bluuebunny/crossref_metadata_2025 huggingface dataset:
Rhinolithiasis: A Forgotten Entity
Authors: Hadi Usamah , Ghossaini Soha , Zaytoun George
Published: February 2003

OBJECTIVE

To review the clinical presentation of patients with rhinoliths, which are calcareous concretions with an unclear pathogenesis.

STUDY DESIGN AND SETTING

Using retrospective chart review we analyzed clinical, radiological, and demographic data as well as our diagnostic work‐up and management of 8 patients.

RESULTS

Most patients presented with nonspecific nasal complaints; most commonly, purulent rhinorrhea and nasal obstruction. The rhinolith was discovered incidentally in some patients.

CONCLUSION

Rhinoliths are rare and can have various clinical presentations. The treatment of choice is surgical removal.

SIGNIFICANCE

A high index of suspicion is required for the diagnosis of such a forgotten entity.
Bell's Palsy in Pregnancy: A Study of Recovery Outcomes
Authors: Gillman Grant S. , Schaitkin Barry M. , May Mark , Klein Susan R.
Published: February 2003

OBJECTIVE

To study facial nerve recovery in patients with Bell's palsy of pregnancy compared with that of the nonpregnant population.

METHODS

A retrospective chart analysis was conducted of all patients seen within 6 weeks of the onset of Bell's palsy of pregnancy, with a minimum of 1‐year follow‐up. Recovery outcomes were compared with similarly chosen randomly selected groups of nonpregnant females 15 to 40 years old (group 1), nonpregnant females of all ages (group 2), males 15 to 40 years old (group 3), and males of all ages (group 4), all of whom were also seen within 6 weeks of onset. Recovery was categorized as satisfactory (House‐Brackmann grade I to II) or unsatisfactory (House‐Brackmann grade III or IV). The 2‐tailed Fisher exact test was used to statistically analyze differences between groups.

RESULTS

Fifty‐two percent of women with Bell's palsy of pregnancy whose facial palsy progressed to complete paralysis within 10 days of onset recovered to a satisfactory level compared with 77% to 88% of comparison patients. These differences were statistically significant in all cases. Recovery for those with an incomplete palsy was satisfactory in virtually 100% of all patients studied.

CONCLUSION

The prognosis for a satisfactory recovery for women who develop a complete facial paralysis with Bell's palsy while pregnant is significantly worse than for that for the general population. This information should be taken into consideration by all physicians involved in the counseling of these patients.
Stomal Recurrence after Total Laryngectomy for Squamous Cell Carcinoma of the Larynx
Authors: Imauchi Yutaka , Ito Ken , Takasago Esao , Nibu Ken‐Ichi , Sugasawa Masashi , Ichimura Keiichi
Published: February 2003

OBJECTIVE

Stomal recurrence after total laryngectomy is one of the most serious issues in the management of laryngeal carcinoma. The management of stomal recurrence, including chemotherapy, radiotherapy, and surgery, has been reported as unsatisfactory.

STUDY DESIGN AND SETTING

From 1985 to 1995, 69 patients underwent total laryngectomy for the treatment of laryngeal cancer at the University of Tokyo Hospital. To identify the risk factors for stomal recurrence, we analyzed these patients according to various clinicopathological factors.

RESULTS

Stomal recurrence developed in 6 of 69 patients who underwent total laryngectomy for laryngeal carcinoma. Statistical analysis reveals that primary site, preoperative tracheotomy, and paratracheal lymph node metastasis are significant risk factors for stomal recurrence.

CONCLUSION

Intensive follow‐up should be performed for patients with glottic carcinoma who had preoperative tracheotomy, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.
The Learning Curve Revisited: Stapedotomy
Authors: Sargent Eric W.
Published: February 2003

OBJECTIVE

To determine whether the outcome of stapedotomy changes with experience.

STUDY DESIGN AND SETTING

Retrospective case review of an academic otologic practice of a fellowship‐trained otologist that consisted of 50 consecutive patients who underwent primary stapedotomy. The main outcome measures were preoperative and postoperative audiograms for both the operated ear and the opposite ear (control).

RESULTS

There were no major complications or loss of hearing among the 50 patients. Minor complications included 1 middle ear infection, 2 torn flaps, and 1 tympanic membrane perforation. One patient had worse conductive hearing loss after surgery. The hearing of 2 patients was unchanged. Hearing for the entire group improved (P > 0.001) from a speech reception threshold of 55 dB (SD, 17 dB) to 30 dB (SD, 19 dB). Complete closure of the air‐bone gap was achieved in 20% of the first 10 patients and 30% of the last 10 patients.

CONCLUSIONS

The results of stapedotomy improve with experience, although the learning curve seems less steep than has been reported for total or near‐total footplate removal.

SIGNIFICANCE

Stapedotomy can be successfully performed early in surgical experience, but the learning curve should be acknowledged and discussed with the patient.
Osteosarcoma of the Hyoid Bone
Authors: Anderson Timothy D. , Kearney James J.
Published: February 2003

Primary lesions of the hyoid bone are exceedingly rare. Reported malignant lesions include chondrosarcoma, plasmacytoma, and metastatic squamous cell carcinoma, and benign masses include aneurysmal bone cysts, chondromas, and osteomas.1 Because all of these diagnoses present as a mass in the neck, differentiation between them is difficult. We report the first case in the English literature of a primary osteosarcoma (OS) of the hyoid bone.
Objective and Early Diagnosis of Chylous Fistula in the Postoperative Period
Authors: Erisen Levent , Coskun Hakan , Basut Oguz
Published: February 2003

OBJECTIVE

The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period.

