bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary Findings from a Prospective, Randomized Trial of Two Tongue‐Base Surgeries for Sleep‐Disordered Breathing
Authors: Thomas Adrian J. , Chavoya Martha , Terris David J.
Published: September 2022

OBJECTIVES

This study compares the efficacy of 2 tongue‐base surgical procedures in the treatment of patients with moderate to severe sleep‐disordered breathing.

STUDY DESIGN AND SETTING

We conducted a prospective, randomized crossover surgical trial at a university hospital.

METHODS

Seventeen patients with moderate to severe sleep‐disordered breathing and Fujita type II upper airway collapse for whom conservative treatment failed were enrolled into an institutional review board‐approved surgical protocol. They were randomly assigned to undergo palatopharyngoplasty combined with either tongue advancement (mandibular osteotomy) or tongue suspension. Parameters assessed included severity of sleep‐disordered breathing (polysomnography), sleepiness (Epworth Sleepiness Scale), and anatomic changes (upper airway endoscopy), as well as demographic factors. Patients not achieving satisfactory improvement in their condition were offered nonsurgical management or additional surgical treatment that varied based on the postoperative assessment but included crossing over to the other tongue surgical procedure.

RESULTS

Nine of the 17 patients were randomized to the tongue suspension group, and 8 to the tongue advancement group. In the 9 tongue suspension patients, Epworth Sleepiness Scale scores fell from 12.1 to 4.1 (P = 0.007). Airway collapse for all 9 patients measured on Müller maneuver improved, by a mean of 64% (P = 0.0006) at the palate and 83% (P = 0.0003) at the base of the tongue. In the 8 tongue advancement patients, Epworth Sleepiness Scale scores fell from a mean of 13.3 to 5.4 (P = 0.004). Airway collapse for 5 of 8 patients measured on Müller maneuver improved by a mean of 31% (P = 0.1) at the palate and 75% (P = 0.03) at the base of the tongue.

CONCLUSION

Prospective, randomized trials of tongue‐base surgery for sleep‐disordered breathing are possible. Preliminary findings from the current protocol reveal a slight advantage of tongue suspension over tongue advancement.
Posterior Marginal Mandibulectomy in the Management of Cancer of the Oral Cavity and Oropharynx
Authors: Petruzzelli Guy J. , Knight Fanchon K. , Vandevender Darl , Clark Joseph I. , Emami Bahman
Published: September 2022

OBJECTIVE

To review a single institution's experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes.

STUDY DESIGN AND SETTING

Retrospective review at a tertiary care academic referral center from 1996 to 2002.

RESULTS

Between 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube.

CONCLUSIONS

A posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food. (Otolaryngol Head Neck Surg 2003;129:713‐9.)
Endoscopic Removal of Juvenile Angiofibromas
Authors: Wormald John Peter , Van Hasselt Andrew
Published: September 2022

BACKGROUND

Angiofibromas have traditionally been removed through open procedures. All tumors in this consecutive series of patients were removed endoscopically.

SETTING

Tertiary care hospital.

MATERIALS AND METHODS

Seven consecutive patients presenting with an angiofibroma between 1994 and 2000 were included in the study. Tumor size varied with 1 stage 1, 2 stage IIa, 3 stage IIb, and 1 stage IIC according to the Radkowski et al classification. The surgical technique is presented.

RESULTS

After an average of 3.75 years (SD, 1.9 years), there have been no tumor recurrences.

CONCLUSION

Endoscopic removal of angiofibromas in the nasal cavity, with extension into the sinuses and pterygopalatine fossa and with limited extension into the infratemporal fossa, can be removed endoscopically with a good success rate. (Otolaryngol Head Neck Surg 2003;129:684‐91.)
Neurotransmitters for the Canine Inferior Pharyngeal Constrictor Muscle
Authors: Tadaki Nobuhisa , Hisa Yasuo , Uno Toshiyuki , Koike Shinobu , Okamura Hitoshi , Ibata Yasuhiko
Published: September 2022

The inferior pharyngeal constrictor muscle plays an important role at the pharyngeal phase of deglutition and is anatomically composed of the thyropharyngeal muscle and cricopharyngeal muscle. In this study we investigated the distribution pattern of neuropeptidergic and catecholaminergic nerve fibers in the thyropharyngeal muscle and cricopharyngeal muscle of seven puppies by immunohistochemistry. Some of the calcitonin gene‐related peptide–, substance P–, vasoactive intestinal polypeptide–, and tyrosine hydroxylase–immunoreactive nerve fibers were found to lie parallel to the muscle fibers in both the thyropharyngeal muscle and cricopharyngeal muscle. Nerve fibers with immunoreactivity to all substances examined were found to be associated with blood vessels in both the thyropharyngeal muscle and cricopharyngeal muscle, and the number of calcitonin gene‐related peptide, neuropeptide Y, and tyrosine hydroxylase nerve fibers was higher than the number of substance P, vasoactive intestinal polypeptide, and galanin nerve fibers. Motor end plate‐like structures with calcitonin gene‐related peptide immunoreactivity were found in both the thyropharyngeal muscle and cricopharyngeal muscle. These structures in the cricopharyngeal muscle were clearly less than those in the thyropharyngeal muscle. Some clusters of neurons were detected only in the cricopharyngeal muscle of all dogs examined. Substance P–, vasoactive intestinal polypeptide–, galanin–, and neuropeptide Y–immunoreactive neurons were found in this ganglion, and the vasoactive intestinal polypeptide–immunoreactive neurons were the most abundant. Abundant calcitonin gene‐related peptide– and vasoactive intestinal polypeptide–immunoreactive nerve fibers, and some substance P– and galanin‐immunoreactive nerve fibers were distributed in the ganglion. A few neuropeptide Y– and tyrosine hydroxylase‐immunoreactive nerve fibers were also found in the ganglion. These findings suggest the complex participation of neuropeptides in the innervation of the inferior constrictor muscle.
Role of Gastroesophageal Reflux Disease in Patients with Cervical Symptoms
Authors: Rival Richard , Wong Robert , Mendelsohn Martyn , Rosgen Susan , Goldberg Melvyn , Freeman Jeremy
Published: September 2022

