bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Neck Dissection in the Management of the Clinically Node‐Negative Neck
Authors: Sefik Hosal A. , Carrau Ricardo L. , Johnson Jonas T. , Myers Eugene N.
Published: November 2003

Objective To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node‐negative neck.

Study Design Case histories were evaluated retrospectively.

Methods The results of 300 neck dissections performed on 210 patients were studied.

Results The primary sites were oral cavity (91), oropharyn‐ (30), hypopharyn‐ (16), and laryn‐ (73). Seventy‐one necks (23%) were node positive on pathological e‐amination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had e‐tracapsular spread. The median follow‐up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological e‐amination (3%) when compared with patients with positive nodes without e‐tracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with e‐tracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pN0) necks in the patients who did not have irradiation.

Conclusion SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.
Time to First Relapse as an Outcome and a Predictor of Survival in Patients With Squamous Cell Carcinoma of the Head and Neck
Authors: Hall Stephen F. , A Groome Patti , Rothwell Deanna
Published: November 2003

Objective To identify patterns and predictors of relapse and to determine whether the time to relapse influences survival.

Study Design Multivariate analysis of prospective database.

Methods We present findings in 446 consecutive prospective patients from a regional cancer center with invasive squamous cell carcinoma who were treated for cure and were declared disease free. Time to relapse, site of relapse, and survival are reported by stage and site using bivariate and multivariate analysis.

Results Thirty‐si‐ percent of patients relapsed. The median time to relapse was 8.3 months, and 95% of relapses occurred within 3 years. T stage in the TNM staging system was associated with relapse, and N stage was not. In patients who relapsed before the median time to relapse, prognosis was worse than in those who relapsed after that time.
Histopathology of the Inferior Turbinate With Compensatory Hypertrophy in Patients With Deviated Nasal Septum
Authors: Berger Gilead , Hammel Ilan , Berger Rachel , Avraham Shabtai , Ophir Dov
Published: November 2003

Objective To measure the dimensions, composition, and possible structural and/or histopathological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum.

Study Design A prospective, nonrandomized, and morphometric study.

Methods Nineteen patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity underwent surgery for correction of nasal obstruction. Patients' specimens were compared with those of a control group consisting of 10 inferior turbinates removed at autopsy. Quantitative measurements of the inferior turbinate histological sections were carried out and included the width of the layers and morphometric calculations of the relative proportions of the soft tissue constituents. Also, qualitative study was performed to detect pathological changes.

Results Of all layers, the inferior turbinate bone underwent a twofold increase in thickness and manifested the most significant expansion (P ≤.001), whereas the contribution of the mucosal layers to the inferior turbinate hypertrophy was modest. The morphometric analysis revealed a larger proportion of venous sinusoids in hypertrophic turbinates, but the difference was small and statistically insignificant. Qualitative assessment disclosed normal mucosal architecture in all inferior turbinates with compensatory hypertrophy. Eleven remained intact, while eight disclosed mild to moderate pathological changes.

Conclusions The data gathered in the present study are of importance to the decision‐making process regarding turbinate surgery. The significant bone expansion and the relative minor role played by the mucosal hypertrophy would support the decision to excise the inferior turbinate bone at the time of septoplasty.
Expression of MUC5AC mRNA in the Goblet Cells of Human Nasal Mucosa
Authors: Kim Chang‐Hoon , Song Kyoung Seob , Kim Sung‐Shik , Kim Hyun‐Ung , Seong Je‐Kyung , Yoon Joo‐Heon
Published: November 2003

Objectives/Hypothesis Mucus hypersecretion is a common feature in chronic sinusitis with polyps. Because mucus hypersecretion is commonly accompanied by goblet cell hyperplasia, it is important to identify which mucin gene mRNAs are expressed in the goblet cells of the surface epithelium in the human airway. This study aims to investigate the pattern of expression of MUC5AC messenger RNA (mRNA) in the goblet cells of human nasal mucosa.

Methods Six nasal polyps, five inferior turbinate mucosa specimens, and three normal‐appearing mucosa specimens of the posterior ethmoid sinus were obtained. Each of the specimens was cut into 10‐μm‐thick serial frozen sections, and in situ hybridization of MUC5AC mRNA was performed with an oligonucleotide probe. Alcian blue (pH 2.5)–periodic acid–Schiff (AB‐PAS) staining was performed on the serial sections.

Results In human nasal polyps, MUC5AC mRNA was expressed in the cytoplasm of most of the goblet cells. However, in the inferior turbinate, MUC5AC mRNA was expressed in only some of the goblet cells. On the contrary, in the normal‐appearing mucosa of the posterior ethmoid sinus, MUC5AC mRNA was barely expressed in the goblet cells. Furthermore, MUC5AC mRNA was mainly expressed in some of the PAS‐positive goblet cells.

