bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Facial Paralysis Resulting from Temporal Bone Fractures: Our Experience in 115 Cases
Authors: Darrouzet Vincent , Duclos Jean‐Yves , Liguoro Dominique , Truilhe Yves , De Bonfils Camille , Bebear Jean‐Pierre
Published: February 2003

OBJECTIVE

The goal of this study was to review decision factors and overall results regarding surgical and nonsurgical management of post‐traumatic facial nerve paralysis (FP).

STUDY DESIGN

A retrospective study and literature review were performed.

METHODS

Between 1984 and 1990, 115 cases of post‐traumatic FP were handled. Patients were evaluated through clinical, audiologic, radiologic, and electromyogram assessment. Depending on examination results, patients were treated either medically or surgically through total facial nerve decompression.

RESULTS

Forty‐nine of the 50 medically treated patients experienced a normal or subnormal facial function recovery (grade I–II). Of the 65 (56.5%) surgically treated patients, 52 (80%) had immediate, 2 had delayed, and 11 (17%) had unknown delay‐associated FP. The approaches chosen were middle fossa and transmastoid (75.3%), translabyrinthine (10.7%), or pure transmastoid according to facial nerve nonmotor branch evaluation, hearing, location of the fracture line, and the patient's general condition. Lesions were predominantly found in the geniculate ganglion area (66.2%). A nerve gap was found in only 13.8% of the cases. At 2 years after surgery, 93.8% had a grade I to III recovery. None had grade V or VI.

CONCLUSION

The rarity of severe nerve lesions encountered in surgically treated patients raises the question of better selection of candidates for surgery. Surgery is clearly indicated when FP is total, is of immediate onset, and is associated with a bad prognosis electromyogram pattern. In other settings, decisions are to be made based on high‐resolution CT data and electromyogram results, thanks to a clinical survey and second electromyogram evaluation.
The Effects of Sensitization and Hypersensitivity Reaction on Transepithelial Antigen Transport of Rat Nasal Mucosa
Authors: Yang Ping‐Chang , Zeng Hai‐Yan , Zhang Tao‐Yuan , Zheng Yi‐Qing , Chen Jie‐Zhu
Published: February 2003

METHODS

The prevalence of airway allergy is very high. The ways that antigen passes across the airway tract epithelial barrier are not well understood. This study uses a model antigen, horseradish peroxidase (HRP), to sensitize and challenge the respiratory tract in the rat model.

RESULTS

The results showed increases in HRP endosomes in nasal epithelial cells 5 minutes after HRP challenge in the sensitized rats compared with controls, which were further increased 30 minutes after HRP challenge, as well as with the paracellular region filled with HRP products. Meanwhile, mast cells were activated as shown by degranulation. Analysis of cell type showed that there were many more HRP endosomes in the nonciliated cells and there were many more nonciliated cells in the nasal mucosa of the sensitized rats.

CONCLUSION

The results demonstrate that sensitization promotes airway mucosal epithelial cells' uptake and transport of specific antigen and that mast cells may play certain roles in this process.
Prospective Analysis of Sinus Symptoms and Correlation with Paranasal Computed Tomography Scan
Authors: Kenny Thomas J. , Duncavage James , Bracikowski James , Yildirim Altan , Murray John J. , Tanner S. Bobo
Published: February 2003

OBJECTIVES

We designed a prospective study to determine whether there is a correlation between the severity of sinus symptoms and the severity of computed tomography (CT) scan evidence of rhinosinusitis.

METHODS

Acute and chronic rhinosinusitis patients rated their symptoms and had a CT scan of the sinuses taken the same day. A Likert severity scale and standardized CT scoring system were used. Data were analyzed by nonparametric methods with Kendall's rank correlation coefficient.

RESULTS

The severity of 5 symptoms correlated with severity of disease on CT scan. Headache and facial pain or pressure had no correlation.

CONCLUSION

The certainty of a clinical diagnosis of rhinosinusitis requiring treatment is enhanced in patients with high symptom severity scores for fatigue, sleep disturbance, nasal discharge, nasal blockage, or decreased sense of smell. Isolated headache and facial pain or pressure are less reliable predictors of CT scan findings supporting the diagnosis rhinosinusitis.
Thyroid Surgery: A Comparison of Outcomes between Experts and Surgeons in Training
Authors: Manolidis Spiros , Takashima Masayoshi , Kirby Matthew , Scarlett Matthew
Published: February 2003

OBJECTIVES

Our objective was to compare the results of thyroid surgery performed by residents in a large metropolitan public hospital (MPH) with those performed by faculty in a large private hospital (PH) setting.

METHODS

All records of thyroid surgery performed by otolaryngologists for the period between 1986 and 1998 were reviewed. Inclusion criteria were adequacy of data and follow‐up. Ninety‐two thyroid procedures performed by residents in an MPH were compared with 181 thyroid operations in a PH setting performed by the faculty of these residents for differences in accuracy of diagnostic studies, operative parameters, and complication rates.

RESULTS

The demographic distribution in both groups was similar. Presenting symptoms were twice as frequent in the MPH group (45% vs 22%). More total thyroidectomies were performed in the PH group (49% vs 32%). Blood loss, operative time, and hospitalization days were similar in both groups. Preoperative fine needle aspiration and intraoperative frozen section results showed sensitivities and specificities that were comparable. No permanent vocal cord paralysis was observed in either group. Permanent hypocalcemia was more frequent in the PH group (8.8%:PH vs 5.1%:MPH).

