bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of Spread in Recurrent Head and Neck Squamous Cell Carcinoma
Authors: Vaidya Atul M. , Petruzzelli Guy J. , Clark Joseph , Emami Bahman
Published: February 2003

OBJECTIVE

To examine the pattern of spread regarding recurrent disease in primary head and neck squamous cell carcinoma.

STUDY DESIGN AND SETTING

A retrospective study reviewed 128 patients who underwent primary tumor resection and postoperative radiation and/or chemoradiation for squamous cell carcinoma at Loyola University Medical Center from July 1993 to August 1998. Patterns of spread of recurrent disease were grouped according to site of recurrence and compared with the histopathology.

RESULTS

Of 128 patients, 40 (32%) had recurrent disease, 22 (17%) died without disease, and 66 (51%) are disease free. Although the recurrences in patients who were N0 were primarily local‐regional (8/11), the majority of recurrences in patients that were N+ with extracapsular nodal spread involved distant sites (18/24); 17/18 involved metastasis to the lung.

SIGNIFICANCE

This study gives the first report at our institution of patterns of spread in recurrent head and neck squamous cell cancer and compares these patterns within subgroups of patients based on the extent of neck disease at the time of primary surgical resection.

CONCLUSION

Not only was there a higher rate of recurrent disease in patients with extracapsular nodal spread, there was a much higher involvement of distant metastatic sites as opposed to local‐regional recurrence more often seen with the N0 neck. The most common site of distant metastasis was the lung.
Experimental Co2 Laser Myringotomy
Authors: Valtonen Hannu J. , Poe Dennis S. , Shapshay Stanley M.
Published: February 2003

OBJECTIVE

The purpose of this study was to compare closure rates of CO2 laser myringotomies with those produced conventionally with a knife.

STUDY DESIGN AND SETTING

We investigated closure rates in 3 experimental groups of chinchillas: (1) semicircular myringotomy in both ears either produced with a knife or CO2 laser; (2) CO2 laser myringotomy, round in one ear and kidney shaped in the other; (3) CO2 laser myringotomy, incisional in one ear and kidney shaped in the other.

RESULTS

Patency of knife myringotomies was shorter (P < 0.01) than of similar laser myringotomies, means 10.0 and 21.8 days, respectively. The patency of kidney‐shaped laser myringotomies was longer (P < 0.05) than of round ones. Incisional laser myringotomies remained open longer (P < 0.01) than round ones.

CONCLUSION

Use of CO2 laser as well as certain geometries delay the closure of myringotomies. By allowing perforations of different shapes and sizes, CO2 laser myringotomy may become an alternative in the treatment of otitis media.
Nasopharyngeal Lith
Authors: Chen Shun‐Chang , Hao Sheng‐Po , Tsang Ngan‐Ming , Lee Kam‐Fai
Published: February 2003

Nasopharyngeal carcinoma (NPC) is a common cancer in Chinese people. The mainstay treatment of NPC is radiotherapy. Brachytherapy is applied in some patients with NPC to improve local control rate; however, it may also leave the patients with complications such as skull base osteoradionecrosis (ORN).1 The classic symptoms of skull base ORN are crust formation, foul odor, necrotic or exposed bone, and purulent nasal discharge.2 A nasopharyngeal lith is a calcified mass within the nasopharyngeal cavity, forming as a result of long‐term encrustation of desquamated epithelium, clotted blood, and sequestra. The symptomatology of nasopharyngeal lithiasis may mimic that of skull base ORN. Fiberoptic nasopharyngoscopy or MRI study may help in differentiating these two conditions. Herein we report a rare case of nasopharyngeal lith. Nasopharyngeal lith is postulated to result from the sequestrum of the floor of the sphenoid sinus after radiotherapy for NPC.
Publication Rate of Abstracts Presented at the Annual Meeting of the American Academy of Otolaryngology‐Head and Neck Surgery
Authors: Larian Babak , Namazie Ali , Agha Neema , Azizzadeh Babak , Blackwell Keith , Wang Marilene B.
Published: February 2003

BACKGROUND

Research projects are frequently presented at national meetings not only to make the data available, but also to further critically evaluate the project. The ultimate goal remains publication of the research. We assessed the publication rate of presentations at 1993‐95 annual meetings.

METHODS

All presentations at the scientific sessions were searched in the computerized database Melvyl MEDLINE and PubMed. The papers were categorized in 6 broad groups.

RESULTS

The overall proportion of presentations that were published was 32%. Clinical papers in pediatrics had the highest publication rate, followed by basic science research in laryngology and plastics.

CONCLUSION

The publication rate of 32% is lower than the rate at meetings in other fields, reflecting variability in selection criteria for the presentations and quality of abstracts presented. Basic science presentations did not have a greater publication rate as compared to clinical presentations.
Office‐Based Esophagoscopy: A Preliminary Report
Authors: Aviv Jonathan E. , Takoudes Thomas G. , Ma Guoguang , Close Lanny G.
Published: February 2003

OBJECTIVE

Preliminary study that describes unsedated, transnasal esophagoscopy (TNE) in an office setting.

STUDY DESIGN AND SETTING

TNE was prospectively performed on 14 consecutive out‐patients with dysphagia whose initial oropharyngeal dysphagia evaluation was insufficient to reveal the cause of their swallowing problem. TNE was carried out without conscious sedation while the patients were sitting in an examining chair. Ease of endoscope insertion, optical quality of images, and examination findings were assessed. Heart rate before and after the procedure and incidence of epistaxis and airway compromise was also determined. Patients were asked to rate the level of discomfort of TNE on a validated 10‐point scale (1 representing none/well tolerated and 10 severe/poorly tolerated).

