bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of the Promontory Stimulation Test in Predicting Speech Perception After Cochlear Implantation
Authors: Lee Jong Cheol , Yoo Myung Hoon , Ahn Joong Ho , Lee Kwang‐Sun
Published: February 2009

Background and Objectives: To determine the role of the promontory stimulation test (PST) in cochlear implantation (CI), we evaluated the correlations between PST parameters and the results of speech perception tests after CI.

Subjects and Method: With use of a retrospective review of the medical records of 58 patients, the GAP50, GAP100, TDL50, and TDL100 parameters of the PST were compared with the results of speech perception tests at fixed time points after CI. Spearman's rank‐order correlation coefficient was used in statistical analyses.

Results: GAP100 scores were correlated with all results of speech perception tests at all time points after CI (r = 0.309–0.509, P = .001–0.010), and TDL100 scores were correlated with the results of open set one‐ and two‐syllabic word tests at 1 month after CI (r = 0.288, P = .028); no other significant correlations were found. The GAP100 scores for postlingually deaf patients, especially for gap intervals up to 100 ms, were correlated with all results of speech perception tests after CI. A stepwise multiple regression analysis revealed that the GAP100 score is the only variable that was significantly correlated with the results of speech perception tests. The duration and onset age of deafness did not significantly affect the results.

Conclusion: The PST may be a useful tool for predicting the prognosis of CI. The GAP100 score, especially for gap intervals up to 100 ms, might be useful in predicting the results of speech perception tests after CI as well as in determining the optimal site for CI in postlingually deaf patients without residual hearing.
Acoustic Neuroma in a Private Neurotology Practice: Trends in Demographics and Practice Patterns
Authors: Chen Douglas A.
Published: February 2009

Objectives/Hypothesis: To determine whether changes in demographics and management of patients with acoustic neuromas occurred between the years 1990 and 2005.

Study Design: Retrospective chart review.

Methods: Charts of all 614 patients with a diagnosis of acoustic neuroma, excluding neurofibromatosis‐2, from 1990 through 2005 were reviewed. Age at diagnosis, tumor size, hearing, and initial therapy (observation, stereotactic radiation, or surgical excision) were obtained. Patients were grouped by time period (1990–1994, 1995–2000, 2001–2005).

Results: Mean age at diagnosis increased slightly from the middle period (53.4 yr) to the most recent (56.9 yr) (P ≤ .025). The proportion of patients 65 years or older increased from 21% to 29% to 32%, respectively, but the change was not significant. Average tumor size decreased from 1.7 cm initially to 1.4 cm most recently (P ≤ .039). There were no significant changes in hearing. Although surgical excision remains our most common treatment (58.5% in 2001–2005), it is becoming less frequent (>80% in earlier periods) (P ≤ .001). Observation with serial imaging was recommended in 37.3% in 2001 to 2005 as compared with 18.3% and 11.6% in the previous two time periods (P ≤ .001). These changes in initial treatment choices occurred for all age groups and primarily for small tumors. Use of radiation has increased only slightly, to 4.2% in the recent period.

Conclusion: Patients with acoustic neuroma are presenting with increased age and smaller tumors compared with 16 years ago. However, these changes cannot totally account for the large change in treatment trends. Technology and demographics are influential in these changes, but other difficult to measure forces, such aspatient influence and patient use of the Internet, are also factors.
The Cytology and Microbiology of Persistent Paranasal Sinus Secretions After Endoscopic Sinus Surgery: A Controlled Study
Authors: Bhattacharyya Neil
Published: February 2009

Objective: To determine the cellular composition and influence of microbiology on persistent paranasal sinus secretions after endoscopic sinus surgery (ESS).

Methods: Persistent sinus secretions from a consecutive series of patients after ESS were studied with cytopathology and cultures for aerobic, anaerobic, and fungal organisms. A control group consisting of patients without persistent secretions after ESS was also studied. Epithelial, neutrophil, and eosinophil cell presence was semiquantitatively assessed on a 4‐point scale and compared between control and diseased groups. Cellular composition was then stratified and analyzed according to the presence of microorganisms.

Results: A total of 50 diseased and 24 control patients were studied. Both diseased and control patients demonstrated sloughed epithelial cells in secretions (53.1% and 66.7%, respectively, P = .131). The diseased group exhibited significantly higher eosinophilic or eosinophilic/neutrophilic cellularity than the controls (P = .048). The average neutrophil infiltration score was 0.82 versus 0.54 for the controls (P = .104). For the diseased group, the mean eosinophil score was 1.56 versus 0.96 in the control group (P = .035). Pathogenic bacteria were identified in 64% of the diseased group patients versus 54.2% in controls (P = .454). Only two fungal cultures were positive (diseased group). Microbiological analysis indicated that in the absence of bacteria, diseased group patients mainly manifested an eosinophilic presence, whereas in the presence of bacteria, the neutrophil response was enhanced in diseased patients and eosinophil response was enhanced in controls.

Conclusions: Persistent sinus secretions after ESS are primarily driven by an eosinophilic presence. Patients without inflammatory exudate after ESS respond to bacteria with increased eosinophilia, whereas hypersecretory patients demonstrate both increased neutrophil and eosinophil presence.
Association of Extraesophageal Reflux Disease and Sinonasal Symptoms: Prevalence and Impact on Quality of Life
Authors: Pasic Thomas R. , Palazzi‐Churas Kerrin L. , Connor Nadine P. , Cohen Stacy B. , Leverson Glen E.
Published: February 2009

Objectives: The purpose of this study was to investigate the prevalence of extraesophageal reflux disease symptoms and their association with sinonasal disorders within a general sample of adults in our community and to determine how these conditions affect perception of general health, sinus‐related quality of life (QOL), and perception of reflux and digestive function.

