bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated Sphenoid Sinus Disease: An Analysis of 132 Cases
Authors: Lawson William , Reino Anthony J.
Published: November 2003

Solitary involvement of the sphenoid sinus is a relatively uncommon entity. A series of 132 patients with isolated sphenoid disease accumulated over a 22‐year period is reported. A retrospective chart review was performed with special attention to the patients' presenting signs, symptoms, and radiographic findings. There were 80 patients with inflammatory disease, 38 with neoplasms, four with fibroosseous disorders, and 10 with traumatic and developmental lesions. The most common presenting symptom was headache, followed by visual changes and cranial nerve palsies. Cranial nerve abnormalities were encountered in 12% of the inflammatory cases, 60% of the benign tumors, and 57% of the malignant tumors. Radiographically, bone remodeling was associated with chronic inflammatory disease, especially mucoceles. Bone erosion was found principally with neoplastic disease, occurring rarely with mucoceles. Extension was associated with malignant tumors.
Oropharyngeal Scintigraphy: A Computerized Analysis of Swallowing in Patients With Obstructive Sleep Apnea
Authors: Zohar Yuval , Grusko Ilia , Sulkes Jaqueline , Melloul Moshe M.
Published: November 2003

This study examines the oropharyngeal‐upper esophageal scintigraphic transit in patients with obstructive sleep apnea (OSA) syndrome, as well as the effect of uvulopalatopharyngoplasty (UPPP) on this transit. Scintigraphy is a safe, noninvasive test that is suitable as a screening test for oropharyngoesophageal motor disorders. A qualitative and quantitative evaluation of the swallowed radionuclide bolus was performed in 47 patients by means of a Cine Mode visual inspection and by computerized analysis. Three groups of patients were studied and compared: group 1, 10 healthy patients; group 2, 18 OSA patients before UPPP; and group 3, 19 OSA patients 6 months up to 2 years after UPPP. Oropharyngoesophageal scintigraphy was normal in 90% of group 1 patients (9/10) as well as in group 3, where 95% of patients (18/19) had a normal transit unlinked to the degree of improvement in the respiratory disturbance index. The radionuclide transit was abnormal in 79% OSA patients(15/18) in group 2. Statistically significant differences of mean transit abnormalities between the three groups were found (
P
= 0.0001). Moreover, mean transit abnormalities in the OSA patients before UPPP were statistically significantly lower than in the group of patients after UPPP(56.2% vs 87.4,
P
≤ 0.05).
Effects of Chronic Administration of Kanamycin on the Basement Membrane Anionic Sites in the Crista Ampullaris of Guinea Pigs
Authors: Suzuki Mitsuya , Yamasoba Tatsuya , Kaga Kimitaka
Published: November 2003

The authors investigated the effects of chronic kanamycin (KM) administration on the basement membrane (BM) anionic sites in the ampulla by studying the binding of cationic polyethyleneimine (PEI). KM sulfate was administered intramuscularly 'to guinea pigs with normal Preyer's reflexes daily for 10 or 17 days. The PEI distribution was unchanged on the subepithelial BM in the dark cell region and on the capillary BM in the crista ampullaris. However, PEI binding decreased significantly on the subepithelial BM in the sensory cell and transitional cell regions of those guinea pigs administered KM for 17 days. In the sensory cell region, the PEI distribution did not recover until 6 weeks after KM treatment. Findings suggest that chronic administration of KM severely alters the number of subepithelial BM anionic sites in the sensory cell region.
Indirect Laryngeal Photography Using Rigid Telescopes
Authors: Benjamin Bruce
Published: November 2003

A technique for indirect laryngeal color photography for the office or clinic using rigid rod‐lens angled telescopes is outlined. The photographic equipment can be used for documentation at both direct and indirect laryngoscopy except that the latter requires purpose‐designed 70° or 90° telescopes. The method, which requires practice and patience, and the equipment are described in detail, and the difficulties and frustrations that are encountered are discussed.
Relief of Upper Airway Obstruction With Hypoglossal Nerve Stimulation in the Canine
Authors: Goding George S. , Eisele David W. , Testerman Roy , Smith Philip L. , Roertgen Karen , Schwartz Alan R.
Published: November 2003

Hypoglossal nerve stimulation was investigated as a method to relieve an induced upper airway obstruction. Six dogs were implanted with a cuff electrode applied to each hypoglossal nerve and a pulse generator. After 4 weeks, the hypoglossal nerve was stimulated (50% duty cycle) for up to 8 weeks. At 12 weeks a double tracheotomy was placed, with a negative pressure intermittently applied to the upper limb, simulating inspiratory airway pressure. Unilateral hypoglossal nerve stimulation improved peak upper airway flow from an average of 0.1 L/s to 1.6 L/s (P = 0.0001). Seventy‐seven percent of the maximum possible flow(explanted tracheotomy tube) was obtained with unilateral stimulation. Histopathological evaluation revealed no nerve damage secondary to chronic stimulation. This study provides support for clinical trials of hypoglossal stimulation for obstructive sleep apnea.
Positron Emission Tomography in the Evaluation of the N0 Neck
Authors: Myers Larry L. , Wax Mark K. , Nabi Hani , Simpson George T. , Lamonica Dominick
Published: November 2003

