bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: Evolution in management of facial paralysis
Authors: Hammerschlag Paul E.
Published: November 2003

When viable proximal facial nerve is inacessible, facial nerve paralysis has been classically managed with the hypoglossal facial anastomosis (HFA) for at least the past 70 years. While this procedure has proven its reliability, its problems with hemilingual atrophy (speech deglutition, drooling, mastication), hypertonia, synkinesis, and mimetic deficits indicate the need for a more perfect solution for facial paralysis. The jump interpositional graft hypoglossal facial anastomosis (JIGHFA) along with gold weight lid implantation and electromyographic (EMG) rehabilitation achieves substantial facial reanimation without hemilingual deficits. We present our results in 18 patients who underwent JIGHFA along with gold weight lid implantation and EMG rehabilitation for facial paralysis. These results were compared with those from published series of 30 patients treated with HFA with EMG rehabilitation evaluated with objective (House‐Brackmann) criteria. Anonymous retrospective information from questionnaires from 22 of 48 patients who were treated with the classic HFA was also presented. In properly selected patients, the JIGHFA technique is capable of achieving substantial facial reinnervation (House‐Brackmann grade III or better) in 83.3% of the patients without hemilingual sequelae which was seen in 45% of the HFA patients. In contrast to the HFA, this procedure can be used by patients with concomitant lower cranial nerve paralysis (except hypoglossal), and bilateral facial paralysis. Hypertonia, synkinesis, and lagophthalmus were less symptomatic in the JIGHFA patients. Mimetic expression was not improved in the JIGHFA population compared with the HFA group.
Effects of acute thyroxin depletion on hearing in humans
Authors: Mra Zan , Wax Mark K.
Published: November 2003

Objective: To study the physiologic effect of acute thyroid hormone depletion on hearing and the function of outer hair cells.Design: Audiologic and otoacoustic emission testing of subjects undergoing total thyroidectomy before surgery and up to 6 weeks after surgery. Magnitude of thyroxin depletion monitored by serum thyroid‐stimulating hormone levels.Setting: Hearing research laboratory at a state university.Subjects: Ten patients undergoing total thyroidectomy.Main Outcome Measures: Detection of hearing loss on audiogram and decrease or disappearance of otoacoustic emissions as a result of acute thyroxin depletion.Results: No significant changes in the audiogram and otoacoustic emission configurations were detected, although thyroid‐stimulating hormone levels became elevated after total thyroidectomy.Conclusion: Although thyroid hormone is thought to play a role in the physiology of hearing in humans, no deleterious effects on hearing can be identified up to 6 weeks after thyroxin depletion
Cochlear reimplantation
Authors: Balkany Thomas J. , Hodges Annelle V. , Gómez‐Marín Orlando , Bird Philip A. , Dolan‐Ash Shelly , Butts Stacy , Telischi Mee Fred F. , Lee David
Published: November 2003

Objective: A small number of multichannel cochlear implant (CI) recipients require reimplantation. This study describes the causes of failure, surgical technique, and hearing outcomes in a consecutive series of 16 patients undergoing reimplantation of multichannel devices. We hypothesize that reimplantation is safe and that hearing results are at least as good as those measured following primary implantation. Study Design: Retrospective analysis of consecutive clinical series. Methods: Chart analysis of 191 consecutive CI operations performed at the University of Miami Ear Institute between 1990 and 1997 revealed 16 patients who received a second multichannel device. All but one had a minimum follow‐up of 1 year after reimplantation. Ten of these patients had initial implantation performed by us, and six were initially operated on elsewhere. Main outcomes of the initial procedure were compared with those of the reimplantation, including electrode insertion length, number of channels programmed, and audiometric results. In addition, cause of failure and relevant surgical findings at the second procedure are described. Results: There were no surgical complications after reimplantation surgery. Device failure was the most frequent cause for reimplantation. Time between initial implantation and failure ranged from 0 to 46 months (mean, 22.4 mo; median, 23 mo). Common intraoperative findings include mastoid fibrosis, bone growth at the cochleostomy, and skin flap breakdown. Following reimplantation, mean length of insertion, number of channels actively programmed, and speech recognition scores were at least as good as findings before initial implant failure. Conclusion: CI reimplantation is safe and effective.
Limitations of adenovirus‐mediated interleukin‐2 gene therapy for oral cancer
Authors: O'Malley Bert W. , Li Daqing , Buckner Alyson , Duan Ling , Woo Savio L.C. , Pardoll Drew M.
Published: November 2003

