bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Arytenoid Repositioning for Unilateral Arytenoid Fixation
Authors: Amin Milan R. , Koufman James A.
Published: November 2003

Objectives To describe a new endoscopic technique for medialization of the laterally fixed arytenoid. The surgical technique, endoscopic arytenoid repositioning, is described, and the results of a series of cases are discussed.

Study Design Retrospective chart review.

Methods Eight patients underwent the procedure. Six patients were available for long‐term follow‐up. Preoperative and postoperative voice ratings were compared to evaluate the success of the procedure. Follow‐up ranged from 3 to 64 months (mean follow‐up, 31.5 mo).

Results Long‐term follow‐up in six cases revealed that 67% (4 of 6) patients had normal or near‐normal postoperative voices and one patient experienced moderate improvement. The mean preoperative voice score was 4.24, and the mean postoperative voice score was 1.83 (range, 1–5). The difference was statistically significant (P <0.001).

Conclusions Endoscopic arytenoid repositioning is a newly described procedure with a very specific indication: a unilateral, laterally fixed arytenoid complex resulting in a severely dysphonic voice. Though technically demanding, this procedure provides a promising option for medialization of the posterior glottis in a scarred larynx.
Recurrent Respiratory Papillomatosis
Authors: Derkay Craig S.
Published: November 2003

Recurrent respiratory papillomatosis (RRP) is the most common benign neoplasm of the larynx in children. Despite its benign histology, RRP has potentially morbid consequences and is often difficult to treat because of its tendency to recur and spread throughout the respiratory tract. Long neglected from an epidemiological standpoint, recent initiatives to better understand this disease process have been launched through coordination between the Centers for Disease Control and Prevention and the American Society of Pediatric Otolaryngology. In this clinical review, I discuss what we currently know regarding the etiology, epidemiology, and transmission of this disease. Clinical features including pertinent aspects of the history, physical examination, airway endoscopy, and other considerations are highlighted. A detailed description of the surgical and anesthetic management of these challenging cases is presented. Adjuvant modalities of surgical and nonsurgical treatment and their indications are discussed. Ongoing research initiatives and the Practice Guidelines of the Recurrent Respiratory Papillomatosis Task Force are also included.
Atypical Indications for OtoScan Laser‐Assisted Myringotomy
Authors: Bent John P. , April Max M. , Ward Robert F.
Published: November 2003

Objective To describe the role of OtoScan laser‐assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media.

Study Design Cross‐sectional review.

Methods Twenty‐seven office‐based OtoLAM procedures were performed in 21 patients for “atypical” reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1).

Results In each of the 20 cases available for follow‐up, middle ear disease resolved with closure of the laser‐assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction.

Conclusions Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.
Chronic Otitis Media Sequelae in Skeletal Material From Medieval Denmark
Authors: Qvist Morten , Grøntved Aksel M.
Published: November 2003

Objectives Chronic otitis media sequelae (COMS) have been identified in archaeological skeletal materials from various ages. COMS reflecting episodes of upper respiratory tract infection may be used as a paleopathological indicator of general health. Estimation of the frequency of COMS may be useful in the gross evaluation of general standard of living.

Materials and Methods Temporal bones and auditory ossicles from 659 individuals from two Danish medieval rural parish cemeteries, dated to 1050–1200 and 1150–1350, respectively, were examined otomicroscopically.

Results Osseous fistulae from mastoid abscesses, remodelling of the hypotympanon, and erosion of the incus were among the convincing indications of COMS. A minimum frequency of COMS of 1% to 7 % was found. The youngest material displayed the highest frequency of pathological changes.

Conclusion Indications of a rising incidence of infectious middle ear disease in early medieval Denmark were found. This may reflect a deterioration of living conditions from the 11th through the 14th centuries.
Complications Associated With the Sistrunk Procedure
Authors: Maddalozzo John , Venkatesan T. K. , Gupta Pankaj
Published: November 2003

Objective To assess the type and rate of complications in the postoperative period of pediatric patients undergoing the Sistrunk procedure.

Study Design A retrospective review of patients with a diagnosis of thyroglossal duct cyst who had not had corrective surgery previously. An attempt to standardize the study was made as follows: all patients had surgery under the direction of one surgeon, using the Sistrunk procedure with minor modifications from its original description. Complications were divided into major and minor categories.

Methods Charts were reviewed for age, se‐, preoperative assessment, and postoperative follow‐up. Complications were recorded. A postoperative telephone survey was conducted.

Results A minor complication rate of 29% was observed. There were no recurrences or major complications.