The presence of cervical lymph node metastasis in patients with head and neck cancer is associated with an unfavorable prognosis. Reports vary as to whether various conventional radiographic studies, such as computed tomography (CT) and magnetic resonance imaging, confer an advantage over physical examination in the patient without clinical findings of cervical metastasis (N0). Positron emission tomography (PET) is a functional imaging modality that has recently been used for head and neck neoplasms. The use of PET in the evaluation of the N0‐staged neck in 14 consecutive patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract is reported. Seven patients (50%) undergoing 13 neck dissections had pathologic evidence of disease. PET scans were positive in five patients with pathologically confirmed cervical metastasis. PET scans were negative in seven patients (11 neck dissections) with no pathologic evidence of disease. PET scans were positive for unilateral cervical metastasis in two of three patients with involvement of a single lymph node. PET scans were positive in two of three patients with more than two lymph nodes involved. PET had an accuracy of 100% in the eight patients with SCC of the oral cavity. In patients with oropharyngeal or hypopharyngeal carcinoma PET localized cervical metastasis in two of four patients with neck metastasis. In the patient with an N0‐staged neck on clinical examination, PET was found to have an overall sensitivity of 78%, specificity of 100%, positive predictive value of 100%, negative predictive value of 88%, and accuracy of 92%. CT demonstrated sensitivity of 57%, specificity of 90%, positive predictive value of 80%, negative predictive value of 75%, and accuracy of 76%. PET showed a trend in increased accuracy (P= 0.11) over CT. PET appears to be a promising diagnostic aid that may be applied when evaluating the N0‐staged neck, especially for SCC of the oral cavity.
Inactivation of p53 and Amplification of Cyclin D1 Correlate With Clinical Outcome in Head and Neck Cancer
Authors: Nogueira Christine P. , Dolan Robert W. , Gooey John , Byahatti Seema , Vaughan Charles W. , Fuleihan Nabil S. , Grillone Gregory , Baker Errol , Domanowski Gerard
Published: November 2003

The authors have investigated whether genetic abnormalities in two genes, loss of heterozygosity (LOH) of p53 and amplification of the cyclin D1 gene, correlate with clinical outcome in 56 matched pairs of blood and tumor from patients with squamous cell carcinoma of the head and neck (SCCHN). Frequency of p53 LOH was 47.4%, of cyclin D1 amplification 33.9%, and of both abnormalities together 23.7%. p53 LOH was associated with T4 (P = 0.003) and stage IV (P = 0.015) tumors. Cyclin D1 amplification was associated with recurrences and/or metachronous tumors (P = 0.007). The total number of p53 and cyclin D1 abnormalities (scored as zero, one, and two) show a pattern that seems to be additive; the increase in the number of these abnormalities is associated with a proportional increase in the frequency of T4, stage IV, presence of recurrences and/or metachronous tumors, and possibly a proportional decrease in the disease‐free interval in the sample. The association of the markers with recurrences and/or metachronous tumors persists if the tumor stage effect is mathematically removed. The combined analysis of the p53 and cyclin D1 abnormalities seems to be more informative than either of them individually and may have predictive value in SCCHN.
Up‐to‐date Report of Botulinum Toxin Type A Treatment in Patients With Gustatory Sweating (Frey's Syndrome)
Authors: Laskawi Rainer , Drobik Christian , Schönebeck Claudia
Published: November 2003

Several therapeutic approaches exist to treat gustatory sweating (Frey's syndrome) following parotidectomy. Because of the lack of effective treatment, a new therapeutic modality using botulinum toxin injections was presented previously by our group. The duration of the demonstrated positive effect was essentially unknown so far. Based on our experiences using this technique since December 1993, the purpose of this clinical investigation was to make an up‐to‐date report and demonstrate the duration of effect of BOTOX injections in patients with severe gustatory sweating. Nineteen patients with severe gustatory sweating have been treated with BOTOX by intracutaneous injections into the affected skin areas. The maximal follow‐up time was 33 months. The results were obtained by interviews and controls using Minor's starch iodine test. In all treated cases (n = 19 patients, 22 treated sides) gustatory sweating ceased completely within 2 days. Side effects were absent. In 12 patients gustatory sweating reappeared. The mean duration of effect was 17.3 months (subjective personal communication of 18 patients). Findings show that intracutaneous injection of BOTOX is a highly effective, safe, and minimally invasive treatment of Frey's syndrome with long‐lasting therapeutic effect.
Interpretation of Anatomic Variations of Computed Tomography Scans of the Sinuses: A Surgeon's Perspective
Authors: Meyers Robert M. , Valvassori Galdino
Published: November 2003

