bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiologic assessment of botulinum toxin effects in the rat larynx
Authors: Inagi Katsuhide , Connor Nadine P. , Ford Charles N. , Schultz Edward , Rodriquez Arthur A. , Bless Diane M. , Pasic Thomas , Heisey Dennis M.
Published: November 2003

Objective: Botulinum toxin (BT) is a currently used treatment for spasmodic dysphoria (SD) and other related focal dystonias. The goal of this study is to provide a basis for using the rat larynx to objectively assess physiological and histological effects of BT. Study Design: Dosages and volumes of BT injection were varied and three physiological parameters were measured. These measures included: optical density of PAS‐stained laryngeal muscle after electrical stimulation, which is an indirect measure of denervation, spontaneous laryngeal muscle activity, and laryngeal movement. Methods: A new microlaryngoscopic technique was developed, which made it possible to observe and manipulate the rat larynx endoscopically. Laryngeal movement and electromyographic (EMG) measures were made prior to injection and 3 days following BT injections of various dosages and volumes. Optical density measures were made 3 days after injection. Results: Significant reductions in vocal fold motion and spontaneous laryngeal muscle activity as a function of increased BT dosage were observed. In addition, the optical density of PAS‐stained laryngeal muscle after electrical stimulation was increased following BT injection. Significant volume effects in optical density were observed in the lateral thyroarytenoid and lateral cricoarytenoid muscles on the contralateral side. Conclusions: The rat laryngeal model is suitable for assessing BT effects. In addition, the three physiological variables provided useful and reliable measures of laryngeal function. It is the authors' intention to use the rat laryngeal model to further examine the physiological and histological effects of BT with the goal of developing new methods for the treatment of patients with SD and other focal dystonias.
Tumor necrosis factor‐α response and herpesvirus infection in bell's palsy
Authors: Larsson Christina , Bernström‐Lundberg Christina , Edström Staffan , Bergström Tomas
Published: November 2003

Objectives: To attempt early diagnosis of patients with Bell's palsy by detection of herpesviral DNA in body fluids, and to investigate whether tumor necrosis factor‐α (TNF‐α), a cytokine associated with demyelination, is involved in the inflammatory response in this disease. Study Design: Eleven patients with acute facial palsy admitted within 1 week after onset of the disease were followed in a consecutive prospective study. Methods: Antibodies reactive to herpesviruses were determined by enzyme‐linked immunosorbent assay in serum samples from acute and convalescent (> 2‐week interval) cases. Intrathecal antibody response was investigated by immunoblotting. Polymerase chain reaction amplification of herpesviral DNA was attempted from samples of serum, cerebrospinal fluid, tear fluid, and saliva. TNF‐α and its soluble receptors (types I and II) were assessed in serum and cerebrospinal fluid samples. Results: Ten of the 11 patients demonstrated serologic evidence of herpesviral primary infection or reactivation, supporting the evidence that herpesviruses are the most prevalent etiologic agents in Bell's palsy. Despite this, DNA amplifications by polymerase chain reaction were negative for herpesviruses in the body fluids tested. TNF‐α concentrations were significantly elevated in serum, as compared with controls. Only one patient had a remaining facial nerve dysfunction at follow‐up after 3 months. Conclusion: The absence of herpes DNA in body fluids in the acute stage of serologically confirmed Bell's palsy suggests that viral replication is transient in cases with an early restoration of the facial nerve function. The elevated serum levels of TNF‐α indicate that this cytokine might be a pathogenetic factor related to the demyelination in this disease.
Molecular temporal bone pathology: III. Genotyping of the ΔF508 deletion in the DNA of patients with cystic fibrosis
Authors: Wackym Phillip A. , Kerner Marc M. , Grody Wayne W.
Published: November 2003

Genomic DNA from a single celloidin‐embedded archival temporal bone section was used to identify a specific genetic mutation. The polymerase chain reaction was used to amplify and detect the ΔF508 deletion, a common molecular genetic defect in cystic fibrosis. This mutation, present in more than 70% of white patients and carriers with cystic fibrosis, results in the deletion of codon 508, which specifies the amino acid phenylalanine of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. When this technique was applied to archival specimens from four patients with cystic fibrosis, all expressed the carrier state of this defective gene. These data demonstrate the feasibility of identifying genetic mutations in archival temporal bone specimens.
Quality of life after acoustic neuroma surgery
Authors: Nikolopoulos Thomas P. , Johnson Ian , O'Donoghue Gerard M.
Published: November 2003

