bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Bone in Chronic Rhinosinusitis
Authors: Khalid Ayesha N. , Hunt Jennifer , Perloff Joel R. , Kennedy David W.
Published: November 2003

Objectives To evaluate and confirm the histological inflammatory changes that occur in bone and in the overlying mucosa in experimentally induced chronic rhinosinusitis and to evaluate differences in the inflammatory patterns that may occur with different organisms.

Study Design Histological study of induced maxillary rhinosinusitis in 29 New Zealand White rabbits (15 with Pseudomonas aeruginosa, 14 with Staphylococcus aureus) 7 to 9 weeks after infection.

Methods Following maxillary sinus ostial infection, unilateral chronic bacterial rhinosinusitis was induced in 29 New Zealand White Rabbits, using Pseudomonas aeruginosa (n = 15) and Staphylococcus aureus (n = 14). The pathogenic organism was confirmed by culture, and the rabbits were sacrificed at predetermined time intervals (7, 8, and 9 wk) from the time of infection. Following harvest, en bloc sinus sections were mounted, stained, and analyzed. Specific attention was given to identifying histological changes in paranasal sinus bones on both sides.

Results All animals (29 of 29) demonstrated histological evidence of operative occlusion on the side of the original inoculum, and all were culture‐positive for the inoculated organism at death. Histological evidence of chronic rhinosinusitis in the inoculated sinus was demonstrated in 86% of animals (25 of 29). Evidence of chronic osteomyelitis in the noninfected side was seen in 15 of 29 animals (52%) overall, or 9 of 15 animals (60%) infected with pseudomonas and 6 of 14 (43%) animals infected with staphylococcus organisms.

Conclusions The study provides further evidence that bacterial rhinosinusitis can involve bone at a distance from the site of primary infection, thereby suggesting that infectious agents may spread through bony structures in the pathogenesis of chronic rhinosinusitis.
Synovial Cell Sarcoma: Diagnosis, Treatment, and Outcomes
Authors: Kartha Swapna S. , Bumpous Jeffrey M.
Published: November 2003

Objectives/Hypothesis Synovial cell sarcoma is a mesenchymal tumor predominantly of the lower extremities. Three percent of cases arise in the head and neck region. It is thought that head and neck synovial sarcoma has a better prognosis than tumors of the extremities. Our experience has demonstrated aggressive behavior of this neoplasm in the head and neck. This compelled us to compare our experience with other studies.

Study Design Retrospective chart review.

Methods We obtained the records of patients diagnosed with head and neck synovial sarcoma from the Tumor Registry of the University of Louisville School of Medicine (Louisville, KY) and affiliated hospitals for data compiled between January 1990 and December 2000. Data on patient demographics, clinical findings and symptoms, histological findings, treatment, extent of disease, recurrence, and survival were recorded. The literature was reviewed identifying reports of synovial cell sarcoma.

Results Five consecutive patients with synovial cell sarcoma were assessed at our facility. The median patient age was 28.2 years. All of the patients underwent an aggressive primary surgical excision followed by irradiation. All patients received chemotherapy after recurrence. Four of the five patients had local recurrence, and all five of the patients developed distant metastases. Three of the patients have died, and two are alive with evidence of disease. Novel sites are reported including the ethmoid sinus and the parotid gland. This group demonstrated a 40% 5‐year overall survival, which was lower than the 60% 5‐year survival reported in the literature for all sites.

Conclusions Synovial cell sarcoma of the head and neck is a disease of young people and carries a poor prognosis. The aggressive nature of the disease may require modification of accepted treatment modalities and sequence.
Lipoic Acid in the Treatment of Smell Dysfunction Following Viral Infection of the Upper Respiratory Tract
Authors: Hummel Thomas , Heilmann Stefan , Hüttenbriuk Karl‐Bernd
Published: November 2003

Objectives/Hypothesis The study aimed to investigate the potential therapeutic effects of α‐lipoic acid in olfactory loss following infections of the upper respiratory tract. Possible mechanisms of actions include the release of nerve growth factor and antioxidative effects, both of which may be helpful in the regeneration of olfactory receptor neurons.

Study Design Unblinded, prospective clinical trial.

Methods A total of 23 patients participated (13 women, 10 men; mean age 57 y, age range 22–79 y; mean duration of olfactory loss, 14 mo; range, 4 to 33 mo); 19 of them were hyposmic and 4 had functional anosmia. Alpha‐lipoic acid was used orally at a dose of 600 mg/day; it was prescribed for an average period of 4.5 months. Olfactory function was assessed using olfactory tests for phenyl ethyl alcohol odor threshold, odor discrimination, and odor identification.

Results Seven patients (30%) showed no change in olfactory function. Two patients (9%) exhibited a moderate decrease in olfactory function; in contrast, six patients (26%) showed moderate and eight patients (35%) remarkable increase in olfactory function. Two of the 4 patients with functional anosmia reached hyposmia; 5 of 19 hyposmic patients became normosmic. Overall, this resulted in a significant improvement in olfactory function following treatment (P = .002). At the end of treatment parosmias were less frequent (22%) than at the beginning of therapy (48%). Interestingly, recovery of olfactory function appeared to be more pronounced in younger patients than in patients above the age of 60 years (P = .018).

