bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Neck Dissection for the Treatment of Neck Metastasis From Squamous Cell Carcinoma of the Head and Neck
Authors: Chepeha Douglas B. , Hoff Paul T. , Taylor Rodney J. , Bradford Carol R. , Teknos Theodoros N. , Esclamado Ramon M.
Published: November 2003

Objective Our objective was to determine the proportion of patients disease free in the neck, with the primary site controlled, who have been treated with a selective neck dissection (SND) for squamous cell carcinoma (SCCa) of the upper aerodigestive tract, and who had cervical metastasis less than 3 cm.

Study Design A cohort of patients who fit the inclusion/exclusion criteria was identified retrospectively. Then all surviving patients were followed for a minimum of 2 years.

Methods A group of 52 patients who had 58 selective neck dissections for cervical metastases from SCCa of the upper aerodigestive tract were identified. The mean age was 56 years (range, 20–85 y), there were 40 males and 12 females, and mean follow‐up was 24.5 months (range, 1–64 mo). Twenty‐six patients had clinically negative (cN0) neck examinations and 26 had clinically positive neck examinations. Postoperative radiation was given for extracapsular spread, greater than 2 positive nodes, T3, T4, or recurrent disease if the patient had not received radiation before surgery. These radiation criteria excluded 18 patients from postoperative radiation treatment.

Results Kaplan‐Meier survival analysis showed that the regional control rate with the primary site controlled was 0.94. Six patients developed recurrent neck disease. Three of these 6 patients were surgically salvaged. Four recurrences were in the dissected field and 2 were out of the dissected field (level V).

Conclusions With similar indications for radiation therapy, the regional control rate in this cohort is comparable to control rates obtained with modified radical neck dissection.
The Association Between Glutathione S‐Transferase P1 Genotype and Plasma Level in Head and Neck Cancer
Authors: Kelders Willem P. A. , Oude Ophuis Michael B. , Roelofs Hennie M. J. , Peters Wilbert H. M. , Manni Johannes J.
Published: November 2003

Objectives/Hypothesis Glutathione S‐transferase P1‐1 (GSTP1‐1) is an important enzyme because it plays a major role in many detoxification reactions, including tobacco‐related metabolic products. GSTP1‐1 is the most abundant of all glutathione S‐transferase (GST) enzymes in normal human head and neck epithelium, whereas it is overexpressed in head and neck malignancies. At least three different GSTP1 genotypes exist, AA, AB, and BB, which have been correlated with reduced enzyme activity. Many authors have studied the GSTP1 genotypes in relation to the risk for human head and neck squamous cell carcinoma (HNSCC). A correlation between GSTP1‐1 genotype and GSTP1‐1 plasma levels has not been made before. We investigated the correlation between GSTP1 genotype and GSTP1‐1 plasma levels.

Study Design To evaluate the possible association between the genetic polymorphisms in GSTP1 and the phenotypic expression (GSTP1‐1 plasma levels) in patients with HNSCC.

Methods GSTP1 genotype and GSTP1‐1 plasma level were established in 87 patients with HNSCC and 51 patients with benign head and neck lesions who served as control subjects.

Results For all GSTP1 genotypes (AA, AB, and BB) in patients with HNSCC, the mean plasma GSTP1‐1 values were significantly higher compared with the control subjects. There was no significant difference in the plasma GSTP1‐1 levels between the different genotypes in patients with HNSCC.

Conclusion There is no association between GSTP1 genotype and GSTP1‐1 plasma levels in patients with head and neck cancer.
Cyclin D1 Amplification and p16(MTS1/CDK4I) Deletion Correlate With Poor Prognosis in Head and Neck Tumors
Authors: Namazie Ali , Alavi Sassan , Olopade Olufunmilayo I. , Pauletti Giovanni , Aghamohammadi Neema , Aghamohammadi M. , Gornbein Jeffrey A. , Calcaterra Thomas C. , Slamon Dennis J. , Wang Marilene B. , Srivatsan Eri S.
Published: November 2003

Objectives/Hypothesis Cyclin D1, a cell cycle regulator localized to chromosome 11q13, is amplified in several human tumors including head and neck squamous cell carcinoma (HNSCC). Amplification and/or overexpression of cyclin D1 have been correlated to a poor prognosis. Deletion of the p16 gene, localized to 9p21, has also been observed in a significant proportion of HNSCC. The p16 gene regulates cyclin D1‐CDK4 activity and prevents retinoblastoma tumor suppressor gene phosphorylation, thereby downregulating cellular proliferation. Detection of cyclin D1 amplification and p16 deletion using a simple and sensitive method will be valuable for the development of effective treatment modalities for head and neck cancer.

Study Design We have used fluorescence in situ hybridization (FISH) to study cyclin D1 amplification and p16 gene deletion in head and neck tumors. Both single‐ and dual‐color FISH were performed.

