bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral medialization laryngoplasty
Authors: Postma Gregory N. , Blalock P. David , Koufman James A.
Published: November 2003

Objectives: To present indications, techniques, and results of bilateral medialization laryngoplasty (BML). Study Design: Retrospective review of 39 consecutive patients who had BML for correction of glottal insufficiency attributable to presbylaryngis (n = 16), bilateral vocal fold paresis (n = 13), unilateral paralysis with contralateral bowing (n = 4), and other miscellaneous neurologic diseases (n = 6). Methods: Complete preoperative and postoperative clinical and acoustical data were analyzed for 74% (29/39) of the subjects. All 39 subjects completed a patient survey to assess their long‐term outcomes. Results: Overall, 90% (35/39) of the patients who had BML experienced significant improvement in voice and swallowing function. Subsequently, 36% (14/39) of the patients underwent adjunctive lipoinjection for closure of small residual glottal gaps (vocal “fine‐tuning”). Of the BML patients (with or without lipoinjection) who had complete preoperative and postoperative voice data, 83% (24/29) had complete glottal closure after surgery, resulting in normal or near‐normal voices. Eighty‐five percent (33/39) of the patients responded that they “would have surgery again.” Of the six patients who said that they would not have surgery again, three had good results and one had progressive neurologic disease. The mean duration of follow‐up was 17 months. Conclusions: BML is an effective rehabilitative surgical treatment for symptomatic vocal fold bowing. In addition, lipoinjection is useful as an adjunct to BML to enhance the voice outcome in selected cases. Laryngoscope, 108:1429–1434, 1998
Preservation of the stapedius tendon in laser stapes surgery
Authors: Silverstein Herbert , Hester T. Oma , Rosenberg Seth I. , Deems Daniel A.
Published: November 2003

Objectives/Hypothesis: The stapedius tendon is routinely transected during stapes surgery. The objective of this study was to evaluate the technique of stapedial tendon preservation during stapes surgery and to compare results of these cases with cases where the stapedial tendon was not preserved. Study Design: Retrospective study. Methods: Four groups of patients were evaluated. Two groups had undergone stapes surgery with preservation of the stapedial tendon. One of these groups underwent a laser stapedotomy minus prosthesis (laser STAMP) procedure, while the other group had a prosthesis inserted. The other two groups had undergone laser stapedotomy with one of two different prostheses being used. Audiometric data were obtained and reviewed both preoperatively and at approximately 6 weeks postoperatively. Results: All groups had overall successful results demonstrating that stapedial tendon preservation is technically possible and does not compromise outcomes. Conclusions: Based on the results, it is recommended that the stapedius tendon be preserved whenever possible during laser stapes surgery. Reasons justifying its preservation are discussed. Laryngoscope, 108:1453–1458, 1998
Functional laryngeal dyskinesia in children and adults
Authors: Ferris Robert L. , Eisele David W. , Tunkel David E.
Published: November 2003

Objective: Functional laryngeal dyskinesia (FLD) is characterized by signs and symptoms of airway obstruction without anatomic basis. Failure to recognize its features often leads to inappropriate diagnostic studies and therapies. A systematic approach is presented for the recognition and management of patients with this disorder. Design: A retrospective case series at a large, urban tertiary care academic hospital. Methods: Retrospective review of charts of adults and children diagnosed with FLD between 1979 and 1996. Presenting symptoms and signs of FLD were categorized and methods of diagnosis were recorded. Therapeutic interventions and resolution of FLD at follow‐up were also analyzed. Results: Ten patients were identified with FLD, seven females and three males, with mean age of 25.9 years at diagnosis (range, 10–59 y). Patients were hospitalized a mean of three times (range, 1 to 6 admissions) before FLD was correctly diagnosed. Nine patients were receiving treatment for asthma prior to diagnosis. Flow volume loops most often showed a fixed extrathoracic inspiratory. Arterial blood gas and radiographic data were essentially normal. The most useful diagnostic test was fiberoptic laryngoscopy, which showed abnormal adduction of the vocal cords on inspiration in the nine patients in this series who underwent laryngoscopy. Conclusions: The authors' experience with FLD shows that its early recognition is associated with fewer interventions and their accompanying risks. A high degree of suspicion is required in these patients, who are often young and well educated. They present with stridor that may disappear while they are asleep or after distraction techniques. Laryngoscope, 108:1520–1523, 1998
Prospective randomized comparative study of tracheoesophageal voice prosthesis: Blom‐singer versus provox
Authors: Delsupehe Kathelijne , Zink Inge , Lejaegere Maryline , Delaere Pierre
Published: November 2003