Objective/Hypothesis: Adenoviral interleukin‐2 (AdV‐IL‐2) gene therapy has previously not proven effective in treating established murine oral cancer. We hypothesize that the intratumoral level of IL‐2 expression is a major limiting factor in treatment outcome. Methods: A microscopic disease and established oral cancer murine model was used to test this hypothesis. IL‐2 gene transfer was performed with a recombinant adenovirus vector. Results: Tumor cells were transduced in vitro with AdV‐IL‐2 and subsequently implanted into the floor of the mouth in C3H/ HeJ mice. IL‐2 expression in vitro ranged from 990 to 1,050 pg/106 tumor cells. This microscopic disease treatment resulted in either complete tumor regression or a dramatic decrease in tumor progression. Cytolytic T‐cell (CTL) assays demonstrated a predominance of CD8‐specific, T‐cell–mediated tumor killing. Reducing IL‐2 expression by half with a mixture of 1:1 transduced to nontransduced tumor cells eliminated the antitumor effect and decreased the CTL response. These findings support the presence of a critical “threshold” of IL‐2 expression. Adenovirus repurification and amplification allowed isolation of a twofoldhigher‐titer AdV‐IL‐2 vector. Treatment of established tumors with the higher‐titer AdV‐IL‐2 at a new maximal dose of 1.4 × 109 plaque‐forming units (pfu) increased in vivo IL‐2 expression to 1,127 pg/106 cells and generated a significant antitumor response. Complete regression of established tumors, however, could not be achieved, and we noted a decrease in IL‐2 expression well below the threshold at 1 week after treatment. Upon repeat maximal AdV‐IL‐2 injection in vivo, a greater antitumor effect and increased CTL response was seen, but also, 28% of the animals died of IL‐2 toxicity. Conclusion: Although limited by expression and toxicity as a single‐treatment strategy for established tumors, AdV‐IL‐2 gene therapy should be considered a potential component of combination therapy strategies.
Combined intratumor cisplatinum injection and Nd:YAG laser therapy
Authors: Graeber Ines P. , Eshraghi Adrien A. , Paiva Marcos B. , Paek Woo H. , Castro Dan J. , Jovanovic Sergije , Scherer Hans , Soudant Jacques , Saxton Romaine E.
Published: November 2003

Objectives/Hypothesis: Interstitial laser therapy (ILT) has become useful for tumor palliation in patients with advanced head and neck cancer. Cisplatinum chemotherapy also is a frequent adjuvant treatment for recurrent tumors, but systemic toxicity limits application. Intratumor cisplatinum injection combined with ILT may improve therapy of these recurrent tumors with reduced toxicity. Study Design: Prospective. Tumor transplants were injected with cisplatinum in a gel implant before ILT to evaluate treatment response and toxicity in a preclinical study. Methods: UCLA‐P3 human squamous cell carcinoma tumors were grown as subcutaneous transplants in nude mice and treated by intratumor injection of 2 mg/mL cisplatinum in a slow‐release, collagen‐based gel carrier 4 hours before interstitial implantation of Nd:YAG laser fiberoptics to induce local tumor hyperthermia. Treatment efficacy and toxicity were followed for 12 weeks after combined drug and laser therapy compared with ILT alone. Results: Combined cisplatinum gel and ILT was a significant improvement (P < .01 by chi‐square test) and induced 57% complete responses without regrowth in 21 transplanted tumors compared with only 24% in 21 tumors after ILT alone during 12‐week follow‐up. Recurrences in both cases appeared to result from nonuniform laser energy delivery within tumors via the implanted fiberoptic tip. Conclusions: The results of this experimental combined cisplatinum and ILT study suggest it may be possible to improve treatment of advanced head and neck cancer by intratumor injection of gel implants containing the drug followed by interstitial Nd:YAG laser hyperthermia.
Evidence of mast cell activity in the middle ears of children with otitis media with effusion
Authors: Hurst David S. , Amin Kawa , Sevéus Lahja , Venge Per
Published: November 2003

Objectives: This is the first study to report the presence of tryptase, a reflection of mast cell activity, in chronic middle ear effusion of patients whose atopic status was characterized. Design and Methods: Mediator activity of mast cells and eosinophils was measured prospectively from effusion of 33 randomly selected patients and 5 control subjects with chronic otitis media with effusion (OME). Atopy was determined by enzyme‐linked immunosorbent assay. Middle ear biopsies from a second group of 8 OME patients and 4 controls were fixed in plastic and stained immunohistochemically for mast cells. Results: Sixty‐one percent of patients had extensive activation of mast cells in their middle ears. Among those with elevated tryptase in their effusion, 95.6% were atopic and 94.7% also had elevated levels of effusion eosinophilic cationic protein (ECP). Tryptase levels were elevated only in the effusion of atopic patients, as compared with 5 controls (P < .01). Mast cells were present in 6 of 8 OME ears and absent in all 4 normal ears. Conclusion: Mast cells and its mediator tryptase, both indicators of a Th2‐driven immune response, are present in a majority of ears that have chronic effusion. These findings support the hypothesis that middle ear mucosa is capable of an allergic response and that the inflammation within the middle ear of most OME patients is allergic in nature.
A technique of mastoidectomy and meatoplasty that minimizes factors associated with a discharging mastoid cavity
Authors: Wormald Peter John , Van Hasselt C. Andrew
Published: November 2003

