bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracheostomal stenosis revision with simultaneous tracheoesophageal puncture
Authors: Wax Mark K. , Touma B. Joseph , Ramadan Hassan H.
Published: November 2003

Objectives/Hypothesis:Vocal rehabilitation of patients who have undergone laryngectomy is best accomplished by a tracheoesophageal puncture. Optimal function of the prosthesis requires an adequate stoma. Patients with tracheostomal stenosis require revision of the stoma if vocal rehabilitation is to take place. Revision and tracheoesophageal placement are usually done as two separate procedures. Creating a tracheoesophageal fistula at the time of stomal revision has not been addressed in the literature.Study Design:Prospective analysis and follow‐up of 10 patients undergoing simultaneous tracheoesophageal puncture and stomal revision for tracheostomal stenosis between 1991 and 1996.Methods:Ten patients were reviewed. An inferiorly based V‐Y advancement flap was used so as not to interfere with the tracheoesophageal puncture. All patients had received radiation prior to revision and tracheoesophageal puncture. Patients were followed for a minimum of 2 years (range, 2–6 y; median, 3 y).Results:All patients maintained an adequate stoma without stenting. Eight of ten patients (80%) developed and maintained good tracheoesophageal speech. Two patients had their speech fistulas removed. There were no intraoperative or postoperative complications.Conclusions:Creation of a tracheoesophageal fistula at the time of stomal revision allows for vocal rehabilitation with a single visit to the operating room.Laryngoscope, 108:1509‐1513, 1998
Th‐2 type cytokine receptors in allergic rhinitis and in response to topical steroids
Authors: Wright Erin D. , Christodoulopoulos Pota , Small Peter , Frenkiel Saul , Hamid Qutayba
Published: November 2003

Objectives: Th‐2 type cytokine production (inter‐leukin‐4 [IL‐4] and interleukin‐5 [IL‐5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th‐2 type cytokines in vivo. However, the contribution and expression of Th‐2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL‐4 and IL‐5 receptors (IL‐4R and IL‐5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th‐1 type cytokine, interferon‐gamma receptor (IFN‐γR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors. Study Design: Randomized prospective study involving 14 ragweed‐allergic subjects evenly divided between placebo and corticosteroid pretreatment. Methods: Immunocytochemistry (alkaline phosphatase‐antial‐kaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti‐CD3, CD4, CD8, MBP, IL‐4R, IL‐5R, and IFN‐γR. Results: Following allergen challenge, we observed a significant increase in the Th‐2 type cytokine receptors (IL‐4R and IL‐5R; P < .05), as well as a significant decrease in the expression of the Th‐1 type cytokine receptor (IFN‐γR; P < .05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL‐4R (P < .05) and IL‐5R (P < .05) and increased expression of IFN‐γR (P < .05). Further, IL‐4R and IL‐5R expression correlated with eosinophil infiltration in the tissues. Conclusions: We have demonstrated that in AR, cytokine receptors for IL‐4, IL‐5, and IFN‐γ follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th‐2 profile more toward a Th‐1 profile. Laryngoscope, 108:1528–1533,1998
Fluoroscopically placed percutaneous gastrostomies in the head and neck patient
Authors: Myssiorek David , Siegel David , Vambutas Andrea
Published: November 2003

Objective: At our institution, percutaneous gastrostomy tubes have been inserted under fluoroscopic guidance (fluoroscopic cutaneous gastrostomy [FPG]), thereby avoiding the need to traverse the pharynx and esophagus with a large‐bore esophagoscope. For this reason, placement in the postoperative patient does not jeopardize the surgical reconstruction. Methods: Thirty‐five patients underwent percutaneous gastrostomy placement under fluoroscopic guidance. These included 12 patients whose cervical esophagus could not be entered safely because of a lesion in the head neck, 11 patients who had recently undergone resection of a head and neck cancer with pharyngeal reconstruction where traditional percutaneous enteral gastrostomy (PEG) placement was contraindicated, and two patients with postoperative fistulae. Results: Thirty‐four of 35 patients underwent successful gastrostomy or gastrojejunostomy placement. One patient had an intrathoracic position of the stomach, and one patient required repeat placement because the tube dislodged 5 days after insertion. No tube occluded. Conclusions: Percutaneous gastrostomy under fluoroscopic guidance (FPG) is an effective, safe method for access for prolonged enteral feeding of the patient whose cervical esophagus cannot be accessed for a variety of reasons. It also allows the safe placement of a gastrostomy catheter when the patient' postoperative course becomes complicated and prolonged enteral nutrition is required. Laryngoscope, 108:1557–1560, 1998
Balanced orbital decompression for graves' ophthalmopathy
Authors: Shepard Kimberly G. , Levin Peter S. , Terris David J.
Published: November 2003

