bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Laser Contraction Myringoplasty for Tympanic Membrane Atelectasis*
Authors: Ostrowski Vincent B. , Bojrab Dennis I.
Published: September 2022

OBJECTIVE

We sought to develop a minimally invasive surgical technique using the CO2 laser to reduce or eliminate tympanic membrane atelectasis in a select group of patients.

STUDY DESIGN

Thirty‐seven ears with varying degrees of tympanic membrane atelectasis underwent CO2 laser myringoplasty with the patients under intravenous sedation in the operating room setting. Atelectasis severity was graded for each patient and documented before and after laser myringoplasty through photodocumentation. Patients were followed for 1 year with comparison tympanic membrane photography.

SETTING

The study was conducted in a tertiary care private otology‐neurotology practice.

RESULTS

Laser myringoplasty significantly reduced retraction pocket severity in most patients. No patients required resection of the retraction pocket or tympanoplasty. The most favorable outcomes were observed in patients with atelectasis addressed early rather than later in its more advanced stages.

CONCLUSION

Laser contraction myringoplasty can reduce or eliminate atelectatic areas of the tympanic membrane through immediate contraction and “tightening” of the tympanic membrane tissues. Clinicians should use a standardized tympanic membrane atelectasis grading format.

SIGNIFICANCE

A minimally invasive surgical technique for addressing tympanic membrane atelectasis is described, and a tympanic membrane at‐electasis grading system is presented based on size, location, and depth of the atelectatic region.
A Randomized Trial of Temperature‐Controlled Radiofrequency, Continuous Positive Airway Pressure, and Placebo for Obstructive Sleep Apnea Syndrome
Authors: Woodson B. Tucker , Steward David L. , Weaver Edward M. , Javaheri Shahrokh
Published: September 2022

OBJECTIVE

The study goal was to determine the effectiveness of (1) multilevel temperature‐controlled radiofrequency tissue ablation (TCRFTA) or (2) continuous positive airway pressure (CPAP) for the treatment of mild to moderate obstructive sleep apnea syndrome (OSAS).

STUDY DESIGN AND METHODS

We conducted a randomized, placebo‐controlled, 2‐site trial, comparing TCRFTA (n=30) and CPAP (n=30) with sham‐placebo (n=30) using intention‐to‐treat analysis.

RESULTS

Compared with pretreatment baseline, TCRFTA improved reaction time, OSAS‐specific quality of life (QOL), and subjective sleepiness (all P < 0.05). Compared with sham‐placebo, TCRFTA improved QOL, airway volume, apnea index, and respiratory arousal index (all P < 0.05). TCRFTA side effects and complications were mild, temporary, and similar to sham‐placebo. CPAP improved QOL and sleepiness compared with baseline and QOL when compared with sham‐placebo (all P < 0.05). Significant differences were not seen between TCRFTA and CPAP outcomes.

CONCLUSION

TCRFTA and CPAP each improve QOL for mild‐moderate OSAS patients. TCRFTA improvements may result from changes in airway volume, apnea index, and respiratory arousal index.
Treatment outcome of N3 nodal head and neck squamous cell carcinoma
Authors: Chan Sor W. , Mukesh Bickol N , Sizeland Andrew
Published: September 2022

OBJECTIVE

The aim of this study was to investigate the treatment outcome of N3 nodal disease.

STUDY DESIGN

A single institution retrospective nonrandomized study was conducted. A total of 53 patients with primary presentation of squamous cell carcinomas from various head and neck sites from 1980 to 1994 were recruited for this study. Eight patients with nasopharyngeal cancers who underwent treatment with palliative intent were excluded from the study. Treatment options were broadly divided into 4 treatment categories; postoperative radiotherapy; preoperative radiotherapy; surgery alone; and chemotherapy pre‐ or postoperatively with or without radiotherapy.

RESULTS

Mean age of the participants was 63 years (SD = 8.2); 93% were men. Median follow‐up period was 12 months (range, 5 to 184 months). Of the 45 N3 patients, 21 patients had a recurrence in the neck after treatment, with 1 in the contralateral neck. The overall rates of control in the neck at 1, 3, and 5 years were 73.1%, 34.6%, and 26.9%, respectively. The 1, 3, and 5‐year neck control rates for each main group were 92.3%, 46.1%, and 46.1% with postoperative radiotherapy; 66.7%, 33.3%, and 11.1% with preoperative radiotherapy and 33.3%, 0%, and 0% with surgery alone. Overall survival rates at 1,3, and 5‐years were 52.8%, 25%, and 22.2%. Survival rates in those who received radiotherapy were better than those who only had surgery. The 5‐year survival rate was significantly higher for those who had postoperative radiotherapy (38.9%) compared with patients who had preoperative radiotherapy (9.1%) and surgery alone (0%).

