bluuebunny/crossref_metadata_2025 huggingface dataset:
Torsional Strength of the Radius After Osteofasciocutaneous Free Flap Harvest with and Without Primary Bone Plating
Authors: Edmonds Joseph L. , Bowers Kevin W. , Toby E. Bruce , Jayaraman Gopal , Girod Douglas A.
Published: February 2003

The osteocutaneous radial forearm free flap (OCRFFF) has not gained widespread popularity in mandibular reconstruction, primarily because of concerns about pathologic fracture of the weakened radius. This study examines the effectiveness of plate fixation of the radius bone after harvest of the OCRFFF as a mechanism to minimize donor‐site morbidity and increase the usefulness of the OCRFFF. Matched pairs of fresh human cadaveric radius bones were used in this study. Two study groups were designed. The first group was used to define the amount of strength lost after a typical bone graft harvest. The second group was designed to demonstrate how much torsional strength was regained by the application of an orthopedic reconstruction plate. Statistically significant results were obtained for both groups. In group 1, the strength of the cut bones compared with that of the unaltered bones was significantly decreased by 82% (P = 0.016). In group 2, the cut bones reinforced with a plate were 75% stronger (P = 0.002) than the bones that were only cut. Although the radius bone is significantly weakened by the harvest of a graft, much of this strength can be regained with plate fixation of the radius. (Otolaryngol Head Neck Surg 2000; 123:400‐8.)
Allergy and Health‐Related Quality of Life
Authors: Derebery M. Jennifer , Berliner Karen I.
Published: February 2003

OBJECTIVE

We asked patients with allergies to complete the SF‐36 Health Survey, a health‐related quality‐of‐life (QOL) measure, to determine the impact of allergy on QOL.

STUDY DESIGN AND SETTING

In total, 377 adults—140 men (37%) and 237 women (63%)—seen in a tertiary care private neurotologic practice allergy clinic completed the questionnaire before beginning immunotherapy and dietary management. One hundred patients completed both initial and 1‐year follow‐up questionnaires. The SF‐36 measures 8 health concepts ranging from physical to mental health, and scale scores range from 0 to 100.

RESULTS

Initial mean scores ranged from a high of 79.1 for the physical functioning scale to a low of 47.2 for the vitality scale, lower (poorer) on all scales than norms for the general US population. Significant improvement occurred from initial to follow‐up on all scales. The largest improvements were in role functioning‐physical, role functioning‐emotional, and social functioning.

CONCLUSION

Findings suggest that allergy symptoms can affect QOL and that treatment with specific immunotherapy and/or dietary management may lead to measurable improvements.

SIGNIFICANCE

The significant impact of allergy must be recognized, and treatment should be offered. The SF‐36 can be used to evaluate treatment outcome.
Clinicoepidemiologic Features of Sudden Deafness Diagnosed and Treated at University Hospitals in Japan
Authors: Nakashima Tsutomu , Itoh Akihide , Misawa Hayato , Ohno Yoshiyuki
Published: February 2003

Nationwide epidemiologic surveys were done 3 times by the Research Committee of the Ministry of Health and Welfare in Japan to investigate the number of patients and clinical manifestations of idiopathic sudden sensorineural hearing loss (sudden deafness). The first, second, and third surveys were carried out during the 1970s, 1980s, and 1990s, respectively. For each patient, we have compiled data regarding age, sex, onset day, presence or absence of vertigo, and hearing ability, including initial and final audiograms, in a computer in the Nagoya University Computer Center. Regarding patients who visited university hospitals, complete data were collected for 421 subjects (age: 40.2 ± 15.4 years, female: 203, male: 218) between July 1973 and June 1974, for 813 subjects (age: 45.1 ± 15.4 years, female: 407, male: 406) in 1987, and for 1112 subjects (age: 49.1 ± 16.0 years, female: 591, male: 521) in 1993. The number of patients with sudden deafness treated in university hospitals in Japan has increased, especially in the elderly population. This increase is associated with population increase and age‐adjusted incidence rates per 100,000 in the elderly population. The initial and final hearing levels in the first survey were worse than those in the second and third surveys; there was no significant difference in hearing between the second and third surveys. The hearing levels were worse in children and elderly patients than in the other age groups.
Cochlear Implant Performance in Senior Citizens
Authors: Labadie Robert F. , Carrasco Vincent N. , Gilmer Carol H. , Pillsbury Harold C.
Published: February 2003

Cochlear implants are indicated for elderly patients with severe‐to‐profound hearing loss (sensorineural hearing loss ≥ 70 dB). Their use has been limited, possibly by the misconception that elderly patients will perform poorly. To document the performance of older adults (≥65 years old), we undertook a retrospective analysis of our postlingually deafened adult patients who underwent implantation with the CLARION Multi‐Strategy Cochlear Implant and underwent formal audiologic analysis (sentence recognition [Central Institute for the Deaf, CID] and monosyllabic word recognition [consonant‐noun‐consonant, CNC]). Both younger (n = 20; mean age = 46.9 years) and older (n = 16; mean age = 71.5 years) adults showed statistically significant increases in CID and CNC scores after cochlear implantation. No statistically significant difference could be detected in operative time, anesthesia time, length of hospitalization, or CID or CNC scores between the two age groups. We conclude that age should not be a criterion for deciding who should receive cochlear implants. (Otolaryngol Head Neck Surg 2000;123:419‐24.)
Obstructive Sleep Apnea Surgery: Patient Perspective and Polysomnographic Results
Authors: Li Kasey K. , Riley Robert W. , Powell Nelson B. , Gervacio Lindsay , Troell Robert J. , Guilleminault Christian
Published: February 2003

OBJECTIVE

The goal of this study was to assess the outcomes of obstructive sleep apnea (OSA) surgery based on the patient perspective and polysomnographic data.