Conclusions The results indicate that α‐lipoic acid may be helpful in patients with olfactory loss after upper respiratory tract infection. However, to judge the true potential of this treatment, the outcome of double‐blind, placebo‐controlled studies in large groups of patients must be awaited, especially when considering the relatively high rate of spontaneous recovery in olfactory loss after upper respiratory tract infection.
The ARF‐p16 Gene Locus in Carcinogenesis and Therapy of Head and Neck Squamous Cell Carcinoma
Authors: Yarbrough Wendell G.
Published: November 2003

Objectives/Hypothesis We have identified families with a high incidence of tumors including head and neck squamous cell carcinoma (HNSCC). The occurrence of melanoma in these kindreds suggested that the ARF‐p16 gene may be involved in carcinogenesis. We wished to determine the gene defect associated with the familial predisposition to HNSCC and to determine whether restoration of the gene may have therapeutic benefit.

Study Design Translational molecular research.

Methods Molecular techniques were used to identify mutations of the ARF‐p16 gene from the affected families and to test the activity of p16 and ARF mutants. In additional, HNSCC tumor tissue was analyzed to determine whether the wild‐type p16 allele was lost or maintained. ARF‐expressing adenoviruses were created, and their effect on HNSCC cell lines and normal head and neck epithelial cells was determined.

Results Mutation of the ARF‐p16 gene was found in two families with predisposition to develop HNSCC. Independent mutations detected in the germline DNA of both families inactivated p16, but not ARF, and the inactive mutant p16 allele segregated with disease within both families. The wild‐type p16 allele was lost in HNSCC tumor tissue from both families. The efficacy of ARF in treatment of HNSCC was found to depend on retention of p53 activity within HNSCC tumor cells. Remarkably, ARF expression was found to kill cells, depending on loss of retinoblastoma activity. Because loss of retinoblastoma activity is nearly universal in tumors, ARF killed tumor cells that retained p53, but ARF spared normal cells.

Conclusions Our results support the recognition of a new clinical entity of familial head and neck cancer. We have shown that this syndrome is associated with inactivating mutations of the p16 gene that these mutations segregate with disease in two described families. Loss of the wild‐type p16 allele in HNSCC tissue from both families strongly supports the role of the mutant p16 in carcinogenesis. We have also investigated the therapeutic utility of the alternate reading frame product of the p16 gene, ARF. The finding that ARF kills cells depending on loss of retinoblastoma activity and retention of p53 suggests that ARF may be effective in treatment of roughly 50% of head and neck cancers while sparing normal cells. Recognition of p16 mutations as an etiological factor in familial HNSCC provides an accessible tool for diagnosis of this syndrome. Clinical acceptance of familial head and neck cancer will ensure that patients are appropriately diagnosed and managed.
The Ulnar Fasciocutaneous Free Flap in Head and Neck Reconstruction
Authors: Wax Mark K. , Rosenthal Eben L. , Winslow Catherine P. , Bascom Daphne A. , Andersen Peter E.
Published: November 2003

Objectives/Hypothesis The radial forearm fasciocutaneous free flap has become the reconstructive tissue of choice for the majority of soft tissue defects in the head and neck. The forearm skin has many of the ideal soft tissue characteristics that optimize reconstruction and rehabilitation in these patients. The tissue is malleable, supple, and moldable in three dimensions; has a reliable pedicle; and can be harvested with a two‐team approach. In some patients, the radial forearm cannot be used. An alternative is to use the adjacent tissue, which shares identical tissue characteristics. This tissue gets its vascular supply from the ulnar artery. The purpose of the report was to describe the authors' experience with the ulnar fasciocutaneous free flap in head and neck reconstruction.

Study Design Prospective consecutive case series.

Methods Retrospective review of all patients undergoing ulnar fasciocutaneous free tissue transfer by a group of microvascular surgeons was performed. Thirty patients underwent free tissue transfer using the ulnar fasciocutaneous free flap. The male‐to‐female ratio was 3:1.

Results Defects were located in the oral cavity (14), oropharynx (12), neck skin (1), and soft tissue of the lateral skull (3). The average size of the skin paddle that was transferred was 7 × 10 cm (range, 3 × 5 to 9 × 12 cm). The mean area of tissue that was transferred was 70 cm2 (range, 15–108 cm2). Vessel sizes were somewhat smaller than the comparable radial forearm. One patient had complete loss of the skin graft on the donor site. There were no median nerve or other wound‐healing problems. Two flaps were lost in the postoperative period. Indications for use of the ulnar fasciocutaneous free flap were failed Allen's test (23), use of a less hairy part of the forearm (3), and surgical preference (4).

Conclusions The ulnar fasciocutaneous free flap has all of the tissue characteristics of the radial forearm flap. When a radial forearm flap cannot be used and forearm skin is desired, consideration of an ulnar fasciocutaneous free flap should be undertaken.
Incidental Metastatic Papillary Thyroid Carcinoma in Microvascular Reconstruction
Authors: Moore Brian A. , Duncan Irenee M. , Burkey Brian B. , Day Terry
Published: November 2003

Objectives/Hypothesis Occult papillary thyroid carcinoma has a reported prevalence of 1% to 35% based on autopsy studies. Cervical lymphatic metastases from papillary thyroid carcinoma have been associated with a higher likelihood of recurrence with a questionable impact on survival. Without clinically evident disease in the thyroid or cervical nodes, management of these patients presents a treatment dilemma. We propose an individualized treatment plan for patients in whom metastatic papillary thyroid carcinoma is incidentally detected during neck exploration for other purposes.

Study Design Retrospective review and discussion of the literature.