CONCLUSIONS

The results of thyroid surgery performed by residents in training in an Otolaryngology‐Head & Neck Surgery program in an MPH, measured by rates of complications, length of hospitalization, and duration of surgery, are similar to those of faculty at a PH setting in groups of patients with very similar characteristics.
Time Necessary for Neovascularization of a Tracheal Segment by the Sternohyoid Muscle
Authors: Câmara Tecchio Simone A. , De Mello‐Filho Francisco Veríssimo , Mamede Rui C. Martins , Velludo Maria A. S. Llorach
Published: February 2003

INTRODUCTION

The reimplantation of a complete tracheal segment (CTS) as an autograft or homograft often results in total or partial necrosis of the CTS. However, previous experiments suggested that when the CTS is first vascularized by the sternohyoid muscle (SM) 21 days before the reimplantation, the CTS can be reimplanted without ischemia or stenosis. However, it is not clear if the CTS requires 21 days to attain full revascularization.

GOAL

This study aims to ascertain the minimum time necessary for revascularization of the 6 rings CTS by the SM allowing reimplantation free of ischemia.

METHODS

Fifteen mongrel dogs, divided into 3 groups were submitted to 2 sequential surgical procedures. In the first procedure, a SM flap was used to envelop 6 rings CTS in all dogs. After periods of 21 days (group 1, n = 5), 14 days (group 2, n = 5) and 7 days (group 3, n = 5), the compound flaps (CTS and SM) were neovascularized. Each CTS was transected and mobilized from the trachea and then replaced again in its original site, as an autoflap.

RESULTS

After a period of at least 60 days, none of dogs presented any respiratory alteration. Macroscopic and microscopic analyses demonstrated adequate viability and no stenosis.

CONCLUSION

Our findings suggest that it is possible to neovascularize the CTS using a SM flap within a period as short as 1 week.
Inflammatory Pseudotumor of the Maxillary Sinus
Authors: Lee Heung‐Man , Choi Geun , Choi Choong Sik , Kim Chul Hwan , Lee Sang Hag
Published: February 2003

Inflammatory pseudotumor of the upper airway is an uncommon lesion that clinically mimics a neoplastic process. It has no identifiable cause and is not associated with systemic disease. It is thought to be a form of idiopathic pseudotumor and has been reported most often to occur in the lungs, airways, and orbit.1 Its occurrence in the maxillary sinus is rare.2,3 We document a case of a 64‐year‐old woman with a maxillary sinus inflammatory pseudotumor that simulated an aggressive neoplasm on CT scan. The difficulties in establishing this clinicopathologic diagnosis are discussed.
Changes in External Ear Resonance after 3 Types of Surgery in the Patients with Chronic Otitis Media
Authors: Cho Yang‐Sun , Seo In‐Seok , Woo Hyo‐Chang , Kang Myung‐Koo , Chung Won‐Ho , Hong Sung Hwa
Published: February 2003

OBJECTIVE

This study was designed to identify the external ear resonance characteristics of patients with tympanic membrane perforation and to investigate subsequent changes in external ear resonance, depending on the length of the postoperative period and which of 3 different types of operation was performed: tympanoplasty with canal wall‐up mastoidectomy, epitympanoplasty, and canal wall‐down mastoidectomy.

STUDY DESIGN AND SETTING

A total of 227 ears of 188 patients and 96 control ears comprised the study. We measured the gain and frequency of the first peak of external ear resonance with a real ear analyzer.

RESULTS

Gain and frequency of the first peak recorded in the preoperative group did not differ from those of the control group. However, negative peaks appeared around 1 to 1.5 kHz in half of these ears. The gain increased markedly in all 3 postoperative groups. The canal wall‐down mastoidectomy and epitympanoplasty groups showed significantly lower frequencies compared with the tympanoplasty with canal wall‐up mastoidectomy and control groups, but there was no difference between them. The increased gain diminished over time, but the peak gain did not equalize with that of the controls, even after 15 months.

CONCLUSIONS

Additional gain should be considered of around 1 to 1.5 kHz for hearing aid users with tympanic membrane perforation. Postoperative changes in external ear resonance should be expected in patients with chronic otitis media, suggesting that fine readjustments of the hearing aid may be necessary.
Incidence of Pulmonary Edema after Tracheotomy for Obstructive Sleep Apnea
Authors: Burke A. J. C. , Duke S. G. , Clyne S. , Khoury S. A. , Chiles Caroline , Matthews B. L.
Published: February 2003

OBJECTIVE

The phenomenon of postobstructive pulmonary edema (POPE) has been associated with the relief of upper airway obstruction, which itself is fundamental to the pathophysiology of obstructive sleep apnea (OSA). A review of patients with OSA undergoing tracheotomy was performed to characterize this process.

STUDY DESIGN

Retrospective chart review of study patients with OSA undergoing tracheotomy and of control patients without OSA undergoing tracheotomy for unrelated problems. Chest radiographs were reviewed in a double‐blind fashion to score posttracheotomy changes in pulmonary status.

SETTING

Academic tertiary referral center.

RESULTS

Thirty (67%) of 45 OSA patients treated by tracheotomy had evidence of POPE, whereas only 5 (20%) of 25 control group patients had increased pulmonary edema. The remaining 15 (33%) of 45 OSA patients and 20 (80%) of 25 control patients had either no change or an improved pulmonary status. Those with OSA that developed POPE were mostly graded as having mild pulmonary edema (22/30, 73%). Far fewer were graded as having moderate pulmonary edema (6/30, 20%), and fewer still with severe pulmonary edema (2/30, 7%). Two (7%) of 45 patients with severe POPE died of complications related to cor pulmonale in the postoperative period.