STUDY DESIGN

Fifty‐six patients with severe OSA completed the 2‐phase reconstructive protocol. A minimum of 6 months after the phase II surgery and after the postoperative polysomnography, questionnaires with visual analog scales (VAS 0‐10) were mailed to the patients to assess their perceptions of treatment results.

RESULTS

Forty‐two (75%) questionnaires were returned. The mean patient age was 46.3 years. The mean respiratory disturbance index improved from 58.7 to 10.0. The mean lowest oxygen saturation improved from 76.3 to 87.3%. All 42 patients reported improved sleep (VAS 8.7). Although 10 patients reported changes in speech, the changes were insignificant, with 9 of the patients scoring 0 on the VAS (VAS 0.08 ± 0.3). Five patients reported changes in swallowing, and their VAS scores were 0.5, 0.9, 1.0, 2.7, and 6.9 (mean VAS 2.4 ± 2.7). Forty patients (95%) were satisfied with their results and would undergo the reconstruction again.

CONCLUSION

Surgical airway reconstruction for severe OSA is a highly effective treatment option base on the objective as well as the subjective assessment.
Complications of Foreign Bodies in the Esophagus
Authors: Seng Loh Kwok , Siang Tan Luke Kim , Smith James D. , Hian Yeoh Kian , Dong Fang
Published: February 2003

Major complications of foreign bodies in the esophagus carry significant morbidity and mortality risks. A retrospective case control study was performed to assess the factors associated with major complications. In total, 273 patients seen within a 7‐year period were divided into 2 groups; 253 had no or minor complications, and 20 had major complications. Age, sex, duration of the foreign body, total white cell count (TWC), and nature and site of the foreign body were analyzed in the 2 groups. The major complication rate was 7.3%. Duration of the foreign body and TWC were the only statistically significant factors associated with major complications. Six patients required open neck exploration, 1 had an open thoracotomy, and 13 were treated by endoscopic removal. There were 2 deaths. Given the significant morbidity and mortality risks, we conclude that patients with a prolonged history of a foreign body in the esophagus and a raised TWC should be treated urgently.
Head and Neck Squamous Cell Carcinoma: Measurement of Plasma Parathyroid Hormone‐Related Protein and Serum and Urine Calcium Concentrations
Authors: Sellers Rani S. , Schuller David E. , Sharma Pramod K. , Tannehill‐Gregg Sarah H. , Capen Charles C. , Rosol Thomas J.
Published: February 2003

OBJECTIVES

Parathyroid hormone‐related protein (PTHrP) is expressed by squamous cell carcinomas. Our first objective was to examine the stability of PTHrP in normal human plasma. Our second objective was to determine whether plasma PTHrP could be used in patients with head and neck squamous cell carcinoma (HNSCC) as an indicator of tumor burden or relapse.

STUDY DESIGN AND SETTING

Blood and urine samples from 55 HNSCC patients undergoing tumor resection at The Ohio State University were measured for plasma PTHrP (1‐86) concentration, serum ionized calcium concentration, and urine calcium/creatinine ratio.

RESULTS

Two of 55 HNSCC patients had detectable levels of plasma PTHrP. Serum ionized calcium concentrations and urinary calcium/creatinine ratios were within normal limits in all patients.

CONCLUSIONS

Plasma PTHrP was not a valuable indicator of tumor presence or recurrence in our patient population.

SIGNIFICANCE

Plasma PTHrP is not a useful marker of tumor presence or recurrence in patients with stage II to IV or recurrent HNSCC.
Do Adenoids Regrow After Excision?
Authors: Buchinsky Farrel J. , Lowry Morgan A. , Isaacson Glenn
Published: February 2003

OBJECTIVE

The goal was to determine the incidence of symptomatic adenoidal regrowth after adenoidectomy.

STUDY DESIGN

A cross‐sectional follow‐up study was done in a randomly selected group of 175 children who had undergone adenoidectomy 2 to 5 years earlier. Nasopharyngoscopy was performed in those children who still had symptoms of nasal obstruction.

SETTING

All surgery was performed at an academic hospital‐based practice in the northeastern United States by a single surgeon using a consistent operative technique.

RESULTS

Forty‐six (26%) patients had nasal airway obstruction symptoms at follow‐up. Of the 35 who agreed to undergo nasopharyngoscopy, not a single one had adenoids occupying more than 40% of the nasopharynx, and most (71%) were found to have either no or only trace amounts of adenoidal tissue (usually in the pharyngeal recess).

