bluuebunny/crossref_metadata_2025 huggingface dataset:
Adenoid cystic carcinoma of the trachea
Authors: Azar Taraneh , Abdul‐Karim Fadi W. , Tucker Harvey M.
Published: November 2003

Objective: Primary tracheal tumors are rare, occurring in 0.2 per 100,000 persons per year. Adenoid cystic carcinoma (ACC) is the second most common histologic type of tracheal malignancy. Its clinical behavior is different from the other tracheal neoplasms and thus should be studied separately. Study Design/Methods: Retrospective review of the medical records of six patients with tracheal ACC who were treated at University Hospitals of Cleveland between 1971 and 1996 and literature review. Results/Conclusion: Tracheal ACC is an indolent tumor that affects people at any age but has a peak incidence in the fifth decade. There is a nearly equal male‐to‐female ratio. Almost half of tracheal ACCs occur in the proximal trachea, accounting for the most common presenting symptoms: dyspnea, cough, and hoarseness. Because of the hoarseness, patients are often referred to an otolaryngologist. Complete resection provides the best chance for increased survival. Neutron beam radiotherapy holds promise for adjuvant therapy. Key Words: Tracheal neoplasm, adenoid cystic carcinoma, hoarseness.
Paradoxical spread of renal cell carcinoma to the head and neck
Authors: Gottlieb Marc D. , Roland J. Thomas
Published: November 2003

Objectives: To present cases of renal cell carcinoma presenting with only head and neck metastases, to review theories of physiology and anatomy describing this phenomenon, and to discuss the role of the otolaryngologist in the treatment of these lesions.Study Design: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases over the 3‐year period from 1992 to 1995.Methods: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases. In addition, English‐language literature was reviewed with special focus on the anatomic and physiologic pathways possible to allow for such a phenomenon.Conclusions: Renal cell carcinoma has an occasional presentation as a head and neck mass without evidence of disease elsewhere. Various routes of spread have been postulated. Batson's venous plexus, as postulated by Nahum and Bailey,2is an anatomic route through which emboli could navigate to the head and neck and avoid pulmonary vascular filtration. Interactions on the cellular level may also be responsible for the seemingly paradoxical spread. We recommend local excision of head and neck metastases of renal cell carcinoma without sacrifice of vital structures as a sound treatment regimen.
Pharyngo‐UES contractile reflex in patients with posterior laryngitis
Authors: Ulualp Seckin O. , Toohill Robert J. , Kern Mark , Shaker Reza
Published: November 2003

Background: Earlier studies have shown that stimulation of the human pharynx by injection of minute amounts of water stimulates the pharyngo‐UES contractile reflex. It has been suggested that this reflex may be activated during pharyngeal reflux of gastric and/or esophageal content, thus increasing the UES pressure and possibly preventing further entry of the refluxate into the pharynx. However, the integrity of this reflex in patients with posterior laryngitis has not been studied. Aim: Evaluate the pharyngo‐UES contractile reflex in a group of patients with objective findings of posterior laryngitis. Methods: Fourteen consecutive patients with posterior laryngitis (mean age, 48 ± 6 y) and 13 healthy volunteers (mean age, 53 ± 6 y) were studied by concurrent pharyngeal water stimulation and UES manometry. Results: The threshold volume required to evoke the pharyngo‐UES contractile reflex in the laryngitis group (0.4 ± 0.05 mL) was significantly higher than that of the control (0.2 ± 0.04 mL) (P < .05). Following stimulation of the pharyngo‐UES contractile reflex, the maximum postinjection pressure in patients (75 ± 6 mm Hg) was similar to that of the controls (78 ± 6 mm Hg). The percent increase in UES pressure following stimulation of the reflex in the laryngitis group (99% ± 15%) was significantly higher than that of controls (55% ± 11%) (P < .05). Conclusions: Compared with normal controls, a significantly larger volume of liquid is required to trigger this reflex in patients with posterior laryngitis. When triggered, the maximum UES pressure induced by the pharyngo‐UES contractile reflex is similar between the two groups. These findings suggest an altered afferent sensory limb of this reflex in patients with posterior laryngitis. Key Words: Upper esophageal sphincter, reflux laryngitis, airway protection.
Auditory neuropathy in childhood
Authors: Doyle Karen Jo , Sininger Yvonne , Starr Arnold
Published: November 2003