Study Design/Methods: A community‐dwelling sample of 1,878 adults completed symptom and QOL surveys in a two‐stage prospective design: an initial screening questionnaire (n = 1,878) and disease‐specific (sinus and reflux/digestion) and general health‐related QOL instruments (n = 1,073). Demographic and response data were summarized and analyzed for prevalence and correlations among data sets.

Results: Sinonasal symptoms were reported in 71% of subjects who completed the initial screening questionnaire, and reflux‐related symptoms were reported by 59% of respondents. The co‐occurrence of sinonasal and reflux symptoms was reported by 45% of respondents. Subjects with both sinonasal and reflux symptoms scored significantly worse on the disease‐specific and general physical and mental QOL scales than subjects with only reflux or sinonasal symptoms or no symptoms.

Conclusions: Symptoms associated with inflammatory sinonasal disorders and gastroesophageal reflux disease are common in the general U.S. adult population and co‐occur in the same individuals to a greater degree than can be attributed to chance alone. Co‐occurrence was found to be associated with significant declines in both disease‐specific and general physical and mental QOL. This finding has implications with regard to pathogenesis and treatment of these disorders.
Effect of Glucocorticoid on the MUC4 Gene in Nasal Polyps
Authors: Bai Chang Hoon , Song Si‐Youn , Kim Yong‐Dae
Published: February 2009

Objectives/Hypothesis: Among the airway mucin genes, the MUC4 gene is an important gene in its response to inflammatory diseases of the upper airway. However, the expression and regulation of the MUC4 gene in the nasal polyps remains unclear.

Study Design: The purpose of this study was to evaluate the expression of MUC4 mRNA and synthesis of mucin glycoprotein in the nasal polyps before and after treatment with a topical steroid in vivo and in vitro.

Methods: Nasal polyps were obtained from 20 patients with chronic rhinosinusitis and were subsequently cultured. The level of MUC4 mRNA was measured by reverse‐transcription polymerase chain reaction, and the amount of the MUC4 mucin glycoprotein was estimated by the enzyme‐linked immunosorbent assay method.

Results: The expression of MUC4 mRNA was found to be significantly higher in the nasal polyps than in the inferior turbinate (P < .05). The addition of interleukin (IL)‐1β and lipopolysaccharide (LPS) increased the expression of MUC4 mRNA and mucin glycoprotein synthesis in cultured nasal polyp epithelial cells. Treatment with glucocorticoid inhibited the expression of MUC4 mRNA in the nasal polyps; it also inhibited the expression of IL‐1β and LPS‐induced MUC4 mRNA and mucin glycoprotein synthesis in cultured nasal polyp epithelial cells. The inhibitory effects of glucocorticoid were restored by treatment with a glucocorticoid receptor antagonist (RU‐486).

Conclusions: These results suggest that the MUC4 gene is expressed in the nasal polyps and that glucocorticoid can control the expression of the MUC4 gene and mucin glycoprotein synthesis.
Effect Of N‐Acetylcysteine on Carboplatin‐Induced Ototoxicity and Nitric Oxide Levels in a Rat Model
Authors: Okur Erdogan , Kilinc Metin , Yildirim Ilhami , Kilic M Akif , Tolun Fatma Inanc
Published: February 2009

Objective: The aim of the present study is to investigate the effect of N‐acetylcysteine (NAC) given 30 minutes before carboplatin administration on carboplatin‐induced ototoxicity and nitric oxide (NO) levels in a rat model.

Study Design: Animal study.

Methods: Eighteen Sprague‐Dawley rats were divided into three groups that each contained six animals. Intraperitoneal injection of physiologic saline was performed in group 1 twice with an interval of 30 minutes. Group 2 was treated with a single bolus administration of carboplatin at a dose of 256 mg/kg 30 minutes after the intraperitoneal injection of physiologic saline. Group 3 was treated with a single bolus administration of carboplatin at a dose of 256 mg/kg 30 minutes after the intraperitoneal injection of NAC at a dose of 400 mg/kg. Pretreatment and posttreatment distortion product otoacoustic emissions (DPOAE) were performed in rats from all groups. Then, the animals were sacrificed on the fourth day, and cochlear tissue NO and glutathione peroxidase (GSH‐Px) levels were measured.

Results: The comparison of pre‐ and posttreatment DPOAE responses did not demonstrate any significant changes for groups 1 and 3. Results of group 2 showed a decrease of the DPOAE amplitude. Cochlear NO levels were significantly higher in rats treated with carboplatin than in controls and in those treated with carboplatin plus NAC (P < .05). Cochlear GSH‐Px levels were higher in rats treated with carboplatin plus NAC than in those treated with carboplatin, but the difference did not reach statistical significance (P = .079).

Conclusions: The present study showed that carboplatin at higher doses induced hearing loss and increased NO levels in the cochlea of rats. NAC appears to have a protective effect against carboplatin‐induced ototoxicity, which may be related to its inhibitory effect on NO production.
Incision and Drainage Followed by Mattress Suture Repair of Auricular Hematoma
Authors: Giles William C. , Iverson Kenneth C. , King Jonathan D. , Hill Frank C. , Woody Edward A. , Bouknight Anna L.
Published: February 2009

Objective: Auricular hematoma is a condition requiring early and effective management to prevent pathogenesis of the unsightly cauliflower ear. The objective of this study is to review cases of auricular hematoma and present incision and drainage followed by through‐and‐through whip‐type absorbable mattress sutures without bolsters as an effective treatment.