CONCLUSION

Results support maintaining a high index of suspicion for the development of postobstructive pulmonary edema in patients treated for OSA. Treatment options, such as positive pressure ventilation and diuresis, and an increased awareness of this condition may help reduce the morbidity and mortality associated with treatment of this disease.
Laryngeal Compartmentalization after Radiation Therapy in a Canine Model
Authors: Yu Larry , Iii Charles Syms , Dietz Wolfgang
Published: February 2003

OBJECTIVE

We set out to study the effects of radiation therapy on laryngeal tissue barriers in a canine model as described by Welsh.

STUDY DESIGN

India ink was injected into 1 vocal fold on irradiated and nonirradiated canine larynges.

RESULTS

The india ink dye spread more prominently into the supraglottis of the irradiated specimens by submucosal lymphatics. Larger dye volumes simulating larger tumor bulk spread to the contralateral larynx in irradiated specimens.

CONCLUSION

Conservation laryngeal surgery for laryngeal carcinoma is a popular method of treatment. Some surgeons advocate partial laryngectomy for radiation failures; in other instances, it is the primary modality of treatment. These findings suggest a cautious approach when planning conservative laryngeal surgery after radiation therapy failures of glottic carcinoma.
A Study of the Effect of Nasal Steroid Sprays in Perennial Allergic Rhinitis Patients with Rhinitis Medicamentosa
Authors: Ferguson Berrylin J. , Paramaesvaran Suchitra , Rubinstein Elaine
Published: February 2003

OBJECTIVE

To determine if rebound congestion can be reduced with concomitant nasal steroid spray usage.

STUDY DESIGN AND SETTING

Randomized, double blind, controlled single center study.

PARTICIPANTS

Twenty subjects with perennial allergic rhinitis with nasal congestion.

INTERVENTION

All subjects received 3 weeks of twice‐daily oxymetazoline. After 2 weeks, subjects were randomized to 2 additional weeks of concomitant budesonide aqueous nasal spray (n = 9) or placebo (n = 10). In the sixth week, all sprays were stopped.

RESULTS

Both groups showed subjective and objective evidence of rebound congestion 24 hours after cessation of oxymetazoline (P < 0.05). Subjective rebound congestion resolved in 48 hours in the budesonide aqueous nasal spray group but persisted for over 1 week in the placebo group.

CONCLUSION

Rebound congestion is objectively present in patients with perennial allergic rhinitis after 3 weeks of oxymetazoline spray. Rebound congestion is reduced by concomitant budesonide aqueous nasal spray use.

SIGNIFICANCE

This study supports the common clinical practice of nasal steroid sprays to ameliorate rebound congestion concomitant with and after cessation of topical decongestant sprays.
Carbon Dioxide Laser and Silver Halide Infrared Transmitting Fibers for Tympanoplasty: An Experimental Animal Model
Authors: Zilkerc Zeev , Nageris Ben I. , Feinmesser Raphael , Fridman Edward , Ravid Avi , Kariv Noam , Katzir Abraham
Published: February 2003

OBJECTIVE

This study evaluates the effectiveness and safety of fiberoptic carbon dioxide (CO2) laser welding for graft closure of tympanic membrane perforations in an animal model.

STUDY DESIGN AND SETTING

Tympanic membrane perforation was surgically induced in 11 eardrums of 7 given pigs. A lumbar facial graft was placed over the wound, and albumin drops served as a biologic solder. CO2laser energy, transmitted through silver halide infrared transmitting fibers, was used for „spot‐welding“ along the circumference of the graft. The welded sites were evaluated by using a surgical microscope as well as by evaluating the sites histologically.

RESULTS

Healing started 3 to 4 days after surgery and was completed within 3 weeks with the formation of a neotympanum. Some inflammation with granulation tissue was noted in 5 eardrums.

CONCLUSIONS AND SIGNIFICANCE

These preliminary results indicate that CO2laser tympanoplasty with a fiberoptic delivery system may be a promising new technique for the clinical setting.
The Meaning of the Word “Vertigo”
Authors: Blakley Brian W. , Goebel Joel
Published: February 2003

OBJECTIVE

To determine whether otologists see a need to further define the word“vertigo” and assess the variety of meanings that are meant in using the word.

METHODS

A questionnaire was mailed to 720 members of the American Otological Society (AOS) and American Neurotological Society (ANS) to assess the need for further definition and the current understanding of the meaning of“vertigo.”

RESULTS

The response rate was 42%. Significant variability in the intended meaning of the word“vertigo” was found suggesting that the definition is inconsistent among experts. Three quarters of the respondents indicated that the word needs further definition. The word was most commonly used to indicate sensations that include spinning or turning only.

CONCLUSION

The definition of the term“vertigo” is inconsistent among otolaryngologists. Refinement of the definition is desirable for accurate history taking and should be limited to false illusions of circular motion.
Increased Levels of Immune Inhibitory Cd34+ Progenitor Cells in the Peripheral Blood of Patients with Node Positive Headc and Neck Squamous Cell Carcinomas and The Ability of These CD34+ Cells to Differentiate Into Immune Stimulatory Dendritic Cells
Authors: Lathers Deanne M.R. , Achille Nicholas , Kolesiak Kristin , Hulett Kevin , Sparano Anthony , Petruzzelli Guy J. , Young M. Rita I.
Published: February 2003

OBJECTIVES

This study determined whether mobilization of immune inhibitory CD34+ cells by head and neck squamous cell carcinomas (HNSCC) is most prominent in patients who are node positive and whether these CD34+ cells could differentiate into immune stimulatory dendritic cells.

STUDY DESIGN AND SETTING

Peripheral blood from patients with head and neck cancer was used to measure the frequency of CD34+ cells and their capacity to differentiate into immune stimulatory dendritic cells.