Objectives: Auditory neuropathy is a recently described disorder in which patients demonstrate hearing loss for pure tones, impaired word discrimination out of proportion to pure tone loss, absent or abnormal auditory brainstem responses, and normal outer hair cell function as measured by otoacoustic emissions and cochlear microphonics. We have identified eight pediatric patients having hearing deficits that are most likely due to a neuropathy of the eighth nerve. In this study, the results of audiologic testing performed with these eight children are described. Study Design: Retrospective review of audiologic findings in eight children with auditory neuropathy. Methods. Each subject was tested with pure tone and speech audiologic testing, auditory brainstem response, and click‐evoked otoacoustic emissions. Results of these tests were tabulated and summarized. Results: Pure tone audiologic testing revealed five children with upsloping sensorineural hearing loss, two with high frequency loss, and one with a mild, flat configuration. Six children demonstrated poor word discrimination scores, and the other two had fair to good word discrimination. All eight subjects had normal distortion product and transient otoacoustic emissions. All eight children demonstrated absent or marked abnormalities of brainstem auditory evoked potentials. These findings suggest that while cochlear outer hair cell function is normal, the lesion is located at the eighth nerve. Conclusions: Recent advances in otoacoustic emissions testing permit differentiation of neural deafness from sensory deafness. This paper describes the clinical presentation and audiologic findings in pediatric auditory neuropathy, as well as the recommended management of these patients. Otolaryngologists should be aware of this disorder and implications for its management, which differs from treatment of sensorineural hearing loss. Key Words: Auditory neuropathy, childhood, hearing loss, auditory brainstem response, evoked otoacoustic emissions.
Middle fossa transpetrosal approach for petroclival and brainstem tumors
Authors: Slater Patrick W. , Welling D. Bradley , Goodman Joseph H. , Miner Michael E.
Published: November 2003

Objective: The purpose of the study was to demonstrate the utility of the middle fossa transpetrosal approach with anterior petrosectomy for difficult‐to‐access petroclival and pontine lesions. Study Design: Retrospective case review in academic tertiary referral center. Methods: Patients for inclusion had pontine and prepontine lesions of the petroclival region. Middle fossa transpetrosal approach with anterior petrosectomy with excision or biopsy of the lesion was performed. The main outcome measure was postoperative neurologic status including motor and cranial nerve function. Results: No patient experienced neuromuscular compromise or cranial nerve deficits as a direct result of the surgical procedure. Complications consisted of a subdural temporal lobe hemorrhage and one case of cerebrospinal fluid rhinorrhea. Conclusions: The middle fossa transpetrosal approach with anterior petrosectomy was utilized for five patients with petroclival or pontine tumors. In this small series, it served well to spare cranial nerves and allowed avoidance of serious vascular injury. To our knowledge, this is the first reported use of this procedure for pontine venous angiomas.
Overexpression of scatter factor and its receptor (c‐met) in oral squamous cell carcinoma
Authors: Marshall Darby D. , Rornberg Lori J.
Published: November 2003

Hypothesis: Scatter factor (SF) is a pleiotropic growth factor that recently has been shown to induce epithelial cell proliferation, random motility, and invasion via interaction with its receptor, a tyrosine kinase encoded by the c‐met proto‐oncogene. Studies involving a variety of solid tumors have suggested that overexpression of the SF/c‐met ligand‐receptor pair is associated with the acquisition of a malignant phenotype. We hypothesize that SF and c‐met are overexpressed in epithelial malignancies of the head and neck including squamous cell carcinoma (SCC) of the oral cavity. Study Design: Immunohistochemical staining of randomly selected normal, dysplastic, and malignant oral tissues. Methods: Formalin‐fixed, paraffin‐embedded tissues were obtained from the Department of Oral Pathology at Shands Hospital (University of Florida), Gainesville, Florida. Examples of mild dysplasia, severe dysplasia, well‐differentiated SCC, moderately differentiated SCC, and poorly differentiated SCC were randomly selected from the dictated reports of one of two staff oral pathologists. Histologically normal margins of each specimen served as normal controls. The tissues were immunohistochemically stained using commercially available antibodies against SF and c‐met. Appropriate negative controls were run with each batch to ensure staining specificity. Evaluation of staining intensity was carried out using a computerized image analysis system. A one‐way analysis of variance (ANOVA) with pairwise multiple‐comparison procedures (Fisher method) was used to analyze the data. Results: Statistically significant differences (P < .0001) in the intensity of staining were noted between the malignant and normal and the malignant and dysplastic tissues for both SF and c‐met. No differences were appreciated when staining of normal and dysplastic sections of the SF‐stained tissue were compared. Conclusions: The results suggest that the SF/c‐met ligand‐receptor pair is overexpressed in SCC of the oral cavity.
Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12‐year experience in more than 900 patients
Authors: Blitzer Andrew , Brin Mitchell F. , Stewart Celia F.
Published: November 2003

Objectives: This paper reviews a 12‐year experience in more than 900 patients with spasmodic dysphonia who have been treated with botulinum toxin. Study Design: This is a retrospective analysis of patients with adductor spasmodic dysphonia (strainstrangled voice), abductor spasmodic dysphonia (whispering voice), and adductor breathing dystonia (paradoxical vocal fold motion), all of whom have been treated with botulinum toxin injections for relief of symptom. Methods: All of the patients were studied with a complete head and neck and neurologic examination; fiberoptic laryngostroboscopy; acoustic and aerodynamic measures; and a speech evaluation including the Universal spasmodic dysphonia rating scale. Some were given electromyography. All patients received botulinum toxin injections into the affected muscles under electromyographic guidance. Results: The adductor patients had an average benefit of 90% of normal function lasting an average of 15.1 weeks. The abductor patients had an average benefit of 66.7% of normal function lasting an average of 10.5 weeks. Adverse effects included mild breathiness and coughing on fluids in the adductor patients, and mild stridor in a few of the abductor patients. Conclusion: Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia. Laryngoscope, 108:1435–1441, 1998
Expression of glycoconjugates in human eustachian tubes with otitis media
Authors: Sone Michihiko , Paparella Michael M. , Schachern Patricia A. , Morizono Noriko , Le Chap T. , Lin Jizhen
Published: November 2003