Four hundred computed tomography (CT) scans of patients undergoing endoscopic sinus surgery were studied with particular attention to anatomic variations. Six specific variations were identified that may predispose the surgeon to inadvertent penetration of the orbit or anterior cranial cavity. These anatomic variants are: 1. lamina papyracea lies medial to the maxillary sinus ostium; 2. maxillary sinus hypoplasia; 3. fovea ethmoidalis abnormalities, such as low or sloping fovea and encephaloceles; 4. lamina papyracea dehiscence resulting in herniation of orbital content into the ethmoids; 5. sphenoid sinus wall variations such as septa attached to the carotid covering, and penetration of the sphenoid by the internal carotid artery or optic nerve; 6. sphenoethmoid cells (Onodi cells), the most posterior ethmoid cells pneumatizing lateral and superior to the sphenoid and intimately associated with the optic nerve.
Interactive Magnetic Resonance Imaging‐Guided Biopsy in the Head and Neck: Initial Patient Experience
Authors: Fried Marvin P. , Hsu Liangge , Jolesz Ferenc A.
Published: November 2003

Because of its excellent soft tissue resolution, magnetic resonance imaging (MRI) can optimize image guidance for interventional and surgical procedures. Notably, needle biopsy of head and neck lesions has been used for years, deeper lesions often requiring some form of image guidance. The closed space of diagnostic MRI scanners proves cumbersome for intervention. The authors report on the first head and neck image‐guided biopsies performed in a new, investigational “open configuration” intraoperative MRI scanner. Vertical space between the scanner's upright coils gives access to the patient while imaging; image acquisition is as fast as 2 sec/image. Biopsies were performed on seven patients (parotid, parapharyngeal space, second cervical vertebra); five specimens were diagnostic. Both general anesthesia and intravenous sedation were used. The procedures were without complications. Imaging provided definition of anatomy to direct needle placement. Access to the patient allowed for both percutaneous and transoral approaches. The environment of the open magnet is well suited for biopsy of the head and neck, and near real‐time intraoperative MRI has promise for guiding more complex head and neck procedures. Further study should optimize the quality of the images and the interactibility of localization and targeting and fully utilize MRI's three‐dimensional imaging capabilities.
A Study on Epidermal Proliferation Ability in Cholesteatoma
Authors: Tanaka Yasuhiro , Shiwa Masanori , Kojima Hiromi , Miyazaki Hidemi , Kamide Yosuke , Moriyama Hiroshi
Published: November 2003

With the objective of estimating proliferation ability of epidermis of middle ear cholesteatoma, the difference in proliferating cell nuclear antigen (PCNA) staining between the skin of the bone region of the external ear canal (control skin) and cholesteatoma epidermis and the effects on PCNA staining of subepidermal inflammatory cell infiltration of cholesteatoma were immunohistochemically studied using an antibody against PCNA. Transforming growth factor‐α (TGF‐α) is known to promote epidermal proliferation based on autocrine mechanism. But it is not clear that cholesteatoma epidermis is actually in the state of hyperproliferation under the effect of this growth factor. To estimate the effect of TGF‐α on epidermal proliferation ability, the authors compared the location of PCNA and TGF‐α in the same specimen. Unlike the control skin, not only epidermal basal cell layer and suprabasal cell layer, but also more superior layers were found to have high levels of PCNA staining in the epidermis of cholesteatoma. However, in the same cholesteatoma epidermal tissue, the PCNA staining was varied and the difference was ascribable to subepidermal cell inflammation. It appeared that the proliferation ability was high in regions where subepidermal inflammatory cell infiltration was severe. These differences in microenvironment are inferred to greatly affect proliferation ability of cholesteatoma epidermis.
Correlation Between Electrical Auditory Brainstem Response and Perceptual Thresholds in Digisonic Cochlear Implant Users
Authors: Truy Eric , Gallego Stéphane , Chanal Jean‐Marc , Collet Lionel , Morgon Alain
Published: November 2003

Objectives: To examine the relationships between psychophysical perceptions and the electrically evoked auditory brainstem responses (EABRs) in multichannel cochlear implant (CI) users and to determine the effectiveness of EABRs in electrode failure.

Design: A descriptive study reported the EABR characteristics while the different electrodes were activated. Characteristics of the EABR and of the perceptual measures served as compared variables in a correlational study.

Setting: The study was carried out in the audiology clinic of an otolaryngology department at a university hospital.

Patients: The subjects consisted of nine consecutively selected habitual Digisonic DX10R multichannel CI users. Seven patients were postlinguistically deafened adult patients; two were congenitally deaf children.

Main Outcome Measures: Ipsilateral recordings were performed using a previously published method. Morphology, latency, and amplitude measures of the EABR recordings were described, computed, and compared with the literature data for EABRs obtained while activating other types of CI and for acoustically evoked ABRs. Correlations between EABRs and behavioral perception thresholds were analyzed using the parametric Pearson's correlation test.