RESULTS

This study demonstrated that increased CD34+ cell levels were most prominent in patients who were node positive and patients with recurrent disease. These CD34+ cells differentiated into dendritic cells that were able to present tetanus toxoid to autologous T‐cells.

CONCLUSIONS

Immune suppressive CD34+ cells that are prominent in patients with HNSCC who are node positive are able to develop into immune stimulatory dendritic cells.

SIGNIFICANCE

Differentiation of tumor‐mobilized CD34+ cells into dendritic cells may be an immuno‐therapeutic approach to stimulate antitumor reactivity.
Otologic Injuries from Airbag Deployment
Authors: Yaremchuk Kathleen , Dobie Robert A.
Published: February 2003

Airbags became available as an optional passive restraint system in motor vehicles in 1973. The National Highway Traffic Safety Administration mandated placement of driver and right passenger airbags in all passenger vehicles and light trucks beginning in model year 1997. An estimated 2.1 million airbags have been deployed from the late 1980s until the present. There have been several case reports of hearing loss after exposure to airbag deployments in drivers and passengers since 1995. Members of the American Academy of Otolaryngology‐Head and Neck Surgery submitted case reports on 71 patients with otologic symptoms after airbag deployment.
Lack of Utility of Postoperative Chest Radiograph in Pediatric Tracheotomy
Authors: Pinto Jayant M. , Ansley John , Baroody Fuad M.
Published: February 2003

OBJECTIVE

To assess the incidence of pulmonary complications after nonemergent pediatric tracheotomy and to determine whether obtaining a routine postoperative chest radiograph is warranted.

STUDY DESIGN

Retrospective review of the records of 107 consecutive patients (age 1 month to 18 years) who underwent tracheotomy from October 1994 to June 2000. Main outcome measures included frequency of pulmonary complications and use of information obtained from postoperative chest radiograph for intervention.

SETTING

Tertiary care university children's hospital.

RESULTS

No pneumothoraces or significant pulmonary complications were detected in the immediate postoperative period. No management changes were undertaken as a result of information obtained from any chest radiograph in this period.

CONCLUSIONS

The incidence of significant pulmonary complications after pediatric tracheotomy is low. Little information is obtained from chest radiograph after tracheotomy, and this information does not change management.

SIGNIFICANCE

Routine postoperative chest radiograph after pediatric tracheotomy is not indicated in all patients.
Giant Extracranial Internal Carotid Artery Aneurysm: A Rare Presentation with an Oropharyngeal Mass
Authors: Oruckaptan H. Hakan , Ozcan Osman E.
Published: February 2003

Aneurysms of the extracranial carotid arteries are infrequent lesions in both neurosurgery and cardiovascular surgery practice. Although the exact frequency is unclear, it has been reported in 1 of 60 to 1 of 800 of all aneurysms found at the other anatomic locations and in less than 1% of surgical procedures performed for carotid artery diseases.1 Most of these aneurysms are believed to be the result of either traumatic or spontaneous dissections. Along with showing the outcome of these lesions, clinical and angiographic presentations show significant variations according to the etiology.2,3 Traumatic aneurysms usually tend to manifest at the time of insult, or a few months after the insult, but occasionally show a prolonged history, whereas spontaneous lesions usually remain silent for years. Spontaneous dissections frequently affect the proximal segment of the internal carotid artery (ICA) and the bifurcation of the common carotid artery (CCA).2 Bilateral involvement of the carotid system is not an infrequent event and suggests an underlying atherosclerotic disease, fibromuscular dysplasia, or other connective tissue disorders. The clinical manifestation of these lesions may vary from the serious ischemic deficits and lower cranial nerve palsies to an asymptomatic mass in the neck or a prolonged history of headache.
The Effect of Esophageal Pressure Monitoring on Nasal Airway Resistance
Authors: Virkkula Paula , Silvola Juha , Lehtonen Hannu , Salmi Tapani , Malmberg Henrik
Published: February 2003

OBJECTIVE

Artificial obstruction of nasal airflow has been shown to increase the amount of apneas and arousals. An esophageal catheter inserted through the nasal cavity is used in sleep studies to show intrathoracic pressure variations as sign of obstructive apneas and increased respiratory resistance. This study evaluates the effect of transnasal esophageal catheter on nasal airflow.

STUDY DESIGN AND SETTING

Fifty patients with problem snoring referred to our ENT clinic underwent overnight limited sleep study with an esophageal catheter. Nasal airway resistance was measured the following morning with active anterior rhino‐manometry. After exclusion of 17 measurements, the results of 33 patients were compared with same parameters obtained earlier without nasal manipulation.

RESULTS AND CONCLUSION

The ipsilateral nasal resistance was clearly elevated when measured with a catheter used overnight compared with the control measurement (P < 0.05). However, the combined nasal resistance was not significantly increased in this material with patent nasal airways. In patients with already compromised nasal airflow, the possibility of clinically relevant changes in nasal airflow during catheter use should be taken in account.
Randomized Controlled Trial of Vestibular Rehabilitation Combined with Cognitive‐Behavioral Therapy for Dizziness in Older People
Authors: Johansson Magnus , Akerlund David , Larsen Hans Christian , Andersson Gerhard
Published: February 2003

OBJECTIVE

To evaluate the effectiveness of vestibular rehabilitation combined with cognitive behavioral therapy in the treatment of dizziness in older people.

STUDY DESIGN AND SETTING

A randomized controlled design was used with patients recruited via an advertisement. Nine patients completed treatment and 10 served as waiting‐list controls. The intervention lasted 7 weeks with 5 weekly group sessions and consisted of vestibular exercises. Cognitive behavioral therapy components were added to promote relaxation, reduce anxiety, and avoidance of feared situations and movements.

