bluuebunny/crossref_metadata_2025 huggingface dataset:
S173 – Ectopic Intratracheal Thyroid Cancer
Authors: Brawner James T , Krempl Greg
Published: August 2008

Objectives

1) To describe a case of ectopic intratracheal thyroid cancer. 2) To review the literature describing ectopic intratracheal thyroid tissue.

Methods

Ectopic thyroid tissue is periodically encountered and can sometimes be malignant. The most common locations for ectopic thyroid tissue to be found are the tongue and along the tract of descent of the thyroid gland into the neck. We describe a case of ectopic intratracheal thyroid cancer and review the literature for similar cases. We also discuss possible explanations for this phenomenon.

Results

A total thyroidectomy with tracheal resection was performed. The patient received postoperative I131 therapy and has no detectable serum thyroglobulin to date. There is a small number of cases that report ectopic thyroid tissue found in the trachea. 3 of these were malignant. Including the current case, 26% of ectopic intratracheal tissue is malignant.

Conclusions

Ectopic intratracheal thyroid tissue is rare. Since 26% of reported cases have been malignant, we suggest that resection is the appropriate therapy, as opposed to the alternative endoscopic laser debulking.
S175 – Endoscopic and Open Approaches for Zenker's Diverticulum
Authors: Seth Rahul , Koch Carl , Lorenz Robert R , Scharpf Joseph , Lee Walter
Published: August 2008

Objectives

To compare 1) long‐term symptomatic outcomes and 2) patient satisfaction between open‐neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker's diverticulum.

Methods

Patients undergoing operation for Zenker's diverticulum during the last 10 years (1998 through 2007) at our institution were telephoned and questioned of dysphagia, coughing and choking, regurgitation, halitosis, weight loss, and recurrent pneumonia based on a validated Gastrointestinal Quality‐of‐Life Index. Symptom degree pre‐operatively, one‐month postoperatively, and time of phone call were recorded.

Results

39 of 81 patients were contacted. Of these, 14 underwent ESD and 25 had open‐neck procedures. Average follow‐up time was longer for the open‐neck group (4.6 vs. 1.8 years, p<0.01, t‐test). Age at operation, diverticulum size, pre‐operative symptom scores, and long‐term follow‐up scores at phone call were not statistically different between the two groups. When patients were asked if symptom relief was complete, improved, unchanged, or worse, a greater proportion of open‐neck patients claimed a complete response (67% vs. 43%, p=0.09, contingency analysis) at longer follow‐up times. The recurrence of symptoms leading to re‐operation was higher for ESD (4 versus 2).

Conclusions

Long‐term symptomatic outcomes between the 2 populations are similar. However, a greater proportion of patients with open‐neck procedures claimed complete response. Since the Zenker's location is unchanged in ESD, this may explain persistent symptoms the patient may be experiencing. Greater patient numbers are needed for statistical significance.
S183 – Intracordal Fat Assessment after Injection Laryngoplasty
Authors: Fang Tuan‐Jen , Wang Chao‐Jan , Li Hsueh‐Yu
Published: August 2008

Objectives

Autologous fat injection for unilateral vocal cord paralysis is a popular procedure for immediate symptoms control, but uneven long‐term outcomes were reported. Most authors believed that the continual resorption of injected fat was the cause of voice degradation. A long‐term residual fat volume was evaluated.

Methods

We retrospectively reviewed the patients following autologous fat injection for symptomatic unilateral vocal cord paralysis from 2002 Aug to 2006 July. The patients accepted head and neck computed tomogragphy (CT) evaluation following surgery were included. A three‐dimensional reconstruction of the images of larynx and upper airway was performed on the work station (Vitrea® 2, version 3.9). The volume of intracordal fat was then calculated.

Results

5 males and 15 females of the mean age 49 were enrolled. The mean duration from lipoinjection surgery to the CT study is 23.0 months (12–50 months). The injection fat was found in all study cases. The estimated fat volume ranged from 0.01 to 0.75 ml with a mean 0.33 ml. Compare with the injected fat volume, a mean 27.5% fat survived. The correlation between residual fat volume rate and duration of follow‐up is not significant.

Conclusions

The intracordal fat volume didn't decline from time. Long‐term intracordal injected fat diminished but survived in all cases. The degradation may be caused by absorption or immediate extrusion from injection wound. An over‐correction and prevention of extrusion postoperatively would improve the long‐term outcomes.
S184 – Communication Experiences and QOL after Laryngeal Cancer
Authors: Finizia Caterina A , Johansson Mia , Rydeé Anna
Published: August 2008

Objectives

1) To investigate the sensitivity to change of the Swedish Self‐Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (S‐SECEL), addressing communication dysfunction in patients treated for laryngeal cancer. 2) To evaluate longitudinal score changes in relation to established and validated quality of life instruments.

Methods

100 patients with Tis‐T4 laryngeal cancer were included prior to treatment onset. Patients answered 4 questionnaires at 6 occasions during 1 year; the S‐SECEL, the EORTC Quality of Life Questionnaire, the EORTC Head and Neck cancer module, and Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. Differences within groups were tested with the Wilcoxon paired signed ranks test and between‐group analyses were carried out using the Mann‐Whitney U test. Magnitude of group differences was analyzed by means of effect sizes.

Results

S‐SECEL was well accepted with a response rate of 76%. Communication dysfunction increased at 1 month, followed by a continuous decrease throughout the year. Changes were statistically significant at most measurement (p < 0.001), demonstrating the sensitivity of the S‐SECEL to changes in communication over time. The S‐SECEL was more sensitive than EORTC regarding communication dysfunction.