Objectives: To present and assess a surgical technique designed to minimize the known causes of a discharging mastoid cavity.Study Design: A temporal bone dissection to establish the anatomical relationships on which the surgical technique is based. A presentation of the proposed surgical technique and a prospective assessment of the technique in twenty consecutive mastoidectomies.Methods: Five temporal bone dissections were performed to establish the relationship between the chorda tympani and the facial nerve when these structures are approached from above. The surgical technique is presented and the mastoid cavities of twenty consecutive patients assessed. The assessment included measurement of the facial ridge height, “kidney‐shape” of the cavity, size of the cavity, size of the meatus, and state of the tympanic membrane.Results: In the temporal bone dissections the vertical height between the chorda tympani and the facial nerve at 3/9 o'clock was a mean of 2.01 mm. Nineteen of the 20 consecutive mastoid cavities (95%) performed with the presented technique remained well healed and dry. The mean facial ridge height was 2.7 mm at 3/9 o'clock and 4.8 mm at 6 o'clock. The kidney‐shaped measurement was 1.45 mm. The mean size of the cavities was 2.6 mm and 18 of the 20 patients (90%) had an intact tympanic membrane. The mean largest diameter of the meatus was 10.1 mm.Conclusions: The surgical technique presented produces a mastoid cavity with a low facial ridge and oval shape. These two factors have been previously identified as important in the outcome of mastoid surgery.
A clinical study on the magnetic stimulation of the facial nerve
Authors: Yamakawa Takuya , Yoshikawa Hiroshi , Arai Akira , Miyazaki Toyo , Ichikawa Ginichiro
Published: November 2003

Objectives: A clinical study on the usefulness of magnetic stimulation of the facial nerve, with special attention paid to the selection of the coil shape and stimulation procedures. Study Design: The subjects consisted of 55 patients with Bell's palsy, 1 patient with a cerebellopontine angle (CPA) tumor, 1 patient with multiple sclerosis (MS), and 30 normal subjects. Three types of coils were used in this study; a 90‐mm large single coil, a 40‐mm small single coil, and a 20‐mm small double coil. Methods: The compound muscle action potentials (CMAPs) and long latency response were evoked by transcranial magnetic stimulation (TMS) with a 90‐mm large single coil. The 40‐mm small single coil was used to test blink reflex by aiming it at the supraorbital nerve as the target site. The subcutaneous activation of the infra‐auricular facial nerve was performed with the 20‐mm double coil. Results: The reproducible CMAP and long latency responses were obtained from normal subjects with TMS. However, responses were observed only in patients with relatively mild Bell's palsy. The magnetic stimulation—evoked responses reflected the brainstem function in the patients with a CPA tumor and MS. Conclusion: Although magnetic stimulation remains inferior to conventional electric stimulation in some sense and requires further study, this method is potentially useful because it can stimulate the facial nerve continuously from the cortex to the periphery and can effectively evoke responses reflecting the brainstem function.
An Integrated Theory of the No‐Reflow Phenomenon and the Beneficial Effect of Vascular Washout on No‐Reflow
Authors: Calhoun Karen H. , Tan Luke , Seikaly Hadi
Published: November 2003

Objectives: No‐reflow is failure of perfusion in free tissue transfer despite adequate arterial inflow. The objectives of this study were to construct a theory of interactive mechanisms of the no‐reflow phenomenon and to determine whether preischemic vascular washout could increase flap ischemia tolerance.

Study Design: The evidence for the role of various mechanisms in the development of no‐reflow is reviewed, and an integrated network proposed. A ratgroin free flap model is used to test preischemic vascular washout with normal saline, heparinized normal saline, lactated Ringer's solution, Tis‐U‐Sol, and Viaspan.

Methods: The mean ischemia tolerance of this flap without any therapeutic intervention was first determined, using 22 animals. An additional 50 animals were used to compare with the control group the ischemia tolerance of flaps washed out with the above fluids before their ischemic period.

Results: The critical ischemia time 50 (time after which half of the flaps are expected to survive and half, die) of the untreated flap is 23.4 hours in this model (P < .05). Flaps washed out with normal saline or lactated Ringer's solution have significantly worse ischemia tolerance (P < .0001). Flaps washed out with Tis‐U‐Sol or Viaspan behave similarly to the control group (P > .57). Flaps receiving preischemic washout with heparinized normal saline (4,000 units/L) had a significantly better outcome than the control group (P < .027).

Conclusions: Preischemic washout with normal saline, lactated Ringer's solution, or heparinized Tis‐U‐Sol is detrimental for flap survival after ischemia, Tis‐U‐Sol‐ and Viaspan‐treated flaps do have ischemia tolerance similar to the control group, and flaps washed out with heparinized normal saline have a survival advantage in this model.
Surgical Experience and Complications During Endonasal Sinus Surgery
Authors: Keerl Rainer , Stankiewicz James , Weber Rainer , Hosemann Werner , Draf Wolfgang
Published: November 2003

Objective/Hypothesis: The introduction of optical aids for endonasal sinus surgery has not produced the expected drop in the rate of serious intraoperative complications.

Study Design/Methods:
1. Retrospectively, consecutive procedures of different surgeons were analyzed in regard to major complications (periorbital injury, orbital lesion, dural injury, endocranial lesion, damage to the internal carotid artery). The chronological distribution was transformed into a personal learning curve. 2. From our own experience and as surveyors, we analyzed the experiences of surgeons having encountered severe complications and compared them with the above‐mentioned learning curve.

