bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentially Expressed Genes in Head and Neck Cancer
Authors: Gottschlich Stefan , Folz Benedikt J. , Lippert Burkard M. , Niemann Anna M. , Goeroegh Tibor , Werner Jochen A.
Published: November 2003

Carcinogenesis is considered a multistep process. To further elucidate involved genetic changes, the differential display method was applied to compare gene expression of head and neck carcinoma cells and normal keratinocytes from the upper aerodigestive tract. Total RNA was extracted from cultured squamous carcinoma cells and keratinocytes. mRNA was reverse transcribed into cDNA, amplified by PCR, and separated on a gel. Currently three DNA transcripts were identified with a length of 191 to 336 base pairs (bp) that were either expressed only by the keratinocytes or by the malignant cells. Differentially expressed DNA fragments of the carcinoma cells and the keratinocytes were cloned and sequenced. A gene bank database search identified one fragment expressed by the carcinoma cells as an unknown gene, another one found in the keratinocytes as probably a part of the human cell attachment domain, and the third one with homology to the mRNA of the human epidermal growth factor receptor (EGFR). Northern blot analysis confirmed the differential expression in the malignant cells or the keratinocytes. Differential display seems to confirm the well‐known overexpression and up‐regulation of the EGFR, the differential expression of the cell attachment domain may play a role as a cofactor in carcinogenesis of head and neck cancer, and the third unknown fragment is still under investigation to elucidate the role in carcinogenesis.
Penetration of Ceftazidime Into Middle Ear Fluid in Children With Otitis Media With Effusion
Authors: Bégué Pierre , Garabédian Erea‐Noël , Bertrand Catherine , Aubert Bernard , Chiche Dan
Published: November 2003

Twenty‐five children with otitis media with effusion received ceftazidime 50 mg/kg intravenously before bilateral myringotomy with insertion of tympanostomy tubes. Concentrations of ceftazidime measured in serum and middle ear fluid exceeded 4 mg/L (i.e., largely above the minimal inhibitory concentrations for the gram‐negative pathogens commonly recovered from children with otitis media) for at least 4 hours. Mean peak concentrations occurred 30 to 90 minutes after the injection and reached 11 to 14 mg/L. These results are in keeping with the clinical efficacy of ceftazidime in the treatment of chronic middle ear infections in children.
Videoendoscopic Swallowing Study for Diagnosis of Zenker's Diverticuli
Authors: Richardson Brent E. , Bastian Robert W.
Published: November 2003

The videoendoscopic swallowing study (VESS) provides an efficient, cost‐effective method for swallowing evaluation in the clinic. Previously thought to be of little value for disorders of the proximal esophagus, this retrospective study (n = 33) demonstrates a high level of sensitivity (85%) and specificity (86%) of VESS for detecting Zenker's diverticuli in patients with symptoms of swallowing dysfunction. Furthermore, the key finding of postswallow reflux into the hypopharynx reliably distinguishes cricopharyngeus dysfunction from diverticuli in this population. This study shows that VESS can provide useful information about the proximal esophagus.
Viscosities of Implantable Biomaterials in Vocal Fold Augmentation Surgery
Authors: Chan Roger W. , Titze Ingo R.
Published: November 2003

Vocal fold vibration depends critically on the viscoelasticity of vocal fold tissues. For instance, phonation threshold pressure, a measure of the “ease” of phonation, has been shown to be directly related to the viscosity of the vibrating mucosa. Various implantable biomaterials have been used in vocal fold augmentation surgery, with implantation sites sometimes close to or inside the mucosa. Yet their viscosities or other mechanical properties are seldom known. This study attempts to provide data on viscosities of commonly used phonosurgical biomaterials. Using a parallel‐plate rotational rheometer, oscillatory shear experiments were performed on implantable polytetrafluoroethylene (Teflon or Polytef; Mentor Inc., Hingham, MA), collagen (Zyderm; Collagen Corp., Palo Alto, CA), glutaraldehyde crosslinked (GAX) collagen (Phonagel or Zyplast; Collagen Corp.), absorbable gelatin (Gelfoam; Upjohn Co., Kalamazoo, MI), and human abdominal subcutaneous fat. Samples of human vocal fold mucosal tissues were also tested. Under sinusoidal oscillatory shear at 10 Hz and at 37°C, the dynamic viscosity was 116 Pascal‐seconds (Pa‐s) for polytetrafluoroethylene, 21 Pa‐s for gelatin, 8‐13 Pa‐s for the two types of collagen, 3 Pa‐s for fat, and 1 to 3 Pa‐s for vocal fold mucosa. Results extrapolated to 100 Hz also show similar differences among the biomaterials, but all values are an order of magnitude lower because of the typical inverse frequency relation (shear thinning effect) for polymeric and biologic materials. The data suggest that the use of fat for vocal fold augmentation may be more conducive to the “ease” of phonation because of its relatively low viscosity, which is closest to physiologic levels. This implication is probably the most relevant in predicting initial outcome of the postoperative voice before there is any significant assimilation (e.g., resorption and fibrosis) of the implanted biomaterial.
Conservation of Resources: Indications for Intensive Care Monitoring After Upper Airway Surgery on Patients With Obstructive Sleep Apnea
Authors: Terris David J. , Fincher Edgar F. , Hanasono Matthew M. , Fee Willard E. , Adachi Kristi
Published: November 2003

