bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Transnasal Transsphenoidal Microsurgery Versus the Sublabial Approach for the Treatment of Pituitary Tumors: Endonasal Complications
Authors: Koren Ilan , Hadar Tuvia , Rappaport Zvi H. , Yaniv Eitan
Published: November 2003

Objective: To evaluate the nasal complications after transnasal transsphenoidal operations for pituitary tumors, comparing two surgical techniques: traditional sublabial transseptal and endoscopic transseptal techniques.

Study Design: We retrospectively evaluated by self‐reported questionnaire and endoscopic examination the nasal condition of 40 consecutive patients with pituitary tumors: 20 patients had endoscopic surgery and 20 had surgery with the traditional sublabial technique.

Results: Compared with the traditional technique, the endoscopic approach was associated with a shorter operative time (about 40 min), shorter hospitalization time (about half), absence of recurrent epistaxis snoring and denture problems, and lower incidence of septal perforation, synechia, and crust formation. Furthermore, loss of nasal tip projection was found only in the group that had surgery with the sublabial technique.

Conclusions: Endoscopically guided transseptal transsphenoidal surgery is simple to perform and time‐saving, and it results in fewer nasal and denture complications than the sublabial technique. At the same time, it allows the surgeon all the benefits of the binocular microscopic surgical field that are associated with the traditional approach.
Nasal Obstruction: An Alternative to Ostiomeatal Complex Dysfunction in Sinus Disease
Authors: Ganjian Emil , Gannon Patrick J. , Fliegelman Lawrence J. , Lawson William
Published: November 2003

Objectives: Ostial patency is thought to be essential to the function of the maxillary sinus. Ostiomeatal complex dysfunction has been implicated as a major factor in the pathogenesis of sinus disease. However, recent work in our laboratory has indicated that other factors may also contribute to this process. The objective of this study was to determine the effect of nasal obstruction in maxillary sinus gas composition, independent of its effect on ostial ventilation.

Study Design: Prospective controlled animal study.

Method: Independent models of nasal obstruction and ostial occlusion in contralateral sinuses were established. Ipsilateral models of nasal obstruction and ostial occlusion were also created. Gas samples from each of the manipulated sinuses were analyzed on a gas chromatogram and compared.

Results: Results revealed a dramatic and highly significant increase in antral carbon dioxide (CO2) concentrations in the sinuses ipsilateral to either an occluded ostium or an obstructed nostril, compared with the controls. These effects on CO2 concentrations were additive when ipsilateral nasal obstruction and ostial occlusion were created. Furthermore, the effect of nasal obstruction in modulation of antral CO2 levels was found to be beyond its effect on hypoventilation of the sinus and to be independent of ostial functional status.

Conclusions: We have established independent models of nasal obstruction and ostial occlusion in the same animal. Our findings suggest that ostiomeatal complex dysfunction might not be the sole underlying factor in the pathogenesis of sinus disease in all individuals. Integrity of nasal airflow seems to have a significant effect on the maintenance of the aerobic antral environment, essential to the maintenance of normal sinus function. Modulation of maxillary sinus gas composition by nasal airflow, independent of ostial patency, may be explained by the possible presence of flow‐sensitive receptors in the upper respiratory tract mucosa. Work to identify such receptors is currently in progress.
A Prospective, Blinded Comparison of Clinical Examination and Computed Tomography in Deep Neck Infections
Authors: Miller William D. , Furst Ian M. , Sàndor George K.B. , Keller M. Anne
Published: November 2003

Objectives/Hypothesis: To determine whether there is a scientific basis for the routine use of contrast‐enhanced computed tomography (CECT) in the evaluation of suspected deep neck infection (DNI).

Study Design: We conducted a prospective, blinded comparison of clinical examination and CECT in DNI.

Methods: Thirty‐five consecutive patients with suspected DNI were prospectively assessed by clinical examination and CECT for the presence and extent of surgically drainable purulent collections. Before CECT a surgeon recorded clinical data and predicted the extent of infection. A head and neck neuroradiologist, blinded to the clinical evaluation, predicted the extent of infection based on CECT. Final outcome (the presence of a purulent collection) was determined at surgery or in long‐term follow‐up. The clinical and CECT findings were compared with the final outcome to determine the sensitivity, specificity, and accuracy of each modality.

Results: Twenty patients had purulent drainable collections. The accuracy of clinical examination alone in identifying a drainable collection was 63%, the sensitivity was 55%, and the specificity was 73%. The accuracy of CECT alone was 77%, the sensitivity was 95%, and the specificity 53%. When CECT and clinical examination were combined, the accuracy in identifying a drainable collection was 89%, the sensitivity was 95%, and the specificity 80%. If fluid collections with volumes of 2 mL or greater on CECT were considered, the accuracy of CECT would have been 85%, the sensitivity 89%, and the specificity 80%.