Objective/Hypothesis: Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external beam radiotherapy. Orbital decompression has commonly been performed via a transantral approach to the medial orbital wall and floor. Although an endoscopic approach to these walls has been described, a balanced approach (incorporating a lateral decompression by an ophthalmology team) is desirable. Study Design: Retrospective review. Methods: Endoscopic medial decompression and extended lateral decompression were accomplished in 18 orbits (11 patients); inferior decompression was performed in 11 of these. Five additional procedures were performed. Results: Exophthalmos improved by a mean of 4.6 mm. All patients who underwent decompression for vision loss had improved vision after surgery. Exposure keratitis improved in six of six orbits. Two of five patients undergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or prism glasses. There were no other significant complications. Conclusions: The endoscopic approach to the medial orbital wall is an important component of balanced orbital decompression for patients with Graves' ophthalmopathy. Balancing the decompression and preserving the medial orbital strut between the ethmoid cavity and the orbital floor may minimize the risk of diplopia. Laryngoscope, 108:1648–1653, 1998
Complications of phonosurgery: Results of a national survey
Authors: Rosen Clark A.
Published: November 2003

Objective: Medialization laryngoplasty (ML) and arytenoid adduction (AA) have become common treatments for vocal fold paralysis. The widespread use of these procedures has required many surgeons to learn these new surgeries through postgraduate education sources. Little is known regarding the efficacy of the learning methods and the types and incidence of complications in a large number of surgeons' experience. Method: A survey consisting of 23 questions regarding complications of ML and AA was sent to 7364 otolaryngologists. Results: A 33% response rate resulted in 2436 returned surveys of which 43% stated they performed ML and/or AA (n = 1039). The survey represents 14,621 cases of ML. The average respondent performed 12 ML in the past 5 years. Forty‐two percent of the respondents reported experience with one or more major complication. Airway complications requiring intervention occurred more frequently following AA than ML. The most common major complications were implant migration and failure to improve voice quality. The ML revision rate was 5.4% and the reported voice quality following revision was positive in 90% of cases. A statistically significant difference in major ML complication rate was found between surgeons with experience doing fewer than 10 MLs and those with experience doing more than 10 MLs. Similar findings showed that a higher major complication rate occurred for surgeons performing fewer than two MLs per year compared with counterparts who average two or more MLs per year. A near 1% implant extrusion rate was found. Most of the extrusions occurred into the airway. Conclusions: This is a study of the use and complications of ML/AA based on more than 14,000 procedures. Wide‐spread use of ML for vocal fold paralysis was found. A notable rate of poor voice quality following ML/AA was identified and led to a 5.5% revision rate for ML. Revision ML resulted in an improved voice quality in more than 90% of the reported cases. There appears to be a “learning curve” for performing ML as well as an increased complication rate for those surgeons who perform fewer than two MLs per year and have a total career experience of fewer than 10 procedures. These findings suggest that ML may result in increased complications if the surgeon is not experienced or does not perform the surgery regularly. Laryngoscope, 108:1697–1703, 1998
A retrospective analysis of airway endoscopy in patients less than 1‐month old
Authors: Ungkanont Kitirat , Friedman Ellen M. , Sulek Marcelle
Published: November 2003

Objectives: To review the authors' experience with neonates who underwent endoscopy over an 8‐year period. Study Design: Retrospective review in a tertiary care children's hospital. Methods: Sixty‐two neonates who underwent endoscopy were reviewed. Results: Common indications for endoscopy were stridor (56%), apnea/cyanotic episodes (30%), and feeding difficulty (23%). Laryngeal abnormalities were the most frequent finding, including laryngomalacia (19%), glottic edema (19%), and vocal cord paralysis (13%). Pierre Robin sequence was the most common associated anomaly. Forty‐eight neonates (77.4%) had more than one endoscopic finding. Gastroesophageal reflux diagnosed by barium swallow or esophageal pH monitoring was found in 34%. Gastroesophageal reflux was the only identified etiologic factor in four cases. Computed tomography and magnetic resonance imaging provided less information than endoscopy. Conclusions: Endoscopy in symptomatic neonates can determine etiology of distress most of the time. Multiple diagnoses were found in 77.4% of the neonates, emphasizing the need for a thorough aerodigestive tract examination. Concomitant diagnoses including gastroesophageal reflux, congenital heart disease, and pulmonary disease were found in 87.1% of neonates. Neonates have a higher likelihood of having multiple lesions in the aerodigestive tract as compared with older infants or children. Laryngoscope, 108:1724–1728, 1998
Is there a correlation between vascular loops and unilateral auditory symptoms?
Authors: Makins Anita E. , Nikolopoulos Thomas P. , Ludman Catherine , O'Donoghue Gerard M.
Published: November 2003