Objectives: To characterize glycoconjugate expression in normal human eustachian tubes and study the alterations in glycoconjugate expression found in eustachian tubes with otitis media. Study Design: Using lectin histochemistry, alterations in glycoconjugates were studied in three normal temporal bones, in four temporal bones with mucoid otitis media (MOM), and in five with serous otitis media (SOM). Methods: Sections of previously processed temporal bones were decelloidinized, and then incubated with seven biotinylated lectins‐WGA, SNA, MAA, BPA, PNA, UEA‐I, and LcH–that reflect seven carbohydrate residues of glycoconjugates, respectively: GlcNAc/NeuNAc, Ne‐uNAcα(2–6)GalNAc, NeuNAcα(2–3)GalNAc, Galβ(1–3) GalNAc, l‐fucose, and α‐mannose residues. Control sections were incubated with inhibitory carbohydrates or without biotinylated lectins. Results: In the normal temporal bones, five carbohydrate residues in goblet cells and cilia of the eustachian tube demonstrated moderate to strong activity—NeuNAcα(2–6)GalNAc, NeuNAcα(2–3)GalNAc, GalNAc, Galβ(1–3)GalNAc, and l‐fucose. Two residues demonstrated weak activity—GlcNAc/NeuNAc and α‐mannose. Temporal bones with MOM revealed increases in sialic acid and α‐mannose, and a decrease in l‐fucose. Residues of carbohydrates in the cilia of bones with SOM were notably decreased, especially for GalNAc, Galβ(1–3)GalNAc, and Neu‐NAcα(2–6)GalNAc. Conclusions: Glycoconjugates in the normal human eustachian tube are rich in GalNAc, Galβ(1–3)GalNAc, l‐fucose, and NeuNAcα(2–3/2–6) GalNAc, but low in α‐mannose and sialic acid. Eustachian tubes from cases with SOM or MOM demonstrated alterations in glycoconjugate expression in cilia and goblet cells, which may reflect disorder of the carbohydrate metabolism during otitis media, especially in SOM. Laryngoscope, 108:1474–1479, 1998
A new mutation in the POU3F4 gene in a japanese family with x‐linked mixed deafness (DFN3)
Authors: Hagiwara Hideo , Tamagawa Yuya , Kitamura Ken , Kodera Kazuoki
Published: November 2003

Objective: The molecular defect in patients with X‐linked mixed deafness showing a perilymphatic gusher at stapedectomy (DFN3) has been attributed to mutations in the POU3F4 gene. This study aimed to clarify an allelic variant of this gene. Study Design: This was a genetic study of a single Japanese family with DFN3. Methods: Products of a polymerase chain reaction (PCR) were subjected to single‐strand conformation polymorphism (SSCP) analysis. Direct sequencing of PCR products from patients and carriers showing SSCP variants was performed using the fluorescent dideoxy termination method and a sequencer. Results: Sequencing of the PCR product revealed a 6‐base deletion (TTCAAA) at nucleotides 601 to 606, resulting in a two‐amino‐acid deletion in the POU3F4 protein, (phenylalanine and lysine at amino acid residues 201 and 202). The deletion was adjacent to the site of a nonsense mutation previously described. Conclusion: Microdeletions at a previously undescribed location account for some clinically important POU3F4 mutations. Laryngoscope, 108:1544–1547, 1998
Occult tonsillar carcinoma in the unknown primary
Authors: Mcquone Shelly J. , Eisele David W. , Lee Ding‐Jen , Westra William H. , Koch Wayne M.
Published: November 2003

Objectives: Evaluate effectiveness of routine tonsillectomy in the assessment of patients with squamous cell carcinoma of the neck of unknown primary, and evaluate outcomes of this group compared with patients without a primary identified initially. Study Design: A retrospective review of the medical records of 37 patients presenting with an unknown primary tumor over a 10‐year period. Methods: Charts were reviewed for age and sex of patients, methods of evaluation and diagnosis, sites of tissues obtained on biopsy, N stage of disease, and presence of extracapsular spread. Recurrence and survival data were collected over a mean follow‐up period of 34 months. Results: All primary lesions discovered through pathologic evaluation arose from the tonsil (9/9), and all were detected in patients undergoing tonsillectomy in conjunction with direct laryngoscopy. None of the patients (0/9) with occult tonsillar carcinoma have had recurrence, in contrast to 60% (15/25) of remaining patients. Patients with tonsillar primary lesions demonstrated less extracapsular spread of disease (25%) than patients without tonsillar primaries (67%), despite similar N staging within the two groups. Conclusions: Occult tonsillar carcinoma accounts for the unknown primary more frequently than was previously recognized. Bilateral tonsillectomy is recommended to increase the detection yield and to capture the rare case of bilateral disease. A lower incidence of extracapsular spread and reduced recurrence rates in patients with unknown primary tumors presenting as occult tonsillar carcinoma may contribute to the improved prognosis observed in this group. Laryngoscope, 108:1605–1610, 1998
An orthotopic floor‐of‐mouth cancer model allows quantification of tumor invasion
Authors: Simon Christian , Nemechiek Andrew J. , Boyd Douglas , O'Malley Bert W. , Goepfert Helmuth , Flaitz Catherine M. , Hicks M. John
Published: November 2003