Conclusion: CECT and clinical examination are both critical components in the evaluation of suspected DNI.
Applications of Distortion‐Product Emissions to an Otological Practice
Authors: Kimberley Barry P.
Published: November 2003

Objectives: The multiple clinical applications of distortion‐product emissions (DPEs) to an otological practice are reviewed. Through an examination of studies involving thousands of infants, as well as adult ears, the relationships between measurements of DPEs and PTTs (PTTs) are examined. The cochlear physiology underlying generation of DPEs and the interpretation of these measurements are described in some detail. We study the contribution of phase measurements of DPEs to calculation of delay in cochlear traveling waves. The clinical applications of these measurements are described. The objective of this work is to demonstrate the clinical utility of DPEs through an examination of the correlation of the features of DPEs with PTTs in patients varying in age from newborn to the elderly.

Study Design: Methods: Experimental design and methodology involved careful prospective selection of large numbers of subjects in each age group, novel techniques for recording DPEs, and multivariate statistical analysis of the data. Three separate experiments encompass issues surrounding the age groups of adults, neonates, and elderly individuals.

Results: The results show that current techniques allow a 90% correct prediction of auditory PTTs for frequencies varying from 1,000 to 6,000 Hz, for patients of all ages.

Conclusion: Techniques for measurement of DPEs currently represent an integral diagnostic component for an otological practice. The potential future application of measures of DPEs to diagnosis of tinnitus is described. With an extension of the technique for measuring DPEs to the phenomenon of reflectance, there may be promise of application to novel approaches to the treatment of tinnitus and the design of hearing aids.
Ketoprofen and Fentanyl for Pain After Uvulopalatopharyngoplasty and Tonsillectomy
Authors: Virtaniemi Jukka , Kokki Hannu , Nikanne Elina , Aho Mikko
Published: November 2003

Objectives: The treatment of postoperative pain after uvulopalatopharyngoplasty (UPPP) and tonsillectomy presents a challenge. Opioids can cause sedation and respiratory depression. Nonsteroidal anti‐inflammatory drugs can increase postoperative bleeding. The authors have evaluated the severity of postoperative pain and the consumption of opioid in 53 adult patients undergoing either UPPP or tonsillectomy.

Study Design: A prospective, parallel‐groups study.

Methods: A general endotracheal anesthesia was used in each patient. After surgery patients received ketoprofen 1 mg/kg as an intravenous bolus, followed by a continuous infusion of 4 mg/kg during 24 hours. For rescue analgesia patient‐controlled intravenous fentanyl was used.

Results: Both UPPP and tonsillectomy are associated with intense postoperative pain. More than 40% of the patients had high pain scores during the first 24 postoperative hours. Postoperative pain after UPPP was more severe and the difference was significant during swallowing (P < .05). The need for fentanyl in the UPPP group was twice that of the tonsillectomy group (P < .01). There was a high interindividual scatter in the patient‐controlled fentanyl attempts in both groups. The patients in the UPPP group needed significantly more oxygen supply during recovery (P = .007). No serious adverse effects occurred and none of the patients experienced postoperative bleeding that required any intervention.

Conclusion: Individually tailored analgesic treatment protocol is essential for patients undergoing UPPP and tonsillectomy to ensure safe and effective pain alleviation.
Computerized Dynamic Posturography and Seasickness Susceptibility
Authors: Shahal Baruch , Nachum Zohar , Spitzer Orna , Ben‐David Jacob , Duchman Hava , Podoshin Ludwik , Shupak Avi
Published: November 2003

Objective/Hypothesis: The neural mismatch theory emphasizes the role of conflicting multimodal sensory interactions in producing both motion sickness and the rearrangement process that finally leads to habituation to the adverse motion conditions. If this theory is, indeed, correct, the patterns of the response to the integrated signal from simultaneous multisensory stimulation, characterized by unusual relationships between the senses responsible for spatial orientation, should differ according to motion sickness susceptibility. Computerized dynamic posturography (CDP) provides the opportunity to simultaneously change the interactions between visual, somatosensory, and vestibular inputs, thus giving an indication of the relative importance of these senses in maintaining balance. The objective was to investigate balance strategies in naval crew members with differing susceptibility to sea conditions using CDP.

Study Design: Cross‐sectional, parallel‐group design.

Methods: Twenty subjects susceptible to seasickness (SS) and 20 nonsusceptible subjects (NSS), healthy male volunteers aged 18 to 25, were tested using the EquiTest system (NeuroCom, Inc., Clackamas, OR).

Results: The SS group exhibited significantly less stability than the NSS group in condition 5 of the sensory organization test (SOT). The ratio of the SOT scores of conditions 5 to 1 (the vestibular organization pattern) was also found to be significantly lower in the SS group.