RESULTS

All patients completed TNE with the esophagus readily intubated and esophageal mucosa clearly visualized. Findings included esophageal stricture, patulous upper esophageal sphincter, and Zenker's diverticulum. There were no incidences of epistaxis or airway compromise and no significant changes in heart rate. Overall tolerance of TNE was rated by the patients as 2.0 (SD, 1.2).

CONCLUSIONS

TNE is well tolerated and can be safely performed in patients with dysphagia in an office setting. TNE may have a role in the comprehensive evaluation of the dysphagic patient in the office.
Pharyngoesophageal Pressure Monitoring in Sleep Apnea Syndrome
Authors: Reda Mohamed , Gibson G. John , Wilson Janet Ann
Published: February 2003

OBJECTIVES

This study tests the sensitivity and the specificity of overnight pharyngoesophageal pressure measurement for identification and classification of obstructive sleep apnea (OSA).

METHODS

Fifty‐nine snoring patients undergoing polysomnography were invited to have simultaneous pharyngo‐esophageal manometry. We used a soft silicone catheter with 4 microtip pressure sensors at different levels.

RESULTS

The apnea hypopnea indexes (AHIs) measured by the 2 methods were highly correlated (r = 0.971). Manometry was 100% sensitive and specific in excluding OSA and identifying severe OSA. It was 90% sensitive in identifying moderate OSA and 80% sensitive in identifying mild OSA.

Conclusion: Overnight ambulatory pharyngo‐esophageal manometry is a reliable tool for the exclusion of OSA and identification of severe OSA. It has additional advantages of localizing the level of obstruction and identifying the upper airway resistance syndrome and can be performed at home. It is cost‐effective when compared with polysomnography and may aid in treatment selection for individual patients.
Clinical Validation of the Bedbugg™ in Detection of Obstructive Sleep Apnea
Authors: Claman David , Murr Andrew , Trotter Kimberly
Published: February 2003

OBJECTIVE

To validate the accuracy of the Bedbugg™, a new home monitoring device for diagnosis of obstructive sleep apnea.

STUDY DESIGN AND SETTING

Simultaneous sleep monitoring was performed by formal polysomnography and by Bedbugg. Monitoring was performed in a university sleep center in 42 subjects who had previously been scheduled for polysomnography.

RESULTS

The correlation for the apnea‐hypopnea index (AHI) between polysomnography and Bedbugg was r = 0.96. The sensitivity of Bedbugg for detecting an AHI > 15 was 85.7%. The specificity of Bedbugg for detecting an AHI < 15 was 95.2%.

CONCLUSION

The Bedbugg device provides an accurate assessment of the apnea‐hypopnea index.

SIGNIFICANCE

Accurate home monitoring for sleep apnea may provide access to care for a higher proportion of undiagnosed sleep apnea patients.
Globe Sparing Orbital Exenteration
Authors: Catalano Peter J. , Laidlaw Douglas , Sen Chandranath
Published: February 2003

OBJECTIVE

Orbital exenteration has long been the oncologic standard for malignant craniofacial lesions that invade the periorbita/orbit from adjacent locations. Although oncologically sound, this radical surgical procedure is cosmetically disfiguring for all patients. Most of the reconstructive options available are complex, requiring further surgery and/or expense. We herein introduce an alternative surgical technique for radical orbital surgery that spares the globe, thereby allowing an early, aesthetic appearance at a nominal cost.

STUDY DESIGN AND SETTING

Twenty consecutive patients requiring an oncologic orbital exenteration and meeting the indications for the new procedure underwent surgery at a tertiary care medical center. Follow‐up ranged from 1 to 6 years.

RESULTS

Only 1 patient recurred in the orbit due to an error in patient selection. There was no surgical morbidity resulting from the globe‐sparing technique itself.

CONCLUSION

Globe‐sparing orbital exenteration is a one‐step, oncologically sound, aesthetically superior, low‐cost alternative for those patients requiring radical orbital surgery and reconstruction.
Internal Carotid Artery Hemorrhage after Irradiation and Osteoradionecrosis of the Skull Base
Authors: Kwong Lam Henry Chuen , Abdullah Victor James , Wormald Peter John , Van Hasselt Charles Andrew
Published: February 2003

OBJECTIVE

To evaluate the clinical presentation and management of internal carotid artery rupture after irradiation and osteoradionecrosis of the skull base.

STUDY DESIGN AND SETTING

A retrospective review of the patients in an otorhinolaryngology‐head and neck secondary and tertiary referral center.

METHODOLOGY

From January 1993 to December 1996, patients with hemorrhage from internal carotid artery as a complication of irradiation and osteoradionecrosis of skull base were reviewed and analyzed.

RESULTS

Four patients with internal carotid arterial rupture were included in this study. Angiography was performed in all cases. Embolization of the aneurysm was performed on 2 patients and the remaining 2 patients underwent occlusion of their internal carotid arteries. Three of the 4 patients did not survive. The fourth is currently alive and well 18 months after embolization of 1 internal carotid artery.

CONCLUSION

Skull base osteoradionecrosis with bleeding from internal carotid artery is a potentially fatal complication of irradiation. Angiography was the mainstay of diagnosis with embolization of the aneurysm and embolization or ligation of the internal carotid artery being the management options. Internal carotid artery occlusion is the definitive treatment provided cross circulation is adequate.

