bluuebunny/crossref_metadata_2025 huggingface dataset:
Histologic Study of an Autologous Fat Graft in the Larynx of Dogs With Unilateral Vocal Fold Paralysis
Authors: Kruschewsky Leonardo de Souza , de Mello‐Filho Francisco Verissimo , Saggioro Fabiano , Serafini Luciano Neder , Rosen Clark Allan
Published: February 2009

Objective: To determine the histologic finds of autologous fat graft (AFG) in 24 paralyzed canine left vocal folds 12 weeks after introduction.

Study Design: Animal model. Experimental prospective study.

Methods: Twenty‐four mongrel dogs of both genders weighing 15 to 20 kg were divided into three study groups (SGs) of eight dogs each, whose larynges were grafted by vocal fold lipoinjection (VFL‐SGA), vocal fold lipoinjection plus insulin (VFLI‐SGB), and by fat graft medialization laryngoplasty (FGML‐SGC), respectively, and observed for 12 weeks, followed by immediate sacrifice. All 24 dogs were submitted to left vagal and recurrent laryngeal nerve resection. All animals were confirmed to have a left vocal fold paralysis four weeks later, when 2 mL of autologous fat graft were placed inside the left paraglottic space. The larynges were removed at pre‐established times and, after they were studied for remaining fat graft volume by magnetic resonance imaging, they were studied histologically to evaluate the influence of the different techniques on the histologic behavior of the graft.

Results: Each of the three study groups had its specific finds for fat graft detection and fat absorption, and its characteristics identified and compared statistically. The groups were not statistically different.

Conclusion: The histologic findings for the AFG applied to a vocal fold were similar in groups VFL‐SGA, VFLI‐SGB and FGML‐SGC 12 weeks after grafting, with no statistically significant differences between groups, and revealed an almost total loss of the grafted fat.
Management of the Post‐Tracheostomy Scar
Authors: Grant Nazaneen , Davison Steven P.
Published: February 2009

Tracheostomy scar management is aimed at filling lost deep tissue bulk, the correction of tracheal skin tug, and a tension‐free closure that falls more naturally into the neck folds. Three cases are used to illustrate the major principles involved in the correction of tracheostomy scars. Those reconstructive principles are 1) re‐approximation of individual layers of the neck for improved contour and release of tracheal skin tug, 2) filling of tissue deficit, using scar de‐epithelialization, muscle flaps, or acellular dermal grafts, 3) excision of hypertrophic scarring or keloids, and 4) horizontal wound closure using simple closure or local skin flaps such as z‐plasty. The goals and techniques outlined can resolve skin adherence to the trachea and can improve scar appearance in this noticeable location.
The Effects of Smoking on Short‐Term Quality of Life Outcomes in Sinus Surgery
Authors: Das Subinoy , Becker Adam M. , Perakis Helen , Prosser J Drew , Kountakis Stilianos E.
Published: February 2009

Objective: The purpose of this study was to prospectively compare the short‐term benefit of endoscopic sinus surgery for smokers and nonsmokers using a disease specific, clinically validated, quality of life outcomes measure, the Sinonasal Outcomes Test‐20 (SNOT‐20).

Study Design: Prospective clinical trial.

Methods: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative SNOT‐20 scores and comprehensive demographic data were obtained. All patients underwent endoscopic sinus surgery under the supervision of the senior author. Preoperative SNOT‐20 scores were compared to short‐term postoperative SNOT‐20 scores.

Results: Short‐term postoperative results were available for 221 patients for comparison. Preoperative SNOT‐20 scores in 49 smokers (mean: 27.8) and 172 nonsmokers (mean: 26.2) were statistically similar. Both smokers and nonsmokers achieved a highly significant reduction in SNOT‐20 scores at short‐term follow‐up evaluations. (P < .0005) Smokers achieved a greater reduction in SNOT‐20 scores (mean difference: 22.1) at short‐term follow‐up compared to nonsmokers (mean difference: 16.1). This result was statistically significant (P < .044).

Conclusions: This study confirms that smokers and nonsmokers achieve a highly significant short‐term benefit from endoscopic sinus surgery using a clinically‐validated symptom severity scale in a prospective study. Interestingly, smokers achieved a greater short‐term benefit than nonsmokers did. This study calls into question the notion that current smokers are poorer candidates for endoscopic sinus surgery. Further prospective studies to confirm these results and provide long‐term analysis should be performed.
Technique, Utility, and Safety of Awake Tracheoplasty Using Combined Laser and Balloon Dilation
Authors: Andrews Brian T. , Graham Scott M. , Ross Alan F. , Barnhart William H. , Ferguson J Scott , McLennan Geoffrey
Published: February 2009

Objectives: Laryngotracheostenosis (LTS) is a condition in which the airway is narrowed between the vocal cords and the carina. We seek to examine whether flexible bronchoscopy with neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser incision and balloon dilation tracheoplasty is a practical choice in the management of patients with subglottic or tracheal stenosis.