Conclusions: The results suggest that SS might be more dependent on somatosensory and visual inputs and less on vestibular inputs for maintenance of balance compared with NSS. Higher susceptibility to seasickness might reflect abnormal weighting of sensory modalities during the integration process. This would result in disruption of the integration process required to maintain balance and a sense of orientation in space in conditions producing conflicting sensory inputs.
Effects of α‐Toxin of Staphylococcus aureus on the Ciliary Activity and Ultrastructure of Human Nasal Ciliated Epithelial Cells
Authors: Yun Yeong‐Seok , Min Yang‐Gi , Rhee Chae‐Seo , Jung In‐Ho , Koh Young Yull , Jang Tae Young , Jung Dong‐Hak
Published: November 2003

Objective: The in vitro effects of staphylococcal α‐toxin on ciliary activity were investigated at different concentrations and exposure times.

Study Design: Ciliated epithelial cells of the sphenoid sinus were taken from patients operated on for pituitary tumors. Video‐computerized analysis technique and transmission electron microscopy were used to analyze the effects of the toxin on ciliary activity.

Methods: Ciliary beat frequency (CBF) was measured in four different concentrations of α‐toxin including 0.1, 1, 10, and 50 μg/mL. CBF was measured at 2, 4, 6, 12, 24, and 48 hours after administration of the toxin. To observe reversibility of the reduced ciliary activity, after 24‐hour incubation in the media containing 10 μg/mL of α‐toxin, the media were replaced with α‐toxin‐free media. The tissues were also processed for transmission electron microscopy to observe ultrastructural changes of the epithelial cells.

Results: CBF increased significantly at 2‐hour incubation and then decreased significantly after 12‐hour incubation in 10 μg/mL of α‐toxin (P< .05, repeated‐measures ANOVA). The transmission electron microscopic findings showed mitochondrial swelling and a slight protrusion of the plasma membrane of the cilia. In toxin‐free media, loss of ciliary activity was not recovered.

Conclusions: CBF increased at first, but with increasing incubation time ciliary movements decreased gradually and stopped eventually. This loss of CBF may be an irreversible change associated with ultrastructural changes in the mitochondria and the plasma membrane of the cilia.
Early Wound Complications in Advanced Head and Neck Cancer Treated With Surgery and Ir192 Brachytherapy
Authors: Smith Richard V. , Krevitt Lane , Yi Su Min , Beitler Jonathan J.
Published: November 2003

Objectives: Brachytherapy, either as primary or adjuvant therapy, is increasingly used to treat head and neck cancer. Reports of complications from the use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I125) therapy. Early complications include wound breakdown, infection, flap failure, and sepsis, and late complications may include osteoradionecrosis, bone marrow suppression, or carotid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (Ir192).

Study Design: A retrospective chart review of all patients receiving adjuvant brachytherapy at a tertiary medical center over a 4‐year period.

Methods: Nine patients receiving Ir192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive margin control were evaluated. It was used during primary therapy in six patients and at salvage surgery in three. Early complications were defined as those occurring within 6 weeks of surgical therapy.

Results: The overall complication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia, and local tissue erosion in one patient each. All complications occurred in patients receiving flap reconstruction and one patient required further surgery to manage the complication. Complication rates were not associated with patient age, site, prior radiotherapy, timing of therapy, number of catheters, or dosimetry.

Conclusions: The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of radiotherapy. Further study should be under‐taken to identify those patients who will achieve maximum therapeutic benefit without prohibitive local complications.
Endoscopic Medial Maxillectomy for Inverted Papillomas of the Paranasal Sinuses: Value of the Intraoperative Endoscopic Examination
Authors: Sukenik Mark A. , Casiano Roy
Published: November 2003

Objective: The extent of paranasal sinus involvement by inverted papilloma and the degree of surgery are often determined before surgery by computer tomography (CT). The sensitivity and specificity of preoperative CT versus intraoperative endoscopic examination are unknown.

Study Design: Prospective.

Methods: Nineteen patients with inverted papilloma who underwent endoscopic medial maxillectomy were staged tomographically. Findings were compared with pathological and intraoperative endoscopic findings.

Results: Twenty sides were evaluated. The overall sensitivity and specificity for the preoperative CT evaluation were 69% and 20%, respectively. For intraoperative endoscopic evaluation they were 69% and 68%, respectively. Excluding the sphenoid sinus, the overall sensitivity for CT scan and intraoperative endoscopic evaluation increased to 87%. Excluding the anterior ethmoids, the overall specificity for CT scan and intraoperative endoscopic evaluation increased to 25% and 79%, respectively. The overall cure rate was 94% (18 patients) with an average follow‐up of 36 months (range, 16‐80 mo).

Conclusion: Intraoperative endoscopic examination is comparable in sensitivity but better in specificity than preoperative CT analysis for differentiating between inverted papilloma and other disease. Both modalities of evaluation tend to overestimate the extent of disease (sensitivity). The presence of a normal intraoperative endoscopic examination may be a better way of determining the extent of mucosal removal during surgery. Endoscopic medial maxillectomy remains an effective surgical option for inverted papilloma removal.
Vocal Fold Paralysis After Anterior Cervical Diskectomy and Fusion
Authors: Morpeth James F. , Williams Mark F.
Published: November 2003

Objective: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis.