Study Design: Retrospective chart review of auricular hematoma cases.

Methods: A 5‐year retrospective evaluation of auricular hematomas presenting to an otolaryngology group was performed. Patients' charts were reviewed and data regarding the treatment and follow‐up of auricular hematomas were assembled and analyzed.

Results: Twenty‐two patients were found to present with auricular hematoma. One patient was lost to follow‐up. Twenty‐eight treatments were performed on 23 ears. Seven hematomas were treated with needle aspiration, two were treated with incision and drainage with iodoform wick placement, and 19 were treated with incision and drainage followed by absorbable mattress sutures. There were five hematoma reaccumulations requiring an additional procedure after treatment by an otolaryngologist. Three followed needle drainage; one followed incision and drainage with wick placement, and one followed incision and drainage with absorbable mattress sutures.

Conclusion: Incision and drainage followed by through‐and‐through absorbable mattress sutures appears to be a superior method of treatment with rare reaccumulation of hematoma. This method of treatment was shown to be simple and well tolerated, and it had few complications.
Scala Tympani Cochleostomy II: Topography and Histology
Authors: Adunka Oliver F. , Radeloff Andreas , Gstoettner Wolfgang K. , Pillsbury Harold C. , Buchman Craig A.
Published: February 2009

Objective: To assess intracochlear trauma using two different round window‐related cochleostomy techniques in human temporal bones.

Methods: Twenty‐eight human temporal bones were included in this study. In 21 specimens, cochleostomies were initiated inferior to the round window (RW) annulus. In seven bones, cochleostomies were drilled anterior‐inferior to the RW annulus. Limited cochlear implant electrode insertions were performed in 19 bones. In each specimen, promontory anatomy and cochleostomy drilling were photographically documented. Basal cochlear damage was assessed histologically and electrode insertion properties were documented in implanted bones.

Results: All implanted specimens showed clear scala tympani electrode placements regardless of cochleostomy technique. All 21 inferior cochleostomies were atraumatic. Anterior‐inferior cochleostomies resulted in various degrees of intracochlear trauma in all seven bones.

Conclusion: For atraumatic opening of the scala tympani using a cochleostomy approach, initiation of drilling should proceed from inferior to the round window annulus, with gradual progression toward the undersurface of the lumen. While cochleostomies initiated anterior‐inferior to the round window annulus resulted in scala tympani opening, many of these bones displayed varying degrees of intracochlear trauma that may result in hearing loss. When intracochlear drilling is avoided, the anterior bony margin of the cochleostomy remains a significant intracochlear impediment to in‐line electrode insertion.
Overall Evaluation of Effectiveness of Type II Thyroplasty for Adductor Spasmodic Dysphonia
Authors: Sanuki Tetsuji , Isshiki Nobuhiko
Published: February 2009

Objective/Hypothesis: To assess the effectiveness of type II thyroplasty with a titanium bridge in adductor spasmodic dysphonia (AdSD).

Study Design: Retrospective chart review, patient response to a questionnaire on the ease of phonation and voice quality, and pre‐ and postoperative fiberoptic laryngoscope findings.

Subjects: Forty‐one patients who underwent type II thyroplasty with a titanium bridge between December 2002 and December 2005 who have been followed for at least 12 months postoperatively.

Results: Six patients were male, and 35 were female. The voice was recorded before and at least 6 months after surgery. Initially, 97.6%, 61%, and 48.8% of the patients had a strangulated, interrupted, or tremulous voice, respectively. The mean ratings of strangulation, interruption, and tremor were calculated. The respective mean pre‐ and postoperative scores were 1.51 and 0.46 for strangulation, 0.76 and 0.05 for interruption, and 0.65 and 0.048 for tremor. In the postoperative questionnaire, 70% of the patients judged their voice as excellent and the remaining patients as improved to good or fair.

Conclusions: Type II thyroplasty is a highly effective therapy for AdSD. The voice in AdSD may roughly be classified into strangulated, tremulous, and interrupted types. The outcome measures justify the continued treatment of AdSD with type II thyroplasty.
Role of Albumin Coating of Tympanostomy Tubes: Long‐Term Clinical Evaluation
Authors: Kinnari Teemu J. , Rihkanen Heikki , Laine Timo , Salonen Eeva‐Marjatta , Jero Jussi
Published: February 2009

Objective: Our previous work has shown that albumin coating of tympanostomy tubes prevented adhesion of proteins or bacteria on the tube surface in vitro and in a 9‐month prospective follow‐up study. This study was continued until all tubes were extruded.

Study Design: A prospective, clinical trial.

Methods: The randomized, double‐blind clinical trial had 149 patients. The randomization was revealed after the follow‐up period of 9 months. The number of tube sequelae in ears with human serum albumin (HSA)‐coated titanium tympanostomy tubes was compared with the contralateral ears with uncoated, otherwise identical titanium tubes. The follow‐up continued until all tubes were extruded, followed by evaluation of each tympanostomized patient.

Results: No significant difference between the two tube types emerged after the 9‐month follow‐up. Among the patients younger than 2 years, one of the three typical bacteria causing acute otitis media (AOM), Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, was found in 45% of all bacterial cultures taken during AOM. However, among patients older than 2, one of these bacteria appeared in 17% of all the bacterial cultures and in 8% of cultures taken during the summer.