Methods Paraffin‐embedded tissues from 103 patients with HNSCC were analyzed using genomic DNA probes for cyclin D1 and p16. Dual‐color FISH was performed with chromosome 11 or 9 centromeric probes as a control. Twenty‐eight of these samples were analyzed for p16 expression by immunohistochemistry.

Results Cyclin D1 amplification was observed in 30% (31/103) of patients, and p16 deletion in 52% (54/103). Lack of p16 expression was observed in 64% (18/28) of patients. There was a good correlation between the deletion of p16 sequences and the loss of p16 expression (P = .008). Amplification of cyclin D1 had a statistically significant association with recurrence, distant metastasis, and survival at 36 months. There was a significant association between p16 deletion and the development of distant metastases. Cyclin D1 amplification and p16 deletion together correlated with recurrence, distant metastasis, and survival.

Conclusions We demonstrate that FISH is a simple and sensitive method for detecting cyclin D1 amplification and p16 deletion in head and neck cancer. Our results suggest that these two genetic aberrations together portend a poorer outcome than either of the abnormalities alone in head and neck cancer.
Lateralization During the Weber Test: Animal Experiments
Authors: Sichel Jean‐Yves , Freeman Sharon , Sohmer Haim
Published: November 2003

Objectives/Hypothesis The objective of this study were to present an assessment of a new theory to explain lateralization during the Weber test using an animal model. This theory is based on the discovery that a major pathway in bone conduction stimulation to the inner ear is through the skull contents (probably the cerebrospinal fluid [CSF]). The placement of a bone vibrator or tuning fork on the skull excites the inner ear by the classic osseous pathway and by the suggested CSF pathway. We assume that there is a phase difference between the stimulation mediated by the ossicular chain (inertial and occlusion mechanisms) and the one mediated by the CSF. The presence of a conductive pathology will decrease the magnitude of the sound energy mediated by the ossicular chain. Thus, the out‐of‐phase signal arriving through the bony pathways will be decreased, hence increasing the resultant sound intensity stimulating the cochlea.

Study Design Prospective animal study.

Methods The experiment was performed on 10 fat sand rats, which had undergone unilateral cochleostomy and a small craniotomy. The auditory nerve brainstem response (ABR) thresholds were measured to air‐conducted stimulation, to stimulation with the bone vibrator applied to the skull, and to stimulation with the bone vibrator applied directly to the brain through the craniotomy. The ossicular chain of the second ear was then fixed to the middle ear walls with cyanoacrylate glue to induce a conductive hearing loss. The ABR thresholds to the same three stimuli were then measured again.

Results After ossicular chain fixation, the ABR threshold to air‐conducted stimulation increased, to bone vibrator stimulation on the bone decreased (hearing improvement), and to bone vibrator stimulation directly on the brain remained unchanged.

Conclusions This experiment confirms the proposed theory. During clinical bone conduction stimulation, there is a phase difference between sound energy reaching the inner ear through the middle ear ossicles and from the CSF. A middle ear conductive pathology removes one of these components, thus increasing the effective sound intensity in the affected ear. On the other hand, when the bone vibrator is applied on the brain, the inner ear is stimulated only through the CSF, so ossicular chain fixation does not change the ABR threshold. Moreover, this study proves that lateralization during the Weber phenomenon is the result, at least in part, of an intensity difference between sound energy reaching the two cochleae.
Evaluating the Upper Airway With Standardized Magnetic Resonance Imaging
Authors: Stuck Boris A. , Köpke Julian , Maurer Joachim T. , Verse Thomas , Kuciak Gregor , Düber Christoph , Hörmann Karl
Published: November 2003

Objectives/Hypothesis Magnetic resonance imaging (MRI) potentially offers various advantages in assessing the upper airway. The aims of the presented study were 1) to evaluate which anatomical parameters of upper airway soft tissue morphology (distances, areas, volumes) could be defined using MRI scans, 2) to examine the stability or variability of these parameters over time and between different investigators, and 3) to develop a standardized protocol for MRI measurements of the upper airway.

Study Design Prospective clinical trial.

Methods Twenty‐four scans were performed on six healthy subjects over a period of 4 weeks. Various parameters such as tongue dimensions, volumes and spaces, posterior airway spaces, and soft palate dimensions were established, and their variation over time between different investigators and with repeated analysis was assessed.

Results All the parameters were of high stability and reproducibility. The time of day had no significant influence on the results. An abbreviated method for the evaluation of the tongue volume was developed. Four‐millimeter slices with a conventional MRI scan generate pictures of high quality in a maintainable acquisition time.