Otolaryngologists commonly see patients with various nonspecific upper aerodigestive or “cervical” symptoms. The relationship between gastroesophageal reflux disease and these symptoms has been studied but remains unclear. We reviewed the records of 216 patients with various cervical symptoms. Each patient underwent a uniform investigation that included barium swallow, esophageal manometry, acid stimulation testing, and esophagoscopy with distal biopsy. Patients were treated with a combination of a histamine H2 blocker or omeprazole and a prokinetic agent. Follow‐up was obtained in 194 patients. Overall, evidence of gastroesophageal reflux disease was detected in 73% of patients. Complete resolution or improvement of symptoms was seen in 84% of patients with treatment. We believe gastroesophageal reflux disease is an important factor in the cause of cervical problems.
Sudden hearing loss in acoustic neuroma patients
Authors: Saunders James E. , Luxford William M. , Devgan K. Kay , Fetterman Bruce L.
Published: September 2022

Patients with acoustic neuroma may have sudden sensorineural hearing loss. Most patients with sudden hearing loss seek medical attention promptly, but the diagnosis of an acoustic neuroma may be delayed for months or years because sudden hearing loss is an unusual initial symptom of an acoustic neuroma. In a retrospective review of 836 cases of sudden hearing loss, we found 13 patients with acoustic neuromas. The prevalence of acoustic neuromas for those screened with auditory brain stem response or magnetic resonance imaging was 2.5%. In addition to these 13 patients, 79 acoustic neuroma patients treated in our clinic had well‐documented sudden hearing loss as the initial symptom. Hearing loss in these 92 patients ranged from mild to profound. Associated symptoms of pain, facial paresthesia, or unilateral tinnitus preceding the sudden hearing loss were suggestive of an acoustic neuroma, as was a midfrequency (U‐shaped) hearing loss. A history of other diseases or events that might explain the sudden hearing loss, a normal electronystagmogram, or recovery of hearing does not eliminate the possibility of a tumor. Because there are no clinical findings that clearly distinguish those patients with acoustic neuromas from other patients with sudden hearing loss, we recommend either an evaluation with auditory brain stem response or gadolinium‐enhanced magnetic resonance imaging for any patient with sudden hearing loss.
Fundamental immune mechanisms of the brain and inner ear
Authors: Harris Jeffrey P. , Ryan Allen F.
Published: September 2022

Because of the blood‐brain and blood‐labyrinthine barriers, the brain and inner ear were once thought to be immunoprivileged sites. Although these barriers provide protection from inflammatory damage to the delicate structures of the organs, both sites have since been shown to be capable of active immune responses when appropriately stimulated. In the inner ear, perisacular tissue around the endolymphatic sac hosts resident lymphocytes and serves as a site of immunosurveillance. Lymphocytes also enter the inner ear from the circulation, and in the cochlea this occurs via the spiral modiolar vein. Immune responses can protect the labyrinth from infection, but they can also cause bystander injury. Moreover, the cochlea can itself become the target of immune responses that damage hearing. Such autoimmune sensorineural hearing loss can be site specific, with the primary manifestation of the disorder being hearing loss and dysequilibrium. Some of these cases can be diagnosed by antibody or lymphocyte responses to inner ear antigens. Alternately, systemic autoimmune disorders can result in inner ear dysfunction as part of a broader spectrum of disease. Both forms of immune‐mediated inner ear dysfunction may respond to immunosuppressive therapies, including steroids, cytotoxic agents, and plasmapheresis.
Day Care and the Incidence of Otitis Media in Young Children
Authors: Marx Jonathan , Osguthorpe David J. , Parsons Gregory
Published: September 2022

OBJECTIVE

This study assesses whether day care is a significant risk variable for otitis media in children younger than 2 years in the United States after controlling for the number of children in the day care group.

DESIGN

The computerized data source used is the 1988 Child Health Supplement (N = 17,110) of the National Health Interview Survey (NHIS‐CH).

SETTING

The NHIS‐CH data is a multistage probability sample with clustering and stratification. It represents the civilian, noninstitutionalized population of the United States.