CONCLUSION

Our treatment outcomes, particularly those in the group receiving postoperative radiotherapy, were similar to other studies. The prognosis of N3 neck disease was poor but improved with radiotherapy, particularly postoperative radiotherapy. The role of definitive chemotherapy and/or radiotherapy and salvage surgery is difficult to evaluate as the results are inconsistent and the available data are limited. Future studies in particular with quality of life assessment are needed to evaluate the management of N3 head and neck cancer.
Congenital aural atresia surgery: Long‐term results
Authors: De La Cruz Antonio , Teufert Karen Borne
Published: September 2022

OBJECTIVES

The study goal was to evaluate the stability of hearing results from short‐ to long‐term follow‐up in patients who underwent surgery for congenital aural atresia. We also reviewed complications such as external auditory canal stenosis, lateralization and perforation of the tympanic membrane, sensorineural hearing loss, and facial palsy.

METHODS

We conducted a retrospective chart review of 116 patients who underwent congenital aural atresiaplasty between 1985 and 2002 at the House Ear Clinic. There were 116 atretic ears. Complication rates and short‐ and long‐term (up to 13.6 years) hearing results were evaluated for primary and revision cases.

RESULTS

Closure of the air‐bone gap (ABG) to 30 dB or less at short‐term follow‐up occurred in 58.5% of primary surgeries and 56% of revisions. The long‐term postoperative ABG was 30 dB or less in 50.8% of the primary cases and 39.1% of the revisions. Paired comparison analysis found no significant change in ABG from short‐ to long‐term follow‐up for either primary or revision cases. Soft tissue stenosis was seen in 8% of primary surgeries and 3.4% of revisions. Ossicular chain refixation was seen in 11.5% and 6.9% of primary and revision surgeries, respectively. There were no dead ears.

CONCLUSION

Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results with a low incidence of complications.
Middle ear epithelial mucin production in response to interleukin 1β exposure in vitro
Authors: Kerschner Joseph E. , Meyer Tanya K. , Wohlfeill Eric
Published: September 2022

OBJECTIVES

To investigate the role of the inflammatory cytokine interleukin‐1β (IL‐1β) in the regulation of mucin secretion by middle ear epithelia.

STUDY DESIGN AND SETTING

Primary chinchilla middle ear epithelial cultures were established and exposed to IL‐1β in a dose‐ and time‐dependent manner. Mucin secretion was characterized by exclusion chromatography and liquid scintillation.

RESULTS

Epithelial cultures exposed to increasing doses of IL‐1β demonstrated greater amounts of mucin secretion (P = 0.007). Additionally, cultures exposed to IL‐1β at 50 ng/mL showed increased secretion of mucin over control noticeable at 6 hours, but significant at the 15‐ and 24‐hour time points (P >. 0001 for each).

CONCLUSIONS

IL‐1β upregulates mucin secretion from cultured middle ear epithelial cells in a dose‐and time‐dependent manner.

SIGNIFICANCE

Elucidating the effect of specific cytokines on the regulation of mucin secretion is vital to understanding the pathophysiology of otitis media and the development of novel therapeutic strategies.
Endoscopic Modified Lothrop Procedure for the Treatment of Chronic Frontal Sinusitis: A Systematic Review
Authors: Scott N. Ann , Wormald Peter , Close David , Gallagher Richard , Anthony Adrian , Maddern Guy J.
Published: September 2022

OBJECTIVE

We sought to assess the safety and efficacy of the endoscopic modified Lothrop procedure (EMLP), performed either wholly intranasally or in combination with an external approach, against the osteoplastic flap (OPF) procedure with or without fat obliteration.

METHODS

All original, published studies on the EMLP and the OPF, with or without fat obliteration, were identified by searching Current Contents, Em‐base, MEDLINE, and The Cochrane Library. The search strategy for OPF was date‐restricted to articles published after 1979 until February 2001. For both EMLP and OPF, only studies of patients diagnosed with chronic frontal sinusitis were included for review. English‐language reports detailing randomized controlled trials, controlled clinical trials, case series, or case reports were included.

RESULTS

The limited comparative data suggested that EMLP caused fewer adverse postoperative outcomes but was more likely to generate a perioperative cerebrospinal fluid leak than OPF. However, none of the morbidity traditionally associated with OPF was evident after EMLP. EMLP appeared to have a shorter operative time and a lower perioperative blood loss than OPF, but little could be determined regarding the long‐term efficacy and durability of EMLP because of the relatively short follow‐up of the majority of the studies.

CONCLUSION

The evidence base for EMLP was deemed inadequate to assess its safety and efficacy, and an audit of the procedure was recommended. Additional clinical recommendations were made regarding the development and current practice of EMLP during this audit phase.
The Role of Chromosomal Translocation (15;19) in the Carcinoma of the Upper Aerodigestive Tract in Children
Authors: Rahbar Reza , Vargas Sara O. , Miyamoto Christopher R. , Perez‐Atayde Antonio R. , French Christopher A. , Robson Caroline D. , Licameli Greg R. , Fletcher Jonathan A. , Marcus Karen C. , Grier Holcombe E. , McGill Trevor J. , Healy Gerald B.
Published: September 2022

OBJECTIVE

To further evaluate the role of chromosomal translocation (15;19) in the presentation of the carcinoma (CA) of the upper aerodigestive tract.