Although significant complications can result after upper airway surgery for obstructive sleep apnea (OSA), there is a lack of consensus regarding the most appropriate level of monitoring in the perioperative period. A retrospective analysis was performed on the operative records of 109 adult patients who underwent 125 surgical procedures from January 1, 1991, to May 31, 1996, with particular emphasis on complications that would have mandated intensive care monitoring and management. Airway complications occurred in one patient (0.8%), who became obstructed immediately after surgery; he responded to naloxone and suctioning. Five other patients (4%) suffered oxygen desaturation to levels below 90% (none fell below 80%, and in only one case was it below the lowest preoperative oxygen saturation level). Cardiac complications, primarily significant hypertension, were the most common adverse events. Four (3.2%) bleeding complications were encountered; all occurred after discharge from the hospital. Routine postoperative intensive care monitoring for all adult patients undergoing upper airway surgery for OSA is unnecessary. Although high‐risk patients cannot always be identified preoperatively, significant complications generally emerge within 2 hours after surgery. Therefore a decision regarding the level of postoperative monitoring needed may be made with confidence during the period of time that the patient is in the recovery room.
Meta‐Analysis of Outcomes of Pediatric Functional Endoscopic Sinus Surgery
Authors: Hebert Richard L. , Bent John P.
Published: November 2003

Objective: To create a consensus of outcomes of pediatric functional endoscopic sinus surgery (FESS) and assess its effectiveness and safety.

Study Design: A meta‐analysis of the literature on outcomes of pediatric FESS.

Methods: A meta‐analysis of the literature was performed focusing on the number of patients per study, length of follow‐up, prospective versus retrospective, and the separation or exclusion of patients with significant underlying systemic diseases (cystic fibrosis and immunodeficiencies). A rating scale based on the above criteria was used to select articles for inclusion.

Results: Eight published articles (832 patients) plus unpublished data from the authors' institution (50 patients) were included. The “positive” outcome rates for published, unpublished, and combined data were 88.4%, 92%, and 88.7%, respectively. No statistically significant differences in “positive” outcome existed between all published or unpublished series using a chi‐squared test (power = .51, P = .38). The average combined follow‐up was 3.7 years, with a major complication rate of 0.6%.

Conclusion: Pediatric FESS is a safe and effective treatment for chronic sinusitis that is refractory to medical therapy.
Significance of Unilateral Submandibular Gland Excision on Salivary Flow in Noncancer Patients
Authors: Cunning Devin M. , Lipke Neil , Wax Mark K.
Published: November 2003

Objectives/Hypothesis: Normal salivary flow is important for maintaining good oral hygiene. Lack of normal flow predisposes to an increased incidence of dental caries and symptomatic xerostomia. The submandibular glands are responsible for 70% of resting salivary flow. Removal of the submandibular gland is most commonly performed for sialolithiasis, chronic sialoadenitis, or as part of a neck dissection. The effect of unilateral gland resection for benign disease on resting salivary flow has not been well examined in the literature.

Study Design: Case controlled study involving patients who had undergone a unilateral submandibular gland resection matched with normal control subjects.

Method: Stimulated and unstimulated salivary flow rates in surgical and control subjects were measured in a controlled setting.

Results: Unstimulated salivary flow rates were 0.805 mL/min in the control group and 0.405 mL/min in the surgical group (P = .01). Stimulated salivary flow rates were not significantly different between the two groups (P > .05). Fifty‐seven percent of patients in the surgical group and 14% in the control group had xerostomia (P < .05).

Conclusion: Unilateral submandibular gland excision results in a decreased rate of resting salivary flow and an increase in subjective xerostomia.
Endoscopic Optic Nerve Decompression: The Graz Experience
Authors: Luxenberger Wolfgang , Stammberger Heinz , Jebeles John A. , Walch Christian
Published: November 2003

Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.
Sinus Surgery: Does Mitomycin C Reduce Stenosis?
Authors: Ingrams Duncan R. , Volk Mark S. , Biesman Brian S. , Pankratov Michail M. , Shapshay Stanley M.
Published: November 2003

This experimental study investigates the effect of mitomycin C (MMC) on sinus mucosal healing. MMC has an antiproliferative action on fibroblasts. It is used in glaucoma surgery to prevent restenosis of fistulas. Antrostomies were drilled in rabbit maxillary sinuses. One side was used as a control and the other treated with MMC at a concentration of 0.04, 0.4, or 1 mg/mL. Two animals from each group were sacrificed at 1, 2, 4, and 12 weeks. The antrostomies in the control and 0.04‐mg/mL groups had closed by 1 week; in the 0.4‐mg/mL group by 4 weeks, and in the 1.0‐mg/mL group by 12 weeks. Ciliary function was initially impaired but normalized within 1 week. Both light and scanning electron microscopy showed no permanent damage to the cilia. These results suggest that MMC can be used to delay closure of antrostomies in sinus surgery.
Use of electrocochleography in the diagnosis of meniere's disease
Authors: Levine Samuel , Margolis Robert H. , Daly Kathleen A.
Published: November 2003