Study Design: Retrospective.

Methods: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed.

Results: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right‐sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms.

Conclusions: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow‐up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.
Avoiding Transfusion in Head and Neck Surgery: Feasibility Study of Erythropoietin
Authors: Sturgis Erich M. , Gianoli Gerard J. , Miller Robert H. , Fisher James W.
Published: November 2003

Objective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery.

Study Design: Retrospective chart review.

Methods: Ninety‐nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed.

Results: Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive.

Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios.
Second Primary Neoplasms in Patients With Laryngeal Carcinoma
Authors: Nikolaou Angelos C. , Markou Constantinos D. , Petridis Dimitrios G. , Daniilidis Ioannis C.
Published: November 2003

Objectives: To better define the characteristics of second primary malignancies appearing in patients suffering from head and neck cancers, and more specifically laryngeal carcinoma, and to elicit those parameters that may be of assistance in better diagnosing, treating, and predicting outcome in such patients.

Study Design: Retrospective review of a group of 514 compliant subjects, examined and treated during an 8‐year period until 1996. After initial diagnosis and subsequent treatment, rigorous follow‐up ensured systematic screening of the subjects, who underwent standard examinations in outpatient clinics for periods of up to 56 months.

Results: Of 514 cases followed, presence of second primary neoplasms was established in 42 or 8.17%, 8 being synchronous and 34 metachronous of the original primary lesion.

Conclusions: Respiratory and upper gastrointestinal localizations were primarily affected, incidence was highest in septuagenarians, and staging of the primary was found to be irrelevant to the incidence rates of second primaries. No statistical significance was attached to the fact that supraglottic primary tumors showed slightly higher second primary rates; the same applying for well‐differentiated primary tumors compared with poorly differentiated ones. Modality of treatment‐surgery, and radiotherapy being the options in question‐did not in the long run statistically influence incidence rates. Throughout, reference to current literature and this study's relevance in light of similar efforts were taken into account.
Long‐Term Quality of Life of Patients With Head and Neck Cancer
Authors: de Graeff Alexander , de Leeuw J. Rob J. , Ros Wynand J.G. , Hordijk Gert‐Jan , Blijham Geert H. , Winnubst Jacques A.M.
Published: November 2003

Objectives: To describe prospectively the long‐term changes of quality of life and mood in patients with squamous cell carcinoma of the head and neck treated with surgery and/or radiotherapy.

Patients and Methods: One hundred seven patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core Questionnaire, the EORTC Head and Neck Cancer Module, and the Center for Epidemiological Studies Depression Scale before treatment, and 6, 12, 24, and 36 months later.

Results: There was limited deterioration of physical and role functioning and of many head and neck symptoms at 6 months, with improvement thereafter. After 36 months only physical functioning, taste/smell, dry mouth, and sticky saliva were significantly worse, compared with baseline. Female sex, higher cancer stage, and combination treatment were associated with more symptoms and worse functioning. Despite physical deterioration, there was a gradual improvement of depressive symptomatology and global quality of life.

Conclusion: Treatment for head and neck cancer results in short‐term morbidity, most of which resolves within 1 year. Despite an initially high level of depressive symptomatology, there is gradual improvement of psychological functioning and global quality of life over the course of 3 years. In this prospective study, the impact of the disease and its treatment in long‐term survivors seems to be less severe than it is often assumed to be.
The Comet Assay of Nasal Epithelia: Measurement of DNA Damage for the Assessment of Genotoxic Air Pollution
Authors: Glück Ulrich , Gebbers Jan‐Olaf
Published: November 2003

Objectives: The alkaline single cell gel electrophoresis or “comet” assay allows measurement of DNA damage in single cells with a high degree of sensitivity, e.g., for investigations of the effect of environmental agents with DNA‐damaging potential. This study aimed to adapt this test to respiratory cells of the human nasal mucosa to examine the genotoxic effect of air pollution (cigarette smoke).

Study Design: In a prospective study, nasal epithelia of 16 cigarette smokers were examined by the adapted comet assay and the results were correlated with the results of the Papanicolaou‐stained nasal cytology, carried out in a blinded fashion. The control group comprised 20 non‐smoking men. All subjects under investigation were healthy office workers.

Methods: Nasal epithelia were harvested from the maxilloturbinates. One part of cells was Papanicolaou stained and evaluated by cytopathologists. The comet assay was performed on the other part of the cells. The examiners were blinded to the study and control groups.

Results: Among cigarette smokers, a significant correlation between cytopathological cell nucleus changes (metaplasia and dysplasia) and the DNA migration (tail lengths) in the comet assay was found as a sign of DNA damage. This was not found in nonsmoking control persons.