Methods The clinical course of two patients with incidentally discovered metastatic papillary thyroid carcinoma to the cervical lymph nodes is described. Both patients had previously received head and neck irradiation in childhood and required free flap reconstruction of extensive skull base defects following extirpation of meningiomas.

Results Neck dissection specimens from levels I and II obtained during exposure of recipient vessels for microvascular tissue transfer revealed papillary thyroid carcinoma in both cases. The patients subsequently underwent total thyroidectomy, neck dissection, and postoperative radioactive iodine ablation of residual thyroid tissue. After 1 year of follow‐up, both patients were without evidence of recurrent disease.

Conclusions An individualized approach is justified to treat metastatic papillary thyroid carcinoma incidentally discovered during other procedures. The case reports underscore the importance of pathological analysis of surgical specimens obtained during head and neck reconstruction.
Computed Tomography's Ability to Predict Sacrifice of Hypoglossal Nerve at Resection
Authors: Dubin Marc G. , Ebert Carlos S. , Mukherji Suresh K. , Pollock Hoke W. , Amjadi Darius , Shockley William W.
Published: November 2003

Objective To assess whether preoperative computed tomography (CT) scan can determine if the hypoglossal nerve (cranial nerve XII) will be sacrificed in floor‐of‐mouth, oral tongue, and tongue base tumor resections.

Study Design Retrospective review.

Methods Patients who underwent resection of floor‐of‐mouth, oral tongue, and tongue base tumors from 1990 to 1999 were identified. Preoperative CT scans were reviewed by a neuroradiologist. The postoperative status of cranial nerve XII was predicted to be “saved” or “sacrificed.” Hypoglossal nerve “sacrifice” was predicted if the fat planes surrounding the takeoff of the proximal lingual artery were obliterated by tumor. The nerve was determined to be sacrificed or spared during resection by review of the operative report.

Results Of the 45 patients, 14 tumors were predicted radiographically to involve the hypoglossal nerve. Twenty‐seven of 31 nerves that were predicted to be saved were saved at the time of surgery. Seven of 14 nerves that were predicted to be sacrificed were sacrificed at the time of surgery. The sensitivity was 0.64 (95% confidence interval [CI], 0.35–0.86) with a specificity of 0.79 (95% CI, 0.70–0.87). The positive predictive value was 0.50 (95% CI, 0.27–0.68) with a negative predictive value of 0.87 (95% CI, 0.77–0.95).

Conclusions The ability to predict preoperatively whether a tumor can be resected without sacrificing the hypoglossal nerve would be an important factor in determining management of these tumors. The results indicate that CT scan accurately predicts the ability of the surgeon to spare the hypoglossal nerve (negative predictive value, 87%) with a specificity of 0.79.
Human Septal Chondrocyte Redifferentiation in Alginate, Polyglycolic Acid Scaffold, and Monolayer Culture
Authors: Homicz Mark R. , Chia Stanley H. , Schumacher Barbara L. , Masuda Koichi , Thonar Eugene J. , Sah Robert L. , Watson Deborah
Published: November 2003

Objectives/Hypothesis Tissue engineering laboratories are attempting to create neocartilage that could serve as an implant material for structural support during reconstructive surgery. One approach to forming such tissue is to proliferate chondrocytes in monolayer culture and then seed the expanded cell population onto biodegradable scaffolds. However, chondrocytes are known to dedifferentiate after this type of monolayer growth and, as a result, decrease their production of cartilaginous extracellular matrix components such as sulfated glycosaminoglycans. The resultant tissue lacks the biomechanical properties characteristic of cartilage. The objective of the study was to determine whether different culture systems could induce monolayer‐expanded human septal chondrocytes to redifferentiate and form extracellular matrix.

Study Design Laboratory research.

Methods Chondrocytes were isolated from human nasal septal cartilage of five donor patients (age, 35.8 ± 9.3 y). Cell populations were seeded at low density (30,000 cells/cm2) into monolayer culture and expanded for 4 to 6 days. Following trypsin release, chondrocytes were placed into three different systems for neocartilage formation: alginate beads, polyglycolic acid scaffolds, and monolayer. After 7 and 14 days of growth, neocartilage was analyzed using histological and quantitative biochemical assessment of cellularity (Hoechst 33258 assay) and sulfated glycosaminoglycan content (dimethyl methylene blue assay).

Results Histologically, alginate beads contained spherical chondrocytes surrounded by dense extracellular matrix, an appearance similar to that of native cartilage. In contrast, polyglycolic acid scaffolds and monolayer cultures contained elongated cells with scant staining for matrix sulfated glycosaminoglycans, which are features that are characteristic of dedifferentiated chondrocytes. Biochemical analysis demonstrated a lower level of cell proliferation (P <.001) in scaffolds (+52% over baseline) and alginate (+96% over baseline) than in monolayer (+366% over baseline), as well as a higher content of sulfated glycosaminoglycans per cell (P <.001), after 14 days of growth in alginate culture than in either polyglycolic acid scaffolds (19‐fold difference) or monolayer (98‐fold difference).