Results: EABRs allowed the authors to detect failure of no. 10 electrode integrity in one child. Perceptual threshold measures were found to be highly significantly related to the EABR threshold across subjects and electrode position (n = 31, r = 0.98; P < 0.001; linear regression equation: perceptual threshold = 1.06 EABR threshold + 0.76). The latencies and amplitudes were found to be similar to those described in the literature.

Conclusions: EABRs may be used to estimate settings for the Digisonic DX10 CI even in a pediatric population, although they cannot entirely replace behavioral measurements, especially in children. The EABR can be employed for electrode dysfunction diagnosis. Further studies are needed to determine whether recordings of EABR quality could contribute to the evaluation of functional prognosis during the rehabilitation.
Effect of Locally Applied Drugs on the Endolymphatic Sac Potential
Authors: Couloigner Vincent , Loiseau Alain , Sterkers Olivier , Amiel Claude , Ferrary Evelyne
Published: November 2003

In Ménière's disease, an inner ear disorder related to an endolymphatic hydrops, an alteration of the functioning of the endolymphatic sac has been proposed. The endolymphatic sac is assumed to be involved in the secretion/resorption of endolymph. The epithelial transport systems have been indirectly studied by the recording of the endolymphatic sac transepithelial potential (ESP) in control conditions and after the local injection of drugs such as diuretics that have been proposed in the treatment of Ménière's disease. The ESP was recorded, in vivo, in guinea pigs up to 150 minutes after the perisaccular injection of 5 μL of a 150 mmol/L (mM) NaCl solution containing various drugs known to inhibit ionic transport systems. The initial ESP was +8.4 ± 0.3 mV (mean ± SEM, n = 78). The basolateral injection of 5 μL of 150 mM NaCl induced an ESP decrease of 64% ± 6.0% (n = 12), 5 minutes after the end of the injection. Then ESP increased, returning to its initial value at 60 minutes and surpassing it at 120 minutes. Diuretics such as acetazolamide (10−3 mol/L [M]), an inhibitor of carbonic anhydrase, and amiloride (10−4 M), an inhibitor of Na channel or Na/H exchanger, decreased the ESP recovery. At variance, bumetanide (10−6 M, 10−4 M), the Na‐K‐Cl cotransport inhibitor, and chlorothiazide (10−4 M), a Na‐Cl cotransporter inhibitor, failed to alter the ESP as compared with the control group. Ouabain (10−3 M), the Na+,K+‐adenosine triphosphatase (ATPase) inhibitor, prevented the ESP recovery otherwise observed 60 minutes after the NaCl injection. Bafilomycin A1, the inhibitor of the vacuolartype H+‐ATPase, prevented the recovery of the ESP with a log‐dose/effect (10−5 M, 10−6 M, 10−8 M). Disulfonic acid stilbene (DIDS) (10−4 M), an inhibitor of transporters involving HCO3−, also prevented the ESP recovery. These results suggest that the genesis of the ESP was highly dependent on acid‐base transport systems including carbonic anhydrase, a vacuolar‐type H+‐ATPase, and an anionic transport system blocked by DIDS. Further studies are needed to confirm the alteration of the acid‐base balance in this epithelium and its possible involvement in the pathogenesis of Ménière's disease.
Vestibular Disease Unmasked by Hyperventilation
Authors: Bance Manohar L. , O'Driscoll Martin , Patel Nimesh , Ramsden Richard T.
Published: November 2003

Hyperventilation‐induced dizziness is often thought to be psychogenic, but its effects in the presence of known vestibular disease have not been adequately examined. In this study hyperventilation was tested in two models of vestibular disease. These were, first, patients with profound unilateral vestibular deficit (prior translabyrinthine acoustic neuroma resection [postsurgery group]) and, second, patients with variable unilateral vestibular deficit (unoperated unilateral acoustic neuroma [presurgery group]). Patients were hyperventilated for 90 seconds. Using infrared videonystagmography, 100% of the 32 postsurgery patients and 82% of the 28 presurgery patients developed nystagmus with hyperventilation. Hyperventilation was more sensitive than head shake for eliciting nystagmus in these models. The false‐positive rate for nystagmus in 29 normal volunteers was 3.5% for hyperventilation and 10% for head shake. Our results show that hyperventilation can unmask underlying vestibular disease.
Angiographic Embolization for Epistaxis: A Review of 114 Cases
Authors: Tseng Ewen Y. , Narducci Carl A. , Willing Steven J. , Sillers Michael J.
Published: November 2003

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5‐year period. The immediate success rate was 93%, with long‐term success achieved in 88% of patients. The overall complication rate was 17%, with the long‐term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.
Inlay Tympanoplasty: Cartilage Butterfly Technique
Authors: Eavey Roland D.
Published: November 2003

