bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitomycin C Effect on Fibrous Adhesions of Rabbit Temporomandibular Joint
Authors: Aydin Erdinc , Uckan Sina , Ozdemir B. Handan , Uyar Pinar
Published: November 2005

OBJECTIVE

To evaluate influence of mitomycin C on fibrosis in temporomandibular joints of rabbits with mandibular traction.

STUDY DESIGN

Twenty rabbits (8 control, 12 mitomycin C group) were included. Titanium screws were placed in the anterior edge of the right masseter tuberosity and the posterior part of the right zygoma. Elastic bands were placed between 2 screws to initiate posterio‐superior displacement of the mandible to the right. Animals in the control group (CG) received intraarticular NaCl (0.9%) on the nondrawing (left) side, and animals in the study group (SG) received mitomycin C weekly (0.4 mg/mL) for 6 weeks. Rabbits were decapitated, temporomandibular joints were removed, and histopathological investigation was performed.

RESULTS

Microscopically, 4 of 6 rabbits in the CG had fibrosis in the temporomandibular joint, whereas only 1 of 11 rabbits in the SG had fibrosis (P < 0.05).

CONCLUSION

Application of mitomycin C to the temporomandibular joint of rabbits significantly reduces formation of intraarticular fibrous adhesions.

SIGNIFICANCE

This is the first study in the literature investigating the use of mitomycin C in the joints.
Histopathologic Effects of Cidofovir on Cartilage
Authors: Spiegel Jeffrey H. , Andrus Jennifer G. , Stefanato Catherine M. , Heeren Timothy
Published: November 2005

OBJECTIVE

To evaluate the effects of subcutaneously injected cidofovir on cartilage in a rabbit model.

STUDY DESIGN

Prospective study. The ears of 6 New Zealand White rabbits received perichondrial injection at 2 sites each of 0.1 mL of cidofovir in concentrations of 75 mg/mL, 25 mg/mL, 5 mg/mL, and 0 mg/mL. Animals were monitored for 6 weeks, and then injection sites excised and evaluated for histopathologic changes in epithelium, perichondrium, and cartilage.

RESULTS

A positive dose–response relationship existed for gross skin changes; however, there was no dose–response relationship for severity of change in the epithelium. There was a temporal component to gross changes, demonstrating peak incidence and severity between 2 and 3 weeks after injection, with resolution of most changes within the 6‐week study period. There was an increased likelihood of cartilage change when injecting cidofovir, but no clear relationship with injected dose.

CONCLUSION

We report the first evaluation of the local effects of cidofovir injection on cartilage. The results of this study using a rabbit model suggest that delayed skin changes or histopathologic change in the cartilage may be expected in approximately one third of sites injected. Although there was a statistical likelihood for increased local change after cidofovir injection, there was no correlation of severity with injected dose.

SIGNIFICANCE

Higher doses of cidofovir than commonly are used in the treatment of recurrent respiratory papillomatosis may be safe to use, although the effects of repeat application and long‐term complications are not yet evident.
Comparison of Delivery of Topical Medications to the Paranasal Sinuses via “Vertex‐to‐floor” Position and Atomizer Spray after FESS
Authors: Cannady Steven B. , Batra Pete S. , Citardi Martin J. , Lanza Donald C.
Published: November 2005

INTRODUCTION

Topical nasal medications are frequently employed for persistent sinonasal symptoms after functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis patients. The optimal means for the delivery of these medications is unclear. In this study, the efficacy of the vertex to floor (VF) position compared to atomizer spray was evaluated in post‐FESS patients.

METHODS

Three trials were performed: two trials in which patients maintained the VF position for 1 and 5 minutes, respectively, after nasal drop administration were compared to a third trial utilizing an atomizer spray in the upright position. Two independent observers rated the distribution of fluorescein‐dyed dexamethasone drops at 5 sinonasal sites: maxillary sinus (MS), ethmoid cavity (EC), frontal recess (FR), sphenoid sinus (SS), and olfactory cleft (OC).

RESULTS

VF position consistently delivered nasal drops to the MS, EC, SS, and OC. The atomizer distributed drops to the MS, EC, SS, and FR. The greatest difference was noted with the nasal drops in the olfactory cleft in the VF position; statistical significance was achieved with ANOVA testing (P = 0.012). Student's paired t test comparing trial 1 to 2, 1 to 3, and 2 to 3 demonstrated greater distribution in the OC at 5 minutes compared with 1 minute and spray (P = 0.042 and 0.003).

CONCLUSIONS

The VF position and atomizer spray were both effective in delivery of the dexamethasone drops to the paranasal sinuses. This has significant implications for management of patients suffering from recalcitrant chronic rhinosinusitis and/or sinonasal polyposis through the delivery of topical medications to the paranasal sinuses and olfactory cleft.
Holocene Dryness and Human Occupation in Brazil During the “Archaic Gap”
Authors: Araujo Astolfo G.M. , Neves Walter A. , Piló Luís B. , Atui João Paulo V.
Published: November 2005

An overview of the archaeological data produced over the last decades for Brazil, coupled with a background of recent paleoenvironmental studies, suggests that during the mid-Holocene vast areas of Central Brazil ceased to be occupied by human groups. Independent data from dated human skeletons, rock-shelter stratigraphy, and chronology of open-air sites converge to support the inference that these areas were depopulated or altogether abandoned. Paleoenvironmental data suggest that dryness events constitute the major cause behind the observed trends. This phenomenon expands the already perceived notion that climatic stresses had a major role in the shaping of human settlement patterns in marginal environments, such as deserts and high-altitude settings.
Vestibular Dysfunction in Gulf War Syndrome
Authors: Roland Peter S. , Haley Robert W. , Yellin Wendy , Owens Kris , Shoup Angela G. , Holt G. Richard
Published: November 2005

METHODS

Vestibular complaints of Gulf War veterans were characterized by a nested case‐control study of 23 veterans with 3 different Gulf War syndromes and 20 matched control subjects. All subjects completed a standardized symptom questionnaire and underwent standard audiovestibular tests administered by audiologists blinded to group identities.

