bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative and Qualitative Analysis of Tracheoesophageal Voice after Pectoralis Major Flap Reconstruction of the Neopharynx
Authors: Deschler Daniel G. , Doherty E. Thomas , Reed Charles G. , Singer Mark I.
Published: November 2005

Although tracheoesophageal voice restoration is accepted after reconstruction of the neopharynx with the pectoralis major myocutaneous flap, the character of such voice is not well described. Six patients reconstructed with the pectoralis major flap after laryngopharyngectomy underwent successful voice restoration with the Blom‐Singer prosthesis. Voice was evaluated by a standardized protocol and compared with voices of control subjects treated with total laryngectomy and similar voice restoration. The patients with pectoralis major flaps produced similar intensity levels for soft voice (53.7 dB vs. 55.6 dB) and loud voice (61.3 dB vs. 65.3 dB) when compared with controls (p > 0.05). No significant differences (p > 0.05) were noted for fundamental frequency (F0) between patients with pectoralis major flaps and controls for soft (62.3 Hz vs. 85.4 Hz) and loud (109.8 Hz vs. 133.8 Hz) voice. Jitter was also comparable. Trained and naive listeners completed qualitative analyses for 10 parameters and judged that control patients had significantly better voice for most parameters. This finding demonstrates that dependable voice is attainable after pectoralis major flap reconstruction of the neopharynx. Although this voice does not differ significantly from voice after standard laryngectomy for acoustic parameters, perceptual analysis does reveal significant differences. (Otolaryngol Head Neck Surg 1998;118:771‐6.)
Preliminary Results of the Use of Indole‐3‐Carbinol for Recurrent Respiratory Papillomatosis
Authors: Rosen Clark A. , Woodson Gayle E. , Thompson Jerome W. , Hengesteg Arne P. , Bradlow H. Leon
Published: November 2005

OBJECTIVE

We report the preliminary results of a phase I trial using indole‐3‐carbinol for the treatment of recurrent respiratory papillomatosis. Indole‐3‐carbinol is a chemical that is found in high concentrations in cruciferous vegetables and has been shown to alter the growth pattern of recurrent respiratory papillomatosis cell cultures and to be effective in an in vivo animal model of recurrent respiratory papillomatosis.

METHODS

Eighteen patients were treated with oral indole‐3‐carbinol and had a minimum follow‐up of 8 months and a mean follow‐up of 14.6 months. All patients received indole‐3‐carbinol, and outcome measures included a change in papilloma growth rate and the need for surgery during treatment compared with before treatment. All patients had serial examinations with videoendoscopy to document papilloma location and growth rate.

RESULTS

Thirty‐three percent (6 of 18) of the study patients had a cessation of their papilloma growth and have not required surgery since the start of the study. Six patients have had reduced papilloma growth rate, and 6 (33%) patients have shown no clinical response to indole‐3‐carbinol. Indole‐3‐carbinol affects the ratio of hydroxylation of estradiol; changes in the ratios of urinary 2‐hydroxylation and 16‐hydroxylation of estradiol caused by indole‐3‐carbinol correlated well with clinical response. No major complications or changes in the children's growth curve were noted.

CONCLUSIONS

The preliminary results of treating recurrent respiratory papillomatosis with indole‐3‐carbinol holds promise. Longer follow‐up of this patient group and a blinded, controlled trial are required. We conclude that indole‐3‐carbinol appears to be safe and well tolerated and may be an efficacious treatment for recurrent respiratory papillomatosis. (Otolaryngol Head Neck Surg 1998;118:810–5.)
Clinical Epidemiology/Outcomes Research
Authors: Piccirillo Jay F. , Gates George A. , White Donna L. , Schectman Kenneth B.
Published: November 2005

Approximately 40 million Americans have chronic sleep disorders, the most serious of which is obstructive sleep apnea. The goals of this research were to serve as a demonstration project for a multicenter treatment outcomes research project for patients with obstructive sleep apnea. A clinical‐severity staging system was created to control for important differences in the severity of sleep apnea among the enrolled patients. A disease‐specific quality‐of‐life measure was used in this project to measure, from the patient's perspective, important pretreatment and posttreatment physical, functional, and emotional aspects of obstructive sleep apnea. Adults with apnea indexes greater than 5 who had not previously undergone uvulopalatoplasty were eligible. In total 142 patients were enrolled from eight otolaryngology practices. The mean age was 48 years, 112 were men, and 114 were white. The mean pretreatment apnea index was 40.0, and the mean respiratory distress index was 60.5. Seventy‐one patients received continuous positive airway pressure, and 48 patients received surgery. Outcomes were assessed from scores on patient‐based general and disease‐specific health status measures 4 months after enrollment. The short duration of follow‐up and limited number of patients undergoing posttreatment polysomnograms prohibit any analysis of treatment effectiveness. Nevertheless, this research represents a step forward for the support of future outcomes research projects by organized otolaryngology. (Otolaryngol Head Neck Surg 1998;118:833–44.)
The use of Preoperative Lidocaine to Prevent Stridor and Laryngospasm after Tonsillectomy and Adenoidectomy
Authors: KOÇ CAN , KOCAMAN FALIH , AYGENÇ ERDINÇ , ÖZDEM CAFER , ÇEKIÇ ALI
Published: November 2005