SIGNIFICANCE

The advantages and disadvantages of the treatment options are discussed and a management protocol is proposed.
Experimental Trauma to the Malar Eminence: Fracture Biomechanics and Injury Patterns
Authors: Rhee John S. , Posey Lisa , Yoganadan Narayan , Pintar Frank
Published: February 2003

OBJECTIVES

To document patterns of facial fractures after trauma to the malar eminence and to elucidate biomechanical factors relevant to the injury patterns.

STUDY DESIGN AND SETTING

Studies were conducted on 14 cadaver heads. Study variables included impact velocity, contact area, impact force, and zygomatic skin thickness. Bony fractures and clinical injury patterns were documented. A fracture severity rating scale was devised and statistically correlated to the study variables using regression ANOVA analysis.

RESULTS

A broad spectrum of facial fracture patterns was found. Skin thickness and surface area did not correlate with fracture severity (P = 0.67, P = 0.83, respectively). Impact force demonstrated a trend toward significance (P = 0.14). Velocity was most correlative with fracture severity (P = 0.07). A critical threshold velocity (3.5 m/s) was found to correlate with the most severe fracture patterns.

CONCLUSIONS

A broad spectrum of facial fracture patterns was demonstrated after experimental trauma to the malar eminence. Contact surface area and zygomatic skin thickness were not found to be significant factors in fracture severity. Velocity, rather than impact force, was most correlative with fracture severity. The most severe fracture patterns were elicited by velocities above 3.5 m/s.
Exploring Health‐Related Quality of Life in Patients with Diseases of the Ear, Nose, and Throat: A Multicenter Observational Study
Authors: Witsell David L. , Dolor Rowena J. , Bolte Jean M. , Stinnett Sandra S.
Published: February 2003

OBJECTIVES

This study was undertaken to explore which diseases of the ear, nose, and throat impact daily functioning of patients in an outpatient setting and to observe how specific demographic variables affect health‐related quality of life (HRQOL) in these patients.

METHODS

This multicenter observational study was conducted anonymously during a 6‐week period at outpatient clinics in adults ≥ 18 years of age. The Short Form‐12 (SF‐12) was used to assess HRQOL. Demographic and clinical variables were recorded for each patient.

RESULTS

In data from 5806 patients, the SF‐12 physical component score was 43.8, and the mental component score was 49.4. SF‐12 physical and emotional functioning scores for ENT patients were poorer than established standards (50 ± 10) for the U.S. population (P < 0.001).

CONCLUSIONS

ENT diseases adversely affect the HRQOL in patients visiting their otolaryngologist. Clinical and demographic variables are important considerations in the measurement of HRQOL.
A Multi‐Institutional Study of Radiofrequency Volumetric Tissue Reduction for OSAS
Authors: Woodson B. Tucker , Nelson Lionel , Mickelson Samuel , Huntley Tod , Sher Aaron
Published: February 2003

OBJECTIVES

Radiofrequency volume reduction (RFTVR) is a minor procedure directed at reducing the tongue base volume to treat obstructive sleep apnea. Subjective and objective treatment effectiveness was evaluated.

STUDY DESIGN AND SETTING

Two separate prospective, matched, nonrandomized, open enrollment treatment groups (RFTVR, n = 73 and nasal continuous positive airway pressure (CPAP, n = 99) were concurrently enrolled in a multicenter study.

RESULTS

Fifty‐six (76.7%) RFTVR completed PSG with a mean 5.4 ± 1.8 treatments (13,394 ± 5459 joules). Perioperatively, acute pain was mild to moderate; edema, mucosal erosion, paresthesia, tinnitus were infrequent; and speech, swallowing taste, or throat irritation were unchanged. Self‐reported outcomes did not differ between RFTVR and CPAP groups. Mean apnea/hypopnea index decreased (40.5 ± 21.5 to 32.8 ± 22.6 events/hr, P < 0.01). Electrolyte solution injected predicted results (r = 0.43, P < 0.001). The most severe complication was abscess (1.1%).

CONCLUSION

RFTVR improves apnea/hypopnea index. Improvement may be related to solution injected with treatment. RFTVR and CPAP clinical outcomes improvement were similar.

CLINICAL SIGNIFICANCE

In mild obstructive sleep apnea, treatment of symptomatic outcomes with RFTVR may be an alternative to CPAP.
Temperature‐Controlled Radiofrequency Tissue Volume Reduction in the Human Soft Palate
Authors: Sher Aaron E. , Flexon Phillip B. , Hillman David , Emery Brian , Swieca John , Smith Timothy L. , Cartwright Rosalind , Dierks Eric , Nelson Lionel
Published: February 2003

OBJECTIVE

To validate the use of temperature‐controlled radiofrequency energy applied to the soft palate in a multicenter setting for reduction of snoring in a minimally morbid manner.

METHODS

Prospective, nonrandomized multicenter study of 113 patients who had a respiratory disturbance index less than 15 and minimum oxygen saturation not less than 85% and who were seeking treatment for habitual disruptive snoring. Patients were given either single or multiple lesions to the soft palate during each treatment session.

RESULTS

Patients received 1978 J on average with an overall average of 2.4 treatments. Snoring scores went from an average of 7.8 (visual analog scale [VAS], 0–10) pretreatment to 3.2 posttreatment. Pain was minimal, averaging 1.7 (VAS 0–10) on days 1 to 6. Complications were few and transient, and mild.