Objectives: To establish an orthotopic murine floor‐of‐mouth cancer model for the analysis of the role of proteases such as urokinase‐type plasminogen activator (u‐PA) and the matrix metalloprotease MMP‐9 (MMP‐9) in in vivo invasion. Study Design: Randomized, prospective animal study. Methods: Two human squamous cell carcinoma cell lines, UM‐SCC‐1 and 022, were assayed via zymography for their in vitro secretion levels of u‐PA and MMP‐9. Both cell lines (5 × 106 cells) were injected into the cervical subcutaneous tissues of female athymic nude (nu/nu) mice superficial to the mylohyoid muscle. Mice were sacrificed after 30 days, and tumor invasion characteristics were histologically compared. Additional mice were then inoculated with invasive UM‐SCC‐1 cells and sacrificed 10, 30, and 40 days after inoculation to identify distinct stages of invasion. Results: In vitro secretion levels of MMP‐9 and activity of u‐PA were higher in UM‐SCC‐1 cells than in 022 cells. In the in vivo studies, tumors formed from 022 cells were found to be noninvasive, whereas tumors derived from UM‐SCC‐1 cells progressed through distinct and readily identifiable histologic stages of invasion. These stages included invasion of adjacent muscle layers (mylohyoid, geniohyoid, and genioglossus muscles) and of associated structures (blood vessels, bone, nerve, and regional lymph nodes). A staging system was devised accordingly. Conclusion: We developed an in vivo quantitative cancer invasion model that allows determination of the effect of the expression and activity levels of the proteases MMP‐9 and u‐PA. Tumor invasion occurred in an orderly and stepwise fashion involving muscles and related vascular, nervous, and bony structures of the floor of the mouth and tongue. This orderly invasion allowed the development of a staging system. We anticipate that this model will have wide applicability in the study of in vivo tumor response to a variety of novel therapeutic approaches. Laryngoscope, 108:1686–1691, 1998
A biomechanical study of the human cricoarytenoid joint
Authors: Kasperbauer Jan L.
Published: November 2003

Objectives/Hypothesis: To develop a model to investigate the biomechanics of the cricoarytenoid joint and establish stiffness, laxity, and range of motion of the cricoarytenoid joint in adult human larynges. Study Design: Laboratory investigation of freshly frozen larynges from adult humans, measuring the stiffness, laxity, and range of motion in intact and injured cricoarytenoid joints. Methods: Eight normal‐appearing frozen cadaver larynges from adult humans were studied. The cricoid cartilage was fixed to a load cell sensitive to forces in three dimensions. A probe was rigidly fixed to the arytenoid cartilage and attached to a frame to allow active rotation, rocking, and gliding of the arytenoid. A computer program simultaneously recorded forces generated by these motions and tracked the motion of the arytenoid in three dimensions. The joint was studied before and after injury to the posterior cricoarytenoid ligament, and the joint surfaces were digitized after completion of these studies. Results: A successful method of evaluating the biomechanical properties of the cricoarytenoid joint was developed. Comparing intact and injured joints confirmed that laxity and range of motion increased during rocking, gliding, and rotational motion when the cricoarytenoid ligament had been divided. Stiffness measurements for rocking, rotation, and gliding also were documented. Conclusions: The model of study introduced in this report provides a significant and unique method of investigating the biomechanics of the cricoarytenoid joint, allowing insight into the basic joint characteristics and alteration in joint biomechanics related to injuries and surgical procedures. Dividing the cricoarytenoid ligament increases laxity and range of motion in sagittal rocking, gliding, and axial rotation. Secondary constraints on the joint provide significant stiffness of greater degrees of displacement. Further studies should provide insight into the significant secondary elements supporting the joint and into the mechanisms of cricoarytenoid injuries, as well as the effect of surgical procedures on the cricoarytenoid joint. Laryngoscope, 108:1704–1711, 1998
Ossiculoplasty with an intact stapes: Superstructure versus footplate prosthesis placement
Authors: Moretz William H.
Published: November 2003

Objectives/Hypothesis: Many techniques and prostheses are used for ossiculoplasty in the various situations of ossicular chain status that the surgeon may encounter in tympanoplasty procedures. The current study seeks to determine whether any particular technique or prosthesis used by the author demonstrates superior hearing results with fewer failures. Study Design: Retrospective review. Methods: This study retrospectively reviews a consecutive series of cases with intact stapes superstructures, with an intact malleus handle (Austin‐Kartush group A) and without (Austin‐Kartush group C). The ossiculoplasties were performed with either partial prosthesis techniques from the stapes superstructure to the drum, malleus, or malleus/drum (as is traditionally reported by most authors) or with less frequently advocated total prosthesis techniques from the stapes footplate to the drum, malleus, or malleus/drum. Results/Conclusions: Of cases for which 1‐year postoperative air and bone hearing results were available, group A cases had significantly smaller air‐bone gaps than group C cases. There was no difference in mean air‐bone gaps between partial and total reconstruction within either group A or C. A few partial and total prosthesis types had low failure rates, good mean air‐bone gap hearing results, and tight spread of results to recommend them in group A cases. Total reconstruction had a lower prosthesis failure rate than partial reconstruction in group C cases, although mean air‐bone gap hearing results were the same.
Vocal mechanics as the basis for phonosurgery
Authors: Isshiki Nobuhiko
Published: November 2003