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double‐blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group. (Otolaryngol Head Neck Surg 1998;118:880–2.)
Influence of the Multichannel Cochlear Implant on Vestibular Function
Authors: ITO JUICHI
Published: November 2005

Vestibular function was examined in 55 adult patients who underwent cochlear implant surgery. The percentages of the patients with normal results on an optokinetic nystagmus test and eye‐tracking test before surgery were 85% and 82%, respectively. A caloric stimulation test was performed before surgery, and 67% of patients showed hypofunction or afunction. This same test was performed approximately 1 month after surgery, and 38% of patients showed functional deterioration. After surgery 47% of the patients reported some kind of subjective dizziness. The characteristics of dizziness were divided into three types: early, prolonged, and delayed. Fifty‐eight percent of the patients had early type, 34% had prolonged type, and 8% had the delayed type. Eighteen percent of the patients felt dizziness when they used the implant device, indicating that electrical current spread from the implant device to the vestibular nerve. The other 82% of the patients did not report any relationship between the use of their cochlear implants and dizziness. (Otolaryngol Head Neck Surg 1998;118:900–2.)
Speech perception results in children with cochlear implants: Contributing factors
Authors: Hodges Annelle V. , Ash Mary Dolan , Balkany Thomas J. , Schloffman Jerry J. , Butts Stacy L.
Published: November 2005

Speech perception test results were obtained from a group of 40 pediatric cochlear implant users. Half of the children participated in oral‐only habilitation programs, which included both traditional oral and auditory‐verbal approaches, and half participated in programs that used a combination of oral and manual communication referred to as total communication (TC). Analysis of the scores showed that children enrolled in oral‐only habilitation programs scored significantly higher on the speech perception measures than did children who were enrolled in total communication‐based programs. These results were inconsistent with those of other reports, which suggested that communication methods had little effect on implant outcomes. To further examine the reasons for the differences in performance, we analyzed 7 additional factors, including length of implant use, age at surgery, device type, socioeconomic status, bilingualism, school setting, and participation in private therapy, which may affect implant performance. Multiple‐regression analysis again showed communication mode to be the factor most highly correlated with speech perception abilities among this group of children.
Healing large tympanic membrane perforations using hyaluronic acid, basic fibroblast growth factor, and epidermal growth factor
Authors: Chauvin Kathy , Bratton Clay , Parkins Charles
Published: November 2005

Large tympanic membrane perforations usually require a surgical tympanoplasty for closure. Reducing surgical costs and risks has encouraged investigators to examine nonsurgical office procedures for healing these perforations. Growth accelerators are the most promising agents. We study here the closure of large acute perforations using weekly applications of 1 mg of 1% hyaluronic acid (HA), 0.4 μg basic fibroblast growth factor (bFGF), or 1.0 μg epidermal growth factor (EGF) directly to the tympanic membranes of the experimental ears. Control ears were treated with 0.1 mL Vasocidin. Complete closure was obtained in 100% of the ears treated with HA and EGF and 85.7% of those treated with bFGF by day 21, compared with 63.6% of the controls by day 32. Moderate‐to‐severe ipsilateral and contralateral external canal hypertrophy was noted in 14.2% and 37.5% of the ears treated with bFGF and HA, respectively, but was not seen in ears treated with EGF or in the control group.
Incidence of abnormal laryngeal findings in asymptomatic singing students
Authors: Lundy Donna S. , Casiano Roy R. , Sullivan Paula A. , Roy Soham , Xue Jun W. , Evans Joseph
Published: November 2005

OBJECTIVE

Abnormalities in the mucosal lining of the vocal folds may interfere with the normal vibratory patterns and result in vocal limitations, especially for singers whose demands are great. A prospective, longitudinal study was undertaken to investigate the incidence of laryngeal abnormalities in asymptomatic singing students.

METHODS

Sixty‐five singing students at the school of music underwent videostroboscopic evaluation and completed a comprehensive questionnaire. Videos were rated by 3 experienced clinicians, and interrater reliability was calculated. Results were correlated with demographic factors, background medical history, and singing history.

RESULTS

Five students (8.3%) exhibited early signs of benign vocal fold lesions (2 with nodules and 3 with cysts). A high incidence of posterior erythema (n = 44; 73.4%), suggesting possible reflux, was found.

CONCLUSIONS

A surprisingly high number of otherwise asymptomatic singing students demonstrated abnormal laryngeal findings. Their relationship with vocal performance will be addressed as well as implications for preventative measures.
Acute effects of palatopharyngoplasty on airway collapsibility
Authors: Woodson B. Tucker
Published: November 2005

OBJECTIVE

The lateral pharyngeal walls contribute to obstruction in obstructive sleep apnea. These structures may be unaffected by uvulopalatopharyngoplasty. This was evaluated by retrospective review of upper airway observations after palatopharyngoplasty.