For closure of a nonmarginal tympanic membrane perforation, currently popular techniques utilize either an underlay or an onlay approach. However, both procedures require incising canal skin. A transcanal inlay procedure could provide theoretical advantages of ease, speed, and comfort. Specifically designed cartilage that could facilitate the transcanal approach similar to placement of a solid tube was employed and evaluated. A transcanal cartilage butterfly inlay technique was found to be efficient and effective to close a subgroup of small‐to‐medium‐sized tympanic membrane perforations including cases in which the condition of the tympanic membrane was somewhat hostile. Postoperative patient comfort was an additional benefit.
Neurotrophin 3, Not Brain‐Derived Neurotrophic Factor or Neurotrophin 4, Knockout Mice Have Delay in Vestibular Compensation After Unilateral Labyrinthectomy
Authors: Gacek Richard R. , Khetarpal Umang
Published: November 2003

On the basis that neurotrophins (NTs) affect neuronal synaptic plasticity, are expressed in various cell types of the vestibular system, and exert a trophic influence on statoacoustic neurons, the authors hypothesized a role for NTs in vestibular compensation. To test this hypothesis, they performed unilateral surgical labyrinthectomy in 11 heterozygous (+/−) neurotrophin 3 (NT3) and brain‐derived neurotrophic factor (BDNF) knockout mice and in two neurotrophin 4 (NT4) homozygous (−/−) knockout mice, each with a control (+/+) sibling, for a total of 26 mice. Four BDNF(+/−) and four NT3(+/−) mice with their (+/+) controls each were allowed to recover in a normal lighted room for 3, 7, 14, and 30 days following labyrinthectomy. Two BDNF(+/−) and two NT4(−/−) mice with controls were kept in total darkness for 1‐and 16‐day survival periods. One NT3(+/−) mouse without a control (which died in surgery) was sacrificed after 16 days in darkness. The behavior of all mice was videorecorded to monitor their recovery. Compared with normal (+/+) littermate controls, NT3(+−) mice demonstrated a delay in compensation (8 to 10 days) in light surround, whereas NT4(−/−) mice showed only a minor delay in dark surround. Despite a 40% lower vestibular ganglion cell population in BDNF(+/−) mice compared with (+/+) controls, BDNF(+/−) mice did not reveal a detectable delay in recovery following labyrinthectomy. These findings suggest that a 50% loss of NT3 protein significantly affects vestibular recovery in adult mice. Perhaps variations in achieving vestibular compensation in humans may be partly secondary to genetically different NT3 levels in vestibular pathways.
Role of the External Nasal Dilator in the Management of Nasal Obstruction
Authors: Roithmann Renato , Chapnik Jerry , Cole Philip , Szalai John , Zamel Noe
Published: November 2003

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross‐sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.
Epithelial Cell Proliferation, Apoptosis, and Apoptosis Inhibition in Inverted Papillomas
Authors: Guichard Christophe , Gilain Laurent , Al Samad Issam Abd , Piron Gaëlle , Brugel Lydia , Escudier Estelle , Coste André
Published: November 2003

Inverted papillomas (IPs) are rare benign tumors of nasal epithelium with high recurrence rates and malignant transformation potential. Their etiology is still uncertain, and the mechanism of their growth has not yet been fully described. The purpose of this study was to detect, quantify, and compare cell proliferation, apoptosis, and apoptosis inhibition in hyperplastic epithelium from IPs and in inflammatory nasal polyps (NPs). IP samples were obtained after surgical removal of tumor in 13 patients, and NPs were sampled during endoscopic ethmoidectomy in 10 patients with nasal polyposis. Cell proliferation and apoptosis inhibition, respectively, were assessed by immunohistochemical identification of the proliferating cell nuclear antigen (PCNA) and the oncoprotein Bcl‐2. Apoptosis was evaluated by analyzing the DNA fragmentation. Cell proliferation and apoptosis were significantly higher in IPs than in NPs (P = .0002 and P = .043, respectively), while apoptosis inhibition was significantly lower in IPs than in NPs (P = .001). Concerning IPs, cell proliferation was significantly higher than apoptosis (P = .0029) and apoptosis inhibition (P = .0015). The increase in epithelial cell proliferation seemed to be greater in IPs with dysplasia than in IPs without dysplasia. Increased epithelial cell proliferation, but not apoptosis and apoptosis inhibition, seems to be involved in the development of IP.
Oral Leukoplakias Show Numerical Chromosomal Aberrations Detected by Fluorescence in Situ Hybridization
Authors: Lenz Christian F. , Pfuhl Andreas , Finckh Martin , Weidauer Hagen , Bosch X.
Published: November 2003

To examine at which stage in the multistep process of head and neck tumorigenesis numerical chromosomal alterations can be detected by fluorescence in situ hybridization (FISH), biopsies and cell smear preparations of clinically healthy oral tissue, premalignant lesions (leukoplakias), and tumors were analyzed by FISH using chromosome‐specific centromeric probes. Aberrations found in tumor biopsies and in tumor cell smears consisted of trisomy of chromosomes 1, 7, 10, and 17 and monosomy of chromosomes 1, 7, 9, 10, and 17. In five of eight dysplastic oral leukoplakia biopsies, aberrations were seen consisting of trisomy of chromosome 1, 7, and 17, and monosomy of chromosome 9. No aberrations were found in biopsies of hyperplastic lesions (n = 8), or in oral cell smears of persons at risk. Because numerical chromosomal aberrations seem to be highly specific for malignant cells, FISH may help to identify leukoplakias that have a high risk of malignant conversion.
Medical treatment of headache after suboccipital acoustic tumor removal
Authors: Hanson Matthew B. , Glasscock Michael E. , Brandes Jan Lewis , Jackson C. Gary
Published: November 2003