Objective: To assess how surgery affected the quality of life of patients with acoustic neuromas and to investigate possible predictors of the functional outcome following surgery.Study Design: A questionnaire based on the Glasgow Benefit Inventory was completed by patients randomly selected following acoustic neuroma surgery.Setting: Skull base surgery unit of a university teaching hospital (tertiary referral center).Patients: Fifty‐three patients with acoustic tumors (follow‐up, 1 to 3 y).Results: With regard to overall quality of life, nine patients (17.4%) reported that it became better, 28 patients (53.8%) worse, and 15 patients (28.8%) that it remained the same. Four patients (7.8%) became better off financially, 15 patients (29.4%) worse, and 32 (62.8%) remained unchanged. Forty‐one patients (78.8%) did not change their occupation, and 11 (21.2%) had to change their occupation, mainly because of the adverse effects of the operation. With regard to the age at operation, older patients were found to have better overall quality of life. Moreover, younger patients had worse postoperative financial status and they were more likely to change their occupation after the operation. The tumor size did not significantly affect the overall postoperative quality, but it did affect the postoperative financial status (patients with larger tumors were more likely to have worse postoperative financial status).Conclusion: Acoustic neuroma surgery has a significant impact on patients' overall quality of life. Surgeons proposing to operate on small tumors should not assume that the impact on patients' life will be necessarily less than that following the removal of larger tumors. All patients, especially in the younger age group, should be prepared and thoroughly informed about the consequences of the operation on their quality of life.
Use of fibrin glue to protect tissue during CO2 laser surgery
Authors: Menovsky Thomas , De Vries Joost
Published: November 2003

Objective: Accidental injury of tissues during CO2 laser irradiation can lead to serious morbidity, especially during ear, nose, and throat, neurosurgical, and plastic‐reconstructive procedures. This experimental study describes a new technique in which vital structures are coated with a thin layer of fibrin glue to protect them from accidental CO2 laser irradiation. Study Design/Materials and Methods: The femoral neurovascular bundles (femoral artery, vein, and nerve) of 12 rats were exposed. On one side the bundle was coated with fibrin glue, which is a biological two‐component glue consisting of fibrinogen solution and thrombin. Upon application, an elastic mass on the neurovascular bundle was formed. The contralateral neurovascular bundle was left uncoated. Subsequently both bundles were subjected to CO2 laser irradiation at different powers (5, 7, and 9 W), with an irradiation time of 0.1 seconds. Light microscopy was performed at 30 minutes and 2 days after surgery. Results: No macroscopic visible hemorrhages occurred during laser irradiation in the glue‐coated bundle. Light microscopic evaluation revealed an undamaged neurovascular bundle without any signs of thermal damage. In the uncoated bundles intraoperative hemorrhages resulting from laser energy occurred in all specimens. Furthermore, severe thermal damage was present in arteries, veins, and nerves. Conclusions: Intraoperative coating with fibrin glue can serve as a shield to protect vital structures such as arteries, veins, and nerves from accidental CO2 laser exposure. Key Words: Arteries, CO2 laser, fibrin glue, peripheral nerve, veins.
Use of glycopyrrolate in the treatment of meniere's disease
Authors: Storper Ian S. , Spitzer Jaclyn B. , Scanlan Mark
Published: November 2003

Objectives/Hypothesis: The objective of this study was to determine whether glycopyrrolate is useful as a vestibular suppressant in patients with Meniere's disease. The tested hypotheses were that glycopyrrolate would decrease the perception of dizziness measured by the Dizziness Handicap Inventory in patients with Meniere's disease and that placebo would cause no such decrease. Study Design: Randomized, prospective. Methods: Thirty‐seven subjects with a diagnosis of Meniere's disease were administered either 2 mg of glycopyrrolate or placebo twice daily as needed for vertigo. All were also administered the regimen of 1500 mg sodium/day diet and diuretic. The following indices were examined: Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, Beck Depression Inventory, hearing examination, and electronystagmography. After 4 to 6 weeks of the drug regimen, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, and Beck Depression Scale were reexamined. Paired t tests were performed to verify the significance of improvement before and after treatment. Results: Subjects who received glycopyrrolate had statistically significant reduction in Dizziness Handicap Inventory, Beck Depression Score, and Modified Somatic Perception Score. In the placebo group, no improvement in any index was found. Conclusions: The hypothesis that glycopyrrolate is a useful vestibular suppressant in patients with Meniere's disease was statistically verified. Laryngoscope, 108:1442–1445, 1998
Effects of hemimandibulectomy on quality of life
Authors: Wilson Keith M. , Rizk Nabil M. , Armstrong Shanna L. , Gluckman Jack L.
Published: November 2003

Objective: To assess the quality of life and functional status of patients who have undergone hemimandibulectomy based on the type of reconstructive procedure performed. Study Design: Survey, retrospective. Methods: Twenty‐one patients who had undergone hemimandibulectomy and had similar defects were divided into two groups based on the reconstructive technique utilized. Eleven patients were placed in the soft tissue reconstruction group. Ten patients were placed in the mandible reconstruction group. All patients were assessed for: function, utilizing the Performance Status Scale, and quality of life, using a general cancer questionnaire (FACT‐G) and a series of questions specific for head and neck cancer patients. Results: Mandible reconstruction produced a perceived better physical appearance (P = .02), better eating ability (P = .04), and a better overall quality of life (P = .002). The mandible reconstruction cohort consistently outscored the soft tissue cohort on all questionnaires. Conclusion: Restoration of mandibular continuity after hemimandibulectomy leads to improved function and a superior quality of life in appropriately selected patients. Laryngoscope, 108:1574–1577, 1998
Role of videoendoscopy in assessment of pharyngeal function in oropharyngeal dysphagia: Comparison with videofluoroscopy and manometry
Authors: Périé Sophie , Laccourreye Laurent , Flahault Antoine , Hazebroucq Vincent , Chaussade Stanislas , Guily Jean Lacau St.
Published: November 2003

