bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation of Fungi by Standard Laboratory Methods in Patients With Chronic Rhinosinusitis
Authors: Lebowitz Richard A. , Waltzman Michael N. , Jacobs Joseph B. , Pearlman Aaron , Tierno Philip M.
Published: November 2003

Objectives/Hypothesis Allergic fungal sinusitis and the role of fungi in the pathogenesis of chronic rhinosinusitis are topics of interest and controversy in rhinology. The classification of chronic rhinosinusitis as either a bacterial infection or an allergic (eosinophilic) reaction to fungi has significant implications for treatment of this disease process. We designed a study to determine whether standard isolation techniques, as employed in a university hospital mycology laboratory, could isolate and identify fungi in the intraoperative specimens from patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis.

Study Design Forty‐five random patients with a diagnosis of chronic rhinosinusitis by clinical and computed tomography criteria underwent endoscopic sinus surgery during 2001, performed by two senior surgeons (j.b.j., r.a.l.). Specimens of mucin, sinus secretions, and/or tissue were obtained intraoperatively and sent to the New York University Medical Center (New York, NY) mycology laboratory for isolation and identification of fungi.

Methods Specimens were treated with Sputolysin and chloramphenicol; plated on Sabouraud, ChromAgar/Candida, Mycosel, and Niger seed agar plates; and incubated at 30°C (or 37°C) for up to 1 month.

Results We were able to demonstrate the presence of fungi in 56% of intraoperative specimens obtained from patients undergoing surgery for chronic rhinosinusitis.

Conclusions Using a standard hospital mycology laboratory protocol, which is relatively inexpensive and readily available, fungus can be isolated from a majority of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Educational statement: Discuss the possible role of fungus in chronic rhinosinusitis and evaluate the efficacy of documenting the presence of fungus in a routine fashion to encourage clinically relevant directed treatments.)
Multiple Motor Unit Recordings of Laryngeal Muscles: The Technique of Vector Laryngeal Electromyography
Authors: Roark Rick M. , Li James C. L. , Schaefer Steven D. , Adam Alexander , De Luca Carlo J.
Published: November 2003

Objectives To display time‐series firing rate and recruitment data for multiple, simultaneously active motoneurons activating human laryngeal muscles. These data provide specific information about how laryngeal muscle force is being controlled by the central nervous system at the level of the lower motoneuron.

Methods A quadrifilar needle electrode was used to record multi‐channel myoelectric signals from thyroarytenoid muscle of normal subjects during tasks ranging from quiet breathing to a short sentence. Motor unit action potentials of the signal space were identified and tracked throughout task productions using pattern recognition and Precision Decomposition software.

Results We present the first recordings and analyses of multiple motor unit activations in the larynx. The firing times and mean firing rates are plotted for each identified motor unit, which reveal recruitment and decruitment information and the database from which common firing statistics across motor units may be derived.

Conclusions This study provides new information about neuromuscular physiology of the larynx. Specifically, the results reveal the ordered recruitment and firing patterns of multiple motor units and the existence of common drive from the central nervous system. The technique may prove fundamental to understanding various neuromuscular pathologies such as laryngeal spasm and to assist clinical prognosis of laryngeal paresis and the diagnosis of certain neurogenic disorders.
The Role of Transnasal Esophagoscopy in Head and Neck Oncology
Authors: Postma Gregory N. , Bach Kevin K. , Belafsky Peter C. , Koufman James A.
Published: November 2003

Objectives/Hypothesis To review the current role of transnasal esophagoscopy (TNE) in all aspects of head and neck cancer patient treatment.

Study Design A retrospective database and chart review.

Methods A retrospective review of head and neck cancer patients undergoing TNE for a variety of diagnostic and therapeutic indications.

Results In a series of 17 patients with presumed head and neck malignancies, TNE provided 100% accuracy in biopsy results and staging of the tumor when compared with standard panendoscopy. The utility of TNE in other areas of head and neck cancer management, such as stricture dilation and secondary tracheoesophageal puncture, is demonstrated. This preliminary report strongly suggests that TNE may play a vital role in the management of head and neck oncology patients.

Conclusions Transnasal esophagoscopy gives the surgeon the ability to perform a remarkable variety of procedures in the outpatient setting without sedation. It may obviate the need for routine panendoscopy in head and neck cancer patients.
Effect of Chronic and Short‐Term Erythropoietin Treatment on Random Flap Survival in Rats: An Experimental Study
Authors: Saray Aydin , Ozakpinar Rifat , Koc Can , Serel Savas , Sen Zeynep , Can Zeki
Published: November 2003

Objective The use of perioperative erythropoietin (EPO) therapy is gaining popularity to avoid blood transfusion and correct anemia in head and neck cancer surgery. The purpose of the study was to determine the effect of various doses and durations of EPO treatment on random flap survival.