Conclusions We were able to evaluate which anatomical parameters of upper airway could be defined using MRI scans. The variability of these parameters over time and between different investigators was assessed. We developed a standardized protocol for MRI measurements of the upper airway. Standardized protocols are mandatory, and the variability of the measurements must be taken into account if results of different clinical centers must be compared or if changes after therapeutic interventions are to be investigated.
Hemangiomas and Vascular Malformations: Analysis of Diagnostic Accuracy
Authors: Very Mark , Nagy Mark , Carr Michelle , Collins Sandy , Brodsky Linda
Published: November 2003

ObjectivesTo evaluate the diagnostic accuracy and satisfaction of patient or family (or both) in the evaluation of hemangiomas and other vascular malformations.

Study DesignProspective, relational database.

MethodsNinety‐eight patients participated in a prospective, Institutional Review Board–approved, relational database study in the Hemangioma and Vascular Birthmark Center at the Children's Hospital of Buffalo (Buffalo, NY) from July 1998 to April 2000. This included 68 patients with hemangiomas and 30 with vascular malformations. Data regarding presenting and final diagnosis and satisfaction of patient or family (or both) were obtained.

ResultsAnalysis of diagnostic accuracy revealed a concurrence between initial and final combined clinical and magnetic resonance imaging–based diagnosis in only 37% of cases. Analysis of patient and family satisfaction with the care received from previous consultants revealed only 26% “entirely” satisfied, 26% “somewhat” satisfied, and 37% “not at all” satisfied. On average, 2.5 (SD = 1.6; range, 1–9; median, 2) different physicians saw the patient before the patient or family (or both) was satisfied.

ConclusionsAccurate diagnosis of hemangiomas and vascular malformations remains a challenge for physicians. Confusing terminology, lack of knowledge regarding lesion behavior, and poorly understood diagnostic criteria by physicians are some of the reasons for patient frustration. Education of primary care providers through improved communication helps to optimize a coordinated, interdisciplinary approach to patients and their families who present with vascular anomalies.
Risk of Injury to the External Branch of the Superior Laryngeal Nerve in Thyroidectomy
Authors: Hurtado‐Lopez Luis Mauricio , Zaldivar‐Ramírez Felipe Rafael
Published: November 2003

Objective To establish in the Mexican population with thyroid disease the risk of injury to the external branch of the superior laryngeal nerve (EBSLN) based on its anatomical position.

Study Design Nonrandomized comparative clinical trial.

Methods Seventy‐three patients subjected to thyroidectomy because of thyroid nodule in which the EBSLN was identified and classified. The dependent variable was Cernea' classification of the EBSLN, and the independent variables were weight (in grams) of the nodule, side studied, gender, and age. For statistical analysis, χ2 test, Fisher's Exact test, and analysis of multiple variables (analysis of variance) were used.

Results We studied 73 patients; 64 (87.62%) were women and 9 (12.38%) were men (average age, 39.3 years [age range, 17–73 y]; median age, 40 y; mode, 40 y; SD ± 23.4 y). Regarding location of the EBSLN, for pathological lobes, 78.1% were located in a high‐risk position and for nonpathological lobes, 72.7%. Comparative analysis between sides and relation between weight and classification revealed no statistical significance.

Conclusion The frequency of high‐risk position for EBSLN lesion in our milieu was higher than that reported in series from other countries and races.
Differential Effects of Short‐Chain Fatty Acids on Head and Neck Squamous Carcinoma Cells
Authors: Krishna Srinivasan , Brown Neil , Faller Douglas V. , Spanjaard Remco A.
Published: November 2003

Objectives/Hypothesis Head and neck squamous cell carcinoma (HNSCC) is a major cause of mortality. Despite advances in therapeutic modalities, recurrences and second primaries are commonly observed. Biological agents that can suppress growth of tumors that are otherwise difficult to treat are greatly needed. The present study examined the effects of short‐chain fatty acids on HNSCC cell lines.

Study Design The effects of short‐chain fatty acids on HNSCC cells was examined using tissue culture and immunoblotting techniques.

Methods The effects of four short‐chain fatty acids, arginine butyrate, α‐methyl hydrocinnamic acid, 2,2‐dimethylbutyrate, and α‐lipoic acid, were evaluated on four HNSCC cell lines (FaDu, SCC9, SCC25, and Detroit‐562). Proliferation assays were performed by means of spectrophotometric techniques. Histone deacetylase activity was assessed by identifying the amount of acetylated histone H4. Involucrin expression was determined to assess cellular differentiation.

Results Inhibition of cellular proliferation was determined after 5 days of incubation with increasing doses with short‐chain fatty acids. Arginine butyrate and α‐lipoic acid were most effective in suppressing growth. Arginine butyrate demonstrated strong histone deacetylase inhibition in FaDu cells, while not inducing cellular differentiation. The short‐chain fatty acid α‐lipoic acid demonstrated weak histone deacetylase inhibition but was the only short‐chain fatty acid that induced involucrin expression in at least two of the cell lines. Histone deacetylase inhibitory activity or induction of involucrin expression correlated with suppression of cell growth.