Objectives: To assess whether contact of a vascular loop formed by the anterior inferior cerebellar artery (AICA) with the eighth cranial nerve correlated with unilateral auditory symptoms so as to produce a “vascular compression syndrome.” Study Design: Prospective evaluation of patients with unilateral auditory symptoms using magnetic resonance imaging (MRI) scans to identify contact of a vascular loop with the eighth cranial nerve. Methods: One hundred twelve patients with idiopathic unilateral auditory symptoms (42 women and 70 men, mean age of 51 years) were evaluated with MRI. Location of the vascular loop and contact with the eighth cranial nerve were assessed in each case. The asymptomatic contralateral ears of the patients were used as controls. A power analysis had determined the size of the sample to be studied. Results: The arterial loop was found to be in contact with the eighth cranial nerve in 28 (25%) of the 112 symptomatic ears and in 24 (21.4%) of the asymptomatic (control) ears. The statistical analysis revealed that the difference was not statistically significant. Conclusion: The results suggest that radiologic demonstration of contact between a vascular loop formed by the AICA and the eighth cranial nerve on MRI scans should be considered a normal anatomic finding and should not, on its own, be used to support the diagnosis of a “vascular compression syndrome.” Laryngoscope, 108:1739–1742, 1998
Airway management in children with major craniofacial anomalies
Authors: Sculerati Nancy , Gottlieb Marc D. , Zimbler Marc S. , Chibbaro Patricia D. , Mccarthy Joseph G.
Published: November 2003

Objectives: Delineation of clinical characteristics affecting the airway in a cohort of craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation? Study Design: Five‐year retrospective chart review at tertiary center. Methods: Two hundred fifty‐one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major craniofacial bony anomalies and underwent administration of general anesthesia at least once. Results: Nearly 20% of all children required tracheotomy (47/251). Craniofacial synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo‐auriculo‐vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with craniosynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision. Conclusions: The likelihood for surgical airway management is related to specific craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of craniofacial syndromes.
Relationship between middle ear pressure, mucosal lesion, and mastoid pneumatization
Authors: Aoki Kazuhiro , Mitani Yukie , Tuji Tomihiko , Hamada Yukio , Utahashi Hiroya , Moriyama Hiroshi
Published: November 2003

Objectives: The inflammatory changes of pneumatic space mucosa are thought to affect the development of pneumatic space and the function of transmucosal gas exchange. So, it is assumed that the mucosal change is deeply involved in the onset and healing process of otitis media with effusion (OME). The objective of this study is to investigate whether the growth of the mastoid cells and the middle ear transmucosal gas exchange function in patients with OME are affected by the histopathologic changes in middle ear mucosa, and whether these two factors are changed by the treatment of OME. Materials and Methods: From 65 children with OME, middle ear mucosal specimens were collected during indwelling of a tympanic tube, and their histopathologic changes were compared with cell growth area measured on radiographic films and with the change in the middle ear total pressure (METP). Results: Suppression of the cell growth area was stronger and the METP stayed lower in cases with a higher degree of mucosal lesion. Significant expansion of pneumatic area was observed after 2 years of tube indwelling, and the peak METP showed a significant increase after 1.5 years. This increase in the METP was caused by diffusion/absorption of CO2 and O2 and indicated recovery of the transmucosal gas exchange function. Conclusions: The growth of the mastoid cells and the middle ear transmucosal gas exchange function are closely affected by the subepithelial histopathologic changes in middle ear mucosa, and these two factors recover by the treatment of OME.
Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy
Authors: Hartikainen Jouko , Antila Jukka , Varpula Matti , Puukka Pauli , Seppä Heikki , Grénman Reidar
Published: November 2003

Objectives and Study Design: The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery (FESS) technique have awakened interest in an endonasal endoscopic dacryocystorhinostomy (EESC‐DCR) in treating nasolacrimal obstruction. This prospective, randomized study compares EESC‐DCR with traditional external dacryocystorhinostomy (EXT‐DCR) for their success rates, surgical duration, and postoperative symptoms. Patients and Methods: Sixty‐four cases in 60 patients with primary acquired nasolacrimal sac or duct obstruction were divided into two subgroups by symptoms (simple epiphora/ chronic dacryocystitis). These patients were randomized within both subgroups into two operation groups. Altogether 32 EESC‐DCRs and 32 EXT‐DCRs were performed. The final follow‐up visit was at 1 year. The patency of the lacrimal passage was investigated by irrigation and patients were questioned about their symptoms. Results: The success rate at 1 year after surgery was 75% for EESC‐DCR and 91% for EXT‐DCR after primary surgery. The difference was not statistically significant (P = .18). The success rate after secondary surgery with a follow‐up time of 1 year was 97% in both study groups. The average duration for EESC‐DCR was 38 minutes, and 78 minutes for EXT‐DCR, (P < .001). Conclusions: EXT‐DCR, when compared with EESC‐DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.
Malignant Glomus Tumors
Authors: Manolidis Spiros , Shohet Jack A. , Jackson C. Gary , Glasscock Michael E.
Published: November 2003