RESULTS

The prevalence of reported dizzy spells was higher in veterans with Gulf War syndromes 1 (100%), 2 (85%), and 3 (100%) than in controls (25%, P < 0.0001). Dizzy spells were more frequent, lasted longer, and involved a wider variety of accompanying symptoms in veterans with syndrome 2 than in those with syndromes 1 and 3. Audiovestibular testing showed greater interocular asymmetry of nystagmic velocity on sinusoidal harmonic acceleration in syndromes 1 (P = 0.015) and 2 (P = 0.002), greater asymmetry of saccadic velocity in syndrome 2 (P = 0.4), diminished nystagmic velocity after caloric stimulation bilaterally in syndrome 3 (P = 0.02 to 0.04), more subjects with pathologic nystagmus (P = 0.09), and greater interside asymmetry of wave I to III interpeak latency on auditory brain stem response in syndromes 1 (P = 0.005) and 2 (P = 0.07). Asymmetry of gain on sinusoidal harmonic acceleration and pathologic nystagmus were most strongly associated with symptoms of paroxysmal vertigo (P = 0.002 and 0.07, respectively); asymmetry of saccadic velocity, with the severity of vertigo (P = 0.004); and abnormal caloric response, with chronic dysequilibrium (P = 0.006).

CONCLUSIONS

The findings are compatible with a subtle neurologic injury from organophosphate‐induced delayed neurotoxicity.
Tympanostomy Tubes and Otic Suspensions: Do They Reach the Middle Ear Space?
Authors: Hebert Richard L. , Vick Michael L. , King Geoffrey E. , Bent John P.
Published: November 2005

The treatment of patients with tympanostomy tubes (TTs) and otorrhea with medicated otic suspensions is well known, but confirmation of penetration into the middle ear is difficult. To address this question, we created an in vitro model of the human head and ear and then tested it with 5 different types of liquid exposure: tap water, soapy water, polymyxin B sulfate (Cortisporin), tobramycin and dexamethasone (TobraDex), and ciprofloxacin (Cipro) suspensions. A positive test result corresponded to liquids entering the middle ear through the TT. No positive test result was elicited with tap water (0/20), but soapy water did enter the middle ear (10/40) and was statistically significant (P = 0.0112). Without the use of slight tragal pressure, Cortisporin, TobraDex, and Cipro drops did not consistently pass through the TT (0/20, 1/25, 1/25). By placing the drops with the addition of tragal pressure, a statistically significant difference was obtained for each solution (20/20, 20/20, and 20/20, respectively [P < 0.0001]). We conclude that with a clean external auditory canal, patent TT, and no middle ear fluid, medicated otic suspensions enter the middle ear only when combined with slight tragal pressure.
Circulating Neutrophil CD18 Receptor Expression and Ischemic Flap Neutrophil Infiltration in a Guinea Pig Model
Authors: Dolan Robert , Hartshorn Kevan , Mcavoy Daniel
Published: November 2005

This article demonstrates a correlation between circulating neutrophil CD18 expression, neutrophil infiltration, and varying periods of ischemia induced in guinea pig island skin flaps. Fifty adult female Hartley guinea pigs were equally separated into a control group, a sham group, and ischemic groups of 2, 4, and 10 hours. All, except those in the control group, had single guinea pig island flank skin flaps raised. Systemic neutrophil surface receptor (CD18) expression was analyzed with monoclonal antibodies, and flap skin biopsy specimens were analyzed for neutrophil infiltration. The results show that neutrophil counts and receptor detection increase as flap ischemia increases. However, a trend toward declining receptor expression was observed in the 10‐hour ischemic group. In conclusion, systemic neutrophil adhesion receptor upregulation is correlated with cutaneous flap neutrophil infiltration and ischemia‐reperfusion injury in a guinea pig model. A trend toward declining receptor expression with advanced ischemia was observed.
Midline Radiofrequency Tissue Reduction of the Palate for Bothersome Snoring and Sleep‐Disordered Breathing: A Clinical Trial
Authors: Coleman Sean C. , Smith Timothy L.
Published: November 2005

