bluuebunny/crossref_metadata_2025 huggingface dataset:
Inlay Butterfly Cartilage Tympanoplasty (Eavey Technique) Modified for Adults
Authors: Lubianca‐Neto José Faibes
Published: February 2003

INTRODUCTION

Popular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafts. In 1998, Eavey described an inlay tympanoplasty technique in children using a cartilage graft which resembled butterfly wings. This technique was effective for closure of tympanic membrane perforations, while being more rapid for the surgeon and more comfortable for the patient. The aim of this study was to describe our results with modification of this technique in adults under local anesthesia.

METHODS AND MATERIAL

Cartilage butterfly inlay tympanoplasty was carried out in 20 adult patients to close small‐to‐medium tympanic membrane perforations over a period of 11 months. Compared with the original description, 3 modifications are noted: (1) adult patients, (2) local anesthesia, and (3) no skin graft over the cartilage. We evaluated the success rate and postoperative hearing results.

RESULTS

Two patients were not evaluated in terms of hearing gain because they had profound preoperative hearing loss. Fourteen patients had a postoperative 4 pure‐tone average between 0 and 9 dB, 3 patients between 10 and 20 dB, and 1 patient greater than 20 dB. The graft “take rate” was 90% (18/20) at the end of the follow‐up period (mean follow‐up 7.25 months). Seventeen of 18 successful cases had cartilage grafts that were intact and dry at the last visit.

CONCLUSIONS

The tympanoplasty technique described by Eavey is effective to close tympanic membrane perforation in adults as well as children. The technique modifications introduced here (abandonment of the skin graft and local anesthesia) reduced surgery time and postoperative morbidity. Postoperative results compared with those of the original technique were good.
Measurement of Peripheral Vestibular Blood Flow in a Gerbil Model of Endolymphatic Hydrops
Authors: Reddy Pavan G. , Burgio Don L. , Quirk Wayne S.
Published: February 2003

Presently, many investigators believe that the dysfunction of microcirculatory mechanisms may be responsible for vestibular symptoms in Meniere's disease. This study, using intravital microscopy (IVM), a technique that provides in vivo microcirculatory measures, was designed to determine whether impaired vestibular blood flow exists in endolymphatic hydrops. Hydrops was induced in the gerbil model by obliteration of the vestibular aqueduct and was confirmed histologically after IVM. Posthydrops gerbil subjects at 8 weeks as well as control animals were prepared for IVM. With a customized intravital microscope, red blood cell velocity and vessel diameter measurements were calculated for individual arterioles and capillaries from the microvascular bed at the horizontal ampulla. Mean arteriole diameter was significantly larger in the control group than in the hydrops group, whereas mean capillary diameters were similar for both groups. No significant difference was observed for mean red blood cell velocity in capillaries or arterioles between control and hydrops animals.
Assessment of the Otolith‐Autonomic Response Using Spectral Analysis of the R‐R Interval and Blood Pressure
Authors: Myers Eugene N. , Yamamoto Ko‐Ichi , Kawasaki Yoshiaki , Izumi Ryutarou , Kubo Takeshi
Published: February 2003

The effects of otolith stimulation on systolic blood pressure (SBP) and R‐R interval fluctuations were investigated in 12 healthy subjects and 5 patients with loss of labyrinthine function. The vestibular otolith organs were stimulated by centrifugal forces, the constant rotation of a chair fixed outside of the rotation axis on the horizontal plane. The chair was fixed along the direction of centrifugal force (eccentric rotation (ECR)) or along the tangent line (eccentric lateral rotation (ECLR)). The ECR stimulates both the utricular and saccular maculae, whereas the ECLR stimulates only the utricular maculae. Spectral analysis showed that in the healthy subjects, low‐frequency SBP increased significantly during ECR but not during ECLR. There was no significant increase in low‐frequency SBP in patients with labyrinthine loss. In the R‐R interval analysis, however, the low‐ and high‐frequency components did not change significantly in the healthy subjects during ECR. Our findings indicate that stimulation of the otolith maculae, especially the saccular organs, predominantly produces augmentation of the α‐sympathetic activities rather than cardiac sympathovagal outflow to the heart.
Treatment of Delayed Food Allergy Based on Specific Immunoglobulin G Rast Testing
Authors: Dixon Hamilton S.
Published: February 2003

This preliminary, descriptive study after extensive clinical experience demonstrates specific IgG food RASTs done in 114 consecutive patients with strong positive histories for delayed food allergy. Elimination of the positive foods was the sole means of treatment. The symptoms leading to the test are detailed, and the method of workup is reviewed. The overall results demonstrated a 71% success rate for all symptoms achieving at least a 75% improvement level. Of particular interest was the group of patients with chronic, disabling symptoms, unresponsive to other intensive treatments. Whereas 70% obtained 75% or more improvement, 20% of these patients obtained 100% relief.
Influence of the Prosthetic Restoration Modality on Bone Loss Around Dental Implants Placed in Vascularized Iliac Bone Grafts for Mandibular Reconstruction
Authors: Kovács Adorján F.
Published: February 2003

OBJECTIVES

Is bone loss associated with implants placed in vascularized iliac crest bone grafts for mandibular reconstruction dependent on the prosthetic restoration modalities used?

