bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment for Monitoring of Education Systems: The U.S. Example
Authors: Fahle Erin M. , Shear Benjamin R. , Shores Kenneth A.
Published: May 2019

Standardized tests are regularly used as education system monitoring tools to compare the average performance of students living in different states or belonging to different subgroups (e.g., defined by race/ethnicity, sex, or parental income) and to track their progress over time. This article describes some uses and design features of tests in system monitoring contexts. We provide the example of the National Assessment of Educational Progress (NAEP), the only large-scale system monitoring test in the United States. The availability of NAEP data, in turn, has facilitated the construction of the Stanford Education Data Archive (SEDA), a publicly available database that can be used to describe patterns of achievement for nearly all school districts in the United States. Here, we discuss progress in and challenges to the use of standardized tests as system monitoring tools.
Assessment for Special Education: Diagnosis and Placement
Authors: Frey Jennifer R.
Published: May 2019

Over the last 40 years, federal legislation has led to improved access to public education for students with disabilities. Today, more than six million students receive special education and related services through American public schools; however, evaluation practices for eligibility determination largely have remained unchanged. Assessment approaches used for identification, program planning, and evaluation of progress, arguably, have been insensitive to cultural differences, contributing to disproportional representation of children from different backgrounds in specific special education disability categories, and inefficient because they are too broad to immediately inform instructional planning for both students within and across disability categories. This article critiques current practices for identifying children for special education services and offers considerations, grounded in developmental and cognitive neuroscience, that could lead to more useful assessment approaches that optimize all students’ learning.
Assessment of Complex Performances in Digital Environments
Authors: Behrens John T. , DiCerbo Kristen E. , Foltz Peter W.
Published: May 2019

Digital technologies hold the potential to transform educational assessment. Recent advances reveal that digital environments will support the development of learning and assessment activities in ways that will both increase the inferential fidelity of assessments and change the form of assessments altogether. Digital technologies can also automate data collection and the production of assessment inferences on a massive scale. Here, we discuss the wide variation in digital learning experiences and explain how they are transforming traditional language for discussing assessment. We argue that the predigital constraints on assessment have skewed our thinking about assessment and give examples of new and novel approaches. Second, we discuss how digital environments can allow us to capture and make inferences from simple or complex learning activities in new ways. Third, we point to advances in machine learning and AI that have the potential to change current and future assessment practices. Finally, we argue for balancing enthusiasm for digital environments against the challenges of making appropriate assessment inferences.
Role of Phosphorylcholine-Specific Immunoglobulin M in Acute Upper Respiratory Tract Infections
Authors: Ohori Junichiro , Jimura Tomohiro , Kurono Yuichi
Published: May 2019

Objectives:

The aim of this study was to clarify the role of serum phosphorylcholine (PC)–specific immunoglobulin M (IgM) as a natural antibody against infectious diseases.

Methods:

The relationship between serum PC-specific IgM level and C-reactive protein level or white blood cell counts was examined in patients with severe upper respiratory tract infections (ie, acute epiglottitis and peritonsillar abscess).

Results:

PC-specific IgM level was significantly negatively correlated with C-reactive protein level and white blood cell count. In addition, C-reactive protein level and white blood cell count was significantly lower in women than in men, whereas PC-specific IgM level was significantly higher in women.

Conclusions:

PC-specific IgM is suggested to have protective and suppressive effects against the progression of infectious and inflammatory reactions. Higher levels of PC-specific IgM in women might be one of the reasons why the incidence and severity of acute epiglottitis and peritonsillar abscess are lower in women.
Cortical and subcortical changes in resting-state functional connectivity before and during an episode of postoperative delirium
Authors: Oh Jooyoung , Shin Jung Eun , Yang Kyu Hyun , Kyeong Sunghyon , Lee Woo Suk , Chung Tae-Sub , Kim Jae-Jin
Published: May 2019

Objective:

Delirium is an acute brain failure related to uncertain problems in neural connectivity, including aberrant functional interactions between remote cortical regions. This study aimed to elucidate the underlying neural mechanisms of delirium by clarifying the changes in resting-state functional connectivity induced by postoperative delirium using imaging data scanned before and after surgery.

Method:

Fifty-eight patients with a femoral neck fracture were preoperatively scanned using resting-state functional magnetic resonance imaging. Twenty-five patients developed postoperative delirium, and 14 of those had follow-up scans during delirium. Eighteen patients without delirium completed follow-up scans 5 or 6 days after surgery. We assessed group differences in voxel-based connectivity, in which the seeds were the posterior cingulate cortex, medial prefrontal cortex and 11 subcortical regions. Connections between the subcortical regions were also examined.

Results:

The results showed four major findings during delirium. Both the posterior cingulate cortex and medial prefrontal cortex were strongly connected to the dorsolateral prefrontal cortex. The posterior cingulate cortex had hyperconnectivity with the inferior parietal lobule, whereas the medial prefrontal cortex had hyperconnectivity with the frontopolar cortex and hypoconnectivity with the superior frontal gyrus. Connectivity of the striatum with the anterior cingulate cortex and insula was increased. Disconnections were found between the lower subcortical regions including the neurotransmitter origins and the striatum/thalamus in the upper level.