METHODS AND PATIENTS

The retropalatal airway was endoscopically observed intraoperatively after each procedure in 7 patients. The airway was dilated with nasal continuous positive airway pressure.

RESULTS

Transpalatal advancement pharyngoplasty increased the area 120% (P = 0.001), and closing pressure decreased 9.2 cm H2O (P < 0.01). The maximal anteroposterior length (MAX‐AP) and maximal lateral radius increased 90% (P = 0.01) and 60% (P < 0.001), respectively. MAX‐AP changed in 2, both increased in 4, and maximal lateral radius increased in 1 patient. The closing pressure change correlated with airway size (r 2 = 0.44, P < 0.05); airway shape was associated with change in MAX‐AP (r 2 = 0.51, P < 0.07).

CONCLUSIONS

Both the anteroposterior and lateral wall dimensions are altered by palatopharyngoplasty techniques, which increase retropalatal airway size. This is not limited to facial advancement surgery.
Effect of the Palmaz balloon‐expandable metallic stent in the trachea of pigs
Authors: Ruegemer Joseph L. , Perkins Jonathan A. , Azarow Kenneth S. , O'Bryant Larry K. , Nielsen Ronald E. , Thomas Richard W.
Published: November 2005

Endoscopically placed airway stents offer a viable option in primary or adjunctive treatment of severe pediatric tracheobronchial stenoses. Optimistic clinical reports substantiate the need for experimental studies to more effectively evaluate their clinical role. Development of an animal model comparable with the pediatric airway, amenable to endoscopic instrumentation, and capable of assessing effect on growth was the purpose of this pilot project. Nine 4‐week‐old piglets underwent endoscopic midtracheal placement of the balloon‐expandable Palmaz metallic stent. Initial expansion and stent position were verified fluoroscopically and by direct videobronchoscopy. Serial endoscopic examination and stent reexpansion were performed 2 and 4 weeks after stent insertion. Animal weight, clinical tolerance, tracheal growth, and stent integrity were observed. Tracheal inflammation was evaluated grossly and by objective histopathologic criteria. Successful endotracheal stent placement and expansion were accomplished in all piglets. One pig died of anesthesia complications less than 24 hours after stent insertion. The remaining pigs exhibited excellent clinical tolerance through experiment completion. No detrimental effect on growth was noted, and effective dilatation of the stented tracheal region was observed. Stent incorporation was evident with significant mucosal ingrowth. Inflammation in the form of nonobstructing granulation tissue was present, and no evidence of necrosis or cartilage invasion was evident. The piglet trachea appears to be an excellent model for evaluation of expandable metallic airway stents in management of congenital and acquired tracheobronchial stenoses.
Higher rates of pressure decrease in inflamed compared with noninflamed middle ears
Authors: Alper Cuneyt M. , Doyle William J. , Seroky James T.
Published: November 2005

Recent clinical trials have renewed interest in middle ear inflation as a treatment for otitis media with effusion. However, air inflation in human beings with significant negative middle ear pressures was shown to be followed by a rapid pressure decrease to approach the preinflation values. In this experiment, the middle ears of anesthetized rhesus monkeys with unilateral inflammation were inflated at different times with air or N2, and pressures were recorded by tympanometry until they had stabilized or the animal had recovered from anesthesia. The results for air inflations reproduced those reported for human beings with negative pressures. Similarly, after N2inflation a significantly greater rate of pressure decrease and significantly lesser terminal pressures were observed for inflamed ears when compared with the contralateral control ears. However, the rate of pressure decrease and the magnitude of the pressure drop were dampened by sequential N2inflations. These observations have clinical implications with respect to the efficacy of inflation as a treatment for otitis media with effusion.
Cerebellar encephalomalacia on magnetic resonance imaging after removal of acoustic tumor
Authors: Bordure R , O'Donoghue G. M. , Jaspan T. , Denunzio M.
Published: November 2005

MRI is widely used for postoperative surveillance of patients undergoing surgery for removal of acoustic neuroma. The purpose of this study was to investigate the frequency and pattern of postoperative changes in the cerebellum and brain stem on MRI after removal of acoustic neuroma. A retrospective study was conducted in 30 consecutive patients who underwent postoperative MRI between 1994 and 1995. The timing of the scans after surgery ranged from 12 months to 10 years. T2‐weighted turbo spin‐echo images revealed cerebellar encephalomalacia in 17 of 30 cases. Cerebellar encephalomalacia was found more consistently in patients who had large tumors and was more frequent after the suboccipital approach. Encephalomalacia is largely caused by gliotic changes in the adjacent cerebellar tissues after tumor removal.
Postoperative hypertension effect of carotid sinus denervation
Authors: KoÇ Can , Ensari Serdar , KaymakÇi Mustafa , Kocaman Falih , Özdem Cafer
Published: November 2005