STUDY DESIGN

Eleven vascularized iliac crest bone grafts for mandibular reconstruction were examined after ablative tumor surgery. Forty implants loaded for at least 1 year were observed for up to 6 years. Horizontal and peri‐implant bone loss was assessed for 2 groups: 6 patients with implant‐supported bridges and 5 patients with implant‐retained overdentures.

RESULTS

Horizontal bone loss reached a steady state around 2 mm after an observation time of 2 years. Bony pockets had a depth of less than 1 mm. The described pattern was nearly independent of the prosthetic restoration modality used. The implant survival rate was 97.6%.

CONCLUSIONS

Vascularized iliac crest bone grafts are safe implant‐bearing areas. Implant‐retained overdentures can be used with as good a long‐term efficacy as the more complicated implant‐supported bridges.
Quantitative Analysis of the Drainage After Neck Dissection
Authors: Erişen Levent , Yircali Gonca , Mesciğoğlu Atilla , Basut Oğuz , Coşkun Hakan
Published: February 2003

The goals of this study are to determine the normal volume and lipid values of the drainage after neck dissection (ND) and to evaluate the changes of these values according to the type and side of the ND. Ninety‐seven uncomplicated NDs involving zones I through IV were evaluated prospectively in this study. The most important result of the analysis of the drainage is that levels of triglyceride and cholesterol in the drainage were lower than serum levels in all but 1 case (P < 0.001). When matched for the type and side of the dissection, only mean total drainage volume was significantly higher in radical NDs than in selective NDs (P = 0.001). The normal volume and lipid values of neck drainage are reported in this study. Being aware of the changes in these values may help early diagnosis of some pathologic conditions.
Third Place—Resident Basic Science Award 1999 Elevated Nitric Oxide Metabolite Levels in Chronic Sinusitis
Authors: Schlosser Rodney J. , Spotnitz William D. , Peters Edward J. , Fang Kezhong , Gaston Benjamin , Gross Charles W.
Published: February 2003

Decreased exhaled nitric oxide (NO) is found in chronic sinusitis. NO metabolites (nitrates, nitrites, and S‐nitrosothiols) were measured in sinus lavages with a rabbit model of chronic sinusitis. NO metabolite levels (mean ± SD) were 3.0 ± 1.6 μmol/L in uninfected rabbits, 10.7 ± 11.4 μmol/L in infected animals, and 7.6 ± 5.4 μmol/L in postantrostomy recovering animals. Infected sinuses had elevated levels of NO metabolites that were statistically significant (P < 0.01) when compared with uninfected sinuses. Mucociliary transport velocity was measured in uninfected (16.0 ± 5.7 mm/minute), infected (5.2 ± 1.3 mm/minute), and recovery phases (3.0 mm/minute). Endoscopic appearance, light and electron microscopy, and bacterial cultures improved during recovery. Elevated levels of NO metabolites were found during chronic sinusitis and began to return to normal levels during recovery. The possible link between NO in epithelial autotoxicity and host defense mechanisms warrants further investigation. (Otolaryngol Head Neck Surg 2000;123:357‐62.)
Endoscope‐Assisted Microvascular Decompression of the Trigeminal Nerve
Authors: Jarrahy Reza , Berci George , Shahinian Hrayr K.
Published: February 2003

Twenty‐one patients with classic symptoms of trigeminal neuralgia underwent microvascular decompression of the trigeminal nerve through a retrosigmoid approach to the cerebellopontine angle. Endoscopy was used as an adjunctive imaging modality to microscopy. Specifically, endoscopes were used to confirm nerve‐vessel conflicts identified by the microscope and to reveal others that escaped microscopic survey. Endoscopes were also used to assess the adequacy of the decompression performed microscopically. A total of 51 nerve‐vessel conflicts were identified and treated, 14 of which were discovered only after endoscopy. Additionally, in 5 patients endoscopic examination of the surgical intervention demonstrated that further maneuvers were required to completely decompress the nerve. These results highlight the value of endoscopy in the diagnosis and therapy of cranial nerve pathology in the posterior fossa.
Endoscopic Repair of Cerebrospinal Fluid Leaks to the Sinonasal Tract: Predictors of Success
Authors: Zweig Julie L. , Carrau Ricardo L. , Celin Scott E. , Schaitkin Barry M. , Pollice Phillip A. , Snyderman Carl H. , Kassam Amin , Hegazy Hassan
Published: February 2003

INTRODUCTION

Cerebrospinal fluid (CSF) leaks may arise as a complication of endoscopic sinus surgery, trauma, or hydrocephalus, or they may occur spontaneously without any identifiable cause. Despite general agreement that CSF leaks should not be left untreated, their initial management, the surgical indications, and the technique of repair are controversial.

OBJECTIVE

We undertook this study to ascertain whether a particular surgical technique or material was more successful for repair. Additionally, we tried to identify which specific characteristics of the patient, the CSF fistula, or the adjunctive treatment influenced the result of the repair.

STUDY DESIGN

We completed a retrospective review of all patients undergoing endoscopic repair of a CSF leak at our academic hospitals.

RESULTS

Forty‐eight patients with 53 CSF fistulas were included in the study. Fifty sites were successfully repaired endoscopically on the first attempt. Three persistent leaks were repaired successfully on the second attempt. Location and size of the leak, cause, technique, and choice of material used for the repair did not significantly affect surgical outcome. However, the presence of hydrocephalus had a statistically significant negative influence on surgical outcome. All patients with increased intraventricular pressure required a ventricular shunt in addition to a second endoscopic repair.

