bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of expandable endotracheal stents in the treatment of surgically induced piglet tracheomalacia
Authors: Mair Eric A. , Parsons David S. , Lally Kevin P. , Van Dellen Adrian F.
Published: October 2006

Present surgical alternatives for pediatric tracheobronchomalacia are limited and associated with many potentially undesirable complications. The feasibility of different intraluminal expandable endotracheal stents for the treatment of surgically induced tracheomalacia was analyzed in 27 piglets. A potentially fatal tracheomalacia was surgically created. Either a stainless steel “zig‐zag” stent or a woven polymeric stent was then implanted. Tracheal patency, mucosal function, histopathologic respiratory tract changes, and effects of the stent on esophageal motility were evaluated over a 16‐week period. Piglets with steel stents uniformly experienced intense inflammation leading to tracheal dysfunction and death. Piglets with polymeric stents experienced minimal respiratory symptoms. Expandable polymeric endotracheal stents alleviate surgically induced piglet tracheomalacia, were easy to insert, allowed for tracheal growth, and reduced the need for high‐risk surgical procedures with prolonged ventilatory support.
One‐eye and locomotor compensation in guinea pigs
Authors: Ishikawa Kazuo , Yamada Masaji , Masaki Masakazu , Togawa Kiyoshi
Published: October 2006

This study was carried out to examine the effect of blindfolding one eye on locomotor compensation after unilateral labyrinthectomy in guinea pigs. A platform runway, designed to examine the locomotion of this species of animals, was used. Eighteen Hartley‐strain albino guinea pigs were used. These animals were divided into three groups, with seven in the control group, six whose right eye had been surgically closed in another group, and five whose left eye had been surgically closed in yet another group. After 7 to 11 days of training, a chemical labyrinthectomy by chloroform injection into the middle ear was performed under light ether anesthesia. Animals were checked for locomotion daily by the aforementioned platform method for about a week until regaining preprocedure levels.

The locomotor compensation, depicted through the decrement of the deviation count and running time, was observed. Results have shown that the animal's locomotor compensation retarded significantly in the one‐eye groups compared to the control group. In addition, those animals whose one eye, ipsilateral to the labyrinthectomy side, was closed required significantly longer time to resume the preprocedure running performance level than the animals whose one eye, contralateral to the lesion side, was closed. Thus, during locomotor compensation, the visual input obtained by animals with one eye ipsilateral to the labyrinthectomy side may be important compared to the visual input of the animals with the contralateral eye.
Treatment of oromandibular dystonia with botulinum toxin
Authors: Hermanowicz Neal , Truong Daniel D.
Published: October 2006

Botulinum toxin produces muscle weakness by inhibition of acetylcholine release at the neuromuscular junction. The toxin has been used successfully for symptomatic treatment of focal dystonias. Our experience in the use of botulinum toxin for the treatment of oromandibular dystonia in five patients is reported. Improvement following treatment was reported as marked by 1 patient, moderate by 1 patient, and mild by 3 patients. Similar improvement was noted by the examiners. One patient with mild cosmetic improvement developed significant dysphagia requiring feeding by a nasogastric tube for a 3‐month period.
Feasibility of multichannel human cochlear nucleus stimulation
Authors: Luetje Charles M. , Whittaker C. Keith , Geier Lisa , Mediavilla Sarah Jo , Shallop Jon K.
Published: October 2006

Bipolar electrical stimulation of the brainstem cochlear nucleus (CN) following acoustic tumor removal in an only‐hearing ear can provide beneficial hearing. However, the benefits of multichannel stimulation have yet to be defined. Following removal of a second acoustic tumor in a patient with neurofibromatosis 2, a Nucleus mini‐22 channel implant device was inserted with the electrode array tip from the foramen of Luschka cephalad along the root entry zone of the eighth nerve, secured by a single suture superficially in the brain stem. Initial stimulation on the sixth postoperative day indicated that electrodes 18 to 22 were capable of CN stimulation without seventh nerve stimulation. Presumed electrode migration precluded further CN stimulation 1 month later. This report illustrates the feasibility of brainstem CN stimulation with an existing multichannel system.
Mandibular osteotomies for tumor extirpation: The advantages of rigid fixation
Authors: Sullivan Patrick K. , Fabian Richard , Driscoll Dan
Published: October 2006

Adequate exposure of intraoral tumors occupying the posterior oral cavity, base of tongue, tonsil, and superior hypopharynx for wide‐field primary surgical resection is critical to precise tumor ablation. The exposure resulting from a mandibular osteotomy has greatly assisted the tumor ablation of these areas. This procedure has also been beneficial in providing exposure to the anterior skull base, pterygomaxillary, and infratemporal space, clivus, and nasopharynx. In evaluating various osteotomy sites and methods of fixation, we reviewed 26 patients treated for benign or malignant neoplasia of the head and neck requiring mandibulotomy. The osteotomy complication rate was 2 (29%) of 7 for wire osteosynthesis and 1 (5.3%) of 19 for plate osteosynthesis. All patients with osteotomy complications had received preoperative radiation therapy. The one complication in the plated group was associated with a lateral stairstep osteotomy and two screws on either side of the osteotomy.