Result: In total, 1,500 operations carried out by five surgeons with 16 serious complications were assessed. For the learning curve, the following stages were defined. stage I: greatest risk of complication, with dural injury (1st to 30th operation); stage II, slighter risk of complication, with frequent periorbital injuries (31st to 180th operation); and stage III, least risk, corresponding to an experienced surgeon. Serious complications occur most frequently among experienced surgeons.

Conclusion: The beginner enjoys the most effective type of assistance, in the form of personal guidance of an experienced surgeon who is constantly present during the first 30 operations, and who should then be readily available during the next 70 operative procedures. The use of multimedia software appears to be helpful, though its actual value still remains to be determined. The experienced surgeon in particular must be willing to exercise repeated self‐criticism to keep his or her rate of complications to a minimum.
Interaction Between Fibronectin and Eosinophils in the Growth of Nasal Polyps
Authors: Nakagawa Takayuki , Yamane Hideo , Shigeta Toshinobu , Takashima Tadayoshi , Nakai Yoshiaki
Published: November 2003

Objectives: The aim of this study was to determine roles of fibronectin and eosinophils in the etiology of nasal polyposis.

Study Design: We designed a cohort study of cases with nasal polyposis. Sampled nasal polyps were differentiated by their histopathologic characteristics, and compared by size and computed tomography (CT) stage.

Methods: The size of nasal polyps was determined on the basis of the endoscopic findings, and the extent of sinusitis was evaluated by CT staging. Nasal polyp samples were taken from 82 patients during ethmoidectomy and differentiated by morphologic characteristics, infiltration cell types, or fibronectin positivity. Then their sizes and CT stages were compared. In addition, correlation among these histological characteristics was analyzed.

Results: Nasal polyps showing edematous morphology, eosinophil infiltration, or fibronectin expression were significantly large in size. Concerning CT stages, only the infiltration cell type showed a significant difference. Significant correlation among edematous morphology, eosinophil infiltration, and fibronectin expression was also recognized.

Conclusions: These findings suggest that interaction between eosinophils and fibronectin may play a role in edema formation, which contributes to the growth of nasal polyps.
Gustatory Otalgia and Wet Ear Syndrome: A Possible Cross‐Innervation After Ear Surgery
Authors: Saito Haruo
Published: November 2003

Hypothesis: The chorda tympani and Arnold's nerves have close approximation to each other and their cross‐innervation is possible after ear surgery.

Study Design: A retrospective study was performed with a temporal bone pathology case and two clinical cases as representatives of such a possibility. Patients had severe otalgia and wet ear during gustatory stimulation.

Methods: A temporal bone pathology case was studied under a light microscope. Earache and/or wet ear were provoked during gustatory stimulation. Wet ear was tested with iodine‐starch reaction after the subject tasted lemon juice.

Results: The temporal bone specimen has clusters of regenerated fibers in the tympanic cavity in the area of the chorda tympani and Arnold's nerves, suggesting a possibility of mixing. There are regenerated fibers in the iter chordae anterius, showing successful bridging of the chorda tympani nerves across a long gap. Detachment of the skin over the operated mastoid bowl obscured signs in one clinical case. Another clinical case of gustatory wet ear showed objective evidence of cross‐innervation with iodine‐starch reaction.

Conclusion: The detachment procedure and iodine‐starch reaction were the proofs that the signs were related to regenerated fibers. This is the first report of gustatory otalgia and wet ear after ear surgery.
Age at Implantation: Its Importance in Pediatric Cochlear Implantation
Authors: Nikolopoulos Thomas P. , O'Donoghue Gerard M. , Archbold Sue
Published: November 2003

Objective: To assess the influence of age at implantation on speech perception and speech intelligibility following pediatric cochlear implantation.

Study Design: A prospective study was undertaken on a consecutive group of 126 congenital and prelingually deaf children up to 4 years after implantation. The study group was confined to prelingually deaf children less than 7 years of age at the time of implantation. All had implantation with the same multichannel cochlear implant system. No child was lost to follow‐up, and there were no exclusions from the study.

Methods: The Iowa Matrix Closed Set Sentence test, connected discourse tracking, categories of auditory performance, and speech intelligibility rating were used to assess the speech perception (closed and open set) and speech intelligibility of the children with implants. Regression analysis and Spearman rank correlation coefficients were used to assess the correlation between the outcome measures with age at implantation. The setting was a tertiary referral pediatric cochlear implant center in the United Kingdom.

Results: Age at implantation positively correlated with preimplantation assessment performance and with most of the outcome measures up to 24 months following implantation. However, at the 3‐ and 4‐year intervals following implantation, age at implantation was found to be a strong negative predictor of all the outcomes studied (correlation coefficients ranging from −0.44 to −0.58, all statistically significant [P < .05]).

Conclusions: The results of the present study provide strong evidence that prelingually deaf children should receive implants as early as possible to facilitate the later development of speech perception skills and speech intelligibility and thus maximize the health gain from the intervention. However, because of the wide variation in individual outcomes, age alone should not be used as a criterion to decide implant candidacy.
Effects of Immunosuppression on the Development of Cochlear Disease in the MRL‐Faslpr Mouse
Authors: Ruckenstein Michael J. , Sarwar Armughan , Hu Lydia , Shami Halla , Marion T. N.
Published: November 2003

Objectives: The MRL‐Faslpr mouse, an animal that spontaneously develops multisystemic autoimmune disease, has been proposed as model of immune‐mediated inner ear disease. Previous studies revealed that this mouse manifested elevated auditory brainstem response thresholds, hydropic degeneration of strial cells, and antibody deposition within strial capillaries. As the etiology of the observed strial disease may be immune, genetic, or uremic, a study was designed to attempt to delineate between these possible etiologic factors.

