bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life in Head and Neck Cancer
Authors: Weymuller Ernest A. , Yueh Bevan , Deleyiannis Frederic W.‐B. , Kuntz Alice L. , Alsarraf Ramsey , Coltrera Marc D.
Published: November 2003

Because treatments for patients with cancer of the head and neck can have major impact on physical, social, and psychological function, the collection of quality of life (QOL) data in this group of patients is critical for our specialty. The University of Washington Quality of Life data have been collected and analyzed on three subsets of cancer patients. Information learned from these patients is summarized and strategies for future projects are outlined.
Calciphylaxis: Is There a Role for Parathyroidectomy?
Authors: Kriskovich Mark D. , Holman John M. , Haller Jeffrey R.
Published: November 2003

Objective Calciphylaxis, a rare disorder typically affecting renal failure patients, results in vascular calcification with subsequent skin necrosis, gangrene, and often death from sepsis. Parathyroid hormone is thought to act as a tissue sensitizer leading to these soft tissue changes. As such, parathyroidectomy is often advocated to control this complicated condition. A discussion of calciphylaxis does not exist in the otolaryngology literature, and head and neck surgeons performing parathyroidectomy should be aware of this phenomenon. This study evaluates the success of parathyroidectomy in reversing the ill effects of calciphylaxis in both our patient population and the literature.

Study Design Retrospective study and review of the literature.

Methods Five patients with calciphylaxis treated at our institution were evaluated for mortality, surgical and perioperative complications, wound healing, and predictors of patient outcomes.

Results Two patients died from sepsis and infectious complications of their calciphylaxis shortly after surgery. Of the three survivors, two later died (15 and 18 mo after surgery) from causes not directly related to calciphylaxis. The other long‐term survivor required partial amputation of a leg for osteomyelitis. There was one operative complication— a wound infection requiring antibiotic therapy, drainage, and packing. Postoperative hypocalcemia required treatment in two patients. Immediate perioperative survival was more likely in patients with leukocyte counts less than 20,000 cells/mL.

Conclusions Calciphylaxis is a serious disease and patients often succumb to sepsis and infectious complications. Patients with extremely high leukocyte counts from coexistent infections may have a worse prognosis. Although a conclusive effective therapy does not exist, parathyroidectomy can be safely performed and may benefit some patients with what is often an otherwise fatal disease. The literature to date generally confirms our findings.
Past History of Otitis Media and Balance in Four‐Year‐Old Children
Authors: Casselbrant Margaretha L. , Furman Joseph M. , Mandel Ellen M. , Fall Patricia A. , Kurs‐Lasky Marcia , Rockette Howard E.
Published: November 2003

Objectives/Hypothesis To obtain normative data for a population of children 4 years of age with respect to standard vestibular and balance test protocols and to determine, in the absence of concurrent middle ear effusion (MEE), the possible changes caused by a history of recurrent or persistent MEE.

Study Design Comparative studies of the results of vestibular and balance tests in a cohort of young children with and without a history of MEE.

Methods Seventy‐one children, 4 years of age, with a well‐documented history since early infancy regarding the presence or absence of MEE were evaluated using pneumatic otoscopy, tympanometry, audiometry, and vestibular and balance (rotational and moving platform posturography) tests. For the results of the vestibular and balance tests, comparisons were made between the group of 31 children (43.7%) without and the group of 40 children (56.3%) with a history of recurrent or persistent MEE, when a positive disease history was defined as at least a 10% cumulative percentage of time with MEE between early infancy and time of testing.

Results When compared with children with a negative history of significant MEE, children with a positive history had a lower average gain to a rotational stimulus of 0.1 Hz, 150°/s (0.57 vs. 0.44;P = .007). There were no significant differences between groups with respect to other measures.

Conclusions These results suggest that a history of recurrent or persistent MEE affects the vestibular and/or balance function of 4‐year‐old children when tested in the absence of a concurrent episode of MEE. The possible sequelae of the disease should be weighed in future considerations of early intervention for MEE.
Laser‐Assisted Endoscopic Stapedectomy: A Prospective Study
Authors: Poe Dennis S.
Published: November 2003

Objective To improve the techniques required to perform a stapedotomy without prosthesis (stapedioplasty).

Study Design New infrared lasers were evaluated for potential use in otological surgery in guinea pigs. A prospective human trial of 34 primary stapes operations using the Argon ion laser was performed, with 11 stapedioplasties and 23 conventional stapedotomies as controls.

Methods Laser–tissue interactions were evaluated for temporal bone and live guinea pig tissues, measuring crater histology and labyrinthine temperature elevations. Patients undergoing stapedioplasty had Argon ion laser cuts with endoscopic assistance made in the anterior crus and footplate to mobilize the posterior segment of the stapes while the anterior portion remained fixed.