CONCLUSION

Adenoids rarely, if ever, regrow enough to cause symptoms of nasal obstruction after adenoidectomy that includes visualization and electrocautery of the adenoid bed.
Results of a humanitarian otologic and audiologic project performed outside of the United States: Lessons learned from the “Oye, Amigos!” project
Authors: Barrs David M. , Muller Stephen P. , Worrndell Donna Beth , Weidmann Eric W.
Published: February 2003

From 1989 to 1993, “Oye, Amigos!” a combined group of hearing health and other medical professionals performed 18 humanitarian medical and audiologic trips to Tepic, Nayarit, Mexico. The group saw 1500 patients, issued over 800 hearing aids, and performed 150 surgeries on 123 patients. Our tympanoplasty success rate, defined as an intact tympanic membrane, was 41% during the first 2 years of the project but increased to 74% during the last 3 years. Two hundred eighteen patients who were candidates for surgery did not return for care. We present the lessons learned from the surgical care and overall management of this project, and present suggestions to improve future projects.
Value of flow cytometry with fine needle aspiration biopsy in patients with head and neck lymphoma
Authors: Cannon C. Ron , Richardson Douglas
Published: February 2003

Lymphomas frequently present in the head and neck clinically as painless adenopathy or as a swelling of an extranodal site, such as salivary gland or Waldeyer's ring. Most non‐Hodgkin's lymphomas are B‐cell neoplasms with distinctive clonal proteins that can be readily detected using flow cytometric analysis. In our experience, flow cytometric analysis has been a useful, convenient adjunct in the diagnosis of head and neck non‐Hodgkin's lymphomas by fine needle aspiration biopsy.
Complications associated with labyrinthine fistula in surgery for chronic otitis media
Authors: Manolidis Spiros
Published: February 2003

OBJECTIVE:

Labyrinthine fistula (LF) is encountered during surgery for chronic otitis media (COM) with an average frequency of 7.5%. This study was undertaken to investigate the prevalence of coexisting complications with LF in surgery for COM.

STUDY DESIGN AND SETTING:

A retrospective review of 111 consecutive cases of COM surgery performed by the same surgeon in a large metropolitan teaching public hospital in the United States serving the inner city population.

RESULTS:

There were 23 (21%) LFs in 111 patients. The majority of cases were revision surgery with an average of 2.6 operations per patient. Other complications were encountered in 18 (78%) of the 23 patients with an LF: 5 (22%) encephaloceles, 9 (39%) dehiscences of the tegmen, 12 (52%) patients with facial nerve involvement by cholesteatoma, and 2 (8.7%) patients with facial nerve paralysis. These patients required extensive surgery for correction of their concurrent complications.

CONCLUSION:

Compared with those cases in which a fistula was not found, the ratio of the above complications were as follows: encephalocele, 1:9; facial nerve involvement by cholesteatoma, 1:11.3; facial nerve paralysis, 1:3.8.

SIGNIFICANCE:

Patients with neglected COM have an incidence of an LF twice that reported in the literature. The prevalence of associated complications with LF requiring extensive surgery is significantly higher than that observed in noncomplicated COM cases.
Nuclear morphometry for the prediction of regional lymph nodes metastases in patients with cancer of the larynx
Authors: Dobroś Wiesław , Gil Krzysztof , Ryś Janusz , Stanisz‐Wallis Krystyna
Published: February 2003

The changes in cell nuclei reflect their activity. Quantitative morphometric analyses of tumor nuclei could be instrumental in providing prognostic information. We studied whether, and if so, which specific nuclear parameters and histoclinical factors in patients with cancer of the larynx could be related to the lymph node metastases. Specimens were taken from 61 patients surgically treated in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The period between the onset of the first symptoms and the actual commencement of the treatment spanned no more than 9 months. The follow‐up period was no shorter than 5 years. Histologically confirmed metastases in the regional lymph nodes were found in 16 patients. The histologic grading and tumor front grading was pursued in all cases. Fourteen parameters of the nuclei were studied with the aid of a computer‐assisted system of image analysis. The morphometric parameters and the histoclinical factors were analyzed by the χ2 test and the step‐wise logistic regression. It was established that nuclear area ≥66 um (P = 0.042), perimeter ≥32 um (P = 0.087), optical density ≥22,500 (P = 0.027), long axis ≥10.15 um (P = 0.025), short axis ≥7.3 um (P = 0.003), TFG assessed (≥15 points) and tumor advancement (T3, T4) were related to more frequent metastases to the lymph nodes. The morphometric parameters of the greatest significance were short axis and optical density. The quantitative morpho‐metric analysis could prove a useful tool in predicting metastases to the lymph nodes.
Improvement in bone conduction threshold after tympanoplasty
Authors: Tüz Mustafa , Doğru Harun , Uygur Kemal , Gedjklj Orhan
Published: February 2003

OBJECTIVE:

To investigate the causes of bone conduction threshold impairment associated with middle ear pathoses and the factors influencing improvement in bone conduction threshold after tympanoplasty.

STUDY DESIGN AND SETTING:

The records of 98 consecutive patients with unilateral chronic otitis media who underwent tympanoplasty were reviewed. Pre‐operatively, 15 dB or more depression of bone conduction threshold at least in 2 frequencies between 500 and 6000 Hz was considered to be significant. Similarly in the postoperative period, 15 dB or more improvement of bone conduction threshold at least in 2 frequencies between 500 and 6000 Hz was regarded as significant.

RESULTS:

Twelve (12.5%) of 98 cases were found to have depressed bone conduction threshold; 6 of 12 cases had improved bone conduction threshold after tympanoplasty.