This study suggests advantages of absolute rigid internal fixation of mandibular osteotomies used for tumor ablation. It is also concluded that a midline osteotomy reapproximated with rigid internal fixation has the benefits of 1. primary bone healing by means of plating counteracting the balanced forces acting on the symphysis; 2. improved reapproximation with minimal bony loss, improving occlusion; 3. decreased incidence of osteoradionecrosis as the symphysis lies outside the usual radiation ports; 4. preservation of the neurovascular bundle; and 5. maintenance of osteotomy‐site immobility in an infected field.

This review helped identify surgical techniques that decrease the complications that are commonly associated with mandibular osteotomies for precise tumor ablation.
Angioedema: 5 Years' experience, with a review of the disorder's presentation and treatment
Authors: Megerian Cliff A. , Arnold James E. , Berger Melvin
Published: October 2006

Angioedema is a problem that the otolaryngologist—head and neck surgeon is often asked to treat. This report concerns 17 patients admitted for care during a 5‐year period. At their initial presentation, 94% of these patients manifested signs and symptoms of angioedema in the head and neck; three of them required urgent tracheotomy or intubation. As treatment of complement‐mediated angioedema is distinct, an etiology‐specific diagnostic and treatment protocol is presented.

Of the patients, 35% had recent initiation of angiotensin‐converting enzyme (ACE) inhibitor therapy for hypertension, and 6% demonstrated classic hereditary angioedema. However, the majority of them (59%) had unclear etiologies for their symptoms. Since angioedema is the final result of several possible abnormalities, a thorough knowledge of the differential diagnosis and clinical presentation is vital to patient management.
Neoadjuvant chemotherapy in multiple synchronous head and neck and esophagus squamous cell carcinomas
Authors: Guillot Thierry , Spielmann Marc , Kac Jean , Luboinski Bernard , Tellez‐Bernal Eduardo , Munck Jean‐Nicolas , Bachouchi Mounir , Armand Jean‐Pierre , Cvitkovic Esteban
Published: October 2006

A consecutive series of 22 patients with multiple synchronous squamous cell carcinomas of the upper aerodigestive tract was retrospectively reviewed. These patients were treated initially with cis‐platinum combination chemotherapy before definitive locoregional therapy (surgery and/or radiation therapy).

Sixteen of 21 patients had simultaneous head and neck and esophageal primaries, 3 patients had multiple synchronous head and neck primaries, 2 patients had head and neck (HN) and a bronchial epidermoid cancer, and 1 patient had simultaneous esophageal and bronchial carcinomas of epidermoid lineage.

Sixteen (77%) of the 21 patients responded to chemotherapy in all the tumor sites evaluated, and a clinically complete response was obtained in 6 (29%). After definitive locoregional treatment, the complete local control rate was 68%, with 34 complete responses for 50 primary tumor sites in 21 patients.

Twelve patients were free of disease after locoregional treatment. Six patients are still alive 27 to 57 months after complementary definitive locoregional treatment and a minimum follow‐up of 27 months. Median survival for the overall group is 17 months. The response to chemotherapy is remarkable, which may be due to the small tumoral volume present in many of the cases (T1 to T2). Nevertheless, the present report stresses the importance of an aggressive combined therapeutic approach in this difficult clinical situation.
Nasoantral windows: An experimental study in rabbits
Authors: Perko Darko , Karin Rom R.
Published: October 2006

An experimental study was designed to compare the effects of enlargement of the maxillary ostium to inferior meatal antrostomy. In 10 rabbits, the sinus ostium was enlarged (osteoplasty group), and in 10 other animals, a window of the same size was created far from the ostium (antrostomy group). The control groups were 7 rabbits in which no surgery was performed and 6 rabbits in which only the surgical approach was performed. At reexploration 14 and 84 days after surgery, it was observed that rabbits in the osteoplasty group had significantly more infections of the sinuses than the antrostomy group and both control groups (P <.05). Possible reasons for the difference in infection rate are discussed. These data indicate that, in normal maxillary sinuses of rabbits, disruption of the ostium results in an increased incidence of infection.
Evaluation of a bedtime dose of a combination antihistamine/analgesic/decongestant product on antigen challenge the next morning
Authors: Majchel Abraham M. , Proud David , Kagey‐Sobotka Anne , Witek Theodore J. , Lichtenstein Lawrence M. , Naclerio Robert M.
Published: October 2006

The effects of CAAD (diphenhydramine hydrochloride, 50 mg; pseudoephedrine hydrochloride, 60 mg; acetaminophen, 1 g in 10% ethanol) were evaluated in a double‐blind, three‐way, placebo‐controlled, cross‐over study on 18 volunteers with allergic rhinitis. The number of sneezes following nasal challenge with antigen was significantly reduced after a bedtime dose of CAAD (P <.005) and a single dose of diphenhydramine (P <.001) given 2 hours before the challenge. The levels of N‐alpha‐tosyl‐L‐arginine methyl ester (TAME) activity decreased after diphenhydramine treatment, while histamine levels following challenge were not different. The drowsiness reported after CAAD was equal to placebo, but significantly less than diphenhydramine (P<.002 for both). The active treatments reduced the actions of histamine without suppressing its release from mast cells. The effect of CAAD persists 10 hours after administration without inducing drowsiness.
Nasal and paranasal sinus anomalies in children with chronic sinusitis
Authors: Milczuk Henry A. , Dalley Robert W. , Wessbacher Frank W. , Richardson Mark A.
Published: October 2006