Conclusions Only a portion of the goblet cells in the human nasal mucosa expressed MUC5AC mRNA. This result suggests that surface goblet cells might have other mucin genes, in addition to MUC2 and MUC5AC.
Early Clinical Results: SOUNDTEC Implantable Hearing Device Phase II Study
Authors: Hough J. V. D. , Dyer R. Kent , Matthews Pamela , Wood Mark W.
Published: November 2003

Objective To assess the safety and efficacy of a new semi‐implantable electromagnetic hearing device, the SOUNDTEC™ Direct Drive Hearing System (DDHS), and to compare its performance with that of subjects' previously worn, optimally fit hearing aids. Preliminary results for the first 10 subjects are presented.

Study Design The protocol specified in the Investigational Device Exemption is used in this ongoing FDA phase II 100‐subject multicenter clinical trial.

Methods For baseline, each subject is tested wearing his or her own optimally fit hearing aid in the ear to be implanted. Six‐month postoperative outcome measures using the SOUNDTEC DDHS are compared with the baseline. Multiple objective and subjective outcomes (as listed under Results) were measured.

Results When compared with the subjects' optimally fit hearing aids, the SOUNDTEC DDHS provided an average improvement of 52% in functional gain (250–6000 Hz), 22% in aided thresholds, 3.8% for speech discrimination in quiet, 17% for speech in noise, 13.1% in articulation index scores, 28% in aided benefit, 27.3% in sound quality of speech, and a 16.7% increase in overall subject satisfaction. In addition, with the SOUNDTEC DDHS, subjects reported absence of acoustic feedback, little or no occlusive effects, and more natural sound perception.

Conclusion Analysis of data on the first 10 subjects using the SOUNDTEC DDHS indicates positive outcomes regarding safety and efficacy, although the small sample size is not sufficient to permit valid statistical inferences to be drawn from our preliminary data. Results also demonstrate improvement in performance compared with the subjects' optimally fit hearing aids and an improvement in quality of life as demonstrated by objective and subjective tests and measures.
Insecticidal Activity of Common Reagents for Insect Foreign Bodies of the Ear
Authors: Antonelli Patrick J. , Ahmadi Anis , Prevatt Angela
Published: November 2003

Objective Insects commonly present as painful and distressing foreign bodies of the external ear canal. Removing live insects can be challenging, especially for primary care physicians who have limited equipment. The purpose of this study is to compare the insecticidal activity of commonly available preparations for insects that are most frequently recovered from ear canals: cockroaches (German and American), ticks, beetles, and honeybees.

Study Design Prospective, blinded.

Methods One hundred seventy insects of each species were placed in test tubes and submerged in 17 test preparations (10 tubes per preparation, 1 insect per test tube). Insect activity was stimulated by agitation of the test tube. Responses were monitored, and the time until death was measured.

Results Most test preparations exhibited some insecticidal activity against most insect species. Ticks were completely resistant to all of the test reagents. Ethanol killed the American cockroaches (mean time, 32.6 s), German cockroaches (mean time, 29.6 s), and honeybees (mean time, 19.6 s) the most rapidly.

Conclusion Many commonly available reagents may be used to kill or immobilize insect foreign bodies of the ear.
Middle Ear Effusions and Structure of the Tympanic Membrane
Authors: Wielinga Eize W. J. , Peters Theo A. , Tonnaer Edith L. G. M. , Kuijpers Wim , Curfs Jo H. A. J.
Published: November 2003

Objective To study the effect of various middle ear effusions on the structure of the lamina propria of the tympanic membrane.

Methods Sterile and infective middle ear effusions were induced by obstruction of the eustachian tube in specific pathogen‐free (SPF) rats and in rats with upper airway infections (URI), respectively. The condition of the tympanic membrane was monitored at regular intervals. After varying survival times, the animals were killed and the tympanic membranes processed for light and electron microscopy.

Results Sterile effusions always resulted in tympanosclerotic lesions. These lesions did not develop in the presence of primary‐infected effusions. These effusions had a severe destructive effect on the lamina propria, followed by fibrosis. Generally, secondary infection did not markedly affect preexisting tympanosclerotic lesions. Moreover, calcification disappeared when re‐aeration of the middle ear occurred, but the abnormal collagen depositions persisted.

Conclusions Both sterile and infective effusions result in comprehensive irreversible changes in the lamina propria of the pars tensa. The development of tympanosclerosis is confined to sterile effusions. Mechanical injury and compromised vascularization of the lamina propria are likely to be important etiological factors in the development of tympanosclerosis.
Distortion‐Product Otoacoustic Emissions and Glycerol Testing in Endolymphatic Hydrops
Authors: Magliulo Giuseppe , Cianfrone Giancarlo , Triches Lorena , Altissimi Giancarlo , D'Amico Raffaello
Published: November 2003

Objectives/Hypothesis Aural fullness is a frequent symptom of endolymphatic hydrops. Its evaluation may provide valuable information on the initial stage of development of endolymphatic hydrops.