STUDY DESIGN AND SETTING

A retrospective study at a tertiary care pediatric medical center.

RESULTS

Seven patients with a mean age of 12 years presented with CA of nasopharynx (N = 2), sinonasal region (N = I), parotid gland (N = 2), or larynx (N = 2). Treatments included combinations of surgery (N = 5), chemotherapy (N = 5), and radiation therapy (N = 4). One patient with sinonasal CA and one patient with laryngeal CA had chromosomal translocation (15;19); these patients both died of their disease with a mean survival of 6 months. The 5 patients without translocation (15;19) responded well to treatment and are disease‐free with a mean follow‐up of 47 months.

CONCLUSION

The preliminary results appear to indicate poor prognosis associated with the presentation of chromosomal translocation (15;19) despite aggressive multi‐modality treatment. Further investigation is needed to better understand the cause and relationship of the translocation (15;19) and aggressive behavior of these tumors. (Otolaryngol Head Neck Surg 2003;129:698‐704.)
Gastroesophageal Reflux Disease: Symptoms Versus pH Monitoring Results
Authors: Yorulmaz Irfan , Ozlugedik Samet , Kucuk Babur
Published: September 2022

OBJECTIVES

The reason why some patients with gastroesophageal reflux disease (GERD) have symptoms of upper aerodigestive system irritation, while others mainly have gastroenterologic symptoms, is not well established. This retrospective case series study was designed to examine the existence of a correlation between symptoms and reflux characteristics, based on data obtained from esophageal pH monitoring.

METHODS

The study population consisted of 139 patients; 97 patients presented with laryngopharyngeal symptoms of GERD, including unexplained hoarseness, throat clearing, chronic cough, laryngospasm, globus, throat pain, and 42 patients presented with gastroenterologic symptoms, including heartburn and regurgitation. The results of 24‐hour, double‐channel ambulatory esophageal pH monitoring were analyzed comparing 2 symptom groups. The incidence of abnormal acid reflux at the upper and lower esophageal segments and the effects of upright and supine positions on reflux parameters were evaluated.

RESULTS

The incidence of laryngopharyngeal reflux was significantly higher in the laryngopharyngeal symptom group than in the other (52% versus 38%). The patients with laryngopharyngeal reflux from both groups showed no significant differences in terms of number of acid reflux episodes, percentage of times pH was <4, and esophageal acid clearance. Upright and supine parameters did not show significant differences between the patient groups. Upright acid reflux episodes were, however, common in both groups at the lower esophageal and laryngopharyngeal segments.

CONCLUSION

Recent studies suggesting that otolaryngologic patients commonly show upright, daytime reflux with normal esophageal clearance and that typical GERD patients commonly have supine, nocturnal reflux with prolonged esophageal clearance are not supported by this study. This study indicates that acid reflux parameters and positional changes are not sufficient to explain why patients with GERD experience different symptoms. The regional symptoms of GERD may be attributed to the impairment of epithelial resistance, motor activity, and buffering systems for the esophageal antireflux barrier.
Intractable Epistaxis: Transantral Ligation vs. Embolization: Efficacy Review and Cost Analysis
Authors: Strong E. Bradley , Bell D. Antonio , Johnson Leland P. , Jacobs John M.
Published: September 2022

After posterior nasal packing, the two most common therapies for Intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We retrospectively reviewed the charts of 21 patients treated for intractable epistaxis and obtained data on presentation, risk factors, treatment, success rates, complications, and cost. Twelve patients received percutaneous embolization, five underwent transantral ligation, and four required both. The success rates for transantral ligation and percutaneous embolization were 89% and 94%, respectively. No mortality or serious morbidity occurred with either technique. A cost comparison revealed that transantral ligation was moderately less expensive than percutaneous embolization ($5941 vs. $6783). Although some authors advocate transantral ligation or percutaneous embolization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable procedures with specific strengths and weaknesses. We present our experience and a review of the literature, highlighting the indications and advantages of each technique. We conclude that the choice of treatment modality should be based on the benefits of each procedure as it pertains to the specific needs of the individual patient.
Clinical Viral Infections and Temporal Bone Histologic Studies of Patients with AIDS
Authors: Davis Larry E. , Rarey Kyle E. , McLaren Leroy C.
Published: September 2022