Functional endoscopic sinus surgery (FESS) is being advocated to treat children with chronic sinusitis. The surgeon performing FESS needs an intimate understanding of the anatomy to adequately treat disease and avoid complications. One hundred thirty‐six patients who had endoscopic sinus surgery were reviewed. Preoperative direct coronal computed tomography scans were available for review in 114 patients. Several nasal and paranasal sinus anomalies were uncovered during this evaluation. The most common was hypoplasia of the maxillary sinuses. All hypoplastic maxillary sinuses had diseased mucosa. Eleven patients were found to have a laterally deviated uncinate process and abnormal anatomy of the maxillary ostia. Other anomalies such as concha bullosa, Haller's cells, and paradoxic curvature of the middle turbinate were found, and their respective frequencies in this population were determined.
Verrucous carcinoma of the larynx: Role of human papillomavirus, radiation, and surgery
Authors: Hagen Patrick , Lyons George D. , Haindel Christian
Published: October 2006

There is confusion regarding verrucous carcinoma of the larynx, an enigmatic, well‐differentiated variant of squamous cell carcinoma known for local recurrence and anaplastic transformation following irradiation. This report adds 12 new cases and reviews the literature concerning radiation results versus surgical results. Treatment of 37 patients with primary radiotherapy resulted in a 49% cure rate and a 51% failure rate; the death rate from anaplastic transformation was 11%. Primary surgery on 144 patients resulted in a 92.4% cure rate, a 7.6% initial failure rate, and a 3.5% rate of deaths attributed to neoplasm. Isolation of human papillomavirus type 16 (HPV‐16) DNA sequences indicates that the lesion is genetically abnormal. Radiation‐induced DNA breaks may activate these sequences. These findings support a surgical approach. Treatment recommendation for T1 lesions is carbon dioxide laser excision to minimize tissue trauma and local recurrence. For T2 to T4 lesions, the recommendation is sound oncologic extirpation. Neck dissection is not indicated.
Transpalatal advancement pharyngoplasty for obstructive sleep apnea
Authors: Woodson B. Tucker , Toohill Robert J.
Published: October 2006

Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue‐base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 ± 12.2 to 12.3 ± 2.8 events per hour. For the entire group, RDI decreased from 73.3 ± 29.4 to 25.1 ± 28.2 events per hour (P<.001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1).

Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in carefully selected patients as part of the surgical treatment of OSA.
Aberrant expression of epidermal growth factor receptor in aural cholesteatoma
Authors: Bujia J. , Holly A. , Schilling V. , Negri B. , Pitzke P. , Schulz P.
Published: October 2006

A monoclonal antibody recognizing an epitope of the external domain of the human epidermal growth factor (EGF) receptor was used in an alkaline phosphatase‐antialkaline phosphatase (APAAP) technique to compare the distribution of this protein in normal human skin and aural cholesteatoma. EGF receptors appear to be highly expressed on the basal layer of the epidermis, in hair follicle apocrine sweat glands, and in the capillary system of normal skin. Cholesteatoma epithelium showed increased positive reactions in the suprabasal layers. A heterogeneity in the expression was found in different parts of the cholesteatoma. These results suggest the presence of an aberrant regulation and persistence of EGF receptors in cholesteatoma and confirm the hyperproliferative character of the cholesteatoma epithelium.
Intrasubject test‐retest variability in clinical electrocochleography
Authors: Roland Peter S. , Rosenbloom Jeff , Yellin Wende , Meyerhoff William L.
Published: October 2006

Seventeen healthy volunteers without a history of auditory or vestibular difficulty and with normal screening audiometry had bilateral (34 ears) electrocochleography performed repeatedly at 1‐week intervals. Each subject had from four to seven electrocochleograms performed on each ear. Measurements were made in the external auditory canal using a gold‐foil “TIPtrode.” Amplitude and latency for the summating potential (SP) and action potential (AP) were measured and SP/AP ratios were calculated. Averages and standard deviations for amplitude, latency, and SP/AP ratios were computed. The average SP/AP ratio was 0.22 with a standard deviation of 0.06. The range was 0.04 to 0.50. The average difference between the highest and lowest SP/AP ratio for a given individual was 0.155 (i.e., the range 0.03 to 0.31) with a standard deviation of 0.07. These normative data are useful in assessing the results of dehydration electrocochleography and in establishing how much test‐retest variation is required to suggest pathology.
Penetrating trauma of the oropharynx in children
Authors: Radkowski Diana , Mcgill Trevor J. , Healy Gerald B. , Jones Dwight T.
Published: October 2006