Methods: A retrospective chart review was performed at a tertiary care hospital. All subjects with laryngotracheostenosis treated between January 1, 2000, and April 2005 who underwent endoscopic Nd:YAG laser incision and balloon dilation tracheoplasty performed using topical anesthesia and intravenous sedation were included.

Results: A total of 18 patients comprised the study and 36 procedures were performed without complication. Only one procedure was required by eight subjects, while five subjects required two procedures, three subjects had three procedures, one subject had four procedures, and one subject had five procedures until an adequate stable airway was obtained. The average follow‐up was 22 months (range 3–55 months). The average body mass index (BMI) was 32.0 kg/m2 (range = 20.8–42.2 kg/m2) and 11 of the 18 subjects (61.1%) were categorized as obese or morbidly obese by BMI criteria.

Conclusion: Combined Nd:YAG laser incision and balloon dilation in an awake, spontaneously breathing patient is a safe and effective management tool in the treatment of laryngotracheostenosis. This technique may be particularly beneficial in patients who are at increased risk for general anesthesia such as those with morbid obesity or who have had a history of airway problems during anesthesia.
Endoscopic and Quality‐of‐Life Outcomes After Revision Endoscopic Sinus Surgery
Authors: Litvack Jamie R. , Griest Susan , James Kenneth E. , Smith Timothy L.
Published: February 2009

Objectives: First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality‐of‐life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co‐morbidities influence the relationship between revision surgery status and outcomes of ESS.

Study Design: Prospective observational study with an internal comparison group.

Methods: Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease‐specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's χ2 and multiple logistic regression models.

Results: Mean preoperative Lund‐Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status.

Conclusions: Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non‐polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.
Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center
Authors: Jacob Abraham , Robinson Lawrence L. , Bortman Jared S. , Yu Lianbo , Dodson Edward E. , Welling D Bradley
Published: February 2009

Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS).

Study Design: Retrospective.

Methods: Chart review.

Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy‐one of 74 patients (95%) patients with IVN tumors achieved a House‐Brackmann (HB) grade I–III, while 35 of 35 patients (100%) with SVN tumors retained HB I–III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1‐cm tumors, and 4 of 20 patients (20%) with 1‐ to 1.5‐cm tumors. For all cases with documented facial nerve function, HB I–III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures.

Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow‐up.
Migration of Cymetra After Vocal Fold Injection for Laryngeal Paralysis
Authors: Bock Jonathan M. , Lee John H. , Robinson Robert A. , Hoffman Henry T.
Published: February 2009

Injection laryngoplasty is a common operative technique used in the management of unilateral vocal fold paralysis. Cymetra is a micronized particulate injectable form of acellular human dermis that is commonly used for vocal cord medialization procedures. We report migration of an intracordal bolus of Cymetra into the medial wall of the pyriform sinus. Histopathology from endoscopic resection of the migrated Cymetra demonstrated a localized foreign body reaction with characteristic giant cells. Specific anatomic considerations through cadaveric laryngeal dissection are presented to demonstrate the likely pathway of intralaryngeal bolus migration.
Cochlear Implantation in Organ Transplantation
Authors: Patterson D Michael , Telischi Fred F. , Connell Sarah S. , Ulubil S Arif , Hodges Annelle V. , Eshraghi Adrien A. , Balkany Thomas J.
Published: February 2009

Objectives/Hypothesis: Compared to immunocompetent patients, organ transplant recipients receiving immunosuppressant medications may experience higher rates of postoperative complications. This study was designed to retrospectively review the outcomes of cochlear implantation among organ transplant patients.

Study Design: Retrospective case series.

Methods: Five organ transplant patients received seven cochlear implantations at the University of Miami Ear Institute from January 1, 1992, until August 31, 2005. Inpatient and outpatient records were analyzed to identify healing problems, wound infections, and speech recognition after implantation.

Results: There were no healing problems, wound infections, or other complications noted among cochlear implant recipients who had also received organ transplantation. Open‐set sentence discrimination as measured by the Hearing in Noise Test (HINT), City University of New York (CUNY) test, and/or Central Institute for the Deaf (CID) tests ranged from 46% to 89%. Open‐set word recognition as measured by the Consonant Nucleus Consonant (CNC) or the Northwestern University number 6 (NU‐6) test ranged from 26% to 64%.

Conclusions: This series suggests that cochlear implantation can be safe and effective for solid organ transplant recipients on immunosuppressants, with discrimination performance within the expected ranges for cochlear implant patients.
High Incidence of Malignant Transformation of Laryngeal Papilloma in Taiwan
Authors: Lee Li‐Ang , Cheng Ann‐Joy , Fang Tuan‐Jen , Huang Chung‐Guei , Liao Chun‐Ta , Chang Joseph Tung‐Chieh , Li Hsueh‐Yu
Published: February 2009

Objectives: Papillomas of the larynx include solitary laryngeal papilloma and recurrent respiratory papillomatosis. This study investigated the incidence of malignant transformation and assessed possible risk factors for laryngeal papillomas.

Study Design: A prospective, longitudinal study.