The brain, eye, and inner ear are each protected from blood‐borne infectious agents by a barrier that has some anatomic and functional differences. In patients with AIDS, opportunistic infections of the central nervous system and eye are frequent. Little is known about the incidence of middle and inner ear infections in patients with AIDS, but deafness and severe vertigo are uncommon. We studied 14 homosexual men with AIDS, aged 28 to 55 years, for 1 to 2 years until death. No patient had deafness, but one had vertigo. Adenovirus type 6 and cytomegalovirus were isolated from the middle ear cavity in four patients. Temporal bone histology demonstrated acute otitis media in four, chronic otitis media in two, and serous otitis media in three. Adenovirus type 6 and cytomegalovirus, either alone or with herpes simplex virus type 1, were isolated from inner fluids of three patients. Histologic inner ear findings were abnormal in only one patient. Viruses were isolated or histologically identified in the brains of four patients and in the eyes of five patients. In our patients viral infections were nearly as common in the inner ears as in the brain and eye, suggesting that protection from the blood‐labyrinth barrier was similar to that from the other barriers. Because the inner ear viral infections were asymptomatic and there was an absence of pathologic damage and inflammation, we suggest that some viral inner ear infections in patients with AIDS are nonpathogenic and elicit no inflammation or that the viral infections occur terminally and elicit no inflammation because of immunosuppression from the AIDS.
Attitudes, Knowledge, and Practices of Otolaryngologists Treating Patients Infected with HIV
Authors: Hwang Peter H. , Tami Thomas A. , Lee Kelvin C. , Raven Raymond B.
Published: September 2022

The AIDS epidemic has become one of the most important public health problems of this century. As the prevalence of HIV infection continues to rise, health care practitioners in all geographic regions can expect greater clinical exposure to patients infected with HIV. We conducted an anonymous survey of all practicing otolaryngologists in Ohio and California to investigate regional differences in attitudes, knowledge, and practices regarding the care of patients infected with HIV. We also examined the data with respect to year of completion of residency training to identify differences in attitudes or practices among otolaryngologists who trained in the era of AIDS (post‐1982 graduates) in comparison with their predecessors (pre‐1982 graduates). In comparison with Ohio otolaryngologists, California otolaryngologists reported more frequent clinical encounters with HIV‐infected patients and displayed significantly better knowledge regarding the otolaryngologic aspects of HIV infection. Californians were more likely to support the right of an HIV‐infected physician to maintain an unrestricted practice and would be less likely to disclose their HIV status to their patients and hospital if they were to become infected with HIV. Post‐1982 graduates had more frequent encounters with HIV‐infected patients than did pre‐1982 graduates and demonstrated a better fund of knowledge. Although Californians were more likely than Ohioans to routinely double glove in surgery, the overall double gloving rate was low at 21%. Californians were no more likely than Ohioans to routinely use protective eyewear, water‐impervious gowns, or indirect instrument‐passing techniques in surgery. No differences were observed in prevalence of protective surgical precautions between pre‐1982 and post‐1982 graduates. The results of the survey indicate a need for broader acceptance and use of “universal” surgical precautions among otolaryngologists.
Intranasal anesthetic effects of lidocaine and tetracaine compared
Authors: Noorily Allen D. , Otto Randal A. , Noorily Susan H.
Published: September 2022

The quality of nasal anesthesia obtained with two local anesthetic solutions (2% lidocaine in oxymetazoline and 1% tetracaine in oxymetazoline) was evaluated in this double‐blind, randomized study. Each local anesthetic mixture was applied to the nasal septum of healthy volunteers with medication‐soaked pledgets. Measurements of anesthetic effect (sensation threshold and pain perception) were made with Semmes‐Weinstein monofilaments (North Coast Medical, San Jose, Calif.). Measurements were performed before local anesthetic application and at 10 and 70 minutes after local anesthetic application. Subjects had greater increases in sensation threshold with tetracaine than with lidocaine at both 10 and 70 minutes (p = 0.0005 and p = 0.0001, respectively). Subjects had greater decreases in pain perception with tetracaine than with lidocaine at both time intervals (p = 0.0003 and p < 0.0001, respectively). Tetracaine mixed with oxymetazoline appears to be a superior topical anesthetic for nasal procedures.
Modified transnasal endoscopic lothrop procedure as an alternative to frontal sinus obliteration
Authors: Gross William E. , Gross Charles W. , Becker Daniel , Moore David , Phillips Douglas
Published: September 2022

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow‐up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.
Evaluation of the hall‐effect sensor for determination of eyelid closure in vivo
Authors: Hamiel Steven R. , Bleicher Joel N. , Tubach Martin R. , Cronan James C.
Published: September 2022