CONCLUSIONS

The multiple lesion protocol was the most successful; reducing snoring from 7.6 to 2.7, on a VAS with an average of 1232 J delivered over 1.6 treatments. Temperature‐controlled radiofrequency was found to be a minimally invasive, well‐tolerated procedure that was safe and efficacious in this study group.
Inhalant Allergy and Meniere's Disease: Use of Electrocochleography and Intranasal Allergen Challenge as Investigational Tools
Authors: Noell Courtney A. , Roland Peter S. , Mabry Richard L. , Shoup Angela G.
Published: February 2003

INTRODUCTION

In an earlier study, we demonstrated the feasibility of using electrocochleography (ECoG) to document changes in inner ear function objectively after intranasal challenge of patients with inhalant allergy (with no prior immunotherapy) and Meniere's disease, using the antigen to which they were most sensitive.

OBJECTIVE

We expand on this earlier study and continue to investigate the feasibility of this model in a subset of patients with inhalant allergy and Meniere's disease after immunotherapy.

STUDY DESIGN

Prospective study of 11 patients identified with both Meniere's disease and inhalant allergy in the practices of 2 neurotologists at our institution. Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen to which they were most sensitive. This was followed by a second ECoG.

RESULTS

Six of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11 had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2 patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG experienced vestibular symptoms after allergen challenge, whereas 2 of group 1 and 2 of group 2 had vestibular symptoms with abnormal ECoGs.

CONCLUSION

This protocol is a useful tool for investigating the relationship of inhalant allergy and Meniere's disease, but needs a larger group of patients and further study to draw valid statistical conclusions.
Cochlear implant/Deaf World dispute: Different bottom elephants
Authors: Gonsoulin Thomas P.
Published: February 2003

OBJECTIVE

To examine the controversy between the proponents of cochlear implantation in children and the Deaf World opponents with the hope of offering a method for decreasing the acrimony of opposing positions.

STUDY DESIGN AND SETTING (METHODS)

The opposing arguments will be presented from a review of pertinent literature. The systemic philosophic process of bottom elephant analysis will be elucidated. Contrasting models of power will be described.

RESULTS

The application of the bottom elephant analysis of each group's position plus a paradigm shift in the utilization of power offers possibilities for the implementation of mutually respectful dialogue that does not undermine each group's stature.

CONCLUSION AND SIGNIFICANCE

Philosophic analysis and paradigm shift could lead to improvement in the interaction of cochlear implant proponents and Deaf World opponents.
Aquatic Activities after Total Laryngectomy
Authors: Karamzadeh Amir M. , Armstrong William B.
Published: February 2003

OBJECTIVE

To assess the techniques used by patients who have undergone laryngectomies to enable them to participate in aquatic activities.

STUDY DESIGN

Unstructured interviews.

METHODS

The case histories of 4 patients who have returned to swimming and other aquatic activities after total laryngectomy were obtained by non‐structured interviews emphasizing techniques used to swim, safety precautions taken, any accidents or near accidents, and perceived effect of aquatic activities on sense of well being and quality of life.

RESULTS

All 4 of the interviewed subjects swim regularly using commercial breathing aids or manual tracheostomal occlusion. One of the four is a regular surfer, who uses a homemade breathing aid. All were active swimmers prior to the development of laryngeal cancer. A single aquatic‐related accident was reported by 1 of the 4 swimmers. All subjects describe feeling an enhanced quality of life resulting from their participation in aquatic activities.

CONCLUSION

Despite recommendations of most clinicians, a small number of highly motivated patients will return to aquatic activities after laryngectomy.
Implications of the AHRQ Evidence Report on Acute Otitis Media
Authors: Rosenfeld Richard M. , Casselbrant Margaretha L. , Hannley Maureen T.
Published: February 2003

OBJECTIVE

To familiarize otolaryngologists with the Agency for Healthcare Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) that reviews the natural history and role of antibiotics in management. The report, by the Southern California Evidence‐Based Practice Center (SC‐EPC), is the most recent of 15 literature syntheses published by the AHRQ.

DATA SOURCES

MEDLINE (1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other computerized databases; manual reference search of proceedings, articles, reports, and guidelines.

STUDY SELECTION

Randomized trials and cohort studies relevant to the natural history of AOM and the efficacy of antimicrobial therapy. AOM was defined by the 11‐member technical expert panel (including 2 authors, RMR and MLC) as middle‐ear effusion with the rapid onset of signs or symptoms of middle ear inflammation.

DATA EXTRACTION

Two physician reviewers at the Southern California Evidence‐Based Practice Center independently rated the articles and extracted data.

DATA SYNTHESIS

Children receiving placebo or no antimicrobial had a pooled clinical success rate of 81% at 1 to 7 days (95% CI, 72% to 90%), with no increase in suppurative complications when followed closely. Amoxicillin or ampicillin increased the absolute success rate by 12.3% (95% CI, 2.8% to 21.8%) in 5 studies pooled using random effects meta‐analysis. The antimicrobial benefit was robust to sensitivity analysis. In contrast, success rates were not influenced by the choice or duration of therapy.

CONCLUSIONS

The AHRQ report emphasizes middle‐ear effusion as a preeminent criteria for AOM diagnosis and provides extensive evidence tables on natural history and antimicrobial impact. About 8 children must receive antibiotics to avoid 1 clinical failure, but children younger than age 2 years or with severe symptoms may benefit more. The report is a starting point for organizations seeking to develop AOM guidelines, performance measures, and other quality improvement tools.
The Role of Helicobacter Pylori Infection in the Cause of Squamous Cell Carcinoma of the Larynx
Authors: Aygenc Erdinc , Selcuk Adin , Celikkanat Serdar , Ozbek Cem , Ozdem Cafer
Published: February 2003

OBJECTIVE

Helicobacter pylori can cause chronic infection that has been linked to the development of both benign and malignant disease of the aerodigestive tract. The purpose of this study was to determine the link between H pylori infection and squamous cell carcinoma of the larynx (SCCL). METHODS: We estimated the presence of IgG antibodies against H pylori antigens by using ELISA technique in the sera of 26 patients with SCCL and 32 matched controls without carcinoma of the larynx.