STUDY DESIGN AND SETTING

We prospectively evaluated 103 consecutive neck dissections during a 2‐year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF.

RESULTS

A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001).

CONCLUSIONS

Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.
Facial Nerve Monitoring in Chronic Ear Surgery: Us Practice Patterns
Authors: Greenberg Jayson S. , Manolidis Spiros , Michael G. Stewart , Kahn Jeffrey B.
Published: February 2003

OBJECTIVE

The use of intraoperative facial nerve monitoring (IOFNM) improves facial nerve outcomes in acoustic neuroma surgery, but the role of IOFNM in chronic ear surgery (CES) is poorly defined. This study was performed to identify IOFNM practice patterns in the United States for CES.

METHODS

A 10‐item survey was mailed to a random sample of 500 active members of the American Academy of Otolaryngology‐Head and Neck Surgery.

RESULTS

The overall response rate was 45.2%. Of the respondents, 75% had access to IOFNM, and of this group, 66% used IOFNM at least some of the time. Otolaryngologists trained in the 1990s (P < 0.0001), those in an academic setting (P = 0.02), and those who perform more otologic than other types of surgery (P = 0.004) were more likely to use IOFNM. Although most respondents had access to IOFNM, only 32% thought that IOFNM should be required for CES.

CONCLUSIONS

The majority of otolaryngologists who perform CES have access to IOFNM and will use it at least some of the time. IOFNM use is especially prevalent in otolaryngologists who have trained recently and in more experienced otologic surgeons. However, there are strong feelings against requiring IOFNM for CES.
The Oto‐Palato‐Digital Syndrome: Variable Clinical Expressions
Authors: Zaytoun George M. , Harboyan Garbis , Kabalan Wael
Published: February 2003

The oto‐palato‐digital (OPD) syndrome is a rare but well‐defined disorder characterized by a skeletal dysplasia of the hands and feet, hearing loss, and anomalies of the palate. Since it was first described by Taybi in 1962, a little over 30 cases have been reported in the literature. A more lethal variant of the syndrome was described later by Fitch and was termed OPD type II. Several studies were conducted to determine the exact mode of inheritance of this syndrome, whereas others have focused on the characterization of the skeletal anomalies and their variations. Otologists were interested in determining the etiology of the associated hearing loss. We report 4 cases of patients with the spectrum of anomalies that characterize the OPD syndrome. These patients include 3 siblings and 1 unrelated patient who presented to our service complaining of hearing loss. The skeletal anomalies, special features, and audiologic findings are described and compared with those in previously reported cases. A discussion based on a literature review of the mode of inheritance, of variation in the clinical expression, and of the etiology of hearing loss is also included. Finally, we review and discuss the subdivision of this syndrome into the 2 types (I and II).
Tympanosclerosis: Long‐Term Hearing Results after Ossicular Reconstruction
Authors: Teufert Karen Borne , De La Cruz Antonio
Published: February 2003

OBJECTIVE

The study goal was to analyze long‐term hearing results and factors likely to affect outcome after ossicular reconstruction in patients with tympanosclerosis, particularly tympanosclerotic stapes fixation.

METHODS

We conducted a retrospective chart review of the past 10 years. The short‐ and long‐term (up to 9 1/2 years) hearing results of first‐stage and second‐stage operations for middle ear tympanosclerosis in 203 consecutive patients, performed in a tertiary referral otologic private practice, are presented. There were 160 tympanoplasties and 43 tympanoplasties with mastoidectomy performed, with ossicular fixation secondary to tympanosclerosis in 135 cases. Of these 203, 42.9% were primary cases, with the majority being planned second‐stage or revision procedures.

RESULTS

The average preoperative air‐bone gap (ABG) was 30.9 dB. The average short‐term postoperative ABG was 17.4 dB with closure of the ABG within 20 dB in 64.6%. The success rate (ABG ≤ 20 dB) for patients with ossicular fixation was 65.3%. Partial sensorineural hearing loss occurred in 1.0% of the patients, and none experienced profound sensorineural hearing loss (dead ears). There was no statistically significant change from short‐term to long‐term follow‐up in either ABG or air PTA, with mean differences of only 0.3 and 2.0 dB, respectively. The mean time to the last follow‐up was 1.6 years.

CONCLUSION

Ossicular reconstruction in individuals with tympanosclerosis can yield satisfactory, lasting hearing results with a low incidence of complications and no dead ears.
Sympathetic Cochleolabyrinthitis in Revision Stapedectomy Surgery
Authors: Richards Michele L. , Moorhead Jacquelyn E. , Antonelli Patrick J.
Published: February 2003

OBJECTIVE

The purpose of this study was to determine whether revision stapedectomy could precipitate sensorineural hearing loss in the contralateral ear.

METHODS

We conducted a retrospective review of 148 patients undergoing primary or revision stapedectomy at an academic, tertiary care facility.