RESULTS

Statistically significant improvements on walking time, 2 dizziness provocative movements, and on the Dizziness Handicap Inventory, but no effects on the Romberg or anxiety and depression. Of the treated patients, 89% reached statistical significant improvement on the total inventory score.

CONCLUSION

Cognitive behavioral therapy combined with vestibular rehabilitation decreases dizziness in older people.

SIGNIFICANCE

These findings indicate that cognitive behavioral therapy can be combined with vestibular rehabilitation in the treatment of dizziness.
The External Approach for Submucosal Lesions of the Larynx
Authors: Myssiorek David , Madnani Dilip , Delacure Mark D.
Published: February 2003

OBJECTIVE

The surgical excision of benign submucosal lesions of the larynx can be performed using a variety of techniques including direct laryngoscopy and external approaches. We propose that small submucosal lesions of the larynx can be removed via the external approach without a tracheotomy.

STUDY DESIGN

Retrospective chart review.

SETTING

Six patients at The Long Island Jewish Medical Center and at the New York University School of Medicine underwent an external approach for the removal of benign submucosal laryngeal lesions without tracheotomies. Lesions included a mixed laryngopyocele, an internal laryngopyocele, a mixed laryngocele, a paraganglioma, a neurilemmoma and a lymphoma. Follow‐up ranged from 1 to 9 years.

RESULTS

All patients were female with an average age of 72. No patient required a tracheotomy. One patient remained intubated for 24 hours postoperatively to ensure an adequate airway. Mild dysphagia was noted in all patients, but it was short‐lived and did not require alternate methods of alimentation. There have been no recurrences of disease.

CONCLUSION

The external approach without tracheotomy allows for good exposure with minimal functional disability for the removal of benign sub‐mucosal lesions of the larynx.
Proton Pump Inhibitor Resistance in the Treatment of Laryngopharyngeal Reflux
Authors: Amin Milan R. , Postma Gregory N. , Johnson Paul , Digges Nicholas , Koufman James A.
Published: February 2003

OBJECTIVE

To describe the occurrence of relative proton pump inhibitor (PPI) drug resistance in the treatment of laryngopharyngeal reflux (LPR).

STUDY DESIGN AND SETTING

A retrospective review was performed for 1053 consecutive adults undergoing double‐probe (simultaneous esophageal and pharyngeal) pH testing in our laboratory. Two hundred five patients who had pH studies performed while taking at least a daily dose of PPI therapy were identified; 167 qualified for further analysis. The pH data was reviewed for the presence of abnormalities in either esophageal or pharyngeal acid exposure to evaluate drug efficacy.

RESULTS

Forty‐four percent (74/167) of the study patients demonstrated abnormal levels of acid exposure. Results were further analyzed to compare failure rates based on different dosage regimens. Patients on once daily doses of PPI failed at a rate of 56%, with lower failure rates for higher‐dose regimens.

CONCLUSIONS

A significant number of LPR patients on PPI therapy demonstrate relative drug resistance.
Implications of Sound Levels Generated by Otologic Devices
Authors: Michaelides Elias M. , Kartush Jack M.
Published: February 2003

OBJECTIVE

Exposure to loud noise can result in sensorineural hearing loss. In otology, a wide variety of devices are used that have significant noise output, both to the operator and the patient. This study quantifies and compares the sound pressure levels (SPL) of a variety of otologic instruments.

METHODS

Using a calibrated sound pressure level meter, the peak and impulse sound pressure levels of several otologic instruments were determined at 1 cm from their application to human temporal bones. Devices measured were an air‐powered drill with a cutting burr, an electric micro‐drill, and KTP, CO2, and erbium lasers.

RESULTS

Impulse sound pressure levels for the KTP laser, CO2 laser, microdrill, air‐powered drill and erbium laser were 67, 71, 90, 105, and 105 dBA, respectively. Peak sound pressure levels were 81, 89, 102, 118, and 132 dBA, respectively.

CONCLUSIONS

Use of the KTP laser, CO2 laser, and microdrill result in impulse levels of less than 100 dBA. Although the impulse levels of the erbium laser and the air‐powered drill were equivalent, the peak sound pressure levels of the erbium laser were significantly higher. These high sound pressure levels may increase the chance for hearing loss.

Like any tool, lasers and drills have benefits and risks. The results of this study demonstrate significant differences in SPLs of common otologic lasers and drills. Although noise‐induced hearing loss is a function of both SPL and duration of exposure, surgeons should consider these differences when selecting and applying these tools, especially when used on or adjacent to the ossicular chain and stapes footplate.
Bariatric Surgery for Treatment of Sleep Apnea Syndrome in 15 Morbidly Obese Patients: Long‐Term Results
Authors: Scheuller Michael , Weider Dudley
Published: February 2003

OBJECTIVE

To evaluate the long‐term outcomes of bariatric surgery with respect to respiratory disturbance index (RDI) in sleep apnea syndrome (SAS).

DESIGN

Case series with long‐term follow‐up (1 to 12 years).

SETTING

Private clinic in an academic tertiary referral center.

PATIENTS

Fifteen morbidly obese patients (10 men, 5 women) who were referred for the treatment of severe SAS.

INTERVENTION

For all 15 patients who presented with severe SAS, nasal positive airway pressure breathing was either not available or was not tolerated by the patient; therefore, bariatric surgery was performed as a means of treatment for SAS.

MAIN OUTCOME MEASURES

RDIs and minimum oxygen saturation were measured both preoperatively and postoperatively (1 to 12 years after surgery).