Conclusions

The questionnaire was responsive to change and showed convergent results when compared to established HRQL questionnaires. As a routine screening instrument, the S‐SECEL could be a valuable tool for identifying patients at risk for psychosocial problems, to help plan rehabilitation and in‐depth counselling. It is therefore recommended for clinical use in evaluation of communication dysfunction for all patients with laryngeal cancer, irrespective of treatment.
S185 – Unilateral Vocal Cord Paralysis: The Miami Experience
Authors: Whitley Matthew , Casiano Roy R , Lundy Donna
Published: August 2008

Objectives

1) Understand the changing etiologies of unilateral vocal cord paralysis. 2) Learn the frequency of return of vocal cord function after paralysis.

Methods

We performed a retrospective analysis of 280 patients treated in the Department of Otolaryngology at the University of Miami for the diagnosis of unilateral vocal cord paralysis from 1999 to 2007. Medical records were reviewed in order to ascertain the etiology of the paralysis and determine on follow‐up if there was recovery of function.

Results

The majority of cases (46%) were of surgical origin, with the leading surgical injury being thyroid surgery. Despite a thorough workup, 28% of cases remained idiopathic in origin. 21 patients (7%) had recovery of vocal fold function, the majority of which had a surgical etiology.

Conclusions

The most common cause of unilateral vocal cord paralysis, in our experience, is surgery, with thyroid surgery being the leading cause. A large majority of these cases remain idiopathic in nature. A small subset of patients regain function of the paralyzed vocal cord.
S187 – Autoimmune Indicators in Idiopathic Subglottic Stenosis
Authors: Alon Eran E , Tombers Nicole M , Hinkley Lucinda , Michael Camilleri , Moore Eric J , Kasperbauer Jan L
Published: August 2008

Objectives

Present new data regarding the role of autoimmune disease in Idiopathic Subglottic Stenosis.

Methods

Patients with ISS identified between April 2007 and February 2008 were included. Directed subglottic biopsies and serum samples were collected after IRB approval and appropriate consent. Direct immunohistochemical staining was conducted on biopsy samples and indirect immunohistochemical staining was performed on serum samples.

Results

35 females were identified with ISS. The mean age was 51 (range 23–81). 12 patients underwent direct Immunofluorescence staining with biopsies taken from the stenotic region. Only 2 biopsies had adequate epithelial surface area to perform direct immunofluorescence, which was negative in both cases. Indirect immunofluorescence stains were performed on 18 samples using a monkey esophagus model and human salt split skin to identify autoimmune antibodies to epithelial and basement membrane components. For the same specimens, ELISA tests were performed for Desmoglein 1, Desmoglein 3, BP 180, and BP230 markers that are positive in various autoimmune mucocutaneous disorders. Only 2 serum specimens were weakly positive for BP180. However, 13 of 18 specimens (72%) displayed nonspecific nuclear staining indicative of a nuclear autoantibody component, suggesting a connective tissue disorder.

Conclusions

This work does not demonstrate clear evidence of an autoimmune mucocutaneous disorder involved in the pathogenesis of ISS; however, the non‐specific antinuclear staining may indicate an association with a connective tissue disorder. Further studies are required to identify the exact role and pathogenesis that the immune system plays in ISS for future targeted therapy.
S189 – Tracheotomy Tube Occlusion Status and Swallowing Function
Authors: Donzelli Joseph J , Brady Susan L , Kaszuba Scott M , Wesling Michele W
Published: August 2008

Objectives

To compare the effects, if any, various types of tracheotomy occlusion conditions may have upon swallowing during either the videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic exam of the swallow (FEES).

Methods

Prospective, repeated measure design. Patients underwent randomized order of tracheotomy occlusion conditions (open, finger, one‐way valve, capped) during selected swallows. Main outcome measures were the presence or absence of aspiration/laryngeal penetration.

Results

39 participants have completed the protocol, 19 males/20 females, mean age of 59.41 years (SD=19.31). 20 underwent the VFSS and 19 underwent FEES. The majority of participants (58.9%, 28/39) were able to safely swallow without any airway invasion under all occlusion conditions. Change in swallow function under 1 or more of the occlusion conditions was present in 25.6% (10/39) of the participants. 4 subjects had increased airway invasion with no occlusion (open), 4 with finger occlusion, and 2 while capped. One subject had less airway invasion with the 1‐way valve as compared to the other conditions. One subject aspirated under all occlusion conditions.

Conclusions

No clear patterns for optimal occlusion condition for swallowing were identified. Results of this study suggest that swallowing disorders in patients with a tracheotomy tube is a multifactiorial problem and several factors may be associated with the swallowing dysfunction. Therefore, patients should be evaluated under various occlusion conditions to determine their specific optimal swallowing condition.
S192 – 3D Diagnosis of Vocalizing Larynx Using Cone Beam CT
Authors: Inagaki Koji , Saito Koichiro , Naganishi Hideki , Takuj Takaoka , Suketaka Momoshima , Ogawa Kaoru
Published: August 2008

Objectives

Cone beam computed tomography (CBCT) was developed for the office‐based quick and precise 3D visualization of maxillofacial region. CBCT requires scanning time of less than 10 seconds and provides isotropic 3D image with high resolution. In this study, we examined the potential role of CBCT as a tool for 3‐dimensional evaluation of the glottal insufficiency.

Methods

CBCT was performed in 2 normal controls and in 14 patients with unilateral vocal fold paralysis (13 cases) or paresis (1 case). Laryngeal CBCT images were taken in the resting state and during phonation. Furthermore, preoperative and postoperative images were evaluated to assess the impact of phonosurgeries in 5 cases.