CONCLUSION

If the surgical technique is sound, endoscopic repair of CSF leaks is highly successful, independent of the choice of the material and technique used in the repair.
Chest Radiographs after Dilatational Percutaneous Tracheotomy: Are they Necessary?
Authors: Donaldson David R. , Emami A. J. , Wax Mark K.
Published: February 2003

BACKGROUND

The efficacy of routinely obtaining chest radiographs after standard open tracheotomy has been questioned. Recent literature would suggest that after a routine, uncomplicated tracheotomy, chest radiography is a low‐yield procedure that incurs unnecessary expense. Percutaneous dilatational tracheotomy (PDT) is rapidly replacing open tracheotomy as the intensive care unit procedure of choice for airway management. Complication rates are equivalent between the two procedures.

OBJECTIVE

We examined the value and cost‐effectiveness of routine postoperative chest radiographs in patients undergoing PDT.

STUDY DESIGN AND SETTING

The study was a prospective analysis of 54 consecutive PDTs performed at a tertiary care academic institution.

RESULTS

Eighteen (33%) patients had chest radiographs obtained within 1 hour of PDT (6 at the request of the otolaryngology service); 35 (66%) underwent radiography more than 2 hours later at the request of the intensive care unit for reasons other than PDT. There were no incidents of pneumothorax, pneumomediastinum, or tracheotomy tube malposition in any patient. Patients undergoing chest radiography within 1 hour of the PDT also had chest radiographs within 12 hours at the request of ICU staff for their underlying disease.

CONCLUSIONS

Routine chest radiography after PDT is of low yield. Because most of these patients require chest radiographs for their underlying disease within 12 hours, a cost savings of approximately $13,500 would be realized in this patient population.

SIGNIFICANCE

Routine chest radiography after PDT is unwarranted in most cases.
In Vitro Resistance to Bacterial Biofilm Formation on Coated Fluoroplastic Tympanostomy Tubes
Authors: Berry Julie A. , Biedlingmaier John F. , Whelan Philip J.
Published: February 2003

Bacterial biofilm formation has been implicated in persistent posttympanostomy otorrhea and irreversible tube contamination. The use of a tympanostomy tube with a resistance to biofilm formation by the most common organisms associated with persistent infection may decrease the incidence of chronic otorrhea and the need for tube removal. In this investigation, scanning electron microscopy was used to compare a phosphorylcholine‐coated fluoroplastic tympanostomy tube to plain fluoroplastic and silver oxide‐impregnated fluoroplastic for resistance to biofilm formation after in vitro incubation with Staphylococcus aureus or Pseudomonas aeruginosa. Only a biofilm from Pseudomonas formed on the untreated fluoroplastic tubes, whereas the silver oxide‐impregnated tubes developed biofilms from both S aureus and P aeruginosa. In contrast, the coated fluoroplastic tube showed resistance to both staphylococcal and pseudomonal biofilm adhesion. This is the first study to demonstrate the effect of a surface treatment of fluoroplastic as a method to inhibit biofilm formation by both S aureus and P aeruginosa. This reinforces our previous studies showing that surface‐adherence properties such as charge or slickness or both may be more beneficial than antibacterial treatments in preventing film adhesion.
Temporal Bone Necrosis: Diagnosis, Classification, and Management
Authors: Pathak Irvin , Bryce Graham
Published: February 2003

OBJECTIVE

The goal of this study was to analyze temporal bone necrosis and classify its diagnosis and treatment according to extent of necrosis and cause.

METHODS AND MATERIAL

Twenty‐six cases of temporal bone necrosis were retrospectively reviewed between 1988 and 1997 at the University of British Columbia.

RESULTS

Patients were classified on the basis of disease extent restricted to the tympanic bone or extension beyond the tympanic bone, as well as on the basis of the cause of disease; treatment based on classification. Patients with localized disease of the tympanic bone had minimal symptoms. Those with radiation‐induced localized necrosis were less likely to respond to conservative medical management. Patients with diffuse disease were more likely to require surgical intervention.

CONCLUSIONS

Temporal bone necrosis comprises a spectrum of disease from idiopathic tympanic bone necrosis, which rarely requires surgery, to the more severe forms of radiation‐induced diffuse temporal bone necrosis that may cause life‐threatening complications requiring surgical intervention.
Predictors of Airway Intervention in Angioedema of the Head and Neck
Authors: Zirkle Molly , Bhattacharyya Neil
Published: February 2003

OBJECTIVE

Records of patients presenting with angioedema of the head and neck were analyzed to determine clinical factors that predict the need for airway intervention.

METHODS

A review of patients with angioedema of the head and neck over a 10‐year period was conducted. Data were collected regarding demographics, cause of edema, and sites of involvement. A logistic regression model was used to ascertain whether any clinical variables were significant in predicting the need for airway intervention.

RESULTS

Review of 138 charts with an admitting diagnosis of angioedema yielded 66 cases of angioedema of the head and neck in 48 patients. Twenty‐three (34.8%) patients required airway intervention. Logistic regression identified increasing age and angioedema involving the oral cavity/ oropharynx as predictors of airway intervention; involvement of other sites, cause, and sex were not predictive.