Objective: The diagnosis of Meniere's disease has always been a source of confusion. There is no single test that is definitive for the diagnosis. Recent advances have enabled clinicians to noninvasively test the function of the inner ear and its associated neural pathways. The electrocochleogram (ECOG) has been advocated as a reliable test that is diagnostic for Meniere's disease. This study was undertaken to assess the value of ECOG in establishing the diagnosis of Meniere's disease. Study Design: Patients who were suspected of having Meniere's disease were prospectively entered into a study of the diagnostic value of ECOG. Each patient had a complete evaluation including a detailed history, physical examination, laboratory studies, and audiometric tests. Setting: University otolaryngology clinic. Patients: A group of 199 patients who presented to a neurotology clinic and were suspected to have symptoms consistent with Meniere's disease. Intervention: ECOG testing. Main Outcome Measures: Audiometric thresholds, action potential magnitude (AP), summating potential amplitude (SP), AP latency, and clinical evaluations were assessed. Results: The ECOG was found to correlate with historical and audiometric criteria that are used to diagnose the disease. The percentage of abnormal ECOG did not correlate with stage of disease or duration of time that symptoms were present. Conclusions: The ECOG has limited value in the diagnosis of Meniere's disease. It appears to correlate with the length of time patients experience symptoms and their audiometric findings. It was not correlated with the number of symptoms that the patient experienced at the time that the study was conducted.
Olfactory and intranasal trigeminal event‐related potentials in anosmic patients
Authors: Kobal Gerd , Hummel Thomas
Published: November 2003

The aim of this study was to investigate the usefulness of chemosensory event–related potentials (CSERPs) in response to both olfactory and intranasal trigeminal stimulation in the diagnosis of anosmia. Forty‐four patients participated. Gaseous CO2 was used for trigeminal stimulation, vanillin and H2S were used as olfactory stimulants. Event‐related potentials to olfactory stimuli could not be obtained in any of the anosmic patients, indicating the complete loss of the sense of smell. However, all patients responded to stimulation of the trigeminal nerve with CO2. These data clearly demonstrate the clinical significance of CSERPs in the assessment of anosmia.
Nasal ciliary beat frequency is age independent
Authors: Jorissen Mark , Willems Tom , Van Der Schueren Bernadette
Published: November 2003

Objectives: Evaluate the age‐dependency of ciliary beat frequency (CBF) in biopsies after ciliogenesis in culture. Study Design: Retrospective analysis of CBF and ciliary ultrastructure in biopsies and after ciliogenesis from 203 individuals, aged 3 months to 74 years. Methods: All patients with successful culture were included. Ciliogenesis was obtained using the sequential monolayer‐suspension culture technique for dissociated nasal epithelial cells. CBF was measured using computerized microscope photometry. Secondary ultrastructural abnormalities were evaluated in transmission electron microscopy. Results: There was no correlation between age and CBF, in either the biopsies (7.0 ± 2.6 Hz; n = 113) or after ciliogenesis in culture (8.1 ± 1.3 Hz; n = 203). Even in individuals older than 70 years, CBF was normal in bioptic material (6.7 ± 1.7 Hz) and after ciliogenesis in culture (7.9 ± 1.0 Hz). Also, in individuals less than 1 year of age CBF was normal in biopsies as well as after ciliogenesis. CBF correlated inversely with the percentage of secondary ultrastructural abnormalities in the biopsies as seen with transmission electron microscopy: 8.1 ± 1.8 Hz when ciliary ultrastructure was normal and 3.5 ± 3.3 Hz in cases of severe secondary ciliary dyskinesia. After ciliogenesis in culture, ciliary ultra‐structure was always normal, as was CBF. Conclusion: CBF is age independent but correlates with secondary ultrastructural abnormalities. CBF after ciliogenesis in culture is the intrinsic one.
Mastoid pneumatization in children with congenital cholesteatoma: An aspect of the formation of open‐type and closed‐type cholesteatoma
Authors: Iino Yukiko , Imamura Yukako , Hiraishi Mitsutoshi , Yabe Takao , Suzuki Jun‐Ichi
Published: November 2003