RESULTS

Weight loss ranged from 60 to 220 pounds (27 to 100 kg). RDI decreased by at least 55% in each patient, and all patients with tracheostomies (8 of 15) had their tracheostomy tubes removed. Average RDI preoperatively was 96.9 and average RDI postoperatively was 11.3. Results were similar for all 15 patients in that minimum oxygen saturation increased during sleep from an average preoperative minimum oxygen saturation of 58.7% to an average postoperative minimum oxygen saturation of 85.2%.

CONCLUSIONS

Bariatric surgery as a means of treating SAS in the morbidly obese provides effective long‐term reduction in RDI. Bariatric surgery also significantly improves minimum oxygen saturation in morbidly obese patients with SAS. Biliopancreatic bypass is more effective in reducing RDI to normal values than vertical banded gastroplasty.
Late‐Phase Allergy and Eustachian Tube Dysfunction
Authors: Hardy Stuart M , Heavner S. Brett , White David R. , Mcqueen Chapman T. , Prazma Jiri , Pillsbury Harold C.
Published: February 2003

OBJECTIVE

This study investigated the role of late‐phase allergy in the development of otitis media with effusion.

METHODS

Brown Norway rats were sensitized to ovalbumin and later challenged transtympanically. Eustachian tube ventilatory function was assessed 2, 4, 8, 24, 28, and 32 hours postchallenge by measuring passive opening and closing pressures, active clearance of positive and negative middle ear pressure, and mucociliary clearance.

RESULTS

The results demonstrate that exposure to transtympanic allergen induces eustachian tube dysfunction and subsequent formation of effusion. Allergic animals showed significant increases in passive and active opening pressures, as well as a decreased ability to actively clear middle ear pressure. Finally, the mucociliary was significantly impaired in all sensitized rats exposed to transtympanic allergen.

CONCLUSION

These findings demonstrate that late‐phase allergy leads to significant eustachian tube dysfunction and subsequent formation of effusion by impairing the ventilatory and clearance functions of the eustachian tube.
Temperature‐Controlled Radiofrequency Tonsil Reduction: Extended Follow‐Up
Authors: Nelson Lionel M.
Published: February 2003

OBJECTIVE

Initial evaluation has shown that temperature‐controlled radiofrequency submucosal tonsil reduction (Tonsil Somnoplasty) effectively treats obstructive symptoms of tonsillar hypertrophy with minimal associated discomfort and rapid return to normal activity and diet. This study assesses the effects of treatment over an extended follow‐up period of up to a year.

STUDY DESIGN

Twelve adults with symptomatic chronic tonsil enlargement underwent an average of 1.5 treatments. Evaluation included periodic oropharyngeal airway measurements, and questionnaires on treatment morbidity and symptom improvement.

RESULTS

Data on 12 patients at 3 months and 6 months, and 5 patients at 1 year show sustained increases in oropharyngeal airway size (1.7 cm/3 mo, 1.8 cm/6 mo, 2.4 cm/12 mo) and reduction in obstructive symptoms (Epworth Score decrease of 70%/3 mo, 58%/6 mo, 67%/12 mo; snoring reduction of 81%/3 mo, 79%/6 mo, 78%/12 mo) without significant differences after 3 months. A second treatment reduced tonsil size but gave variable further symptom improvement.

CONCLUSION

The effects of Tonsil Somnoplasty are maintained on follow‐up to 1 year.
Intratympanic Dexamethasone, Intratympanic Gentamicin, and Endolymphatic Sac Surgery for Intractable Vertigo in Meniere's Disease
Authors: Sennaroglu Levent , Sennaroglu Gonca , Gursel Bulent , Dini Farzin Mottaghian
Published: February 2003

OBJECTIVE

To compare the efficacy of intratympanic dexamethasone (ID), intratympanic gentamicin (IG), and decompression of the endolymphatic sac (ESD) for intractable vertigo in Meniere's disease.

STUDY DESIGN AND SETTING

This prospective study was conducted at Hacettepe University Medical Faculty, a tertiary care center. Dexamethasone was applied through a ventilation tube in 24 patients, intratympanic gentamicin (also through a ventilation tube) to 16 patients, and 25 patients underwent ESD.

RESULTS

Satisfactory control of vertigo was 72%, 75%, and 52%, respectively for the ID, IG, and ESD. Two patients in the gentamicine group had total hearing loss. In the dexamethasone group, hearing level remained the same in 46% of the patients with 16% increase and 38% decrease (30% 10dB and 8% 20 dB).

CONCLUSION

If the vertiginous symptoms still persist after 6 months of medical treatment, ID can be started. If there is no further improvement after 3 months with ID, patients with profound sensorineural hearing loss undergo treatment with IG, ESD is reserved for patients with good hearing. If ESD also fails, patients with good hearing may undergo vestibular nerve section; patients with nonservicable hearing become candidates for labyrinthectomy.
Emerging Perceptions of Facial Plastic Surgery Among Medical Students
Authors: Rosenthal Eben , Clark J. Madison , Wax Mark K. , Cook Ted A.
Published: February 2003

OBJECTIVE

The purpose of this study was to examine the perceptions of medical students regarding facial aesthetic surgery and those specialists most likely to perform aesthetic or reconstructive facial surgery.

METHODS

A survey was designed based on a review of the literature to assess the desirable characteristics and the perceived role of the facial plastic and reconstructive surgeon (FPRS). The surveys were distributed to 2 populations: medical students from 4 medical schools and members of the general public.