This study is a prospective, nonrandomized clinical trial initiated to assess the safety and efficacy of radiofrequency tissue reduction of the palate for the treatment of bothersome snoring and sleep‐disordered breathing. Twelve healthy volunteers with socially disruptive snoring underwent a baseline polysomnogram along with a battery of visual analog scales (VASs) to measure daytime sleepiness, snoring level, pain, and disturbances of speech and swallowing. After radiofrequency tissue reduction of the palate, they were re‐evaluated with a mean follow‐up after the final procedure of 15.7 ± 5.1 (mean ± SD) weeks. As rated by the bed partner, a significant reduction in the level of snoring occurred in all 12 patients, with a mean pretreatment snoring level of 8.3 ± 2.1 to a mean posttreatment snoring level of 2.1 ± 1.4. (Student t test, P < 0.0001) These patients required an average of 2.3 treatment sessions each. Nine of 12 had a reduction in snoring from a bothersome level (VAS range 5‐10) to a nonbothersome level (VAS range 0‐3). Daytime sleepiness as measured by the Epworth Sleepiness Scale (0‐24) decreased from 10.8 ± 4.4 to 8.3 ± 4.1 (P = 0.011). Posttreatment pain was considered absent or minimal in 11 of 12 patients and was managed with acetaminophen. No significant adverse events or complications were reported.
Pharyngeal Suspension Suture with Repose Bone Screw for Obstructive Sleep Apnea
Authors: Woodson B. Tucker , Derowe Ari , Hawke Michael , Wenig Barry , Ross E.B. , Katsantonis George P. , Mickelson Samuel A. , Bonham Robert E. , Benbadis Selim
Published: November 2005

OBJECTIVE

Multilevel surgery for obstructive sleep apnea syndrome (OSA) may improve success. This study's goal is to prospectively evaluate the feasibility and short‐term subjective effectiveness of a new tongue‐suspension technique.

METHODS

A multicenter nonrandomized open enrollment trial used the Repose device to treat tongue obstruction in 39 snoring and OSA patients. Outcomes include 1‐ and 2‐month subjective reports of general health, snoring, and sleep.

RESULTS

Twenty‐three patients completed 1 month and 19 completed 2 months of follow‐up. In OSA patients, activity level, energy/fatigue, and sleepiness improved. Two‐month outcomes were less (activity level, energy/fatigue, and sleepiness). Fewer changes were observed in snorers than in OSA patients. There were 6 complications (18%), including sialadenitis (4), gastrointestinal bleeding (1), and dehydration (1) after the procedure.

CONCLUSION

A pharyngeal suspension suture changes subjective outcomes. Improvement is incomplete. The procedure is nonexcisional, but significant complications may occur. Further evaluation is required to demonstrate effectiveness.
Radiofrequency Volumetric Reduction of the Palate: An Extended Follow‐Up Study
Authors: Li Kasey K. , Powell Nelson B. , Riley Robert W. , Troell Robert J. , Guilleminault Christian
Published: November 2005

OBJECTIVE

The goal was to evaluate the effect of radiofrequency (RF) of the palate on speech, swallowing, taste, sleep, and snoring 12 to 18 months after treatment.

METHODS

Twenty‐two patients were evaluated by clinical examination, questionnaires, and visual analog scales. The patients with relapse of snoring were offered further RF treatment.

RESULTS

After a mean follow‐up of 14 months, no adverse effect was reported. Subjective snoring scores relapsed by 29% overall. Nine patients (41%) noted relapse of snoring from 2.1 ± 1.1 to 5.7 ± 2.7 (P < 0.001). Eight of the patients underwent further RF treatment with a reduction of snoring from 5.8 ± 2.9 to 3.3 ± 3.1 (P = 0.01).

CONCLUSION

The success of RF volumetric reduction of the palate diminishes with time, as with other surgical procedures of the palate. However, the minimal invasiveness of the RF provided a high patient acceptance for retreatment, and relapse of snoring can be improved.
Use of mitomycin C for maintaining myringotomy patency
Authors: Estrem Scott A. , Vanleeuwen R. Neil
Published: November 2005

The purpose of this study was to determine whether topical mitomycin C could be used to prolong the patency of a myringotomy site in the absence of a ventilation tube. Mitomycin C is an antineoplastic agent used to maintain a patent trabeculectomy site in patients with glaucoma. The KTP laser was used to create bilateral myringotomies 0.4 mm in diameter in 28 chicks (Gallus domesticus). Mitomycin C was applied to the right myringotomy site, and sterile water, used as a control, was applied to the left myringotomy site. The animals were divided into 2 groups with group A treated with freshly prepared mitomycin C and group B treated with 2‐week‐old mitomycin C. The patency rates of the experimental ears of groups A and B were 80% and 70%, respectively, 15 days after surgery and 33% and 7.7%, respectively, at 30 days. All myringotomy sites in the control ears were healed within 5 days. Using a logistic regression model for repeated measures, we determined the odds ratio between the experimental and control myringotomies of the combined groups to be 149.1 (P = 0.0001). We conclude that mitomycin C had a significant effect in prolonging the patency of myringotomies in chick tympanic membranes. (Otolaryngol Head Neck Surg 2000;122:8‐10.)
Interlaboratory variability of rotational chair test results II: Analysis of simulated data
Authors: Furman Joseph M. , Goebel Joel A. , Hanson Jason , Schumann Timothy ,   Interlaboratory Rotational Chair Study Group
Published: November 2005

Standardization of rotational chair testing across laboratories has not been achieved because of differences in test protocol and analysis algorithms. The Interlaboratory Rotational Chair Study Group was formed to investigate these differences. Its first study demonstrated significant variability in calculated results using actual patient data files. No estimation of accuracy could be made, however, because the “true” values of response parameters were unknown. In this study we used simulated “patient” data files to further explore the differences among analysis algorithms. We found a high degree of agreement and accuracy across laboratories using automated analysis of high signal‐to‐noise/low‐artifact data for gain, phase, and asymmetry. Variability increased significantly for the lower signal‐to‐noise ratio/higher artifact files. Operator intervention generally improved accuracy and decreased variability, but there were cases in which operator intervention reduced accuracy. (Otolaryngol Head Neck Surg 2000;122:23‐30.)
Endoscopic repair of cerebrospinal fluid rhinorrhea
Authors: Mao Vivian H. , Keane William M. , Atkins Joseph P. , Spiegel Joseph R. , Willcox Thomas O. , Rosen Marc R. , Andrews David , Zwillenberg David
Published: November 2005

Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer‐aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer‐aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.(Otolaryngol Head Neck Surg 2000;122:56‐60.)
Antiepidermal growth factor receptor antibodies augment cytotoxicity of chemotherapeutic agents on squamous cell carcinoma cell lines
Authors: Brown Deanna , Wang Robert , Russell Paul
Published: November 2005

Recent literature by Fan et al (1993) demonstrated that addition of cisplatin and monoclonal antibody to the epidermal growth factor receptor (EGFR MAb) of the human squamous cell carcinoma (SCC), A431, eradicated gross tumors in nude mice. To determine whether a combination of either cisplatin or 5‐fluorouracil (5‐FU) with EGFR MAb could affect an SCC other than the A431 tumor model, an assay using 2 human tongue SCC cell lines, BroTo and SCC‐25, was performed. Cells were pretreated with 1.25 μg/mL cisplatin or 10 μg/mL 5‐FU. After a 4‐hour incubation period, cisplatin‐treated cells were washed with phosphate‐buffered saline solution. Various concentrations of EGFR MAb were then added, and after a 24‐hour incubation period, an MTT cell growth assay was performed. SCC‐25 cells exhibited a greater decrease in growth with the addition of 16 nmol/L EGFR MAb to cisplatin compared with the cytotoxicity of cisplatin alone (P < 0.001). However, this combination did not produce similar results with BroTo cells (P > 0.05). The combination of EGFR MAb and 5‐FU produced a growth inhibition versus control (unexposed cells) in both cell lines (P < 0.05). These findings suggest the possible augmentation of the activity of chemotherapeutic agents, cisplatin and/or 5‐FU, with the addition of EGFR MAb on SCC cell lines other than A431. (Otolaryngol Head Neck Surg 2000;122:75‐83.)
Effect of verapamil on cholesteatoma migration in vitro
Authors: Kountakis Stilianos E. , Chang C. Y. Joseph , Minotti A. M. , Fernando R. Cabral
Published: November 2005

OBJECTIVES

It was previously shown that cholesteatoma migration in vitro is influenced by the calcium concentration of the culture medium. This study was designed to determine whether the calcium channel blocker verapamil affects cholesteatoma migration in vitro.

METHODS

Cholesteatoma cells harvested from patients with chronic ear disease were grown in culture and were exposed to culture medium containing verapamil. The migration rate of the verapamil‐exposed cells was compared with control rates.

RESULTS

Verapamil at 300 μg/L caused marked reduction in the rate of migration compared with control values. The migration rate returned to normal within 48 hours after verapamil was removed from the culture medium. Higher verapamil concentrations (500 μg/L) caused complete detachment of the epithelial cells from the substrate within 24 hours.

CONCLUSION

Our findings suggest that cholesteatoma migration in vitro is calcium channel dependent and can be reduced with calcium channel blockers such as verapamil. (Otolaryngol Head Neck Surg 2000;122:91‐5.)
Patients with head and neck tumors excrete a chondroitin sulfate with a low degree of sulfation: A new tool for diagnosis and follow‐up of cancer therapy
Authors: Martins JoÃo R. M. , Gadelha Maria E. C. , Fonseca Sonia M. , Sampaio Lucia O. , Pontes Paulo A. De L. , Dietrich Carl P. , Nader Helena B.
Published: November 2005

The chondroitin sulfate excreted in the urine of 10 patients with cancer of the head and neck and 27 healthy subjects was analyzed. The disaccharide products formed from chondroitin sulfate excreted by these 10 patients by action of chondroitinase ABC show a significant (P < 0.0001) relative increase of nonsulfated disaccharide (35.6% ± 5.7%) when compared with the nonsulfated disaccharide (10.0% ± 0.9%) present in the chondroitin sulfate of 27 healthy subjects. In 6 patients the structure of the excreted compound was analyzed up to 4 months after surgery. After removal of the cancer, the percent amounts of the nonsulfated disaccharide tend to approach the values found for the chondroitin sulfate of healthy subjects. A significant (P < 0.0001) change in the ratio of urinary chondroitin sulfate and heparan sulfate and a decrease in the electrophoretic migration of chondroitin sulfate were also observed. All of the patients with head and neck cancer analyzed so far have shown this structural anomaly of urinary chondroitin sulfate. This assay may be useful in the diagnosis and follow‐up of cancer therapy. (Otolaryngol Head Neck Surg 2000;122:115‐8.)
Monoclonal antibodies against squamous cell carcinoma of the upper aerodigestive mucous membranes
Authors: Folz Benedikt J. , Tibor GÖRÖGh , Lippert Burkard M. , Werner Jochen A.
Published: November 2005

BALB/c mice were immunized with viable cells from human squamous cell carcinoma (SCC) cell lines derived from maligant tumors of the upper aerodigestive tract. Hybridomas were selectively grown for the production of monoclonal antibodies. About 700 hybridoma clones produced antibodies that were tested for immunoreactivity in frozen sections of human SCC and hyperplastic tonsils. Monoclonal antibodies produced by the hybridoma clone K‐640 were strongly accumulated at the cell membrane of SCC cells, whereas no immune reaction was detected in the squamous epithelium of the tonsil. This study describes cloning and recloning of the K‐640 clone, which enabled further enhancement of the antigen specificity. The antibodies of this highly selected clone belong to the IgM class, as shown by isotype determination with an ELISA. Immunoblotting exhibited that the antibodies recognized an antigen with an approximate molecular weight of 55 kD. (Otolaryngol Head Neck Surg 2000;122:124‐8.)
Cochlear Implantation: Minimal Hair Removal Technique
Authors: Roberson Joseph B. , Stidham Katrina R. , Scott Kenneth M. , Tonokawa Lisa
Published: November 2005