A small device to detect eyelid closure was designed on the basis of a Hall‐effect sensor. Accurate sensing of normal eyelid closure is required to develop a prosthetic eyelid closure device for patients with paralyzed orbicularis oculi muscles. In this study, six rabbits had the sensors surgically implanted. A Hall‐effect sensor, a small device that measures magnetic fields, was implanted in the inferior eyelid near the ciliary margin. An opposing magnet was implanted in the upper eyelid. Thus, as the eyelid closes, the output of the Hall‐effect sensor will increase. This output voltage was monitored weekly. During the first 5 weeks the output of the Hall‐effect sensor decreased slightly but then reached a steady state for the duration of the experiment. This study suggests that the Hall‐effect sensor could be used to detect normal eyelid closure in an implantable facial reanimation device.
Detection of epstein‐barr virus genome in sinonasal undifferentiated carcinoma by use of in situ hybridization
Authors: Gallo Oreste , Di Lollo Simonetta , Graziani Paola , Gallina Ezio , Baroni Gianna
Published: September 2022

Associations between Epstein‐Barr virus and undifferentiated carcinomas of nasopharynx, parotid gland, and thymus have recently been reported. Epstein‐Barr virus has also been associated with malignant lymphoma of the nose and paranasal sinuses. These findings raise the possibility that Epstein‐Barr virus may additionally be linked to undifferentiated carcinoma of the nose and paranasal sinuses (SNUC), an uncommon but distinctive and highly aggressive neoplasm. Histologically, SNUC consists of small and medium cells, the precise characterization of which often requires immunocytochemical analysis. This study investigates the presence of DNA sequences of Epstein‐Barr virus in biopsy specimens of 13 cases of SNUC that were defined immunocytochemically by use of previously reported criteria. In situ hybridization was used to detect Epstein‐Barr virus genome in different cell types in routinely processed, paraffin‐embedded tissues. Epstein‐Barr virus‐specific DNA sequences were detected in tumor cells of SNUC specimens from 5 of the 13 cases examined. No correlation was found between positive hybridization and primary tumor site, morphologic subtype, or disease course. Epstein‐Barr virus DNA was detected in 38% (5 of 13) of the SNUC samples analyzed. This finding suggests that this virus may play a role in the pathogenesis of this rare neoplasm.
Distribution of C cells in the thyroid gland with pyriform sinus fistula
Authors: Himi Tetsuo , Kataura Akikatsu
Published: September 2022

A pyriform sinus fistula can cause acute thyroiditis or recurrent infection in the neck. This fistula is believed to be a remnant of the branchial apparatus, although its origin has yet to be pinpointed. The spatial distribution of C cells in the thyroid gland was mapped by immunohistologic method in four patients with a pyriform sinus fistula. The C cells were identified immunohistologically with anticalcitonin antibody. The stained calcitonin‐positive cells also crossreacted with the antibodies to carcinoembryonic antigen, chromogranin A, and neuron‐specific enolase. The C cells were mainly distributed near the end of the fistula, and in three patients their concentration per unit volume of thyroid tissue was found to be inversely proportional to the distance from the end of the fistulas. Comparison of distant locations of the left‐sided thyroid lobe in patients and the same region in control subjects showed a similar number of C cells. Thus this limited distribution of C cells suggested that the pyriform sinus fistula was either a remnant of the ultimobranchial body, the result of disturbed migration of the C cell in the fetus, or both.
Contemporary vestibular function testing: Accomplishments and future perspectives
Authors: Honrubia Vicente
Published: September 2022

The development of a standard test battery for the evaluation of vestibular function required a variety of preliminary investigations about the technical and physiologic foundations of the tests. The most important technologic development was the creation of computerized methods, including hardware and software capabilities. The designs of tests were based on physiologic and diagnostic considerations, as demonstrated in experiments on normal subjects and patients. Although time tested and sound, the available test battery satisfies only a limited number of requirements for comprehensive evaluation of vestibular function. This article describes the list of accomplishments, the state of the present limitations, and the needs for the future.
Positional vertigo related to semicircular canalithiasis
Authors: Epley John M.
Published: September 2022

My clinical and laboratory observations support the theoretical concept that the mechanism of typical nystagmus, and most forms of atypical transient nystagmus, is hydrodynamic drag by gravitating free densities‐most commonly displaced otoconia‐in the endolymph of a semicircular canal; and that these “canaliths” have a significant mechanical advantage, by virtue of the canal/ampulla cross‐sectional differential, over densities acting directly on the cupula. Positional vertigo related to apparent canalithiasis (benign paroxysmal positional vertigo) is a common cause of incapacitation. The profile of the concomitant nystagmus localizes the semicircular canal involved. The canalith repositioning procedure, appropriately administered and targeted according to the observed nystagmus, provides a highly effective means for control of symptoms and a valuable resource for diagnostic evaluation of the more complex case. Surgery is rarely indicated.
Early Speech Changes in Children with Multichannel Cochlear Implants
Authors: Te Gabriel O. , Hamilton Margaret J. , Rizer Franklin M. , Schatz Kimberly A. , Arkis Peter N. , Rose Heather C.
Published: September 2022