Objectives: Suboccipital craniotomy is a frequently used surgical approach for removal of cerebellopontine angle (CPA) tumors. A frequently cited consequence, however, is the high incidence of postoperative headaches. Much has been written regarding prevention of these headaches, but little has been written of their treatment. The authors review their extensive experience in suboccipital tumor removal and the medical management of postoperative headache, highlighting the recent use of a regimen of divalproex sodium and verapamil. Study Design: Retrospective chart review. Methods: The charts of a consecutive series of patients having suboccipital craniotomies for CPA tumors were reviewed. Presence, duration, and severity of headache were noted. Medical treatments and their effectiveness were also noted. Results: Between 1980 and 1997, 228 patients underwent suboccipital craniotomy for removal of CPA tumors. Of these patients, 124 (54.4%) complained of headache. For 62 (27.2%) the headaches persisted for more than a year after surgery. Twenty‐nine patients (12.7%) received no relief from any medication. Ten of these patients received a regimen of divalproex sodium and verapamil, with all patients obtaining significant relief. Conclusion: Headache is a significant problem with the suboccipital approach for acoustic tumor removal. The majority of patients that complain of headache can be adequately treated with nonsteroidal anti‐inflammatory drugs (NSAIDs). If pain is unrelieved by NSAIDs, treatment becomes problematic. The authors' early experience with divalproex sodium/verapamil is encouraging and deserves further investigation as a treatment for these refractory cases.
Pharyngeal acid reflux events in patients with vocal cord nodules
Authors: Kuhn Joan , Toohill Robert J. , Ulualp Seckin O. , Kulpa Judith , Hofmann Candy , Arndorfer Ronald , Shaker Reza
Published: November 2003

Objective: Gastroesophageal reflux has been implicated in the pathogenesis of vocal cord nodules. However, a cause‐and‐effect relationship has not been established. Because documentation of pharyngeal acid reflux events makes this correlation more plausible, the aim of the present study was to determine the frequency of pharyngeal acid reflux events in patients with vocal cord nodules. Methods: Eleven patients with vocal cord nodules (mean age, 42 ± 6 years) and eleven healthy volunteers (mean age, 45 ± 6 years) were studied. Patients underwent barium esophagram and ambulatory 24‐hour simultaneous three‐site pharyngo‐esophageal pH monitoring. Controls only had ambulatory 24‐hour simultaneous three‐site pH monitoring. In the ambulatory pH monitoring studies, pH was recorded from the manometrically determined sites of pharynx (2 cm above upper esophageal sphincter), proximal esophagus (10 cm distal to pharyngeal site), and distal esophagus (5 cm above the lower esophageal sphincter). Pharyngeal acid reflux event was deemed acceptable if all three sites recorded a decrease in pH below 4 which was not related to meal or drinking. Results: Pharyngeal acid reflux events occurred in seven of 11 patients with vocal cord nodules (1–4 episodes) and two of 11 controls (1–2 episodes) (P < .05). In both groups all pharyngeal acid reflux events occurred in upright position and were not associated with belching or coughing. Barium studies documented hiatal hernia in two patients and gastroesophageal reflux in five of 11 patients. However, none of the esophageal reflux events reached the pharynx on barium esophagram. Conclusions: Prevalence of pharyngeal acid reflux events is significantly higher in patients with vocal cord nodules compared with normal controls and suggests a contributory role for gastroesophagopharyngeal acid reflux in the pathogenesis of some vocal cord nodules.
Presentation, course, and outcome of head and neck skin cancer in african americans: A case‐control study
Authors: Singh Bhuvanesh , Bhaya Mahesh , Shaha Ashok , Har‐El Gady , Lucente Frank E.
Published: November 2003

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African‐American patients. Methods: Retrospective case‐control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5‐year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin‐American patients with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African‐American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non–sun‐exposed regions, the ratio was 1:8.5 for African‐American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease‐free interval was similar to the control group. Only the margin status was a significant predictor of disease‐free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58–18.24) Conclusions: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non–sun‐exposed regions.
A comparison of image guidance systems for sinus surgery
Authors: Metson Ralph , Gliklich Richard E. , Cosenza Mathew
Published: November 2003