Results

CBCT of the vocalizing vocal fold was successfully performed in all the cases, producing clear coronal images. During phonation, no remarkable differences in levels between the paralyzed and normal vocal folds were observed in 10 cases, proving the 2‐dimensional glottal gap (2D cases). On the other hand, the levels of paralyzed vocal folds stayed higher during phonation compared to the normal side in 4 cases, proving the 3‐dimensional glottal gap (3D cases). 4 of the 2D cases had injection laryngoplasty and 1 of the 3D cases had arytenoid adduction procedure to correct their glottal gaps. Postoperative CBCT images verified the successful correction of these gaps.

Conclusions

Our study proved the feasibility of CBCT for 3D evaluation of vocalizing larynx. This quick and easy system may have an informative role to suggest the proper phonosurgical procedure for glottic insufficiency.
S200 – Ventricular Folds in Laryngeal Dystonia Treated with Botox
Authors: Silveira Paula Lorenzon , De Biase Noemi
Published: August 2008

Objectives

Analyze the behavior of Vestibular Folds(VF) in Adductor Laryngeal Dystonia(ALD) after and before the treatment with unilateral botulinum toxin injection(BTX) during different laryngeal tasks, comparing treated side(IPSI) and opposite side (CLT).

Methods

23 patients with adductor laryngeal dystonia were studied retrospectively. Categorical data were obtained about ventricular fold medial compression from qualitative judgment of the flexible laryngoscopic dynamic examination. It was realized after and before BTX comparing the compression grade of VF in IPSI with CLT. The VF medial compression was graduated in 4 points scale. The tasks were sustained phonation of /e/ and /i/, during inspiration, soft breathing, whispering, emissions with voiceless sounds and voiceful sounds, sniff and whistling. McNemar and Wilcoxon tests were used to statistical analysis.

Results

Statistical significance was noted on improvement of medial compression of CLT and on reduction of medialization of IPSI as follow: soft breathing (IPSI: p=0,031* CLT: p=0,039*), sustained /e/ (IPSI: p<0,001* CLT: p=0,001*), sustained /i/ (IPSI: p=0,012* CLT: p<0,001*), phonation with voiceful souds (IPSI: p<0,001*) and voiceless souds (IPSI: p<0,001*). The whispering (IPSI: p=0,001* CLT: p=0,057) and the whistling (CLT: p=0,125) was significantly improved on IPSI, without significance at CLT. Phonation during inspiration and sniff didn't show significance.

Conclusions

Significant variation occur on VF behavior in ALD after BTX, with reduction of VF medialization in the IPSI in comparison with increased medialization of VF in the CLT, mainly at phonatory tasks and rest. This variation hasn't the same behavior at atypical and non‐phonatory tasks.
S201 – The Progress of Reflux‐Related Symptoms in Healthy Persons
Authors: Möller Riitta Ylitalo , Olle Andersson , Finizia Caterina A , Ruth Magnus
Published: August 2008

Objectives

To evaluate prospectively the progress of pharyngeal and esophageal symptoms in previously healthy subjects.

Methods

33 healthy persons (mean 57 yrs) earlier included in a normative pH monitoring study were contacted. After a mean follow‐up period of 13 years, the subjects completed 2 symptom questionnaires, Short Form 36, and ambulatory 24‐hour pharyngeal and esophageal pH monitoring.

Results

24 subjects, 9 males and 15 females (mean age, 57 years), completed the study. All subjects were symptom‐free at baseline. At follow‐up, 11 of the 24 (46%) subjects (p=0.001) reported typical reflux symptoms, e.g. heartburn or regurgitation, of mild to moderate severity. Extraesophageal symptoms occurring at least 1–2 days/week developed across time in 10 of the 24 (42%) subjects. The most common symptoms were throat clearing, excessive phlegm, and daytime cough, in that order. There was no statistically significant correlation between reflux parameters and the occurrence of symptoms (p>0.01). The esophageal, or airway symptoms, or combination of them were similar among persons with and without LPR at baseline and at the follow‐up. The perceived health by 10 subjects who had upper airway symptoms at follow‐up, or those 8 subjects who had pharyngeal reflux at follow‐up, as reflected by the domain specific and summary SF‐36 scores, was not significantly different from the age‐ and gender‐matched randomly selected sample from the Swedish normative database.

Conclusions

The increase in the upper airway as well as esophageal symptoms across time is not correlated to perceived health, or increase in the occurrence of reflux.
S204 – Postoperative Residual Cholesteatoma: Value of MR Imaging
Authors: Fukushima Hisaki , Nishiike Suetaka , Tamada Tsutomu , Yoda Shigetoshi , Harada Tamotsu
Published: August 2008

Objectives

This study was carried out to evaluate the utility of diffusion‐weighted imaging (DWI) and contrast‐enhanced MR imaging (CE‐MRI) for the detection of postoperative residual cholesteatoma in cases where computed tomographic (CT) findings were not conclusive.

Methods

14 ears from 13 patients, who had undergone canal wall‐up tympanoplasty for cholesteatoma and nonspecific opacity images on postoperative follow‐up CT, underwent MR imaging before revision surgery. T1WI, T2WI DWI (using b‐factors of 0 and 800 sec/mm2) and CE‐MRI were performed using a 1.5‐T MR unit. MR imaging examination was generally completed within 30 min. In all cases, imaging findings were compared with second‐ or third‐look operative findings.

Results

MR imaging depicted 9 out of 10 residual cholesteatomas (sensitivity, 90.0%). In a remaining (false‐negative) case, a 3‐mm cholesteatoma pearl that was encircled by granulation tissue was not depicted. There were no false‐positive cases (specificity, 100%). The positive predictive value and negative predicitive value were 100% and 75%, respectively. DWI showed cholesteatoma high signal intensity in peculiarity. However, the spatial resolution was low and artifacts appeared at the base of skull in DWI. In the case with a small cholesteatoma in the dura mater, CE‐MRI was effective. The minimum size of the cholesteatomas detected by the MR imaging including DWI was 4 mm.

