bluuebunny/crossref_metadata_2025 huggingface dataset:
Short‐duration space flight and hearing loss
Authors: Roller Carrie A. , Clark Jonathan B.
Published: September 2022

OBJECTIVES

The study goal was to determine whether a single Space Shuttle mission can induce decrements in astronaut hearing.

STUDY DESIGN

We retrospectively compared audiogram information obtained from Space Shuttle astronauts at 10 days preflight, day of return (R + 0), 3 days after landing return (R + 3), and at a mean delayed postflight follow‐up of 8 months.

RESULTS

Temporary threshold shift (mean, 4.6 dB) was noted in R + 0 versus preflight conditions (P < 0.01). Small permanent threshold shifts (mean, 0.83 dB) were found at R + 3 and postflight follow‐up compared with preflight in the lower frequencies (500 to 2000 Hz), and corresponding pure tone average (P < 0.001).

CONCLUSIONS AND SIGNIFICANCE

The data indicate that a single Shuttle flight can induce a substantial temporary threshold shift and a small but statistically significant permanent threshold shift, particularly in the frequencies involved in speech reception. Although single‐mission effects are small, cumulative effects over several missions may ultimately produce clinically significant hearing loss.
The Effect of Bolus Consistency on Dysphagia in Unilateral Vocal Cord Paralysis
Authors: Bhattacharyya Neil , Kotz Tamar , Shapiro Jo
Published: September 2022

OBJECTIVE

To examine the risk of aspiration for liquid versus paste bolus consistencies in patients with unilateral vocal cord paralysis (UVCP).

METHODS

The swallowing function of adult patients with UVCP was prospectively studied videofluoro‐graphically to examine the incidence of laryngeal penetration and aspiration for both liquid and paste boluses. The degree of penetration or aspiration was quantified using the penetration‐aspiration scale (PAS). The presence and location of pharyngeal bolus residue were also documented for each consistency. Results were compared between liquid and paste bolus consistencies.

RESULTS

Fifty‐five patients with UVCP were studied with a mean age of 60.2 years. Intrathoracic surgery or malignancy accounted for 38 (69.1%) of cases. The mean PAS scores for liquid and paste bolus consistency were 3.1 vs. 1.5, respectively (P < 0.001). The liquid bolus penetrated in 19 (34.5%) patients and was aspirated in 11 (20%) patients. In contrast, the paste bolus penetrated in 12 (21.8%) cases and was aspirated in 0 cases (P < 0.001). Pharyngeal residue was more likely to occur at the base of the tongue or vallecula for the paste bolus consistency versus the liquid bolus.

CONCLUSIONS

A significant percentage of patients with UVCP will aspirate thin liquids. Paste bolus consistencies are safer for patients with UVCP as they are much less likely to lead to penetration or aspiration despite a higher prevalence of pharyngeal residue.
The Wound Amylase Concentration in the Prediction of Pharyngocutaneous Fistula
Authors: Aydogan L. Barlas , Kiroglu Mete , Tuncer Ulku , Soylu Levent
Published: September 2022

Pharyngocutaneous fistula (PCF) is not uncommon after laryngeal surgery. Because it leads to prolonged hospitalization and increased patient morbidity, it is important to predict the formation of fistula. We studied the wound amylase concentrations of 87 consecutive laryngectomized patients. The PCF rate was 11.5% in this series. The amylase levels in patients with PCF begin to elevate significantly on the third, fourth, and fifth postoperative days. Our data indicate that increase in the wound amylase levels seems to be a significant predictor of PCF, and this should alert the surgeon for the presence of fistula.
Matrix Metalloproteinases in a Gerbil Cholesteatoma Model
Authors: Wilmoth Jason G. , Schultz Gregory S. , Antonelli Patrick J.
Published: September 2022

OBJECTIVE

The goal of this study was to determine whether expression of matrix metalloproteinases (MMP) and tumor necrosis factor‐α (TNF‐α) occurs in a gerbil cholesteatoma model, which may be involved early in the pathogenesis of cholesteatoma.

STUDY DESIGN

Atelectasis was induced by transpalatal, bilateral Eustachian tube obstruction on gerbil ears (n = 60). Tympanic membranes were removed at days 0, 3, 7, 14, 28, 56, and 84, and quantitative analysis of TNF‐α and MMPs was performed.

RESULTS

Atelectasis and middle ear inflammation increased with time. TNF‐α and MMP levels increased (P < 0.0083) with time, inflammation, and atelectatic stage with some variability seen between different MMPs.

CONCLUSION

Elevation of TNF‐α and MMPs associated with progressive tympanic membrane atelectasis suggests a possible role for these inflammatory mediators in the pathogenesis of cholesteatoma. (Otolaryngol Head Neck Surg 2003;129:402–7.)
Arytenoid Adduction Combined with Medialization Thyroplasty: An Evidence‐Based Review
Authors: Chester Michael W. , Stewart Michael G.
Published: September 2022

OBJECTIVE

Medialization thyroplasty (MT) and arytenoid adduction (AA) are effective treatments for medializing the paralyzed vocal cord, but indications and benefits of each procedure are controversial. We performed a formal evidence‐based review to answer this question: In patients with unilateral vocal cord paralysis, does AA combined with MT significantly improve subjective and objective voice outcomes compared with MT alone?