Objectives/Hypothesis: To ascertain the incidence of malignancy in a large glomus and skull base series and to compare the clinical course of such patients with those who do not have malignant skull base lesions. Study Design: Retrospective review of all skull base surgery cases treated at the Otology Group between 1970 and 1995. Results: In a series of 175 jugulotympanic glomus tumors, 9 cases (5.1%) were identified. The surgery required for their extirpation is more extensive than nonmalignant glomus tumors. Attendant deficits and mortality from these procedures are accordingly greater. Five‐year survival in this limited population was 72%. Prolonged periods of survival are possible with distant metastases. Conclusions: This rate of malignancy should advocate against a watchful, waiting approach. Radiation therapy is not advocated as a primary modality for this type of tumor, as it may lead to recurrence/persistence with either subsequent malignant degeneration and metastases or local recurrence.
Effects of Atropine and Scopolamine on Bradycardia and Emetic Symptoms in Otoplasty
Authors: Honkavaara Pekka , Pyykkö Ilmari
Published: November 2003

Objective: To assess the effects of unilateral or bilateral otoplasty on bradycardia and postoperative nausea and vomiting (PONV) and the efficiency of transdermal scopolamine in the prophylaxis of PONV. Study Design: Post hoc assessment of the data from a double‐blind, randomized study. Methods: Fifty otoplasty patients were studied; half of them received randomly and in double‐blind fashion a transdermal therapeutic system (patch) of scopolamine (TTS‐scopolamine) as prophylaxis against PONV before general anesthesia. The placebo group received atropine 10 μg·kg−1 intravenously during induction. Results: The scopolamine‐treated patients suffered more from moderate peroperative bradycardia (8/25; P < .05) than the atropine‐treated patients (1/25). Two patients wearing a half of the TTS‐scopolamine patch needed intravenous atropine. After unilateral otoplasty, none of the TTS‐scopolamine‐treated patients and 50% of the atropine‐treated patients suffered from PONV. After bilateral operation, the respective incidences were 39% and 81% (P < .01). After unilateral otoplasty no patient needed droperidol, but after bilateral otoplasty, 12 of 19 of the atropine‐treated and 4 of 18 (P < .05) of the scopolamine‐treated patients needed droperidol. The mean numbers of doses of droperidol were 0.8 ± 0.9 and 0.3 ± 0.6 (P < .05), respectively. Two additional patients, wearing half of the TTS‐scopolamine patch, suffered from mild central anticholinergic syndrome. Conclusion: TTS‐scopolamine offers effective prophylaxis against PONV (auriculoemetic reflex), but does not protect from bradycardia (auriculocardiac reflex) in otoplasty. Cutting of the TTS‐scopolamine patch may lead to undesirable side effects.
Laryngeal Motion During Exercise
Authors: Beaty Mark M. , Wilson Jeff S. , Smith Richard J. H.
Published: November 2003

Objective: To compare laryngoscopically observed changes in the larynx during exercise in persons with exercise‐induced laryngomalacia (EIL) with changes in asymptomatic control subjects.Study Design: Clinical study using a standardized exercise protocol.Methods: Subjects exercised on an incremental ergometer: videotaped recordings of the larynx were obtained through the entire exercise; pulmonary function tests were completed before and/or immediately after the exercise.Results: Laryngeal lumen size decreases during exercise in subjects with EIL.Conclusion: Subjects with EIL had a significant decrease in laryngeal lumen size during exercise compared with asymptomatic control subjects.
Complications of Rhytidectomy in an Otolaryngology Training Program
Authors: Sullivan Christopher A. , Masin Jeffrey , Maniglia Anthony J. , Stepnick David W.
Published: November 2003

Objectives/Hypothesis: Complications of rhytidectomy have been widely reported in the literature. This study examines the incidence of complications after rhytidectomy in the hands of chief residents under appropriate attending supervision in an otolaryngology—head and neck surgery training program. Materials and Methods: The charts of 96 consecutive SMAS rhytidectomy patients were retrospectively reviewed. Patients were selected for surgery from a clinic designed exclusively for cosmetic facial surgery patients. This clinic was run by the otolaryngology chief resident and was supervised by an attending staff surgeon. Most patients elected local anesthesia and sedation administered by the surgical team. Submental liposuction was performed followed by SMAS plication rhytidectomy. Results: Follow‐up ranged from 1 to 60 months. Complications included expanding hematoma (1%), temporary facial nerve weakness (3%), pretragal/mastoid skin slough (4.2%), permanent ear numbness (1%), hypertrophic scar (3.1%), wound infection (1%), and dissatisfaction with result (4%). There were no cases of permanent facial nerve injury. Conclusion: These complication rates compare favorably with reported rates of larger studies over the past 30 years. These data support the conclusion that rhytidectomy can be performed safely by otolaryngology residents with little morbidity and good patient satisfaction.
Squamous Cell Carcinoma of the Sinonasal Tract Invading the Orbit
Authors: Carrau Ricardo L. , Segas John , Nuss Daniel W. , Snyderman Carl H. , Janecka Ivo P. , Myers Eugene N. , D'Amico Frank , Johnson Jonas T.
Published: November 2003