Conclusions

When postoperative CT is not conclusive, DWI combined with CE‐MRI is a valuable technique for the detection of residual cholesteatoma.
S205 – Neuroradiologic Assessment of Pulsatile Tinnitus
Authors: Kircher Matthew L , Leonetti John P , Marzo Sam J , Standring Bob
Published: August 2008

Objectives

To present a neuroradiographic imaging algorithm for patients presenting with pulsatile tinnitus.

Methods

This was a retrospective review of patients presenting to a tertiary care academic medical center from 1993 to 2007 with a chief complaint of pulsatile tinnitus. Clinical presentation and diagnostic imaging data were analyzed.

Results

Of the 108 patients identified, 93 patients had subjective pulsatile tinnitus and 15 patients presented with objective pulsatile tinnitus. In patients with subjective pulsatile tinnitus, 27/93 (29%) had positive radiologic findings, with 71% of cerebral angiogram studies and 57% of MR studies revealing anatomic abnormalities responsible for the pulsatile tinnitus. In patients with objective pulsatile tinnitus, 9/15 (60%) had positive radiologic findings, with 80% of cerebral angiogram studies and 57% of MR studies revealing anatomic abnormalities responsible for the pulsatile tinnitus. Magnetic resonance sensitivity in subjective and objective pulsatile tinnitus was 67% and 57% respectively.

Conclusions

Magnetic resonance is an excellent first‐line diagnostic imaging modality in the assessment of pulsatile tinnitus. However, regardless of the subjective or objective nature of pulsatile tinnitus, cerebral angiography should be considered in patients with a negative MR and disabling pulsatile tinnitus.
S208 – Catabolism of Gycoconjugates in Cholesteatoma Tissue
Authors: Olszewska Ewa , Borzym‐Kluczyk Malgorzata , Olszewski Slawomir , Rogowski Marek
Published: August 2008

Objectives

1) To determine the activity of N‐acetylo‐beta‐D‐hexosaminidase (HEX), alpha‐mannosidase (alpha‐MAN) and beta‐galactosidase (beta‐GAL)in acquired cholesteatoma and normal retroauricular skin specimens. 2) To assess the level of catabolism of glycoconjugates in assays of cholesteatoma extracts, quantifying HEX, alpha‐MAN and beta‐GAL.

Methods

Cholesteatomas (n=21) and normal adult post‐auricular skin, served as controls(n=21), were collected during surgery in 2006–2007. Exoglycosidases activity was evaluated by determination, the amount of released p‐nitrophenol from p‐nitrophenol derivatives of appropriate sugars (beta‐N‐acetylglucosamine, alpha‐mannose, and beta‐galactose). Statistical analysis was conducted using the Student's t‐test; p<0.05 was regarded as significant.

Results

In 19 of 21 specimens we observed significantly higher activity of investigated enzymes in cholesteatoma tissue compared with control tissue (p<0.05). Mean activity of HEX, alpha‐MAN and beta‐GAL from the cholesteatoma cells was adequate: 68.55 ±30.77 nkat/g, 1.85 ±1.14 nkat/g and 1.92 ±1.11 nkat/g wet tissue. In the control probes, adequate: HEX: 31.79 ±10.02 nkat/g, alpha‐MAN: 0.69 ±0.24 nkat/g and beta‐GAL: 0.86±0.22 nkat/g wet tissue. The correlation of two variables: enzyme activity in cholesteatoma and enzyme activity in skin specimens was positive. Pearson's coefficient was equal r= 0.3815 (HEX), r= 0.527 (alpha‐MAN) and r= 0.489 (beta‐GAL).

Conclusions

Catabolic reactions involving glycoproteins, glycolipids, and proteoglycans may play a role in the pathogenesis of acquired cholesteatoma. The present data indicating that lysosomal exoglycosidases HEX, alpha‐MAN and beta‐GAL are significantly and consistently elevated suggest the need to further assess correlations between levels of HEX, alpha‐MAN and beta‐GAL and cholesteatoma behavior. Further research should also evaluate the relative importance of these particular exoglycosidases in considering the spectrum of identified inflammatory mediators.
S209 – Optimal Electrode Position for ENoG for Facial Palsy
Authors: Haginomori Shin‐Ichi , Takamaki Atsuko , Takenaka Hiroshi
Published: August 2008

Objectives

To develop a more simple procedure for electroneurography (ENoG) of facial palsy for assessing prognosis, we conducted a preliminary study to examine an optimal electrode position for recording evoked compound muscle action potentials (CMAPs) of the perioral muscles.

Methods

We evaluated a new method called the submentall method, in which the electrode connected to the negative input (G1) was placed on the skin over the orbicularis oris muscle, and the other electrode connected to the positive input of the amplifier (G2) was placed on the mental protuberance. We compared the amplitudes and morphology between the CMAPs recorded with this method and those recorded using the standard electrode positions (G1 placed on the skin over the orbicularis oris muscle; G2 placed on the nasolabial fold, closely lateral to the ala nasi). Furthermore, the amplitudes and waveforms of CMAPs were recorded from 4 different G1 positions on the skin over the orbicularis oris muscle, with G2 set on the mental protuberance. The main trunk of the facial nerve was stimulated by percutaneous supramaximal electrical stimulation beneath the auricle.

Results

The submental method gave greater amplitudes and more obvious biphasic CMAPs than those produced with the standard method. In the submental method, the optimal G1 recording electrode position was on the philtrum.