CONCLUSION:

In cases with cholesteatoma and extensive middle ear disease, successful results could be achieved after tympanoplasty disregarding the air‐bone gap and deteriorated bone conduction threshold.

SIGNIFICANCE:

Bone conduction threshold may improve after tympanoplasty.
Cochlear implantation in patients with compromised healing
Authors: Odabasi Onur , Mobley Steven Ross , Bolanos Rodrigo A. , Hodges Annelle , Balkany Thomas
Published: February 2003

BACKGROUND:

The indications for cochlear implantation (CI) are continually evolving and, as experience accumulates, the relative contraindications for CI continue to decrease. However, there is little information regarding CI in patients who may be considered to be at risk for poor wound healing due to immunosuppression or intercurrent disease.

OBJECTIVE:

To assess and report the complication rates, postoperative course, postimplant rehabilitation, and long‐term performance of patients considered at risk due to presumably impaired healing capability. We hypothesized that these patients had outcomes similar to other implanted patients.

METHODS:

This is a retrospective chart review of 277 patients who have received CI at the University of Miami Ear Institute between 1990 and 1999. The clinical courses of 6 patients on immunosuppressive medications and 7 patients with diseases believed to be associated with poor healing are reported.

RESULTS:

Long‐term follow‐up (mean, 33 months) showed postoperative complication rates, performance, and rehabilitation compliance that were similar to published reports of noncompromised patients.

CONCLUSION:

CI of selected patients with potentially reduced healing capabilities is safe and effective.
Increased retinal image velocity after vestibular lesion
Authors: Hirvonen Timo Petteri , Aalto Heikki , Pyykkö Ilmari , Juhola Martti
Published: February 2003

The vestibuloocular reflex stabilizes gaze during head movements by producing compensatory eye movements. Retinal image velocity (RIV) is defined as the difference between the eye and head velocities. The RIV of 20 vestibular schwannoma (VS) patients and 17 healthy controls was measured with a head autorotation test. The head autorotation test had a sensitivity of 80% and a specificity of 88%. The mean RIV (degree/second) ± 95% confidence intervals of the VS patients in the 5 frequency bands of 1 to 5 Hz was respectively 4.8 (4.2 to 5.5), 11.5 (8.6 to 14.4), 21.7 (15.5 to 27.9), 25.2 (17.1 to 33.4), and 26.1 (13.1 to 39.1). The RIV of the VS patients was asymmetrically larger on the operated side (P < 0.05) in the frequency band of 1 Hz. The mean RIV was significantly (P < 0.05) larger in the VS patients than in the controls in the frequency bands of 1 to 4 Hz. The vestibuloocular reflex is inaccurate after VS surgery; but the inaccuracy may not lead to the occurrence of any symptoms.
Use of Plain Radiography and Computed Tomography to Identify Fish Bone Foreign Bodies
Authors: Lue Allen J. , Fang W. Daniel , Manolidis Spiros
Published: February 2003

INTRODUCTION

Fish bones are the most common aerodigestive foreign bodies in adults. Radiographic studies, often ordered for diagnosis, have questionable utility.

METHODS

With a laryngoscope, bones from 10 fish species were placed in a variety of positions in a human head and neck cadaver specimen. Plain films and CT scans were obtained and evaluated by blinded readers.

RESULTS

Plain radiography exhibited a sensitivity and specificity of 39% and 72%. Cooking did not grossly change radio‐opacity. The species of fish affected visibility in soft tissue, without correlation to the characteristic optical density of each species. Bones placed orthogonal to the film in the vallecula were most readily identified. CT scanning correctly identified 9 of 10 bones.

CONCLUSIONS

Plain radiography poorly visualizes fish bone foreign bodies in soft tissue; visibility varied with fish species, location, and orientation. CT is the test of choice to radiographically diagnose fish bone impactions.
Efficacy of Evaluation of Audiometric Results After Stapes Surgery in Otosclerosis. II. A Method for Reporting Results from Individual Cases
Authors: De Bruijn Arthur J. G. , Tange Rinze A. , Dreschler Wouter A.
Published: February 2003

To standardize the reporting of hearing results after middle ear surgery, the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology‐Head and Neck Surgery proposed 2 levels of guidelines: level 1 for reporting summary data and level 2 for reporting raw data. The Committee encourages the reporting of raw data from each individual case. However, in studies in which the examined population is too large, this can yield difficulties. With respect to this point, we designed a method for a simple visual presentation of hearing results in an attempt to provide data from each individually operated ear in a patient group. In this method the relation between the preoperative and postoperative bone‐conduction levels is evaluated to assess overclosure and iatrogenic cochlear damage, and the relation between postoperative gain in air conduction and the preoperative airbone gap is evaluated as a measure of technical success rate. This results in 2 plots, which we called the Amsterdam Hearing Evaluation Plots. Audiometric data from 451 stapes operations were used to demonstrate the use of the Amsterdam Hearing Evaluation Plots. (Otolaryngol Head Neck Surg 2001; 124:84‐9.)
Identification of Internal Acoustic Canal in the Middle Cranial Fossa Approach: A Safe Technique
Authors: Cokkeser Yasar , Aristegui Miguel , Naguib Maged B. , Saleh Essam , Taibah Abdel K. , Sanna Mario
Published: February 2003

BACKGROUND

The middle cranial fossa approach (MCFA) is a very valuable functional approach in the armamentarium of the neuro‐otologic surgeon. Identification of the internal acoustic canal (IAC) in MCFA is one of the most tedious steps. Many techniques have been described to locate the IAC safely when using the MCFA.