Objective: A number of modifications in laryngoplastic phonosurgery have recently been proposed. This report is intended to clarify the concept on which the surgery should be based, vocal mechanics, for further rational development of the surgery. Study Design: The results of various previous surgeries were compared. In an attempt to elucidate what makes the difference in the results, simulation of voice production was conducted with the use of excised larynges. Methods: Excised larynges were mounted on a tube so as to be blown from below. Experimental variables in the model included the glottal area initially set, stiffness of the vocal folds, and subglottal pressure. The conditions under which the voice became hoarse were examined. Results: The voice became hoarse under the following major conditions: 1) the initial glottal area exceeded a certain value, 2) stiffness was too high, and 3) the glottis was too tightly closed. Clinical representation for each condition was made, particularly for excessively tight glottal closure such as in spasmodic dysphonia. A new type of surgical treatment for spasmodic dysphonia, lateralization thyroplasty, was briefly reported, which restored the voice to normal without recurrence for 1 year at the time of this writing. Conclusions: A potential new type of laryngoplastic phonosurgery should be conformed to the mechanics of voice production. In treating dysphonia, it is often necessary to switch from etiologic or radical treatment, if infertile, to symptomatic treatment instead, at the level of mechanics.
Endoscope‐assisted vestibular neurectomy
Authors: Wackym Phillip A. , King Wesley A. , Barker Fred G. , Poe Dennis S.
Published: November 2003

Objective/Hypothesis: In some instances endoscopes offer better visualization than the microscope and frequently allow less invasive surgery. This study was undertaken to determine whether endoscopy is safe and effective during neurectomy of the vestibular nerve. Method: Ten patients with intractable unilateral Meniere's disease underwent a retrosigmoid craniotomy for neurectomy of the vestibular nerve. Endoscopy with a Hopkins telescope was used during each procedure to study posterior fossa anatomic relationships and to assist the neurectomy. Preoperative and postoperative audiometric evaluation was performed in all patients undergoing vestibular neurectomy. Nine of these patients had preoperative electronystagmography, and four patients completed postoperative electronystagmography. The 1995 American Academy of Otolaryngology—Head and Neck Surgery's Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease were used. Results: Complete neurectomy was achieved in all 10 patients. Endoscopy allowed improved identification of the nervus intermedius and the facial, cochlear, and vestibular nerves and adjacent neurovascular relationships without the need for significant retraction of the cerebellum or brainstem. In addition, endoscopic identification of the cleavage plane between the cochlear and vestibular nerves medial to or within the internal auditory canal (n = 3) was not made with the 0‐degree endoscope; however, identification was made with the 30‐ or 70‐degree endoscope in all cases. In all patients with Meniere's disease, elimination of the recurrent episodes of vertigo (n = 10) or otolithic crisis of Tumarkin (n = 1) was achieved. Conclusions: Posterior fossa endoscopy can be performed safely. Endoscope‐assisted neurectomy of the vestibular nerve may offer some advantages over standard microsurgery including increased visualization, more complete neurectomy, minimal cerebellar retraction, and a lowered risk of cerebrospinal fluid leakage.
A review of 308 cases of revision stapedectomy
Authors: Hammerschlag Paul E. , Fishman Andrew , Scheer Allan Austin
Published: November 2003

Objective/Hypothesis: Identify causes of primary and revision stapedectomy failure in 308 patients, assess whether these are different based on source of initial surgery, and evaluate hearing results in revision stapedectomy to improve outcome. Study Design: Retrospective, nonrandomized chart review of patients undergoing revision stapedectomy in a referral otology practice in a large metropolitan region. Materials and Methods: Intraoperative findings, preoperative and postoperative revision stapedectomy air and bone conduction pure‐tone averages, speech discrimination scores, postoperative air‐bone gaps, complications, and repeated revisions were noted in 308 patients. Results: Leading causes of primary stapedectomy failure included dislocated prosthesis (24.4%), inadequate prosthesis length (14%), long process resorption (14%), and fibrous adhesions (13.6%). Revision stapedectomy air‐bone gaps were less than 10 dB in 80% and greater than 30 dB in 6.8% of cases. Increased sensorineural hearing loss occurred in 0.8% of revision stapedectomy cases. Five of seven cases of vertigo associated with primary stapedectomy resolved after revision surgery. Conclusion: Revision stapedectomy by experienced surgeons is highly effective in attaining successful air‐bone gap closure in 80% and improved closure in 84.8% of operative cases. Risk of vertigo and/or sensorineural hearing loss was not any higher in this patient population when compared with reports of primary stapedectomy.
Argon Plasma Coagulation for the Treatment of Hereditary Hemorrhagic Telangiectasia
Authors: Bergler Wolfgang , Riedel Frank , Baker‐Schreyer Antonio , Juncker Cathrin , Hörmann Karl
Published: November 2003