This prospective study was undertaken to evaluate the safety and patient acceptance of minimal hair removal during cochlear implantation. Forty‐six consecutive patients (17 adults, 29 children; age range 13 months to 84 years) received cochlear implantation with a minimal hair removal technique. A questionnaire was used to evaluate acceptance and value of this technique among the first 15 patients and parents. Postoperative examinations were completed 1 and 4 weeks after implantation. Patients were monitored for complications, which included 3 cases of transient seroma, 2 cases of transient dysequilibrium, 2 individual electrode failures, and 1 facial nerve stimulation. Importantly, no wound infections were documented. Use of a small shave technique did not increase surgical risk. This technique has proved to be cosmetically and psychologically more desirable for the patients and their families than complete hair removal in the operative field.
Short‐ and Long‐Term Outcomes of Canalith Repositioning for Benign Paroxysmal Positional Vertigo
Authors: Nunez Robert A. , Cass Stephen P. , Furman Joseph M. , Holt G. Richard
Published: November 2005

This is a prospective, nonrandomized study of the canalith repositioning procedure (CRP) for treatment of benign paroxysmal positional vertigo (BPPV). CRP was used to treat 168 patients with BPPV. Patient data were gathered by yearly telephone interviews to determine whether symptoms of position‐induced vertigo had returned. After 1 or 2 treatment sessions 91.3% of patients reported complete symptom resolution. Average follow‐up for the study population after the initial treatment was 26 months. A recurrence rate of 26.8% was found among those patients who initially reported resolution of symptoms after CRP. Application of recurrence data to a Kaplan‐Meier estimation suggests a 15% recurrence rate per year of BPPV, with a 50% recurrence rate of BPPV at 40 months after treatment. There was no significant association between cure or recurrence rate and sex, age, duration of symptoms, presumed cause, or treating physician.
Intraoperative Radiolymphoscintigraphy for Detection of Occult Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma
Authors: Zitsch Robert P. , Todd Daniel W. , Renner Gregory J. , Singh Amolak
Published: November 2005

OBJECTIVES

We sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC).

METHODS

Patients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a handheld gamma probe was used to find the radiolabeled sentinel lymph node (SLN). The neck specimen was examined ex vivo by using the gamma probe; the SLN or SLNs were dissected free from the specimen and sent separately for histopathologic examination.

RESULTS

At least one SLN was identified in all patients enrolled thus far. Four patients had microscopic carcinoma found in the SLN. Two of these had cancer only in the SLN, and two had disease both in the SLN and the remaining specimen.

CONCLUSIONS

Intraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC.
Unilateral True Vocal Fold Paralysis: Cause of Right‐Sided Lesions
Authors: Hughes C. Anthony , Troost Sven , Miller Susan , Troost Thomas
Published: November 2005

At the Georgetown University Center for the Voice, 778 patients were referred for evaluation between July 1, 1990, and June 30, 1995. During this 5‐year period, right true vocal fold paralysis or paresis was diagnosed in 24 of these patients (3%). Videostroboscopy, voice analysis, and patient records were reviewed. Ages ranged from 23 to 80 years, and sex distribution approximated a 1:1 ratio. The patients presenting symptoms included hoarseness, dysphagia, choking, voice pitch change, voice weakness, fatigability, and breathiness. Sources of the vocal fold dysfunction included iatrogenic, traumatic, central, and infectious causes.
Health Status in Allergic Rhinitis
Authors: Corey Jacquelynne P. , Kemker Bryan J. , Branca Joseph T. , Kuo Felicia , Chang Yuchiao , Gliklich Richard E.
Published: November 2005

Although valid and reliable instruments exist to measure the quality of life of allergic rhinitis patients, a statistically sensitive and clinically meaningful way to evaluate patients undergoing immunotherapy has not been reported. A 21‐site prospective, observational study was performed in a population of consecutive patients with allergic rhinitis. Baseline general health measures revealed significant (P > 0.05) decrements from reported normative levels in 8 domains for patients choosing to undergo immunotherapy and 5 domains for patients choosing not to undergo immunotherapy. The General Health Survey was less sensitive in detecting change than the Nasal Health Survey (Chronic Sinusitis Survey) and allergy‐specific (Rhinoconjunctivitis Quality of Life Questionnaire and Allergy Outcome Survey) surveys. Severity of symptoms was associated with both the likelihood to choose immunotherapy and the likelihood for early improvement. We conclude that general and condition‐specific measures can be used to observe patients after immunotherapy; however, obtaining baseline data and controlling for seasonality are important considerations.
Dynamics of Nasopharyngitis in Children
Authors: Brook Itzhak , Gober Alan E. , Gober Alan E.
Published: November 2005

PURPOSE

Our goal was to characterize the dynamics and bacterial interaction of the aerobic and anaerobic flora of nasal discharge of children at different stages of uncomplicated nasopharyngitis.