Postoperative arterial blood pressures were monitored in 43 patients who had undergone bilateral neck dissection during a 6‐week period at Ankara Numune Hospital's Ilnd Otorhinolaryngology Department. During the first operations, all cases received carotid sinus denervation, whereas no denervation was done for the opposite side dissections held 6 weeks later. Study and control groups were composed of the same patients to achieve an objective outcome for the risk of postoperative hypertension. Hypertension was observed in 10 (23%) of 43 patients after the first operations and 12 (28%) of 43 patients after the opposite side dissections, for which no carotid denervation was done. The difference between the rates was insignificant statistically.
Minimally invasive surgery for posterior glottic stenosis
Authors: Rovó László , Jóri József , Brzozka Marek , Czigner Jenô
Published: November 2005

Posterior glottic stenosis most commonly results from prolonged endotracheal intubation. The tube causes decubitus and perichondritis with a consequent scar tissue formation in the posterior commissure that often limits the abduction of the vocal cords. Many different surgical methods are known for the treatment, but in most cases temporary tracheostomy is required. We recommend a minimally invasive method to avoid tracheostomy, which is a very inconvenient state for the patient. The scar of the posterior commissure is excised endoscopically with the CO2 laser, and a modification of the endoextralaryngeal vocal cord laterofixation—described by Lichtenberger—is used to lateralize 1 or both vocal cords until the posterior commissure is completely reepithelialized. In this article we report on the first 5 cases. All patients had satisfactory airways immediately after the laterofixation procedure, which proved to be stable later on as well. In the cases of moderate stenosis, further scarring was prevented, and after the healing of the mucosa in the posterior glottic area, the laterofixation sutures were removed. The vocal cord mobility was recovered in the cases in which the cricoarytenoid joint was not fixed. In 1 case of severe stenosis (bilateral cricoarytenoid joint fixation), the procedure yielded only partial improvement.
Otologic Surgery in Patients with HIV‐1 and AIDS
Authors: Kohan Darius , Giacchi Renato J.
Published: November 2005

Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV‐infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long‐term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.
Otologic Injuries Caused by Airbag Deployment
Authors: McFeely William J. , Bojrab Dennis I. , Davis Kent G. , Hegyi Douglas F.
Published: November 2005

Airbags are clearly successful at mitigating injury severity during motor vehicle accidents. Deployment unfortunately has introduced new injury‐causing mechanisms. A retrospective review of 20 patients who sustained otologic injuries resulting from airbag inflation was conducted. The most common symptoms were hearing loss in 17 (85%) and tinnitus in 17 (85%). Objective hearing loss was documented in 21 of 24 (88%) subjectively affected ears; this included unilateral and bilateral sensorineural, unilateral conductive, and mixed hearing losses. Ten patients (50%) had dysequilibrium. Four subjects (20%) had a tympanic membrane perforation; each required surgical closure. Ear orientation toward the airbag was found to be associated with hearing loss (P = 0.027), aural fullness (P = 0.039), and tympanic membrane perforation (P = 0.0004). A wide variety of airbag‐induced otologic injuries occur and may have long‐term sequelae. It is important for health care personnel to be aware of these potential problems.
Optimal Elective Scalp Incision Design
Authors: Frodel John L. , Mabrie David
Published: November 2005

Scalp incisions of an elective nature are commonly used as an approach in upper cranial maxillofacial surgery. Similarly, isolated linear parietal incisions are occasionally used to harvest outer table calvarial bone grafts. Although morbidity from these incisions is generally minimal, there is a tendency, particularly when a scar is widened, for it to be more visible if it is of a linear nature. In this review we will present our results with 16 consecutive patients in which a geometric pattern incision was used instead of a straight incision in hopes of improving the ultimate appearance of this scar. We have found that, in general, incisions made in a geometric fashion are less noticeable than traditional linear elective scalp incisions. This is particularly true when there was widening of the scar.
Treatment of Lymphangiomas in Children: An Update of Picibanil (OK‐432) Sclerotherapy
Authors: Greinwald John H. , Burke Diane K. , Sato Yukato , Poust Rolland I. , Kimura Ken , Bauman Nancy M. , Smith Richard J. H.
Published: November 2005

Picibanil (OK‐432) is a sclerosing agent derived from a low‐virulence strain of Streptococcus pyogenes that induces regression of macrocystic lymphangiomas. This report describes a prospective, nonrandomized trial to evaluate the efficacy of Picibanil in the treatment of 13 affected children ranging in age from 1 to 94 months. On average, 4.1 fluoroscopically guided intracystic injections were performed per child, with an average total dose of 0.56 mg of Picibanil. As judged by physical examination and radiographic studies, 5 children (42%) showed a complete or substantial response, and 2 children (16%) showed an intermediate response. No response was seen in 5 children (42%), 2 of whom had massive craniofacial lymphangioma. Factors that contribute to failure with Picibanil sclerotherapy are the presence of a significant micro‐cystic component to the lesion, massive craniofacial involvement, and previous surgical resection. Macrocystic lymphangiomas of the infratemporal fossa or cervical area have the best response to therapy.
Success of Preoperative Imaging and Unilateral Neck Exploration for Primary Hyperparathyroidism
Authors: Song Angie U. , Phillips Thomas E. , Edmond Charles V. , Moore David W. , Clark Stephen K.
Published: November 2005

