPV) types 6b and 16; for loss of heterozygosity (LOH) at p53 and NAT2; and for the cellular DNA content.

Results FGF3 and FGF4 showed a significantly higher frequency of amplification in hypopharyngeal tumors (P = .006 and P = .0002, respectively). CCND1 amplification had a nearly statistically significant (P = .072) higher frequency of amplification in hypopharyngeal tumors. Aneuploid tumors were found in a significantly lower proportion in the larynx (P = .03) compared with the other sites. For the other genetic alterations, no significant differences among the three sites were found.

Conclusions These results suggest that cancers originating from different sites in the head and neck may have different tumor biology. Therefore, they should be considered as different entities.
Complications of Type I Thyroplasty and Arytenoid Adduction
Authors: Abraham Manoj T. , Gonen Mithat , Kraus Dennis H.
Published: November 2003

Objectives/Hypothesis Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery.

Study Design and Methods The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed.

Results There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%–94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P = .0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P = .1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone.

Conclusion Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.
Base‐of‐Tongue Cancer: Survival, Function, and Quality of Life After External‐Beam Irradiation and Brachytherapy
Authors: Robertson Matt L. , Gleich Lyon L. , Barrett William L. , Gluckman Jack L.
Published: November 2003

Objective Base‐of‐tongue cancer has traditionally been treated by surgical resection followed by radiation therapy. Primary radiation therapy with brachytherapy has recently been proposed as an alternative. In a prior analysis, we found that patients with advanced tongue‐base cancer treated by total glossectomy and postoperative radiation therapy can be cured while potentially maintaining good quality of life. Therefore, we designed the current study to assess survival, function, and quality of life in our patients with tongue‐base cancer who were treated with primary radiation therapy and brachytherapy with neck dissection as indicated.

Study Design Consecutive case series.

Methods Twenty patients were treated between 1993 and 1997 using the approach just named. The T stages were T1 (3), T2 (10), T3 (6), and T4 (1). The N stages were N0 (3), N1 (3), N2 (11), and N3 (3). At the time of brachytherapy catheter placement, neck dissections were performed in all 14 patients with N2 or N3 disease. Surviving patients completed a functional status survey and quality of life questionnaire.

Results The 3‐ and 5‐year Kaplan‐Meier corrected actuarial survival rates were 57% and 38%, respectively. Eight patients remained alive at the time of this writing and completed the functional status survey and quality of life assessment. Function and quality of life were well maintained in patients treated with external‐beam irradiation followed by brachytherapy and neck dissection. However, none of our patients with T3 disease had long‐term survival.

Conclusion Although we do not endorse external‐beam irradiation and brachytherapy for advanced tongue‐base cancers, this treatment should be strongly considered for patients with T1 or T2 tumors in whom preservation of function and quality of life is a priority.
An Evolution in the Management of Sinonasal Inverting Papilloma
Authors: Han Joseph K. , Smith Timothy L. , Loehrl Todd , Toohill Robert J. , Smith Michelle M.
Published: November 2003

Objective We reviewed the 15‐year experience of our institution (Medical College of Wisconsin, Milwaukee, WI) in managing sinonasal inverting papilloma, examining trends in diagnosis and treatment.

Study Design Retrospective.

Methods Thirty‐seven patients with inverting papilloma were treated from 1986 to 1999. Demographic data, clinical presentations, pathological findings, surgical approaches and procedures, and recurrence rates were collected retrospectively. Each lesion was categorized into one of four groups based on computed tomography scans and endoscopic findings. This categorization was developed to compare various surgical approaches for tumors in each group.

Results Thirty‐one patients had complete information for inclusion in our study. Nineteen patients were treated endoscopically with an average follow‐up of 50 months. Eight patients were in group I, five were in group II, six were in group III, and no patients were in group IV. The recurrence rate for the endoscopic group was 10%. Twelve patients underwent lateral rhinotomy or sublabial degloving approach with an average follow‐up of 58 months. Five patients were in group I, three patients were in group II, 1 patient was in group III, and three patients were in group IV. The recurrence rate for the external group was 8%. Difference in recurrence rates (P = .85) was not observed between the endoscopic and external approach groups. Regardless of approach, patients who had primary resection had a recurrence of 0%, whereas those with secondary resection had a recurrence of 17% (P = .10).

Conclusions Technological advancements have led to a trend of detecting sinonasal inverting papilloma before extension beyond the sinonasal region. Difference in recurrence rates was not observed between the endoscopic and the external approach groups. Recurrence rates are lower for primary resection versus secondary resection, regardless of surgical approach.
Sclerotherapy With Picibanil (OK‐432) for Congenital Lymphatic Malformation in the Head and Neck
Authors: Sung Myung‐Whun , Lee Dong‐Wook , Kim Dong‐Young , Lee Sang‐Jun , Hwang Chan Ho , Park Seok‐Woo , Kim Kwang Hyun
Published: November 2003

Hypothesis/Objectives Congenital lymphatic malformations of the head and neck (LMHN) present special challenges to the otolaryngologist—head and neck surgeon. Recently, a number of sclerotherapy trials have shown promising results. In this study, we present our experiences with picibanil (OK‐432) sclerotherapy for this lesion.

Study Design Retrospectively review.

Methods We retrospectively reviewed 21 patients who have undergone sclerotherapy with picibanil for LMHN.

Results Satisfactory response with complete or nearly complete shrinkage of the lesions was observed in 15 cases after repeated sclerotherapy (average, two times). We did not observe any significant morbidity or complications in the patients treated with picibanil. Reduction in size of the mass was achieved in weeks to months. Some of the patients who had not had any other previous treatment showed remarkable reductions in size even after the first therapy. When we used picibanil sclerotherapy as a primary treatment for the LMHN, most of our patients showed satisfactory results regardless of the size or location of the lesions.

Conclusion Given with our experience and the reports that failure of picibanil sclerotherapy does not hinder subsequent surgical salvage procedures, we recommend trying picibanil sclerotherapy as a primary treatment for the LMHN and performing surgical excision as a secondary modality if the response to the sclerotherapy is not satisfactory.
Management of Chronic Otitis Media With Effusion: The Role of Glutathione
Authors: Testa Benedetto , Testa Domenico , Mesolella Massimo , D'Errico Gioacchino , Tricarico Davide , Motta Gaetano
Published: November 2003

Background The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense.

Purpose To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME).

Subjects and Intervention Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2‐minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment.

Results Three months after therapy improvement had occurred in 66.6% of patients in the GSH‐treated group and in 8% of the control subjects (P <.01).

Conclusion On the basis of these results, GSH treatment could be considered for the nonsurgical management of chronic OME.
Feasibility and Outcome of Endoscopic Staple‐Assisted Esophagodiverticulostomy for Zenker's Diverticulum
Authors: Thaler Erica R. , Weber Randal S. , Goldberg Andrew N. , Weinstein Gregory S.
Published: November 2003

Objectives/Hypothesis Endoscopic staple‐assisted esophagodiverticulostomy (ESED) is a newly described method of surgically correcting Zenker's diverticulum. Initial reports on the ease and success of the surgery have been quite enthusiastic, making it seem the procedure of choice. We initiated the procedure in an algorithm of treatment of Zenker's diverticulum, to further explore the feasibility and outcome of this new technique.

Study Design This is a case series of 23 patients with Zenker's diverticulum who have undergone surgical repair. For each patient, an attempt at ESED was made. If unsuccessful, an open approach was then taken.

Results Seven of 23 patients (30%) were unable to be treated with ESED because of inability to expose the diverticulum or unfavorable anatomy of the diverticulum itself. Of the remaining 16 patients, ESED was successful in resolving the symptoms of diverticulum in 14 (87%). Two patients (13%) were somewhat improved but had persistent dysphagia. No significant complications occurred. All patients resumed oral diet within the first 24 hours after surgery.

Conclusion Esophagodiverticulostomy is an excellent method of surgically correcting Zenker's diverticulum in many patients, but anatomical considerations may prevent its use, making open approaches of continued importance in a surgeon's armamentarium.
Management of Nasopharyngeal Salivary Gland Malignancy
Authors: Schramm Victor L. , Imola Mario J.
Published: November 2003

ObjectiveThe objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy.

Study DesignRetrospective case review at tertiary care skull base center.

MethodsPertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan‐Meier and Cox proportional hazards methods.

ResultsHistological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High‐grade tumors had a significantly poorer outcome (P= .035) with a relative risk of 4.6 compared with low‐grade disease. Local control was seen to be 77% at 5 years.

ConclusionsPlanned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro‐omental free flap.
Hodgkin's and Non‐Hodgkin's Lymphoma of the Head and Neck
Authors: Urquhart Andrew , Berg Richard
Published: November 2003

Objectives/Hypothesis Lymphomas are a frequent cause of malignant lymphadenopathy in the head and neck. This study was performed to evaluate the head and neck manifestations of lymphomas and to emphasize the different presentations of Hodgkin's disease (HD) and non‐Hodgkin's lymphoma (NHL).

Study Design Retrospective review.

Methods A retrospective review was made of all cases of lymphomas involving the head and neck at Marshfield Clinic (Marshfield, WI) between 1988 and 1996. Specifically, the clinical presentations, staging, and prognosis for HD and NHL with head and neck involvement were sought.

Results Three hundred eleven patients were included in the study, 76 with HD and 235 with NHL. The median age at diagnosis for patients with HD was 27.7 years, and for patients with NHL, 67.2 years. This difference was highly significant (P <.001). No significant difference in gender was noted, with male patients occurring in 59% with HD and 49% with NHL (P = .135). Extranodal involvement including the oral cavity, oropharynx, nasopharynx, paranasal sinuses, and larynx occurred with HD in 3 patients (4%) and with NHL in 54 patients (23%P <.001). Cervical adenopathy consisted of a single node in 24% of patients with HD and 33% of those with NHL (no significant difference, P = .236). The difference in mediastinal nodal involvement was highly significant, occurring in 65% of patients with HD and 38% of patients with NHL (P <.001). Abdominal nodes occurred in 20% of cases of HD and 45% of cases of NHL ( P < .001). A significant difference in constitutional symptoms was noted with 41% of cases in HD and 27% of cases in NHL (P = .020). For the percentage of patients with stage IV disease, there was a highly significant difference by diagnosis with 10% in HD and 36% in NHL (P <.001). The median follow‐up time was 51 months, and 12% of patients with HD and 41% of patients with NHL died of their disease. Both the overall survival and survival from death attributable to disease were significantly better for HD (P < .001).

Conclusions Hodgkin's disease presents at a younger age and is less common than NHL. Cervical lymphadenopathy is the most common head and neck presentation for both diseases. Associated mediastinal adenopathy was more common with HD, and abdominal adenopathy with NHL. Constitutional symptoms were more common with HD. More advanced disease with a decreased overall survival was seen with NHL.
Intraoperative Magnetic Resonance Imaging for Skull Base Surgery
Authors: Dort Joseph C. , Sutherland Garnette R.
Published: November 2003

Objectives/Hypothesis Skull base surgery has evolved over the past several decades. Major improvements in the imaging of skull base pathology led to better target localization and better surgical planning. The objectives of this study were to assess the use of intraoperative magnetic resonance (MR) imaging in the management of a series of patients with skull base pathology. We hypothesized that high‐quality intraoperative MR imaging would have an impact on surgery in this patient group.

Study Design Prospective, non‐randomized, cohort study.

Methods Thirty‐one patients with skull base lesions underwent surgery in a 1.5‐Tesla intraoperative MR suite. The concepts of a moving magnet, high magnetic field strength, and radiofrequency coil design are presented.

Results Eleven of 31 patients had the course of surgery significantly altered by the information acquired from the images obtained during surgery.

Conclusions Intraoperative MR imaging is a valuable adjunct to skull base surgery. One third of patients had altered surgery as a result of this adjunct. Intraoperative MR imaging is of particular value in the treatment of pituitary adenomas and benign skull base tumors.
Nasal Nitric Oxide and the Nasal Cycle
Authors: Qian Wei , Sabo Reni , Ohm Mikael , Haight James S. J. , Fenton Ron S.
Published: November 2003

Objectives To establish the relationship between nasal patency and the nitric oxide (NO) concentration in the nasal airways.

Methods Unilateral nasal NO concentration (n = 11) and inhaled nasal NO concentration at oropharynx (n = 9) were measured in healthy adult volunteers. Subjects breathed normally through the nose with a known resistance (ranged from none to total occlusion) placed in one nostril. In a subgroup (n = 7), the unilateral nasal NO concentrations were determined with nasal cavity congestion induced by lateral decubitus.

Results When the added nasal resistance was less than 6 cm H20 per liter per second, the peak NO concentrations in the nose remained below 80 parts per billion (ppb). Thereafter, the higher the resistance, the greater the NO concentration. It was up to 1109.7 ppb when the front nostril was totally occluded. There was no correlation between oropharyngeal NO concentrations and resistance in the front of the nose (r = 0.4). There was a significantly negative correlation between nasal cavity volumes and nasal NO concentrations (r = ‐0.8, P <.001).

Conclusions Increases in nasal resistance to levels encountered in the nasal cycle and in recumbency augments the NO concentration within the obstructed side of the nose. Although that within the nose changes with patency, the NO concentration is constant down to the lower airways. The modulation role of the upper airways to the inhaled NO concentration remains unclear.
Cochlear Reimplantation: Surgical Techniques and Functional Results
Authors: Alexiades George , Roland J. Thomas , Fishman Andrew J. , Shapiro William , Waltzman Susan B. , Cohen Noel L.
Published: November 2003

Objectives/Hypothesis The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of “upgrades” (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist.

Study Design Retrospective chart review.

Methods The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single‐channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation.

Results Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation.

Conclusions Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.