Conclusions Short‐chain fatty acids have variable effects on HNSCC cells. Arginine butyrate and α‐lipoic acid are the most effective in suppressing growth and appear to do so through different biochemical mechanisms. These compounds warrant further research as chemotherapeutic or chemopreventive agents in HNSCC.
Adenotonsillectomy as a Treatment Option for Poststreptococcal Uveitis
Authors: Ovchinsky Alexander , Schulman Susan , Rosenfeld Richard M.
Published: November 2003

Objectives To report recurrent uveitis as a manifestation of poststreptococcal syndrome and discuss a role of adenotonsillectomy as a treatment option.

Study Design Case study.

Methods A case report of a 6‐year‐old, otherwise healthy girl with group A streptococcal uveitis managed successfully with adenotonsillectomy.

Results In the year after surgery there were only two episodes of uveitis, contrasted with a preoperative 3‐year history of 8 to 10 annual episodes despite corticosteroid therapy. Moreover, as a result of the postoperative improvement the child was able to avoid impending methotrexate therapy.

Conclusions Although the role of tonsillectomy in managing poststreptococcal uveitis is unknown, our results suggest a positive impact independent of the baseline tonsillitis frequency. Otolaryngologists should be aware of these uncommon sequelae of streptococcal infection and the potential role of tonsillectomy in treatment.
Otological and Audiological Outcomes Five Years After Tympanostomy in Early Childhood
Authors: Valtonen Hannu J. , Qvarnberg Yrjö H. , Nuutinen Juhani
Published: November 2003

Objective Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long‐term follow‐up studies have included even a minority of patients under 1 year old. We investigated long‐term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes.

Study Design Prospective follow‐up.

Methods Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure‐tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds).

Results Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively.

Conclusions Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow‐up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.
Intratympanic Ciprofloxacin and the Human Labyrinthine Sampling Model
Authors: Becvarovski Zoran , Kartush Jack M. , Bojrab Dennis I.
Published: November 2003

Objective The aim of the study was to investigate the potential absorption of intratympanic ciprofloxacin through the human round window membrane.

Study Design A prospective study.

Methods Ciprofloxacin was instilled into the middle ear of 10 patients undergoing acoustic tumor removal. The lateral semicircular canal and vestibule were subsequently opened and, using a microsyringe, labyrinthine fluid was aspirated. A sample each of serum and cerebrospinal fluid was also drawn.

Results Into each middle ear, 0.5 mL ciprofloxacin (0.3%) was instilled. The time interval between the ciprofloxacin application to the round window membrane and sampling of labyrinthine fluid and plasma ranged from 9 to 120 minutes. There was no measurable ciprofloxacin in the labyrinthine fluid, cerebrospinal fluid, or serum of 10 patients.

Conclusion The lack of measurable absorption of intratympanic ciprofloxacin into the inner ear indicates that the chance of ototoxicity when ciprofloxacin is used clinically, even in the presence of a tympanic membrane perforation, is low.
Is the Trachea a Marker of the Type of Environmental Pollution?
Authors: Foltinová Janka , Schrott‐Fischer Annelies , Zilínek Viliam , Foltin Viktor , Freysinger Wolfgang
Published: November 2003

Objectives/Hypothesis The differentiated character of changes in the mucous relief of the trachea as induced by air containing pollutants from the wastes of nickel‐, mercury‐, and cement‐producing plants and by Candida albicans occurring in the waste disposal site of a large town are identified. The trachea was chosen because it is the entrance gate for the penetration of polluted air into the lungs. Changes on the trachea influence the character and extent of changes in lungs.

Study Design Histological study with Viennese grey strain laboratory rabbits and rats caught directly on an investigated site.

Methods We present new results of the functional morphology of the respiratory system as the results of scanning and transmission electron microscopy studies that can reveal character and range of damage of mucosal relief of trachea relevant to the functional dynamics of mucociliary clearance. Under physiological conditions this mechanism allows that only respirable dust particles enter the deep respiratory tract.

Results In case of a damaged tracheal relief because of exposure to various aerosols, the functional morphology is changed, which aids in understanding the mechanisms damaging to mucociliary clearance induced by living in heavily polluted areas.

Conclusion Understanding of these morphological changes on base of detailed electron microscopic findings sheds new light on elaborating novel diagnostic methods for clinical practice.
Neck Crepitance: Evaluation and Management of Suspected Upper Aerodigestive Tract Injury
Authors: Goudy Steven L. , Miller Frank B. , Bumpous Jeffrey M.
Published: November 2003

Objective To determine safe criteria for the management of patients with crepitance of the neck.

Hypothesis Upper aerodigestive tract injury may lead to significant morbidity and mortality. Historically, this kind of injury has been managed by immediate surgical exploration, repair, and drainage. More recently, a nonoperative approach has been advocated.