RESULTS

The incidence of seropositivity of patients with SCCL was 73.07% and of controls was 40.62%. These data support an etiologic role for H pylori infection on development of SCCL (χ2 = 4.85, P < 0.05).

CONCLUSION

H pylori infection of the upper aerodigestive tract might result in mucosal disruption, allowing for subsequent transformation by known carcinogens such as tobacco and alcohol.
A New Device for Frontal Sinus Endoscopy: First Clinical Report
Authors: Iro Heinrich , Zenk J.
Published: February 2003

OBJECTIVE

Endoscopically or microscopically controlled paranasal sinus surgery currently represents the state of the art. For anatomic reasons the ostium of the frontal sinus and the frontal sinus itself are difficult to observe. Flexible endoscopes are often difficult to implement and do not provide enough light intensity to visualize all parts of the frontal sinus.

MATERIALS AND METHODS

A specially curved rigid endoscope with a working channel of 1.5 mm that allows passage into the frontal sinus has been developed to manage this problem. The system was used on 15 patients during paranasal sinus surgery to evaluate possible indications and its clinical usefulness.

RESULTS

The endoscope could be introduced into the frontal sinus after an ethmoidectomy had been performed in all of the patients. The anatomy of the sinus could be visualized with sufficient light intensity in 14 patients. The shadowing of the frontal sinus seen in CT was not due to polyps of the mucosa of the frontal sinus in all cases, but rather due to secretion with otherwise normal mucosa. In the cases with polyps, it was necessary to irrigate with saline solution to prevent the buoyant polyps from collapsing over the endoscope. The following specific indications for this endoscopic version were established during this first test: intraoperative and postoperative control of the frontal sinus, clinical evaluation of tumor growth into the frontal sinus, biopsies within the frontal sinus, and evaluation of fractures.

CONCLUSION

The new device provides further insight within the field.
Refractory Chronic Sinusitis: Evaluation of Symptom Improvement after Denker's Procedure
Authors: Wreesmann Volkert B. , Fokkens Wytske J. , Knegt Paul P.
Published: February 2003

OBJECTIVES

Although there is ample literature describing various aspects of functional endoscopic sinus surgery (FESS) in relationship to its success rates, very little has been reported regarding possibilities in case of recurrent failure. We investigated subjective results of Denker's procedure used as a last resort for refractory chronic rhinosinusitis/polyposis.

STUDY DESIGN AND SETTING

A retrospective questionnaire‐based study of 82 patients who underwent Denker's procedure between 1986 and 1997 at the Erasmus University Medical Center, The Netherlands, was conducted.

RESULTS

Eighty‐four percent of patients reported reduction of overall symptomatology. A significant reduction of nasal obstruction, headache, feeling of fullness, post‐nasal drip, rhinorrhoea, facial pain, dental pain, and coughing was reported. In addition, symptoms of lower airway inflammation did improve significantly in asthmatic patients.

CONCLUSIONS

These data suggest that radical surgery using Denker's approach should be considered in selected cases after recurrent failure of functional sinus surgery.

SIGNIFICANCE

A prospective study is warranted to validate this approach for refractory chronic rhino‐sinusitis.
Ocular Motility Complications after Endoscopic Sinus Surgery with Powered Cutting Instruments
Authors: Bhatti M. Tariq , Giannoni Carla M. , Raynor Eileen , Monshizadeh Ramin , Levine Lawrence M.
Published: February 2003

OBJECTIVE

The purpose of this study was to describe 2 unique cases of ocular motility dysfunction after powered endoscopic sinus surgery and identify potential risk factors for extraocular muscle injury.

STUDY DESIGN

Interventional case series. RESULTS: Patient 1 developed a restrictive global ophthalmoplegia after inadvertent entry into the medial orbit during powered endoscopic sinus surgery. Patient 2 had complete loss of adduction of the left eye as a result of transection of the medial rectus muscle by a powered cutting instrument.

CONCLUSIONS

Despite advances in endoscopic sinus surgery technique and instrumentation, serious ophthalmic complications may still occur. Inadvertent entry into the medial orbital wall can result in ocular motility complications. Furthermore, it is possible that attraction of orbital contents into the tip of a powered cutting instrument may occur without significant entry into the orbital cavity.

SIGNIFICANCE

It is important for endoscopic sinus surgeons to be aware of the intimate anatomical relationship between the orbit and sinuses, as well as the potential risks of the current instruments used in endoscopic sinus surgery.
Use of Immunotherapy in Previously Treated Patients with Allergic Fungal Sinusitis
Authors: Bassichis Benjamin A. , Marple Bradley F. , Mabry Richard L. , Newcomer Mark T. , Schwade Nathan D.
Published: February 2003

OBJECTIVE

Sixty patients with a diagnosis of allergic fungal sinusitis were studied. The objective was to show whether, after initial surgical removal of allergic mucin and polyps, immunotherapy decreases re‐operation rates and office visits that require medical intervention.

STUDY DESIGN AND SETTING

Sixty patients with adequate follow‐up for at least 1 year were evaluated: 24 patients who did not receive immunotherapy and 36 patients whose treatment included postoperative immunotherapy.

RESULTS

The re‐operation rates were 33.0% in those not receiving immunotherapy versus 11.1% in the treated group. Furthermore, the total number of postoperative office visits that required medical therapy decreased from 4.79 per patient to 3.17 with the addition of immunotherapy.