RESULTS

Stapedectomy resulted in significant improvements in mean air conduction thresholds in the ipsilateral ear. Overall, there were no significant changes in either the air or bone conduction values of the contralateral ear. Two patients demonstrated a >20‐dB decline in speech reception threshold and/or >20% decrease word recognition in the contralateral ear. Both of these patients demonstrated the decline only after revision surgery.

CONCLUSION

Revision stapedectomy is on rare occasions associated with hearing loss in the contralateral ear. Contralateral hearing loss after revision stapedectomy may be due to sympathetic cochleolabyrinthitis.
Tracheal Bronchus: Classification, Endoscopic Analysis, and Airway Management
Authors: Doolittle Andrew M. , Mair Eric A.
Published: February 2003

OBJECTIVE

Tracheal bronchus (bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum.

STUDY DESIGN/METHODS

Retrospective case series.

RESULTS

The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12‐year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right‐sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy.

CONCLUSIONS

Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options.

Tracheal bronchus is a congenital anomaly in which a right upper lobe bronchus has its origin in the trachea rather than at the carina. Bronchus suis, or “pig bronchus,” is an alternate name that is used because a tracheal bronchus is normal in swine and other ruminant animals. In approximately 1000 pediatric bronchoscopy procedures performed by the senior author during a 12‐year period, only 5 children (approximately 0.5%) were identified with a tracheal bronchus. We present 3 representative cases to highlight salient features of each variant of the tracheal bronchus. A newly described “tracheal diverticulum” variant is presented. Tracheal bronchus classification based on endoscopic analysis assists with airway management for this uncommon anomaly.
Continuous Gentamicin Therapy Using an IntraEAR Microcatheter for Meniere's Disease: A Retrospective Study
Authors: Seidman Michael
Published: February 2003

OBJECTIVES

The study goals were to evaluate the safety and effectiveness of continuous gentamicin therapy (CGT) in the treatment of Meniere's disease and to evaluate the effect of flow rate.

STUDY DESIGN

In a retrospective study, physicians who were known to have used CGT in the treatment of Meniere's disease were asked to report patient information on a standardized data collection form.

RESULTS

In patients treated with low‐flow CGT, vertigo was eliminated or substantially controlled in 90%, tinnitus was improved in 69%, pressure was improved in 77%, hearing was worse in 23%, and vestibular function was ablated in only 14% of patients.

CONCLUSION

On the basis of an average 10‐month follow‐up period, of the methods currently available to treat Meniere's patients with gentamicin, low‐flow CGT seems to provide an excellent combination of vertigo control and tinnitus and pressure improvement, with a relatively low risk to hearing and vestibular function.

SIGNIFICANCE

The clinical use of low‐flow CGT appears to be justified based on these data.
Congenital cholesteatoma: 20 years' experience at The Children's Hospital of Philadelphia
Authors: Potsic William P. , Korman S. Bruce , Samadi Daniel S. , Wetmore Ralph F.
Published: February 2003

OBJECTIVE

We report our experience with congenital cholesteatoma over a span of 20 years with an emphasis on presenting characteristics and predictors of outcome.

METHODS

We conducted a retrospective review from 1981 through 2000.

RESULTS

One hundred seventy‐two congenital cases were identified in 167 patients. Five patients had bilateral disease. The majority (72%) were found in boys, with an average age of 5.0 years. Hearing loss was slight to moderate. When confined to 1 quadrant, cholesteatoma was anterosuperior in 82% of cases; 47% had cholesteatoma in 2 or more quadrants. Ossicular chain involvement was found in 43% of all cases, and mastoid extension was evident in 23%. The rate of recurrent disease was directly related to the extent and number of quadrants involved.

CONCLUSION

To our knowledge, this is the largest series of congenital cholesteatomas to be reported. This review confirms the male predominance and predilection for the anterosuperior quadrant. The extent of cholesteatoma and its relation to residual disease should be used as a guide for planning a second‐look procedure.
Surgery for pediatric vocal cord paralysis: A meta‐analysis
Authors: Brigger Matthew T. , Hartnick Christopher J.
Published: February 2003

OBJECTIVE

The study goal was to determine the impact of various surgical procedures for bilateral vocal cord paralysis in children by using established principles of meta‐analysis.

STUDY DESIGN AND SETTING

We conducted a retrospective review of the literature in which a predetermined protocol was used to identify articles for meta‐analysis. Six articles met inclusion criteria, and pertinent data were extracted.

RESULTS

Pooled data analysis demonstrated primary procedure‐specific decannulation rates for external arytenoidopexy for 19 of 24 (79%), external arytenoidectomy for 14 of 19 (74%), CO2 laser arytenoidectomy for 4 of 10 (40%), and costal cartilage graft procedures for 2 of 2 (100%). External arytenoid procedures are more efficacious than CO2 laser procedures in terms of primary decannulation (P = 0.02).

CONCLUSION

Meta‐analysis of the existing literature reveals that external arytenoidopexy and external arytenoidectomy are equivalently effective procedures and that the two combined are significantly more effective than CO2 ablative procedures.