CONCLUSION

Location of edema and patient age predict which patients with angioedema of the head and neck are likely to require airway intervention.
Risk Factors Associated with Hypothyroidism after Laryngectomy
Authors: Gal Robin L. , Gal Thomas J. , Klotch Douglas W. , Cantor Alan B.
Published: February 2003

Hypothyroidism is a well‐documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy. The Cox proportional hazards model was used to identify factors significantly related to an increased risk for development of hypothyroidism. The actuarial method was used to estimate the period of greatest risk for the development of hypothyroidism. Increased risks were found for patients who were female (P = 0.0049), received preoperative radiation therapy (P = 0.0022), had invasion of the thyroid gland by tumor (P = 0.0003), had presence of cervical metastases (P = 0.0022), and had postoperative fistula (P = 0.0095). From the actuarial method, we estimated that the period of time when patients were at greatest risk for development of hypothyroidism was between 0 and 14 months after surgical intervention. Wound complications were twice as frequent in hypothyroid patients. Perioperative awareness of risk factors associated with the development of hypothyroidism in patients undergoing laryngectomy allows for early recognition and management of hypothyroidism and may reduce the number of complications related to wound healing and fistula.
Applications of Fast‐Setting Hydroxyapatite Cement: Cranioplasty
Authors: Costantino Peter D. , Chaplin John M. , Wolpoe Matt E. , Catalano Peter J. , Sen Chandranath , Bederson Joshua B. , Govindaraj Satish
Published: February 2003

A variety of autogenous and synthetic materials have been used to repair cranial defects resulting from traumatic and iatrogenic causes. In theory, the ideal material should be readily available and safe. It should adequately protect the underlying central nervous system, resist cerebrospinal fluid fistula formation, and be easily contoured. One promising synthetic biomaterial that has been used for cranioplasty is hydroxyapatite cement. This biomaterial has successfully restored cranial contour in most patients in whom it has been used; however, difficulties have arisen because of the material's prolonged water solubility. When exposed to cerebrospinal fluid or blood, inadequate setting of the cement occurs, resulting in loss of its structural integrity. This problem can be alleviated with the use of fast‐setting hydroxyapatite cement, which hardens 6 to 12 times faster than the traditional cement. We present, to the best of our knowledge, the first series of the use of this material in 21 patients requiring cranioplasty. The advantages and limitations of fast‐setting hydroxyapatite cement will be discussed. (Otolaryngol Head Neck Surg 2000; 123:409‐12.)
Amplification of Herpes Simplex Virus Type 1 DNA in Human Geniculate Ganglia from Formalin‐Fixed, Nonembedded Temporal Bones
Authors: Carreño Marcos , OñA María , Melón Santiago , Llorente Jose Luis , DÍAZ Juan José , Suárez Carlos
Published: February 2003

Polymerase chain reaction (PCR) has provided new insights in molecular biology. Recently, some studies have been focused on temporal bone pathology, with amplification of DNA from fixed sections of celloidin‐embedded bones. The purpose of our study was to elucidate the utility of PCR in detection of minor concentrations of DNA from nonoptimal stored samples. We obtained geniculate ganglia from 30 temporal bones preserved in formalin for a long time, without any process of embedding. By performing a nested PCR assay, we detected herpes simplex virus type 1 DNA in 13 of 30 ganglia (43%). We conclude therefore that study of temporal bones stored under poor conditions by PCR is possible, although there are some limitations when compared with fresh or optimally archived samples. (Otolaryngol Head Neck Surg 2000;123:508‐11.)
Diagnostic Value of Epstein‐Barr Viral Serology in Nasopharyngeal Carcinoma
Authors: Low Wong‐Kein , Leong Jern‐Lin , Goh Yau‐Hong , Fong Kam‐Weng
Published: February 2003

Although Epstein‐Barr virus (EBV) IgA serology has been established as an effective marker for nasopharyngeal carcinoma (NPC), it remains unclear how useful or cost‐effective it is as a screening test. This article is aimed at establishing how these tests could be used most effectively in the diagnosis of NPC in an otolaryngology outpatient clinic. A total of 111 consecutive patients with NPC and an equal number of control subjects were studied. Fortyseven patients with NPC had early (AJCC stages 1 and 2) and 64 had advanced (stages 3 and 4) disease. A positive early antigen (EA) serology result was found in 81.2% of NPC patients and in none of the controls. Negative EA and viral capsid antigen (VCA) serology results were present in 2.7% of NPC patients and in 46.8% of controls. Negative EA and positive VCA serology results were found in 30.0% of NPC patients with early disease, 7.8% of NPC patients with advanced disease, and 53.2% of controls. Given its high specificity, serology for EA is recommended as a clinically useful screening test. Serology for VCA, although highly sensitive, has an unacceptably high false‐positive rate, and its cost‐effectiveness as a universal screening test is questionable. (Otolaryngol Head Neck Surg 2000;123:505‐7.)
Development and application of a health‐related quality‐of‐life instrument for adults with cochlear implants: The Nijmegen Cochlear Implant Questionnaire
Authors: Hinderink Johannes B. , Krabbe Paul F. M. , Van Den Broek Paul
Published: February 2003

OBJECTIVE:

The goal was to develop a quantifiable, self‐assessment health‐related quality of life (QoL) instrument for use in cochlear implant (CI) users.DESIGN:Three principal domains were distinguished: physical, psychological, and social. Forty‐five postlingually deaf adult multichannel CI users and 46 deaf candidates on the waiting list for CIs (control group) participated in the study.