Objectives: To clarify mastoid pneumatization in children with congenital cholesteatoma and compare their clinical characteristics. Study Design: The mastoid pneumatization of 34 children with congenital middle ear cholesteatoma, of 34 age‐matched children with unilateral acquired cholesteatoma, and of 17 age‐matched control children without middle ear diseases was studied. Methods: The sizes of the mastoid cells were measured from 1.5‐mm sliced semiaxial sections of a temporal bone computed tomography scan. The sum of the two areas from the two images, one showing the lateral semicircular canal and the other, 3 mm below this, was defined as the area of the pneumatized mastoid cells. Results: The mastoid cells in ears of children with congenital cholesteatoma were poorly pneumatized compared with those of control children without middle ear diseases, but were better pneumatized compared with those of children with acquired cholesteatoma. In children with congenital cholesteatoma, the degree of pneumatization in the cholesteatoma side was significantly poorer than that in the opposite side. A well‐pneumatized mastoid was seen in ears with no episode of otitis media, in ears with the open‐type cholesteatoma, and in ears with ossicular anomalies. Conclusions: The presence of cholesteatoma matrix accelerates the inflammatory response when middle ear infections occur, and this probably leads to the suppression of mastoid pneumatization. The authors also propose the hypothesis that cholesteatoma in most congenital cases is the open type, and that middle ear inflammation may contribute to the formation of cystic and closed‐type cholesteatoma.
Increased risk of salivary gland tumors after low‐dose irradiation
Authors: Modan Baruch , Chetrit Angela , Alfandary Esther , Tamir Arnon , Lusky Ayala , Wolf Michael , Shpilberg Ofer
Published: November 2003

Objective: To assess the risk of neoplastic development among persons exposed to scalp irradiation. Study Design: Historical cohort study initially; prospective follow‐up subsequently. Method: Two control groups—population and siblings—matched for age, sex, ethnic origin, and year of immigration. Follow‐up from time of irradiation (1950s) until the end of 1991. Linkage with nationwide cancer registry. Results: A 4.5–fold incidence of cancer (P < .01) and a 2.6–fold increase of benign tumors were noted. The mean length of latency period until tumor development was 11 years for malignant tumors and 21.5 years for benign. A clear dose response effect for both cancer and benign tumors was demonstrated. Conclusions: The study confirms the role of radiation in salivary gland carcinogenesis. It indicates a need for better awareness, a comprehensive examination, and long‐term follow‐up of patients who have been subjected to head and neck radiation.
Soft‐palate reconstruction with a “SCARF” superior‐constrictor advancement‐rotation flap
Authors: Zeitels Steven M. , Kim Jennifer
Published: November 2003

Reconstruction of hemi‐soft‐palate defects after tumor resection is usually done by means of a regional flap, free‐tissue transfer or a prosthesis. These options vary in complexity and have a number of shortcomings. A local myomucosal flap was designed that employs a superior‐constrictor advancement‐rotation flap (SCARF) to achieve circumferential closure of the velopharynx and to reestablish its valvular sphincteric function. Ten patients underwent a SCARF reconstruction of the velopharynx after 35% to 65% of the soft palate was resected. All patients reestablished normal velopharyngeal function without significant phonatory or deglutitive disability. Two patients did require a second‐stage reinforcement of the suture line after partial dehiscence. The SCARF reconstruction of the soft palate is simple, fast, and reliable and there is no significant donor site morbidity. Patients resume oral intake earlier than standard reconstructive approaches. The SCARF can be done transorally, which allows for primary resection and discontinuous neck dissection. These factors facilitate short hospitalization and effective use of resources.
Silent intratympanic membrane cholesteatoma
Authors: Jaisinghani Vikram J. , Paparella Michael M. , Schachern Patricia A.
Published: November 2003

Objective: To detect the presence of intratympanic membrane cholesteatoma in cases of chronic otitis media. Design: Two hundred forty‐three temporal bones from patients with chronic otitis media were studied for the presence of intratympanic membrane cholesteatoma. Methods: Specimens had been previously removed at autopsy, fixed in 10% buffered formalin, decalcified in trichloroacetic acid, dehydrated in a graded series of ethanol, and embedded in celloidin. Sections were cut at a thickness of 20 μm, stained with hematoxylin eosin, and examined using light microscopy. Results: Intratympanic membrane cholesteatomas were found in five of the 243 temporal bones with chronic otitis media. All temporal bones with intratympanic membrane cholesteatomas were from adult patients. Two patients had bilateral intratympanic cholesteatomas in symmetric quadrants of the tympanic membrane, and the remaining patients with unilateral intratympanic membrane cholesteatoma had been operated on previously for a cholesteatoma of the opposite ear. Other common findings included chronic granulation tissue in the middle ears and mastoids, ossicular pathologic conditions, and in four of the five ears, fluid in the middle ears and/or mastoids. Conclusion: When a white area is observed on the tympanic membrane of patients (especially those with “silent” chronic otitis media), differential diagnosis should include not only tympanosclerosis, but also intratympanic membrane cholesteatoma.
Plating techniques and plate orientation in repair of mandibular angle fractures: An in vitro study
Authors: Fedok Fred G. , Van Kooten David W. , Dejoseph Louis M. , Mcginn Johnathan D. , Sobota Bret , Levin Roger J. , Jacobs Christopher R.
Published: November 2003