Study Design A McFarlane type random and musculocutaneous (3 × 10 cm) flap were elevated on the dorsum of each rat.

Methods Eighty‐four male Albino rats were randomly assigned into seven groups (2 animals in each group): group I, control animals receiving placebo; group II, chronic EPO injections (50 U/kg); group III, chronic EPO injections (100 mg/kg); group IV, chronic EPO injections (150 mg/kg); group V, short‐term EPO injections (50 mg/kg); group VI, short‐term EPO injections (100 mg/kg); and group VII, short‐term EPO injections (150 mg/kg). Rats in groups II to IV began to receive EPO 3 weeks (thrice weekly) before the construction of flaps, and rats in groups V to VII received EPO after flap elevation for 1 week (thrice) subcutaneously. Following 7 days of recovery, the area of flap survival was measured. Hematocrit and systolic blood pressure were followed weekly in all groups.

Results Erythropoietin increased the hematocrit levels and systolic blood pressure in all groups, but significant increases were noted only in the long‐term treatment groups. There was a significant increase in distal necrosis of random skin flaps after long‐term EPO treatment (P <.05). However, short‐term low and therapeutic doses of EPO improved flap survival significantly (P <.05).

Conclusions Long‐term EPO treatment might have impaired flap survival because of direct or prostaglandin‐mediated vasoconstriction, endothelin‐induced hypertension, increased peripheral vascular resistance, hyperviscosity, and increased thrombosis. However, EPO might have enhanced flap survival because of its antioxidant effect and modulation of nitric oxide levels. Effects of EPO are controversial, and further research is necessary to delineate the dose and duration relationship and the exact mechanism of action on flap viability.
The Treatment of Drooling by Ultrasound‐Guided Intraglandular Injections of Botulinum Toxin Type A Into the Salivary Glands
Authors: Jongerius Peter H. , Joosten Frank , Hoogen Frank J. A. , Gabreels Fons J. M. , Rotteveel Jan J.
Published: November 2003

Objective The aim of the study was to present the background, procedure, and technique of bilateral ultrasound‐guided, single‐dose injections of botulinum toxin type A (BTX) into the salivary glands in patients with severe drooling.

Study Design Clinical trial.

Methods Initially, an in vitro study was performed to determine the volume of the dilution of BTX required for optimal spreading and to gain insight in the spreading pattern of the fluid in the submandibular gland. Subsequently, patients with severe drooling were included in a clinical study. Salivary flow was measured under standardized conditions, and BTX was injected into the submandibular glands with the patient under general anesthesia and with ultrasound guidance as an outpatient procedure or during a short stay at the daytime care unit.

Results BTX for each gland should be diluted in a volume of 1 to 1.5 mL saline to achieve adequate spreading within the gland and to diminish the risk of diffusion into surrounding structures. With ultrasound guidance, separate structures surrounding the glands and structures within the glandular parenchyma are well recognized and injection errors can be avoided.

Conclusions With the procedure described, it is possible to accurately inject BTX directly into the glandular parenchyma and to visualize spreading of the fluid in the glandular parenchyma. It is found to be a safe method that guarantees an optimal clinical effect and avoids potentially harmful side effects. We recommend ultrasound guidance if injections of BTX into the salivary glands are considered.
Delayed Optic Nerve Decompression for Indirect Optic Nerve Injury
Authors: Thakar A. , Mahapatra A. K. , Tandon D. A.
Published: November 2003

Objective To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury.

Study Design Critical analysis of Proforma‐based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks.

Methods Thirty‐five cases with a median injury to surgery interval of 56 days (range, 16–374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre‐ and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated.

Results Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 ± 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P = .97).

Conclusions Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.
Bipolar Radiofrequency‐Induced Thermotherapy of Turbinate Hypertrophy: Pilot Study and 20 Months' Follow‐up
Authors: Seeger Jan , Zenev Emil , Gundlach Peter , Stein Thomas , Müller Gerhard
Published: November 2003

Objectives/Hypothesis The present report is a pilot clinical study about a new bipolar ablation technique for the treatment of turbinate hypertrophy, which offers an alternative to conventional methods.

Study Design Prospective, clinical.

Methods From August 1999 to March 2000, a new bipolar radiofrequency system with acoustic feedback control was submucosally applied for the treatment of 38 patients with nasal airway obstruction of vasomotor (n = 31) or allergic (n = 7) genesis. The therapy was made ambulatory with surface anesthesia. Data were collected by questionnaire and rhinomanometry preoperatively and 2 and 20 months postoperatively.

Results Nearly all patients reported an improvement of their nasal breathing, with 68% of them reporting a full and 29% a partial recovery. No significant differences were reported with regard to the response of the allergic versus the vasomotor rhinitis. On average, a definite benefit was observed after 2 weeks. Side effects, such as bleeding, synechia, or atrophic changes of the mucosa, which would have to be treated, were not observed.