Study Design: Prospective, controlled animal study.

Methods: Dexamethasone, which is known to suppress autoantibody production and glomerulonephritis in these animals, was administered systemically on a daily basis to experimental animals, beginning at 6 weeks of age. Control animals received no treatment. Animals were allowed to age, with control animals predictably manifesting systemic disease at 20 weeks of age, at which point all animals were sacrificed.

Results: Animals receiving dexamethasone treatment manifested a significant reduction in serum immunoglobulin levels, lymphoid hyperplasia, and a significant improvement in the level of renal function. However, morphologic analysis revealed a persistence of strial disease despite the elimination of strial antibody deposition.

Conclusion: The results of this experiment support the hypothesis that genetic mechanisms may be responsible for the observed strial disease. Further studies are under way to confirm these findings.
Lateral Dural Sinus Thrombosis in Childhood
Authors: Holzmann David , Huisman Thierry A.G.M. , Linder Thomas E.
Published: November 2003

Objectives: To present etiology, diagnosis, and treatment of dural sinus thrombosis (DST) in children. To discuss the diagnostic role of contrast‐enhanced computed tomography (CECT) and to evaluate the controversial treatment modalities of anticoagulation, surgical drainage of the infected sinus, and ligation of the internal jugular vein (IJV).

Study Design: Retrospective chart review and analysis of computed tomography (CT) scans and follow‐up visits to document the clinical outcome.

Methods: Between 1986 and 1996, CT scans of 15 children revealed DST. These patients were further investigated.

Results: The etiology could be divided in three groups: group A, infection (6); group B, trauma (6); and group C, coagulation disorders. There were neither symptoms nor clinical findings specifically related to DST but rather, these were related to the underlying disease or condition (otitis media, skull base fractures). Diagnosis was made by CECT in all cases. Fusobacterium necrophorum was found in 4 of 6 patients in group A. Early mastoidectomy with incision and drainage of the thrombosed sigmoid sinus was performed in patients in group A. Postoperative intravenous (IV) heparin was given; however, no ligation of the IJV became necessary. In all patients in group C, protein C or protein S deficiency, or both, was detected.

Conclusions: CECT with adequate window‐level settings allows the diagnosis of a DST with high sensitivity. Treatment of choice for septic DST consists of administration of antibiotics and early surgical drainage. We recommend anticoagulation therapy in children with septic DST during their hospitalization.
Vocal function after vertical partial laryngectomy with glottic reconstruction by false vocal fold flap: Durational and frequency measures
Authors: Biacabe Bernard , Crevier‐Buchman Lise , Hans Stéphane , Laccourreye Ollivier , Brasnu Daniel
Published: November 2003

Objective: Compare vocal function following vertical partial laryngectomy (VPL) with or without glottic reconstruction by false vocal fold (FVF) mucosal flap. Study Design: Twenty‐seven patients with T1a squamous cell carcinoma (SCC) of the glottis were included in a prospective randomized clinical study. All patients were treated by frontolateral partial laryngectomy (FLPL). Glottic reconstruction with FVF mucosal flap was performed in 14 patients at the time of the FLPL, whereas 13 patients had standard FLPL. Methods: Objective voice assessment was based on computerized acoustic recordings performed before and 1 year after surgery. When possible, additional recordings were performed at 3 months, 6 months, and 2 years postoperatively. Incidence of postoperative granuloma and anterior neoglottic web were noted. Repeated analysis of variance (ANOVA) was used to compare the durational (maximum phonation time, speech rate) and frequency measurements (average fundamental frequency [Fo], standard deviation of Fo, jitter, shimmer, noise‐to‐harmonics ratio, degree of voice breaks) between patients with or without glottic reconstruction, postoperative granuloma, and anterior neoglottic web. Linear regression was used to study the evolution over time of the durational and frequency measurements. Results: Frequency measurements improved with time and were significantly better in patients treated with glottic reconstruction. In addition, glottic reconstruction decreased incidence of postoperative granuloma and anterior neoglottic web. Conclusions: The FVF mucosal flap technique can improve vocal results in selected cases of T1a SCC of the glottis when FLPL is the adequate surgical treatment.
Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo
Authors: Buckingham Richard A.
Published: November 2003