RESULTS:

Retrospective scores for the CI group corresponded very well with the scores for the control group. Current QoL scores were substantially higher for all 6 subdomains. Internal consistency and test‐retest reliability coefficients proved to be satisfactory, and the ability to detect clinical changes with the Nijmegen Cochlear Implantation Questionnaire (NCIQ) proved to be good.

CONCLUSIONS:

The psychometric characteristics of the NCIQ proved to be reliable and probably valid and sensitive to clinical changes. The data obtained with the NCIQ reflected that the instrument was able to detect that a CI had significant effects on several health‐related QoL aspects, including the social and psychological domains.
Analysis of Aerobic Bacterial Strains Found in Chronic Rhinosinusitis Using the Polymerase Chain Reaction
Authors: Keech Daniel R. , Ramadan Hassan , Mathers Peter
Published: February 2003

INTRODUCTION

Rhinosinusitis is a common disease affecting an estimated 14% of the population. Although there is general agreement in the literature regarding acute rhinosinusitis, chronic rhinosinusitis is not as well studied, and no consensus has been reached regarding the bacterial etiology. The goal of this study was to test chronic rhinosinusitis mucosal specimens using the polymerase chain reaction (PCR) for aerobic bacterial content and to compare the results with standard culture data.

RESULTS

Routine culture samples grew 50% aerobic bacteria, whereas PCR detected 62% aerobic bacteria contamination.

CONCLUSION

PCR detected more bacteria in mucosal samples than in standard culture, but standard culture of this mucosa reflects the general aerobic bacteria found in chronic rhinosinusitis, with no predominant species of aerobic bacteria.

SIGNIFICANCE

The analysis of chronic rhinosinusitis mucosa with the PCR method should give a more accurate picture of the bacteria found in chronic rhinosinusitis so that proper therapy can be instituted.
Single‐Stage Laryngotracheal Reconstruction in Children: A Review of 200 Cases
Authors: Gustafson L. Mark , Hartley Benjamin E. J. , Liu James H. , Link Dana T. , Chadwell Jon , Koebbe Chris , Myer Charles M. , Cotton Robin T.
Published: February 2003

OBJECTIVE

We reviewed our experience with pediatric single‐stage laryngotracheal reconstruction (SSLTR) to identify factors that affect postoperative outcomes, including the need for reintubation and tracheostomy.

STUDY DESIGN

Retrospective chart review was done.

RESULTS

In total, 190 children underwent 200 SSLTRs; 29% were reintubated, and 15% required postoperative tracheostomy. Currently, 96% are decannulated. The use of anterior and posterior costal cartilage grafting, age less than 4 years, sedation for more than 48 hours, a leak pressure around the endotracheal tube at greater than 20 cm H2O, and moderate/severe tracheomalacia significantly increased the rate of reintubation. The duration of stenting did not affect outcomes. Children with anterior and posterior grafts and those with moderate or severe tracheomalacia were more likely to need a postoperative tracheostomy.

CONCLUSION

SSLTR can be effective for the treatment of pediatric laryngotracheal stenosis. Diligent preoperative assessment of the patient and the patient's airway and close postoperative care are important to the success of this operation.
Evaluation of Hydroxyapatite Ossicular Chain Prostheses
Authors: Pasha Raza , Hill Samuel L. , Burgio Don L.
Published: February 2003

Hydroxyapatite (HA) middle ear prostheses have gained popularity as an alternative to human autografts and homografts. This study reports on 3 HA prostheses types: total ossicular chain prostheses, used for grafting the stapes footplate to the tympanic membrane; partial ossicular chain prostheses, used for grafting the stapes superstructure to the tympanic membrane; and Kartush incus struts (Smith & Nephew Richards Inc), used for grafting the stapes superstructure to the undersurface of the malleus. This single‐surgeon study of 33 consecutive cases revealed a statistically significant difference in mean postoperative air‐bone gap and air‐bone gap closure between incus struts (14/26 dB) or partial (22/11 dB) or total (25/10 dB) ossicular chain prostheses (ttest:P< 0.05). Prognostic risk factors graded by the Middle Ear Risk Index indicate a tendency for worse postoperative hearing with increasing Middle Ear Risk Index. This study supports the use of HA ossicular prostheses and, in particular, the use of the malleus for ossicular chain construction. (Otolaryngol Head Neck Surg 2000;123:425‐9.)
Pilot Study to Evaluate the Efficacy of Hyperbaric Oxygen Therapy in Improving the Survival of Reattached Auricular Composite Grafts in the New Zealand White Rabbit
Authors: McClane Stacie , Renner Gregory , Bell Patricia L. , Early Elizabeth K. , Shaw Bharat
Published: February 2003

OBJECTIVE

This investigation is a prospective, randomized, blinded study seeking to evaluate the efficacy of hyperbaric oxygen (HBO) therapy in improving the survival of the reattached auricular composite graft.

STUDY DESIGN

Twenty New Zealand White rabbits were randomly assigned to control (10) and treatment (10) groups in a prospective fashion. After amputation and reattachment of measured segments of each ear, the treatment group received 14 HBO treatments for 10 days. The control group received only standard postoperative care. On postoperative day 18, the surviving composite grafts were measured, recorded, and statistically analyzed.

RESULTS

The mean percentage of graft survival for the control group was 0.31% (range 0%‐2.5%), and the mean for the group receiving HBO was 15.94% (range 0%‐38%). A median test was used to evaluate this difference, which was found to be statistically significant (P = 0057).