STUDY DESIGN

We performed a MEDLINE literature search using specific search terms to identify pertinent articles, which were reviewed and graded according to the evidence quality.

RESULTS

We identified 219 potentially pertinent articles; detailed review yielded 10 studies for further analysis. Only 3 studies directly compared MT with AA plus MT: overall, there was no clear benefit in subjective or objective outcomes for AA plus MT.

CONCLUSIONS

Very limited grade C evidence indicates no clear benefit, or lack of benefit, in subjective or objective outcomes if AA is added to MT, compared with MT alone.
Ossiculoplasty with polymaleinate ionomeric prosthesis
Authors: McElveen John T. , Feghali Joseph G. , Barrs David M. , Shelton Clough , Green J. Douglas , Horn Karl L. , McKenna Michael J. , Thedinger Bradley S. , Wilson David F. , Chen Douglas A. , Krueger Wesley W. O. , Beatty Charles W. , Kurokawa Hironobu
Published: September 2022

With the continued concern over the possible transmission of viral infections through homologous middle ear implants, there is increasing pressure to develop a truly biocompatible alloplastic middle ear prosthesis. The polymaleinate ionomer, which has been used in dentistry as a filling and luting material for more than 15 years, has recently been used to construct total and partial ossicular replacement prostheses. In an attempt to evaluate these new implants, a multicenter prospective clinical trial was initiated. To date, 92 patients have undergone implantation. The follow‐up interval ranged from 3 months to 22 months. Although it is premature to discuss the long‐term results, the preliminary surgical experience and audio‐metric data with these implants are reviewed. From a surgical perspective, the ionomeric prostheses were easily contoured with a diamond burr and were not prone to shattering. Preliminary follow‐up audiometric data were available on 80 patients (59 partial ossicular replacement prostheses and 21 total ossicular replacement prostheses). Of the 59 partial ossicular replacement prostheses the air‐bone gaps (average of 500 Hz, 1 kHz, 2 kHz and 3 kHz) were as follows: 0 dB to 10 dB, 15 (25%) of 59; 11 dB to 20 dB, 20 (34%) of 59; 21 dB to 30 dB, 11 (19%) of 59; and greater than 30 dB, 13 (22%) of 59. Of the 21 total ossicular replacement prostheses the air‐bone gaps were as follows: 0 dB to 10 dB, 6 (29%) of 21; 11 dB to 20 dB, 6 (29%) of 21; 21 dB to 30 dB, 5 (24%) of 21; and greater than 30 dB, 4 (19%) of 21.
Carbon dioxide laser occlusion of the guinea pig posterior semicircular canal
Authors: Antonelli Patrick J. , Bouchard Kenneth R. , Kartush Jack M.
Published: September 2022

Preservation of hearing is possible with selective ablation of the vestibular system and mechanical occlusion of the semicircular canals. Complete ablation of all three canals would improve exposure of the internal auditory canal fundus (e.g., for acoustic tumor exposure), but mechanical packing of the vestibule would disrupt normal sound transduction. This study was designed to assess the feasibility of preserving hearing with CO2 laser occlusion, without mechanical packing of the posterior semicircular canal membranous labyrinth. Twenty adult Hartley guinea pigs underwent occlusion of the right posterior semicircular canal with one of three techniques: mechanical packing, laser coagulation, or laser coagulation with mechanical packing. Electrocochleographic thresholds to clicks and 1‐kHz and 8‐kHz tone bursts did not change significantly 6 weeks after posterior semicircular canal occlusion with any of these techniques. Histopathologic examination revealed complete canal occlusion with all methods. These findings suggest that mechanical occlusion and CO2 laser occlusion of the posterior semicircular canal do not significantly affect cochlear function in the guinea pig. CO2 laser occlusion of the membranous labyrinth may prove useful for more extensive selective vestibular ablation by obviating the need for mechanical packing of the labyrinth.
Outpatient uvuloplasty: An inexpensive, single‐staged procedure for the relief of symptomatic snoring
Authors: Blythe William R. , Henrich Douglas E. , Pillsbury Harold C.
Published: September 2022

Outpatient uvulopalatoplasty is an inexpensive alternative to laser‐assisted uvulopalatoplasty for relief of symptomatic snoring. This single‐stage procedure successfully reduced snoring in properly selected patients. Patients reported improvement in most cases, with 55% indicating great improvement or complete resolution. Spouses reported 83% of the patients were significantly improved or resolved. To date we have had no complications, including bleeding, infection, or velopharyngeal insufficiency or stenosis.
The health impact of chronic sinusitis in patients seeking otolaryngologic care
Authors: Gliklich Richard E. , Metson Ralph
Published: September 2022

Although chronic sinusitis is an increasingly common diagnosis in the United States, the health burden of this disorder relative to the general population and to other chronic diseases has not been previously evaluated. One hundred fifty‐eight patients with chronic sinusitis and no prior surgery underwent cross‐sectional evaluation by use of the Medical Outcome Study Short‐form 36‐Item Health Survey. These patients were all referred for otolaryngologic care, and more than 80% subsequently underwent sinus surgery. Mean scores were compared from the eight subscales of general health assessment with similarly derived data for the United States general population. Significant differences (p < 0.05) were seen in several domains, including bodily pain, general health, vitality, and social functioning. Comparisons with other chronic diseases revealed significantly lower scores (p < 0.05) in measures of bodily pain and social functioning for sinusitis patients than in patients with congestive heart failure, angina, chronic obstructive pulmonary disease, and back pain. These findings suggest that the national health impact of chronic sinusitis is far greater than is currently appreciated.
Allergic fungal sinusitis: Allergic, infectious, or both?
Authors: Harner Stephen G. , Corey Jacquelynne P. , Delsupehe Kathelyne G. , Ferguson Berrylin J.
Published: September 2022