OBJECTIVE

We sought to describe a safe technique for identification of the IAC and to demonstrate its feasibility in temporal bone dissections, as well as to discuss our clinical experience with this technique.

METHODS

The surgical anatomy of the 20 temporal bones were evaluated and measured, especially by defining the medial and lateral ends of the IAC and relations to the nearby located structures. Measurements were obtained at 3 levels: the width of the IAC at the level of the fundus, the width of the IAC at the level of the porus, and the safe distance around the IAC at the meatal level. The medial and lateral IAC end widths were compared with each other and with the safe area at the meatal level.

RESULTS

The smallest, the largest, and the mean values were recorded. The mean width of the IAC at the level of the porus was found to be more than 3‐fold that of the width of the IAC at the level of the Bill's bar, and the ratio between the width of the medial safe area around the IAC and the lateral end of the IAC was found to be more than 7‐fold as wide.

CONCLUSION

This technique offers direct quick exposure of the IAC, without handling the facial nerve and the inner ear structures. Forty‐five cases of operations with the same technique showed excellent ease and safety of identifying the IAC medially in the MCFA. (Otolaryngol Head Neck Surg 2001;124:94‐8.)
Creating a Stable Tympanic Membrane Perforation Using Mitomycin C
Authors: O'Reilly Robert C. , Goldman Steven A. , Widner Sheri A. , Cass Stephen P.
Published: February 2003

OBJECTIVE

To determine the ability of topically applied mitomycin C to create a stable tympanic membrane perforation.

STUDY DESIGN AND SETTING

Twenty‐four rats underwent subtotal removal of the tympanic membranes bilaterally. Forty ears received 0.2 mg/ml of mitomycin C. The remaining 8 received phosphatebuffered saline solution (control). Photographs taken every 3 to 5 days for 44 days were digitally scanned and computer analyzed to calculate the percentage of residual perforation. Application of solutions, photography, and data analysis were performed in a blinded fashion.

RESULTS

The mitomycin C treated ears had delayed closure time and healing rate (from day 0 to 25) compared to the control group. All controls healed by day 14. By day 44, 92.5% of the mitomycin C treated ears healed.

CONCLUSION

Mitomycin C prolongs the closure and healing rate of myringotomies in rat tympanic membranes.

SIGNIFICANCE

Myringotomy with concurrent mitomycin C application may be useful for creating an animal model for chronic tympanic membrane perforation and should be tested in human beings as a method to maintain myringotomy patency for long‐term ventilation. (Otolaryngol Head Neck Surg 2001;124:40‐5)
Factors Related to Nerve Injury and Hypocalcemia in Thyroid Gland Surgery
Authors: Prim M. P. , Diego J. I. DE , Hardisson D. , Madero R. , Gavilan J.
Published: February 2003

To identify potential risk factors related to complications after thyroidectomy, a study was designed that included 675 patients. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated. The rate of paralysis of the RLN was calculated on nerves at risk for hypocalcemia (n = 890) in patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Multivariate analysis was used to identify the relationships between the variables included in the study. All statistical tests received the same level of significance of 0.05. Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral paralysis of the RLN developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis had a significant relationship with preoperative diagnosis of malignancy (P < 0.03). Likewise, hypocalcemia was related to sex and surgical procedure (P < 0.03). Serohematoma was linked with age (P < 0.001), and hemorrhage was associated with previous radiation of the neck (P < 0.03). (Otolaryngol Head Neck Surg 2001; 124:111‐4.)
Continuous Intratympanic Infusion of Gentamicin Via a Microcatheter in Menière's Disease
Authors: Schoendorf Jakob , Neugebauer Peter , Michel Olaf
Published: February 2003

Between 1995 and 1998, 11 patients with disabling Menière's disease were treated at our institution with a continuous gentamicin infusion into the middle ear via a microcatheter. The patients had frequent attacks of vertigo and vomiting (functional levels 3‐5). Hearing threshold on the affected side was significantly worse than on the healthy side (stage 4+5). Gentamicin was applied by a high‐precision insulin pump with a flow rate of 40 mg per day directly in front of the round window. Application was stopped as soon as signs of vestibular affection appeared. A good overall control of vertiginous spells was achieved in 8 patients. Eight patients experienced complete hearing loss on the affected side, 1 experienced a slight worsening, and 1 had no hearing change. There was no correlation between the cumulative gentamicin dosage and the hearing loss. Our findings show that in terms of hearing loss and hospitalization time the continuous gentamicin application is inferior to other applications presented in the literature.
Role of Routine Panendoscopy in Cancer of the Upper Aerodigestive Tract
Authors: Stoeckli Sandro J. , Zimmermann Rahel , Schmid Stephan
Published: February 2003