Penetrating trauma of the oropharynx is not an uncommon problem in the pediatric population. Innocuous injuries with minor soft‐tissue trauma have been associated with severe neurologic sequelae. A review of 77 oral trauma cases that occurred from 1981 to 1990 at Boston Children's Hospital was undertaken to see if constant factors could be identified so that a treatment protocol might be outlined for these patients. Twenty‐three (30%) patients sustained injury to the soft palate and peritonsillar area. Fifty percent of these cases required surgical debridement and repair. None of the 23 patients developed neurological sequelae. Physical examination may not correlate with the development of symptoms nor the mechanism of injury. Care should be taken during the examination to identify any neurological problems that may not relate to the degree of injury. Conservative management can be entertained if no abnormal neurologic findings are noted.
Endoscopic sinus surgery: 4‐year follow‐up on the first 100 patients
Authors: Schaitkin Barry , May Mark , Shapiro Adam , Fucci Michael , Mester Sara J.
Published: October 2006

Endoscopic sinus surgery has been reported to be successful, but lack of a standardized classification system hampers comparison of results between studies, and long‐term results of surgery have not been reported in a series of consecutive patients. The results of our first 100 endoscopic sinus surgery procedures, reported previously after an average 9‐month follow‐up, were reviewed with the application of a new classification scheme and in light of a longer (4‐year) follow‐up. Surgery was successful in all patients whose sinus symptoms resulted from anatomical variations or suppurative infection, but failed in some patients with hyperplastic disease or polyps. In addition, the presence of reactive airway disease or the acetylsalicylic acid (ASA) triad was a bad prognostic sign. The overall success of the procedure in relieving sinus symptoms decreased from 98% at early follow‐up to 91% at 4‐year follow‐up. Sixty‐six percent were successful after one procedure and 25% required more than one procedure to achieve success. The decline in success since our first report in 1990 was mostly attributable to late failure in patients with recurrent symptomatic polyposis. Because symptoms may not recur in these patients for up to 3 years, long‐term results of surgery for this disorder are necessary. Symptoms of recurrent polyposis can be controlled medically or by revision surgery.
Nasal mucosal congestion after treatment with bromocriptine
Authors: Bende Mats , Bergman Boinge , Sjögren Christer
Published: October 2006

Nine women were given bromocriptine a few days after delivery in order to inhibit lactation. Nasal airway resistance to airflow (NAR) was recorded and blood samples were taken before treatment with bromocriptine, 2 to 3 hours after the first dose of this drug, and after 3 to 5 days on this treatment. All the women had increased nasal congestion after bromocriptine and NAR rose significantly. The prolactin, estradiol, and progesterone hormone levels decreased significantly, but no significant difference was found in the levels of thyroid‐stimulating hormone (TSH) and vasoactive intestinal polypeptide (VIP). The bromocriptine effect may be caused by different mechanisms.
Measurement of laryngeal resistance in the evaluation of botulinum toxin injection for treatment of focal laryngeal dystonia
Authors: Witsell David L. , Weissler Mark C. , Martinkosky Stanley J. , Kathleen Donovan M. , Howard James F.
Published: October 2006

In the past, there has been no consistent, objective method of following patients undergoing botulinum toxin injections for treatment of laryngeal dystonia. Herein, the application of translaryngeal resistance measurements to 15 dysphonic patients is described. Laryngeal resistance is calculated from analysis of translaryngeal pressure and airflow during the utterance /pi/, and found to fall predictably after successful toxin injection. In our series of patients, laryngeal resistance dropped by 69.1% after initial toxin injection. The changes in resistance over time correlate with subjective impressions of voice quality. Translaryngeal resistance measurements can be used objectively to follow patients longitudinally after injection and to collect objective data for analysis. No previously described measurements have met all these criteria. Laryngeal resistance measurement is an ideal method of documenting the results of botulinum toxin injection for the treatment of focal laryngeal dystonia.
The vienna cochlear implant in patients with obliteration of the cochlea
Authors: Kürsten R. , Cozzarini W. , Eisenwort B. , Denk D. M. , Zrunek M. , Burian K.
Published: October 2006

Twelve deaf patients with obliterated or ossified cochleas received the extracochlear version of the Vienna Cochlear Implant. Four patients, 1 of them a child, developed open speech comprehension. Obliteration of the cochlea could not always be predicted by conventional tomography of the temporal bone. Short duration of deafness, wide dynamic range, and good ability of time resolution (small temporal difference limen [TDL]) are predictors for good postoperative results. Obliteration or ossification of the cochlea per se is no contraindication to cochlear implantation.
Histopathology of temporal bone fractures: Implications for cochlear implantation
Authors: Morgan Warren E. , Coker Newton J. , Jenkins Herman A.
Published: October 2006

Temporal bone fractures often cause loss of audiovestibular function. Those patients with bilateral profound sensorineural hearing losses secondary to temporal bone fractures become candidates for cochlear implantation. The authors present the histopathology of five temporal bone fractures in three patients, evaluating specifically the traumatic effects on the neural elements of the inner ear. Transverse fractures of the temporal bone result in severe loss of hair cells, ganglion cells, and other supporting cells in the inner ear. Occasionally labyrinthitis ossificans may occur as a consequence of trauma or infection. While longitudinal fractures do not violate the otic capsule, these same neural elements may be damaged by concussion.
Selective inner hair cell ototoxicity induced by carboplatin
Authors: Wake Mark , Takeno Sachio , Ibrahim Danyal , Harrison Robert
Published: October 2006