Results Diode laser (808‐nm) vaporization craters and temperature elevations in the vestibule were suitable for clinical use. Overall, stapedioplasty patients' hearing was improved with air‐bone gap closure to a mean of 8.3 dB (SD ± 9.8 dB).

Conclusions Patients with anterior footplate otosclerosis are candidates for stapedioplasty preserving the annular ring and stapes tendon and eliminating prosthesis complications. High‐resolution small endoscopes, coupled with Argon ion or diode lasers promise to improve stapes visualization, enhancing the ability to perform minimally invasive surgery on the stapes footplate.
Antisense RNA to eIF4E Suppresses Oncogenic Properties of a Head and Neck Squamous Cell Carcinoma Cell Line
Authors: DeFatta Robert J. , Nathan Cherie‐Ann O. , De Benedetti Arrigo
Published: November 2003

Objective The translation initiation factor eIF4E is elevated in all head and neck squamous cell cancers (HNSCCs) and appears to be essential in the progression of solid tumors. Overexpression of eIF4E results in preferential upregulation of two angiogenic factors, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (FGF‐2). We wanted to determine whether reducing eIF4E in a HNSCC cell line could suppress its oncogenic properties and in turn decrease expression of VEGF and FGF‐2.

Methods Levels of eIF4E protein expression were determined in a panel of HNSCC cell lines. An episomal vector containing antisense RNA to eIF4E was used to reduce the eIF4E level in one of these cell lines, FaDu. After a stable transfection, Western blot analysis was performed to determine the level of eIF4E and FGF‐2 reduction, while an enzyme‐linked immunosorbent assay (ELISA) was used to determine the level of VEGF reduction. In vitro and in vivo experiments were performed to determine whether there was a reversion in the tumorigenic properties of the FaDu cells.

Results All six cell lines had elevated levels of eIF4E compared with Detroit 551, a normal cell line. Reducing eIF4E expression via antisense RNA suppressed both the tumorigenic and angiogenic properties of the FaDu cells, as demonstrated by loss of capacity to grow in soft agar, reduced expression of angiogenic factors, and loss of tumorigenicity in nude mice.

Conclusions Antisense RNA therapy to eIF4E can potentially be used as adjuvant therapy for head and neck cancers, particularly in cases in which elevated eIF4E is found in the surgical margins.
A Retrospective Analysis of Temporomandibular Joint Reconstruction With Free Fibula Microvascular Flap
Authors: Wax Mark K. , Winslow Catherine P. , Hansen Juliana , MacKenzie Douglas , Cohen James , Andersen Peter , Albert Thomas
Published: November 2003

Objectives The temporomandibular joint is occasionally encountered in extirpative surgery of the head and neck. It presents a difficult management issue. Little has been reported on functional outcomes after resection and reconstruction of the temporomandibular joint.

Design A retrospective analysis consisting of chart reviews and phone interviews was performed on 17 patients who underwent fibular free flap reconstruction of the temporomandibular joint from 1993 to 1998.

Results Mean follow‐up in surviving patients (10) was 41.3 months. Mean age of the group was 62; male‐to‐female ratio was 11:6. Average hospital stay was 11.6 days. Four patients had no radiation therapy, 2 had preoperative and 11 had postoperative treatment. Five patients had one osteotomy, seven had two, one had three, and one had four. Ten patients could chew, one could not, and none were recorded for the remaining. Diet consisted of regular food for two patients, soft food for seven, full liquids for four, and tube feeds for four. Cosmesis was judged as excellent by eight patients, acceptable by two, and unacceptable by two. Five patients did not describe cosmesis. Most patients stated that bony contour was excellent, but that the soft tissue defect was noticeable. Speech was judged as intelligible by seven and moderately understandable by one. Nine patients did not describe speech. Two patients had postoperative displacement of the fibular head out of the fossa.

Conclusion Primary reconstruction of the temporomandibular joint with microvascular fibular flaps is a viable and effective means of restoring function. The majority of patients are able to resume oral feeds, obtain excellent or pleasing cosmetic results, and maintain intelligible speech.
Nasal Interleukin‐5, Immunoglobulin E, Eosinophilic Cationic Protein, and Soluble Intercellular Adhesion Molecule‐1 in Chronic Sinusitis, Allergic Rhinitis, and Nasal Polyposis
Authors: Kramer Matthias F. , Ostertag Peter , Pfrogner Elisabeth , Rasp Gerd
Published: November 2003

Objective To compare concentrations of interleukin‐5 (IL‐5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule‐1 (sICAM‐1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases.