A number of studies have demonstrated that cochlear implants provide an improved auditory signal and enhance the development of speech‐perception and production skills for profoundly deaf children. However, exactly when these early speech skills begin to develop remains unclear. To explore this issue, we observed, for a 1‐year period, four prelingually deaf children who underwent implantation consecutively within 1 month of each other, and we paid particular attention to the first few months of rehabilitation. We found immediate speech scores as early as the first day of implant tune‐up. Speech production continued to improve rapidly throughout the first 4 months but exhibited a generally slower rate of progress in some of the speech‐production skills at 1 year. We also found vowel‐production skills to be the easiest to achieve, with word‐pattern recognition and consonant voicing of intermediate difficulty. Consonant placing and manner of consonant production were the hardest skills to achieve. Results of speech‐perception tests 1 year after implantation were markedly improved over preimplantation levels in three of the four children. These early speech changes stress the need for maximization of the capability of the cochlear implant by institution of immediate and intensive speech rehabilitation efforts for prelingually deaf children.
Effect of Temperature Elevation on Rabbit Cochlear Function as Measured by Distortion‐Product Otoacoustic Emissions
Authors: Noyes Willard S. , McCaffrey Thomas V. , Fabry David A. , Robinette Martin S. , Suman Vera J.
Published: September 2022

Low‐intensity laser stapedotomy has been shown to produce temperature elevations of 3° to 4° C within the cochlea. This study investigates the effect of temperature elevations in this range on cochlear outer hair cell function by use of distortion‐product otoacoustic emissions in rabbits. Using esophageal temperature monitoring, we compared 2f1‐f2 distortion‐product otoacoustic emissions over a range of frequencies (1806 to 8691 Hz) at rabbit normothermia, normothermia plus 3° C, and normothermia after passive cooling. Cochlear temperature was found to exceed changes in esophageal temperature by as much as 1.2° C. We found that a maximum of 3° C elevation in esophageal temperature did not permanently impair outer hair cell function in the rabbit cochlea. Results of this study suggest that moderate changes in cochlear temperature, such as those produced by low‐intensity CO2 and holmium‐yttrium aluminum garnet lasers, may not produce irreversible thermal damage to the cochlear outer hair cells.
Legacy of Lead Exposure: Consequences for the Central Nervous System
Authors: Cory‐Slechta Deborah A.
Published: September 2022

The central nervous system appears to be the primary target organ for lead. Children in particular remain at risk for the central nervous system effects of lead, not only in many American cities but also in numerous developing countries where the use of leaded gasoline continues. Those same children, moreover, may sustain many of the risk factors, such as low socioeconomic status and calcium and iron insufficiencies, known to exacerbate the manifestations of lead exposure, including its central nervous system effects. Physiologic conditions associated with bone resorption, including pregnancy, lactation, and aging can also potentiate the central nervous system effects of lead and enhance exposure of adults. Questions regarding safe and efficacious diagnosis and treatment of elevated lead burden, particularly as they relate to central nervous system‐based effects of lead have recently been raised. Clearly, greater education of and awareness in the medical community are needed for recognition of problems accruing from lead exposure.
Psychiatric Aspects of Air Pollution
Authors: Lundberg Ante
Published: September 2022

Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well‐being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Manifestations are often insidious or delayed, but they can provide a more sensitive indicator of toxic effects than cancer rates or mortality data. Other medical effects of air pollution, such as asthma, can indirectly affect psychological health. The sick building syndrome and multiple chemical sensitivity are conditions with toxicologic and psychiatric aspects. Psychosocial stress can cause symptoms similar to those of organic mental disorders. Reactions to stress depend on cultural, individual, and situational variables. We must understand these factors to be able to alleviate and prevent the consequences of environmental trauma. Expanded research is recommended in three main areas: (1) how people perceive and cope with environmental health risks, (2) the effects of air pollution on behavior and neuropsychological functioning, and (3) neurotoxicologic evaluation of air pollutants with both behavioral and in Vitro Studies.
Effect of Air Pollution in Asthma and Respiratory Allergy
Authors: Peden David B.
Published: September 2022

Epidemiologic and controlled exposure studies of human volunteers have shown that exposure to a variety of pollutants induces asthma exacerbations. Interestingly, in the case of ozone, recent evidence suggests that this pollutant acts to enhance the effect of inhaled allergen in persons with asthma. These and other data also suggest that pollutants may influence lung function in persons with asthma by increasing airway inflammation. The interaction of pollutants and inhaled allergens and the effect of pollutant exposure on baseline airway inflammation may be a key mechanism of pollutant‐induced exacerbation of asthma. Further study of this interaction, as well as interactions of multiple pollutants, will be crucial for rational development of intervention and regulatory strategies.
Quantitative Evaluation of Fine‐Needle Aspiration
Authors: Cannon C. Ron , Richardson Douglas , Replogle William , Halloran Rosa
Published: September 2022