Conclusions: After the first 9 follow‐up months, no difference was found in the sequelae related to uncoated and HSA‐coated tubes. The typical bacteria causing AOM were found less frequently among patients older than 2 years. A profile of tympanostomy patients in Finland will be given.
Ototoxicity of Topical Moxifloxacin in a Chinchilla Animal Model
Authors: Daniel Sam J. , Duval Melanie , Sahmkow Sofia , Akache Fadi
Published: February 2009

Objective: Ciprofloxacin is currently the only proven nonototoxic topical antibiotic. However, its widespread use has resulted in the emergence of antimicrobial resistance. There are also concerns that there is currently no safe alternative to ciprofloxacin for patients with a nonintact eardrum. We thus wished to evaluate whether a moxifloxacin solution is ototoxic when used topically in chinchilla ears in the presence of a pressure‐equalizing tube (PET).

Study Design: A prospective, randomized, controlled trial was conducted in an animal model.

Methods: Twenty chinchillas were included in this study. After bilateral insertion of PETs, four drops of a moxifloxacin solution were delivered twice daily for 7 days in the randomly assigned experimental ear. The control ear received an equal amount of a solution of Ringer's lactate. Distortion product otoacoustic emissions (DPOAE) were recorded at baseline (after PET insertion) and at days 1, 3, 7, 14, and 28 after treatment initiation.

Results: When baseline DPOAE measurements were compared with the final measurements at day 28, moxifloxacin caused a statistically significant (P < .05) hearing loss (HL) in the experimental ears for the frequencies between 3.7 and 15 kHz. There was no significant change in hearing in the control ears.

Conclusion: This represents the first study on the ototoxicity of topical moxifloxacin. Our results demonstrate that moxifloxacin causes HL when used with a nonintact tympanic membrane in a chinchilla animal model.
Modified Retrograde Approach to Upper Eyelid Static Loading
Authors: Kim David W. , Ali M Jafer
Published: February 2009

Objectives/Hypothesis: Upper eyelid static weight loading is a technique commonly used to treat paralytic lagophthalmos. The traditional approach using the pretarsal crease incision leads to interruption of the anterior levator muscle fibers that attach to the face of the tarsus at its upper two thirds. This disruption can lead to permanent upper eyelid blepharoptosis. The retrograde approach avoids this problem but results in an incision at the lid margin, the dependent aspect of the weight. This increases the risk of implant extrusion. We hypothesize that a newly described modified retrograde approach is a safe and effective approach that avoids the pitfalls of previously described techniques.

Study Design: Retrospective review.

Methods: Eight patients were evaluated with preoperative and 3 to 6 month postoperative photographs with the eyes in the open and closed positions for the degree of lagophthalmos and blepharoptosis present. Patients were also evaluated for development of complications such as implant extrusion, pain, or infection. The surgical technique uses a supratarsal skin crease incision, supramuscular dissection to the lid margin, entry into the tarsal plane at its inferior‐most aspect, creation of a pocket for implant insertion, and layered closure.

Results: All patients had complete correction of lagophthalmos. No patients experienced infection, extrusion, or eye pain after surgery. All patients had less than 2‐mm ptosis after surgery, with no patients experiencing any visual field disruption.

Conclusions: The modified retrograde approach to upper eyelid static loading for paralytic lagophthalmos provides advantages over other techniques described. It is a safe, efficacious procedure, well tolerated by patients.
A New Model of Laryngitis: Neuropeptide, Cyclooxygenase, and Cytokine Profile
Authors: Lima‐Rodrigues Manuel , Valle‐Fernandes Ana , Lamas Nuno , Cruz Andrea , Baltazar Fátima , Milanezi Fernanda , Nunes Rui , Reis Rui M. , Pedrosa Jorge , Castro António G. , Almeida Armando
Published: February 2009

Objectives/Hypothesis: To develop and characterize a new model of laryngeal inflammation by analyzing the presence of neurogenic peptides and expression of cyclooxygenases (COX) and cytokines in the mucosa.

Study Design: Laryngitis induced by nasogastric intubation (NGI) was evaluated by histopathologic changes of the mucosa, alterations in calcitonin gene related peptide (CGRP) and substance P (SP) neuropeptides in sensory fibers, and COX‐1,2, and cytokine (interleukin [IL]‐1, IL‐6, IL‐10, tumor necrosis factor [TNF]‐α) expression in the laryngeal mucosa.

Methods: Rats submitted to NGI for 1 to 5 weeks were compared with controls. Laryngeal sections were immunostained for stereologic analysis of SP and CGRP fiber density and number of mucosal cells expressing COX‐2. Alterations in inflammatory mediators were evaluated by quantitative reverse‐transcriptase polymerase chain reaction.

Results: NGI induced metaplasia of the epithelium and narrowing of the laryngeal lumen because of hypertrophy of laryngeal glandules and edema. An initial decrease in CGRP‐ and SP‐immunoreactive fibers in the laryngeal mucosa (1–3 wk) was reverted with time (5 wk). COX‐2 expression in mucosal cells increased progressively, reaching a maximum level at 5 weeks, and was observed in mononuclear immune cells, which is indicative of a chronic inflammatory process. In regard to mRNA expression levels of inflammatory mediators, TNF‐α was increased during the 5 week NGI, and IL‐10 decreased during the 5 weeks,whereas IL‐1β, IL‐6, and COX‐2 increased in the first 1 to 2 weeks and returned to baseline at 5 weeks.