Methods Nasal secretion and serum were analyzed by routine enzyme‐linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects.

Results Significantly elevated concentrations of IL‐5 (5‐fold, P < .05) and IgE (15‐fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL‐5, 51.8 ± 13.2 pg/mL; IgE, 41.9 ± 20.9 kU/L) or nonallergic nasal polyposis (IL‐5, 57.9 ± 36.9 pg/mL; IgE, 40.5 ± 20.2 kU/L) compared with controls (IL‐5, 10.6 ± 7.8 pg/mL; IgE, 2.8 ± 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL‐5, 16.5 ± 13.2 pg/mL; IgE, 5.4 ± 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL ± 173.1) compared with controls (52.4 ± 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 ± 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 ± 26.6 ng/mL). Significantly elevated concentrations of sICAM‐1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 ± 45.6 ng/mL). The elevated sICAM‐1 nasal secretion values in this group correlated significantly (P < .05) to the serum values.

Conclusions Equally elevated concentrations of IL‐5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE‐specific, the pathogenesis of nasal polyps is not as clear. IL‐5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia—a characteristic of both diseases. Elevated concentrations of sICAM‐1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out.
Fiberoptic Endoscopic Evaluation of Swallowing in the Pediatric Population
Authors: Leder Steven B. , Karas David E.
Published: November 2003

Objective To investigate the diagnostic and rehabilitative usefulness of routine fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population.

Study Design Prospective, consecutive, blinded.

Patients and Methods Thirty pediatric inpatients from a large, urban, tertiary care teaching hospital participated. Their ages ranged from 11 days to 20 years (mean, 10 years and 4 months). In a random fashion, seven subjects were assessed with both videofluoroscopic evaluation of swallowing (VFES) and FEES and 23 subjects were assessed solely with FEES. Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration. Rehabilitative strategies, e.g., positioning and modification of bolus consistencies, were based on diagnostic findings.

Results There was 100% agreement between the blinded diagnostic results and implementation of rehabilitative strategies for subjects randomly assigned to receive both VFES and FEES and for subjects who received solely FEES. Of the 23 subjects assessed solely with FEES, 13 of 23 (57%) exhibited normal swallowing and 10 of 23 (43%) exhibited dysphagia. The feeding recommendation for 4 of 10 subjects with dysphagia (40%) was for a non‐oral diet because of aspiration. FEES allowed for specific feeding recommendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to reduce aspiration risk in 6 of 10 subjects with dysphagia (60%).

Conclusion FEES can be used routinely to diagnose and treat pediatric dysphagia in the acute care setting.
Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: A Meta‐Analysis
Authors: Hegazy Hassan M. , Carrau Ricardo L. , Snyderman Carl H. , Kassam Amin , Zweig Julie
Published: November 2003

Objectives/Hypothesis Trauma and surgery are the most common causes of cerebrospinal fluid (CSF) rhinorrhea. Surgical repair is recommended for patients with CSF leaks that do not respond to conservative measures, traumatic CSF leaks that require transcranial surgery for associated brain injuries, and iatrogenic defects that are discovered intraoperatively. The purpose of our study was to ascertain the outcome after transnasal endoscopic repair of CSF leaks and to identify factors regarding the patient, CSF fistula, and treatment that may influence the results of the repair.

Methods We performed a meta‐analysis of all studies published in English between 1990 and 1999 that reported a minimum of five patients with CSF fistulae that were repaired using an endoscopic approach. We analyzed data that included type of graft and technique used during the repair, surgical complications, the use of packing, and the use of lumbar drains and antibiotics. The success rate was monitored and correlated with the other variables. The meta‐analysis database was compared with and added to a database comprising our own patients.

Results Fourteen studies comprising 289 CSF fistulae met the inclusion criteria. Endoscopic repair of CSF leaks was successful in 90% (259/289) of the cases after a first attempt. Seventeen of 30 persistent leaks (52%) were closed after a second attempt. Thus ultimately 97% (276/289) of the leaks were repaired using an endoscopic approach. The success rate of repairs using any of the reported techniques and materials was high and not statistically different. The incidence of major complications such a meningitis, subdural hematoma, and intracranial abscess was less than 1% for each complication.

Conclusion The endoscopic approach is highly effective and is associated with low morbidity. The literature supports the endoscopic approach using a variety of techniques and materials for the repair of CSF leaks.
Neck Dissection for Advanced Lymph Node Metastasis Before Definitive Radiotherapy for Primary Carcinoma of the Head and Neck
Authors: Smeele Ludwig E. , Leemans Charles R. , Reid Colin B.A. , Tiwari Rammohan , Snow Gordon B.
Published: November 2003

Objective To evaluate the outcome of neck dissection for advanced metastasis and subsequent planned radiotherapy to the neck and primary tumor.