METHODS AND PATIENTS

Serial semiquantitative nasopharyngeal (NP) and quantitative nasal discharge (ND) cultures were taken every 3 to 5 days from 20 children in whom purulent discharge eventually developed (group 1), and a single culture was obtained from a group of 20 who had only clear discharge (group 2).

RESULTS

Aerobic and anaerobic bacteria were isolated from all NP cultures. Bacterial growth was present in 8 (40%) NDs of group 2. Only 7 (35%) of the clear NDs of group 1 showed bacterial growth; the number increased to 14 (70%) at the mucoid stage and 20 (100%) at the purulent stage. It declined to 6 (30%) at the final clear stage. The number of species and total number of organisms increased in the NDs of group 1. Group 1 patients had higher recovery rates of Streptococcus pneumoniae and Haemophilus influenzae in their NP cultures than group 2 patients (P > 0.05). During the purulent stage, Peptostreptococcus species were isolated in 15 (75%), Fusobacterium species in 10 (50%), Prevotella species in 9 (45%), H influenzae in 8 (40%), S pneumoniae in 6 (30%), and β‐hemolytic streptococci in 5 (25%) of group 1 NDs. This was higher than their recovery in the clear stages of both groups and the mucoid stage of group 1. A total of 8 organisms capable of interfering with the growth of potential pathogens were isolated from the NPs of group 1, as compared with 35 from group 2 (P > 0.001).

CONCLUSIONS

The development of purulent nasopharyngitis is associated with the pre‐existing presence of potential pathogens and the absence of interfering organisms.
Postoperative Management of Pediatric Tracheostomy: Results of a Nationwide Survey
Authors: Gluth Michael B. , Maska Suzy , Nelson Joely , Otto Randal A.
Published: November 2005

OBJECTIVE

A survey was undertaken to document the postoperative care of pediatric tracheostomies by otolaryngologists.

STUDY DESIGN

This study represents the results of a national survey of 564 otolaryngologists covering a broad scope of postoperative pediatric tracheostomy issues considered for patients younger than 2 years and patients older than 5 years.

RESULTS

Of the surveys sent, 134 responses were received, portraying a certain standard management scheme that seems to be used by most respondents.

CONCLUSIONS

Very little difference was seen in respondents' management of patients younger than 2 years of age as compared with those who are older than 5 years. Furthermore, agreement between actual practice and published recommendations seems to vary with some management issues. The results of this study provide a means by which otolaryngologists may familiarize themselves with national trends in the postoperative management of pediatric tracheostomies.
Expression of Matrix Metalloproteinases and Tissue Inhibitor of Metalloproteinases in Laryngeal and Pharyngeal Squamous Cell Carcinoma: A Quantitative Analysis
Authors: Magary Steven P. , Ryan Matthew W. , Tarnuzzer R. W. , Kornberg Lori
Published: November 2005

Squamous cell carcinomas of the head and neck are known for their aggressive growth and propensity to metastasize. Invasion is facilitated by matrix metalloproteineases (MMPs). Tissue inhibitors of MMPs (TIMPs) negatively regulate MMP activity. MMP and TIMP expression in head and neck squamous cell carcinomas was determined by quantitative reverse transcriptase polymerase chain reaction (qRT‐PCR). qRT‐PCR allows measurement of several mRNAs from as little as 4 μg of total cellular RNA. We measured MMP‐1, MMP‐2, MMP‐9, and TIMP‐1 expression in 8 specimens of primary tumors and adjacent normal tissue. MMP‐1 was overexpressed in 6 of 8 tumors, and MMP‐9 was over‐expressed in 4 of 7 tumors. MMP‐2 was expressed in 3 of 8 tumors and 3 of 8 normal samples. TIMP‐1 was expressed in all specimens. This work demonstrates that qRT‐PCR can be used to examine expression of specific mRNAs in clinical specimens. Therefore this method provides another tool for the molecular analysis of tumors.
Chemoprevention of Head and Neck Cancer
Authors: Armstrong William B. , Meyskens Frank L.
Published: November 2005

Increasing emphasis has been placed on chemoprevention as understanding of the genetic and molecular events of carcinogenesis has evolved. More than 1000 compounds that inhibit cancer development in vitro or in animal models have been identified, and active research is under way to determine which of these agents will be both effective and nontoxic in human beings. Currently, 13‐cis‐retinoic acid is the most studied chemopreventive agent against head and neck cancers. Unfortunately, this vitamin A derivative has significant clinical toxicity, which limits its utility in a practice setting. The efficacy of the retinoids, however, has stimulated efforts to find other chemopreventive compounds that are both effective and non‐toxic. This review discusses head and neck premalignancy, chemoprevention strategies, retinoids, and several other classes of chemopreventive agents with potential efficacy against head and neck premalignancy.
Comparison of Regional Recurrence Rates of Radical and Comprehensive Neck Dissection Type 3 in N0 Laryngeal Cancer
Authors: Myers Eugene N. , Yilmaz Taner , Turan Ergin , Hoşal A. Şefik , Kaya Sefa
Published: November 2005