Objective: To determine if there is an anatomic basis for the assumption that loose, “rogue” otoliths presumed to arise from the utricular macula and theorized to cause benign paroxysmal positional vertigo (BPPV) by impinging on semicircular canal ampullae could be returned to their original site by a series of changes in the position of the head called particle repositioning maneuvers (PRMs). Further, if such otolith movement were possible, once they were replaced into the utricle, would they adhere to the utricular macula? Study Design: Kodachrome photographs of 2‐mm‐thick macrosections of human temporal bones were available for evaluation. The bones were sectioned in horizontal, coronal, and sagittal planes. Rice grains were placed on the photographs of the cross‐sections to demonstrate the possible paths taken by loose otoliths under the influence of gravity in different positions of the head. Results: A study of cross‐sections of the temporal bone shows that loose macular otoliths after PRMs would tend to fall into the lumen of the utricle. Once the patient assumes the erect position, however, repositioned otoliths would tend to fall into the near or utriculopetal side of the cupula of the posterior semicircular canal, which opens directly into the inferior portion of the utricle, and could cause labyrinth stimulation and BPPV by the same mechanism of misplaced otoliths on the opposite or far side of the cupula. Loose otoliths in the utricle could also stimulate the horizontal ampullae. Conclusions: PRMs do not remove or fix otoliths in any specific site in the labyrinth. Repositioning of loose otoliths onto the original site in the macula of the utricle, which lies superiorly in the vestibule, could not be accomplished by any of the repositioning maneuvers. If otoliths were to be repositioned on the utricular macula, there is no evidence that the otoliths would adhere to the macula when the patient assumes the erect position. The good results obtained by physiotherapeutic procedures suggest that some other mechanism than repositioning of otoliths is responsible for the relief of BPPV.
Bone modeling dynamics in acute otitis media
Authors: Cayé‐Thomasen Per , Hermansson Ann , Tos Mirko , Prellner Karin
Published: November 2003

Objective: A number of middle ear diseases are associated with pathologic bone modeling, either formative or resorptive. As such, the pathogenesis of a sclerotic mastoid has been controversial for decades. Experimental studies on acute middle ear infection have shown varying degrees of both osteoresorption and osteoneogenesis. This study presents data on the dynamics of bone modeling in a rat model of acute pneumococcal otitis media, studied longitudinally from day 1 through 6 months after inoculation. Results: Qualitative, as well as quantitative histopathology revealed initial osteoresorption, followed by increasing apposition of new bone in the middle ear cavity, initiated at the outer periosteum. Measured bone thickness in four anatomically distinct locations peaked 3 months after inoculation, followed by some degree of normalization. However, bone thickness was still massively increased 6 months after the acute incident. Except in perilymphatic spaces of the otic capsule, resorptive and formative activity were found in all bone tissue structures surrounding the middle ear cavity, including the bony external auditory canal and the ossicles. Conclusion: These findings may support the existence of a perilymphatic barrier of specialized bone and suggest that even a single episode of acute infection may alter properties of ossicular chain conduction. The authors conclude that acute otitis media is accompanied by massive and progressing net osteoneogenesis, already evident at 3 days and peaking 3 months after inoculation, followed by some degree of normalization. This is conceivably in support of the environmental theory of mastoid pneumatization, claiming inflammatory disease as the cause of a sclerotic mastoid.
Prevalence of meniere disease in finland
Authors: Kotimäki Jouko , Sorri Martti , Aantaa Eero , Nuutinen Juhani
Published: November 2003

Objectives: To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) recommendation. Study Design: Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD‐9 or ICD‐10) in seven Finnish hospitals serving a population of 1.5 million people. Methods: Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re‐evaluated. Definite cases according to AAO‐HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996. ReRults: A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P < .001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000). Conclusions: The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.
Association of vascular endothelial growth factor expression with angiogenesis and lymph node metastasis in nasopharyngeal carcinoma
Authors: Wakisaka Naohiro , Wen Qing‐Hua , Yoshizaki Tomokazu , Nishimura Toshiro , Furukawa Mitsuru , Kawahara Ei , Nakanishi Isao
Published: November 2003

Objective: Recent experimental evidence indicates that angiogenesis affects tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is considered to be an important regulator of tumor angiogenesis. The present study was designed to examine the role of VEGF on angiogenesis and lymph node metastasis in primary nasopharyngeal carcinomas (NPCs). Study Design: Formalin‐fixed paraffin‐embedded biopsy specimens were obtained from 29 primary NPCs that consisted of 22 differentiated nonkeratinizing carcinomas and seven undifferentiated carcinomas. Methods: Microvessels were highlighted by staining endothelial cells with von Willebrand factor (VWF) using immunohistochemical techniques, and were counted (per × 400 field) in the most active area of angiogenesis on light microscopy. The expression of VEGF was also studied with immunohistochemistry. Positive ratio for VEGF was graded on a scale of 1 and 2. Scale 1 represents patients with less than the mean value of the positive ratio, and scale 2 represents patients with more than the corresponding value. Results: There was a significant correlation between increased microvessel count and the progression of regional lymph node involvement. The microvessel counts and the progression of N factor were significantly higher in scale 2 patients than in scale 1 patients. Conclusion: These results suggest that VEGF plays an important role in lymph node metastasis through induction of angiogenesis in NPCs.
Botulinum toxin: Adjunctive treatment for posterior glottic synechiae
Authors: Nathan Cherie‐Ann O. , Yin Shengguang , Stucker Fred J.
Published: November 2003