Conclusions: This NGI model results in laryngeal chronic inflammation without direct mechanical aggression of the mucosa and may contribute to the study of future therapeutic approaches to this pathology.
Role of Microvascular Density in Nonlocalizing Parathyroid Sestamibi Scans
Authors: Peters Glenn , Kulbersh Brian , Mantle Belinda , Bell Walter , Grizzle William , Rosenthal Eben
Published: February 2009

Objectives: Sestamibi scans for localization of abnormal parathyroid glands in patients with hyperparathyroidism are widely used at many institutions. Minimally invasive parathyroid surgery demands accurate preoperative localization imaging; however, nonlocalizing sestamibi scans occur in 15% of patients with primary hyperparathyroidism. It remains unknown why some sestamibi scans fail to localize. We hypothesize that an increase in microvascular density (MVD) within an adenoma will result in rapid tracer washout and a subsequent nonlocalizing scan. This study investigates the role of MVD in sestamibi localization.

Study Design: Retrospective chart review with immunohistochemical staining and data analysis.

Methods: Medical records of 83 patients who had a sestamibi scan for evaluation of primary hyperparathyroidism and underwent initial parathyroidectomy from 2000 to 2002 were retrospectively reviewed. Patients' age, sex, preoperative imaging results, operative procedure, gland weight, and histologic findings were collected. Immunohistochemistry was performed to assess MVD.

Results: Of the 75 preoperative sestamibi scans used, 51 patients had a localizing scan, and 24 were nonlocalizing. Localizing sestamibi scans for primary hyperparathyroidism demonstrated a sensitivity of 94% and specificity of 85%. By identifying multiglandular hyperplasia, nonlocalizing sestamibi scans produced a sensitivity of 83%. The localizing group had a greater percentage of solitary adenomas (94%) compared with the nonlocalizing group (15.6%) (P < .001). The mean gland weight for the nonlocalizing group was less than 398 g compared with the localizing groupweight of 1,113 g (P < .001). The mean MVD for localizing scan group was 229 vessels per high‐power field,and the mean for the nonlocalizing scans was 213 vessels per high‐power field (P = .2).

Conclusions: MVD does not predict whether sestamibi scans are localizing or nonlocalizing.
Static Facial Suspension With Surgisis ES (Enhanced Strength) Sling
Authors: Leventhal Douglas D. , Pribitkin Edmund A.
Published: February 2009

Background: Static suspension procedures stabilize and support paralyzed facial muscles and enhance facial symmetry, appearance, mastication, and speech production in patients with facial palsy. A variety of autografts and allografts have been used for static facial suspension, but each has its limitations, and few studies document the efficacy or benefit of one substance over another. Xenograft tissue scaffoldings potentially offer both the compatibility of autografts and the convenience of allografts.

Objective: Pilot study to evaluate efficacy of Surgisis ES (Enhanced Strength) static facial suspension in a series of six patients with facial paralysis.

Methods: Retrospective chart review, illustrative case series, and review of the literature.

Results: Six patients with facial paralysis were treated with the Surgisis ES facial sling procedure. Four patients achieved satisfactory results after the initial procedure. One patient was displeased with the esthetic outcome and required a revision procedure to increase the tautness of the implant. In the initial four cases, the sling was tunneled subcutaneously and sutured to the muscle. In two cases, the sling was tunneled subcutaneously and subperiosteally, thereby suspending all the soft tissue in the midface.

Conclusion: Static facial suspension with Surgisis ES improved cosmesis and function in this limited pilot study. In particular, a two‐plane dissection technique provided excellent results. Further studies need to be conducted to evaluate the ongoing benefit over time.
p75NTR and Sortilin Increase After Facial Nerve Injury
Authors: Provenzano Matthew J. , Xu Ningyong , Ver Meer Mark R. , Clark J Jason , Hansen Marlan R.
Published: February 2009

Objectives: After axotomy, Schwann cells (SCs), required for successful nerve regeneration, undergo a number of cellular changes including dedifferentiation, proliferation, expression of molecules that support axon growth, and apoptosis. This study investigated the role of p75NTR, sortilin, and proneurotrophins in SC survival after facial nerve (FN) axotomy.

Study Design: Preliminary animal study.

Methods: With use of FN SCs, expression of p75NTR and its coreceptor sortilin were quantified by immunofluorescence on days 12, 22, and 52 after axotomy in vivo and by Western blot in vitro. Contralateral FNs served as a control. SC apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). To verify a causative role for p75NTR in FN SC death, cultured FN SCs were treated with pro‐nerve growth factor (NGF), and apoptosis was determined by TUNEL.

Results: Expression of p75NTR and sortilin increased in FN SCs distal (P < .05) to the axotomy compared with the contralateral controls for all time points. SC apoptosis also significantly increased in the distal segment compared with the contralateral and proximal portions (P < .05). ProNGF, a p75NTR ligand, increased apoptosis and p75NTR expression in primary FN SC cultures.

Conclusion: FN axotomy increases p75NTR and sortilin expression in SCs, which correlates with increased apoptosis. These findings suggest roles for p75NTR and sortilin in SC loss after FN injury. Sortilin is a novel target in promoting FN healing after injury.
Differential Capture of Serum Proteins for Expression Profiling and Biomarker Discovery in Pre‐ and Posttreatment Head and Neck Cancer Samples
Authors: Freed Gary L. , Cazares Lisa H. , Fichandler Craig E. , Fuller Thomas W. , Sawyer Christopher A. , Stack Brendan C. , Schraff Scott , Semmes O John , Wadsworth J Trad , Drake Richard R.
Published: February 2009

Introduction: A long‐term goal of our group is to develop proteomic‐based approaches to the detection and use of protein biomarkers for improvement in diagnosis, prognosis, and tailoring of treatment for head and neck squamous cell cancer (HNSCC). We have previously demonstrated that protein expression profiling of serum can identify multiple protein biomarker events that can serve as molecular fingerprints for the assessment of HNSCC disease state and prognosis.

