bluuebunny/crossref_metadata_2025 huggingface dataset:
Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998
Authors: Fisher Samuel R.
Published: November 2003

Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck.

Study Design and Methods A retrospective computer‐aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease‐free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared.

Results A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND⊕ or TLND (P = .01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five‐year survival after DLND and TLND was 56% and 36%, respectively.

Conclusion Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.
Relationships Between Otoacoustic Emissions and Auditory Brainstem Responses in Neonates and Young Children: A Correlation and Factor Analytical Study
Authors: Cacace Anthony T. , Pinheiro Joaquim M. B.
Published: November 2003

Objectives To establish relationships among transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR) variables in a sample of normal hearing neonates and young children, ranging in age from approximately 3 weeks to 4 years.

Study Design Retrospective, non‐randomized, cross‐sectional analysis of clinical data obtained at a tertiary care medical center.

Methods Pearson product moment and Spearman rank order correlation analyses to evaluate pairwise relationships between TEOAE variables, ABR variables and age; factor analysis, to identify the structural composition and dimensionality of these relationships.

Results Significant pairwise correlations were obtained between variables within each test paradigm (TEOAEs, ABRs) and between ABR absolute and interpeak latencies with age. However, the most striking effect was the absence of strong correlations between ABR and TEOAE variables, indicating that these test measures provide independent information about auditory system integrity and sensitivity. Two factors, accounting for over 55% of the variance, characterized this data set: 1) a frequency‐dependent OAE factor, which showed an inverse relation between biologic noise and whole wave percent reproducibility and half‐octave band TEOAE amplitudes; and 2) a central nervous system (CNS) maturational factor, which showed an inverse relationship between age and certain absolute and interpeak ABR latency components.

Conclusions TEOAE and ABR test results provide unique and functionally independent information about normal auditory system integrity and sensitivity. Therefore, a combination of both tests is well suited for use within a pediatric test battery. These results confirm that biologic noise and age at test differentially affect OAE and ABR test measures, and both effects require consideration during data acquisition and interpretation.
Otolaryngology Retirement Profile in the Southeastern United States
Authors: McGuirt W. Frederick , McGuirt William F.
Published: November 2003

Objective To document retirement‐related issues and trends among otolaryngologists.

Study Design Survey of 438 retired members in the Southern geographical region of the American Laryngological, Rhinological and Otological Society, Inc.

Methods A questionnaire was mailed to retired members, completed anonymously, and returned to the author.

Results A total of 138 (31.5%) surveys were received. Respondents' average age at retirement was 63.2 years; approximately half had retired in the last 5 years. Since 1995, most had left either a group practice (45%) or a solo practice (41%). The majority of respondents (40%) retired for previously planned or personal reasons. Two thirds of respondents reported that they were more satisfied with retirement than expected. This greater satisfaction was seen in those with a higher average income after retirement. The most common advice for colleagues still practicing was to save more money and invest more money.

Conclusions Although these results are biased because of a self‐selected group of respondents, they illustrate that for this group of retired otolaryngologists, although retirement is being planned for, it is not occurring earlier than in previous years. The experience of retirement was largely positive for these respondents.
The Role of Computed Tomography and Magnetic Resonance Imaging in Patients With Sinusitis With Complications
Authors: Younis Ramzi T. , Anand Vinod K. , Davidson Beverly
Published: November 2003

Objectives This study compares the use of computed tomography (CT) with magnetic resonance imaging (MRI) and clinical assessment in the diagnosis and surgical management of patients with sinusitis with complications. The common CT findings of patients with intracranial or orbital infection of sinusitis are reviewed.

Study Design We reviewed the charts of 82 adult and pediatric patients with the diagnosis of sinusitis with intracranial or orbital infection who were seen at the University of Mississippi Medical Center from January 1985 through December 1999. We assessed the diagnoses and outcomes to determine the most effective use of CT, with or without MRI, in the treatment of these patients.

Methods Clinical presentations were reviewed, along with the CT and MRI findings, for patients who had sinusitis with complications. Clinical, CT, and MRI findings were compared for accuracy in diagnosing 43 patients with orbital infections and 39 patients with intracranial infections.

Results For patients with orbital complications, most of whom had unilateral ethmoiditis, the diagnostic accuracy was 82% for clinical assessment compared with 91% for CT. For patients with intracranial complications, meningitis was the most common diagnosis, and MRI was more accurate (97%) in determining the diagnosis than CT (87%) or clinical findings (82%).

Conclusion CT remains the standard modality for diagnosing sinusitis, but MRI frequently is necessary, especially for patients with intracranial complications. Both diagnostic methods have improved the management and outcomes of patients who have sinusitis with complications.
Preoperative versus Postoperative Role of Vestibular‐Evoked Myogenic Potentials in Cerebellopontine Angle Tumor
Authors: Chen Cheng‐Wei , Young Yi‐Ho , Tseng Ham‐Min
Published: November 2003

Objective/Hypothesis Vestibular‐evoked myogenic potential (VEMP) examination was performed on patients with a cerebellopontine angle (CPA) tumor to evaluate its clinical role.