Objective: Intraoperative computed tomographic guidance systems are available which utilize either electromagnetic (radiofrequency) or optical (infrared) signals to localize instruments within the surgical field. The objective of this study was to compare the use of these two different image guidance technologies for sinus surgery. Study Design: Prospective cohort study. Methods: The electromagnetic‐based InstaTrak system (n = 24) and the optical‐based Stealth‐Station (n = 49) were compared in a series of 73 consecutive sinus series which utilized image guidance technology. Results: Both the electromagnetic and optical systems provided anatomic localization to within 2 mm during surgery. Intraoperative reregistration was effective in correcting for any anatomic drift. There were no intraoperative complications. Mean operative times were 156.3 ± 8.9 minutes for the electromagnetic and 139.2 ± 17.7 minutes for the optical system (P < .05). The average intraoperative blood loss did not differ significantly between groups (electromagnetic, 190.6 ± 28.7 mL; optical, 172.4 ± 23.0 mL). Each system was noted to have limitations. The presence of metallic objects in the operative field interfered with functioning of the electromagnetic system, whereas the optical system required a clear line of sight to be maintained between the infrared camera and surgical handpiece. Both systems required specialized headsets to be worn by patients during surgery to monitor head position. The electromagnetic system also required these headsets to be worn during the preoperative computed tomography scan. Conclusion: Although these two image guidance systems both proved valuable for anatomic localization during sinus surgery, individual preferences can be based on distinct differences in their design and operation.
Expression of glucocorticoid receptor mRNA and protein in the olfactory mucosa: Physiologic and pathophysiologic implications
Authors: Robinson Alan M. , Kern Robert C. , Foster James D. , Fong Karen J. , Pitovski Dimitri Z.
Published: November 2003

Objectives: Define the presence and distribution of glucocorticoid receptors (GRs) within the olfactory mucosa in order to assess potential physiologic and pathophysiologic effects of these hormones on olfaction. Study Design: The olfactory mucosa was harvested from adult male rats and guinea pigs. Kidney tissue was utilized as a known positive control. Methods: The techniques of reverse transcriptase‐polymerase chain reaction (RT‐PCR) and immunocyto‐chemistry were utilized to examine the expression of GR mRNA and protein. To assure the presence of olfactory mucosa in the nasal tissue samples, RT‐PCR was utilized to identify the olfactory marker protein (OMP). Results: The presence of GR mRNA was confirmed in both the olfactory mucosa and kidney. GR‐like immunoreactivity associated with the olfactory epithelium was greatest at the apical surface, a position corresponding to the dendrites, knobs, and cilia of olfactory receptor neurons, as well as the supranuclear region of sustentacular cells. Weaker GR‐like immunoreactivity was associated with the region of the cell bodies of the olfactory receptor neurons. Within the lamina propria, acinar cells of the Bowman's glands and olfactory nerve bundles were intensely immunoreactive. Conclusions: The presence of GR mRNA and protein within the olfactory mucosa is consistent with a functional role for glucocorticoid hormones in the systemic regulation of olfaction. Furthermore, these studies suggest that corticosteroid medications may have direct effects on the cells of the olfactory mucosa in the pathologic state. The potential mechanisms whereby these hormones may act are discussed.
Efficacy of tonsillectomy for recurrent throat infection in adults
Authors: Mui Stanley , Rasgon Barry M. , Hilsinger Raymond L.
Published: November 2003

Objective/Hypothesis: Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) guidelines for tonsillectomy. We sought to determine whether tonsillectomy would benefit this group. Study Design: Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993. Methods: Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2‐year periods before and after tonsillectomy were tabulated. Statistical comparisons were made using the Student's t test. Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy. Results: Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci. When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure. Conclusions: Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources.
Changing etiology of vocal fold immobility
Authors: Benninger Michael S. , Gillen John B. , Altaian Jerald S.
Published: November 2003

Hypothesis: Vocal fold immobility is a sign of underlying disease. When the etiology remains unclear, evaluation may become time consuming and costly, and directed work‐up imperative. This study examined the hypothesis that the etiologies of vocal fold immobility are changing, with extralaryngeal malignancies and nonthyroidectomy surgical trauma having become more common causes. Methods: A retrospective review of consecutive patients with vocal fold immobility who had an adequate workup to determine the etiology. Results: Three hundred ninety‐seven cases with a determined etiology were identified, yielding 280 unilateral and 117 bilateral immobilities. The largest single category in unilateral immobility was nonlaryngeal malignancy—69 patients (24.7%)—80% of which were pulmonary or mediastinal, followed by 67 patients (23.9%) with immobility secondary to surgical trauma. Thyroidectomy accounted for only 8.2%. The leading cause of bilateral immobility was surgical trauma—30 patients (25.7%)—21 (18%) of whom had thyroidectomy. Acute and chronic intubation injuries accounted for 21 unilateral (7.5%) and 18 bilateral (15.4%) cases. Conclusions: These data indicate a changing etiology of vocal fold immobility, with growing percentages of extralaryngeal malignancies and surgery‐related injuries. These findings have implications for the timing and method of management based on anticipated outcome.
Split calvarial graft cranioplasty for the prevention of headache after retrosigmoid resection of acoustic neuromas
Authors: Feghali Joseph G. , Elowitz Eric H.
Published: November 2003