Methods: Twenty‐six consecutive laryngeal papilloma patients were prospectively studied for 5 or more years, and each patient was periodically examined at 3 to 6 month intervals. A detailed epidemiologic questionnaire was administered at the initial visit. After enrollment, tissue obtained during each laryngeal surgery was examined by polymerase chain reaction assay for human papilloma virus (HPV) and typing.

Results: During 237 person‐years of follow‐up, six new, pathologically confirmed cases of laryngeal carcinoma were ascertained (incidence 2.5/100 person‐years), and all were associated with HPV‐6 or HPV‐11. Malignant transformation revealed no correlation with the following: age less than 3 years at diagnosis, sex, history of tobacco use, history of alcohol consumption, family history of laryngeal cancer, or type of laryngeal papilloma. Laryngeal papilloma without demonstrable HPV DNA was the only significant risk factor for malignant transformation (P < .05). The cumulative risk of malignant transformation in subjects without demonstrable HPV DNA was significantly higher than that in HPV‐positive patients (relative risk, 8.0; 95% confidence interval, 1.1–60.3; P = .05).

Conclusions: A relatively high incidence of malignant transformation of laryngeal papilloma was noted in Taiwanese patients. Patients without demonstrable HPV DNA require more frequent follow‐up and may benefit from anti‐HPV vaccinations.
The Malleus‐Stapes Offset
Authors: Todd N Wendell
Published: February 2009

Background: The malleus‐stapes offset create challenges during ossiculoplasty, specifically the positioning of an interposed incus or replacement prosthesis relative to the manubrium.

Objectives: To depict the malleus‐stapes offset, its relationship to the orientation of the manubrium as viewed through the external ear canal relative to a horizontal plane, and mastoid pneumatization size.

Study Design: Postmortem anatomic dissection of 41 bequeathed adult crania (82 temporal bones) without clinical otitis.

Methods: The malleus‐stapes offset was analyzed both as a surgeon does intraoperatively and from above through the tegmen tympani. Mastoid sizes were determined radiographically.

Results: From the surgeon's perspective, for the right ear, the “height” (manubrium to caput stapedis) ranged from 0 to 1.5 (mean, 0.5) mm; the “horizontal” offset ranged from 1.0 to 4.0 (mean, 2.2) mm. Differences in angular offset, as viewed transcanally versus trans‐tegmenally, averaged 8.5 degrees (range to 53 degrees). Both height and horizontal offset exhibited wide intersubject variability, quite weak bilateral symmetry, and no relationship with either manubrium orientation or mastoid size.

Conclusion: Reliable determination of the malleus‐stapes offset is difficult. Because the error of visual offset assessment exceeds the generally accepted 45 degrees alignment allowance for an ossicular prosthesis, visualized ossiculoplasty alignment should be perfect. The ranges of manubrium‐stapes offset do not correlate with either manubrium orientation or the extent of mastoid pneumatization.
The Influence of Olfactory Loss on Dietary Behaviors
Authors: Aschenbrenner Katja , Hummel Cornelia , Teszmer Katja , Krone Franziska , Ishimaru Tadashi , Seo Han‐Seok , Hummel Thomas
Published: February 2009

Objectives: To assess dietary behavior and possible changes in food selection in patients with smell loss.

Patients and Methods: A total of 176 patients (114 women and 62 men) age 17 to 86 years were classified into three diagnostic groups (normosmia, n = 12; hyposmia, n = 75; functional anosmia, n = 89) according to their olfactory test scores obtained with “Sniffin' Sticks.” Group differences in food intake and dietary behaviors were investigated with a specifically designed questionnaire providing a dietary alterations score (DAS).

Results: Numerous dietary changes were reported, e.g., 29% of all patients reported that they eat less since the onset of olfactory dysfunction, 39% use more spices with their food, 47% go out to eat at restaurants less frequently, 37% eat less sweets, and 48% drink less sweet beverages.

Subjects with weight gain or weight loss scored higher on the DAS scale than subjects who did not report changes in weight. Similarly, DAS scale changes were more pronounced in subjects with a gradual onset of olfactory loss compared to subjects with a sudden loss of olfaction. Finally, a change of taste preferences toward savory and salty foods was observed across all patients enrolled in the present study.

Conclusions: Patients with olfactory loss report alterations of dietary behaviors. Numerous factors appear to impact the results of olfactory loss in terms of changes in diet.
Responses to Trigeminal Irritants at Different Locations of the Human Nasal Mucosa
Authors: Scheibe Mandy , van Thriel Christoph , Hummel Thomas
Published: February 2009

Background: Previous work suggests differences in the distribution of human intranasal trigeminal receptors. The aim of this study was to investigate these topographic differences for different concentrations of different trigeminal irritants using an electrophysiologic measure of trigeminal activation, the negative mucosa potential (NMP).

Materials and Methods: A total of 15 healthy volunteers participated. Presented by a computer‐controlled olfactometer CO2 (30% and 40% v/v), ethyl acetate (5.5% and 9.3% v/v) and acetic acid (205 and 40% v/v) were used for stimulation. NMP was recorded at the middle septum, the middle turbinate, and the floor of the nasal cavity.