A biomechanical model utilizing polystyrene mandibles was devised to evaluate the fixation efficacy of various plating techniques for repair of mandibular angle fractures. A simple angle fracture was created in the mandible models at a standardized location and was repaired using five different plating techniques. Each experimental group consisted of 15 mandibles, with fracture site, plate placement, load application, and fracture displacement measurement standardized to ensure consistency among experimental groups. Measurement of fracture distraction under load application generated a load deformation curve and corresponding slope for each technique. Comparison of load deformation slopes allowed assessment of fixation stability. When applied with a subapical, medially placed monocortical tension band, bicortical compression plating demonstrated the most stable fracture fixation. The data show that biplanar plate placement in both monocortical noncompression and bicortical compression techniques yields a stronger fixation than monoplanar placement.
Self‐expanding metal stents for the management of bronchial stenosis and bronchomalacia after lung transplantation
Authors: Bolot Guillaume , Poupart Marc , Pignat Jean‐Christian , Bertocchi Michele , Wiesendanger Thérèse , Thevenet François , Gamondes Jean‐Paul , Mornex Jean‐François
Published: November 2003

Background: Airway stenosis or malacia after lung transplantation, usually as a result of anastomotic ischemia, remains a major problem. Methods: The authors report their experience with the Gianturco expandable stent for the management of 23 bronchial stenoses in 18 patients following lung transplantation. Stent placement occurred an average of 5.6 months after transplantation. Results: Stents were well tolerated and produced immediate symptomatic and functional improvement. The mean follow‐up after implantation was 21 months (range, 4 to 48 mo). The authors removed five stents by endoscopy and replaced them, and removed one stent entirely. Laser resection was used to control granulomas or partial fibrosis stenosis that occurred in four stents (14.3%) after an average of 4 months. One stent broke but was still in place and effective 32 months later. One patient died of hemorrhage 4 months after stenting. Conclusion: Although it can still be improved, this expandable metal stent is suitable for the treatment of posttransplantation proximal bronchial stenosis.
Hyperbaric oxygen for the management of radionecrosis of bone and cartilage
Authors: London Scott D. , Park Stephen S. , Gampper Thomas J. , Hoard Martin A.
Published: November 2003

Objectives: To review the use of hyperbaric oxygen in the management of radionecrosis of the head and neck. Study Design: A retrospective analysis of patients utilizing chart review and telephone interviews. All patients diagnosed with osteoradionecrosis and chondroradionecrosis of the head and neck and treated with hyperbaric oxygen at the University of Virginia are included. Methods: Demographics, pretreatment data, and precipitating events were recorded. Outcomes were evaluated using a grading scale of symptomatology and physical examination as determined by the patient and physician. Results: Sixteen patients with osteoradionecrosis and five with chondroradionecrosis were reviewed. All patients showed clinical improvement with decreased pain following HBO therapy. None of the patients with chondroradionecrosis required laryngectomies, and two of the four who were tracheotomy dependent were successfully decannulated. The patient and physician grading scores demonstrated moderate to significant improvement in both groups following therapy. Conclusion: The successful use of hyperbaric oxygen for the management of radionecrosis of the head and neck is supported. The unusual prevalence of chondroradionecrosis may be an early reflection of changes in treatment protocols for patients with head and neck cancer. Key Words: Hyperbaric oxygen, osteoradionecrosis, chondroradionecrosis.
Embryonic middle ear mesenchyme disappears by redistribution
Authors: Piza Jorge , Northrop Clarinda , Eavey Roland D.
Published: November 2003

Objective: The fate of embryonic middle ear mesenchyme from a postgestational infant ear has been speculative. Recently a volume analysis of human neonatal temporal bones demonstrated that embryonic mesenchyme disappeared by redistribution and thinning to surface a growing middle ear space.1 If this model is accurate, interaction with amniotic fluid and the gestational environment should not influence mesenchymal behavior. Therefore an opossum marsupial model was compared with human data. Methods: The temporal bones of opossum pups (20 to 36 days of age) were sectioned for histologic analysis. Computations were made for the volume of the middle ear air cavity (VAC), volume of the bone cavity (VBC), volume of mesenchyme (VM), and percentage of the middle ear occupied by mesenchyme (%M), which were plotted against height using regression statistics. These data were compared with human neonatal (0 to 30 days of age) temporal bones. Results: In both the opossum and the human the VAC and the VBC increased in parallel with growth of the body. In the opossum the VAC and VBC both grew at 0.148 mm3/mm of body length. In humans, both the VAC and VBC grew 6.1 mm3/cm of body length. The VM in the opossum remained constant at 0.98 mm3, regardless of body length. In humans the VM remained constant at 71.7 mm3, regardless of body length. Therefore the %M proportionately decreased inversely with increasing ear size in both the opossum and the human neonate. Conclusion: This study supports a simple and credible explanation for the illusion of mesenchymal disappearance in the neonatal middle ear. The mesenchymal connective tissue redistributes to cover a larger surface area in a persistently enlarging cavity. These findings occur in different species, whether gestation is completed in an intrauterine or an extrauterine environment.
Systemic neutrophil intrinsic 5‐lipoxygenase activity and CD 18 receptor expression linked to reperfusion injury
Authors: Dolan Robert , Hartshorn Kevan , Andry Chris , McAvoy Daniel
Published: November 2003