Conclusion The new bipolar radiofrequency thermotherapy presents an efficient option for the treatment of turbinate hypertrophy, which meets the requirements for an outpatient treatment.
Microdebrider Versus CO2 Laser Removal of Recurrent Respiratory Papillomas: A Prospective Analysis
Authors: Pasquale Kimberly , Wiatrak Brian , Woolley Audie , Lewis Linda
Published: November 2003

Objective To compare postoperative patient discomfort, voice quality, and procedure time and cost for removal of recurrent respiratory papillomas using the microdebrider versus the CO2 laser.

Study Design A randomized prospective study comparing children undergoing excision of recurrent respiratory papillomas by CO2 laser versus excision by microdebrider.

Methods For the 6‐month study, patients for whom removal of recurrent respiratory papillomas was indicated were randomly assigned by birth year to microdebrider or CO2 laser therapy. Disease severity was scored as the sum of ratings of 1+ (minimal), 2+ (moderate), or 3+ (severe) for involvement of 27 areas of the aerodigestive tract by direct microlaryngoscopy immediately before treatment. Parents scored patient discomfort and improvement in voice quality 24 hours after surgery, using a 5‐point (0 = no pain; 4 = worst pain) and a 10‐point (1 = minimal change; 10 = significant improvement) scale, respectively.

Results Nineteen patients ranging in age from 2.5 to 20 years underwent 32 procedures in all. Groups did not differ significantly in age, sex, or severity of disease. For disease of equivalent severity, microdebrider treatment was associated with equivalent 24‐hour‐postoperative pain scores, greater improvement in voice quality, shorter procedure times, and lower overall procedure cost.

Conclusions Immediate postoperative results indicate that the microdebrider may be as safe as and, at some institutions, might be more cost‐effective than the CO2 laser for removal of recurrent respiratory papillomas.
Eosinophilic Fungal Rhinosinusitis of the Lacrimal Sac
Authors: Facer Michelle L. , Ponikau Jens U. , Sherris David A.
Published: November 2003

Objectives/Hypothesis Chronic sinusitis is a condition affecting millions of individuals each year. Recent findings indicate that chronic rhinosinusitis is a response to fungi mediated by the eosinophil in some of these individuals. We report a case of eosinophilic fungal rhinosinusitis of the lacrimal sac, an entity not previously reported.

Study Design Case report.

Methods A 69‐year‐old man presented with a 1‐cm cystic lesion in the right‐side medial canthal region. This lesion was fluctuant, and mucoid material was freely expressed from the medial canthal area. Endoscopic examination revealed bilateral nasal polyps anteriorly and superiorly with mucopurulent drainage from both maxillary sinuses. He had undergone three prior sinus surgeries and two prior lacrimal cannulations elsewhere. A computed tomography scan showed opacification of both maxillary sinuses, ethmoid sinuses, and the left sphenoid sinus and moderate thickening in the frontal sinuses. There was significant soft tissue prominence in the area of both lacrimal fossae with erosion into the medial orbit. The patient underwent bilateral endoscopic revision ethmoidectomies, middle meatal antrostomies, sphenoidotomies, frontal sinusotomies, and endoscopic right‐side dacryocystorhinostomy at the Department of Otorhinolaryngology, Mayo Clinic (Rochester, MN).

Results At the time of surgery, massive amounts of thick mucoid material were aspirated from both lacrimal regions. The aspiration of the lacrimal duct on the left side was sufficient treatment, whereas the dacryocystorhinostomy was necessary to decompress the cyst of the face on the right side. The material aspirated was allergic mucin, and the patient met the criteria for diagnosing eosinophilic fungal rhinosinusitis. The patient was started on a regimen of antifungal nasal irrigations postoperatively and has done well in follow‐up.

Conclusions Although never previously reported, eosinophilic fungal rhinosinusitis can occur in the lacrimal sac. It is important to recognize this so that the underlying disease process can be treated appropriately.
The Effect of Mitomycin on Extracellular Matrix Proteins in a Rat Wound Model
Authors: Gray Steven D. , Tritle Nathan , Li Wenhua
Published: November 2003

Objective To evaluate the effect of topical and injected mitomycin on the expression of extracellular matrix proteins by fibroblasts in an early surgical wound model.

Study Design A prospective, controlled study in a rat wound model.

Methods Six linear incisions were placed on the backs of each of three Sprague‐Dawley rats, and polyvinyl alcohol sponges were implanted. Two control wounds were implanted with saline‐soaked sponges. The two topical test group wounds were treated with 0.5 mg/mL topical mitomycin for 2 minutes, followed by sponge implantation. The two injection test group wounds were injected with 0.3 mL mitomycin (0.5 mg/mL) before incision and sponge implantation. Each incision was closed uniformly with 3‐0 nylon suture. The sponges were harvested on the tenth postoperative day. Fibroblasts that had grown into the sponges were separated, and polymerase chain reaction analysis was used to quantify the expression of messenger RNA for several extracellular matrix proteins.