Methods Patients with a CPA tumor were subjected to caloric test and VEMP examination. Follow‐up study was performed 1 year after the surgery.

Results Six (69%) of the 9 tumors did not exhibit either caloric response or VEMP on the lesioned side. Three patients received tumor excision and all tumors involved both the superior and inferior vestibular nerves. Two (22%) of the 9 tumors had normal caloric responses but no VEMP. One underwent surgical excision, and the tumor originated from the inferior vestibular nerve. In the follow‐up study, only 1 patient with epidermoid cyst presented complete recovery of caloric response and VEMP, whereas in the other 3 patients with vestibular schwannoma, the responses were all absent persistently.

Conclusion Before surgery, VEMP test can be used to predict the nerve of origin and to formulate the best surgical approach. After surgery, VEMP test can be used to define the nature of the tumor (compressing or infiltrating the nerve) and disclose the residual function of the inferior vestibular nerve.
Endoscopic Repair of Bilateral Congenital Choanal Atresia
Authors: Khafagy Yasser W.
Published: November 2003

Objective The literature about endoscopic repair of bilateral choanal atresia is scarce. The advantages and difficulties encountered with this technique are discussed.

Study Design Prospective case series in a tertiary care center.

Methods Nine infants with bilateral choanal atresia underwent transnasal endoscopic repair. On computed tomography scans, six had mixed atresia and three had bony atresia. Extra‐long burrs, ear curettes, and dissectors all have been used with 4‐ and 2‐mm, 0° telescopes. The neochoana has been stented for 5 to 8 weeks. All cases were examined with the endoscope on removal of the stent; any granulation or polyps were removed at that time.

Results Five cases remained patent after removal of stenting. Two patients required revision surgery because of repeat stenosis; one case remained patent and the other had repeat stenosis on one side. One infant died because of unrelated medical problems that occurred later. In one case the atretic tissue was thick, and the procedure was stopped because of bleeding; the infant died in the postoperative period after resuscitation.

Conclusion Careful review of the computed tomography scan and experience with endoscopic nasal surgery makes the transnasal endoscopic treatment a safe and effective approach for managing bilateral choanal atresia.
CO2 Laser Cordectomy for Early‐Stage Glottic Carcinoma: A Long‐Term Follow‐up of 156 Cases
Authors: Gallo Andrea , de Vincentiis Marco , Manciocco Valentina , Simonelli Marilia , Fiorella Maria Luisa , Shah Jatin P.
Published: November 2003

Objectives To define when laser resection of early‐stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options.

Study Design Retrospective study of 151 patients treated from April 1982 to June 1996 in the Department of Otorhinolaryngology at “La Sapienza” University. We provide analysis of indications, techniques, and oncologic results of this study.

Methods Glottic tumors were treated with type III, type IV, and type Va cordectomies according to the classification of endoscopic cordectomies proposed by the European Laryngological Society in 2000.

Results The results are summarized as follows: all patients with carcinoma in situ Tis are free of disease with local control rate at 3 years of 100%; 2 died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 83.2%. Of the 117 patients with stage T1a cancer, 110 are free of disease at 3 years with local control rate of 94%; 4 patients died of other causes without evidence of local recurrence with an overall survival rate of 96.5%. Of the 22 patients with stage T1b cancer, 20 are free of disease at 3 years with a local control rate of 91%; 1 patient died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 95.4%.

Conclusions According to our experience, we can conclude that endoscopic laser surgery is an efficacious and cost‐effective treatment for early stage glottic cancer.
First Evidence of Genetic Imbalances in Angiofibromas
Authors: Schick Bernhard , Brunner Christian , Praetorius Mark , Plinkert Peter Karl , Urbschat Steffi
Published: November 2003

Objective/Hypothesis Angiofibromas are clinically well characterized by their origin at the posterior lateral nasal wall close to the sphenopalatine foramen, their occurrence in male adolescent patients, and the histological findings of a benign fibrovascular neoplasm with irregular, endothelium‐lined vascular spaces in a fibrous stroma. However, their etiology and genetic causes remain unknown. The present study addresses genetic imbalances in angiofibromas.

Study Design The present pilot study compared genomic hybridization in three angiofibromas to search for chromosomal abnormalities in this rare tumor.

Methods Fluorescence‐marked normal DNA and angiofibroma DNA were compared using genomic hybridization screening to detect chromosomal abnormalities. Their binding ratio to metaphase chromosomes were analyzed by special digital image analysis.

Results Chromosomal gains and losses showing a high level of agreement were detected in all three angiofibromas. Specifically, DNA gains were observed on chromosomes 3q, 4q, 5q, 6q, 7q, 8q, 12p, 12q, 13q, 14q, 18q, 21q, and X, and DNA losses were screened on chromosomes 17, 19p, 22q, and Y. Finding chromosomal abnormalities at the sex chromosomes X and Y of this rare tumor is remarkable. Concurrent chromosomal gain on 8q12q22 was noted in all three tumor specimens.

Conclusions Comparative genomic hybridization is suitable for screening angiofibromas on a genetic level. The results on these screens indicate that further genetic investigations of this rare benign tumor may provide more details about the tumor's genetic abnormalities and perhaps clarify the etiology of angiofibromas.
Prognostic Indicators of Occult Metastases in Oral Cancer
Authors: Russolo Mario , Giacomarra Vittorio , Papanikolla Ledia , Tirelli Giancarlo
Published: November 2003

Objective We evaluated the importance of several tumor factors related to predicting the presence of occult metastases in the oral cavity.

Study Design Retrospective case study.

Methods The study comprises 29 patients treated at the Department of Otorhinolaryngology (University of Trieste, Cattinara Hospital, Trieste, Italy) between January 1990 and December 2000, who had T1‐T2 carcinoma of the oral cavity that had or had not extended to the oropharynx and were clinically evaluated as N0 neck. The patients all underwent surgery with removal of tumor and neck dissection. Four tumor‐related parameters were examined with the aim of evaluating their predictivity of metastasis: tumor class, degree of keratinization, degree of differentiation according to Brooler's histopathological grading, and invasive cell grading (ICG). With the exception of tumor class, these parameters were evaluated both in the biopsy and in the surgical specimen and the findings were then compared. We evaluated existing correlations between each individual parameter and the histopathological presence of micrometastases (pN+) and extracapsular spread revealed when specimens from the neck were examined.

Results There was a highly significant correlation between ICG equal to or greater than 13 (range, 5–20) and the presence of occult metastases (P = .0017). On the basis of our findings, the ICG parameter correctly identified 9 of 10 (pN+) patients and could have reduced overtreatment from 65.5% to 17.2% in histopathological necks (pN0).

Conclusion It would appear that with a delay in programming a neck dissection so as to consider ICG in combination with thickness, as in seven recent patients, identification of locoregional occult metastases (pN+) might be more precise.
Parotid Gland Metastasis From Renal Cell Carcinoma
Authors: Park Youn W. , Hlivko Thomas J.
Published: November 2003

ObjectiveTo discuss the diagnosis and management of metastatic renal cell carcinoma presenting as a parotid mass by studying such cases.

Study DesignRetrospective review.

MethodsIdentification of 24 previously reported cases of renal cell carcinoma metastatic to the parotid gland in the English language literature and an analysis of a total of 25 patients including our case.

ResultsParotid metastasis was the initial presenting sign of the malignancy in the kidney in 14 of 25 (56%) cases; 11 of 25 (44%) cases presented with metachronous metastasis to the parotid. The most common presenting complaint was parotid mass. No case presented with facial paralysis. In three of six (50%) patients, fine‐needle aspiration biopsy was diagnostic.

ConclusionsIn the majority of cases, parotid metastases are the first clinical sign of the renal cell carcinoma. Fine‐needle aspiration biopsy can provide crucial information without parotidectomy as in our case. Parotidectomy with facial nerve preservation should be considered as a therapeutic option for solitary parotid metastasis.
Epstein‐Barr Virus Latent Membrane Protein‐1 (LMP‐1) Expression in Oral Squamous Cell Carcinoma
Authors: Gonzalez‐Moles M. A. , Gutierrez J. , Rodriguez M. J. , Ruiz‐Avila I. , Rodriguez‐Archilla A.
Published: November 2003

Objectives Epstein‐Barr virus (EBV) is frequently associated with malignant cell transformation through the action of the oncoprotein latent membrane protein‐1 (LMP‐1). The present study aimed to determine the presence of EBV in oral squamous cell carcinomas (OSCCs) and the expression of LMP‐1 in neoplastic cells of EBV‐positive OSCCs.

Study Design/Methods In a retrospective study of 78 OSCCs, we investigated the presence of the DNA of EBV by polymerase chain reaction, the expression of the oncoprotein LMP‐1 by immunohistochemistry, and the presence of EBV‐encoded RNA (EBER) by in situ hybridization.

Results EBV DNA was detected in 19.2% of the cases. Expression of LMP‐1 in neoplastic cells was found in 85.7% of the EBV‐positive OSCCs. EBV presence was significantly more frequent (P <.05) in OSCCs localized on the lateral tongue. EBV‐positive OSCCs more frequently presented (P <.05) greater nuclear atypia.

Conclusion EBV can appear in latent form in OSCC and express its main oncoprotein, LMP‐1.
The Axillary Flap Approach to the Frontal Recess
Authors: Wormald Peter John
Published: November 2003

Objectives To evaluate the access to the frontal recess using the axillary flap approach by identifying the frontal ostium during endoscopic sinus surgery.

Study Design Prospective review of 64 consecutive patients (118 sides) undergoing axillary flap exposure of the frontal recess between November 1998 and July 1999.

Methods Demographic data, identification of the frontal ostium, findings at surgery, use of nasal packing, the presence of postoperative symptoms, revision surgery, and the endoscopic appearance of the frontal recess were collected. The operative technique is presented.

Results The frontal sinus ostium was identified in 96% of patients (104 of the 118 sides). Eight sides had Kuhn type 3 cells that required removal for clearance of the frontal ostium. Eighty‐two percent of sides (97 sides) had endoscopically healed sinuses without symptoms after an average follow‐up of 15.4 months. Six sides had middle meatal adhesions requiring division under local anesthetic. One patient has required revision surgery.

Conclusion The axillary flap approach to the frontal recess provides excellent access to the frontal recess and allows clearance of cells in the recess with identification of the frontal ostium in the vast majority of cases.
Incidence of Inadvertent Parathyroid Removal During Thyroidectomy
Authors: Lin Derrick T. , Patel Snehal G. , Shaha Ashok R. , Singh Bhuvanesh , Shah Jatin P.
Published: November 2003

Objectives To assess the incidence of unintentional parathyroid removal during routine thyroidectomy and to identify factors that might predict patients at high risk.

Study Design Retrospective review of case records. Data analyzed for incidental finding of parathyroid gland(s) in the thyroidectomy specimen and postoperative temporary or permanent hypocalcemia.

Methods The clinical records of 220 patients undergoing thyroidectomies between January 1997 and October 1999 were reviewed. Pathology reports were screened for information on the presence of parathyroid tissue along with the thyroid specimen. Operative reports were reviewed to exclude the possibility of intentional parathyroid gland removal. Case records were scrutinized to determine whether the patient developed symptomatic hypocalcemia postoperatively.

Results Nine percent of the 220 patients were found to have had inadvertent removal of parathyroid tissue. The majority of patients (95%) had two or less parathyroid glands in their specimens. The size and histological nature of the thyroid lesion were not predictive of inadvertent parathyroid removal. Of the 25 repeat operations for recurrent or persistent malignancy, 5 (20%) were found to have unintentional parathyroid removal compared with 15 (7.7%) of 195 primary thyroidectomy cases (P <.05). Nineteen percent of patients who had tracheoesophageal groove node dissection had an incidental parathyroid in their specimen compared with 7% who did not undergo tracheoesophageal groove node dissection (P = .04). None of the patients with unintentional parathyroid gland removal developed either temporary or permanent postoperative hypocalcemia.

Conclusions Inadvertent excision of a parathyroid gland(s) occurred in 9% of patients undergoing thyroidectomy in our experience. Reoperative thyroid surgery and tracheoesophageal node dissection were associated with a significantly higher risk of inadvertent parathyroid gland excision. Inadvertent parathyroidectomy did not result in symptomatic temporary or permanent hypocalcemia postoperatively.
The Node‐Negative Neck: Accuracy of Clinical Intraoperative Lymph Node Assessment for Metastatic Disease in Head and Neck Cancer
Authors: Finn Stephen , Toner Mary , Timon Conrad
Published: November 2003

Objectives/Hypothesis Often, the type of neck dissection performed in patients with head and neck malignancy is finally determined by intraoperative assessment of clinically suspect lymph nodes by frozen section. This prospective study aimed to assess the accuracy of clinical intraoperative lymph node assessment and therefore to examine validity of the underlying assumption that the surgeon can consistently identify nodes that contain metastatic tumor. We also aimed to assess whether gross morphological characteristics of the lymph nodes examined could be correlated with nodal status and therefore used to predict those nodes containing metastatic disease.

Study Design A prospective study assessing the accuracy of clinical intraoperative lymph node assessment in the node‐negative neck.

Methods Forty‐six neck dissections from 34 patients with head and neck cancer were prospectively examined intraoperatively by a single surgeon. All obvious nodes were clinically assessed, morphologically described, and subsequently correlated with pathological findings.

Results Sixty palpable nodes were identified in 32 neck dissections. They were clinically categorized as malignant or suspect (22) or benign (38). Pathological examination revealed a false‐positive rate of 30% and a false‐negative rate of 44%. The sensitivity of intraoperative lymph node assessment was 56%, and the specificity was 70%. Apart from “infiltration,” morphological characteristics could not be correlated with nodal status. In the 14 neck dissections with no obviously palpable lymph nodes, 4 (29%) were positive for metastatic disease.

Conclusions In the node‐negative neck, intraoperative assessment does not seem to improve the accuracy of staging. The only parameter of benefit and correlating with metastatic disease is clinical evidence of infiltration. The assumption that frozen section is a good determinate for selection of type of neck dissection is questionable. If selective neck dissection is not found to be therapeutic, its use leads to over‐reliance on other therapeutic treatment such as postoperative radiotherapy, depriving the patient of a potential useful treatment modality in cases of locoregional recurrence.
Colonization of Voice Prostheses by Albicans and Non‐Albicans Candida Species
Authors: Bauters Tiene G. M. , Moerman Mieke , Vermeersch Hubert , Nelis Hans J.
Published: November 2003

Objectives The purposes of the study were to assess the colonization of tracheoesophageal voice prostheses by albicans and non‐albicans Candida species and to determine their susceptibility for three antimycotics that are frequently used for prophylaxis or treatment of oral candidiasis (i.e., miconazole, fluconazole, and nystatin).

Study Design In total, 101 patients, corresponding to 170 voice prostheses, were monitored over a period of 28 months.

Methods An enzymatic two‐step method was used for differentiation and presumptive identification of Candida species colonizing the voice prostheses. The identity of the isolates was confirmed by the germ‐tube test, morphological appearance on cornmeal agar with 0.5% Tween 80, sugar assimilation tests, and appearance on CHROMagar Candida (CHROMagar Co., Paris), Albicans ID (BioMérieux Vitek, Hazelwood, MO), and Fluoroplate Candida (Merck, Darmstadt, Germany). Susceptibility testing for miconazole, fluconazole, and nystatin was performed according to the microdilution method of the National Committee for Clinical Laboratory Standards.

Results The predominant species isolated were Candida albicans (41.4%), Candida glabrata (33.1%), Candida krusei (15.9%), and Candida tropicalis (5.3%). A broad range of minimal inhibitory concentrations of the isolates was observed for miconazole and fluconazole. In contrast, minimal inhibitory concentration values for nystatin were narrowly distributed around 4 μg/mL for all isolates, suggesting uniform sensitivity.

Conclusion Our data on the prevalence and susceptibility of yeast isolates will contribute to a rational choice of an antimycotic for prophylaxis of the early deterioration and leakage of tracheoesophageal voice prostheses.
Informed Consent in Functional Endoscopic Sinus Surgery
Authors: Wolf Jeffrey S. , Malekzadeh Sonya , Berry Julie A. , O'Malley Bert W.
Published: November 2003

Objectives Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS.

Study Design Survey.

Methods Surveys were sent to 1000 American Academy of Otolaryngology—Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS.

Results Three hundred forty‐six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 8%; and death, 28.0%.

Conclusions The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.
Over‐Under Tympanoplasty
Authors: Kartush Jack M. , Michaelides Elias M. , Becvarovski Zoran , LaRouere Michael J.
Published: November 2003

Objective Common techniques of tympanic membrane repair include underlay and overlay grafting. The over‐under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures.

Study Design This study was a retrospective case review.

Setting Tertiary referral center with hospital‐setting surgery and outpatient ambulatory patient visits.

Patients One hundred twenty patients who underwent over‐under tympanoplasty were included in this study. Average follow‐up was 1.8 years.

Intervention Over‐under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included.

Main Outcome Measures Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy.

Results All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air–bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB.

Conclusion Over‐under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.
Immunohistochemical Localization of Interleukin‐10 in Human Oral and Pharyngeal Carcinomas
Authors: Chandler Stephen W. , Rassekh Christopher H. , Rodman Susan M. , Ducatman Barbara S.
Published: November 2003

Objectives/Hypothesis Interleukin‐10 (IL‐10) is an immunosuppressive cytokine with numerous, well‐described effects on the human cellular and humoral immune response. The oncogenic potential of IL‐10 has been previously investigated in bronchogenic carcinoma, nasopharyngeal carcinoma, Waldeyer's ring carcinoma, and serum supernatants of patients with squamous cell carcinoma of the head and neck (SCCHN). The purpose of the study was to determine the prevalence and cellular localization of IL‐10 in human SCCHN.

Study Design Immunohistochemistry of archival tissues.

Methods Paraffin‐embedded archival tissues were retrospectively obtained from 98 patients with oral and pharyngeal squamous cell carcinoma. Using a standard immunohistochemical technique, these specimens were stained with a polyclonal antibody to IL‐10.

Results Using these methods, we found specific localization of antigenic IL‐10 to individual tumor cells in 65% of tumors studied. Intensity of staining was significantly, but inversely, related to tumor grade and N stage; there also existed a significant staining predisposition for oral cavity lesions when samples from this site were compared with tissues derived from elsewhere in the pharynx. Furthermore, IL‐10 was not localized to normal epithelial keratinocytes or inflammatory cells at the level of sensitivity achieved by the immunohistochemical methods used in the study.

Conclusions The findings demonstrate that IL‐10 can be specifically localized to human oral and pharyngeal cancer cells. These data also suggest an inverse association for both tumor grade and N stage with specific tumor marker staining. Future studies should investigate the role of this cytokine in the pathogenesis of human SCCHN.
Long‐Term Effect of Submucous Turbinectomy in Patients With Perennial Allergic Rhinitis
Authors: Mori Shigehito , Fujieda Shigeharu , Yamada Takechiyo , Kimura Yuichi , Takahashi Noboru , Saito Hitoshi
Published: November 2003

Objectives The long‐term effect of submucous turbinectomy for patients with perennial allergic rhinitis was assessed.

Study Design A cohort study of 45 patients with severe perennial allergic rhinitis who underwent submucous turbinectomy and were followed up after surgery for more than 3 years was performed. We investigated quality of life in 30 of 45 patients who had passed over 5 years after the surgery.

Methods Nasal symptoms were assessed with a standard symptom score by diary cards. Nasal congestion was evaluated by rhinometry. Nasal challenge tests in vivo were performed to evaluate allergic reactions. These examinations were performed before surgery and at 1 year, more than 3 years, and more than 5 years after submucous turbinectomy. We determined the symptom scores and the quality of life using card questionnaires in 30 patients at the time point of more than 5 years after surgery.

Results The mean [± SD] total nasal symptom score (maximum 9) was significantly lower at 1 year after surgery (7.5 ± 1.6 vs. 1.8 ± 1.8, P <.0001) compared with before surgery. A significant improvement in nasal symptoms was noted at the 3‐year (2.8 ± 2.3, P <.0001) and 5‐year (3.3 ± 1.6, P <.0001) time points. A significant increase in total nasal airflow value was noted at each time point after surgery, with a gradual reduction in the total nasal symptom score as well (before surgery, 269.4 ± 249.5 cm3/s; 1 y after surgery, 450.1 ± 197.7cm3/s; more than 3 y after surgery, 385.1 ± 182.3 cm3/s). The nasal challenge test score was also reduced 1 year after surgery (2.1 ± 1.0 vs. 0.6 ± 0.7, P <.0001). However, there was no further significant increase at the 3‐year time point (0.4 ± 0.7, P <.0001) after surgery. In regard to postoperative quality of life, according to the results of the card questionnaire, 50% of the patients had not been receiving antiallergic treatments in the postoperative period.

Conclusion Our results suggest that submucous turbinectomy is a useful strategy for the long‐term management of nasal allergic reaction and contributes to the improvement in quality of life.
The Effects of Tonsillectomy and Adenoidectomy on Serum IGF‐I and IGFBP3 Levels in Children
Authors: Ylmaz Mustafa Deniz , Hoşal A. Sefik , Oğuz Havva , Yordam Nurşen , Kaya Sefa
Published: November 2003

Objective Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. Interruption of growth hormone‐insulin‐like growth factor I axis resulting from abnormal nocturnal growth hormone secretion is among the postulated causes. Growth hormone (GH) mediates its anabolic effects on tissues through insulin‐like growth factor I (IGF‐I). Most of the circulating IGF‐I is bound to insulin‐like growth factor binding protein 3 (IGFBP3). The objective of this study is to determine blood serum levels of IGF‐I and IGFBP3 in patients with adenoid and tonsillar hypertrophy. Furthermore, we want to investigate the effect of tonsillectomy and adenoidectomy (T&A) on these levels.

Study Design The blood serum levels of IGF‐I and its binding protein IGFBP3 were examined in 41 randomly selected children with a diagnosis of upper airway obstruction resulting from hypertrophic tonsils and adenoids.

Methods Blood samples were taken preoperatively and repeated at 3 to 6 months (mean, 4.3 mo) following T&A operation. Coated‐tube immunoradiometric assay (IRMA) method was used to analyze IGF‐I and IGFBP3 levels.

Results Thirty‐two of 41 children were eligible for the analysis. When the preoperative and postoperative results were compared, it was found that there was a statistically significant increase in serum IGF‐I and IGFBP3 levels in these 32 children (P <.001). In 7 of the 32 patients, the preoperative serum IGF‐I levels were below normal. Postoperatively these levels increased within normal range. This was also statistically significant (P = .016).

Conclusion These findings revealed that obstructive adenoid and tonsillar hypertrophy may cause decreased serum IGF‐I levels by affecting the GH‐IGF‐I axis, and T&A is an effective therapeutic measure in these patients.
Ectodermal Dysplasia: Otolaryngologic Manifestations and Management
Authors: Daniel Elena , McCurdy Elizabeth A. , Shashi Vandana , McGuirt William F.
Published: November 2003

Objective To present the otolaryngologic manifestations and management of 12 patients with the rare presentation of ectodermal dysplasia.

Study Design A retrospective chart review combined with a patient evaluation by the specialties of genetics, dermatology, dentistry, and otolaryngology.

Methods A review of the head and neck manifestations of the spectrum of ectodermal dysplasia was undertaken by a retrospective chart review performed at a tertiary care children's hospital combined with a multidisciplinary evaluation by specialties of genetics, dermatology, dentistry, and otolaryngology.

Results All 12 patients had confirmed ectodermal dysplasia by genetic evaluation with strong familial manifestations of the spectrum. Seven of 12 patients presented with X‐linked hypohidrotic ectodermal dysplasia. Three of these seven were female patients and presented with variable expression. Common otolaryngologic manifestations included eczematoid skin changes, unusual facies, hypodontia, sparse scalp hair, chronic infections (rhinitis, pharyngitis, otitis media), epistaxis, ocular drying with corneal injury, dysphagia, hearing loss, and dysphonia. Immune evaluation was normal. Nasal cilia were deficient.

Conclusions Ectodermal dysplasia is a rare syndrome with heterogeneous manifestations secondary to hypoplasia of the mucous glands of the upper aerodigestive tract and ectodermal abnormalities. The spectrum is marked by hypohidrosis, recurrent ocular infections, chronic rhinitis, hypodontia, dystrophic nails, alopecia, and atypical facies. The recognition of this syndrome allows early management of ocular, dental, infectious, and dermatologic concerns with a multidisciplinary approach to management. Direct otolaryngologic management includes ocular and oral lubrication, treatment of infectious complications, and intervention to prevent and address hearing loss.
The Effects of Epoetin Alfa on Transfusion Requirements in Head and Neck Cancer Patients: A Prospective, Randomized, Placebo‐Controlled Study
Authors: Scott Shaun N. , Boeve Thomas J. , McCulloch Timothy M. , Fitzpatrick Kari A. , Karnell Lucy H.
Published: November 2003

Objective To evaluate the efficacy of perioperative recombinant human erythropoietin (r‐HuEPO, epoetin alfa) in stimulating hematopoiesis and reducing allogeneic blood transfusion requirements in major head and neck cancer surgery.

Study Design Double‐blinded, placebo‐controlled, randomized, prospective clinical trial.

Methods Fifty‐eight patients undergoing surgical resection of head and neck tumors at the University of Iowa hospitals completed this study. Patients were required to have a pre‐study hemoglobin ≥10.0 g/dL and ≤13.5 g/dL. Group 1 (29 patients) received three doses of 600 IU/kg epoetin alfa before surgery. Group 2 (29 patients) received a placebo. All patients received oral iron supplementation (150 mg FeSO4 twice per day).

Results The epoetin alfa group demonstrated a significant increase in baseline to day‐of‐surgery mean hemoglobin (0.57 g/dL, P = .016), hematocrit (2.04%, P = .015), and reticulocyte count (95.3 × 103 cells/mm3, P = <.001), whereas there was no significant change in these hematologic variables in the placebo group. The percent of patients who avoided transfusion in the epoetin alfa group was 34.5% versus 17.2% in the placebo group. Patients requiring allogeneic blood transfusions received an average of 3.16 units in the epoetin alfa group and 4.12 units in the placebo group.

Conclusion In this single institution study, we demonstrated a significant improvement in hematopoietic parameters and a trend toward decreased transfusion requirements using perioperative epoetin alfa in a head and neck cancer patient population. Further studies may delineate additional benefits in treating qualified patients with epoetin alfa during therapy for head and neck malignancies.
Simulated Zenker's Endoscopic Staple‐Assisted Esophagodiverticulostomy (ESED) Surgery
Authors: Richtsmeier William J.
Published: November 2003

Purpose The process of learning new surgical procedures remains a challenge in otolaryngology–head and neck (OHN) surgery. Endoscopic surgery for Zenker's diverticulum presents a dilemma mandating simulated surgery because there is no animal model or cadaver situation resembling the pathologic condition.

Study Design The author has developed an inexpensive model for ESED using a utility latex glove to provide a simulated pharynx with a Zenker's diverticula.

Methods First, the thumb and index finger are isolated with a staple line and a rubber band is placed around the long and ring fingers to simulate the cricopharyngeus muscle. The long finger, which will act as the larynx, is cannulated with a noncompressible endotracheal tube. The ring finger then simulates the esophagus and the little finger, the Zenker's diverticular pouch. The glove and the endotracheal tube are positioned inside a 1‐ft length of 3‐in polyvinyl chloride (PVC) pipe. A bivalving laryngoscope is suspended to visualize the “postcricoid area” and the parting wall. The rubber band pulls the inferior aspect of the “esophagus” up against the “larynx,” simulating the tight cricopharyngeal segment. Using video‐telescopic control, the endoscopic stapler is used in the standard fashion as described for ESED.

Results This model provides an opportunity for OHN surgeons to become familiar with endoscopic stapling and suturing devices, and experience the difficulty of using long telescopes, suspension laryngoscopes, and staplers in a confined area.

Conclusion Part of the experience of endoscopic surgery of the pharynx can be gained through an inexpensive simulation of a Zenker's diverticulum.
Prognostic Indicators of Occult Metastases in Oral Cancer
Authors: Russolo Mario , Giacomarra Vittorio , Papanikolla Ledia , Tirelli Giancarlo
Published: November 2003

Objective We evaluated the importance of several tumor factors related to predicting the presence of occult metastases in the oral cavity.