CONCLUSION/SIGNIFICANCE

These results indicate that immunotherapy is a beneficial part of the overall treatment regimen for allergic fungal sinusitis.
Pathologic Analysis of Routine Tonsillectomy and Adenoidectomy Specimens
Authors: Strong E. Bradley , Rubinstein Brian , Senders Craig W.
Published: February 2003

OBJECTIVES

Recent literature has suggested that histopathologic analysis of routine tonsillectomy and adenoidectomy (T&A) specimens may be unnecessary. This study investigates T&A specimen handling practices in the United States between 1989 and 1999.

METHODS

Surveys were sent to 4715 members of the American Academy of Otolaryngology. Surveys assessed practice type, pathologic processing practices (full, gross, no pathology), and reasons for change. The authors also performed a retrospective analysis of 1583 pediatric T&A specimens for evidence of occult malignancy.

RESULTS

Practice types were 80% private, 12% academic, 6% salaried, and 2% military. Chi squared analysis revealed a significant increase (P < 0.001) in respondents ordering “gross only” and “no pathology.” The retrospective analysis found no occult malignancies.

CONCLUSIONS

There is a statistically significant increase in the number of otolaryngologists sending routine T&A specimens for “gross only” and “no pathology.” There was no correlation between the type of practice and changes in pathologic analysis performed.
Occult Mucosal Injuries with Radiofrequency Ablation of the Palate
Authors: Terris David J. , Chen Vince
Published: February 2003

OBJECTIVE

To determine the true incidence of mucosal injury after radiofrequency ablation of the palate (RFAP) for snoring and mild obstructive sleep apnea, and to evaluate the consequences of this injury.

STUDY DESIGN AND SETTING

A prospective, nonrandomized analysis of RFAP was undertaken at Stanford University Hospital. Endoscopic examinations of the nasal surface of the palate and of the posterior pharyngeal wall were performed to supplement the routine oral cavity examinations in the postoperative period. Visual analog scales of pain were completed by the patients. Twenty‐three patients underwent a total of 54 RFAP procedures using the Somnus system at the recommended level of energy (600 J in the midline palate, and 300 J to each lateral palate).

RESULTS

Fourteen of the 23 first stage procedures were associated with a total of 16 mucosal injuries representing an incidence of 60.9%. Mucosal injury at the 1st stage prompted a reduction in energy at the 2nd stage to 500 J in the midline and 250 J laterally; there were 4 injuries among 19 2nd stage procedures (21.1%). The overall incidence of mucosal injury, including stage 3 and 4 procedures, was therefore 42.6%; 37% of these were “occult” (only visualized endoscopically).

CONCLUSIONS AND SIGNIFICANCE

RFAP, although intended to be mucosa‐sparing, is nevertheless associated with a high incidence of mucosal injuries, many of which are occult. The occurrence of these mucosal ulcers is usually associated with only a trivial degree of increased pain postoperatively.
Prevalence of Hypersensitivity to Specific Fungal Allergens as Determined by Intradermal Dilutional Testing
Authors: Stroud Robert H. , Calhoun Karen H. , Wright Steven T. , Kennedy Kyle L.
Published: February 2003

OBJECTIVE

To determine fungal allergen reactivity prevalence by intradermal dilutional testing in patients with and without chronic rhinitis or rhinosinusitis symptoms.

STUDY DESIGN

Prospective comparison of fungal allergen reactivity prevalence in symptomatic and asymptomatic patients.

SETTING

University medical center.

METHODS

Group I (chronic rhinitis and/or rhinosinusitis symptoms) and Group II (asymptomatic) patients underwent intradermal dilutional testing with usual and fungal allergens.

RESULTS

Fungal reactivity occurred in 65% (13/20) of Group I, and 13% (4/30) of Group II (P < 0.0002 by χ 2 testing). Group I was more reactive to non‐fungal allergens (85% vs. 33%, p < 0.0004), and to all allergens considered together (95% vs. 40%, p < 0.0001).

CONCLUSIONS

Patients with chronic rhinitis and rhinosinusitis symptoms were more reactive to fungal and nonfungal allergens. Fungal allergens were as likely as nonfungal to elicit reactivity.

SIGNIFICANCE

These findings suggest a role for fungal hypersensitivity in chronic rhinitis and chronic rhinosinusitis.
Sepragel Sinus (Hylan B) as a Postsurgical Dressing for Endoscopic Sinus Surgery
Authors: Kimmelman Charles P. , Edelstein David R. , Cheng Han Jin
Published: February 2003

OBJECTIVE

To assess the safety and efficacy of Sepragel sinus, a hylan B gel (cross‐linked hyaluronic acid molecule), when used as a postoperative dressing after endoscopic sinus surgery as a facilitator of healing and a preventative for scarring and stenosis.

STUDY DESIGN

Ten patients undergoing bilateral endoscopic ethmoidectomy in an outpatient specialty hospital operating room underwent complete filling of a randomly selected right or left ethmoidectomy cavity with Sepragel sinus. Outcome measures were synechiae, middle meatal stenosis, mucosal status, mucosal regeneration, transparency of Sepragel sinus, and subjective pain and congestion.

RESULTS

Sepragel sinus significantly improved all outcome measures by week 2 and remained statistically significant for reduction of synechiae and stenosis.

CONCLUSION

Sepragel sinus is useful as a space‐occupying gel stent to separate sinus mucosal surfaces. The data strongly support the superiority of Sepragel sinus over no treatment in the control of postethmoidectomy synechiae and middle meatal stenosis, as well as early improvement in mucosal healing and postoperative pain.