Allergic fungal sinusitis is a benign noninvasive sinus disease related to a hypersensitivity reaction to fungal antigens. A wide variety of fungal agents has been implicated, with the vast majority belonging to the Dematiaceae family. Allergic fungal sinusitis should be suspected in any atopic patient with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but not diagnostic. Diagnosis requires histopathologic examination, which shows characteristic allergic mucin. Hyphae can be demonstrated on special fungal stains or confirmed by a positive fungal culture. At surgery, the diagnosis should be considered if thick, tenacious allergic mucin is encountered in the atopic patient with nasal polyps. Fungal cultures should then be obtained, and the pathologist alerted to the possible diagnosis of allergic fungal sinusitus. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. This can often be accomplished endoscopically. Adjunctive short‐term systemic steroids are often helpful, and nasal steroid sprays should be continued long term. The length and dose of steroid therapy is controversial. Persistence of allergic fungal sinusitis with recurrence of sinonasal symptoms is common, particularly when there has been incomplete eradication of allergic fungal mucin. Even when the patient is clinically disease free, recurrence can occur, presumably from reexposure to fungal antigens. Therefore close clinical, endoscopic, and radiographic follow‐up is important.
Pharmacotherapy of allergic rhinitis: Corticosteroids
Authors: Mabry Richard L.
Published: September 2022

Corticosteroids are potent antiinflammatory preparations that have become a mainstay of pharmacotherapy for allergic rhinitis. Numerous forms are available, and these may be administered systemically or locally. It is incumbent upon the prescribing physician to be aware of the general guidelines for use of corticosteroids, the various preparations available, and the potential side effects associated with their administration.
Supplemental maxillomandibular fixation with miniplate osteosynthesis
Authors: Valentino Joseph , Marentette Lawrence J.
Published: September 2022

Monocortical miniplate fixation provides biomechanical fixation of mandibular fractures. The ability of this system to adequately fixate fractures clinically has not been fully accepted. We analyzed our use of supplemental maxillomandibular fixation with miniplate osteosynthesis during a 5‐year period, in 287 patients with 499 mandible fractures. A retrospective, matched pairing of identical fractures fixated with identical plating schemes was carried out. Sixty‐five pairs of patients undergoing intraoral monocortical plating were identified. Patients in group 1 were treated with supplemental maxillomandibular fixation after surgery, whereas patients in group 2 were treated without postoperative maxillomandibular fixation. The rate of major complications was 11% with supplemental maxillomandibular fixation and 9% without supplemental maxillomandibular fixation (p > 0.05). The total rate of complications was 17% with supplemental maxillomandibular fixation and 20% without supplemental maxillomandibular fixation (p > 0.05). No statistically significant outcome advantage could be attributed to the use of maxillomandibular fixation.
Correlation of compound action potential and electromyography with facial muscle tension
Authors: Goodnight James W. , Dulguerov Pavel , Berke Gerald S. , Lesavoy Malcolm , Hoffman Larry F.
Published: September 2022

Functional electric stimulation is a new method for dynamic rehabilitation of paralyzed muscles. The output of such prosthetic devices needs to be modulated by some index of the muscle movement. In facial paralysis a measure of the muscle contractions of the normal contralateral side seems to be an appropriate input. In the rabbit, we simultaneously measured the compound action potential of the buccal branch of the facial nerve, the electromyogram of the zygomaticus major muscle, and the muscle twitch tension through strain gauge. The compound action potential, electromyogram, and strain gauge each had a sigmoidal relationship to stimulus intensity. The compound action potential peak‐to‐peak amplitude was found to have a linear correlation to the peak twitch tension of the corresponding facial muscle. The electromyogram response, although more variable, also had a linear correlation with muscle contraction. The possibility of predicting the contraction of facial muscles before they actually occur is discussed in the context of available and future functional electric rehabilitation models.
Comparison of polydioxanone and silicone plastic in the prevention of adhesive otitis media in the mongolian gerbil
Authors: Liening Douglas A. , McGath John H. , McKinney Luann
Published: September 2022

Adhesion of the tympanic membrane to the promontory may occur in chronic otitis media or in the postoperative ear. Silicone plastic sheets are commonly used to form a physical barrier to adhesion. These sheets are generally well tolerated, but they are subject to occasional extrusion, encapsulation, or foreign body reaction. The ideal barrier to adhesion formation would be a nonreactive, flexible, absorbable substance that would obviate long‐term toxicity considerations. In this study polydioxanone sheets were compared with silicone plastic sheets in the middle ear of the Mongolian gerbil. The eustachian tube was cauterized to create severe tympanic membrane retraction. A fabricated sheet of polydioxanone was implanted in the middle ear of 30 Mongolian gerbils and compared with silicone plastic sheets implanted in another group of 30 animals. A sham operation was performed on the other ear to serve as a surgical control. Evaluation of the temporal bones at 5, 10, and 15 weeks showed no significant differences in the rate of adhesion formation, effusion formation, or polymorphonuclear infiltration by the Fisher exact test. There was histologic evidence that polydioxanone was still providing an effective barrier at 10 weeks. The results of this study demonstrate that polydioxanone sheets are as effective and as well tolerated as silicone plastic sheets in an animal model. Further study of polydioxanone in this role is warranted.
c‐erbB‐2/neu Oncogene and Ki‐67 Analysis in the assessment of palatal salivary gland neoplasms
Authors: Giannoni Carla , El‐Naggar Adel K. , Ordonez Nelson G. , Nora Tu Z. , Austin John , Luna Mario A. , Batsakis John G.
Published: September 2022