Methods: An automated Bruker Daltonics (Billerica, MA) ClinProt matrix‐assisted laser desorption/ionization time‐of‐flight (MALDI‐TOF) mass spectrometer was used. Magnetic chemical affinity beads were used to differentially capture serum proteins prior to MALDI‐TOF analysis. The resulting spectra were analyzed using postprocessing software and a pattern recognition genetic algorithm (ClinProt 2.0). An HNSCC cohort of 48 sera samples from 24 patients consisting of matched pretreatment and 6 to 12 month posttreatment samples was used for further analysis. Low‐mass differentially expressed peptides were identified using MALDI‐TOF/TOF.

Results: In the working mass range of 1,000 to 10,000 m/z, approximately 200 peaks were resolved for ionic bead capture approaches. For spectra generated from weak cation bead capture, a k‐nearest neighbor genetic algorithm was able to correctly classify 94% normal from pretreatment HNSCC samples, 80% of pretreatment from posttreatment samples, and 87% of normal from posttreatment samples. These peptides were then analyzed by MALDI‐TOF/TOF mass spectometry for sequence identification directly from serum processed with the same magnetic bead chemistry or alternatively after gel electrophoresis separation of the captured proteins. We were able to compare this with similar studies using surface‐enhanced laser desorption ionization (SELDI)‐TOF to show this method as a valid tool for this process with some improvement in the identification of our groups.

Conclusions: This initial study using new high‐resolution MALDI‐TOF mass spectrometry coupled with bead fractionation is suitable for automated protein profiling and has the capability to simultaneously identify potential biomarker proteins for HNSCC. In addition, we were able to show improvement with the MALDI‐TOF in identifying groups with HNSCC when compared with our prior data using SELDI‐TOF. Using this MALDI‐TOF technology as a discovery platform, we anticipate generating biomarker panels for use in more accurate prediction of prognosis and treatment efficacies for HNSCC.
Benign Calcified Thyroid Cyst With Skin Sinus Formation
Authors: Pal Indranil , Sengupta Subhabrata , Ramaswamy Balakrishnan , Saha Somnath
Published: February 2009

Objectives: To present a rare case of calcified thyroid cyst with discharging neck sinus and its probable explanation.

Materials and Methods: A 75‐year‐old male patient presented to the outpatients department who had had thyroid swelling for the last 50 years and a discharging neck sinus from the swelling with ulceration and fungation of the adjoining area for the last year.

Results: An X‐ray of the soft tissue of the neck showed tracheal shift to the right and irregular calcification of the left lobe of the thyroid. Fine needle aspiration cytology (FNAC) of the left lobe yielded little material with inflammatory cells as the swelling was too hard to be easily penetrated with a needle. FNAC of the right lobe revealed a picture similar to adenomatous goiter. A subtotal thyroidectomy was performed and the histopathologic report was suggestive of multinodular goiter with dystrophic calcification.

Conclusion: Though the clinical features of the patient mimicked malignant change in a pre‐existing adenomatoid goiter, histopathologically, it was found to be a calcified thyroid cyst. Probable explanation is given in the “Discussion” section.
Standardized Video‐Endoscopy and Surgical Field Grading Scale for Endoscopic Sinus Surgery: A Multi‐Centre Study
Authors: Athanasiadis Theodore , Beule Achim , Embate Jose , Steinmeier Elke , Field John , Wormald P J.
Published: February 2009

Background: Bleeding is a major concern in endoscopic sinus surgery (ESS), as it may impede surgical progress and is often associated with complications. To improve the study and management of intraoperative bleeding, a standardized method of recording bleeding during ESS is needed. The aim of this study was to develop a standardized method of documenting bleeding in ESS and of grading the surgical field.

Methods: Bleeding after endoscopic sinus surgery was recorded using video‐endoscopy. Standardized and non‐standardized video‐endoscopies of 20 patients were graded using a previously published grading scale (the Boezaart scale) in randomized order on two different occasions. Effects of standardization on intra‐ and interrater reliability were evaluated.

Based on this experience, a new 11‐point surgical field grading scale was developed and simultaneously compared with the six‐point Boezaart scale via means of a DVD in three international centers.

Results: Inter and intrarater reliability of the Boezaart and new Wormald scales significantly improved by employing a standardized video‐endoscopy technique. The Wormald scale had significantly higher interrater (0.80 vs. 0.74, P < .001) and intrarater (0.89 vs. 0.83, P < .001) reliability than the Boezaart scale. Linear regression analysis revealed the Wormald scale to be more sensitive to changes in the most common surgical fields experienced in ESS.

Conclusion: Standardized video‐endoscopy has been demonstrated to significantly improve reliability and reproducibility of results and is recommended for future work evaluating bleeding in ESS. The new Wormald grading scale has been shown to be an inexpensive, reliable, and sensitive tool to rapidly evaluate intraoperative bleeding in ESS. It overcomes several limitations of the Boezaart scale, enabling us to analyze currently employed and newly developed hemostatic methods and agents.
Sleep Disordered Breathing and Obstructive Sleep Apnea in the Cleft Population
Authors: Muntz Harlan , Wilson Matthew , Park Albert , Smith Marshall , Grimmer J Fredrik
Published: February 2009

Objectives/Hypothesis: Children with cleft deformities have the tendency for multilevel airway obstruction. The incidence of sleep disordered breathing (SDB) in this population has not been well studied. This study attempts to describe the high incidence and the results of intervention.