Results: Maximum amplitudes of the NMP were found at the middle septum and were lowest at the nasal floor. Response amplitudes were related to stimulus concentrations. There was no significant difference between responses to the three different stimuli in relation to three recording sites.

Conclusions: In agreement with previous work, the present data suggest that there are topographic differences in the responsiveness of the mucosa to chemical irritants.
Resolving Feeding Difficulties With Early Airway Intervention in Pierre Robin Sequence
Authors: Lidsky Michael E. , Lander Timothy A. , Sidman James D.
Published: February 2009

Objectives/Hypothesis: To observe rates of gastrostomy tube (g‐tube) placement in Pierre Robin Sequence (PRS) and to determine whether relieving airway obstruction solves feeding difficulties.

Study Design: All PRS referrals to a multidisciplinary cleft team for children at a tertiary pediatric hospital from January 1988 to June 2006 were retrospectively reviewed.

Methods: Patients were analyzed for occurrence of g‐tube placement, neurologic disorders, and airway intervention including tracheotomy and mandibular distraction osteogenesis.

Results: Sixty‐seven PRS patients were divided into two categories: 51 (76.1%) isolated PRS (iPRS) and 16 (23.9%) with additional disorders and syndromes (sPRS). Patients were then placed into two subgroups: those who received early airway intervention and those who received late or no airway intervention. Of the 51 iPRS children, 12 (23.5%) received early airway intervention, none of whom required a g‐tube. There were 39 (76.5%) children who received late or no airway intervention, and 5 (12.8%) of these required g‐tube placement. Of the 16 sPRS children, 8 (50%) received early airway intervention, and 7 (87.5%) of these still required a g‐tube. Of the remaining 8 (50%) sPRS patients who received late or no airway intervention, 5 (62.5%) required a g‐tube.

Conclusion: In children with iPRS, feeding difficulties can be resolved with early airway intervention. Delaying airway intervention may necessitate feeding assistance because all of the iPRS children who required a g‐tube fell into this category. The presence of additional disorders and syndromes further complicates treatment because most of the sPRS children required g‐tubes regardless of airway intervention.
Role of Local Immunoglobulin E Specific for Alternaria alternata in the Pathogenesis of Nasal Polyposis
Authors: Sabirov Albert , Hamilton Robert G. , Jacobs Joseph B. , Hillman Dean E. , Lebowitz Richard A. , Watts Joe D.
Published: February 2009

Objective/Hypothesis: The role of fungal pathogens in the etiology of nasal polyposis remains unclear. The aim of this study was to determine whether there was a correlation between the presence of Alternaria‐specific immunoglobulin (Ig)E antibodies, eosinophilic inflammation, and the development of nasal polyps.

Study Design: Prospective study.

Methods: Serum and nasal tissue homogenates from 21 patients with manifestations of chronic sinusitis with nasal polyps were compared with specimens from 13 chronic sinusitis patients without polyps and 8 healthy controls. The Phadia ImmunoCAP and enzyme‐linked immunosorbent assay were used to quantify levels of total IgE and Alternaria‐specific (IgE, IgG, and IgA) antibodies. Eosinophil cationic protein (ECP) and tryptase levels were measured in tissue homogenates, whereas the inflammatory response was evaluated using tissue eosinophil counts in tissue samples.

Results: Serum analysis revealed no difference in the levels of total IgE and Alternaria‐specific IgE, IgG, and IgA antibodies between the study groups. In contrast, the levels of Alternaria‐specific IgE in tissue with polyps were significantly higher than in nonpolyp tissue. Increases in total tissue IgE paralleled increased levels of Alternaria‐specific IgG and IgA antibodies in chronic sinusitis with nasal polyps as compared with control groups. A positive correlation was found between Alternaria‐specific IgE and ECP in tissue. Increased mean levels of ECP corresponded to increased eosinophil counts in the group of patients with polyps.

Conclusions: Alternaria‐specific IgE and eosinophilic inflammation in nasal tissue correlates with the incidence of nasal polyps irrespective of specific IgE antibodies in serum. Together, the correlation between the local immune responses and the eosinophilic inflammation in nasal polyps suggests a possible role of Alternaria in the pathogenesis of nasal polyposis.
Potential Structures That Could Be Confused With a Nonrecurrent Inferior Laryngeal Nerve: An Anatomic Study
Authors: Maranillo Eva , Vazquez Teresa , Quer Miquel , Niedenführ Marc Rodriguez , Leon Xavier , Viejo Fermin , Parkin Ian , Sanudo Jose R.
Published: February 2009

Objectives: Study and detailed description of the large connections between the normally recurrent inferior laryngeal nerve (RILN) and the sympathetic trunk (ST) because these may be mistaken for a nonrecurrent inferior laryngeal nerve (NRILN).

Study Design: Morphologic study of adult human necks.