Conclusions

This recording procedure has the potential to be a simpler and more reliable method for calculating ENoG values than the standard method. However, further studies to establish prognostic criteria of ENoG for facial palsy are needed.
S211 – Staged Tympanoplasty with Tympanic Ventilation Tube
Authors: Murakami Masataka
Published: August 2008

Objectives

A technique for providing long‐term ventilation of the middle ear (ME) during staged tympanoplasty is described, and the results using this treatment in patients with chronic Eustachian tube dysfunction (ETD) are reported.

Methods

Retrospective, nonrandomized case review. All operations were performed by the same surgeon (author). 26 consecutive patients who underwent staged tympanoplasty with ETD have been followed up and and examined for more than 5 years. Adhesive otitis media, cholesteatoma, and cholesterol granuloma were included in this study. All patients had a T‐tube placed at the first stage tympanoplasty for long‐term ventilation of the middle space. The 3 main outcome measures were inflammation control, hearing improvement, and recurrence of the disease.

Results

6 had adhesive otitis media, 16 had cholesteatoma, and 4 had cholesterol granuloma. All patients underwent planned first stage tympanoplasty with simultaneous ventilation tube placement; 12 underwent concomitant ossiculoplasty, and 22 underwent mastoidectomy. 2 patients (1 cholesteatoma and 1 cholesterol granuloma) had recurrence. 2 patients with adhesive otitis media had intermittent otorrhea (with maintained ventilation tube). In patients who underwent planned staged tympanoplasty with tube placement, the success rate both in inflammation control and in hearing improvement was higher.

Conclusions

The simultaneous placement of the long‐term ME ventilation tube during planned staged tympanoplasty is a simple, safe, and effective alternative for longer‐term ME ventilation in patients with severe ETD. Staged tympanoplasty technique with ventilation tube is effective and available for the treatment of adhesive otitis media, cholesteatoma, and cholesterol granuloma.
S213 – Gustatory Alterations in Patients with Chronic Otitis Media
Authors: Felix Felippe , Jamerson Reis , Cabral Gustavo A. Porto Sereno , Guilherme Carleti , De Barros Fernando Souza , Tomita Shiro
Published: August 2008

Objectives

1) To identify gustatory alterations due to chorda tympani nerve involvement in patients with chronic otitis media (COM) without prior surgery, and 2) To see if the presence of cholesteatoma worsened gustatory sensitivity in these patients.

Methods

Study Design: prospective study. The test was performed in patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery. The test was based on “taste strips” with different concentrations of salt, sweet, bitter, and sour, using the otological disease‐free side as the control. The score could be between 0 (worst) and 16 (best). All the other data were collected by interview and physical exam and analysed by Poisson Regression.

Results

A total of 45 patients with COM were evaluated, including 25 with cholesteatoma and 20 with non‐cholesteatomatous COM, with a mean age of 38 years. 8 cases of unilateral ageusia were found on the affected side. The mean score was 6.65 for the affected side and 9.91 for the half of the tongue on the side of the healthy ear (p<0,05). No patients had complained of gustatory alterations before the examination. There was an association between presence of cholesteatoma and worse gustatory sensitivity (p<0.05).

Conclusions

Patients with cholesteatomatous or suppurated COM can present gustatory alterations, even in the absence of complaints. The presence of cholesteatoma worsened gustatory sensitivity.
S214 – Temporal Fascial and Periosteal Flap in Tympanoplasty
Authors: Yabe Takao
Published: August 2008

Objectives

It is very important to maintain a stable reconstructed posterior canal wall with bone plate and cartilage in the posterior canal wall reconstructed tympanoplasty. We treat reconstructed posterior canal wall with the temporal fascial flap (TFF) and the temporal periosteal flap (TPF) to have a stable posterior canal wall and a tympanic membrane graft. We investigated the blood supplies of TFF and TPF to know the effectiveness of those flaps.

Methods

Retrospecyive analysis of a prospective patient data set. Tertiary care referral center. 25 patients with chronic otitis media underwent canal wall reconstructed tympanoplasty between December 2005 and December 2007. We employed Laser Doppler blood flowmeters to measure the blood supplies of TFF(F1: the tip and F2: the root) and TPF(P) during surgeries. The data were analyzed by Welch's t‐test (p<0.05).

Results

The mean ± SD were F1:23.3±8.6 Flux?F2: 25.3±8.3 Flux and P:17.1±5.1 Flux in controls, and F1:21.1±4.2 Flux?F2:21.9±3.1 Flux and P:17.1±2.4 Flux in pedicled flaps, respectively. There were no significant statistical differences between controls and pedicled flaps, but were significant differences between TFF (F1 and F2) and TPF (P) (p<0.05).

Conclusions

These findings suggested that the TFF and TPF were reliable sources of local well‐vascularized tissue to be extremely pliable and facilitate to create the stable posterior canal wall. Furthermore, it seems that it was linked to prompt postoperative healing, the avoidance of postoperative infection, the postoperative hearing improvement, the shorter hospitalization stay, and early discharge from the hospital.
S216 – Is Oculomotor Testing Useful in the Modern Era?
Authors: Dewji Zameel , Blakley Brian W
Published: August 2008

Objectives

To understand the role of oculomotor testing in the era of advanced imaging with MRI.

Methods

First, the literature was evaluated systematically to determine the level of evidence that oculomotor testing is sensitive in central nervous system lesions. Next, the sensitivity and specificity of saccade, pursuit, and gaze testing in detection of brain abnormalities were assessed using a database of 561 patients who underwent ENG using magnetic resonance imaging (MRI) as the “gold standard.” Among the abnormal MRI scans, oculomotor testing was abnormal in 1 and normal in 37. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR), and the diagnostic odds ratio (OR) with 95% confidence interval (± CI) were calculated.