Introduction: Synechiae formation of the posterior glottis can result in tracheostomy dependence secondary to airway obstruction. Stenosis is caused by total or partial fixation of the vocal folds in adduction resulting from scar contracture. The treatment poses a management dilemma because of recurrent scar formation, made worse by mobility of the vocal folds. Although various treatment options from conservative endoscopic repair to open procedures have been proposed, the results are not satisfactory and patients often require multiple procedures. Methods: We present the trial of a conservative approach that includes microscopic CO2 laser resection of the scar with concomitant botulinum toxin injection of the interarytenoid and thyroarytenoid muscles of the more mobile cord. This results in a temporary paresis of the adductor muscles and hence prevents overadduction in the posterior commissure during the postoperative healing period. Study Design: We present the surgical technique and results in three patients who underwent the procedure. Results: Treatment in all three patients was successful. Conclusions: The appropriate use of botulinum toxin may help improve the treatment outcome of posterior synechiae of the larynx without sacrificing any laryngeal components. Key Words: Larynx, stenosis, botulinum toxin.
Zenker's diverticulum: Analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy
Authors: Feeley Marc A. , Righi Paul D. , Weisberger Edward C. , Hamaker Ronald C. , Spahn Thomas J. , Radpour Shokri , Wynne Michael K.
Published: November 2003

Objective: To identify risk factors for postoperative complications in patients undergoing diverticulectomy and cricopharyngeal (CP) myotomy for Zenker's diverticulum. Study Design: Retrospective. Materials and Methods: A chart review was conducted of all patients with a Zenker's diverticulum who were treated with diverticulectomy and cricopharyngeal myotomy at three tertiary care centers in central Indiana between 1988 and 1998. Results: Of the 24 patients identified, 9 developed postoperative complications (2 medical and 7 surgical). Statistical analysis of multiple potential risk factors revealed that only diverticulum size greater than 10 cm2 at surgery placed the patient at increased risk for postoperative surgical complications. To our knowledge, this is the first report that has specifically addressed diverticulum size as an independent risk factor for postoperative surgical complications following diverticulectomy and CP myotomy. Conclusions: Given our findings, we recommend considering diverticulopexy rather than diverticulectomy in a patient with a Zenker's diverticulum greater than 10 cm2 in size if a cervical approach is the selected treatment. Key Words: Zenker's diverticulum, cricopharyngeal myotomy, surgical complications, diverticulectomy.
Magnetic resonance navigation for head and neck lesions
Authors: Davis Shane P. , Anand Vinod K. , Dhillon Gurmeet
Published: November 2003

Objective: Review applications of interventional magnetic resonance imaging and describe methods, procedures, and additional instrumentation for the magnetic resonance “operating theater.” Describe advantages of magnetic resonance navigation for biopsies of head and neck tumors. Study Design: Patients with palpable and nonpalpable head and neck and cranial base tumors were recruited into the study. Patients underwent magnetic resonance–guided biopsy. Retrospective analysis of 21 patients was conducted. Methods: 0.5 Tesla superconducting open magnetic resonance imaging was used for navigation of the biopsy needle. Patient records and magnetic resonance images were reviewed. The type, size, and location of the lesions were tabulated. Type of anesthesia and monitoring method were analyzed. The histopathologic correlation was conducted in patients who required further surgeries or open surgical biopsies. Results: Twenty‐two biopsies were carried out in the magnetic resonance suite. One patient required general anesthesia and the other biopsies were conducted under intravenous sedation. There was only one case of nonconcurrence in a patient with Wegener's granulomatosis of the posterior orbit. Overall, a 92% concurrence rate between image‐directed fine‐needle aspiration, open biopsy, and surgical therapy was encountered. No complications occurred. Conclusions: The use of interventional magnetic resonance imaging to assist with fine‐needle aspiration core biopsy has made the biopsy procedure safer and more accurate. Potentially morbid and disfiguring surgeries have been avoided in some patients. Deeper lesions have been more easily approached, as the needle for biopsy is under constant magnetic resonance guidance. Improved visualization for critical structures allows safer performance of biopsies. The primary difficulties of open magnetic resonance imaging relate to the need for nonferromagnetic instrumentation and equipment and their high costs. An inverse relationship exists between the imaging quality and the “dead time” required to acquire images. Key Words: Interventional magnetic resonance imaging, fine‐needle aspiration, head and neck tumors.
Effect of photodynamic therapy on the critical primary ischemic time of fasciocutaneous flaps
Authors: Belmont Michael J. , Marabelle Nicole , Mang Thomas S. , Wax Mark K.
Published: November 2003

Background: Photodynamic therapy (PDT) may be used as an adjuvant intraoperative therapy to improve locoregional control. PDT has been shown to delay wound healing. This raises concern about PDT's effect on survival of fasciocutaneous flaps. Objective: Evaluate the effect of 1) PDT on the critical ischemic time in a rat fasciocutaneous flap model and 2) photosensitizer activation by the surgical light source. Design: A fasciocutaneous flap, based on the left inferior epigastric vessels, was used. Ischemic times of 2, 4, 6, 8, 10, and 12 hours were induced by clamping the vascular pedicle. Animals were randomly divided into five groups: ischemia only, group I; light treatment to wound bed, group II; Photofrin before surgery with the flap elevated without a fiber optic head light, group III, or with a headlight, group IV; Photofrin prior to surgery with light treatment to the wound bed, group V. Flap survival was assessed on postoperative day 7. Results: The critical primary ischemic time of group V (PDT) was significantly less (P < .05) than groups I, II, III, and IV. There was no statistical difference in the critical primary ischemic time when a fiber optic headlight was used (group III vs. group IV). Conclusion: Intraoperative PDT significantly reduces the critical primary ischemic time of the rat fasciocutaneous flap. White light illumination of the operative field does not result in photosensitizer activation and has no effect on the critical primary ischemic time.
Postoperative care in functional endoscopic sinus surgery?
Authors: Fernandes Sylvester Valentine
Published: November 2003