Methods: The necks of 144 human, adult, embalmed cadavers were examined (68 males, 76 females). They had been partially dissected by Cambridge preclinical medical students and then further dissected by the authors using magnification. The RILN, the ST, and their branches were identified and dissected. A total of 277 RILNs and STs (137 rights, 140 lefts) were observed.

Results: A communicating branch (CB) with a similar diameter to the RILN occurred between the ST and the RILN in 48 of the 277 (17.3%) dissections, 24 from the 137 (17.5%) right dissections, and 24 from the 140 (17%) left dissections. In 12 cases, the CB was bilateral. The CB arose from the superior cervical sympathetic ganglion in 3 of the 48 (6.25%) cases, from the middle ganglion in 10 (21%) cases, from the stellate ganglion in 3 (6.25%) cases, and from the ST in 32 (66.6%) cases. One (0.36%) NRILN associated with a right retro‐esophageal subclavian artery (arteria lusoria) was found.

Conclusions: 1) The CB between the RILN and the ST may have a diameter and course similar to an NRILN and may be confused with it. 2) The occurrence of the CB is greater than the occurrence referred to in previous studies. 3) The occurrence of the CB is similar by side and sex. 4) The CB may arise at different levels from the cervical ST and ganglia and end in the thyroid area. 5) Other neural elements may also be confused with an RILN, such as the cardiac nerves and the collateral branches from an NRILN to the trachea and esophagus.
Severe Posterior Epistaxis–Endoscopic Surgical Anatomy
Authors: Pádua Francini G. M. , Voegels Richard L.
Published: February 2009

Objective: To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations.

Study Design: Prospective study accomplished from September, 2006, to January, 2007.

Methods: The sphenopalatine foramen (SPF) of 61 cadavers were carefully dissected. Presence of the ethmoidal crest, location of sphenopalatine and accessory foramens, and the number of arterial branches emerging through foramens were observed. Data were analyzed in relation to gender, racial group, and symmetry of the cadaver. Prediction of the presence of accessory foramen was evaluated.

Results: Mixed race cadavers prevailed in 122 nasal fossae dissected (75% males). Ethmoidal crest was present in 100% of the cadavers, being anterior to the SPF in 98.4% of the cases. The most frequent SPF location was the transition of the middle and superior meatus (86.9%). Mean distance from the SPF and accessory foramen to anterior nasal spine was 6.6 cm and 6.7 cm, respectively. Accessory foramen was present in 9.83% of the cases. A single arterial stem emerged through the SPF in 67.2% of the cases, and 100% through accessory foramens. The prevalence analyses showed no differences that were statistically significant (P > 0.05) between gender and racial group. The symmetry analyses showed a strong conformity (P < 0.01) between nasal fossae in relation to the SPF location. There was no statistically significant conformity between nasal fossae and accessory foramen (P = 0.53). None of the variables of interest presents any statistically significant (P > 0.05) association with the presence of the accessory foramen.

Conclusions: There are anatomical variations in the lateral nose wall that should be considered for successful endoscopic surgical treatment of severe epistaxis.
Active Noise Reduction Audiometry: A Prospective Analysis of a New Approach to Noise Management in Audiometric Testing
Authors: Bromwich Matthew A. , Parsa Vijay , Lanthier Nicole , Yoo John , Parnes Lorne S.
Published: February 2009

Objectives: To develop a new method of screening audiometry that reduces the adverse effects of low frequency background noise by using active noise reduction (ANR) headphone technology.

Design: Prospective testing within an anechoic chamber evaluated the physical properties of ANR headphones. A prospective clinical crossover study compared standard audiometry with ANR headphone audiometry.

Methods: Bose Aviation X circum‐aural ANR headphones were tested for both active and passive attenuation properties in a hemi‐anechoic chamber using a head and torso simulator. Thirty‐seven otology clinic patients then underwent standard audiometry and ANR audiometry, which was performed in a 30‐ and/or 40‐dB sound field.

Results: Objective ANR headphone attenuation levels of up to 12 dB were achieved at frequencies below 2,000 Hz. In standard audiometric testing, 40 dB of narrow‐band background noise decreased patient pure tone thresholds by 24 dB at 250 Hz. The use of ANR technology provided 12 dB of additional attenuation. This resulted in a significant improvement in test results despite the 40 dB of background noise (P = <0.001). In a 30‐dB sound field, standard audiometric thresholds were shifted down by an average of 12 dB. The use of ANR technology completely attenuated this effect and resulted in a significant improvement in results (P = <0.01). These results were identical to those obtained in a quiet sound booth.