SIGNIFICANCE

External procedures appear to be more effective as a first‐line treatment in pediatric vocal cord paralysis, with arytenoidopexy with or without partial arytenoidectomy offering an attractive first‐line surgical option.
Same‐stage nasal and palatopharyngeal surgery for obstructive sleep apnea: Is it safe?
Authors: Busaba Nicolas Y.
Published: February 2003

OBJECTIVE

The study goal was to determine the safety of performing same‐stage nasal and palatopharyngeal surgery for the treatment of obstructive sleep apnea syndrome (OSAS).

STUDY DESIGN AND SETTING

We conducted a retrospective review of 91 consecutive patients who underwent surgery for OSAS at tertiary care facilities. METHODS: Patients were divided into 2 groups: group 1 had same‐stage nasal and palatopharyngeal surgery (n = 63), whereas group 2 had palatopharyngeal surgery at a stage separate from the nasal surgery (n = 28). Patient demographics, severity of OSAS, type of surgery, perioperative care, and postoperative complications were reviewed.

RESULTS

There were 55 men and 8 women in group 1, with an average age of 48 years. Group 2 consisted of 20 men and 8 women, with an average age of 45 years. The mean respiratory disturbance index was 36.5 and 33.5 for group 1 and 2, respectively. The mean lowest arterial Oxygen saturation for group 1 was 82%, whereas that of group 2 was 81%. Patients in both groups were observed in a hospital setting for a minimum of 1 day. They were admitted to a room close to the nurse's station, with continuous pulse oximeter monitoring. There were 3 complications reported for group 1: pneumonia (1 patient, postoperative day 4), tonsil bleed (1 patient, postoperative day 6), and septal hematoma (1 patient). One patient in group 2 had a tonsil bleed (postoperative day 8). There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period.

CONCLUSION

Same‐stage nasal and palatopharyngeal surgery for OSAS is safe. Patients could be monitored with continuous pulse oximetry and managed outside of an intensive care unit setting in the immediate postoperative period.
No evidence of acute Chlamydia pneumoniae infection in patients with Bell's palsy
Authors: Pitkäranta Anne , Vaheri Antti , Penttilä Tuula , Puolakkainen Mirja
Published: February 2003

The cause of Bell's palsy remains unknown even though available evidence suggests that infection could be a factor. In recent studies, Chlamydia pneumoniae has been associated with neurologic diseases such as multiple sclerosis. In the present study, the association of C pneumoniae with Bell's palsy was studied with the use of serology and polymerase chain reaction to test tear fluid and peripheral blood mononuclear cells from 21 patients with Bell's palsy and 21 control subjects. C pneumoniae DNA was detected from tear fluid samples in 1 patient with Bell's palsy and in 2 healthy control subjects. Whether this indicates earlier disease or subclinical infection remains to be studied. However, an association between Bell's palsy and acute C pneumoniae infection could not be shown.
Tumor necrosis factor‐α and interleukin‐1 β levels in recurrent and persistent otitis media with effusion
Authors: Yetiser Sertac , Satar Bulent , Gumusgun Atilla , Unal Faruk , Ozkaptan Yalcin
Published: February 2003

OBJECTIVE

Based on interleukin (IL)‐1β and tumor necrosis factor (TNF)‐α levels in effusions, our goals were to specify either recurrent or persistent otitis media with effusion (OME) is a mid stage in the development of chronic disease and to identify the factors that have an influence on cytokine levels.

STUDY DESIGN

Samples from groups with recurrent (n = 15) and persistent (n = 39) OME were essayed for IL‐1 β and TNF‐α. Children were also grouped with respect to age, sex, quality of effusion, and the presence of pharyngeal adenoid tissue.

SETTING

Tertiary referral center.

RESULTS

In recurrent and persistent OME groups, IL‐1β was higher than TNF‐α (P < 0.01). IL‐β was higher in recurrent OME than in persistent OME (P < 0.05).

CONCLUSION

Recurrent OME seems to be closer to the chronic stage of the disease relative to persistent OME in terms of higher IL‐1 β levels. Each exacerbation of acute disease in recurrent otitis media is likely to be mediated by IL‐1 β.

SIGNIFICANCE

We were able to clarify that recurrent OME is a stage that occurs before chronic OME. Therefore, the prevention of acute attacks in recurrent disease would also impede long‐term damage to the middle ear.
Mitomycin C for the Prevention of Adhesion Formation after Endoscopic Sinus Surgery: A Randomized, Controlled Study
Authors: Chung Jeannie H. , Cosenza Mathew J. , Rahbar Reza , Metson Ralph B.
Published: February 2003

OBJECTIVE

Mitomycin C (MMC) is an antineoplastic agent that has been shown to decrease scar tissue after ophthalmologic surgery. Our goal was to determine whether the application of MMC at the conclusion of sinus surgery decreases the incidence of postoperative adhesion formation.

METHODS

At the completion of endoscopic sinus surgery in 55 patients, a cotton pledget saturated with 1 mL of 0.4 mg/mL MMC was placed for 4 minutes in the right or left middle meatus and a similar saline‐soaked pledget was placed on the opposite side. Patients were examined postoperatively by a masked observer for the presence of synechiae and mucosal changes.

RESULTS

Postoperative adhesions were observed in 16 patients (29%) with a mean follow‐up of 4.1 months. These adhesions were bilateral in 6 patients (10.9%) and unilateral in 10 patients (18%). Unilateral adhesions were observed on only 2 sides (3.6%) treated with MMC and 8 controls (14.5%) (P = 0.058). No adverse effects were observed.

CONCLUSIONS

MMC was found to be safe to use during sinus surgery, and it may reduce the incidence of postoperative adhesions at the dosage used in this study.

SIGNIFICANCE

Because of the observed trend toward decreased synechiae formation with MMC application, further trials using higher concentrations and application times are warranted.
Botulinum Toxin Type B (MyoBloc) in the Management of Hyperkinetic Facial Lines
Authors: Ramirez Alexander L. , Reeck Jay , Maas Corey S.
Published: February 2003

OBJECTIVE

Our goal was to evaluate the safety and efficacy of botulinum toxin type B (BTX‐B) in the management of hyperfunctional facial lines.

STUDY DESIGN AND SETTING

Twenty‐four patients from an academic faculty practice were treated with 400 to 800 units BTX‐B in the corrugator, orbicularis oculi, or frontalis. Patients were evaluated with the Wrinkle Improvement Score (WIS) and Rated Numeric Kinetic Line Scale (RNKLS) and questioned about side effects and pain. Evaluations were made at 1, 2, 4, 8, and 12 weeks.

RESULTS

Onset of effect was within 72 hours. WIS and RNKLS for all sites were statistically better after treatment, with the effect lasting 8 weeks. In general, patients noted a moderate improvement (grade 2) on WIS and a 2‐point improvement on RNKLS. Injection was more painful than that of BTX‐A. There were no complications.

CONCLUSION

BTX‐B is a safe and effective technique to eliminate wrinkles. Further studies are needed to elucidate dosage and duration.

SIGNIFICANCE

BTX‐B is stable for prolonged periods of time, requires no preparation before use, and is antigenetically distinct from BTX‐A.
One‐Year Low‐Dose Erythromycin Treatment of Persistent Chronic Sinusitis after Sinus Surgery: Clinical Outcome and Effects on Mucociliary Parameters and Nasal Nitric Oxide
Authors: Cervin Anders , Kalm Olof , Sandkull Per , Lindberg Sven
Published: February 2003

OBJECTIVE

In 17 patients with chronic sinusitis persistent after sinus surgery, long‐term, low‐dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time).

STUDY DESIGN AND SETTING

We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment.

RESULTS

Of 17 patients, 12 responded to treatment. The 12‐month follow‐up showed an improvement in saccharine transit time (P< 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P= 0.12). Endoscopic nasal examination scoring improved significantly (P< 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P< 0.01). Improvements were also seen in headache (P< 0.05).

CONCLUSION

The present study suggests that long‐term, low‐dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment.

SIGNIFICANCE

Long‐term, low‐dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo‐controlled studies are needed to validate the potential of this treatment.
World Wide Web‐Based Temporal Bone Anatomic Sections
Authors: Kavanagh Kevin T.
Published: February 2003

The study goal was to post a complete set of temporal bone anatomy slides on the World Wide Web for anatomic study. Magnification of the width of the sections varied from 2.4 to 33.6 inches. Good representation of gross and tissue anatomy was obtained, but cellular detail was lacking. The website used approximately 37 megs of disk space. The resultant website provides a cost‐effective method of presenting large color photographs of temporal bone anatomy. Thumbnails allow comparison between sections, which aids in learning 3‐dimensional anatomy. A method for measuring distance on digitized images is also described. The sections may be viewed at www.ear‐anatomy.com, and continuing medical education credits may be earned at www.cme‐usa.org.
A Rat Model of Otitis Media with Effusion Caused by Eustachian Tube Obstruction with and without Streptococcus Pneumoniae Infection: Methods and Disease Course
Authors: Piltcher Otavio B. , Swarts J. Douglas , Magnuson Karin , Alper Cuneyt M. , Doyle William J. , Hebda Patricia A.
Published: February 2003

OBJECTIVE

To describe the clinical and histopathologic progression of a rat model of otitis media with effusion caused by eustachian tube obstruction (ETO) with and without Streptococcus pneumoniae infection.

METHODS

In 164 rats, the left, bony eustachian tube was approached via a ventral incision and obstructed with dental material. Then 108 rats were infected via an intrabullar injection with S pneumoniae. At 48 hours, the infected rats were treated for 5 days with ampicillin. All ears were evaluated by weekly otomicroscopy. On each of days 1, 2, 7, 21, 35, 56, and 112, four rats were killed for histologic study. All effusions were cultured for bacteria.

RESULTS

Fourteen rats died of surgical complications; effusion resolved by 2 weeks in 9 rats. During the first few days, infected ears with ETO had bulging tympanic membranes, followed by tympanic membrane retraction, purulent effusion, and otorrhea (50%) over the next few weeks, whereas uninfected ears with ETO developed retraction and serous effusion during the same time frame. At later times, all ears with ETO presented with retraction and serous or serous‐mucoid effusion. S pneumoniae was recovered only from the infected ears with ETO (days 1 and 2), with some colonization by nonpathogenic microorganisms observed equally in both groups of ears. Histology showed a typical acute inflammatory reaction in the challenged ears with ETO through day 14 and then a chronic inflammation for all ears with ETO.

CONCLUSION

The experimental methods provoked reproducible pathologic signs similar to those for otitis media with effusion. Given the availability of rat‐specific reagents, this model is well suited for studies of cytokine elaboration during disease pathogenesis.
Rhinosinusitis Treatment Protocol: Changing Provider Habits in Primary Care
Authors: Kinney William C.
Published: February 2003

OBJECTIVE

Sinus infections are common and represent a high cost to the health care industry. Clinical protocols can be used to develop cost‐effective treatment strategies. Our objective was to show that a protocol for rhinosinusitis can change provider practice patterns in primary care.

STUDY DESIGN AND SETTING

We used a literature search, survey of primary caregivers, and chart review from an academic health center to define and document current patterns. A protocol was developed and evaluated using the Rhinosinusitis Disability Index.

RESULTS

Survey and chart review identified that primary caregivers do not elicit a detailed history for rhinosinusitis. Protocol use increased this to 100%. First‐line antibiotic therapy was used for only 49.4% of the patients before protocol use and for 68.5% after protocol use. Patients felt better after treatment 84.1% of the time; the Rhinosinusitis Disability Index could not measure improvement.

CONCLUSION

Provider practice patterns were positively influenced by use of the protocol.

SIGNIFICANCE

Clinical protocols should be developed to direct provider treatment practices.
The Association between Laryngeal Pseudosulcus and Laryngopharyngeal Reflux
Authors: Belafsky Peter C. , Postma Gregory N. , Koufman James A.
Published: February 2003

BACKGROUND

A pattern of edema on the ventral surface of the vocal fold, called pseudosulcus vocalis, was described in 1995. It refers to infraglottic edema extending from the anterior commissure to the posterior larynx. It can be differentiated from sulcus vergeture, which is caused by adhesion of the vocal fold epithelium to the vocal ligament. Although it has been related to laryngopharyngeal reflux (LPR), this has not been thoroughly investigated.

PURPOSE

Our goal was to evaluate the association between pseudosulcus and LPR.

METHODS

Thirty patients with a clinical diagnosis of LPR confirmed by double‐probe pH monitoring and 30 controls without LPR were enrolled. The prevalence of pseudosulcus was determined with fiberoptic laryngoscopy.

RESULTS

Seventy percent (21 of 30) of patients with LPR and 30% (9 of 30) of controls had pseudosulcus. Patients with pseudosulcus were 2.3 times more likely to have pH‐documented LPR (95% confidence interval 1.3–4.2). The sensitivity and specificity of pseudosulcus in the diagnosis of LPR are 70% and 77%, respectively.

CONCLUSIONS

Pseudosulcus is highly correlated with pH‐documented LPR (P < 0.001). The presence of pseudosulcus is suggestive of LPR.
Office‐Based Treatment of Laryngeal Papillomatosis with Percutaneous Injection of Cidofovir
Authors: Chhetri Dinesh K. , Blumin Joel H. , Shapiro Nina L. , Berke Gerald S.
Published: February 2003

OBJECTIVE

Our aim was to report our experience with office‐based treatment of severe laryngeal papillomatosis with percutaneous injection of cidofovir in a case series of 5 patients.

STUDY DESIGN AND SETTING

We conducted a retrospective review of a case series in a tertiary academic care voice disorders clinic. Adult patients with papillomas of the vocal cords and anterior commissure received percutaneous injection using a point‐touch technique. Clinical improvement or remission of the papillomatosis was noted.

RESULTS

Before initiation of office treatments, patients required direct laryngoscopy and CO2 laser ablation of papillomas on average every 2.8 months. There were no complications related to the injection technique. During a treatment period of 7 to 16 months (mean 12 months), a significant reduction in the volume of papillomatosis was achieved in all patients. One patient received 2 treatments and another received 1 treatment in the operating room for final clearance of papillomas.

CONCLUSION

Office‐based treatment of adult patients with anterior laryngeal papillomatosis using percutaneous injection of cidofovir reduces the need for repeated direct laryngoscopy and laser ablation under general anesthesia.

SIGNIFICANCE

Percutaneous injection treatment with cidofovir is a useful adjunct to direct laryngoscopy and laser ablation in the treatment of laryngeal papillomatosis.
Skull Base Cerebrospinal Fluid Fistulas: A Comprehensive Diagnostic Algorithm
Authors: Zapalac Jeffrey S. , Marple Bradley F. , Schwade Nathan D.
Published: February 2003

OBJECTIVE

Our goal was to assess the efficacy of current diagnostic modalities in the management of skull base cerebrospinal fluid (CSF) fistulas.

METHODS

We conducted a retrospective review of all patients presenting to our institution over the past 6 years with skull base CSF fistulas.

RESULTS

Fifty‐two patients were included in the study. β2‐Transferrin analysis of collected specimen was the most efficacious means of confirming a CSF leak. High‐resolution computed tomography was the most informative radiographic study, yielding a sensitivity and an accuracy of 87%. Magnetic resonance cisternography, yielding a sensitivity and an accuracy of 78%, was instrumental in localizing the site of leak for a few cases but was most commonly corroborative. Using a graduated diagnostic approach, successful repair was attained in 88% of cases after 1 attempt and 98% after 1 or 2 attempts.

CONCLUSION

For patients with skull base CSF fistulas, a graduated diagnostic approach with emphasis on confirmation of leak by β2‐transferrin analysis and precise localization by high‐resolution computed tomography is both efficacious and cost effective.
Minimally Invasive Approaches to the Sphenoid Sinus
Authors: Gibbons Mark D. , Sillers Michael J.
Published: February 2003

OBJECTIVE

We sought to develop an algorithm for surgical approaches to the sphenoid sinus.

STUDY DESIGN AND SETTING

Retrospective review was conducted of all patients who underwent a sphenoid sinusotomy by the senior author between July 1994 and August 2001.

RESULTS

The study population consisted of 141 patients, in whom 5 different surgical approaches were used: transseptal (47 (33.3%)), transnasal (19 (13.5%)), transethmoid (72 (51.1%)), transmaxillary (2 (1.42%)), and external (1 (0.7%)). Of the 47 transseptal approaches, 43 (91.5%) were for extirpation of a neoplasm. In contrast, 60 of 72 (83.3%) transethmoid procedures were for infectious/inflammatory disorders. An endoscopic approach was used for 7 of 8 (87.5%) skull base repairs. Four transsphenoid optic nerve decompressions were performed. The minor and major complication rates were 2.1% and 0.71%, respectively.

CONCLUSIONS

The anatomic location of the pathologic process can guide the surgeon in selecting the most appropriate technique.

SIGNIFICANCE

Surgical treatment of sphenoid pathology can be safely and successfully performed through a variety of approaches.
Hearing Status in Brucellosis
Authors: Bayazit Yildirim A. , Namiduru Mustafa , Bayazit Nurhayat , Özer Enver , Kanlikama Muzaffer
Published: February 2003

BACKGROUND

Although brucellosis can lead to multisystem complications, involvement of the ear in brucellosis is rarely reported in the literature. The purpose of this study was to assess the hearing status of patients with brucellosis.

STUDY DESIGN

Thirty‐two patients with brucellosis were included in the study. Pure tone and speech audiometry and tympanometry were performed in the patients.

RESULTS

The mean pure tone averages of the patients were within normal limits and were similar in both ears (P > 0.05). The pure tone averages of the patients with or without anti‐Brucella treatment were not significantly different (P > 0.05) and were within the normal limits. When the hearing levels of these patients were compared at the frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, there was no significant difference as well (P > 0.05).

CONCLUSIONS

Peripheral brucellosis does not appear to be associated with hearing loss.
Silver Nitrate Injury in the Rat Sciatic Nerve: A Model of Facial Nerve Injury
Authors: Wachter Bryan G. , Leonetti John P. , Lee John M. , Wurster Robert D. , Young M. Rita I.
Published: February 2003

BACKGROUND

An unpublished communication of a permanent facial paralysis secondary to silver nitrate application in a postoperative mastoid cavity with a dehiscent facial nerve raises concern regarding its neurotoxicity. This study was performed to examine functional neural injury and the morphology of nerve injury due to silver nitrate contact with a peripheral motor nerve.

METHODS

Sprague‐Dawley male rats were assigned to a sham surgery group or to a group where silver nitrate was applied directly to a surgically exposed sciatic nerve for 1, 5, or 10 seconds. Individual walking track data were collected on postoperative days (POD) 1, 4, 7, and 14, and the Sciatic Functional Index (SFI) was calculated to assess neural function. On POD 14, the cauterized nerve was harvested, and the histologic axon loss of each specimen was graded.

RESULTS

In all experimental groups, the most severe functional loss was noted on POD 1. At POD 14 the greatest neural recovery was observed in the 1‐second group, whereas the 5‐ and 10‐second cautery groups demonstrated a significantly worse deficit. A moderate or greater degree of axon loss was observed in 50% of animals injured for 1 second and nearly all animals injured for 5 or 10 seconds.

CONCLUSION

Functional and neuropathologic data demonstrate that silver nitrate causes significant injury to the rat sciatic nerve. A 5‐second cautery causes greater functional impairment and more severe axonal loss than a 1‐second injury.
Short Treatment Durations for Acute Bacterial Rhinosinusitis: Five Days of Gemifloxacin versus 7 Days of Gemifloxacin
Authors: Ferguson Berrylin J. , Anon Jack , Poole Michael D. , Hendrick Kim , Gilson Martyn , Seltzer Elyse G. ,   The Gemifloxacin 186 Study Group
Published: February 2003

OBJECTIVE

The primary objective of this study was to demonstrate the clinical and radiologic efficacy of 5 days compared with 7 days of gemifloxacin therapy in the treatment of acute bacterial rhinosinusitis (ABRS).

STUDY DESIGN

In this prospective, double‐blind, multicenter, parallel‐group study, adult patients presenting with ABRS were randomized to receive gemifloxacin 320 mg once daily for either 5 days (n = 218) or 7 days (n = 203).

RESULTS

For the primary efficacy end point, clinical response to therapy at follow‐up, 5 days of therapy with gemifloxacin was as effective as 7 days of therapy (per‐protocol population; treatment difference 0.44%; 95% confidence interval (CI), −6.54 to 7.41). Five and 7 days of treatment with gemifloxacin were well tolerated.

CONCLUSION AND SIGNIFICANCE

The clinical efficacy of gemifloxacin 320 mg daily for 5 days is at least as good as the efficacy of gemifloxacin 320 mg daily for 7 days in the treatment of ABRS.
Retrograde Degeneration of the Facial Nerve after Acute Traction on Parotid Gland: An Experimental Investigation
Authors: Wang Zhengmin , Dai Chun‐Fu , Chi Fanglu
Published: February 2003

The parotid gland of the cat underwent traction for 2 hours (group A) or until the facial nerve was broken (group B). The cats survived postoperatively for 1 day, 2 weeks, 1 month, and 3 months, respectively. Each cat underwent an electroneurography session before they were killed. The facial nerve was harvested and underwent histologic examination. The present study demonstrated that, in group A, the degree of facial nerve degeneration indicated with evoked electroneurography was 100% at 1 day and 2 weeks and 85% and 35%, respectively, at 1 and 3 months after damage. In group B, no electric response was recorded, epineurium of extratemporal segment was broken. This study also showed that the pronounced alteration of the facial nerve following acute traction on the parotid gland was retrograde degeneration; it involved up to its internal acoustic meatus segment. Furthermore, pronounced damage was noted in its stylomastoid foramen and extratemporal segment.
A New Absorbable Pressure‐Equalizing Tube
Authors: D'Eredità Riccardo , Marsh Roger R. , Lora Silvano , Kazahaya Ken
Published: February 2003

OBJECTIVE

We investigated pressure‐equalizing (PE) tubes made of biodegradable, absorbable material in an animal model.

METHODS

PE tubes, made of poly‐bis(ethylanate)phosphazene (PBE) were inserted in 55 ears of 28 Hartley guinea pigs, with survival times of 10, 30, and 60 days after tube insertion. In vivo reactions between the PBE‐PE tube and the tympanic membrane (TM) were studied. Tubes, TMs, and middle ears were examined by scanning electron microscopy and light microscopy.

RESULTS

There was neither infection nor an inflammatory reaction to the tube within the middle ear in any animal. At 30 days, 53% of the tubes had disintegrated. At 60 days, tubes were still functioning in the 25% of ears.

CONCLUSION

More research must be performed before these new PBE PE tubes can be considered for clinical use. Nonetheless, these tubes are promising. The disintegration rate can be controlled by varying the formulation of the polymer, so treatment can be adjusted to the needs of each patient.
Free Tissue Transfer versus Pedicled Flap Cost in Head and Neck Cancer
Authors: Funk Gerry F. , Karnell Lucy Hynds , Whitehead Stacey , Paulino Arnold , Ricks Joan , Smith Russell B.
Published: February 2003

OBJECTIVE

We sought to compare the overall 1‐year management costs for patients receiving a free tissue transfer with those of patients receiving a pedicled flap reconstruction as a component of their primary head and neck cancer treatment.

STUDY DESIGN AND SETTING

Case‐control, cost identification analysis of 21 matched pairs of patients and multivariate analysis of variables associated with treatment costs was conducted in a tertiary referral academic institution.

RESULTS

No significant difference in total 1‐year charges between the pedicled and free tissue transfer groups was found. A structured measure of patient comorbidity was the only variable significantly associated with total 1‐year charges.

CONCLUSIONS

Total 1‐year treatment costs of primary upper aerodigestive tract cancers are similar for patients reconstructed with free tissue transfer or a pedicled flap.

SIGNIFICANCE

Within the context of overall 1‐year management costs, the primary determinants of health care expense for these patients are comorbidity and extent of disease, not reconstructive technique.
Influence of Lecithin on Mitochondrial DNA and Age‐Related Hearing Loss
Authors: Seidman Michael D. , Khan Mumtaz J. , Tang Wen Xue , Quirk Wayne S.
Published: February 2003

;OBJECTIVES

Lecithin is a polyunsaturated phosphatidylcholine (PPC), which are high energy functional and structural elements of all biologic membranes. PPC play a rate‐limiting role in the activation of numerous membrane‐located enzymes, including superoxide dismutase and glutathione, which are important antioxidants protecting cell membranes from damage by reactive oxygen species (ROS). ROS‐induced damage to mitochondrial DNA may lead to reduced mitochondrial function in the cochlea and resultant hearing loss.

STUDY DESIGN AND SETTING

The effects of lecithin on aging and age‐associated hearing loss were studied in rats by measuring hearing sensitivities using auditory brainstem responses (ABR). In addition, mitochondrial function as a measure of aging was assessed by determining mitochondrial membrane potentials using flow cytometry and by amplifying mitochondrial DNA deletions associated with aging. Harlan‐Fischer rats aged 18 to 20 months (n = 14) were divided into 2 groups. The experimental group was supplemented orally for 6 months with lecithin, a purified extract of soybean phospholipid (Nutritional Therapeutics, Allendale, NJ).

RESULTS

The data obtained were compared with the control group. ABRs were recorded at 2‐month intervals and showed significant preservation of hearing sensitivities in the treated subjects. Flow cytometry revealed significantly higher mitochondrial membrane potentials in the treated subjects, suggesting preserved mitochondrial function. Finally, the common aging mitochondrial DNA deletion (mtDNA4834) were amplified from brain and cochlear tissue including stria vascularis and auditory nerve. This specific deletion was found significantly less frequent in all tissues in the treated group compared with the controls.

CONCLUSION

These experiments support our hypothesis and provide evidence that lecithin may preserve cochlear mitochondrial function and protect hearing loss associated with aging.