RESULTS

A total of 339 surveys were collected, 217 from medical students and 122 from the general public. Medical students and the public had similar responses. The results demonstrated that respondents preferred a male plastic surgeon from the ages of 41 to 50 years old and would look to their family doctor for a recommendation. Facial aesthetic and reconstructive surgery was considered the domain of maxillofacial and general plastic surgeons, not the FPRS.

CONCLUSION

Integration of the FPRS into the medical school curriculum may help to improve the perceived role of the specialty within the medical community. It is important for the specialty to communicate to aspiring physicians the dedicated training of an otolaryngologist specializing in FPRS.
Complications of Radiofrequency Ablation in the Treatment of Sleep‐Disordered Breathing
Authors: Pazos George , Mair Eric A.
Published: February 2003

OBJECTIVE

To evaluate complications of radiofrequency ablation (RFA) in the treatment of sleep‐disordered breathing and to outline complication avoidance strategies.

STUDY DESIGN AND SETTING

Retrospective review of 51 consecutive RFA treatment sessions for SDB to the soft palate and tongue base by a single surgeon at a tertiary medical center.

RESULTS

Over 2 years, 51 treatments comprising 26 palatal and 25 tongue base RFA treatments were performed for sleep‐disordered breathing on 30 patients. Complications included palatal mucosal breakdown (11 cases), temporary tongue base neuralgias (4 cases), uvular sloughing (2 cases), tongue base abscesses (2 cases), and floor of mouth edema with airway compromise (2 cases). CONCLUSIONS/SIGNIFICANCE: This is the first paper focusing on complications of RFA. While complications from soft palate RFA present rapidly and are self‐limiting, complications from tongue base RFA may be delayed and life threatening. A detailed strategy is provided to avoid and treat these complications.
Investigation of Skeletal Muscle Denervation and Reinnervation Using Magnetic Resonance Spectroscopy
Authors: Dort Joseph C. , Fan Yan , McIntyre Deane D.
Published: February 2003

OBJECTIVE

To determine changes in skeletal muscle metabolism after nerve transection and repair and to correlate metabolic changes with functional recovery.

STUDY DESIGN AND SETTING

Male Wistar rats were divided into 6 experimental groups plus a control group. The posterior tibial nerve was transected and reapproximated. At varying times after surgery (1, 2, 4, 6, or 8 weeks) animals were sacrificed, the gastrocnemius muscle was harvested, and proton nuclear magnetic resonance (NMR) spectroscopy was performed. Functional recovery was measured using the sciatic function index.

RESULTS

Animals undergoing nerve repair all showed functional recovery whereas the nonrepaired nerve group did not. Concentration of glucose and lactate increased after denervation and then returned toward normal. Choline concentration decreased and then returned toward normal. In animals not undergoing nerve repair, the metabolic abnormalities persisted and showed no sign of recovery over the 8‐week observation period.

CONCLUSIONS

1H NMR spectroscopy is a potentially useful tool to study changes in skeletal muscle metabolism after motor nerve injury.

SIGNIFICANCE

NMR spectroscopy is rapidly developing into a clinically useful tool. High‐field magnets have improved resolution and data acquisition. Basic experiments, such as those described here, will help guide the use of NMR spectroscopy in clinical medicine and will also lead to a better understanding of basic mechanisms of nerve injury and repair.
Molecular Typing of Paired Bacterial Isolates From the Adenoid and Lateral Wall of the Nose in Children Undergoing Adenoidectomy: Implications in Acute Rhinosinusitis
Authors: Bernstein Joel M. , Dryja Diane , Murphy Timothy F.
Published: February 2003

OBJECTIVE

Recent studies have suggested that the origin of bacteria that enter the lateral wall of the nose and paranasal sinuses arise from the nasopharynx. The purpose of this study was to compare the molecular biological profiles of potential pathogens found in the nasopharynx and lateral wall of the nose concomittantly in children undergoing surgery for upper respiratory tract disease.

STUDY DESIGN AND SETTING

Fifty‐two children undergoing adenoidectomy for either tonsillectomy or adenoidectomy (hypertrophy) or otitis media with effusion were studied. Bacterial cultures were taken from the crypts of the adenoids and from the lateral wall of the nose under endoscopic control after sterilization of the vestibule and inferior turbinate. Routine cultures of these areas were performed in the bacteriology laboratory of the Children's Hospital of Buffalo.

RESULTS

Bacterial pathogens were isolated from 79% of adenoids and 46% of lateral walls of the nose. Molecular typing of pairs of nontypable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis revealed that in 16 of 18 pairs (89%) the identical strain was present in both sites simultaneously.

CONCLUSIONS

These results support the concept that when potential bacterial pathogens that may cause acute bacterial rhinosinusitis are found con‐comitantly in the nasopharynx and lateral wall of the nose, they are usually identical.
The Evaluation of Rhytidectomy Flap Healing After CO2 Laser Resurfacing in a Pig Model
Authors: Park Gregory C. , Wiseman Joe B. , Hayes David K
Published: February 2003

OBJECTIVE

This study was conducted to determine when it becomes safe to perform laser resurfacing after rhytidectomy flap elevation.

STUDY DESIGN

Eighty‐four sites on 12 domestic Yorkshire pigs were selected; 4 × 10‐cm skin flaps were elevated in 72 of the 84 sites and shortened 10%. The 12 remaining sites (controls) were treated with laser resurfacing alone. Laser resurfacing was also performed at days 0, 7, 14, 21, and 28 after closing the skin flaps. The healing time for the laser‐resurfaced sites without flap elevation were compared to that of the skin flaps treated with the laser at days 0, 7, 14, 21, and 28. Twelve “skin flap” controls were elevated, shortened 10%, and closed without laser treatment. Resurfacing was performed using 2 passes with the Sharplan Silk Touch CO2 laser.