Objective: To assess the value of nonintervention after FESS. Study Design: Prospective study. Methods: Fifty‐five patients with diagnosed chronic rhinosinusitis who failed adequate medical therapy were subjected to FESS. No postoperative care, apart from nasal douching with hypertonic saline after the tenth postoperative day, was done. No antibiotics or steroids were administered routinely. Because 10 patients were not available for follow‐up, only 45 patients were included in the study. Results: Success rate judged by at least 50% subjective improvement of symptoms was 95.5%. However, all patients derived some benefit. The occurrence of postoperative synechiae is discussed. Conclusions: The usefulness of postoperative care of the FESS cavity needs reappraisal. Key Words: Postoperative care in FESS, functional endoscopic sinus surgery, FESS.
Breaking the Bad News of Cancer: The Patient's Perspective
Authors: Kim Michael K. , Alvi Aijaz
Published: November 2003

Objective: Head and neck cancers present a special challenge to the patient and the physician because they affect the quintessential aspects of living such as breathing, eating, and speaking. Numerous articles have described how the physician should perform the difficult task of conveying bad news, but only a small number of articles specifically assess the patients' perceptions when being told of a serious diagnosis. The purpose of this survey was to evaluate the thoughts and concerns of patients receiving diagnoses of head and neck cancer. Study Design: Questionnaire survey. Methods: A 41‐item questionnaire was sent to head and neck cancer patients who have been treated for and remain free of disease for at least 2 years. Results: All of the respondents felt that their diagnosis was adequately explained to them and that no further explanations were necessary. Eighty‐one percent of the respondents did not wish to have anyone else present at the time of diagnosis. Additionally, 75% of the respondents did not want the physician to touch their hands or hug them when given the bad news. Only 63% of the respondents had further discussions with family, friends, or other physicians after being told of their diagnosis. Conclusion: When patients are told of the diagnosis of head and neck cancer, they want their physician to be truthful, caring, and compassionate. The patients want their diagnosis in simple and direct terms without the incorporation of complex medical terminology. The results of this survey can provide insightful information to physicians when they are undertaking the difficult task of conveying bad news to their patients.
Preoperative Antibiotics and Steroids in Vestibular Schwannoma Excision
Authors: Welling D. Bradley , Thomas Robert , Slater Patrick , Daniels Robert L. , Goodman Joseph H.
Published: November 2003

Objective: To examine the benefits of preoperative admission for intravenous steroids and antibiotics for patients undergoing vestibular schwannoma excision. Study Design: Retrospective cohort study. Methods: One hundred twenty patients with pathologically confirmed vestibular schwannoma followed for at least 1 year after surgery were included. Sixty patients were assigned to the preoperative admission group and 60 patients to the same‐day‐admission surgery group. The preoperative admission group was given intravenous dexamethasone (0.1 mg/kg) and intravenous cefazolin (1 g) beginning 12 hours before surgery. The same‐day‐surgery group received the same dosage of medication beginning at induction of anesthesia. Outcomes: Facial nerve function, meningitis, and wound infection rates, duration of hospital stay, and readmission rates were examined. Results: There was no statistical difference in facial nerve function between the groups when controlling for tumor size. Likewise, there was no difference in meningitis or wound infection rates in the groups. As expected, hospital stay was significantly reduced but readmission rates were not affected. Conclusions: There are no apparent facial nerve function or infection control benefits to 1‐day preoperative admission for intravenous steroids and antibiotics for patients undergoing vestibular schwannoma excision.
Nasal Stuffiness During Pregnancy
Authors: Bende Mats , Gredmark Thomas
Published: November 2003

Objective: To investigate the occurrence of nasal stuffiness during pregnancy. Study Design: Prospective longitudinal study, with collection of data during 1 year in a cohort of 2,264 pregnant women. Methods: Self‐reported nasal stuffiness in gestational weeks 12, 20, 30, and 36 was correlated to age, parity, body mass index, and smoking habits. Results: The prevalence of nasal stuffiness increased during pregnancy and occurred in 27% of the women at 12 weeks of gestation, in 37% at 20 weeks, in 40% at 30 weeks and in 42% at 36 weeks. Sixty‐five percent of the women reported stuffiness at some time when asked. It was commoner in multiparous than in nulliparous women. Age, body mass index, and smoking habits were not associated with nasal stuffiness. Conclusion: Self‐reported nasal stuffiness for 3 or more weeks was common during pregnancy and could occur at any time in two thirds of the women. Treatment regimens to alleviate this symptom should be developed.