Patients with squamous cell carcinoma of the aerodigestive tract routinely undergo panendoscopy to detect possible synchronous second primary tumors. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumors and to refine the role of panendoscopy. The charts of 358 patients evaluated by means of panendoscopy during work‐up of a first primary squamous cell carcinoma of the upper aerodigestive tract were reviewed. The incidence of a second primary tumor was 16.2%, with 6.4% being synchronous and 9.8% being metachronous. In only 3.1% of all patients, a synchronous tumor was clinically silent and only revealed by means of the panendoscopy. The synchronous tumors were mainly in the oral cavity, pharynx, or larynx (61%), whereas the metachronous tumors were most likely in the lung (57%). Despite the low incidence of synchronous second primary tumors, we still recommend panendoscopy for assessment of the primary tumor and as a training field for residents.
Altered MUC1 and MUC2 Glycoprotein Expression in Laryngeal Cancer
Authors: Jeannon Jean‐Pierre , Stafford Frank W. , Soames James V. , Wilson Janet A.
Published: February 2003

The purpose of this study was to determine whether mucin expression is altered in laryngeal cancer. MUC1 and MUC2 mucin expression was examined in biopsy specimens from 80 patients that comprised 23 laryngeal dysplasias, 36 laryngeal carcinomas, and 21 normal larynx control specimens. High MUC1 expression was found in all 3 groups (P = 0.689, Fisher exact test). However, significantly higher levels of MUC2 expression were detected in carcinomas compared with dysplasias and control specimens (P = 0.009, Fisher exact test). Altered MUC2 expression may be an important step in carcinogenesis in laryngeal cancer.
Salivary Flow Dynamics after Parotid Surgery: A Preliminary Report
Authors: Chaushu Gavriel , Dori Shay , Sela Ben‐Ami , Taicher Shlomo , Kronenberg Jona , Talmi Yoav P.
Published: February 2003

BACKGROUND

Tumors in the parotid gland may affect salivary flow. The effects of tumor on glandular function and postoperative changes in both resected gland and contralateral gland were not formerly reported. We prospectively evaluated salivary flow rates and composition in patients undergoing parotidectomy preoperatively and postoperatively.

METHOD

Stimulated parotid saliva from 17 patients undergoing parotidectomy was collected bilaterally preoperatively and postoperatively by using a parotid cup. Subjective complaints were recorded. Salivary flow rates, sodium, potassium, and amylase levels were evaluated.

RESULTS

None of the patients complained of “dry mouth” before or after surgery. Analysis of the individual results revealed 3 patterns of preoperative and postoperative response, compatible with either a preoperative or postoperative compensatory mechanism in the contralateral gland. The postoperative decrease in flow rate corresponds with the amount of gland removed. Salivary electrolyte composition was unchanged.

CONCLUSION

This study is the first to demonstrate the effects of parotid tumors and their surgery on salivary flow and a compensatory response and its different patterns in human parotid glands after their excision.
MUC4 (Sialomucin Complex) Expression in Salivary Gland Tumors and Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Authors: Weed Donald T. , Gomez‐Fernandez Carmen , Bonfante Esteban , Lee Thomas D. , Pacheco Jeffrey , Carvajal Maria E. , Goodwin W. Jarrard , Carraway Kermit L.
Published: February 2003

OBJECTIVES

This study investigates MUC4 expression in normal squamous epithelia and squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT), and in salivary gland neoplasms.

STUDY DESIGN

MUC4 antigens in tumor and adjacent normal tissue are localized by immunocytochemical studies. Fresh frozen tissues from surgical resection specimens are further analyzed by Western blot.

RESULTS

MUC4 is identified by immunocytochemical staining throughout the normal UADT mucosa, in 34 of 40 primary UADT SCC, and in 11 of 12 metastatic cervical lymph nodes. A trend toward decreased MUC4 staining in moderately and poorly differentiated tumors is noted. Immunoblots show MUC4 in 4 of 5 SCC analyzed. Immunocytochemical staining of MUC4 in 13 major and minor salivary gland neoplasms reveal variable staining of normal and neoplastic tissue. MUC4 is demonstrated in immunoblots of normal parotid tissue and in the single parotid malignancy analyzed, but is not demonstrated in one minor salivary gland malignancy. These findings characterize normal UADT mucosal and salivary MUC4 expression, and MUC4 expression in SCC of the UADT and in salivary gland tumors.

SIGNIFICANCE

Correlation of MUC4 expression with clinical outcomes may establish MUC4 as a potential molecular prognostic marker for these tumors.
Computed Tomography Imaging of the Maxillary and Ethmoid Sinuses in Children with Short‐duration Purulent Rhinorrhea
Authors: Schwartz Richard H. , Pitkaranta A. , Winther Birgit
Published: February 2003

INTRODUCTION

Adults with a common cold often have paranasal sinus effusions detected by computed tomographic (CT) scans. There are no comparable data for children. The purpose of this study was to document the sinus CT findings in children with short‐duration purulent rhinorrhea.

DESIGN

Thirty Children, 3 to 12 years of age (median age, 7 years), with purulent rhinorrhea for a mean duration of 5 days (and always less than 9 days) were enrolled in the study. The children were otherwise well. Institutional Review Board (IRB)‐approval was obtained before enrollment of the first patient. Informed written consent was obtained from each child's parent. CT imaging of the maxillary and ethmoid sinuses was obtained on the day of the initial visit (occasionally, the following day). Follow‐up CT scans were obtained from cooperative children/parents, 3 to 4 weeks later.

RESULTS

Opacification or an air/fluid level in the maxillary sinuses was seen in 27 (90%) of 30 study children at study entry. Ethmoid sinuses were not opacified without opacification of a maxillary sinus. Three weeks later, 24 of 27 study children, who had positive CT scans on study entry, improved clinically. Of 17 follow‐up CT scans, 10 (58%) normalized, 4 had improvement of bilateral disease, and 3 improved with unilateral disease. None appeared worse than baseline.