Objective: To determine if systemic neutrophil intrinsic 5‐lipoxygenase (5‐LO) inhibition correlates with decreased expression of surface adhesion molecules and attenuation of ischemia‐reperfusion (i/r) injury in guinea pig island skin flaps. Methods: Eighty‐one adult female Hartley guinea pigs were divided into one control group, three 2‐hour ischemia groups, and four 10‐hour ischemia groups. Island dorsal skin flaps were developed (except in the control group), and 2 hours before reperfusion, zileutin (a 5‐LO inhibitor) or vehicle was administered orally. Postreperfusion systemic neutrophil receptor expression, neutrophil flap infiltration, and flap survival were measured. Neutrophils from whole blood were analyzed for CD 18 containing surface receptor expression using monoclonal antibodies and cell associated fluorescence. Neutrophil infiltration into a distal centimeter squared of flap tissue was assessed using myeloperoxidase antibodies, and flap survival was determined within 7 days postoperatively. Results: Flaps in the treated 2− and 10‐hour ischemic groups survived totally intact, while the untreated 10‐hour ischemic flaps underwent total necrosis. A significant main effect of the drug was detected using analysis of variance (ANOVA) (P =.0001). Surface receptor detection and neutrophil infiltration were significantly increased in the untreated animals. Conclusions: Zileuton, a 5‐LO inhibitor, reduces adhesion receptor expression on systemic neutrophils and attenuates i/r injury. Systemic neutrophil intrinsic 5‐LO activity and CD18 receptor expression are linked to reperfusion injury and may be fundamental events in its pathogenesis.
Scar recollagenation
Authors: Burres Steven A.
Published: November 2003

Objectives: This study was designed to show that native collagen could be regenerated in an area of prior tissue loss. Study Design: Prospective. Methods: Preserved, irradiated human cadaver fascia lata was inserted intradermally to restore topographic skin irregularities. Graft insertion was performed through a skin perforation created by a sterile, hypodermic 20‐gauge needle hole into an intradermal pocket. Eighteen subjects with posttraumatic depressions were treated over a 13‐month period and examined periodically afterward. Biopsies of selected sites were taken. Results: Of the 44 defects treated in the study group, 14 were judged to be excellent or resolved, 23 were improved, and seven were unchanged at 24 weeks' follow‐up. Biopsies showed graft preservation and fibroblast invasion at 12 weeks. Discussion: Recollagenation is the application of a stimulator material into an area of prior collagen destruction to induce collagen production. Commonly, banked human cadaver fascia has been used to enhance the tissue volume in depressed acne scars, but this process has been successfully performed on a variety of postinflammatory and posttraumatic lesions. The process of fascia graft assimilation into human skin is demonstrated histologically. Conclusion: Recollagenation is an effective process for elevation of depressed, posttraumatic scars. Key Words: collagen, graft, scar, fascia, skin.
Diagnosis, management, and follow‐up of congenital head and neck teratomas
Authors: April Max M. , Ward Robert F. , Garelick Jordan M.
Published: November 2003

Objective: To describe our clinical experience with congenital teratomas of the head and neck. Study Design: A retrospective review of the six patients as well as a review of the literature in the setting of academic referral centers. Methods: In six infants with teratomas, four in the cervical region and two arising from the nasopharynx, surgical excision of all tumors was performed. Outcome measures were clinical and radiographic follow‐up and the use of α‐fetoprotein (AFP) for postoperative monitoring. Results: There was no recurrence of teratomas. Conclusions: Surgical excision is the treatment for congenital teratomas. Postoperative monitoring for recurrences should include AFP levels in difficult cases.
Transtympanic gentamicin for meniere's syndrome
Authors: Harner Stephen G. , Kasperbauer Jan L. , Facer George W. , Beatty Charles W.
Published: November 2003

Objectives: Study the impact of transtympanic gentamicin on patients with unilateral Meniere's syndrome. Partial chemical labyrinthectomy is a relatively recent concept for the treatment of Meniere's syndrome. It uses the ototoxic effect of gentamicin to reduce the symptom of vertigo and maintain cochlear function. Study Design: A prospective study using transtympanic gentamicin was begun in January 1994. Patients selected had failed medical therapy, but were not incapacitated. Patients had preinjection audiometric and electronystagmography data. Most had an imaging study. All had one injection, about half had more than one. Patients were seen 1 month after therapy and repeat studies were obtained. Repeat injection was performed if indicated. Follow‐up from the chart or by telephone was obtained. Data were tabulated using the 1995 American Academy of Otologaryngology—Head and Neck Surgery guidelines. Results: Through December 1996 43 patients with unilateral Meniere's syndrome were treated. The pretherapy function level was 3 through 5. After therapy the function level was 1 or 2. There was almost no change in cochlear function and no patient became deaf. Many patients had mild ataxia or dysequilibrium during the first 2 weeks following therapy. Most patients showed some decrease in labyrinthine function measured on electronystagmography. No attempt was made to ablate labyrinthine function. Seventeen of 18 patients had a vertigo index in the class A or B category after 2 years. Conclusions: Transtympanic gentamicin has become the treatment of choice for patients who fail medical therapy for Meniere's syndrome at the authors' institution. Laryngoscope, 108:1446–1449, 1998
Minimal‐access parathyroid surgery using intraoperative parathyroid hormone assay
Authors: Sofferman Robert A. , Standage Jeanette , Tang Mary E.
Published: November 2003