Results

For oculomotor testing, our data which concur with the literature indicate: Sensitivity 2.6%, (± 0.005–1.1); Specificity 96%, ± (0.89–0.98); Diagnostic OR 0.71 ± (0.065–5.6); PPV 20% ± (0.043, −0.64); NPV 71% ±(0.62, 0.78).

Conclusions

Our data suggest that oculomotor testing adds little diagnostic information. The cost and benefit of oculomotor testing are low.
S219 – Japanese Otosclerosis Patient with Otospongiotic Lesions
Authors: Hashimoto Shigehisa , Yamamoto Yutaka , Takahashi Sugata
Published: August 2008

Objectives

Although it has been reported that the incidence of otosclerosis is much lower among Japanese patients and clinically the disease shows a reduced activity level, otosclerotic foci are sometimes detected in recent years. However, about the clinical significance, it is not still unclear. This study investigated the incidence of otosclerosis in Japanese patients with otosclerotic foci around the otic capsule, their audiometric correlation and surgical outcome.

Methods

We evaluated 59 patients (86 ears) with confirmed otosclerosis (at least one ear underwent surgery) in our hospital between 2001 and 2006. All patients underwent hearing and CT examination on the same day and hearing examination were repeated every 6 months regardless of whether the patient underwent surgery or observation only.

Results

Otosclerotic foci around the otic capsule were observed in 30.2% of the all ears in the Japanese otosclerosis. There was a correlation between the presence of otosclerotic foci and air‐bone gap (p<0.05). In the surgical group, there was no significant difference between the patients with and without the presence of otosclerotic foci for the hearing improvements after stapes surgery. In the no‐surgical groups, there was significant worsening of the hearing level in patients with otosclerotic foci in comparison to that of those without otosclerotic foci (p<0.01).

Conclusions

This incidence of Japanese otosclerosis patient with otosclerotic foci is not lower than those of Caucasians. Surgical outcome was not affecting by otosclerotic foci. It is concluded that CT examination is important for predicting the hearing level of patients.
S224 – Efficacy of Long Silastic Sheet in COM Surgery
Authors: Cho Hyong‐Ho , Choi Hyun‐Seok , Jang Chul‐Ho , Cho Yong‐Bum
Published: August 2008

Objectives

To determine the effect of long silastic sheet for middle ear aeration in chronic otitis media surgery.

Methods

Between January 2003 and May 2007, 46 patients underwent planned staged canal wall up tympanomastoidetomy, because possibility of residual cholesteatoma and severe swelling middle ear mucosa, especially around the stapes. Long silastic sheet was inserted from mastoid cavity to middle ear via facial recess during operation procedure. To determine the effect of long silastic sheet for recovery of mastoid aeration, various factors such as computed tomography grading, Valsalva maneuver grading for Eustachian function, and hearing result were compared.

Results

During the average follow‐up of 31 months, there was 1 recurred chronic otitis media which was revealed tuberculosis otitis media. Intact tympanic membrane was obtained in 45(97.8%) of 46 patients. In CT grading, middle ear aeration was increased significantly (p<0.05). Air‐Bone gap was significantly decreased after staged operation, preoperative average ABG was 29.7dB and last average ABG was 21.0dB (p <0.05). But Eustachian function using Valsalva manerver was not significantly changed (p >0.05).

Conclusions

Long silastic sheet insertion from mastoid to middle ear is statistically effective for amelioration of middle ear and mastoid aeration after the first‐stage operation.
S225 – A New Meatoplasty Technique in Canal Wall Down
Authors: Kim Kwang‐Hyun , Choi Ik Joon , Chang Sun O , Song Jae‐Jin , Lee Jun Ho , Oh Seung‐ha , Kim Chong Sun
Published: August 2008

Objectives

Although it is well recognized that a small meatus after canal wall down tympanomastoidectomy can cause a lifetime problem, unsatisfactory results are frequently encountered. We introduce a new technique to maintain a large external auditory meatus, reduce the mastoid dead space, and improve the posterior auricular cosmetics outcome.

Methods

From Jan 2005 through Dec 2006, 39 ears had undergone canal wall down tympanomastoidectomy with the perichondreial posterior fixation technique. 2 stitches were made to pull the perichondrium of the canvun conchal cartilage posteriorly to the periostium of the mastoid bone. Medical records were retrospectively reviewed for the postoperative complications, including infection. Postoperative size of the meatus and the extent of cavum conchal cartilage burying into the mastoid cavity were evaluated by taking digital photographs.

Results

15 males and 24 females were included; the mean age was 54 years (37yr‐66yr). The postoperative follow‐up duration was 9.5 months (6mo‐23mo) in average. All the ears maintained a clean and large external meatus. The posterior auricular cavum conchal cartilage was successfully prevented from being buried into the mastoid cavity in all the ears. The extent of burying was much improved compared to the conventional technique. 2 ears (5%) had a very mild postoperative inflammation but it was easily controlled by topical antibiotics.

Conclusions

The perichondreial posterior fixation, which is a new meatoplasty technique in canal wall down tympanomastoidectomy, seems to be effective in maintaining a large external auditory meatus and improving the cosmetic outcome with minimal risk of complications.
S226 – MRSA and Pseudomonas Infection in Chronic Otitis Media
Authors: Choi Young‐Seok , Shin See‐Ok , Yoo Seung‐Doo
Published: August 2008

Objectives

1) Compare postoperative healing process between otorrhea and non‐otorrhea group. 2) Evaluate the influence of MRSA and Pseudomonas infection on postoperative healing process. 3) Describe the affecting factors of postoperative reperforation and retroauricular abscess.