Carboplatin is a second‐generation platinum antineoplastic agent. It has biological activity similar to cisplatin and is currently recommended for the treatment of ovarian cancer. In clinical use, carboplatin appears less ototoxic than cisplatin. This paper reports the ototoxic effects of carboplatin, in doses equivalent to the clinical use of the drug, in the chinchilla. Intravenous carboplatin 200 to 400 mg/m2 by bolus injection caused significant ototoxicity in this model as revealed by brainstem evoked responses (ABR audiometry). The cochlear pathology as seen by scanning electron microscopy revealed predominantly inner hair cell (IHC) stereocilia damage. Furthermore, the extent (grade) of the morphological lesions appears to be well correlated with the auditory brainstem response pattern of threshold elevation.
Airway obstruction in the pierre robin sequence
Authors: Tomaski Sharon M. , Zalzal George H. , Saal Howard M.
Published: October 2006

Airway obstruction and feeding difficulties vary among patients with Pierre Robin sequence (PRS). Treatment is challenging and the appropriate management may not be readily identified, leading to delay in securing the airway.

A retrospective review of 90 children with PRS was done to identify subgroups at a higher risk of developing severe airway obstruction using oxygen and apnea monitoring, sleep studies, and response to treatment. Patients with isolated PRS (group I, 27 patients) and Stickler syndrome (group II, 32 patients) do not suffer from debilitating airway and feeding difficulties when compared to those with unique syndromes (group III, 16 patients) and recognized named syndromes (group IV, 15 patients). Feeding difficulties were universal with the severity proportional to airway obstruction. Aggressive intervention should be considered early in group III and IV patients.
Atypical stromal cells in inflammatory nasal polyps: Immunohistochemical and ultrastructural analysis in defining histogenesis
Authors: Nakayama Meijin , Wenig Bruce M. , Heffner Dennis K.
Published: October 2006

The authors investigated 29 cases of sinonasal polyps with atypical stromal cells (ASC). The clinicopathologic features of these lesions were of benign inflammatory polyps except for the presence of ASC. Misinterpretation of these cells resulted in contributor diagnosis of sarcoma (rhabdomyosarcoma). Immunohistochemical study of the ASC demonstrated the presence of actin (smooth muscle and muscle specific), KP‐1, and vimentin; no reactivity was seen with desmin, myoglobin, S‐100 protein, or glial fibrillary acidic protein (GFAP). Unexpectedly, cytokeratin reactivity was identified in more than 75% of the cases analyzed. Ultrastructural analysis revealed that the ASC shared morphologic features in common with fibroblasts and smooth muscle cells. Based on the light microscopic, immunohistochemical, and ultrastructural findings, it was concluded that the ASC represent reactive myofibroblasts and not a neoplastic proliferation. Follow‐up data supported this contention indicating the absence of an aggressive biological course. Misinterpretation as a malignant neoplasm might result in unwarranted and unnecessary therapeutic intervention.
The use of a laryngotracheal separation procedure in pediatric patients
Authors: Lawless Stephen T. , Cook Steven , Luft Jay , Jasani Melinda , Kettrick Robert
Published: October 2006

The objective of this study was to review experience, outcome, and satisfaction after a laryngotracheal separation (LTS) procedure in pediatric patients. Chart reviews and phone questionnaires were used. Factors reviewed included hospitalizations and infections prior to and after LTS, morbidity, and impact on quality of life.

Twenty‐one pediatric patients ranging in age from 8 to 172 months underwent LTS. Follow‐up time ranged from 1 to 49 months. Complications were minor. Eighty‐eight percent of patients had fewer hospitalizations or were discharged for the first time after LTS. Number of pneumonias and suctioning frequency decreased, mobility increased in patients with prior tracheostomies, and care requirements decreased in 95% of patients. Parents reported satisfaction and improved quality of life. LTS is a low‐risk, successful procedure which increases quality of life and decreases morbidity in pediatric patients with irreversible upper airway dysfunction.
Complications of endoscopic sinus surgery in a residency training program
Authors: Ramadan Hassan H. , Allen Gregory C.
Published: October 2006

Endoscopic sinus surgery has emerged in the last decade as the treatment of choice for chronic sinusitis. Reports of complications of the procedure from different centers vary depending on the technique used and the experience of the surgeon.

Between August 1990 and August 1993, 337 patients underwent endoscopic sinus surgery at West Virginia University. Most of the cases were performed by senior residents under faculty supervision.

Minor complications were encountered in 15.1% of the cases and major complications in 1.5% of the patients.

The most common major complication was cerebrospinal fluid leak. All patients with cerebrospinal fluid leaks were diagnosed and treated successfully at the time of surgery. Middle turbinate adhesions and orbital penetration were the most common minor complications. Routine partial middle turbinectomy did not decrease the adhesion rate.