A protocol was developed to obtain mature lymphocytes from freshly harvested tonsils by a combination of 5‐, 10‐, and 20‐ cm3syringes and 21‐, 23‐, and 27‐gauge needles. The cells were then suspended in Earle's balanced salt solution and counted with an automated cell counter. Cell counts for each study group was compared as a function of needle and syringe size. The range of harvested cells was 900 to 2800 cells per cubic millimeter, allowing adequate cellular material for diagnostic purposes. The amount of negative pressure for each syringes/needle combination was measured with a manometer. Pressures ranged from –500 to –700 cm of H2O pressure. In this particular study, fine‐needle aspiration with a 20‐cm3syringe and 21‐gauge needle yielded the best results.
Levels of Eosinophil Cationic Protein and Myeloperoxidase from Chronic Middle Ear Effusion in Patients with Allergy and/or Acute Infection.
Authors: Hurst David S. , Venge Per
Published: September 2022

BACKGROUND AND OBJECTIVE: Allergy may play a role in the middle ear inflammation that leads to otitis media with effusion. The purpose of this study was to determine whether an elevated mediator correlated with the patient's disease and thus could be used to differentiate allergy vs. infection as the cause of the middle ear inflammation.

METHODS: We evaluated 57 individuals with otitis media with effusion, 32 with persistent effusion but no recent acute infection, 14 with recent infection and purulent otitis media with effusion, and 11 healthy subjects. The mediator activity of eosinophils and neutrophils in effusion was studied in patients characterized as having allergy by positive intradermal skin test results and positive radioallergosorbent test results. Eosinophils were characterized by measurement of eosinophil cationic protein in the effusion. Neutrophils were characterized by measurement of myeloperoxidase in the effusion. The levels of eosinophil cationic protein and myeloperoxidase in patients with and without allergy were correlated to patient history.

RESULTS: Significantly elevated levels of both eosinophil cationic protein and myeloperoxidase indicated that inflammation in the ear of patients with otitis media with effusion was characterized by a pronounced involvement of both eosinophils and neutrophils. Eighty‐nine percent of all patients with disease had allergy. A higher ratio of myeloperoxidase to eosinophil cationic protein in patients with purulent otitis media with effusion indicated that in patients with a superimposed acute infection, neutrophil activity was increased even further. The level of eosinophil cationic protein was elevated only during the effusion of patients with allergies as compared with controls (p < 0.01). Among 29 cases of nonpurulent otitis media with effusion, 96.5% had allergic immune‐mediated disease proved by skin testing, which was related clinically to their ear disease. Eighty‐nine percent (89.6%) of these patients had eosinophil cationic protein levels greater than 10 μg/L.

CONCLUSION: Middle ear eosinophil cationic protein may be used as a marker of related allergy.
Submandibular Swelling in Patients with Fibrodysplasia Ossificans Progressiva
Authors: Janoff Hal B. , Zasloff Michael A. , Kaplan Frederick S.
Published: September 2022

Fibrodysplasia ossifcans progressiva (FOP) is a rare genetic disorder characterized by congenital malformation of the great toes and by progressive heterotopic ossification of soft tissues. Although ankylosis of the temporomandibular joint occurs commonly in the late stages of the disease, only one well‐documented case of submandibular heterotopic ossification in a patient who had FOP exists. Twelve (11%) of our 107 patients who have FOP had submandibular heterotopic ossification that was mistaken initially in seven of the patients for mumps, angioneurotic edema, abscess, mononucleosis, or neoplasm. Two male patients and 10 female patients ranging in age from 6 to 47 years (mean, 21 years) were studied. Ten patients survived following assiduous precautionary measures. One patient who required emergency tracheostomy and ventilatory support also survived. Another patient died of inanition from chronic swallowing difficulty. An effective treatment program includes early identification of the submandibular flare‐up, nutritional support, and glucocorticoid therapy. Submandibular swelling in patients who have FOP can be a medical emergency and requires intensive precautionary measures to avoid catastrophic clinical deterioration. These measures include avoidance of lesional manipulation, airway monitoring, and aspiration precautions. Submandibular swelling should be recognized as a variable feature of FOP.
Dorsal Cochlear Nucleus Blood Flow During Acoustic Stimulation
Authors: Quirk Wayne S. , Goldwyn Benzion G. , Meleca Robert J. , Kaltenbach James A.
Published: September 2022

Dynamic in vivo changes in dorsal cochlear nucleus blood flow during pure‐tone stimulation were assessed with intravital microscopy. Subjects were stimulated with 5‐, 10‐, or 15‐kHz pure tones at 70, 80, and 90 dB sound pressure level. Measurements in red blood cell velocity and vessel diameter were made in capillaries overlying the 10‐kHz isofrequency band of the dorsal cochlear nucleus. Stimulation with 10 kHz induced intensity‐dependent increases in local blood flow in the 10‐kHz isofrequency band of the dorsal cochlear nucleus. Stimulation with 5 kHz and 15 kHz, frequencies represented in remote locations on the dorsal cochlear nucleus surface, did not significantly alter blood flow in the defined 10‐kHz isofrequency band. These data demonstrate a direct relationship between spectral and intensity‐dependent pure‐tone stimulation of the dorsal cochlear nucleus and increases in local blood flow. These findings suggest that tonal stimulation of the dorsal cochlear nucleus induces an increase in local metabolic demands with resultant rapid blood flow increases.
Use of the Melolabial Flap in Intraoral Reconstruction
Authors: Roth Jeffrey , Patete Michael , Goodwin W. Jarrard
Published: September 2022