To determine whether comprehensive neck dissection (CND) type 3 could accomplish regional tumor control as well as radical neck dissection (RND) in clinically N0 laryngeal cancer patients, we compared the regional recurrence rates of 316 N0 laryngeal cancer patients. In the 316 N0 patients, 486 neck dissections were performed. For 170 patients the dissection was bilateral, and for 146 patients it was unilateral. Of these, 193 were type 3 CNDs, and 293 were RNDs. In 30 (15.5%) of 193 type 3 CNDs and in 53 (18.1%) of 293 RNDs, metastatic lymph nodes were determined histopathologically in neck dissection specimens. The difference in cervical lymph node metastasis rates was not statistically significant (P < 0.05). During follow‐up, 3 patients who underwent CND type 3 (1.6%) and 12 who underwent RND (4.1%) had regional recurrences. The difference between recurrence rates was not statistically significant (P < 0.05). A conclusion was reached that CND type 3 safely provided regional cancer control in N0 laryngeal cancer and that it might be performed to decrease the morbidity of RND.
Treatment of recurrent pleomorphic adenomas of the parotid gland
Authors: Carew John F. , Spiro Ronald H. , Singh Bhuvanesh , Shah Jatin P.
Published: November 2005

Recurrent pleomorphic adenomas (RPAs) of the parotid gland are an uncommon but challenging problem. The records of 31 patients with RPAs were reviewed to assess the clinical presentation and treatment results. More than half of these patients underwent total parotidectomy. Local control was achieved in 94% of patients at 7 years (median follow‐up 7.3 years). Patients who had surgery for recurrence after a formal parotidectomy were more likely to have another recurrence (63% local control at 7 years) than patients whose initial procedure was a limited excision (100% local control at 7 years; P < 0.01). Better local control was seen in 11 patients who received postoperative irradiation (100% at 10 years) than in 20 patients who did not (71% at 10 years; P < 0.28). Adequate surgical resection yields an acceptable local control rate in patients with RPAs. Postoperative radiation therapy may improve control in patients at high risk for another recurrence.
Securing meshed split‐thickness skin grafts with 2‐octylcyanoacrylate
Authors: Tamez Oscar A. , Mcguff Howard S. , Prihoda Thomas J. , Otto Randal A.
Published: November 2005

Meshed split‐thickness skin grafts (STSGs) secured with 2‐octylcyanoacrylate (2‐OCA) were compared with meshed STSGs secured by suture and bolster (S&B). The 2 techniques were compared for graft survival, foreign‐body giant cell response, inflammatory response, appearance, texture, and application time. Sixteen 2.5 × 2.5 cm meshed STSGs were harvested from the dorsa of 2 pigs for a total of 32 grafts. On each pig 8 grafts were sprayed with 2‐OCA, and the other 8 were secured with S&B. Evaluations were performed on postoperative days 14, 24, 48, and 56. Biopsy specimens were obtained on postoperative days 14 and 56. There were no significant differences in percent survival, foreign‐body giant cell response, inflammatory response, and appearance between control and study grafts. The average time to apply the 2‐OCA onto a graft was 3 seconds, compared with 8 minutes for S&B application. 2‐OCA provides a quick and reliable means of securing meshed STSGs and would be especially useful in areas where it is difficult to use S&B, such as total maxillectomy defects.
Persistent rhinosinusitis in children after endoscopic sinus surgery
Authors: Chan Kenny H. , Winslow Catherine P. , Abzug Mark J.
Published: November 2005

The efficacy of endoscopic sinus surgery (ESS) in children is insufficiently addressed in the medical literature. We report a cohort of 14 children (mean age 7.7 years, median age 5.1 years) seen at our multidisciplinary clinic for refractory rhinosinusitis during a 30‐month period who continued to have rhinosinusitis despite previous ESS. Prior ESS procedures were performed by 11 surgeons in 3 states. The first ESS was performed when the children were a mean age of 4.6 years, and in 10 of 14, it was performed when they were younger than 4.8 years. This cohort required a disproportionately high rate of subsequent surgical intervention, 50%, versus a 9% surgical rate in the remaining clinic population (P = 0.0002). Osteomeatal scarring was the single most difficult surgical complication. Significant morbidity, in the form of persistent disease, is encountered after ESS in young children. Although chronic rhinosinusitis after ESS, to a certain degree, can still be managed by medical therapy, judicial use of ESS, especially in the very young, is recommended.
Choosing the optimal wound dressing for irradiated soft tissue wounds
Authors: Hom David B. , Adams George , Koreis Mary , Maisel Robert
Published: November 2005

This article reviews the healing state of the previously irradiated wound, the tenets for optimal wound care, and the choices of wound dressings now available for its management. The goal in assisting a previously irradiated surgical wound to heal is to transform its chronic wound state into an acute wound state. This transformation encourages wound healing to proceed. Six major moisture‐retentive dressing categories exist to optimize its healing. They are classified into the alginates, foams, gauzes, hydrogels, hydrocolloids, and transparent films. Optimal wound care management for previously irradiated wounds involves (1) adequately debriding and cleansing the local wound, (2) accurately assessing the wound, (3) choosing the appropriate dressing based on the wound assessment, and (4) encouraging granulation tissue formation and reepithelialization.
Results of tympanoplasty with titanium prostheses
Authors: Wang Xijun , Song Jiangshun , Wang Hongnan , Myers Eugene N.
Published: November 2005