Conclusions: Despite a 30‐dB sound field, ANR audiometry can produce an audiogram identical to that obtained in a double‐walled sound booth. ANR headphone audiometry improves the sensitivity of audiometric screening for mild low‐frequency hearing loss. This technology may have important applications for screening in schools, industry, and community practices.
Middle Turbinate Medialization With Bovine Serum Albumin Tissue Adhesive (BioGlue)
Authors: Friedman Michael , Schalch Paul
Published: February 2009

Middle turbinate (MT) medialization without resection is an approach designed to both preserve the MT and prevent lateralization, which may cause obstruction of the outflow of the ethmoid, maxillary, and frontal sinuses after endoscopic sinus surgery. Many techniques for medialization have been described. We present a quick and easy technique that involves using the microdebrider to create small areas of denuded mucosa on opposite surfaces of the MT and the nasal septum followed by an application of a bovine serum albumin tissue adhesive to promote the formation of controlled synechiae without the need for nasal packing.
Superficial Musculoaponeurotic System Elevation and Fat Graft Reconstruction After Superficial Parotidectomy
Authors: Curry Joseph M. , Fisher Kyle W. , Heffelfinger Ryan N. , Rosen Marc R. , Keane William M. , Pribitkin Edmund A.
Published: February 2009

Objective/Hypothesis: Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome.

Study Design: Retrospective, case‐control study.

Methods: Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms.

Results: Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable.

Conclusions: Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.
Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?
Authors: Ahn Joong Ho , Yoo Myung Hoon , Yoon Tae Hyun , Chung Jong Woo
Published: February 2009

Objective: To evaluate the therapeutic efficacy of intratympanic dexamethasone (ITD) injections added to systemic steroids in patients with idiopathic sudden sensorineural hearing loss (HL).

Materials and Methods: A total of 120 patients diagnosed with sudden HL were treated with ITD injections (0.3 mL on days 1, 3, and 5) plus 48 mg methylprednisolone (ITD group) or methylprednisolone alone (control group).

Results: The total recovery rate after the treatment was 73.3% in the ITD group and 70.0% in the control group. Although improvements in pure‐tone average were the same in the two groups, the ITD group showed significantly better hearing improvement at 250 Hz than the control group.

Conclusion: The addition of ITD to systemic steroids did not result in significant improvements in the treatment of idiopathic sudden HL.
Nasal Surgery for Snoring in Patients With Obstructive Sleep Apnea
Authors: Li Hsueh‐Yu , Lee Li‐Ang , Wang Pa‐Chun , Chen Ning‐Hung , Lin Ying , Fang Tuan‐Jen
Published: February 2009

Objective: To evaluate the efficacy of nasal surgery to relieve snoring and to identify predictive factors.

Study Design: Prospective comparative study.

Methods: Fifty‐two consecutive patients (51 males; mean age, 38 yr; body mass index, 25.4 ± 5.2 kg/m2) were enrolled. All patients had been previously diagnosed with obstructive sleep apnea (apnea/hypopnea index, 38.5 ± 33.2 events/hr) and symptomatic nasal obstruction secondary to deviated nasal septum. Septomeatoplasty alone was the treatment in this study cohort. Snoring was assessed by Snore Outcome Survey (SOS), and nasal obstruction was assessed by visual analogue scale (VAS) and anterior rhinomanometry at baseline and approximately 3 months after nasal surgery.

Results: Body mass index remained unchanged (P > .05) after surgery. Significantly improved SOS (P < .001), VAS (P < .001), and total nasal resistance (P = .002) were noted after nasal surgery. Eighty‐six percent of patients had improved SOS scores, and average improvement was 46%. Complete relief of snoring was reported by the sleep partners of six (12%) patients. Change in SOS scores (22.5 ± 14.5 vs. 10.1 ± 10.4) significantly differed (P = .01) between tonsil size grade (TON) 0/I and TON II/III groups. Other baseline variables did not significantly differ (P > .05) in SOS score changes.

Conclusions: In patients with obstructive sleep apnea suffering from both snoring and nasal obstruction, nasal surgery for deviated septum relieves snoring in 12%. The tonsil size affects the outcome of nasal surgery for snoring.
Dual Action of TGF‐β1 on Nasal‐Polyp Derived Fibroblasts
Authors: Little Stewart C. , Early S Brandon , Woodard Charles R. , Shonka David C. , Han Joseph K. , Borish Larry , Steinke John W.
Published: February 2009

Objectives: Transforming growth factor β‐1 (TGF‐β1) is a known fibrogenic factor with immunosuppressive properties. We wanted to determine the effect of stimulation with TGF‐β1 on nasal polyp‐derived fibroblasts and assess the role this molecule would have in polyp formation and growth.

Study Design: Nasal‐polyp derived fibroblasts were cultured with or without TGF‐β1, and proliferation and cytokine secretion were measured.

Methods: Fibroblasts were isolated from nasal polyps following endoscopic surgery. Cells were plated and grown until confluent, after which they were split and used in assays. Cells were stimulated with TGF‐ β1 and mRNA collected after 16 hours, supernatants after 72 hours, and proliferation measured after 96 hours of culture.

Results: TGF‐β1 significantly (P < .02) increased proliferation of nasal‐polyp derived fibroblasts. We examined the expression of inflammatory cytokines and found that TGF‐β1 decreased expression of CCL2 (MCP‐1), CCL5 (RANTES), CCL11 (eotaxin), granulocyte‐colony stimulating factor (G‐CSF), and GM‐CSF (P < .05). In contrast, incubation with TGF‐β1 increased fibronectin, procollagen, vascular endothelial growth factor (VEGF), and TGF‐β2 protein production (P < .05). For select samples, we confirmed that the increased protein production was due to increased mRNA expression.