Conclusions:

Our findings suggest that cortical dysfunction during delirium is characterized by a diminution of the anticorrelation between the default mode network and task-positive regions, excessive internal connections in the posterior default mode network and a complex imbalance of internal connectivity in the anterior default mode network. These dysfunctions can be attributed to the loss of reciprocity between the default mode network and central executive network associated with defective function in the salience network, which might be closely linked to aberrant subcortical neurotransmission-related connectivity and striato-cortical connectivity.
Continuing competency in ethical decision making: An interpretive description of occupational therapists’ perspectives
Authors: VanderKaay Sandra , Jung Bonny , Letts Lori , Moll Sandra E.
Published: May 2019

Background.

Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited.

Purpose.

The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists.

Method.

Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency.

Findings.

Two main themes regarding gaps were identified: “I didn’t have the knowledge” and “I don’t have anybody.” Education, tool development, and ethics mentorship were identified directions for development.

Implications.

Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making.
Secrecy among Friends: Covert Military Alliances and Portfolio Consistency
Authors: Kuo Raymond
Published: May 2019

Scholars think that friendly nations adopt secrecy to avoid domestic costs and facilitate cooperation. But this article uncovers a historical puzzle. Between 1870 and 1916, over 80 percent of alliance ties were partially or completely covert. Otherwise, hidden pacts are rare. Why was secrecy prevalent in this particular period and not others? This article presents a theory of “portfolio consistency.” Public agreements undermine the rank of hidden alliances. A partner willing to openly commit to another country but not to you signals the increased importance of this other relationship. States pressure their covert partners to avoid subsequent public pacts. This creates a network effect: the more secret partners a state has, the greater the incentives to maintain secrecy in later military agreements. Covert alliances have a cumulative effect. In seeking the flexibility of hidden partnerships, states can lock themselves into a rigid adherence to secrecy.
Profiling Autoantibodies against Salivary Proteins in Sicca Conditions
Authors: Burbelo P.D. , Ferré E.M.N. , Chaturvedi A. , Chiorini J.A. , Alevizos I. , Lionakis M.S. , Warner B.M.
Published: May 2019

Salivary gland dysfunction occurs in several autoimmune and immune-related conditions, including Sjögren syndrome (SS); immune checkpoint inhibitor-induced sicca (ICIS) that develops in some cancer patients and is characterized by severe, sudden-onset dry mouth; and autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Although subjects with these conditions present with oral dryness and often exhibit inflammatory infiltration of the salivary gland, little is known about the B-cell humoral responses directed against salivary gland protein targets. In this study, autoantibodies were evaluated against Ro52, Ro60, and La, as well as against a panel of 22 proteins derived from the salivary proteome. The tested cohort included healthy volunteers and subjects with SS, ICIS, and APECED without and with sicca. As expected, a high percentage of autoantibody seropositivity was detected against Ro52, Ro60, and La in SS, but only a few ICIS patients were seropositive for these autoantigens. A few APECED subjects also harbored autoantibodies to Ro52 and La, but only Ro60 autoantibodies were weakly associated with a small subset of APECED patients with sicca. Additional testing of the salivary panel failed to detect seropositive autoantibodies against any of the salivary-enriched proteins in the SS and ICIS subjects. However, APECED subjects selectively demonstrated seropositivity against BPI fold containing family A member 1 (BPIFA1), BPI fold containing family A member 2 (BPIFA2)/parotid salivary protein (PSP), and lactoperoxidase, 3 salivary-enriched proteins. Moreover, high levels of serum autoantibodies against BPIFA1 and BPIFA2/PSP occurred in 30% and 67% of the APECED patients with sicca symptoms, respectively, and were associated with an earlier age onset of oral dryness ( P = 0.001). These findings highlight the complexity of humoral responses in different sicca diseases and provide new insights and biomarkers for APECED-associated sicca (ClinicalTrials.gov: NCT00001196; NCT00001390; NCT01425892; NCT01386437).
Nurturing Is Not Enough: A Case Study on Social Justice, Caring, and Discipline
Authors: Smith Darrick , Yeh Christine J.
Published: May 2019

We explore the dynamics of nurturing, caring, and enabling in a social justice school and how a problematic context of educational enabling can develop when notions of nurturing are not balanced with consistent disciplinary consequences. In-depth interviews were conducted with eight school staff, teachers, and a student at a social justice urban school. Observational data and institutional documents were also analyzed, and three main themes emerged revealing the tension between nurturing and enabling: (a) sentimentalist standards, (b) perceptions of authority as oppressive, and (c) contradictions in social justice values. We discuss implications for school policy, multicultural education, and school leadership.
Dialogic Consensus as the Moral Philosophical Basis for Shared Decision-making
Authors: Walker Paul
Published: May 2019

Shared decision-making is important and beneficial for patients. Practically, this requires that we explore the values of the patient and the clinician and then consider available treatment options. The aim is to maximize the good of the patient in the context of their illness. Hence, clinical consultations are situations in which we can, and should, draw upon moral philosophical precepts. One such precept, which can fortify the foundations of shared decision-making, is a process of inclusive, noncoercive, and reflective dialogue, which aims at reaching a consensual decision as to what is best for the patient in their situation.

Summary: Shared decision making is important and helpful for patients. This is based upon having a conversation about values and what is important. We can base that conversation on principles of moral philosophy, via a process termed “dialogic consensus”.
Facial Emotion Recognition and Persecutory Ideation in Paranoid Schizophrenia
Authors: Mitrovic Milica , Ristic Milica , Dimitrijevic Bojana , Hadzi Pesic Marina
Published: May 2019

The recognition of facial signals has a crucial role in social interaction. It is well known that people suffering from paranoid schizophrenia have problems in the social domain, predominantly related to misinterpreting the intentions, emotions, and actions of others. The aim of this study was to examine whether there are differences in facial emotion recognition between people with paranoid schizophrenia and healthy controls. In addition, we examined the correlation between facial emotion recognition and the expression of persecutory ideation in people suffering from paranoid schizophrenia. The study involved 60 participants, 30 of whom suffered from paranoid schizophrenia and 30 healthy controls, equalized by gender, age, and education. The following instruments were used: Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces and the Persecutory Ideation Questionnaire. Compared with the controls, people suffering from paranoid schizophrenia were significantly less accurate in recognizing the following emotions: surprise, contempt, sadness, disgust, and emotionally neutral faces. Since the attribution of emotions to emotionally neutral faces is an important finding that could be linked with the social (dis)functionality of people suffering from paranoid schizophrenia, we analyzed and compared the wrong answers given by the two groups and found some differences between them. The results show that persecutory ideation has a statistically significant negative correlation with the successful recognition of emotionally neutral faces. All of the findings lead to the conclusion that paranoid schizophrenia, and within it the existence of persecutory ideation, leads to problems in recognizing the basic facial signals that form the foundation of everyday social interaction.
Territory and Public Policy in Brazil
Authors: Cezar Kilma Gonçalves , do Nascimento Elimar Pinheiro
Published: May 2019

A new, territorial focus, replacing the regionalization of the past. emerged in state planning in Brazil between 1950 and 1970 and again between 1995 and 2010. From the traditional conception of the region predominant throughout the twentieth century, a shift occurred in public policy making to application of the notion of differentiated territories, with two dominant perspectives: one based on the economic potentials of territories, under the Fernando Henrique Cardoso government, and the other, under the Lula government, based on the concept of socially vulnerable territories. The causes of this change have to do with the reduction of the importance of regional inequality in favor of social inequality, with the risk of separatism being replaced by the loss of social cohesion. The new territorial focus in government planning seemed to point to a loss of power of regional oligarchies, but this practice was interrupted for political reasons in 2007.

Um novo foco territorial, substituindo a regionalização do primeiro período, ocorreu no planejamento estatal entre os anos 1950–1970 e 1995–2010. Da concepção tradicional de região, predominante ao longo do século XX, migrou-se para o uso da noção de territórios diferenciados nas políticas públicas, com duas noções dominantes: a primeira, baseada nas potencialidades econômicas dos territórios, no governo Fernando Henrique Cardoso, e a segunda, baseada na concepção de territórios socialmente vulneráveis, no governo Lula. As razões para esta transformação tem como fundamento a perda da principalidade da desigualdade regional em favor da desigualdade social; o risco do separatismo foi subtituido pelo da perda da coesão social. O novo foco territorial no planejamento governamental parecia indicar uma perda de poder das oligarquias regionais. Esta prática, porém, foi interrompida por razões de ordem política a partir de 2007.
Otorhinolaryngology Emergency Unit Care: The Experience of a Large University Hospital in Italy
Authors: Gallo Andrea , Moi Rossana , Minni Antonio , Simonelli Marilia , De Vincentiis Marco
Published: May 2019

We recorded the symptoms and disposition of every patient who visited the otorhinolaryngology emergency department at our hospital in Rome, Italy, during 1996. During that time, our ENT specialists saw 21,548 patients. Only 311 of these patients (1.4%) required immediate hospitalization, while another 2,391 patients (11.1%) received treatment and were released. The other 18,846 patients (87.5%) did not have any pathology or condition that qualified as an actual emergency, and they were examined and released, often with a prescription or instructions for home care. These patients could have easily been treated by a family physician.

The fact that emergency care in Italy is rendered free of charge (unlike ambulatory care, for which fees are charged) provides patients with a strong incentive to misuse the system. Such overutilization drives up the cost of health care and stretches the capacity of the medical staff. Steps need to be taken to redirect patients who misuse emergency services to seek medical care in ambulatory care centers.
Description of an Office Technique for Laser Ventilation of the Ears
Authors: Siegel Gordon J.
Published: May 2019

The author presents a description of a technique he developed called laser office ventilation of ears (LOVE). LOVE, an office-based procedure performed under local anesthesia, can provide intermediate-term ventilation for middle ear disease. This procedure has potential to change the standard of care for otitis media. Such changes might include a decrease in the need for antibiotics (and thus antibiotic resistance), a decrease in hearing loss associated with otitis media, and a decrease in the overall cost of treatment.
Basal Cell Carcinoma of the Head and Neck: Identification of Predictors of Recurrence
Authors: Bumpous Jeffrey M. , Padhya Tapan A. , Barnett Susan N.
Published: May 2019

The goal of this retrospective study was to identify factors that predict the recurrence of basal cell carcinoma of the head and neck. We reviewed the medical records of 165 patients who had undergone a wide surgical excision (negative margins) of one or more basal cell carcinomas of the head and neck. Univariate analysis revealed that recurrence was significantly influenced by the patient's gender (p<0.01), the presence of preoperative risk factors (p<0.05), the presence of multiple lesions (p<0.01), and their histopathologic subtype (p<0.05). Multivariate analysis revealed that the best predictors of recurrence were the presence of preoperative risk factors and the presence of multiple lesions (p<0.01); the lesion's histologic subtype approached but did not reach statistical significance in predicting recurrence (p=0.06).
Intralesional Cidofovir for Recurrent Laryngeal Papillomas: Preliminary Report
Authors: Wilson William R. , Hashemiyoon Robert , Hawrych Andrew
Published: May 2019

This is a preliminary report of an ongoing study to test the efficacy of intralesional injections of the antiviral drug cidofovir in adults with recurrent laryngeal papillomas in whom multiple other treatments have previously failed. This study has been designed to include 10 to 20 patients, a number sufficient to either prove or disprove the safety and efficacy of this agent. This report conveys information on the first three patients enrolled in the trial. Each patient received an overall dose of 5 to 10 ml of cidofovir, at a concentration of 4.17 mg/ml, intralesionally at 2- to 4-week intervals. The approximate volume injected into each wart was 0.2 to 0.5 ml. Biopsies of the lesion sites were obtained at the initiation and completion of therapy. No other treatment was given. Resolution of lesions was monitored by videolaryngoscopy and still photography 1 to 2 weeks after each treatment. In time, the lesions resolved in all three patients, although all three later experienced a minor recurrence. We conclude that intralesional cidofovir appears to be a promising new treatment for controlling—and perhaps at higher dosages curing—refractory laryngeal papillomas, while causing little or no injury to laryngeal structures.
A Case of Squamous Papilloma after Uvulopalatopharyngoplasty
Authors: Eliashar Ron , Eliachar Isaac
Published: May 2019

We report the case of an adult who developed an isolated-solitary papilloma on the margin of the soft palate 1 month after he had undergone a uvulopalatopharyngoplasty. We describe the clinical and cellular characteristics of this common lesion.
eMedicine Otolaryngology: An Online Textbook for Ent Specialists
Authors: Meyers Arlen D.
Published: May 2019

A new online publishing effort, eMedicine Otolaryngology–Facial Plastic Surgery (FPS), is a comprehensive textbook now being developed on the Internet ( www.emedicine.com ). This book is one of a series of 15 electronic textbooks written by a worldwide panel of authors and editors, and it is distributed free of charge to anyone with a computer and a modem. Advantages of online textbooks such as eMedicine Otolaryngology–FPS are that they provide readers with easy accessibility to reliable, up-to-date information, and they allow authors to quickly edit and revise editorial content and supplement traditional text with sound, graphics, and video. An ambitious undertaking, eMedicine Otolaryngology–FPS represents a significant advance in the way medical information is written, edited, and distributed. Although it is unlikely that electronic textbooks will replace traditional textbooks any time soon, these types of publishing efforts will continue to proliferate.
Transient Speech Compromise following Sublabial Transsphenoidal Surgery: A Case Report and Findings of a Small Preliminary Study
Authors: Viswanath Nagalapura S. , Rosenfield David B. , Baskin David S. , Wieber Sandra J.
Published: May 2019

Sublabial transsphenoidal surgical removal of pituitary tumors is a common procedure with minimal complications. Although many investigators have reported oral sensory compromises following surgery, none has reported any postoperative compromise in speaking ability. In this article, we describe the case of a 33-year-old woman who developed transient but severe speech symptoms after she underwent sublabial transsphenoidal surgery. This case prompted us to undertake a brief retrospective analysis of our experience with this procedure in other patients, which revealed that speech compromise is far more common than heretofore realized.
Otomycosis: A Clinicomycologic Study
Authors: Kaur Ravinder , Mittal Nalini , Kakkar Manish , Aggarwal Arun Kumar , Mathur Maheshwar Dayal
Published: May 2019

Otomycosis is a common fungal infection of the ear that is seen in the tropical and subtropical regions of the world. We performed mycologic analyses on debris and scraping samples from the external ear canals of 95 patients who had been clinically diagnosed with otomycosis. Seventy-one samples (74.7%) were positive for fungal growth; two of these samples contained two fungi, bringing the total number of isolates to 73. The most common pathogens were Aspergillus fumigatus (41.1% of all isolates), A niger (36.9%), and Candida albicans (8.2%).
Factors Associated with Post-tonsillectomy Hemorrhage
Authors: Collison Patrick J. , Mettler Bret
Published: May 2019

Despite the otolaryngologist's most diligent efforts to prevent it, hemorrhage is the most common, albeit sporadic, significant complication of tonsillectomy. For this retrospective study of post-tonsillectomy hemorrhage rates, we examined the charts of 430 consecutive tonsillectomy patients who had been operated on by one of two general otolaryngologists at our institution. The two surgeons used the same removal technique (cold dissection and snare), but slightly different methods of hemostasis.

We found that the overall bleeding rate was 4%; the primary (<24 hr) hemorrhage rate was 0.23%, and the secondary rate was 3.7%. Factors that were positively correlated with postoperative bleeding were the patient's sex, the time of year the surgery was performed, the length of the procedure, the amount of blood lost during surgery, and the use of intraoperative vasoconstrictors and steroids. However, we believe the use of steroids can probably be discounted as a causative factor.

The χ2 test was used to determine statistical significance. None of the 21 patients who were operated on for peritonsillar abscess experienced any delayed postoperative bleeding. The mean decrease in hemoglobin was 2.3 grams; the lowest postoperative level was 6.6 grams. The highest incidence of delayed bleeding occurred on the eighth postoperative day. Two patients required transfusions, and both recovered without any adverse consequences.

It appears that one controllable variable in preventing delayed bleeding following tonsillectomy and adenoidectomy might be related to certain details of hemostatic technique. Vasoconstrictors and “field” cauterization might be associated with an increased temporal and spatial application of coagulating current. Although this technique is very effective in preventing primary hemorrhage, it does result in a deeper and more extensive zone of necrosis and the exposure of more and larger vessels when sloughing of the eschar occurs.
Nasal Congestion: A Review of its Etiology, Evaluation, and Treatment
Authors: Corey Jacquelynne P. , Houser Steven M. , Ng Bernard A.
Published: May 2019

The most common clinical syndromes that cause nasal congestion are allergic rhinitis, vasomotor rhinitis, chronic sinusitis, and upper respiratory viral infections (common colds). Nasal congestion, in turn, can lead to sequelae such as sinusitis, otitis media, and the onset or worsening of mild to severe sleep disturbances, including obstructive sleep apnea. There is a host of conservative treatments, including decongestant pharmacotherapy, antiallergy measures, and nasal dilation devices. Several surgical procedures are also available. This article reviews the current guidelines for the workup and diagnosis of nasal congestion and briefly describes the many and varied approaches to treatment.
Primary Non-Hodgkin's Lymphoma of the Frontal Sinus: How we Diagnosed it
Authors: El-Hakim Hamdy , Ahsan Farhan , Wills Leslie C.
Published: May 2019

Isolated primary non-Hodgkin's lymphoma of the frontal sinus is rare. We describe the case of a middle-aged man who came to us with signs of orbital cellulitis complicating an acute infected frontal mucocele. His condition was initially controlled with medical therapy and subsequent endoscopic sinus surgery, but his symptoms eventually returned. We were able to diagnose the lymphoma only by approaching the sinus externally to obtain a biopsy. This case highlights the importance of making a full visual inspection of the involved sinus in order to avoid missing an unexpected, albeit a rarely encountered, pathology.
Zinc Nasal gel for the Treatment of Common Cold Symptoms: A Double-blind, Placebo-controlled Trial
Authors: Hirt Michael , Nobel Sion , Barron Ernesto
Published: May 2019

Effective treatments for the common cold have been difficult to develop because so many different types of virus are responsible for this condition. Oral zinc has been studied as a possible means of preventing or alleviating symptoms, with mixed results. We studied a new approach to zinc therapy—an over-the-counter nasal gel formulation (Zicam)—to independently evaluate its efficacy as a treatment for the common cold. Our study was conducted at four sites over a 5-month period. The study group consisted of 213 patients with recent-onset (≤24 hr) cold symptoms; 108 patients received zinc therapy, and 105 received placebo. Symptom charts were used to track the duration and severity of each patient's symptoms. At study's end, the duration of symptoms was 2.3 days (± 0.9) in the zinc group and 9.0 days (± 2.5) in the control group—a statistically significant difference (p< 0.05). These results provide evidence that zinc nasal gel is effective in shortening the duration of common cold symptoms when taken within 24 hours of their onset.
Myringoplasty with a Single Flap
Authors: Gupta S.C.
Published: May 2019

This article describes a myringoplasty technique that involves the use of a single flap of meatal skin and tympanic membrane epithelium. The procedure was performed on 148 patients. A success rate of 90.5% was achieved, with early epithelialization of the grafted tympanic membrane and the avoidance of various problems encountered in the performance of other forms of myringoplasty.
The Effect of Recreational Gunfire Noise on Hearing in Workers Exposed to Occupational Noise
Authors: Stewart Michael , Konkle Dan F. , Simpson Thomas H.
Published: May 2019

Hearing sensitivity for an experimental group of 278 industrial workers who engaged in recreational shooting was compared with that of an age-matched control group of 278 nonshooting industrial workers to examine the effect of gunfire exposure on auditory thresholds. The influence of age and the number of unprotected gunshot exposures per year also was examined. The subjects in the experimental group completed a questionnaire to define the types of firearms used, the number of years shooting, and the number of protected and unprotected gunshot exposures per year. Results revealed that hearing sensitivity for frequencies 3.0, 4.0, and 6.0 kHz for both ears in the experimental group was an average of approximately 5 to 10 dB poorer than that of the control subjects. Although both subject groups demonstrated poorer 3.0-to-6.0-kHz hearing sensitivity for left-ear compared with right-ear listening, the degree of asymmetry between ears was greater for the experimental subjects. Older shooters had more hearing loss and greater threshold asymmetry than younger shooters, but there was no significant relationship between hearing sensitivity and the number of unprotected exposures per year. This latter finding was attributed to a fourfold increase in the number of unprotected annual exposures that were reported by younger shooters, who had inherently better hearing than did the older shooters.
Myoepithelioma of the Parotid Gland: A Report of two Cases
Authors: Turgut Suat , Çekiç Ali , Ergül Gülüsan , Aksoy Fehmi , Seçkin Selda , Özdem Cafer
Published: May 2019

We describe the clinical and pathologic features of two benign myoepitheliomas of the parotid gland. Through 1985, only 42 other cases had been reported in the literature—39 benign and three malignant. Fewer than 100 cases had been reported through 1993. Since then, two other reports have been published. But are these tumors really rare, or are they simply not well recognized? It is our opinion that they are not as rare as is generally believed because the number of case reports is increasing as pathologists have become more aware of their existence.
Lingual Artery Embolization for Severe and Uncontrollable Postoperative Tonsillar Bleeding
Authors: Levy Elad I. , Horowitz Michael B. , Cahill Anne M.
Published: May 2019

We performed emergent angiography of the external carotid artery to evaluate a patient who experienced uncontrollable oropharyngeal bleeding 3 days following an adenotonsillectomy. Angiography demonstrated a left lingual artery disruption and hemorrhage. We then performed a coil embolization of the left lingual artery, which immediately halted the hemorrhage. We conclude that coil embolization is a rapid and effective strategy for the management of massive, uncontrollable postoperative tonsillar bleeding.
Nasopharyngeal Abscess and Facial Paralysis as Complications of Petrous Apicitis: A Case Report
Authors: Fitzgerald Dennis C.
Published: May 2019

An 83-year-old man with a lifelong history of intermittent otorrhea and hearing loss was referred for management of a facial paralysis of 3 weeks’ duration. Computed tomography (CT) of the head detected a neoplasm of the nasopharynx along with chronic otomastoiditis. A followup CT suggested the development of a nasopharyngeal abscess, which was confirmed by needle aspiration. A later coronal-projection CT showed definite bone destruction in the anterior petrous apex, confirming suspicions that a petrous apicitis was responsible for the facial paralysis and abscess. This article describes the management of this patient and reviews the historical, medical, and surgical aspects of petrous apicitis.
Superficial Leiomyosarcoma of the Head and Neck: Case Report and Review of the Literature
Authors: Snowden R. Todd , Osborn F. David , Wong Frank S.H. , Sebelik Merry E.
Published: May 2019

Superficial leiomyosarcomas are rare in the head and neck region. Because of the infrequent nature of soft tissue sarcomas in general, superficial leiomyosarcomas are often misdiagnosed on clinical grounds. Immunohistochemistry is essential for an accurate histologic diagnosis, and it should include a broad panel of antibody studies. With respect to differences in clinical appearance and biologic behavior, superficial leiomyosarcomas can be broadly classified as either cutaneous or subcutaneous; local control and overall survival are significantly more favorable in patients with the former. The primary treatment of a leiomyosarcoma is a wide surgical excision with an emphasis on negative margins. Treatment failures are usually attributable to a local recurrence. Systemic metastasis occurs in about one-third of patients with subcutaneous involvement. Although cutaneous leiomyosarcoma is considered a relatively more benign process with minimal metastatic potential, systemic metastasis is still possible. This was demonstrated in our case, as a recurrent cutaneous leiomyosarcoma metastasized to the lung. Proper management requires inclusion of this entity in the differential diagnosis, as well as familiarity with its clinical behavior. In this article, we review the literature on superficial leiomyosarcoma and discuss its epidemiology, presentation, clinical behavior, evaluation, tissue diagnosis, staging, and treatment.
Unilateral versus Bilateral Neck Exploration in Parathyroid Surgery: An Assessment of 55 Cases
Authors: Kacker Ashutosh , Komisar Arnold
Published: May 2019

We retrospectively evaluated the cases of 55 patients who had undergone surgery for primary hyperparathyroidism at our institution to determine whether their parathyroid glands were abnormal on both sides. Thirty-six of these patients had undergone a bilateral neck exploration, and 19 had had a unilateral investigation. Of the 36 bilaterally explored patients, 30 had a solitary adenoma and no parathyroid pathology on the opposite side, five patients had hyperplastic glands with more than one gland involved, and one patient had two adenomas. In the unilaterally explored group, all 19 patients had a solitary adenoma. There were no failures in the way of persistent hypercalcemia in either group. Based on our findings, we conclude that a unilateral neck exploration should be performed during surgery for primary hyperparathyroidism whenever a large parathyroid adenoma and a normal parathyroid gland are found on the same side. Bilateral exploration should be reserved for patients in whom pathology cannot be found on the initially explored side during surgery and for patients who have obvious parathyroid hyperplasia.
Malignant Fibrous Histiocytoma Arising in the Upper Posterior Triangle of the Neck
Authors: Lin Ho-Sheng , Sidhu Gurdip , Wieczorek Rosemary L. , Doud Galli Suzanne R. , Kaufman David
Published: May 2019

We describe the case of a 59-year-old man who came to us with a right neck mass of 4 to 5 months’ duration. A histologic diagnosis of malignant fibrous histiocytoma was made, and the patient underwent wide local excision and neck dissection followed by postoperative radiation therapy. We briefly discuss the characteristics and treatment of this rare entity.
Use of Adenoidectomy and Adenotonsillectomy in Children with Otitis Media with Effusion
Authors: Abdul-Baqi Khader J. , Shakhatreh Farouk M. , Khader Qasim A.
Published: May 2019

We conducted a prospective study of 48 children, aged 2 to 14 years, who had persistent bilateral otitis media with effusion, enlarged adenoids, and a bilateral conductive hearing loss. Half of these patients underwent adenoidectomy and the other half adenotonsillectomy. All patients were followed every 2 weeks for up to 6 months. At 2 months postoperatively, the overall success rate in terms of the resolution of middle ear effusion was 85.1%. Success rates were 82.6% in the adenoidectomy group and 87.5% in the adenotonsillectomy group; the difference was not statistically significant. Our findings demonstrate that both adenoidectomy and adenotonsillectomy are effective for the treatment of persistent otitis media with effusion, and they confirm the findings of other studies. Based on our findings and those of other investigators, we offer a four-step approach to the management of these children.
Midfacial Osteomyelitis in a Chronic Cocaine Abuser: A Case Report
Authors: Talbott Jason F. , Gorti Gouthan K. , Koch R. James
Published: May 2019

We describe the case of a 56-year-old man who was admitted for treatment of a progressive destruction of his hard palate, septum, nasal cartilage, and soft palate that had been caused by chronic cocaine inhalation. Biopsy of the bony septum revealed acute osteomyelitis and an extensive overgrowth of bacteria and Actinomyces- like organisms. There was no evidence of granuloma or neoplasm. The patient received intravenous ampicillin/sulbactam for 6 weeks, followed by lifetime oral amoxicillin. When there was no further evidence that destruction was progressing, the patient underwent nasal reconstruction with a cranial bone graft. The surgery was completed with no complications. To our knowledge, this is the first reported case of midfacial osteomyelitis associated with chronic cocaine abuse. The severity of this patient's complications, coupled with the success of his reconstructive surgery, makes this case particularly interesting. We believe that it is important for physicians to understand that septal perforation in a cocaine abuser should not be underestimated because it could result in a secondary bone infection. Nasoseptal destruction secondary to intranasal cocaine abuse is a result of cocaine's vasoconstrictive properties, and a decrease in the oxygen tension of intranasal tissue can facilitate the growth of anaerobic pathogens.
Microscopic Removal of an Embedded Foreign Body from the Hypopharynx: Report of two Cases
Authors: Shu Min-Tsan , Leu Yi-Shing
Published: May 2019

Incidents of foreign bodies in the hypopharynx, especially fish bones, are very common. In most cases, these bones can be easily located and removed. However, in other cases, they become embedded in the pharyngeal wall and cannot be located, even by fiberoptic endoscopy and rigid esophagoscopy. Left in place, these foreign bodies can eventually cause serious complications. We treated two patients who had an embedded foreign body in the hypopharyngeal wall that we were unable to locate by fiberoptic endoscopy and rigid esophagoscopy. Ultimately, we performed direct laryngoscopy and were able to locate and remove the foreign bodies with the aid of a microscope.
Laryngeal Adenoid Cystic Carcinoma in a Child: A Case Report
Authors: Javadi Morteza , Bafrouee Fathollah Mousavi , Mohseni Mohammad , Asghari Alimohamad
Published: May 2019

Adenoid cystic carcinoma is a malignant tumor of the major and minor salivary glands. Because it grows very slowly, it is often diagnosed at a late stage. The combination of a delayed diagnosis and the tumor's propensity for early perineural and hematologic spread increases the risk of local recurrence and systemic metastasis, often many years after the primary tumor has been diagnosed and treated. Only 80 cases of adenoid cystic carcinoma of the larynx have been previously reported in the literature. We report a new case of laryngeal subglottic adenoid cystic carcinoma in a 12-year-old boy.
Technique and Timing for Closed Reduction of Isolated Nasal Fractures: A Retrospective Study
Authors: Ridder Gerd Jürgen , Boedeker Carsten Christof , Fradis Milo , Schipper Jörg
Published: May 2019

Isolated fractures of the nasal pyramid are among the most common facial injuries. Nevertheless, studies of therapeutic results following closed reduction of nasal fractures are rare. We conducted a retrospective clinical review of 187 patients who were evaluated for nasal trauma (including nondislocated fractures, dislocated fractures, and contusions) at our otolaryngology department during 1997 and 1998. Of this group, 96 fractures were treated with closed reduction—either under local anesthesia (n = 68), under general anesthesia (n = 21), or with concomitant septoplasty under general anesthesia (n = 7). At follow-up, which ranged from 1 to 2 years, 91 of the 96 patients (94.8%) expressed satisfaction with their results. Prior to deciding on a course of action, the surgeon must conduct a careful physical examination because the decision as to whether treatment is required, which technique to use (open vs closed reduction), and which type of anesthesia is appropriate (local vs general) all depend on the clinical findings, such as the degree of deviation and airflow obstruction. We also suggest that all patients receive both a Waters’ view and a lateral view x-ray. In our opinion, closed reduction is a safe procedure for isolated nasal fractures and can be performed with local anesthesia in most adult patients. Morbidity is minimal in the hands of an experienced ENT surgeon.
Seborrheic Keratosis of the Auricle: Report of an Unusual Case
Authors: Kyrmizakis Dionysios E. , Vrentzos Emmanuel E. , Papadakis Chariton E. , Chroniaris Nick E. , Bizakis John G. , Amanakis Zaharias E.
Published: May 2019

Seborrheic keratoses are superficial epithelial lesions. They are usually pigmented and often warty, but sometimes they appear as smooth papules. These lesions frequently occur on the face during middle and old age. We report an unusual case of a large seborrheic keratosis of the auricle. We also emphasize the importance of the differential diagnosis, and we discuss the treatment strategy for these usually benign but disfiguring tumors.
Extramedullary Plasmacytoma Manifesting as a Palpable Mass in the Nasal Cavity
Authors: Windfuhr Jochen P. , Ott German
Published: May 2019

We report a rare case of plasmacytoma of the nasal cavity in a 60-year-old man. The patient had a history of a steadily growing and palpable mass in the opening of the left nostril. The tumor was found to be localized, and it was identified as an extramedullary plasmacytoma. The patient underwent therapy with 55 Gy of radiation. Six months following the cessation of radiotherapy, the size of the tumor had not changed. The mass was then completely excised under microscopic vision. Histopathologic examination identified the growth as a plasmacytoma with monotypic light-chain expression. To optimize the management of patients with an extramedullary plasmacytoma of the head and neck, interdisciplinary management is mandatory.
Homograft Microlathed Femur Prosthesis in Stapedectomy
Authors: McGee Michael , Hough J.V.D. , Wood Mark W.
Published: May 2019

The use of homografts in ossiculoplasty has been well documented in the literature. In the early 1980s, nonossicular homograft otic capsule bone was used as a prosthetic material in stapedectomy. We began using homograft femur as a prosthetic material in the early 1990s. In this article, we report the results of a retrospective study of the use of homograft femur prostheses. A series of 300 stapedectomies was performed between Aug. 24, 1992, and Jan. 20, 2000. Total footplate removal with preservation of the posterior crus was our procedure of choice. However, in 116 of these cases, the posterior crus could not be used, and a homograft femur prosthesis was substituted. For these prostheses, all homograft femurs were obtained from the American Red Cross. All prostheses were prepared in the bone laboratory and stored in the bone bank until needed. After an adequate period of follow-up, we tabulated our results. We found that in 89 of 113 cases (78.8%) available for follow-up, the air-bone gap was completely closed. In addition, the air-bone gap was closed to within 5 dB in 11 patients (9.7%) and closed to within 10 dB in five patients (4.4%). In all, 105 of the 113 homograft femur prosthetic procedures (92.9%) resulted in a successful outcome.
Basaloid Squamous Cell Carcinoma of the Larynx: Report of a Case
Authors: Prasad Kishore Chandra , Kaniyur Vishnu , Devan P.P. , Kedakalathil Jithendran
Published: May 2019

Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma. This malignancy has a predilection for the upper aerodigestive tract, although it has been found in multiple other sites. The tumor is highly aggressive biologically, and the overall prognosis is poor despite intensive treatment. We describe a case of basaloid squamous cell carcinoma of the larynx that metastasized to the spine.
Congenital Absence of the Incus Bilaterally without other Otologic Anomalies: A New Case Report
Authors: Rahbar Reza , Neault Marilyn W. , Kenna Margaret A.
Published: May 2019

We describe only the third reported case of congenital, bilaterally absent incudes that were not accompanied by another otologic abnormality. This condition was detected in a 3-year-old boy who was being evaluated for a hearing impairment and speech and language delay. The patient was treated with partial ossicular replacement prostheses, which resulted in an improvement in his hearing.
Schneiderian Papilloma of the Nasopharynx
Authors: Low Wong-Kein , Toh Song-Tar , Lim Chee-Meng , Ramesh Girija
Published: May 2019

We report a rare case of a schneiderian papilloma of the nasopharynx. Because this tumor is locally invasive, has a tendency to recur, and can undergo malignant transformation, it should be completely excised. It is possible to completely remove such a tumor in a minimally invasive way by using a combination of transnasal and transoral approaches and high-resolution angled endoscopes and other suitably designed instruments.