Objectives: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom Singer and Provox. Study Design: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom‐Singer and Provox. Methods: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type of procedure was performed. In addition, patients were asked for their subjective assessment. Results: Overall, Blom‐Singer and Provox prostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom‐Singer prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. Conclusions: Given the equal and good results in terms of voice quality, other factors (e.g., costs, surgery‐related factors, maintenance, patient preference) should be taken into account when deciding which type of tracheoesophageal voice prosthesis to use. Laryngoscope, 108:1561–1665, 1998
Tissue‐conserving surgery for prognosis, treatment, and function preservation
Authors: Schuller David E. , Laning Carol M. Bier , Sharma Pramod K. , Siegle Ronald J. , Pellegrini Arthur E. , Karanfilov Boris , Bellisari Greg , Miller Ryan , Young Donn C.
Published: November 2003

Objectives: To describe an approach based on initial tissue‐conserving surgery used to obtain histologically determined prognostic information that has therapeutic implications and the potential to enhance preservation of function. Study Design: Analysis of a group of patients with head and neck cancer treated initially with tissue‐conserving surgery based on Mohs' histographic sectioning and selected neck dissection to derive histologically determined prognostic information with therapeutic implications and preservation in function. Methods: This study is primarily based on an analysis of patients from January 1, 1989, through June 4, 1996 assigned to a protocol evaluating resection of oral cavity squamous cell cancer with margin control using Mohs' histographic technique and/or a group of patients with neck assessment of N0 on clinical examination who are undergoing supraomohyoid neck dissections. Results: Thirty‐three primary tumor resections were performed using the Mohs' technique, and 54% required two or more Mohs' sections before clear histologic margins were obtained following resection based on clinically determined negative margins. There were 44 patients who underwent unilateral or bilateral supraomohyoid neck dissections, and 33% had occult, histologically positive nodes. When compared with the disease of the neck specimens, a preoperative computed tomography scan had a sensitivity of 25%, a specificity of 77%, and an accuracy of 63%. Conclusions: This report describes the effectiveness of Mohs' histographic sectioning and selective neck dissection as a means of determining prognostic information that can be used to develop a focused and cost‐effective treatment program that, along with contemporary reconstructive techniques, provides a potential enhancement of function preservation. Laryngoscope, 108:1599–1604, 1998
Management of substernal goiter
Authors: Netterville James L. , Coleman Sean C. , Smith Jonathan C. , Smith Michelle M. , Day Terrence A. , Burkey Brian B.
Published: November 2003

Objective: To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment. Study Design: A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology—Head and Neck Surgery. Methods: Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist. Results: Twenty‐three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0–14.0 cm) and weighed 148 g (range, 39–426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered. Conclusion: Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning. Laryngoscope, 108:1611–1617, 1998
Repair of nasal defects using collagen gels containing insulin‐like growth factor 1
Authors: Toung James S. , Griffin Adam , Ogle Roy C. , Lindsey William H.
Published: November 2003

Objective: Facial osseous defects are a common and challenging problem for the otolaryngologist—head and neck surgeon. Current methods of repair including synthetic grafts, cadaveric material, and autologous tissue have drawbacks of foreign body reactions, infectious agent transmission, and the morbidity of a second surgical site. In the effort to develop an ideal technique for osseous reconstruction, a critical‐size facial defect has previously been developed in the Sprague‐Dawley rat. This model exhibits less than 10% healing by surface area over 6 months. A novel approach to osseous reconstruction is attempted using this model with type I collagen gel augmented with insulin‐like growth factor 1 (IGF‐1). Study Design: Randomized controlled trial using a rodent model. Methods: Twelve adult male Sprague‐Dawley rats underwent a surgical procedure to produce a critical‐size nasal defect by removing the nasal bones with a cutting burr. Six animals were repaired with 300 μg of type I collagen gel. Six animals were repaired with 300 μg of type I collagen gel augmented with 3.0 μg of IGF‐1. Thirty days later, the animals were examined after necropsy. Precise planimetry, radiodensitometric analysis, and histologic sectioning were performed. Results: All animals had complete coverage of this defect with a thin layer of bone. Radiodensitometric analysis indicated that there was a statistically significant (P < .037) increase in bone density in the collagen plus IGF‐1 group compared with that of collagen only. In addition, histologic evaluation revealed increased bone density and thickness in the IGF‐1 group. Conclusion: Type I collagen gel augmented with IGF‐1 results in a significant increase in healing of a nasal critical‐size defect in a rodent model. Laryngoscope, 108:1654–1658, 1998
Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma
Authors: Zhang Ming , Garvis William , Linder Thomas , Fisch Ugo
Published: November 2003