Study Design: A three‐year retrospective chart review by a tertiary cleft and craniofacial team.

Methods: The symptoms of sleep disordered breathing and polysomnographic data were reviewed and analyzed using descriptive statistics and multivariate analysis.

Results: Of the 539 children seen during the period, 120 (22%) had symptoms suggestive of SDB. Twenty‐four of them had a tonsillectomy with or without partial adenoidectomy without polysomnogram (PSG). Sixty‐nine (57%) had a PSG, and 28 (40%) had a follow‐up PSG.

Syndromic children had significantly more symptoms of SDB (P < .001) and were more likely to undergo PSG (P < .05). Of those children who underwent a PSG, only six had a normal obstructive apnea–hypopnea index (OAHI) with a mean (±standard deviation) respiratory disturbance index (RDI) of 15.5 (±17.5) and OAHI of 12.05 (±15.57). Post intervention PSG showed significant improvement in RDI (P = .048) and OAHI (P = .012) using a single‐tailed Wilcoxan analysis. Unfortunately, most of these children still had significant sleep apnea. There was also a high percentage of children with periodic leg motion syndrome (24.7%), some of whom also had OSA.

Conclusion: There is a high incidence of SDB and definable OSA in the cleft population. Though there is a statistically significant improvement after intervention, some were not cured. Sleep disturbance and OSA is likely under‐reported and treated in the cleft population. PSG should be done more frequently, and post intervention PSG should be strongly considered.
Seeding of Tumor Cells After Fine Needle Aspiration Cytology in Benign Parotid Tumor: A Case Report and Literature Review
Authors: Supriya Mrinal , Denholm Stuart , Palmer Tim
Published: February 2009

Fine needle aspiration cytology (FNAC) is generally considered a safe, sensitive, and specific diagnostic tool and is widely used for various clinical indications. However, some authors have raised concerns regarding the possibility of tumor cell seeding along the needle track. We present to our knowledge the first case of tumor seeding after FNAC of a benign parotid tumor. This is followed by a review of the literature on tumor seeding after aspiration with fine needles of 20 gauge and smaller and the implications for clinical practice.
Relationship Between Obesity, Obstructive Sleep Apnea, and Spontaneous Cerebrospinal Fluid Otorrhea
Authors: LeVay Adam J. , Kveton John F.
Published: February 2009

Objectives/Hypothesis: To investigate the relationship between obesity, obstructive sleep apnea (OSA), and spontaneous cerebrospinal fluid (CSF) otorrhea.

Study Design: Retrospective review of patients presenting with the diagnosis of CSF otorrhea during a 15‐year period to a tertiary care medical center.

Methods: Patient records were reviewed and the following data were extracted: age, sex, height, weight, past medical/surgical history, laterality of otorrhea, findings at operation, and method of repair. Otorrhea was considered spontaneous in the absence of trauma, otologic surgery, infection, and neoplasm.

Results: Of the 29 adult patients identified, 14 patients presented with CSF otorrhea that was spontaneous in nature. The average body mass index among these patients was 35.2 ± 8, which was higher than the average in the nonspontaneous group, 28.5 ± 5 (P = .01). Diagnoses of OSA were also more common in the spontaneous group (n = 4) compared with the nonspontaneous group (n = 0). One case of bilateral spontaneous CSF leaks was recorded. The majority of patients were repaired with hydroxyapatite cement through a transmastoid approach. There were no recurrences.

Conclusions: In this series, patients with spontaneous CSF otorrhea were more likely to be severely and morbidly obese than were patients with nonspontaneous otorrhea. OSA was also more common in these patients. The findings from this study support an association between obesity and spontaneous CSF leaks. Patients presenting with spontaneous CSF otorrhea should therefore be screened for OSA and signs of increased intracranial pressure.
Computational Modeling of Upper Airway Before and After Adenotonsillectomy for Obstructive Sleep Apnea
Authors: Mihaescu Mihai , Murugappan Shanmugam , Gutmark Ephraim , Donnelly Lane F. , Kalra Maninder
Published: February 2009

Adenotonsillectomy, the first‐line surgical treatment for obstructive sleep apnea (OSA) in children, is successful in only 50% of obese children. Computational fluid dynamics tools, which have been applied to differentiate OSA patients from those without OSA based on the airway flow characteristics, can be potentially used to identify patients likely to benefit from surgical intervention. We present computational modeling of the upper airway before and after adenotonsillectomy in an obese female adolescent with OSA. The subject underwent upper airway imaging on a 1.5 Tesla magnetic resonance imaging (MRI) scanner, and three‐dimensional airway models were constructed using airway boundary coordinates from cross‐sectional MRI scans. Our results using computational simulations indicate that, in an obese child, the resolution of OSA after adenotonsillectomy is associated with changes in flow characteristics that result in decreased pressure differentials across the airway walls and thus lower compressive forces that predispose to airway collapse. Application of such findings to an obese child seeking surgical treatment for OSA can potentially lead to selection of the surgical procedure most likely to result in OSA resolution. Effective intervention for OSA in this high‐risk group will result in reduction in morbidity and the public health concerns associated with OSA.
Free Posterior Tibial Flap for Head and Neck Reconstruction After Tumor Expiration
Authors: Ng Raymond W. M. , Chan Jimmy Y. W. , Mok Vivian , Wei William I.
Published: February 2009

Background: Similar to the radial forearm flap, free tissue transfer of a fasciocutaneous flap is possible if the septocutaneous perforators of the posterior tibial vessels are preserved.