Methods

Retrospective chart review of 392 patients who were operated with canal wall up procedures by one surgeon and followed up at least over 12 months. The patients were divided into control and study groups; 106 non‐otorrhea control group; 74 Pseudomonas infected group (P); 145 MRSA infected group (M); 61 other bacteria infected group (0). The following data were collected: 1) postoperative dressing frequency and duration; 2) the duration of oral antibiotics and intravenous antibitics use; 3) the incidence of postoperative otorrhea; 4) the incidence of reperforation and retroauricular abscess. The Mantel‐Haenszel test and ANOVA test were used for statistical analysis.

Results

Statistical analysis indicates a significant difference in frequency and duration of postoperative dressing and oral antibiotics using peroid (p<0.01). Nevertheless, there were no correlations in postoperative otorrhea and reperforation between the infected group and non‐otorreha group (p>0.05). The incidence of retroauricular abscess was high in the antibiotic‐changed group (p<0.01).

Conclusions

MRSA and Pseudomonas infection in chronic otitis media indicated a significant difference in the duration of postoperative follow‐up and the antibiotic‐using period, compared with the control group. The isolated MRSA or Pseudomonas infection after surgery had more incidence of a retroauricular abscess.
S228 – Direct Round Window Drug Application and Ototoxicity in Rats
Authors: Rivera Teresa , Alcantara Fernando García , Suarez Jon Alexander Sistiaga , Silvia Murillo‐Cuesta , Elena Vacas , Rodríguez Julio Contreras , Varela‐Nieto Isabel
Published: August 2008

Objectives

1) Manage to introduce ototoxic drugs, such as kanamycin and furosemide, directly on the round window in rats. 2) Use a purified gelatine sponge as a proper delivery vehicle. The purpose of the study is to assess the validity of this method to provoke local ototoxicity.

Methods

We carried out an experimental design with 3 groups of 6 male Wistar rats. The bulla and round window membrane were exposed using a ventral approach. In the first control group we only made a hole in the tympanic bulla. Second control group was treated with saline solution. The problem group was treated with 20 mg/kg of kanamycin and 5 mg/Kg of furosemide‐soaked gelatine sponge directly upon the round window membrane. Cochlear function was assessed through tone burst auditory brainstem response (ABR) threshold (dB) and peak latency (ms) measurements. Anova with bonferroni correction was used (p level=0.05).

Results

All animals treated with kanamycin and furosemide exhibited significant increase in ABR threshold (x = 51.25 dB; SD = 6.29; p = 0,001) in contrast to the other groups, whose ABR thresholds did not show significant differences before and after treatment(x=31,50 dB; SD=5.53); and not significant increase in peak latencies I (x = 0.22 ms; SD = 0.12), II (x = 0.22 ms; SD = 0.20) and IV (x = 0.21 ms; SD = 0.18).

Conclusions

The ventral approach and placement of kanamycin and furosemide‐soaked gelatine sponge directly upon the round window membrane represents a reliable method for ototoxicity in rats.
S230 – MRI Findings in Delayed Facial Palsy after Stapedectomy
Authors: Cohen Marc , Kirsch Claudia , Mendelsohn Abie , Ishiyama Akira
Published: August 2008

Objectives

1) To retrospectively review the pathophysiology and radiologic features of delayed facial palsy after stapedectomy. 2) To discuss the management strategy of this unusual problem.

Methods

450 stapedectomies performed at our institution were retrospectively reviewed from 1997 to 2007. A total of 2 patients in this series developed a delayed facial paralysis postoperatively. The clinical presentation, radiographic characteristics on magnetic resonance imaging (MRI), and the management of these patients are presented.

Results

A total of 2 patients out of 450 stapedectomies within a 10‐year period developed the rare complication of delayed facial paralysis (postoperative days 12 and 41, respectively). Both patients developed rapidly progressive complete facial nerve paralysis preceded by periauricular pain and dysguesia. No sign of infection was present in the operated ear. MRI with gadolinium of the internal auditory canal demonstrated gadolinium enhancement of the labyrinthine portion of the facial nerve as seen in Bell's palsy. Both patients were treated with oral corticosteroids and antiviral medications. Subsequent imaging revealed decreased enhancement of the facial nerve with complete resolution of facial paralysis.

Conclusions

In the rare complication of delayed facial paralysis after stapedectomy, MR imaging is a useful diagnostic tool to dictate the treatment strategy. Delayed facial paralysis following stapedectomy can be treated medically when the MRI scan demonstrates enhancement of the facial nerve in the labyrinthine segment.
S231 – Middle Ear Carcinoma: A Population‐based Study
Authors: Gurgel Richard K , Hansen Marlan , Karnell Lucy
Published: August 2008

Objectives

Carcinoma of the middle ear is a rare clinical entity, best suited for evaluation using a large, population‐based database. The objective of this study was to utilize the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence, treatment patterns, and survival of middle ear carcinoma.

Methods

Using SEER*Stat software, data for patients diagnosed between 1973–2004 were extracted based on the middle ear's anatomic code (C30.1). 5‐year observed survival was analyzed with SPSS software, with significant differences determined by the Wilcoxon statistic.