Objectives: Patients with (HHT) often suffer from recurrent epistaxis, which poses considerable therapeutic problems. Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. Study Design: In a prospective study 12 patients (aged 8–68 y) who presented with a long history of treatment for epistaxis were treated with telangiectasia in the nasal mucosa. After 2 weeks and again after 4 months the treatment results were evaluated by questionnaire. Methods: APC is based on high‐frequency electric energy transmitted through ionized argon gas to the tissue in a noncontact mode. Coagulation and desiccation of tissue are limited to 1 to 2 mm of penetration and therefore risk of tissue damage is low. Coagulative effects are best in tissue with high electrical conductivity, especially blood vessels. Results: All patients were satisfied with the postoperative results. Frequency and intensity of bleeding were significantly reduced. All patients reported better postoperative results than with any other treatment they had received previously. Conclusion: First clinical experience shows that APC is a useful alternative for the treatment of telangiectasia in the nasal mucosa and should be a therapeutic option for this disease.
Surgical Causes of Failure in Endoscopic Sinus Surgery
Authors: Ramadan Hassan H.
Published: November 2003

Objectives: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. Study Design: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. Methods: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. Results: Fifty‐two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. Conclusion: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.
Prognosis in Bilateral Vestibular Hypofunction
Authors: Gillespie M. Boyd , Minor Lloyd B.
Published: November 2003

Objectives/Hypotheses: The outcomes of patients with bilateral vestibular hypofunction vary widely. Some resume relatively normal activity within months, whereas others have a more debilitated course. This study sought to identify factors that may affect outcome. Study Design: A retrospective review of patients treated for bilateral vestibular hypofunction over a 2‐year period at a neurotology clinic. Methods: Patients' medical charts, electronystagmography data, rotatory chair testing, and posturography results were reviewed. Subjective and objective measures were used to evaluate outcome. Results: Bilateral vestibular hypofunction was diagnosed in 35 patients. Improvement after vestibular rehabilitation therapy was noted in 18 patients (51%), whereas 12 (34%) showed little or no change and 5 (15%) were not available for follow‐up. The patients without improvement were more likely to have a chronic disorder as a cause of the vestibulopathy and had more medical comorbidities, on average, when compared with those who improved. Lower gains and time constants on rotatory chair testing were also seen in the group that did not improve. Conclusions: Poor rehabilitation results may be attributable to increased severity of vestibular insult, progressive peripheral or central vestibular dysfunction, and multiple medical problems.
Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas Presenting As Pulsatile Tinnitus
Authors: Shah Saurabh B. , Lalwani Anil K. , Dowd Christopher F.
Published: November 2003

Objective/Hypothesis: Transverse/sigmoid sinus dural arteriovenous fistula (TSDAVF) is a diagnostically elusive entity that is critical for the otologist to account for, when confronted by pulsatile tinnitus in the face of normal otoscopy. Left untreated, TSDAVF may result in catastrophic outcome. We have previously proposed a grading system specifically for TSDAVF based on venous restrictive disease. Our objective was to assess the validity of this grading system for clinical severity and therapeutic outcome. Methods: Through a retrospective review of 41 patients with TSDAVF, we evaluated clinical presentation, diagnostic evaluation, therapy, and outcome. Patients were classified into four grades based on the severity of venous restrictive disease as determined by superselective angiography. Our treatment algorithm combined compression therapy, transarterial embolization, and for more severe grades, surgery. Results: Pulsatile tinnitus was the chief complaint of all the patients in this series, and of 90% of all cases of TSDAVF treated at our institution. While angiography remains the gold standard, magnetic resonance imaging/magnetic resonance arteriography is far superior to computed tomography scanning in detecting dural arteriouvenous fistulas. As normal venous outflow gives way to aberrant cortical venous drainage in higher grades, there is a dramatically increased risk for adverse consequences with therapeutic intervention. Using our treatment algorithm, 82% of patients achieved clinical resolution of symptoms. Half of these patients had complete angiographic obliteration of their TSDAVF. Conclusions: The TSDAVF‐specific grading system for the severity of venous restrictive disease is reflective of clinical presentation, fundamental in planning treatment, and predictive of therapeutic outcome.
Radiologic and Mechanical Properties of Inactivated Ossicle Homografts
Authors: Hotz Michel A. , Speirs Andrew D. , Oxland Thomas , Müller Markus , Hämmerle Christoph , Häusler Rudolf
Published: November 2003