PARTICIPANTS

The NHIS‐CH sample consists of one randomly selected child from each NHIS household containing a child younger than 18 years. The overall response rate for the NHIS‐CH was approximately 90%, For this analysis the focus is on children younger than 2 years (N = 2294).

MAIN OUTCOME MEASURES

The NHIS‐CH includes a direct questioning of an adult member of the household, usually the mother, about whether the child has ever had frequent or repeated ear infections.

RESULTS

After controlling for the total size of the day care group for children younger than 12 months, the previously established relationship between attending a day care center and frequent ear infections is reduced from an odds ratio of 3.17 (95% confidence interval, 1.50 to 6.71) to an odds ratio of 1.34 (not significant p = 0.60).

CONCLUSION

The total size of the day care group is an important intervening variable in the relationship between attending day care and frequent ear infections for children younger than 12 months. The size of the day care group rather than the day care per se is the primary “modifiable risk variable” for many working parents.
Staging of chronic hyperplastic rhinosinusitis: Treatment strategies
Authors: Friedman William H. , Katsantonis George P. , Bumpous Jeffrey M.
Published: September 2022

In 1990 we reported an initial prospective study of 100 patients using a four‐stage system for classification of chronic rhinosinusitis. Between January 1988 and July 1992, we used this system in staging an additional 1814 patients, on whom 2980 intranasal sphenoethmoidectomies were performed. In this staging system a protocol trial of medication was given for 2 weeks, followed by axial and coronal computed tomography. Medication consisted of a second‐generation cephalosporin antibiotic, usually cefuroxime; a 4‐day burst of intraoral steroids, usually prednisone; and an antihistamine decongestant if not contraindicated. The stages of chronic hyperplastic rhinosinusitis included the stages described in the 1990 report (i.e., stage I, single‐focus disease; stage II, discontiguous disease throughout the ethmoid labyrinth; stage III, diffuse disease responsive to medication; and stage IV, diffuse disease unresponsive to or poorly responsive to medication). The results of this study have shown that the computed tomography staging system based on computed tomography extent of disease after medical therapy is a simple, easily remembered, and very effective modality for the classification of chronic sinusitis. This system provides a rationale for discussing and planning surgery with patients and physicians and is a convenient reference for the reporting of end results. More importantly, a linear relationship between disease stage and outcomes is demonstrated. This statistically highly significant feature of the staging system provides a firm basis for the production of outcomes after various treatment strategies, particularly ethmoidectomy and the treatment of sinusitis.
Acute postobstructive pulmonary edema
Authors: Guffin Thomas N. , Har‐El Gady , Sanders Abraham , Lucente Frank E. , Nash Michael
Published: September 2022

Acute postobstructive pulmonary edema may occur after airway obstruction. A decrease in intrathoracic and intraalveolar pressures causes an increased blood flow into the pulmonary vasculature and favors the development of pulmonary edema. Two mechanisms for the development of acute postobstructive pulmonary edema are proposed: type 1 follows acute airway obstruction, and type 2 follows relief of chronic airway obstruction.
Head and neck space infections in infants and children
Authors: Ungkanont Kitirat , Yellon Robert F. , Weissman Jane L. , Casselbrant Margaretha L. , GonzÁAlez‐Valdepena Hugo , Bluestone Charles D.
Published: September 2022

A retrospective study was performed In 117 children with head and neck space infections treated at the Children's Hospital of Pittsburgh from January 1986 through June 1992. Peritonsillar space infections were the most common (49%), followed by retropharyngeal (22%), submandibular (14%), buccal (11%), parapharyngeal (2%), and canine (2%) space infections. The most common pathogens isolated (N = 78) were the aerobes β‐hemolytic streptococcus (18%) and Staphylococcus aureus (18%), the anaerobes Bacteroides melaninogenicus (17%) and Veillonella (14%), and the gram‐negative organism Haemophllus parainfluenzae (14%). β‐Lactamase production by aerobic pathogens was detected in 22% of cultures. Computed tomography scans (N = 16) were reviewed in blinded fashion and compared with operative findings. The sensitivity of computed tomography scan in detecting the presence of an abscess vs. cellulitis was high (91%), whereas the specificity was rather low (60%). Treatment of head and neck space infections in children should consist of accurate physical diagnosis aided by imaging studies, empiric antibiotic therapy that covers gram‐negative and β‐lactamase‐producing organisms as well as gram‐positive organisms and anaerobes, and timely surgical intervention, when indicated.
Management of the open labyrinth
Authors: Dornhoffer John L. , Milewski Christian
Published: September 2022

Labyrinthine fistulas occur in approximately 5% of cholesteatoma cases, but the management of this difficult problem remains controversial. This study assessed the preoperative presentation and outcome in 37 patients operated on for cholestatoma complicated by labyrinthine fistula. Therapy involved removing the matrix from each fistula and reconstructing the bony wall of the labyrinth with bone dust, fibrin glue, and perichondrium. Corticosteroids were added to the management protocol in more recent cases. A fistula classification scheme was introduced to standardize the reporting of the extent of labyrinthine involvement and results of treatment. The most common preoperative symptoms, sensorineural hearing loss and vertigo, were notably lacking in more than 30% of patients. The fistula test was positive in only 32% of cases. Corticosteroids were seen to have a beneficial impact on postoperative outcome in those cases involving injury to the membranous labyrinth or removal of perilymph.
Diesel exhaust, diesel fumes, and laryngeal cancer
Authors: Muscat Joshua E. , Wynder Ernst L.
Published: September 2022

A hospital‐based, case‐control study of 235 male patients with laryngeal cancer and 205 male control patients was conducted to determine the effects of exposure to diesel engine exhaust and diesel fumes and the risk of laryngeal cancer. All patients were interviewed directly in the hospital with a standardized questionnaire that gathered information on smoking habits, alcohol consumption, employment history, and occupational exposures. Occupations that Involve substantial exposure to diesel engine exhaust include mainly truck drivers, as well as mine workers, firefighters, and railroad workers. The odds ratio for laryngeal cancer associated with these occupations was 0.96 (95% confidence interval, 0.5 to 1.8). The odds ratio for self‐reported exposure to diesel exhaust was 1.47 (95% confidence interval, 0.5 to 4.1). An elevated risk was found for self‐reported exposure to diesel fumes (odds ratio, 6.4; 95% confidence interval, 1.8 to 22.6). No association was observed between jobs that entail exposure to diesel fumes, such as automobile mechanics, and the risk of laryngeal cancer. These results show that diesel engine exhaust is unrelated to laryngeal cancer risk. The different findings for self‐reported diesel fumes and occupations that involve exposure to diesel fumes could reflect a recall bias.
Approach to the evaluation of the dizzy patient
Authors: Baloh Robert W.
Published: September 2022

Dizziness is a nonspecific symptom caused by many different pathophysiologic mechanisms. Vertigo, an illusion of movement, indicates a lesion within the vestibular system. The duration of attacks and associated symptoms helps to determine the site of lesion and likely diagnosis. Examination of the dizzy patient should include a careful assessment of gait and balance and a search for spontaneous and positional nystagmus. The vestibulo‐ocular reflex can be evaluated qualitatively at the bedside with the doll's eye, dynamic visual acuity, and ice water caloric tests. Each test provides different information about vestibular function.
Histopathologic findings in meniere's disease
Authors: Wackym Phillip A.
Published: September 2022

The etiopathogenesis of Meniere's disease has remained controversial since the early 1900s. Many investigators have studied the histopathology of the inner ear in patients with this disorder. Three basic pathologic mechanisms have emerged: fibrosis of the endolymphatic sac and vestibular epithelia, altered glycoprotein metabolism, and inner ear viral infection. This article reviews the current understanding of these three basic pathologic processes.
Association of Esophageal Reflux and Globus Symptom: Comparison of Laryngoscopy and 24‐Hour pH Manometry
Authors: Woo Peak , Noordzij Pieter , Ross Jo‐Ann
Published: September 2022

Thirty‐one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty‐one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders.
Skin Effects of Air Pollution
Authors: Goldsmith Lowell A.
Published: September 2022

The skin is a target organ for pollution and also allows the penetration of exogenous agents into the body. About 700,000 new cases of skin cancer were diagnosed in 1993, and 9100 people died of cancer; 76% of the deaths were due to melanoma. Skin cancers are most closely associated with exposure to UVB (290 to 320 nm) irradiation. For every 1% decrease in ozone there is a 2% increase in UVB irradiance, and therefore a 2% increase in skin cancer is predicted. Therefore the atmospheric pollution by ozone‐depleting chemicals is a major concern to dermatologists. In addition to being a target organ and site of neoplasms and contact allergens, the skin is the site of significant absorption of environmental pollutants. In the case of chloroform, the percutaneous absorption is equivalent to the respiratory uptake, emphasizing how important it is to recognize skin absorption in toxicologic exposures.
Environment and The Genitourinary Tract
Authors: Droller Michael J.
Published: September 2022

A variety of environmental factors have been associated with conditions that affect the genitourinary system. Chronic lead exposure and halogenated hydrocarbons have been found to affect sperm production and fertility. Heavy metals such as mercury and cadmium have been associated with renal tubular toxicity and kidney failure. Aromatic amines, used in a number of industrial processes and most commonly found in the dye industry, have been associated with development of bladder cancer. The same substances that are metabolites in cigarette smoke have been found to explain the strong association between bladder cancer and cigarette smoking. Chlorination and fluoridation have recently been associated with bladder cancer. In each of these associations, host factors may contribute to the toxicity of these substances either by detoxifying them or by converting them to more active agents. Education and regulation are needed to decrease the environmental risk they create.
Importance of Radon as a Threat to Public Health
Authors: Donohoe Kevin , Royal Henry
Published: September 2022

Since the discovery of x rays, the public has shown increasing concern about exposure to radiation. In the mid‐1980s, with the dissemination of information about the ubiquitous nature of radon, this concern about radiation exposure has taken on a new perspective. As the general public realizes that exposure to radiation is an unavoidable part of life, questions arise as to how much exposure is acceptable when weighed against the costs of reducing the exposure. Because limited resources are available to protect the public's health and the environment, these resources need to be used wisely. The cost‐effectiveness of the various options to lessen the potential adverse health effects from radon must be considered.
Aerospace Air Pollution Issues
Authors: Patterson Relford E. , Rayman Russell B.
Published: September 2022

Practitioners of aerospace medicine are mindful of the environmental effects, particularly air pollution, caused by aviation and spaceflight operations. To an aerospace medicine specialist, the environment includes not only the air, water, and soil of the earth, but also the cabin milieu of aircraft and space vehicles where crews must work, sleep, and in some cases, live. Consequently, this article will address the following areas of concern: cabin air quality of aircraft, cabin air quality of space vehicles, noise, air pollution, and aerial spraying.
Pediatric Fiberoptic Laser Rigid Bronchoscopy
Authors: Rimell Frank L. , Shapiro Andrew M. , Mitskavich Mary T. , Modreck Patricia , Post J. Christopher , Maisel Robert H.
Published: September 2022

Use of the fiberoptic laser for treatment of tracheobronchial lesions in the adult is well established. However, there is a paucity of experience with the fiberoptic laser in the pediatric airway. Tracheal obstruction caused by granulation tissue or stenosis, as is often seen in children, may be effectively treated with this approach. This article documents the successful use as well as the technologic advantage of the flexible fiberoptic laser systems, primarily the potassium titanyl phosphate (KTP) laser, combined with standard pediatric rigid bronchoscopic equipment in 73 procedures involving 52 children (43 children younger than five years, with an average age of 21 months). Visualization was excellent, assisted or spontaneous ventilation was well maintained, and complications were few.
Cost‐Effectiveness Considerations in Otitis Media Treatment
Authors: Gates George A.
Published: September 2022

The costs of treatment of children with otitis media with effusion comprise a substantial part of the total health care expenditure. However, there is little information about the value of therapy expressed in cost‐effectiveness terms, and disagreement still exists about optimal therapy. This article considers the elements of cost‐effectiveness analysis as they pertain to treatment of young children with otitis media with effusion and develops a first approximation model using data from several sources. The assumptions on which this model is based need to be validated by additional research. Otitis media with effusion treatment costs are high because of the large, and apparently increasing, number of symptomatic cases. Medical therapy, which is the primary treatment modality, consumes two thirds of the expenditures for otitis media with effusion. Surgical therapy is a cost‐effective treatment for children in whom medical therapy for otitis media with effusion fails. Medical and surgical therapy are complementary, and each should be included in the analysis of cost‐effectiveness.
Vestibular Neuritis: Clinical‐Pathologic Correlation
Authors: Baloh Robert W. , Lopez Ivan , Ishiyama Akira , Wackym Phillip A. , Honrubia Vicente
Published: September 2022

Postmortem examination of the brain and temporal bones of a patient with well‐documented vestibular neuritis showed selective neuronal loss in Scarpa's ganglia on the side with absent caloric response. There was loss of hair cells and an “epithelialization” of the utricular macule and semicircular canal cristae on the deafferented side, and synaptic density in the vestibular nuclei on the deafferented side was decreased compared with that on the normal side. All findings were consistent with an isolated viral infection of Scarpa's ganglia. This is the first description of the effects of chronic deafferentation on the vestibular sensory epithelia and the vestibular nuclei in a human being.
Effect of a Second Laryngeal Stimulation during Recovery from the Laryngeal Chemoreflex
Authors: Goding George S. , Pernell Kerri Johnson
Published: September 2022

The laryngeal chemoreflex is a potential mechanism for sudden infant death. In experimental protocols in which a full recovery is allowed between stimuli, no laryngeal chemoreflex responses result in a fatal outcome. In the clinical situation there are no controls to prevent repeated laryngeal stimulation before a full recovery. The effect of a laryngeal stimulus applied during or soon after a laryngeal chemoreflex‐induced apnea was investigated. Eighteen piglets were divided into groups aged 10 to 12 days, 17 to 21 days, and 32 to 36 days. Laryngeal stimulation was performed under normoxic conditions with water applied to the mucosa. Baseline respiratory and cardiovascular response data were measured. After recovery an initial stimulation was applied, followed by a second stimulation during the apnea or 5, 30, 60, or 120 seconds after restoration of breathing. No profound apneas occurred with baseline laryngeal stimulation. In piglets aged 32 to 36 and 17 to 21 days, a second laryngeal stimulus resulted in a shortened apnea duration. The response varied in piglets aged 10 to 12 days with profound apneas observed In 2 of 6 subjects and 4 of 30 trials. Piglets aged 17 to 36 days are less susceptible to the laryngeal chemoreflex during the immediate recovery period. In piglets aged 10 to 12 days, the laryngeal chemoreflex response may be more severe after a second Stimulus.
A Comparison of Methods of Botulinum Toxin Injection for Abductory Spasmodic Dysphonia
Authors: Meleca Robert J. , Hogikyan Norman D. , Bastian Robert W.
Published: September 2022

Treatment of abductory spasmodic dysphonia with botulinum toxin injection into the posterior cricoarytenoid muscles often results in only partial symptom relief. In contrast, excellent results can be achieved after thyroarytenoid injection for the adductory type of spasmodic dysphonia. One reason for disappointing results may be inaccurate placement of the botulinum toxin into the posterior cricoarytenoid muscles. We describe a new approach to posterior cricoarytenoid injection used in 18 patients for treatment of abductory spasmodic dysphonia. Of the 30 patients treated for abductory spasmodic dysphonia at Loyola University‐Chicago, 6 underwent both a retrocricoid approach and the newer franscricoid method, thus allowing patient and clinician comparison of techniques. We and all six of our patients preferred the franscricoid approach because of less discomfort, equivalent or better voice results, and fewer side effects.
Prevalence of Mold‐Specific Immunoglobulins in a Midwestern Allergy Practice
Authors: Corey Jacquelynne R , Kaiseruddin Saba , Gungor Anil
Published: September 2022

Mold allergy surveys are an important part of the correct identification and treatment of mold allergies. This study included 100 patients who were referred to a Midwestern allergy clinic for the evaluation of rhinitis, suspected to be of allergic origin. An in vitro screening test for allergen‐specific IgE (ImmunoCAP) comprised of 10 allergens, including Candida, Aspergillus, Helminthosporium, and Alternaria, was used. To assess the seasonal distribution of mold allergies, we randomly selected 8 patients out of the 100 from each season during which the clinical contact occurred, and we tested them for 14 varieties of mold. The overall incidence of mold allergy in atopic subjects was 44%. The most common molds were (in descending order of frequency) Alternaria, Helminthosporium, Aspergillus, Candida, and Curvularia. Mold allergy was diagnosed most frequently in the winter; the second highest period was the fall. Population surveys of IgE antibody sensitization by in vitro techniques can provide useful information about fungal allergy.
Mechanisms of Auditory Impairment During Acoustic Neuroma Surgery
Authors: Colletti Vittorio , Fiorino Francesco G. , Carner Marco , Tonoli Giovanni
Published: September 2022

Hearing loss during removal of acoustic neuroma (AN) may be due to labyrinthine and/or neural and/or vascular damage. Surgical maneuvers relating to perioperative and postoperative hearing may give rise to mechanisms of auditory impairment. Recording action potentials from the intracranial portion of the cochlear nerve (CN) has proven particularly useful for identifying the mechanisms of iatrogenic auditory injury. In this paper intraoperative and postoperative auditory impairments are investigated in relation to surgical steps in a group of 47 subjects with AN (size ranging from 5 to 25 mm) undergoing removal by a retrosigmoid‐transmeatal approach. Drilling of the Internal auditory canal (IAC), removal of the AN from the IAC fundus, coagulation close to the CN, lateral to medial tumor traction, separation of the CN from the facial nerve, and stretching of the CN have proven to be the most critical surgical steps in hearing preservation. On the other hand, maneuvers such as intracapsular tumor removal, vestibular neurectomy, suction close to the AN, and closure of the IAC defect did not correlate with changes in auditory potentials. Predisposing factors to postoperative hearing deterioration were IAC enlargement greater than 3 mm, IAC tumor size greater than 7 mm, extracanalar tumor size greater than 20 mm, labyrinth medial to the IAC fundus, severe involvement of the CN in the IAC, preoperative abnormal auditory brainstem responses, and normal vestibular reflectivity. Age and preoperative hearing did not prove to be statistically related to postoperative hearing. The variations in morphology and latency of CNAPs are discussed in relation to the mechanisms of iatrogenic injury.
Sinus Mucoceles: Is Marsupialization Enough?
Authors: Har‐el Gady , Balwally Atul N. , Lucente Frank E.
Published: September 2022

Traditional teaching in the United States has emphasized the need for complete removal of sinus mucoceles to achieve a cure. In Europe, however, many rhinologic surgeons have been treating sinus mucoceles by draining and marsupializing them. We present our experience with the treatment of 16 patients with sinus mucoceles. This series includes nine frontal, two ethmoid, two sphenoid, one sphenoethmoid, and two maxillary sinus mucoceles. All patients were treated transnasally under telescopic control. All mucoceles were marsupialized, and 11 were stented. Intraoperative transillumination as well as intraoperative lateral x rays (for sphenoethmoid lesions) and anteroposterior x rays (for frontal mucoceles) were used to ensure complete marsupialization of the lesion and to confirm proper placement of the stent. There were no complications associated with the procedure. Follow‐up periods ranged from 8 to 62 months (median, 32 months). No evidence of recurrent mucocele has been seen in any of the patients.
Adenoid Bacteriology and Sinonasal Symptoms in Children
Authors: Lee Dennis , Rosenfeld Richard M.
Published: September 2022

OBJECTIVE

To study the correlation between sinonasal symptoms in children and the prevalence of bacterial pathogens in the adenoid core.

DESIGN

Prospective cross‐sectional survey.

SETTING

Tertiary referral center.

PATIENTS

Consecutive sample of 84 children, aged 2 to 12 years, scheduled for adenoidectomy between July 1995 and November 1995. A blocked recruitment scheme was used to ensure a balanced distribution of sinonasal symptoms in the study sample.

METHODS

A caregiver‐completed quality‐of‐life survey was used to measure the frequency and severity of baseline sinonasal, ear, obstructive, and behavioral symptoms. Standard microbiologic techniques were used for qualitative and quantitative adenoid bacteriology.

OUTCOME MEASURES

Pathogenic and nonpathogenic bacteria isolated, percentage of specimens with no growth, colony‐forming units of pathogens per gram of adenoid tissue, dominant bacterial organism, and number of pathogenic species per adenoid with concentration greater than 105 colony‐forming units.

RESULTS

One or more bacterial pathogens were recovered from core samples of all adenoids, with a concentration greater than 105 colony‐forming units in 31 specimens (26%). Haemophilus influenzae, group A β‐hemolytic streptococcus, and Staphylococcus aureus were encountered most often. Multivariate analysis revealed a significant correlation of sinonasal infection symptom scores with colony‐forming units of adenoid core pathogens (R2 = 0.48, p < 0.0001), adjusted for the confounding effects of nasal obstructive symptoms and adenoid size (specimen weight).

CONCLUSIONS

Sinonasal infectious symptoms explain 48% of the variability in quantitative bacteriology of the adenoid core, independent of adenoid size. Although longitudinal studies are required, our results support a potential role for adenoidectomy in the management of refractory pediatric sinusitis.
Stretch‐Induced Nerve Injury as a Cause of Paralysis Secondary to the Anterior Cervical Approach
Authors: Weisberg Noah Kawika , Spengler Dan M. , Netterville James L.
Published: September 2022

The anterior approach to the cervical spine, first described 40 years ago, has become a popular and widely used procedure by spine surgeons to expose the anterior vertebral bodies from C3 to T1. A significant complication of this procedure is transient or permanent ipsilateral recurrent laryngeal nerve paralysis. In a previous review at our institution of patients with hoarseness after an anterior cervical approach, 15 of 16 patients demonstrated right‐sided paralysis. The asymmetry in the anatomic courses and lengths of the recurrent laryngeal nerves are proposed to place the right recurrent laryngeal nerve at an increased risk of stretch‐related injury during this surgical procedure. We developed a cadaver model to evaluate the in‐line stretch on the recurrent laryngeal nerve during the right‐ and left‐sided approaches to the C4 and C7 vertebral bodies. To assess the difference in risk of injury to the two recurrent laryngeal nerves, we performed the anterior approach to the cervical spine in four anatomic positions: the left neck and right neck at the levels of C4 and C7 on 10 fresh human cadavers during the immediate postmortem period. The blades of a Cloward retractor were progressively spread to 2, 3, and 4 cm in the four anatomic positions while the corresponding degrees of ipsilateral recurrent laryngeal nerve stretch resulting from retraction were simultaneously measured. The left recurrent laryngeal nerve had sufficient redundancy in its course within the tracheoesophageal groove in 10 of 10 cadavers such that it exhibited no in situ stretch during the left‐sided approach to either the C4 or C7 vertebrae. In contrast, the right recurrent laryngeal nerve has little redundancy in its course and is not protected within the tracheoesophageal groove. The right‐sided approach to C7 resulted in an average in situ stretch on the ipsilateral recurrent laryngeal nerve of 12% and 24%, with 3 cm and 4 cm of Cloward retraction, respectively. The right‐sided approach to C4 resulted in significant levels of stretch in 3 (30%) of 10 cadavers and no stretch in 7 (70%) of 10 cadavers. The relevance of these data is demonstrated by the review of numerous studies demonstrating the potential for significant neural damage with nerve stretch greater than 12%.
Use of Botulinum Toxin for Diagnosis and Management of Cricopharyngeal Achalasia
Authors: Blitzer Andrew , Brin Mitchell F.
Published: September 2022

Cricopharyngeal achalasia produces dysphagia in many patients. The spasm has been treated in the past with medication, bouginage, pharyngeal plexus neurectomy, and cricopharyngeal myotomy. In some patients the cause of dysphagia may be elusive, or the patient may be a poor risk for a surgical intervention. We have found that cricopharyngeal muscle injections of botulinum toxin can be useful in the diagnosis and therapy of cricopharyngeal spasm.
Role of the Modified Barium Swallow in Management of Patients with Dysphagia
Authors: Logemann Jeri A.
Published: September 2022

The modified barium swallow is a radiographic (videofluoroscopic) procedure designed to define the anatomy and physiology of the patient's oropharyngeal swallow and examine the effectiveness of selected rehabilitation strategies designed to eliminate aspiration or excess oral or pharyngeal residue (the symptoms of the patient's dysphagia). Rehabilitation strategies introduced during the modified barium swallow after the patient's oropharyngeal anatomy and physiology have been defined include (1) postural changes to redirect food flow and change pharyngeal dimensions, (2) sensory enhancement techniques, and (3) swallow maneuvers. Combining the modified barium swallow with a follow‐up swallowing rehabilitation plan can decrease the cost and time for rehabilitation of patients with dysphagia. In some cases the patient can begin safe oral intake immediately after the modified barium swallow, and therapy may not be needed if consistent spontaneous recovery is anticipated.
Laryngeal Electromyography for the Diagnosis and Management of Swallowing Disorders
Authors: Hillel Allen D. , Robinson Lawrence R. , Waugh Patricia
Published: September 2022

Laryngeal electromyography has proved useful for the evaluation of neurologic disorders of the larynx. The techniques for this procedure are also well suited to investigate disorders of the pharyngeal phase of swallowing. The responses from the thyroarytenoid muscles, the cricothyroid muscles, and the cricopharyngeus muscle can offer information to aid in the diagnosis, prognosis, and in some cases, treatment of dysphagia. A general review of electromyographic responses with sample tracings from the larynx are included in this article.
A Comparison of Mucosal Incisions Made by Scalpel, CO2 Laser, Electrocautery, and Constant‐Voltage Electrocautery
Authors: Liboon John , Funkhouser William , Terris David J.
Published: September 2022

This study compares the histologic effects of scalpel, CO2 laser, electrosurgery, and constant‐voltage electrosurgery incisions on the mucosal tissue of swine. Tissue studies comparing the CO2 laser with the scalpel and electrosurgery have been done. However, a gross and histologic comparison of the effects of all three techniques on oral mucosal tissue has not been reported. A swine model of both tongue and buccal mucosa was used to compare the scalpel, CO2 laser, electrosurgery unit, and constant‐voltage electrosurgery unit in an effort to assess their value in oral surgery. Tissue samples of tongue and buccal mucosal incisions and excisions were histologically examined at 0, 3, 7, 14, 28, and 42 days after surgery to evaluate tissue damage and wound healing properties induced by the four instruments. The instruments were also evaluated for performance and ease of use. On subjective evaluation of ease of use, constant‐voltage electrosurgery scored highest (p < 0.05) on a scale of 0 to 4, followed by the CO2 laser. Speed of incisions and excisions, measured in seconds, was fastest with the scalpel (p < 0.001) and electrosurgery unit (p < 0.05). The amount of bleeding, as evaluated on a scale of 0 to 4, was least for electrosurgery (p < 0.001) and CO2 laser (p < 0.001). Histologic damage, as expected, was least with a scalpel. The extent of epithelial damage lateral to the wound edge and the extent of collagen denaturation were the lowest with the scalpel (p < 0.001), followed by constant‐voltage electrosurgery. The wounds created by all four instruments displayed intact epithelium by 4 weeks, and granulation tissue peaked at 4 weeks with all methods except constant‐voltage electrosurgery, where granulation tissue was still prevalent at week 6. Constant‐voltage electrosurgery and the CO2 laser provided the best combination of ease of use, hemostasis, and lack of tissue injury among the instruments compared. Incisions and excisions made with constant‐voltage electrosurgery required less time than those made with the laser, but constant‐voltage electrosurgery wounds also had significantly more granulation tissue in later weeks of the study, suggesting that wound healing may be delayed.
Efficacy of Ototopical Ciprofloxacin in Pediatric Patients with Otorrhea
Authors: Wintermeyer Susan M. , Hart Mary C. , Nahata Milap C.
Published: September 2022

OBJECTIVE

The objective of this study was to evaluate the efficacy and safety of topical ciprofloxacin in patients with recurrent otorrhea that was unresponsive to other antibiotics.

METHODS

Pediatric patients with otorrhea and confirmed Pseudomonas aeruginosa in the ear fluid were enrolled. Topical ciprofloxacin, three drops three times daily for 14 days, was prescribed with aural care. Efficacy and safety were evaluated on days 7 and 14. A phone follow‐up was conducted monthly thereafter for 8.6 months.

RESULTS

Twenty‐nine pediatric patients were enrolled. On day 14, 18 were cured, 8 were improved, 2 were changed to an alternate therapy and cured, and 1 showed no improvement, perhaps due to a small external ear canal. Two additional patients were cured at day 21. None of the patients reported any adverse effects. Twelve patients had no recurrence at 3 to 15 months after the study.

CONCLUSION

The use of topical ciprofloxacin in pediatric patients was curative in nearly 70% of patients with otorrhea associated with P. aeruginosa who were previously unresponsive to other antimicrobials. No adverse reactions were reported in the study population.
Physiologic Motion after Laryngeal Nerve Reinnervation: A New Method
Authors: Sercarz Joel A. , Nguyen Li , Nasri Sina , Graves Michael C. , Wenokur Randall , Berke Gerald S.
Published: September 2022

In this study a new method of reinnervation for unilateral recurrent laryngeal nerve paralysis was performed in canines, producing physiologic vocal fold motion in each of a small series of animals. During the procedure the left anterior division of the recurrent laryngeal nerve was reinnervated with axons from the thyroarytenoid branch of the contralateral recurrent laryngeal nerve. The posterior branch of the left recurrent laryngeal nerve was divided and sutured to the ansa cervicalis to maintain tone in the posterior cricoarytenoid muscle. In all four animals, the right distal vocalis stump was reinnervated with an ansa cervicalis nerve branch. After 3 months physiologic vocal fold motion and electromyographic activity could be demonstrated during mechanical stimulation of the supraglottis (adduction) and during tracheostomy obstruction (abduction). Acoustic data revealed improvement of jitter, shimmer, signal‐to‐noise ratio, and vocal efficiency in reinnervated animals compared with paralyzed canines before treatment, although the results lacked statistical significance. This approach to the rehabilitation of unilateral vocal fold paralysis is discussed. (Otolaryngol Head Neck Surg 1997;116:466–74.)