Results The expression of mRNA for some extracellular matrix proteins (elastase, hyaluronidase, and procollagen) was downregulated in the mitomycin test groups. The effect was more pronounced in the topical mitomycin test group compared with the injection test group. The wounds in the topical group were prone to dehiscence, and the wounds in the injection group demonstrated poor healing when compared with controls.

Conclusions Mitomycin may inhibit wound healing by downregulating the gene expression for extracellular matrix proteins. This effect may be selective and may be more pronounced on inducible genes. Such findings prompt further studies regarding possible “best time” windows and selective gene suppression. The use of mitomycin may be limited in situations where wound integrity is necessary.
Bacteria Detected by Culture and 16S rRNA Sequencing in Maxillary Sinus Samples From Intensive Care Unit Patients
Authors: Westergren Viveka , Bassiri Mansour , Engstrand Lars
Published: November 2003

Objectives/Hypothesis In critically ill patients, the occurrence of artificial ventilation–acquired sinus disease is common. A possible sinus bacterial infection is occult and is combined with diagnostic difficulties. Culture as a method has limited capacity to verify the presence of bacteria and leaves unanswered the question of a possible infective agent because bacteria are difficult to grow when killed or suppressed by current antibiotic therapy. Hitherto unidentified micro‐organisms are also possible in the microenvironments of maxillary sinuses.

Study Design Prospective case series.

Methods Twenty maxillary sinus samples (17 aspirates and 3 lavages) from nine critically ill patients with possible infectious disease were investigated by broad‐range 16S rRNA polymerase chain reaction followed by sequencing. These results were compared with the previous culture results from gingiva (passage route), maxillary sinus absorption, and mucosa samples.

Results The contaminations were rare (2 of 20) and corresponded well to culture results. One previously undiagnosed bacterium was found. Two aspirates were negative on both culture and polymerase chain reaction, whereas the corresponding maxillary sinus mucosal cultures had been positive.

Conclusions Applying a low‐contamination maxillary sinuses sampling technique makes 16S rRNA sequencing clinically useful. The polymerase chain reaction and culture results were generally comparable. However, by polymerase chain reaction, bacteria were found that were missed by culturing. Some aspirates were free of bacterial remnants on 16S rRNA polymerase chain reaction, but corresponding mucosal cultures were positive. This could indicate that infection is induced within the tissue. It also indicates that infectious agents introduced into the sinuses may have routes other than the ostium. Further clinical use of 16S rRNA sequencing is required to enlarge our knowledge in applied microbiology and paranasal sinus disease.
Investigating the Nasal Cycle Using Endoscopy, Rhinoresistometry, and Acoustic Rhinometry
Authors: Lang Christian , Grützenmacher Stefan , Mlynski Barbara , Plontke Stefan , Mlynski Gunter
Published: November 2003

Objectives Cyclic congestion and decongestion in the two nasal cavities is seen in connection with the respiratory function of the nose. The turbulent behavior of nasal airflow is a prerequisite for adequate contact of inspired air particles with the mucosa. The aim of this study was to gain insight into this turbulent behavior of nasal airflow during the nasal cycle.

Methods The nasal cycle in 10 healthy human subjects was investigated using endoscopic imaging, rhinoresistometry, and acoustic rhinometry every 20 minutes over a time period of up to 15 hours. The following parameters were recorded for each nasal cavity: airflow resistance, hydraulic diameter, friction coefficient λ as an indicator for the wall configuration triggering turbulence, transition from laminar to turbulent flow, and the minimal cross‐sectional areas.

Results In addition to the known cyclic change of flow resistance and nasal width, a periodic change in the turbulence behavior was observed. In the resting phase, mainly laminar flow was found. During the working phase, the onset of turbulence occurred already at low flow velocities. The increase of turbulence during the working phase is caused by the increase in cross‐sectional area in the anterior cavum due to decongestion of the mucosa of the head of the inferior turbinate and the septal tuberculum.

Conclusions Rhinoresistometry and acoustic rhinometry complement each other. The combination of the two methods provides insight into the functional changes during the nasal cycle and into nasal physiology in general. The authors therefore advocate a combination of the two methods for functional evaluation of the nasal airway.
Inflammation and Remodeling of the Sinus Mucosa in Children and Adults With Chronic Sinusitis
Authors: Sobol Steven E. , Fukakusa Moto , Christodoulopoulos Pota , Manoukian John J. , Schloss Melvin D. , Frenkiel Saul , Hamid Qutayba
Published: November 2003

Objectives/Hypothesis The sinus mucosal inflammatory response in adult patients with chronic sinusitis is well documented in the literature. In contrast, little is known about the pathogenesis of this condition in children. The objective of the study was to compare the inflammatory cell profile and the extent of tissue remodeling in the sinus mucosa of children and adults with chronic sinusitis.