Objective: The purpose of the current report is to evaluate the ability of videoendoscopic swallowing study in assessing pharyngeal propulsion and aspiration episodes when compared with videofluoroscopy and manometry. Study Design: Prospective study. Methods: Thirty‐four patients with oropharyngeal dysphagia underwent videoendoscopy of swallowing to assess pharyngeal propulsion as pathologic or non‐pathologic, and aspiration. These features were compared with those found on manometry and videofluoroscopy, which were considered as the reference examinations. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy were estimated, with their 95% confidence intervals. Results: A total agreement between videoendoscopy and videofluoroscopy was found in 76.4% of cases for pharyngeal propulsion and in 82.3% for aspiration. This rate for pharyngeal propulsion reached 82.3% between videoendoscopy and manometry. Moreover, in 24 cases (70.5%) in which videofluoroscopy and manometry agreed for pharyngeal propulsion, 22 were assessed similarly through fiberoscopy. When using fluoroscopy and manometry as reference examinations, videoendoscopy detected nearly 90% (95% confidence interval [CI] = 0.80, 1.0) of impaired pharyngeal propulsion. Concerning aspiration, 70% (95% CI = 0.54, 0.85) of events detected by videoendoscopy were also observed on videofluoroscopy. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy reached a higher rate (90% to 92.8%) when agreement was found between fluoroscopy and manometry. Conclusions: Videoendoscopy is an examination that can be used to detect inexpensively pharyngeal propulsion disorders and aspiration episodes. Laryngoscope, 108:1712–1716, 1998
Videostroboscopy of the pharyngoesophageal segment in total laryngectomees
Authors: Dworkin James Paul , Meleca Robert J. , Zormeier Michelle M. , Simpson Mark L. , Ma Ilene Garfield, , Jacobs John R. , Mathog Robert H.
Published: November 2003

Objectives: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy. Study Design: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication. Materials and Methods: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven‐point scale. Results: The patients demonstrated differences that allowed for separation of patients into two main groups: “poor” and “effective” TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency. Conclusion: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production.
A Model to Explain the Rapid Pressure Decrease After Air–Inflation of Diseased Middle Ears
Authors: Doyle William J. , Alper Cuneyt M.
Published: November 2003

Objectives: Air‐inflation in humans and monkeys with significant negative middle ear pressure or with middle ear inflammation was shown to cause greater than ambient middle ear pressure initially, followed by a rapid rate of pressure decrease to approach the preinflation value.Study Design: A mathematical model of middle ear pressure regulation is presented and used to simulate air‐inflation of the normal and diseased middle ear.Materials and Methods: The model represents the total volume of the middle ear as consisting of three subcompartments representing the airspace, effusion, and mucosa/blood. Gas exchange among those compartments was assumed to be diffusion limited, and the gas exchange between the mucosa/blood compartment and systemic blood was assumed to be perfusion limited. Disease was modeled as an increase in mucosal blood flow or, alternatively, as an increase in the volumes of the effusion and mucosa/blood compartments.Results: The predictions of the model agree better with the experimental data when the increased rate of pressure change after middle ear inflation in diseased ears is driven by an increased volume of the effusion compartment as opposed to an increased perfusion rate. The responsible mechanism is a rapid redistribution among subcompartments of the gas volume introduced into the air compartment.Conclusions: These results suggest that middle ear inflation with inert gas can be used to diagnose the presence and relative amount of middle ear effusion, and that current protocols for treating otitis media with effusion using inflation need to be modified to optimize their intended effect.
Effect of Harvesting Autogenous Laryngeal Cartilage for Laryngotracheal Reconstruction on Laryngeal Growth and Support
Authors: Park Albert H. , Forte Vito
Published: November 2003

Objective: Determine the effect of harvesting autogenous thyroid cartilage on subsequent laryngeal growth and stability in a kitten model. Study Design: Prospective controlled trial in animals. Methods: Seventeen kittens were divided into three groups. Group one (n = 5) included kittens that underwent a unilateral thyroid cartilage resection. Group two (n = 5) included kittens that underwent a bilateral cartilage resection. Group three (n = 7) comprised kittens that did not undergo any surgical procedure (controls). All animals underwent endoscopic examination followed by the surgical procedure designated for that group. Kittens were then assessed daily for 2.5 months. At the end of that period the now “adolescent” cats were examined endoscopically then euthanized. The larynx was removed for gross and histopathologic analysis. Results: All kittens tolerated the surgical procedure without airway compromise. Subsequent endoscopic examination 2.5 months after surgery revealed normal vocal cord function. Measurements of the true vocal cord and aryepiglottic and subglottic diameter did not differ significantly (one‐way analysis of variance, P = .05) with respect to the side or the group. Histopathologic evaluation of the laryngeal sections indicated a patent airway, stable and viable thyroid cartilage, and no evidence of cartilaginous regrowth. Conclusions: The removal of unilateral and bilateral superior thyroid alar cartilage can be performed in kittens without postoperative respiratory or wound problems. The harvesting of autogenous thyroid cartilage has no apparent effect on subsequent laryngeal growth and stability in a kitten model.
Physiologic and hypertonic saline solutions impair ciliary activity in vitro
Authors: Boek Wilbert M. , Keleş Nesil , Graamans Kees , Huizing Egbert H.
Published: November 2003

Objective/Hypothesis: Physiologic saline (NaCl 0.9%) is commonly used in treating acute and chronic rhinosinusitis. Moreover, physiologic saline is used as a control medium, vehicle, or solvent in studies on ciliary beat frequency (CBF). Hypertonic saline (NaCl 7% and 14.4%) has been applied in attempts to enhance mucociliary transport in patients with cystic fibrosis or asthma and in healthy subjects. Therefore the objective of this study is to document in vitro effects of saline solutions in different concentrations on CBF. Study Design: Experimental, in vitro. Methods: The effects on CBF of cryopreserved mucosa of the sphenoidal sinus was measured by a photoelectrical method. Initial frequencies, measured in Locke‐Ringer's solution (LR), were compared with CBF after exposure to NaCl in concentrations of 0.9%, 7.0%, and 14.4% (w/v). Results: NaCl 0.9% has a moderately negative effect on CBF. The 7% solution leads to a complete ciliostasis within 5 minutes, although this effect turns out to be reversible after rinsing with LR. A hypertonic solution of 14.4% has an irreversible ciliostatic effect. Conclusion: LR is an isotonic solution that has no effect on CBF. Therefore it is probable that this solution is more appropriate than saline for nasal irrigation and nebulization or antral lavage. Moreover, the results of this study suggest that mucolytic effects induced by hyperosmolarity should be attained preferably with hypertonic saline 7% in patients with cystic fibrosis or asthma. At this concentration, the ciliostatic effect is reversible, whereas irreversible changes are to be expected at higher concentrations.
Frontal Sinus Obliteration Using a Laterally Based Pedicled Pericranial Flap
Authors: Ducic Yadranko , Stone Thomas L.
Published: November 2003

Objective: Fractures of the frontal sinus represent one of the more uncommon injuries of the maxillofacial skeleton. In an effort to avoid potential mucocele formation, frontal sinus obliteration has been put forward as the treatment of choice when there has been significant disruption of normal frontal sinus drainage. Traditionally, sinus obliteration has been accomplished with nonvascularized free adipose tissue or bone grafts and a variety of alloplastic materials. We developed a laterally based pedicled pericranial flap to accomplish frontal sinus obliteration.

Study Design/Methods: A total of 10 consecutive patients underwent obliteration of the frontal sinus with a vascularized, pedicled, laterally based pericranial flap. The patients were clinically followed prospectively to ascertain whether any adverse effects could be detected.

Results: With a follow‐up ranging from 6 months to 2 years, we have observed no adverse effects in any of the patients in whom this procedure was performed.

Conclusions: Based on our preliminary results, we believe that the laterally based pedicled pericranial flap appears to provide readily available vascularized tissue, with no distant donor morbidity. It represents an inexpensive, safe, and effective modality that should be considered when treating this type of injury.
Long‐Term Results of Surgery for Temporal Bone Paragangliomas
Authors: Briner Hans Rudolf , Linder Thomas E. , Pauw Bernard , Fisch Ugo
Published: November 2003

Objectives:Assessment of the long‐term results of surgery for temporal bone paragangliomas with special consideration of the patient's ability to cope with the functional deficits.

Study Design:Retrospective review of 36 patients who had undergone resection of a temporal bone paraganglioma 10 to 15 years previously. Assessment of the patients' subjective view of the functional outcome and quality of life by a questionnaire.

Methods:Clinical records were reviewed regarding size of tumor, technique of surgery, supportive therapy, and tumor recurrence. Patients were sent a 50‐item questionnaire evaluating their quality of life and the preoperative and postoperative function of cranial nerves VII through XII.

Results:A complete tumor removal was achieved in 30 patients (83%). There was only one tumor recurrence. The major negative effects of surgery involved hearing and dysphagia, which deterioriated in 14 and 12 patients, respectively. Thirty‐five of the 36 patients (97%) reported that, despite deterioration, the cranial nerve deficits were still acceptable. Seventy‐five percent of the patients regained their preoperative quality of life and 97% returned to their previous occupation in 1 to 2 years.

Conclusions:The otologic extradural approach allowed complete tumor removal in 83%, with minimal perioperative morbidity. No surgically induced central nervous system lesions occured. Tracheostomy was avoided and all patients resumed oral feeding. Full rehabilitation after removal of class C and CD paragangliomas may take 1 to 2 years. However, the fact that 97% of the patients finally resumed normal social life showed the ability of most patients to cope with the sequelae of surgery even in class C and CD paragangliomas.
Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? in vivo and in vitro studies
Authors: Saunders Michael W. , Wheatley A. Hugh , George Sarah J. , Lai Theresa , Birchall Martin A.
Published: November 2003

Objective/Hypothesis: Corticosteroids are an effective treatment for nasal polyposis. The exact mechanism of action is not certain. Recent research demonstrates that apoptosis (programmed cell death) in inflammatory cells is an important factor in the resolution of inflammation, and apoptosis is induced in eosinophils in cell culture with steroids. We hypothesized that inflammatory cell apoptosis is a key feature of regression of nasal polyps on exposure to steroids and examined this hypothesis in vivo and in vitro. Methods: A double‐blind, placebo‐controlled pilot study of fluticasone propionate aqueous nasal spray (FPANS) in nasal polyposis in humans in vivo was undertaken, and the effect of treatment on indices of cell death and proliferation measured. In addition, explants of nasal polyp tissue were maintained in vitro in short‐term tissue culture with dexamethasone at increasing doses (0.1–50 μmol) over varying time intervals and then analyzed for similar indices of proliferation and cell death. Results: Apart from a marginal increase in apoptotic: mitotic ratio in epithelium, little difference between the effect of FPANS and placebo was demonstrated in vivo. However, in vitro, apoptotic index was significantly increased in the stromal layers in relation to time of incubation (P = .0169), and a significant dose‐response relationship was demonstrated at 24 hours between stromal cell apoptosis and dexamethasone concentration (P = .001). Eosinophil apoptosis was confirmed by in situ end labeling and transmission electron microscopy. No steroid or time effect on epithelial cells was demonstrated in vitro. Conclusion: Corticosteroids induce apoptosis in inflammatory cells in human nasal polyps in vitro. This is not reflected by a similar response to FPANS at 14 days in vivo, but may still play a part in regression of polyps with other forms of administration or at other time points.
Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas
Authors: Giacomarra Vittorio , Tirelli Giancarlo , Papanikolla Ledia , Bussani Rossana
Published: November 2003

Objective: To estimate the value of tumor (T)‐related parameters (singly or in association) in predicting the presence of occult metastases in oral cavity and oropharynx carcinomas. Study Design: We considered tumor size (T size), Broders' grading of histologic differentiation (G), invasive cell grading (ICG), and thickness. For every single factor, we evaluated the correlation between the parameter and occult metastases in N0 neck disease, the correlation between the parameter and metastases independently from node (N) class, and the relation between the parameter and extracapsular spread. On the basis of previous results, we gave a score to each parameter that showed higher significativity the sum of which we called global score (GS). We compared the predictivity of metastasis of the GS to that of the single parameters to obtain a more efficacious index. Methods: Sixty‐one patients with carcinomas of the oral cavity and oropharynx who underwent surgery on T and N were examined. Results: Our preliminary results have highlighted a significant correlation between G, ICG, and the presence of occult metastases. No correlation between T size and metastases was highlighted. The GS obtained from G and ICG turned out to be highly significant. A strong correlation was found between the ICG score and extracapsular spread: a high risk of extracapsular spread was found in patients with an ICG score ⩾13. Conclusion: We perform elective neck dissection in T1–T2 N0 neck disease with ICG ⩾13 and GS1 ⩾9.
Stereotactic radiotherapy for locally recurrent nasopharyngeal carcinoma
Authors: Mitsuhashi Norio , Sakurai Hideyuki , Katano Susumu , Kurosaki Hiromasa , Hasegawa Masatoshi , Akimoto Tetsuo , Nozaki Miwako , Hayakawa Kazushige , Niibe Hideo
Published: November 2003

Objective: To determine the efficacy of stereotactic radiotherapy (SRT) in the treatment of recurrent nasopharyngeal carcinoma. Study Design: A retrospective review of the outcome of SRT for patients with recurrent nasopharyngeal carcinomas following definitive conventional radiation therapy. Methods: Five patients were treated with daily static multiportal irradiation. Two Gy was administered with eight isocentric portals in a single plane 5 days a week, and the plane was changed for every 20 to 30 Gy. Of these patients, three had poorly differentiated squamous cell carcinoma. Tumor sizes ranged from 1 to 15 cm3, with a median size 3.2 cm3. Median follow‐up time from SRT was 34 months (range, 4–61 mo). Results: Four of five recurrent tumors responded well and achieved complete regression. Three patients have survived without evidence of local recurrence with a median follow‐up time of 34 months. Marginal recurrence was observed at the posterosuperior wall in a patient with adenoid cystic carcinoma at 30 months after SRT. One patient who received SRT after the two complete courses of radiation therapy died 6 months after SRT as a result of rupture of a branch of the left carotid artery, but autopsy revealed no local residual tumor. Conclusions: Stereotactic radiotherapy with isocentric multiportals in one plane, which is changed at every 20 to 30 Gy, can provide local control with acceptable toxicity in patients with recurrent nasopharyngeal carcinoma, but increased clinical experience and longer follow‐up will be necessary to evaluate the overall role of this technique in nasopharyngeal carcinoma.
Uses and limitations of fdg positron emission tomography in patients with head and neck cancer
Authors: Hanasono Matthew M. , Kunda Larisa D. , Segall George M. , Ku Grace H. , Terris David J.
Published: November 2003

Objective: Numerous authors have reported the potential usefulness of positron emission tomography (PET). These studies have had conflicting results, at least partly owing to limited sample sizes. The objective of this study is to define not only the uses, but also the limitations of PET in patients with head and neck cancer. Study Design: Nonrandomized, retrospective analysis of PET at an academic institution. Methods: The authors performed 146 PET scans on 133 patients with head and neck cancer. Eighteen patients (19 PET scans) with thyroid disorders were excluded. A minimum 1 year of follow‐up was available in 84 patients, who were separated into groups based on whether the PET was used to detect unknown primary cancers (n = 20), stage neck nodal and distant metastases (n = 8), monitor response to nonsurgical therapy (n = 22), or detect recurrent or residual cancers (n = 34). The results of PET were compared with results from computed tomography (CT) and magnetic resonance imaging (MRI) performed in the same patients. Results: Of the unknown primary cancers, PET correctly identified 7 of 20 primary sites, giving a sensitivity of 35%. When combined with CT or MRI, the sensitivity increased to 40%. When used for detection of metastatic disease, PET demonstrated five of five nodal metastases (100%) and two of four distant metastases (50%). In evaluating the response to nonsurgical therapy, PET had a sensitivity of 50% and a specificity of 83% for detecting tumor at the primary site and a sensitivity of 86% and a specificity of 73% for detecting nodal disease. When used for evaluation of recurrent/residual disease, PET identified seven of seven cases of local recurrences/residual disease and had a specificity of 85%. PET also detected seven of seven cases of nodal disease and had a specificity of 89%. Conclusions: For staging purposes, PET is limited by its lack of anatomic detail. However, PET compares favorably with CT and MRI in detecting recurrent/residual cancers. PET imaging complements the more traditional imaging modalities (CT or MRI), especially for an unknown primary cancer. Key Words: Head and neck cancer, squamous cell carcinoma, positron emission tomography, unknown primary cancer, cervical lymph node metastasis.
Human temporal bone study on the postnatal ossification process of auditory ossicles
Authors: Yokoyama Tomoko , Iino Yukiko , Kakizaki Keiko , Murakami Yoshihiko
Published: November 2003

Objective: In infancy the head of the malleus and body of the incus normally contain bone marrow, which is gradually replaced by bone and converted into vascular channels with age. This study was carried out to clarify the age at which ossification of the ossicles is complete and to examine factors influencing the ossification process. Study Design: Human temporal bone sections from 32 infants and children with or without congenital anomalies, aged 1 day to 9 years, who were born at term were studied. Methods: The percentage bone marrow area occupying the head of the malleus and body of the incus was calculated in three horizontal temporal bone sections for each case, using computer‐aided digital processing of images. Results: Bone marrow was observed in both the malleus and incus in children until 25 months of age, while after the age of 25 months no bone marrow tissue was present in either of the ossicles. It appeared that the bone marrow space disappeared somewhat earlier in the malleus than in the incus. The bone marrow space around the otic capsule disappeared much earlier than that within the ossicles. The age at completion of ossification was correlated with neither the presence of congenital anomalies nor the presence of residual mesenchyme in the middle ear. Conclusions: Ossification of the ossicles seems to occur steadily throughout fetal life and after birth during development of the middle ear. Although the clinical significance of postnatal residual bone marrow within the ossicles is not known, it possibly plays a role as a blood‐forming organ in early infancy. Key Words: Ossicles, bone marrow space, ossification, otic capsule, congenital anomaly.
Chronology of labyrinthitis ossificans induced by streptococcus pneumoniae meningitis
Authors: Nabili Vishad , Brodie Hilary A. , Neverov Nikita I. , Tinling Steven P.
Published: November 2003

Objective: Labyrinthitis ossificans consists of novel osteogenesis that fills the normally patent cochlear and vestibular lumen as an end‐stage sequelae to various pathologies. This study was designed to establish the sequence of events and chronology of the osteoneogenesis and calcification. Study Design: A prospective randomized double‐blind study. Methods: By using serial application of different colored fluorochromes, which deposit in newly forming bone, the timing of bone deposition and bone remodeling can be established. Labyrinthitis ossificans was induced in she groups (n = 5) of gerbils by an intrathecal injection of live Streptococcus pneumoniae. Group 1 received no fluorochrome labels, group 2 received one label, group 3 received three labels, and groups 4, 5, and 6 received four labels. The temporal bones were harvested after 2 weeks (group 1), 1 month (group 2), 3 months (group 3), 4 months (group 4), 6 months (group 5), and 12 months (group 6). Results: Sixteen of the 25 animals that received labels developed ossification, demonstrated with fluorescent microscopy. In the animals that developed labyrinthitis ossificans, newly formed disorganized bone began calcifying as early as 3 weeks (label 1) after S pneumoniae injection. Osteoneogenesis continued as evidenced by the presence of the other labels when first applied at 6 weeks (label 2), and 10 weeks (label 3). Ossification, calcification, and remodeling proceeded through a 12‐month course, wherein a reduction of labels was present at 6 months and total disappearance by 12 months. Conclusions: The use of fluorescent stains in this animal model provides a means to establish a timeline of the ossification seen in labyrinthitis ossificans. Key Words: Ossified cochlea, labyrinthitis, deafness, cochlear implant, meningitis.
Surgical Techniques to Facilitate Endoscopic Second‐Look Mastoidectomy
Authors: Haberkamp Thomas J. , Tanyeri Hasan
Published: November 2003

Objectives/Hypothesis: Mastoidoscopy has shown to be a safe, effective alternative to traditional second‐look mastoidectomy. This study was undertaken to review surgical modifications to facilitate successful mastoidoscopy. Study Design: Retrospective database review of all surgical procedures performed by the senior author (t.j.h.) since January 1995. All surgeries were performed in a tertiary hospital setting. Results: Fifteen second‐look procedures were performed in this series. Five were performed endoscopically, 10 with traditional techniques. In the traditional surgeries five were prior to the use of endoscopy, five had contraindications to endoscopic mastoidectomy. There were six residual cholesteatomas in the series, one in the endoscopic cases (20%), and five in the traditional cases (50%). No cholesteatomas were identified with microscopic examination performed after endoscopy. There were no complications in the series. Mastoidoscopy gives limited access to the mesotympanum, eustachian tube and, in particular, the sinus tympani. The creation of a wide extended facial recess with removal of the buttress at the fossa incudis and removal of the incus and head of the maleus will facilitate inspection of the middle ear. Additional techniques are necessary to view the sinus tympani. The fallopian bridge technique, and the infratympanic extended facial recess technique may allow better visualization of the middle ear. Conclusion: Mastoidoscopy offers a safe alternative to traditional techniques for second‐look surgery. The morbidity appears similar to traditional techniques.
Use of the Laryngeal Mask Airway in Otologic Surgery
Authors: Duff Brian E.
Published: November 2003

Objective/Hypothesis: The combination of intravenous sedation and local infiltration anesthesia is routinely utilized in otologic surgery. Advantages over general anesthesia with endotracheal intubation include ease and speed of induction and emergence, safety, and decreased postoperative discomfort. Anatomic and physiological patient constraints may preclude the use of intravenous sedation and anesthetists inexperienced in this technique may find it difficult to achieve a consistent level of anesthesia appropriate for major otologic surgery. Administration of anesthesia using the laryngeal mask airway (LMA) has been proposed to offer many of the advantages of intravenous sedation with less risk of oversedation and obstructive apnea. Study Design: A retrospective chart review. Methods: A review of 100 consecutive adult and pediatric patients undergoing major otologic procedures in which the LMA was utilized. Results: All laryngeal masks were introduced without a laryngoscope and successful placement was accomplished on the first attempt in 98%. Procedures were performed under spontaneous ventilation and in only one instance was surgery temporarily interrupted because of patient movement. No major complications occurred and no patients required endotracheal intubation. Only three patients complained of mild throat discomfort in the immediate postoperative period. Conclusions: The laryngeal mask airway is a safe and effective means of providing anesthesia during major otologic surgery.
Glutamate‐like Immunoreactivity During Hair Cell Recovery After Gentamicin Exposure in the Chinchilla Vestibular Sensory Periphery
Authors: Chin Kenley W. , Lopez Ivan , Lee Seung‐Chul , Honrubia Vicente
Published: November 2003

Objective: Determine the expression of glutamate by immunohistochemistry in normal and recovering vestibular hair cells in the chinchilla crista ampullaris after gentamicin ototoxicity. Study Design: In five groups of three animals each, ototoxicity was produced by placing gentamicin (50 μg)‐impregnated Gelfoam pellets within the perilymphatic space of the superior semicircular canal. Animals were sacrificed at 1, 2, 4, 8, and 16 weeks after treatment. A group of normal (n=3) animals was also processed. Methods: For the detection of glutamate the inner ears of these animals were dissected, and the horizontal cristae ampullaris embedded in plastic. Two‐micron‐thick tissue sections were obtained and incubated with monoclonal antibodies against glutamate. The immunoreaction was detected using the avidinbiotiny‐lated‐complex technique and diaminobenzidine was the chromogen. Results: Normal sensory epithelia demonstrated type I and type II hair cells with moderate glutamate‐like immunoreactivity. Supporting cells demonstrated no glutamate‐like immunoreactivity. Afferent nerve fibers and calyxes surrounding type I hair cells demonstrated strong glutamate‐like immunoreactivity. At 1 and 2 weeks after treatment the few type II hair cells surviving ototoxic treatment (15%–18%) contained moderate glutamate‐like immunoreactivity, supporting cells showed no immunoreactivity, and nerve terminals and fibers displayed strong immunoreactivity. At 4 and 8 weeks after treatment, recovered hair cells (80%) had greater glutamate‐like immunoreactivity when compared with normal hair cells, supporting cells displayed no glutamate‐like immunoreactivity, and afferent fibers contained strong glutamate‐like immunoreactivity. At 16 weeks, glutamate‐like immunoreactivity in hair cells returned to normal level. Conclusion: Glutamate may be used as an indicator of hair cell differentiation and as an index of the molecular recovery of hair cells after ototoxicity.
Test‐Retest Reliability of Computed Tomography in the Assessment of Chronic Rhinosinusitis
Authors: Bhattacharyya Neil
Published: November 2003

Objective: Computed tomography (CT) of the paranasal sinuses has emerged as the standard test for the assessment of chronic rhinosinusitis, as evidenced by the emergence of several CT‐based staging systems. Despite its central role in the diagnosis and treatment planning for chronic rhinosinusitis, the sinus CT represents a “snapshot in time.” This study was conducted to determine the reliability of the CT scan for chronic sinus disease: are the CT findings in chronic rhinosinusitis stable over time? Methods: A prospective series of patients scheduled for endoscopic sinus surgery was evaluated. A total of 45 patients received two CT scans: an initial scan obtained during routine diagnostic evaluation, and a second scan performed for use as part of an image‐guided sinus surgery protocol. No surgical intervention occurred between scans. The patients' scans were staged according to the Lund system by a blinded observer. The correlation between scans for each patient was determined using the matched pairs t test and the Pearson correlation coefficient. Results: The mean time interval between scans was 122.6 days (range, 5–364 d). The average Lund scores for the initial and second scans were 13.56 and 13.27, respectively. The Lund score for 5 patients remained the same, increased in 22 patients, and decreased in 18 patients. Overall, 75.6% of patients' second scans were within ±2 points of the first scan Lund score. The mean change in score between scans of —0.29 was not significant (P = .606, paired samples t test). The Pearson correlation coefficient between scans was 0.796 (P > .0001). Conclusions: CT scan assessment of chronic rhinosinusitis is a reliable test. The CT findings in patients with chronic rhinosinusitis remain consistent over time.
The Rhinology Laboratory
Authors: Bent John P. , Porubsky Edward S.
Published: November 2003

Objectives: This study seeks to develop a rhinology lab model and to assess its effectiveness for physicians‐in‐training. Study Design: We established a rhinology lab at our institution with simple and affordable modifications to our temporal bone lab. Residents attended a seven‐part lecture series and received a list of endoscopic and open procedures to perform on computed tomography (CT)‐scanned, vessel‐injected cadaver heads. Methods: After 2 years we asked participating residents to rate their lab experience on a 1‐to‐10 (disagree‐agree) scale. Results: Cumulative scores indicated that residents enthusiastically perceived this additional training as worth while (μ=10), while increasing their efficiency (μ=9.5), safety (μ=9.875), and anatomic knowledge (μ=9.875). The lab has opened opportunities for rhinology research, as evidence by one resident publication and another project in progress. Survey feedback has helped develop guidelines for instructor participation in the lab as well as for assigned reading and independent study. Conclusions: Based on our preliminary experience, we recommend the rhinology lab to all residency programs as an important yet cost‐effective means of maintaining education in step with rapidly changing technologies.
Experimental Nasal Intubation: A Study of Changes in Nasoantral Mucosa and Bacterial Flora
Authors: Westergren Viveka , Otori Nobuyoshi , Stierna Pontus
Published: November 2003

Objectives: To investigate the local effects in a nasal cavity and its adjacent sinuses of long‐term detention of an endonasal tube, with special attention to inflammatory pathology and microbiology. Study Design: Experimental rabbit study. Methods: Four groups of 4 rabbits, in all 16, were unilaterally nasally intubated and evaluated macroscopically, histopathologically, and bacteriologically after 1, 2, 4, and 8 weeks, respectively. Results: At first, in the 1‐ and 2‐week groups to the 4‐week group, histopathology, such as degeneration of olfactory mucosa, squamous cell metaplasia, and polyp formations, was observed together with frequent opportunistic bacterial findings in the nasal cavity. Later, in the 4‐ and 8‐week groups, inflammatory mucosal changes, such as septal increase of connective tissue, goblet cell hyperplasia, and epithelial invaginations, were found in the nasal cavity containing a tube. A concomitant increase was found of commensal bacteria adjacent to the tube and the similar bacterial findings in the ipsilateral maxillary sinuses. However, there were no signs of inflammatory reactions in the sinuses. Conclusions: Our investigation points to the tube as the cause of local goblet cell hyperplasia with an increased mucus production, and as a food source for the commensals with a marked increase of the amount of bacteria. The positive bacterial cultures from the maxillary sinuses might be considered to be colonization. However, because of the possibility of contamination, improved sampling techniques are required, as are further studies.