The surgical treatment of hyperparathyroidism has become controversial with the recent advent of reliable preoperative imaging modalities. This study examines the efficacy and economy of using preoperative imaging studies to localize the pathology and allow for unilateral neck exploration. From January 1990 to May 1996, a total of 91 patients with primary hyperparathyroidism were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Eighty‐six nuclear scintigraphy studies were performed, of which 44 were technetium 99m sestamibi (Tc‐99m‐sestamibi) scans and 42 were thallium 99m technetium (Th‐99m‐Tc) scans. The overall sensitivity for Tc‐99m‐sestamibi was 91% (40/44), and that for Th‐99m‐Tc scans was 81% (34/42). Ultrasound examination revealed a sensitivity of 80% (66/82). There was a statistically significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypercalcemia 93% (85/91) of the time with the use of preoperative imaging studies. Tc‐99m‐sestamibi is a reliable tool for planning the initial unilateral neck exploration for treatment of primary hyperparathyroidism.
Retropharyngeal Abscess Management in Children: Current Practices
Authors: Lalakea M. Lauren , Messner Anna H.
Published: November 2005

Retropharyngeal abscesses (RAs) in children are uncommon in the modern antibiotic era. As a result, there are few large series outlining the management of these infections in contemporary literature. The goal of this study is to determine the current standard of care for RA. The membership of the American Society of Pediatric Otolaryngology was surveyed, and the response rate was 77.5%. Seventy‐two percent of practitioners reported that CT is their preferred diagnostic method. Nearly two thirds recommended a trial of intravenous antibiotics at least occasionally for suspected RA before operative drainage was considered; 51% of respondents indicated that 20% to 40% of RA may resolve with antibiotics alone. Intraoral incision and drainage is the surgical technique preferred by 83% of respondents. Tracheotomy and short‐term intubation (24 to 72 hours) are rarely required. This study defines current management practices for RA in children among pediatric otolaryngologists. Results are compared with those in the existing literature.
Vocal Fold Granuloma: Successful Treatment with Botulinum Toxin
Authors: Orloff Lisa A. , Goldman Stephen N.
Published: November 2005

Vocal fold granulomas are benign but frequently recurrent lesions that can cause frustration for both the patient and the treating physician. Etiologic factors include endotracheal intubation, vocal abuse, and gastroesophageal reflux. Conventional treatment for granulomas has included medical, voice, and surgical therapy, none with uniform success. In this study 8 patients with vocal fold granulomas were treated with intralaryngeal injection of botulinum toxin. The resultant temporary paresis of the vocal folds allowed for a window of time during which the vocal process could heal and the granulomas could resolve without being exposed to ongoing intermittent contact and friction with the opposing arytenoid. Although the underlying cause of a granuloma must also be addressed, we have found that botulinum toxin can be a useful adjunct to traditional therapy and can lead to avoidance of repetitive surgical procedures.
Comparison of Computer‐Assisted Instruction and Seminar Instruction to Acquire Psychomotor and Cognitive Knowledge of Epistaxis Management
Authors: Carr Michele M. , Reznick Richard K. , Brown Dale H.
Published: November 2005

Epistaxis is a common problem faced by primary care physicians. Typically, first‐hand experience with this problem is not obtained in medical school. A computer learning module was developed to address practical management of epistaxis. It was evaluated by use of third‐year clerks and compared with an interactive seminar based on the same material. Fifty‐eight students doing their required otolaryngology rotations were randomly separated into 3 groups: (1) doing a preinstruction test, (2) using the computer module, and (3) participating in a small‐group seminar. All participants were tested with a short written test and a practical test that involved performing anterior nasal pack placement in a model patient. Percentage scores for the 2 groups were compared by use of t tests, and there was no significant difference between the written, practical, or combined scores at a level where P = 0.05. This study shows that basic patient management and a simple procedure can be taught as effectively with a computer module as with a small‐group interactive seminar.
Age‐Related Changes in Muscle Fiber Types in the Human Thyroarytenoid Muscle: An Immunohistochemical and Stereological Study Using Confocal Laser Scanning Microscopy
Authors: Malmgren Leslie T. , Fisher Patricia J. , Bookman Linda M. , Uno Toshiyuki
Published: November 2005

A decline in motor performance contributes to laryngeal dysfunction in the elderly, but the pathogenetic mechanisms are unknown. Quantitative 3‐dimensional, age‐related changes in the muscle fiber content of the human thyroarytenoid muscle were estimated from geometric probability (stereology) by use of a technique that provided a statistically unbiased sample of all possible section orientations and locations in the entire muscle volume. There was a preferential 27% age‐related loss in the length density (LV type, muscle) of type 1 (slow) fibers in contrast to the selective type 2 (fast) fiber loss typical of aging limb muscles. In type 2 fibers there was no significant loss in the LV, but there was an age‐related decrease (P < 0.05) in the surface density (SV type, muscle) and an increase (P < 0.05) in the atrophy factor, an index of the content of very small, atrophic fibers. There was also an age‐related increase in the length fraction (LL type, all fibers) of muscle fibers that coexpress both fast and slow myosin heavy‐chain isoforms (P < 0.05). These findings demonstrate a type‐specific fiber loss and atrophy that differs from that in aging limb muscles and an age‐related increase in motor unit remodeling.
Surgical Treatment of Zenker's Diverticulum: Transcutaneous Diverticulectomy Versus Microendoscopic Myotomy of the Cricopharyngeal Muscle with CO2 Laser
Authors: Zbären P. , Schär P. , Tschopp L. , Becker M. , Häusler R.
Published: November 2005