Results

The 5‐year survival rate for the 215 patients in this study was 36.4%. Histologic subtypes included squamous cell carcinoma (62.8%), adenocarcinoma (18.2%), other carcinomas (13.0%), and non‐carcinomas (6.0%), with 5‐year survival rates of 23.9%, 65.0%, 60.0%, and 38.6%, respectively (p=0.003). Of the 123 patients with known stage, 23.6% had local, 69.1% had regional, and 7.3% had distant disease, with their 5‐year survival rates being 64.9%, 34.2%, and 0%, respectively (p=<0.001). Treatment included surgery (31.2%), radiation (16.3%), surgery and radiation (38.6%), or no treatment (8.4%) with 5‐year survival of 69.2%, 14.6%, 26.4%, and 0%, respectively (p<0.001).

Conclusions

Patients with middle ear carcinoma have a relatively poor prognosis, reflected by a 5‐year survival rate of 38.6%. However, subsets such as those with adenocarcinomas (65.0%) and with localized tumors (64.9%), demonstrated significantly better survival. Surgery alone had significantly better survival than the other treatment groups, presumably due to less advanced disease. These data are useful in counseling patients and understanding the natural history of middle ear carcinoma.
S232 – Hearing Gain Following Stapes Surgery Maintained Long‐term?
Authors: Sen Purushotam , Bhattacharyya Abir K
Published: August 2008

Objectives

To analyse whether the hearing gain following stapes surgery is maintained long‐term.

Methods

Databases (PubMed, EMBASE and MEDLINE) were searched systematically, with no limits on the year or language of publications, for observational studies on the long‐term hearing results of stapedectomy (>10 years). References identified from pertinent reviews and articles were also retrieved. 2 reviewers independently searched the databases and selected the studies using pre‐specified standardized criteria. These criteria included appropriate adjustments for confounding factors in the analyses. The terms used in the search included stapes surgery, stapedectomy, stapedotomy, long‐term results, hearing gain. Data extraction and study quality evaluation were performed independently and results were pooled quantitatively.

Results

Early studies noted that both air conduction (AC) and bone conduction (BC) deteriorated with time, resulting in a return to baseline pre‐operative hearing in the long‐term. More recent studies showed that in the long term, the hearing gain was maintained by 75% of patients despite the advent of presbycusis. Surgeons' experience may play a more important role than the type of stapes surgery. On average, studies have shown that the air bone gap tended to increase at a rate of 0.9 dB per year.

Conclusions

Though some earlier studies were equivocal, recent studies indicate that most stapes surgery patients maintain good hearing long‐term, even though there is a gradual decline in the air conduction and bone conduction thresholds. Longitudinal studies are required to better understand this subject.
S234 – The Immune System in Immunomediated Inner Ear Disease
Authors: Olarieta Javier , Rivera Teresa , Suarez Jon Alexander Sistiaga , Eduardo Reyes , de Mon Melchor Alvarez
Published: August 2008

Objectives

1) To assess the different clinical varieties and the evolution of the patients. 2) To assess the clinical impact of the use of high dose corticotherapy. 3) To analyze the phenotype of the lymphocyte populations in peripheral blood. 4) To study the proliferative answer of mononuclear cells in peripheral blood under polyclonal mitogen stimulus.

Methods

A prospective study in patients with immunomediated inner ear disease was carried out, dividing them in 4 different clinical presentations: Sudden deafness, fluctuant hearing loss, Meniere's disease, and rapidly progressive hearing loss. We analysed 22 patients, controlling their clinical evolution and response to corticotherapy. We also made an immunophenotypical and functional characterization of the T lymphocytes in patients before and after treatment and comparing them with healthy controls. Mann‐Whitney U and Wilcoxon range tests were used as statistical resources.

Results

59.09% of the patients treated with corticotherapy improved, with a 95% of treatment fulfillment. The T lymphocyte compartment's proliferative response was significantly lower in these patients (p value less than 0.05) and there was a higher CD56+ (p value less than 0,01) and CD8+ CD45RO+(p value less than 0.01) lymphocyte subpopulations expression in absolute and percentage numbers.

Conclusions

Immunomediated inner ear disease is related to T, B, and especially NK lymphocytosis associated to a redistribution of the T cell subpopulations.
S239 – Labyrinthine Changes in Otitis Media
Authors: Joglekar Shruti Siddharth , Deroee Armin Farajzadeh , Morita Norimasa , Cureoglu Sebahattin , Patricia Schachern , Paparella Michael M , Juhn Steven K
Published: August 2008

Objectives

Otitis media causes labyrinthine changes and subsequent sensorineural hearing loss. The aim of this histopathologic study was to evaluate the extension of inflammation to the inner ear and its effects.

Methods

Out of 614 temporal bones with otitis media, 47 (30 cases) with chronic and 35 (21 cases) with purulent were selected for histopathologic study. Subjects with a history of acoustic trauma, head trauma, ototoxic drugs and other otologic and systemic diseases affecting the inner ear were excluded. The pattern of labyrinthine inflammation was classified as localized purulent, localized serous, generalized seropurulent and generalized serous. Inner ear findings were compared to age‐matched controls.

Results

19% of temporal bones with chronic and 9% of temporal bones with purulent otitis media showed labyrinthine inflammatory changes. In chronic otitis media, inflammatory changes were: 56% localized purulent; 22% localized serous; 11% generalized seropurulent; and 11% generalized serous. Inflammatory changes in temporal bones with purulent otitis media included: 67% localized purulent; and 33% generalized seropurulent. Pathological findings included: serofibrinous precipitates and inflammatory cells in the scala tympani of basal turn and cochlear aqueduct; significant decrease in area of stria vascularis (p = 0.033); and loss of hair cells in the organs of Corti. No significant difference was found in area of spiral ligament area or number of fibrocytes in diseased and control bones.

Conclusions

Middle ear/inner ear interaction in otitis media can result in labyrinthine inflammation and cochlear damage. Early diagnosis and treatment of otitis media is important in preventing inner ear damage.