CONCLUSION

Our study appears to indicate a possible survival benefit for the composite grafts in those rabbits that received HBO treatments. We believe that there are several significant difficulties with the rabbit as a model for this study, but we are encouraged at this point that a limited measurable benefit was observed. Further investigations with HBO appear to be warranted at this time.
Tumors and Tumorous Masses Presenting as Temporomandibular Joint Syndrome
Authors: Mostafapour Sam P. , Futran Neal D.
Published: February 2003

OBJECTIVE

Neoplasms of the temporomandibular joint (TMJ) usually mimic common causes of TMJ syndrome, leading to delay in diagnosis. To increase awareness of TMJ neoplasms and establish guidelines for early intervention, we performed a retrospective analysis of a series of patients with neoplasms of the TMJ.

STUDY DESIGN AND SETTING

A retrospective review of the records of patients with neoplasms of the TMJ from 1990 to 1997 was done.

RESULTS

Six patients were identified. The neoplasms included benign and malignant neoplasms. The time from initial presentation to final diagnosis was in most cases prolonged, ranging from 3 months to 8 years. Patients typically showed advanced lesions radiographically. All patients required surgical extirpation. Postoperative radiation therapy was used for malignant lesions. Patient outcomes were delineated.

CONCLUSIONS AND SIGNIFICANCE

Neoplasms, both benign and malignant, of the TMJ are rare but represent a challenging diagnostic problem. In patients with 1 month or more of recalcitrant TMJ swelling or pain, radiographic imaging may be considered to rule out these rare neoplasms. This may lead to earlier intervention and improved outcome.
Penetrating Neck Trauma in Children: An Urban Hospital's Experience
Authors: Kim Michael K. , Buckman Robert , Szeremeta Wasyl
Published: February 2003

OBJECTIVE

As the incidence of violent crime increases in our society, the rate of penetrating head and neck trauma in children also rises. The methods of management of pediatric penetrating neck wounds are addressed.

METHODS

All clinical records of children younger than 18 years admitted with penetrating neck injuries between 1990 and 1997 were reviewed. The injuries were classified according to type and location of the neck wound. Demographic data, clinical presentation, diagnostic studies, and management techniques were evaluated.

RESULTS

Thirty‐five children aged 6 to 18 years old were evaluated for 31 missile wounds and 4 stab wounds. There were 30 boys and 5 girls. Fourteen percent of injuries were in zone 1, 60% in zone II, and 26% in zone III. Of the 33% of children with zone II penetrating neck traumas who underwent selective neck explorations, 86% had significant intraoperative findings. The mortality rates for zones I, II, and III were 60%, 29%, and 56%, respectively. The overall mortality rate was 40%.

CONCLUSIONS

Penetrating neck trauma in children may lead to potentially life‐threatening injuries. Selective management of penetrating head and neck injuries in children can be a safe and effective policy in an experienced trauma center.
The Workforce in Otolaryngology‐Head and Neck Surgery: Moving into the Next Millennium
Authors: Pillsbury Harold C. , Cannon C. Ron , Holzer Susan E. Sedory , Jacoby Itzhak , Nielsen David R. , Benninger Michael S. , Denneny James C. , Smith Richard V. , Cheng Eme Y. , Hagner Alison P. , Meyer Gregg S.
Published: February 2003

OBJECTIVE

The goal was to examine the current scope of otolaryngologists’ practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck.

STUDY DESIGN

A large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios.

RESULTS

The current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted.

CONCLUSIONS

This study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology.
Glabellar Frown Lines as a Reliable Landmark for the Supratrochlear Artery
Authors: Vural Emre , Batay Funda , Key J. Michael
Published: February 2003

OBJECTIVE

Preservation of the supratrochlear vascular pedicle (SVP) during use of the paramedian forehead flap can be accomplished by the aid of Doppler imaging; however, a reliable surface landmark may be invaluable in cases where Doppler examination fails. Our observations showed that the most prominent glabellar frown lines (GFLs) are very close to the SVP; however, the actual relationship of these structures remains unclear.

STUDY DESIGN

The relationship between GFLs and the SVP was investigated in 19 volunteers by the aid of Doppler imaging and in 8 cadaver heads by dissection. The distance between the GFLs and the SVP was measured.

SETTING

The study took place at an academic tertiary‐care facility.

RESULTS

The SVP was located just at the GFLs in almost 50% of the cases and an average of 3.2 mm lateral to GFLs in the remaining cases.

CONCLUSION

GFLs may serve as reliable surface landmarks in the use of the paramedian forehead flap where Doppler imaging was not helpful.
Calvarial Bone Graft Harvest: A New Technique
Authors: Strong E. Bradley , Moulthrop Thomas
Published: February 2003

OBJECTIVE

This study evaluates the use of a new calvarial bone graft‐harvesting device (BHD).

STUDY DESIGN

A total of 18 calvarial bone grafts (CBGs) were harvested from 9 cadavers with the BHD. The recorded parameters included drilling time, graft harvest time, graft size, graft integrity, and violation of the calvarial inner table. Five CBGs were subsequently harvested in vivo and used for 2 nasal reconstructions and 3 orbital reconstructions.