Objectives: Review the most current preoperative localization imaging techniques in patients with primary hyperparathyroidism and demonstrate their applicability to targeted tumor removal with intraoperative parathyroid hormone (PTH) monitoring. Study Design: Retrospective review of 40 consecutive patients undergoing parathyroid surgery with intraoperative PTH assay as the principal determinant of correction of the hyperparathyroid state. Details of the technology, cost analysis, and comparison with other management methods are discussed. Methods: The standard intact PTH chemiluminescent assay (Nichols Diagnostics) and modifications to allow accelerated intraoperative results are discussed in detail. The time intervals between completion of parathyroid excision and postremoval assay and subsequent laboratory investigation present a practical therapeutic algorithm. Results: Forty consecutive patients with hyperparathyroidism were treated surgically with intraoperative PTH as the determinant of satisfactory resolution of the disease state. In most instances, the surgical field was reduced to the targeted pathology identified by preoperative localization, and all patients became eucalcemic when this method was employed. Approximately half of eligible patients were treated under local anesthesia. Conclusions: Intraoperative PTH assay has added a new dimension to primary and revision parathyroid surgery. It is cost‐effective and accurate and may reduce the morbidity of surgical intervention in revision procedures. Laryngoscope, 108:1497–1503, 1998
Classification of otitis media
Authors: Harkness Paul , Topham John
Published: November 2003

Objectives: To review the International Classification of Diseases (ICD) system of classifying otitis media. To highlight the failings of this system and to propose an alternative (Read version 3). Study Design: An historical review of the literature and a presentation of two distinct classification schemes. Methods: The advantages and disadvantages of the alternative schemes are analyzed and an algorithm for the classification of otitis media is presented that describes the decisions taken to reach a diagnosis. Results: The proposed classification of otitis media as used in the Read Codes thesaurus is more logical than the ICD classification. Conclusions: The widely used ICD schema of otitis media fails to provide the otologist or general medical practitioner with a logically organized set of terms to describe inflammatory middle ear disease. This article proposes a simple, hierarchical classification that can be used by specialists, generalists and epidemiologists alike. Laryngoscope, 108:1539–1543, 1998
Suppurative intracranial complications of sinusitis
Authors: Gallagher Richard M. , Gross Charles W. , Phillips C. Douglas
Published: November 2003

Objectives: To familiarize the contemporary surgeon with the pathogenesis, diagnosis, and appropriate management of suppurative intracranial complications of sinusitis. Study Design: Retrospective chart review. Methods: All patients admitted to the University of Virginia Health Sciences Center with a diagnosis of intracranial suppuration between 1992 and 1997 were reviewed. Results: One hundred seventy‐six cases were identified, of which 15 patients had 22 suppurative intracranial complications of sinusitis. These were epidural abscess (23%), subdural empyema (18%), meningitis (18%), cerebral abscess (14%), superior sagittal sinus thrombosis (9%), cavernous sinus thrombosis (9%), and osteomyelitis (9%). Conclusions: The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series. Laryngoscope, 108:1635–1642, 1998
Selective role of partial XI‐VII anastomosis in facial reanimation
Authors: Griebie Matthew S. , Huff John S.
Published: November 2003

Objectives: Review techniques available for transposition of an alternative motor neuron if end‐to‐end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory‐facial nerve anastomosis and highlight cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension‐free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage. Study Design: Report of three cases and a review of the literature. Methods: Charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak. Results: The results varied between Class III and Class IV on the House‐Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted. Conclusions: The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face. Laryngoscope 108:1664–1668, 1998
Argon laser in difficult stapedotomy cases
Authors: Nissen Rick L.
Published: November 2003

Objective: The success and safety of argon lasers in stapedotomy surgery is now well documented. This study reviews results in problematic situations in which the argon laser may be of particular advantage to successful completion of the stapedotomy procedure. Study Design: Retrospective chart review. Methods: A retrospective review of the author's most recent 200 stapedotomy cases was performed, identifying 32 patients who at surgery were either found to have a prolapsed dehiscent facial nerve (three cases), developed a floating footplate (eight cases), or were undergoing a revision stapedotomy (21 cases). Four‐frequency, pure‐tone average air and bone conduction thresholds were computed before and after surgery. Success was defined as closure of the air‐bone gap to within 10 dB, while an air‐bone gap within 20 dB was considered improvement. Results: Successful closure of the air‐bone gap was achieved in all eight patients with a mobilized footplate, in all three patients with a prolapsed dehiscent facial nerve, and in 43% of the patients undergoing a revision stapedotomy. The rate of improved air‐bone gap in the revision cases was 62%. In one revision stapedotomy patient a decrease in speech discrimination occurred. Otherwise, there were no cases of sensorineural hearing loss. Neither intraoperative nor postoperative dizziness was reported by any patient, and all were discharged on an outpatient basis. Conclusion: The argon laser was found to be safe, effective, and a valuable adjunct for the difficult stapedotomy cases when unexpected obstacles such as a prolapsed dehiscent facial nerve or a mobilized footplate are encountered, as well as for the planned, more difficult revision cases. Laryngoscope, 108:1669‐1673, 1998
Partial ossicular reconstruction in children: A review of 62 operations
Authors: Daniels Robert L. , Rizer Franklin M. , Schuring Arnold G. , Lippy William L.
Published: November 2003