Study Design Single‐center, retrospective case series.

Methods From 1988 to 1998, 37 previously untreated patients were included into the study protocol. Two had a single tumor‐positive neck node and the remaining 35 had multiple tumor‐positive neck nodes (mean number, 6.0). Extranodal spread was reported in 35 cases (95%); mean nodal size was 5.7 cm (SD, 2.4 cm). Five patients (14%) were not irradiated or were irradiated with palliative intention. Of the remaining patients, 30 received irradiation of 60 Gy or more to the neck and the primary tumor (mean dose, 66.9 Gy; SD, 4.2 Gy). Cumulative survival distributions were estimated by the Kaplan‐Meier method, and differences between groups were analyzed with the log‐rank test.

Results Treatment‐related mortality was observed in three patients (8%). Disease‐specific survival was 49% at 2 years and the overall locoregional control rate was 43% at 2 years. Patients with T1 to T2 primary lesions were compared with those with advanced primary disease, and the 2‐year local control rates were 76% and 47%, respectively (P = .056). The following prognostic factors were identified for distant metastasis: three or more positive nodes (P = .037), positive surgical margins in the neck dissection specimen (P = .004), and time from diagnosis until neck dissection of 23 days or more (P = .043). The influence of distant metastasis on disease‐specific survival was evident (P = .0003).

Conclusion Patients with low‐T‐stage tumors have a better local control rate with this regimen and survival depends on the status of the neck.
Esthesioneuroblastoma and Sinonasal Undifferentiated Carcinoma: Impact of Histological Grading and Clinical Staging on Survival and Prognosis
Authors: Christopher Miyamoto R. , Gleich Lyon L. , Biddinger Paul W. , Gluckman Jack L.
Published: November 2003

Objectives Hyams proposed a histological grading system for esthesioneuroblastoma in which grade I tumors have an excellent prognosis and grade IV tumors are uniformly fatal. The Hyams grading system predated advanced craniofacial techniques, extensive use of immunohistochemistry, and the recognition of sinonasal undifferentiated carcinoma (SNUC) as a distinct entity. Therefore we aimed to determine whether Hyams classification is useful in predicting outcome for esthesioneuroblastoma and SNUC.

Study Design A retrospective review of cases from 1970 to 1999.

Methods Twenty‐six patients (12 with esthesioneuroblastoma and 14 with SNUC) were reviewed. The Kadish clinical stage was determined, and histopathological slides were reviewed and graded using the Hyams system.

Results Kadish staging was available for 26 patients (2 patients with stage A tumors; 7 with stage B; and 17 with stage C). Of the 8 evaluable patients with Kadish stage A or B tumors, 6 remained disease free for more than 2 years compared with only 5 of the 17 Kadish stage C tumors. Slides were available for Hyams grading in 21 patients (2 patients with grade I tumors; 4 with grade II; 4 with grade III; and 11 with grade IV). Of the 6 patients with Hyams grade I or II tumors, 4 remained disease free for more than 2 years compared with only 4 of the 15 patients with Hyams grade III or IV tumors. Of note, three patients with Kadish stage C tumors (two with esthesioneuroblastoma, one with SNUC) and two patients with Hyams grade IV tumors (one with esthesioneuroblastoma and one with SNUC) survived for more than 5 years.

Conclusions Both the Hyams grading system and the Kadish staging system can be used as independent predictors of outcome. Although limited by small numbers, the results of this study demonstrate that patients with either advanced clinical stage or pathological grade of esthesioneuroblastoma or SNUC have poor prognosis, but that long‐term survival is possible in these patients if aggressive treatment is used.
The Aspiration‐Irrigation Maneuver
Authors: Martin Richard A.
Published: November 2003

Objectives/Hypothesis To compare cultures obtained from the aspiration‐irrigation maneuver (AIM) with other reports and compare diagnostic and therapeutic value after AIM versus the Proetz maneuver and needle aspiration‐irrigation.

Study Design Patients with radiographic evidence (mucous membrane thickness greater than 6 mm, air‐fluid levels, or complete opacification) and symptoms (nocturnal cough, fever, postnasal drainage [PND], otitis, mucopurulent discharge from the nose) of sinus disease who were referred from pediatrician and/or family physician and who otherwise would be candidates for surgery were selected to receive treatment with AIM. The study was divided into three separate groups (54 patients who were age 8 years and younger, 54 patients who were age 9 years and older, and 32 adult patients who were treated with both needle aspiration and AIM.