Conclusions Of the systems compared, monolayer‐expanded human septal chondrocytes demonstrated the greatest accumulation of sulfated glycosaminoglycans per cell when grown in alginate beads. Future research on cartilage tissue engineering may use alginate culture for reverting dedifferentiated cells back to the chondrocytic phenotype.
Cochlear Implantation in Patients With Auditory Neuropathy of Varied Etiologies
Authors: Mason John C. , De Michele Anne , Stevens Christopher , Ruth Roger A. , Hashisaki George T.
Published: November 2003

Objectives/Hypothesis Auditory neuropathy is a relatively recently described pattern of hearing loss characterized by preservation of outer hair cell function despite absent brainstem auditory evoked responses. Intact outer hair cell function is demonstrated by the presence of otoacoustic emissions and/or a measurable cochlear microphonic on electrocochleography, whereas no synchronous neural activity (absent action potentials) is seen on acoustically evoked brainstem auditory evoked response testing. The study reviews the authors' experience with six patients diagnosed with auditory neuropathy, four of whom have undergone cochlear implantation.

Materials and Methods A retrospective review of all medical and audiological charts at the University of Virginia Hospitals (Charlottesville, VA) was performed to identify patients who have undergone cochlear implantation or have been diagnosed with auditory neuropathy, or both.

Results Six patients with hearing loss attributable to auditory neuropathy were identified, four of whom have undergone cochlear implantation. Causes varied, including congenital, infectious, and idiopathic origins. Adults demonstrated subjective auditory perception on promontory stimulation, whereas no repeatable brainstem auditory evoked response waveforms could be demonstrated on pediatric promontory stimulation testing. Patients with implants demonstrated implant‐evoked brainstem auditory evoked responses and improved audiological performance.

Conclusions The six cases presented in the study represent varied causes and, probably, varied sites of lesions of auditory neuropathy. Promontory stimulation has been valuable, particularly in adults. Cochlear implantation allows the opportunity to provide a supraphysiological electrical stimulation to the auditory nerve, with the hope of reintroducing synchronous neural activity. Greater confidence and enthusiasm for cochlear implantation in appropriately selected patients with auditory neuropathy are gained through experience with such diverse cases.
Esthesioneuroblastoma: The Northwestern University Experience
Authors: Argiris Athanassios , Dutra Jose , Tseke Paraskevi , Haines Kenneth
Published: November 2003

Objective To review our experience with esthesioneuroblastoma, a rare malignancy of the head and neck.

Study Design Retrospective review of Tumor Registry data.

Methods We performed a computerized search of the Northwestern Memorial Hospital Tumor Registry database from 1981 to 2000.

Results Sixteen patients with esthesioneuroblastoma were identified and analyzed. Their mean age was 42 years. Eleven of 16 patients (69%) had Kadish stage C; 8 patients (50%) had brain involvement at presentation. Craniofacial resection was performed in 13 patients (81%). Fourteen patients received either preoperative or postoperative therapy; radiation therapy was employed in 11 cases and chemotherapy in 4. The actuarial 5‐year survival was 60%, and the actuarial 5‐year disease‐free survival was 33%, with a median follow‐up of 4.3 years. Recurrences occurred at a median time of 11 months after diagnosis (2.5 mo–18 y). The first site of failure was locoregional alone in 10 of 12 patients who progressed, and in 6 patients involved the brain or the meninges. Two patients were successfully salvaged. Patients with high‐grade tumors had a trend toward work survival.

Conclusions Esthesioneuroblastoma is a rare tumor that is potentially curable by surgical resection and radiation therapy. However, the rate of local failure is high, and late recurrences are not uncommon. The role of chemotherapy warrants further investigation.
Association Between Tobacco Use and Metastatic Neck Disease
Authors: Mansour Ossama I. , Snyderman Carl H. , D'Amico Frank
Published: November 2003

Objectives/Hypothesis Tobacco has multiple effects on connective tissues that might affect tumor behavior. This study examined the association between tobacco use and tumor behavior (lymphatic metastasis and extracapsular spread) in head and neck cancers.

Study Design Chart audit.

Methods Medical records of patients from the Department of Otolaryngology, University of Pittsburgh Medical Center (Pittsburgh, PA) with oral cavity, pharyngeal, and laryngeal cancers who underwent neck dissection were reviewed focusing on their tobacco use habits, as well as the clinical and pathological criteria of primary tumors and cervical lymph nodes. Univariate and multivariate analyses were performed to study the significance between pathological and tobacco use variables.

Results The study included 171 patients. Both univariate and multivariate analyses revealed significant associations between tobacco use and pathological findings. Cervical metastasis was observed in 100% of tobacco users and 54% of nonusers (P <.0001). Extracapsular spread was observed in 100% of tobacco users and 19% of nonusers (P <.0001). Tobacco use was independently associated with pathological nodal stage in multivariate analysis. Former users and light users of tobacco were not at reduced risk of cervical metastasis or extracapsular spread.

Conclusions The study demonstrates that tobacco use is a possible risk factor for cervical metastasis and extracapsular spread, which may be helpful information in planning therapy for patients with clinically staged node‐negative necks.
The Long‐Term Evaluation of Tracheostomy in the Management of Severe Obstructive Sleep Apnea
Authors: Thatcher Gentry W. , Maisel Robert H.
Published: November 2003

Objective To determine the long‐term success and morbidity of tracheostomies for patients with severe obstructive sleep apnea.

Study Design A retrospective study of patients who have undergone tracheostomy for documented obstructive sleep apnea at Hennepin County Medical Center since 1979.

Methods Retrospective chart review of all tracheostomy patients operated January 1, 1979, to June 30, 1999, were evaluated. Follow‐up data from patient records, death certificates, and DMV.

Results Seventy‐nine patients (70 men and 9 women; age range, 25–70 y; mean age, 47 y) received tracheostomies at a regional sleep disorder center. Respiratory distress index ranged from 45 to 146 (mean value, 81). Tracheostomy eliminated obstructive sleep apnea in all cases. Follow‐up ranged from 3 months to 20 years (mean period, 8.3 y). In all, 16 patients had decannulation (range, 2 mo to 13 y): 5 of the patients chose continuous positive airway pressure, 3 grew intolerant of their tracheostomy, 3 had obstructive sleep apnea fully resolve after uvulopalatopharyngoplasty, 3 unknown diagnosis for decannulation, 2 had significant weight loss. Morbidity seen within the first year was primarily limited to granulation tissue, infection, and stoma revision. Fourteen deaths were identified. Average age at time of death was 62 years. Five deaths were cardiopulmonary related, four were from cancer, two were from postoperative complications of unrelated surgery, and one was from aspiration. Tracheostomy‐related mortality included one postoperative myocardial infarction and one tracheal‐innominate fistula.

Conclusion Severe obstructive sleep apnea and its comorbid conditions are effectively treated in the long term with tracheostomy. Initial management of more frequent complication is well tolerated. Significant morbidity and mortality are low. Chances of obstructive sleep apnea resolution allowing decannulation remain poor.
Bordetella pertussis Causing Otitis Media: A Case Report
Authors: Decherd Michael E. , Deskin Ronald W. , Rowen Judith L. , Brindley Mace B.
Published: November 2003

Objective/Hypothesis Bordetella pertussis is an unusual cause of otitis media with effusion. We report a case in a neonate.

Study Design Case report.

Methods A case is presented.

Results A 1‐month‐old infant girl was admitted because of respiratory distress and subsequently was found to have pertussis. On examination she was noted to have a middle ear effusion. Myringotomy was performed for culture. Culture confirmed B pertussis. We were unable to find a previous report of B pertussis otitis media.

Conclusion Bordetella pertussis has been identified in the middle ear effusion of an infant with the pertussis syndrome.
Healing of Composite Chondrocutaneous Auricular Grafts Covered by Skin Flaps in Nasal Reconstructive Surgery
Authors: Keck Tilman , Lindemann Jörg , Kühnemann Stephan , Sigg Otto
Published: November 2003

Objective/Hypothesis Healing of composite chondrocutaneous auricular grafts combined with overlying skin flaps for reconstruction of the internal lining in partial nasal defects should be evaluated.

Study Design A retrospective chart review and prospective clinical follow‐up of 15 patients with partial nasal defects.

Methods Fifteen patients with partial defects of the middle and lower third of the nose were reviewed. Nineteen composite ear grafts were used for reconstruction of the internal nasal lining in the patient group. The composite grafts were used in combination with overlying nasolabial transposition flaps. In some patients paramedian forehead or turn‐in flaps were needed as well. Functional and aesthetic results of nasal reconstruction were subjectively graded by the patients and medical doctors of the department.

Results Three of 19 transplanted composite grafts showed postoperative deformation. Relative shrinkage was observed in 5 of 19 composite grafts, whereas complete loss of the composite graft was seen in only one patient. Nasal airway obstruction was observed in the patients with deformity or loss of composite graft (4 of 15 patients), and an unsuccessful aesthetic result was seen only in the patient with total composite graft failure (1 of 19 transplanted grafts).

Conclusions Composite ear grafts may provide good functional and aesthetic results when combined with overlying skin flaps in reconstruction of partial nasal defects. Even though composite ear grafts used for restoration of the inner nasal lining may be deformed or absorbed and impairment of nasal airway patency or aesthetic result may be postoperatively observed, the combination of composite ear grafts with locoregional transposition flaps provides additional reconstructive options for selected nasal defects.
‘Eosinophilic Fungal Rhinosinusitis’: A Common Disorder in Europe?
Authors: Braun Hannes , Buzina Walter , Freudenschuss Kurt , Beham Alfred , Stammberger Heinz
Published: November 2003

Objectives/Hypothesis The traditional criteria for the diagnosis of allergic fungal sinusitis include chronic rhinosinusitis, “allergic mucin” (mucus containing clusters of eosinophils), and detection of fungi by means of histological examination or culture. In 1999, a group of Mayo Clinic researchers, with a novel method of mucus collection and fungal culturing technique, were able to find fungi in 96% of patients with chronic rhinosinusitis. Immunoglobulin E–mediated hypersensitivity to fungal allergens was not evident in the majority of their patients. Because the presence of eosinophils in the allergic mucin, not a type I hypersensitivity, is probably the common denominator in the pathophysiology of allergic fungal sinusitis, the Mayo Clinic group proposed a change in terminology from allergic fungal sinusitis to eosinophilic fungal rhinosinusitis. Using new techniques of culturing fungi from nasal secretion, as well as preservation and histological examination of mucus, we investigated the incidence of “eosinophilic fungal rhinosinusitis” in our patient population.

Study Design Methods In an open prospective study nasal mucus from patients with chronic rhinosinusitis as well as from healthy volunteers was cultured for fungi. In patients, who underwent functional endoscopic sinus surgery, nasal mucus was investigated histologically to detect fungi and eosinophils within the mucus.

Results Fungal cultures were positive in 84 of 92 patients with chronic rhinosinusitis (91.3%). In all, 290 positive cultures grew 33 different genera, with 3.2 species per patient, on average. Fungal cultures from a control group of healthy volunteers yielded positive results in 21 of 23 (91.3%). Histologically, fungal elements were found in 28 of 37 patients (75.5%) and eosinophilic mucin in 35 of 37 patients (94.6%). Neither fungi nor eosinophils were present in 2 of 37 patients (5.4%).

Conclusions Our data show that the postulated criteria of allergic fungal sinusitis are present in the majority of patients with chronic rhinosinusitis. Either those criteria will be found to be invalid and need to be changed or, indeed, “eosinophilic fungal rhinosinusitis” exists in the majority of patients with chronic rhinosinusitis. Based on our results, fungi and eosinophilic mucin appear to be a standard component of nasal mucus in patients with chronic rhinosinusitis.
Aggressiveness and Quantification of Epithelial Proliferation of Middle Ear Cholesteatoma by MIB1
Authors: Mallet Y. , Nouwen J. , Lecomte‐Houcke M. , Desaulty A.
Published: November 2003

Objective To assess an easy method that predicts cholesteatoma aggressiveness.

Study Design An experimental prospective study.

Methods Monoclonal antibody MIB1 was used to determine epithelium proliferation in 91 cholesteatomatous ears. Clinical and surgical parameters were compared with proliferation activity to determine pathological and clinical correlation.

Results Statistical correlations were established between hyperproliferation of the cholesteatoma and severe bone erosion (leading to major cholesteatoma complications) and between hyperproliferation and middle ear inflammation (associated with more surgical difficulties and a higher risk of recurrence). A high proliferation index was also found in children's cholesteatoma, which is known to have more aggressive behavior.

Conclusion Immunohistochemical use of the MIB1 antibody is a simple technique that can help to determine the aggressiveness of a cholesteatoma.
Recurrent Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery: The University of Michigan Experience
Authors: Marcus Benjamin , Edwards Bruce , Yoo Sirius , Byrne Anne , Gupta Anurag , Kandrevas Janet , Bradford Carol , Chepeha Douglas B. , Teknos Theodoros N.
Published: November 2003

Objectives/Hypothesis Intraoperative monitoring of the recurrent laryngeal nerve (RLN) is finding increasing acceptance during thyroidectomy. Recently, a laryngeal surface electrode was introduced to enable another form of noninvasive monitoring of the RLN. The present report examines the University of Michigan experience with RLN monitoring using the postcricoid surface electrode.

Study Design All patients undergoing partial or total thyroidectomy or parathyroidectomy from January 1999 to July 2001 were considered candidates for the study. Audiologists trained in intraoperative electrophysiological techniques performed all of the monitoring.

Methods Data collected on each patient included 1) stimulation threshold for a laryngeal compound muscle action potential on initial RLN identification, 2) stimulation threshold of the laryngeal compound muscle action potential on completion of the procedure, and 3) flexible fiberoptic evaluation of the larynx at the initial postoperative visit and at the 3‐month follow‐up visit. The average duration of follow‐up was 9.8 months with a range of 3 to 60 months

Results The average minimum current required for stimulation on first identification of all nerves was 0.57 mA (±0.48 mA). After completion of the procedure a mean threshold level of 0.42 mA (±0.55 mA) was obtained during direct RLN stimulation. Post‐dissection stimulation of the RLN on the side of tumor dissection was 0.92 mA (±0.65 mA) compared with a stimulation threshold of 0.76 mA (±0.57 mA) for the nontumor side.

Conclusions Electromyographic monitoring of the RLN using a postcricoid surface electrode provides a safe, simple, and effective method for intraoperative monitoring during thyroid or parathyroid surgery. Further, evoked electromyography confirms RLN integrity at the conclusion of surgery.
Effects of Uvulopalatopharyngoplasty on Collapsibility of the Retropalatal Airway in Patients With Obstructive Sleep Apnea
Authors: Isono Shiroh , Shimada Akiko , Tanaka Atsuko , Ishikawa Teruhiko , Nishino Takashi , Konno Akiyoshi
Published: November 2003

Objectives/Hypothesis Uvulopalatopharyngoplasty improves sleep‐disordered breathing, particularly in patients with sleep‐disordered breathing with abnormally high collapsible airway exclusively at the retropalatal airway, as was previously reported. The present study examined the direct and long‐term effects of uvulopalatopharyngoplasty on retropalatal airway collapsibility.

Study Design Prospective longitudinal study of 18 patients with abnormally high collapsible airway exclusively at the retropalatal airway.

Methods Closing pressure of the retropalatal airway was estimated by endoscopically obtaining static pressure/area relationship of the passive pharynx in completely paralyzed and anesthetized patients with sleep‐disordered breathing (n = 18) before and 3 months after uvulopalatopharyngoplasty. The measurements were repeated 1 year after uvulopalatopharyngoplasty in eight of these patients.

Results Uvulopalatopharyngoplasty decreased retropalatal airway closing pressure by 3.5 cm H2O; furthermore, a direct correlation between the severity of sleep‐disordered breathing (as determined by nocturnal oximetry) and retropalatal airway closing pressure was revealed. Uvulopalatopharyngoplasty failures revealed retropalatal airway closing pressure greater than atmospheric pressure. Reduced retropalatal airway collapsibility was maintained up to 1 year after uvulopalatopharyngoplasty. Two patients developed marked stenosis of the retropalatal airway with aggravation of sleep‐disordered breathing after initial improvement of sleep‐disordered breathing and retropalatal airway collapsibility.

Conclusions Uvulopalatopharyngoplasty decreases the retropalatal airway collapsibility. The effect is maintained for at least 1 year after uvulopalatopharyngoplasty, whereas a few patients develop retropalatal airway stenosis leading to recurrence of sleep‐disordered breathing.
Local Administration of Nitric Oxide Donor Significantly Impacts Microvascular Thrombosis
Authors: Chiang Scott , Azizzadeh Babak , Buga Georgette , Ignarro Lou , Calcaterra Thomas , Blackwell Keith
Published: November 2003

Objectives/Hypothesis Clinical pharmacotherapy has demonstrated a role in preventing microvascular thrombosis in both experimental and clinical settings. Previous studies in the rabbit model have noted an increased rate of thrombosis with intravenous infusion of nitric oxide antagonists. The study assessed the effects of local application of nitric oxide agonists and antagonists on microvascular anastomotic patency rates.

Study Design A randomized, prospective analysis.

Methods An arterial inversion graft microvascular thrombosis model was used in New Zealand white rabbits. The rabbits were randomly assigned to nitric oxide agonist, antagonist, and control groups. In each rabbit, the common femoral artery was surgically exposed and a 2‐mm arterial inversion graft was harvested. The anastomosis of the graft to the common femoral artery was performed in solutions of either 100 μmol/L spermine NONOate (nitric oxide donor), 100 μmol/L nitro‐L‐arginine‐methyl ester (L‐NAME) (nitric oxide synthase inhibitor), or 0.9% sodium chloride (control) solution. The contralateral common femoral artery also underwent arterial inversion graft testing with the use of the same solution. Arterial patency was assessed 1 hour after anastomosis.

Results Sixteen of 22 arterial inversion grafts performed in the spermine NONOate solution remained patent, and 6 of 22 clotted. Eleven of 21 arterial inversion grafts performed in the control solution remained patent, and 10 clotted. Seven of 21 arterial inversion grafts performed in the L‐NAME solution remained patent, and 14 clotted. These results were found to be statistically significant using the χ2 test with a P value of less than .05.

Conclusions In the rabbit model, local application of nitric oxide agonists and antagonists can significantly impact anastomotic patency rates. Further studies may demonstrate a role for the clinical use of nitric oxide in microvascular surgery.
Osteoclast Stimulating and Differentiating Factors in Human Cholesteatoma
Authors: Hamzei Michael , Ventriglia Giovanni , Hagnia Mitra , Antonopolous Alexandra , Bernal‐Sprekelsen Manuel , Dazert Stefan , Hildmann Henning , Sudhoff Holger
Published: November 2003

Objectives To investigate the expression of osteoclast‐activating and differentiating factors and to study the occurrence of osteoclast precursor cells and osteoclasts in acquired human cholesteatoma tissue.

Methods We examined 21 cholesteatoma samples versus 18 normal auditory canal skin specimens for the expression of osteoprotegerin ligand (OPGL), osteoprotegerin (OPG), and macrophage‐colony stimulating factor (M‐CSF) using reverse transcriptase–polymerase chain reaction (RT‐PCR) and immunohistochemistry. Immunohistochemistry and computer‐assisted microscopy using markers CD4, CD11a, CD11b, CD14, CD51, CD68, and TRAP obtained the detection of osteoclast cell lineage.

Results An increased expression of the investigated cytokines M‐CSF, OPG, and OPGL was demonstrated by immunohistochemistry and RT‐PCR in cholesteatoma tissue compared with normal external meatal skin. Several CD4‐positive cells exhibited a co‐expression for OPGL within the perimatrix of cholesteatoma. The presence of osteoclast precursor cells was confirmed in all samples of cholesteatoma tissue.

Conclusions This study reveals that the number of osteoclast precursor cells is markedly increased in the perimatrix of cholesteatoma tissue. Our results support a concept described for inflammatory arthritis: the inflammation related to cholesteatoma induces bone resorption by release of OPGL from activated T‐cells and triggers osteoclastogenesis. This could be a major target for drugs to inhibit osteoclast formation and bone resorption and may be an adjunct in cholesteatoma management.
Gentamicin‐Induced Hair Cell Death Is Not Dependent on the Apoptosis Receptor Fas
Authors: Bodmer Daniel , Brors Dominik , Pak Kwang , Bodmer Morana , Ryan Allen F.
Published: November 2003

Objectives/Hypothesis The hair cells are the most vulnerable elements in the cochlea, and damage to them is the most common cause of sensorineural hearing loss. Understanding the intracellular events that lead to the death of hair cells is a key to developing protective strategies. The Fas death receptor–mediated apoptotic pathway is well studied and plays an important role in the elimination of damaged cells in a number of different cellular systems. We have studied the role of the Fas receptor in aminoglycoside‐mediated toxicity in vitro. We employed the MRL/MpJ‐Fas lpr/lpr mouse, which does not express a functional Fas receptor.

Study Design Response of Fas‐deficient hair cells to gentamicin was compared with the response of normal hair cells in vitro.

Methods Basal turn organ of Corti explants from p3‐5 mice were maintained in tissue culture and treated with gentamicin for 72 hours. The explants were fixed and were stained with phalloidin, and counting was performed.

Results There was no difference in hair cell loss between Fas mutant mice and control MRL/MpJ mice with a functional Fas receptor.

Conclusion The gentamicin‐mediated hair cell death is not dependent on a functional Fas receptor.
Tutorials in Clinical Research, Part VIII: Creating a Journal Club
Authors: Forsen James W. , Hartman James M. , Neely J. Gail
Published: November 2003

Objective The present report is the eighth in a series of sequential tutorials entitled “Tutorials in Clinical Research.” The objective of the report is to provide the reader with information to create or refine a journal club.

Study Design Tutorial.

Methods The authors met weekly for 3 months and discussed the features of a journal club that would be of interest to otolaryngologists. A Medline search provided a number of relevant articles for review.

Results The report is organized into the following sections: Introduction, History of Journal Club, Goals of Journal Club, Basic Organization, Factors Associated With Successful Journal Clubs, Design of Journal Club, Selecting Literature, Evaluation of Journal Club, and Summary.

Conclusions There is a paucity of information within the otolaryngology literature regarding the journal club and the significant role it can play in physician education. The flexible nature of the journal club gives it the potential to address many educational needs. Its relevance has never been greater.
Translaryngeal Tracheostomy: Experience of 340 Cases
Authors: Sharpe Michael D. , Parnes Lorne S. , Drover John W. , Harris Chris
Published: November 2003

Objective To describe the authors' initial experience with a new and innovative dilational translaryngeal tracheostomy bedside technique.

Study Design A prospective documentation of 340 patients who received an elective translaryngeal tracheostomy in a multidisciplinary, tertiary care intensive care unit during a 45‐month period.

Results All translaryngeal tracheostomy procedures but one were completed successfully; one was aborted because of bleeding from a thyroid vein. Minor perioperative complications occurred in 42% of patients, which caused no adverse effects. The most common complication was arterial desaturation occurring in 17% of patients; this was short‐lived, and the lowest saturation was 79%. Blood loss was minimal (<5 mL) in all but one case, despite an elevated international normalized ratio (INR) and partial thromboplastin time in 42% and 41% of patients, respectively, and a low platelet count in 13% of patients.

Conclusions Translaryngeal tracheostomy is a safe and reliable technique and can also be used in patients with unstable cervical spines and bleeding diathesis. It has become the authors' procedure of choice for an elective bedside tracheostomy in the intensive care unit.
Genetically Engineered Tumor Cell Vaccine in a Head and Neck Cancer Model
Authors: Couch Marion , Saunders John K. , O'Malley Bert W. , Pardoll Drew , Jaffee Elizabeth
Published: November 2003

Objectives Using a murine model, a novel tumor vaccine for head and neck squamous cell carcinoma expressing the granulocyte‐macrophage colony stimulating factor (GM‐CSF) gene was evaluated for its ability to protect against tumor challenge.

Study Design Mice vaccinated in the floor of the mouth with the GM‐CSF tumor cell vaccine were challenged with parental tumor cells, and subsequent tumor development was monitored. Specificity of the antitumor response was demonstrated by vaccinating the mice and then challenging them with an unrelated but syngeneic radiation–induced fibrosarcoma tumor cell line, RIF. Irradiated (only) tumor cells were used as a control to see whether an augmented antitumor response was attributable to possible increased immunogenicity that could theoretically be induced by the irradiation.

Methods The GM‐CSF gene was transduced into tumor cells via a retroviral vector. The tumor cells were irradiated to prevent replication in vivo. GM‐CSF concentrations were determined using ELISA, and physiological activity was confirmed using a biological assay with a GM‐CSF–dependent cell line.

Results Vaccination with genetically engineered tumor cells significantly protected against subsequent tumor challenge (5% level) when compared to control groups. Mice were not protected when vaccinated and challenged with the unrelated tumor cell line, RIF. Mice vaccinated with irradiated (only) tumor cells were not protected, either.

Conclusions Vaccination with genetically engineered tumor cells offers significant protection from later tumor challenge. The response is systemic and tumor specific, not due to an inflammatory response. Irradiation of the tumor cells does not account for the augmented antitumor response. This work supports the continued investigation of the GM‐CSF tumor vaccine for the treatment of head and neck squamous cell carcinoma.
Swallow Function in Patients Before and After Intra‐Arterial Chemoradiation
Authors: Graner Darlene E. , Foote Robert L. , Kasperbauer Jan L. , Stoeckel Ruth E. , Okuno Scott H. , Olsen Kerry D. , Sabri Alain N. , Maragos Nicolas E. , Cha Stephen S. , Sargent Dan J. , Strome Scott E.
Published: November 2003

Objectives/Hypothesis To prospectively evaluate swallow function in patients with advanced head and neck cancer before and after completion of intra‐arterial chemoradiation therapy and planned neck dissection.

Study Design Prospective nonrandomized study.

Methods Swallow function was evaluated in 11 patients with resectable T4 and selected T3 head and neck cancer before and, on average, 19 weeks after completion of treatment.

Results The Performance Status Scale demonstrated worse scores for both eating in public (P = .004) and normalcy of diet (P = .004) after treatment. Patients who underwent neck dissections had significantly worse scores (P = .02) in normalcy of diet. A significant decline was noted in swallowing functional measures at the time of the repeat evaluation (P = .02). Videofluoroscopic swallow studies revealed altered swallow function in 9 of 11 patients before treatment, with aspiration seen in 3 patients. Following treatment, the incidence of aspiration increased to seven patients. Tongue base retraction, reduced laryngeal elevation, and increased laryngeal vestibule penetration of thick liquid were all statistically significantly worse after treatment. The overall score on the quality of life instrument was not significantly changed from before to after treatment.

Conclusions The majority of patients demonstrated significantly worse swallow function on all three methods of analysis at 19 weeks after completion of treatment. Continued detailed monitoring of patients' swallow function is critical in determining long‐term effects of intra‐arterial chemoradiation therapy and neck dissection.