Objectives: Review of preoperative evaluation, surgical management, and outcome of patients operated on for nasopharyngeal angiofibroma using lateral infratemporal fossa approaches. Study Design: Retrospective review of 20 patients with either extensive (Fisch class IIIa to IVb, n = 17) or less massive (Fisch class II, n = 3) nasopharyngeal angiofibromas. Analysis of preoperative radiologic classification and angiography and description of indications and surgical techniques of the infratemporal fossa approaches types C and D. Evaluation of the surgical morbidity and radicality of tumor removal. Methods: Clinical data were obtained from medical records from 1987 to 1994. Tumor classification, preoperative symptoms, type of surgery, and neuroradiologic and surgical complications were evaluated. The completeness of tumor removal was assessed using postoperative magnetic resonance imaging. Results: Temporary visual disturbance or headache, or both, was seen in two of 20 patients after superselective tumor embolization, and further visual diminution was observed in one of six patients after balloon occlusion of the internal carotid artery. Radical resection was obtained in 80% of the cases. The infratemporal fossa type C approach was used in 16 of the cases, with type D approaches used in the other four. There were no deaths. The major morbidity was the conductive hearing loss associated with the type C approach. Conclusions: Preoperative embolization (and balloon occlusion in selected cases) remains an important adjunct with minimal morbidity. The lateral infratemporal fossa approaches yield a high rate of radical tumor removal (80%) and a low rate of recurrence (6%). If applicable, the type D approach avoids the conductive hearing loss but allows direct tumor access into the infratemporal and pterygopalatine fossae. Laryngoscope, 108:1717–1723, 1998
Acoustic and perceptual evaluation of laryngeal reinnervation by ansa cervicalis transfer
Authors: Olson David E. L. , Goding George S. , Michael Deirdre D.
Published: November 2003

Objectives/Hypothesis: To evaluate the acoustic and perceptual results of laryngeal reinnervation with ansa cervicalis to recurrent laryngeal nerve anastomosis. Study Design: Retrospective study of voice samples from 12 patients with unilateral recurrent laryngeal nerve paralysis, treated with ansa cervicalis to recurrent laryngeal nerve anastomosis. Samples were recorded before surgery and at least 8 months after surgery. Methods: The samples were subjected to several acoustic analyses sensitive to paralytic dysphonia, including cepstral peak prominence, noise‐to‐harmonics ratio, and measures of frequency and amplitude perturbation. The voice samples from the patients were randomized with age‐ and sexmatched samples from normal subjects and judged by trained listeners for overall dysphonia, roughness, breathiness, asthenia, and strain. The preoperative and postoperative results were compared statistically, and the postoperative results were compared with the matched normal subjects. Results: As a group, the patients showed improvement (P < .05) in cepstral peak prominence, frequency perturbation, and perceptual judgments of overall dysphonia, breathiness, and asthenia. The best results occurred in patients with isolated vocal fold paralysis. The postoperative group as a whole did not improve to the level seen in matched normals. Suboptimal results were seen primarily in patients with untreated laryngeal or extralaryngeal pathology beyond the laryngeal paralysis. Conclusions: These data suggest that laryngeal reinnervation has the potential to bring about a return to normal or near‐normal voice in patients with isolated unilateral vocal fold paralysis.
Congenital aural atresia: Stability of surgical results
Authors: Lambert Paul R.
Published: November 2003

Objectives/Hypothesis: To compare early (<1 y) and longer‐term (1.0–7.5 y; mean follow‐up, 2.8 y) hearing results following surgery for congenital aural atresia and to analyze revision cases for cause of failure, time of occurrence, and outcome. Study Design: Retrospective study of 55 consecutive patients (59 ears) undergoing surgery during an 11‐year period for congenital aural atresia. Methods: The best speech reception threshold (SRT) during the first postoperative year was compared with the most recent SRT beyond the first postoperative year. The complication rate and long‐term hearing results (>1 y) for initial and revision surgeries were compared. Results: In the early postoperative period, an SRT of ≤25 dB was achieved in 60% and an SRT of ≤30 dB in 70%. With longer follow‐up (mean, 2.8 y), 46% of patients maintained an SRT ±25 dB. Revision surgery was necessary in approximately one third of patients. Longer‐term hearing results following initial surgery only or after revision surgery showed an SRT ±25 dB in 53% and an SRT ±30 dB in 64%. For primary and revisions surgeries the incidence of temporary facial paralysis was 1.5% and for significant hearing loss, 3.0%. Conclusions: Some degradation in hearing does occur as patients are followed beyond the first postoperative year. Revision surgery will be necessary in approximately one third of cases. With revisions, an SRT ±25 dB can be expected in half of cases and an SRT ±30 dB in two thirds of cases. The ability to provide these hearing results supports this surgery in unilateral cases.
Second malignant neoplasia in patients with T1 glottic cancer treated with radiation
Authors: Fujita Mihoko , Rudoltz Marc S. , Canady Daniel J. , Patel Pushpa , Machtay Mitchel , Pittard Ms Melissa Q. , Mohiuddin Mohammed , Regine William F.
Published: November 2003

Objective/Hypothesis: To evaluate incidence, site of occurrence and outcome of second malignant neoplasia (SMN) in patients with T1 glottic cancer treated with radiation. Study Design: Retrospective. Methods: Between February 1964 and May 1993, 158 patients with T1 squamous carcinoma of the larynx were treated with definitive radiation. Incidence, site (aerodigestive tract or not) and outcome of SMN were analyzed. Median follow‐up was 63 months (range, 12–245 mo). Results: Thirty‐four patients developed SMN, for an overall incidence of 22%. Twenty‐four (67%) SMNs occurred in an aero‐upper‐digestive‐tract site compared with nine (25%) occurring in a non‐aero‐upper‐digestive tract site. The incidence of SMN observed was higher than would be expected for the general population at risk. The observed‐to‐expected ratios (OER) for all SMN, aero‐upper‐digestive SMN and non‐aero‐upper‐digestive SMNs were 1.73, 5.53, and 0.62, respectively. Overall 5‐ and 10‐year survivals were 76% and 57%, respectively, for those who did not develop SMN, as compared with 68% and 26%, for those who developed SMN (P = .003). Overall, 13 patients (8.2%) have died from laryngeal cancer, while 23 (15%) died from SMN (P = .001). Conclusion: This study confirms a higher incidence of SMN in T1 glottic cancer patients, compared with the general population. The majority of cases occur in aero‐upper‐digestive sites. These patients are more likely to die from their SMN than from glottic cancer. Patients with T1 squamous cell carcinoma of the glottic larynx represent a group of head and neck cancer patients who should be targeted in studies evaluating the potential benefits of chemoprevention, and aggressively counseled for social and/or behavioral modifications.
Myringoplasty in Children: Predictive Factors of Outcome
Authors: Denoyelle Françoise , Roger Gilles , Chauvin P. , Garabedian Eréa‐Noël
Published: November 2003

Objectives: To assess the results of myringoplasty in children and to determine which factors independently influence the postoperative results.Study Design: Retrospective study of the anatomic and functional results of 231 consecutive myringoplasties performed in 188 children between 1988 and 1992. Multivariate analysis of poor prognostic factors by cross‐sectional comparison 1 year after surgery.Methods: Myringoplasties were performed via an endaural approach with a fascia temporalis underlay graft.Results: In 216 of 231 ears (93.5%) the tympanic membrane was closed. A good anatomic outcome was considered to have been achieved in 188 ears (81.6%), although in 18 ears (7.8%) seromucous otitis media occurred, in 8 ears (3.5%) a progressive retraction pocket was encountered, and in 2 ears significant lateralization was present. One hundred thirty‐nine (67.5%) of the 206 ears tested in the postoperative period had a postoperative air‐bone gap of 10 dB or less. On average, mean bone conduction remained unaltered. The age of the patient and the size and the location of the perforation did not affect the outcome. Three prognostic factors for an abnormal postoperative tympanic membrane were found, with 95% confidence intervals: inflammatory changes in the middle ear mucosa (P< .05), contralateral tympanic perforation (P< .05), and contralateral cholesteatoma (P< .01).Conclusions: Myringoplasty with underlay grafting of the fascia temporalis in children gives good anatomic and functional results. Inflammatory changes within the middle ear mucosa, contralateral tympanic perforation, and contralateral cholesteatoma independently influence the risk of an abnormal postoperative tympanic membrane. The presence of one of these factors preoperatively should lead to the consideration of alternative, more durable graft material, such as autologous cartilage.
Electrocochleographic and Audiometric Evaluation of Hypobaric Effect in Meniere's Disease
Authors: Konrádsson Konrád S. , Carlborg Björn , Grenner Jan , Tjernström Örjan
Published: November 2003

Objectives: To elucidate the effects of hypobaric pressure on cochlear hydrodynamics in patents with well‐defined Meniere's disease. Design: Sixteen patients were consecutively selected. Elevated hearing threshold levels and pathological transtympanal electrocochleography (tt‐ECOG) were confirmed at the day of trial. The patients were exposed to repeated episodes of hypobaric pressure in a pressure chamber. The rate (20 daPa/s) and magnitude (‐285 daPa) of chamber pressure change were low. The induced tympanic overpressure (+185 daPa) was continuously monitored and any tympanic equilibration was avoided. Methods: The results of Bekesy and speech audiometry as well as tt‐ECOG performed immediately before and after exposure were compared. The importance of chamber pressure change, number of hypobaric episodes, duration of exposure, and the induced relative tympanic overpressure was tested. Results: It is shown that the relative tympanic overpressure is the most important factor to affect the cochlear hydrodynamics. Higher relative overpressure was associated with improvement of hearing threshold levels, while the ECOG results tended to improve with lower induced tympanic overpressure. Conclusion: The importance of tympanic overpressure shown in this study is in agreement with previous findings from hypobaric animal experiments. The inverse relation of psychoacoustic and ECOG tests suggests that the two methods evaluate different parameters, perhaps contributing differently to the physiology of hearing.
Persisting Dysphagia After Uvulopalatoplasty Performed With Steel Scalpel
Authors: Levring‐Jäghagen Eva , Nilsson Mats E. , Isberg Annika
Published: November 2003

Objectives/Hypothesis: The aim of the present study was to determine the incidence of postoperative persisting dysphagia after uvulopalatoplasty performed with conventional steel scalpel (UPP) and to videoradiographically evaluate the oral and pharyngeal phases of swallowing in patients reporting persisting dysphagia. The hypothesis to be tested was that patients treated with UPP would demonstrate a lower incidence of persisting dysphagia than previously found after uvulopalatoplasty performed with laser technique (LUPP). Study Design: Retrospective. Methods: Sixty‐eight of 76 consecutive patients treated with UPP answered a questionnaire concerning outcome and late complications after the operation. The patients who reported postoperative dysphagia were additionally interviewed at a minimum of 1 year postoperatively, and the oral and pharyngeal phases of swallowing were videoradiographically examined in those with persisting dysphagia. Results: The incidence of persisting dysphagia after UPP was 29%. Videoradiographically 71% of the dysphagic patients showed a deviant pharyngeal swallowing pattern. Conclusion: The incidence of persisting dysphagia after UPP did not differ from that reported after laser uvulopalatoplasty. Dysphagia after UPP was mostly associated with videoradiographic signs of deviant pharyngeal swallowing function. Patients should be informed that there is a risk of developing dysphagia after uvulopalatoplasty.
Ciliary Activity in Differentiating and Reactivated Human Respiratory Epithelial Cells
Authors: Hard Robert , Besch Stephen R. , Tristram Deborah , Han Jin , Hicks Wesley
Published: November 2003

Objective: Experimental studies of mucociliary clearance, especially those involving drug effects, suffer from the difficulty of determining whether drugs act directly on ciliary motility or whether their effects are indirect, acting via changes in cell metabolism, viscous load, or alternative mechanisms. The present study provides a solution to this problem by comparing the motile characteristics of ciliated cells that have differentiated in primary cell culture with those of demembranated cilia reactivated with MgATP. Methods: Human respiratory epithelial cells (REC) were dissociated from trachea, bronchus, nasal polyps, or turbinates and then placed in a dissociated cell culture system. Thirty‐three percent of the dissociated cells contain beating cilia. Following 1 week in culture, the REC dedifferentiated, but then rediffer‐entiated within 96 hours after they were brought to an air interface. Results: The cilia on such cells beat with planar waves consisting of power and recovery strokes. Beat frequencies at 20°C were 15 ± 2.3 Hz. Ciliary beating often was coordinated both within and between cells with a defined antilaeoplectic pattern of coordination. Either fresh or cultured cells could be demembranated with Triton X‐100 and reactivated with MgATP. The activity of these reactivated models was equivalent to those observed in living cells. Conclusion: The authors have demonstrated that ciliary beat frequency of demembranated human respiratory epithelial cells can be modulated by MgATP and can be adjusted to the same level of activity as measured in living cells. This allows them to selectively test whether a drug's effects on mucociliary transport are the result of direct interactions with the ciliary apparatus or are produced through other indirect mechanisms.
Pervasive Developmental Delay in Children Presenting As Possible Hearing Loss
Authors: Ho Philip T. , Keller Jeffrey L. , Berg Abbey L. , Cargan Abba L. , Haddad Joseph
Published: November 2003

Objective/Hypothesis: Children who fail to develop adequate language skills and/or appropriate social skills by age 2 years often are referred to the department of otolaryngology for otolaryngologic examination and evaluation of possible hearing deficits. Discovering a gross disparity between hearing function and language ability often uncovers an underlying developmental disorder satisfying criteria for diagnosis on the spectrum of autism and pervasive developmental delay (PDD). The otolaryngologist has a unique opportunity to identify these autistic children and initiate their evaluation and management. Study Design: Retrospective review. Methods: Review of charts of children referred over the past 4 years to the Department of Otolaryngology for possible hearing loss identified 15 children who were later diagnosed with PDD. Results: Fifteen children initially referred for hearing evaluation were subsequently identified with a diagnosis of PDD. Males outnumbered females 4 to 1, with the average age of referral being 2 years. One third of the patients displayed middle ear disease that improved with PE tube placement. One third of the patients showed brainstem conduction dysfunction on auditory brainstem evoked response testing. Conclusions: Children with developmental delays, especially higher functioning ones, may present with a myriad of language and communication deficits that are often mistakenly attributed to hearing loss. Otolaryngologists and audiologists can assist in their early identification and appropriate referral for therapy.
Congenital Absence of the Long Process of the Incus
Authors: Wehrs Roger E.
Published: November 2003

Objective/Hypothesis: To review the case reports of three generations of one family, suffering from bilateral conductive hearing loss due to congenital absence of the long process of the incus. Study Design: Review of the literature regarding hereditary congenital absence of the long process of the incus to determine its mode of inheritance such as autosomal dominant or X‐linked. Also document the types and results of surgical repairs performed by previous investigators of this defect and compare them with the present study. Methods: Three female patients of direct lineage. Mother, daughter, and granddaughter, who were personally seen, operated on, and followed up over a period of 26 years. Results: All three female patients presented with similar symptoms and findings of hearing impairment since birth, with no history of ear infections, and with normal appearing tympanic membranes. However, they had severe conductive hearing loss with normal bone conduction and discrimination. Operative findings were identical in all three patients, with the incus ending in a blind stub, and with absence of the capitulum of the stapes. The type of ossicular reconstruction varied with the changing of times and advances in otologic surgery, as well as the prosthetic materials used. All three patients received improvement in their hearing, and this improvement has been maintained over the 26‐year span of the study. Conclusions: Hearing loss due to congenital absence of the incus is uncommon but not rare. Interestingly, no other instance of inherited cases were reported in the literature. In this family the defect appears to be an inherited trait either due to an autosomal dominant mutation or an X‐linked dominant inheritance. This abnormality is amendable to surgery, and any well‐executed technique usually gives good hearing results.
Extent of Lymphadenectomy Achieved by Various Modifications of Neck Dissection: A Pathologic Analysis
Authors: Busaba Nicolas Y. , Fabian Richard L.
Published: November 2003

Objectives: Quantify the extent of lymphadenectomy achieved by the various modifications of neck dissection based on microscopic pathologic analysis.Study Design: Retrospective review of neck specimens of patients who underwent neck dissection for head and neck malignancies at our institution over a 5‐year period.Methods: Charts and pathology report findings on patients who underwent neck dissection were reviewed. Patients who received preoperative chemotherapy or radiation therapy to the neck were excluded. The number of lymph nodes documented by pathologic microscopic examination for each specimen was recorded.Results: There were 164 neck specimens on 135 patients (29 patient had simultaneous bilateral neck dissection). Those were divided into four groups based on the non‐lymphatic structures preserved. There were 58 radical neck dissections (radical neck dissections) (group 1), 50 modified radical neck dissections sparing the eleventh cranial nerve (group 2), 15 modified radical neck dissections sparing the eleventh cranial nerve and internal jugular vein (group 3), and 33 modified radical neck dissections sparing the eleventh cranial nerve, internal jugular vein, and sternocleidomastoid muscle (group 4). The remaining 8 had other modifications of radical neck dissection. The mean number of lymph nodes found per specimen was 34 in group 1, 27 in group 2, 31 in group 3, and 22 in group 4. We performed one‐way between‐group analysis of variance (ANOVA). Pair‐wise comparisons of means were carried out subsequent to ANOVA utilizing the Fisher Exact Test. Group 4 was significantly different from all other groups. Additionally, group 2 significantly differed from group 1.Conclusions: The extent of lymphadenectomy achieved by neck dissection decreases as the number of nonlymphatic structures preserved in the neck increases. The impact of this finding on the pathologic staging or prognosis needs further analysis.
In Situ Identification of Normal Visceral Tissues Using Contact Telescopic Microscopy
Authors: Richtsmeier William J. , Huang Patti , Scher Richard L.
Published: November 2003

Objectives: To improve the intraoperative anatomic identification of normal tissues during surgery using histologic‐like criteria. Study Design: A contact telescope was used to identify normal visceral tissues in an animal model using pigs and dogs during routine human surgical procedures. Methods: Tissues that could be identified grossly were stained topically with methylene blue and then examined with the contact telescope. The histologic appearance of these tissues with the contact telescope was correlated with routine histologic hematoxylin and eosin stains obtained after such tissues were excised. Results: Normal tissues, such as fat, blood vessels, muscle, and parathyroid tissue, can be identified reliably in animals and humans. The contact telescope appears to be able to differentiate between a variety of visceral tissues in the neck and may become useful for practical differentiation between tissues during surgery.
Multidimensional Assessment of Voice Characteristics After Radiotherapy for Early Glottic Cancer
Authors: Verdonck‐De Leeuw Irma M. , Hilgers Frans J. M. , Keus Ronald B. , Koopmans‐Van Beinum Florien J. , Greven An J. , De Jong Jos M. A. , Vreeburg Gerard , Bartelink Harry
Published: November 2003

Objectives/Hypothesis: To assess voice characteristics of patients following radiotherapy for early glottic cancer through a multidimensional analysis protocol including vocal function and voice quality measures. Methods: Voice analyses were performed for 60 patients treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, or 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers. There was a longitudinal group of 10 patients for whom data were collected before as well as 6 months and 2 years after radiation. Furthermore, data were collected for five separate groups of 10 patients each, before, 6 months after, 2 years after, 3 to 7 years after, and 7 to 10 years after radiation. Vocal function was investigated by means of videolaryngostroboscopy, phonetography, maximum phonation time, and phonation quotient measures. Voice quality was assessed by means of objective acoustical analysis and subjective perceptual ratings by trained raters. Results: Voice characteristics of patients were decreased before radiotherapy, improved after treatment, and became comparable to the voice characteristics of control speakers in at least 55% of the patients. Following radiotherapy, deviant voice quality was mainly negatively affected by increased age and stripping the vocal cord for initial diagnosis. Stroboscopy revealed that next to increasing age and stripping the vocal cord, continued smoking after treatment decreased vocal function following radio‐therapy. Conclusion: Voices of patients diagnosed with early glottic cancer improved but did not normalize fully after radiotherapy. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased voice characteristics. A multidimensional analysis protocol including perceptual and acoustical analysis of voice quality and stroboscopic analysis of vocal function is recommended to investigate voice characteristics following treatment for early glottic cancer.
Evidence for Laryngeal Paralysis in Cricoarytenoid Joint Arthritis
Authors: Gacek Richard R. , Gacek Mark R. , Montgomery William W.
Published: November 2003

Objective/Hypothesis: To demonstrate denervation atrophy of laryngeal muscles in a case of gout involving the cricoarytenoid joint. Methods: The posterior cricoarytenoid (PCA) and arytenoideus (A) muscles from a 72‐year‐old man with extensive gout were compared with those from a normal adult larynx (age and sex unknown) using stereologic techniques for changes in muscle composition and fiber diameter. Results: The PCA and A muscles in the gout specimen contained changes Indicative of muscle degeneration. In the PCA the volume fraction (VF) of intact muscle was 0.30, of degenerating muscle 0.13, and of fat 0.16. A normal PCA had a VF for intact muscle of 0.64 and 0 for degenerating muscle and fat. Similar changes were seen in the gout A muscle but were not measured. Muscle fiber diameters in the gout PCA (1,024 fibers) showed a significantly higher atrophy and hypertrophy factor than the normal PCA (1,255 fibers). The variability coefficient in the gout PCA (487) was almost double that in the normal PCA (290). Although muscle fiber diameters were not measured in the A muscle in gout, variability in fiber size was seen. Conclusions: The pattern and magnitude of muscle fiber degeneration in the PCA and A muscles from a larynx with gout fixation of the cricoarytenoid joint indicate neural degeneration. Since similar changes were not found in the thyroarytenoid (TA) and lateral cricoarytenoid (LCA), the neuropathy is selective for the posterior branch of the recurrent laryngeal nerve. This neuropathy is likely responsible for vocal cord adduction (stridor) and incomplete closure of the posterior commissure (aspiration) associated with acute cricoarytenoid arthritis. In chronic cricoarytenoid joint arthritis, ankylosis of the joint space maintains the adducted cord position.
Vascular Anomalies Causing Symptomatic Tracheobronchial Compression
Authors: Mclaughlin Robert B. , Wetmore Ralph F. , Tavill Michael A. , Gaynor J. William , Spray Thomas L.
Published: November 2003

Objectives/Hypothesis: To review the clinical presentation and diagnostic evaluation of patients with symptomatic congenital vascular anomalies causing tracheobronchial compression and to establish the short‐ and long‐term results of surgical intervention with respect to postoperative complications, persistent symptoms, and ventilator and tracheostomy dependence. Study Design: Retrospective review. Methods: Chart review and telephone follow‐up. Results: Between 1987 and 1996, 35 children underwent surgical intervention to relieve symptomatic tracheobronchial compression resulting from a congenital vascular anomaly. Historically, the onset of symptoms occurs within the first months of life; however, only 12 (34%) of patients were diagnosed by 6 months of age and 13 (37%) were diagnosed at greater than 1 year of age. Excluding anomalous innominate artery, chest radiography or barium swallow was suggestive of a congenital vascular anomaly in 30 (94%) of the patients. Magnetic resonance imaging correctly delineated the anatomy of the vascular anomaly in 29 patients. Bronchoscopy was diagnostic in all three patients with anomalous innominate arteries causing tracheal compression. Postoperative follow‐up was obtained in 32 (91%) of patients; 25 (78%) of these were asymptomatic at the time of their most recent examination. The remaining patients had persistent stridor, recurrent respiratory tract infections, and/or chronic cough. In all three patients who underwent postoperative bronchoscopy for persistent symptoms, tracheomalacia was demonstrated in the region of previous compression. Conclusions: Tracheobronchial compression from congenital vascular anomalies is a rare but treatable cause of respiratory symptoms. Early diagnosis requires a prompt, thorough clinical and radiologic evaluation. Surgery affords excellent long‐term resolution of symptoms.
Isolated Nasalis Muscle Reconstruction in Secondary Unilateral Cleft Lip Nasal Reconstruction
Authors: Bagatain Marijo , Khosh M. Morad , Nishioka Gary , Larrabee Wayne F.
Published: November 2003

Objectives/Hypothesis: Reconstruction of the nasalis muscle in the unilateral cleft lip nasal deformity improves surgical results. Study Design: A retrospective analysis of a series of 112 consecutive procedures. Methods: Chart review and analysis of standardized preoperative and postoperative clinical photographs. Results: Patients treated with this technique had improved contour of the alar base compared with historical controls. Conclusion: Nasalis muscle reconstruction should be considered in the repair of the moderate to severe unilateral cleft nose deformity.
Hearing Loss With a Mitochondrial Gene Mutation Is Highly Prevalent in Japan
Authors: Oshima Takeshi , Ueda Narihisa , Ikeda Katsuhisa , Abe Koji , Takasaka Tomonori
Published: November 2003

Objectives/Hypothesis: Mutations in the mitochondrial genome may predispose people to sensorineural hearing loss. An adenine to guanine point mutation in the tRNALeu(UUR) gene at nucleotide 3,243 is one of the deaf‐related mutations. This mutation is reported to be associated with 0.9% of diabetes mellitus patients. However, the prevalence of this mutation in hearing‐impaired patients still remains unknown. The aim of this study was to determine the prevalence of this mutation among bilaterally sensorineural hearing‐impaired patients in Japan. Study Design: Retrospective survey of 100 patients with bilateral sensorineural hearing loss without any evident causes. Methods: Mitochondrial DNA fragments from the patients were amplified by polymerase chain reaction, followed by a restriction enzyme fragment length polymorphism method. Results: Three patients with this mutation were identified. Their clinical profiles were different from the category which had been considered as hearing loss caused by this mitochondrial gene mutation. Conclusions: The mutation is associated with approximately 3% of bilateral sensorineural hearing loss cases of unknown origin and is possibly distributed widely in sensorineural hearing‐impaired patients in Japan.
Effects of medialization laryngoplasty on airway resistance: A pilot study
Authors: O'Grady Kevin F. , Irish Jonathan C. , Doyle D. John , Gullane Patrick , Butany Jagdish
Published: November 2003

Objective: To investigate the effects of medialization laryngoplasty on laryngeal airway resistance at various clinically relevant flow rates. Study Design: This study was conducted using a total of 13 laboratory experiments. Two of the experiments were used to validate the cadaveric model employed. Eleven experiments were used to quantify airway resistance relative to increasing medialization laryngoplasty stent size. Methods: With autopsy consent the authors obtained 13 consecutive and anatomically complete larynges for experimentation. A thyrotomy window measuring 8 × 6 mm was made on the left side of the thyroid cartilage. A #4 laryngeal mask was secured to the pharyngeal airway with sutures. Eleven experiments were conducted at the same flow rates using increasingly larger stents from 1 mm to 11 mm in size. Using the Bernoulli equation, the pressure measured at the proximal end of the laryngeal mask is representative of the pressure drop across the airway. The experimental model was validated in two experiments using flow rates between 5 and 50 L/min and stents measured at 5, 10, 15, and 20 mm. Results: Average results from the 11 experiments indicate that at increasing levels of medialization, from 0 to 11 mm, there is essentially the same pressure drop across the larynx at a given flow rate. Conclusion: At physiologic airflow rates in a cadaveric model, medialization laryngoplasty implants of 11 mm or less seem to have no obvious effect on airway resistance.
Phonation threshold pressure measurements during phonation by airflow interruption
Authors: Jiang Jack , O'Mara Timothy , Conley David , Hanson David
Published: November 2003

Objective/Hypothesis: Most methods to measure phonation threshold pressure (PTP) are clinically impractical because they are invasive. This report concerns an airflow interruption system developed to allow noninvasive estimation of (PTP) at different levels of vocal intensity. An estimation of PTP was made for normal subjects with normal larynges and no voice complaints and for individuals who had dysphonia associated with vocal polyps to compare the estimated minimal pressure across the glottis that was required to sustain phonation in the two conditions. Study Design: This was a methodological study designed to measure an unanticipated PTP from a subject. Methods: Subjects sustained a constant tone and the airflow was directed into a section of pipe with an airtight mask over the mouth and nose. The airflow, intramask pressure, and intensity of the acoustic output were recorded. A PTP was predicted from a difference between an estimate of the subglottal pressure and the vocal tract pressure at the point that phonation ceased after interruption of airflow. Eleven control subjects and 13 patients with vocal fold polyps were studied. In each population there were eight men and five women. The individuals in the group with vocal fold polyps averaged 39 years of age, and the control subject group averaged 49 years of age. Normal subjects produced a steady vowel /a/ at 75, 80, and 85 dB. Patients with polyps were unable to sustain phonation at these levels but were able to produce phonation at 65, 70, and 75 dB. The validity of the system was tested using a laryngeal model and in a patient with a normal larynx and voice who had a tracheotomy (placed for sleep apnea syndrome) which allowed direct measurement of subglottal pressure. Results: The measured mean PTP levels (with standard deviation [SD]) for the control subjects were 2.38 (1.273), 2.67 (1.879), and 2.98 (2.23) cm H2O at 75, 80, and 85 dB, respectively. The measured mean PTP levels (with SD) for the patients with polyps were 4.79 (2.67), 5.85 (2.34), and 7.37 (3.26) cm H2O at 75, 80, and 85 dB, respectively. The differences in mean PTP between groups at 75, 80, and 85 dB were significant at P = .013, P = .017, and P = .010, respectively. Conclusions: The estimations of PTP for patients with vocal fold polyps were significantly higher than for the control subjects at three phonation levels.