Methods Using Bernoulli's principle and the Venturi effect, saline and a vacuum apparatus were used to capture the contents of the sinuses for culture, and results were compared with results of needle aspirate cultures.

Results Children's cultures from group 1 compared favorably with the literature (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae or a combination of these); cultures in patients age 9 years and older revealed a greater variety of bacteria, depending on chronicity of infection, and a high incidence of Staphylococcus aureus (β‐lactamase positive). There was a 66% correlation of AIM with needle aspiration.

Conclusions AIM was found to be a safe, simple, painless, and inexpensive adjunct to the diagnosis and treatment of sinus disease.
Cranioplasty in Acoustic Neuroma Surgery
Authors: Wazen Jack J. , Sisti Michael , Lam Samuel M.
Published: November 2003

Objectives To measure the incidence of postoperative headaches after retrosigmoid resections of acoustic neuromas and to evaluate the impact of cranioplasty on the prevention and management of these headaches.

Study Design A prospective evaluation was performed on 30 consecutive patients who underwent a cranioplasty after retrosigmoid excision of their acoustic neuroma. The results were compared with 30 historical control patients who underwent the same procedure but did not have reconstruction with a cranioplasty. The patients were evaluated by review of office records and via telephone questionnaire.

Methods One group of patients (30 patients) had no cranioplasty, and the other group of 30 patients had primary reconstruction with a titanium mesh‐acrylic cranioplasty. All 60 patients were asked to report on the duration and severity of their headaches by means of a standard questionnaire, grading their symptoms on a scale of 1 to 4. The data were subjected to χ2 and Student t test statistical analyses.

Results New‐onset, postoperative headaches occurred in 27% of patients, 23% in the cranioplasty group compared with 30% in the group without cranioplasty (a difference that was not statistically significant [P = .158]). However, there was a statistically significant difference in the severity of the headaches (P < .03). The headaches in the cranioplasty group were less severe and were not disabling. There were no complications, infections, or extrusions related to the cranioplasty.

Conclusions Cranioplasty has not been able to eliminate postoperative headaches. However, the use of cranioplasty has significantly decreased the severity of postoperative headaches after retrosigmoid excision of acoustic neuromas.
Prognostic Significance of p53/bcl‐2 Co‐expression in Patients With Laryngeal Squamous Cell Carcinoma
Authors: Jäckel Martin C. , Sellmann Ludger , Dorudian Mansur A. , Youssef Sumaya , Füzesi Làszlò
Published: November 2003

Objective The p53, bcl‐2, and bax genes are known to be involved in control of cell cycle progression and regulation of apoptotic cell death. Although they are frequently altered in laryngeal squamous cell carcinoma, their clinical relevance is not yet fully understood. In the present study, individual and combined expressions of these genes were related with patient survival as well as with proliferative and apoptotic activity.

Design Retrospective study.

Methods Paraffin‐embedded tissue sections of 88 laryngeal squamous cell carcinomas that were diagnosed and treated between 1986 and 1996 were investigated for p53, bcl‐2, and bax protein expression by immunohistochemistry. Apoptotic cells were visualized using the nick end labeling method. To assess proliferative activity of tumors, mitotic indices were determined.

Results Age of patients, advanced disease (stages III and IV), high mitotic activity, positive bcl‐2 expression, high level of p53 expression, and p53/bcl‐2 co‐expression were significantly associated with shortened overall survival in univariate analysis. In multivariate analysis, only age and p53/bcl‐2 co‐expression had independent prognostic value. Other combinations of genes, i.e., bcl‐2‐to‐bax and p53‐to‐bax ratios, were not associated with patient outcome. A significant positive correlation was found between apoptotic and mitotic activity. However, protein levels of p53, bcl‐2, and bax were unrelated to proliferation and apoptosis of tumor cells.

Conclusions The co‐expression of p53/bcl‐2 was an independent predictor of patient outcome and had a prognostic value superior to both parameters considered separately. The rate of apoptosis mainly counterbalanced proliferative activity but appeared not to be significantly influenced by p53, bcl‐2, and bax.
Effectiveness of the Particle Repositioning Maneuver in Subtypes of Benign Paroxysmal Positional Vertigo
Authors: O'Reilly Robert C. , Elford Brian , Slater Robert
Published: November 2003

Objectives To assess the efficacy of the particle repositioning maneuver (PRM) in patients presenting with idiopathic benign paroxysmal positional vertigo (BPPV) compared with those with evidence of additional peripheral vestibulopathies.

Methods Retrospective administration of the Dizziness Handicap Inventory (DHI) to 41 patients with primary BPPV and 31 patients with secondary BPPV to subjectively evaluate their symptoms before and after the PRM.