CONCLUSIONS

Pansinus opacification (ethmoid and maxillary sinuses), on CT scans in children with short‐duration purulent nasal drainage was seen in 70% of children. An additional 20% had isolated maxillary sinus effusions (10% had no effusion). Three‐week follow‐up CT scans on 17 children were normal in 60% and improved (partial clearance) in 40%. In this patient population, the decision to treat with antibiotics should be made on clinical grounds alone.
Small Doses of Propofol, Droperidol, and Metoclopramide for the Prevention of Postoperative Nausea and Vomiting After Thyroidectomy
Authors: Fujii Yoshitaka , Tanaka Hiroyoshi , Kobayashi Noriaki
Published: February 2003

OBJECTIVE

To evaluate the efficacy and safety of small doses of propofol, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting (PONV) after thyroidectomy.

STUDY DESIGN

Prospective, randomized, double‐blinded study.

SETTING

University‐affiliated teaching hospital.

METHODS

In a randomized, double‐blinded study, 90 patients (75 females) received propofol 0.5 mg/kg, droperidol 20 μg/kg, or metoclopramide 0.2 mg/kg intravenously (n = 30 in each group) at the end of surgery. A standardized general anesthetic technique was used.

RESULTS

The incidence of PONV during the first 24 hours after anesthesia was recorded in 13%, 47%, and 50% of patients who had received propofol, droperidol, and metoclopramide, respectively (P < 0.05; overall Fisher exact probability test). No clinically important adverse events were observed in any of the groups.

CONCLUSION

Small dose (0.5 mg/kg) of propofol is more effective than droperidol or metoclopramide for the prevention of PONV after thyroidectomy.
Hypertonic Saline Decreases Ciliary Movement in Human Nasal Epithelium in Vitro
Authors: Min Yang‐Gi , Lee Kang Soo , Yun Ja Bock , Rhee Chae‐Seo , Rhyoo Chan , Koh Young‐Yull , Yi Won Jin , Park Kwang‐Suk
Published: February 2003

Various saline solution formulae are frequently used in patients with rhinosinusitis. Osmolarity affects ciliary beat frequency (CBF); however, little is known about the effects of saline solutions on ciliary activity of nasal epithelial cells. The aim of this study was to assess whether CBF of normal turbinate mucosa is affected by hypertonic, isotonic, or hypotonic saline solution in vitro and whether histologic changes are associated with the alteration of ciliary movement. We assessed variations of CBF after exposure to 0.06%, 0.12%, 0.9%, 3.0%, or 7.0% saline solutions and histologic changes were examined by transmission electron microscopy. Isotonic and hypotonic solutions produced no ciliary slowing; however, ciliostasis was observed within a few minutes in 3.0% or 7.0% solution. The histologic changes demonstrated that the ciliary slowing might be attributed to epithelial damage by fluid transport toward the surrounding medium. In conclusion, hypertonic saline solutions decrease CBF and disrupt nasal epithelial cells in vitro.
Occult Lymph Node Metastases in Supraglottic Cancers of the Larynx
Authors: Esposito Erik D.A.V.E. , Motta Sergio , Cassiano Bernardino , Motta Giovanni
Published: February 2003

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).
Estrogen Metabolism as a Risk Factor for Head and Neck Cancer
Authors: Yoo Helen J. , Sepkovic Daniel W. , Bradlow H. Leon , Yu Guo Pei , Sirilian Henedia V. , Schantz Stimson P.
Published: February 2003

OBJECTIVE

Estrogen metabolites have been associated in the pathogenesis of breast and cervical cancer; 16α‐hydroxyestrone(16α‐OHE1) demonstrated proliferative effects whereas 2‐hydroxyestrone(2‐OHE1) had antiproliferative effects. Our study's objective is to demonstrate that head and neck (H&N) cancer patients metabolize estrogen differently than healthy controls, which may constitute a risk factor for H&N cancer development.

STUDY DESIGN

Urinary metabolite levels of 2‐OHE1 and 16α‐OHE1 from 50 H&N cancer patients and 50 age‐ and sex‐matched controls were measured using enzyme‐linked immunosorbent assay (ELISA). Absolute values and 2‐/16α‐OHE1 ratios were calculated. Conditional logistic regression for univariate and multivariate analysis with odds ratio (OR) and 95% confidence interval (Cl) were used.

RESULTS

Thirty percent (15 of 50) from the case group had a low 2‐/16α‐OHE1 ratio compared with only 4% (2 of 50) in the control group (OR = 11.1; 1.4‐91.5, 95% Cl) (P < 0.05). When adjusted for tobacco, OR remained significant at 15.6 (1.1212.5, 95% Cl) (P < 0.05).

CONCLUSION

H&N cancer patients are more likely to express abnormal estrogen metabolism than healthy controls; 2‐/16α‐OHE1 may serve as a potential biological marker of individuals at increased risk of H&N cancer.
Endoscopic Ligature of the Sphenopalatine Artery for Severe Posterior Epistaxis
Authors: Voegels Richard Louis , Thomé Daniela Curti , Iturralde Patsy Priscilla Vasquez , Butugan Ossamu
Published: February 2003

OBJECTIVE

To present our experience with endoscopic ligature of the sphenopalatine artery in the treatment of severe posterior epistaxis of patients who had previously undergone conservative procedures.

METHODS

Eleven patients with severe posterior epistaxis were treated during a 25‐month period with an endoscopic ligature of the sphenopalatine artery. The basic principle of the surgical technique is to identify the branches of the sphenopalatine artery through an endoscopic endonasal approach and to apply a titanium clip under direct vision.

RESULTS

The endoscopic ligature of the sphenopalatine artery was performed unilaterally in 10 patients and bilaterally in 1 patient, with a total of 12 ligatures. It was possible to identify the sphenopalatine artery in all cases with a successful outcome using this surgical technique alone.

CONCLUSION

Endonasal endoscopic ligature of the sphenopalatine artery has been an effective surgical technique for treating severe posterior epistaxis.
Analysis of Vocal Fold Vibration by X‐Ray Stroboscopy With Multiple Markers
Authors: Kusuyama Toshiyuki , Fukuda Hiroyuki , Shiotani Akihiro , Nakagawa Hideki , Kanzaki Jin
Published: February 2003

OBJECTIVE

To derive a more precise description of vocal fold vibration, experimental phonation of excised canine larynxes was studied.

STUDY DESIGN AND SETTING

Multiple X‐ray‐positive markers were inserted, and their vibratory movement was observed with x‐ray stroboscopy with change of pitch and intensity. A histologic study was also carried out.

RESULT

Regular waves were observed just above the lowest point of the lamina propria of the mucous membrane, which shifted upward at high pitch, but downward in high intensity.

CONCLUSIONS

The starting point of the mucosal wave was confirmed on the lower surface of the vocal fold, histologically just above the lowest point of the lamina propria of the mucous membrane and shifted upward at high pitch, but downward in high intensity.

SIGNIFICANCE

This is the first study investigating the starting point of mucosal wave in vocal fold vibration in a frontal plane using x‐ray stroboscopy, providing the evidence for the body‐cover theory.
Posterior petrous face meningiomas
Authors: Selesnick Samuel H. , Nguyen Teri D. , Gutin Philip H. , Lavyne Michael H.
Published: February 2003

OBJECTIVE

To define the clinical presentation, treatment options, and outcomes for a subset of meningiomas of the posterior fossa skull base that arise from the posterior petrous face between the region of the porus acousticus and the sigmoid sinus.

STUDY DESIGN AND SETTING

A retrospective chart review from a large skull base surgery practice at a tertiary care institution.

RESULTS

This cohort of patients presented with minimal symptoms, yet large tumors, averaging 3.8 cms and causing significant cerebellar compression. Retrosigmoid craniotomies afforded excellent exposure.

CONCLUSION AND SIGNIFICANCE

Patients with large tumors emanating from the posterior fossa aspect of the temporal bone should be evaluated on the basis of their site of origin. Patients with tumors emanating from the anterior or ventral portion of the temporal bone have greater symptoms and greater operative complications than those emanating from the posterior petrous face, between the porus acousticus and sigmoid sinus.
Acoustic Role of the Buttress and Posterior Incudal Ligament in Human Temporal Bones
Authors: Hato Naohito , Welsh Joseph T. , Goode Richard L. , Stenfelt Stefan
Published: February 2003

OBJECTIVES

In middle ear surgery using intact ear canal wall techniques, the buttress, which is the bony bridge at the medial end of the posterior‐superior bony ear canal, is commonly retained during posterior tympanotomy. In some cases, the surgical exposure may be improved by resectioning the buttress, and this requires sectioning the posterior incudal ligament. To date, the acoustic effects of removing the buttress with sectioning of the attached ligament have not been studied.

METHOD

Using a laser Doppler vibrometer system, 15 human cadaver temporal bones were measured with 80 dB sound pressure level at the tympanic membrane over the 0.1 to 10 kHz frequency range.

RESULT

The resection of the buttress and sectioning the posterior incudal ligament had no effect on stapes footplate velocity.

CONCLUSION

These results suggest that the posterior incudal ligament does not play a significant role in the acoustic function of the ossicles.
Action of histamine on eustachian tube function
Authors: Downs Brian W. , Butehorn Henry F. , Prazma Jiri , Rose Austin S. , Stamat Jocelyn C. , Pillsbury Harold C.
Published: February 2003

INTRODUCTION

The role of allergy in eustachian tube dysfunction is controversial. In this study, allergy was simulated by exposure to histamine, and eustachian tube function testing was performed in an experimental rat model.

METHODS

Ventilatory function was assessed by measuring passive opening and closing pressures of the eustachian tube after challenge with either transtympanic or intranasal histamine. The mucociliary clearance time of the tubotympanum was assessed by observing dye transport from the middle ear to the nasopharynx after challenge with either transtympanic histamine or control solution.

RESULTS

There was a statistically significant increase in passive opening and closing pressures with transtympanic histamine versus intranasal histamine. In addition, mucociliary clearance times of the tubotympanum after transtympanic histamine showed a statistically significant increase when compared with those after transtympanic control solution.

CONCLUSIONS

Transtympanic histamine exposure causes eustachian tube dysfunction in the rat by increasing passive opening and closing pressures of the eustachian tube and impairing mucociliary clearance time.