Objective/Hypothesis: The treatment of squamous cell carcinoma (SCC) of the sinonasal tract has evolved from routine exenteration of the orbital contents to sparing of the orbit when the SCC does not transgress the periorbita. Nonetheless, the influence of this change in treatment over the rate of local recurrence or survival has not been clearly elucidated. The objective was to ascertain whether orbital sparing surgery for the treatment of SCC of the paranasal sinuses influences the rate of local recurrence or survival. Study Design: This is a retrospective study of patients presenting with SCC arising in the sinonasal tract, treated primarily at the University of Pittsburgh Medical Center from 1977 to 1990, including meta‐analysis of the English literature regarding SCC of the sinonasal tract. Methods: Review of medical records regarding demographics, histology, extension of tumor, pathologic results, type of surgery, adjunctive therapy, and outcome. Articles for meta‐analysis were identified by Medline search and cross‐referencing. Results: Fifty‐eight patients with orbital invasion, including bone and/or soft tissue invasion, were included in the study. Patients presenting with invasion of the bony orbit without soft tissue invasion were treated with maxillectomy and/or ethmoidectomy, sparing the orbital contents. Patients presenting with invasion of the orbital bones and soft tissues were treated with ethmoidectomy or maxillectomy, including orbital exenteration. At 3 years' follow‐up, 52% of the patients whose orbit was exenterated were alive and without evidence of disease, compared with 59% of the patients whose orbit was spared. This difference was not statistically significant. Similarly, the rate of local recurrence was not statistically significant (P > .05). A meta‐analysis of the literature revealed similar results. Conclusions: Our data suggest that sparing of the soft tissues of the orbit when the periorbita has not been transgressed by SCC does not downgrade the rate of cure or local control.
Clinical Evolution of Laryngeal Granulomas: Treatment and Prognosis
Authors: De Lima Pontes Paulo Augusto , De Biase Noemi Grigoletto , Gadelha Maria Emília C.
Published: November 2003

Objective/Hypothesis: To study the response to treatment by patients with granulomas not related to surgery, considering their respective causes. Methods: Retrospective study of larynx granulomas seen at the Institute da Laringe (Sǎo Paulo, Brazil) from June 1996, totaling 66 patients, being 20 (30,3%) diagnosed with gastroesophageal reflux syndrome, 22 (33,3%) due to vocal abuse, 15 (22,7%) to postorotracheal intubation, and 9 (13,6%) of idiopathic cause. Findings: Of the 66 patients diagnosed, 10 did not start the treatment, with only 56 being analyzed, 6 of whom later abandoned the treatment. The cause‐oriented treatment showed 100% control in postintubation granulomas. In the cases of reflux and vocal abuse, the success rates when considering only the cause were 75% and 87.5%, respectively. In the cases of undefined cause, all were subjected to surgical removal with or without clinical or speech‐therapy treatment; we attained only a 37.5% success rate in the first trial. Of these, after various unsuccessful rescue treatments, three which were treated with botulinum toxin type A had 100% resolution. The recurrence percentage varied according to the cause, being nonexistent in the postintubation cases, 21.4% in patients with reflux esophagitis, 35.2% in vocal abuse, and 62.5% in those of idiopathic etiology. Conclusion: Of the laryngeal granulomas, the best prognoses were given by the postintubation ones, whereas the worst were those of undefined cause. Those ascribed to gastroesophageal reflux and vocal abuse have a high resolution rate, although some cases need rescue procedures.
Differentiation of Spasmodic and Psychogenic Dysphonias With Phonoscopic Evaluation
Authors: Leonard Rebecca , Kendall Katherine
Published: November 2003

Objectives: Identify laryngeal behaviors that differentiate patients with spasmodic dysphonia and patients with psychogenic dysphonia. Study Design: Retrospective review of patients evaluated over a 3‐year period with a diagnosis of either spasmodic or psychogenic dysphonia. Videotaped phonoscopic (laryngeal imaging) examinations of all noted aberrant behaviors were examined. Tally behaviors according to each subject group. Methods: Three examiners unfamiliar with patients' previous diagnoses reviewed videotaped studies. Aberrant behaviors were noted and each patient was assigned to spasmodic or psychogenic dysphonia group. Agreement among examiners and agreement with previous diagnoses was established. Results: Six abnormal behaviors were noted, including tremor, hyperadduction, false fold constriction, sphincteric constriction, hyperabduction and paradoxical movements of the true and false folds. Percentage of patients in each group with each behavior was determined. Conclusions: Individual behaviors did not generally appear to differentiate the two groups; however, patterns of behaviors did, and may be of considerable value in differentiating spasmodic and psychogenic dysphonias.
Cost‐Effectiveness of the Diagnostic Evaluation of Vertigo
Authors: Stewart Michael G. , Chen Amy Y. , Wyatt J. Robert , Favrot Steven , Beinart Sean , Coker Newton J. , Jenkins Herman A.
Published: November 2003

Objective: To evaluate the cost‐effectiveness of several diagnostic tests used in the evaluation of vertigo.

Study Design: Cost‐effectiveness analysis, using data from retrospective case review.

