bluuebunny/crossref_metadata_2025 huggingface dataset:
Meningiomas presenting in the middle ear
Authors: Salama N. , Stafford N.
Published: October 2006

Meningiomas can present in the middle ear either as primary tumors or as an extension of an intracranial tumor. Symptoms and signs of such rare tumors are easily confused with more common conditions of the ear. Two cases of meningiomas involving the middle ear are presented, the operative details of the second case are summarized because of the unusual extent of the tumor. A brief review of primary intratympanic meningiomas reported in the literature is also presented. An account of the pathology, diagnois, and treatment of meningiomas in the middle ear is given in the hope that this diagnosis may be considered when middle ear tumors present.
Computed tomography in the evaluation of acquired stenosis in the neonate
Authors: Faw Kenneth , Muntz Harlan , Siegel Marilyn , Spector Gershon
Published: October 2006

We studied the feasibility of computed tomographic evaluation of the neonatal airway. Three neonatal larynges, removed at necroscopy, were examined by computed tomography. Good resolution of soft tissue, cartilage and airway lumen was obtained in these small specimens. On the basis of these findings two neonates with acquired subglottic stenosis were examined by endoscopy, soft tissue airway radiographs, and computed tomography. Measurements of radiation dose revealed that a computed tomographic study delivered 36% of the mean tissue dose of standard image intensifier fluoroscopy. Computed tomography and fluoroscopy both demonstrated the degree and length of this stenosis accurately. An advantage of CT over conventional imaging procedures was better definition of the cross sectional area of the airway.
Allergic aspergillus sinusitis: Concepts in diagnosis and treatment of a new clinical entity
Authors: Waxman Joel E. , Spector J. Gershon , Sale Scott R. , Katzenstein Anna‐Luise A.
Published: October 2006

The clinical features in 15 young adult patients with allergic Aspergillus sinusitis includes a history of asthma, recurrent nasal polyps, and radiographic evidence of pansinusitis. Multiple surgical procedures were performed on 12 patients.

The histologic diagnosis is made on the mucinous material which contains eosinophils, fungal hyphae (Aspergillus species), and Charcot‐Leyden crystals. Mycetomas, direct mucosal and soft tissue invasion by fungi, were not observed.

Immunologic findings include an immediate cutaneous reactivity to Aspergillus in 60% of patients, total serum IgE elevation in 85%, and serum precipitins to Aspergillus in 85%.

A new therapeutic protocol was devised based on the current treatment of allergic bronchopulmonary aspergillosis. Therapy includes wide local debridement, adequate sinus aeration, and the postoperative use of systemic steroids. Seven patients placed on systemic corticosteroids are asymptomatic for a mean of 14 months.

Diagnosis of allergic Aspergillus sinusitis requires a high index of suspicion, a confirmatory diagnosis from the inspissated mucus, and an immunologic evaluation prior to the institution of corticosteroid therapy.
Central vocal cord paralysis and paresis presenting as laryngeal stridor in children
Authors: Ross Douglas A. , Ward Paul H.
Published: October 2006

Vocal cord paralysis or paresis as the initial presenting symptom for intracranial tumors in children are rare. Recently, two pediatric patients who were later diagnosed as having intracranial tumors presented with the symptom of voice changes and stridor. Telescopic examination revealed bilateral vocal cord paresis and paralysis as demonstrated by video recordings. The majority of pediatric brain tumors present with both generalized and localized complaints; however, by discussing these two rare cases, we hope to underscore the importance of a thorough workup of the paralyzed or paretic vocal cords.
Comparison of the erbium‐yttrium aluminum garnet and carbon dioxide lasers for in vitro bone and cartilage ablation
Authors: Gonzalez Carlos , Van De Merwe Willem P. , Smith Michael , Reinisch Lou
Published: October 2006

The in vitro bone‐ and cartilage‐ablation characteristics of the solid‐state erbium:yttrium aluminum garnet laser were compared to those of the carbon dioxide laser. Ablations of fresh, frozen cadaver septal cartilage and maxillary sinus bone were performed using total energies between 1 and 6 J. Specimens were studied using hematoxylin and eosin stain and digitized, computer‐assisted measurements of 35‐mm photographs. Erbium‐yttrium aluminum garnet‐ablated bone averaged 5 μm of adjacent tissue thermal injury, compared with 67 μm with carbon dioxide‐ablated bone. Erbium‐yttrium aluminum garnet‐ablated cartilage averaged 2 μm of adjacent tissue thermal injury, compared with 21 μm with the carbon dioxide‐ablated cartilage. The tissue‐ablation characteristics of the erbium‐yttrium aluminum garnet laser are promising for future oto‐laryngologic applications.
A matched‐pairs comparison of single and multichannel cochlear implants in children
Authors: Chute Patricia M. , Hellman Sharon A. , Parisier Simon C. , Selesnick Samuel H.
Published: October 2006

Auditory capabilities of Nucleus 22® multichannel cochlear implant users were compared to those of matched 3M/House® single‐channel users. Six children who received either the 3M/House or Nucleus 22 cochlear implants were separated into three matched pairs. Group 1 consisted of two postlinguistically deafened adolescents, group 2 consisted of two prelinguistically deafened school‐age children, and group 3 consisted of two perilinguistically deafened preschoolers.

Participants were evaluated using auditory comprehension and discrimination tasks as indicated by the 3M/House and Nucleus 22 protocols. However, only tasks common to both were included here. While the 3M/House single‐channel device has been under an IDE for children under the age of 18 years since 1984, the Nucleus 22 multichannel implant only recently became available for this age group. Thus, short‐term evaluations at 6 months and 1 year postimplanta‐tion have been used for comparison.

Two of the three groups indicated that the multichannel users performed as early as the 6‐month level; the children in the third group performed equally. These results indicate that multichannel cochlear implants show great promise in deaf children.
Percutaneous feeding gastrostomy in patients with head and neck tumors: A 5‐year review
Authors: O'Dwyer Timothy P. , Gullane Patrick J. , Awerbuch David , Ho Chia‐Sing
Published: October 2006

Since the beginning of this decade major advances have taken place in the alimentation of patients with tumors of the head and neck. Gauderer and Ponsky described a percutaneous method of gastrostomy and, in 1983, a number of radiologists, including the senior author, described a percutaneous radiologic method using the Seldinger technique to create a feeding gastrostomy. This method is ideally suited for patients with advanced tumors of the head and neck because it requires neither endoscopy nor general anesthesia. Over the past 5 years, 55 patients with tumors of the head and neck have undergone this procedure. Eighty‐one percent of the patients had advanced disease at initial presentation. One patient (1.8%) had a procedure‐related death and another patient (1.8%) had a complication that required a laparotomy. Three patients (5.4%) had minor complications that required minimal medical attention. None of the patients required general anesthesia and an endoscopy was not required. Patient discomfort during the procedure was minimal.
Objective tinnitus in benign intracranial hypertension: An update
Authors: Sismanis Aristides , Butts Frank M. , Hughes Gordon B.
Published: October 2006

Previously, the authors reported that objective pulsatile tinnitus can be the major or only manifestation of benign intracranial hypertension. This report updates the authors' experience with 31 patients managed over the past 7 years.

Benign intracranial hypertension should be suspected in all patients with pulsatile‐objective tinnitus, especially when the patient is a young, obese female with headaches and/or visual disturbances. Papilledema and small ventricles or an empty sella on computerized tomography are almost diagnostic. The diagnosis is confirmed by elevated spinal fluid pressure on lumbar puncture. In such patients, angiography is not indicated. Furosemide and acetazol‐amide are very effective. Ligation of the internal jugular vein is contraindicated.
Primary extracranial meningiomas of the head and neck
Authors: Friedman Craig D. , Costantino Peter D. , Teitelbaum Benjamin , Berktold Robert E. , Sisson George A.
Published: October 2006

Extracranial meningiomas comprise approximately 2% of all meningiomas. Primary extracranial meningiomas are even less common. This report details our experience with these unusual tumors from 1972 to 1989. The diagnosis, surgical management, and significant histopathologic features are discussed. The correlation of primary extracranial meningiomas with neurofibromatosis type II and a treatment algorithm are presented.
Rationale for elective neck dissection in 1990
Authors: Friedman Michael , Mafee Mahmood F. , Pacella Bernard L. , Strorigl Terri L. , Dew Linda L. , Toriumi Dean M.
Published: October 2006

Elective neck dissection has long been a subject of debate among surgeons. The proponents of elective neck dissection base their rationale on studies that show a 30% incidence of occult disease in those situations for which elective neck dissection is recommended. One hundred eighty‐two patients with advanced stages of squamous cell carcinoma of the head and neck were studied. All patients had preopera‐tive computed tomography or magnetic resonance imaging, and all patients had some form of radical neck dissection. The sensitivity of clinical exam was compared with the sensitivity of computed tomography or magnetic resonance imaging in ability to detect nodal disease. The sensitivity of clinical exam alone was 71.7%, while the sensitivity of computed tomography or magnetic resonance imaging was 91.1%. Based on physical exam alone, there would be a 39% rate of occult disease; if computed tomography or magnetic resonance imaging data is combined with physical exam, the occult disease rate would drop to 12%. All centers performing elective neck dissection must reassess their rationale or restudy their occult disease rate with computed tomography or magnetic resonance imaging.
Mechanisms of Middle ear aeration: Anatomic and physiologic evidence in primates
Authors: Eden Avrim R. , Gannon Patrick J. , Laitman Jeffrey T.
Published: October 2006

Proper aeration is a prerequisite for normal middle ear function in all terrestrial mammals. Our previous studies in primates provided anatomic evidence of neural circuits between the middle ear, brain, and eustachian tube by which central respiratory neurons can control middle ear aeration. Yet mechanisms that regulate middle ear aeration remain poorly understood. This study extends our research by examining maturation of these neural circuits, and investigating their underlying physiology. Ultrastructural examination of tympanic nerves, the afferent limb of the neural circuit, in an age‐graded series of cynomolgus monkeys (Macaca fascicularis) showed substantial differences between newborn, young, and adult animals. These included a twofold increase in average myelin thickness, and greater than threefold increase in the ratio of myelinated to un‐myelinated fibers from newborn to adult animals. These marked developmental changes may translate into functional differences in regulation of middle ear aeration in young animals, and possibly explain the extraordinarily high incidence of middle ear disease in early childhood. In physiologic experiments, bilateral electromyographic responses were recorded from eustachian tube muscles, the efferent limb of the neural circuit, in adult monkeys after ipsilateral stimulation of the tympanic nerve. Response latencies were 9 to 28 msec, similar to those of other multi‐synaptic bilateral brainstem reflexes. These physiologic data strongly suggest a concept of active control of middle ear aeration by respiratory neurons in the brain.
Tamoxifen Therapy In Patients With Recurrent Laryngeal Squamous Carcinoma
Authors: Urba Susan G. , Carey Thomas E. , Kudla‐Hatch Vickie , Wolf Gregory T. , Forastiere Arlene A.
Published: October 2006

Twelve patients with recurrent, advanced laryngeal carcinoma were treated with tamoxifen hormonal therapy. Rationale was based on previous in vitro data identifying estrogen receptors and progesterone receptors in some laryngeal carcinoma cell lines. Four patients received tamoxifen, 10 to 20 mg by mouth twice a day; eight received 40 mg by mouth four times a day. The drug was well tolerated at all dose levels. There were no clinical responses. Two patients' tumor tissue was assayed for estrogen and progesterone receptors. One was negative for both, and the other was indeterminate for estrogen receptors and negative for progesterone receptors. A review of literature and a discussion of the possible reasons for the negative results are presented.
Effect of age on nasal cross‐sectional area and respiratory mode in children
Authors: Warren Donald W. , Hairfield W. Michael , Dalston Eileen T.
Published: October 2006

Although nasal cross‐sectional size has been reported for adults, no information is available concerning the effects of age on nasal area and breathing mode in children. Determination of the effect of age on nasal size is necessary in order to define nasal airway impairment in children. The purpose of this study was to determine mean nasal cross‐sectional size in children between the ages of 6 and 15 years. One hundred two children were assessed during resting breathing. The pressure‐flow technique was used to estimate nasal cross‐sectional size, and inductive plethys‐mography was used to assess nasal‐oral breathing. The results indicate that nasal airway size increased approximately 0.032 cm2 each year. Mean nasal cross‐sectional area increased from 0.21 ± 0.05 cm2 at age 6 to 0.46 ± 0.15 cm2 at age 14. The percentage of nasal breathing also increased with age.
Supraglottic laryngectomy for intermediate‐stage cancer: U.T. M.D. Anderson cancer center experience with combined therapy
Authors: Lee K. , Goepfert Helmuth , Wendt Charles D.
Published: October 2006

We reviewed the records of all patients with previously untreated squamous cell carcinomas of the supraglottic larynx who presented to The University of Texas M. D. Anderson Cancer Center from 1974 to 1987. Of 404 patients, 60 (15%) underwent supraglottic laryngectomy and functional anterior neck dissection as a primary modality of therapy; these patients were studied. Fifty of the 60 patients (83%) received adjunctive postoperative radiotherapy. Tumor‐free survival was 96% at 2 years and 91% at 5 years. There were no local failures, 4 regional failures, and 3 distant metastases. Second cancers, mostly of the lung, occurred in 9 patients (15%). Three patients required completion laryngectomies for intractable aspiration. Analysis of deglutition and tracheal decannulation rehabilitation revealed a higher incidence of complications in patients who underwent arytenoidectomies.
Allogeneic (homograft) reconstruction of the mandible
Authors: Lowlicht Roger A. , Delacure Mark D. , Sasaki Clarence T.
Published: October 2006

Reconstruction of the tumor‐ablated patient remains one of the most challenging problems for the head‐and‐neck surgeon. Various methods have been described, including alloplastic reconstruction, free vascularized flaps, osteo‐myocutaneous flaps, and allogeneic reconstruction with particulate marrow grafts. Sixteen patients who have undergone homograft mandibular replacement at the Yale New Haven Hospital are described. Eighty‐one percent of these grafts were successful in restoring form and function to a high degree of patient satisfaction. Eleven of the sixteen patients had radiation therapy after initial tumor surgery; 91% of these grafts were successful.
The predictive value of tumor classification compared with results of the british institute of radiology fractionation trial in the treatment of laryngopharyngeal carcinoma
Authors: Wiernik George , Hopewell John W. , Rezvani Mohiaddin , Alcock Christopher J. , Fowler John F. , Haybittle John L.
Published: October 2006

Data from a clinical trial involving 734 patients have shown the value and the deficiencies of the current Union Internationale Contre le Cancer's tumor, node, and metastasis classification system for prognostic purposes. The tumor‐category classification provides a good discriminant for both nodal involvement and survival; however, the previous node classification system only discriminated between node‐negative and node‐positive patients, as nodal fixity was not found to be a discriminator. The current anatomical site classification is ambiguous for some laryngeal and pharyngeal subsites, and modifications to the present system based on prognostic values are proposed. A difference in patient age between tumor categories has been shown, and various differences in incidence and survival data for the sexes have been demonstrated. Differences in observed and expected survival rates are related to continued late deaths from tumor. Multivariate analyses have shown that stage grouping is the most powerful prognostic discriminator, followed by anatomical site and age.
So‐Called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary
Authors: Micheau Christian , Klijanienko Jerzy , Luboinski Bernard , Richard Jean
Published: October 2006

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis.

This study reports on an additional 21 patients with this entity. Treatment of these patients included removal of the cystic metastasis with or without radical neck dissection and irradiation of Waldeyer's ring.

Two patients have died of unrelated disease and two were lost to follow‐up, but the remainder are alive without disease 2 months to 12 years following initial diagnosis.

We believe that cystic metastases from tonsillar squamous cell carcinomas have often been mistaken for either primary squamous cell carcinomas of branchiogenic origin or with branchial cleft cysts. The distinctive histological features of cystic metastases reviewed after its correct identification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options.
Argon laser phototherapy of human malignancies using rhodamine‐123 as a new laser dye: The intracellular role of oxygen
Authors: Castro Dan J. , Ward Paul H. , Fetterman Harold R. , Foote Christopher S. , Saxton Romaine E. , Markley John , Castro Donna J.
Published: October 2006

Recent studies demonstrated that the cationic, mito‐chondrial‐specific dye Rhodamine‐123 (Rh‐123), is an efficient tumor photosensitizer for Argon laser treatment of human cancer cells both in vitro1–4 and in tumors grown as xenografts in athymic mice.5–7 To demonstrate the photo‐dynamic mechanism of action of this reaction, the intracellular role of oxygen and temperature changes in treated cells have to be defined. In the current study, a large panel of human tumor cell lines of diverse histologic origin were tested for in vitro sensitivity to Rh‐123 and the Argon laser (514.5 nm) in oxygen, deuterium oxide (D2O), and nitrogen (N2) environment. Tumor cells in suspension were first sensitized to Rh‐123 (1 or 20 μg/ml for 1 hour), cooled on ice to 4°C, and then exposed to the Argon laser (ΔT = 14 ± 1°C). Cell proliferation measured by [3H]‐thymidine uptake 24 hours after sensitization with Rh‐123 and laser treatment was significantly decreased in tumor cells kept in oxygen and D2O atmospheres. No decrease in DNA synthesis was seen in Rh‐123 and laser treated cells kept in an N2 environment. Control tumor cells treated with Rh‐123 or the Argon laser separately did not show any decreased [3H]‐thymidine uptake in oxygen, D2O or N2 environment. These results provide evidence of a photodynamic process since Rh‐123 sensitization and Argon laser activation occur at nonther‐mal levels of energy and are oxygen dependent. The high effectiveness of this technique of photodynamic therapy with the Argon laser, and low toxicity of Rh‐123 could make its clinical use very attractive for the treatment of superficial malignancies.
Conservation surgery for glomus jugulare tumors: The value of early diagnosis
Authors: Jackson C. Gary , Cueva Roberto A. , Thedinger Britt A. , Glasscock Michael E.
Published: October 2006

The results of‐lateral cranial base surgery for glomus jugulare tumors are gratifying when normal anatomy and function can be preserved. The goal of conservation surgery is to preserve normal ear anatomy and cranial nerve function. In general, conservation surgery is tumor‐size dependent. Thus, excellent states of functional recovery depend upon accurate early diagnosis. This paper reviews the technical aspects of transtemporal conservation skull base tumor surgery while also reviewing our experience with nearly 100 glomus jugulare patients. Adjuvants to early diagnosis will be highlighted from a review of presenting symptoms, clinical signs, and related diagnosis. Our objective is to provoke a high index of suspicion in physicians charged with the responsibility of diagnosing these tumors. Diagnostic guidelines are proposed.
Effects of uvulopalatopharyngoplasty on sleep architecture and patterns of obstructed breathing
Authors: Katsantonis George P. , Miyazaki Sohichiro , Walsh James K.
Published: October 2006

In this retrospective study, 72 obstructive sleep apnea patients with polysomnograms taken before and after uvulopalatopharyngoplasty were evaluated. Postoperative‐ly, there was a significant improvement of sleep architecture and respiratory indices. In addition, a second group of 17 patients also had position recordings with their polysomnograms. Time spent in supine and lateral sleep positions changed postoperatively. There was significant decrease of the apnea plus hypopnea index in the lateral position. This study indicates that there is significant improvement of sleep architecture and respiratory indices in the majority of patients after uvulopalatopharyngoplasty, particularly in the lateral sleep position.
Endoscopic laser surgery for early glottic carcinoma: A clinical and experimental study
Authors: Wolfensberger Markus , Dort Joseph C.
Published: October 2006

The purpose of this study is to define the indications for using the CO2 laser for the treatment of early glottic cancer. For this purpose, 52 consecutive laser resections of Tis to T2 vocal cord carcinomas were studied prospectively. In addition, laser resection was performed in eight human cadaver larynges, which were then examined histologically using whole organ sections. Both tumor size and tumor location had important influences on tumor resectability by laser. All of the Tis, 78% of T1, and one of four T2 carcinomas were successfully treated by laser surgery alone. Of the 10 carcinomas involving the anterior commissure, only four could completely be resected with the laser; of these four, two recurred in the anterior commissure. This finding is corroborated by the histologic study, which clearly shows that anterior commissure resection poses problems. The only laser resection complication of early glottic cancer was persistent hoarseness in one third of the patients. It is concluded that CO2 laser resection is a safe and effective alternative treatment for patients with Tis and T1 glottic carcinoma, provided the anterior commissure is free of tumor.
A targeted problem and its solution: A new method of needle‐electrode placement in the posterior cricoarytenoid muscle for electromyography
Authors: Mu Liancai , Yang Shilin
Published: October 2006

In 1979 the authors developed a new method of needle‐electrode placement in the posterior cricoarytenoid muscle (PCA) for electromyography. The PCA muscle is easily reached by inserting a needle electrode through the cri‐cothyroid membrane at the midline and penetrating the lamina of the cricoid cartilage in the subglottic cavity. Access to the PCA muscle for electrode insertion was best afforded by a percartilaginous approach. This report details the new technique used at our laboratory. To our knowledge, this is the first report of needle‐electrode placement in the PCA muscle by a percartilaginous approach.

This new electrode insertion technique has been applied to more than 100 dogs for research purposes and to 1200 patients with laryngeal motor disorders for clinical diagnosis. This is a simple technique requiring the usual skills. Reliable electromyographic recordings have been obtained by this new method. No untoward effects, such as hematoma or infection from repeated placements were observed in approximately 3200 examinations performed to date. It is reasonable to assume that the percartilaginous route for electrode insertion in the PCA muscle is feasible in man.

Techniques of electrode placement in the intrinsic laryngeal muscles are reviewed and compared.
Otolaryngologic aspects of lyme disease
Authors: Moscatello Augustine L. , Worden Douglas L. , Nadelman Robert B. , Wormser Gary , Lucente Frank
Published: October 2006

Lyme disease is a systemic illness caused by the spirochete Borrelia burgdorferi and transmitted by the bite of a tick in the Iocodes ricinus complex. While the illness is often associated with a characteristic rash, erythema migrans, patients may also present with a variety of complaints in the absence of the rash. The otolaryngologist may be called upon to see both groups of patients, with any number of signs and symptoms referable to the head and neck, including headache, neck pain, odynophagia, cranial nerve palsy, head and neck dysesthesia, otalgia, tinnitus, hearing loss, vertigo, temporomandibular pain, lymphad‐enopathy, and dysgeusia. We review our institutional experience with 266 patients with Lyme disease, 75% of whom experienced head and neck symptoms. We also summarize the diagnostic and treatment modalities for this illness.
Congenital cholesteatoma of the middle ear in children: A clinical and histopathological report
Authors: Mcgill Trevor J. , Merchant Saumil , Healy Gerald B. , Friedman Ellen M.
Published: October 2006

Forty‐one children with congenital cholesteatoma of the middle ear seen from 1978 through 1989 are reviewed. The most common presentation was that of an asymptomatic white mass behind a normal intact tympanic membrane. Computed tomography (CT) scan was useful in documenting extension beyond the mesotympanum. Surgical removal was performed using an extended tympanotomy for lesions in the middle ear and tympanomastoidectomy for those that had extended into attic and mas‐toid air cells. Observation over an average 3.1‐year period indicated that 80% of children were free of disease after initial surgery. Residual disease that required further surgery was present in 20%.

The importance of early diagnosis of congenital cholesteatoma is strongly advocated. The prognosis is better when the cholesteatoma is confined to the anterosuperior quadrant of the middle ear. Seventeen patients in this study had such a lesion, and extended tympanotomy allowed removal of an encapsulated closed cholesteatoma with normal postoperative hearing and no residual cholesteatoma. The average age was 2.3 years.

Temporal bone histopathological studies of three cases of congenital cholesteatoma demonstrate two distinct pathological types of congenital cholesteatoma. A “closed” keratotic cyst in the anterior mesotympanum, which is easily removed, and an “open” infiltrative type in which there is no containment of the keratotic debris and the cholesteatoma matrix is in direct continuity with middle ear mu‐cosa. Surgical extirpation of the “open” type is difficult and more likely to be associated with residual disease.
Necrotizing soft‐tissue infections in the head and neck: A clinicopathological study
Authors: Tovi Ferit , Fliss Dan M. , Zirkin Howard J.
Published: October 2006

The clinicopathological aspects of 15 patients with necrotizing soft‐tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature.

Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy‐appearing tissues at the periphery of the lesions.

The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen‐section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.
Antibody response against the epstein‐barr virus‐coded nuclear antigen2 (EBNA2) in nasopharyngeal carcinoma
Authors: Chatani Masashi , Teshima Teruki , Inoue Toshihiko , Yoshino Kunitoshi , Ikegami Nobuko , Shimakage Misuzu , Hirai Kanji
Published: October 2006

Specific antibody responses against the Epstein‐Barr virus‐coded nuclear antigen2 (EBNA2) were evaluated. Thirty‐five sera from pretreatment patients of nasopharyngeal carcinoma (NPC) and 12 from healthy adults were tested. Although the anti‐EBNA2 response did not show any correlation with T stage, overall stage, or histopathology, it showed a correlation with the N stage of the disease. In a se‐rological follow‐up study, 17 (85%) of 20 patients showed a correlation on the change of antibody levels to EBNA2 and clinical progression. This suggests that EBNA2 serology might represent a useful marker relative to tumor status.
Double‐blind controlled study of botulinum toxin in adductor spasmodic dysphonia
Authors: Truong Daniel D. , Rontal Michael , Rolnick Michael , Aronson Arnold E. , Mistura Kathy
Published: October 2006

The treatment of adductor spasmodic dysphonia using botulinum toxin A was conducted in 13 patients as a double‐blind, placebo‐controlled study. Patients were diagnosed independently by an interdisciplinary team consisting of speech pathologists, an otolaryngol‐ogist, and a neurologist. The toxin or saline was injected into each thyroarytenoid muscle under electro‐myographic and laryngoscopic guidance. Botulinum toxin A markedly reduced perturbation, decreased fundamental frequency range, and improved the spectrographic characteristics of the voice. Fundamental frequency and phonation time remained unchanged. Patients injected with botulinum toxin A noticed significant improvement in their voices in comparison with the placebo‐treated group. Excessive breathiness of the voice occurred in two patients, and mild bleeding in one patient in the botulinum toxin A‐treated group. Injection with saline resulted in edema of the vocal cord in one patient. Botulinum toxin A proved to be an effective and safe treatment of adductor spasmodic dysphonia.
Nasopharyngeal carcinoma treated at the finsen institute, Copenhagen 1965‐1985: Survival and some prognostic factors
Authors: Bentzen Jens K. D. , Ockelmann Hans H. , Albeck Henrik , Olsen Jens , Hansen Hanne S.
Published: October 2006

Clinical data from 218 patients consecutively treated for nasopharyngeal carcinoma at the Finsen Institute in Copenhagen during the period 1965 through 1985 have been analyzed for factors of prognostic importance. Of the 218 patients, 47 were Greenland Inuit eskimos and 169 were white Danish. The 5‐year crude survival for the entire group of patients was 30%.

The two groups of patients differed with respect to the importance of different prognostic factors. Keratinizing tumors were only present in the Danish population. These patients had a highly significant worse outcome than the rest of the Danish (P<0.00001). Age, stage, and T classification were important prognostic factors in the Danish population, but not in the Inuit population.
Transient retrocochlear low‐frequency sensorineural hearing loss: A new clinical entity
Authors: Fukaya Takashi , Nomura Yasuya , Fukushima Takanori
Published: October 2006

Sensorineural hearing loss (SNHL) of varying types and extent developed in a number of the 963 patients who underwent microvascular decompression for hemifacial spasm. Fourteen of the patients with hearing loss had transient low‐frequency SNHL. Low‐frequency SNHL is seldom noted in patients with retrocochlear hearing loss, but five of these patients had Homer's syndrome or bulbar palsy. The results of Békésy audiometry, auditory brainstem response, and electrocochleography in the patients were also suggestive of brainstem pathology. Surgical records revealed that all of them had excessively short perforating arteries surrounding the entry zone of nerves VII and VIII, so that they had to be stretched during surgery. Occlusion of perforating arteries is suspected to have caused lateral brainstem infarction around the entry zone of nerves VII and VIII, and resulted in low‐frequency SNHL.
The measurement and manipulation of intralabyrinthine pressure in experimental endolymphatic hydrops
Authors: Andrews James C. , Bohmer Andreas , Hoffman Larry F.
Published: October 2006

Three to four months after unilateral surgical ablation of the endolymphatic duct and sac, endolymphatic and perilymphatic pressures were measured in both the normal and hydropic ears of 11 guinea pigs. In normal ears, endolymphatic pressure always approximated perilymphatic pressure. Endolymphatic pressure exceeded perilymphatic pressure in all ears with hydrops, except one in which these pressures were equal. The effect of postural inversion on inner ear pressures were studied in both normal and hydropic inner ears. Normal ears showed endolymphatic and perilymphatic pressure to rise equally during this maneuver. In hydropic ears, the difference between endolymphatic and perilymphatic pressure was notably reduced from measurements obtained in the prone position. This study indicates that an alteration in pressure regulation within the inner ear may be important in the pathogenesis and manifestation of experimental endolymphatic hydrops in the guinea pig. Physiologic mechanisms and clinical implications of these results are described.
Primary mandibular reconstruction: Analysis of 64 cases and evaluation of interface radiation dosimetry on bridging plates
Authors: Gullane Patrick J.
Published: October 2006

The combination of a myocutaneous flap or free cutaneous tissue transfer with a three‐dimensional bendable reconstruction plate either of stainless steel or titanium has provided very satisfactory results in primary restoration of mandibular defects following surgical resections in irradiated patients or in those who require postoperative radiotherapy. Sixty‐four cases have been treated and evaluated pro‐spectively using this technique. Fifty‐three of the patients had the soft‐tissue defect restored with a myocutaneous flap, 8 had a free cutaneous tissue flap, 2 were reconstructed with tongue flaps, and 1 closed primarily. The stainless steel plate of the A.O. type was used in 53 cases and the titanium plate system and hollow screws in the other 11 cases. A success rate of 78.9% was found with a median follow‐up of 384 days. Thirty of the 64 cases had preoperative irradiation and 15 were treated postoperatively. A plate failure rate of 23% was encountered in those treated with preoperative irradiation and in 20% with those having postoperative irradiation. Forty‐nine of the 64 patients or 76.5% experienced no perioperative complications. Five or 7.8% of the complications were minor. Ten patients or 15.6% experienced a major complication with one death due to a myocardial infarct. A radiation dosimetric model was employed using both stainless steel and titanium. The results from this study showed that, when using a parallel pair of beams, an excess dose of irradiation for the lowest energy cobalt‐60 is 13%, for 6 mV it is 15%, and for 18 mV it is 20%. The excess tissue dose, both for stainless steel and titanium plates, extends for about 0.2 mm for cobalt‐60, 1.1 mm at 6 mV, and for 25 mm at 18 mV. Patients with plates, therefore, can be treated safely with postoperative irradiation using either cobalt‐60 or 6‐mV energy.
Management of the internal carotid artery during carotid body tumor surgery
Authors: Anand Vinod K. , Alemar Gilberto O. , Sanders Tammy S.
Published: October 2006

Patients with carotid body tumors require accurate preoperative assessment of vessel involvement and the probable impact of interrupting blood flow through the internal carotid artery. Recent developments in imaging, methods of measuring cerebral blood flow, balloon occlusion testing, and techniques to maintain vascular flow when a graft is required have improved the surgeon's ability to completely resect these tumors with reduced complications. We discuss these methods with respect to our review of 20 carotid body tumors in 18 patients. Twenty‐five percent of patients were misdiagnosed, and in four patients injury to the vessel wall required appropriate surgical intervention.
Insulin‐dependent diabetic microangiopathy in the inner ear
Authors: Smith Timothy L. , Raynor Eileen , Prazma Jiri , Buenting John E. , Pillsbury Harold C.
Published: October 2006

Thickening of the basement membrane in capillaries is implicated in the microangiopathic complications of diabetes mellitus. This study was designed to evaluate microangiopathic changes of the inner ear associated with insulin‐dependent diabetes mellitus (IDDM) and concurrent moderate‐intensity noise exposure.

Male Sprague‐Dawley rats were injected with streptozotocin (65 mg/kg) to induce IDDM. Half of the control and diabetic animals were exposed to chronic noise of 95 dB over the 6‐month study period. Photomicrographs of the capillaries in the stria vascularis were obtained by transmission electron microscopy, and basement‐membrane thickness was measured with an image processing system.

This study quantitatively demonstrates basement‐membrane thickening consistent with diabetic microangiopathy in the inner ear of IDDM rats. Noise exposure did not significantly change basement‐membrane thickness in either diabetic or control animals.
Detection of metastases from head and neck cancers
Authors: Troell Robert J. , Terris David J.
Published: October 2006

Before treatment for head and neck malignancies is begun, a search for distant metastases (DM) is performed. The first objective of this review was to determine the accuracy of liver function tests (LFT), alkaline phosphatase (AP) tests, and chest radiographs (CXR) in detection of DM. Second, an effort was made to identify tumor characteristics which are associated with a higher incidence of DM and therefore justify the use of more precise screening tools.

An analysis of 97 patients with noncutaneous squamous cell carcinomas presenting to the Stanford Head and Neck Tumor Board in 1991 revealed 17 DM in 14 patients. There were 10 pulmonary metastases, 5 bone metastases, and 2 hepatic metastases. CXR had a sensitivity of 50% and a specificity of 94% for detection of pulmonary DM. AP tests showed a sensitivity of 20% and a specificity of 98% for detection of bone DM. LFT had a sensitivity of 50% and an 81% specificity for demonstration of hepatic DM.

A separate analysis of 79 patients with known DM from two hospitals showed the incidence of DM to be increased in patients who had tumors of advanced stage, advanced T status, and poor histologic differentiation and to also be increased in the presence of local‐regional recurrence. There was little association of DM with N status.

The sensitivity of CXR and laboratory tests, which are currently used in evaluation for DM at most cancer centers, is disappointing; these tests should be viewed as gross screening examinations. We recommend a chest computed tomography scan in the event of an abnormal CXR, a bone scan in the event of an elevated AP, and either an ultrasound or computed tomography/magnetic resonance imaging scan of the liver when elevated LFT levels are present, depending on tumor stage and differentiation.
Management of thyroid nodules during pregnancy
Authors: Doherty Carolyn M. , Shindo Maisie L. , Rice Dale H. , Montero Martin , Mestman Jorge H.
Published: October 2006

Guidelines for the management of thyroid nodules discovered during pregnancy have not yet been established. The authors reviewed the records of 23 patients with thyroid nodules that were first detected during pregnancy. These patients were divided into three groups according to how they were managed. Seven patients who presented early in pregnancy had their work‐up completed during pregnancy, 11 patients underwent biopsy after delivery, and 5 patients were managed with observation alone. The incidence of malignancy in the series was 39%. Four patients underwent surgery during pregnancy, and 7 patients were operated on in the postpartum period. No fetal morbidity or mortality occurred.

The authors recommend that fine‐needle aspiration be performed in patients who present before 20 weeks of gestation with rapidly enlarging thyroid nodules, nodules associated with palpable cervical adenopathy, solid nodules larger than 2 cm, or cystic nodules larger than 4 cm. Growth of a nodule while a patient is receiving thyroid hormone suppression therapy is highly suspicious for malignancy; in this situation, consideration should be given to performing biopsy later in gestation.
Quantitative measures of laryngeal function following teflon® injection or thyroplasty type I
Authors: D'Antonio Linda L. , Wigley Terry L. , Zimmerman Grenith J.
Published: October 2006

Laryngeal/voice function was evaluated in six patients with unilateral true vocal fold paralysis following treatment with Teflon® injection (TEF) compared to six patients treated with thyroplasty type I (THY). Auditory perceptual, aerodynamic, and endoscopic assessments were conducted. Three judges rated nine voice characteristics. Aerodynamic measures included estimated subglottal pressure, airflow, and laryngeal resistance. Two judges rated laryngeal characteristics from flexible fiberoptic assessment. The THY group had significantly better voice quality and better quantitative aerodynamic findings compared to the TEF group. The TEF group also was more likely to have an irregular vocal fold edge, an irregular glottal closure pattern, a higher occurrence of hyperfunction and hypertrophy of the false vocal folds, edema, and erythema of the paralyzed folds. Results suggest that THY was associated with more favorable measures of laryngeal/voice function than TEF. It is likely that the poorer perceptual, aerodynamic, and endoscopic findings associated with TEF injection may be due to violation of the true vocal fold cover, particularly increased true vocal fold mass and stiffness.
Posterior semicircular canal occlusion for benign paroxysmal positional vertigo—CO2laser‐assisted technique: Preliminary results
Authors: Kartush Jack M. , Sargent Eric W.
Published: October 2006

Benign paroxysmal positional vertigo (BPPV) is a common vestibular end‐organ disorder that in the majority of patients resolves with conservative management. In the occasional patient who has unremitting BPPV despite conservative treatment, posterior semicircular canal occlusion (PCO) may be effective in eliminating symptoms. In an attempt to minimize the risk of hearing loss, a modified procedure was developed that uses the CO2laser to shrink the membranous vestibular posterior semicircular canal prior to mechanically plugging the canal. Preliminary results of this CO2laser‐assisted occlusion technique used in four patients are presented.
Acoustic rhinometry in the evaluation of nasal obstruction
Authors: Roithmann Renato , Cole Philip , Chapnik Jerry , Shpirer Isaac , Hoffstein Victor , Zamel Noe
Published: October 2006

Acoustic rhinometry (AR) is a recently developed objective technique for assessment of geometry of the nasal cavity. The technique is based on the analysis of sound waves reflected from the nasal cavities. It measures cross‐sectional areas and nasal volume (NV). To obtain dependable assessments of nasal resistance by rhinomanometry or cross‐sectional area measurements by AR, it is essential that the structural relations of the compliant vestibular region remain undisturbed by the measuring apparatus. The use of nozzles in making these measurements carries a great risk of direct distortion of the nasal valve. We used a nasal adapter that does not invade the nasal cavity and a chin support that stabilizes the head. In 51 healthy nasal cavities, the average minimum cross‐sectional area (MCA) was 0.62 cm2 at 2.35 cm from the nostril and 0.67 cm2 at 2 cm from the nostril, respectively, before and after topical decongestion of the nasal mucosa. The MCA and NV findings in this group were significantly higher than MCA and NV (P<0.001) in people with structural or mucosal abnormalities before mucosal decongestion. After mucosal decongestion, the MCA and NV were significantly higher in healthy nasal cavities than in nasal cavities with structural abnormalities (P<0.001) but were not higher than nasal cavities with mucosal abnormalities (MCA, P = 0.05; NV, P = 0.06). A nozzle was applied in 20 healthy nasal cavities after mucosal decongestion, and a significantly higher MCA was found compared to measurements made with the nasal adapter (P = 0.02). We conclude that the nasal adapter, which does not invade the nasal cavities, avoids the distortion of the nasal valve and gives more accurate results.
Inverted papilloma: A report of 112 cases
Authors: Lawson William , Ho Bryan T. , Shaari Christopher M. , Biller Hugh F.
Published: October 2006

Inverted papilloma is a benign sinonasal tumor which is locally aggressive and has a significant malignant potential. This report updates the experience of the two senior authors, who have treated 112 patients with inverted papilloma at the Mount Sinai Medical Center over a 20‐year period.

As clinical examination often underestimates tumor extent, preoperative radiographic assessment is of paramount importance in guiding selection of surgical therapy. Complete en bloc excision via lateral rhinotomy and medial maxillectomy was the method of treatment in the majority of patients (84%). In selected patients with limited disease, or in patients who refused en bloc excision, conservative therapy employing intranasal or transantral ethmoidectomy was performed. The recurrence rates for the two groups were 14% and 20%, respectively. Recurrent disease developed throughout the paranasal sinuses, with the maxillary antrum and ethmoid labyrinth constituting the major sites. In two patients presenting with anterior skull base erosion, craniofacial resection was undertaken to eradicate disease. The latter cases underscore the aggressive nature of the tumor if left untreated. The overall rate of squamous carcinoma in this series was 5%.

Given the predilection for local recurrence, multicentricity, and the possibility of malignancy, the authors continue to recommend lateral rhinotomy and medial maxillectomy as the standard therapy for the majority of cases. Management principles as well as a review of the literature are discussed.