Conclusions: These results confirm the sensitivity of the comet assay and the hypothesis that cell nucleus changes in conventional nasal cytology are associated with DNA damage.
Airway Complication After Thyroid Surgery: Minimally Invasive Management of Bilateral Recurrent Nerve Injury
Authors: Rovó László , Jóri József , Brzózka Marek , Czigner Jenô
Published: November 2003

Objectives: After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy.

Study Design: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery.

Methods: The operation was performed endoscopically with a special endo‐extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed. Regular spirometric measurements and radiological aspiration tests were conducted on the patients.

Results: During the follow‐up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days.

Conclusions: This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a “one‐stage” solution for permanent bilateral recurrent nerve injuries.
Prevalence of Herpes Simplex Virus in Malignant Laryngeal Lesions
Authors: Pou Anna M. , Vrabec Jeffrey T. , Jordan Jeanne , Wilson Deborah , Wang Su , Payne Deborah
Published: November 2003

Objective: To determine the prevalence of herpes simplex virus (HSV) in malignant laryngeal lesions.

Study Design: Retrospective review.

Materials and Methods: Paraffin‐embedded, histologically confirmed specimens containing benign laryngeal lesions, squamous cell carcinoma of the larynx, and squamous cell carcinoma of the oral cavity were identified from archived surgical specimens. Biopsies of normal‐appearing oral cavity tissue were also obtained from fresh‐frozen cadavers. These tissues were analyzed for the presence of HSV DNA using polymerase chain reaction techniques. Patient charts were reviewed for patient demographics, risk factors, stage, clinical course, treatment, and outcome.

Results: HSV was detected in nine laryngeal squamous cell carcinomas (75%) and in none of the benign laryngeal lesions (P = .0001). HSV was also found in three oral cavity squamous cell carcinomas (25%) and in none of the controls (P = .049).

Conclusion: HSV is more prevalent in squamous cell carcinoma of the larynx and oral cavity than in their respective control groups, suggesting a role for carcinogenesis. HSV is more prevalent in squamous cell carcinoma of the larynx than of the oral cavity. Further studies to determine the role of HSV as a cocarcinogen and its interrelationship with other environmental factors in laryngeal cancer are warranted.
Extradural Extranasal Combined Transmaxillary Transsphenoidal Approach to the Cavernous Sinus: A Minimally Invasive Microsurgical Model
Authors: Sabit Ibrahim , Schaefer Steven D. , Couldwell William T.
Published: November 2003

The authors have previously described an extradural transmaxillary approach to the anterior compartment of the cavernous sinus. In an effort to expand the surgical access to that area without necessitating a craniotomy or wide transfacial dissection, they present a modification of the transmaxillary approach to the sellar region and cavernous sinus.

Methods:The approach was developed on 12 fresh and 12 embalmed cadaveric specimen, and 2 dry skulls. The initial sublabial incision is followed by a maxillotomy to expose the course of the infraorbital nerve (terminal branch of maxillary branch of the trigeminal nerve) on the roof of the maxillary sinus. The route of the infraorbital nerve is traced to the pterygopalatine fossa as a guide to the foramen rotundum. Superomedial drilling of the foramen rotundum is then performed to reveal the contents of the superior orbital fissure. After the nerves are safely identified in the superior orbital fissure, medial enlargement of the window into the cavernous sinus is made possible by drilling the lateral and posterior wall and septum of the sphenoid sinus.

Results:The combined transmaxillary transsphenoidal approach offers an excellent exposure of the sellar and infrasellar region. The approach offers clear visualization of the ipsilateral loop of the carotid artery, the pituitary fossa, and the cranial nerves of the ipsilateral cavernous sinus. Mean operative reach is 38 mm from the posterior wall of the maxillary sinus to the ipsilateral carotid loop and 56 mm to the contralateral loop. The width of the operative window is 26 mm at the base within the cavernous sinus.

Conclusion:The model offers a minimally invasive approach that avoids the need for craniotomy or violating the nasal cavity. It may be safely employed to access vascular as well as invasive lesions of the sellar and infrasellar region. The approach offers excellent visualization of the ipsilateral intracavernous carotid artery with both proximal and distal control, as well as cranial nerves III, IV, VI, V2, the hypophyseal region, and the medial aspect of the contralateral cavernous sinus.
Predictive Factors for Complications in Children With Laryngeal Damage at Extubation
Authors: Watier‐Launey Cécile , Buronfosse Anne , Saliba Elie , Bertrand Philippe , Ployet Marie‐Josèphe
Published: November 2003

Objectives: To determine which factors contribute to early complications when intubated children show macroscopic lesions at extubation.

Study Design: Retrospective review of 96 consecutive medical records of children aged 1 day to 15 years. Patients were divided into three groups depending on the extent of the subsequent treatment required: medical, reintubation, and surgical.

Methods: Age, sex, clinical history, and macroscopic features of the lesions were collected and data were compared in each group.

Results: Underlying noninfectious respiratory diseases and young age were found to be risk factors for higher incidence of complications, but not prolonged or multiple intubations. Edema, especially in the glottic area, was a risk factor for surgical treatment. Multiple lesions were risk factors for reintubation.

Conclusions: History of intubation, its cause, and lesions discovered at extubation can provide the basis for definition of an “at risk” profile for intubated children.
Corticosteroid Treatment for Idiopathic Facial Nerve Paralysis: A Meta‐analysis
Authors: Ramsey Mitchell Jay , DerSimonian Rebecca , Holtel Michael R. , Burgess Lawrence P. A.
Published: November 2003

Objective A meta‐analysis was designed to evaluate facial recovery in patients with complete idiopathic facial nerve paralysis (IFNP) by comparing outcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment.

Study Design Meta‐analysis of prospective trials evaluating corticosteroid therapy for idiopathic facial nerve paralysis.

Methods A protocol was followed outlining methods for trial selection, data extraction, and statistical analysis. A MEDLINE search of the English language literature was performed to identify clinical trials evaluating steroid treatment of IFNP. Three independent observers used an eight‐point analysis to determine inclusion criteria. Data analysis was limited to individuals with clinically complete IFNP. The endpoints measured were clinically complete or incomplete facial motor recovery. Effect magnitude and significance were evaluated by calculating the rate difference and Fisher's Exact Test P value. Pooled analysis was performed with a random effects model.

Results Forty‐seven trials were identified. Of those, 27 were prospective and 20 retrospective. Three prospective trials met the inclusion criteria. Tests of heterogeneity indicate the trial with the smallest sample size (RD = −0.19; 95% CI, −0.58–0.20), to be an outlier. It was excluded from the final analysis. Analyses of data from the remaining two studies indicate corticosteroid treatment improves complete facial motor recovery for individuals with complete IFNP. Rate difference demonstrates a 17% (99% CI, 0.01–0.32) improvement in clinically complete recovery for the treatment group based on the random effects model.

Conclusions Corticosteroid treatment provides a clinically and statistically significant improvement in recovery of function in complete IFNP.
Adenoidectomy With Laser or Incisional Myringotomy for Otitis Media With Effusion
Authors: Szeremeta Wasyl , Parameswaran Mahesh S. , Isaacson Glenn
Published: November 2003

ObjectiveTo compare the effectiveness of CO2laser myringotomy to incisional myringotomy at the time of adenoidectomy for refractory otitis media with effusion (OME).

Study DesignControlled retrospective consecutive case series.

MethodsAll children undergoing myringotomy and adenoidectomy for OME in the spring of 1999 had 1.7‐mm‐diameter perforations created in their tympanic membranes using a CO2laser and conventional microslad. Their ears were evaluated at first postoperative visit (mean, 16.65 days after surgery) by a validated otoscopist to determine the presence or absence of perforations and middle ear effusions. These patients were compared with historical controls comprising all children undergoing incisional myringotomy and adenoidectomy in 1998. A χ2analysis was performed to compare the results of these two myringotomy techniques.

ResultsTwenty‐three children (39 ears) underwent laser myringotomy and adenoidectomy in 1999, compared with 26 children (48 ears) who underwent incisional myringotomy and adenoidectomy in 1998. In the laser myringotomy group, 8 of the 39 ears had a persistent opening at first follow‐up; 4 of the 39 ears showed evidence of effusion. In the incisional myringotomy group, all 48 ears had healed; 7 of these ears showed evidence of effusion.

ConclusionMyringotomies created using the CO2laser are more likely to be patent at first postoperative visit than those made with incisional technique (P< .01). However, this prolonged middle ear ventilation does not significantly decrease the prevalence of effusion (P> .1).
Otolaryngological Manifestations of Velocardiofacial Syndrome: A Retrospective Review of 35 Patients
Authors: Ford Lloyd C. , Sulprizio Sandra L. , Rasgon Barry M.
Published: November 2003

Objective Because many patients with velocardiofacial syndrome (VCFS) are first examined by otolaryngologists for ear or speech problems before being diagnosed with VCFS, we describe a series of patients with this genetic disorder, which is associated with multiple anomalies, including velopharyngeal insufficiency, cardiac defects, characteristic facial features, and learning disabilities.

Study Design We retrospectively analyzed the medical charts and available nasoendoscopic observations for 35 patients who were diagnosed with VCFS and who had a microscopic deletion in chromosome 22q11 as shown by DNA probe and fluorescence in situ hybridization.

Results For most patients, the medical chart documented cardiac anomalies, velopharyngeal insufficiency with hypernasal speech, and characteristic facial features including nasal, auricular, craniofacial, and ocular abnormalities. Incidence of middle ear infection with associated conductive hearing loss was also high and necessitated early placement of pressure equalization tubes. Some patients were treated with adenoidectomy for chronic otitis media; consequently, velopharyngeal insufficiency and hypernasal speech worsened. Nasoendoscopic examination as documented in the medical chart showed occult cleft palate, a small adenoid pad, and pulsation in the muscular wall.

Conclusion Otolaryngologists have an important role in diagnosis and treatment of persons with VCFS and therefore should familiarize themselves with the typical history and most frequent head and neck manifestations of this syndrome.
Identification of Genes Overexpressed in Head and Neck Squamous Cell Carcinoma Using a Combination of Complementary DNA Subtraction and Microarray Analysis
Authors: Villaret Douglas B. , Wang Tongtong , Dillon Davin , Xu Jiangchun , Sivam Dhileep , Cheever Martin A. , Reed Steven G.
Published: November 2003

Objectives/Hypothesis To discover unique genes specific for squamous cell carcinoma of the head and neck for eventual development as tumor markers and vaccine candidates.

Study Design Molecular biological analysis of fresh‐frozen head and neck squamous cell cancer (HNSCC).

Methods A subtractive library was made from two HNSCC and six normal tissues using a polymerase chain reaction (PCR)–based approach. Genes from this library were PCR amplified and placed on a microarray glass slide. RNA was prepared or obtained from 16 fresh‐frozen HNSCC and 22 normal tissue sources. Fluorescent probes were made from the polyA+ RNA derived from the tumor and normal tissues. The probes were hybridized to the glass slides and excited by a tuneable laser. One hundred seven of the genes showing the highest differential fluorescence value between tumor and normal tissue were identified by sequence analysis.

Results Thirteen independent genes were found to be overexpressed in tumor tissues. Of these, nine were previously known: keratins K6 and K16, laminin‐5, plakophilin‐1, matrix metalloproteinase‐2 (MMP), vascular endothelial growth factor, connexin 26, 14–3‐3 sigma, and CaN19. The level of polyA+ RNA of these genes in the tumors was significantly different from the levels in normal tissue (P < .05). Four previously unidentified genes were also discovered to have increased expression in tumor tissue. Comparing the total tumor group (n = 16) to the normal group (n = 22), only one of these genes showed significant overexpression.

Conclusion We report the identification of nine known genes that are significantly overexpressed in HNSCC as compared to normal tissue using subtractive and microarray technology. In addition, we present four previously unidentified genes that are overexpressed in a subset of tumors. These genes will be developed as tumor markers and vaccine candidates.
Assessment of Carotid Artery Invasion in Patients With Head and Neck Cancer
Authors: Yoo George H. , Hocwald Eitan , Korkmaz Hakan , Du Wei , Logani Sanjay , Kelly John K. , Sakr Wael , Jacobs John R.
Published: November 2003

Purpose Define radiological and histological features in which patients with head and neck cancer would benefit from a carotid artery resection. Resection of the carotid artery has been advocated for local control of advanced squamous cell carcinoma of the head and neck. To provide appropriate preoperative counseling and optimize the utilization of resources, the criteria for patient selection has to be defined.

Methods Thirty‐four patients underwent carotid artery resection based on the clinical impression of tumor fixation. Eighteen and 28 patients were evaluated using computed tomography (CT) and histological analysis, respectively. The distance between the tumor cells and external elastic lamina was measured. CT scans were examined to determine the circumference of tumor attachment around the carotid artery.

Results Clinical assessment predicted tumor within 1.8 mm of the carotid artery in 68% of cases. The overall survival for patients with tumor greater than 1.8 mm (N = 9) was better than that of patients with less (N = 19) than 1.8 mm (33.3% vs. 5.3%; median 24 versus 9 mo, P = .0899). Three of six patients (50%) with less than 180° circumference tumor attachment had tumor within 1.8 mm from the external elastic lamina. Eight of twelve patients (67%) with tumors encompassing more than 180° of the artery wall had tumor within 1.8 mm from the external elastic lamina. The overall survival rates for patients with tumor attachment greater and less than 180° were 8.3% and 33%, respectively.

Discussion Tumor invasion into the carotid artery was the strongest predictor of outcome. Clinical assessment was as predictive as CT for tumor invasion. If tumor involvement of the carotid artery is less than 180°, peeling the tumor is an alternative to carotid artery resection.
Anterior Distribution of Human Olfactory Epithelium
Authors: Leopold Donald A. , Hummel Thomas , Schwob James E. , Hong Seok Chen , Knecht Michael , Kobal Gerd
Published: November 2003

Objectives/Hypothesis To functionally investigate the distribution of the olfactory epithelium in humans by means of the electro‐olfactogram (EOG) and anatomically located biopsy specimens.

Study Design Prospective, nonrandomized, investigational.

Methods Supra‐threshold EOG recordings were made on 12 healthy, trained volunteers (6 women, 6 men; age range, 21–48 y). Vanillin was used as the stimulus, since it exclusively excites olfactory receptor neurons. The EOG was recorded with tubular electrodes that were placed using thin‐fiber endoscopic guidance. Biopsy specimens were obtained of anterosuperior nasal cavity mucosa in the same regions as the positive EOGs in 15 smell‐tested patients (7 women, 8 men; age range, 22–60 y) during routine nasal and sinus surgery. This biopsied tissue was histologically processed and stained for olfactory and neural proteins.

Results Viable responses to EOG testing were obtained in 7 of 12 subjects. In these seven subjects it was possible to identify nine sites above or below the anterior middle turbinate insertion where EOGs were obtained. The biopsy results showed mature olfactory receptor neurons in this same area.

Conclusions Human olfactory epithelium appears to be distributed more anteriorly than previously assumed.
Objective and Subjective Outcomes in Surgery for Chronic Sinusitis
Authors: Kennedy David W. , Wright Erin D. , Goldberg Andrew N.
Published: November 2003

Endoscopic and radiological findings in patients with chronic sinusitis do not always correlate with symptoms. Studies suggest that postoperative endoscopic examination of the sinonasal cavity provides prognostic information regarding the potential for future episodes of sinusitis and the need for revision surgery. It is recommended that findings on nasal endoscopy be included in future outcomes studies on sinusitis.
Ototoxicity of Common Topical Antimycotic Preparations
Authors: Tom Lawrence W. C.
Published: November 2003

Objective To determine the ototoxic effects of five commonly used topical antimycotic agents—clotrimazole, miconazole, nystatin, tolnaftate, and gentian violet—in the guinea pig.

Design A controlled animal study in which the ototoxicity of commonly used topical antifungal agents was investigated by measurement of hair cell loss.

Methods Several readily available topical antimycotic preparations were instilled into the middle ears of female Hartley guinea pigs over a 1‐week period. Two weeks after the last instillation, the animals were euthanized. An active control group was treated with neomycin to confirm the adequacy of the treatment in delivering a known ototoxin; an untreated control group defined the normal distribution of hair cells. The temporal bones were removed, and the cochleas were fixed and dissected. The basilar membranes were examined under the scanning electron microscope. A map of hair cell survival was made for each row in segments of each turn.

Results The untreated control animals had no discernible hair cell loss in the two lower turns. In the apical turn and sometimes the third turn, loss of hair cells was a common finding; this is a known effect of aging in this species. The animals treated with neomycin had damage consistently in the basal turn, sometimes extending into the second turn, as well as the expected hair cell loss in the apical turn. Clotrimazole, miconazole, or tolnaftate did not cause any hair cell loss in the first two turns. Hair cell loss in the third and fourth turns was similar to that of the untreated control group. Likewise, nystatin exhibited no evidence of ototoxicity. Of note, however, the preparation used in this study left a persistent residue in the round window niche. Of the first four animals treated with gentian violet, three developed pronounced behavioral signs of vestibular damage, and three demonstrated extensive middle ear inflammation and extensive new bone growth. Hair cell counts were not attempted because the extreme bone growth interfered with successful perfusion and dissection.

Conclusions Extrapolating from guinea pigs to humans requires caution. However, it is likely that guinea pigs are, if anything, more susceptible to topical ototoxins than are humans. The specific antimycotics clotrimazole, miconazole, and tolnaftate appear to be safe. Gentian violet has the potential for severe damage. The persistent residue left by the nystatin preparation is cause for concern and is a reminder that both the active ingredient and vehicle must be considered in evaluation of safety.
Intractable Benign Paroxysmal Positional Vertigo in Patients With Meniere's Disease
Authors: Gross Eric M. , Ress Bradford D. , Viirre Erik S. , Nelson James R. , Harris Jeffrey P.
Published: November 2003

Objective To provide a detailed description of the coexistence of benign paroxysmal positional vertigo (BPPV) and Meniere's disease in individuals and to offer a possible mechanism that explains the findings in these patients.

Study Design Retrospective.

Methods Chart review.

Results Of 162 patients diagnosed with Meniere's disease between January 1998 and January 1999, 9 were found to have both “definite” Meniere's disease and “certain” BPPV. Meniere's symptoms preceded the onset of BPPV in all of our patients. Seven of the 9 patients were female. Except for one patient who experienced BPPV bilaterally, BPPV was limited to the same ear as the Meniere's disease. All patients presented with intractable BPPV that did not respond completely to otolith repositioning procedures. A detailed description of five patients is presented.

Conclusion Our data, in conjunction with that of others, suggest that Meniere's disease may predispose patients to intractable BPPV. Hydropically induced damage to the maculae of the utricle and saccule or partial obstruction of the membranous labyrinth may be possible mechanisms that explain the coexistence of Meniere's disease and BPPV.