Objective: This study examined the effects of old and new inactivation (sterilization) techniques on the radiologic and mechanical properties of ossicle homografts. Materials and Methods: Ninety normal incuses and malleuses received either treatment with 1) 5% formaldehyde/cialit, 2) 1N NaOH, 3) 0.9% LpH,R̊ or 4) autoclaving at 134°C, or no treatment. All ossicles were assessed radiologically by high‐resolution computed tomography. After imaging, all ossicles underwent mechanical testing by destructive axial compression in a mechanical testing machine measuring force and displacement. Results: Ossicles treated with cialit, NaOH, or autoclaving showed a significant decrease of ultimate force and stiffness compared with controls. LpH treatment caused no such changes in these structural properties. Material properties of yield strength, ultimate strength, and elastic modulus were also altered by cialit, NaOH, and autoclaving, but were much more difficult to assess because of uncertainty in parameter estimates. There was a significant increase in radiologic density in autoclaved ossicles, a reduction in cialit‐ and LpH‐treated ossicles, and no change in NaOH‐treated ossicles. Conclusions: All tested inactivation procedures changed the biomechanical and/or radiologic properties of ossicle homografts. However, the new procedures used to inactivate infectious agents produced changes similar to the older treatments with formaldehyde/cialit. Human allografts are able to withstand harsh but safe sterilization procedures. The NaOH treatment seems to be the most suitable method for the future. The biologic (osteogenic) potentials of ossicle homografts treated with these new preservation/inactivation methods are still unknown. Further investigations are necessary to re‐evaluate the clinical use of ossicle homografts in middle ear reconstructive surgery.
Laser‐Assisted Uvulopalatoplasty for the Treatment of Mild, Moderate, and Severe Obstructive Sleep Apnea
Authors: Walker Regina Paloyan , Grigg‐Damberger Madeleine M. , Gopalsami Chellam
Published: November 2003

Objectives/Hypothesis: Until recently, laser‐assisted uvulopalatoplasty (LAUP) has been used to treat only snoring and mild cases of obstructive sleep apnea (OSA). The purpose of this study was to evaluate the efficacy and safety of LAUP in patients with mild, moderate, and severe OSA. Study Design: A prospective study of 38 patients who completed LAUP for the treatment of OSA who were evaluated based on the severity level of their preoperative apnea. Materials and Methods: Between July 1993 and December 1995, 96 patients with a diagnosis of OSA based on polysomnography underwent staged outpatient LAUP treatment. Thirty‐eight patients completed treatment and obtained postoperative polysomnography. Postoperative complications and polysomnographic findings were reviewed. Results: Fifteen patients had a diagnosis of mild apnea, 12 had moderate apnea, and 11 had severe apnea based on preoperative polysomnography. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative respiratory disturbance index (RDI) and a postoperative RDI of less than 20, were 46.7% in the mild apneics, 41.7% in the moderate apneics, and 45.5% in the severe apneics. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopharyngeal insufficiency. There were no serious complications. Conclusions: In the carefully selected and prepared patient with mild, moderate, or severe OSA, LAUP should be considered a surgical option for the treatment of this disorder. LAUP remains a cost‐effective and safe alternative to uvulopalatopharyngoplasty.
Biomechanics of A‐to‐T Flap Design
Authors: Stevens Carl “Rusty” , Tan Luke , Kassir Ramtin , Calhoun Karen
Published: November 2003

Objectives/Hypothesis: The objective of this study was to determine the vertical height, horizontal incision width, and extent of undermining that correlated with the lowest closure tension. Study Design: Prospective, cadaver study. Methods: Forty “A‐to‐T” flaps were made on the torso and lower extremities of fresh cadavers. Ten flaps each were designed at heights of three, four, and five defect radii. Closing tensions were measured for each of these flaps initially, followed by serial base extensions. Based on the information from these first flaps, 10 additional flaps were made at the optimal height and base extensions. These flaps were then serially undermined and tension measurements taken. Results: Our results suggest that making the vertical height of the “A” twice the height of the defect yields a significant decrease in tension of closure when compared with a vertical height one and a half times the defect (P < .01), while increasing the height to two and a half times the defect height provides only a minimal further reduction in closure tension. Extending the base (horizontal) incision one defect diameter in each direction offers the greatest reduction in closing tension. Undermining up to three times the diameter of the defect offers progressive improvement in the tension of closure, while further undermining confers little additional benefit. Conclusions: Our findings indicate that the ideal A‐to‐T flap is designed to be twice the height of the original defect, with base extensions one defect diameter in each direction, and undermined to three times the diameter of the defect.
Clinical Experience With Gore‐Tex for Vocal Fold Medialization
Authors: Giovanni Antoine , Vallicioni Jean‐Marc , Gras Régis , Zanaret Michel
Published: November 2003

Objectives/Hypothesis: Present clinical experience with vocal fold medialization under local anesthesia using a Gore‐Tex implant. The procedure consists of placing the implant into a pocket formed by dissection of the inner perichondrium of the thyroid cartilage through a small window made in the thyroid ala. Study Design: During 2 years, we used this technique preferentially in 13 of the 16 cases of vocal fold medialization (three patients underwent Teflon injection because of a contraindication to local anesthesia). Follow‐up was longer than 3 months in 11 cases (mean, 13 mo). Methods: Vocal result was analyzed by the means of perceptual analysis and by the measurement of jitter factor. Glottal leakage was evaluated perceptually using videolaryngoscopy, and oral airflow was measured during the production of a vowel. In cases with preoperative aspiration, videofluoroscopy was performed. Results: Implantation was successful in all but one patient in whom extrusion of the implant material occurred. In the latter case, the implant was removed and the patient recuperated his preoperative voice without any other complication. In the 10 other cases, voice improvement assessed by perceptual and objective evaluation was satisfactory. Conclusions: Results compare favorably with those of endoscopic techniques using Teflon or collagen and laryngeal frame surgery techniques using silicone or cartilage. We conclude that Gore‐Tex implantation is a simple, reproducible, and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.
Quantification of lymph nodes in selective neck dissection
Authors: Friedman Michael , Lim Jessica W. , Dickey William , Tanyeri Hasan , Kirshenbaum Gary L. , Phadke Dattatreya M. , Caldarelli David
Published: November 2003