Objective: This study describes the technique and efficacy of split calvarial graft cranioplasty for the reconstruction of retrosigmoid/suboccipital defects following surgery for acoustic neuromas. Study Design: A prospective study of the technique of split calvarial graft cranioplasty, its postoperative healing, and incidence of postoperative headache. Methods: The technique requires splitting of the craniotomy bone flap into outer and inner table bone grafts. The combination of both bony grafts allows the coverage of a wider area of posterior fossa dura. This technique was used in 18 patients. All patients were followed for a minimum of 6 months. Eleven of 18 patients were followed for 1 year or longer. Four patients had three‐dimensional computed tomography of their skull and area of split calvarial bone graft. Results: One of 18 patients had a persistent disabling headache at 1 year postoperatively. A natural contour of the retrosigmoid area was achieved in all patients. Three‐dimensional computed tomography scan, obtained 6 months postoperatively, showed total coverage of the retrosigmoid area and fusion of the bone flap to the surrounding skull. Conclusion: The technique of split calvarial grafting of posterior fossa defects is a feasible, safe, and effective way of separating the nuchal musculature and posterior fossa dura. The technique also allows the restoration of the contour and bony covering of the retrosigmoid area. The technique is a simple alternative to other types of cranioplasties aimed at reducing the incidence of postoperative headache in patients with acoustic neuromas. Laryngoscope, 108:1450–1452, 1998
Lipomas of the internal auditory canal and cerebellopontine angle
Authors: Bigelow Douglas C. , Eisen Marc D. , Smith Peter G. , Yousem David M. , Levine Richard S. , Jackler Robert K. , Kennedy David W. , Kotapka Mark J.
Published: November 2003

Objective: To evaluate lipomas of the internal auditory canal (IAC) and cerebellopontine angle (CPA). Study Design: Retrospective review. Methods: Review of a multi‐institutional series of 17 lipomas of the IAC/CPA, combined with a Medline review of the 67 cases reported in the world literature. Results: This series of 17 IAC/CPA lipomas is the largest reported series to date, bringing the total number of documented cases to 84. There appears to be a nearly 2:1 male to female predominance. Sixty percent were leftsided lesions, and three were bilateral. Hearing loss, dizziness, and tinnitus were the most common presenting symptoms. Surgical resection was performed in 52 (62%) of these lesions; however, total tumor removal was accomplished in only 17 (33%), which is most likely because of the fact that these tumors tend to have a poorly defined matrix and a dense adherence to neurovascular structures. Sixty‐eight percent of patients experienced a new deficit postoperatively, 11% were unchanged, and only 19% improved with no new deficit. Only one documented case of tumor growth was identified; however, the reported follow‐up was short (average, less than 3 years). Conclusion: With the magnetic resonance imaging techniques now available, lipomas can be reliably differentiated from other masses within the CPA and IAC, so histopathologic diagnosis is rarely necessary. Because of the potential for significant morbidity with resection of these lesions, we believe that conservative follow‐up is the best treatment option for patients with these rare lesions. Surgery is indicated only when significant progressive or disabling symptoms are present. Laryngoscope, 108:1459–1469, 1998
Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma
Authors: Wilson Lynn D. , Chung Joyce Y. , Haffty Bruce G. , Cahow Elton C. , Sasaki Clarence T. , Son Yung H.
Published: November 2003

Objective: To evaluate the role of laryngopharyngoesophagectomy (LPE), intraoperative 125I brachytherapy (IOBT), and gastric transposition (GT) in patients with recurrent carcinoma involving the hypopharynx, or cervical esophagus. Methods: Between 1988 and 1994 a total of 21 patients were managed with LPE/IOBT/GT. All patients had documentation of recurrent disease at the hypopharynx or cervical esophagus and had previously been treated with external‐beam radiation (EBRT) to a total median dose of 60 Gy. Median age was 67 years, with 17 male patients and four female. IOBT was performed in all cases with permanent 125I implantation. Medical records were retrospectively reviewed. Overall survival, local control, and complications were evaluated. Median follow‐up was 6 months. Results: The median activity of 125I was 36 mCi, with a median dose of 80 Gy to the region at risk. Fifteen patients had lymph node dissections performed in conjunction with LPE, and 10 patients had nodal involvement on pathologic examination. Margins were microscopically positive in nine patients, and lymphvascular space invasion noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, respectively, with patients alive and with local control at 6, 24, 36, and 48 months, (negative margins). Actuarial local control at 1 and 3 years was 63%. Complications included fistula in five patients, facial edema in four, protracted facial pain in two, cervical abscess in one, and mucosal hemorrhage in one. Conclusion: Patients with recurrent carcinoma of the hypopharynx or cervical esophagus after EBRT have an extremely poor prognosis. LPE, IOBT, and GT may provide very good local control for all candidates and prolonged survival for a small percentage of patients with an acceptable risk profile. Laryngoscope, 108:1504–1508, 1998