Conclusions The Sistrunk procedure remains the operation of choice for removal of the thyroglossal duct cyst. When the surgery is properly performed, with attention to key surgical landmarks, the risk of major complication is minimal. Complications that do occur are minor and wound related.
Modern Concepts of Frontal Sinus Surgery
Authors: Weber Rainer , Draf Wolfgang , Kratzsch Barbara , Hosemann Werner , Schaefer Steven D.
Published: November 2003

Objectives/Hypothesis To validate the endonasal surgical approach to frontal sinus in inflammatory sinus disease, trauma, and selective tumor surgery, and to define the role of external approaches to the frontal sinus. Endonasal frontal sinusotomy can range from endoscopic removal of obstructing frontal recess cells or uncinate process to the more complex unilateral or bilateral removal of the frontal sinus floor as described in the Draf II–III drainage procedures. In contrast, the osteoplastic frontal sinusotomy remains the “gold standard” for external approaches to frontal sinus disease.

Methods A retrospective review of 1286 patients undergoing either endonasal or external frontal sinusotomy by the authors at four university teaching programs from 1977. Prior author reports were updated and previously unreported patient series were combined.

Results Six hundred thirty‐five patients underwent type I frontal sinusotomy, 312 type II sinusotomy, and 156 type III sinusotomy. A successful result was seen in these groups, 85.2% to 99.3%, 79% to 93.3%, and 91.5% to 95%, respectively. External frontal sinusotomy or osteoplastic frontal sinusotomy was successfully performed in 187 of 194 patients. Clinical symptoms, endoscopic findings, computed tomography, and magnetic resonance image scanning, and reoperation rate measured postoperative success.

Conclusions A stepwise approach to the surgical treatment of frontal sinusitis, trauma, and selective benign tumors yields successful results as defined by specific criteria which vary from 79% to 97.8%. The details of specific techniques are discussed, essential points emphasized, and author variations noted.
Argon Plasma Surgery for the Inferior Turbinate of Patients With Perennial Nasal Allergy
Authors: Fukazawa Keijiro , Ogasawara Hiroshi , Tomofuji Seiichi , Fujii Megumi , Sakagami Masafumi
Published: November 2003

Objectives Argon plasma coagulation (APC) is a new electrosurgical modality. The advantages of APC are coagulating of the target tissue without contact and the creation of uniformly deep devitalized and coagulated zones. The objectives of the present study were to determine the clinical effects of APC for the inferior turbinate of patients with nasal allergy and to clarify the histological changes in the mucosa after APC.

Study Design In a prospective study, 95 patients with perennial nasal allergy were treated with APC. Nasal symptoms and intranasal findings were evaluated preoperatively and 1, 3, and 6 months, and 1 year after the APC. Mucosal specimens from the turbinates were examined under light and electron microscopy.

Results Nasal stuffiness was improved in 77 of 79 (97.5%) patients after 1 month, in 50 of 51 (98.0%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 9 of 12 (75.0%) patients at 1 year after the APC. Rhinorrhea was improved in 46 of 75 (61.3%) patients after 1 month, in 40 of 51 (78.4%) patients after 3 months, in 16 of 21 (76.2%) patients after 6 months, and in 6 of 10 (60.0%) patients at 1 year after the APC. The sneezing was improved in 32 of 54 (59.3%) patients after 1 month, in 21 of 35 (60.0%) patients after 3 months, in 10 of 14 (71.4%) patients after 6 months, and in 6 of 8 (75.0%) patients at 1 year after the APC. In the intranasal findings, congestion of the inferior turbinate improved in 75 of 76 (98.7%) patients after 1 month, in 49 of 52 (94.2%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 7 of 11 (63.6%) patients at 1 year after the APC. The nasal discharge was reduced in 40 of 75 (53.3%) patients after 1 month, in 32 of 52 (61.5%) patients after 3 months, in 15 of 22 (68.2%) patients after 6 months, and in 5 of 11 (45.5%) patients at 1 year after the APC. No patients needed nasal packing after the APC.

Conclusions This is the first report on the clinical effects of turbinate surgery for nasal allergy using APC. APC was useful for turbinate surgery of nasal allergy, especially for nasal stuffiness and congestion of the turbinate.
Evaluation of the Effect of Passive Smoking on Otitis Media in Children by an Objective Method: Urinary Cotinine Analysis
Authors: Ilicali Ömer Cenker , Keleş Nesil , Dèger Kemal , Sàgun Ömer Faik , Güldíken Yahya
Published: November 2003

Objectives We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis.

Study Design We designed a prospective case‐control study with follow‐up of the case group for 1 year after insertion of tympanostomy tubes to evaluate postoperative complications such as otorrhea and early e‐trusion (<6 months), in case a significant risk factor was found.

Methods One hundred fourteen children between 3 and 8 years of age requiring tympanostomy tubes because of OME and ROM were chosen and compared with 40 age‐matched children. E‐posure to environmental tobacco smoke was assessed by cotinine urinalysis, which was performed by means of the radioimmunoassay method.

Results In this study, 73.7% (84 of 114) of the children in the case group and 55.0% (22 of 40) of the children in the control group were found to be “e‐posed” (P = .0461). This difference was statistically significant. Comparing the cotinine urinalysis results with parental smoking histories, 23.1% (9 of 39) of the children without parental smoking histories were “exposed” to tobacco smoke versus 84.3% (97 of 115) of the children with parental smoking histories (at least one person smoking).