Study Design Retrospective chart review of patients admitted to the University of Louisville Trauma Center with suspected upper aerodigestive tract injury.

Methods We reviewed the charts of 236 patients admitted to the trauma service from 1995 to 1999 with the diagnosis of aerodigestive tract injury or subcutaneous emphysema.

Results Nineteen patients were identified with cervical emphysema or cervical crepitance, or both, thought to be caused by an upper aerodigestive tract injury. The average patient age was 38.5 years; 68% of patients were men. The mechanisms of injury were motor vehicle accident (43%), gunshot wound (37%), assault (10%), blunt neck trauma (5%), and stabbing (5%). Each patient presented with cervical emphysema shown by radiograph or crepitance, or both; 21% had dysphagia and 63% were hoarse or had stridor. Location of the injury was tracheal or laryngeal in 37%, hypopharyngeal in 27%, oral pharynx in 16%, esophageal in 5%, and unidentified in 15% of patients. Because of suspected aerodigestive tract injury, 79% of patients were taken to the operating room for direct laryngoscopy and esophagoscopy, and abnormalities were found in 80%. The diameter of the average laceration of the upper aerodigestive tract was 1.6 cm. Associated injuries included mandible fractures in 37% of patients. Broad‐spectrum antibiotics were given to 95% of the patients. The initial management involved immediate surgical exploration in 55% of the total number of patients, with 83% of the surgically explored patients undergoing tracheotomy. The remaining 45% of patients were managed without surgery. Complications occurred only in operative patients, with aspiration occurring in 10%, bilateral hypoglossal nerve paralysis in 5%, and vocal cord paralysis in 5%. None of the patients developed postinjury or operative abscess.

Conclusion The findings show that suspected upper aerodigestive tract injury can be managed without surgery but that a high index of suspicion for airway compromise and associated facial injuries must be considered.
Cancer of the Oral Cavity and Medical Malpractice
Authors: Lydiatt Daniel D.
Published: November 2003

Objective To analyze malpractice litigation initiated by patients with cancer of the oral cavity as a result of allegations concerning their diagnosis and treatment.

Study Design Retrospective review.

Methods Jury verdict reviews from 1984 to 2000 were obtained from a computerized legal database and analyzed. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, and allegations of wrongdoing and provide case summaries. Fifty cases from 21 of all 50 states were obtained. Data were entered into a spreadsheet for analysis.

Results Overall, a young age (mean age, 45 y) and poor oncological outcome (47% dead) were seen. The younger age group (<47 y) had a better outcome (65% without disease), were more often misdiagnosed (19%), won awards (60%), and had higher awards (average award, $755,824) as compared with those older than 47 years of age, who had 39% without disease, 0% misdiagnosed, and 52% who won awards that were less, on average, at $495,417. Failure to diagnose the cancer was alleged, overall, in 43 of 50 cases (86%), and in general practice, dentists, and otolaryngologist in 100%, 85%, and 89%, respectively. Suits alleging a delay in diagnosis of less than 3 months were defendant verdicts in 86%, and of more than 3 months, in 40%. Failures to perform biopsy and to refer were common allegations.

Conclusions Young age of patients bringing litigation is seen in patients with oral cancer. These patients frequently have poor oncological outcomes. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.
Quality of Life After Parotid and Temporal Bone Surgery for Cancer
Authors: Kwok Henry C. K. , Morton Randall P. , Chaplin John M. , McIvor Nicholas P. , Sillars Hamish A.
Published: November 2003

Objectives The purposes of this study were to examine the quality of life (QL) of patients who received treatment for cancer of the parotid or temporal region, and to identify factors contributing to it. The relationships between clinician‐based measures of treatment outcome and the patient‐based counterparts were also evaluated.

Methods A retrospective, cross‐sectional study was conducted on 23 patients who had received either a temporal bone resection or a combination of parotidectomy and radiotherapy. The QL survey involved both global QL and measures of the appearance, communication, hearing, physical, psychological, and social domains. Patients were assessed clinically for their performance status, facial nerve function, disfigurement, and hearing and the results were compared with patient‐rated QL. Correlation between the QL variables and global QL was identified using Spearman correlation tests.

Results Ongoing physical symptoms, communication difficulties, and social disturbances were associated with poorer global QL (P <.05). No correlation was detected between global QL and objective disfigurement, facial function, and measures of hearing loss. With the exception of hearing testing, clinical assessments generally did not correlate well with patient ratings.

Conclusion QL measures provide insight into patients' perceptions of the treatment outcome but do not necessarily correlate with the clinicians' views. The use of a global QL measure overcomes the difficulty of extrapolating the impact of symptom scores or observational measures on patients' overall quality of survival.
Middle Turbinate Lateralization: A Simple Treatment for Rhinologic Headache
Authors: Kunachak Somyos
Published: November 2003

Objective To introduce a minimally invasive method to eliminate the symptoms of contact‐point rhinologic cephalgia.