In a retrospective study, we analyzed 97 patients who were treated by either transcutaneous diverticulectomy (n = 66) or microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser (n = 31). Two (6.4%) of 31 patients in the microendoscopic myotomy group had complications, compared with 10 (15%) of 66 patients in the diverticulectomy group. In addition, the complications observed in the microendoscopic myotomy group were less severe than those observed in the trans‐cutaneous diverticulectomy group. The average length of hospitalization was shorter in the microendoscopic myotomy group than in the diverticulectomy group (8 days versus 11.4 days). We conclude that microendoscopic CO2‐laser myotomy is a less invasive, more precise, and safer procedure, which results in a shortened period of hospitalization and complete relief of symptoms in the vast majority of cases.
Clinical Practice Guidelines for the Management of Chronic Sinusitis in Children
Authors: Chan Kenny H. , Winslow Catherine P. , Levin Myron J. , Abzug Mark J. , Shira James E. , Liu Andrew H. , Simoes Eric A. F. , Strain John D. , Stool Sylvan E.
Published: November 2005

Chronic sinusitis in children is a common and vexing disease for clinicians and the public. There are insufficient data in the literature to develop an evidence‐based clinical guideline. Experience in managing pediatric chronic sinusitis has been gained through a multidisciplinary clinic at our institution during the past 3 years. A panel of experts was formed, and with the guidance of a guideline methodologist, the development of a rigorous outcome‐based guideline was undertaken. Symptom‐improvement and recurrence estimates for a variety of medical and surgical treatments were assessed. Wide probability estimates were made by the panelists in most cases. Although we refrained from making specific recommendations, we developed a ranked series of practical treatment options taking into account side effects and costs.
Computed Tomography and the Diagnosis of Coalescent Mastoiditis
Authors: Antonelli Patrick J. , Garside John A. , Mancuso Anthony A. , Strickler Steven T. , Kubilis Paul S.
Published: November 2005

OBJECTIVE

To evaluate the sensitivity and accuracy of temporal bone CT findings for the diagnosis of acute coalescent mastoiditis.

DESIGN

CT scans were blindly scored for mastoid bone integrity (air cell septae, sigmoid cortical plate, and lateral cortical wall) by an otologist and 2 neuroradiologists. Scores were analyzed to determine their sensitivity and specificity for acute coalescent mastoiditis.

SUBJECTS

Twenty‐one patients with acute coalescent mastoiditis or acute noncoalescent mastoiditis and 12 patients with chronic mastoiditis.

SETTING

Academic tertiary care facility.

RESULTS

Pair‐wise interobserver agreement was good to excellent (κ = 0.4 to 0.83) for the sigmoid plate, the lateral cortex, and the septae. Scores for the sigmoid plate were significantly greater (indicative of greater bone destruction) in the coalescent group than in either the noncoalescent group or the chronic group (P < 0.05). Within the coalescent group, scores were highest for the sigmoid plate, followed by the septae and the lateral wall. Sensitivity and specificity for coalescent mastoiditis were both highest for the sigmoid plate (67% and 90%, respectively).

CONCLUSIONS

Erosion of the cortical plate overlying the sigmoid sinus is the most sensitive and specific CT finding for distinguishing coalescent from noncoalescent acute mastoiditis.
Factors Related to Dropout in a Study of Head and Neck Cancer Patients after Surgery
Authors: Colangelo Laura A. , Logemann Jeri A. , Rademaker Alfred W. , Pauloski Barbara Roa , Smith Christina H. , McConnel Fred M. S. , Stein David W. , Beery Quinter C. , Myers Eugene N. , Heiser Mary Anne , Cardinale Salvatore , Shedd Donald P.
Published: November 2005

The extent and nature of dropout was assessed in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing function in patients with head and neck cancer. Of 150 patients who were enrolled to be followed up with speech and swallow assessments for 1 year after surgery, 113 (75%) dropped out and 37 (25%) returned to complete the study at the final 12‐month evaluation point. In general, those completing the study had a smaller resection than the patients who dropped out before the 12‐month evaluation. Fifty percent of the dropout was accounted for by medical reasons, 23% by administrative reasons, and 27% by patient‐specific reasons (ie, reasons known only to the patient). Analysis of the dropout categories revealed that higher cancer stage, larger volume of resection, and having a flap surgical closure versus a primary closure or skin graft increased a patient's chance of dropping out. A larger volume of resection was also related to an increased chance of being a patient‐specific dropout. Patients who reported no or low alcohol usage had a greater chance of completing follow‐up than being a patient‐specific dropout.
Labyrinthine Fenestration in the Guinea Pig
Authors: Isaacson David J. , Antonelli Patrick J.
Published: November 2005

OBJECTIVE

To evaluate the auditory effects of single, double, and triple semicircular canal fenestration procedures, with and without sealing the labyrinthine defect.