RESULTS

The CBG dimensions ranged from 1.25 to 2.5 cm in width and 3.0 to 16.0 cm in length. Graft harvest time ranged from 5 minutes, 55 seconds to 25 minutes, 30 seconds (mean 13 minutes, 7 seconds). There were no fractured grafts. The cadaveric inner table was violated twice with a cutting burr, and 1 dural exposure occurred in the clinical study.

CONCLUSION

Although caution must be used with all CBGs, the BHD appears to be safe and more efficient than osteotomes or oscillating saws.
Fine‐Needle Aspiration: Survey of Clinical Utility
Authors: Cannon C. Ron , Replogle William H.
Published: February 2003

OBJECTIVES

The goal was to determine the features of clinical usage of fine‐needle aspiration (FNA) in this country in terms of utilization, indications, and practice and demographic characteristics of those who use FNA.

STUDY DESIGN

A survey was mailed to otolaryngologist‐head and neck surgeons (OTO‐HNSs) in the United States. The results were totaled and analyzed for indications for FNA performance, practice setting, age, and geographic location of practitioners.

RESULTS

The most common indications for use of FNA were in the diagnoses of neck, thyroid, salivary, and other masses in the head and neck. In the survey group the average number of FNAs performed per month was 4.7 per respondent practitioner. FNA was statistically related to age (older physicians performed it less) and region of the country. FNAs are performed at a lower rate in the West.

CONCLUSIONS

FNA is a commonly performed procedure. Certain groups of OTO‐HNSs (older, located in western states) do not perform FNA as commonly as other OTO‐HNSs. Further education regarding the merits of FNA is needed.
Preoperative Evaluation of the Radial Forearm Free Flap Patient with the Objective Allen's Test
Authors: Nuckols Douglas A. , Tsue Terance T. , Toby E. Bruce , Girod Douglas A.
Published: February 2003

OBJECTIVE

The conventional subjective Allen's test (SAT) can be problematic because of its subjective nature. The objective Allen's test (OAT) was used before surgery to reliably and objectively assess forearm vascular flow in anticipation of harvesting a radial forearm free flap (RFFF) for use in head and neck reconstruction.

STUDY DESIGN AND SETTING

Retrospective analysis of 65 patients undergoing both preoperative SAT and OAT was completed at the University of Kansas Medical Center between December 1994 and March 1998.

RESULTS

The sensitivity and specificity of the SAT compared with the sensitivity and specificity of the OAT were only 65% and 76%, respectively. In 40 patients with at least 1 forearm with a positive SAT, only 1 (2.5%) patient was found by OAT to have vasculature that would not have allowed safe RFFF harvest in either forearm. In contrast, of the 25 patients with equivocal or negative SAT results in both arms, 18 (72%) were found by OAT to be safe candidates for RFFF harvests.

CONCLUSIONS

The OAT is an objective measure of forearm vascular flow and is superior to conventional SAT in RFFF donor‐site selection.
Osteocutaneous radial forearm free flap: Its use without significant donor site morbidity
Authors: Werle Andreas H. , Tsue Terance T. , Toby E. Bruce , Girod Douglas A.
Published: February 2003

While the fasciocutaneous radial forearm free flap has gained increasing popularity, the osteocutaneous radial forearm free flap has been condemned because of a high rate of pathologic donor radius fracture. On the basis of studies that demonstrated increased strength in ostectomized radii after dynamic compression plating, we believed that internal fixation at the time of graft harvest would significantly reduce the incidence of donor radius fracture. This is a retrospective review of the first 54 patients undergoing osteocutaneous radial forearm free flap reconstruction of the head and neck at our institution; 52 underwent prophylactic plating of their donor radii. No clinically significant donor radius fractures have occurred in plated patients. Five asymptomatic fractures were discovered on routine radiographs and required no treatment. Objective evaluation of forearm range of motion and strength after graft harvest demonstrated excellent function compared with unoperated arms. Serial radiographs have shown remodeling and reconstitution of donor radii without localized osteopenia.
Management of nasopharyngeal stenosis after uvulopalatoplasty
Authors: Krespi Yusef P. , Kacker Ashutosh
Published: February 2003

OBJECTIVE:

The objective of this study is to evaluate the management of nasopharyngeal stenosis (NPS) with the CO2 laser and a customized nasopharyngeal obturator.

STUDY DESIGN:

An 8‐year retrospective study based at a tertiary care teaching hospital consisting of 18 patients with NPS after uvulopalatoplasty treated over an 8‐year period with the CO2 laser and a nasopharyngeal obturator. Patients with grade I stenosis were treated in the office and did not require a nasopharyngeal obturator. More severe cases (grades II and III) were treated in the operating room and required a nasopharyngeal obturator.

RESULTS:

Eighteen patients with NPS, stages I to III, were treated with a CO2 laser with or without a nasopharyngeal obturator with good results.

CONCLUSION:

The repair of NPS with a CO2 laser and a nasopharyngeal obturator in severe cases helps in restoring nasopharyngeal patency.

SIGNIFICANCE:

This technique provided a reliable method of correcting postuvulopalatoplasty NPS.
Revision stapedectomy
Authors: De La Cruz Antonio , Fayad Jose N.
Published: February 2003

OBJECTIVE:

To evaluate results of revision stapedectomy with and without use of the laser and determine factors predictive of hearing outcome.

STUDY DESIGN AND SETTING:

Retrospective review of 356 revision stapedectomy operations performed at the House Ear Clinic, a tertiary neurotologic private practice, between 1983 and 1995.