Objective: The authors report their clinical experience on using the free posterior tibial flap for primary reconstruction of head and neck defects after tumor extirpation.

Methods: Eleven patients were included between October of 2005 and March of 2007. Patients' clinical and demographic data were collected. The flap harvesting results and outcomes were retrospectively reviewed. Representative cases are presented for illustration.

Result: There were nine men and two women, and their ages ranged from 34 to 83 (mean, 60.3) years. The flaps measured from 6 × 9 cm to 8 × 12 cm. Two cutaneous perforators were included in the majority of cases. The average flap thickness was 0.7 cm, and the average pedicle length was 14 cm. Flap survival was 100%. Skin grafts of all donor sites healed well. All patients were ambulatory early in the postoperative period, and there was no distal limb ischemia or cold intolerance on follow‐up. Four patients needed postoperative adjuvant radiotherapy.

Conclusion: Our study demonstrates that the posterior tibial flap is a safe and reliable flap for reconstruction of head and neck defects after tumor expiration. It has all the comparable properties of a radial forearm flap. In addition, a larger area of skin can be removed, and the graft donor site is less conspicuous.
Effects of Ototopical Antihistamine on Otitis Media in an Allergic Rat
Authors: Cutler Jeffrey L. , Labadie Robert F.
Published: February 2009

Objectives/Hypothesis: A reliable model of allergy has been created in the Brown Norway rat. In this model, allergen presentation to the middle ear causes functional disruption of the eustachian tube, predisposing to the development of otitis media with effusion. The purpose of this study was to study the effects of ototopical antihistamine on lipopolysaccharide (LPS)‐induced otitis media in the allergic rat model.

Study Design: Prospective animal‐based research study.

Methods: Fifteen (n = 15) rats were made allergic via sensitization to ovalbumin (OVA) by subcutaneous injection and randomized into three groups: saline (SAL) + LPS, olopatadine (OLO) + LPS, and azelastine (AZE) + LPS. Allergic rats were transtympanically injected with OVA 24 hours prior to challenge, creating a subclinical inflammatory response in which there is no visible middle ear effusion. Thirty‐five microliters of test substance (SAL + LPS, OLO + LPS, or AZE + LPS) were injected into the middle ear at 0, 2, and 4 hours. Effusion was collected at 2, 4, and 6 hours. Statistical analysis was performed on effusion volume and albumin concentration.

Results: Significant increase in effusion volume with respect to time was noted for the SAL + LPS group, whereas the AZE + LPS group demonstrated a decrease. Intergroup comparison revealed a significant decrease in effusion volume at hour 6, with both AZE and OLO less than LPS alone. A significant decrease in albumin concentration over time was noted in the AZE group. Intergroup comparison revealed a significant difference inalbumin concentration at hour 6, with OLO significantly lower than LPS.

Conclusions: Ototopical antihistamines are effective in reducing effusion volume and albumin concentration in LPS‐induced otitis media in an allergic rat model. This finding supports the hypothesis that ototopic antihistamines may prove effective in treating patients with allergy‐induced eustachian tube dysfunction.
Nasal Polyposis in Churg‐Strauss Syndrome
Authors: Bacciu Andrea , Buzio Carlo , Giordano Davide , Pasanisi Enrico , Vincenti Vincenzo , Mercante Giuseppe , Grasselli Chiara , Bacciu Salvatore
Published: February 2009

Objectives: Churg‐Strauss syndrome (CSS) is a systemic vasculitic disorder of unknown etiology that affects small‐to‐medium‐size blood vessels. Patients affected by CSS frequently show ear, nose, and throat manifestations, which are often present at the time of disease onset. The purpose of this study was to determine the frequency of nasal polyposis in a series of 29 patients with CSS and to correlate the nasal findings to the total health situation of these patients.

Study Design: Retrospective analysis.

Setting: Department of Otolaryngology and Department of Clinical Medicine, Nephrology and Health Science, University of Parma.

Methods: Twenty‐nine patients with CSS were identified. Of the 29 patients, 17 (58.6%) had nasal polyposis and were enrolled in this study. The nasal polyps were graded according to the Lund and Mackay endoscopic and radiological classifications.

Results: At diagnosis, endoscopic intranasal evaluation identified nasal polyposis of grade 3 in nine cases (52.9%), grade 2 in six cases (35.2%), and grade 1 in the remaining case (5.8%). After corticosteroid and immunosuppressive therapy, clinical remission was achieved in 14 patients (82.3%), whereas 3 patients experienced a relapse. Posttreatment endoscopic evaluation showed a permanent disappearance (grade 0) of nasal polyps in eight patients (47%). The other nine patients (52.92%) were found to have a small polyp situated in the middle meatus (grade 1).

Conclusions: Nasal polyposis in patients with CSS may represent the initial phase of the syndrome, though patients often have concurrent pulmonary disease. Corticosteroid therapy either alone or combined with immunosuppressive drugs usually yielded improvement or stabilization.
Removal of a Fronto‐Ethmoidal Osteoma Using the Sonopet Omni Ultrasonic Bone Curette: First Impressions
Authors: Pagella Fabio , Giourgos Georgios , Matti Elina , Colombo Andrea , Carena Paolo
Published: February 2009

Endoscopic exeresis of sinonasal osteomas usually implicates the use of surgical drills with some disadvantages, as underlined by many authors. A new device that performs an ultrasound bone emulsification has been proposed in recent years for bone removal in various surgical disciplines. In this case report, we present the first clinical ENT experience with this device in removing a fronto‐ethmoidal osteoma, and we briefly discuss our impressions.