Study Design A prospective study of 55 patients with chronic nasal or glabellar pain and endoscopically proven nasal origin.

Methods All 55 patients in whom endoscopic examination demonstrated a contact point between the middle turbinate and the nasal septum were treated by fracturing the middle turbinate lateralward using a small metal tongue depressor under 10% lidocaine HCL topical anesthesia.

Results Of the treated cohort, 48 (87%) of the patients had complete clinical symptom resolution after one treatment and all had resolution after two treatments. Recurrence occurred in 1 patient. There were no short‐term or long‐term adverse sequelae. The results persisted at a mean follow‐up time of 50 months (range, 6–84 mo).

Conclusion Middle turbinate lateralization is safe and effective in eliminating the symptoms of rhinologic cephalgia induced by contact point between the middle turbinate and nasal septum.
Association of Laryngopharyngeal Symptoms With Gastroesophageal Reflux Disease
Authors: Tauber Stefan , Gross Manfred , Issing Wolfgang J.
Published: November 2003

Objectives The prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal disorders is probably greater than realized.

Study Design Prospective study.

Methods To investigate the incidence of gastroenterological diseases including GERD in patients complaining of nonspecific laryngopharyngeal symptoms, laryngological examinations and gastroenterological evaluation with esophagogastroduodenoscopy were performed in 30 patients who refused to undergo 24‐hour pH monitoring. Therapeutic intervention by behavioural and dietary modifications, antireflux medication, and eradication of Helicobacter pylori were assessed for changes in laryngeal findings and relief of symptoms.

Results Posterior laryngitis was present in 26 patients and in 19 of them was accompanied by erythema and edema of the interarytenoid region. Gastroenterological diseases such as GERD (43%), hiatal hernia (43%), and Helicobacter pylori‐positive antrum gastritis (23%) were confirmed in 22 (73%) cases by esophagogastroduodenoscopy and histological examination of biopsy specimens. Medical antireflux treatment and eradication of Helicobacter pylori resulted in a remarkably therapeutic success rate of 90% because there was resolution of laryngopharyngeal symptoms and laryngeal findings in 20 of 22 patients with gastroenterological diseases for the mean follow‐up period of 8 months.

Conclusions Laryngopharyngeal symptoms can be predictors of gastroesophageal diseases and GERD because the most frequent underlying cause is supposed to be associated with posterior laryngitis. Medical antireflux treatment is effective for relief of symptoms and mucosal healing of posterior laryngitis.
Nonsurgical Management of Parapharyngeal Space Infections: A Prospective Study
Authors: Sichel Jean‐Yves , Dano Itshac , Hocwald Eitan , Biron Adi , Eliashar Ron
Published: November 2003

Objective/Hypothesis Parapharyngeal infections, which can potentially cause life‐threatening complications, may, in certain cases, be treated conservatively with no need for surgical drainage. A review of the literature reveals that the most recommended treatment of parapharyngeal infection is surgical drainage combined with intravenous antibiotic therapy. Several retrospective reports recommend conservative treatment with no surgical drainage.

Study Design Prospective, nonrandomized.

Methods A prospective study was performed on all patients with an infection limited to the parapharyngeal space.

Results Twelve patients presented with clinical and radiological diagnosis of parapharyngeal infection during a 5‐year period. Five patients showed obvious presence of pus in other spaces and therefore were excluded. Seven patients with no gross extension into other spaces and with no respiratory distress or septic shock were treated with intravenous amoxicillin‐clavulanic acid for 9 to 14 days (average period, 11 days). All patients except one were children. All were cured with conservative management, and no surgical drainage was needed. None had any complications.

Conclusion Our results confirm the effectiveness of nonsurgical treatment of infections limited to the parapharyngeal space, at least in the pediatric population.
Congenital Pyriform Aperture Stenosis: Surgery and Evaluation with Three‐Dimensional Computed Tomography
Authors: Lee Kuo‐Sheng , Yang Cheng‐Chien , Huang Jon‐Kway , Chen Yu‐Chun , Chang Ke‐Chang
Published: November 2003

Objective We described the surgical efficacy of congenital pyriform aperture stenosis by measuring the width of the nasal pyriform aperture with three‐dimensional computed tomography.

Methods Six patients with congenital pyriform aperture stenosis accepted surgical intervention. Three‐dimensional computed tomography was performed for preoperative and postoperative evaluation of nasal pyriform aperture width. We marked the midpoint between the tip of nasal bone and the anterior nasal spine. The distances between the bilateral nasal processes of the maxilla and between the lateral rims of the pyriform aperture were measured by crossing the midpoint horizontally.