RESULTS

The average healing time for the skin flaps treated with the laser at day 0 was 23.9 days. All of these flaps showed skin slough with delayed healing followed by scar formation. The areas treated with the laser alone (controls), and the subsequent skin flaps treated with the laser postoperatively at days 7, 14, 21, and 28 days completely re‐epithelialized in an average of 7.8, 8.1, 7.3, 7.4, and 7.3 days, respectively. There were no statistically significant differences in healing time between the controls and flaps treated with the laser on or after 7 days (P > 0.05). However, there were statistically significant differences in healing time between the laser‐treated skin flaps at day 0 and the controls, between the laser‐treated flaps on day 0 and day 7, and between the laser‐treated flaps on day 0 and day 14 (P < 0.001). Because there was little difference in healing time after 14 days, only the healing times for laser‐treated skin flaps up to 14 days were compared using paired t tests.

CONCLUSIONS

From our observations using a pig model, we conclude that skin flaps may be safely laser resurfaced about 1 week postoperatively. On the other hand, simultaneous flap elevation and laser resurfacing results in delayed healing with subsequent scar formation.
Transcolumellar Approach in Transsphenoidal Pituitary Surgery for Patients with Small Nostril
Authors: Kim Sun Ho , Yoon Joo‐Heon , Choi Joong Uhn , Chung Sang Sup , Lee Kyu Chang
Published: February 2003

OBJECTIVE

Sublabial approach has been widely used as the standard technique for transsphenoidal pituitary surgery. But it has several possible drawbacks, such as; postoperative flat nose deformity, hypesthesia of upper gum, and feeding difficulty until 2 to 3 weeks after surgery. As an alternative, an endonasal approach was adopted for patients who had large nostrils, such as white or acromegalic patients. In patients with small nostrils, especially oriental people, it requires an additional tension release incision that leaves a definitely visible scar at the base of nose.

STUDY DESIGN

We applied the transcolumellar approach, which modified the external rhinoplasty approach on the 136 cases of transsphenoidal pituitary surgery that were performed from 1994 to June 1999.

RESULTS

In all patients, we found we could reach the anterior portion of nasal septum in 7 to 8 mm in depth from the skin surface and eliminate the disadvantages of sublabial and endonasal approach. Also, this method can markedly reduce the surgical dissection time and blood loss.

CONCLUSIONS

We concluded that this technique was relatively simple and more than adequate in most transsphenoidal pituitary surgery, even in patients with small nostrils.
An Anatomic Classification of the Ethmoidal Bulla
Authors: Setliff Reuben C. , Catalano Peter J. , Catalano Lisa A. , Francis Chad
Published: February 2003

OBJECTIVE

The ethmoid bone is arguably the most complex and varied osseous structure in the human body. The partitions within form a unique labyrinth of lamellae and spaces from specimen to specimen or, as in this study, from patient to patient. The surgical anatomy of the ethmoid bone, and the ethmoidal bulla in particular, is ill‐defined and heretofore largely unclassified. In an attempt to better understand the ethmoid labyrinth, a prospective anatomic study of 107 patients undergoing primary intranasal endoscopic ethmoidectomy was undertaken.

STUDY DESIGN

Two hundred fourteen ethmoidal bullae were dissected intraoperatively with video‐documentation obtained in over 90% of cases. Based on these dissections, the compartments or cells formed by the partitioning within the ethmoidal bulla and the respective communication with adjacent spaces were the parameters used to develop the classification system.

SETTING

Private midwestern rhinologic referral practice.

RESULTS

Three main categories of ethmoidal development were identified: simple, compound, and complex. Forty‐seven percent of bullae were of the simple type, 26% were compound, and 27% complex. Sixty‐eight percent of ethmoidal bullae had a single opening into the hiatus semilunaris superior; 6 (2.8%) ethmoidal bullae had a single anterior opening to the ethmoidal infundibulum. The remaining 28.7% had multiple cells with multiple openings, at least 1 of which opened into the hiatus semilunaris superior 98.4% of the time. There was a cell in the complex bulla opening anteriorly to the ethmoidal infundibulum in 46.5%. In 58% of cases, there was symmetry from side to side.

CONCLUSION

A novel anatomic classification for the ethmoidal bulla is presented, with examples of the 3 types of sinus development encountered. We believe that understanding ethmoid sinus anatomy and potential drainage pathways is a core principle to functional sinus surgery.
Radiofrequency versus Laup for the Treatment of Snoring
Authors: Blumen Marc B. , Dahan Serge , Wagner Isabelle , De Dieuleveult Thibault , Chabolle Frédéric
Published: February 2003

OBJECTIVE

To compare efficacy and tolerance of controlled temperature radiofrequency and laserassisted uvulopalatopharyngoplasty (LAUP) for the treatment of snoring.

METHODS

This was a prospective, nonrandomized study on 30 patients who snored. All patients had a sleep night study. Only patients with simple snoring or mild sleep apnea and soft palate obstruction were included. Efficacy was subjectively evaluated by the bed partner 2 months after the last treatment. Tolerance was estimated daily by the patient during 18 first postoperative days. Discomfort, pain, medication intake, diet, and number of days off from work were assessed.

RESULTS

Both treatments were effective on snoring. Mean discomfort and pain as well as mean intake of analgesics were significantly greater with laserassisted uvulopalatopharyngoplasty.

CONCLUSION

Controlled temperature radiofrequency was as effective as laser‐assisted uvulopalatopharyngoplasty on snoring on a short‐term basis but was better tolerated.