SIGNIFICANCE

Because of its biocompatibility, lack of inflammatory response, transparency, and ability to fill any complex volume, Sepragel sinus offers distinct advantages over currently used stenting materials.
High Incidence of Complications Encountered in Chronic Otitis Media Surgery in a U.S. Metropolitan Public Hospital
Authors: Greenberg Jayson S. , Manolidis Spiros
Published: February 2003

OBJECTIVES

To examine the incidence and nature of complicating factors in surgery for chronic otitis media (COM) in a metropolitan public hospital in the United States.

METHODS

A retrospective review was performed over 2 years in a metropolitan public hospital to identify cases of surgery for chronic ear disease with the following complicating factors: intracranial or extracranial abscess, labyrinthine fistula, dural dehiscence with or without associated encephalocele or meningocele, or extensive involvement of the facial nerve by cholesteatoma with or without paralysis.

RESULTS

Thirty‐three of 90 consecutive operations for COM (37%) met criteria for complicated chronic otitis media (CCOM). The majority (85%) of patients had cholesteatoma involvement. Most patients (73%) were managed by an extended modified radical mastoidectomy. An additional 31 procedures were required in these 33 patients for control of complications. There was no iatrogenic sensorineural hearing loss or facial paralysis.

CONCLUSIONS

The incidence of CCOM in this large, U.S. metropolitan public hospital is similar to that observed in developing nations. CCOM significantly complicates chronic ear surgery and substantially increases the use of resources. Maintaining functional hearing is possible, but difficult, and should be considered secondary to prevention of further complications and eradication of disease. Access to health care and proper follow‐up are crucial in prevention of CCOM.
Reconstruction of the Ossicular Chain with Titanium Implants
Authors: Dalchow C. V. , Grün D. , Stupp H. F.
Published: February 2003

OBJECTIVES

Since 1994 more than 1300 titanium implants have been used to reconstruct the ossicular chain of the middle ear for chronic otitis media. Two different types of implants were used. First, a total and a partial implant of fixed length, available in numerous different lengths. And second, a total and partial implant that has an adjustable length. The implants are commercially available from 2 different companies. Patients were followed for a postoperative term from 6 to 72 months.

METHODS

A wide variety of patients aged 5 to 82 years received a tympanoplasty type III. Those patients whose ossicular chain had been reconstructed with titanium implants since 1994 were evaluated. As implants from one company are fixed in length; implants of a second company are trimmable inlength. All prostheses are lightweight and made of pure titanium, fitting most anatomical situations.

RESULTS

Earlier results already showed a very low complication rate. Extrusions occurred only in cases of middle ear atalectasis with resorption of interposed cartilage (<1%). No adverse reaction to the prostheses could be seen, even in histologic reviews. An average air‐bone gap less than 20 dB(A) for all calculated frequencies of 0.5, 1, 2, and 4 kHz was achieved for 76% of cases; 43% of cases showed a calculated air‐bone gap of less than 10 dB(A), only 10% higher than 30 dB(A).

CONCLUSION

All implants used offer the proven benefits of titanium, namely high biocompatibility and high stability at a very low complication rate with excellent hearing results for the patients. Titanium implants can highly be recommended to reconstruct the ossicular chain of the middle ear.
Transnasal Esophagoscopy
Authors: Belafsky Peter C. , Postma Gregory N. , Daniel Elena , Koufman James A.
Published: February 2003

BACKGROUND

Transnasal esophagoscopy (TNE), a new diagnostic technology, allows comprehensive, in‐office examination of the esophagus without sedation.

OBJECTIVE

To report the authors' experience using TNE.

METHODOLOGY

Retrospective review of 100 consecutive patients undergoing TNE.

RESULTS

The most frequent indications for TNE were screening examination of the esophagus in reflux, globus, and/or dysphagia patients (n = 79), biopsy of a lesion in the laryngopharynx, trachea, or esophagus (n = 8), screening examination of the esophagus in head and neck cancer patients (n = 5), tracheoscopy and bronchoscopy (n = 4), and evaluation for an esophageal foreign body (n = 2). Four procedures were aborted secondary to a tight nasal vault. Significant findings were found in 44% (42/96). The most frequent findings were esophagitis (n = 19), Barrett's (n = 6), hiatal hernia (n = 4), and carcinoma (n = 5).

CONCLUSIONS

TNE is safe and well tolerated by patients with topical anesthesia alone. TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.
Intratympanic Gentamicin Therapy for Persistent Vertigo after Endolymphatic Sac Surgery
Authors: Marzo Sam J. , Leonetti John P.
Published: February 2003

OBJECTIVES

To evaluate the role of intratympanic gentamycin therapy (ITGM) in controlling vertigo in patients with refractory Meniere's who have recurrent or persistent vertigo after endolymphatic sac surgery.

STUDY DESIGN AND SETTING

A retrospective review of 491 patients seen in a university balance clinic between July 1999 and July 2000. Of these, 68 patients had Meniere's disease; 4 patients had recurrent vertigo after endolymphatic sac surgery and were followed for at least 1 year. These 4 patients received a series of ITGM injections. Outcome measures included control of vertigo and audiometric results.

RESULTS

Three of 4 (75%) patients had control of their vertigo with ITGM therapy. The 1 patient who failed ITGM therapy underwent a successful vestibular neurectomy with ultimate control of his vertigo. No patients had progression of their sensorineural hearing loss.

CONCLUSION

ITGM therapy can be used to control vertigo in selected patients with Meniere's disease who have persistent vertigo after unsuccessful endolymphatic sac surgery.