Results Both groups indicated a marked improvement in symptoms after the PRM. Only two patients reported an increase in their symptoms after the PRM and both had secondary BPPV.

Conclusions The PRM was found to be highly effective in all forms of BPPV, but careful history and judicious testing may identify patients requiring additional intervention to relieve their symptoms.
Nasal Alar Necrosis
Authors: Rachel John D. , Mathog Robert H.
Published: November 2003

Objective To describe an unrecognized clinical entity, nasal alar necrosis, and propose recommendations regarding the diagnosis, pathophysiology, and management of these cases.

Study Design Retrospective review of four patients with this condition.

Methods Histories, treatments, and outcomes were evaluated using office and hospital chart data.

Results We noted that three patients had prior trauma or surgery, other than to the nose, in the head and neck region. All four patients had comorbidities such as diabetes, hypothyroidism, depression, or tobacco abuse. Three patients had sensory deficits over the distribution of the maxillary nerve, and three volunteered that they had a habit of picking the crusted wound. Two patients improved over several months with aggressive wound care. One patient refused treatment and another underwent successful reconstruction.

Conclusions After malignant and granulomatous diseases were ruled out, our evaluations suggested that the pathogenesis was multifactorial including several factors alone or in combination, such as, hypoesthesia, self‐mutilation, and an inadequate blood supply. Deficits in vascularity and sensory innervation must be considered as potential obstacles in reconstruction. Psychological problems causing factitious wounding may complicate therapeutic interventions.
Salvage Surgery for Recurrent Nasopharyngeal Carcinoma
Authors: Shu Chih‐Hung , Cheng Henrich , Lirng Jiing‐Feng , Chang Feng‐Chi , Chao Yee , Chi Kwan‐Hwa , Yen Sang‐Hue
Published: November 2003

Objective To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site.

Study Design A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy.

Methods The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranial‐intracranial (EC‐IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins.

Results Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients.

Conclusions In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC‐IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.
Non‐Hodgkin's Lymphoma of the Sinonasal Tract
Authors: Quraishi M. S. , Bessell E. M. , Clark D. , Jones N. S. , Bradley P. J.
Published: November 2003

Objectives A review of the presenting features, management, and outcome of extranodal non‐Hodgkin's lymphoma (NHL) of the sinonasal tract during a 10‐year period in Nottingham, UK.

Study Design Twenty‐four patients received a diagnosis of extranodal NHL of the nasal cavity, paranasal sinuses, or both, from 1987 to 1996. The patients' data were collected prospectively in the Nottinghamshire Lymphoma Registry.

Methods All patients' records and their histology were reviewed along with data entered into the Nottinghamshire Lymphoma Registry, noting the patient's age, sex, presenting symptoms and signs, staging, computed tomography findings, histology, treatment, complications, and outcome.

Results The 24 patients with extranodal NHL of the sinonasal tract represent 1.63% of the 1,457 patients with NHL seen in the 10‐year period of this study in Nottinghamshire. The median age was 72 years (range, 42–96 y), with a male dominance (male‐to‐female ratio: 15:9). Most patients presented with nonspecific nasal symptoms such as nasal obstruction and epistaxis. Only one patient had a relapse involving the central nervous system after treatment. All the histology was reviewed and showed a predominance of large B‐cell subtype (21 patients). The overall 5‐year survival was 40% (95% CI, 19%–61%) and 33% for 10‐year (95% CI, 12%–54%). The cause‐specific survival at 5 years and 10 years was 62% (95% CI, 39%–86%).

Conclusions A high degree of suspicion and appropriate use of computed tomography scans and surgical biopsy are the keys to the management of NHL.
Connexin26 Mutations Associated With Nonsyndromic Hearing Loss
Authors: Park Hong‐Joon , Houn Hahn Si , Chun Young‐Myoung , Park Keehyun , Kim Hee‐Nam
Published: November 2003

Objective Mutations in the GJB2 gene are a major cause of autosomal recessive and sporadic types of congenital deafness. The 35delG mutation is the most frequent type of mutation in white populations. However, several other forms were reported, such as 167delT among Ashkenazi Jews and R143W in Africans. The present study investigated the mutations of connexin26 (Cx26) found in patients with nonsyndromic hearing loss (NSHL) and newborns in the Korean population.

Study Design The sequencing data for 147 unrelated patients with congenital NSHL and 100 audiologically screened newborns were included in this prospective study.

Methods Genomic DNA samples from all patients and newborns were sequenced in both directions for detection of Cx26 mutations.