To evaluate the role of the Ki‐67 proliferation antigen and c‐erbB‐2/neu oncogene expression in the clinical assessment of salivary gland tumors, we followed up 71 patients with minor salivary tumors of the palate. All benign neoplasms (n= 18) showed low Ki‐67 scores (< 12%), whereas 26% (14 of 53) of malignant neoplasms manifested high Ki‐67 scores (<12%). A significant statistical difference between Ki‐67 scores for benign and malignant neoplasms was observed (p < 0.001). Ki‐67 index also correlated significantly with malignant tumor grade (p = 0.04) and patient survival (p = 0.02). Only 1 of the 18 benign tumors had c‐erbB‐2/neu oncogene overexpression. A significant difference between c‐erbB‐2/neu overexpression in benign and malignant tumors was observed (p = 0.01). Overexpression of c‐erbB‐2/neu oncogene was noted in 38% (16 of 42) of malignant tumors and was significantly associated with aggressive tumor behavior (p <0.001). Multivariate analysis of significant factors revealed that gender, tumor stage, and c‐erbB‐2/neu oncogene overexpression were jointly predictive of survival. Our data indicate that although the Ki‐67 proliferating antigen and c‐erbB‐2/neu oncogene expression may reflect certain intrinsic biologic properties of these neoplasms, only c‐erbB‐2/neu overexpression is significantly associated with their biologic aggression.
Results of surgical salvage for radiation failures of laryngeal carcinoma
Authors: Po Wing Yuen Anthony , Ignace Wei William , Ming Ho Chiu
Published: September 2022

The results of surgical salvage of radiation failures of laryngeal carcinoma were reviewed. There were 167 stage T3 and T4 patients. The operative mortality was 7%. The complication rates were 8% wound infection, 13% chest complication, and 25% anastomotic leakage. After the first salvage operation, pharyngeal recurrence developed in 28 (48%) patients. Seven (25%| patients were feasible for second salvage operation, and none of them had further local recurrence. There were 9 (5%) tracheostomal recurrences. Of the 126 NO patients, 23(18%) had nodal recurrence, and only 5 of the nodal recurrences were feasible for salvage by radical neck dissection. All 41 node‐positive patients underwent radical neck dissection, and 9 (23%) had nodal recurrence. Of the 126 node‐negative patients, 19 (15%) had distant metastasis. Of the 41 node‐positive patients, 18 (44%) had distant metastasis. The node‐positive patients had a significantly high distant failure rate despite locoregional control of tumor. The adjusted 5‐year survival rate of T3‐4NOMO was 45%, and that of T3‐4N + MO was 22%.
Imaging of the vestibule
Authors: Vignaud Jacqueline , Marsot‐Dupuch Kathleen , Pharaboz Christian , Derosier Christian , Cordoliani Yves‐Sebastien
Published: September 2022

PURPOSE

State‐of‐the‐art imaging of the normal and pathologic vestibule.

METHODS AND MATERIAL

This study is based on the experience of three French imaging centers (Val de Grâce, Bégin, and Saint‐Antoine hospitals) working with 1‐ and 1.5‐tesla magnetic resonance units and high‐resolution computed tomography, and it includes a review of the literature. Computed tomography is performed with a high‐resolution program, matrix 512 × 512, field of view 9.6 cm, joined 1‐mm section, overlapped sections every 0.5 mm, axial and coronal sections, or reformatted images. High‐resolution magnetic resonance imaging (matrix 512 × 384), field of view 18 cm, is used with fast T2‐weighted sequences (sections 3 or 2 mm thick, constructive interference in steady state, T2‐weighted gradient echo sequence three‐dimensional Fourier transformation). A joined section of 0.7 mm in any direction is obtained if necessary. Superimposition of computed tomography and magnetic resonance imaging with a stereotactic technique by identification of identical anatomic points is sometimes used.

RESULTS

We review the interest and place of computed tomography and magnetic resonance imaging in the diseases of the labyrinth and internal auditory canal related to abnormal vestibular functions: inflammatory labyrinthitis, vestibular hemorrhages, sclerosing and ossifying labyrinthitis, traumatism, malformations, perilymphatic fistulas, otosclerosis, tumors, cochleovestibular neuritis, and hydrops of the endolymphatic system.
Cardiovascular Effects of Environmental Chemicals
Authors: Taylor Aubrey E.
Published: September 2022

This article presents recent data on several environmental toxins: lead, carbon disulfide, asbestos, arsenic, ozone, cadmium, vinyl chloride, fiuorocarbons, freon, and pesticides. These environmental toxins produce both hypertension and cardiac arrhythmias in most studies, and they are not necessarily related to primary lung disease and secondary heart disease. The possible mechanisms that could cause the cardiovascular diseases include (1) damage to the endothelial barrier in the vascular system, (2) activation of leukocytes and platelets, (3) initiation of plaque formation, (4) stimulation of the inflammatory response, (5) kidney‐related hypertension, and (6) direct damage to cardiac and blood vessel tissue. Recommendations are that more animal, human cultured cell, and epidemiologic studies should be conducted on the environmental toxins identified in this article.
Bone: Target and Source of Environmental Pollutant Exposure
Authors: McGowan Joan A.
Published: September 2022

The skeleton can play a unique role in modulating and responding to environmental air pollutants. Bone and its metabolic activities may be immediate targets for particular agents, leading to skeletal disease. However, bone is also an important storage site in the body. Chemical pollutants may be actively absorbed into bone mineral and released later during the normal process of bone remodeling. Critical periods when bone remodeling is enhanced, such as pregnancy, lactation, menopause, immobilization, and exposure to microgravity, may be important to recognize because of the potential for enhanced release of previously stored chemical agents. Lead has been identified as a “criteria air pollutant” by the 1970 Clean Air Act because of its ubiquity in the environment and its effect on a multiplicity of health outcomes. It is used in this article as an example of a substance that can have both a direct effect on bone and a latent effect on other organ systems through release from bone long after the initial exposure.
Hispanic Environmental Health: Ambient and Indoor Air Pollution
Authors:   NATIONAL COALITION OF HISPANIC HEALTH AND HUMAN SERVICES ORGANIZATIONS (COSSMHO)
Published: September 2022

Air pollution has serious deleterious effects on health and is a public health matter of the utmost importance. The National Coalition of Hispanic Health and Human Services Organizations (COSSMHO) believes that reducing exposure to air pollution is a priority issue for the Hispanic community because 80% of Hispanics (compared with 65% of non‐Hispanic blacks and 57% of non‐Hispanic whites) live in nonattainment areas‐areas that fail to meet the Environmental Protection Agency ambient air quality standard. Although Hispanics in general live as long as or longer than non‐Hispanic whites, what morbidity data are available reveal that the quality of that life is severely impaired by a variety of chronic conditions, such as asthma. This makes environmental health a pressing matter for Hispanic communities, particularly in the area of air pollution. Action items are included.
Rapid Intraoperative Facial Nerve Expansion
Authors: Martini David V. , Har‐El Gady , McPhee Joseph , Lucente Frank E.
Published: September 2022

The repair of nerve length defect presents a reconstructive challenge after trauma and oncologic resection. This study examined rapid intraoperative nerve expansion as a method of repairing nerve length defects with the cat facial nerve model. We compared expanded nerves with grafted nerves and intact nerves 1 year after repair using the criteria of gross function (symmetry and blink reflex according to a modified House scale), electromyography thresholds, nerve‐conduction velocity, morphology, and axon count. Three of the five expanded nerves regenerated, and all of the grafted nerves regenerated. Functional results were similar for the regenerated expanded and the grafted facial nerves, and both methods achieved an equivalent level of function. The facial nerves of the regenerated expanded group, grafted group, and intact group had mean electromyography thresholds of 132 mV, 98 mV, and 134 mV, respectively, and mean conduction velocities of 48.3 mg/second, 47.9 m/second, and 44.7 m/second, respectively. Morphologic examination of all five expanded nerves immediately after the expansion process revealed an intact fascicular structure. However, 1 year after excision of the expanded segment and repair, only three of the five nerves regenerated. Axon count at 1 year was as follows: 404 for the regenerated expanded nerves, 449 for the grafted nerves, and 403 for the intact nerves. The potential advantages of rapid intraoperative nerve expansion over nerve grafting for the repair of nerve gap defects include a single suture line and absence of donor site morbidity. This pilot study demonstrates that rapid intraoperative nerve expansion and regeneration is possible and can be used to repair a nerve length deficit. The development of a rapid and reliable method of intraoperative nerve expansion deserves further study.
Effects of Radiation Therapy on Reconstruction of Mandibular Defects with a Titanium Reconstruction Plate
Authors: Klotch Douglas W. , Ganey Timothy , Greenburg Harvey , Slater‐Haase Alicia
Published: September 2022

Titanium fixation plates are commonly used in reconstruction of mandibular defects resulting from tumor resections in head and neck surgery. The effects of radiation therapy on the interface of bone, plate, and soft tissue were examined in this in vivo study. Four conditioned beagles had 1‐cm segmental mandibular defects that were reconstructed with titanium plates. Two of the four also had placement of vascularized bone grafts. Healing was evaluated with or without postoperative radiotherapy. After collection of tissues using histologic methods and analysis with energy‐dispersive spectroscopy, we found that the effects of radiation on bone‐plate and bone‐screw interfaces is minimal. Although radiation decreased the bone density and the rate of bone repair at the bone‐screw interface, this did not appear to affect stability of the plate repair or the viability of bone tissue.
Power Microdebrider for Functional Endoscopic Sinus Surgery
Authors: Goode Richard L.
Published: September 2022

Associate Editors Note: Readers should be aware that since the acceptance of this manuscript into our system, other companies have made available microdebriders. These companies include Linvotec and Xomed‐Treace. These microdebriders present a variety of features, which may include bendable router blades, a variety of different levels of “aggressiveness” of router blades, automatic irrigation systems, suction adjustment valves, and a variety of motor sizes providing power for the units. Surgeons wishing to optimize their individual needs for their patient populations should be aware of differences and the assortment of microdebriders available.
Microsatellite Alterations at Chromosome 8q Loci in Pleomorphic Adenoma
Authors: Gillenwater Ann , Hurr Kenneth , Wolf Pat , Batsakis John G. , Goepfert Helmuth , El‐Naggar Adel K.
Published: September 2022

OBJECTIVE

To determine the extent, localization, and clinical significance of microsatellite loci alterations at sites of reported cytogenetic abnormalities in pleomorphic adenomas.

BACKGROUND

Pleomorphic adenoma is a benign salivary gland tumor with a propensity for recurrence and potential for malignant conversion. Although its cause remains unclear, clonal cytogenetic abnormalities have been reported consistently.

DESIGN

DNA extracted from paired normal and tumor tissue specimens from 1 patient with carcinoma ex pleomorphic adenoma and 17 patients with pleomorphic adenoma (3 contained foci of carcinoma ex pleomorphic adenoma) was evaluated for loss of heterozygosity at microsatellite loci with a multiplex polymerase chain reaction‐based analysis. Correlation with clinical and pathologic features was performed.

RESULTS

Overall 10 (56%) of 18 cases manifested loss of heterozygosity at the loci tested. The frequency of loss of heterozygosity noted on 3p, 6q, 8p, 8q, and 12q microsatellite loci was 17%, 12%, 8%, 47%, and 27% of informative cases, respectively. Specimens from patients with carcinoma ex pleomorphic adenoma showed a similar loss of heterozygosity incidence at these loci. No apparent association between molecular abnormalities and clinical‐pathologic features was observed in this cohort.

CONCLUSIONS

Loss of heterozygosity at microsatellite loci on 8q, a breakpoint at which translocations have been previously documented in pleomorphic adenoma, is a frequent event in this tumor. The incidence is not increased in patients with focal carcinoma ex pleomorphic adenoma, suggesting that loss of heterozygosity at 8q is an early event in tumorigenesis. Further evaluation at these loci is needed to identify potential tumor suppressor genes that may be associated with the initiation and progression of pleomorphic adenomas.
Regulation of Mucin Secretion in the Ferret Trachea
Authors: Kishioka Chikako , Cheng Pi‐Wan , Seftor Richard E. B. , Lartey Paul A. , Rubin Bruce K.
Published: September 2022

Mucin is the major component of mucus and can be used as a marker for mucus secretion. The purpose of this study was to develop an in vitro method to evaluate the regulation of mucin secretion. To do this, we used a sandwiched enzyme‐linked lectin assay to measure mucin secretion from isolated ferret tracheal segments. This assay entailed coating microtiter plate wells with dolichos biflorus agglutinin and detecting the bound mucin that was secreted into a buffer solution by the tracheal segments. We used this method to evaluate the secretory response to four secretogogues: prostaglandin F2α (PGF2α), adenosine triphosphate (ATP), methacholine, and human neutrophil elastase (HNE). Each agent stimulated mucin secretion above baseline secretion (ATP (p = 0.022), PGF2α (p = 0.009), and HNE (p < 0.05)), and the relative potency of these secretogogues was PGF2α ≤ ATP < MCh < HNE. We also demonstrated that there is an anatomic gradient for both constitutive and stimulated mucin secretion, with the distal tracheal segments secreting more mucin per gram of weight than the proximal segments. This fairly simple and reproducible technique can be used to evaluate the regulation of mucin secretion in the airway and to assess the efficacy of agents that might alter the secretory response.
Mastoidectomy in Noncholesteatomatous Chronic Suppurative Otitis Media: Is it Necessary?
Authors: Balyan Fatih R. , Celikkanat Serdar , Asian Asim , Taibah Abdelkader , Russo Alessandra , Sanna Mario
Published: September 2022

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated Into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow‐up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).
The effect of acidic fibroblast growth factor and live yeast cell derivative on tympanic membrane regeneration in a rat model
Authors: Goldman Steven A. , Siegfried Jill , Scoleri Paul , Aydogen L. barlas , Cass Stephen P.
Published: September 2022

The current treatment of choice for chronic tympanic membrane perforations is surgery. Recent studies using various polypeptide growth factors to accelerate closure of tympanic membrane perforations in model systems have produced mixed results. This study evaluates the effect of acidic fibroblast growth factor (AFGF) and live yeast cell derivative (LYCD) on the rate of healing of acute tympanic membrane perforations in a rat model. Thirty‐seven rats had both ears separately randomized in a blinded fashion to receive AFGF in one of three concentrations, LYCD, or a control solution. The rats initially underwent subtotal removal of the tympanic membranes bilaterally. Solutions were applied to the randomized ears daily for 3 days, starting at the time of the surgical perforation. The ears were photographed every 3 to 8 days for 35 days. The photographs were digitally scanned and a computer analysis was used to calculate the percentage of residual perforation. No significant difference in the rate of healing was observed for ears treated with AFGF or LYCD versus the controls. Given the potential advantages of medical treatment of tympanic membrane perforations and the established efficacy of growth factors in other model systems, however, further research is warranted.
Microscopic tonsillectomy: A double‐blind randomized trial
Authors: Kujawski Oskar , Dulguerov Pavel , Gysin Claudine , Lehmann Willy
Published: September 2022

OBJECTIVE

To evaluate microsurgical bipolar cautery tonsillectomy (TEmic) by comparing it with traditional blunt dissection tonsillectomy (TEtrad).

DESIGN

A double‐blind prospective randomized trial with stratification in two age groups.

PATIENTS

200 consecutive patients undergoing tonsillectomy for tonsillar hypertrophy, or recurrent or chronic tonsillitis.

OUTCOME MEASURES

Duration of surgery, intraoperative bleeding, daily postoperative pain and otalgia, postoperative bleeding episodes.

METHODS

Duration of surgery and operative bleeding were evaluated by the anesthesiologist. The patients were instructed to record daily pain and otalgia. Final postoperative evaluation was done by a different physician, blinded to the surgical technique.

RESULTS

Mean intraoperative bleeding was 12 ml for TEmicand 36 ml for TEtrad(p< 0.001). Mean duration of surgery was 37 minutes for TEmicand 36 minutes for TEtrad(NS). Otalgia was present in 41% of TEmicpatients and 69% of TEtradpatients (p< 0.001). Daily postoperative pain was lower in the TEmicgroup than it was in the TEtradgroup for the entire study period (10 days). Postoperative hemorrhage was present in three TEmicpatients (3%) and in eight TEtradpatients (8%), a difference that did not reach significance (p> 0.1).

CONCLUSION
Use of color Doppler flow imaging for preoperative assessment in fibular osteoseptocutaneous free tissue transfer
Authors: Futran Neal D. , Stack Brendan C. , Payne Lynn P.
Published: September 2022

Fibular osteocutaneous free tissue transfer represents state‐of‐the‐art reconstruction of the oromandibular complex after oncologic resection. Because the blood supply of the fibular flap is based on the peroneal artery and venae comitantes, it is essential to determine preoperatively whether adequate perfusion to the donor extremity will persist after sacrifice of the peroneal pedicle. Vascular variations or peripheral arterial occlusive disease may exist whereby sacrifice of peroneal vessels can cause ischemia of the lower leg and foot. Therefore, angiography of the lower extremity and magnetic resonance angiography have been advocated to determine the arterial supply to the lower leg. Though accurate, these examinations carry risk for morbidity, and both are expensive. Color Doppler flow imaging is a noninvasive ultrasound examination used to measure antegrade and retrograde blood flow. We prospectively evaluated color Doppler flow imaging as a means of preoperative evaluation of the lower extremity for candidates for fibular flaps. Ability to image peroneal vessels and to determine collateral and distal perfusion were evaluated. The patients were compared with a control group of patients with peripheral arterial occlusive disease. Color Doppler flow imaging provided accurate hemodynamic information for all patients and allowed successful fibular transfer for all patients who received free flaps. The modality is comparable in accuracy with the angiography of the lower extremity and magnetic resonance angiography and has the advantages of low cost and no morbidity.
Effect of sinus surgery on quality of life
Authors: Gliklich Richard E. , Metson Ralph
Published: September 2022

Although sinus surgery may reduce the incidence of recurrent infection in patients with chronic sinusitis, little is known about the effect of such surgery on a patient's quality of life. One hundred eight patients undergoing ethmoid sinus surgery were prospectively evaluated with statistically validated measures of sinusitis‐specific and general health‐related quality of life. Twelve months after surgery significant improvements were found in sinus‐specific health status, including a reduction in symptoms (p < 0.001) and medication usage (p < 0.001). An overall improvement was found in 82% of patients, whereas 11% were worse, and 7% remained unchanged. Measures of general health status demonstrated preoperative decrements in five of eight subscales as compared with the normal population. Six months after surgery significant improvements were noted in six categories (p < 0.05), and most attained near‐normative levels. Individuals with asthma demonstrated greater overall improvement in general health status than did other cohorts (p < 0.05). We conclude that patients with chronic sinusitis achieve large improvements in sinusitis‐specific quality‐of‐life measures 12 months after sinus surgery, as well as improvements in general health status.
Evaluation of the nasal cavity by acoustic rhinometry in normal and allergic subjects
Authors: Corey Jacquelynne P. , Kemker Bryan J. , Nelson Robert , Gungor Anil
Published: September 2022

With acoustic rhinometry, one can detect a difference in response to a topical decongestant between normal and allergic subjects at the minimal cross‐sectional area. The minimal cross‐sectional area corresponds in most cases to the anterior end of the inferior turbinate or the first valley, which occurs after the nose piece of the acoustic rhinometer on the acoustic rhinometry graph. Allergic patients typically have an increase in nasal mucosal swelling, which leads to a decrease in the nasal volume and area and, subsequently, to an increase in congestion. In this study acoustic rhinometry was used to test normal and allergic subjects before and after the application of a topical decongestant (1% phenylephrine (Neo‐Synephrine)). Symptoms were measured by a five‐point scale. Results showed that increasing symptom scores demonstrated a trend toward being related to decreasing area as measured at the minimal cross‐sectional area or nasal valve. The average total percent change at the minimal cross‐sectional area was calculated for both groups and compared. The normal subjects had an average total percent area change at the minimal cross‐sectional area of 15.6% ± 14.8%, and the allergic subjects had a percent change of 24.6% ± 20.8%. This represents a significant difference between the normal and allergic subjects in response to the topical decongestant at the minimal cross‐sectional area (p = 0.04). However, the average total percent change was not significantly different between the two groups at the second and third valleys. At the second valley, the normal subjects had a percent change of 40% ± 17.5%, and the allergic subjects had a percent change of 36% ± 18.5%. At the third valley, the normal subjects had a percent change of 35% ± 15.4%, and the allergic subjects had a percent change of 32% ± 20.6% (p = 0.4 and 0.5, respectively). The total area was calculated by adding measurements from both right and left nasal cavities for each subject in an attempt to control the effect of the nasal cycle. Acoustic rhinometry makes it possible to detect a trend in the relationship between either a decrease in area at the minimal cross‐sectional area or a decrease in the total volume from 0 to 7 cm into the nasal cavity and congestion. A statistically significant difference between normal and allergic subjects in their response to a topical decongestant at the minimal cross‐sectional area was detected by acoustic rhinometry at the nasal valve.
Eosinophil cationic protein in mucosal biopsies from patients with allergy and otitis media with effusion
Authors: Hurst David S. , Fredens Kjeld
Published: September 2022

Nine patients with persistent middle ear effusion and allergy confirmed by skin testing were evaluated for eosinophils by histochemical staining of middle ear mucosal biopsy specimens for eosinophil cationic protein. The study was designed to determine whether eosinophils were present in the middle ear mucosa of these patients and whether the elevated levels of eosinophil cationic protein reported in effusion from patients with chronic otitis media with effusion and allergy might originate within the mucosa itself. Seven of nine patients with otitis media with effusion had eosinophil cationic protein containing eosinophils (12 to 15 per high‐power field) and degranulated eosinophil cationic protein material in the stroma of their mucosal biopsy specimens. Positive and negative biopsy findings correlated directly with respective high and low effusion levels of eosinophil cationic protein (p = 0.03), reflecting an intrinsic immune‐mediated process occurring within the middle ear mucosa.
Postoperative hypertension after radical neck dissection
Authors: Çelikkanat Serdar , Akyol Mehmet Umut , Koç Can , Ölçer Selim , Ensari Serdar , Turgut Suat , Özdem Cafer
Published: September 2022

Postoperative hypertension after radical neck dissection was detected in 20.2% of 109 neck dissections in our department between 1989 and 1993. It was probably caused by carotid sinus denervation and appeared after the vasodilation generated by anesthesia had subsided. If postoperative hypertension was encountered after the first operation, the risk of such hypertension after surgery on the contralateral side significantly increased. (Otolaryngol Head Neck Surg 1997;117:91–2.)
Markus Hajek, his Students and Friends (1907–1941)
Authors: Seitz Phillip R.
Published: September 2022

The formal contributions of the European university system to American medicine and medical education before World War II are well documented. Less so is the personal dimension of the international teacher‐student encounter, which included friendships that were sometimes intimate and long‐standing. One such example is offered by University of Vienna rhinologist Markus Hajek, whose long friendship with his American student Roy Philip Scholz is recorded by surviving archival sources. Hajek's letters to Scholz document their relationship over a period of more than 30 years, including many examples of mutual aid and shared sorrow. Ultimately Scholz was part of an international committee of students and admirers organized by the English laryngologist Sir St. Clair Thomson to rescue their professor from Nazi‐controlled Vienna on the eve of World War II.
Nitric Oxide Mediates Mucin Secretion in Endotoxin‐Induced Otitis Media with Effusion
Authors: Rose Austin S. , Prazma Jiri , Randell Scott H. , Baggett Henry C. , Lane Andrew P. , Pillsbury Harold C.
Published: September 2022

The mechanisms that regulate mucin release in chronic otitis media with effusion, a leading cause of hearing loss in children, remain largely unknown. We developed an animal model using Sprague‐Dawley rats to determine the factors responsible for mucin production in chronic otitis media with effusion. N‐nitro‐l‐arginine methyl ester (l‐NAME), a competitive inhibitor of nitric oxide synthase, was used to investigate the role of nitric oxide in mucin secretion by the middle ear epithelium. All rats underwent eustachian tube obstruction. In the first set of rats, the middle ear was then injected transtympanically with 35 μl of either 300 mOsm Krebs‐Ringer bicarbonate buffer (control group) or 1 mg/ml lipopolysac‐charide in Krebs‐Ringer (experimental group 1). In a second set of rats, the middle ear space was injected with lipopolysaccharide and then infused at a continuous rate for 7 days with either Krebs‐Ringer (experimental group 2) or 1 mmol/L l‐NAME in Krebs‐Ringer (experimental group 3) through an osmotic infusion pump. After 7 days the volume of effusion and the quantity of mucin collected were significantly greater in lipopolysaccharide‐exposed ears than in controls. In addition, antimucin immunostaining demonstrated mucous cell hyperplasia in response to lipopolysaccharide. The lipopolysaccharide‐induced production of mucin and mucous cell hyperplasia was inhibited in ears treated with lipopolysaccharide and l‐NAME. These results suggest that nitric oxide is a mediator in the pathway of mucin secretion in chronic otitis media with effusion.