SIGNIFICANCE

ITGM therapy may reduce the need for vestibular neurectomy in patients with refractory Meniere's disease after endolymphatic sac surgery.
Recurrent Epithelial‐Myoepithelial Carcinoma of the Parotid with Direct Intracranial Extension
Authors: Amin Kay S. , McGuff H. Stan , Cashman Steve W. , Newman Richard
Published: February 2003

Epithelial‐myoepithelial carcinoma (EMC) is a rare malignant salivary gland neoplasm. First described in 1972 by Donath et al,1 it was recognized as a distinct pathologic entity by the World Health Organization Classification in 1991.2 It is thought to represent about 1% of all salivary gland tumors.2

EMC is a low‐grade malignancy, however, recurrences and metastases to periparotid and cervical lymph nodes, as well as to distant sites, have occurred.2 Metastasis to the brain has been reported.2 To the best of our knowledge, direct intracranial extension has not been observed. We report a case of recurrent epithelial‐myoepithelial carcinoma of the parotid gland that exhibited local aggressive behavior with direct intracranial invasion.
Angiocentric T‐Cell Lymphoma of the Temporal Bone
Authors: Lewis William B. , Patel Uresh , Roberts Jay K. , Palis James , Teot Lisa
Published: February 2003

Although there have been several reports of lymphoma with metastasis to the temporal bone,1–3 primary lymphoma of the temporal bone is extremely rare. There are only 2 cases reported,4 both presenting with facial paralysis and otitis media due to B‐cell neoplasms. We present the first case of a histologically proven angiocentric T‐cell lymphoma with distinct clinical features.
The Association between Periodontal Disease and Peritonsillar Infection: A Prospective Study
Authors: Georgalas Christos , Kanagalingam Jeeve , Zainal Azida , Ahmed Hamid , Singh Arvind , Patel Kalpesh S.
Published: February 2003

OBJECTIVE

To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis.

STUDY DESIGN AND SETTING

A total of 158 patients presenting over a 3‐year period with peritonsillar abscess (PTA) confirmed by needle aspiration and a control group of 112 patients booked for elective tonsillectomy for recurrent tonsillitis (RT) were examined in terms of their periodontal status using the WHO Community Periodontal Index of Treatment Needs (CPITN).

RESULTS

The mean CPITN index was 2.81 (Standard Deviation [SD], 1.10) in patients with PTA and 1.41 (SD, 0.92) in patients with RT. One hundred seven of 158 patients with PTA had significant periodontal pathology (CPITN, 3 or 4) compared with 12 of 112 patients with RT. These differences were statistically significant.

CONCLUSION

Patients with peritonsillar abscess had an increased prevalence of periodontal disease as compared with patients with recurrent tonsillitis.

SIGNIFICANCE

There is a need to further explore this correlation and determine its nature, although it could be the result of common pathogenic factors, a causal relation cannot be excluded.
Vertebral Hydatid Disease Presenting as a Parapharyngeal and Neck Mass: A Case Report
Authors: Bilgen Cem , Öner Kazim , Övül Izzet , Kirazli Tayfun
Published: February 2003

Echinococcus granulosus is a cestode causing disease in human beings. Both the vertebral column and cervicofacial region are uncommon sites for hydatid involve‐ment, even in countries of the Middle East, South America, Australia, and New Zealand, where Echinococcus infestation is high.1 It was stated that only 1 in 1000 cases will exhibit cervical spine infestation, if the spine is infected in 1% to 2% of hydatid cases.12
Tracheal Stenosis after Percutaneous Dilational Tracheotomy
Authors: Bartels Sande , Mayberry John C. , Goldman Robert K. , Askew Judah A. , Wax Mark K.
Published: February 2003

OBJECTIVE

In many critical care units percutaneous dilational tracheotomy (PDT) has become an alternative to open tracheotomy. Although significant tracheal stenosis after PDT has been reported, the exact incidence is unknown. We report our findings on endoscopic laryngotracheoscopy for a group of patients who had undergone PDT more than 6 months before their examination.

STUDY DESIGN AND SETTING

We did a retrospective review of 108 trauma patients who underwent PDT at least 6 months before enrollment in the study. Twenty‐eight patients were either deceased or ineligible. Participation requests were mailed to the last recorded address of 80 patients. Thirty‐four of those patients were contacted by phone, and 14 indicated their willingness to participate. Only 10 patients were able to make it to the clinic for examination. After transorally anesthetizing the hypopharynx and larynx with 4% lidocaine, each patient underwent flexible laryngotracheoscopy. Findings were categorized as normal or tracheal stenosis (<25%, 25% to 50%, or >50%).

RESULTS

The tracheotomy site was virtually undetectable in 5 patients. In 4 patients, a scar was visible at the tracheotomy site, but there was no decrease in cross‐sectional area. In 1 patient there was a 25% to 50% stenosis. All patients were completely asymptomatic with regard to airway and voice quality.

CONCLUSION

One out of 10 patients in our series had a significant but asymptomatic stenosis after PDT. The risk of tracheal stenosis in PDT appears to be the same as that of open tracheotomy.
Anthrax: ENT Manifestations and Current Concepts
Authors: Wirtschafter Ari , Cherukuri Sreekant , Benninger Michael S.
Published: February 2003

In light of recent events, anthrax has once again taken center stage in the world of science and the world in which we live. Because patients with anthrax may initially present to otolaryngology clinics, it is important for the otolaryngologist to know how to diagnose and treat this entity. This article will present current information on epidemiology, microbiology, pathogenesis/clinical manifestations, diagnosis, and treatment with a particular interest in the head and neck region.