Study Design The present investigation was specifically designed to ascertain the ability of the glycerol test, combined with pure tone audiometry and distortion product otoacoustic emissions (DPOAEs) testing, to diagnose endolymphatic hydrops early and to identify patients who may evolve toward Meniere's disease. For these purposes, patients who complained about aural fullness as their only audiologic symptom were selected.

Methods This investigation consisted of 19 consecutive patients with unilateral or bilateral aural fullness who received no treatment. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with both DPOAEs. For the traditional pure‐tone glycerol test, a hearing improvement of at least 10 dB, at the lower two or three frequencies (125, 250, and 500 Hz), was judged as a positive result. For the DPOAE glycerol test, a smaller positive difference (5 dB) for at least three frequencies was interpreted as an ameliorative fluctuation.

Results The outcomes of the glycerol tests (24 ears examined) showed variable patterns. Seven ears showed no significant changes of either the pure‐tone audiogram or DPOAE. In seven other ears, the comparison of the traditional glycerol test and the DPOAE glycerol test indicated an improvement in both measures. Another seven ears showed negative glycerol tests, whereas DPOAE responses gradually recovered reaching levels significantly higher than those recorded before glycerol administration. The three remaining ears showed contrasting results.

Conclusions Patients with aural fullness in the absence of other associated symptoms may potentially be in the initial stages of Meniere's disease. This notion is confirmed by the present findings showing a high rate (58%) of positive glycerol tests in the selected patients. The importance of DPOAE testing is supported by their ability to detect minimal dysfunction, possibly representing endolymphatic hydrops that goes undetected by routine pure‐tone audiometry.
Steroid‐Dependent Anosmia
Authors: Stevens Michael H.
Published: November 2003

Objective To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy.

Study Design A prospective study of 24 patients with nasal and sinus polyps who were anosmic prior to endoscopic nasal and sinus surgery. Those who remained anosmic after surgery were treated with steroids. Most patients had asthma, allergic rhinitis, or both. A few had aspirin sensitivity.

Methods All 24 patients had testing of their sense of smell before and after surgery. Those who remained anosmic postoperatively were first treated with topical nasal and then oral steroids and then tested again.

Results Twelve of the 24 remained anosmic after surgery and were found to be unresponsive to nasal steroids, but oral steroids were found to restore the sense of smell to normal in most patients. Few patients continued to take the medication for long periods of time mainly because of a fear of side effects. Recent studies have suggested the role of systemic steroids in olfactory secretion, which may explain the mechanism for this response.

Conclusion Patients who remain anosmic after the removal of nasal and sinus polyps can be treated with oral steroids resulting in improvement of their sense of smell. Further research is needed on a molecular level to determine the reason for this and also why oral but not nasal steroids are helpful in these patients.
A Comparison of Monopolar Electrosurgery to a New Multipolar Electrosurgical System in a Rat Model
Authors: Chinpairoj Suchet , Feldman Michael D. , Saunders James C. , Thaler Erica R.
Published: November 2003

Objectives/Hypothesis The purpose of this study is to compare collateral tissue damage and wound healing in incisions created by electro‐dissociation and conventional electrosurgery. Conventional electrosurgery has been used as an alternative to the scalpel to improve hemostasis. However, the heat generated by this instrument can cause tissue damage surrounding the incision, limiting its use around nerves and large blood vessels. A new technology, Coblation (Arthrocare Corp., Sunnyvale, CA), uses “electro‐dissociation” to achieve similar results by creating charged particles from a conductive medium to make an incision while simultaneously achieving hemostasis. This new approach to electrosurgery may reduce soft tissue damage.

Study Design: Methods Two prospective, matched design experiments were performed. In experiment I, both devices were set at the same electrical power in watts and then used to create an incision on the tongue of rats. In experiment II, the electrical power settings of both devices were adjusted until they created incisions of the same size. Epithelial destruction and collateral tissue damage were measured in histologically prepared tissue in both experiments, and the wound healing process was observed in experiment II at 0, 3, 7, and 14 days after surgery.

Results The results showed that the electro‐dissociation method created significantly less epithelial destruction and collateral tissue damage in both experiments. Granulation tissue formation was also significantly less extensive in the electro‐dissociation–induced incision after 7 and 14 days of recovery.

Conclusions Wound healing may be faster than with conventional electrosurgery if the Coblation device is used.
Arytenoid Appearance and Vertical Level Difference Between the Paralyzed and Innervated Vocal Cords
Authors: Hong Ki Hwan , Jung Kyung Soo
Published: November 2003

Objectives/Hypothesis In unilateral vocal fold paralysis, it has been generally accepted that the paralyzed vocal fold presents at a higher level than a normally innervated vocal fold. In this study, we correlate the appearances of the paralyzed arytenoid and the differences in level between the paralyzed and innervated vocal folds.

Study Design Retrospective review using video‐recorded images of larynx.

Methods A total of 38 patients were selected for this study who reported symptoms of voice change attributable to a paralyzed vocal fold unilaterally. Video recordings were obtained using the laryngeal telescope. The heights were assessed according to the paralyzed positions, status (inspiration or phonation), and appearances of the paralyzed arytenoid. The appearances of paralyzed arytenoid were further clarified as the portions of the medial surface of the arytenoid that were visualized.

Results In medial paralysis, the paralyzed vocal fold appeared mainly as being at an equal vertical level or as having no distinct difference from normal vocal fold during phonation. However, a few cases of medial paralysis showed a lower than normal or higher than normal vocal fold during phonation, depending on the appearance of the paralyzed arytenoid. In lateral paralysis, most of the paralyzed vocal folds were not higher than the innervated vocal folds during phonation.

Conclusions The heights of paralyzed vocal folds were variable depending on the paralyzed positions, the status of the larynx, and appearances of the paralyzed arytenoid. The fact that the paralyzed vocal fold is at a higher level than the normal vocal fold should be reconsidered.
Autologous Fibrin Sealant Reduces Pain After Tonsillectomy
Authors: Gross Charles W. , Gallagher Richard , Schlosser Rodney J. , Burks Sandra G. , Flanagan Heidi L. , Mintz Paul D. , Avery Nancy L. , Mayers S. Lynne , Spotnitz William D.
Published: November 2003

Objectives/Hypothesis Pain is a major cause of morbidity after tonsillectomy. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of care. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain after this operation.

Study Design A prospective, randomized, blinded study was performed on 20 children aged 5 to 17 years who were undergoing tonsillectomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain.

Methods All patients pre‐donated 40 mL of blood from which autologous concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. The 10 patients in the control group (C) received no fibrin sealant. Patients rated their level of pain immediately after surgery and at regular intervals for 3 days after surgery using the Wong‐Baker Faces Pain Rating Scale (1–6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated.

Results At 7:00 p.m. on postoperative day (POD) 0, the mean ± SD fibrin sealant group pain score (2.9 ± 0.41 units) was significantly lower than for the C group (4.1 ± 0.43 units;P ≤ .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 p.m. on POD 1, with a mean of 3.5 ± 0.43 units versus 2.4 ± 0.48 units for C (P = .15). The odds of a patient in C experiencing emesis were 8.16 times higher, (P ≤ .05) than for patients in the fibrin sealant group.

Conclusions Fibrin sealant significantly reduced pain the evening after pediatric tonsillectomy and also decreased the chance of e‐periencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.
The Relationship Between Dental Overbite and Eustachian Tube Dysfunction
Authors: McDonnell James P. , Needleman Howard L. , Charchut Steven , Allred Elizabeth N. , Roberson David W. , Kenna Margaret A. , Jones Dwight
Published: November 2003

Objective The purpose of this study was to investigate the association between deep dental overbite and eustachian tube dysfunction (ETD).

Design Case‐control study

Setting Tertiary care pediatric otolaryngology outpatient clinic at the Children's Hospital, Boston, Massachusetts.

Patients 105 patients between the ages of 2 and 6 years.

Study Measurements Dental overbite, overjet, and occlusal relationships were measured by an observer who was unaware of ETD status. ETD was defined as having ventilation tubes in place or having the recommendation for ventilation tube placement by an attending pediatric otolaryngologist. In addition, demographic information and medical and social histories were prospectively recorded.

Results In a multivariate logistic regression model, children with deep bites were 2.8 times more likely to have ETD than those without deep bites (P = .03). Other independent risk factors for ETD identified in this model were family history of otitis media (OM) and age less than 3 years.

Conclusions Children with deep dental overbites are at a significantly increased risk for developing ETD.
The Role of Topical Antibiotic Prophylaxis in Patients Undergoing Contaminated Head and Neck Surgery With Flap Reconstruction
Authors: Simons Jeffrey P. , Johnson Jonas T. , Yu Victor L. , Vickers Richard M. , Gooding William E. , Myers Eugene N. , Pou Anna M. , Wagner Robin L. , Grandis Jennifer Rubin
Published: November 2003

Objectives/Hypothesis Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high‐risk patients.

Study Design We performed a randomized, prospective clinical trial.

Methods Patients received either 1) parenteral piperacillin/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively, with piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria.

Results Sixty‐two patients met inclusion criteria and were enrolled in the study. The overall wound infection rate was 8.1% (95% confidence interval [CI], 2.7%–17.8%). Two of 31 patients (6.4%) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients (9.7%) randomly assigned to receive topical plus parenteral antibiotics. This difference was not statistically significant (P = >.05). Infection rate was not associated with flap type (rotational vs. free tissue transfer), mandibular reconstruction, age, gender, tumor site, stage, surgical duration, or blood loss.

Conclusions These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery. However, the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone.
Bedside Tracheostomy in the Intensive Care Unit: A Prospective Randomized Trial Comparing Open Surgical Tracheostomy With Endoscopically Guided Percutaneous Dilational Tracheotomy
Authors: Massick Douglas D. , Yao Shonan , Powell David M. , Griesen Dawn , Hobgood Todd , Allen James N. , Schuller David E.
Published: November 2003

Objectives Objectives of the study were 1) to analyze the complication incidence and resource utilization of two methods of bedside tracheostomy and 2) to define selection criteria for bedside tracheostomy.

Study Design Prospective randomized trial in the setting of a tertiary care center at a university hospital.

Methods One hundred sixty‐four consecutive intubated patients selected for elective tracheostomy were enrolled. One hundred patients met selection criteria for bedside tracheostomy and were randomly assigned to either open surgical tracheostomy (50) or endoscopically guided percutaneous dilational tracheotomy(50). The remaining 64 patients received open surgical tracheostomies in the operating room. Main outcome measures were 1) perioperative and postoperative complication incidence and 2) resource utilization.

Results Patients meeting our selection criteria for bedside tracheostomy had a significantly reduced perioperative complication rate compared with those who failed to meet these criteria, and subsequently underwent tracheostomy placement in the operating room (5% vs. 20%, P less than or equal to .01). No statistically significant difference was found in the perioperative complication incidence between the two methods of bedside tracheostomy. However, percutaneous tracheostomy placement at the bedside resulted in a significant increase in postoperative complication incidence (16% vs. 2%, P <.05) and incurred an additional patient charge of $436 per bedside procedure.

Conclusions This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidence and resource utilization are defined for two methods of bedside tracheostomy. The results of this study confirm that open surgical tracheostomy represents the standard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge. These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost‐effective, high‐quality care.
Variance of Vestibular‐Evoked Myogenic Potentials
Authors: Ochi Kentaro , Ohashi Toru , Nishino Hirohito
Published: November 2003

Objectives/Hypothesis Vestibular‐evoked myogenic potential (VEMP) has been thought to originate from sacculus. The variance of this potential and the effectiveness of the adjustments of pInII amplitudes using average muscle tonus of ipsilateral sternocleidomastoid muscle were evaluated. In addition, clinical application of VEMP was examined in patients with acoustic tumors (ATs) and vestibular neurolabyrinthitis (VNL).

Study Design Prospective evaluation of the VEMP in 18 normal volunteers and 6 patients.

Methods Variance and left–right difference of each parameter, including pI latency, nII latency, pInII amplitude, and threshold, was analyzed. Input– output function of pInII amplitude was evaluated. Average muscle tonus was calculated in 20 ears and applied for adjustment of pInII amplitude. Sensitivity of each parameter of VEMP was examined in 3 patients with ATs and 3 patients with VNL.

Results VEMP was present in all 36 ears of 18 control subjects. Thresholds of VEMP for normal subjects were 80 to 95 dB normal hearing level (nHL). The muscle tonus affected pInII amplitude significantly; however, no statistically significant improvement was observed in test–retest investigation after adjustment using muscle tonus. The threshold of the affected side was elevated compared with the non‐affected side in all patients with ATs, whereas 2 of 3 patients showed normal pInII‐ratio. One patient with VNL presented normal VEMP, whereas 2 patients presented no VEMP to the highest stimulus intensity.

Conclusions Interaural difference of thresholds might be the most useful parameters. Adjustment using average muscle tonus is not necessary when the subject is able to get sufficient muscle tonus.
Cochlear Implants in Five Cases of Auditory Neuropathy: Postoperative Findings and Progress
Authors: Shallop Jon K. , Peterson Ann , Facer George W. , Fabry Lee B. , Driscoll Colin L. W.
Published: November 2003

Objectives To review our experiences with some of the preoperative and postoperative findings in five children who were diagnosed with auditory neuropathy and were provided with cochlear implants. We describe changes in auditory function, which enabled these children to have significant improvement in their hearing and communication skills.

Study Design Pre‐ and postoperatively, these children received complete medical examinations at Mayo Clinic, including related consultations in audiology, pediatrics, neurology, medical genetics, otolaryngology, psychology, speech pathology, and radiology.

Methods These children typically had additional medical and audiological examinations at more than one medical center. The hearing assessments of these children included appropriate behavioral audiometric techniques, objective measures of middle ear function, acoustic reflex studies, transient (TOAE) or distortion product (DPOAE) otoacoustic emissions, auditory brainstem responses (ABR), and, in some cases, transtympanic electrocochleography (ECoG). After placement of the internal cochlear implant devices (Nucleus CI24), intraoperatively we measured electrode impedances, visually detected electrical stapedius reflexes (VESR) and neural response telemetry (NRT). These intraoperative objective measures were used to help program the speech processor for each child. Postoperatively, each child has had regular follow‐up to assure complete healing of the surgical incision, to assess their general medical conditions, and for speech processor programming. Their hearing and communication skills have been assessed on a regular basis. Postoperatively, we have also repeated electrode impedance measurements, NRT measurements, otoacoustic emissions, and electrical auditory brainstem responses (EABR). We now have 1 year or more follow‐up information on the five children.

Results The five children implanted at Mayo Clinic Rochester have not had any postoperative medical or cochlear implant device complications. All of the children have shown significant improvements in their sound detection, speech perception abilities and communication skills. All of the children have shown evidence of good NRT results. All but case D (who was not tested) showed evidence of good postoperative EABR results. Otoacoustic emissions typically remained in the non‐operated ear but, as expected, they are now absent in the operated ear.

Conclusion Our experiences with cochlear implantation for children diagnosed with auditory neuropathy have been very positive. The five children we have implanted have not had any complications postoperatively, and each child has shown improved listening and communication skills that have enabled each child to take advantage of different communication and educational options.
Accuracy of Acoustic Rhinometry Measurements
Authors: Cakmak Ozcan , Çelik Hüseyin , Ergin Tan , Sennaroglu Levent
Published: November 2003

Objectives To identify the factors that influence the accuracy of acoustic rhinometry measurements recorded with commercially available equipment.

Study Design A simple model was used which consisted of a metal pipe and cylindrical inserts. These inserts comprised various lengths, and aperture dimensions were comparable to, or smaller than, the nasal valve areas of both adults and children.

Methods Accuracy of the acoustic rhinometry technique was evaluated by comparing the measured and actual cross‐sectional areas. The results were discussed in terms of the calculated acoustic transmission, reflection, and attenuation coefficients of the pipe model variations.

Results Reducing the inner diameter of the insert increased the degree of measurement error. As the length of the insert was increased, the measured cross‐sectional area gradually decreased, approaching the actual area of the experimental passageway. For larger inserts, level of error was not highly dependent on passageway length compared with the narrower inserts.

Conclusion Our results show that both the cross‐sectional area and passageway length of the narrow segment are the most significant factors that influence the accuracy in acoustic rhinometry measurements.
Relief of Post‐Tonsillectomy Pain by Release of Lidocaine From Fibrin Glue
Authors: Kitajiri Shin‐ichiro , Tabuchi Keisaku , Hiraumi Harukazu , Kaetsu Hiroshi
Published: November 2003

Objectives Pain inevitably develops after resection of the palatine tonsil (tonsillectomy). Therefore, we applied a mixture of lidocaine and fibrin glue to the tonsillar fossae immediately after tonsillectomy and evaluated its analgesic effects.

Study Design A prospective randomized trial.

Methods Seventy‐four consecutive patients who had undergone tonsillectomy by the same surgeon (S.K.) were allocated by the sealed envelope method into three groups. After routine tonsillectomy, the operation was terminated in group A (control group), but the bilateral tonsillar fossae were covered with 1 mL fibrin glue using CaCl2 as solution to dissolve thrombin in group B and using 4% lidocaine chloride instead of CaCl2 in group C. No significant difference was observed in age or sex among the three groups. Analgesic effects were evaluated in terms of the postoperative days required until the patient began to eat normally and the postoperative days on which the patient desired analgesic administration.

Results The mean postoperative days until the patient began to eat normally were 4.22 in group A and 3.78 in group B, showing no significant difference, but 2.83 in group C, being significantly shorter (P <.05). The mean postoperative days on which analgesic administration was necessary were 4.56 in group A and 4.91 in group B, showing no significant difference, but 2.88 in group C, being significantly shorter (P <.05).

Conclusion This method can be readily performed, requires no special treatment, and appears to have adequate pain‐relieving effects.
Effect of Tumor Necrosis Factor‐α on Experimental Otitis Media With Effusion
Authors: Lee Dong‐Hee , Park Yong‐Soo , Jung Timothy T. K. , Yeo Sang‐Won , Choi Young‐Chul , Jeon Eun‐ju
Published: November 2003

Objectives/Hypothesis Up to the present, many reports have demonstrated that local immune response is associated with maintenance and persistence of effusion in the middle ear cavity. Resulting retention of inflammatory cells and mediators in the middle ear results in ongoing effusion. The purpose of this study was to clarify the role of tumor necrosis factor in experimental otitis media with effusion, which was induced by transtympanic injection of tumor necrosis factor in the rats.

Study Design Four groups were designed in two e‐periments. The purpose of e‐periment 1 was to confirm that transtympanic injection of TNF‐α produces the middle ear effusion. In experiment 2, TNFsolRI was used to evaluate the possibility as an inhibitor in otitis media with effusion.

Methods The histopathological changes were observed under light microscope, and the changes in microvascular permeability were examined using Evans blue vital dye technique.

Results Middle ear effusion was developed in 70% of specimens, and histopathological changes, such as subepithelial edema and marked infiltration of neutrophils, were present in 100% at 24 hours after administration of tumor necrosis factor‐α through transtympanic approach. Extravasation of Evans blue dye was found in all specimens injected by tumor necrosis factor‐α, which was qualified using a fluorescence microscope and quantified using a spectrophotometer. These histopathological findings and changes in microvascular permeability were significantly reduced by tumor necrosis factor soluble receptor type I.

Conclusions Neutrophil infiltration, subepithelial edema, increased microvascular permeability, and resultant effusion were indirectly proved to be induced by tumor necrosis factor‐α. We hope that this study may contribute to understanding the role of tumor necrosis factor‐α in otitis media with effusion and clarifying the future role of tumor necrosis factor soluble receptor type I in preventing otitis media with effusion.
Functional Study of Four Neurotoxins as Inhibitors of Post‐traumatic Nerve Regeneration
Authors: Paydarfar Joseph A. , Paniello Randal C.
Published: November 2003

Objectives/HypothesisChemical inhibition of nerve regeneration was studied as a potential adjunct in the treatment of injuries to the facial or recurrent laryngeal nerve. We propose that by treating selected muscles with an inhibitor of nerve regeneration shortly after injury, synkinesis may be controlled.

Study DesignNerve regeneration after crush injury was studied in the rat posterior tibial and sciatic nerves, well‐established models for the study of peripheral nerve injuries.

MethodsFour days after controlled crush injury to the posterior tibial nerve, the gastrocnemius muscle was injected with saline (control, n = 8), phenol (n = 6), doxorubicin (n = 6), or vincristine (n = 11). Injection without crush injury was performed using vincristine (n = 4) or botulinum toxin (n = 4). Four rats underwent crush injury to the sciatic nerve followed 4 days later by botulinum toxin injection to the gastrocnemius muscle. The percent of functional recovery (%FR) of the nerve was assessed using walking track analysis.

ResultsVincristine significantly retarded nerve regeneration. Five weeks after injury, %FR returned to normal in controls, as well as in the phenol, doxorubicin, and botulinum toxin groups, while in the vincristine group %FR was less than 60% of baseline (P<.0001). Vincristine injections without crush injury showed no significant reduction in print length factor. Functional recovery in the botulinum/crush group was more rapid than the botulinum without crush group.

ConclusionsApplication of vincristine to the gastrocnemius muscle significantly inhibits regeneration of the posterior tibial nerve after crush injury. Botulinum toxin does not prolong functional recovery after nerve injury; rather, crush injury protects against the prolonged chemodenervation seen with botulinum toxin. Doxorubicin and phenol injection did not prolong functional recovery at the doses tested.
Inner Ear Decompression Sickness in Sport Compressed‐Air Diving
Authors: Nachum Zohar , Shupak Avi , Spitzer Orna , Sharoni Zohara , Doweck Ilana , Gordon Carlos R.
Published: November 2003

Objective We report our experience over the past 12 years with recreational diving‐related inner ear decompression sickness (IEDCS).

Study Design Retrospective, consecutive case series.

Methods Twenty‐four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow‐up.

Results These 29 cases represent 26% of the severe decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the decompression schedule. The mean time from surfacing to appearance of symptoms was 47 ± 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo‐cochlear injury. Except for one patient who had central as well as peripheral vestibulo‐cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty‐six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05).

Conclusions IEDCS related to compressed‐air recreational diving is more common than previously thought, and might occur even when no decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.
Can Eustachian Tube Ventilatory Function Impairment After Oxygen Diving Be Influenced by Application of Free Radical Scavenger Vitamins C and E?
Authors: Mutzbauer Till S. , Neubauer B. , Mueller P. H. J. , Sigg O. , Tetzlaff K.
Published: November 2003

Objectives/Hypothesis To evaluate the influence of free radical scavenger vitamins C and E on eustachian tube ventilatory function changes related to oxygen dives.

Study Design Prospective, randomized, double‐blind, placebo‐controlled study of middle ear impedance changes of oxygen divers being orally treated with free radical scavenger vitamins C and E.

Methods Fifteen divers were allocated to two groups. Before diving on oxygen on consecutive days (days 1 and 2), divers in group 1 took a daily dose of 1 g ascorbic acid and 600 International Units d‐α‐tocopherol and divers in group 2 were given placebo. Before diving and 2 and 24 hours after diving on days 1 and 2, middle ear impedance was measured.

Results Impedance decreased overnight after dive 1 (P = .04) but not after dive 2 (P = .31). No impedance differences were found between groups after the dive on day 1 (P = .83). Twenty‐four hours after the dive on day 1 and after the dive on day 2, impedance values in both groups were different (P = .02 vs. P = .07), emphasizing slightly more negative pressures in the vitamin group.

Conclusion Vitamins C and E did not reduce eustachian tube ventilatory function impairment overnight after the dive on day 1, suggesting no evidence of free radical–mediated toxicity affecting the eustachian tube or middle ear mucosa. Repetitive oxygen dives may cause tissue adaptation suggesting other than antioxidant defense mechanisms.
Pediatric Laser‐Assisted Tympanostomy
Authors: Silverstein Herbert , Jackson Lance E. , Rosenberg Seth I. , Conlon W. Sean
Published: November 2003

Objective To evaluate effectiveness of laser‐assisted tympanostomy in treatment of pediatric patients with chronic otitis media with effusion.

Study Design Retrospective review of 23 pediatric patients who received office laser‐assisted tympanostomy.

Methods A CO2 laser attached to an operating microscope with a microscope laser adaptor device or the handheld Oto‐LAM (Needham, MA) was used to perform all of the tympanostomies. The average diameter of tympanostomy was 2 mm; on average, 13.6 W was applied for 0.13 seconds.

Results Laser‐assisted tympanostomy was performed on 37 pediatric ears (patient age range, 2–16 y) for the diagnosis of chronic otitis media with effusion. Average follow‐up time was 4.7 weeks. At the time of the follow‐up examination, 46% of the ears had no evidence of fluid and required no further intervention. Forty‐nine percent of the ears required placement of pressure equalization tubes. The average SRT improved from 30.8 dB preoperatively to 21.03 dB postoperatively.

Conclusions Laser‐assisted tympanostomy appears to be an effective treatment for chronic otitis media with effusion in pediatric patients.
Gender‐Related Differences of Hyaluronic Acid Distribution in the Human Vocal Fold
Authors: Butler John E. , Hammond Thomas H. , Gray Steven D.
Published: November 2003

Objective To quantify the distribution of hyaluronic acid (HA) within the normal human vocal fold and evaluate gender‐ and age‐related differences.

Study Design Prospective, cross‐sectional study by age and gender groups using cadaveric vocal folds to study hyaluronic acid differences.

Methods Twenty‐five vocal fold halves obtained at autopsy were evaluated from nine adult male (age range, 34–52 y), seven adult female (age range, 21–41 y), four geriatric male (age range, 65–77 y), and five geriatric female (age range 65–82 y) subjects. Midmembranous vocal fold sections were stained for HA using the Muller‐Mowry colloidal iron (acid mucopolysaccharide) stain with and without hyaluronidase. Digital imaging software was used to quantify the distribution of HA across the lamina propria at the vocal fold edge from superficial (subepithelial) to deep (vocalis muscle).

Results A significant gender difference (P = .03) was noted in distribution when controlled for age. Combined, male subjects had a relatively constant distribution pattern throughout the depth of lamina propria. Female subjects showed relatively less HA in the first 15% of depth (most superficial) but showed more HA in the deeper 40% to 100% (toward vocalis muscle) than in male subjects.

Conclusions Important clinical implications may be extrapolated from our findings. First, relatively less HA in the most superficial area implies less protection from vibratory trauma and overuse and may explain in part why more female than male patients have phonotrauma to phonotraumatic lesions. Second, evaluating the distribution of HA in the normal human vocal fold allows more direction in our application of HA as a therapeutic lamina propria substitute in patients with voice disorders.
Cost/Benefit Analysis of Open Tracheotomy, in the OR and at the Bedside, With Percutaneous Tracheotomy
Authors: Levin Roger , Trivikram Lalitha
Published: November 2003

Objectives/Hypothesis (1) To determine whether percutaneous dilational tracheotomy (PDT), open tracheotomy in the operating room (OT/OR), and open tracheotomy at the bedside (OT/BS) are equally safe; and (2) to determine which procedure was most cost effective.

Study Design Retrospective review of patient medical records and billing data.

Methods Any adult patient (>20 y of age) on the medical or surgical services at Penn State Milton S. Hershey Medical Center who required a tracheotomy, elective or emergent, from September 1996 to July 1997 was included. The decision to perform OT in the OR, PDT, or OT at BS was made by the attending surgeon independent of this study. Each patient's course after tracheotomy was reviewed. All complications, perioperatively or postoperatively, for up to 10 days were documented. The complications were divided into two groups: major and minor. Determination of patient cost used surgical billing and OR materials staff records. The necessary equipment and staff for each procedure was determined, and an itemized cost list was retrospectively developed for a typical PDT, OT in OR, or OT at BS. The P values were calculated with the Cochran‐Mantel‐Haenszel (CMH) χ2 test of association.

Results All procedures were equally safe, with PDT being the most cost effective.

Conclusion This report confirms the results of several studies demonstrating that PDT, OT in the OR, and OT at the BS are equally safe; PDT appears to be most cost effective. Our analysis, however, does reveal several options for decreasing the cost of bedside tracheotomy to allow this procedure to be even more cost effective than PDT.