Objectives: Provide reference for surgeon and pathologist regarding expected yield from selective neck dissections. Quantify lymph nodes obtained from cadaver dissection based on current nodal classification and compare with clinical series. Study Design: 1. Quantification of lymph nodes at levels I–V harvested from human cadavers and correlation with nodal grouping for supraomohyoid (I–III) and lateral (II–IV) neck dissections. 2. Retrospective review of operative specimens from clinical neck dissections for lymph node quantity. Methods: 1. Twenty radical neck dissection specimens, harvested from 10 fresh human cadavers without evidence of head and neck cancer, were separated by nodal level for gross and microscopic examination by a pathologist. The quantity of nodes obtained per level for each specimen was tabulated. 2. Charts of patients treated with neck dissection for squamous cell carcinoma were reviewed and tabulated for type of dissection and number of lymph nodes reported. Results: In the 20 cadaver neck dissections, the average number of lymph nodes removed for levels I–V was 24, with 13 for levels I–III and 19 for levels II–IV. In the clinical review, 98 total neck dissections were included. In the six supraomohyoid dissections, an average of 20 lymph nodes (range, 14–26) were found, with an average of 30 (range, 15–43) in the 11 lateral compartment specimens. In 81 radical or modified radical dissections, an average of 31 nodes (range, 19–63) was reported. Conclusions: The number of lymph nodes removed in selective neck dissection should be comparable to that of the corresponding levels in radical neck dissection, provided that strict adherence to surgical boundaries is maintained. Dissection of normal cadavers provides a reference for the surgeon and the pathologist but may under‐represent lymph node quantity in the diseased state.
Olfactory secretion and sodium, potassium–adenosine triphosphatase: Regulation by corticosteroids
Authors: Fong Karen J. , Kern Robert C. , Foster James D. , Zhao Jin‐Cheng , Pitovski Dimitri Z.
Published: November 2003

Objectives: To investigate the cellular distribution and relative intensity of the immunoreactivity associated with the expression of sodium, potassium‐adenosine triphosphatase (Na, K–ATPase) in cells of the olfactory mucosa. Second, changes in the activity of this enzyme in the olfactory mucosa are correlated with changes in the circulating corticosteroid aldosterone. Methods: Combination of immunohistochemical and biochemical techniques were employed to examine the olfactory Na, K–ATPase. Results: Within the olfactory epithelium, the Na, K–ATPase immunoreactivity was greatest at the supranuclear region of sustentacular cells and/or dendrites of olfactory receptor neurons (ORNs). Cell bodies of ORNs demonstrated moderate immunoreactivity, whereas the duct cells of Bowman's gland exhibited moderate to intense immunoreactivity. Acinar cells of the Bowman's gland were the most intensely stained components of the lamina propria, exhibiting strong immunoreactivity at the basolateral plasma membrane domains of the acinar cells and less within the cytoplasm. Binding of ouabain, a specific inhibitor of Na, K–ATPase, was significantly elevated for aldosterone‐injected versus sham‐injected controls. Conclusion: These results suggest that olfactory Na, K–ATPase is regulated by the systemic corticosteroid aldosterone. The results are consistent with the hypothesis that corticosteroids regulate olfactory secretion.
Inhibitory effect of erythromycin on interleukin‐8 secretion from exudative cells in the nasal discharge of patients with chronic sinusitis
Authors: Suzuki Hideaki , Asada Yukinori , Ikeda Katsuhisa , Oshima Takeshi , Takasaka Tomonori
Published: November 2003

Objectives: The mechanism of the efficacy of long‐term low‐dose macrolide therapy for chronic sinusitis is not fully understood. The authors studied the inhibitory effect of erythromycin on interleukin‐8 (IL‐8) secretion from exudative cells in the nasal discharge of patients with chronic sinusitis. Study Design and Methods: Exudative cells in the nasal discharge were isolated from six patients with nonallergic chronic sinusitis. The cells, more than 90% of which were neutrophils, were incubated with or without erythromycin in the presence of 10 μg/mL of lipopolysaccharide. The IL‐8 concentrations in the culture supernatants were measured by enzyme‐linked immunoassay. Results: The amount of secreted EL‐8 in the absence of erythromycin was 682 ± 226 pg/106 cells/24 h. The IL‐8 secretion was significantly reduced to 66 ± 15% and 46 ± 13% of the control in the presence of 10−6 and 10−5 M of erythromycin, respectively. Conclusion: Erythromycin may act as a biologic modulator that inhibits IL‐8 secretion from exudative cells and thereby blocks the vicious circle of neutrophil recruitment and IL‐8 generation in the inflammatory site in chronic sinusitis.