To improve the hearing results associated with tympanoplasty, we performed the operation in 113 cases (124 ears) using ossicular replacement prostheses made of titanium. The results demonstrated that among all the operated ears, 115 of 124 (92.7%) had a hearing gain of more than 10 dB. The average improvement of pure‐tone hearing was 24.6 dB, and the average reduction of the air‐bone gap was 23.2 dB. No rejection reaction or recurrent cholesteatoma was found. This operative technique, based on animal experiments and applied anatomic study of the suprastapedial structure in human beings, has had a good rate of success and has resulted in remarkable hearing improvement of a relatively large magnitude. The application of a new material—titanium—which has high biocompatibility with human body tissues, is in large measure the reason for this success. The ossicular replacement prosthesis was appropriately designed and manufactured. It fit well, could be tightly joined to the suprastapedial structure, and was difficult to displace. We also adopted the method of enlarging the tympanic isthmus, which led to good aeration of the mastoid and attic, resulting in the best state of mobility of the tympanic membrane. All these factors contributed to the effective hearing gain.
Salvage surgery for recurrent nasopharyngeal carcinoma in anterior marginal miss after radiotherapy
Authors: Shu Chih‐Hung , Shiau Cheng‐Ying , Chi Kwan‐Hwa , Yen Sang‐Hue , Li Wing‐Yin
Published: November 2005

Nasopharyngeal carcinoma (NPC) is treated primarily by radiotherapy. Marginal miss after radiotherapy is a potential cause for treatment failure in NPC. Anterior marginal miss after irradiation results in recurrent tumors in the nasal cavity outside the nasopharynx. From 1991 to January 1997, 6 recurrent NPCs arising in the anterior marginal miss zone after radiotherapy were confirmed by pathologic and radiologic evaluation. One patient had infiltrating growth of the original NPC tumor into the anterior part of nasal septum, and the other 5 had microscopic extensions from the original NPC tumors into the nasal cavity that were beyond detection by endoscopy or CT scan. In some cases the tumors extended further to include the hard palate or the lacrimal sac. Medial maxillectomy and partial maxillectomy with or without resection of the hard palate were necessary to encompass the extent of the tumors. Surgical margins were free of cancer cells in 5 patients. No further treatment was given in these 5 patients. Another patient with tumor extending to the lacrimal sac received postoperative radiotherapy. Five of the 6 patients survived with no evidence of disease for 8 to 65 months. One patient had distant metastasis 14 months after surgery but was free from tumor at the primary site. Radical surgery can result in good and sustained local control for anterior marginal miss of NPC after radiotherapy. (Otolaryngol Head Neck Surg 1999;121:622–6.)
Management of acute complicated sinusitis: A 5‐year review
Authors: Mortimore Sean , Wormald Peter‐John
Published: November 2005

Acute sinusitis is a relatively common problem; however, sinusitis associated with a complication is less frequent. Currently there is debate as to whether acute complicated sinusitis should be managed by frontal sinus trephine and sinus washout or by immediate frontoethmoidectomy/functional endoscopic sinus surgery. To assess the effectiveness of frontal sinus trephine in the management of acute complicated frontal sinusitis, we reviewed all patients admitted to Groote Schuur Hospital with acute pansinusitis (includes frontal, maxillary, and ethmoid) from 1989 to 1993. Eighty‐seven patients were admitted, of whom 43 were treated medically and 44 were treated surgically. Of the surgical patients 38 had frontal trephines and management of associated complications. Thirty (80%) of the patients who received frontal trephines recovered without further surgery, and 8 required further sinus surgery for persistent disease. Frontal trephine with management of associated complications is an acceptable management option for patients with acute complicated pansinusitis. Frontoethmoidectomy or functional endoscopic sinus surgery can be held in reserve for those patients with persistent disease that does not resolve after the initial frontal trephine.
Multichannel cochlear nucleus stimulation
Authors: El‐Kashlan Hussam K.
Published: November 2005

Stimulation of the cochlear nucleus (CN) has been used on a limited basis for rehabilitation of a select group of patients with bilateral acoustic neuromas. These patients were implanted with an electrode placed on the surface of the CN after resection of their tumors. Animal studies have demonstrated greater efficiency of a penetrating CN electrode in activating the central auditory system than a surface electrode. The objective of this work was to study the electrically evoked middle latency response generated by stimulation through a penetrating multichannel CN electrode in an animal model. Six pigmented guinea pigs underwent implantation with a penetrating multichannel CN electrode. Threshold, latency, and input‐output functions of electrically evoked middle latency responses with different stimulation pads were studied. There were systematic differences in the latency and amplitude of the input‐output functions depending on the site of stimulation within the CN. The results support the hypothesis that discrete activation of neuronal subpopulations within the CN is possible with a penetrating multichannel micro‐electrode.
Role of motor unit number estimate electromyography in experimental canine laryngeal reinnervation
Authors: Peterson K. Linnea , Graves Michael , Berke Gerald S. , Ye Ming , Wallace Roger , Bell Theodore , Sercarz Joel A.
Published: November 2005

Laryngeal electromyography has been used clinically to differentiate neuromuscular pathology from other causes of vocal fold immobility such as arytenoid dislocation, tumor invasion, or cricoarytenoid joint fixation. Electromyography has also been used to predict the prognosis for nerve recovery in laryngeal paralysis. Existing electromyographic techniques either record activity with voluntary motion or study nerve conduction. In this study a new technique, motor unit number estimation, a commercially available quantitative method of electromyographic analysis, is used to study the progress of recovery of vocal fold function after recurrent laryngeal nerve injury. Four dogs underwent transection and immediate reanastomosis of selected branches of the adductor and abductor branches of the recurrent laryngeal nerve on 1 side; the opposite side served as a control. Baseline electromyographic and videolaryngoscopic studies were performed. These measures were then repeated in a longitudinal fashion every 6 weeks after denervation. The motor unit number estimation technique indicated a return of motor unit numbers with time, along with estimates of their size. This was consistent with the expected progress of laryngeal reinnervation. These data and their predictive value for nerve recovery will be discussed.