Study Design Retrospective case study.

Methods The study comprises 29 patients treated at the Department of Otorhinolaryngology (University of Trieste, Cattinara Hospital, Trieste, Italy) between January 1990 and December 2000, who had T1‐T2 carcinoma of the oral cavity that had or had not extended to the oropharynx and were clinically evaluated as N0 neck. The patients all underwent surgery with removal of tumor and neck dissection. Four tumor‐related parameters were examined with the aim of evaluating their predictivity of metastasis: tumor class, degree of keratinization, degree of differentiation according to Brooler's histopathological grading, and invasive cell grading (ICG). With the exception of tumor class, these parameters were evaluated both in the biopsy and in the surgical specimen and the findings were then compared. We evaluated existing correlations between each individual parameter and the histopathological presence of micrometastases (pN+) and extracapsular spread revealed when specimens from the neck were examined.

Results There was a highly significant correlation between ICG equal to or greater than 13 (range, 5–20) and the presence of occult metastases (P = .0017). On the basis of our findings, the ICG parameter correctly identified 9 of 10 (pN+) patients and could have reduced overtreatment from 65.5% to 17.2% in histopathologically negative necks (pN0).

Conclusion It would appear that with a delay in programming a neck dissection so as to consider ICG in combination with thickness, as in seven recent patients, identification of locoregional occult metastases (pN+) might be more precise.
In Vitro and In Vivo Assessment of the Ability of Adeno‐Associated Virus–Brain‐Derived Neurotrophic Factor to Enhance Spiral Ganglion Cell Survival Following Ototoxic Insult
Authors: Lalwani Anil K. , Han Jay J. , Castelein Caley M. , Carvalho Gerard J. , Mhatre Anand N.
Published: November 2003

Objectives/Hypothesis Auditory dysfunction following ototoxic insult results from loss of cochlear hair cells. Secondary degeneration of auditory neurons ensues from withdrawal of neurotrophic support from hair cells and can be prevented with administration of neurotrophins. Administration of adeno‐associated virus containing the gene for brain‐derived neurotrophic factor will promote spiral ganglion neuron survival after the destruction of hair cells.

Methods Prevention of aminoglycoside‐induced spiral ganglion neuron loss through the expression of brain‐derived neurotrophic factor mediated by means of the adeno‐associated virus was tested in vitro in cochlear explants and in vivo in mammalian cochlea.

Results Neuronal survival was significantly enhanced in adeno‐associated virus–brain‐derived neurotrophic factor transfected rat cochlear explants compared with control samples (30% vs. 19%, P <.05) following exposure to aminoglycoside. Following deafening with aminoglycoside and loop diuretic and introduction of adeno‐associated virus–brain‐derived neurotrophic factor through osmotic minipump, the experimental group of animals infused with adeno‐associated virus–brain‐derived neurotrophic factor displayed enhanced spiral ganglion neuron survival in the basal turn of the cochlea when compared with the control group infused with adeno‐associated virus containing green fluorescent protein reporter gene.

Conclusions Administration of adeno‐associated virus–brain‐derived neurotrophic factor enhances spiral ganglion neuron survival following ototoxic exposure in vitro and in vivo. These studies lay the groundwork for further exploration of its application as an adjunct therapy for patients undergoing cochlear implantation because the success of implantation depends directly on the population of neurons available for electrical stimulation.
Revision Ossicular Reconstruction With the Titanium Kurz Prosthesis
Authors: Downs Brian W. , Pearson James M. , Zdanski Carlton J. , Buchman Craig A. , Pillsbury Harold C.
Published: November 2003

Objective/Hypothesis One European multicenter study has reported favorable outcomes after ossicular reconstruction with the titanium Kurz prosthesis. At the time of this study, however, no study has analyzed its outcomes when used for reconstruction after prior failure with another implant (revision reconstruction). The study reports our experience with the titanium Kurz prosthesis for revision ossicular reconstruction.

Study Design A retrospective review was made of all revision ossicular reconstructions at our institution from October 1998 to September 2001.

Methods Seventeen cases were reviewed. Patients were divided into two groups: patients who underwent revision ossicular reconstruction with the Kurz prosthesis and patients who underwent revision ossicular reconstruction with another prosthesis (the “other” group). Audiograms were reviewed and air–bone gaps were calculated for each patient.

Results The average postoperative air–bone gap after Kurz revision was 15.6 dB, a statistically significant improvement over the average postoperative air–bone gap from the “other” revision group (P = .022).

Conclusion The titanium Kurz prosthesis has been an effective implant at our institution for revision ossicular reconstruction. Future research should focus on a prospective, randomized trial comparing the Kurz prosthesis with other prostheses currently in use.