BACKGROUND

Violation of the inner ear remains a feared complication in otologic surgery because it commonly leads to profound sensorineural hearing loss. It has been assumed that the natural history of labyrinthine injury in the guinea pig is similar to that in human beings; however, this assumption has not been rigorously studied.

DESIGN

Prospective, randomized, and controlled animal study.

SUBJECTS

Sixty pigmented guinea pigs.

OUTCOME

Click‐evoked electrocochleographic response, with same‐ear prefenestration control.

RESULTS

All of the fenestration groups had elevated auditory thresholds at 1 hour when compared with controls (P < 0.01); however, this difference lost statistical significance at 1 and 4 weeks. The degree of labyrinthine injury did not correlate with the degree of hearing loss or with the incidence of anacusis. Hearing remained stable during the study period. Sealing the fenestration had no significant audiologic effect (P > 0.40).

CONCLUSIONS

The guinea pig model of labyrinthine fenestration may not be representative of the human condition.
Does it Take a Village to Write a Case Report?
Authors: Har‐EL Gady
Published: November 2005

Editor's Note: I believe it is appropriate for readers and authors to consider the following comments by Dr Har‐El. The issue of what role the case report plays in peer‐reviewed medical journalism is quite appropriate. We in the Journal's editorial process have elected to be very selective regarding which submitted case reports are published. Realizing the importance of such publications to young physician authors, we must temper this mission with that of quality and focused scientific literature. Thus we require a strict adherence to our published rules for a case report—short, concise, and to the point, but mainly that it provide a clear educational value to the clinician.
Microtia Repair: Creation of a Functional Postauricular Sulcus
Authors: Eavey Roland D.
Published: November 2005

OBJECTIVE

Auricular reconstruction for repair of severe congenital microtia can provide the patient with a realistic‐looking pinna. However, an unseen functional cephaloauricular sulcus is necessary, especially for patients with eyeglasses.

TECHNIQUE

(1) A skin graft is harvested. (2) The ear framework is separated substantially from the side of the head. (3) A crescent of hair‐bearing scalp skin is excised. (4) The donor skin graft is divided. One part of the graft surfaces the superolateral and medial portions of the auricular framework into the sulcus depth; the remainder covers the side of the head.

RESULTS

This simple technique was effective. Minor transient sequelae have included granulation tissue (2 patients), localized infection (2 patients), and adhesion (1 patient). Patients requiring glasses have worn frames soon after surgery, and no sulcus problems have resulted.

CONCLUSION

Creation of this postauricular sulcus during microtia reconstruction is easily performed and offers the patient a durable and functional space, especially for eyeglass wear.
Asymmetric Sensorineural Hearing Loss in a Community‐Based Population
Authors: Urben Susan L. , Benninger Michael S. , Gibbens Noreen D.
Published: November 2005

Asymmetric sensorineural hearing loss (ASNHL) is fairly common, but it can be an indication of retrocochlear pathology. The incidence of acoustic neuroma (AN) has been estimated at 1/100,000; however, the incidence of AN in patients with ASNHL is unknown. The limitation of health care resources challenges otolaryngologists to develop reasonable cost‐containment guidelines for the evaluation of patients with ASNHL for the presence of retrocochlear pathology. A 5‐year (1990 to 1994) retrospective study of all patients with ASNHL who were evaluated in a community‐based general otolaryngology practice was performed. Demographic, historic, and audiologic data and results from ABRs and radiologic studies were summarized. ASNHL was present in 325 patients. Auditory brain stem response tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconclusive auditory brain stem responses and patients with severe SNHL were evaluated with radiologic studies (46 patients). Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%. The charge of diagnosis per AN was more than $41,000. In summary, a small percentage of patients with ASNHL have retrocochlear pathology, and the charge of diagnosis per AN can be excessive. A cost‐containment approach for the evaluation and management of patients with ASNHL is proposed.
Incidental Discovery of Acoustic Neuromas
Authors: Selesnick Samuel H. , Deora Mona , Drotman Michele B. , Heier Linda A.
Published: November 2005

Our objective is to report 4 cases of incidentally discovered acoustic neuromas (ANs) and to determine the incidence of asymptomatic ANs. A prospective study of 161 consecutive patients undergoing gadolinium‐enhanced MRI (Gd‐MRI) at a tertiary‐care university‐affiliated medical center was carried out from September 1994 to April 1995. The Gd‐MRI scans were performed for tentative diagnoses other than AN or sensorineural hearing loss. In 161 consecutive patients examined, no ANs were found incidentally on Gd‐MRI scans. Previous studies have suggested that the incidence of occult ANs is as high as 1%. On the basis of our results, we suggest that the actual incidence may be lower. However, our study is limited by its small size and the low incidence of ANs in the general population. Also reported are the clinical and MRI characteristics of 4 patients with incidentally diagnosed ANs.
Transnasal Transsphenoidal Hypophysectomy: Choice of Approach for the Otolaryngologist
Authors: Dew Leigh Anne , Haller Jeffrey R. , Major Scott
Published: November 2005