Conclusion: These studies suggest that TGF‐β1 expression in polyp tissue can have dual effects. One role is to act as an anti‐inflammatory agent shown by the ability to inhibit pro‐inflammatory mRNA and protein production. At the same time, TGF‐β1 expression leads to increases in factors involved in fibrosis and angiogenesis, promoting remodeling and cell growth.
Long‐Term Results of Provox ActiValve, Solving the Problem of Frequent Candida‐ and “Underpressure”‐Related Voice Prosthesis Replacements
Authors: Soolsma Jessica , van den Brekel Michiel W. , Ackerstaff Annemieke H. , Balm Alfons J. , Tan Bing , Hilgers Frans J.
Published: February 2009

Objectives: To assess the long‐term results of the Provox ActiValve, a prosthesis for voice rehabilitation after total laryngectomy that was designed to lessen the need for frequent replacements caused by Candida and “underpressure.”

Patients and Methods: Retrospective assessment of device lifetime, indications for replacement, voice quality, and maintenance issues, measured by a structured trial specific questionnaire, in a cohort of 42 laryngectomized patients, experiencing a short Provox2 device lifetime (median, 21 days).

Results: The median device lifetime of Provox ActiValve, replaced for leakage through the device and those still in situ at the date of data collection (N = 32), was 337 days (mean 376 days): a statistically significant 16‐fold increase compared to the Provox2 prosthesis (P < .001). In 10 patients, replacement was fistula‐related (median after 86 days): esophageal pouch (N = 4), fistula granulation (N = 3), extrusion of the device (N = 2), and periprosthetic leakage (N = 1). Eighty‐six percent of the patients used a special lubricant to diminish “stickiness” of the valve. Provox ActiValve was preferred by 90% of the patients who completed the trial‐specific questionnaire.

Conclusions: For patients requiring frequent device‐related replacements, Provox ActiValve, also long‐term, provides a true solution and thereby is a valuable addition to prosthetic voice rehabilitation.
“Not One Single Case of Throat Irritation”: Misuse of the Image of the Otolaryngologist in Cigarette Advertising
Authors: Samji Hussein A. , Jackler Robert K.
Published: February 2009

Early in the last century, when questions about the health effects of smoking became a topic of widespread discussion, tobacco companies undertook a multi‐faceted campaign to allay the public's fears. As terms like “smoker's cough” and “coffin nails” (referring to cigarettes) began to appear in the popular vernacular, tobacco marketers recognized the need to counter this threat to their livelihood. One strategy was to use endorsements by healthy and vigorous‐appearing singers, radio stars, and actors. Another was to raise fears over weight gain: “Reach for a Lucky instead of a sweet.” Among the more reprehensible tactics was the utilization of the image of the noble and caring physician to sell cigarettes: doctors were depicted both as satisfied and enthusiastic partakers of the smoking habit (e.g., “More doctors smoke Camels”). Images of medical men (and a few token women) appeared under warm reassurances of the safety of smoking. Frequently, images appeared of a head‐mirrored “throat doctor,” smiling benignly, while indicating that the company's product would do no harm. Indeed, many cigarette ads, especially for menthol brands, suggested a therapeutic soothing benefit from smoking. Liberal use was also made of pseudo‐scientific medical reports and surveys. Our intention is to tell, principally through advertising images–the story of how, between the late 1920s and the early 1950s, tobacco companies used deceptive and often patently false claims in an effort to reassure the public of the safety of their products.
Long‐Term Results of a Phase III Randomized Trial of Postoperative Radiotherapy With or Without Carboplatin in Patients With High‐Risk Head and Neck Cancer
Authors: Argiris Athanassios , Karamouzis Michalis V. , Johnson Jonas T. , Heron Dwight E. , Myers Eugene , Eibling David , Cano Elmer , Urba Susan , Gluckman Jack , Grandis Jennifer R. , Wang Yun , Agarwala Sanjiv S.
Published: February 2009

Background:The role of postoperative radiotherapy and carboplatin in squamous cell carcinoma of the head and neck (SCCHN) has not been established.

Methods:Patients with macroscopically resected stage III/IV SCCHN with high‐risk pathologic features (≥3 lymph nodes, extracapsular extension, perineural or angiolymphatic invasion, or involved margins) were randomized to receive postoperative radiotherapy alone (arm A) or the same radiotherapy plus carboplatin 100 mg/m2intravenously once weekly during radiation (arm B). The primary endpoint was 2‐year disease‐free survival.

Results:Seventy‐six patients were randomized, of whom 72 were eligible and analyzable (36 in each arm). The study was prematurely closed because of slow accrual. With a median follow‐up of 5.3 years, the disease‐free survival at 2 and 5 years was 71% and 53% in arm B versus 58% (P= .27) and 49% (P= .72) in arm A. The overall survival at 2 and 5 years was 74% and 47% in arm B versus 51% (P= .04) and 41% (P= .61) in arm A. Serious toxicities were infrequent in both arms.