Objective/Hypothesis: The published experience and audiometric results with ossicular reconstruction in children are limited. To better understand the role of ossiculoplasty in children, audiometric results were examined for partial ossicular reconstructions performed on a pediatric population. Study Design: Retrospective. Methods: Sixty‐two partial ossicular reconstructions performed on a pediatric population were reviewed for audiometric results, prosthesis extrusion rates, and mechanisms of failure at revision. Comparison of techniques and prosthesis types: porous polyethylene partial ossicular replacement prosthesis (POP), Schuring ossicle cup (SOC), and modified Robinson prosthesis (MRP) were also evaluated. Follow‐up ranged from 6 to 72 months. Results: Six‐month hearing results showed postoperative air‐bone gaps less than or equal to 20 dB in 77% of cases. Successful results at 1 and 2 years were retained in 66% and 63% of cases, respectively. Results for POPs at 1 and 2 years were 78% and 89%. Results for SOCs at 1 and 2 years were 61% and 55%. The overall extrusion rate was approximately 3%. Conclusions: These results compare favorably with those from other, mostly adult, studies. Comparison of prosthesis types revealed generally stable long‐term results with few significant differences. Success with ossiculoplasty in children can be obtained by applying the same principles and approach to ossicular reconstruction as used in adults. Ossicular reconstruction in children remains a secondary goal after establishing a safe, dry, and stable ear. A discussion of techniques and comparative literature review are presented. Laryngoscope, 108:1674–1681, 1998
Hearing results of intratympanic steroid treatment of endolymphatic hydrops
Authors: Arriaga Moisés A. , Goldman Steve
Published: November 2003

Objectives/Hypothesis: This study evaluated the effectiveness of a single application of steroids to the open middle ear in improving short‐term hearing in patients with Meniere's disease and cochlear hydrops. Study Design: Retrospective study in which each patient's pretreatment hearing served as the control compared with posttreatment hearing. Methods: Patients were treated with a single application of dexamethasone, 8 mg, in hyaluronan. Following tympanotomy and lysis of round window adhesions, steroids were placed in the round window niche with absorbable gelatin sponge and the remainder of the middle ear was then filled with the steroid solution. Systemic steroids were not administered. Audiograms were performed within 1 month before surgery and at least 1 month after surgery. Results: Between September 1996 and July 1997, 21 ears in 19 patients underwent intratympanic steroid treatment. The criterion for hearing change was a 10‐dB or greater change in pure‐tone average (PTA), or a 15% change in speech discrimination score (SDS). Of the 15 ears meeting inclusion criteria for this study, five (33%) demonstrated hearing improvement and three (20%) demonstrated hearing deterioration. Maximum improvement was a 38‐dB improvement in PTA and a 32% improvement in SDS. Conclusion: A single application of intratympanic dexamethasone/hyaluronan solution directly to the round window did not produce dramatic short‐term hearing improvement in patients with endolymphatic hydrops. Although the theoretical basis for intratympanic steroid treatment of endolymphatic hydrops is appealing, we urge close evaluation of the results of specific protocols of intratympanic steroid administration before widespread utilization of this treatment. The choice of steroid, route of administration, frequency of application, and need for simultaneous systemic administration require standardization to adequately assess the efficacy of this treatment. Laryngoscope, 108:1682–1685, 1998
Submandibular and lacrimal gland immunoglobulin in the C3H.MRL‐Faslpr autoimmune mouse model of sjögren's syndrome
Authors: Trune Dennis R. , Leedy Daniel A.
Published: November 2003

Objective: To distinguish potential autoimmune and nonautoimmune mechanisms underlying the salivary gland inflammation seen in Sjögren's syndrome and normal aging. Study Design: Immunohistochemical studies were conducted on the lacrimal and salivary glands of 2‐ and 5‐month‐old C3H.MRL‐Faslpr autoimmune strain mice and age‐matched C3H/HeJ nonautoimmune controls. Methods: Glandular inflammatory foci, interstitial areas, and vasculature were stained for immunoglobulin G (IgG), immunoglobulin A (IgA), and complement to determine differences in their local immune parameter. Differences between the two strains were compared for immune changes attributable to autoimmune disease and between the two normal groups for normal aging changes. Results: Greater staining of IgG, IgA, and complement occurred in the inflammatory foci and interstitial areas of 5‐month‐old C3H.MRL‐Faslpr lacrimal and submandibular glands compared with 5‐month‐old controls. Normal mice showed some increased immunoglobulin staining with aging, but little or no complement in any glands. Conclusions: These differential findings suggest that the systemic autoimmune disease plays a more direct role in focal glandular inflammation in Sjögren's syndrome, whereas less severe immune mechanisms are involved in the inflammation of normal glands. Laryngoscope, 108:1729–1732, 1998