Study Design Prospective design.

Methods Children (n = 7) and adult patients (n = 7) with chronic sinusitis undergoing functional endoscopic sinus surgery were recruited for the study. Patients with no evidence of sinus disease (n = 6) were used as control subjects. Using immunohistochemical analysis, sinus mucosal specimens were assessed for the presence of T lymphocytes, eosinophils, basophils, mast cells, and neutrophils. The extent of submucosal collagen deposition was evaluated in histological sections using van Gieson stain.

Results The number of T lymphocytes, eosinophils, and basophils and the amount of subepithelial collagen deposition are significantly higher in the mucosa of both adults and children with chronic sinusitis compared with normal control subjects (P <.01). The number of mast cells is significantly higher in the mucosa of children with chronic sinusitis compared with normal control subjects (P <.01). The number of eosinophils and neutrophils and the amount of subepithelial collagen deposition are significantly greater in adults compared with children with chronic sinusitis (P <.01).

Conclusions The sinus mucosal inflammatory profile is similar in adults and children with chronic sinusitis. However, the degree of tissue eosinophilia and remodeling is significantly greater in adult sinus specimens when compared with those of children with chronic sinusitis.
Postoperative Magnetic Resonance Imaging Findings After Transtemporal and Translabyrinthine Vestibular Schwannoma Resection
Authors: Brors Dominik , Schäfers Maria , Bodmer Daniel , Draf Wolfgang , Kahle Gabriele , Schick Bernhard
Published: November 2003

Objectives/Hypothesis Magnetic resonance imaging (MRI) has become the investigation of choice to follow up patients after vestibular schwannoma resection.

Study Design Retrospective.

Methods Postoperative MRI findings of 70 patients after vestibular schwannoma resection through a transtemporal (n = 48) and a translabyrinthine (n = 22) approach were reviewed. Time‐dependent changes in intensity, size, and shape of enhancement in the internal auditory canal before and after contrast administration, postoperative temporal lobe gliosis, and changes of fat grafts were evaluated.

Results After vestibular schwannoma resection, all patients showed signal enhancements in the internal auditory canal ranging from a faint to high signal intensity in the first postoperative MRI, 3 to 6 months after surgery. In the next MRI at 12 to 24 months after surgery, 30 patients (43%) showed a decreased signal, 35 patients (50%) a stable enhancement, and 5 patients (7%) an increased enhancement in the internal auditory canal depicted as an intense nodular or mass‐like pattern. In patients with decreased or stable enhancement, a residual tumor could be excluded in the following MRI scans, whereas in all patients with increased enhancements after 12 to 24 months, signal enhancement further increased and residual tumors were detected. Different degrees of temporal lobe gliosis were found in 15 of 48 cases (31%) after transtemporal tumor removal. Enhancement of fat grafts used in 22 cases decreased to different degrees in 14 cases (64%).

Conclusions Differentiation of residual tumor from scar tissue in the internal auditory canal after vestibular schwannoma resection requires close, long‐term follow‐up. Nodular and progressive enhancements in the internal auditory canal indicate residual tumor. Linear enhancement in the internal auditory canal has been found to be a common finding after vestibular schwannoma resection not associated with residual tumor.
Single Cell Analysis of Adenoid CD5+ B Cells and Their Protective Contributions to Nasopharyngeal Immunity
Authors: Arita Miori , Kodama Satoru , Suzuki Masashi , Mogi Goro
Published: November 2003

Objectives CD5+ B cells are phenotypically and functionally distinct from the conventional (CD5−) B cells, and the function of CD5+ B cells in the upper respiratory tract remains unknown. A previous study showed that immunoglobulin A–producing cells in the adenoid play a protective role in the nasopharynx. In the present study, the contribution of adenoid CD5+ B cells to nasopharyngeal immunity at the single cell level was investigated.

Study Design In vitro laboratory study.

Methods Mononuclear cells were isolated from adenoids of children aged 1 to 12 years, and the frequency of CD5+ B cells was determined by flow cytometry. The numbers of cells producing immunoglobulin M, immunoglobulin G, and immunoglobulin A in sorted adenoid CD5+ B cells were determined by enzyme‐linked immunospot assay. Further, to characterize adenoid CD5+ B cells, the expression of various surface molecules was analyzed by flow cytometry.

Results The results showed that adenoids of young children contain a relatively large number of CD5+ B cells, which have a greater capacity for antibody production than do CD5− B cells. CD5+ B cells also differed from CD5− B cells in the expression of interleukin receptors Il‐4R, IL‐5R, and IL‐10R as well as CD27, B7‐1, B7‐2, Fas, and Bcl‐2.

Conclusions These findings suggest that adenoid CD5+ B cells contribute to protective immunity by forming a first line of defense in the upper respiratory tract of young children and that they are probably regulated in a manner that differs from that of CD5− B cells.
Comparison of the Effects of Radiofrequency Tissue Ablation, CO2 Laser Ablation, and Partial Turbinectomy Applications on Nasal Mucociliary Functions
Authors: Şapçi Tarik , Şahin Betül , Karavus Ahmet , Akbulut Uğur Günter
Published: November 2003

Objectives One of the major causes of chronic nasal airway obstruction is disease of the inferior turbinate. However, there is no agreement on how to deal with this problem. Comparison was made of the nasal functions after treatment by radiofrequency tissue ablation, laser ablation, and partial turbinectomy using subjective symptom scores and objective tests.

Study Design Prospective, randomized clinical trial.

Methods The study was conducted on three groups of 45 adult volunteer patients with symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates. In group A, laser ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group B, radiofrequency tissue ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group C, patients who were not treated by any surgical techniques were the control subjects. Clinical examinations, visual analogue scales, rhinomanometry, and isotopic study of nasal mucociliary transport time were used to assess treatment outcomes.

Results At 12 weeks after surgery, the nasal mucociliary transport time results were compared in the same patients. The average time was 25.60 minutes on the side where laser ablation was applied and 11.40 minutes on the side where partial turbinectomy (PT) was applied. In the patients on whom radiofrequency tissue ablation and partial turbinectomy were applied, the average nasal mucociliary transport time was 10.33 minutes on the radiofrequency tissue ablation side, whereas it was 11.33 minutes on the partial turbinectomy side. Rhinomanometric measurements demonstrated a significant decrease in nasal resistances at 12 weeks in both sides in groups A and B.

Conclusions In the study it was demonstrated that radiofrequency tissue ablation to the turbinate is effective in improving nasal obstruction objectively and in preserving nasal mucociliary function. Laser ablation of the turbinate is effective in improving the nasal obstruction; however, it disturbs the mucociliary function significantly. With the partial turbinectomy technique, results obtained were similar to the results with the radiofrequency tissue ablation technique.
Vocal Cord Palsy Resulting From Spontaneous Carotid Dissection
Authors: Wessels Tiemo , Sparing R. , Neuschaefer‐Rube C. , Klötzsch C.
Published: November 2003

Objectives/Hypothesis Vocal cord palsy has a variety of causes, such as malignant tumors of the thyroid, lung, or upper mediastinum, aortic aneurysm, surgery of the thyroid, and infectious diseases.

Study Design Case report.

Methods A 43‐year‐old biologist had a holocephalic headache and right‐sided neck pain for 1 day. Five days later, he developed paralysis of the right‐side vocal cord. In addition, an angiotensin converting enzyme (ACE) inhibitor was administered because the patient had high systolic and diastolic blood pressures, which were formerly not known to the patient. Five days after admission, a temporary sensorimotor hemiparesis occurred.

Results Neurological examination revealed, in addition to the known paralysis of the right‐side vocal cord, right‐side palatoplegia, right‐side hypoglossal nerve palsy, and mild dysphagia. Duplex sonography showed evidence of lumen narrowing of the right‐side internal carotid artery caused by an hypoechogenic mural hematoma. Magnetic resonance imaging (0.5 T, Philips Gyroscan) revealed a circumscribed dissection of the right‐side internal carotid artery from the carotid bifurcation to the petrosal segment. The diffusion‐weighted magnetic resonance imaging scan of the brain also demonstrated multiple embolic ischemic lesions in the right hemisphere.

Conclusion Internal carotid artery dissection must be included in the differential diagnosis of lower cranial nerve palsy and should be assessed by duplex ultrasonography and magnetic resonance imaging.
Altered Fractionation and/or Adjuvant Chemotherapy in Definitive Irradiation of Squamous Cell Carcinoma of the Head and Neck
Authors: Mendenhall William M. , Riggs Charles E. , Amdur Robert J. , Hinerman Russell W. , Villaret Douglas B.
Published: November 2003

Objective To review the roles of altered fractionation and adjuvant chemotherapy in the treatment of patients with squamous cell carcinomas of the head and neck.

Study Design Review of the pertinent literature.

Methods The literature pertaining to altered fractionation and/or adjuvant chemotherapy for patients with squamous cell carcinomas of the head and neck was reviewed to define the optimal combination of radiotherapy and adjuvant chemotherapy.

Results The efficacy of altered fractionation compared with conventional fractionation depends on the fractionation schedule employed. Some hyperfractionated and accelerated fractionation schedules have resulted in improved locoregional control but no significant improvement in overall survival. In contrast to induction and maintenance chemotherapy, concomitant chemotherapy appears to result in improved locoregional control and survival.

Conclusions Altered fractionation and/or concomitant chemotherapy results in improved locoregional control and, in some instances, survival for patients with advanced head and neck cancer. Depending on primary site, the applicability of these aggressive treatment regimens is limited by an enhanced probability of severe complications as tumor volume increases. The optimal combination of these modalities is unclear and will be defined by future prospective trials.
Laser Eustachian Tuboplasty: A Preliminary Report
Authors: Poe Dennis S. , Metson Ralph B. , Kujawski Oskar
Published: November 2003

Objectives/Hypothesis Surgical correction of eustachian tube dysfunction remains an elusive challenge. Repeat ventilation tube placement is often inadequate to prevent tympanic membrane and middle ear complications. Endoscopic analyses of eustachian tube dynamics have localized the site of primary pathophysiology to within the cartilaginous tube. The study investigated the feasibility, safety, and efficacy of a new endoluminal eustachian tube operation for the treatment of eustachian tube dysfunction.

Study Design Prospective, institutional review board–approved surgical trial in a tertiary‐care medical center.

Methods Ten patients with more than 5 consecutive years of intractable otitis media with effusion recurring after two or more tympanostomy tube placements were treated with unilateral laser eustachian tuboplasty. Surgery was performed on an outpatient basis with the use of general anesthesia and combined both transnasal and transoral approaches. A 980‐nm diode or argon laser was used to vaporize an appropriate amount of mucosa and cartilage on the posterior wall of the tubal lumen. Preoperative and postoperative dynamic video eustachian tube function analyses were compared. Outcome measures were presence or absence of middle ear effusion and impedance tympanograms.

Results Five patients had at least 12 months of follow‐up, and three of them had absence of any effusion (60%). Two patients had recurrence of their otitis media with effusion and required tympanostomy tubes again. Five patients had at least 6 months of follow‐up, and four of them had absence of any effusion. The remaining patient had recurrence of otitis media with effusion and received a tympanostomy tube again. Overall results for all 10 patients after 6 months were 7 free of effusion (70%). There were no intraoperative complications. Postoperative complications were limited to minimal peritubal adhesions and one intranasal synechia.

Conclusions Preliminary results suggest that laser eustachian tuboplasty is safe and efficacious in the treatment of intractable eustachian tube dysfunction. Further study will be necessary to determine whether laser eustachian tuboplasty is a suitable alternative to repeated tympanostomy tube placement in selected patients.
Perioperative Adenotonsillectomy Management in Children: Current Practices
Authors: Kay David J. , Mehta Vishvesh , Goldsmith Ari J.
Published: November 2003

Objective To determine the current practices of preoperative evaluation, surgical techniques, and postoperative treatment of pediatric adenotonsillectomy.

Study Design Forty‐one‐item survey measuring the frequency of different evaluations, procedures, and treatments performed, including selected case scenarios, with all items scored on a five‐point ordinal scale ranking frequency.

Methods The entire membership of the American Society of Pediatric Otolaryngology (ASPO) and active fellows and members of the American Academy of Otolaryngology—Head and Neck Surgery (AAO–HNS) residing in New York state were anonymously surveyed through mail‐in questionnaires.

Results History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea. The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count; ASPO members ordered fewer preoperative laboratory tests than AAO–HNS members. Unipolar cautery is the most frequently used tonsillectomy technique, and curettage followed by cautery is the most popular adenoidectomy technique. Steroids are the most common intraoperative medication administered during an adenotonsillectomy, and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively.

Conclusions Although there are statistically significant trends uncovered by the survey, the results reflect a lack of consensus regarding adenotonsillectomy management. Further randomized controlled trials or large‐scale outcomes projects are much needed to evaluate critically the current practices of pediatric adenotonsillectomies. Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns, moving us toward a more evidence‐based paradigm of treating pediatric adenotonsillar disease.
Geometrical Deformation of Vocal Fold Tissues Induced by Formalin Fixation
Authors: Kimura Miwako , Tayama Niro , Chan Roger W.
Published: November 2003

Objectives/Hypothesis Many existing studies of vocal fold geometry are based on anatomical measurements made on histologically fixed laryngeal tissues using formalin. However, the validity of these geometric data is questionable because of the potentially significant tissue deformation associated with formalin fixation, particularly tissue shrinkage. Previous experiments have shown that valid geometric data may be obtained on vocal fold tissue samples quickly frozen with liquid nitrogen. Based on this finding, the present study attempted to quantify the geometric deformation of formalin‐fixed vocal fold tissues with respect to quick‐frozen tissues.

Methods Six freshly harvested canine larynges were quickly frozen with liquid nitrogen and sectioned at the mid‐membranous coronal plane. Each larynx was thawed and divided into halves along the midsagittal plane, one of which was not fixed; the other was fixed with formalin, from which histological tissue sections were also prepared. Measurements of vocal fold geometry were made on digital images of mid‐membranous coronal sections of the tissue samples, based on linear dimensions of vocal fold depth and thickness defined functionally for biomechanical applications.