Results Thirteen different types of mutations were found in the patients and newborns. V27I and E114G are the popular types of polymorphic mutations in both groups. 235delC—deletion and frameshift—was detected in patients (15 in 294 alleles) and newborns (1 in 200 alleles). 35delG was rarely found in both group. In addition to above mutations, several types of mutations—S85P, K41R, S72C, V84A, 176‐191del, and 299‐300del—were identified. The family study of the 235delC showed a typical autosomal recessive trait of NSHL in their audiological evaluation of hearing threshold.

Conclusion The frequency of 235delC allele showed much higher in the patients (5%) than in newborns (0.5%). We rarely found 35delC mutant in both groups. These results suggest that the different types of Cx26 mutations affect autosomal recessive NSHL according to ethnic background.
Correlation of Findings on Direct Laryngoscopy and Bronchoscopy With Presence of Extraesophageal Reflux Disease
Authors: Carr Michele M. , Nguyen Anthony , Poje Christopher , Pizzuto Michael , Nagy Mark , Brodsky Linda
Published: November 2003

Objective To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD).

Study Design Retrospective chart review

Methods Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy).

Results A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality.

Conclusion Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.
A Review of Facial Nerve Outcome in 100 Consecutive Cases of Acoustic Tumor Surgery
Authors: McElveen John T. , Belmonte Raymond G. , Fukushima Takanori , Bullard Dennis E.
Published: November 2003

Objective To determine the facial nerve outcomes at a tertiary neurotological referral center specializing in acoustic neuroma and skull base surgery.

Study Design Retrospective review of 100 consecutive patients in whom acoustic neuromas were removed using all of the standard surgical approaches.

Methods Functional facial nerve outcomes were independently assessed using the House‐Brackmann facial nerve grading system.

Results The tumors were categorized as small, medium, large, and giant. If one excludes the three patients with preoperative facial palsies, 100% of the small tumors, 98.6% of the medium tumors, 100% of the large tumors, and 71% of the giant tumors had facial nerve function grade I‐II/VI after surgery.

Conclusion Facial nerve results from alternative nonsurgical treatments must be compared with facial nerve outcomes from experienced surgical centers. Based on the facial nerve outcomes from our 100 consecutive patients, microsurgical resection remains the preferred treatment modality for acoustic tumors.
Vestibular Schwannoma Growth: The Continuing Controversy
Authors: Charabi Samih , Tos Mirko , Thomsen Jens , Charabi Birgitte , Mantoni Margit
Published: November 2003

Objective To investigate the growth of vestibular schwannoma (VS) in a series of 123 patients with 127 tumors allocated to the “wait and scan” group in the period 1973–1999.

Study Design Retrospective review of prospectively registered data on all patients with VSIÈ from the entire country who were allocated to the wait and scan group.

Method Clinical charts, audiometric data, and neuroradiological images were reviewed and tabulated for age, hearing level expressed as speech reception threshold (SRT) and speech discrimination score (SDS), maximum extracanalicular tumor extension, and possible changes in tumor diameter. The material was updated three times (in June 1993, June 1996, and June 1999). Via the Danish national register, data on whether the included patients were alive or dead were collected in 1999.

Results The tumor growth, growth rate, and growth patterns were calculated in three periods 1973 to 1993 (mean observation period, 3.4 y), 1973 to 1996 (mean observation period, 3.8 y), and from 1973 to 1999 (mean observation period, 4.2 y). By termination of the first period, 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth, and 10 tumors (8%) revealed negative growth. By the end of the extended observation period, tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%), and negative growth in 8 tumors (6%). Subsequent to the third observation period, growth was observed in 108 tumors (85%), no growth in 11 tumors (9%) and negative growth in 8 tumors (6%). However, the results may also be interpreted in another way: 52 patients (42%) were alive at the time of writing, tumor growth did not demand any intervention, 23 patients (19%) died as a result of non–tumor‐related causes, and 35 patients (28%) were previously treated and alive by the termination of the third observation period.

Conclusion Depending on the observation period, three sets of growth results were obtained. The long observation period, updating and re‐updating the results, gave us the opportunity for a de novo interpretation of the results and the long‐term consequences of the wait and scan policy. Combined with other factors, the achieved results should be considered when timing of surgery is to be decided.
Resection of Cancer of the Tongue Base and Tonsil via the Transhyoid Approach
Authors: Agrawal Amit , Wenig Barry L.
Published: November 2003

Objective To assess whether transhyoid resection of the tongue base and tonsil lesions is an effective approach to tumors involving this region compared with more traditional anterior surgical approaches that arbitrarily involve either segmental resection or division of the mandible.

Study Design Retrospective review.