Endoscopic sinus surgery is a relatively safe procedure, even when performed by residents under adequate supervision.
Dehiscence of the jugular bulb in crouzon's disease
Authors: Van Die A. , De Groot J. A. M. , Zonneveld F. W. , Vaandrager J. M. , Beck F. J. A.
Published: October 2006

Patients with Crouzon's disease have a distorted nasopharynx, which frequently leads to retained middle ear secretions and necessitates myringotomy. A review of the computed tomographic (CT) scans of 21 ears in 11 patients with Crouzon's disease found that 12 jugular bulbs were protruding or dehiscent. The relationship between the jugular bulb and the middle ear space was normal bilaterally in only 2 of the 11 patients. Consequently, patients with Crouzon's disease are at risk for inadvertent puncture of the jugular bulb during myringotomy. CT scans obtained prior to myringotomy can be helpful in detecting dehiscent or protruding jugular bulbs.
Performance of prelingually and postlingually deaf patients using single‐channel or multichanel cochlear implants
Authors: Hinderink Johannes B. , Mens Lucas H.M. , Van Der Broek Paul , Brokx Jan P.L.
Published: October 2006

The auditory and aided lipreading performance of 8 prelingually and 11 postlingually deaf patients who had received a single‐channel or multichannel cochlear implant was evaluated during 2 years of follow‐up. Although all the patients improved on both closed‐set pattern recognition and speech drimination tests and on a Continouous Discourse Tracking task, the most significant improvement was observed in the postlingually deaf patients who were using a multichannel implant. These patients were the only ones to achieve open‐set speech recognition in the auditory‐only condition. Only small differences were found between prelingually deaf patients who were using a single‐channel system and those who were using a multichannel system. The users' evaluations, obtained by means of a questionnaire, were generally positive in all patients. Based on the study results, the authors concluded that it is feasible to use cochlear implants in highly motivated prelingaully deaf patients who have learned to use oral‐aural communication.
Laryngeal reconstruction using allogeneic cartilages
Authors: Bujia J. , Wilmes E. , Osete J. M. , Sprekelsen C. , Hammer C.
Published: October 2006

Preserved allogeneic cartilage has been used to reconstruct laryngeal defects. The most important problem with this approach has been graft resorption, which seems to be caused by devitalization of the grafts as a consequence of preservation. In this study, the authors compared the in vivo behavior of vital and nonvital preserved cartilage used to reconstruct the larynx of New Zealand white rabbits. The vital cartilage grafts were stored using organ culture procedures, and the nonvital grafts were stored in formaldehyde. While the formaldehyde‐preserved cartilage showed inflammatory changes, the transplanted vital cartilage was well accepted and showed no evidence of immune cell infiltrations. The authors concluded that viable cartilage grafts are preferable to grafts of chemically preserved cartilage.
Does uvulopalatopharyngoplasty inhibit automobile accidents?
Authors: Haraldsson Per‐Olle , Carenfelt Christer , Lysdahl Michael , Tingvall Claes
Published: October 2006

Patients with rhonchopathy, which includes obstructive sleep apnea syndrome (OSAS), who report sleepy spells at the wheel do poorly on simulated monotonous driving tests and have a twofold to threefold increase in traffic accidents. To assess whether drivers with rhonchopathy (heavy snoring, sleep disturbances, and daytime sleepiness) cause fewer automobile accidents after uvulopalatopharyngoplasty (UPPP), the car accident rate for the first 5 years after surgery was compared to the rate of the 5 years immediately before the operation. Data were collected by means of a self‐report questionnaire. Fifty‐six patients with rhonchopathy were compared to 142 controls without rhonchopathy who had been subjected to nasal surgery. The response rates were 96% and 94%, respectively. The reported habitual sleepiness while driving had disappeared in 87% (P<.001) of drivers who had the problem preoperative. The accident risk reduction (corrected for mileage) in patients was almost four times greater than the reduction in controls (P<.001) after surgery. The relative rate of patients involved in any single‐car accident fell by 77% (P<.05), and the relative rate of single‐car accidents fell by 83% (P<.001). It is concluded that drivers with rhonchopathy have an increased risk for car accidents, especially single‐car accidents, but that this risk returns to normal after UPPP.
Branchial anomalies: A review of 52 cases
Authors: Choi Sukgi S. , Zalzal George H.
Published: October 2006

Fifty‐two patients with branchial anomalies (BA) treated at the Children's National Medical Center between 1983 and 1993 were reviewed to determine the incidence of different types of anomalies and to analyze the authors' method of diagnosis and management. First BA was seen in 25%, second in 40%, third in 8%, and fourth in 2%. In 25%, the origin of the anomaly was undetermined. Our incidence of first BA was significantly higher than the incidence reported in other series. Of the anomalies, sinuses were more common than cysts or fistulae. Sinuses tend to present at an earlier age than cysts, which take time to enlarge and present clinically. Repeated incision and drainage and incomplete excisions were frequently seen with first, third, and fourth anomalies due to misdiagnosis. Recent trend has been to utilize radiographic studies more frequently, and they have been found to be helpful in guiding surgical therapy, particularly with the more complicated cases.
Unilateral acoustic tumors: How often do they recur after translabyrinthine removal?
Authors: Shelton Clough
Published: October 2006

Unilateral acoustic tumors rarely recur after total translabyrinthine removal. Review of the patient records of the House Ear Clinic revealed five recurrent tumors, for an approximate incidence of 0.3%. A questionnaire was mailed to 857 patients who were at least 9 years postoperative and failed to find any additional recurrent tumors. No preoperative or intraoperative factors were identified to predict recurrence. The average time interval from initial removal to recurrence was approximately 10 years. Flow cytometric analysis did not reveal any fundamental differences between the recurrent acoustic tumor group and a larger group of 112 acoustic tumors.