Results Significant shrinkage of the vocal fold (particularly the vocal fold body) and considerable distortion of the vocal fold contour (particularly at the free edge) were observed for the formalin‐fixed samples and the histological sections in comparison with the unfixed samples.

Conclusions Results of the present study suggested that significant geometric artifacts are induced by conventional histological fixation of laryngeal tissues using formalin. These artifacts should be carefully considered for interpreting any vocal fold geometric data obtained through formalin fixation.
The Utility of Cephalometry With the Muller Maneuver in Evaluating the Upper Airway and Its Surrounding Structures in Chinese Patients With Sleep‐Disordered Breathing
Authors: Liao Yu‐Fang , Huang Chiung‐Shing , Chuang Ming‐Lung
Published: November 2003

Objective The objective was to simultaneously measure the size and collapsibility of the upper airway in Chinese patients with sleep‐disordered breathing using cephalometry with the Muller maneuver.

Study Design Prospective study of 100 consecutive Chinese patients evaluated for sleep‐disordered breathing at a sleep center.

Methods Each patient received overnight polysomnography and two lateral cephalograms (at the end‐expiration phase and the Muller maneuver, respectively) to evaluate the upper airway and its surrounding structures (soft palate, tongue, and hyoid bone). After excluding 15 subjects from this study because of unclear cephalograms, 85 patients with sleep‐disordered breathing were enrolled, including 32 with snoring or mild obstructive sleep apnea and 53 with moderate to severe obstructive sleep apnea.

Results Patients with varying degrees of severity of sleep‐disordered breathing significantly differed in terms of the structure and function of the upper airway and the surrounding structures. The Muller maneuver may result in dynamic changes in the retropalatal airway and pharyngeal length, and the levels of dynamic changes were related to the severity of sleep‐disordered breathing. Pearson correlation analysis revealed that the decrease in the minimum retropalatal dimension during the Muller maneuver in patients with snoring or with mild obstructive sleep apnea was related to the thickening of the soft palate and posterior displacement of tongue. Meanwhile, the decrease in the minimum retropalatal dimension in patients with moderate to severe obstructive sleep apnea was related to lengthening of the soft palate, increased tongue height, and downward displacement of the tongue and hyoid bone.

Conclusion Cephalometry with the Muller maneuver may provide further insight into the pathogenesis of various levels of severity of sleep‐disordered breathing.
Difference in Facial Canal Anatomy in Terms of Severity of Microtia and Deformity of Middle Ear in Patients With Microtia
Authors: Takegoshi Hideki , Kaga Kimitaka
Published: November 2003

ObjectiveTo study the difference in the facial canal anatomy in terms of the severity of microtia and deformity of the middle ear in patients with microtia using high‐resolution computed tomography (HRCT).

Study DesignForty‐six ears with microtia were examined by HRCT. These ears were graded based on two systems of classification and scoring, respectively. The HRCT findings of each group were compared with those of other groups by multiple comparison using the Tukey honestly significant difference test.

MethodsForty‐six ears with microtia (unilateral microtia, n = 12; bilateral microtia, n = 34) were examined by HRCT. These ears were graded based on two systems of classification and scoring, respectively. The HRCT findings and age distribution of each group were compared with those of other groups by multiple comparison using the Tukey honestly significant difference test.

ResultsThe mastoid portion of the facial nerve was 3 mm more anteriorly displaced in patients with grades II and III microtia than in those with grade I microtia (P<.01). From the scoring system that was used, the course of the facial nerve was not significantly different between patients with a score of 5 points or less and those with a score of 6 points or more.

ConclusionThe mastoid portion of the facial nerve in patients with grades II and III microtia would be more anteriorly displaced because of hypoplasia of the second genu.
Acute Vertigo Following Cervical Manipulation
Authors: Young Yi‐Ho , Chen Chia‐Hung
Published: November 2003

Objective/Hypothesis Either licensed American chiropractors or traditional Chinese herbalists may produce vertiginous attack in a patient after cervical manipulation. The purpose of the study was to present our experience in treating these patients to determine the risk of this procedure.

Study Design A retrospective study from May 1999 to April 2002.

Methods Nine patients (one man and eight women) with acute vertigo after cervical manipulation were admitted and underwent a battery of audiometric and vestibular tests, accompanied by magnetic resonance imaging and magnetic resonance angiography examination.

Results The mean interval for the onset of acute vertigo after cervical manipulation was within 1 day (17 h). Electronystagmography revealed multiple central signs. Magnetic resonance angiography scan also disclosed abnormality in the vertebral artery such as occlusion, stenosis, or slow blood flow in three patients. After treatment with dextran, relief of vertigo without neurological deficits was experienced in all nine patients.

Conclusions When there are multiple central signs in electronystagmography results or slow blood flow of the vertebral artery is displayed in neck on Doppler sonography or magnetic resonance angiography scan, the therapeutic benefits of cervical manipulation cannot be expected to outweigh its potential risk for the morbidity of cervical vessels.