Methods Since 1988, we have used a combined transhyoid and transoral approach to resect lesions involving the tongue base, tonsil, or both. Forty‐one patients were identified who underwent surgical resection of lesions involving this region via this combined approach during this period. A stage‐matched group of 41 patients was also identified in which patients underwent resection via traditional composite or mandibulotomy approaches and was used as a basis for comparison. Factors assessed included status of surgical margins, postoperative complications, degree of postoperative dysphagia, and long‐term outcome.

Results Comparison between the two groups revealed similar rates of negative surgical margins. Levels of postoperative dysphagia, notably severe primarily in patients with either T4 or recurrent disease, were also similar between groups. Complication rates, especially with regard to fistula occurrence and mandible‐healing problems, were significantly lower in the transhyoid group. Analysis of long‐term outcome revealed similar patterns with regard to disease status in both groups.

Conclusions The combined transhyoid and transoral approach is an effective surgical option for a number of lesions affecting the tongue base, tonsil, or both. Although similar to other approaches with regard to postoperative function and disease outcome, the transhyoid approach is associated with decreased postoperative morbidity. However, tumors that e‐tend to involve the mandible or pterygoid musculature or skull base are probably best suited for traditional approaches that involve division of the mandible.
Acetaminophen Versus Acetaminophen With Codeine After Pediatric Tonsillectomy
Authors: Moir Melinda S. , Bair Ellen , Shinnick Pam , Messner Anna
Published: November 2003

Objective To compare the effectiveness of acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy and adenoidectomy.

Study Design Prospective, randomized, double‐blind study.

Methods Fifty‐one children ages 3 to 12 years scheduled for outpatient tonsillectomy and adenoidectomy were studied. Patients were randomly assigned to receive acetaminophen or acetaminophen with codeine in unlabeled bottles for postoperative pain control. The Wong‐Baker FACES pain rating scale was used to help children quantify their level of pain after surgery. The level of pain, quantity of pain medication required, presence of side effects, and the percentage of a normal diet consumed was recorded for 10 postoperative days.

Results There was no difference (P > .05, all time points) in the level of postoperative pain reported by the parents and children in the two groups. The acetaminophen with codeine group tended to have increased problems with nausea, emesis, and constipation, but these differences did not reach statistical significance. Children in the acetaminophen group consumed a significantly higher percentage of a normal diet on the first 6 postoperative days (P < .05, all time points).

Conclusion There was no difference in the level of pain control provided by acetaminophen and acetaminophen with codeine as measured by the Wong‐Baker FACES pain rating scale. Postoperative oral intake was significantly higher in children treated with acetaminophen alone.
Embryological Development and Large Vestibular Aqueduct Syndrome
Authors: Mark Pyle G.
Published: November 2003

Objectives/Hypothesis Large vestibular aqueduct syndrome (LVAS) is a significant cause of hearing loss in early childhood. Many theories on the origins and causes of LVAS have been proposed, including arrest or maldevelopment of the vestibular labyrinth in embryonic life. Prior studies have described postnatal and adult vestibular aqueduct anatomy, but none has analyzed aqueduct growth throughout embryonic life. This study was undertaken to characterize the growth of the developing vestibular aqueduct to gain a better understanding of the possible origins of LVAS.

Study Design Basic science, temporal bone histopathological study.

Methods Serial sections from 48 temporal bones from human embryos ranging in age from 5 weeks' gestation to full term were studied with computer image analysis. Measurements of vestibular aqueduct internal and external aperture, midportion diameter, and length were analyzed to obtain a growth model of development.

Results The vestibular aqueduct grows in a nonlinear fashion throughout embryonic life. All parameters fit a similar growth curve and never reached a maximum or began narrowing during development. Growth in one parameter correlated well with growth of another. There was good side‐to‐side correlation with all but the external aperture.

Conclusions Most of the membranous labyrinth reaches adult size by 20 weeks' gestation, but the vestibular aqueduct grows throughout embryonic life. The measurements and growth model obtained in this study are not consistent with the theory that LVAS results from an arrest in development early in fetal life. The data suggest that LVAS may result from postnatal and early childhood maldevelopment.
Variables Affecting Treatment in Benign Paroxysmal Positional Vertigo
Authors: Macias John D. , Lambert Kim M. , Massingale Shelly , Ellensohn Andrea , Ann Fritz Jean
Published: November 2003

Objective To identify variables affecting outcome in patients with benign paro‐ysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers.

Study Design Retrospective review of patients at a tertiary vestibular rehabilitation center.

Methods Variables identified for statistical analysis included method of diagnosis, age, se‐, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson χ2, likelihood ratio, linear‐by‐linear association, and cross‐tabulation tests were performed.

Results Two hundred fifty‐nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow‐up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, se‐, method of diagnosis, and onset association with trauma had no statistically significant impact.

Conclusion Patients with benign paro‐ysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning.