bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant Therapy for Organ Preservation in Head and Neck Cancer
Authors: Urba Susan G. , Wolf Gregory T. , Bradford Carol R. , Thornton Allan F. , Eisbruch Avraham , Terrell Jeffrey E. , Carpenter Veronica , Miller Tamara , Tang Gong , Strawderman Myla
Published: November 2003

Objectives/Hypothesis We designed two sequential trials of induction chemotherapy followed by definitive radiation in patients with potentially resectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival.

Study Design Both trials were Phase II studies.

Methods Two clinical trials were conducted sequentially at the University of Michigan. Fifty‐two patients enrolled in the first study and were treated with a planned three cycles of carboplatin and 5‐fluorouracil. Patients who achieved at least 50% reduction in the size of the primary tumor received definitive radiation therapy, to a dose of 6600 to 7380 cGy. Patients with minimal response or progression had immediate salvage surgery. Thirty‐seven patients enrolled in the second trial, in which the chemotherapy consisted of carboplatin, 5‐fluororuracil, and leukovorin. Responders were treated with accelerated radiation therapy, to a total dose of 7120 cGy delivered in 41 fractions over 5.5 weeks.

Results Toxicity and response were similar in both trials; therefore, the results are reported first separately and then combined for all 89 patients. Tumor sites included: oropharynx, 55 patients; hypopharynx, 34 patients. Eighty‐three percent of patients tolerated all three cycles of chemotherapy and toxicity was mild. Response to chemotherapy was: 48% complete response at the primary tumor site, and 34% partial response at the primary tumor site. Initial organ preservation at individual tumor sites was: oropharynx, 58%; hypopharynx, 59%. Median survival was 28 months, and survival at 3 and 5 years was 40% and 24%, respectively.

Conclusions These two regimens were well tolerated, and survival did not appear to be compromised by organ preservation treatment compared with historical controls. This approach warrants further investigation, particularly in those patients for whom surgery could be functionally debilitating.
Immunohistochemical Absence of CD21 Membrane Receptor in Nasopharyngeal Carcinoma Cells Infected by Epstein‐Barr Virus in Spanish Patients
Authors: Burgos Javier S. , Vera‐Sempere Francisco J.
Published: November 2003

Objectives/Hypothesis The aim of this study was to analyze the relevance of the CD21 membrane receptor in nasopharyngeal carcinoma (NPC). CD21 is implicated in the introduction of the Epstein‐Barr virus (EBV) genome into epithelial cells and B lymphocytes.

Study Design Immunohistochemical analysis of CD21 in NPC.

Methods Paraffin‐embedded samples of NPC of different histological types with demonstrated presence of EBV were analyzed for CD21 expression using immunohistochemistry.

Results We detected EBV by non‐isotopic in situ hybridization (NISH) and nested polymerase chain reaction (PCR) in 100% of samples, regardless of histological type, supporting the previous view that all the types of NPC are variants of an EBV‐associated malignancy. CD21 was not detected in NPC, and this absence was a typical feature in our data group.

Conclusions The loss of the CD21 membrane receptor could be one of the immunophenotypical changes of the neoplastic cells that occur in the evolution of the NPC malignancy.
Effect of Mechanical Reinforcement on Stability of the Rotary Door Flap Laryngotracheal Reconstruction: a Canine Study
Authors: Stein Jeannine M. , Eliashar Ron , Eliachar Isaac , Strome Marshall
Published: November 2003

Objective/Hypothesis The rotary door flap (RDF) laryngotracheal reconstructive procedure uses a 180° rotation of the sternohyoid muscle into a laryngofissure. Despite excellent clinical results, there are concerns of flap inspiratory prolapse. This study examined RDF stability and the efficacy of ancillary materials in providing additional support.

Methods Seventeen dogs underwent endoscopic induction of subglottic stenosis and delayed RDF reconstruction. Animals received 1) traditional RDF (control), 2) RDF with titanium screen implant, 3) RDF with porous polyethylene implant, or 4) RDF with hydroxyapatite cement (HAC) injection. Four weeks postoperatively the flaps were tested for stability. On qualitative assessment, endoscopic visualization was completed with quiet respiration and then following endotracheal tube occlusion. On quantitative assessment, after animals were killed, the RDF segment was isolated and subjected to negative pressure (maximum pressure, −50 mm Hg). The pressure‐causing collapse was measured.

Results In the traditional RDF animals (control), five of six flaps were stable in vivo and with negative pressures. In the titanium screen, porous polyethylene group, and HAC groups, respectively, four of four, three of four, and two of three flaps were stable in vivo and under negative pressure. Flaps that demonstrated instability had granulation, dehiscence, and poor healing. These occurred in 1 of 6 animals in the traditional RDF group and in 2 of 11 animals in the implant groups. In addition, 13 of 24 animals assigned to the implant groups died, compared with 2 of 8 of those in the traditional RDF group.

Conclusions The RDF is stable and maintains the airway under physiological conditions. Support materials did not improve stability, render flap harvest more difficult, or increase morbidity and mortality.
Preoperative Functional Assessment of Auditory Cortex in Adult Cochlear Implant Users
Authors: Roland Peter S. , Tobey Emily A. , Devous Michael D.
Published: November 2003

Objectives To e‐plore functional neuroanatomical responses to auditory stimulation before and after implantation.

Study Design A prospective study of three cochlear implant candidates (pure‐tone averages of 90 dB HL or greater bilaterally and hearing in noise test [HINT] performances of <40%) in which regional cerebral blood flow (rCBF) was assessed using single photon emission computed tomography (SPECT).

Methods Candidates watched a 15‐minute videotaped story under four conditions: audio presented monaurally in the right and left ears (aided), audio presented binaurally (aided), and visual‐only presentation of the story. Five minutes into each story, 20 to 25 mCi of technetium 99m (99mTc) hexamethyl‐propyleneamine‐oxime (HMPAO) (Ceratec; Nycomed Amersham, Princeton, NJ, U.S.A.) was injected over a 30‐second period to ensure that subjects were unaware of tracer administration. Subjects were scanned for 20 minutes using a PRISM 3000 gamma camera (Picker International, Cleveland, OH, U.S.A.). Data were normalized and co‐registered, and subtraction images were compiled. Subtraction images contrasted activation patterns generated under the visual‐only control condition to the auditory activation states acquired monaurally and binaurally.

Results Right and left ear monaural stimulation in normal hearing subjects resulted in significant bilateral activation of Brodmann areas 41, 42, 21, 22, and 38. Although substantial intersubject response variability was noted, subjects generally failed to bilaterally activate these areas under monaural hearing aid presentations; however, bilateral activation of areas 41 and 22 was noted under binaural presentations.

Conclusions Despite relatively similar hearing losses in each ear, significant differences in preoperative auditory corte‐ activation were observed between ears. These data suggest that functional brain imaging provides a useful tool for e‐ploring the responsiveness of the auditory corte‐ in cochlear implant candidates.
Vestibular End‐Organ Impairment in an Animal Model of Type 2 Diabetes Mellitus
Authors: Perez Ronen , Ziv Ehud , Freeman Sharon , Sichel Jean‐Yves , Sohmer Haim
Published: November 2003

Objectives/Hypothesis To define and assess the functional impairment of the vestibular part of the inner ear in a diabetic state, using a direct and objective test for evaluating the vestibular end‐organ and an animal model for diet‐induced type 2 diabetes mellitus.

Study Design Prospective controlled animal study.

Methods Two groups of sand rats (Psammomys obesus) were maintained on two different diets. The experimental group received a specially designed high‐energy diet known to induce a diabetic state, and the control group a low‐energy diet maintaining these animals in a normal metabolic state. After 1 month of documented hyperglycemia in the experimental group, recordings of vestibular evoked potentials (VsEPs) and recordings of auditory brainstem response (ABR) were conducted in all animals. The latency and the amplitude of the first wave of both responses, shown to reflect end‐organ activity, were compared between the two groups.

Results The mean latency of the first wave of the VsEPs was significantly (P = .002) prolonged and the amplitude was significantly (P = .005) decreased in the diabetic group in comparison to the control group. The latency of the first wave of ABR was significantly (P = .02) prolonged, the amplitude was not significantly decreased, and threshold was significantly elevated (P = .01) in the diabetic group.

Conclusion For the first time, using an objective assessment test, functional impairment of the vestibular part of the inner ear has been demonstrated in the diabetic metabolic state. Despite this being an animal study, these findings would seem to indicate that the vestibular‐end‐organ should be added to the long list of organs and tissues adversely affected by diabetes.
Microwave Decalcification of Human Temporal Bones
Authors: Cunningham Calhoun D. , Schulte Bradley A. , Bianchi Lynne M. , Weber Peter C. , Schmiedt Barbara N.
Published: November 2003

Objectives/Hypothesis Morphological and immunohistochemical studies of human temporal bones are challenging as a result of difficulties in obtaining reliably fi‐ed specimens and the lengthy time required for decalcification, typically 4 to 7 months. A novel method of processing human temporal bones using a microwave oven to accelerate decalcification is described. This procedure provides a rapid means of decalcifying temporal bones with good preservation of tissue morphology and antigenicity.

Methods Human temporal bone specimens obtained at autopsy (n = 12, from specimens aged 43–91 y) were fixed within 6.5 hours of death by transtympanic perilymphatic perfusion of the inner ear. Decalcification was carried out using ethylenediaminetetra‐acetic acid (EDTA) in a microwave oven and required only 3 to 6 weeks. Specimens were then dehydrated, embedded in paraffin, sectioned, and mounted on slides for morphological and immunohistochemical evaluation.

Results Microscopic e‐amination revealed no obvious artifacts attributable to the microwave decalcification process. The quality of morphological preservation was largely dependent on the postmortem fi‐ation interval and adequacy of perilymphatic perfusion. Immunohistochemical analysis demonstrated strong positive staining for the enzyme Na,K‐ATPase, an integral membrane protein.

Conclusions This study demonstrates that microwave decalcification provides an efficient and reliable means of processing human temporal bones for histological and histochemical e‐amination. Decalcification time is significantly reduced with no apparent adverse effects on structural preservation or antigenicity.
The Clinical Features of Functional Dysphonia
Authors: Sama A. , Carding P. N. , Price S. , Kelly P. , Wilson J. A.
Published: November 2003

Objective This report aims to study the prevalence of features of laryngeal muscle tension in a population of patients with functional dysphonia (FD) and nondysphonic control subjects.

Study Design Prospective control‐blinded, cross‐sectional study.

Methods We reported on a prospective control‐blinded, cross‐sectional study of the prevalence of the six features described by Van Lawrence and the six features incorporated in the Morrison‐Rammage classification. A senior laryngologist and senior speech pathologist independently rated sound‐free, random‐sequence video laryngoscopies of 51 patients with FD and 52 nondysphonic control subjects. Assessments were made of the presence or absence of the 12 laryngoscopic features of laryngeal dysfunction, and an overall rating made of the vocal technique as “normal” or “abnormal.”

Results More than 60% of the control population demonstrated 1 or more of the 12 features of hyperfunction. There was no significant difference in the prevalence of the six Van Lawrence features, the six Morrison‐Rammage features, or the total number of abnormal features between patients with FD and control subjects. On overall assessment, both assessors noted a high prevalence (50% and 36%, respectively) of abnormal vocal technique in the control population. There was no statistical difference in the total number of abnormal features observed between patients with FD and control subjects. Positive predictive value calculations showed that the presence of a clinical feature, at best, presented a 75% chance of correctly identifying a patient with FD and, at worst, a 50% chance.

Conclusion The laryngoscopy features commonly associated with FD are frequently prevalent in the nondysphonic population and fail to distinguish patients with FD from normal subjects.
The Nucleus Contour Electrode Array: A Radiological and Histological Study
Authors: Richter Bernhard , Aschendorff Antje , Lohnstein Petra , Husstedt Hartmut , Nagursky Heiner , Laszig Roland
Published: November 2003

Objectives To evaluate the handling and insertion trauma of the recently developed Nucleus perimodiolar Contour electrode array (Cochlear Ltd., Pty, Lane Cove, New South Wales, Australia) in human temporal bones compared with the Nucleus standard straight electrode array.

Study Design E‐perimental control group.

Methods Twenty‐nine fresh‐frozen bones were implanted with different electrode arrays by an experienced cochlear implant surgeon, and evaluated both radiologically and histologically.

Results Intracochlear insertion of the standard Nucleus straight electrode array was found to be atraumatic, confirming previous findings in the literature. Insertion of the Nucleus Contour electrode array resulted in instances of localized basilar membrane penetration causing the electrode array to move from the scala tympani into the scala vestibuli. However, this trauma did not result in any observable damage to the osseous spiral lamina or the modiolus. Basilar membrane penetration was observed in six of eight cochlear bones when a standard cochleostomy size (approximately 0.8 mm) and site (anterior and superior to the round window) were used. However, when the surgical technique was modified to use a slightly larger cochleostomy (approximately 1.8 mm) situated closer to the round window and employ a partial stylet withdrawal technique during electrode insertion, the frequency of penetrations was restricted to two of seven bones. This trauma rate is comparable to that observed with other cochlear implants designs.

Conclusions Following our results, the design of the Nucleus Contour electrode appears to fulfill the safety requirements for an intracochlear electrode array, provided that the surgical insertion technique is modified in the manner outlined.
Frontal and Lateral Cephalometry in Patients With Sleep‐Disordered Breathing
Authors: Finkelstein Yehuda , Wexler David , Horowitz Eran , Berger Gilead , Nachmani Ariela , Shapiro‐Feinberg Myra , Ophir Dov
Published: November 2003

Objectives/Hypothesis The traditional lateral‐view cephalometric analysis is limited because it provides only two‐dimensional analysis of the three‐dimensional craniofacial structure. The objectives were to analyze lateral and frontal cephalometric radiographs in a series of normal patients and those with varying degrees of sleep‐disordered breathing and to define the degrees of narrowing or other unfavorable anatomical changes that might differentiate the patients with sleep‐disordered breathing from normal subjects.

Study Design A prospective study of 100 adult patients with sleep‐disordered breathing and 60 age‐matched normal subjects.

Methods An analysis of the lateral and frontal cephalometric measurements was performed to assess velopharyngeal anatomical features. A comparison was made between the patients' polysomnographic and cephalometric analyses.

Results The compromised cephalometric parameters that may be found in patients with sleep‐disordered breathing include acute skull‐base and bony nasopharynx angles, inferior hyoid position, thickening of the velum, reduced retrovelar posterior air space along with thickening of the velum, thickening of the posterior pharyngeal wall, and narrowing of the velopharyngeal lumen. Worsening of sleep‐disordered breathing was generally associated with increased numbers of compromised cephalometric parameters. As body mass index increases, there is reduced velopharyngeal width, the velum thickness is increased, and the posterior pharyngeal wall thickness is increased.

Conclusions Sleep‐disordered breathing is associated with statistically significant changes in a number of cephalometric measurements. Frontal cephalometric analysis adds further information regarding the anatomical assessment of patients with upper airway obstruction, enhancing the traditional lateral cephalometric view.
Carcinoma of the Larynx: Predictors of Diagnostic Delay
Authors: Habermann Walter , Berghold Andrea , J. DeVaney Trevor T. , Friedrich Gerhard
Published: November 2003

Objectives In tumors of the upper aerodigestive tract a dose‐response relationship between tumor stage and its prognosis raises the chance of a reduction in the diagnostic delay. The interval between the first symptom and the start of tumor‐specific therapy and the influencing factors is not well known. The goals of this study were to investigate the diagnostic delay and the influencing factors and to predict the factors that prolong the diagnostic process.

Study Design Prospective, nonrandomized study.

Methods The intervals between first symptom and first consultation of a physician (patient delay) and between first consultation and first tumor‐specific therapy (doctor delay) were investigated. Predictors for increased patient or doctor delay were evaluated, and a multiple logistic regression model for increased doctor delay was developed.

Results The total diagnostic delay (sum of patient and doctor delays) was 3 to 4 months. A multifactorial model for the ratio of odds revealed that for women and glottic cancers (1.73) the chance was twice as high for a doctor delay greater than 30 days, whereas subjects with an increased patient delay (>30 d) had reduced odds of being delayed by the physician.

Conclusions The higher chance of extended doctor delay for glottic tumors compared with supraglottic tumors should be reflected in differential therapeutic strategies. Even unspecific lesions of the vocal folds should be followed up at the end of the therapy, at least. Therapies of glottic lesions without final control have the chance of resulting in delays in treatment. Women, especially, should be included in a follow‐up examination. On the other hand, patients with increased patient delay have lower odds of longer doctor delay, which may be the result of tumor growth and, consequently, easier diagnosis.
Partial Frontolateral Laryngectomy With Epiglottic Reconstruction for Management of Early‐Stage Glottic Carcinoma
Authors: Giovanni Antoine , Guelfucci Bruno , Gras Régis , Yu Ping , Zanaret Michel
Published: November 2003

Objectives The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma.

Study Design Retrospective study.

Methods Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased.

Results Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five‐year survival rates calculated according to the Kaplan‐Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow‐up of 5 years.

Conclusion These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.
Tympanic Membrane Repair With a Dermal Allograft
Authors: Laidlaw Douglas W. , Costantino Peter D. , Govindaraj Satish , Hiltzik David H. , Catalano Peter J.
Published: November 2003

Objectives To assess the use of an acellular dermal allograft in the repair of chronic tympanic membrane perforations. Chronic tympanic membrane perforations are a common problem in otolaryngology, and although surgical tympanoplasty using either temporalis fascia or rice paper has proven to be highly successful, these materials are not without their own limitations. The search has continued for a simpler, yet equally effective, means of repairing persistent tympanic membrane perforations in an office setting. In this study we experimentally evaluated the use of an acellular dermis (AlloDerm, (LifeCell Corporation, The Woodlands, TX) as an alternative to traditional tympanoplasty materials.

Study Design Prospective study using 28 adult chinchillas.

Methods Subtotal tympanic membrane perforations were created bilaterally in 28 adult chinchillas. Animals with noninfected, stable perforations that showed no signs of epithelial regeneration after 5 to 8 weeks were used to compare the use of rice paper patch with AlloDerm in patch tympanoplasties.

Results Eighteen of 23 tympanoplasties (78%) that were performed using AlloDerm showed no signs of perforation after 5 to 6 weeks. In those performed using rice paper control, 14 of 21 (66%) showed no signs of perforation after 5 to 6 weeks. In addition, histological evaluation of the healed tympanic membranes demonstrated that the acellular dermis had been incorporated within the middle fibrous layer of the tympanic membrane.

Conclusions The results and histological studies suggest that acellular dermis may be a suitable alternative to traditional materials currently used for patch tympanoplasty. Future studies to evaluate the efficacy of acellular dermis in humans are warranted.
Genetic Testing and Genetic Counseling for Deafness: The Future Is Here
Authors: Brunger Jeannie Weir , Matthews Anne L. , Smith Richard H. J. , Robin Nathaniel H.
Published: November 2003

Today, genetic testing is an option for individuals who have deafness and hard‐of‐hearing conditions (D/HOH) and their families for diagnosis and carrier detection. As more and more D/HOH genes are identified, genetic testing will become commonplace. However, genetic testing is different from other tests that physicians commonly order and therefore should be conducted differently. The objective of this study was to determine the best manner in which to conduct genetic testing for individuals who have D/HOH.

Numerous studies have shown that pretest and post‐test genetic counseling is beneficial for patients and families undergoing genetic testing for a variety of conditions. The need for counseling was emphasized by our recently completed study in which we found that the majority of individuals whose children had genetic testing for D/HOH had a poor understanding of many genetic issues concerning recurrence risks for D/HOH and the meaning of the test results. We think that genetic counseling should be an integral part of genetic testing for individuals who have D/HOH.
Epstein‐Barr Virus DNA Is Not Increased in Tonsillar Carcinoma
Authors: Khabie Nissim , Savva Athanasia , Kasperbauer Jan L. , McGovern Renee , Gostout Bobbie , Strome Scott E.
Published: November 2003

Epstein‐Barr virus (EBV) is a known oncogenic virus associated with a wide variety of cancers, including nasopharyngeal carcinoma. Waldeyer's ring, a collection of lymphoid tissues, includes the nasopharynx, pharyngeal, and lingual tonsils. To determine if EBV plays a causative role in carcinomas arising from other tissues in Waldeyer's ring, we examined pharyngeal tonsillar carcinomas for evidence of EBV infection. As previously reported, DNA was extracted from 53 consecutive tonsil cancers, as well as from age‐ and gender‐matched non‐cancerous tonsillectomy specimens. Three different sets of primers for discrete exons of EBV were then used to determine if active or latent EBV infection was expressed in the extracted DNA using the polymerase chain reaction (PCR). All positive bands were then sequenced to confirm the presence of amplified EBV fragments. None of the samples showed evidence for active EBV infection. In primers demonstrating latent infection, 1 of 53 (1.9%) of tumors were positive, versus 6 of 53 (11.3%) of the controls. These results indicate that EBV expression is not increased in DNA from tonsil cancers and that EBV infection does not have a causal relationship with tonsil cancer.
Molecular Biological Diagnosis of Congenital and Acquired Cholesteatoma on the Basis of Differences in Telomere Length
Authors: Kojima Hiromi , Miyazaki Hidemi , Shiwa Masanori , Tanaka Yasuhiro , Moriyama Hiroshi
Published: November 2003

Objective To establish a molecular biological basis for differentiation of congenital and acquired cholesteatoma.

Study Design The time of onset was estimated for congenital cholesteatoma and for acquired cholesteatoma by comparing the telomere length and the telomerase activity in the tissues of both diseases with the values of those parameters in normal external ear canal skin.

Methods The telomere length was determined by extracting DNA from each tissue and then applying the Southern blot technique to hybridize it with a 32P‐labeled telomeric oligonucleotide (TAAGGG)8 probe. The telomerase activity was analyzed by a modification of the polymerase chain reaction–based telomeric repeat amplification protocol.

Results The telomere length in congenital cholesteatoma tissue was shorter than the length in normal external ear canal skin from the same patient, whereas in acquired cholesteatoma tissue the telomere length was almost the same as in the normal external ear canal skin. Some of the acquired cholesteatoma tissue specimens and normal external ear canal skin specimens were positive for telomerase activity, but all of the specimens of congenital cholesteatoma tissue were negative for telomerase activity. No correlation was found between the presence of telomerase activity and the telomere length.

Conclusions The present results indicate that congenital cholesteatoma manifests at an earlier time compared with acquired cholesteatoma, and the results can be thought to support the theory that congenital cholesteatoma originates from vestigial fetal tissue or aberrant tissue. In addition, the finding that telomerase activity was weak in the congenital cholesteatoma tissue suggests the possibility that vestigial fetal tissues and aberrant tissues are naturally eliminated in normal subjects as a result of apoptosis.
A Morphological Study of Age Changes in Adult Human Auricular Cartilage With Special Emphasis on Elastic Fibers
Authors: Ito Isamu , Imada Masato , Ikeda Minoru , Sueno Kouhei , Arikuni Tomio , Kida Akinori
Published: November 2003

Objective It is well known that the size of the human auricle increases after it has finished development. The reason why the size of the human auricle continues to enlarge until advanced age after reaching adulthood was investigated by observation of the ultrastructure of elastic fibers in human auricular cartilage.

Methods A total of 1958 subjects (966 males and 992 females) were classified into 18 age groups from 0 to 5 years up to 85 years and above by 5‐year intervals. Ear length, ear width, and length of ear attachment were measured with calipers. Human auricular cartilage was obtained from 26 subjects (16 males and 10 females) aged 14 to 79 years, stained by orcein, and examined by light and electron microscopy.

Results Each item of measurement of human auricular size increased significantly with age in both males and females. On morphological examination by light and electron microscopy after orcein staining, elastic fibers in the cartilage were almost homogeneous in diameter and surrounded the cartilage lacuna in bundle‐like fashion in young persons, whereas those in elderly persons were heterogeneous in thickness and had many fragments surrounding the territorial matrix. In elderly persons, collagen‐like fibers and small vesicles with heterogeneous electron density were frequently observed near elastic bundles around the territorial matrix.

Conclusion Structural changes of auricular cartilage associated with morphological age changes of elastic fibers may be one of the causes of expansion of the auricle after reaching adulthood.
The Road to Danger: The Comparative Risks of Driving While Sleepy
Authors: Powell Nelson B. , Schechtman Kenneth B. , Riley Robert W. , Li Kasey , Troell Robert , Guilleminault Christian
Published: November 2003

Objectives/Hypothesis A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions resulting in human error, accidents, and catastrophic events. The magnitude of risks in the workplace or on the highways resulting from sleepiness is not fully understood or appreciated by the general population. Hence, to more clearly emphasize the magnitude of these risks, we question whether mild sleep deprivation may have the same effect as alcohol on reaction times and driving performance.

Study Design Nonrandomized prospective cohort investigation.

Methods Sixteen healthy matched adult subjects (50% women) were stratified into two groups, sleep deprived and alcohol challenged. The sleep‐deprived group was further subdivided into acute (one night without sleep) and chronic (2 h less sleep nightly for 7 d) sleep deprivation. Each group underwent baseline reaction time testing and then drove on a closed course set up to test performance. Seven days later, the group repeated this sequence after either sleep deprivation or alcohol intake.

Results There were no significant between‐group differences (sleep deprivation or alcohol challenged) in the changes before and after intervention for all 11 reaction time test metrics. Moreover, with few exceptions, the magnitude of change was nearly identical in the two groups, despite a mean blood alcohol concentration of 0.089 g/dL in the alcohol‐challenged group. On‐track driving performances were similar (P = .724) when change scores (hits and errors) between groups were compared (baseline minus final driving trial).

Conclusion This comparative model suggests that the potential risks of driving while sleepy are at least as dangerous as the risks of driving illegally under the influence of alcohol.
Health‐Related Quality of Life in Patients With Laryngeal Cancer: A Post‐Treatment Comparison of Different Modes of Communication
Authors: Finizia Caterina , Bergman Bengt
Published: November 2003

Introduction The effects of different treatment modalities and voice and speech rehabilitation methods on the quality of life in patients with laryngeal cancer are not fully understood.

Materials and Methods A cross‐sectional post‐treatment questionnaire survey of 125 patients with laryngeal cancer was performed. The response rate was 74%. Three patient groups were identified: patients treated with radiotherapy and communicating with preserved larynx (n = 70), laryngectomized patients using a tracheoesophageal prosthesis (TEP) for speech (n = 14), and laryngectomized patients communicating with an electrolarynx (n = 5). Two established generic questionnaires, the Sickness Impact Profile (SIP) and the Hospital Anxiety and Depression (HAD) scale, were used.

Results The radiotherapy and the TEP groups displayed similar SIP and HAD profiles. No significant differences were seen in favor of the radiotherapy group, whereas the TEP group reported fewer problems in the SIP sleep/rest subscale. In 10 of 12 SIP categories, the numerically highest proportion of patients with clinically important dysfunction (SIP scores >10) was found in the small electrolarynx group.

Conclusion Successful speech rehabilitation with a TEP after laryngectomy may be as effective as conservative treatment with radiotherapy for laryngeal cancer with regard to psychosocial adjustment and functional ability, as measured with generic quality of life instruments.
An Investigation of Airway Wound Healing Using a Novel in vivo Model
Authors: Hardillo Jose , Vanclooster Christoph , Delaere Pierre R.
Published: November 2003

Objective To study the amount of wound contraction and reepithelialization occurring in the healing process of full‐thickness mucosal defects treated with and without mitomycin.

Study Design A new wound healing model was developed in which the tracheal mucosa was exteriorized without interference with the blood supply or with the cartilage support of the trachea. This was done by: 1) orthotopic tracheal revascularization in vascularized fascia; 2) isolation of revascularized segment after 14 days; 3) posterior longitudinal incision of revascularized segment; 4) exteriorization of tracheal mucosa with formation of anterior full‐thickness mucosal defect; and 5) closure of posterior tracheal incision and reimplantation in the airway. This model was used to study airway wound healing in three groups of animals: 1) controls (revascularization, exteriorization, reimplantation) (N = 6); 2) full‐thickness mucosal defect: patch defect (N = 5), circumferential defect (N = 3); and 3) full‐thickness mucosal defect after topical mitomycin application: patch defect (N = 7), circumferential defect (N = 3). The animals were followed for periods varying from 2 to 4 weeks or until signs of dyspnea. The surface areas of the wounds before and after follow‐up were measured. Wound healing was studied histologically on axial and longitudinal sections.

Results Group 1: All the animals survived for 1 month. No significant difference existed between surface area of isolated trachea and of reimplanted trachea after follow‐up. Group 2: Five animals (patch defects) survived for 1 month. Full‐thickness mucosal defects healed by reepithelialization and by a surface area reduction of 58.9% (mean ‐ standard deviation = 10.5). The animals with the circumferential defects showed dyspnea after an average follow‐up of 14 days as a result of excessive granulation tissue formation. Group 3: Mitomycin reproducibly inhibited wound closure, yielding wounds that on average closed 56% less than controls by day 14 (P <.001). Histologic comparisons showed that mitomycin blocks angiogenesis during wound healing.

Conclusions A wound healing model based on tracheal revascularization, isolation, and reimplantation was developed in rabbits. This model allowed us to study the healing of full‐thickness mucosal defects inside the airway.
Functional Magnetic Resonance Imaging of the Pediatric Swallow: Imaging the Cortex and the Brainstem
Authors: Hartnick Christopher J. , Rudolph Colin , Willging J. Paul , Holland Scott K.
Published: November 2003

Objective To design and implement a functional magnetic resonance imaging (fMRI) protocol to investigate the cortical and brainstem patterns of activity in children with regard to the act of swallowing.

Study Design Pilot study to assess the clinical feasibility of the project.

Methods Using a 3T Bruker Biospec 30/60 MRI scanner, images were obtained using the Behavior Interleaved Gradient/Blood Oxygen Level Dependent (BIG‐BOLD) image acquisition method. Initially, regions of interest (ROI) were developed to identify the mean time from the onset of a swallow to maximum cortical blood flow in the motor cortex. Using this data to design the BIG‐BOLD acquisition method followed by postprocessing of the data, images from two volunteer adults and four volunteer children were obtained.

Results The average time from the onset of a swallow to maximum cortical blood flow was 6 to 8 seconds. Regions of cortical activity include pre‐ and post‐central gyrus (Brodmann's areas 3 and 4), superior motor cortex (B.A. 24), insula, inferior frontal cortex (B.A. 44 and 45), Heschl gyrus (B.A. 41 and 42), putamen, globus pallidus, and the superior temporal gyrus (B.A. 38). Of particular note is the first mapping of the functional activity of swallowing at the level of the brainstem; activity was seen in the region of the nucleus ambiguous.

Conclusions fMRI provides a novel means of studying the central processes of both normal swallowing and its various pathologic forms in children. Further understanding of how a child coordinates a swallow and how this coordination can be altered at the level of the brainstem and cortex may aid in the development of novel rehabilitative strategies.
Pulsed‐Dye Laser and Retinoic Acid Delay Progression of Oral Squamous Cell Carcinoma: A Murine Model
Authors: Shah Rahul K. , Valdez Tulio A. , Wang Zhi , Shapshay Stanley M.
Published: November 2003

Objectives/Hypothesis This study examined the role of the pulsed‐dye laser (PDL) at 585 nm coupled with retinoic acid at therapeutic (5.0 mg/kg) and nontherapeutic (0.5 mg/kg) doses to delay the progression of cancer with a two‐hit approach. The existing vasculature is selectively targeted by the laser, whereas retinoic acid inhibits future angiogenesis.

Study Design Randomized, prospective study in a murine model.

Methods Twenty‐five athymic nude mice were inoculated with oral squamous cell cancers on six flank sites and randomly divided into five groups: 1) control subjects, 2) treatment with 0.5 mg/kg retinoic acid (RA 0.5), 3) treatment with 5.0 mg/kg retinoic acid (RA 5.0), 4) treatment with RA 0.5 + PDL, and 5) treatment with RA 5.0 + PDL. The PDL groups received irradiation after inoculation. The retinoic acid was administered daily. The tumors were counted and measured for 14 days.

Results The control group developed visible tumors in 50% of the inoculation sites at 3 days compared with 3 days (RA 0.5) and 4 days (RA 5.0) for the retinoic acid groups and 9 days (RA 0.5 + PDL) and 10 days (RA 5.0 + PDL) for the laser treatment groups. There was no tumor growth until day 7 in the RA 5.0 + PDL group. The tumor volume was statistically different between the treatment groups.

Conclusion This study demonstrated the superiority of a single treatment with the PDL coupled with retinoic acid to delay the progression of cancer when compared with treatment with retinoic acid alone, thus introducing a novel strategy in cancer control.
Nasal Ciliary Function and Ultrastructure in Down Syndrome
Authors: Piatti Gioia , Allegra Luigi , Ambrosetti Umberto , De Santi Maria Margherita
Published: November 2003

Objectives/Hypothesis To investigate the in vivo nasal ciliary beat and the ciliary ultrastructure in Down syndrome because, although in this condition an increased susceptibility to respiratory tract infections has been reported by several authors, the nature of this phenomenon is not fully understood.

Study Design Experimental study of 18 subjects with Down syndrome and 18 healthy control subjects.

Methods Ciliary beat frequency (CBF) was measured on samples of ciliated epithelium obtained from the inferior nasal turbinate; a further brushing for ultrastructural analysis was performed only in subjects showing a CBF reduction or a ciliary movement alteration.

Results The mean CBF in the group with Down syndrome was 7 ± 2.82 Hz, and in the control subjects it was 10.94 ± 0.65 Hz. In the same 66.6% of subjects with Down syndrome, we observed a fibrillatory movement of cilia and no metachronicity was present. Moreover, in 14 subjects with Down syndrome as hyperproduction of mucus was present. Ultrastructural evaluation at transmission election microscopy instead revealed a normal architecture of cilia.

Conclusion We attribute the nature of the mucociliary defect in Down syndrome to recurrent respiratory tract infections causing changes in mucus properties as in rheological parameters and not to a primitive defect of cilia.
A Large Arteriovenous Malformation of the External Ear in an Adult: Report of a Case and Approach to Management
Authors: Pham Tuan H. , Wong Brian J. F. , Allison Glenn
Published: November 2003

Objectives/Hypothesis Arteriovenous malformations involving the external ear are relatively uncommon in adults. Arteriovenous malformations in the head and neck can poses difficult therapeutic challenges.

Study Design Case report.

Methods We report a case of a large arteriovenous malformation in the external ear in a 41‐year‐old man.

Results Extensive enlargement of the previously latent and asymptomatic arteriovenous malformation was triggered by blunt trauma to the ear.

Conclusion We discuss the definition, clinical findings, diagnostic approaches, and therapeutic management of arteriovenous malformations.
Surgical Management of Retropharyngeal Space Infections in Children
Authors: Kirse Daniel J. , Roberson David W.
Published: November 2003

Objective To study the perioperative management strategies in a large group of pediatric patients undergoing surgical therapy for suppurative adenitis of the parapharyngeal and retropharyngeal spaces.

Study Design Retrospective analysis of all patients treated surgically from January 1, 1989, to December 31, 1998, in a tertiary care pediatric hospital.

Methods Charts were reviewed for demographic data, duration and nature of symptoms, radiological workup, surgical approach, complications, duration of medical therapy and antibiotic choice, and bacteriological findings. Computed tomography (CT) results were correlated to surgical findings.

Results A dramatic increase in the incidence of deep neck space infection was seen during the study period; this increase was congruent with the increase in culture‐positive group A β‐hemolytic streptococcal abscesses. More than two‐thirds of the patients were boys with the peak incidence being in the 3‐ to 5‐year‐old group. The duration of symptoms before presentation was less than might be expected, especially in the younger age groups. Seventy of 73 children were treated with a transoral approach. Sixty‐eight of 73 were successfully treated with one operative intervention. Irregularity of the abscess wall was found to be a stronger predictor of the presence of pus than the presence of ring enhancement.

Conclusions The current study represents the largest series of pediatric retropharyngeal abscesses in the modern medical literature. Changes in the disease process and in management from the first half of the century to today are reviewed, and recommendations for optimal management presented. The data in this series support a transoral approach to these abscesses unless there is extension lateral to the great vessels.
Cochlear Implantation in Healthy and Otitis‐Prone Children: A Prospective Study
Authors: Luntz Michal , Teszler Christian B. , Shpak Talma , Feiglin Hava , Farah‐Sima'an Afnan
Published: November 2003

Objective To evaluate and compare the timing of surgery, intraoperative findings, and otitis media‐related outcome of cochlear implantation in children who are otitis‐prone with their counterparts who are not otitis‐prone.

Study Design Prospective.

Methods Children referred for cochlear implantation were assigned to a non‐otitis‐prone group (group A: normal otoscopy on their first visit after referral) or an otitis‐prone group (group B: current or a recent history of otitis media at referral). Group B patients were managed using a structured protocol aimed at preimplantation otitis media control. The study reviewed pre‐, intra‐, and postoperative data.

Results Of the 18 children studied, 8 were assigned to group A (mean age at referral, 40.6 mo) and 10 to group B (mean age at referral, 31.6 mo). For otitis media control, all otitis‐prone children underwent ventilating tube insertion (various numbers of procedures before implantation). Only one otitis‐prone child required cortical mastoidectomy also. Time from referral to implantation was similar in the two groups (mean, 6.6 mo). High‐resolution computed tomography data showed mastoid pneumatization to be significantly smaller in the otitis‐prone group, but the facial recess was not smaller in this group. During implantation, 10 children had inflamed middle ear mucosa. Seven of these belonged to group B. All of these seven children had a round window niche obliterated by the inflamed mucosa, which had to be removed for round window membrane identification. After implantation, only one child had drainage through the ventilating tube for more than 1 week. Two children in group B developed otitis media (1 year postimplantation) that was overcome within 1 week. There were no otitis media‐related complications.

Conclusions If a structured protocol is used for the control of otitis media before cochlear implantation, otitis media should not require a delay in implantation. In otitis media‐prone children, the round window niche is often obscured by inflamed mucosa. Its removal is mandatory for identification of the round window membrane. After cochlear implantation, otitis media is not a frequent occurrence.
Relationship of Vestibular Aqueduct and Inner Ear Pressure in Ménière's Disease and the Normal Population
Authors: Sennaroglu Levent , Ylmazer Cuneyt , Basaran Figen , Sennaroglu Gonca , Gursel Bulent
Published: November 2003

Objective Etiopathogenesis of Ménière's disease has not been resolved. The principal histopathologic finding in this disease is endolymphatic hydrops. The majority of radiologic and histopathologic studies demonstrated a narrow vestibular aqueduct in Ménière's disease. There is no study in the literature investigating the relationship between inner ear pressure and vestibular aqueduct dimensions. Static acoustic compliance is a noninvasive procedure that is thought to measure perilymphatic pressure at the footplate. An increase in mechanical fluid pressure in the inner ear is transmitted to the footplate of the stapes. This causes a reduction in the compliance at the drum. The aim of this study is to investigate the relationship between vestibular aqueduct dimensions and static acoustic compliance in Ménière's disease and the normal population.

Study Design Prospective study.

Methods Forty patients with Ménière's disease and 40 healthy individuals with no otolaryngologic disorders were the subjects of this study. Each group was further divided into two according to static compliance value (normal and low static compliance). In these four groups dimensions of vestibular aqueduct were determined radiologically by high‐resolution computerized tomography and correlated with normal and low static acoustic compliance values (normal and high perilymphatic pressure).

Results The results demonstrated that vestibular aqueduct is narrower in patients with Ménière's disease than the normal population. However, there is no relationship between vestibular aqueduct dimensions and inner ear pressure obtained by static acoustic compliance measurements.