Conclusions Our results indicate that sidestream smoking increases the risk of OME and ROM. Legal regulations and guidelines must be established to protect children from passive smoking. Because cotinine urinalysis is a noninvasive and reliable method for the determination of passive smoking, it can be used for that purpose.
Free Radical Production by Antibiotic‐Killed Bacteria in the Guinea Pig Middle Ear
Authors: Takoudes Thomas G. , Haddad Joseph
Published: November 2003

Objectives Oxygen free radicals are implicated in the pathogenesis of otitis media. Recent investigations with animal models have demonstrated that free radical–mediated damage of the middle ear mucosa, measured as lipid hydroperoxide, occurs when the middle ear cavity is inoculated with Streptococcus pneumoniae. The present study was conducted to examine the effect of antibiotics on free radical–mediated damage in pneumococcal acute otitis media.

Study Design Animal model of acute otitis media.

Methods Seventy‐eight guinea pigs underwent bilateral middle ear inoculation with 100 μl of 1) sterile saline as a control, 2) 50 μg/mL amoxicillin, 3) 107 colony forming units (CFU)/mL Streptococcus pneumoniae killed with 50 μg/mL amoxicillin, or 4) 107 CFU/mL S pneumoniae. Animals were killed on postoperative day 1 or 5, and the middle ear mucosa was examined for lipid peroxidation as evidence of free radical damage.

Results Mucosal lipid hydroperoxide was significantly elevated compared with control subjects on day 1 in both the antibiotic‐killed S pneumoniae group and the S pneumoniae–infected group. On day 5, the S pneumoniae–infected mucosa had significantly higher lipid hydroperoxide levels compared with the antibiotic‐killed group and the control subjects. Histological studies confirmed mucosal edema and the presence of inflammatory cells in the infected groups.

Conclusions Antibiotic‐killed bacteria seem to produce free radical–mediated damage to the middle ear mucosa in the early phase of acute otitis media. The clinical implication of this study is that free radical damage to the middle ear mucosa may occur in otitis media despite appropriate antibiotic therapy.
Ionomeric Cement in the Human Middle Ear Cavity: Long‐Term Results of 23 Cases
Authors: Kupperman David , Tange Rinze A.
Published: November 2003

Objectives The long‐term results of the implantation of glass ionomer cement in the human mastoid and middle ear were studied.

Study Design A prospective study of the survival of bone cement in the middle ear.

Methods Ionocem (Ionos, Medizinische Produkte Gmbh & Co., Seefeld/Obb, Germany), a two‐compound bone material that forms a stable, waterproof junction with bone, was implanted in 23 middle ears of 23 patients (13 male and 10 female patients). Closure of the dehiscence of the tegmen was performed in 7 cases, obliteration of the mastoid cavity in 10 cases, and ossicular chain reconstruction in 6 cases.

Results The follow‐up period was 5.1 years. Complications attributable to operation were not seen, but adverse tissue reaction with severe middle ear infection and abundant otorrhea occurred in six cases after 12 months, requiring repeat operation. In three more cases, a spontaneous extrusion of the bone cement was seen after 4 years. The bone cement was totally extruded in nine cases. The mean survival time was 28 months.

Conclusions The use of Ionocem for obliteration of the mastoid cavity or for the closure of dehiscence of the tegmen has a high risk of extrusion. Therefore, it is not the first‐choice material to use for obliteration or tegmen defect closure in the middle ear.
Optic Nerve Decompression in the Comatose and Conscious Patients After Trauma
Authors: Lübben Björn , Stoll Wolfgang , Grenzebach Ulrike
Published: November 2003

Objective To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy.

Study Design Retrospective analysis of 65 optic nerve decompressions.

Methods The total collective of optic nerve decompressions comprised 65 patients treated within the period between February 1987 and December 1998. Thirteen of these 65 patients (average age, 32 y) were comatose and required critical care treatment, so visual acuity could not be measured. The indication for surgical decompression in all patients was based on the ophthalmological examination and the finding on computed tomography (CT) scan of a lesion inside the optic nerve canal or the orbit apex, respectively.

Results In the comatose patients the time interval between trauma and surgery was 16.1 ± 12.1 hours (mean ± standard deviation). During the subsequent postoperative examinations (on average, 12.3 mo postoperatively) five patients showed a normal visual acuity (20/20), two patients a visual acuity of 20/30 and 20/50, and one a visual acuity of 20/200. Three patients (three eyes) remained amaurotic. Two patients died of the general and severe consequences of injury. The beneficial visual acuity results achieved within the group of comatose patients were equivalent to those achieved within the group of patients who were conscious during the preoperative examination. The success rate, defined as an improvement of three lines with a final visual acuity of at least 20/1000, was 57.7% versus 61.5%.

Conclusion The results confirm our concept of early decompression of the optic nerve, based on close interdisciplinary cooperation and the ophthalmological findings.
Early Oral Feeding Following Total Laryngectomy
Authors: Medina Jesus E. , Khafif Avi
Published: November 2003

Objectives The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy.

Study Design Two‐part study includes, first, a sequential study and, second, a prospective analysis of our practice.

Methods Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery.

Results In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days.

Conclusion Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice.
Validation of a Patient‐Graded Instrument for Facial Nerve Paralysis: The FaCE Scale
Authors: Kahn Jeffrey B. , Gliklich Richard E. , Boyev K. Paul , Stewart Michael G. , Metson Ralph B. , McKenna Michael J.
Published: November 2003

Objective To develop and validate a patient‐based instrument to measure both facial impairment and disability, the Facial Clinimetric Evaluation (FaCE) Scale.

Study Design Prospective instrument validation.

Methods Eighty‐six patients with a documented history of facial paralysis completed a preliminary, 51‐item instrument (alpha FaCE Scale), as well as the previously developed Facial Disability Index (FDI) and the Medical Outcomes Study Short Form 36 Item Questionnaire (SF‐36). Two weeks after completing these instruments, 76 patients again completed the alpha FaCE Scale. Forty‐one of the patients were also evaluated using the House‐Brackmann Grading System (HBGS) and the Facial Grading System (FGS).

Results Exploratory principal component factor analysis grouped 15 FaCE Scale items into 6 impairment and disability categories (domains), forming the beta FaCE Scale. Overall, the test‐retest reliability of the FaCE Scale was high (Spearman's correlation coefficient (r) = 0.88, P <.01), as were the reliability coefficients of the individual domains (r = 0.81–0.92, P <.01). The FaCE Scale domains showed appropriate correlation to global visual analogue scale questions posed on the original alpha FaCE Scale (r = 0.65–0.81, P <.01). Overall, the FaCE Scale showed significant correlation with HBGS and FGS scores (r = −0.55 and 0.57, respectively;P <.01). However, not all FaCE Scale domains correlated with the HBGS and FGS scores.

Conclusions A reliable and valid patient‐based system to measure impairment and disability in facial paralysis has been developed. This system appears to be better than traditional, physician‐graded scales for evaluating quality‐of‐life issues affected by facial disability.
Olfaction and Its Alteration by Nasal Obstruction, Rhinitis, and Rhinosinusitis
Authors: Doty Richard L. , Mishra Anupam
Published: November 2003

The sense of smell has been largely ignored by otorhinolaryngologists, even though 1) its medical stewardship falls within their specialty's purview, 2) olfactory dysfunction is not uncommon in the general population, and 3) disorders of olfaction have significant quality of life, nutritional, and safety consequences. This report provides a succinct overview of the major intranasal neural systems present in humans (namely, cranial nerves O, I, and V, and the nonfunctional accessory [vomeronasal] organ system), along with a summary of notable findings resulting from the application of modern olfactory tests to patient populations, emphasizing diseases of the nose. Such tests have led to the discovery of significant influences of age, gender, smoking, toxic exposure, and genetics on the ability to smell. Within the field of otorhinolaryngology, they have revealed that 1) surgical and medical interventions in patients with rhinosinusitis do not, on average, lead to complete recovery of olfactory function, despite common beliefs to the contrary, and 2) associations are generally lacking between measures of airway patency and olfactory function in such cases. These findings have thrown into question the dogma that olfactory loss in rhinosinusitis is attributable primarily to blockage of airflow to the receptors and have led to histopathological studies demonstrating significant olfactory epithelial compromise in sinonasal syndromes.
Giant Ethmoid Osteoma With Orbital Extension, a Nasoendoscopic Approach Using an Intranasal Drill
Authors: Huang Hung‐Meng , Liu Chia‐Ming , Lin Kai‐Nan , Chen Hann‐Tsong
Published: November 2003

Objective Ethmoid osteoma is a slow‐growing, benign, and encapsulated bony tumor. Symptoms occur earlier than with osteomas of the frontal sinus because of the small volume of the ethmoid sinus. Interestingly, orbital extension is uncommon. Treatment remains controversial, with open procedures typically being used. In this article, we present a less invasive yet safe and effective approach to treatment.

Study Design A nasoendoscopic approach using a Stammberger‐Saches intranasal drill was developed for treatment of patients with ethmoid osteoma, with or without orbital extension. Between 1995 to 1999, seven patients underwent the new surgical procedure.

Methods All procedures were performed under general anesthesia. Using 0° and 30° endoscopes, surface anesthesia of the nasal mucosa was performed, the anterior ethmoid cell was resected, and the whitish osteoma found. The osteoma was drilled out inferolaterally to superomedially. In the patient with orbital extension, a double‐ended blunt elevator was used to separate the remaining osteoma from the lamina papyracea and to push the residual osteoma medially toward the nasal septum. With alternate drilling and elevation, the osteoma was gently removed. The surgical site was then packed.

Results The method successfully treated all patients. There were no major complications. The single patient with orbital extension had mild postoperative periorbital ecchymoses. Nasoendoscopy showed normal epithelialization 4 to 6 weeks after surgery. Computed tomography showed no residual tumors 6 months after surgery.

Conclusion The 30° nasoendoscopic approach using an intranasal drill provides a good operative field and is a safe and effective technique, with the potential to become the treatment of choice in selected cases.
Autologous Transplantation of Fascia Into the Vocal Fold: Long‐Term Results of a New Phonosurgical Technique for Glottal Incompetence
Authors: Tsunoda Koichi , Baer Thomas , Niimi Seiji
Published: November 2003

Objectives To study the long‐term results of autologous transplantation of fascia into the vocal fold, and to evaluate our use of autologous transplantation instead of bovine collagen injection in cases of glottal incompetence.

Study Design Retrospective study of the patients who have undergone autologous fascia transplantation using our new technique.

Methods Follow‐up studies were performed for at least 1 year (up to 3 y) on 9 autologous fascia transplant patients (6 cases with type 1 procedures and 3 cases with type 2 procedures). Clinical observations, including laryngeal stroboscopy, and measurement of maximum phonation time (MPT) were carried out.

Results During 3 months after autologous fascia transplantation, MPT gradually increased and stroboscopy showed improved glottal closure. These improvements continued beyond 1 year in all cases of type 1 surgery and 2 of 3 cases of type 2 surgery.

Conclusions Autologous transplantation of fascia into the vocal folds as a phonosurgical treatment for glottal incompetence yields excellent long‐term results. Temporal fascia appears to be a highly suitable tissue for transplantation in Reinke's space. However, the fascia is less suitable for transplantation in the muscle. We speculate that transplantation of temporal fascia leads to regeneration of vocal fold tissue, perhaps using a mechanism similar to stem cell transplantation in other organs.
Progressive Sensorineural Hearing Loss in Children With Mitochondrial Encephalomyopathies
Authors: Zwirner Petra , Wilichowski Ekkehard
Published: November 2003

Objective Mitochondrial disorders are responsible for a variety of neurological syndromes. Specific mitochondrial DNA mutations have been identified recently in some of these rare disorders. Clinical symptoms may occur in different organs to various extent; often they are associated with progressive hearing loss. The aims of this study were to determine incidence, onset, and characteristics of hearing loss in children with mitochondrial encephalomyopathies and to investigate a possible correlation between the degree of hearing loss and neurological symptoms. In addition, we investigated the prognostic value of hearing loss as a predictor of the disease.

Study Design From August 1992 to September 1998, 29 patients ranging in age from 5 to 23 years (mean years) were studied. These children were hospitalized for diagnostic purposes in the neuropediatric department.

Methods The mitochondrial disorder was diagnosed by clinical and laboratory testings, including analysis of the mtDNA. Audiological evaluation consisted of measurements of pure‐tone and speech audiometry, tympanometry, and acoustic refle‐ threshold testing, auditory brainstem response, and evoked as well as distortion‐product otoacoustic emissions.

Results A sensorineural hearing loss was identified in 12 children. Three of these were diagnosed as having classic Kearns‐Sayre syndrome; five as having multisystem KSS; two as having the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes (MELAS); one as having KSS‐MELAS overlap syndrome; and one as having Friedreich ataxia. Longitudinal testing was performed in seven children, and in all of them a progression of the hearing loss could be demonstrated. Audiological test results in all 12 children suggested cochlear as well as retrocochlear origin of the hearing loss presenting independently from the severity of hearing impairment. No correlation between the characteristics and degrees of hearing loss and the number and severity of clinical neurological symptoms could be found.

Conclusions The present study demonstrated a high incidence (42%) of sensorineural hearing loss in children with mitochondrial encephalomyopathies. The progressive nature of the hearing impairment was confirmed by a significant correlation between the duration in years and severity of hearing loss in the children. The hearing loss does not have a prognostic value for the progression of the disorder. Based on our findings, we recommend regular audiometric examinations in patients with mitochondrial disorders.
A Prospective Comparison of Scalpel Versus Bipolar Scissors in the Elevation of Radial Forearm Fasciocutaneous Free Flaps
Authors: Wax Mark K. , Winslow Catherine , Desyatnikova Stella , Andersen Peter E. , Cohen James I.
Published: November 2003

Objectives/Hypothesis The radial forearm fasciocutaneous free flap has become the workhorse for reconstruction of head and neck ablative defects. A location distal to the head and neck allows this flap to be elevated concurrent with the ablation. Most commonly, the flap is elevated under tourniquet control. This involves a primary ischemic insult with a certain amount of hemorrhage after the tourniquet is released. Bipolar scissors are a new method of dissection. They may allow for a speedier dissection with a concomitant decrease in ischemic time. Their hemostatic properties may control hemorrhage after use of the tourniquet.

Study Design A prospective study of patients undergoing radial forearm free flaps over a 12‐month period at a tertiary care referral center was undertaken.

Results Forty patients were entered into the study, flaps were elevated with scalpel (20) and with bipolar scissors (20). Mean time under tourniquet was 39 minutes (range, 30–56 min) with scalpel compared with 27 minutes (range, 21–31 min) with bipolar scissors (P <.001). Total mean time of elevation (including control of hemostasis and pedicle dissection) for scalpel elevation was 50 minutes (range, 35–61 min) compared with 32 minutes (range, 20–41 min) for bipolar scissors elevation (P <.001). Mean blood loss was 46 mL (range, 15–110 mL) in the scalpel elevation group compared with 14 mL (range, 0–50 mL) in the bipolar scissors elevation group (P <.001). Complications at the donor site were equal between groups.

Conclusions Bipolar scissors are a safe, efficient method for elevating radial forearm free flaps.
Surgical Anatomy of the Nasofrontal Duct: Anatomical and Computed Tomographic Analysis
Authors: Kim Kyung Su , Kim Hyun Ung , Chung In Hyuk , Lee Jeung Gweon , Park In Yong , Yoon Joo‐Heon
Published: November 2003

Objectives Although complete anatomical knowledge of the nasofrontal duct has been of great importance, little is known about it. The aim of this study is to examine the drainage site of the nasofrontal duct and to investigate the anatomical boundaries of the nasofrontal duct according to the drainage site.

Study Design One hundred sagittally divided adult head specimens were analyzed by computed tomography and dissection under the surgical microscope.

Methods Computed tomography scans of 50 adult cadaver heads were taken sagittally at 1‐mm intervals and coronally at 3‐mm intervals to find the nasofrontal duct. One hundred specimens, made up of sagittally divided adult cadaver heads, were dissected under the microscope to study the structure of the nasofrontal duct.

Results We identified the anterior, posterior, medial, and lateral boundaries of the nasofrontal duct. In the most common type, the superior portion of the uncinate process formed the anterior border and the superior portion of the bulla ethmoidalis formed the posterior border of the nasofrontal duct. The conchal plate formed the medial border and the suprainfundibular plate formed the lateral border of the nasofrontal duct. Other variations are described in detail.

Conclusions To widen the nasofrontal communication, removing the upper portion of the ground lamella of the ethmoid bulla, which is the posterior boundary of the nasofrontal duct, with cutting forceps seems to be a safe and easy method.
A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part I: At Diagnosis
Authors: Hammerlid Eva , Bjordal Kristin , Ahlner‐Elmqvist Marianne , Boysen Morten , Evensen Jan F. , Biörklund Anders , Jannert Magnus , Kaasa Stein , Sullivan Marianne , Westin Thomas
Published: November 2003

Purpose A Swedish and Norwegian study was designed to examine health‐related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II). This article presents the results at diagnosis.

Method Patients with head and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate. They were asked to answer the EORTC QLQ‐C30 and QLQ‐H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during 1 year. A total of 357 patients (mean age, 63 y; 72% males) were included.

Results Patients with different tumor locations all had their special problems at diagnosis, for example, those with tumors in the larynx with communication, those with oral tumors with pain, and those with pharyngeal tumors with nutrition and pain. The patients with hypopharyngeal cancer reported the worst HQL. Stage appeared to have the strongest impact on HQL. Patients with a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social functioning than patients <65 years but worse for physical functioning and various symptoms. The traditional way of grouping the tumor locations into oral, pharyngeal, laryngeal, and “other” tumors (salivary gland, sinus and nose, and unknown primary) was tested from a HQL point of view and found to be consistent.

Conclusions The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the most powerful impact on HQL score.
Pseudotumor of Infancy and Congenital Muscular Torticollis: 170 Cases
Authors: Wei Julie L. , Schwartz Kara M. , Weaver Amy L. , Orvidas Laura J.
Published: November 2003

Objectives To review pseudotumor of infancy (POI) and congenital muscular torticollis (CMT) and to suggest an algorithm for treatment.

Study Design Retrospective review of cases from 1962 to 1998 at a tertiary care center.

Methods Patients included in this study were 81 boys and 89 girls who had a diagnosis of POI (n = 38) or CMT (n = 132) before 24 months of age.

Results For all patients, the mean age at diagnosis was 4 months; 54.1% had the left side of the neck affected, over 90% had a head tilt, and 2.4% had feeding difficulty as a result of the disorder. Plagiocephaly was present in 39.5% of patients with POI and 63.6% of patients with CMT; a neck mass, in 63.2% and 18.2%, respectively; and facial asymmetry, in 7.9% and 15.9%, respectively. All patients had a complete physical examination; 54.1% had plain cervical radiography, 4.1%, computed tomography, and 2.9%, ultrasonography. Passive range of motion was the initial treatment recommended for 65.3% of patients. Conservative treatment failed for 16 patients; subsequently, they had surgical treatment. Follow‐up data were available for 159 patients; 85.5% experienced total resolution and 14.5% experienced subtotal resolution or long‐term abnormality.

Conclusions Children diagnosed with POI or CMT should be treated and observed for at least 12 months or until symptoms resolve. If symptoms persist 1 year after diagnosis despite conservative therapy, surgical treatment should be considered. The majority of children with POI or CMT experience total resolution of symptoms.
Western Blot Analysis for Diagnosis of Lyme Disease in Acute Facial Palsy
Authors: Furuta Yasushi , Kawabata Hiroki , Ohtani Fumio , Watanabe Haruo
Published: November 2003

Background Lyme borreliosis has been implicated in the pathogenesis of acute peripheral facial palsy (APFP). Few studies, however, have used Western blot analyses to confirm the serological diagnosis.

Purpose To analyze the prevalence of anti‐Borrelia antibodies in patients with APFP compared with healthy control subjects living in Hokkaido Island, Japan.

Patients and Methods In total, 113 patients with APFP were analyzed. They included 32 patients with varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome and zoster sine herpete) and 81 patients with Bell's palsy. Fifty‐eight healthy control subjects were also included. IgM and IgG antibodies to Borrelia garinii and afzelii were tested by Western blot, and diagnoses were made according to the Centers for Disease Control and Prevention criteria.

Results Five of 81 (6.2%) patients with Bell's palsy, 1 of 32 (3.1%) patients with VZV reactivation, and 1 of 58 control subjects (1.7%) were judged to have both IgM and IgG antibodies to Borrelia. This difference was not significant (P >.05, χ2 test). Patients with Bell's palsy who had herpes simplex virus type 1 (HSV‐1) reactivation at the onset of palsy had a higher IgM‐immunoreactivity to Borrelia afzelii.

Conclusions Although it is one of the endemic areas of Lyme disease in Japan, the prevalence of APFP caused by Lyme borreliosis is low in Hokkaido Island. In addition, cross‐reactivity to B. afzelii in IgM blots is often observed in patients with HSV‐1 reactivation, suggesting that careful interpretation of Borrelia IgM immunoblot data are needed for accurate serological diagnosis.
The Study of Laryngeal Muscle Activity in Normal Human Subjects and in Patients With Laryngeal Dystonia Using Multiple Fine‐Wire Electromyography
Authors: Hillel Allen D.
Published: November 2003

The normal human larynx performs numerous complex tasks with nearly complete reliability. These tasks require precise timing of movements that are effected by the laryngeal muscles. The most specific method to examine these muscles is by electromyography. Although many studies on laryngeal electromyography have been reported using multichannel recordings, none has provided a detailed analysis of each laryngeal muscle's role during a variety of common tasks and the spectrum of normative values. Simultaneous eight‐channel, fine‐wire electromyographic recordings were made in 11 human subjects. The timing patterns of the laryngeal muscles during the coordinated efforts for phonation and other common glottic functions were examined. In addition, normative values for latencies and amplitudes of response were determined. During simple phonation, a “set pattern” for the thyroarytenoid, lateral cricoarytenoid, and interarytenoid muscles was found. The thyroarytenoid and lateral cricoarytenoid muscles demonstrated a burst at onset preceding phonation and then decreased activity, whereas the interarytenoid sustained glottic position during phonation. The coordination of the laryngeal muscles was similarly determined for connected speech, respiration, Valsalva maneuver, cough, throat‐clear task, and swallow. These patterns of response, the latencies for activities, and the amplitudes of response in normal subjects provided the basis to examine the abnormal laryngeal function in a group of 59 patients with four clinical varieties of laryngeal dystonia (adductor, tremor, abductor, and mixed). The findings include abnormal patterns of response, increased latencies, and increased amplitudes of recruitment in many tasks including nonphonatory tasks. Although specific distinctions were noted in each group, the responses were remarkably similar, indicating that all clinical varieties of laryngeal dystonia should be classified as mixed dystonia with a clinical preponderance for one or more types of behavior.
Distraction Osteogenesis of the Mandible for Airway Obstruction in Children
Authors: Sidman James D. , Sampson Daniel , Templeton Bruce
Published: November 2003

Objectives Objectives of the study were to determine the effectiveness of distraction osteogenesis of the mandible to relieve airway obstruction in children with tongue‐base airway obstruction and to describe the new surgical techniques developed for use in infants and young children.

Study Design Prospective, nonrandomized study.

Methods Analysis of 11 children with severe airway obstruction secondary to tongue‐base obstruction was performed. Patients were between 2 weeks and 5.5 years of age. All patients underwent distraction osteogenesis of the mandible.

Results Twelve distraction procedures in the 11 children in the study were accomplished; decannulation or extubation was successful in all children.

Conclusion Distraction osteogenesis of the mandible can be used to treat tongue‐base airway obstruction in appropriately selected children.
L‐N‐Acetyl‐Cysteine Protection Against Cisplatin‐Induced Auditory Neuronal and Hair Cell Toxicity
Authors: Feghali Joseph G. , Liu Wei , Van De Water Thomas R.
Published: November 2003

Objectives The aim of this study is to determine the efficacy of L‐N‐acetyl‐cysteine (L‐NAC) as a protectant for inner ear auditory sensory cells against the toxic effects of cisplatin.

Study Design Prospective laboratory study of the otoprotective effect of L‐NAC on auditory neurons and hair cells in vitro.

Methods The study has two arms. The first arm evaluated the neuroprotective effect of L‐NAC on early postpartum auditory ganglion cell cultures. Two culture media were used. The two media differed in that one of them was enhanced by the addition of neurotrophins (neurotrophin type 3 and brain‐derived neurotrophic factor) and a growth factor (transforming growth factor‐β1). Then the survival of cisplatin‐treated auditory neurons was studied before and after pretreatment with protective levels of L‐NAC. The second arm of the study evaluated the effect of L‐NAC on cisplatin damage initiated to auditory hair cells. Early‐postpartum organ of Corti explants were grown in culture. Their rate of survival was studied after exposure to toxic levels of cisplatin. Then, survival of cisplatin‐damaged hair cells was studied after they were pretreated with L‐NAC.

Results Pretreatment of cultures with L‐NAC protected both auditory neurons and hair cells from the effects of exposure to toxic levels of cisplatin. This observed otoprotective effect was dose dependent.

Conclusions Our in vitro studies have demonstrated that L‐NAC protected both auditory neurons and hair cells from the toxic effects of cisplatin. Because it protects both of these inner ear structures, L‐NAC may be potentially useful in protecting hearing, in general, from cisplatin‐induced damage. In addition, L‐NAC has low systemic and mucosal toxicity. It also has a low molecular weight that may allow it to readily cross the round window membrane. All these characteristics make it potentially suitable for transtympanic application for the prevention of the ototoxicity of cisplatin in vivo.
Potassium Recycling Pathways in the Human Cochlea
Authors: Weber Peter C. , Cunningham Calhoun D. , Schulte Bradley A.
Published: November 2003

Objectives/Hypothesis Potential pathways for recycling potassium (K+) used in the maintenance of inner ear electrochemical gradients have been elucidated in animal models. However, little is known about K+ transport in the human cochlea. This study was designed to characterize putative K+ recycling pathways in the human ear and to determine whether observations from animal models can be extrapolated to humans.

Study Design A prospective laboratory study using an immunohistochemical approach to analyze the distribution of key ion transport mediators in the human cochlea.

Methods Human temporal bones were fixed in situ within 1 to 6 hours of death and subsequently harvested at autopsy. Decalcification was accomplished with the aid of microwaving. Immunohistochemical staining was then performed to define the presence and cell type‐specific distribution of Na,K‐ATPase, sodium–potassium–chloride cotransporter (NKCC), and carbonic anhydrase (CA) in the inner ear.

Results Staining patterns visualized in the human cochlea closely paralleled those seen in other species. Anti‐Na,K‐ATPase stained strongly the basolateral plasma membrane of strial marginal cells and nerve endings underlying hair cells. This antibody also localized Na,K‐ATPase to type II, type IV, and type V fibrocytes in the spiral ligament and in limbal fibrocytes. NKCC was present in the basolateral membrane of strial marginal cells as well as in type II, type V, and limbal fibrocytes. Immunoreactive carbonic anhydrase was present in type I and type III fibrocytes and in epithelial cells lining Reissner's membrane and the spiral prominence.

Conclusions The distribution of several major ion transport proteins in the human cochlea is similar but not identical to that described in various rodent models. These results support the presence of a complex system for recycling and regulating K+ homeostasis in the human cochlea, similar to that described in other mammalian species.
Improving the Otolaryngology Consultation Service in a Teaching Hospital
Authors: Carr Michele M.
Published: November 2003

Objective To examine the type and quality of consultations requested from the otolaryngology service at a tertiary care hospital.

Study Design Retrospective.

Method Review of written documentation of consultations over a 6‐month period.

Results One hundred eleven requests were received, and 107 written reports were made. Twenty services made requests. Thirty‐two percent of requests had a legible requester or contact listed. Sixty‐seven percent of requests stated why the patient was in hospital, and 85% stated the otolaryngological complaint. Thirty‐two percent of requests made accurate reference to the otolaryngological history, and 6% recorded an ENT examination that was accurate. Seven percent of patients were intubated, and 16% had a tracheostomy prior to evaluation. Forty‐eight percent of patients required flexible nasopharyngolaryngoscopy. Sixteen percent of patients required rhinoscopy, and 16% required tracheotomy. Twelve percent of patients needed audiograms, and small numbers of patients required biopsy, debridement of ears, ventilation tube insertion, nasal packing, or radiological studies. Reports were made by senior residents, and evidence that the case was discussed with or seen by an attending surgeon was present in 43% of reports. A diagnosis was stated in 85% of reports, and in 3% the diagnosis appeared to be inaccurate as compared with the history and physical examination recorded. A follow‐up plan was stated in 70% of reports.

Conclusions There is a need to educate physicians about collegial communication regarding patients. This information can direct curriculum needed to prepare otolaryngology residents to provide a consultative service in a teaching hospital. This method of determining “true learning needs” can be used in other situations to improve resident training.