Based on observed growth rates of the recurrent acoustic tumors, a single gadolinium‐enhanced magnetic resonance image 5 years after surgery is advised. To prevent recurrence, a margin of normal‐appearing proximal eighth cranial nerve should be removed and the nerve stump cauterized.
The role and significance of chondroitin sulfate in the development of otosclerosis
Authors: Ye Sheng‐Nan , Yi Zi‐Xiang , Wang Pei‐Ying , Jiang Si‐Chang
Published: October 2006

Chondroitin sulfate is a sulfated glycosaminoglycan that predominates in the ground substance of cartilage. Using monoclonal antichondroitin sulfate in 61 specimens of human otosclerotic lesions, we studied the distribution of this glucosaminoglycan in various stages of otosclerosis. Our findings show that chondroitin sulfate plays an important role in the development of otosclerosis. In addition, the distribution of chondroitin sulfate clearly delineates the stage of otosclerosis referred to as active into two distinct histologic stages. Dividing the active stage into “osteolytic” and “sponge‐chondroid” would be reasonable based on our findings.
Minor salivary gland tumors of the palate: Clinical and pathologic correlates of outcome
Authors: Beckhardt Russell N. , Weber Randal S. , Zane Randall , Wolf Pat , Garden Adam S. , Carrillo Rosario , Luna Mario A.
Published: October 2006

Minor salivary gland tumors of the palate are rare and may pose a diagnostic and therapeutic dilemma for the head and neck surgeon. The authors reviewed their 46 years of experience with minor salivary gland tumors of the palate to determine the factors that influence outcome and their implications for treatment.

Malignant tumors were seen in 116 patients (78%) and benign tumors were found in 33 patients (22%). Adenoid cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients.

Univariate analysis on the malignant lesions showed that grade 3 tumor histology (P<.001), tumor size greater than 3 cm (P<.001), perineural invasion (P=.031), bone invasion (P=.012), positive surgical margins (P<.001), and positive initial but negative final margins (P=.004) were all associated with decreased survival.

With multivariate analysis, tumor size, margin status, and grade were shown to be independently associated with decreased survival (P<.05). The recurrence rate at the primary site was significantly higher for adenoid cystic carcinoma than for other histologies (P=.0059). The 2‐, 5‐, and 10‐year disease‐specific survival rates for patients with malignant disease were 96%, 87%, and 80%, respectively.

Wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with grade 3 tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear‐cut survival advantage has not been proven. Recurrence, especially regional and distant metastasis, portends an extremely poor prognosis.

Laryngoscope, 105:1155‐1160, 1995
Distribution of efferent cholinergic terminals and α‐bungarotoxin binding to putative nicotinic acetylcholine receptors in the human vestibular end‐organs
Authors: Ishiyama Akira , Lopez Ivan , Wackym Phillip A.
Published: October 2006

Although acetylcholine (ACh) has been identified as the primary neurotransmitter of the efferent vestibular system in most animals studied, no direct evidence exists that ACh is the efferent neurotransmitter of the human vestibular system. Choline acetyltransferase immunohistochemistry (ChATi), acetylcholinesterase (AChE) histochemistry, and α‐bungarotoxin binding were used in human vestibular end‐organs to address this question. ChATi and AChE activity was found in numerous bouton‐type terminals contacting the basal area of type II vestibular hair cells and the afferent chalices surrounding type I hair cells; α‐bungarotoxin binding suggested the presence of nicotinic acetylcholine receptors on type II vestibular hair cells and on the afferent chalices surrounding type I hair cells. This study provides evidence that the human efferent vestibular axons and terminals are cholinergic and that the receptors receiving this innervation may be nicotinic.

Laryngoscope, 105:1167‐1172, 1995
Outcome analysis of mohs surgery of the lip and chin: Comparing secondary intention healing and surgery
Authors: Becker Gary D. , Levin Barry C. , Adams Lawrence A.
Published: October 2006

Wounds of the lip and chin resulting from microscopically controlled (Mohs) surgery are often repaired immediately. However, wounds allowed to heal by secondary intention have the advantage of optimal cancer surveillance, simplified wound care, and avoidance of the costs and potential complications associated with reconstructive procedures. Accurate prediction of the course of wound healing would allow a rational approach to selection of surgery or healing by secondary intention.

The authors evaluated 105 patients with defects of the lip and chin after Mohs excision for cancer who healed by secondary intention. Forty‐six patients treated surgically were followed for comparison. The lip and chin were divided into subunits and the wound location, size, and depth were recorded. Patients were followed at intervals and a final determination regarding cosmesis was made after 6 or more months.