Increasingly, the otolaryngologist is called on to provide exposure for the neurosurgeon performing transsphenoidal hypophysectomy. The 3 most common approaches for this exposure are the trans‐nasal transseptal, sublabial transseptal, and external rhinoplasty approaches. We reviewed our series of 135 patients undergoing transnasal hypophysectomy for postoperative complications. In our series, we found that 18% of patients had a postoperative septal perforation, 2% of which were symptomatic; 6% of patients reported nasal cosmetic deformity; 13% reported transient lip numbness; and 3% reported postoperative nasal dysfunction. When comparing our complication rate with those published for the sublabial and external rhinoplasty approaches, we found the transnasal approach provides excellent exposure with less dissection and fewer postoperative complications. On the basis of these results, we believe that the transnasal transseptal approach provides excellent exposure for transsphenoidal hypophysectomy in all patients who require pituitary surgery.
Incidence Rates of Salivary Gland Tumors: Results from a Population‐Based Study
Authors: Pinkston John A. , Cole Philip
Published: November 2005

Salivary gland tumors are uncommon, and their epidemiology has not been well described. We conducted a descriptive epidemiologic study of parotid, submaxillary, and sublingual gland tumors newly diagnosed in Jefferson County, Alabama, hospitals from 1968 to 1989. Incidence rates were estimated with a population‐based subset of cases diagnosed during the years 1979 to 1980, 1983 to 1984, or 1987 to 1988. Among 248 incident cases, 84.3% were benign and 15.7% were malignant. Eighty‐six percent of cases arose in the parotid gland, and 14% arose in the submaxillary gland. No sublingual gland tumor was identified. The benign mixed tumor was the most frequent tumor (65.6%), followed by Warthin's tumor (29.2%). Mucoepidermoid carcinoma was the most frequent malignant tumor (51.3%). The average annual age‐adjusted incidence rate per 100,000 was 4.7 for benign tumors and 0.9 for malignant tumors. Incidence rates for both benign and malignant tumors increased with age until ages 65 to 74 years and then declined. Benign mixed tumors occurred more frequently in female patients, whereas Warthin's tumors and malignant tumors occurred more frequently in male patients (P < 0.05). Warthin's tumor was rare in black patients (P < 0.001). We conclude that salivary gland tumors are an uncommon but epidemiologically diverse group of tumors. Their causes are also likely to differ.
Localized Sinus Inflammation in a Rabbit Sinusitis Model Induced by Bacteroides Fragilis is Accompanied by Rigorous Immune Responses
Authors: Jyonouchi Harumi , Sun Sining , Kennedy Cynthia A. , Roche Anie K. , Kajander Keith C. , Miller James R. , Germaine Greg R. , Rimell Frank L.
Published: November 2005

We evaluated inflammatory and immune responses against Bacteroides fragilis in a rabbit sinusitis model. Bacteroides was inoculated into the left maxillary sinus, and inflammatory (histology, cell number/cytology, lactose dehydrogenase, and apoptosis) and immune responses in the sinus, airway, and peripheral blood (PB) were determined for up to 4 weeks. In the inflamed sinus, the lactose dehydrogenase level was markedly elevated, with neutrophilic infiltration, severe tissue inflammation, and increased apoptosis. Low‐grade tissue inflammation was present in the contralateral and sham‐operated sinuses, but other parameters remained unchanged, and so did those in the airway and PB in the inoculated rabbits. Serum IgG antibody levels increased rapidly, were highest at 3 weeks, and began to decline at 4 weeks. Cellular immune responses (proliferation and interferon‐γ mRNA expression) against Bacteroides were detected in the PB of all inoculated rabbits. Vigorous immune responses against Bacteroides may have localized but failed to terminate inflammation in the sinus, indicating importance of microenvironmental factors.
Muscle Fiber‐Type Changes Induced by Botulinum Toxin Injection in the Rat Larynx
Authors: Inagi Katsuhide , Connor Nadine P. , Schultz Edward , Ford Charles N. , Cook Crist H. , Heisey Dennis M.
Published: November 2005

This study examined muscle fiber‐type alterations after single or multiple botulinum toxin (BT) injections to better understand possible morphologic changes induced by therapeutic BT injections in patients with spasmodic dysphonia. Muscle fiber staining was accomplished in rat intrinsic laryngeal muscles with antibodies to specific myosin heavy chains. Results indicated that the typical baseline distributions of type II muscle fibers (ie, types IIa, IIb, IIx, and IIL) were altered by BT injection, while no change was observed in type I fibers. Embryonic fibers were observed only along the needle insertion site at 7 days post BT injection. Although inferences from these animal data to human neuromuscular function must be made with caution, our findings provide insight into the possible cellular and molecular changes characterizing BT‐injected muscles.