Functional reconstruction of the oral cavity after tumor ablation is challenging. A variety of methods are available for reconstruction including primary closure, skin grafts, local cutaneous flaps, musculocutaneous flaps, and free flaps. Appropriate reconstruction addresses the size, location, and tissue needs of the defect. The melolabial flap allows for reliable and effective intraoral reconstruction with minimal donor morbidity, making it ideal for select defects. From 1989 to 1993 16 patients aged 51 to 81 years underwent reconstruction of intraoral defects with 24 melolabial flaps. Twenty‐two flaps survived without complication and two flaps failed, for success rate of 91.7%. The two failed flaps occurred in the same patient. Of the remaining patients 8 had prior radiation therapy and 11 had prior or concomitant neck dissections. The flaps were used to reconstruct 13 floor‐of‐mouth, 1 buccal mucosa, 1 retromolar trigone, and 1 gingival defect. We conclude that the melolabial flap is ideal for select intraoral defects.
Correlates of Cochlear Implantation, 1986–1992
Authors: Buck Steven H. , Mahoney Martin C. , Ginsberg Irwin A. , Hoffman Sanford R. , White Thomas
Published: September 2022

There is a paucity of information regarding the use of cochlear implants within large populations. This article describes correlates of cochlear implantation procedures using a statewide hospital discharge database. Among the 146 implant procedures, 55% involved female patients, whereas the largest groups of patients were represented by younger and older persons (27% between ages 2 and 9 years and 24% 60 years and older). A bimodal distribution was apparent for average annual age‐specific rates of cochlear implantation, with the highest rates among persons aged 2 to 9 years (5.4 implants per 1 million) and persons aged 60 to 69 years (3.7 implants per 1 million). Total hospital charges, excluding professional fees, exceeded $12,000 per implant and were found to vary significantly when examined by length of stay and by calendar year of procedure. The data presented are unique with regard to the total number of cochlear implant procedures included and the large, diverse population used. This study expands knowledge concerning the epidemiology and utilization of cochlear implantation.
Otitis Media Incidence and Impact on the Auditory Brain Stem Response in Lipopolysaccharide‐Nonresponsive C3H/HeJ Mice
Authors: Mitchell Curtin R. , Kempton J. Beth , Scott‐Tyler Brenda , Trune Dennis R.
Published: September 2022

Although mice of the C3H strain normally respond to bacterial lipopolysaccharide with appropriate immune system activation, mice of the C3H/HeJ substrain do not because of a gene defect. This suggests they may be more susceptible to opportunistic bacterial infections and more likely to have otitis media than a normally responding substrain, such as the C3H/HeSnJ. Therefore these two substrains were evaluated for incidence of spontaneous middle ear disease at 2, 4, 6, 10, 12, 15, and 18 months of age. Auditory brain stem response audiometry to pure tones of 4, 8, 16, 24, and 32 kHz was performed to establish the impact of middle ear disease on auditory function. None of the lipopolysaccharide‐responsive C3H/HeSnJ mice demonstrated middle ear disease. However, middle ear disease was present in 33% of the C3H/HeJ mice. The conductive loss caused by the otitis media resulted in auditory brain stem response threshold shifts of 15 to 40 dB SPL, lowered peak amplitudes, and increased latencies. Reduced lipopolysaccharide responsiveness by C3H/HeJ mice makes them less capable of reacting immunologically to bacterial infection and presumably underlies the failure to clear middle ear disease. The C3H/HeJ mouse may provide a valuable model in which to study lipopolysaccharide biologic activity and related middle ear inflammatory or immune mechanisms.
The Clavipectoral Osteomyocutaneous Free Flap
Authors: Seikaly H. , Calhoun K. , Rassekh Christopher H. , Slaughter D.
Published: September 2022

Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two‐team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction.
Mucoceles of the maxillary sinus
Authors: Marks Steven C. , Latoni Jorge D. , Mathog Robert H.
Published: September 2022

The maxillary sinus is an uncommon site for mucoceles within the paranasal sinuses. In this study nine patients with maxillary sinus mucoceles are presented. Six of these patients were treated by open approaches, and three were treated by endoscopic drainage alone. For uncomplicated maxillary sinus mucoceles, endoscopic drainage appears to be a reasonable approach, whereas for more complicated cases extending outside the sinus, open approaches may be required.