RESULTS:

A postoperative gap of <10 dB was obtained in 60% of cases. Results were similar with and without the use of a laser. Sensorineural hearing loss of >10 dB occurred in 7.7%, with 3 (1.4%) ears with profound hearing loss. A poorer outcome was related to incus necrosis, multiple revisions, and indications for surgery other than conductive hearing loss.

CONCLUSION:

Revision stapedectomy can provide good gap closure in 60% of cases, with small risk of sensorineural hearing loss.

SIGNIFICANCE:

Although not as satisfactory as primary stapedectomy, revision stapedectomy can be offered to patients with reasonable expectations for good gap closure.
A meta‐analysis of dexamethasone use with tonsillectomy
Authors: Goldman Andrew C. , Govindaraj Satish , Rosenfeld Richard M.
Published: February 2003

OBJECTIVE:

To determine the quantitative impact of intravenous dexamethasone on recovery after ton‐sillectomy using established principles for meta‐analysis.

STUDY DESIGN/SETTING:

Double‐blind randomized‐control trials in which subjects were treated identically except for the presence or absence of peri‐operative intravenous dexamethasone. Six articles met inclusion criteria. Two investigators extracted data regarding postoperative emesis and return to a soft/regular diet.

RESULTS:

Pooled analysis using a random effects model revealed a 27% decrease (P < 0.00001) in postoperative emesis attributable to dexamethasone (95% CI, 12% to 42%). Dexamethasone increased the tolerance of a soft/regular diet at 24 hours by 22% (P < 0.001), but studies were heterogenous with low precision (95% CI, 1% to 44%).

CONCLUSION:

To prevent emesis in 1 child after tonsillectomy, approximately 4 children must receive perioperative dexamethasone. An additional benefit is earlier tolerance of a soft/regular diet, but low precision and heterogeneity among studies preclude definitive conclusions.

SIGNIFICANCE:

Perioperative dexamethasone administration had a positive impact on recovery from tonsillectomy.
Correlation between Ki‐67 index and some clinical aspects of acoustic neuromas (vestibular schwannomas)
Authors: Niemczyk Kazimierz , Vaneecloo Francois Michel , Lecomte Martine Houcke , Lejeune Jean Paul , Lemaitre Laurent , Skarzynski Henryk , Vincent Christophe , Dubrulle Frederique
Published: February 2003

Evaluation of the proliferation activity of neuromas has a practical meaning when there are doubts about the complete resection of the tumor. Evaluation of the clinical aspects connected with increased proliferation activity may have a much broader application. The aim of this study was to correlate selected clinical and radiologic aspects of vestibular schwannomas with the results of the Ki‐67 index. The studied group included 23 males and 20 females. Unilateral neuromas were stated in 38 cases (mean age, 52.2 years) and bilateral tumors in 5 cases (mean age, 44.2 years). The immunohisto‐chemical tests (Ki‐67) were performed on the specimens preserved in formalin and stored in paraffin. The Ki‐67 index was estimated in a semiquantitative study. The mean value of Ki‐67 index was 1.86%. In case of unilateral neuromas (n = 38), the average Ki‐67 index was 1.74%. In 5 cases of bilateral tumors, the index amounted to 2.79% (P = 0.278). No significant correlation was found by comparing the value of the Ki‐67 index with the age of patients (P = 0.410: r = 0.128). Significant differences in the value of the Ki‐67 index were noted in the subgroups of tumors that were evaluated radiologically as growing and stable. The mean value of Ki‐67 index was 3.17% in the first subgroup; in stable neuromas, it was significantly lower, amounting to 1.11% (P = 0.020). Such results may confirm that the growth rate of vestibular schwannomas varies and may explain the difficulties in estimating the growth of neuromas on the basis of clinical aspects only.
Management of Bilateral Vocal Fold Paralysis: Experience at the University of Athens
Authors: Segas John , Stavroulakis Pelagia , Manolopoulos Leonidas , Yiotakis John , Adamopoulos George
Published: February 2003

The treatment of patients with vocal fold paralysis presents a challenge to the otolaryngologist‐head and neck surgeon. Many techniques have been proposed to manage individuals with unilateral or bilateral vocal fold paralysis. We herein describe the experience of our department in dealing with bilateral vocal fold paralysis. At the University of Athens, patients presenting with symptomatic bilateral paralysis are treated with a posterior cordectomy by using the CO2 or KTP‐532 laser. During the last 5 years, we have treated 20 patients (8 men and 12 women) presenting with symptomatic bilateral vocal fold paralysis. For augmentation of the glottic airway, a modification of Kashima's cordotomy was used, completing a partial posterior cordectomy of one or both true and false vocal folds with the CO2 laser (15 patients) and the KTP‐532 laser (5 patients). An elective tracheotomy was done before the cordotomy. Complications, such as infection, stridor, or dyspnea, were minimal. Although no objective voice analysis was performed, all patients were able to communicate without any phonation device and were satisfied with the result of the surgery. When compared with other techniques, the advantages offered by the posterior cordectomy included rapidity and simplicity in concept, reliability of outcome, short hospitalization, low risk of complications, and the possibility for revision when necessary (posterior cordectomy). From the successful postsurgical results of this study, it can be concluded that the posterior cordectomy is a reliable treatment option for the management of patients with bilateral vocal fold paralysis. (Otolaryngol Head Neck Surg 2001; 124:68–71.)