Conclusions:We could not demonstrate a benefit with the addition of carboplatin to postoperative radiotherapy, possibly because of insufficient sample size.
In Vitro Activity of Mupirocin on Clinical Isolates of Staphylococcus aureus and its Potential Implications in Chronic Rhinosinusitis
Authors: Ha Kien R. , Psaltis Alkis J. , Butcher Andrew R. , Wormald Peter‐John , Tan Lor Wai
Published: February 2009

Background: It has been postulated that bacterial biofilms are involved in the pathogenesis of chronic rhinosinusitis (CRS). Biofilms present on sinus mucosa are difficult to eradicate with conventional antibiotic therapy and are thought to provide a nidus for recurrent infection. Topical delivery of antibiotics via nasal irrigation may present a way of delivering high concentrations of antibiofilm agents with potentially low systemic absorption and side effects. This study investigates the effectiveness of mupirocin and two other antibiotics, ciprofloxacin and vancomycin, on established in vitro biofilms of Staphylococcus aureus isolated from patients with CRS.

Methods:
S. aureus American Type Culture Collection 25923 and 12 clinical isolates were investigated for their ability to form biofilms in an in vitro setting using a 96 well microtiter crystal violet (CV) plate assay and confocal scanning laser microscopy (CSLM). Antimicrobial susceptibility tests to determine minimum inhibitory concentrations were performed on planktonic and biofilm forming strains. In addition, established biofilms were subjected to the antimicrobial agents at a twofold dilution series. A CV analysis of biofilm mass was performed after 1 and 24 hours of treatment, and minimum biofilm inhibition concentrations at 50% (MIB50) and 90% (MIB90) biofilm inhibition were recorded.

Results: With use of a 96‐well microtiter plate CV assay, 8 of the 12 clinical isolates formed mature biofilms after 8 days of culture. These results correlated with findings from CSLM analysis of in vitro biofilms grown on Permanox chamber slides. Increased antimicrobial resistance was observed in the biofilm isolates when compared with planktonic counterparts. Mupirocin was capable of reducing biofilm mass by greater than 90% at concentrations of 125 μg/mL or less in all S. aureus isolates. Ciprofloxacin and vancomycin were largely ineffective in attaining MIB90 concentrations within safe dosage ranges.

Conclusions: The topical application of mupirocin via nasal irrigation may be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS and may offer an additional treatment to patients with recalcitrant sinusitis.
Prognostic Value of Electroneurography and Electromyography in Facial Palsy
Authors: Grosheva Maria , Wittekindt Claus , Guntinas‐Lichius Orlando
Published: February 2009

Objectives: To compare the prognostic value of electroneurography (ENG) and needle electromyography (EMG) to estimate facial function outcome after acute facial palsy.

Study Design: Retrospective study using electrodiagnostic data and medical chart review.

Methods: Two hundred one patients treated 1995 to 2004 were included. Initial and final facial function was established clinically by the House‐Brackmann (HB) scale. ENG results were classified into amplitude loss less than 75% and amplitude loss 75% or greater to predict complete recovery and defective healing, respectively. Initial and follow‐up EMG results were classified into neurapraxia and predicted complete recovery. In contrast, axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective healing.

Results: Initial HB was II to IV in 154 patients and V to VI in 47 patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29, traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients showed a full recovery. Sixty‐seven (33%) patients showed signs of defective healing. ENG presented a sensitivity, specificity, accuracy, positive predictive value (to predict defective healing), and negative predictive value of 60%, 79%, 73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%, 89%, 91%, and 89%. The best results showed the follow‐up EMG with 85%, 100%, 97%, 100%, and 96%. EMG results were not classifiable in 32 (16%) patients.

Conclusions: EMG showed higher prognostic values than ENG, especially when repeated during the time course of the facial palsy. ENG might be helpful if the EMG result is not classifiable.
Persistent Allergic Rhinitis Includes Different Pathophysiologic Types
Authors: Ciprandi Giorgio , Cirillo Ignazio , Pistorio Angela
Published: February 2009

Background: Allergy rhinitis is typically classified as seasonal allergy rhinitis (SAR) and perennial allergy rhinitis (PAR). More recently, the Allergic Rhinitis and its Impact on Asthma document proposed the intermittent (ITR) and persistent forms (PER). However, it has been previously reported that each single allergen may induce different clinical and pathophysiologic features.

Objective: The aim of the study was to test the hypothesis that the type of causal allergen might characterize pathophysiologic differences in a cohort of patients with PER.

Methods: Three hundred nineteen patients, sailors of the Italian Navy, with moderate‐severe PER were prospectively and consecutively evaluated with clinical evaluation, skin prick test, rhinomanometry, and nasal decongestion test.

Results: Patients with pollen allergy showed significantly more severe symptoms, lower nasal airflow, and higher response to decongestion test than patients with allergy to perennial allergens (P < .0001).

Conclusion: This study provides evidence that patients with PER may show different pathophysiologic patterns depending on the type of causal allergen.