Results Among the six patients (three male and three female patients), the mean age was 76.2 ± 23.9 days. Silicon stents were removed 6 to 7 days after operation. During 9 months of follow‐up, there were no cases of restenosis, respiratory failure, or cyanosis. The mean preoperative and postoperative interprocess distances were 4.5 ± 0.84 and 8.7 ± 1.37 mm, respectively, and data were statistically significant at a confidence level of P <.05. The mean preoperative and postoperative interwall distances were 9.8 ± 0.75 and 10.8 ± 1.5 mm, respectively.

Conclusions Congenital pyriform aperture stenosis should be suspected whenever there is both severe nasal obstruction and difficulty in passing a small catheter or nasogastric tube through the anterior nasal valve. Operation is the most extreme treatment, but it is effective for congenital pyriform aperture stenosis. Nasal stenting for 7 days seemed to be adequate. The use of three‐dimensional computed tomography to evaluate preoperative and postoperative nasal pyriform aperture is effective and reliable.
Bilateral Squamous Cell Carcinoma of the External Auditory Canals
Authors: Wolfe Stephen G. , Lai Stephen Y. , Bigelow Douglas C.
Published: November 2003

Objectives To report a case of bilateral squamous cell carcinoma of the external auditory canals and to present a management algorithm for this difficult clinical scenario.

Study Design Case report and literature review.

Methods The study comprises a case report of a 69‐year‐old man who initially presented with complaints of bilateral otorrhea, left‐sided otalgia, and a left‐sided hearing loss. Following attempted treatment of a presumed case of otitis externa, biopsy of both external auditory canals revealed squamous cell carcinoma. A computed tomography scan demonstrated marked abnormal soft tissue in the left external auditory canal with no bony erosion and thickening of the soft tissue in the right external auditory canal.

Results The left‐sided lesion required a lateral temporal bone resection, a partial superficial and deep‐lobe parotidectomy, and postoperative irradiation. The right‐sided lesion was more limited and was managed with a lateral temporal bone resection and tympanoplasty for hearing preservation.

Conclusions Bilateral squamous cell carcinoma of the external auditory canals is an extremely uncommon but aggressive malignancy that may present with symptoms similar to a case of otitis externa, and this can result in delays in proper diagnosis. Early recognition is essential because management and prognosis are determined by the extent of the lesion.
Evaluation of Selective Lymph Node Sampling in the Node‐Negative Neck
Authors: Wein Richard O. , Winkle Mark R. , Norante John D. , Coniglio John U.
Published: November 2003

Objective To determine whether intraoperative selective lymph node sampling before neck dissection in the node‐negative (N0) neck accurately reflects the disease content of the neck and can be used to assist in treatment selection.

Study Design A prospective clinical study at a university medical center.

Methods Over a 2‐year period, 36 patients with head and neck squamous cell carcinoma scheduled to undergo 41 elective neck dissections were enrolled. At the initiation of the neck dissection, biopsy of the “most suspicious” lymph node within the tumor's primary nodal drainage basin was performed, and the specimen was measured and sent for frozen‐section evaluation. The results of lymph node sampling were compared with the final histopathologic interpretation of the resected primary and neck dissection.

Results Of the 41 N0 necks, 29% (12 of 41) were positive for occult metastases. Results of selective lymph node biopsy correlated with the results of neck dissection in 34 of 41 specimens (83%). The specificity and positive predictive value of node sampling were both 100%. The proportion of cases with a positive neck dissection with a positive sampled node (sensitivity) was 42% (5 of 12).

Conclusion The results of selective lymph node biopsy with frozen‐section analysis in the N0 neck, as defined in the current study, did not reflect a technique with adequate sensitivity to alter intraoperative treatment strategy.
Telephone Appointment Visits for Head and Neck Surgery Follow‐up Care
Authors: Eaton Jeffrey , Rasgon Barry , Derbin Leslie Widrow , Hilsinger Raymond L. , Buenavista Tracy
Published: November 2003

Objectives/Hypothesis To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow‐up care in a head and neck surgery clinic.

Study Design Randomized, nonblinded cross‐sectional study.

Methods After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow‐up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow‐up care. Study data were collected using telephone interviews and physician trackingforms.

Results Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (χ2 = 25.4, P <.005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree “somewhat” or “strongly” that 1) the physician addressed their questions and concerns (χ2 = 24.0, P <.005); 2) the physician provided personal care and attention (χ2 =29.9, P <.005); and 3) the physician provided high‐quality care (χ2 =34.5, P <.005).

Conclusions Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow‐up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow‐up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow‐up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow‐up visit.
Functional Impairment of the Vestibular End Organ Resulting From Impulse Noise Exposure
Authors: Perez Ronen , Freeman Sharon , Cohen David , Sohmer Haim
Published: November 2003

Objectives/Hypothesis To assess the effect of exposure to impulse noise, known to cause damage to the cochlea, on the vestibular part of the inner ear using short latency vestibular evoked potentials (VsEPs), which is a direct and objective test for evaluating the function of the vestibular end organs.