It is concluded that the final cosmetic result can be confidently predicted on the basis of location by subunit, size, and depth of the wound.

Laryngoscope, 105:1176‐1183, 1995
Expression of a cell‐cycle‐associated nuclear antigen (MIB 1) in cholesteatoma and auditory meatal skin
Authors: Sudhoff Holger , Hildmann H. , Fisseler‐Eckhoff Annette , Bujía Jesus , Holly Anja , Schulz‐Flake Christian
Published: October 2006

Middle ear cholesteatoma is often invasive with consequent bone destruction. Inflammatory stimulation of the underlying connective tissue, as well as an autocrine mechanism, may be responsible for the dys‐regulation and abnormal proliferative features of the keratinocytes in cholesteatoma. Comparative investigations were performed to assess the epithelial cell kinetics of cholesteatoma and normal auditory meatal skin. Monoclonal antibody MIB 1 immuno‐staining (which recognizes a nuclear antigen expressed by dividing cells) was applied using the alkaline phosphatase antialkaline phosphatase im‐munolabeling method.

Specimens of normal auditory meatal skin (n = 7) revealed an average MIB 1 score (quotient of the MIB 1‐positive cells and the total number of cells) of 7.6 ± 2.2%. Cholesteatoma samples (n = 13) showed an average MIB 1 score of 17.4 ± 8.9% and a heterogeneity of proliferating epithelial areas. Epithelial cones growing toward the underlying stroma exhibited high mitotic activity. Statistically, the results of this study confirm a highly significant increase in the proliferation rate of cholesteatoma keratinocytes, which had an MIB 1 score that was 2.3 times higher than the score for keratinocytes of normal external auditory meatal skin.
Stiffness and cyclic response of clayey fine sands
Authors: Smith N.
Published: October 2006

A substantial programme of cyclic testing has been carried out on a variable silty/clayey sand deposit from the central North Sea. The test programme included triaxial and simple shear tests, using intact and reconstituted specimens and different triaxial specimen sizes. Some tests included pre-shearing while others did not. The testing was carried out in three phases. In the first two phases of testing, large variations were found in the cyclic response of the soil. The third phase was initiated to address some of the questions raised by the first two phases. It comprised triaxial tests in which all but one specimen had internal axial strain measurement. This paper presents the principal results of the testing work. It is argued that the most important factor governing test specimen response is the shear stiffness of the specimen. The correlation between relative density (which was used as the criterion for reconstitution of specimens) and shear modulus was found to be poor. The variability of stiffness within specimens is a further important factor. Careful analysis of the specimen stiffnesses in the final series of tests has shown the importance of shear modulus and, more particularly, variations in shear modulus within the test specimen, in determining the cyclic response of the soil. In every case where closely similar soil specimens were compared, the softer sample developed excess pore pressure more rapidly than the stiffer sample. It is proposed that the cyclic response of laboratory specimens can be related to the in situ behaviour of the stratum by means of a comparison between the laboratory and in situ shear moduli. Changes to testing techniques are proposed to improve the quality of laboratory data. Relationships between pore pressure, number of cycles and shear stress ratio are presented for the reference site.
Some observations on Statnamic pile testing
Authors: Brown M. J. , Hyde A. F. L.
Published: October 2006

Limited guidance on usage and methodology is currently available to engineers for the most common rapid load pile test, known as Statnamic. In order to improve the analysis of Statnamic testing in clay soils a full-scale instrumented auger bored pile was installed and tested in glacial lodgement till. As a result, improvements have been suggested in the test methodology and analysis. The inclusion of an accelerometer at the pile head would allow direct measurement of acceleration and verification of displacement measurements and velocity calculations. High-precision optical levelling of the pile before and after test cycles would allow multiple loading cycles to be considered cumulatively with greater confidence. The separation of the laser reference source from the test pile should be sufficient to avoid surface wave disturbance.
Pipe pile installation effects in soft clay
Authors: Xu X. T. , Liu H. L. , Lehane B. M.
Published: October 2006

The shortage of field measurements to examine existing predictive methods for pipe piles in clay prompted an experimental programme in Shanghai, China, in which displacements and stresses were measured in the vicinity of two pipe piles during their installation in a soft lightly overconsolidated clay. The test programme was also conducted to assist assessment of the installation effects associated with a recently patented cast-in-place concrete pipe pile, referred to as the PCC pile. The field measurements are compared with existing predictive methods such as the shallow strain path and cavity expansion methods (SSPM and CEM). The SSPM is shown to be the most suitable for the prediction of ground displacements, although the more straightforward CEM can provide realistic predictions of radial movements when calculations are performed using a solid pile with an area equivalent to that of the annulus of the pipe pile. Installation-induced excess pore pressures remote from pipe piles are also shown to be well predicted using the same cavity expansion method combined with this equivalent radius, while changes in lateral total stress display a faster degradation than that of the theoretical predictions. The paper provides verification of an expedient means of assessing installation disturbance due to undrained pipe pile installation.