Methods: Charts and test results were reviewed from 192 outpatients seen in an academic tertiary referral center for evaluation of vertigo. Cost‐effectiveness analysis was performed using decision analysis software, data from office and hospital charges, and expert‐based estimations of the utility of different test outcomes. Sensitivity analysis was performed using standard algorithms and wide variable ranges.

Results: We found that audiologic testing, posturography, and electronystagmography were the most cost‐effective tests, and that magnetic resonance imaging and blood tests had the lowest cost‐effectiveness. The analysis was sensitive to the effects of financial costs of tests but, with a few exceptions, was typically not sensitive to the utility of test outcomes or the distribution of test results.

Conclusions: The use of cost‐effectiveness analysis, the estimation of utility of test outcomes, and techniques of sensitivity analysis should help guide the clinician's decision making on appropriate testing for patients with vertigo.
Recognition of a Dominant Epitope in Bovine Heat‐Shock Protein 70 in Inner Ear Disease
Authors: Bloch Donald B. , Gutierrez Jesus A. , Guerriero Vince , Rauch Steven D. , Bloch Kurt J.
Published: November 2003

Objective: To investigate the specificity of anti‐bodies to heat‐shock protein 70 (HSP70) in patients with idiopathic, progressive, bilateral sensorineural hearing loss (IPBSNHL) and Meniere disease.

Study Design: Test immunoreactivity of patients' sera using recombinant human (rh) and bovine (rb) HSP70, as well as segments representing different regions of bovine HSP70 as antigen.

Methods: Sera were tested by Western blotting.

Results: Of 52 patients with IPB‐SNHL, 40 sera reacted only with rbHSP70; 12 reacted with both rbHSP70 and rhHSP70. Sera from 13 patients with IPBSNHL and from 8 with Meniere disease were tested on the panel of bovine HSP70 segments. Eleven and 7 samples, respectively, reacted with amino acid segment 427‐461 from the carboxy (C)‐terminal region of the molecule.

Conclusion: In IPBSNHL and Meniere disease, antibodies are directed primarily against an epitope(s) within the C‐terminal region of HSP70 where diversity in sequence among different species, including possible pathogens, is greatest. These findings may provide clues to the pathogenesis or specific serodiagnosis (or both) of diseases of the inner ear.
Improved Nerve Regeneration With Neutralization of Transforming Growth Factor‐β1
Authors: Davison Steven P. , McCaffrey Thomas V. , Porter M. Nora , Manders Ernest
Published: November 2003

Objectives: Recovery of injured peripheral nerves depends on a balance between Schwann cell regeneration and scar formation. Transforming growth factor‐β1 (TGF‐β1) has been implicated as a humoral stimulus in scar formation. The neutralization of TGF‐β1 has been beneficial in the reduction of fibrosis. This study was to identify the presence of TGF‐β1 in regenerating peripheral nerve and to measure motor nerve regeneration by the neutralization of TGF‐β1 in neural wounds.

Study Design: A randomized study of rat sciatic nerve regeneration.

Method: Sciatic nerve axotomy was performed, followed by serial immunohistochemical staining by anti‐TGF‐β1 at 12 to 216 hours (n = 5). Two groups (n = 10) with sciatic axotomy and epineural repair were treated with a 7‐day perineural administration of neutralizing antibody of TGF‐β1 or saline carrier via subcutaneous silicone infusion port. A control group (n = 10) without axotomy with anti‐TGF‐β1 administration was established. At 12 weeks the compound muscle action potential amplitude (CMAP) and the muscle twitch strength generated by the gastrocnemius‐soleus muscle complex were measured.

Results: TGF‐β1 was qualitatively present with maximal concentration by 72 to 144 hours. CMAP amplitude in the anti‐TGF‐β1/axotomy group was 49.6% of the control and the axotomy/saline group was 31% of the control. Muscle twitch strength was 74% and 46.5%, respectively. These differences were statistically significant, P = .05.

Conclusions: The presence of TGF‐β1 at regenerating nerve sites was confirmed. The benefit of neutralization of transforming growth factor on CMAP and muscle twitch strength was shown. These results suggest improved regeneration at nerve injury sites with neutralization of TGF‐β1.
A Prospective Randomized Double‐Blind Trial of Fibrin Glue for Pain and Bleeding After Tonsillectomy
Authors: Stoeckli Sandro J. , Moe Kris S. , Huber Alex , Schmid Stephan
Published: November 2003

Objectives: The notable morbidity of tonsillectomy includes considerable postoperative pain and a rate of postoperative bleeding that have remained largely uninfluenced by modern surgical techniques or medication. Fibrin glue is known to have a hemostatic effect in some settings, and there is research suggesting it may also reduce postoperative pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy.

Study Design: A prospective randomized double‐blind study was performed on 50 consecutive adult patients undergoing tonsillectomy for chronic tonsillitis.

Methods: After removal of both tonsils the tonsillar fossa randomly assigned to the treatment protocol was coated with fibrin glue. The other side was left unaltered. The patient was then monitored for postoperative bleeding and wound healing, and a patient‐based pain assessment instrument was used to evaluate symptoms every 8 hours for 10 days after surgery.

Results: Detailed evaluation of the pain scores allowed the authors to create a pain profile for what the typical patient experiences over the first 10 postoperative days, as well as during the course of a single day. The pain remains relatively constant for the first 7 days and begins to decrease only on the eighth postoperative day. During a single day there is increased pain in the morning compared with noon and evening. However, no statistically significant difference was detected in postoperative pain, bleeding, or healing between the wounds treated with fibrin glue and controls.

Conclusions: The patient‐based pain evaluation data should aid the physician in preoperative outcome counselling and targeted prescription of pain medication. However, contrary to previous indications, the authors cannot substantiate a significant beneficial effect of fibrin glue in postoperative pain control. Furthermore, we did not find its action as a hemostatic agent clinically applicable in this setting, and thus find no indication for the routine use of fibrin glue in tonsillectomy.
Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy
Authors: Utley David S. , Goode Richard L. , Hakim Ishrat
Published: November 2003

Objective/Hypothesis: We hypothesized that the success rate of radiofrequency energy (RFe) tissue ablation of the inferior turbinate for nasal obstruction achieved by previous investigators would be improved by using a longer needle electrode and creating two lesions per turbinate. Methods: Ten patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. A 40‐mm needle delivered RFe to two sites in each inferior turbinate. Patients used a visual analog scale (VAS) to grade nasal obstruction preoperatively and at 1 week and 8 weeks after surgery. Preoperative and postoperative digital images of the nasal cavity were graded for obstruction (0% to 100%) in a blinded manner. Results: All patients (100%) were subjectively improved at 8 weeks. Mean obstruction (VAS) improved from 50% ± 21% to 16% ± 15% (right side) and from 53% ± 29% to 13% ± 13% (left side). Mean improvements were 68% (right side) (P = .004) and 75% (left side) (P = .001). Mean obstruction graded during blinded review of nasal cavity images improved from 73.5% ± 8% to 51% ± 8% (right side) and from 76% ± 6% to 64% ± 7% (left side). Of nine patients using medications for nasal obstruction before treatment, eight (89%) noted no further need for medications at 8 weeks. Conclusion: The use of RFe for submucosal tissue ablation in the hypertrophied inferior turbinate is an effective modality for reducing symptoms of nasal obstruction. Improved results may occur by using a longer needle and creating two lesions per turbinate. Of patients in this study, 100% reported improvement of nasal obstruction.
Role of angiogenic factors: Coexpression of interleukin‐8 and vascular endothelial growth factor in patients with head and neck squamous carcinoma
Authors: Eisma Roselle J. , Spiro Jeffrey D. , Kreutzer Donald L.
Published: November 2003

Objective/Hypothesis: Angiogenesis has been used as a prognostic indicator in a variety of cancers and is believed to be controlled by angiogenic factors, including the cytokines interleukin‐8 (IL‐8) and vascular endothelial growth factor (VEGF). We hypothesized that the in vivo coexpression of both IL‐8 and VEGF in head and neck tumors contributes to perpetuating tumor growth and metastasis by enhancing angiogenesis. Methods: Immunohistochemical analysis for IL‐8 and VEGF was performed using specimens from 33 cancer patients and 6 control patients. We quantitatively evaluated levels of IL‐8 and VEGF in tumor tissue homogenates from those same patients using enzyme‐linked immunosorbent assay and radioimmunoassay. Comprehensive histories of each patient were taken and later analyzed for clinical correlations with IL‐8 or VEGF levels. Results: IL‐8 and VEGF were found to be colocalized within the head and neck squamous cell carcinoma (HNSCCA) tumor cells. In the head and neck tumor specimens, IL‐8 levels ([38,152 ± 1.8] × 105 pg/mg total protein [TP]) were 22‐fold greater than controls (1,721 ± 2,122 pg/mg TP). The tumor levels of VEGF (1,304 ± 6,037 pg/mg TP) were nearly fourfold higher than the controls (317 ± 400 pg/mg TP. Interleukin‐8 and VEGF levels were found to have a positive correlation (P ⩽ .0001). Patients exhibiting high levels in picograms per milligram of TP and/or number of moles of IL‐8 and VEGF were found to clinically have more aggressive disease manifested by higher TNM stage, more recurrences, and shorter disease‐free intervals (P ⩽ .03) Conclusions: Marked increase in HNSCCA of IL‐8 and VEGF underscores the importance of these angiogenic factors in this disease. Understanding the roles and interplay of angiogenic factors such as IL‐8 and VEGF may have value in the treatment of HNSCCA.
Paroxysmal laryngospasm after laryngeal nerve injury
Authors: Wani Manish K. , Woodson Gayle E.
Published: November 2003

Objective: Describe a clinical syndrome of laryngeal hypersensitivity following laryngeal nerve injury. Study Design: Retrospective review of six patients with laryngeal paralysis sustained during neck surgery who presented with paroxysms of coughing and stridor, progressing to brief episodes of complete airway occlusion. Methods: Chart review. Results: Superior laryngeal nerve blockade temporarily improved symptoms in four of five patients. Botulinum toxin relieved spasm in two of three patients and reduced symptoms in the third. Symptoms gradually diminished or resolved in four patients from 1 to 2.5 years later. One patient underwent arytenoidectomy and one patient has a tracheostomy. Conclusions: Patients with laryngeal injury may present with stridor and acute airway obstruction secondary to paroxysmal laryngospasm. The authors have found that superior laryngeal nerve blockade or botulinum toxin may be effective in temporary relief of symptoms.
Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeal muscle
Authors: Brok Heidy A. J. , Copper Marcel P. , Stroeve Rutger J. , de Visser Bram W. Ongerboer , Venker‐van Haagen Anjob J. , Schouwenburg Paul F.
Published: November 2003

Objective: To study the functional motor nerve supply of the upper esophageal sphincter in humans.Study Design: Intraoperative electromyographic study.Methods: The contribution of the recurrent laryngeal nerve and the pharyngeal plexus in the motor nerve innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle was examined intraoperatively.Results: Electromyography showed that there is a considerable overlap in the innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle. The recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal muscle in all patients and contributes to the motor innervation of the inferior pharyngeal constrictor muscle in most patients. The pharyngeal plexus functionally contributes to the motor innervation of the inferior pharyngeal constrictor muscle but does not always contribute to the motor innervation of the cricopharyngeal muscle.Conclusions: This is the first report which provides evidence that the recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal and inferior pharyngeal constrictor muscle. Furthermore, this study shows that intraoperative electromyography in humans is a feasible method to analyze the physiology of the motor innervation of the upper esophageal sphincter.
Functional results of plastipore prostheses for middle ear ossicular chain reconstruction
Authors: Bayazit Yildirim , Göksu Nebil , Beder Levent
Published: November 2003

Objective: Assessment of plastipore prostheses for middle ear ossicular chain reconstruction. Hearing results with total and partial Plastipore ossicular replacement prostheses (TORP and PORP) were evaluated in open‐ and closed‐cavity operations. Study Design: A retrospective review of 237 patients who underwent operation for chronic ear disease as well as ossiculoplasty with plastipore prostheses. In order to assess the functional results, only 156 of 237 patients were included in the study. Follow‐up ranged from 6 to 46 months. Methods: Canal wall up and canal wall down operations were performed. Either TORP or PORP ossiculoplasty was performed in each operation. An air‐bone gap closure to within 20 dB was considered successful. Results: With TORPs, the air‐bone gap closure to within 20 dB was achieved in 43.1%, and similar results were obtained with PORPs in 63.3%. In canal wall down and canal wall up operations, the success rates were 55.8% and 55.7%, respectively. The best results were obtained with PORPs in canal wall down operations, with a success rate of 82%. The extrusion rate of the prostheses was 4.2%. Conclusion: Hearing results of PORPs are better than TORPs. In canal wall up and canal wall down operations similar hearing results are obtained. PORP ossiculoplasty in a canal wall down operation yields the most favorable hearing result.
Nerve cell adhesion molecule expression in squamous cell carcinoma of the head and neck: A predictor of propensity toward perineural spread
Authors: McLaughlin Robert B. , Montone Kathleen T. , Wall Stephen J. , Chalian Ara A. , Weinstein Gregory S. , Roberts Shelley A. , Wolf Patricia F. , Weber Randal S.
Published: November 2003

Objective: To evaluate head and neck squamous cell carcinomas (SCCAs) for the expression of nerve cell adhesion molecule (N‐CAM). We propose that expression of N‐CAM by tumor cells may be associated with perineural invasion in SCCA of the head and neck. Methods: Seventy‐six archived specimens of histologically proven SCCA were analyzed by immuno‐histochemistry for the expression of N‐CAM. Positive and negative controls were used to assess staining. Two sections of each specimen were reviewed for the presence of perineural invasion. A retrospective chart review was performed for each patient that corresponded to the above specimens. Results: Perineural invasion was present in 28 (37%) of the 76 patients evaluated for the expression of N‐CAM. N‐CAM expression was demonstrated in 38 (50%) of the 76 specimens. The incidence of N‐CAM expression was significantly associated with perineural invasion (P = .002). There was no significant association between the presence of staining or the presence of perineural invasion and the incidence of locoregional recurrence, distant metastasis, or survival status; however, the mean follow‐up was only 13.6 months (range, 1–49 mo). Conclusion: There is a positive correlation between the presence of N‐CAM expression and perineural invasion in SCCA of the head and neck. The expression of this adhesion molecule by tumor cells may facilitate both homophilic cell‐to‐cell and heterophilic cell‐to‐substrate adhesion, thereby enabling the tumor cells to use the perineural tissues or neural cells, or both as a conduit for perineural spread.