Study Design Prospective animal study.

Methods Sand rats (Psammomys obesus) underwent baseline measurements of VsEPs in response to linear and angular acceleration stimuli and measurement of the auditory nerve and brainstem evoked response (ABR). The animals were then exposed to 10 gunshots generating impulse noise at an intensity of approximately 160 dB sound pressure level (SPL). Repeat measurements of the evoked potentials were conducted 2 to 4 hours, 1 week, and 6 weeks after the exposure. The amplitude and latency of the first wave of VsEPs in response to linear and angular acceleration stimuli, reflecting the function of the otolith organs and semicircular canals respectively, were compared between baseline and post‐exposure measurements, as were ABR thresholds.

Results The amplitude of the first wave of the VsEPs in response to linear acceleration was significantly (P <.001) reduced and the latency significantly (P <.005) prolonged 2 to 4 hours after the exposure in comparison to baseline measurements. The latency prolongation persisted in follow‐up measurements, whereas the amplitude showed partial recovery. The first wave of VsEPs in response to angular acceleration was unchanged long‐term. ABR thresholds were elevated in the long‐term by 60 dB.

Conclusion It seems that impulse noise not only damages the cochlea, but also causes clear functional impairment to the vestibular end organs, mainly the otolith organs.
Impact of the Endoscopic Sinus Surgical Simulator on Operating Room Performance
Authors: Edmond Charles V.
Published: November 2003

Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance.

Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer.

Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating.

Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation‐trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times.

Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.
Microbiology of Acute Otitis Externa
Authors: Roland Peter S. , Stroman David W.
Published: November 2003

Objective To isolate and characterize bacteria and fungi from acute otitis externa (AOE) and to obtain susceptibility profiles on each bacterial isolate.

Study Design Prospective core series.

Methods Specimens were collected from the external canals of subjects with clinically diagnosed acute otitis externa. Species‐level identification for each bacterial isolate recovered was obtained by combining phenotypic and genotypic data. End point mean inhibitory concentration (MIC) testing was performed using National Committee for Clinical Laboratory Standards (NCCLS) recommended methods.

Results In Alcon‐sponsored clinical studies conducted in 1998 to 2000, microbiology specimens were collected from 2039 subjects (2240 diseased ears) by 101 investigators throughout the United States. A total of 2838 bacteria, 32 yeast, and 17 molds were recovered from 2048 ears clinically diagnosed as acute otitis externa. Of the 202 bacterial species recovered, the species most frequently isolated was Pseudomonas aeruginosa (38%). The next 10 species most frequently isolated were:Staphylococcus epidermidis, 9.1%;Staphylococcus aureus, 7.8%;Microbacterium otitidis, 6.6%;Microbacterium alconae, 2.9%;Staphylococcus caprae, 2.6%;Staphylococcus auricularis, 2.0%;Enterococcus faecalis, 1.9%;Enterobacter cloacae, 1.6%;Staphylococcus capitis subsp. Ureolyticus,1.4%; and Staphylococcus haemolyticus, 1.3%. Susceptibility profiles of S. epidermidis isolates revealed the greatest frequency of high‐level resistance to selected antibiotics (≥8 μg/mL): 23%, neomycin‐resistant; 11%, oxacillin‐resistant; and 12%, ofloxacin‐resistant. Susceptibility profiles of S. aureus isolates revealed a lower frequency of high‐level resistance: 6.3%, neomycin‐resistant; 2.7%, oxacillin‐resistant; and 4.5%, ofloxacin‐resistant. P. aeruginosa with high‐level resistance to quinolones (≥128 mcg/mL for ofloxacin) was recovered from only 1 subject. Likewise, resistance of P. aeruginosa to aminoglycosides was rare. Twenty isolates had neomycin MICs ≥64 mcg/mL and 10 isolates had gentamicin MICs ≥16 mcg/mL. The coryneform isolates identified as Microbacterium otitidis had an intrinsic lack of susceptibility to quinolones (ofloxacin MICs ≥16 mcg/mL) and aminoglycosides (tobramycin MICs ≥32 mcg/mL and gentamicin MICs ≥8 mcg/mL).

Conclusions Bacterial infections of the external ear canal are most often caused by P. aeruginosa. However, there are a great number of other gram‐positive and gram‐negative bacterial species that are recovered from patients with acute otitis externa. Because of this diverse etiology, the best topical therapeutic choice for topical therapy is for the most potent, broad‐spectrum (especially anti‐P. aeruginosa) antibiotic available.
The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction
Authors: Koch Wayne M.
Published: November 2003

Objectives The use, advantages, and disadvantages of the platysma flap were assessed.

Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001.

Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the χ2 test.

Results Thirty‐four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions.

Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects.